hospital_name,last_updated_on,version,location_name,hospital_address,type_2_npi,license_number|NV,attester_name,"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula."
Banner Churchill Community Hospital,2026-09-22,3.0.0,Banner Churchill Community Hospital,"801 East Williams Avenue, Fallon, NV 89406",1265811251|1356230205,638-RUH-43,Katie LeBlanc,true
description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,code|4,code|4|type,billing_class,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,payer_name,plan_name,modifiers,standard_charge|negotiated_dollar,standard_charge|negotiated_percentage,standard_charge|negotiated_algorithm,median_amount,10th_percentile,90th_percentile,count,standard_charge|min,standard_charge|max,standard_charge|methodology,additional_generic_notes
"Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple",360,RC,10061,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (e.g., excisional debridement); skin, subcutaneous tissue, muscle fascia, muscle, and bone",360,RC,11012,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less",360,RC,11043,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0 cm",360,RC,11403,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm",360,RC,11421,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm",360,RC,11422,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm",360,RC,11442,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 1.1 to 2.0 cm",360,RC,11602,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cm",360,RC,11606,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
Excision of pilonidal cyst or sinus; simple,360,RC,11770,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
Excision of pilonidal cyst or sinus; extensive,360,RC,11771,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cm",360,RC,14021,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"MASTOTOMY WITH EXPLORATION OR DRAINAGE OF ABSCESS, DEEP",360,RC,19020,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions",360,RC,19120,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy);",360,RC,19301,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Mastectomy, simple, complete",360,RC,19303,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle",360,RC,19307,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Revision of reconstructed breast (e.g., significant removal of tissue, re-advancement and/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue excision in implant-based reconstruction)",360,RC,19380,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Arthrocentesis, aspiration and/or injection, major joint or bursa (e.g., shoulder, hip, knee, subacromial bursa); without ultrasound guidance",360,RC,20610,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"REMOVAL OF IMPLANT; SUPERFICIAL (EG, BURIED WIRE, PIN OR ROD) (SEPARATE PROCEDURE)",360,RC,20670,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBCUTANEOUS; 3 CM OR GREATER",360,RC,21552,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Excision, tumor, soft tissue of neck or anterior thorax, subfascial (e.g., intramuscular); 5 cm or greater",360,RC,21554,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM",360,RC,21556,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Excision, tumor, soft tissue of back or flank, subcutaneous; 3 cm or greater",360,RC,21931,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Excision, tumor, soft tissue of abdominal wall, subcutaneous; less than 3 cm",360,RC,22902,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Excision, tumor, soft tissue of shoulder area, subcutaneous; 3 cm or greater",360,RC,23071,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"OPEN TREATMENT OF CLAVICULAR FRACTURE, INCLUDES INTERNAL FIXATION, WHEN PERFORMED",360,RC,23515,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"OPEN TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR THUMB, INCLUDES INTERNAL FIXATION, WHEN PERFORMED, EACH",360,RC,26765,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft",360,RC,27130,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Excision, tumor, soft tissue of thigh or knee area, subcutaneous; less than 3 cm",360,RC,27327,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); UNICONDYLAR, INCLUDES INTERNAL FIXATION, WHEN PERFORMED",360,RC,27535,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"REPAIR, PRIMARY, DISRUPTED LIGAMENT, ANKLE; COLLATERAL",360,RC,27695,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"OPEN TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL MALLEOLUS), INCLUDES INTERNAL FIXATION, WHEN PERFORMED",360,RC,27792,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Arthroscopy, shoulder, surgical; repair of SLAP lesion",360,RC,29807,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Arthroscopy, shoulder, surgical; debridement, limited, 1 or 2 discrete structures (e.g., humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies])",360,RC,29822,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure)",360,RC,29824,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (i.e., arch) release, when performed (list separately in addition to code for primary procedure)",360,RC,29826,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Arthroscopy, shoulder, surgical; biceps tenodesis",360,RC,29828,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), SURGICAL; DEBRIDEMENT, LIMITED",360,RC,29897,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy(s), single or multiple sites",360,RC,31625,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older",360,RC,36561,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"REMOVAL OF TUNNELED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL OR PERIPHERAL INSERTION",360,RC,36590,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Biopsy or excision of lymph node(s); open, deep axillary node(s)",360,RC,38525,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Intraoperative identification (e.g., mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (list separately in addition to code for primary procedure)",360,RC,38900,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
MOBILIZATION (TAKE-DOWN) OF SPLENIC FLEXURE PERFORMED IN CONJUNCTION WITH PARTIAL COLECTOMY (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE),360,RC,44139,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"COLECTOMY, PARTIAL; WITH SKIN LEVEL CECOSTOMY OR COLOSTOMY",360,RC,44141,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Laparoscopy, surgical, appendectomy",360,RC,44970,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)",360,RC,45378,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Colonoscopy, flexible; with biopsy, single or multiple",360,RC,45380,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S)",360,RC,46221,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORE COLUMNS/GROUPS;",360,RC,46260,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Laparoscopy, surgical; cholecystectomy",360,RC,47562,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"LAPAROSCOPY, ABDOMEN, PERITONEUM, AND OMENTUM, DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)",360,RC,49320,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"LAPAROSCOPY, SURGICAL; WITH BIOPSY (SINGLE OR MULTIPLE)",360,RC,49321,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Laparoscopy, surgical; with aspiration of cavity or cyst (e.g., ovarian cyst) (single or multiple)",360,RC,49322,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM",360,RC,49329,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Repair initial inguinal hernia, age 5 years or older; reducible",360,RC,49505,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated",360,RC,49507,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED",360,RC,49521,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Repair initial femoral hernia, any age; incarcerated or strangulated",360,RC,49553,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Repair of anterior abdominal hernia(s) (i.e., epigastric, incisional, ventral, umbilical, Spigelian), any approach (i.e., open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); less than 3 cm, reducible",360,RC,49591,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, INCARCERATED OR STRANGULATED",360,RC,49592,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); 3 CM TO 10 CM, REDUCIBLE",360,RC,49593,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Repair of anterior abdominal hernia(s) (i.e., epigastric, incisional, ventral, umbilical, Spigelian), any approach (i.e., open, laparoscopic, robotic), initial, including implantation of mesh or other prosthesis when performed, total length of defect(s); 3 cm to 10 cm, incarcerated or strangulated",360,RC,49594,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), RECURRENT, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); LESS THAN 3 CM, INCARCERATED OR STRANGULATED",360,RC,49614,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Laparoscopy, surgical; repair recurrent inguinal hernia",360,RC,49651,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
Cystourethroscopy (separate procedure),360,RC,52000,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
EXCISION OF LESION OF SPERMATIC CORD (SEPARATE PROCEDURE),360,RC,55520,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
Incision and drainage of vulva or perineal abscess,360,RC,56405,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); 1 LESION,360,RC,56605,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
EXCISION OF BARTHOLIN'S GLAND OR CYST,360,RC,56740,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele, including cystourethroscopy, when performed",360,RC,57240,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
PELVIC EXAMINATION UNDER ANESTHESIA (OTHER THAN LOCAL),360,RC,57410,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; loop electrode excision",360,RC,57522,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL)",360,RC,58120,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s);",360,RC,58150,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INSERTION OF INTRAUTERINE DEVICE (IUD),360,RC,58300,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
REMOVAL OF INTRAUTERINE DEVICE (IUD),360,RC,58301,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"ENDOMETRIAL ABLATION, THERMAL, WITHOUT HYSTEROSCOPIC GUIDANCE",360,RC,58353,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;",360,RC,58550,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)",360,RC,58552,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 G; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)",360,RC,58554,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C",360,RC,58558,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less;",360,RC,58570,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)",360,RC,58571,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"UNLISTED HYSTEROSCOPY PROCEDURE, UTERUS",360,RC,58579,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
Ligation or transection of Fallopian tube(s) when done at the time of cesarean delivery or intra-abdominal surgery (not a separate procedure) (list separately in addition to code for primary procedure),360,RC,58611,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)",360,RC,58661,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method",360,RC,58662,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"UNLISTED PROCEDURE, FEMALE GENITAL SYSTEM (NONOBSTETRICAL)",360,RC,58999,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Curettage, postpartum",360,RC,59160,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
Vaginal delivery only (with or without episiotomy and/or forceps);,360,RC,59409,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
Cesarean delivery only;,360,RC,59514,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Treatment of incomplete abortion, any trimester, completed surgically",360,RC,59812,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER",360,RC,59820,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"SUTURE OF DIGITAL NERVE, HAND OR FOOT; 1 NERVE",360,RC,64831,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
"Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation",360,RC,66984,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
Colorectal cancer screening; colonoscopy on individual at high risk,360,RC,G0105,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,360,RC,G0121,CPT,,,,,facility,outpatient,,,,,Aetna,Medical Rental Products,,,94.00,,,,,0,,,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
R&B OBSTETRICS PVT,3012,CDM,112,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Aetna,Medical Rental Products,,,94.00,,,,,0,2502.90,3111.10,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
R&B MEDICAL/SURGICAL SEMI-PVT,23010,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Aetna,Medical Rental Products,,,94.00,,,,,0,2502.90,3111.10,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
R&B ICU,33019,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Aetna,Medical Rental Products,,,94.00,,,,,0,2512.00,8498.17,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
R&B ICU INTERMEDIATE,13011,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Aetna,Medical Rental Products,,,94.00,,,,,0,2512.00,5665.77,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,244.00000,77.10000,Aetna,Medical Rental Products,,229.36,,,,,,,63.44,236.68,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,24075,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Aetna,Medical Rental Products,,,94.00,,,,,0,2502.90,3111.10,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
R&B OBSTETRICS SEMI-PVT,44073,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Aetna,Medical Rental Products,,,94.00,,,,,0,2502.90,3111.10,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
R&B NURSERY LEVEL 1,55160,CDM,171,RC,,,,,facility,inpatient,,,3477.00000,1975.46000,Aetna,Medical Rental Products,,,94.00,,,,,0,2512.00,3372.69,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,outpatient,,,16.00000,7.71000,Aetna,Medical Rental Products,,15.04,,,,,,,4.16,15.52,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Aetna,Medical Rental Products,,197.40,,,,,,,54.60,203.70,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,outpatient,,,380.00000,215.90000,Aetna,Medical Rental Products,,357.20,,,,,,,98.80,368.60,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Aetna,Medical Rental Products,,109.04,,,,,,,30.16,112.52,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22012,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Aetna,Medical Rental Products,,,94.00,,,,,0,2502.90,3111.10,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
R&B ADMIN DAY SKILLED,82016,CDM,160,RC,,,,,facility,inpatient,,,1923.00000,1092.55000,Aetna,Medical Rental Products,,,94.00,,,,,0,1730.70,3111.10,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
R&B SWING BED SKILLED,62018,CDM,160,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Aetna,Medical Rental Products,,,94.00,,,,,0,2502.90,3111.10,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
R&B ADMIN DAY INTERMEDIATE,72017,CDM,169,RC,,,,,facility,inpatient,,,1176.00000,668.14000,Aetna,Medical Rental Products,,,94.00,,,,,0,1058.40,3111.10,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
R&B ICU,32011,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Aetna,Medical Rental Products,,,94.00,,,,,0,2512.00,8498.17,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
R&B ICU INTERMEDIATE,12013,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Aetna,Medical Rental Products,,,94.00,,,,,0,2512.00,5665.77,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Aetna,Medical Rental Products,,109.04,,,,,,,30.16,112.52,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Aetna,Medical Rental Products,,473.76,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Aetna,Medical Rental Products,,92.12,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Aetna,Medical Rental Products,,571.52,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Aetna,Medical Rental Products,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Aetna,Medical Rental Products,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Aetna,Medical Rental Products,,201.16,,,,,,,55.64,207.58,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Aetna,Medical Rental Products,,78.96,,,,,,,21.84,81.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Aetna,Medical Rental Products,,266.96,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Aetna,Medical Rental Products,,430.52,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Aetna,Medical Rental Products,,524.52,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Aetna,Medical Rental Products,,453.08,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Aetna,Medical Rental Products,,222.78,,,,,,,61.62,229.89,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,outpatient,,,2041.00000,659.24000,Aetna,Medical Rental Products,,,94.00,,,,,0,530.66,1979.77,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,outpatient,,,259.00000,83.66000,Aetna,Medical Rental Products,,,94.00,,,,,0,67.34,251.23,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,outpatient,,,672.00000,217.06000,Aetna,Medical Rental Products,,,94.00,,,,,0,174.72,651.84,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,outpatient,,,530.00000,171.19000,Aetna,Medical Rental Products,,,94.00,,,,,0,137.80,514.10,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,outpatient,,,580.00000,187.34000,Aetna,Medical Rental Products,,,94.00,,,,,0,150.80,562.60,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,outpatient,,,435.00000,140.50000,Aetna,Medical Rental Products,,,94.00,,,,,0,113.10,421.95,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Aetna,Medical Rental Products,,,94.00,,,,,0,224.38,837.11,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,outpatient,,,334.00000,107.88000,Aetna,Medical Rental Products,,,94.00,,,,,0,86.84,323.98,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,outpatient,,,1188.00000,383.72000,Aetna,Medical Rental Products,50,,94.00,,,,,0,308.88,1152.36,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,205.92,768.24,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,205.92,768.24,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,outpatient,,,572.00000,184.76000,Aetna,Medical Rental Products,50,,94.00,,,,,0,148.72,554.84,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,99.06,369.57,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,99.06,369.57,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,outpatient,,,455.00000,146.96000,Aetna,Medical Rental Products,,,94.00,,,,,0,118.30,441.35,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,outpatient,,,403.00000,130.17000,Aetna,Medical Rental Products,,,94.00,,,,,0,104.78,390.91,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,outpatient,,,370.00000,119.51000,Aetna,Medical Rental Products,,,94.00,,,,,0,96.20,358.90,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,outpatient,,,357.00000,115.31000,Aetna,Medical Rental Products,,,94.00,,,,,0,92.82,346.29,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,outpatient,,,334.00000,107.88000,Aetna,Medical Rental Products,,,94.00,,,,,0,86.84,323.98,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,outpatient,,,194.00000,62.66000,Aetna,Medical Rental Products,,,94.00,,,,,0,50.44,188.18,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,outpatient,,,457.00000,147.61000,Aetna,Medical Rental Products,,,94.00,,,,,0,118.82,443.29,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,outpatient,,,492.00000,158.92000,Aetna,Medical Rental Products,,,94.00,,,,,0,127.92,477.24,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,outpatient,,,780.00000,251.94000,Aetna,Medical Rental Products,,,94.00,,,,,0,202.80,756.60,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,outpatient,,,1165.00000,376.30000,Aetna,Medical Rental Products,,,94.00,,,,,0,302.90,1130.05,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,outpatient,,,2350.00000,759.05000,Aetna,Medical Rental Products,,,94.00,,,,,0,611.00,2279.50,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,outpatient,,,896.00000,289.41000,Aetna,Medical Rental Products,,,94.00,,,,,0,232.96,869.12,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,outpatient,,,490.00000,158.27000,Aetna,Medical Rental Products,,,94.00,,,,,0,127.40,475.30,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,outpatient,,,520.00000,167.96000,Aetna,Medical Rental Products,,,94.00,,,,,0,135.20,504.40,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,outpatient,,,720.00000,232.56000,Aetna,Medical Rental Products,,,94.00,,,,,0,187.20,698.40,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,outpatient,,,215.00000,69.45000,Aetna,Medical Rental Products,,,94.00,,,,,0,55.90,208.55,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,outpatient,,,240.00000,77.52000,Aetna,Medical Rental Products,,,94.00,,,,,0,62.40,232.80,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,outpatient,,,1241.00000,400.84000,Aetna,Medical Rental Products,,,94.00,,,,,0,322.66,1203.77,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Aetna,Medical Rental Products,,791.48,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Aetna,Medical Rental Products,,989.82,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Aetna,Medical Rental Products,,1187.22,,,,,,,328.38,1225.11,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,outpatient,,,668.00000,559.78000,Aetna,Medical Rental Products,,627.92,,,,,,,173.68,647.96,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Aetna,Medical Rental Products,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Aetna,Medical Rental Products,,38.54,,,,,,,10.66,39.77,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Aetna,Medical Rental Products,,425.82,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Aetna,Medical Rental Products,,135.36,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Aetna,Medical Rental Products,,100.58,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Aetna,Medical Rental Products,,135.36,,,,,,,37.44,139.68,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Aetna,Medical Rental Products,,3.20,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Aetna,Medical Rental Products,,3.20,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Aetna,Medical Rental Products,,3.20,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Aetna,Medical Rental Products,,4.61,,,,,,,1.27,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,7.90000,4.49000,Aetna,Medical Rental Products,,7.43,,,,,,,2.05,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Aetna,Medical Rental Products,,4.61,,,,,,,1.27,4.75,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Aetna,Medical Rental Products,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Aetna,Medical Rental Products,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Aetna,Medical Rental Products,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,outpatient,,,3141500.00000,1784843.22000,Aetna,Medical Rental Products,,2953010.00,,,,,,,816790.00,3047255.00,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Aetna,Medical Rental Products,UD,0.20680,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.52000,0.30000,Aetna,Medical Rental Products,UD,0.48880,,,,,,,0.13520,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.56000,0.32000,Aetna,Medical Rental Products,UD,0.52640,,,,,,,0.14560,0.54320,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Aetna,Medical Rental Products,UD,0.20680,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.85000,0.48000,Aetna,Medical Rental Products,UD,0.79900,,,,,,,0.22100,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Aetna,Medical Rental Products,UD,0.20680,,,,,,,0.05720,0.21340,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,outpatient,,,102.00000,65.18000,Aetna,Medical Rental Products,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,outpatient,,,190.00000,121.41000,Aetna,Medical Rental Products,,178.60,,,,,,,49.40,184.30,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Aetna,Medical Rental Products,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Aetna,Medical Rental Products,,502.90,,,,,,,139.10,518.95,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,outpatient,,,766.00000,489.47000,Aetna,Medical Rental Products,,720.04,,,,,,,199.16,743.02,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,outpatient,,,159.00000,101.60000,Aetna,Medical Rental Products,,149.46,,,,,,,41.34,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,outpatient,,,447.00000,285.63000,Aetna,Medical Rental Products,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,outpatient,,,1413.00000,902.91000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,outpatient,,,3853.00000,2462.07000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,outpatient,,,313.00000,200.01000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,outpatient,,,1132.00000,723.35000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,outpatient,,,2695.00000,1722.10000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,outpatient,,,1619.00000,1034.54000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Aetna,Medical Rental Products,,502.90,,,,,,,139.10,518.95,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,outpatient,,,850.00000,543.15000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,outpatient,,,32.00000,20.45000,Aetna,Medical Rental Products,,30.08,,,,,,,8.32,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,outpatient,,,134.00000,85.63000,Aetna,Medical Rental Products,,125.96,,,,,,,34.84,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Aetna,Medical Rental Products,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,outpatient,,,709.00000,453.05000,Aetna,Medical Rental Products,,666.46,,,,,,,184.34,687.73,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,outpatient,,,4880.00000,2357.04000,Aetna,Medical Rental Products,,4587.20,,,,,,,1268.80,4733.60,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,outpatient,,,6024.00000,2909.59000,Aetna,Medical Rental Products,,5662.56,,,,,,,1566.24,5843.28,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Aetna,Medical Rental Products,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Aetna,Medical Rental Products,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Medical Rental Products,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,outpatient,,,7413.00000,3580.48000,Aetna,Medical Rental Products,,6968.22,,,,,,,1927.38,7190.61,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Aetna,Medical Rental Products,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Aetna,Medical Rental Products,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Aetna,Medical Rental Products,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Aetna,Medical Rental Products,,6750.14,,,,,,,1867.06,6965.57,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,outpatient,,,10654.00000,5145.88000,Aetna,Medical Rental Products,,10014.76,,,,,,,2770.04,10334.38,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Medical Rental Products,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Aetna,Medical Rental Products,,6097.78,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Aetna,Medical Rental Products,,6968.22,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,11575.00000,5590.72000,Aetna,Medical Rental Products,,10880.50,,,,,,,3009.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,13432.00000,6487.66000,Aetna,Medical Rental Products,,12626.08,,,,,,,3492.32,13029.04,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,21904.00000,10579.63000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Medical Rental Products,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Aetna,Medical Rental Products,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Medical Rental Products,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Aetna,Medical Rental Products,,6968.22,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,12969.00000,6264.03000,Aetna,Medical Rental Products,,12190.86,,,,,,,3371.94,12579.93,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Medical Rental Products,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Aetna,Medical Rental Products,,2280.44,,,,,,,630.76,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Aetna,Medical Rental Products,,2657.38,,,,,,,735.02,2742.19,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Aetna,Medical Rental Products,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Aetna,Medical Rental Products,,125.96,,,,,,,34.84,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,outpatient,,,251.00000,121.23000,Aetna,Medical Rental Products,,235.94,,,,,,,65.26,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Medical Rental Products,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Medical Rental Products,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Medical Rental Products,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,447.00000,215.90000,Aetna,Medical Rental Products,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Aetna,Medical Rental Products,,2657.38,,,,,,,735.02,2742.19,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Aetna,Medical Rental Products,,2528.60,,,,,,,699.40,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Aetna,Medical Rental Products,,6097.78,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,2426.00000,1171.76000,Aetna,Medical Rental Products,,2280.44,,,,,,,630.76,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,15334.00000,7406.32000,Aetna,Medical Rental Products,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Medical Rental Products,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Aetna,Medical Rental Products,,2657.38,,,,,,,735.02,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,251.00000,121.23000,Aetna,Medical Rental Products,,235.94,,,,,,,65.26,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Medical Rental Products,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Aetna,Medical Rental Products,,2657.38,,,,,,,735.02,2742.19,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Aetna,Medical Rental Products,,30.08,,,,,,,8.32,31.04,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Medical Rental Products,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Aetna,Medical Rental Products,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,outpatient,,,1485.00000,717.26000,Aetna,Medical Rental Products,,1395.90,,,,,,,386.10,1440.45,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,outpatient,,,2028.00000,979.52000,Aetna,Medical Rental Products,,1906.32,,,,,,,527.28,1967.16,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Aetna,Medical Rental Products,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,8107.00000,3915.68000,Aetna,Medical Rental Products,,7620.58,,,,,,,2107.82,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,10422.00000,5033.83000,Aetna,Medical Rental Products,,9796.68,,,,,,,2709.72,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,12737.00000,6151.97000,Aetna,Medical Rental Products,,11972.78,,,,,,,3311.62,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,14239.00000,6877.44000,Aetna,Medical Rental Products,,13384.66,,,,,,,3702.14,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,16429.00000,7935.21000,Aetna,Medical Rental Products,,15443.26,,,,,,,4271.54,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,18619.00000,8992.98000,Aetna,Medical Rental Products,,17501.86,,,,,,,4840.94,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,20809.00000,10050.75000,Aetna,Medical Rental Products,,19560.46,,,,,,,5410.34,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,22999.00000,11108.52000,Aetna,Medical Rental Products,,21619.06,,,,,,,5979.74,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,25189.00000,12166.29000,Aetna,Medical Rental Products,,23677.66,,,,,,,6549.14,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,27379.00000,13224.06000,Aetna,Medical Rental Products,,25736.26,,,,,,,7118.54,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,29569.00000,14281.83000,Aetna,Medical Rental Products,,27794.86,,,,,,,7687.94,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,31759.00000,15339.60000,Aetna,Medical Rental Products,,29853.46,,,,,,,8257.34,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,36139.00000,17455.14000,Aetna,Medical Rental Products,,33970.66,,,,,,,9396.14,35054.83,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Medical Rental Products,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Aetna,Medical Rental Products,,3139.60,,,,,,,868.40,3239.80,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Medical Rental Products,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Aetna,Medical Rental Products,,30.08,,,,,,,8.32,31.04,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Aetna,Medical Rental Products,,125.96,,,,,,,34.84,129.98,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Aetna,Medical Rental Products,,178.60,,,,,,,49.40,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,outpatient,,,476.00000,229.91000,Aetna,Medical Rental Products,,447.44,,,,,,,123.76,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Aetna,Medical Rental Products,,30.08,,,,,,,8.32,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Aetna,Medical Rental Products,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Medical Rental Products,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Medical Rental Products,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,outpatient,,,12506.00000,6040.40000,Aetna,Medical Rental Products,,11755.64,,,,,,,3251.56,12130.82,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,outpatient,,,2404.80000,1161.52000,Aetna,Medical Rental Products,,2260.51,,,,,,,625.25,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,outpatient,,,969.00000,468.03000,Aetna,Medical Rental Products,,910.86,,,,,,,251.94,939.93,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,outpatient,,,2256.90000,1090.08000,Aetna,Medical Rental Products,,2121.49,,,,,,,586.79,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,outpatient,,,644.30000,311.20000,Aetna,Medical Rental Products,,605.64,,,,,,,167.52,624.97,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Aetna,Medical Rental Products,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Aetna,Medical Rental Products,,178.60,,,,,,,49.40,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Aetna,Medical Rental Products,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,outpatient,,,43804.00000,21157.33000,Aetna,Medical Rental Products,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,outpatient,,,52564.00000,25388.41000,Aetna,Medical Rental Products,,49410.16,,,,,,,13666.64,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,outpatient,,,61324.00000,29619.49000,Aetna,Medical Rental Products,,57644.56,,,,,,,15944.24,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,outpatient,,,70084.00000,33850.57000,Aetna,Medical Rental Products,,65878.96,,,,,,,18221.84,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,outpatient,,,78844.00000,38081.65000,Aetna,Medical Rental Products,,74113.36,,,,,,,20499.44,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,outpatient,,,87604.00000,42312.73000,Aetna,Medical Rental Products,,82347.76,,,,,,,22777.04,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,outpatient,,,96364.00000,46543.81000,Aetna,Medical Rental Products,,90582.16,,,,,,,25054.64,93473.08,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Aetna,Medical Rental Products,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,outpatient,,,39424.00000,19041.79000,Aetna,Medical Rental Products,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Aetna,Medical Rental Products,,3674.46,,,,,,,1016.34,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Aetna,Medical Rental Products,,178.60,,,,,,,49.40,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Medical Rental Products,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Aetna,Medical Rental Products,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Medical Rental Products,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2023.00000,977.11000,Aetna,Medical Rental Products,,1901.62,,,,,,,525.98,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Medical Rental Products,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Medical Rental Products,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Medical Rental Products,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Aetna,Medical Rental Products,,7403.44,,,,,,,2047.76,7639.72,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,outpatient,,,10191.00000,4922.25000,Aetna,Medical Rental Products,,9579.54,,,,,,,2649.66,9885.27,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,96.00000,46.37000,Aetna,Medical Rental Products,,90.24,,,,,,,24.96,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Medical Rental Products,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,7876.00000,3804.11000,Aetna,Medical Rental Products,,7403.44,,,,,,,2047.76,7639.72,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Aetna,Medical Rental Products,,3674.46,,,,,,,1016.34,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,outpatient,,,5373.00000,2595.16000,Aetna,Medical Rental Products,,5050.62,,,,,,,1396.98,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,outpatient,,,6487.00000,3133.22000,Aetna,Medical Rental Products,,6097.78,,,,,,,1686.62,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Aetna,Medical Rental Products,,7403.44,,,,,,,2047.76,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Aetna,Medical Rental Products,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Medical Rental Products,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,outpatient,,,1126.00000,543.86000,Aetna,Medical Rental Products,,1058.44,,,,,,,292.76,1092.22,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Aetna,Medical Rental Products,,2528.60,,,,,,,699.40,2609.30,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,4880.00000,2357.04000,Aetna,Medical Rental Products,,4587.20,,,,,,,1268.80,4733.60,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,9260.00000,4472.58000,Aetna,Medical Rental Products,,8704.40,,,,,,,2407.60,8982.20,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Medical Rental Products,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,588.00000,284.00000,Aetna,Medical Rental Products,,552.72,,,,,,,152.88,570.36,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Medical Rental Products,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Aetna,Medical Rental Products,,2280.44,,,,,,,630.76,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Aetna,Medical Rental Products,,2657.38,,,,,,,735.02,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Aetna,Medical Rental Products,,3139.60,,,,,,,868.40,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Aetna,Medical Rental Products,,3139.60,,,,,,,868.40,3239.80,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Aetna,Medical Rental Products,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Aetna,Medical Rental Products,,3674.46,,,,,,,1016.34,3791.73,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Medical Rental Products,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,outpatient,,,159.00000,76.80000,Aetna,Medical Rental Products,,149.46,,,,,,,41.34,154.23,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,outpatient,,,588.00000,284.00000,Aetna,Medical Rental Products,,552.72,,,,,,,152.88,570.36,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Aetna,Medical Rental Products,,2280.44,,,,,,,630.76,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Aetna,Medical Rental Products,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,outpatient,,,8107.00000,3915.68000,Aetna,Medical Rental Products,,7620.58,,,,,,,2107.82,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,outpatient,,,10422.00000,5033.83000,Aetna,Medical Rental Products,,9796.68,,,,,,,2709.72,10109.34,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Medical Rental Products,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Medical Rental Products,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Aetna,Medical Rental Products,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,outpatient,,,221.00000,106.74000,Aetna,Medical Rental Products,,207.74,,,,,,,57.46,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Aetna,Medical Rental Products,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Aetna,Medical Rental Products,,2280.44,,,,,,,630.76,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Aetna,Medical Rental Products,,3139.60,,,,,,,868.40,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,outpatient,,,4153.00000,2005.90000,Aetna,Medical Rental Products,,3903.82,,,,,,,1079.78,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,outpatient,,,5129.00000,2477.31000,Aetna,Medical Rental Products,,4821.26,,,,,,,1333.54,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Aetna,Medical Rental Products,,6750.14,,,,,,,1867.06,6965.57,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,outpatient,,,52.50000,25.36000,Aetna,Medical Rental Products,,49.35,,,,,,,13.65,50.92,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,outpatient,,,50.40000,24.34000,Aetna,Medical Rental Products,,47.38,,,,,,,13.10,48.89,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Aetna,Medical Rental Products,,2280.44,,,,,,,630.76,2353.22,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Aetna,Medical Rental Products,,3674.46,,,,,,,1016.34,3791.73,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Aetna,Medical Rental Products,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Aetna,Medical Rental Products,,30.08,,,,,,,8.32,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Aetna,Medical Rental Products,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,outpatient,,,709.00000,342.45000,Aetna,Medical Rental Products,,666.46,,,,,,,184.34,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Aetna,Medical Rental Products,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Aetna,Medical Rental Products,,82347.76,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Aetna,Medical Rental Products,,102933.76,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,131404.00000,74657.18000,Aetna,Medical Rental Products,,123519.76,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,43800.00000,24884.97000,Aetna,Medical Rental Products,,41172.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Aetna,Medical Rental Products,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Aetna,Medical Rental Products,,82347.76,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Aetna,Medical Rental Products,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,24090.00000,13686.73000,Aetna,Medical Rental Products,,22644.60,,,,,,,6263.40,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Aetna,Medical Rental Products,,26765.56,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Aetna,Medical Rental Products,,16468.80,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Aetna,Medical Rental Products,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Aetna,Medical Rental Products,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Aetna,Medical Rental Products,,82347.76,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Aetna,Medical Rental Products,,102933.76,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,6105.00000,3468.56000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,13895.00000,7894.44000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,21900.00000,12442.48000,Aetna,Medical Rental Products,,20586.00,,,,,,,5694.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,35040.00000,19907.98000,Aetna,Medical Rental Products,,32937.60,,,,,,,9110.40,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Aetna,Medical Rental Products,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Aetna,Medical Rental Products,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,22776.00000,12940.18000,Aetna,Medical Rental Products,,21409.44,,,,,,,5921.76,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Aetna,Medical Rental Products,,26765.56,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Aetna,Medical Rental Products,,16468.80,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,30664.00000,17421.75000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,35044.00000,19910.25000,Aetna,Medical Rental Products,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2695.00000,1080.70000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,3853.00000,1545.05000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,outpatient,,,1413.00000,566.61000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,3229.80000,1857.14000,Aetna,Medical Rental Products,,3036.01,,,,,,,839.75,3132.91,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,854.40000,491.28000,Aetna,Medical Rental Products,,803.14,,,,,,,222.14,828.77,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1200.50000,690.29000,Aetna,Medical Rental Products,,1128.47,,,,,,,312.13,1164.48,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1011.00000,581.32000,Aetna,Medical Rental Products,,950.34,,,,,,,262.86,980.67,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1823.80000,1048.68000,Aetna,Medical Rental Products,,1714.37,,,,,,,474.19,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2028.50000,1166.39000,Aetna,Medical Rental Products,,1906.79,,,,,,,527.41,1967.64,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,841.00000,483.58000,Aetna,Medical Rental Products,,790.54,,,,,,,218.66,815.77,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1366.20000,785.56000,Aetna,Medical Rental Products,,1284.23,,,,,,,355.21,1325.21,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1384.00000,795.80000,Aetna,Medical Rental Products,,1300.96,,,,,,,359.84,1342.48,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2458.70000,1413.75000,Aetna,Medical Rental Products,,2311.18,,,,,,,639.26,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2393.50000,1376.26000,Aetna,Medical Rental Products,,2249.89,,,,,,,622.31,2321.70,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1369.50000,787.46000,Aetna,Medical Rental Products,,1287.33,,,,,,,356.07,1328.41,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2697.40000,1551.00000,Aetna,Medical Rental Products,,2535.56,,,,,,,701.32,2616.48,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4621.80000,2657.54000,Aetna,Medical Rental Products,,4344.49,,,,,,,1201.67,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2592.50000,1490.69000,Aetna,Medical Rental Products,,2436.95,,,,,,,674.05,2514.72,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Aetna,Medical Rental Products,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Aetna,Medical Rental Products,,7838.66,,,,,,,2168.14,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Aetna,Medical Rental Products,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Aetna,Medical Rental Products,,7620.58,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Aetna,Medical Rental Products,,1058.44,,,,,,,292.76,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Aetna,Medical Rental Products,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Aetna,Medical Rental Products,,6968.22,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,outpatient,,,20152.00000,11587.40000,Aetna,Medical Rental Products,,18942.88,,,,,,,5239.52,19547.44,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Aetna,Medical Rental Products,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Aetna,Medical Rental Products,,666.46,,,,,,,184.34,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,1272.00000,731.40000,Aetna,Medical Rental Products,,1195.68,,,,,,,330.72,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Aetna,Medical Rental Products,,2528.60,,,,,,,699.40,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,3078.00000,1769.85000,Aetna,Medical Rental Products,,2893.32,,,,,,,800.28,2985.66,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,70.00000,40.25000,Aetna,Medical Rental Products,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,102.00000,58.65000,Aetna,Medical Rental Products,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,221.00000,127.07000,Aetna,Medical Rental Products,,207.74,,,,,,,57.46,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Aetna,Medical Rental Products,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Aetna,Medical Rental Products,,666.46,,,,,,,184.34,687.73,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Aetna,Medical Rental Products,,11755.64,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35482.00000,20402.15000,Aetna,Medical Rental Products,,33353.08,,,,,,,9225.32,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39862.00000,22920.65000,Aetna,Medical Rental Products,,37470.28,,,,,,,10364.12,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,44242.00000,25439.15000,Aetna,Medical Rental Products,,41587.48,,,,,,,11502.92,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,48622.00000,27957.65000,Aetna,Medical Rental Products,,45704.68,,,,,,,12641.72,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,53002.00000,30476.15000,Aetna,Medical Rental Products,,49821.88,,,,,,,13780.52,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Aetna,Medical Rental Products,,57644.56,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Aetna,Medical Rental Products,,65878.96,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Aetna,Medical Rental Products,,74113.36,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Aetna,Medical Rental Products,,82347.76,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Aetna,Medical Rental Products,,90582.16,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,844.00000,485.30000,Aetna,Medical Rental Products,,793.36,,,,,,,219.44,818.68,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,11575.00000,6655.62000,Aetna,Medical Rental Products,,10880.50,,,,,,,3009.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14892.00000,8562.90000,Aetna,Medical Rental Products,,13998.48,,,,,,,3871.92,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,24970.00000,14357.75000,Aetna,Medical Rental Products,,23471.80,,,,,,,6492.20,24220.90,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Aetna,Medical Rental Products,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Aetna,Medical Rental Products,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Aetna,Medical Rental Products,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Aetna,Medical Rental Products,,3139.60,,,,,,,868.40,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Aetna,Medical Rental Products,,3903.82,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4641.00000,2668.58000,Aetna,Medical Rental Products,,4362.54,,,,,,,1206.66,4501.77,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Aetna,Medical Rental Products,,4587.20,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Medical Rental Products,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Aetna,Medical Rental Products,,90582.16,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Aetna,Medical Rental Products,,102933.76,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Aetna,Medical Rental Products,,123519.76,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,153304.00000,88149.80000,Aetna,Medical Rental Products,,144105.76,,,,,,,39859.04,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,175204.00000,100742.30000,Aetna,Medical Rental Products,,164691.76,,,,,,,45553.04,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,197104.00000,113334.80000,Aetna,Medical Rental Products,,185277.76,,,,,,,51247.04,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,219004.00000,125927.30000,Aetna,Medical Rental Products,,205863.76,,,,,,,56941.04,212433.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Medical Rental Products,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Medical Rental Products,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Medical Rental Products,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Medical Rental Products,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Aetna,Medical Rental Products,,45292.96,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Aetna,Medical Rental Products,,49410.16,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Aetna,Medical Rental Products,,53527.36,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Aetna,Medical Rental Products,,57644.56,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Aetna,Medical Rental Products,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Medical Rental Products,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Medical Rental Products,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Aetna,Medical Rental Products,,49410.16,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Aetna,Medical Rental Products,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Aetna,Medical Rental Products,,82347.76,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Aetna,Medical Rental Products,,102933.76,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Aetna,Medical Rental Products,,4587.20,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Medical Rental Products,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Medical Rental Products,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Medical Rental Products,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Aetna,Medical Rental Products,,45292.96,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Aetna,Medical Rental Products,,49410.16,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Aetna,Medical Rental Products,,53527.36,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Aetna,Medical Rental Products,,57644.56,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Aetna,Medical Rental Products,,65878.96,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Aetna,Medical Rental Products,,74113.36,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Aetna,Medical Rental Products,,82347.76,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Aetna,Medical Rental Products,,90582.16,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Aetna,Medical Rental Products,,102933.76,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Aetna,Medical Rental Products,,115285.36,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,135784.00000,78075.80000,Aetna,Medical Rental Products,,127636.96,,,,,,,35303.84,131710.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Medical Rental Products,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Medical Rental Products,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Medical Rental Products,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Aetna,Medical Rental Products,,45292.96,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,55630.00000,31987.25000,Aetna,Medical Rental Products,,52292.20,,,,,,,14463.80,53961.10,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Aetna,Medical Rental Products,,2528.60,,,,,,,699.40,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Aetna,Medical Rental Products,,13178.80,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,17962.00000,10328.15000,Aetna,Medical Rental Products,,16884.28,,,,,,,4670.12,17423.14,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,2421.00000,1392.07000,Aetna,Medical Rental Products,,2275.74,,,,,,,629.46,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Medical Rental Products,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Aetna,Medical Rental Products,,2280.44,,,,,,,630.76,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Aetna,Medical Rental Products,,2528.60,,,,,,,699.40,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,27160.00000,15617.00000,Aetna,Medical Rental Products,,25530.40,,,,,,,7061.60,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Aetna,Medical Rental Products,,30882.76,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Medical Rental Products,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Aetna,Medical Rental Products,,49410.16,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Aetna,Medical Rental Products,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Aetna,Medical Rental Products,,74113.36,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,28470.00000,16370.25000,Aetna,Medical Rental Products,,26761.80,,,,,,,7402.20,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,43800.00000,25185.00000,Aetna,Medical Rental Products,,41172.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Aetna,Medical Rental Products,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Aetna,Medical Rental Products,,82347.76,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Aetna,Medical Rental Products,,102933.76,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Aetna,Medical Rental Products,,3674.46,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Aetna,Medical Rental Products,,30882.76,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Medical Rental Products,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,54754.00000,31483.55000,Aetna,Medical Rental Products,,51468.76,,,,,,,14236.04,53111.38,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Aetna,Medical Rental Products,,2528.60,,,,,,,699.40,2609.30,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,61320.00000,35259.00000,Aetna,Medical Rental Products,,57640.80,,,,,,,15943.20,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,70080.00000,40296.00000,Aetna,Medical Rental Products,,65875.20,,,,,,,18220.80,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,78840.00000,45333.00000,Aetna,Medical Rental Products,,74109.60,,,,,,,20498.40,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Aetna,Medical Rental Products,,90582.16,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Aetna,Medical Rental Products,,102933.76,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Aetna,Medical Rental Products,,115285.36,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Medical Rental Products,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Medical Rental Products,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Aetna,Medical Rental Products,,22648.36,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Aetna,Medical Rental Products,,30882.76,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Medical Rental Products,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Medical Rental Products,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1883.00000,1082.72000,Aetna,Medical Rental Products,,1770.02,,,,,,,489.58,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Aetna,Medical Rental Products,,3674.46,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,7644.00000,4395.30000,Aetna,Medical Rental Products,,7185.36,,,,,,,1987.44,7414.68,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Aetna,Medical Rental Products,,2528.60,,,,,,,699.40,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Medical Rental Products,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Medical Rental Products,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Aetna,Medical Rental Products,,1517.16,,,,,,,419.64,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Medical Rental Products,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Medical Rental Products,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Aetna,Medical Rental Products,,22648.36,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Aetna,Medical Rental Products,,26765.56,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Aetna,Medical Rental Products,,30882.76,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,37234.00000,21409.55000,Aetna,Medical Rental Products,,34999.96,,,,,,,9680.84,36116.98,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Medical Rental Products,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Aetna,Medical Rental Products,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Medical Rental Products,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Medical Rental Products,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Aetna,Medical Rental Products,,49410.16,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Aetna,Medical Rental Products,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Aetna,Medical Rental Products,,74113.36,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,159.00000,91.42000,Aetna,Medical Rental Products,,149.46,,,,,,,41.34,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Aetna,Medical Rental Products,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Aetna,Medical Rental Products,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Aetna,Medical Rental Products,,2280.44,,,,,,,630.76,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Aetna,Medical Rental Products,,2657.38,,,,,,,735.02,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Aetna,Medical Rental Products,,3139.60,,,,,,,868.40,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Aetna,Medical Rental Products,,7620.58,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Aetna,Medical Rental Products,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Aetna,Medical Rental Products,,82347.76,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Aetna,Medical Rental Products,,102933.76,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Aetna,Medical Rental Products,,123519.76,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Medical Rental Products,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,18400.00000,10580.00000,Aetna,Medical Rental Products,,17296.00,,,,,,,4784.00,17848.00,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Aetna,Medical Rental Products,,22648.36,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Aetna,Medical Rental Products,,26765.56,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Aetna,Medical Rental Products,,30882.76,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Medical Rental Products,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Medical Rental Products,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Medical Rental Products,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Medical Rental Products,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Aetna,Medical Rental Products,,1517.16,,,,,,,419.64,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Medical Rental Products,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Aetna,Medical Rental Products,,53527.36,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Aetna,Medical Rental Products,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,5368.00000,3086.60000,Aetna,Medical Rental Products,,5045.92,,,,,,,1395.68,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Medical Rental Products,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Medical Rental Products,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Aetna,Medical Rental Products,,13178.80,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Medical Rental Products,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,25408.00000,14609.60000,Aetna,Medical Rental Products,,23883.52,,,,,,,6606.08,24645.76,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Medical Rental Products,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Medical Rental Products,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,8112.00000,4664.40000,Aetna,Medical Rental Products,,7625.28,,,,,,,2109.12,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,10431.00000,5997.82000,Aetna,Medical Rental Products,,9805.14,,,,,,,2712.06,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Medical Rental Products,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Aetna,Medical Rental Products,,30882.76,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Medical Rental Products,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,46870.00000,26950.25000,Aetna,Medical Rental Products,,44057.80,,,,,,,12186.20,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,51250.00000,29468.75000,Aetna,Medical Rental Products,,48175.00,,,,,,,13325.00,49712.50,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Medical Rental Products,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Aetna,Medical Rental Products,,49410.16,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Aetna,Medical Rental Products,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Aetna,Medical Rental Products,,74113.36,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Aetna,Medical Rental Products,,82347.76,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,588.00000,338.10000,Aetna,Medical Rental Products,,552.72,,,,,,,152.88,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Aetna,Medical Rental Products,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Aetna,Medical Rental Products,,3674.46,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Aetna,Medical Rental Products,,5050.62,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Aetna,Medical Rental Products,,6097.78,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7876.00000,4528.70000,Aetna,Medical Rental Products,,7403.44,,,,,,,2047.76,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Medical Rental Products,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Medical Rental Products,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Aetna,Medical Rental Products,,22648.36,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5856.00000,3367.20000,Aetna,Medical Rental Products,,5504.64,,,,,,,1522.56,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Aetna,Medical Rental Products,,6097.78,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Aetna,Medical Rental Products,,6968.22,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Aetna,Medical Rental Products,,7838.66,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Aetna,Medical Rental Products,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Aetna,Medical Rental Products,,5050.62,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Aetna,Medical Rental Products,,5662.56,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Aetna,Medical Rental Products,,11755.64,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Aetna,Medical Rental Products,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Aetna,Medical Rental Products,,5050.62,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Aetna,Medical Rental Products,,5662.56,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Aetna,Medical Rental Products,,11755.64,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4392.00000,2525.40000,Aetna,Medical Rental Products,,4128.48,,,,,,,1141.92,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Aetna,Medical Rental Products,,5050.62,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Aetna,Medical Rental Products,,6097.78,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Aetna,Medical Rental Products,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Aetna,Medical Rental Products,,5050.62,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Aetna,Medical Rental Products,,6097.78,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Aetna,Medical Rental Products,,4587.20,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Aetna,Medical Rental Products,,1058.44,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Aetna,Medical Rental Products,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Aetna,Medical Rental Products,,5050.62,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Aetna,Medical Rental Products,,5662.56,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Aetna,Medical Rental Products,,11755.64,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Aetna,Medical Rental Products,,12767.08,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Medical Rental Products,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Medical Rental Products,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2152.00000,1237.40000,Aetna,Medical Rental Products,,2022.88,,,,,,,559.52,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Aetna,Medical Rental Products,,4587.20,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Aetna,Medical Rental Products,,3674.46,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Aetna,Medical Rental Products,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Aetna,Medical Rental Products,,5662.56,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Medical Rental Products,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Aetna,Medical Rental Products,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Aetna,Medical Rental Products,,5050.62,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Aetna,Medical Rental Products,,5662.56,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Aetna,Medical Rental Products,,1058.44,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Aetna,Medical Rental Products,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Aetna,Medical Rental Products,,5050.62,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Aetna,Medical Rental Products,,5662.56,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Aetna,Medical Rental Products,,11755.64,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Aetna,Medical Rental Products,,12767.08,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Medical Rental Products,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Medical Rental Products,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Aetna,Medical Rental Products,,5050.62,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8802.00000,5061.15000,Aetna,Medical Rental Products,,8273.88,,,,,,,2288.52,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10654.00000,6126.05000,Aetna,Medical Rental Products,,10014.76,,,,,,,2770.04,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Aetna,Medical Rental Products,,11755.64,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Aetna,Medical Rental Products,,12767.08,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Medical Rental Products,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17086.00000,9824.45000,Aetna,Medical Rental Products,,16060.84,,,,,,,4442.36,16573.42,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Aetna,Medical Rental Products,,4587.20,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Aetna,Medical Rental Products,,6097.78,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Aetna,Medical Rental Products,,6968.22,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Aetna,Medical Rental Products,,7838.66,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Aetna,Medical Rental Products,,4587.20,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Aetna,Medical Rental Products,,4587.20,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Medical Rental Products,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Aetna,Medical Rental Products,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Medical Rental Products,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Medical Rental Products,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Medical Rental Products,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Aetna,Medical Rental Products,,22648.36,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Aetna,Medical Rental Products,,3674.46,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Aetna,Medical Rental Products,,6097.78,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Aetna,Medical Rental Products,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Aetna,Medical Rental Products,,2280.44,,,,,,,630.76,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Aetna,Medical Rental Products,,2657.38,,,,,,,735.02,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Aetna,Medical Rental Products,,3139.60,,,,,,,868.40,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Aetna,Medical Rental Products,,3903.82,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Aetna,Medical Rental Products,,6968.22,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Aetna,Medical Rental Products,,7838.66,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9728.00000,5593.60000,Aetna,Medical Rental Products,,9144.32,,,,,,,2529.28,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11117.00000,6392.28000,Aetna,Medical Rental Products,,10449.98,,,,,,,2890.42,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Medical Rental Products,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Medical Rental Products,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Medical Rental Products,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Aetna,Medical Rental Products,,45292.96,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Aetna,Medical Rental Products,,49410.16,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Aetna,Medical Rental Products,,53527.36,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Aetna,Medical Rental Products,,57644.56,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Aetna,Medical Rental Products,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Aetna,Medical Rental Products,,65878.96,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Aetna,Medical Rental Products,,69996.16,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Aetna,Medical Rental Products,,74113.36,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Aetna,Medical Rental Products,,78230.56,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,111694.00000,64224.05000,Aetna,Medical Rental Products,,104992.36,,,,,,,29040.44,108343.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Aetna,Medical Rental Products,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Aetna,Medical Rental Products,,666.46,,,,,,,184.34,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,991.00000,569.82000,Aetna,Medical Rental Products,,931.54,,,,,,,257.66,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1490.00000,856.75000,Aetna,Medical Rental Products,,1400.60,,,,,,,387.40,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Aetna,Medical Rental Products,,3674.46,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Aetna,Medical Rental Products,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Aetna,Medical Rental Products,,6097.78,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Aetna,Medical Rental Products,,6968.22,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Aetna,Medical Rental Products,,7838.66,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Medical Rental Products,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Medical Rental Products,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Medical Rental Products,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Medical Rental Products,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Medical Rental Products,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Medical Rental Products,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,6945.00000,3993.37000,Aetna,Medical Rental Products,,6528.30,,,,,,,1805.70,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Medical Rental Products,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Aetna,Medical Rental Products,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Medical Rental Products,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Aetna,Medical Rental Products,,3674.46,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Aetna,Medical Rental Products,,5050.62,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Medical Rental Products,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Medical Rental Products,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Medical Rental Products,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Medical Rental Products,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,50374.00000,28965.05000,Aetna,Medical Rental Products,,47351.56,,,,,,,13097.24,48862.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Medical Rental Products,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Aetna,Medical Rental Products,,22648.36,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Aetna,Medical Rental Products,,26765.56,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Medical Rental Products,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Medical Rental Products,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Medical Rental Products,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Medical Rental Products,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Medical Rental Products,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Medical Rental Products,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Medical Rental Products,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Aetna,Medical Rental Products,,45292.96,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Medical Rental Products,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Aetna,Medical Rental Products,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Medical Rental Products,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Medical Rental Products,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Aetna,Medical Rental Products,,45292.96,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Aetna,Medical Rental Products,,49410.16,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Aetna,Medical Rental Products,,53527.36,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Aetna,Medical Rental Products,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Aetna,Medical Rental Products,,69996.16,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Aetna,Medical Rental Products,,78230.56,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,91984.00000,52890.80000,Aetna,Medical Rental Products,,86464.96,,,,,,,23915.84,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,100744.00000,57927.80000,Aetna,Medical Rental Products,,94699.36,,,,,,,26193.44,97721.68,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Aetna,Medical Rental Products,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Aetna,Medical Rental Products,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Aetna,Medical Rental Products,,666.46,,,,,,,184.34,687.73,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Medical Rental Products,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Medical Rental Products,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Medical Rental Products,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Medical Rental Products,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Medical Rental Products,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Medical Rental Products,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Medical Rental Products,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Aetna,Medical Rental Products,,49410.16,,,,,,,13666.64,50987.08,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Medical Rental Products,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Medical Rental Products,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Medical Rental Products,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2180.20000,1253.61000,Aetna,Medical Rental Products,,2049.39,,,,,,,566.85,2114.79,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1880.60000,1081.34000,Aetna,Medical Rental Products,,1767.76,,,,,,,488.96,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2908.70000,1672.50000,Aetna,Medical Rental Products,,2734.18,,,,,,,756.26,2821.44,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,outpatient,,,34.00000,25.74000,Aetna,Medical Rental Products,,31.96,,,,,,,8.84,32.98,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,outpatient,,,13.00000,9.84000,Aetna,Medical Rental Products,,12.22,,,,,,,3.38,12.61,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Aetna,Medical Rental Products,,264.14,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Aetna,Medical Rental Products,,264.14,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Aetna,Medical Rental Products,,264.14,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Aetna,Medical Rental Products,,705.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Aetna,Medical Rental Products,,705.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Aetna,Medical Rental Products,,705.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,outpatient,,,122.00000,92.35000,Aetna,Medical Rental Products,,114.68,,,,,,,31.72,118.34,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Aetna,Medical Rental Products,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Aetna,Medical Rental Products,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Aetna,Medical Rental Products,,14.10,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Aetna,Medical Rental Products,,14.10,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Aetna,Medical Rental Products,,15.98,,,,,,,4.42,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Aetna,Medical Rental Products,,15.98,,,,,,,4.42,16.49,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,outpatient,,,359.00000,271.76000,Aetna,Medical Rental Products,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,outpatient,,,359.00000,271.76000,Aetna,Medical Rental Products,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,outpatient,,,359.00000,271.76000,Aetna,Medical Rental Products,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,outpatient,,,155.00000,117.34000,Aetna,Medical Rental Products,,145.70,,,,,,,40.30,150.35,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,outpatient,,,294.00000,222.56000,Aetna,Medical Rental Products,,276.36,,,,,,,76.44,285.18,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,outpatient,,,1511.00000,1143.83000,Aetna,Medical Rental Products,,1420.34,,,,,,,392.86,1465.67,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Aetna,Medical Rental Products,,705.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Aetna,Medical Rental Products,,705.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,outpatient,,,150.00000,113.55000,Aetna,Medical Rental Products,,141.00,,,,,,,39.00,145.50,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,outpatient,,,110.00000,83.27000,Aetna,Medical Rental Products,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,outpatient,,,158.00000,119.61000,Aetna,Medical Rental Products,,148.52,,,,,,,41.08,153.26,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,outpatient,,,153.00000,115.82000,Aetna,Medical Rental Products,,143.82,,,,,,,39.78,148.41,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,outpatient,,,157.00000,118.85000,Aetna,Medical Rental Products,,147.58,,,,,,,40.82,152.29,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,outpatient,,,26.00000,19.68000,Aetna,Medical Rental Products,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,outpatient,,,37.00000,28.01000,Aetna,Medical Rental Products,,34.78,,,,,,,9.62,35.89,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,outpatient,,,268.00000,202.88000,Aetna,Medical Rental Products,,251.92,,,,,,,69.68,259.96,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,outpatient,,,91.00000,68.89000,Aetna,Medical Rental Products,,85.54,,,,,,,23.66,88.27,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,outpatient,,,200.00000,151.40000,Aetna,Medical Rental Products,,188.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,outpatient,,,152.00000,115.06000,Aetna,Medical Rental Products,,142.88,,,,,,,39.52,147.44,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,outpatient,,,359.00000,271.76000,Aetna,Medical Rental Products,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,outpatient,,,69.00000,33.26000,Aetna,Medical Rental Products,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,outpatient,,,75.00000,36.15000,Aetna,Medical Rental Products,,70.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,outpatient,,,45.00000,21.69000,Aetna,Medical Rental Products,,42.30,,,,,,,11.70,43.65,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,outpatient,,,68.00000,32.78000,Aetna,Medical Rental Products,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,outpatient,,,61.00000,29.40000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,outpatient,,,64.00000,30.85000,Aetna,Medical Rental Products,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,outpatient,,,195.00000,93.99000,Aetna,Medical Rental Products,,183.30,,,,,,,50.70,189.15,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,outpatient,,,14.00000,6.75000,Aetna,Medical Rental Products,,13.16,,,,,,,3.64,13.58,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,outpatient,,,53.00000,25.55000,Aetna,Medical Rental Products,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,outpatient,,,82.00000,39.52000,Aetna,Medical Rental Products,,77.08,,,,,,,21.32,79.54,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Aetna,Medical Rental Products,,132.54,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Aetna,Medical Rental Products,,132.54,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,outpatient,,,91.00000,43.86000,Aetna,Medical Rental Products,,85.54,,,,,,,23.66,88.27,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,outpatient,,,69.00000,33.26000,Aetna,Medical Rental Products,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,outpatient,,,205.00000,98.81000,Aetna,Medical Rental Products,,192.70,,,,,,,53.30,198.85,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,outpatient,,,50.00000,24.10000,Aetna,Medical Rental Products,,47.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,outpatient,,,406.00000,195.69000,Aetna,Medical Rental Products,,381.64,,,,,,,105.56,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,outpatient,,,101.00000,48.68000,Aetna,Medical Rental Products,,94.94,,,,,,,26.26,97.97,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,outpatient,,,375.00000,180.75000,Aetna,Medical Rental Products,,352.50,,,,,,,97.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,outpatient,,,362.00000,174.48000,Aetna,Medical Rental Products,,340.28,,,,,,,94.12,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,outpatient,,,325.00000,156.65000,Aetna,Medical Rental Products,,305.50,,,,,,,84.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,outpatient,,,121.00000,58.32000,Aetna,Medical Rental Products,,113.74,,,,,,,31.46,117.37,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,outpatient,,,115.00000,55.43000,Aetna,Medical Rental Products,,108.10,,,,,,,29.90,111.55,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,outpatient,,,300.00000,144.60000,Aetna,Medical Rental Products,,282.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,outpatient,,,51.00000,24.58000,Aetna,Medical Rental Products,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Aetna,Medical Rental Products,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Aetna,Medical Rental Products,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,outpatient,,,194.00000,93.51000,Aetna,Medical Rental Products,,182.36,,,,,,,50.44,188.18,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,outpatient,,,68.00000,32.78000,Aetna,Medical Rental Products,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,outpatient,,,329.00000,158.58000,Aetna,Medical Rental Products,,309.26,,,,,,,85.54,319.13,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,outpatient,,,24.00000,11.57000,Aetna,Medical Rental Products,,22.56,,,,,,,6.24,23.28,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,outpatient,,,30.00000,14.46000,Aetna,Medical Rental Products,,28.20,,,,,,,7.80,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,outpatient,,,53.00000,25.55000,Aetna,Medical Rental Products,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,outpatient,,,270.00000,130.14000,Aetna,Medical Rental Products,,253.80,,,,,,,70.20,261.90,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Aetna,Medical Rental Products,,115.62,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Aetna,Medical Rental Products,,115.62,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,outpatient,,,37.00000,17.83000,Aetna,Medical Rental Products,,34.78,,,,,,,9.62,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,outpatient,,,41.00000,19.76000,Aetna,Medical Rental Products,,38.54,,,,,,,10.66,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,outpatient,,,72.00000,34.70000,Aetna,Medical Rental Products,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,outpatient,,,77.00000,37.11000,Aetna,Medical Rental Products,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,outpatient,,,90.00000,43.38000,Aetna,Medical Rental Products,,84.60,,,,,,,23.40,87.30,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,outpatient,,,44.00000,21.21000,Aetna,Medical Rental Products,,41.36,,,,,,,11.44,42.68,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,outpatient,,,115.00000,55.43000,Aetna,Medical Rental Products,,108.10,,,,,,,29.90,111.55,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,outpatient,,,20.00000,9.64000,Aetna,Medical Rental Products,,18.80,,,,,,,5.20,19.40,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Medical Rental Products,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,outpatient,,,341.00000,164.36000,Aetna,Medical Rental Products,,320.54,,,,,,,88.66,330.77,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,outpatient,,,54.00000,26.03000,Aetna,Medical Rental Products,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,outpatient,,,53.00000,25.55000,Aetna,Medical Rental Products,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,outpatient,,,88.00000,42.42000,Aetna,Medical Rental Products,,82.72,,,,,,,22.88,85.36,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,outpatient,,,89.00000,42.90000,Aetna,Medical Rental Products,,83.66,,,,,,,23.14,86.33,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,outpatient,,,61.00000,29.40000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Aetna,Medical Rental Products,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Aetna,Medical Rental Products,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Aetna,Medical Rental Products,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Aetna,Medical Rental Products,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,outpatient,,,95.00000,45.79000,Aetna,Medical Rental Products,,89.30,,,,,,,24.70,92.15,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,outpatient,,,132.00000,63.62000,Aetna,Medical Rental Products,,124.08,,,,,,,34.32,128.04,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,outpatient,,,83.00000,40.01000,Aetna,Medical Rental Products,,78.02,,,,,,,21.58,80.51,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,outpatient,,,387.00000,186.53000,Aetna,Medical Rental Products,,363.78,,,,,,,100.62,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,outpatient,,,387.00000,186.53000,Aetna,Medical Rental Products,,363.78,,,,,,,100.62,375.39,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,outpatient,,,31.00000,14.94000,Aetna,Medical Rental Products,,29.14,,,,,,,8.06,30.07,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,outpatient,,,36.00000,17.35000,Aetna,Medical Rental Products,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,outpatient,,,160.00000,77.12000,Aetna,Medical Rental Products,,150.40,,,,,,,41.60,155.20,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,outpatient,,,112.00000,53.98000,Aetna,Medical Rental Products,,105.28,,,,,,,29.12,108.64,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,outpatient,,,14.00000,6.75000,Aetna,Medical Rental Products,,13.16,,,,,,,3.64,13.58,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,outpatient,,,16.00000,7.71000,Aetna,Medical Rental Products,,15.04,,,,,,,4.16,15.52,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,outpatient,,,71.00000,34.22000,Aetna,Medical Rental Products,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,outpatient,,,116.00000,55.91000,Aetna,Medical Rental Products,,109.04,,,,,,,30.16,112.52,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,outpatient,,,81.00000,39.04000,Aetna,Medical Rental Products,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,outpatient,,,97.00000,46.75000,Aetna,Medical Rental Products,,91.18,,,,,,,25.22,94.09,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,outpatient,,,77.00000,37.11000,Aetna,Medical Rental Products,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,outpatient,,,35.00000,16.87000,Aetna,Medical Rental Products,,32.90,,,,,,,9.10,33.95,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,outpatient,,,65.00000,31.33000,Aetna,Medical Rental Products,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,outpatient,,,74.00000,35.67000,Aetna,Medical Rental Products,,69.56,,,,,,,19.24,71.78,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,outpatient,,,250.00000,120.50000,Aetna,Medical Rental Products,,235.00,,,,,,,65.00,242.50,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,outpatient,,,90.00000,43.38000,Aetna,Medical Rental Products,,84.60,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,outpatient,,,90.00000,43.38000,Aetna,Medical Rental Products,,84.60,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Medical Rental Products,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,outpatient,,,36.00000,17.35000,Aetna,Medical Rental Products,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,outpatient,,,78.00000,37.60000,Aetna,Medical Rental Products,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,outpatient,,,115.00000,55.43000,Aetna,Medical Rental Products,,108.10,,,,,,,29.90,111.55,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Medical Rental Products,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,outpatient,,,76.00000,36.63000,Aetna,Medical Rental Products,,71.44,,,,,,,19.76,73.72,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,outpatient,,,53.00000,25.55000,Aetna,Medical Rental Products,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,outpatient,,,70.00000,33.74000,Aetna,Medical Rental Products,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,outpatient,,,169.00000,81.46000,Aetna,Medical Rental Products,,158.86,,,,,,,43.94,163.93,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,outpatient,,,28.00000,13.50000,Aetna,Medical Rental Products,,26.32,,,,,,,7.28,27.16,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,outpatient,,,51.00000,24.58000,Aetna,Medical Rental Products,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,outpatient,,,15.00000,7.23000,Aetna,Medical Rental Products,,14.10,,,,,,,3.90,14.55,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,outpatient,,,18.00000,8.68000,Aetna,Medical Rental Products,,16.92,,,,,,,4.68,17.46,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,outpatient,,,61.00000,29.40000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,outpatient,,,550.00000,265.10000,Aetna,Medical Rental Products,,517.00,,,,,,,143.00,533.50,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Aetna,Medical Rental Products,,68.62,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,outpatient,,,392.00000,188.94000,Aetna,Medical Rental Products,,368.48,,,,,,,101.92,380.24,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,outpatient,,,75.00000,36.15000,Aetna,Medical Rental Products,,70.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Aetna,Medical Rental Products,,68.62,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,outpatient,,,100.00000,48.20000,Aetna,Medical Rental Products,,94.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,outpatient,,,153.00000,73.75000,Aetna,Medical Rental Products,,143.82,,,,,,,39.78,148.41,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,outpatient,,,909.00000,438.14000,Aetna,Medical Rental Products,,854.46,,,,,,,236.34,881.73,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,outpatient,,,266.00000,128.21000,Aetna,Medical Rental Products,,250.04,,,,,,,69.16,258.02,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,outpatient,,,275.00000,132.55000,Aetna,Medical Rental Products,,258.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,outpatient,,,61.00000,29.40000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,outpatient,,,84.00000,40.49000,Aetna,Medical Rental Products,,78.96,,,,,,,21.84,81.48,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,outpatient,,,174.00000,83.87000,Aetna,Medical Rental Products,,163.56,,,,,,,45.24,168.78,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Medical Rental Products,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,outpatient,,,68.00000,32.78000,Aetna,Medical Rental Products,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,outpatient,,,211.00000,101.70000,Aetna,Medical Rental Products,,198.34,,,,,,,54.86,204.67,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,outpatient,,,65.00000,31.33000,Aetna,Medical Rental Products,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,outpatient,,,83.00000,40.01000,Aetna,Medical Rental Products,,78.02,,,,,,,21.58,80.51,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,outpatient,,,54.00000,26.03000,Aetna,Medical Rental Products,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,outpatient,,,323.00000,155.69000,Aetna,Medical Rental Products,,303.62,,,,,,,83.98,313.31,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,outpatient,,,35.00000,16.87000,Aetna,Medical Rental Products,,32.90,,,,,,,9.10,33.95,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,outpatient,,,20.00000,9.64000,Aetna,Medical Rental Products,,18.80,,,,,,,5.20,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,outpatient,,,34.00000,16.39000,Aetna,Medical Rental Products,,31.96,,,,,,,8.84,32.98,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,outpatient,,,29.00000,13.98000,Aetna,Medical Rental Products,,27.26,,,,,,,7.54,28.13,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,outpatient,,,80.00000,38.56000,Aetna,Medical Rental Products,,75.20,,,,,,,20.80,77.60,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,outpatient,,,73.00000,35.19000,Aetna,Medical Rental Products,,68.62,,,,,,,18.98,70.81,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,outpatient,,,16.00000,7.71000,Aetna,Medical Rental Products,,15.04,,,,,,,4.16,15.52,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Medical Rental Products,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,outpatient,,,113.00000,54.47000,Aetna,Medical Rental Products,,106.22,,,,,,,29.38,109.61,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,outpatient,,,68.00000,32.78000,Aetna,Medical Rental Products,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,outpatient,,,78.00000,37.60000,Aetna,Medical Rental Products,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,outpatient,,,54.00000,26.03000,Aetna,Medical Rental Products,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,outpatient,,,76.00000,36.63000,Aetna,Medical Rental Products,,71.44,,,,,,,19.76,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Medical Rental Products,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,outpatient,,,88.00000,42.42000,Aetna,Medical Rental Products,,82.72,,,,,,,22.88,85.36,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Medical Rental Products,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,outpatient,,,53.00000,25.55000,Aetna,Medical Rental Products,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,outpatient,,,88.00000,42.42000,Aetna,Medical Rental Products,,82.72,,,,,,,22.88,85.36,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,outpatient,,,105.00000,50.61000,Aetna,Medical Rental Products,,98.70,,,,,,,27.30,101.85,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Aetna,Medical Rental Products,,68.62,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,outpatient,,,83.00000,40.01000,Aetna,Medical Rental Products,,78.02,,,,,,,21.58,80.51,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Aetna,Medical Rental Products,,144.76,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,outpatient,,,97.00000,46.75000,Aetna,Medical Rental Products,,91.18,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Aetna,Medical Rental Products,,144.76,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,outpatient,,,87.00000,41.93000,Aetna,Medical Rental Products,,81.78,,,,,,,22.62,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,outpatient,,,68.00000,32.78000,Aetna,Medical Rental Products,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Medical Rental Products,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,outpatient,,,51.00000,24.58000,Aetna,Medical Rental Products,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,outpatient,,,97.00000,46.75000,Aetna,Medical Rental Products,,91.18,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,outpatient,,,176.00000,84.83000,Aetna,Medical Rental Products,,165.44,,,,,,,45.76,170.72,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,outpatient,,,158.00000,76.16000,Aetna,Medical Rental Products,,148.52,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Medical Rental Products,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Medical Rental Products,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,outpatient,,,84.00000,40.49000,Aetna,Medical Rental Products,,78.96,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,outpatient,,,189.00000,91.10000,Aetna,Medical Rental Products,,177.66,,,,,,,49.14,183.33,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,outpatient,,,109.00000,52.54000,Aetna,Medical Rental Products,,102.46,,,,,,,28.34,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,outpatient,,,129.00000,62.18000,Aetna,Medical Rental Products,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,outpatient,,,84.00000,40.49000,Aetna,Medical Rental Products,,78.96,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Aetna,Medical Rental Products,,68.62,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Medical Rental Products,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Medical Rental Products,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,outpatient,,,149.00000,71.82000,Aetna,Medical Rental Products,,140.06,,,,,,,38.74,144.53,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,outpatient,,,130.00000,62.66000,Aetna,Medical Rental Products,,122.20,,,,,,,33.80,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,outpatient,,,110.00000,53.02000,Aetna,Medical Rental Products,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,outpatient,,,158.00000,76.16000,Aetna,Medical Rental Products,,148.52,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,outpatient,,,117.00000,56.39000,Aetna,Medical Rental Products,,109.98,,,,,,,30.42,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,outpatient,,,61.00000,29.40000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Medical Rental Products,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Aetna,Medical Rental Products,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,outpatient,,,145.00000,69.89000,Aetna,Medical Rental Products,,136.30,,,,,,,37.70,140.65,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Medical Rental Products,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,outpatient,,,165.00000,79.53000,Aetna,Medical Rental Products,,155.10,,,,,,,42.90,160.05,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,outpatient,,,70.00000,33.74000,Aetna,Medical Rental Products,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Medical Rental Products,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Aetna,Medical Rental Products,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,outpatient,,,154.00000,74.23000,Aetna,Medical Rental Products,,144.76,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,outpatient,,,104.00000,50.13000,Aetna,Medical Rental Products,,97.76,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,outpatient,,,70.00000,33.74000,Aetna,Medical Rental Products,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,outpatient,,,104.00000,50.13000,Aetna,Medical Rental Products,,97.76,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,outpatient,,,70.00000,33.74000,Aetna,Medical Rental Products,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,outpatient,,,123.00000,59.29000,Aetna,Medical Rental Products,,115.62,,,,,,,31.98,119.31,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,outpatient,,,95.00000,45.79000,Aetna,Medical Rental Products,,89.30,,,,,,,24.70,92.15,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,outpatient,,,160.00000,77.12000,Aetna,Medical Rental Products,,150.40,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,outpatient,,,147.00000,70.85000,Aetna,Medical Rental Products,,138.18,,,,,,,38.22,142.59,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,outpatient,,,178.00000,85.80000,Aetna,Medical Rental Products,,167.32,,,,,,,46.28,172.66,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,outpatient,,,160.00000,77.12000,Aetna,Medical Rental Products,,150.40,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Aetna,Medical Rental Products,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Medical Rental Products,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,outpatient,,,70.00000,33.74000,Aetna,Medical Rental Products,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Aetna,Medical Rental Products,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Aetna,Medical Rental Products,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Aetna,Medical Rental Products,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Aetna,Medical Rental Products,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Aetna,Medical Rental Products,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Aetna,Medical Rental Products,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Aetna,Medical Rental Products,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Aetna,Medical Rental Products,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,outpatient,,,449.00000,216.42000,Aetna,Medical Rental Products,,422.06,,,,,,,116.74,435.53,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,outpatient,,,104.00000,50.13000,Aetna,Medical Rental Products,,97.76,,,,,,,27.04,100.88,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Aetna,Medical Rental Products,,173.90,,,,,,,48.10,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Aetna,Medical Rental Products,,173.90,,,,,,,48.10,179.45,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,outpatient,,,84.00000,40.49000,Aetna,Medical Rental Products,,78.96,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Aetna,Medical Rental Products,,78.96,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Aetna,Medical Rental Products,,78.96,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Aetna,Medical Rental Products,,68.62,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Aetna,Medical Rental Products,,68.62,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,outpatient,,,98.00000,47.24000,Aetna,Medical Rental Products,,92.12,,,,,,,25.48,95.06,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,outpatient,,,75.00000,36.15000,Aetna,Medical Rental Products,,70.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,outpatient,,,107.00000,51.57000,Aetna,Medical Rental Products,,100.58,,,,,,,27.82,103.79,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,outpatient,,,81.00000,39.04000,Aetna,Medical Rental Products,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,outpatient,,,68.00000,32.78000,Aetna,Medical Rental Products,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,outpatient,,,51.00000,24.58000,Aetna,Medical Rental Products,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,outpatient,,,74.00000,35.67000,Aetna,Medical Rental Products,,69.56,,,,,,,19.24,71.78,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,outpatient,,,194.00000,93.51000,Aetna,Medical Rental Products,,182.36,,,,,,,50.44,188.18,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,outpatient,,,111.00000,53.50000,Aetna,Medical Rental Products,,104.34,,,,,,,28.86,107.67,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,outpatient,,,77.00000,37.11000,Aetna,Medical Rental Products,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Aetna,Medical Rental Products,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Aetna,Medical Rental Products,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Aetna,Medical Rental Products,,222.78,,,,,,,61.62,229.89,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,outpatient,,,51.00000,24.58000,Aetna,Medical Rental Products,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Aetna,Medical Rental Products,,77.08,,,,,,,21.32,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Aetna,Medical Rental Products,,77.08,,,,,,,21.32,79.54,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Medical Rental Products,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,outpatient,,,131.00000,63.14000,Aetna,Medical Rental Products,,123.14,,,,,,,34.06,127.07,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,outpatient,,,15.00000,7.23000,Aetna,Medical Rental Products,,14.10,,,,,,,3.90,14.55,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,outpatient,,,39.00000,18.80000,Aetna,Medical Rental Products,,36.66,,,,,,,10.14,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,outpatient,,,12.00000,5.78000,Aetna,Medical Rental Products,,11.28,,,,,,,3.12,11.64,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Aetna,Medical Rental Products,,190.82,,,,,,,52.78,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Aetna,Medical Rental Products,,190.82,,,,,,,52.78,196.91,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,outpatient,,,99.00000,47.72000,Aetna,Medical Rental Products,,93.06,,,,,,,25.74,96.03,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,outpatient,,,53.00000,25.55000,Aetna,Medical Rental Products,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,outpatient,,,23.00000,11.09000,Aetna,Medical Rental Products,,21.62,,,,,,,5.98,22.31,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,outpatient,,,46.00000,22.17000,Aetna,Medical Rental Products,,43.24,,,,,,,11.96,44.62,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Medical Rental Products,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,outpatient,,,288.00000,138.82000,Aetna,Medical Rental Products,,270.72,,,,,,,74.88,279.36,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,outpatient,,,106.00000,51.09000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,outpatient,,,30.00000,14.46000,Aetna,Medical Rental Products,,28.20,,,,,,,7.80,29.10,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,outpatient,,,71.00000,34.22000,Aetna,Medical Rental Products,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Medical Rental Products,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,outpatient,,,89.00000,42.90000,Aetna,Medical Rental Products,,83.66,,,,,,,23.14,86.33,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,outpatient,,,116.00000,55.91000,Aetna,Medical Rental Products,,109.04,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Aetna,Medical Rental Products,,109.04,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Aetna,Medical Rental Products,,109.04,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,outpatient,,,51.00000,24.58000,Aetna,Medical Rental Products,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,outpatient,,,174.00000,83.87000,Aetna,Medical Rental Products,,163.56,,,,,,,45.24,168.78,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,outpatient,,,82.00000,39.52000,Aetna,Medical Rental Products,,77.08,,,,,,,21.32,79.54,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,outpatient,,,112.00000,53.98000,Aetna,Medical Rental Products,,105.28,,,,,,,29.12,108.64,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,outpatient,,,61.00000,29.40000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,outpatient,,,69.00000,33.26000,Aetna,Medical Rental Products,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Medical Rental Products,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,outpatient,,,286.00000,137.85000,Aetna,Medical Rental Products,,268.84,,,,,,,74.36,277.42,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,outpatient,,,300.00000,144.60000,Aetna,Medical Rental Products,,282.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,outpatient,,,73.00000,35.19000,Aetna,Medical Rental Products,,68.62,,,,,,,18.98,70.81,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,outpatient,,,90.00000,43.38000,Aetna,Medical Rental Products,,84.60,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Medical Rental Products,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,outpatient,,,315.00000,151.83000,Aetna,Medical Rental Products,,296.10,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,outpatient,,,100.00000,48.20000,Aetna,Medical Rental Products,,94.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,outpatient,,,89.00000,42.90000,Aetna,Medical Rental Products,,83.66,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,outpatient,,,71.00000,34.22000,Aetna,Medical Rental Products,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,outpatient,,,135.00000,65.07000,Aetna,Medical Rental Products,,126.90,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,outpatient,,,80.00000,38.56000,Aetna,Medical Rental Products,,75.20,,,,,,,20.80,77.60,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Aetna,Medical Rental Products,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Aetna,Medical Rental Products,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,outpatient,,,100.00000,48.20000,Aetna,Medical Rental Products,,94.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,outpatient,,,305.00000,147.01000,Aetna,Medical Rental Products,,286.70,,,,,,,79.30,295.85,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,outpatient,,,70.00000,33.74000,Aetna,Medical Rental Products,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,outpatient,,,69.00000,33.26000,Aetna,Medical Rental Products,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,outpatient,,,64.00000,30.85000,Aetna,Medical Rental Products,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,outpatient,,,368.00000,177.38000,Aetna,Medical Rental Products,,345.92,,,,,,,95.68,356.96,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,outpatient,,,104.00000,50.13000,Aetna,Medical Rental Products,,97.76,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,outpatient,,,109.00000,52.54000,Aetna,Medical Rental Products,,102.46,,,,,,,28.34,105.73,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,outpatient,,,114.00000,54.95000,Aetna,Medical Rental Products,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,outpatient,,,135.00000,65.07000,Aetna,Medical Rental Products,,126.90,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,outpatient,,,105.00000,50.61000,Aetna,Medical Rental Products,,98.70,,,,,,,27.30,101.85,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,outpatient,,,315.00000,151.83000,Aetna,Medical Rental Products,,296.10,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,outpatient,,,148.00000,71.34000,Aetna,Medical Rental Products,,139.12,,,,,,,38.48,143.56,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Medical Rental Products,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,outpatient,,,107.00000,51.57000,Aetna,Medical Rental Products,,100.58,,,,,,,27.82,103.79,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,outpatient,,,35.00000,16.87000,Aetna,Medical Rental Products,,32.90,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,outpatient,,,104.00000,50.13000,Aetna,Medical Rental Products,,97.76,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,outpatient,,,650.00000,313.30000,Aetna,Medical Rental Products,,611.00,,,,,,,169.00,630.50,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,outpatient,,,91.00000,43.86000,Aetna,Medical Rental Products,,85.54,,,,,,,23.66,88.27,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,outpatient,,,114.00000,54.95000,Aetna,Medical Rental Products,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Medical Rental Products,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,outpatient,,,360.00000,173.52000,Aetna,Medical Rental Products,,338.40,,,,,,,93.60,349.20,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,outpatient,,,106.00000,51.09000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,outpatient,,,78.00000,37.60000,Aetna,Medical Rental Products,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,outpatient,,,72.00000,34.70000,Aetna,Medical Rental Products,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,outpatient,,,94.00000,45.31000,Aetna,Medical Rental Products,,88.36,,,,,,,24.44,91.18,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,outpatient,,,101.00000,48.68000,Aetna,Medical Rental Products,,94.94,,,,,,,26.26,97.97,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,outpatient,,,82.00000,39.52000,Aetna,Medical Rental Products,,77.08,,,,,,,21.32,79.54,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,outpatient,,,77.00000,37.11000,Aetna,Medical Rental Products,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,outpatient,,,145.00000,69.89000,Aetna,Medical Rental Products,,136.30,,,,,,,37.70,140.65,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,outpatient,,,266.00000,128.21000,Aetna,Medical Rental Products,,250.04,,,,,,,69.16,258.02,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,outpatient,,,79.00000,38.08000,Aetna,Medical Rental Products,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,outpatient,,,144.00000,69.41000,Aetna,Medical Rental Products,,135.36,,,,,,,37.44,139.68,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,outpatient,,,20.00000,9.64000,Aetna,Medical Rental Products,,18.80,,,,,,,5.20,19.40,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,outpatient,,,208.00000,100.26000,Aetna,Medical Rental Products,,195.52,,,,,,,54.08,201.76,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,outpatient,,,135.00000,65.07000,Aetna,Medical Rental Products,,126.90,,,,,,,35.10,130.95,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,outpatient,,,131.00000,63.14000,Aetna,Medical Rental Products,,123.14,,,,,,,34.06,127.07,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,outpatient,,,69.00000,33.26000,Aetna,Medical Rental Products,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,outpatient,,,25.00000,12.05000,Aetna,Medical Rental Products,,23.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,outpatient,,,61.00000,29.40000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,outpatient,,,80.00000,38.56000,Aetna,Medical Rental Products,,75.20,,,,,,,20.80,77.60,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,outpatient,,,82.00000,39.52000,Aetna,Medical Rental Products,,77.08,,,,,,,21.32,79.54,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,outpatient,,,35.00000,16.87000,Aetna,Medical Rental Products,,32.90,,,,,,,9.10,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,outpatient,,,88.00000,42.42000,Aetna,Medical Rental Products,,82.72,,,,,,,22.88,85.36,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,outpatient,,,98.00000,47.24000,Aetna,Medical Rental Products,,92.12,,,,,,,25.48,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,outpatient,,,204.00000,98.33000,Aetna,Medical Rental Products,,191.76,,,,,,,53.04,197.88,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,outpatient,,,61.00000,29.40000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,outpatient,,,19.00000,9.16000,Aetna,Medical Rental Products,,17.86,,,,,,,4.94,18.43,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,outpatient,,,37.00000,17.83000,Aetna,Medical Rental Products,,34.78,,,,,,,9.62,35.89,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,outpatient,,,79.00000,38.08000,Aetna,Medical Rental Products,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,outpatient,,,21.00000,10.12000,Aetna,Medical Rental Products,,19.74,,,,,,,5.46,20.37,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Medical Rental Products,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,outpatient,,,32.00000,15.42000,Aetna,Medical Rental Products,,30.08,,,,,,,8.32,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,outpatient,,,94.00000,45.31000,Aetna,Medical Rental Products,,88.36,,,,,,,24.44,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,outpatient,,,103.00000,49.65000,Aetna,Medical Rental Products,,96.82,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,outpatient,,,64.00000,30.85000,Aetna,Medical Rental Products,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,outpatient,,,102.00000,49.16000,Aetna,Medical Rental Products,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,outpatient,,,103.00000,49.65000,Aetna,Medical Rental Products,,96.82,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,outpatient,,,139.00000,67.00000,Aetna,Medical Rental Products,,130.66,,,,,,,36.14,134.83,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Medical Rental Products,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Aetna,Medical Rental Products,,19.74,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,outpatient,,,88.00000,42.42000,Aetna,Medical Rental Products,,82.72,,,,,,,22.88,85.36,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Aetna,Medical Rental Products,,19.74,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Medical Rental Products,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,outpatient,,,80.00000,38.56000,Aetna,Medical Rental Products,,75.20,,,,,,,20.80,77.60,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,outpatient,,,49.00000,23.62000,Aetna,Medical Rental Products,,46.06,,,,,,,12.74,47.53,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,outpatient,,,88.00000,42.42000,Aetna,Medical Rental Products,,82.72,,,,,,,22.88,85.36,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,outpatient,,,68.00000,32.78000,Aetna,Medical Rental Products,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,outpatient,,,93.00000,44.83000,Aetna,Medical Rental Products,,87.42,,,,,,,24.18,90.21,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,outpatient,,,73.00000,35.19000,Aetna,Medical Rental Products,,68.62,,,,,,,18.98,70.81,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,outpatient,,,41.00000,19.76000,Aetna,Medical Rental Products,,38.54,,,,,,,10.66,39.77,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,outpatient,,,94.00000,45.31000,Aetna,Medical Rental Products,,88.36,,,,,,,24.44,91.18,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,outpatient,,,124.00000,59.77000,Aetna,Medical Rental Products,,116.56,,,,,,,32.24,120.28,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,outpatient,,,71.00000,34.22000,Aetna,Medical Rental Products,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,outpatient,,,33.00000,15.91000,Aetna,Medical Rental Products,,31.02,,,,,,,8.58,32.01,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Medical Rental Products,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,outpatient,,,68.00000,32.78000,Aetna,Medical Rental Products,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,outpatient,,,99.00000,47.72000,Aetna,Medical Rental Products,,93.06,,,,,,,25.74,96.03,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,outpatient,,,197.00000,94.95000,Aetna,Medical Rental Products,,185.18,,,,,,,51.22,191.09,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,outpatient,,,194.00000,93.51000,Aetna,Medical Rental Products,,182.36,,,,,,,50.44,188.18,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,outpatient,,,68.00000,32.78000,Aetna,Medical Rental Products,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,outpatient,,,90.00000,43.38000,Aetna,Medical Rental Products,,84.60,,,,,,,23.40,87.30,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,outpatient,,,109.00000,52.54000,Aetna,Medical Rental Products,,102.46,,,,,,,28.34,105.73,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,outpatient,,,108.00000,52.06000,Aetna,Medical Rental Products,,101.52,,,,,,,28.08,104.76,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Medical Rental Products,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,outpatient,,,69.00000,33.26000,Aetna,Medical Rental Products,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,outpatient,,,71.00000,34.22000,Aetna,Medical Rental Products,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,outpatient,,,98.00000,47.24000,Aetna,Medical Rental Products,,92.12,,,,,,,25.48,95.06,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,outpatient,,,141.00000,67.96000,Aetna,Medical Rental Products,,132.54,,,,,,,36.66,136.77,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,outpatient,,,226.00000,108.93000,Aetna,Medical Rental Products,,212.44,,,,,,,58.76,219.22,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,outpatient,,,92.00000,44.34000,Aetna,Medical Rental Products,,86.48,,,,,,,23.92,89.24,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,outpatient,,,69.00000,33.26000,Aetna,Medical Rental Products,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,outpatient,,,100.00000,48.20000,Aetna,Medical Rental Products,,94.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,outpatient,,,124.00000,59.77000,Aetna,Medical Rental Products,,116.56,,,,,,,32.24,120.28,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,outpatient,,,69.00000,33.26000,Aetna,Medical Rental Products,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Aetna,Medical Rental Products,,116.56,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Aetna,Medical Rental Products,,116.56,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Aetna,Medical Rental Products,,116.56,,,,,,,32.24,120.28,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,outpatient,,,118.00000,56.88000,Aetna,Medical Rental Products,,110.92,,,,,,,30.68,114.46,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,outpatient,,,51.00000,24.58000,Aetna,Medical Rental Products,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,outpatient,,,104.00000,50.13000,Aetna,Medical Rental Products,,97.76,,,,,,,27.04,100.88,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,outpatient,,,72.00000,34.70000,Aetna,Medical Rental Products,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,outpatient,,,54.00000,26.03000,Aetna,Medical Rental Products,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,outpatient,,,17.00000,8.19000,Aetna,Medical Rental Products,,15.98,,,,,,,4.42,16.49,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,outpatient,,,36.00000,17.35000,Aetna,Medical Rental Products,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Medical Rental Products,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,outpatient,,,18.00000,8.68000,Aetna,Medical Rental Products,,16.92,,,,,,,4.68,17.46,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,outpatient,,,74.00000,35.67000,Aetna,Medical Rental Products,,69.56,,,,,,,19.24,71.78,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,outpatient,,,118.00000,56.88000,Aetna,Medical Rental Products,,110.92,,,,,,,30.68,114.46,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,outpatient,,,82.00000,39.52000,Aetna,Medical Rental Products,,77.08,,,,,,,21.32,79.54,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,outpatient,,,30.00000,14.46000,Aetna,Medical Rental Products,,28.20,,,,,,,7.80,29.10,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,outpatient,,,70.00000,33.74000,Aetna,Medical Rental Products,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,outpatient,,,54.00000,26.03000,Aetna,Medical Rental Products,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,outpatient,,,51.00000,24.58000,Aetna,Medical Rental Products,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,outpatient,,,141.00000,67.96000,Aetna,Medical Rental Products,,132.54,,,,,,,36.66,136.77,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,outpatient,,,81.00000,39.04000,Aetna,Medical Rental Products,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,outpatient,,,335.00000,161.47000,Aetna,Medical Rental Products,,314.90,,,,,,,87.10,324.95,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Medical Rental Products,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Aetna,Medical Rental Products,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Aetna,Medical Rental Products,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,outpatient,,,53.00000,25.55000,Aetna,Medical Rental Products,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,outpatient,,,53.00000,25.55000,Aetna,Medical Rental Products,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,outpatient,,,12.00000,5.78000,Aetna,Medical Rental Products,,11.28,,,,,,,3.12,11.64,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,outpatient,,,710.00000,342.22000,Aetna,Medical Rental Products,,667.40,,,,,,,184.60,688.70,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,outpatient,,,104.00000,50.13000,Aetna,Medical Rental Products,,97.76,,,,,,,27.04,100.88,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,outpatient,,,155.00000,74.71000,Aetna,Medical Rental Products,,145.70,,,,,,,40.30,150.35,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,outpatient,,,139.00000,67.00000,Aetna,Medical Rental Products,,130.66,,,,,,,36.14,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,outpatient,,,89.00000,42.90000,Aetna,Medical Rental Products,,83.66,,,,,,,23.14,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,outpatient,,,88.00000,42.42000,Aetna,Medical Rental Products,,82.72,,,,,,,22.88,85.36,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,outpatient,,,111.00000,53.50000,Aetna,Medical Rental Products,,104.34,,,,,,,28.86,107.67,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,outpatient,,,70.00000,33.74000,Aetna,Medical Rental Products,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,outpatient,,,85.00000,40.97000,Aetna,Medical Rental Products,,79.90,,,,,,,22.10,82.45,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,outpatient,,,110.00000,53.02000,Aetna,Medical Rental Products,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,outpatient,,,500.00000,241.00000,Aetna,Medical Rental Products,,470.00,,,,,,,130.00,485.00,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,outpatient,,,140.00000,67.48000,Aetna,Medical Rental Products,,131.60,,,,,,,36.40,135.80,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,outpatient,,,74.00000,35.67000,Aetna,Medical Rental Products,,69.56,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,outpatient,,,77.00000,37.11000,Aetna,Medical Rental Products,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,outpatient,,,93.00000,44.83000,Aetna,Medical Rental Products,,87.42,,,,,,,24.18,90.21,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,outpatient,,,15.00000,7.23000,Aetna,Medical Rental Products,,14.10,,,,,,,3.90,14.55,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,outpatient,,,24.00000,11.57000,Aetna,Medical Rental Products,,22.56,,,,,,,6.24,23.28,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,outpatient,,,72.00000,34.70000,Aetna,Medical Rental Products,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Aetna,Medical Rental Products,,15.04,,,,,,,4.16,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Aetna,Medical Rental Products,,15.04,,,,,,,4.16,15.52,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,outpatient,,,64.00000,30.85000,Aetna,Medical Rental Products,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,outpatient,,,82.00000,39.52000,Aetna,Medical Rental Products,,77.08,,,,,,,21.32,79.54,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,outpatient,,,157.00000,75.67000,Aetna,Medical Rental Products,,147.58,,,,,,,40.82,152.29,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,outpatient,,,70.00000,33.74000,Aetna,Medical Rental Products,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,outpatient,,,229.00000,110.38000,Aetna,Medical Rental Products,,215.26,,,,,,,59.54,222.13,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,outpatient,,,64.00000,30.85000,Aetna,Medical Rental Products,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,outpatient,,,72.00000,34.70000,Aetna,Medical Rental Products,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,outpatient,,,17.00000,8.19000,Aetna,Medical Rental Products,,15.98,,,,,,,4.42,16.49,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,outpatient,,,64.00000,30.85000,Aetna,Medical Rental Products,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,outpatient,,,387.00000,186.53000,Aetna,Medical Rental Products,,363.78,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Aetna,Medical Rental Products,,363.78,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Aetna,Medical Rental Products,,363.78,,,,,,,100.62,375.39,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,outpatient,,,77.00000,37.11000,Aetna,Medical Rental Products,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Aetna,Medical Rental Products,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Aetna,Medical Rental Products,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,outpatient,,,43.00000,20.73000,Aetna,Medical Rental Products,,40.42,,,,,,,11.18,41.71,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,outpatient,,,64.00000,30.85000,Aetna,Medical Rental Products,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,outpatient,,,160.00000,77.12000,Aetna,Medical Rental Products,,150.40,,,,,,,41.60,155.20,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,outpatient,,,112.00000,53.98000,Aetna,Medical Rental Products,,105.28,,,,,,,29.12,108.64,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,outpatient,,,82.00000,39.52000,Aetna,Medical Rental Products,,77.08,,,,,,,21.32,79.54,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,outpatient,,,54.00000,26.03000,Aetna,Medical Rental Products,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,outpatient,,,153.00000,73.75000,Aetna,Medical Rental Products,,143.82,,,,,,,39.78,148.41,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,outpatient,,,45.00000,21.69000,Aetna,Medical Rental Products,,42.30,,,,,,,11.70,43.65,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,outpatient,,,28.00000,13.50000,Aetna,Medical Rental Products,,26.32,,,,,,,7.28,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Aetna,Medical Rental Products,,46.06,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Aetna,Medical Rental Products,,46.06,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Aetna,Medical Rental Products,,46.06,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,outpatient,,,36.00000,17.35000,Aetna,Medical Rental Products,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,outpatient,,,38.00000,18.32000,Aetna,Medical Rental Products,,35.72,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,outpatient,,,38.00000,18.32000,Aetna,Medical Rental Products,,35.72,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,outpatient,,,76.00000,36.63000,Aetna,Medical Rental Products,,71.44,,,,,,,19.76,73.72,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,outpatient,,,173.00000,83.39000,Aetna,Medical Rental Products,,162.62,,,,,,,44.98,167.81,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,outpatient,,,22.00000,10.60000,Aetna,Medical Rental Products,,20.68,,,,,,,5.72,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,outpatient,,,39.00000,18.80000,Aetna,Medical Rental Products,,36.66,,,,,,,10.14,37.83,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,outpatient,,,41.00000,19.76000,Aetna,Medical Rental Products,,38.54,,,,,,,10.66,39.77,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,outpatient,,,54.00000,26.03000,Aetna,Medical Rental Products,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,outpatient,,,71.00000,34.22000,Aetna,Medical Rental Products,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Aetna,Medical Rental Products,,40.42,,,,,,,11.18,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Aetna,Medical Rental Products,,40.42,,,,,,,11.18,41.71,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,outpatient,,,38.00000,18.32000,Aetna,Medical Rental Products,,35.72,,,,,,,9.88,36.86,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,outpatient,,,72.00000,34.70000,Aetna,Medical Rental Products,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,outpatient,,,226.00000,108.93000,Aetna,Medical Rental Products,,212.44,,,,,,,58.76,219.22,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Aetna,Medical Rental Products,,38.54,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Aetna,Medical Rental Products,,38.54,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Aetna,Medical Rental Products,,38.54,,,,,,,10.66,39.77,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,outpatient,,,160.00000,77.12000,Aetna,Medical Rental Products,,150.40,,,,,,,41.60,155.20,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,outpatient,,,102.00000,49.16000,Aetna,Medical Rental Products,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,outpatient,,,317.00000,152.79000,Aetna,Medical Rental Products,,297.98,,,,,,,82.42,307.49,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,outpatient,,,116.00000,55.91000,Aetna,Medical Rental Products,,109.04,,,,,,,30.16,112.52,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Aetna,Medical Rental Products,,83.66,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Aetna,Medical Rental Products,,83.66,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,outpatient,,,85.00000,40.97000,Aetna,Medical Rental Products,,79.90,,,,,,,22.10,82.45,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,outpatient,,,184.00000,88.69000,Aetna,Medical Rental Products,,172.96,,,,,,,47.84,178.48,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,outpatient,,,127.00000,61.21000,Aetna,Medical Rental Products,,119.38,,,,,,,33.02,123.19,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,outpatient,,,61.00000,29.40000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,outpatient,,,35.00000,16.87000,Aetna,Medical Rental Products,,32.90,,,,,,,9.10,33.95,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,outpatient,,,79.00000,38.08000,Aetna,Medical Rental Products,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Medical Rental Products,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,outpatient,,,57.00000,32.83000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Aetna,Medical Rental Products,,143.82,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,outpatient,,,77.00000,44.35000,Aetna,Medical Rental Products,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,outpatient,,,70.00000,40.32000,Aetna,Medical Rental Products,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,outpatient,,,67.00000,38.59000,Aetna,Medical Rental Products,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,outpatient,,,40.00000,23.04000,Aetna,Medical Rental Products,,37.60,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,outpatient,,,71.00000,40.90000,Aetna,Medical Rental Products,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,outpatient,,,80.00000,46.08000,Aetna,Medical Rental Products,,75.20,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,outpatient,,,72.00000,41.47000,Aetna,Medical Rental Products,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,outpatient,,,444.00000,255.74000,Aetna,Medical Rental Products,,417.36,,,,,,,115.44,430.68,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,outpatient,,,81.00000,46.66000,Aetna,Medical Rental Products,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,outpatient,,,66.00000,38.02000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,outpatient,,,57.00000,32.83000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,outpatient,,,53.00000,30.53000,Aetna,Medical Rental Products,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Medical Rental Products,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Medical Rental Products,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,outpatient,,,60.00000,34.56000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,outpatient,,,40.00000,23.04000,Aetna,Medical Rental Products,,37.60,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,outpatient,,,42.00000,24.19000,Aetna,Medical Rental Products,,39.48,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,outpatient,,,46.00000,26.50000,Aetna,Medical Rental Products,,43.24,,,,,,,11.96,44.62,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,outpatient,,,54.00000,31.10000,Aetna,Medical Rental Products,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,outpatient,,,71.00000,40.90000,Aetna,Medical Rental Products,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,outpatient,,,54.00000,31.10000,Aetna,Medical Rental Products,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,outpatient,,,80.00000,46.08000,Aetna,Medical Rental Products,,75.20,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,outpatient,,,60.00000,34.56000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Aetna,Medical Rental Products,,116.56,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,outpatient,,,130.00000,74.88000,Aetna,Medical Rental Products,,122.20,,,,,,,33.80,126.10,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Aetna,Medical Rental Products,,115.62,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,outpatient,,,77.00000,44.35000,Aetna,Medical Rental Products,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Medical Rental Products,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,outpatient,,,115.00000,66.24000,Aetna,Medical Rental Products,,108.10,,,,,,,29.90,111.55,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Aetna,Medical Rental Products,,115.62,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,outpatient,,,161.00000,92.74000,Aetna,Medical Rental Products,,151.34,,,,,,,41.86,156.17,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Aetna,Medical Rental Products,,116.56,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Medical Rental Products,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Medical Rental Products,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Medical Rental Products,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Medical Rental Products,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,outpatient,,,102.00000,58.75000,Aetna,Medical Rental Products,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,outpatient,,,219.00000,126.14000,Aetna,Medical Rental Products,,205.86,,,,,,,56.94,212.43,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Aetna,Medical Rental Products,,182.36,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,outpatient,,,103.00000,59.33000,Aetna,Medical Rental Products,,96.82,,,,,,,26.78,99.91,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,outpatient,,,60.00000,34.56000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,outpatient,,,837.00000,482.11000,Aetna,Medical Rental Products,,786.78,,,,,,,217.62,811.89,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Medical Rental Products,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Medical Rental Products,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Aetna,Medical Rental Products,,182.36,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,outpatient,,,78.00000,44.93000,Aetna,Medical Rental Products,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,outpatient,,,285.00000,164.16000,Aetna,Medical Rental Products,,267.90,,,,,,,74.10,276.45,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,outpatient,,,190.00000,109.44000,Aetna,Medical Rental Products,,178.60,,,,,,,49.40,184.30,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,outpatient,,,100.00000,57.60000,Aetna,Medical Rental Products,,94.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Aetna,Medical Rental Products,,37.60,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,outpatient,,,67.00000,38.59000,Aetna,Medical Rental Products,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,outpatient,,,78.00000,44.93000,Aetna,Medical Rental Products,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Medical Rental Products,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Medical Rental Products,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,outpatient,,,57.00000,32.83000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,outpatient,,,72.00000,41.47000,Aetna,Medical Rental Products,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,outpatient,,,59.00000,33.98000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,outpatient,,,72.00000,41.47000,Aetna,Medical Rental Products,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,outpatient,,,239.00000,137.66000,Aetna,Medical Rental Products,,224.66,,,,,,,62.14,231.83,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,outpatient,,,85.00000,48.96000,Aetna,Medical Rental Products,,79.90,,,,,,,22.10,82.45,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,outpatient,,,44.00000,25.34000,Aetna,Medical Rental Products,,41.36,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,outpatient,,,40.00000,23.04000,Aetna,Medical Rental Products,,37.60,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,outpatient,,,53.00000,30.53000,Aetna,Medical Rental Products,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,outpatient,,,68.00000,39.17000,Aetna,Medical Rental Products,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,outpatient,,,76.00000,43.78000,Aetna,Medical Rental Products,,71.44,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,outpatient,,,42.00000,24.19000,Aetna,Medical Rental Products,,39.48,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,outpatient,,,87.00000,50.11000,Aetna,Medical Rental Products,,81.78,,,,,,,22.62,84.39,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,outpatient,,,503.00000,289.73000,Aetna,Medical Rental Products,,472.82,,,,,,,130.78,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,outpatient,,,472.00000,271.87000,Aetna,Medical Rental Products,,443.68,,,,,,,122.72,457.84,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,outpatient,,,28.00000,16.13000,Aetna,Medical Rental Products,,26.32,,,,,,,7.28,27.16,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,outpatient,,,236.00000,135.94000,Aetna,Medical Rental Products,,221.84,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,outpatient,,,54.00000,31.10000,Aetna,Medical Rental Products,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,outpatient,,,238.00000,137.09000,Aetna,Medical Rental Products,,223.72,,,,,,,61.88,230.86,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,outpatient,,,236.00000,135.94000,Aetna,Medical Rental Products,,221.84,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,outpatient,,,145.00000,83.52000,Aetna,Medical Rental Products,,136.30,,,,,,,37.70,140.65,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Aetna,Medical Rental Products,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Aetna,Medical Rental Products,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,outpatient,,,66.00000,38.02000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,outpatient,,,59.00000,33.98000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,outpatient,,,158.00000,91.01000,Aetna,Medical Rental Products,,148.52,,,,,,,41.08,153.26,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,outpatient,,,71.00000,40.90000,Aetna,Medical Rental Products,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,outpatient,,,144.00000,82.94000,Aetna,Medical Rental Products,,135.36,,,,,,,37.44,139.68,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,outpatient,,,1448.00000,834.05000,Aetna,Medical Rental Products,,1361.12,,,,,,,376.48,1404.56,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,outpatient,,,72.00000,41.47000,Aetna,Medical Rental Products,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,outpatient,,,102.00000,58.75000,Aetna,Medical Rental Products,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,outpatient,,,154.00000,88.70000,Aetna,Medical Rental Products,,144.76,,,,,,,40.04,149.38,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Aetna,Medical Rental Products,,143.82,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,outpatient,,,66.00000,38.02000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Aetna,Medical Rental Products,,143.82,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,outpatient,,,44.00000,25.34000,Aetna,Medical Rental Products,,41.36,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,outpatient,,,150.00000,86.40000,Aetna,Medical Rental Products,,141.00,,,,,,,39.00,145.50,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,outpatient,,,56.00000,32.26000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,outpatient,,,66.00000,38.02000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,outpatient,,,60.00000,34.56000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,outpatient,,,58.00000,33.41000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,outpatient,,,71.00000,40.90000,Aetna,Medical Rental Products,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,outpatient,,,72.00000,41.47000,Aetna,Medical Rental Products,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,outpatient,,,60.00000,34.56000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,outpatient,,,56.00000,32.26000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,outpatient,,,39.00000,22.46000,Aetna,Medical Rental Products,,36.66,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Aetna,Medical Rental Products,,143.82,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,outpatient,,,73.00000,42.05000,Aetna,Medical Rental Products,,68.62,,,,,,,18.98,70.81,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Aetna,Medical Rental Products,,119.38,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Aetna,Medical Rental Products,,119.38,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Medical Rental Products,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,outpatient,,,372.00000,214.27000,Aetna,Medical Rental Products,,349.68,,,,,,,96.72,360.84,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,outpatient,,,69.00000,39.74000,Aetna,Medical Rental Products,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Aetna,Medical Rental Products,,143.82,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Aetna,Medical Rental Products,,143.82,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,outpatient,,,57.00000,32.83000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,outpatient,,,96.00000,55.30000,Aetna,Medical Rental Products,,90.24,,,,,,,24.96,93.12,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,outpatient,,,44.00000,25.34000,Aetna,Medical Rental Products,,41.36,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,outpatient,,,60.00000,34.56000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,outpatient,,,60.00000,34.56000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,outpatient,,,74.00000,42.62000,Aetna,Medical Rental Products,,69.56,,,,,,,19.24,71.78,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,outpatient,,,69.00000,39.74000,Aetna,Medical Rental Products,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Aetna,Medical Rental Products,,36.66,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,outpatient,,,53.00000,30.53000,Aetna,Medical Rental Products,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Aetna,Medical Rental Products,,36.66,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Aetna,Medical Rental Products,,36.66,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,outpatient,,,70.00000,40.32000,Aetna,Medical Rental Products,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,outpatient,,,71.00000,40.90000,Aetna,Medical Rental Products,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Medical Rental Products,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,outpatient,,,325.00000,187.20000,Aetna,Medical Rental Products,,305.50,,,,,,,84.50,315.25,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,outpatient,,,72.00000,41.47000,Aetna,Medical Rental Products,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,outpatient,,,72.00000,41.47000,Aetna,Medical Rental Products,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,outpatient,,,76.00000,43.78000,Aetna,Medical Rental Products,,71.44,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,outpatient,,,240.00000,138.24000,Aetna,Medical Rental Products,,225.60,,,,,,,62.40,232.80,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,outpatient,,,93.00000,53.57000,Aetna,Medical Rental Products,,87.42,,,,,,,24.18,90.21,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,outpatient,,,59.00000,33.98000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,outpatient,,,81.00000,46.66000,Aetna,Medical Rental Products,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,outpatient,,,58.00000,33.41000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,outpatient,,,21.00000,12.10000,Aetna,Medical Rental Products,,19.74,,,,,,,5.46,20.37,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,outpatient,,,56.00000,32.26000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,outpatient,,,64.00000,36.86000,Aetna,Medical Rental Products,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,outpatient,,,80.00000,46.08000,Aetna,Medical Rental Products,,75.20,,,,,,,20.80,77.60,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,outpatient,,,109.00000,62.78000,Aetna,Medical Rental Products,,102.46,,,,,,,28.34,105.73,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,outpatient,,,59.00000,33.98000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,outpatient,,,115.00000,66.24000,Aetna,Medical Rental Products,,108.10,,,,,,,29.90,111.55,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,outpatient,,,57.00000,32.83000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,outpatient,,,118.00000,67.97000,Aetna,Medical Rental Products,,110.92,,,,,,,30.68,114.46,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,outpatient,,,268.00000,154.37000,Aetna,Medical Rental Products,,251.92,,,,,,,69.68,259.96,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Aetna,Medical Rental Products,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Aetna,Medical Rental Products,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,outpatient,,,78.00000,44.93000,Aetna,Medical Rental Products,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,outpatient,,,91.00000,52.42000,Aetna,Medical Rental Products,,85.54,,,,,,,23.66,88.27,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,outpatient,,,300.00000,172.80000,Aetna,Medical Rental Products,,282.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,outpatient,,,185.00000,106.56000,Aetna,Medical Rental Products,,173.90,,,,,,,48.10,179.45,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Aetna,Medical Rental Products,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,outpatient,,,76.00000,43.78000,Aetna,Medical Rental Products,,71.44,,,,,,,19.76,73.72,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Aetna,Medical Rental Products,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Aetna,Medical Rental Products,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,outpatient,,,53.00000,30.53000,Aetna,Medical Rental Products,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,outpatient,,,77.00000,44.35000,Aetna,Medical Rental Products,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Aetna,Medical Rental Products,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,outpatient,,,222.00000,127.87000,Aetna,Medical Rental Products,,208.68,,,,,,,57.72,215.34,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,outpatient,,,292.00000,168.19000,Aetna,Medical Rental Products,,274.48,,,,,,,75.92,283.24,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Aetna,Medical Rental Products,,117.50,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Aetna,Medical Rental Products,,117.50,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,outpatient,,,359.00000,206.78000,Aetna,Medical Rental Products,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,outpatient,,,111.00000,63.94000,Aetna,Medical Rental Products,,104.34,,,,,,,28.86,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Aetna,Medical Rental Products,,132.54,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Aetna,Medical Rental Products,,132.54,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Aetna,Medical Rental Products,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Aetna,Medical Rental Products,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Aetna,Medical Rental Products,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Aetna,Medical Rental Products,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,outpatient,,,78.00000,44.93000,Aetna,Medical Rental Products,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Aetna,Medical Rental Products,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Aetna,Medical Rental Products,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,outpatient,,,70.00000,40.32000,Aetna,Medical Rental Products,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,outpatient,,,18.00000,10.37000,Aetna,Medical Rental Products,,16.92,,,,,,,4.68,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,outpatient,,,408.00000,235.01000,Aetna,Medical Rental Products,,383.52,,,,,,,106.08,395.76,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,outpatient,,,102.00000,58.75000,Aetna,Medical Rental Products,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,outpatient,,,330.00000,190.08000,Aetna,Medical Rental Products,,310.20,,,,,,,85.80,320.10,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,outpatient,,,56.00000,32.26000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,outpatient,,,136.00000,78.34000,Aetna,Medical Rental Products,,127.84,,,,,,,35.36,131.92,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,outpatient,,,83.00000,47.81000,Aetna,Medical Rental Products,,78.02,,,,,,,21.58,80.51,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,outpatient,,,142.00000,81.79000,Aetna,Medical Rental Products,,133.48,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,outpatient,,,51.00000,29.38000,Aetna,Medical Rental Products,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,outpatient,,,70.00000,40.32000,Aetna,Medical Rental Products,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,outpatient,,,99.00000,57.02000,Aetna,Medical Rental Products,,93.06,,,,,,,25.74,96.03,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,outpatient,,,78.00000,44.93000,Aetna,Medical Rental Products,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,outpatient,,,75.00000,43.20000,Aetna,Medical Rental Products,,70.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Aetna,Medical Rental Products,,34.78,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Aetna,Medical Rental Products,,34.78,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,outpatient,,,59.00000,33.98000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,outpatient,,,35.00000,20.16000,Aetna,Medical Rental Products,,32.90,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,outpatient,,,59.00000,33.98000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,outpatient,,,56.00000,32.26000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,outpatient,,,74.00000,42.62000,Aetna,Medical Rental Products,,69.56,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,outpatient,,,90.00000,51.84000,Aetna,Medical Rental Products,,84.60,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Aetna,Medical Rental Products,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,outpatient,,,142.00000,81.79000,Aetna,Medical Rental Products,,133.48,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Aetna,Medical Rental Products,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,outpatient,,,74.00000,42.62000,Aetna,Medical Rental Products,,69.56,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Aetna,Medical Rental Products,,83.66,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Aetna,Medical Rental Products,,83.66,,,,,,,23.14,86.33,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,outpatient,,,57.00000,32.83000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,outpatient,,,77.00000,44.35000,Aetna,Medical Rental Products,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,outpatient,,,64.00000,36.86000,Aetna,Medical Rental Products,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,outpatient,,,69.00000,39.74000,Aetna,Medical Rental Products,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,outpatient,,,1178.00000,678.53000,Aetna,Medical Rental Products,,1107.32,,,,,,,306.28,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,outpatient,,,127.00000,73.15000,Aetna,Medical Rental Products,,119.38,,,,,,,33.02,123.19,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,outpatient,,,277.00000,159.55000,Aetna,Medical Rental Products,,260.38,,,,,,,72.02,268.69,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,outpatient,,,940.00000,541.44000,Aetna,Medical Rental Products,,883.60,,,,,,,244.40,911.80,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,outpatient,,,97.00000,55.87000,Aetna,Medical Rental Products,,91.18,,,,,,,25.22,94.09,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,outpatient,,,16.00000,9.22000,Aetna,Medical Rental Products,,15.04,,,,,,,4.16,15.52,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,outpatient,,,57.00000,32.83000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,outpatient,,,131.00000,75.46000,Aetna,Medical Rental Products,,123.14,,,,,,,34.06,127.07,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,outpatient,,,2160.00000,1244.16000,Aetna,Medical Rental Products,,2030.40,,,,,,,561.60,2095.20,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,outpatient,,,37.00000,21.31000,Aetna,Medical Rental Products,,34.78,,,,,,,9.62,35.89,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Aetna,Medical Rental Products,,69.56,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,outpatient,,,54.00000,31.10000,Aetna,Medical Rental Products,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,outpatient,,,76.00000,43.78000,Aetna,Medical Rental Products,,71.44,,,,,,,19.76,73.72,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,outpatient,,,606.00000,349.06000,Aetna,Medical Rental Products,,569.64,,,,,,,157.56,587.82,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,outpatient,,,300.00000,172.80000,Aetna,Medical Rental Products,,282.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,outpatient,,,59.00000,33.98000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,outpatient,,,98.00000,56.45000,Aetna,Medical Rental Products,,92.12,,,,,,,25.48,95.06,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,outpatient,,,128.00000,73.73000,Aetna,Medical Rental Products,,120.32,,,,,,,33.28,124.16,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Aetna,Medical Rental Products,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,outpatient,,,16.00000,9.22000,Aetna,Medical Rental Products,,15.04,,,,,,,4.16,15.52,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,outpatient,,,565.00000,325.44000,Aetna,Medical Rental Products,,531.10,,,,,,,146.90,548.05,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,outpatient,,,850.00000,489.60000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,outpatient,,,77.00000,44.35000,Aetna,Medical Rental Products,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,outpatient,,,86.00000,49.54000,Aetna,Medical Rental Products,,80.84,,,,,,,22.36,83.42,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,outpatient,,,837.00000,482.11000,Aetna,Medical Rental Products,,786.78,,,,,,,217.62,811.89,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,outpatient,,,60.00000,34.56000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,outpatient,,,56.00000,32.26000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,outpatient,,,56.00000,32.26000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Aetna,Medical Rental Products,,69.56,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Aetna,Medical Rental Products,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Aetna,Medical Rental Products,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,outpatient,,,167.00000,96.19000,Aetna,Medical Rental Products,,156.98,,,,,,,43.42,161.99,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,outpatient,,,200.00000,115.20000,Aetna,Medical Rental Products,,188.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,outpatient,,,93.00000,53.57000,Aetna,Medical Rental Products,,87.42,,,,,,,24.18,90.21,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Medical Rental Products,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,outpatient,,,190.00000,109.44000,Aetna,Medical Rental Products,,178.60,,,,,,,49.40,184.30,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,outpatient,,,64.00000,36.86000,Aetna,Medical Rental Products,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,outpatient,,,525.00000,302.40000,Aetna,Medical Rental Products,,493.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,outpatient,,,54.00000,31.10000,Aetna,Medical Rental Products,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Aetna,Medical Rental Products,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,outpatient,,,53.00000,30.53000,Aetna,Medical Rental Products,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Aetna,Medical Rental Products,,37.60,,,,,,,10.40,38.80,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,outpatient,,,453.00000,260.93000,Aetna,Medical Rental Products,,425.82,,,,,,,117.78,439.41,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,outpatient,,,25.00000,14.40000,Aetna,Medical Rental Products,,23.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,outpatient,,,56.00000,32.26000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,outpatient,,,59.00000,33.98000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,outpatient,,,53.00000,30.53000,Aetna,Medical Rental Products,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,outpatient,,,350.00000,201.60000,Aetna,Medical Rental Products,,329.00,,,,,,,91.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,outpatient,,,225.00000,129.60000,Aetna,Medical Rental Products,,211.50,,,,,,,58.50,218.25,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,outpatient,,,52.00000,29.95000,Aetna,Medical Rental Products,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,outpatient,,,134.00000,77.18000,Aetna,Medical Rental Products,,125.96,,,,,,,34.84,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,outpatient,,,52.00000,29.95000,Aetna,Medical Rental Products,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,outpatient,,,186.00000,107.14000,Aetna,Medical Rental Products,,174.84,,,,,,,48.36,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Aetna,Medical Rental Products,,282.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Aetna,Medical Rental Products,,282.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,outpatient,,,205.00000,118.08000,Aetna,Medical Rental Products,,192.70,,,,,,,53.30,198.85,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,outpatient,,,75.00000,36.15000,Aetna,Medical Rental Products,,70.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,outpatient,,,65.00000,31.33000,Aetna,Medical Rental Products,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,outpatient,,,92.00000,44.34000,Aetna,Medical Rental Products,,86.48,,,,,,,23.92,89.24,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Aetna,Medical Rental Products,,22.56,,,,,,,6.24,23.28,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,outpatient,,,20.00000,9.64000,Aetna,Medical Rental Products,,18.80,,,,,,,5.20,19.40,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,outpatient,,,42.00000,20.24000,Aetna,Medical Rental Products,,39.48,,,,,,,10.92,40.74,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,outpatient,,,69.00000,33.26000,Aetna,Medical Rental Products,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,outpatient,,,65.00000,31.33000,Aetna,Medical Rental Products,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,outpatient,,,76.00000,36.63000,Aetna,Medical Rental Products,,71.44,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,outpatient,,,89.00000,42.90000,Aetna,Medical Rental Products,,83.66,,,,,,,23.14,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,outpatient,,,76.00000,36.63000,Aetna,Medical Rental Products,,71.44,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,outpatient,,,28.00000,13.50000,Aetna,Medical Rental Products,,26.32,,,,,,,7.28,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,outpatient,,,98.00000,47.24000,Aetna,Medical Rental Products,,92.12,,,,,,,25.48,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,outpatient,,,64.00000,30.85000,Aetna,Medical Rental Products,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,outpatient,,,75.00000,36.15000,Aetna,Medical Rental Products,,70.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,outpatient,,,76.00000,36.63000,Aetna,Medical Rental Products,,71.44,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,outpatient,,,114.00000,54.95000,Aetna,Medical Rental Products,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,outpatient,,,74.00000,35.67000,Aetna,Medical Rental Products,,69.56,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,outpatient,,,69.00000,33.26000,Aetna,Medical Rental Products,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,outpatient,,,74.00000,35.67000,Aetna,Medical Rental Products,,69.56,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,outpatient,,,87.00000,41.93000,Aetna,Medical Rental Products,,81.78,,,,,,,22.62,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,outpatient,,,79.00000,38.08000,Aetna,Medical Rental Products,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,outpatient,,,75.00000,36.15000,Aetna,Medical Rental Products,,70.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,outpatient,,,64.00000,30.85000,Aetna,Medical Rental Products,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,outpatient,,,164.00000,79.05000,Aetna,Medical Rental Products,,154.16,,,,,,,42.64,159.08,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,outpatient,,,54.00000,26.03000,Aetna,Medical Rental Products,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,outpatient,,,8.00000,3.86000,Aetna,Medical Rental Products,,7.52,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,outpatient,,,69.00000,33.26000,Aetna,Medical Rental Products,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,outpatient,,,8.00000,3.86000,Aetna,Medical Rental Products,,7.52,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,outpatient,,,8.00000,3.86000,Aetna,Medical Rental Products,,7.52,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,outpatient,,,14.00000,6.75000,Aetna,Medical Rental Products,,13.16,,,,,,,3.64,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,outpatient,,,112.00000,53.98000,Aetna,Medical Rental Products,,105.28,,,,,,,29.12,108.64,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,outpatient,,,13.00000,6.27000,Aetna,Medical Rental Products,,12.22,,,,,,,3.38,12.61,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,outpatient,,,31.00000,14.94000,Aetna,Medical Rental Products,,29.14,,,,,,,8.06,30.07,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,outpatient,,,92.00000,44.34000,Aetna,Medical Rental Products,,86.48,,,,,,,23.92,89.24,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,outpatient,,,80.00000,38.56000,Aetna,Medical Rental Products,,75.20,,,,,,,20.80,77.60,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Aetna,Medical Rental Products,,28.20,,,,,,,7.80,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Aetna,Medical Rental Products,,28.20,,,,,,,7.80,29.10,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Aetna,Medical Rental Products,,22.56,,,,,,,6.24,23.28,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,outpatient,,,29.00000,13.98000,Aetna,Medical Rental Products,,27.26,,,,,,,7.54,28.13,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,outpatient,,,97.00000,46.75000,Aetna,Medical Rental Products,,91.18,,,,,,,25.22,94.09,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,outpatient,,,225.00000,108.45000,Aetna,Medical Rental Products,,211.50,,,,,,,58.50,218.25,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,outpatient,,,71.00000,34.22000,Aetna,Medical Rental Products,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,outpatient,,,71.00000,34.22000,Aetna,Medical Rental Products,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,outpatient,,,108.00000,52.06000,Aetna,Medical Rental Products,,101.52,,,,,,,28.08,104.76,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,outpatient,,,51.00000,24.58000,Aetna,Medical Rental Products,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,outpatient,,,19.00000,9.16000,Aetna,Medical Rental Products,,17.86,,,,,,,4.94,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,outpatient,,,54.00000,26.03000,Aetna,Medical Rental Products,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,outpatient,,,103.00000,49.65000,Aetna,Medical Rental Products,,96.82,,,,,,,26.78,99.91,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,outpatient,,,9.00000,4.34000,Aetna,Medical Rental Products,,8.46,,,,,,,2.34,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,outpatient,,,13.00000,6.27000,Aetna,Medical Rental Products,,12.22,,,,,,,3.38,12.61,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,outpatient,,,80.00000,38.56000,Aetna,Medical Rental Products,,75.20,,,,,,,20.80,77.60,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,outpatient,,,47.00000,22.65000,Aetna,Medical Rental Products,,44.18,,,,,,,12.22,45.59,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,outpatient,,,91.00000,43.86000,Aetna,Medical Rental Products,,85.54,,,,,,,23.66,88.27,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,outpatient,,,18.00000,8.68000,Aetna,Medical Rental Products,,16.92,,,,,,,4.68,17.46,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Aetna,Medical Rental Products,,19.74,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,outpatient,,,71.00000,37.70000,Aetna,Medical Rental Products,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Aetna,Medical Rental Products,,19.74,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,outpatient,,,128.00000,67.97000,Aetna,Medical Rental Products,,120.32,,,,,,,33.28,124.16,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,outpatient,,,65.00000,34.52000,Aetna,Medical Rental Products,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Aetna,Medical Rental Products,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,outpatient,,,31.00000,16.46000,Aetna,Medical Rental Products,,29.14,,,,,,,8.06,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Aetna,Medical Rental Products,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Aetna,Medical Rental Products,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Aetna,Medical Rental Products,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,outpatient,,,61.00000,32.39000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Aetna,Medical Rental Products,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Aetna,Medical Rental Products,,23.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Aetna,Medical Rental Products,91,23.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,outpatient,,,103.00000,54.69000,Aetna,Medical Rental Products,,96.82,,,,,,,26.78,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,outpatient,,,96.00000,50.98000,Aetna,Medical Rental Products,,90.24,,,,,,,24.96,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,outpatient,,,75.00000,39.83000,Aetna,Medical Rental Products,,70.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,outpatient,,,68.00000,36.11000,Aetna,Medical Rental Products,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,outpatient,,,61.00000,32.39000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Aetna,Medical Rental Products,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Aetna,Medical Rental Products,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,outpatient,,,29.00000,15.40000,Aetna,Medical Rental Products,,27.26,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Aetna,Medical Rental Products,,27.26,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Aetna,Medical Rental Products,,27.26,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,outpatient,,,63.00000,33.45000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,outpatient,,,79.00000,41.95000,Aetna,Medical Rental Products,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,outpatient,,,63.00000,33.45000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Aetna,Medical Rental Products,,27.26,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,outpatient,,,112.00000,59.47000,Aetna,Medical Rental Products,,105.28,,,,,,,29.12,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Aetna,Medical Rental Products,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,outpatient,,,25.00000,13.28000,Aetna,Medical Rental Products,,23.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,outpatient,,,118.00000,62.66000,Aetna,Medical Rental Products,,110.92,,,,,,,30.68,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,outpatient,,,29.00000,15.40000,Aetna,Medical Rental Products,,27.26,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,outpatient,,,25.00000,13.28000,Aetna,Medical Rental Products,,23.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Aetna,Medical Rental Products,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,outpatient,,,25.00000,13.28000,Aetna,Medical Rental Products,,23.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,outpatient,,,71.00000,37.70000,Aetna,Medical Rental Products,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,outpatient,,,59.00000,31.33000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,outpatient,,,62.00000,32.92000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,outpatient,,,138.00000,73.28000,Aetna,Medical Rental Products,,129.72,,,,,,,35.88,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,outpatient,,,62.00000,32.92000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,outpatient,,,78.00000,41.42000,Aetna,Medical Rental Products,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,outpatient,,,69.00000,36.64000,Aetna,Medical Rental Products,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,outpatient,,,88.00000,46.73000,Aetna,Medical Rental Products,,82.72,,,,,,,22.88,85.36,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,outpatient,,,60.00000,31.86000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,outpatient,,,64.00000,33.98000,Aetna,Medical Rental Products,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,outpatient,,,63.00000,33.45000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,outpatient,,,137.00000,72.75000,Aetna,Medical Rental Products,,128.78,,,,,,,35.62,132.89,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,outpatient,,,347.00000,184.26000,Aetna,Medical Rental Products,,326.18,,,,,,,90.22,336.59,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,outpatient,,,57.00000,30.27000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,outpatient,,,56.00000,29.74000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,outpatient,,,16.00000,8.50000,Aetna,Medical Rental Products,,15.04,,,,,,,4.16,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,outpatient,,,85.00000,45.14000,Aetna,Medical Rental Products,,79.90,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,outpatient,,,34.00000,18.05000,Aetna,Medical Rental Products,,31.96,,,,,,,8.84,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,outpatient,,,231.00000,122.66000,Aetna,Medical Rental Products,,217.14,,,,,,,60.06,224.07,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,outpatient,,,36.00000,19.12000,Aetna,Medical Rental Products,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,outpatient,,,61.00000,32.39000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,outpatient,,,111.00000,58.94000,Aetna,Medical Rental Products,,104.34,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,outpatient,,,61.00000,32.39000,Aetna,Medical Rental Products,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,outpatient,,,60.00000,31.86000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,outpatient,,,60.00000,31.86000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,outpatient,,,60.00000,31.86000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,outpatient,,,60.00000,31.86000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,outpatient,,,60.00000,31.86000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,outpatient,,,36.00000,19.12000,Aetna,Medical Rental Products,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,outpatient,,,76.00000,40.36000,Aetna,Medical Rental Products,,71.44,,,,,,,19.76,73.72,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,outpatient,,,60.00000,31.86000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,outpatient,,,60.00000,31.86000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,outpatient,,,152.00000,80.71000,Aetna,Medical Rental Products,,142.88,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,outpatient,,,78.00000,41.42000,Aetna,Medical Rental Products,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,outpatient,,,42.00000,22.30000,Aetna,Medical Rental Products,,39.48,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,outpatient,,,73.00000,38.76000,Aetna,Medical Rental Products,,68.62,,,,,,,18.98,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,outpatient,,,97.00000,51.51000,Aetna,Medical Rental Products,,91.18,,,,,,,25.22,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,outpatient,,,157.00000,83.37000,Aetna,Medical Rental Products,,147.58,,,,,,,40.82,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,outpatient,,,36.00000,19.12000,Aetna,Medical Rental Products,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,outpatient,,,66.00000,35.05000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,outpatient,,,58.00000,30.80000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,outpatient,,,85.00000,45.14000,Aetna,Medical Rental Products,,79.90,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,outpatient,,,59.00000,31.33000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,outpatient,,,175.00000,92.93000,Aetna,Medical Rental Products,,164.50,,,,,,,45.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,outpatient,,,152.00000,80.71000,Aetna,Medical Rental Products,,142.88,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,outpatient,,,43.00000,22.83000,Aetna,Medical Rental Products,,40.42,,,,,,,11.18,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,outpatient,,,66.00000,35.05000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,outpatient,,,36.00000,19.12000,Aetna,Medical Rental Products,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,outpatient,,,36.00000,19.12000,Aetna,Medical Rental Products,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,outpatient,,,42.00000,22.30000,Aetna,Medical Rental Products,,39.48,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,outpatient,,,147.00000,78.06000,Aetna,Medical Rental Products,,138.18,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,outpatient,,,64.00000,33.98000,Aetna,Medical Rental Products,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,outpatient,,,60.00000,31.86000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,outpatient,,,75.00000,39.83000,Aetna,Medical Rental Products,,70.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,outpatient,,,44.00000,23.36000,Aetna,Medical Rental Products,,41.36,,,,,,,11.44,42.68,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,outpatient,,,87.00000,46.20000,Aetna,Medical Rental Products,,81.78,,,,,,,22.62,84.39,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,outpatient,,,65.00000,34.52000,Aetna,Medical Rental Products,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,outpatient,,,75.00000,39.83000,Aetna,Medical Rental Products,,70.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,outpatient,,,50.00000,26.55000,Aetna,Medical Rental Products,,47.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,outpatient,,,40.00000,21.24000,Aetna,Medical Rental Products,,37.60,,,,,,,10.40,38.80,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,outpatient,,,50.00000,26.55000,Aetna,Medical Rental Products,,47.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Medical Rental Products,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,outpatient,,,115.00000,61.07000,Aetna,Medical Rental Products,,108.10,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1309.00000,695.08000,Aetna,Medical Rental Products,,1230.46,,,,,,,340.34,1269.73,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Medical Rental Products,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Medical Rental Products,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,outpatient,,,328.00000,174.17000,Aetna,Medical Rental Products,,308.32,,,,,,,85.28,318.16,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,outpatient,,,115.00000,61.07000,Aetna,Medical Rental Products,,108.10,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Medical Rental Products,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Medical Rental Products,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,outpatient,,,1251.00000,664.28000,Aetna,Medical Rental Products,,1175.94,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Aetna,Medical Rental Products,,144.76,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Aetna,Medical Rental Products,,144.76,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,outpatient,,,96.00000,50.98000,Aetna,Medical Rental Products,,90.24,,,,,,,24.96,93.12,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,outpatient,,,211.00000,112.04000,Aetna,Medical Rental Products,,198.34,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,outpatient,,,290.00000,153.99000,Aetna,Medical Rental Products,,272.60,,,,,,,75.40,281.30,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Medical Rental Products,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Medical Rental Products,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,outpatient,,,411.00000,218.24000,Aetna,Medical Rental Products,,386.34,,,,,,,106.86,398.67,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,outpatient,,,139.00000,73.81000,Aetna,Medical Rental Products,,130.66,,,,,,,36.14,134.83,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,outpatient,,,288.00000,152.93000,Aetna,Medical Rental Products,,270.72,,,,,,,74.88,279.36,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1372.00000,728.53000,Aetna,Medical Rental Products,,1289.68,,,,,,,356.72,1330.84,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,outpatient,,,1251.00000,664.28000,Aetna,Medical Rental Products,,1175.94,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,outpatient,,,135.00000,71.68000,Aetna,Medical Rental Products,,126.90,,,,,,,35.10,130.95,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Medical Rental Products,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Medical Rental Products,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,outpatient,,,147.00000,78.06000,Aetna,Medical Rental Products,,138.18,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,outpatient,,,126.00000,66.91000,Aetna,Medical Rental Products,,118.44,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,outpatient,,,120.00000,63.72000,Aetna,Medical Rental Products,,112.80,,,,,,,31.20,116.40,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Medical Rental Products,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,outpatient,,,124.00000,65.84000,Aetna,Medical Rental Products,,116.56,,,,,,,32.24,120.28,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,outpatient,,,108.00000,57.35000,Aetna,Medical Rental Products,,101.52,,,,,,,28.08,104.76,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Aetna,Medical Rental Products,,240.64,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Aetna,Medical Rental Products,,240.64,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,outpatient,,,122.00000,64.78000,Aetna,Medical Rental Products,,114.68,,,,,,,31.72,118.34,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Medical Rental Products,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,outpatient,,,123.00000,65.31000,Aetna,Medical Rental Products,,115.62,,,,,,,31.98,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Medical Rental Products,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,outpatient,,,518.00000,275.06000,Aetna,Medical Rental Products,,486.92,,,,,,,134.68,502.46,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,outpatient,,,275.00000,146.02000,Aetna,Medical Rental Products,,258.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,outpatient,,,270.00000,143.37000,Aetna,Medical Rental Products,,253.80,,,,,,,70.20,261.90,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,outpatient,,,450.00000,238.95000,Aetna,Medical Rental Products,,423.00,,,,,,,117.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,outpatient,,,126.00000,66.91000,Aetna,Medical Rental Products,,118.44,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,outpatient,,,362.00000,192.22000,Aetna,Medical Rental Products,,340.28,,,,,,,94.12,351.14,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Aetna,Medical Rental Products,,102.46,,,,,,,28.34,105.73,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,outpatient,,,638.00000,338.78000,Aetna,Medical Rental Products,,599.72,,,,,,,165.88,618.86,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,outpatient,,,211.00000,112.04000,Aetna,Medical Rental Products,,198.34,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,outpatient,,,154.00000,81.77000,Aetna,Medical Rental Products,,144.76,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,outpatient,,,141.00000,74.87000,Aetna,Medical Rental Products,,132.54,,,,,,,36.66,136.77,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,outpatient,,,2040.00000,1083.24000,Aetna,Medical Rental Products,,1917.60,,,,,,,530.40,1978.80,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,outpatient,,,421.00000,223.55000,Aetna,Medical Rental Products,,395.74,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,outpatient,,,275.00000,146.02000,Aetna,Medical Rental Products,,258.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,outpatient,,,1251.00000,664.28000,Aetna,Medical Rental Products,,1175.94,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Aetna,Medical Rental Products,,402.32,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Aetna,Medical Rental Products,,402.32,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Aetna,Medical Rental Products,,615.70,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Aetna,Medical Rental Products,,615.70,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,outpatient,,,211.00000,112.04000,Aetna,Medical Rental Products,,198.34,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Aetna,Medical Rental Products,,105.28,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Aetna,Medical Rental Products,,105.28,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,outpatient,,,130.00000,69.03000,Aetna,Medical Rental Products,,122.20,,,,,,,33.80,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,outpatient,,,421.00000,223.55000,Aetna,Medical Rental Products,,395.74,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,outpatient,,,111.00000,58.94000,Aetna,Medical Rental Products,,104.34,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,outpatient,,,200.00000,106.20000,Aetna,Medical Rental Products,,188.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Medical Rental Products,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,outpatient,,,13.00000,6.90000,Aetna,Medical Rental Products,,12.22,,,,,,,3.38,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,outpatient,,,58.00000,30.80000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,outpatient,,,13.00000,6.90000,Aetna,Medical Rental Products,,12.22,,,,,,,3.38,12.61,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,outpatient,,,773.00000,410.46000,Aetna,Medical Rental Products,,726.62,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,outpatient,,,773.00000,410.46000,Aetna,Medical Rental Products,,726.62,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,outpatient,,,773.00000,410.46000,Aetna,Medical Rental Products,,726.62,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,outpatient,,,773.00000,410.46000,Aetna,Medical Rental Products,,726.62,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,outpatient,,,387.00000,205.50000,Aetna,Medical Rental Products,,363.78,,,,,,,100.62,375.39,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,outpatient,,,52.00000,27.61000,Aetna,Medical Rental Products,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Aetna,Medical Rental Products,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Aetna,Medical Rental Products,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,outpatient,,,79.00000,41.95000,Aetna,Medical Rental Products,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,outpatient,,,65.00000,34.52000,Aetna,Medical Rental Products,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,outpatient,,,100.00000,53.10000,Aetna,Medical Rental Products,,94.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,outpatient,,,64.00000,33.98000,Aetna,Medical Rental Products,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Aetna,Medical Rental Products,,102.46,,,,,,,28.34,105.73,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,outpatient,,,58.00000,30.80000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Aetna,Medical Rental Products,,18.80,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,outpatient,,,66.00000,35.05000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Aetna,Medical Rental Products,,18.80,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Aetna,Medical Rental Products,,18.80,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Aetna,Medical Rental Products,,18.80,,,,,,,5.20,19.40,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,outpatient,,,13.00000,6.90000,Aetna,Medical Rental Products,,12.22,,,,,,,3.38,12.61,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,outpatient,,,53.00000,28.14000,Aetna,Medical Rental Products,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,outpatient,,,18.00000,9.56000,Aetna,Medical Rental Products,,16.92,,,,,,,4.68,17.46,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,outpatient,,,17.00000,9.03000,Aetna,Medical Rental Products,,15.98,,,,,,,4.42,16.49,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,outpatient,,,71.00000,37.70000,Aetna,Medical Rental Products,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,outpatient,,,57.00000,30.27000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,outpatient,,,68.00000,36.11000,Aetna,Medical Rental Products,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,outpatient,,,58.00000,30.80000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,outpatient,,,27.00000,14.34000,Aetna,Medical Rental Products,,25.38,,,,,,,7.02,26.19,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,outpatient,,,56.00000,29.74000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,outpatient,,,56.00000,29.74000,Aetna,Medical Rental Products,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,outpatient,,,58.00000,30.80000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,outpatient,,,115.00000,61.07000,Aetna,Medical Rental Products,,108.10,,,,,,,29.90,111.55,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,outpatient,,,23.00000,12.21000,Aetna,Medical Rental Products,,21.62,,,,,,,5.98,22.31,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,outpatient,,,255.00000,135.40000,Aetna,Medical Rental Products,,239.70,,,,,,,66.30,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,outpatient,,,66.00000,35.05000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,outpatient,,,26.00000,13.81000,Aetna,Medical Rental Products,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,outpatient,,,64.00000,33.98000,Aetna,Medical Rental Products,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,outpatient,,,215.00000,114.16000,Aetna,Medical Rental Products,,202.10,,,,,,,55.90,208.55,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,outpatient,,,79.00000,41.95000,Aetna,Medical Rental Products,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,outpatient,,,11.00000,5.29000,Aetna,Medical Rental Products,,10.34,,,,,,,2.86,10.67,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,outpatient,,,58.00000,27.90000,Aetna,Medical Rental Products,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,outpatient,,,10.00000,4.81000,Aetna,Medical Rental Products,,9.40,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,outpatient,,,7.00000,3.37000,Aetna,Medical Rental Products,,6.58,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,outpatient,,,53.00000,25.49000,Aetna,Medical Rental Products,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,outpatient,,,10.00000,4.81000,Aetna,Medical Rental Products,,9.40,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Aetna,Medical Rental Products,,10.34,,,,,,,2.86,10.67,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,outpatient,,,7.00000,3.37000,Aetna,Medical Rental Products,,6.58,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Aetna,Medical Rental Products,,10.34,,,,,,,2.86,10.67,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,outpatient,,,597.00000,290.14000,Aetna,Medical Rental Products,,561.18,,,,,,,155.22,579.09,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,outpatient,,,6379.00000,3100.19000,Aetna,Medical Rental Products,,5996.26,,,,,,,1658.54,6187.63,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,outpatient,,,471.00000,228.91000,Aetna,Medical Rental Products,,442.74,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,outpatient,,,471.00000,228.91000,Aetna,Medical Rental Products,,442.74,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,outpatient,,,1251.00000,607.99000,Aetna,Medical Rental Products,,1175.94,,,,,,,325.26,1213.47,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,outpatient,,,260.00000,126.36000,Aetna,Medical Rental Products,,244.40,,,,,,,67.60,252.20,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,outpatient,,,785.00000,381.51000,Aetna,Medical Rental Products,,737.90,,,,,,,204.10,761.45,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,outpatient,,,529.00000,257.09000,Aetna,Medical Rental Products,,497.26,,,,,,,137.54,513.13,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,outpatient,,,1623.00000,788.78000,Aetna,Medical Rental Products,,1525.62,,,,,,,421.98,1574.31,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,outpatient,,,10800.00000,5248.80000,Aetna,Medical Rental Products,,10152.00,,,,,,,2808.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,outpatient,,,25365.00000,12327.39000,Aetna,Medical Rental Products,,23843.10,,,,,,,6594.90,24604.05,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,outpatient,,,101.00000,21.82000,Aetna,Medical Rental Products,,94.94,,,,,,,26.26,97.97,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,outpatient,,,81.00000,17.50000,Aetna,Medical Rental Products,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,outpatient,,,104.00000,22.46000,Aetna,Medical Rental Products,,97.76,,,,,,,27.04,100.88,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,outpatient,,,377.00000,81.43000,Aetna,Medical Rental Products,,354.38,,,,,,,98.02,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,outpatient,,,532.00000,114.91000,Aetna,Medical Rental Products,,500.08,,,,,,,138.32,516.04,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,outpatient,,,521.00000,112.54000,Aetna,Medical Rental Products,,489.74,,,,,,,135.46,505.37,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,outpatient,,,451.00000,97.42000,Aetna,Medical Rental Products,,423.94,,,,,,,117.26,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,outpatient,,,1148.00000,247.97000,Aetna,Medical Rental Products,,1079.12,,,,,,,298.48,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,outpatient,,,350.00000,75.60000,Aetna,Medical Rental Products,,329.00,,,,,,,91.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,outpatient,,,423.00000,91.37000,Aetna,Medical Rental Products,,397.62,,,,,,,109.98,410.31,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Aetna,Medical Rental Products,,705.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Aetna,Medical Rental Products,,705.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,outpatient,,,119.00000,25.70000,Aetna,Medical Rental Products,,111.86,,,,,,,30.94,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,outpatient,,,126.00000,27.22000,Aetna,Medical Rental Products,,118.44,,,,,,,32.76,122.22,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Aetna,Medical Rental Products,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Aetna,Medical Rental Products,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,outpatient,,,79.00000,17.06000,Aetna,Medical Rental Products,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Aetna,Medical Rental Products,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Aetna,Medical Rental Products,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,outpatient,,,79.00000,17.06000,Aetna,Medical Rental Products,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,outpatient,,,335.00000,72.36000,Aetna,Medical Rental Products,,314.90,,,,,,,87.10,324.95,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Aetna,Medical Rental Products,,144.76,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Aetna,Medical Rental Products,,144.76,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,outpatient,,,128.00000,27.65000,Aetna,Medical Rental Products,,120.32,,,,,,,33.28,124.16,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,outpatient,,,65.00000,14.04000,Aetna,Medical Rental Products,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,outpatient,,,272.00000,58.75000,Aetna,Medical Rental Products,,255.68,,,,,,,70.72,263.84,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,outpatient,,,26.00000,11.44000,Aetna,Medical Rental Products,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,outpatient,,,359.00000,157.96000,Aetna,Medical Rental Products,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,outpatient,,,189.00000,83.16000,Aetna,Medical Rental Products,,177.66,,,,,,,49.14,183.33,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,outpatient,,,359.00000,157.96000,Aetna,Medical Rental Products,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,outpatient,,,137.00000,60.28000,Aetna,Medical Rental Products,,128.78,,,,,,,35.62,132.89,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,outpatient,,,1665.00000,732.60000,Aetna,Medical Rental Products,,1565.10,,,,,,,432.90,1615.05,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,outpatient,,,751.00000,330.44000,Aetna,Medical Rental Products,,705.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,outpatient,,,374.00000,164.56000,Aetna,Medical Rental Products,,351.56,,,,,,,97.24,362.78,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,outpatient,,,553.00000,243.32000,Aetna,Medical Rental Products,,519.82,,,,,,,143.78,536.41,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,outpatient,,,359.00000,157.96000,Aetna,Medical Rental Products,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,outpatient,,,62.00000,27.28000,Aetna,Medical Rental Products,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,outpatient,,,79.00000,34.76000,Aetna,Medical Rental Products,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,outpatient,,,110.00000,48.40000,Aetna,Medical Rental Products,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,outpatient,,,110.00000,48.40000,Aetna,Medical Rental Products,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,outpatient,,,751.00000,330.44000,Aetna,Medical Rental Products,,705.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,outpatient,,,1665.00000,732.60000,Aetna,Medical Rental Products,,1565.10,,,,,,,432.90,1615.05,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,outpatient,,,110.00000,48.40000,Aetna,Medical Rental Products,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Aetna,Medical Rental Products,,264.14,,,,,,,73.06,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Aetna,Medical Rental Products,,264.14,,,,,,,73.06,272.57,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,outpatient,,,451.00000,341.41000,Aetna,Medical Rental Products,,423.94,,,,,,,117.26,437.47,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,outpatient,,,300.00000,145.80000,Aetna,Medical Rental Products,,282.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,outpatient,,,2278.00000,1107.11000,Aetna,Medical Rental Products,,2141.32,,,,,,,592.28,2209.66,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,outpatient,,,3912.00000,1901.23000,Aetna,Medical Rental Products,,3677.28,,,,,,,1017.12,3794.64,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,outpatient,,,900.00000,437.40000,Aetna,Medical Rental Products,,846.00,,,,,,,234.00,873.00,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,outpatient,,,365.00000,177.39000,Aetna,Medical Rental Products,,343.10,,,,,,,94.90,354.05,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,outpatient,,,989.00000,480.65000,Aetna,Medical Rental Products,,929.66,,,,,,,257.14,959.33,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Aetna,Medical Rental Products,,462.48,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Aetna,Medical Rental Products,,408.90,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Aetna,Medical Rental Products,,408.90,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,outpatient,,,644.00000,312.98000,Aetna,Medical Rental Products,,605.36,,,,,,,167.44,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Aetna,Medical Rental Products,,462.48,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Aetna,Medical Rental Products,,462.48,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,outpatient,,,527.00000,256.12000,Aetna,Medical Rental Products,,495.38,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,outpatient,,,1404.00000,682.34000,Aetna,Medical Rental Products,,1319.76,,,,,,,365.04,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,outpatient,,,5475.00000,2660.85000,Aetna,Medical Rental Products,,5146.50,,,,,,,1423.50,5310.75,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,outpatient,,,726.00000,352.84000,Aetna,Medical Rental Products,,682.44,,,,,,,188.76,704.22,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,outpatient,,,507.00000,246.40000,Aetna,Medical Rental Products,,476.58,,,,,,,131.82,491.79,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,outpatient,,,1670.00000,811.62000,Aetna,Medical Rental Products,,1569.80,,,,,,,434.20,1619.90,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,outpatient,,,1139.00000,553.55000,Aetna,Medical Rental Products,,1070.66,,,,,,,296.14,1104.83,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,outpatient,,,875.00000,425.25000,Aetna,Medical Rental Products,,822.50,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,outpatient,,,525.00000,255.15000,Aetna,Medical Rental Products,,493.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,outpatient,,,1353.00000,657.56000,Aetna,Medical Rental Products,,1271.82,,,,,,,351.78,1312.41,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,outpatient,,,525.00000,255.15000,Aetna,Medical Rental Products,,493.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,outpatient,,,525.00000,255.15000,Aetna,Medical Rental Products,,493.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,outpatient,,,825.00000,400.95000,Aetna,Medical Rental Products,,775.50,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Aetna,Medical Rental Products,,493.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Aetna,Medical Rental Products,,493.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,outpatient,,,974.00000,473.36000,Aetna,Medical Rental Products,,915.56,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Aetna,Medical Rental Products,,186.12,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Aetna,Medical Rental Products,,186.12,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Aetna,Medical Rental Products,,207.74,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Aetna,Medical Rental Products,,207.74,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,outpatient,,,497.00000,241.54000,Aetna,Medical Rental Products,,467.18,,,,,,,129.22,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,outpatient,,,2340.00000,1137.24000,Aetna,Medical Rental Products,,2199.60,,,,,,,608.40,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,outpatient,,,249.00000,121.01000,Aetna,Medical Rental Products,,234.06,,,,,,,64.74,241.53,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,outpatient,,,135.00000,65.61000,Aetna,Medical Rental Products,,126.90,,,,,,,35.10,130.95,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,outpatient,,,172.00000,83.59000,Aetna,Medical Rental Products,,161.68,,,,,,,44.72,166.84,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,outpatient,,,307.00000,149.20000,Aetna,Medical Rental Products,,288.58,,,,,,,79.82,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,outpatient,,,1800.00000,874.80000,Aetna,Medical Rental Products,,1692.00,,,,,,,468.00,1746.00,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,outpatient,,,974.00000,473.36000,Aetna,Medical Rental Products,,915.56,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Aetna,Medical Rental Products,,185.18,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Aetna,Medical Rental Products,,185.18,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,outpatient,,,411.00000,199.75000,Aetna,Medical Rental Products,,386.34,,,,,,,106.86,398.67,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,outpatient,,,221.00000,107.41000,Aetna,Medical Rental Products,,207.74,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,outpatient,,,884.00000,429.62000,Aetna,Medical Rental Products,,830.96,,,,,,,229.84,857.48,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,outpatient,,,594.00000,288.68000,Aetna,Medical Rental Products,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,outpatient,,,519.00000,252.23000,Aetna,Medical Rental Products,,487.86,,,,,,,134.94,503.43,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,outpatient,,,1046.00000,508.36000,Aetna,Medical Rental Products,,983.24,,,,,,,271.96,1014.62,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,outpatient,,,556.00000,270.22000,Aetna,Medical Rental Products,,522.64,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,outpatient,,,275.00000,133.65000,Aetna,Medical Rental Products,,258.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,outpatient,,,580.00000,281.88000,Aetna,Medical Rental Products,,545.20,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,outpatient,,,580.00000,281.88000,Aetna,Medical Rental Products,,545.20,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Aetna,Medical Rental Products,,3271.20,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Aetna,Medical Rental Products,,3271.20,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,outpatient,,,700.00000,340.20000,Aetna,Medical Rental Products,,658.00,,,,,,,182.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,outpatient,,,1427.00000,693.52000,Aetna,Medical Rental Products,,1341.38,,,,,,,371.02,1384.19,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,outpatient,,,614.00000,298.40000,Aetna,Medical Rental Products,,577.16,,,,,,,159.64,595.58,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,outpatient,,,2027.00000,985.12000,Aetna,Medical Rental Products,,1905.38,,,,,,,527.02,1966.19,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,outpatient,,,556.00000,270.22000,Aetna,Medical Rental Products,,522.64,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,outpatient,,,1146.00000,556.96000,Aetna,Medical Rental Products,,1077.24,,,,,,,297.96,1111.62,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Aetna,Medical Rental Products,,185.18,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Aetna,Medical Rental Products,,185.18,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,outpatient,,,527.00000,256.12000,Aetna,Medical Rental Products,,495.38,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,outpatient,,,740.00000,359.64000,Aetna,Medical Rental Products,,695.60,,,,,,,192.40,717.80,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Aetna,Medical Rental Products,,822.50,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Aetna,Medical Rental Products,,822.50,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,outpatient,,,1399.00000,679.91000,Aetna,Medical Rental Products,,1315.06,,,,,,,363.74,1357.03,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,outpatient,,,51.00000,24.79000,Aetna,Medical Rental Products,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,outpatient,,,825.00000,400.95000,Aetna,Medical Rental Products,,775.50,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,outpatient,,,576.00000,279.94000,Aetna,Medical Rental Products,,541.44,,,,,,,149.76,558.72,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,outpatient,,,224.00000,108.86000,Aetna,Medical Rental Products,,210.56,,,,,,,58.24,217.28,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,outpatient,,,346.00000,168.16000,Aetna,Medical Rental Products,,325.24,,,,,,,89.96,335.62,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,outpatient,,,525.00000,255.15000,Aetna,Medical Rental Products,,493.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,outpatient,,,525.00000,255.15000,Aetna,Medical Rental Products,,493.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Aetna,Medical Rental Products,,493.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Aetna,Medical Rental Products,,493.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,outpatient,,,627.00000,304.72000,Aetna,Medical Rental Products,,589.38,,,,,,,163.02,608.19,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,outpatient,,,605.00000,294.03000,Aetna,Medical Rental Products,,568.70,,,,,,,157.30,586.85,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,outpatient,,,510.00000,247.86000,Aetna,Medical Rental Products,,479.40,,,,,,,132.60,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,outpatient,,,223.00000,108.38000,Aetna,Medical Rental Products,,209.62,,,,,,,57.98,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,outpatient,,,1211.00000,588.55000,Aetna,Medical Rental Products,,1138.34,,,,,,,314.86,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,outpatient,,,383.00000,186.14000,Aetna,Medical Rental Products,,360.02,,,,,,,99.58,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,outpatient,,,1214.00000,590.00000,Aetna,Medical Rental Products,,1141.16,,,,,,,315.64,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,outpatient,,,328.00000,159.41000,Aetna,Medical Rental Products,,308.32,,,,,,,85.28,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,outpatient,,,372.00000,180.79000,Aetna,Medical Rental Products,,349.68,,,,,,,96.72,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,outpatient,,,285.00000,138.51000,Aetna,Medical Rental Products,,267.90,,,,,,,74.10,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,outpatient,,,367.00000,178.36000,Aetna,Medical Rental Products,,344.98,,,,,,,95.42,355.99,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Aetna,Medical Rental Products,,659.88,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Aetna,Medical Rental Products,,659.88,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,outpatient,,,265.00000,128.79000,Aetna,Medical Rental Products,,249.10,,,,,,,68.90,257.05,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2279.00000,1107.59000,Aetna,Medical Rental Products,,2142.26,,,,,,,592.54,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2395.00000,1163.97000,Aetna,Medical Rental Products,,2251.30,,,,,,,622.70,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Aetna,Medical Rental Products,,8233.46,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Aetna,Medical Rental Products,,8233.46,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,outpatient,,,2752.00000,1337.47000,Aetna,Medical Rental Products,,2586.88,,,,,,,715.52,2669.44,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Aetna,Medical Rental Products,,203.98,,,,,,,56.42,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Aetna,Medical Rental Products,,203.98,,,,,,,56.42,210.49,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,outpatient,,,292.00000,141.91000,Aetna,Medical Rental Products,,274.48,,,,,,,75.92,283.24,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Aetna,Medical Rental Products,,386.34,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Aetna,Medical Rental Products,,386.34,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Aetna,Medical Rental Products,,386.34,,,,,,,106.86,398.67,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,outpatient,,,2275.00000,1105.65000,Aetna,Medical Rental Products,,2138.50,,,,,,,591.50,2206.75,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,outpatient,,,192.00000,93.31000,Aetna,Medical Rental Products,,180.48,,,,,,,49.92,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,outpatient,,,451.00000,219.19000,Aetna,Medical Rental Products,,423.94,,,,,,,117.26,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,outpatient,,,617.00000,299.86000,Aetna,Medical Rental Products,,579.98,,,,,,,160.42,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,outpatient,,,825.00000,400.95000,Aetna,Medical Rental Products,,775.50,,,,,,,214.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,outpatient,,,905.00000,439.83000,Aetna,Medical Rental Products,,850.70,,,,,,,235.30,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,outpatient,,,849.00000,412.61000,Aetna,Medical Rental Products,,798.06,,,,,,,220.74,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,outpatient,,,2539.00000,1233.95000,Aetna,Medical Rental Products,,2386.66,,,,,,,660.14,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,outpatient,,,6000.00000,2916.00000,Aetna,Medical Rental Products,,5640.00,,,,,,,1560.00,5820.00,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,outpatient,,,8260.00000,4014.36000,Aetna,Medical Rental Products,,7764.40,,,,,,,2147.60,8012.20,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,outpatient,,,202.00000,88.88000,Aetna,Medical Rental Products,,189.88,,,,,,,52.52,195.94,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,outpatient,,,66.00000,31.81000,Aetna,Medical Rental Products,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,outpatient,,,295.00000,142.19000,Aetna,Medical Rental Products,,277.30,,,,,,,76.70,286.15,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,89.00000,26.79000,Aetna,Medical Rental Products,,83.66,,,,,,,23.14,86.33,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Aetna,Medical Rental Products,,87.42,,,,,,,24.18,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Aetna,Medical Rental Products,,87.42,,,,,,,24.18,90.21,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Aetna,Medical Rental Products,,1762.50,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Aetna,Medical Rental Products,,1762.50,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Aetna,Medical Rental Products,,1646.88,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Aetna,Medical Rental Products,,1646.88,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,731.00000,220.03000,Aetna,Medical Rental Products,,687.14,,,,,,,190.06,709.07,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,787.00000,236.89000,Aetna,Medical Rental Products,,739.78,,,,,,,204.62,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,2042.00000,614.64000,Aetna,Medical Rental Products,,1919.48,,,,,,,530.92,1980.74,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Aetna,Medical Rental Products,,1762.50,,,,,,,487.50,1818.75,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,714.00000,214.91000,Aetna,Medical Rental Products,,671.16,,,,,,,185.64,692.58,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,294.00000,88.49000,Aetna,Medical Rental Products,,276.36,,,,,,,76.44,285.18,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,350.00000,105.35000,Aetna,Medical Rental Products,,329.00,,,,,,,91.00,339.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,outpatient,,,1350.00000,780.30000,Aetna,Medical Rental Products,,,94.00,,,,,0,351.00,1309.50,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,outpatient,,,3680.00000,2127.04000,Aetna,Medical Rental Products,,,94.00,,,,,0,956.80,3569.60,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,outpatient,,,1600.00000,924.80000,Aetna,Medical Rental Products,,,94.00,,,,,0,416.00,1552.00,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,outpatient,,,4680.00000,2705.04000,Aetna,Medical Rental Products,,,94.00,,,,,0,1216.80,4539.60,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,outpatient,,,2100.00000,1213.80000,Aetna,Medical Rental Products,,,94.00,,,,,0,546.00,2037.00,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,outpatient,,,5680.00000,3283.04000,Aetna,Medical Rental Products,,,94.00,,,,,0,1476.80,5509.60,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,outpatient,,,2420.00000,1398.76000,Aetna,Medical Rental Products,,,94.00,,,,,0,629.20,2347.40,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,outpatient,,,6415.00000,3707.87000,Aetna,Medical Rental Products,,,94.00,,,,,0,1667.90,6222.55,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,outpatient,,,2920.00000,1687.76000,Aetna,Medical Rental Products,,,94.00,,,,,0,759.20,2832.40,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,outpatient,,,8915.00000,5152.87000,Aetna,Medical Rental Products,,,94.00,,,,,0,2317.90,8647.55,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,outpatient,,,3420.00000,1976.76000,Aetna,Medical Rental Products,,,94.00,,,,,0,889.20,3317.40,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,outpatient,,,11415.00000,6597.87000,Aetna,Medical Rental Products,,,94.00,,,,,0,2967.90,11072.55,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,outpatient,,,142.00000,154.35000,Aetna,Medical Rental Products,,133.48,,,,,,,36.92,137.74,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Aetna,Medical Rental Products,,319.60,,,,,,,88.40,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Aetna,Medical Rental Products,,629.80,,,,,,,174.20,649.90,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,outpatient,,,390.00000,262.47000,Aetna,Medical Rental Products,,366.60,,,,,,,101.40,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,outpatient,,,1170.00000,787.41000,Aetna,Medical Rental Products,,1099.80,,,,,,,304.20,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,outpatient,,,440.00000,296.12000,Aetna,Medical Rental Products,,413.60,,,,,,,114.40,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,outpatient,,,1670.00000,1123.91000,Aetna,Medical Rental Products,,1569.80,,,,,,,434.20,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,outpatient,,,640.00000,430.72000,Aetna,Medical Rental Products,,601.60,,,,,,,166.40,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,outpatient,,,2170.00000,1460.41000,Aetna,Medical Rental Products,,2039.80,,,,,,,564.20,2104.90,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,outpatient,,,17.00000,10.96000,Aetna,Medical Rental Products,,15.98,,,,,,,4.42,16.49,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,outpatient,,,535.00000,345.08000,Aetna,Medical Rental Products,,502.90,,,,,,,139.10,518.95,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,outpatient,,,23.00000,14.84000,Aetna,Medical Rental Products,,21.62,,,,,,,5.98,22.31,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,outpatient,,,635.00000,409.58000,Aetna,Medical Rental Products,,596.90,,,,,,,165.10,615.95,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,outpatient,,,30.00000,19.35000,Aetna,Medical Rental Products,,28.20,,,,,,,7.80,29.10,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,outpatient,,,735.00000,474.08000,Aetna,Medical Rental Products,,690.90,,,,,,,191.10,712.95,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,outpatient,,,33.00000,21.28000,Aetna,Medical Rental Products,,31.02,,,,,,,8.58,32.01,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,outpatient,,,835.00000,538.58000,Aetna,Medical Rental Products,,784.90,,,,,,,217.10,809.95,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,outpatient,,,140.00000,80.92000,Aetna,Medical Rental Products,,,94.00,,,,,0,36.40,135.80,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,outpatient,,,275.00000,158.95000,Aetna,Medical Rental Products,,,94.00,,,,,0,71.50,266.75,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,outpatient,,,295.00000,170.51000,Aetna,Medical Rental Products,,,94.00,,,,,0,76.70,286.15,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,outpatient,,,590.00000,341.02000,Aetna,Medical Rental Products,,,94.00,,,,,0,153.40,572.30,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,outpatient,,,690.00000,398.82000,Aetna,Medical Rental Products,,,94.00,,,,,0,179.40,669.30,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,outpatient,,,1375.00000,794.75000,Aetna,Medical Rental Products,,,94.00,,,,,0,357.50,1333.75,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,outpatient,,,950.00000,549.10000,Aetna,Medical Rental Products,,,94.00,,,,,0,247.00,921.50,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,outpatient,,,1900.00000,1098.20000,Aetna,Medical Rental Products,,,94.00,,,,,0,494.00,1843.00,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,outpatient,,,140.00000,45.22000,Aetna,Medical Rental Products,,,94.00,,,,,0,36.40,135.80,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,outpatient,,,275.00000,88.82000,Aetna,Medical Rental Products,,,94.00,,,,,0,71.50,266.75,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,outpatient,,,295.00000,95.28000,Aetna,Medical Rental Products,,,94.00,,,,,0,76.70,286.15,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,outpatient,,,590.00000,190.57000,Aetna,Medical Rental Products,,,94.00,,,,,0,153.40,572.30,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,outpatient,,,690.00000,222.87000,Aetna,Medical Rental Products,,,94.00,,,,,0,179.40,669.30,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,outpatient,,,1375.00000,444.12000,Aetna,Medical Rental Products,,,94.00,,,,,0,357.50,1333.75,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,outpatient,,,950.00000,306.85000,Aetna,Medical Rental Products,,,94.00,,,,,0,247.00,921.50,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,outpatient,,,1900.00000,613.70000,Aetna,Medical Rental Products,,,94.00,,,,,0,494.00,1843.00,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Aetna,Medical Rental Products,,319.60,,,,,,,88.40,329.80,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Aetna,Medical Rental Products,,629.80,,,,,,,174.20,649.90,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Aetna,Medical Rental Products,,460.60,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Aetna,Medical Rental Products,,460.60,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Aetna,Medical Rental Products,,460.60,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Aetna,Medical Rental Products,,230.30,,,,,,,63.70,237.65,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Aetna,Medical Rental Products,,791.48,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Aetna,Medical Rental Products,,989.82,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Aetna,Medical Rental Products,,1187.22,,,,,,,328.38,1225.11,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1178.00000,669.28000,Aetna,Medical Rental Products,,1107.32,,,,,,,306.28,1142.66,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,outpatient,,,140.00000,102.34000,Aetna,Medical Rental Products,,131.60,,,,,,,36.40,135.80,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,outpatient,,,275.00000,201.02000,Aetna,Medical Rental Products,,258.50,,,,,,,71.50,266.75,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,outpatient,,,295.00000,215.64000,Aetna,Medical Rental Products,,277.30,,,,,,,76.70,286.15,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,outpatient,,,590.00000,431.29000,Aetna,Medical Rental Products,,554.60,,,,,,,153.40,572.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,outpatient,,,690.00000,504.39000,Aetna,Medical Rental Products,,648.60,,,,,,,179.40,669.30,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,outpatient,,,1375.00000,1005.12000,Aetna,Medical Rental Products,,1292.50,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,outpatient,,,950.00000,694.45000,Aetna,Medical Rental Products,,893.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,outpatient,,,1900.00000,1388.90000,Aetna,Medical Rental Products,,1786.00,,,,,,,494.00,1843.00,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,outpatient,,,584.00000,426.90000,Aetna,Medical Rental Products,,548.96,,,,,,,151.84,566.48,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,outpatient,,,1391.00000,1016.82000,Aetna,Medical Rental Products,,1307.54,,,,,,,361.66,1349.27,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,outpatient,,,359.00000,271.76000,Aetna,Medical Rental Products,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,outpatient,,,95.00000,71.92000,Aetna,Medical Rental Products,,89.30,,,,,,,24.70,92.15,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,outpatient,,,37.00000,17.83000,Aetna,Medical Rental Products,,34.78,,,,,,,9.62,35.89,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Aetna,Medical Rental Products,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Aetna,Medical Rental Products,,222.78,,,,,,,61.62,229.89,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,outpatient,,,33.00000,15.91000,Aetna,Medical Rental Products,,31.02,,,,,,,8.58,32.01,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,outpatient,,,25.00000,12.05000,Aetna,Medical Rental Products,,23.50,,,,,,,6.50,24.25,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,outpatient,,,497.00000,160.53000,Aetna,Medical Rental Products,,,94.00,,,,,0,129.22,482.09,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Aetna,Medical Rental Products,,829.08,,,,,,,229.32,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Aetna,Medical Rental Products,,829.08,,,,,,,229.32,855.54,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Aetna,Medical Rental Products,,92.12,,,,,,,25.48,95.06,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Aetna,Medical Rental Products,,90.24,,,,,,,24.96,93.12,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Aetna,Medical Rental Products,,829.08,,,,,,,229.32,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Aetna,Medical Rental Products,,829.08,,,,,,,229.32,855.54,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,outpatient,,,763.00000,291.47000,Aetna,Medical Rental Products,,717.22,,,,,,,198.38,740.11,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,outpatient,,,199.00000,76.02000,Aetna,Medical Rental Products,,187.06,,,,,,,51.74,193.03,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Aetna,Medical Rental Products,,92.12,,,,,,,25.48,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Aetna,Medical Rental Products,,90.24,,,,,,,24.96,93.12,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,outpatient,,,1265.00000,483.23000,Aetna,Medical Rental Products,,1189.10,,,,,,,328.90,1227.05,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,outpatient,,,924.00000,352.97000,Aetna,Medical Rental Products,,868.56,,,,,,,240.24,896.28,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,outpatient,,,580.00000,215.76000,Aetna,Medical Rental Products,,545.20,,,,,,,150.80,562.60,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,outpatient,,,110.00000,40.92000,Aetna,Medical Rental Products,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,outpatient,,,373.00000,138.76000,Aetna,Medical Rental Products,,350.62,,,,,,,96.98,361.81,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,outpatient,,,337.00000,125.36000,Aetna,Medical Rental Products,,316.78,,,,,,,87.62,326.89,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,outpatient,,,784.00000,291.65000,Aetna,Medical Rental Products,,736.96,,,,,,,203.84,760.48,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,outpatient,,,341.00000,126.85000,Aetna,Medical Rental Products,,320.54,,,,,,,88.66,330.77,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,outpatient,,,252.00000,93.74000,Aetna,Medical Rental Products,,236.88,,,,,,,65.52,244.44,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,outpatient,,,282.00000,104.90000,Aetna,Medical Rental Products,,265.08,,,,,,,73.32,273.54,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,outpatient,,,404.00000,150.29000,Aetna,Medical Rental Products,,379.76,,,,,,,105.04,391.88,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,outpatient,,,306.00000,173.85000,Aetna,Medical Rental Products,,287.64,,,,,,,79.56,296.82,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,outpatient,,,158.00000,89.77000,Aetna,Medical Rental Products,,148.52,,,,,,,41.08,153.26,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Aetna,Medical Rental Products,GP,138.18,,,,,,,38.22,142.59,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Aetna,Medical Rental Products,GP,253.80,,,,,,,70.20,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Aetna,Medical Rental Products,GP,78.96,,,,,,,21.84,81.48,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Aetna,Medical Rental Products,GP,80.84,,,,,,,22.36,83.42,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Aetna,Medical Rental Products,GP,77.08,,,,,,,21.32,79.54,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Aetna,Medical Rental Products,GP,79.90,,,,,,,22.10,82.45,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Aetna,Medical Rental Products,GP,40.42,,,,,,,11.18,41.71,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Aetna,Medical Rental Products,GP,38.54,,,,,,,10.66,39.77,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Aetna,Medical Rental Products,GP,74.26,,,,,,,20.54,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Aetna,Medical Rental Products,GP,69.56,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Aetna,Medical Rental Products,GP,69.56,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Aetna,Medical Rental Products,GP,31.96,,,,,,,8.84,32.98,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Aetna,Medical Rental Products,GP,61.10,,,,,,,16.90,63.05,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,outpatient,,,113.00000,68.70000,Aetna,Medical Rental Products,,106.22,,,,,,,29.38,109.61,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Aetna,Medical Rental Products,GP,75.20,,,,,,,20.80,77.60,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Aetna,Medical Rental Products,GP,78.96,,,,,,,21.84,81.48,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Aetna,Medical Rental Products,GP,68.62,,,,,,,18.98,70.81,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,outpatient,,,100.00000,60.80000,Aetna,Medical Rental Products,,94.00,,,,,,,26.00,97.00,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,outpatient,,,167.00000,101.54000,Aetna,Medical Rental Products,GP,156.98,,,,,,,43.42,161.99,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Aetna,Medical Rental Products,"50,GP",388.22,,,,,,,107.38,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Aetna,Medical Rental Products,"LT,GP",258.50,,,,,,,71.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Aetna,Medical Rental Products,"RT,GP",258.50,,,,,,,71.50,266.75,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Aetna,Medical Rental Products,GP,89.30,,,,,,,24.70,92.15,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Aetna,Medical Rental Products,GP,137.24,,,,,,,37.96,141.62,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Aetna,Medical Rental Products,GP,130.66,,,,,,,36.14,134.83,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Aetna,Medical Rental Products,GP,70.50,,,,,,,19.50,72.75,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Aetna,Medical Rental Products,GP,144.76,,,,,,,40.04,149.38,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Aetna,Medical Rental Products,GP,68.62,,,,,,,18.98,70.81,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Aetna,Medical Rental Products,GP,150.40,,,,,,,41.60,155.20,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Aetna,Medical Rental Products,GP,305.50,,,,,,,84.50,315.25,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,outpatient,,,98.00000,59.58000,Aetna,Medical Rental Products,GP,92.12,,,,,,,25.48,95.06,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,outpatient,,,303.00000,184.22000,Aetna,Medical Rental Products,GP,284.82,,,,,,,78.78,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,outpatient,,,115.00000,69.92000,Aetna,Medical Rental Products,GP,108.10,,,,,,,29.90,111.55,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Aetna,Medical Rental Products,GP,69.56,,,,,,,19.24,71.78,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Aetna,Medical Rental Products,GP,74.26,,,,,,,20.54,76.63,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Aetna,Medical Rental Products,GP,67.68,,,,,,,18.72,69.84,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Aetna,Medical Rental Products,GP,138.18,,,,,,,38.22,142.59,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Aetna,Medical Rental Products,GP,253.80,,,,,,,70.20,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Aetna,Medical Rental Products,GP,78.96,,,,,,,21.84,81.48,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Aetna,Medical Rental Products,GP,80.84,,,,,,,22.36,83.42,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Aetna,Medical Rental Products,GP,77.08,,,,,,,21.32,79.54,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Aetna,Medical Rental Products,GP,79.90,,,,,,,22.10,82.45,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Aetna,Medical Rental Products,GP,40.42,,,,,,,11.18,41.71,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Aetna,Medical Rental Products,GP,38.54,,,,,,,10.66,39.77,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Aetna,Medical Rental Products,GP,74.26,,,,,,,20.54,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Aetna,Medical Rental Products,"CQ,GP",69.56,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Aetna,Medical Rental Products,"CQ,GP",69.56,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Aetna,Medical Rental Products,GP,31.96,,,,,,,8.84,32.98,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Aetna,Medical Rental Products,GP,61.10,,,,,,,16.90,63.05,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Aetna,Medical Rental Products,GP,75.20,,,,,,,20.80,77.60,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Aetna,Medical Rental Products,GP,78.96,,,,,,,21.84,81.48,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Aetna,Medical Rental Products,GP,68.62,,,,,,,18.98,70.81,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Aetna,Medical Rental Products,"GP,50",388.22,,,,,,,107.38,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Aetna,Medical Rental Products,"GP,LT",258.50,,,,,,,71.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Aetna,Medical Rental Products,"GP,RT",258.50,,,,,,,71.50,266.75,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Aetna,Medical Rental Products,GP,89.30,,,,,,,24.70,92.15,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Aetna,Medical Rental Products,GP,137.24,,,,,,,37.96,141.62,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Aetna,Medical Rental Products,GP,130.66,,,,,,,36.14,134.83,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Aetna,Medical Rental Products,GP,70.50,,,,,,,19.50,72.75,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Aetna,Medical Rental Products,GP,144.76,,,,,,,40.04,149.38,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Aetna,Medical Rental Products,GP,68.62,,,,,,,18.98,70.81,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Aetna,Medical Rental Products,GP,150.40,,,,,,,41.60,155.20,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Aetna,Medical Rental Products,GP,305.50,,,,,,,84.50,315.25,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Aetna,Medical Rental Products,GP,69.56,,,,,,,19.24,71.78,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Aetna,Medical Rental Products,GP,74.26,,,,,,,20.54,76.63,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Aetna,Medical Rental Products,GP,67.68,,,,,,,18.72,69.84,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,outpatient,,,445.00000,262.55000,Aetna,Medical Rental Products,GP,418.30,,,,,,,115.70,431.65,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,outpatient,,,310.00000,182.90000,Aetna,Medical Rental Products,GP,291.40,,,,,,,80.60,300.70,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,outpatient,,,393.00000,231.87000,Aetna,Medical Rental Products,GP,369.42,,,,,,,102.18,381.21,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,outpatient,,,310.00000,182.90000,Aetna,Medical Rental Products,GP,291.40,,,,,,,80.60,300.70,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Aetna,Medical Rental Products,GO,75.20,,,,,,,20.80,77.60,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Aetna,Medical Rental Products,GO,78.96,,,,,,,21.84,81.48,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Aetna,Medical Rental Products,GO,118.44,,,,,,,32.76,122.22,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Aetna,Medical Rental Products,GO,62.04,,,,,,,17.16,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Aetna,Medical Rental Products,GO,58.28,,,,,,,16.12,60.14,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Aetna,Medical Rental Products,GO,84.60,,,,,,,23.40,87.30,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Aetna,Medical Rental Products,GO,89.30,,,,,,,24.70,92.15,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Aetna,Medical Rental Products,GO,137.24,,,,,,,37.96,141.62,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Aetna,Medical Rental Products,GO,130.66,,,,,,,36.14,134.83,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Aetna,Medical Rental Products,GO,70.50,,,,,,,19.50,72.75,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Aetna,Medical Rental Products,GO,144.76,,,,,,,40.04,149.38,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Aetna,Medical Rental Products,GO,68.62,,,,,,,18.98,70.81,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Aetna,Medical Rental Products,GO,150.40,,,,,,,41.60,155.20,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,outpatient,,,98.00000,37.93000,Aetna,Medical Rental Products,GO,92.12,,,,,,,25.48,95.06,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,outpatient,,,303.00000,117.26000,Aetna,Medical Rental Products,GO,284.82,,,,,,,78.78,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,outpatient,,,115.00000,44.50000,Aetna,Medical Rental Products,GO,108.10,,,,,,,29.90,111.55,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Aetna,Medical Rental Products,GO,69.56,,,,,,,19.24,71.78,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Aetna,Medical Rental Products,GO,67.68,,,,,,,18.72,69.84,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Aetna,Medical Rental Products,"CO,GO",75.20,,,,,,,20.80,77.60,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Aetna,Medical Rental Products,"CO,GO",78.96,,,,,,,21.84,81.48,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Aetna,Medical Rental Products,"CO,GO",118.44,,,,,,,32.76,122.22,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Aetna,Medical Rental Products,"CO,GO",58.28,,,,,,,16.12,60.14,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Aetna,Medical Rental Products,"CO,GO",62.04,,,,,,,17.16,64.02,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Aetna,Medical Rental Products,"CO,GO",84.60,,,,,,,23.40,87.30,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Aetna,Medical Rental Products,"CO,GO",89.30,,,,,,,24.70,92.15,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Aetna,Medical Rental Products,"CO,GO",137.24,,,,,,,37.96,141.62,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Aetna,Medical Rental Products,"CO,GO",130.66,,,,,,,36.14,134.83,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Aetna,Medical Rental Products,"CO,GO",70.50,,,,,,,19.50,72.75,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Aetna,Medical Rental Products,"CO,GO",144.76,,,,,,,40.04,149.38,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Aetna,Medical Rental Products,"CO,GO",68.62,,,,,,,18.98,70.81,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Aetna,Medical Rental Products,"CO,GO",150.40,,,,,,,41.60,155.20,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Aetna,Medical Rental Products,"CO,GO",69.56,,,,,,,19.24,71.78,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Aetna,Medical Rental Products,"CO,GO",67.68,,,,,,,18.72,69.84,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Aetna,Medical Rental Products,GO,44.18,,,,,,,12.22,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Aetna,Medical Rental Products,"CO,GO",44.18,,,,,,,12.22,45.59,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,outpatient,,,250.00000,142.04000,Aetna,Medical Rental Products,GO,235.00,,,,,,,65.00,242.50,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,outpatient,,,175.00000,99.43000,Aetna,Medical Rental Products,GO,164.50,,,,,,,45.50,169.75,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,outpatient,,,233.00000,132.38000,Aetna,Medical Rental Products,GO,219.02,,,,,,,60.58,226.01,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,outpatient,,,175.00000,99.43000,Aetna,Medical Rental Products,GO,164.50,,,,,,,45.50,169.75,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,outpatient,,,291.00000,93.99000,Aetna,Medical Rental Products,,,94.00,,,,,0,75.66,282.27,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,outpatient,,,273.00000,155.10000,Aetna,Medical Rental Products,GN,256.62,,,,,,,70.98,264.81,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,outpatient,,,279.00000,158.51000,Aetna,Medical Rental Products,GN,262.26,,,,,,,72.54,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,outpatient,,,426.00000,242.03000,Aetna,Medical Rental Products,GN,400.44,,,,,,,110.76,413.22,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,outpatient,,,242.00000,137.49000,Aetna,Medical Rental Products,GN,227.48,,,,,,,62.92,234.74,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,outpatient,,,128.00000,72.72000,Aetna,Medical Rental Products,,120.32,,,,,,,33.28,124.16,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,outpatient,,,66.00000,37.50000,Aetna,Medical Rental Products,GN,62.04,,,,,,,17.16,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,outpatient,,,62.00000,35.23000,Aetna,Medical Rental Products,GN,58.28,,,,,,,16.12,60.14,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,outpatient,,,269.00000,152.83000,Aetna,Medical Rental Products,GN,252.86,,,,,,,69.94,260.93,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,outpatient,,,153.00000,86.93000,Aetna,Medical Rental Products,GN,143.82,,,,,,,39.78,148.41,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,outpatient,,,98.00000,55.68000,Aetna,Medical Rental Products,GN,92.12,,,,,,,25.48,95.06,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,outpatient,,,303.00000,172.15000,Aetna,Medical Rental Products,GN,284.82,,,,,,,78.78,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,outpatient,,,115.00000,65.34000,Aetna,Medical Rental Products,GN,108.10,,,,,,,29.90,111.55,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,outpatient,,,210.00000,119.31000,Aetna,Medical Rental Products,GN,197.40,,,,,,,54.60,203.70,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,outpatient,,,250.00000,142.04000,Aetna,Medical Rental Products,GN,235.00,,,,,,,65.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,outpatient,,,78.00000,44.32000,Aetna,Medical Rental Products,GN,73.32,,,,,,,20.28,75.66,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,outpatient,,,322.00000,182.94000,Aetna,Medical Rental Products,GN,302.68,,,,,,,83.72,312.34,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,outpatient,,,309.00000,175.56000,Aetna,Medical Rental Products,GN,290.46,,,,,,,80.34,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,outpatient,,,245.00000,139.20000,Aetna,Medical Rental Products,GN,230.30,,,,,,,63.70,237.65,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,outpatient,,,313.00000,116.44000,Aetna,Medical Rental Products,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,outpatient,,,1250.00000,632.50000,Aetna,Medical Rental Products,,1175.00,,,,,,,325.00,1212.50,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Aetna,Medical Rental Products,,136.30,,,,,,,37.70,140.65,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Aetna,Medical Rental Products,,458.72,,,,,,,126.88,473.36,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,outpatient,,,684.00000,337.90000,Aetna,Medical Rental Products,,642.96,,,,,,,177.84,663.48,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,outpatient,,,206.00000,101.76000,Aetna,Medical Rental Products,,193.64,,,,,,,53.56,199.82,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,outpatient,,,195.00000,96.33000,Aetna,Medical Rental Products,,183.30,,,,,,,50.70,189.15,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,outpatient,,,375.00000,185.25000,Aetna,Medical Rental Products,,352.50,,,,,,,97.50,363.75,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,outpatient,,,429.00000,211.93000,Aetna,Medical Rental Products,,403.26,,,,,,,111.54,416.13,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22475,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Aetna,Medical Rental Products,,,94.00,,,,,0,2502.90,3111.10,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
R&B OBSTETRICS SEMI-PVT,42473,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Aetna,Medical Rental Products,,,94.00,,,,,0,2502.90,3111.10,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
R&B ICU,32474,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Aetna,Medical Rental Products,,,94.00,,,,,0,2512.00,8498.17,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
R&B ICU INTERMEDIATE,12476,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Aetna,Medical Rental Products,,,94.00,,,,,0,2512.00,5665.77,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Aetna,Medical Rental Products,,78.96,,,,,,,21.84,81.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Aetna,Medical Rental Products,,266.96,,,,,,,73.84,275.48,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Aetna,Medical Rental Products,,430.52,,,,,,,119.08,444.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Aetna,Medical Rental Products,,524.52,,,,,,,145.08,541.26,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Aetna,Medical Rental Products,,453.08,,,,,,,125.32,467.54,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Aetna,Medical Rental Products,,222.78,,,,,,,61.62,229.89,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,outpatient,,,490.00000,329.77000,Aetna,Medical Rental Products,,460.60,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,outpatient,,,490.00000,329.77000,Aetna,Medical Rental Products,,460.60,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,outpatient,,,245.00000,164.89000,Aetna,Medical Rental Products,,230.30,,,,,,,63.70,237.65,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Aetna,Medical Rental Products,,460.60,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Aetna,Medical Rental Products,,460.60,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Aetna,Medical Rental Products,,230.30,,,,,,,63.70,237.65,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Aetna,Medical Rental Products,,791.48,,,,,,,218.92,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Aetna,Medical Rental Products,,989.82,,,,,,,273.78,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Aetna,Medical Rental Products,,1187.22,,,,,,,328.38,1225.11,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,outpatient,,,2466.00000,986.40000,Aetna,Medical Rental Products,,2318.04,,,,,,,641.16,2392.02,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,outpatient,,,260.00000,104.00000,Aetna,Medical Rental Products,,244.40,,,,,,,67.60,252.20,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,outpatient,,,2041.00000,816.40000,Aetna,Medical Rental Products,,1918.54,,,,,,,530.66,1979.77,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,outpatient,,,375.00000,150.00000,Aetna,Medical Rental Products,,352.50,,,,,,,97.50,363.75,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,outpatient,,,1178.00000,471.20000,Aetna,Medical Rental Products,,1107.32,,,,,,,306.28,1142.66,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,outpatient,,,245.00000,98.00000,Aetna,Medical Rental Products,,230.30,,,,,,,63.70,237.65,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,outpatient,,,280.00000,112.00000,Aetna,Medical Rental Products,,263.20,,,,,,,72.80,271.60,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,outpatient,,,336.00000,134.40000,Aetna,Medical Rental Products,,315.84,,,,,,,87.36,325.92,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,outpatient,,,380.00000,152.00000,Aetna,Medical Rental Products,,357.20,,,,,,,98.80,368.60,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Aetna,Medical Rental Products,,498.20,,,,,,,137.80,514.10,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,outpatient,,,264.00000,105.60000,Aetna,Medical Rental Products,,248.16,,,,,,,68.64,256.08,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,outpatient,,,763.00000,305.20000,Aetna,Medical Rental Products,,717.22,,,,,,,198.38,740.11,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,outpatient,,,672.00000,268.80000,Aetna,Medical Rental Products,,631.68,,,,,,,174.72,651.84,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,outpatient,,,1940.00000,776.00000,Aetna,Medical Rental Products,,1823.60,,,,,,,504.40,1881.80,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,outpatient,,,3875.00000,1550.00000,Aetna,Medical Rental Products,,3642.50,,,,,,,1007.50,3758.75,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,outpatient,,,505.00000,202.00000,Aetna,Medical Rental Products,,474.70,,,,,,,131.30,489.85,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Aetna,Medical Rental Products,,277.30,,,,,,,76.70,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,outpatient,,,585.00000,234.00000,Aetna,Medical Rental Products,,549.90,,,,,,,152.10,567.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,outpatient,,,285.00000,114.00000,Aetna,Medical Rental Products,,267.90,,,,,,,74.10,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,outpatient,,,575.00000,230.00000,Aetna,Medical Rental Products,,540.50,,,,,,,149.50,557.75,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,outpatient,,,697.00000,278.80000,Aetna,Medical Rental Products,,655.18,,,,,,,181.22,676.09,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Aetna,Medical Rental Products,,498.20,,,,,,,137.80,514.10,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,outpatient,,,580.00000,232.00000,Aetna,Medical Rental Products,,545.20,,,,,,,150.80,562.60,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,outpatient,,,435.00000,174.00000,Aetna,Medical Rental Products,,408.90,,,,,,,113.10,421.95,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,outpatient,,,270.00000,108.00000,Aetna,Medical Rental Products,,253.80,,,,,,,70.20,261.90,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,outpatient,,,504.00000,201.60000,Aetna,Medical Rental Products,,473.76,,,,,,,131.04,488.88,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,outpatient,,,98.00000,39.20000,Aetna,Medical Rental Products,,92.12,,,,,,,25.48,95.06,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,outpatient,,,608.00000,243.20000,Aetna,Medical Rental Products,,571.52,,,,,,,158.08,589.76,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,outpatient,,,114.00000,45.60000,Aetna,Medical Rental Products,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,outpatient,,,187.00000,74.80000,Aetna,Medical Rental Products,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,outpatient,,,214.00000,85.60000,Aetna,Medical Rental Products,,201.16,,,,,,,55.64,207.58,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,outpatient,,,863.00000,345.20000,Aetna,Medical Rental Products,,811.22,,,,,,,224.38,837.11,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,outpatient,,,453.00000,181.20000,Aetna,Medical Rental Products,,425.82,,,,,,,117.78,439.41,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,outpatient,,,144.00000,57.60000,Aetna,Medical Rental Products,,135.36,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,outpatient,,,107.00000,42.80000,Aetna,Medical Rental Products,,100.58,,,,,,,27.82,103.79,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,outpatient,,,403.00000,161.20000,Aetna,Medical Rental Products,,378.82,,,,,,,104.78,390.91,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,outpatient,,,144.00000,57.60000,Aetna,Medical Rental Products,,135.36,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,outpatient,,,370.00000,148.00000,Aetna,Medical Rental Products,,347.80,,,,,,,96.20,358.90,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,outpatient,,,334.00000,133.60000,Aetna,Medical Rental Products,,313.96,,,,,,,86.84,323.98,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,outpatient,,,1188.00000,475.20000,Aetna,Medical Rental Products,50,1116.72,,,,,,,308.88,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Aetna,Medical Rental Products,LT,744.48,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Aetna,Medical Rental Products,RT,744.48,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,outpatient,,,572.00000,228.80000,Aetna,Medical Rental Products,50,537.68,,,,,,,148.72,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Aetna,Medical Rental Products,LT,358.14,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Aetna,Medical Rental Products,RT,358.14,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,outpatient,,,683.00000,273.20000,Aetna,Medical Rental Products,50,642.02,,,,,,,177.58,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Aetna,Medical Rental Products,LT,427.70,,,,,,,118.30,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Aetna,Medical Rental Products,RT,427.70,,,,,,,118.30,441.35,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,outpatient,,,357.00000,142.80000,Aetna,Medical Rental Products,,335.58,,,,,,,92.82,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,outpatient,,,334.00000,133.60000,Aetna,Medical Rental Products,,313.96,,,,,,,86.84,323.98,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,outpatient,,,194.00000,77.60000,Aetna,Medical Rental Products,,182.36,,,,,,,50.44,188.18,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,outpatient,,,608.00000,243.20000,Aetna,Medical Rental Products,,571.52,,,,,,,158.08,589.76,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,outpatient,,,257.00000,102.80000,Aetna,Medical Rental Products,,241.58,,,,,,,66.82,249.29,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,outpatient,,,343.00000,137.20000,Aetna,Medical Rental Products,,322.42,,,,,,,89.18,332.71,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,outpatient,,,457.00000,182.80000,Aetna,Medical Rental Products,,429.58,,,,,,,118.82,443.29,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,outpatient,,,630.00000,252.00000,Aetna,Medical Rental Products,,592.20,,,,,,,163.80,611.10,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,outpatient,,,623.00000,249.20000,Aetna,Medical Rental Products,,585.62,,,,,,,161.98,604.31,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,outpatient,,,1457.00000,582.80000,Aetna,Medical Rental Products,,1369.58,,,,,,,378.82,1413.29,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,outpatient,,,890.00000,356.00000,Aetna,Medical Rental Products,,836.60,,,,,,,231.40,863.30,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,outpatient,,,532.00000,212.80000,Aetna,Medical Rental Products,,500.08,,,,,,,138.32,516.04,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,outpatient,,,492.00000,196.80000,Aetna,Medical Rental Products,,462.48,,,,,,,127.92,477.24,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,outpatient,,,550.00000,220.00000,Aetna,Medical Rental Products,,517.00,,,,,,,143.00,533.50,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,outpatient,,,305.00000,122.00000,Aetna,Medical Rental Products,,286.70,,,,,,,79.30,295.85,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,outpatient,,,220.00000,88.00000,Aetna,Medical Rental Products,,206.80,,,,,,,57.20,213.40,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,outpatient,,,780.00000,312.00000,Aetna,Medical Rental Products,,733.20,,,,,,,202.80,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,outpatient,,,1165.00000,466.00000,Aetna,Medical Rental Products,,1095.10,,,,,,,302.90,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,outpatient,,,2350.00000,940.00000,Aetna,Medical Rental Products,,2209.00,,,,,,,611.00,2279.50,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,outpatient,,,896.00000,358.40000,Aetna,Medical Rental Products,,842.24,,,,,,,232.96,869.12,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,outpatient,,,385.00000,154.00000,Aetna,Medical Rental Products,,361.90,,,,,,,100.10,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,outpatient,,,470.00000,188.00000,Aetna,Medical Rental Products,,441.80,,,,,,,122.20,455.90,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,outpatient,,,150.00000,60.00000,Aetna,Medical Rental Products,,141.00,,,,,,,39.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,outpatient,,,100.00000,40.00000,Aetna,Medical Rental Products,,94.00,,,,,,,26.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,outpatient,,,143.00000,57.20000,Aetna,Medical Rental Products,,134.42,,,,,,,37.18,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,outpatient,,,95.00000,38.00000,Aetna,Medical Rental Products,,89.30,,,,,,,24.70,92.15,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,outpatient,,,269.00000,107.60000,Aetna,Medical Rental Products,,252.86,,,,,,,69.94,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,outpatient,,,388.00000,155.20000,Aetna,Medical Rental Products,,364.72,,,,,,,100.88,376.36,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,outpatient,,,344.00000,137.60000,Aetna,Medical Rental Products,,323.36,,,,,,,89.44,333.68,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,outpatient,,,321.00000,128.40000,Aetna,Medical Rental Products,,301.74,,,,,,,83.46,311.37,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,outpatient,,,155.00000,62.00000,Aetna,Medical Rental Products,,145.70,,,,,,,40.30,150.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,outpatient,,,817.00000,326.80000,Aetna,Medical Rental Products,,767.98,,,,,,,212.42,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,outpatient,,,1255.00000,502.00000,Aetna,Medical Rental Products,,1179.70,,,,,,,326.30,1217.35,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,outpatient,,,391.00000,156.40000,Aetna,Medical Rental Products,,367.54,,,,,,,101.66,379.27,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,outpatient,,,671.00000,268.40000,Aetna,Medical Rental Products,,630.74,,,,,,,174.46,650.87,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,outpatient,,,456.00000,182.40000,Aetna,Medical Rental Products,,428.64,,,,,,,118.56,442.32,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,outpatient,,,112.00000,44.80000,Aetna,Medical Rental Products,,105.28,,,,,,,29.12,108.64,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,outpatient,,,84.00000,33.60000,Aetna,Medical Rental Products,,78.96,,,,,,,21.84,81.48,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,outpatient,,,216.00000,86.40000,Aetna,Medical Rental Products,,203.04,,,,,,,56.16,209.52,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,outpatient,,,2660.00000,1064.00000,Aetna,Medical Rental Products,,2500.40,,,,,,,691.60,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,outpatient,,,2960.00000,1184.00000,Aetna,Medical Rental Products,,2782.40,,,,,,,769.60,2871.20,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,outpatient,,,3225.00000,1290.00000,Aetna,Medical Rental Products,,3031.50,,,,,,,838.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,outpatient,,,3395.00000,1358.00000,Aetna,Medical Rental Products,,3191.30,,,,,,,882.70,3293.15,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,outpatient,,,490.00000,196.00000,Aetna,Medical Rental Products,,460.60,,,,,,,127.40,475.30,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,outpatient,,,520.00000,208.00000,Aetna,Medical Rental Products,,488.80,,,,,,,135.20,504.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,outpatient,,,720.00000,288.00000,Aetna,Medical Rental Products,,676.80,,,,,,,187.20,698.40,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,outpatient,,,215.00000,86.00000,Aetna,Medical Rental Products,,202.10,,,,,,,55.90,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,outpatient,,,240.00000,96.00000,Aetna,Medical Rental Products,,225.60,,,,,,,62.40,232.80,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,outpatient,,,1241.00000,496.40000,Aetna,Medical Rental Products,,1166.54,,,,,,,322.66,1203.77,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,outpatient,,,850.00000,340.00000,Aetna,Medical Rental Products,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,outpatient,,,1085.00000,434.00000,Aetna,Medical Rental Products,,1019.90,,,,,,,282.10,1052.45,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Aetna,Medical Rental Products,,277.30,,,,,,,76.70,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,outpatient,,,492.00000,196.80000,Aetna,Medical Rental Products,,462.48,,,,,,,127.92,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,outpatient,,,563.00000,225.20000,Aetna,Medical Rental Products,,529.22,,,,,,,146.38,546.11,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,outpatient,,,1612.00000,644.80000,Aetna,Medical Rental Products,,1515.28,,,,,,,419.12,1563.64,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,outpatient,,,1366.00000,546.40000,Aetna,Medical Rental Products,,1284.04,,,,,,,355.16,1325.02,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,outpatient,,,1911.00000,764.40000,Aetna,Medical Rental Products,,1796.34,,,,,,,496.86,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,outpatient,,,956.00000,382.40000,Aetna,Medical Rental Products,,898.64,,,,,,,248.56,927.32,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,outpatient,,,189.00000,123.20000,Aetna,Medical Rental Products,,177.66,,,,,,,49.14,183.33,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,outpatient,,,352.00000,256.87000,Aetna,Medical Rental Products,,330.88,,,,,,,91.52,341.44,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,outpatient,,,625.00000,738.40000,Aetna,Medical Rental Products,,587.50,,,,,,,162.50,606.25,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1024.00000,2097.47000,Aetna,Medical Rental Products,,962.56,,,,,,,266.24,993.28,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,outpatient,,,1455.00000,2469.72000,Aetna,Medical Rental Products,,1367.70,,,,,,,378.30,1411.35,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Aetna,Medical Rental Products,,136.30,,,,,,,37.70,140.65,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Aetna,Medical Rental Products,,458.72,,,,,,,126.88,473.36,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Aetna,Medical Rental Products,,109.04,,,,,,,30.16,112.52,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Aetna,Medical Rental Products,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Aetna,Medical Rental Products,,38.54,,,,,,,10.66,39.77,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,outpatient,,,170.00000,73.95000,Aetna,Medical Rental Products,,159.80,,,,,,,44.20,164.90,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,2.70000,1.17000,Aetna,Medical Rental Products,,2.54,,,,,,,0.70200,2.62,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,27.00000,11.74000,Aetna,Medical Rental Products,,25.38,,,,,,,7.02,26.19,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,outpatient,,,20440.00000,8891.40000,Aetna,Medical Rental Products,,19213.60,,,,,,,5314.40,19826.80,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,3322.00000,1445.07000,Aetna,Medical Rental Products,,3122.68,,,,,,,863.72,3222.34,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,2492.00000,1084.02000,Aetna,Medical Rental Products,,2342.48,,,,,,,647.92,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1814.00000,789.09000,Aetna,Medical Rental Products,,1705.16,,,,,,,471.64,1759.58,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,2153.00000,936.56000,Aetna,Medical Rental Products,,2023.82,,,,,,,559.78,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1525.00000,663.38000,Aetna,Medical Rental Products,,1433.50,,,,,,,396.50,1479.25,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2716.00000,1181.46000,Aetna,Medical Rental Products,,2553.04,,,,,,,706.16,2634.52,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,outpatient,,,2.70000,0.39000,Aetna,Medical Rental Products,,2.54,,,,,,,0.70200,2.62,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,outpatient,,,222.00000,32.41000,Aetna,Medical Rental Products,,208.68,,,,,,,57.72,215.34,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,outpatient,,,211.00000,113.10000,Aetna,Medical Rental Products,,198.34,,,,,,,54.86,204.67,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,outpatient,,,497.00000,266.39000,Aetna,Medical Rental Products,,467.18,,,,,,,129.22,482.09,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,outpatient,,,296.00000,158.66000,Aetna,Medical Rental Products,,278.24,,,,,,,76.96,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,outpatient,,,723.00000,387.53000,Aetna,Medical Rental Products,,679.62,,,,,,,187.98,701.31,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,outpatient,,,326.00000,174.74000,Aetna,Medical Rental Products,,306.44,,,,,,,84.76,316.22,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,outpatient,,,532.00000,285.15000,Aetna,Medical Rental Products,,500.08,,,,,,,138.32,516.04,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,outpatient,,,635.00000,340.36000,Aetna,Medical Rental Products,,596.90,,,,,,,165.10,615.95,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,outpatient,,,639.00000,342.50000,Aetna,Medical Rental Products,,600.66,,,,,,,166.14,619.83,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,outpatient,,,780.00000,418.08000,Aetna,Medical Rental Products,,733.20,,,,,,,202.80,756.60,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,outpatient,,,390.00000,209.04000,Aetna,Medical Rental Products,,366.60,,,,,,,101.40,378.30,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,outpatient,,,731.00000,391.82000,Aetna,Medical Rental Products,,687.14,,,,,,,190.06,709.07,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,outpatient,,,585.00000,313.56000,Aetna,Medical Rental Products,,549.90,,,,,,,152.10,567.45,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,outpatient,,,365.00000,195.64000,Aetna,Medical Rental Products,,343.10,,,,,,,94.90,354.05,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,outpatient,,,1086.00000,582.10000,Aetna,Medical Rental Products,,1020.84,,,,,,,282.36,1053.42,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,outpatient,,,197.00000,105.59000,Aetna,Medical Rental Products,,185.18,,,,,,,51.22,191.09,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,outpatient,,,2774.00000,1486.86000,Aetna,Medical Rental Products,,2607.56,,,,,,,721.24,2690.78,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,outpatient,,,1456.00000,780.42000,Aetna,Medical Rental Products,,1368.64,,,,,,,378.56,1412.32,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,outpatient,,,2647.00000,1418.79000,Aetna,Medical Rental Products,,2488.18,,,,,,,688.22,2567.59,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,outpatient,,,1359.00000,728.42000,Aetna,Medical Rental Products,,1277.46,,,,,,,353.34,1318.23,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,outpatient,,,273.00000,146.33000,Aetna,Medical Rental Products,,256.62,,,,,,,70.98,264.81,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,outpatient,,,325.00000,174.20000,Aetna,Medical Rental Products,,305.50,,,,,,,84.50,315.25,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Aetna,Medical Rental Products,,572.46,,,,,,,158.34,590.73,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,outpatient,,,491.00000,263.18000,Aetna,Medical Rental Products,,461.54,,,,,,,127.66,476.27,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,outpatient,,,561.00000,300.70000,Aetna,Medical Rental Products,,527.34,,,,,,,145.86,544.17,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,outpatient,,,845.00000,452.92000,Aetna,Medical Rental Products,,794.30,,,,,,,219.70,819.65,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,outpatient,,,612.00000,328.03000,Aetna,Medical Rental Products,,575.28,,,,,,,159.12,593.64,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,outpatient,,,536.00000,287.30000,Aetna,Medical Rental Products,,503.84,,,,,,,139.36,519.92,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,outpatient,,,1225.00000,656.60000,Aetna,Medical Rental Products,,1151.50,,,,,,,318.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Aetna,Medical Rental Products,LT,767.04,,,,,,,212.16,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Aetna,Medical Rental Products,RT,767.04,,,,,,,212.16,791.52,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,outpatient,,,250.00000,134.00000,Aetna,Medical Rental Products,,235.00,,,,,,,65.00,242.50,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,outpatient,,,302.00000,161.87000,Aetna,Medical Rental Products,,283.88,,,,,,,78.52,292.94,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,outpatient,,,354.00000,189.74000,Aetna,Medical Rental Products,,332.76,,,,,,,92.04,343.38,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,outpatient,,,409.00000,219.22000,Aetna,Medical Rental Products,,384.46,,,,,,,106.34,396.73,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,outpatient,,,593.00000,317.85000,Aetna,Medical Rental Products,,557.42,,,,,,,154.18,575.21,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Aetna,Medical Rental Products,LT,288.58,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Aetna,Medical Rental Products,"52,LT",288.58,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Aetna,Medical Rental Products,RT,288.58,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Aetna,Medical Rental Products,"52,RT",288.58,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Aetna,Medical Rental Products,LT,310.20,,,,,,,85.80,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Aetna,Medical Rental Products,RT,310.20,,,,,,,85.80,320.10,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,outpatient,,,195.00000,104.52000,Aetna,Medical Rental Products,,183.30,,,,,,,50.70,189.15,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,outpatient,,,578.00000,309.81000,Aetna,Medical Rental Products,,543.32,,,,,,,150.28,560.66,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,outpatient,,,384.00000,205.82000,Aetna,Medical Rental Products,,360.96,,,,,,,99.84,372.48,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Aetna,Medical Rental Products,LT,284.82,,,,,,,78.78,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Aetna,Medical Rental Products,RT,284.82,,,,,,,78.78,293.91,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Aetna,Medical Rental Products,LT,418.30,,,,,,,115.70,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Aetna,Medical Rental Products,RT,418.30,,,,,,,115.70,431.65,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,outpatient,,,937.00000,502.23000,Aetna,Medical Rental Products,,880.78,,,,,,,243.62,908.89,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,outpatient,,,615.00000,329.64000,Aetna,Medical Rental Products,,578.10,,,,,,,159.90,596.55,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Aetna,Medical Rental Products,LT,269.78,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Aetna,Medical Rental Products,"52,LT",269.78,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Aetna,Medical Rental Products,RT,269.78,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Aetna,Medical Rental Products,"52,RT",269.78,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Aetna,Medical Rental Products,LT,303.62,,,,,,,83.98,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Aetna,Medical Rental Products,RT,303.62,,,,,,,83.98,313.31,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,outpatient,,,694.00000,371.98000,Aetna,Medical Rental Products,,652.36,,,,,,,180.44,673.18,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Aetna,Medical Rental Products,LT,259.44,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Aetna,Medical Rental Products,RT,259.44,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Aetna,Medical Rental Products,LT,238.76,,,,,,,66.04,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Aetna,Medical Rental Products,RT,238.76,,,,,,,66.04,246.38,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Aetna,Medical Rental Products,LT,258.50,,,,,,,71.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Aetna,Medical Rental Products,RT,258.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,outpatient,,,173.00000,92.73000,Aetna,Medical Rental Products,,162.62,,,,,,,44.98,167.81,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Aetna,Medical Rental Products,LT,454.02,,,,,,,125.58,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Aetna,Medical Rental Products,RT,454.02,,,,,,,125.58,468.51,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Aetna,Medical Rental Products,LT,179.54,,,,,,,49.66,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Aetna,Medical Rental Products,RT,179.54,,,,,,,49.66,185.27,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Aetna,Medical Rental Products,LT,139.12,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Aetna,Medical Rental Products,"52,LT",139.12,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Aetna,Medical Rental Products,RT,139.12,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Aetna,Medical Rental Products,"52,RT",139.12,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Aetna,Medical Rental Products,LT,452.14,,,,,,,125.06,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Aetna,Medical Rental Products,RT,452.14,,,,,,,125.06,466.57,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Aetna,Medical Rental Products,LT,202.10,,,,,,,55.90,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Aetna,Medical Rental Products,RT,202.10,,,,,,,55.90,208.55,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Aetna,Medical Rental Products,LT,258.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Aetna,Medical Rental Products,"52,LT",258.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Aetna,Medical Rental Products,RT,258.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Aetna,Medical Rental Products,"52,RT",258.50,,,,,,,71.50,266.75,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Aetna,Medical Rental Products,LT,427.70,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Aetna,Medical Rental Products,"52,LT",427.70,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Aetna,Medical Rental Products,RT,427.70,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Aetna,Medical Rental Products,"52,RT",427.70,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Aetna,Medical Rental Products,LT,472.82,,,,,,,130.78,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Aetna,Medical Rental Products,RT,472.82,,,,,,,130.78,487.91,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Aetna,Medical Rental Products,LT,196.46,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Aetna,Medical Rental Products,RT,196.46,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Aetna,Medical Rental Products,LT,532.04,,,,,,,147.16,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Aetna,Medical Rental Products,RT,532.04,,,,,,,147.16,549.02,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,outpatient,,,598.00000,320.53000,Aetna,Medical Rental Products,,562.12,,,,,,,155.48,580.06,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Aetna,Medical Rental Products,"52,LT",427.70,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Aetna,Medical Rental Products,"52,RT",427.70,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Aetna,Medical Rental Products,LT,427.70,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Aetna,Medical Rental Products,RT,427.70,,,,,,,118.30,441.35,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,outpatient,,,1913.00000,1025.37000,Aetna,Medical Rental Products,,1798.22,,,,,,,497.38,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,outpatient,,,312.00000,167.23000,Aetna,Medical Rental Products,,293.28,,,,,,,81.12,302.64,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,outpatient,,,327.00000,175.27000,Aetna,Medical Rental Products,,307.38,,,,,,,85.02,317.19,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,outpatient,,,425.00000,227.80000,Aetna,Medical Rental Products,,399.50,,,,,,,110.50,412.25,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,outpatient,,,210.00000,112.56000,Aetna,Medical Rental Products,,197.40,,,,,,,54.60,203.70,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,outpatient,,,495.00000,265.32000,Aetna,Medical Rental Products,,465.30,,,,,,,128.70,480.15,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,outpatient,,,541.00000,289.98000,Aetna,Medical Rental Products,,508.54,,,,,,,140.66,524.77,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Aetna,Medical Rental Products,LT,324.30,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Aetna,Medical Rental Products,RT,324.30,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Aetna,Medical Rental Products,LT,393.86,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Aetna,Medical Rental Products,RT,393.86,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Aetna,Medical Rental Products,LT,580.92,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Aetna,Medical Rental Products,RT,580.92,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,outpatient,,,463.00000,248.17000,Aetna,Medical Rental Products,,435.22,,,,,,,120.38,449.11,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,outpatient,,,511.00000,273.90000,Aetna,Medical Rental Products,,480.34,,,,,,,132.86,495.67,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,outpatient,,,132.00000,70.75000,Aetna,Medical Rental Products,,124.08,,,,,,,34.32,128.04,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Aetna,Medical Rental Products,LT,331.82,,,,,,,91.78,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Aetna,Medical Rental Products,RT,331.82,,,,,,,91.78,342.41,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,outpatient,,,273.00000,146.33000,Aetna,Medical Rental Products,,256.62,,,,,,,70.98,264.81,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,outpatient,,,503.00000,269.61000,Aetna,Medical Rental Products,,472.82,,,,,,,130.78,487.91,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,outpatient,,,561.00000,300.70000,Aetna,Medical Rental Products,,527.34,,,,,,,145.86,544.17,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Aetna,Medical Rental Products,LT,423.00,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Aetna,Medical Rental Products,RT,423.00,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,outpatient,,,650.00000,348.40000,Aetna,Medical Rental Products,,611.00,,,,,,,169.00,630.50,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,outpatient,,,642.00000,344.11000,Aetna,Medical Rental Products,,603.48,,,,,,,166.92,622.74,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,outpatient,,,777.00000,416.47000,Aetna,Medical Rental Products,,730.38,,,,,,,202.02,753.69,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,outpatient,,,381.00000,204.22000,Aetna,Medical Rental Products,,358.14,,,,,,,99.06,369.57,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Aetna,Medical Rental Products,LT,351.56,,,,,,,97.24,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Aetna,Medical Rental Products,RT,351.56,,,,,,,97.24,362.78,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Aetna,Medical Rental Products,LT,151.34,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Aetna,Medical Rental Products,RT,151.34,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Aetna,Medical Rental Products,LT,469.06,,,,,,,129.74,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Aetna,Medical Rental Products,RT,469.06,,,,,,,129.74,484.03,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,outpatient,,,214.00000,114.70000,Aetna,Medical Rental Products,,201.16,,,,,,,55.64,207.58,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,outpatient,,,329.00000,176.34000,Aetna,Medical Rental Products,,309.26,,,,,,,85.54,319.13,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,outpatient,,,197.00000,105.59000,Aetna,Medical Rental Products,,185.18,,,,,,,51.22,191.09,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,outpatient,,,263.00000,140.97000,Aetna,Medical Rental Products,,247.22,,,,,,,68.38,255.11,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,outpatient,,,234.00000,125.42000,Aetna,Medical Rental Products,,219.96,,,,,,,60.84,226.98,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,outpatient,,,401.00000,214.94000,Aetna,Medical Rental Products,,376.94,,,,,,,104.26,388.97,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,outpatient,,,515.00000,276.04000,Aetna,Medical Rental Products,,484.10,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,outpatient,,,747.00000,400.39000,Aetna,Medical Rental Products,,702.18,,,,,,,194.22,724.59,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,outpatient,,,854.00000,457.74000,Aetna,Medical Rental Products,,802.76,,,,,,,222.04,828.38,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,outpatient,,,589.00000,315.70000,Aetna,Medical Rental Products,,553.66,,,,,,,153.14,571.33,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,outpatient,,,613.00000,328.57000,Aetna,Medical Rental Products,,576.22,,,,,,,159.38,594.61,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,outpatient,,,806.00000,432.02000,Aetna,Medical Rental Products,,757.64,,,,,,,209.56,781.82,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,outpatient,,,529.00000,283.54000,Aetna,Medical Rental Products,,497.26,,,,,,,137.54,513.13,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,outpatient,,,939.00000,503.30000,Aetna,Medical Rental Products,,882.66,,,,,,,244.14,910.83,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,outpatient,,,515.00000,276.04000,Aetna,Medical Rental Products,,484.10,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,outpatient,,,616.00000,330.18000,Aetna,Medical Rental Products,,579.04,,,,,,,160.16,597.52,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,outpatient,,,377.00000,202.07000,Aetna,Medical Rental Products,,354.38,,,,,,,98.02,365.69,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,outpatient,,,340.00000,182.24000,Aetna,Medical Rental Products,,319.60,,,,,,,88.40,329.80,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,outpatient,,,388.00000,207.97000,Aetna,Medical Rental Products,,364.72,,,,,,,100.88,376.36,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,outpatient,,,456.00000,244.42000,Aetna,Medical Rental Products,,428.64,,,,,,,118.56,442.32,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,outpatient,,,267.00000,143.11000,Aetna,Medical Rental Products,,250.98,,,,,,,69.42,258.99,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Aetna,Medical Rental Products,LT,287.64,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Aetna,Medical Rental Products,"52,LT",287.64,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Aetna,Medical Rental Products,RT,287.64,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Aetna,Medical Rental Products,"52,RT",287.64,,,,,,,79.56,296.82,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,outpatient,,,456.00000,244.42000,Aetna,Medical Rental Products,,428.64,,,,,,,118.56,442.32,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,outpatient,,,381.00000,204.22000,Aetna,Medical Rental Products,,358.14,,,,,,,99.06,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Aetna,Medical Rental Products,LT,134.42,,,,,,,37.18,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Aetna,Medical Rental Products,RT,134.42,,,,,,,37.18,138.71,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Aetna,Medical Rental Products,LT,311.14,,,,,,,86.06,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Aetna,Medical Rental Products,RT,311.14,,,,,,,86.06,321.07,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1113.00000,596.57000,Aetna,Medical Rental Products,,1046.22,,,,,,,289.38,1079.61,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,outpatient,,,1043.00000,559.05000,Aetna,Medical Rental Products,,980.42,,,,,,,271.18,1011.71,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Aetna,Medical Rental Products,LT,240.64,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Aetna,Medical Rental Products,"52,LT",240.64,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Aetna,Medical Rental Products,RT,240.64,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Aetna,Medical Rental Products,"52,RT",240.64,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Aetna,Medical Rental Products,LT,480.34,,,,,,,132.86,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Aetna,Medical Rental Products,RT,480.34,,,,,,,132.86,495.67,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Aetna,Medical Rental Products,LT,519.82,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Aetna,Medical Rental Products,RT,519.82,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Aetna,Medical Rental Products,LT,1011.44,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Aetna,Medical Rental Products,RT,1011.44,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Aetna,Medical Rental Products,LT,813.10,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Aetna,Medical Rental Products,RT,813.10,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Aetna,Medical Rental Products,LT,689.96,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Aetna,Medical Rental Products,RT,689.96,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Aetna,Medical Rental Products,LT,686.20,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Aetna,Medical Rental Products,RT,686.20,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Aetna,Medical Rental Products,LT,244.40,,,,,,,67.60,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Aetna,Medical Rental Products,RT,244.40,,,,,,,67.60,252.20,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,outpatient,,,428.00000,203.73000,Aetna,Medical Rental Products,,402.32,,,,,,,111.28,415.16,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,outpatient,,,492.00000,234.19000,Aetna,Medical Rental Products,,462.48,,,,,,,127.92,477.24,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,outpatient,,,607.00000,288.93000,Aetna,Medical Rental Products,,570.58,,,,,,,157.82,588.79,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,outpatient,,,649.00000,308.92000,Aetna,Medical Rental Products,,610.06,,,,,,,168.74,629.53,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,outpatient,,,377.00000,121.77000,Aetna,Medical Rental Products,50,,94.00,,,,,0,98.02,365.69,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,65.26,243.47,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,65.26,243.47,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,outpatient,,,1170.00000,377.91000,Aetna,Medical Rental Products,50,,94.00,,,,,0,304.20,1134.90,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,202.80,756.60,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,202.80,756.60,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,outpatient,,,1389.00000,448.65000,Aetna,Medical Rental Products,,,94.00,,,,,0,361.14,1347.33,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,outpatient,,,345.00000,111.44000,Aetna,Medical Rental Products,50,,94.00,,,,,0,89.70,334.65,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,59.80,223.10,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,59.80,223.10,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,outpatient,,,2102.00000,678.95000,Aetna,Medical Rental Products,50,,94.00,,,,,0,546.52,2038.94,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,364.26,1358.97,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,364.26,1358.97,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,outpatient,,,357.00000,115.31000,Aetna,Medical Rental Products,50,,94.00,,,,,0,92.82,346.29,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,61.88,230.86,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,61.88,230.86,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,outpatient,,,2082.00000,672.49000,Aetna,Medical Rental Products,50,,94.00,,,,,0,541.32,2019.54,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,360.88,1346.36,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,360.88,1346.36,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,outpatient,,,246.00000,79.46000,Aetna,Medical Rental Products,50,,94.00,,,,,0,63.96,238.62,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,42.64,159.08,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,42.64,159.08,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,outpatient,,,309.00000,99.81000,Aetna,Medical Rental Products,50,,94.00,,,,,0,80.34,299.73,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,53.56,199.82,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,53.56,199.82,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,outpatient,,,471.00000,152.13000,Aetna,Medical Rental Products,50,,94.00,,,,,0,122.46,456.87,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,81.64,304.58,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,81.64,304.58,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,outpatient,,,239.00000,77.20000,Aetna,Medical Rental Products,50,,94.00,,,,,0,62.14,231.83,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,41.34,154.23,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,41.34,154.23,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,outpatient,,,558.00000,180.23000,Aetna,Medical Rental Products,50,,94.00,,,,,0,145.08,541.26,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,96.72,360.84,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,96.72,360.84,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,outpatient,,,413.00000,133.40000,Aetna,Medical Rental Products,50,,94.00,,,,,0,107.38,400.61,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,71.50,266.75,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,71.50,266.75,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,outpatient,,,462.00000,149.23000,Aetna,Medical Rental Products,,,94.00,,,,,0,120.12,448.14,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,outpatient,,,170.00000,54.91000,Aetna,Medical Rental Products,,,94.00,,,,,0,44.20,164.90,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,outpatient,,,281.00000,90.76000,Aetna,Medical Rental Products,,,94.00,,,,,0,73.06,272.57,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,outpatient,,,562.00000,181.53000,Aetna,Medical Rental Products,,,94.00,,,,,0,146.12,545.14,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,outpatient,,,2076.00000,670.55000,Aetna,Medical Rental Products,50,,94.00,,,,,0,539.76,2013.72,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,359.84,1342.48,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,359.84,1342.48,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,outpatient,,,934.00000,301.68000,Aetna,Medical Rental Products,,,94.00,,,,,0,242.84,905.98,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,outpatient,,,842.00000,271.97000,Aetna,Medical Rental Products,,,94.00,,,,,0,218.92,816.74,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,outpatient,,,846.00000,273.26000,Aetna,Medical Rental Products,,,94.00,,,,,0,219.96,820.62,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,outpatient,,,971.00000,313.63000,Aetna,Medical Rental Products,,,94.00,,,,,0,252.46,941.87,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,outpatient,,,762.00000,246.13000,Aetna,Medical Rental Products,,,94.00,,,,,0,198.12,739.14,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,outpatient,,,758.00000,244.83000,Aetna,Medical Rental Products,,,94.00,,,,,0,197.08,735.26,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,outpatient,,,161.00000,52.00000,Aetna,Medical Rental Products,,,94.00,,,,,0,41.86,156.17,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,outpatient,,,234.00000,75.58000,Aetna,Medical Rental Products,50,,94.00,,,,,0,60.84,226.98,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,40.56,151.32,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,40.56,151.32,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1517.00000,489.99000,Aetna,Medical Rental Products,50,,94.00,,,,,0,394.42,1471.49,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,262.86,980.67,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,262.86,980.67,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,outpatient,,,822.00000,265.51000,Aetna,Medical Rental Products,50,,94.00,,,,,0,213.72,797.34,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,142.48,531.56,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,142.48,531.56,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,outpatient,,,2613.00000,844.00000,Aetna,Medical Rental Products,,,94.00,,,,,0,679.38,2534.61,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,outpatient,,,903.00000,291.67000,Aetna,Medical Rental Products,,,94.00,,,,,0,234.78,875.91,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,outpatient,,,1156.00000,373.39000,Aetna,Medical Rental Products,,,94.00,,,,,0,300.56,1121.32,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,outpatient,,,677.00000,218.67000,Aetna,Medical Rental Products,,,94.00,,,,,0,176.02,656.69,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1928.00000,622.74000,Aetna,Medical Rental Products,50,,94.00,,,,,0,501.28,1870.16,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,334.10,1246.45,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,334.10,1246.45,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,outpatient,,,812.00000,262.28000,Aetna,Medical Rental Products,50,,94.00,,,,,0,211.12,787.64,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,140.66,524.77,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,140.66,524.77,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,outpatient,,,825.00000,266.48000,Aetna,Medical Rental Products,50,,94.00,,,,,0,214.50,800.25,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,143.00,533.50,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,143.00,533.50,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,outpatient,,,3494.00000,1128.56000,Aetna,Medical Rental Products,50,,94.00,,,,,0,908.44,3389.18,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,605.54,2259.13,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,605.54,2259.13,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,outpatient,,,840.00000,271.32000,Aetna,Medical Rental Products,50,,94.00,,,,,0,218.40,814.80,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,145.60,543.20,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,145.60,543.20,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,outpatient,,,792.00000,255.82000,Aetna,Medical Rental Products,50,,94.00,,,,,0,205.92,768.24,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,137.28,512.16,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,137.28,512.16,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,outpatient,,,272.00000,87.86000,Aetna,Medical Rental Products,,,94.00,,,,,0,70.72,263.84,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,outpatient,,,1268.00000,409.56000,Aetna,Medical Rental Products,,,94.00,,,,,0,329.68,1229.96,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,outpatient,,,896.00000,289.41000,Aetna,Medical Rental Products,,,94.00,,,,,0,232.96,869.12,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,outpatient,,,884.00000,285.53000,Aetna,Medical Rental Products,,,94.00,,,,,0,229.84,857.48,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Aetna,Medical Rental Products,,572.46,,,,,,,158.34,590.73,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,outpatient,,,966.00000,383.50000,Aetna,Medical Rental Products,,908.04,,,,,,,251.16,937.02,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,outpatient,,,872.00000,346.18000,Aetna,Medical Rental Products,,819.68,,,,,,,226.72,845.84,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,outpatient,,,492.00000,195.32000,Aetna,Medical Rental Products,,462.48,,,,,,,127.92,477.24,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,outpatient,,,331.00000,131.41000,Aetna,Medical Rental Products,,311.14,,,,,,,86.06,321.07,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,outpatient,,,5215.00000,2070.36000,Aetna,Medical Rental Products,,4902.10,,,,,,,1355.90,5058.55,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,outpatient,,,5422.00000,2152.53000,Aetna,Medical Rental Products,,5096.68,,,,,,,1409.72,5259.34,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1878.00000,788.76000,Aetna,Medical Rental Products,,1765.32,,,,,,,488.28,1821.66,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,outpatient,,,2253.00000,946.26000,Aetna,Medical Rental Products,,2117.82,,,,,,,585.78,2185.41,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1502.00000,630.84000,Aetna,Medical Rental Products,,1411.88,,,,,,,390.52,1456.94,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,outpatient,,,2024.00000,850.08000,Aetna,Medical Rental Products,,1902.56,,,,,,,526.24,1963.28,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,outpatient,,,2429.00000,1020.18000,Aetna,Medical Rental Products,,2283.26,,,,,,,631.54,2356.13,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1619.00000,679.98000,Aetna,Medical Rental Products,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,outpatient,,,2425.00000,1018.50000,Aetna,Medical Rental Products,,2279.50,,,,,,,630.50,2352.25,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2910.00000,1222.20000,Aetna,Medical Rental Products,,2735.40,,,,,,,756.60,2822.70,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1940.00000,814.80000,Aetna,Medical Rental Products,,1823.60,,,,,,,504.40,1881.80,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2317.00000,973.14000,Aetna,Medical Rental Products,,2177.98,,,,,,,602.42,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2780.00000,1167.60000,Aetna,Medical Rental Products,,2613.20,,,,,,,722.80,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1853.00000,778.26000,Aetna,Medical Rental Products,,1741.82,,,,,,,481.78,1797.41,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2366.00000,993.72000,Aetna,Medical Rental Products,,2224.04,,,,,,,615.16,2295.02,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,outpatient,,,3056.00000,1283.52000,Aetna,Medical Rental Products,,2872.64,,,,,,,794.56,2964.32,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,outpatient,,,2829.00000,1386.21000,Aetna,Medical Rental Products,,2659.26,,,,,,,735.54,2744.13,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,outpatient,,,3395.00000,1663.55000,Aetna,Medical Rental Products,,3191.30,,,,,,,882.70,3293.15,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,outpatient,,,2263.00000,1108.87000,Aetna,Medical Rental Products,,2127.22,,,,,,,588.38,2195.11,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,outpatient,,,4697.00000,2301.53000,Aetna,Medical Rental Products,,4415.18,,,,,,,1221.22,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,outpatient,,,5636.00000,2761.64000,Aetna,Medical Rental Products,,5297.84,,,,,,,1465.36,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,outpatient,,,3757.00000,1840.93000,Aetna,Medical Rental Products,,3531.58,,,,,,,976.82,3644.29,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,outpatient,,,2619.00000,1283.31000,Aetna,Medical Rental Products,,2461.86,,,,,,,680.94,2540.43,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,outpatient,,,3143.00000,1540.07000,Aetna,Medical Rental Products,,2954.42,,,,,,,817.18,3048.71,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,outpatient,,,2095.00000,1026.55000,Aetna,Medical Rental Products,,1969.30,,,,,,,544.70,2032.15,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,outpatient,,,278.00000,136.22000,Aetna,Medical Rental Products,,261.32,,,,,,,72.28,269.66,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Aetna,Medical Rental Products,LT,1983.40,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Aetna,Medical Rental Products,RT,1983.40,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Aetna,Medical Rental Products,LT,2380.08,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Aetna,Medical Rental Products,RT,2380.08,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Aetna,Medical Rental Products,LT,1586.72,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Aetna,Medical Rental Products,RT,1586.72,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Aetna,Medical Rental Products,LT,1902.56,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Aetna,Medical Rental Products,RT,1902.56,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Aetna,Medical Rental Products,LT,2283.26,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Aetna,Medical Rental Products,RT,2283.26,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Aetna,Medical Rental Products,LT,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Aetna,Medical Rental Products,RT,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,outpatient,,,1224.00000,599.76000,Aetna,Medical Rental Products,,1150.56,,,,,,,318.24,1187.28,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,outpatient,,,3020.00000,1479.80000,Aetna,Medical Rental Products,,2838.80,,,,,,,785.20,2929.40,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,outpatient,,,3624.00000,1775.76000,Aetna,Medical Rental Products,,3406.56,,,,,,,942.24,3515.28,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,outpatient,,,2416.00000,1183.84000,Aetna,Medical Rental Products,,2271.04,,,,,,,628.16,2343.52,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,outpatient,,,2728.00000,1336.72000,Aetna,Medical Rental Products,,2564.32,,,,,,,709.28,2646.16,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,outpatient,,,3273.00000,1603.77000,Aetna,Medical Rental Products,,3076.62,,,,,,,850.98,3174.81,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,outpatient,,,2182.00000,1069.18000,Aetna,Medical Rental Products,,2051.08,,,,,,,567.32,2116.54,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,outpatient,,,3133.00000,1535.17000,Aetna,Medical Rental Products,,2945.02,,,,,,,814.58,3039.01,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,outpatient,,,3759.00000,1841.91000,Aetna,Medical Rental Products,,3533.46,,,,,,,977.34,3646.23,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,outpatient,,,2506.00000,1227.94000,Aetna,Medical Rental Products,,2355.64,,,,,,,651.56,2430.82,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,outpatient,,,2857.00000,1399.93000,Aetna,Medical Rental Products,,2685.58,,,,,,,742.82,2771.29,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,outpatient,,,3428.00000,1679.72000,Aetna,Medical Rental Products,,3222.32,,,,,,,891.28,3325.16,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,outpatient,,,2285.00000,1119.65000,Aetna,Medical Rental Products,,2147.90,,,,,,,594.10,2216.45,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,outpatient,,,3565.00000,1746.85000,Aetna,Medical Rental Products,,3351.10,,,,,,,926.90,3458.05,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,outpatient,,,5918.00000,2899.82000,Aetna,Medical Rental Products,,5562.92,,,,,,,1538.68,5740.46,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,outpatient,,,3301.00000,1617.49000,Aetna,Medical Rental Products,,3102.94,,,,,,,858.26,3201.97,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Aetna,Medical Rental Products,LT,2499.46,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Aetna,Medical Rental Products,RT,2499.46,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Aetna,Medical Rental Products,LT,2397.94,,,,,,,663.26,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Aetna,Medical Rental Products,RT,2397.94,,,,,,,663.26,2474.47,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3806.00000,1864.94000,Aetna,Medical Rental Products,,3577.64,,,,,,,989.56,3691.82,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,outpatient,,,2149.00000,694.13000,Aetna,Medical Rental Products,,,94.00,,,,,0,558.74,2084.53,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,outpatient,,,1973.00000,637.28000,Aetna,Medical Rental Products,,,94.00,,,,,0,512.98,1913.81,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1784.00000,576.23000,Aetna,Medical Rental Products,50,,94.00,,,,,0,463.84,1730.48,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,309.14,1153.33,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,309.14,1153.33,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,outpatient,,,130.00000,69.68000,Aetna,Medical Rental Products,,122.20,,,,,,,33.80,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,outpatient,,,44.00000,23.58000,Aetna,Medical Rental Products,,41.36,,,,,,,11.44,42.68,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,outpatient,,,456.00000,244.42000,Aetna,Medical Rental Products,,428.64,,,,,,,118.56,442.32,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,outpatient,,,108.00000,57.89000,Aetna,Medical Rental Products,,101.52,,,,,,,28.08,104.76,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,outpatient,,,306.00000,164.02000,Aetna,Medical Rental Products,,287.64,,,,,,,79.56,296.82,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,outpatient,,,257.00000,137.75000,Aetna,Medical Rental Products,,241.58,,,,,,,66.82,249.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Aetna,Medical Rental Products,,3813.58,,,,,,,1054.82,3935.29,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Aetna,Medical Rental Products,,4575.92,,,,,,,1265.68,4721.96,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Aetna,Medical Rental Products,,3050.30,,,,,,,843.70,3147.65,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Aetna,Medical Rental Products,,3813.58,,,,,,,1054.82,3935.29,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Aetna,Medical Rental Products,,4575.92,,,,,,,1265.68,4721.96,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Aetna,Medical Rental Products,,3050.30,,,,,,,843.70,3147.65,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,outpatient,,,1725.00000,865.95000,Aetna,Medical Rental Products,,1621.50,,,,,,,448.50,1673.25,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,outpatient,,,1743.00000,874.99000,Aetna,Medical Rental Products,,1638.42,,,,,,,453.18,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Aetna,Medical Rental Products,LT,1386.50,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Aetna,Medical Rental Products,RT,1386.50,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,outpatient,,,1162.00000,583.32000,Aetna,Medical Rental Products,,1092.28,,,,,,,302.12,1127.14,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Aetna,Medical Rental Products,LT,924.02,,,,,,,255.58,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Aetna,Medical Rental Products,RT,924.02,,,,,,,255.58,953.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,outpatient,,,3183.00000,1597.87000,Aetna,Medical Rental Products,,2992.02,,,,,,,827.58,3087.51,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,outpatient,,,3819.00000,1917.14000,Aetna,Medical Rental Products,,3589.86,,,,,,,992.94,3704.43,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,outpatient,,,2546.00000,1278.09000,Aetna,Medical Rental Products,,2393.24,,,,,,,661.96,2469.62,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Aetna,Medical Rental Products,LT,3626.52,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Aetna,Medical Rental Products,RT,3626.52,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Aetna,Medical Rental Products,LT,4351.26,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Aetna,Medical Rental Products,RT,4351.26,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Aetna,Medical Rental Products,LT,2900.84,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Aetna,Medical Rental Products,RT,2900.84,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Aetna,Medical Rental Products,LT,2354.70,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Aetna,Medical Rental Products,RT,2354.70,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Aetna,Medical Rental Products,LT,2825.64,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Aetna,Medical Rental Products,RT,2825.64,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Aetna,Medical Rental Products,LT,1883.76,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Aetna,Medical Rental Products,RT,1883.76,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Aetna,Medical Rental Products,LT,2948.78,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Aetna,Medical Rental Products,RT,2948.78,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Aetna,Medical Rental Products,LT,3538.16,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Aetna,Medical Rental Products,RT,3538.16,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Aetna,Medical Rental Products,LT,2358.46,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Aetna,Medical Rental Products,RT,2358.46,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Aetna,Medical Rental Products,LT,2841.62,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Aetna,Medical Rental Products,RT,2841.62,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Aetna,Medical Rental Products,LT,3409.38,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Aetna,Medical Rental Products,RT,3409.38,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Aetna,Medical Rental Products,LT,2272.92,,,,,,,628.68,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Aetna,Medical Rental Products,RT,2272.92,,,,,,,628.68,2345.46,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,outpatient,,,870.00000,436.74000,Aetna,Medical Rental Products,,817.80,,,,,,,226.20,843.90,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,outpatient,,,1353.00000,679.21000,Aetna,Medical Rental Products,,1271.82,,,,,,,351.78,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Aetna,Medical Rental Products,LT,847.88,,,,,,,234.52,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Aetna,Medical Rental Products,RT,847.88,,,,,,,234.52,874.94,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3489.00000,1751.48000,Aetna,Medical Rental Products,,3279.66,,,,,,,907.14,3384.33,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,outpatient,,,4187.00000,2101.87000,Aetna,Medical Rental Products,,3935.78,,,,,,,1088.62,4061.39,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,outpatient,,,2791.00000,1401.08000,Aetna,Medical Rental Products,,2623.54,,,,,,,725.66,2707.27,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,outpatient,,,492.00000,246.98000,Aetna,Medical Rental Products,,462.48,,,,,,,127.92,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,outpatient,,,331.00000,166.16000,Aetna,Medical Rental Products,,311.14,,,,,,,86.06,321.07,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,outpatient,,,4440.00000,2357.64000,Aetna,Medical Rental Products,,4173.60,,,,,,,1154.40,4306.80,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,outpatient,,,5328.00000,2829.17000,Aetna,Medical Rental Products,,5008.32,,,,,,,1385.28,5168.16,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,outpatient,,,3552.00000,1886.11000,Aetna,Medical Rental Products,,3338.88,,,,,,,923.52,3445.44,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,outpatient,,,2528.00000,1342.37000,Aetna,Medical Rental Products,,2376.32,,,,,,,657.28,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,outpatient,,,3033.00000,1610.52000,Aetna,Medical Rental Products,,2851.02,,,,,,,788.58,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,outpatient,,,2022.00000,1073.68000,Aetna,Medical Rental Products,,1900.68,,,,,,,525.72,1961.34,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,outpatient,,,3610.00000,1909.69000,Aetna,Medical Rental Products,,3393.40,,,,,,,938.60,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,outpatient,,,4332.00000,2291.63000,Aetna,Medical Rental Products,,4072.08,,,,,,,1126.32,4202.04,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,outpatient,,,2888.00000,1527.75000,Aetna,Medical Rental Products,,2714.72,,,,,,,750.88,2801.36,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,outpatient,,,4532.00000,2397.43000,Aetna,Medical Rental Products,,4260.08,,,,,,,1178.32,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,outpatient,,,5438.00000,2876.70000,Aetna,Medical Rental Products,,5111.72,,,,,,,1413.88,5274.86,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,outpatient,,,3625.00000,1917.62000,Aetna,Medical Rental Products,,3407.50,,,,,,,942.50,3516.25,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,outpatient,,,3639.00000,1925.03000,Aetna,Medical Rental Products,,3420.66,,,,,,,946.14,3529.83,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,outpatient,,,4367.00000,2310.14000,Aetna,Medical Rental Products,,4104.98,,,,,,,1135.42,4235.99,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,outpatient,,,2911.00000,1539.92000,Aetna,Medical Rental Products,,2736.34,,,,,,,756.86,2823.67,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3494.00000,1719.05000,Aetna,Medical Rental Products,,3284.36,,,,,,,908.44,3389.18,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,outpatient,,,4193.00000,2062.96000,Aetna,Medical Rental Products,,3941.42,,,,,,,1090.18,4067.21,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,outpatient,,,2795.00000,1375.14000,Aetna,Medical Rental Products,,2627.30,,,,,,,726.70,2711.15,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,outpatient,,,2717.00000,1336.76000,Aetna,Medical Rental Products,,2553.98,,,,,,,706.42,2635.49,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,outpatient,,,3260.00000,1603.92000,Aetna,Medical Rental Products,,3064.40,,,,,,,847.60,3162.20,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,outpatient,,,2173.00000,1069.12000,Aetna,Medical Rental Products,,2042.62,,,,,,,564.98,2107.81,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Aetna,Medical Rental Products,LT,3807.94,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Aetna,Medical Rental Products,RT,3807.94,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Aetna,Medical Rental Products,LT,4569.34,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Aetna,Medical Rental Products,RT,4569.34,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Aetna,Medical Rental Products,LT,3046.54,,,,,,,842.66,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Aetna,Medical Rental Products,RT,3046.54,,,,,,,842.66,3143.77,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,outpatient,,,4260.00000,2420.32000,Aetna,Medical Rental Products,,4004.40,,,,,,,1107.60,4132.20,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,outpatient,,,5112.00000,2904.38000,Aetna,Medical Rental Products,,4805.28,,,,,,,1329.12,4958.64,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3408.00000,1936.26000,Aetna,Medical Rental Products,,3203.52,,,,,,,886.08,3305.76,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3343.00000,1899.33000,Aetna,Medical Rental Products,,3142.42,,,,,,,869.18,3242.71,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,outpatient,,,4010.00000,2278.28000,Aetna,Medical Rental Products,,3769.40,,,,,,,1042.60,3889.70,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,outpatient,,,2674.00000,1519.23000,Aetna,Medical Rental Products,,2513.56,,,,,,,695.24,2593.78,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Aetna,Medical Rental Products,LT,3096.36,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Aetna,Medical Rental Products,RT,3096.36,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Aetna,Medical Rental Products,LT,3715.82,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Aetna,Medical Rental Products,RT,3715.82,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Aetna,Medical Rental Products,LT,2476.90,,,,,,,685.10,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Aetna,Medical Rental Products,RT,2476.90,,,,,,,685.10,2555.95,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3664.00000,2081.70000,Aetna,Medical Rental Products,,3444.16,,,,,,,952.64,3554.08,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,outpatient,,,4397.00000,2498.16000,Aetna,Medical Rental Products,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,outpatient,,,2931.00000,1665.25000,Aetna,Medical Rental Products,,2755.14,,,,,,,762.06,2843.07,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,outpatient,,,4759.00000,2703.83000,Aetna,Medical Rental Products,,4473.46,,,,,,,1237.34,4616.23,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,outpatient,,,5710.00000,3244.14000,Aetna,Medical Rental Products,,5367.40,,,,,,,1484.60,5538.70,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3807.00000,2162.95000,Aetna,Medical Rental Products,,3578.58,,,,,,,989.82,3692.79,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2915.00000,1574.10000,Aetna,Medical Rental Products,,2740.10,,,,,,,757.90,2827.55,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1918.00000,1035.72000,Aetna,Medical Rental Products,,1802.92,,,,,,,498.68,1860.46,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2292.00000,1237.68000,Aetna,Medical Rental Products,,2154.48,,,,,,,595.92,2223.24,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,outpatient,,,2984.00000,1611.36000,Aetna,Medical Rental Products,,2804.96,,,,,,,775.84,2894.48,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,outpatient,,,769.00000,415.26000,Aetna,Medical Rental Products,,722.86,,,,,,,199.94,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,outpatient,,,1280.00000,691.20000,Aetna,Medical Rental Products,,1203.20,,,,,,,332.80,1241.60,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,outpatient,,,1878.00000,1014.12000,Aetna,Medical Rental Products,,1765.32,,,,,,,488.28,1821.66,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,outpatient,,,2196.00000,1185.84000,Aetna,Medical Rental Products,,2064.24,,,,,,,570.96,2130.12,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,outpatient,,,844.00000,455.76000,Aetna,Medical Rental Products,,793.36,,,,,,,219.44,818.68,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,outpatient,,,1305.00000,704.70000,Aetna,Medical Rental Products,,1226.70,,,,,,,339.30,1265.85,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,outpatient,,,576.00000,311.04000,Aetna,Medical Rental Products,,541.44,,,,,,,149.76,558.72,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,outpatient,,,809.00000,436.86000,Aetna,Medical Rental Products,,760.46,,,,,,,210.34,784.73,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,outpatient,,,2462.00000,1329.48000,Aetna,Medical Rental Products,,2314.28,,,,,,,640.12,2388.14,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,outpatient,,,918.00000,495.72000,Aetna,Medical Rental Products,,862.92,,,,,,,238.68,890.46,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,outpatient,,,1102.00000,595.08000,Aetna,Medical Rental Products,,1035.88,,,,,,,286.52,1068.94,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,outpatient,,,812.00000,438.48000,Aetna,Medical Rental Products,,763.28,,,,,,,211.12,787.64,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,outpatient,,,1407.00000,759.78000,Aetna,Medical Rental Products,,1322.58,,,,,,,365.82,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,outpatient,,,1980.00000,1069.20000,Aetna,Medical Rental Products,,1861.20,,,,,,,514.80,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,outpatient,,,964.00000,520.56000,Aetna,Medical Rental Products,,906.16,,,,,,,250.64,935.08,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,outpatient,,,1040.00000,561.60000,Aetna,Medical Rental Products,,977.60,,,,,,,270.40,1008.80,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,outpatient,,,795.00000,429.30000,Aetna,Medical Rental Products,,747.30,,,,,,,206.70,771.15,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,outpatient,,,1124.00000,606.96000,Aetna,Medical Rental Products,,1056.56,,,,,,,292.24,1090.28,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,outpatient,,,736.00000,397.44000,Aetna,Medical Rental Products,,691.84,,,,,,,191.36,713.92,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,outpatient,,,700.00000,378.00000,Aetna,Medical Rental Products,,658.00,,,,,,,182.00,679.00,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,outpatient,,,821.00000,443.34000,Aetna,Medical Rental Products,,771.74,,,,,,,213.46,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,outpatient,,,846.00000,456.84000,Aetna,Medical Rental Products,,795.24,,,,,,,219.96,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,outpatient,,,958.00000,517.32000,Aetna,Medical Rental Products,,900.52,,,,,,,249.08,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,outpatient,,,1261.00000,680.94000,Aetna,Medical Rental Products,,1185.34,,,,,,,327.86,1223.17,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,outpatient,,,971.00000,524.34000,Aetna,Medical Rental Products,,912.74,,,,,,,252.46,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,outpatient,,,1837.00000,991.98000,Aetna,Medical Rental Products,,1726.78,,,,,,,477.62,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,outpatient,,,1099.00000,593.46000,Aetna,Medical Rental Products,,1033.06,,,,,,,285.74,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,outpatient,,,2178.00000,1176.12000,Aetna,Medical Rental Products,,2047.32,,,,,,,566.28,2112.66,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,outpatient,,,1226.00000,662.04000,Aetna,Medical Rental Products,,1152.44,,,,,,,318.76,1189.22,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,outpatient,,,1048.00000,565.92000,Aetna,Medical Rental Products,,985.12,,,,,,,272.48,1016.56,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,outpatient,,,970.00000,523.80000,Aetna,Medical Rental Products,,911.80,,,,,,,252.20,940.90,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,outpatient,,,1803.00000,973.62000,Aetna,Medical Rental Products,,1694.82,,,,,,,468.78,1748.91,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,outpatient,,,2504.00000,1352.16000,Aetna,Medical Rental Products,,2353.76,,,,,,,651.04,2428.88,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2457.00000,1326.78000,Aetna,Medical Rental Products,,2309.58,,,,,,,638.82,2383.29,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,outpatient,,,923.00000,498.42000,Aetna,Medical Rental Products,,867.62,,,,,,,239.98,895.31,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,outpatient,,,5478.00000,2958.12000,Aetna,Medical Rental Products,,5149.32,,,,,,,1424.28,5313.66,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,outpatient,,,4551.00000,2457.54000,Aetna,Medical Rental Products,,4277.94,,,,,,,1183.26,4414.47,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,outpatient,,,1360.00000,734.40000,Aetna,Medical Rental Products,,1278.40,,,,,,,353.60,1319.20,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,outpatient,,,1209.00000,652.86000,Aetna,Medical Rental Products,,1136.46,,,,,,,314.34,1172.73,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,outpatient,,,848.00000,457.92000,Aetna,Medical Rental Products,,797.12,,,,,,,220.48,822.56,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,outpatient,,,1071.00000,578.34000,Aetna,Medical Rental Products,,1006.74,,,,,,,278.46,1038.87,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,outpatient,,,1792.00000,967.68000,Aetna,Medical Rental Products,,1684.48,,,,,,,465.92,1738.24,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,outpatient,,,35.00000,18.90000,Aetna,Medical Rental Products,,32.90,,,,,,,9.10,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,outpatient,,,285.00000,153.90000,Aetna,Medical Rental Products,,267.90,,,,,,,74.10,276.45,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,outpatient,,,1012.00000,546.48000,Aetna,Medical Rental Products,,951.28,,,,,,,263.12,981.64,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,outpatient,,,492.00000,265.68000,Aetna,Medical Rental Products,,462.48,,,,,,,127.92,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,outpatient,,,739.00000,399.06000,Aetna,Medical Rental Products,,694.66,,,,,,,192.14,716.83,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,outpatient,,,515.00000,278.10000,Aetna,Medical Rental Products,,484.10,,,,,,,133.90,499.55,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,outpatient,,,1467.00000,792.18000,Aetna,Medical Rental Products,,1378.98,,,,,,,381.42,1422.99,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,outpatient,,,1683.00000,888.62000,Aetna,Medical Rental Products,,1582.02,,,,,,,437.58,1632.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,426.30000,225.09000,Aetna,Medical Rental Products,,400.72,,,,,,,110.84,413.51,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,725.00000,382.80000,Aetna,Medical Rental Products,,681.50,,,,,,,188.50,1855.42,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,1852.00000,977.86000,Aetna,Medical Rental Products,,1740.88,,,,,,,481.52,1868.26,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,110.00000,58.08000,Aetna,Medical Rental Products,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,98.00000,51.74000,Aetna,Medical Rental Products,,92.12,,,,,,,25.48,1662.92,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,2018.00000,1065.50000,Aetna,Medical Rental Products,,1896.92,,,,,,,524.68,1957.46,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,4325.00000,2283.60000,Aetna,Medical Rental Products,,4065.50,,,,,,,1124.50,4195.25,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Aetna,Medical Rental Products,,161.68,,,,,,,44.72,166.84,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,942.00000,497.38000,Aetna,Medical Rental Products,,885.48,,,,,,,244.92,913.74,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,413.00000,218.06000,Aetna,Medical Rental Products,,388.22,,,,,,,107.38,400.61,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,outpatient,,,257.00000,135.70000,Aetna,Medical Rental Products,,241.58,,,,,,,66.82,249.29,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,116.00000,61.25000,Aetna,Medical Rental Products,,109.04,,,,,,,30.16,112.52,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,463.20000,244.57000,Aetna,Medical Rental Products,,435.41,,,,,,,120.43,449.30,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,804.00000,424.51000,Aetna,Medical Rental Products,,755.76,,,,,,,209.04,779.88,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Aetna,Medical Rental Products,,161.68,,,,,,,44.72,166.84,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,354.30000,187.07000,Aetna,Medical Rental Products,,333.04,,,,,,,92.12,343.67,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,277.90000,146.73000,Aetna,Medical Rental Products,,261.23,,,,,,,72.25,269.56,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,200.00000,105.60000,Aetna,Medical Rental Products,,188.00,,,,,,,52.00,194.00,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,outpatient,,,197.00000,63.63000,Aetna,Medical Rental Products,,,94.00,,,,,0,51.22,191.09,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,outpatient,,,468.00000,151.16000,Aetna,Medical Rental Products,50,,94.00,,,,,0,121.68,453.96,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,81.12,302.64,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,81.12,302.64,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Aetna,Medical Rental Products,,425.82,,,,,,,117.78,439.41,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Aetna,Medical Rental Products,,,94.00,,,,,0,158.34,590.73,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1248.00000,403.10000,Aetna,Medical Rental Products,50,,94.00,,,,,0,324.48,1210.56,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,216.32,807.04,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,216.32,807.04,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,1101.10,4107.95,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,1101.10,4107.95,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,outpatient,,,2119.00000,684.44000,Aetna,Medical Rental Products,,,94.00,,,,,0,550.94,2055.43,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1943.00000,627.59000,Aetna,Medical Rental Products,,,94.00,,,,,0,505.18,1884.71,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,outpatient,,,1426.00000,460.60000,Aetna,Medical Rental Products,,,94.00,,,,,0,370.76,1383.22,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,outpatient,,,4202.00000,1357.25000,Aetna,Medical Rental Products,50,,94.00,,,,,0,1092.52,4075.94,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,728.26,2716.97,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,728.26,2716.97,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,outpatient,,,832.00000,268.74000,Aetna,Medical Rental Products,,,94.00,,,,,0,216.32,807.04,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,outpatient,,,1457.00000,470.61000,Aetna,Medical Rental Products,,,94.00,,,,,0,378.82,1413.29,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,193.18,720.71,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,193.18,720.71,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,outpatient,,,232.00000,74.94000,Aetna,Medical Rental Products,,,94.00,,,,,0,60.32,225.04,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,outpatient,,,1364.00000,440.57000,Aetna,Medical Rental Products,50,,94.00,,,,,0,354.64,1323.08,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,236.34,881.73,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,236.34,881.73,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,outpatient,,,510.00000,355.98000,Aetna,Medical Rental Products,,479.40,,,,,,,132.60,494.70,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,outpatient,,,1001.00000,698.70000,Aetna,Medical Rental Products,,940.94,,,,,,,260.26,970.97,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,outpatient,,,887.00000,619.13000,Aetna,Medical Rental Products,,833.78,,,,,,,230.62,860.39,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,outpatient,,,1022.00000,713.36000,Aetna,Medical Rental Products,50,960.68,,,,,,,265.72,991.34,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Aetna,Medical Rental Products,LT,640.14,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Aetna,Medical Rental Products,RT,640.14,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,outpatient,,,945.00000,659.61000,Aetna,Medical Rental Products,50,888.30,,,,,,,245.70,916.65,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Aetna,Medical Rental Products,LT,592.20,,,,,,,163.80,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Aetna,Medical Rental Products,RT,592.20,,,,,,,163.80,611.10,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,outpatient,,,577.00000,402.75000,Aetna,Medical Rental Products,,542.38,,,,,,,150.02,559.69,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,outpatient,,,433.00000,302.23000,Aetna,Medical Rental Products,,407.02,,,,,,,112.58,420.01,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,outpatient,,,331.00000,231.04000,Aetna,Medical Rental Products,,311.14,,,,,,,86.06,321.07,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,outpatient,,,662.00000,462.08000,Aetna,Medical Rental Products,,622.28,,,,,,,172.12,642.14,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,outpatient,,,752.00000,524.90000,Aetna,Medical Rental Products,,706.88,,,,,,,195.52,729.44,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Aetna,Medical Rental Products,,171.08,,,,,,,47.32,176.54,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,outpatient,,,420.00000,293.16000,Aetna,Medical Rental Products,,394.80,,,,,,,109.20,407.40,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,outpatient,,,253.00000,176.59000,Aetna,Medical Rental Products,,237.82,,,,,,,65.78,245.41,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,outpatient,,,168.00000,117.26000,Aetna,Medical Rental Products,,157.92,,,,,,,43.68,162.96,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,outpatient,,,695.00000,485.11000,Aetna,Medical Rental Products,,653.30,,,,,,,180.70,674.15,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,outpatient,,,474.00000,330.85000,Aetna,Medical Rental Products,,445.56,,,,,,,123.24,459.78,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,outpatient,,,930.00000,649.14000,Aetna,Medical Rental Products,,874.20,,,,,,,241.80,902.10,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,outpatient,,,786.00000,548.63000,Aetna,Medical Rental Products,,738.84,,,,,,,204.36,762.42,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Aetna,Medical Rental Products,,582.80,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Aetna,Medical Rental Products,59,582.80,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Aetna,Medical Rental Products,,408.90,,,,,,,113.10,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Aetna,Medical Rental Products,59,408.90,,,,,,,113.10,421.95,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,outpatient,,,492.00000,343.42000,Aetna,Medical Rental Products,,462.48,,,,,,,127.92,477.24,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,outpatient,,,331.00000,231.04000,Aetna,Medical Rental Products,,311.14,,,,,,,86.06,321.07,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,outpatient,,,875.00000,610.75000,Aetna,Medical Rental Products,,822.50,,,,,,,227.50,848.75,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,outpatient,,,688.00000,480.22000,Aetna,Medical Rental Products,,646.72,,,,,,,178.88,667.36,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,outpatient,,,465.00000,324.57000,Aetna,Medical Rental Products,,437.10,,,,,,,120.90,451.05,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,outpatient,,,846.00000,590.51000,Aetna,Medical Rental Products,,795.24,,,,,,,219.96,820.62,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,outpatient,,,482.00000,336.44000,Aetna,Medical Rental Products,,453.08,,,,,,,125.32,467.54,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,outpatient,,,926.00000,646.35000,Aetna,Medical Rental Products,,870.44,,,,,,,240.76,898.22,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,outpatient,,,292.00000,203.82000,Aetna,Medical Rental Products,,274.48,,,,,,,75.92,283.24,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,outpatient,,,827.00000,577.25000,Aetna,Medical Rental Products,,777.38,,,,,,,215.02,802.19,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,outpatient,,,253.00000,176.59000,Aetna,Medical Rental Products,,237.82,,,,,,,65.78,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,outpatient,,,901.00000,628.90000,Aetna,Medical Rental Products,,846.94,,,,,,,234.26,873.97,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,outpatient,,,460.00000,321.08000,Aetna,Medical Rental Products,,432.40,,,,,,,119.60,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1029.00000,718.24000,Aetna,Medical Rental Products,,967.26,,,,,,,267.54,998.13,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,outpatient,,,959.00000,669.38000,Aetna,Medical Rental Products,,901.46,,,,,,,249.34,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,outpatient,,,558.00000,389.48000,Aetna,Medical Rental Products,,524.52,,,,,,,145.08,541.26,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,outpatient,,,705.00000,492.09000,Aetna,Medical Rental Products,,662.70,,,,,,,183.30,683.85,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,outpatient,,,249.00000,173.80000,Aetna,Medical Rental Products,,234.06,,,,,,,64.74,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,outpatient,,,427.00000,298.05000,Aetna,Medical Rental Products,,401.38,,,,,,,111.02,414.19,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Aetna,Medical Rental Products,,692.78,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Aetna,Medical Rental Products,59,692.78,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,outpatient,,,809.00000,564.68000,Aetna,Medical Rental Products,,760.46,,,,,,,210.34,784.73,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,outpatient,,,525.00000,366.45000,Aetna,Medical Rental Products,,493.50,,,,,,,136.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,outpatient,,,319.00000,222.66000,Aetna,Medical Rental Products,,299.86,,,,,,,82.94,309.43,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1437.00000,678.26000,Aetna,Medical Rental Products,,1350.78,,,,,,,373.62,1393.89,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2143.00000,1011.50000,Aetna,Medical Rental Products,,2014.42,,,,,,,557.18,2078.71,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,outpatient,,,755.00000,356.36000,Aetna,Medical Rental Products,,709.70,,,,,,,196.30,732.35,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,outpatient,,,979.00000,462.09000,Aetna,Medical Rental Products,,920.26,,,,,,,254.54,949.63,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,outpatient,,,436.00000,205.79000,Aetna,Medical Rental Products,,409.84,,,,,,,113.36,422.92,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,outpatient,,,220.00000,103.84000,Aetna,Medical Rental Products,,206.80,,,,,,,57.20,213.40,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,outpatient,,,344.00000,162.37000,Aetna,Medical Rental Products,,323.36,,,,,,,89.44,333.68,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,outpatient,,,818.00000,393.46000,Aetna,Medical Rental Products,,768.92,,,,,,,212.68,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,outpatient,,,545.00000,262.14000,Aetna,Medical Rental Products,52,512.30,,,,,,,141.70,528.65,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,outpatient,,,1347.00000,647.91000,Aetna,Medical Rental Products,,1266.18,,,,,,,350.22,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,outpatient,,,898.00000,431.94000,Aetna,Medical Rental Products,52,844.12,,,,,,,233.48,871.06,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,outpatient,,,469.00000,225.59000,Aetna,Medical Rental Products,,440.86,,,,,,,121.94,454.93,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,outpatient,,,1762.00000,847.52000,Aetna,Medical Rental Products,,1656.28,,,,,,,458.12,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,outpatient,,,627.00000,301.59000,Aetna,Medical Rental Products,,589.38,,,,,,,163.02,608.19,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,outpatient,,,590.00000,283.79000,Aetna,Medical Rental Products,,554.60,,,,,,,153.40,572.30,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,outpatient,,,1550.00000,745.55000,Aetna,Medical Rental Products,,1457.00,,,,,,,403.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Aetna,Medical Rental Products,LT,930.60,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Aetna,Medical Rental Products,RT,930.60,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,outpatient,,,1402.00000,674.36000,Aetna,Medical Rental Products,,1317.88,,,,,,,364.52,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Aetna,Medical Rental Products,LT,921.20,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Aetna,Medical Rental Products,RT,921.20,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,outpatient,,,1661.00000,798.94000,Aetna,Medical Rental Products,,1561.34,,,,,,,431.86,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,outpatient,,,980.00000,471.38000,Aetna,Medical Rental Products,,921.20,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1740.00000,836.94000,Aetna,Medical Rental Products,,1635.60,,,,,,,452.40,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1168.00000,561.81000,Aetna,Medical Rental Products,,1097.92,,,,,,,303.68,1132.96,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,outpatient,,,433.00000,232.09000,Aetna,Medical Rental Products,,407.02,,,,,,,112.58,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Aetna,Medical Rental Products,LT,364.72,,,,,,,100.88,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Aetna,Medical Rental Products,RT,364.72,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,outpatient,,,388.00000,207.97000,Aetna,Medical Rental Products,,364.72,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,outpatient,,,604.00000,323.74000,Aetna,Medical Rental Products,,567.76,,,,,,,157.04,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,outpatient,,,667.00000,357.51000,Aetna,Medical Rental Products,,626.98,,,,,,,173.42,646.99,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,outpatient,,,176.00000,94.34000,Aetna,Medical Rental Products,,165.44,,,,,,,45.76,170.72,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,23.92,89.24,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,23.92,89.24,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,95.16,355.02,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,95.16,355.02,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,290.42,1083.49,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,290.42,1083.49,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,outpatient,,,559.00000,180.56000,Aetna,Medical Rental Products,,,94.00,,,,,0,145.34,542.23,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,outpatient,,,252.00000,81.40000,Aetna,Medical Rental Products,50,,94.00,,,,,0,65.52,244.44,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,43.68,162.96,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,43.68,162.96,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Aetna,Medical Rental Products,LT,,94.00,,,,,0,298.48,1113.56,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Aetna,Medical Rental Products,RT,,94.00,,,,,0,298.48,1113.56,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,outpatient,,,379.00000,122.42000,Aetna,Medical Rental Products,,,94.00,,,,,0,98.54,367.63,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,outpatient,,,1015.00000,327.84000,Aetna,Medical Rental Products,,,94.00,,,,,0,263.90,984.55,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,outpatient,,,591.00000,190.89000,Aetna,Medical Rental Products,,,94.00,,,,,0,153.66,573.27,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,outpatient,,,271.00000,169.92000,Aetna,Medical Rental Products,,254.74,,,,,,,70.46,262.87,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Aetna,Medical Rental Products,LT,198.34,,,,,,,54.86,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Aetna,Medical Rental Products,RT,198.34,,,,,,,54.86,204.67,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,59.00000,36.99000,Aetna,Medical Rental Products,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,outpatient,,,336.00000,219.74000,Aetna,Medical Rental Products,,315.84,,,,,,,87.36,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,outpatient,,,224.00000,146.50000,Aetna,Medical Rental Products,52,210.56,,,,,,,58.24,217.28,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,outpatient,,,63.00000,41.20000,Aetna,Medical Rental Products,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Aetna,Medical Rental Products,,473.76,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Aetna,Medical Rental Products,,92.12,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Aetna,Medical Rental Products,,571.52,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Aetna,Medical Rental Products,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Aetna,Medical Rental Products,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Aetna,Medical Rental Products,,201.16,,,,,,,55.64,207.58,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Aetna,Medical Rental Products,,,94.00,,,,,0,158.34,590.73,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Aetna,Medical Rental Products,,,94.00,,,,,0,224.38,837.11,percent of total billed charges,"There were no paid claims found for this combination of service, payer, and plan within the prior 12-15 months of this file's publishing"
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,outpatient,,,900.00000,605.70000,Aetna,Medical Rental Products,,846.00,,,,,,,234.00,873.00,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,outpatient,,,1940.00000,1102.21000,Aetna,Medical Rental Products,,1823.60,,,,,,,504.40,1881.80,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,outpatient,,,422.00000,239.76000,Aetna,Medical Rental Products,,396.68,,,,,,,109.72,409.34,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,outpatient,,,1430.00000,812.45000,Aetna,Medical Rental Products,,1344.20,,,,,,,371.80,1387.10,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,outpatient,,,745.00000,423.27000,Aetna,Medical Rental Products,,700.30,,,,,,,193.70,722.65,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,outpatient,,,2655.00000,2487.74000,Aetna,Medical Rental Products,,2495.70,,,,,,,690.30,2575.35,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,outpatient,,,3990.00000,3738.63000,Aetna,Medical Rental Products,,3750.60,,,,,,,1037.40,3870.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,outpatient,,,290.00000,271.73000,Aetna,Medical Rental Products,,272.60,,,,,,,75.40,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,outpatient,,,735.00000,688.70000,Aetna,Medical Rental Products,,690.90,,,,,,,191.10,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Aetna,Medical Rental Products,,1386.50,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,outpatient,,,2275.00000,2131.68000,Aetna,Medical Rental Products,,2138.50,,,,,,,591.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,outpatient,,,3205.00000,3003.08000,Aetna,Medical Rental Products,,3012.70,,,,,,,833.30,3108.85,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,outpatient,,,770.00000,721.49000,Aetna,Medical Rental Products,,723.80,,,,,,,200.20,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Aetna,Medical Rental Products,,1386.50,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,outpatient,,,2210.00000,2070.77000,Aetna,Medical Rental Products,,2077.40,,,,,,,574.60,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,outpatient,,,2660.00000,2492.42000,Aetna,Medical Rental Products,,2500.40,,,,,,,691.60,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,outpatient,,,3560.00000,3335.72000,Aetna,Medical Rental Products,,3346.40,,,,,,,925.60,3453.20,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,outpatient,,,5730.00000,3255.50000,Aetna,Medical Rental Products,,5386.20,,,,,,,1489.80,5558.10,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,outpatient,,,3875.00000,2201.58000,Aetna,Medical Rental Products,,3642.50,,,,,,,1007.50,3758.75,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,outpatient,,,519.00000,564.15000,Aetna,Medical Rental Products,,487.86,,,,,,,134.94,503.43,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,outpatient,,,536.00000,582.63000,Aetna,Medical Rental Products,,503.84,,,,,,,139.36,519.92,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Aetna,Medical Rental Products,,425.82,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Aetna,Medical Rental Products,,135.36,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Aetna,Medical Rental Products,,100.58,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Aetna,Medical Rental Products,,135.36,,,,,,,37.44,139.68,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Aetna,Medical Rental Products,,473.76,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Aetna,Medical Rental Products,,92.12,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Aetna,Medical Rental Products,,571.52,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Aetna,Medical Rental Products,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Aetna,Medical Rental Products,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Aetna,Medical Rental Products,,201.16,,,,,,,55.64,207.58,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,outpatient,,,175.00000,63.18000,Aetna,Medical Rental Products,,164.50,,,,,,,45.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,outpatient,,,304.00000,109.74000,Aetna,Medical Rental Products,,285.76,,,,,,,79.04,294.88,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Aetna,Medical Rental Products,,266.96,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Aetna,Medical Rental Products,,430.52,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,outpatient,,,438.00000,158.12000,Aetna,Medical Rental Products,,411.72,,,,,,,113.88,424.86,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Aetna,Medical Rental Products,,524.52,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Aetna,Medical Rental Products,,453.08,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Aetna,Medical Rental Products,,222.78,,,,,,,61.62,229.89,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Aetna,Medical Rental Products,,473.76,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Aetna,Medical Rental Products,,473.76,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Aetna,Medical Rental Products,,473.76,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Aetna,Medical Rental Products,,473.76,,,,,,,131.04,488.88,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Aetna,Medical Rental Products,,791.48,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Aetna,Medical Rental Products,,989.82,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Aetna,Medical Rental Products,,1187.22,,,,,,,328.38,1225.11,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Aetna,Medical Rental Products,,171.08,,,,,,,47.32,176.54,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Aetna,Medical Rental Products,,197.40,,,,,,,54.60,203.70,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,outpatient,,,140.00000,79.54000,Aetna,Medical Rental Products,,131.60,,,,,,,36.40,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,outpatient,,,190.00000,107.95000,Aetna,Medical Rental Products,,178.60,,,,,,,49.40,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,outpatient,,,240.00000,136.36000,Aetna,Medical Rental Products,,225.60,,,,,,,62.40,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,outpatient,,,290.00000,164.76000,Aetna,Medical Rental Products,,272.60,,,,,,,75.40,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,outpatient,,,340.00000,193.17000,Aetna,Medical Rental Products,,319.60,,,,,,,88.40,329.80,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,outpatient,,,150.00000,85.22000,Aetna,Medical Rental Products,,141.00,,,,,,,39.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,outpatient,,,200.00000,113.63000,Aetna,Medical Rental Products,,188.00,,,,,,,52.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,outpatient,,,270.00000,153.40000,Aetna,Medical Rental Products,,253.80,,,,,,,70.20,261.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,outpatient,,,370.00000,210.22000,Aetna,Medical Rental Products,,347.80,,,,,,,96.20,358.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,outpatient,,,470.00000,267.03000,Aetna,Medical Rental Products,,441.80,,,,,,,122.20,455.90,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,outpatient,,,248.00000,96.22000,Aetna,Medical Rental Products,,233.12,,,,,,,64.48,240.56,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,outpatient,,,245.00000,95.06000,Aetna,Medical Rental Products,,230.30,,,,,,,63.70,237.65,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,outpatient,,,497.00000,192.84000,Aetna,Medical Rental Products,,467.18,,,,,,,129.22,482.09,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,outpatient,,,357.00000,138.52000,Aetna,Medical Rental Products,,335.58,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,outpatient,,,334.00000,129.59000,Aetna,Medical Rental Products,,313.96,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,outpatient,,,194.00000,75.27000,Aetna,Medical Rental Products,,182.36,,,,,,,50.44,188.18,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,outpatient,,,1035.00000,401.58000,Aetna,Medical Rental Products,,972.90,,,,,,,269.10,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,outpatient,,,1137.00000,441.16000,Aetna,Medical Rental Products,,1068.78,,,,,,,295.62,1102.89,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,outpatient,,,963.00000,373.64000,Aetna,Medical Rental Products,,905.22,,,,,,,250.38,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,outpatient,,,990.00000,384.12000,Aetna,Medical Rental Products,,930.60,,,,,,,257.40,960.30,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,outpatient,,,112.00000,43.46000,Aetna,Medical Rental Products,,105.28,,,,,,,29.12,108.64,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,outpatient,,,84.00000,32.59000,Aetna,Medical Rental Products,,78.96,,,,,,,21.84,81.48,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,outpatient,,,176.00000,68.29000,Aetna,Medical Rental Products,,165.44,,,,,,,45.76,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,outpatient,,,283.00000,109.80000,Aetna,Medical Rental Products,,266.02,,,,,,,73.58,274.51,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Aetna,Medical Rental Products,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Aetna,Medical Rental Products,,38.54,,,,,,,10.66,39.77,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,35.00000,19.89000,Aetna,Medical Rental Products,,32.90,,,,,,,9.10,33.95,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,outpatient,,,191.00000,89.39000,Aetna,Medical Rental Products,,179.54,,,,,,,49.66,185.27,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Aetna,Medical Rental Products,,425.82,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Aetna,Medical Rental Products,,135.36,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Aetna,Medical Rental Products,,100.58,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Aetna,Medical Rental Products,,135.36,,,,,,,37.44,139.68,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,outpatient,,,281.00000,131.51000,Aetna,Medical Rental Products,,264.14,,,,,,,73.06,272.57,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,outpatient,,,192.00000,89.86000,Aetna,Medical Rental Products,,180.48,,,,,,,49.92,186.24,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,outpatient,,,365.00000,170.82000,Aetna,Medical Rental Products,,343.10,,,,,,,94.90,354.05,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,outpatient,,,8391.00000,5856.92000,Aetna,Medical Rental Products,,7887.54,,,,,,,2181.66,8139.27,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Aetna,Medical Rental Products,52,6501.98,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Aetna,Medical Rental Products,,5640.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Aetna,Medical Rental Products,,6501.98,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Aetna,Medical Rental Products,52,5640.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,outpatient,,,8855.00000,9625.38000,Aetna,Medical Rental Products,,8323.70,,,,,,,2302.30,8589.35,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Aetna,Medical Rental Products,,793.36,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Aetna,Medical Rental Products,52,793.36,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Aetna,Medical Rental Products,,737.90,,,,,,,204.10,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Aetna,Medical Rental Products,52,737.90,,,,,,,204.10,761.45,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Aetna,Medical Rental Products,,4426.46,,,,,,,1224.34,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Aetna,Medical Rental Products,52,4426.46,,,,,,,1224.34,4567.73,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,outpatient,,,345.00000,128.34000,Aetna,Medical Rental Products,,324.30,,,,,,,89.70,334.65,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,outpatient,,,120.00000,99.60000,Aetna,Medical Rental Products,,112.80,,,,,,,31.20,116.40,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,outpatient,,,106.00000,87.98000,Aetna,Medical Rental Products,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,outpatient,,,32.00000,26.56000,Aetna,Medical Rental Products,,30.08,,,,,,,8.32,31.04,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,outpatient,,,60.00000,49.80000,Aetna,Medical Rental Products,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,outpatient,,,57.00000,47.31000,Aetna,Medical Rental Products,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,outpatient,1.0,ME,7.40000,0.65000,Aetna,Medical Rental Products,,6.96,,,,,,,1.92,7.18,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,outpatient,1.0,EA,6.60000,1.43000,Aetna,Medical Rental Products,UD,6.20,,,,,,,1.72,6.40,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,outpatient,1.0,EA,2.95000,0.64000,Aetna,Medical Rental Products,UD,2.77,,,,,,,0.76700,2.86,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,56.08000,12.11000,Aetna,Medical Rental Products,UD,52.72,,,,,,,14.58,54.40,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,outpatient,1.0,UN,82.10000,28.90000,Aetna,Medical Rental Products,,77.17,,,,,,,15.48,79.64,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.04000,,Aetna,Medical Rental Products,UD,0.03760,,,,,,,0.01040,0.03880,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.05000,,Aetna,Medical Rental Products,UD,0.04700,,,,,,,0.01300,0.04850,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,outpatient,1.0,ME,6.20000,0.55000,Aetna,Medical Rental Products,,5.83,,,,,,,1.61,6.01,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.12000,0.01000,Aetna,Medical Rental Products,UD,0.11280,,,,,,,0.03120,0.11640,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,outpatient,2.0,ML,5.80000,1.25000,Aetna,Medical Rental Products,,5.45,,,,,,,1.51,5.63,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,outpatient,1.0,ME,3.10000,0.27000,Aetna,Medical Rental Products,,2.91,,,,,,,0.80600,3.01,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,outpatient,1.0,EA,44.40000,3.91000,Aetna,Medical Rental Products,,41.74,,,,,,,11.54,43.07,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,8.26000,0.73000,Aetna,Medical Rental Products,UD,7.76,,,,,,,2.15,8.01,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,2.19000,0.19000,Aetna,Medical Rental Products,UD,2.06,,,,,,,0.56940,2.12,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,outpatient,1.0,EA,28.60000,2.52000,Aetna,Medical Rental Products,,26.88,,,,,,,7.44,27.74,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,outpatient,1.0,EA,2.58000,0.91000,Aetna,Medical Rental Products,UD,2.43,,,,,,,0.67080,2.50,percent of total billed charges,
R&B OBSTETRICS PVT,3012,CDM,112,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Aetna,Commercial,,2512.00,,,,,,,2502.90,3111.10,per diem,
R&B MEDICAL/SURGICAL SEMI-PVT,23010,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Aetna,Commercial,,2512.00,,,,,,,2502.90,3111.10,per diem,
R&B ICU,33019,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Aetna,Commercial,,2512.00,,,,,,,2512.00,8498.17,per diem,
R&B ICU INTERMEDIATE,13011,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Aetna,Commercial,,2512.00,,,,,,,2512.00,5665.77,per diem,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,244.00000,77.10000,Aetna,Commercial,,63.44,,,,,,,63.44,236.68,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,24075,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Aetna,Commercial,,2512.00,,,,,,,2502.90,3111.10,per diem,
R&B OBSTETRICS SEMI-PVT,44073,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Aetna,Commercial,,2512.00,,,,,,,2502.90,3111.10,per diem,
R&B NURSERY LEVEL 1,55160,CDM,171,RC,,,,,facility,inpatient,,,3477.00000,1975.46000,Aetna,Commercial,,2512.00,,,,,,,2512.00,3372.69,per diem,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,outpatient,,,16.00000,7.71000,Aetna,Commercial,,4.16,,,,,,,4.16,15.52,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Aetna,Commercial,,54.60,,,,,,,54.60,203.70,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,outpatient,,,380.00000,215.90000,Aetna,Commercial,,98.80,,,,,,,98.80,368.60,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Aetna,Commercial,,30.16,,,,,,,30.16,112.52,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22012,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Aetna,Commercial,,2512.00,,,,,,,2502.90,3111.10,per diem,
R&B ADMIN DAY SKILLED,82016,CDM,160,RC,,,,,facility,inpatient,,,1923.00000,1092.55000,Aetna,Commercial,,2512.00,,,,,,,1730.70,3111.10,per diem,
R&B SWING BED SKILLED,62018,CDM,160,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Aetna,Commercial,,2512.00,,,,,,,2502.90,3111.10,per diem,
R&B ADMIN DAY INTERMEDIATE,72017,CDM,169,RC,,,,,facility,inpatient,,,1176.00000,668.14000,Aetna,Commercial,,2512.00,,,,,,,1058.40,3111.10,per diem,
R&B ICU,32011,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Aetna,Commercial,,2512.00,,,,,,,2512.00,8498.17,per diem,
R&B ICU INTERMEDIATE,12013,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Aetna,Commercial,,2512.00,,,,,,,2512.00,5665.77,per diem,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Aetna,Commercial,,30.16,,,,,,,30.16,112.52,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Aetna,Commercial,,131.04,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Aetna,Commercial,,25.48,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Aetna,Commercial,,158.08,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Aetna,Commercial,,29.64,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Aetna,Commercial,,48.62,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Aetna,Commercial,,55.64,,,,,,,55.64,207.58,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Aetna,Commercial,,21.84,,,,,,,21.84,81.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Aetna,Commercial,,73.84,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Aetna,Commercial,,119.08,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Aetna,Commercial,,145.08,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Aetna,Commercial,,125.32,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Aetna,Commercial,,61.62,,,,,,,61.62,229.89,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,outpatient,,,2041.00000,659.24000,Aetna,Commercial,,530.66,,,,,,,530.66,1979.77,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,outpatient,,,259.00000,83.66000,Aetna,Commercial,,67.34,,,,,,,67.34,251.23,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,outpatient,,,672.00000,217.06000,Aetna,Commercial,,174.72,,,,,,,174.72,651.84,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,outpatient,,,530.00000,171.19000,Aetna,Commercial,,137.80,,,,,,,137.80,514.10,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,outpatient,,,580.00000,187.34000,Aetna,Commercial,,150.80,,,,,,,150.80,562.60,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,outpatient,,,435.00000,140.50000,Aetna,Commercial,,113.10,,,,,,,113.10,421.95,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Aetna,Commercial,,224.38,,,,,,,224.38,837.11,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,outpatient,,,334.00000,107.88000,Aetna,Commercial,,86.84,,,,,,,86.84,323.98,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,outpatient,,,1188.00000,383.72000,Aetna,Commercial,50,308.88,,,,,,,308.88,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Aetna,Commercial,LT,205.92,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Aetna,Commercial,RT,205.92,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,outpatient,,,572.00000,184.76000,Aetna,Commercial,50,148.72,,,,,,,148.72,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Aetna,Commercial,LT,99.06,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Aetna,Commercial,RT,99.06,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,outpatient,,,455.00000,146.96000,Aetna,Commercial,,118.30,,,,,,,118.30,441.35,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,outpatient,,,403.00000,130.17000,Aetna,Commercial,,104.78,,,,,,,104.78,390.91,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,outpatient,,,370.00000,119.51000,Aetna,Commercial,,96.20,,,,,,,96.20,358.90,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,outpatient,,,357.00000,115.31000,Aetna,Commercial,,92.82,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,outpatient,,,334.00000,107.88000,Aetna,Commercial,,86.84,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,outpatient,,,194.00000,62.66000,Aetna,Commercial,,50.44,,,,,,,50.44,188.18,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,outpatient,,,457.00000,147.61000,Aetna,Commercial,,118.82,,,,,,,118.82,443.29,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,outpatient,,,492.00000,158.92000,Aetna,Commercial,,127.92,,,,,,,127.92,477.24,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,outpatient,,,780.00000,251.94000,Aetna,Commercial,,202.80,,,,,,,202.80,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,outpatient,,,1165.00000,376.30000,Aetna,Commercial,,302.90,,,,,,,302.90,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,outpatient,,,2350.00000,759.05000,Aetna,Commercial,,611.00,,,,,,,611.00,2279.50,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,outpatient,,,896.00000,289.41000,Aetna,Commercial,,232.96,,,,,,,232.96,869.12,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,outpatient,,,490.00000,158.27000,Aetna,Commercial,,127.40,,,,,,,127.40,475.30,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,outpatient,,,520.00000,167.96000,Aetna,Commercial,,135.20,,,,,,,135.20,504.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,outpatient,,,720.00000,232.56000,Aetna,Commercial,,187.20,,,,,,,187.20,698.40,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,outpatient,,,215.00000,69.45000,Aetna,Commercial,,55.90,,,,,,,55.90,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,outpatient,,,240.00000,77.52000,Aetna,Commercial,,62.40,,,,,,,62.40,232.80,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,outpatient,,,1241.00000,400.84000,Aetna,Commercial,,322.66,,,,,,,322.66,1203.77,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Aetna,Commercial,,218.92,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Aetna,Commercial,,273.78,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Aetna,Commercial,,328.38,,,,,,,328.38,1225.11,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,outpatient,,,668.00000,559.78000,Aetna,Commercial,,173.68,,,,,,,173.68,647.96,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Aetna,Commercial,,21.06,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Aetna,Commercial,,10.66,,,,,,,10.66,39.77,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Aetna,Commercial,,117.78,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Aetna,Commercial,,37.44,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Aetna,Commercial,,27.82,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Aetna,Commercial,,37.44,,,,,,,37.44,139.68,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Aetna,Commercial,,0.88400,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Aetna,Commercial,,0.88400,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Aetna,Commercial,,0.88400,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Aetna,Commercial,,1.27,,,,,,,1.27,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,7.90000,4.49000,Aetna,Commercial,,2.05,,,,,,,2.05,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Aetna,Commercial,,1.27,,,,,,,1.27,4.75,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Aetna,Commercial,,21.06,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Aetna,Commercial,,21.06,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Aetna,Commercial,,21.06,,,,,,,21.06,78.57,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,outpatient,,,3141500.00000,1784843.22000,Aetna,Commercial,,816790.00,,,,,,,816790.00,3047255.00,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Aetna,Commercial,UD,0.05720,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.52000,0.30000,Aetna,Commercial,UD,0.13520,,,,,,,0.13520,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.56000,0.32000,Aetna,Commercial,UD,0.14560,,,,,,,0.14560,0.54320,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Aetna,Commercial,UD,0.05720,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.85000,0.48000,Aetna,Commercial,UD,0.22100,,,,,,,0.22100,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Aetna,Commercial,UD,0.05720,,,,,,,0.05720,0.21340,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,outpatient,,,102.00000,65.18000,Aetna,Commercial,,26.52,,,,,,,26.52,98.94,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,outpatient,,,190.00000,121.41000,Aetna,Commercial,,49.40,,,,,,,49.40,184.30,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Aetna,Commercial,,93.34,,,,,,,93.34,348.23,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Aetna,Commercial,,139.10,,,,,,,139.10,518.95,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,outpatient,,,766.00000,489.47000,Aetna,Commercial,,199.16,,,,,,,199.16,743.02,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,outpatient,,,159.00000,101.60000,Aetna,Commercial,,41.34,,,,,,,41.34,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,outpatient,,,447.00000,285.63000,Aetna,Commercial,,116.22,,,,,,,116.22,433.59,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,outpatient,,,1413.00000,902.91000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,outpatient,,,3853.00000,2462.07000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,outpatient,,,313.00000,200.01000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,outpatient,,,1132.00000,723.35000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,outpatient,,,2695.00000,1722.10000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,outpatient,,,1619.00000,1034.54000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Aetna,Commercial,,139.10,,,,,,,139.10,518.95,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,outpatient,,,850.00000,543.15000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,outpatient,,,32.00000,20.45000,Aetna,Commercial,,8.32,,,,,,,8.32,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,outpatient,,,134.00000,85.63000,Aetna,Commercial,,34.84,,,,,,,34.84,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Aetna,Commercial,,93.34,,,,,,,93.34,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,outpatient,,,709.00000,453.05000,Aetna,Commercial,,184.34,,,,,,,184.34,687.73,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,outpatient,,,4880.00000,2357.04000,Aetna,Commercial,,1268.80,,,,,,,1268.80,4733.60,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,outpatient,,,6024.00000,2909.59000,Aetna,Commercial,,1566.24,,,,,,,1566.24,5843.28,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Aetna,Commercial,,116.22,,,,,,,116.22,433.59,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Aetna,Commercial,,1143.22,,,,,,,1143.22,4265.09,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Commercial,,1523.86,,,,,,,1523.86,5685.17,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,outpatient,,,7413.00000,3580.48000,Aetna,Commercial,,1927.38,,,,,,,1927.38,7190.61,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Aetna,Commercial,,116.22,,,,,,,116.22,433.59,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Aetna,Commercial,,116.22,,,,,,,116.22,433.59,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Aetna,Commercial,,1143.22,,,,,,,1143.22,4265.09,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Aetna,Commercial,,1867.06,,,,,,,1867.06,6965.57,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,outpatient,,,10654.00000,5145.88000,Aetna,Commercial,,2770.04,,,,,,,2770.04,10334.38,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Commercial,,1523.86,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Aetna,Commercial,,1686.62,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Aetna,Commercial,,1927.38,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,11575.00000,5590.72000,Aetna,Commercial,,3009.50,,,,,,,3009.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,13432.00000,6487.66000,Aetna,Commercial,,3492.32,,,,,,,3492.32,13029.04,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,21904.00000,10579.63000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Commercial,,490.88,,,,,,,490.88,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Aetna,Commercial,,1143.22,,,,,,,1143.22,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Commercial,,1523.86,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Aetna,Commercial,,1927.38,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,12969.00000,6264.03000,Aetna,Commercial,,3371.94,,,,,,,3371.94,12579.93,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Commercial,,490.88,,,,,,,490.88,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Aetna,Commercial,,630.76,,,,,,,630.76,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Aetna,Commercial,,735.02,,,,,,,735.02,2742.19,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Aetna,Commercial,,26.52,,,,,,,26.52,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Aetna,Commercial,,34.84,,,,,,,34.84,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,outpatient,,,251.00000,121.23000,Aetna,Commercial,,65.26,,,,,,,65.26,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Commercial,,1523.86,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Commercial,,490.88,,,,,,,490.88,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Commercial,,1523.86,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,447.00000,215.90000,Aetna,Commercial,,116.22,,,,,,,116.22,433.59,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Aetna,Commercial,,735.02,,,,,,,735.02,2742.19,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Aetna,Commercial,,699.40,,,,,,,699.40,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Aetna,Commercial,,1686.62,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,2426.00000,1171.76000,Aetna,Commercial,,630.76,,,,,,,630.76,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,15334.00000,7406.32000,Aetna,Commercial,,3986.84,,,,,,,3986.84,14873.98,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Commercial,,490.88,,,,,,,490.88,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Aetna,Commercial,,735.02,,,,,,,735.02,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,251.00000,121.23000,Aetna,Commercial,,65.26,,,,,,,65.26,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Commercial,,490.88,,,,,,,490.88,1831.36,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Aetna,Commercial,,735.02,,,,,,,735.02,2742.19,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Aetna,Commercial,,8.32,,,,,,,8.32,31.04,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Commercial,,490.88,,,,,,,490.88,1831.36,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Aetna,Commercial,,3986.84,,,,,,,3986.84,14873.98,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,outpatient,,,1485.00000,717.26000,Aetna,Commercial,,386.10,,,,,,,386.10,1440.45,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,outpatient,,,2028.00000,979.52000,Aetna,Commercial,,527.28,,,,,,,527.28,1967.16,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Aetna,Commercial,,1143.22,,,,,,,1143.22,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,8107.00000,3915.68000,Aetna,Commercial,,2107.82,,,,,,,2107.82,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,10422.00000,5033.83000,Aetna,Commercial,,2709.72,,,,,,,2709.72,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,12737.00000,6151.97000,Aetna,Commercial,,3311.62,,,,,,,3311.62,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,14239.00000,6877.44000,Aetna,Commercial,,3702.14,,,,,,,3702.14,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,16429.00000,7935.21000,Aetna,Commercial,,4271.54,,,,,,,4271.54,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,18619.00000,8992.98000,Aetna,Commercial,,4840.94,,,,,,,4840.94,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,20809.00000,10050.75000,Aetna,Commercial,,5410.34,,,,,,,5410.34,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,22999.00000,11108.52000,Aetna,Commercial,,5979.74,,,,,,,5979.74,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,25189.00000,12166.29000,Aetna,Commercial,,6549.14,,,,,,,6549.14,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,27379.00000,13224.06000,Aetna,Commercial,,7118.54,,,,,,,7118.54,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,29569.00000,14281.83000,Aetna,Commercial,,7687.94,,,,,,,7687.94,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,31759.00000,15339.60000,Aetna,Commercial,,8257.34,,,,,,,8257.34,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,36139.00000,17455.14000,Aetna,Commercial,,9396.14,,,,,,,9396.14,35054.83,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Commercial,,490.88,,,,,,,490.88,1831.36,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Aetna,Commercial,,868.40,,,,,,,868.40,3239.80,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Commercial,,1523.86,,,,,,,1523.86,5685.17,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Aetna,Commercial,,8.32,,,,,,,8.32,31.04,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Aetna,Commercial,,34.84,,,,,,,34.84,129.98,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Aetna,Commercial,,49.40,,,,,,,49.40,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,outpatient,,,476.00000,229.91000,Aetna,Commercial,,123.76,,,,,,,123.76,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Aetna,Commercial,,8.32,,,,,,,8.32,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Aetna,Commercial,,116.22,,,,,,,116.22,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Commercial,,490.88,,,,,,,490.88,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Commercial,,1523.86,,,,,,,1523.86,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,outpatient,,,12506.00000,6040.40000,Aetna,Commercial,,3251.56,,,,,,,3251.56,12130.82,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,outpatient,,,2404.80000,1161.52000,Aetna,Commercial,,625.25,,,,,,,625.25,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,outpatient,,,969.00000,468.03000,Aetna,Commercial,,251.94,,,,,,,251.94,939.93,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,outpatient,,,2256.90000,1090.08000,Aetna,Commercial,,586.79,,,,,,,586.79,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,outpatient,,,644.30000,311.20000,Aetna,Commercial,,167.52,,,,,,,167.52,624.97,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Aetna,Commercial,,26.52,,,,,,,26.52,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Aetna,Commercial,,49.40,,,,,,,49.40,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Aetna,Commercial,,9111.44,,,,,,,9111.44,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,outpatient,,,43804.00000,21157.33000,Aetna,Commercial,,11389.04,,,,,,,11389.04,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,outpatient,,,52564.00000,25388.41000,Aetna,Commercial,,13666.64,,,,,,,13666.64,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,outpatient,,,61324.00000,29619.49000,Aetna,Commercial,,15944.24,,,,,,,15944.24,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,outpatient,,,70084.00000,33850.57000,Aetna,Commercial,,18221.84,,,,,,,18221.84,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,outpatient,,,78844.00000,38081.65000,Aetna,Commercial,,20499.44,,,,,,,20499.44,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,outpatient,,,87604.00000,42312.73000,Aetna,Commercial,,22777.04,,,,,,,22777.04,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,outpatient,,,96364.00000,46543.81000,Aetna,Commercial,,25054.64,,,,,,,25054.64,93473.08,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Aetna,Commercial,,9111.44,,,,,,,9111.44,33992.68,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,outpatient,,,39424.00000,19041.79000,Aetna,Commercial,,10250.24,,,,,,,10250.24,38241.28,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Aetna,Commercial,,1016.34,,,,,,,1016.34,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Aetna,Commercial,,49.40,,,,,,,49.40,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Commercial,,1523.86,,,,,,,1523.86,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Aetna,Commercial,,3986.84,,,,,,,3986.84,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Commercial,,490.88,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2023.00000,977.11000,Aetna,Commercial,,525.98,,,,,,,525.98,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Commercial,,490.88,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Commercial,,490.88,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Commercial,,1523.86,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Aetna,Commercial,,2047.76,,,,,,,2047.76,7639.72,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,outpatient,,,10191.00000,4922.25000,Aetna,Commercial,,2649.66,,,,,,,2649.66,9885.27,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,96.00000,46.37000,Aetna,Commercial,,24.96,,,,,,,24.96,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Commercial,,1523.86,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,7876.00000,3804.11000,Aetna,Commercial,,2047.76,,,,,,,2047.76,7639.72,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Aetna,Commercial,,1016.34,,,,,,,1016.34,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,outpatient,,,5373.00000,2595.16000,Aetna,Commercial,,1396.98,,,,,,,1396.98,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,outpatient,,,6487.00000,3133.22000,Aetna,Commercial,,1686.62,,,,,,,1686.62,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Aetna,Commercial,,2047.76,,,,,,,2047.76,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Aetna,Commercial,,1143.22,,,,,,,1143.22,4265.09,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Commercial,,1523.86,,,,,,,1523.86,5685.17,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,outpatient,,,1126.00000,543.86000,Aetna,Commercial,,292.76,,,,,,,292.76,1092.22,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Aetna,Commercial,,699.40,,,,,,,699.40,2609.30,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,4880.00000,2357.04000,Aetna,Commercial,,1268.80,,,,,,,1268.80,4733.60,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,9260.00000,4472.58000,Aetna,Commercial,,2407.60,,,,,,,2407.60,8982.20,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Commercial,,1523.86,,,,,,,1523.86,5685.17,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,588.00000,284.00000,Aetna,Commercial,,152.88,,,,,,,152.88,570.36,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Commercial,,490.88,,,,,,,490.88,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Aetna,Commercial,,630.76,,,,,,,630.76,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Aetna,Commercial,,735.02,,,,,,,735.02,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Aetna,Commercial,,868.40,,,,,,,868.40,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Aetna,Commercial,,868.40,,,,,,,868.40,3239.80,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Aetna,Commercial,,116.22,,,,,,,116.22,433.59,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Aetna,Commercial,,1016.34,,,,,,,1016.34,3791.73,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Commercial,,1523.86,,,,,,,1523.86,5685.17,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,outpatient,,,159.00000,76.80000,Aetna,Commercial,,41.34,,,,,,,41.34,154.23,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,outpatient,,,588.00000,284.00000,Aetna,Commercial,,152.88,,,,,,,152.88,570.36,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Aetna,Commercial,,630.76,,,,,,,630.76,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Aetna,Commercial,,116.22,,,,,,,116.22,433.59,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,outpatient,,,8107.00000,3915.68000,Aetna,Commercial,,2107.82,,,,,,,2107.82,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,outpatient,,,10422.00000,5033.83000,Aetna,Commercial,,2709.72,,,,,,,2709.72,10109.34,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Aetna,Commercial,,1523.86,,,,,,,1523.86,5685.17,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Aetna,Commercial,,490.88,,,,,,,490.88,1831.36,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Aetna,Commercial,,26.52,,,,,,,26.52,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,outpatient,,,221.00000,106.74000,Aetna,Commercial,,57.46,,,,,,,57.46,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Aetna,Commercial,,116.22,,,,,,,116.22,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Aetna,Commercial,,630.76,,,,,,,630.76,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Aetna,Commercial,,868.40,,,,,,,868.40,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,outpatient,,,4153.00000,2005.90000,Aetna,Commercial,,1079.78,,,,,,,1079.78,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,outpatient,,,5129.00000,2477.31000,Aetna,Commercial,,1333.54,,,,,,,1333.54,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Aetna,Commercial,,1867.06,,,,,,,1867.06,6965.57,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,outpatient,,,52.50000,25.36000,Aetna,Commercial,,13.65,,,,,,,13.65,50.92,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,outpatient,,,50.40000,24.34000,Aetna,Commercial,,13.10,,,,,,,13.10,48.89,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Aetna,Commercial,,630.76,,,,,,,630.76,2353.22,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Aetna,Commercial,,1016.34,,,,,,,1016.34,3791.73,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Aetna,Commercial,,26.52,,,,,,,26.52,98.94,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Aetna,Commercial,,8.32,,,,,,,8.32,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Aetna,Commercial,,116.22,,,,,,,116.22,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,outpatient,,,709.00000,342.45000,Aetna,Commercial,,184.34,,,,,,,184.34,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Aetna,Commercial,,17083.04,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Aetna,Commercial,,22777.04,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Aetna,Commercial,,28471.04,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,131404.00000,74657.18000,Aetna,Commercial,,34165.04,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,43800.00000,24884.97000,Aetna,Commercial,,11388.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Aetna,Commercial,,17083.04,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Aetna,Commercial,,22777.04,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Aetna,Commercial,,5125.64,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,24090.00000,13686.73000,Aetna,Commercial,,6263.40,,,,,,,6263.40,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Aetna,Commercial,,7403.24,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Aetna,Commercial,,4555.20,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Aetna,Commercial,,11389.04,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Aetna,Commercial,,17083.04,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Aetna,Commercial,,22777.04,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Aetna,Commercial,,28471.04,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,6105.00000,3468.56000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,13895.00000,7894.44000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,21900.00000,12442.48000,Aetna,Commercial,,5694.00,,,,,,,5694.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,35040.00000,19907.98000,Aetna,Commercial,,9110.40,,,,,,,9110.40,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Aetna,Commercial,,11389.04,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Aetna,Commercial,,5125.64,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,22776.00000,12940.18000,Aetna,Commercial,,5921.76,,,,,,,5921.76,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Aetna,Commercial,,7403.24,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Aetna,Commercial,,4555.20,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,30664.00000,17421.75000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,35044.00000,19910.25000,Aetna,Commercial,,9111.44,,,,,,,9111.44,33992.68,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2695.00000,1080.70000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,3853.00000,1545.05000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,outpatient,,,1413.00000,566.61000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,3229.80000,1857.14000,Aetna,Commercial,,839.75,,,,,,,839.75,3132.91,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,854.40000,491.28000,Aetna,Commercial,,222.14,,,,,,,222.14,828.77,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1200.50000,690.29000,Aetna,Commercial,,312.13,,,,,,,312.13,1164.48,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1011.00000,581.32000,Aetna,Commercial,,262.86,,,,,,,262.86,980.67,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1823.80000,1048.68000,Aetna,Commercial,,474.19,,,,,,,474.19,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2028.50000,1166.39000,Aetna,Commercial,,527.41,,,,,,,527.41,1967.64,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,841.00000,483.58000,Aetna,Commercial,,218.66,,,,,,,218.66,815.77,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1366.20000,785.56000,Aetna,Commercial,,355.21,,,,,,,355.21,1325.21,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1384.00000,795.80000,Aetna,Commercial,,359.84,,,,,,,359.84,1342.48,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2458.70000,1413.75000,Aetna,Commercial,,639.26,,,,,,,639.26,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2393.50000,1376.26000,Aetna,Commercial,,622.31,,,,,,,622.31,2321.70,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1369.50000,787.46000,Aetna,Commercial,,356.07,,,,,,,356.07,1328.41,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2697.40000,1551.00000,Aetna,Commercial,,701.32,,,,,,,701.32,2616.48,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4621.80000,2657.54000,Aetna,Commercial,,1201.67,,,,,,,1201.67,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2592.50000,1490.69000,Aetna,Commercial,,674.05,,,,,,,674.05,2514.72,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Aetna,Commercial,,1523.86,,,,,,,1523.86,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Aetna,Commercial,,2168.14,,,,,,,2168.14,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Aetna,Commercial,,1523.86,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Aetna,Commercial,,2107.82,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Aetna,Commercial,,292.76,,,,,,,292.76,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Aetna,Commercial,,1143.22,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Aetna,Commercial,,1927.38,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,outpatient,,,20152.00000,11587.40000,Aetna,Commercial,,5239.52,,,,,,,5239.52,19547.44,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Aetna,Commercial,,116.22,,,,,,,116.22,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Aetna,Commercial,,184.34,,,,,,,184.34,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,1272.00000,731.40000,Aetna,Commercial,,330.72,,,,,,,330.72,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Aetna,Commercial,,699.40,,,,,,,699.40,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,3078.00000,1769.85000,Aetna,Commercial,,800.28,,,,,,,800.28,2985.66,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,70.00000,40.25000,Aetna,Commercial,,18.20,,,,,,,18.20,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,102.00000,58.65000,Aetna,Commercial,,26.52,,,,,,,26.52,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,221.00000,127.07000,Aetna,Commercial,,57.46,,,,,,,57.46,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Aetna,Commercial,,116.22,,,,,,,116.22,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Aetna,Commercial,,184.34,,,,,,,184.34,687.73,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Aetna,Commercial,,3251.56,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35482.00000,20402.15000,Aetna,Commercial,,9225.32,,,,,,,9225.32,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39862.00000,22920.65000,Aetna,Commercial,,10364.12,,,,,,,10364.12,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,44242.00000,25439.15000,Aetna,Commercial,,11502.92,,,,,,,11502.92,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,48622.00000,27957.65000,Aetna,Commercial,,12641.72,,,,,,,12641.72,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,53002.00000,30476.15000,Aetna,Commercial,,13780.52,,,,,,,13780.52,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Aetna,Commercial,,15944.24,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Aetna,Commercial,,18221.84,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Aetna,Commercial,,20499.44,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Aetna,Commercial,,22777.04,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Aetna,Commercial,,25054.64,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,844.00000,485.30000,Aetna,Commercial,,219.44,,,,,,,219.44,818.68,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,11575.00000,6655.62000,Aetna,Commercial,,3009.50,,,,,,,3009.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14892.00000,8562.90000,Aetna,Commercial,,3871.92,,,,,,,3871.92,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,24970.00000,14357.75000,Aetna,Commercial,,6492.20,,,,,,,6492.20,24220.90,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Aetna,Commercial,,490.88,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Aetna,Commercial,,116.22,,,,,,,116.22,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Aetna,Commercial,,490.88,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Aetna,Commercial,,868.40,,,,,,,868.40,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Aetna,Commercial,,1079.78,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4641.00000,2668.58000,Aetna,Commercial,,1206.66,,,,,,,1206.66,4501.77,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Aetna,Commercial,,1268.80,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Commercial,,3986.84,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Aetna,Commercial,,25054.64,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Aetna,Commercial,,28471.04,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Aetna,Commercial,,34165.04,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,153304.00000,88149.80000,Aetna,Commercial,,39859.04,,,,,,,39859.04,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,175204.00000,100742.30000,Aetna,Commercial,,45553.04,,,,,,,45553.04,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,197104.00000,113334.80000,Aetna,Commercial,,51247.04,,,,,,,51247.04,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,219004.00000,125927.30000,Aetna,Commercial,,56941.04,,,,,,,56941.04,212433.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Commercial,,9111.44,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Commercial,,9111.44,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Commercial,,10250.24,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Commercial,,11389.04,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Aetna,Commercial,,12527.84,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Aetna,Commercial,,13666.64,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Aetna,Commercial,,14805.44,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Aetna,Commercial,,15944.24,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Aetna,Commercial,,17083.04,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Commercial,,9111.44,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Commercial,,11389.04,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Aetna,Commercial,,13666.64,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Aetna,Commercial,,17083.04,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Aetna,Commercial,,22777.04,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Aetna,Commercial,,28471.04,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Aetna,Commercial,,1268.80,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Commercial,,9111.44,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Commercial,,10250.24,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Commercial,,11389.04,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Aetna,Commercial,,12527.84,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Aetna,Commercial,,13666.64,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Aetna,Commercial,,14805.44,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Aetna,Commercial,,15944.24,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Aetna,Commercial,,18221.84,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Aetna,Commercial,,20499.44,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Aetna,Commercial,,22777.04,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Aetna,Commercial,,25054.64,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Aetna,Commercial,,28471.04,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Aetna,Commercial,,31887.44,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,135784.00000,78075.80000,Aetna,Commercial,,35303.84,,,,,,,35303.84,131710.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Commercial,,9111.44,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Commercial,,10250.24,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Commercial,,11389.04,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Aetna,Commercial,,12527.84,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,55630.00000,31987.25000,Aetna,Commercial,,14463.80,,,,,,,14463.80,53961.10,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Aetna,Commercial,,699.40,,,,,,,699.40,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Aetna,Commercial,,3645.20,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,17962.00000,10328.15000,Aetna,Commercial,,4670.12,,,,,,,4670.12,17423.14,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,2421.00000,1392.07000,Aetna,Commercial,,629.46,,,,,,,629.46,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Commercial,,3986.84,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Aetna,Commercial,,630.76,,,,,,,630.76,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Aetna,Commercial,,699.40,,,,,,,699.40,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,27160.00000,15617.00000,Aetna,Commercial,,7061.60,,,,,,,7061.60,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Aetna,Commercial,,8542.04,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Commercial,,10250.24,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Aetna,Commercial,,13666.64,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Aetna,Commercial,,17083.04,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Aetna,Commercial,,20499.44,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,28470.00000,16370.25000,Aetna,Commercial,,7402.20,,,,,,,7402.20,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,43800.00000,25185.00000,Aetna,Commercial,,11388.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Aetna,Commercial,,17083.04,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Aetna,Commercial,,22777.04,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Aetna,Commercial,,28471.04,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Aetna,Commercial,,1016.34,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Aetna,Commercial,,8542.04,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Commercial,,11389.04,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,54754.00000,31483.55000,Aetna,Commercial,,14236.04,,,,,,,14236.04,53111.38,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Aetna,Commercial,,699.40,,,,,,,699.40,2609.30,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,61320.00000,35259.00000,Aetna,Commercial,,15943.20,,,,,,,15943.20,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,70080.00000,40296.00000,Aetna,Commercial,,18220.80,,,,,,,18220.80,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,78840.00000,45333.00000,Aetna,Commercial,,20498.40,,,,,,,20498.40,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Aetna,Commercial,,25054.64,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Aetna,Commercial,,28471.04,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Aetna,Commercial,,31887.44,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Commercial,,3986.84,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Commercial,,5125.64,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Aetna,Commercial,,6264.44,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Aetna,Commercial,,8542.04,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Commercial,,3986.84,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Commercial,,5125.64,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1883.00000,1082.72000,Aetna,Commercial,,489.58,,,,,,,489.58,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Aetna,Commercial,,1016.34,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,7644.00000,4395.30000,Aetna,Commercial,,1987.44,,,,,,,1987.44,7414.68,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Aetna,Commercial,,699.40,,,,,,,699.40,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Commercial,,3986.84,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Commercial,,5125.64,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Aetna,Commercial,,419.64,,,,,,,419.64,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Commercial,,3986.84,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Commercial,,5125.64,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Aetna,Commercial,,6264.44,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Aetna,Commercial,,7403.24,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Aetna,Commercial,,8542.04,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,37234.00000,21409.55000,Aetna,Commercial,,9680.84,,,,,,,9680.84,36116.98,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Commercial,,11389.04,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Aetna,Commercial,,17083.04,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Commercial,,9111.44,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Commercial,,10250.24,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Aetna,Commercial,,13666.64,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Aetna,Commercial,,17083.04,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Aetna,Commercial,,20499.44,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,159.00000,91.42000,Aetna,Commercial,,41.34,,,,,,,41.34,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Aetna,Commercial,,490.88,,,,,,,490.88,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Aetna,Commercial,,490.88,,,,,,,490.88,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Aetna,Commercial,,630.76,,,,,,,630.76,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Aetna,Commercial,,735.02,,,,,,,735.02,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Aetna,Commercial,,868.40,,,,,,,868.40,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Aetna,Commercial,,2107.82,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Aetna,Commercial,,17083.04,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Aetna,Commercial,,22777.04,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Aetna,Commercial,,28471.04,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Aetna,Commercial,,34165.04,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Commercial,,3986.84,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,18400.00000,10580.00000,Aetna,Commercial,,4784.00,,,,,,,4784.00,17848.00,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Aetna,Commercial,,6264.44,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Aetna,Commercial,,7403.24,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Aetna,Commercial,,8542.04,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Commercial,,9111.44,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Commercial,,9111.44,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Commercial,,10250.24,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Commercial,,11389.04,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Aetna,Commercial,,419.64,,,,,,,419.64,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Commercial,,11389.04,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Aetna,Commercial,,14805.44,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Aetna,Commercial,,17083.04,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,5368.00000,3086.60000,Aetna,Commercial,,1395.68,,,,,,,1395.68,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Commercial,,3986.84,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Commercial,,5125.64,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Aetna,Commercial,,3645.20,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Commercial,,5125.64,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,25408.00000,14609.60000,Aetna,Commercial,,6606.08,,,,,,,6606.08,24645.76,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Commercial,,9111.44,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Commercial,,11389.04,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,8112.00000,4664.40000,Aetna,Commercial,,2109.12,,,,,,,2109.12,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,10431.00000,5997.82000,Aetna,Commercial,,2712.06,,,,,,,2712.06,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Commercial,,5125.64,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Aetna,Commercial,,8542.04,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Commercial,,10250.24,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,46870.00000,26950.25000,Aetna,Commercial,,12186.20,,,,,,,12186.20,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,51250.00000,29468.75000,Aetna,Commercial,,13325.00,,,,,,,13325.00,49712.50,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Commercial,,10250.24,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Aetna,Commercial,,13666.64,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Aetna,Commercial,,17083.04,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Aetna,Commercial,,20499.44,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Aetna,Commercial,,22777.04,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,588.00000,338.10000,Aetna,Commercial,,152.88,,,,,,,152.88,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Aetna,Commercial,,1143.22,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Aetna,Commercial,,1016.34,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Aetna,Commercial,,1396.98,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Aetna,Commercial,,1686.62,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7876.00000,4528.70000,Aetna,Commercial,,2047.76,,,,,,,2047.76,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Commercial,,3986.84,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Commercial,,5125.64,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Aetna,Commercial,,6264.44,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5856.00000,3367.20000,Aetna,Commercial,,1522.56,,,,,,,1522.56,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Aetna,Commercial,,1686.62,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Aetna,Commercial,,1927.38,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Aetna,Commercial,,2168.14,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Aetna,Commercial,,1143.22,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Aetna,Commercial,,1396.98,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Aetna,Commercial,,1566.24,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Aetna,Commercial,,3251.56,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Aetna,Commercial,,1143.22,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Aetna,Commercial,,1396.98,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Aetna,Commercial,,1566.24,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Aetna,Commercial,,3251.56,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4392.00000,2525.40000,Aetna,Commercial,,1141.92,,,,,,,1141.92,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Aetna,Commercial,,1396.98,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Aetna,Commercial,,1686.62,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Aetna,Commercial,,1143.22,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Aetna,Commercial,,1396.98,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Aetna,Commercial,,1686.62,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Aetna,Commercial,,1268.80,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Aetna,Commercial,,292.76,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Aetna,Commercial,,1143.22,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Aetna,Commercial,,1396.98,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Aetna,Commercial,,1566.24,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Aetna,Commercial,,3251.56,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Aetna,Commercial,,3531.32,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Commercial,,3986.84,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Commercial,,5125.64,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2152.00000,1237.40000,Aetna,Commercial,,559.52,,,,,,,559.52,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Aetna,Commercial,,1268.80,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Aetna,Commercial,,1016.34,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Aetna,Commercial,,1523.86,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Aetna,Commercial,,1566.24,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Commercial,,5125.64,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Aetna,Commercial,,1143.22,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Aetna,Commercial,,1396.98,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Aetna,Commercial,,1566.24,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Aetna,Commercial,,292.76,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Aetna,Commercial,,1143.22,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Aetna,Commercial,,1396.98,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Aetna,Commercial,,1566.24,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Aetna,Commercial,,3251.56,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Aetna,Commercial,,3531.32,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Commercial,,3986.84,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Commercial,,5125.64,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Aetna,Commercial,,1396.98,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8802.00000,5061.15000,Aetna,Commercial,,2288.52,,,,,,,2288.52,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10654.00000,6126.05000,Aetna,Commercial,,2770.04,,,,,,,2770.04,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Aetna,Commercial,,3251.56,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Aetna,Commercial,,3531.32,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Commercial,,3986.84,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17086.00000,9824.45000,Aetna,Commercial,,4442.36,,,,,,,4442.36,16573.42,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Aetna,Commercial,,1268.80,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Aetna,Commercial,,1686.62,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Aetna,Commercial,,1927.38,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Aetna,Commercial,,2168.14,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Aetna,Commercial,,1268.80,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Aetna,Commercial,,1268.80,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Aetna,Commercial,,934.96,,,,,,,934.96,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Aetna,Commercial,,1143.22,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Aetna,Commercial,,1587.30,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Commercial,,3986.84,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Commercial,,5125.64,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Aetna,Commercial,,6264.44,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Aetna,Commercial,,1016.34,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Aetna,Commercial,,1686.62,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Aetna,Commercial,,490.88,,,,,,,490.88,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Aetna,Commercial,,630.76,,,,,,,630.76,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Aetna,Commercial,,735.02,,,,,,,735.02,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Aetna,Commercial,,868.40,,,,,,,868.40,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Aetna,Commercial,,1079.78,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Aetna,Commercial,,1927.38,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Aetna,Commercial,,2168.14,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9728.00000,5593.60000,Aetna,Commercial,,2529.28,,,,,,,2529.28,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11117.00000,6392.28000,Aetna,Commercial,,2890.42,,,,,,,2890.42,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Commercial,,9111.44,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Commercial,,10250.24,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Commercial,,11389.04,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Aetna,Commercial,,12527.84,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Aetna,Commercial,,13666.64,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Aetna,Commercial,,14805.44,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Aetna,Commercial,,15944.24,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Aetna,Commercial,,17083.04,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Aetna,Commercial,,18221.84,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Aetna,Commercial,,19360.64,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Aetna,Commercial,,20499.44,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Aetna,Commercial,,21638.24,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,111694.00000,64224.05000,Aetna,Commercial,,29040.44,,,,,,,29040.44,108343.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Aetna,Commercial,,116.22,,,,,,,116.22,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Aetna,Commercial,,184.34,,,,,,,184.34,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,991.00000,569.82000,Aetna,Commercial,,257.66,,,,,,,257.66,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1490.00000,856.75000,Aetna,Commercial,,387.40,,,,,,,387.40,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Aetna,Commercial,,1016.34,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Aetna,Commercial,,1523.86,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Aetna,Commercial,,1686.62,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Aetna,Commercial,,1927.38,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Aetna,Commercial,,2168.14,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Commercial,,3986.84,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Commercial,,9111.44,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Commercial,,10250.24,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Commercial,,11389.04,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Aetna,Commercial,,367.38,,,,,,,367.38,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Aetna,Commercial,,1001.78,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,6945.00000,3993.37000,Aetna,Commercial,,1805.70,,,,,,,1805.70,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Commercial,,9111.44,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Aetna,Commercial,,116.22,,,,,,,116.22,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Commercial,,9111.44,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Aetna,Commercial,,1016.34,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Aetna,Commercial,,1396.98,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Aetna,Commercial,,294.32,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Commercial,,9111.44,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Commercial,,10250.24,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Commercial,,11389.04,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,50374.00000,28965.05000,Aetna,Commercial,,13097.24,,,,,,,13097.24,48862.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Aetna,Commercial,,5125.64,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Aetna,Commercial,,6264.44,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Aetna,Commercial,,7403.24,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Aetna,Commercial,,700.70,,,,,,,700.70,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Aetna,Commercial,,1807.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Aetna,Commercial,,3010.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Aetna,Commercial,,3986.84,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Commercial,,9111.44,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Commercial,,10250.24,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Commercial,,11389.04,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Aetna,Commercial,,12527.84,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Aetna,Commercial,,560.82,,,,,,,560.82,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Aetna,Commercial,,801.58,,,,,,,801.58,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Commercial,,10250.24,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Commercial,,11389.04,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Aetna,Commercial,,12527.84,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Aetna,Commercial,,13666.64,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Aetna,Commercial,,14805.44,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Aetna,Commercial,,17083.04,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Aetna,Commercial,,19360.64,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Aetna,Commercial,,21638.24,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,91984.00000,52890.80000,Aetna,Commercial,,23915.84,,,,,,,23915.84,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,100744.00000,57927.80000,Aetna,Commercial,,26193.44,,,,,,,26193.44,97721.68,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Aetna,Commercial,,43.16,,,,,,,43.16,161.02,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Aetna,Commercial,,116.22,,,,,,,116.22,433.59,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Aetna,Commercial,,184.34,,,,,,,184.34,687.73,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Aetna,Commercial,,4556.24,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Aetna,Commercial,,5695.04,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Aetna,Commercial,,6833.84,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Aetna,Commercial,,7972.64,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Aetna,Commercial,,9111.44,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Aetna,Commercial,,10250.24,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Aetna,Commercial,,11389.04,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Aetna,Commercial,,13666.64,,,,,,,13666.64,50987.08,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Aetna,Commercial,,1270.10,,,,,,,1270.10,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Aetna,Commercial,,2408.90,,,,,,,2408.90,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Aetna,Commercial,,3612.70,,,,,,,3612.70,13478.15,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2180.20000,1253.61000,Aetna,Commercial,,566.85,,,,,,,566.85,2114.79,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1880.60000,1081.34000,Aetna,Commercial,,488.96,,,,,,,488.96,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2908.70000,1672.50000,Aetna,Commercial,,756.26,,,,,,,756.26,2821.44,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,outpatient,,,34.00000,25.74000,Aetna,Commercial,,8.84,,,,,,,8.84,32.98,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,outpatient,,,13.00000,9.84000,Aetna,Commercial,,3.38,,,,,,,3.38,12.61,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Aetna,Commercial,,73.06,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Aetna,Commercial,,73.06,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Aetna,Commercial,,73.06,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Aetna,Commercial,,195.26,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Aetna,Commercial,,195.26,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Aetna,Commercial,,195.26,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,outpatient,,,122.00000,92.35000,Aetna,Commercial,,31.72,,,,,,,31.72,118.34,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Aetna,Commercial,,20.54,,,,,,,20.54,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Aetna,Commercial,,20.54,,,,,,,20.54,76.63,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Aetna,Commercial,,3.90,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Aetna,Commercial,,3.90,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Aetna,Commercial,,4.42,,,,,,,4.42,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Aetna,Commercial,,4.42,,,,,,,4.42,16.49,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,outpatient,,,359.00000,271.76000,Aetna,Commercial,,93.34,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,outpatient,,,359.00000,271.76000,Aetna,Commercial,,93.34,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,outpatient,,,359.00000,271.76000,Aetna,Commercial,,93.34,,,,,,,93.34,348.23,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,outpatient,,,155.00000,117.34000,Aetna,Commercial,,40.30,,,,,,,40.30,150.35,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,outpatient,,,294.00000,222.56000,Aetna,Commercial,,76.44,,,,,,,76.44,285.18,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,outpatient,,,1511.00000,1143.83000,Aetna,Commercial,,392.86,,,,,,,392.86,1465.67,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Aetna,Commercial,,195.26,,,,,,,195.26,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Aetna,Commercial,,195.26,,,,,,,195.26,728.47,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,outpatient,,,150.00000,113.55000,Aetna,Commercial,,39.00,,,,,,,39.00,145.50,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,outpatient,,,110.00000,83.27000,Aetna,Commercial,,28.60,,,,,,,28.60,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,outpatient,,,158.00000,119.61000,Aetna,Commercial,,41.08,,,,,,,41.08,153.26,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,outpatient,,,153.00000,115.82000,Aetna,Commercial,,39.78,,,,,,,39.78,148.41,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,outpatient,,,157.00000,118.85000,Aetna,Commercial,,40.82,,,,,,,40.82,152.29,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,outpatient,,,26.00000,19.68000,Aetna,Commercial,,6.76,,,,,,,6.76,25.22,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,outpatient,,,37.00000,28.01000,Aetna,Commercial,,9.62,,,,,,,9.62,35.89,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,outpatient,,,268.00000,202.88000,Aetna,Commercial,,69.68,,,,,,,69.68,259.96,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,outpatient,,,91.00000,68.89000,Aetna,Commercial,,23.66,,,,,,,23.66,88.27,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,outpatient,,,200.00000,151.40000,Aetna,Commercial,,52.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,outpatient,,,152.00000,115.06000,Aetna,Commercial,,39.52,,,,,,,39.52,147.44,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,outpatient,,,359.00000,271.76000,Aetna,Commercial,,93.34,,,,,,,93.34,348.23,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,outpatient,,,69.00000,33.26000,Aetna,Commercial,,17.94,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,outpatient,,,75.00000,36.15000,Aetna,Commercial,,19.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,outpatient,,,45.00000,21.69000,Aetna,Commercial,,11.70,,,,,,,11.70,43.65,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,outpatient,,,68.00000,32.78000,Aetna,Commercial,,17.68,,,,,,,17.68,65.96,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,outpatient,,,61.00000,29.40000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,outpatient,,,64.00000,30.85000,Aetna,Commercial,,16.64,,,,,,,16.64,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,outpatient,,,195.00000,93.99000,Aetna,Commercial,,50.70,,,,,,,50.70,189.15,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,outpatient,,,14.00000,6.75000,Aetna,Commercial,,3.64,,,,,,,3.64,13.58,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,outpatient,,,53.00000,25.55000,Aetna,Commercial,,13.78,,,,,,,13.78,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,outpatient,,,82.00000,39.52000,Aetna,Commercial,,21.32,,,,,,,21.32,79.54,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Aetna,Commercial,,36.66,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Aetna,Commercial,,36.66,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,outpatient,,,91.00000,43.86000,Aetna,Commercial,,23.66,,,,,,,23.66,88.27,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,outpatient,,,69.00000,33.26000,Aetna,Commercial,,17.94,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,outpatient,,,205.00000,98.81000,Aetna,Commercial,,53.30,,,,,,,53.30,198.85,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,outpatient,,,50.00000,24.10000,Aetna,Commercial,,13.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,outpatient,,,406.00000,195.69000,Aetna,Commercial,,105.56,,,,,,,105.56,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,outpatient,,,101.00000,48.68000,Aetna,Commercial,,26.26,,,,,,,26.26,97.97,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,outpatient,,,375.00000,180.75000,Aetna,Commercial,,97.50,,,,,,,97.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,outpatient,,,362.00000,174.48000,Aetna,Commercial,,94.12,,,,,,,94.12,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,outpatient,,,325.00000,156.65000,Aetna,Commercial,,84.50,,,,,,,84.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,outpatient,,,121.00000,58.32000,Aetna,Commercial,,31.46,,,,,,,31.46,117.37,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,outpatient,,,115.00000,55.43000,Aetna,Commercial,,29.90,,,,,,,29.90,111.55,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,outpatient,,,300.00000,144.60000,Aetna,Commercial,,78.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,outpatient,,,51.00000,24.58000,Aetna,Commercial,,13.26,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Aetna,Commercial,,13.26,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Aetna,Commercial,,13.26,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,outpatient,,,194.00000,93.51000,Aetna,Commercial,,50.44,,,,,,,50.44,188.18,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,outpatient,,,68.00000,32.78000,Aetna,Commercial,,17.68,,,,,,,17.68,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,outpatient,,,329.00000,158.58000,Aetna,Commercial,,85.54,,,,,,,85.54,319.13,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,outpatient,,,24.00000,11.57000,Aetna,Commercial,,6.24,,,,,,,6.24,23.28,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,outpatient,,,30.00000,14.46000,Aetna,Commercial,,7.80,,,,,,,7.80,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,outpatient,,,53.00000,25.55000,Aetna,Commercial,,13.78,,,,,,,13.78,51.41,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,outpatient,,,270.00000,130.14000,Aetna,Commercial,,70.20,,,,,,,70.20,261.90,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Aetna,Commercial,,31.98,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Aetna,Commercial,,31.98,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,outpatient,,,37.00000,17.83000,Aetna,Commercial,,9.62,,,,,,,9.62,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,outpatient,,,41.00000,19.76000,Aetna,Commercial,,10.66,,,,,,,10.66,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,outpatient,,,72.00000,34.70000,Aetna,Commercial,,18.72,,,,,,,18.72,69.84,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,outpatient,,,77.00000,37.11000,Aetna,Commercial,,20.02,,,,,,,20.02,74.69,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,outpatient,,,90.00000,43.38000,Aetna,Commercial,,23.40,,,,,,,23.40,87.30,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,outpatient,,,44.00000,21.21000,Aetna,Commercial,,11.44,,,,,,,11.44,42.68,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,outpatient,,,115.00000,55.43000,Aetna,Commercial,,29.90,,,,,,,29.90,111.55,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,outpatient,,,20.00000,9.64000,Aetna,Commercial,,5.20,,,,,,,5.20,19.40,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Commercial,,13.52,,,,,,,13.52,50.44,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,outpatient,,,341.00000,164.36000,Aetna,Commercial,,88.66,,,,,,,88.66,330.77,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,outpatient,,,54.00000,26.03000,Aetna,Commercial,,14.04,,,,,,,14.04,52.38,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,outpatient,,,53.00000,25.55000,Aetna,Commercial,,13.78,,,,,,,13.78,51.41,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,outpatient,,,88.00000,42.42000,Aetna,Commercial,,22.88,,,,,,,22.88,85.36,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,outpatient,,,89.00000,42.90000,Aetna,Commercial,,23.14,,,,,,,23.14,86.33,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,outpatient,,,61.00000,29.40000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Aetna,Commercial,,20.02,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Aetna,Commercial,,20.02,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Aetna,Commercial,,16.64,,,,,,,16.64,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Aetna,Commercial,,16.64,,,,,,,16.64,62.08,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,outpatient,,,95.00000,45.79000,Aetna,Commercial,,24.70,,,,,,,24.70,92.15,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,outpatient,,,132.00000,63.62000,Aetna,Commercial,,34.32,,,,,,,34.32,128.04,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,outpatient,,,83.00000,40.01000,Aetna,Commercial,,21.58,,,,,,,21.58,80.51,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,outpatient,,,387.00000,186.53000,Aetna,Commercial,,100.62,,,,,,,100.62,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,outpatient,,,387.00000,186.53000,Aetna,Commercial,,100.62,,,,,,,100.62,375.39,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,outpatient,,,31.00000,14.94000,Aetna,Commercial,,8.06,,,,,,,8.06,30.07,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,outpatient,,,36.00000,17.35000,Aetna,Commercial,,9.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,outpatient,,,160.00000,77.12000,Aetna,Commercial,,41.60,,,,,,,41.60,155.20,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,outpatient,,,112.00000,53.98000,Aetna,Commercial,,29.12,,,,,,,29.12,108.64,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,outpatient,,,14.00000,6.75000,Aetna,Commercial,,3.64,,,,,,,3.64,13.58,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,outpatient,,,16.00000,7.71000,Aetna,Commercial,,4.16,,,,,,,4.16,15.52,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,outpatient,,,71.00000,34.22000,Aetna,Commercial,,18.46,,,,,,,18.46,68.87,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,outpatient,,,116.00000,55.91000,Aetna,Commercial,,30.16,,,,,,,30.16,112.52,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,outpatient,,,81.00000,39.04000,Aetna,Commercial,,21.06,,,,,,,21.06,78.57,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,outpatient,,,97.00000,46.75000,Aetna,Commercial,,25.22,,,,,,,25.22,94.09,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,outpatient,,,77.00000,37.11000,Aetna,Commercial,,20.02,,,,,,,20.02,74.69,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,outpatient,,,35.00000,16.87000,Aetna,Commercial,,9.10,,,,,,,9.10,33.95,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,outpatient,,,65.00000,31.33000,Aetna,Commercial,,16.90,,,,,,,16.90,63.05,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,outpatient,,,74.00000,35.67000,Aetna,Commercial,,19.24,,,,,,,19.24,71.78,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,outpatient,,,250.00000,120.50000,Aetna,Commercial,,65.00,,,,,,,65.00,242.50,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,outpatient,,,90.00000,43.38000,Aetna,Commercial,,23.40,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,outpatient,,,90.00000,43.38000,Aetna,Commercial,,23.40,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Commercial,,13.52,,,,,,,13.52,50.44,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,outpatient,,,36.00000,17.35000,Aetna,Commercial,,9.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,outpatient,,,78.00000,37.60000,Aetna,Commercial,,20.28,,,,,,,20.28,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,outpatient,,,115.00000,55.43000,Aetna,Commercial,,29.90,,,,,,,29.90,111.55,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Commercial,,17.42,,,,,,,17.42,64.99,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,outpatient,,,76.00000,36.63000,Aetna,Commercial,,19.76,,,,,,,19.76,73.72,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,outpatient,,,53.00000,25.55000,Aetna,Commercial,,13.78,,,,,,,13.78,51.41,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,outpatient,,,70.00000,33.74000,Aetna,Commercial,,18.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,outpatient,,,169.00000,81.46000,Aetna,Commercial,,43.94,,,,,,,43.94,163.93,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,outpatient,,,28.00000,13.50000,Aetna,Commercial,,7.28,,,,,,,7.28,27.16,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,outpatient,,,51.00000,24.58000,Aetna,Commercial,,13.26,,,,,,,13.26,49.47,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,outpatient,,,15.00000,7.23000,Aetna,Commercial,,3.90,,,,,,,3.90,14.55,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,outpatient,,,18.00000,8.68000,Aetna,Commercial,,4.68,,,,,,,4.68,17.46,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,outpatient,,,61.00000,29.40000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,outpatient,,,550.00000,265.10000,Aetna,Commercial,,143.00,,,,,,,143.00,533.50,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Aetna,Commercial,,18.98,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,outpatient,,,392.00000,188.94000,Aetna,Commercial,,101.92,,,,,,,101.92,380.24,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,outpatient,,,75.00000,36.15000,Aetna,Commercial,,19.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Aetna,Commercial,,18.98,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,outpatient,,,100.00000,48.20000,Aetna,Commercial,,26.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,outpatient,,,153.00000,73.75000,Aetna,Commercial,,39.78,,,,,,,39.78,148.41,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,outpatient,,,909.00000,438.14000,Aetna,Commercial,,236.34,,,,,,,236.34,881.73,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,outpatient,,,266.00000,128.21000,Aetna,Commercial,,69.16,,,,,,,69.16,258.02,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,outpatient,,,275.00000,132.55000,Aetna,Commercial,,71.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,outpatient,,,61.00000,29.40000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,outpatient,,,84.00000,40.49000,Aetna,Commercial,,21.84,,,,,,,21.84,81.48,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,outpatient,,,174.00000,83.87000,Aetna,Commercial,,45.24,,,,,,,45.24,168.78,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Commercial,,17.42,,,,,,,17.42,64.99,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,outpatient,,,68.00000,32.78000,Aetna,Commercial,,17.68,,,,,,,17.68,65.96,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,outpatient,,,211.00000,101.70000,Aetna,Commercial,,54.86,,,,,,,54.86,204.67,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,outpatient,,,65.00000,31.33000,Aetna,Commercial,,16.90,,,,,,,16.90,63.05,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,outpatient,,,83.00000,40.01000,Aetna,Commercial,,21.58,,,,,,,21.58,80.51,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,outpatient,,,54.00000,26.03000,Aetna,Commercial,,14.04,,,,,,,14.04,52.38,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,outpatient,,,323.00000,155.69000,Aetna,Commercial,,83.98,,,,,,,83.98,313.31,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,outpatient,,,35.00000,16.87000,Aetna,Commercial,,9.10,,,,,,,9.10,33.95,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,outpatient,,,20.00000,9.64000,Aetna,Commercial,,5.20,,,,,,,5.20,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,outpatient,,,34.00000,16.39000,Aetna,Commercial,,8.84,,,,,,,8.84,32.98,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,outpatient,,,29.00000,13.98000,Aetna,Commercial,,7.54,,,,,,,7.54,28.13,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,outpatient,,,80.00000,38.56000,Aetna,Commercial,,20.80,,,,,,,20.80,77.60,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,outpatient,,,73.00000,35.19000,Aetna,Commercial,,18.98,,,,,,,18.98,70.81,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,outpatient,,,16.00000,7.71000,Aetna,Commercial,,4.16,,,,,,,4.16,15.52,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Commercial,,13.52,,,,,,,13.52,50.44,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,outpatient,,,113.00000,54.47000,Aetna,Commercial,,29.38,,,,,,,29.38,109.61,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,outpatient,,,68.00000,32.78000,Aetna,Commercial,,17.68,,,,,,,17.68,65.96,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,outpatient,,,78.00000,37.60000,Aetna,Commercial,,20.28,,,,,,,20.28,75.66,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,outpatient,,,54.00000,26.03000,Aetna,Commercial,,14.04,,,,,,,14.04,52.38,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,outpatient,,,76.00000,36.63000,Aetna,Commercial,,19.76,,,,,,,19.76,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Commercial,,17.42,,,,,,,17.42,64.99,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,outpatient,,,88.00000,42.42000,Aetna,Commercial,,22.88,,,,,,,22.88,85.36,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Commercial,,17.42,,,,,,,17.42,64.99,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,outpatient,,,53.00000,25.55000,Aetna,Commercial,,13.78,,,,,,,13.78,51.41,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,outpatient,,,88.00000,42.42000,Aetna,Commercial,,22.88,,,,,,,22.88,85.36,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,outpatient,,,105.00000,50.61000,Aetna,Commercial,,27.30,,,,,,,27.30,101.85,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Aetna,Commercial,,18.98,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,outpatient,,,83.00000,40.01000,Aetna,Commercial,,21.58,,,,,,,21.58,80.51,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Aetna,Commercial,,40.04,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,outpatient,,,97.00000,46.75000,Aetna,Commercial,,25.22,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Aetna,Commercial,,40.04,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,outpatient,,,87.00000,41.93000,Aetna,Commercial,,22.62,,,,,,,22.62,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,outpatient,,,68.00000,32.78000,Aetna,Commercial,,17.68,,,,,,,17.68,65.96,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Commercial,,13.52,,,,,,,13.52,50.44,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,outpatient,,,51.00000,24.58000,Aetna,Commercial,,13.26,,,,,,,13.26,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,outpatient,,,97.00000,46.75000,Aetna,Commercial,,25.22,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,outpatient,,,176.00000,84.83000,Aetna,Commercial,,45.76,,,,,,,45.76,170.72,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,outpatient,,,158.00000,76.16000,Aetna,Commercial,,41.08,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Commercial,,17.42,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Commercial,,17.42,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,outpatient,,,84.00000,40.49000,Aetna,Commercial,,21.84,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,outpatient,,,189.00000,91.10000,Aetna,Commercial,,49.14,,,,,,,49.14,183.33,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,outpatient,,,109.00000,52.54000,Aetna,Commercial,,28.34,,,,,,,28.34,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,outpatient,,,129.00000,62.18000,Aetna,Commercial,,33.54,,,,,,,33.54,125.13,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,outpatient,,,84.00000,40.49000,Aetna,Commercial,,21.84,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Aetna,Commercial,,18.98,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Commercial,,17.42,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Commercial,,17.42,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,outpatient,,,149.00000,71.82000,Aetna,Commercial,,38.74,,,,,,,38.74,144.53,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,outpatient,,,130.00000,62.66000,Aetna,Commercial,,33.80,,,,,,,33.80,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,outpatient,,,110.00000,53.02000,Aetna,Commercial,,28.60,,,,,,,28.60,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,outpatient,,,158.00000,76.16000,Aetna,Commercial,,41.08,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,outpatient,,,117.00000,56.39000,Aetna,Commercial,,30.42,,,,,,,30.42,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,outpatient,,,61.00000,29.40000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Commercial,,17.42,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Aetna,Commercial,,48.62,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,outpatient,,,145.00000,69.89000,Aetna,Commercial,,37.70,,,,,,,37.70,140.65,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Commercial,,17.42,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,outpatient,,,165.00000,79.53000,Aetna,Commercial,,42.90,,,,,,,42.90,160.05,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,outpatient,,,70.00000,33.74000,Aetna,Commercial,,18.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Commercial,,17.42,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Aetna,Commercial,,48.62,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,outpatient,,,154.00000,74.23000,Aetna,Commercial,,40.04,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,outpatient,,,104.00000,50.13000,Aetna,Commercial,,27.04,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,outpatient,,,70.00000,33.74000,Aetna,Commercial,,18.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,outpatient,,,104.00000,50.13000,Aetna,Commercial,,27.04,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,outpatient,,,70.00000,33.74000,Aetna,Commercial,,18.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,outpatient,,,123.00000,59.29000,Aetna,Commercial,,31.98,,,,,,,31.98,119.31,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,outpatient,,,95.00000,45.79000,Aetna,Commercial,,24.70,,,,,,,24.70,92.15,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,outpatient,,,160.00000,77.12000,Aetna,Commercial,,41.60,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,outpatient,,,147.00000,70.85000,Aetna,Commercial,,38.22,,,,,,,38.22,142.59,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,outpatient,,,178.00000,85.80000,Aetna,Commercial,,46.28,,,,,,,46.28,172.66,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,outpatient,,,160.00000,77.12000,Aetna,Commercial,,41.60,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Aetna,Commercial,,48.62,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Commercial,,17.42,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,outpatient,,,70.00000,33.74000,Aetna,Commercial,,18.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Aetna,Commercial,,48.62,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Aetna,Commercial,,48.62,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Aetna,Commercial,,48.62,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Aetna,Commercial,,48.62,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Aetna,Commercial,,48.62,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Aetna,Commercial,,48.62,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Aetna,Commercial,,48.62,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Aetna,Commercial,,48.62,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,outpatient,,,449.00000,216.42000,Aetna,Commercial,,116.74,,,,,,,116.74,435.53,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,outpatient,,,104.00000,50.13000,Aetna,Commercial,,27.04,,,,,,,27.04,100.88,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Aetna,Commercial,,48.10,,,,,,,48.10,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Aetna,Commercial,,48.10,,,,,,,48.10,179.45,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,outpatient,,,84.00000,40.49000,Aetna,Commercial,,21.84,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Aetna,Commercial,,21.84,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Aetna,Commercial,,21.84,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Aetna,Commercial,,18.98,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Aetna,Commercial,,18.98,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,outpatient,,,98.00000,47.24000,Aetna,Commercial,,25.48,,,,,,,25.48,95.06,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,outpatient,,,75.00000,36.15000,Aetna,Commercial,,19.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,outpatient,,,107.00000,51.57000,Aetna,Commercial,,27.82,,,,,,,27.82,103.79,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,outpatient,,,81.00000,39.04000,Aetna,Commercial,,21.06,,,,,,,21.06,78.57,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,outpatient,,,68.00000,32.78000,Aetna,Commercial,,17.68,,,,,,,17.68,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,outpatient,,,51.00000,24.58000,Aetna,Commercial,,13.26,,,,,,,13.26,49.47,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,outpatient,,,74.00000,35.67000,Aetna,Commercial,,19.24,,,,,,,19.24,71.78,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,outpatient,,,194.00000,93.51000,Aetna,Commercial,,50.44,,,,,,,50.44,188.18,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,outpatient,,,111.00000,53.50000,Aetna,Commercial,,28.86,,,,,,,28.86,107.67,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,outpatient,,,77.00000,37.11000,Aetna,Commercial,,20.02,,,,,,,20.02,74.69,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Aetna,Commercial,,20.54,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Aetna,Commercial,,20.54,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Aetna,Commercial,,61.62,,,,,,,61.62,229.89,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,outpatient,,,51.00000,24.58000,Aetna,Commercial,,13.26,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Aetna,Commercial,,21.32,,,,,,,21.32,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Aetna,Commercial,,21.32,,,,,,,21.32,79.54,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Commercial,,17.42,,,,,,,17.42,64.99,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,outpatient,,,131.00000,63.14000,Aetna,Commercial,,34.06,,,,,,,34.06,127.07,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,outpatient,,,15.00000,7.23000,Aetna,Commercial,,3.90,,,,,,,3.90,14.55,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,outpatient,,,39.00000,18.80000,Aetna,Commercial,,10.14,,,,,,,10.14,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,outpatient,,,12.00000,5.78000,Aetna,Commercial,,3.12,,,,,,,3.12,11.64,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Aetna,Commercial,,52.78,,,,,,,52.78,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Aetna,Commercial,,52.78,,,,,,,52.78,196.91,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,outpatient,,,99.00000,47.72000,Aetna,Commercial,,25.74,,,,,,,25.74,96.03,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,outpatient,,,53.00000,25.55000,Aetna,Commercial,,13.78,,,,,,,13.78,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,outpatient,,,23.00000,11.09000,Aetna,Commercial,,5.98,,,,,,,5.98,22.31,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,outpatient,,,46.00000,22.17000,Aetna,Commercial,,11.96,,,,,,,11.96,44.62,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Commercial,,17.42,,,,,,,17.42,64.99,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,outpatient,,,288.00000,138.82000,Aetna,Commercial,,74.88,,,,,,,74.88,279.36,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,outpatient,,,106.00000,51.09000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,outpatient,,,30.00000,14.46000,Aetna,Commercial,,7.80,,,,,,,7.80,29.10,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,outpatient,,,71.00000,34.22000,Aetna,Commercial,,18.46,,,,,,,18.46,68.87,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Commercial,,17.42,,,,,,,17.42,64.99,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,outpatient,,,89.00000,42.90000,Aetna,Commercial,,23.14,,,,,,,23.14,86.33,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,outpatient,,,116.00000,55.91000,Aetna,Commercial,,30.16,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Aetna,Commercial,,30.16,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Aetna,Commercial,,30.16,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,outpatient,,,51.00000,24.58000,Aetna,Commercial,,13.26,,,,,,,13.26,49.47,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,outpatient,,,174.00000,83.87000,Aetna,Commercial,,45.24,,,,,,,45.24,168.78,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,outpatient,,,82.00000,39.52000,Aetna,Commercial,,21.32,,,,,,,21.32,79.54,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,outpatient,,,112.00000,53.98000,Aetna,Commercial,,29.12,,,,,,,29.12,108.64,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,outpatient,,,61.00000,29.40000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,outpatient,,,69.00000,33.26000,Aetna,Commercial,,17.94,,,,,,,17.94,66.93,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Commercial,,13.52,,,,,,,13.52,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,outpatient,,,286.00000,137.85000,Aetna,Commercial,,74.36,,,,,,,74.36,277.42,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,outpatient,,,300.00000,144.60000,Aetna,Commercial,,78.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,outpatient,,,73.00000,35.19000,Aetna,Commercial,,18.98,,,,,,,18.98,70.81,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,outpatient,,,90.00000,43.38000,Aetna,Commercial,,23.40,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Commercial,,13.52,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,outpatient,,,315.00000,151.83000,Aetna,Commercial,,81.90,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,outpatient,,,100.00000,48.20000,Aetna,Commercial,,26.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,outpatient,,,89.00000,42.90000,Aetna,Commercial,,23.14,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,outpatient,,,71.00000,34.22000,Aetna,Commercial,,18.46,,,,,,,18.46,68.87,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,outpatient,,,135.00000,65.07000,Aetna,Commercial,,35.10,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,outpatient,,,80.00000,38.56000,Aetna,Commercial,,20.80,,,,,,,20.80,77.60,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Aetna,Commercial,,18.72,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Aetna,Commercial,,18.72,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,outpatient,,,100.00000,48.20000,Aetna,Commercial,,26.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,outpatient,,,305.00000,147.01000,Aetna,Commercial,,79.30,,,,,,,79.30,295.85,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,outpatient,,,70.00000,33.74000,Aetna,Commercial,,18.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,outpatient,,,69.00000,33.26000,Aetna,Commercial,,17.94,,,,,,,17.94,66.93,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,outpatient,,,64.00000,30.85000,Aetna,Commercial,,16.64,,,,,,,16.64,62.08,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,outpatient,,,368.00000,177.38000,Aetna,Commercial,,95.68,,,,,,,95.68,356.96,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,outpatient,,,104.00000,50.13000,Aetna,Commercial,,27.04,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,outpatient,,,109.00000,52.54000,Aetna,Commercial,,28.34,,,,,,,28.34,105.73,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,outpatient,,,114.00000,54.95000,Aetna,Commercial,,29.64,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,outpatient,,,135.00000,65.07000,Aetna,Commercial,,35.10,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,outpatient,,,105.00000,50.61000,Aetna,Commercial,,27.30,,,,,,,27.30,101.85,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,outpatient,,,315.00000,151.83000,Aetna,Commercial,,81.90,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,outpatient,,,148.00000,71.34000,Aetna,Commercial,,38.48,,,,,,,38.48,143.56,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Commercial,,17.42,,,,,,,17.42,64.99,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,outpatient,,,107.00000,51.57000,Aetna,Commercial,,27.82,,,,,,,27.82,103.79,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,outpatient,,,35.00000,16.87000,Aetna,Commercial,,9.10,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,outpatient,,,104.00000,50.13000,Aetna,Commercial,,27.04,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,outpatient,,,650.00000,313.30000,Aetna,Commercial,,169.00,,,,,,,169.00,630.50,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,outpatient,,,91.00000,43.86000,Aetna,Commercial,,23.66,,,,,,,23.66,88.27,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,outpatient,,,114.00000,54.95000,Aetna,Commercial,,29.64,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Commercial,,13.52,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,outpatient,,,360.00000,173.52000,Aetna,Commercial,,93.60,,,,,,,93.60,349.20,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,outpatient,,,106.00000,51.09000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,outpatient,,,78.00000,37.60000,Aetna,Commercial,,20.28,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,outpatient,,,72.00000,34.70000,Aetna,Commercial,,18.72,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,outpatient,,,94.00000,45.31000,Aetna,Commercial,,24.44,,,,,,,24.44,91.18,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,outpatient,,,101.00000,48.68000,Aetna,Commercial,,26.26,,,,,,,26.26,97.97,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,outpatient,,,82.00000,39.52000,Aetna,Commercial,,21.32,,,,,,,21.32,79.54,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,outpatient,,,77.00000,37.11000,Aetna,Commercial,,20.02,,,,,,,20.02,74.69,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,outpatient,,,145.00000,69.89000,Aetna,Commercial,,37.70,,,,,,,37.70,140.65,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,outpatient,,,266.00000,128.21000,Aetna,Commercial,,69.16,,,,,,,69.16,258.02,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,outpatient,,,79.00000,38.08000,Aetna,Commercial,,20.54,,,,,,,20.54,76.63,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,outpatient,,,144.00000,69.41000,Aetna,Commercial,,37.44,,,,,,,37.44,139.68,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,outpatient,,,20.00000,9.64000,Aetna,Commercial,,5.20,,,,,,,5.20,19.40,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,outpatient,,,208.00000,100.26000,Aetna,Commercial,,54.08,,,,,,,54.08,201.76,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,outpatient,,,135.00000,65.07000,Aetna,Commercial,,35.10,,,,,,,35.10,130.95,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,outpatient,,,131.00000,63.14000,Aetna,Commercial,,34.06,,,,,,,34.06,127.07,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,outpatient,,,69.00000,33.26000,Aetna,Commercial,,17.94,,,,,,,17.94,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,outpatient,,,25.00000,12.05000,Aetna,Commercial,,6.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,outpatient,,,61.00000,29.40000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,outpatient,,,80.00000,38.56000,Aetna,Commercial,,20.80,,,,,,,20.80,77.60,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,outpatient,,,82.00000,39.52000,Aetna,Commercial,,21.32,,,,,,,21.32,79.54,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,outpatient,,,35.00000,16.87000,Aetna,Commercial,,9.10,,,,,,,9.10,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,outpatient,,,88.00000,42.42000,Aetna,Commercial,,22.88,,,,,,,22.88,85.36,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,outpatient,,,98.00000,47.24000,Aetna,Commercial,,25.48,,,,,,,25.48,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,outpatient,,,204.00000,98.33000,Aetna,Commercial,,53.04,,,,,,,53.04,197.88,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,outpatient,,,61.00000,29.40000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,outpatient,,,19.00000,9.16000,Aetna,Commercial,,4.94,,,,,,,4.94,18.43,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,outpatient,,,37.00000,17.83000,Aetna,Commercial,,9.62,,,,,,,9.62,35.89,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,outpatient,,,79.00000,38.08000,Aetna,Commercial,,20.54,,,,,,,20.54,76.63,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,outpatient,,,21.00000,10.12000,Aetna,Commercial,,5.46,,,,,,,5.46,20.37,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Commercial,,13.52,,,,,,,13.52,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,outpatient,,,32.00000,15.42000,Aetna,Commercial,,8.32,,,,,,,8.32,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,outpatient,,,94.00000,45.31000,Aetna,Commercial,,24.44,,,,,,,24.44,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,outpatient,,,103.00000,49.65000,Aetna,Commercial,,26.78,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,outpatient,,,64.00000,30.85000,Aetna,Commercial,,16.64,,,,,,,16.64,62.08,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,outpatient,,,102.00000,49.16000,Aetna,Commercial,,26.52,,,,,,,26.52,98.94,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,outpatient,,,103.00000,49.65000,Aetna,Commercial,,26.78,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,outpatient,,,139.00000,67.00000,Aetna,Commercial,,36.14,,,,,,,36.14,134.83,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Commercial,,13.52,,,,,,,13.52,50.44,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Aetna,Commercial,,5.46,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,outpatient,,,88.00000,42.42000,Aetna,Commercial,,22.88,,,,,,,22.88,85.36,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Aetna,Commercial,,5.46,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Commercial,,13.52,,,,,,,13.52,50.44,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,outpatient,,,80.00000,38.56000,Aetna,Commercial,,20.80,,,,,,,20.80,77.60,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,outpatient,,,49.00000,23.62000,Aetna,Commercial,,12.74,,,,,,,12.74,47.53,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,outpatient,,,88.00000,42.42000,Aetna,Commercial,,22.88,,,,,,,22.88,85.36,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,outpatient,,,68.00000,32.78000,Aetna,Commercial,,17.68,,,,,,,17.68,65.96,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,outpatient,,,93.00000,44.83000,Aetna,Commercial,,24.18,,,,,,,24.18,90.21,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,outpatient,,,73.00000,35.19000,Aetna,Commercial,,18.98,,,,,,,18.98,70.81,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,outpatient,,,41.00000,19.76000,Aetna,Commercial,,10.66,,,,,,,10.66,39.77,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,outpatient,,,94.00000,45.31000,Aetna,Commercial,,24.44,,,,,,,24.44,91.18,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,outpatient,,,124.00000,59.77000,Aetna,Commercial,,32.24,,,,,,,32.24,120.28,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,outpatient,,,71.00000,34.22000,Aetna,Commercial,,18.46,,,,,,,18.46,68.87,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,outpatient,,,33.00000,15.91000,Aetna,Commercial,,8.58,,,,,,,8.58,32.01,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Commercial,,13.52,,,,,,,13.52,50.44,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,outpatient,,,68.00000,32.78000,Aetna,Commercial,,17.68,,,,,,,17.68,65.96,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,outpatient,,,99.00000,47.72000,Aetna,Commercial,,25.74,,,,,,,25.74,96.03,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,outpatient,,,197.00000,94.95000,Aetna,Commercial,,51.22,,,,,,,51.22,191.09,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,outpatient,,,194.00000,93.51000,Aetna,Commercial,,50.44,,,,,,,50.44,188.18,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,outpatient,,,68.00000,32.78000,Aetna,Commercial,,17.68,,,,,,,17.68,65.96,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,outpatient,,,90.00000,43.38000,Aetna,Commercial,,23.40,,,,,,,23.40,87.30,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,outpatient,,,109.00000,52.54000,Aetna,Commercial,,28.34,,,,,,,28.34,105.73,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,outpatient,,,108.00000,52.06000,Aetna,Commercial,,28.08,,,,,,,28.08,104.76,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,outpatient,,,67.00000,32.29000,Aetna,Commercial,,17.42,,,,,,,17.42,64.99,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,outpatient,,,69.00000,33.26000,Aetna,Commercial,,17.94,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,outpatient,,,71.00000,34.22000,Aetna,Commercial,,18.46,,,,,,,18.46,68.87,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,outpatient,,,98.00000,47.24000,Aetna,Commercial,,25.48,,,,,,,25.48,95.06,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,outpatient,,,141.00000,67.96000,Aetna,Commercial,,36.66,,,,,,,36.66,136.77,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,outpatient,,,226.00000,108.93000,Aetna,Commercial,,58.76,,,,,,,58.76,219.22,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,outpatient,,,92.00000,44.34000,Aetna,Commercial,,23.92,,,,,,,23.92,89.24,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,outpatient,,,69.00000,33.26000,Aetna,Commercial,,17.94,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,outpatient,,,100.00000,48.20000,Aetna,Commercial,,26.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,outpatient,,,124.00000,59.77000,Aetna,Commercial,,32.24,,,,,,,32.24,120.28,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,outpatient,,,69.00000,33.26000,Aetna,Commercial,,17.94,,,,,,,17.94,66.93,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Aetna,Commercial,,32.24,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Aetna,Commercial,,32.24,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Aetna,Commercial,,32.24,,,,,,,32.24,120.28,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,outpatient,,,118.00000,56.88000,Aetna,Commercial,,30.68,,,,,,,30.68,114.46,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,outpatient,,,51.00000,24.58000,Aetna,Commercial,,13.26,,,,,,,13.26,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,outpatient,,,104.00000,50.13000,Aetna,Commercial,,27.04,,,,,,,27.04,100.88,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,outpatient,,,72.00000,34.70000,Aetna,Commercial,,18.72,,,,,,,18.72,69.84,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,outpatient,,,54.00000,26.03000,Aetna,Commercial,,14.04,,,,,,,14.04,52.38,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,outpatient,,,17.00000,8.19000,Aetna,Commercial,,4.42,,,,,,,4.42,16.49,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,outpatient,,,36.00000,17.35000,Aetna,Commercial,,9.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Commercial,,13.52,,,,,,,13.52,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,outpatient,,,18.00000,8.68000,Aetna,Commercial,,4.68,,,,,,,4.68,17.46,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,outpatient,,,74.00000,35.67000,Aetna,Commercial,,19.24,,,,,,,19.24,71.78,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,outpatient,,,118.00000,56.88000,Aetna,Commercial,,30.68,,,,,,,30.68,114.46,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,outpatient,,,82.00000,39.52000,Aetna,Commercial,,21.32,,,,,,,21.32,79.54,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,outpatient,,,30.00000,14.46000,Aetna,Commercial,,7.80,,,,,,,7.80,29.10,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,outpatient,,,70.00000,33.74000,Aetna,Commercial,,18.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,outpatient,,,54.00000,26.03000,Aetna,Commercial,,14.04,,,,,,,14.04,52.38,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,outpatient,,,51.00000,24.58000,Aetna,Commercial,,13.26,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,outpatient,,,141.00000,67.96000,Aetna,Commercial,,36.66,,,,,,,36.66,136.77,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,outpatient,,,81.00000,39.04000,Aetna,Commercial,,21.06,,,,,,,21.06,78.57,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,outpatient,,,335.00000,161.47000,Aetna,Commercial,,87.10,,,,,,,87.10,324.95,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,outpatient,,,52.00000,25.06000,Aetna,Commercial,,13.52,,,,,,,13.52,50.44,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Aetna,Commercial,,14.04,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Aetna,Commercial,,14.04,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,outpatient,,,53.00000,25.55000,Aetna,Commercial,,13.78,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,outpatient,,,53.00000,25.55000,Aetna,Commercial,,13.78,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,outpatient,,,12.00000,5.78000,Aetna,Commercial,,3.12,,,,,,,3.12,11.64,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,outpatient,,,710.00000,342.22000,Aetna,Commercial,,184.60,,,,,,,184.60,688.70,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,outpatient,,,104.00000,50.13000,Aetna,Commercial,,27.04,,,,,,,27.04,100.88,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,outpatient,,,155.00000,74.71000,Aetna,Commercial,,40.30,,,,,,,40.30,150.35,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,outpatient,,,139.00000,67.00000,Aetna,Commercial,,36.14,,,,,,,36.14,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,outpatient,,,89.00000,42.90000,Aetna,Commercial,,23.14,,,,,,,23.14,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,outpatient,,,88.00000,42.42000,Aetna,Commercial,,22.88,,,,,,,22.88,85.36,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,outpatient,,,111.00000,53.50000,Aetna,Commercial,,28.86,,,,,,,28.86,107.67,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,outpatient,,,70.00000,33.74000,Aetna,Commercial,,18.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,outpatient,,,85.00000,40.97000,Aetna,Commercial,,22.10,,,,,,,22.10,82.45,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,outpatient,,,110.00000,53.02000,Aetna,Commercial,,28.60,,,,,,,28.60,106.70,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,outpatient,,,500.00000,241.00000,Aetna,Commercial,,130.00,,,,,,,130.00,485.00,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,outpatient,,,140.00000,67.48000,Aetna,Commercial,,36.40,,,,,,,36.40,135.80,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,outpatient,,,74.00000,35.67000,Aetna,Commercial,,19.24,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,outpatient,,,77.00000,37.11000,Aetna,Commercial,,20.02,,,,,,,20.02,74.69,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,outpatient,,,93.00000,44.83000,Aetna,Commercial,,24.18,,,,,,,24.18,90.21,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,outpatient,,,15.00000,7.23000,Aetna,Commercial,,3.90,,,,,,,3.90,14.55,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,outpatient,,,24.00000,11.57000,Aetna,Commercial,,6.24,,,,,,,6.24,23.28,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,outpatient,,,72.00000,34.70000,Aetna,Commercial,,18.72,,,,,,,18.72,69.84,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Aetna,Commercial,,4.16,,,,,,,4.16,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Aetna,Commercial,,4.16,,,,,,,4.16,15.52,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,outpatient,,,64.00000,30.85000,Aetna,Commercial,,16.64,,,,,,,16.64,62.08,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,outpatient,,,82.00000,39.52000,Aetna,Commercial,,21.32,,,,,,,21.32,79.54,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,outpatient,,,157.00000,75.67000,Aetna,Commercial,,40.82,,,,,,,40.82,152.29,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,outpatient,,,70.00000,33.74000,Aetna,Commercial,,18.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,outpatient,,,229.00000,110.38000,Aetna,Commercial,,59.54,,,,,,,59.54,222.13,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,outpatient,,,64.00000,30.85000,Aetna,Commercial,,16.64,,,,,,,16.64,62.08,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,outpatient,,,72.00000,34.70000,Aetna,Commercial,,18.72,,,,,,,18.72,69.84,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,outpatient,,,17.00000,8.19000,Aetna,Commercial,,4.42,,,,,,,4.42,16.49,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,outpatient,,,64.00000,30.85000,Aetna,Commercial,,16.64,,,,,,,16.64,62.08,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,outpatient,,,387.00000,186.53000,Aetna,Commercial,,100.62,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Aetna,Commercial,,100.62,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Aetna,Commercial,,100.62,,,,,,,100.62,375.39,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,outpatient,,,77.00000,37.11000,Aetna,Commercial,,20.02,,,,,,,20.02,74.69,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Aetna,Commercial,,20.28,,,,,,,20.28,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Aetna,Commercial,,20.28,,,,,,,20.28,75.66,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,outpatient,,,43.00000,20.73000,Aetna,Commercial,,11.18,,,,,,,11.18,41.71,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,outpatient,,,64.00000,30.85000,Aetna,Commercial,,16.64,,,,,,,16.64,62.08,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,outpatient,,,160.00000,77.12000,Aetna,Commercial,,41.60,,,,,,,41.60,155.20,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,outpatient,,,112.00000,53.98000,Aetna,Commercial,,29.12,,,,,,,29.12,108.64,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,outpatient,,,82.00000,39.52000,Aetna,Commercial,,21.32,,,,,,,21.32,79.54,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,outpatient,,,55.00000,26.51000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,outpatient,,,54.00000,26.03000,Aetna,Commercial,,14.04,,,,,,,14.04,52.38,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,outpatient,,,153.00000,73.75000,Aetna,Commercial,,39.78,,,,,,,39.78,148.41,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,outpatient,,,45.00000,21.69000,Aetna,Commercial,,11.70,,,,,,,11.70,43.65,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,outpatient,,,28.00000,13.50000,Aetna,Commercial,,7.28,,,,,,,7.28,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Aetna,Commercial,,12.74,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Aetna,Commercial,,12.74,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Aetna,Commercial,,12.74,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,outpatient,,,36.00000,17.35000,Aetna,Commercial,,9.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,outpatient,,,38.00000,18.32000,Aetna,Commercial,,9.88,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,outpatient,,,38.00000,18.32000,Aetna,Commercial,,9.88,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,outpatient,,,76.00000,36.63000,Aetna,Commercial,,19.76,,,,,,,19.76,73.72,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,outpatient,,,173.00000,83.39000,Aetna,Commercial,,44.98,,,,,,,44.98,167.81,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,outpatient,,,22.00000,10.60000,Aetna,Commercial,,5.72,,,,,,,5.72,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,outpatient,,,39.00000,18.80000,Aetna,Commercial,,10.14,,,,,,,10.14,37.83,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,outpatient,,,41.00000,19.76000,Aetna,Commercial,,10.66,,,,,,,10.66,39.77,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,outpatient,,,54.00000,26.03000,Aetna,Commercial,,14.04,,,,,,,14.04,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,outpatient,,,71.00000,34.22000,Aetna,Commercial,,18.46,,,,,,,18.46,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Aetna,Commercial,,11.18,,,,,,,11.18,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Aetna,Commercial,,11.18,,,,,,,11.18,41.71,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,outpatient,,,38.00000,18.32000,Aetna,Commercial,,9.88,,,,,,,9.88,36.86,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,outpatient,,,72.00000,34.70000,Aetna,Commercial,,18.72,,,,,,,18.72,69.84,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,outpatient,,,226.00000,108.93000,Aetna,Commercial,,58.76,,,,,,,58.76,219.22,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Aetna,Commercial,,10.66,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Aetna,Commercial,,10.66,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Aetna,Commercial,,10.66,,,,,,,10.66,39.77,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,outpatient,,,160.00000,77.12000,Aetna,Commercial,,41.60,,,,,,,41.60,155.20,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,outpatient,,,102.00000,49.16000,Aetna,Commercial,,26.52,,,,,,,26.52,98.94,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,outpatient,,,317.00000,152.79000,Aetna,Commercial,,82.42,,,,,,,82.42,307.49,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,outpatient,,,116.00000,55.91000,Aetna,Commercial,,30.16,,,,,,,30.16,112.52,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Aetna,Commercial,,23.14,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Aetna,Commercial,,23.14,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,outpatient,,,85.00000,40.97000,Aetna,Commercial,,22.10,,,,,,,22.10,82.45,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,outpatient,,,184.00000,88.69000,Aetna,Commercial,,47.84,,,,,,,47.84,178.48,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,outpatient,,,127.00000,61.21000,Aetna,Commercial,,33.02,,,,,,,33.02,123.19,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,outpatient,,,61.00000,29.40000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,outpatient,,,35.00000,16.87000,Aetna,Commercial,,9.10,,,,,,,9.10,33.95,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,outpatient,,,79.00000,38.08000,Aetna,Commercial,,20.54,,,,,,,20.54,76.63,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Commercial,,16.90,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,outpatient,,,57.00000,32.83000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Aetna,Commercial,,39.78,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,outpatient,,,77.00000,44.35000,Aetna,Commercial,,20.02,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,outpatient,,,70.00000,40.32000,Aetna,Commercial,,18.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,outpatient,,,67.00000,38.59000,Aetna,Commercial,,17.42,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,outpatient,,,40.00000,23.04000,Aetna,Commercial,,10.40,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,outpatient,,,71.00000,40.90000,Aetna,Commercial,,18.46,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,outpatient,,,80.00000,46.08000,Aetna,Commercial,,20.80,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,outpatient,,,72.00000,41.47000,Aetna,Commercial,,18.72,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,outpatient,,,444.00000,255.74000,Aetna,Commercial,,115.44,,,,,,,115.44,430.68,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,outpatient,,,81.00000,46.66000,Aetna,Commercial,,21.06,,,,,,,21.06,78.57,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,outpatient,,,66.00000,38.02000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,outpatient,,,57.00000,32.83000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,outpatient,,,53.00000,30.53000,Aetna,Commercial,,13.78,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Commercial,,16.90,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Commercial,,16.90,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,outpatient,,,60.00000,34.56000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,outpatient,,,40.00000,23.04000,Aetna,Commercial,,10.40,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,outpatient,,,42.00000,24.19000,Aetna,Commercial,,10.92,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,outpatient,,,46.00000,26.50000,Aetna,Commercial,,11.96,,,,,,,11.96,44.62,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,outpatient,,,54.00000,31.10000,Aetna,Commercial,,14.04,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,outpatient,,,71.00000,40.90000,Aetna,Commercial,,18.46,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,outpatient,,,54.00000,31.10000,Aetna,Commercial,,14.04,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,outpatient,,,80.00000,46.08000,Aetna,Commercial,,20.80,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,outpatient,,,60.00000,34.56000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Aetna,Commercial,,32.24,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,outpatient,,,130.00000,74.88000,Aetna,Commercial,,33.80,,,,,,,33.80,126.10,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Aetna,Commercial,,31.98,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,outpatient,,,77.00000,44.35000,Aetna,Commercial,,20.02,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Commercial,,16.90,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,outpatient,,,115.00000,66.24000,Aetna,Commercial,,29.90,,,,,,,29.90,111.55,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Aetna,Commercial,,31.98,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,outpatient,,,161.00000,92.74000,Aetna,Commercial,,41.86,,,,,,,41.86,156.17,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Aetna,Commercial,,32.24,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Commercial,,16.90,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Commercial,,16.90,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Commercial,,16.90,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Commercial,,16.90,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,outpatient,,,102.00000,58.75000,Aetna,Commercial,,26.52,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,outpatient,,,219.00000,126.14000,Aetna,Commercial,,56.94,,,,,,,56.94,212.43,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Aetna,Commercial,,50.44,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,outpatient,,,103.00000,59.33000,Aetna,Commercial,,26.78,,,,,,,26.78,99.91,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,outpatient,,,60.00000,34.56000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,outpatient,,,837.00000,482.11000,Aetna,Commercial,,217.62,,,,,,,217.62,811.89,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Commercial,,16.90,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Commercial,,16.90,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Aetna,Commercial,,50.44,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,outpatient,,,78.00000,44.93000,Aetna,Commercial,,20.28,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,outpatient,,,285.00000,164.16000,Aetna,Commercial,,74.10,,,,,,,74.10,276.45,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,outpatient,,,190.00000,109.44000,Aetna,Commercial,,49.40,,,,,,,49.40,184.30,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,outpatient,,,100.00000,57.60000,Aetna,Commercial,,26.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Aetna,Commercial,,10.40,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,outpatient,,,67.00000,38.59000,Aetna,Commercial,,17.42,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,outpatient,,,78.00000,44.93000,Aetna,Commercial,,20.28,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Commercial,,16.90,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Commercial,,16.90,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,outpatient,,,57.00000,32.83000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,outpatient,,,72.00000,41.47000,Aetna,Commercial,,18.72,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,outpatient,,,59.00000,33.98000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,outpatient,,,72.00000,41.47000,Aetna,Commercial,,18.72,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,outpatient,,,239.00000,137.66000,Aetna,Commercial,,62.14,,,,,,,62.14,231.83,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,outpatient,,,85.00000,48.96000,Aetna,Commercial,,22.10,,,,,,,22.10,82.45,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,outpatient,,,44.00000,25.34000,Aetna,Commercial,,11.44,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,outpatient,,,40.00000,23.04000,Aetna,Commercial,,10.40,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,outpatient,,,53.00000,30.53000,Aetna,Commercial,,13.78,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,outpatient,,,68.00000,39.17000,Aetna,Commercial,,17.68,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,outpatient,,,76.00000,43.78000,Aetna,Commercial,,19.76,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,outpatient,,,42.00000,24.19000,Aetna,Commercial,,10.92,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,outpatient,,,87.00000,50.11000,Aetna,Commercial,,22.62,,,,,,,22.62,84.39,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,outpatient,,,503.00000,289.73000,Aetna,Commercial,,130.78,,,,,,,130.78,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,outpatient,,,472.00000,271.87000,Aetna,Commercial,,122.72,,,,,,,122.72,457.84,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,outpatient,,,28.00000,16.13000,Aetna,Commercial,,7.28,,,,,,,7.28,27.16,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,outpatient,,,236.00000,135.94000,Aetna,Commercial,,61.36,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,outpatient,,,54.00000,31.10000,Aetna,Commercial,,14.04,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,outpatient,,,238.00000,137.09000,Aetna,Commercial,,61.88,,,,,,,61.88,230.86,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,outpatient,,,236.00000,135.94000,Aetna,Commercial,,61.36,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,outpatient,,,145.00000,83.52000,Aetna,Commercial,,37.70,,,,,,,37.70,140.65,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Aetna,Commercial,,17.68,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Aetna,Commercial,,17.68,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,outpatient,,,66.00000,38.02000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,outpatient,,,59.00000,33.98000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,outpatient,,,158.00000,91.01000,Aetna,Commercial,,41.08,,,,,,,41.08,153.26,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,outpatient,,,71.00000,40.90000,Aetna,Commercial,,18.46,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,outpatient,,,144.00000,82.94000,Aetna,Commercial,,37.44,,,,,,,37.44,139.68,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,outpatient,,,1448.00000,834.05000,Aetna,Commercial,,376.48,,,,,,,376.48,1404.56,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,outpatient,,,72.00000,41.47000,Aetna,Commercial,,18.72,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,outpatient,,,102.00000,58.75000,Aetna,Commercial,,26.52,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,outpatient,,,154.00000,88.70000,Aetna,Commercial,,40.04,,,,,,,40.04,149.38,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Aetna,Commercial,,39.78,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,outpatient,,,66.00000,38.02000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Aetna,Commercial,,39.78,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,outpatient,,,44.00000,25.34000,Aetna,Commercial,,11.44,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,outpatient,,,150.00000,86.40000,Aetna,Commercial,,39.00,,,,,,,39.00,145.50,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,outpatient,,,56.00000,32.26000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,outpatient,,,66.00000,38.02000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,outpatient,,,60.00000,34.56000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,outpatient,,,58.00000,33.41000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,outpatient,,,71.00000,40.90000,Aetna,Commercial,,18.46,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,outpatient,,,72.00000,41.47000,Aetna,Commercial,,18.72,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,outpatient,,,60.00000,34.56000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,outpatient,,,56.00000,32.26000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,outpatient,,,39.00000,22.46000,Aetna,Commercial,,10.14,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Aetna,Commercial,,39.78,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,outpatient,,,73.00000,42.05000,Aetna,Commercial,,18.98,,,,,,,18.98,70.81,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Aetna,Commercial,,33.02,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Aetna,Commercial,,33.02,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Commercial,,16.90,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,outpatient,,,372.00000,214.27000,Aetna,Commercial,,96.72,,,,,,,96.72,360.84,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,outpatient,,,69.00000,39.74000,Aetna,Commercial,,17.94,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Aetna,Commercial,,39.78,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Aetna,Commercial,,39.78,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,outpatient,,,57.00000,32.83000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,outpatient,,,96.00000,55.30000,Aetna,Commercial,,24.96,,,,,,,24.96,93.12,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,outpatient,,,44.00000,25.34000,Aetna,Commercial,,11.44,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,outpatient,,,60.00000,34.56000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,outpatient,,,60.00000,34.56000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,outpatient,,,74.00000,42.62000,Aetna,Commercial,,19.24,,,,,,,19.24,71.78,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,outpatient,,,69.00000,39.74000,Aetna,Commercial,,17.94,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Aetna,Commercial,,10.14,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,outpatient,,,53.00000,30.53000,Aetna,Commercial,,13.78,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Aetna,Commercial,,10.14,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Aetna,Commercial,,10.14,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,outpatient,,,70.00000,40.32000,Aetna,Commercial,,18.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,outpatient,,,71.00000,40.90000,Aetna,Commercial,,18.46,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,outpatient,,,65.00000,37.44000,Aetna,Commercial,,16.90,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,outpatient,,,325.00000,187.20000,Aetna,Commercial,,84.50,,,,,,,84.50,315.25,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,outpatient,,,72.00000,41.47000,Aetna,Commercial,,18.72,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,outpatient,,,72.00000,41.47000,Aetna,Commercial,,18.72,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,outpatient,,,76.00000,43.78000,Aetna,Commercial,,19.76,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,outpatient,,,240.00000,138.24000,Aetna,Commercial,,62.40,,,,,,,62.40,232.80,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,outpatient,,,93.00000,53.57000,Aetna,Commercial,,24.18,,,,,,,24.18,90.21,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,outpatient,,,59.00000,33.98000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,outpatient,,,81.00000,46.66000,Aetna,Commercial,,21.06,,,,,,,21.06,78.57,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,outpatient,,,58.00000,33.41000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,outpatient,,,21.00000,12.10000,Aetna,Commercial,,5.46,,,,,,,5.46,20.37,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,outpatient,,,56.00000,32.26000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,outpatient,,,64.00000,36.86000,Aetna,Commercial,,16.64,,,,,,,16.64,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,outpatient,,,80.00000,46.08000,Aetna,Commercial,,20.80,,,,,,,20.80,77.60,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,outpatient,,,109.00000,62.78000,Aetna,Commercial,,28.34,,,,,,,28.34,105.73,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,outpatient,,,59.00000,33.98000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,outpatient,,,115.00000,66.24000,Aetna,Commercial,,29.90,,,,,,,29.90,111.55,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,outpatient,,,57.00000,32.83000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,outpatient,,,118.00000,67.97000,Aetna,Commercial,,30.68,,,,,,,30.68,114.46,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,outpatient,,,268.00000,154.37000,Aetna,Commercial,,69.68,,,,,,,69.68,259.96,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Aetna,Commercial,,29.64,,,,,,,29.64,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Aetna,Commercial,,29.64,,,,,,,29.64,110.58,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,outpatient,,,78.00000,44.93000,Aetna,Commercial,,20.28,,,,,,,20.28,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,outpatient,,,91.00000,52.42000,Aetna,Commercial,,23.66,,,,,,,23.66,88.27,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,outpatient,,,300.00000,172.80000,Aetna,Commercial,,78.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,outpatient,,,185.00000,106.56000,Aetna,Commercial,,48.10,,,,,,,48.10,179.45,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Aetna,Commercial,,9.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,outpatient,,,76.00000,43.78000,Aetna,Commercial,,19.76,,,,,,,19.76,73.72,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Aetna,Commercial,,9.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Aetna,Commercial,,9.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,outpatient,,,53.00000,30.53000,Aetna,Commercial,,13.78,,,,,,,13.78,51.41,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,outpatient,,,77.00000,44.35000,Aetna,Commercial,,20.02,,,,,,,20.02,74.69,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Aetna,Commercial,,9.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,outpatient,,,222.00000,127.87000,Aetna,Commercial,,57.72,,,,,,,57.72,215.34,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,outpatient,,,292.00000,168.19000,Aetna,Commercial,,75.92,,,,,,,75.92,283.24,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Aetna,Commercial,,32.50,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Aetna,Commercial,,32.50,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,outpatient,,,359.00000,206.78000,Aetna,Commercial,,93.34,,,,,,,93.34,348.23,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,outpatient,,,111.00000,63.94000,Aetna,Commercial,,28.86,,,,,,,28.86,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Aetna,Commercial,,36.66,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Aetna,Commercial,,36.66,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Aetna,Commercial,,29.64,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Aetna,Commercial,,29.64,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Aetna,Commercial,,29.64,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Aetna,Commercial,,29.64,,,,,,,29.64,110.58,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,outpatient,,,78.00000,44.93000,Aetna,Commercial,,20.28,,,,,,,20.28,75.66,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Aetna,Commercial,,93.34,,,,,,,93.34,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Aetna,Commercial,,93.34,,,,,,,93.34,348.23,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,outpatient,,,70.00000,40.32000,Aetna,Commercial,,18.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,outpatient,,,18.00000,10.37000,Aetna,Commercial,,4.68,,,,,,,4.68,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,outpatient,,,408.00000,235.01000,Aetna,Commercial,,106.08,,,,,,,106.08,395.76,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,outpatient,,,102.00000,58.75000,Aetna,Commercial,,26.52,,,,,,,26.52,98.94,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,outpatient,,,330.00000,190.08000,Aetna,Commercial,,85.80,,,,,,,85.80,320.10,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,outpatient,,,56.00000,32.26000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,outpatient,,,136.00000,78.34000,Aetna,Commercial,,35.36,,,,,,,35.36,131.92,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,outpatient,,,83.00000,47.81000,Aetna,Commercial,,21.58,,,,,,,21.58,80.51,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,outpatient,,,142.00000,81.79000,Aetna,Commercial,,36.92,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,outpatient,,,51.00000,29.38000,Aetna,Commercial,,13.26,,,,,,,13.26,49.47,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,outpatient,,,70.00000,40.32000,Aetna,Commercial,,18.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,outpatient,,,99.00000,57.02000,Aetna,Commercial,,25.74,,,,,,,25.74,96.03,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,outpatient,,,78.00000,44.93000,Aetna,Commercial,,20.28,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,outpatient,,,75.00000,43.20000,Aetna,Commercial,,19.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Aetna,Commercial,,9.62,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Aetna,Commercial,,9.62,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,outpatient,,,59.00000,33.98000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,outpatient,,,35.00000,20.16000,Aetna,Commercial,,9.10,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,outpatient,,,59.00000,33.98000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,outpatient,,,56.00000,32.26000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,outpatient,,,74.00000,42.62000,Aetna,Commercial,,19.24,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,outpatient,,,90.00000,51.84000,Aetna,Commercial,,23.40,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Aetna,Commercial,,17.68,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,outpatient,,,142.00000,81.79000,Aetna,Commercial,,36.92,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Aetna,Commercial,,17.68,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,outpatient,,,74.00000,42.62000,Aetna,Commercial,,19.24,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Aetna,Commercial,,23.14,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Aetna,Commercial,,23.14,,,,,,,23.14,86.33,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,outpatient,,,57.00000,32.83000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,outpatient,,,77.00000,44.35000,Aetna,Commercial,,20.02,,,,,,,20.02,74.69,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,outpatient,,,64.00000,36.86000,Aetna,Commercial,,16.64,,,,,,,16.64,62.08,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,outpatient,,,69.00000,39.74000,Aetna,Commercial,,17.94,,,,,,,17.94,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,outpatient,,,1178.00000,678.53000,Aetna,Commercial,,306.28,,,,,,,306.28,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,outpatient,,,127.00000,73.15000,Aetna,Commercial,,33.02,,,,,,,33.02,123.19,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,outpatient,,,277.00000,159.55000,Aetna,Commercial,,72.02,,,,,,,72.02,268.69,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,outpatient,,,940.00000,541.44000,Aetna,Commercial,,244.40,,,,,,,244.40,911.80,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,outpatient,,,97.00000,55.87000,Aetna,Commercial,,25.22,,,,,,,25.22,94.09,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,outpatient,,,16.00000,9.22000,Aetna,Commercial,,4.16,,,,,,,4.16,15.52,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,outpatient,,,57.00000,32.83000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,outpatient,,,131.00000,75.46000,Aetna,Commercial,,34.06,,,,,,,34.06,127.07,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,outpatient,,,2160.00000,1244.16000,Aetna,Commercial,,561.60,,,,,,,561.60,2095.20,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,outpatient,,,37.00000,21.31000,Aetna,Commercial,,9.62,,,,,,,9.62,35.89,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Aetna,Commercial,,19.24,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,outpatient,,,54.00000,31.10000,Aetna,Commercial,,14.04,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,outpatient,,,76.00000,43.78000,Aetna,Commercial,,19.76,,,,,,,19.76,73.72,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,outpatient,,,606.00000,349.06000,Aetna,Commercial,,157.56,,,,,,,157.56,587.82,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,outpatient,,,300.00000,172.80000,Aetna,Commercial,,78.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,outpatient,,,59.00000,33.98000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,outpatient,,,98.00000,56.45000,Aetna,Commercial,,25.48,,,,,,,25.48,95.06,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,outpatient,,,61.00000,35.14000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,outpatient,,,128.00000,73.73000,Aetna,Commercial,,33.28,,,,,,,33.28,124.16,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Aetna,Commercial,,13.78,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,outpatient,,,16.00000,9.22000,Aetna,Commercial,,4.16,,,,,,,4.16,15.52,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,outpatient,,,565.00000,325.44000,Aetna,Commercial,,146.90,,,,,,,146.90,548.05,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,outpatient,,,850.00000,489.60000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,outpatient,,,77.00000,44.35000,Aetna,Commercial,,20.02,,,,,,,20.02,74.69,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,outpatient,,,86.00000,49.54000,Aetna,Commercial,,22.36,,,,,,,22.36,83.42,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,outpatient,,,837.00000,482.11000,Aetna,Commercial,,217.62,,,,,,,217.62,811.89,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,outpatient,,,60.00000,34.56000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,outpatient,,,56.00000,32.26000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,outpatient,,,56.00000,32.26000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Aetna,Commercial,,19.24,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Aetna,Commercial,,13.78,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Aetna,Commercial,,13.78,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,outpatient,,,167.00000,96.19000,Aetna,Commercial,,43.42,,,,,,,43.42,161.99,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,outpatient,,,200.00000,115.20000,Aetna,Commercial,,52.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,outpatient,,,93.00000,53.57000,Aetna,Commercial,,24.18,,,,,,,24.18,90.21,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Aetna,Commercial,,14.30,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,outpatient,,,190.00000,109.44000,Aetna,Commercial,,49.40,,,,,,,49.40,184.30,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,outpatient,,,64.00000,36.86000,Aetna,Commercial,,16.64,,,,,,,16.64,62.08,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,outpatient,,,525.00000,302.40000,Aetna,Commercial,,136.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,outpatient,,,54.00000,31.10000,Aetna,Commercial,,14.04,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Aetna,Commercial,,13.78,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,outpatient,,,53.00000,30.53000,Aetna,Commercial,,13.78,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Aetna,Commercial,,10.40,,,,,,,10.40,38.80,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,outpatient,,,453.00000,260.93000,Aetna,Commercial,,117.78,,,,,,,117.78,439.41,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,outpatient,,,25.00000,14.40000,Aetna,Commercial,,6.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,outpatient,,,56.00000,32.26000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,outpatient,,,59.00000,33.98000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,outpatient,,,53.00000,30.53000,Aetna,Commercial,,13.78,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,outpatient,,,350.00000,201.60000,Aetna,Commercial,,91.00,,,,,,,91.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,outpatient,,,225.00000,129.60000,Aetna,Commercial,,58.50,,,,,,,58.50,218.25,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,outpatient,,,52.00000,29.95000,Aetna,Commercial,,13.52,,,,,,,13.52,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,outpatient,,,134.00000,77.18000,Aetna,Commercial,,34.84,,,,,,,34.84,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,outpatient,,,52.00000,29.95000,Aetna,Commercial,,13.52,,,,,,,13.52,50.44,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,outpatient,,,186.00000,107.14000,Aetna,Commercial,,48.36,,,,,,,48.36,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Aetna,Commercial,,78.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Aetna,Commercial,,78.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,outpatient,,,62.00000,35.71000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,outpatient,,,205.00000,118.08000,Aetna,Commercial,,53.30,,,,,,,53.30,198.85,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,outpatient,,,75.00000,36.15000,Aetna,Commercial,,19.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,outpatient,,,65.00000,31.33000,Aetna,Commercial,,16.90,,,,,,,16.90,63.05,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,outpatient,,,92.00000,44.34000,Aetna,Commercial,,23.92,,,,,,,23.92,89.24,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Aetna,Commercial,,6.24,,,,,,,6.24,23.28,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,outpatient,,,20.00000,9.64000,Aetna,Commercial,,5.20,,,,,,,5.20,19.40,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,outpatient,,,42.00000,20.24000,Aetna,Commercial,,10.92,,,,,,,10.92,40.74,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,outpatient,,,69.00000,33.26000,Aetna,Commercial,,17.94,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,outpatient,,,65.00000,31.33000,Aetna,Commercial,,16.90,,,,,,,16.90,63.05,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,outpatient,,,76.00000,36.63000,Aetna,Commercial,,19.76,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,outpatient,,,89.00000,42.90000,Aetna,Commercial,,23.14,,,,,,,23.14,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,outpatient,,,76.00000,36.63000,Aetna,Commercial,,19.76,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,outpatient,,,28.00000,13.50000,Aetna,Commercial,,7.28,,,,,,,7.28,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,outpatient,,,98.00000,47.24000,Aetna,Commercial,,25.48,,,,,,,25.48,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,outpatient,,,64.00000,30.85000,Aetna,Commercial,,16.64,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,outpatient,,,75.00000,36.15000,Aetna,Commercial,,19.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,outpatient,,,76.00000,36.63000,Aetna,Commercial,,19.76,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,outpatient,,,114.00000,54.95000,Aetna,Commercial,,29.64,,,,,,,29.64,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,outpatient,,,74.00000,35.67000,Aetna,Commercial,,19.24,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,outpatient,,,69.00000,33.26000,Aetna,Commercial,,17.94,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,outpatient,,,74.00000,35.67000,Aetna,Commercial,,19.24,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,outpatient,,,87.00000,41.93000,Aetna,Commercial,,22.62,,,,,,,22.62,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,outpatient,,,79.00000,38.08000,Aetna,Commercial,,20.54,,,,,,,20.54,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,outpatient,,,75.00000,36.15000,Aetna,Commercial,,19.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,outpatient,,,64.00000,30.85000,Aetna,Commercial,,16.64,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,outpatient,,,164.00000,79.05000,Aetna,Commercial,,42.64,,,,,,,42.64,159.08,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,outpatient,,,54.00000,26.03000,Aetna,Commercial,,14.04,,,,,,,14.04,52.38,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,outpatient,,,8.00000,3.86000,Aetna,Commercial,,2.08,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,outpatient,,,69.00000,33.26000,Aetna,Commercial,,17.94,,,,,,,17.94,66.93,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,outpatient,,,8.00000,3.86000,Aetna,Commercial,,2.08,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,outpatient,,,8.00000,3.86000,Aetna,Commercial,,2.08,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,outpatient,,,14.00000,6.75000,Aetna,Commercial,,3.64,,,,,,,3.64,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,outpatient,,,62.00000,29.88000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,outpatient,,,112.00000,53.98000,Aetna,Commercial,,29.12,,,,,,,29.12,108.64,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,outpatient,,,13.00000,6.27000,Aetna,Commercial,,3.38,,,,,,,3.38,12.61,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,outpatient,,,31.00000,14.94000,Aetna,Commercial,,8.06,,,,,,,8.06,30.07,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,outpatient,,,92.00000,44.34000,Aetna,Commercial,,23.92,,,,,,,23.92,89.24,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,outpatient,,,80.00000,38.56000,Aetna,Commercial,,20.80,,,,,,,20.80,77.60,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Aetna,Commercial,,7.80,,,,,,,7.80,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Aetna,Commercial,,7.80,,,,,,,7.80,29.10,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Aetna,Commercial,,6.24,,,,,,,6.24,23.28,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,outpatient,,,59.00000,28.44000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,outpatient,,,29.00000,13.98000,Aetna,Commercial,,7.54,,,,,,,7.54,28.13,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,outpatient,,,97.00000,46.75000,Aetna,Commercial,,25.22,,,,,,,25.22,94.09,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,outpatient,,,225.00000,108.45000,Aetna,Commercial,,58.50,,,,,,,58.50,218.25,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,outpatient,,,71.00000,34.22000,Aetna,Commercial,,18.46,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,outpatient,,,71.00000,34.22000,Aetna,Commercial,,18.46,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,outpatient,,,108.00000,52.06000,Aetna,Commercial,,28.08,,,,,,,28.08,104.76,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,outpatient,,,66.00000,31.81000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,outpatient,,,51.00000,24.58000,Aetna,Commercial,,13.26,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,outpatient,,,63.00000,30.37000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,outpatient,,,58.00000,27.96000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,outpatient,,,19.00000,9.16000,Aetna,Commercial,,4.94,,,,,,,4.94,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,outpatient,,,54.00000,26.03000,Aetna,Commercial,,14.04,,,,,,,14.04,52.38,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,outpatient,,,103.00000,49.65000,Aetna,Commercial,,26.78,,,,,,,26.78,99.91,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,outpatient,,,9.00000,4.34000,Aetna,Commercial,,2.34,,,,,,,2.34,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,outpatient,,,13.00000,6.27000,Aetna,Commercial,,3.38,,,,,,,3.38,12.61,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,outpatient,,,80.00000,38.56000,Aetna,Commercial,,20.80,,,,,,,20.80,77.60,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,outpatient,,,47.00000,22.65000,Aetna,Commercial,,12.22,,,,,,,12.22,45.59,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,outpatient,,,91.00000,43.86000,Aetna,Commercial,,23.66,,,,,,,23.66,88.27,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,outpatient,,,56.00000,26.99000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,outpatient,,,18.00000,8.68000,Aetna,Commercial,,4.68,,,,,,,4.68,17.46,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,outpatient,,,60.00000,28.92000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,outpatient,,,57.00000,27.47000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Aetna,Commercial,,5.46,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,outpatient,,,71.00000,37.70000,Aetna,Commercial,,18.46,,,,,,,18.46,68.87,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Aetna,Commercial,,5.46,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,outpatient,,,128.00000,67.97000,Aetna,Commercial,,33.28,,,,,,,33.28,124.16,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,outpatient,,,65.00000,34.52000,Aetna,Commercial,,16.90,,,,,,,16.90,63.05,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Aetna,Commercial,,6.76,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,outpatient,,,31.00000,16.46000,Aetna,Commercial,,8.06,,,,,,,8.06,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Aetna,Commercial,,6.76,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Aetna,Commercial,,6.76,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Aetna,Commercial,,6.76,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,outpatient,,,61.00000,32.39000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Aetna,Commercial,,6.76,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Aetna,Commercial,,6.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Aetna,Commercial,91,6.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,outpatient,,,103.00000,54.69000,Aetna,Commercial,,26.78,,,,,,,26.78,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,outpatient,,,96.00000,50.98000,Aetna,Commercial,,24.96,,,,,,,24.96,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,outpatient,,,75.00000,39.83000,Aetna,Commercial,,19.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,outpatient,,,68.00000,36.11000,Aetna,Commercial,,17.68,,,,,,,17.68,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,outpatient,,,61.00000,32.39000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Aetna,Commercial,,6.76,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Aetna,Commercial,,6.76,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,outpatient,,,29.00000,15.40000,Aetna,Commercial,,7.54,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Aetna,Commercial,,7.54,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Aetna,Commercial,,7.54,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,outpatient,,,63.00000,33.45000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,outpatient,,,79.00000,41.95000,Aetna,Commercial,,20.54,,,,,,,20.54,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,outpatient,,,63.00000,33.45000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Aetna,Commercial,,7.54,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,outpatient,,,112.00000,59.47000,Aetna,Commercial,,29.12,,,,,,,29.12,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Aetna,Commercial,,6.76,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,outpatient,,,25.00000,13.28000,Aetna,Commercial,,6.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,outpatient,,,118.00000,62.66000,Aetna,Commercial,,30.68,,,,,,,30.68,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,outpatient,,,29.00000,15.40000,Aetna,Commercial,,7.54,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,outpatient,,,25.00000,13.28000,Aetna,Commercial,,6.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Aetna,Commercial,,6.76,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,outpatient,,,25.00000,13.28000,Aetna,Commercial,,6.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,outpatient,,,71.00000,37.70000,Aetna,Commercial,,18.46,,,,,,,18.46,68.87,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,outpatient,,,59.00000,31.33000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,outpatient,,,62.00000,32.92000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,outpatient,,,138.00000,73.28000,Aetna,Commercial,,35.88,,,,,,,35.88,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,outpatient,,,62.00000,32.92000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,outpatient,,,78.00000,41.42000,Aetna,Commercial,,20.28,,,,,,,20.28,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,outpatient,,,69.00000,36.64000,Aetna,Commercial,,17.94,,,,,,,17.94,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,outpatient,,,88.00000,46.73000,Aetna,Commercial,,22.88,,,,,,,22.88,85.36,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,outpatient,,,60.00000,31.86000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,outpatient,,,64.00000,33.98000,Aetna,Commercial,,16.64,,,,,,,16.64,62.08,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,outpatient,,,63.00000,33.45000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,outpatient,,,137.00000,72.75000,Aetna,Commercial,,35.62,,,,,,,35.62,132.89,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,outpatient,,,347.00000,184.26000,Aetna,Commercial,,90.22,,,,,,,90.22,336.59,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,outpatient,,,57.00000,30.27000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,outpatient,,,56.00000,29.74000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,outpatient,,,16.00000,8.50000,Aetna,Commercial,,4.16,,,,,,,4.16,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,outpatient,,,85.00000,45.14000,Aetna,Commercial,,22.10,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,outpatient,,,34.00000,18.05000,Aetna,Commercial,,8.84,,,,,,,8.84,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,outpatient,,,231.00000,122.66000,Aetna,Commercial,,60.06,,,,,,,60.06,224.07,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,outpatient,,,36.00000,19.12000,Aetna,Commercial,,9.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,outpatient,,,61.00000,32.39000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,outpatient,,,111.00000,58.94000,Aetna,Commercial,,28.86,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,outpatient,,,61.00000,32.39000,Aetna,Commercial,,15.86,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,outpatient,,,60.00000,31.86000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,outpatient,,,60.00000,31.86000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,outpatient,,,60.00000,31.86000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,outpatient,,,60.00000,31.86000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,outpatient,,,60.00000,31.86000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,outpatient,,,36.00000,19.12000,Aetna,Commercial,,9.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,outpatient,,,76.00000,40.36000,Aetna,Commercial,,19.76,,,,,,,19.76,73.72,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,outpatient,,,60.00000,31.86000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,outpatient,,,60.00000,31.86000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,outpatient,,,152.00000,80.71000,Aetna,Commercial,,39.52,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,outpatient,,,78.00000,41.42000,Aetna,Commercial,,20.28,,,,,,,20.28,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,outpatient,,,42.00000,22.30000,Aetna,Commercial,,10.92,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,outpatient,,,73.00000,38.76000,Aetna,Commercial,,18.98,,,,,,,18.98,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,outpatient,,,97.00000,51.51000,Aetna,Commercial,,25.22,,,,,,,25.22,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,outpatient,,,157.00000,83.37000,Aetna,Commercial,,40.82,,,,,,,40.82,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,outpatient,,,36.00000,19.12000,Aetna,Commercial,,9.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,outpatient,,,66.00000,35.05000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,outpatient,,,58.00000,30.80000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,outpatient,,,85.00000,45.14000,Aetna,Commercial,,22.10,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,outpatient,,,59.00000,31.33000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,outpatient,,,175.00000,92.93000,Aetna,Commercial,,45.50,,,,,,,45.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,outpatient,,,152.00000,80.71000,Aetna,Commercial,,39.52,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,outpatient,,,43.00000,22.83000,Aetna,Commercial,,11.18,,,,,,,11.18,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,outpatient,,,66.00000,35.05000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,outpatient,,,36.00000,19.12000,Aetna,Commercial,,9.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,outpatient,,,36.00000,19.12000,Aetna,Commercial,,9.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,outpatient,,,42.00000,22.30000,Aetna,Commercial,,10.92,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,outpatient,,,147.00000,78.06000,Aetna,Commercial,,38.22,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,outpatient,,,64.00000,33.98000,Aetna,Commercial,,16.64,,,,,,,16.64,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,outpatient,,,60.00000,31.86000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,outpatient,,,75.00000,39.83000,Aetna,Commercial,,19.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,outpatient,,,44.00000,23.36000,Aetna,Commercial,,11.44,,,,,,,11.44,42.68,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,outpatient,,,87.00000,46.20000,Aetna,Commercial,,22.62,,,,,,,22.62,84.39,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,outpatient,,,65.00000,34.52000,Aetna,Commercial,,16.90,,,,,,,16.90,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,outpatient,,,75.00000,39.83000,Aetna,Commercial,,19.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,outpatient,,,50.00000,26.55000,Aetna,Commercial,,13.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,outpatient,,,40.00000,21.24000,Aetna,Commercial,,10.40,,,,,,,10.40,38.80,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,outpatient,,,50.00000,26.55000,Aetna,Commercial,,13.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Commercial,,33.54,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,outpatient,,,115.00000,61.07000,Aetna,Commercial,,29.90,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1309.00000,695.08000,Aetna,Commercial,,340.34,,,,,,,340.34,1269.73,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Commercial,,33.54,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Commercial,,33.54,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,outpatient,,,328.00000,174.17000,Aetna,Commercial,,85.28,,,,,,,85.28,318.16,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,outpatient,,,115.00000,61.07000,Aetna,Commercial,,29.90,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Commercial,,33.54,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Commercial,,33.54,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,outpatient,,,1251.00000,664.28000,Aetna,Commercial,,325.26,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Aetna,Commercial,,40.04,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Aetna,Commercial,,40.04,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,outpatient,,,96.00000,50.98000,Aetna,Commercial,,24.96,,,,,,,24.96,93.12,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,outpatient,,,211.00000,112.04000,Aetna,Commercial,,54.86,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,outpatient,,,290.00000,153.99000,Aetna,Commercial,,75.40,,,,,,,75.40,281.30,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Commercial,,33.54,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Commercial,,33.54,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,outpatient,,,411.00000,218.24000,Aetna,Commercial,,106.86,,,,,,,106.86,398.67,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,outpatient,,,139.00000,73.81000,Aetna,Commercial,,36.14,,,,,,,36.14,134.83,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,outpatient,,,288.00000,152.93000,Aetna,Commercial,,74.88,,,,,,,74.88,279.36,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1372.00000,728.53000,Aetna,Commercial,,356.72,,,,,,,356.72,1330.84,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,outpatient,,,1251.00000,664.28000,Aetna,Commercial,,325.26,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,outpatient,,,135.00000,71.68000,Aetna,Commercial,,35.10,,,,,,,35.10,130.95,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Commercial,,33.54,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Commercial,,33.54,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,outpatient,,,147.00000,78.06000,Aetna,Commercial,,38.22,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,outpatient,,,126.00000,66.91000,Aetna,Commercial,,32.76,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,outpatient,,,120.00000,63.72000,Aetna,Commercial,,31.20,,,,,,,31.20,116.40,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Commercial,,33.54,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,outpatient,,,124.00000,65.84000,Aetna,Commercial,,32.24,,,,,,,32.24,120.28,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,outpatient,,,108.00000,57.35000,Aetna,Commercial,,28.08,,,,,,,28.08,104.76,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Aetna,Commercial,,66.56,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Aetna,Commercial,,66.56,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,outpatient,,,122.00000,64.78000,Aetna,Commercial,,31.72,,,,,,,31.72,118.34,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Commercial,,33.54,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,outpatient,,,123.00000,65.31000,Aetna,Commercial,,31.98,,,,,,,31.98,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Commercial,,33.54,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,outpatient,,,518.00000,275.06000,Aetna,Commercial,,134.68,,,,,,,134.68,502.46,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,outpatient,,,275.00000,146.02000,Aetna,Commercial,,71.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,outpatient,,,270.00000,143.37000,Aetna,Commercial,,70.20,,,,,,,70.20,261.90,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,outpatient,,,450.00000,238.95000,Aetna,Commercial,,117.00,,,,,,,117.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,outpatient,,,126.00000,66.91000,Aetna,Commercial,,32.76,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,outpatient,,,362.00000,192.22000,Aetna,Commercial,,94.12,,,,,,,94.12,351.14,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Aetna,Commercial,,28.34,,,,,,,28.34,105.73,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,outpatient,,,638.00000,338.78000,Aetna,Commercial,,165.88,,,,,,,165.88,618.86,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,outpatient,,,211.00000,112.04000,Aetna,Commercial,,54.86,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,outpatient,,,154.00000,81.77000,Aetna,Commercial,,40.04,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,outpatient,,,141.00000,74.87000,Aetna,Commercial,,36.66,,,,,,,36.66,136.77,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,outpatient,,,2040.00000,1083.24000,Aetna,Commercial,,530.40,,,,,,,530.40,1978.80,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,outpatient,,,421.00000,223.55000,Aetna,Commercial,,109.46,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,outpatient,,,275.00000,146.02000,Aetna,Commercial,,71.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,outpatient,,,1251.00000,664.28000,Aetna,Commercial,,325.26,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Aetna,Commercial,,111.28,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Aetna,Commercial,,111.28,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Aetna,Commercial,,170.30,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Aetna,Commercial,,170.30,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,outpatient,,,211.00000,112.04000,Aetna,Commercial,,54.86,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Aetna,Commercial,,29.12,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Aetna,Commercial,,29.12,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,outpatient,,,130.00000,69.03000,Aetna,Commercial,,33.80,,,,,,,33.80,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,outpatient,,,421.00000,223.55000,Aetna,Commercial,,109.46,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,outpatient,,,111.00000,58.94000,Aetna,Commercial,,28.86,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,outpatient,,,200.00000,106.20000,Aetna,Commercial,,52.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Aetna,Commercial,,33.54,,,,,,,33.54,125.13,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,outpatient,,,13.00000,6.90000,Aetna,Commercial,,3.38,,,,,,,3.38,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,outpatient,,,58.00000,30.80000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,outpatient,,,13.00000,6.90000,Aetna,Commercial,,3.38,,,,,,,3.38,12.61,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,outpatient,,,773.00000,410.46000,Aetna,Commercial,,200.98,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,outpatient,,,773.00000,410.46000,Aetna,Commercial,,200.98,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,outpatient,,,773.00000,410.46000,Aetna,Commercial,,200.98,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,outpatient,,,773.00000,410.46000,Aetna,Commercial,,200.98,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,outpatient,,,387.00000,205.50000,Aetna,Commercial,,100.62,,,,,,,100.62,375.39,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,outpatient,,,52.00000,27.61000,Aetna,Commercial,,13.52,,,,,,,13.52,50.44,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Aetna,Commercial,,26.52,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Aetna,Commercial,,26.52,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,outpatient,,,79.00000,41.95000,Aetna,Commercial,,20.54,,,,,,,20.54,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,outpatient,,,65.00000,34.52000,Aetna,Commercial,,16.90,,,,,,,16.90,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,outpatient,,,100.00000,53.10000,Aetna,Commercial,,26.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,outpatient,,,64.00000,33.98000,Aetna,Commercial,,16.64,,,,,,,16.64,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,outpatient,,,106.00000,56.29000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Aetna,Commercial,,28.34,,,,,,,28.34,105.73,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,outpatient,,,58.00000,30.80000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Aetna,Commercial,,5.20,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,outpatient,,,66.00000,35.05000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Aetna,Commercial,,5.20,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Aetna,Commercial,,5.20,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Aetna,Commercial,,5.20,,,,,,,5.20,19.40,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,outpatient,,,13.00000,6.90000,Aetna,Commercial,,3.38,,,,,,,3.38,12.61,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,outpatient,,,53.00000,28.14000,Aetna,Commercial,,13.78,,,,,,,13.78,51.41,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,outpatient,,,18.00000,9.56000,Aetna,Commercial,,4.68,,,,,,,4.68,17.46,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,outpatient,,,17.00000,9.03000,Aetna,Commercial,,4.42,,,,,,,4.42,16.49,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,outpatient,,,71.00000,37.70000,Aetna,Commercial,,18.46,,,,,,,18.46,68.87,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,outpatient,,,57.00000,30.27000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,outpatient,,,68.00000,36.11000,Aetna,Commercial,,17.68,,,,,,,17.68,65.96,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,outpatient,,,58.00000,30.80000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,outpatient,,,27.00000,14.34000,Aetna,Commercial,,7.02,,,,,,,7.02,26.19,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,outpatient,,,56.00000,29.74000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,outpatient,,,56.00000,29.74000,Aetna,Commercial,,14.56,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,outpatient,,,58.00000,30.80000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,outpatient,,,115.00000,61.07000,Aetna,Commercial,,29.90,,,,,,,29.90,111.55,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,outpatient,,,23.00000,12.21000,Aetna,Commercial,,5.98,,,,,,,5.98,22.31,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,outpatient,,,255.00000,135.40000,Aetna,Commercial,,66.30,,,,,,,66.30,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,outpatient,,,66.00000,35.05000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,outpatient,,,26.00000,13.81000,Aetna,Commercial,,6.76,,,,,,,6.76,25.22,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,outpatient,,,64.00000,33.98000,Aetna,Commercial,,16.64,,,,,,,16.64,62.08,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,outpatient,,,215.00000,114.16000,Aetna,Commercial,,55.90,,,,,,,55.90,208.55,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,outpatient,,,79.00000,41.95000,Aetna,Commercial,,20.54,,,,,,,20.54,76.63,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,outpatient,,,11.00000,5.29000,Aetna,Commercial,,2.86,,,,,,,2.86,10.67,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,outpatient,,,58.00000,27.90000,Aetna,Commercial,,15.08,,,,,,,15.08,56.26,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,outpatient,,,10.00000,4.81000,Aetna,Commercial,,2.60,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,outpatient,,,7.00000,3.37000,Aetna,Commercial,,1.82,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,outpatient,,,53.00000,25.49000,Aetna,Commercial,,13.78,,,,,,,13.78,51.41,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,outpatient,,,10.00000,4.81000,Aetna,Commercial,,2.60,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Aetna,Commercial,,2.86,,,,,,,2.86,10.67,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,outpatient,,,7.00000,3.37000,Aetna,Commercial,,1.82,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Aetna,Commercial,,2.86,,,,,,,2.86,10.67,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,outpatient,,,597.00000,290.14000,Aetna,Commercial,,155.22,,,,,,,155.22,579.09,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,outpatient,,,6379.00000,3100.19000,Aetna,Commercial,,1658.54,,,,,,,1658.54,6187.63,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,outpatient,,,471.00000,228.91000,Aetna,Commercial,,122.46,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,outpatient,,,471.00000,228.91000,Aetna,Commercial,,122.46,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,outpatient,,,1251.00000,607.99000,Aetna,Commercial,,325.26,,,,,,,325.26,1213.47,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,outpatient,,,260.00000,126.36000,Aetna,Commercial,,67.60,,,,,,,67.60,252.20,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,outpatient,,,785.00000,381.51000,Aetna,Commercial,,204.10,,,,,,,204.10,761.45,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,outpatient,,,529.00000,257.09000,Aetna,Commercial,,137.54,,,,,,,137.54,513.13,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,outpatient,,,1623.00000,788.78000,Aetna,Commercial,,421.98,,,,,,,421.98,1574.31,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,outpatient,,,10800.00000,5248.80000,Aetna,Commercial,,2808.00,,,,,,,2808.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,outpatient,,,25365.00000,12327.39000,Aetna,Commercial,,6594.90,,,,,,,6594.90,24604.05,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,outpatient,,,101.00000,21.82000,Aetna,Commercial,,26.26,,,,,,,26.26,97.97,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,outpatient,,,81.00000,17.50000,Aetna,Commercial,,21.06,,,,,,,21.06,78.57,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,outpatient,,,104.00000,22.46000,Aetna,Commercial,,27.04,,,,,,,27.04,100.88,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,outpatient,,,377.00000,81.43000,Aetna,Commercial,,98.02,,,,,,,98.02,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,outpatient,,,532.00000,114.91000,Aetna,Commercial,,138.32,,,,,,,138.32,516.04,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,outpatient,,,521.00000,112.54000,Aetna,Commercial,,135.46,,,,,,,135.46,505.37,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,outpatient,,,451.00000,97.42000,Aetna,Commercial,,117.26,,,,,,,117.26,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,outpatient,,,1148.00000,247.97000,Aetna,Commercial,,298.48,,,,,,,298.48,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,outpatient,,,350.00000,75.60000,Aetna,Commercial,,91.00,,,,,,,91.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,outpatient,,,423.00000,91.37000,Aetna,Commercial,,109.98,,,,,,,109.98,410.31,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Aetna,Commercial,,195.26,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Aetna,Commercial,,195.26,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,outpatient,,,119.00000,25.70000,Aetna,Commercial,,30.94,,,,,,,30.94,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,outpatient,,,126.00000,27.22000,Aetna,Commercial,,32.76,,,,,,,32.76,122.22,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Aetna,Commercial,,28.60,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Aetna,Commercial,,28.60,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,outpatient,,,79.00000,17.06000,Aetna,Commercial,,20.54,,,,,,,20.54,76.63,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Aetna,Commercial,,28.60,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Aetna,Commercial,,28.60,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,outpatient,,,79.00000,17.06000,Aetna,Commercial,,20.54,,,,,,,20.54,76.63,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,outpatient,,,335.00000,72.36000,Aetna,Commercial,,87.10,,,,,,,87.10,324.95,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Aetna,Commercial,,40.04,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Aetna,Commercial,,40.04,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,outpatient,,,128.00000,27.65000,Aetna,Commercial,,33.28,,,,,,,33.28,124.16,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,outpatient,,,65.00000,14.04000,Aetna,Commercial,,16.90,,,,,,,16.90,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,outpatient,,,272.00000,58.75000,Aetna,Commercial,,70.72,,,,,,,70.72,263.84,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,outpatient,,,26.00000,11.44000,Aetna,Commercial,,6.76,,,,,,,6.76,25.22,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,outpatient,,,359.00000,157.96000,Aetna,Commercial,,93.34,,,,,,,93.34,348.23,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,outpatient,,,189.00000,83.16000,Aetna,Commercial,,49.14,,,,,,,49.14,183.33,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,outpatient,,,359.00000,157.96000,Aetna,Commercial,,93.34,,,,,,,93.34,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,outpatient,,,137.00000,60.28000,Aetna,Commercial,,35.62,,,,,,,35.62,132.89,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,outpatient,,,1665.00000,732.60000,Aetna,Commercial,,432.90,,,,,,,432.90,1615.05,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,outpatient,,,751.00000,330.44000,Aetna,Commercial,,195.26,,,,,,,195.26,728.47,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,outpatient,,,374.00000,164.56000,Aetna,Commercial,,97.24,,,,,,,97.24,362.78,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,outpatient,,,553.00000,243.32000,Aetna,Commercial,,143.78,,,,,,,143.78,536.41,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,outpatient,,,359.00000,157.96000,Aetna,Commercial,,93.34,,,,,,,93.34,348.23,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,outpatient,,,62.00000,27.28000,Aetna,Commercial,,16.12,,,,,,,16.12,60.14,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,outpatient,,,79.00000,34.76000,Aetna,Commercial,,20.54,,,,,,,20.54,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,outpatient,,,110.00000,48.40000,Aetna,Commercial,,28.60,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,outpatient,,,110.00000,48.40000,Aetna,Commercial,,28.60,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,outpatient,,,751.00000,330.44000,Aetna,Commercial,,195.26,,,,,,,195.26,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,outpatient,,,1665.00000,732.60000,Aetna,Commercial,,432.90,,,,,,,432.90,1615.05,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,outpatient,,,110.00000,48.40000,Aetna,Commercial,,28.60,,,,,,,28.60,106.70,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Aetna,Commercial,,73.06,,,,,,,73.06,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Aetna,Commercial,,73.06,,,,,,,73.06,272.57,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,outpatient,,,451.00000,341.41000,Aetna,Commercial,,117.26,,,,,,,117.26,437.47,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,outpatient,,,300.00000,145.80000,Aetna,Commercial,,78.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,outpatient,,,2278.00000,1107.11000,Aetna,Commercial,,592.28,,,,,,,592.28,2209.66,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,outpatient,,,3912.00000,1901.23000,Aetna,Commercial,,1017.12,,,,,,,1017.12,3794.64,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,outpatient,,,900.00000,437.40000,Aetna,Commercial,,234.00,,,,,,,234.00,873.00,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,outpatient,,,365.00000,177.39000,Aetna,Commercial,,94.90,,,,,,,94.90,354.05,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,outpatient,,,989.00000,480.65000,Aetna,Commercial,,257.14,,,,,,,257.14,959.33,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Aetna,Commercial,,127.92,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Aetna,Commercial,,113.10,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Aetna,Commercial,,113.10,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,outpatient,,,644.00000,312.98000,Aetna,Commercial,,167.44,,,,,,,167.44,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Aetna,Commercial,,127.92,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Aetna,Commercial,,127.92,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,outpatient,,,527.00000,256.12000,Aetna,Commercial,,137.02,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,outpatient,,,1404.00000,682.34000,Aetna,Commercial,,365.04,,,,,,,365.04,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,outpatient,,,5475.00000,2660.85000,Aetna,Commercial,,1423.50,,,,,,,1423.50,5310.75,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,outpatient,,,726.00000,352.84000,Aetna,Commercial,,188.76,,,,,,,188.76,704.22,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,outpatient,,,507.00000,246.40000,Aetna,Commercial,,131.82,,,,,,,131.82,491.79,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,outpatient,,,1670.00000,811.62000,Aetna,Commercial,,434.20,,,,,,,434.20,1619.90,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,outpatient,,,1139.00000,553.55000,Aetna,Commercial,,296.14,,,,,,,296.14,1104.83,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,outpatient,,,875.00000,425.25000,Aetna,Commercial,,227.50,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,outpatient,,,525.00000,255.15000,Aetna,Commercial,,136.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,outpatient,,,1353.00000,657.56000,Aetna,Commercial,,351.78,,,,,,,351.78,1312.41,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,outpatient,,,525.00000,255.15000,Aetna,Commercial,,136.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,outpatient,,,525.00000,255.15000,Aetna,Commercial,,136.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,outpatient,,,825.00000,400.95000,Aetna,Commercial,,214.50,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Aetna,Commercial,,136.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Aetna,Commercial,,136.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,outpatient,,,974.00000,473.36000,Aetna,Commercial,,253.24,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Aetna,Commercial,,51.48,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Aetna,Commercial,,51.48,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Aetna,Commercial,,57.46,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Aetna,Commercial,,57.46,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,outpatient,,,497.00000,241.54000,Aetna,Commercial,,129.22,,,,,,,129.22,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,outpatient,,,2340.00000,1137.24000,Aetna,Commercial,,608.40,,,,,,,608.40,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,outpatient,,,249.00000,121.01000,Aetna,Commercial,,64.74,,,,,,,64.74,241.53,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,outpatient,,,135.00000,65.61000,Aetna,Commercial,,35.10,,,,,,,35.10,130.95,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,outpatient,,,172.00000,83.59000,Aetna,Commercial,,44.72,,,,,,,44.72,166.84,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,outpatient,,,307.00000,149.20000,Aetna,Commercial,,79.82,,,,,,,79.82,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,outpatient,,,1800.00000,874.80000,Aetna,Commercial,,468.00,,,,,,,468.00,1746.00,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,outpatient,,,974.00000,473.36000,Aetna,Commercial,,253.24,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Aetna,Commercial,,51.22,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Aetna,Commercial,,51.22,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,outpatient,,,411.00000,199.75000,Aetna,Commercial,,106.86,,,,,,,106.86,398.67,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,outpatient,,,221.00000,107.41000,Aetna,Commercial,,57.46,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,outpatient,,,884.00000,429.62000,Aetna,Commercial,,229.84,,,,,,,229.84,857.48,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,outpatient,,,594.00000,288.68000,Aetna,Commercial,,154.44,,,,,,,154.44,576.18,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,outpatient,,,519.00000,252.23000,Aetna,Commercial,,134.94,,,,,,,134.94,503.43,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,outpatient,,,1046.00000,508.36000,Aetna,Commercial,,271.96,,,,,,,271.96,1014.62,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,outpatient,,,556.00000,270.22000,Aetna,Commercial,,144.56,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,outpatient,,,275.00000,133.65000,Aetna,Commercial,,71.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,outpatient,,,580.00000,281.88000,Aetna,Commercial,,150.80,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,outpatient,,,580.00000,281.88000,Aetna,Commercial,,150.80,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Aetna,Commercial,,904.80,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Aetna,Commercial,,904.80,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,outpatient,,,700.00000,340.20000,Aetna,Commercial,,182.00,,,,,,,182.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,outpatient,,,1427.00000,693.52000,Aetna,Commercial,,371.02,,,,,,,371.02,1384.19,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,outpatient,,,614.00000,298.40000,Aetna,Commercial,,159.64,,,,,,,159.64,595.58,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,outpatient,,,2027.00000,985.12000,Aetna,Commercial,,527.02,,,,,,,527.02,1966.19,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,outpatient,,,556.00000,270.22000,Aetna,Commercial,,144.56,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,outpatient,,,1146.00000,556.96000,Aetna,Commercial,,297.96,,,,,,,297.96,1111.62,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Aetna,Commercial,,51.22,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Aetna,Commercial,,51.22,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,outpatient,,,527.00000,256.12000,Aetna,Commercial,,137.02,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,outpatient,,,740.00000,359.64000,Aetna,Commercial,,192.40,,,,,,,192.40,717.80,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Aetna,Commercial,,227.50,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Aetna,Commercial,,227.50,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,outpatient,,,1399.00000,679.91000,Aetna,Commercial,,363.74,,,,,,,363.74,1357.03,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,outpatient,,,51.00000,24.79000,Aetna,Commercial,,13.26,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,outpatient,,,825.00000,400.95000,Aetna,Commercial,,214.50,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,outpatient,,,576.00000,279.94000,Aetna,Commercial,,149.76,,,,,,,149.76,558.72,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,outpatient,,,224.00000,108.86000,Aetna,Commercial,,58.24,,,,,,,58.24,217.28,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,outpatient,,,346.00000,168.16000,Aetna,Commercial,,89.96,,,,,,,89.96,335.62,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,outpatient,,,525.00000,255.15000,Aetna,Commercial,,136.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,outpatient,,,525.00000,255.15000,Aetna,Commercial,,136.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Aetna,Commercial,,136.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Aetna,Commercial,,136.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,outpatient,,,627.00000,304.72000,Aetna,Commercial,,163.02,,,,,,,163.02,608.19,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,outpatient,,,605.00000,294.03000,Aetna,Commercial,,157.30,,,,,,,157.30,586.85,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,outpatient,,,510.00000,247.86000,Aetna,Commercial,,132.60,,,,,,,132.60,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,outpatient,,,223.00000,108.38000,Aetna,Commercial,,57.98,,,,,,,57.98,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,outpatient,,,1211.00000,588.55000,Aetna,Commercial,,314.86,,,,,,,314.86,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,outpatient,,,383.00000,186.14000,Aetna,Commercial,,99.58,,,,,,,99.58,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,outpatient,,,1214.00000,590.00000,Aetna,Commercial,,315.64,,,,,,,315.64,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,outpatient,,,328.00000,159.41000,Aetna,Commercial,,85.28,,,,,,,85.28,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,outpatient,,,372.00000,180.79000,Aetna,Commercial,,96.72,,,,,,,96.72,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,outpatient,,,285.00000,138.51000,Aetna,Commercial,,74.10,,,,,,,74.10,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,outpatient,,,367.00000,178.36000,Aetna,Commercial,,95.42,,,,,,,95.42,355.99,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Aetna,Commercial,,182.52,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Aetna,Commercial,,182.52,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,outpatient,,,265.00000,128.79000,Aetna,Commercial,,68.90,,,,,,,68.90,257.05,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2279.00000,1107.59000,Aetna,Commercial,,592.54,,,,,,,592.54,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2395.00000,1163.97000,Aetna,Commercial,,622.70,,,,,,,622.70,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Aetna,Commercial,,2277.34,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Aetna,Commercial,,2277.34,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,outpatient,,,2752.00000,1337.47000,Aetna,Commercial,,715.52,,,,,,,715.52,2669.44,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Aetna,Commercial,,56.42,,,,,,,56.42,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Aetna,Commercial,,56.42,,,,,,,56.42,210.49,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,outpatient,,,292.00000,141.91000,Aetna,Commercial,,75.92,,,,,,,75.92,283.24,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Aetna,Commercial,,106.86,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Aetna,Commercial,,106.86,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Aetna,Commercial,,106.86,,,,,,,106.86,398.67,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,outpatient,,,2275.00000,1105.65000,Aetna,Commercial,,591.50,,,,,,,591.50,2206.75,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,outpatient,,,192.00000,93.31000,Aetna,Commercial,,49.92,,,,,,,49.92,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,outpatient,,,451.00000,219.19000,Aetna,Commercial,,117.26,,,,,,,117.26,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,outpatient,,,617.00000,299.86000,Aetna,Commercial,,160.42,,,,,,,160.42,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,outpatient,,,825.00000,400.95000,Aetna,Commercial,,214.50,,,,,,,214.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,outpatient,,,905.00000,439.83000,Aetna,Commercial,,235.30,,,,,,,235.30,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,outpatient,,,849.00000,412.61000,Aetna,Commercial,,220.74,,,,,,,220.74,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,outpatient,,,2539.00000,1233.95000,Aetna,Commercial,,660.14,,,,,,,660.14,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,outpatient,,,6000.00000,2916.00000,Aetna,Commercial,,1560.00,,,,,,,1560.00,5820.00,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,outpatient,,,8260.00000,4014.36000,Aetna,Commercial,,2147.60,,,,,,,2147.60,8012.20,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,outpatient,,,202.00000,88.88000,Aetna,Commercial,,52.52,,,,,,,52.52,195.94,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,outpatient,,,66.00000,31.81000,Aetna,Commercial,,17.16,,,,,,,17.16,64.02,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,outpatient,,,295.00000,142.19000,Aetna,Commercial,,76.70,,,,,,,76.70,286.15,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,89.00000,26.79000,Aetna,Commercial,,23.14,,,,,,,23.14,86.33,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Aetna,Commercial,,24.18,,,,,,,24.18,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Aetna,Commercial,,24.18,,,,,,,24.18,90.21,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Aetna,Commercial,,487.50,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Aetna,Commercial,,487.50,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Aetna,Commercial,,455.52,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Aetna,Commercial,,455.52,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,731.00000,220.03000,Aetna,Commercial,,190.06,,,,,,,190.06,709.07,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,787.00000,236.89000,Aetna,Commercial,,204.62,,,,,,,204.62,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,2042.00000,614.64000,Aetna,Commercial,,530.92,,,,,,,530.92,1980.74,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Aetna,Commercial,,487.50,,,,,,,487.50,1818.75,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,714.00000,214.91000,Aetna,Commercial,,185.64,,,,,,,185.64,692.58,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,294.00000,88.49000,Aetna,Commercial,,76.44,,,,,,,76.44,285.18,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,350.00000,105.35000,Aetna,Commercial,,91.00,,,,,,,91.00,339.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,outpatient,,,1350.00000,780.30000,Aetna,Commercial,,351.00,,,,,,,351.00,1309.50,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,outpatient,,,3680.00000,2127.04000,Aetna,Commercial,,956.80,,,,,,,956.80,3569.60,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,outpatient,,,1600.00000,924.80000,Aetna,Commercial,,416.00,,,,,,,416.00,1552.00,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,outpatient,,,4680.00000,2705.04000,Aetna,Commercial,,1216.80,,,,,,,1216.80,4539.60,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,outpatient,,,2100.00000,1213.80000,Aetna,Commercial,,546.00,,,,,,,546.00,2037.00,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,outpatient,,,5680.00000,3283.04000,Aetna,Commercial,,1476.80,,,,,,,1476.80,5509.60,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,outpatient,,,2420.00000,1398.76000,Aetna,Commercial,,629.20,,,,,,,629.20,2347.40,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,outpatient,,,6415.00000,3707.87000,Aetna,Commercial,,1667.90,,,,,,,1667.90,6222.55,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,outpatient,,,2920.00000,1687.76000,Aetna,Commercial,,759.20,,,,,,,759.20,2832.40,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,outpatient,,,8915.00000,5152.87000,Aetna,Commercial,,2317.90,,,,,,,2317.90,8647.55,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,outpatient,,,3420.00000,1976.76000,Aetna,Commercial,,889.20,,,,,,,889.20,3317.40,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,outpatient,,,11415.00000,6597.87000,Aetna,Commercial,,2967.90,,,,,,,2967.90,11072.55,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,outpatient,,,142.00000,154.35000,Aetna,Commercial,,36.92,,,,,,,36.92,137.74,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Aetna,Commercial,,88.40,,,,,,,88.40,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Aetna,Commercial,,174.20,,,,,,,174.20,649.90,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,outpatient,,,390.00000,262.47000,Aetna,Commercial,,101.40,,,,,,,101.40,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,outpatient,,,1170.00000,787.41000,Aetna,Commercial,,304.20,,,,,,,304.20,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,outpatient,,,440.00000,296.12000,Aetna,Commercial,,114.40,,,,,,,114.40,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,outpatient,,,1670.00000,1123.91000,Aetna,Commercial,,434.20,,,,,,,434.20,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,outpatient,,,640.00000,430.72000,Aetna,Commercial,,166.40,,,,,,,166.40,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,outpatient,,,2170.00000,1460.41000,Aetna,Commercial,,564.20,,,,,,,564.20,2104.90,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,outpatient,,,17.00000,10.96000,Aetna,Commercial,,4.42,,,,,,,4.42,16.49,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,outpatient,,,535.00000,345.08000,Aetna,Commercial,,139.10,,,,,,,139.10,518.95,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,outpatient,,,23.00000,14.84000,Aetna,Commercial,,5.98,,,,,,,5.98,22.31,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,outpatient,,,635.00000,409.58000,Aetna,Commercial,,165.10,,,,,,,165.10,615.95,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,outpatient,,,30.00000,19.35000,Aetna,Commercial,,7.80,,,,,,,7.80,29.10,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,outpatient,,,735.00000,474.08000,Aetna,Commercial,,191.10,,,,,,,191.10,712.95,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,outpatient,,,33.00000,21.28000,Aetna,Commercial,,8.58,,,,,,,8.58,32.01,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,outpatient,,,835.00000,538.58000,Aetna,Commercial,,217.10,,,,,,,217.10,809.95,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,outpatient,,,140.00000,80.92000,Aetna,Commercial,,36.40,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,outpatient,,,275.00000,158.95000,Aetna,Commercial,,71.50,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,outpatient,,,295.00000,170.51000,Aetna,Commercial,,76.70,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,outpatient,,,590.00000,341.02000,Aetna,Commercial,,153.40,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,outpatient,,,690.00000,398.82000,Aetna,Commercial,,179.40,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,outpatient,,,1375.00000,794.75000,Aetna,Commercial,,357.50,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,outpatient,,,950.00000,549.10000,Aetna,Commercial,,247.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,outpatient,,,1900.00000,1098.20000,Aetna,Commercial,,494.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,outpatient,,,140.00000,45.22000,Aetna,Commercial,,36.40,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,outpatient,,,275.00000,88.82000,Aetna,Commercial,,71.50,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,outpatient,,,295.00000,95.28000,Aetna,Commercial,,76.70,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,outpatient,,,590.00000,190.57000,Aetna,Commercial,,153.40,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,outpatient,,,690.00000,222.87000,Aetna,Commercial,,179.40,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,outpatient,,,1375.00000,444.12000,Aetna,Commercial,,357.50,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,outpatient,,,950.00000,306.85000,Aetna,Commercial,,247.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,outpatient,,,1900.00000,613.70000,Aetna,Commercial,,494.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Aetna,Commercial,,88.40,,,,,,,88.40,329.80,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Aetna,Commercial,,174.20,,,,,,,174.20,649.90,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Aetna,Commercial,,127.40,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Aetna,Commercial,,127.40,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Aetna,Commercial,,127.40,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Aetna,Commercial,,63.70,,,,,,,63.70,237.65,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Aetna,Commercial,,218.92,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Aetna,Commercial,,273.78,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Aetna,Commercial,,328.38,,,,,,,328.38,1225.11,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1178.00000,669.28000,Aetna,Commercial,,306.28,,,,,,,306.28,1142.66,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,outpatient,,,140.00000,102.34000,Aetna,Commercial,,36.40,,,,,,,36.40,135.80,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,outpatient,,,275.00000,201.02000,Aetna,Commercial,,71.50,,,,,,,71.50,266.75,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,outpatient,,,295.00000,215.64000,Aetna,Commercial,,76.70,,,,,,,76.70,286.15,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,outpatient,,,590.00000,431.29000,Aetna,Commercial,,153.40,,,,,,,153.40,572.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,outpatient,,,690.00000,504.39000,Aetna,Commercial,,179.40,,,,,,,179.40,669.30,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,outpatient,,,1375.00000,1005.12000,Aetna,Commercial,,357.50,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,outpatient,,,950.00000,694.45000,Aetna,Commercial,,247.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,outpatient,,,1900.00000,1388.90000,Aetna,Commercial,,494.00,,,,,,,494.00,1843.00,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,outpatient,,,584.00000,426.90000,Aetna,Commercial,,151.84,,,,,,,151.84,566.48,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,outpatient,,,1391.00000,1016.82000,Aetna,Commercial,,361.66,,,,,,,361.66,1349.27,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,outpatient,,,359.00000,271.76000,Aetna,Commercial,,93.34,,,,,,,93.34,348.23,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,outpatient,,,95.00000,71.92000,Aetna,Commercial,,24.70,,,,,,,24.70,92.15,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,outpatient,,,37.00000,17.83000,Aetna,Commercial,,9.62,,,,,,,9.62,35.89,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Aetna,Commercial,,20.54,,,,,,,20.54,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Aetna,Commercial,,61.62,,,,,,,61.62,229.89,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,outpatient,,,33.00000,15.91000,Aetna,Commercial,,8.58,,,,,,,8.58,32.01,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,outpatient,,,25.00000,12.05000,Aetna,Commercial,,6.50,,,,,,,6.50,24.25,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,outpatient,,,497.00000,160.53000,Aetna,Commercial,,129.22,,,,,,,129.22,482.09,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Aetna,Commercial,,229.32,,,,,,,229.32,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Aetna,Commercial,,229.32,,,,,,,229.32,855.54,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Aetna,Commercial,,25.48,,,,,,,25.48,95.06,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Aetna,Commercial,,24.96,,,,,,,24.96,93.12,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Aetna,Commercial,,229.32,,,,,,,229.32,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Aetna,Commercial,,229.32,,,,,,,229.32,855.54,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,outpatient,,,763.00000,291.47000,Aetna,Commercial,,198.38,,,,,,,198.38,740.11,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,outpatient,,,199.00000,76.02000,Aetna,Commercial,,51.74,,,,,,,51.74,193.03,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Aetna,Commercial,,25.48,,,,,,,25.48,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Aetna,Commercial,,24.96,,,,,,,24.96,93.12,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,outpatient,,,1265.00000,483.23000,Aetna,Commercial,,328.90,,,,,,,328.90,1227.05,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,outpatient,,,924.00000,352.97000,Aetna,Commercial,,240.24,,,,,,,240.24,896.28,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,outpatient,,,580.00000,215.76000,Aetna,Commercial,,150.80,,,,,,,150.80,562.60,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,outpatient,,,110.00000,40.92000,Aetna,Commercial,,28.60,,,,,,,28.60,106.70,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,outpatient,,,373.00000,138.76000,Aetna,Commercial,,96.98,,,,,,,96.98,361.81,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,outpatient,,,337.00000,125.36000,Aetna,Commercial,,87.62,,,,,,,87.62,326.89,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,outpatient,,,784.00000,291.65000,Aetna,Commercial,,203.84,,,,,,,203.84,760.48,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,outpatient,,,341.00000,126.85000,Aetna,Commercial,,88.66,,,,,,,88.66,330.77,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,outpatient,,,252.00000,93.74000,Aetna,Commercial,,65.52,,,,,,,65.52,244.44,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,outpatient,,,282.00000,104.90000,Aetna,Commercial,,73.32,,,,,,,73.32,273.54,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,outpatient,,,404.00000,150.29000,Aetna,Commercial,,105.04,,,,,,,105.04,391.88,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,outpatient,,,306.00000,173.85000,Aetna,Commercial,,79.56,,,,,,,79.56,296.82,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,outpatient,,,158.00000,89.77000,Aetna,Commercial,,41.08,,,,,,,41.08,153.26,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Aetna,Commercial,GP,38.22,,,,,,,38.22,142.59,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Aetna,Commercial,GP,70.20,,,,,,,70.20,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Aetna,Commercial,GP,21.84,,,,,,,21.84,81.48,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Aetna,Commercial,GP,22.36,,,,,,,22.36,83.42,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Aetna,Commercial,GP,21.32,,,,,,,21.32,79.54,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Aetna,Commercial,GP,22.10,,,,,,,22.10,82.45,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Aetna,Commercial,GP,11.18,,,,,,,11.18,41.71,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Aetna,Commercial,GP,10.66,,,,,,,10.66,39.77,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Aetna,Commercial,GP,20.54,,,,,,,20.54,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Aetna,Commercial,GP,19.24,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Aetna,Commercial,GP,19.24,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Aetna,Commercial,GP,8.84,,,,,,,8.84,32.98,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Aetna,Commercial,GP,16.90,,,,,,,16.90,63.05,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,outpatient,,,113.00000,68.70000,Aetna,Commercial,,29.38,,,,,,,29.38,109.61,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Aetna,Commercial,GP,20.80,,,,,,,20.80,77.60,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Aetna,Commercial,GP,21.84,,,,,,,21.84,81.48,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Aetna,Commercial,GP,18.98,,,,,,,18.98,70.81,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,outpatient,,,100.00000,60.80000,Aetna,Commercial,,26.00,,,,,,,26.00,97.00,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,outpatient,,,167.00000,101.54000,Aetna,Commercial,GP,43.42,,,,,,,43.42,161.99,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Aetna,Commercial,"50,GP",107.38,,,,,,,107.38,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Aetna,Commercial,"LT,GP",71.50,,,,,,,71.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Aetna,Commercial,"RT,GP",71.50,,,,,,,71.50,266.75,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Aetna,Commercial,GP,24.70,,,,,,,24.70,92.15,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Aetna,Commercial,GP,37.96,,,,,,,37.96,141.62,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Aetna,Commercial,GP,36.14,,,,,,,36.14,134.83,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Aetna,Commercial,GP,19.50,,,,,,,19.50,72.75,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Aetna,Commercial,GP,40.04,,,,,,,40.04,149.38,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Aetna,Commercial,GP,18.98,,,,,,,18.98,70.81,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Aetna,Commercial,GP,41.60,,,,,,,41.60,155.20,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Aetna,Commercial,GP,84.50,,,,,,,84.50,315.25,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,outpatient,,,98.00000,59.58000,Aetna,Commercial,GP,25.48,,,,,,,25.48,95.06,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,outpatient,,,303.00000,184.22000,Aetna,Commercial,GP,78.78,,,,,,,78.78,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,outpatient,,,115.00000,69.92000,Aetna,Commercial,GP,29.90,,,,,,,29.90,111.55,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Aetna,Commercial,GP,19.24,,,,,,,19.24,71.78,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Aetna,Commercial,GP,20.54,,,,,,,20.54,76.63,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Aetna,Commercial,GP,18.72,,,,,,,18.72,69.84,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Aetna,Commercial,GP,38.22,,,,,,,38.22,142.59,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Aetna,Commercial,GP,70.20,,,,,,,70.20,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Aetna,Commercial,GP,21.84,,,,,,,21.84,81.48,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Aetna,Commercial,GP,22.36,,,,,,,22.36,83.42,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Aetna,Commercial,GP,21.32,,,,,,,21.32,79.54,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Aetna,Commercial,GP,22.10,,,,,,,22.10,82.45,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Aetna,Commercial,GP,11.18,,,,,,,11.18,41.71,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Aetna,Commercial,GP,10.66,,,,,,,10.66,39.77,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Aetna,Commercial,GP,20.54,,,,,,,20.54,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Aetna,Commercial,"CQ,GP",19.24,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Aetna,Commercial,"CQ,GP",19.24,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Aetna,Commercial,GP,8.84,,,,,,,8.84,32.98,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Aetna,Commercial,GP,16.90,,,,,,,16.90,63.05,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Aetna,Commercial,GP,20.80,,,,,,,20.80,77.60,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Aetna,Commercial,GP,21.84,,,,,,,21.84,81.48,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Aetna,Commercial,GP,18.98,,,,,,,18.98,70.81,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Aetna,Commercial,"GP,50",107.38,,,,,,,107.38,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Aetna,Commercial,"GP,LT",71.50,,,,,,,71.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Aetna,Commercial,"GP,RT",71.50,,,,,,,71.50,266.75,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Aetna,Commercial,GP,24.70,,,,,,,24.70,92.15,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Aetna,Commercial,GP,37.96,,,,,,,37.96,141.62,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Aetna,Commercial,GP,36.14,,,,,,,36.14,134.83,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Aetna,Commercial,GP,19.50,,,,,,,19.50,72.75,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Aetna,Commercial,GP,40.04,,,,,,,40.04,149.38,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Aetna,Commercial,GP,18.98,,,,,,,18.98,70.81,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Aetna,Commercial,GP,41.60,,,,,,,41.60,155.20,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Aetna,Commercial,GP,84.50,,,,,,,84.50,315.25,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Aetna,Commercial,GP,19.24,,,,,,,19.24,71.78,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Aetna,Commercial,GP,20.54,,,,,,,20.54,76.63,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Aetna,Commercial,GP,18.72,,,,,,,18.72,69.84,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,outpatient,,,445.00000,262.55000,Aetna,Commercial,GP,115.70,,,,,,,115.70,431.65,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,outpatient,,,310.00000,182.90000,Aetna,Commercial,GP,80.60,,,,,,,80.60,300.70,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,outpatient,,,393.00000,231.87000,Aetna,Commercial,GP,102.18,,,,,,,102.18,381.21,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,outpatient,,,310.00000,182.90000,Aetna,Commercial,GP,80.60,,,,,,,80.60,300.70,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Aetna,Commercial,GO,20.80,,,,,,,20.80,77.60,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Aetna,Commercial,GO,21.84,,,,,,,21.84,81.48,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Aetna,Commercial,GO,32.76,,,,,,,32.76,122.22,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Aetna,Commercial,GO,17.16,,,,,,,17.16,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Aetna,Commercial,GO,16.12,,,,,,,16.12,60.14,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Aetna,Commercial,GO,23.40,,,,,,,23.40,87.30,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Aetna,Commercial,GO,24.70,,,,,,,24.70,92.15,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Aetna,Commercial,GO,37.96,,,,,,,37.96,141.62,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Aetna,Commercial,GO,36.14,,,,,,,36.14,134.83,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Aetna,Commercial,GO,19.50,,,,,,,19.50,72.75,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Aetna,Commercial,GO,40.04,,,,,,,40.04,149.38,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Aetna,Commercial,GO,18.98,,,,,,,18.98,70.81,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Aetna,Commercial,GO,41.60,,,,,,,41.60,155.20,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,outpatient,,,98.00000,37.93000,Aetna,Commercial,GO,25.48,,,,,,,25.48,95.06,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,outpatient,,,303.00000,117.26000,Aetna,Commercial,GO,78.78,,,,,,,78.78,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,outpatient,,,115.00000,44.50000,Aetna,Commercial,GO,29.90,,,,,,,29.90,111.55,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Aetna,Commercial,GO,19.24,,,,,,,19.24,71.78,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Aetna,Commercial,GO,18.72,,,,,,,18.72,69.84,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Aetna,Commercial,"CO,GO",20.80,,,,,,,20.80,77.60,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Aetna,Commercial,"CO,GO",21.84,,,,,,,21.84,81.48,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Aetna,Commercial,"CO,GO",32.76,,,,,,,32.76,122.22,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Aetna,Commercial,"CO,GO",16.12,,,,,,,16.12,60.14,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Aetna,Commercial,"CO,GO",17.16,,,,,,,17.16,64.02,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Aetna,Commercial,"CO,GO",23.40,,,,,,,23.40,87.30,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Aetna,Commercial,"CO,GO",24.70,,,,,,,24.70,92.15,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Aetna,Commercial,"CO,GO",37.96,,,,,,,37.96,141.62,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Aetna,Commercial,"CO,GO",36.14,,,,,,,36.14,134.83,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Aetna,Commercial,"CO,GO",19.50,,,,,,,19.50,72.75,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Aetna,Commercial,"CO,GO",40.04,,,,,,,40.04,149.38,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Aetna,Commercial,"CO,GO",18.98,,,,,,,18.98,70.81,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Aetna,Commercial,"CO,GO",41.60,,,,,,,41.60,155.20,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Aetna,Commercial,"CO,GO",19.24,,,,,,,19.24,71.78,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Aetna,Commercial,"CO,GO",18.72,,,,,,,18.72,69.84,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Aetna,Commercial,GO,12.22,,,,,,,12.22,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Aetna,Commercial,"CO,GO",12.22,,,,,,,12.22,45.59,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,outpatient,,,250.00000,142.04000,Aetna,Commercial,GO,65.00,,,,,,,65.00,242.50,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,outpatient,,,175.00000,99.43000,Aetna,Commercial,GO,45.50,,,,,,,45.50,169.75,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,outpatient,,,233.00000,132.38000,Aetna,Commercial,GO,60.58,,,,,,,60.58,226.01,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,outpatient,,,175.00000,99.43000,Aetna,Commercial,GO,45.50,,,,,,,45.50,169.75,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,outpatient,,,291.00000,93.99000,Aetna,Commercial,,75.66,,,,,,,75.66,282.27,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,outpatient,,,273.00000,155.10000,Aetna,Commercial,GN,70.98,,,,,,,70.98,264.81,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,outpatient,,,279.00000,158.51000,Aetna,Commercial,GN,72.54,,,,,,,72.54,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,outpatient,,,426.00000,242.03000,Aetna,Commercial,GN,110.76,,,,,,,110.76,413.22,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,outpatient,,,242.00000,137.49000,Aetna,Commercial,GN,62.92,,,,,,,62.92,234.74,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,outpatient,,,128.00000,72.72000,Aetna,Commercial,,33.28,,,,,,,33.28,124.16,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,outpatient,,,66.00000,37.50000,Aetna,Commercial,GN,17.16,,,,,,,17.16,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,outpatient,,,62.00000,35.23000,Aetna,Commercial,GN,16.12,,,,,,,16.12,60.14,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,outpatient,,,269.00000,152.83000,Aetna,Commercial,GN,69.94,,,,,,,69.94,260.93,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,outpatient,,,153.00000,86.93000,Aetna,Commercial,GN,39.78,,,,,,,39.78,148.41,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,outpatient,,,98.00000,55.68000,Aetna,Commercial,GN,25.48,,,,,,,25.48,95.06,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,outpatient,,,303.00000,172.15000,Aetna,Commercial,GN,78.78,,,,,,,78.78,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,outpatient,,,115.00000,65.34000,Aetna,Commercial,GN,29.90,,,,,,,29.90,111.55,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,outpatient,,,210.00000,119.31000,Aetna,Commercial,GN,54.60,,,,,,,54.60,203.70,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,outpatient,,,250.00000,142.04000,Aetna,Commercial,GN,65.00,,,,,,,65.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,outpatient,,,78.00000,44.32000,Aetna,Commercial,GN,20.28,,,,,,,20.28,75.66,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,outpatient,,,322.00000,182.94000,Aetna,Commercial,GN,83.72,,,,,,,83.72,312.34,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,outpatient,,,309.00000,175.56000,Aetna,Commercial,GN,80.34,,,,,,,80.34,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,outpatient,,,245.00000,139.20000,Aetna,Commercial,GN,63.70,,,,,,,63.70,237.65,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,outpatient,,,313.00000,116.44000,Aetna,Commercial,,81.38,,,,,,,81.38,303.61,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,outpatient,,,1250.00000,632.50000,Aetna,Commercial,,325.00,,,,,,,325.00,1212.50,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Aetna,Commercial,,37.70,,,,,,,37.70,140.65,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Aetna,Commercial,,126.88,,,,,,,126.88,473.36,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,outpatient,,,684.00000,337.90000,Aetna,Commercial,,177.84,,,,,,,177.84,663.48,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,outpatient,,,206.00000,101.76000,Aetna,Commercial,,53.56,,,,,,,53.56,199.82,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,outpatient,,,195.00000,96.33000,Aetna,Commercial,,50.70,,,,,,,50.70,189.15,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,outpatient,,,375.00000,185.25000,Aetna,Commercial,,97.50,,,,,,,97.50,363.75,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,outpatient,,,429.00000,211.93000,Aetna,Commercial,,111.54,,,,,,,111.54,416.13,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22475,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Aetna,Commercial,,2512.00,,,,,,,2502.90,3111.10,per diem,
R&B OBSTETRICS SEMI-PVT,42473,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Aetna,Commercial,,2512.00,,,,,,,2502.90,3111.10,per diem,
R&B ICU,32474,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Aetna,Commercial,,2512.00,,,,,,,2512.00,8498.17,per diem,
R&B ICU INTERMEDIATE,12476,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Aetna,Commercial,,2512.00,,,,,,,2512.00,5665.77,per diem,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Aetna,Commercial,,21.84,,,,,,,21.84,81.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Aetna,Commercial,,73.84,,,,,,,73.84,275.48,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Aetna,Commercial,,119.08,,,,,,,119.08,444.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Aetna,Commercial,,145.08,,,,,,,145.08,541.26,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Aetna,Commercial,,125.32,,,,,,,125.32,467.54,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Aetna,Commercial,,61.62,,,,,,,61.62,229.89,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,outpatient,,,490.00000,329.77000,Aetna,Commercial,,127.40,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,outpatient,,,490.00000,329.77000,Aetna,Commercial,,127.40,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,outpatient,,,245.00000,164.89000,Aetna,Commercial,,63.70,,,,,,,63.70,237.65,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Aetna,Commercial,,127.40,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Aetna,Commercial,,127.40,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Aetna,Commercial,,63.70,,,,,,,63.70,237.65,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Aetna,Commercial,,218.92,,,,,,,218.92,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Aetna,Commercial,,273.78,,,,,,,273.78,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Aetna,Commercial,,328.38,,,,,,,328.38,1225.11,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,outpatient,,,2466.00000,986.40000,Aetna,Commercial,,641.16,,,,,,,641.16,2392.02,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,outpatient,,,260.00000,104.00000,Aetna,Commercial,,67.60,,,,,,,67.60,252.20,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,outpatient,,,2041.00000,816.40000,Aetna,Commercial,,530.66,,,,,,,530.66,1979.77,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,outpatient,,,375.00000,150.00000,Aetna,Commercial,,97.50,,,,,,,97.50,363.75,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,outpatient,,,1178.00000,471.20000,Aetna,Commercial,,306.28,,,,,,,306.28,1142.66,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,outpatient,,,245.00000,98.00000,Aetna,Commercial,,63.70,,,,,,,63.70,237.65,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,outpatient,,,280.00000,112.00000,Aetna,Commercial,,72.80,,,,,,,72.80,271.60,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,outpatient,,,336.00000,134.40000,Aetna,Commercial,,87.36,,,,,,,87.36,325.92,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,outpatient,,,380.00000,152.00000,Aetna,Commercial,,98.80,,,,,,,98.80,368.60,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Aetna,Commercial,,137.80,,,,,,,137.80,514.10,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,outpatient,,,264.00000,105.60000,Aetna,Commercial,,68.64,,,,,,,68.64,256.08,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,outpatient,,,763.00000,305.20000,Aetna,Commercial,,198.38,,,,,,,198.38,740.11,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,outpatient,,,672.00000,268.80000,Aetna,Commercial,,174.72,,,,,,,174.72,651.84,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,outpatient,,,1940.00000,776.00000,Aetna,Commercial,,504.40,,,,,,,504.40,1881.80,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,outpatient,,,3875.00000,1550.00000,Aetna,Commercial,,1007.50,,,,,,,1007.50,3758.75,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,outpatient,,,505.00000,202.00000,Aetna,Commercial,,131.30,,,,,,,131.30,489.85,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Aetna,Commercial,,76.70,,,,,,,76.70,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,outpatient,,,585.00000,234.00000,Aetna,Commercial,,152.10,,,,,,,152.10,567.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,outpatient,,,285.00000,114.00000,Aetna,Commercial,,74.10,,,,,,,74.10,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,outpatient,,,575.00000,230.00000,Aetna,Commercial,,149.50,,,,,,,149.50,557.75,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,outpatient,,,697.00000,278.80000,Aetna,Commercial,,181.22,,,,,,,181.22,676.09,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Aetna,Commercial,,137.80,,,,,,,137.80,514.10,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,outpatient,,,580.00000,232.00000,Aetna,Commercial,,150.80,,,,,,,150.80,562.60,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,outpatient,,,435.00000,174.00000,Aetna,Commercial,,113.10,,,,,,,113.10,421.95,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,outpatient,,,270.00000,108.00000,Aetna,Commercial,,70.20,,,,,,,70.20,261.90,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,outpatient,,,504.00000,201.60000,Aetna,Commercial,,131.04,,,,,,,131.04,488.88,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,outpatient,,,98.00000,39.20000,Aetna,Commercial,,25.48,,,,,,,25.48,95.06,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,outpatient,,,608.00000,243.20000,Aetna,Commercial,,158.08,,,,,,,158.08,589.76,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,outpatient,,,114.00000,45.60000,Aetna,Commercial,,29.64,,,,,,,29.64,110.58,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,outpatient,,,187.00000,74.80000,Aetna,Commercial,,48.62,,,,,,,48.62,181.39,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,outpatient,,,214.00000,85.60000,Aetna,Commercial,,55.64,,,,,,,55.64,207.58,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,outpatient,,,863.00000,345.20000,Aetna,Commercial,,224.38,,,,,,,224.38,837.11,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,outpatient,,,453.00000,181.20000,Aetna,Commercial,,117.78,,,,,,,117.78,439.41,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,outpatient,,,144.00000,57.60000,Aetna,Commercial,,37.44,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,outpatient,,,107.00000,42.80000,Aetna,Commercial,,27.82,,,,,,,27.82,103.79,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,outpatient,,,403.00000,161.20000,Aetna,Commercial,,104.78,,,,,,,104.78,390.91,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,outpatient,,,144.00000,57.60000,Aetna,Commercial,,37.44,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,outpatient,,,370.00000,148.00000,Aetna,Commercial,,96.20,,,,,,,96.20,358.90,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,outpatient,,,334.00000,133.60000,Aetna,Commercial,,86.84,,,,,,,86.84,323.98,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,outpatient,,,1188.00000,475.20000,Aetna,Commercial,50,308.88,,,,,,,308.88,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Aetna,Commercial,LT,205.92,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Aetna,Commercial,RT,205.92,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,outpatient,,,572.00000,228.80000,Aetna,Commercial,50,148.72,,,,,,,148.72,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Aetna,Commercial,LT,99.06,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Aetna,Commercial,RT,99.06,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,outpatient,,,683.00000,273.20000,Aetna,Commercial,50,177.58,,,,,,,177.58,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Aetna,Commercial,LT,118.30,,,,,,,118.30,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Aetna,Commercial,RT,118.30,,,,,,,118.30,441.35,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,outpatient,,,357.00000,142.80000,Aetna,Commercial,,92.82,,,,,,,92.82,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,outpatient,,,334.00000,133.60000,Aetna,Commercial,,86.84,,,,,,,86.84,323.98,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,outpatient,,,194.00000,77.60000,Aetna,Commercial,,50.44,,,,,,,50.44,188.18,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,outpatient,,,608.00000,243.20000,Aetna,Commercial,,158.08,,,,,,,158.08,589.76,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,outpatient,,,257.00000,102.80000,Aetna,Commercial,,66.82,,,,,,,66.82,249.29,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,outpatient,,,343.00000,137.20000,Aetna,Commercial,,89.18,,,,,,,89.18,332.71,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,outpatient,,,457.00000,182.80000,Aetna,Commercial,,118.82,,,,,,,118.82,443.29,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,outpatient,,,630.00000,252.00000,Aetna,Commercial,,163.80,,,,,,,163.80,611.10,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,outpatient,,,623.00000,249.20000,Aetna,Commercial,,161.98,,,,,,,161.98,604.31,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,outpatient,,,1457.00000,582.80000,Aetna,Commercial,,378.82,,,,,,,378.82,1413.29,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,outpatient,,,890.00000,356.00000,Aetna,Commercial,,231.40,,,,,,,231.40,863.30,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,outpatient,,,532.00000,212.80000,Aetna,Commercial,,138.32,,,,,,,138.32,516.04,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,outpatient,,,492.00000,196.80000,Aetna,Commercial,,127.92,,,,,,,127.92,477.24,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,outpatient,,,550.00000,220.00000,Aetna,Commercial,,143.00,,,,,,,143.00,533.50,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,outpatient,,,305.00000,122.00000,Aetna,Commercial,,79.30,,,,,,,79.30,295.85,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,outpatient,,,220.00000,88.00000,Aetna,Commercial,,57.20,,,,,,,57.20,213.40,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,outpatient,,,780.00000,312.00000,Aetna,Commercial,,202.80,,,,,,,202.80,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,outpatient,,,1165.00000,466.00000,Aetna,Commercial,,302.90,,,,,,,302.90,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,outpatient,,,2350.00000,940.00000,Aetna,Commercial,,611.00,,,,,,,611.00,2279.50,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,outpatient,,,896.00000,358.40000,Aetna,Commercial,,232.96,,,,,,,232.96,869.12,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,outpatient,,,385.00000,154.00000,Aetna,Commercial,,100.10,,,,,,,100.10,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,outpatient,,,470.00000,188.00000,Aetna,Commercial,,122.20,,,,,,,122.20,455.90,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,outpatient,,,150.00000,60.00000,Aetna,Commercial,,39.00,,,,,,,39.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,outpatient,,,100.00000,40.00000,Aetna,Commercial,,26.00,,,,,,,26.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,outpatient,,,143.00000,57.20000,Aetna,Commercial,,37.18,,,,,,,37.18,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,outpatient,,,95.00000,38.00000,Aetna,Commercial,,24.70,,,,,,,24.70,92.15,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,outpatient,,,269.00000,107.60000,Aetna,Commercial,,69.94,,,,,,,69.94,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,outpatient,,,388.00000,155.20000,Aetna,Commercial,,100.88,,,,,,,100.88,376.36,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,outpatient,,,344.00000,137.60000,Aetna,Commercial,,89.44,,,,,,,89.44,333.68,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,outpatient,,,321.00000,128.40000,Aetna,Commercial,,83.46,,,,,,,83.46,311.37,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,outpatient,,,155.00000,62.00000,Aetna,Commercial,,40.30,,,,,,,40.30,150.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,outpatient,,,817.00000,326.80000,Aetna,Commercial,,212.42,,,,,,,212.42,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,outpatient,,,1255.00000,502.00000,Aetna,Commercial,,326.30,,,,,,,326.30,1217.35,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,outpatient,,,391.00000,156.40000,Aetna,Commercial,,101.66,,,,,,,101.66,379.27,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,outpatient,,,671.00000,268.40000,Aetna,Commercial,,174.46,,,,,,,174.46,650.87,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,outpatient,,,456.00000,182.40000,Aetna,Commercial,,118.56,,,,,,,118.56,442.32,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,outpatient,,,112.00000,44.80000,Aetna,Commercial,,29.12,,,,,,,29.12,108.64,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,outpatient,,,84.00000,33.60000,Aetna,Commercial,,21.84,,,,,,,21.84,81.48,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,outpatient,,,216.00000,86.40000,Aetna,Commercial,,56.16,,,,,,,56.16,209.52,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,outpatient,,,2660.00000,1064.00000,Aetna,Commercial,,691.60,,,,,,,691.60,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,outpatient,,,2960.00000,1184.00000,Aetna,Commercial,,769.60,,,,,,,769.60,2871.20,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,outpatient,,,3225.00000,1290.00000,Aetna,Commercial,,838.50,,,,,,,838.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,outpatient,,,3395.00000,1358.00000,Aetna,Commercial,,882.70,,,,,,,882.70,3293.15,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,outpatient,,,490.00000,196.00000,Aetna,Commercial,,127.40,,,,,,,127.40,475.30,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,outpatient,,,520.00000,208.00000,Aetna,Commercial,,135.20,,,,,,,135.20,504.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,outpatient,,,720.00000,288.00000,Aetna,Commercial,,187.20,,,,,,,187.20,698.40,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,outpatient,,,215.00000,86.00000,Aetna,Commercial,,55.90,,,,,,,55.90,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,outpatient,,,240.00000,96.00000,Aetna,Commercial,,62.40,,,,,,,62.40,232.80,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,outpatient,,,1241.00000,496.40000,Aetna,Commercial,,322.66,,,,,,,322.66,1203.77,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,outpatient,,,850.00000,340.00000,Aetna,Commercial,,221.00,,,,,,,221.00,824.50,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,outpatient,,,1085.00000,434.00000,Aetna,Commercial,,282.10,,,,,,,282.10,1052.45,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Aetna,Commercial,,76.70,,,,,,,76.70,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,outpatient,,,492.00000,196.80000,Aetna,Commercial,,127.92,,,,,,,127.92,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,outpatient,,,563.00000,225.20000,Aetna,Commercial,,146.38,,,,,,,146.38,546.11,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,outpatient,,,1612.00000,644.80000,Aetna,Commercial,,419.12,,,,,,,419.12,1563.64,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,outpatient,,,1366.00000,546.40000,Aetna,Commercial,,355.16,,,,,,,355.16,1325.02,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,outpatient,,,1911.00000,764.40000,Aetna,Commercial,,496.86,,,,,,,496.86,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,outpatient,,,956.00000,382.40000,Aetna,Commercial,,248.56,,,,,,,248.56,927.32,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,outpatient,,,189.00000,123.20000,Aetna,Commercial,,49.14,,,,,,,49.14,183.33,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,outpatient,,,352.00000,256.87000,Aetna,Commercial,,91.52,,,,,,,91.52,341.44,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,outpatient,,,625.00000,738.40000,Aetna,Commercial,,162.50,,,,,,,162.50,606.25,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1024.00000,2097.47000,Aetna,Commercial,,266.24,,,,,,,266.24,993.28,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,outpatient,,,1455.00000,2469.72000,Aetna,Commercial,,378.30,,,,,,,378.30,1411.35,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Aetna,Commercial,,37.70,,,,,,,37.70,140.65,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Aetna,Commercial,,126.88,,,,,,,126.88,473.36,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Aetna,Commercial,,30.16,,,,,,,30.16,112.52,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Aetna,Commercial,,21.06,,,,,,,21.06,78.57,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Aetna,Commercial,,10.66,,,,,,,10.66,39.77,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,outpatient,,,170.00000,73.95000,Aetna,Commercial,,44.20,,,,,,,44.20,164.90,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,2.70000,1.17000,Aetna,Commercial,,0.70200,,,,,,,0.70200,2.62,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,27.00000,11.74000,Aetna,Commercial,,7.02,,,,,,,7.02,26.19,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,outpatient,,,20440.00000,8891.40000,Aetna,Commercial,,5314.40,,,,,,,5314.40,19826.80,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,3322.00000,1445.07000,Aetna,Commercial,,863.72,,,,,,,863.72,3222.34,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,2492.00000,1084.02000,Aetna,Commercial,,647.92,,,,,,,647.92,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1814.00000,789.09000,Aetna,Commercial,,471.64,,,,,,,471.64,1759.58,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,2153.00000,936.56000,Aetna,Commercial,,559.78,,,,,,,559.78,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1525.00000,663.38000,Aetna,Commercial,,396.50,,,,,,,396.50,1479.25,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2716.00000,1181.46000,Aetna,Commercial,,706.16,,,,,,,706.16,2634.52,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,outpatient,,,2.70000,0.39000,Aetna,Commercial,,0.70200,,,,,,,0.70200,2.62,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,outpatient,,,222.00000,32.41000,Aetna,Commercial,,57.72,,,,,,,57.72,215.34,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,outpatient,,,211.00000,113.10000,Aetna,Commercial,,54.86,,,,,,,54.86,204.67,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,outpatient,,,497.00000,266.39000,Aetna,Commercial,,129.22,,,,,,,129.22,482.09,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,outpatient,,,296.00000,158.66000,Aetna,Commercial,,76.96,,,,,,,76.96,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,outpatient,,,723.00000,387.53000,Aetna,Commercial,,187.98,,,,,,,187.98,701.31,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,outpatient,,,326.00000,174.74000,Aetna,Commercial,,84.76,,,,,,,84.76,316.22,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,outpatient,,,532.00000,285.15000,Aetna,Commercial,,138.32,,,,,,,138.32,516.04,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,outpatient,,,635.00000,340.36000,Aetna,Commercial,,165.10,,,,,,,165.10,615.95,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,outpatient,,,639.00000,342.50000,Aetna,Commercial,,166.14,,,,,,,166.14,619.83,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,outpatient,,,780.00000,418.08000,Aetna,Commercial,,202.80,,,,,,,202.80,756.60,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,outpatient,,,390.00000,209.04000,Aetna,Commercial,,101.40,,,,,,,101.40,378.30,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,outpatient,,,731.00000,391.82000,Aetna,Commercial,,190.06,,,,,,,190.06,709.07,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,outpatient,,,585.00000,313.56000,Aetna,Commercial,,152.10,,,,,,,152.10,567.45,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,outpatient,,,365.00000,195.64000,Aetna,Commercial,,94.90,,,,,,,94.90,354.05,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,outpatient,,,1086.00000,582.10000,Aetna,Commercial,,282.36,,,,,,,282.36,1053.42,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,outpatient,,,197.00000,105.59000,Aetna,Commercial,,51.22,,,,,,,51.22,191.09,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,outpatient,,,2774.00000,1486.86000,Aetna,Commercial,,721.24,,,,,,,721.24,2690.78,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,outpatient,,,1456.00000,780.42000,Aetna,Commercial,,378.56,,,,,,,378.56,1412.32,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,outpatient,,,2647.00000,1418.79000,Aetna,Commercial,,688.22,,,,,,,688.22,2567.59,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,outpatient,,,1359.00000,728.42000,Aetna,Commercial,,353.34,,,,,,,353.34,1318.23,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,outpatient,,,273.00000,146.33000,Aetna,Commercial,,70.98,,,,,,,70.98,264.81,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,outpatient,,,325.00000,174.20000,Aetna,Commercial,,84.50,,,,,,,84.50,315.25,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Aetna,Commercial,,158.34,,,,,,,158.34,590.73,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,outpatient,,,491.00000,263.18000,Aetna,Commercial,,127.66,,,,,,,127.66,476.27,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,outpatient,,,561.00000,300.70000,Aetna,Commercial,,145.86,,,,,,,145.86,544.17,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,outpatient,,,845.00000,452.92000,Aetna,Commercial,,219.70,,,,,,,219.70,819.65,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,outpatient,,,612.00000,328.03000,Aetna,Commercial,,159.12,,,,,,,159.12,593.64,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,outpatient,,,536.00000,287.30000,Aetna,Commercial,,139.36,,,,,,,139.36,519.92,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,outpatient,,,1225.00000,656.60000,Aetna,Commercial,,318.50,,,,,,,318.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Aetna,Commercial,LT,212.16,,,,,,,212.16,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Aetna,Commercial,RT,212.16,,,,,,,212.16,791.52,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,outpatient,,,250.00000,134.00000,Aetna,Commercial,,65.00,,,,,,,65.00,242.50,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,outpatient,,,302.00000,161.87000,Aetna,Commercial,,78.52,,,,,,,78.52,292.94,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,outpatient,,,354.00000,189.74000,Aetna,Commercial,,92.04,,,,,,,92.04,343.38,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,outpatient,,,409.00000,219.22000,Aetna,Commercial,,106.34,,,,,,,106.34,396.73,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,outpatient,,,593.00000,317.85000,Aetna,Commercial,,154.18,,,,,,,154.18,575.21,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Aetna,Commercial,LT,79.82,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Aetna,Commercial,"52,LT",79.82,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Aetna,Commercial,RT,79.82,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Aetna,Commercial,"52,RT",79.82,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Aetna,Commercial,LT,85.80,,,,,,,85.80,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Aetna,Commercial,RT,85.80,,,,,,,85.80,320.10,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,outpatient,,,195.00000,104.52000,Aetna,Commercial,,50.70,,,,,,,50.70,189.15,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,outpatient,,,578.00000,309.81000,Aetna,Commercial,,150.28,,,,,,,150.28,560.66,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,outpatient,,,384.00000,205.82000,Aetna,Commercial,,99.84,,,,,,,99.84,372.48,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Aetna,Commercial,LT,78.78,,,,,,,78.78,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Aetna,Commercial,RT,78.78,,,,,,,78.78,293.91,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Aetna,Commercial,LT,115.70,,,,,,,115.70,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Aetna,Commercial,RT,115.70,,,,,,,115.70,431.65,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,outpatient,,,937.00000,502.23000,Aetna,Commercial,,243.62,,,,,,,243.62,908.89,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,outpatient,,,615.00000,329.64000,Aetna,Commercial,,159.90,,,,,,,159.90,596.55,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Aetna,Commercial,LT,74.62,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Aetna,Commercial,"52,LT",74.62,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Aetna,Commercial,RT,74.62,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Aetna,Commercial,"52,RT",74.62,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Aetna,Commercial,LT,83.98,,,,,,,83.98,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Aetna,Commercial,RT,83.98,,,,,,,83.98,313.31,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,outpatient,,,694.00000,371.98000,Aetna,Commercial,,180.44,,,,,,,180.44,673.18,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Aetna,Commercial,LT,71.76,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Aetna,Commercial,RT,71.76,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Aetna,Commercial,LT,66.04,,,,,,,66.04,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Aetna,Commercial,RT,66.04,,,,,,,66.04,246.38,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Aetna,Commercial,LT,71.50,,,,,,,71.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Aetna,Commercial,RT,71.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,outpatient,,,173.00000,92.73000,Aetna,Commercial,,44.98,,,,,,,44.98,167.81,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Aetna,Commercial,LT,125.58,,,,,,,125.58,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Aetna,Commercial,RT,125.58,,,,,,,125.58,468.51,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Aetna,Commercial,LT,49.66,,,,,,,49.66,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Aetna,Commercial,RT,49.66,,,,,,,49.66,185.27,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Aetna,Commercial,LT,38.48,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Aetna,Commercial,"52,LT",38.48,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Aetna,Commercial,RT,38.48,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Aetna,Commercial,"52,RT",38.48,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Aetna,Commercial,LT,125.06,,,,,,,125.06,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Aetna,Commercial,RT,125.06,,,,,,,125.06,466.57,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Aetna,Commercial,LT,55.90,,,,,,,55.90,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Aetna,Commercial,RT,55.90,,,,,,,55.90,208.55,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Aetna,Commercial,LT,71.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Aetna,Commercial,"52,LT",71.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Aetna,Commercial,RT,71.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Aetna,Commercial,"52,RT",71.50,,,,,,,71.50,266.75,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Aetna,Commercial,LT,118.30,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Aetna,Commercial,"52,LT",118.30,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Aetna,Commercial,RT,118.30,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Aetna,Commercial,"52,RT",118.30,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Aetna,Commercial,LT,130.78,,,,,,,130.78,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Aetna,Commercial,RT,130.78,,,,,,,130.78,487.91,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Aetna,Commercial,LT,54.34,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Aetna,Commercial,RT,54.34,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Aetna,Commercial,LT,147.16,,,,,,,147.16,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Aetna,Commercial,RT,147.16,,,,,,,147.16,549.02,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,outpatient,,,598.00000,320.53000,Aetna,Commercial,,155.48,,,,,,,155.48,580.06,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Aetna,Commercial,"52,LT",118.30,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Aetna,Commercial,"52,RT",118.30,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Aetna,Commercial,LT,118.30,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Aetna,Commercial,RT,118.30,,,,,,,118.30,441.35,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,outpatient,,,1913.00000,1025.37000,Aetna,Commercial,,497.38,,,,,,,497.38,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,outpatient,,,312.00000,167.23000,Aetna,Commercial,,81.12,,,,,,,81.12,302.64,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,outpatient,,,327.00000,175.27000,Aetna,Commercial,,85.02,,,,,,,85.02,317.19,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,outpatient,,,425.00000,227.80000,Aetna,Commercial,,110.50,,,,,,,110.50,412.25,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,outpatient,,,210.00000,112.56000,Aetna,Commercial,,54.60,,,,,,,54.60,203.70,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,outpatient,,,495.00000,265.32000,Aetna,Commercial,,128.70,,,,,,,128.70,480.15,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,outpatient,,,541.00000,289.98000,Aetna,Commercial,,140.66,,,,,,,140.66,524.77,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Aetna,Commercial,LT,89.70,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Aetna,Commercial,RT,89.70,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Aetna,Commercial,LT,108.94,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Aetna,Commercial,RT,108.94,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Aetna,Commercial,LT,160.68,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Aetna,Commercial,RT,160.68,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,outpatient,,,463.00000,248.17000,Aetna,Commercial,,120.38,,,,,,,120.38,449.11,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,outpatient,,,511.00000,273.90000,Aetna,Commercial,,132.86,,,,,,,132.86,495.67,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,outpatient,,,132.00000,70.75000,Aetna,Commercial,,34.32,,,,,,,34.32,128.04,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Aetna,Commercial,LT,91.78,,,,,,,91.78,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Aetna,Commercial,RT,91.78,,,,,,,91.78,342.41,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,outpatient,,,273.00000,146.33000,Aetna,Commercial,,70.98,,,,,,,70.98,264.81,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,outpatient,,,503.00000,269.61000,Aetna,Commercial,,130.78,,,,,,,130.78,487.91,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,outpatient,,,561.00000,300.70000,Aetna,Commercial,,145.86,,,,,,,145.86,544.17,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Aetna,Commercial,LT,117.00,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Aetna,Commercial,RT,117.00,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,outpatient,,,650.00000,348.40000,Aetna,Commercial,,169.00,,,,,,,169.00,630.50,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,outpatient,,,642.00000,344.11000,Aetna,Commercial,,166.92,,,,,,,166.92,622.74,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,outpatient,,,777.00000,416.47000,Aetna,Commercial,,202.02,,,,,,,202.02,753.69,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,outpatient,,,381.00000,204.22000,Aetna,Commercial,,99.06,,,,,,,99.06,369.57,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Aetna,Commercial,LT,97.24,,,,,,,97.24,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Aetna,Commercial,RT,97.24,,,,,,,97.24,362.78,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Aetna,Commercial,LT,41.86,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Aetna,Commercial,RT,41.86,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Aetna,Commercial,LT,129.74,,,,,,,129.74,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Aetna,Commercial,RT,129.74,,,,,,,129.74,484.03,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,outpatient,,,214.00000,114.70000,Aetna,Commercial,,55.64,,,,,,,55.64,207.58,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,outpatient,,,329.00000,176.34000,Aetna,Commercial,,85.54,,,,,,,85.54,319.13,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,outpatient,,,197.00000,105.59000,Aetna,Commercial,,51.22,,,,,,,51.22,191.09,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,outpatient,,,263.00000,140.97000,Aetna,Commercial,,68.38,,,,,,,68.38,255.11,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,outpatient,,,234.00000,125.42000,Aetna,Commercial,,60.84,,,,,,,60.84,226.98,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,outpatient,,,401.00000,214.94000,Aetna,Commercial,,104.26,,,,,,,104.26,388.97,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,outpatient,,,515.00000,276.04000,Aetna,Commercial,,133.90,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,outpatient,,,747.00000,400.39000,Aetna,Commercial,,194.22,,,,,,,194.22,724.59,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,outpatient,,,854.00000,457.74000,Aetna,Commercial,,222.04,,,,,,,222.04,828.38,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,outpatient,,,589.00000,315.70000,Aetna,Commercial,,153.14,,,,,,,153.14,571.33,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,outpatient,,,613.00000,328.57000,Aetna,Commercial,,159.38,,,,,,,159.38,594.61,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,outpatient,,,806.00000,432.02000,Aetna,Commercial,,209.56,,,,,,,209.56,781.82,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,outpatient,,,529.00000,283.54000,Aetna,Commercial,,137.54,,,,,,,137.54,513.13,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,outpatient,,,939.00000,503.30000,Aetna,Commercial,,244.14,,,,,,,244.14,910.83,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,outpatient,,,515.00000,276.04000,Aetna,Commercial,,133.90,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,outpatient,,,616.00000,330.18000,Aetna,Commercial,,160.16,,,,,,,160.16,597.52,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,outpatient,,,377.00000,202.07000,Aetna,Commercial,,98.02,,,,,,,98.02,365.69,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,outpatient,,,340.00000,182.24000,Aetna,Commercial,,88.40,,,,,,,88.40,329.80,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,outpatient,,,388.00000,207.97000,Aetna,Commercial,,100.88,,,,,,,100.88,376.36,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,outpatient,,,456.00000,244.42000,Aetna,Commercial,,118.56,,,,,,,118.56,442.32,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,outpatient,,,267.00000,143.11000,Aetna,Commercial,,69.42,,,,,,,69.42,258.99,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Aetna,Commercial,LT,79.56,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Aetna,Commercial,"52,LT",79.56,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Aetna,Commercial,RT,79.56,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Aetna,Commercial,"52,RT",79.56,,,,,,,79.56,296.82,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,outpatient,,,456.00000,244.42000,Aetna,Commercial,,118.56,,,,,,,118.56,442.32,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,outpatient,,,381.00000,204.22000,Aetna,Commercial,,99.06,,,,,,,99.06,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Aetna,Commercial,LT,37.18,,,,,,,37.18,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Aetna,Commercial,RT,37.18,,,,,,,37.18,138.71,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Aetna,Commercial,LT,86.06,,,,,,,86.06,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Aetna,Commercial,RT,86.06,,,,,,,86.06,321.07,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1113.00000,596.57000,Aetna,Commercial,,289.38,,,,,,,289.38,1079.61,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,outpatient,,,1043.00000,559.05000,Aetna,Commercial,,271.18,,,,,,,271.18,1011.71,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Aetna,Commercial,LT,66.56,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Aetna,Commercial,"52,LT",66.56,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Aetna,Commercial,RT,66.56,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Aetna,Commercial,"52,RT",66.56,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Aetna,Commercial,LT,132.86,,,,,,,132.86,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Aetna,Commercial,RT,132.86,,,,,,,132.86,495.67,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Aetna,Commercial,LT,143.78,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Aetna,Commercial,RT,143.78,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Aetna,Commercial,LT,279.76,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Aetna,Commercial,RT,279.76,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Aetna,Commercial,LT,224.90,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Aetna,Commercial,RT,224.90,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Aetna,Commercial,LT,190.84,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Aetna,Commercial,RT,190.84,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Aetna,Commercial,LT,189.80,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Aetna,Commercial,RT,189.80,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Aetna,Commercial,LT,67.60,,,,,,,67.60,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Aetna,Commercial,RT,67.60,,,,,,,67.60,252.20,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,outpatient,,,428.00000,203.73000,Aetna,Commercial,,111.28,,,,,,,111.28,415.16,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,outpatient,,,492.00000,234.19000,Aetna,Commercial,,127.92,,,,,,,127.92,477.24,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,outpatient,,,607.00000,288.93000,Aetna,Commercial,,157.82,,,,,,,157.82,588.79,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,outpatient,,,649.00000,308.92000,Aetna,Commercial,,168.74,,,,,,,168.74,629.53,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,outpatient,,,377.00000,121.77000,Aetna,Commercial,50,98.02,,,,,,,98.02,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Aetna,Commercial,LT,65.26,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Aetna,Commercial,RT,65.26,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,outpatient,,,1170.00000,377.91000,Aetna,Commercial,50,304.20,,,,,,,304.20,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Aetna,Commercial,LT,202.80,,,,,,,202.80,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Aetna,Commercial,RT,202.80,,,,,,,202.80,756.60,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,outpatient,,,1389.00000,448.65000,Aetna,Commercial,,361.14,,,,,,,361.14,1347.33,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,outpatient,,,345.00000,111.44000,Aetna,Commercial,50,89.70,,,,,,,89.70,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Aetna,Commercial,LT,59.80,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Aetna,Commercial,RT,59.80,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,outpatient,,,2102.00000,678.95000,Aetna,Commercial,50,546.52,,,,,,,546.52,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Aetna,Commercial,LT,364.26,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Aetna,Commercial,RT,364.26,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,outpatient,,,357.00000,115.31000,Aetna,Commercial,50,92.82,,,,,,,92.82,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Aetna,Commercial,LT,61.88,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Aetna,Commercial,RT,61.88,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,outpatient,,,2082.00000,672.49000,Aetna,Commercial,50,541.32,,,,,,,541.32,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Aetna,Commercial,LT,360.88,,,,,,,360.88,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Aetna,Commercial,RT,360.88,,,,,,,360.88,1346.36,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,outpatient,,,246.00000,79.46000,Aetna,Commercial,50,63.96,,,,,,,63.96,238.62,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Aetna,Commercial,LT,42.64,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Aetna,Commercial,RT,42.64,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,outpatient,,,309.00000,99.81000,Aetna,Commercial,50,80.34,,,,,,,80.34,299.73,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Aetna,Commercial,LT,53.56,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Aetna,Commercial,RT,53.56,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,outpatient,,,471.00000,152.13000,Aetna,Commercial,50,122.46,,,,,,,122.46,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Aetna,Commercial,LT,81.64,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Aetna,Commercial,RT,81.64,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,outpatient,,,239.00000,77.20000,Aetna,Commercial,50,62.14,,,,,,,62.14,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Aetna,Commercial,LT,41.34,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Aetna,Commercial,RT,41.34,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,outpatient,,,558.00000,180.23000,Aetna,Commercial,50,145.08,,,,,,,145.08,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Aetna,Commercial,LT,96.72,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Aetna,Commercial,RT,96.72,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,outpatient,,,413.00000,133.40000,Aetna,Commercial,50,107.38,,,,,,,107.38,400.61,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Aetna,Commercial,LT,71.50,,,,,,,71.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Aetna,Commercial,RT,71.50,,,,,,,71.50,266.75,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,outpatient,,,462.00000,149.23000,Aetna,Commercial,,120.12,,,,,,,120.12,448.14,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,outpatient,,,170.00000,54.91000,Aetna,Commercial,,44.20,,,,,,,44.20,164.90,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,outpatient,,,281.00000,90.76000,Aetna,Commercial,,73.06,,,,,,,73.06,272.57,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,outpatient,,,562.00000,181.53000,Aetna,Commercial,,146.12,,,,,,,146.12,545.14,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,outpatient,,,2076.00000,670.55000,Aetna,Commercial,50,539.76,,,,,,,539.76,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Aetna,Commercial,LT,359.84,,,,,,,359.84,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Aetna,Commercial,RT,359.84,,,,,,,359.84,1342.48,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,outpatient,,,934.00000,301.68000,Aetna,Commercial,,242.84,,,,,,,242.84,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,outpatient,,,842.00000,271.97000,Aetna,Commercial,,218.92,,,,,,,218.92,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,outpatient,,,846.00000,273.26000,Aetna,Commercial,,219.96,,,,,,,219.96,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,outpatient,,,971.00000,313.63000,Aetna,Commercial,,252.46,,,,,,,252.46,941.87,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,outpatient,,,762.00000,246.13000,Aetna,Commercial,,198.12,,,,,,,198.12,739.14,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,outpatient,,,758.00000,244.83000,Aetna,Commercial,,197.08,,,,,,,197.08,735.26,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,outpatient,,,161.00000,52.00000,Aetna,Commercial,,41.86,,,,,,,41.86,156.17,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,outpatient,,,234.00000,75.58000,Aetna,Commercial,50,60.84,,,,,,,60.84,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Aetna,Commercial,LT,40.56,,,,,,,40.56,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Aetna,Commercial,RT,40.56,,,,,,,40.56,151.32,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1517.00000,489.99000,Aetna,Commercial,50,394.42,,,,,,,394.42,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Aetna,Commercial,LT,262.86,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Aetna,Commercial,RT,262.86,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,outpatient,,,822.00000,265.51000,Aetna,Commercial,50,213.72,,,,,,,213.72,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Aetna,Commercial,LT,142.48,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Aetna,Commercial,RT,142.48,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,outpatient,,,2613.00000,844.00000,Aetna,Commercial,,679.38,,,,,,,679.38,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,outpatient,,,903.00000,291.67000,Aetna,Commercial,,234.78,,,,,,,234.78,875.91,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,outpatient,,,1156.00000,373.39000,Aetna,Commercial,,300.56,,,,,,,300.56,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,outpatient,,,677.00000,218.67000,Aetna,Commercial,,176.02,,,,,,,176.02,656.69,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1928.00000,622.74000,Aetna,Commercial,50,501.28,,,,,,,501.28,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Aetna,Commercial,LT,334.10,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Aetna,Commercial,RT,334.10,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,outpatient,,,812.00000,262.28000,Aetna,Commercial,50,211.12,,,,,,,211.12,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Aetna,Commercial,LT,140.66,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Aetna,Commercial,RT,140.66,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,outpatient,,,825.00000,266.48000,Aetna,Commercial,50,214.50,,,,,,,214.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Aetna,Commercial,LT,143.00,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Aetna,Commercial,RT,143.00,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,outpatient,,,3494.00000,1128.56000,Aetna,Commercial,50,908.44,,,,,,,908.44,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Aetna,Commercial,LT,605.54,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Aetna,Commercial,RT,605.54,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,outpatient,,,840.00000,271.32000,Aetna,Commercial,50,218.40,,,,,,,218.40,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Aetna,Commercial,LT,145.60,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Aetna,Commercial,RT,145.60,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,outpatient,,,792.00000,255.82000,Aetna,Commercial,50,205.92,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Aetna,Commercial,LT,137.28,,,,,,,137.28,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Aetna,Commercial,RT,137.28,,,,,,,137.28,512.16,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,outpatient,,,272.00000,87.86000,Aetna,Commercial,,70.72,,,,,,,70.72,263.84,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,outpatient,,,1268.00000,409.56000,Aetna,Commercial,,329.68,,,,,,,329.68,1229.96,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,outpatient,,,896.00000,289.41000,Aetna,Commercial,,232.96,,,,,,,232.96,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,outpatient,,,884.00000,285.53000,Aetna,Commercial,,229.84,,,,,,,229.84,857.48,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Aetna,Commercial,,158.34,,,,,,,158.34,590.73,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,outpatient,,,966.00000,383.50000,Aetna,Commercial,,251.16,,,,,,,251.16,937.02,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,outpatient,,,872.00000,346.18000,Aetna,Commercial,,226.72,,,,,,,226.72,845.84,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,outpatient,,,492.00000,195.32000,Aetna,Commercial,,127.92,,,,,,,127.92,477.24,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,outpatient,,,331.00000,131.41000,Aetna,Commercial,,86.06,,,,,,,86.06,321.07,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,outpatient,,,5215.00000,2070.36000,Aetna,Commercial,,1355.90,,,,,,,1355.90,5058.55,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,outpatient,,,5422.00000,2152.53000,Aetna,Commercial,,1409.72,,,,,,,1409.72,5259.34,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1878.00000,788.76000,Aetna,Commercial,,488.28,,,,,,,488.28,1821.66,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,outpatient,,,2253.00000,946.26000,Aetna,Commercial,,585.78,,,,,,,585.78,2185.41,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1502.00000,630.84000,Aetna,Commercial,,390.52,,,,,,,390.52,1456.94,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,outpatient,,,2024.00000,850.08000,Aetna,Commercial,,526.24,,,,,,,526.24,1963.28,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,outpatient,,,2429.00000,1020.18000,Aetna,Commercial,,631.54,,,,,,,631.54,2356.13,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1619.00000,679.98000,Aetna,Commercial,,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,outpatient,,,2425.00000,1018.50000,Aetna,Commercial,,630.50,,,,,,,630.50,2352.25,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2910.00000,1222.20000,Aetna,Commercial,,756.60,,,,,,,756.60,2822.70,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1940.00000,814.80000,Aetna,Commercial,,504.40,,,,,,,504.40,1881.80,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2317.00000,973.14000,Aetna,Commercial,,602.42,,,,,,,602.42,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2780.00000,1167.60000,Aetna,Commercial,,722.80,,,,,,,722.80,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1853.00000,778.26000,Aetna,Commercial,,481.78,,,,,,,481.78,1797.41,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2366.00000,993.72000,Aetna,Commercial,,615.16,,,,,,,615.16,2295.02,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,outpatient,,,3056.00000,1283.52000,Aetna,Commercial,,794.56,,,,,,,794.56,2964.32,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,outpatient,,,2829.00000,1386.21000,Aetna,Commercial,,735.54,,,,,,,735.54,2744.13,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,outpatient,,,3395.00000,1663.55000,Aetna,Commercial,,882.70,,,,,,,882.70,3293.15,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,outpatient,,,2263.00000,1108.87000,Aetna,Commercial,,588.38,,,,,,,588.38,2195.11,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,outpatient,,,4697.00000,2301.53000,Aetna,Commercial,,1221.22,,,,,,,1221.22,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,outpatient,,,5636.00000,2761.64000,Aetna,Commercial,,1465.36,,,,,,,1465.36,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,outpatient,,,3757.00000,1840.93000,Aetna,Commercial,,976.82,,,,,,,976.82,3644.29,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,outpatient,,,2619.00000,1283.31000,Aetna,Commercial,,680.94,,,,,,,680.94,2540.43,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,outpatient,,,3143.00000,1540.07000,Aetna,Commercial,,817.18,,,,,,,817.18,3048.71,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,outpatient,,,2095.00000,1026.55000,Aetna,Commercial,,544.70,,,,,,,544.70,2032.15,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,outpatient,,,278.00000,136.22000,Aetna,Commercial,,72.28,,,,,,,72.28,269.66,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Aetna,Commercial,LT,548.60,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Aetna,Commercial,RT,548.60,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Aetna,Commercial,LT,658.32,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Aetna,Commercial,RT,658.32,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Aetna,Commercial,LT,438.88,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Aetna,Commercial,RT,438.88,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Aetna,Commercial,LT,526.24,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Aetna,Commercial,RT,526.24,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Aetna,Commercial,LT,631.54,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Aetna,Commercial,RT,631.54,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Aetna,Commercial,LT,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Aetna,Commercial,RT,420.94,,,,,,,420.94,1570.43,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,outpatient,,,1224.00000,599.76000,Aetna,Commercial,,318.24,,,,,,,318.24,1187.28,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,outpatient,,,3020.00000,1479.80000,Aetna,Commercial,,785.20,,,,,,,785.20,2929.40,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,outpatient,,,3624.00000,1775.76000,Aetna,Commercial,,942.24,,,,,,,942.24,3515.28,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,outpatient,,,2416.00000,1183.84000,Aetna,Commercial,,628.16,,,,,,,628.16,2343.52,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,outpatient,,,2728.00000,1336.72000,Aetna,Commercial,,709.28,,,,,,,709.28,2646.16,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,outpatient,,,3273.00000,1603.77000,Aetna,Commercial,,850.98,,,,,,,850.98,3174.81,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,outpatient,,,2182.00000,1069.18000,Aetna,Commercial,,567.32,,,,,,,567.32,2116.54,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,outpatient,,,3133.00000,1535.17000,Aetna,Commercial,,814.58,,,,,,,814.58,3039.01,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,outpatient,,,3759.00000,1841.91000,Aetna,Commercial,,977.34,,,,,,,977.34,3646.23,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,outpatient,,,2506.00000,1227.94000,Aetna,Commercial,,651.56,,,,,,,651.56,2430.82,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,outpatient,,,2857.00000,1399.93000,Aetna,Commercial,,742.82,,,,,,,742.82,2771.29,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,outpatient,,,3428.00000,1679.72000,Aetna,Commercial,,891.28,,,,,,,891.28,3325.16,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,outpatient,,,2285.00000,1119.65000,Aetna,Commercial,,594.10,,,,,,,594.10,2216.45,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,outpatient,,,3565.00000,1746.85000,Aetna,Commercial,,926.90,,,,,,,926.90,3458.05,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,outpatient,,,5918.00000,2899.82000,Aetna,Commercial,,1538.68,,,,,,,1538.68,5740.46,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,outpatient,,,3301.00000,1617.49000,Aetna,Commercial,,858.26,,,,,,,858.26,3201.97,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Aetna,Commercial,LT,691.34,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Aetna,Commercial,RT,691.34,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Aetna,Commercial,LT,663.26,,,,,,,663.26,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Aetna,Commercial,RT,663.26,,,,,,,663.26,2474.47,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3806.00000,1864.94000,Aetna,Commercial,,989.56,,,,,,,989.56,3691.82,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,outpatient,,,2149.00000,694.13000,Aetna,Commercial,,558.74,,,,,,,558.74,2084.53,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,outpatient,,,1973.00000,637.28000,Aetna,Commercial,,512.98,,,,,,,512.98,1913.81,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1784.00000,576.23000,Aetna,Commercial,50,463.84,,,,,,,463.84,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Aetna,Commercial,LT,309.14,,,,,,,309.14,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Aetna,Commercial,RT,309.14,,,,,,,309.14,1153.33,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,outpatient,,,130.00000,69.68000,Aetna,Commercial,,33.80,,,,,,,33.80,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,outpatient,,,44.00000,23.58000,Aetna,Commercial,,11.44,,,,,,,11.44,42.68,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,outpatient,,,456.00000,244.42000,Aetna,Commercial,,118.56,,,,,,,118.56,442.32,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,outpatient,,,108.00000,57.89000,Aetna,Commercial,,28.08,,,,,,,28.08,104.76,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,outpatient,,,306.00000,164.02000,Aetna,Commercial,,79.56,,,,,,,79.56,296.82,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,outpatient,,,257.00000,137.75000,Aetna,Commercial,,66.82,,,,,,,66.82,249.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Aetna,Commercial,,1054.82,,,,,,,1054.82,3935.29,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Aetna,Commercial,,1265.68,,,,,,,1265.68,4721.96,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Aetna,Commercial,,843.70,,,,,,,843.70,3147.65,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Aetna,Commercial,,1054.82,,,,,,,1054.82,3935.29,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Aetna,Commercial,,1265.68,,,,,,,1265.68,4721.96,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Aetna,Commercial,,843.70,,,,,,,843.70,3147.65,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,outpatient,,,1725.00000,865.95000,Aetna,Commercial,,448.50,,,,,,,448.50,1673.25,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,outpatient,,,1743.00000,874.99000,Aetna,Commercial,,453.18,,,,,,,453.18,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Aetna,Commercial,LT,383.50,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Aetna,Commercial,RT,383.50,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,outpatient,,,1162.00000,583.32000,Aetna,Commercial,,302.12,,,,,,,302.12,1127.14,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Aetna,Commercial,LT,255.58,,,,,,,255.58,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Aetna,Commercial,RT,255.58,,,,,,,255.58,953.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,outpatient,,,3183.00000,1597.87000,Aetna,Commercial,,827.58,,,,,,,827.58,3087.51,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,outpatient,,,3819.00000,1917.14000,Aetna,Commercial,,992.94,,,,,,,992.94,3704.43,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,outpatient,,,2546.00000,1278.09000,Aetna,Commercial,,661.96,,,,,,,661.96,2469.62,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Aetna,Commercial,LT,1003.08,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Aetna,Commercial,RT,1003.08,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Aetna,Commercial,LT,1203.54,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Aetna,Commercial,RT,1203.54,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Aetna,Commercial,LT,802.36,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Aetna,Commercial,RT,802.36,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Aetna,Commercial,LT,651.30,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Aetna,Commercial,RT,651.30,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Aetna,Commercial,LT,781.56,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Aetna,Commercial,RT,781.56,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Aetna,Commercial,LT,521.04,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Aetna,Commercial,RT,521.04,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Aetna,Commercial,LT,815.62,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Aetna,Commercial,RT,815.62,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Aetna,Commercial,LT,978.64,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Aetna,Commercial,RT,978.64,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Aetna,Commercial,LT,652.34,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Aetna,Commercial,RT,652.34,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Aetna,Commercial,LT,785.98,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Aetna,Commercial,RT,785.98,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Aetna,Commercial,LT,943.02,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Aetna,Commercial,RT,943.02,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Aetna,Commercial,LT,628.68,,,,,,,628.68,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Aetna,Commercial,RT,628.68,,,,,,,628.68,2345.46,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,outpatient,,,870.00000,436.74000,Aetna,Commercial,,226.20,,,,,,,226.20,843.90,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,outpatient,,,1353.00000,679.21000,Aetna,Commercial,,351.78,,,,,,,351.78,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Aetna,Commercial,LT,234.52,,,,,,,234.52,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Aetna,Commercial,RT,234.52,,,,,,,234.52,874.94,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3489.00000,1751.48000,Aetna,Commercial,,907.14,,,,,,,907.14,3384.33,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,outpatient,,,4187.00000,2101.87000,Aetna,Commercial,,1088.62,,,,,,,1088.62,4061.39,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,outpatient,,,2791.00000,1401.08000,Aetna,Commercial,,725.66,,,,,,,725.66,2707.27,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,outpatient,,,492.00000,246.98000,Aetna,Commercial,,127.92,,,,,,,127.92,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,outpatient,,,331.00000,166.16000,Aetna,Commercial,,86.06,,,,,,,86.06,321.07,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,outpatient,,,4440.00000,2357.64000,Aetna,Commercial,,1154.40,,,,,,,1154.40,4306.80,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,outpatient,,,5328.00000,2829.17000,Aetna,Commercial,,1385.28,,,,,,,1385.28,5168.16,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,outpatient,,,3552.00000,1886.11000,Aetna,Commercial,,923.52,,,,,,,923.52,3445.44,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,outpatient,,,2528.00000,1342.37000,Aetna,Commercial,,657.28,,,,,,,657.28,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,outpatient,,,3033.00000,1610.52000,Aetna,Commercial,,788.58,,,,,,,788.58,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,outpatient,,,2022.00000,1073.68000,Aetna,Commercial,,525.72,,,,,,,525.72,1961.34,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,outpatient,,,3610.00000,1909.69000,Aetna,Commercial,,938.60,,,,,,,938.60,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,outpatient,,,4332.00000,2291.63000,Aetna,Commercial,,1126.32,,,,,,,1126.32,4202.04,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,outpatient,,,2888.00000,1527.75000,Aetna,Commercial,,750.88,,,,,,,750.88,2801.36,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,outpatient,,,4532.00000,2397.43000,Aetna,Commercial,,1178.32,,,,,,,1178.32,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,outpatient,,,5438.00000,2876.70000,Aetna,Commercial,,1413.88,,,,,,,1413.88,5274.86,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,outpatient,,,3625.00000,1917.62000,Aetna,Commercial,,942.50,,,,,,,942.50,3516.25,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,outpatient,,,3639.00000,1925.03000,Aetna,Commercial,,946.14,,,,,,,946.14,3529.83,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,outpatient,,,4367.00000,2310.14000,Aetna,Commercial,,1135.42,,,,,,,1135.42,4235.99,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,outpatient,,,2911.00000,1539.92000,Aetna,Commercial,,756.86,,,,,,,756.86,2823.67,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3494.00000,1719.05000,Aetna,Commercial,,908.44,,,,,,,908.44,3389.18,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,outpatient,,,4193.00000,2062.96000,Aetna,Commercial,,1090.18,,,,,,,1090.18,4067.21,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,outpatient,,,2795.00000,1375.14000,Aetna,Commercial,,726.70,,,,,,,726.70,2711.15,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,outpatient,,,2717.00000,1336.76000,Aetna,Commercial,,706.42,,,,,,,706.42,2635.49,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,outpatient,,,3260.00000,1603.92000,Aetna,Commercial,,847.60,,,,,,,847.60,3162.20,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,outpatient,,,2173.00000,1069.12000,Aetna,Commercial,,564.98,,,,,,,564.98,2107.81,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Aetna,Commercial,LT,1053.26,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Aetna,Commercial,RT,1053.26,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Aetna,Commercial,LT,1263.86,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Aetna,Commercial,RT,1263.86,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Aetna,Commercial,LT,842.66,,,,,,,842.66,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Aetna,Commercial,RT,842.66,,,,,,,842.66,3143.77,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,outpatient,,,4260.00000,2420.32000,Aetna,Commercial,,1107.60,,,,,,,1107.60,4132.20,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,outpatient,,,5112.00000,2904.38000,Aetna,Commercial,,1329.12,,,,,,,1329.12,4958.64,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3408.00000,1936.26000,Aetna,Commercial,,886.08,,,,,,,886.08,3305.76,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3343.00000,1899.33000,Aetna,Commercial,,869.18,,,,,,,869.18,3242.71,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,outpatient,,,4010.00000,2278.28000,Aetna,Commercial,,1042.60,,,,,,,1042.60,3889.70,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,outpatient,,,2674.00000,1519.23000,Aetna,Commercial,,695.24,,,,,,,695.24,2593.78,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Aetna,Commercial,LT,856.44,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Aetna,Commercial,RT,856.44,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Aetna,Commercial,LT,1027.78,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Aetna,Commercial,RT,1027.78,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Aetna,Commercial,LT,685.10,,,,,,,685.10,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Aetna,Commercial,RT,685.10,,,,,,,685.10,2555.95,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3664.00000,2081.70000,Aetna,Commercial,,952.64,,,,,,,952.64,3554.08,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,outpatient,,,4397.00000,2498.16000,Aetna,Commercial,,1143.22,,,,,,,1143.22,4265.09,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,outpatient,,,2931.00000,1665.25000,Aetna,Commercial,,762.06,,,,,,,762.06,2843.07,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,outpatient,,,4759.00000,2703.83000,Aetna,Commercial,,1237.34,,,,,,,1237.34,4616.23,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,outpatient,,,5710.00000,3244.14000,Aetna,Commercial,,1484.60,,,,,,,1484.60,5538.70,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3807.00000,2162.95000,Aetna,Commercial,,989.82,,,,,,,989.82,3692.79,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2915.00000,1574.10000,Aetna,Commercial,,757.90,,,,,,,757.90,2827.55,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1918.00000,1035.72000,Aetna,Commercial,,498.68,,,,,,,498.68,1860.46,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2292.00000,1237.68000,Aetna,Commercial,,595.92,,,,,,,595.92,2223.24,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,outpatient,,,2984.00000,1611.36000,Aetna,Commercial,,775.84,,,,,,,775.84,2894.48,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,outpatient,,,769.00000,415.26000,Aetna,Commercial,,199.94,,,,,,,199.94,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,outpatient,,,1280.00000,691.20000,Aetna,Commercial,,332.80,,,,,,,332.80,1241.60,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,outpatient,,,1878.00000,1014.12000,Aetna,Commercial,,488.28,,,,,,,488.28,1821.66,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,outpatient,,,2196.00000,1185.84000,Aetna,Commercial,,570.96,,,,,,,570.96,2130.12,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,outpatient,,,844.00000,455.76000,Aetna,Commercial,,219.44,,,,,,,219.44,818.68,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,outpatient,,,1305.00000,704.70000,Aetna,Commercial,,339.30,,,,,,,339.30,1265.85,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,outpatient,,,576.00000,311.04000,Aetna,Commercial,,149.76,,,,,,,149.76,558.72,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,outpatient,,,809.00000,436.86000,Aetna,Commercial,,210.34,,,,,,,210.34,784.73,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,outpatient,,,2462.00000,1329.48000,Aetna,Commercial,,640.12,,,,,,,640.12,2388.14,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,outpatient,,,918.00000,495.72000,Aetna,Commercial,,238.68,,,,,,,238.68,890.46,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,outpatient,,,1102.00000,595.08000,Aetna,Commercial,,286.52,,,,,,,286.52,1068.94,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,outpatient,,,812.00000,438.48000,Aetna,Commercial,,211.12,,,,,,,211.12,787.64,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,outpatient,,,1407.00000,759.78000,Aetna,Commercial,,365.82,,,,,,,365.82,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,outpatient,,,1980.00000,1069.20000,Aetna,Commercial,,514.80,,,,,,,514.80,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,outpatient,,,964.00000,520.56000,Aetna,Commercial,,250.64,,,,,,,250.64,935.08,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,outpatient,,,1040.00000,561.60000,Aetna,Commercial,,270.40,,,,,,,270.40,1008.80,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,outpatient,,,795.00000,429.30000,Aetna,Commercial,,206.70,,,,,,,206.70,771.15,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,outpatient,,,1124.00000,606.96000,Aetna,Commercial,,292.24,,,,,,,292.24,1090.28,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,outpatient,,,736.00000,397.44000,Aetna,Commercial,,191.36,,,,,,,191.36,713.92,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,outpatient,,,700.00000,378.00000,Aetna,Commercial,,182.00,,,,,,,182.00,679.00,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,outpatient,,,821.00000,443.34000,Aetna,Commercial,,213.46,,,,,,,213.46,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,outpatient,,,846.00000,456.84000,Aetna,Commercial,,219.96,,,,,,,219.96,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,outpatient,,,958.00000,517.32000,Aetna,Commercial,,249.08,,,,,,,249.08,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,outpatient,,,1261.00000,680.94000,Aetna,Commercial,,327.86,,,,,,,327.86,1223.17,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,outpatient,,,971.00000,524.34000,Aetna,Commercial,,252.46,,,,,,,252.46,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,outpatient,,,1837.00000,991.98000,Aetna,Commercial,,477.62,,,,,,,477.62,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,outpatient,,,1099.00000,593.46000,Aetna,Commercial,,285.74,,,,,,,285.74,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,outpatient,,,2178.00000,1176.12000,Aetna,Commercial,,566.28,,,,,,,566.28,2112.66,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,outpatient,,,1226.00000,662.04000,Aetna,Commercial,,318.76,,,,,,,318.76,1189.22,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,outpatient,,,1048.00000,565.92000,Aetna,Commercial,,272.48,,,,,,,272.48,1016.56,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,outpatient,,,970.00000,523.80000,Aetna,Commercial,,252.20,,,,,,,252.20,940.90,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,outpatient,,,1803.00000,973.62000,Aetna,Commercial,,468.78,,,,,,,468.78,1748.91,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,outpatient,,,2504.00000,1352.16000,Aetna,Commercial,,651.04,,,,,,,651.04,2428.88,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2457.00000,1326.78000,Aetna,Commercial,,638.82,,,,,,,638.82,2383.29,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,outpatient,,,923.00000,498.42000,Aetna,Commercial,,239.98,,,,,,,239.98,895.31,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,outpatient,,,5478.00000,2958.12000,Aetna,Commercial,,1424.28,,,,,,,1424.28,5313.66,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,outpatient,,,4551.00000,2457.54000,Aetna,Commercial,,1183.26,,,,,,,1183.26,4414.47,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,outpatient,,,1360.00000,734.40000,Aetna,Commercial,,353.60,,,,,,,353.60,1319.20,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,outpatient,,,1209.00000,652.86000,Aetna,Commercial,,314.34,,,,,,,314.34,1172.73,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,outpatient,,,848.00000,457.92000,Aetna,Commercial,,220.48,,,,,,,220.48,822.56,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,outpatient,,,1071.00000,578.34000,Aetna,Commercial,,278.46,,,,,,,278.46,1038.87,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,outpatient,,,1792.00000,967.68000,Aetna,Commercial,,465.92,,,,,,,465.92,1738.24,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,outpatient,,,35.00000,18.90000,Aetna,Commercial,,9.10,,,,,,,9.10,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,outpatient,,,285.00000,153.90000,Aetna,Commercial,,74.10,,,,,,,74.10,276.45,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,outpatient,,,1012.00000,546.48000,Aetna,Commercial,,263.12,,,,,,,263.12,981.64,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,outpatient,,,492.00000,265.68000,Aetna,Commercial,,127.92,,,,,,,127.92,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,outpatient,,,739.00000,399.06000,Aetna,Commercial,,192.14,,,,,,,192.14,716.83,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,outpatient,,,515.00000,278.10000,Aetna,Commercial,,133.90,,,,,,,133.90,499.55,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,outpatient,,,1467.00000,792.18000,Aetna,Commercial,,381.42,,,,,,,381.42,1422.99,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,outpatient,,,1683.00000,888.62000,Aetna,Commercial,,437.58,,,,,,,437.58,1632.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,426.30000,225.09000,Aetna,Commercial,,110.84,,,,,,,110.84,413.51,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,725.00000,382.80000,Aetna,Commercial,,188.50,,,,,,,188.50,1855.42,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,1852.00000,977.86000,Aetna,Commercial,,481.52,,,,,,,481.52,1868.26,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,110.00000,58.08000,Aetna,Commercial,,28.60,,,,,,,28.60,106.70,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,98.00000,51.74000,Aetna,Commercial,,25.48,,,,,,,25.48,1662.92,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,2018.00000,1065.50000,Aetna,Commercial,,524.68,,,,,,,524.68,1957.46,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,4325.00000,2283.60000,Aetna,Commercial,,1124.50,,,,,,,1124.50,4195.25,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Aetna,Commercial,,44.72,,,,,,,44.72,166.84,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,942.00000,497.38000,Aetna,Commercial,,244.92,,,,,,,244.92,913.74,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,413.00000,218.06000,Aetna,Commercial,,107.38,,,,,,,107.38,400.61,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,outpatient,,,257.00000,135.70000,Aetna,Commercial,,66.82,,,,,,,66.82,249.29,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,116.00000,61.25000,Aetna,Commercial,,30.16,,,,,,,30.16,112.52,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,463.20000,244.57000,Aetna,Commercial,,120.43,,,,,,,120.43,449.30,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,804.00000,424.51000,Aetna,Commercial,,209.04,,,,,,,209.04,779.88,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Aetna,Commercial,,44.72,,,,,,,44.72,166.84,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,354.30000,187.07000,Aetna,Commercial,,92.12,,,,,,,92.12,343.67,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,277.90000,146.73000,Aetna,Commercial,,72.25,,,,,,,72.25,269.56,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,200.00000,105.60000,Aetna,Commercial,,52.00,,,,,,,52.00,194.00,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,outpatient,,,197.00000,63.63000,Aetna,Commercial,,51.22,,,,,,,51.22,191.09,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,outpatient,,,468.00000,151.16000,Aetna,Commercial,50,121.68,,,,,,,121.68,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Aetna,Commercial,LT,81.12,,,,,,,81.12,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Aetna,Commercial,RT,81.12,,,,,,,81.12,302.64,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Aetna,Commercial,,117.78,,,,,,,117.78,439.41,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Aetna,Commercial,,158.34,,,,,,,158.34,590.73,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1248.00000,403.10000,Aetna,Commercial,50,324.48,,,,,,,324.48,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Aetna,Commercial,LT,216.32,,,,,,,216.32,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Aetna,Commercial,RT,216.32,,,,,,,216.32,807.04,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Aetna,Commercial,LT,1101.10,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Aetna,Commercial,RT,1101.10,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,outpatient,,,2119.00000,684.44000,Aetna,Commercial,,550.94,,,,,,,550.94,2055.43,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1943.00000,627.59000,Aetna,Commercial,,505.18,,,,,,,505.18,1884.71,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,outpatient,,,1426.00000,460.60000,Aetna,Commercial,,370.76,,,,,,,370.76,1383.22,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,outpatient,,,4202.00000,1357.25000,Aetna,Commercial,50,1092.52,,,,,,,1092.52,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Aetna,Commercial,LT,728.26,,,,,,,728.26,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Aetna,Commercial,RT,728.26,,,,,,,728.26,2716.97,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,outpatient,,,832.00000,268.74000,Aetna,Commercial,,216.32,,,,,,,216.32,807.04,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,outpatient,,,1457.00000,470.61000,Aetna,Commercial,,378.82,,,,,,,378.82,1413.29,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Aetna,Commercial,LT,193.18,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Aetna,Commercial,RT,193.18,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,outpatient,,,232.00000,74.94000,Aetna,Commercial,,60.32,,,,,,,60.32,225.04,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,outpatient,,,1364.00000,440.57000,Aetna,Commercial,50,354.64,,,,,,,354.64,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Aetna,Commercial,LT,236.34,,,,,,,236.34,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Aetna,Commercial,RT,236.34,,,,,,,236.34,881.73,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,outpatient,,,510.00000,355.98000,Aetna,Commercial,,132.60,,,,,,,132.60,494.70,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,outpatient,,,1001.00000,698.70000,Aetna,Commercial,,260.26,,,,,,,260.26,970.97,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,outpatient,,,887.00000,619.13000,Aetna,Commercial,,230.62,,,,,,,230.62,860.39,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,outpatient,,,1022.00000,713.36000,Aetna,Commercial,50,265.72,,,,,,,265.72,991.34,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Aetna,Commercial,LT,177.06,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Aetna,Commercial,RT,177.06,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,outpatient,,,945.00000,659.61000,Aetna,Commercial,50,245.70,,,,,,,245.70,916.65,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Aetna,Commercial,LT,163.80,,,,,,,163.80,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Aetna,Commercial,RT,163.80,,,,,,,163.80,611.10,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,outpatient,,,577.00000,402.75000,Aetna,Commercial,,150.02,,,,,,,150.02,559.69,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,outpatient,,,433.00000,302.23000,Aetna,Commercial,,112.58,,,,,,,112.58,420.01,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,outpatient,,,331.00000,231.04000,Aetna,Commercial,,86.06,,,,,,,86.06,321.07,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,outpatient,,,662.00000,462.08000,Aetna,Commercial,,172.12,,,,,,,172.12,642.14,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,outpatient,,,752.00000,524.90000,Aetna,Commercial,,195.52,,,,,,,195.52,729.44,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Aetna,Commercial,,47.32,,,,,,,47.32,176.54,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,outpatient,,,420.00000,293.16000,Aetna,Commercial,,109.20,,,,,,,109.20,407.40,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,outpatient,,,253.00000,176.59000,Aetna,Commercial,,65.78,,,,,,,65.78,245.41,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,outpatient,,,168.00000,117.26000,Aetna,Commercial,,43.68,,,,,,,43.68,162.96,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,outpatient,,,695.00000,485.11000,Aetna,Commercial,,180.70,,,,,,,180.70,674.15,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,outpatient,,,474.00000,330.85000,Aetna,Commercial,,123.24,,,,,,,123.24,459.78,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,outpatient,,,930.00000,649.14000,Aetna,Commercial,,241.80,,,,,,,241.80,902.10,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,outpatient,,,786.00000,548.63000,Aetna,Commercial,,204.36,,,,,,,204.36,762.42,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Aetna,Commercial,,161.20,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Aetna,Commercial,59,161.20,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Aetna,Commercial,,113.10,,,,,,,113.10,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Aetna,Commercial,59,113.10,,,,,,,113.10,421.95,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,outpatient,,,492.00000,343.42000,Aetna,Commercial,,127.92,,,,,,,127.92,477.24,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,outpatient,,,331.00000,231.04000,Aetna,Commercial,,86.06,,,,,,,86.06,321.07,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,outpatient,,,875.00000,610.75000,Aetna,Commercial,,227.50,,,,,,,227.50,848.75,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,outpatient,,,688.00000,480.22000,Aetna,Commercial,,178.88,,,,,,,178.88,667.36,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,outpatient,,,465.00000,324.57000,Aetna,Commercial,,120.90,,,,,,,120.90,451.05,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,outpatient,,,846.00000,590.51000,Aetna,Commercial,,219.96,,,,,,,219.96,820.62,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,outpatient,,,482.00000,336.44000,Aetna,Commercial,,125.32,,,,,,,125.32,467.54,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,outpatient,,,926.00000,646.35000,Aetna,Commercial,,240.76,,,,,,,240.76,898.22,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,outpatient,,,292.00000,203.82000,Aetna,Commercial,,75.92,,,,,,,75.92,283.24,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,outpatient,,,827.00000,577.25000,Aetna,Commercial,,215.02,,,,,,,215.02,802.19,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,outpatient,,,253.00000,176.59000,Aetna,Commercial,,65.78,,,,,,,65.78,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,outpatient,,,901.00000,628.90000,Aetna,Commercial,,234.26,,,,,,,234.26,873.97,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,outpatient,,,460.00000,321.08000,Aetna,Commercial,,119.60,,,,,,,119.60,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1029.00000,718.24000,Aetna,Commercial,,267.54,,,,,,,267.54,998.13,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,outpatient,,,959.00000,669.38000,Aetna,Commercial,,249.34,,,,,,,249.34,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,outpatient,,,558.00000,389.48000,Aetna,Commercial,,145.08,,,,,,,145.08,541.26,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,outpatient,,,705.00000,492.09000,Aetna,Commercial,,183.30,,,,,,,183.30,683.85,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,outpatient,,,249.00000,173.80000,Aetna,Commercial,,64.74,,,,,,,64.74,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,outpatient,,,427.00000,298.05000,Aetna,Commercial,,111.02,,,,,,,111.02,414.19,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Aetna,Commercial,,191.62,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Aetna,Commercial,59,191.62,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,outpatient,,,809.00000,564.68000,Aetna,Commercial,,210.34,,,,,,,210.34,784.73,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,outpatient,,,525.00000,366.45000,Aetna,Commercial,,136.50,,,,,,,136.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,outpatient,,,319.00000,222.66000,Aetna,Commercial,,82.94,,,,,,,82.94,309.43,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1437.00000,678.26000,Aetna,Commercial,,373.62,,,,,,,373.62,1393.89,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2143.00000,1011.50000,Aetna,Commercial,,557.18,,,,,,,557.18,2078.71,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,outpatient,,,755.00000,356.36000,Aetna,Commercial,,196.30,,,,,,,196.30,732.35,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,outpatient,,,979.00000,462.09000,Aetna,Commercial,,254.54,,,,,,,254.54,949.63,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,outpatient,,,436.00000,205.79000,Aetna,Commercial,,113.36,,,,,,,113.36,422.92,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,outpatient,,,220.00000,103.84000,Aetna,Commercial,,57.20,,,,,,,57.20,213.40,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,outpatient,,,344.00000,162.37000,Aetna,Commercial,,89.44,,,,,,,89.44,333.68,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,outpatient,,,818.00000,393.46000,Aetna,Commercial,,212.68,,,,,,,212.68,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,outpatient,,,545.00000,262.14000,Aetna,Commercial,52,141.70,,,,,,,141.70,528.65,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,outpatient,,,1347.00000,647.91000,Aetna,Commercial,,350.22,,,,,,,350.22,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,outpatient,,,898.00000,431.94000,Aetna,Commercial,52,233.48,,,,,,,233.48,871.06,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,outpatient,,,469.00000,225.59000,Aetna,Commercial,,121.94,,,,,,,121.94,454.93,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,outpatient,,,1762.00000,847.52000,Aetna,Commercial,,458.12,,,,,,,458.12,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,outpatient,,,627.00000,301.59000,Aetna,Commercial,,163.02,,,,,,,163.02,608.19,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,outpatient,,,590.00000,283.79000,Aetna,Commercial,,153.40,,,,,,,153.40,572.30,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,outpatient,,,1550.00000,745.55000,Aetna,Commercial,,403.00,,,,,,,403.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Aetna,Commercial,LT,257.40,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Aetna,Commercial,RT,257.40,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,outpatient,,,1402.00000,674.36000,Aetna,Commercial,,364.52,,,,,,,364.52,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Aetna,Commercial,LT,254.80,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Aetna,Commercial,RT,254.80,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,outpatient,,,1661.00000,798.94000,Aetna,Commercial,,431.86,,,,,,,431.86,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,outpatient,,,980.00000,471.38000,Aetna,Commercial,,254.80,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1740.00000,836.94000,Aetna,Commercial,,452.40,,,,,,,452.40,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1168.00000,561.81000,Aetna,Commercial,,303.68,,,,,,,303.68,1132.96,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,outpatient,,,433.00000,232.09000,Aetna,Commercial,,112.58,,,,,,,112.58,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Aetna,Commercial,LT,100.88,,,,,,,100.88,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Aetna,Commercial,RT,100.88,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,outpatient,,,388.00000,207.97000,Aetna,Commercial,,100.88,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,outpatient,,,604.00000,323.74000,Aetna,Commercial,,157.04,,,,,,,157.04,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,outpatient,,,667.00000,357.51000,Aetna,Commercial,,173.42,,,,,,,173.42,646.99,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,outpatient,,,176.00000,94.34000,Aetna,Commercial,,45.76,,,,,,,45.76,170.72,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Aetna,Commercial,LT,23.92,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Aetna,Commercial,RT,23.92,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Aetna,Commercial,LT,95.16,,,,,,,95.16,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Aetna,Commercial,RT,95.16,,,,,,,95.16,355.02,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Aetna,Commercial,LT,290.42,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Aetna,Commercial,RT,290.42,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,outpatient,,,559.00000,180.56000,Aetna,Commercial,,145.34,,,,,,,145.34,542.23,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,outpatient,,,252.00000,81.40000,Aetna,Commercial,50,65.52,,,,,,,65.52,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Aetna,Commercial,LT,43.68,,,,,,,43.68,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Aetna,Commercial,RT,43.68,,,,,,,43.68,162.96,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Aetna,Commercial,LT,298.48,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Aetna,Commercial,RT,298.48,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,outpatient,,,379.00000,122.42000,Aetna,Commercial,,98.54,,,,,,,98.54,367.63,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,outpatient,,,1015.00000,327.84000,Aetna,Commercial,,263.90,,,,,,,263.90,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,outpatient,,,591.00000,190.89000,Aetna,Commercial,,153.66,,,,,,,153.66,573.27,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,outpatient,,,271.00000,169.92000,Aetna,Commercial,,70.46,,,,,,,70.46,262.87,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Aetna,Commercial,LT,54.86,,,,,,,54.86,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Aetna,Commercial,RT,54.86,,,,,,,54.86,204.67,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,59.00000,36.99000,Aetna,Commercial,,15.34,,,,,,,15.34,57.23,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,outpatient,,,336.00000,219.74000,Aetna,Commercial,,87.36,,,,,,,87.36,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,outpatient,,,224.00000,146.50000,Aetna,Commercial,52,58.24,,,,,,,58.24,217.28,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,outpatient,,,63.00000,41.20000,Aetna,Commercial,,16.38,,,,,,,16.38,61.11,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Aetna,Commercial,,131.04,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Aetna,Commercial,,25.48,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Aetna,Commercial,,158.08,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Aetna,Commercial,,29.64,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Aetna,Commercial,,48.62,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Aetna,Commercial,,55.64,,,,,,,55.64,207.58,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Aetna,Commercial,,158.34,,,,,,,158.34,590.73,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Aetna,Commercial,,224.38,,,,,,,224.38,837.11,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,outpatient,,,900.00000,605.70000,Aetna,Commercial,,234.00,,,,,,,234.00,873.00,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,outpatient,,,1940.00000,1102.21000,Aetna,Commercial,,504.40,,,,,,,504.40,1881.80,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,outpatient,,,422.00000,239.76000,Aetna,Commercial,,109.72,,,,,,,109.72,409.34,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,outpatient,,,1430.00000,812.45000,Aetna,Commercial,,371.80,,,,,,,371.80,1387.10,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,outpatient,,,745.00000,423.27000,Aetna,Commercial,,193.70,,,,,,,193.70,722.65,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,outpatient,,,2655.00000,2487.74000,Aetna,Commercial,,690.30,,,,,,,690.30,2575.35,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,outpatient,,,3990.00000,3738.63000,Aetna,Commercial,,1037.40,,,,,,,1037.40,3870.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,outpatient,,,290.00000,271.73000,Aetna,Commercial,,75.40,,,,,,,75.40,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,outpatient,,,735.00000,688.70000,Aetna,Commercial,,191.10,,,,,,,191.10,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Aetna,Commercial,,383.50,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,outpatient,,,2275.00000,2131.68000,Aetna,Commercial,,591.50,,,,,,,591.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,outpatient,,,3205.00000,3003.08000,Aetna,Commercial,,833.30,,,,,,,833.30,3108.85,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,outpatient,,,770.00000,721.49000,Aetna,Commercial,,200.20,,,,,,,200.20,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Aetna,Commercial,,383.50,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,outpatient,,,2210.00000,2070.77000,Aetna,Commercial,,574.60,,,,,,,574.60,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,outpatient,,,2660.00000,2492.42000,Aetna,Commercial,,691.60,,,,,,,691.60,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,outpatient,,,3560.00000,3335.72000,Aetna,Commercial,,925.60,,,,,,,925.60,3453.20,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,outpatient,,,5730.00000,3255.50000,Aetna,Commercial,,1489.80,,,,,,,1489.80,5558.10,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,outpatient,,,3875.00000,2201.58000,Aetna,Commercial,,1007.50,,,,,,,1007.50,3758.75,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,outpatient,,,519.00000,564.15000,Aetna,Commercial,,134.94,,,,,,,134.94,503.43,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,outpatient,,,536.00000,582.63000,Aetna,Commercial,,139.36,,,,,,,139.36,519.92,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Aetna,Commercial,,117.78,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Aetna,Commercial,,37.44,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Aetna,Commercial,,27.82,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Aetna,Commercial,,37.44,,,,,,,37.44,139.68,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Aetna,Commercial,,131.04,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Aetna,Commercial,,25.48,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Aetna,Commercial,,158.08,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Aetna,Commercial,,29.64,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Aetna,Commercial,,48.62,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Aetna,Commercial,,55.64,,,,,,,55.64,207.58,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,outpatient,,,175.00000,63.18000,Aetna,Commercial,,45.50,,,,,,,45.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,outpatient,,,304.00000,109.74000,Aetna,Commercial,,79.04,,,,,,,79.04,294.88,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Aetna,Commercial,,73.84,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Aetna,Commercial,,119.08,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,outpatient,,,438.00000,158.12000,Aetna,Commercial,,113.88,,,,,,,113.88,424.86,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Aetna,Commercial,,145.08,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Aetna,Commercial,,125.32,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Aetna,Commercial,,61.62,,,,,,,61.62,229.89,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Aetna,Commercial,,131.04,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Aetna,Commercial,,131.04,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Aetna,Commercial,,131.04,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Aetna,Commercial,,131.04,,,,,,,131.04,488.88,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Aetna,Commercial,,218.92,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Aetna,Commercial,,273.78,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Aetna,Commercial,,328.38,,,,,,,328.38,1225.11,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Aetna,Commercial,,47.32,,,,,,,47.32,176.54,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Aetna,Commercial,,54.60,,,,,,,54.60,203.70,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,outpatient,,,140.00000,79.54000,Aetna,Commercial,,36.40,,,,,,,36.40,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,outpatient,,,190.00000,107.95000,Aetna,Commercial,,49.40,,,,,,,49.40,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,outpatient,,,240.00000,136.36000,Aetna,Commercial,,62.40,,,,,,,62.40,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,outpatient,,,290.00000,164.76000,Aetna,Commercial,,75.40,,,,,,,75.40,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,outpatient,,,340.00000,193.17000,Aetna,Commercial,,88.40,,,,,,,88.40,329.80,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,outpatient,,,150.00000,85.22000,Aetna,Commercial,,39.00,,,,,,,39.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,outpatient,,,200.00000,113.63000,Aetna,Commercial,,52.00,,,,,,,52.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,outpatient,,,270.00000,153.40000,Aetna,Commercial,,70.20,,,,,,,70.20,261.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,outpatient,,,370.00000,210.22000,Aetna,Commercial,,96.20,,,,,,,96.20,358.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,outpatient,,,470.00000,267.03000,Aetna,Commercial,,122.20,,,,,,,122.20,455.90,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,outpatient,,,248.00000,96.22000,Aetna,Commercial,,64.48,,,,,,,64.48,240.56,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,outpatient,,,245.00000,95.06000,Aetna,Commercial,,63.70,,,,,,,63.70,237.65,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,outpatient,,,497.00000,192.84000,Aetna,Commercial,,129.22,,,,,,,129.22,482.09,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,outpatient,,,357.00000,138.52000,Aetna,Commercial,,92.82,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,outpatient,,,334.00000,129.59000,Aetna,Commercial,,86.84,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,outpatient,,,194.00000,75.27000,Aetna,Commercial,,50.44,,,,,,,50.44,188.18,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,outpatient,,,1035.00000,401.58000,Aetna,Commercial,,269.10,,,,,,,269.10,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,outpatient,,,1137.00000,441.16000,Aetna,Commercial,,295.62,,,,,,,295.62,1102.89,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,outpatient,,,963.00000,373.64000,Aetna,Commercial,,250.38,,,,,,,250.38,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,outpatient,,,990.00000,384.12000,Aetna,Commercial,,257.40,,,,,,,257.40,960.30,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,outpatient,,,112.00000,43.46000,Aetna,Commercial,,29.12,,,,,,,29.12,108.64,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,outpatient,,,84.00000,32.59000,Aetna,Commercial,,21.84,,,,,,,21.84,81.48,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,outpatient,,,176.00000,68.29000,Aetna,Commercial,,45.76,,,,,,,45.76,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,outpatient,,,283.00000,109.80000,Aetna,Commercial,,73.58,,,,,,,73.58,274.51,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Aetna,Commercial,,21.06,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Aetna,Commercial,,10.66,,,,,,,10.66,39.77,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,35.00000,19.89000,Aetna,Commercial,,9.10,,,,,,,9.10,33.95,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,outpatient,,,191.00000,89.39000,Aetna,Commercial,,49.66,,,,,,,49.66,185.27,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Aetna,Commercial,,117.78,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Aetna,Commercial,,37.44,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Aetna,Commercial,,27.82,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Aetna,Commercial,,37.44,,,,,,,37.44,139.68,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,outpatient,,,281.00000,131.51000,Aetna,Commercial,,73.06,,,,,,,73.06,272.57,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,outpatient,,,192.00000,89.86000,Aetna,Commercial,,49.92,,,,,,,49.92,186.24,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,outpatient,,,365.00000,170.82000,Aetna,Commercial,,94.90,,,,,,,94.90,354.05,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,outpatient,,,8391.00000,5856.92000,Aetna,Commercial,,2181.66,,,,,,,2181.66,8139.27,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Aetna,Commercial,52,1798.42,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Aetna,Commercial,,1560.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Aetna,Commercial,,1798.42,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Aetna,Commercial,52,1560.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,outpatient,,,8855.00000,9625.38000,Aetna,Commercial,,2302.30,,,,,,,2302.30,8589.35,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Aetna,Commercial,,219.44,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Aetna,Commercial,52,219.44,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Aetna,Commercial,,204.10,,,,,,,204.10,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Aetna,Commercial,52,204.10,,,,,,,204.10,761.45,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Aetna,Commercial,,1224.34,,,,,,,1224.34,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Aetna,Commercial,52,1224.34,,,,,,,1224.34,4567.73,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,outpatient,,,345.00000,128.34000,Aetna,Commercial,,89.70,,,,,,,89.70,334.65,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,outpatient,,,120.00000,99.60000,Aetna,Commercial,,31.20,,,,,,,31.20,116.40,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,outpatient,,,106.00000,87.98000,Aetna,Commercial,,27.56,,,,,,,27.56,102.82,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,outpatient,,,32.00000,26.56000,Aetna,Commercial,,8.32,,,,,,,8.32,31.04,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,outpatient,,,60.00000,49.80000,Aetna,Commercial,,15.60,,,,,,,15.60,58.20,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,outpatient,,,57.00000,47.31000,Aetna,Commercial,,14.82,,,,,,,14.82,55.29,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,outpatient,1.0,ME,7.40000,0.65000,Aetna,Commercial,,1.92,,,,,,,1.92,7.18,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,outpatient,1.0,EA,6.60000,1.43000,Aetna,Commercial,UD,1.72,,,,,,,1.72,6.40,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,outpatient,1.0,EA,2.95000,0.64000,Aetna,Commercial,UD,0.76700,,,,,,,0.76700,2.86,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,56.08000,12.11000,Aetna,Commercial,UD,14.58,,,,,,,14.58,54.40,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,outpatient,1.0,UN,82.10000,28.90000,Aetna,Commercial,,21.35,,,,,,,15.48,79.64,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.04000,,Aetna,Commercial,UD,0.01040,,,,,,,0.01040,0.03880,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.05000,,Aetna,Commercial,UD,0.01300,,,,,,,0.01300,0.04850,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,outpatient,1.0,ME,6.20000,0.55000,Aetna,Commercial,,1.61,,,,,,,1.61,6.01,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.12000,0.01000,Aetna,Commercial,UD,0.03120,,,,,,,0.03120,0.11640,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,outpatient,2.0,ML,5.80000,1.25000,Aetna,Commercial,,1.51,,,,,,,1.51,5.63,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,outpatient,1.0,ME,3.10000,0.27000,Aetna,Commercial,,0.80600,,,,,,,0.80600,3.01,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,outpatient,1.0,EA,44.40000,3.91000,Aetna,Commercial,,11.54,,,,,,,11.54,43.07,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,8.26000,0.73000,Aetna,Commercial,UD,2.15,,,,,,,2.15,8.01,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,2.19000,0.19000,Aetna,Commercial,UD,0.56940,,,,,,,0.56940,2.12,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,outpatient,1.0,EA,28.60000,2.52000,Aetna,Commercial,,7.44,,,,,,,7.44,27.74,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,outpatient,1.0,EA,2.58000,0.91000,Aetna,Commercial,UD,0.67080,,,,,,,0.67080,2.50,percent of total billed charges,
R&B OBSTETRICS PVT,3012,CDM,112,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2558.52,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,23010,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2558.52,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ICU,33019,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8060.12,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,13011,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5373.72,,,,,,,2512.00,5665.77,percent of total billed charges,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,244.00000,77.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,224.48,,,,,,,219.60,236.68,percent of total billed charges,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,244.00000,77.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,224.48,,,,,,,63.44,236.68,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,24075,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2558.52,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B OBSTETRICS SEMI-PVT,44073,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2558.52,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B NURSERY LEVEL 1,55160,CDM,171,RC,,,,,facility,inpatient,,,3477.00000,1975.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3198.84,,,,,,,2512.00,3372.69,percent of total billed charges,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,inpatient,,,16.00000,7.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14.72,,,,,,,14.40,15.52,percent of total billed charges,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,outpatient,,,16.00000,7.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14.72,,,,,,,4.16,15.52,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,inpatient,,,210.00000,119.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,193.20,,,,,,,189.00,203.70,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,193.20,,,,,,,54.60,203.70,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,inpatient,,,380.00000,215.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,349.60,,,,,,,342.00,368.60,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,outpatient,,,380.00000,215.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,349.60,,,,,,,98.80,368.60,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,106.72,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,106.72,,,,,,,30.16,112.52,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22012,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2558.52,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ADMIN DAY SKILLED,82016,CDM,160,RC,,,,,facility,inpatient,,,1923.00000,1092.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1769.16,,,,,,,1730.70,3111.10,percent of total billed charges,
R&B SWING BED SKILLED,62018,CDM,160,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2558.52,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ADMIN DAY INTERMEDIATE,72017,CDM,169,RC,,,,,facility,inpatient,,,1176.00000,668.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1081.92,,,,,,,1058.40,3111.10,percent of total billed charges,
R&B ICU,32011,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8060.12,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,12013,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5373.72,,,,,,,2512.00,5665.77,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,106.72,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,106.72,,,,,,,30.16,112.52,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,463.68,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,463.68,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,559.36,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,559.36,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,196.88,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,196.88,,,,,,,55.64,207.58,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,84.00000,63.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,77.28,,,,,,,75.60,81.48,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,77.28,,,,,,,21.84,81.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,261.28,,,,,,,255.60,275.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,261.28,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,421.36,,,,,,,412.20,444.26,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,421.36,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,513.36,,,,,,,502.20,541.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,513.36,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,443.44,,,,,,,433.80,467.54,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,443.44,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,218.04,,,,,,,213.30,229.89,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,218.04,,,,,,,61.62,229.89,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,inpatient,,,2041.00000,659.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1877.72,,,,,,,1836.90,1979.77,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,outpatient,,,2041.00000,659.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1877.72,,,,,,,530.66,1979.77,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,inpatient,,,259.00000,83.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,238.28,,,,,,,233.10,251.23,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,outpatient,,,259.00000,83.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,238.28,,,,,,,67.34,251.23,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,inpatient,,,672.00000,217.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,618.24,,,,,,,604.80,651.84,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,outpatient,,,672.00000,217.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,618.24,,,,,,,174.72,651.84,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,inpatient,,,530.00000,171.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,487.60,,,,,,,477.00,514.10,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,outpatient,,,530.00000,171.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,487.60,,,,,,,137.80,514.10,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,inpatient,,,580.00000,187.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,533.60,,,,,,,522.00,562.60,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,outpatient,,,580.00000,187.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,533.60,,,,,,,150.80,562.60,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,inpatient,,,435.00000,140.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,400.20,,,,,,,391.50,421.95,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,outpatient,,,435.00000,140.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,400.20,,,,,,,113.10,421.95,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,inpatient,,,863.00000,278.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,793.96,,,,,,,776.70,837.11,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,793.96,,,,,,,224.38,837.11,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,inpatient,,,334.00000,107.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,307.28,,,,,,,300.60,323.98,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,outpatient,,,334.00000,107.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,307.28,,,,,,,86.84,323.98,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,inpatient,,,1188.00000,383.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,1092.96,,,,,,,1069.20,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,outpatient,,,1188.00000,383.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,1092.96,,,,,,,308.88,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,inpatient,,,792.00000,255.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,728.64,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,728.64,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,inpatient,,,792.00000,255.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,728.64,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,728.64,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,inpatient,,,572.00000,184.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,526.24,,,,,,,514.80,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,outpatient,,,572.00000,184.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,526.24,,,,,,,148.72,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,inpatient,,,381.00000,123.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,350.52,,,,,,,342.90,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,350.52,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,inpatient,,,381.00000,123.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,350.52,,,,,,,342.90,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,350.52,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,inpatient,,,455.00000,146.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,418.60,,,,,,,409.50,441.35,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,outpatient,,,455.00000,146.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,418.60,,,,,,,118.30,441.35,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,inpatient,,,403.00000,130.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,370.76,,,,,,,362.70,390.91,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,outpatient,,,403.00000,130.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,370.76,,,,,,,104.78,390.91,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,inpatient,,,370.00000,119.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,340.40,,,,,,,333.00,358.90,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,outpatient,,,370.00000,119.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,340.40,,,,,,,96.20,358.90,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,inpatient,,,357.00000,115.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,328.44,,,,,,,321.30,346.29,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,outpatient,,,357.00000,115.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,328.44,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,inpatient,,,334.00000,107.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,307.28,,,,,,,300.60,323.98,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,outpatient,,,334.00000,107.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,307.28,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,inpatient,,,194.00000,62.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,178.48,,,,,,,174.60,188.18,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,outpatient,,,194.00000,62.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,178.48,,,,,,,50.44,188.18,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,inpatient,,,457.00000,147.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,420.44,,,,,,,411.30,443.29,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,outpatient,,,457.00000,147.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,420.44,,,,,,,118.82,443.29,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,inpatient,,,492.00000,158.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,452.64,,,,,,,442.80,477.24,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,outpatient,,,492.00000,158.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,452.64,,,,,,,127.92,477.24,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,inpatient,,,780.00000,251.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,717.60,,,,,,,702.00,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,outpatient,,,780.00000,251.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,717.60,,,,,,,202.80,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,inpatient,,,1165.00000,376.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1071.80,,,,,,,1048.50,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,outpatient,,,1165.00000,376.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1071.80,,,,,,,302.90,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,inpatient,,,2350.00000,759.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2162.00,,,,,,,2115.00,2279.50,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,outpatient,,,2350.00000,759.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2162.00,,,,,,,611.00,2279.50,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,inpatient,,,896.00000,289.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,824.32,,,,,,,806.40,869.12,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,outpatient,,,896.00000,289.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,824.32,,,,,,,232.96,869.12,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,inpatient,,,490.00000,158.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,450.80,,,,,,,441.00,475.30,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,outpatient,,,490.00000,158.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,450.80,,,,,,,127.40,475.30,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,inpatient,,,520.00000,167.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,478.40,,,,,,,468.00,504.40,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,outpatient,,,520.00000,167.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,478.40,,,,,,,135.20,504.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,inpatient,,,720.00000,232.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,662.40,,,,,,,648.00,698.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,outpatient,,,720.00000,232.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,662.40,,,,,,,187.20,698.40,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,inpatient,,,215.00000,69.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,197.80,,,,,,,193.50,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,outpatient,,,215.00000,69.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,197.80,,,,,,,55.90,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,inpatient,,,240.00000,77.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,220.80,,,,,,,216.00,232.80,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,outpatient,,,240.00000,77.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,220.80,,,,,,,62.40,232.80,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,inpatient,,,1241.00000,400.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1141.72,,,,,,,1116.90,1203.77,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,outpatient,,,1241.00000,400.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1141.72,,,,,,,322.66,1203.77,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,774.64,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,774.64,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,968.76,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,968.76,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1161.96,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1161.96,,,,,,,328.38,1225.11,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,inpatient,,,668.00000,559.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,614.56,,,,,,,601.20,647.96,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,outpatient,,,668.00000,559.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,614.56,,,,,,,173.68,647.96,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,72.90,78.57,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,37.72,,,,,,,36.90,39.77,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,37.72,,,,,,,10.66,39.77,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,416.76,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,416.76,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,132.48,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,132.48,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,98.44,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,98.44,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,132.48,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,132.48,,,,,,,37.44,139.68,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3.13,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3.13,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3.13,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3.13,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3.13,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3.13,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,4.90000,2.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4.51,,,,,,,4.41,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4.51,,,,,,,1.27,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,7.90000,4.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7.27,,,,,,,7.11,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,7.90000,4.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7.27,,,,,,,2.05,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,4.90000,2.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4.51,,,,,,,4.41,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4.51,,,,,,,1.27,4.75,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,21.06,78.57,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,inpatient,,,3141500.00000,1784843.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2890180.00,,,,,,,2827350.00,3047255.00,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,outpatient,,,3141500.00000,1784843.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2890180.00,,,,,,,816790.00,3047255.00,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,0.20240,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,0.20240,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.52000,0.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,0.47840,,,,,,,0.46800,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.52000,0.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,0.47840,,,,,,,0.13520,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.56000,0.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,0.51520,,,,,,,0.50400,0.54320,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.56000,0.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,0.51520,,,,,,,0.14560,0.54320,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,0.20240,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,0.20240,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.85000,0.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,0.78200,,,,,,,0.76500,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.85000,0.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,0.78200,,,,,,,0.22100,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,0.20240,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,0.20240,,,,,,,0.05720,0.21340,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,inpatient,,,102.00000,65.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,91.80,98.94,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,outpatient,,,102.00000,65.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,26.52,98.94,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,inpatient,,,190.00000,121.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,174.80,,,,,,,171.00,184.30,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,outpatient,,,190.00000,121.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,174.80,,,,,,,49.40,184.30,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,inpatient,,,359.00000,229.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,323.10,348.23,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,93.34,348.23,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,inpatient,,,535.00000,341.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,492.20,,,,,,,481.50,518.95,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,492.20,,,,,,,139.10,518.95,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,inpatient,,,766.00000,489.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,704.72,,,,,,,689.40,743.02,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,outpatient,,,766.00000,489.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,704.72,,,,,,,199.16,743.02,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,inpatient,,,159.00000,101.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,146.28,,,,,,,143.10,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,outpatient,,,159.00000,101.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,146.28,,,,,,,41.34,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,inpatient,,,447.00000,285.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,402.30,433.59,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,outpatient,,,447.00000,285.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,116.22,433.59,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,inpatient,,,1413.00000,902.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,outpatient,,,1413.00000,902.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,inpatient,,,3853.00000,2462.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,outpatient,,,3853.00000,2462.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,inpatient,,,313.00000,200.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,outpatient,,,313.00000,200.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,inpatient,,,1132.00000,723.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,outpatient,,,1132.00000,723.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,inpatient,,,2695.00000,1722.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,outpatient,,,2695.00000,1722.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,inpatient,,,1619.00000,1034.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,outpatient,,,1619.00000,1034.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,inpatient,,,535.00000,341.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,492.20,,,,,,,481.50,518.95,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,492.20,,,,,,,139.10,518.95,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,inpatient,,,850.00000,543.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,outpatient,,,850.00000,543.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,inpatient,,,32.00000,20.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,29.44,,,,,,,28.80,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,outpatient,,,32.00000,20.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,29.44,,,,,,,8.32,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,inpatient,,,134.00000,85.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,123.28,,,,,,,120.60,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,outpatient,,,134.00000,85.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,123.28,,,,,,,34.84,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,inpatient,,,359.00000,229.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,323.10,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,93.34,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,inpatient,,,709.00000,453.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,652.28,,,,,,,638.10,687.73,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,outpatient,,,709.00000,453.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,652.28,,,,,,,184.34,687.73,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,inpatient,,,4880.00000,2357.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4489.60,,,,,,,4392.00,4733.60,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,outpatient,,,4880.00000,2357.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4489.60,,,,,,,1268.80,4733.60,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,inpatient,,,6024.00000,2909.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5542.08,,,,,,,5421.60,5843.28,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,outpatient,,,6024.00000,2909.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5542.08,,,,,,,1566.24,5843.28,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,402.30,433.59,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,116.22,433.59,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,3957.30,4265.09,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,1143.22,4265.09,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,5274.90,5685.17,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,1523.86,5685.17,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,inpatient,,,7413.00000,3580.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6819.96,,,,,,,6671.70,7190.61,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,outpatient,,,7413.00000,3580.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6819.96,,,,,,,1927.38,7190.61,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,402.30,433.59,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,116.22,433.59,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,402.30,433.59,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,116.22,433.59,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,3957.30,4265.09,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,1143.22,4265.09,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,inpatient,,,7181.00000,3468.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6606.52,,,,,,,6462.90,6965.57,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6606.52,,,,,,,1867.06,6965.57,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,inpatient,,,10654.00000,5145.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,9801.68,,,,,,,9588.60,10334.38,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,outpatient,,,10654.00000,5145.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,9801.68,,,,,,,2770.04,10334.38,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,6487.00000,3133.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5968.04,,,,,,,5838.30,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5968.04,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,7413.00000,3580.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6819.96,,,,,,,6671.70,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6819.96,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,11575.00000,5590.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10649.00,,,,,,,10417.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,11575.00000,5590.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10649.00,,,,,,,3009.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,13432.00000,6487.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12357.44,,,,,,,12088.80,13029.04,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,13432.00000,6487.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12357.44,,,,,,,3492.32,13029.04,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,21904.00000,10579.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,21904.00000,10579.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,490.88,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,4397.00000,2123.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,3957.30,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,1143.22,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,7413.00000,3580.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6819.96,,,,,,,6671.70,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6819.96,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,12969.00000,6264.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11931.48,,,,,,,11672.10,12579.93,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,12969.00000,6264.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11931.48,,,,,,,3371.94,12579.93,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,490.88,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2231.92,,,,,,,2183.40,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2231.92,,,,,,,630.76,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2600.84,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2600.84,,,,,,,735.02,2742.19,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,91.80,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,26.52,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,inpatient,,,134.00000,64.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,123.28,,,,,,,120.60,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,123.28,,,,,,,34.84,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,inpatient,,,251.00000,121.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,230.92,,,,,,,225.90,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,outpatient,,,251.00000,121.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,230.92,,,,,,,65.26,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,490.88,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,447.00000,215.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,402.30,433.59,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,447.00000,215.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,116.22,433.59,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,2827.00000,1365.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2600.84,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2600.84,,,,,,,735.02,2742.19,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,2690.00000,1299.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2474.80,,,,,,,2421.00,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2474.80,,,,,,,699.40,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,6487.00000,3133.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5968.04,,,,,,,5838.30,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5968.04,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,2426.00000,1171.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2231.92,,,,,,,2183.40,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,2426.00000,1171.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2231.92,,,,,,,630.76,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,15334.00000,7406.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,13800.60,14873.98,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,15334.00000,7406.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,3986.84,14873.98,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,490.88,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2600.84,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2600.84,,,,,,,735.02,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,251.00000,121.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,230.92,,,,,,,225.90,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,251.00000,121.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,230.92,,,,,,,65.26,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,490.88,1831.36,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,2827.00000,1365.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2600.84,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2600.84,,,,,,,735.02,2742.19,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,29.44,,,,,,,28.80,31.04,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,29.44,,,,,,,8.32,31.04,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,490.88,1831.36,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,inpatient,,,15334.00000,7406.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,13800.60,14873.98,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,3986.84,14873.98,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,inpatient,,,1485.00000,717.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1366.20,,,,,,,1336.50,1440.45,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,outpatient,,,1485.00000,717.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1366.20,,,,,,,386.10,1440.45,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,inpatient,,,2028.00000,979.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1865.76,,,,,,,1825.20,1967.16,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,outpatient,,,2028.00000,979.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1865.76,,,,,,,527.28,1967.16,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,4397.00000,2123.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,3957.30,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,1143.22,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,8107.00000,3915.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7458.44,,,,,,,7296.30,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,8107.00000,3915.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7458.44,,,,,,,2107.82,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,10422.00000,5033.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,9588.24,,,,,,,9379.80,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,10422.00000,5033.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,9588.24,,,,,,,2709.72,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,12737.00000,6151.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11718.04,,,,,,,11463.30,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,12737.00000,6151.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11718.04,,,,,,,3311.62,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,14239.00000,6877.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,13099.88,,,,,,,12815.10,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,14239.00000,6877.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,13099.88,,,,,,,3702.14,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,16429.00000,7935.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,15114.68,,,,,,,14786.10,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,16429.00000,7935.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,15114.68,,,,,,,4271.54,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,18619.00000,8992.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,17129.48,,,,,,,16757.10,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,18619.00000,8992.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,17129.48,,,,,,,4840.94,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,20809.00000,10050.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,19144.28,,,,,,,18728.10,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,20809.00000,10050.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,19144.28,,,,,,,5410.34,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,22999.00000,11108.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,21159.08,,,,,,,20699.10,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,22999.00000,11108.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,21159.08,,,,,,,5979.74,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,25189.00000,12166.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23173.88,,,,,,,22670.10,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,25189.00000,12166.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23173.88,,,,,,,6549.14,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,27379.00000,13224.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,25188.68,,,,,,,24641.10,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,27379.00000,13224.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,25188.68,,,,,,,7118.54,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,29569.00000,14281.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,27203.48,,,,,,,26612.10,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,29569.00000,14281.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,27203.48,,,,,,,7687.94,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,31759.00000,15339.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,29218.28,,,,,,,28583.10,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,31759.00000,15339.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,29218.28,,,,,,,8257.34,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,36139.00000,17455.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33247.88,,,,,,,32525.10,35054.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,36139.00000,17455.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33247.88,,,,,,,9396.14,35054.83,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,1699.20,1831.36,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,490.88,1831.36,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3072.80,,,,,,,3006.00,3239.80,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3072.80,,,,,,,868.40,3239.80,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,5274.90,5685.17,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,1523.86,5685.17,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,29.44,,,,,,,28.80,31.04,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,29.44,,,,,,,8.32,31.04,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,inpatient,,,134.00000,64.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,123.28,,,,,,,120.60,129.98,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,123.28,,,,,,,34.84,129.98,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,174.80,,,,,,,171.00,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,174.80,,,,,,,49.40,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,inpatient,,,476.00000,229.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,437.92,,,,,,,428.40,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,outpatient,,,476.00000,229.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,437.92,,,,,,,123.76,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,29.44,,,,,,,28.80,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,29.44,,,,,,,8.32,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,402.30,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,116.22,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,1699.20,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,490.88,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,5274.90,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,1523.86,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,inpatient,,,12506.00000,6040.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11505.52,,,,,,,11255.40,12130.82,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,outpatient,,,12506.00000,6040.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11505.52,,,,,,,3251.56,12130.82,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,inpatient,,,2404.80000,1161.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2212.42,,,,,,,2164.32,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,outpatient,,,2404.80000,1161.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2212.42,,,,,,,625.25,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,inpatient,,,969.00000,468.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,891.48,,,,,,,872.10,939.93,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,outpatient,,,969.00000,468.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,891.48,,,,,,,251.94,939.93,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,inpatient,,,2256.90000,1090.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2076.35,,,,,,,2031.21,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,outpatient,,,2256.90000,1090.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2076.35,,,,,,,586.79,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,inpatient,,,644.30000,311.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,592.76,,,,,,,579.87,624.97,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,outpatient,,,644.30000,311.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,592.76,,,,,,,167.52,624.97,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,91.80,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,26.52,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,174.80,,,,,,,171.00,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,174.80,,,,,,,49.40,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,inpatient,,,26284.00000,12695.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,inpatient,,,30664.00000,14810.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,inpatient,,,35044.00000,16926.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,31539.60,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,9111.44,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,inpatient,,,43804.00000,21157.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,39423.60,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,outpatient,,,43804.00000,21157.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,11389.04,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,inpatient,,,52564.00000,25388.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48358.88,,,,,,,47307.60,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,outpatient,,,52564.00000,25388.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48358.88,,,,,,,13666.64,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,inpatient,,,61324.00000,29619.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56418.08,,,,,,,55191.60,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,outpatient,,,61324.00000,29619.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56418.08,,,,,,,15944.24,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,inpatient,,,70084.00000,33850.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64477.28,,,,,,,63075.60,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,outpatient,,,70084.00000,33850.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64477.28,,,,,,,18221.84,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,inpatient,,,78844.00000,38081.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72536.48,,,,,,,70959.60,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,outpatient,,,78844.00000,38081.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72536.48,,,,,,,20499.44,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,inpatient,,,87604.00000,42312.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80595.68,,,,,,,78843.60,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,outpatient,,,87604.00000,42312.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80595.68,,,,,,,22777.04,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,inpatient,,,96364.00000,46543.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,88654.88,,,,,,,86727.60,93473.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,outpatient,,,96364.00000,46543.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,88654.88,,,,,,,25054.64,93473.08,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,inpatient,,,26284.00000,12695.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,inpatient,,,30664.00000,14810.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,inpatient,,,35044.00000,16926.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,31539.60,33992.68,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,9111.44,33992.68,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,inpatient,,,39424.00000,19041.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,35481.60,38241.28,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,outpatient,,,39424.00000,19041.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,10250.24,38241.28,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3596.28,,,,,,,3518.10,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3596.28,,,,,,,1016.34,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,174.80,,,,,,,171.00,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,174.80,,,,,,,49.40,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,5274.90,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,1523.86,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,inpatient,,,15334.00000,7406.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,13800.60,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,3986.84,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,2023.00000,977.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1861.16,,,,,,,1820.70,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2023.00000,977.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1861.16,,,,,,,525.98,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,5274.90,5685.17,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,inpatient,,,7876.00000,3804.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7245.92,,,,,,,7088.40,7639.72,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7245.92,,,,,,,2047.76,7639.72,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,inpatient,,,10191.00000,4922.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,9375.72,,,,,,,9171.90,9885.27,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,outpatient,,,10191.00000,4922.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,9375.72,,,,,,,2649.66,9885.27,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,96.00000,46.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,88.32,,,,,,,86.40,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,96.00000,46.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,88.32,,,,,,,24.96,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,5274.90,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,7876.00000,3804.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7245.92,,,,,,,7088.40,7639.72,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,7876.00000,3804.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7245.92,,,,,,,2047.76,7639.72,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3596.28,,,,,,,3518.10,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3596.28,,,,,,,1016.34,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,inpatient,,,5373.00000,2595.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4943.16,,,,,,,4835.70,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,outpatient,,,5373.00000,2595.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4943.16,,,,,,,1396.98,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,inpatient,,,6487.00000,3133.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5968.04,,,,,,,5838.30,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,outpatient,,,6487.00000,3133.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5968.04,,,,,,,1686.62,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,inpatient,,,7876.00000,3804.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7245.92,,,,,,,7088.40,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7245.92,,,,,,,2047.76,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,3957.30,4265.09,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,1143.22,4265.09,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,5274.90,5685.17,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,1523.86,5685.17,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,inpatient,,,1126.00000,543.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1035.92,,,,,,,1013.40,1092.22,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,outpatient,,,1126.00000,543.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1035.92,,,,,,,292.76,1092.22,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,2690.00000,1299.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2474.80,,,,,,,2421.00,2609.30,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2474.80,,,,,,,699.40,2609.30,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,4880.00000,2357.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4489.60,,,,,,,4392.00,4733.60,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,4880.00000,2357.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4489.60,,,,,,,1268.80,4733.60,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,9260.00000,4472.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8519.20,,,,,,,8334.00,8982.20,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,9260.00000,4472.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8519.20,,,,,,,2407.60,8982.20,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,5274.90,5685.17,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,1523.86,5685.17,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,inpatient,,,588.00000,284.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,540.96,,,,,,,529.20,570.36,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,588.00000,284.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,540.96,,,,,,,152.88,570.36,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,1699.20,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,490.88,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2231.92,,,,,,,2183.40,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2231.92,,,,,,,630.76,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2600.84,,,,,,,2544.30,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2600.84,,,,,,,735.02,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3072.80,,,,,,,3006.00,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3072.80,,,,,,,868.40,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3072.80,,,,,,,3006.00,3239.80,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3072.80,,,,,,,868.40,3239.80,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,402.30,433.59,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,116.22,433.59,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3596.28,,,,,,,3518.10,3791.73,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3596.28,,,,,,,1016.34,3791.73,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,5274.90,5685.17,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,1523.86,5685.17,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,inpatient,,,159.00000,76.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,146.28,,,,,,,143.10,154.23,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,outpatient,,,159.00000,76.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,146.28,,,,,,,41.34,154.23,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,inpatient,,,588.00000,284.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,540.96,,,,,,,529.20,570.36,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,outpatient,,,588.00000,284.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,540.96,,,,,,,152.88,570.36,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2231.92,,,,,,,2183.40,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2231.92,,,,,,,630.76,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,402.30,433.59,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,116.22,433.59,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,inpatient,,,8107.00000,3915.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7458.44,,,,,,,7296.30,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,outpatient,,,8107.00000,3915.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7458.44,,,,,,,2107.82,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,inpatient,,,10422.00000,5033.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,9588.24,,,,,,,9379.80,10109.34,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,outpatient,,,10422.00000,5033.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,9588.24,,,,,,,2709.72,10109.34,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,5274.90,5685.17,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,1523.86,5685.17,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,1699.20,1831.36,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,490.88,1831.36,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,91.80,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,26.52,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,inpatient,,,221.00000,106.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,203.32,,,,,,,198.90,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,outpatient,,,221.00000,106.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,203.32,,,,,,,57.46,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,402.30,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,116.22,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2231.92,,,,,,,2183.40,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2231.92,,,,,,,630.76,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3072.80,,,,,,,3006.00,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3072.80,,,,,,,868.40,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,inpatient,,,4153.00000,2005.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3820.76,,,,,,,3737.70,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,outpatient,,,4153.00000,2005.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3820.76,,,,,,,1079.78,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,inpatient,,,5129.00000,2477.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4718.68,,,,,,,4616.10,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,outpatient,,,5129.00000,2477.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4718.68,,,,,,,1333.54,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,inpatient,,,7181.00000,3468.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6606.52,,,,,,,6462.90,6965.57,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6606.52,,,,,,,1867.06,6965.57,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,inpatient,,,52.50000,25.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.30,,,,,,,47.25,50.92,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,outpatient,,,52.50000,25.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.30,,,,,,,13.65,50.92,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,inpatient,,,50.40000,24.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.37,,,,,,,45.36,48.89,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,outpatient,,,50.40000,24.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.37,,,,,,,13.10,48.89,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2231.92,,,,,,,2183.40,2353.22,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2231.92,,,,,,,630.76,2353.22,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3596.28,,,,,,,3518.10,3791.73,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3596.28,,,,,,,1016.34,3791.73,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,91.80,98.94,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,26.52,98.94,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,29.44,,,,,,,28.80,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,29.44,,,,,,,8.32,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,402.30,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,116.22,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,inpatient,,,709.00000,342.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,652.28,,,,,,,638.10,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,outpatient,,,709.00000,342.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,652.28,,,,,,,184.34,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80595.68,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80595.68,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,109504.00000,62214.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100743.68,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100743.68,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,131404.00000,74657.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,120891.68,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,131404.00000,74657.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,120891.68,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,43800.00000,24884.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40296.00,,,,,,,39420.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,43800.00000,24884.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40296.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80595.68,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80595.68,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,19714.00000,11200.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,24090.00000,13686.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22162.80,,,,,,,21681.00,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,24090.00000,13686.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22162.80,,,,,,,6263.40,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,28474.00000,16177.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26196.08,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26196.08,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,17520.00000,9953.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16118.40,,,,,,,15768.00,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16118.40,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,21904.00000,12444.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,26284.00000,14933.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,43804.00000,24887.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80595.68,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80595.68,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,109504.00000,62214.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100743.68,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100743.68,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,6105.00000,3468.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,6105.00000,3468.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,13895.00000,7894.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,13895.00000,7894.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,21900.00000,12442.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20148.00,,,,,,,19710.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,21900.00000,12442.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20148.00,,,,,,,5694.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,35040.00000,19907.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32236.80,,,,,,,31536.00,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,35040.00000,19907.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32236.80,,,,,,,9110.40,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,43804.00000,24887.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,19714.00000,11200.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,22776.00000,12940.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20953.92,,,,,,,20498.40,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,22776.00000,12940.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20953.92,,,,,,,5921.76,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,28474.00000,16177.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26196.08,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26196.08,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,17520.00000,9953.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16118.40,,,,,,,15768.00,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16118.40,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,21904.00000,12444.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,26284.00000,14933.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,30664.00000,17421.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,30664.00000,17421.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,35044.00000,19910.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,35044.00000,19910.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,9111.44,33992.68,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,2157.00000,864.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,2157.00000,864.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,2695.00000,1080.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2695.00000,1080.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,3853.00000,1545.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,3853.00000,1545.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,inpatient,,,1413.00000,566.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,outpatient,,,1413.00000,566.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,3229.80000,1857.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2971.42,,,,,,,2906.82,3132.91,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,3229.80000,1857.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2971.42,,,,,,,839.75,3132.91,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,854.40000,491.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,786.05,,,,,,,768.96,828.77,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,854.40000,491.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,786.05,,,,,,,222.14,828.77,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1200.50000,690.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1104.46,,,,,,,1080.45,1164.48,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1200.50000,690.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1104.46,,,,,,,312.13,1164.48,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1011.00000,581.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,930.12,,,,,,,909.90,980.67,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1011.00000,581.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,930.12,,,,,,,262.86,980.67,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1823.80000,1048.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1677.90,,,,,,,1641.42,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1823.80000,1048.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1677.90,,,,,,,474.19,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2028.50000,1166.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1866.22,,,,,,,1825.65,1967.64,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2028.50000,1166.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1866.22,,,,,,,527.41,1967.64,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,841.00000,483.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,773.72,,,,,,,756.90,815.77,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,841.00000,483.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,773.72,,,,,,,218.66,815.77,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1366.20000,785.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1256.90,,,,,,,1229.58,1325.21,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1366.20000,785.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1256.90,,,,,,,355.21,1325.21,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1384.00000,795.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1273.28,,,,,,,1245.60,1342.48,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1384.00000,795.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1273.28,,,,,,,359.84,1342.48,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2458.70000,1413.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2262.00,,,,,,,2212.83,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2458.70000,1413.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2262.00,,,,,,,639.26,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2393.50000,1376.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2202.02,,,,,,,2154.15,2321.70,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2393.50000,1376.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2202.02,,,,,,,622.31,2321.70,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1369.50000,787.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1259.94,,,,,,,1232.55,1328.41,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1369.50000,787.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1259.94,,,,,,,356.07,1328.41,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2697.40000,1551.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2481.61,,,,,,,2427.66,2616.48,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2697.40000,1551.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2481.61,,,,,,,701.32,2616.48,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4621.80000,2657.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4252.06,,,,,,,4159.62,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4621.80000,2657.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4252.06,,,,,,,1201.67,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2592.50000,1490.69000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2385.10,,,,,,,2333.25,2514.72,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2592.50000,1490.69000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2385.10,,,,,,,674.05,2514.72,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,5274.90,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,1523.86,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7671.88,,,,,,,7505.10,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7671.88,,,,,,,2168.14,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,8107.00000,4661.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7458.44,,,,,,,7296.30,7863.79,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7458.44,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1035.92,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1035.92,,,,,,,292.76,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6819.96,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6819.96,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,inpatient,,,20152.00000,11587.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18539.84,,,,,,,18136.80,19547.44,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,outpatient,,,20152.00000,11587.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18539.84,,,,,,,5239.52,19547.44,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,402.30,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,116.22,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,652.28,,,,,,,638.10,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,652.28,,,,,,,184.34,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,1272.00000,731.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1170.24,,,,,,,1144.80,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,1272.00000,731.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1170.24,,,,,,,330.72,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2474.80,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2474.80,,,,,,,699.40,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,3078.00000,1769.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2831.76,,,,,,,2770.20,2985.66,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,3078.00000,1769.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2831.76,,,,,,,800.28,2985.66,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,70.00000,40.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,63.00,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,70.00000,40.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,18.20,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,102.00000,58.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,91.80,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,102.00000,58.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,26.52,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,221.00000,127.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,203.32,,,,,,,198.90,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,221.00000,127.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,203.32,,,,,,,57.46,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,402.30,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,116.22,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,652.28,,,,,,,638.10,687.73,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,652.28,,,,,,,184.34,687.73,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11505.52,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11505.52,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35482.00000,20402.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32643.44,,,,,,,31933.80,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35482.00000,20402.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32643.44,,,,,,,9225.32,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39862.00000,22920.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36673.04,,,,,,,35875.80,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39862.00000,22920.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36673.04,,,,,,,10364.12,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,44242.00000,25439.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40702.64,,,,,,,39817.80,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,44242.00000,25439.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40702.64,,,,,,,11502.92,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,48622.00000,27957.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,44732.24,,,,,,,43759.80,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,48622.00000,27957.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,44732.24,,,,,,,12641.72,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,53002.00000,30476.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48761.84,,,,,,,47701.80,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,53002.00000,30476.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48761.84,,,,,,,13780.52,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56418.08,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56418.08,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64477.28,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64477.28,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72536.48,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72536.48,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80595.68,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80595.68,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,88654.88,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,88654.88,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,844.00000,485.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,776.48,,,,,,,759.60,818.68,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,844.00000,485.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,776.48,,,,,,,219.44,818.68,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,11575.00000,6655.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10649.00,,,,,,,10417.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,11575.00000,6655.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10649.00,,,,,,,3009.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,14892.00000,8562.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,13700.64,,,,,,,13402.80,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14892.00000,8562.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,13700.64,,,,,,,3871.92,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,24970.00000,14357.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22972.40,,,,,,,22473.00,24220.90,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,24970.00000,14357.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22972.40,,,,,,,6492.20,24220.90,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,402.30,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,116.22,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3072.80,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3072.80,,,,,,,868.40,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,4153.00000,2387.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3820.76,,,,,,,3737.70,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3820.76,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,4641.00000,2668.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4269.72,,,,,,,4176.90,4501.77,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4641.00000,2668.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4269.72,,,,,,,1206.66,4501.77,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4489.60,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4489.60,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,88654.88,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,88654.88,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100743.68,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100743.68,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,131404.00000,75557.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,120891.68,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,120891.68,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,153304.00000,88149.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,141039.68,,,,,,,137973.60,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,153304.00000,88149.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,141039.68,,,,,,,39859.04,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,175204.00000,100742.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,161187.68,,,,,,,157683.60,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,175204.00000,100742.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,161187.68,,,,,,,45553.04,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,197104.00000,113334.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,181335.68,,,,,,,177393.60,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,197104.00000,113334.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,181335.68,,,,,,,51247.04,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,219004.00000,125927.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,201483.68,,,,,,,197103.60,212433.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,219004.00000,125927.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,201483.68,,,,,,,56941.04,212433.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,44329.28,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,44329.28,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48358.88,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48358.88,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52388.48,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52388.48,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56418.08,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56418.08,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48358.88,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48358.88,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80595.68,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80595.68,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100743.68,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100743.68,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4489.60,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4489.60,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,44329.28,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,44329.28,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48358.88,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48358.88,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52388.48,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52388.48,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56418.08,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56418.08,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64477.28,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64477.28,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72536.48,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72536.48,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80595.68,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80595.68,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,88654.88,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,88654.88,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100743.68,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100743.68,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,122644.00000,70520.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,112832.48,,,,,,,110379.60,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,112832.48,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,135784.00000,78075.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,124921.28,,,,,,,122205.60,131710.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,135784.00000,78075.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,124921.28,,,,,,,35303.84,131710.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,44329.28,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,44329.28,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,55630.00000,31987.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51179.60,,,,,,,50067.00,53961.10,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,55630.00000,31987.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51179.60,,,,,,,14463.80,53961.10,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2474.80,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2474.80,,,,,,,699.40,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,14020.00000,8061.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12898.40,,,,,,,12618.00,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12898.40,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,17962.00000,10328.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16525.04,,,,,,,16165.80,17423.14,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,17962.00000,10328.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16525.04,,,,,,,4670.12,17423.14,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,2421.00000,1392.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2227.32,,,,,,,2178.90,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,2421.00000,1392.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2227.32,,,,,,,629.46,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2231.92,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2231.92,,,,,,,630.76,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2474.80,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2474.80,,,,,,,699.40,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,27160.00000,15617.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24987.20,,,,,,,24444.00,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,27160.00000,15617.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24987.20,,,,,,,7061.60,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,30225.68,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,30225.68,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48358.88,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48358.88,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72536.48,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72536.48,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,28470.00000,16370.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26192.40,,,,,,,25623.00,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,28470.00000,16370.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26192.40,,,,,,,7402.20,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,43800.00000,25185.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40296.00,,,,,,,39420.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,43800.00000,25185.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40296.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80595.68,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80595.68,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100743.68,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100743.68,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3596.28,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3596.28,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,30225.68,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,30225.68,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,54754.00000,31483.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50373.68,,,,,,,49278.60,53111.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,54754.00000,31483.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50373.68,,,,,,,14236.04,53111.38,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2474.80,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2474.80,,,,,,,699.40,2609.30,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,61320.00000,35259.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56414.40,,,,,,,55188.00,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,61320.00000,35259.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56414.40,,,,,,,15943.20,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,70080.00000,40296.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64473.60,,,,,,,63072.00,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,70080.00000,40296.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64473.60,,,,,,,18220.80,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,78840.00000,45333.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72532.80,,,,,,,70956.00,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,78840.00000,45333.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72532.80,,,,,,,20498.40,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,88654.88,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,88654.88,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100743.68,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100743.68,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,122644.00000,70520.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,112832.48,,,,,,,110379.60,118964.68,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,112832.48,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22166.48,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22166.48,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,30225.68,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,30225.68,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,1883.00000,1082.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1732.36,,,,,,,1694.70,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1883.00000,1082.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1732.36,,,,,,,489.58,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3596.28,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3596.28,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,7644.00000,4395.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7032.48,,,,,,,6879.60,7414.68,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,7644.00000,4395.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7032.48,,,,,,,1987.44,7414.68,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2474.80,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2474.80,,,,,,,699.40,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,inpatient,,,1614.00000,928.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1484.88,,,,,,,1452.60,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1484.88,,,,,,,419.64,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22166.48,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22166.48,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26196.08,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26196.08,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,30225.68,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,30225.68,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,37234.00000,21409.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,34255.28,,,,,,,33510.60,36116.98,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,37234.00000,21409.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,34255.28,,,,,,,9680.84,36116.98,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48358.88,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48358.88,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72536.48,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72536.48,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,159.00000,91.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,146.28,,,,,,,143.10,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,159.00000,91.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,146.28,,,,,,,41.34,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,490.88,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,490.88,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2231.92,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2231.92,,,,,,,630.76,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2827.00000,1625.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2600.84,,,,,,,2544.30,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2600.84,,,,,,,735.02,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3072.80,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3072.80,,,,,,,868.40,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8107.00000,4661.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7458.44,,,,,,,7296.30,7863.79,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7458.44,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80595.68,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80595.68,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100743.68,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100743.68,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,131404.00000,75557.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,120891.68,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,120891.68,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,18400.00000,10580.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16928.00,,,,,,,16560.00,17848.00,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,18400.00000,10580.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16928.00,,,,,,,4784.00,17848.00,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22166.48,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22166.48,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26196.08,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26196.08,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,30225.68,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,30225.68,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1614.00000,928.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1484.88,,,,,,,1452.60,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1484.88,,,,,,,419.64,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52388.48,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52388.48,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,5368.00000,3086.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4938.56,,,,,,,4831.20,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,5368.00000,3086.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4938.56,,,,,,,1395.68,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,14020.00000,8061.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12898.40,,,,,,,12618.00,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12898.40,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,25408.00000,14609.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23375.36,,,,,,,22867.20,24645.76,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,25408.00000,14609.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23375.36,,,,,,,6606.08,24645.76,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,8112.00000,4664.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7463.04,,,,,,,7300.80,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,8112.00000,4664.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7463.04,,,,,,,2109.12,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,10431.00000,5997.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,9596.52,,,,,,,9387.90,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,10431.00000,5997.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,9596.52,,,,,,,2712.06,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,30225.68,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,30225.68,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,46870.00000,26950.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,43120.40,,,,,,,42183.00,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,46870.00000,26950.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,43120.40,,,,,,,12186.20,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,51250.00000,29468.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47150.00,,,,,,,46125.00,49712.50,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,51250.00000,29468.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47150.00,,,,,,,13325.00,49712.50,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48358.88,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48358.88,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72536.48,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72536.48,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80595.68,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80595.68,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,588.00000,338.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,540.96,,,,,,,529.20,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,588.00000,338.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,540.96,,,,,,,152.88,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3596.28,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3596.28,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4943.16,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4943.16,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5968.04,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5968.04,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,7876.00000,4528.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7245.92,,,,,,,7088.40,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7876.00000,4528.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7245.92,,,,,,,2047.76,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22166.48,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22166.48,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5856.00000,3367.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5387.52,,,,,,,5270.40,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5856.00000,3367.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5387.52,,,,,,,1522.56,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5968.04,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5968.04,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6819.96,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6819.96,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7671.88,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7671.88,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4943.16,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4943.16,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5542.08,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5542.08,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11505.52,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11505.52,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4943.16,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4943.16,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5542.08,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5542.08,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11505.52,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11505.52,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4392.00000,2525.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4040.64,,,,,,,3952.80,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4392.00000,2525.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4040.64,,,,,,,1141.92,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4943.16,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4943.16,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5968.04,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5968.04,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4943.16,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4943.16,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5968.04,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5968.04,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4489.60,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4489.60,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1035.92,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1035.92,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4943.16,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4943.16,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5542.08,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5542.08,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11505.52,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11505.52,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12495.44,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12495.44,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2152.00000,1237.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1979.84,,,,,,,1936.80,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2152.00000,1237.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1979.84,,,,,,,559.52,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4489.60,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4489.60,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3596.28,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3596.28,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5542.08,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5542.08,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4943.16,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4943.16,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5542.08,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5542.08,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1035.92,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1035.92,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4943.16,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4943.16,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5542.08,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5542.08,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11505.52,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11505.52,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12495.44,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12495.44,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4943.16,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4943.16,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8802.00000,5061.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8097.84,,,,,,,7921.80,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8802.00000,5061.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8097.84,,,,,,,2288.52,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,10654.00000,6126.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,9801.68,,,,,,,9588.60,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10654.00000,6126.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,9801.68,,,,,,,2770.04,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11505.52,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11505.52,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12495.44,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12495.44,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17086.00000,9824.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,15719.12,,,,,,,15377.40,16573.42,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17086.00000,9824.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,15719.12,,,,,,,4442.36,16573.42,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4489.60,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4489.60,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5968.04,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5968.04,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6819.96,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6819.96,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7671.88,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7671.88,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4489.60,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4489.60,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4489.60,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4489.60,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3308.32,,,,,,,934.96,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5616.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22166.48,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22166.48,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3596.28,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3596.28,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5968.04,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5968.04,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1736.96,,,,,,,490.88,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2231.92,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2231.92,,,,,,,630.76,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2827.00000,1625.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2600.84,,,,,,,2544.30,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2600.84,,,,,,,735.02,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3072.80,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3072.80,,,,,,,868.40,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4153.00000,2387.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3820.76,,,,,,,3737.70,4028.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3820.76,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6819.96,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6819.96,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7671.88,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7671.88,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9728.00000,5593.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8949.76,,,,,,,8755.20,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9728.00000,5593.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8949.76,,,,,,,2529.28,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11117.00000,6392.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10227.64,,,,,,,10005.30,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11117.00000,6392.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10227.64,,,,,,,2890.42,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,44329.28,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,44329.28,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48358.88,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48358.88,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52388.48,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52388.48,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56418.08,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56418.08,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64477.28,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64477.28,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,74464.00000,42816.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68506.88,,,,,,,67017.60,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68506.88,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72536.48,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72536.48,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,83224.00000,47853.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,76566.08,,,,,,,74901.60,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,76566.08,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,111694.00000,64224.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,102758.48,,,,,,,100524.60,108343.18,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,111694.00000,64224.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,102758.48,,,,,,,29040.44,108343.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,402.30,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,116.22,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,652.28,,,,,,,638.10,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,652.28,,,,,,,184.34,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,991.00000,569.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,911.72,,,,,,,891.90,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,991.00000,569.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,911.72,,,,,,,257.66,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1490.00000,856.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1370.80,,,,,,,1341.00,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1490.00000,856.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1370.80,,,,,,,387.40,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3596.28,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3596.28,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5392.12,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5968.04,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5968.04,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6819.96,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6819.96,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7671.88,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7671.88,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1299.96,,,,,,,367.38,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3544.76,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,6945.00000,3993.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6389.40,,,,,,,6250.50,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,6945.00000,3993.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6389.40,,,,,,,1805.70,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,402.30,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,116.22,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3596.28,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3596.28,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4943.16,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4943.16,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1041.44,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,50374.00000,28965.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46344.08,,,,,,,45336.60,48862.78,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,50374.00000,28965.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46344.08,,,,,,,13097.24,48862.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18136.88,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22166.48,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22166.48,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26196.08,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26196.08,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2479.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6394.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10653.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14107.28,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,44329.28,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,44329.28,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1984.44,,,,,,,560.82,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2836.36,,,,,,,801.58,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,44329.28,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,44329.28,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48358.88,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48358.88,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52388.48,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52388.48,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60447.68,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,74464.00000,42816.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68506.88,,,,,,,67017.60,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68506.88,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,83224.00000,47853.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,76566.08,,,,,,,74901.60,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,76566.08,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,91984.00000,52890.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,84625.28,,,,,,,82785.60,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,91984.00000,52890.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,84625.28,,,,,,,23915.84,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,100744.00000,57927.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92684.48,,,,,,,90669.60,97721.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,100744.00000,57927.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92684.48,,,,,,,26193.44,97721.68,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,149.40,161.02,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,152.72,,,,,,,43.16,161.02,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,402.30,433.59,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,411.24,,,,,,,116.22,433.59,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,652.28,,,,,,,638.10,687.73,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,652.28,,,,,,,184.34,687.73,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16122.08,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20151.68,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24181.28,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28210.88,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32240.48,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36270.08,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40299.68,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48358.88,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48358.88,,,,,,,13666.64,50987.08,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,4396.50,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4494.20,,,,,,,1270.10,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,8338.50,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8523.80,,,,,,,2408.90,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,12505.50,13478.15,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12783.40,,,,,,,3612.70,13478.15,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2180.20000,1253.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2005.78,,,,,,,1962.18,2114.79,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2180.20000,1253.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2005.78,,,,,,,566.85,2114.79,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1880.60000,1081.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1730.15,,,,,,,1692.54,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1880.60000,1081.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1730.15,,,,,,,488.96,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2908.70000,1672.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2676.00,,,,,,,2617.83,2821.44,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2908.70000,1672.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2676.00,,,,,,,756.26,2821.44,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,inpatient,,,34.00000,25.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,31.28,,,,,,,30.60,32.98,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,outpatient,,,34.00000,25.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,31.28,,,,,,,8.84,32.98,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,inpatient,,,13.00000,9.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11.96,,,,,,,11.70,12.61,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,outpatient,,,13.00000,9.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11.96,,,,,,,3.38,12.61,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,258.52,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,258.52,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,258.52,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,258.52,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,258.52,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,258.52,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,690.92,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,690.92,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,690.92,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,690.92,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,690.92,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,690.92,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,inpatient,,,122.00000,92.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,112.24,,,,,,,109.80,118.34,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,outpatient,,,122.00000,92.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,112.24,,,,,,,31.72,118.34,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,inpatient,,,79.00000,59.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,71.10,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,20.54,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,inpatient,,,79.00000,59.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,71.10,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,20.54,76.63,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,inpatient,,,15.00000,11.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,13.80,,,,,,,13.50,14.55,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,13.80,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,inpatient,,,15.00000,11.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,13.80,,,,,,,13.50,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,13.80,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,inpatient,,,17.00000,12.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,15.64,,,,,,,15.30,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,15.64,,,,,,,4.42,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,inpatient,,,17.00000,12.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,15.64,,,,,,,15.30,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,15.64,,,,,,,4.42,16.49,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,inpatient,,,359.00000,271.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,outpatient,,,359.00000,271.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,inpatient,,,359.00000,271.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,outpatient,,,359.00000,271.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,inpatient,,,359.00000,271.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,outpatient,,,359.00000,271.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,93.34,348.23,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,inpatient,,,155.00000,117.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,142.60,,,,,,,139.50,150.35,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,outpatient,,,155.00000,117.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,142.60,,,,,,,40.30,150.35,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,inpatient,,,294.00000,222.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,270.48,,,,,,,264.60,285.18,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,outpatient,,,294.00000,222.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,270.48,,,,,,,76.44,285.18,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,inpatient,,,1511.00000,1143.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1390.12,,,,,,,1359.90,1465.67,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,outpatient,,,1511.00000,1143.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1390.12,,,,,,,392.86,1465.67,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,inpatient,,,751.00000,568.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,690.92,,,,,,,675.90,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,690.92,,,,,,,195.26,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,inpatient,,,751.00000,568.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,690.92,,,,,,,675.90,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,690.92,,,,,,,195.26,728.47,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,inpatient,,,150.00000,113.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,138.00,,,,,,,135.00,145.50,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,outpatient,,,150.00000,113.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,138.00,,,,,,,39.00,145.50,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,inpatient,,,110.00000,83.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,99.00,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,outpatient,,,110.00000,83.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,28.60,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,inpatient,,,158.00000,119.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,145.36,,,,,,,142.20,153.26,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,outpatient,,,158.00000,119.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,145.36,,,,,,,41.08,153.26,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,inpatient,,,153.00000,115.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,140.76,,,,,,,137.70,148.41,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,outpatient,,,153.00000,115.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,140.76,,,,,,,39.78,148.41,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,inpatient,,,157.00000,118.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,144.44,,,,,,,141.30,152.29,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,outpatient,,,157.00000,118.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,144.44,,,,,,,40.82,152.29,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,inpatient,,,26.00000,19.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,23.40,25.22,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,outpatient,,,26.00000,19.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,6.76,25.22,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,inpatient,,,37.00000,28.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,34.04,,,,,,,33.30,35.89,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,outpatient,,,37.00000,28.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,34.04,,,,,,,9.62,35.89,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,inpatient,,,268.00000,202.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,246.56,,,,,,,241.20,259.96,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,outpatient,,,268.00000,202.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,246.56,,,,,,,69.68,259.96,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,inpatient,,,91.00000,68.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,83.72,,,,,,,81.90,88.27,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,outpatient,,,91.00000,68.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,83.72,,,,,,,23.66,88.27,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,inpatient,,,200.00000,151.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,184.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,outpatient,,,200.00000,151.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,184.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,inpatient,,,152.00000,115.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,139.84,,,,,,,136.80,147.44,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,outpatient,,,152.00000,115.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,139.84,,,,,,,39.52,147.44,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,inpatient,,,359.00000,271.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,323.10,348.23,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,outpatient,,,359.00000,271.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,93.34,348.23,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,inpatient,,,69.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,62.10,66.93,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,outpatient,,,69.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,inpatient,,,75.00000,36.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.00,,,,,,,67.50,72.75,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,outpatient,,,75.00000,36.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,inpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,outpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,inpatient,,,45.00000,21.69000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,41.40,,,,,,,40.50,43.65,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,outpatient,,,45.00000,21.69000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,41.40,,,,,,,11.70,43.65,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,inpatient,,,68.00000,32.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,61.20,65.96,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,outpatient,,,68.00000,32.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,17.68,65.96,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,inpatient,,,61.00000,29.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,outpatient,,,61.00000,29.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,inpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,inpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,inpatient,,,64.00000,30.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,57.60,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,outpatient,,,64.00000,30.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,16.64,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,inpatient,,,195.00000,93.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,179.40,,,,,,,175.50,189.15,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,outpatient,,,195.00000,93.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,179.40,,,,,,,50.70,189.15,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,inpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,outpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,inpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,outpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,inpatient,,,14.00000,6.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12.88,,,,,,,12.60,13.58,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,outpatient,,,14.00000,6.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12.88,,,,,,,3.64,13.58,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,inpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,outpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,inpatient,,,53.00000,25.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,47.70,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,outpatient,,,53.00000,25.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,13.78,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,inpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,outpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,inpatient,,,82.00000,39.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,75.44,,,,,,,73.80,79.54,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,outpatient,,,82.00000,39.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,75.44,,,,,,,21.32,79.54,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,inpatient,,,141.00000,67.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,129.72,,,,,,,126.90,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,129.72,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,inpatient,,,141.00000,67.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,129.72,,,,,,,126.90,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,129.72,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,inpatient,,,91.00000,43.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,83.72,,,,,,,81.90,88.27,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,outpatient,,,91.00000,43.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,83.72,,,,,,,23.66,88.27,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,inpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,outpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,inpatient,,,69.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,62.10,66.93,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,outpatient,,,69.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,inpatient,,,205.00000,98.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,188.60,,,,,,,184.50,198.85,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,outpatient,,,205.00000,98.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,188.60,,,,,,,53.30,198.85,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,inpatient,,,50.00000,24.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.00,,,,,,,45.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,outpatient,,,50.00000,24.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,inpatient,,,406.00000,195.69000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,373.52,,,,,,,365.40,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,outpatient,,,406.00000,195.69000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,373.52,,,,,,,105.56,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,inpatient,,,101.00000,48.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92.92,,,,,,,90.90,97.97,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,outpatient,,,101.00000,48.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92.92,,,,,,,26.26,97.97,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,inpatient,,,375.00000,180.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,345.00,,,,,,,337.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,outpatient,,,375.00000,180.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,345.00,,,,,,,97.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,inpatient,,,362.00000,174.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,333.04,,,,,,,325.80,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,outpatient,,,362.00000,174.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,333.04,,,,,,,94.12,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,inpatient,,,325.00000,156.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,299.00,,,,,,,292.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,outpatient,,,325.00000,156.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,299.00,,,,,,,84.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,inpatient,,,121.00000,58.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,111.32,,,,,,,108.90,117.37,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,outpatient,,,121.00000,58.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,111.32,,,,,,,31.46,117.37,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,inpatient,,,115.00000,55.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,105.80,,,,,,,103.50,111.55,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,outpatient,,,115.00000,55.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,105.80,,,,,,,29.90,111.55,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,inpatient,,,300.00000,144.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,276.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,outpatient,,,300.00000,144.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,276.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,inpatient,,,51.00000,24.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,outpatient,,,51.00000,24.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,inpatient,,,51.00000,24.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,inpatient,,,51.00000,24.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,inpatient,,,194.00000,93.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,178.48,,,,,,,174.60,188.18,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,outpatient,,,194.00000,93.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,178.48,,,,,,,50.44,188.18,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,inpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,outpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,inpatient,,,68.00000,32.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,61.20,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,outpatient,,,68.00000,32.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,17.68,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,inpatient,,,329.00000,158.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,302.68,,,,,,,296.10,319.13,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,outpatient,,,329.00000,158.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,302.68,,,,,,,85.54,319.13,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,inpatient,,,24.00000,11.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22.08,,,,,,,21.60,23.28,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,outpatient,,,24.00000,11.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22.08,,,,,,,6.24,23.28,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,inpatient,,,30.00000,14.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,27.60,,,,,,,27.00,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,outpatient,,,30.00000,14.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,27.60,,,,,,,7.80,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,inpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,outpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,inpatient,,,53.00000,25.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,47.70,51.41,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,outpatient,,,53.00000,25.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,13.78,51.41,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,inpatient,,,270.00000,130.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,248.40,,,,,,,243.00,261.90,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,outpatient,,,270.00000,130.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,248.40,,,,,,,70.20,261.90,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,inpatient,,,123.00000,59.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,113.16,,,,,,,110.70,119.31,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,113.16,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,inpatient,,,123.00000,59.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,113.16,,,,,,,110.70,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,113.16,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,inpatient,,,37.00000,17.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,34.04,,,,,,,33.30,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,outpatient,,,37.00000,17.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,34.04,,,,,,,9.62,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,inpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,outpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,inpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,outpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,inpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,outpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,inpatient,,,41.00000,19.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,37.72,,,,,,,36.90,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,outpatient,,,41.00000,19.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,37.72,,,,,,,10.66,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,inpatient,,,72.00000,34.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,64.80,69.84,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,outpatient,,,72.00000,34.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,18.72,69.84,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,inpatient,,,77.00000,37.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,69.30,74.69,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,outpatient,,,77.00000,37.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,20.02,74.69,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,inpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,inpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,inpatient,,,90.00000,43.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,82.80,,,,,,,81.00,87.30,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,outpatient,,,90.00000,43.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,82.80,,,,,,,23.40,87.30,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,inpatient,,,44.00000,21.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40.48,,,,,,,39.60,42.68,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,outpatient,,,44.00000,21.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40.48,,,,,,,11.44,42.68,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,inpatient,,,115.00000,55.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,105.80,,,,,,,103.50,111.55,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,outpatient,,,115.00000,55.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,105.80,,,,,,,29.90,111.55,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,inpatient,,,20.00000,9.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18.40,,,,,,,18.00,19.40,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,outpatient,,,20.00000,9.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,inpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,46.80,50.44,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,outpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,13.52,50.44,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,inpatient,,,341.00000,164.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,313.72,,,,,,,306.90,330.77,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,outpatient,,,341.00000,164.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,313.72,,,,,,,88.66,330.77,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,inpatient,,,54.00000,26.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,48.60,52.38,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,outpatient,,,54.00000,26.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,14.04,52.38,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,inpatient,,,53.00000,25.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,47.70,51.41,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,outpatient,,,53.00000,25.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,13.78,51.41,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,inpatient,,,88.00000,42.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.96,,,,,,,79.20,85.36,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,outpatient,,,88.00000,42.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.96,,,,,,,22.88,85.36,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,inpatient,,,89.00000,42.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,81.88,,,,,,,80.10,86.33,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,outpatient,,,89.00000,42.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,81.88,,,,,,,23.14,86.33,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,inpatient,,,61.00000,29.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,outpatient,,,61.00000,29.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,inpatient,,,77.00000,37.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,69.30,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,inpatient,,,77.00000,37.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,69.30,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,inpatient,,,64.00000,30.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,57.60,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,16.64,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,inpatient,,,64.00000,30.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,57.60,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,16.64,62.08,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,inpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,outpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,inpatient,,,95.00000,45.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,87.40,,,,,,,85.50,92.15,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,outpatient,,,95.00000,45.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,87.40,,,,,,,24.70,92.15,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,inpatient,,,132.00000,63.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,121.44,,,,,,,118.80,128.04,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,outpatient,,,132.00000,63.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,121.44,,,,,,,34.32,128.04,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,inpatient,,,83.00000,40.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,76.36,,,,,,,74.70,80.51,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,outpatient,,,83.00000,40.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,76.36,,,,,,,21.58,80.51,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,inpatient,,,387.00000,186.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,356.04,,,,,,,348.30,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,outpatient,,,387.00000,186.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,356.04,,,,,,,100.62,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,inpatient,,,387.00000,186.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,356.04,,,,,,,348.30,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,outpatient,,,387.00000,186.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,356.04,,,,,,,100.62,375.39,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,inpatient,,,31.00000,14.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28.52,,,,,,,27.90,30.07,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,outpatient,,,31.00000,14.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28.52,,,,,,,8.06,30.07,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,inpatient,,,36.00000,17.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,32.40,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,outpatient,,,36.00000,17.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,9.36,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,inpatient,,,160.00000,77.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,147.20,,,,,,,144.00,155.20,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,outpatient,,,160.00000,77.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,147.20,,,,,,,41.60,155.20,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,inpatient,,,112.00000,53.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,103.04,,,,,,,100.80,108.64,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,outpatient,,,112.00000,53.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,103.04,,,,,,,29.12,108.64,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,inpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,inpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,inpatient,,,14.00000,6.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12.88,,,,,,,12.60,13.58,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,outpatient,,,14.00000,6.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12.88,,,,,,,3.64,13.58,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,inpatient,,,16.00000,7.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14.72,,,,,,,14.40,15.52,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,outpatient,,,16.00000,7.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14.72,,,,,,,4.16,15.52,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,inpatient,,,71.00000,34.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,63.90,68.87,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,outpatient,,,71.00000,34.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,18.46,68.87,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,inpatient,,,116.00000,55.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,106.72,,,,,,,104.40,112.52,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,outpatient,,,116.00000,55.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,106.72,,,,,,,30.16,112.52,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,inpatient,,,81.00000,39.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,72.90,78.57,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,outpatient,,,81.00000,39.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,21.06,78.57,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,inpatient,,,97.00000,46.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,89.24,,,,,,,87.30,94.09,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,outpatient,,,97.00000,46.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,89.24,,,,,,,25.22,94.09,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,inpatient,,,77.00000,37.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,69.30,74.69,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,outpatient,,,77.00000,37.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,20.02,74.69,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,inpatient,,,35.00000,16.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32.20,,,,,,,31.50,33.95,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,outpatient,,,35.00000,16.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32.20,,,,,,,9.10,33.95,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,inpatient,,,65.00000,31.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,58.50,63.05,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,outpatient,,,65.00000,31.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,inpatient,,,74.00000,35.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68.08,,,,,,,66.60,71.78,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,outpatient,,,74.00000,35.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68.08,,,,,,,19.24,71.78,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,inpatient,,,250.00000,120.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,230.00,,,,,,,225.00,242.50,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,outpatient,,,250.00000,120.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,230.00,,,,,,,65.00,242.50,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,inpatient,,,90.00000,43.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,82.80,,,,,,,81.00,87.30,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,outpatient,,,90.00000,43.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,82.80,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,inpatient,,,90.00000,43.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,82.80,,,,,,,81.00,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,outpatient,,,90.00000,43.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,82.80,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,inpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,46.80,50.44,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,outpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,13.52,50.44,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,inpatient,,,36.00000,17.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,32.40,34.92,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,outpatient,,,36.00000,17.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,9.36,34.92,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,inpatient,,,78.00000,37.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,70.20,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,outpatient,,,78.00000,37.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,20.28,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,inpatient,,,115.00000,55.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,105.80,,,,,,,103.50,111.55,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,outpatient,,,115.00000,55.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,105.80,,,,,,,29.90,111.55,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,inpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,60.30,64.99,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,outpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,17.42,64.99,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,inpatient,,,76.00000,36.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.92,,,,,,,68.40,73.72,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,outpatient,,,76.00000,36.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.92,,,,,,,19.76,73.72,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,inpatient,,,53.00000,25.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,47.70,51.41,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,outpatient,,,53.00000,25.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,13.78,51.41,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,inpatient,,,70.00000,33.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,63.00,67.90,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,outpatient,,,70.00000,33.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,inpatient,,,169.00000,81.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,155.48,,,,,,,152.10,163.93,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,outpatient,,,169.00000,81.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,155.48,,,,,,,43.94,163.93,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,inpatient,,,28.00000,13.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,25.76,,,,,,,25.20,27.16,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,outpatient,,,28.00000,13.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,25.76,,,,,,,7.28,27.16,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,inpatient,,,51.00000,24.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,45.90,49.47,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,outpatient,,,51.00000,24.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,inpatient,,,15.00000,7.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,13.80,,,,,,,13.50,14.55,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,outpatient,,,15.00000,7.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,13.80,,,,,,,3.90,14.55,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,inpatient,,,18.00000,8.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16.56,,,,,,,16.20,17.46,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,outpatient,,,18.00000,8.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16.56,,,,,,,4.68,17.46,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,inpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,outpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,inpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,outpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,inpatient,,,61.00000,29.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,outpatient,,,61.00000,29.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,inpatient,,,550.00000,265.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,506.00,,,,,,,495.00,533.50,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,outpatient,,,550.00000,265.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,506.00,,,,,,,143.00,533.50,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,inpatient,,,73.00000,35.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,67.16,,,,,,,65.70,70.81,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,67.16,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,inpatient,,,392.00000,188.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,360.64,,,,,,,352.80,380.24,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,outpatient,,,392.00000,188.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,360.64,,,,,,,101.92,380.24,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,inpatient,,,75.00000,36.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.00,,,,,,,67.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,outpatient,,,75.00000,36.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,inpatient,,,73.00000,35.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,67.16,,,,,,,65.70,70.81,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,67.16,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,inpatient,,,100.00000,48.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,outpatient,,,100.00000,48.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,inpatient,,,153.00000,73.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,140.76,,,,,,,137.70,148.41,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,outpatient,,,153.00000,73.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,140.76,,,,,,,39.78,148.41,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,inpatient,,,909.00000,438.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,836.28,,,,,,,818.10,881.73,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,outpatient,,,909.00000,438.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,836.28,,,,,,,236.34,881.73,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,inpatient,,,266.00000,128.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,244.72,,,,,,,239.40,258.02,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,outpatient,,,266.00000,128.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,244.72,,,,,,,69.16,258.02,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,inpatient,,,275.00000,132.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,253.00,,,,,,,247.50,266.75,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,outpatient,,,275.00000,132.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,253.00,,,,,,,71.50,266.75,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,inpatient,,,61.00000,29.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,outpatient,,,61.00000,29.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,inpatient,,,84.00000,40.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,77.28,,,,,,,75.60,81.48,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,outpatient,,,84.00000,40.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,77.28,,,,,,,21.84,81.48,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,inpatient,,,174.00000,83.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,160.08,,,,,,,156.60,168.78,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,outpatient,,,174.00000,83.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,160.08,,,,,,,45.24,168.78,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,inpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,outpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,inpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,60.30,64.99,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,outpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,17.42,64.99,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,inpatient,,,68.00000,32.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,61.20,65.96,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,outpatient,,,68.00000,32.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,17.68,65.96,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,inpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,outpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,inpatient,,,211.00000,101.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,194.12,,,,,,,189.90,204.67,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,outpatient,,,211.00000,101.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,194.12,,,,,,,54.86,204.67,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,inpatient,,,65.00000,31.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,58.50,63.05,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,outpatient,,,65.00000,31.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,inpatient,,,83.00000,40.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,76.36,,,,,,,74.70,80.51,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,outpatient,,,83.00000,40.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,76.36,,,,,,,21.58,80.51,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,inpatient,,,54.00000,26.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,48.60,52.38,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,outpatient,,,54.00000,26.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,14.04,52.38,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,inpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,outpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,inpatient,,,323.00000,155.69000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,297.16,,,,,,,290.70,313.31,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,outpatient,,,323.00000,155.69000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,297.16,,,,,,,83.98,313.31,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,inpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,outpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,inpatient,,,35.00000,16.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32.20,,,,,,,31.50,33.95,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,outpatient,,,35.00000,16.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32.20,,,,,,,9.10,33.95,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,inpatient,,,20.00000,9.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18.40,,,,,,,18.00,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,outpatient,,,20.00000,9.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,inpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,outpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,inpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,inpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,inpatient,,,34.00000,16.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,31.28,,,,,,,30.60,32.98,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,outpatient,,,34.00000,16.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,31.28,,,,,,,8.84,32.98,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,inpatient,,,29.00000,13.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26.68,,,,,,,26.10,28.13,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,outpatient,,,29.00000,13.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26.68,,,,,,,7.54,28.13,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,inpatient,,,80.00000,38.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,73.60,,,,,,,72.00,77.60,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,outpatient,,,80.00000,38.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,73.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,inpatient,,,73.00000,35.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,67.16,,,,,,,65.70,70.81,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,outpatient,,,73.00000,35.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,67.16,,,,,,,18.98,70.81,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,inpatient,,,16.00000,7.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14.72,,,,,,,14.40,15.52,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,outpatient,,,16.00000,7.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14.72,,,,,,,4.16,15.52,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,inpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,46.80,50.44,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,outpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,13.52,50.44,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,inpatient,,,113.00000,54.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,103.96,,,,,,,101.70,109.61,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,outpatient,,,113.00000,54.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,103.96,,,,,,,29.38,109.61,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,inpatient,,,68.00000,32.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,61.20,65.96,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,outpatient,,,68.00000,32.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,17.68,65.96,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,inpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,inpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,inpatient,,,78.00000,37.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,70.20,75.66,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,outpatient,,,78.00000,37.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,20.28,75.66,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,inpatient,,,54.00000,26.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,48.60,52.38,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,outpatient,,,54.00000,26.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,14.04,52.38,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,inpatient,,,76.00000,36.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.92,,,,,,,68.40,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,outpatient,,,76.00000,36.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.92,,,,,,,19.76,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,inpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,60.30,64.99,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,outpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,17.42,64.99,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,inpatient,,,88.00000,42.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.96,,,,,,,79.20,85.36,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,outpatient,,,88.00000,42.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.96,,,,,,,22.88,85.36,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,inpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,outpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,inpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,60.30,64.99,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,outpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,17.42,64.99,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,inpatient,,,53.00000,25.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,47.70,51.41,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,outpatient,,,53.00000,25.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,13.78,51.41,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,inpatient,,,88.00000,42.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.96,,,,,,,79.20,85.36,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,outpatient,,,88.00000,42.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.96,,,,,,,22.88,85.36,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,inpatient,,,105.00000,50.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,96.60,,,,,,,94.50,101.85,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,outpatient,,,105.00000,50.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,96.60,,,,,,,27.30,101.85,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,inpatient,,,73.00000,35.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,67.16,,,,,,,65.70,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,67.16,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,inpatient,,,83.00000,40.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,76.36,,,,,,,74.70,80.51,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,outpatient,,,83.00000,40.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,76.36,,,,,,,21.58,80.51,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,inpatient,,,154.00000,74.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,141.68,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,141.68,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,inpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,outpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,inpatient,,,97.00000,46.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,89.24,,,,,,,87.30,94.09,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,outpatient,,,97.00000,46.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,89.24,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,inpatient,,,154.00000,74.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,141.68,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,141.68,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,inpatient,,,87.00000,41.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.04,,,,,,,78.30,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,outpatient,,,87.00000,41.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.04,,,,,,,22.62,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,inpatient,,,68.00000,32.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,61.20,65.96,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,outpatient,,,68.00000,32.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,17.68,65.96,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,inpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,46.80,50.44,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,outpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,13.52,50.44,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,inpatient,,,51.00000,24.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,45.90,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,outpatient,,,51.00000,24.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,inpatient,,,97.00000,46.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,89.24,,,,,,,87.30,94.09,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,outpatient,,,97.00000,46.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,89.24,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,inpatient,,,176.00000,84.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,161.92,,,,,,,158.40,170.72,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,outpatient,,,176.00000,84.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,161.92,,,,,,,45.76,170.72,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,inpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,outpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,inpatient,,,158.00000,76.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,145.36,,,,,,,142.20,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,outpatient,,,158.00000,76.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,145.36,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,inpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,outpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,inpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,outpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,inpatient,,,84.00000,40.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,77.28,,,,,,,75.60,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,outpatient,,,84.00000,40.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,77.28,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,inpatient,,,189.00000,91.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,173.88,,,,,,,170.10,183.33,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,outpatient,,,189.00000,91.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,173.88,,,,,,,49.14,183.33,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,inpatient,,,109.00000,52.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100.28,,,,,,,98.10,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,outpatient,,,109.00000,52.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100.28,,,,,,,28.34,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,inpatient,,,129.00000,62.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,116.10,125.13,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,outpatient,,,129.00000,62.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,33.54,125.13,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,inpatient,,,84.00000,40.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,77.28,,,,,,,75.60,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,outpatient,,,84.00000,40.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,77.28,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,inpatient,,,73.00000,35.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,67.16,,,,,,,65.70,70.81,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,67.16,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,inpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,outpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,inpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,outpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,inpatient,,,149.00000,71.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,137.08,,,,,,,134.10,144.53,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,outpatient,,,149.00000,71.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,137.08,,,,,,,38.74,144.53,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,inpatient,,,130.00000,62.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,119.60,,,,,,,117.00,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,outpatient,,,130.00000,62.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,119.60,,,,,,,33.80,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,inpatient,,,110.00000,53.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,99.00,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,outpatient,,,110.00000,53.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,28.60,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,inpatient,,,158.00000,76.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,145.36,,,,,,,142.20,153.26,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,outpatient,,,158.00000,76.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,145.36,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,inpatient,,,117.00000,56.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,107.64,,,,,,,105.30,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,outpatient,,,117.00000,56.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,107.64,,,,,,,30.42,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,inpatient,,,61.00000,29.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,outpatient,,,61.00000,29.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,inpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,outpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,inpatient,,,145.00000,69.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,133.40,,,,,,,130.50,140.65,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,outpatient,,,145.00000,69.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,133.40,,,,,,,37.70,140.65,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,inpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,outpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,inpatient,,,165.00000,79.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,151.80,,,,,,,148.50,160.05,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,outpatient,,,165.00000,79.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,151.80,,,,,,,42.90,160.05,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,inpatient,,,70.00000,33.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,outpatient,,,70.00000,33.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,inpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,outpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,inpatient,,,154.00000,74.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,141.68,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,outpatient,,,154.00000,74.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,141.68,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,inpatient,,,104.00000,50.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,95.68,,,,,,,93.60,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,outpatient,,,104.00000,50.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,95.68,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,inpatient,,,70.00000,33.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,outpatient,,,70.00000,33.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,inpatient,,,104.00000,50.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,95.68,,,,,,,93.60,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,outpatient,,,104.00000,50.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,95.68,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,inpatient,,,70.00000,33.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,outpatient,,,70.00000,33.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,inpatient,,,123.00000,59.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,113.16,,,,,,,110.70,119.31,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,outpatient,,,123.00000,59.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,113.16,,,,,,,31.98,119.31,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,inpatient,,,95.00000,45.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,87.40,,,,,,,85.50,92.15,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,outpatient,,,95.00000,45.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,87.40,,,,,,,24.70,92.15,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,inpatient,,,160.00000,77.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,147.20,,,,,,,144.00,155.20,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,outpatient,,,160.00000,77.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,147.20,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,inpatient,,,147.00000,70.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,135.24,,,,,,,132.30,142.59,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,outpatient,,,147.00000,70.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,135.24,,,,,,,38.22,142.59,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,inpatient,,,178.00000,85.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,163.76,,,,,,,160.20,172.66,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,outpatient,,,178.00000,85.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,163.76,,,,,,,46.28,172.66,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,inpatient,,,160.00000,77.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,147.20,,,,,,,144.00,155.20,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,outpatient,,,160.00000,77.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,147.20,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,inpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,outpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,inpatient,,,70.00000,33.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,outpatient,,,70.00000,33.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,inpatient,,,449.00000,216.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,413.08,,,,,,,404.10,435.53,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,outpatient,,,449.00000,216.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,413.08,,,,,,,116.74,435.53,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,inpatient,,,104.00000,50.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,95.68,,,,,,,93.60,100.88,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,outpatient,,,104.00000,50.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,95.68,,,,,,,27.04,100.88,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,inpatient,,,185.00000,89.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,170.20,,,,,,,166.50,179.45,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,170.20,,,,,,,48.10,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,inpatient,,,185.00000,89.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,170.20,,,,,,,166.50,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,170.20,,,,,,,48.10,179.45,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,inpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,outpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,inpatient,,,84.00000,40.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,77.28,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,outpatient,,,84.00000,40.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,77.28,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,inpatient,,,84.00000,40.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,77.28,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,77.28,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,inpatient,,,84.00000,40.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,77.28,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,77.28,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,inpatient,,,73.00000,35.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,67.16,,,,,,,65.70,70.81,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,67.16,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,inpatient,,,73.00000,35.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,67.16,,,,,,,65.70,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,67.16,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,inpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,inpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,inpatient,,,98.00000,47.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,88.20,95.06,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,outpatient,,,98.00000,47.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,25.48,95.06,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,inpatient,,,75.00000,36.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.00,,,,,,,67.50,72.75,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,outpatient,,,75.00000,36.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,inpatient,,,107.00000,51.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,98.44,,,,,,,96.30,103.79,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,outpatient,,,107.00000,51.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,98.44,,,,,,,27.82,103.79,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,inpatient,,,81.00000,39.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,72.90,78.57,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,outpatient,,,81.00000,39.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,21.06,78.57,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,inpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,outpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,inpatient,,,68.00000,32.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,61.20,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,outpatient,,,68.00000,32.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,17.68,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,inpatient,,,51.00000,24.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,45.90,49.47,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,outpatient,,,51.00000,24.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,inpatient,,,74.00000,35.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68.08,,,,,,,66.60,71.78,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,outpatient,,,74.00000,35.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68.08,,,,,,,19.24,71.78,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,inpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,outpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,inpatient,,,194.00000,93.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,178.48,,,,,,,174.60,188.18,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,outpatient,,,194.00000,93.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,178.48,,,,,,,50.44,188.18,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,inpatient,,,111.00000,53.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,102.12,,,,,,,99.90,107.67,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,outpatient,,,111.00000,53.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,102.12,,,,,,,28.86,107.67,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,inpatient,,,77.00000,37.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,69.30,74.69,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,outpatient,,,77.00000,37.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,20.02,74.69,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,71.10,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,71.10,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,inpatient,,,237.00000,114.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,218.04,,,,,,,213.30,229.89,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,218.04,,,,,,,61.62,229.89,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,inpatient,,,51.00000,24.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,45.90,49.47,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,outpatient,,,51.00000,24.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,inpatient,,,82.00000,39.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,75.44,,,,,,,73.80,79.54,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,75.44,,,,,,,21.32,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,inpatient,,,82.00000,39.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,75.44,,,,,,,73.80,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,75.44,,,,,,,21.32,79.54,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,inpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,60.30,64.99,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,outpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,17.42,64.99,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,inpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,inpatient,,,131.00000,63.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,120.52,,,,,,,117.90,127.07,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,outpatient,,,131.00000,63.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,120.52,,,,,,,34.06,127.07,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,inpatient,,,15.00000,7.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,13.80,,,,,,,13.50,14.55,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,outpatient,,,15.00000,7.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,13.80,,,,,,,3.90,14.55,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,inpatient,,,39.00000,18.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,35.88,,,,,,,35.10,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,outpatient,,,39.00000,18.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,35.88,,,,,,,10.14,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,inpatient,,,12.00000,5.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11.04,,,,,,,10.80,11.64,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,outpatient,,,12.00000,5.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11.04,,,,,,,3.12,11.64,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,inpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,inpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,outpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,inpatient,,,203.00000,97.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,186.76,,,,,,,182.70,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,186.76,,,,,,,52.78,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,inpatient,,,203.00000,97.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,186.76,,,,,,,182.70,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,186.76,,,,,,,52.78,196.91,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,inpatient,,,99.00000,47.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,91.08,,,,,,,89.10,96.03,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,outpatient,,,99.00000,47.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,91.08,,,,,,,25.74,96.03,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,inpatient,,,53.00000,25.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,47.70,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,outpatient,,,53.00000,25.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,13.78,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,inpatient,,,23.00000,11.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,21.16,,,,,,,20.70,22.31,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,outpatient,,,23.00000,11.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,21.16,,,,,,,5.98,22.31,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,inpatient,,,46.00000,22.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,42.32,,,,,,,41.40,44.62,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,outpatient,,,46.00000,22.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,42.32,,,,,,,11.96,44.62,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,inpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,60.30,64.99,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,outpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,17.42,64.99,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,inpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,outpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,inpatient,,,288.00000,138.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,264.96,,,,,,,259.20,279.36,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,outpatient,,,288.00000,138.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,264.96,,,,,,,74.88,279.36,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,inpatient,,,106.00000,51.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,outpatient,,,106.00000,51.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,inpatient,,,30.00000,14.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,27.60,,,,,,,27.00,29.10,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,outpatient,,,30.00000,14.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,27.60,,,,,,,7.80,29.10,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,inpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,outpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,inpatient,,,71.00000,34.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,63.90,68.87,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,outpatient,,,71.00000,34.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,18.46,68.87,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,inpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,60.30,64.99,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,outpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,17.42,64.99,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,inpatient,,,89.00000,42.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,81.88,,,,,,,80.10,86.33,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,outpatient,,,89.00000,42.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,81.88,,,,,,,23.14,86.33,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,inpatient,,,116.00000,55.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,106.72,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,outpatient,,,116.00000,55.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,106.72,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,inpatient,,,116.00000,55.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,106.72,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,106.72,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,inpatient,,,116.00000,55.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,106.72,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,106.72,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,inpatient,,,51.00000,24.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,45.90,49.47,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,outpatient,,,51.00000,24.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,inpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,outpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,inpatient,,,174.00000,83.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,160.08,,,,,,,156.60,168.78,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,outpatient,,,174.00000,83.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,160.08,,,,,,,45.24,168.78,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,inpatient,,,82.00000,39.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,75.44,,,,,,,73.80,79.54,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,outpatient,,,82.00000,39.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,75.44,,,,,,,21.32,79.54,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,inpatient,,,112.00000,53.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,103.04,,,,,,,100.80,108.64,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,outpatient,,,112.00000,53.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,103.04,,,,,,,29.12,108.64,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,inpatient,,,61.00000,29.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,outpatient,,,61.00000,29.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,inpatient,,,69.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,62.10,66.93,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,outpatient,,,69.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,17.94,66.93,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,inpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,inpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,46.80,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,outpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,13.52,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,inpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,inpatient,,,286.00000,137.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,263.12,,,,,,,257.40,277.42,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,outpatient,,,286.00000,137.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,263.12,,,,,,,74.36,277.42,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,inpatient,,,300.00000,144.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,276.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,outpatient,,,300.00000,144.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,276.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,inpatient,,,73.00000,35.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,67.16,,,,,,,65.70,70.81,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,outpatient,,,73.00000,35.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,67.16,,,,,,,18.98,70.81,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,inpatient,,,90.00000,43.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,82.80,,,,,,,81.00,87.30,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,outpatient,,,90.00000,43.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,82.80,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,inpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,outpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,inpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,46.80,50.44,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,inpatient,,,315.00000,151.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,289.80,,,,,,,283.50,305.55,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,outpatient,,,315.00000,151.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,289.80,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,inpatient,,,100.00000,48.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,outpatient,,,100.00000,48.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,inpatient,,,89.00000,42.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,81.88,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,outpatient,,,89.00000,42.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,81.88,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,inpatient,,,71.00000,34.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,63.90,68.87,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,outpatient,,,71.00000,34.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,18.46,68.87,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,inpatient,,,135.00000,65.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,124.20,,,,,,,121.50,130.95,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,outpatient,,,135.00000,65.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,124.20,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,inpatient,,,80.00000,38.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,73.60,,,,,,,72.00,77.60,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,outpatient,,,80.00000,38.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,73.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,inpatient,,,72.00000,34.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,inpatient,,,72.00000,34.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,inpatient,,,100.00000,48.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,outpatient,,,100.00000,48.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,inpatient,,,305.00000,147.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,280.60,,,,,,,274.50,295.85,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,outpatient,,,305.00000,147.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,280.60,,,,,,,79.30,295.85,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,inpatient,,,70.00000,33.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,63.00,67.90,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,outpatient,,,70.00000,33.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,inpatient,,,69.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,62.10,66.93,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,outpatient,,,69.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,17.94,66.93,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,inpatient,,,64.00000,30.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,57.60,62.08,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,outpatient,,,64.00000,30.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,16.64,62.08,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,inpatient,,,368.00000,177.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,338.56,,,,,,,331.20,356.96,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,outpatient,,,368.00000,177.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,338.56,,,,,,,95.68,356.96,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,inpatient,,,104.00000,50.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,95.68,,,,,,,93.60,100.88,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,outpatient,,,104.00000,50.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,95.68,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,inpatient,,,109.00000,52.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100.28,,,,,,,98.10,105.73,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,outpatient,,,109.00000,52.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100.28,,,,,,,28.34,105.73,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,inpatient,,,114.00000,54.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,102.60,110.58,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,outpatient,,,114.00000,54.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,inpatient,,,135.00000,65.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,124.20,,,,,,,121.50,130.95,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,outpatient,,,135.00000,65.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,124.20,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,inpatient,,,105.00000,50.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,96.60,,,,,,,94.50,101.85,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,outpatient,,,105.00000,50.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,96.60,,,,,,,27.30,101.85,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,inpatient,,,315.00000,151.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,289.80,,,,,,,283.50,305.55,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,outpatient,,,315.00000,151.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,289.80,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,inpatient,,,148.00000,71.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,136.16,,,,,,,133.20,143.56,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,outpatient,,,148.00000,71.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,136.16,,,,,,,38.48,143.56,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,inpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,outpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,inpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,60.30,64.99,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,outpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,17.42,64.99,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,inpatient,,,107.00000,51.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,98.44,,,,,,,96.30,103.79,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,outpatient,,,107.00000,51.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,98.44,,,,,,,27.82,103.79,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,inpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,outpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,inpatient,,,35.00000,16.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32.20,,,,,,,31.50,33.95,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,outpatient,,,35.00000,16.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32.20,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,inpatient,,,104.00000,50.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,95.68,,,,,,,93.60,100.88,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,outpatient,,,104.00000,50.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,95.68,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,inpatient,,,650.00000,313.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,598.00,,,,,,,585.00,630.50,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,outpatient,,,650.00000,313.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,598.00,,,,,,,169.00,630.50,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,inpatient,,,91.00000,43.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,83.72,,,,,,,81.90,88.27,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,outpatient,,,91.00000,43.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,83.72,,,,,,,23.66,88.27,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,inpatient,,,114.00000,54.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,102.60,110.58,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,outpatient,,,114.00000,54.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,inpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,46.80,50.44,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,inpatient,,,360.00000,173.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,331.20,,,,,,,324.00,349.20,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,outpatient,,,360.00000,173.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,331.20,,,,,,,93.60,349.20,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,inpatient,,,106.00000,51.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,outpatient,,,106.00000,51.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,inpatient,,,78.00000,37.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,70.20,75.66,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,outpatient,,,78.00000,37.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,inpatient,,,72.00000,34.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,outpatient,,,72.00000,34.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,inpatient,,,94.00000,45.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,86.48,,,,,,,84.60,91.18,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,outpatient,,,94.00000,45.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,86.48,,,,,,,24.44,91.18,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,inpatient,,,101.00000,48.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92.92,,,,,,,90.90,97.97,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,outpatient,,,101.00000,48.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92.92,,,,,,,26.26,97.97,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,inpatient,,,82.00000,39.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,75.44,,,,,,,73.80,79.54,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,outpatient,,,82.00000,39.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,75.44,,,,,,,21.32,79.54,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,inpatient,,,77.00000,37.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,69.30,74.69,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,outpatient,,,77.00000,37.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,20.02,74.69,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,inpatient,,,145.00000,69.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,133.40,,,,,,,130.50,140.65,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,outpatient,,,145.00000,69.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,133.40,,,,,,,37.70,140.65,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,inpatient,,,266.00000,128.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,244.72,,,,,,,239.40,258.02,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,outpatient,,,266.00000,128.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,244.72,,,,,,,69.16,258.02,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,inpatient,,,79.00000,38.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,71.10,76.63,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,outpatient,,,79.00000,38.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,20.54,76.63,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,inpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,outpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,inpatient,,,144.00000,69.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,132.48,,,,,,,129.60,139.68,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,outpatient,,,144.00000,69.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,132.48,,,,,,,37.44,139.68,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,inpatient,,,20.00000,9.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18.40,,,,,,,18.00,19.40,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,outpatient,,,20.00000,9.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,inpatient,,,208.00000,100.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,191.36,,,,,,,187.20,201.76,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,outpatient,,,208.00000,100.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,191.36,,,,,,,54.08,201.76,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,inpatient,,,135.00000,65.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,124.20,,,,,,,121.50,130.95,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,outpatient,,,135.00000,65.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,124.20,,,,,,,35.10,130.95,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,inpatient,,,131.00000,63.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,120.52,,,,,,,117.90,127.07,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,outpatient,,,131.00000,63.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,120.52,,,,,,,34.06,127.07,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,inpatient,,,69.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,62.10,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,outpatient,,,69.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,17.94,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,inpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,outpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,inpatient,,,25.00000,12.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.00,,,,,,,22.50,24.25,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,outpatient,,,25.00000,12.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.00,,,,,,,6.50,24.25,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,inpatient,,,61.00000,29.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,outpatient,,,61.00000,29.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,inpatient,,,80.00000,38.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,73.60,,,,,,,72.00,77.60,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,outpatient,,,80.00000,38.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,73.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,inpatient,,,82.00000,39.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,75.44,,,,,,,73.80,79.54,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,outpatient,,,82.00000,39.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,75.44,,,,,,,21.32,79.54,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,inpatient,,,35.00000,16.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32.20,,,,,,,31.50,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,outpatient,,,35.00000,16.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32.20,,,,,,,9.10,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,inpatient,,,88.00000,42.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.96,,,,,,,79.20,85.36,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,outpatient,,,88.00000,42.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.96,,,,,,,22.88,85.36,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,inpatient,,,98.00000,47.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,88.20,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,outpatient,,,98.00000,47.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,25.48,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,inpatient,,,204.00000,98.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,187.68,,,,,,,183.60,197.88,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,outpatient,,,204.00000,98.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,187.68,,,,,,,53.04,197.88,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,inpatient,,,61.00000,29.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,outpatient,,,61.00000,29.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,inpatient,,,19.00000,9.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,17.48,,,,,,,17.10,18.43,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,outpatient,,,19.00000,9.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,17.48,,,,,,,4.94,18.43,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,inpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,outpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,inpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,outpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,inpatient,,,37.00000,17.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,34.04,,,,,,,33.30,35.89,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,outpatient,,,37.00000,17.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,34.04,,,,,,,9.62,35.89,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,inpatient,,,79.00000,38.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,71.10,76.63,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,outpatient,,,79.00000,38.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,20.54,76.63,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,inpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,outpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,inpatient,,,21.00000,10.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,19.32,,,,,,,18.90,20.37,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,outpatient,,,21.00000,10.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,19.32,,,,,,,5.46,20.37,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,inpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,46.80,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,outpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,13.52,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,inpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,outpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,inpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,outpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,inpatient,,,32.00000,15.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,29.44,,,,,,,28.80,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,outpatient,,,32.00000,15.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,29.44,,,,,,,8.32,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,inpatient,,,94.00000,45.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,86.48,,,,,,,84.60,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,outpatient,,,94.00000,45.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,86.48,,,,,,,24.44,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,inpatient,,,103.00000,49.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,94.76,,,,,,,92.70,99.91,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,outpatient,,,103.00000,49.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,94.76,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,inpatient,,,64.00000,30.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,57.60,62.08,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,outpatient,,,64.00000,30.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,16.64,62.08,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,inpatient,,,102.00000,49.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,91.80,98.94,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,outpatient,,,102.00000,49.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,26.52,98.94,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,inpatient,,,103.00000,49.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,94.76,,,,,,,92.70,99.91,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,outpatient,,,103.00000,49.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,94.76,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,inpatient,,,139.00000,67.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,127.88,,,,,,,125.10,134.83,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,outpatient,,,139.00000,67.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,127.88,,,,,,,36.14,134.83,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,inpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,46.80,50.44,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,outpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,13.52,50.44,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,inpatient,,,21.00000,10.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,19.32,,,,,,,18.90,20.37,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,19.32,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,inpatient,,,88.00000,42.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.96,,,,,,,79.20,85.36,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,outpatient,,,88.00000,42.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.96,,,,,,,22.88,85.36,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,inpatient,,,21.00000,10.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,19.32,,,,,,,18.90,20.37,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,19.32,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,inpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,46.80,50.44,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,outpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,13.52,50.44,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,inpatient,,,80.00000,38.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,73.60,,,,,,,72.00,77.60,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,outpatient,,,80.00000,38.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,73.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,inpatient,,,49.00000,23.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,45.08,,,,,,,44.10,47.53,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,outpatient,,,49.00000,23.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,45.08,,,,,,,12.74,47.53,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,inpatient,,,88.00000,42.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.96,,,,,,,79.20,85.36,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,outpatient,,,88.00000,42.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.96,,,,,,,22.88,85.36,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,inpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,outpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,inpatient,,,68.00000,32.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,61.20,65.96,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,outpatient,,,68.00000,32.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,17.68,65.96,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,inpatient,,,93.00000,44.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,85.56,,,,,,,83.70,90.21,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,outpatient,,,93.00000,44.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,85.56,,,,,,,24.18,90.21,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,inpatient,,,73.00000,35.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,67.16,,,,,,,65.70,70.81,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,outpatient,,,73.00000,35.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,67.16,,,,,,,18.98,70.81,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,inpatient,,,41.00000,19.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,37.72,,,,,,,36.90,39.77,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,outpatient,,,41.00000,19.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,37.72,,,,,,,10.66,39.77,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,inpatient,,,94.00000,45.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,86.48,,,,,,,84.60,91.18,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,outpatient,,,94.00000,45.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,86.48,,,,,,,24.44,91.18,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,inpatient,,,124.00000,59.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,114.08,,,,,,,111.60,120.28,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,outpatient,,,124.00000,59.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,114.08,,,,,,,32.24,120.28,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,inpatient,,,71.00000,34.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,63.90,68.87,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,outpatient,,,71.00000,34.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,18.46,68.87,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,inpatient,,,33.00000,15.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,30.36,,,,,,,29.70,32.01,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,outpatient,,,33.00000,15.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,30.36,,,,,,,8.58,32.01,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,inpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,46.80,50.44,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,outpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,13.52,50.44,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,inpatient,,,68.00000,32.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,61.20,65.96,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,outpatient,,,68.00000,32.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,17.68,65.96,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,inpatient,,,99.00000,47.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,91.08,,,,,,,89.10,96.03,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,outpatient,,,99.00000,47.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,91.08,,,,,,,25.74,96.03,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,inpatient,,,197.00000,94.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,181.24,,,,,,,177.30,191.09,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,outpatient,,,197.00000,94.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,181.24,,,,,,,51.22,191.09,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,inpatient,,,194.00000,93.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,178.48,,,,,,,174.60,188.18,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,outpatient,,,194.00000,93.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,178.48,,,,,,,50.44,188.18,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,inpatient,,,68.00000,32.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,61.20,65.96,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,outpatient,,,68.00000,32.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,17.68,65.96,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,inpatient,,,90.00000,43.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,82.80,,,,,,,81.00,87.30,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,outpatient,,,90.00000,43.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,82.80,,,,,,,23.40,87.30,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,inpatient,,,109.00000,52.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100.28,,,,,,,98.10,105.73,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,outpatient,,,109.00000,52.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100.28,,,,,,,28.34,105.73,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,inpatient,,,108.00000,52.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,99.36,,,,,,,97.20,104.76,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,outpatient,,,108.00000,52.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,99.36,,,,,,,28.08,104.76,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,inpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,60.30,64.99,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,outpatient,,,67.00000,32.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,17.42,64.99,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,inpatient,,,69.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,62.10,66.93,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,outpatient,,,69.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,inpatient,,,71.00000,34.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,63.90,68.87,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,outpatient,,,71.00000,34.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,18.46,68.87,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,inpatient,,,98.00000,47.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,88.20,95.06,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,outpatient,,,98.00000,47.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,25.48,95.06,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,inpatient,,,141.00000,67.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,129.72,,,,,,,126.90,136.77,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,outpatient,,,141.00000,67.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,129.72,,,,,,,36.66,136.77,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,inpatient,,,226.00000,108.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,207.92,,,,,,,203.40,219.22,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,outpatient,,,226.00000,108.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,207.92,,,,,,,58.76,219.22,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,inpatient,,,92.00000,44.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,84.64,,,,,,,82.80,89.24,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,outpatient,,,92.00000,44.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,84.64,,,,,,,23.92,89.24,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,inpatient,,,69.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,62.10,66.93,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,outpatient,,,69.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,inpatient,,,100.00000,48.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,outpatient,,,100.00000,48.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,inpatient,,,124.00000,59.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,114.08,,,,,,,111.60,120.28,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,outpatient,,,124.00000,59.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,114.08,,,,,,,32.24,120.28,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,inpatient,,,69.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,62.10,66.93,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,outpatient,,,69.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,17.94,66.93,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,114.08,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,114.08,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,114.08,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,114.08,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,114.08,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,114.08,,,,,,,32.24,120.28,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,inpatient,,,118.00000,56.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,108.56,,,,,,,106.20,114.46,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,outpatient,,,118.00000,56.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,108.56,,,,,,,30.68,114.46,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,inpatient,,,51.00000,24.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,45.90,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,outpatient,,,51.00000,24.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,inpatient,,,104.00000,50.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,95.68,,,,,,,93.60,100.88,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,outpatient,,,104.00000,50.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,95.68,,,,,,,27.04,100.88,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,inpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,outpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,inpatient,,,72.00000,34.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,64.80,69.84,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,outpatient,,,72.00000,34.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,18.72,69.84,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,inpatient,,,54.00000,26.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,48.60,52.38,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,outpatient,,,54.00000,26.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,14.04,52.38,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,inpatient,,,17.00000,8.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,15.64,,,,,,,15.30,16.49,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,outpatient,,,17.00000,8.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,15.64,,,,,,,4.42,16.49,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,inpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,outpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,inpatient,,,36.00000,17.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,32.40,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,outpatient,,,36.00000,17.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,9.36,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,inpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,46.80,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,outpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,13.52,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,inpatient,,,18.00000,8.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16.56,,,,,,,16.20,17.46,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,outpatient,,,18.00000,8.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16.56,,,,,,,4.68,17.46,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,inpatient,,,74.00000,35.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68.08,,,,,,,66.60,71.78,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,outpatient,,,74.00000,35.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68.08,,,,,,,19.24,71.78,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,inpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,outpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,inpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,outpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,inpatient,,,118.00000,56.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,108.56,,,,,,,106.20,114.46,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,outpatient,,,118.00000,56.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,108.56,,,,,,,30.68,114.46,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,inpatient,,,82.00000,39.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,75.44,,,,,,,73.80,79.54,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,outpatient,,,82.00000,39.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,75.44,,,,,,,21.32,79.54,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,inpatient,,,30.00000,14.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,27.60,,,,,,,27.00,29.10,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,outpatient,,,30.00000,14.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,27.60,,,,,,,7.80,29.10,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,inpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,outpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,inpatient,,,70.00000,33.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,63.00,67.90,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,outpatient,,,70.00000,33.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,inpatient,,,54.00000,26.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,48.60,52.38,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,outpatient,,,54.00000,26.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,14.04,52.38,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,inpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,outpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,inpatient,,,51.00000,24.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,45.90,49.47,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,outpatient,,,51.00000,24.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,inpatient,,,141.00000,67.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,129.72,,,,,,,126.90,136.77,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,outpatient,,,141.00000,67.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,129.72,,,,,,,36.66,136.77,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,inpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,outpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,inpatient,,,81.00000,39.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,72.90,78.57,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,outpatient,,,81.00000,39.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,21.06,78.57,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,inpatient,,,335.00000,161.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,308.20,,,,,,,301.50,324.95,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,outpatient,,,335.00000,161.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,308.20,,,,,,,87.10,324.95,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,inpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,46.80,50.44,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,outpatient,,,52.00000,25.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,13.52,50.44,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,inpatient,,,54.00000,26.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,48.60,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,inpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,outpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,inpatient,,,54.00000,26.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,48.60,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,inpatient,,,53.00000,25.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,47.70,51.41,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,outpatient,,,53.00000,25.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,inpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,outpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,inpatient,,,53.00000,25.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,47.70,51.41,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,outpatient,,,53.00000,25.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,inpatient,,,12.00000,5.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11.04,,,,,,,10.80,11.64,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,outpatient,,,12.00000,5.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11.04,,,,,,,3.12,11.64,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,inpatient,,,710.00000,342.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,653.20,,,,,,,639.00,688.70,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,outpatient,,,710.00000,342.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,653.20,,,,,,,184.60,688.70,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,inpatient,,,104.00000,50.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,95.68,,,,,,,93.60,100.88,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,outpatient,,,104.00000,50.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,95.68,,,,,,,27.04,100.88,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,inpatient,,,155.00000,74.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,142.60,,,,,,,139.50,150.35,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,outpatient,,,155.00000,74.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,142.60,,,,,,,40.30,150.35,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,inpatient,,,139.00000,67.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,127.88,,,,,,,125.10,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,outpatient,,,139.00000,67.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,127.88,,,,,,,36.14,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,inpatient,,,89.00000,42.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,81.88,,,,,,,80.10,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,outpatient,,,89.00000,42.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,81.88,,,,,,,23.14,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,inpatient,,,88.00000,42.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.96,,,,,,,79.20,85.36,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,outpatient,,,88.00000,42.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.96,,,,,,,22.88,85.36,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,inpatient,,,111.00000,53.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,102.12,,,,,,,99.90,107.67,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,outpatient,,,111.00000,53.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,102.12,,,,,,,28.86,107.67,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,inpatient,,,70.00000,33.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,63.00,67.90,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,outpatient,,,70.00000,33.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,inpatient,,,85.00000,40.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,78.20,,,,,,,76.50,82.45,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,outpatient,,,85.00000,40.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,78.20,,,,,,,22.10,82.45,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,inpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,outpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,inpatient,,,110.00000,53.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,99.00,106.70,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,outpatient,,,110.00000,53.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,28.60,106.70,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,inpatient,,,500.00000,241.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,460.00,,,,,,,450.00,485.00,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,outpatient,,,500.00000,241.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,460.00,,,,,,,130.00,485.00,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,inpatient,,,140.00000,67.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,128.80,,,,,,,126.00,135.80,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,outpatient,,,140.00000,67.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,128.80,,,,,,,36.40,135.80,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,inpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,outpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,inpatient,,,74.00000,35.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68.08,,,,,,,66.60,71.78,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,outpatient,,,74.00000,35.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68.08,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,inpatient,,,77.00000,37.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,69.30,74.69,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,outpatient,,,77.00000,37.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,20.02,74.69,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,inpatient,,,93.00000,44.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,85.56,,,,,,,83.70,90.21,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,outpatient,,,93.00000,44.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,85.56,,,,,,,24.18,90.21,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,inpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,outpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,inpatient,,,15.00000,7.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,13.80,,,,,,,13.50,14.55,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,outpatient,,,15.00000,7.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,13.80,,,,,,,3.90,14.55,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,inpatient,,,24.00000,11.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22.08,,,,,,,21.60,23.28,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,outpatient,,,24.00000,11.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22.08,,,,,,,6.24,23.28,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,inpatient,,,72.00000,34.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,64.80,69.84,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,outpatient,,,72.00000,34.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,18.72,69.84,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,inpatient,,,16.00000,7.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14.72,,,,,,,14.40,15.52,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14.72,,,,,,,4.16,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,inpatient,,,16.00000,7.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14.72,,,,,,,14.40,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14.72,,,,,,,4.16,15.52,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,inpatient,,,64.00000,30.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,57.60,62.08,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,outpatient,,,64.00000,30.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,16.64,62.08,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,inpatient,,,82.00000,39.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,75.44,,,,,,,73.80,79.54,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,outpatient,,,82.00000,39.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,75.44,,,,,,,21.32,79.54,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,inpatient,,,157.00000,75.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,144.44,,,,,,,141.30,152.29,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,outpatient,,,157.00000,75.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,144.44,,,,,,,40.82,152.29,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,inpatient,,,70.00000,33.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,63.00,67.90,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,outpatient,,,70.00000,33.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,inpatient,,,229.00000,110.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,210.68,,,,,,,206.10,222.13,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,outpatient,,,229.00000,110.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,210.68,,,,,,,59.54,222.13,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,inpatient,,,64.00000,30.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,57.60,62.08,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,outpatient,,,64.00000,30.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,16.64,62.08,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,inpatient,,,72.00000,34.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,64.80,69.84,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,outpatient,,,72.00000,34.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,18.72,69.84,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,inpatient,,,17.00000,8.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,15.64,,,,,,,15.30,16.49,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,outpatient,,,17.00000,8.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,15.64,,,,,,,4.42,16.49,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,inpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,outpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,inpatient,,,64.00000,30.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,57.60,62.08,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,outpatient,,,64.00000,30.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,16.64,62.08,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,inpatient,,,387.00000,186.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,356.04,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,outpatient,,,387.00000,186.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,356.04,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,inpatient,,,387.00000,186.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,356.04,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,356.04,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,inpatient,,,387.00000,186.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,356.04,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,356.04,,,,,,,100.62,375.39,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,inpatient,,,77.00000,37.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,69.30,74.69,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,outpatient,,,77.00000,37.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,20.02,74.69,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,inpatient,,,78.00000,37.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,70.20,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,20.28,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,inpatient,,,78.00000,37.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,70.20,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,20.28,75.66,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,inpatient,,,43.00000,20.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,39.56,,,,,,,38.70,41.71,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,outpatient,,,43.00000,20.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,39.56,,,,,,,11.18,41.71,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,inpatient,,,64.00000,30.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,57.60,62.08,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,outpatient,,,64.00000,30.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,16.64,62.08,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,inpatient,,,160.00000,77.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,147.20,,,,,,,144.00,155.20,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,outpatient,,,160.00000,77.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,147.20,,,,,,,41.60,155.20,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,inpatient,,,112.00000,53.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,103.04,,,,,,,100.80,108.64,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,outpatient,,,112.00000,53.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,103.04,,,,,,,29.12,108.64,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,inpatient,,,82.00000,39.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,75.44,,,,,,,73.80,79.54,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,outpatient,,,82.00000,39.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,75.44,,,,,,,21.32,79.54,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,inpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,outpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,inpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,outpatient,,,55.00000,26.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,inpatient,,,54.00000,26.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,48.60,52.38,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,outpatient,,,54.00000,26.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,14.04,52.38,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,inpatient,,,153.00000,73.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,140.76,,,,,,,137.70,148.41,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,outpatient,,,153.00000,73.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,140.76,,,,,,,39.78,148.41,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,inpatient,,,45.00000,21.69000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,41.40,,,,,,,40.50,43.65,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,outpatient,,,45.00000,21.69000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,41.40,,,,,,,11.70,43.65,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,inpatient,,,28.00000,13.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,25.76,,,,,,,25.20,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,outpatient,,,28.00000,13.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,25.76,,,,,,,7.28,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,inpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,outpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,45.08,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,45.08,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,45.08,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,45.08,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,45.08,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,45.08,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,inpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,outpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,inpatient,,,36.00000,17.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,32.40,34.92,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,outpatient,,,36.00000,17.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,9.36,34.92,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,inpatient,,,38.00000,18.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,34.96,,,,,,,34.20,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,outpatient,,,38.00000,18.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,34.96,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,inpatient,,,38.00000,18.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,34.96,,,,,,,34.20,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,outpatient,,,38.00000,18.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,34.96,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,inpatient,,,76.00000,36.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.92,,,,,,,68.40,73.72,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,outpatient,,,76.00000,36.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.92,,,,,,,19.76,73.72,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,inpatient,,,173.00000,83.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,159.16,,,,,,,155.70,167.81,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,outpatient,,,173.00000,83.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,159.16,,,,,,,44.98,167.81,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,inpatient,,,22.00000,10.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20.24,,,,,,,19.80,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,outpatient,,,22.00000,10.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,20.24,,,,,,,5.72,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,inpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,outpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,inpatient,,,39.00000,18.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,35.88,,,,,,,35.10,37.83,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,outpatient,,,39.00000,18.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,35.88,,,,,,,10.14,37.83,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,inpatient,,,41.00000,19.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,37.72,,,,,,,36.90,39.77,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,outpatient,,,41.00000,19.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,37.72,,,,,,,10.66,39.77,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,inpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,outpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,inpatient,,,54.00000,26.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,48.60,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,outpatient,,,54.00000,26.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,14.04,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,inpatient,,,71.00000,34.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,63.90,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,outpatient,,,71.00000,34.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,18.46,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,inpatient,,,43.00000,20.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,39.56,,,,,,,38.70,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,39.56,,,,,,,11.18,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,inpatient,,,43.00000,20.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,39.56,,,,,,,38.70,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,39.56,,,,,,,11.18,41.71,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,inpatient,,,38.00000,18.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,34.96,,,,,,,34.20,36.86,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,outpatient,,,38.00000,18.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,34.96,,,,,,,9.88,36.86,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,inpatient,,,72.00000,34.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,64.80,69.84,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,outpatient,,,72.00000,34.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,18.72,69.84,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,inpatient,,,226.00000,108.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,207.92,,,,,,,203.40,219.22,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,outpatient,,,226.00000,108.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,207.92,,,,,,,58.76,219.22,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,37.72,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,37.72,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,37.72,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,37.72,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,37.72,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,37.72,,,,,,,10.66,39.77,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,inpatient,,,160.00000,77.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,147.20,,,,,,,144.00,155.20,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,outpatient,,,160.00000,77.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,147.20,,,,,,,41.60,155.20,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,inpatient,,,102.00000,49.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,91.80,98.94,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,outpatient,,,102.00000,49.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,26.52,98.94,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,inpatient,,,317.00000,152.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,291.64,,,,,,,285.30,307.49,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,outpatient,,,317.00000,152.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,291.64,,,,,,,82.42,307.49,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,inpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,outpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,inpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,outpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,inpatient,,,116.00000,55.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,106.72,,,,,,,104.40,112.52,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,outpatient,,,116.00000,55.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,106.72,,,,,,,30.16,112.52,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,inpatient,,,89.00000,42.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,81.88,,,,,,,80.10,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,81.88,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,inpatient,,,89.00000,42.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,81.88,,,,,,,80.10,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,81.88,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,inpatient,,,85.00000,40.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,78.20,,,,,,,76.50,82.45,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,outpatient,,,85.00000,40.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,78.20,,,,,,,22.10,82.45,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,inpatient,,,184.00000,88.69000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,169.28,,,,,,,165.60,178.48,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,outpatient,,,184.00000,88.69000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,169.28,,,,,,,47.84,178.48,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,inpatient,,,127.00000,61.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,116.84,,,,,,,114.30,123.19,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,outpatient,,,127.00000,61.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,116.84,,,,,,,33.02,123.19,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,inpatient,,,61.00000,29.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,outpatient,,,61.00000,29.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,inpatient,,,35.00000,16.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32.20,,,,,,,31.50,33.95,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,outpatient,,,35.00000,16.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32.20,,,,,,,9.10,33.95,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,inpatient,,,79.00000,38.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,71.10,76.63,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,outpatient,,,79.00000,38.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,20.54,76.63,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,inpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,outpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,inpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,outpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,inpatient,,,57.00000,32.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,outpatient,,,57.00000,32.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,140.76,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,140.76,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,inpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,outpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,inpatient,,,77.00000,44.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,69.30,74.69,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,outpatient,,,77.00000,44.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,inpatient,,,70.00000,40.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,63.00,67.90,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,outpatient,,,70.00000,40.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,inpatient,,,67.00000,38.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,60.30,64.99,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,outpatient,,,67.00000,38.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,inpatient,,,40.00000,23.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36.80,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,outpatient,,,40.00000,23.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36.80,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,inpatient,,,71.00000,40.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,outpatient,,,71.00000,40.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,inpatient,,,80.00000,46.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,73.60,,,,,,,72.00,77.60,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,outpatient,,,80.00000,46.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,73.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,inpatient,,,72.00000,41.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,outpatient,,,72.00000,41.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,inpatient,,,444.00000,255.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,408.48,,,,,,,399.60,430.68,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,outpatient,,,444.00000,255.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,408.48,,,,,,,115.44,430.68,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,inpatient,,,81.00000,46.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,72.90,78.57,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,outpatient,,,81.00000,46.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,21.06,78.57,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,inpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,outpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,inpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,inpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,inpatient,,,66.00000,38.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,outpatient,,,66.00000,38.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,inpatient,,,57.00000,32.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,outpatient,,,57.00000,32.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,inpatient,,,53.00000,30.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,outpatient,,,53.00000,30.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,inpatient,,,60.00000,34.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,outpatient,,,60.00000,34.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,inpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,outpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,inpatient,,,40.00000,23.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36.80,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,outpatient,,,40.00000,23.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36.80,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,inpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,outpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,inpatient,,,42.00000,24.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,38.64,,,,,,,37.80,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,outpatient,,,42.00000,24.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,38.64,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,inpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,outpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,inpatient,,,46.00000,26.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,42.32,,,,,,,41.40,44.62,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,outpatient,,,46.00000,26.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,42.32,,,,,,,11.96,44.62,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,inpatient,,,54.00000,31.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,outpatient,,,54.00000,31.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,inpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,outpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,inpatient,,,71.00000,40.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,outpatient,,,71.00000,40.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,inpatient,,,54.00000,31.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,outpatient,,,54.00000,31.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,inpatient,,,80.00000,46.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,73.60,,,,,,,72.00,77.60,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,outpatient,,,80.00000,46.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,73.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,inpatient,,,60.00000,34.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,outpatient,,,60.00000,34.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,inpatient,,,124.00000,71.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,114.08,,,,,,,111.60,120.28,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,114.08,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,inpatient,,,130.00000,74.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,119.60,,,,,,,117.00,126.10,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,outpatient,,,130.00000,74.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,119.60,,,,,,,33.80,126.10,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,inpatient,,,123.00000,70.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,113.16,,,,,,,110.70,119.31,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,113.16,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,inpatient,,,77.00000,44.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,69.30,74.69,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,outpatient,,,77.00000,44.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,inpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,outpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,inpatient,,,115.00000,66.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,105.80,,,,,,,103.50,111.55,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,outpatient,,,115.00000,66.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,105.80,,,,,,,29.90,111.55,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,inpatient,,,123.00000,70.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,113.16,,,,,,,110.70,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,113.16,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,inpatient,,,161.00000,92.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,148.12,,,,,,,144.90,156.17,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,outpatient,,,161.00000,92.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,148.12,,,,,,,41.86,156.17,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,inpatient,,,124.00000,71.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,114.08,,,,,,,111.60,120.28,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,114.08,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,inpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,outpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,inpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,outpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,inpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,outpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,inpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,outpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,inpatient,,,102.00000,58.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,91.80,98.94,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,outpatient,,,102.00000,58.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,inpatient,,,219.00000,126.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,201.48,,,,,,,197.10,212.43,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,outpatient,,,219.00000,126.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,201.48,,,,,,,56.94,212.43,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,inpatient,,,194.00000,111.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,178.48,,,,,,,174.60,188.18,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,178.48,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,inpatient,,,103.00000,59.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,94.76,,,,,,,92.70,99.91,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,outpatient,,,103.00000,59.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,94.76,,,,,,,26.78,99.91,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,inpatient,,,60.00000,34.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,outpatient,,,60.00000,34.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,inpatient,,,837.00000,482.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,770.04,,,,,,,753.30,811.89,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,outpatient,,,837.00000,482.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,770.04,,,,,,,217.62,811.89,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,inpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,inpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,inpatient,,,194.00000,111.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,178.48,,,,,,,174.60,188.18,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,178.48,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,inpatient,,,78.00000,44.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,70.20,75.66,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,outpatient,,,78.00000,44.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,inpatient,,,285.00000,164.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,262.20,,,,,,,256.50,276.45,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,outpatient,,,285.00000,164.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,262.20,,,,,,,74.10,276.45,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,inpatient,,,190.00000,109.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,174.80,,,,,,,171.00,184.30,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,outpatient,,,190.00000,109.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,174.80,,,,,,,49.40,184.30,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,inpatient,,,100.00000,57.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,outpatient,,,100.00000,57.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,inpatient,,,40.00000,23.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36.80,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36.80,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,inpatient,,,67.00000,38.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,60.30,64.99,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,outpatient,,,67.00000,38.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,61.64,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,inpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,outpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,inpatient,,,78.00000,44.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,70.20,75.66,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,outpatient,,,78.00000,44.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,inpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,outpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,inpatient,,,57.00000,32.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,outpatient,,,57.00000,32.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,inpatient,,,72.00000,41.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,outpatient,,,72.00000,41.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,inpatient,,,59.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,outpatient,,,59.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,inpatient,,,72.00000,41.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,outpatient,,,72.00000,41.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,inpatient,,,239.00000,137.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,219.88,,,,,,,215.10,231.83,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,outpatient,,,239.00000,137.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,219.88,,,,,,,62.14,231.83,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,inpatient,,,85.00000,48.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,78.20,,,,,,,76.50,82.45,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,outpatient,,,85.00000,48.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,78.20,,,,,,,22.10,82.45,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,inpatient,,,44.00000,25.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40.48,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,outpatient,,,44.00000,25.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40.48,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,inpatient,,,40.00000,23.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36.80,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,outpatient,,,40.00000,23.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36.80,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,inpatient,,,53.00000,30.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,outpatient,,,53.00000,30.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,inpatient,,,59.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,inpatient,,,59.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,inpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,outpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,inpatient,,,68.00000,39.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,outpatient,,,68.00000,39.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,inpatient,,,76.00000,43.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.92,,,,,,,68.40,73.72,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,outpatient,,,76.00000,43.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.92,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,inpatient,,,42.00000,24.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,38.64,,,,,,,37.80,40.74,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,outpatient,,,42.00000,24.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,38.64,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,inpatient,,,87.00000,50.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.04,,,,,,,78.30,84.39,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,outpatient,,,87.00000,50.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.04,,,,,,,22.62,84.39,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,inpatient,,,503.00000,289.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,462.76,,,,,,,452.70,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,outpatient,,,503.00000,289.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,462.76,,,,,,,130.78,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,inpatient,,,472.00000,271.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,434.24,,,,,,,424.80,457.84,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,outpatient,,,472.00000,271.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,434.24,,,,,,,122.72,457.84,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,inpatient,,,28.00000,16.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,25.76,,,,,,,25.20,27.16,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,outpatient,,,28.00000,16.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,25.76,,,,,,,7.28,27.16,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,inpatient,,,236.00000,135.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,217.12,,,,,,,212.40,228.92,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,outpatient,,,236.00000,135.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,217.12,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,inpatient,,,54.00000,31.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,outpatient,,,54.00000,31.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,inpatient,,,238.00000,137.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,218.96,,,,,,,214.20,230.86,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,outpatient,,,238.00000,137.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,218.96,,,,,,,61.88,230.86,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,inpatient,,,236.00000,135.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,217.12,,,,,,,212.40,228.92,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,outpatient,,,236.00000,135.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,217.12,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,inpatient,,,145.00000,83.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,133.40,,,,,,,130.50,140.65,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,outpatient,,,145.00000,83.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,133.40,,,,,,,37.70,140.65,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,inpatient,,,68.00000,39.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,inpatient,,,68.00000,39.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,inpatient,,,66.00000,38.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,outpatient,,,66.00000,38.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,inpatient,,,59.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,outpatient,,,59.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,inpatient,,,158.00000,91.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,145.36,,,,,,,142.20,153.26,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,outpatient,,,158.00000,91.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,145.36,,,,,,,41.08,153.26,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,inpatient,,,71.00000,40.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,outpatient,,,71.00000,40.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,inpatient,,,144.00000,82.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,132.48,,,,,,,129.60,139.68,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,outpatient,,,144.00000,82.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,132.48,,,,,,,37.44,139.68,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,inpatient,,,1448.00000,834.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1332.16,,,,,,,1303.20,1404.56,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,outpatient,,,1448.00000,834.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1332.16,,,,,,,376.48,1404.56,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,inpatient,,,72.00000,41.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,outpatient,,,72.00000,41.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,inpatient,,,102.00000,58.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,91.80,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,outpatient,,,102.00000,58.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,inpatient,,,154.00000,88.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,141.68,,,,,,,138.60,149.38,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,outpatient,,,154.00000,88.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,141.68,,,,,,,40.04,149.38,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,140.76,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,140.76,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,inpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,outpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,inpatient,,,66.00000,38.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,outpatient,,,66.00000,38.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,140.76,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,140.76,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,inpatient,,,44.00000,25.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40.48,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,outpatient,,,44.00000,25.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40.48,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,inpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,outpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,inpatient,,,150.00000,86.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,138.00,,,,,,,135.00,145.50,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,outpatient,,,150.00000,86.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,138.00,,,,,,,39.00,145.50,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,inpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,outpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,inpatient,,,56.00000,32.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,outpatient,,,56.00000,32.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,inpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,outpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,inpatient,,,66.00000,38.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,outpatient,,,66.00000,38.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,inpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,inpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,inpatient,,,60.00000,34.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,outpatient,,,60.00000,34.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,inpatient,,,58.00000,33.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,outpatient,,,58.00000,33.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,inpatient,,,71.00000,40.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,outpatient,,,71.00000,40.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,inpatient,,,72.00000,41.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,outpatient,,,72.00000,41.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,inpatient,,,56.00000,32.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,inpatient,,,56.00000,32.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,inpatient,,,60.00000,34.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,outpatient,,,60.00000,34.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,inpatient,,,56.00000,32.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,outpatient,,,56.00000,32.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,inpatient,,,39.00000,22.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,35.88,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,outpatient,,,39.00000,22.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,35.88,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,140.76,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,140.76,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,inpatient,,,73.00000,42.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,67.16,,,,,,,65.70,70.81,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,outpatient,,,73.00000,42.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,67.16,,,,,,,18.98,70.81,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,inpatient,,,127.00000,73.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,116.84,,,,,,,114.30,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,116.84,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,inpatient,,,127.00000,73.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,116.84,,,,,,,114.30,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,116.84,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,inpatient,,,372.00000,214.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,342.24,,,,,,,334.80,360.84,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,outpatient,,,372.00000,214.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,342.24,,,,,,,96.72,360.84,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,inpatient,,,69.00000,39.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,62.10,66.93,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,outpatient,,,69.00000,39.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,140.76,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,140.76,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,140.76,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,140.76,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,inpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,outpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,inpatient,,,57.00000,32.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,outpatient,,,57.00000,32.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,inpatient,,,96.00000,55.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,88.32,,,,,,,86.40,93.12,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,outpatient,,,96.00000,55.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,88.32,,,,,,,24.96,93.12,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,inpatient,,,44.00000,25.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40.48,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,outpatient,,,44.00000,25.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40.48,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,inpatient,,,60.00000,34.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,outpatient,,,60.00000,34.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,inpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,outpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,inpatient,,,60.00000,34.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,outpatient,,,60.00000,34.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,inpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,outpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,inpatient,,,74.00000,42.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68.08,,,,,,,66.60,71.78,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,outpatient,,,74.00000,42.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68.08,,,,,,,19.24,71.78,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,inpatient,,,69.00000,39.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,62.10,66.93,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,outpatient,,,69.00000,39.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,35.88,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,35.88,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,inpatient,,,53.00000,30.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,outpatient,,,53.00000,30.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,35.88,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,35.88,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,35.88,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,35.88,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,inpatient,,,70.00000,40.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,63.00,67.90,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,outpatient,,,70.00000,40.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,inpatient,,,71.00000,40.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,outpatient,,,71.00000,40.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,inpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,outpatient,,,65.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,inpatient,,,325.00000,187.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,299.00,,,,,,,292.50,315.25,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,outpatient,,,325.00000,187.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,299.00,,,,,,,84.50,315.25,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,inpatient,,,72.00000,41.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,outpatient,,,72.00000,41.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,inpatient,,,72.00000,41.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,outpatient,,,72.00000,41.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,66.24,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,inpatient,,,76.00000,43.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.92,,,,,,,68.40,73.72,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,outpatient,,,76.00000,43.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.92,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,inpatient,,,240.00000,138.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,220.80,,,,,,,216.00,232.80,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,outpatient,,,240.00000,138.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,220.80,,,,,,,62.40,232.80,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,inpatient,,,93.00000,53.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,85.56,,,,,,,83.70,90.21,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,outpatient,,,93.00000,53.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,85.56,,,,,,,24.18,90.21,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,inpatient,,,59.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,outpatient,,,59.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,inpatient,,,81.00000,46.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,72.90,78.57,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,outpatient,,,81.00000,46.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,21.06,78.57,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,inpatient,,,58.00000,33.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,outpatient,,,58.00000,33.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,inpatient,,,21.00000,12.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,19.32,,,,,,,18.90,20.37,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,outpatient,,,21.00000,12.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,19.32,,,,,,,5.46,20.37,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,inpatient,,,56.00000,32.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,outpatient,,,56.00000,32.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,inpatient,,,64.00000,36.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,57.60,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,outpatient,,,64.00000,36.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,16.64,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,inpatient,,,80.00000,46.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,73.60,,,,,,,72.00,77.60,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,outpatient,,,80.00000,46.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,73.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,inpatient,,,109.00000,62.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100.28,,,,,,,98.10,105.73,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,outpatient,,,109.00000,62.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100.28,,,,,,,28.34,105.73,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,inpatient,,,59.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,outpatient,,,59.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,inpatient,,,115.00000,66.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,105.80,,,,,,,103.50,111.55,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,outpatient,,,115.00000,66.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,105.80,,,,,,,29.90,111.55,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,inpatient,,,57.00000,32.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,outpatient,,,57.00000,32.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,inpatient,,,118.00000,67.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,108.56,,,,,,,106.20,114.46,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,outpatient,,,118.00000,67.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,108.56,,,,,,,30.68,114.46,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,inpatient,,,268.00000,154.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,246.56,,,,,,,241.20,259.96,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,outpatient,,,268.00000,154.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,246.56,,,,,,,69.68,259.96,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,inpatient,,,114.00000,65.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,102.60,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,29.64,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,inpatient,,,114.00000,65.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,102.60,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,29.64,110.58,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,inpatient,,,78.00000,44.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,70.20,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,outpatient,,,78.00000,44.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,20.28,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,inpatient,,,91.00000,52.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,83.72,,,,,,,81.90,88.27,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,outpatient,,,91.00000,52.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,83.72,,,,,,,23.66,88.27,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,inpatient,,,66.00000,38.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,inpatient,,,66.00000,38.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,inpatient,,,300.00000,172.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,276.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,outpatient,,,300.00000,172.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,276.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,inpatient,,,185.00000,106.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,170.20,,,,,,,166.50,179.45,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,outpatient,,,185.00000,106.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,170.20,,,,,,,48.10,179.45,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,inpatient,,,76.00000,43.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.92,,,,,,,68.40,73.72,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,outpatient,,,76.00000,43.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.92,,,,,,,19.76,73.72,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,inpatient,,,53.00000,30.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,47.70,51.41,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,outpatient,,,53.00000,30.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,13.78,51.41,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,inpatient,,,77.00000,44.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,69.30,74.69,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,outpatient,,,77.00000,44.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,20.02,74.69,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,inpatient,,,222.00000,127.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,204.24,,,,,,,199.80,215.34,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,outpatient,,,222.00000,127.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,204.24,,,,,,,57.72,215.34,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,inpatient,,,292.00000,168.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,268.64,,,,,,,262.80,283.24,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,outpatient,,,292.00000,168.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,268.64,,,,,,,75.92,283.24,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,inpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,outpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,inpatient,,,125.00000,72.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,115.00,,,,,,,112.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,115.00,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,inpatient,,,125.00000,72.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,115.00,,,,,,,112.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,115.00,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,inpatient,,,359.00000,206.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,323.10,348.23,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,outpatient,,,359.00000,206.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,93.34,348.23,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,inpatient,,,111.00000,63.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,102.12,,,,,,,99.90,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,outpatient,,,111.00000,63.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,102.12,,,,,,,28.86,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,inpatient,,,141.00000,81.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,129.72,,,,,,,126.90,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,129.72,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,inpatient,,,141.00000,81.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,129.72,,,,,,,126.90,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,129.72,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,inpatient,,,114.00000,65.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,inpatient,,,114.00000,65.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,inpatient,,,114.00000,65.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,inpatient,,,114.00000,65.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,29.64,110.58,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,inpatient,,,78.00000,44.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,70.20,75.66,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,outpatient,,,78.00000,44.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,20.28,75.66,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,inpatient,,,359.00000,206.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,323.10,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,93.34,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,inpatient,,,359.00000,206.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,323.10,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,93.34,348.23,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,inpatient,,,70.00000,40.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,63.00,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,outpatient,,,70.00000,40.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,inpatient,,,18.00000,10.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16.56,,,,,,,16.20,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,outpatient,,,18.00000,10.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16.56,,,,,,,4.68,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,inpatient,,,408.00000,235.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,375.36,,,,,,,367.20,395.76,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,outpatient,,,408.00000,235.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,375.36,,,,,,,106.08,395.76,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,inpatient,,,102.00000,58.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,91.80,98.94,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,outpatient,,,102.00000,58.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,26.52,98.94,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,inpatient,,,330.00000,190.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,303.60,,,,,,,297.00,320.10,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,outpatient,,,330.00000,190.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,303.60,,,,,,,85.80,320.10,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,inpatient,,,56.00000,32.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,outpatient,,,56.00000,32.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,inpatient,,,136.00000,78.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,125.12,,,,,,,122.40,131.92,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,outpatient,,,136.00000,78.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,125.12,,,,,,,35.36,131.92,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,inpatient,,,83.00000,47.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,76.36,,,,,,,74.70,80.51,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,outpatient,,,83.00000,47.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,76.36,,,,,,,21.58,80.51,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,inpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,outpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,inpatient,,,142.00000,81.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,130.64,,,,,,,127.80,137.74,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,outpatient,,,142.00000,81.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,130.64,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,inpatient,,,51.00000,29.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,45.90,49.47,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,outpatient,,,51.00000,29.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,inpatient,,,70.00000,40.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,63.00,67.90,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,outpatient,,,70.00000,40.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,64.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,inpatient,,,99.00000,57.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,91.08,,,,,,,89.10,96.03,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,outpatient,,,99.00000,57.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,91.08,,,,,,,25.74,96.03,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,inpatient,,,78.00000,44.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,70.20,75.66,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,outpatient,,,78.00000,44.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,inpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,outpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,inpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,inpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,outpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,inpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,inpatient,,,75.00000,43.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.00,,,,,,,67.50,72.75,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,outpatient,,,75.00000,43.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,inpatient,,,37.00000,21.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,34.04,,,,,,,33.30,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,34.04,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,inpatient,,,37.00000,21.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,34.04,,,,,,,33.30,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,34.04,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,inpatient,,,59.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,outpatient,,,59.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,inpatient,,,35.00000,20.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32.20,,,,,,,31.50,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,outpatient,,,35.00000,20.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32.20,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,inpatient,,,59.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,outpatient,,,59.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,inpatient,,,56.00000,32.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,outpatient,,,56.00000,32.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,inpatient,,,74.00000,42.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68.08,,,,,,,66.60,71.78,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,outpatient,,,74.00000,42.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68.08,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,inpatient,,,90.00000,51.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,82.80,,,,,,,81.00,87.30,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,outpatient,,,90.00000,51.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,82.80,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,inpatient,,,68.00000,39.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,61.20,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,inpatient,,,142.00000,81.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,130.64,,,,,,,127.80,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,outpatient,,,142.00000,81.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,130.64,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,inpatient,,,68.00000,39.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,61.20,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,inpatient,,,74.00000,42.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68.08,,,,,,,66.60,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,outpatient,,,74.00000,42.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68.08,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,inpatient,,,89.00000,51.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,81.88,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,81.88,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,inpatient,,,89.00000,51.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,81.88,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,81.88,,,,,,,23.14,86.33,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,inpatient,,,57.00000,32.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,outpatient,,,57.00000,32.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,inpatient,,,77.00000,44.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,69.30,74.69,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,outpatient,,,77.00000,44.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,20.02,74.69,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,inpatient,,,64.00000,36.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,57.60,62.08,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,outpatient,,,64.00000,36.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,16.64,62.08,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,inpatient,,,69.00000,39.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,62.10,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,outpatient,,,69.00000,39.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,17.94,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,inpatient,,,1178.00000,678.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1083.76,,,,,,,1060.20,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,outpatient,,,1178.00000,678.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1083.76,,,,,,,306.28,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,inpatient,,,127.00000,73.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,116.84,,,,,,,114.30,123.19,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,outpatient,,,127.00000,73.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,116.84,,,,,,,33.02,123.19,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,inpatient,,,277.00000,159.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,254.84,,,,,,,249.30,268.69,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,outpatient,,,277.00000,159.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,254.84,,,,,,,72.02,268.69,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,inpatient,,,940.00000,541.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,864.80,,,,,,,846.00,911.80,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,outpatient,,,940.00000,541.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,864.80,,,,,,,244.40,911.80,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,inpatient,,,97.00000,55.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,89.24,,,,,,,87.30,94.09,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,outpatient,,,97.00000,55.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,89.24,,,,,,,25.22,94.09,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,inpatient,,,16.00000,9.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14.72,,,,,,,14.40,15.52,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,outpatient,,,16.00000,9.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14.72,,,,,,,4.16,15.52,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,inpatient,,,57.00000,32.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,outpatient,,,57.00000,32.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,inpatient,,,131.00000,75.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,120.52,,,,,,,117.90,127.07,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,outpatient,,,131.00000,75.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,120.52,,,,,,,34.06,127.07,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,inpatient,,,2160.00000,1244.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1987.20,,,,,,,1944.00,2095.20,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,outpatient,,,2160.00000,1244.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1987.20,,,,,,,561.60,2095.20,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,inpatient,,,37.00000,21.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,34.04,,,,,,,33.30,35.89,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,outpatient,,,37.00000,21.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,34.04,,,,,,,9.62,35.89,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,inpatient,,,74.00000,42.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68.08,,,,,,,66.60,71.78,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68.08,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,inpatient,,,54.00000,31.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,48.60,52.38,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,outpatient,,,54.00000,31.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,inpatient,,,76.00000,43.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.92,,,,,,,68.40,73.72,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,outpatient,,,76.00000,43.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.92,,,,,,,19.76,73.72,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,inpatient,,,606.00000,349.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,557.52,,,,,,,545.40,587.82,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,outpatient,,,606.00000,349.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,557.52,,,,,,,157.56,587.82,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,inpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,outpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,inpatient,,,300.00000,172.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,276.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,outpatient,,,300.00000,172.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,276.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,inpatient,,,59.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,outpatient,,,59.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,inpatient,,,98.00000,56.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,88.20,95.06,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,outpatient,,,98.00000,56.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,25.48,95.06,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,inpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,outpatient,,,61.00000,35.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,inpatient,,,128.00000,73.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,117.76,,,,,,,115.20,124.16,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,outpatient,,,128.00000,73.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,117.76,,,,,,,33.28,124.16,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,inpatient,,,16.00000,9.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14.72,,,,,,,14.40,15.52,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,outpatient,,,16.00000,9.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14.72,,,,,,,4.16,15.52,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,inpatient,,,565.00000,325.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,519.80,,,,,,,508.50,548.05,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,outpatient,,,565.00000,325.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,519.80,,,,,,,146.90,548.05,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,inpatient,,,850.00000,489.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,outpatient,,,850.00000,489.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,inpatient,,,77.00000,44.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,69.30,74.69,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,outpatient,,,77.00000,44.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,70.84,,,,,,,20.02,74.69,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,inpatient,,,86.00000,49.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,79.12,,,,,,,77.40,83.42,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,outpatient,,,86.00000,49.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,79.12,,,,,,,22.36,83.42,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,inpatient,,,837.00000,482.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,770.04,,,,,,,753.30,811.89,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,outpatient,,,837.00000,482.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,770.04,,,,,,,217.62,811.89,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,inpatient,,,60.00000,34.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,outpatient,,,60.00000,34.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,inpatient,,,56.00000,32.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,outpatient,,,56.00000,32.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,inpatient,,,56.00000,32.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,outpatient,,,56.00000,32.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,inpatient,,,74.00000,42.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68.08,,,,,,,66.60,71.78,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68.08,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,inpatient,,,167.00000,96.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,153.64,,,,,,,150.30,161.99,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,outpatient,,,167.00000,96.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,153.64,,,,,,,43.42,161.99,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,inpatient,,,200.00000,115.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,184.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,outpatient,,,200.00000,115.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,184.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,inpatient,,,93.00000,53.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,85.56,,,,,,,83.70,90.21,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,outpatient,,,93.00000,53.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,85.56,,,,,,,24.18,90.21,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,inpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,49.50,53.35,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,50.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,inpatient,,,190.00000,109.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,174.80,,,,,,,171.00,184.30,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,outpatient,,,190.00000,109.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,174.80,,,,,,,49.40,184.30,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,inpatient,,,64.00000,36.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,57.60,62.08,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,outpatient,,,64.00000,36.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,16.64,62.08,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,inpatient,,,525.00000,302.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,483.00,,,,,,,472.50,509.25,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,outpatient,,,525.00000,302.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,483.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,inpatient,,,54.00000,31.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,48.60,52.38,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,outpatient,,,54.00000,31.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,inpatient,,,53.00000,30.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,outpatient,,,53.00000,30.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,inpatient,,,40.00000,23.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36.80,,,,,,,36.00,38.80,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36.80,,,,,,,10.40,38.80,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,inpatient,,,453.00000,260.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,416.76,,,,,,,407.70,439.41,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,outpatient,,,453.00000,260.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,416.76,,,,,,,117.78,439.41,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,inpatient,,,25.00000,14.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.00,,,,,,,22.50,24.25,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,outpatient,,,25.00000,14.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.00,,,,,,,6.50,24.25,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,inpatient,,,56.00000,32.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,outpatient,,,56.00000,32.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,inpatient,,,59.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,outpatient,,,59.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,inpatient,,,53.00000,30.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,outpatient,,,53.00000,30.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,inpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,outpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,inpatient,,,350.00000,201.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,322.00,,,,,,,315.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,outpatient,,,350.00000,201.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,322.00,,,,,,,91.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,inpatient,,,225.00000,129.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,207.00,,,,,,,202.50,218.25,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,outpatient,,,225.00000,129.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,207.00,,,,,,,58.50,218.25,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,inpatient,,,52.00000,29.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,46.80,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,outpatient,,,52.00000,29.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,13.52,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,inpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,outpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,inpatient,,,134.00000,77.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,123.28,,,,,,,120.60,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,outpatient,,,134.00000,77.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,123.28,,,,,,,34.84,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,inpatient,,,52.00000,29.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,46.80,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,outpatient,,,52.00000,29.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,13.52,50.44,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,inpatient,,,186.00000,107.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,171.12,,,,,,,167.40,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,outpatient,,,186.00000,107.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,171.12,,,,,,,48.36,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,inpatient,,,300.00000,172.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,276.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,276.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,inpatient,,,300.00000,172.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,276.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,276.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,inpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,outpatient,,,62.00000,35.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,inpatient,,,205.00000,118.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,188.60,,,,,,,184.50,198.85,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,outpatient,,,205.00000,118.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,188.60,,,,,,,53.30,198.85,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,inpatient,,,75.00000,36.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.00,,,,,,,67.50,72.75,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,outpatient,,,75.00000,36.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,inpatient,,,65.00000,31.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,58.50,63.05,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,outpatient,,,65.00000,31.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,inpatient,,,92.00000,44.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,84.64,,,,,,,82.80,89.24,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,outpatient,,,92.00000,44.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,84.64,,,,,,,23.92,89.24,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,inpatient,,,24.00000,11.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22.08,,,,,,,21.60,23.28,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22.08,,,,,,,6.24,23.28,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,inpatient,,,20.00000,9.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18.40,,,,,,,18.00,19.40,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,outpatient,,,20.00000,9.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,inpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,outpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,inpatient,,,42.00000,20.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,38.64,,,,,,,37.80,40.74,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,outpatient,,,42.00000,20.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,38.64,,,,,,,10.92,40.74,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,inpatient,,,69.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,62.10,66.93,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,outpatient,,,69.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,inpatient,,,65.00000,31.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,58.50,63.05,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,outpatient,,,65.00000,31.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,inpatient,,,76.00000,36.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.92,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,outpatient,,,76.00000,36.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.92,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,inpatient,,,89.00000,42.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,81.88,,,,,,,80.10,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,outpatient,,,89.00000,42.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,81.88,,,,,,,23.14,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,inpatient,,,76.00000,36.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.92,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,outpatient,,,76.00000,36.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.92,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,inpatient,,,28.00000,13.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,25.76,,,,,,,25.20,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,outpatient,,,28.00000,13.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,25.76,,,,,,,7.28,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,inpatient,,,98.00000,47.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,88.20,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,outpatient,,,98.00000,47.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,25.48,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,inpatient,,,64.00000,30.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,57.60,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,outpatient,,,64.00000,30.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,inpatient,,,75.00000,36.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.00,,,,,,,67.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,outpatient,,,75.00000,36.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,inpatient,,,76.00000,36.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.92,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,outpatient,,,76.00000,36.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.92,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,inpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,outpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,inpatient,,,114.00000,54.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,102.60,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,outpatient,,,114.00000,54.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,29.64,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,inpatient,,,74.00000,35.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68.08,,,,,,,66.60,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,outpatient,,,74.00000,35.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68.08,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,inpatient,,,69.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,62.10,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,outpatient,,,69.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,inpatient,,,74.00000,35.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68.08,,,,,,,66.60,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,outpatient,,,74.00000,35.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,68.08,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,inpatient,,,87.00000,41.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.04,,,,,,,78.30,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,outpatient,,,87.00000,41.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.04,,,,,,,22.62,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,inpatient,,,79.00000,38.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,71.10,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,outpatient,,,79.00000,38.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,20.54,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,inpatient,,,75.00000,36.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.00,,,,,,,67.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,outpatient,,,75.00000,36.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,inpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,outpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,inpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,outpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,inpatient,,,64.00000,30.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,57.60,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,outpatient,,,64.00000,30.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,inpatient,,,164.00000,79.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,150.88,,,,,,,147.60,159.08,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,outpatient,,,164.00000,79.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,150.88,,,,,,,42.64,159.08,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,inpatient,,,54.00000,26.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,48.60,52.38,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,outpatient,,,54.00000,26.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,14.04,52.38,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,inpatient,,,8.00000,3.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7.36,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,outpatient,,,8.00000,3.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7.36,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,inpatient,,,69.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,62.10,66.93,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,outpatient,,,69.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,17.94,66.93,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,inpatient,,,8.00000,3.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7.36,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,outpatient,,,8.00000,3.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7.36,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,inpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,outpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,inpatient,,,8.00000,3.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7.36,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,outpatient,,,8.00000,3.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7.36,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,inpatient,,,14.00000,6.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12.88,,,,,,,12.60,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,outpatient,,,14.00000,6.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,12.88,,,,,,,3.64,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,inpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,outpatient,,,62.00000,29.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,inpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,outpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,inpatient,,,112.00000,53.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,103.04,,,,,,,100.80,108.64,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,outpatient,,,112.00000,53.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,103.04,,,,,,,29.12,108.64,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,inpatient,,,13.00000,6.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11.96,,,,,,,11.70,12.61,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,outpatient,,,13.00000,6.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11.96,,,,,,,3.38,12.61,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,inpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,outpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,inpatient,,,31.00000,14.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28.52,,,,,,,27.90,30.07,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,outpatient,,,31.00000,14.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28.52,,,,,,,8.06,30.07,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,inpatient,,,92.00000,44.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,84.64,,,,,,,82.80,89.24,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,outpatient,,,92.00000,44.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,84.64,,,,,,,23.92,89.24,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,inpatient,,,80.00000,38.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,73.60,,,,,,,72.00,77.60,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,outpatient,,,80.00000,38.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,73.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,inpatient,,,30.00000,14.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,27.60,,,,,,,27.00,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,27.60,,,,,,,7.80,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,inpatient,,,30.00000,14.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,27.60,,,,,,,27.00,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,27.60,,,,,,,7.80,29.10,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,inpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,outpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,inpatient,,,24.00000,11.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22.08,,,,,,,21.60,23.28,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,22.08,,,,,,,6.24,23.28,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,inpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,outpatient,,,59.00000,28.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,inpatient,,,29.00000,13.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26.68,,,,,,,26.10,28.13,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,outpatient,,,29.00000,13.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26.68,,,,,,,7.54,28.13,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,inpatient,,,97.00000,46.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,89.24,,,,,,,87.30,94.09,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,outpatient,,,97.00000,46.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,89.24,,,,,,,25.22,94.09,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,inpatient,,,225.00000,108.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,207.00,,,,,,,202.50,218.25,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,outpatient,,,225.00000,108.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,207.00,,,,,,,58.50,218.25,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,inpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,outpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,inpatient,,,71.00000,34.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,63.90,68.87,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,outpatient,,,71.00000,34.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,inpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,outpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,inpatient,,,71.00000,34.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,63.90,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,outpatient,,,71.00000,34.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,inpatient,,,108.00000,52.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,99.36,,,,,,,97.20,104.76,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,outpatient,,,108.00000,52.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,99.36,,,,,,,28.08,104.76,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,inpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,outpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,inpatient,,,51.00000,24.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,45.90,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,outpatient,,,51.00000,24.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,inpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,outpatient,,,63.00000,30.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,inpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,outpatient,,,58.00000,27.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,inpatient,,,19.00000,9.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,17.48,,,,,,,17.10,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,outpatient,,,19.00000,9.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,17.48,,,,,,,4.94,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,inpatient,,,54.00000,26.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,48.60,52.38,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,outpatient,,,54.00000,26.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,49.68,,,,,,,14.04,52.38,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,inpatient,,,103.00000,49.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,94.76,,,,,,,92.70,99.91,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,outpatient,,,103.00000,49.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,94.76,,,,,,,26.78,99.91,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,inpatient,,,9.00000,4.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8.28,,,,,,,8.10,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,outpatient,,,9.00000,4.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8.28,,,,,,,2.34,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,inpatient,,,13.00000,6.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11.96,,,,,,,11.70,12.61,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,outpatient,,,13.00000,6.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11.96,,,,,,,3.38,12.61,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,inpatient,,,80.00000,38.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,73.60,,,,,,,72.00,77.60,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,outpatient,,,80.00000,38.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,73.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,inpatient,,,47.00000,22.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,43.24,,,,,,,42.30,45.59,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,outpatient,,,47.00000,22.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,43.24,,,,,,,12.22,45.59,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,inpatient,,,91.00000,43.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,83.72,,,,,,,81.90,88.27,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,outpatient,,,91.00000,43.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,83.72,,,,,,,23.66,88.27,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,inpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,outpatient,,,56.00000,26.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,inpatient,,,18.00000,8.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16.56,,,,,,,16.20,17.46,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,outpatient,,,18.00000,8.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16.56,,,,,,,4.68,17.46,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,inpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,outpatient,,,60.00000,28.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,inpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,outpatient,,,57.00000,27.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,inpatient,,,21.00000,11.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,19.32,,,,,,,18.90,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,19.32,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,inpatient,,,71.00000,37.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,63.90,68.87,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,outpatient,,,71.00000,37.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,18.46,68.87,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,inpatient,,,21.00000,11.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,19.32,,,,,,,18.90,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,19.32,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,inpatient,,,128.00000,67.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,117.76,,,,,,,115.20,124.16,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,outpatient,,,128.00000,67.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,117.76,,,,,,,33.28,124.16,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,inpatient,,,65.00000,34.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,58.50,63.05,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,outpatient,,,65.00000,34.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,inpatient,,,31.00000,16.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28.52,,,,,,,27.90,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,outpatient,,,31.00000,16.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,28.52,,,,,,,8.06,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,inpatient,,,61.00000,32.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,outpatient,,,61.00000,32.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,inpatient,,,25.00000,13.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.00,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.00,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,inpatient,,,25.00000,13.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,91,23.00,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,91,23.00,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,inpatient,,,103.00000,54.69000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,94.76,,,,,,,92.70,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,outpatient,,,103.00000,54.69000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,94.76,,,,,,,26.78,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,inpatient,,,96.00000,50.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,88.32,,,,,,,86.40,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,outpatient,,,96.00000,50.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,88.32,,,,,,,24.96,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,inpatient,,,75.00000,39.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.00,,,,,,,67.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,outpatient,,,75.00000,39.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,inpatient,,,68.00000,36.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,61.20,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,outpatient,,,68.00000,36.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,17.68,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,inpatient,,,61.00000,32.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,outpatient,,,61.00000,32.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,inpatient,,,29.00000,15.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26.68,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,outpatient,,,29.00000,15.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26.68,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26.68,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26.68,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26.68,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26.68,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,inpatient,,,63.00000,33.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,outpatient,,,63.00000,33.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,inpatient,,,79.00000,41.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,71.10,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,outpatient,,,79.00000,41.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,20.54,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,inpatient,,,63.00000,33.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,outpatient,,,63.00000,33.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26.68,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26.68,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,inpatient,,,112.00000,59.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,103.04,,,,,,,100.80,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,outpatient,,,112.00000,59.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,103.04,,,,,,,29.12,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,inpatient,,,25.00000,13.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.00,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,outpatient,,,25.00000,13.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.00,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,inpatient,,,118.00000,62.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,108.56,,,,,,,106.20,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,outpatient,,,118.00000,62.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,108.56,,,,,,,30.68,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,inpatient,,,29.00000,15.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26.68,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,outpatient,,,29.00000,15.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26.68,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,inpatient,,,25.00000,13.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.00,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,outpatient,,,25.00000,13.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.00,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,inpatient,,,25.00000,13.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.00,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,outpatient,,,25.00000,13.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.00,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,inpatient,,,71.00000,37.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,63.90,68.87,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,outpatient,,,71.00000,37.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,18.46,68.87,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,inpatient,,,59.00000,31.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,outpatient,,,59.00000,31.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,inpatient,,,62.00000,32.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,outpatient,,,62.00000,32.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,inpatient,,,138.00000,73.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,126.96,,,,,,,124.20,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,outpatient,,,138.00000,73.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,126.96,,,,,,,35.88,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,inpatient,,,62.00000,32.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,outpatient,,,62.00000,32.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,inpatient,,,78.00000,41.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,70.20,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,outpatient,,,78.00000,41.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,20.28,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,inpatient,,,69.00000,36.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,62.10,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,outpatient,,,69.00000,36.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,63.48,,,,,,,17.94,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,inpatient,,,88.00000,46.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.96,,,,,,,79.20,85.36,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,outpatient,,,88.00000,46.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.96,,,,,,,22.88,85.36,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,inpatient,,,60.00000,31.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,outpatient,,,60.00000,31.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,inpatient,,,64.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,57.60,62.08,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,outpatient,,,64.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,16.64,62.08,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,inpatient,,,63.00000,33.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,outpatient,,,63.00000,33.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,inpatient,,,137.00000,72.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,126.04,,,,,,,123.30,132.89,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,outpatient,,,137.00000,72.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,126.04,,,,,,,35.62,132.89,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,inpatient,,,347.00000,184.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,319.24,,,,,,,312.30,336.59,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,outpatient,,,347.00000,184.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,319.24,,,,,,,90.22,336.59,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,inpatient,,,57.00000,30.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,outpatient,,,57.00000,30.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,inpatient,,,56.00000,29.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,outpatient,,,56.00000,29.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,inpatient,,,16.00000,8.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14.72,,,,,,,14.40,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,outpatient,,,16.00000,8.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,14.72,,,,,,,4.16,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,inpatient,,,85.00000,45.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,78.20,,,,,,,76.50,82.45,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,outpatient,,,85.00000,45.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,78.20,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,inpatient,,,34.00000,18.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,31.28,,,,,,,30.60,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,outpatient,,,34.00000,18.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,31.28,,,,,,,8.84,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,inpatient,,,231.00000,122.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,212.52,,,,,,,207.90,224.07,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,outpatient,,,231.00000,122.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,212.52,,,,,,,60.06,224.07,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,inpatient,,,36.00000,19.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,outpatient,,,36.00000,19.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,inpatient,,,61.00000,32.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,outpatient,,,61.00000,32.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,inpatient,,,111.00000,58.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,102.12,,,,,,,99.90,107.67,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,outpatient,,,111.00000,58.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,102.12,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,inpatient,,,61.00000,32.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,54.90,59.17,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,outpatient,,,61.00000,32.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,56.12,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,inpatient,,,60.00000,31.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,outpatient,,,60.00000,31.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,inpatient,,,60.00000,31.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,outpatient,,,60.00000,31.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,inpatient,,,60.00000,31.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,outpatient,,,60.00000,31.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,inpatient,,,60.00000,31.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,outpatient,,,60.00000,31.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,inpatient,,,60.00000,31.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,outpatient,,,60.00000,31.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,inpatient,,,36.00000,19.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,outpatient,,,36.00000,19.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,inpatient,,,76.00000,40.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.92,,,,,,,68.40,73.72,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,outpatient,,,76.00000,40.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.92,,,,,,,19.76,73.72,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,inpatient,,,60.00000,31.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,outpatient,,,60.00000,31.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,inpatient,,,60.00000,31.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,outpatient,,,60.00000,31.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,inpatient,,,152.00000,80.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,139.84,,,,,,,136.80,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,outpatient,,,152.00000,80.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,139.84,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,inpatient,,,78.00000,41.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,70.20,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,outpatient,,,78.00000,41.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,71.76,,,,,,,20.28,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,inpatient,,,42.00000,22.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,38.64,,,,,,,37.80,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,outpatient,,,42.00000,22.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,38.64,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,inpatient,,,73.00000,38.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,67.16,,,,,,,65.70,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,outpatient,,,73.00000,38.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,67.16,,,,,,,18.98,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,inpatient,,,97.00000,51.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,89.24,,,,,,,87.30,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,outpatient,,,97.00000,51.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,89.24,,,,,,,25.22,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,inpatient,,,157.00000,83.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,144.44,,,,,,,141.30,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,outpatient,,,157.00000,83.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,144.44,,,,,,,40.82,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,inpatient,,,36.00000,19.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,outpatient,,,36.00000,19.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,inpatient,,,66.00000,35.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,outpatient,,,66.00000,35.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,inpatient,,,58.00000,30.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,outpatient,,,58.00000,30.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,inpatient,,,85.00000,45.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,78.20,,,,,,,76.50,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,outpatient,,,85.00000,45.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,78.20,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,inpatient,,,59.00000,31.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,outpatient,,,59.00000,31.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,inpatient,,,175.00000,92.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,161.00,,,,,,,157.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,outpatient,,,175.00000,92.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,161.00,,,,,,,45.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,inpatient,,,152.00000,80.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,139.84,,,,,,,136.80,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,outpatient,,,152.00000,80.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,139.84,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,inpatient,,,43.00000,22.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,39.56,,,,,,,38.70,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,outpatient,,,43.00000,22.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,39.56,,,,,,,11.18,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,inpatient,,,66.00000,35.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,outpatient,,,66.00000,35.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,inpatient,,,36.00000,19.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,outpatient,,,36.00000,19.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,inpatient,,,36.00000,19.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,outpatient,,,36.00000,19.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,33.12,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,inpatient,,,42.00000,22.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,38.64,,,,,,,37.80,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,outpatient,,,42.00000,22.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,38.64,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,inpatient,,,147.00000,78.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,135.24,,,,,,,132.30,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,outpatient,,,147.00000,78.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,135.24,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,inpatient,,,64.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,57.60,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,outpatient,,,64.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,16.64,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,inpatient,,,60.00000,31.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,outpatient,,,60.00000,31.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,inpatient,,,75.00000,39.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.00,,,,,,,67.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,outpatient,,,75.00000,39.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,inpatient,,,44.00000,23.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40.48,,,,,,,39.60,42.68,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,outpatient,,,44.00000,23.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40.48,,,,,,,11.44,42.68,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,inpatient,,,87.00000,46.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.04,,,,,,,78.30,84.39,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,outpatient,,,87.00000,46.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,80.04,,,,,,,22.62,84.39,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,inpatient,,,65.00000,34.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,58.50,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,outpatient,,,65.00000,34.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,inpatient,,,75.00000,39.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.00,,,,,,,67.50,72.75,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,outpatient,,,75.00000,39.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,69.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,inpatient,,,50.00000,26.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.00,,,,,,,45.00,48.50,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,outpatient,,,50.00000,26.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,inpatient,,,40.00000,21.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36.80,,,,,,,36.00,38.80,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,outpatient,,,40.00000,21.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,36.80,,,,,,,10.40,38.80,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,inpatient,,,50.00000,26.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.00,,,,,,,45.00,48.50,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,outpatient,,,50.00000,26.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,inpatient,,,115.00000,61.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,105.80,,,,,,,103.50,111.55,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,outpatient,,,115.00000,61.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,105.80,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,inpatient,,,1309.00000,695.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1204.28,,,,,,,1178.10,1269.73,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1309.00000,695.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1204.28,,,,,,,340.34,1269.73,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,inpatient,,,328.00000,174.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,301.76,,,,,,,295.20,318.16,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,outpatient,,,328.00000,174.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,301.76,,,,,,,85.28,318.16,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,inpatient,,,115.00000,61.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,105.80,,,,,,,103.50,111.55,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,outpatient,,,115.00000,61.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,105.80,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,inpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,inpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,inpatient,,,1251.00000,664.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1150.92,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,outpatient,,,1251.00000,664.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1150.92,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,inpatient,,,154.00000,81.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,141.68,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,141.68,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,inpatient,,,154.00000,81.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,141.68,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,141.68,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,inpatient,,,96.00000,50.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,88.32,,,,,,,86.40,93.12,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,outpatient,,,96.00000,50.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,88.32,,,,,,,24.96,93.12,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,inpatient,,,211.00000,112.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,194.12,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,outpatient,,,211.00000,112.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,194.12,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,inpatient,,,290.00000,153.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,266.80,,,,,,,261.00,281.30,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,outpatient,,,290.00000,153.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,266.80,,,,,,,75.40,281.30,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,inpatient,,,411.00000,218.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,378.12,,,,,,,369.90,398.67,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,outpatient,,,411.00000,218.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,378.12,,,,,,,106.86,398.67,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,inpatient,,,139.00000,73.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,127.88,,,,,,,125.10,134.83,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,outpatient,,,139.00000,73.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,127.88,,,,,,,36.14,134.83,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,inpatient,,,288.00000,152.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,264.96,,,,,,,259.20,279.36,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,outpatient,,,288.00000,152.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,264.96,,,,,,,74.88,279.36,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,inpatient,,,1372.00000,728.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1262.24,,,,,,,1234.80,1330.84,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1372.00000,728.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1262.24,,,,,,,356.72,1330.84,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,inpatient,,,1251.00000,664.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1150.92,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,outpatient,,,1251.00000,664.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1150.92,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,inpatient,,,135.00000,71.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,124.20,,,,,,,121.50,130.95,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,outpatient,,,135.00000,71.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,124.20,,,,,,,35.10,130.95,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,inpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,outpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,inpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,outpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,inpatient,,,147.00000,78.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,135.24,,,,,,,132.30,142.59,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,outpatient,,,147.00000,78.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,135.24,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,inpatient,,,126.00000,66.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,115.92,,,,,,,113.40,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,outpatient,,,126.00000,66.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,115.92,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,inpatient,,,120.00000,63.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,110.40,,,,,,,108.00,116.40,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,outpatient,,,120.00000,63.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,110.40,,,,,,,31.20,116.40,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,inpatient,,,124.00000,65.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,114.08,,,,,,,111.60,120.28,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,outpatient,,,124.00000,65.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,114.08,,,,,,,32.24,120.28,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,inpatient,,,108.00000,57.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,99.36,,,,,,,97.20,104.76,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,outpatient,,,108.00000,57.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,99.36,,,,,,,28.08,104.76,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,inpatient,,,256.00000,135.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,235.52,,,,,,,230.40,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,235.52,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,inpatient,,,256.00000,135.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,235.52,,,,,,,230.40,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,235.52,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,inpatient,,,122.00000,64.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,112.24,,,,,,,109.80,118.34,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,outpatient,,,122.00000,64.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,112.24,,,,,,,31.72,118.34,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,inpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,outpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,inpatient,,,123.00000,65.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,113.16,,,,,,,110.70,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,outpatient,,,123.00000,65.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,113.16,,,,,,,31.98,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,inpatient,,,518.00000,275.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,476.56,,,,,,,466.20,502.46,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,outpatient,,,518.00000,275.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,476.56,,,,,,,134.68,502.46,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,inpatient,,,275.00000,146.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,253.00,,,,,,,247.50,266.75,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,outpatient,,,275.00000,146.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,253.00,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,inpatient,,,270.00000,143.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,248.40,,,,,,,243.00,261.90,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,outpatient,,,270.00000,143.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,248.40,,,,,,,70.20,261.90,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,inpatient,,,450.00000,238.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,414.00,,,,,,,405.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,outpatient,,,450.00000,238.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,414.00,,,,,,,117.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,inpatient,,,126.00000,66.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,115.92,,,,,,,113.40,122.22,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,outpatient,,,126.00000,66.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,115.92,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,inpatient,,,362.00000,192.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,333.04,,,,,,,325.80,351.14,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,outpatient,,,362.00000,192.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,333.04,,,,,,,94.12,351.14,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,inpatient,,,109.00000,57.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100.28,,,,,,,98.10,105.73,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100.28,,,,,,,28.34,105.73,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,inpatient,,,638.00000,338.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,586.96,,,,,,,574.20,618.86,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,outpatient,,,638.00000,338.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,586.96,,,,,,,165.88,618.86,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,inpatient,,,211.00000,112.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,194.12,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,outpatient,,,211.00000,112.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,194.12,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,inpatient,,,154.00000,81.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,141.68,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,outpatient,,,154.00000,81.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,141.68,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,inpatient,,,141.00000,74.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,129.72,,,,,,,126.90,136.77,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,outpatient,,,141.00000,74.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,129.72,,,,,,,36.66,136.77,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,inpatient,,,2040.00000,1083.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1876.80,,,,,,,1836.00,1978.80,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,outpatient,,,2040.00000,1083.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1876.80,,,,,,,530.40,1978.80,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,inpatient,,,421.00000,223.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,387.32,,,,,,,378.90,408.37,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,outpatient,,,421.00000,223.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,387.32,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,inpatient,,,275.00000,146.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,253.00,,,,,,,247.50,266.75,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,outpatient,,,275.00000,146.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,253.00,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,inpatient,,,1251.00000,664.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1150.92,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,outpatient,,,1251.00000,664.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1150.92,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,inpatient,,,428.00000,227.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,393.76,,,,,,,385.20,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,393.76,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,inpatient,,,428.00000,227.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,393.76,,,,,,,385.20,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,393.76,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,inpatient,,,655.00000,347.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,602.60,,,,,,,589.50,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,602.60,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,inpatient,,,655.00000,347.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,602.60,,,,,,,589.50,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,602.60,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,inpatient,,,211.00000,112.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,194.12,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,outpatient,,,211.00000,112.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,194.12,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,inpatient,,,112.00000,59.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,103.04,,,,,,,100.80,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,103.04,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,inpatient,,,112.00000,59.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,103.04,,,,,,,100.80,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,103.04,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,inpatient,,,130.00000,69.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,119.60,,,,,,,117.00,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,outpatient,,,130.00000,69.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,119.60,,,,,,,33.80,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,inpatient,,,421.00000,223.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,387.32,,,,,,,378.90,408.37,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,outpatient,,,421.00000,223.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,387.32,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,inpatient,,,111.00000,58.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,102.12,,,,,,,99.90,107.67,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,outpatient,,,111.00000,58.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,102.12,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,inpatient,,,200.00000,106.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,184.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,outpatient,,,200.00000,106.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,184.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,118.68,,,,,,,33.54,125.13,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,inpatient,,,13.00000,6.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11.96,,,,,,,11.70,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,outpatient,,,13.00000,6.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11.96,,,,,,,3.38,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,inpatient,,,58.00000,30.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,outpatient,,,58.00000,30.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,inpatient,,,13.00000,6.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11.96,,,,,,,11.70,12.61,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,outpatient,,,13.00000,6.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11.96,,,,,,,3.38,12.61,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,inpatient,,,773.00000,410.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,711.16,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,outpatient,,,773.00000,410.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,711.16,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,inpatient,,,773.00000,410.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,711.16,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,outpatient,,,773.00000,410.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,711.16,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,inpatient,,,773.00000,410.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,711.16,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,outpatient,,,773.00000,410.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,711.16,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,inpatient,,,773.00000,410.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,711.16,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,outpatient,,,773.00000,410.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,711.16,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,inpatient,,,387.00000,205.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,356.04,,,,,,,348.30,375.39,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,outpatient,,,387.00000,205.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,356.04,,,,,,,100.62,375.39,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,inpatient,,,52.00000,27.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,46.80,50.44,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,outpatient,,,52.00000,27.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,47.84,,,,,,,13.52,50.44,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,inpatient,,,102.00000,54.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,91.80,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,inpatient,,,102.00000,54.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,91.80,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,93.84,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,inpatient,,,79.00000,41.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,71.10,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,outpatient,,,79.00000,41.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,20.54,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,inpatient,,,65.00000,34.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,58.50,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,outpatient,,,65.00000,34.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,inpatient,,,100.00000,53.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,outpatient,,,100.00000,53.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,inpatient,,,64.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,57.60,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,outpatient,,,64.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,16.64,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,inpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,outpatient,,,106.00000,56.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,inpatient,,,109.00000,57.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100.28,,,,,,,98.10,105.73,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,100.28,,,,,,,28.34,105.73,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,inpatient,,,58.00000,30.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,outpatient,,,58.00000,30.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18.40,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,inpatient,,,66.00000,35.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,outpatient,,,66.00000,35.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18.40,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18.40,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18.40,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,inpatient,,,13.00000,6.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11.96,,,,,,,11.70,12.61,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,outpatient,,,13.00000,6.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,11.96,,,,,,,3.38,12.61,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,inpatient,,,53.00000,28.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,47.70,51.41,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,outpatient,,,53.00000,28.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,13.78,51.41,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,inpatient,,,18.00000,9.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16.56,,,,,,,16.20,17.46,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,outpatient,,,18.00000,9.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,16.56,,,,,,,4.68,17.46,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,inpatient,,,17.00000,9.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,15.64,,,,,,,15.30,16.49,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,outpatient,,,17.00000,9.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,15.64,,,,,,,4.42,16.49,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,inpatient,,,71.00000,37.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,63.90,68.87,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,outpatient,,,71.00000,37.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,65.32,,,,,,,18.46,68.87,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,inpatient,,,57.00000,30.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,outpatient,,,57.00000,30.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,inpatient,,,68.00000,36.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,61.20,65.96,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,outpatient,,,68.00000,36.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,62.56,,,,,,,17.68,65.96,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,inpatient,,,58.00000,30.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,outpatient,,,58.00000,30.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,inpatient,,,27.00000,14.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24.84,,,,,,,24.30,26.19,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,outpatient,,,27.00000,14.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24.84,,,,,,,7.02,26.19,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,inpatient,,,56.00000,29.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,outpatient,,,56.00000,29.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,inpatient,,,56.00000,29.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,50.40,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,outpatient,,,56.00000,29.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,51.52,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,inpatient,,,58.00000,30.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,outpatient,,,58.00000,30.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,inpatient,,,115.00000,61.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,105.80,,,,,,,103.50,111.55,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,outpatient,,,115.00000,61.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,105.80,,,,,,,29.90,111.55,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,inpatient,,,23.00000,12.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,21.16,,,,,,,20.70,22.31,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,outpatient,,,23.00000,12.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,21.16,,,,,,,5.98,22.31,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,inpatient,,,255.00000,135.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,234.60,,,,,,,229.50,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,outpatient,,,255.00000,135.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,234.60,,,,,,,66.30,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,inpatient,,,66.00000,35.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,outpatient,,,66.00000,35.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,inpatient,,,26.00000,13.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,23.40,25.22,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,outpatient,,,26.00000,13.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,6.76,25.22,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,inpatient,,,64.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,57.60,62.08,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,outpatient,,,64.00000,33.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,58.88,,,,,,,16.64,62.08,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,inpatient,,,215.00000,114.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,197.80,,,,,,,193.50,208.55,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,outpatient,,,215.00000,114.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,197.80,,,,,,,55.90,208.55,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,inpatient,,,79.00000,41.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,71.10,76.63,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,outpatient,,,79.00000,41.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,20.54,76.63,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,inpatient,,,11.00000,5.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10.12,,,,,,,9.90,10.67,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,outpatient,,,11.00000,5.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10.12,,,,,,,2.86,10.67,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,inpatient,,,58.00000,27.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,52.20,56.26,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,outpatient,,,58.00000,27.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,53.36,,,,,,,15.08,56.26,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,inpatient,,,10.00000,4.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,9.20,,,,,,,9.00,9.70,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,outpatient,,,10.00000,4.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,9.20,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,inpatient,,,7.00000,3.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6.44,,,,,,,6.30,6.79,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,outpatient,,,7.00000,3.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6.44,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,inpatient,,,53.00000,25.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,47.70,51.41,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,outpatient,,,53.00000,25.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,48.76,,,,,,,13.78,51.41,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,inpatient,,,10.00000,4.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,9.20,,,,,,,9.00,9.70,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,outpatient,,,10.00000,4.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,9.20,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,inpatient,,,11.00000,5.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10.12,,,,,,,9.90,10.67,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10.12,,,,,,,2.86,10.67,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,inpatient,,,7.00000,3.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6.44,,,,,,,6.30,6.79,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,outpatient,,,7.00000,3.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6.44,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,inpatient,,,11.00000,5.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10.12,,,,,,,9.90,10.67,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10.12,,,,,,,2.86,10.67,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,inpatient,,,597.00000,290.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,549.24,,,,,,,537.30,579.09,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,outpatient,,,597.00000,290.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,549.24,,,,,,,155.22,579.09,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,inpatient,,,6379.00000,3100.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5868.68,,,,,,,5741.10,6187.63,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,outpatient,,,6379.00000,3100.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5868.68,,,,,,,1658.54,6187.63,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,inpatient,,,471.00000,228.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,433.32,,,,,,,423.90,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,outpatient,,,471.00000,228.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,433.32,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,inpatient,,,471.00000,228.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,433.32,,,,,,,423.90,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,outpatient,,,471.00000,228.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,433.32,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,inpatient,,,1251.00000,607.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1150.92,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,outpatient,,,1251.00000,607.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1150.92,,,,,,,325.26,1213.47,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,inpatient,,,260.00000,126.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,239.20,,,,,,,234.00,252.20,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,outpatient,,,260.00000,126.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,239.20,,,,,,,67.60,252.20,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,inpatient,,,785.00000,381.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,722.20,,,,,,,706.50,761.45,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,outpatient,,,785.00000,381.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,722.20,,,,,,,204.10,761.45,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,inpatient,,,529.00000,257.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,486.68,,,,,,,476.10,513.13,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,outpatient,,,529.00000,257.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,486.68,,,,,,,137.54,513.13,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,inpatient,,,1623.00000,788.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1493.16,,,,,,,1460.70,1574.31,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,outpatient,,,1623.00000,788.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1493.16,,,,,,,421.98,1574.31,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,inpatient,,,10800.00000,5248.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,9936.00,,,,,,,9720.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,outpatient,,,10800.00000,5248.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,9936.00,,,,,,,2808.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,inpatient,,,25365.00000,12327.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23335.80,,,,,,,22828.50,24604.05,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,outpatient,,,25365.00000,12327.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23335.80,,,,,,,6594.90,24604.05,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,inpatient,,,101.00000,21.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92.92,,,,,,,90.90,97.97,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,outpatient,,,101.00000,21.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92.92,,,,,,,26.26,97.97,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,inpatient,,,81.00000,17.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,72.90,78.57,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,outpatient,,,81.00000,17.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,21.06,78.57,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,inpatient,,,104.00000,22.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,95.68,,,,,,,93.60,100.88,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,outpatient,,,104.00000,22.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,95.68,,,,,,,27.04,100.88,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,inpatient,,,377.00000,81.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,346.84,,,,,,,339.30,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,outpatient,,,377.00000,81.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,346.84,,,,,,,98.02,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,inpatient,,,532.00000,114.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,489.44,,,,,,,478.80,516.04,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,outpatient,,,532.00000,114.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,489.44,,,,,,,138.32,516.04,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,inpatient,,,521.00000,112.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,479.32,,,,,,,468.90,505.37,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,outpatient,,,521.00000,112.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,479.32,,,,,,,135.46,505.37,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,inpatient,,,451.00000,97.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,414.92,,,,,,,405.90,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,outpatient,,,451.00000,97.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,414.92,,,,,,,117.26,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,inpatient,,,1148.00000,247.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1056.16,,,,,,,1033.20,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,outpatient,,,1148.00000,247.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1056.16,,,,,,,298.48,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,inpatient,,,350.00000,75.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,322.00,,,,,,,315.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,outpatient,,,350.00000,75.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,322.00,,,,,,,91.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,inpatient,,,423.00000,91.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,389.16,,,,,,,380.70,410.31,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,outpatient,,,423.00000,91.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,389.16,,,,,,,109.98,410.31,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,inpatient,,,751.00000,162.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,690.92,,,,,,,675.90,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,690.92,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,inpatient,,,751.00000,162.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,690.92,,,,,,,675.90,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,690.92,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,inpatient,,,119.00000,25.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,109.48,,,,,,,107.10,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,outpatient,,,119.00000,25.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,109.48,,,,,,,30.94,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,inpatient,,,126.00000,27.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,115.92,,,,,,,113.40,122.22,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,outpatient,,,126.00000,27.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,115.92,,,,,,,32.76,122.22,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,inpatient,,,110.00000,23.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,inpatient,,,110.00000,23.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,inpatient,,,79.00000,17.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,71.10,76.63,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,outpatient,,,79.00000,17.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,20.54,76.63,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,inpatient,,,110.00000,23.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,inpatient,,,110.00000,23.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,inpatient,,,79.00000,17.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,71.10,76.63,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,outpatient,,,79.00000,17.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,20.54,76.63,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,inpatient,,,335.00000,72.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,308.20,,,,,,,301.50,324.95,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,outpatient,,,335.00000,72.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,308.20,,,,,,,87.10,324.95,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,inpatient,,,154.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,141.68,,,,,,,138.60,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,141.68,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,inpatient,,,154.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,141.68,,,,,,,138.60,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,141.68,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,inpatient,,,128.00000,27.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,117.76,,,,,,,115.20,124.16,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,outpatient,,,128.00000,27.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,117.76,,,,,,,33.28,124.16,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,inpatient,,,65.00000,14.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,58.50,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,outpatient,,,65.00000,14.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,59.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,inpatient,,,272.00000,58.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,250.24,,,,,,,244.80,263.84,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,outpatient,,,272.00000,58.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,250.24,,,,,,,70.72,263.84,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,inpatient,,,26.00000,11.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,23.40,25.22,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,outpatient,,,26.00000,11.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.92,,,,,,,6.76,25.22,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,inpatient,,,359.00000,157.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,323.10,348.23,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,outpatient,,,359.00000,157.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,93.34,348.23,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,inpatient,,,189.00000,83.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,173.88,,,,,,,170.10,183.33,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,outpatient,,,189.00000,83.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,173.88,,,,,,,49.14,183.33,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,inpatient,,,359.00000,157.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,323.10,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,outpatient,,,359.00000,157.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,93.34,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,inpatient,,,137.00000,60.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,126.04,,,,,,,123.30,132.89,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,outpatient,,,137.00000,60.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,126.04,,,,,,,35.62,132.89,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,inpatient,,,1665.00000,732.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1531.80,,,,,,,1498.50,1615.05,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,outpatient,,,1665.00000,732.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1531.80,,,,,,,432.90,1615.05,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,inpatient,,,751.00000,330.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,690.92,,,,,,,675.90,728.47,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,outpatient,,,751.00000,330.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,690.92,,,,,,,195.26,728.47,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,inpatient,,,374.00000,164.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,344.08,,,,,,,336.60,362.78,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,outpatient,,,374.00000,164.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,344.08,,,,,,,97.24,362.78,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,inpatient,,,553.00000,243.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,508.76,,,,,,,497.70,536.41,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,outpatient,,,553.00000,243.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,508.76,,,,,,,143.78,536.41,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,inpatient,,,359.00000,157.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,323.10,348.23,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,outpatient,,,359.00000,157.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,93.34,348.23,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,inpatient,,,62.00000,27.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,55.80,60.14,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,outpatient,,,62.00000,27.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.04,,,,,,,16.12,60.14,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,inpatient,,,79.00000,34.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,71.10,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,outpatient,,,79.00000,34.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,20.54,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,inpatient,,,110.00000,48.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,99.00,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,outpatient,,,110.00000,48.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,inpatient,,,110.00000,48.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,99.00,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,outpatient,,,110.00000,48.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,inpatient,,,751.00000,330.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,690.92,,,,,,,675.90,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,outpatient,,,751.00000,330.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,690.92,,,,,,,195.26,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,inpatient,,,1665.00000,732.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1531.80,,,,,,,1498.50,1615.05,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,outpatient,,,1665.00000,732.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1531.80,,,,,,,432.90,1615.05,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,inpatient,,,110.00000,48.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,99.00,106.70,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,outpatient,,,110.00000,48.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,28.60,106.70,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,inpatient,,,281.00000,123.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,258.52,,,,,,,252.90,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,258.52,,,,,,,73.06,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,inpatient,,,281.00000,123.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,258.52,,,,,,,252.90,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,258.52,,,,,,,73.06,272.57,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,inpatient,,,451.00000,341.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,414.92,,,,,,,405.90,437.47,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,outpatient,,,451.00000,341.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,414.92,,,,,,,117.26,437.47,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,inpatient,,,300.00000,145.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,276.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,outpatient,,,300.00000,145.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,276.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,inpatient,,,2278.00000,1107.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2095.76,,,,,,,2050.20,2209.66,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,outpatient,,,2278.00000,1107.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2095.76,,,,,,,592.28,2209.66,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,inpatient,,,3912.00000,1901.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3599.04,,,,,,,3520.80,3794.64,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,outpatient,,,3912.00000,1901.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3599.04,,,,,,,1017.12,3794.64,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,inpatient,,,900.00000,437.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,828.00,,,,,,,810.00,873.00,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,outpatient,,,900.00000,437.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,828.00,,,,,,,234.00,873.00,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,inpatient,,,365.00000,177.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,335.80,,,,,,,328.50,354.05,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,outpatient,,,365.00000,177.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,335.80,,,,,,,94.90,354.05,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,inpatient,,,989.00000,480.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,909.88,,,,,,,890.10,959.33,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,outpatient,,,989.00000,480.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,909.88,,,,,,,257.14,959.33,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,452.64,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,452.64,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,inpatient,,,435.00000,211.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,400.20,,,,,,,391.50,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,400.20,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,inpatient,,,435.00000,211.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,400.20,,,,,,,391.50,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,400.20,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,inpatient,,,644.00000,312.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,592.48,,,,,,,579.60,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,outpatient,,,644.00000,312.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,592.48,,,,,,,167.44,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,452.64,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,452.64,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,452.64,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,452.64,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,inpatient,,,527.00000,256.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,484.84,,,,,,,474.30,511.19,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,outpatient,,,527.00000,256.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,484.84,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,inpatient,,,1404.00000,682.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1291.68,,,,,,,1263.60,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,outpatient,,,1404.00000,682.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1291.68,,,,,,,365.04,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,inpatient,,,5475.00000,2660.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5037.00,,,,,,,4927.50,5310.75,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,outpatient,,,5475.00000,2660.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5037.00,,,,,,,1423.50,5310.75,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,inpatient,,,726.00000,352.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,667.92,,,,,,,653.40,704.22,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,outpatient,,,726.00000,352.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,667.92,,,,,,,188.76,704.22,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,inpatient,,,507.00000,246.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,466.44,,,,,,,456.30,491.79,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,outpatient,,,507.00000,246.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,466.44,,,,,,,131.82,491.79,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,inpatient,,,1670.00000,811.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1536.40,,,,,,,1503.00,1619.90,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,outpatient,,,1670.00000,811.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1536.40,,,,,,,434.20,1619.90,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,inpatient,,,1139.00000,553.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1047.88,,,,,,,1025.10,1104.83,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,outpatient,,,1139.00000,553.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1047.88,,,,,,,296.14,1104.83,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,inpatient,,,875.00000,425.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,805.00,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,outpatient,,,875.00000,425.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,805.00,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,inpatient,,,525.00000,255.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,483.00,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,outpatient,,,525.00000,255.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,483.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,inpatient,,,1353.00000,657.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1244.76,,,,,,,1217.70,1312.41,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,outpatient,,,1353.00000,657.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1244.76,,,,,,,351.78,1312.41,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,inpatient,,,525.00000,255.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,483.00,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,outpatient,,,525.00000,255.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,483.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,inpatient,,,525.00000,255.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,483.00,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,outpatient,,,525.00000,255.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,483.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,inpatient,,,825.00000,400.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,759.00,,,,,,,742.50,800.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,outpatient,,,825.00000,400.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,759.00,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,inpatient,,,525.00000,255.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,483.00,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,483.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,inpatient,,,525.00000,255.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,483.00,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,483.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,inpatient,,,974.00000,473.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,896.08,,,,,,,876.60,944.78,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,outpatient,,,974.00000,473.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,896.08,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,inpatient,,,198.00000,96.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,182.16,,,,,,,178.20,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,182.16,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,inpatient,,,198.00000,96.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,182.16,,,,,,,178.20,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,182.16,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,inpatient,,,221.00000,107.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,203.32,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,203.32,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,inpatient,,,221.00000,107.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,203.32,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,203.32,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,inpatient,,,497.00000,241.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,457.24,,,,,,,447.30,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,outpatient,,,497.00000,241.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,457.24,,,,,,,129.22,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,inpatient,,,2340.00000,1137.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2152.80,,,,,,,2106.00,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,outpatient,,,2340.00000,1137.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2152.80,,,,,,,608.40,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,inpatient,,,249.00000,121.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,229.08,,,,,,,224.10,241.53,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,outpatient,,,249.00000,121.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,229.08,,,,,,,64.74,241.53,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,inpatient,,,135.00000,65.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,124.20,,,,,,,121.50,130.95,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,outpatient,,,135.00000,65.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,124.20,,,,,,,35.10,130.95,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,inpatient,,,172.00000,83.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,158.24,,,,,,,154.80,166.84,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,outpatient,,,172.00000,83.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,158.24,,,,,,,44.72,166.84,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,inpatient,,,307.00000,149.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,282.44,,,,,,,276.30,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,outpatient,,,307.00000,149.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,282.44,,,,,,,79.82,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,inpatient,,,1800.00000,874.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1656.00,,,,,,,1620.00,1746.00,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,outpatient,,,1800.00000,874.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1656.00,,,,,,,468.00,1746.00,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,inpatient,,,974.00000,473.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,896.08,,,,,,,876.60,944.78,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,outpatient,,,974.00000,473.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,896.08,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,inpatient,,,197.00000,95.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,181.24,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,181.24,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,inpatient,,,197.00000,95.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,181.24,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,181.24,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,inpatient,,,411.00000,199.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,378.12,,,,,,,369.90,398.67,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,outpatient,,,411.00000,199.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,378.12,,,,,,,106.86,398.67,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,inpatient,,,221.00000,107.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,203.32,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,outpatient,,,221.00000,107.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,203.32,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,inpatient,,,884.00000,429.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,813.28,,,,,,,795.60,857.48,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,outpatient,,,884.00000,429.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,813.28,,,,,,,229.84,857.48,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,inpatient,,,594.00000,288.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,534.60,576.18,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,outpatient,,,594.00000,288.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,546.48,,,,,,,154.44,576.18,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,inpatient,,,519.00000,252.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,477.48,,,,,,,467.10,503.43,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,outpatient,,,519.00000,252.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,477.48,,,,,,,134.94,503.43,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,inpatient,,,1046.00000,508.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,962.32,,,,,,,941.40,1014.62,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,outpatient,,,1046.00000,508.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,962.32,,,,,,,271.96,1014.62,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,inpatient,,,556.00000,270.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,511.52,,,,,,,500.40,539.32,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,outpatient,,,556.00000,270.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,511.52,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,inpatient,,,275.00000,133.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,253.00,,,,,,,247.50,266.75,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,outpatient,,,275.00000,133.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,253.00,,,,,,,71.50,266.75,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,inpatient,,,580.00000,281.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,533.60,,,,,,,522.00,562.60,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,outpatient,,,580.00000,281.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,533.60,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,inpatient,,,580.00000,281.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,533.60,,,,,,,522.00,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,outpatient,,,580.00000,281.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,533.60,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,inpatient,,,3480.00000,1691.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3201.60,,,,,,,3132.00,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3201.60,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,inpatient,,,3480.00000,1691.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3201.60,,,,,,,3132.00,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3201.60,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,inpatient,,,700.00000,340.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,644.00,,,,,,,630.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,outpatient,,,700.00000,340.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,644.00,,,,,,,182.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,inpatient,,,1427.00000,693.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1312.84,,,,,,,1284.30,1384.19,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,outpatient,,,1427.00000,693.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1312.84,,,,,,,371.02,1384.19,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,inpatient,,,614.00000,298.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,564.88,,,,,,,552.60,595.58,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,outpatient,,,614.00000,298.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,564.88,,,,,,,159.64,595.58,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,inpatient,,,2027.00000,985.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1864.84,,,,,,,1824.30,1966.19,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,outpatient,,,2027.00000,985.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1864.84,,,,,,,527.02,1966.19,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,inpatient,,,556.00000,270.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,511.52,,,,,,,500.40,539.32,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,outpatient,,,556.00000,270.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,511.52,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,inpatient,,,1146.00000,556.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1054.32,,,,,,,1031.40,1111.62,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,outpatient,,,1146.00000,556.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1054.32,,,,,,,297.96,1111.62,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,inpatient,,,197.00000,95.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,181.24,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,181.24,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,inpatient,,,197.00000,95.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,181.24,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,181.24,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,inpatient,,,527.00000,256.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,484.84,,,,,,,474.30,511.19,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,outpatient,,,527.00000,256.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,484.84,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,inpatient,,,740.00000,359.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,680.80,,,,,,,666.00,717.80,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,outpatient,,,740.00000,359.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,680.80,,,,,,,192.40,717.80,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,inpatient,,,875.00000,425.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,805.00,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,805.00,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,inpatient,,,875.00000,425.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,805.00,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,805.00,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,inpatient,,,1399.00000,679.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1287.08,,,,,,,1259.10,1357.03,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,outpatient,,,1399.00000,679.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1287.08,,,,,,,363.74,1357.03,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,inpatient,,,51.00000,24.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,45.90,49.47,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,outpatient,,,51.00000,24.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,46.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,inpatient,,,825.00000,400.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,759.00,,,,,,,742.50,800.25,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,outpatient,,,825.00000,400.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,759.00,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,inpatient,,,576.00000,279.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,529.92,,,,,,,518.40,558.72,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,outpatient,,,576.00000,279.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,529.92,,,,,,,149.76,558.72,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,inpatient,,,224.00000,108.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,206.08,,,,,,,201.60,217.28,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,outpatient,,,224.00000,108.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,206.08,,,,,,,58.24,217.28,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,inpatient,,,346.00000,168.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,318.32,,,,,,,311.40,335.62,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,outpatient,,,346.00000,168.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,318.32,,,,,,,89.96,335.62,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,inpatient,,,525.00000,255.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,483.00,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,outpatient,,,525.00000,255.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,483.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,inpatient,,,525.00000,255.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,483.00,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,outpatient,,,525.00000,255.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,483.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,inpatient,,,525.00000,255.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,483.00,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,483.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,inpatient,,,525.00000,255.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,483.00,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,483.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,inpatient,,,627.00000,304.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,576.84,,,,,,,564.30,608.19,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,outpatient,,,627.00000,304.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,576.84,,,,,,,163.02,608.19,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,inpatient,,,605.00000,294.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,556.60,,,,,,,544.50,586.85,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,outpatient,,,605.00000,294.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,556.60,,,,,,,157.30,586.85,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,inpatient,,,510.00000,247.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,469.20,,,,,,,459.00,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,outpatient,,,510.00000,247.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,469.20,,,,,,,132.60,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,inpatient,,,223.00000,108.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,205.16,,,,,,,200.70,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,outpatient,,,223.00000,108.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,205.16,,,,,,,57.98,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,inpatient,,,1211.00000,588.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1114.12,,,,,,,1089.90,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,outpatient,,,1211.00000,588.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1114.12,,,,,,,314.86,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,inpatient,,,383.00000,186.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,352.36,,,,,,,344.70,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,outpatient,,,383.00000,186.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,352.36,,,,,,,99.58,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,inpatient,,,1214.00000,590.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1116.88,,,,,,,1092.60,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,outpatient,,,1214.00000,590.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1116.88,,,,,,,315.64,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,inpatient,,,328.00000,159.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,301.76,,,,,,,295.20,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,outpatient,,,328.00000,159.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,301.76,,,,,,,85.28,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,inpatient,,,372.00000,180.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,342.24,,,,,,,334.80,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,outpatient,,,372.00000,180.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,342.24,,,,,,,96.72,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,inpatient,,,285.00000,138.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,262.20,,,,,,,256.50,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,outpatient,,,285.00000,138.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,262.20,,,,,,,74.10,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,inpatient,,,367.00000,178.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,337.64,,,,,,,330.30,355.99,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,outpatient,,,367.00000,178.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,337.64,,,,,,,95.42,355.99,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,inpatient,,,702.00000,341.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,645.84,,,,,,,631.80,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,645.84,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,inpatient,,,702.00000,341.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,645.84,,,,,,,631.80,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,645.84,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,inpatient,,,265.00000,128.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,243.80,,,,,,,238.50,257.05,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,outpatient,,,265.00000,128.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,243.80,,,,,,,68.90,257.05,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,inpatient,,,2279.00000,1107.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2096.68,,,,,,,2051.10,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2279.00000,1107.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2096.68,,,,,,,592.54,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,inpatient,,,2395.00000,1163.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2203.40,,,,,,,2155.50,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2395.00000,1163.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2203.40,,,,,,,622.70,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,inpatient,,,8759.00000,4256.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8058.28,,,,,,,7883.10,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8058.28,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,inpatient,,,8759.00000,4256.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8058.28,,,,,,,7883.10,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8058.28,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,inpatient,,,2752.00000,1337.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2531.84,,,,,,,2476.80,2669.44,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,outpatient,,,2752.00000,1337.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2531.84,,,,,,,715.52,2669.44,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,inpatient,,,217.00000,105.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,199.64,,,,,,,195.30,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,199.64,,,,,,,56.42,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,inpatient,,,217.00000,105.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,199.64,,,,,,,195.30,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,199.64,,,,,,,56.42,210.49,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,inpatient,,,292.00000,141.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,268.64,,,,,,,262.80,283.24,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,outpatient,,,292.00000,141.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,268.64,,,,,,,75.92,283.24,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,378.12,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,378.12,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,378.12,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,378.12,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,378.12,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,378.12,,,,,,,106.86,398.67,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,inpatient,,,2275.00000,1105.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2093.00,,,,,,,2047.50,2206.75,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,outpatient,,,2275.00000,1105.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2093.00,,,,,,,591.50,2206.75,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,inpatient,,,192.00000,93.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,176.64,,,,,,,172.80,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,outpatient,,,192.00000,93.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,176.64,,,,,,,49.92,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,inpatient,,,451.00000,219.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,414.92,,,,,,,405.90,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,outpatient,,,451.00000,219.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,414.92,,,,,,,117.26,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,inpatient,,,617.00000,299.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,567.64,,,,,,,555.30,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,outpatient,,,617.00000,299.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,567.64,,,,,,,160.42,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,inpatient,,,825.00000,400.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,759.00,,,,,,,742.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,outpatient,,,825.00000,400.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,759.00,,,,,,,214.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,inpatient,,,905.00000,439.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,832.60,,,,,,,814.50,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,outpatient,,,905.00000,439.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,832.60,,,,,,,235.30,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,inpatient,,,849.00000,412.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,781.08,,,,,,,764.10,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,outpatient,,,849.00000,412.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,781.08,,,,,,,220.74,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,inpatient,,,2539.00000,1233.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2335.88,,,,,,,2285.10,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,outpatient,,,2539.00000,1233.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2335.88,,,,,,,660.14,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,inpatient,,,6000.00000,2916.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5520.00,,,,,,,5400.00,5820.00,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,outpatient,,,6000.00000,2916.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5520.00,,,,,,,1560.00,5820.00,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,inpatient,,,8260.00000,4014.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7599.20,,,,,,,7434.00,8012.20,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,outpatient,,,8260.00000,4014.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7599.20,,,,,,,2147.60,8012.20,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,inpatient,,,202.00000,88.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,185.84,,,,,,,181.80,195.94,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,outpatient,,,202.00000,88.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,185.84,,,,,,,52.52,195.94,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,inpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,59.40,64.02,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,outpatient,,,66.00000,31.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,60.72,,,,,,,17.16,64.02,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,inpatient,,,295.00000,142.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,271.40,,,,,,,265.50,286.15,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,outpatient,,,295.00000,142.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,271.40,,,,,,,76.70,286.15,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,89.00000,26.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,81.88,,,,,,,80.10,86.33,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,89.00000,26.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,81.88,,,,,,,23.14,86.33,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,inpatient,,,93.00000,27.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,85.56,,,,,,,83.70,90.21,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,85.56,,,,,,,24.18,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,93.00000,27.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,85.56,,,,,,,83.70,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,85.56,,,,,,,24.18,90.21,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1725.00,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1725.00,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1725.00,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1725.00,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1752.00000,527.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1611.84,,,,,,,1576.80,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1611.84,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1752.00000,527.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1611.84,,,,,,,1576.80,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1611.84,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,731.00000,220.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,672.52,,,,,,,657.90,709.07,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,731.00000,220.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,672.52,,,,,,,190.06,709.07,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,787.00000,236.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,724.04,,,,,,,708.30,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,787.00000,236.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,724.04,,,,,,,204.62,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,2042.00000,614.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1878.64,,,,,,,1837.80,1980.74,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,2042.00000,614.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1878.64,,,,,,,530.92,1980.74,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1725.00,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1725.00,,,,,,,487.50,1818.75,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,714.00000,214.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,656.88,,,,,,,642.60,692.58,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,714.00000,214.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,656.88,,,,,,,185.64,692.58,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,294.00000,88.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,270.48,,,,,,,264.60,285.18,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,294.00000,88.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,270.48,,,,,,,76.44,285.18,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,inpatient,,,350.00000,105.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,322.00,,,,,,,315.00,339.50,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,350.00000,105.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,322.00,,,,,,,91.00,339.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,inpatient,,,1350.00000,780.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1242.00,,,,,,,1215.00,1309.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,outpatient,,,1350.00000,780.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1242.00,,,,,,,351.00,1309.50,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,inpatient,,,3680.00000,2127.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3385.60,,,,,,,3312.00,3569.60,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,outpatient,,,3680.00000,2127.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3385.60,,,,,,,956.80,3569.60,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,inpatient,,,1600.00000,924.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1472.00,,,,,,,1440.00,1552.00,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,outpatient,,,1600.00000,924.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1472.00,,,,,,,416.00,1552.00,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,inpatient,,,4680.00000,2705.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4305.60,,,,,,,4212.00,4539.60,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,outpatient,,,4680.00000,2705.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4305.60,,,,,,,1216.80,4539.60,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,inpatient,,,2100.00000,1213.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1932.00,,,,,,,1890.00,2037.00,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,outpatient,,,2100.00000,1213.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1932.00,,,,,,,546.00,2037.00,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,inpatient,,,5680.00000,3283.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5225.60,,,,,,,5112.00,5509.60,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,outpatient,,,5680.00000,3283.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5225.60,,,,,,,1476.80,5509.60,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,inpatient,,,2420.00000,1398.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2226.40,,,,,,,2178.00,2347.40,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,outpatient,,,2420.00000,1398.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2226.40,,,,,,,629.20,2347.40,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,inpatient,,,6415.00000,3707.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5901.80,,,,,,,5773.50,6222.55,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,outpatient,,,6415.00000,3707.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5901.80,,,,,,,1667.90,6222.55,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,inpatient,,,2920.00000,1687.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2686.40,,,,,,,2628.00,2832.40,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,outpatient,,,2920.00000,1687.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2686.40,,,,,,,759.20,2832.40,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,inpatient,,,8915.00000,5152.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8201.80,,,,,,,8023.50,8647.55,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,outpatient,,,8915.00000,5152.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8201.80,,,,,,,2317.90,8647.55,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,inpatient,,,3420.00000,1976.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3146.40,,,,,,,3078.00,3317.40,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,outpatient,,,3420.00000,1976.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3146.40,,,,,,,889.20,3317.40,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,inpatient,,,11415.00000,6597.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10501.80,,,,,,,10273.50,11072.55,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,outpatient,,,11415.00000,6597.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,10501.80,,,,,,,2967.90,11072.55,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,inpatient,,,142.00000,154.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,130.64,,,,,,,127.80,137.74,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,outpatient,,,142.00000,154.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,130.64,,,,,,,36.92,137.74,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,inpatient,,,340.00000,228.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,312.80,,,,,,,306.00,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,312.80,,,,,,,88.40,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,inpatient,,,670.00000,450.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,616.40,,,,,,,603.00,649.90,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,616.40,,,,,,,174.20,649.90,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,inpatient,,,390.00000,262.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,358.80,,,,,,,351.00,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,outpatient,,,390.00000,262.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,358.80,,,,,,,101.40,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,inpatient,,,1170.00000,787.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1076.40,,,,,,,1053.00,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,outpatient,,,1170.00000,787.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1076.40,,,,,,,304.20,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,inpatient,,,440.00000,296.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,404.80,,,,,,,396.00,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,outpatient,,,440.00000,296.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,404.80,,,,,,,114.40,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,inpatient,,,1670.00000,1123.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1536.40,,,,,,,1503.00,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,outpatient,,,1670.00000,1123.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1536.40,,,,,,,434.20,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,inpatient,,,640.00000,430.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,588.80,,,,,,,576.00,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,outpatient,,,640.00000,430.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,588.80,,,,,,,166.40,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,inpatient,,,2170.00000,1460.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1996.40,,,,,,,1953.00,2104.90,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,outpatient,,,2170.00000,1460.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1996.40,,,,,,,564.20,2104.90,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,inpatient,,,17.00000,10.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,15.64,,,,,,,15.30,16.49,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,outpatient,,,17.00000,10.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,15.64,,,,,,,4.42,16.49,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,inpatient,,,535.00000,345.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,492.20,,,,,,,481.50,518.95,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,outpatient,,,535.00000,345.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,492.20,,,,,,,139.10,518.95,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,inpatient,,,23.00000,14.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,21.16,,,,,,,20.70,22.31,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,outpatient,,,23.00000,14.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,21.16,,,,,,,5.98,22.31,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,inpatient,,,635.00000,409.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,584.20,,,,,,,571.50,615.95,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,outpatient,,,635.00000,409.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,584.20,,,,,,,165.10,615.95,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,inpatient,,,30.00000,19.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,27.60,,,,,,,27.00,29.10,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,outpatient,,,30.00000,19.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,27.60,,,,,,,7.80,29.10,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,inpatient,,,735.00000,474.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,676.20,,,,,,,661.50,712.95,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,outpatient,,,735.00000,474.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,676.20,,,,,,,191.10,712.95,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,inpatient,,,33.00000,21.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,30.36,,,,,,,29.70,32.01,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,outpatient,,,33.00000,21.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,30.36,,,,,,,8.58,32.01,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,inpatient,,,835.00000,538.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,768.20,,,,,,,751.50,809.95,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,outpatient,,,835.00000,538.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,768.20,,,,,,,217.10,809.95,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,inpatient,,,140.00000,80.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,128.80,,,,,,,126.00,135.80,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,outpatient,,,140.00000,80.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,128.80,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,inpatient,,,275.00000,158.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,253.00,,,,,,,247.50,266.75,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,outpatient,,,275.00000,158.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,253.00,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,inpatient,,,295.00000,170.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,271.40,,,,,,,265.50,286.15,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,outpatient,,,295.00000,170.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,271.40,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,inpatient,,,590.00000,341.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,542.80,,,,,,,531.00,572.30,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,outpatient,,,590.00000,341.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,542.80,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,inpatient,,,690.00000,398.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,634.80,,,,,,,621.00,669.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,outpatient,,,690.00000,398.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,634.80,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,inpatient,,,1375.00000,794.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1265.00,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,outpatient,,,1375.00000,794.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1265.00,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,inpatient,,,950.00000,549.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,874.00,,,,,,,855.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,outpatient,,,950.00000,549.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,874.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,inpatient,,,1900.00000,1098.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1748.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,outpatient,,,1900.00000,1098.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1748.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,inpatient,,,140.00000,45.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,128.80,,,,,,,126.00,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,outpatient,,,140.00000,45.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,128.80,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,inpatient,,,275.00000,88.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,253.00,,,,,,,247.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,outpatient,,,275.00000,88.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,253.00,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,inpatient,,,295.00000,95.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,271.40,,,,,,,265.50,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,outpatient,,,295.00000,95.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,271.40,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,inpatient,,,590.00000,190.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,542.80,,,,,,,531.00,572.30,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,outpatient,,,590.00000,190.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,542.80,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,inpatient,,,690.00000,222.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,634.80,,,,,,,621.00,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,outpatient,,,690.00000,222.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,634.80,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,inpatient,,,1375.00000,444.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1265.00,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,outpatient,,,1375.00000,444.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1265.00,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,inpatient,,,950.00000,306.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,874.00,,,,,,,855.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,outpatient,,,950.00000,306.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,874.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,inpatient,,,1900.00000,613.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1748.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,outpatient,,,1900.00000,613.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1748.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,inpatient,,,340.00000,228.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,312.80,,,,,,,306.00,329.80,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,312.80,,,,,,,88.40,329.80,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,inpatient,,,670.00000,450.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,616.40,,,,,,,603.00,649.90,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,616.40,,,,,,,174.20,649.90,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,450.80,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,450.80,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,inpatient,,,490.00000,329.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,450.80,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,450.80,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,450.80,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,450.80,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,inpatient,,,245.00000,164.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,225.40,,,,,,,220.50,237.65,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,225.40,,,,,,,63.70,237.65,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,774.64,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,774.64,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,968.76,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,968.76,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1161.96,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1161.96,,,,,,,328.38,1225.11,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,inpatient,,,1178.00000,669.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1083.76,,,,,,,1060.20,1142.66,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1178.00000,669.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1083.76,,,,,,,306.28,1142.66,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,inpatient,,,140.00000,102.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,128.80,,,,,,,126.00,135.80,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,outpatient,,,140.00000,102.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,128.80,,,,,,,36.40,135.80,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,inpatient,,,275.00000,201.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,253.00,,,,,,,247.50,266.75,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,outpatient,,,275.00000,201.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,253.00,,,,,,,71.50,266.75,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,inpatient,,,295.00000,215.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,271.40,,,,,,,265.50,286.15,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,outpatient,,,295.00000,215.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,271.40,,,,,,,76.70,286.15,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,inpatient,,,590.00000,431.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,542.80,,,,,,,531.00,572.30,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,outpatient,,,590.00000,431.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,542.80,,,,,,,153.40,572.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,inpatient,,,690.00000,504.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,634.80,,,,,,,621.00,669.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,outpatient,,,690.00000,504.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,634.80,,,,,,,179.40,669.30,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,inpatient,,,1375.00000,1005.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1265.00,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,outpatient,,,1375.00000,1005.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1265.00,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,inpatient,,,950.00000,694.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,874.00,,,,,,,855.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,outpatient,,,950.00000,694.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,874.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,inpatient,,,1900.00000,1388.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1748.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,outpatient,,,1900.00000,1388.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1748.00,,,,,,,494.00,1843.00,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,inpatient,,,584.00000,426.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,537.28,,,,,,,525.60,566.48,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,outpatient,,,584.00000,426.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,537.28,,,,,,,151.84,566.48,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,inpatient,,,1391.00000,1016.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1279.72,,,,,,,1251.90,1349.27,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,outpatient,,,1391.00000,1016.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1279.72,,,,,,,361.66,1349.27,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,inpatient,,,359.00000,271.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,323.10,348.23,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,outpatient,,,359.00000,271.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,330.28,,,,,,,93.34,348.23,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,inpatient,,,95.00000,71.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,87.40,,,,,,,85.50,92.15,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,outpatient,,,95.00000,71.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,87.40,,,,,,,24.70,92.15,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,inpatient,,,37.00000,17.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,34.04,,,,,,,33.30,35.89,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,outpatient,,,37.00000,17.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,34.04,,,,,,,9.62,35.89,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,71.10,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,72.68,,,,,,,20.54,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,inpatient,,,237.00000,114.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,218.04,,,,,,,213.30,229.89,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,218.04,,,,,,,61.62,229.89,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,inpatient,,,33.00000,15.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,30.36,,,,,,,29.70,32.01,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,outpatient,,,33.00000,15.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,30.36,,,,,,,8.58,32.01,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,inpatient,,,25.00000,12.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.00,,,,,,,22.50,24.25,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,outpatient,,,25.00000,12.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,23.00,,,,,,,6.50,24.25,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,inpatient,,,497.00000,160.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,457.24,,,,,,,447.30,482.09,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,outpatient,,,497.00000,160.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,457.24,,,,,,,129.22,482.09,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,811.44,,,,,,,793.80,855.54,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,811.44,,,,,,,229.32,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,811.44,,,,,,,793.80,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,811.44,,,,,,,229.32,855.54,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,inpatient,,,98.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,88.20,95.06,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,25.48,95.06,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,inpatient,,,96.00000,36.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,88.32,,,,,,,86.40,93.12,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,88.32,,,,,,,24.96,93.12,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,811.44,,,,,,,793.80,855.54,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,811.44,,,,,,,229.32,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,811.44,,,,,,,793.80,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,811.44,,,,,,,229.32,855.54,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,inpatient,,,763.00000,291.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,701.96,,,,,,,686.70,740.11,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,outpatient,,,763.00000,291.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,701.96,,,,,,,198.38,740.11,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,inpatient,,,199.00000,76.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,183.08,,,,,,,179.10,193.03,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,outpatient,,,199.00000,76.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,183.08,,,,,,,51.74,193.03,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,inpatient,,,98.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,88.20,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,25.48,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,inpatient,,,96.00000,36.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,88.32,,,,,,,86.40,93.12,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,88.32,,,,,,,24.96,93.12,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,inpatient,,,1265.00000,483.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1163.80,,,,,,,1138.50,1227.05,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,outpatient,,,1265.00000,483.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1163.80,,,,,,,328.90,1227.05,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,inpatient,,,924.00000,352.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,850.08,,,,,,,831.60,896.28,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,outpatient,,,924.00000,352.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,850.08,,,,,,,240.24,896.28,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,inpatient,,,580.00000,215.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,533.60,,,,,,,522.00,562.60,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,outpatient,,,580.00000,215.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,533.60,,,,,,,150.80,562.60,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,inpatient,,,110.00000,40.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,99.00,106.70,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,outpatient,,,110.00000,40.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,28.60,106.70,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,inpatient,,,373.00000,138.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,343.16,,,,,,,335.70,361.81,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,outpatient,,,373.00000,138.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,343.16,,,,,,,96.98,361.81,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,inpatient,,,337.00000,125.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,310.04,,,,,,,303.30,326.89,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,outpatient,,,337.00000,125.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,310.04,,,,,,,87.62,326.89,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,inpatient,,,784.00000,291.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,721.28,,,,,,,705.60,760.48,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,outpatient,,,784.00000,291.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,721.28,,,,,,,203.84,760.48,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,inpatient,,,341.00000,126.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,313.72,,,,,,,306.90,330.77,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,outpatient,,,341.00000,126.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,313.72,,,,,,,88.66,330.77,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,inpatient,,,252.00000,93.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,231.84,,,,,,,226.80,244.44,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,outpatient,,,252.00000,93.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,231.84,,,,,,,65.52,244.44,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,inpatient,,,282.00000,104.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,259.44,,,,,,,253.80,273.54,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,outpatient,,,282.00000,104.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,259.44,,,,,,,73.32,273.54,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,inpatient,,,404.00000,150.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,371.68,,,,,,,363.60,391.88,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,outpatient,,,404.00000,150.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,371.68,,,,,,,105.04,391.88,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,inpatient,,,306.00000,173.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,281.52,,,,,,,275.40,296.82,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,outpatient,,,306.00000,173.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,281.52,,,,,,,79.56,296.82,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,inpatient,,,158.00000,89.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,145.36,,,,,,,142.20,153.26,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,outpatient,,,158.00000,89.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,145.36,,,,,,,41.08,153.26,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,inpatient,,,147.00000,89.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,135.24,,,,,,,132.30,142.59,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,135.24,,,,,,,38.22,142.59,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,inpatient,,,270.00000,164.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,248.40,,,,,,,243.00,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,248.40,,,,,,,70.20,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,inpatient,,,84.00000,51.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,77.28,,,,,,,75.60,81.48,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,77.28,,,,,,,21.84,81.48,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,inpatient,,,86.00000,52.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,79.12,,,,,,,77.40,83.42,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,79.12,,,,,,,22.36,83.42,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,inpatient,,,82.00000,49.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,75.44,,,,,,,73.80,79.54,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,75.44,,,,,,,21.32,79.54,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,inpatient,,,85.00000,51.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,78.20,,,,,,,76.50,82.45,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,78.20,,,,,,,22.10,82.45,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,inpatient,,,43.00000,26.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,39.56,,,,,,,38.70,41.71,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,39.56,,,,,,,11.18,41.71,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,inpatient,,,41.00000,24.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,37.72,,,,,,,36.90,39.77,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,37.72,,,,,,,10.66,39.77,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,inpatient,,,79.00000,48.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,72.68,,,,,,,71.10,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,72.68,,,,,,,20.54,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,68.08,,,,,,,66.60,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,68.08,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,68.08,,,,,,,66.60,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,68.08,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,inpatient,,,34.00000,20.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,31.28,,,,,,,30.60,32.98,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,31.28,,,,,,,8.84,32.98,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,inpatient,,,65.00000,39.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,59.80,,,,,,,58.50,63.05,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,59.80,,,,,,,16.90,63.05,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,inpatient,,,113.00000,68.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,103.96,,,,,,,101.70,109.61,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,outpatient,,,113.00000,68.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,103.96,,,,,,,29.38,109.61,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,inpatient,,,80.00000,48.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,73.60,,,,,,,72.00,77.60,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,73.60,,,,,,,20.80,77.60,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,inpatient,,,84.00000,51.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,77.28,,,,,,,75.60,81.48,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,77.28,,,,,,,21.84,81.48,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,inpatient,,,73.00000,44.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,67.16,,,,,,,65.70,70.81,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,67.16,,,,,,,18.98,70.81,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,inpatient,,,100.00000,60.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92.00,,,,,,,90.00,97.00,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,outpatient,,,100.00000,60.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92.00,,,,,,,26.00,97.00,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,inpatient,,,167.00000,101.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,153.64,,,,,,,150.30,161.99,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,outpatient,,,167.00000,101.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,153.64,,,,,,,43.42,161.99,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,inpatient,,,413.00000,251.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"50,GP",379.96,,,,,,,371.70,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"50,GP",379.96,,,,,,,107.38,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"LT,GP",253.00,,,,,,,247.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"LT,GP",253.00,,,,,,,71.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"RT,GP",253.00,,,,,,,247.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"RT,GP",253.00,,,,,,,71.50,266.75,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,inpatient,,,95.00000,57.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,87.40,,,,,,,85.50,92.15,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,87.40,,,,,,,24.70,92.15,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,inpatient,,,146.00000,88.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,134.32,,,,,,,131.40,141.62,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,134.32,,,,,,,37.96,141.62,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,inpatient,,,139.00000,84.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,127.88,,,,,,,125.10,134.83,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,127.88,,,,,,,36.14,134.83,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,inpatient,,,75.00000,45.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,69.00,,,,,,,67.50,72.75,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,69.00,,,,,,,19.50,72.75,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,inpatient,,,154.00000,93.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,141.68,,,,,,,138.60,149.38,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,141.68,,,,,,,40.04,149.38,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,inpatient,,,73.00000,44.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,67.16,,,,,,,65.70,70.81,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,67.16,,,,,,,18.98,70.81,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,inpatient,,,160.00000,97.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,147.20,,,,,,,144.00,155.20,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,147.20,,,,,,,41.60,155.20,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,inpatient,,,325.00000,197.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,299.00,,,,,,,292.50,315.25,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,299.00,,,,,,,84.50,315.25,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,inpatient,,,98.00000,59.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,90.16,,,,,,,88.20,95.06,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,outpatient,,,98.00000,59.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,90.16,,,,,,,25.48,95.06,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,inpatient,,,303.00000,184.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,278.76,,,,,,,272.70,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,outpatient,,,303.00000,184.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,278.76,,,,,,,78.78,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,inpatient,,,115.00000,69.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,105.80,,,,,,,103.50,111.55,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,outpatient,,,115.00000,69.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,105.80,,,,,,,29.90,111.55,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,inpatient,,,74.00000,44.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,68.08,,,,,,,66.60,71.78,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,68.08,,,,,,,19.24,71.78,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,inpatient,,,79.00000,48.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,72.68,,,,,,,71.10,76.63,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,72.68,,,,,,,20.54,76.63,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,inpatient,,,72.00000,43.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,66.24,,,,,,,64.80,69.84,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,66.24,,,,,,,18.72,69.84,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,inpatient,,,147.00000,89.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,135.24,,,,,,,132.30,142.59,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,135.24,,,,,,,38.22,142.59,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,inpatient,,,270.00000,164.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,248.40,,,,,,,243.00,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,248.40,,,,,,,70.20,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,inpatient,,,84.00000,51.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,77.28,,,,,,,75.60,81.48,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,77.28,,,,,,,21.84,81.48,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,inpatient,,,86.00000,52.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,79.12,,,,,,,77.40,83.42,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,79.12,,,,,,,22.36,83.42,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,inpatient,,,82.00000,49.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,75.44,,,,,,,73.80,79.54,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,75.44,,,,,,,21.32,79.54,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,inpatient,,,85.00000,51.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,78.20,,,,,,,76.50,82.45,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,78.20,,,,,,,22.10,82.45,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,inpatient,,,43.00000,26.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,39.56,,,,,,,38.70,41.71,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,39.56,,,,,,,11.18,41.71,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,inpatient,,,41.00000,24.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,37.72,,,,,,,36.90,39.77,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,37.72,,,,,,,10.66,39.77,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,inpatient,,,79.00000,48.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,72.68,,,,,,,71.10,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,72.68,,,,,,,20.54,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CQ,GP",68.08,,,,,,,66.60,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CQ,GP",68.08,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CQ,GP",68.08,,,,,,,66.60,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CQ,GP",68.08,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,inpatient,,,34.00000,20.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,31.28,,,,,,,30.60,32.98,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,31.28,,,,,,,8.84,32.98,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,inpatient,,,65.00000,39.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,59.80,,,,,,,58.50,63.05,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,59.80,,,,,,,16.90,63.05,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,inpatient,,,80.00000,48.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,73.60,,,,,,,72.00,77.60,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,73.60,,,,,,,20.80,77.60,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,inpatient,,,84.00000,51.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,77.28,,,,,,,75.60,81.48,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,77.28,,,,,,,21.84,81.48,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,inpatient,,,73.00000,44.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,67.16,,,,,,,65.70,70.81,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,67.16,,,,,,,18.98,70.81,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,inpatient,,,413.00000,251.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"GP,50",379.96,,,,,,,371.70,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"GP,50",379.96,,,,,,,107.38,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"GP,LT",253.00,,,,,,,247.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"GP,LT",253.00,,,,,,,71.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"GP,RT",253.00,,,,,,,247.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"GP,RT",253.00,,,,,,,71.50,266.75,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,inpatient,,,95.00000,57.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,87.40,,,,,,,85.50,92.15,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,87.40,,,,,,,24.70,92.15,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,inpatient,,,146.00000,88.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,134.32,,,,,,,131.40,141.62,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,134.32,,,,,,,37.96,141.62,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,inpatient,,,139.00000,84.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,127.88,,,,,,,125.10,134.83,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,127.88,,,,,,,36.14,134.83,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,inpatient,,,75.00000,45.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,69.00,,,,,,,67.50,72.75,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,69.00,,,,,,,19.50,72.75,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,inpatient,,,154.00000,93.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,141.68,,,,,,,138.60,149.38,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,141.68,,,,,,,40.04,149.38,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,inpatient,,,73.00000,44.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,67.16,,,,,,,65.70,70.81,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,67.16,,,,,,,18.98,70.81,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,inpatient,,,160.00000,97.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,147.20,,,,,,,144.00,155.20,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,147.20,,,,,,,41.60,155.20,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,inpatient,,,325.00000,197.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,299.00,,,,,,,292.50,315.25,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,299.00,,,,,,,84.50,315.25,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,inpatient,,,74.00000,44.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,68.08,,,,,,,66.60,71.78,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,68.08,,,,,,,19.24,71.78,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,inpatient,,,79.00000,48.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,72.68,,,,,,,71.10,76.63,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,72.68,,,,,,,20.54,76.63,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,inpatient,,,72.00000,43.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,66.24,,,,,,,64.80,69.84,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,66.24,,,,,,,18.72,69.84,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,inpatient,,,445.00000,262.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,409.40,,,,,,,400.50,431.65,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,outpatient,,,445.00000,262.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,409.40,,,,,,,115.70,431.65,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,inpatient,,,310.00000,182.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,285.20,,,,,,,279.00,300.70,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,outpatient,,,310.00000,182.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,285.20,,,,,,,80.60,300.70,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,inpatient,,,393.00000,231.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,361.56,,,,,,,353.70,381.21,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,outpatient,,,393.00000,231.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,361.56,,,,,,,102.18,381.21,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,inpatient,,,310.00000,182.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,285.20,,,,,,,279.00,300.70,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,outpatient,,,310.00000,182.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GP,285.20,,,,,,,80.60,300.70,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,inpatient,,,80.00000,30.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,73.60,,,,,,,72.00,77.60,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,73.60,,,,,,,20.80,77.60,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,inpatient,,,84.00000,32.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,77.28,,,,,,,75.60,81.48,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,77.28,,,,,,,21.84,81.48,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,inpatient,,,126.00000,48.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,115.92,,,,,,,113.40,122.22,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,115.92,,,,,,,32.76,122.22,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,inpatient,,,66.00000,25.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,60.72,,,,,,,59.40,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,60.72,,,,,,,17.16,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,inpatient,,,62.00000,23.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,57.04,,,,,,,55.80,60.14,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,57.04,,,,,,,16.12,60.14,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,inpatient,,,90.00000,34.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,82.80,,,,,,,81.00,87.30,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,82.80,,,,,,,23.40,87.30,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,inpatient,,,95.00000,36.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,87.40,,,,,,,85.50,92.15,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,87.40,,,,,,,24.70,92.15,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,inpatient,,,146.00000,56.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,134.32,,,,,,,131.40,141.62,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,134.32,,,,,,,37.96,141.62,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,inpatient,,,139.00000,53.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,127.88,,,,,,,125.10,134.83,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,127.88,,,,,,,36.14,134.83,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,inpatient,,,75.00000,29.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,69.00,,,,,,,67.50,72.75,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,69.00,,,,,,,19.50,72.75,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,inpatient,,,154.00000,59.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,141.68,,,,,,,138.60,149.38,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,141.68,,,,,,,40.04,149.38,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,inpatient,,,73.00000,28.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,67.16,,,,,,,65.70,70.81,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,67.16,,,,,,,18.98,70.81,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,inpatient,,,160.00000,61.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,147.20,,,,,,,144.00,155.20,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,147.20,,,,,,,41.60,155.20,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,inpatient,,,98.00000,37.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,90.16,,,,,,,88.20,95.06,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,outpatient,,,98.00000,37.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,90.16,,,,,,,25.48,95.06,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,inpatient,,,303.00000,117.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,278.76,,,,,,,272.70,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,outpatient,,,303.00000,117.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,278.76,,,,,,,78.78,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,inpatient,,,115.00000,44.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,105.80,,,,,,,103.50,111.55,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,outpatient,,,115.00000,44.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,105.80,,,,,,,29.90,111.55,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,inpatient,,,74.00000,28.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,68.08,,,,,,,66.60,71.78,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,68.08,,,,,,,19.24,71.78,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,inpatient,,,72.00000,27.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,66.24,,,,,,,64.80,69.84,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,66.24,,,,,,,18.72,69.84,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,inpatient,,,80.00000,30.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",73.60,,,,,,,72.00,77.60,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",73.60,,,,,,,20.80,77.60,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,inpatient,,,84.00000,32.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",77.28,,,,,,,75.60,81.48,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",77.28,,,,,,,21.84,81.48,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,inpatient,,,126.00000,48.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",115.92,,,,,,,113.40,122.22,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",115.92,,,,,,,32.76,122.22,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,inpatient,,,62.00000,23.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",57.04,,,,,,,55.80,60.14,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",57.04,,,,,,,16.12,60.14,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,inpatient,,,66.00000,25.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",60.72,,,,,,,59.40,64.02,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",60.72,,,,,,,17.16,64.02,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,inpatient,,,90.00000,34.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",82.80,,,,,,,81.00,87.30,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",82.80,,,,,,,23.40,87.30,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,inpatient,,,95.00000,36.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",87.40,,,,,,,85.50,92.15,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",87.40,,,,,,,24.70,92.15,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,inpatient,,,146.00000,56.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",134.32,,,,,,,131.40,141.62,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",134.32,,,,,,,37.96,141.62,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,inpatient,,,139.00000,53.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",127.88,,,,,,,125.10,134.83,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",127.88,,,,,,,36.14,134.83,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,inpatient,,,75.00000,29.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",69.00,,,,,,,67.50,72.75,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",69.00,,,,,,,19.50,72.75,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,inpatient,,,154.00000,59.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",141.68,,,,,,,138.60,149.38,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",141.68,,,,,,,40.04,149.38,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,inpatient,,,73.00000,28.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",67.16,,,,,,,65.70,70.81,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",67.16,,,,,,,18.98,70.81,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,inpatient,,,160.00000,61.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",147.20,,,,,,,144.00,155.20,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",147.20,,,,,,,41.60,155.20,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,inpatient,,,74.00000,28.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",68.08,,,,,,,66.60,71.78,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",68.08,,,,,,,19.24,71.78,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,inpatient,,,72.00000,27.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",66.24,,,,,,,64.80,69.84,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",66.24,,,,,,,18.72,69.84,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,inpatient,,,47.00000,26.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,43.24,,,,,,,42.30,45.59,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,43.24,,,,,,,12.22,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,inpatient,,,47.00000,26.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",43.24,,,,,,,42.30,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"CO,GO",43.24,,,,,,,12.22,45.59,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,inpatient,,,250.00000,142.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,230.00,,,,,,,225.00,242.50,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,outpatient,,,250.00000,142.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,230.00,,,,,,,65.00,242.50,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,inpatient,,,175.00000,99.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,161.00,,,,,,,157.50,169.75,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,outpatient,,,175.00000,99.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,161.00,,,,,,,45.50,169.75,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,inpatient,,,233.00000,132.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,214.36,,,,,,,209.70,226.01,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,outpatient,,,233.00000,132.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,214.36,,,,,,,60.58,226.01,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,inpatient,,,175.00000,99.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,161.00,,,,,,,157.50,169.75,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,outpatient,,,175.00000,99.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GO,161.00,,,,,,,45.50,169.75,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,inpatient,,,291.00000,93.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,267.72,,,,,,,261.90,282.27,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,outpatient,,,291.00000,93.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,267.72,,,,,,,75.66,282.27,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,inpatient,,,273.00000,155.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,251.16,,,,,,,245.70,264.81,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,outpatient,,,273.00000,155.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,251.16,,,,,,,70.98,264.81,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,inpatient,,,279.00000,158.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,256.68,,,,,,,251.10,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,outpatient,,,279.00000,158.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,256.68,,,,,,,72.54,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,inpatient,,,426.00000,242.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,391.92,,,,,,,383.40,413.22,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,outpatient,,,426.00000,242.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,391.92,,,,,,,110.76,413.22,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,inpatient,,,242.00000,137.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,222.64,,,,,,,217.80,234.74,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,outpatient,,,242.00000,137.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,222.64,,,,,,,62.92,234.74,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,inpatient,,,128.00000,72.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,117.76,,,,,,,115.20,124.16,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,outpatient,,,128.00000,72.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,117.76,,,,,,,33.28,124.16,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,inpatient,,,66.00000,37.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,60.72,,,,,,,59.40,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,outpatient,,,66.00000,37.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,60.72,,,,,,,17.16,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,inpatient,,,62.00000,35.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,57.04,,,,,,,55.80,60.14,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,outpatient,,,62.00000,35.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,57.04,,,,,,,16.12,60.14,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,inpatient,,,269.00000,152.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,247.48,,,,,,,242.10,260.93,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,outpatient,,,269.00000,152.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,247.48,,,,,,,69.94,260.93,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,inpatient,,,153.00000,86.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,140.76,,,,,,,137.70,148.41,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,outpatient,,,153.00000,86.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,140.76,,,,,,,39.78,148.41,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,inpatient,,,98.00000,55.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,90.16,,,,,,,88.20,95.06,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,outpatient,,,98.00000,55.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,90.16,,,,,,,25.48,95.06,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,inpatient,,,303.00000,172.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,278.76,,,,,,,272.70,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,outpatient,,,303.00000,172.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,278.76,,,,,,,78.78,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,inpatient,,,115.00000,65.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,105.80,,,,,,,103.50,111.55,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,outpatient,,,115.00000,65.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,105.80,,,,,,,29.90,111.55,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,inpatient,,,210.00000,119.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,193.20,,,,,,,189.00,203.70,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,outpatient,,,210.00000,119.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,193.20,,,,,,,54.60,203.70,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,inpatient,,,250.00000,142.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,230.00,,,,,,,225.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,outpatient,,,250.00000,142.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,230.00,,,,,,,65.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,inpatient,,,78.00000,44.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,71.76,,,,,,,70.20,75.66,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,outpatient,,,78.00000,44.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,71.76,,,,,,,20.28,75.66,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,inpatient,,,322.00000,182.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,296.24,,,,,,,289.80,312.34,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,outpatient,,,322.00000,182.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,296.24,,,,,,,83.72,312.34,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,inpatient,,,309.00000,175.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,284.28,,,,,,,278.10,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,outpatient,,,309.00000,175.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,284.28,,,,,,,80.34,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,inpatient,,,245.00000,139.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,225.40,,,,,,,220.50,237.65,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,outpatient,,,245.00000,139.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,GN,225.40,,,,,,,63.70,237.65,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,inpatient,,,313.00000,116.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,281.70,303.61,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,outpatient,,,313.00000,116.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.96,,,,,,,81.38,303.61,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,inpatient,,,1250.00000,632.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1150.00,,,,,,,1125.00,1212.50,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,outpatient,,,1250.00000,632.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1150.00,,,,,,,325.00,1212.50,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,inpatient,,,145.00000,75.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,133.40,,,,,,,130.50,140.65,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,133.40,,,,,,,37.70,140.65,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,inpatient,,,488.00000,254.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,448.96,,,,,,,439.20,473.36,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,448.96,,,,,,,126.88,473.36,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,inpatient,,,684.00000,337.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,629.28,,,,,,,615.60,663.48,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,outpatient,,,684.00000,337.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,629.28,,,,,,,177.84,663.48,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,inpatient,,,206.00000,101.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,189.52,,,,,,,185.40,199.82,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,outpatient,,,206.00000,101.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,189.52,,,,,,,53.56,199.82,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,inpatient,,,195.00000,96.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,179.40,,,,,,,175.50,189.15,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,outpatient,,,195.00000,96.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,179.40,,,,,,,50.70,189.15,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,inpatient,,,375.00000,185.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,345.00,,,,,,,337.50,363.75,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,outpatient,,,375.00000,185.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,345.00,,,,,,,97.50,363.75,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,inpatient,,,429.00000,211.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,394.68,,,,,,,386.10,416.13,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,outpatient,,,429.00000,211.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,394.68,,,,,,,111.54,416.13,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22475,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2558.52,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B OBSTETRICS SEMI-PVT,42473,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2558.52,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ICU,32474,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8060.12,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,12476,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5373.72,,,,,,,2512.00,5665.77,percent of total billed charges,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,84.00000,63.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,77.28,,,,,,,75.60,81.48,percent of total billed charges,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,77.28,,,,,,,21.84,81.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,261.28,,,,,,,255.60,275.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,261.28,,,,,,,73.84,275.48,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,421.36,,,,,,,412.20,444.26,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,421.36,,,,,,,119.08,444.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,513.36,,,,,,,502.20,541.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,513.36,,,,,,,145.08,541.26,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,443.44,,,,,,,433.80,467.54,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,443.44,,,,,,,125.32,467.54,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,218.04,,,,,,,213.30,229.89,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,218.04,,,,,,,61.62,229.89,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,inpatient,,,490.00000,329.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,450.80,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,outpatient,,,490.00000,329.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,450.80,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,inpatient,,,490.00000,329.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,450.80,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,outpatient,,,490.00000,329.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,450.80,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,inpatient,,,245.00000,164.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,225.40,,,,,,,220.50,237.65,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,outpatient,,,245.00000,164.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,225.40,,,,,,,63.70,237.65,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,inpatient,,,490.00000,329.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,450.80,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,450.80,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,450.80,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,450.80,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,inpatient,,,245.00000,164.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,225.40,,,,,,,220.50,237.65,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,225.40,,,,,,,63.70,237.65,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,774.64,,,,,,,757.80,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,774.64,,,,,,,218.92,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,968.76,,,,,,,947.70,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,968.76,,,,,,,273.78,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1161.96,,,,,,,1136.70,1225.11,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1161.96,,,,,,,328.38,1225.11,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,inpatient,,,2466.00000,986.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2268.72,,,,,,,2219.40,2392.02,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,outpatient,,,2466.00000,986.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2268.72,,,,,,,641.16,2392.02,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,inpatient,,,260.00000,104.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,239.20,,,,,,,234.00,252.20,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,outpatient,,,260.00000,104.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,239.20,,,,,,,67.60,252.20,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,inpatient,,,2041.00000,816.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1877.72,,,,,,,1836.90,1979.77,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,outpatient,,,2041.00000,816.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1877.72,,,,,,,530.66,1979.77,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,inpatient,,,375.00000,150.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,345.00,,,,,,,337.50,363.75,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,outpatient,,,375.00000,150.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,345.00,,,,,,,97.50,363.75,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,inpatient,,,1178.00000,471.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1083.76,,,,,,,1060.20,1142.66,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,outpatient,,,1178.00000,471.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1083.76,,,,,,,306.28,1142.66,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,inpatient,,,245.00000,98.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,225.40,,,,,,,220.50,237.65,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,outpatient,,,245.00000,98.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,225.40,,,,,,,63.70,237.65,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,inpatient,,,280.00000,112.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,257.60,,,,,,,252.00,271.60,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,outpatient,,,280.00000,112.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,257.60,,,,,,,72.80,271.60,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,inpatient,,,336.00000,134.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,309.12,,,,,,,302.40,325.92,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,outpatient,,,336.00000,134.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,309.12,,,,,,,87.36,325.92,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,inpatient,,,380.00000,152.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,349.60,,,,,,,342.00,368.60,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,outpatient,,,380.00000,152.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,349.60,,,,,,,98.80,368.60,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,inpatient,,,530.00000,212.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,487.60,,,,,,,477.00,514.10,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,487.60,,,,,,,137.80,514.10,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,inpatient,,,264.00000,105.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,242.88,,,,,,,237.60,256.08,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,outpatient,,,264.00000,105.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,242.88,,,,,,,68.64,256.08,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,inpatient,,,763.00000,305.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,701.96,,,,,,,686.70,740.11,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,outpatient,,,763.00000,305.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,701.96,,,,,,,198.38,740.11,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,inpatient,,,672.00000,268.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,618.24,,,,,,,604.80,651.84,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,outpatient,,,672.00000,268.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,618.24,,,,,,,174.72,651.84,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,inpatient,,,1940.00000,776.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1784.80,,,,,,,1746.00,1881.80,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,outpatient,,,1940.00000,776.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1784.80,,,,,,,504.40,1881.80,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,inpatient,,,3875.00000,1550.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3565.00,,,,,,,3487.50,3758.75,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,outpatient,,,3875.00000,1550.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3565.00,,,,,,,1007.50,3758.75,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,inpatient,,,505.00000,202.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,464.60,,,,,,,454.50,489.85,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,outpatient,,,505.00000,202.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,464.60,,,,,,,131.30,489.85,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,inpatient,,,295.00000,118.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,271.40,,,,,,,265.50,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,271.40,,,,,,,76.70,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,inpatient,,,585.00000,234.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,538.20,,,,,,,526.50,567.45,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,outpatient,,,585.00000,234.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,538.20,,,,,,,152.10,567.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,inpatient,,,285.00000,114.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,262.20,,,,,,,256.50,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,outpatient,,,285.00000,114.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,262.20,,,,,,,74.10,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,inpatient,,,575.00000,230.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,529.00,,,,,,,517.50,557.75,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,outpatient,,,575.00000,230.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,529.00,,,,,,,149.50,557.75,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,inpatient,,,697.00000,278.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,641.24,,,,,,,627.30,676.09,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,outpatient,,,697.00000,278.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,641.24,,,,,,,181.22,676.09,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,inpatient,,,530.00000,212.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,487.60,,,,,,,477.00,514.10,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,487.60,,,,,,,137.80,514.10,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,inpatient,,,580.00000,232.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,533.60,,,,,,,522.00,562.60,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,outpatient,,,580.00000,232.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,533.60,,,,,,,150.80,562.60,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,inpatient,,,435.00000,174.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,400.20,,,,,,,391.50,421.95,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,outpatient,,,435.00000,174.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,400.20,,,,,,,113.10,421.95,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,inpatient,,,270.00000,108.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,248.40,,,,,,,243.00,261.90,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,outpatient,,,270.00000,108.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,248.40,,,,,,,70.20,261.90,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,inpatient,,,504.00000,201.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,463.68,,,,,,,453.60,488.88,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,outpatient,,,504.00000,201.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,463.68,,,,,,,131.04,488.88,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,inpatient,,,98.00000,39.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,88.20,95.06,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,outpatient,,,98.00000,39.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,25.48,95.06,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,inpatient,,,608.00000,243.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,559.36,,,,,,,547.20,589.76,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,outpatient,,,608.00000,243.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,559.36,,,,,,,158.08,589.76,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,inpatient,,,114.00000,45.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,102.60,110.58,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,outpatient,,,114.00000,45.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,29.64,110.58,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,inpatient,,,187.00000,74.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,168.30,181.39,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,outpatient,,,187.00000,74.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,48.62,181.39,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,inpatient,,,214.00000,85.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,196.88,,,,,,,192.60,207.58,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,outpatient,,,214.00000,85.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,196.88,,,,,,,55.64,207.58,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,inpatient,,,863.00000,345.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,793.96,,,,,,,776.70,837.11,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,outpatient,,,863.00000,345.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,793.96,,,,,,,224.38,837.11,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,inpatient,,,453.00000,181.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,416.76,,,,,,,407.70,439.41,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,outpatient,,,453.00000,181.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,416.76,,,,,,,117.78,439.41,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,inpatient,,,144.00000,57.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,132.48,,,,,,,129.60,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,outpatient,,,144.00000,57.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,132.48,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,inpatient,,,107.00000,42.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,98.44,,,,,,,96.30,103.79,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,outpatient,,,107.00000,42.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,98.44,,,,,,,27.82,103.79,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,inpatient,,,403.00000,161.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,370.76,,,,,,,362.70,390.91,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,outpatient,,,403.00000,161.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,370.76,,,,,,,104.78,390.91,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,inpatient,,,144.00000,57.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,132.48,,,,,,,129.60,139.68,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,outpatient,,,144.00000,57.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,132.48,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,inpatient,,,370.00000,148.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,340.40,,,,,,,333.00,358.90,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,outpatient,,,370.00000,148.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,340.40,,,,,,,96.20,358.90,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,inpatient,,,334.00000,133.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,307.28,,,,,,,300.60,323.98,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,outpatient,,,334.00000,133.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,307.28,,,,,,,86.84,323.98,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,inpatient,,,1188.00000,475.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,1092.96,,,,,,,1069.20,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,outpatient,,,1188.00000,475.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,1092.96,,,,,,,308.88,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,inpatient,,,792.00000,316.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,728.64,,,,,,,712.80,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,728.64,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,inpatient,,,792.00000,316.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,728.64,,,,,,,712.80,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,728.64,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,inpatient,,,572.00000,228.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,526.24,,,,,,,514.80,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,outpatient,,,572.00000,228.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,526.24,,,,,,,148.72,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,inpatient,,,381.00000,152.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,350.52,,,,,,,342.90,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,350.52,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,inpatient,,,381.00000,152.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,350.52,,,,,,,342.90,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,350.52,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,inpatient,,,683.00000,273.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,628.36,,,,,,,614.70,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,outpatient,,,683.00000,273.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,628.36,,,,,,,177.58,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,inpatient,,,455.00000,182.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,418.60,,,,,,,409.50,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,418.60,,,,,,,118.30,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,inpatient,,,455.00000,182.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,418.60,,,,,,,409.50,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,418.60,,,,,,,118.30,441.35,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,inpatient,,,357.00000,142.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,328.44,,,,,,,321.30,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,outpatient,,,357.00000,142.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,328.44,,,,,,,92.82,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,inpatient,,,334.00000,133.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,307.28,,,,,,,300.60,323.98,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,outpatient,,,334.00000,133.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,307.28,,,,,,,86.84,323.98,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,inpatient,,,194.00000,77.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,178.48,,,,,,,174.60,188.18,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,outpatient,,,194.00000,77.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,178.48,,,,,,,50.44,188.18,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,inpatient,,,608.00000,243.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,559.36,,,,,,,547.20,589.76,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,outpatient,,,608.00000,243.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,559.36,,,,,,,158.08,589.76,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,inpatient,,,257.00000,102.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,236.44,,,,,,,231.30,249.29,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,outpatient,,,257.00000,102.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,236.44,,,,,,,66.82,249.29,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,inpatient,,,343.00000,137.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,315.56,,,,,,,308.70,332.71,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,outpatient,,,343.00000,137.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,315.56,,,,,,,89.18,332.71,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,inpatient,,,457.00000,182.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,420.44,,,,,,,411.30,443.29,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,outpatient,,,457.00000,182.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,420.44,,,,,,,118.82,443.29,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,inpatient,,,630.00000,252.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,579.60,,,,,,,567.00,611.10,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,outpatient,,,630.00000,252.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,579.60,,,,,,,163.80,611.10,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,inpatient,,,623.00000,249.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,573.16,,,,,,,560.70,604.31,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,outpatient,,,623.00000,249.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,573.16,,,,,,,161.98,604.31,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,inpatient,,,1457.00000,582.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1340.44,,,,,,,1311.30,1413.29,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,outpatient,,,1457.00000,582.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1340.44,,,,,,,378.82,1413.29,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,inpatient,,,890.00000,356.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,818.80,,,,,,,801.00,863.30,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,outpatient,,,890.00000,356.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,818.80,,,,,,,231.40,863.30,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,inpatient,,,532.00000,212.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,489.44,,,,,,,478.80,516.04,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,outpatient,,,532.00000,212.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,489.44,,,,,,,138.32,516.04,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,inpatient,,,492.00000,196.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,452.64,,,,,,,442.80,477.24,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,outpatient,,,492.00000,196.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,452.64,,,,,,,127.92,477.24,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,inpatient,,,550.00000,220.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,506.00,,,,,,,495.00,533.50,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,outpatient,,,550.00000,220.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,506.00,,,,,,,143.00,533.50,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,inpatient,,,305.00000,122.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,280.60,,,,,,,274.50,295.85,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,outpatient,,,305.00000,122.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,280.60,,,,,,,79.30,295.85,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,inpatient,,,220.00000,88.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,202.40,,,,,,,198.00,213.40,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,outpatient,,,220.00000,88.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,202.40,,,,,,,57.20,213.40,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,inpatient,,,780.00000,312.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,717.60,,,,,,,702.00,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,outpatient,,,780.00000,312.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,717.60,,,,,,,202.80,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,inpatient,,,1165.00000,466.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1071.80,,,,,,,1048.50,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,outpatient,,,1165.00000,466.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1071.80,,,,,,,302.90,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,inpatient,,,2350.00000,940.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2162.00,,,,,,,2115.00,2279.50,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,outpatient,,,2350.00000,940.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2162.00,,,,,,,611.00,2279.50,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,inpatient,,,896.00000,358.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,824.32,,,,,,,806.40,869.12,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,outpatient,,,896.00000,358.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,824.32,,,,,,,232.96,869.12,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,inpatient,,,385.00000,154.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,354.20,,,,,,,346.50,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,outpatient,,,385.00000,154.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,354.20,,,,,,,100.10,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,inpatient,,,470.00000,188.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,432.40,,,,,,,423.00,455.90,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,outpatient,,,470.00000,188.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,432.40,,,,,,,122.20,455.90,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,inpatient,,,150.00000,60.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,138.00,,,,,,,135.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,outpatient,,,150.00000,60.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,138.00,,,,,,,39.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,inpatient,,,100.00000,40.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92.00,,,,,,,90.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,outpatient,,,100.00000,40.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,92.00,,,,,,,26.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,inpatient,,,143.00000,57.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,131.56,,,,,,,128.70,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,outpatient,,,143.00000,57.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,131.56,,,,,,,37.18,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,inpatient,,,95.00000,38.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,87.40,,,,,,,85.50,92.15,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,outpatient,,,95.00000,38.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,87.40,,,,,,,24.70,92.15,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,inpatient,,,269.00000,107.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,247.48,,,,,,,242.10,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,outpatient,,,269.00000,107.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,247.48,,,,,,,69.94,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,inpatient,,,388.00000,155.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,356.96,,,,,,,349.20,376.36,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,outpatient,,,388.00000,155.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,356.96,,,,,,,100.88,376.36,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,inpatient,,,344.00000,137.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,316.48,,,,,,,309.60,333.68,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,outpatient,,,344.00000,137.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,316.48,,,,,,,89.44,333.68,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,inpatient,,,321.00000,128.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,295.32,,,,,,,288.90,311.37,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,outpatient,,,321.00000,128.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,295.32,,,,,,,83.46,311.37,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,inpatient,,,155.00000,62.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,142.60,,,,,,,139.50,150.35,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,outpatient,,,155.00000,62.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,142.60,,,,,,,40.30,150.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,inpatient,,,817.00000,326.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,751.64,,,,,,,735.30,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,outpatient,,,817.00000,326.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,751.64,,,,,,,212.42,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,inpatient,,,1255.00000,502.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1154.60,,,,,,,1129.50,1217.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,outpatient,,,1255.00000,502.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1154.60,,,,,,,326.30,1217.35,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,inpatient,,,391.00000,156.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,359.72,,,,,,,351.90,379.27,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,outpatient,,,391.00000,156.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,359.72,,,,,,,101.66,379.27,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,inpatient,,,671.00000,268.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,617.32,,,,,,,603.90,650.87,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,outpatient,,,671.00000,268.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,617.32,,,,,,,174.46,650.87,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,inpatient,,,456.00000,182.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,419.52,,,,,,,410.40,442.32,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,outpatient,,,456.00000,182.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,419.52,,,,,,,118.56,442.32,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,inpatient,,,112.00000,44.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,103.04,,,,,,,100.80,108.64,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,outpatient,,,112.00000,44.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,103.04,,,,,,,29.12,108.64,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,inpatient,,,84.00000,33.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,77.28,,,,,,,75.60,81.48,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,outpatient,,,84.00000,33.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,77.28,,,,,,,21.84,81.48,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,inpatient,,,216.00000,86.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,198.72,,,,,,,194.40,209.52,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,outpatient,,,216.00000,86.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,198.72,,,,,,,56.16,209.52,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,inpatient,,,2660.00000,1064.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2447.20,,,,,,,2394.00,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,outpatient,,,2660.00000,1064.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2447.20,,,,,,,691.60,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,inpatient,,,2960.00000,1184.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2723.20,,,,,,,2664.00,2871.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,outpatient,,,2960.00000,1184.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2723.20,,,,,,,769.60,2871.20,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,inpatient,,,3225.00000,1290.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2967.00,,,,,,,2902.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,outpatient,,,3225.00000,1290.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2967.00,,,,,,,838.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,inpatient,,,3395.00000,1358.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3123.40,,,,,,,3055.50,3293.15,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,outpatient,,,3395.00000,1358.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3123.40,,,,,,,882.70,3293.15,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,inpatient,,,490.00000,196.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,450.80,,,,,,,441.00,475.30,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,outpatient,,,490.00000,196.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,450.80,,,,,,,127.40,475.30,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,inpatient,,,520.00000,208.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,478.40,,,,,,,468.00,504.40,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,outpatient,,,520.00000,208.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,478.40,,,,,,,135.20,504.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,inpatient,,,720.00000,288.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,662.40,,,,,,,648.00,698.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,outpatient,,,720.00000,288.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,662.40,,,,,,,187.20,698.40,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,inpatient,,,215.00000,86.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,197.80,,,,,,,193.50,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,outpatient,,,215.00000,86.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,197.80,,,,,,,55.90,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,inpatient,,,240.00000,96.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,220.80,,,,,,,216.00,232.80,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,outpatient,,,240.00000,96.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,220.80,,,,,,,62.40,232.80,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,inpatient,,,1241.00000,496.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1141.72,,,,,,,1116.90,1203.77,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,outpatient,,,1241.00000,496.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1141.72,,,,,,,322.66,1203.77,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,inpatient,,,850.00000,340.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,765.00,824.50,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,outpatient,,,850.00000,340.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,782.00,,,,,,,221.00,824.50,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,inpatient,,,1085.00000,434.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,998.20,,,,,,,976.50,1052.45,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,outpatient,,,1085.00000,434.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,998.20,,,,,,,282.10,1052.45,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,inpatient,,,295.00000,118.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,271.40,,,,,,,265.50,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,271.40,,,,,,,76.70,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,inpatient,,,492.00000,196.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,452.64,,,,,,,442.80,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,outpatient,,,492.00000,196.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,452.64,,,,,,,127.92,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,inpatient,,,563.00000,225.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,517.96,,,,,,,506.70,546.11,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,outpatient,,,563.00000,225.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,517.96,,,,,,,146.38,546.11,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,inpatient,,,1612.00000,644.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1483.04,,,,,,,1450.80,1563.64,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,outpatient,,,1612.00000,644.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1483.04,,,,,,,419.12,1563.64,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,inpatient,,,1366.00000,546.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1256.72,,,,,,,1229.40,1325.02,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,outpatient,,,1366.00000,546.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1256.72,,,,,,,355.16,1325.02,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,inpatient,,,1911.00000,764.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1758.12,,,,,,,1719.90,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,outpatient,,,1911.00000,764.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1758.12,,,,,,,496.86,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,inpatient,,,956.00000,382.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,879.52,,,,,,,860.40,927.32,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,outpatient,,,956.00000,382.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,879.52,,,,,,,248.56,927.32,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,inpatient,,,189.00000,123.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,173.88,,,,,,,170.10,183.33,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,outpatient,,,189.00000,123.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,173.88,,,,,,,49.14,183.33,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,inpatient,,,352.00000,256.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,323.84,,,,,,,316.80,341.44,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,outpatient,,,352.00000,256.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,323.84,,,,,,,91.52,341.44,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,inpatient,,,625.00000,738.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,575.00,,,,,,,562.50,606.25,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,outpatient,,,625.00000,738.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,575.00,,,,,,,162.50,606.25,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,inpatient,,,1024.00000,2097.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,942.08,,,,,,,921.60,993.28,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1024.00000,2097.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,942.08,,,,,,,266.24,993.28,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,inpatient,,,1455.00000,2469.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1338.60,,,,,,,1309.50,1411.35,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,outpatient,,,1455.00000,2469.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1338.60,,,,,,,378.30,1411.35,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,inpatient,,,145.00000,75.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,133.40,,,,,,,130.50,140.65,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,133.40,,,,,,,37.70,140.65,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,inpatient,,,488.00000,254.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,448.96,,,,,,,439.20,473.36,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,448.96,,,,,,,126.88,473.36,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,106.72,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,106.72,,,,,,,30.16,112.52,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,72.90,78.57,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,21.06,78.57,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,37.72,,,,,,,36.90,39.77,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,37.72,,,,,,,10.66,39.77,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,inpatient,,,170.00000,73.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,156.40,,,,,,,153.00,164.90,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,outpatient,,,170.00000,73.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,156.40,,,,,,,44.20,164.90,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,2.70000,1.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2.48,,,,,,,2.43,2.62,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,2.70000,1.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2.48,,,,,,,0.70200,2.62,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,27.00000,11.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24.84,,,,,,,24.30,26.19,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,27.00000,11.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,24.84,,,,,,,7.02,26.19,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,inpatient,,,20440.00000,8891.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18804.80,,,,,,,18396.00,19826.80,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,outpatient,,,20440.00000,8891.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,18804.80,,,,,,,5314.40,19826.80,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,inpatient,,,3322.00000,1445.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3056.24,,,,,,,2989.80,3222.34,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,3322.00000,1445.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3056.24,,,,,,,863.72,3222.34,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,inpatient,,,2492.00000,1084.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2292.64,,,,,,,2242.80,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,2492.00000,1084.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2292.64,,,,,,,647.92,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,inpatient,,,1814.00000,789.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1668.88,,,,,,,1632.60,1759.58,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1814.00000,789.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1668.88,,,,,,,471.64,1759.58,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,inpatient,,,2153.00000,936.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1980.76,,,,,,,1937.70,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,2153.00000,936.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1980.76,,,,,,,559.78,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,inpatient,,,1525.00000,663.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1403.00,,,,,,,1372.50,1479.25,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1525.00000,663.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1403.00,,,,,,,396.50,1479.25,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,inpatient,,,2716.00000,1181.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2498.72,,,,,,,2444.40,2634.52,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2716.00000,1181.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2498.72,,,,,,,706.16,2634.52,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,inpatient,,,2.70000,0.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2.48,,,,,,,2.43,2.62,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,outpatient,,,2.70000,0.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2.48,,,,,,,0.70200,2.62,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,inpatient,,,222.00000,32.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,204.24,,,,,,,199.80,215.34,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,outpatient,,,222.00000,32.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,204.24,,,,,,,57.72,215.34,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,inpatient,,,211.00000,113.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,194.12,,,,,,,189.90,204.67,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,outpatient,,,211.00000,113.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,194.12,,,,,,,54.86,204.67,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,inpatient,,,497.00000,266.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,457.24,,,,,,,447.30,482.09,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,outpatient,,,497.00000,266.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,457.24,,,,,,,129.22,482.09,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,inpatient,,,296.00000,158.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,272.32,,,,,,,266.40,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,outpatient,,,296.00000,158.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,272.32,,,,,,,76.96,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,inpatient,,,723.00000,387.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,665.16,,,,,,,650.70,701.31,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,outpatient,,,723.00000,387.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,665.16,,,,,,,187.98,701.31,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,inpatient,,,326.00000,174.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,299.92,,,,,,,293.40,316.22,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,outpatient,,,326.00000,174.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,299.92,,,,,,,84.76,316.22,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,inpatient,,,532.00000,285.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,489.44,,,,,,,478.80,516.04,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,outpatient,,,532.00000,285.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,489.44,,,,,,,138.32,516.04,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,inpatient,,,635.00000,340.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,584.20,,,,,,,571.50,615.95,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,outpatient,,,635.00000,340.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,584.20,,,,,,,165.10,615.95,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,inpatient,,,639.00000,342.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,587.88,,,,,,,575.10,619.83,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,outpatient,,,639.00000,342.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,587.88,,,,,,,166.14,619.83,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,inpatient,,,780.00000,418.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,717.60,,,,,,,702.00,756.60,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,outpatient,,,780.00000,418.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,717.60,,,,,,,202.80,756.60,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,inpatient,,,390.00000,209.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,358.80,,,,,,,351.00,378.30,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,outpatient,,,390.00000,209.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,358.80,,,,,,,101.40,378.30,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,inpatient,,,731.00000,391.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,672.52,,,,,,,657.90,709.07,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,outpatient,,,731.00000,391.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,672.52,,,,,,,190.06,709.07,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,inpatient,,,585.00000,313.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,538.20,,,,,,,526.50,567.45,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,outpatient,,,585.00000,313.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,538.20,,,,,,,152.10,567.45,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,inpatient,,,365.00000,195.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,335.80,,,,,,,328.50,354.05,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,outpatient,,,365.00000,195.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,335.80,,,,,,,94.90,354.05,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,inpatient,,,1086.00000,582.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,999.12,,,,,,,977.40,1053.42,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,outpatient,,,1086.00000,582.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,999.12,,,,,,,282.36,1053.42,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,inpatient,,,197.00000,105.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,181.24,,,,,,,177.30,191.09,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,outpatient,,,197.00000,105.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,181.24,,,,,,,51.22,191.09,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,inpatient,,,2774.00000,1486.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2552.08,,,,,,,2496.60,2690.78,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,outpatient,,,2774.00000,1486.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2552.08,,,,,,,721.24,2690.78,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,inpatient,,,1456.00000,780.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1339.52,,,,,,,1310.40,1412.32,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,outpatient,,,1456.00000,780.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1339.52,,,,,,,378.56,1412.32,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,inpatient,,,2647.00000,1418.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2435.24,,,,,,,2382.30,2567.59,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,outpatient,,,2647.00000,1418.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2435.24,,,,,,,688.22,2567.59,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,inpatient,,,1359.00000,728.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1250.28,,,,,,,1223.10,1318.23,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,outpatient,,,1359.00000,728.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1250.28,,,,,,,353.34,1318.23,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,inpatient,,,273.00000,146.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,251.16,,,,,,,245.70,264.81,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,outpatient,,,273.00000,146.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,251.16,,,,,,,70.98,264.81,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,inpatient,,,325.00000,174.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,299.00,,,,,,,292.50,315.25,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,outpatient,,,325.00000,174.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,299.00,,,,,,,84.50,315.25,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,inpatient,,,609.00000,326.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,560.28,,,,,,,548.10,590.73,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,560.28,,,,,,,158.34,590.73,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,inpatient,,,491.00000,263.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,451.72,,,,,,,441.90,476.27,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,outpatient,,,491.00000,263.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,451.72,,,,,,,127.66,476.27,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,inpatient,,,561.00000,300.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,516.12,,,,,,,504.90,544.17,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,outpatient,,,561.00000,300.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,516.12,,,,,,,145.86,544.17,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,inpatient,,,845.00000,452.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,777.40,,,,,,,760.50,819.65,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,outpatient,,,845.00000,452.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,777.40,,,,,,,219.70,819.65,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,inpatient,,,612.00000,328.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,563.04,,,,,,,550.80,593.64,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,outpatient,,,612.00000,328.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,563.04,,,,,,,159.12,593.64,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,inpatient,,,536.00000,287.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,493.12,,,,,,,482.40,519.92,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,outpatient,,,536.00000,287.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,493.12,,,,,,,139.36,519.92,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,inpatient,,,1225.00000,656.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1127.00,,,,,,,1102.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,outpatient,,,1225.00000,656.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1127.00,,,,,,,318.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,inpatient,,,816.00000,437.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,750.72,,,,,,,734.40,791.52,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,750.72,,,,,,,212.16,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,inpatient,,,816.00000,437.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,750.72,,,,,,,734.40,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,750.72,,,,,,,212.16,791.52,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,inpatient,,,250.00000,134.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,230.00,,,,,,,225.00,242.50,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,outpatient,,,250.00000,134.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,230.00,,,,,,,65.00,242.50,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,inpatient,,,302.00000,161.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,277.84,,,,,,,271.80,292.94,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,outpatient,,,302.00000,161.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,277.84,,,,,,,78.52,292.94,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,inpatient,,,354.00000,189.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,325.68,,,,,,,318.60,343.38,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,outpatient,,,354.00000,189.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,325.68,,,,,,,92.04,343.38,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,inpatient,,,409.00000,219.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,376.28,,,,,,,368.10,396.73,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,outpatient,,,409.00000,219.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,376.28,,,,,,,106.34,396.73,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,inpatient,,,593.00000,317.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,545.56,,,,,,,533.70,575.21,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,outpatient,,,593.00000,317.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,545.56,,,,,,,154.18,575.21,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,282.44,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,282.44,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,LT",282.44,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,LT",282.44,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,282.44,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,282.44,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,RT",282.44,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,RT",282.44,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,inpatient,,,330.00000,176.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,303.60,,,,,,,297.00,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,303.60,,,,,,,85.80,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,inpatient,,,330.00000,176.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,303.60,,,,,,,297.00,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,303.60,,,,,,,85.80,320.10,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,inpatient,,,195.00000,104.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,179.40,,,,,,,175.50,189.15,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,outpatient,,,195.00000,104.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,179.40,,,,,,,50.70,189.15,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,inpatient,,,578.00000,309.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,531.76,,,,,,,520.20,560.66,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,outpatient,,,578.00000,309.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,531.76,,,,,,,150.28,560.66,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,inpatient,,,384.00000,205.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,353.28,,,,,,,345.60,372.48,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,outpatient,,,384.00000,205.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,353.28,,,,,,,99.84,372.48,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,inpatient,,,303.00000,162.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,278.76,,,,,,,272.70,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,278.76,,,,,,,78.78,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,inpatient,,,303.00000,162.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,278.76,,,,,,,272.70,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,278.76,,,,,,,78.78,293.91,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,inpatient,,,445.00000,238.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,409.40,,,,,,,400.50,431.65,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,409.40,,,,,,,115.70,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,inpatient,,,445.00000,238.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,409.40,,,,,,,400.50,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,409.40,,,,,,,115.70,431.65,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,inpatient,,,937.00000,502.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,862.04,,,,,,,843.30,908.89,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,outpatient,,,937.00000,502.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,862.04,,,,,,,243.62,908.89,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,inpatient,,,615.00000,329.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,565.80,,,,,,,553.50,596.55,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,outpatient,,,615.00000,329.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,565.80,,,,,,,159.90,596.55,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,264.04,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,264.04,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,LT",264.04,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,LT",264.04,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,264.04,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,264.04,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,RT",264.04,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,RT",264.04,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,inpatient,,,323.00000,173.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,297.16,,,,,,,290.70,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,297.16,,,,,,,83.98,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,inpatient,,,323.00000,173.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,297.16,,,,,,,290.70,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,297.16,,,,,,,83.98,313.31,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,inpatient,,,694.00000,371.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,638.48,,,,,,,624.60,673.18,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,outpatient,,,694.00000,371.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,638.48,,,,,,,180.44,673.18,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,inpatient,,,276.00000,147.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,253.92,,,,,,,248.40,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,253.92,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,inpatient,,,276.00000,147.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,253.92,,,,,,,248.40,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,253.92,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,inpatient,,,254.00000,136.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,233.68,,,,,,,228.60,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,233.68,,,,,,,66.04,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,inpatient,,,254.00000,136.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,233.68,,,,,,,228.60,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,233.68,,,,,,,66.04,246.38,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,inpatient,,,275.00000,147.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,253.00,,,,,,,247.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,253.00,,,,,,,71.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,inpatient,,,275.00000,147.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,253.00,,,,,,,247.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,253.00,,,,,,,71.50,266.75,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,inpatient,,,173.00000,92.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,159.16,,,,,,,155.70,167.81,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,outpatient,,,173.00000,92.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,159.16,,,,,,,44.98,167.81,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,inpatient,,,483.00000,258.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,444.36,,,,,,,434.70,468.51,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,444.36,,,,,,,125.58,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,inpatient,,,483.00000,258.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,444.36,,,,,,,434.70,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,444.36,,,,,,,125.58,468.51,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,inpatient,,,191.00000,102.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,175.72,,,,,,,171.90,185.27,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,175.72,,,,,,,49.66,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,inpatient,,,191.00000,102.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,175.72,,,,,,,171.90,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,175.72,,,,,,,49.66,185.27,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,136.16,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,136.16,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,LT",136.16,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,LT",136.16,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,136.16,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,136.16,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,RT",136.16,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,RT",136.16,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,inpatient,,,481.00000,257.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,442.52,,,,,,,432.90,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,442.52,,,,,,,125.06,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,inpatient,,,481.00000,257.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,442.52,,,,,,,432.90,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,442.52,,,,,,,125.06,466.57,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,inpatient,,,215.00000,115.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,197.80,,,,,,,193.50,208.55,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,197.80,,,,,,,55.90,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,inpatient,,,215.00000,115.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,197.80,,,,,,,193.50,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,197.80,,,,,,,55.90,208.55,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,253.00,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,253.00,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,LT",253.00,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,LT",253.00,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,253.00,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,253.00,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,RT",253.00,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,RT",253.00,,,,,,,71.50,266.75,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,418.60,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,418.60,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,LT",418.60,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,LT",418.60,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,418.60,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,418.60,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,RT",418.60,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,RT",418.60,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,inpatient,,,503.00000,269.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,462.76,,,,,,,452.70,487.91,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,462.76,,,,,,,130.78,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,inpatient,,,503.00000,269.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,462.76,,,,,,,452.70,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,462.76,,,,,,,130.78,487.91,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,inpatient,,,209.00000,112.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,192.28,,,,,,,188.10,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,192.28,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,inpatient,,,209.00000,112.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,192.28,,,,,,,188.10,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,192.28,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,inpatient,,,566.00000,303.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,520.72,,,,,,,509.40,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,520.72,,,,,,,147.16,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,inpatient,,,566.00000,303.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,520.72,,,,,,,509.40,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,520.72,,,,,,,147.16,549.02,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,inpatient,,,598.00000,320.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,550.16,,,,,,,538.20,580.06,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,outpatient,,,598.00000,320.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,550.16,,,,,,,155.48,580.06,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,LT",418.60,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,LT",418.60,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,RT",418.60,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,RT",418.60,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,418.60,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,418.60,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,418.60,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,418.60,,,,,,,118.30,441.35,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,inpatient,,,1913.00000,1025.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1759.96,,,,,,,1721.70,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,outpatient,,,1913.00000,1025.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1759.96,,,,,,,497.38,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,inpatient,,,312.00000,167.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.04,,,,,,,280.80,302.64,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,outpatient,,,312.00000,167.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,287.04,,,,,,,81.12,302.64,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,inpatient,,,327.00000,175.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,300.84,,,,,,,294.30,317.19,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,outpatient,,,327.00000,175.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,300.84,,,,,,,85.02,317.19,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,inpatient,,,425.00000,227.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,391.00,,,,,,,382.50,412.25,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,outpatient,,,425.00000,227.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,391.00,,,,,,,110.50,412.25,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,inpatient,,,210.00000,112.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,193.20,,,,,,,189.00,203.70,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,outpatient,,,210.00000,112.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,193.20,,,,,,,54.60,203.70,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,inpatient,,,495.00000,265.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,455.40,,,,,,,445.50,480.15,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,outpatient,,,495.00000,265.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,455.40,,,,,,,128.70,480.15,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,inpatient,,,541.00000,289.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,497.72,,,,,,,486.90,524.77,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,outpatient,,,541.00000,289.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,497.72,,,,,,,140.66,524.77,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,inpatient,,,345.00000,184.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,317.40,,,,,,,310.50,334.65,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,317.40,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,inpatient,,,345.00000,184.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,317.40,,,,,,,310.50,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,317.40,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,inpatient,,,419.00000,224.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,385.48,,,,,,,377.10,406.43,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,385.48,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,inpatient,,,419.00000,224.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,385.48,,,,,,,377.10,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,385.48,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,inpatient,,,618.00000,331.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,568.56,,,,,,,556.20,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,568.56,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,inpatient,,,618.00000,331.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,568.56,,,,,,,556.20,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,568.56,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,inpatient,,,463.00000,248.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,425.96,,,,,,,416.70,449.11,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,outpatient,,,463.00000,248.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,425.96,,,,,,,120.38,449.11,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,inpatient,,,511.00000,273.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,470.12,,,,,,,459.90,495.67,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,outpatient,,,511.00000,273.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,470.12,,,,,,,132.86,495.67,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,inpatient,,,132.00000,70.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,121.44,,,,,,,118.80,128.04,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,outpatient,,,132.00000,70.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,121.44,,,,,,,34.32,128.04,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,inpatient,,,353.00000,189.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,324.76,,,,,,,317.70,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,324.76,,,,,,,91.78,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,inpatient,,,353.00000,189.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,324.76,,,,,,,317.70,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,324.76,,,,,,,91.78,342.41,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,inpatient,,,273.00000,146.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,251.16,,,,,,,245.70,264.81,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,outpatient,,,273.00000,146.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,251.16,,,,,,,70.98,264.81,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,inpatient,,,503.00000,269.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,462.76,,,,,,,452.70,487.91,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,outpatient,,,503.00000,269.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,462.76,,,,,,,130.78,487.91,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,inpatient,,,561.00000,300.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,516.12,,,,,,,504.90,544.17,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,outpatient,,,561.00000,300.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,516.12,,,,,,,145.86,544.17,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,inpatient,,,450.00000,241.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,414.00,,,,,,,405.00,436.50,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,414.00,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,inpatient,,,450.00000,241.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,414.00,,,,,,,405.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,414.00,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,inpatient,,,650.00000,348.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,598.00,,,,,,,585.00,630.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,outpatient,,,650.00000,348.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,598.00,,,,,,,169.00,630.50,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,inpatient,,,642.00000,344.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,590.64,,,,,,,577.80,622.74,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,outpatient,,,642.00000,344.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,590.64,,,,,,,166.92,622.74,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,inpatient,,,777.00000,416.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,714.84,,,,,,,699.30,753.69,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,outpatient,,,777.00000,416.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,714.84,,,,,,,202.02,753.69,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,inpatient,,,381.00000,204.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,350.52,,,,,,,342.90,369.57,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,outpatient,,,381.00000,204.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,350.52,,,,,,,99.06,369.57,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,inpatient,,,374.00000,200.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,344.08,,,,,,,336.60,362.78,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,344.08,,,,,,,97.24,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,inpatient,,,374.00000,200.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,344.08,,,,,,,336.60,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,344.08,,,,,,,97.24,362.78,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,inpatient,,,161.00000,86.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,148.12,,,,,,,144.90,156.17,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,148.12,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,inpatient,,,161.00000,86.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,148.12,,,,,,,144.90,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,148.12,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,inpatient,,,499.00000,267.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,459.08,,,,,,,449.10,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,459.08,,,,,,,129.74,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,inpatient,,,499.00000,267.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,459.08,,,,,,,449.10,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,459.08,,,,,,,129.74,484.03,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,inpatient,,,214.00000,114.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,196.88,,,,,,,192.60,207.58,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,outpatient,,,214.00000,114.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,196.88,,,,,,,55.64,207.58,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,inpatient,,,329.00000,176.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,302.68,,,,,,,296.10,319.13,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,outpatient,,,329.00000,176.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,302.68,,,,,,,85.54,319.13,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,inpatient,,,197.00000,105.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,181.24,,,,,,,177.30,191.09,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,outpatient,,,197.00000,105.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,181.24,,,,,,,51.22,191.09,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,inpatient,,,263.00000,140.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,241.96,,,,,,,236.70,255.11,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,outpatient,,,263.00000,140.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,241.96,,,,,,,68.38,255.11,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,inpatient,,,234.00000,125.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,215.28,,,,,,,210.60,226.98,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,outpatient,,,234.00000,125.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,215.28,,,,,,,60.84,226.98,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,inpatient,,,401.00000,214.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,368.92,,,,,,,360.90,388.97,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,outpatient,,,401.00000,214.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,368.92,,,,,,,104.26,388.97,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,inpatient,,,515.00000,276.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,473.80,,,,,,,463.50,499.55,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,outpatient,,,515.00000,276.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,473.80,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,inpatient,,,747.00000,400.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,687.24,,,,,,,672.30,724.59,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,outpatient,,,747.00000,400.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,687.24,,,,,,,194.22,724.59,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,inpatient,,,854.00000,457.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,785.68,,,,,,,768.60,828.38,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,outpatient,,,854.00000,457.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,785.68,,,,,,,222.04,828.38,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,inpatient,,,589.00000,315.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,541.88,,,,,,,530.10,571.33,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,outpatient,,,589.00000,315.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,541.88,,,,,,,153.14,571.33,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,inpatient,,,613.00000,328.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,563.96,,,,,,,551.70,594.61,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,outpatient,,,613.00000,328.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,563.96,,,,,,,159.38,594.61,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,inpatient,,,806.00000,432.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,741.52,,,,,,,725.40,781.82,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,outpatient,,,806.00000,432.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,741.52,,,,,,,209.56,781.82,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,inpatient,,,529.00000,283.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,486.68,,,,,,,476.10,513.13,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,outpatient,,,529.00000,283.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,486.68,,,,,,,137.54,513.13,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,inpatient,,,939.00000,503.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,863.88,,,,,,,845.10,910.83,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,outpatient,,,939.00000,503.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,863.88,,,,,,,244.14,910.83,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,inpatient,,,515.00000,276.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,473.80,,,,,,,463.50,499.55,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,outpatient,,,515.00000,276.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,473.80,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,inpatient,,,616.00000,330.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,566.72,,,,,,,554.40,597.52,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,outpatient,,,616.00000,330.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,566.72,,,,,,,160.16,597.52,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,inpatient,,,377.00000,202.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,346.84,,,,,,,339.30,365.69,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,outpatient,,,377.00000,202.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,346.84,,,,,,,98.02,365.69,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,inpatient,,,340.00000,182.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,312.80,,,,,,,306.00,329.80,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,outpatient,,,340.00000,182.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,312.80,,,,,,,88.40,329.80,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,inpatient,,,388.00000,207.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,356.96,,,,,,,349.20,376.36,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,outpatient,,,388.00000,207.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,356.96,,,,,,,100.88,376.36,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,inpatient,,,456.00000,244.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,419.52,,,,,,,410.40,442.32,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,outpatient,,,456.00000,244.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,419.52,,,,,,,118.56,442.32,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,inpatient,,,267.00000,143.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,245.64,,,,,,,240.30,258.99,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,outpatient,,,267.00000,143.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,245.64,,,,,,,69.42,258.99,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,281.52,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,281.52,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,LT",281.52,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,LT",281.52,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,281.52,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,281.52,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,RT",281.52,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,RT",281.52,,,,,,,79.56,296.82,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,inpatient,,,456.00000,244.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,419.52,,,,,,,410.40,442.32,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,outpatient,,,456.00000,244.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,419.52,,,,,,,118.56,442.32,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,inpatient,,,381.00000,204.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,350.52,,,,,,,342.90,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,outpatient,,,381.00000,204.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,350.52,,,,,,,99.06,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,inpatient,,,143.00000,76.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,131.56,,,,,,,128.70,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,131.56,,,,,,,37.18,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,inpatient,,,143.00000,76.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,131.56,,,,,,,128.70,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,131.56,,,,,,,37.18,138.71,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,inpatient,,,331.00000,177.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,304.52,,,,,,,297.90,321.07,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,304.52,,,,,,,86.06,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,inpatient,,,331.00000,177.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,304.52,,,,,,,297.90,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,304.52,,,,,,,86.06,321.07,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,inpatient,,,1113.00000,596.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1023.96,,,,,,,1001.70,1079.61,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1113.00000,596.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1023.96,,,,,,,289.38,1079.61,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,inpatient,,,1043.00000,559.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,959.56,,,,,,,938.70,1011.71,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,outpatient,,,1043.00000,559.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,959.56,,,,,,,271.18,1011.71,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,235.52,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,235.52,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,LT",235.52,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,LT",235.52,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,235.52,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,235.52,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,RT",235.52,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,"52,RT",235.52,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,inpatient,,,511.00000,273.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,470.12,,,,,,,459.90,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,470.12,,,,,,,132.86,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,inpatient,,,511.00000,273.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,470.12,,,,,,,459.90,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,470.12,,,,,,,132.86,495.67,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,inpatient,,,553.00000,314.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,508.76,,,,,,,497.70,536.41,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,508.76,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,inpatient,,,553.00000,314.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,508.76,,,,,,,497.70,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,508.76,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,inpatient,,,1076.00000,611.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,989.92,,,,,,,968.40,1043.72,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,989.92,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,inpatient,,,1076.00000,611.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,989.92,,,,,,,968.40,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,989.92,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,inpatient,,,865.00000,491.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,795.80,,,,,,,778.50,839.05,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,795.80,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,inpatient,,,865.00000,491.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,795.80,,,,,,,778.50,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,795.80,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,inpatient,,,734.00000,417.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,675.28,,,,,,,660.60,711.98,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,675.28,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,inpatient,,,734.00000,417.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,675.28,,,,,,,660.60,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,675.28,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,inpatient,,,730.00000,414.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,671.60,,,,,,,657.00,708.10,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,671.60,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,inpatient,,,730.00000,414.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,671.60,,,,,,,657.00,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,671.60,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,inpatient,,,260.00000,147.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,239.20,,,,,,,234.00,252.20,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,239.20,,,,,,,67.60,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,inpatient,,,260.00000,147.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,239.20,,,,,,,234.00,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,239.20,,,,,,,67.60,252.20,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,inpatient,,,428.00000,203.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,393.76,,,,,,,385.20,415.16,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,outpatient,,,428.00000,203.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,393.76,,,,,,,111.28,415.16,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,inpatient,,,492.00000,234.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,452.64,,,,,,,442.80,477.24,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,outpatient,,,492.00000,234.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,452.64,,,,,,,127.92,477.24,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,inpatient,,,607.00000,288.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,558.44,,,,,,,546.30,588.79,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,outpatient,,,607.00000,288.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,558.44,,,,,,,157.82,588.79,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,inpatient,,,649.00000,308.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,597.08,,,,,,,584.10,629.53,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,outpatient,,,649.00000,308.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,597.08,,,,,,,168.74,629.53,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,inpatient,,,377.00000,121.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,346.84,,,,,,,339.30,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,outpatient,,,377.00000,121.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,346.84,,,,,,,98.02,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,inpatient,,,251.00000,81.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,230.92,,,,,,,225.90,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,230.92,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,inpatient,,,251.00000,81.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,230.92,,,,,,,225.90,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,230.92,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,inpatient,,,1170.00000,377.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,1076.40,,,,,,,1053.00,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,outpatient,,,1170.00000,377.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,1076.40,,,,,,,304.20,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,inpatient,,,780.00000,251.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,717.60,,,,,,,702.00,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,717.60,,,,,,,202.80,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,inpatient,,,780.00000,251.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,717.60,,,,,,,702.00,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,717.60,,,,,,,202.80,756.60,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,inpatient,,,1389.00000,448.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1277.88,,,,,,,1250.10,1347.33,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,outpatient,,,1389.00000,448.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1277.88,,,,,,,361.14,1347.33,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,inpatient,,,345.00000,111.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,317.40,,,,,,,310.50,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,outpatient,,,345.00000,111.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,317.40,,,,,,,89.70,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,inpatient,,,230.00000,74.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,211.60,,,,,,,207.00,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,211.60,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,inpatient,,,230.00000,74.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,211.60,,,,,,,207.00,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,211.60,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,inpatient,,,2102.00000,678.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,1933.84,,,,,,,1891.80,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,outpatient,,,2102.00000,678.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,1933.84,,,,,,,546.52,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,inpatient,,,1401.00000,452.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1288.92,,,,,,,1260.90,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1288.92,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,inpatient,,,1401.00000,452.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1288.92,,,,,,,1260.90,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1288.92,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,inpatient,,,357.00000,115.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,328.44,,,,,,,321.30,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,outpatient,,,357.00000,115.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,328.44,,,,,,,92.82,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,inpatient,,,238.00000,76.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,218.96,,,,,,,214.20,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,218.96,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,inpatient,,,238.00000,76.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,218.96,,,,,,,214.20,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,218.96,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,inpatient,,,2082.00000,672.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,1915.44,,,,,,,1873.80,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,outpatient,,,2082.00000,672.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,1915.44,,,,,,,541.32,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,inpatient,,,1388.00000,448.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1276.96,,,,,,,1249.20,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1276.96,,,,,,,360.88,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,inpatient,,,1388.00000,448.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1276.96,,,,,,,1249.20,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1276.96,,,,,,,360.88,1346.36,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,inpatient,,,246.00000,79.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,226.32,,,,,,,221.40,238.62,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,outpatient,,,246.00000,79.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,226.32,,,,,,,63.96,238.62,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,inpatient,,,164.00000,52.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,150.88,,,,,,,147.60,159.08,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,150.88,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,inpatient,,,164.00000,52.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,150.88,,,,,,,147.60,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,150.88,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,inpatient,,,309.00000,99.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,284.28,,,,,,,278.10,299.73,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,outpatient,,,309.00000,99.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,284.28,,,,,,,80.34,299.73,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,inpatient,,,206.00000,66.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,189.52,,,,,,,185.40,199.82,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,189.52,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,inpatient,,,206.00000,66.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,189.52,,,,,,,185.40,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,189.52,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,inpatient,,,471.00000,152.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,433.32,,,,,,,423.90,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,outpatient,,,471.00000,152.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,433.32,,,,,,,122.46,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,inpatient,,,314.00000,101.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,288.88,,,,,,,282.60,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,288.88,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,inpatient,,,314.00000,101.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,288.88,,,,,,,282.60,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,288.88,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,inpatient,,,239.00000,77.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,219.88,,,,,,,215.10,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,outpatient,,,239.00000,77.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,219.88,,,,,,,62.14,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,inpatient,,,159.00000,51.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,146.28,,,,,,,143.10,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,146.28,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,inpatient,,,159.00000,51.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,146.28,,,,,,,143.10,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,146.28,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,inpatient,,,558.00000,180.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,513.36,,,,,,,502.20,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,outpatient,,,558.00000,180.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,513.36,,,,,,,145.08,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,inpatient,,,372.00000,120.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,342.24,,,,,,,334.80,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,342.24,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,inpatient,,,372.00000,120.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,342.24,,,,,,,334.80,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,342.24,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,inpatient,,,413.00000,133.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,379.96,,,,,,,371.70,400.61,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,outpatient,,,413.00000,133.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,379.96,,,,,,,107.38,400.61,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,inpatient,,,275.00000,88.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,253.00,,,,,,,247.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,253.00,,,,,,,71.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,inpatient,,,275.00000,88.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,253.00,,,,,,,247.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,253.00,,,,,,,71.50,266.75,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,inpatient,,,462.00000,149.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,425.04,,,,,,,415.80,448.14,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,outpatient,,,462.00000,149.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,425.04,,,,,,,120.12,448.14,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,inpatient,,,170.00000,54.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,156.40,,,,,,,153.00,164.90,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,outpatient,,,170.00000,54.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,156.40,,,,,,,44.20,164.90,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,inpatient,,,281.00000,90.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,258.52,,,,,,,252.90,272.57,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,outpatient,,,281.00000,90.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,258.52,,,,,,,73.06,272.57,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,inpatient,,,562.00000,181.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,517.04,,,,,,,505.80,545.14,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,outpatient,,,562.00000,181.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,517.04,,,,,,,146.12,545.14,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,inpatient,,,2076.00000,670.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,1909.92,,,,,,,1868.40,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,outpatient,,,2076.00000,670.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,1909.92,,,,,,,539.76,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1384.00000,447.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1273.28,,,,,,,1245.60,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1273.28,,,,,,,359.84,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1384.00000,447.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1273.28,,,,,,,1245.60,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1273.28,,,,,,,359.84,1342.48,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,inpatient,,,934.00000,301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,859.28,,,,,,,840.60,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,outpatient,,,934.00000,301.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,859.28,,,,,,,242.84,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,inpatient,,,842.00000,271.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,774.64,,,,,,,757.80,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,outpatient,,,842.00000,271.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,774.64,,,,,,,218.92,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,inpatient,,,846.00000,273.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,778.32,,,,,,,761.40,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,outpatient,,,846.00000,273.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,778.32,,,,,,,219.96,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,inpatient,,,971.00000,313.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,893.32,,,,,,,873.90,941.87,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,outpatient,,,971.00000,313.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,893.32,,,,,,,252.46,941.87,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,inpatient,,,762.00000,246.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,701.04,,,,,,,685.80,739.14,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,outpatient,,,762.00000,246.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,701.04,,,,,,,198.12,739.14,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,inpatient,,,758.00000,244.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,697.36,,,,,,,682.20,735.26,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,outpatient,,,758.00000,244.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,697.36,,,,,,,197.08,735.26,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,inpatient,,,161.00000,52.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,148.12,,,,,,,144.90,156.17,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,outpatient,,,161.00000,52.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,148.12,,,,,,,41.86,156.17,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,inpatient,,,234.00000,75.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,215.28,,,,,,,210.60,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,outpatient,,,234.00000,75.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,215.28,,,,,,,60.84,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,inpatient,,,156.00000,50.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,143.52,,,,,,,140.40,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,143.52,,,,,,,40.56,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,inpatient,,,156.00000,50.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,143.52,,,,,,,140.40,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,143.52,,,,,,,40.56,151.32,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1517.00000,489.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,1395.64,,,,,,,1365.30,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1517.00000,489.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,1395.64,,,,,,,394.42,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1011.00000,326.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,930.12,,,,,,,909.90,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,930.12,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1011.00000,326.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,930.12,,,,,,,909.90,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,930.12,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,inpatient,,,822.00000,265.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,756.24,,,,,,,739.80,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,outpatient,,,822.00000,265.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,756.24,,,,,,,213.72,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,inpatient,,,548.00000,177.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,504.16,,,,,,,493.20,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,504.16,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,inpatient,,,548.00000,177.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,504.16,,,,,,,493.20,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,504.16,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,inpatient,,,2613.00000,844.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2403.96,,,,,,,2351.70,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,outpatient,,,2613.00000,844.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2403.96,,,,,,,679.38,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,inpatient,,,903.00000,291.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,830.76,,,,,,,812.70,875.91,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,outpatient,,,903.00000,291.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,830.76,,,,,,,234.78,875.91,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,inpatient,,,1156.00000,373.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1063.52,,,,,,,1040.40,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,outpatient,,,1156.00000,373.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1063.52,,,,,,,300.56,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,inpatient,,,677.00000,218.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,622.84,,,,,,,609.30,656.69,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,outpatient,,,677.00000,218.67000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,622.84,,,,,,,176.02,656.69,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1928.00000,622.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,1773.76,,,,,,,1735.20,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1928.00000,622.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,1773.76,,,,,,,501.28,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1285.00000,415.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1182.20,,,,,,,1156.50,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1182.20,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1285.00000,415.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1182.20,,,,,,,1156.50,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1182.20,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,inpatient,,,812.00000,262.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,747.04,,,,,,,730.80,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,outpatient,,,812.00000,262.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,747.04,,,,,,,211.12,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,inpatient,,,541.00000,174.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,497.72,,,,,,,486.90,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,497.72,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,inpatient,,,541.00000,174.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,497.72,,,,,,,486.90,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,497.72,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,inpatient,,,825.00000,266.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,759.00,,,,,,,742.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,outpatient,,,825.00000,266.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,759.00,,,,,,,214.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,inpatient,,,550.00000,177.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,506.00,,,,,,,495.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,506.00,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,inpatient,,,550.00000,177.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,506.00,,,,,,,495.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,506.00,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,inpatient,,,3494.00000,1128.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,3214.48,,,,,,,3144.60,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,outpatient,,,3494.00000,1128.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,3214.48,,,,,,,908.44,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2329.00000,752.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2142.68,,,,,,,2096.10,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2142.68,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2329.00000,752.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2142.68,,,,,,,2096.10,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2142.68,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,inpatient,,,840.00000,271.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,772.80,,,,,,,756.00,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,outpatient,,,840.00000,271.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,772.80,,,,,,,218.40,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,inpatient,,,560.00000,180.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,515.20,,,,,,,504.00,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,515.20,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,inpatient,,,560.00000,180.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,515.20,,,,,,,504.00,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,515.20,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,inpatient,,,792.00000,255.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,728.64,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,outpatient,,,792.00000,255.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,728.64,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,inpatient,,,528.00000,170.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,485.76,,,,,,,475.20,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,485.76,,,,,,,137.28,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,inpatient,,,528.00000,170.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,485.76,,,,,,,475.20,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,485.76,,,,,,,137.28,512.16,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,inpatient,,,272.00000,87.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,250.24,,,,,,,244.80,263.84,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,outpatient,,,272.00000,87.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,250.24,,,,,,,70.72,263.84,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,inpatient,,,1268.00000,409.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1166.56,,,,,,,1141.20,1229.96,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,outpatient,,,1268.00000,409.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1166.56,,,,,,,329.68,1229.96,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,inpatient,,,896.00000,289.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,824.32,,,,,,,806.40,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,outpatient,,,896.00000,289.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,824.32,,,,,,,232.96,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,inpatient,,,884.00000,285.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,813.28,,,,,,,795.60,857.48,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,outpatient,,,884.00000,285.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,813.28,,,,,,,229.84,857.48,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,inpatient,,,609.00000,326.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,560.28,,,,,,,548.10,590.73,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,560.28,,,,,,,158.34,590.73,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,inpatient,,,966.00000,383.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,888.72,,,,,,,869.40,937.02,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,outpatient,,,966.00000,383.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,888.72,,,,,,,251.16,937.02,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,inpatient,,,872.00000,346.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,802.24,,,,,,,784.80,845.84,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,outpatient,,,872.00000,346.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,802.24,,,,,,,226.72,845.84,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,inpatient,,,492.00000,195.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,452.64,,,,,,,442.80,477.24,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,outpatient,,,492.00000,195.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,452.64,,,,,,,127.92,477.24,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,inpatient,,,331.00000,131.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,304.52,,,,,,,297.90,321.07,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,outpatient,,,331.00000,131.41000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,304.52,,,,,,,86.06,321.07,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,inpatient,,,5215.00000,2070.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4797.80,,,,,,,4693.50,5058.55,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,outpatient,,,5215.00000,2070.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4797.80,,,,,,,1355.90,5058.55,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,inpatient,,,5422.00000,2152.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4988.24,,,,,,,4879.80,5259.34,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,outpatient,,,5422.00000,2152.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4988.24,,,,,,,1409.72,5259.34,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,inpatient,,,1878.00000,788.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1727.76,,,,,,,1690.20,1821.66,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1878.00000,788.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1727.76,,,,,,,488.28,1821.66,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,inpatient,,,2253.00000,946.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2072.76,,,,,,,2027.70,2185.41,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,outpatient,,,2253.00000,946.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2072.76,,,,,,,585.78,2185.41,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,inpatient,,,1502.00000,630.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1381.84,,,,,,,1351.80,1456.94,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1502.00000,630.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1381.84,,,,,,,390.52,1456.94,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,inpatient,,,2024.00000,850.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1862.08,,,,,,,1821.60,1963.28,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,outpatient,,,2024.00000,850.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1862.08,,,,,,,526.24,1963.28,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,inpatient,,,2429.00000,1020.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2234.68,,,,,,,2186.10,2356.13,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,outpatient,,,2429.00000,1020.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2234.68,,,,,,,631.54,2356.13,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,inpatient,,,1619.00000,679.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1619.00000,679.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,inpatient,,,2425.00000,1018.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2231.00,,,,,,,2182.50,2352.25,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,outpatient,,,2425.00000,1018.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2231.00,,,,,,,630.50,2352.25,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,inpatient,,,2910.00000,1222.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2677.20,,,,,,,2619.00,2822.70,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2910.00000,1222.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2677.20,,,,,,,756.60,2822.70,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,inpatient,,,1940.00000,814.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1784.80,,,,,,,1746.00,1881.80,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1940.00000,814.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1784.80,,,,,,,504.40,1881.80,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,inpatient,,,2317.00000,973.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2131.64,,,,,,,2085.30,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2317.00000,973.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2131.64,,,,,,,602.42,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,inpatient,,,2780.00000,1167.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2557.60,,,,,,,2502.00,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2780.00000,1167.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2557.60,,,,,,,722.80,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,inpatient,,,1853.00000,778.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1704.76,,,,,,,1667.70,1797.41,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1853.00000,778.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1704.76,,,,,,,481.78,1797.41,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,inpatient,,,2366.00000,993.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2176.72,,,,,,,2129.40,2295.02,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2366.00000,993.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2176.72,,,,,,,615.16,2295.02,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,inpatient,,,3056.00000,1283.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2811.52,,,,,,,2750.40,2964.32,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,outpatient,,,3056.00000,1283.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2811.52,,,,,,,794.56,2964.32,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,inpatient,,,2829.00000,1386.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2602.68,,,,,,,2546.10,2744.13,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,outpatient,,,2829.00000,1386.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2602.68,,,,,,,735.54,2744.13,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,inpatient,,,3395.00000,1663.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3123.40,,,,,,,3055.50,3293.15,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,outpatient,,,3395.00000,1663.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3123.40,,,,,,,882.70,3293.15,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,inpatient,,,2263.00000,1108.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2081.96,,,,,,,2036.70,2195.11,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,outpatient,,,2263.00000,1108.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2081.96,,,,,,,588.38,2195.11,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,inpatient,,,4697.00000,2301.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4321.24,,,,,,,4227.30,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,outpatient,,,4697.00000,2301.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4321.24,,,,,,,1221.22,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,inpatient,,,5636.00000,2761.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5185.12,,,,,,,5072.40,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,outpatient,,,5636.00000,2761.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5185.12,,,,,,,1465.36,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,inpatient,,,3757.00000,1840.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3456.44,,,,,,,3381.30,3644.29,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,outpatient,,,3757.00000,1840.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3456.44,,,,,,,976.82,3644.29,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,inpatient,,,2619.00000,1283.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2409.48,,,,,,,2357.10,2540.43,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,outpatient,,,2619.00000,1283.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2409.48,,,,,,,680.94,2540.43,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,inpatient,,,3143.00000,1540.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2891.56,,,,,,,2828.70,3048.71,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,outpatient,,,3143.00000,1540.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2891.56,,,,,,,817.18,3048.71,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,inpatient,,,2095.00000,1026.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1927.40,,,,,,,1885.50,2032.15,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,outpatient,,,2095.00000,1026.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1927.40,,,,,,,544.70,2032.15,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,inpatient,,,278.00000,136.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,255.76,,,,,,,250.20,269.66,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,outpatient,,,278.00000,136.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,255.76,,,,,,,72.28,269.66,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,inpatient,,,2110.00000,1033.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1941.20,,,,,,,1899.00,2046.70,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1941.20,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,inpatient,,,2110.00000,1033.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1941.20,,,,,,,1899.00,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1941.20,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2532.00000,1240.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2329.44,,,,,,,2278.80,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2329.44,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2532.00000,1240.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2329.44,,,,,,,2278.80,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2329.44,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1688.00000,827.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1552.96,,,,,,,1519.20,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1552.96,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1688.00000,827.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1552.96,,,,,,,1519.20,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1552.96,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,inpatient,,,2024.00000,991.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1862.08,,,,,,,1821.60,1963.28,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1862.08,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,inpatient,,,2024.00000,991.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1862.08,,,,,,,1821.60,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1862.08,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2429.00000,1190.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2234.68,,,,,,,2186.10,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2234.68,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2429.00000,1190.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2234.68,,,,,,,2186.10,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2234.68,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1619.00000,793.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1619.00000,793.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1489.48,,,,,,,1457.10,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1489.48,,,,,,,420.94,1570.43,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,inpatient,,,1224.00000,599.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1126.08,,,,,,,1101.60,1187.28,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,outpatient,,,1224.00000,599.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1126.08,,,,,,,318.24,1187.28,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,inpatient,,,3020.00000,1479.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2778.40,,,,,,,2718.00,2929.40,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,outpatient,,,3020.00000,1479.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2778.40,,,,,,,785.20,2929.40,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,inpatient,,,3624.00000,1775.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3334.08,,,,,,,3261.60,3515.28,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,outpatient,,,3624.00000,1775.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3334.08,,,,,,,942.24,3515.28,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,inpatient,,,2416.00000,1183.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2222.72,,,,,,,2174.40,2343.52,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,outpatient,,,2416.00000,1183.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2222.72,,,,,,,628.16,2343.52,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,inpatient,,,2728.00000,1336.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2509.76,,,,,,,2455.20,2646.16,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,outpatient,,,2728.00000,1336.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2509.76,,,,,,,709.28,2646.16,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,inpatient,,,3273.00000,1603.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3011.16,,,,,,,2945.70,3174.81,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,outpatient,,,3273.00000,1603.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3011.16,,,,,,,850.98,3174.81,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,inpatient,,,2182.00000,1069.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2007.44,,,,,,,1963.80,2116.54,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,outpatient,,,2182.00000,1069.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2007.44,,,,,,,567.32,2116.54,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,inpatient,,,3133.00000,1535.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2882.36,,,,,,,2819.70,3039.01,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,outpatient,,,3133.00000,1535.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2882.36,,,,,,,814.58,3039.01,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,inpatient,,,3759.00000,1841.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3458.28,,,,,,,3383.10,3646.23,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,outpatient,,,3759.00000,1841.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3458.28,,,,,,,977.34,3646.23,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,inpatient,,,2506.00000,1227.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2305.52,,,,,,,2255.40,2430.82,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,outpatient,,,2506.00000,1227.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2305.52,,,,,,,651.56,2430.82,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,inpatient,,,2857.00000,1399.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2628.44,,,,,,,2571.30,2771.29,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,outpatient,,,2857.00000,1399.93000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2628.44,,,,,,,742.82,2771.29,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,inpatient,,,3428.00000,1679.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3153.76,,,,,,,3085.20,3325.16,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,outpatient,,,3428.00000,1679.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3153.76,,,,,,,891.28,3325.16,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,inpatient,,,2285.00000,1119.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2102.20,,,,,,,2056.50,2216.45,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,outpatient,,,2285.00000,1119.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2102.20,,,,,,,594.10,2216.45,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,inpatient,,,3565.00000,1746.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3279.80,,,,,,,3208.50,3458.05,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,outpatient,,,3565.00000,1746.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3279.80,,,,,,,926.90,3458.05,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,inpatient,,,5918.00000,2899.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5444.56,,,,,,,5326.20,5740.46,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,outpatient,,,5918.00000,2899.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5444.56,,,,,,,1538.68,5740.46,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,inpatient,,,3301.00000,1617.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3036.92,,,,,,,2970.90,3201.97,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,outpatient,,,3301.00000,1617.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3036.92,,,,,,,858.26,3201.97,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2659.00000,1302.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2446.28,,,,,,,2393.10,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2446.28,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2659.00000,1302.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2446.28,,,,,,,2393.10,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2446.28,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2551.00000,1249.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2346.92,,,,,,,2295.90,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2346.92,,,,,,,663.26,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2551.00000,1249.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2346.92,,,,,,,2295.90,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2346.92,,,,,,,663.26,2474.47,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,inpatient,,,3806.00000,1864.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3501.52,,,,,,,3425.40,3691.82,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3806.00000,1864.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3501.52,,,,,,,989.56,3691.82,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,inpatient,,,2149.00000,694.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1977.08,,,,,,,1934.10,2084.53,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,outpatient,,,2149.00000,694.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1977.08,,,,,,,558.74,2084.53,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,inpatient,,,1973.00000,637.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1815.16,,,,,,,1775.70,1913.81,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,outpatient,,,1973.00000,637.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1815.16,,,,,,,512.98,1913.81,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1784.00000,576.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,1641.28,,,,,,,1605.60,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1784.00000,576.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,1641.28,,,,,,,463.84,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1189.00000,384.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1093.88,,,,,,,1070.10,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1093.88,,,,,,,309.14,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1189.00000,384.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1093.88,,,,,,,1070.10,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1093.88,,,,,,,309.14,1153.33,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,inpatient,,,130.00000,69.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,119.60,,,,,,,117.00,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,outpatient,,,130.00000,69.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,119.60,,,,,,,33.80,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,inpatient,,,44.00000,23.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40.48,,,,,,,39.60,42.68,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,outpatient,,,44.00000,23.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40.48,,,,,,,11.44,42.68,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,inpatient,,,456.00000,244.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,419.52,,,,,,,410.40,442.32,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,outpatient,,,456.00000,244.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,419.52,,,,,,,118.56,442.32,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,inpatient,,,108.00000,57.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,99.36,,,,,,,97.20,104.76,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,outpatient,,,108.00000,57.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,99.36,,,,,,,28.08,104.76,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,inpatient,,,306.00000,164.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,281.52,,,,,,,275.40,296.82,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,outpatient,,,306.00000,164.02000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,281.52,,,,,,,79.56,296.82,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,inpatient,,,257.00000,137.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,236.44,,,,,,,231.30,249.29,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,outpatient,,,257.00000,137.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,236.44,,,,,,,66.82,249.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4057.00000,2036.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3732.44,,,,,,,3651.30,3935.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3732.44,,,,,,,1054.82,3935.29,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4868.00000,2443.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4478.56,,,,,,,4381.20,4721.96,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4478.56,,,,,,,1265.68,4721.96,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,inpatient,,,3245.00000,1628.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2985.40,,,,,,,2920.50,3147.65,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2985.40,,,,,,,843.70,3147.65,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4057.00000,2036.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3732.44,,,,,,,3651.30,3935.29,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3732.44,,,,,,,1054.82,3935.29,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4868.00000,2443.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4478.56,,,,,,,4381.20,4721.96,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4478.56,,,,,,,1265.68,4721.96,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,inpatient,,,3245.00000,1628.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2985.40,,,,,,,2920.50,3147.65,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2985.40,,,,,,,843.70,3147.65,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,inpatient,,,1725.00000,865.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1587.00,,,,,,,1552.50,1673.25,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,outpatient,,,1725.00000,865.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1587.00,,,,,,,448.50,1673.25,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,inpatient,,,1743.00000,874.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1603.56,,,,,,,1568.70,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,outpatient,,,1743.00000,874.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1603.56,,,,,,,453.18,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,inpatient,,,1475.00000,740.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1357.00,,,,,,,1327.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1357.00,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,inpatient,,,1475.00000,740.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1357.00,,,,,,,1327.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1357.00,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,inpatient,,,1162.00000,583.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1069.04,,,,,,,1045.80,1127.14,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,outpatient,,,1162.00000,583.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1069.04,,,,,,,302.12,1127.14,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,inpatient,,,983.00000,493.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,904.36,,,,,,,884.70,953.51,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,904.36,,,,,,,255.58,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,inpatient,,,983.00000,493.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,904.36,,,,,,,884.70,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,904.36,,,,,,,255.58,953.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,inpatient,,,3183.00000,1597.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2928.36,,,,,,,2864.70,3087.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,outpatient,,,3183.00000,1597.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2928.36,,,,,,,827.58,3087.51,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,inpatient,,,3819.00000,1917.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3513.48,,,,,,,3437.10,3704.43,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,outpatient,,,3819.00000,1917.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3513.48,,,,,,,992.94,3704.43,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,inpatient,,,2546.00000,1278.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2342.32,,,,,,,2291.40,2469.62,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,outpatient,,,2546.00000,1278.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2342.32,,,,,,,661.96,2469.62,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,inpatient,,,3858.00000,1936.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,3549.36,,,,,,,3472.20,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,3549.36,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,inpatient,,,3858.00000,1936.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,3549.36,,,,,,,3472.20,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,3549.36,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,inpatient,,,4629.00000,2323.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,4258.68,,,,,,,4166.10,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,4258.68,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,inpatient,,,4629.00000,2323.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,4258.68,,,,,,,4166.10,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,4258.68,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,inpatient,,,3086.00000,1549.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2839.12,,,,,,,2777.40,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2839.12,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,inpatient,,,3086.00000,1549.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2839.12,,,,,,,2777.40,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2839.12,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,inpatient,,,2505.00000,1257.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2304.60,,,,,,,2254.50,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2304.60,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,inpatient,,,2505.00000,1257.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2304.60,,,,,,,2254.50,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2304.60,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,inpatient,,,3006.00000,1509.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2765.52,,,,,,,2705.40,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2765.52,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,inpatient,,,3006.00000,1509.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2765.52,,,,,,,2705.40,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2765.52,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,inpatient,,,2004.00000,1006.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1843.68,,,,,,,1803.60,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1843.68,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,inpatient,,,2004.00000,1006.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1843.68,,,,,,,1803.60,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1843.68,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,inpatient,,,3137.00000,1574.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2886.04,,,,,,,2823.30,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2886.04,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,inpatient,,,3137.00000,1574.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2886.04,,,,,,,2823.30,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2886.04,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,inpatient,,,3764.00000,1889.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,3462.88,,,,,,,3387.60,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,3462.88,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,inpatient,,,3764.00000,1889.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,3462.88,,,,,,,3387.60,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,3462.88,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,inpatient,,,2509.00000,1259.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2308.28,,,,,,,2258.10,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2308.28,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,inpatient,,,2509.00000,1259.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2308.28,,,,,,,2258.10,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2308.28,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,inpatient,,,3023.00000,1517.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2781.16,,,,,,,2720.70,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2781.16,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,inpatient,,,3023.00000,1517.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2781.16,,,,,,,2720.70,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2781.16,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,inpatient,,,3627.00000,1820.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,3336.84,,,,,,,3264.30,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,3336.84,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,inpatient,,,3627.00000,1820.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,3336.84,,,,,,,3264.30,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,3336.84,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,inpatient,,,2418.00000,1213.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2224.56,,,,,,,2176.20,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2224.56,,,,,,,628.68,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,inpatient,,,2418.00000,1213.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2224.56,,,,,,,2176.20,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2224.56,,,,,,,628.68,2345.46,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,inpatient,,,870.00000,436.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,800.40,,,,,,,783.00,843.90,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,outpatient,,,870.00000,436.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,800.40,,,,,,,226.20,843.90,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,inpatient,,,1353.00000,679.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1244.76,,,,,,,1217.70,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,outpatient,,,1353.00000,679.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1244.76,,,,,,,351.78,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,inpatient,,,902.00000,452.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,829.84,,,,,,,811.80,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,829.84,,,,,,,234.52,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,inpatient,,,902.00000,452.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,829.84,,,,,,,811.80,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,829.84,,,,,,,234.52,874.94,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,inpatient,,,3489.00000,1751.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3209.88,,,,,,,3140.10,3384.33,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3489.00000,1751.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3209.88,,,,,,,907.14,3384.33,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,inpatient,,,4187.00000,2101.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3852.04,,,,,,,3768.30,4061.39,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,outpatient,,,4187.00000,2101.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3852.04,,,,,,,1088.62,4061.39,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,inpatient,,,2791.00000,1401.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2567.72,,,,,,,2511.90,2707.27,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,outpatient,,,2791.00000,1401.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2567.72,,,,,,,725.66,2707.27,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,inpatient,,,492.00000,246.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,452.64,,,,,,,442.80,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,outpatient,,,492.00000,246.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,452.64,,,,,,,127.92,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,inpatient,,,331.00000,166.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,304.52,,,,,,,297.90,321.07,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,outpatient,,,331.00000,166.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,304.52,,,,,,,86.06,321.07,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,inpatient,,,4440.00000,2357.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4084.80,,,,,,,3996.00,4306.80,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,outpatient,,,4440.00000,2357.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4084.80,,,,,,,1154.40,4306.80,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,inpatient,,,5328.00000,2829.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4901.76,,,,,,,4795.20,5168.16,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,outpatient,,,5328.00000,2829.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4901.76,,,,,,,1385.28,5168.16,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,inpatient,,,3552.00000,1886.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3267.84,,,,,,,3196.80,3445.44,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,outpatient,,,3552.00000,1886.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3267.84,,,,,,,923.52,3445.44,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,inpatient,,,2528.00000,1342.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2325.76,,,,,,,2275.20,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,outpatient,,,2528.00000,1342.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2325.76,,,,,,,657.28,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,inpatient,,,3033.00000,1610.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2790.36,,,,,,,2729.70,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,outpatient,,,3033.00000,1610.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2790.36,,,,,,,788.58,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,inpatient,,,2022.00000,1073.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1860.24,,,,,,,1819.80,1961.34,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,outpatient,,,2022.00000,1073.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1860.24,,,,,,,525.72,1961.34,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,inpatient,,,3610.00000,1909.69000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3321.20,,,,,,,3249.00,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,outpatient,,,3610.00000,1909.69000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3321.20,,,,,,,938.60,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,inpatient,,,4332.00000,2291.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3985.44,,,,,,,3898.80,4202.04,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,outpatient,,,4332.00000,2291.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3985.44,,,,,,,1126.32,4202.04,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,inpatient,,,2888.00000,1527.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2656.96,,,,,,,2599.20,2801.36,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,outpatient,,,2888.00000,1527.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2656.96,,,,,,,750.88,2801.36,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,inpatient,,,4532.00000,2397.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4169.44,,,,,,,4078.80,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,outpatient,,,4532.00000,2397.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4169.44,,,,,,,1178.32,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,inpatient,,,5438.00000,2876.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5002.96,,,,,,,4894.20,5274.86,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,outpatient,,,5438.00000,2876.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5002.96,,,,,,,1413.88,5274.86,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,inpatient,,,3625.00000,1917.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3335.00,,,,,,,3262.50,3516.25,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,outpatient,,,3625.00000,1917.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3335.00,,,,,,,942.50,3516.25,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,inpatient,,,3639.00000,1925.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3347.88,,,,,,,3275.10,3529.83,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,outpatient,,,3639.00000,1925.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3347.88,,,,,,,946.14,3529.83,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,inpatient,,,4367.00000,2310.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4017.64,,,,,,,3930.30,4235.99,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,outpatient,,,4367.00000,2310.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4017.64,,,,,,,1135.42,4235.99,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,inpatient,,,2911.00000,1539.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2678.12,,,,,,,2619.90,2823.67,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,outpatient,,,2911.00000,1539.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2678.12,,,,,,,756.86,2823.67,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,inpatient,,,3494.00000,1719.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3214.48,,,,,,,3144.60,3389.18,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3494.00000,1719.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3214.48,,,,,,,908.44,3389.18,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,inpatient,,,4193.00000,2062.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3857.56,,,,,,,3773.70,4067.21,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,outpatient,,,4193.00000,2062.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3857.56,,,,,,,1090.18,4067.21,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,inpatient,,,2795.00000,1375.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2571.40,,,,,,,2515.50,2711.15,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,outpatient,,,2795.00000,1375.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2571.40,,,,,,,726.70,2711.15,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,inpatient,,,2717.00000,1336.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2499.64,,,,,,,2445.30,2635.49,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,outpatient,,,2717.00000,1336.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2499.64,,,,,,,706.42,2635.49,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,inpatient,,,3260.00000,1603.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2999.20,,,,,,,2934.00,3162.20,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,outpatient,,,3260.00000,1603.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2999.20,,,,,,,847.60,3162.20,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,inpatient,,,2173.00000,1069.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1999.16,,,,,,,1955.70,2107.81,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,outpatient,,,2173.00000,1069.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1999.16,,,,,,,564.98,2107.81,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4051.00000,2301.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,3726.92,,,,,,,3645.90,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,3726.92,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4051.00000,2301.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,3726.92,,,,,,,3645.90,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,3726.92,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4861.00000,2761.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,4472.12,,,,,,,4374.90,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,4472.12,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4861.00000,2761.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,4472.12,,,,,,,4374.90,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,4472.12,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3241.00000,1841.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2981.72,,,,,,,2916.90,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2981.72,,,,,,,842.66,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3241.00000,1841.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2981.72,,,,,,,2916.90,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2981.72,,,,,,,842.66,3143.77,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,inpatient,,,4260.00000,2420.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3919.20,,,,,,,3834.00,4132.20,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,outpatient,,,4260.00000,2420.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3919.20,,,,,,,1107.60,4132.20,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,inpatient,,,5112.00000,2904.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4703.04,,,,,,,4600.80,4958.64,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,outpatient,,,5112.00000,2904.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4703.04,,,,,,,1329.12,4958.64,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,inpatient,,,3408.00000,1936.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3135.36,,,,,,,3067.20,3305.76,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3408.00000,1936.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3135.36,,,,,,,886.08,3305.76,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,inpatient,,,3343.00000,1899.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3075.56,,,,,,,3008.70,3242.71,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3343.00000,1899.33000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3075.56,,,,,,,869.18,3242.71,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,inpatient,,,4010.00000,2278.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3689.20,,,,,,,3609.00,3889.70,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,outpatient,,,4010.00000,2278.28000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3689.20,,,,,,,1042.60,3889.70,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,inpatient,,,2674.00000,1519.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2460.08,,,,,,,2406.60,2593.78,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,outpatient,,,2674.00000,1519.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2460.08,,,,,,,695.24,2593.78,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3294.00000,1871.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,3030.48,,,,,,,2964.60,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,3030.48,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3294.00000,1871.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,3030.48,,,,,,,2964.60,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,3030.48,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3953.00000,2245.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,3636.76,,,,,,,3557.70,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,3636.76,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3953.00000,2245.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,3636.76,,,,,,,3557.70,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,3636.76,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,inpatient,,,2635.00000,1497.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2424.20,,,,,,,2371.50,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2424.20,,,,,,,685.10,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,inpatient,,,2635.00000,1497.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2424.20,,,,,,,2371.50,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2424.20,,,,,,,685.10,2555.95,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,inpatient,,,3664.00000,2081.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3370.88,,,,,,,3297.60,3554.08,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3664.00000,2081.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3370.88,,,,,,,952.64,3554.08,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,inpatient,,,4397.00000,2498.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,3957.30,4265.09,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,outpatient,,,4397.00000,2498.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4045.24,,,,,,,1143.22,4265.09,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,inpatient,,,2931.00000,1665.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2696.52,,,,,,,2637.90,2843.07,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,outpatient,,,2931.00000,1665.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2696.52,,,,,,,762.06,2843.07,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,inpatient,,,4759.00000,2703.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4378.28,,,,,,,4283.10,4616.23,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,outpatient,,,4759.00000,2703.83000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4378.28,,,,,,,1237.34,4616.23,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,inpatient,,,5710.00000,3244.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5253.20,,,,,,,5139.00,5538.70,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,outpatient,,,5710.00000,3244.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5253.20,,,,,,,1484.60,5538.70,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,inpatient,,,3807.00000,2162.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3502.44,,,,,,,3426.30,3692.79,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3807.00000,2162.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3502.44,,,,,,,989.82,3692.79,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,inpatient,,,2915.00000,1574.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2681.80,,,,,,,2623.50,2827.55,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2915.00000,1574.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2681.80,,,,,,,757.90,2827.55,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,inpatient,,,1918.00000,1035.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1764.56,,,,,,,1726.20,1860.46,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1918.00000,1035.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1764.56,,,,,,,498.68,1860.46,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,inpatient,,,2292.00000,1237.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2108.64,,,,,,,2062.80,2223.24,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2292.00000,1237.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2108.64,,,,,,,595.92,2223.24,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,inpatient,,,2984.00000,1611.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2745.28,,,,,,,2685.60,2894.48,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,outpatient,,,2984.00000,1611.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2745.28,,,,,,,775.84,2894.48,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,inpatient,,,769.00000,415.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,707.48,,,,,,,692.10,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,outpatient,,,769.00000,415.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,707.48,,,,,,,199.94,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,inpatient,,,1280.00000,691.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1177.60,,,,,,,1152.00,1241.60,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,outpatient,,,1280.00000,691.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1177.60,,,,,,,332.80,1241.60,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,inpatient,,,1878.00000,1014.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1727.76,,,,,,,1690.20,1821.66,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,outpatient,,,1878.00000,1014.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1727.76,,,,,,,488.28,1821.66,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,inpatient,,,2196.00000,1185.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2020.32,,,,,,,1976.40,2130.12,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,outpatient,,,2196.00000,1185.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2020.32,,,,,,,570.96,2130.12,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,inpatient,,,844.00000,455.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,776.48,,,,,,,759.60,818.68,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,outpatient,,,844.00000,455.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,776.48,,,,,,,219.44,818.68,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,inpatient,,,1305.00000,704.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1200.60,,,,,,,1174.50,1265.85,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,outpatient,,,1305.00000,704.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1200.60,,,,,,,339.30,1265.85,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,inpatient,,,576.00000,311.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,529.92,,,,,,,518.40,558.72,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,outpatient,,,576.00000,311.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,529.92,,,,,,,149.76,558.72,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,inpatient,,,809.00000,436.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,744.28,,,,,,,728.10,784.73,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,outpatient,,,809.00000,436.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,744.28,,,,,,,210.34,784.73,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,inpatient,,,2462.00000,1329.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2265.04,,,,,,,2215.80,2388.14,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,outpatient,,,2462.00000,1329.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2265.04,,,,,,,640.12,2388.14,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,inpatient,,,918.00000,495.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,844.56,,,,,,,826.20,890.46,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,outpatient,,,918.00000,495.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,844.56,,,,,,,238.68,890.46,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,inpatient,,,1102.00000,595.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1013.84,,,,,,,991.80,1068.94,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,outpatient,,,1102.00000,595.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1013.84,,,,,,,286.52,1068.94,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,inpatient,,,812.00000,438.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,747.04,,,,,,,730.80,787.64,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,outpatient,,,812.00000,438.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,747.04,,,,,,,211.12,787.64,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,inpatient,,,1407.00000,759.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1294.44,,,,,,,1266.30,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,outpatient,,,1407.00000,759.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1294.44,,,,,,,365.82,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,inpatient,,,1980.00000,1069.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1821.60,,,,,,,1782.00,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,outpatient,,,1980.00000,1069.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1821.60,,,,,,,514.80,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,inpatient,,,964.00000,520.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,886.88,,,,,,,867.60,935.08,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,outpatient,,,964.00000,520.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,886.88,,,,,,,250.64,935.08,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,inpatient,,,1040.00000,561.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,956.80,,,,,,,936.00,1008.80,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,outpatient,,,1040.00000,561.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,956.80,,,,,,,270.40,1008.80,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,inpatient,,,795.00000,429.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,731.40,,,,,,,715.50,771.15,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,outpatient,,,795.00000,429.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,731.40,,,,,,,206.70,771.15,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,inpatient,,,1124.00000,606.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1034.08,,,,,,,1011.60,1090.28,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,outpatient,,,1124.00000,606.96000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1034.08,,,,,,,292.24,1090.28,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,inpatient,,,736.00000,397.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,677.12,,,,,,,662.40,713.92,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,outpatient,,,736.00000,397.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,677.12,,,,,,,191.36,713.92,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,inpatient,,,700.00000,378.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,644.00,,,,,,,630.00,679.00,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,outpatient,,,700.00000,378.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,644.00,,,,,,,182.00,679.00,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,inpatient,,,821.00000,443.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,755.32,,,,,,,738.90,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,outpatient,,,821.00000,443.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,755.32,,,,,,,213.46,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,inpatient,,,846.00000,456.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,778.32,,,,,,,761.40,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,outpatient,,,846.00000,456.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,778.32,,,,,,,219.96,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,inpatient,,,958.00000,517.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,881.36,,,,,,,862.20,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,outpatient,,,958.00000,517.32000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,881.36,,,,,,,249.08,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,inpatient,,,1261.00000,680.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1160.12,,,,,,,1134.90,1223.17,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,outpatient,,,1261.00000,680.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1160.12,,,,,,,327.86,1223.17,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,inpatient,,,971.00000,524.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,893.32,,,,,,,873.90,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,outpatient,,,971.00000,524.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,893.32,,,,,,,252.46,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,inpatient,,,1837.00000,991.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1690.04,,,,,,,1653.30,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,outpatient,,,1837.00000,991.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1690.04,,,,,,,477.62,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,inpatient,,,1099.00000,593.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1011.08,,,,,,,989.10,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,outpatient,,,1099.00000,593.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1011.08,,,,,,,285.74,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,inpatient,,,2178.00000,1176.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2003.76,,,,,,,1960.20,2112.66,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,outpatient,,,2178.00000,1176.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2003.76,,,,,,,566.28,2112.66,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,inpatient,,,1226.00000,662.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1127.92,,,,,,,1103.40,1189.22,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,outpatient,,,1226.00000,662.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1127.92,,,,,,,318.76,1189.22,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,inpatient,,,1048.00000,565.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,964.16,,,,,,,943.20,1016.56,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,outpatient,,,1048.00000,565.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,964.16,,,,,,,272.48,1016.56,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,inpatient,,,970.00000,523.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,892.40,,,,,,,873.00,940.90,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,outpatient,,,970.00000,523.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,892.40,,,,,,,252.20,940.90,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,inpatient,,,1803.00000,973.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1658.76,,,,,,,1622.70,1748.91,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,outpatient,,,1803.00000,973.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1658.76,,,,,,,468.78,1748.91,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,inpatient,,,2504.00000,1352.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2303.68,,,,,,,2253.60,2428.88,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,outpatient,,,2504.00000,1352.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2303.68,,,,,,,651.04,2428.88,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,inpatient,,,2457.00000,1326.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2260.44,,,,,,,2211.30,2383.29,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2457.00000,1326.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2260.44,,,,,,,638.82,2383.29,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,inpatient,,,923.00000,498.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,849.16,,,,,,,830.70,895.31,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,outpatient,,,923.00000,498.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,849.16,,,,,,,239.98,895.31,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,inpatient,,,5478.00000,2958.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5039.76,,,,,,,4930.20,5313.66,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,outpatient,,,5478.00000,2958.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5039.76,,,,,,,1424.28,5313.66,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,inpatient,,,4551.00000,2457.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4186.92,,,,,,,4095.90,4414.47,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,outpatient,,,4551.00000,2457.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4186.92,,,,,,,1183.26,4414.47,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,inpatient,,,1360.00000,734.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1251.20,,,,,,,1224.00,1319.20,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,outpatient,,,1360.00000,734.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1251.20,,,,,,,353.60,1319.20,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,inpatient,,,1209.00000,652.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1112.28,,,,,,,1088.10,1172.73,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,outpatient,,,1209.00000,652.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1112.28,,,,,,,314.34,1172.73,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,inpatient,,,848.00000,457.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,780.16,,,,,,,763.20,822.56,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,outpatient,,,848.00000,457.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,780.16,,,,,,,220.48,822.56,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,inpatient,,,1071.00000,578.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,985.32,,,,,,,963.90,1038.87,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,outpatient,,,1071.00000,578.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,985.32,,,,,,,278.46,1038.87,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,inpatient,,,1792.00000,967.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1648.64,,,,,,,1612.80,1738.24,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,outpatient,,,1792.00000,967.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1648.64,,,,,,,465.92,1738.24,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,inpatient,,,35.00000,18.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32.20,,,,,,,31.50,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,outpatient,,,35.00000,18.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32.20,,,,,,,9.10,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,inpatient,,,285.00000,153.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,262.20,,,,,,,256.50,276.45,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,outpatient,,,285.00000,153.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,262.20,,,,,,,74.10,276.45,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,inpatient,,,1012.00000,546.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,931.04,,,,,,,910.80,981.64,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,outpatient,,,1012.00000,546.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,931.04,,,,,,,263.12,981.64,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,inpatient,,,492.00000,265.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,452.64,,,,,,,442.80,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,outpatient,,,492.00000,265.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,452.64,,,,,,,127.92,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,inpatient,,,739.00000,399.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,679.88,,,,,,,665.10,716.83,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,outpatient,,,739.00000,399.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,679.88,,,,,,,192.14,716.83,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,inpatient,,,515.00000,278.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,473.80,,,,,,,463.50,499.55,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,outpatient,,,515.00000,278.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,473.80,,,,,,,133.90,499.55,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,inpatient,,,1467.00000,792.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1349.64,,,,,,,1320.30,1422.99,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,outpatient,,,1467.00000,792.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1349.64,,,,,,,381.42,1422.99,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,inpatient,,,1683.00000,888.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1548.36,,,,,,,1514.70,1632.51,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,outpatient,,,1683.00000,888.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1548.36,,,,,,,437.58,1632.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,inpatient,,,426.30000,225.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,392.20,,,,,,,383.67,413.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,426.30000,225.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,392.20,,,,,,,110.84,413.51,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,inpatient,,,725.00000,382.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,667.00,,,,,,,652.50,703.25,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,725.00000,382.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,667.00,,,,,,,188.50,1855.42,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,inpatient,,,1852.00000,977.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1703.84,,,,,,,1666.80,1796.44,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,1852.00000,977.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1703.84,,,,,,,481.52,1868.26,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,110.00000,58.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,99.00,106.70,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,110.00000,58.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,101.20,,,,,,,28.60,106.70,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,inpatient,,,98.00000,51.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,88.20,95.06,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,98.00000,51.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,25.48,1662.92,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,inpatient,,,2018.00000,1065.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1856.56,,,,,,,1816.20,1957.46,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,2018.00000,1065.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1856.56,,,,,,,524.68,1957.46,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,inpatient,,,4325.00000,2283.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3979.00,,,,,,,3892.50,4195.25,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,4325.00000,2283.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3979.00,,,,,,,1124.50,4195.25,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,inpatient,,,172.00000,90.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,158.24,,,,,,,154.80,166.84,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,158.24,,,,,,,44.72,166.84,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,inpatient,,,942.00000,497.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,866.64,,,,,,,847.80,913.74,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,942.00000,497.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,866.64,,,,,,,244.92,913.74,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,inpatient,,,413.00000,218.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,379.96,,,,,,,371.70,400.61,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,413.00000,218.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,379.96,,,,,,,107.38,400.61,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,inpatient,,,257.00000,135.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,236.44,,,,,,,231.30,249.29,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,outpatient,,,257.00000,135.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,236.44,,,,,,,66.82,249.29,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,inpatient,,,116.00000,61.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,106.72,,,,,,,104.40,112.52,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,116.00000,61.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,106.72,,,,,,,30.16,112.52,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,inpatient,,,463.20000,244.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,426.14,,,,,,,416.88,449.30,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,463.20000,244.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,426.14,,,,,,,120.43,449.30,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,inpatient,,,804.00000,424.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,739.68,,,,,,,723.60,779.88,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,804.00000,424.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,739.68,,,,,,,209.04,779.88,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,inpatient,,,172.00000,90.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,158.24,,,,,,,154.80,166.84,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,158.24,,,,,,,44.72,166.84,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,inpatient,,,354.30000,187.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,325.96,,,,,,,318.87,343.67,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,354.30000,187.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,325.96,,,,,,,92.12,343.67,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,inpatient,,,277.90000,146.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,255.67,,,,,,,250.11,269.56,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,277.90000,146.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,255.67,,,,,,,72.25,269.56,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,inpatient,,,200.00000,105.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,184.00,,,,,,,180.00,194.00,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,200.00000,105.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,184.00,,,,,,,52.00,194.00,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,inpatient,,,197.00000,63.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,181.24,,,,,,,177.30,191.09,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,outpatient,,,197.00000,63.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,181.24,,,,,,,51.22,191.09,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,inpatient,,,468.00000,151.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,430.56,,,,,,,421.20,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,outpatient,,,468.00000,151.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,430.56,,,,,,,121.68,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,inpatient,,,312.00000,100.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,287.04,,,,,,,280.80,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,287.04,,,,,,,81.12,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,inpatient,,,312.00000,100.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,287.04,,,,,,,280.80,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,287.04,,,,,,,81.12,302.64,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,416.76,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,416.76,,,,,,,117.78,439.41,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,inpatient,,,609.00000,196.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,560.28,,,,,,,548.10,590.73,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,560.28,,,,,,,158.34,590.73,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,inpatient,,,1248.00000,403.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,1148.16,,,,,,,1123.20,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1248.00000,403.10000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,1148.16,,,,,,,324.48,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,inpatient,,,832.00000,268.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,765.44,,,,,,,748.80,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,765.44,,,,,,,216.32,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,inpatient,,,832.00000,268.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,765.44,,,,,,,748.80,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,765.44,,,,,,,216.32,807.04,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,inpatient,,,4235.00000,1367.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,3896.20,,,,,,,3811.50,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,3896.20,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,inpatient,,,4235.00000,1367.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,3896.20,,,,,,,3811.50,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,3896.20,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,inpatient,,,2119.00000,684.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1949.48,,,,,,,1907.10,2055.43,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,outpatient,,,2119.00000,684.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1949.48,,,,,,,550.94,2055.43,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,inpatient,,,1943.00000,627.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1787.56,,,,,,,1748.70,1884.71,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1943.00000,627.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1787.56,,,,,,,505.18,1884.71,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,inpatient,,,1426.00000,460.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1311.92,,,,,,,1283.40,1383.22,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,outpatient,,,1426.00000,460.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1311.92,,,,,,,370.76,1383.22,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,inpatient,,,4202.00000,1357.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,3865.84,,,,,,,3781.80,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,outpatient,,,4202.00000,1357.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,3865.84,,,,,,,1092.52,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,inpatient,,,2801.00000,904.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2576.92,,,,,,,2520.90,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,2576.92,,,,,,,728.26,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,inpatient,,,2801.00000,904.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2576.92,,,,,,,2520.90,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,2576.92,,,,,,,728.26,2716.97,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,inpatient,,,832.00000,268.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,765.44,,,,,,,748.80,807.04,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,outpatient,,,832.00000,268.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,765.44,,,,,,,216.32,807.04,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,inpatient,,,1457.00000,470.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1340.44,,,,,,,1311.30,1413.29,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,outpatient,,,1457.00000,470.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1340.44,,,,,,,378.82,1413.29,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,inpatient,,,743.00000,239.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,683.56,,,,,,,668.70,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,683.56,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,inpatient,,,743.00000,239.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,683.56,,,,,,,668.70,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,683.56,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,inpatient,,,232.00000,74.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,213.44,,,,,,,208.80,225.04,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,outpatient,,,232.00000,74.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,213.44,,,,,,,60.32,225.04,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,inpatient,,,1364.00000,440.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,1254.88,,,,,,,1227.60,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,outpatient,,,1364.00000,440.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,1254.88,,,,,,,354.64,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,inpatient,,,909.00000,293.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,836.28,,,,,,,818.10,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,836.28,,,,,,,236.34,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,inpatient,,,909.00000,293.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,836.28,,,,,,,818.10,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,836.28,,,,,,,236.34,881.73,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,inpatient,,,510.00000,355.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,469.20,,,,,,,459.00,494.70,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,outpatient,,,510.00000,355.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,469.20,,,,,,,132.60,494.70,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,inpatient,,,1001.00000,698.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,920.92,,,,,,,900.90,970.97,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,outpatient,,,1001.00000,698.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,920.92,,,,,,,260.26,970.97,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,inpatient,,,887.00000,619.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,816.04,,,,,,,798.30,860.39,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,outpatient,,,887.00000,619.13000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,816.04,,,,,,,230.62,860.39,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,inpatient,,,1022.00000,713.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,940.24,,,,,,,919.80,991.34,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,outpatient,,,1022.00000,713.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,940.24,,,,,,,265.72,991.34,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,inpatient,,,681.00000,475.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,626.52,,,,,,,612.90,660.57,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,626.52,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,inpatient,,,681.00000,475.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,626.52,,,,,,,612.90,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,626.52,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,inpatient,,,945.00000,659.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,869.40,,,,,,,850.50,916.65,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,outpatient,,,945.00000,659.61000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,869.40,,,,,,,245.70,916.65,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,inpatient,,,630.00000,439.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,579.60,,,,,,,567.00,611.10,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,579.60,,,,,,,163.80,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,inpatient,,,630.00000,439.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,579.60,,,,,,,567.00,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,579.60,,,,,,,163.80,611.10,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,inpatient,,,577.00000,402.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,530.84,,,,,,,519.30,559.69,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,outpatient,,,577.00000,402.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,530.84,,,,,,,150.02,559.69,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,inpatient,,,433.00000,302.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,398.36,,,,,,,389.70,420.01,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,outpatient,,,433.00000,302.23000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,398.36,,,,,,,112.58,420.01,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,inpatient,,,331.00000,231.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,304.52,,,,,,,297.90,321.07,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,outpatient,,,331.00000,231.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,304.52,,,,,,,86.06,321.07,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,inpatient,,,662.00000,462.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,609.04,,,,,,,595.80,642.14,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,outpatient,,,662.00000,462.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,609.04,,,,,,,172.12,642.14,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,inpatient,,,752.00000,524.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,691.84,,,,,,,676.80,729.44,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,outpatient,,,752.00000,524.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,691.84,,,,,,,195.52,729.44,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,inpatient,,,182.00000,127.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,167.44,,,,,,,163.80,176.54,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,167.44,,,,,,,47.32,176.54,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,inpatient,,,420.00000,293.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,386.40,,,,,,,378.00,407.40,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,outpatient,,,420.00000,293.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,386.40,,,,,,,109.20,407.40,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,inpatient,,,253.00000,176.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,232.76,,,,,,,227.70,245.41,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,outpatient,,,253.00000,176.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,232.76,,,,,,,65.78,245.41,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,inpatient,,,168.00000,117.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,154.56,,,,,,,151.20,162.96,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,outpatient,,,168.00000,117.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,154.56,,,,,,,43.68,162.96,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,inpatient,,,695.00000,485.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,639.40,,,,,,,625.50,674.15,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,outpatient,,,695.00000,485.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,639.40,,,,,,,180.70,674.15,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,inpatient,,,474.00000,330.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,436.08,,,,,,,426.60,459.78,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,outpatient,,,474.00000,330.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,436.08,,,,,,,123.24,459.78,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,inpatient,,,930.00000,649.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,855.60,,,,,,,837.00,902.10,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,outpatient,,,930.00000,649.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,855.60,,,,,,,241.80,902.10,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,inpatient,,,786.00000,548.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,723.12,,,,,,,707.40,762.42,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,outpatient,,,786.00000,548.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,723.12,,,,,,,204.36,762.42,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,inpatient,,,620.00000,432.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,570.40,,,,,,,558.00,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,570.40,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,inpatient,,,620.00000,432.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,59,570.40,,,,,,,558.00,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,59,570.40,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,inpatient,,,435.00000,303.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,400.20,,,,,,,391.50,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,400.20,,,,,,,113.10,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,inpatient,,,435.00000,303.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,59,400.20,,,,,,,391.50,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,59,400.20,,,,,,,113.10,421.95,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,inpatient,,,492.00000,343.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,452.64,,,,,,,442.80,477.24,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,outpatient,,,492.00000,343.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,452.64,,,,,,,127.92,477.24,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,inpatient,,,331.00000,231.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,304.52,,,,,,,297.90,321.07,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,outpatient,,,331.00000,231.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,304.52,,,,,,,86.06,321.07,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,inpatient,,,875.00000,610.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,805.00,,,,,,,787.50,848.75,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,outpatient,,,875.00000,610.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,805.00,,,,,,,227.50,848.75,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,inpatient,,,688.00000,480.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,632.96,,,,,,,619.20,667.36,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,outpatient,,,688.00000,480.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,632.96,,,,,,,178.88,667.36,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,inpatient,,,465.00000,324.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,427.80,,,,,,,418.50,451.05,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,outpatient,,,465.00000,324.57000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,427.80,,,,,,,120.90,451.05,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,inpatient,,,846.00000,590.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,778.32,,,,,,,761.40,820.62,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,outpatient,,,846.00000,590.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,778.32,,,,,,,219.96,820.62,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,inpatient,,,482.00000,336.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,443.44,,,,,,,433.80,467.54,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,outpatient,,,482.00000,336.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,443.44,,,,,,,125.32,467.54,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,inpatient,,,926.00000,646.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,851.92,,,,,,,833.40,898.22,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,outpatient,,,926.00000,646.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,851.92,,,,,,,240.76,898.22,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,inpatient,,,292.00000,203.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,268.64,,,,,,,262.80,283.24,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,outpatient,,,292.00000,203.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,268.64,,,,,,,75.92,283.24,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,inpatient,,,827.00000,577.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,760.84,,,,,,,744.30,802.19,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,outpatient,,,827.00000,577.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,760.84,,,,,,,215.02,802.19,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,inpatient,,,253.00000,176.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,232.76,,,,,,,227.70,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,outpatient,,,253.00000,176.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,232.76,,,,,,,65.78,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,inpatient,,,901.00000,628.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,828.92,,,,,,,810.90,873.97,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,outpatient,,,901.00000,628.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,828.92,,,,,,,234.26,873.97,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,inpatient,,,460.00000,321.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,423.20,,,,,,,414.00,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,outpatient,,,460.00000,321.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,423.20,,,,,,,119.60,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,inpatient,,,1029.00000,718.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,946.68,,,,,,,926.10,998.13,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1029.00000,718.24000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,946.68,,,,,,,267.54,998.13,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,inpatient,,,959.00000,669.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,882.28,,,,,,,863.10,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,outpatient,,,959.00000,669.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,882.28,,,,,,,249.34,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,inpatient,,,558.00000,389.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,513.36,,,,,,,502.20,541.26,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,outpatient,,,558.00000,389.48000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,513.36,,,,,,,145.08,541.26,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,inpatient,,,705.00000,492.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,648.60,,,,,,,634.50,683.85,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,outpatient,,,705.00000,492.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,648.60,,,,,,,183.30,683.85,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,inpatient,,,249.00000,173.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,229.08,,,,,,,224.10,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,outpatient,,,249.00000,173.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,229.08,,,,,,,64.74,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,inpatient,,,427.00000,298.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,392.84,,,,,,,384.30,414.19,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,outpatient,,,427.00000,298.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,392.84,,,,,,,111.02,414.19,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,inpatient,,,737.00000,514.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,678.04,,,,,,,663.30,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,678.04,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,inpatient,,,737.00000,514.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,59,678.04,,,,,,,663.30,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,59,678.04,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,inpatient,,,809.00000,564.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,744.28,,,,,,,728.10,784.73,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,outpatient,,,809.00000,564.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,744.28,,,,,,,210.34,784.73,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,inpatient,,,525.00000,366.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,483.00,,,,,,,472.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,outpatient,,,525.00000,366.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,483.00,,,,,,,136.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,inpatient,,,319.00000,222.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,293.48,,,,,,,287.10,309.43,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,outpatient,,,319.00000,222.66000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,293.48,,,,,,,82.94,309.43,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,inpatient,,,1437.00000,678.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1322.04,,,,,,,1293.30,1393.89,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1437.00000,678.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1322.04,,,,,,,373.62,1393.89,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,inpatient,,,2143.00000,1011.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1971.56,,,,,,,1928.70,2078.71,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2143.00000,1011.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1971.56,,,,,,,557.18,2078.71,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,inpatient,,,755.00000,356.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,694.60,,,,,,,679.50,732.35,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,outpatient,,,755.00000,356.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,694.60,,,,,,,196.30,732.35,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,inpatient,,,979.00000,462.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,900.68,,,,,,,881.10,949.63,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,outpatient,,,979.00000,462.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,900.68,,,,,,,254.54,949.63,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,inpatient,,,436.00000,205.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,401.12,,,,,,,392.40,422.92,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,outpatient,,,436.00000,205.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,401.12,,,,,,,113.36,422.92,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,inpatient,,,220.00000,103.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,202.40,,,,,,,198.00,213.40,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,outpatient,,,220.00000,103.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,202.40,,,,,,,57.20,213.40,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,inpatient,,,344.00000,162.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,316.48,,,,,,,309.60,333.68,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,outpatient,,,344.00000,162.37000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,316.48,,,,,,,89.44,333.68,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,inpatient,,,818.00000,393.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,752.56,,,,,,,736.20,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,outpatient,,,818.00000,393.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,752.56,,,,,,,212.68,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,inpatient,,,545.00000,262.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,52,501.40,,,,,,,490.50,528.65,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,outpatient,,,545.00000,262.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,52,501.40,,,,,,,141.70,528.65,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,inpatient,,,1347.00000,647.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1239.24,,,,,,,1212.30,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,outpatient,,,1347.00000,647.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1239.24,,,,,,,350.22,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,inpatient,,,898.00000,431.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,52,826.16,,,,,,,808.20,871.06,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,outpatient,,,898.00000,431.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,52,826.16,,,,,,,233.48,871.06,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,inpatient,,,469.00000,225.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,431.48,,,,,,,422.10,454.93,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,outpatient,,,469.00000,225.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,431.48,,,,,,,121.94,454.93,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,inpatient,,,1762.00000,847.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1621.04,,,,,,,1585.80,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,outpatient,,,1762.00000,847.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1621.04,,,,,,,458.12,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,inpatient,,,627.00000,301.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,576.84,,,,,,,564.30,608.19,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,outpatient,,,627.00000,301.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,576.84,,,,,,,163.02,608.19,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,inpatient,,,590.00000,283.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,542.80,,,,,,,531.00,572.30,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,outpatient,,,590.00000,283.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,542.80,,,,,,,153.40,572.30,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,inpatient,,,1550.00000,745.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1426.00,,,,,,,1395.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,outpatient,,,1550.00000,745.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1426.00,,,,,,,403.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,inpatient,,,990.00000,476.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,910.80,,,,,,,891.00,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,910.80,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,inpatient,,,990.00000,476.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,910.80,,,,,,,891.00,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,910.80,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,inpatient,,,1402.00000,674.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1289.84,,,,,,,1261.80,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,outpatient,,,1402.00000,674.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1289.84,,,,,,,364.52,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,inpatient,,,980.00000,471.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,901.60,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,901.60,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,inpatient,,,980.00000,471.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,901.60,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,901.60,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,inpatient,,,1661.00000,798.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1528.12,,,,,,,1494.90,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,outpatient,,,1661.00000,798.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1528.12,,,,,,,431.86,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,inpatient,,,980.00000,471.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,901.60,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,outpatient,,,980.00000,471.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,901.60,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,inpatient,,,1740.00000,836.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1600.80,,,,,,,1566.00,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1740.00000,836.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1600.80,,,,,,,452.40,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,inpatient,,,1168.00000,561.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1074.56,,,,,,,1051.20,1132.96,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1168.00000,561.81000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1074.56,,,,,,,303.68,1132.96,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,inpatient,,,433.00000,232.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,398.36,,,,,,,389.70,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,outpatient,,,433.00000,232.09000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,398.36,,,,,,,112.58,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,inpatient,,,388.00000,207.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,356.96,,,,,,,349.20,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,356.96,,,,,,,100.88,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,inpatient,,,388.00000,207.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,356.96,,,,,,,349.20,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,356.96,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,inpatient,,,388.00000,207.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,356.96,,,,,,,349.20,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,outpatient,,,388.00000,207.97000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,356.96,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,inpatient,,,604.00000,323.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,555.68,,,,,,,543.60,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,outpatient,,,604.00000,323.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,555.68,,,,,,,157.04,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,inpatient,,,667.00000,357.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,613.64,,,,,,,600.30,646.99,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,outpatient,,,667.00000,357.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,613.64,,,,,,,173.42,646.99,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,inpatient,,,176.00000,94.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,161.92,,,,,,,158.40,170.72,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,outpatient,,,176.00000,94.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,161.92,,,,,,,45.76,170.72,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,inpatient,,,92.00000,29.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,84.64,,,,,,,82.80,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,84.64,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,inpatient,,,92.00000,29.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,84.64,,,,,,,82.80,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,84.64,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,inpatient,,,366.00000,118.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,336.72,,,,,,,329.40,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,336.72,,,,,,,95.16,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,inpatient,,,366.00000,118.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,336.72,,,,,,,329.40,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,336.72,,,,,,,95.16,355.02,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,inpatient,,,1117.00000,360.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1027.64,,,,,,,1005.30,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1027.64,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,inpatient,,,1117.00000,360.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1027.64,,,,,,,1005.30,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1027.64,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,inpatient,,,559.00000,180.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,514.28,,,,,,,503.10,542.23,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,outpatient,,,559.00000,180.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,514.28,,,,,,,145.34,542.23,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,inpatient,,,252.00000,81.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,231.84,,,,,,,226.80,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,outpatient,,,252.00000,81.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,50,231.84,,,,,,,65.52,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,inpatient,,,168.00000,54.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,154.56,,,,,,,151.20,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,154.56,,,,,,,43.68,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,inpatient,,,168.00000,54.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,154.56,,,,,,,151.20,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,154.56,,,,,,,43.68,162.96,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,inpatient,,,1148.00000,370.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1056.16,,,,,,,1033.20,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,1056.16,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,inpatient,,,1148.00000,370.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1056.16,,,,,,,1033.20,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,1056.16,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,inpatient,,,379.00000,122.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,348.68,,,,,,,341.10,367.63,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,outpatient,,,379.00000,122.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,348.68,,,,,,,98.54,367.63,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,inpatient,,,1015.00000,327.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,933.80,,,,,,,913.50,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,outpatient,,,1015.00000,327.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,933.80,,,,,,,263.90,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,inpatient,,,591.00000,190.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,543.72,,,,,,,531.90,573.27,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,outpatient,,,591.00000,190.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,543.72,,,,,,,153.66,573.27,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,inpatient,,,271.00000,169.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,249.32,,,,,,,243.90,262.87,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,outpatient,,,271.00000,169.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,249.32,,,,,,,70.46,262.87,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,inpatient,,,211.00000,132.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,194.12,,,,,,,189.90,204.67,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,LT,194.12,,,,,,,54.86,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,inpatient,,,211.00000,132.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,194.12,,,,,,,189.90,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,RT,194.12,,,,,,,54.86,204.67,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,59.00000,36.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,53.10,57.23,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,59.00000,36.99000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,54.28,,,,,,,15.34,57.23,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,inpatient,,,336.00000,219.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,309.12,,,,,,,302.40,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,outpatient,,,336.00000,219.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,309.12,,,,,,,87.36,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,inpatient,,,224.00000,146.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,52,206.08,,,,,,,201.60,217.28,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,outpatient,,,224.00000,146.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,52,206.08,,,,,,,58.24,217.28,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,inpatient,,,63.00000,41.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,56.70,61.11,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,outpatient,,,63.00000,41.20000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,57.96,,,,,,,16.38,61.11,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,463.68,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,463.68,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,559.36,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,559.36,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,196.88,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,196.88,,,,,,,55.64,207.58,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,inpatient,,,609.00000,196.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,560.28,,,,,,,548.10,590.73,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,560.28,,,,,,,158.34,590.73,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,inpatient,,,863.00000,278.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,793.96,,,,,,,776.70,837.11,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,793.96,,,,,,,224.38,837.11,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,inpatient,,,900.00000,605.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,828.00,,,,,,,810.00,873.00,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,outpatient,,,900.00000,605.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,828.00,,,,,,,234.00,873.00,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,inpatient,,,1940.00000,1102.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1784.80,,,,,,,1746.00,1881.80,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,outpatient,,,1940.00000,1102.21000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1784.80,,,,,,,504.40,1881.80,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,inpatient,,,422.00000,239.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,388.24,,,,,,,379.80,409.34,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,outpatient,,,422.00000,239.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,388.24,,,,,,,109.72,409.34,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,inpatient,,,1430.00000,812.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1315.60,,,,,,,1287.00,1387.10,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,outpatient,,,1430.00000,812.45000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1315.60,,,,,,,371.80,1387.10,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,inpatient,,,745.00000,423.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,685.40,,,,,,,670.50,722.65,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,outpatient,,,745.00000,423.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,685.40,,,,,,,193.70,722.65,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,inpatient,,,2655.00000,2487.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2442.60,,,,,,,2389.50,2575.35,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,outpatient,,,2655.00000,2487.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2442.60,,,,,,,690.30,2575.35,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,inpatient,,,3990.00000,3738.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3670.80,,,,,,,3591.00,3870.30,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,outpatient,,,3990.00000,3738.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3670.80,,,,,,,1037.40,3870.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,inpatient,,,290.00000,271.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,266.80,,,,,,,261.00,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,outpatient,,,290.00000,271.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,266.80,,,,,,,75.40,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,inpatient,,,735.00000,688.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,676.20,,,,,,,661.50,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,outpatient,,,735.00000,688.70000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,676.20,,,,,,,191.10,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,inpatient,,,1475.00000,1382.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1357.00,,,,,,,1327.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1357.00,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,inpatient,,,2275.00000,2131.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2093.00,,,,,,,2047.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,outpatient,,,2275.00000,2131.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2093.00,,,,,,,591.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,inpatient,,,3205.00000,3003.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2948.60,,,,,,,2884.50,3108.85,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,outpatient,,,3205.00000,3003.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2948.60,,,,,,,833.30,3108.85,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,inpatient,,,770.00000,721.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,708.40,,,,,,,693.00,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,outpatient,,,770.00000,721.49000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,708.40,,,,,,,200.20,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,inpatient,,,1475.00000,1382.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1357.00,,,,,,,1327.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1357.00,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,inpatient,,,2210.00000,2070.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2033.20,,,,,,,1989.00,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,outpatient,,,2210.00000,2070.77000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2033.20,,,,,,,574.60,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,inpatient,,,2660.00000,2492.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2447.20,,,,,,,2394.00,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,outpatient,,,2660.00000,2492.42000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2447.20,,,,,,,691.60,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,inpatient,,,3560.00000,3335.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3275.20,,,,,,,3204.00,3453.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,outpatient,,,3560.00000,3335.72000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3275.20,,,,,,,925.60,3453.20,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,inpatient,,,5730.00000,3255.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5271.60,,,,,,,5157.00,5558.10,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,outpatient,,,5730.00000,3255.50000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5271.60,,,,,,,1489.80,5558.10,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,inpatient,,,3875.00000,2201.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3565.00,,,,,,,3487.50,3758.75,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,outpatient,,,3875.00000,2201.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,3565.00,,,,,,,1007.50,3758.75,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,inpatient,,,519.00000,564.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,477.48,,,,,,,467.10,503.43,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,outpatient,,,519.00000,564.15000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,477.48,,,,,,,134.94,503.43,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,inpatient,,,536.00000,582.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,493.12,,,,,,,482.40,519.92,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,outpatient,,,536.00000,582.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,493.12,,,,,,,139.36,519.92,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,416.76,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,416.76,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,132.48,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,132.48,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,98.44,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,98.44,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,132.48,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,132.48,,,,,,,37.44,139.68,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,463.68,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,463.68,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,90.16,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,559.36,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,559.36,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,104.88,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,172.04,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,196.88,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,196.88,,,,,,,55.64,207.58,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,inpatient,,,175.00000,63.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,161.00,,,,,,,157.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,outpatient,,,175.00000,63.18000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,161.00,,,,,,,45.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,inpatient,,,304.00000,109.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,279.68,,,,,,,273.60,294.88,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,outpatient,,,304.00000,109.74000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,279.68,,,,,,,79.04,294.88,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,261.28,,,,,,,255.60,275.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,261.28,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,421.36,,,,,,,412.20,444.26,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,421.36,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,inpatient,,,438.00000,158.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,402.96,,,,,,,394.20,424.86,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,outpatient,,,438.00000,158.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,402.96,,,,,,,113.88,424.86,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,513.36,,,,,,,502.20,541.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,513.36,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,443.44,,,,,,,433.80,467.54,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,443.44,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,218.04,,,,,,,213.30,229.89,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,218.04,,,,,,,61.62,229.89,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,463.68,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,463.68,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,463.68,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,463.68,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,463.68,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,463.68,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,463.68,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,463.68,,,,,,,131.04,488.88,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,774.64,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,774.64,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,968.76,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,968.76,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1161.96,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1161.96,,,,,,,328.38,1225.11,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,inpatient,,,182.00000,127.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,167.44,,,,,,,163.80,176.54,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,167.44,,,,,,,47.32,176.54,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,inpatient,,,210.00000,119.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,193.20,,,,,,,189.00,203.70,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,193.20,,,,,,,54.60,203.70,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,inpatient,,,140.00000,79.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,128.80,,,,,,,126.00,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,outpatient,,,140.00000,79.54000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,128.80,,,,,,,36.40,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,inpatient,,,190.00000,107.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,174.80,,,,,,,171.00,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,outpatient,,,190.00000,107.95000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,174.80,,,,,,,49.40,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,inpatient,,,240.00000,136.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,220.80,,,,,,,216.00,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,outpatient,,,240.00000,136.36000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,220.80,,,,,,,62.40,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,inpatient,,,290.00000,164.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,266.80,,,,,,,261.00,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,outpatient,,,290.00000,164.76000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,266.80,,,,,,,75.40,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,inpatient,,,340.00000,193.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,312.80,,,,,,,306.00,329.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,outpatient,,,340.00000,193.17000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,312.80,,,,,,,88.40,329.80,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,inpatient,,,150.00000,85.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,138.00,,,,,,,135.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,outpatient,,,150.00000,85.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,138.00,,,,,,,39.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,inpatient,,,200.00000,113.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,184.00,,,,,,,180.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,outpatient,,,200.00000,113.63000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,184.00,,,,,,,52.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,inpatient,,,270.00000,153.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,248.40,,,,,,,243.00,261.90,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,outpatient,,,270.00000,153.40000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,248.40,,,,,,,70.20,261.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,inpatient,,,370.00000,210.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,340.40,,,,,,,333.00,358.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,outpatient,,,370.00000,210.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,340.40,,,,,,,96.20,358.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,inpatient,,,470.00000,267.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,432.40,,,,,,,423.00,455.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,outpatient,,,470.00000,267.03000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,432.40,,,,,,,122.20,455.90,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,inpatient,,,248.00000,96.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,228.16,,,,,,,223.20,240.56,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,outpatient,,,248.00000,96.22000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,228.16,,,,,,,64.48,240.56,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,inpatient,,,245.00000,95.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,225.40,,,,,,,220.50,237.65,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,outpatient,,,245.00000,95.06000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,225.40,,,,,,,63.70,237.65,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,inpatient,,,497.00000,192.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,457.24,,,,,,,447.30,482.09,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,outpatient,,,497.00000,192.84000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,457.24,,,,,,,129.22,482.09,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,inpatient,,,357.00000,138.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,328.44,,,,,,,321.30,346.29,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,outpatient,,,357.00000,138.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,328.44,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,inpatient,,,334.00000,129.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,307.28,,,,,,,300.60,323.98,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,outpatient,,,334.00000,129.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,307.28,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,inpatient,,,194.00000,75.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,178.48,,,,,,,174.60,188.18,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,outpatient,,,194.00000,75.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,178.48,,,,,,,50.44,188.18,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,inpatient,,,1035.00000,401.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,952.20,,,,,,,931.50,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,outpatient,,,1035.00000,401.58000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,952.20,,,,,,,269.10,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,inpatient,,,1137.00000,441.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1046.04,,,,,,,1023.30,1102.89,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,outpatient,,,1137.00000,441.16000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,1046.04,,,,,,,295.62,1102.89,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,inpatient,,,963.00000,373.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,885.96,,,,,,,866.70,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,outpatient,,,963.00000,373.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,885.96,,,,,,,250.38,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,inpatient,,,990.00000,384.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,910.80,,,,,,,891.00,960.30,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,outpatient,,,990.00000,384.12000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,910.80,,,,,,,257.40,960.30,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,inpatient,,,112.00000,43.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,103.04,,,,,,,100.80,108.64,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,outpatient,,,112.00000,43.46000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,103.04,,,,,,,29.12,108.64,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,inpatient,,,84.00000,32.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,77.28,,,,,,,75.60,81.48,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,outpatient,,,84.00000,32.59000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,77.28,,,,,,,21.84,81.48,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,inpatient,,,176.00000,68.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,161.92,,,,,,,158.40,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,outpatient,,,176.00000,68.29000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,161.92,,,,,,,45.76,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,inpatient,,,283.00000,109.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,260.36,,,,,,,254.70,274.51,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,outpatient,,,283.00000,109.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,260.36,,,,,,,73.58,274.51,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,72.90,78.57,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,74.52,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,37.72,,,,,,,36.90,39.77,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,37.72,,,,,,,10.66,39.77,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,inpatient,,,35.00000,19.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32.20,,,,,,,31.50,33.95,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,35.00000,19.89000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,32.20,,,,,,,9.10,33.95,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,inpatient,,,191.00000,89.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,175.72,,,,,,,171.90,185.27,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,outpatient,,,191.00000,89.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,175.72,,,,,,,49.66,185.27,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,416.76,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,416.76,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,132.48,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,132.48,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,98.44,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,98.44,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,132.48,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,132.48,,,,,,,37.44,139.68,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,inpatient,,,281.00000,131.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,258.52,,,,,,,252.90,272.57,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,outpatient,,,281.00000,131.51000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,258.52,,,,,,,73.06,272.57,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,inpatient,,,192.00000,89.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,176.64,,,,,,,172.80,186.24,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,outpatient,,,192.00000,89.86000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,176.64,,,,,,,49.92,186.24,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,inpatient,,,365.00000,170.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,335.80,,,,,,,328.50,354.05,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,outpatient,,,365.00000,170.82000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,335.80,,,,,,,94.90,354.05,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,inpatient,,,8391.00000,5856.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7719.72,,,,,,,7551.90,8139.27,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,outpatient,,,8391.00000,5856.92000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,7719.72,,,,,,,2181.66,8139.27,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,inpatient,,,6917.00000,4828.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,52,6363.64,,,,,,,6225.30,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,52,6363.64,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,inpatient,,,6000.00000,4188.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5520.00,,,,,,,5400.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5520.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,inpatient,,,6917.00000,4828.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6363.64,,,,,,,6225.30,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6363.64,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,inpatient,,,6000.00000,4188.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,52,5520.00,,,,,,,5400.00,5820.00,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,52,5520.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,inpatient,,,8855.00000,9625.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8146.60,,,,,,,7969.50,8589.35,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,outpatient,,,8855.00000,9625.38000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,8146.60,,,,,,,2302.30,8589.35,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,inpatient,,,844.00000,917.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,776.48,,,,,,,759.60,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,776.48,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,inpatient,,,844.00000,917.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,52,776.48,,,,,,,759.60,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,52,776.48,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,inpatient,,,785.00000,853.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,722.20,,,,,,,706.50,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,722.20,,,,,,,204.10,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,inpatient,,,785.00000,853.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,52,722.20,,,,,,,706.50,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,52,722.20,,,,,,,204.10,761.45,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4709.00000,5118.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4332.28,,,,,,,4238.10,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,4332.28,,,,,,,1224.34,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4709.00000,5118.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,52,4332.28,,,,,,,4238.10,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,52,4332.28,,,,,,,1224.34,4567.73,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,inpatient,,,345.00000,128.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,317.40,,,,,,,310.50,334.65,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,outpatient,,,345.00000,128.34000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,317.40,,,,,,,89.70,334.65,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,inpatient,,,120.00000,99.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,110.40,,,,,,,108.00,116.40,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,outpatient,,,120.00000,99.60000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,110.40,,,,,,,31.20,116.40,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,inpatient,,,106.00000,87.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,95.40,102.82,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,outpatient,,,106.00000,87.98000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,97.52,,,,,,,27.56,102.82,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,inpatient,,,32.00000,26.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,29.44,,,,,,,28.80,31.04,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,outpatient,,,32.00000,26.56000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,29.44,,,,,,,8.32,31.04,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,inpatient,,,60.00000,49.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,54.00,58.20,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,outpatient,,,60.00000,49.80000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,55.20,,,,,,,15.60,58.20,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,inpatient,,,57.00000,47.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,51.30,55.29,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,outpatient,,,57.00000,47.31000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,52.44,,,,,,,14.82,55.29,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,inpatient,1.0,ME,7.40000,0.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6.81,,,,,,,6.66,7.18,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,outpatient,1.0,ME,7.40000,0.65000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,6.81,,,,,,,1.92,7.18,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,inpatient,1.0,EA,6.60000,1.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,6.07,,,,,,,5.94,6.40,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,outpatient,1.0,EA,6.60000,1.43000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,6.07,,,,,,,1.72,6.40,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,inpatient,1.0,EA,2.95000,0.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,2.71,,,,,,,2.65,2.86,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,outpatient,1.0,EA,2.95000,0.64000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,2.71,,,,,,,0.76700,2.86,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,inpatient,1.0,EA,56.08000,12.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,51.59,,,,,,,50.47,54.40,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,56.08000,12.11000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,51.59,,,,,,,14.58,54.40,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,inpatient,1.0,UN,82.10000,28.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,75.53,,,,,,,73.89,79.64,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,outpatient,1.0,UN,82.10000,28.90000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,75.53,,,,,,,15.48,79.64,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.04000,,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,0.03680,,,,,,,0.03600,0.03880,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.04000,,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,0.03680,,,,,,,0.01040,0.03880,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.05000,,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,0.04600,,,,,,,0.04500,0.04850,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.05000,,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,0.04600,,,,,,,0.01300,0.04850,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,inpatient,1.0,ME,6.20000,0.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5.70,,,,,,,5.58,6.01,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,outpatient,1.0,ME,6.20000,0.55000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5.70,,,,,,,1.61,6.01,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.12000,0.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,0.11040,,,,,,,0.10800,0.11640,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.12000,0.01000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,0.11040,,,,,,,0.03120,0.11640,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,inpatient,2.0,ML,5.80000,1.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5.34,,,,,,,5.22,5.63,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,outpatient,2.0,ML,5.80000,1.25000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,5.34,,,,,,,1.51,5.63,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,inpatient,1.0,ME,3.10000,0.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2.85,,,,,,,2.79,3.01,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,outpatient,1.0,ME,3.10000,0.27000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,2.85,,,,,,,0.80600,3.01,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,inpatient,1.0,EA,44.40000,3.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40.85,,,,,,,39.96,43.07,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,outpatient,1.0,EA,44.40000,3.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,40.85,,,,,,,11.54,43.07,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,inpatient,1.0,EA,8.26000,0.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,7.60,,,,,,,7.43,8.01,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,8.26000,0.73000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,7.60,,,,,,,2.15,8.01,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,2.19000,0.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,2.01,,,,,,,1.97,2.12,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,2.19000,0.19000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,2.01,,,,,,,0.56940,2.12,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,inpatient,1.0,EA,28.60000,2.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26.31,,,,,,,25.74,27.74,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,outpatient,1.0,EA,28.60000,2.52000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,,26.31,,,,,,,7.44,27.74,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,inpatient,1.0,EA,2.58000,0.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,2.37,,,,,,,2.32,2.50,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,outpatient,1.0,EA,2.58000,0.91000,Anthem Blue Cross Blue Shield Colorado,HMO/Indemnity/PPO/Pathway/Pathway X,UD,2.37,,,,,,,0.67080,2.50,percent of total billed charges,
R&B OBSTETRICS PVT,3012,CDM,112,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Banner Health,Banner Choice Plus/Banner Select,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B MEDICAL/SURGICAL SEMI-PVT,23010,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Banner Health,Banner Choice Plus/Banner Select,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B ICU,33019,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Banner Health,Banner Choice Plus/Banner Select,,2935.00,,,,,,,2512.00,8498.17,per diem,
R&B ICU INTERMEDIATE,13011,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Banner Health,Banner Choice Plus/Banner Select,,2935.00,,,,,,,2512.00,5665.77,per diem,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,244.00000,77.10000,Banner Health,Banner Choice Plus/Banner Select,,85.40,,,,,,,63.44,236.68,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,24075,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Banner Health,Banner Choice Plus/Banner Select,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B OBSTETRICS SEMI-PVT,44073,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Banner Health,Banner Choice Plus/Banner Select,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B NURSERY LEVEL 1,55160,CDM,171,RC,,,,,facility,inpatient,,,3477.00000,1975.46000,Banner Health,Banner Choice Plus/Banner Select,,2935.00,,,,,,,2512.00,3372.69,per diem,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,outpatient,,,16.00000,7.71000,Banner Health,Banner Choice Plus/Banner Select,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Banner Health,Banner Choice Plus/Banner Select,,73.50,,,,,,,54.60,203.70,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,outpatient,,,380.00000,215.90000,Banner Health,Banner Choice Plus/Banner Select,,133.00,,,,,,,98.80,368.60,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Banner Health,Banner Choice Plus/Banner Select,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22012,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Banner Health,Banner Choice Plus/Banner Select,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B ADMIN DAY SKILLED,82016,CDM,160,RC,,,,,facility,inpatient,,,1923.00000,1092.55000,Banner Health,Banner Choice Plus/Banner Select,,2935.00,,,,,,,1730.70,3111.10,per diem,
R&B SWING BED SKILLED,62018,CDM,160,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Banner Health,Banner Choice Plus/Banner Select,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B ADMIN DAY INTERMEDIATE,72017,CDM,169,RC,,,,,facility,inpatient,,,1176.00000,668.14000,Banner Health,Banner Choice Plus/Banner Select,,2935.00,,,,,,,1058.40,3111.10,per diem,
R&B ICU,32011,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Banner Health,Banner Choice Plus/Banner Select,,2935.00,,,,,,,2512.00,8498.17,per diem,
R&B ICU INTERMEDIATE,12013,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Banner Health,Banner Choice Plus/Banner Select,,2935.00,,,,,,,2512.00,5665.77,per diem,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Banner Health,Banner Choice Plus/Banner Select,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Banner Health,Banner Choice Plus/Banner Select,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Banner Health,Banner Choice Plus/Banner Select,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Banner Health,Banner Choice Plus/Banner Select,,212.80,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Banner Health,Banner Choice Plus/Banner Select,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Banner Health,Banner Choice Plus/Banner Select,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Banner Health,Banner Choice Plus/Banner Select,,74.90,,,,,,,55.64,207.58,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Banner Health,Banner Choice Plus/Banner Select,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Banner Health,Banner Choice Plus/Banner Select,,99.40,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Banner Health,Banner Choice Plus/Banner Select,,160.30,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Banner Health,Banner Choice Plus/Banner Select,,195.30,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Banner Health,Banner Choice Plus/Banner Select,,168.70,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Banner Health,Banner Choice Plus/Banner Select,,82.95,,,,,,,61.62,229.89,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,outpatient,,,2041.00000,659.24000,Banner Health,Banner Choice Plus/Banner Select,,714.35,,,,,,,530.66,1979.77,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,outpatient,,,259.00000,83.66000,Banner Health,Banner Choice Plus/Banner Select,,90.65,,,,,,,67.34,251.23,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,outpatient,,,672.00000,217.06000,Banner Health,Banner Choice Plus/Banner Select,,235.20,,,,,,,174.72,651.84,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,outpatient,,,530.00000,171.19000,Banner Health,Banner Choice Plus/Banner Select,,185.50,,,,,,,137.80,514.10,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,outpatient,,,580.00000,187.34000,Banner Health,Banner Choice Plus/Banner Select,,203.00,,,,,,,150.80,562.60,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,outpatient,,,435.00000,140.50000,Banner Health,Banner Choice Plus/Banner Select,,152.25,,,,,,,113.10,421.95,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Banner Health,Banner Choice Plus/Banner Select,,302.05,,,,,,,224.38,837.11,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,outpatient,,,334.00000,107.88000,Banner Health,Banner Choice Plus/Banner Select,,116.90,,,,,,,86.84,323.98,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,outpatient,,,1188.00000,383.72000,Banner Health,Banner Choice Plus/Banner Select,50,415.80,,,,,,,308.88,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Banner Health,Banner Choice Plus/Banner Select,LT,277.20,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Banner Health,Banner Choice Plus/Banner Select,RT,277.20,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,outpatient,,,572.00000,184.76000,Banner Health,Banner Choice Plus/Banner Select,50,200.20,,,,,,,148.72,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Banner Health,Banner Choice Plus/Banner Select,LT,133.35,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Banner Health,Banner Choice Plus/Banner Select,RT,133.35,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,outpatient,,,455.00000,146.96000,Banner Health,Banner Choice Plus/Banner Select,,159.25,,,,,,,118.30,441.35,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,outpatient,,,403.00000,130.17000,Banner Health,Banner Choice Plus/Banner Select,,141.05,,,,,,,104.78,390.91,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,outpatient,,,370.00000,119.51000,Banner Health,Banner Choice Plus/Banner Select,,129.50,,,,,,,96.20,358.90,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,outpatient,,,357.00000,115.31000,Banner Health,Banner Choice Plus/Banner Select,,124.95,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,outpatient,,,334.00000,107.88000,Banner Health,Banner Choice Plus/Banner Select,,116.90,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,outpatient,,,194.00000,62.66000,Banner Health,Banner Choice Plus/Banner Select,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,outpatient,,,457.00000,147.61000,Banner Health,Banner Choice Plus/Banner Select,,159.95,,,,,,,118.82,443.29,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,outpatient,,,492.00000,158.92000,Banner Health,Banner Choice Plus/Banner Select,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,outpatient,,,780.00000,251.94000,Banner Health,Banner Choice Plus/Banner Select,,273.00,,,,,,,202.80,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,outpatient,,,1165.00000,376.30000,Banner Health,Banner Choice Plus/Banner Select,,407.75,,,,,,,302.90,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,outpatient,,,2350.00000,759.05000,Banner Health,Banner Choice Plus/Banner Select,,822.50,,,,,,,611.00,2279.50,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,outpatient,,,896.00000,289.41000,Banner Health,Banner Choice Plus/Banner Select,,313.60,,,,,,,232.96,869.12,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,outpatient,,,490.00000,158.27000,Banner Health,Banner Choice Plus/Banner Select,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,outpatient,,,520.00000,167.96000,Banner Health,Banner Choice Plus/Banner Select,,182.00,,,,,,,135.20,504.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,outpatient,,,720.00000,232.56000,Banner Health,Banner Choice Plus/Banner Select,,252.00,,,,,,,187.20,698.40,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,outpatient,,,215.00000,69.45000,Banner Health,Banner Choice Plus/Banner Select,,75.25,,,,,,,55.90,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,outpatient,,,240.00000,77.52000,Banner Health,Banner Choice Plus/Banner Select,,84.00,,,,,,,62.40,232.80,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,outpatient,,,1241.00000,400.84000,Banner Health,Banner Choice Plus/Banner Select,,434.35,,,,,,,322.66,1203.77,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Banner Health,Banner Choice Plus/Banner Select,,294.70,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Banner Health,Banner Choice Plus/Banner Select,,368.55,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Banner Health,Banner Choice Plus/Banner Select,,442.05,,,,,,,328.38,1225.11,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,outpatient,,,668.00000,559.78000,Banner Health,Banner Choice Plus/Banner Select,,233.80,,,,,,,173.68,647.96,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Banner Health,Banner Choice Plus/Banner Select,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Banner Health,Banner Choice Plus/Banner Select,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Banner Health,Banner Choice Plus/Banner Select,,158.55,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Banner Health,Banner Choice Plus/Banner Select,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Banner Health,Banner Choice Plus/Banner Select,,37.45,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Banner Health,Banner Choice Plus/Banner Select,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Banner Health,Banner Choice Plus/Banner Select,,1.19,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Banner Health,Banner Choice Plus/Banner Select,,1.19,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Banner Health,Banner Choice Plus/Banner Select,,1.19,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Banner Health,Banner Choice Plus/Banner Select,,1.72,,,,,,,1.27,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,7.90000,4.49000,Banner Health,Banner Choice Plus/Banner Select,,2.77,,,,,,,2.05,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Banner Health,Banner Choice Plus/Banner Select,,1.72,,,,,,,1.27,4.75,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Banner Health,Banner Choice Plus/Banner Select,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Banner Health,Banner Choice Plus/Banner Select,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Banner Health,Banner Choice Plus/Banner Select,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,outpatient,,,3141500.00000,1784843.22000,Banner Health,Banner Choice Plus/Banner Select,,1099525.00,,,,,,,816790.00,3047255.00,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Banner Health,Banner Choice Plus/Banner Select,UD,0.07700,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.52000,0.30000,Banner Health,Banner Choice Plus/Banner Select,UD,0.18200,,,,,,,0.13520,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.56000,0.32000,Banner Health,Banner Choice Plus/Banner Select,UD,0.19600,,,,,,,0.14560,0.54320,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Banner Health,Banner Choice Plus/Banner Select,UD,0.07700,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.85000,0.48000,Banner Health,Banner Choice Plus/Banner Select,UD,0.29750,,,,,,,0.22100,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Banner Health,Banner Choice Plus/Banner Select,UD,0.07700,,,,,,,0.05720,0.21340,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,outpatient,,,102.00000,65.18000,Banner Health,Banner Choice Plus/Banner Select,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,outpatient,,,190.00000,121.41000,Banner Health,Banner Choice Plus/Banner Select,,66.50,,,,,,,49.40,184.30,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Banner Health,Banner Choice Plus/Banner Select,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Banner Health,Banner Choice Plus/Banner Select,,187.25,,,,,,,139.10,518.95,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,outpatient,,,766.00000,489.47000,Banner Health,Banner Choice Plus/Banner Select,,268.10,,,,,,,199.16,743.02,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,outpatient,,,159.00000,101.60000,Banner Health,Banner Choice Plus/Banner Select,,55.65,,,,,,,41.34,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,outpatient,,,447.00000,285.63000,Banner Health,Banner Choice Plus/Banner Select,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,outpatient,,,1413.00000,902.91000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,outpatient,,,3853.00000,2462.07000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,outpatient,,,313.00000,200.01000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,outpatient,,,1132.00000,723.35000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,outpatient,,,2695.00000,1722.10000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,outpatient,,,1619.00000,1034.54000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Banner Health,Banner Choice Plus/Banner Select,,187.25,,,,,,,139.10,518.95,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,outpatient,,,850.00000,543.15000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,outpatient,,,32.00000,20.45000,Banner Health,Banner Choice Plus/Banner Select,,11.20,,,,,,,8.32,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,outpatient,,,134.00000,85.63000,Banner Health,Banner Choice Plus/Banner Select,,46.90,,,,,,,34.84,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Banner Health,Banner Choice Plus/Banner Select,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,outpatient,,,709.00000,453.05000,Banner Health,Banner Choice Plus/Banner Select,,248.15,,,,,,,184.34,687.73,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,outpatient,,,4880.00000,2357.04000,Banner Health,Banner Choice Plus/Banner Select,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,outpatient,,,6024.00000,2909.59000,Banner Health,Banner Choice Plus/Banner Select,,2108.40,,,,,,,1566.24,5843.28,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Banner Health,Banner Choice Plus/Banner Select,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Banner Health,Banner Choice Plus/Banner Select,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Banner Health,Banner Choice Plus/Banner Select,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,outpatient,,,7413.00000,3580.48000,Banner Health,Banner Choice Plus/Banner Select,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Banner Health,Banner Choice Plus/Banner Select,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Banner Health,Banner Choice Plus/Banner Select,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Banner Health,Banner Choice Plus/Banner Select,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Banner Health,Banner Choice Plus/Banner Select,,2513.35,,,,,,,1867.06,6965.57,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,outpatient,,,10654.00000,5145.88000,Banner Health,Banner Choice Plus/Banner Select,,3728.90,,,,,,,2770.04,10334.38,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Banner Health,Banner Choice Plus/Banner Select,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Banner Health,Banner Choice Plus/Banner Select,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Banner Health,Banner Choice Plus/Banner Select,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,11575.00000,5590.72000,Banner Health,Banner Choice Plus/Banner Select,,4051.25,,,,,,,3009.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,13432.00000,6487.66000,Banner Health,Banner Choice Plus/Banner Select,,4701.20,,,,,,,3492.32,13029.04,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,21904.00000,10579.63000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Banner Health,Banner Choice Plus/Banner Select,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Banner Health,Banner Choice Plus/Banner Select,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Banner Health,Banner Choice Plus/Banner Select,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Banner Health,Banner Choice Plus/Banner Select,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,12969.00000,6264.03000,Banner Health,Banner Choice Plus/Banner Select,,4539.15,,,,,,,3371.94,12579.93,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Banner Health,Banner Choice Plus/Banner Select,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Banner Health,Banner Choice Plus/Banner Select,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Banner Health,Banner Choice Plus/Banner Select,,989.45,,,,,,,735.02,2742.19,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Banner Health,Banner Choice Plus/Banner Select,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Banner Health,Banner Choice Plus/Banner Select,,46.90,,,,,,,34.84,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,outpatient,,,251.00000,121.23000,Banner Health,Banner Choice Plus/Banner Select,,87.85,,,,,,,65.26,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Banner Health,Banner Choice Plus/Banner Select,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Banner Health,Banner Choice Plus/Banner Select,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Banner Health,Banner Choice Plus/Banner Select,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,447.00000,215.90000,Banner Health,Banner Choice Plus/Banner Select,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Banner Health,Banner Choice Plus/Banner Select,,989.45,,,,,,,735.02,2742.19,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Banner Health,Banner Choice Plus/Banner Select,,941.50,,,,,,,699.40,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Banner Health,Banner Choice Plus/Banner Select,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,2426.00000,1171.76000,Banner Health,Banner Choice Plus/Banner Select,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,15334.00000,7406.32000,Banner Health,Banner Choice Plus/Banner Select,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Banner Health,Banner Choice Plus/Banner Select,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Banner Health,Banner Choice Plus/Banner Select,,989.45,,,,,,,735.02,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,251.00000,121.23000,Banner Health,Banner Choice Plus/Banner Select,,87.85,,,,,,,65.26,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Banner Health,Banner Choice Plus/Banner Select,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Banner Health,Banner Choice Plus/Banner Select,,989.45,,,,,,,735.02,2742.19,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Banner Health,Banner Choice Plus/Banner Select,,11.20,,,,,,,8.32,31.04,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Banner Health,Banner Choice Plus/Banner Select,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Banner Health,Banner Choice Plus/Banner Select,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,outpatient,,,1485.00000,717.26000,Banner Health,Banner Choice Plus/Banner Select,,519.75,,,,,,,386.10,1440.45,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,outpatient,,,2028.00000,979.52000,Banner Health,Banner Choice Plus/Banner Select,,709.80,,,,,,,527.28,1967.16,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Banner Health,Banner Choice Plus/Banner Select,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,8107.00000,3915.68000,Banner Health,Banner Choice Plus/Banner Select,,2837.45,,,,,,,2107.82,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,10422.00000,5033.83000,Banner Health,Banner Choice Plus/Banner Select,,3647.70,,,,,,,2709.72,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,12737.00000,6151.97000,Banner Health,Banner Choice Plus/Banner Select,,4457.95,,,,,,,3311.62,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,14239.00000,6877.44000,Banner Health,Banner Choice Plus/Banner Select,,4983.65,,,,,,,3702.14,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,16429.00000,7935.21000,Banner Health,Banner Choice Plus/Banner Select,,5750.15,,,,,,,4271.54,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,18619.00000,8992.98000,Banner Health,Banner Choice Plus/Banner Select,,6516.65,,,,,,,4840.94,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,20809.00000,10050.75000,Banner Health,Banner Choice Plus/Banner Select,,7283.15,,,,,,,5410.34,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,22999.00000,11108.52000,Banner Health,Banner Choice Plus/Banner Select,,8049.65,,,,,,,5979.74,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,25189.00000,12166.29000,Banner Health,Banner Choice Plus/Banner Select,,8816.15,,,,,,,6549.14,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,27379.00000,13224.06000,Banner Health,Banner Choice Plus/Banner Select,,9582.65,,,,,,,7118.54,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,29569.00000,14281.83000,Banner Health,Banner Choice Plus/Banner Select,,10349.15,,,,,,,7687.94,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,31759.00000,15339.60000,Banner Health,Banner Choice Plus/Banner Select,,11115.65,,,,,,,8257.34,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,36139.00000,17455.14000,Banner Health,Banner Choice Plus/Banner Select,,12648.65,,,,,,,9396.14,35054.83,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Banner Health,Banner Choice Plus/Banner Select,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Banner Health,Banner Choice Plus/Banner Select,,1169.00,,,,,,,868.40,3239.80,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Banner Health,Banner Choice Plus/Banner Select,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Banner Health,Banner Choice Plus/Banner Select,,11.20,,,,,,,8.32,31.04,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Banner Health,Banner Choice Plus/Banner Select,,46.90,,,,,,,34.84,129.98,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Banner Health,Banner Choice Plus/Banner Select,,66.50,,,,,,,49.40,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,outpatient,,,476.00000,229.91000,Banner Health,Banner Choice Plus/Banner Select,,166.60,,,,,,,123.76,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Banner Health,Banner Choice Plus/Banner Select,,11.20,,,,,,,8.32,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Banner Health,Banner Choice Plus/Banner Select,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Banner Health,Banner Choice Plus/Banner Select,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Banner Health,Banner Choice Plus/Banner Select,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,outpatient,,,12506.00000,6040.40000,Banner Health,Banner Choice Plus/Banner Select,,4377.10,,,,,,,3251.56,12130.82,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,outpatient,,,2404.80000,1161.52000,Banner Health,Banner Choice Plus/Banner Select,,841.68,,,,,,,625.25,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,outpatient,,,969.00000,468.03000,Banner Health,Banner Choice Plus/Banner Select,,339.15,,,,,,,251.94,939.93,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,outpatient,,,2256.90000,1090.08000,Banner Health,Banner Choice Plus/Banner Select,,789.91,,,,,,,586.79,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,outpatient,,,644.30000,311.20000,Banner Health,Banner Choice Plus/Banner Select,,225.50,,,,,,,167.52,624.97,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Banner Health,Banner Choice Plus/Banner Select,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Banner Health,Banner Choice Plus/Banner Select,,66.50,,,,,,,49.40,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Banner Health,Banner Choice Plus/Banner Select,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,outpatient,,,43804.00000,21157.33000,Banner Health,Banner Choice Plus/Banner Select,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,outpatient,,,52564.00000,25388.41000,Banner Health,Banner Choice Plus/Banner Select,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,outpatient,,,61324.00000,29619.49000,Banner Health,Banner Choice Plus/Banner Select,,21463.40,,,,,,,15944.24,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,outpatient,,,70084.00000,33850.57000,Banner Health,Banner Choice Plus/Banner Select,,24529.40,,,,,,,18221.84,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,outpatient,,,78844.00000,38081.65000,Banner Health,Banner Choice Plus/Banner Select,,27595.40,,,,,,,20499.44,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,outpatient,,,87604.00000,42312.73000,Banner Health,Banner Choice Plus/Banner Select,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,outpatient,,,96364.00000,46543.81000,Banner Health,Banner Choice Plus/Banner Select,,33727.40,,,,,,,25054.64,93473.08,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Banner Health,Banner Choice Plus/Banner Select,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,outpatient,,,39424.00000,19041.79000,Banner Health,Banner Choice Plus/Banner Select,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Banner Health,Banner Choice Plus/Banner Select,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Banner Health,Banner Choice Plus/Banner Select,,66.50,,,,,,,49.40,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Banner Health,Banner Choice Plus/Banner Select,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Banner Health,Banner Choice Plus/Banner Select,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Banner Health,Banner Choice Plus/Banner Select,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2023.00000,977.11000,Banner Health,Banner Choice Plus/Banner Select,,708.05,,,,,,,525.98,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Banner Health,Banner Choice Plus/Banner Select,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Banner Health,Banner Choice Plus/Banner Select,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Banner Health,Banner Choice Plus/Banner Select,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Banner Health,Banner Choice Plus/Banner Select,,2756.60,,,,,,,2047.76,7639.72,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,outpatient,,,10191.00000,4922.25000,Banner Health,Banner Choice Plus/Banner Select,,3566.85,,,,,,,2649.66,9885.27,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,96.00000,46.37000,Banner Health,Banner Choice Plus/Banner Select,,33.60,,,,,,,24.96,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Banner Health,Banner Choice Plus/Banner Select,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,7876.00000,3804.11000,Banner Health,Banner Choice Plus/Banner Select,,2756.60,,,,,,,2047.76,7639.72,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Banner Health,Banner Choice Plus/Banner Select,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,outpatient,,,5373.00000,2595.16000,Banner Health,Banner Choice Plus/Banner Select,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,outpatient,,,6487.00000,3133.22000,Banner Health,Banner Choice Plus/Banner Select,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Banner Health,Banner Choice Plus/Banner Select,,2756.60,,,,,,,2047.76,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Banner Health,Banner Choice Plus/Banner Select,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Banner Health,Banner Choice Plus/Banner Select,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,outpatient,,,1126.00000,543.86000,Banner Health,Banner Choice Plus/Banner Select,,394.10,,,,,,,292.76,1092.22,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Banner Health,Banner Choice Plus/Banner Select,,941.50,,,,,,,699.40,2609.30,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,4880.00000,2357.04000,Banner Health,Banner Choice Plus/Banner Select,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,9260.00000,4472.58000,Banner Health,Banner Choice Plus/Banner Select,,3241.00,,,,,,,2407.60,8982.20,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Banner Health,Banner Choice Plus/Banner Select,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,588.00000,284.00000,Banner Health,Banner Choice Plus/Banner Select,,205.80,,,,,,,152.88,570.36,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Banner Health,Banner Choice Plus/Banner Select,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Banner Health,Banner Choice Plus/Banner Select,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Banner Health,Banner Choice Plus/Banner Select,,989.45,,,,,,,735.02,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Banner Health,Banner Choice Plus/Banner Select,,1169.00,,,,,,,868.40,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Banner Health,Banner Choice Plus/Banner Select,,1169.00,,,,,,,868.40,3239.80,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Banner Health,Banner Choice Plus/Banner Select,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Banner Health,Banner Choice Plus/Banner Select,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Banner Health,Banner Choice Plus/Banner Select,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,outpatient,,,159.00000,76.80000,Banner Health,Banner Choice Plus/Banner Select,,55.65,,,,,,,41.34,154.23,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,outpatient,,,588.00000,284.00000,Banner Health,Banner Choice Plus/Banner Select,,205.80,,,,,,,152.88,570.36,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Banner Health,Banner Choice Plus/Banner Select,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Banner Health,Banner Choice Plus/Banner Select,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,outpatient,,,8107.00000,3915.68000,Banner Health,Banner Choice Plus/Banner Select,,2837.45,,,,,,,2107.82,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,outpatient,,,10422.00000,5033.83000,Banner Health,Banner Choice Plus/Banner Select,,3647.70,,,,,,,2709.72,10109.34,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Banner Health,Banner Choice Plus/Banner Select,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Banner Health,Banner Choice Plus/Banner Select,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Banner Health,Banner Choice Plus/Banner Select,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,outpatient,,,221.00000,106.74000,Banner Health,Banner Choice Plus/Banner Select,,77.35,,,,,,,57.46,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Banner Health,Banner Choice Plus/Banner Select,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Banner Health,Banner Choice Plus/Banner Select,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Banner Health,Banner Choice Plus/Banner Select,,1169.00,,,,,,,868.40,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,outpatient,,,4153.00000,2005.90000,Banner Health,Banner Choice Plus/Banner Select,,1453.55,,,,,,,1079.78,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,outpatient,,,5129.00000,2477.31000,Banner Health,Banner Choice Plus/Banner Select,,1795.15,,,,,,,1333.54,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Banner Health,Banner Choice Plus/Banner Select,,2513.35,,,,,,,1867.06,6965.57,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,outpatient,,,52.50000,25.36000,Banner Health,Banner Choice Plus/Banner Select,,18.38,,,,,,,13.65,50.92,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,outpatient,,,50.40000,24.34000,Banner Health,Banner Choice Plus/Banner Select,,17.64,,,,,,,13.10,48.89,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Banner Health,Banner Choice Plus/Banner Select,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Banner Health,Banner Choice Plus/Banner Select,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Banner Health,Banner Choice Plus/Banner Select,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Banner Health,Banner Choice Plus/Banner Select,,11.20,,,,,,,8.32,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Banner Health,Banner Choice Plus/Banner Select,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,outpatient,,,709.00000,342.45000,Banner Health,Banner Choice Plus/Banner Select,,248.15,,,,,,,184.34,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Banner Health,Banner Choice Plus/Banner Select,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Banner Health,Banner Choice Plus/Banner Select,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Banner Health,Banner Choice Plus/Banner Select,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,131404.00000,74657.18000,Banner Health,Banner Choice Plus/Banner Select,,45991.40,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,43800.00000,24884.97000,Banner Health,Banner Choice Plus/Banner Select,,15330.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Banner Health,Banner Choice Plus/Banner Select,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Banner Health,Banner Choice Plus/Banner Select,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Banner Health,Banner Choice Plus/Banner Select,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,24090.00000,13686.73000,Banner Health,Banner Choice Plus/Banner Select,,8431.50,,,,,,,6263.40,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Banner Health,Banner Choice Plus/Banner Select,,9965.90,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Banner Health,Banner Choice Plus/Banner Select,,6132.00,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Banner Health,Banner Choice Plus/Banner Select,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Banner Health,Banner Choice Plus/Banner Select,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Banner Health,Banner Choice Plus/Banner Select,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Banner Health,Banner Choice Plus/Banner Select,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,6105.00000,3468.56000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,13895.00000,7894.44000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,21900.00000,12442.48000,Banner Health,Banner Choice Plus/Banner Select,,7665.00,,,,,,,5694.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,35040.00000,19907.98000,Banner Health,Banner Choice Plus/Banner Select,,12264.00,,,,,,,9110.40,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Banner Health,Banner Choice Plus/Banner Select,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Banner Health,Banner Choice Plus/Banner Select,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,22776.00000,12940.18000,Banner Health,Banner Choice Plus/Banner Select,,7971.60,,,,,,,5921.76,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Banner Health,Banner Choice Plus/Banner Select,,9965.90,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Banner Health,Banner Choice Plus/Banner Select,,6132.00,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,30664.00000,17421.75000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,35044.00000,19910.25000,Banner Health,Banner Choice Plus/Banner Select,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2695.00000,1080.70000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,3853.00000,1545.05000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,outpatient,,,1413.00000,566.61000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,3229.80000,1857.14000,Banner Health,Banner Choice Plus/Banner Select,,1130.43,,,,,,,839.75,3132.91,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,854.40000,491.28000,Banner Health,Banner Choice Plus/Banner Select,,299.04,,,,,,,222.14,828.77,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1200.50000,690.29000,Banner Health,Banner Choice Plus/Banner Select,,420.18,,,,,,,312.13,1164.48,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1011.00000,581.32000,Banner Health,Banner Choice Plus/Banner Select,,353.85,,,,,,,262.86,980.67,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1823.80000,1048.68000,Banner Health,Banner Choice Plus/Banner Select,,638.33,,,,,,,474.19,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2028.50000,1166.39000,Banner Health,Banner Choice Plus/Banner Select,,709.98,,,,,,,527.41,1967.64,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,841.00000,483.58000,Banner Health,Banner Choice Plus/Banner Select,,294.35,,,,,,,218.66,815.77,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1366.20000,785.56000,Banner Health,Banner Choice Plus/Banner Select,,478.17,,,,,,,355.21,1325.21,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1384.00000,795.80000,Banner Health,Banner Choice Plus/Banner Select,,484.40,,,,,,,359.84,1342.48,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2458.70000,1413.75000,Banner Health,Banner Choice Plus/Banner Select,,860.54,,,,,,,639.26,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2393.50000,1376.26000,Banner Health,Banner Choice Plus/Banner Select,,837.73,,,,,,,622.31,2321.70,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1369.50000,787.46000,Banner Health,Banner Choice Plus/Banner Select,,479.32,,,,,,,356.07,1328.41,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2697.40000,1551.00000,Banner Health,Banner Choice Plus/Banner Select,,944.09,,,,,,,701.32,2616.48,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4621.80000,2657.54000,Banner Health,Banner Choice Plus/Banner Select,,1617.63,,,,,,,1201.67,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2592.50000,1490.69000,Banner Health,Banner Choice Plus/Banner Select,,907.38,,,,,,,674.05,2514.72,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Banner Health,Banner Choice Plus/Banner Select,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Banner Health,Banner Choice Plus/Banner Select,,2918.65,,,,,,,2168.14,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Banner Health,Banner Choice Plus/Banner Select,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Banner Health,Banner Choice Plus/Banner Select,,2837.45,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Banner Health,Banner Choice Plus/Banner Select,,394.10,,,,,,,292.76,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Banner Health,Banner Choice Plus/Banner Select,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Banner Health,Banner Choice Plus/Banner Select,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,outpatient,,,20152.00000,11587.40000,Banner Health,Banner Choice Plus/Banner Select,,7053.20,,,,,,,5239.52,19547.44,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Banner Health,Banner Choice Plus/Banner Select,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Banner Health,Banner Choice Plus/Banner Select,,248.15,,,,,,,184.34,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,1272.00000,731.40000,Banner Health,Banner Choice Plus/Banner Select,,445.20,,,,,,,330.72,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Banner Health,Banner Choice Plus/Banner Select,,941.50,,,,,,,699.40,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,3078.00000,1769.85000,Banner Health,Banner Choice Plus/Banner Select,,1077.30,,,,,,,800.28,2985.66,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,70.00000,40.25000,Banner Health,Banner Choice Plus/Banner Select,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,102.00000,58.65000,Banner Health,Banner Choice Plus/Banner Select,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,221.00000,127.07000,Banner Health,Banner Choice Plus/Banner Select,,77.35,,,,,,,57.46,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Banner Health,Banner Choice Plus/Banner Select,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Banner Health,Banner Choice Plus/Banner Select,,248.15,,,,,,,184.34,687.73,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Banner Health,Banner Choice Plus/Banner Select,,4377.10,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35482.00000,20402.15000,Banner Health,Banner Choice Plus/Banner Select,,12418.70,,,,,,,9225.32,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39862.00000,22920.65000,Banner Health,Banner Choice Plus/Banner Select,,13951.70,,,,,,,10364.12,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,44242.00000,25439.15000,Banner Health,Banner Choice Plus/Banner Select,,15484.70,,,,,,,11502.92,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,48622.00000,27957.65000,Banner Health,Banner Choice Plus/Banner Select,,17017.70,,,,,,,12641.72,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,53002.00000,30476.15000,Banner Health,Banner Choice Plus/Banner Select,,18550.70,,,,,,,13780.52,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Banner Health,Banner Choice Plus/Banner Select,,21463.40,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Banner Health,Banner Choice Plus/Banner Select,,24529.40,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Banner Health,Banner Choice Plus/Banner Select,,27595.40,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Banner Health,Banner Choice Plus/Banner Select,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Banner Health,Banner Choice Plus/Banner Select,,33727.40,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,844.00000,485.30000,Banner Health,Banner Choice Plus/Banner Select,,295.40,,,,,,,219.44,818.68,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,11575.00000,6655.62000,Banner Health,Banner Choice Plus/Banner Select,,4051.25,,,,,,,3009.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14892.00000,8562.90000,Banner Health,Banner Choice Plus/Banner Select,,5212.20,,,,,,,3871.92,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,24970.00000,14357.75000,Banner Health,Banner Choice Plus/Banner Select,,8739.50,,,,,,,6492.20,24220.90,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Banner Health,Banner Choice Plus/Banner Select,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Banner Health,Banner Choice Plus/Banner Select,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Banner Health,Banner Choice Plus/Banner Select,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Banner Health,Banner Choice Plus/Banner Select,,1169.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Banner Health,Banner Choice Plus/Banner Select,,1453.55,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4641.00000,2668.58000,Banner Health,Banner Choice Plus/Banner Select,,1624.35,,,,,,,1206.66,4501.77,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Banner Health,Banner Choice Plus/Banner Select,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Banner Health,Banner Choice Plus/Banner Select,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Banner Health,Banner Choice Plus/Banner Select,,33727.40,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Banner Health,Banner Choice Plus/Banner Select,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Banner Health,Banner Choice Plus/Banner Select,,45991.40,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,153304.00000,88149.80000,Banner Health,Banner Choice Plus/Banner Select,,53656.40,,,,,,,39859.04,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,175204.00000,100742.30000,Banner Health,Banner Choice Plus/Banner Select,,61321.40,,,,,,,45553.04,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,197104.00000,113334.80000,Banner Health,Banner Choice Plus/Banner Select,,68986.40,,,,,,,51247.04,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,219004.00000,125927.30000,Banner Health,Banner Choice Plus/Banner Select,,76651.40,,,,,,,56941.04,212433.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Banner Health,Banner Choice Plus/Banner Select,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Banner Health,Banner Choice Plus/Banner Select,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Banner Health,Banner Choice Plus/Banner Select,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Banner Health,Banner Choice Plus/Banner Select,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Banner Health,Banner Choice Plus/Banner Select,,16864.40,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Banner Health,Banner Choice Plus/Banner Select,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Banner Health,Banner Choice Plus/Banner Select,,19930.40,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Banner Health,Banner Choice Plus/Banner Select,,21463.40,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Banner Health,Banner Choice Plus/Banner Select,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Banner Health,Banner Choice Plus/Banner Select,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Banner Health,Banner Choice Plus/Banner Select,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Banner Health,Banner Choice Plus/Banner Select,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Banner Health,Banner Choice Plus/Banner Select,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Banner Health,Banner Choice Plus/Banner Select,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Banner Health,Banner Choice Plus/Banner Select,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Banner Health,Banner Choice Plus/Banner Select,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Banner Health,Banner Choice Plus/Banner Select,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Banner Health,Banner Choice Plus/Banner Select,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Banner Health,Banner Choice Plus/Banner Select,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Banner Health,Banner Choice Plus/Banner Select,,16864.40,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Banner Health,Banner Choice Plus/Banner Select,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Banner Health,Banner Choice Plus/Banner Select,,19930.40,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Banner Health,Banner Choice Plus/Banner Select,,21463.40,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Banner Health,Banner Choice Plus/Banner Select,,24529.40,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Banner Health,Banner Choice Plus/Banner Select,,27595.40,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Banner Health,Banner Choice Plus/Banner Select,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Banner Health,Banner Choice Plus/Banner Select,,33727.40,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Banner Health,Banner Choice Plus/Banner Select,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Banner Health,Banner Choice Plus/Banner Select,,42925.40,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,135784.00000,78075.80000,Banner Health,Banner Choice Plus/Banner Select,,47524.40,,,,,,,35303.84,131710.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Banner Health,Banner Choice Plus/Banner Select,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Banner Health,Banner Choice Plus/Banner Select,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Banner Health,Banner Choice Plus/Banner Select,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Banner Health,Banner Choice Plus/Banner Select,,16864.40,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,55630.00000,31987.25000,Banner Health,Banner Choice Plus/Banner Select,,19470.50,,,,,,,14463.80,53961.10,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Banner Health,Banner Choice Plus/Banner Select,,941.50,,,,,,,699.40,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Banner Health,Banner Choice Plus/Banner Select,,4907.00,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,17962.00000,10328.15000,Banner Health,Banner Choice Plus/Banner Select,,6286.70,,,,,,,4670.12,17423.14,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,2421.00000,1392.07000,Banner Health,Banner Choice Plus/Banner Select,,847.35,,,,,,,629.46,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Banner Health,Banner Choice Plus/Banner Select,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Banner Health,Banner Choice Plus/Banner Select,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Banner Health,Banner Choice Plus/Banner Select,,941.50,,,,,,,699.40,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,27160.00000,15617.00000,Banner Health,Banner Choice Plus/Banner Select,,9506.00,,,,,,,7061.60,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Banner Health,Banner Choice Plus/Banner Select,,11498.90,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Banner Health,Banner Choice Plus/Banner Select,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Banner Health,Banner Choice Plus/Banner Select,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Banner Health,Banner Choice Plus/Banner Select,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Banner Health,Banner Choice Plus/Banner Select,,27595.40,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,28470.00000,16370.25000,Banner Health,Banner Choice Plus/Banner Select,,9964.50,,,,,,,7402.20,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,43800.00000,25185.00000,Banner Health,Banner Choice Plus/Banner Select,,15330.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Banner Health,Banner Choice Plus/Banner Select,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Banner Health,Banner Choice Plus/Banner Select,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Banner Health,Banner Choice Plus/Banner Select,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Banner Health,Banner Choice Plus/Banner Select,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Banner Health,Banner Choice Plus/Banner Select,,11498.90,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Banner Health,Banner Choice Plus/Banner Select,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,54754.00000,31483.55000,Banner Health,Banner Choice Plus/Banner Select,,19163.90,,,,,,,14236.04,53111.38,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Banner Health,Banner Choice Plus/Banner Select,,941.50,,,,,,,699.40,2609.30,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,61320.00000,35259.00000,Banner Health,Banner Choice Plus/Banner Select,,21462.00,,,,,,,15943.20,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,70080.00000,40296.00000,Banner Health,Banner Choice Plus/Banner Select,,24528.00,,,,,,,18220.80,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,78840.00000,45333.00000,Banner Health,Banner Choice Plus/Banner Select,,27594.00,,,,,,,20498.40,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Banner Health,Banner Choice Plus/Banner Select,,33727.40,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Banner Health,Banner Choice Plus/Banner Select,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Banner Health,Banner Choice Plus/Banner Select,,42925.40,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Banner Health,Banner Choice Plus/Banner Select,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Banner Health,Banner Choice Plus/Banner Select,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Banner Health,Banner Choice Plus/Banner Select,,8432.90,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Banner Health,Banner Choice Plus/Banner Select,,11498.90,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Banner Health,Banner Choice Plus/Banner Select,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Banner Health,Banner Choice Plus/Banner Select,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1883.00000,1082.72000,Banner Health,Banner Choice Plus/Banner Select,,659.05,,,,,,,489.58,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Banner Health,Banner Choice Plus/Banner Select,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,7644.00000,4395.30000,Banner Health,Banner Choice Plus/Banner Select,,2675.40,,,,,,,1987.44,7414.68,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Banner Health,Banner Choice Plus/Banner Select,,941.50,,,,,,,699.40,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Banner Health,Banner Choice Plus/Banner Select,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Banner Health,Banner Choice Plus/Banner Select,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Banner Health,Banner Choice Plus/Banner Select,,564.90,,,,,,,419.64,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Banner Health,Banner Choice Plus/Banner Select,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Banner Health,Banner Choice Plus/Banner Select,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Banner Health,Banner Choice Plus/Banner Select,,8432.90,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Banner Health,Banner Choice Plus/Banner Select,,9965.90,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Banner Health,Banner Choice Plus/Banner Select,,11498.90,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,37234.00000,21409.55000,Banner Health,Banner Choice Plus/Banner Select,,13031.90,,,,,,,9680.84,36116.98,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Banner Health,Banner Choice Plus/Banner Select,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Banner Health,Banner Choice Plus/Banner Select,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Banner Health,Banner Choice Plus/Banner Select,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Banner Health,Banner Choice Plus/Banner Select,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Banner Health,Banner Choice Plus/Banner Select,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Banner Health,Banner Choice Plus/Banner Select,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Banner Health,Banner Choice Plus/Banner Select,,27595.40,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,159.00000,91.42000,Banner Health,Banner Choice Plus/Banner Select,,55.65,,,,,,,41.34,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Banner Health,Banner Choice Plus/Banner Select,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Banner Health,Banner Choice Plus/Banner Select,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Banner Health,Banner Choice Plus/Banner Select,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Banner Health,Banner Choice Plus/Banner Select,,989.45,,,,,,,735.02,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Banner Health,Banner Choice Plus/Banner Select,,1169.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Banner Health,Banner Choice Plus/Banner Select,,2837.45,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Banner Health,Banner Choice Plus/Banner Select,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Banner Health,Banner Choice Plus/Banner Select,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Banner Health,Banner Choice Plus/Banner Select,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Banner Health,Banner Choice Plus/Banner Select,,45991.40,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Banner Health,Banner Choice Plus/Banner Select,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,18400.00000,10580.00000,Banner Health,Banner Choice Plus/Banner Select,,6440.00,,,,,,,4784.00,17848.00,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Banner Health,Banner Choice Plus/Banner Select,,8432.90,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Banner Health,Banner Choice Plus/Banner Select,,9965.90,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Banner Health,Banner Choice Plus/Banner Select,,11498.90,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Banner Health,Banner Choice Plus/Banner Select,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Banner Health,Banner Choice Plus/Banner Select,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Banner Health,Banner Choice Plus/Banner Select,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Banner Health,Banner Choice Plus/Banner Select,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Banner Health,Banner Choice Plus/Banner Select,,564.90,,,,,,,419.64,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Banner Health,Banner Choice Plus/Banner Select,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Banner Health,Banner Choice Plus/Banner Select,,19930.40,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Banner Health,Banner Choice Plus/Banner Select,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,5368.00000,3086.60000,Banner Health,Banner Choice Plus/Banner Select,,1878.80,,,,,,,1395.68,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Banner Health,Banner Choice Plus/Banner Select,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Banner Health,Banner Choice Plus/Banner Select,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Banner Health,Banner Choice Plus/Banner Select,,4907.00,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Banner Health,Banner Choice Plus/Banner Select,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,25408.00000,14609.60000,Banner Health,Banner Choice Plus/Banner Select,,8892.80,,,,,,,6606.08,24645.76,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Banner Health,Banner Choice Plus/Banner Select,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Banner Health,Banner Choice Plus/Banner Select,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,8112.00000,4664.40000,Banner Health,Banner Choice Plus/Banner Select,,2839.20,,,,,,,2109.12,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,10431.00000,5997.82000,Banner Health,Banner Choice Plus/Banner Select,,3650.85,,,,,,,2712.06,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Banner Health,Banner Choice Plus/Banner Select,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Banner Health,Banner Choice Plus/Banner Select,,11498.90,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Banner Health,Banner Choice Plus/Banner Select,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,46870.00000,26950.25000,Banner Health,Banner Choice Plus/Banner Select,,16404.50,,,,,,,12186.20,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,51250.00000,29468.75000,Banner Health,Banner Choice Plus/Banner Select,,17937.50,,,,,,,13325.00,49712.50,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Banner Health,Banner Choice Plus/Banner Select,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Banner Health,Banner Choice Plus/Banner Select,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Banner Health,Banner Choice Plus/Banner Select,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Banner Health,Banner Choice Plus/Banner Select,,27595.40,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Banner Health,Banner Choice Plus/Banner Select,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,588.00000,338.10000,Banner Health,Banner Choice Plus/Banner Select,,205.80,,,,,,,152.88,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Banner Health,Banner Choice Plus/Banner Select,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Banner Health,Banner Choice Plus/Banner Select,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Banner Health,Banner Choice Plus/Banner Select,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Banner Health,Banner Choice Plus/Banner Select,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7876.00000,4528.70000,Banner Health,Banner Choice Plus/Banner Select,,2756.60,,,,,,,2047.76,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Banner Health,Banner Choice Plus/Banner Select,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Banner Health,Banner Choice Plus/Banner Select,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Banner Health,Banner Choice Plus/Banner Select,,8432.90,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5856.00000,3367.20000,Banner Health,Banner Choice Plus/Banner Select,,2049.60,,,,,,,1522.56,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Banner Health,Banner Choice Plus/Banner Select,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Banner Health,Banner Choice Plus/Banner Select,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Banner Health,Banner Choice Plus/Banner Select,,2918.65,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Banner Health,Banner Choice Plus/Banner Select,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Banner Health,Banner Choice Plus/Banner Select,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Banner Health,Banner Choice Plus/Banner Select,,2108.40,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Banner Health,Banner Choice Plus/Banner Select,,4377.10,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Banner Health,Banner Choice Plus/Banner Select,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Banner Health,Banner Choice Plus/Banner Select,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Banner Health,Banner Choice Plus/Banner Select,,2108.40,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Banner Health,Banner Choice Plus/Banner Select,,4377.10,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4392.00000,2525.40000,Banner Health,Banner Choice Plus/Banner Select,,1537.20,,,,,,,1141.92,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Banner Health,Banner Choice Plus/Banner Select,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Banner Health,Banner Choice Plus/Banner Select,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Banner Health,Banner Choice Plus/Banner Select,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Banner Health,Banner Choice Plus/Banner Select,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Banner Health,Banner Choice Plus/Banner Select,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Banner Health,Banner Choice Plus/Banner Select,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Banner Health,Banner Choice Plus/Banner Select,,394.10,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Banner Health,Banner Choice Plus/Banner Select,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Banner Health,Banner Choice Plus/Banner Select,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Banner Health,Banner Choice Plus/Banner Select,,2108.40,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Banner Health,Banner Choice Plus/Banner Select,,4377.10,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Banner Health,Banner Choice Plus/Banner Select,,4753.70,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Banner Health,Banner Choice Plus/Banner Select,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Banner Health,Banner Choice Plus/Banner Select,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2152.00000,1237.40000,Banner Health,Banner Choice Plus/Banner Select,,753.20,,,,,,,559.52,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Banner Health,Banner Choice Plus/Banner Select,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Banner Health,Banner Choice Plus/Banner Select,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Banner Health,Banner Choice Plus/Banner Select,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Banner Health,Banner Choice Plus/Banner Select,,2108.40,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Banner Health,Banner Choice Plus/Banner Select,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Banner Health,Banner Choice Plus/Banner Select,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Banner Health,Banner Choice Plus/Banner Select,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Banner Health,Banner Choice Plus/Banner Select,,2108.40,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Banner Health,Banner Choice Plus/Banner Select,,394.10,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Banner Health,Banner Choice Plus/Banner Select,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Banner Health,Banner Choice Plus/Banner Select,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Banner Health,Banner Choice Plus/Banner Select,,2108.40,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Banner Health,Banner Choice Plus/Banner Select,,4377.10,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Banner Health,Banner Choice Plus/Banner Select,,4753.70,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Banner Health,Banner Choice Plus/Banner Select,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Banner Health,Banner Choice Plus/Banner Select,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Banner Health,Banner Choice Plus/Banner Select,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8802.00000,5061.15000,Banner Health,Banner Choice Plus/Banner Select,,3080.70,,,,,,,2288.52,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10654.00000,6126.05000,Banner Health,Banner Choice Plus/Banner Select,,3728.90,,,,,,,2770.04,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Banner Health,Banner Choice Plus/Banner Select,,4377.10,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Banner Health,Banner Choice Plus/Banner Select,,4753.70,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Banner Health,Banner Choice Plus/Banner Select,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17086.00000,9824.45000,Banner Health,Banner Choice Plus/Banner Select,,5980.10,,,,,,,4442.36,16573.42,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Banner Health,Banner Choice Plus/Banner Select,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Banner Health,Banner Choice Plus/Banner Select,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Banner Health,Banner Choice Plus/Banner Select,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Banner Health,Banner Choice Plus/Banner Select,,2918.65,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Banner Health,Banner Choice Plus/Banner Select,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Banner Health,Banner Choice Plus/Banner Select,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Banner Health,Banner Choice Plus/Banner Select,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Banner Health,Banner Choice Plus/Banner Select,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Banner Health,Banner Choice Plus/Banner Select,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Banner Health,Banner Choice Plus/Banner Select,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Banner Health,Banner Choice Plus/Banner Select,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Banner Health,Banner Choice Plus/Banner Select,,8432.90,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Banner Health,Banner Choice Plus/Banner Select,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Banner Health,Banner Choice Plus/Banner Select,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Banner Health,Banner Choice Plus/Banner Select,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Banner Health,Banner Choice Plus/Banner Select,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Banner Health,Banner Choice Plus/Banner Select,,989.45,,,,,,,735.02,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Banner Health,Banner Choice Plus/Banner Select,,1169.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Banner Health,Banner Choice Plus/Banner Select,,1453.55,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Banner Health,Banner Choice Plus/Banner Select,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Banner Health,Banner Choice Plus/Banner Select,,2918.65,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9728.00000,5593.60000,Banner Health,Banner Choice Plus/Banner Select,,3404.80,,,,,,,2529.28,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11117.00000,6392.28000,Banner Health,Banner Choice Plus/Banner Select,,3890.95,,,,,,,2890.42,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Banner Health,Banner Choice Plus/Banner Select,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Banner Health,Banner Choice Plus/Banner Select,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Banner Health,Banner Choice Plus/Banner Select,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Banner Health,Banner Choice Plus/Banner Select,,16864.40,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Banner Health,Banner Choice Plus/Banner Select,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Banner Health,Banner Choice Plus/Banner Select,,19930.40,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Banner Health,Banner Choice Plus/Banner Select,,21463.40,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Banner Health,Banner Choice Plus/Banner Select,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Banner Health,Banner Choice Plus/Banner Select,,24529.40,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Banner Health,Banner Choice Plus/Banner Select,,26062.40,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Banner Health,Banner Choice Plus/Banner Select,,27595.40,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Banner Health,Banner Choice Plus/Banner Select,,29128.40,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,111694.00000,64224.05000,Banner Health,Banner Choice Plus/Banner Select,,39092.90,,,,,,,29040.44,108343.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Banner Health,Banner Choice Plus/Banner Select,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Banner Health,Banner Choice Plus/Banner Select,,248.15,,,,,,,184.34,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,991.00000,569.82000,Banner Health,Banner Choice Plus/Banner Select,,346.85,,,,,,,257.66,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1490.00000,856.75000,Banner Health,Banner Choice Plus/Banner Select,,521.50,,,,,,,387.40,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Banner Health,Banner Choice Plus/Banner Select,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Banner Health,Banner Choice Plus/Banner Select,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Banner Health,Banner Choice Plus/Banner Select,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Banner Health,Banner Choice Plus/Banner Select,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Banner Health,Banner Choice Plus/Banner Select,,2918.65,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Banner Health,Banner Choice Plus/Banner Select,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Banner Health,Banner Choice Plus/Banner Select,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Banner Health,Banner Choice Plus/Banner Select,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Banner Health,Banner Choice Plus/Banner Select,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Banner Health,Banner Choice Plus/Banner Select,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Banner Health,Banner Choice Plus/Banner Select,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,6945.00000,3993.37000,Banner Health,Banner Choice Plus/Banner Select,,2430.75,,,,,,,1805.70,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Banner Health,Banner Choice Plus/Banner Select,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Banner Health,Banner Choice Plus/Banner Select,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Banner Health,Banner Choice Plus/Banner Select,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Banner Health,Banner Choice Plus/Banner Select,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Banner Health,Banner Choice Plus/Banner Select,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Banner Health,Banner Choice Plus/Banner Select,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Banner Health,Banner Choice Plus/Banner Select,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Banner Health,Banner Choice Plus/Banner Select,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Banner Health,Banner Choice Plus/Banner Select,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,50374.00000,28965.05000,Banner Health,Banner Choice Plus/Banner Select,,17630.90,,,,,,,13097.24,48862.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Banner Health,Banner Choice Plus/Banner Select,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Banner Health,Banner Choice Plus/Banner Select,,8432.90,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Banner Health,Banner Choice Plus/Banner Select,,9965.90,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Banner Health,Banner Choice Plus/Banner Select,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Banner Health,Banner Choice Plus/Banner Select,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Banner Health,Banner Choice Plus/Banner Select,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Banner Health,Banner Choice Plus/Banner Select,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Banner Health,Banner Choice Plus/Banner Select,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Banner Health,Banner Choice Plus/Banner Select,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Banner Health,Banner Choice Plus/Banner Select,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Banner Health,Banner Choice Plus/Banner Select,,16864.40,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Banner Health,Banner Choice Plus/Banner Select,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Banner Health,Banner Choice Plus/Banner Select,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Banner Health,Banner Choice Plus/Banner Select,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Banner Health,Banner Choice Plus/Banner Select,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Banner Health,Banner Choice Plus/Banner Select,,16864.40,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Banner Health,Banner Choice Plus/Banner Select,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Banner Health,Banner Choice Plus/Banner Select,,19930.40,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Banner Health,Banner Choice Plus/Banner Select,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Banner Health,Banner Choice Plus/Banner Select,,26062.40,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Banner Health,Banner Choice Plus/Banner Select,,29128.40,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,91984.00000,52890.80000,Banner Health,Banner Choice Plus/Banner Select,,32194.40,,,,,,,23915.84,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,100744.00000,57927.80000,Banner Health,Banner Choice Plus/Banner Select,,35260.40,,,,,,,26193.44,97721.68,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Banner Health,Banner Choice Plus/Banner Select,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Banner Health,Banner Choice Plus/Banner Select,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Banner Health,Banner Choice Plus/Banner Select,,248.15,,,,,,,184.34,687.73,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Banner Health,Banner Choice Plus/Banner Select,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Banner Health,Banner Choice Plus/Banner Select,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Banner Health,Banner Choice Plus/Banner Select,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Banner Health,Banner Choice Plus/Banner Select,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Banner Health,Banner Choice Plus/Banner Select,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Banner Health,Banner Choice Plus/Banner Select,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Banner Health,Banner Choice Plus/Banner Select,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Banner Health,Banner Choice Plus/Banner Select,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Banner Health,Banner Choice Plus/Banner Select,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Banner Health,Banner Choice Plus/Banner Select,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Banner Health,Banner Choice Plus/Banner Select,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2180.20000,1253.61000,Banner Health,Banner Choice Plus/Banner Select,,763.07,,,,,,,566.85,2114.79,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1880.60000,1081.34000,Banner Health,Banner Choice Plus/Banner Select,,658.21,,,,,,,488.96,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2908.70000,1672.50000,Banner Health,Banner Choice Plus/Banner Select,,1018.04,,,,,,,756.26,2821.44,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,outpatient,,,34.00000,25.74000,Banner Health,Banner Choice Plus/Banner Select,,11.90,,,,,,,8.84,32.98,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,outpatient,,,13.00000,9.84000,Banner Health,Banner Choice Plus/Banner Select,,4.55,,,,,,,3.38,12.61,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Banner Health,Banner Choice Plus/Banner Select,,98.35,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Banner Health,Banner Choice Plus/Banner Select,,98.35,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Banner Health,Banner Choice Plus/Banner Select,,98.35,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Banner Health,Banner Choice Plus/Banner Select,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Banner Health,Banner Choice Plus/Banner Select,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Banner Health,Banner Choice Plus/Banner Select,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,outpatient,,,122.00000,92.35000,Banner Health,Banner Choice Plus/Banner Select,,42.70,,,,,,,31.72,118.34,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Banner Health,Banner Choice Plus/Banner Select,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Banner Health,Banner Choice Plus/Banner Select,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Banner Health,Banner Choice Plus/Banner Select,,5.25,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Banner Health,Banner Choice Plus/Banner Select,,5.25,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Banner Health,Banner Choice Plus/Banner Select,,5.95,,,,,,,4.42,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Banner Health,Banner Choice Plus/Banner Select,,5.95,,,,,,,4.42,16.49,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,outpatient,,,359.00000,271.76000,Banner Health,Banner Choice Plus/Banner Select,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,outpatient,,,359.00000,271.76000,Banner Health,Banner Choice Plus/Banner Select,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,outpatient,,,359.00000,271.76000,Banner Health,Banner Choice Plus/Banner Select,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,outpatient,,,155.00000,117.34000,Banner Health,Banner Choice Plus/Banner Select,,54.25,,,,,,,40.30,150.35,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,outpatient,,,294.00000,222.56000,Banner Health,Banner Choice Plus/Banner Select,,102.90,,,,,,,76.44,285.18,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,outpatient,,,1511.00000,1143.83000,Banner Health,Banner Choice Plus/Banner Select,,528.85,,,,,,,392.86,1465.67,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Banner Health,Banner Choice Plus/Banner Select,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Banner Health,Banner Choice Plus/Banner Select,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,outpatient,,,150.00000,113.55000,Banner Health,Banner Choice Plus/Banner Select,,52.50,,,,,,,39.00,145.50,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,outpatient,,,110.00000,83.27000,Banner Health,Banner Choice Plus/Banner Select,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,outpatient,,,158.00000,119.61000,Banner Health,Banner Choice Plus/Banner Select,,55.30,,,,,,,41.08,153.26,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,outpatient,,,153.00000,115.82000,Banner Health,Banner Choice Plus/Banner Select,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,outpatient,,,157.00000,118.85000,Banner Health,Banner Choice Plus/Banner Select,,54.95,,,,,,,40.82,152.29,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,outpatient,,,26.00000,19.68000,Banner Health,Banner Choice Plus/Banner Select,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,outpatient,,,37.00000,28.01000,Banner Health,Banner Choice Plus/Banner Select,,12.95,,,,,,,9.62,35.89,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,outpatient,,,268.00000,202.88000,Banner Health,Banner Choice Plus/Banner Select,,93.80,,,,,,,69.68,259.96,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,outpatient,,,91.00000,68.89000,Banner Health,Banner Choice Plus/Banner Select,,31.85,,,,,,,23.66,88.27,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,outpatient,,,200.00000,151.40000,Banner Health,Banner Choice Plus/Banner Select,,70.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,outpatient,,,152.00000,115.06000,Banner Health,Banner Choice Plus/Banner Select,,53.20,,,,,,,39.52,147.44,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,outpatient,,,359.00000,271.76000,Banner Health,Banner Choice Plus/Banner Select,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,outpatient,,,69.00000,33.26000,Banner Health,Banner Choice Plus/Banner Select,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,outpatient,,,75.00000,36.15000,Banner Health,Banner Choice Plus/Banner Select,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,outpatient,,,55.00000,26.51000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,outpatient,,,45.00000,21.69000,Banner Health,Banner Choice Plus/Banner Select,,15.75,,,,,,,11.70,43.65,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,outpatient,,,68.00000,32.78000,Banner Health,Banner Choice Plus/Banner Select,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,outpatient,,,61.00000,29.40000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,outpatient,,,64.00000,30.85000,Banner Health,Banner Choice Plus/Banner Select,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,outpatient,,,195.00000,93.99000,Banner Health,Banner Choice Plus/Banner Select,,68.25,,,,,,,50.70,189.15,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,outpatient,,,60.00000,28.92000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,outpatient,,,63.00000,30.37000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,outpatient,,,14.00000,6.75000,Banner Health,Banner Choice Plus/Banner Select,,4.90,,,,,,,3.64,13.58,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,outpatient,,,66.00000,31.81000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,outpatient,,,53.00000,25.55000,Banner Health,Banner Choice Plus/Banner Select,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,outpatient,,,66.00000,31.81000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,outpatient,,,82.00000,39.52000,Banner Health,Banner Choice Plus/Banner Select,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Banner Health,Banner Choice Plus/Banner Select,,49.35,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Banner Health,Banner Choice Plus/Banner Select,,49.35,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,outpatient,,,91.00000,43.86000,Banner Health,Banner Choice Plus/Banner Select,,31.85,,,,,,,23.66,88.27,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,outpatient,,,63.00000,30.37000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,outpatient,,,69.00000,33.26000,Banner Health,Banner Choice Plus/Banner Select,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,outpatient,,,205.00000,98.81000,Banner Health,Banner Choice Plus/Banner Select,,71.75,,,,,,,53.30,198.85,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,outpatient,,,50.00000,24.10000,Banner Health,Banner Choice Plus/Banner Select,,17.50,,,,,,,13.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,outpatient,,,406.00000,195.69000,Banner Health,Banner Choice Plus/Banner Select,,142.10,,,,,,,105.56,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,outpatient,,,101.00000,48.68000,Banner Health,Banner Choice Plus/Banner Select,,35.35,,,,,,,26.26,97.97,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,outpatient,,,375.00000,180.75000,Banner Health,Banner Choice Plus/Banner Select,,131.25,,,,,,,97.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,outpatient,,,362.00000,174.48000,Banner Health,Banner Choice Plus/Banner Select,,126.70,,,,,,,94.12,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,outpatient,,,325.00000,156.65000,Banner Health,Banner Choice Plus/Banner Select,,113.75,,,,,,,84.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,outpatient,,,121.00000,58.32000,Banner Health,Banner Choice Plus/Banner Select,,42.35,,,,,,,31.46,117.37,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,outpatient,,,115.00000,55.43000,Banner Health,Banner Choice Plus/Banner Select,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,outpatient,,,300.00000,144.60000,Banner Health,Banner Choice Plus/Banner Select,,105.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,outpatient,,,51.00000,24.58000,Banner Health,Banner Choice Plus/Banner Select,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Banner Health,Banner Choice Plus/Banner Select,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Banner Health,Banner Choice Plus/Banner Select,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,outpatient,,,194.00000,93.51000,Banner Health,Banner Choice Plus/Banner Select,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,outpatient,,,57.00000,27.47000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,outpatient,,,68.00000,32.78000,Banner Health,Banner Choice Plus/Banner Select,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,outpatient,,,329.00000,158.58000,Banner Health,Banner Choice Plus/Banner Select,,115.15,,,,,,,85.54,319.13,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,outpatient,,,24.00000,11.57000,Banner Health,Banner Choice Plus/Banner Select,,8.40,,,,,,,6.24,23.28,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,outpatient,,,30.00000,14.46000,Banner Health,Banner Choice Plus/Banner Select,,10.50,,,,,,,7.80,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,outpatient,,,63.00000,30.37000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,outpatient,,,53.00000,25.55000,Banner Health,Banner Choice Plus/Banner Select,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,outpatient,,,270.00000,130.14000,Banner Health,Banner Choice Plus/Banner Select,,94.50,,,,,,,70.20,261.90,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Banner Health,Banner Choice Plus/Banner Select,,43.05,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Banner Health,Banner Choice Plus/Banner Select,,43.05,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,outpatient,,,37.00000,17.83000,Banner Health,Banner Choice Plus/Banner Select,,12.95,,,,,,,9.62,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,outpatient,,,57.00000,27.47000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,outpatient,,,57.00000,27.47000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,outpatient,,,63.00000,30.37000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,outpatient,,,41.00000,19.76000,Banner Health,Banner Choice Plus/Banner Select,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,outpatient,,,72.00000,34.70000,Banner Health,Banner Choice Plus/Banner Select,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,outpatient,,,77.00000,37.11000,Banner Health,Banner Choice Plus/Banner Select,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,outpatient,,,90.00000,43.38000,Banner Health,Banner Choice Plus/Banner Select,,31.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,outpatient,,,44.00000,21.21000,Banner Health,Banner Choice Plus/Banner Select,,15.40,,,,,,,11.44,42.68,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,outpatient,,,115.00000,55.43000,Banner Health,Banner Choice Plus/Banner Select,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,outpatient,,,20.00000,9.64000,Banner Health,Banner Choice Plus/Banner Select,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,outpatient,,,52.00000,25.06000,Banner Health,Banner Choice Plus/Banner Select,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,outpatient,,,341.00000,164.36000,Banner Health,Banner Choice Plus/Banner Select,,119.35,,,,,,,88.66,330.77,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,outpatient,,,54.00000,26.03000,Banner Health,Banner Choice Plus/Banner Select,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,outpatient,,,53.00000,25.55000,Banner Health,Banner Choice Plus/Banner Select,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,outpatient,,,88.00000,42.42000,Banner Health,Banner Choice Plus/Banner Select,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,outpatient,,,89.00000,42.90000,Banner Health,Banner Choice Plus/Banner Select,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,outpatient,,,61.00000,29.40000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Banner Health,Banner Choice Plus/Banner Select,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Banner Health,Banner Choice Plus/Banner Select,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Banner Health,Banner Choice Plus/Banner Select,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Banner Health,Banner Choice Plus/Banner Select,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,outpatient,,,63.00000,30.37000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,outpatient,,,95.00000,45.79000,Banner Health,Banner Choice Plus/Banner Select,,33.25,,,,,,,24.70,92.15,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,outpatient,,,132.00000,63.62000,Banner Health,Banner Choice Plus/Banner Select,,46.20,,,,,,,34.32,128.04,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,outpatient,,,83.00000,40.01000,Banner Health,Banner Choice Plus/Banner Select,,29.05,,,,,,,21.58,80.51,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,outpatient,,,387.00000,186.53000,Banner Health,Banner Choice Plus/Banner Select,,135.45,,,,,,,100.62,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,outpatient,,,387.00000,186.53000,Banner Health,Banner Choice Plus/Banner Select,,135.45,,,,,,,100.62,375.39,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,outpatient,,,31.00000,14.94000,Banner Health,Banner Choice Plus/Banner Select,,10.85,,,,,,,8.06,30.07,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,outpatient,,,36.00000,17.35000,Banner Health,Banner Choice Plus/Banner Select,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,outpatient,,,160.00000,77.12000,Banner Health,Banner Choice Plus/Banner Select,,56.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,outpatient,,,112.00000,53.98000,Banner Health,Banner Choice Plus/Banner Select,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,outpatient,,,14.00000,6.75000,Banner Health,Banner Choice Plus/Banner Select,,4.90,,,,,,,3.64,13.58,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,outpatient,,,16.00000,7.71000,Banner Health,Banner Choice Plus/Banner Select,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,outpatient,,,71.00000,34.22000,Banner Health,Banner Choice Plus/Banner Select,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,outpatient,,,116.00000,55.91000,Banner Health,Banner Choice Plus/Banner Select,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,outpatient,,,81.00000,39.04000,Banner Health,Banner Choice Plus/Banner Select,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,outpatient,,,97.00000,46.75000,Banner Health,Banner Choice Plus/Banner Select,,33.95,,,,,,,25.22,94.09,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,outpatient,,,77.00000,37.11000,Banner Health,Banner Choice Plus/Banner Select,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,outpatient,,,35.00000,16.87000,Banner Health,Banner Choice Plus/Banner Select,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,outpatient,,,65.00000,31.33000,Banner Health,Banner Choice Plus/Banner Select,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,outpatient,,,74.00000,35.67000,Banner Health,Banner Choice Plus/Banner Select,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,outpatient,,,250.00000,120.50000,Banner Health,Banner Choice Plus/Banner Select,,87.50,,,,,,,65.00,242.50,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,outpatient,,,90.00000,43.38000,Banner Health,Banner Choice Plus/Banner Select,,31.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,outpatient,,,90.00000,43.38000,Banner Health,Banner Choice Plus/Banner Select,,31.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,outpatient,,,52.00000,25.06000,Banner Health,Banner Choice Plus/Banner Select,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,outpatient,,,36.00000,17.35000,Banner Health,Banner Choice Plus/Banner Select,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,outpatient,,,78.00000,37.60000,Banner Health,Banner Choice Plus/Banner Select,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,outpatient,,,115.00000,55.43000,Banner Health,Banner Choice Plus/Banner Select,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,outpatient,,,67.00000,32.29000,Banner Health,Banner Choice Plus/Banner Select,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,outpatient,,,76.00000,36.63000,Banner Health,Banner Choice Plus/Banner Select,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,outpatient,,,53.00000,25.55000,Banner Health,Banner Choice Plus/Banner Select,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,outpatient,,,70.00000,33.74000,Banner Health,Banner Choice Plus/Banner Select,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,outpatient,,,169.00000,81.46000,Banner Health,Banner Choice Plus/Banner Select,,59.15,,,,,,,43.94,163.93,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,outpatient,,,28.00000,13.50000,Banner Health,Banner Choice Plus/Banner Select,,9.80,,,,,,,7.28,27.16,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,outpatient,,,51.00000,24.58000,Banner Health,Banner Choice Plus/Banner Select,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,outpatient,,,15.00000,7.23000,Banner Health,Banner Choice Plus/Banner Select,,5.25,,,,,,,3.90,14.55,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,outpatient,,,18.00000,8.68000,Banner Health,Banner Choice Plus/Banner Select,,6.30,,,,,,,4.68,17.46,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,outpatient,,,55.00000,26.51000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,outpatient,,,55.00000,26.51000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,outpatient,,,61.00000,29.40000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,outpatient,,,550.00000,265.10000,Banner Health,Banner Choice Plus/Banner Select,,192.50,,,,,,,143.00,533.50,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Banner Health,Banner Choice Plus/Banner Select,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,outpatient,,,392.00000,188.94000,Banner Health,Banner Choice Plus/Banner Select,,137.20,,,,,,,101.92,380.24,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,outpatient,,,75.00000,36.15000,Banner Health,Banner Choice Plus/Banner Select,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Banner Health,Banner Choice Plus/Banner Select,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,outpatient,,,100.00000,48.20000,Banner Health,Banner Choice Plus/Banner Select,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,outpatient,,,153.00000,73.75000,Banner Health,Banner Choice Plus/Banner Select,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,outpatient,,,909.00000,438.14000,Banner Health,Banner Choice Plus/Banner Select,,318.15,,,,,,,236.34,881.73,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,outpatient,,,266.00000,128.21000,Banner Health,Banner Choice Plus/Banner Select,,93.10,,,,,,,69.16,258.02,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,outpatient,,,275.00000,132.55000,Banner Health,Banner Choice Plus/Banner Select,,96.25,,,,,,,71.50,266.75,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,outpatient,,,61.00000,29.40000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,outpatient,,,84.00000,40.49000,Banner Health,Banner Choice Plus/Banner Select,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,outpatient,,,174.00000,83.87000,Banner Health,Banner Choice Plus/Banner Select,,60.90,,,,,,,45.24,168.78,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,outpatient,,,62.00000,29.88000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,outpatient,,,67.00000,32.29000,Banner Health,Banner Choice Plus/Banner Select,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,outpatient,,,68.00000,32.78000,Banner Health,Banner Choice Plus/Banner Select,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,outpatient,,,63.00000,30.37000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,outpatient,,,211.00000,101.70000,Banner Health,Banner Choice Plus/Banner Select,,73.85,,,,,,,54.86,204.67,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,outpatient,,,65.00000,31.33000,Banner Health,Banner Choice Plus/Banner Select,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,outpatient,,,83.00000,40.01000,Banner Health,Banner Choice Plus/Banner Select,,29.05,,,,,,,21.58,80.51,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,outpatient,,,54.00000,26.03000,Banner Health,Banner Choice Plus/Banner Select,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,outpatient,,,55.00000,26.51000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,outpatient,,,323.00000,155.69000,Banner Health,Banner Choice Plus/Banner Select,,113.05,,,,,,,83.98,313.31,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,outpatient,,,63.00000,30.37000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,outpatient,,,35.00000,16.87000,Banner Health,Banner Choice Plus/Banner Select,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,outpatient,,,20.00000,9.64000,Banner Health,Banner Choice Plus/Banner Select,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,outpatient,,,55.00000,26.51000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,outpatient,,,34.00000,16.39000,Banner Health,Banner Choice Plus/Banner Select,,11.90,,,,,,,8.84,32.98,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,outpatient,,,29.00000,13.98000,Banner Health,Banner Choice Plus/Banner Select,,10.15,,,,,,,7.54,28.13,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,outpatient,,,80.00000,38.56000,Banner Health,Banner Choice Plus/Banner Select,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,outpatient,,,73.00000,35.19000,Banner Health,Banner Choice Plus/Banner Select,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,outpatient,,,16.00000,7.71000,Banner Health,Banner Choice Plus/Banner Select,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,outpatient,,,52.00000,25.06000,Banner Health,Banner Choice Plus/Banner Select,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,outpatient,,,113.00000,54.47000,Banner Health,Banner Choice Plus/Banner Select,,39.55,,,,,,,29.38,109.61,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,outpatient,,,68.00000,32.78000,Banner Health,Banner Choice Plus/Banner Select,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,outpatient,,,78.00000,37.60000,Banner Health,Banner Choice Plus/Banner Select,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,outpatient,,,54.00000,26.03000,Banner Health,Banner Choice Plus/Banner Select,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,outpatient,,,76.00000,36.63000,Banner Health,Banner Choice Plus/Banner Select,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,outpatient,,,67.00000,32.29000,Banner Health,Banner Choice Plus/Banner Select,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,outpatient,,,88.00000,42.42000,Banner Health,Banner Choice Plus/Banner Select,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,outpatient,,,60.00000,28.92000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,outpatient,,,67.00000,32.29000,Banner Health,Banner Choice Plus/Banner Select,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,outpatient,,,53.00000,25.55000,Banner Health,Banner Choice Plus/Banner Select,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,outpatient,,,88.00000,42.42000,Banner Health,Banner Choice Plus/Banner Select,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,outpatient,,,105.00000,50.61000,Banner Health,Banner Choice Plus/Banner Select,,36.75,,,,,,,27.30,101.85,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Banner Health,Banner Choice Plus/Banner Select,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,outpatient,,,83.00000,40.01000,Banner Health,Banner Choice Plus/Banner Select,,29.05,,,,,,,21.58,80.51,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Banner Health,Banner Choice Plus/Banner Select,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,outpatient,,,57.00000,27.47000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,outpatient,,,97.00000,46.75000,Banner Health,Banner Choice Plus/Banner Select,,33.95,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Banner Health,Banner Choice Plus/Banner Select,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,outpatient,,,87.00000,41.93000,Banner Health,Banner Choice Plus/Banner Select,,30.45,,,,,,,22.62,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,outpatient,,,68.00000,32.78000,Banner Health,Banner Choice Plus/Banner Select,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,outpatient,,,52.00000,25.06000,Banner Health,Banner Choice Plus/Banner Select,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,outpatient,,,51.00000,24.58000,Banner Health,Banner Choice Plus/Banner Select,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,outpatient,,,97.00000,46.75000,Banner Health,Banner Choice Plus/Banner Select,,33.95,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,outpatient,,,176.00000,84.83000,Banner Health,Banner Choice Plus/Banner Select,,61.60,,,,,,,45.76,170.72,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,outpatient,,,57.00000,27.47000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,outpatient,,,158.00000,76.16000,Banner Health,Banner Choice Plus/Banner Select,,55.30,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,outpatient,,,67.00000,32.29000,Banner Health,Banner Choice Plus/Banner Select,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,outpatient,,,67.00000,32.29000,Banner Health,Banner Choice Plus/Banner Select,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,outpatient,,,84.00000,40.49000,Banner Health,Banner Choice Plus/Banner Select,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,outpatient,,,189.00000,91.10000,Banner Health,Banner Choice Plus/Banner Select,,66.15,,,,,,,49.14,183.33,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,outpatient,,,109.00000,52.54000,Banner Health,Banner Choice Plus/Banner Select,,38.15,,,,,,,28.34,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,outpatient,,,129.00000,62.18000,Banner Health,Banner Choice Plus/Banner Select,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,outpatient,,,84.00000,40.49000,Banner Health,Banner Choice Plus/Banner Select,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Banner Health,Banner Choice Plus/Banner Select,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,outpatient,,,67.00000,32.29000,Banner Health,Banner Choice Plus/Banner Select,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,outpatient,,,67.00000,32.29000,Banner Health,Banner Choice Plus/Banner Select,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,outpatient,,,149.00000,71.82000,Banner Health,Banner Choice Plus/Banner Select,,52.15,,,,,,,38.74,144.53,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,outpatient,,,130.00000,62.66000,Banner Health,Banner Choice Plus/Banner Select,,45.50,,,,,,,33.80,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,outpatient,,,110.00000,53.02000,Banner Health,Banner Choice Plus/Banner Select,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,outpatient,,,158.00000,76.16000,Banner Health,Banner Choice Plus/Banner Select,,55.30,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,outpatient,,,117.00000,56.39000,Banner Health,Banner Choice Plus/Banner Select,,40.95,,,,,,,30.42,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,outpatient,,,61.00000,29.40000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,outpatient,,,67.00000,32.29000,Banner Health,Banner Choice Plus/Banner Select,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Banner Health,Banner Choice Plus/Banner Select,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,outpatient,,,145.00000,69.89000,Banner Health,Banner Choice Plus/Banner Select,,50.75,,,,,,,37.70,140.65,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,outpatient,,,67.00000,32.29000,Banner Health,Banner Choice Plus/Banner Select,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,outpatient,,,165.00000,79.53000,Banner Health,Banner Choice Plus/Banner Select,,57.75,,,,,,,42.90,160.05,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,outpatient,,,70.00000,33.74000,Banner Health,Banner Choice Plus/Banner Select,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,outpatient,,,67.00000,32.29000,Banner Health,Banner Choice Plus/Banner Select,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Banner Health,Banner Choice Plus/Banner Select,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,outpatient,,,154.00000,74.23000,Banner Health,Banner Choice Plus/Banner Select,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,outpatient,,,104.00000,50.13000,Banner Health,Banner Choice Plus/Banner Select,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,outpatient,,,70.00000,33.74000,Banner Health,Banner Choice Plus/Banner Select,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,outpatient,,,104.00000,50.13000,Banner Health,Banner Choice Plus/Banner Select,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,outpatient,,,70.00000,33.74000,Banner Health,Banner Choice Plus/Banner Select,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,outpatient,,,123.00000,59.29000,Banner Health,Banner Choice Plus/Banner Select,,43.05,,,,,,,31.98,119.31,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,outpatient,,,95.00000,45.79000,Banner Health,Banner Choice Plus/Banner Select,,33.25,,,,,,,24.70,92.15,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,outpatient,,,160.00000,77.12000,Banner Health,Banner Choice Plus/Banner Select,,56.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,outpatient,,,147.00000,70.85000,Banner Health,Banner Choice Plus/Banner Select,,51.45,,,,,,,38.22,142.59,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,outpatient,,,178.00000,85.80000,Banner Health,Banner Choice Plus/Banner Select,,62.30,,,,,,,46.28,172.66,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,outpatient,,,160.00000,77.12000,Banner Health,Banner Choice Plus/Banner Select,,56.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Banner Health,Banner Choice Plus/Banner Select,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,outpatient,,,67.00000,32.29000,Banner Health,Banner Choice Plus/Banner Select,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,outpatient,,,70.00000,33.74000,Banner Health,Banner Choice Plus/Banner Select,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Banner Health,Banner Choice Plus/Banner Select,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Banner Health,Banner Choice Plus/Banner Select,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Banner Health,Banner Choice Plus/Banner Select,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Banner Health,Banner Choice Plus/Banner Select,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Banner Health,Banner Choice Plus/Banner Select,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Banner Health,Banner Choice Plus/Banner Select,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Banner Health,Banner Choice Plus/Banner Select,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Banner Health,Banner Choice Plus/Banner Select,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,outpatient,,,449.00000,216.42000,Banner Health,Banner Choice Plus/Banner Select,,157.15,,,,,,,116.74,435.53,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,outpatient,,,104.00000,50.13000,Banner Health,Banner Choice Plus/Banner Select,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Banner Health,Banner Choice Plus/Banner Select,,64.75,,,,,,,48.10,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Banner Health,Banner Choice Plus/Banner Select,,64.75,,,,,,,48.10,179.45,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,outpatient,,,57.00000,27.47000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,outpatient,,,84.00000,40.49000,Banner Health,Banner Choice Plus/Banner Select,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Banner Health,Banner Choice Plus/Banner Select,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Banner Health,Banner Choice Plus/Banner Select,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Banner Health,Banner Choice Plus/Banner Select,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Banner Health,Banner Choice Plus/Banner Select,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,outpatient,,,98.00000,47.24000,Banner Health,Banner Choice Plus/Banner Select,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,outpatient,,,75.00000,36.15000,Banner Health,Banner Choice Plus/Banner Select,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,outpatient,,,107.00000,51.57000,Banner Health,Banner Choice Plus/Banner Select,,37.45,,,,,,,27.82,103.79,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,outpatient,,,81.00000,39.04000,Banner Health,Banner Choice Plus/Banner Select,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,outpatient,,,60.00000,28.92000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,outpatient,,,68.00000,32.78000,Banner Health,Banner Choice Plus/Banner Select,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,outpatient,,,51.00000,24.58000,Banner Health,Banner Choice Plus/Banner Select,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,outpatient,,,74.00000,35.67000,Banner Health,Banner Choice Plus/Banner Select,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,outpatient,,,60.00000,28.92000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,outpatient,,,194.00000,93.51000,Banner Health,Banner Choice Plus/Banner Select,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,outpatient,,,111.00000,53.50000,Banner Health,Banner Choice Plus/Banner Select,,38.85,,,,,,,28.86,107.67,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,outpatient,,,77.00000,37.11000,Banner Health,Banner Choice Plus/Banner Select,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Banner Health,Banner Choice Plus/Banner Select,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Banner Health,Banner Choice Plus/Banner Select,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Banner Health,Banner Choice Plus/Banner Select,,82.95,,,,,,,61.62,229.89,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,outpatient,,,51.00000,24.58000,Banner Health,Banner Choice Plus/Banner Select,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Banner Health,Banner Choice Plus/Banner Select,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Banner Health,Banner Choice Plus/Banner Select,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,outpatient,,,67.00000,32.29000,Banner Health,Banner Choice Plus/Banner Select,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,outpatient,,,131.00000,63.14000,Banner Health,Banner Choice Plus/Banner Select,,45.85,,,,,,,34.06,127.07,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,outpatient,,,15.00000,7.23000,Banner Health,Banner Choice Plus/Banner Select,,5.25,,,,,,,3.90,14.55,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,outpatient,,,39.00000,18.80000,Banner Health,Banner Choice Plus/Banner Select,,13.65,,,,,,,10.14,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,outpatient,,,12.00000,5.78000,Banner Health,Banner Choice Plus/Banner Select,,4.20,,,,,,,3.12,11.64,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,outpatient,,,57.00000,27.47000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Banner Health,Banner Choice Plus/Banner Select,,71.05,,,,,,,52.78,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Banner Health,Banner Choice Plus/Banner Select,,71.05,,,,,,,52.78,196.91,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,outpatient,,,99.00000,47.72000,Banner Health,Banner Choice Plus/Banner Select,,34.65,,,,,,,25.74,96.03,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,outpatient,,,53.00000,25.55000,Banner Health,Banner Choice Plus/Banner Select,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,outpatient,,,23.00000,11.09000,Banner Health,Banner Choice Plus/Banner Select,,8.05,,,,,,,5.98,22.31,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,outpatient,,,46.00000,22.17000,Banner Health,Banner Choice Plus/Banner Select,,16.10,,,,,,,11.96,44.62,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,outpatient,,,67.00000,32.29000,Banner Health,Banner Choice Plus/Banner Select,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,outpatient,,,57.00000,27.47000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,outpatient,,,288.00000,138.82000,Banner Health,Banner Choice Plus/Banner Select,,100.80,,,,,,,74.88,279.36,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,outpatient,,,106.00000,51.09000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,outpatient,,,30.00000,14.46000,Banner Health,Banner Choice Plus/Banner Select,,10.50,,,,,,,7.80,29.10,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,outpatient,,,55.00000,26.51000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,outpatient,,,71.00000,34.22000,Banner Health,Banner Choice Plus/Banner Select,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,outpatient,,,67.00000,32.29000,Banner Health,Banner Choice Plus/Banner Select,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,outpatient,,,89.00000,42.90000,Banner Health,Banner Choice Plus/Banner Select,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,outpatient,,,116.00000,55.91000,Banner Health,Banner Choice Plus/Banner Select,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Banner Health,Banner Choice Plus/Banner Select,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Banner Health,Banner Choice Plus/Banner Select,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,outpatient,,,51.00000,24.58000,Banner Health,Banner Choice Plus/Banner Select,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,outpatient,,,66.00000,31.81000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,outpatient,,,174.00000,83.87000,Banner Health,Banner Choice Plus/Banner Select,,60.90,,,,,,,45.24,168.78,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,outpatient,,,82.00000,39.52000,Banner Health,Banner Choice Plus/Banner Select,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,outpatient,,,112.00000,53.98000,Banner Health,Banner Choice Plus/Banner Select,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,outpatient,,,61.00000,29.40000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,outpatient,,,69.00000,33.26000,Banner Health,Banner Choice Plus/Banner Select,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,outpatient,,,52.00000,25.06000,Banner Health,Banner Choice Plus/Banner Select,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,outpatient,,,286.00000,137.85000,Banner Health,Banner Choice Plus/Banner Select,,100.10,,,,,,,74.36,277.42,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,outpatient,,,300.00000,144.60000,Banner Health,Banner Choice Plus/Banner Select,,105.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,outpatient,,,73.00000,35.19000,Banner Health,Banner Choice Plus/Banner Select,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,outpatient,,,90.00000,43.38000,Banner Health,Banner Choice Plus/Banner Select,,31.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,outpatient,,,60.00000,28.92000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Banner Health,Banner Choice Plus/Banner Select,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,outpatient,,,315.00000,151.83000,Banner Health,Banner Choice Plus/Banner Select,,110.25,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,outpatient,,,100.00000,48.20000,Banner Health,Banner Choice Plus/Banner Select,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,outpatient,,,89.00000,42.90000,Banner Health,Banner Choice Plus/Banner Select,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,outpatient,,,71.00000,34.22000,Banner Health,Banner Choice Plus/Banner Select,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,outpatient,,,135.00000,65.07000,Banner Health,Banner Choice Plus/Banner Select,,47.25,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,outpatient,,,80.00000,38.56000,Banner Health,Banner Choice Plus/Banner Select,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Banner Health,Banner Choice Plus/Banner Select,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Banner Health,Banner Choice Plus/Banner Select,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,outpatient,,,100.00000,48.20000,Banner Health,Banner Choice Plus/Banner Select,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,outpatient,,,305.00000,147.01000,Banner Health,Banner Choice Plus/Banner Select,,106.75,,,,,,,79.30,295.85,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,outpatient,,,70.00000,33.74000,Banner Health,Banner Choice Plus/Banner Select,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,outpatient,,,69.00000,33.26000,Banner Health,Banner Choice Plus/Banner Select,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,outpatient,,,64.00000,30.85000,Banner Health,Banner Choice Plus/Banner Select,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,outpatient,,,368.00000,177.38000,Banner Health,Banner Choice Plus/Banner Select,,128.80,,,,,,,95.68,356.96,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,outpatient,,,104.00000,50.13000,Banner Health,Banner Choice Plus/Banner Select,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,outpatient,,,109.00000,52.54000,Banner Health,Banner Choice Plus/Banner Select,,38.15,,,,,,,28.34,105.73,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,outpatient,,,114.00000,54.95000,Banner Health,Banner Choice Plus/Banner Select,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,outpatient,,,135.00000,65.07000,Banner Health,Banner Choice Plus/Banner Select,,47.25,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,outpatient,,,105.00000,50.61000,Banner Health,Banner Choice Plus/Banner Select,,36.75,,,,,,,27.30,101.85,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,outpatient,,,315.00000,151.83000,Banner Health,Banner Choice Plus/Banner Select,,110.25,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,outpatient,,,148.00000,71.34000,Banner Health,Banner Choice Plus/Banner Select,,51.80,,,,,,,38.48,143.56,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,outpatient,,,62.00000,29.88000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,outpatient,,,67.00000,32.29000,Banner Health,Banner Choice Plus/Banner Select,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,outpatient,,,107.00000,51.57000,Banner Health,Banner Choice Plus/Banner Select,,37.45,,,,,,,27.82,103.79,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,outpatient,,,57.00000,27.47000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,outpatient,,,35.00000,16.87000,Banner Health,Banner Choice Plus/Banner Select,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,outpatient,,,104.00000,50.13000,Banner Health,Banner Choice Plus/Banner Select,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,outpatient,,,650.00000,313.30000,Banner Health,Banner Choice Plus/Banner Select,,227.50,,,,,,,169.00,630.50,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,outpatient,,,91.00000,43.86000,Banner Health,Banner Choice Plus/Banner Select,,31.85,,,,,,,23.66,88.27,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,outpatient,,,114.00000,54.95000,Banner Health,Banner Choice Plus/Banner Select,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Banner Health,Banner Choice Plus/Banner Select,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,outpatient,,,360.00000,173.52000,Banner Health,Banner Choice Plus/Banner Select,,126.00,,,,,,,93.60,349.20,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,outpatient,,,106.00000,51.09000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,outpatient,,,78.00000,37.60000,Banner Health,Banner Choice Plus/Banner Select,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,outpatient,,,72.00000,34.70000,Banner Health,Banner Choice Plus/Banner Select,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,outpatient,,,94.00000,45.31000,Banner Health,Banner Choice Plus/Banner Select,,32.90,,,,,,,24.44,91.18,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,outpatient,,,101.00000,48.68000,Banner Health,Banner Choice Plus/Banner Select,,35.35,,,,,,,26.26,97.97,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,outpatient,,,82.00000,39.52000,Banner Health,Banner Choice Plus/Banner Select,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,outpatient,,,77.00000,37.11000,Banner Health,Banner Choice Plus/Banner Select,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,outpatient,,,145.00000,69.89000,Banner Health,Banner Choice Plus/Banner Select,,50.75,,,,,,,37.70,140.65,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,outpatient,,,266.00000,128.21000,Banner Health,Banner Choice Plus/Banner Select,,93.10,,,,,,,69.16,258.02,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,outpatient,,,79.00000,38.08000,Banner Health,Banner Choice Plus/Banner Select,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,outpatient,,,57.00000,27.47000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,outpatient,,,144.00000,69.41000,Banner Health,Banner Choice Plus/Banner Select,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,outpatient,,,20.00000,9.64000,Banner Health,Banner Choice Plus/Banner Select,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,outpatient,,,208.00000,100.26000,Banner Health,Banner Choice Plus/Banner Select,,72.80,,,,,,,54.08,201.76,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,outpatient,,,135.00000,65.07000,Banner Health,Banner Choice Plus/Banner Select,,47.25,,,,,,,35.10,130.95,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,outpatient,,,131.00000,63.14000,Banner Health,Banner Choice Plus/Banner Select,,45.85,,,,,,,34.06,127.07,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,outpatient,,,69.00000,33.26000,Banner Health,Banner Choice Plus/Banner Select,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,outpatient,,,55.00000,26.51000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,outpatient,,,25.00000,12.05000,Banner Health,Banner Choice Plus/Banner Select,,8.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,outpatient,,,61.00000,29.40000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,outpatient,,,80.00000,38.56000,Banner Health,Banner Choice Plus/Banner Select,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,outpatient,,,82.00000,39.52000,Banner Health,Banner Choice Plus/Banner Select,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,outpatient,,,35.00000,16.87000,Banner Health,Banner Choice Plus/Banner Select,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,outpatient,,,88.00000,42.42000,Banner Health,Banner Choice Plus/Banner Select,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,outpatient,,,98.00000,47.24000,Banner Health,Banner Choice Plus/Banner Select,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,outpatient,,,204.00000,98.33000,Banner Health,Banner Choice Plus/Banner Select,,71.40,,,,,,,53.04,197.88,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,outpatient,,,61.00000,29.40000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,outpatient,,,19.00000,9.16000,Banner Health,Banner Choice Plus/Banner Select,,6.65,,,,,,,4.94,18.43,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,outpatient,,,57.00000,27.47000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,outpatient,,,55.00000,26.51000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,outpatient,,,37.00000,17.83000,Banner Health,Banner Choice Plus/Banner Select,,12.95,,,,,,,9.62,35.89,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,outpatient,,,79.00000,38.08000,Banner Health,Banner Choice Plus/Banner Select,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,outpatient,,,63.00000,30.37000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,outpatient,,,21.00000,10.12000,Banner Health,Banner Choice Plus/Banner Select,,7.35,,,,,,,5.46,20.37,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,outpatient,,,52.00000,25.06000,Banner Health,Banner Choice Plus/Banner Select,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,outpatient,,,57.00000,27.47000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,outpatient,,,60.00000,28.92000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,outpatient,,,32.00000,15.42000,Banner Health,Banner Choice Plus/Banner Select,,11.20,,,,,,,8.32,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,outpatient,,,94.00000,45.31000,Banner Health,Banner Choice Plus/Banner Select,,32.90,,,,,,,24.44,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,outpatient,,,103.00000,49.65000,Banner Health,Banner Choice Plus/Banner Select,,36.05,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,outpatient,,,64.00000,30.85000,Banner Health,Banner Choice Plus/Banner Select,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,outpatient,,,102.00000,49.16000,Banner Health,Banner Choice Plus/Banner Select,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,outpatient,,,103.00000,49.65000,Banner Health,Banner Choice Plus/Banner Select,,36.05,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,outpatient,,,139.00000,67.00000,Banner Health,Banner Choice Plus/Banner Select,,48.65,,,,,,,36.14,134.83,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,outpatient,,,52.00000,25.06000,Banner Health,Banner Choice Plus/Banner Select,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Banner Health,Banner Choice Plus/Banner Select,,7.35,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,outpatient,,,88.00000,42.42000,Banner Health,Banner Choice Plus/Banner Select,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Banner Health,Banner Choice Plus/Banner Select,,7.35,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,outpatient,,,52.00000,25.06000,Banner Health,Banner Choice Plus/Banner Select,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,outpatient,,,80.00000,38.56000,Banner Health,Banner Choice Plus/Banner Select,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,outpatient,,,49.00000,23.62000,Banner Health,Banner Choice Plus/Banner Select,,17.15,,,,,,,12.74,47.53,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,outpatient,,,88.00000,42.42000,Banner Health,Banner Choice Plus/Banner Select,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,outpatient,,,66.00000,31.81000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,outpatient,,,68.00000,32.78000,Banner Health,Banner Choice Plus/Banner Select,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,outpatient,,,93.00000,44.83000,Banner Health,Banner Choice Plus/Banner Select,,32.55,,,,,,,24.18,90.21,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,outpatient,,,73.00000,35.19000,Banner Health,Banner Choice Plus/Banner Select,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,outpatient,,,41.00000,19.76000,Banner Health,Banner Choice Plus/Banner Select,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,outpatient,,,94.00000,45.31000,Banner Health,Banner Choice Plus/Banner Select,,32.90,,,,,,,24.44,91.18,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,outpatient,,,124.00000,59.77000,Banner Health,Banner Choice Plus/Banner Select,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,outpatient,,,71.00000,34.22000,Banner Health,Banner Choice Plus/Banner Select,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,outpatient,,,33.00000,15.91000,Banner Health,Banner Choice Plus/Banner Select,,11.55,,,,,,,8.58,32.01,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,outpatient,,,52.00000,25.06000,Banner Health,Banner Choice Plus/Banner Select,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,outpatient,,,68.00000,32.78000,Banner Health,Banner Choice Plus/Banner Select,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,outpatient,,,99.00000,47.72000,Banner Health,Banner Choice Plus/Banner Select,,34.65,,,,,,,25.74,96.03,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,outpatient,,,197.00000,94.95000,Banner Health,Banner Choice Plus/Banner Select,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,outpatient,,,194.00000,93.51000,Banner Health,Banner Choice Plus/Banner Select,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,outpatient,,,68.00000,32.78000,Banner Health,Banner Choice Plus/Banner Select,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,outpatient,,,90.00000,43.38000,Banner Health,Banner Choice Plus/Banner Select,,31.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,outpatient,,,109.00000,52.54000,Banner Health,Banner Choice Plus/Banner Select,,38.15,,,,,,,28.34,105.73,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,outpatient,,,108.00000,52.06000,Banner Health,Banner Choice Plus/Banner Select,,37.80,,,,,,,28.08,104.76,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,outpatient,,,67.00000,32.29000,Banner Health,Banner Choice Plus/Banner Select,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,outpatient,,,69.00000,33.26000,Banner Health,Banner Choice Plus/Banner Select,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,outpatient,,,71.00000,34.22000,Banner Health,Banner Choice Plus/Banner Select,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,outpatient,,,98.00000,47.24000,Banner Health,Banner Choice Plus/Banner Select,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,outpatient,,,141.00000,67.96000,Banner Health,Banner Choice Plus/Banner Select,,49.35,,,,,,,36.66,136.77,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,outpatient,,,226.00000,108.93000,Banner Health,Banner Choice Plus/Banner Select,,79.10,,,,,,,58.76,219.22,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,outpatient,,,92.00000,44.34000,Banner Health,Banner Choice Plus/Banner Select,,32.20,,,,,,,23.92,89.24,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,outpatient,,,69.00000,33.26000,Banner Health,Banner Choice Plus/Banner Select,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,outpatient,,,100.00000,48.20000,Banner Health,Banner Choice Plus/Banner Select,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,outpatient,,,124.00000,59.77000,Banner Health,Banner Choice Plus/Banner Select,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,outpatient,,,69.00000,33.26000,Banner Health,Banner Choice Plus/Banner Select,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Banner Health,Banner Choice Plus/Banner Select,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Banner Health,Banner Choice Plus/Banner Select,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Banner Health,Banner Choice Plus/Banner Select,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,outpatient,,,118.00000,56.88000,Banner Health,Banner Choice Plus/Banner Select,,41.30,,,,,,,30.68,114.46,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,outpatient,,,51.00000,24.58000,Banner Health,Banner Choice Plus/Banner Select,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,outpatient,,,104.00000,50.13000,Banner Health,Banner Choice Plus/Banner Select,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,outpatient,,,66.00000,31.81000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,outpatient,,,72.00000,34.70000,Banner Health,Banner Choice Plus/Banner Select,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,outpatient,,,54.00000,26.03000,Banner Health,Banner Choice Plus/Banner Select,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,outpatient,,,17.00000,8.19000,Banner Health,Banner Choice Plus/Banner Select,,5.95,,,,,,,4.42,16.49,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,outpatient,,,63.00000,30.37000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,outpatient,,,36.00000,17.35000,Banner Health,Banner Choice Plus/Banner Select,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,outpatient,,,52.00000,25.06000,Banner Health,Banner Choice Plus/Banner Select,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,outpatient,,,18.00000,8.68000,Banner Health,Banner Choice Plus/Banner Select,,6.30,,,,,,,4.68,17.46,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,outpatient,,,74.00000,35.67000,Banner Health,Banner Choice Plus/Banner Select,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,outpatient,,,62.00000,29.88000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,outpatient,,,62.00000,29.88000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,outpatient,,,118.00000,56.88000,Banner Health,Banner Choice Plus/Banner Select,,41.30,,,,,,,30.68,114.46,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,outpatient,,,82.00000,39.52000,Banner Health,Banner Choice Plus/Banner Select,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,outpatient,,,30.00000,14.46000,Banner Health,Banner Choice Plus/Banner Select,,10.50,,,,,,,7.80,29.10,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,outpatient,,,55.00000,26.51000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,outpatient,,,70.00000,33.74000,Banner Health,Banner Choice Plus/Banner Select,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,outpatient,,,54.00000,26.03000,Banner Health,Banner Choice Plus/Banner Select,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,outpatient,,,63.00000,30.37000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,outpatient,,,51.00000,24.58000,Banner Health,Banner Choice Plus/Banner Select,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,outpatient,,,141.00000,67.96000,Banner Health,Banner Choice Plus/Banner Select,,49.35,,,,,,,36.66,136.77,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,outpatient,,,63.00000,30.37000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,outpatient,,,81.00000,39.04000,Banner Health,Banner Choice Plus/Banner Select,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,outpatient,,,335.00000,161.47000,Banner Health,Banner Choice Plus/Banner Select,,117.25,,,,,,,87.10,324.95,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,outpatient,,,52.00000,25.06000,Banner Health,Banner Choice Plus/Banner Select,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Banner Health,Banner Choice Plus/Banner Select,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,outpatient,,,57.00000,27.47000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Banner Health,Banner Choice Plus/Banner Select,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,outpatient,,,53.00000,25.55000,Banner Health,Banner Choice Plus/Banner Select,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,outpatient,,,63.00000,30.37000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,outpatient,,,53.00000,25.55000,Banner Health,Banner Choice Plus/Banner Select,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,outpatient,,,12.00000,5.78000,Banner Health,Banner Choice Plus/Banner Select,,4.20,,,,,,,3.12,11.64,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,outpatient,,,710.00000,342.22000,Banner Health,Banner Choice Plus/Banner Select,,248.50,,,,,,,184.60,688.70,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,outpatient,,,104.00000,50.13000,Banner Health,Banner Choice Plus/Banner Select,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,outpatient,,,155.00000,74.71000,Banner Health,Banner Choice Plus/Banner Select,,54.25,,,,,,,40.30,150.35,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,outpatient,,,139.00000,67.00000,Banner Health,Banner Choice Plus/Banner Select,,48.65,,,,,,,36.14,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,outpatient,,,89.00000,42.90000,Banner Health,Banner Choice Plus/Banner Select,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,outpatient,,,88.00000,42.42000,Banner Health,Banner Choice Plus/Banner Select,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,outpatient,,,111.00000,53.50000,Banner Health,Banner Choice Plus/Banner Select,,38.85,,,,,,,28.86,107.67,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,outpatient,,,70.00000,33.74000,Banner Health,Banner Choice Plus/Banner Select,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,outpatient,,,85.00000,40.97000,Banner Health,Banner Choice Plus/Banner Select,,29.75,,,,,,,22.10,82.45,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,outpatient,,,60.00000,28.92000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,outpatient,,,110.00000,53.02000,Banner Health,Banner Choice Plus/Banner Select,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,outpatient,,,500.00000,241.00000,Banner Health,Banner Choice Plus/Banner Select,,175.00,,,,,,,130.00,485.00,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,outpatient,,,140.00000,67.48000,Banner Health,Banner Choice Plus/Banner Select,,49.00,,,,,,,36.40,135.80,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,outpatient,,,66.00000,31.81000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,outpatient,,,74.00000,35.67000,Banner Health,Banner Choice Plus/Banner Select,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,outpatient,,,77.00000,37.11000,Banner Health,Banner Choice Plus/Banner Select,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,outpatient,,,93.00000,44.83000,Banner Health,Banner Choice Plus/Banner Select,,32.55,,,,,,,24.18,90.21,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,outpatient,,,57.00000,27.47000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,outpatient,,,15.00000,7.23000,Banner Health,Banner Choice Plus/Banner Select,,5.25,,,,,,,3.90,14.55,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,outpatient,,,24.00000,11.57000,Banner Health,Banner Choice Plus/Banner Select,,8.40,,,,,,,6.24,23.28,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,outpatient,,,72.00000,34.70000,Banner Health,Banner Choice Plus/Banner Select,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Banner Health,Banner Choice Plus/Banner Select,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Banner Health,Banner Choice Plus/Banner Select,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,outpatient,,,64.00000,30.85000,Banner Health,Banner Choice Plus/Banner Select,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,outpatient,,,82.00000,39.52000,Banner Health,Banner Choice Plus/Banner Select,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,outpatient,,,157.00000,75.67000,Banner Health,Banner Choice Plus/Banner Select,,54.95,,,,,,,40.82,152.29,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,outpatient,,,70.00000,33.74000,Banner Health,Banner Choice Plus/Banner Select,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,outpatient,,,229.00000,110.38000,Banner Health,Banner Choice Plus/Banner Select,,80.15,,,,,,,59.54,222.13,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,outpatient,,,64.00000,30.85000,Banner Health,Banner Choice Plus/Banner Select,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,outpatient,,,72.00000,34.70000,Banner Health,Banner Choice Plus/Banner Select,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,outpatient,,,17.00000,8.19000,Banner Health,Banner Choice Plus/Banner Select,,5.95,,,,,,,4.42,16.49,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,outpatient,,,57.00000,27.47000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,outpatient,,,64.00000,30.85000,Banner Health,Banner Choice Plus/Banner Select,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,outpatient,,,387.00000,186.53000,Banner Health,Banner Choice Plus/Banner Select,,135.45,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Banner Health,Banner Choice Plus/Banner Select,,135.45,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Banner Health,Banner Choice Plus/Banner Select,,135.45,,,,,,,100.62,375.39,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,outpatient,,,77.00000,37.11000,Banner Health,Banner Choice Plus/Banner Select,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Banner Health,Banner Choice Plus/Banner Select,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Banner Health,Banner Choice Plus/Banner Select,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,outpatient,,,43.00000,20.73000,Banner Health,Banner Choice Plus/Banner Select,,15.05,,,,,,,11.18,41.71,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,outpatient,,,64.00000,30.85000,Banner Health,Banner Choice Plus/Banner Select,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,outpatient,,,160.00000,77.12000,Banner Health,Banner Choice Plus/Banner Select,,56.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,outpatient,,,112.00000,53.98000,Banner Health,Banner Choice Plus/Banner Select,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,outpatient,,,82.00000,39.52000,Banner Health,Banner Choice Plus/Banner Select,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,outpatient,,,57.00000,27.47000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,outpatient,,,55.00000,26.51000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,outpatient,,,54.00000,26.03000,Banner Health,Banner Choice Plus/Banner Select,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,outpatient,,,153.00000,73.75000,Banner Health,Banner Choice Plus/Banner Select,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,outpatient,,,45.00000,21.69000,Banner Health,Banner Choice Plus/Banner Select,,15.75,,,,,,,11.70,43.65,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,outpatient,,,28.00000,13.50000,Banner Health,Banner Choice Plus/Banner Select,,9.80,,,,,,,7.28,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,outpatient,,,66.00000,31.81000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Banner Health,Banner Choice Plus/Banner Select,,17.15,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Banner Health,Banner Choice Plus/Banner Select,,17.15,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Banner Health,Banner Choice Plus/Banner Select,,17.15,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,outpatient,,,62.00000,29.88000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,outpatient,,,36.00000,17.35000,Banner Health,Banner Choice Plus/Banner Select,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,outpatient,,,38.00000,18.32000,Banner Health,Banner Choice Plus/Banner Select,,13.30,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,outpatient,,,38.00000,18.32000,Banner Health,Banner Choice Plus/Banner Select,,13.30,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,outpatient,,,76.00000,36.63000,Banner Health,Banner Choice Plus/Banner Select,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,outpatient,,,173.00000,83.39000,Banner Health,Banner Choice Plus/Banner Select,,60.55,,,,,,,44.98,167.81,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,outpatient,,,22.00000,10.60000,Banner Health,Banner Choice Plus/Banner Select,,7.70,,,,,,,5.72,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,outpatient,,,62.00000,29.88000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,outpatient,,,39.00000,18.80000,Banner Health,Banner Choice Plus/Banner Select,,13.65,,,,,,,10.14,37.83,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,outpatient,,,41.00000,19.76000,Banner Health,Banner Choice Plus/Banner Select,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,outpatient,,,57.00000,27.47000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,outpatient,,,54.00000,26.03000,Banner Health,Banner Choice Plus/Banner Select,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,outpatient,,,71.00000,34.22000,Banner Health,Banner Choice Plus/Banner Select,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Banner Health,Banner Choice Plus/Banner Select,,15.05,,,,,,,11.18,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Banner Health,Banner Choice Plus/Banner Select,,15.05,,,,,,,11.18,41.71,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,outpatient,,,38.00000,18.32000,Banner Health,Banner Choice Plus/Banner Select,,13.30,,,,,,,9.88,36.86,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,outpatient,,,72.00000,34.70000,Banner Health,Banner Choice Plus/Banner Select,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,outpatient,,,226.00000,108.93000,Banner Health,Banner Choice Plus/Banner Select,,79.10,,,,,,,58.76,219.22,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Banner Health,Banner Choice Plus/Banner Select,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Banner Health,Banner Choice Plus/Banner Select,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Banner Health,Banner Choice Plus/Banner Select,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,outpatient,,,160.00000,77.12000,Banner Health,Banner Choice Plus/Banner Select,,56.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,outpatient,,,102.00000,49.16000,Banner Health,Banner Choice Plus/Banner Select,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,outpatient,,,317.00000,152.79000,Banner Health,Banner Choice Plus/Banner Select,,110.95,,,,,,,82.42,307.49,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,outpatient,,,62.00000,29.88000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,outpatient,,,66.00000,31.81000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,outpatient,,,116.00000,55.91000,Banner Health,Banner Choice Plus/Banner Select,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Banner Health,Banner Choice Plus/Banner Select,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Banner Health,Banner Choice Plus/Banner Select,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,outpatient,,,85.00000,40.97000,Banner Health,Banner Choice Plus/Banner Select,,29.75,,,,,,,22.10,82.45,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,outpatient,,,184.00000,88.69000,Banner Health,Banner Choice Plus/Banner Select,,64.40,,,,,,,47.84,178.48,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,outpatient,,,127.00000,61.21000,Banner Health,Banner Choice Plus/Banner Select,,44.45,,,,,,,33.02,123.19,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,outpatient,,,61.00000,29.40000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,outpatient,,,35.00000,16.87000,Banner Health,Banner Choice Plus/Banner Select,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,outpatient,,,79.00000,38.08000,Banner Health,Banner Choice Plus/Banner Select,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,outpatient,,,61.00000,35.14000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,outpatient,,,65.00000,37.44000,Banner Health,Banner Choice Plus/Banner Select,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,outpatient,,,57.00000,32.83000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Banner Health,Banner Choice Plus/Banner Select,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,outpatient,,,62.00000,35.71000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,outpatient,,,77.00000,44.35000,Banner Health,Banner Choice Plus/Banner Select,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,outpatient,,,70.00000,40.32000,Banner Health,Banner Choice Plus/Banner Select,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,outpatient,,,67.00000,38.59000,Banner Health,Banner Choice Plus/Banner Select,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,outpatient,,,40.00000,23.04000,Banner Health,Banner Choice Plus/Banner Select,,14.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,outpatient,,,71.00000,40.90000,Banner Health,Banner Choice Plus/Banner Select,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,outpatient,,,80.00000,46.08000,Banner Health,Banner Choice Plus/Banner Select,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,outpatient,,,72.00000,41.47000,Banner Health,Banner Choice Plus/Banner Select,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,outpatient,,,444.00000,255.74000,Banner Health,Banner Choice Plus/Banner Select,,155.40,,,,,,,115.44,430.68,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,outpatient,,,81.00000,46.66000,Banner Health,Banner Choice Plus/Banner Select,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,outpatient,,,62.00000,35.71000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,outpatient,,,66.00000,38.02000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,outpatient,,,57.00000,32.83000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,outpatient,,,53.00000,30.53000,Banner Health,Banner Choice Plus/Banner Select,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Banner Health,Banner Choice Plus/Banner Select,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Banner Health,Banner Choice Plus/Banner Select,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,outpatient,,,60.00000,34.56000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,outpatient,,,61.00000,35.14000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,outpatient,,,40.00000,23.04000,Banner Health,Banner Choice Plus/Banner Select,,14.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,outpatient,,,63.00000,36.29000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,outpatient,,,42.00000,24.19000,Banner Health,Banner Choice Plus/Banner Select,,14.70,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,outpatient,,,62.00000,35.71000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,outpatient,,,46.00000,26.50000,Banner Health,Banner Choice Plus/Banner Select,,16.10,,,,,,,11.96,44.62,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,outpatient,,,54.00000,31.10000,Banner Health,Banner Choice Plus/Banner Select,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,outpatient,,,62.00000,35.71000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,outpatient,,,71.00000,40.90000,Banner Health,Banner Choice Plus/Banner Select,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,outpatient,,,54.00000,31.10000,Banner Health,Banner Choice Plus/Banner Select,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,outpatient,,,80.00000,46.08000,Banner Health,Banner Choice Plus/Banner Select,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,outpatient,,,60.00000,34.56000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Banner Health,Banner Choice Plus/Banner Select,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,outpatient,,,130.00000,74.88000,Banner Health,Banner Choice Plus/Banner Select,,45.50,,,,,,,33.80,126.10,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Banner Health,Banner Choice Plus/Banner Select,,43.05,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,outpatient,,,77.00000,44.35000,Banner Health,Banner Choice Plus/Banner Select,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,outpatient,,,65.00000,37.44000,Banner Health,Banner Choice Plus/Banner Select,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,outpatient,,,115.00000,66.24000,Banner Health,Banner Choice Plus/Banner Select,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Banner Health,Banner Choice Plus/Banner Select,,43.05,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,outpatient,,,161.00000,92.74000,Banner Health,Banner Choice Plus/Banner Select,,56.35,,,,,,,41.86,156.17,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Banner Health,Banner Choice Plus/Banner Select,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,outpatient,,,65.00000,37.44000,Banner Health,Banner Choice Plus/Banner Select,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,outpatient,,,65.00000,37.44000,Banner Health,Banner Choice Plus/Banner Select,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,outpatient,,,65.00000,37.44000,Banner Health,Banner Choice Plus/Banner Select,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,outpatient,,,65.00000,37.44000,Banner Health,Banner Choice Plus/Banner Select,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,outpatient,,,102.00000,58.75000,Banner Health,Banner Choice Plus/Banner Select,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,outpatient,,,219.00000,126.14000,Banner Health,Banner Choice Plus/Banner Select,,76.65,,,,,,,56.94,212.43,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Banner Health,Banner Choice Plus/Banner Select,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,outpatient,,,103.00000,59.33000,Banner Health,Banner Choice Plus/Banner Select,,36.05,,,,,,,26.78,99.91,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,outpatient,,,60.00000,34.56000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,outpatient,,,837.00000,482.11000,Banner Health,Banner Choice Plus/Banner Select,,292.95,,,,,,,217.62,811.89,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Banner Health,Banner Choice Plus/Banner Select,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Banner Health,Banner Choice Plus/Banner Select,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Banner Health,Banner Choice Plus/Banner Select,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,outpatient,,,78.00000,44.93000,Banner Health,Banner Choice Plus/Banner Select,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,outpatient,,,285.00000,164.16000,Banner Health,Banner Choice Plus/Banner Select,,99.75,,,,,,,74.10,276.45,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,outpatient,,,190.00000,109.44000,Banner Health,Banner Choice Plus/Banner Select,,66.50,,,,,,,49.40,184.30,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,outpatient,,,100.00000,57.60000,Banner Health,Banner Choice Plus/Banner Select,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Banner Health,Banner Choice Plus/Banner Select,,14.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,outpatient,,,67.00000,38.59000,Banner Health,Banner Choice Plus/Banner Select,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,outpatient,,,62.00000,35.71000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,outpatient,,,78.00000,44.93000,Banner Health,Banner Choice Plus/Banner Select,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Banner Health,Banner Choice Plus/Banner Select,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,outpatient,,,65.00000,37.44000,Banner Health,Banner Choice Plus/Banner Select,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,outpatient,,,57.00000,32.83000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,outpatient,,,72.00000,41.47000,Banner Health,Banner Choice Plus/Banner Select,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,outpatient,,,59.00000,33.98000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,outpatient,,,72.00000,41.47000,Banner Health,Banner Choice Plus/Banner Select,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,outpatient,,,239.00000,137.66000,Banner Health,Banner Choice Plus/Banner Select,,83.65,,,,,,,62.14,231.83,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,outpatient,,,85.00000,48.96000,Banner Health,Banner Choice Plus/Banner Select,,29.75,,,,,,,22.10,82.45,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,outpatient,,,44.00000,25.34000,Banner Health,Banner Choice Plus/Banner Select,,15.40,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,outpatient,,,40.00000,23.04000,Banner Health,Banner Choice Plus/Banner Select,,14.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,outpatient,,,53.00000,30.53000,Banner Health,Banner Choice Plus/Banner Select,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,outpatient,,,63.00000,36.29000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,outpatient,,,68.00000,39.17000,Banner Health,Banner Choice Plus/Banner Select,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,outpatient,,,76.00000,43.78000,Banner Health,Banner Choice Plus/Banner Select,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,outpatient,,,42.00000,24.19000,Banner Health,Banner Choice Plus/Banner Select,,14.70,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,outpatient,,,87.00000,50.11000,Banner Health,Banner Choice Plus/Banner Select,,30.45,,,,,,,22.62,84.39,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,outpatient,,,503.00000,289.73000,Banner Health,Banner Choice Plus/Banner Select,,176.05,,,,,,,130.78,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,outpatient,,,472.00000,271.87000,Banner Health,Banner Choice Plus/Banner Select,,165.20,,,,,,,122.72,457.84,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,outpatient,,,28.00000,16.13000,Banner Health,Banner Choice Plus/Banner Select,,9.80,,,,,,,7.28,27.16,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,outpatient,,,236.00000,135.94000,Banner Health,Banner Choice Plus/Banner Select,,82.60,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,outpatient,,,54.00000,31.10000,Banner Health,Banner Choice Plus/Banner Select,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,outpatient,,,238.00000,137.09000,Banner Health,Banner Choice Plus/Banner Select,,83.30,,,,,,,61.88,230.86,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,outpatient,,,236.00000,135.94000,Banner Health,Banner Choice Plus/Banner Select,,82.60,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,outpatient,,,145.00000,83.52000,Banner Health,Banner Choice Plus/Banner Select,,50.75,,,,,,,37.70,140.65,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Banner Health,Banner Choice Plus/Banner Select,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Banner Health,Banner Choice Plus/Banner Select,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,outpatient,,,66.00000,38.02000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,outpatient,,,59.00000,33.98000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,outpatient,,,158.00000,91.01000,Banner Health,Banner Choice Plus/Banner Select,,55.30,,,,,,,41.08,153.26,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,outpatient,,,71.00000,40.90000,Banner Health,Banner Choice Plus/Banner Select,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,outpatient,,,144.00000,82.94000,Banner Health,Banner Choice Plus/Banner Select,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,outpatient,,,1448.00000,834.05000,Banner Health,Banner Choice Plus/Banner Select,,506.80,,,,,,,376.48,1404.56,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,outpatient,,,72.00000,41.47000,Banner Health,Banner Choice Plus/Banner Select,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,outpatient,,,102.00000,58.75000,Banner Health,Banner Choice Plus/Banner Select,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,outpatient,,,154.00000,88.70000,Banner Health,Banner Choice Plus/Banner Select,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Banner Health,Banner Choice Plus/Banner Select,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,outpatient,,,61.00000,35.14000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,outpatient,,,66.00000,38.02000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Banner Health,Banner Choice Plus/Banner Select,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,outpatient,,,44.00000,25.34000,Banner Health,Banner Choice Plus/Banner Select,,15.40,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,outpatient,,,63.00000,36.29000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,outpatient,,,150.00000,86.40000,Banner Health,Banner Choice Plus/Banner Select,,52.50,,,,,,,39.00,145.50,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,outpatient,,,61.00000,35.14000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,outpatient,,,56.00000,32.26000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,outpatient,,,62.00000,35.71000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,outpatient,,,66.00000,38.02000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,outpatient,,,60.00000,34.56000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,outpatient,,,58.00000,33.41000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,outpatient,,,71.00000,40.90000,Banner Health,Banner Choice Plus/Banner Select,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,outpatient,,,72.00000,41.47000,Banner Health,Banner Choice Plus/Banner Select,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,outpatient,,,60.00000,34.56000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,outpatient,,,56.00000,32.26000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,outpatient,,,39.00000,22.46000,Banner Health,Banner Choice Plus/Banner Select,,13.65,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Banner Health,Banner Choice Plus/Banner Select,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,outpatient,,,73.00000,42.05000,Banner Health,Banner Choice Plus/Banner Select,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Banner Health,Banner Choice Plus/Banner Select,,44.45,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Banner Health,Banner Choice Plus/Banner Select,,44.45,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Banner Health,Banner Choice Plus/Banner Select,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,outpatient,,,372.00000,214.27000,Banner Health,Banner Choice Plus/Banner Select,,130.20,,,,,,,96.72,360.84,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,outpatient,,,69.00000,39.74000,Banner Health,Banner Choice Plus/Banner Select,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Banner Health,Banner Choice Plus/Banner Select,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Banner Health,Banner Choice Plus/Banner Select,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,outpatient,,,63.00000,36.29000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,outpatient,,,57.00000,32.83000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,outpatient,,,96.00000,55.30000,Banner Health,Banner Choice Plus/Banner Select,,33.60,,,,,,,24.96,93.12,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,outpatient,,,44.00000,25.34000,Banner Health,Banner Choice Plus/Banner Select,,15.40,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,outpatient,,,60.00000,34.56000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,outpatient,,,63.00000,36.29000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,outpatient,,,60.00000,34.56000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,outpatient,,,63.00000,36.29000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,outpatient,,,74.00000,42.62000,Banner Health,Banner Choice Plus/Banner Select,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,outpatient,,,69.00000,39.74000,Banner Health,Banner Choice Plus/Banner Select,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Banner Health,Banner Choice Plus/Banner Select,,13.65,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,outpatient,,,53.00000,30.53000,Banner Health,Banner Choice Plus/Banner Select,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Banner Health,Banner Choice Plus/Banner Select,,13.65,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Banner Health,Banner Choice Plus/Banner Select,,13.65,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,outpatient,,,70.00000,40.32000,Banner Health,Banner Choice Plus/Banner Select,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,outpatient,,,71.00000,40.90000,Banner Health,Banner Choice Plus/Banner Select,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,outpatient,,,65.00000,37.44000,Banner Health,Banner Choice Plus/Banner Select,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,outpatient,,,325.00000,187.20000,Banner Health,Banner Choice Plus/Banner Select,,113.75,,,,,,,84.50,315.25,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,outpatient,,,72.00000,41.47000,Banner Health,Banner Choice Plus/Banner Select,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,outpatient,,,72.00000,41.47000,Banner Health,Banner Choice Plus/Banner Select,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,outpatient,,,76.00000,43.78000,Banner Health,Banner Choice Plus/Banner Select,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,outpatient,,,240.00000,138.24000,Banner Health,Banner Choice Plus/Banner Select,,84.00,,,,,,,62.40,232.80,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,outpatient,,,93.00000,53.57000,Banner Health,Banner Choice Plus/Banner Select,,32.55,,,,,,,24.18,90.21,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,outpatient,,,59.00000,33.98000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,outpatient,,,81.00000,46.66000,Banner Health,Banner Choice Plus/Banner Select,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,outpatient,,,58.00000,33.41000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,outpatient,,,21.00000,12.10000,Banner Health,Banner Choice Plus/Banner Select,,7.35,,,,,,,5.46,20.37,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,outpatient,,,56.00000,32.26000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,outpatient,,,64.00000,36.86000,Banner Health,Banner Choice Plus/Banner Select,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,outpatient,,,80.00000,46.08000,Banner Health,Banner Choice Plus/Banner Select,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,outpatient,,,109.00000,62.78000,Banner Health,Banner Choice Plus/Banner Select,,38.15,,,,,,,28.34,105.73,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,outpatient,,,59.00000,33.98000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,outpatient,,,115.00000,66.24000,Banner Health,Banner Choice Plus/Banner Select,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,outpatient,,,57.00000,32.83000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,outpatient,,,118.00000,67.97000,Banner Health,Banner Choice Plus/Banner Select,,41.30,,,,,,,30.68,114.46,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,outpatient,,,268.00000,154.37000,Banner Health,Banner Choice Plus/Banner Select,,93.80,,,,,,,69.68,259.96,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Banner Health,Banner Choice Plus/Banner Select,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Banner Health,Banner Choice Plus/Banner Select,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,outpatient,,,78.00000,44.93000,Banner Health,Banner Choice Plus/Banner Select,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,outpatient,,,91.00000,52.42000,Banner Health,Banner Choice Plus/Banner Select,,31.85,,,,,,,23.66,88.27,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,outpatient,,,300.00000,172.80000,Banner Health,Banner Choice Plus/Banner Select,,105.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,outpatient,,,185.00000,106.56000,Banner Health,Banner Choice Plus/Banner Select,,64.75,,,,,,,48.10,179.45,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Banner Health,Banner Choice Plus/Banner Select,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,outpatient,,,76.00000,43.78000,Banner Health,Banner Choice Plus/Banner Select,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Banner Health,Banner Choice Plus/Banner Select,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Banner Health,Banner Choice Plus/Banner Select,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,outpatient,,,53.00000,30.53000,Banner Health,Banner Choice Plus/Banner Select,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,outpatient,,,77.00000,44.35000,Banner Health,Banner Choice Plus/Banner Select,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Banner Health,Banner Choice Plus/Banner Select,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,outpatient,,,222.00000,127.87000,Banner Health,Banner Choice Plus/Banner Select,,77.70,,,,,,,57.72,215.34,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,outpatient,,,292.00000,168.19000,Banner Health,Banner Choice Plus/Banner Select,,102.20,,,,,,,75.92,283.24,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,outpatient,,,61.00000,35.14000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Banner Health,Banner Choice Plus/Banner Select,,43.75,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Banner Health,Banner Choice Plus/Banner Select,,43.75,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,outpatient,,,359.00000,206.78000,Banner Health,Banner Choice Plus/Banner Select,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,outpatient,,,111.00000,63.94000,Banner Health,Banner Choice Plus/Banner Select,,38.85,,,,,,,28.86,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Banner Health,Banner Choice Plus/Banner Select,,49.35,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Banner Health,Banner Choice Plus/Banner Select,,49.35,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Banner Health,Banner Choice Plus/Banner Select,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Banner Health,Banner Choice Plus/Banner Select,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Banner Health,Banner Choice Plus/Banner Select,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Banner Health,Banner Choice Plus/Banner Select,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,outpatient,,,78.00000,44.93000,Banner Health,Banner Choice Plus/Banner Select,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Banner Health,Banner Choice Plus/Banner Select,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Banner Health,Banner Choice Plus/Banner Select,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,outpatient,,,70.00000,40.32000,Banner Health,Banner Choice Plus/Banner Select,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,outpatient,,,18.00000,10.37000,Banner Health,Banner Choice Plus/Banner Select,,6.30,,,,,,,4.68,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,outpatient,,,408.00000,235.01000,Banner Health,Banner Choice Plus/Banner Select,,142.80,,,,,,,106.08,395.76,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,outpatient,,,102.00000,58.75000,Banner Health,Banner Choice Plus/Banner Select,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,outpatient,,,330.00000,190.08000,Banner Health,Banner Choice Plus/Banner Select,,115.50,,,,,,,85.80,320.10,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,outpatient,,,56.00000,32.26000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,outpatient,,,136.00000,78.34000,Banner Health,Banner Choice Plus/Banner Select,,47.60,,,,,,,35.36,131.92,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,outpatient,,,83.00000,47.81000,Banner Health,Banner Choice Plus/Banner Select,,29.05,,,,,,,21.58,80.51,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,outpatient,,,63.00000,36.29000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,outpatient,,,142.00000,81.79000,Banner Health,Banner Choice Plus/Banner Select,,49.70,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,outpatient,,,51.00000,29.38000,Banner Health,Banner Choice Plus/Banner Select,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,outpatient,,,70.00000,40.32000,Banner Health,Banner Choice Plus/Banner Select,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,outpatient,,,99.00000,57.02000,Banner Health,Banner Choice Plus/Banner Select,,34.65,,,,,,,25.74,96.03,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,outpatient,,,78.00000,44.93000,Banner Health,Banner Choice Plus/Banner Select,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,outpatient,,,63.00000,36.29000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,outpatient,,,63.00000,36.29000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,outpatient,,,75.00000,43.20000,Banner Health,Banner Choice Plus/Banner Select,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Banner Health,Banner Choice Plus/Banner Select,,12.95,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Banner Health,Banner Choice Plus/Banner Select,,12.95,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,outpatient,,,59.00000,33.98000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,outpatient,,,35.00000,20.16000,Banner Health,Banner Choice Plus/Banner Select,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,outpatient,,,59.00000,33.98000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,outpatient,,,56.00000,32.26000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,outpatient,,,74.00000,42.62000,Banner Health,Banner Choice Plus/Banner Select,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,outpatient,,,90.00000,51.84000,Banner Health,Banner Choice Plus/Banner Select,,31.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Banner Health,Banner Choice Plus/Banner Select,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,outpatient,,,142.00000,81.79000,Banner Health,Banner Choice Plus/Banner Select,,49.70,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Banner Health,Banner Choice Plus/Banner Select,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,outpatient,,,74.00000,42.62000,Banner Health,Banner Choice Plus/Banner Select,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Banner Health,Banner Choice Plus/Banner Select,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Banner Health,Banner Choice Plus/Banner Select,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,outpatient,,,57.00000,32.83000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,outpatient,,,77.00000,44.35000,Banner Health,Banner Choice Plus/Banner Select,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,outpatient,,,64.00000,36.86000,Banner Health,Banner Choice Plus/Banner Select,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,outpatient,,,69.00000,39.74000,Banner Health,Banner Choice Plus/Banner Select,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,outpatient,,,1178.00000,678.53000,Banner Health,Banner Choice Plus/Banner Select,,412.30,,,,,,,306.28,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,outpatient,,,127.00000,73.15000,Banner Health,Banner Choice Plus/Banner Select,,44.45,,,,,,,33.02,123.19,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,outpatient,,,277.00000,159.55000,Banner Health,Banner Choice Plus/Banner Select,,96.95,,,,,,,72.02,268.69,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,outpatient,,,940.00000,541.44000,Banner Health,Banner Choice Plus/Banner Select,,329.00,,,,,,,244.40,911.80,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,outpatient,,,97.00000,55.87000,Banner Health,Banner Choice Plus/Banner Select,,33.95,,,,,,,25.22,94.09,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,outpatient,,,16.00000,9.22000,Banner Health,Banner Choice Plus/Banner Select,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,outpatient,,,57.00000,32.83000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,outpatient,,,131.00000,75.46000,Banner Health,Banner Choice Plus/Banner Select,,45.85,,,,,,,34.06,127.07,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,outpatient,,,2160.00000,1244.16000,Banner Health,Banner Choice Plus/Banner Select,,756.00,,,,,,,561.60,2095.20,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,outpatient,,,37.00000,21.31000,Banner Health,Banner Choice Plus/Banner Select,,12.95,,,,,,,9.62,35.89,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Banner Health,Banner Choice Plus/Banner Select,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,outpatient,,,54.00000,31.10000,Banner Health,Banner Choice Plus/Banner Select,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,outpatient,,,76.00000,43.78000,Banner Health,Banner Choice Plus/Banner Select,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,outpatient,,,606.00000,349.06000,Banner Health,Banner Choice Plus/Banner Select,,212.10,,,,,,,157.56,587.82,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,outpatient,,,62.00000,35.71000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,outpatient,,,300.00000,172.80000,Banner Health,Banner Choice Plus/Banner Select,,105.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,outpatient,,,59.00000,33.98000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,outpatient,,,98.00000,56.45000,Banner Health,Banner Choice Plus/Banner Select,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,outpatient,,,61.00000,35.14000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,outpatient,,,128.00000,73.73000,Banner Health,Banner Choice Plus/Banner Select,,44.80,,,,,,,33.28,124.16,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Banner Health,Banner Choice Plus/Banner Select,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,outpatient,,,16.00000,9.22000,Banner Health,Banner Choice Plus/Banner Select,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,outpatient,,,565.00000,325.44000,Banner Health,Banner Choice Plus/Banner Select,,197.75,,,,,,,146.90,548.05,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,outpatient,,,850.00000,489.60000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,outpatient,,,77.00000,44.35000,Banner Health,Banner Choice Plus/Banner Select,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,outpatient,,,86.00000,49.54000,Banner Health,Banner Choice Plus/Banner Select,,30.10,,,,,,,22.36,83.42,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,outpatient,,,837.00000,482.11000,Banner Health,Banner Choice Plus/Banner Select,,292.95,,,,,,,217.62,811.89,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,outpatient,,,60.00000,34.56000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,outpatient,,,56.00000,32.26000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,outpatient,,,56.00000,32.26000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Banner Health,Banner Choice Plus/Banner Select,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Banner Health,Banner Choice Plus/Banner Select,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Banner Health,Banner Choice Plus/Banner Select,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,outpatient,,,167.00000,96.19000,Banner Health,Banner Choice Plus/Banner Select,,58.45,,,,,,,43.42,161.99,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,outpatient,,,200.00000,115.20000,Banner Health,Banner Choice Plus/Banner Select,,70.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,outpatient,,,93.00000,53.57000,Banner Health,Banner Choice Plus/Banner Select,,32.55,,,,,,,24.18,90.21,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Banner Health,Banner Choice Plus/Banner Select,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,outpatient,,,190.00000,109.44000,Banner Health,Banner Choice Plus/Banner Select,,66.50,,,,,,,49.40,184.30,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,outpatient,,,64.00000,36.86000,Banner Health,Banner Choice Plus/Banner Select,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,outpatient,,,525.00000,302.40000,Banner Health,Banner Choice Plus/Banner Select,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,outpatient,,,54.00000,31.10000,Banner Health,Banner Choice Plus/Banner Select,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Banner Health,Banner Choice Plus/Banner Select,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,outpatient,,,53.00000,30.53000,Banner Health,Banner Choice Plus/Banner Select,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Banner Health,Banner Choice Plus/Banner Select,,14.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,outpatient,,,453.00000,260.93000,Banner Health,Banner Choice Plus/Banner Select,,158.55,,,,,,,117.78,439.41,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,outpatient,,,25.00000,14.40000,Banner Health,Banner Choice Plus/Banner Select,,8.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,outpatient,,,56.00000,32.26000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,outpatient,,,59.00000,33.98000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,outpatient,,,53.00000,30.53000,Banner Health,Banner Choice Plus/Banner Select,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,outpatient,,,62.00000,35.71000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,outpatient,,,350.00000,201.60000,Banner Health,Banner Choice Plus/Banner Select,,122.50,,,,,,,91.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,outpatient,,,225.00000,129.60000,Banner Health,Banner Choice Plus/Banner Select,,78.75,,,,,,,58.50,218.25,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,outpatient,,,52.00000,29.95000,Banner Health,Banner Choice Plus/Banner Select,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,outpatient,,,62.00000,35.71000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,outpatient,,,134.00000,77.18000,Banner Health,Banner Choice Plus/Banner Select,,46.90,,,,,,,34.84,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,outpatient,,,52.00000,29.95000,Banner Health,Banner Choice Plus/Banner Select,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,outpatient,,,186.00000,107.14000,Banner Health,Banner Choice Plus/Banner Select,,65.10,,,,,,,48.36,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Banner Health,Banner Choice Plus/Banner Select,,105.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Banner Health,Banner Choice Plus/Banner Select,,105.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,outpatient,,,62.00000,35.71000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,outpatient,,,205.00000,118.08000,Banner Health,Banner Choice Plus/Banner Select,,71.75,,,,,,,53.30,198.85,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,outpatient,,,75.00000,36.15000,Banner Health,Banner Choice Plus/Banner Select,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,outpatient,,,65.00000,31.33000,Banner Health,Banner Choice Plus/Banner Select,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,outpatient,,,92.00000,44.34000,Banner Health,Banner Choice Plus/Banner Select,,32.20,,,,,,,23.92,89.24,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Banner Health,Banner Choice Plus/Banner Select,,8.40,,,,,,,6.24,23.28,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,outpatient,,,20.00000,9.64000,Banner Health,Banner Choice Plus/Banner Select,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,outpatient,,,63.00000,30.37000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,outpatient,,,42.00000,20.24000,Banner Health,Banner Choice Plus/Banner Select,,14.70,,,,,,,10.92,40.74,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,outpatient,,,69.00000,33.26000,Banner Health,Banner Choice Plus/Banner Select,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,outpatient,,,65.00000,31.33000,Banner Health,Banner Choice Plus/Banner Select,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,outpatient,,,76.00000,36.63000,Banner Health,Banner Choice Plus/Banner Select,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,outpatient,,,89.00000,42.90000,Banner Health,Banner Choice Plus/Banner Select,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,outpatient,,,76.00000,36.63000,Banner Health,Banner Choice Plus/Banner Select,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,outpatient,,,28.00000,13.50000,Banner Health,Banner Choice Plus/Banner Select,,9.80,,,,,,,7.28,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,outpatient,,,98.00000,47.24000,Banner Health,Banner Choice Plus/Banner Select,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,outpatient,,,64.00000,30.85000,Banner Health,Banner Choice Plus/Banner Select,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,outpatient,,,75.00000,36.15000,Banner Health,Banner Choice Plus/Banner Select,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,outpatient,,,76.00000,36.63000,Banner Health,Banner Choice Plus/Banner Select,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,outpatient,,,66.00000,31.81000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,outpatient,,,114.00000,54.95000,Banner Health,Banner Choice Plus/Banner Select,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,outpatient,,,74.00000,35.67000,Banner Health,Banner Choice Plus/Banner Select,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,outpatient,,,69.00000,33.26000,Banner Health,Banner Choice Plus/Banner Select,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,outpatient,,,74.00000,35.67000,Banner Health,Banner Choice Plus/Banner Select,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,outpatient,,,87.00000,41.93000,Banner Health,Banner Choice Plus/Banner Select,,30.45,,,,,,,22.62,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,outpatient,,,79.00000,38.08000,Banner Health,Banner Choice Plus/Banner Select,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,outpatient,,,75.00000,36.15000,Banner Health,Banner Choice Plus/Banner Select,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,outpatient,,,66.00000,31.81000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,outpatient,,,60.00000,28.92000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,outpatient,,,64.00000,30.85000,Banner Health,Banner Choice Plus/Banner Select,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,outpatient,,,164.00000,79.05000,Banner Health,Banner Choice Plus/Banner Select,,57.40,,,,,,,42.64,159.08,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,outpatient,,,54.00000,26.03000,Banner Health,Banner Choice Plus/Banner Select,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,outpatient,,,8.00000,3.86000,Banner Health,Banner Choice Plus/Banner Select,,2.80,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,outpatient,,,69.00000,33.26000,Banner Health,Banner Choice Plus/Banner Select,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,outpatient,,,8.00000,3.86000,Banner Health,Banner Choice Plus/Banner Select,,2.80,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,outpatient,,,60.00000,28.92000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,outpatient,,,8.00000,3.86000,Banner Health,Banner Choice Plus/Banner Select,,2.80,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,outpatient,,,14.00000,6.75000,Banner Health,Banner Choice Plus/Banner Select,,4.90,,,,,,,3.64,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,outpatient,,,62.00000,29.88000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,outpatient,,,63.00000,30.37000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,outpatient,,,112.00000,53.98000,Banner Health,Banner Choice Plus/Banner Select,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,outpatient,,,13.00000,6.27000,Banner Health,Banner Choice Plus/Banner Select,,4.55,,,,,,,3.38,12.61,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,outpatient,,,57.00000,27.47000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,outpatient,,,31.00000,14.94000,Banner Health,Banner Choice Plus/Banner Select,,10.85,,,,,,,8.06,30.07,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,outpatient,,,92.00000,44.34000,Banner Health,Banner Choice Plus/Banner Select,,32.20,,,,,,,23.92,89.24,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,outpatient,,,80.00000,38.56000,Banner Health,Banner Choice Plus/Banner Select,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Banner Health,Banner Choice Plus/Banner Select,,10.50,,,,,,,7.80,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Banner Health,Banner Choice Plus/Banner Select,,10.50,,,,,,,7.80,29.10,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,outpatient,,,57.00000,27.47000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Banner Health,Banner Choice Plus/Banner Select,,8.40,,,,,,,6.24,23.28,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,outpatient,,,59.00000,28.44000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,outpatient,,,29.00000,13.98000,Banner Health,Banner Choice Plus/Banner Select,,10.15,,,,,,,7.54,28.13,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,outpatient,,,97.00000,46.75000,Banner Health,Banner Choice Plus/Banner Select,,33.95,,,,,,,25.22,94.09,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,outpatient,,,225.00000,108.45000,Banner Health,Banner Choice Plus/Banner Select,,78.75,,,,,,,58.50,218.25,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,outpatient,,,57.00000,27.47000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,outpatient,,,71.00000,34.22000,Banner Health,Banner Choice Plus/Banner Select,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,outpatient,,,57.00000,27.47000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,outpatient,,,71.00000,34.22000,Banner Health,Banner Choice Plus/Banner Select,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,outpatient,,,108.00000,52.06000,Banner Health,Banner Choice Plus/Banner Select,,37.80,,,,,,,28.08,104.76,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,outpatient,,,66.00000,31.81000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,outpatient,,,51.00000,24.58000,Banner Health,Banner Choice Plus/Banner Select,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,outpatient,,,63.00000,30.37000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,outpatient,,,58.00000,27.96000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,outpatient,,,19.00000,9.16000,Banner Health,Banner Choice Plus/Banner Select,,6.65,,,,,,,4.94,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,outpatient,,,54.00000,26.03000,Banner Health,Banner Choice Plus/Banner Select,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,outpatient,,,103.00000,49.65000,Banner Health,Banner Choice Plus/Banner Select,,36.05,,,,,,,26.78,99.91,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,outpatient,,,9.00000,4.34000,Banner Health,Banner Choice Plus/Banner Select,,3.15,,,,,,,2.34,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,outpatient,,,13.00000,6.27000,Banner Health,Banner Choice Plus/Banner Select,,4.55,,,,,,,3.38,12.61,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,outpatient,,,80.00000,38.56000,Banner Health,Banner Choice Plus/Banner Select,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,outpatient,,,47.00000,22.65000,Banner Health,Banner Choice Plus/Banner Select,,16.45,,,,,,,12.22,45.59,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,outpatient,,,91.00000,43.86000,Banner Health,Banner Choice Plus/Banner Select,,31.85,,,,,,,23.66,88.27,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,outpatient,,,56.00000,26.99000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,outpatient,,,18.00000,8.68000,Banner Health,Banner Choice Plus/Banner Select,,6.30,,,,,,,4.68,17.46,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,outpatient,,,60.00000,28.92000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,outpatient,,,57.00000,27.47000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Banner Health,Banner Choice Plus/Banner Select,,7.35,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,outpatient,,,71.00000,37.70000,Banner Health,Banner Choice Plus/Banner Select,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Banner Health,Banner Choice Plus/Banner Select,,7.35,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,outpatient,,,128.00000,67.97000,Banner Health,Banner Choice Plus/Banner Select,,44.80,,,,,,,33.28,124.16,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,outpatient,,,65.00000,34.52000,Banner Health,Banner Choice Plus/Banner Select,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Banner Health,Banner Choice Plus/Banner Select,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,outpatient,,,31.00000,16.46000,Banner Health,Banner Choice Plus/Banner Select,,10.85,,,,,,,8.06,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Banner Health,Banner Choice Plus/Banner Select,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Banner Health,Banner Choice Plus/Banner Select,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Banner Health,Banner Choice Plus/Banner Select,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,outpatient,,,61.00000,32.39000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Banner Health,Banner Choice Plus/Banner Select,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Banner Health,Banner Choice Plus/Banner Select,,8.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Banner Health,Banner Choice Plus/Banner Select,91,8.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,outpatient,,,103.00000,54.69000,Banner Health,Banner Choice Plus/Banner Select,,36.05,,,,,,,26.78,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,outpatient,,,96.00000,50.98000,Banner Health,Banner Choice Plus/Banner Select,,33.60,,,,,,,24.96,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,outpatient,,,75.00000,39.83000,Banner Health,Banner Choice Plus/Banner Select,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,outpatient,,,68.00000,36.11000,Banner Health,Banner Choice Plus/Banner Select,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,outpatient,,,61.00000,32.39000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Banner Health,Banner Choice Plus/Banner Select,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Banner Health,Banner Choice Plus/Banner Select,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,outpatient,,,29.00000,15.40000,Banner Health,Banner Choice Plus/Banner Select,,10.15,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Banner Health,Banner Choice Plus/Banner Select,,10.15,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Banner Health,Banner Choice Plus/Banner Select,,10.15,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,outpatient,,,63.00000,33.45000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,outpatient,,,79.00000,41.95000,Banner Health,Banner Choice Plus/Banner Select,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,outpatient,,,63.00000,33.45000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Banner Health,Banner Choice Plus/Banner Select,,10.15,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,outpatient,,,112.00000,59.47000,Banner Health,Banner Choice Plus/Banner Select,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Banner Health,Banner Choice Plus/Banner Select,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,outpatient,,,25.00000,13.28000,Banner Health,Banner Choice Plus/Banner Select,,8.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,outpatient,,,118.00000,62.66000,Banner Health,Banner Choice Plus/Banner Select,,41.30,,,,,,,30.68,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,outpatient,,,29.00000,15.40000,Banner Health,Banner Choice Plus/Banner Select,,10.15,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,outpatient,,,25.00000,13.28000,Banner Health,Banner Choice Plus/Banner Select,,8.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Banner Health,Banner Choice Plus/Banner Select,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,outpatient,,,25.00000,13.28000,Banner Health,Banner Choice Plus/Banner Select,,8.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,outpatient,,,71.00000,37.70000,Banner Health,Banner Choice Plus/Banner Select,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,outpatient,,,59.00000,31.33000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,outpatient,,,62.00000,32.92000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,outpatient,,,138.00000,73.28000,Banner Health,Banner Choice Plus/Banner Select,,48.30,,,,,,,35.88,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,outpatient,,,62.00000,32.92000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,outpatient,,,78.00000,41.42000,Banner Health,Banner Choice Plus/Banner Select,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,outpatient,,,69.00000,36.64000,Banner Health,Banner Choice Plus/Banner Select,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,outpatient,,,88.00000,46.73000,Banner Health,Banner Choice Plus/Banner Select,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,outpatient,,,60.00000,31.86000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,outpatient,,,64.00000,33.98000,Banner Health,Banner Choice Plus/Banner Select,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,outpatient,,,63.00000,33.45000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,outpatient,,,137.00000,72.75000,Banner Health,Banner Choice Plus/Banner Select,,47.95,,,,,,,35.62,132.89,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,outpatient,,,347.00000,184.26000,Banner Health,Banner Choice Plus/Banner Select,,121.45,,,,,,,90.22,336.59,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,outpatient,,,57.00000,30.27000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,outpatient,,,56.00000,29.74000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,outpatient,,,16.00000,8.50000,Banner Health,Banner Choice Plus/Banner Select,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,outpatient,,,85.00000,45.14000,Banner Health,Banner Choice Plus/Banner Select,,29.75,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,outpatient,,,34.00000,18.05000,Banner Health,Banner Choice Plus/Banner Select,,11.90,,,,,,,8.84,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,outpatient,,,231.00000,122.66000,Banner Health,Banner Choice Plus/Banner Select,,80.85,,,,,,,60.06,224.07,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,outpatient,,,36.00000,19.12000,Banner Health,Banner Choice Plus/Banner Select,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,outpatient,,,61.00000,32.39000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,outpatient,,,111.00000,58.94000,Banner Health,Banner Choice Plus/Banner Select,,38.85,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,outpatient,,,61.00000,32.39000,Banner Health,Banner Choice Plus/Banner Select,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,outpatient,,,60.00000,31.86000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,outpatient,,,60.00000,31.86000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,outpatient,,,60.00000,31.86000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,outpatient,,,60.00000,31.86000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,outpatient,,,60.00000,31.86000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,outpatient,,,36.00000,19.12000,Banner Health,Banner Choice Plus/Banner Select,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,outpatient,,,76.00000,40.36000,Banner Health,Banner Choice Plus/Banner Select,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,outpatient,,,60.00000,31.86000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,outpatient,,,60.00000,31.86000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,outpatient,,,152.00000,80.71000,Banner Health,Banner Choice Plus/Banner Select,,53.20,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,outpatient,,,78.00000,41.42000,Banner Health,Banner Choice Plus/Banner Select,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,outpatient,,,42.00000,22.30000,Banner Health,Banner Choice Plus/Banner Select,,14.70,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,outpatient,,,73.00000,38.76000,Banner Health,Banner Choice Plus/Banner Select,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,outpatient,,,97.00000,51.51000,Banner Health,Banner Choice Plus/Banner Select,,33.95,,,,,,,25.22,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,outpatient,,,157.00000,83.37000,Banner Health,Banner Choice Plus/Banner Select,,54.95,,,,,,,40.82,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,outpatient,,,36.00000,19.12000,Banner Health,Banner Choice Plus/Banner Select,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,outpatient,,,66.00000,35.05000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,outpatient,,,58.00000,30.80000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,outpatient,,,85.00000,45.14000,Banner Health,Banner Choice Plus/Banner Select,,29.75,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,outpatient,,,59.00000,31.33000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,outpatient,,,175.00000,92.93000,Banner Health,Banner Choice Plus/Banner Select,,61.25,,,,,,,45.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,outpatient,,,152.00000,80.71000,Banner Health,Banner Choice Plus/Banner Select,,53.20,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,outpatient,,,43.00000,22.83000,Banner Health,Banner Choice Plus/Banner Select,,15.05,,,,,,,11.18,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,outpatient,,,66.00000,35.05000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,outpatient,,,36.00000,19.12000,Banner Health,Banner Choice Plus/Banner Select,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,outpatient,,,36.00000,19.12000,Banner Health,Banner Choice Plus/Banner Select,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,outpatient,,,42.00000,22.30000,Banner Health,Banner Choice Plus/Banner Select,,14.70,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,outpatient,,,147.00000,78.06000,Banner Health,Banner Choice Plus/Banner Select,,51.45,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,outpatient,,,64.00000,33.98000,Banner Health,Banner Choice Plus/Banner Select,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,outpatient,,,60.00000,31.86000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,outpatient,,,75.00000,39.83000,Banner Health,Banner Choice Plus/Banner Select,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,outpatient,,,44.00000,23.36000,Banner Health,Banner Choice Plus/Banner Select,,15.40,,,,,,,11.44,42.68,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,outpatient,,,87.00000,46.20000,Banner Health,Banner Choice Plus/Banner Select,,30.45,,,,,,,22.62,84.39,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,outpatient,,,65.00000,34.52000,Banner Health,Banner Choice Plus/Banner Select,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,outpatient,,,75.00000,39.83000,Banner Health,Banner Choice Plus/Banner Select,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,outpatient,,,50.00000,26.55000,Banner Health,Banner Choice Plus/Banner Select,,17.50,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,outpatient,,,40.00000,21.24000,Banner Health,Banner Choice Plus/Banner Select,,14.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,outpatient,,,50.00000,26.55000,Banner Health,Banner Choice Plus/Banner Select,,17.50,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Banner Health,Banner Choice Plus/Banner Select,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,outpatient,,,115.00000,61.07000,Banner Health,Banner Choice Plus/Banner Select,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1309.00000,695.08000,Banner Health,Banner Choice Plus/Banner Select,,458.15,,,,,,,340.34,1269.73,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Banner Health,Banner Choice Plus/Banner Select,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Banner Health,Banner Choice Plus/Banner Select,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,outpatient,,,328.00000,174.17000,Banner Health,Banner Choice Plus/Banner Select,,114.80,,,,,,,85.28,318.16,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,outpatient,,,115.00000,61.07000,Banner Health,Banner Choice Plus/Banner Select,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Banner Health,Banner Choice Plus/Banner Select,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Banner Health,Banner Choice Plus/Banner Select,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,outpatient,,,1251.00000,664.28000,Banner Health,Banner Choice Plus/Banner Select,,437.85,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Banner Health,Banner Choice Plus/Banner Select,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Banner Health,Banner Choice Plus/Banner Select,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,outpatient,,,96.00000,50.98000,Banner Health,Banner Choice Plus/Banner Select,,33.60,,,,,,,24.96,93.12,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,outpatient,,,211.00000,112.04000,Banner Health,Banner Choice Plus/Banner Select,,73.85,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,outpatient,,,290.00000,153.99000,Banner Health,Banner Choice Plus/Banner Select,,101.50,,,,,,,75.40,281.30,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Banner Health,Banner Choice Plus/Banner Select,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Banner Health,Banner Choice Plus/Banner Select,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,outpatient,,,411.00000,218.24000,Banner Health,Banner Choice Plus/Banner Select,,143.85,,,,,,,106.86,398.67,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,outpatient,,,139.00000,73.81000,Banner Health,Banner Choice Plus/Banner Select,,48.65,,,,,,,36.14,134.83,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,outpatient,,,288.00000,152.93000,Banner Health,Banner Choice Plus/Banner Select,,100.80,,,,,,,74.88,279.36,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1372.00000,728.53000,Banner Health,Banner Choice Plus/Banner Select,,480.20,,,,,,,356.72,1330.84,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,outpatient,,,1251.00000,664.28000,Banner Health,Banner Choice Plus/Banner Select,,437.85,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,outpatient,,,135.00000,71.68000,Banner Health,Banner Choice Plus/Banner Select,,47.25,,,,,,,35.10,130.95,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,outpatient,,,129.00000,68.50000,Banner Health,Banner Choice Plus/Banner Select,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,outpatient,,,129.00000,68.50000,Banner Health,Banner Choice Plus/Banner Select,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,outpatient,,,147.00000,78.06000,Banner Health,Banner Choice Plus/Banner Select,,51.45,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,outpatient,,,126.00000,66.91000,Banner Health,Banner Choice Plus/Banner Select,,44.10,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,outpatient,,,120.00000,63.72000,Banner Health,Banner Choice Plus/Banner Select,,42.00,,,,,,,31.20,116.40,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Banner Health,Banner Choice Plus/Banner Select,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,outpatient,,,124.00000,65.84000,Banner Health,Banner Choice Plus/Banner Select,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,outpatient,,,108.00000,57.35000,Banner Health,Banner Choice Plus/Banner Select,,37.80,,,,,,,28.08,104.76,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Banner Health,Banner Choice Plus/Banner Select,,89.60,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Banner Health,Banner Choice Plus/Banner Select,,89.60,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,outpatient,,,122.00000,64.78000,Banner Health,Banner Choice Plus/Banner Select,,42.70,,,,,,,31.72,118.34,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,outpatient,,,129.00000,68.50000,Banner Health,Banner Choice Plus/Banner Select,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,outpatient,,,123.00000,65.31000,Banner Health,Banner Choice Plus/Banner Select,,43.05,,,,,,,31.98,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Banner Health,Banner Choice Plus/Banner Select,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,outpatient,,,518.00000,275.06000,Banner Health,Banner Choice Plus/Banner Select,,181.30,,,,,,,134.68,502.46,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,outpatient,,,275.00000,146.02000,Banner Health,Banner Choice Plus/Banner Select,,96.25,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,outpatient,,,270.00000,143.37000,Banner Health,Banner Choice Plus/Banner Select,,94.50,,,,,,,70.20,261.90,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,outpatient,,,450.00000,238.95000,Banner Health,Banner Choice Plus/Banner Select,,157.50,,,,,,,117.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,outpatient,,,126.00000,66.91000,Banner Health,Banner Choice Plus/Banner Select,,44.10,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,outpatient,,,362.00000,192.22000,Banner Health,Banner Choice Plus/Banner Select,,126.70,,,,,,,94.12,351.14,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Banner Health,Banner Choice Plus/Banner Select,,38.15,,,,,,,28.34,105.73,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,outpatient,,,638.00000,338.78000,Banner Health,Banner Choice Plus/Banner Select,,223.30,,,,,,,165.88,618.86,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,outpatient,,,211.00000,112.04000,Banner Health,Banner Choice Plus/Banner Select,,73.85,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,outpatient,,,154.00000,81.77000,Banner Health,Banner Choice Plus/Banner Select,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,outpatient,,,141.00000,74.87000,Banner Health,Banner Choice Plus/Banner Select,,49.35,,,,,,,36.66,136.77,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,outpatient,,,2040.00000,1083.24000,Banner Health,Banner Choice Plus/Banner Select,,714.00,,,,,,,530.40,1978.80,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,outpatient,,,421.00000,223.55000,Banner Health,Banner Choice Plus/Banner Select,,147.35,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,outpatient,,,275.00000,146.02000,Banner Health,Banner Choice Plus/Banner Select,,96.25,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,outpatient,,,1251.00000,664.28000,Banner Health,Banner Choice Plus/Banner Select,,437.85,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Banner Health,Banner Choice Plus/Banner Select,,149.80,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Banner Health,Banner Choice Plus/Banner Select,,149.80,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Banner Health,Banner Choice Plus/Banner Select,,229.25,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Banner Health,Banner Choice Plus/Banner Select,,229.25,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,outpatient,,,211.00000,112.04000,Banner Health,Banner Choice Plus/Banner Select,,73.85,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Banner Health,Banner Choice Plus/Banner Select,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Banner Health,Banner Choice Plus/Banner Select,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,outpatient,,,130.00000,69.03000,Banner Health,Banner Choice Plus/Banner Select,,45.50,,,,,,,33.80,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,outpatient,,,421.00000,223.55000,Banner Health,Banner Choice Plus/Banner Select,,147.35,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,outpatient,,,111.00000,58.94000,Banner Health,Banner Choice Plus/Banner Select,,38.85,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,outpatient,,,200.00000,106.20000,Banner Health,Banner Choice Plus/Banner Select,,70.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Banner Health,Banner Choice Plus/Banner Select,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,outpatient,,,13.00000,6.90000,Banner Health,Banner Choice Plus/Banner Select,,4.55,,,,,,,3.38,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,outpatient,,,58.00000,30.80000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,outpatient,,,13.00000,6.90000,Banner Health,Banner Choice Plus/Banner Select,,4.55,,,,,,,3.38,12.61,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,outpatient,,,773.00000,410.46000,Banner Health,Banner Choice Plus/Banner Select,,270.55,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,outpatient,,,773.00000,410.46000,Banner Health,Banner Choice Plus/Banner Select,,270.55,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,outpatient,,,773.00000,410.46000,Banner Health,Banner Choice Plus/Banner Select,,270.55,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,outpatient,,,773.00000,410.46000,Banner Health,Banner Choice Plus/Banner Select,,270.55,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,outpatient,,,387.00000,205.50000,Banner Health,Banner Choice Plus/Banner Select,,135.45,,,,,,,100.62,375.39,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,outpatient,,,52.00000,27.61000,Banner Health,Banner Choice Plus/Banner Select,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Banner Health,Banner Choice Plus/Banner Select,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Banner Health,Banner Choice Plus/Banner Select,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,outpatient,,,79.00000,41.95000,Banner Health,Banner Choice Plus/Banner Select,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,outpatient,,,65.00000,34.52000,Banner Health,Banner Choice Plus/Banner Select,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,outpatient,,,100.00000,53.10000,Banner Health,Banner Choice Plus/Banner Select,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,outpatient,,,64.00000,33.98000,Banner Health,Banner Choice Plus/Banner Select,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,outpatient,,,106.00000,56.29000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Banner Health,Banner Choice Plus/Banner Select,,38.15,,,,,,,28.34,105.73,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,outpatient,,,58.00000,30.80000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Banner Health,Banner Choice Plus/Banner Select,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,outpatient,,,66.00000,35.05000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Banner Health,Banner Choice Plus/Banner Select,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Banner Health,Banner Choice Plus/Banner Select,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Banner Health,Banner Choice Plus/Banner Select,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,outpatient,,,13.00000,6.90000,Banner Health,Banner Choice Plus/Banner Select,,4.55,,,,,,,3.38,12.61,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,outpatient,,,53.00000,28.14000,Banner Health,Banner Choice Plus/Banner Select,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,outpatient,,,18.00000,9.56000,Banner Health,Banner Choice Plus/Banner Select,,6.30,,,,,,,4.68,17.46,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,outpatient,,,17.00000,9.03000,Banner Health,Banner Choice Plus/Banner Select,,5.95,,,,,,,4.42,16.49,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,outpatient,,,71.00000,37.70000,Banner Health,Banner Choice Plus/Banner Select,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,outpatient,,,57.00000,30.27000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,outpatient,,,68.00000,36.11000,Banner Health,Banner Choice Plus/Banner Select,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,outpatient,,,58.00000,30.80000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,outpatient,,,27.00000,14.34000,Banner Health,Banner Choice Plus/Banner Select,,9.45,,,,,,,7.02,26.19,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,outpatient,,,56.00000,29.74000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,outpatient,,,56.00000,29.74000,Banner Health,Banner Choice Plus/Banner Select,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,outpatient,,,58.00000,30.80000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,outpatient,,,115.00000,61.07000,Banner Health,Banner Choice Plus/Banner Select,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,outpatient,,,23.00000,12.21000,Banner Health,Banner Choice Plus/Banner Select,,8.05,,,,,,,5.98,22.31,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,outpatient,,,255.00000,135.40000,Banner Health,Banner Choice Plus/Banner Select,,89.25,,,,,,,66.30,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,outpatient,,,66.00000,35.05000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,outpatient,,,26.00000,13.81000,Banner Health,Banner Choice Plus/Banner Select,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,outpatient,,,64.00000,33.98000,Banner Health,Banner Choice Plus/Banner Select,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,outpatient,,,215.00000,114.16000,Banner Health,Banner Choice Plus/Banner Select,,75.25,,,,,,,55.90,208.55,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,outpatient,,,79.00000,41.95000,Banner Health,Banner Choice Plus/Banner Select,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,outpatient,,,11.00000,5.29000,Banner Health,Banner Choice Plus/Banner Select,,3.85,,,,,,,2.86,10.67,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,outpatient,,,58.00000,27.90000,Banner Health,Banner Choice Plus/Banner Select,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,outpatient,,,10.00000,4.81000,Banner Health,Banner Choice Plus/Banner Select,,3.50,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,outpatient,,,7.00000,3.37000,Banner Health,Banner Choice Plus/Banner Select,,2.45,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,outpatient,,,53.00000,25.49000,Banner Health,Banner Choice Plus/Banner Select,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,outpatient,,,10.00000,4.81000,Banner Health,Banner Choice Plus/Banner Select,,3.50,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Banner Health,Banner Choice Plus/Banner Select,,3.85,,,,,,,2.86,10.67,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,outpatient,,,7.00000,3.37000,Banner Health,Banner Choice Plus/Banner Select,,2.45,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Banner Health,Banner Choice Plus/Banner Select,,3.85,,,,,,,2.86,10.67,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,outpatient,,,597.00000,290.14000,Banner Health,Banner Choice Plus/Banner Select,,208.95,,,,,,,155.22,579.09,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,outpatient,,,6379.00000,3100.19000,Banner Health,Banner Choice Plus/Banner Select,,2232.65,,,,,,,1658.54,6187.63,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,outpatient,,,471.00000,228.91000,Banner Health,Banner Choice Plus/Banner Select,,164.85,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,outpatient,,,471.00000,228.91000,Banner Health,Banner Choice Plus/Banner Select,,164.85,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,outpatient,,,1251.00000,607.99000,Banner Health,Banner Choice Plus/Banner Select,,437.85,,,,,,,325.26,1213.47,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,outpatient,,,260.00000,126.36000,Banner Health,Banner Choice Plus/Banner Select,,91.00,,,,,,,67.60,252.20,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,outpatient,,,785.00000,381.51000,Banner Health,Banner Choice Plus/Banner Select,,274.75,,,,,,,204.10,761.45,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,outpatient,,,529.00000,257.09000,Banner Health,Banner Choice Plus/Banner Select,,185.15,,,,,,,137.54,513.13,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,outpatient,,,1623.00000,788.78000,Banner Health,Banner Choice Plus/Banner Select,,568.05,,,,,,,421.98,1574.31,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,outpatient,,,10800.00000,5248.80000,Banner Health,Banner Choice Plus/Banner Select,,3780.00,,,,,,,2808.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,outpatient,,,25365.00000,12327.39000,Banner Health,Banner Choice Plus/Banner Select,,8877.75,,,,,,,6594.90,24604.05,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,outpatient,,,101.00000,21.82000,Banner Health,Banner Choice Plus/Banner Select,,35.35,,,,,,,26.26,97.97,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,outpatient,,,81.00000,17.50000,Banner Health,Banner Choice Plus/Banner Select,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,outpatient,,,104.00000,22.46000,Banner Health,Banner Choice Plus/Banner Select,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,outpatient,,,377.00000,81.43000,Banner Health,Banner Choice Plus/Banner Select,,131.95,,,,,,,98.02,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,outpatient,,,532.00000,114.91000,Banner Health,Banner Choice Plus/Banner Select,,186.20,,,,,,,138.32,516.04,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,outpatient,,,521.00000,112.54000,Banner Health,Banner Choice Plus/Banner Select,,182.35,,,,,,,135.46,505.37,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,outpatient,,,451.00000,97.42000,Banner Health,Banner Choice Plus/Banner Select,,157.85,,,,,,,117.26,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,outpatient,,,1148.00000,247.97000,Banner Health,Banner Choice Plus/Banner Select,,401.80,,,,,,,298.48,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,outpatient,,,350.00000,75.60000,Banner Health,Banner Choice Plus/Banner Select,,122.50,,,,,,,91.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,outpatient,,,423.00000,91.37000,Banner Health,Banner Choice Plus/Banner Select,,148.05,,,,,,,109.98,410.31,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Banner Health,Banner Choice Plus/Banner Select,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Banner Health,Banner Choice Plus/Banner Select,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,outpatient,,,119.00000,25.70000,Banner Health,Banner Choice Plus/Banner Select,,41.65,,,,,,,30.94,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,outpatient,,,126.00000,27.22000,Banner Health,Banner Choice Plus/Banner Select,,44.10,,,,,,,32.76,122.22,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Banner Health,Banner Choice Plus/Banner Select,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Banner Health,Banner Choice Plus/Banner Select,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,outpatient,,,79.00000,17.06000,Banner Health,Banner Choice Plus/Banner Select,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Banner Health,Banner Choice Plus/Banner Select,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Banner Health,Banner Choice Plus/Banner Select,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,outpatient,,,79.00000,17.06000,Banner Health,Banner Choice Plus/Banner Select,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,outpatient,,,335.00000,72.36000,Banner Health,Banner Choice Plus/Banner Select,,117.25,,,,,,,87.10,324.95,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Banner Health,Banner Choice Plus/Banner Select,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Banner Health,Banner Choice Plus/Banner Select,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,outpatient,,,128.00000,27.65000,Banner Health,Banner Choice Plus/Banner Select,,44.80,,,,,,,33.28,124.16,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,outpatient,,,65.00000,14.04000,Banner Health,Banner Choice Plus/Banner Select,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,outpatient,,,272.00000,58.75000,Banner Health,Banner Choice Plus/Banner Select,,95.20,,,,,,,70.72,263.84,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,outpatient,,,26.00000,11.44000,Banner Health,Banner Choice Plus/Banner Select,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,outpatient,,,359.00000,157.96000,Banner Health,Banner Choice Plus/Banner Select,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,outpatient,,,189.00000,83.16000,Banner Health,Banner Choice Plus/Banner Select,,66.15,,,,,,,49.14,183.33,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,outpatient,,,359.00000,157.96000,Banner Health,Banner Choice Plus/Banner Select,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,outpatient,,,137.00000,60.28000,Banner Health,Banner Choice Plus/Banner Select,,47.95,,,,,,,35.62,132.89,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,outpatient,,,1665.00000,732.60000,Banner Health,Banner Choice Plus/Banner Select,,582.75,,,,,,,432.90,1615.05,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,outpatient,,,751.00000,330.44000,Banner Health,Banner Choice Plus/Banner Select,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,outpatient,,,374.00000,164.56000,Banner Health,Banner Choice Plus/Banner Select,,130.90,,,,,,,97.24,362.78,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,outpatient,,,553.00000,243.32000,Banner Health,Banner Choice Plus/Banner Select,,193.55,,,,,,,143.78,536.41,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,outpatient,,,359.00000,157.96000,Banner Health,Banner Choice Plus/Banner Select,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,outpatient,,,62.00000,27.28000,Banner Health,Banner Choice Plus/Banner Select,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,outpatient,,,79.00000,34.76000,Banner Health,Banner Choice Plus/Banner Select,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,outpatient,,,110.00000,48.40000,Banner Health,Banner Choice Plus/Banner Select,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,outpatient,,,110.00000,48.40000,Banner Health,Banner Choice Plus/Banner Select,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,outpatient,,,751.00000,330.44000,Banner Health,Banner Choice Plus/Banner Select,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,outpatient,,,1665.00000,732.60000,Banner Health,Banner Choice Plus/Banner Select,,582.75,,,,,,,432.90,1615.05,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,outpatient,,,110.00000,48.40000,Banner Health,Banner Choice Plus/Banner Select,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Banner Health,Banner Choice Plus/Banner Select,,98.35,,,,,,,73.06,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Banner Health,Banner Choice Plus/Banner Select,,98.35,,,,,,,73.06,272.57,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,outpatient,,,451.00000,341.41000,Banner Health,Banner Choice Plus/Banner Select,,157.85,,,,,,,117.26,437.47,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,outpatient,,,300.00000,145.80000,Banner Health,Banner Choice Plus/Banner Select,,105.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,outpatient,,,2278.00000,1107.11000,Banner Health,Banner Choice Plus/Banner Select,,797.30,,,,,,,592.28,2209.66,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,outpatient,,,3912.00000,1901.23000,Banner Health,Banner Choice Plus/Banner Select,,1369.20,,,,,,,1017.12,3794.64,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,outpatient,,,900.00000,437.40000,Banner Health,Banner Choice Plus/Banner Select,,315.00,,,,,,,234.00,873.00,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,outpatient,,,365.00000,177.39000,Banner Health,Banner Choice Plus/Banner Select,,127.75,,,,,,,94.90,354.05,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,outpatient,,,989.00000,480.65000,Banner Health,Banner Choice Plus/Banner Select,,346.15,,,,,,,257.14,959.33,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Banner Health,Banner Choice Plus/Banner Select,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Banner Health,Banner Choice Plus/Banner Select,,152.25,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Banner Health,Banner Choice Plus/Banner Select,,152.25,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,outpatient,,,644.00000,312.98000,Banner Health,Banner Choice Plus/Banner Select,,225.40,,,,,,,167.44,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Banner Health,Banner Choice Plus/Banner Select,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Banner Health,Banner Choice Plus/Banner Select,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,outpatient,,,527.00000,256.12000,Banner Health,Banner Choice Plus/Banner Select,,184.45,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,outpatient,,,1404.00000,682.34000,Banner Health,Banner Choice Plus/Banner Select,,491.40,,,,,,,365.04,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,outpatient,,,5475.00000,2660.85000,Banner Health,Banner Choice Plus/Banner Select,,1916.25,,,,,,,1423.50,5310.75,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,outpatient,,,726.00000,352.84000,Banner Health,Banner Choice Plus/Banner Select,,254.10,,,,,,,188.76,704.22,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,outpatient,,,507.00000,246.40000,Banner Health,Banner Choice Plus/Banner Select,,177.45,,,,,,,131.82,491.79,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,outpatient,,,1670.00000,811.62000,Banner Health,Banner Choice Plus/Banner Select,,584.50,,,,,,,434.20,1619.90,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,outpatient,,,1139.00000,553.55000,Banner Health,Banner Choice Plus/Banner Select,,398.65,,,,,,,296.14,1104.83,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,outpatient,,,875.00000,425.25000,Banner Health,Banner Choice Plus/Banner Select,,306.25,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,outpatient,,,525.00000,255.15000,Banner Health,Banner Choice Plus/Banner Select,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,outpatient,,,1353.00000,657.56000,Banner Health,Banner Choice Plus/Banner Select,,473.55,,,,,,,351.78,1312.41,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,outpatient,,,525.00000,255.15000,Banner Health,Banner Choice Plus/Banner Select,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,outpatient,,,525.00000,255.15000,Banner Health,Banner Choice Plus/Banner Select,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,outpatient,,,825.00000,400.95000,Banner Health,Banner Choice Plus/Banner Select,,288.75,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Banner Health,Banner Choice Plus/Banner Select,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Banner Health,Banner Choice Plus/Banner Select,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,outpatient,,,974.00000,473.36000,Banner Health,Banner Choice Plus/Banner Select,,340.90,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Banner Health,Banner Choice Plus/Banner Select,,69.30,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Banner Health,Banner Choice Plus/Banner Select,,69.30,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Banner Health,Banner Choice Plus/Banner Select,,77.35,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Banner Health,Banner Choice Plus/Banner Select,,77.35,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,outpatient,,,497.00000,241.54000,Banner Health,Banner Choice Plus/Banner Select,,173.95,,,,,,,129.22,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,outpatient,,,2340.00000,1137.24000,Banner Health,Banner Choice Plus/Banner Select,,819.00,,,,,,,608.40,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,outpatient,,,249.00000,121.01000,Banner Health,Banner Choice Plus/Banner Select,,87.15,,,,,,,64.74,241.53,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,outpatient,,,135.00000,65.61000,Banner Health,Banner Choice Plus/Banner Select,,47.25,,,,,,,35.10,130.95,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,outpatient,,,172.00000,83.59000,Banner Health,Banner Choice Plus/Banner Select,,60.20,,,,,,,44.72,166.84,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,outpatient,,,307.00000,149.20000,Banner Health,Banner Choice Plus/Banner Select,,107.45,,,,,,,79.82,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,outpatient,,,1800.00000,874.80000,Banner Health,Banner Choice Plus/Banner Select,,630.00,,,,,,,468.00,1746.00,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,outpatient,,,974.00000,473.36000,Banner Health,Banner Choice Plus/Banner Select,,340.90,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Banner Health,Banner Choice Plus/Banner Select,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Banner Health,Banner Choice Plus/Banner Select,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,outpatient,,,411.00000,199.75000,Banner Health,Banner Choice Plus/Banner Select,,143.85,,,,,,,106.86,398.67,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,outpatient,,,221.00000,107.41000,Banner Health,Banner Choice Plus/Banner Select,,77.35,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,outpatient,,,884.00000,429.62000,Banner Health,Banner Choice Plus/Banner Select,,309.40,,,,,,,229.84,857.48,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,outpatient,,,594.00000,288.68000,Banner Health,Banner Choice Plus/Banner Select,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,outpatient,,,519.00000,252.23000,Banner Health,Banner Choice Plus/Banner Select,,181.65,,,,,,,134.94,503.43,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,outpatient,,,1046.00000,508.36000,Banner Health,Banner Choice Plus/Banner Select,,366.10,,,,,,,271.96,1014.62,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,outpatient,,,556.00000,270.22000,Banner Health,Banner Choice Plus/Banner Select,,194.60,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,outpatient,,,275.00000,133.65000,Banner Health,Banner Choice Plus/Banner Select,,96.25,,,,,,,71.50,266.75,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,outpatient,,,580.00000,281.88000,Banner Health,Banner Choice Plus/Banner Select,,203.00,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,outpatient,,,580.00000,281.88000,Banner Health,Banner Choice Plus/Banner Select,,203.00,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Banner Health,Banner Choice Plus/Banner Select,,1218.00,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Banner Health,Banner Choice Plus/Banner Select,,1218.00,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,outpatient,,,700.00000,340.20000,Banner Health,Banner Choice Plus/Banner Select,,245.00,,,,,,,182.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,outpatient,,,1427.00000,693.52000,Banner Health,Banner Choice Plus/Banner Select,,499.45,,,,,,,371.02,1384.19,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,outpatient,,,614.00000,298.40000,Banner Health,Banner Choice Plus/Banner Select,,214.90,,,,,,,159.64,595.58,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,outpatient,,,2027.00000,985.12000,Banner Health,Banner Choice Plus/Banner Select,,709.45,,,,,,,527.02,1966.19,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,outpatient,,,556.00000,270.22000,Banner Health,Banner Choice Plus/Banner Select,,194.60,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,outpatient,,,1146.00000,556.96000,Banner Health,Banner Choice Plus/Banner Select,,401.10,,,,,,,297.96,1111.62,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Banner Health,Banner Choice Plus/Banner Select,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Banner Health,Banner Choice Plus/Banner Select,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,outpatient,,,527.00000,256.12000,Banner Health,Banner Choice Plus/Banner Select,,184.45,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,outpatient,,,740.00000,359.64000,Banner Health,Banner Choice Plus/Banner Select,,259.00,,,,,,,192.40,717.80,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Banner Health,Banner Choice Plus/Banner Select,,306.25,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Banner Health,Banner Choice Plus/Banner Select,,306.25,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,outpatient,,,1399.00000,679.91000,Banner Health,Banner Choice Plus/Banner Select,,489.65,,,,,,,363.74,1357.03,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,outpatient,,,51.00000,24.79000,Banner Health,Banner Choice Plus/Banner Select,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,outpatient,,,825.00000,400.95000,Banner Health,Banner Choice Plus/Banner Select,,288.75,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,outpatient,,,576.00000,279.94000,Banner Health,Banner Choice Plus/Banner Select,,201.60,,,,,,,149.76,558.72,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,outpatient,,,224.00000,108.86000,Banner Health,Banner Choice Plus/Banner Select,,78.40,,,,,,,58.24,217.28,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,outpatient,,,346.00000,168.16000,Banner Health,Banner Choice Plus/Banner Select,,121.10,,,,,,,89.96,335.62,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,outpatient,,,525.00000,255.15000,Banner Health,Banner Choice Plus/Banner Select,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,outpatient,,,525.00000,255.15000,Banner Health,Banner Choice Plus/Banner Select,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Banner Health,Banner Choice Plus/Banner Select,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Banner Health,Banner Choice Plus/Banner Select,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,outpatient,,,627.00000,304.72000,Banner Health,Banner Choice Plus/Banner Select,,219.45,,,,,,,163.02,608.19,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,outpatient,,,605.00000,294.03000,Banner Health,Banner Choice Plus/Banner Select,,211.75,,,,,,,157.30,586.85,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,outpatient,,,510.00000,247.86000,Banner Health,Banner Choice Plus/Banner Select,,178.50,,,,,,,132.60,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,outpatient,,,223.00000,108.38000,Banner Health,Banner Choice Plus/Banner Select,,78.05,,,,,,,57.98,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,outpatient,,,1211.00000,588.55000,Banner Health,Banner Choice Plus/Banner Select,,423.85,,,,,,,314.86,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,outpatient,,,383.00000,186.14000,Banner Health,Banner Choice Plus/Banner Select,,134.05,,,,,,,99.58,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,outpatient,,,1214.00000,590.00000,Banner Health,Banner Choice Plus/Banner Select,,424.90,,,,,,,315.64,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,outpatient,,,328.00000,159.41000,Banner Health,Banner Choice Plus/Banner Select,,114.80,,,,,,,85.28,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,outpatient,,,372.00000,180.79000,Banner Health,Banner Choice Plus/Banner Select,,130.20,,,,,,,96.72,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,outpatient,,,285.00000,138.51000,Banner Health,Banner Choice Plus/Banner Select,,99.75,,,,,,,74.10,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,outpatient,,,367.00000,178.36000,Banner Health,Banner Choice Plus/Banner Select,,128.45,,,,,,,95.42,355.99,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Banner Health,Banner Choice Plus/Banner Select,,245.70,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Banner Health,Banner Choice Plus/Banner Select,,245.70,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,outpatient,,,265.00000,128.79000,Banner Health,Banner Choice Plus/Banner Select,,92.75,,,,,,,68.90,257.05,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2279.00000,1107.59000,Banner Health,Banner Choice Plus/Banner Select,,797.65,,,,,,,592.54,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2395.00000,1163.97000,Banner Health,Banner Choice Plus/Banner Select,,838.25,,,,,,,622.70,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Banner Health,Banner Choice Plus/Banner Select,,3065.65,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Banner Health,Banner Choice Plus/Banner Select,,3065.65,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,outpatient,,,2752.00000,1337.47000,Banner Health,Banner Choice Plus/Banner Select,,963.20,,,,,,,715.52,2669.44,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Banner Health,Banner Choice Plus/Banner Select,,75.95,,,,,,,56.42,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Banner Health,Banner Choice Plus/Banner Select,,75.95,,,,,,,56.42,210.49,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,outpatient,,,292.00000,141.91000,Banner Health,Banner Choice Plus/Banner Select,,102.20,,,,,,,75.92,283.24,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Banner Health,Banner Choice Plus/Banner Select,,143.85,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Banner Health,Banner Choice Plus/Banner Select,,143.85,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Banner Health,Banner Choice Plus/Banner Select,,143.85,,,,,,,106.86,398.67,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,outpatient,,,2275.00000,1105.65000,Banner Health,Banner Choice Plus/Banner Select,,796.25,,,,,,,591.50,2206.75,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,outpatient,,,192.00000,93.31000,Banner Health,Banner Choice Plus/Banner Select,,67.20,,,,,,,49.92,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,outpatient,,,451.00000,219.19000,Banner Health,Banner Choice Plus/Banner Select,,157.85,,,,,,,117.26,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,outpatient,,,617.00000,299.86000,Banner Health,Banner Choice Plus/Banner Select,,215.95,,,,,,,160.42,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,outpatient,,,825.00000,400.95000,Banner Health,Banner Choice Plus/Banner Select,,288.75,,,,,,,214.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,outpatient,,,905.00000,439.83000,Banner Health,Banner Choice Plus/Banner Select,,316.75,,,,,,,235.30,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,outpatient,,,849.00000,412.61000,Banner Health,Banner Choice Plus/Banner Select,,297.15,,,,,,,220.74,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,outpatient,,,2539.00000,1233.95000,Banner Health,Banner Choice Plus/Banner Select,,888.65,,,,,,,660.14,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,outpatient,,,6000.00000,2916.00000,Banner Health,Banner Choice Plus/Banner Select,,2100.00,,,,,,,1560.00,5820.00,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,outpatient,,,8260.00000,4014.36000,Banner Health,Banner Choice Plus/Banner Select,,2891.00,,,,,,,2147.60,8012.20,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,outpatient,,,202.00000,88.88000,Banner Health,Banner Choice Plus/Banner Select,,70.70,,,,,,,52.52,195.94,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,outpatient,,,66.00000,31.81000,Banner Health,Banner Choice Plus/Banner Select,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,outpatient,,,295.00000,142.19000,Banner Health,Banner Choice Plus/Banner Select,,103.25,,,,,,,76.70,286.15,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,89.00000,26.79000,Banner Health,Banner Choice Plus/Banner Select,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Banner Health,Banner Choice Plus/Banner Select,,32.55,,,,,,,24.18,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Banner Health,Banner Choice Plus/Banner Select,,32.55,,,,,,,24.18,90.21,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Banner Health,Banner Choice Plus/Banner Select,,656.25,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Banner Health,Banner Choice Plus/Banner Select,,656.25,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Banner Health,Banner Choice Plus/Banner Select,,613.20,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Banner Health,Banner Choice Plus/Banner Select,,613.20,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,731.00000,220.03000,Banner Health,Banner Choice Plus/Banner Select,,255.85,,,,,,,190.06,709.07,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,787.00000,236.89000,Banner Health,Banner Choice Plus/Banner Select,,275.45,,,,,,,204.62,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,2042.00000,614.64000,Banner Health,Banner Choice Plus/Banner Select,,714.70,,,,,,,530.92,1980.74,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Banner Health,Banner Choice Plus/Banner Select,,656.25,,,,,,,487.50,1818.75,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,714.00000,214.91000,Banner Health,Banner Choice Plus/Banner Select,,249.90,,,,,,,185.64,692.58,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,294.00000,88.49000,Banner Health,Banner Choice Plus/Banner Select,,102.90,,,,,,,76.44,285.18,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,350.00000,105.35000,Banner Health,Banner Choice Plus/Banner Select,,122.50,,,,,,,91.00,339.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,outpatient,,,1350.00000,780.30000,Banner Health,Banner Choice Plus/Banner Select,,472.50,,,,,,,351.00,1309.50,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,outpatient,,,3680.00000,2127.04000,Banner Health,Banner Choice Plus/Banner Select,,1288.00,,,,,,,956.80,3569.60,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,outpatient,,,1600.00000,924.80000,Banner Health,Banner Choice Plus/Banner Select,,560.00,,,,,,,416.00,1552.00,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,outpatient,,,4680.00000,2705.04000,Banner Health,Banner Choice Plus/Banner Select,,1638.00,,,,,,,1216.80,4539.60,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,outpatient,,,2100.00000,1213.80000,Banner Health,Banner Choice Plus/Banner Select,,735.00,,,,,,,546.00,2037.00,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,outpatient,,,5680.00000,3283.04000,Banner Health,Banner Choice Plus/Banner Select,,1988.00,,,,,,,1476.80,5509.60,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,outpatient,,,2420.00000,1398.76000,Banner Health,Banner Choice Plus/Banner Select,,847.00,,,,,,,629.20,2347.40,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,outpatient,,,6415.00000,3707.87000,Banner Health,Banner Choice Plus/Banner Select,,2245.25,,,,,,,1667.90,6222.55,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,outpatient,,,2920.00000,1687.76000,Banner Health,Banner Choice Plus/Banner Select,,1022.00,,,,,,,759.20,2832.40,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,outpatient,,,8915.00000,5152.87000,Banner Health,Banner Choice Plus/Banner Select,,3120.25,,,,,,,2317.90,8647.55,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,outpatient,,,3420.00000,1976.76000,Banner Health,Banner Choice Plus/Banner Select,,1197.00,,,,,,,889.20,3317.40,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,outpatient,,,11415.00000,6597.87000,Banner Health,Banner Choice Plus/Banner Select,,3995.25,,,,,,,2967.90,11072.55,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,outpatient,,,142.00000,154.35000,Banner Health,Banner Choice Plus/Banner Select,,49.70,,,,,,,36.92,137.74,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Banner Health,Banner Choice Plus/Banner Select,,119.00,,,,,,,88.40,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Banner Health,Banner Choice Plus/Banner Select,,234.50,,,,,,,174.20,649.90,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,outpatient,,,390.00000,262.47000,Banner Health,Banner Choice Plus/Banner Select,,136.50,,,,,,,101.40,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,outpatient,,,1170.00000,787.41000,Banner Health,Banner Choice Plus/Banner Select,,409.50,,,,,,,304.20,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,outpatient,,,440.00000,296.12000,Banner Health,Banner Choice Plus/Banner Select,,154.00,,,,,,,114.40,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,outpatient,,,1670.00000,1123.91000,Banner Health,Banner Choice Plus/Banner Select,,584.50,,,,,,,434.20,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,outpatient,,,640.00000,430.72000,Banner Health,Banner Choice Plus/Banner Select,,224.00,,,,,,,166.40,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,outpatient,,,2170.00000,1460.41000,Banner Health,Banner Choice Plus/Banner Select,,759.50,,,,,,,564.20,2104.90,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,outpatient,,,17.00000,10.96000,Banner Health,Banner Choice Plus/Banner Select,,5.95,,,,,,,4.42,16.49,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,outpatient,,,535.00000,345.08000,Banner Health,Banner Choice Plus/Banner Select,,187.25,,,,,,,139.10,518.95,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,outpatient,,,23.00000,14.84000,Banner Health,Banner Choice Plus/Banner Select,,8.05,,,,,,,5.98,22.31,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,outpatient,,,635.00000,409.58000,Banner Health,Banner Choice Plus/Banner Select,,222.25,,,,,,,165.10,615.95,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,outpatient,,,30.00000,19.35000,Banner Health,Banner Choice Plus/Banner Select,,10.50,,,,,,,7.80,29.10,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,outpatient,,,735.00000,474.08000,Banner Health,Banner Choice Plus/Banner Select,,257.25,,,,,,,191.10,712.95,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,outpatient,,,33.00000,21.28000,Banner Health,Banner Choice Plus/Banner Select,,11.55,,,,,,,8.58,32.01,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,outpatient,,,835.00000,538.58000,Banner Health,Banner Choice Plus/Banner Select,,292.25,,,,,,,217.10,809.95,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,outpatient,,,140.00000,80.92000,Banner Health,Banner Choice Plus/Banner Select,,49.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,outpatient,,,275.00000,158.95000,Banner Health,Banner Choice Plus/Banner Select,,96.25,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,outpatient,,,295.00000,170.51000,Banner Health,Banner Choice Plus/Banner Select,,103.25,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,outpatient,,,590.00000,341.02000,Banner Health,Banner Choice Plus/Banner Select,,206.50,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,outpatient,,,690.00000,398.82000,Banner Health,Banner Choice Plus/Banner Select,,241.50,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,outpatient,,,1375.00000,794.75000,Banner Health,Banner Choice Plus/Banner Select,,481.25,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,outpatient,,,950.00000,549.10000,Banner Health,Banner Choice Plus/Banner Select,,332.50,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,outpatient,,,1900.00000,1098.20000,Banner Health,Banner Choice Plus/Banner Select,,665.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,outpatient,,,140.00000,45.22000,Banner Health,Banner Choice Plus/Banner Select,,49.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,outpatient,,,275.00000,88.82000,Banner Health,Banner Choice Plus/Banner Select,,96.25,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,outpatient,,,295.00000,95.28000,Banner Health,Banner Choice Plus/Banner Select,,103.25,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,outpatient,,,590.00000,190.57000,Banner Health,Banner Choice Plus/Banner Select,,206.50,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,outpatient,,,690.00000,222.87000,Banner Health,Banner Choice Plus/Banner Select,,241.50,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,outpatient,,,1375.00000,444.12000,Banner Health,Banner Choice Plus/Banner Select,,481.25,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,outpatient,,,950.00000,306.85000,Banner Health,Banner Choice Plus/Banner Select,,332.50,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,outpatient,,,1900.00000,613.70000,Banner Health,Banner Choice Plus/Banner Select,,665.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Banner Health,Banner Choice Plus/Banner Select,,119.00,,,,,,,88.40,329.80,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Banner Health,Banner Choice Plus/Banner Select,,234.50,,,,,,,174.20,649.90,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Banner Health,Banner Choice Plus/Banner Select,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Banner Health,Banner Choice Plus/Banner Select,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Banner Health,Banner Choice Plus/Banner Select,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Banner Health,Banner Choice Plus/Banner Select,,85.75,,,,,,,63.70,237.65,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Banner Health,Banner Choice Plus/Banner Select,,294.70,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Banner Health,Banner Choice Plus/Banner Select,,368.55,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Banner Health,Banner Choice Plus/Banner Select,,442.05,,,,,,,328.38,1225.11,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1178.00000,669.28000,Banner Health,Banner Choice Plus/Banner Select,,412.30,,,,,,,306.28,1142.66,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,outpatient,,,140.00000,102.34000,Banner Health,Banner Choice Plus/Banner Select,,49.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,outpatient,,,275.00000,201.02000,Banner Health,Banner Choice Plus/Banner Select,,96.25,,,,,,,71.50,266.75,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,outpatient,,,295.00000,215.64000,Banner Health,Banner Choice Plus/Banner Select,,103.25,,,,,,,76.70,286.15,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,outpatient,,,590.00000,431.29000,Banner Health,Banner Choice Plus/Banner Select,,206.50,,,,,,,153.40,572.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,outpatient,,,690.00000,504.39000,Banner Health,Banner Choice Plus/Banner Select,,241.50,,,,,,,179.40,669.30,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,outpatient,,,1375.00000,1005.12000,Banner Health,Banner Choice Plus/Banner Select,,481.25,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,outpatient,,,950.00000,694.45000,Banner Health,Banner Choice Plus/Banner Select,,332.50,,,,,,,247.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,outpatient,,,1900.00000,1388.90000,Banner Health,Banner Choice Plus/Banner Select,,665.00,,,,,,,494.00,1843.00,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,outpatient,,,584.00000,426.90000,Banner Health,Banner Choice Plus/Banner Select,,204.40,,,,,,,151.84,566.48,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,outpatient,,,1391.00000,1016.82000,Banner Health,Banner Choice Plus/Banner Select,,486.85,,,,,,,361.66,1349.27,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,outpatient,,,359.00000,271.76000,Banner Health,Banner Choice Plus/Banner Select,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,outpatient,,,95.00000,71.92000,Banner Health,Banner Choice Plus/Banner Select,,33.25,,,,,,,24.70,92.15,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,outpatient,,,37.00000,17.83000,Banner Health,Banner Choice Plus/Banner Select,,12.95,,,,,,,9.62,35.89,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Banner Health,Banner Choice Plus/Banner Select,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Banner Health,Banner Choice Plus/Banner Select,,82.95,,,,,,,61.62,229.89,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,outpatient,,,33.00000,15.91000,Banner Health,Banner Choice Plus/Banner Select,,11.55,,,,,,,8.58,32.01,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,outpatient,,,25.00000,12.05000,Banner Health,Banner Choice Plus/Banner Select,,8.75,,,,,,,6.50,24.25,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,outpatient,,,497.00000,160.53000,Banner Health,Banner Choice Plus/Banner Select,,173.95,,,,,,,129.22,482.09,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Banner Health,Banner Choice Plus/Banner Select,,308.70,,,,,,,229.32,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Banner Health,Banner Choice Plus/Banner Select,,308.70,,,,,,,229.32,855.54,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Banner Health,Banner Choice Plus/Banner Select,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Banner Health,Banner Choice Plus/Banner Select,,33.60,,,,,,,24.96,93.12,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Banner Health,Banner Choice Plus/Banner Select,,308.70,,,,,,,229.32,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Banner Health,Banner Choice Plus/Banner Select,,308.70,,,,,,,229.32,855.54,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,outpatient,,,763.00000,291.47000,Banner Health,Banner Choice Plus/Banner Select,,267.05,,,,,,,198.38,740.11,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,outpatient,,,199.00000,76.02000,Banner Health,Banner Choice Plus/Banner Select,,69.65,,,,,,,51.74,193.03,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Banner Health,Banner Choice Plus/Banner Select,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Banner Health,Banner Choice Plus/Banner Select,,33.60,,,,,,,24.96,93.12,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,outpatient,,,1265.00000,483.23000,Banner Health,Banner Choice Plus/Banner Select,,442.75,,,,,,,328.90,1227.05,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,outpatient,,,924.00000,352.97000,Banner Health,Banner Choice Plus/Banner Select,,323.40,,,,,,,240.24,896.28,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,outpatient,,,580.00000,215.76000,Banner Health,Banner Choice Plus/Banner Select,,203.00,,,,,,,150.80,562.60,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,outpatient,,,110.00000,40.92000,Banner Health,Banner Choice Plus/Banner Select,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,outpatient,,,373.00000,138.76000,Banner Health,Banner Choice Plus/Banner Select,,130.55,,,,,,,96.98,361.81,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,outpatient,,,337.00000,125.36000,Banner Health,Banner Choice Plus/Banner Select,,117.95,,,,,,,87.62,326.89,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,outpatient,,,784.00000,291.65000,Banner Health,Banner Choice Plus/Banner Select,,274.40,,,,,,,203.84,760.48,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,outpatient,,,341.00000,126.85000,Banner Health,Banner Choice Plus/Banner Select,,119.35,,,,,,,88.66,330.77,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,outpatient,,,252.00000,93.74000,Banner Health,Banner Choice Plus/Banner Select,,88.20,,,,,,,65.52,244.44,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,outpatient,,,282.00000,104.90000,Banner Health,Banner Choice Plus/Banner Select,,98.70,,,,,,,73.32,273.54,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,outpatient,,,404.00000,150.29000,Banner Health,Banner Choice Plus/Banner Select,,141.40,,,,,,,105.04,391.88,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,outpatient,,,306.00000,173.85000,Banner Health,Banner Choice Plus/Banner Select,,107.10,,,,,,,79.56,296.82,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,outpatient,,,158.00000,89.77000,Banner Health,Banner Choice Plus/Banner Select,,55.30,,,,,,,41.08,153.26,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Banner Health,Banner Choice Plus/Banner Select,GP,51.45,,,,,,,38.22,142.59,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Banner Health,Banner Choice Plus/Banner Select,GP,94.50,,,,,,,70.20,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Banner Health,Banner Choice Plus/Banner Select,GP,29.40,,,,,,,21.84,81.48,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Banner Health,Banner Choice Plus/Banner Select,GP,30.10,,,,,,,22.36,83.42,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Banner Health,Banner Choice Plus/Banner Select,GP,28.70,,,,,,,21.32,79.54,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Banner Health,Banner Choice Plus/Banner Select,GP,29.75,,,,,,,22.10,82.45,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Banner Health,Banner Choice Plus/Banner Select,GP,15.05,,,,,,,11.18,41.71,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Banner Health,Banner Choice Plus/Banner Select,GP,14.35,,,,,,,10.66,39.77,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Banner Health,Banner Choice Plus/Banner Select,GP,27.65,,,,,,,20.54,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Banner Health,Banner Choice Plus/Banner Select,GP,25.90,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Banner Health,Banner Choice Plus/Banner Select,GP,25.90,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Banner Health,Banner Choice Plus/Banner Select,GP,11.90,,,,,,,8.84,32.98,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Banner Health,Banner Choice Plus/Banner Select,GP,22.75,,,,,,,16.90,63.05,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,outpatient,,,113.00000,68.70000,Banner Health,Banner Choice Plus/Banner Select,,39.55,,,,,,,29.38,109.61,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Banner Health,Banner Choice Plus/Banner Select,GP,28.00,,,,,,,20.80,77.60,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Banner Health,Banner Choice Plus/Banner Select,GP,29.40,,,,,,,21.84,81.48,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Banner Health,Banner Choice Plus/Banner Select,GP,25.55,,,,,,,18.98,70.81,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,outpatient,,,100.00000,60.80000,Banner Health,Banner Choice Plus/Banner Select,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,outpatient,,,167.00000,101.54000,Banner Health,Banner Choice Plus/Banner Select,GP,58.45,,,,,,,43.42,161.99,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Banner Health,Banner Choice Plus/Banner Select,"50,GP",144.55,,,,,,,107.38,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Banner Health,Banner Choice Plus/Banner Select,"LT,GP",96.25,,,,,,,71.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Banner Health,Banner Choice Plus/Banner Select,"RT,GP",96.25,,,,,,,71.50,266.75,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Banner Health,Banner Choice Plus/Banner Select,GP,33.25,,,,,,,24.70,92.15,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Banner Health,Banner Choice Plus/Banner Select,GP,51.10,,,,,,,37.96,141.62,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Banner Health,Banner Choice Plus/Banner Select,GP,48.65,,,,,,,36.14,134.83,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Banner Health,Banner Choice Plus/Banner Select,GP,26.25,,,,,,,19.50,72.75,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Banner Health,Banner Choice Plus/Banner Select,GP,53.90,,,,,,,40.04,149.38,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Banner Health,Banner Choice Plus/Banner Select,GP,25.55,,,,,,,18.98,70.81,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Banner Health,Banner Choice Plus/Banner Select,GP,56.00,,,,,,,41.60,155.20,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Banner Health,Banner Choice Plus/Banner Select,GP,113.75,,,,,,,84.50,315.25,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,outpatient,,,98.00000,59.58000,Banner Health,Banner Choice Plus/Banner Select,GP,34.30,,,,,,,25.48,95.06,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,outpatient,,,303.00000,184.22000,Banner Health,Banner Choice Plus/Banner Select,GP,106.05,,,,,,,78.78,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,outpatient,,,115.00000,69.92000,Banner Health,Banner Choice Plus/Banner Select,GP,40.25,,,,,,,29.90,111.55,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Banner Health,Banner Choice Plus/Banner Select,GP,25.90,,,,,,,19.24,71.78,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Banner Health,Banner Choice Plus/Banner Select,GP,27.65,,,,,,,20.54,76.63,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Banner Health,Banner Choice Plus/Banner Select,GP,25.20,,,,,,,18.72,69.84,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Banner Health,Banner Choice Plus/Banner Select,GP,51.45,,,,,,,38.22,142.59,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Banner Health,Banner Choice Plus/Banner Select,GP,94.50,,,,,,,70.20,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Banner Health,Banner Choice Plus/Banner Select,GP,29.40,,,,,,,21.84,81.48,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Banner Health,Banner Choice Plus/Banner Select,GP,30.10,,,,,,,22.36,83.42,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Banner Health,Banner Choice Plus/Banner Select,GP,28.70,,,,,,,21.32,79.54,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Banner Health,Banner Choice Plus/Banner Select,GP,29.75,,,,,,,22.10,82.45,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Banner Health,Banner Choice Plus/Banner Select,GP,15.05,,,,,,,11.18,41.71,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Banner Health,Banner Choice Plus/Banner Select,GP,14.35,,,,,,,10.66,39.77,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Banner Health,Banner Choice Plus/Banner Select,GP,27.65,,,,,,,20.54,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Banner Health,Banner Choice Plus/Banner Select,"CQ,GP",25.90,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Banner Health,Banner Choice Plus/Banner Select,"CQ,GP",25.90,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Banner Health,Banner Choice Plus/Banner Select,GP,11.90,,,,,,,8.84,32.98,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Banner Health,Banner Choice Plus/Banner Select,GP,22.75,,,,,,,16.90,63.05,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Banner Health,Banner Choice Plus/Banner Select,GP,28.00,,,,,,,20.80,77.60,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Banner Health,Banner Choice Plus/Banner Select,GP,29.40,,,,,,,21.84,81.48,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Banner Health,Banner Choice Plus/Banner Select,GP,25.55,,,,,,,18.98,70.81,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Banner Health,Banner Choice Plus/Banner Select,"GP,50",144.55,,,,,,,107.38,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Banner Health,Banner Choice Plus/Banner Select,"GP,LT",96.25,,,,,,,71.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Banner Health,Banner Choice Plus/Banner Select,"GP,RT",96.25,,,,,,,71.50,266.75,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Banner Health,Banner Choice Plus/Banner Select,GP,33.25,,,,,,,24.70,92.15,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Banner Health,Banner Choice Plus/Banner Select,GP,51.10,,,,,,,37.96,141.62,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Banner Health,Banner Choice Plus/Banner Select,GP,48.65,,,,,,,36.14,134.83,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Banner Health,Banner Choice Plus/Banner Select,GP,26.25,,,,,,,19.50,72.75,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Banner Health,Banner Choice Plus/Banner Select,GP,53.90,,,,,,,40.04,149.38,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Banner Health,Banner Choice Plus/Banner Select,GP,25.55,,,,,,,18.98,70.81,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Banner Health,Banner Choice Plus/Banner Select,GP,56.00,,,,,,,41.60,155.20,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Banner Health,Banner Choice Plus/Banner Select,GP,113.75,,,,,,,84.50,315.25,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Banner Health,Banner Choice Plus/Banner Select,GP,25.90,,,,,,,19.24,71.78,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Banner Health,Banner Choice Plus/Banner Select,GP,27.65,,,,,,,20.54,76.63,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Banner Health,Banner Choice Plus/Banner Select,GP,25.20,,,,,,,18.72,69.84,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,outpatient,,,445.00000,262.55000,Banner Health,Banner Choice Plus/Banner Select,GP,155.75,,,,,,,115.70,431.65,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,outpatient,,,310.00000,182.90000,Banner Health,Banner Choice Plus/Banner Select,GP,108.50,,,,,,,80.60,300.70,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,outpatient,,,393.00000,231.87000,Banner Health,Banner Choice Plus/Banner Select,GP,137.55,,,,,,,102.18,381.21,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,outpatient,,,310.00000,182.90000,Banner Health,Banner Choice Plus/Banner Select,GP,108.50,,,,,,,80.60,300.70,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Banner Health,Banner Choice Plus/Banner Select,GO,28.00,,,,,,,20.80,77.60,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Banner Health,Banner Choice Plus/Banner Select,GO,29.40,,,,,,,21.84,81.48,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Banner Health,Banner Choice Plus/Banner Select,GO,44.10,,,,,,,32.76,122.22,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Banner Health,Banner Choice Plus/Banner Select,GO,23.10,,,,,,,17.16,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Banner Health,Banner Choice Plus/Banner Select,GO,21.70,,,,,,,16.12,60.14,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Banner Health,Banner Choice Plus/Banner Select,GO,31.50,,,,,,,23.40,87.30,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Banner Health,Banner Choice Plus/Banner Select,GO,33.25,,,,,,,24.70,92.15,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Banner Health,Banner Choice Plus/Banner Select,GO,51.10,,,,,,,37.96,141.62,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Banner Health,Banner Choice Plus/Banner Select,GO,48.65,,,,,,,36.14,134.83,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Banner Health,Banner Choice Plus/Banner Select,GO,26.25,,,,,,,19.50,72.75,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Banner Health,Banner Choice Plus/Banner Select,GO,53.90,,,,,,,40.04,149.38,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Banner Health,Banner Choice Plus/Banner Select,GO,25.55,,,,,,,18.98,70.81,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Banner Health,Banner Choice Plus/Banner Select,GO,56.00,,,,,,,41.60,155.20,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,outpatient,,,98.00000,37.93000,Banner Health,Banner Choice Plus/Banner Select,GO,34.30,,,,,,,25.48,95.06,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,outpatient,,,303.00000,117.26000,Banner Health,Banner Choice Plus/Banner Select,GO,106.05,,,,,,,78.78,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,outpatient,,,115.00000,44.50000,Banner Health,Banner Choice Plus/Banner Select,GO,40.25,,,,,,,29.90,111.55,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Banner Health,Banner Choice Plus/Banner Select,GO,25.90,,,,,,,19.24,71.78,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Banner Health,Banner Choice Plus/Banner Select,GO,25.20,,,,,,,18.72,69.84,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Banner Health,Banner Choice Plus/Banner Select,"CO,GO",28.00,,,,,,,20.80,77.60,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Banner Health,Banner Choice Plus/Banner Select,"CO,GO",29.40,,,,,,,21.84,81.48,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Banner Health,Banner Choice Plus/Banner Select,"CO,GO",44.10,,,,,,,32.76,122.22,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Banner Health,Banner Choice Plus/Banner Select,"CO,GO",21.70,,,,,,,16.12,60.14,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Banner Health,Banner Choice Plus/Banner Select,"CO,GO",23.10,,,,,,,17.16,64.02,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Banner Health,Banner Choice Plus/Banner Select,"CO,GO",31.50,,,,,,,23.40,87.30,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Banner Health,Banner Choice Plus/Banner Select,"CO,GO",33.25,,,,,,,24.70,92.15,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Banner Health,Banner Choice Plus/Banner Select,"CO,GO",51.10,,,,,,,37.96,141.62,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Banner Health,Banner Choice Plus/Banner Select,"CO,GO",48.65,,,,,,,36.14,134.83,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Banner Health,Banner Choice Plus/Banner Select,"CO,GO",26.25,,,,,,,19.50,72.75,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Banner Health,Banner Choice Plus/Banner Select,"CO,GO",53.90,,,,,,,40.04,149.38,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Banner Health,Banner Choice Plus/Banner Select,"CO,GO",25.55,,,,,,,18.98,70.81,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Banner Health,Banner Choice Plus/Banner Select,"CO,GO",56.00,,,,,,,41.60,155.20,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Banner Health,Banner Choice Plus/Banner Select,"CO,GO",25.90,,,,,,,19.24,71.78,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Banner Health,Banner Choice Plus/Banner Select,"CO,GO",25.20,,,,,,,18.72,69.84,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Banner Health,Banner Choice Plus/Banner Select,GO,16.45,,,,,,,12.22,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Banner Health,Banner Choice Plus/Banner Select,"CO,GO",16.45,,,,,,,12.22,45.59,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,outpatient,,,250.00000,142.04000,Banner Health,Banner Choice Plus/Banner Select,GO,87.50,,,,,,,65.00,242.50,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,outpatient,,,175.00000,99.43000,Banner Health,Banner Choice Plus/Banner Select,GO,61.25,,,,,,,45.50,169.75,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,outpatient,,,233.00000,132.38000,Banner Health,Banner Choice Plus/Banner Select,GO,81.55,,,,,,,60.58,226.01,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,outpatient,,,175.00000,99.43000,Banner Health,Banner Choice Plus/Banner Select,GO,61.25,,,,,,,45.50,169.75,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,outpatient,,,291.00000,93.99000,Banner Health,Banner Choice Plus/Banner Select,,101.85,,,,,,,75.66,282.27,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,outpatient,,,273.00000,155.10000,Banner Health,Banner Choice Plus/Banner Select,GN,95.55,,,,,,,70.98,264.81,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,outpatient,,,279.00000,158.51000,Banner Health,Banner Choice Plus/Banner Select,GN,97.65,,,,,,,72.54,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,outpatient,,,426.00000,242.03000,Banner Health,Banner Choice Plus/Banner Select,GN,149.10,,,,,,,110.76,413.22,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,outpatient,,,242.00000,137.49000,Banner Health,Banner Choice Plus/Banner Select,GN,84.70,,,,,,,62.92,234.74,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,outpatient,,,128.00000,72.72000,Banner Health,Banner Choice Plus/Banner Select,,44.80,,,,,,,33.28,124.16,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,outpatient,,,66.00000,37.50000,Banner Health,Banner Choice Plus/Banner Select,GN,23.10,,,,,,,17.16,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,outpatient,,,62.00000,35.23000,Banner Health,Banner Choice Plus/Banner Select,GN,21.70,,,,,,,16.12,60.14,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,outpatient,,,269.00000,152.83000,Banner Health,Banner Choice Plus/Banner Select,GN,94.15,,,,,,,69.94,260.93,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,outpatient,,,153.00000,86.93000,Banner Health,Banner Choice Plus/Banner Select,GN,53.55,,,,,,,39.78,148.41,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,outpatient,,,98.00000,55.68000,Banner Health,Banner Choice Plus/Banner Select,GN,34.30,,,,,,,25.48,95.06,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,outpatient,,,303.00000,172.15000,Banner Health,Banner Choice Plus/Banner Select,GN,106.05,,,,,,,78.78,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,outpatient,,,115.00000,65.34000,Banner Health,Banner Choice Plus/Banner Select,GN,40.25,,,,,,,29.90,111.55,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,outpatient,,,210.00000,119.31000,Banner Health,Banner Choice Plus/Banner Select,GN,73.50,,,,,,,54.60,203.70,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,outpatient,,,250.00000,142.04000,Banner Health,Banner Choice Plus/Banner Select,GN,87.50,,,,,,,65.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,outpatient,,,78.00000,44.32000,Banner Health,Banner Choice Plus/Banner Select,GN,27.30,,,,,,,20.28,75.66,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,outpatient,,,322.00000,182.94000,Banner Health,Banner Choice Plus/Banner Select,GN,112.70,,,,,,,83.72,312.34,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,outpatient,,,309.00000,175.56000,Banner Health,Banner Choice Plus/Banner Select,GN,108.15,,,,,,,80.34,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,outpatient,,,245.00000,139.20000,Banner Health,Banner Choice Plus/Banner Select,GN,85.75,,,,,,,63.70,237.65,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,outpatient,,,313.00000,116.44000,Banner Health,Banner Choice Plus/Banner Select,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,outpatient,,,1250.00000,632.50000,Banner Health,Banner Choice Plus/Banner Select,,437.50,,,,,,,325.00,1212.50,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Banner Health,Banner Choice Plus/Banner Select,,50.75,,,,,,,37.70,140.65,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Banner Health,Banner Choice Plus/Banner Select,,170.80,,,,,,,126.88,473.36,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,outpatient,,,684.00000,337.90000,Banner Health,Banner Choice Plus/Banner Select,,239.40,,,,,,,177.84,663.48,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,outpatient,,,206.00000,101.76000,Banner Health,Banner Choice Plus/Banner Select,,72.10,,,,,,,53.56,199.82,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,outpatient,,,195.00000,96.33000,Banner Health,Banner Choice Plus/Banner Select,,68.25,,,,,,,50.70,189.15,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,outpatient,,,375.00000,185.25000,Banner Health,Banner Choice Plus/Banner Select,,131.25,,,,,,,97.50,363.75,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,outpatient,,,429.00000,211.93000,Banner Health,Banner Choice Plus/Banner Select,,150.15,,,,,,,111.54,416.13,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22475,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Banner Health,Banner Choice Plus/Banner Select,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B OBSTETRICS SEMI-PVT,42473,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Banner Health,Banner Choice Plus/Banner Select,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B ICU,32474,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Banner Health,Banner Choice Plus/Banner Select,,2935.00,,,,,,,2512.00,8498.17,per diem,
R&B ICU INTERMEDIATE,12476,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Banner Health,Banner Choice Plus/Banner Select,,2935.00,,,,,,,2512.00,5665.77,per diem,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Banner Health,Banner Choice Plus/Banner Select,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Banner Health,Banner Choice Plus/Banner Select,,99.40,,,,,,,73.84,275.48,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Banner Health,Banner Choice Plus/Banner Select,,160.30,,,,,,,119.08,444.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Banner Health,Banner Choice Plus/Banner Select,,195.30,,,,,,,145.08,541.26,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Banner Health,Banner Choice Plus/Banner Select,,168.70,,,,,,,125.32,467.54,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Banner Health,Banner Choice Plus/Banner Select,,82.95,,,,,,,61.62,229.89,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,outpatient,,,490.00000,329.77000,Banner Health,Banner Choice Plus/Banner Select,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,outpatient,,,490.00000,329.77000,Banner Health,Banner Choice Plus/Banner Select,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,outpatient,,,245.00000,164.89000,Banner Health,Banner Choice Plus/Banner Select,,85.75,,,,,,,63.70,237.65,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Banner Health,Banner Choice Plus/Banner Select,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Banner Health,Banner Choice Plus/Banner Select,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Banner Health,Banner Choice Plus/Banner Select,,85.75,,,,,,,63.70,237.65,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Banner Health,Banner Choice Plus/Banner Select,,294.70,,,,,,,218.92,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Banner Health,Banner Choice Plus/Banner Select,,368.55,,,,,,,273.78,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Banner Health,Banner Choice Plus/Banner Select,,442.05,,,,,,,328.38,1225.11,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,outpatient,,,2466.00000,986.40000,Banner Health,Banner Choice Plus/Banner Select,,863.10,,,,,,,641.16,2392.02,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,outpatient,,,260.00000,104.00000,Banner Health,Banner Choice Plus/Banner Select,,91.00,,,,,,,67.60,252.20,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,outpatient,,,2041.00000,816.40000,Banner Health,Banner Choice Plus/Banner Select,,714.35,,,,,,,530.66,1979.77,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,outpatient,,,375.00000,150.00000,Banner Health,Banner Choice Plus/Banner Select,,131.25,,,,,,,97.50,363.75,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,outpatient,,,1178.00000,471.20000,Banner Health,Banner Choice Plus/Banner Select,,412.30,,,,,,,306.28,1142.66,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,outpatient,,,245.00000,98.00000,Banner Health,Banner Choice Plus/Banner Select,,85.75,,,,,,,63.70,237.65,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,outpatient,,,280.00000,112.00000,Banner Health,Banner Choice Plus/Banner Select,,98.00,,,,,,,72.80,271.60,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,outpatient,,,336.00000,134.40000,Banner Health,Banner Choice Plus/Banner Select,,117.60,,,,,,,87.36,325.92,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,outpatient,,,380.00000,152.00000,Banner Health,Banner Choice Plus/Banner Select,,133.00,,,,,,,98.80,368.60,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Banner Health,Banner Choice Plus/Banner Select,,185.50,,,,,,,137.80,514.10,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,outpatient,,,264.00000,105.60000,Banner Health,Banner Choice Plus/Banner Select,,92.40,,,,,,,68.64,256.08,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,outpatient,,,763.00000,305.20000,Banner Health,Banner Choice Plus/Banner Select,,267.05,,,,,,,198.38,740.11,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,outpatient,,,672.00000,268.80000,Banner Health,Banner Choice Plus/Banner Select,,235.20,,,,,,,174.72,651.84,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,outpatient,,,1940.00000,776.00000,Banner Health,Banner Choice Plus/Banner Select,,679.00,,,,,,,504.40,1881.80,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,outpatient,,,3875.00000,1550.00000,Banner Health,Banner Choice Plus/Banner Select,,1356.25,,,,,,,1007.50,3758.75,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,outpatient,,,505.00000,202.00000,Banner Health,Banner Choice Plus/Banner Select,,176.75,,,,,,,131.30,489.85,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Banner Health,Banner Choice Plus/Banner Select,,103.25,,,,,,,76.70,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,outpatient,,,585.00000,234.00000,Banner Health,Banner Choice Plus/Banner Select,,204.75,,,,,,,152.10,567.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,outpatient,,,285.00000,114.00000,Banner Health,Banner Choice Plus/Banner Select,,99.75,,,,,,,74.10,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,outpatient,,,575.00000,230.00000,Banner Health,Banner Choice Plus/Banner Select,,201.25,,,,,,,149.50,557.75,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,outpatient,,,697.00000,278.80000,Banner Health,Banner Choice Plus/Banner Select,,243.95,,,,,,,181.22,676.09,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Banner Health,Banner Choice Plus/Banner Select,,185.50,,,,,,,137.80,514.10,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,outpatient,,,580.00000,232.00000,Banner Health,Banner Choice Plus/Banner Select,,203.00,,,,,,,150.80,562.60,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,outpatient,,,435.00000,174.00000,Banner Health,Banner Choice Plus/Banner Select,,152.25,,,,,,,113.10,421.95,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,outpatient,,,270.00000,108.00000,Banner Health,Banner Choice Plus/Banner Select,,94.50,,,,,,,70.20,261.90,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,outpatient,,,504.00000,201.60000,Banner Health,Banner Choice Plus/Banner Select,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,outpatient,,,98.00000,39.20000,Banner Health,Banner Choice Plus/Banner Select,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,outpatient,,,608.00000,243.20000,Banner Health,Banner Choice Plus/Banner Select,,212.80,,,,,,,158.08,589.76,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,outpatient,,,114.00000,45.60000,Banner Health,Banner Choice Plus/Banner Select,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,outpatient,,,187.00000,74.80000,Banner Health,Banner Choice Plus/Banner Select,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,outpatient,,,214.00000,85.60000,Banner Health,Banner Choice Plus/Banner Select,,74.90,,,,,,,55.64,207.58,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,outpatient,,,863.00000,345.20000,Banner Health,Banner Choice Plus/Banner Select,,302.05,,,,,,,224.38,837.11,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,outpatient,,,453.00000,181.20000,Banner Health,Banner Choice Plus/Banner Select,,158.55,,,,,,,117.78,439.41,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,outpatient,,,144.00000,57.60000,Banner Health,Banner Choice Plus/Banner Select,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,outpatient,,,107.00000,42.80000,Banner Health,Banner Choice Plus/Banner Select,,37.45,,,,,,,27.82,103.79,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,outpatient,,,403.00000,161.20000,Banner Health,Banner Choice Plus/Banner Select,,141.05,,,,,,,104.78,390.91,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,outpatient,,,144.00000,57.60000,Banner Health,Banner Choice Plus/Banner Select,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,outpatient,,,370.00000,148.00000,Banner Health,Banner Choice Plus/Banner Select,,129.50,,,,,,,96.20,358.90,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,outpatient,,,334.00000,133.60000,Banner Health,Banner Choice Plus/Banner Select,,116.90,,,,,,,86.84,323.98,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,outpatient,,,1188.00000,475.20000,Banner Health,Banner Choice Plus/Banner Select,50,415.80,,,,,,,308.88,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Banner Health,Banner Choice Plus/Banner Select,LT,277.20,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Banner Health,Banner Choice Plus/Banner Select,RT,277.20,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,outpatient,,,572.00000,228.80000,Banner Health,Banner Choice Plus/Banner Select,50,200.20,,,,,,,148.72,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Banner Health,Banner Choice Plus/Banner Select,LT,133.35,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Banner Health,Banner Choice Plus/Banner Select,RT,133.35,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,outpatient,,,683.00000,273.20000,Banner Health,Banner Choice Plus/Banner Select,50,239.05,,,,,,,177.58,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Banner Health,Banner Choice Plus/Banner Select,LT,159.25,,,,,,,118.30,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Banner Health,Banner Choice Plus/Banner Select,RT,159.25,,,,,,,118.30,441.35,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,outpatient,,,357.00000,142.80000,Banner Health,Banner Choice Plus/Banner Select,,124.95,,,,,,,92.82,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,outpatient,,,334.00000,133.60000,Banner Health,Banner Choice Plus/Banner Select,,116.90,,,,,,,86.84,323.98,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,outpatient,,,194.00000,77.60000,Banner Health,Banner Choice Plus/Banner Select,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,outpatient,,,608.00000,243.20000,Banner Health,Banner Choice Plus/Banner Select,,212.80,,,,,,,158.08,589.76,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,outpatient,,,257.00000,102.80000,Banner Health,Banner Choice Plus/Banner Select,,89.95,,,,,,,66.82,249.29,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,outpatient,,,343.00000,137.20000,Banner Health,Banner Choice Plus/Banner Select,,120.05,,,,,,,89.18,332.71,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,outpatient,,,457.00000,182.80000,Banner Health,Banner Choice Plus/Banner Select,,159.95,,,,,,,118.82,443.29,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,outpatient,,,630.00000,252.00000,Banner Health,Banner Choice Plus/Banner Select,,220.50,,,,,,,163.80,611.10,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,outpatient,,,623.00000,249.20000,Banner Health,Banner Choice Plus/Banner Select,,218.05,,,,,,,161.98,604.31,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,outpatient,,,1457.00000,582.80000,Banner Health,Banner Choice Plus/Banner Select,,509.95,,,,,,,378.82,1413.29,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,outpatient,,,890.00000,356.00000,Banner Health,Banner Choice Plus/Banner Select,,311.50,,,,,,,231.40,863.30,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,outpatient,,,532.00000,212.80000,Banner Health,Banner Choice Plus/Banner Select,,186.20,,,,,,,138.32,516.04,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,outpatient,,,492.00000,196.80000,Banner Health,Banner Choice Plus/Banner Select,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,outpatient,,,550.00000,220.00000,Banner Health,Banner Choice Plus/Banner Select,,192.50,,,,,,,143.00,533.50,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,outpatient,,,305.00000,122.00000,Banner Health,Banner Choice Plus/Banner Select,,106.75,,,,,,,79.30,295.85,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,outpatient,,,220.00000,88.00000,Banner Health,Banner Choice Plus/Banner Select,,77.00,,,,,,,57.20,213.40,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,outpatient,,,780.00000,312.00000,Banner Health,Banner Choice Plus/Banner Select,,273.00,,,,,,,202.80,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,outpatient,,,1165.00000,466.00000,Banner Health,Banner Choice Plus/Banner Select,,407.75,,,,,,,302.90,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,outpatient,,,2350.00000,940.00000,Banner Health,Banner Choice Plus/Banner Select,,822.50,,,,,,,611.00,2279.50,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,outpatient,,,896.00000,358.40000,Banner Health,Banner Choice Plus/Banner Select,,313.60,,,,,,,232.96,869.12,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,outpatient,,,385.00000,154.00000,Banner Health,Banner Choice Plus/Banner Select,,134.75,,,,,,,100.10,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,outpatient,,,470.00000,188.00000,Banner Health,Banner Choice Plus/Banner Select,,164.50,,,,,,,122.20,455.90,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,outpatient,,,150.00000,60.00000,Banner Health,Banner Choice Plus/Banner Select,,52.50,,,,,,,39.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,outpatient,,,100.00000,40.00000,Banner Health,Banner Choice Plus/Banner Select,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,outpatient,,,143.00000,57.20000,Banner Health,Banner Choice Plus/Banner Select,,50.05,,,,,,,37.18,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,outpatient,,,95.00000,38.00000,Banner Health,Banner Choice Plus/Banner Select,,33.25,,,,,,,24.70,92.15,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,outpatient,,,269.00000,107.60000,Banner Health,Banner Choice Plus/Banner Select,,94.15,,,,,,,69.94,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,outpatient,,,388.00000,155.20000,Banner Health,Banner Choice Plus/Banner Select,,135.80,,,,,,,100.88,376.36,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,outpatient,,,344.00000,137.60000,Banner Health,Banner Choice Plus/Banner Select,,120.40,,,,,,,89.44,333.68,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,outpatient,,,321.00000,128.40000,Banner Health,Banner Choice Plus/Banner Select,,112.35,,,,,,,83.46,311.37,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,outpatient,,,155.00000,62.00000,Banner Health,Banner Choice Plus/Banner Select,,54.25,,,,,,,40.30,150.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,outpatient,,,817.00000,326.80000,Banner Health,Banner Choice Plus/Banner Select,,285.95,,,,,,,212.42,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,outpatient,,,1255.00000,502.00000,Banner Health,Banner Choice Plus/Banner Select,,439.25,,,,,,,326.30,1217.35,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,outpatient,,,391.00000,156.40000,Banner Health,Banner Choice Plus/Banner Select,,136.85,,,,,,,101.66,379.27,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,outpatient,,,671.00000,268.40000,Banner Health,Banner Choice Plus/Banner Select,,234.85,,,,,,,174.46,650.87,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,outpatient,,,456.00000,182.40000,Banner Health,Banner Choice Plus/Banner Select,,159.60,,,,,,,118.56,442.32,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,outpatient,,,112.00000,44.80000,Banner Health,Banner Choice Plus/Banner Select,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,outpatient,,,84.00000,33.60000,Banner Health,Banner Choice Plus/Banner Select,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,outpatient,,,216.00000,86.40000,Banner Health,Banner Choice Plus/Banner Select,,75.60,,,,,,,56.16,209.52,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,outpatient,,,2660.00000,1064.00000,Banner Health,Banner Choice Plus/Banner Select,,931.00,,,,,,,691.60,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,outpatient,,,2960.00000,1184.00000,Banner Health,Banner Choice Plus/Banner Select,,1036.00,,,,,,,769.60,2871.20,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,outpatient,,,3225.00000,1290.00000,Banner Health,Banner Choice Plus/Banner Select,,1128.75,,,,,,,838.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,outpatient,,,3395.00000,1358.00000,Banner Health,Banner Choice Plus/Banner Select,,1188.25,,,,,,,882.70,3293.15,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,outpatient,,,490.00000,196.00000,Banner Health,Banner Choice Plus/Banner Select,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,outpatient,,,520.00000,208.00000,Banner Health,Banner Choice Plus/Banner Select,,182.00,,,,,,,135.20,504.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,outpatient,,,720.00000,288.00000,Banner Health,Banner Choice Plus/Banner Select,,252.00,,,,,,,187.20,698.40,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,outpatient,,,215.00000,86.00000,Banner Health,Banner Choice Plus/Banner Select,,75.25,,,,,,,55.90,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,outpatient,,,240.00000,96.00000,Banner Health,Banner Choice Plus/Banner Select,,84.00,,,,,,,62.40,232.80,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,outpatient,,,1241.00000,496.40000,Banner Health,Banner Choice Plus/Banner Select,,434.35,,,,,,,322.66,1203.77,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,outpatient,,,850.00000,340.00000,Banner Health,Banner Choice Plus/Banner Select,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,outpatient,,,1085.00000,434.00000,Banner Health,Banner Choice Plus/Banner Select,,379.75,,,,,,,282.10,1052.45,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Banner Health,Banner Choice Plus/Banner Select,,103.25,,,,,,,76.70,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,outpatient,,,492.00000,196.80000,Banner Health,Banner Choice Plus/Banner Select,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,outpatient,,,563.00000,225.20000,Banner Health,Banner Choice Plus/Banner Select,,197.05,,,,,,,146.38,546.11,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,outpatient,,,1612.00000,644.80000,Banner Health,Banner Choice Plus/Banner Select,,564.20,,,,,,,419.12,1563.64,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,outpatient,,,1366.00000,546.40000,Banner Health,Banner Choice Plus/Banner Select,,478.10,,,,,,,355.16,1325.02,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,outpatient,,,1911.00000,764.40000,Banner Health,Banner Choice Plus/Banner Select,,668.85,,,,,,,496.86,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,outpatient,,,956.00000,382.40000,Banner Health,Banner Choice Plus/Banner Select,,334.60,,,,,,,248.56,927.32,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,outpatient,,,189.00000,123.20000,Banner Health,Banner Choice Plus/Banner Select,,66.15,,,,,,,49.14,183.33,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,outpatient,,,352.00000,256.87000,Banner Health,Banner Choice Plus/Banner Select,,123.20,,,,,,,91.52,341.44,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,outpatient,,,625.00000,738.40000,Banner Health,Banner Choice Plus/Banner Select,,218.75,,,,,,,162.50,606.25,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1024.00000,2097.47000,Banner Health,Banner Choice Plus/Banner Select,,358.40,,,,,,,266.24,993.28,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,outpatient,,,1455.00000,2469.72000,Banner Health,Banner Choice Plus/Banner Select,,509.25,,,,,,,378.30,1411.35,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Banner Health,Banner Choice Plus/Banner Select,,50.75,,,,,,,37.70,140.65,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Banner Health,Banner Choice Plus/Banner Select,,170.80,,,,,,,126.88,473.36,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Banner Health,Banner Choice Plus/Banner Select,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Banner Health,Banner Choice Plus/Banner Select,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Banner Health,Banner Choice Plus/Banner Select,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,outpatient,,,170.00000,73.95000,Banner Health,Banner Choice Plus/Banner Select,,59.50,,,,,,,44.20,164.90,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,2.70000,1.17000,Banner Health,Banner Choice Plus/Banner Select,,0.94500,,,,,,,0.70200,2.62,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,27.00000,11.74000,Banner Health,Banner Choice Plus/Banner Select,,9.45,,,,,,,7.02,26.19,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,outpatient,,,20440.00000,8891.40000,Banner Health,Banner Choice Plus/Banner Select,,7154.00,,,,,,,5314.40,19826.80,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,3322.00000,1445.07000,Banner Health,Banner Choice Plus/Banner Select,,1162.70,,,,,,,863.72,3222.34,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,2492.00000,1084.02000,Banner Health,Banner Choice Plus/Banner Select,,872.20,,,,,,,647.92,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1814.00000,789.09000,Banner Health,Banner Choice Plus/Banner Select,,634.90,,,,,,,471.64,1759.58,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,2153.00000,936.56000,Banner Health,Banner Choice Plus/Banner Select,,753.55,,,,,,,559.78,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1525.00000,663.38000,Banner Health,Banner Choice Plus/Banner Select,,533.75,,,,,,,396.50,1479.25,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2716.00000,1181.46000,Banner Health,Banner Choice Plus/Banner Select,,950.60,,,,,,,706.16,2634.52,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,outpatient,,,2.70000,0.39000,Banner Health,Banner Choice Plus/Banner Select,,0.94500,,,,,,,0.70200,2.62,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,outpatient,,,222.00000,32.41000,Banner Health,Banner Choice Plus/Banner Select,,77.70,,,,,,,57.72,215.34,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,outpatient,,,211.00000,113.10000,Banner Health,Banner Choice Plus/Banner Select,,73.85,,,,,,,54.86,204.67,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,outpatient,,,497.00000,266.39000,Banner Health,Banner Choice Plus/Banner Select,,173.95,,,,,,,129.22,482.09,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,outpatient,,,296.00000,158.66000,Banner Health,Banner Choice Plus/Banner Select,,103.60,,,,,,,76.96,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,outpatient,,,723.00000,387.53000,Banner Health,Banner Choice Plus/Banner Select,,253.05,,,,,,,187.98,701.31,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,outpatient,,,326.00000,174.74000,Banner Health,Banner Choice Plus/Banner Select,,114.10,,,,,,,84.76,316.22,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,outpatient,,,532.00000,285.15000,Banner Health,Banner Choice Plus/Banner Select,,186.20,,,,,,,138.32,516.04,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,outpatient,,,635.00000,340.36000,Banner Health,Banner Choice Plus/Banner Select,,222.25,,,,,,,165.10,615.95,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,outpatient,,,639.00000,342.50000,Banner Health,Banner Choice Plus/Banner Select,,223.65,,,,,,,166.14,619.83,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,outpatient,,,780.00000,418.08000,Banner Health,Banner Choice Plus/Banner Select,,273.00,,,,,,,202.80,756.60,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,outpatient,,,390.00000,209.04000,Banner Health,Banner Choice Plus/Banner Select,,136.50,,,,,,,101.40,378.30,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,outpatient,,,731.00000,391.82000,Banner Health,Banner Choice Plus/Banner Select,,255.85,,,,,,,190.06,709.07,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,outpatient,,,585.00000,313.56000,Banner Health,Banner Choice Plus/Banner Select,,204.75,,,,,,,152.10,567.45,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,outpatient,,,365.00000,195.64000,Banner Health,Banner Choice Plus/Banner Select,,127.75,,,,,,,94.90,354.05,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,outpatient,,,1086.00000,582.10000,Banner Health,Banner Choice Plus/Banner Select,,380.10,,,,,,,282.36,1053.42,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,outpatient,,,197.00000,105.59000,Banner Health,Banner Choice Plus/Banner Select,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,outpatient,,,2774.00000,1486.86000,Banner Health,Banner Choice Plus/Banner Select,,970.90,,,,,,,721.24,2690.78,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,outpatient,,,1456.00000,780.42000,Banner Health,Banner Choice Plus/Banner Select,,509.60,,,,,,,378.56,1412.32,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,outpatient,,,2647.00000,1418.79000,Banner Health,Banner Choice Plus/Banner Select,,926.45,,,,,,,688.22,2567.59,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,outpatient,,,1359.00000,728.42000,Banner Health,Banner Choice Plus/Banner Select,,475.65,,,,,,,353.34,1318.23,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,outpatient,,,273.00000,146.33000,Banner Health,Banner Choice Plus/Banner Select,,95.55,,,,,,,70.98,264.81,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,outpatient,,,325.00000,174.20000,Banner Health,Banner Choice Plus/Banner Select,,113.75,,,,,,,84.50,315.25,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Banner Health,Banner Choice Plus/Banner Select,,213.15,,,,,,,158.34,590.73,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,outpatient,,,491.00000,263.18000,Banner Health,Banner Choice Plus/Banner Select,,171.85,,,,,,,127.66,476.27,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,outpatient,,,561.00000,300.70000,Banner Health,Banner Choice Plus/Banner Select,,196.35,,,,,,,145.86,544.17,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,outpatient,,,845.00000,452.92000,Banner Health,Banner Choice Plus/Banner Select,,295.75,,,,,,,219.70,819.65,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,outpatient,,,612.00000,328.03000,Banner Health,Banner Choice Plus/Banner Select,,214.20,,,,,,,159.12,593.64,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,outpatient,,,536.00000,287.30000,Banner Health,Banner Choice Plus/Banner Select,,187.60,,,,,,,139.36,519.92,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,outpatient,,,1225.00000,656.60000,Banner Health,Banner Choice Plus/Banner Select,,428.75,,,,,,,318.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Banner Health,Banner Choice Plus/Banner Select,LT,285.60,,,,,,,212.16,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Banner Health,Banner Choice Plus/Banner Select,RT,285.60,,,,,,,212.16,791.52,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,outpatient,,,250.00000,134.00000,Banner Health,Banner Choice Plus/Banner Select,,87.50,,,,,,,65.00,242.50,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,outpatient,,,302.00000,161.87000,Banner Health,Banner Choice Plus/Banner Select,,105.70,,,,,,,78.52,292.94,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,outpatient,,,354.00000,189.74000,Banner Health,Banner Choice Plus/Banner Select,,123.90,,,,,,,92.04,343.38,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,outpatient,,,409.00000,219.22000,Banner Health,Banner Choice Plus/Banner Select,,143.15,,,,,,,106.34,396.73,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,outpatient,,,593.00000,317.85000,Banner Health,Banner Choice Plus/Banner Select,,207.55,,,,,,,154.18,575.21,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Banner Health,Banner Choice Plus/Banner Select,LT,107.45,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Banner Health,Banner Choice Plus/Banner Select,"52,LT",107.45,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Banner Health,Banner Choice Plus/Banner Select,RT,107.45,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Banner Health,Banner Choice Plus/Banner Select,"52,RT",107.45,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Banner Health,Banner Choice Plus/Banner Select,LT,115.50,,,,,,,85.80,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Banner Health,Banner Choice Plus/Banner Select,RT,115.50,,,,,,,85.80,320.10,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,outpatient,,,195.00000,104.52000,Banner Health,Banner Choice Plus/Banner Select,,68.25,,,,,,,50.70,189.15,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,outpatient,,,578.00000,309.81000,Banner Health,Banner Choice Plus/Banner Select,,202.30,,,,,,,150.28,560.66,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,outpatient,,,384.00000,205.82000,Banner Health,Banner Choice Plus/Banner Select,,134.40,,,,,,,99.84,372.48,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Banner Health,Banner Choice Plus/Banner Select,LT,106.05,,,,,,,78.78,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Banner Health,Banner Choice Plus/Banner Select,RT,106.05,,,,,,,78.78,293.91,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Banner Health,Banner Choice Plus/Banner Select,LT,155.75,,,,,,,115.70,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Banner Health,Banner Choice Plus/Banner Select,RT,155.75,,,,,,,115.70,431.65,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,outpatient,,,937.00000,502.23000,Banner Health,Banner Choice Plus/Banner Select,,327.95,,,,,,,243.62,908.89,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,outpatient,,,615.00000,329.64000,Banner Health,Banner Choice Plus/Banner Select,,215.25,,,,,,,159.90,596.55,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Banner Health,Banner Choice Plus/Banner Select,LT,100.45,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Banner Health,Banner Choice Plus/Banner Select,"52,LT",100.45,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Banner Health,Banner Choice Plus/Banner Select,RT,100.45,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Banner Health,Banner Choice Plus/Banner Select,"52,RT",100.45,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Banner Health,Banner Choice Plus/Banner Select,LT,113.05,,,,,,,83.98,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Banner Health,Banner Choice Plus/Banner Select,RT,113.05,,,,,,,83.98,313.31,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,outpatient,,,694.00000,371.98000,Banner Health,Banner Choice Plus/Banner Select,,242.90,,,,,,,180.44,673.18,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Banner Health,Banner Choice Plus/Banner Select,LT,96.60,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Banner Health,Banner Choice Plus/Banner Select,RT,96.60,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Banner Health,Banner Choice Plus/Banner Select,LT,88.90,,,,,,,66.04,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Banner Health,Banner Choice Plus/Banner Select,RT,88.90,,,,,,,66.04,246.38,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Banner Health,Banner Choice Plus/Banner Select,LT,96.25,,,,,,,71.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Banner Health,Banner Choice Plus/Banner Select,RT,96.25,,,,,,,71.50,266.75,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,outpatient,,,173.00000,92.73000,Banner Health,Banner Choice Plus/Banner Select,,60.55,,,,,,,44.98,167.81,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Banner Health,Banner Choice Plus/Banner Select,LT,169.05,,,,,,,125.58,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Banner Health,Banner Choice Plus/Banner Select,RT,169.05,,,,,,,125.58,468.51,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Banner Health,Banner Choice Plus/Banner Select,LT,66.85,,,,,,,49.66,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Banner Health,Banner Choice Plus/Banner Select,RT,66.85,,,,,,,49.66,185.27,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Banner Health,Banner Choice Plus/Banner Select,LT,51.80,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Banner Health,Banner Choice Plus/Banner Select,"52,LT",51.80,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Banner Health,Banner Choice Plus/Banner Select,RT,51.80,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Banner Health,Banner Choice Plus/Banner Select,"52,RT",51.80,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Banner Health,Banner Choice Plus/Banner Select,LT,168.35,,,,,,,125.06,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Banner Health,Banner Choice Plus/Banner Select,RT,168.35,,,,,,,125.06,466.57,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Banner Health,Banner Choice Plus/Banner Select,LT,75.25,,,,,,,55.90,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Banner Health,Banner Choice Plus/Banner Select,RT,75.25,,,,,,,55.90,208.55,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Banner Health,Banner Choice Plus/Banner Select,LT,96.25,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Banner Health,Banner Choice Plus/Banner Select,"52,LT",96.25,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Banner Health,Banner Choice Plus/Banner Select,RT,96.25,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Banner Health,Banner Choice Plus/Banner Select,"52,RT",96.25,,,,,,,71.50,266.75,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Banner Health,Banner Choice Plus/Banner Select,LT,159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Banner Health,Banner Choice Plus/Banner Select,"52,LT",159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Banner Health,Banner Choice Plus/Banner Select,RT,159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Banner Health,Banner Choice Plus/Banner Select,"52,RT",159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Banner Health,Banner Choice Plus/Banner Select,LT,176.05,,,,,,,130.78,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Banner Health,Banner Choice Plus/Banner Select,RT,176.05,,,,,,,130.78,487.91,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Banner Health,Banner Choice Plus/Banner Select,LT,73.15,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Banner Health,Banner Choice Plus/Banner Select,RT,73.15,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Banner Health,Banner Choice Plus/Banner Select,LT,198.10,,,,,,,147.16,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Banner Health,Banner Choice Plus/Banner Select,RT,198.10,,,,,,,147.16,549.02,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,outpatient,,,598.00000,320.53000,Banner Health,Banner Choice Plus/Banner Select,,209.30,,,,,,,155.48,580.06,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Banner Health,Banner Choice Plus/Banner Select,"52,LT",159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Banner Health,Banner Choice Plus/Banner Select,"52,RT",159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Banner Health,Banner Choice Plus/Banner Select,LT,159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Banner Health,Banner Choice Plus/Banner Select,RT,159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,outpatient,,,1913.00000,1025.37000,Banner Health,Banner Choice Plus/Banner Select,,669.55,,,,,,,497.38,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,outpatient,,,312.00000,167.23000,Banner Health,Banner Choice Plus/Banner Select,,109.20,,,,,,,81.12,302.64,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,outpatient,,,327.00000,175.27000,Banner Health,Banner Choice Plus/Banner Select,,114.45,,,,,,,85.02,317.19,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,outpatient,,,425.00000,227.80000,Banner Health,Banner Choice Plus/Banner Select,,148.75,,,,,,,110.50,412.25,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,outpatient,,,210.00000,112.56000,Banner Health,Banner Choice Plus/Banner Select,,73.50,,,,,,,54.60,203.70,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,outpatient,,,495.00000,265.32000,Banner Health,Banner Choice Plus/Banner Select,,173.25,,,,,,,128.70,480.15,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,outpatient,,,541.00000,289.98000,Banner Health,Banner Choice Plus/Banner Select,,189.35,,,,,,,140.66,524.77,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Banner Health,Banner Choice Plus/Banner Select,LT,120.75,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Banner Health,Banner Choice Plus/Banner Select,RT,120.75,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Banner Health,Banner Choice Plus/Banner Select,LT,146.65,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Banner Health,Banner Choice Plus/Banner Select,RT,146.65,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Banner Health,Banner Choice Plus/Banner Select,LT,216.30,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Banner Health,Banner Choice Plus/Banner Select,RT,216.30,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,outpatient,,,463.00000,248.17000,Banner Health,Banner Choice Plus/Banner Select,,162.05,,,,,,,120.38,449.11,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,outpatient,,,511.00000,273.90000,Banner Health,Banner Choice Plus/Banner Select,,178.85,,,,,,,132.86,495.67,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,outpatient,,,132.00000,70.75000,Banner Health,Banner Choice Plus/Banner Select,,46.20,,,,,,,34.32,128.04,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Banner Health,Banner Choice Plus/Banner Select,LT,123.55,,,,,,,91.78,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Banner Health,Banner Choice Plus/Banner Select,RT,123.55,,,,,,,91.78,342.41,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,outpatient,,,273.00000,146.33000,Banner Health,Banner Choice Plus/Banner Select,,95.55,,,,,,,70.98,264.81,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,outpatient,,,503.00000,269.61000,Banner Health,Banner Choice Plus/Banner Select,,176.05,,,,,,,130.78,487.91,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,outpatient,,,561.00000,300.70000,Banner Health,Banner Choice Plus/Banner Select,,196.35,,,,,,,145.86,544.17,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Banner Health,Banner Choice Plus/Banner Select,LT,157.50,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Banner Health,Banner Choice Plus/Banner Select,RT,157.50,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,outpatient,,,650.00000,348.40000,Banner Health,Banner Choice Plus/Banner Select,,227.50,,,,,,,169.00,630.50,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,outpatient,,,642.00000,344.11000,Banner Health,Banner Choice Plus/Banner Select,,224.70,,,,,,,166.92,622.74,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,outpatient,,,777.00000,416.47000,Banner Health,Banner Choice Plus/Banner Select,,271.95,,,,,,,202.02,753.69,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,outpatient,,,381.00000,204.22000,Banner Health,Banner Choice Plus/Banner Select,,133.35,,,,,,,99.06,369.57,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Banner Health,Banner Choice Plus/Banner Select,LT,130.90,,,,,,,97.24,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Banner Health,Banner Choice Plus/Banner Select,RT,130.90,,,,,,,97.24,362.78,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Banner Health,Banner Choice Plus/Banner Select,LT,56.35,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Banner Health,Banner Choice Plus/Banner Select,RT,56.35,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Banner Health,Banner Choice Plus/Banner Select,LT,174.65,,,,,,,129.74,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Banner Health,Banner Choice Plus/Banner Select,RT,174.65,,,,,,,129.74,484.03,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,outpatient,,,214.00000,114.70000,Banner Health,Banner Choice Plus/Banner Select,,74.90,,,,,,,55.64,207.58,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,outpatient,,,329.00000,176.34000,Banner Health,Banner Choice Plus/Banner Select,,115.15,,,,,,,85.54,319.13,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,outpatient,,,197.00000,105.59000,Banner Health,Banner Choice Plus/Banner Select,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,outpatient,,,263.00000,140.97000,Banner Health,Banner Choice Plus/Banner Select,,92.05,,,,,,,68.38,255.11,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,outpatient,,,234.00000,125.42000,Banner Health,Banner Choice Plus/Banner Select,,81.90,,,,,,,60.84,226.98,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,outpatient,,,401.00000,214.94000,Banner Health,Banner Choice Plus/Banner Select,,140.35,,,,,,,104.26,388.97,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,outpatient,,,515.00000,276.04000,Banner Health,Banner Choice Plus/Banner Select,,180.25,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,outpatient,,,747.00000,400.39000,Banner Health,Banner Choice Plus/Banner Select,,261.45,,,,,,,194.22,724.59,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,outpatient,,,854.00000,457.74000,Banner Health,Banner Choice Plus/Banner Select,,298.90,,,,,,,222.04,828.38,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,outpatient,,,589.00000,315.70000,Banner Health,Banner Choice Plus/Banner Select,,206.15,,,,,,,153.14,571.33,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,outpatient,,,613.00000,328.57000,Banner Health,Banner Choice Plus/Banner Select,,214.55,,,,,,,159.38,594.61,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,outpatient,,,806.00000,432.02000,Banner Health,Banner Choice Plus/Banner Select,,282.10,,,,,,,209.56,781.82,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,outpatient,,,529.00000,283.54000,Banner Health,Banner Choice Plus/Banner Select,,185.15,,,,,,,137.54,513.13,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,outpatient,,,939.00000,503.30000,Banner Health,Banner Choice Plus/Banner Select,,328.65,,,,,,,244.14,910.83,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,outpatient,,,515.00000,276.04000,Banner Health,Banner Choice Plus/Banner Select,,180.25,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,outpatient,,,616.00000,330.18000,Banner Health,Banner Choice Plus/Banner Select,,215.60,,,,,,,160.16,597.52,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,outpatient,,,377.00000,202.07000,Banner Health,Banner Choice Plus/Banner Select,,131.95,,,,,,,98.02,365.69,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,outpatient,,,340.00000,182.24000,Banner Health,Banner Choice Plus/Banner Select,,119.00,,,,,,,88.40,329.80,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,outpatient,,,388.00000,207.97000,Banner Health,Banner Choice Plus/Banner Select,,135.80,,,,,,,100.88,376.36,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,outpatient,,,456.00000,244.42000,Banner Health,Banner Choice Plus/Banner Select,,159.60,,,,,,,118.56,442.32,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,outpatient,,,267.00000,143.11000,Banner Health,Banner Choice Plus/Banner Select,,93.45,,,,,,,69.42,258.99,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Banner Health,Banner Choice Plus/Banner Select,LT,107.10,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Banner Health,Banner Choice Plus/Banner Select,"52,LT",107.10,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Banner Health,Banner Choice Plus/Banner Select,RT,107.10,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Banner Health,Banner Choice Plus/Banner Select,"52,RT",107.10,,,,,,,79.56,296.82,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,outpatient,,,456.00000,244.42000,Banner Health,Banner Choice Plus/Banner Select,,159.60,,,,,,,118.56,442.32,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,outpatient,,,381.00000,204.22000,Banner Health,Banner Choice Plus/Banner Select,,133.35,,,,,,,99.06,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Banner Health,Banner Choice Plus/Banner Select,LT,50.05,,,,,,,37.18,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Banner Health,Banner Choice Plus/Banner Select,RT,50.05,,,,,,,37.18,138.71,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Banner Health,Banner Choice Plus/Banner Select,LT,115.85,,,,,,,86.06,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Banner Health,Banner Choice Plus/Banner Select,RT,115.85,,,,,,,86.06,321.07,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1113.00000,596.57000,Banner Health,Banner Choice Plus/Banner Select,,389.55,,,,,,,289.38,1079.61,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,outpatient,,,1043.00000,559.05000,Banner Health,Banner Choice Plus/Banner Select,,365.05,,,,,,,271.18,1011.71,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Banner Health,Banner Choice Plus/Banner Select,LT,89.60,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Banner Health,Banner Choice Plus/Banner Select,"52,LT",89.60,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Banner Health,Banner Choice Plus/Banner Select,RT,89.60,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Banner Health,Banner Choice Plus/Banner Select,"52,RT",89.60,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Banner Health,Banner Choice Plus/Banner Select,LT,178.85,,,,,,,132.86,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Banner Health,Banner Choice Plus/Banner Select,RT,178.85,,,,,,,132.86,495.67,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Banner Health,Banner Choice Plus/Banner Select,LT,193.55,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Banner Health,Banner Choice Plus/Banner Select,RT,193.55,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Banner Health,Banner Choice Plus/Banner Select,LT,376.60,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Banner Health,Banner Choice Plus/Banner Select,RT,376.60,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Banner Health,Banner Choice Plus/Banner Select,LT,302.75,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Banner Health,Banner Choice Plus/Banner Select,RT,302.75,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Banner Health,Banner Choice Plus/Banner Select,LT,256.90,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Banner Health,Banner Choice Plus/Banner Select,RT,256.90,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Banner Health,Banner Choice Plus/Banner Select,LT,255.50,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Banner Health,Banner Choice Plus/Banner Select,RT,255.50,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Banner Health,Banner Choice Plus/Banner Select,LT,91.00,,,,,,,67.60,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Banner Health,Banner Choice Plus/Banner Select,RT,91.00,,,,,,,67.60,252.20,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,outpatient,,,428.00000,203.73000,Banner Health,Banner Choice Plus/Banner Select,,149.80,,,,,,,111.28,415.16,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,outpatient,,,492.00000,234.19000,Banner Health,Banner Choice Plus/Banner Select,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,outpatient,,,607.00000,288.93000,Banner Health,Banner Choice Plus/Banner Select,,212.45,,,,,,,157.82,588.79,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,outpatient,,,649.00000,308.92000,Banner Health,Banner Choice Plus/Banner Select,,227.15,,,,,,,168.74,629.53,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,outpatient,,,377.00000,121.77000,Banner Health,Banner Choice Plus/Banner Select,50,131.95,,,,,,,98.02,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Banner Health,Banner Choice Plus/Banner Select,LT,87.85,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Banner Health,Banner Choice Plus/Banner Select,RT,87.85,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,outpatient,,,1170.00000,377.91000,Banner Health,Banner Choice Plus/Banner Select,50,409.50,,,,,,,304.20,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Banner Health,Banner Choice Plus/Banner Select,LT,273.00,,,,,,,202.80,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Banner Health,Banner Choice Plus/Banner Select,RT,273.00,,,,,,,202.80,756.60,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,outpatient,,,1389.00000,448.65000,Banner Health,Banner Choice Plus/Banner Select,,486.15,,,,,,,361.14,1347.33,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,outpatient,,,345.00000,111.44000,Banner Health,Banner Choice Plus/Banner Select,50,120.75,,,,,,,89.70,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Banner Health,Banner Choice Plus/Banner Select,LT,80.50,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Banner Health,Banner Choice Plus/Banner Select,RT,80.50,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,outpatient,,,2102.00000,678.95000,Banner Health,Banner Choice Plus/Banner Select,50,735.70,,,,,,,546.52,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Banner Health,Banner Choice Plus/Banner Select,LT,490.35,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Banner Health,Banner Choice Plus/Banner Select,RT,490.35,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,outpatient,,,357.00000,115.31000,Banner Health,Banner Choice Plus/Banner Select,50,124.95,,,,,,,92.82,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Banner Health,Banner Choice Plus/Banner Select,LT,83.30,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Banner Health,Banner Choice Plus/Banner Select,RT,83.30,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,outpatient,,,2082.00000,672.49000,Banner Health,Banner Choice Plus/Banner Select,50,728.70,,,,,,,541.32,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Banner Health,Banner Choice Plus/Banner Select,LT,485.80,,,,,,,360.88,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Banner Health,Banner Choice Plus/Banner Select,RT,485.80,,,,,,,360.88,1346.36,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,outpatient,,,246.00000,79.46000,Banner Health,Banner Choice Plus/Banner Select,50,86.10,,,,,,,63.96,238.62,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Banner Health,Banner Choice Plus/Banner Select,LT,57.40,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Banner Health,Banner Choice Plus/Banner Select,RT,57.40,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,outpatient,,,309.00000,99.81000,Banner Health,Banner Choice Plus/Banner Select,50,108.15,,,,,,,80.34,299.73,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Banner Health,Banner Choice Plus/Banner Select,LT,72.10,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Banner Health,Banner Choice Plus/Banner Select,RT,72.10,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,outpatient,,,471.00000,152.13000,Banner Health,Banner Choice Plus/Banner Select,50,164.85,,,,,,,122.46,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Banner Health,Banner Choice Plus/Banner Select,LT,109.90,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Banner Health,Banner Choice Plus/Banner Select,RT,109.90,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,outpatient,,,239.00000,77.20000,Banner Health,Banner Choice Plus/Banner Select,50,83.65,,,,,,,62.14,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Banner Health,Banner Choice Plus/Banner Select,LT,55.65,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Banner Health,Banner Choice Plus/Banner Select,RT,55.65,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,outpatient,,,558.00000,180.23000,Banner Health,Banner Choice Plus/Banner Select,50,195.30,,,,,,,145.08,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Banner Health,Banner Choice Plus/Banner Select,LT,130.20,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Banner Health,Banner Choice Plus/Banner Select,RT,130.20,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,outpatient,,,413.00000,133.40000,Banner Health,Banner Choice Plus/Banner Select,50,144.55,,,,,,,107.38,400.61,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Banner Health,Banner Choice Plus/Banner Select,LT,96.25,,,,,,,71.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Banner Health,Banner Choice Plus/Banner Select,RT,96.25,,,,,,,71.50,266.75,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,outpatient,,,462.00000,149.23000,Banner Health,Banner Choice Plus/Banner Select,,161.70,,,,,,,120.12,448.14,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,outpatient,,,170.00000,54.91000,Banner Health,Banner Choice Plus/Banner Select,,59.50,,,,,,,44.20,164.90,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,outpatient,,,281.00000,90.76000,Banner Health,Banner Choice Plus/Banner Select,,98.35,,,,,,,73.06,272.57,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,outpatient,,,562.00000,181.53000,Banner Health,Banner Choice Plus/Banner Select,,196.70,,,,,,,146.12,545.14,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,outpatient,,,2076.00000,670.55000,Banner Health,Banner Choice Plus/Banner Select,50,726.60,,,,,,,539.76,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Banner Health,Banner Choice Plus/Banner Select,LT,484.40,,,,,,,359.84,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Banner Health,Banner Choice Plus/Banner Select,RT,484.40,,,,,,,359.84,1342.48,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,outpatient,,,934.00000,301.68000,Banner Health,Banner Choice Plus/Banner Select,,326.90,,,,,,,242.84,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,outpatient,,,842.00000,271.97000,Banner Health,Banner Choice Plus/Banner Select,,294.70,,,,,,,218.92,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,outpatient,,,846.00000,273.26000,Banner Health,Banner Choice Plus/Banner Select,,296.10,,,,,,,219.96,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,outpatient,,,971.00000,313.63000,Banner Health,Banner Choice Plus/Banner Select,,339.85,,,,,,,252.46,941.87,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,outpatient,,,762.00000,246.13000,Banner Health,Banner Choice Plus/Banner Select,,266.70,,,,,,,198.12,739.14,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,outpatient,,,758.00000,244.83000,Banner Health,Banner Choice Plus/Banner Select,,265.30,,,,,,,197.08,735.26,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,outpatient,,,161.00000,52.00000,Banner Health,Banner Choice Plus/Banner Select,,56.35,,,,,,,41.86,156.17,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,outpatient,,,234.00000,75.58000,Banner Health,Banner Choice Plus/Banner Select,50,81.90,,,,,,,60.84,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Banner Health,Banner Choice Plus/Banner Select,LT,54.60,,,,,,,40.56,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Banner Health,Banner Choice Plus/Banner Select,RT,54.60,,,,,,,40.56,151.32,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1517.00000,489.99000,Banner Health,Banner Choice Plus/Banner Select,50,530.95,,,,,,,394.42,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Banner Health,Banner Choice Plus/Banner Select,LT,353.85,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Banner Health,Banner Choice Plus/Banner Select,RT,353.85,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,outpatient,,,822.00000,265.51000,Banner Health,Banner Choice Plus/Banner Select,50,287.70,,,,,,,213.72,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Banner Health,Banner Choice Plus/Banner Select,LT,191.80,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Banner Health,Banner Choice Plus/Banner Select,RT,191.80,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,outpatient,,,2613.00000,844.00000,Banner Health,Banner Choice Plus/Banner Select,,914.55,,,,,,,679.38,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,outpatient,,,903.00000,291.67000,Banner Health,Banner Choice Plus/Banner Select,,316.05,,,,,,,234.78,875.91,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,outpatient,,,1156.00000,373.39000,Banner Health,Banner Choice Plus/Banner Select,,404.60,,,,,,,300.56,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,outpatient,,,677.00000,218.67000,Banner Health,Banner Choice Plus/Banner Select,,236.95,,,,,,,176.02,656.69,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1928.00000,622.74000,Banner Health,Banner Choice Plus/Banner Select,50,674.80,,,,,,,501.28,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Banner Health,Banner Choice Plus/Banner Select,LT,449.75,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Banner Health,Banner Choice Plus/Banner Select,RT,449.75,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,outpatient,,,812.00000,262.28000,Banner Health,Banner Choice Plus/Banner Select,50,284.20,,,,,,,211.12,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Banner Health,Banner Choice Plus/Banner Select,LT,189.35,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Banner Health,Banner Choice Plus/Banner Select,RT,189.35,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,outpatient,,,825.00000,266.48000,Banner Health,Banner Choice Plus/Banner Select,50,288.75,,,,,,,214.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Banner Health,Banner Choice Plus/Banner Select,LT,192.50,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Banner Health,Banner Choice Plus/Banner Select,RT,192.50,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,outpatient,,,3494.00000,1128.56000,Banner Health,Banner Choice Plus/Banner Select,50,1222.90,,,,,,,908.44,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Banner Health,Banner Choice Plus/Banner Select,LT,815.15,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Banner Health,Banner Choice Plus/Banner Select,RT,815.15,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,outpatient,,,840.00000,271.32000,Banner Health,Banner Choice Plus/Banner Select,50,294.00,,,,,,,218.40,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Banner Health,Banner Choice Plus/Banner Select,LT,196.00,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Banner Health,Banner Choice Plus/Banner Select,RT,196.00,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,outpatient,,,792.00000,255.82000,Banner Health,Banner Choice Plus/Banner Select,50,277.20,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Banner Health,Banner Choice Plus/Banner Select,LT,184.80,,,,,,,137.28,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Banner Health,Banner Choice Plus/Banner Select,RT,184.80,,,,,,,137.28,512.16,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,outpatient,,,272.00000,87.86000,Banner Health,Banner Choice Plus/Banner Select,,95.20,,,,,,,70.72,263.84,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,outpatient,,,1268.00000,409.56000,Banner Health,Banner Choice Plus/Banner Select,,443.80,,,,,,,329.68,1229.96,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,outpatient,,,896.00000,289.41000,Banner Health,Banner Choice Plus/Banner Select,,313.60,,,,,,,232.96,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,outpatient,,,884.00000,285.53000,Banner Health,Banner Choice Plus/Banner Select,,309.40,,,,,,,229.84,857.48,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Banner Health,Banner Choice Plus/Banner Select,,213.15,,,,,,,158.34,590.73,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,outpatient,,,966.00000,383.50000,Banner Health,Banner Choice Plus/Banner Select,,338.10,,,,,,,251.16,937.02,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,outpatient,,,872.00000,346.18000,Banner Health,Banner Choice Plus/Banner Select,,305.20,,,,,,,226.72,845.84,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,outpatient,,,492.00000,195.32000,Banner Health,Banner Choice Plus/Banner Select,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,outpatient,,,331.00000,131.41000,Banner Health,Banner Choice Plus/Banner Select,,115.85,,,,,,,86.06,321.07,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,outpatient,,,5215.00000,2070.36000,Banner Health,Banner Choice Plus/Banner Select,,1825.25,,,,,,,1355.90,5058.55,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,outpatient,,,5422.00000,2152.53000,Banner Health,Banner Choice Plus/Banner Select,,1897.70,,,,,,,1409.72,5259.34,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1878.00000,788.76000,Banner Health,Banner Choice Plus/Banner Select,,657.30,,,,,,,488.28,1821.66,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,outpatient,,,2253.00000,946.26000,Banner Health,Banner Choice Plus/Banner Select,,788.55,,,,,,,585.78,2185.41,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1502.00000,630.84000,Banner Health,Banner Choice Plus/Banner Select,,525.70,,,,,,,390.52,1456.94,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,outpatient,,,2024.00000,850.08000,Banner Health,Banner Choice Plus/Banner Select,,708.40,,,,,,,526.24,1963.28,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,outpatient,,,2429.00000,1020.18000,Banner Health,Banner Choice Plus/Banner Select,,850.15,,,,,,,631.54,2356.13,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1619.00000,679.98000,Banner Health,Banner Choice Plus/Banner Select,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,outpatient,,,2425.00000,1018.50000,Banner Health,Banner Choice Plus/Banner Select,,848.75,,,,,,,630.50,2352.25,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2910.00000,1222.20000,Banner Health,Banner Choice Plus/Banner Select,,1018.50,,,,,,,756.60,2822.70,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1940.00000,814.80000,Banner Health,Banner Choice Plus/Banner Select,,679.00,,,,,,,504.40,1881.80,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2317.00000,973.14000,Banner Health,Banner Choice Plus/Banner Select,,810.95,,,,,,,602.42,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2780.00000,1167.60000,Banner Health,Banner Choice Plus/Banner Select,,973.00,,,,,,,722.80,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1853.00000,778.26000,Banner Health,Banner Choice Plus/Banner Select,,648.55,,,,,,,481.78,1797.41,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2366.00000,993.72000,Banner Health,Banner Choice Plus/Banner Select,,828.10,,,,,,,615.16,2295.02,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,outpatient,,,3056.00000,1283.52000,Banner Health,Banner Choice Plus/Banner Select,,1069.60,,,,,,,794.56,2964.32,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,outpatient,,,2829.00000,1386.21000,Banner Health,Banner Choice Plus/Banner Select,,990.15,,,,,,,735.54,2744.13,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,outpatient,,,3395.00000,1663.55000,Banner Health,Banner Choice Plus/Banner Select,,1188.25,,,,,,,882.70,3293.15,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,outpatient,,,2263.00000,1108.87000,Banner Health,Banner Choice Plus/Banner Select,,792.05,,,,,,,588.38,2195.11,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,outpatient,,,4697.00000,2301.53000,Banner Health,Banner Choice Plus/Banner Select,,1643.95,,,,,,,1221.22,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,outpatient,,,5636.00000,2761.64000,Banner Health,Banner Choice Plus/Banner Select,,1972.60,,,,,,,1465.36,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,outpatient,,,3757.00000,1840.93000,Banner Health,Banner Choice Plus/Banner Select,,1314.95,,,,,,,976.82,3644.29,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,outpatient,,,2619.00000,1283.31000,Banner Health,Banner Choice Plus/Banner Select,,916.65,,,,,,,680.94,2540.43,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,outpatient,,,3143.00000,1540.07000,Banner Health,Banner Choice Plus/Banner Select,,1100.05,,,,,,,817.18,3048.71,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,outpatient,,,2095.00000,1026.55000,Banner Health,Banner Choice Plus/Banner Select,,733.25,,,,,,,544.70,2032.15,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,outpatient,,,278.00000,136.22000,Banner Health,Banner Choice Plus/Banner Select,,97.30,,,,,,,72.28,269.66,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Banner Health,Banner Choice Plus/Banner Select,LT,738.50,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Banner Health,Banner Choice Plus/Banner Select,RT,738.50,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Banner Health,Banner Choice Plus/Banner Select,LT,886.20,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Banner Health,Banner Choice Plus/Banner Select,RT,886.20,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Banner Health,Banner Choice Plus/Banner Select,LT,590.80,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Banner Health,Banner Choice Plus/Banner Select,RT,590.80,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Banner Health,Banner Choice Plus/Banner Select,LT,708.40,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Banner Health,Banner Choice Plus/Banner Select,RT,708.40,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Banner Health,Banner Choice Plus/Banner Select,LT,850.15,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Banner Health,Banner Choice Plus/Banner Select,RT,850.15,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Banner Health,Banner Choice Plus/Banner Select,LT,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Banner Health,Banner Choice Plus/Banner Select,RT,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,outpatient,,,1224.00000,599.76000,Banner Health,Banner Choice Plus/Banner Select,,428.40,,,,,,,318.24,1187.28,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,outpatient,,,3020.00000,1479.80000,Banner Health,Banner Choice Plus/Banner Select,,1057.00,,,,,,,785.20,2929.40,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,outpatient,,,3624.00000,1775.76000,Banner Health,Banner Choice Plus/Banner Select,,1268.40,,,,,,,942.24,3515.28,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,outpatient,,,2416.00000,1183.84000,Banner Health,Banner Choice Plus/Banner Select,,845.60,,,,,,,628.16,2343.52,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,outpatient,,,2728.00000,1336.72000,Banner Health,Banner Choice Plus/Banner Select,,954.80,,,,,,,709.28,2646.16,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,outpatient,,,3273.00000,1603.77000,Banner Health,Banner Choice Plus/Banner Select,,1145.55,,,,,,,850.98,3174.81,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,outpatient,,,2182.00000,1069.18000,Banner Health,Banner Choice Plus/Banner Select,,763.70,,,,,,,567.32,2116.54,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,outpatient,,,3133.00000,1535.17000,Banner Health,Banner Choice Plus/Banner Select,,1096.55,,,,,,,814.58,3039.01,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,outpatient,,,3759.00000,1841.91000,Banner Health,Banner Choice Plus/Banner Select,,1315.65,,,,,,,977.34,3646.23,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,outpatient,,,2506.00000,1227.94000,Banner Health,Banner Choice Plus/Banner Select,,877.10,,,,,,,651.56,2430.82,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,outpatient,,,2857.00000,1399.93000,Banner Health,Banner Choice Plus/Banner Select,,999.95,,,,,,,742.82,2771.29,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,outpatient,,,3428.00000,1679.72000,Banner Health,Banner Choice Plus/Banner Select,,1199.80,,,,,,,891.28,3325.16,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,outpatient,,,2285.00000,1119.65000,Banner Health,Banner Choice Plus/Banner Select,,799.75,,,,,,,594.10,2216.45,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,outpatient,,,3565.00000,1746.85000,Banner Health,Banner Choice Plus/Banner Select,,1247.75,,,,,,,926.90,3458.05,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,outpatient,,,5918.00000,2899.82000,Banner Health,Banner Choice Plus/Banner Select,,2071.30,,,,,,,1538.68,5740.46,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,outpatient,,,3301.00000,1617.49000,Banner Health,Banner Choice Plus/Banner Select,,1155.35,,,,,,,858.26,3201.97,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Banner Health,Banner Choice Plus/Banner Select,LT,930.65,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Banner Health,Banner Choice Plus/Banner Select,RT,930.65,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Banner Health,Banner Choice Plus/Banner Select,LT,892.85,,,,,,,663.26,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Banner Health,Banner Choice Plus/Banner Select,RT,892.85,,,,,,,663.26,2474.47,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3806.00000,1864.94000,Banner Health,Banner Choice Plus/Banner Select,,1332.10,,,,,,,989.56,3691.82,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,outpatient,,,2149.00000,694.13000,Banner Health,Banner Choice Plus/Banner Select,,752.15,,,,,,,558.74,2084.53,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,outpatient,,,1973.00000,637.28000,Banner Health,Banner Choice Plus/Banner Select,,690.55,,,,,,,512.98,1913.81,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1784.00000,576.23000,Banner Health,Banner Choice Plus/Banner Select,50,624.40,,,,,,,463.84,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Banner Health,Banner Choice Plus/Banner Select,LT,416.15,,,,,,,309.14,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Banner Health,Banner Choice Plus/Banner Select,RT,416.15,,,,,,,309.14,1153.33,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,outpatient,,,130.00000,69.68000,Banner Health,Banner Choice Plus/Banner Select,,45.50,,,,,,,33.80,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,outpatient,,,44.00000,23.58000,Banner Health,Banner Choice Plus/Banner Select,,15.40,,,,,,,11.44,42.68,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,outpatient,,,456.00000,244.42000,Banner Health,Banner Choice Plus/Banner Select,,159.60,,,,,,,118.56,442.32,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,outpatient,,,108.00000,57.89000,Banner Health,Banner Choice Plus/Banner Select,,37.80,,,,,,,28.08,104.76,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,outpatient,,,306.00000,164.02000,Banner Health,Banner Choice Plus/Banner Select,,107.10,,,,,,,79.56,296.82,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,outpatient,,,257.00000,137.75000,Banner Health,Banner Choice Plus/Banner Select,,89.95,,,,,,,66.82,249.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Banner Health,Banner Choice Plus/Banner Select,,1419.95,,,,,,,1054.82,3935.29,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Banner Health,Banner Choice Plus/Banner Select,,1703.80,,,,,,,1265.68,4721.96,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Banner Health,Banner Choice Plus/Banner Select,,1135.75,,,,,,,843.70,3147.65,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Banner Health,Banner Choice Plus/Banner Select,,1419.95,,,,,,,1054.82,3935.29,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Banner Health,Banner Choice Plus/Banner Select,,1703.80,,,,,,,1265.68,4721.96,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Banner Health,Banner Choice Plus/Banner Select,,1135.75,,,,,,,843.70,3147.65,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,outpatient,,,1725.00000,865.95000,Banner Health,Banner Choice Plus/Banner Select,,603.75,,,,,,,448.50,1673.25,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,outpatient,,,1743.00000,874.99000,Banner Health,Banner Choice Plus/Banner Select,,610.05,,,,,,,453.18,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Banner Health,Banner Choice Plus/Banner Select,LT,516.25,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Banner Health,Banner Choice Plus/Banner Select,RT,516.25,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,outpatient,,,1162.00000,583.32000,Banner Health,Banner Choice Plus/Banner Select,,406.70,,,,,,,302.12,1127.14,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Banner Health,Banner Choice Plus/Banner Select,LT,344.05,,,,,,,255.58,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Banner Health,Banner Choice Plus/Banner Select,RT,344.05,,,,,,,255.58,953.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,outpatient,,,3183.00000,1597.87000,Banner Health,Banner Choice Plus/Banner Select,,1114.05,,,,,,,827.58,3087.51,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,outpatient,,,3819.00000,1917.14000,Banner Health,Banner Choice Plus/Banner Select,,1336.65,,,,,,,992.94,3704.43,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,outpatient,,,2546.00000,1278.09000,Banner Health,Banner Choice Plus/Banner Select,,891.10,,,,,,,661.96,2469.62,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Banner Health,Banner Choice Plus/Banner Select,LT,1350.30,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Banner Health,Banner Choice Plus/Banner Select,RT,1350.30,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Banner Health,Banner Choice Plus/Banner Select,LT,1620.15,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Banner Health,Banner Choice Plus/Banner Select,RT,1620.15,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Banner Health,Banner Choice Plus/Banner Select,LT,1080.10,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Banner Health,Banner Choice Plus/Banner Select,RT,1080.10,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Banner Health,Banner Choice Plus/Banner Select,LT,876.75,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Banner Health,Banner Choice Plus/Banner Select,RT,876.75,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Banner Health,Banner Choice Plus/Banner Select,LT,1052.10,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Banner Health,Banner Choice Plus/Banner Select,RT,1052.10,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Banner Health,Banner Choice Plus/Banner Select,LT,701.40,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Banner Health,Banner Choice Plus/Banner Select,RT,701.40,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Banner Health,Banner Choice Plus/Banner Select,LT,1097.95,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Banner Health,Banner Choice Plus/Banner Select,RT,1097.95,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Banner Health,Banner Choice Plus/Banner Select,LT,1317.40,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Banner Health,Banner Choice Plus/Banner Select,RT,1317.40,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Banner Health,Banner Choice Plus/Banner Select,LT,878.15,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Banner Health,Banner Choice Plus/Banner Select,RT,878.15,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Banner Health,Banner Choice Plus/Banner Select,LT,1058.05,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Banner Health,Banner Choice Plus/Banner Select,RT,1058.05,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Banner Health,Banner Choice Plus/Banner Select,LT,1269.45,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Banner Health,Banner Choice Plus/Banner Select,RT,1269.45,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Banner Health,Banner Choice Plus/Banner Select,LT,846.30,,,,,,,628.68,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Banner Health,Banner Choice Plus/Banner Select,RT,846.30,,,,,,,628.68,2345.46,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,outpatient,,,870.00000,436.74000,Banner Health,Banner Choice Plus/Banner Select,,304.50,,,,,,,226.20,843.90,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,outpatient,,,1353.00000,679.21000,Banner Health,Banner Choice Plus/Banner Select,,473.55,,,,,,,351.78,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Banner Health,Banner Choice Plus/Banner Select,LT,315.70,,,,,,,234.52,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Banner Health,Banner Choice Plus/Banner Select,RT,315.70,,,,,,,234.52,874.94,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3489.00000,1751.48000,Banner Health,Banner Choice Plus/Banner Select,,1221.15,,,,,,,907.14,3384.33,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,outpatient,,,4187.00000,2101.87000,Banner Health,Banner Choice Plus/Banner Select,,1465.45,,,,,,,1088.62,4061.39,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,outpatient,,,2791.00000,1401.08000,Banner Health,Banner Choice Plus/Banner Select,,976.85,,,,,,,725.66,2707.27,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,outpatient,,,492.00000,246.98000,Banner Health,Banner Choice Plus/Banner Select,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,outpatient,,,331.00000,166.16000,Banner Health,Banner Choice Plus/Banner Select,,115.85,,,,,,,86.06,321.07,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,outpatient,,,4440.00000,2357.64000,Banner Health,Banner Choice Plus/Banner Select,,1554.00,,,,,,,1154.40,4306.80,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,outpatient,,,5328.00000,2829.17000,Banner Health,Banner Choice Plus/Banner Select,,1864.80,,,,,,,1385.28,5168.16,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,outpatient,,,3552.00000,1886.11000,Banner Health,Banner Choice Plus/Banner Select,,1243.20,,,,,,,923.52,3445.44,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,outpatient,,,2528.00000,1342.37000,Banner Health,Banner Choice Plus/Banner Select,,884.80,,,,,,,657.28,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,outpatient,,,3033.00000,1610.52000,Banner Health,Banner Choice Plus/Banner Select,,1061.55,,,,,,,788.58,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,outpatient,,,2022.00000,1073.68000,Banner Health,Banner Choice Plus/Banner Select,,707.70,,,,,,,525.72,1961.34,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,outpatient,,,3610.00000,1909.69000,Banner Health,Banner Choice Plus/Banner Select,,1263.50,,,,,,,938.60,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,outpatient,,,4332.00000,2291.63000,Banner Health,Banner Choice Plus/Banner Select,,1516.20,,,,,,,1126.32,4202.04,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,outpatient,,,2888.00000,1527.75000,Banner Health,Banner Choice Plus/Banner Select,,1010.80,,,,,,,750.88,2801.36,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,outpatient,,,4532.00000,2397.43000,Banner Health,Banner Choice Plus/Banner Select,,1586.20,,,,,,,1178.32,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,outpatient,,,5438.00000,2876.70000,Banner Health,Banner Choice Plus/Banner Select,,1903.30,,,,,,,1413.88,5274.86,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,outpatient,,,3625.00000,1917.62000,Banner Health,Banner Choice Plus/Banner Select,,1268.75,,,,,,,942.50,3516.25,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,outpatient,,,3639.00000,1925.03000,Banner Health,Banner Choice Plus/Banner Select,,1273.65,,,,,,,946.14,3529.83,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,outpatient,,,4367.00000,2310.14000,Banner Health,Banner Choice Plus/Banner Select,,1528.45,,,,,,,1135.42,4235.99,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,outpatient,,,2911.00000,1539.92000,Banner Health,Banner Choice Plus/Banner Select,,1018.85,,,,,,,756.86,2823.67,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3494.00000,1719.05000,Banner Health,Banner Choice Plus/Banner Select,,1222.90,,,,,,,908.44,3389.18,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,outpatient,,,4193.00000,2062.96000,Banner Health,Banner Choice Plus/Banner Select,,1467.55,,,,,,,1090.18,4067.21,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,outpatient,,,2795.00000,1375.14000,Banner Health,Banner Choice Plus/Banner Select,,978.25,,,,,,,726.70,2711.15,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,outpatient,,,2717.00000,1336.76000,Banner Health,Banner Choice Plus/Banner Select,,950.95,,,,,,,706.42,2635.49,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,outpatient,,,3260.00000,1603.92000,Banner Health,Banner Choice Plus/Banner Select,,1141.00,,,,,,,847.60,3162.20,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,outpatient,,,2173.00000,1069.12000,Banner Health,Banner Choice Plus/Banner Select,,760.55,,,,,,,564.98,2107.81,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Banner Health,Banner Choice Plus/Banner Select,LT,1417.85,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Banner Health,Banner Choice Plus/Banner Select,RT,1417.85,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Banner Health,Banner Choice Plus/Banner Select,LT,1701.35,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Banner Health,Banner Choice Plus/Banner Select,RT,1701.35,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Banner Health,Banner Choice Plus/Banner Select,LT,1134.35,,,,,,,842.66,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Banner Health,Banner Choice Plus/Banner Select,RT,1134.35,,,,,,,842.66,3143.77,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,outpatient,,,4260.00000,2420.32000,Banner Health,Banner Choice Plus/Banner Select,,1491.00,,,,,,,1107.60,4132.20,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,outpatient,,,5112.00000,2904.38000,Banner Health,Banner Choice Plus/Banner Select,,1789.20,,,,,,,1329.12,4958.64,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3408.00000,1936.26000,Banner Health,Banner Choice Plus/Banner Select,,1192.80,,,,,,,886.08,3305.76,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3343.00000,1899.33000,Banner Health,Banner Choice Plus/Banner Select,,1170.05,,,,,,,869.18,3242.71,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,outpatient,,,4010.00000,2278.28000,Banner Health,Banner Choice Plus/Banner Select,,1403.50,,,,,,,1042.60,3889.70,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,outpatient,,,2674.00000,1519.23000,Banner Health,Banner Choice Plus/Banner Select,,935.90,,,,,,,695.24,2593.78,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Banner Health,Banner Choice Plus/Banner Select,LT,1152.90,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Banner Health,Banner Choice Plus/Banner Select,RT,1152.90,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Banner Health,Banner Choice Plus/Banner Select,LT,1383.55,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Banner Health,Banner Choice Plus/Banner Select,RT,1383.55,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Banner Health,Banner Choice Plus/Banner Select,LT,922.25,,,,,,,685.10,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Banner Health,Banner Choice Plus/Banner Select,RT,922.25,,,,,,,685.10,2555.95,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3664.00000,2081.70000,Banner Health,Banner Choice Plus/Banner Select,,1282.40,,,,,,,952.64,3554.08,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,outpatient,,,4397.00000,2498.16000,Banner Health,Banner Choice Plus/Banner Select,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,outpatient,,,2931.00000,1665.25000,Banner Health,Banner Choice Plus/Banner Select,,1025.85,,,,,,,762.06,2843.07,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,outpatient,,,4759.00000,2703.83000,Banner Health,Banner Choice Plus/Banner Select,,1665.65,,,,,,,1237.34,4616.23,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,outpatient,,,5710.00000,3244.14000,Banner Health,Banner Choice Plus/Banner Select,,1998.50,,,,,,,1484.60,5538.70,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3807.00000,2162.95000,Banner Health,Banner Choice Plus/Banner Select,,1332.45,,,,,,,989.82,3692.79,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2915.00000,1574.10000,Banner Health,Banner Choice Plus/Banner Select,,1020.25,,,,,,,757.90,2827.55,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1918.00000,1035.72000,Banner Health,Banner Choice Plus/Banner Select,,671.30,,,,,,,498.68,1860.46,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2292.00000,1237.68000,Banner Health,Banner Choice Plus/Banner Select,,802.20,,,,,,,595.92,2223.24,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,outpatient,,,2984.00000,1611.36000,Banner Health,Banner Choice Plus/Banner Select,,1044.40,,,,,,,775.84,2894.48,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,outpatient,,,769.00000,415.26000,Banner Health,Banner Choice Plus/Banner Select,,269.15,,,,,,,199.94,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,outpatient,,,1280.00000,691.20000,Banner Health,Banner Choice Plus/Banner Select,,448.00,,,,,,,332.80,1241.60,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,outpatient,,,1878.00000,1014.12000,Banner Health,Banner Choice Plus/Banner Select,,657.30,,,,,,,488.28,1821.66,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,outpatient,,,2196.00000,1185.84000,Banner Health,Banner Choice Plus/Banner Select,,768.60,,,,,,,570.96,2130.12,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,outpatient,,,844.00000,455.76000,Banner Health,Banner Choice Plus/Banner Select,,295.40,,,,,,,219.44,818.68,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,outpatient,,,1305.00000,704.70000,Banner Health,Banner Choice Plus/Banner Select,,456.75,,,,,,,339.30,1265.85,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,outpatient,,,576.00000,311.04000,Banner Health,Banner Choice Plus/Banner Select,,201.60,,,,,,,149.76,558.72,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,outpatient,,,809.00000,436.86000,Banner Health,Banner Choice Plus/Banner Select,,283.15,,,,,,,210.34,784.73,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,outpatient,,,2462.00000,1329.48000,Banner Health,Banner Choice Plus/Banner Select,,861.70,,,,,,,640.12,2388.14,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,outpatient,,,918.00000,495.72000,Banner Health,Banner Choice Plus/Banner Select,,321.30,,,,,,,238.68,890.46,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,outpatient,,,1102.00000,595.08000,Banner Health,Banner Choice Plus/Banner Select,,385.70,,,,,,,286.52,1068.94,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,outpatient,,,812.00000,438.48000,Banner Health,Banner Choice Plus/Banner Select,,284.20,,,,,,,211.12,787.64,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,outpatient,,,1407.00000,759.78000,Banner Health,Banner Choice Plus/Banner Select,,492.45,,,,,,,365.82,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,outpatient,,,1980.00000,1069.20000,Banner Health,Banner Choice Plus/Banner Select,,693.00,,,,,,,514.80,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,outpatient,,,964.00000,520.56000,Banner Health,Banner Choice Plus/Banner Select,,337.40,,,,,,,250.64,935.08,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,outpatient,,,1040.00000,561.60000,Banner Health,Banner Choice Plus/Banner Select,,364.00,,,,,,,270.40,1008.80,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,outpatient,,,795.00000,429.30000,Banner Health,Banner Choice Plus/Banner Select,,278.25,,,,,,,206.70,771.15,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,outpatient,,,1124.00000,606.96000,Banner Health,Banner Choice Plus/Banner Select,,393.40,,,,,,,292.24,1090.28,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,outpatient,,,736.00000,397.44000,Banner Health,Banner Choice Plus/Banner Select,,257.60,,,,,,,191.36,713.92,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,outpatient,,,700.00000,378.00000,Banner Health,Banner Choice Plus/Banner Select,,245.00,,,,,,,182.00,679.00,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,outpatient,,,821.00000,443.34000,Banner Health,Banner Choice Plus/Banner Select,,287.35,,,,,,,213.46,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,outpatient,,,846.00000,456.84000,Banner Health,Banner Choice Plus/Banner Select,,296.10,,,,,,,219.96,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,outpatient,,,958.00000,517.32000,Banner Health,Banner Choice Plus/Banner Select,,335.30,,,,,,,249.08,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,outpatient,,,1261.00000,680.94000,Banner Health,Banner Choice Plus/Banner Select,,441.35,,,,,,,327.86,1223.17,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,outpatient,,,971.00000,524.34000,Banner Health,Banner Choice Plus/Banner Select,,339.85,,,,,,,252.46,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,outpatient,,,1837.00000,991.98000,Banner Health,Banner Choice Plus/Banner Select,,642.95,,,,,,,477.62,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,outpatient,,,1099.00000,593.46000,Banner Health,Banner Choice Plus/Banner Select,,384.65,,,,,,,285.74,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,outpatient,,,2178.00000,1176.12000,Banner Health,Banner Choice Plus/Banner Select,,762.30,,,,,,,566.28,2112.66,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,outpatient,,,1226.00000,662.04000,Banner Health,Banner Choice Plus/Banner Select,,429.10,,,,,,,318.76,1189.22,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,outpatient,,,1048.00000,565.92000,Banner Health,Banner Choice Plus/Banner Select,,366.80,,,,,,,272.48,1016.56,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,outpatient,,,970.00000,523.80000,Banner Health,Banner Choice Plus/Banner Select,,339.50,,,,,,,252.20,940.90,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,outpatient,,,1803.00000,973.62000,Banner Health,Banner Choice Plus/Banner Select,,631.05,,,,,,,468.78,1748.91,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,outpatient,,,2504.00000,1352.16000,Banner Health,Banner Choice Plus/Banner Select,,876.40,,,,,,,651.04,2428.88,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2457.00000,1326.78000,Banner Health,Banner Choice Plus/Banner Select,,859.95,,,,,,,638.82,2383.29,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,outpatient,,,923.00000,498.42000,Banner Health,Banner Choice Plus/Banner Select,,323.05,,,,,,,239.98,895.31,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,outpatient,,,5478.00000,2958.12000,Banner Health,Banner Choice Plus/Banner Select,,1917.30,,,,,,,1424.28,5313.66,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,outpatient,,,4551.00000,2457.54000,Banner Health,Banner Choice Plus/Banner Select,,1592.85,,,,,,,1183.26,4414.47,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,outpatient,,,1360.00000,734.40000,Banner Health,Banner Choice Plus/Banner Select,,476.00,,,,,,,353.60,1319.20,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,outpatient,,,1209.00000,652.86000,Banner Health,Banner Choice Plus/Banner Select,,423.15,,,,,,,314.34,1172.73,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,outpatient,,,848.00000,457.92000,Banner Health,Banner Choice Plus/Banner Select,,296.80,,,,,,,220.48,822.56,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,outpatient,,,1071.00000,578.34000,Banner Health,Banner Choice Plus/Banner Select,,374.85,,,,,,,278.46,1038.87,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,outpatient,,,1792.00000,967.68000,Banner Health,Banner Choice Plus/Banner Select,,627.20,,,,,,,465.92,1738.24,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,outpatient,,,35.00000,18.90000,Banner Health,Banner Choice Plus/Banner Select,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,outpatient,,,285.00000,153.90000,Banner Health,Banner Choice Plus/Banner Select,,99.75,,,,,,,74.10,276.45,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,outpatient,,,1012.00000,546.48000,Banner Health,Banner Choice Plus/Banner Select,,354.20,,,,,,,263.12,981.64,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,outpatient,,,492.00000,265.68000,Banner Health,Banner Choice Plus/Banner Select,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,outpatient,,,739.00000,399.06000,Banner Health,Banner Choice Plus/Banner Select,,258.65,,,,,,,192.14,716.83,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,outpatient,,,515.00000,278.10000,Banner Health,Banner Choice Plus/Banner Select,,180.25,,,,,,,133.90,499.55,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,outpatient,,,1467.00000,792.18000,Banner Health,Banner Choice Plus/Banner Select,,513.45,,,,,,,381.42,1422.99,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,outpatient,,,1683.00000,888.62000,Banner Health,Banner Choice Plus/Banner Select,,589.05,,,,,,,437.58,1632.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,426.30000,225.09000,Banner Health,Banner Choice Plus/Banner Select,,149.21,,,,,,,110.84,413.51,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,725.00000,382.80000,Banner Health,Banner Choice Plus/Banner Select,,253.75,,,,,,,188.50,1855.42,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,1852.00000,977.86000,Banner Health,Banner Choice Plus/Banner Select,,648.20,,,,,,,481.52,1868.26,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,110.00000,58.08000,Banner Health,Banner Choice Plus/Banner Select,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,98.00000,51.74000,Banner Health,Banner Choice Plus/Banner Select,,34.30,,,,,,,25.48,1662.92,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,2018.00000,1065.50000,Banner Health,Banner Choice Plus/Banner Select,,706.30,,,,,,,524.68,1957.46,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,4325.00000,2283.60000,Banner Health,Banner Choice Plus/Banner Select,,1513.75,,,,,,,1124.50,4195.25,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Banner Health,Banner Choice Plus/Banner Select,,60.20,,,,,,,44.72,166.84,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,942.00000,497.38000,Banner Health,Banner Choice Plus/Banner Select,,329.70,,,,,,,244.92,913.74,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,413.00000,218.06000,Banner Health,Banner Choice Plus/Banner Select,,144.55,,,,,,,107.38,400.61,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,outpatient,,,257.00000,135.70000,Banner Health,Banner Choice Plus/Banner Select,,89.95,,,,,,,66.82,249.29,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,116.00000,61.25000,Banner Health,Banner Choice Plus/Banner Select,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,463.20000,244.57000,Banner Health,Banner Choice Plus/Banner Select,,162.12,,,,,,,120.43,449.30,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,804.00000,424.51000,Banner Health,Banner Choice Plus/Banner Select,,281.40,,,,,,,209.04,779.88,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Banner Health,Banner Choice Plus/Banner Select,,60.20,,,,,,,44.72,166.84,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,354.30000,187.07000,Banner Health,Banner Choice Plus/Banner Select,,124.00,,,,,,,92.12,343.67,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,277.90000,146.73000,Banner Health,Banner Choice Plus/Banner Select,,97.27,,,,,,,72.25,269.56,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,200.00000,105.60000,Banner Health,Banner Choice Plus/Banner Select,,70.00,,,,,,,52.00,194.00,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,outpatient,,,197.00000,63.63000,Banner Health,Banner Choice Plus/Banner Select,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,outpatient,,,468.00000,151.16000,Banner Health,Banner Choice Plus/Banner Select,50,163.80,,,,,,,121.68,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Banner Health,Banner Choice Plus/Banner Select,LT,109.20,,,,,,,81.12,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Banner Health,Banner Choice Plus/Banner Select,RT,109.20,,,,,,,81.12,302.64,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Banner Health,Banner Choice Plus/Banner Select,,158.55,,,,,,,117.78,439.41,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Banner Health,Banner Choice Plus/Banner Select,,213.15,,,,,,,158.34,590.73,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1248.00000,403.10000,Banner Health,Banner Choice Plus/Banner Select,50,436.80,,,,,,,324.48,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Banner Health,Banner Choice Plus/Banner Select,LT,291.20,,,,,,,216.32,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Banner Health,Banner Choice Plus/Banner Select,RT,291.20,,,,,,,216.32,807.04,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Banner Health,Banner Choice Plus/Banner Select,LT,1482.25,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Banner Health,Banner Choice Plus/Banner Select,RT,1482.25,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,outpatient,,,2119.00000,684.44000,Banner Health,Banner Choice Plus/Banner Select,,741.65,,,,,,,550.94,2055.43,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1943.00000,627.59000,Banner Health,Banner Choice Plus/Banner Select,,680.05,,,,,,,505.18,1884.71,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,outpatient,,,1426.00000,460.60000,Banner Health,Banner Choice Plus/Banner Select,,499.10,,,,,,,370.76,1383.22,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,outpatient,,,4202.00000,1357.25000,Banner Health,Banner Choice Plus/Banner Select,50,1470.70,,,,,,,1092.52,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Banner Health,Banner Choice Plus/Banner Select,LT,980.35,,,,,,,728.26,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Banner Health,Banner Choice Plus/Banner Select,RT,980.35,,,,,,,728.26,2716.97,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,outpatient,,,832.00000,268.74000,Banner Health,Banner Choice Plus/Banner Select,,291.20,,,,,,,216.32,807.04,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,outpatient,,,1457.00000,470.61000,Banner Health,Banner Choice Plus/Banner Select,,509.95,,,,,,,378.82,1413.29,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Banner Health,Banner Choice Plus/Banner Select,LT,260.05,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Banner Health,Banner Choice Plus/Banner Select,RT,260.05,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,outpatient,,,232.00000,74.94000,Banner Health,Banner Choice Plus/Banner Select,,81.20,,,,,,,60.32,225.04,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,outpatient,,,1364.00000,440.57000,Banner Health,Banner Choice Plus/Banner Select,50,477.40,,,,,,,354.64,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Banner Health,Banner Choice Plus/Banner Select,LT,318.15,,,,,,,236.34,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Banner Health,Banner Choice Plus/Banner Select,RT,318.15,,,,,,,236.34,881.73,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,outpatient,,,510.00000,355.98000,Banner Health,Banner Choice Plus/Banner Select,,178.50,,,,,,,132.60,494.70,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,outpatient,,,1001.00000,698.70000,Banner Health,Banner Choice Plus/Banner Select,,350.35,,,,,,,260.26,970.97,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,outpatient,,,887.00000,619.13000,Banner Health,Banner Choice Plus/Banner Select,,310.45,,,,,,,230.62,860.39,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,outpatient,,,1022.00000,713.36000,Banner Health,Banner Choice Plus/Banner Select,50,357.70,,,,,,,265.72,991.34,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Banner Health,Banner Choice Plus/Banner Select,LT,238.35,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Banner Health,Banner Choice Plus/Banner Select,RT,238.35,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,outpatient,,,945.00000,659.61000,Banner Health,Banner Choice Plus/Banner Select,50,330.75,,,,,,,245.70,916.65,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Banner Health,Banner Choice Plus/Banner Select,LT,220.50,,,,,,,163.80,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Banner Health,Banner Choice Plus/Banner Select,RT,220.50,,,,,,,163.80,611.10,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,outpatient,,,577.00000,402.75000,Banner Health,Banner Choice Plus/Banner Select,,201.95,,,,,,,150.02,559.69,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,outpatient,,,433.00000,302.23000,Banner Health,Banner Choice Plus/Banner Select,,151.55,,,,,,,112.58,420.01,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,outpatient,,,331.00000,231.04000,Banner Health,Banner Choice Plus/Banner Select,,115.85,,,,,,,86.06,321.07,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,outpatient,,,662.00000,462.08000,Banner Health,Banner Choice Plus/Banner Select,,231.70,,,,,,,172.12,642.14,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,outpatient,,,752.00000,524.90000,Banner Health,Banner Choice Plus/Banner Select,,263.20,,,,,,,195.52,729.44,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Banner Health,Banner Choice Plus/Banner Select,,63.70,,,,,,,47.32,176.54,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,outpatient,,,420.00000,293.16000,Banner Health,Banner Choice Plus/Banner Select,,147.00,,,,,,,109.20,407.40,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,outpatient,,,253.00000,176.59000,Banner Health,Banner Choice Plus/Banner Select,,88.55,,,,,,,65.78,245.41,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,outpatient,,,168.00000,117.26000,Banner Health,Banner Choice Plus/Banner Select,,58.80,,,,,,,43.68,162.96,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,outpatient,,,695.00000,485.11000,Banner Health,Banner Choice Plus/Banner Select,,243.25,,,,,,,180.70,674.15,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,outpatient,,,474.00000,330.85000,Banner Health,Banner Choice Plus/Banner Select,,165.90,,,,,,,123.24,459.78,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,outpatient,,,930.00000,649.14000,Banner Health,Banner Choice Plus/Banner Select,,325.50,,,,,,,241.80,902.10,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,outpatient,,,786.00000,548.63000,Banner Health,Banner Choice Plus/Banner Select,,275.10,,,,,,,204.36,762.42,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Banner Health,Banner Choice Plus/Banner Select,,217.00,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Banner Health,Banner Choice Plus/Banner Select,59,217.00,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Banner Health,Banner Choice Plus/Banner Select,,152.25,,,,,,,113.10,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Banner Health,Banner Choice Plus/Banner Select,59,152.25,,,,,,,113.10,421.95,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,outpatient,,,492.00000,343.42000,Banner Health,Banner Choice Plus/Banner Select,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,outpatient,,,331.00000,231.04000,Banner Health,Banner Choice Plus/Banner Select,,115.85,,,,,,,86.06,321.07,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,outpatient,,,875.00000,610.75000,Banner Health,Banner Choice Plus/Banner Select,,306.25,,,,,,,227.50,848.75,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,outpatient,,,688.00000,480.22000,Banner Health,Banner Choice Plus/Banner Select,,240.80,,,,,,,178.88,667.36,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,outpatient,,,465.00000,324.57000,Banner Health,Banner Choice Plus/Banner Select,,162.75,,,,,,,120.90,451.05,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,outpatient,,,846.00000,590.51000,Banner Health,Banner Choice Plus/Banner Select,,296.10,,,,,,,219.96,820.62,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,outpatient,,,482.00000,336.44000,Banner Health,Banner Choice Plus/Banner Select,,168.70,,,,,,,125.32,467.54,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,outpatient,,,926.00000,646.35000,Banner Health,Banner Choice Plus/Banner Select,,324.10,,,,,,,240.76,898.22,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,outpatient,,,292.00000,203.82000,Banner Health,Banner Choice Plus/Banner Select,,102.20,,,,,,,75.92,283.24,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,outpatient,,,827.00000,577.25000,Banner Health,Banner Choice Plus/Banner Select,,289.45,,,,,,,215.02,802.19,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,outpatient,,,253.00000,176.59000,Banner Health,Banner Choice Plus/Banner Select,,88.55,,,,,,,65.78,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,outpatient,,,901.00000,628.90000,Banner Health,Banner Choice Plus/Banner Select,,315.35,,,,,,,234.26,873.97,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,outpatient,,,460.00000,321.08000,Banner Health,Banner Choice Plus/Banner Select,,161.00,,,,,,,119.60,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1029.00000,718.24000,Banner Health,Banner Choice Plus/Banner Select,,360.15,,,,,,,267.54,998.13,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,outpatient,,,959.00000,669.38000,Banner Health,Banner Choice Plus/Banner Select,,335.65,,,,,,,249.34,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,outpatient,,,558.00000,389.48000,Banner Health,Banner Choice Plus/Banner Select,,195.30,,,,,,,145.08,541.26,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,outpatient,,,705.00000,492.09000,Banner Health,Banner Choice Plus/Banner Select,,246.75,,,,,,,183.30,683.85,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,outpatient,,,249.00000,173.80000,Banner Health,Banner Choice Plus/Banner Select,,87.15,,,,,,,64.74,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,outpatient,,,427.00000,298.05000,Banner Health,Banner Choice Plus/Banner Select,,149.45,,,,,,,111.02,414.19,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Banner Health,Banner Choice Plus/Banner Select,,257.95,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Banner Health,Banner Choice Plus/Banner Select,59,257.95,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,outpatient,,,809.00000,564.68000,Banner Health,Banner Choice Plus/Banner Select,,283.15,,,,,,,210.34,784.73,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,outpatient,,,525.00000,366.45000,Banner Health,Banner Choice Plus/Banner Select,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,outpatient,,,319.00000,222.66000,Banner Health,Banner Choice Plus/Banner Select,,111.65,,,,,,,82.94,309.43,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1437.00000,678.26000,Banner Health,Banner Choice Plus/Banner Select,,502.95,,,,,,,373.62,1393.89,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2143.00000,1011.50000,Banner Health,Banner Choice Plus/Banner Select,,750.05,,,,,,,557.18,2078.71,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,outpatient,,,755.00000,356.36000,Banner Health,Banner Choice Plus/Banner Select,,264.25,,,,,,,196.30,732.35,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,outpatient,,,979.00000,462.09000,Banner Health,Banner Choice Plus/Banner Select,,342.65,,,,,,,254.54,949.63,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,outpatient,,,436.00000,205.79000,Banner Health,Banner Choice Plus/Banner Select,,152.60,,,,,,,113.36,422.92,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,outpatient,,,220.00000,103.84000,Banner Health,Banner Choice Plus/Banner Select,,77.00,,,,,,,57.20,213.40,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,outpatient,,,344.00000,162.37000,Banner Health,Banner Choice Plus/Banner Select,,120.40,,,,,,,89.44,333.68,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,outpatient,,,818.00000,393.46000,Banner Health,Banner Choice Plus/Banner Select,,286.30,,,,,,,212.68,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,outpatient,,,545.00000,262.14000,Banner Health,Banner Choice Plus/Banner Select,52,190.75,,,,,,,141.70,528.65,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,outpatient,,,1347.00000,647.91000,Banner Health,Banner Choice Plus/Banner Select,,471.45,,,,,,,350.22,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,outpatient,,,898.00000,431.94000,Banner Health,Banner Choice Plus/Banner Select,52,314.30,,,,,,,233.48,871.06,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,outpatient,,,469.00000,225.59000,Banner Health,Banner Choice Plus/Banner Select,,164.15,,,,,,,121.94,454.93,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,outpatient,,,1762.00000,847.52000,Banner Health,Banner Choice Plus/Banner Select,,616.70,,,,,,,458.12,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,outpatient,,,627.00000,301.59000,Banner Health,Banner Choice Plus/Banner Select,,219.45,,,,,,,163.02,608.19,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,outpatient,,,590.00000,283.79000,Banner Health,Banner Choice Plus/Banner Select,,206.50,,,,,,,153.40,572.30,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,outpatient,,,1550.00000,745.55000,Banner Health,Banner Choice Plus/Banner Select,,542.50,,,,,,,403.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Banner Health,Banner Choice Plus/Banner Select,LT,346.50,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Banner Health,Banner Choice Plus/Banner Select,RT,346.50,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,outpatient,,,1402.00000,674.36000,Banner Health,Banner Choice Plus/Banner Select,,490.70,,,,,,,364.52,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Banner Health,Banner Choice Plus/Banner Select,LT,343.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Banner Health,Banner Choice Plus/Banner Select,RT,343.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,outpatient,,,1661.00000,798.94000,Banner Health,Banner Choice Plus/Banner Select,,581.35,,,,,,,431.86,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,outpatient,,,980.00000,471.38000,Banner Health,Banner Choice Plus/Banner Select,,343.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1740.00000,836.94000,Banner Health,Banner Choice Plus/Banner Select,,609.00,,,,,,,452.40,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1168.00000,561.81000,Banner Health,Banner Choice Plus/Banner Select,,408.80,,,,,,,303.68,1132.96,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,outpatient,,,433.00000,232.09000,Banner Health,Banner Choice Plus/Banner Select,,151.55,,,,,,,112.58,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Banner Health,Banner Choice Plus/Banner Select,LT,135.80,,,,,,,100.88,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Banner Health,Banner Choice Plus/Banner Select,RT,135.80,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,outpatient,,,388.00000,207.97000,Banner Health,Banner Choice Plus/Banner Select,,135.80,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,outpatient,,,604.00000,323.74000,Banner Health,Banner Choice Plus/Banner Select,,211.40,,,,,,,157.04,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,outpatient,,,667.00000,357.51000,Banner Health,Banner Choice Plus/Banner Select,,233.45,,,,,,,173.42,646.99,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,outpatient,,,176.00000,94.34000,Banner Health,Banner Choice Plus/Banner Select,,61.60,,,,,,,45.76,170.72,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Banner Health,Banner Choice Plus/Banner Select,LT,32.20,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Banner Health,Banner Choice Plus/Banner Select,RT,32.20,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Banner Health,Banner Choice Plus/Banner Select,LT,128.10,,,,,,,95.16,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Banner Health,Banner Choice Plus/Banner Select,RT,128.10,,,,,,,95.16,355.02,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Banner Health,Banner Choice Plus/Banner Select,LT,390.95,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Banner Health,Banner Choice Plus/Banner Select,RT,390.95,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,outpatient,,,559.00000,180.56000,Banner Health,Banner Choice Plus/Banner Select,,195.65,,,,,,,145.34,542.23,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,outpatient,,,252.00000,81.40000,Banner Health,Banner Choice Plus/Banner Select,50,88.20,,,,,,,65.52,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Banner Health,Banner Choice Plus/Banner Select,LT,58.80,,,,,,,43.68,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Banner Health,Banner Choice Plus/Banner Select,RT,58.80,,,,,,,43.68,162.96,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Banner Health,Banner Choice Plus/Banner Select,LT,401.80,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Banner Health,Banner Choice Plus/Banner Select,RT,401.80,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,outpatient,,,379.00000,122.42000,Banner Health,Banner Choice Plus/Banner Select,,132.65,,,,,,,98.54,367.63,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,outpatient,,,1015.00000,327.84000,Banner Health,Banner Choice Plus/Banner Select,,355.25,,,,,,,263.90,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,outpatient,,,591.00000,190.89000,Banner Health,Banner Choice Plus/Banner Select,,206.85,,,,,,,153.66,573.27,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,outpatient,,,271.00000,169.92000,Banner Health,Banner Choice Plus/Banner Select,,94.85,,,,,,,70.46,262.87,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Banner Health,Banner Choice Plus/Banner Select,LT,73.85,,,,,,,54.86,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Banner Health,Banner Choice Plus/Banner Select,RT,73.85,,,,,,,54.86,204.67,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,59.00000,36.99000,Banner Health,Banner Choice Plus/Banner Select,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,outpatient,,,336.00000,219.74000,Banner Health,Banner Choice Plus/Banner Select,,117.60,,,,,,,87.36,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,outpatient,,,224.00000,146.50000,Banner Health,Banner Choice Plus/Banner Select,52,78.40,,,,,,,58.24,217.28,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,outpatient,,,63.00000,41.20000,Banner Health,Banner Choice Plus/Banner Select,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Banner Health,Banner Choice Plus/Banner Select,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Banner Health,Banner Choice Plus/Banner Select,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Banner Health,Banner Choice Plus/Banner Select,,212.80,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Banner Health,Banner Choice Plus/Banner Select,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Banner Health,Banner Choice Plus/Banner Select,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Banner Health,Banner Choice Plus/Banner Select,,74.90,,,,,,,55.64,207.58,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Banner Health,Banner Choice Plus/Banner Select,,213.15,,,,,,,158.34,590.73,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Banner Health,Banner Choice Plus/Banner Select,,302.05,,,,,,,224.38,837.11,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,outpatient,,,900.00000,605.70000,Banner Health,Banner Choice Plus/Banner Select,,315.00,,,,,,,234.00,873.00,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,outpatient,,,1940.00000,1102.21000,Banner Health,Banner Choice Plus/Banner Select,,679.00,,,,,,,504.40,1881.80,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,outpatient,,,422.00000,239.76000,Banner Health,Banner Choice Plus/Banner Select,,147.70,,,,,,,109.72,409.34,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,outpatient,,,1430.00000,812.45000,Banner Health,Banner Choice Plus/Banner Select,,500.50,,,,,,,371.80,1387.10,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,outpatient,,,745.00000,423.27000,Banner Health,Banner Choice Plus/Banner Select,,260.75,,,,,,,193.70,722.65,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,outpatient,,,2655.00000,2487.74000,Banner Health,Banner Choice Plus/Banner Select,,929.25,,,,,,,690.30,2575.35,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,outpatient,,,3990.00000,3738.63000,Banner Health,Banner Choice Plus/Banner Select,,1396.50,,,,,,,1037.40,3870.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,outpatient,,,290.00000,271.73000,Banner Health,Banner Choice Plus/Banner Select,,101.50,,,,,,,75.40,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,outpatient,,,735.00000,688.70000,Banner Health,Banner Choice Plus/Banner Select,,257.25,,,,,,,191.10,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Banner Health,Banner Choice Plus/Banner Select,,516.25,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,outpatient,,,2275.00000,2131.68000,Banner Health,Banner Choice Plus/Banner Select,,796.25,,,,,,,591.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,outpatient,,,3205.00000,3003.08000,Banner Health,Banner Choice Plus/Banner Select,,1121.75,,,,,,,833.30,3108.85,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,outpatient,,,770.00000,721.49000,Banner Health,Banner Choice Plus/Banner Select,,269.50,,,,,,,200.20,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Banner Health,Banner Choice Plus/Banner Select,,516.25,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,outpatient,,,2210.00000,2070.77000,Banner Health,Banner Choice Plus/Banner Select,,773.50,,,,,,,574.60,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,outpatient,,,2660.00000,2492.42000,Banner Health,Banner Choice Plus/Banner Select,,931.00,,,,,,,691.60,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,outpatient,,,3560.00000,3335.72000,Banner Health,Banner Choice Plus/Banner Select,,1246.00,,,,,,,925.60,3453.20,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,outpatient,,,5730.00000,3255.50000,Banner Health,Banner Choice Plus/Banner Select,,2005.50,,,,,,,1489.80,5558.10,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,outpatient,,,3875.00000,2201.58000,Banner Health,Banner Choice Plus/Banner Select,,1356.25,,,,,,,1007.50,3758.75,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,outpatient,,,519.00000,564.15000,Banner Health,Banner Choice Plus/Banner Select,,181.65,,,,,,,134.94,503.43,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,outpatient,,,536.00000,582.63000,Banner Health,Banner Choice Plus/Banner Select,,187.60,,,,,,,139.36,519.92,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Banner Health,Banner Choice Plus/Banner Select,,158.55,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Banner Health,Banner Choice Plus/Banner Select,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Banner Health,Banner Choice Plus/Banner Select,,37.45,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Banner Health,Banner Choice Plus/Banner Select,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Banner Health,Banner Choice Plus/Banner Select,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Banner Health,Banner Choice Plus/Banner Select,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Banner Health,Banner Choice Plus/Banner Select,,212.80,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Banner Health,Banner Choice Plus/Banner Select,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Banner Health,Banner Choice Plus/Banner Select,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Banner Health,Banner Choice Plus/Banner Select,,74.90,,,,,,,55.64,207.58,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,outpatient,,,175.00000,63.18000,Banner Health,Banner Choice Plus/Banner Select,,61.25,,,,,,,45.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,outpatient,,,304.00000,109.74000,Banner Health,Banner Choice Plus/Banner Select,,106.40,,,,,,,79.04,294.88,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Banner Health,Banner Choice Plus/Banner Select,,99.40,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Banner Health,Banner Choice Plus/Banner Select,,160.30,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,outpatient,,,438.00000,158.12000,Banner Health,Banner Choice Plus/Banner Select,,153.30,,,,,,,113.88,424.86,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Banner Health,Banner Choice Plus/Banner Select,,195.30,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Banner Health,Banner Choice Plus/Banner Select,,168.70,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Banner Health,Banner Choice Plus/Banner Select,,82.95,,,,,,,61.62,229.89,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Banner Health,Banner Choice Plus/Banner Select,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Banner Health,Banner Choice Plus/Banner Select,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Banner Health,Banner Choice Plus/Banner Select,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Banner Health,Banner Choice Plus/Banner Select,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Banner Health,Banner Choice Plus/Banner Select,,294.70,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Banner Health,Banner Choice Plus/Banner Select,,368.55,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Banner Health,Banner Choice Plus/Banner Select,,442.05,,,,,,,328.38,1225.11,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Banner Health,Banner Choice Plus/Banner Select,,63.70,,,,,,,47.32,176.54,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Banner Health,Banner Choice Plus/Banner Select,,73.50,,,,,,,54.60,203.70,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,outpatient,,,140.00000,79.54000,Banner Health,Banner Choice Plus/Banner Select,,49.00,,,,,,,36.40,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,outpatient,,,190.00000,107.95000,Banner Health,Banner Choice Plus/Banner Select,,66.50,,,,,,,49.40,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,outpatient,,,240.00000,136.36000,Banner Health,Banner Choice Plus/Banner Select,,84.00,,,,,,,62.40,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,outpatient,,,290.00000,164.76000,Banner Health,Banner Choice Plus/Banner Select,,101.50,,,,,,,75.40,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,outpatient,,,340.00000,193.17000,Banner Health,Banner Choice Plus/Banner Select,,119.00,,,,,,,88.40,329.80,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,outpatient,,,150.00000,85.22000,Banner Health,Banner Choice Plus/Banner Select,,52.50,,,,,,,39.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,outpatient,,,200.00000,113.63000,Banner Health,Banner Choice Plus/Banner Select,,70.00,,,,,,,52.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,outpatient,,,270.00000,153.40000,Banner Health,Banner Choice Plus/Banner Select,,94.50,,,,,,,70.20,261.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,outpatient,,,370.00000,210.22000,Banner Health,Banner Choice Plus/Banner Select,,129.50,,,,,,,96.20,358.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,outpatient,,,470.00000,267.03000,Banner Health,Banner Choice Plus/Banner Select,,164.50,,,,,,,122.20,455.90,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,outpatient,,,248.00000,96.22000,Banner Health,Banner Choice Plus/Banner Select,,86.80,,,,,,,64.48,240.56,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,outpatient,,,245.00000,95.06000,Banner Health,Banner Choice Plus/Banner Select,,85.75,,,,,,,63.70,237.65,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,outpatient,,,497.00000,192.84000,Banner Health,Banner Choice Plus/Banner Select,,173.95,,,,,,,129.22,482.09,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,outpatient,,,357.00000,138.52000,Banner Health,Banner Choice Plus/Banner Select,,124.95,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,outpatient,,,334.00000,129.59000,Banner Health,Banner Choice Plus/Banner Select,,116.90,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,outpatient,,,194.00000,75.27000,Banner Health,Banner Choice Plus/Banner Select,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,outpatient,,,1035.00000,401.58000,Banner Health,Banner Choice Plus/Banner Select,,362.25,,,,,,,269.10,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,outpatient,,,1137.00000,441.16000,Banner Health,Banner Choice Plus/Banner Select,,397.95,,,,,,,295.62,1102.89,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,outpatient,,,963.00000,373.64000,Banner Health,Banner Choice Plus/Banner Select,,337.05,,,,,,,250.38,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,outpatient,,,990.00000,384.12000,Banner Health,Banner Choice Plus/Banner Select,,346.50,,,,,,,257.40,960.30,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,outpatient,,,112.00000,43.46000,Banner Health,Banner Choice Plus/Banner Select,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,outpatient,,,84.00000,32.59000,Banner Health,Banner Choice Plus/Banner Select,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,outpatient,,,176.00000,68.29000,Banner Health,Banner Choice Plus/Banner Select,,61.60,,,,,,,45.76,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,outpatient,,,283.00000,109.80000,Banner Health,Banner Choice Plus/Banner Select,,99.05,,,,,,,73.58,274.51,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Banner Health,Banner Choice Plus/Banner Select,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Banner Health,Banner Choice Plus/Banner Select,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,35.00000,19.89000,Banner Health,Banner Choice Plus/Banner Select,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,outpatient,,,191.00000,89.39000,Banner Health,Banner Choice Plus/Banner Select,,66.85,,,,,,,49.66,185.27,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Banner Health,Banner Choice Plus/Banner Select,,158.55,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Banner Health,Banner Choice Plus/Banner Select,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Banner Health,Banner Choice Plus/Banner Select,,37.45,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Banner Health,Banner Choice Plus/Banner Select,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,outpatient,,,281.00000,131.51000,Banner Health,Banner Choice Plus/Banner Select,,98.35,,,,,,,73.06,272.57,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,outpatient,,,192.00000,89.86000,Banner Health,Banner Choice Plus/Banner Select,,67.20,,,,,,,49.92,186.24,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,outpatient,,,365.00000,170.82000,Banner Health,Banner Choice Plus/Banner Select,,127.75,,,,,,,94.90,354.05,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,outpatient,,,8391.00000,5856.92000,Banner Health,Banner Choice Plus/Banner Select,,2936.85,,,,,,,2181.66,8139.27,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Banner Health,Banner Choice Plus/Banner Select,52,2420.95,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Banner Health,Banner Choice Plus/Banner Select,,2100.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Banner Health,Banner Choice Plus/Banner Select,,2420.95,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Banner Health,Banner Choice Plus/Banner Select,52,2100.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,outpatient,,,8855.00000,9625.38000,Banner Health,Banner Choice Plus/Banner Select,,3099.25,,,,,,,2302.30,8589.35,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Banner Health,Banner Choice Plus/Banner Select,,295.40,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Banner Health,Banner Choice Plus/Banner Select,52,295.40,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Banner Health,Banner Choice Plus/Banner Select,,274.75,,,,,,,204.10,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Banner Health,Banner Choice Plus/Banner Select,52,274.75,,,,,,,204.10,761.45,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Banner Health,Banner Choice Plus/Banner Select,,1648.15,,,,,,,1224.34,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Banner Health,Banner Choice Plus/Banner Select,52,1648.15,,,,,,,1224.34,4567.73,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,outpatient,,,345.00000,128.34000,Banner Health,Banner Choice Plus/Banner Select,,120.75,,,,,,,89.70,334.65,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,outpatient,,,120.00000,99.60000,Banner Health,Banner Choice Plus/Banner Select,,42.00,,,,,,,31.20,116.40,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,outpatient,,,106.00000,87.98000,Banner Health,Banner Choice Plus/Banner Select,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,outpatient,,,32.00000,26.56000,Banner Health,Banner Choice Plus/Banner Select,,11.20,,,,,,,8.32,31.04,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,outpatient,,,60.00000,49.80000,Banner Health,Banner Choice Plus/Banner Select,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,outpatient,,,57.00000,47.31000,Banner Health,Banner Choice Plus/Banner Select,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,outpatient,1.0,ME,7.40000,0.65000,Banner Health,Banner Choice Plus/Banner Select,,2.59,,,,,,,1.92,7.18,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,outpatient,1.0,EA,6.60000,1.43000,Banner Health,Banner Choice Plus/Banner Select,UD,2.31,,,,,,,1.72,6.40,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,outpatient,1.0,EA,2.95000,0.64000,Banner Health,Banner Choice Plus/Banner Select,UD,1.03,,,,,,,0.76700,2.86,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,56.08000,12.11000,Banner Health,Banner Choice Plus/Banner Select,UD,19.63,,,,,,,14.58,54.40,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,outpatient,1.0,UN,82.10000,28.90000,Banner Health,Banner Choice Plus/Banner Select,,28.73,,,,,,,15.48,79.64,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.04000,,Banner Health,Banner Choice Plus/Banner Select,UD,0.01400,,,,,,,0.01040,0.03880,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.05000,,Banner Health,Banner Choice Plus/Banner Select,UD,0.01750,,,,,,,0.01300,0.04850,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,outpatient,1.0,ME,6.20000,0.55000,Banner Health,Banner Choice Plus/Banner Select,,2.17,,,,,,,1.61,6.01,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.12000,0.01000,Banner Health,Banner Choice Plus/Banner Select,UD,0.04200,,,,,,,0.03120,0.11640,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,outpatient,2.0,ML,5.80000,1.25000,Banner Health,Banner Choice Plus/Banner Select,,2.03,,,,,,,1.51,5.63,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,outpatient,1.0,ME,3.10000,0.27000,Banner Health,Banner Choice Plus/Banner Select,,1.08,,,,,,,0.80600,3.01,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,outpatient,1.0,EA,44.40000,3.91000,Banner Health,Banner Choice Plus/Banner Select,,15.54,,,,,,,11.54,43.07,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,8.26000,0.73000,Banner Health,Banner Choice Plus/Banner Select,UD,2.89,,,,,,,2.15,8.01,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,2.19000,0.19000,Banner Health,Banner Choice Plus/Banner Select,UD,0.76650,,,,,,,0.56940,2.12,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,outpatient,1.0,EA,28.60000,2.52000,Banner Health,Banner Choice Plus/Banner Select,,10.01,,,,,,,7.44,27.74,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,outpatient,1.0,EA,2.58000,0.91000,Banner Health,Banner Choice Plus/Banner Select,UD,0.90300,,,,,,,0.67080,2.50,percent of total billed charges,
R&B OBSTETRICS PVT,3012,CDM,112,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2625.26,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,23010,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2625.26,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ICU,33019,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8270.38,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,13011,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5513.90,,,,,,,2512.00,5665.77,percent of total billed charges,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,244.00000,77.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,230.34,,,,,,,219.60,236.68,percent of total billed charges,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,244.00000,77.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,230.34,,,,,,,63.44,236.68,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,24075,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2625.26,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B OBSTETRICS SEMI-PVT,44073,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2625.26,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B NURSERY LEVEL 1,55160,CDM,171,RC,,,,,facility,inpatient,,,3477.00000,1975.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3282.29,,,,,,,2512.00,3372.69,percent of total billed charges,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,inpatient,,,16.00000,7.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,15.10,,,,,,,14.40,15.52,percent of total billed charges,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,outpatient,,,16.00000,7.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,15.10,,,,,,,4.16,15.52,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,inpatient,,,210.00000,119.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,198.24,,,,,,,189.00,203.70,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,198.24,,,,,,,54.60,203.70,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,inpatient,,,380.00000,215.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,358.72,,,,,,,342.00,368.60,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,outpatient,,,380.00000,215.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,358.72,,,,,,,98.80,368.60,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,109.50,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,109.50,,,,,,,30.16,112.52,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22012,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2625.26,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ADMIN DAY SKILLED,82016,CDM,160,RC,,,,,facility,inpatient,,,1923.00000,1092.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1815.31,,,,,,,1730.70,3111.10,percent of total billed charges,
R&B SWING BED SKILLED,62018,CDM,160,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2625.26,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ADMIN DAY INTERMEDIATE,72017,CDM,169,RC,,,,,facility,inpatient,,,1176.00000,668.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1110.14,,,,,,,1058.40,3111.10,percent of total billed charges,
R&B ICU,32011,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8270.38,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,12013,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5513.90,,,,,,,2512.00,5665.77,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,109.50,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,109.50,,,,,,,30.16,112.52,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,475.78,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,475.78,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,573.95,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,573.95,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,202.02,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,202.02,,,,,,,55.64,207.58,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,84.00000,63.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,79.30,,,,,,,75.60,81.48,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,79.30,,,,,,,21.84,81.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,268.10,,,,,,,255.60,275.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,268.10,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,432.35,,,,,,,412.20,444.26,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,432.35,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,526.75,,,,,,,502.20,541.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,526.75,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,455.01,,,,,,,433.80,467.54,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,455.01,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,223.73,,,,,,,213.30,229.89,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,223.73,,,,,,,61.62,229.89,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,inpatient,,,2041.00000,659.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1926.70,,,,,,,1836.90,1979.77,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,outpatient,,,2041.00000,659.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1926.70,,,,,,,530.66,1979.77,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,inpatient,,,259.00000,83.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,244.50,,,,,,,233.10,251.23,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,outpatient,,,259.00000,83.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,244.50,,,,,,,67.34,251.23,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,inpatient,,,672.00000,217.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,634.37,,,,,,,604.80,651.84,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,outpatient,,,672.00000,217.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,634.37,,,,,,,174.72,651.84,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,inpatient,,,530.00000,171.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,500.32,,,,,,,477.00,514.10,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,outpatient,,,530.00000,171.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,500.32,,,,,,,137.80,514.10,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,inpatient,,,580.00000,187.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,547.52,,,,,,,522.00,562.60,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,outpatient,,,580.00000,187.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,547.52,,,,,,,150.80,562.60,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,inpatient,,,435.00000,140.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,410.64,,,,,,,391.50,421.95,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,outpatient,,,435.00000,140.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,410.64,,,,,,,113.10,421.95,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,inpatient,,,863.00000,278.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,814.67,,,,,,,776.70,837.11,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,814.67,,,,,,,224.38,837.11,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,inpatient,,,334.00000,107.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,315.30,,,,,,,300.60,323.98,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,outpatient,,,334.00000,107.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,315.30,,,,,,,86.84,323.98,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,inpatient,,,1188.00000,383.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,1121.47,,,,,,,1069.20,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,outpatient,,,1188.00000,383.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,1121.47,,,,,,,308.88,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,inpatient,,,792.00000,255.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,747.65,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,747.65,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,inpatient,,,792.00000,255.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,747.65,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,747.65,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,inpatient,,,572.00000,184.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,539.97,,,,,,,514.80,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,outpatient,,,572.00000,184.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,539.97,,,,,,,148.72,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,inpatient,,,381.00000,123.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,359.66,,,,,,,342.90,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,359.66,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,inpatient,,,381.00000,123.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,359.66,,,,,,,342.90,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,359.66,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,inpatient,,,455.00000,146.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,429.52,,,,,,,409.50,441.35,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,outpatient,,,455.00000,146.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,429.52,,,,,,,118.30,441.35,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,inpatient,,,403.00000,130.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,380.43,,,,,,,362.70,390.91,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,outpatient,,,403.00000,130.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,380.43,,,,,,,104.78,390.91,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,inpatient,,,370.00000,119.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,349.28,,,,,,,333.00,358.90,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,outpatient,,,370.00000,119.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,349.28,,,,,,,96.20,358.90,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,inpatient,,,357.00000,115.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,337.01,,,,,,,321.30,346.29,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,outpatient,,,357.00000,115.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,337.01,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,inpatient,,,334.00000,107.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,315.30,,,,,,,300.60,323.98,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,outpatient,,,334.00000,107.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,315.30,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,inpatient,,,194.00000,62.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,183.14,,,,,,,174.60,188.18,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,outpatient,,,194.00000,62.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,183.14,,,,,,,50.44,188.18,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,inpatient,,,457.00000,147.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,431.41,,,,,,,411.30,443.29,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,outpatient,,,457.00000,147.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,431.41,,,,,,,118.82,443.29,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,inpatient,,,492.00000,158.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,464.45,,,,,,,442.80,477.24,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,outpatient,,,492.00000,158.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,464.45,,,,,,,127.92,477.24,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,inpatient,,,780.00000,251.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,736.32,,,,,,,702.00,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,outpatient,,,780.00000,251.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,736.32,,,,,,,202.80,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,inpatient,,,1165.00000,376.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1099.76,,,,,,,1048.50,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,outpatient,,,1165.00000,376.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1099.76,,,,,,,302.90,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,inpatient,,,2350.00000,759.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2218.40,,,,,,,2115.00,2279.50,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,outpatient,,,2350.00000,759.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2218.40,,,,,,,611.00,2279.50,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,inpatient,,,896.00000,289.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,845.82,,,,,,,806.40,869.12,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,outpatient,,,896.00000,289.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,845.82,,,,,,,232.96,869.12,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,inpatient,,,490.00000,158.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,462.56,,,,,,,441.00,475.30,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,outpatient,,,490.00000,158.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,462.56,,,,,,,127.40,475.30,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,inpatient,,,520.00000,167.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,490.88,,,,,,,468.00,504.40,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,outpatient,,,520.00000,167.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,490.88,,,,,,,135.20,504.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,inpatient,,,720.00000,232.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,679.68,,,,,,,648.00,698.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,outpatient,,,720.00000,232.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,679.68,,,,,,,187.20,698.40,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,inpatient,,,215.00000,69.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,202.96,,,,,,,193.50,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,outpatient,,,215.00000,69.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,202.96,,,,,,,55.90,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,inpatient,,,240.00000,77.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,226.56,,,,,,,216.00,232.80,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,outpatient,,,240.00000,77.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,226.56,,,,,,,62.40,232.80,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,inpatient,,,1241.00000,400.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1171.50,,,,,,,1116.90,1203.77,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,outpatient,,,1241.00000,400.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1171.50,,,,,,,322.66,1203.77,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,794.85,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,794.85,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,994.03,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,994.03,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1192.27,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1192.27,,,,,,,328.38,1225.11,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,inpatient,,,668.00000,559.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,630.59,,,,,,,601.20,647.96,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,outpatient,,,668.00000,559.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,630.59,,,,,,,173.68,647.96,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,72.90,78.57,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,38.70,,,,,,,36.90,39.77,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,38.70,,,,,,,10.66,39.77,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,427.63,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,427.63,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,135.94,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,135.94,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,101.01,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,101.01,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,135.94,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,135.94,,,,,,,37.44,139.68,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3.21,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3.21,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3.21,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3.21,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3.21,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3.21,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,4.90000,2.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4.63,,,,,,,4.41,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4.63,,,,,,,1.27,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,7.90000,4.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7.46,,,,,,,7.11,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,7.90000,4.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7.46,,,,,,,2.05,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,4.90000,2.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4.63,,,,,,,4.41,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4.63,,,,,,,1.27,4.75,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,21.06,78.57,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,inpatient,,,3141500.00000,1784843.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2965576.00,,,,,,,2827350.00,3047255.00,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,outpatient,,,3141500.00000,1784843.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2965576.00,,,,,,,816790.00,3047255.00,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,0.20768,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,0.20768,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.52000,0.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,0.49088,,,,,,,0.46800,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.52000,0.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,0.49088,,,,,,,0.13520,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.56000,0.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,0.52864,,,,,,,0.50400,0.54320,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.56000,0.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,0.52864,,,,,,,0.14560,0.54320,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,0.20768,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,0.20768,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.85000,0.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,0.80240,,,,,,,0.76500,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.85000,0.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,0.80240,,,,,,,0.22100,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,0.20768,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,0.20768,,,,,,,0.05720,0.21340,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,inpatient,,,102.00000,65.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,91.80,98.94,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,outpatient,,,102.00000,65.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,26.52,98.94,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,inpatient,,,190.00000,121.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,179.36,,,,,,,171.00,184.30,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,outpatient,,,190.00000,121.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,179.36,,,,,,,49.40,184.30,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,inpatient,,,359.00000,229.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,323.10,348.23,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,93.34,348.23,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,inpatient,,,535.00000,341.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,505.04,,,,,,,481.50,518.95,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,505.04,,,,,,,139.10,518.95,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,inpatient,,,766.00000,489.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,723.10,,,,,,,689.40,743.02,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,outpatient,,,766.00000,489.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,723.10,,,,,,,199.16,743.02,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,inpatient,,,159.00000,101.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,150.10,,,,,,,143.10,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,outpatient,,,159.00000,101.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,150.10,,,,,,,41.34,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,inpatient,,,447.00000,285.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,402.30,433.59,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,outpatient,,,447.00000,285.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,116.22,433.59,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,inpatient,,,1413.00000,902.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,outpatient,,,1413.00000,902.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,inpatient,,,3853.00000,2462.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,outpatient,,,3853.00000,2462.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,inpatient,,,313.00000,200.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,outpatient,,,313.00000,200.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,inpatient,,,1132.00000,723.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,outpatient,,,1132.00000,723.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,inpatient,,,2695.00000,1722.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,outpatient,,,2695.00000,1722.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,inpatient,,,1619.00000,1034.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,outpatient,,,1619.00000,1034.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,inpatient,,,535.00000,341.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,505.04,,,,,,,481.50,518.95,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,505.04,,,,,,,139.10,518.95,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,inpatient,,,850.00000,543.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,outpatient,,,850.00000,543.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,inpatient,,,32.00000,20.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,30.21,,,,,,,28.80,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,outpatient,,,32.00000,20.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,30.21,,,,,,,8.32,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,inpatient,,,134.00000,85.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,126.50,,,,,,,120.60,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,outpatient,,,134.00000,85.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,126.50,,,,,,,34.84,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,inpatient,,,359.00000,229.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,323.10,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,93.34,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,inpatient,,,709.00000,453.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,669.30,,,,,,,638.10,687.73,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,outpatient,,,709.00000,453.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,669.30,,,,,,,184.34,687.73,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,inpatient,,,4880.00000,2357.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4606.72,,,,,,,4392.00,4733.60,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,outpatient,,,4880.00000,2357.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4606.72,,,,,,,1268.80,4733.60,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,inpatient,,,6024.00000,2909.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5686.66,,,,,,,5421.60,5843.28,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,outpatient,,,6024.00000,2909.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5686.66,,,,,,,1566.24,5843.28,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,402.30,433.59,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,116.22,433.59,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,3957.30,4265.09,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,1143.22,4265.09,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,5274.90,5685.17,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,1523.86,5685.17,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,inpatient,,,7413.00000,3580.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6997.87,,,,,,,6671.70,7190.61,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,outpatient,,,7413.00000,3580.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6997.87,,,,,,,1927.38,7190.61,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,402.30,433.59,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,116.22,433.59,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,402.30,433.59,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,116.22,433.59,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,3957.30,4265.09,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,1143.22,4265.09,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,inpatient,,,7181.00000,3468.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6778.86,,,,,,,6462.90,6965.57,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6778.86,,,,,,,1867.06,6965.57,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,inpatient,,,10654.00000,5145.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10057.38,,,,,,,9588.60,10334.38,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,outpatient,,,10654.00000,5145.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10057.38,,,,,,,2770.04,10334.38,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,6487.00000,3133.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6123.73,,,,,,,5838.30,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6123.73,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,7413.00000,3580.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6997.87,,,,,,,6671.70,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6997.87,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,11575.00000,5590.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10926.80,,,,,,,10417.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,11575.00000,5590.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10926.80,,,,,,,3009.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,13432.00000,6487.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12679.81,,,,,,,12088.80,13029.04,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,13432.00000,6487.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12679.81,,,,,,,3492.32,13029.04,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,21904.00000,10579.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,21904.00000,10579.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,490.88,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,4397.00000,2123.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,3957.30,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,1143.22,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,7413.00000,3580.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6997.87,,,,,,,6671.70,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6997.87,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,12969.00000,6264.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12242.74,,,,,,,11672.10,12579.93,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,12969.00000,6264.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12242.74,,,,,,,3371.94,12579.93,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,490.88,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2290.14,,,,,,,2183.40,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2290.14,,,,,,,630.76,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2668.69,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2668.69,,,,,,,735.02,2742.19,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,91.80,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,26.52,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,inpatient,,,134.00000,64.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,126.50,,,,,,,120.60,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,126.50,,,,,,,34.84,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,inpatient,,,251.00000,121.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,236.94,,,,,,,225.90,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,outpatient,,,251.00000,121.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,236.94,,,,,,,65.26,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,490.88,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,447.00000,215.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,402.30,433.59,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,447.00000,215.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,116.22,433.59,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,2827.00000,1365.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2668.69,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2668.69,,,,,,,735.02,2742.19,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,2690.00000,1299.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2539.36,,,,,,,2421.00,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2539.36,,,,,,,699.40,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,6487.00000,3133.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6123.73,,,,,,,5838.30,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6123.73,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,2426.00000,1171.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2290.14,,,,,,,2183.40,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,2426.00000,1171.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2290.14,,,,,,,630.76,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,15334.00000,7406.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,13800.60,14873.98,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,15334.00000,7406.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,3986.84,14873.98,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,490.88,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2668.69,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2668.69,,,,,,,735.02,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,251.00000,121.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,236.94,,,,,,,225.90,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,251.00000,121.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,236.94,,,,,,,65.26,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,490.88,1831.36,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,2827.00000,1365.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2668.69,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2668.69,,,,,,,735.02,2742.19,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,30.21,,,,,,,28.80,31.04,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,30.21,,,,,,,8.32,31.04,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,490.88,1831.36,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,inpatient,,,15334.00000,7406.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,13800.60,14873.98,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,3986.84,14873.98,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,inpatient,,,1485.00000,717.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1401.84,,,,,,,1336.50,1440.45,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,outpatient,,,1485.00000,717.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1401.84,,,,,,,386.10,1440.45,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,inpatient,,,2028.00000,979.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1914.43,,,,,,,1825.20,1967.16,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,outpatient,,,2028.00000,979.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1914.43,,,,,,,527.28,1967.16,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,4397.00000,2123.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,3957.30,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,1143.22,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,8107.00000,3915.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7653.01,,,,,,,7296.30,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,8107.00000,3915.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7653.01,,,,,,,2107.82,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,10422.00000,5033.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,9838.37,,,,,,,9379.80,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,10422.00000,5033.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,9838.37,,,,,,,2709.72,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,12737.00000,6151.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12023.73,,,,,,,11463.30,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,12737.00000,6151.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12023.73,,,,,,,3311.62,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,14239.00000,6877.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13441.62,,,,,,,12815.10,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,14239.00000,6877.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13441.62,,,,,,,3702.14,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,16429.00000,7935.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,15508.98,,,,,,,14786.10,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,16429.00000,7935.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,15508.98,,,,,,,4271.54,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,18619.00000,8992.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,17576.34,,,,,,,16757.10,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,18619.00000,8992.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,17576.34,,,,,,,4840.94,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,20809.00000,10050.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,19643.70,,,,,,,18728.10,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,20809.00000,10050.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,19643.70,,,,,,,5410.34,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,22999.00000,11108.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,21711.06,,,,,,,20699.10,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,22999.00000,11108.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,21711.06,,,,,,,5979.74,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,25189.00000,12166.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,23778.42,,,,,,,22670.10,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,25189.00000,12166.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,23778.42,,,,,,,6549.14,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,27379.00000,13224.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,25845.78,,,,,,,24641.10,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,27379.00000,13224.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,25845.78,,,,,,,7118.54,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,29569.00000,14281.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,27913.14,,,,,,,26612.10,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,29569.00000,14281.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,27913.14,,,,,,,7687.94,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,31759.00000,15339.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,29980.50,,,,,,,28583.10,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,31759.00000,15339.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,29980.50,,,,,,,8257.34,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,36139.00000,17455.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,34115.22,,,,,,,32525.10,35054.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,36139.00000,17455.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,34115.22,,,,,,,9396.14,35054.83,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,1699.20,1831.36,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,490.88,1831.36,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3152.96,,,,,,,3006.00,3239.80,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3152.96,,,,,,,868.40,3239.80,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,5274.90,5685.17,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,1523.86,5685.17,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,30.21,,,,,,,28.80,31.04,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,30.21,,,,,,,8.32,31.04,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,inpatient,,,134.00000,64.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,126.50,,,,,,,120.60,129.98,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,126.50,,,,,,,34.84,129.98,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,179.36,,,,,,,171.00,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,179.36,,,,,,,49.40,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,inpatient,,,476.00000,229.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,449.34,,,,,,,428.40,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,outpatient,,,476.00000,229.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,449.34,,,,,,,123.76,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,30.21,,,,,,,28.80,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,30.21,,,,,,,8.32,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,402.30,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,116.22,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,1699.20,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,490.88,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,5274.90,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,1523.86,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,inpatient,,,12506.00000,6040.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,11805.66,,,,,,,11255.40,12130.82,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,outpatient,,,12506.00000,6040.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,11805.66,,,,,,,3251.56,12130.82,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,inpatient,,,2404.80000,1161.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2270.13,,,,,,,2164.32,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,outpatient,,,2404.80000,1161.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2270.13,,,,,,,625.25,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,inpatient,,,969.00000,468.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,914.74,,,,,,,872.10,939.93,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,outpatient,,,969.00000,468.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,914.74,,,,,,,251.94,939.93,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,inpatient,,,2256.90000,1090.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2130.51,,,,,,,2031.21,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,outpatient,,,2256.90000,1090.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2130.51,,,,,,,586.79,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,inpatient,,,644.30000,311.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,608.22,,,,,,,579.87,624.97,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,outpatient,,,644.30000,311.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,608.22,,,,,,,167.52,624.97,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,91.80,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,26.52,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,179.36,,,,,,,171.00,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,179.36,,,,,,,49.40,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,inpatient,,,26284.00000,12695.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,inpatient,,,30664.00000,14810.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,inpatient,,,35044.00000,16926.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,31539.60,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,9111.44,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,inpatient,,,43804.00000,21157.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,39423.60,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,outpatient,,,43804.00000,21157.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,11389.04,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,inpatient,,,52564.00000,25388.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49620.42,,,,,,,47307.60,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,outpatient,,,52564.00000,25388.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49620.42,,,,,,,13666.64,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,inpatient,,,61324.00000,29619.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57889.86,,,,,,,55191.60,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,outpatient,,,61324.00000,29619.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57889.86,,,,,,,15944.24,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,inpatient,,,70084.00000,33850.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66159.30,,,,,,,63075.60,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,outpatient,,,70084.00000,33850.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66159.30,,,,,,,18221.84,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,inpatient,,,78844.00000,38081.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74428.74,,,,,,,70959.60,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,outpatient,,,78844.00000,38081.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74428.74,,,,,,,20499.44,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,inpatient,,,87604.00000,42312.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82698.18,,,,,,,78843.60,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,outpatient,,,87604.00000,42312.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82698.18,,,,,,,22777.04,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,inpatient,,,96364.00000,46543.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,90967.62,,,,,,,86727.60,93473.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,outpatient,,,96364.00000,46543.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,90967.62,,,,,,,25054.64,93473.08,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,inpatient,,,26284.00000,12695.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,inpatient,,,30664.00000,14810.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,inpatient,,,35044.00000,16926.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,31539.60,33992.68,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,9111.44,33992.68,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,inpatient,,,39424.00000,19041.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,35481.60,38241.28,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,outpatient,,,39424.00000,19041.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,10250.24,38241.28,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3690.10,,,,,,,3518.10,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3690.10,,,,,,,1016.34,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,179.36,,,,,,,171.00,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,179.36,,,,,,,49.40,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,5274.90,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,1523.86,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,inpatient,,,15334.00000,7406.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,13800.60,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,3986.84,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,2023.00000,977.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1909.71,,,,,,,1820.70,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2023.00000,977.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1909.71,,,,,,,525.98,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,5274.90,5685.17,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,inpatient,,,7876.00000,3804.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7434.94,,,,,,,7088.40,7639.72,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7434.94,,,,,,,2047.76,7639.72,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,inpatient,,,10191.00000,4922.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,9620.30,,,,,,,9171.90,9885.27,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,outpatient,,,10191.00000,4922.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,9620.30,,,,,,,2649.66,9885.27,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,96.00000,46.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,90.62,,,,,,,86.40,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,96.00000,46.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,90.62,,,,,,,24.96,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,5274.90,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,7876.00000,3804.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7434.94,,,,,,,7088.40,7639.72,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,7876.00000,3804.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7434.94,,,,,,,2047.76,7639.72,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3690.10,,,,,,,3518.10,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3690.10,,,,,,,1016.34,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,inpatient,,,5373.00000,2595.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5072.11,,,,,,,4835.70,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,outpatient,,,5373.00000,2595.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5072.11,,,,,,,1396.98,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,inpatient,,,6487.00000,3133.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6123.73,,,,,,,5838.30,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,outpatient,,,6487.00000,3133.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6123.73,,,,,,,1686.62,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,inpatient,,,7876.00000,3804.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7434.94,,,,,,,7088.40,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7434.94,,,,,,,2047.76,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,3957.30,4265.09,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,1143.22,4265.09,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,5274.90,5685.17,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,1523.86,5685.17,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,inpatient,,,1126.00000,543.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1062.94,,,,,,,1013.40,1092.22,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,outpatient,,,1126.00000,543.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1062.94,,,,,,,292.76,1092.22,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,2690.00000,1299.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2539.36,,,,,,,2421.00,2609.30,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2539.36,,,,,,,699.40,2609.30,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,4880.00000,2357.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4606.72,,,,,,,4392.00,4733.60,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,4880.00000,2357.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4606.72,,,,,,,1268.80,4733.60,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,9260.00000,4472.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8741.44,,,,,,,8334.00,8982.20,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,9260.00000,4472.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8741.44,,,,,,,2407.60,8982.20,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,5274.90,5685.17,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,1523.86,5685.17,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,inpatient,,,588.00000,284.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,555.07,,,,,,,529.20,570.36,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,588.00000,284.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,555.07,,,,,,,152.88,570.36,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,1699.20,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,490.88,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2290.14,,,,,,,2183.40,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2290.14,,,,,,,630.76,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2668.69,,,,,,,2544.30,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2668.69,,,,,,,735.02,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3152.96,,,,,,,3006.00,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3152.96,,,,,,,868.40,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3152.96,,,,,,,3006.00,3239.80,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3152.96,,,,,,,868.40,3239.80,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,402.30,433.59,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,116.22,433.59,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3690.10,,,,,,,3518.10,3791.73,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3690.10,,,,,,,1016.34,3791.73,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,5274.90,5685.17,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,1523.86,5685.17,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,inpatient,,,159.00000,76.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,150.10,,,,,,,143.10,154.23,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,outpatient,,,159.00000,76.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,150.10,,,,,,,41.34,154.23,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,inpatient,,,588.00000,284.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,555.07,,,,,,,529.20,570.36,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,outpatient,,,588.00000,284.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,555.07,,,,,,,152.88,570.36,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2290.14,,,,,,,2183.40,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2290.14,,,,,,,630.76,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,402.30,433.59,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,116.22,433.59,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,inpatient,,,8107.00000,3915.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7653.01,,,,,,,7296.30,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,outpatient,,,8107.00000,3915.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7653.01,,,,,,,2107.82,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,inpatient,,,10422.00000,5033.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,9838.37,,,,,,,9379.80,10109.34,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,outpatient,,,10422.00000,5033.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,9838.37,,,,,,,2709.72,10109.34,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,5274.90,5685.17,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,1523.86,5685.17,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,1699.20,1831.36,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,490.88,1831.36,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,91.80,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,26.52,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,inpatient,,,221.00000,106.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,208.62,,,,,,,198.90,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,outpatient,,,221.00000,106.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,208.62,,,,,,,57.46,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,402.30,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,116.22,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2290.14,,,,,,,2183.40,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2290.14,,,,,,,630.76,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3152.96,,,,,,,3006.00,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3152.96,,,,,,,868.40,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,inpatient,,,4153.00000,2005.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3920.43,,,,,,,3737.70,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,outpatient,,,4153.00000,2005.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3920.43,,,,,,,1079.78,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,inpatient,,,5129.00000,2477.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4841.78,,,,,,,4616.10,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,outpatient,,,5129.00000,2477.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4841.78,,,,,,,1333.54,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,inpatient,,,7181.00000,3468.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6778.86,,,,,,,6462.90,6965.57,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6778.86,,,,,,,1867.06,6965.57,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,inpatient,,,52.50000,25.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.56,,,,,,,47.25,50.92,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,outpatient,,,52.50000,25.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.56,,,,,,,13.65,50.92,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,inpatient,,,50.40000,24.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,47.58,,,,,,,45.36,48.89,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,outpatient,,,50.40000,24.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,47.58,,,,,,,13.10,48.89,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2290.14,,,,,,,2183.40,2353.22,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2290.14,,,,,,,630.76,2353.22,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3690.10,,,,,,,3518.10,3791.73,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3690.10,,,,,,,1016.34,3791.73,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,91.80,98.94,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,26.52,98.94,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,30.21,,,,,,,28.80,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,30.21,,,,,,,8.32,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,402.30,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,116.22,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,inpatient,,,709.00000,342.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,669.30,,,,,,,638.10,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,outpatient,,,709.00000,342.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,669.30,,,,,,,184.34,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82698.18,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82698.18,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,109504.00000,62214.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103371.78,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103371.78,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,131404.00000,74657.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,124045.38,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,131404.00000,74657.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,124045.38,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,43800.00000,24884.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41347.20,,,,,,,39420.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,43800.00000,24884.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41347.20,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82698.18,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82698.18,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,19714.00000,11200.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,24090.00000,13686.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,22740.96,,,,,,,21681.00,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,24090.00000,13686.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,22740.96,,,,,,,6263.40,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,28474.00000,16177.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,26879.46,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,26879.46,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,17520.00000,9953.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16538.88,,,,,,,15768.00,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16538.88,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,21904.00000,12444.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,26284.00000,14933.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,43804.00000,24887.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82698.18,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82698.18,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,109504.00000,62214.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103371.78,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103371.78,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,6105.00000,3468.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,6105.00000,3468.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,13895.00000,7894.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,13895.00000,7894.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,21900.00000,12442.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20673.60,,,,,,,19710.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,21900.00000,12442.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20673.60,,,,,,,5694.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,35040.00000,19907.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33077.76,,,,,,,31536.00,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,35040.00000,19907.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33077.76,,,,,,,9110.40,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,43804.00000,24887.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,19714.00000,11200.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,22776.00000,12940.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,21500.54,,,,,,,20498.40,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,22776.00000,12940.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,21500.54,,,,,,,5921.76,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,28474.00000,16177.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,26879.46,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,26879.46,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,17520.00000,9953.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16538.88,,,,,,,15768.00,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16538.88,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,21904.00000,12444.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,26284.00000,14933.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,30664.00000,17421.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,30664.00000,17421.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,35044.00000,19910.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,35044.00000,19910.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,9111.44,33992.68,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,2157.00000,864.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,2157.00000,864.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,2695.00000,1080.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2695.00000,1080.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,3853.00000,1545.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,3853.00000,1545.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,inpatient,,,1413.00000,566.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,outpatient,,,1413.00000,566.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,3229.80000,1857.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3048.93,,,,,,,2906.82,3132.91,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,3229.80000,1857.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3048.93,,,,,,,839.75,3132.91,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,854.40000,491.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,806.55,,,,,,,768.96,828.77,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,854.40000,491.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,806.55,,,,,,,222.14,828.77,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1200.50000,690.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1133.27,,,,,,,1080.45,1164.48,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1200.50000,690.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1133.27,,,,,,,312.13,1164.48,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1011.00000,581.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,954.38,,,,,,,909.90,980.67,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1011.00000,581.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,954.38,,,,,,,262.86,980.67,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1823.80000,1048.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1721.67,,,,,,,1641.42,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1823.80000,1048.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1721.67,,,,,,,474.19,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2028.50000,1166.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1914.90,,,,,,,1825.65,1967.64,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2028.50000,1166.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1914.90,,,,,,,527.41,1967.64,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,841.00000,483.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,793.90,,,,,,,756.90,815.77,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,841.00000,483.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,793.90,,,,,,,218.66,815.77,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1366.20000,785.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1289.69,,,,,,,1229.58,1325.21,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1366.20000,785.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1289.69,,,,,,,355.21,1325.21,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1384.00000,795.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1306.50,,,,,,,1245.60,1342.48,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1384.00000,795.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1306.50,,,,,,,359.84,1342.48,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2458.70000,1413.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2321.01,,,,,,,2212.83,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2458.70000,1413.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2321.01,,,,,,,639.26,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2393.50000,1376.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2259.46,,,,,,,2154.15,2321.70,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2393.50000,1376.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2259.46,,,,,,,622.31,2321.70,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1369.50000,787.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1292.81,,,,,,,1232.55,1328.41,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1369.50000,787.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1292.81,,,,,,,356.07,1328.41,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2697.40000,1551.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2546.35,,,,,,,2427.66,2616.48,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2697.40000,1551.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2546.35,,,,,,,701.32,2616.48,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4621.80000,2657.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4362.98,,,,,,,4159.62,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4621.80000,2657.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4362.98,,,,,,,1201.67,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2592.50000,1490.69000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2447.32,,,,,,,2333.25,2514.72,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2592.50000,1490.69000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2447.32,,,,,,,674.05,2514.72,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,5274.90,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,1523.86,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7872.02,,,,,,,7505.10,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7872.02,,,,,,,2168.14,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,8107.00000,4661.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7653.01,,,,,,,7296.30,7863.79,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7653.01,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1062.94,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1062.94,,,,,,,292.76,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6997.87,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6997.87,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,inpatient,,,20152.00000,11587.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,19023.49,,,,,,,18136.80,19547.44,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,outpatient,,,20152.00000,11587.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,19023.49,,,,,,,5239.52,19547.44,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,402.30,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,116.22,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,669.30,,,,,,,638.10,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,669.30,,,,,,,184.34,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,1272.00000,731.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1200.77,,,,,,,1144.80,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,1272.00000,731.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1200.77,,,,,,,330.72,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2539.36,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2539.36,,,,,,,699.40,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,3078.00000,1769.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2905.63,,,,,,,2770.20,2985.66,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,3078.00000,1769.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2905.63,,,,,,,800.28,2985.66,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,70.00000,40.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,63.00,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,70.00000,40.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,18.20,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,102.00000,58.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,91.80,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,102.00000,58.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,26.52,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,221.00000,127.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,208.62,,,,,,,198.90,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,221.00000,127.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,208.62,,,,,,,57.46,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,402.30,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,116.22,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,669.30,,,,,,,638.10,687.73,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,669.30,,,,,,,184.34,687.73,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,11805.66,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,11805.66,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35482.00000,20402.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33495.01,,,,,,,31933.80,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35482.00000,20402.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33495.01,,,,,,,9225.32,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39862.00000,22920.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37629.73,,,,,,,35875.80,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39862.00000,22920.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37629.73,,,,,,,10364.12,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,44242.00000,25439.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41764.45,,,,,,,39817.80,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,44242.00000,25439.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41764.45,,,,,,,11502.92,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,48622.00000,27957.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,45899.17,,,,,,,43759.80,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,48622.00000,27957.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,45899.17,,,,,,,12641.72,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,53002.00000,30476.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50033.89,,,,,,,47701.80,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,53002.00000,30476.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50033.89,,,,,,,13780.52,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57889.86,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57889.86,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66159.30,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66159.30,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74428.74,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74428.74,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82698.18,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82698.18,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,90967.62,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,90967.62,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,844.00000,485.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,796.74,,,,,,,759.60,818.68,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,844.00000,485.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,796.74,,,,,,,219.44,818.68,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,11575.00000,6655.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10926.80,,,,,,,10417.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,11575.00000,6655.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10926.80,,,,,,,3009.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,14892.00000,8562.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14058.05,,,,,,,13402.80,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14892.00000,8562.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14058.05,,,,,,,3871.92,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,24970.00000,14357.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,23571.68,,,,,,,22473.00,24220.90,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,24970.00000,14357.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,23571.68,,,,,,,6492.20,24220.90,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,402.30,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,116.22,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3152.96,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3152.96,,,,,,,868.40,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,4153.00000,2387.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3920.43,,,,,,,3737.70,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3920.43,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,4641.00000,2668.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4381.10,,,,,,,4176.90,4501.77,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4641.00000,2668.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4381.10,,,,,,,1206.66,4501.77,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4606.72,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4606.72,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,90967.62,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,90967.62,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103371.78,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103371.78,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,131404.00000,75557.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,124045.38,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,124045.38,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,153304.00000,88149.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,144718.98,,,,,,,137973.60,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,153304.00000,88149.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,144718.98,,,,,,,39859.04,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,175204.00000,100742.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,165392.58,,,,,,,157683.60,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,175204.00000,100742.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,165392.58,,,,,,,45553.04,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,197104.00000,113334.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,186066.18,,,,,,,177393.60,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,197104.00000,113334.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,186066.18,,,,,,,51247.04,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,219004.00000,125927.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,206739.78,,,,,,,197103.60,212433.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,219004.00000,125927.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,206739.78,,,,,,,56941.04,212433.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,45485.70,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,45485.70,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49620.42,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49620.42,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53755.14,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53755.14,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57889.86,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57889.86,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49620.42,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49620.42,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82698.18,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82698.18,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103371.78,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103371.78,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4606.72,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4606.72,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,45485.70,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,45485.70,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49620.42,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49620.42,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53755.14,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53755.14,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57889.86,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57889.86,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66159.30,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66159.30,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74428.74,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74428.74,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82698.18,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82698.18,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,90967.62,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,90967.62,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103371.78,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103371.78,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,122644.00000,70520.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,115775.94,,,,,,,110379.60,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,115775.94,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,135784.00000,78075.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,128180.10,,,,,,,122205.60,131710.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,135784.00000,78075.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,128180.10,,,,,,,35303.84,131710.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,45485.70,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,45485.70,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,55630.00000,31987.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52514.72,,,,,,,50067.00,53961.10,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,55630.00000,31987.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52514.72,,,,,,,14463.80,53961.10,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2539.36,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2539.36,,,,,,,699.40,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,14020.00000,8061.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13234.88,,,,,,,12618.00,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13234.88,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,17962.00000,10328.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16956.13,,,,,,,16165.80,17423.14,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,17962.00000,10328.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16956.13,,,,,,,4670.12,17423.14,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,2421.00000,1392.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2285.42,,,,,,,2178.90,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,2421.00000,1392.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2285.42,,,,,,,629.46,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2290.14,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2290.14,,,,,,,630.76,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2539.36,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2539.36,,,,,,,699.40,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,27160.00000,15617.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,25639.04,,,,,,,24444.00,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,27160.00000,15617.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,25639.04,,,,,,,7061.60,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,31014.18,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,31014.18,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49620.42,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49620.42,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74428.74,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74428.74,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,28470.00000,16370.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,26875.68,,,,,,,25623.00,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,28470.00000,16370.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,26875.68,,,,,,,7402.20,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,43800.00000,25185.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41347.20,,,,,,,39420.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,43800.00000,25185.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41347.20,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82698.18,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82698.18,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103371.78,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103371.78,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3690.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3690.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,31014.18,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,31014.18,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,54754.00000,31483.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51687.78,,,,,,,49278.60,53111.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,54754.00000,31483.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51687.78,,,,,,,14236.04,53111.38,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2539.36,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2539.36,,,,,,,699.40,2609.30,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,61320.00000,35259.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57886.08,,,,,,,55188.00,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,61320.00000,35259.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57886.08,,,,,,,15943.20,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,70080.00000,40296.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66155.52,,,,,,,63072.00,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,70080.00000,40296.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66155.52,,,,,,,18220.80,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,78840.00000,45333.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74424.96,,,,,,,70956.00,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,78840.00000,45333.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74424.96,,,,,,,20498.40,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,90967.62,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,90967.62,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103371.78,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103371.78,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,122644.00000,70520.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,115775.94,,,,,,,110379.60,118964.68,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,115775.94,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,22744.74,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,22744.74,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,31014.18,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,31014.18,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,1883.00000,1082.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1777.55,,,,,,,1694.70,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1883.00000,1082.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1777.55,,,,,,,489.58,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3690.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3690.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,7644.00000,4395.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7215.94,,,,,,,6879.60,7414.68,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,7644.00000,4395.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7215.94,,,,,,,1987.44,7414.68,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2539.36,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2539.36,,,,,,,699.40,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,inpatient,,,1614.00000,928.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1523.62,,,,,,,1452.60,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1523.62,,,,,,,419.64,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,22744.74,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,22744.74,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,26879.46,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,26879.46,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,31014.18,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,31014.18,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,37234.00000,21409.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,35148.90,,,,,,,33510.60,36116.98,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,37234.00000,21409.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,35148.90,,,,,,,9680.84,36116.98,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49620.42,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49620.42,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74428.74,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74428.74,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,159.00000,91.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,150.10,,,,,,,143.10,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,159.00000,91.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,150.10,,,,,,,41.34,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,490.88,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,490.88,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2290.14,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2290.14,,,,,,,630.76,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2827.00000,1625.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2668.69,,,,,,,2544.30,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2668.69,,,,,,,735.02,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3152.96,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3152.96,,,,,,,868.40,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8107.00000,4661.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7653.01,,,,,,,7296.30,7863.79,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7653.01,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82698.18,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82698.18,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103371.78,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103371.78,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,131404.00000,75557.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,124045.38,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,124045.38,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,18400.00000,10580.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,17369.60,,,,,,,16560.00,17848.00,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,18400.00000,10580.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,17369.60,,,,,,,4784.00,17848.00,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,22744.74,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,22744.74,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,26879.46,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,26879.46,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,31014.18,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,31014.18,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1614.00000,928.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1523.62,,,,,,,1452.60,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1523.62,,,,,,,419.64,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53755.14,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53755.14,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,5368.00000,3086.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5067.39,,,,,,,4831.20,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,5368.00000,3086.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5067.39,,,,,,,1395.68,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,14020.00000,8061.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13234.88,,,,,,,12618.00,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13234.88,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,25408.00000,14609.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,23985.15,,,,,,,22867.20,24645.76,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,25408.00000,14609.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,23985.15,,,,,,,6606.08,24645.76,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,8112.00000,4664.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7657.73,,,,,,,7300.80,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,8112.00000,4664.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7657.73,,,,,,,2109.12,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,10431.00000,5997.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,9846.86,,,,,,,9387.90,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,10431.00000,5997.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,9846.86,,,,,,,2712.06,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,31014.18,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,31014.18,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,46870.00000,26950.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,44245.28,,,,,,,42183.00,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,46870.00000,26950.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,44245.28,,,,,,,12186.20,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,51250.00000,29468.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48380.00,,,,,,,46125.00,49712.50,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,51250.00000,29468.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48380.00,,,,,,,13325.00,49712.50,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49620.42,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49620.42,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74428.74,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74428.74,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82698.18,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82698.18,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,588.00000,338.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,555.07,,,,,,,529.20,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,588.00000,338.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,555.07,,,,,,,152.88,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3690.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3690.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5072.11,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5072.11,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6123.73,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6123.73,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,7876.00000,4528.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7434.94,,,,,,,7088.40,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7876.00000,4528.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7434.94,,,,,,,2047.76,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,22744.74,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,22744.74,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5856.00000,3367.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5528.06,,,,,,,5270.40,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5856.00000,3367.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5528.06,,,,,,,1522.56,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6123.73,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6123.73,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6997.87,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6997.87,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7872.02,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7872.02,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5072.11,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5072.11,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5686.66,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5686.66,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,11805.66,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,11805.66,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5072.11,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5072.11,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5686.66,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5686.66,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,11805.66,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,11805.66,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4392.00000,2525.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4146.05,,,,,,,3952.80,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4392.00000,2525.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4146.05,,,,,,,1141.92,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5072.11,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5072.11,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6123.73,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6123.73,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5072.11,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5072.11,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6123.73,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6123.73,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4606.72,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4606.72,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1062.94,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1062.94,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5072.11,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5072.11,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5686.66,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5686.66,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,11805.66,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,11805.66,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12821.41,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12821.41,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2152.00000,1237.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2031.49,,,,,,,1936.80,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2152.00000,1237.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2031.49,,,,,,,559.52,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4606.72,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4606.72,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3690.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3690.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5686.66,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5686.66,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5072.11,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5072.11,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5686.66,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5686.66,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1062.94,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1062.94,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5072.11,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5072.11,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5686.66,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5686.66,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,11805.66,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,11805.66,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12821.41,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12821.41,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5072.11,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5072.11,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8802.00000,5061.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8309.09,,,,,,,7921.80,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8802.00000,5061.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8309.09,,,,,,,2288.52,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,10654.00000,6126.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10057.38,,,,,,,9588.60,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10654.00000,6126.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10057.38,,,,,,,2770.04,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,11805.66,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,11805.66,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12821.41,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12821.41,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17086.00000,9824.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16129.18,,,,,,,15377.40,16573.42,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17086.00000,9824.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16129.18,,,,,,,4442.36,16573.42,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4606.72,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4606.72,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6123.73,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6123.73,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6997.87,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6997.87,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7872.02,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7872.02,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4606.72,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4606.72,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4606.72,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4606.72,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3394.62,,,,,,,934.96,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5763.12,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,22744.74,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,22744.74,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3690.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3690.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6123.73,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6123.73,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1782.27,,,,,,,490.88,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2290.14,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2290.14,,,,,,,630.76,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2827.00000,1625.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2668.69,,,,,,,2544.30,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2668.69,,,,,,,735.02,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3152.96,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3152.96,,,,,,,868.40,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4153.00000,2387.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3920.43,,,,,,,3737.70,4028.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3920.43,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6997.87,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6997.87,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7872.02,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7872.02,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9728.00000,5593.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,9183.23,,,,,,,8755.20,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9728.00000,5593.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,9183.23,,,,,,,2529.28,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11117.00000,6392.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10494.45,,,,,,,10005.30,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11117.00000,6392.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10494.45,,,,,,,2890.42,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,45485.70,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,45485.70,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49620.42,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49620.42,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53755.14,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53755.14,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57889.86,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57889.86,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66159.30,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66159.30,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,74464.00000,42816.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70294.02,,,,,,,67017.60,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70294.02,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74428.74,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74428.74,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,83224.00000,47853.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,78563.46,,,,,,,74901.60,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,78563.46,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,111694.00000,64224.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,105439.14,,,,,,,100524.60,108343.18,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,111694.00000,64224.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,105439.14,,,,,,,29040.44,108343.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,402.30,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,116.22,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,669.30,,,,,,,638.10,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,669.30,,,,,,,184.34,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,991.00000,569.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,935.50,,,,,,,891.90,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,991.00000,569.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,935.50,,,,,,,257.66,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1490.00000,856.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1406.56,,,,,,,1341.00,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1490.00000,856.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1406.56,,,,,,,387.40,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3690.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3690.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5532.78,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6123.73,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6123.73,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6997.87,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6997.87,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7872.02,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7872.02,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1333.87,,,,,,,367.38,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3637.23,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,6945.00000,3993.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6556.08,,,,,,,6250.50,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,6945.00000,3993.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6556.08,,,,,,,1805.70,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,402.30,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,116.22,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3690.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3690.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5072.11,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5072.11,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1068.61,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,50374.00000,28965.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,47553.06,,,,,,,45336.60,48862.78,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,50374.00000,28965.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,47553.06,,,,,,,13097.24,48862.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18610.02,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,22744.74,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,22744.74,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,26879.46,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,26879.46,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2544.08,,,,,,,700.70,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6560.80,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10931.52,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14475.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,45485.70,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,45485.70,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2036.21,,,,,,,560.82,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2910.35,,,,,,,801.58,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,45485.70,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,45485.70,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49620.42,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49620.42,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53755.14,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53755.14,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62024.58,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,74464.00000,42816.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70294.02,,,,,,,67017.60,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70294.02,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,83224.00000,47853.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,78563.46,,,,,,,74901.60,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,78563.46,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,91984.00000,52890.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,86832.90,,,,,,,82785.60,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,91984.00000,52890.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,86832.90,,,,,,,23915.84,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,100744.00000,57927.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,95102.34,,,,,,,90669.60,97721.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,100744.00000,57927.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,95102.34,,,,,,,26193.44,97721.68,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,149.40,161.02,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,156.70,,,,,,,43.16,161.02,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,402.30,433.59,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,421.97,,,,,,,116.22,433.59,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,669.30,,,,,,,638.10,687.73,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,669.30,,,,,,,184.34,687.73,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16542.66,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20677.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24812.10,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28946.82,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33081.54,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37216.26,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41350.98,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49620.42,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49620.42,,,,,,,13666.64,50987.08,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,4396.50,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4611.44,,,,,,,1270.10,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,8338.50,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8746.16,,,,,,,2408.90,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,12505.50,13478.15,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13116.88,,,,,,,3612.70,13478.15,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2180.20000,1253.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2058.11,,,,,,,1962.18,2114.79,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2180.20000,1253.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2058.11,,,,,,,566.85,2114.79,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1880.60000,1081.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1775.29,,,,,,,1692.54,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1880.60000,1081.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1775.29,,,,,,,488.96,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2908.70000,1672.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2745.81,,,,,,,2617.83,2821.44,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2908.70000,1672.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2745.81,,,,,,,756.26,2821.44,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,inpatient,,,34.00000,25.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,32.10,,,,,,,30.60,32.98,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,outpatient,,,34.00000,25.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,32.10,,,,,,,8.84,32.98,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,inpatient,,,13.00000,9.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12.27,,,,,,,11.70,12.61,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,outpatient,,,13.00000,9.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12.27,,,,,,,3.38,12.61,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,265.26,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,265.26,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,265.26,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,265.26,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,265.26,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,265.26,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,708.94,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,708.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,708.94,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,708.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,708.94,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,708.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,inpatient,,,122.00000,92.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,115.17,,,,,,,109.80,118.34,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,outpatient,,,122.00000,92.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,115.17,,,,,,,31.72,118.34,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,inpatient,,,79.00000,59.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,71.10,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,20.54,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,inpatient,,,79.00000,59.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,71.10,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,20.54,76.63,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,inpatient,,,15.00000,11.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14.16,,,,,,,13.50,14.55,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14.16,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,inpatient,,,15.00000,11.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14.16,,,,,,,13.50,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14.16,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,inpatient,,,17.00000,12.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16.05,,,,,,,15.30,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16.05,,,,,,,4.42,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,inpatient,,,17.00000,12.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16.05,,,,,,,15.30,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16.05,,,,,,,4.42,16.49,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,inpatient,,,359.00000,271.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,outpatient,,,359.00000,271.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,inpatient,,,359.00000,271.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,outpatient,,,359.00000,271.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,inpatient,,,359.00000,271.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,outpatient,,,359.00000,271.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,93.34,348.23,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,inpatient,,,155.00000,117.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,146.32,,,,,,,139.50,150.35,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,outpatient,,,155.00000,117.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,146.32,,,,,,,40.30,150.35,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,inpatient,,,294.00000,222.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,277.54,,,,,,,264.60,285.18,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,outpatient,,,294.00000,222.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,277.54,,,,,,,76.44,285.18,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,inpatient,,,1511.00000,1143.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1426.38,,,,,,,1359.90,1465.67,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,outpatient,,,1511.00000,1143.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1426.38,,,,,,,392.86,1465.67,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,inpatient,,,751.00000,568.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,708.94,,,,,,,675.90,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,708.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,inpatient,,,751.00000,568.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,708.94,,,,,,,675.90,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,708.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,inpatient,,,150.00000,113.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,141.60,,,,,,,135.00,145.50,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,outpatient,,,150.00000,113.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,141.60,,,,,,,39.00,145.50,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,inpatient,,,110.00000,83.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,99.00,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,outpatient,,,110.00000,83.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,28.60,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,inpatient,,,158.00000,119.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,149.15,,,,,,,142.20,153.26,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,outpatient,,,158.00000,119.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,149.15,,,,,,,41.08,153.26,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,inpatient,,,153.00000,115.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,144.43,,,,,,,137.70,148.41,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,outpatient,,,153.00000,115.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,144.43,,,,,,,39.78,148.41,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,inpatient,,,157.00000,118.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,148.21,,,,,,,141.30,152.29,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,outpatient,,,157.00000,118.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,148.21,,,,,,,40.82,152.29,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,inpatient,,,26.00000,19.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,23.40,25.22,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,outpatient,,,26.00000,19.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,6.76,25.22,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,inpatient,,,37.00000,28.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,34.93,,,,,,,33.30,35.89,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,outpatient,,,37.00000,28.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,34.93,,,,,,,9.62,35.89,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,inpatient,,,268.00000,202.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,252.99,,,,,,,241.20,259.96,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,outpatient,,,268.00000,202.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,252.99,,,,,,,69.68,259.96,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,inpatient,,,91.00000,68.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,85.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,outpatient,,,91.00000,68.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,85.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,inpatient,,,200.00000,151.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,188.80,,,,,,,180.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,outpatient,,,200.00000,151.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,188.80,,,,,,,52.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,inpatient,,,152.00000,115.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,143.49,,,,,,,136.80,147.44,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,outpatient,,,152.00000,115.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,143.49,,,,,,,39.52,147.44,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,inpatient,,,359.00000,271.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,323.10,348.23,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,outpatient,,,359.00000,271.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,93.34,348.23,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,inpatient,,,69.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,62.10,66.93,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,outpatient,,,69.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,inpatient,,,75.00000,36.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70.80,,,,,,,67.50,72.75,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,outpatient,,,75.00000,36.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70.80,,,,,,,19.50,72.75,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,inpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,outpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,inpatient,,,45.00000,21.69000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,42.48,,,,,,,40.50,43.65,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,outpatient,,,45.00000,21.69000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,42.48,,,,,,,11.70,43.65,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,inpatient,,,68.00000,32.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,61.20,65.96,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,outpatient,,,68.00000,32.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,17.68,65.96,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,inpatient,,,61.00000,29.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,outpatient,,,61.00000,29.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,inpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,inpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,inpatient,,,64.00000,30.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,57.60,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,outpatient,,,64.00000,30.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,16.64,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,inpatient,,,195.00000,93.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,184.08,,,,,,,175.50,189.15,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,outpatient,,,195.00000,93.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,184.08,,,,,,,50.70,189.15,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,inpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,outpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,inpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,outpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,inpatient,,,14.00000,6.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13.22,,,,,,,12.60,13.58,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,outpatient,,,14.00000,6.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13.22,,,,,,,3.64,13.58,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,inpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,outpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,inpatient,,,53.00000,25.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,47.70,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,outpatient,,,53.00000,25.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,13.78,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,inpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,outpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,inpatient,,,82.00000,39.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,77.41,,,,,,,73.80,79.54,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,outpatient,,,82.00000,39.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,77.41,,,,,,,21.32,79.54,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,inpatient,,,141.00000,67.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,133.10,,,,,,,126.90,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,133.10,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,inpatient,,,141.00000,67.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,133.10,,,,,,,126.90,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,133.10,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,inpatient,,,91.00000,43.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,85.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,outpatient,,,91.00000,43.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,85.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,inpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,outpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,inpatient,,,69.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,62.10,66.93,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,outpatient,,,69.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,inpatient,,,205.00000,98.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,193.52,,,,,,,184.50,198.85,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,outpatient,,,205.00000,98.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,193.52,,,,,,,53.30,198.85,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,inpatient,,,50.00000,24.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,47.20,,,,,,,45.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,outpatient,,,50.00000,24.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,47.20,,,,,,,13.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,inpatient,,,406.00000,195.69000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,383.26,,,,,,,365.40,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,outpatient,,,406.00000,195.69000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,383.26,,,,,,,105.56,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,inpatient,,,101.00000,48.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,95.34,,,,,,,90.90,97.97,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,outpatient,,,101.00000,48.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,95.34,,,,,,,26.26,97.97,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,inpatient,,,375.00000,180.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,354.00,,,,,,,337.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,outpatient,,,375.00000,180.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,354.00,,,,,,,97.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,inpatient,,,362.00000,174.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,341.73,,,,,,,325.80,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,outpatient,,,362.00000,174.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,341.73,,,,,,,94.12,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,inpatient,,,325.00000,156.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,306.80,,,,,,,292.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,outpatient,,,325.00000,156.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,306.80,,,,,,,84.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,inpatient,,,121.00000,58.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,114.22,,,,,,,108.90,117.37,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,outpatient,,,121.00000,58.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,114.22,,,,,,,31.46,117.37,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,inpatient,,,115.00000,55.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,108.56,,,,,,,103.50,111.55,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,outpatient,,,115.00000,55.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,108.56,,,,,,,29.90,111.55,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,inpatient,,,300.00000,144.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,283.20,,,,,,,270.00,291.00,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,outpatient,,,300.00000,144.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,283.20,,,,,,,78.00,291.00,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,inpatient,,,51.00000,24.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,outpatient,,,51.00000,24.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,inpatient,,,51.00000,24.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,inpatient,,,51.00000,24.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,inpatient,,,194.00000,93.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,183.14,,,,,,,174.60,188.18,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,outpatient,,,194.00000,93.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,183.14,,,,,,,50.44,188.18,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,inpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,outpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,inpatient,,,68.00000,32.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,61.20,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,outpatient,,,68.00000,32.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,17.68,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,inpatient,,,329.00000,158.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,310.58,,,,,,,296.10,319.13,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,outpatient,,,329.00000,158.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,310.58,,,,,,,85.54,319.13,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,inpatient,,,24.00000,11.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,22.66,,,,,,,21.60,23.28,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,outpatient,,,24.00000,11.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,22.66,,,,,,,6.24,23.28,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,inpatient,,,30.00000,14.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28.32,,,,,,,27.00,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,outpatient,,,30.00000,14.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28.32,,,,,,,7.80,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,inpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,outpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,inpatient,,,53.00000,25.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,47.70,51.41,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,outpatient,,,53.00000,25.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,13.78,51.41,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,inpatient,,,270.00000,130.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,254.88,,,,,,,243.00,261.90,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,outpatient,,,270.00000,130.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,254.88,,,,,,,70.20,261.90,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,inpatient,,,123.00000,59.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,116.11,,,,,,,110.70,119.31,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,116.11,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,inpatient,,,123.00000,59.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,116.11,,,,,,,110.70,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,116.11,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,inpatient,,,37.00000,17.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,34.93,,,,,,,33.30,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,outpatient,,,37.00000,17.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,34.93,,,,,,,9.62,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,inpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,outpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,inpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,outpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,inpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,outpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,inpatient,,,41.00000,19.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,38.70,,,,,,,36.90,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,outpatient,,,41.00000,19.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,38.70,,,,,,,10.66,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,inpatient,,,72.00000,34.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,64.80,69.84,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,outpatient,,,72.00000,34.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,18.72,69.84,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,inpatient,,,77.00000,37.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,outpatient,,,77.00000,37.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,inpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,inpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,inpatient,,,90.00000,43.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.96,,,,,,,81.00,87.30,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,outpatient,,,90.00000,43.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.96,,,,,,,23.40,87.30,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,inpatient,,,44.00000,21.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41.54,,,,,,,39.60,42.68,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,outpatient,,,44.00000,21.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41.54,,,,,,,11.44,42.68,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,inpatient,,,115.00000,55.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,108.56,,,,,,,103.50,111.55,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,outpatient,,,115.00000,55.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,108.56,,,,,,,29.90,111.55,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,inpatient,,,20.00000,9.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18.88,,,,,,,18.00,19.40,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,outpatient,,,20.00000,9.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18.88,,,,,,,5.20,19.40,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,inpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,46.80,50.44,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,outpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,13.52,50.44,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,inpatient,,,341.00000,164.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,321.90,,,,,,,306.90,330.77,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,outpatient,,,341.00000,164.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,321.90,,,,,,,88.66,330.77,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,inpatient,,,54.00000,26.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,48.60,52.38,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,outpatient,,,54.00000,26.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,14.04,52.38,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,inpatient,,,53.00000,25.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,47.70,51.41,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,outpatient,,,53.00000,25.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,13.78,51.41,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,inpatient,,,88.00000,42.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,83.07,,,,,,,79.20,85.36,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,outpatient,,,88.00000,42.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,83.07,,,,,,,22.88,85.36,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,inpatient,,,89.00000,42.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.02,,,,,,,80.10,86.33,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,outpatient,,,89.00000,42.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.02,,,,,,,23.14,86.33,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,inpatient,,,61.00000,29.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,outpatient,,,61.00000,29.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,inpatient,,,77.00000,37.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,inpatient,,,77.00000,37.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,inpatient,,,64.00000,30.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,57.60,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,16.64,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,inpatient,,,64.00000,30.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,57.60,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,16.64,62.08,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,inpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,outpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,inpatient,,,95.00000,45.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,89.68,,,,,,,85.50,92.15,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,outpatient,,,95.00000,45.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,89.68,,,,,,,24.70,92.15,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,inpatient,,,132.00000,63.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,124.61,,,,,,,118.80,128.04,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,outpatient,,,132.00000,63.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,124.61,,,,,,,34.32,128.04,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,inpatient,,,83.00000,40.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,78.35,,,,,,,74.70,80.51,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,outpatient,,,83.00000,40.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,78.35,,,,,,,21.58,80.51,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,inpatient,,,387.00000,186.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,365.33,,,,,,,348.30,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,outpatient,,,387.00000,186.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,365.33,,,,,,,100.62,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,inpatient,,,387.00000,186.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,365.33,,,,,,,348.30,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,outpatient,,,387.00000,186.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,365.33,,,,,,,100.62,375.39,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,inpatient,,,31.00000,14.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,29.26,,,,,,,27.90,30.07,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,outpatient,,,31.00000,14.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,29.26,,,,,,,8.06,30.07,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,inpatient,,,36.00000,17.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,32.40,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,outpatient,,,36.00000,17.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,9.36,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,inpatient,,,160.00000,77.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,151.04,,,,,,,144.00,155.20,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,outpatient,,,160.00000,77.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,151.04,,,,,,,41.60,155.20,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,inpatient,,,112.00000,53.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,105.73,,,,,,,100.80,108.64,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,outpatient,,,112.00000,53.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,105.73,,,,,,,29.12,108.64,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,inpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,inpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,inpatient,,,14.00000,6.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13.22,,,,,,,12.60,13.58,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,outpatient,,,14.00000,6.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13.22,,,,,,,3.64,13.58,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,inpatient,,,16.00000,7.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,15.10,,,,,,,14.40,15.52,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,outpatient,,,16.00000,7.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,15.10,,,,,,,4.16,15.52,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,inpatient,,,71.00000,34.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,63.90,68.87,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,outpatient,,,71.00000,34.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,18.46,68.87,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,inpatient,,,116.00000,55.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,109.50,,,,,,,104.40,112.52,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,outpatient,,,116.00000,55.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,109.50,,,,,,,30.16,112.52,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,inpatient,,,81.00000,39.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,72.90,78.57,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,outpatient,,,81.00000,39.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,21.06,78.57,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,inpatient,,,97.00000,46.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,91.57,,,,,,,87.30,94.09,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,outpatient,,,97.00000,46.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,91.57,,,,,,,25.22,94.09,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,inpatient,,,77.00000,37.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,outpatient,,,77.00000,37.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,inpatient,,,35.00000,16.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.04,,,,,,,31.50,33.95,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,outpatient,,,35.00000,16.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.04,,,,,,,9.10,33.95,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,inpatient,,,65.00000,31.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,58.50,63.05,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,outpatient,,,65.00000,31.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,16.90,63.05,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,inpatient,,,74.00000,35.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,69.86,,,,,,,66.60,71.78,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,outpatient,,,74.00000,35.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,69.86,,,,,,,19.24,71.78,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,inpatient,,,250.00000,120.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,236.00,,,,,,,225.00,242.50,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,outpatient,,,250.00000,120.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,236.00,,,,,,,65.00,242.50,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,inpatient,,,90.00000,43.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.96,,,,,,,81.00,87.30,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,outpatient,,,90.00000,43.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.96,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,inpatient,,,90.00000,43.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.96,,,,,,,81.00,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,outpatient,,,90.00000,43.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.96,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,inpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,46.80,50.44,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,outpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,13.52,50.44,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,inpatient,,,36.00000,17.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,32.40,34.92,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,outpatient,,,36.00000,17.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,9.36,34.92,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,inpatient,,,78.00000,37.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,70.20,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,outpatient,,,78.00000,37.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,20.28,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,inpatient,,,115.00000,55.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,108.56,,,,,,,103.50,111.55,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,outpatient,,,115.00000,55.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,108.56,,,,,,,29.90,111.55,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,inpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,60.30,64.99,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,outpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,17.42,64.99,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,inpatient,,,76.00000,36.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,71.74,,,,,,,68.40,73.72,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,outpatient,,,76.00000,36.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,71.74,,,,,,,19.76,73.72,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,inpatient,,,53.00000,25.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,47.70,51.41,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,outpatient,,,53.00000,25.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,13.78,51.41,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,inpatient,,,70.00000,33.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,63.00,67.90,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,outpatient,,,70.00000,33.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,18.20,67.90,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,inpatient,,,169.00000,81.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,159.54,,,,,,,152.10,163.93,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,outpatient,,,169.00000,81.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,159.54,,,,,,,43.94,163.93,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,inpatient,,,28.00000,13.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,26.43,,,,,,,25.20,27.16,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,outpatient,,,28.00000,13.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,26.43,,,,,,,7.28,27.16,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,inpatient,,,51.00000,24.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,45.90,49.47,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,outpatient,,,51.00000,24.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,13.26,49.47,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,inpatient,,,15.00000,7.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14.16,,,,,,,13.50,14.55,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,outpatient,,,15.00000,7.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14.16,,,,,,,3.90,14.55,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,inpatient,,,18.00000,8.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16.99,,,,,,,16.20,17.46,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,outpatient,,,18.00000,8.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16.99,,,,,,,4.68,17.46,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,inpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,outpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,inpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,outpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,inpatient,,,61.00000,29.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,outpatient,,,61.00000,29.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,inpatient,,,550.00000,265.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,519.20,,,,,,,495.00,533.50,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,outpatient,,,550.00000,265.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,519.20,,,,,,,143.00,533.50,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,inpatient,,,73.00000,35.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,68.91,,,,,,,65.70,70.81,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,68.91,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,inpatient,,,392.00000,188.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,370.05,,,,,,,352.80,380.24,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,outpatient,,,392.00000,188.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,370.05,,,,,,,101.92,380.24,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,inpatient,,,75.00000,36.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70.80,,,,,,,67.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,outpatient,,,75.00000,36.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70.80,,,,,,,19.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,inpatient,,,73.00000,35.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,68.91,,,,,,,65.70,70.81,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,68.91,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,inpatient,,,100.00000,48.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,94.40,,,,,,,90.00,97.00,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,outpatient,,,100.00000,48.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,94.40,,,,,,,26.00,97.00,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,inpatient,,,153.00000,73.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,144.43,,,,,,,137.70,148.41,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,outpatient,,,153.00000,73.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,144.43,,,,,,,39.78,148.41,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,inpatient,,,909.00000,438.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,858.10,,,,,,,818.10,881.73,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,outpatient,,,909.00000,438.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,858.10,,,,,,,236.34,881.73,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,inpatient,,,266.00000,128.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,251.10,,,,,,,239.40,258.02,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,outpatient,,,266.00000,128.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,251.10,,,,,,,69.16,258.02,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,inpatient,,,275.00000,132.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,259.60,,,,,,,247.50,266.75,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,outpatient,,,275.00000,132.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,259.60,,,,,,,71.50,266.75,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,inpatient,,,61.00000,29.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,outpatient,,,61.00000,29.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,inpatient,,,84.00000,40.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,79.30,,,,,,,75.60,81.48,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,outpatient,,,84.00000,40.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,79.30,,,,,,,21.84,81.48,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,inpatient,,,174.00000,83.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,164.26,,,,,,,156.60,168.78,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,outpatient,,,174.00000,83.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,164.26,,,,,,,45.24,168.78,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,inpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,outpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,inpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,60.30,64.99,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,outpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,17.42,64.99,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,inpatient,,,68.00000,32.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,61.20,65.96,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,outpatient,,,68.00000,32.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,17.68,65.96,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,inpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,outpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,inpatient,,,211.00000,101.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,199.18,,,,,,,189.90,204.67,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,outpatient,,,211.00000,101.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,199.18,,,,,,,54.86,204.67,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,inpatient,,,65.00000,31.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,58.50,63.05,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,outpatient,,,65.00000,31.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,16.90,63.05,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,inpatient,,,83.00000,40.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,78.35,,,,,,,74.70,80.51,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,outpatient,,,83.00000,40.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,78.35,,,,,,,21.58,80.51,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,inpatient,,,54.00000,26.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,48.60,52.38,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,outpatient,,,54.00000,26.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,14.04,52.38,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,inpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,outpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,inpatient,,,323.00000,155.69000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,304.91,,,,,,,290.70,313.31,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,outpatient,,,323.00000,155.69000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,304.91,,,,,,,83.98,313.31,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,inpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,outpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,inpatient,,,35.00000,16.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.04,,,,,,,31.50,33.95,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,outpatient,,,35.00000,16.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.04,,,,,,,9.10,33.95,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,inpatient,,,20.00000,9.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18.88,,,,,,,18.00,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,outpatient,,,20.00000,9.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18.88,,,,,,,5.20,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,inpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,outpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,inpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,inpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,inpatient,,,34.00000,16.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,32.10,,,,,,,30.60,32.98,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,outpatient,,,34.00000,16.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,32.10,,,,,,,8.84,32.98,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,inpatient,,,29.00000,13.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,27.38,,,,,,,26.10,28.13,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,outpatient,,,29.00000,13.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,27.38,,,,,,,7.54,28.13,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,inpatient,,,80.00000,38.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,75.52,,,,,,,72.00,77.60,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,outpatient,,,80.00000,38.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,75.52,,,,,,,20.80,77.60,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,inpatient,,,73.00000,35.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,68.91,,,,,,,65.70,70.81,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,outpatient,,,73.00000,35.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,68.91,,,,,,,18.98,70.81,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,inpatient,,,16.00000,7.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,15.10,,,,,,,14.40,15.52,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,outpatient,,,16.00000,7.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,15.10,,,,,,,4.16,15.52,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,inpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,46.80,50.44,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,outpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,13.52,50.44,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,inpatient,,,113.00000,54.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,106.67,,,,,,,101.70,109.61,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,outpatient,,,113.00000,54.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,106.67,,,,,,,29.38,109.61,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,inpatient,,,68.00000,32.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,61.20,65.96,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,outpatient,,,68.00000,32.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,17.68,65.96,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,inpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,inpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,inpatient,,,78.00000,37.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,70.20,75.66,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,outpatient,,,78.00000,37.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,20.28,75.66,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,inpatient,,,54.00000,26.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,48.60,52.38,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,outpatient,,,54.00000,26.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,14.04,52.38,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,inpatient,,,76.00000,36.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,71.74,,,,,,,68.40,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,outpatient,,,76.00000,36.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,71.74,,,,,,,19.76,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,inpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,60.30,64.99,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,outpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,17.42,64.99,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,inpatient,,,88.00000,42.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,83.07,,,,,,,79.20,85.36,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,outpatient,,,88.00000,42.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,83.07,,,,,,,22.88,85.36,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,inpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,outpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,inpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,60.30,64.99,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,outpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,17.42,64.99,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,inpatient,,,53.00000,25.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,47.70,51.41,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,outpatient,,,53.00000,25.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,13.78,51.41,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,inpatient,,,88.00000,42.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,83.07,,,,,,,79.20,85.36,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,outpatient,,,88.00000,42.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,83.07,,,,,,,22.88,85.36,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,inpatient,,,105.00000,50.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,99.12,,,,,,,94.50,101.85,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,outpatient,,,105.00000,50.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,99.12,,,,,,,27.30,101.85,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,inpatient,,,73.00000,35.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,68.91,,,,,,,65.70,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,68.91,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,inpatient,,,83.00000,40.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,78.35,,,,,,,74.70,80.51,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,outpatient,,,83.00000,40.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,78.35,,,,,,,21.58,80.51,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,inpatient,,,154.00000,74.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,145.38,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,145.38,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,inpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,outpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,inpatient,,,97.00000,46.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,91.57,,,,,,,87.30,94.09,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,outpatient,,,97.00000,46.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,91.57,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,inpatient,,,154.00000,74.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,145.38,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,145.38,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,inpatient,,,87.00000,41.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82.13,,,,,,,78.30,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,outpatient,,,87.00000,41.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82.13,,,,,,,22.62,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,inpatient,,,68.00000,32.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,61.20,65.96,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,outpatient,,,68.00000,32.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,17.68,65.96,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,inpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,46.80,50.44,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,outpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,13.52,50.44,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,inpatient,,,51.00000,24.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,45.90,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,outpatient,,,51.00000,24.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,13.26,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,inpatient,,,97.00000,46.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,91.57,,,,,,,87.30,94.09,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,outpatient,,,97.00000,46.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,91.57,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,inpatient,,,176.00000,84.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,166.14,,,,,,,158.40,170.72,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,outpatient,,,176.00000,84.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,166.14,,,,,,,45.76,170.72,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,inpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,outpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,inpatient,,,158.00000,76.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,149.15,,,,,,,142.20,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,outpatient,,,158.00000,76.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,149.15,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,inpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,outpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,inpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,outpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,inpatient,,,84.00000,40.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,79.30,,,,,,,75.60,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,outpatient,,,84.00000,40.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,79.30,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,inpatient,,,189.00000,91.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,178.42,,,,,,,170.10,183.33,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,outpatient,,,189.00000,91.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,178.42,,,,,,,49.14,183.33,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,inpatient,,,109.00000,52.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,102.90,,,,,,,98.10,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,outpatient,,,109.00000,52.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,102.90,,,,,,,28.34,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,inpatient,,,129.00000,62.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,116.10,125.13,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,outpatient,,,129.00000,62.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,33.54,125.13,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,inpatient,,,84.00000,40.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,79.30,,,,,,,75.60,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,outpatient,,,84.00000,40.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,79.30,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,inpatient,,,73.00000,35.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,68.91,,,,,,,65.70,70.81,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,68.91,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,inpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,outpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,inpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,outpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,inpatient,,,149.00000,71.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,140.66,,,,,,,134.10,144.53,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,outpatient,,,149.00000,71.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,140.66,,,,,,,38.74,144.53,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,inpatient,,,130.00000,62.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,122.72,,,,,,,117.00,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,outpatient,,,130.00000,62.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,122.72,,,,,,,33.80,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,inpatient,,,110.00000,53.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,99.00,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,outpatient,,,110.00000,53.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,28.60,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,inpatient,,,158.00000,76.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,149.15,,,,,,,142.20,153.26,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,outpatient,,,158.00000,76.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,149.15,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,inpatient,,,117.00000,56.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,110.45,,,,,,,105.30,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,outpatient,,,117.00000,56.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,110.45,,,,,,,30.42,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,inpatient,,,61.00000,29.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,outpatient,,,61.00000,29.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,inpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,outpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,inpatient,,,145.00000,69.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,136.88,,,,,,,130.50,140.65,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,outpatient,,,145.00000,69.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,136.88,,,,,,,37.70,140.65,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,inpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,outpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,inpatient,,,165.00000,79.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,155.76,,,,,,,148.50,160.05,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,outpatient,,,165.00000,79.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,155.76,,,,,,,42.90,160.05,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,inpatient,,,70.00000,33.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,outpatient,,,70.00000,33.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,inpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,outpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,inpatient,,,154.00000,74.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,145.38,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,outpatient,,,154.00000,74.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,145.38,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,inpatient,,,104.00000,50.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,98.18,,,,,,,93.60,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,outpatient,,,104.00000,50.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,98.18,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,inpatient,,,70.00000,33.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,outpatient,,,70.00000,33.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,inpatient,,,104.00000,50.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,98.18,,,,,,,93.60,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,outpatient,,,104.00000,50.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,98.18,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,inpatient,,,70.00000,33.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,outpatient,,,70.00000,33.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,inpatient,,,123.00000,59.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,116.11,,,,,,,110.70,119.31,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,outpatient,,,123.00000,59.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,116.11,,,,,,,31.98,119.31,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,inpatient,,,95.00000,45.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,89.68,,,,,,,85.50,92.15,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,outpatient,,,95.00000,45.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,89.68,,,,,,,24.70,92.15,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,inpatient,,,160.00000,77.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,151.04,,,,,,,144.00,155.20,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,outpatient,,,160.00000,77.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,151.04,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,inpatient,,,147.00000,70.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,138.77,,,,,,,132.30,142.59,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,outpatient,,,147.00000,70.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,138.77,,,,,,,38.22,142.59,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,inpatient,,,178.00000,85.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,168.03,,,,,,,160.20,172.66,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,outpatient,,,178.00000,85.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,168.03,,,,,,,46.28,172.66,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,inpatient,,,160.00000,77.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,151.04,,,,,,,144.00,155.20,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,outpatient,,,160.00000,77.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,151.04,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,inpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,outpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,inpatient,,,70.00000,33.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,outpatient,,,70.00000,33.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,inpatient,,,449.00000,216.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,423.86,,,,,,,404.10,435.53,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,outpatient,,,449.00000,216.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,423.86,,,,,,,116.74,435.53,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,inpatient,,,104.00000,50.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,98.18,,,,,,,93.60,100.88,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,outpatient,,,104.00000,50.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,98.18,,,,,,,27.04,100.88,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,inpatient,,,185.00000,89.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,174.64,,,,,,,166.50,179.45,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,174.64,,,,,,,48.10,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,inpatient,,,185.00000,89.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,174.64,,,,,,,166.50,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,174.64,,,,,,,48.10,179.45,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,inpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,outpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,inpatient,,,84.00000,40.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,79.30,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,outpatient,,,84.00000,40.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,79.30,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,inpatient,,,84.00000,40.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,79.30,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,79.30,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,inpatient,,,84.00000,40.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,79.30,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,79.30,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,inpatient,,,73.00000,35.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,68.91,,,,,,,65.70,70.81,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,68.91,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,inpatient,,,73.00000,35.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,68.91,,,,,,,65.70,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,68.91,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,inpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,inpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,inpatient,,,98.00000,47.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,88.20,95.06,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,outpatient,,,98.00000,47.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,25.48,95.06,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,inpatient,,,75.00000,36.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70.80,,,,,,,67.50,72.75,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,outpatient,,,75.00000,36.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70.80,,,,,,,19.50,72.75,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,inpatient,,,107.00000,51.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,101.01,,,,,,,96.30,103.79,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,outpatient,,,107.00000,51.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,101.01,,,,,,,27.82,103.79,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,inpatient,,,81.00000,39.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,72.90,78.57,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,outpatient,,,81.00000,39.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,21.06,78.57,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,inpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,outpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,inpatient,,,68.00000,32.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,61.20,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,outpatient,,,68.00000,32.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,17.68,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,inpatient,,,51.00000,24.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,45.90,49.47,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,outpatient,,,51.00000,24.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,13.26,49.47,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,inpatient,,,74.00000,35.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,69.86,,,,,,,66.60,71.78,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,outpatient,,,74.00000,35.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,69.86,,,,,,,19.24,71.78,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,inpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,outpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,inpatient,,,194.00000,93.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,183.14,,,,,,,174.60,188.18,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,outpatient,,,194.00000,93.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,183.14,,,,,,,50.44,188.18,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,inpatient,,,111.00000,53.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,104.78,,,,,,,99.90,107.67,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,outpatient,,,111.00000,53.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,104.78,,,,,,,28.86,107.67,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,inpatient,,,77.00000,37.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,outpatient,,,77.00000,37.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,71.10,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,71.10,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,inpatient,,,237.00000,114.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,223.73,,,,,,,213.30,229.89,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,223.73,,,,,,,61.62,229.89,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,inpatient,,,51.00000,24.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,45.90,49.47,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,outpatient,,,51.00000,24.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,inpatient,,,82.00000,39.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,77.41,,,,,,,73.80,79.54,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,77.41,,,,,,,21.32,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,inpatient,,,82.00000,39.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,77.41,,,,,,,73.80,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,77.41,,,,,,,21.32,79.54,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,inpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,60.30,64.99,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,outpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,17.42,64.99,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,inpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,inpatient,,,131.00000,63.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,123.66,,,,,,,117.90,127.07,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,outpatient,,,131.00000,63.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,123.66,,,,,,,34.06,127.07,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,inpatient,,,15.00000,7.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14.16,,,,,,,13.50,14.55,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,outpatient,,,15.00000,7.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14.16,,,,,,,3.90,14.55,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,inpatient,,,39.00000,18.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,36.82,,,,,,,35.10,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,outpatient,,,39.00000,18.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,36.82,,,,,,,10.14,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,inpatient,,,12.00000,5.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,11.33,,,,,,,10.80,11.64,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,outpatient,,,12.00000,5.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,11.33,,,,,,,3.12,11.64,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,inpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,inpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,outpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,inpatient,,,203.00000,97.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,191.63,,,,,,,182.70,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,191.63,,,,,,,52.78,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,inpatient,,,203.00000,97.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,191.63,,,,,,,182.70,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,191.63,,,,,,,52.78,196.91,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,inpatient,,,99.00000,47.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,93.46,,,,,,,89.10,96.03,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,outpatient,,,99.00000,47.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,93.46,,,,,,,25.74,96.03,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,inpatient,,,53.00000,25.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,47.70,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,outpatient,,,53.00000,25.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,13.78,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,inpatient,,,23.00000,11.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,21.71,,,,,,,20.70,22.31,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,outpatient,,,23.00000,11.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,21.71,,,,,,,5.98,22.31,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,inpatient,,,46.00000,22.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,43.42,,,,,,,41.40,44.62,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,outpatient,,,46.00000,22.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,43.42,,,,,,,11.96,44.62,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,inpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,60.30,64.99,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,outpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,17.42,64.99,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,inpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,outpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,inpatient,,,288.00000,138.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,271.87,,,,,,,259.20,279.36,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,outpatient,,,288.00000,138.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,271.87,,,,,,,74.88,279.36,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,inpatient,,,106.00000,51.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,outpatient,,,106.00000,51.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,inpatient,,,30.00000,14.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28.32,,,,,,,27.00,29.10,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,outpatient,,,30.00000,14.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28.32,,,,,,,7.80,29.10,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,inpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,outpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,inpatient,,,71.00000,34.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,63.90,68.87,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,outpatient,,,71.00000,34.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,18.46,68.87,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,inpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,60.30,64.99,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,outpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,17.42,64.99,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,inpatient,,,89.00000,42.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.02,,,,,,,80.10,86.33,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,outpatient,,,89.00000,42.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.02,,,,,,,23.14,86.33,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,inpatient,,,116.00000,55.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,109.50,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,outpatient,,,116.00000,55.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,109.50,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,inpatient,,,116.00000,55.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,109.50,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,109.50,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,inpatient,,,116.00000,55.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,109.50,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,109.50,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,inpatient,,,51.00000,24.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,45.90,49.47,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,outpatient,,,51.00000,24.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,13.26,49.47,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,inpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,outpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,inpatient,,,174.00000,83.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,164.26,,,,,,,156.60,168.78,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,outpatient,,,174.00000,83.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,164.26,,,,,,,45.24,168.78,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,inpatient,,,82.00000,39.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,77.41,,,,,,,73.80,79.54,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,outpatient,,,82.00000,39.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,77.41,,,,,,,21.32,79.54,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,inpatient,,,112.00000,53.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,105.73,,,,,,,100.80,108.64,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,outpatient,,,112.00000,53.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,105.73,,,,,,,29.12,108.64,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,inpatient,,,61.00000,29.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,outpatient,,,61.00000,29.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,inpatient,,,69.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,62.10,66.93,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,outpatient,,,69.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,17.94,66.93,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,inpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,inpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,46.80,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,outpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,13.52,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,inpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,inpatient,,,286.00000,137.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,269.98,,,,,,,257.40,277.42,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,outpatient,,,286.00000,137.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,269.98,,,,,,,74.36,277.42,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,inpatient,,,300.00000,144.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,283.20,,,,,,,270.00,291.00,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,outpatient,,,300.00000,144.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,283.20,,,,,,,78.00,291.00,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,inpatient,,,73.00000,35.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,68.91,,,,,,,65.70,70.81,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,outpatient,,,73.00000,35.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,68.91,,,,,,,18.98,70.81,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,inpatient,,,90.00000,43.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.96,,,,,,,81.00,87.30,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,outpatient,,,90.00000,43.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.96,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,inpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,outpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,inpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,46.80,50.44,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,inpatient,,,315.00000,151.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,297.36,,,,,,,283.50,305.55,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,outpatient,,,315.00000,151.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,297.36,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,inpatient,,,100.00000,48.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,94.40,,,,,,,90.00,97.00,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,outpatient,,,100.00000,48.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,94.40,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,inpatient,,,89.00000,42.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.02,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,outpatient,,,89.00000,42.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.02,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,inpatient,,,71.00000,34.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,63.90,68.87,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,outpatient,,,71.00000,34.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,18.46,68.87,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,inpatient,,,135.00000,65.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,127.44,,,,,,,121.50,130.95,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,outpatient,,,135.00000,65.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,127.44,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,inpatient,,,80.00000,38.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,75.52,,,,,,,72.00,77.60,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,outpatient,,,80.00000,38.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,75.52,,,,,,,20.80,77.60,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,inpatient,,,72.00000,34.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,inpatient,,,72.00000,34.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,inpatient,,,100.00000,48.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,94.40,,,,,,,90.00,97.00,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,outpatient,,,100.00000,48.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,94.40,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,inpatient,,,305.00000,147.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,287.92,,,,,,,274.50,295.85,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,outpatient,,,305.00000,147.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,287.92,,,,,,,79.30,295.85,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,inpatient,,,70.00000,33.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,63.00,67.90,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,outpatient,,,70.00000,33.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,inpatient,,,69.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,62.10,66.93,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,outpatient,,,69.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,17.94,66.93,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,inpatient,,,64.00000,30.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,57.60,62.08,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,outpatient,,,64.00000,30.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,16.64,62.08,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,inpatient,,,368.00000,177.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,347.39,,,,,,,331.20,356.96,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,outpatient,,,368.00000,177.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,347.39,,,,,,,95.68,356.96,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,inpatient,,,104.00000,50.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,98.18,,,,,,,93.60,100.88,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,outpatient,,,104.00000,50.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,98.18,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,inpatient,,,109.00000,52.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,102.90,,,,,,,98.10,105.73,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,outpatient,,,109.00000,52.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,102.90,,,,,,,28.34,105.73,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,inpatient,,,114.00000,54.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,102.60,110.58,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,outpatient,,,114.00000,54.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,inpatient,,,135.00000,65.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,127.44,,,,,,,121.50,130.95,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,outpatient,,,135.00000,65.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,127.44,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,inpatient,,,105.00000,50.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,99.12,,,,,,,94.50,101.85,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,outpatient,,,105.00000,50.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,99.12,,,,,,,27.30,101.85,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,inpatient,,,315.00000,151.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,297.36,,,,,,,283.50,305.55,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,outpatient,,,315.00000,151.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,297.36,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,inpatient,,,148.00000,71.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,139.71,,,,,,,133.20,143.56,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,outpatient,,,148.00000,71.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,139.71,,,,,,,38.48,143.56,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,inpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,outpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,inpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,60.30,64.99,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,outpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,17.42,64.99,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,inpatient,,,107.00000,51.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,101.01,,,,,,,96.30,103.79,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,outpatient,,,107.00000,51.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,101.01,,,,,,,27.82,103.79,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,inpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,outpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,inpatient,,,35.00000,16.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.04,,,,,,,31.50,33.95,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,outpatient,,,35.00000,16.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.04,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,inpatient,,,104.00000,50.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,98.18,,,,,,,93.60,100.88,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,outpatient,,,104.00000,50.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,98.18,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,inpatient,,,650.00000,313.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,613.60,,,,,,,585.00,630.50,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,outpatient,,,650.00000,313.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,613.60,,,,,,,169.00,630.50,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,inpatient,,,91.00000,43.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,85.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,outpatient,,,91.00000,43.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,85.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,inpatient,,,114.00000,54.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,102.60,110.58,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,outpatient,,,114.00000,54.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,inpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,46.80,50.44,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,inpatient,,,360.00000,173.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,339.84,,,,,,,324.00,349.20,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,outpatient,,,360.00000,173.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,339.84,,,,,,,93.60,349.20,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,inpatient,,,106.00000,51.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,outpatient,,,106.00000,51.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,inpatient,,,78.00000,37.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,70.20,75.66,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,outpatient,,,78.00000,37.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,inpatient,,,72.00000,34.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,outpatient,,,72.00000,34.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,inpatient,,,94.00000,45.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,88.74,,,,,,,84.60,91.18,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,outpatient,,,94.00000,45.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,88.74,,,,,,,24.44,91.18,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,inpatient,,,101.00000,48.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,95.34,,,,,,,90.90,97.97,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,outpatient,,,101.00000,48.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,95.34,,,,,,,26.26,97.97,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,inpatient,,,82.00000,39.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,77.41,,,,,,,73.80,79.54,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,outpatient,,,82.00000,39.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,77.41,,,,,,,21.32,79.54,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,inpatient,,,77.00000,37.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,outpatient,,,77.00000,37.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,inpatient,,,145.00000,69.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,136.88,,,,,,,130.50,140.65,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,outpatient,,,145.00000,69.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,136.88,,,,,,,37.70,140.65,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,inpatient,,,266.00000,128.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,251.10,,,,,,,239.40,258.02,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,outpatient,,,266.00000,128.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,251.10,,,,,,,69.16,258.02,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,inpatient,,,79.00000,38.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,71.10,76.63,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,outpatient,,,79.00000,38.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,20.54,76.63,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,inpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,outpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,inpatient,,,144.00000,69.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,135.94,,,,,,,129.60,139.68,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,outpatient,,,144.00000,69.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,135.94,,,,,,,37.44,139.68,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,inpatient,,,20.00000,9.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18.88,,,,,,,18.00,19.40,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,outpatient,,,20.00000,9.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18.88,,,,,,,5.20,19.40,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,inpatient,,,208.00000,100.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,196.35,,,,,,,187.20,201.76,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,outpatient,,,208.00000,100.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,196.35,,,,,,,54.08,201.76,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,inpatient,,,135.00000,65.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,127.44,,,,,,,121.50,130.95,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,outpatient,,,135.00000,65.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,127.44,,,,,,,35.10,130.95,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,inpatient,,,131.00000,63.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,123.66,,,,,,,117.90,127.07,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,outpatient,,,131.00000,63.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,123.66,,,,,,,34.06,127.07,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,inpatient,,,69.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,62.10,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,outpatient,,,69.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,17.94,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,inpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,outpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,inpatient,,,25.00000,12.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,23.60,,,,,,,22.50,24.25,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,outpatient,,,25.00000,12.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,23.60,,,,,,,6.50,24.25,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,inpatient,,,61.00000,29.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,outpatient,,,61.00000,29.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,inpatient,,,80.00000,38.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,75.52,,,,,,,72.00,77.60,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,outpatient,,,80.00000,38.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,75.52,,,,,,,20.80,77.60,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,inpatient,,,82.00000,39.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,77.41,,,,,,,73.80,79.54,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,outpatient,,,82.00000,39.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,77.41,,,,,,,21.32,79.54,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,inpatient,,,35.00000,16.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.04,,,,,,,31.50,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,outpatient,,,35.00000,16.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.04,,,,,,,9.10,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,inpatient,,,88.00000,42.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,83.07,,,,,,,79.20,85.36,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,outpatient,,,88.00000,42.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,83.07,,,,,,,22.88,85.36,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,inpatient,,,98.00000,47.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,88.20,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,outpatient,,,98.00000,47.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,25.48,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,inpatient,,,204.00000,98.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,192.58,,,,,,,183.60,197.88,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,outpatient,,,204.00000,98.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,192.58,,,,,,,53.04,197.88,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,inpatient,,,61.00000,29.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,outpatient,,,61.00000,29.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,inpatient,,,19.00000,9.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,17.94,,,,,,,17.10,18.43,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,outpatient,,,19.00000,9.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,17.94,,,,,,,4.94,18.43,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,inpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,outpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,inpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,outpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,inpatient,,,37.00000,17.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,34.93,,,,,,,33.30,35.89,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,outpatient,,,37.00000,17.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,34.93,,,,,,,9.62,35.89,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,inpatient,,,79.00000,38.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,71.10,76.63,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,outpatient,,,79.00000,38.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,20.54,76.63,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,inpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,outpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,inpatient,,,21.00000,10.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,19.82,,,,,,,18.90,20.37,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,outpatient,,,21.00000,10.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,19.82,,,,,,,5.46,20.37,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,inpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,46.80,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,outpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,13.52,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,inpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,outpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,inpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,outpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,inpatient,,,32.00000,15.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,30.21,,,,,,,28.80,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,outpatient,,,32.00000,15.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,30.21,,,,,,,8.32,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,inpatient,,,94.00000,45.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,88.74,,,,,,,84.60,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,outpatient,,,94.00000,45.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,88.74,,,,,,,24.44,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,inpatient,,,103.00000,49.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,97.23,,,,,,,92.70,99.91,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,outpatient,,,103.00000,49.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,97.23,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,inpatient,,,64.00000,30.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,57.60,62.08,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,outpatient,,,64.00000,30.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,16.64,62.08,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,inpatient,,,102.00000,49.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,91.80,98.94,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,outpatient,,,102.00000,49.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,26.52,98.94,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,inpatient,,,103.00000,49.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,97.23,,,,,,,92.70,99.91,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,outpatient,,,103.00000,49.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,97.23,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,inpatient,,,139.00000,67.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,131.22,,,,,,,125.10,134.83,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,outpatient,,,139.00000,67.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,131.22,,,,,,,36.14,134.83,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,inpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,46.80,50.44,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,outpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,13.52,50.44,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,inpatient,,,21.00000,10.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,19.82,,,,,,,18.90,20.37,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,19.82,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,inpatient,,,88.00000,42.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,83.07,,,,,,,79.20,85.36,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,outpatient,,,88.00000,42.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,83.07,,,,,,,22.88,85.36,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,inpatient,,,21.00000,10.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,19.82,,,,,,,18.90,20.37,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,19.82,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,inpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,46.80,50.44,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,outpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,13.52,50.44,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,inpatient,,,80.00000,38.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,75.52,,,,,,,72.00,77.60,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,outpatient,,,80.00000,38.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,75.52,,,,,,,20.80,77.60,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,inpatient,,,49.00000,23.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,46.26,,,,,,,44.10,47.53,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,outpatient,,,49.00000,23.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,46.26,,,,,,,12.74,47.53,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,inpatient,,,88.00000,42.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,83.07,,,,,,,79.20,85.36,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,outpatient,,,88.00000,42.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,83.07,,,,,,,22.88,85.36,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,inpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,outpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,inpatient,,,68.00000,32.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,61.20,65.96,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,outpatient,,,68.00000,32.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,17.68,65.96,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,inpatient,,,93.00000,44.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,87.79,,,,,,,83.70,90.21,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,outpatient,,,93.00000,44.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,87.79,,,,,,,24.18,90.21,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,inpatient,,,73.00000,35.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,68.91,,,,,,,65.70,70.81,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,outpatient,,,73.00000,35.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,68.91,,,,,,,18.98,70.81,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,inpatient,,,41.00000,19.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,38.70,,,,,,,36.90,39.77,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,outpatient,,,41.00000,19.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,38.70,,,,,,,10.66,39.77,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,inpatient,,,94.00000,45.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,88.74,,,,,,,84.60,91.18,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,outpatient,,,94.00000,45.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,88.74,,,,,,,24.44,91.18,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,inpatient,,,124.00000,59.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,117.06,,,,,,,111.60,120.28,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,outpatient,,,124.00000,59.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,117.06,,,,,,,32.24,120.28,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,inpatient,,,71.00000,34.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,63.90,68.87,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,outpatient,,,71.00000,34.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,18.46,68.87,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,inpatient,,,33.00000,15.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,31.15,,,,,,,29.70,32.01,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,outpatient,,,33.00000,15.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,31.15,,,,,,,8.58,32.01,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,inpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,46.80,50.44,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,outpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,13.52,50.44,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,inpatient,,,68.00000,32.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,61.20,65.96,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,outpatient,,,68.00000,32.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,17.68,65.96,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,inpatient,,,99.00000,47.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,93.46,,,,,,,89.10,96.03,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,outpatient,,,99.00000,47.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,93.46,,,,,,,25.74,96.03,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,inpatient,,,197.00000,94.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,185.97,,,,,,,177.30,191.09,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,outpatient,,,197.00000,94.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,185.97,,,,,,,51.22,191.09,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,inpatient,,,194.00000,93.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,183.14,,,,,,,174.60,188.18,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,outpatient,,,194.00000,93.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,183.14,,,,,,,50.44,188.18,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,inpatient,,,68.00000,32.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,61.20,65.96,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,outpatient,,,68.00000,32.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,17.68,65.96,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,inpatient,,,90.00000,43.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.96,,,,,,,81.00,87.30,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,outpatient,,,90.00000,43.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.96,,,,,,,23.40,87.30,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,inpatient,,,109.00000,52.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,102.90,,,,,,,98.10,105.73,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,outpatient,,,109.00000,52.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,102.90,,,,,,,28.34,105.73,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,inpatient,,,108.00000,52.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,101.95,,,,,,,97.20,104.76,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,outpatient,,,108.00000,52.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,101.95,,,,,,,28.08,104.76,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,inpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,60.30,64.99,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,outpatient,,,67.00000,32.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,17.42,64.99,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,inpatient,,,69.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,62.10,66.93,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,outpatient,,,69.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,inpatient,,,71.00000,34.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,63.90,68.87,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,outpatient,,,71.00000,34.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,18.46,68.87,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,inpatient,,,98.00000,47.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,88.20,95.06,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,outpatient,,,98.00000,47.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,25.48,95.06,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,inpatient,,,141.00000,67.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,133.10,,,,,,,126.90,136.77,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,outpatient,,,141.00000,67.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,133.10,,,,,,,36.66,136.77,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,inpatient,,,226.00000,108.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,213.34,,,,,,,203.40,219.22,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,outpatient,,,226.00000,108.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,213.34,,,,,,,58.76,219.22,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,inpatient,,,92.00000,44.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,86.85,,,,,,,82.80,89.24,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,outpatient,,,92.00000,44.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,86.85,,,,,,,23.92,89.24,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,inpatient,,,69.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,62.10,66.93,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,outpatient,,,69.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,inpatient,,,100.00000,48.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,94.40,,,,,,,90.00,97.00,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,outpatient,,,100.00000,48.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,94.40,,,,,,,26.00,97.00,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,inpatient,,,124.00000,59.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,117.06,,,,,,,111.60,120.28,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,outpatient,,,124.00000,59.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,117.06,,,,,,,32.24,120.28,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,inpatient,,,69.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,62.10,66.93,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,outpatient,,,69.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,17.94,66.93,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,117.06,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,117.06,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,117.06,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,117.06,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,117.06,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,117.06,,,,,,,32.24,120.28,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,inpatient,,,118.00000,56.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,111.39,,,,,,,106.20,114.46,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,outpatient,,,118.00000,56.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,111.39,,,,,,,30.68,114.46,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,inpatient,,,51.00000,24.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,45.90,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,outpatient,,,51.00000,24.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,13.26,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,inpatient,,,104.00000,50.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,98.18,,,,,,,93.60,100.88,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,outpatient,,,104.00000,50.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,98.18,,,,,,,27.04,100.88,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,inpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,outpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,inpatient,,,72.00000,34.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,64.80,69.84,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,outpatient,,,72.00000,34.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,18.72,69.84,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,inpatient,,,54.00000,26.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,48.60,52.38,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,outpatient,,,54.00000,26.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,14.04,52.38,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,inpatient,,,17.00000,8.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16.05,,,,,,,15.30,16.49,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,outpatient,,,17.00000,8.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16.05,,,,,,,4.42,16.49,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,inpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,outpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,inpatient,,,36.00000,17.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,32.40,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,outpatient,,,36.00000,17.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,9.36,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,inpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,46.80,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,outpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,13.52,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,inpatient,,,18.00000,8.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16.99,,,,,,,16.20,17.46,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,outpatient,,,18.00000,8.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16.99,,,,,,,4.68,17.46,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,inpatient,,,74.00000,35.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,69.86,,,,,,,66.60,71.78,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,outpatient,,,74.00000,35.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,69.86,,,,,,,19.24,71.78,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,inpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,outpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,inpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,outpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,inpatient,,,118.00000,56.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,111.39,,,,,,,106.20,114.46,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,outpatient,,,118.00000,56.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,111.39,,,,,,,30.68,114.46,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,inpatient,,,82.00000,39.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,77.41,,,,,,,73.80,79.54,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,outpatient,,,82.00000,39.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,77.41,,,,,,,21.32,79.54,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,inpatient,,,30.00000,14.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28.32,,,,,,,27.00,29.10,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,outpatient,,,30.00000,14.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28.32,,,,,,,7.80,29.10,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,inpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,outpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,inpatient,,,70.00000,33.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,63.00,67.90,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,outpatient,,,70.00000,33.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,18.20,67.90,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,inpatient,,,54.00000,26.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,48.60,52.38,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,outpatient,,,54.00000,26.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,14.04,52.38,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,inpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,outpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,inpatient,,,51.00000,24.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,45.90,49.47,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,outpatient,,,51.00000,24.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,inpatient,,,141.00000,67.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,133.10,,,,,,,126.90,136.77,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,outpatient,,,141.00000,67.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,133.10,,,,,,,36.66,136.77,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,inpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,outpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,inpatient,,,81.00000,39.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,72.90,78.57,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,outpatient,,,81.00000,39.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,21.06,78.57,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,inpatient,,,335.00000,161.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,316.24,,,,,,,301.50,324.95,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,outpatient,,,335.00000,161.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,316.24,,,,,,,87.10,324.95,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,inpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,46.80,50.44,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,outpatient,,,52.00000,25.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,13.52,50.44,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,inpatient,,,54.00000,26.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,48.60,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,inpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,outpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,inpatient,,,54.00000,26.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,48.60,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,inpatient,,,53.00000,25.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,47.70,51.41,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,outpatient,,,53.00000,25.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,inpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,outpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,inpatient,,,53.00000,25.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,47.70,51.41,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,outpatient,,,53.00000,25.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,inpatient,,,12.00000,5.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,11.33,,,,,,,10.80,11.64,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,outpatient,,,12.00000,5.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,11.33,,,,,,,3.12,11.64,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,inpatient,,,710.00000,342.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,670.24,,,,,,,639.00,688.70,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,outpatient,,,710.00000,342.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,670.24,,,,,,,184.60,688.70,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,inpatient,,,104.00000,50.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,98.18,,,,,,,93.60,100.88,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,outpatient,,,104.00000,50.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,98.18,,,,,,,27.04,100.88,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,inpatient,,,155.00000,74.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,146.32,,,,,,,139.50,150.35,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,outpatient,,,155.00000,74.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,146.32,,,,,,,40.30,150.35,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,inpatient,,,139.00000,67.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,131.22,,,,,,,125.10,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,outpatient,,,139.00000,67.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,131.22,,,,,,,36.14,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,inpatient,,,89.00000,42.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.02,,,,,,,80.10,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,outpatient,,,89.00000,42.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.02,,,,,,,23.14,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,inpatient,,,88.00000,42.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,83.07,,,,,,,79.20,85.36,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,outpatient,,,88.00000,42.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,83.07,,,,,,,22.88,85.36,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,inpatient,,,111.00000,53.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,104.78,,,,,,,99.90,107.67,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,outpatient,,,111.00000,53.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,104.78,,,,,,,28.86,107.67,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,inpatient,,,70.00000,33.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,63.00,67.90,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,outpatient,,,70.00000,33.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,18.20,67.90,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,inpatient,,,85.00000,40.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,80.24,,,,,,,76.50,82.45,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,outpatient,,,85.00000,40.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,80.24,,,,,,,22.10,82.45,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,inpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,outpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,inpatient,,,110.00000,53.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,99.00,106.70,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,outpatient,,,110.00000,53.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,28.60,106.70,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,inpatient,,,500.00000,241.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,472.00,,,,,,,450.00,485.00,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,outpatient,,,500.00000,241.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,472.00,,,,,,,130.00,485.00,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,inpatient,,,140.00000,67.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,132.16,,,,,,,126.00,135.80,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,outpatient,,,140.00000,67.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,132.16,,,,,,,36.40,135.80,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,inpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,outpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,inpatient,,,74.00000,35.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,69.86,,,,,,,66.60,71.78,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,outpatient,,,74.00000,35.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,69.86,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,inpatient,,,77.00000,37.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,outpatient,,,77.00000,37.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,inpatient,,,93.00000,44.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,87.79,,,,,,,83.70,90.21,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,outpatient,,,93.00000,44.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,87.79,,,,,,,24.18,90.21,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,inpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,outpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,inpatient,,,15.00000,7.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14.16,,,,,,,13.50,14.55,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,outpatient,,,15.00000,7.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,14.16,,,,,,,3.90,14.55,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,inpatient,,,24.00000,11.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,22.66,,,,,,,21.60,23.28,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,outpatient,,,24.00000,11.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,22.66,,,,,,,6.24,23.28,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,inpatient,,,72.00000,34.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,64.80,69.84,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,outpatient,,,72.00000,34.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,18.72,69.84,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,inpatient,,,16.00000,7.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,15.10,,,,,,,14.40,15.52,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,15.10,,,,,,,4.16,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,inpatient,,,16.00000,7.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,15.10,,,,,,,14.40,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,15.10,,,,,,,4.16,15.52,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,inpatient,,,64.00000,30.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,57.60,62.08,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,outpatient,,,64.00000,30.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,16.64,62.08,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,inpatient,,,82.00000,39.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,77.41,,,,,,,73.80,79.54,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,outpatient,,,82.00000,39.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,77.41,,,,,,,21.32,79.54,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,inpatient,,,157.00000,75.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,148.21,,,,,,,141.30,152.29,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,outpatient,,,157.00000,75.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,148.21,,,,,,,40.82,152.29,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,inpatient,,,70.00000,33.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,63.00,67.90,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,outpatient,,,70.00000,33.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,18.20,67.90,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,inpatient,,,229.00000,110.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,216.18,,,,,,,206.10,222.13,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,outpatient,,,229.00000,110.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,216.18,,,,,,,59.54,222.13,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,inpatient,,,64.00000,30.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,57.60,62.08,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,outpatient,,,64.00000,30.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,16.64,62.08,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,inpatient,,,72.00000,34.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,64.80,69.84,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,outpatient,,,72.00000,34.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,18.72,69.84,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,inpatient,,,17.00000,8.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16.05,,,,,,,15.30,16.49,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,outpatient,,,17.00000,8.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16.05,,,,,,,4.42,16.49,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,inpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,outpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,inpatient,,,64.00000,30.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,57.60,62.08,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,outpatient,,,64.00000,30.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,16.64,62.08,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,inpatient,,,387.00000,186.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,365.33,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,outpatient,,,387.00000,186.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,365.33,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,inpatient,,,387.00000,186.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,365.33,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,365.33,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,inpatient,,,387.00000,186.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,365.33,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,365.33,,,,,,,100.62,375.39,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,inpatient,,,77.00000,37.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,outpatient,,,77.00000,37.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,inpatient,,,78.00000,37.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,70.20,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,20.28,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,inpatient,,,78.00000,37.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,70.20,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,20.28,75.66,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,inpatient,,,43.00000,20.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,40.59,,,,,,,38.70,41.71,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,outpatient,,,43.00000,20.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,40.59,,,,,,,11.18,41.71,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,inpatient,,,64.00000,30.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,57.60,62.08,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,outpatient,,,64.00000,30.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,16.64,62.08,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,inpatient,,,160.00000,77.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,151.04,,,,,,,144.00,155.20,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,outpatient,,,160.00000,77.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,151.04,,,,,,,41.60,155.20,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,inpatient,,,112.00000,53.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,105.73,,,,,,,100.80,108.64,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,outpatient,,,112.00000,53.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,105.73,,,,,,,29.12,108.64,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,inpatient,,,82.00000,39.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,77.41,,,,,,,73.80,79.54,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,outpatient,,,82.00000,39.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,77.41,,,,,,,21.32,79.54,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,inpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,outpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,inpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,outpatient,,,55.00000,26.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,inpatient,,,54.00000,26.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,48.60,52.38,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,outpatient,,,54.00000,26.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,14.04,52.38,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,inpatient,,,153.00000,73.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,144.43,,,,,,,137.70,148.41,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,outpatient,,,153.00000,73.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,144.43,,,,,,,39.78,148.41,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,inpatient,,,45.00000,21.69000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,42.48,,,,,,,40.50,43.65,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,outpatient,,,45.00000,21.69000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,42.48,,,,,,,11.70,43.65,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,inpatient,,,28.00000,13.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,26.43,,,,,,,25.20,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,outpatient,,,28.00000,13.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,26.43,,,,,,,7.28,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,inpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,outpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,46.26,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,46.26,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,46.26,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,46.26,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,46.26,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,46.26,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,inpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,outpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,inpatient,,,36.00000,17.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,32.40,34.92,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,outpatient,,,36.00000,17.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,9.36,34.92,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,inpatient,,,38.00000,18.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,35.87,,,,,,,34.20,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,outpatient,,,38.00000,18.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,35.87,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,inpatient,,,38.00000,18.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,35.87,,,,,,,34.20,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,outpatient,,,38.00000,18.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,35.87,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,inpatient,,,76.00000,36.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,71.74,,,,,,,68.40,73.72,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,outpatient,,,76.00000,36.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,71.74,,,,,,,19.76,73.72,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,inpatient,,,173.00000,83.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,163.31,,,,,,,155.70,167.81,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,outpatient,,,173.00000,83.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,163.31,,,,,,,44.98,167.81,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,inpatient,,,22.00000,10.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20.77,,,,,,,19.80,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,outpatient,,,22.00000,10.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,20.77,,,,,,,5.72,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,inpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,outpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,inpatient,,,39.00000,18.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,36.82,,,,,,,35.10,37.83,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,outpatient,,,39.00000,18.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,36.82,,,,,,,10.14,37.83,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,inpatient,,,41.00000,19.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,38.70,,,,,,,36.90,39.77,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,outpatient,,,41.00000,19.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,38.70,,,,,,,10.66,39.77,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,inpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,outpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,inpatient,,,54.00000,26.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,48.60,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,outpatient,,,54.00000,26.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,14.04,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,inpatient,,,71.00000,34.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,63.90,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,outpatient,,,71.00000,34.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,18.46,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,inpatient,,,43.00000,20.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,40.59,,,,,,,38.70,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,40.59,,,,,,,11.18,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,inpatient,,,43.00000,20.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,40.59,,,,,,,38.70,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,40.59,,,,,,,11.18,41.71,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,inpatient,,,38.00000,18.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,35.87,,,,,,,34.20,36.86,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,outpatient,,,38.00000,18.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,35.87,,,,,,,9.88,36.86,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,inpatient,,,72.00000,34.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,64.80,69.84,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,outpatient,,,72.00000,34.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,18.72,69.84,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,inpatient,,,226.00000,108.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,213.34,,,,,,,203.40,219.22,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,outpatient,,,226.00000,108.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,213.34,,,,,,,58.76,219.22,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,38.70,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,38.70,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,38.70,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,38.70,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,38.70,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,38.70,,,,,,,10.66,39.77,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,inpatient,,,160.00000,77.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,151.04,,,,,,,144.00,155.20,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,outpatient,,,160.00000,77.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,151.04,,,,,,,41.60,155.20,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,inpatient,,,102.00000,49.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,91.80,98.94,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,outpatient,,,102.00000,49.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,26.52,98.94,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,inpatient,,,317.00000,152.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,299.25,,,,,,,285.30,307.49,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,outpatient,,,317.00000,152.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,299.25,,,,,,,82.42,307.49,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,inpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,outpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,inpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,outpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,inpatient,,,116.00000,55.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,109.50,,,,,,,104.40,112.52,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,outpatient,,,116.00000,55.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,109.50,,,,,,,30.16,112.52,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,inpatient,,,89.00000,42.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.02,,,,,,,80.10,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.02,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,inpatient,,,89.00000,42.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.02,,,,,,,80.10,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.02,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,inpatient,,,85.00000,40.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,80.24,,,,,,,76.50,82.45,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,outpatient,,,85.00000,40.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,80.24,,,,,,,22.10,82.45,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,inpatient,,,184.00000,88.69000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,173.70,,,,,,,165.60,178.48,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,outpatient,,,184.00000,88.69000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,173.70,,,,,,,47.84,178.48,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,inpatient,,,127.00000,61.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,119.89,,,,,,,114.30,123.19,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,outpatient,,,127.00000,61.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,119.89,,,,,,,33.02,123.19,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,inpatient,,,61.00000,29.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,outpatient,,,61.00000,29.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,inpatient,,,35.00000,16.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.04,,,,,,,31.50,33.95,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,outpatient,,,35.00000,16.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.04,,,,,,,9.10,33.95,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,inpatient,,,79.00000,38.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,71.10,76.63,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,outpatient,,,79.00000,38.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,20.54,76.63,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,inpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,outpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,inpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,outpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,inpatient,,,57.00000,32.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,outpatient,,,57.00000,32.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,144.43,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,144.43,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,inpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,outpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,inpatient,,,77.00000,44.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,outpatient,,,77.00000,44.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,inpatient,,,70.00000,40.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,63.00,67.90,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,outpatient,,,70.00000,40.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,inpatient,,,67.00000,38.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,60.30,64.99,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,outpatient,,,67.00000,38.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,inpatient,,,40.00000,23.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37.76,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,outpatient,,,40.00000,23.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37.76,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,inpatient,,,71.00000,40.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,outpatient,,,71.00000,40.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,inpatient,,,80.00000,46.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,75.52,,,,,,,72.00,77.60,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,outpatient,,,80.00000,46.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,75.52,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,inpatient,,,72.00000,41.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,outpatient,,,72.00000,41.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,inpatient,,,444.00000,255.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,419.14,,,,,,,399.60,430.68,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,outpatient,,,444.00000,255.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,419.14,,,,,,,115.44,430.68,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,inpatient,,,81.00000,46.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,72.90,78.57,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,outpatient,,,81.00000,46.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,21.06,78.57,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,inpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,outpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,inpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,inpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,inpatient,,,66.00000,38.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,outpatient,,,66.00000,38.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,inpatient,,,57.00000,32.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,outpatient,,,57.00000,32.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,inpatient,,,53.00000,30.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,outpatient,,,53.00000,30.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,inpatient,,,60.00000,34.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,outpatient,,,60.00000,34.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,inpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,outpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,inpatient,,,40.00000,23.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37.76,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,outpatient,,,40.00000,23.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37.76,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,inpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,outpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,inpatient,,,42.00000,24.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,39.65,,,,,,,37.80,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,outpatient,,,42.00000,24.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,39.65,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,inpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,outpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,inpatient,,,46.00000,26.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,43.42,,,,,,,41.40,44.62,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,outpatient,,,46.00000,26.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,43.42,,,,,,,11.96,44.62,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,inpatient,,,54.00000,31.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,outpatient,,,54.00000,31.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,inpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,outpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,inpatient,,,71.00000,40.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,outpatient,,,71.00000,40.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,inpatient,,,54.00000,31.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,outpatient,,,54.00000,31.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,inpatient,,,80.00000,46.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,75.52,,,,,,,72.00,77.60,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,outpatient,,,80.00000,46.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,75.52,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,inpatient,,,60.00000,34.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,outpatient,,,60.00000,34.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,inpatient,,,124.00000,71.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,117.06,,,,,,,111.60,120.28,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,117.06,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,inpatient,,,130.00000,74.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,122.72,,,,,,,117.00,126.10,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,outpatient,,,130.00000,74.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,122.72,,,,,,,33.80,126.10,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,inpatient,,,123.00000,70.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,116.11,,,,,,,110.70,119.31,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,116.11,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,inpatient,,,77.00000,44.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,outpatient,,,77.00000,44.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,inpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,outpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,inpatient,,,115.00000,66.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,108.56,,,,,,,103.50,111.55,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,outpatient,,,115.00000,66.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,108.56,,,,,,,29.90,111.55,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,inpatient,,,123.00000,70.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,116.11,,,,,,,110.70,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,116.11,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,inpatient,,,161.00000,92.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,151.98,,,,,,,144.90,156.17,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,outpatient,,,161.00000,92.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,151.98,,,,,,,41.86,156.17,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,inpatient,,,124.00000,71.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,117.06,,,,,,,111.60,120.28,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,117.06,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,inpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,outpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,inpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,outpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,inpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,outpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,inpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,outpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,inpatient,,,102.00000,58.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,91.80,98.94,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,outpatient,,,102.00000,58.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,inpatient,,,219.00000,126.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,206.74,,,,,,,197.10,212.43,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,outpatient,,,219.00000,126.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,206.74,,,,,,,56.94,212.43,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,inpatient,,,194.00000,111.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,183.14,,,,,,,174.60,188.18,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,183.14,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,inpatient,,,103.00000,59.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,97.23,,,,,,,92.70,99.91,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,outpatient,,,103.00000,59.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,97.23,,,,,,,26.78,99.91,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,inpatient,,,60.00000,34.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,outpatient,,,60.00000,34.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,inpatient,,,837.00000,482.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,790.13,,,,,,,753.30,811.89,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,outpatient,,,837.00000,482.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,790.13,,,,,,,217.62,811.89,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,inpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,inpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,inpatient,,,194.00000,111.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,183.14,,,,,,,174.60,188.18,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,183.14,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,inpatient,,,78.00000,44.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,70.20,75.66,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,outpatient,,,78.00000,44.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,inpatient,,,285.00000,164.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,269.04,,,,,,,256.50,276.45,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,outpatient,,,285.00000,164.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,269.04,,,,,,,74.10,276.45,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,inpatient,,,190.00000,109.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,179.36,,,,,,,171.00,184.30,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,outpatient,,,190.00000,109.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,179.36,,,,,,,49.40,184.30,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,inpatient,,,100.00000,57.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,94.40,,,,,,,90.00,97.00,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,outpatient,,,100.00000,57.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,94.40,,,,,,,26.00,97.00,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,inpatient,,,40.00000,23.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37.76,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37.76,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,inpatient,,,67.00000,38.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,60.30,64.99,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,outpatient,,,67.00000,38.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,63.25,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,inpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,outpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,inpatient,,,78.00000,44.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,70.20,75.66,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,outpatient,,,78.00000,44.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,inpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,outpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,inpatient,,,57.00000,32.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,outpatient,,,57.00000,32.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,inpatient,,,72.00000,41.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,outpatient,,,72.00000,41.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,inpatient,,,59.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,outpatient,,,59.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,inpatient,,,72.00000,41.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,outpatient,,,72.00000,41.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,inpatient,,,239.00000,137.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,225.62,,,,,,,215.10,231.83,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,outpatient,,,239.00000,137.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,225.62,,,,,,,62.14,231.83,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,inpatient,,,85.00000,48.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,80.24,,,,,,,76.50,82.45,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,outpatient,,,85.00000,48.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,80.24,,,,,,,22.10,82.45,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,inpatient,,,44.00000,25.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41.54,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,outpatient,,,44.00000,25.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41.54,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,inpatient,,,40.00000,23.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37.76,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,outpatient,,,40.00000,23.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37.76,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,inpatient,,,53.00000,30.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,outpatient,,,53.00000,30.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,inpatient,,,59.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,inpatient,,,59.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,inpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,outpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,inpatient,,,68.00000,39.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,outpatient,,,68.00000,39.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,inpatient,,,76.00000,43.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,71.74,,,,,,,68.40,73.72,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,outpatient,,,76.00000,43.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,71.74,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,inpatient,,,42.00000,24.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,39.65,,,,,,,37.80,40.74,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,outpatient,,,42.00000,24.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,39.65,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,inpatient,,,87.00000,50.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82.13,,,,,,,78.30,84.39,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,outpatient,,,87.00000,50.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82.13,,,,,,,22.62,84.39,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,inpatient,,,503.00000,289.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,474.83,,,,,,,452.70,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,outpatient,,,503.00000,289.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,474.83,,,,,,,130.78,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,inpatient,,,472.00000,271.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,445.57,,,,,,,424.80,457.84,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,outpatient,,,472.00000,271.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,445.57,,,,,,,122.72,457.84,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,inpatient,,,28.00000,16.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,26.43,,,,,,,25.20,27.16,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,outpatient,,,28.00000,16.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,26.43,,,,,,,7.28,27.16,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,inpatient,,,236.00000,135.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,222.78,,,,,,,212.40,228.92,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,outpatient,,,236.00000,135.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,222.78,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,inpatient,,,54.00000,31.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,outpatient,,,54.00000,31.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,inpatient,,,238.00000,137.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,224.67,,,,,,,214.20,230.86,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,outpatient,,,238.00000,137.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,224.67,,,,,,,61.88,230.86,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,inpatient,,,236.00000,135.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,222.78,,,,,,,212.40,228.92,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,outpatient,,,236.00000,135.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,222.78,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,inpatient,,,145.00000,83.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,136.88,,,,,,,130.50,140.65,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,outpatient,,,145.00000,83.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,136.88,,,,,,,37.70,140.65,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,inpatient,,,68.00000,39.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,inpatient,,,68.00000,39.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,inpatient,,,66.00000,38.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,outpatient,,,66.00000,38.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,inpatient,,,59.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,outpatient,,,59.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,inpatient,,,158.00000,91.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,149.15,,,,,,,142.20,153.26,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,outpatient,,,158.00000,91.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,149.15,,,,,,,41.08,153.26,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,inpatient,,,71.00000,40.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,outpatient,,,71.00000,40.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,inpatient,,,144.00000,82.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,135.94,,,,,,,129.60,139.68,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,outpatient,,,144.00000,82.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,135.94,,,,,,,37.44,139.68,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,inpatient,,,1448.00000,834.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1366.91,,,,,,,1303.20,1404.56,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,outpatient,,,1448.00000,834.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1366.91,,,,,,,376.48,1404.56,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,inpatient,,,72.00000,41.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,outpatient,,,72.00000,41.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,inpatient,,,102.00000,58.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,91.80,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,outpatient,,,102.00000,58.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,inpatient,,,154.00000,88.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,145.38,,,,,,,138.60,149.38,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,outpatient,,,154.00000,88.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,145.38,,,,,,,40.04,149.38,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,144.43,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,144.43,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,inpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,outpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,inpatient,,,66.00000,38.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,outpatient,,,66.00000,38.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,144.43,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,144.43,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,inpatient,,,44.00000,25.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41.54,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,outpatient,,,44.00000,25.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41.54,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,inpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,outpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,inpatient,,,150.00000,86.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,141.60,,,,,,,135.00,145.50,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,outpatient,,,150.00000,86.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,141.60,,,,,,,39.00,145.50,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,inpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,outpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,inpatient,,,56.00000,32.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,outpatient,,,56.00000,32.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,inpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,outpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,inpatient,,,66.00000,38.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,outpatient,,,66.00000,38.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,inpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,inpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,inpatient,,,60.00000,34.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,outpatient,,,60.00000,34.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,inpatient,,,58.00000,33.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,outpatient,,,58.00000,33.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,inpatient,,,71.00000,40.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,outpatient,,,71.00000,40.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,inpatient,,,72.00000,41.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,outpatient,,,72.00000,41.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,inpatient,,,56.00000,32.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,inpatient,,,56.00000,32.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,inpatient,,,60.00000,34.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,outpatient,,,60.00000,34.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,inpatient,,,56.00000,32.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,outpatient,,,56.00000,32.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,inpatient,,,39.00000,22.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,36.82,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,outpatient,,,39.00000,22.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,36.82,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,144.43,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,144.43,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,inpatient,,,73.00000,42.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,68.91,,,,,,,65.70,70.81,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,outpatient,,,73.00000,42.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,68.91,,,,,,,18.98,70.81,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,inpatient,,,127.00000,73.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,119.89,,,,,,,114.30,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,119.89,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,inpatient,,,127.00000,73.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,119.89,,,,,,,114.30,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,119.89,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,inpatient,,,372.00000,214.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,351.17,,,,,,,334.80,360.84,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,outpatient,,,372.00000,214.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,351.17,,,,,,,96.72,360.84,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,inpatient,,,69.00000,39.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,62.10,66.93,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,outpatient,,,69.00000,39.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,144.43,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,144.43,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,144.43,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,144.43,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,inpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,outpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,inpatient,,,57.00000,32.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,outpatient,,,57.00000,32.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,inpatient,,,96.00000,55.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,90.62,,,,,,,86.40,93.12,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,outpatient,,,96.00000,55.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,90.62,,,,,,,24.96,93.12,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,inpatient,,,44.00000,25.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41.54,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,outpatient,,,44.00000,25.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41.54,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,inpatient,,,60.00000,34.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,outpatient,,,60.00000,34.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,inpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,outpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,inpatient,,,60.00000,34.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,outpatient,,,60.00000,34.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,inpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,outpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,inpatient,,,74.00000,42.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,69.86,,,,,,,66.60,71.78,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,outpatient,,,74.00000,42.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,69.86,,,,,,,19.24,71.78,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,inpatient,,,69.00000,39.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,62.10,66.93,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,outpatient,,,69.00000,39.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,36.82,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,36.82,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,inpatient,,,53.00000,30.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,outpatient,,,53.00000,30.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,36.82,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,36.82,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,36.82,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,36.82,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,inpatient,,,70.00000,40.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,63.00,67.90,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,outpatient,,,70.00000,40.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,inpatient,,,71.00000,40.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,outpatient,,,71.00000,40.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,inpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,outpatient,,,65.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,inpatient,,,325.00000,187.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,306.80,,,,,,,292.50,315.25,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,outpatient,,,325.00000,187.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,306.80,,,,,,,84.50,315.25,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,inpatient,,,72.00000,41.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,outpatient,,,72.00000,41.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,inpatient,,,72.00000,41.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,outpatient,,,72.00000,41.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.97,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,inpatient,,,76.00000,43.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,71.74,,,,,,,68.40,73.72,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,outpatient,,,76.00000,43.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,71.74,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,inpatient,,,240.00000,138.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,226.56,,,,,,,216.00,232.80,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,outpatient,,,240.00000,138.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,226.56,,,,,,,62.40,232.80,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,inpatient,,,93.00000,53.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,87.79,,,,,,,83.70,90.21,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,outpatient,,,93.00000,53.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,87.79,,,,,,,24.18,90.21,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,inpatient,,,59.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,outpatient,,,59.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,inpatient,,,81.00000,46.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,72.90,78.57,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,outpatient,,,81.00000,46.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,21.06,78.57,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,inpatient,,,58.00000,33.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,outpatient,,,58.00000,33.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,inpatient,,,21.00000,12.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,19.82,,,,,,,18.90,20.37,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,outpatient,,,21.00000,12.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,19.82,,,,,,,5.46,20.37,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,inpatient,,,56.00000,32.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,outpatient,,,56.00000,32.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,inpatient,,,64.00000,36.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,57.60,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,outpatient,,,64.00000,36.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,16.64,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,inpatient,,,80.00000,46.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,75.52,,,,,,,72.00,77.60,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,outpatient,,,80.00000,46.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,75.52,,,,,,,20.80,77.60,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,inpatient,,,109.00000,62.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,102.90,,,,,,,98.10,105.73,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,outpatient,,,109.00000,62.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,102.90,,,,,,,28.34,105.73,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,inpatient,,,59.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,outpatient,,,59.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,inpatient,,,115.00000,66.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,108.56,,,,,,,103.50,111.55,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,outpatient,,,115.00000,66.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,108.56,,,,,,,29.90,111.55,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,inpatient,,,57.00000,32.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,outpatient,,,57.00000,32.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,inpatient,,,118.00000,67.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,111.39,,,,,,,106.20,114.46,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,outpatient,,,118.00000,67.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,111.39,,,,,,,30.68,114.46,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,inpatient,,,268.00000,154.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,252.99,,,,,,,241.20,259.96,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,outpatient,,,268.00000,154.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,252.99,,,,,,,69.68,259.96,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,inpatient,,,114.00000,65.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,102.60,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,29.64,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,inpatient,,,114.00000,65.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,102.60,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,29.64,110.58,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,inpatient,,,78.00000,44.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,70.20,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,outpatient,,,78.00000,44.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,20.28,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,inpatient,,,91.00000,52.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,85.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,outpatient,,,91.00000,52.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,85.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,inpatient,,,66.00000,38.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,inpatient,,,66.00000,38.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,inpatient,,,300.00000,172.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,283.20,,,,,,,270.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,outpatient,,,300.00000,172.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,283.20,,,,,,,78.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,inpatient,,,185.00000,106.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,174.64,,,,,,,166.50,179.45,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,outpatient,,,185.00000,106.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,174.64,,,,,,,48.10,179.45,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,inpatient,,,76.00000,43.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,71.74,,,,,,,68.40,73.72,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,outpatient,,,76.00000,43.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,71.74,,,,,,,19.76,73.72,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,inpatient,,,53.00000,30.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,47.70,51.41,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,outpatient,,,53.00000,30.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,13.78,51.41,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,inpatient,,,77.00000,44.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,outpatient,,,77.00000,44.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,inpatient,,,222.00000,127.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,209.57,,,,,,,199.80,215.34,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,outpatient,,,222.00000,127.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,209.57,,,,,,,57.72,215.34,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,inpatient,,,292.00000,168.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,275.65,,,,,,,262.80,283.24,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,outpatient,,,292.00000,168.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,275.65,,,,,,,75.92,283.24,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,inpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,outpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,inpatient,,,125.00000,72.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,118.00,,,,,,,112.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,118.00,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,inpatient,,,125.00000,72.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,118.00,,,,,,,112.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,118.00,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,inpatient,,,359.00000,206.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,323.10,348.23,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,outpatient,,,359.00000,206.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,93.34,348.23,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,inpatient,,,111.00000,63.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,104.78,,,,,,,99.90,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,outpatient,,,111.00000,63.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,104.78,,,,,,,28.86,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,inpatient,,,141.00000,81.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,133.10,,,,,,,126.90,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,133.10,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,inpatient,,,141.00000,81.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,133.10,,,,,,,126.90,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,133.10,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,inpatient,,,114.00000,65.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,inpatient,,,114.00000,65.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,inpatient,,,114.00000,65.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,inpatient,,,114.00000,65.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,29.64,110.58,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,inpatient,,,78.00000,44.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,70.20,75.66,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,outpatient,,,78.00000,44.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,20.28,75.66,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,inpatient,,,359.00000,206.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,323.10,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,93.34,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,inpatient,,,359.00000,206.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,323.10,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,93.34,348.23,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,inpatient,,,70.00000,40.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,63.00,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,outpatient,,,70.00000,40.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,18.20,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,inpatient,,,18.00000,10.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16.99,,,,,,,16.20,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,outpatient,,,18.00000,10.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16.99,,,,,,,4.68,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,inpatient,,,408.00000,235.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,385.15,,,,,,,367.20,395.76,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,outpatient,,,408.00000,235.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,385.15,,,,,,,106.08,395.76,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,inpatient,,,102.00000,58.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,91.80,98.94,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,outpatient,,,102.00000,58.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,26.52,98.94,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,inpatient,,,330.00000,190.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,311.52,,,,,,,297.00,320.10,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,outpatient,,,330.00000,190.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,311.52,,,,,,,85.80,320.10,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,inpatient,,,56.00000,32.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,outpatient,,,56.00000,32.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,inpatient,,,136.00000,78.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,128.38,,,,,,,122.40,131.92,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,outpatient,,,136.00000,78.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,128.38,,,,,,,35.36,131.92,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,inpatient,,,83.00000,47.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,78.35,,,,,,,74.70,80.51,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,outpatient,,,83.00000,47.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,78.35,,,,,,,21.58,80.51,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,inpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,outpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,inpatient,,,142.00000,81.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,134.05,,,,,,,127.80,137.74,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,outpatient,,,142.00000,81.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,134.05,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,inpatient,,,51.00000,29.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,45.90,49.47,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,outpatient,,,51.00000,29.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,13.26,49.47,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,inpatient,,,70.00000,40.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,63.00,67.90,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,outpatient,,,70.00000,40.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,66.08,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,inpatient,,,99.00000,57.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,93.46,,,,,,,89.10,96.03,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,outpatient,,,99.00000,57.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,93.46,,,,,,,25.74,96.03,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,inpatient,,,78.00000,44.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,70.20,75.66,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,outpatient,,,78.00000,44.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,inpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,outpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,inpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,inpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,outpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,inpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,inpatient,,,75.00000,43.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70.80,,,,,,,67.50,72.75,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,outpatient,,,75.00000,43.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70.80,,,,,,,19.50,72.75,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,inpatient,,,37.00000,21.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,34.93,,,,,,,33.30,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,34.93,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,inpatient,,,37.00000,21.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,34.93,,,,,,,33.30,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,34.93,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,inpatient,,,59.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,outpatient,,,59.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,inpatient,,,35.00000,20.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.04,,,,,,,31.50,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,outpatient,,,35.00000,20.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.04,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,inpatient,,,59.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,outpatient,,,59.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,inpatient,,,56.00000,32.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,outpatient,,,56.00000,32.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,inpatient,,,74.00000,42.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,69.86,,,,,,,66.60,71.78,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,outpatient,,,74.00000,42.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,69.86,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,inpatient,,,90.00000,51.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.96,,,,,,,81.00,87.30,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,outpatient,,,90.00000,51.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.96,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,inpatient,,,68.00000,39.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,61.20,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,inpatient,,,142.00000,81.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,134.05,,,,,,,127.80,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,outpatient,,,142.00000,81.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,134.05,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,inpatient,,,68.00000,39.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,61.20,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,inpatient,,,74.00000,42.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,69.86,,,,,,,66.60,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,outpatient,,,74.00000,42.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,69.86,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,inpatient,,,89.00000,51.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.02,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.02,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,inpatient,,,89.00000,51.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.02,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.02,,,,,,,23.14,86.33,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,inpatient,,,57.00000,32.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,outpatient,,,57.00000,32.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,inpatient,,,77.00000,44.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,outpatient,,,77.00000,44.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,inpatient,,,64.00000,36.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,57.60,62.08,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,outpatient,,,64.00000,36.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,16.64,62.08,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,inpatient,,,69.00000,39.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,62.10,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,outpatient,,,69.00000,39.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,17.94,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,inpatient,,,1178.00000,678.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1112.03,,,,,,,1060.20,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,outpatient,,,1178.00000,678.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1112.03,,,,,,,306.28,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,inpatient,,,127.00000,73.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,119.89,,,,,,,114.30,123.19,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,outpatient,,,127.00000,73.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,119.89,,,,,,,33.02,123.19,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,inpatient,,,277.00000,159.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,261.49,,,,,,,249.30,268.69,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,outpatient,,,277.00000,159.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,261.49,,,,,,,72.02,268.69,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,inpatient,,,940.00000,541.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,887.36,,,,,,,846.00,911.80,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,outpatient,,,940.00000,541.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,887.36,,,,,,,244.40,911.80,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,inpatient,,,97.00000,55.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,91.57,,,,,,,87.30,94.09,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,outpatient,,,97.00000,55.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,91.57,,,,,,,25.22,94.09,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,inpatient,,,16.00000,9.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,15.10,,,,,,,14.40,15.52,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,outpatient,,,16.00000,9.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,15.10,,,,,,,4.16,15.52,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,inpatient,,,57.00000,32.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,outpatient,,,57.00000,32.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,inpatient,,,131.00000,75.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,123.66,,,,,,,117.90,127.07,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,outpatient,,,131.00000,75.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,123.66,,,,,,,34.06,127.07,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,inpatient,,,2160.00000,1244.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2039.04,,,,,,,1944.00,2095.20,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,outpatient,,,2160.00000,1244.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2039.04,,,,,,,561.60,2095.20,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,inpatient,,,37.00000,21.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,34.93,,,,,,,33.30,35.89,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,outpatient,,,37.00000,21.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,34.93,,,,,,,9.62,35.89,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,inpatient,,,74.00000,42.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,69.86,,,,,,,66.60,71.78,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,69.86,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,inpatient,,,54.00000,31.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,48.60,52.38,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,outpatient,,,54.00000,31.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,inpatient,,,76.00000,43.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,71.74,,,,,,,68.40,73.72,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,outpatient,,,76.00000,43.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,71.74,,,,,,,19.76,73.72,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,inpatient,,,606.00000,349.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,572.06,,,,,,,545.40,587.82,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,outpatient,,,606.00000,349.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,572.06,,,,,,,157.56,587.82,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,inpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,outpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,inpatient,,,300.00000,172.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,283.20,,,,,,,270.00,291.00,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,outpatient,,,300.00000,172.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,283.20,,,,,,,78.00,291.00,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,inpatient,,,59.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,outpatient,,,59.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,inpatient,,,98.00000,56.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,88.20,95.06,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,outpatient,,,98.00000,56.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,25.48,95.06,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,inpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,outpatient,,,61.00000,35.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,inpatient,,,128.00000,73.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,120.83,,,,,,,115.20,124.16,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,outpatient,,,128.00000,73.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,120.83,,,,,,,33.28,124.16,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,inpatient,,,16.00000,9.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,15.10,,,,,,,14.40,15.52,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,outpatient,,,16.00000,9.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,15.10,,,,,,,4.16,15.52,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,inpatient,,,565.00000,325.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,533.36,,,,,,,508.50,548.05,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,outpatient,,,565.00000,325.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,533.36,,,,,,,146.90,548.05,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,inpatient,,,850.00000,489.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,outpatient,,,850.00000,489.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,inpatient,,,77.00000,44.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,outpatient,,,77.00000,44.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,72.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,inpatient,,,86.00000,49.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,81.18,,,,,,,77.40,83.42,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,outpatient,,,86.00000,49.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,81.18,,,,,,,22.36,83.42,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,inpatient,,,837.00000,482.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,790.13,,,,,,,753.30,811.89,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,outpatient,,,837.00000,482.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,790.13,,,,,,,217.62,811.89,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,inpatient,,,60.00000,34.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,outpatient,,,60.00000,34.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,inpatient,,,56.00000,32.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,outpatient,,,56.00000,32.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,inpatient,,,56.00000,32.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,outpatient,,,56.00000,32.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,inpatient,,,74.00000,42.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,69.86,,,,,,,66.60,71.78,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,69.86,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,inpatient,,,167.00000,96.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,157.65,,,,,,,150.30,161.99,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,outpatient,,,167.00000,96.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,157.65,,,,,,,43.42,161.99,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,inpatient,,,200.00000,115.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,188.80,,,,,,,180.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,outpatient,,,200.00000,115.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,188.80,,,,,,,52.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,inpatient,,,93.00000,53.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,87.79,,,,,,,83.70,90.21,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,outpatient,,,93.00000,53.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,87.79,,,,,,,24.18,90.21,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,inpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,49.50,53.35,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,51.92,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,inpatient,,,190.00000,109.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,179.36,,,,,,,171.00,184.30,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,outpatient,,,190.00000,109.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,179.36,,,,,,,49.40,184.30,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,inpatient,,,64.00000,36.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,57.60,62.08,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,outpatient,,,64.00000,36.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,16.64,62.08,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,inpatient,,,525.00000,302.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,495.60,,,,,,,472.50,509.25,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,outpatient,,,525.00000,302.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,495.60,,,,,,,136.50,509.25,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,inpatient,,,54.00000,31.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,48.60,52.38,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,outpatient,,,54.00000,31.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,inpatient,,,53.00000,30.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,outpatient,,,53.00000,30.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,inpatient,,,40.00000,23.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37.76,,,,,,,36.00,38.80,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37.76,,,,,,,10.40,38.80,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,inpatient,,,453.00000,260.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,427.63,,,,,,,407.70,439.41,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,outpatient,,,453.00000,260.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,427.63,,,,,,,117.78,439.41,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,inpatient,,,25.00000,14.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,23.60,,,,,,,22.50,24.25,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,outpatient,,,25.00000,14.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,23.60,,,,,,,6.50,24.25,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,inpatient,,,56.00000,32.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,outpatient,,,56.00000,32.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,inpatient,,,59.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,outpatient,,,59.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,inpatient,,,53.00000,30.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,outpatient,,,53.00000,30.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,inpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,outpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,inpatient,,,350.00000,201.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,330.40,,,,,,,315.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,outpatient,,,350.00000,201.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,330.40,,,,,,,91.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,inpatient,,,225.00000,129.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,212.40,,,,,,,202.50,218.25,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,outpatient,,,225.00000,129.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,212.40,,,,,,,58.50,218.25,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,inpatient,,,52.00000,29.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,46.80,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,outpatient,,,52.00000,29.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,13.52,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,inpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,outpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,inpatient,,,134.00000,77.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,126.50,,,,,,,120.60,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,outpatient,,,134.00000,77.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,126.50,,,,,,,34.84,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,inpatient,,,52.00000,29.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,46.80,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,outpatient,,,52.00000,29.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,13.52,50.44,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,inpatient,,,186.00000,107.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,175.58,,,,,,,167.40,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,outpatient,,,186.00000,107.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,175.58,,,,,,,48.36,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,inpatient,,,300.00000,172.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,283.20,,,,,,,270.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,283.20,,,,,,,78.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,inpatient,,,300.00000,172.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,283.20,,,,,,,270.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,283.20,,,,,,,78.00,291.00,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,inpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,outpatient,,,62.00000,35.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,inpatient,,,205.00000,118.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,193.52,,,,,,,184.50,198.85,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,outpatient,,,205.00000,118.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,193.52,,,,,,,53.30,198.85,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,inpatient,,,75.00000,36.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70.80,,,,,,,67.50,72.75,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,outpatient,,,75.00000,36.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70.80,,,,,,,19.50,72.75,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,inpatient,,,65.00000,31.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,58.50,63.05,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,outpatient,,,65.00000,31.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,16.90,63.05,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,inpatient,,,92.00000,44.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,86.85,,,,,,,82.80,89.24,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,outpatient,,,92.00000,44.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,86.85,,,,,,,23.92,89.24,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,inpatient,,,24.00000,11.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,22.66,,,,,,,21.60,23.28,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,22.66,,,,,,,6.24,23.28,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,inpatient,,,20.00000,9.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18.88,,,,,,,18.00,19.40,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,outpatient,,,20.00000,9.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18.88,,,,,,,5.20,19.40,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,inpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,outpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,inpatient,,,42.00000,20.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,39.65,,,,,,,37.80,40.74,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,outpatient,,,42.00000,20.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,39.65,,,,,,,10.92,40.74,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,inpatient,,,69.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,62.10,66.93,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,outpatient,,,69.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,inpatient,,,65.00000,31.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,58.50,63.05,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,outpatient,,,65.00000,31.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,16.90,63.05,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,inpatient,,,76.00000,36.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,71.74,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,outpatient,,,76.00000,36.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,71.74,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,inpatient,,,89.00000,42.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.02,,,,,,,80.10,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,outpatient,,,89.00000,42.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.02,,,,,,,23.14,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,inpatient,,,76.00000,36.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,71.74,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,outpatient,,,76.00000,36.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,71.74,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,inpatient,,,28.00000,13.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,26.43,,,,,,,25.20,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,outpatient,,,28.00000,13.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,26.43,,,,,,,7.28,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,inpatient,,,98.00000,47.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,88.20,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,outpatient,,,98.00000,47.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,25.48,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,inpatient,,,64.00000,30.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,57.60,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,outpatient,,,64.00000,30.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,inpatient,,,75.00000,36.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70.80,,,,,,,67.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,outpatient,,,75.00000,36.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70.80,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,inpatient,,,76.00000,36.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,71.74,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,outpatient,,,76.00000,36.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,71.74,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,inpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,outpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,inpatient,,,114.00000,54.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,102.60,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,outpatient,,,114.00000,54.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,29.64,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,inpatient,,,74.00000,35.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,69.86,,,,,,,66.60,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,outpatient,,,74.00000,35.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,69.86,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,inpatient,,,69.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,62.10,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,outpatient,,,69.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,inpatient,,,74.00000,35.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,69.86,,,,,,,66.60,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,outpatient,,,74.00000,35.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,69.86,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,inpatient,,,87.00000,41.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82.13,,,,,,,78.30,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,outpatient,,,87.00000,41.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82.13,,,,,,,22.62,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,inpatient,,,79.00000,38.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,71.10,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,outpatient,,,79.00000,38.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,20.54,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,inpatient,,,75.00000,36.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70.80,,,,,,,67.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,outpatient,,,75.00000,36.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70.80,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,inpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,outpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,inpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,outpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,inpatient,,,64.00000,30.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,57.60,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,outpatient,,,64.00000,30.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,inpatient,,,164.00000,79.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,154.82,,,,,,,147.60,159.08,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,outpatient,,,164.00000,79.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,154.82,,,,,,,42.64,159.08,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,inpatient,,,54.00000,26.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,48.60,52.38,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,outpatient,,,54.00000,26.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,14.04,52.38,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,inpatient,,,8.00000,3.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7.55,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,outpatient,,,8.00000,3.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7.55,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,inpatient,,,69.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,62.10,66.93,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,outpatient,,,69.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,17.94,66.93,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,inpatient,,,8.00000,3.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7.55,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,outpatient,,,8.00000,3.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7.55,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,inpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,outpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,inpatient,,,8.00000,3.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7.55,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,outpatient,,,8.00000,3.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7.55,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,inpatient,,,14.00000,6.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13.22,,,,,,,12.60,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,outpatient,,,14.00000,6.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,13.22,,,,,,,3.64,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,inpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,outpatient,,,62.00000,29.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,inpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,outpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,inpatient,,,112.00000,53.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,105.73,,,,,,,100.80,108.64,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,outpatient,,,112.00000,53.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,105.73,,,,,,,29.12,108.64,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,inpatient,,,13.00000,6.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12.27,,,,,,,11.70,12.61,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,outpatient,,,13.00000,6.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12.27,,,,,,,3.38,12.61,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,inpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,outpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,inpatient,,,31.00000,14.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,29.26,,,,,,,27.90,30.07,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,outpatient,,,31.00000,14.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,29.26,,,,,,,8.06,30.07,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,inpatient,,,92.00000,44.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,86.85,,,,,,,82.80,89.24,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,outpatient,,,92.00000,44.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,86.85,,,,,,,23.92,89.24,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,inpatient,,,80.00000,38.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,75.52,,,,,,,72.00,77.60,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,outpatient,,,80.00000,38.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,75.52,,,,,,,20.80,77.60,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,inpatient,,,30.00000,14.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28.32,,,,,,,27.00,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28.32,,,,,,,7.80,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,inpatient,,,30.00000,14.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28.32,,,,,,,27.00,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28.32,,,,,,,7.80,29.10,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,inpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,outpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,inpatient,,,24.00000,11.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,22.66,,,,,,,21.60,23.28,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,22.66,,,,,,,6.24,23.28,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,inpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,outpatient,,,59.00000,28.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,inpatient,,,29.00000,13.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,27.38,,,,,,,26.10,28.13,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,outpatient,,,29.00000,13.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,27.38,,,,,,,7.54,28.13,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,inpatient,,,97.00000,46.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,91.57,,,,,,,87.30,94.09,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,outpatient,,,97.00000,46.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,91.57,,,,,,,25.22,94.09,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,inpatient,,,225.00000,108.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,212.40,,,,,,,202.50,218.25,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,outpatient,,,225.00000,108.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,212.40,,,,,,,58.50,218.25,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,inpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,outpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,inpatient,,,71.00000,34.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,63.90,68.87,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,outpatient,,,71.00000,34.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,inpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,outpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,inpatient,,,71.00000,34.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,63.90,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,outpatient,,,71.00000,34.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,inpatient,,,108.00000,52.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,101.95,,,,,,,97.20,104.76,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,outpatient,,,108.00000,52.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,101.95,,,,,,,28.08,104.76,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,inpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,outpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,inpatient,,,51.00000,24.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,45.90,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,outpatient,,,51.00000,24.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,inpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,outpatient,,,63.00000,30.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,inpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,outpatient,,,58.00000,27.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,inpatient,,,19.00000,9.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,17.94,,,,,,,17.10,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,outpatient,,,19.00000,9.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,17.94,,,,,,,4.94,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,inpatient,,,54.00000,26.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,48.60,52.38,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,outpatient,,,54.00000,26.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.98,,,,,,,14.04,52.38,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,inpatient,,,103.00000,49.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,97.23,,,,,,,92.70,99.91,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,outpatient,,,103.00000,49.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,97.23,,,,,,,26.78,99.91,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,inpatient,,,9.00000,4.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8.50,,,,,,,8.10,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,outpatient,,,9.00000,4.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8.50,,,,,,,2.34,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,inpatient,,,13.00000,6.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12.27,,,,,,,11.70,12.61,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,outpatient,,,13.00000,6.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12.27,,,,,,,3.38,12.61,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,inpatient,,,80.00000,38.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,75.52,,,,,,,72.00,77.60,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,outpatient,,,80.00000,38.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,75.52,,,,,,,20.80,77.60,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,inpatient,,,47.00000,22.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,44.37,,,,,,,42.30,45.59,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,outpatient,,,47.00000,22.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,44.37,,,,,,,12.22,45.59,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,inpatient,,,91.00000,43.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,85.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,outpatient,,,91.00000,43.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,85.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,inpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,outpatient,,,56.00000,26.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,inpatient,,,18.00000,8.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16.99,,,,,,,16.20,17.46,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,outpatient,,,18.00000,8.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16.99,,,,,,,4.68,17.46,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,inpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,outpatient,,,60.00000,28.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,inpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,outpatient,,,57.00000,27.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,inpatient,,,21.00000,11.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,19.82,,,,,,,18.90,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,19.82,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,inpatient,,,71.00000,37.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,63.90,68.87,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,outpatient,,,71.00000,37.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,18.46,68.87,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,inpatient,,,21.00000,11.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,19.82,,,,,,,18.90,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,19.82,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,inpatient,,,128.00000,67.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,120.83,,,,,,,115.20,124.16,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,outpatient,,,128.00000,67.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,120.83,,,,,,,33.28,124.16,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,inpatient,,,65.00000,34.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,58.50,63.05,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,outpatient,,,65.00000,34.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,16.90,63.05,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,inpatient,,,31.00000,16.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,29.26,,,,,,,27.90,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,outpatient,,,31.00000,16.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,29.26,,,,,,,8.06,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,inpatient,,,61.00000,32.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,outpatient,,,61.00000,32.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,inpatient,,,25.00000,13.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,23.60,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,23.60,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,inpatient,,,25.00000,13.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,91,23.60,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,91,23.60,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,inpatient,,,103.00000,54.69000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,97.23,,,,,,,92.70,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,outpatient,,,103.00000,54.69000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,97.23,,,,,,,26.78,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,inpatient,,,96.00000,50.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,90.62,,,,,,,86.40,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,outpatient,,,96.00000,50.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,90.62,,,,,,,24.96,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,inpatient,,,75.00000,39.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70.80,,,,,,,67.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,outpatient,,,75.00000,39.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70.80,,,,,,,19.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,inpatient,,,68.00000,36.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,61.20,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,outpatient,,,68.00000,36.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,17.68,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,inpatient,,,61.00000,32.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,outpatient,,,61.00000,32.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,inpatient,,,29.00000,15.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,27.38,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,outpatient,,,29.00000,15.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,27.38,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,27.38,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,27.38,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,27.38,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,27.38,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,inpatient,,,63.00000,33.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,outpatient,,,63.00000,33.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,inpatient,,,79.00000,41.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,71.10,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,outpatient,,,79.00000,41.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,20.54,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,inpatient,,,63.00000,33.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,outpatient,,,63.00000,33.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,27.38,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,27.38,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,inpatient,,,112.00000,59.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,105.73,,,,,,,100.80,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,outpatient,,,112.00000,59.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,105.73,,,,,,,29.12,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,inpatient,,,25.00000,13.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,23.60,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,outpatient,,,25.00000,13.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,23.60,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,inpatient,,,118.00000,62.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,111.39,,,,,,,106.20,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,outpatient,,,118.00000,62.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,111.39,,,,,,,30.68,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,inpatient,,,29.00000,15.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,27.38,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,outpatient,,,29.00000,15.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,27.38,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,inpatient,,,25.00000,13.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,23.60,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,outpatient,,,25.00000,13.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,23.60,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,inpatient,,,25.00000,13.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,23.60,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,outpatient,,,25.00000,13.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,23.60,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,inpatient,,,71.00000,37.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,63.90,68.87,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,outpatient,,,71.00000,37.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,18.46,68.87,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,inpatient,,,59.00000,31.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,outpatient,,,59.00000,31.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,inpatient,,,62.00000,32.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,outpatient,,,62.00000,32.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,inpatient,,,138.00000,73.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,130.27,,,,,,,124.20,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,outpatient,,,138.00000,73.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,130.27,,,,,,,35.88,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,inpatient,,,62.00000,32.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,outpatient,,,62.00000,32.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,inpatient,,,78.00000,41.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,70.20,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,outpatient,,,78.00000,41.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,20.28,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,inpatient,,,69.00000,36.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,62.10,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,outpatient,,,69.00000,36.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,65.14,,,,,,,17.94,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,inpatient,,,88.00000,46.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,83.07,,,,,,,79.20,85.36,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,outpatient,,,88.00000,46.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,83.07,,,,,,,22.88,85.36,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,inpatient,,,60.00000,31.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,outpatient,,,60.00000,31.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,inpatient,,,64.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,57.60,62.08,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,outpatient,,,64.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,16.64,62.08,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,inpatient,,,63.00000,33.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,outpatient,,,63.00000,33.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,inpatient,,,137.00000,72.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,129.33,,,,,,,123.30,132.89,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,outpatient,,,137.00000,72.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,129.33,,,,,,,35.62,132.89,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,inpatient,,,347.00000,184.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,327.57,,,,,,,312.30,336.59,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,outpatient,,,347.00000,184.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,327.57,,,,,,,90.22,336.59,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,inpatient,,,57.00000,30.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,outpatient,,,57.00000,30.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,inpatient,,,56.00000,29.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,outpatient,,,56.00000,29.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,inpatient,,,16.00000,8.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,15.10,,,,,,,14.40,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,outpatient,,,16.00000,8.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,15.10,,,,,,,4.16,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,inpatient,,,85.00000,45.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,80.24,,,,,,,76.50,82.45,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,outpatient,,,85.00000,45.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,80.24,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,inpatient,,,34.00000,18.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,32.10,,,,,,,30.60,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,outpatient,,,34.00000,18.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,32.10,,,,,,,8.84,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,inpatient,,,231.00000,122.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,218.06,,,,,,,207.90,224.07,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,outpatient,,,231.00000,122.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,218.06,,,,,,,60.06,224.07,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,inpatient,,,36.00000,19.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,outpatient,,,36.00000,19.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,inpatient,,,61.00000,32.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,outpatient,,,61.00000,32.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,inpatient,,,111.00000,58.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,104.78,,,,,,,99.90,107.67,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,outpatient,,,111.00000,58.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,104.78,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,inpatient,,,61.00000,32.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,54.90,59.17,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,outpatient,,,61.00000,32.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,57.58,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,inpatient,,,60.00000,31.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,outpatient,,,60.00000,31.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,inpatient,,,60.00000,31.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,outpatient,,,60.00000,31.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,inpatient,,,60.00000,31.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,outpatient,,,60.00000,31.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,inpatient,,,60.00000,31.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,outpatient,,,60.00000,31.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,inpatient,,,60.00000,31.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,outpatient,,,60.00000,31.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,inpatient,,,36.00000,19.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,outpatient,,,36.00000,19.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,inpatient,,,76.00000,40.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,71.74,,,,,,,68.40,73.72,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,outpatient,,,76.00000,40.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,71.74,,,,,,,19.76,73.72,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,inpatient,,,60.00000,31.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,outpatient,,,60.00000,31.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,inpatient,,,60.00000,31.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,outpatient,,,60.00000,31.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,inpatient,,,152.00000,80.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,143.49,,,,,,,136.80,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,outpatient,,,152.00000,80.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,143.49,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,inpatient,,,78.00000,41.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,70.20,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,outpatient,,,78.00000,41.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,73.63,,,,,,,20.28,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,inpatient,,,42.00000,22.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,39.65,,,,,,,37.80,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,outpatient,,,42.00000,22.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,39.65,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,inpatient,,,73.00000,38.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,68.91,,,,,,,65.70,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,outpatient,,,73.00000,38.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,68.91,,,,,,,18.98,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,inpatient,,,97.00000,51.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,91.57,,,,,,,87.30,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,outpatient,,,97.00000,51.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,91.57,,,,,,,25.22,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,inpatient,,,157.00000,83.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,148.21,,,,,,,141.30,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,outpatient,,,157.00000,83.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,148.21,,,,,,,40.82,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,inpatient,,,36.00000,19.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,outpatient,,,36.00000,19.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,inpatient,,,66.00000,35.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,outpatient,,,66.00000,35.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,inpatient,,,58.00000,30.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,outpatient,,,58.00000,30.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,inpatient,,,85.00000,45.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,80.24,,,,,,,76.50,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,outpatient,,,85.00000,45.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,80.24,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,inpatient,,,59.00000,31.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,outpatient,,,59.00000,31.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,inpatient,,,175.00000,92.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,165.20,,,,,,,157.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,outpatient,,,175.00000,92.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,165.20,,,,,,,45.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,inpatient,,,152.00000,80.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,143.49,,,,,,,136.80,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,outpatient,,,152.00000,80.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,143.49,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,inpatient,,,43.00000,22.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,40.59,,,,,,,38.70,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,outpatient,,,43.00000,22.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,40.59,,,,,,,11.18,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,inpatient,,,66.00000,35.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,outpatient,,,66.00000,35.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,inpatient,,,36.00000,19.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,outpatient,,,36.00000,19.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,inpatient,,,36.00000,19.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,outpatient,,,36.00000,19.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.98,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,inpatient,,,42.00000,22.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,39.65,,,,,,,37.80,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,outpatient,,,42.00000,22.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,39.65,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,inpatient,,,147.00000,78.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,138.77,,,,,,,132.30,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,outpatient,,,147.00000,78.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,138.77,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,inpatient,,,64.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,57.60,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,outpatient,,,64.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,16.64,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,inpatient,,,60.00000,31.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,outpatient,,,60.00000,31.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,inpatient,,,75.00000,39.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70.80,,,,,,,67.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,outpatient,,,75.00000,39.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70.80,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,inpatient,,,44.00000,23.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41.54,,,,,,,39.60,42.68,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,outpatient,,,44.00000,23.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41.54,,,,,,,11.44,42.68,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,inpatient,,,87.00000,46.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82.13,,,,,,,78.30,84.39,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,outpatient,,,87.00000,46.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,82.13,,,,,,,22.62,84.39,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,inpatient,,,65.00000,34.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,58.50,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,outpatient,,,65.00000,34.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,16.90,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,inpatient,,,75.00000,39.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70.80,,,,,,,67.50,72.75,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,outpatient,,,75.00000,39.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,70.80,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,inpatient,,,50.00000,26.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,47.20,,,,,,,45.00,48.50,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,outpatient,,,50.00000,26.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,47.20,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,inpatient,,,40.00000,21.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37.76,,,,,,,36.00,38.80,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,outpatient,,,40.00000,21.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,37.76,,,,,,,10.40,38.80,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,inpatient,,,50.00000,26.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,47.20,,,,,,,45.00,48.50,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,outpatient,,,50.00000,26.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,47.20,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,inpatient,,,115.00000,61.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,108.56,,,,,,,103.50,111.55,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,outpatient,,,115.00000,61.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,108.56,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,inpatient,,,1309.00000,695.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1235.70,,,,,,,1178.10,1269.73,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1309.00000,695.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1235.70,,,,,,,340.34,1269.73,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,inpatient,,,328.00000,174.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,309.63,,,,,,,295.20,318.16,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,outpatient,,,328.00000,174.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,309.63,,,,,,,85.28,318.16,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,inpatient,,,115.00000,61.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,108.56,,,,,,,103.50,111.55,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,outpatient,,,115.00000,61.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,108.56,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,inpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,inpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,inpatient,,,1251.00000,664.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1180.94,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,outpatient,,,1251.00000,664.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1180.94,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,inpatient,,,154.00000,81.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,145.38,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,145.38,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,inpatient,,,154.00000,81.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,145.38,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,145.38,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,inpatient,,,96.00000,50.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,90.62,,,,,,,86.40,93.12,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,outpatient,,,96.00000,50.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,90.62,,,,,,,24.96,93.12,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,inpatient,,,211.00000,112.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,199.18,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,outpatient,,,211.00000,112.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,199.18,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,inpatient,,,290.00000,153.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,273.76,,,,,,,261.00,281.30,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,outpatient,,,290.00000,153.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,273.76,,,,,,,75.40,281.30,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,inpatient,,,411.00000,218.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,387.98,,,,,,,369.90,398.67,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,outpatient,,,411.00000,218.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,387.98,,,,,,,106.86,398.67,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,inpatient,,,139.00000,73.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,131.22,,,,,,,125.10,134.83,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,outpatient,,,139.00000,73.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,131.22,,,,,,,36.14,134.83,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,inpatient,,,288.00000,152.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,271.87,,,,,,,259.20,279.36,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,outpatient,,,288.00000,152.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,271.87,,,,,,,74.88,279.36,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,inpatient,,,1372.00000,728.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1295.17,,,,,,,1234.80,1330.84,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1372.00000,728.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1295.17,,,,,,,356.72,1330.84,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,inpatient,,,1251.00000,664.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1180.94,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,outpatient,,,1251.00000,664.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1180.94,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,inpatient,,,135.00000,71.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,127.44,,,,,,,121.50,130.95,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,outpatient,,,135.00000,71.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,127.44,,,,,,,35.10,130.95,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,inpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,outpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,inpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,outpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,inpatient,,,147.00000,78.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,138.77,,,,,,,132.30,142.59,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,outpatient,,,147.00000,78.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,138.77,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,inpatient,,,126.00000,66.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,118.94,,,,,,,113.40,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,outpatient,,,126.00000,66.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,118.94,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,inpatient,,,120.00000,63.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,113.28,,,,,,,108.00,116.40,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,outpatient,,,120.00000,63.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,113.28,,,,,,,31.20,116.40,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,inpatient,,,124.00000,65.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,117.06,,,,,,,111.60,120.28,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,outpatient,,,124.00000,65.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,117.06,,,,,,,32.24,120.28,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,inpatient,,,108.00000,57.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,101.95,,,,,,,97.20,104.76,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,outpatient,,,108.00000,57.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,101.95,,,,,,,28.08,104.76,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,inpatient,,,256.00000,135.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,241.66,,,,,,,230.40,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,241.66,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,inpatient,,,256.00000,135.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,241.66,,,,,,,230.40,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,241.66,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,inpatient,,,122.00000,64.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,115.17,,,,,,,109.80,118.34,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,outpatient,,,122.00000,64.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,115.17,,,,,,,31.72,118.34,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,inpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,outpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,inpatient,,,123.00000,65.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,116.11,,,,,,,110.70,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,outpatient,,,123.00000,65.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,116.11,,,,,,,31.98,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,inpatient,,,518.00000,275.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,488.99,,,,,,,466.20,502.46,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,outpatient,,,518.00000,275.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,488.99,,,,,,,134.68,502.46,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,inpatient,,,275.00000,146.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,259.60,,,,,,,247.50,266.75,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,outpatient,,,275.00000,146.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,259.60,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,inpatient,,,270.00000,143.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,254.88,,,,,,,243.00,261.90,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,outpatient,,,270.00000,143.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,254.88,,,,,,,70.20,261.90,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,inpatient,,,450.00000,238.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,424.80,,,,,,,405.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,outpatient,,,450.00000,238.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,424.80,,,,,,,117.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,inpatient,,,126.00000,66.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,118.94,,,,,,,113.40,122.22,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,outpatient,,,126.00000,66.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,118.94,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,inpatient,,,362.00000,192.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,341.73,,,,,,,325.80,351.14,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,outpatient,,,362.00000,192.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,341.73,,,,,,,94.12,351.14,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,inpatient,,,109.00000,57.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,102.90,,,,,,,98.10,105.73,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,102.90,,,,,,,28.34,105.73,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,inpatient,,,638.00000,338.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,602.27,,,,,,,574.20,618.86,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,outpatient,,,638.00000,338.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,602.27,,,,,,,165.88,618.86,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,inpatient,,,211.00000,112.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,199.18,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,outpatient,,,211.00000,112.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,199.18,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,inpatient,,,154.00000,81.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,145.38,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,outpatient,,,154.00000,81.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,145.38,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,inpatient,,,141.00000,74.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,133.10,,,,,,,126.90,136.77,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,outpatient,,,141.00000,74.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,133.10,,,,,,,36.66,136.77,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,inpatient,,,2040.00000,1083.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1925.76,,,,,,,1836.00,1978.80,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,outpatient,,,2040.00000,1083.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1925.76,,,,,,,530.40,1978.80,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,inpatient,,,421.00000,223.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,397.42,,,,,,,378.90,408.37,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,outpatient,,,421.00000,223.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,397.42,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,inpatient,,,275.00000,146.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,259.60,,,,,,,247.50,266.75,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,outpatient,,,275.00000,146.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,259.60,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,inpatient,,,1251.00000,664.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1180.94,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,outpatient,,,1251.00000,664.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1180.94,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,inpatient,,,428.00000,227.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,404.03,,,,,,,385.20,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,404.03,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,inpatient,,,428.00000,227.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,404.03,,,,,,,385.20,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,404.03,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,inpatient,,,655.00000,347.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,618.32,,,,,,,589.50,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,618.32,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,inpatient,,,655.00000,347.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,618.32,,,,,,,589.50,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,618.32,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,inpatient,,,211.00000,112.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,199.18,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,outpatient,,,211.00000,112.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,199.18,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,inpatient,,,112.00000,59.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,105.73,,,,,,,100.80,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,105.73,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,inpatient,,,112.00000,59.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,105.73,,,,,,,100.80,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,105.73,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,inpatient,,,130.00000,69.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,122.72,,,,,,,117.00,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,outpatient,,,130.00000,69.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,122.72,,,,,,,33.80,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,inpatient,,,421.00000,223.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,397.42,,,,,,,378.90,408.37,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,outpatient,,,421.00000,223.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,397.42,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,inpatient,,,111.00000,58.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,104.78,,,,,,,99.90,107.67,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,outpatient,,,111.00000,58.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,104.78,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,inpatient,,,200.00000,106.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,188.80,,,,,,,180.00,194.00,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,outpatient,,,200.00000,106.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,188.80,,,,,,,52.00,194.00,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,121.78,,,,,,,33.54,125.13,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,inpatient,,,13.00000,6.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12.27,,,,,,,11.70,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,outpatient,,,13.00000,6.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12.27,,,,,,,3.38,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,inpatient,,,58.00000,30.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,outpatient,,,58.00000,30.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,inpatient,,,13.00000,6.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12.27,,,,,,,11.70,12.61,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,outpatient,,,13.00000,6.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12.27,,,,,,,3.38,12.61,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,inpatient,,,773.00000,410.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,729.71,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,outpatient,,,773.00000,410.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,729.71,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,inpatient,,,773.00000,410.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,729.71,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,outpatient,,,773.00000,410.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,729.71,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,inpatient,,,773.00000,410.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,729.71,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,outpatient,,,773.00000,410.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,729.71,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,inpatient,,,773.00000,410.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,729.71,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,outpatient,,,773.00000,410.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,729.71,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,inpatient,,,387.00000,205.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,365.33,,,,,,,348.30,375.39,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,outpatient,,,387.00000,205.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,365.33,,,,,,,100.62,375.39,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,inpatient,,,52.00000,27.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,46.80,50.44,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,outpatient,,,52.00000,27.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,49.09,,,,,,,13.52,50.44,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,inpatient,,,102.00000,54.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,91.80,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,inpatient,,,102.00000,54.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,91.80,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,96.29,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,inpatient,,,79.00000,41.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,71.10,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,outpatient,,,79.00000,41.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,20.54,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,inpatient,,,65.00000,34.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,58.50,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,outpatient,,,65.00000,34.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,16.90,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,inpatient,,,100.00000,53.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,94.40,,,,,,,90.00,97.00,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,outpatient,,,100.00000,53.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,94.40,,,,,,,26.00,97.00,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,inpatient,,,64.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,57.60,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,outpatient,,,64.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,16.64,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,inpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,outpatient,,,106.00000,56.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,inpatient,,,109.00000,57.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,102.90,,,,,,,98.10,105.73,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,102.90,,,,,,,28.34,105.73,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,inpatient,,,58.00000,30.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,outpatient,,,58.00000,30.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18.88,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18.88,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,inpatient,,,66.00000,35.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,outpatient,,,66.00000,35.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18.88,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18.88,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18.88,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18.88,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18.88,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,18.88,,,,,,,5.20,19.40,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,inpatient,,,13.00000,6.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12.27,,,,,,,11.70,12.61,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,outpatient,,,13.00000,6.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,12.27,,,,,,,3.38,12.61,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,inpatient,,,53.00000,28.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,47.70,51.41,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,outpatient,,,53.00000,28.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,13.78,51.41,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,inpatient,,,18.00000,9.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16.99,,,,,,,16.20,17.46,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,outpatient,,,18.00000,9.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16.99,,,,,,,4.68,17.46,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,inpatient,,,17.00000,9.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16.05,,,,,,,15.30,16.49,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,outpatient,,,17.00000,9.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16.05,,,,,,,4.42,16.49,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,inpatient,,,71.00000,37.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,63.90,68.87,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,outpatient,,,71.00000,37.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,67.02,,,,,,,18.46,68.87,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,inpatient,,,57.00000,30.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,outpatient,,,57.00000,30.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,inpatient,,,68.00000,36.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,61.20,65.96,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,outpatient,,,68.00000,36.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,64.19,,,,,,,17.68,65.96,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,inpatient,,,58.00000,30.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,outpatient,,,58.00000,30.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,inpatient,,,27.00000,14.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,25.49,,,,,,,24.30,26.19,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,outpatient,,,27.00000,14.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,25.49,,,,,,,7.02,26.19,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,inpatient,,,56.00000,29.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,outpatient,,,56.00000,29.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,inpatient,,,56.00000,29.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,50.40,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,outpatient,,,56.00000,29.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,52.86,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,inpatient,,,58.00000,30.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,outpatient,,,58.00000,30.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,inpatient,,,115.00000,61.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,108.56,,,,,,,103.50,111.55,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,outpatient,,,115.00000,61.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,108.56,,,,,,,29.90,111.55,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,inpatient,,,23.00000,12.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,21.71,,,,,,,20.70,22.31,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,outpatient,,,23.00000,12.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,21.71,,,,,,,5.98,22.31,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,inpatient,,,255.00000,135.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,240.72,,,,,,,229.50,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,outpatient,,,255.00000,135.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,240.72,,,,,,,66.30,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,inpatient,,,66.00000,35.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,outpatient,,,66.00000,35.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,inpatient,,,26.00000,13.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,23.40,25.22,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,outpatient,,,26.00000,13.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,6.76,25.22,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,inpatient,,,64.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,57.60,62.08,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,outpatient,,,64.00000,33.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,60.42,,,,,,,16.64,62.08,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,inpatient,,,215.00000,114.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,202.96,,,,,,,193.50,208.55,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,outpatient,,,215.00000,114.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,202.96,,,,,,,55.90,208.55,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,inpatient,,,79.00000,41.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,71.10,76.63,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,outpatient,,,79.00000,41.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,20.54,76.63,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,inpatient,,,11.00000,5.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10.38,,,,,,,9.90,10.67,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,outpatient,,,11.00000,5.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10.38,,,,,,,2.86,10.67,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,inpatient,,,58.00000,27.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,52.20,56.26,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,outpatient,,,58.00000,27.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,54.75,,,,,,,15.08,56.26,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,inpatient,,,10.00000,4.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,9.44,,,,,,,9.00,9.70,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,outpatient,,,10.00000,4.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,9.44,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,inpatient,,,7.00000,3.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6.61,,,,,,,6.30,6.79,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,outpatient,,,7.00000,3.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6.61,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,inpatient,,,53.00000,25.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,47.70,51.41,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,outpatient,,,53.00000,25.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,50.03,,,,,,,13.78,51.41,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,inpatient,,,10.00000,4.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,9.44,,,,,,,9.00,9.70,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,outpatient,,,10.00000,4.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,9.44,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,inpatient,,,11.00000,5.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10.38,,,,,,,9.90,10.67,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10.38,,,,,,,2.86,10.67,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,inpatient,,,7.00000,3.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6.61,,,,,,,6.30,6.79,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,outpatient,,,7.00000,3.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6.61,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,inpatient,,,11.00000,5.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10.38,,,,,,,9.90,10.67,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10.38,,,,,,,2.86,10.67,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,inpatient,,,597.00000,290.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,563.57,,,,,,,537.30,579.09,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,outpatient,,,597.00000,290.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,563.57,,,,,,,155.22,579.09,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,inpatient,,,6379.00000,3100.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6021.78,,,,,,,5741.10,6187.63,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,outpatient,,,6379.00000,3100.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6021.78,,,,,,,1658.54,6187.63,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,inpatient,,,471.00000,228.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,444.62,,,,,,,423.90,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,outpatient,,,471.00000,228.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,444.62,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,inpatient,,,471.00000,228.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,444.62,,,,,,,423.90,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,outpatient,,,471.00000,228.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,444.62,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,inpatient,,,1251.00000,607.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1180.94,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,outpatient,,,1251.00000,607.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1180.94,,,,,,,325.26,1213.47,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,inpatient,,,260.00000,126.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,245.44,,,,,,,234.00,252.20,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,outpatient,,,260.00000,126.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,245.44,,,,,,,67.60,252.20,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,inpatient,,,785.00000,381.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,741.04,,,,,,,706.50,761.45,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,outpatient,,,785.00000,381.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,741.04,,,,,,,204.10,761.45,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,inpatient,,,529.00000,257.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,499.38,,,,,,,476.10,513.13,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,outpatient,,,529.00000,257.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,499.38,,,,,,,137.54,513.13,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,inpatient,,,1623.00000,788.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1532.11,,,,,,,1460.70,1574.31,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,outpatient,,,1623.00000,788.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1532.11,,,,,,,421.98,1574.31,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,inpatient,,,10800.00000,5248.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10195.20,,,,,,,9720.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,outpatient,,,10800.00000,5248.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10195.20,,,,,,,2808.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,inpatient,,,25365.00000,12327.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,23944.56,,,,,,,22828.50,24604.05,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,outpatient,,,25365.00000,12327.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,23944.56,,,,,,,6594.90,24604.05,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,inpatient,,,101.00000,21.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,95.34,,,,,,,90.90,97.97,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,outpatient,,,101.00000,21.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,95.34,,,,,,,26.26,97.97,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,inpatient,,,81.00000,17.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,72.90,78.57,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,outpatient,,,81.00000,17.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,21.06,78.57,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,inpatient,,,104.00000,22.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,98.18,,,,,,,93.60,100.88,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,outpatient,,,104.00000,22.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,98.18,,,,,,,27.04,100.88,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,inpatient,,,377.00000,81.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,355.89,,,,,,,339.30,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,outpatient,,,377.00000,81.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,355.89,,,,,,,98.02,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,inpatient,,,532.00000,114.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,502.21,,,,,,,478.80,516.04,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,outpatient,,,532.00000,114.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,502.21,,,,,,,138.32,516.04,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,inpatient,,,521.00000,112.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,491.82,,,,,,,468.90,505.37,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,outpatient,,,521.00000,112.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,491.82,,,,,,,135.46,505.37,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,inpatient,,,451.00000,97.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,425.74,,,,,,,405.90,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,outpatient,,,451.00000,97.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,425.74,,,,,,,117.26,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,inpatient,,,1148.00000,247.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1083.71,,,,,,,1033.20,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,outpatient,,,1148.00000,247.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1083.71,,,,,,,298.48,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,inpatient,,,350.00000,75.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,330.40,,,,,,,315.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,outpatient,,,350.00000,75.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,330.40,,,,,,,91.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,inpatient,,,423.00000,91.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,399.31,,,,,,,380.70,410.31,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,outpatient,,,423.00000,91.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,399.31,,,,,,,109.98,410.31,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,inpatient,,,751.00000,162.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,708.94,,,,,,,675.90,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,708.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,inpatient,,,751.00000,162.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,708.94,,,,,,,675.90,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,708.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,inpatient,,,119.00000,25.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,112.34,,,,,,,107.10,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,outpatient,,,119.00000,25.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,112.34,,,,,,,30.94,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,inpatient,,,126.00000,27.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,118.94,,,,,,,113.40,122.22,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,outpatient,,,126.00000,27.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,118.94,,,,,,,32.76,122.22,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,inpatient,,,110.00000,23.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,inpatient,,,110.00000,23.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,inpatient,,,79.00000,17.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,71.10,76.63,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,outpatient,,,79.00000,17.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,20.54,76.63,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,inpatient,,,110.00000,23.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,inpatient,,,110.00000,23.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,inpatient,,,79.00000,17.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,71.10,76.63,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,outpatient,,,79.00000,17.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,20.54,76.63,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,inpatient,,,335.00000,72.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,316.24,,,,,,,301.50,324.95,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,outpatient,,,335.00000,72.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,316.24,,,,,,,87.10,324.95,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,inpatient,,,154.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,145.38,,,,,,,138.60,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,145.38,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,inpatient,,,154.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,145.38,,,,,,,138.60,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,145.38,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,inpatient,,,128.00000,27.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,120.83,,,,,,,115.20,124.16,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,outpatient,,,128.00000,27.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,120.83,,,,,,,33.28,124.16,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,inpatient,,,65.00000,14.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,58.50,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,outpatient,,,65.00000,14.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,61.36,,,,,,,16.90,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,inpatient,,,272.00000,58.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,256.77,,,,,,,244.80,263.84,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,outpatient,,,272.00000,58.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,256.77,,,,,,,70.72,263.84,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,inpatient,,,26.00000,11.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,23.40,25.22,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,outpatient,,,26.00000,11.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,24.54,,,,,,,6.76,25.22,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,inpatient,,,359.00000,157.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,323.10,348.23,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,outpatient,,,359.00000,157.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,93.34,348.23,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,inpatient,,,189.00000,83.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,178.42,,,,,,,170.10,183.33,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,outpatient,,,189.00000,83.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,178.42,,,,,,,49.14,183.33,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,inpatient,,,359.00000,157.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,323.10,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,outpatient,,,359.00000,157.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,93.34,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,inpatient,,,137.00000,60.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,129.33,,,,,,,123.30,132.89,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,outpatient,,,137.00000,60.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,129.33,,,,,,,35.62,132.89,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,inpatient,,,1665.00000,732.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1571.76,,,,,,,1498.50,1615.05,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,outpatient,,,1665.00000,732.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1571.76,,,,,,,432.90,1615.05,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,inpatient,,,751.00000,330.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,708.94,,,,,,,675.90,728.47,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,outpatient,,,751.00000,330.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,708.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,inpatient,,,374.00000,164.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,353.06,,,,,,,336.60,362.78,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,outpatient,,,374.00000,164.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,353.06,,,,,,,97.24,362.78,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,inpatient,,,553.00000,243.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,522.03,,,,,,,497.70,536.41,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,outpatient,,,553.00000,243.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,522.03,,,,,,,143.78,536.41,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,inpatient,,,359.00000,157.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,323.10,348.23,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,outpatient,,,359.00000,157.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,93.34,348.23,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,inpatient,,,62.00000,27.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,55.80,60.14,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,outpatient,,,62.00000,27.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,58.53,,,,,,,16.12,60.14,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,inpatient,,,79.00000,34.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,71.10,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,outpatient,,,79.00000,34.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,20.54,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,inpatient,,,110.00000,48.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,99.00,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,outpatient,,,110.00000,48.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,inpatient,,,110.00000,48.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,99.00,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,outpatient,,,110.00000,48.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,inpatient,,,751.00000,330.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,708.94,,,,,,,675.90,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,outpatient,,,751.00000,330.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,708.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,inpatient,,,1665.00000,732.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1571.76,,,,,,,1498.50,1615.05,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,outpatient,,,1665.00000,732.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1571.76,,,,,,,432.90,1615.05,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,inpatient,,,110.00000,48.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,99.00,106.70,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,outpatient,,,110.00000,48.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,28.60,106.70,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,inpatient,,,281.00000,123.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,265.26,,,,,,,252.90,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,265.26,,,,,,,73.06,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,inpatient,,,281.00000,123.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,265.26,,,,,,,252.90,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,265.26,,,,,,,73.06,272.57,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,inpatient,,,451.00000,341.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,425.74,,,,,,,405.90,437.47,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,outpatient,,,451.00000,341.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,425.74,,,,,,,117.26,437.47,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,inpatient,,,300.00000,145.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,283.20,,,,,,,270.00,291.00,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,outpatient,,,300.00000,145.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,283.20,,,,,,,78.00,291.00,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,inpatient,,,2278.00000,1107.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2150.43,,,,,,,2050.20,2209.66,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,outpatient,,,2278.00000,1107.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2150.43,,,,,,,592.28,2209.66,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,inpatient,,,3912.00000,1901.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3692.93,,,,,,,3520.80,3794.64,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,outpatient,,,3912.00000,1901.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3692.93,,,,,,,1017.12,3794.64,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,inpatient,,,900.00000,437.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,849.60,,,,,,,810.00,873.00,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,outpatient,,,900.00000,437.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,849.60,,,,,,,234.00,873.00,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,inpatient,,,365.00000,177.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,344.56,,,,,,,328.50,354.05,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,outpatient,,,365.00000,177.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,344.56,,,,,,,94.90,354.05,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,inpatient,,,989.00000,480.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,933.62,,,,,,,890.10,959.33,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,outpatient,,,989.00000,480.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,933.62,,,,,,,257.14,959.33,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,464.45,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,464.45,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,inpatient,,,435.00000,211.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,410.64,,,,,,,391.50,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,410.64,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,inpatient,,,435.00000,211.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,410.64,,,,,,,391.50,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,410.64,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,inpatient,,,644.00000,312.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,607.94,,,,,,,579.60,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,outpatient,,,644.00000,312.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,607.94,,,,,,,167.44,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,464.45,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,464.45,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,464.45,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,464.45,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,inpatient,,,527.00000,256.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,497.49,,,,,,,474.30,511.19,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,outpatient,,,527.00000,256.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,497.49,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,inpatient,,,1404.00000,682.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1325.38,,,,,,,1263.60,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,outpatient,,,1404.00000,682.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1325.38,,,,,,,365.04,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,inpatient,,,5475.00000,2660.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5168.40,,,,,,,4927.50,5310.75,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,outpatient,,,5475.00000,2660.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5168.40,,,,,,,1423.50,5310.75,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,inpatient,,,726.00000,352.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,685.34,,,,,,,653.40,704.22,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,outpatient,,,726.00000,352.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,685.34,,,,,,,188.76,704.22,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,inpatient,,,507.00000,246.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,478.61,,,,,,,456.30,491.79,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,outpatient,,,507.00000,246.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,478.61,,,,,,,131.82,491.79,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,inpatient,,,1670.00000,811.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1576.48,,,,,,,1503.00,1619.90,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,outpatient,,,1670.00000,811.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1576.48,,,,,,,434.20,1619.90,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,inpatient,,,1139.00000,553.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1075.22,,,,,,,1025.10,1104.83,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,outpatient,,,1139.00000,553.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1075.22,,,,,,,296.14,1104.83,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,inpatient,,,875.00000,425.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,826.00,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,outpatient,,,875.00000,425.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,826.00,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,inpatient,,,525.00000,255.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,495.60,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,outpatient,,,525.00000,255.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,495.60,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,inpatient,,,1353.00000,657.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1277.23,,,,,,,1217.70,1312.41,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,outpatient,,,1353.00000,657.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1277.23,,,,,,,351.78,1312.41,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,inpatient,,,525.00000,255.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,495.60,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,outpatient,,,525.00000,255.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,495.60,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,inpatient,,,525.00000,255.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,495.60,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,outpatient,,,525.00000,255.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,495.60,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,inpatient,,,825.00000,400.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,778.80,,,,,,,742.50,800.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,outpatient,,,825.00000,400.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,778.80,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,inpatient,,,525.00000,255.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,495.60,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,495.60,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,inpatient,,,525.00000,255.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,495.60,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,495.60,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,inpatient,,,974.00000,473.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,919.46,,,,,,,876.60,944.78,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,outpatient,,,974.00000,473.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,919.46,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,inpatient,,,198.00000,96.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,186.91,,,,,,,178.20,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,186.91,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,inpatient,,,198.00000,96.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,186.91,,,,,,,178.20,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,186.91,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,inpatient,,,221.00000,107.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,208.62,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,208.62,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,inpatient,,,221.00000,107.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,208.62,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,208.62,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,inpatient,,,497.00000,241.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,469.17,,,,,,,447.30,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,outpatient,,,497.00000,241.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,469.17,,,,,,,129.22,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,inpatient,,,2340.00000,1137.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2208.96,,,,,,,2106.00,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,outpatient,,,2340.00000,1137.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2208.96,,,,,,,608.40,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,inpatient,,,249.00000,121.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,235.06,,,,,,,224.10,241.53,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,outpatient,,,249.00000,121.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,235.06,,,,,,,64.74,241.53,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,inpatient,,,135.00000,65.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,127.44,,,,,,,121.50,130.95,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,outpatient,,,135.00000,65.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,127.44,,,,,,,35.10,130.95,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,inpatient,,,172.00000,83.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,162.37,,,,,,,154.80,166.84,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,outpatient,,,172.00000,83.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,162.37,,,,,,,44.72,166.84,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,inpatient,,,307.00000,149.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,289.81,,,,,,,276.30,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,outpatient,,,307.00000,149.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,289.81,,,,,,,79.82,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,inpatient,,,1800.00000,874.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1699.20,,,,,,,1620.00,1746.00,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,outpatient,,,1800.00000,874.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1699.20,,,,,,,468.00,1746.00,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,inpatient,,,974.00000,473.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,919.46,,,,,,,876.60,944.78,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,outpatient,,,974.00000,473.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,919.46,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,inpatient,,,197.00000,95.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,185.97,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,185.97,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,inpatient,,,197.00000,95.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,185.97,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,185.97,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,inpatient,,,411.00000,199.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,387.98,,,,,,,369.90,398.67,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,outpatient,,,411.00000,199.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,387.98,,,,,,,106.86,398.67,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,inpatient,,,221.00000,107.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,208.62,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,outpatient,,,221.00000,107.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,208.62,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,inpatient,,,884.00000,429.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,834.50,,,,,,,795.60,857.48,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,outpatient,,,884.00000,429.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,834.50,,,,,,,229.84,857.48,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,inpatient,,,594.00000,288.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,534.60,576.18,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,outpatient,,,594.00000,288.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,560.74,,,,,,,154.44,576.18,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,inpatient,,,519.00000,252.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,489.94,,,,,,,467.10,503.43,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,outpatient,,,519.00000,252.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,489.94,,,,,,,134.94,503.43,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,inpatient,,,1046.00000,508.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,987.42,,,,,,,941.40,1014.62,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,outpatient,,,1046.00000,508.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,987.42,,,,,,,271.96,1014.62,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,inpatient,,,556.00000,270.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,524.86,,,,,,,500.40,539.32,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,outpatient,,,556.00000,270.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,524.86,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,inpatient,,,275.00000,133.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,259.60,,,,,,,247.50,266.75,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,outpatient,,,275.00000,133.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,259.60,,,,,,,71.50,266.75,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,inpatient,,,580.00000,281.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,547.52,,,,,,,522.00,562.60,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,outpatient,,,580.00000,281.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,547.52,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,inpatient,,,580.00000,281.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,547.52,,,,,,,522.00,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,outpatient,,,580.00000,281.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,547.52,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,inpatient,,,3480.00000,1691.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3285.12,,,,,,,3132.00,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3285.12,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,inpatient,,,3480.00000,1691.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3285.12,,,,,,,3132.00,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3285.12,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,inpatient,,,700.00000,340.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,660.80,,,,,,,630.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,outpatient,,,700.00000,340.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,660.80,,,,,,,182.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,inpatient,,,1427.00000,693.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1347.09,,,,,,,1284.30,1384.19,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,outpatient,,,1427.00000,693.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1347.09,,,,,,,371.02,1384.19,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,inpatient,,,614.00000,298.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,579.62,,,,,,,552.60,595.58,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,outpatient,,,614.00000,298.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,579.62,,,,,,,159.64,595.58,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,inpatient,,,2027.00000,985.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1913.49,,,,,,,1824.30,1966.19,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,outpatient,,,2027.00000,985.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1913.49,,,,,,,527.02,1966.19,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,inpatient,,,556.00000,270.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,524.86,,,,,,,500.40,539.32,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,outpatient,,,556.00000,270.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,524.86,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,inpatient,,,1146.00000,556.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1081.82,,,,,,,1031.40,1111.62,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,outpatient,,,1146.00000,556.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1081.82,,,,,,,297.96,1111.62,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,inpatient,,,197.00000,95.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,185.97,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,185.97,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,inpatient,,,197.00000,95.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,185.97,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,185.97,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,inpatient,,,527.00000,256.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,497.49,,,,,,,474.30,511.19,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,outpatient,,,527.00000,256.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,497.49,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,inpatient,,,740.00000,359.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,698.56,,,,,,,666.00,717.80,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,outpatient,,,740.00000,359.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,698.56,,,,,,,192.40,717.80,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,inpatient,,,875.00000,425.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,826.00,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,826.00,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,inpatient,,,875.00000,425.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,826.00,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,826.00,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,inpatient,,,1399.00000,679.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1320.66,,,,,,,1259.10,1357.03,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,outpatient,,,1399.00000,679.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1320.66,,,,,,,363.74,1357.03,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,inpatient,,,51.00000,24.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,45.90,49.47,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,outpatient,,,51.00000,24.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,48.14,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,inpatient,,,825.00000,400.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,778.80,,,,,,,742.50,800.25,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,outpatient,,,825.00000,400.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,778.80,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,inpatient,,,576.00000,279.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,543.74,,,,,,,518.40,558.72,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,outpatient,,,576.00000,279.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,543.74,,,,,,,149.76,558.72,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,inpatient,,,224.00000,108.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,211.46,,,,,,,201.60,217.28,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,outpatient,,,224.00000,108.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,211.46,,,,,,,58.24,217.28,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,inpatient,,,346.00000,168.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,326.62,,,,,,,311.40,335.62,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,outpatient,,,346.00000,168.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,326.62,,,,,,,89.96,335.62,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,inpatient,,,525.00000,255.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,495.60,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,outpatient,,,525.00000,255.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,495.60,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,inpatient,,,525.00000,255.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,495.60,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,outpatient,,,525.00000,255.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,495.60,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,inpatient,,,525.00000,255.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,495.60,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,495.60,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,inpatient,,,525.00000,255.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,495.60,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,495.60,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,inpatient,,,627.00000,304.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,591.89,,,,,,,564.30,608.19,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,outpatient,,,627.00000,304.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,591.89,,,,,,,163.02,608.19,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,inpatient,,,605.00000,294.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,571.12,,,,,,,544.50,586.85,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,outpatient,,,605.00000,294.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,571.12,,,,,,,157.30,586.85,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,inpatient,,,510.00000,247.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,481.44,,,,,,,459.00,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,outpatient,,,510.00000,247.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,481.44,,,,,,,132.60,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,inpatient,,,223.00000,108.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,210.51,,,,,,,200.70,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,outpatient,,,223.00000,108.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,210.51,,,,,,,57.98,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,inpatient,,,1211.00000,588.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1143.18,,,,,,,1089.90,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,outpatient,,,1211.00000,588.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1143.18,,,,,,,314.86,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,inpatient,,,383.00000,186.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,361.55,,,,,,,344.70,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,outpatient,,,383.00000,186.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,361.55,,,,,,,99.58,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,inpatient,,,1214.00000,590.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1146.02,,,,,,,1092.60,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,outpatient,,,1214.00000,590.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1146.02,,,,,,,315.64,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,inpatient,,,328.00000,159.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,309.63,,,,,,,295.20,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,outpatient,,,328.00000,159.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,309.63,,,,,,,85.28,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,inpatient,,,372.00000,180.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,351.17,,,,,,,334.80,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,outpatient,,,372.00000,180.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,351.17,,,,,,,96.72,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,inpatient,,,285.00000,138.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,269.04,,,,,,,256.50,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,outpatient,,,285.00000,138.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,269.04,,,,,,,74.10,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,inpatient,,,367.00000,178.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,346.45,,,,,,,330.30,355.99,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,outpatient,,,367.00000,178.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,346.45,,,,,,,95.42,355.99,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,inpatient,,,702.00000,341.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,662.69,,,,,,,631.80,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,662.69,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,inpatient,,,702.00000,341.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,662.69,,,,,,,631.80,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,662.69,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,inpatient,,,265.00000,128.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,250.16,,,,,,,238.50,257.05,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,outpatient,,,265.00000,128.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,250.16,,,,,,,68.90,257.05,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,inpatient,,,2279.00000,1107.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2151.38,,,,,,,2051.10,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2279.00000,1107.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2151.38,,,,,,,592.54,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,inpatient,,,2395.00000,1163.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2260.88,,,,,,,2155.50,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2395.00000,1163.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2260.88,,,,,,,622.70,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,inpatient,,,8759.00000,4256.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8268.50,,,,,,,7883.10,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8268.50,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,inpatient,,,8759.00000,4256.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8268.50,,,,,,,7883.10,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8268.50,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,inpatient,,,2752.00000,1337.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2597.89,,,,,,,2476.80,2669.44,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,outpatient,,,2752.00000,1337.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2597.89,,,,,,,715.52,2669.44,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,inpatient,,,217.00000,105.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,204.85,,,,,,,195.30,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,204.85,,,,,,,56.42,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,inpatient,,,217.00000,105.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,204.85,,,,,,,195.30,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,204.85,,,,,,,56.42,210.49,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,inpatient,,,292.00000,141.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,275.65,,,,,,,262.80,283.24,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,outpatient,,,292.00000,141.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,275.65,,,,,,,75.92,283.24,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,387.98,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,387.98,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,387.98,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,387.98,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,387.98,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,387.98,,,,,,,106.86,398.67,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,inpatient,,,2275.00000,1105.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2147.60,,,,,,,2047.50,2206.75,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,outpatient,,,2275.00000,1105.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2147.60,,,,,,,591.50,2206.75,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,inpatient,,,192.00000,93.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,181.25,,,,,,,172.80,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,outpatient,,,192.00000,93.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,181.25,,,,,,,49.92,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,inpatient,,,451.00000,219.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,425.74,,,,,,,405.90,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,outpatient,,,451.00000,219.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,425.74,,,,,,,117.26,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,inpatient,,,617.00000,299.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,582.45,,,,,,,555.30,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,outpatient,,,617.00000,299.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,582.45,,,,,,,160.42,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,inpatient,,,825.00000,400.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,778.80,,,,,,,742.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,outpatient,,,825.00000,400.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,778.80,,,,,,,214.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,inpatient,,,905.00000,439.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,854.32,,,,,,,814.50,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,outpatient,,,905.00000,439.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,854.32,,,,,,,235.30,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,inpatient,,,849.00000,412.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,801.46,,,,,,,764.10,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,outpatient,,,849.00000,412.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,801.46,,,,,,,220.74,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,inpatient,,,2539.00000,1233.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2396.82,,,,,,,2285.10,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,outpatient,,,2539.00000,1233.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2396.82,,,,,,,660.14,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,inpatient,,,6000.00000,2916.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5664.00,,,,,,,5400.00,5820.00,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,outpatient,,,6000.00000,2916.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5664.00,,,,,,,1560.00,5820.00,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,inpatient,,,8260.00000,4014.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7797.44,,,,,,,7434.00,8012.20,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,outpatient,,,8260.00000,4014.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7797.44,,,,,,,2147.60,8012.20,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,inpatient,,,202.00000,88.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,190.69,,,,,,,181.80,195.94,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,outpatient,,,202.00000,88.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,190.69,,,,,,,52.52,195.94,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,inpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,59.40,64.02,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,outpatient,,,66.00000,31.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,62.30,,,,,,,17.16,64.02,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,inpatient,,,295.00000,142.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,278.48,,,,,,,265.50,286.15,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,outpatient,,,295.00000,142.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,278.48,,,,,,,76.70,286.15,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,89.00000,26.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.02,,,,,,,80.10,86.33,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,89.00000,26.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,84.02,,,,,,,23.14,86.33,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,inpatient,,,93.00000,27.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,87.79,,,,,,,83.70,90.21,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,87.79,,,,,,,24.18,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,93.00000,27.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,87.79,,,,,,,83.70,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,87.79,,,,,,,24.18,90.21,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1770.00,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1770.00,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1770.00,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1770.00,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1752.00000,527.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1653.89,,,,,,,1576.80,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1653.89,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1752.00000,527.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1653.89,,,,,,,1576.80,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1653.89,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,731.00000,220.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,690.06,,,,,,,657.90,709.07,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,731.00000,220.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,690.06,,,,,,,190.06,709.07,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,787.00000,236.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,742.93,,,,,,,708.30,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,787.00000,236.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,742.93,,,,,,,204.62,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,2042.00000,614.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1927.65,,,,,,,1837.80,1980.74,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,2042.00000,614.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1927.65,,,,,,,530.92,1980.74,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1770.00,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1770.00,,,,,,,487.50,1818.75,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,714.00000,214.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,674.02,,,,,,,642.60,692.58,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,714.00000,214.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,674.02,,,,,,,185.64,692.58,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,294.00000,88.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,277.54,,,,,,,264.60,285.18,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,294.00000,88.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,277.54,,,,,,,76.44,285.18,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,inpatient,,,350.00000,105.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,330.40,,,,,,,315.00,339.50,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,350.00000,105.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,330.40,,,,,,,91.00,339.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,inpatient,,,1350.00000,780.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1274.40,,,,,,,1215.00,1309.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,outpatient,,,1350.00000,780.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1274.40,,,,,,,351.00,1309.50,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,inpatient,,,3680.00000,2127.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3473.92,,,,,,,3312.00,3569.60,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,outpatient,,,3680.00000,2127.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3473.92,,,,,,,956.80,3569.60,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,inpatient,,,1600.00000,924.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1510.40,,,,,,,1440.00,1552.00,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,outpatient,,,1600.00000,924.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1510.40,,,,,,,416.00,1552.00,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,inpatient,,,4680.00000,2705.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4417.92,,,,,,,4212.00,4539.60,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,outpatient,,,4680.00000,2705.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4417.92,,,,,,,1216.80,4539.60,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,inpatient,,,2100.00000,1213.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1982.40,,,,,,,1890.00,2037.00,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,outpatient,,,2100.00000,1213.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1982.40,,,,,,,546.00,2037.00,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,inpatient,,,5680.00000,3283.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5361.92,,,,,,,5112.00,5509.60,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,outpatient,,,5680.00000,3283.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5361.92,,,,,,,1476.80,5509.60,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,inpatient,,,2420.00000,1398.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2284.48,,,,,,,2178.00,2347.40,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,outpatient,,,2420.00000,1398.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2284.48,,,,,,,629.20,2347.40,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,inpatient,,,6415.00000,3707.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6055.76,,,,,,,5773.50,6222.55,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,outpatient,,,6415.00000,3707.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6055.76,,,,,,,1667.90,6222.55,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,inpatient,,,2920.00000,1687.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2756.48,,,,,,,2628.00,2832.40,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,outpatient,,,2920.00000,1687.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2756.48,,,,,,,759.20,2832.40,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,inpatient,,,8915.00000,5152.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8415.76,,,,,,,8023.50,8647.55,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,outpatient,,,8915.00000,5152.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8415.76,,,,,,,2317.90,8647.55,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,inpatient,,,3420.00000,1976.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3228.48,,,,,,,3078.00,3317.40,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,outpatient,,,3420.00000,1976.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3228.48,,,,,,,889.20,3317.40,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,inpatient,,,11415.00000,6597.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10775.76,,,,,,,10273.50,11072.55,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,outpatient,,,11415.00000,6597.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,10775.76,,,,,,,2967.90,11072.55,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,inpatient,,,142.00000,154.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,134.05,,,,,,,127.80,137.74,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,outpatient,,,142.00000,154.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,134.05,,,,,,,36.92,137.74,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,inpatient,,,340.00000,228.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,320.96,,,,,,,306.00,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,320.96,,,,,,,88.40,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,inpatient,,,670.00000,450.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,632.48,,,,,,,603.00,649.90,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,632.48,,,,,,,174.20,649.90,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,inpatient,,,390.00000,262.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,368.16,,,,,,,351.00,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,outpatient,,,390.00000,262.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,368.16,,,,,,,101.40,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,inpatient,,,1170.00000,787.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1104.48,,,,,,,1053.00,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,outpatient,,,1170.00000,787.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1104.48,,,,,,,304.20,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,inpatient,,,440.00000,296.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,415.36,,,,,,,396.00,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,outpatient,,,440.00000,296.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,415.36,,,,,,,114.40,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,inpatient,,,1670.00000,1123.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1576.48,,,,,,,1503.00,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,outpatient,,,1670.00000,1123.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1576.48,,,,,,,434.20,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,inpatient,,,640.00000,430.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,604.16,,,,,,,576.00,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,outpatient,,,640.00000,430.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,604.16,,,,,,,166.40,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,inpatient,,,2170.00000,1460.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2048.48,,,,,,,1953.00,2104.90,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,outpatient,,,2170.00000,1460.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2048.48,,,,,,,564.20,2104.90,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,inpatient,,,17.00000,10.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16.05,,,,,,,15.30,16.49,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,outpatient,,,17.00000,10.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,16.05,,,,,,,4.42,16.49,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,inpatient,,,535.00000,345.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,505.04,,,,,,,481.50,518.95,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,outpatient,,,535.00000,345.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,505.04,,,,,,,139.10,518.95,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,inpatient,,,23.00000,14.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,21.71,,,,,,,20.70,22.31,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,outpatient,,,23.00000,14.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,21.71,,,,,,,5.98,22.31,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,inpatient,,,635.00000,409.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,599.44,,,,,,,571.50,615.95,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,outpatient,,,635.00000,409.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,599.44,,,,,,,165.10,615.95,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,inpatient,,,30.00000,19.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28.32,,,,,,,27.00,29.10,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,outpatient,,,30.00000,19.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,28.32,,,,,,,7.80,29.10,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,inpatient,,,735.00000,474.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,693.84,,,,,,,661.50,712.95,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,outpatient,,,735.00000,474.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,693.84,,,,,,,191.10,712.95,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,inpatient,,,33.00000,21.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,31.15,,,,,,,29.70,32.01,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,outpatient,,,33.00000,21.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,31.15,,,,,,,8.58,32.01,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,inpatient,,,835.00000,538.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,788.24,,,,,,,751.50,809.95,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,outpatient,,,835.00000,538.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,788.24,,,,,,,217.10,809.95,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,inpatient,,,140.00000,80.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,132.16,,,,,,,126.00,135.80,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,outpatient,,,140.00000,80.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,132.16,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,inpatient,,,275.00000,158.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,259.60,,,,,,,247.50,266.75,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,outpatient,,,275.00000,158.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,259.60,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,inpatient,,,295.00000,170.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,278.48,,,,,,,265.50,286.15,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,outpatient,,,295.00000,170.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,278.48,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,inpatient,,,590.00000,341.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,556.96,,,,,,,531.00,572.30,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,outpatient,,,590.00000,341.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,556.96,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,inpatient,,,690.00000,398.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,651.36,,,,,,,621.00,669.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,outpatient,,,690.00000,398.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,651.36,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,inpatient,,,1375.00000,794.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1298.00,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,outpatient,,,1375.00000,794.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1298.00,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,inpatient,,,950.00000,549.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,896.80,,,,,,,855.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,outpatient,,,950.00000,549.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,896.80,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,inpatient,,,1900.00000,1098.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1793.60,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,outpatient,,,1900.00000,1098.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1793.60,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,inpatient,,,140.00000,45.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,132.16,,,,,,,126.00,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,outpatient,,,140.00000,45.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,132.16,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,inpatient,,,275.00000,88.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,259.60,,,,,,,247.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,outpatient,,,275.00000,88.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,259.60,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,inpatient,,,295.00000,95.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,278.48,,,,,,,265.50,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,outpatient,,,295.00000,95.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,278.48,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,inpatient,,,590.00000,190.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,556.96,,,,,,,531.00,572.30,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,outpatient,,,590.00000,190.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,556.96,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,inpatient,,,690.00000,222.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,651.36,,,,,,,621.00,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,outpatient,,,690.00000,222.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,651.36,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,inpatient,,,1375.00000,444.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1298.00,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,outpatient,,,1375.00000,444.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1298.00,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,inpatient,,,950.00000,306.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,896.80,,,,,,,855.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,outpatient,,,950.00000,306.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,896.80,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,inpatient,,,1900.00000,613.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1793.60,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,outpatient,,,1900.00000,613.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1793.60,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,inpatient,,,340.00000,228.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,320.96,,,,,,,306.00,329.80,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,320.96,,,,,,,88.40,329.80,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,inpatient,,,670.00000,450.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,632.48,,,,,,,603.00,649.90,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,632.48,,,,,,,174.20,649.90,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,462.56,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,462.56,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,inpatient,,,490.00000,329.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,462.56,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,462.56,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,462.56,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,462.56,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,inpatient,,,245.00000,164.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,231.28,,,,,,,220.50,237.65,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,231.28,,,,,,,63.70,237.65,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,794.85,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,794.85,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,994.03,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,994.03,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1192.27,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1192.27,,,,,,,328.38,1225.11,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,inpatient,,,1178.00000,669.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1112.03,,,,,,,1060.20,1142.66,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1178.00000,669.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1112.03,,,,,,,306.28,1142.66,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,inpatient,,,140.00000,102.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,132.16,,,,,,,126.00,135.80,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,outpatient,,,140.00000,102.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,132.16,,,,,,,36.40,135.80,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,inpatient,,,275.00000,201.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,259.60,,,,,,,247.50,266.75,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,outpatient,,,275.00000,201.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,259.60,,,,,,,71.50,266.75,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,inpatient,,,295.00000,215.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,278.48,,,,,,,265.50,286.15,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,outpatient,,,295.00000,215.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,278.48,,,,,,,76.70,286.15,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,inpatient,,,590.00000,431.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,556.96,,,,,,,531.00,572.30,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,outpatient,,,590.00000,431.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,556.96,,,,,,,153.40,572.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,inpatient,,,690.00000,504.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,651.36,,,,,,,621.00,669.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,outpatient,,,690.00000,504.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,651.36,,,,,,,179.40,669.30,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,inpatient,,,1375.00000,1005.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1298.00,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,outpatient,,,1375.00000,1005.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1298.00,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,inpatient,,,950.00000,694.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,896.80,,,,,,,855.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,outpatient,,,950.00000,694.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,896.80,,,,,,,247.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,inpatient,,,1900.00000,1388.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1793.60,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,outpatient,,,1900.00000,1388.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1793.60,,,,,,,494.00,1843.00,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,inpatient,,,584.00000,426.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,551.30,,,,,,,525.60,566.48,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,outpatient,,,584.00000,426.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,551.30,,,,,,,151.84,566.48,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,inpatient,,,1391.00000,1016.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1313.10,,,,,,,1251.90,1349.27,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,outpatient,,,1391.00000,1016.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1313.10,,,,,,,361.66,1349.27,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,inpatient,,,359.00000,271.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,323.10,348.23,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,outpatient,,,359.00000,271.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,338.90,,,,,,,93.34,348.23,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,inpatient,,,95.00000,71.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,89.68,,,,,,,85.50,92.15,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,outpatient,,,95.00000,71.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,89.68,,,,,,,24.70,92.15,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,inpatient,,,37.00000,17.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,34.93,,,,,,,33.30,35.89,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,outpatient,,,37.00000,17.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,34.93,,,,,,,9.62,35.89,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,71.10,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,74.58,,,,,,,20.54,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,inpatient,,,237.00000,114.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,223.73,,,,,,,213.30,229.89,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,223.73,,,,,,,61.62,229.89,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,inpatient,,,33.00000,15.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,31.15,,,,,,,29.70,32.01,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,outpatient,,,33.00000,15.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,31.15,,,,,,,8.58,32.01,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,inpatient,,,25.00000,12.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,23.60,,,,,,,22.50,24.25,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,outpatient,,,25.00000,12.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,23.60,,,,,,,6.50,24.25,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,inpatient,,,497.00000,160.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,469.17,,,,,,,447.30,482.09,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,outpatient,,,497.00000,160.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,469.17,,,,,,,129.22,482.09,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,832.61,,,,,,,793.80,855.54,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,832.61,,,,,,,229.32,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,832.61,,,,,,,793.80,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,832.61,,,,,,,229.32,855.54,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,inpatient,,,98.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,88.20,95.06,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,25.48,95.06,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,inpatient,,,96.00000,36.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,90.62,,,,,,,86.40,93.12,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,90.62,,,,,,,24.96,93.12,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,832.61,,,,,,,793.80,855.54,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,832.61,,,,,,,229.32,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,832.61,,,,,,,793.80,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,832.61,,,,,,,229.32,855.54,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,inpatient,,,763.00000,291.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,720.27,,,,,,,686.70,740.11,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,outpatient,,,763.00000,291.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,720.27,,,,,,,198.38,740.11,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,inpatient,,,199.00000,76.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,187.86,,,,,,,179.10,193.03,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,outpatient,,,199.00000,76.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,187.86,,,,,,,51.74,193.03,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,inpatient,,,98.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,88.20,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,25.48,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,inpatient,,,96.00000,36.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,90.62,,,,,,,86.40,93.12,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,90.62,,,,,,,24.96,93.12,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,inpatient,,,1265.00000,483.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1194.16,,,,,,,1138.50,1227.05,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,outpatient,,,1265.00000,483.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1194.16,,,,,,,328.90,1227.05,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,inpatient,,,924.00000,352.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,872.26,,,,,,,831.60,896.28,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,outpatient,,,924.00000,352.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,872.26,,,,,,,240.24,896.28,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,inpatient,,,580.00000,215.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,547.52,,,,,,,522.00,562.60,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,outpatient,,,580.00000,215.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,547.52,,,,,,,150.80,562.60,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,inpatient,,,110.00000,40.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,99.00,106.70,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,outpatient,,,110.00000,40.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,28.60,106.70,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,inpatient,,,373.00000,138.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,352.11,,,,,,,335.70,361.81,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,outpatient,,,373.00000,138.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,352.11,,,,,,,96.98,361.81,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,inpatient,,,337.00000,125.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,318.13,,,,,,,303.30,326.89,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,outpatient,,,337.00000,125.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,318.13,,,,,,,87.62,326.89,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,inpatient,,,784.00000,291.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,740.10,,,,,,,705.60,760.48,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,outpatient,,,784.00000,291.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,740.10,,,,,,,203.84,760.48,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,inpatient,,,341.00000,126.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,321.90,,,,,,,306.90,330.77,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,outpatient,,,341.00000,126.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,321.90,,,,,,,88.66,330.77,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,inpatient,,,252.00000,93.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,237.89,,,,,,,226.80,244.44,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,outpatient,,,252.00000,93.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,237.89,,,,,,,65.52,244.44,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,inpatient,,,282.00000,104.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,266.21,,,,,,,253.80,273.54,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,outpatient,,,282.00000,104.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,266.21,,,,,,,73.32,273.54,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,inpatient,,,404.00000,150.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,381.38,,,,,,,363.60,391.88,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,outpatient,,,404.00000,150.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,381.38,,,,,,,105.04,391.88,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,inpatient,,,306.00000,173.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,288.86,,,,,,,275.40,296.82,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,outpatient,,,306.00000,173.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,288.86,,,,,,,79.56,296.82,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,inpatient,,,158.00000,89.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,149.15,,,,,,,142.20,153.26,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,outpatient,,,158.00000,89.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,149.15,,,,,,,41.08,153.26,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,inpatient,,,147.00000,89.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,138.77,,,,,,,132.30,142.59,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,138.77,,,,,,,38.22,142.59,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,inpatient,,,270.00000,164.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,254.88,,,,,,,243.00,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,254.88,,,,,,,70.20,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,inpatient,,,84.00000,51.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,79.30,,,,,,,75.60,81.48,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,79.30,,,,,,,21.84,81.48,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,inpatient,,,86.00000,52.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,81.18,,,,,,,77.40,83.42,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,81.18,,,,,,,22.36,83.42,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,inpatient,,,82.00000,49.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,77.41,,,,,,,73.80,79.54,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,77.41,,,,,,,21.32,79.54,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,inpatient,,,85.00000,51.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,80.24,,,,,,,76.50,82.45,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,80.24,,,,,,,22.10,82.45,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,inpatient,,,43.00000,26.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,40.59,,,,,,,38.70,41.71,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,40.59,,,,,,,11.18,41.71,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,inpatient,,,41.00000,24.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,38.70,,,,,,,36.90,39.77,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,38.70,,,,,,,10.66,39.77,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,inpatient,,,79.00000,48.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,74.58,,,,,,,71.10,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,74.58,,,,,,,20.54,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,69.86,,,,,,,66.60,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,69.86,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,69.86,,,,,,,66.60,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,69.86,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,inpatient,,,34.00000,20.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,32.10,,,,,,,30.60,32.98,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,32.10,,,,,,,8.84,32.98,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,inpatient,,,65.00000,39.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,61.36,,,,,,,58.50,63.05,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,61.36,,,,,,,16.90,63.05,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,inpatient,,,113.00000,68.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,106.67,,,,,,,101.70,109.61,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,outpatient,,,113.00000,68.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,106.67,,,,,,,29.38,109.61,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,inpatient,,,80.00000,48.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,75.52,,,,,,,72.00,77.60,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,75.52,,,,,,,20.80,77.60,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,inpatient,,,84.00000,51.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,79.30,,,,,,,75.60,81.48,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,79.30,,,,,,,21.84,81.48,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,inpatient,,,73.00000,44.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,68.91,,,,,,,65.70,70.81,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,68.91,,,,,,,18.98,70.81,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,inpatient,,,100.00000,60.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,94.40,,,,,,,90.00,97.00,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,outpatient,,,100.00000,60.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,94.40,,,,,,,26.00,97.00,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,inpatient,,,167.00000,101.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,157.65,,,,,,,150.30,161.99,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,outpatient,,,167.00000,101.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,157.65,,,,,,,43.42,161.99,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,inpatient,,,413.00000,251.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"50,GP",389.87,,,,,,,371.70,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"50,GP",389.87,,,,,,,107.38,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"LT,GP",259.60,,,,,,,247.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"LT,GP",259.60,,,,,,,71.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"RT,GP",259.60,,,,,,,247.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"RT,GP",259.60,,,,,,,71.50,266.75,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,inpatient,,,95.00000,57.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,89.68,,,,,,,85.50,92.15,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,89.68,,,,,,,24.70,92.15,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,inpatient,,,146.00000,88.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,137.82,,,,,,,131.40,141.62,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,137.82,,,,,,,37.96,141.62,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,inpatient,,,139.00000,84.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,131.22,,,,,,,125.10,134.83,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,131.22,,,,,,,36.14,134.83,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,inpatient,,,75.00000,45.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,70.80,,,,,,,67.50,72.75,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,70.80,,,,,,,19.50,72.75,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,inpatient,,,154.00000,93.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,145.38,,,,,,,138.60,149.38,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,145.38,,,,,,,40.04,149.38,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,inpatient,,,73.00000,44.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,68.91,,,,,,,65.70,70.81,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,68.91,,,,,,,18.98,70.81,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,inpatient,,,160.00000,97.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,151.04,,,,,,,144.00,155.20,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,151.04,,,,,,,41.60,155.20,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,inpatient,,,325.00000,197.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,306.80,,,,,,,292.50,315.25,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,306.80,,,,,,,84.50,315.25,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,inpatient,,,98.00000,59.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,92.51,,,,,,,88.20,95.06,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,outpatient,,,98.00000,59.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,92.51,,,,,,,25.48,95.06,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,inpatient,,,303.00000,184.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,286.03,,,,,,,272.70,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,outpatient,,,303.00000,184.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,286.03,,,,,,,78.78,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,inpatient,,,115.00000,69.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,108.56,,,,,,,103.50,111.55,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,outpatient,,,115.00000,69.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,108.56,,,,,,,29.90,111.55,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,inpatient,,,74.00000,44.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,69.86,,,,,,,66.60,71.78,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,69.86,,,,,,,19.24,71.78,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,inpatient,,,79.00000,48.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,74.58,,,,,,,71.10,76.63,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,74.58,,,,,,,20.54,76.63,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,inpatient,,,72.00000,43.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,67.97,,,,,,,64.80,69.84,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,67.97,,,,,,,18.72,69.84,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,inpatient,,,147.00000,89.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,138.77,,,,,,,132.30,142.59,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,138.77,,,,,,,38.22,142.59,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,inpatient,,,270.00000,164.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,254.88,,,,,,,243.00,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,254.88,,,,,,,70.20,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,inpatient,,,84.00000,51.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,79.30,,,,,,,75.60,81.48,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,79.30,,,,,,,21.84,81.48,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,inpatient,,,86.00000,52.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,81.18,,,,,,,77.40,83.42,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,81.18,,,,,,,22.36,83.42,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,inpatient,,,82.00000,49.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,77.41,,,,,,,73.80,79.54,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,77.41,,,,,,,21.32,79.54,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,inpatient,,,85.00000,51.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,80.24,,,,,,,76.50,82.45,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,80.24,,,,,,,22.10,82.45,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,inpatient,,,43.00000,26.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,40.59,,,,,,,38.70,41.71,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,40.59,,,,,,,11.18,41.71,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,inpatient,,,41.00000,24.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,38.70,,,,,,,36.90,39.77,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,38.70,,,,,,,10.66,39.77,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,inpatient,,,79.00000,48.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,74.58,,,,,,,71.10,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,74.58,,,,,,,20.54,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CQ,GP",69.86,,,,,,,66.60,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CQ,GP",69.86,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CQ,GP",69.86,,,,,,,66.60,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CQ,GP",69.86,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,inpatient,,,34.00000,20.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,32.10,,,,,,,30.60,32.98,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,32.10,,,,,,,8.84,32.98,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,inpatient,,,65.00000,39.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,61.36,,,,,,,58.50,63.05,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,61.36,,,,,,,16.90,63.05,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,inpatient,,,80.00000,48.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,75.52,,,,,,,72.00,77.60,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,75.52,,,,,,,20.80,77.60,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,inpatient,,,84.00000,51.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,79.30,,,,,,,75.60,81.48,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,79.30,,,,,,,21.84,81.48,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,inpatient,,,73.00000,44.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,68.91,,,,,,,65.70,70.81,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,68.91,,,,,,,18.98,70.81,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,inpatient,,,413.00000,251.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"GP,50",389.87,,,,,,,371.70,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"GP,50",389.87,,,,,,,107.38,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"GP,LT",259.60,,,,,,,247.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"GP,LT",259.60,,,,,,,71.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"GP,RT",259.60,,,,,,,247.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"GP,RT",259.60,,,,,,,71.50,266.75,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,inpatient,,,95.00000,57.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,89.68,,,,,,,85.50,92.15,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,89.68,,,,,,,24.70,92.15,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,inpatient,,,146.00000,88.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,137.82,,,,,,,131.40,141.62,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,137.82,,,,,,,37.96,141.62,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,inpatient,,,139.00000,84.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,131.22,,,,,,,125.10,134.83,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,131.22,,,,,,,36.14,134.83,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,inpatient,,,75.00000,45.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,70.80,,,,,,,67.50,72.75,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,70.80,,,,,,,19.50,72.75,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,inpatient,,,154.00000,93.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,145.38,,,,,,,138.60,149.38,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,145.38,,,,,,,40.04,149.38,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,inpatient,,,73.00000,44.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,68.91,,,,,,,65.70,70.81,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,68.91,,,,,,,18.98,70.81,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,inpatient,,,160.00000,97.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,151.04,,,,,,,144.00,155.20,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,151.04,,,,,,,41.60,155.20,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,inpatient,,,325.00000,197.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,306.80,,,,,,,292.50,315.25,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,306.80,,,,,,,84.50,315.25,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,inpatient,,,74.00000,44.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,69.86,,,,,,,66.60,71.78,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,69.86,,,,,,,19.24,71.78,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,inpatient,,,79.00000,48.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,74.58,,,,,,,71.10,76.63,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,74.58,,,,,,,20.54,76.63,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,inpatient,,,72.00000,43.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,67.97,,,,,,,64.80,69.84,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,67.97,,,,,,,18.72,69.84,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,inpatient,,,445.00000,262.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,420.08,,,,,,,400.50,431.65,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,outpatient,,,445.00000,262.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,420.08,,,,,,,115.70,431.65,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,inpatient,,,310.00000,182.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,292.64,,,,,,,279.00,300.70,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,outpatient,,,310.00000,182.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,292.64,,,,,,,80.60,300.70,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,inpatient,,,393.00000,231.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,370.99,,,,,,,353.70,381.21,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,outpatient,,,393.00000,231.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,370.99,,,,,,,102.18,381.21,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,inpatient,,,310.00000,182.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,292.64,,,,,,,279.00,300.70,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,outpatient,,,310.00000,182.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GP,292.64,,,,,,,80.60,300.70,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,inpatient,,,80.00000,30.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,75.52,,,,,,,72.00,77.60,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,75.52,,,,,,,20.80,77.60,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,inpatient,,,84.00000,32.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,79.30,,,,,,,75.60,81.48,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,79.30,,,,,,,21.84,81.48,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,inpatient,,,126.00000,48.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,118.94,,,,,,,113.40,122.22,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,118.94,,,,,,,32.76,122.22,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,inpatient,,,66.00000,25.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,62.30,,,,,,,59.40,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,62.30,,,,,,,17.16,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,inpatient,,,62.00000,23.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,58.53,,,,,,,55.80,60.14,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,58.53,,,,,,,16.12,60.14,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,inpatient,,,90.00000,34.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,84.96,,,,,,,81.00,87.30,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,84.96,,,,,,,23.40,87.30,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,inpatient,,,95.00000,36.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,89.68,,,,,,,85.50,92.15,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,89.68,,,,,,,24.70,92.15,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,inpatient,,,146.00000,56.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,137.82,,,,,,,131.40,141.62,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,137.82,,,,,,,37.96,141.62,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,inpatient,,,139.00000,53.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,131.22,,,,,,,125.10,134.83,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,131.22,,,,,,,36.14,134.83,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,inpatient,,,75.00000,29.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,70.80,,,,,,,67.50,72.75,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,70.80,,,,,,,19.50,72.75,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,inpatient,,,154.00000,59.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,145.38,,,,,,,138.60,149.38,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,145.38,,,,,,,40.04,149.38,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,inpatient,,,73.00000,28.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,68.91,,,,,,,65.70,70.81,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,68.91,,,,,,,18.98,70.81,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,inpatient,,,160.00000,61.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,151.04,,,,,,,144.00,155.20,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,151.04,,,,,,,41.60,155.20,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,inpatient,,,98.00000,37.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,92.51,,,,,,,88.20,95.06,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,outpatient,,,98.00000,37.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,92.51,,,,,,,25.48,95.06,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,inpatient,,,303.00000,117.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,286.03,,,,,,,272.70,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,outpatient,,,303.00000,117.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,286.03,,,,,,,78.78,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,inpatient,,,115.00000,44.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,108.56,,,,,,,103.50,111.55,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,outpatient,,,115.00000,44.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,108.56,,,,,,,29.90,111.55,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,inpatient,,,74.00000,28.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,69.86,,,,,,,66.60,71.78,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,69.86,,,,,,,19.24,71.78,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,inpatient,,,72.00000,27.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,67.97,,,,,,,64.80,69.84,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,67.97,,,,,,,18.72,69.84,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,inpatient,,,80.00000,30.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",75.52,,,,,,,72.00,77.60,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",75.52,,,,,,,20.80,77.60,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,inpatient,,,84.00000,32.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",79.30,,,,,,,75.60,81.48,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",79.30,,,,,,,21.84,81.48,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,inpatient,,,126.00000,48.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",118.94,,,,,,,113.40,122.22,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",118.94,,,,,,,32.76,122.22,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,inpatient,,,62.00000,23.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",58.53,,,,,,,55.80,60.14,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",58.53,,,,,,,16.12,60.14,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,inpatient,,,66.00000,25.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",62.30,,,,,,,59.40,64.02,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",62.30,,,,,,,17.16,64.02,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,inpatient,,,90.00000,34.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",84.96,,,,,,,81.00,87.30,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",84.96,,,,,,,23.40,87.30,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,inpatient,,,95.00000,36.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",89.68,,,,,,,85.50,92.15,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",89.68,,,,,,,24.70,92.15,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,inpatient,,,146.00000,56.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",137.82,,,,,,,131.40,141.62,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",137.82,,,,,,,37.96,141.62,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,inpatient,,,139.00000,53.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",131.22,,,,,,,125.10,134.83,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",131.22,,,,,,,36.14,134.83,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,inpatient,,,75.00000,29.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",70.80,,,,,,,67.50,72.75,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",70.80,,,,,,,19.50,72.75,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,inpatient,,,154.00000,59.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",145.38,,,,,,,138.60,149.38,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",145.38,,,,,,,40.04,149.38,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,inpatient,,,73.00000,28.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",68.91,,,,,,,65.70,70.81,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",68.91,,,,,,,18.98,70.81,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,inpatient,,,160.00000,61.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",151.04,,,,,,,144.00,155.20,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",151.04,,,,,,,41.60,155.20,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,inpatient,,,74.00000,28.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",69.86,,,,,,,66.60,71.78,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",69.86,,,,,,,19.24,71.78,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,inpatient,,,72.00000,27.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",67.97,,,,,,,64.80,69.84,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",67.97,,,,,,,18.72,69.84,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,inpatient,,,47.00000,26.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,44.37,,,,,,,42.30,45.59,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,44.37,,,,,,,12.22,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,inpatient,,,47.00000,26.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",44.37,,,,,,,42.30,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"CO,GO",44.37,,,,,,,12.22,45.59,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,inpatient,,,250.00000,142.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,236.00,,,,,,,225.00,242.50,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,outpatient,,,250.00000,142.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,236.00,,,,,,,65.00,242.50,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,inpatient,,,175.00000,99.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,165.20,,,,,,,157.50,169.75,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,outpatient,,,175.00000,99.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,165.20,,,,,,,45.50,169.75,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,inpatient,,,233.00000,132.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,219.95,,,,,,,209.70,226.01,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,outpatient,,,233.00000,132.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,219.95,,,,,,,60.58,226.01,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,inpatient,,,175.00000,99.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,165.20,,,,,,,157.50,169.75,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,outpatient,,,175.00000,99.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GO,165.20,,,,,,,45.50,169.75,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,inpatient,,,291.00000,93.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,274.70,,,,,,,261.90,282.27,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,outpatient,,,291.00000,93.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,274.70,,,,,,,75.66,282.27,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,inpatient,,,273.00000,155.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,257.71,,,,,,,245.70,264.81,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,outpatient,,,273.00000,155.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,257.71,,,,,,,70.98,264.81,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,inpatient,,,279.00000,158.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,263.38,,,,,,,251.10,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,outpatient,,,279.00000,158.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,263.38,,,,,,,72.54,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,inpatient,,,426.00000,242.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,402.14,,,,,,,383.40,413.22,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,outpatient,,,426.00000,242.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,402.14,,,,,,,110.76,413.22,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,inpatient,,,242.00000,137.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,228.45,,,,,,,217.80,234.74,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,outpatient,,,242.00000,137.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,228.45,,,,,,,62.92,234.74,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,inpatient,,,128.00000,72.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,120.83,,,,,,,115.20,124.16,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,outpatient,,,128.00000,72.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,120.83,,,,,,,33.28,124.16,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,inpatient,,,66.00000,37.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,62.30,,,,,,,59.40,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,outpatient,,,66.00000,37.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,62.30,,,,,,,17.16,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,inpatient,,,62.00000,35.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,58.53,,,,,,,55.80,60.14,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,outpatient,,,62.00000,35.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,58.53,,,,,,,16.12,60.14,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,inpatient,,,269.00000,152.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,253.94,,,,,,,242.10,260.93,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,outpatient,,,269.00000,152.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,253.94,,,,,,,69.94,260.93,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,inpatient,,,153.00000,86.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,144.43,,,,,,,137.70,148.41,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,outpatient,,,153.00000,86.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,144.43,,,,,,,39.78,148.41,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,inpatient,,,98.00000,55.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,92.51,,,,,,,88.20,95.06,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,outpatient,,,98.00000,55.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,92.51,,,,,,,25.48,95.06,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,inpatient,,,303.00000,172.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,286.03,,,,,,,272.70,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,outpatient,,,303.00000,172.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,286.03,,,,,,,78.78,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,inpatient,,,115.00000,65.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,108.56,,,,,,,103.50,111.55,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,outpatient,,,115.00000,65.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,108.56,,,,,,,29.90,111.55,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,inpatient,,,210.00000,119.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,198.24,,,,,,,189.00,203.70,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,outpatient,,,210.00000,119.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,198.24,,,,,,,54.60,203.70,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,inpatient,,,250.00000,142.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,236.00,,,,,,,225.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,outpatient,,,250.00000,142.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,236.00,,,,,,,65.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,inpatient,,,78.00000,44.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,73.63,,,,,,,70.20,75.66,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,outpatient,,,78.00000,44.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,73.63,,,,,,,20.28,75.66,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,inpatient,,,322.00000,182.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,303.97,,,,,,,289.80,312.34,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,outpatient,,,322.00000,182.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,303.97,,,,,,,83.72,312.34,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,inpatient,,,309.00000,175.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,291.70,,,,,,,278.10,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,outpatient,,,309.00000,175.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,291.70,,,,,,,80.34,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,inpatient,,,245.00000,139.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,231.28,,,,,,,220.50,237.65,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,outpatient,,,245.00000,139.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,GN,231.28,,,,,,,63.70,237.65,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,inpatient,,,313.00000,116.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,281.70,303.61,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,outpatient,,,313.00000,116.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,295.47,,,,,,,81.38,303.61,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,inpatient,,,1250.00000,632.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1180.00,,,,,,,1125.00,1212.50,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,outpatient,,,1250.00000,632.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1180.00,,,,,,,325.00,1212.50,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,inpatient,,,145.00000,75.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,136.88,,,,,,,130.50,140.65,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,136.88,,,,,,,37.70,140.65,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,inpatient,,,488.00000,254.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,460.67,,,,,,,439.20,473.36,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,460.67,,,,,,,126.88,473.36,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,inpatient,,,684.00000,337.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,645.70,,,,,,,615.60,663.48,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,outpatient,,,684.00000,337.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,645.70,,,,,,,177.84,663.48,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,inpatient,,,206.00000,101.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,194.46,,,,,,,185.40,199.82,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,outpatient,,,206.00000,101.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,194.46,,,,,,,53.56,199.82,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,inpatient,,,195.00000,96.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,184.08,,,,,,,175.50,189.15,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,outpatient,,,195.00000,96.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,184.08,,,,,,,50.70,189.15,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,inpatient,,,375.00000,185.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,354.00,,,,,,,337.50,363.75,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,outpatient,,,375.00000,185.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,354.00,,,,,,,97.50,363.75,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,inpatient,,,429.00000,211.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,404.98,,,,,,,386.10,416.13,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,outpatient,,,429.00000,211.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,404.98,,,,,,,111.54,416.13,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22475,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2625.26,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B OBSTETRICS SEMI-PVT,42473,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2625.26,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ICU,32474,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8270.38,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,12476,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5513.90,,,,,,,2512.00,5665.77,percent of total billed charges,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,84.00000,63.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,79.30,,,,,,,75.60,81.48,percent of total billed charges,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,79.30,,,,,,,21.84,81.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,268.10,,,,,,,255.60,275.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,268.10,,,,,,,73.84,275.48,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,432.35,,,,,,,412.20,444.26,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,432.35,,,,,,,119.08,444.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,526.75,,,,,,,502.20,541.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,526.75,,,,,,,145.08,541.26,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,455.01,,,,,,,433.80,467.54,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,455.01,,,,,,,125.32,467.54,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,223.73,,,,,,,213.30,229.89,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,223.73,,,,,,,61.62,229.89,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,inpatient,,,490.00000,329.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,462.56,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,outpatient,,,490.00000,329.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,462.56,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,inpatient,,,490.00000,329.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,462.56,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,outpatient,,,490.00000,329.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,462.56,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,inpatient,,,245.00000,164.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,231.28,,,,,,,220.50,237.65,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,outpatient,,,245.00000,164.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,231.28,,,,,,,63.70,237.65,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,inpatient,,,490.00000,329.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,462.56,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,462.56,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,462.56,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,462.56,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,inpatient,,,245.00000,164.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,231.28,,,,,,,220.50,237.65,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,231.28,,,,,,,63.70,237.65,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,794.85,,,,,,,757.80,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,794.85,,,,,,,218.92,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,994.03,,,,,,,947.70,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,994.03,,,,,,,273.78,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1192.27,,,,,,,1136.70,1225.11,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1192.27,,,,,,,328.38,1225.11,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,inpatient,,,2466.00000,986.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2327.90,,,,,,,2219.40,2392.02,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,outpatient,,,2466.00000,986.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2327.90,,,,,,,641.16,2392.02,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,inpatient,,,260.00000,104.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,245.44,,,,,,,234.00,252.20,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,outpatient,,,260.00000,104.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,245.44,,,,,,,67.60,252.20,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,inpatient,,,2041.00000,816.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1926.70,,,,,,,1836.90,1979.77,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,outpatient,,,2041.00000,816.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1926.70,,,,,,,530.66,1979.77,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,inpatient,,,375.00000,150.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,354.00,,,,,,,337.50,363.75,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,outpatient,,,375.00000,150.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,354.00,,,,,,,97.50,363.75,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,inpatient,,,1178.00000,471.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1112.03,,,,,,,1060.20,1142.66,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,outpatient,,,1178.00000,471.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1112.03,,,,,,,306.28,1142.66,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,inpatient,,,245.00000,98.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,231.28,,,,,,,220.50,237.65,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,outpatient,,,245.00000,98.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,231.28,,,,,,,63.70,237.65,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,inpatient,,,280.00000,112.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,264.32,,,,,,,252.00,271.60,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,outpatient,,,280.00000,112.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,264.32,,,,,,,72.80,271.60,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,inpatient,,,336.00000,134.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,317.18,,,,,,,302.40,325.92,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,outpatient,,,336.00000,134.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,317.18,,,,,,,87.36,325.92,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,inpatient,,,380.00000,152.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,358.72,,,,,,,342.00,368.60,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,outpatient,,,380.00000,152.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,358.72,,,,,,,98.80,368.60,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,inpatient,,,530.00000,212.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,500.32,,,,,,,477.00,514.10,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,500.32,,,,,,,137.80,514.10,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,inpatient,,,264.00000,105.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,249.22,,,,,,,237.60,256.08,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,outpatient,,,264.00000,105.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,249.22,,,,,,,68.64,256.08,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,inpatient,,,763.00000,305.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,720.27,,,,,,,686.70,740.11,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,outpatient,,,763.00000,305.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,720.27,,,,,,,198.38,740.11,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,inpatient,,,672.00000,268.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,634.37,,,,,,,604.80,651.84,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,outpatient,,,672.00000,268.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,634.37,,,,,,,174.72,651.84,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,inpatient,,,1940.00000,776.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1831.36,,,,,,,1746.00,1881.80,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,outpatient,,,1940.00000,776.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1831.36,,,,,,,504.40,1881.80,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,inpatient,,,3875.00000,1550.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3658.00,,,,,,,3487.50,3758.75,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,outpatient,,,3875.00000,1550.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3658.00,,,,,,,1007.50,3758.75,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,inpatient,,,505.00000,202.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,476.72,,,,,,,454.50,489.85,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,outpatient,,,505.00000,202.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,476.72,,,,,,,131.30,489.85,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,inpatient,,,295.00000,118.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,278.48,,,,,,,265.50,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,278.48,,,,,,,76.70,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,inpatient,,,585.00000,234.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,552.24,,,,,,,526.50,567.45,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,outpatient,,,585.00000,234.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,552.24,,,,,,,152.10,567.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,inpatient,,,285.00000,114.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,269.04,,,,,,,256.50,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,outpatient,,,285.00000,114.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,269.04,,,,,,,74.10,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,inpatient,,,575.00000,230.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,542.80,,,,,,,517.50,557.75,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,outpatient,,,575.00000,230.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,542.80,,,,,,,149.50,557.75,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,inpatient,,,697.00000,278.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,657.97,,,,,,,627.30,676.09,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,outpatient,,,697.00000,278.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,657.97,,,,,,,181.22,676.09,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,inpatient,,,530.00000,212.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,500.32,,,,,,,477.00,514.10,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,500.32,,,,,,,137.80,514.10,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,inpatient,,,580.00000,232.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,547.52,,,,,,,522.00,562.60,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,outpatient,,,580.00000,232.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,547.52,,,,,,,150.80,562.60,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,inpatient,,,435.00000,174.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,410.64,,,,,,,391.50,421.95,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,outpatient,,,435.00000,174.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,410.64,,,,,,,113.10,421.95,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,inpatient,,,270.00000,108.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,254.88,,,,,,,243.00,261.90,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,outpatient,,,270.00000,108.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,254.88,,,,,,,70.20,261.90,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,inpatient,,,504.00000,201.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,475.78,,,,,,,453.60,488.88,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,outpatient,,,504.00000,201.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,475.78,,,,,,,131.04,488.88,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,inpatient,,,98.00000,39.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,88.20,95.06,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,outpatient,,,98.00000,39.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,25.48,95.06,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,inpatient,,,608.00000,243.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,573.95,,,,,,,547.20,589.76,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,outpatient,,,608.00000,243.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,573.95,,,,,,,158.08,589.76,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,inpatient,,,114.00000,45.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,102.60,110.58,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,outpatient,,,114.00000,45.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,29.64,110.58,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,inpatient,,,187.00000,74.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,168.30,181.39,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,outpatient,,,187.00000,74.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,48.62,181.39,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,inpatient,,,214.00000,85.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,202.02,,,,,,,192.60,207.58,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,outpatient,,,214.00000,85.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,202.02,,,,,,,55.64,207.58,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,inpatient,,,863.00000,345.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,814.67,,,,,,,776.70,837.11,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,outpatient,,,863.00000,345.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,814.67,,,,,,,224.38,837.11,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,inpatient,,,453.00000,181.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,427.63,,,,,,,407.70,439.41,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,outpatient,,,453.00000,181.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,427.63,,,,,,,117.78,439.41,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,inpatient,,,144.00000,57.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,135.94,,,,,,,129.60,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,outpatient,,,144.00000,57.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,135.94,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,inpatient,,,107.00000,42.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,101.01,,,,,,,96.30,103.79,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,outpatient,,,107.00000,42.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,101.01,,,,,,,27.82,103.79,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,inpatient,,,403.00000,161.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,380.43,,,,,,,362.70,390.91,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,outpatient,,,403.00000,161.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,380.43,,,,,,,104.78,390.91,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,inpatient,,,144.00000,57.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,135.94,,,,,,,129.60,139.68,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,outpatient,,,144.00000,57.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,135.94,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,inpatient,,,370.00000,148.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,349.28,,,,,,,333.00,358.90,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,outpatient,,,370.00000,148.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,349.28,,,,,,,96.20,358.90,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,inpatient,,,334.00000,133.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,315.30,,,,,,,300.60,323.98,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,outpatient,,,334.00000,133.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,315.30,,,,,,,86.84,323.98,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,inpatient,,,1188.00000,475.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,1121.47,,,,,,,1069.20,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,outpatient,,,1188.00000,475.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,1121.47,,,,,,,308.88,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,inpatient,,,792.00000,316.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,747.65,,,,,,,712.80,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,747.65,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,inpatient,,,792.00000,316.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,747.65,,,,,,,712.80,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,747.65,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,inpatient,,,572.00000,228.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,539.97,,,,,,,514.80,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,outpatient,,,572.00000,228.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,539.97,,,,,,,148.72,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,inpatient,,,381.00000,152.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,359.66,,,,,,,342.90,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,359.66,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,inpatient,,,381.00000,152.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,359.66,,,,,,,342.90,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,359.66,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,inpatient,,,683.00000,273.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,644.75,,,,,,,614.70,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,outpatient,,,683.00000,273.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,644.75,,,,,,,177.58,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,inpatient,,,455.00000,182.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,429.52,,,,,,,409.50,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,429.52,,,,,,,118.30,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,inpatient,,,455.00000,182.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,429.52,,,,,,,409.50,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,429.52,,,,,,,118.30,441.35,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,inpatient,,,357.00000,142.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,337.01,,,,,,,321.30,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,outpatient,,,357.00000,142.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,337.01,,,,,,,92.82,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,inpatient,,,334.00000,133.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,315.30,,,,,,,300.60,323.98,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,outpatient,,,334.00000,133.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,315.30,,,,,,,86.84,323.98,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,inpatient,,,194.00000,77.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,183.14,,,,,,,174.60,188.18,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,outpatient,,,194.00000,77.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,183.14,,,,,,,50.44,188.18,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,inpatient,,,608.00000,243.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,573.95,,,,,,,547.20,589.76,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,outpatient,,,608.00000,243.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,573.95,,,,,,,158.08,589.76,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,inpatient,,,257.00000,102.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,242.61,,,,,,,231.30,249.29,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,outpatient,,,257.00000,102.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,242.61,,,,,,,66.82,249.29,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,inpatient,,,343.00000,137.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,323.79,,,,,,,308.70,332.71,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,outpatient,,,343.00000,137.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,323.79,,,,,,,89.18,332.71,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,inpatient,,,457.00000,182.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,431.41,,,,,,,411.30,443.29,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,outpatient,,,457.00000,182.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,431.41,,,,,,,118.82,443.29,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,inpatient,,,630.00000,252.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,594.72,,,,,,,567.00,611.10,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,outpatient,,,630.00000,252.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,594.72,,,,,,,163.80,611.10,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,inpatient,,,623.00000,249.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,588.11,,,,,,,560.70,604.31,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,outpatient,,,623.00000,249.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,588.11,,,,,,,161.98,604.31,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,inpatient,,,1457.00000,582.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1375.41,,,,,,,1311.30,1413.29,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,outpatient,,,1457.00000,582.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1375.41,,,,,,,378.82,1413.29,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,inpatient,,,890.00000,356.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,840.16,,,,,,,801.00,863.30,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,outpatient,,,890.00000,356.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,840.16,,,,,,,231.40,863.30,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,inpatient,,,532.00000,212.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,502.21,,,,,,,478.80,516.04,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,outpatient,,,532.00000,212.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,502.21,,,,,,,138.32,516.04,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,inpatient,,,492.00000,196.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,464.45,,,,,,,442.80,477.24,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,outpatient,,,492.00000,196.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,464.45,,,,,,,127.92,477.24,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,inpatient,,,550.00000,220.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,519.20,,,,,,,495.00,533.50,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,outpatient,,,550.00000,220.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,519.20,,,,,,,143.00,533.50,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,inpatient,,,305.00000,122.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,287.92,,,,,,,274.50,295.85,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,outpatient,,,305.00000,122.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,287.92,,,,,,,79.30,295.85,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,inpatient,,,220.00000,88.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,207.68,,,,,,,198.00,213.40,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,outpatient,,,220.00000,88.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,207.68,,,,,,,57.20,213.40,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,inpatient,,,780.00000,312.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,736.32,,,,,,,702.00,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,outpatient,,,780.00000,312.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,736.32,,,,,,,202.80,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,inpatient,,,1165.00000,466.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1099.76,,,,,,,1048.50,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,outpatient,,,1165.00000,466.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1099.76,,,,,,,302.90,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,inpatient,,,2350.00000,940.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2218.40,,,,,,,2115.00,2279.50,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,outpatient,,,2350.00000,940.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2218.40,,,,,,,611.00,2279.50,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,inpatient,,,896.00000,358.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,845.82,,,,,,,806.40,869.12,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,outpatient,,,896.00000,358.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,845.82,,,,,,,232.96,869.12,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,inpatient,,,385.00000,154.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,363.44,,,,,,,346.50,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,outpatient,,,385.00000,154.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,363.44,,,,,,,100.10,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,inpatient,,,470.00000,188.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,443.68,,,,,,,423.00,455.90,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,outpatient,,,470.00000,188.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,443.68,,,,,,,122.20,455.90,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,inpatient,,,150.00000,60.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,141.60,,,,,,,135.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,outpatient,,,150.00000,60.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,141.60,,,,,,,39.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,inpatient,,,100.00000,40.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,94.40,,,,,,,90.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,outpatient,,,100.00000,40.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,94.40,,,,,,,26.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,inpatient,,,143.00000,57.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,134.99,,,,,,,128.70,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,outpatient,,,143.00000,57.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,134.99,,,,,,,37.18,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,inpatient,,,95.00000,38.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,89.68,,,,,,,85.50,92.15,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,outpatient,,,95.00000,38.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,89.68,,,,,,,24.70,92.15,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,inpatient,,,269.00000,107.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,253.94,,,,,,,242.10,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,outpatient,,,269.00000,107.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,253.94,,,,,,,69.94,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,inpatient,,,388.00000,155.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,366.27,,,,,,,349.20,376.36,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,outpatient,,,388.00000,155.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,366.27,,,,,,,100.88,376.36,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,inpatient,,,344.00000,137.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,324.74,,,,,,,309.60,333.68,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,outpatient,,,344.00000,137.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,324.74,,,,,,,89.44,333.68,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,inpatient,,,321.00000,128.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,303.02,,,,,,,288.90,311.37,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,outpatient,,,321.00000,128.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,303.02,,,,,,,83.46,311.37,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,inpatient,,,155.00000,62.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,146.32,,,,,,,139.50,150.35,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,outpatient,,,155.00000,62.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,146.32,,,,,,,40.30,150.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,inpatient,,,817.00000,326.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,771.25,,,,,,,735.30,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,outpatient,,,817.00000,326.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,771.25,,,,,,,212.42,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,inpatient,,,1255.00000,502.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1184.72,,,,,,,1129.50,1217.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,outpatient,,,1255.00000,502.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1184.72,,,,,,,326.30,1217.35,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,inpatient,,,391.00000,156.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,369.10,,,,,,,351.90,379.27,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,outpatient,,,391.00000,156.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,369.10,,,,,,,101.66,379.27,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,inpatient,,,671.00000,268.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,633.42,,,,,,,603.90,650.87,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,outpatient,,,671.00000,268.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,633.42,,,,,,,174.46,650.87,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,inpatient,,,456.00000,182.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,430.46,,,,,,,410.40,442.32,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,outpatient,,,456.00000,182.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,430.46,,,,,,,118.56,442.32,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,inpatient,,,112.00000,44.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,105.73,,,,,,,100.80,108.64,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,outpatient,,,112.00000,44.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,105.73,,,,,,,29.12,108.64,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,inpatient,,,84.00000,33.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,79.30,,,,,,,75.60,81.48,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,outpatient,,,84.00000,33.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,79.30,,,,,,,21.84,81.48,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,inpatient,,,216.00000,86.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,203.90,,,,,,,194.40,209.52,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,outpatient,,,216.00000,86.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,203.90,,,,,,,56.16,209.52,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,inpatient,,,2660.00000,1064.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2511.04,,,,,,,2394.00,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,outpatient,,,2660.00000,1064.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2511.04,,,,,,,691.60,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,inpatient,,,2960.00000,1184.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2794.24,,,,,,,2664.00,2871.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,outpatient,,,2960.00000,1184.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2794.24,,,,,,,769.60,2871.20,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,inpatient,,,3225.00000,1290.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3044.40,,,,,,,2902.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,outpatient,,,3225.00000,1290.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3044.40,,,,,,,838.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,inpatient,,,3395.00000,1358.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3204.88,,,,,,,3055.50,3293.15,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,outpatient,,,3395.00000,1358.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3204.88,,,,,,,882.70,3293.15,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,inpatient,,,490.00000,196.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,462.56,,,,,,,441.00,475.30,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,outpatient,,,490.00000,196.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,462.56,,,,,,,127.40,475.30,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,inpatient,,,520.00000,208.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,490.88,,,,,,,468.00,504.40,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,outpatient,,,520.00000,208.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,490.88,,,,,,,135.20,504.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,inpatient,,,720.00000,288.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,679.68,,,,,,,648.00,698.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,outpatient,,,720.00000,288.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,679.68,,,,,,,187.20,698.40,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,inpatient,,,215.00000,86.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,202.96,,,,,,,193.50,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,outpatient,,,215.00000,86.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,202.96,,,,,,,55.90,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,inpatient,,,240.00000,96.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,226.56,,,,,,,216.00,232.80,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,outpatient,,,240.00000,96.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,226.56,,,,,,,62.40,232.80,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,inpatient,,,1241.00000,496.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1171.50,,,,,,,1116.90,1203.77,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,outpatient,,,1241.00000,496.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1171.50,,,,,,,322.66,1203.77,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,inpatient,,,850.00000,340.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,765.00,824.50,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,outpatient,,,850.00000,340.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,802.40,,,,,,,221.00,824.50,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,inpatient,,,1085.00000,434.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1024.24,,,,,,,976.50,1052.45,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,outpatient,,,1085.00000,434.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1024.24,,,,,,,282.10,1052.45,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,inpatient,,,295.00000,118.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,278.48,,,,,,,265.50,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,278.48,,,,,,,76.70,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,inpatient,,,492.00000,196.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,464.45,,,,,,,442.80,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,outpatient,,,492.00000,196.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,464.45,,,,,,,127.92,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,inpatient,,,563.00000,225.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,531.47,,,,,,,506.70,546.11,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,outpatient,,,563.00000,225.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,531.47,,,,,,,146.38,546.11,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,inpatient,,,1612.00000,644.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1521.73,,,,,,,1450.80,1563.64,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,outpatient,,,1612.00000,644.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1521.73,,,,,,,419.12,1563.64,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,inpatient,,,1366.00000,546.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1289.50,,,,,,,1229.40,1325.02,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,outpatient,,,1366.00000,546.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1289.50,,,,,,,355.16,1325.02,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,inpatient,,,1911.00000,764.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1803.98,,,,,,,1719.90,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,outpatient,,,1911.00000,764.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1803.98,,,,,,,496.86,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,inpatient,,,956.00000,382.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,902.46,,,,,,,860.40,927.32,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,outpatient,,,956.00000,382.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,902.46,,,,,,,248.56,927.32,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,inpatient,,,189.00000,123.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,178.42,,,,,,,170.10,183.33,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,outpatient,,,189.00000,123.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,178.42,,,,,,,49.14,183.33,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,inpatient,,,352.00000,256.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,332.29,,,,,,,316.80,341.44,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,outpatient,,,352.00000,256.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,332.29,,,,,,,91.52,341.44,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,inpatient,,,625.00000,738.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,590.00,,,,,,,562.50,606.25,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,outpatient,,,625.00000,738.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,590.00,,,,,,,162.50,606.25,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,inpatient,,,1024.00000,2097.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,966.66,,,,,,,921.60,993.28,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1024.00000,2097.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,966.66,,,,,,,266.24,993.28,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,inpatient,,,1455.00000,2469.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1373.52,,,,,,,1309.50,1411.35,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,outpatient,,,1455.00000,2469.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1373.52,,,,,,,378.30,1411.35,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,inpatient,,,145.00000,75.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,136.88,,,,,,,130.50,140.65,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,136.88,,,,,,,37.70,140.65,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,inpatient,,,488.00000,254.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,460.67,,,,,,,439.20,473.36,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,460.67,,,,,,,126.88,473.36,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,109.50,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,109.50,,,,,,,30.16,112.52,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,72.90,78.57,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,21.06,78.57,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,38.70,,,,,,,36.90,39.77,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,38.70,,,,,,,10.66,39.77,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,inpatient,,,170.00000,73.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,160.48,,,,,,,153.00,164.90,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,outpatient,,,170.00000,73.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,160.48,,,,,,,44.20,164.90,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,2.70000,1.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2.55,,,,,,,2.43,2.62,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,2.70000,1.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2.55,,,,,,,0.70200,2.62,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,27.00000,11.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,25.49,,,,,,,24.30,26.19,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,27.00000,11.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,25.49,,,,,,,7.02,26.19,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,inpatient,,,20440.00000,8891.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,19295.36,,,,,,,18396.00,19826.80,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,outpatient,,,20440.00000,8891.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,19295.36,,,,,,,5314.40,19826.80,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,inpatient,,,3322.00000,1445.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3135.97,,,,,,,2989.80,3222.34,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,3322.00000,1445.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3135.97,,,,,,,863.72,3222.34,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,inpatient,,,2492.00000,1084.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2352.45,,,,,,,2242.80,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,2492.00000,1084.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2352.45,,,,,,,647.92,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,inpatient,,,1814.00000,789.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1712.42,,,,,,,1632.60,1759.58,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1814.00000,789.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1712.42,,,,,,,471.64,1759.58,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,inpatient,,,2153.00000,936.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2032.43,,,,,,,1937.70,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,2153.00000,936.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2032.43,,,,,,,559.78,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,inpatient,,,1525.00000,663.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1439.60,,,,,,,1372.50,1479.25,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1525.00000,663.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1439.60,,,,,,,396.50,1479.25,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,inpatient,,,2716.00000,1181.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2563.90,,,,,,,2444.40,2634.52,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2716.00000,1181.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2563.90,,,,,,,706.16,2634.52,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,inpatient,,,2.70000,0.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2.55,,,,,,,2.43,2.62,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,outpatient,,,2.70000,0.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2.55,,,,,,,0.70200,2.62,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,inpatient,,,222.00000,32.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,209.57,,,,,,,199.80,215.34,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,outpatient,,,222.00000,32.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,209.57,,,,,,,57.72,215.34,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,inpatient,,,211.00000,113.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,199.18,,,,,,,189.90,204.67,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,outpatient,,,211.00000,113.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,199.18,,,,,,,54.86,204.67,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,inpatient,,,497.00000,266.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,469.17,,,,,,,447.30,482.09,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,outpatient,,,497.00000,266.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,469.17,,,,,,,129.22,482.09,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,inpatient,,,296.00000,158.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,279.42,,,,,,,266.40,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,outpatient,,,296.00000,158.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,279.42,,,,,,,76.96,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,inpatient,,,723.00000,387.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,682.51,,,,,,,650.70,701.31,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,outpatient,,,723.00000,387.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,682.51,,,,,,,187.98,701.31,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,inpatient,,,326.00000,174.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,307.74,,,,,,,293.40,316.22,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,outpatient,,,326.00000,174.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,307.74,,,,,,,84.76,316.22,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,inpatient,,,532.00000,285.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,502.21,,,,,,,478.80,516.04,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,outpatient,,,532.00000,285.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,502.21,,,,,,,138.32,516.04,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,inpatient,,,635.00000,340.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,599.44,,,,,,,571.50,615.95,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,outpatient,,,635.00000,340.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,599.44,,,,,,,165.10,615.95,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,inpatient,,,639.00000,342.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,603.22,,,,,,,575.10,619.83,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,outpatient,,,639.00000,342.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,603.22,,,,,,,166.14,619.83,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,inpatient,,,780.00000,418.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,736.32,,,,,,,702.00,756.60,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,outpatient,,,780.00000,418.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,736.32,,,,,,,202.80,756.60,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,inpatient,,,390.00000,209.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,368.16,,,,,,,351.00,378.30,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,outpatient,,,390.00000,209.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,368.16,,,,,,,101.40,378.30,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,inpatient,,,731.00000,391.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,690.06,,,,,,,657.90,709.07,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,outpatient,,,731.00000,391.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,690.06,,,,,,,190.06,709.07,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,inpatient,,,585.00000,313.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,552.24,,,,,,,526.50,567.45,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,outpatient,,,585.00000,313.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,552.24,,,,,,,152.10,567.45,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,inpatient,,,365.00000,195.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,344.56,,,,,,,328.50,354.05,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,outpatient,,,365.00000,195.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,344.56,,,,,,,94.90,354.05,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,inpatient,,,1086.00000,582.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1025.18,,,,,,,977.40,1053.42,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,outpatient,,,1086.00000,582.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1025.18,,,,,,,282.36,1053.42,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,inpatient,,,197.00000,105.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,185.97,,,,,,,177.30,191.09,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,outpatient,,,197.00000,105.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,185.97,,,,,,,51.22,191.09,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,inpatient,,,2774.00000,1486.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2618.66,,,,,,,2496.60,2690.78,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,outpatient,,,2774.00000,1486.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2618.66,,,,,,,721.24,2690.78,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,inpatient,,,1456.00000,780.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1374.46,,,,,,,1310.40,1412.32,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,outpatient,,,1456.00000,780.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1374.46,,,,,,,378.56,1412.32,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,inpatient,,,2647.00000,1418.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2498.77,,,,,,,2382.30,2567.59,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,outpatient,,,2647.00000,1418.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2498.77,,,,,,,688.22,2567.59,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,inpatient,,,1359.00000,728.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1282.90,,,,,,,1223.10,1318.23,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,outpatient,,,1359.00000,728.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1282.90,,,,,,,353.34,1318.23,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,inpatient,,,273.00000,146.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,257.71,,,,,,,245.70,264.81,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,outpatient,,,273.00000,146.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,257.71,,,,,,,70.98,264.81,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,inpatient,,,325.00000,174.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,306.80,,,,,,,292.50,315.25,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,outpatient,,,325.00000,174.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,306.80,,,,,,,84.50,315.25,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,inpatient,,,609.00000,326.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,574.90,,,,,,,548.10,590.73,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,574.90,,,,,,,158.34,590.73,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,inpatient,,,491.00000,263.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,463.50,,,,,,,441.90,476.27,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,outpatient,,,491.00000,263.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,463.50,,,,,,,127.66,476.27,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,inpatient,,,561.00000,300.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,529.58,,,,,,,504.90,544.17,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,outpatient,,,561.00000,300.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,529.58,,,,,,,145.86,544.17,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,inpatient,,,845.00000,452.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,797.68,,,,,,,760.50,819.65,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,outpatient,,,845.00000,452.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,797.68,,,,,,,219.70,819.65,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,inpatient,,,612.00000,328.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,577.73,,,,,,,550.80,593.64,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,outpatient,,,612.00000,328.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,577.73,,,,,,,159.12,593.64,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,inpatient,,,536.00000,287.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,505.98,,,,,,,482.40,519.92,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,outpatient,,,536.00000,287.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,505.98,,,,,,,139.36,519.92,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,inpatient,,,1225.00000,656.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1156.40,,,,,,,1102.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,outpatient,,,1225.00000,656.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1156.40,,,,,,,318.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,inpatient,,,816.00000,437.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,770.30,,,,,,,734.40,791.52,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,770.30,,,,,,,212.16,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,inpatient,,,816.00000,437.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,770.30,,,,,,,734.40,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,770.30,,,,,,,212.16,791.52,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,inpatient,,,250.00000,134.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,236.00,,,,,,,225.00,242.50,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,outpatient,,,250.00000,134.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,236.00,,,,,,,65.00,242.50,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,inpatient,,,302.00000,161.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,285.09,,,,,,,271.80,292.94,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,outpatient,,,302.00000,161.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,285.09,,,,,,,78.52,292.94,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,inpatient,,,354.00000,189.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,334.18,,,,,,,318.60,343.38,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,outpatient,,,354.00000,189.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,334.18,,,,,,,92.04,343.38,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,inpatient,,,409.00000,219.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,386.10,,,,,,,368.10,396.73,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,outpatient,,,409.00000,219.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,386.10,,,,,,,106.34,396.73,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,inpatient,,,593.00000,317.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,559.79,,,,,,,533.70,575.21,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,outpatient,,,593.00000,317.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,559.79,,,,,,,154.18,575.21,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,289.81,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,289.81,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,LT",289.81,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,LT",289.81,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,289.81,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,289.81,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,RT",289.81,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,RT",289.81,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,inpatient,,,330.00000,176.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,311.52,,,,,,,297.00,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,311.52,,,,,,,85.80,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,inpatient,,,330.00000,176.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,311.52,,,,,,,297.00,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,311.52,,,,,,,85.80,320.10,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,inpatient,,,195.00000,104.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,184.08,,,,,,,175.50,189.15,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,outpatient,,,195.00000,104.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,184.08,,,,,,,50.70,189.15,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,inpatient,,,578.00000,309.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,545.63,,,,,,,520.20,560.66,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,outpatient,,,578.00000,309.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,545.63,,,,,,,150.28,560.66,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,inpatient,,,384.00000,205.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,362.50,,,,,,,345.60,372.48,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,outpatient,,,384.00000,205.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,362.50,,,,,,,99.84,372.48,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,inpatient,,,303.00000,162.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,286.03,,,,,,,272.70,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,286.03,,,,,,,78.78,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,inpatient,,,303.00000,162.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,286.03,,,,,,,272.70,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,286.03,,,,,,,78.78,293.91,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,inpatient,,,445.00000,238.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,420.08,,,,,,,400.50,431.65,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,420.08,,,,,,,115.70,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,inpatient,,,445.00000,238.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,420.08,,,,,,,400.50,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,420.08,,,,,,,115.70,431.65,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,inpatient,,,937.00000,502.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,884.53,,,,,,,843.30,908.89,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,outpatient,,,937.00000,502.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,884.53,,,,,,,243.62,908.89,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,inpatient,,,615.00000,329.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,580.56,,,,,,,553.50,596.55,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,outpatient,,,615.00000,329.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,580.56,,,,,,,159.90,596.55,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,270.93,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,270.93,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,LT",270.93,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,LT",270.93,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,270.93,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,270.93,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,RT",270.93,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,RT",270.93,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,inpatient,,,323.00000,173.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,304.91,,,,,,,290.70,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,304.91,,,,,,,83.98,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,inpatient,,,323.00000,173.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,304.91,,,,,,,290.70,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,304.91,,,,,,,83.98,313.31,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,inpatient,,,694.00000,371.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,655.14,,,,,,,624.60,673.18,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,outpatient,,,694.00000,371.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,655.14,,,,,,,180.44,673.18,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,inpatient,,,276.00000,147.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,260.54,,,,,,,248.40,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,260.54,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,inpatient,,,276.00000,147.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,260.54,,,,,,,248.40,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,260.54,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,inpatient,,,254.00000,136.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,239.78,,,,,,,228.60,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,239.78,,,,,,,66.04,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,inpatient,,,254.00000,136.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,239.78,,,,,,,228.60,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,239.78,,,,,,,66.04,246.38,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,inpatient,,,275.00000,147.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,259.60,,,,,,,247.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,259.60,,,,,,,71.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,inpatient,,,275.00000,147.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,259.60,,,,,,,247.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,259.60,,,,,,,71.50,266.75,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,inpatient,,,173.00000,92.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,163.31,,,,,,,155.70,167.81,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,outpatient,,,173.00000,92.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,163.31,,,,,,,44.98,167.81,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,inpatient,,,483.00000,258.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,455.95,,,,,,,434.70,468.51,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,455.95,,,,,,,125.58,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,inpatient,,,483.00000,258.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,455.95,,,,,,,434.70,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,455.95,,,,,,,125.58,468.51,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,inpatient,,,191.00000,102.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,180.30,,,,,,,171.90,185.27,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,180.30,,,,,,,49.66,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,inpatient,,,191.00000,102.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,180.30,,,,,,,171.90,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,180.30,,,,,,,49.66,185.27,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,139.71,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,139.71,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,LT",139.71,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,LT",139.71,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,139.71,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,139.71,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,RT",139.71,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,RT",139.71,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,inpatient,,,481.00000,257.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,454.06,,,,,,,432.90,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,454.06,,,,,,,125.06,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,inpatient,,,481.00000,257.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,454.06,,,,,,,432.90,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,454.06,,,,,,,125.06,466.57,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,inpatient,,,215.00000,115.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,202.96,,,,,,,193.50,208.55,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,202.96,,,,,,,55.90,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,inpatient,,,215.00000,115.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,202.96,,,,,,,193.50,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,202.96,,,,,,,55.90,208.55,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,259.60,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,259.60,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,LT",259.60,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,LT",259.60,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,259.60,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,259.60,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,RT",259.60,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,RT",259.60,,,,,,,71.50,266.75,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,429.52,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,429.52,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,LT",429.52,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,LT",429.52,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,429.52,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,429.52,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,RT",429.52,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,RT",429.52,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,inpatient,,,503.00000,269.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,474.83,,,,,,,452.70,487.91,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,474.83,,,,,,,130.78,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,inpatient,,,503.00000,269.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,474.83,,,,,,,452.70,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,474.83,,,,,,,130.78,487.91,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,inpatient,,,209.00000,112.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,197.30,,,,,,,188.10,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,197.30,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,inpatient,,,209.00000,112.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,197.30,,,,,,,188.10,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,197.30,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,inpatient,,,566.00000,303.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,534.30,,,,,,,509.40,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,534.30,,,,,,,147.16,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,inpatient,,,566.00000,303.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,534.30,,,,,,,509.40,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,534.30,,,,,,,147.16,549.02,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,inpatient,,,598.00000,320.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,564.51,,,,,,,538.20,580.06,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,outpatient,,,598.00000,320.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,564.51,,,,,,,155.48,580.06,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,LT",429.52,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,LT",429.52,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,RT",429.52,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,RT",429.52,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,429.52,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,429.52,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,429.52,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,429.52,,,,,,,118.30,441.35,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,inpatient,,,1913.00000,1025.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1805.87,,,,,,,1721.70,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,outpatient,,,1913.00000,1025.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1805.87,,,,,,,497.38,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,inpatient,,,312.00000,167.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,294.53,,,,,,,280.80,302.64,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,outpatient,,,312.00000,167.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,294.53,,,,,,,81.12,302.64,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,inpatient,,,327.00000,175.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,308.69,,,,,,,294.30,317.19,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,outpatient,,,327.00000,175.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,308.69,,,,,,,85.02,317.19,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,inpatient,,,425.00000,227.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,401.20,,,,,,,382.50,412.25,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,outpatient,,,425.00000,227.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,401.20,,,,,,,110.50,412.25,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,inpatient,,,210.00000,112.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,198.24,,,,,,,189.00,203.70,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,outpatient,,,210.00000,112.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,198.24,,,,,,,54.60,203.70,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,inpatient,,,495.00000,265.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,467.28,,,,,,,445.50,480.15,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,outpatient,,,495.00000,265.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,467.28,,,,,,,128.70,480.15,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,inpatient,,,541.00000,289.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,510.70,,,,,,,486.90,524.77,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,outpatient,,,541.00000,289.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,510.70,,,,,,,140.66,524.77,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,inpatient,,,345.00000,184.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,325.68,,,,,,,310.50,334.65,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,325.68,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,inpatient,,,345.00000,184.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,325.68,,,,,,,310.50,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,325.68,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,inpatient,,,419.00000,224.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,395.54,,,,,,,377.10,406.43,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,395.54,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,inpatient,,,419.00000,224.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,395.54,,,,,,,377.10,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,395.54,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,inpatient,,,618.00000,331.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,583.39,,,,,,,556.20,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,583.39,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,inpatient,,,618.00000,331.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,583.39,,,,,,,556.20,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,583.39,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,inpatient,,,463.00000,248.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,437.07,,,,,,,416.70,449.11,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,outpatient,,,463.00000,248.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,437.07,,,,,,,120.38,449.11,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,inpatient,,,511.00000,273.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,482.38,,,,,,,459.90,495.67,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,outpatient,,,511.00000,273.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,482.38,,,,,,,132.86,495.67,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,inpatient,,,132.00000,70.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,124.61,,,,,,,118.80,128.04,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,outpatient,,,132.00000,70.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,124.61,,,,,,,34.32,128.04,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,inpatient,,,353.00000,189.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,333.23,,,,,,,317.70,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,333.23,,,,,,,91.78,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,inpatient,,,353.00000,189.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,333.23,,,,,,,317.70,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,333.23,,,,,,,91.78,342.41,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,inpatient,,,273.00000,146.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,257.71,,,,,,,245.70,264.81,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,outpatient,,,273.00000,146.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,257.71,,,,,,,70.98,264.81,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,inpatient,,,503.00000,269.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,474.83,,,,,,,452.70,487.91,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,outpatient,,,503.00000,269.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,474.83,,,,,,,130.78,487.91,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,inpatient,,,561.00000,300.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,529.58,,,,,,,504.90,544.17,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,outpatient,,,561.00000,300.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,529.58,,,,,,,145.86,544.17,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,inpatient,,,450.00000,241.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,424.80,,,,,,,405.00,436.50,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,424.80,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,inpatient,,,450.00000,241.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,424.80,,,,,,,405.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,424.80,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,inpatient,,,650.00000,348.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,613.60,,,,,,,585.00,630.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,outpatient,,,650.00000,348.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,613.60,,,,,,,169.00,630.50,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,inpatient,,,642.00000,344.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,606.05,,,,,,,577.80,622.74,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,outpatient,,,642.00000,344.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,606.05,,,,,,,166.92,622.74,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,inpatient,,,777.00000,416.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,733.49,,,,,,,699.30,753.69,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,outpatient,,,777.00000,416.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,733.49,,,,,,,202.02,753.69,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,inpatient,,,381.00000,204.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,359.66,,,,,,,342.90,369.57,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,outpatient,,,381.00000,204.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,359.66,,,,,,,99.06,369.57,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,inpatient,,,374.00000,200.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,353.06,,,,,,,336.60,362.78,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,353.06,,,,,,,97.24,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,inpatient,,,374.00000,200.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,353.06,,,,,,,336.60,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,353.06,,,,,,,97.24,362.78,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,inpatient,,,161.00000,86.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,151.98,,,,,,,144.90,156.17,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,151.98,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,inpatient,,,161.00000,86.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,151.98,,,,,,,144.90,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,151.98,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,inpatient,,,499.00000,267.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,471.06,,,,,,,449.10,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,471.06,,,,,,,129.74,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,inpatient,,,499.00000,267.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,471.06,,,,,,,449.10,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,471.06,,,,,,,129.74,484.03,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,inpatient,,,214.00000,114.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,202.02,,,,,,,192.60,207.58,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,outpatient,,,214.00000,114.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,202.02,,,,,,,55.64,207.58,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,inpatient,,,329.00000,176.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,310.58,,,,,,,296.10,319.13,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,outpatient,,,329.00000,176.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,310.58,,,,,,,85.54,319.13,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,inpatient,,,197.00000,105.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,185.97,,,,,,,177.30,191.09,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,outpatient,,,197.00000,105.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,185.97,,,,,,,51.22,191.09,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,inpatient,,,263.00000,140.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,248.27,,,,,,,236.70,255.11,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,outpatient,,,263.00000,140.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,248.27,,,,,,,68.38,255.11,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,inpatient,,,234.00000,125.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,220.90,,,,,,,210.60,226.98,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,outpatient,,,234.00000,125.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,220.90,,,,,,,60.84,226.98,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,inpatient,,,401.00000,214.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,378.54,,,,,,,360.90,388.97,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,outpatient,,,401.00000,214.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,378.54,,,,,,,104.26,388.97,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,inpatient,,,515.00000,276.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,486.16,,,,,,,463.50,499.55,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,outpatient,,,515.00000,276.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,486.16,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,inpatient,,,747.00000,400.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,705.17,,,,,,,672.30,724.59,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,outpatient,,,747.00000,400.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,705.17,,,,,,,194.22,724.59,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,inpatient,,,854.00000,457.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,806.18,,,,,,,768.60,828.38,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,outpatient,,,854.00000,457.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,806.18,,,,,,,222.04,828.38,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,inpatient,,,589.00000,315.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,556.02,,,,,,,530.10,571.33,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,outpatient,,,589.00000,315.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,556.02,,,,,,,153.14,571.33,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,inpatient,,,613.00000,328.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,578.67,,,,,,,551.70,594.61,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,outpatient,,,613.00000,328.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,578.67,,,,,,,159.38,594.61,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,inpatient,,,806.00000,432.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,760.86,,,,,,,725.40,781.82,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,outpatient,,,806.00000,432.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,760.86,,,,,,,209.56,781.82,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,inpatient,,,529.00000,283.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,499.38,,,,,,,476.10,513.13,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,outpatient,,,529.00000,283.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,499.38,,,,,,,137.54,513.13,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,inpatient,,,939.00000,503.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,886.42,,,,,,,845.10,910.83,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,outpatient,,,939.00000,503.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,886.42,,,,,,,244.14,910.83,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,inpatient,,,515.00000,276.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,486.16,,,,,,,463.50,499.55,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,outpatient,,,515.00000,276.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,486.16,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,inpatient,,,616.00000,330.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,581.50,,,,,,,554.40,597.52,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,outpatient,,,616.00000,330.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,581.50,,,,,,,160.16,597.52,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,inpatient,,,377.00000,202.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,355.89,,,,,,,339.30,365.69,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,outpatient,,,377.00000,202.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,355.89,,,,,,,98.02,365.69,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,inpatient,,,340.00000,182.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,320.96,,,,,,,306.00,329.80,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,outpatient,,,340.00000,182.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,320.96,,,,,,,88.40,329.80,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,inpatient,,,388.00000,207.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,366.27,,,,,,,349.20,376.36,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,outpatient,,,388.00000,207.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,366.27,,,,,,,100.88,376.36,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,inpatient,,,456.00000,244.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,430.46,,,,,,,410.40,442.32,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,outpatient,,,456.00000,244.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,430.46,,,,,,,118.56,442.32,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,inpatient,,,267.00000,143.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,252.05,,,,,,,240.30,258.99,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,outpatient,,,267.00000,143.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,252.05,,,,,,,69.42,258.99,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,288.86,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,288.86,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,LT",288.86,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,LT",288.86,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,288.86,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,288.86,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,RT",288.86,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,RT",288.86,,,,,,,79.56,296.82,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,inpatient,,,456.00000,244.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,430.46,,,,,,,410.40,442.32,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,outpatient,,,456.00000,244.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,430.46,,,,,,,118.56,442.32,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,inpatient,,,381.00000,204.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,359.66,,,,,,,342.90,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,outpatient,,,381.00000,204.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,359.66,,,,,,,99.06,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,inpatient,,,143.00000,76.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,134.99,,,,,,,128.70,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,134.99,,,,,,,37.18,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,inpatient,,,143.00000,76.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,134.99,,,,,,,128.70,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,134.99,,,,,,,37.18,138.71,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,inpatient,,,331.00000,177.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,312.46,,,,,,,297.90,321.07,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,312.46,,,,,,,86.06,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,inpatient,,,331.00000,177.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,312.46,,,,,,,297.90,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,312.46,,,,,,,86.06,321.07,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,inpatient,,,1113.00000,596.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1050.67,,,,,,,1001.70,1079.61,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1113.00000,596.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1050.67,,,,,,,289.38,1079.61,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,inpatient,,,1043.00000,559.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,984.59,,,,,,,938.70,1011.71,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,outpatient,,,1043.00000,559.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,984.59,,,,,,,271.18,1011.71,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,241.66,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,241.66,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,LT",241.66,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,LT",241.66,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,241.66,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,241.66,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,RT",241.66,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,"52,RT",241.66,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,inpatient,,,511.00000,273.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,482.38,,,,,,,459.90,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,482.38,,,,,,,132.86,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,inpatient,,,511.00000,273.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,482.38,,,,,,,459.90,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,482.38,,,,,,,132.86,495.67,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,inpatient,,,553.00000,314.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,522.03,,,,,,,497.70,536.41,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,522.03,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,inpatient,,,553.00000,314.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,522.03,,,,,,,497.70,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,522.03,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,inpatient,,,1076.00000,611.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1015.74,,,,,,,968.40,1043.72,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1015.74,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,inpatient,,,1076.00000,611.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1015.74,,,,,,,968.40,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1015.74,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,inpatient,,,865.00000,491.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,816.56,,,,,,,778.50,839.05,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,816.56,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,inpatient,,,865.00000,491.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,816.56,,,,,,,778.50,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,816.56,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,inpatient,,,734.00000,417.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,692.90,,,,,,,660.60,711.98,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,692.90,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,inpatient,,,734.00000,417.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,692.90,,,,,,,660.60,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,692.90,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,inpatient,,,730.00000,414.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,689.12,,,,,,,657.00,708.10,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,689.12,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,inpatient,,,730.00000,414.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,689.12,,,,,,,657.00,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,689.12,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,inpatient,,,260.00000,147.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,245.44,,,,,,,234.00,252.20,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,245.44,,,,,,,67.60,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,inpatient,,,260.00000,147.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,245.44,,,,,,,234.00,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,245.44,,,,,,,67.60,252.20,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,inpatient,,,428.00000,203.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,404.03,,,,,,,385.20,415.16,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,outpatient,,,428.00000,203.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,404.03,,,,,,,111.28,415.16,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,inpatient,,,492.00000,234.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,464.45,,,,,,,442.80,477.24,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,outpatient,,,492.00000,234.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,464.45,,,,,,,127.92,477.24,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,inpatient,,,607.00000,288.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,573.01,,,,,,,546.30,588.79,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,outpatient,,,607.00000,288.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,573.01,,,,,,,157.82,588.79,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,inpatient,,,649.00000,308.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,612.66,,,,,,,584.10,629.53,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,outpatient,,,649.00000,308.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,612.66,,,,,,,168.74,629.53,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,inpatient,,,377.00000,121.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,355.89,,,,,,,339.30,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,outpatient,,,377.00000,121.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,355.89,,,,,,,98.02,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,inpatient,,,251.00000,81.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,236.94,,,,,,,225.90,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,236.94,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,inpatient,,,251.00000,81.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,236.94,,,,,,,225.90,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,236.94,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,inpatient,,,1170.00000,377.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,1104.48,,,,,,,1053.00,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,outpatient,,,1170.00000,377.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,1104.48,,,,,,,304.20,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,inpatient,,,780.00000,251.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,736.32,,,,,,,702.00,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,736.32,,,,,,,202.80,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,inpatient,,,780.00000,251.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,736.32,,,,,,,702.00,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,736.32,,,,,,,202.80,756.60,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,inpatient,,,1389.00000,448.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1311.22,,,,,,,1250.10,1347.33,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,outpatient,,,1389.00000,448.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1311.22,,,,,,,361.14,1347.33,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,inpatient,,,345.00000,111.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,325.68,,,,,,,310.50,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,outpatient,,,345.00000,111.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,325.68,,,,,,,89.70,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,inpatient,,,230.00000,74.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,217.12,,,,,,,207.00,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,217.12,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,inpatient,,,230.00000,74.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,217.12,,,,,,,207.00,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,217.12,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,inpatient,,,2102.00000,678.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,1984.29,,,,,,,1891.80,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,outpatient,,,2102.00000,678.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,1984.29,,,,,,,546.52,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,inpatient,,,1401.00000,452.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1322.54,,,,,,,1260.90,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1322.54,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,inpatient,,,1401.00000,452.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1322.54,,,,,,,1260.90,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1322.54,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,inpatient,,,357.00000,115.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,337.01,,,,,,,321.30,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,outpatient,,,357.00000,115.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,337.01,,,,,,,92.82,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,inpatient,,,238.00000,76.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,224.67,,,,,,,214.20,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,224.67,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,inpatient,,,238.00000,76.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,224.67,,,,,,,214.20,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,224.67,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,inpatient,,,2082.00000,672.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,1965.41,,,,,,,1873.80,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,outpatient,,,2082.00000,672.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,1965.41,,,,,,,541.32,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,inpatient,,,1388.00000,448.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1310.27,,,,,,,1249.20,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1310.27,,,,,,,360.88,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,inpatient,,,1388.00000,448.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1310.27,,,,,,,1249.20,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1310.27,,,,,,,360.88,1346.36,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,inpatient,,,246.00000,79.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,232.22,,,,,,,221.40,238.62,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,outpatient,,,246.00000,79.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,232.22,,,,,,,63.96,238.62,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,inpatient,,,164.00000,52.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,154.82,,,,,,,147.60,159.08,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,154.82,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,inpatient,,,164.00000,52.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,154.82,,,,,,,147.60,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,154.82,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,inpatient,,,309.00000,99.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,291.70,,,,,,,278.10,299.73,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,outpatient,,,309.00000,99.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,291.70,,,,,,,80.34,299.73,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,inpatient,,,206.00000,66.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,194.46,,,,,,,185.40,199.82,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,194.46,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,inpatient,,,206.00000,66.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,194.46,,,,,,,185.40,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,194.46,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,inpatient,,,471.00000,152.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,444.62,,,,,,,423.90,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,outpatient,,,471.00000,152.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,444.62,,,,,,,122.46,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,inpatient,,,314.00000,101.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,296.42,,,,,,,282.60,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,296.42,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,inpatient,,,314.00000,101.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,296.42,,,,,,,282.60,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,296.42,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,inpatient,,,239.00000,77.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,225.62,,,,,,,215.10,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,outpatient,,,239.00000,77.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,225.62,,,,,,,62.14,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,inpatient,,,159.00000,51.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,150.10,,,,,,,143.10,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,150.10,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,inpatient,,,159.00000,51.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,150.10,,,,,,,143.10,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,150.10,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,inpatient,,,558.00000,180.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,526.75,,,,,,,502.20,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,outpatient,,,558.00000,180.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,526.75,,,,,,,145.08,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,inpatient,,,372.00000,120.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,351.17,,,,,,,334.80,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,351.17,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,inpatient,,,372.00000,120.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,351.17,,,,,,,334.80,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,351.17,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,inpatient,,,413.00000,133.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,389.87,,,,,,,371.70,400.61,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,outpatient,,,413.00000,133.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,389.87,,,,,,,107.38,400.61,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,inpatient,,,275.00000,88.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,259.60,,,,,,,247.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,259.60,,,,,,,71.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,inpatient,,,275.00000,88.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,259.60,,,,,,,247.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,259.60,,,,,,,71.50,266.75,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,inpatient,,,462.00000,149.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,436.13,,,,,,,415.80,448.14,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,outpatient,,,462.00000,149.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,436.13,,,,,,,120.12,448.14,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,inpatient,,,170.00000,54.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,160.48,,,,,,,153.00,164.90,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,outpatient,,,170.00000,54.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,160.48,,,,,,,44.20,164.90,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,inpatient,,,281.00000,90.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,265.26,,,,,,,252.90,272.57,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,outpatient,,,281.00000,90.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,265.26,,,,,,,73.06,272.57,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,inpatient,,,562.00000,181.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,530.53,,,,,,,505.80,545.14,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,outpatient,,,562.00000,181.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,530.53,,,,,,,146.12,545.14,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,inpatient,,,2076.00000,670.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,1959.74,,,,,,,1868.40,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,outpatient,,,2076.00000,670.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,1959.74,,,,,,,539.76,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1384.00000,447.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1306.50,,,,,,,1245.60,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1306.50,,,,,,,359.84,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1384.00000,447.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1306.50,,,,,,,1245.60,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1306.50,,,,,,,359.84,1342.48,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,inpatient,,,934.00000,301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,881.70,,,,,,,840.60,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,outpatient,,,934.00000,301.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,881.70,,,,,,,242.84,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,inpatient,,,842.00000,271.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,794.85,,,,,,,757.80,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,outpatient,,,842.00000,271.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,794.85,,,,,,,218.92,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,inpatient,,,846.00000,273.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,798.62,,,,,,,761.40,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,outpatient,,,846.00000,273.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,798.62,,,,,,,219.96,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,inpatient,,,971.00000,313.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,916.62,,,,,,,873.90,941.87,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,outpatient,,,971.00000,313.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,916.62,,,,,,,252.46,941.87,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,inpatient,,,762.00000,246.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,719.33,,,,,,,685.80,739.14,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,outpatient,,,762.00000,246.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,719.33,,,,,,,198.12,739.14,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,inpatient,,,758.00000,244.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,715.55,,,,,,,682.20,735.26,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,outpatient,,,758.00000,244.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,715.55,,,,,,,197.08,735.26,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,inpatient,,,161.00000,52.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,151.98,,,,,,,144.90,156.17,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,outpatient,,,161.00000,52.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,151.98,,,,,,,41.86,156.17,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,inpatient,,,234.00000,75.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,220.90,,,,,,,210.60,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,outpatient,,,234.00000,75.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,220.90,,,,,,,60.84,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,inpatient,,,156.00000,50.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,147.26,,,,,,,140.40,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,147.26,,,,,,,40.56,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,inpatient,,,156.00000,50.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,147.26,,,,,,,140.40,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,147.26,,,,,,,40.56,151.32,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1517.00000,489.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,1432.05,,,,,,,1365.30,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1517.00000,489.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,1432.05,,,,,,,394.42,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1011.00000,326.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,954.38,,,,,,,909.90,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,954.38,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1011.00000,326.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,954.38,,,,,,,909.90,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,954.38,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,inpatient,,,822.00000,265.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,775.97,,,,,,,739.80,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,outpatient,,,822.00000,265.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,775.97,,,,,,,213.72,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,inpatient,,,548.00000,177.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,517.31,,,,,,,493.20,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,517.31,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,inpatient,,,548.00000,177.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,517.31,,,,,,,493.20,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,517.31,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,inpatient,,,2613.00000,844.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2466.67,,,,,,,2351.70,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,outpatient,,,2613.00000,844.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2466.67,,,,,,,679.38,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,inpatient,,,903.00000,291.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,852.43,,,,,,,812.70,875.91,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,outpatient,,,903.00000,291.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,852.43,,,,,,,234.78,875.91,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,inpatient,,,1156.00000,373.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1091.26,,,,,,,1040.40,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,outpatient,,,1156.00000,373.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1091.26,,,,,,,300.56,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,inpatient,,,677.00000,218.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,639.09,,,,,,,609.30,656.69,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,outpatient,,,677.00000,218.67000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,639.09,,,,,,,176.02,656.69,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1928.00000,622.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,1820.03,,,,,,,1735.20,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1928.00000,622.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,1820.03,,,,,,,501.28,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1285.00000,415.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1213.04,,,,,,,1156.50,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1213.04,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1285.00000,415.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1213.04,,,,,,,1156.50,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1213.04,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,inpatient,,,812.00000,262.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,766.53,,,,,,,730.80,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,outpatient,,,812.00000,262.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,766.53,,,,,,,211.12,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,inpatient,,,541.00000,174.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,510.70,,,,,,,486.90,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,510.70,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,inpatient,,,541.00000,174.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,510.70,,,,,,,486.90,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,510.70,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,inpatient,,,825.00000,266.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,778.80,,,,,,,742.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,outpatient,,,825.00000,266.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,778.80,,,,,,,214.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,inpatient,,,550.00000,177.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,519.20,,,,,,,495.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,519.20,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,inpatient,,,550.00000,177.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,519.20,,,,,,,495.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,519.20,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,inpatient,,,3494.00000,1128.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,3298.34,,,,,,,3144.60,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,outpatient,,,3494.00000,1128.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,3298.34,,,,,,,908.44,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2329.00000,752.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2198.58,,,,,,,2096.10,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2198.58,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2329.00000,752.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2198.58,,,,,,,2096.10,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2198.58,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,inpatient,,,840.00000,271.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,792.96,,,,,,,756.00,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,outpatient,,,840.00000,271.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,792.96,,,,,,,218.40,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,inpatient,,,560.00000,180.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,528.64,,,,,,,504.00,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,528.64,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,inpatient,,,560.00000,180.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,528.64,,,,,,,504.00,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,528.64,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,inpatient,,,792.00000,255.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,747.65,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,outpatient,,,792.00000,255.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,747.65,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,inpatient,,,528.00000,170.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,498.43,,,,,,,475.20,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,498.43,,,,,,,137.28,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,inpatient,,,528.00000,170.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,498.43,,,,,,,475.20,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,498.43,,,,,,,137.28,512.16,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,inpatient,,,272.00000,87.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,256.77,,,,,,,244.80,263.84,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,outpatient,,,272.00000,87.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,256.77,,,,,,,70.72,263.84,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,inpatient,,,1268.00000,409.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1196.99,,,,,,,1141.20,1229.96,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,outpatient,,,1268.00000,409.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1196.99,,,,,,,329.68,1229.96,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,inpatient,,,896.00000,289.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,845.82,,,,,,,806.40,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,outpatient,,,896.00000,289.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,845.82,,,,,,,232.96,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,inpatient,,,884.00000,285.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,834.50,,,,,,,795.60,857.48,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,outpatient,,,884.00000,285.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,834.50,,,,,,,229.84,857.48,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,inpatient,,,609.00000,326.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,574.90,,,,,,,548.10,590.73,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,574.90,,,,,,,158.34,590.73,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,inpatient,,,966.00000,383.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,911.90,,,,,,,869.40,937.02,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,outpatient,,,966.00000,383.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,911.90,,,,,,,251.16,937.02,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,inpatient,,,872.00000,346.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,823.17,,,,,,,784.80,845.84,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,outpatient,,,872.00000,346.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,823.17,,,,,,,226.72,845.84,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,inpatient,,,492.00000,195.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,464.45,,,,,,,442.80,477.24,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,outpatient,,,492.00000,195.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,464.45,,,,,,,127.92,477.24,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,inpatient,,,331.00000,131.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,312.46,,,,,,,297.90,321.07,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,outpatient,,,331.00000,131.41000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,312.46,,,,,,,86.06,321.07,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,inpatient,,,5215.00000,2070.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4922.96,,,,,,,4693.50,5058.55,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,outpatient,,,5215.00000,2070.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4922.96,,,,,,,1355.90,5058.55,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,inpatient,,,5422.00000,2152.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5118.37,,,,,,,4879.80,5259.34,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,outpatient,,,5422.00000,2152.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5118.37,,,,,,,1409.72,5259.34,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,inpatient,,,1878.00000,788.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1772.83,,,,,,,1690.20,1821.66,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1878.00000,788.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1772.83,,,,,,,488.28,1821.66,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,inpatient,,,2253.00000,946.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2126.83,,,,,,,2027.70,2185.41,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,outpatient,,,2253.00000,946.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2126.83,,,,,,,585.78,2185.41,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,inpatient,,,1502.00000,630.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1417.89,,,,,,,1351.80,1456.94,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1502.00000,630.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1417.89,,,,,,,390.52,1456.94,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,inpatient,,,2024.00000,850.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1910.66,,,,,,,1821.60,1963.28,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,outpatient,,,2024.00000,850.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1910.66,,,,,,,526.24,1963.28,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,inpatient,,,2429.00000,1020.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2292.98,,,,,,,2186.10,2356.13,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,outpatient,,,2429.00000,1020.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2292.98,,,,,,,631.54,2356.13,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,inpatient,,,1619.00000,679.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1619.00000,679.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,inpatient,,,2425.00000,1018.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2289.20,,,,,,,2182.50,2352.25,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,outpatient,,,2425.00000,1018.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2289.20,,,,,,,630.50,2352.25,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,inpatient,,,2910.00000,1222.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2747.04,,,,,,,2619.00,2822.70,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2910.00000,1222.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2747.04,,,,,,,756.60,2822.70,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,inpatient,,,1940.00000,814.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1831.36,,,,,,,1746.00,1881.80,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1940.00000,814.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1831.36,,,,,,,504.40,1881.80,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,inpatient,,,2317.00000,973.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2187.25,,,,,,,2085.30,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2317.00000,973.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2187.25,,,,,,,602.42,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,inpatient,,,2780.00000,1167.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2624.32,,,,,,,2502.00,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2780.00000,1167.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2624.32,,,,,,,722.80,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,inpatient,,,1853.00000,778.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1749.23,,,,,,,1667.70,1797.41,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1853.00000,778.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1749.23,,,,,,,481.78,1797.41,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,inpatient,,,2366.00000,993.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2233.50,,,,,,,2129.40,2295.02,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2366.00000,993.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2233.50,,,,,,,615.16,2295.02,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,inpatient,,,3056.00000,1283.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2884.86,,,,,,,2750.40,2964.32,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,outpatient,,,3056.00000,1283.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2884.86,,,,,,,794.56,2964.32,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,inpatient,,,2829.00000,1386.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2670.58,,,,,,,2546.10,2744.13,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,outpatient,,,2829.00000,1386.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2670.58,,,,,,,735.54,2744.13,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,inpatient,,,3395.00000,1663.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3204.88,,,,,,,3055.50,3293.15,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,outpatient,,,3395.00000,1663.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3204.88,,,,,,,882.70,3293.15,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,inpatient,,,2263.00000,1108.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2136.27,,,,,,,2036.70,2195.11,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,outpatient,,,2263.00000,1108.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2136.27,,,,,,,588.38,2195.11,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,inpatient,,,4697.00000,2301.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4433.97,,,,,,,4227.30,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,outpatient,,,4697.00000,2301.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4433.97,,,,,,,1221.22,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,inpatient,,,5636.00000,2761.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5320.38,,,,,,,5072.40,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,outpatient,,,5636.00000,2761.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5320.38,,,,,,,1465.36,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,inpatient,,,3757.00000,1840.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3546.61,,,,,,,3381.30,3644.29,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,outpatient,,,3757.00000,1840.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3546.61,,,,,,,976.82,3644.29,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,inpatient,,,2619.00000,1283.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2472.34,,,,,,,2357.10,2540.43,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,outpatient,,,2619.00000,1283.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2472.34,,,,,,,680.94,2540.43,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,inpatient,,,3143.00000,1540.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2966.99,,,,,,,2828.70,3048.71,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,outpatient,,,3143.00000,1540.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2966.99,,,,,,,817.18,3048.71,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,inpatient,,,2095.00000,1026.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1977.68,,,,,,,1885.50,2032.15,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,outpatient,,,2095.00000,1026.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1977.68,,,,,,,544.70,2032.15,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,inpatient,,,278.00000,136.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,262.43,,,,,,,250.20,269.66,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,outpatient,,,278.00000,136.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,262.43,,,,,,,72.28,269.66,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,inpatient,,,2110.00000,1033.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1991.84,,,,,,,1899.00,2046.70,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1991.84,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,inpatient,,,2110.00000,1033.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1991.84,,,,,,,1899.00,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1991.84,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2532.00000,1240.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2390.21,,,,,,,2278.80,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2390.21,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2532.00000,1240.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2390.21,,,,,,,2278.80,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2390.21,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1688.00000,827.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1593.47,,,,,,,1519.20,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1593.47,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1688.00000,827.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1593.47,,,,,,,1519.20,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1593.47,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,inpatient,,,2024.00000,991.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1910.66,,,,,,,1821.60,1963.28,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1910.66,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,inpatient,,,2024.00000,991.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1910.66,,,,,,,1821.60,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1910.66,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2429.00000,1190.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2292.98,,,,,,,2186.10,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2292.98,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2429.00000,1190.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2292.98,,,,,,,2186.10,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2292.98,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1619.00000,793.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1619.00000,793.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1528.34,,,,,,,1457.10,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1528.34,,,,,,,420.94,1570.43,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,inpatient,,,1224.00000,599.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1155.46,,,,,,,1101.60,1187.28,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,outpatient,,,1224.00000,599.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1155.46,,,,,,,318.24,1187.28,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,inpatient,,,3020.00000,1479.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2850.88,,,,,,,2718.00,2929.40,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,outpatient,,,3020.00000,1479.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2850.88,,,,,,,785.20,2929.40,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,inpatient,,,3624.00000,1775.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3421.06,,,,,,,3261.60,3515.28,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,outpatient,,,3624.00000,1775.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3421.06,,,,,,,942.24,3515.28,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,inpatient,,,2416.00000,1183.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2280.70,,,,,,,2174.40,2343.52,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,outpatient,,,2416.00000,1183.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2280.70,,,,,,,628.16,2343.52,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,inpatient,,,2728.00000,1336.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2575.23,,,,,,,2455.20,2646.16,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,outpatient,,,2728.00000,1336.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2575.23,,,,,,,709.28,2646.16,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,inpatient,,,3273.00000,1603.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3089.71,,,,,,,2945.70,3174.81,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,outpatient,,,3273.00000,1603.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3089.71,,,,,,,850.98,3174.81,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,inpatient,,,2182.00000,1069.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2059.81,,,,,,,1963.80,2116.54,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,outpatient,,,2182.00000,1069.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2059.81,,,,,,,567.32,2116.54,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,inpatient,,,3133.00000,1535.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2957.55,,,,,,,2819.70,3039.01,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,outpatient,,,3133.00000,1535.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2957.55,,,,,,,814.58,3039.01,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,inpatient,,,3759.00000,1841.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3548.50,,,,,,,3383.10,3646.23,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,outpatient,,,3759.00000,1841.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3548.50,,,,,,,977.34,3646.23,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,inpatient,,,2506.00000,1227.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2365.66,,,,,,,2255.40,2430.82,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,outpatient,,,2506.00000,1227.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2365.66,,,,,,,651.56,2430.82,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,inpatient,,,2857.00000,1399.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2697.01,,,,,,,2571.30,2771.29,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,outpatient,,,2857.00000,1399.93000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2697.01,,,,,,,742.82,2771.29,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,inpatient,,,3428.00000,1679.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3236.03,,,,,,,3085.20,3325.16,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,outpatient,,,3428.00000,1679.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3236.03,,,,,,,891.28,3325.16,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,inpatient,,,2285.00000,1119.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2157.04,,,,,,,2056.50,2216.45,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,outpatient,,,2285.00000,1119.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2157.04,,,,,,,594.10,2216.45,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,inpatient,,,3565.00000,1746.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3365.36,,,,,,,3208.50,3458.05,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,outpatient,,,3565.00000,1746.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3365.36,,,,,,,926.90,3458.05,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,inpatient,,,5918.00000,2899.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5586.59,,,,,,,5326.20,5740.46,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,outpatient,,,5918.00000,2899.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5586.59,,,,,,,1538.68,5740.46,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,inpatient,,,3301.00000,1617.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3116.14,,,,,,,2970.90,3201.97,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,outpatient,,,3301.00000,1617.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3116.14,,,,,,,858.26,3201.97,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2659.00000,1302.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2510.10,,,,,,,2393.10,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2510.10,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2659.00000,1302.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2510.10,,,,,,,2393.10,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2510.10,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2551.00000,1249.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2408.14,,,,,,,2295.90,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2408.14,,,,,,,663.26,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2551.00000,1249.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2408.14,,,,,,,2295.90,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2408.14,,,,,,,663.26,2474.47,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,inpatient,,,3806.00000,1864.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3592.86,,,,,,,3425.40,3691.82,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3806.00000,1864.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3592.86,,,,,,,989.56,3691.82,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,inpatient,,,2149.00000,694.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2028.66,,,,,,,1934.10,2084.53,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,outpatient,,,2149.00000,694.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2028.66,,,,,,,558.74,2084.53,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,inpatient,,,1973.00000,637.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1862.51,,,,,,,1775.70,1913.81,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,outpatient,,,1973.00000,637.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1862.51,,,,,,,512.98,1913.81,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1784.00000,576.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,1684.10,,,,,,,1605.60,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1784.00000,576.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,1684.10,,,,,,,463.84,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1189.00000,384.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1122.42,,,,,,,1070.10,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1122.42,,,,,,,309.14,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1189.00000,384.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1122.42,,,,,,,1070.10,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1122.42,,,,,,,309.14,1153.33,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,inpatient,,,130.00000,69.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,122.72,,,,,,,117.00,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,outpatient,,,130.00000,69.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,122.72,,,,,,,33.80,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,inpatient,,,44.00000,23.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41.54,,,,,,,39.60,42.68,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,outpatient,,,44.00000,23.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41.54,,,,,,,11.44,42.68,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,inpatient,,,456.00000,244.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,430.46,,,,,,,410.40,442.32,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,outpatient,,,456.00000,244.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,430.46,,,,,,,118.56,442.32,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,inpatient,,,108.00000,57.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,101.95,,,,,,,97.20,104.76,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,outpatient,,,108.00000,57.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,101.95,,,,,,,28.08,104.76,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,inpatient,,,306.00000,164.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,288.86,,,,,,,275.40,296.82,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,outpatient,,,306.00000,164.02000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,288.86,,,,,,,79.56,296.82,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,inpatient,,,257.00000,137.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,242.61,,,,,,,231.30,249.29,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,outpatient,,,257.00000,137.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,242.61,,,,,,,66.82,249.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4057.00000,2036.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3829.81,,,,,,,3651.30,3935.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3829.81,,,,,,,1054.82,3935.29,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4868.00000,2443.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4595.39,,,,,,,4381.20,4721.96,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4595.39,,,,,,,1265.68,4721.96,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,inpatient,,,3245.00000,1628.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3063.28,,,,,,,2920.50,3147.65,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3063.28,,,,,,,843.70,3147.65,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4057.00000,2036.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3829.81,,,,,,,3651.30,3935.29,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3829.81,,,,,,,1054.82,3935.29,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4868.00000,2443.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4595.39,,,,,,,4381.20,4721.96,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4595.39,,,,,,,1265.68,4721.96,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,inpatient,,,3245.00000,1628.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3063.28,,,,,,,2920.50,3147.65,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3063.28,,,,,,,843.70,3147.65,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,inpatient,,,1725.00000,865.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1628.40,,,,,,,1552.50,1673.25,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,outpatient,,,1725.00000,865.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1628.40,,,,,,,448.50,1673.25,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,inpatient,,,1743.00000,874.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1645.39,,,,,,,1568.70,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,outpatient,,,1743.00000,874.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1645.39,,,,,,,453.18,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,inpatient,,,1475.00000,740.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1392.40,,,,,,,1327.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1392.40,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,inpatient,,,1475.00000,740.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1392.40,,,,,,,1327.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1392.40,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,inpatient,,,1162.00000,583.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1096.93,,,,,,,1045.80,1127.14,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,outpatient,,,1162.00000,583.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1096.93,,,,,,,302.12,1127.14,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,inpatient,,,983.00000,493.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,927.95,,,,,,,884.70,953.51,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,927.95,,,,,,,255.58,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,inpatient,,,983.00000,493.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,927.95,,,,,,,884.70,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,927.95,,,,,,,255.58,953.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,inpatient,,,3183.00000,1597.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3004.75,,,,,,,2864.70,3087.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,outpatient,,,3183.00000,1597.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3004.75,,,,,,,827.58,3087.51,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,inpatient,,,3819.00000,1917.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3605.14,,,,,,,3437.10,3704.43,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,outpatient,,,3819.00000,1917.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3605.14,,,,,,,992.94,3704.43,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,inpatient,,,2546.00000,1278.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2403.42,,,,,,,2291.40,2469.62,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,outpatient,,,2546.00000,1278.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2403.42,,,,,,,661.96,2469.62,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,inpatient,,,3858.00000,1936.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,3641.95,,,,,,,3472.20,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,3641.95,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,inpatient,,,3858.00000,1936.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,3641.95,,,,,,,3472.20,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,3641.95,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,inpatient,,,4629.00000,2323.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,4369.78,,,,,,,4166.10,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,4369.78,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,inpatient,,,4629.00000,2323.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,4369.78,,,,,,,4166.10,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,4369.78,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,inpatient,,,3086.00000,1549.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2913.18,,,,,,,2777.40,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2913.18,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,inpatient,,,3086.00000,1549.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2913.18,,,,,,,2777.40,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2913.18,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,inpatient,,,2505.00000,1257.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2364.72,,,,,,,2254.50,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2364.72,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,inpatient,,,2505.00000,1257.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2364.72,,,,,,,2254.50,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2364.72,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,inpatient,,,3006.00000,1509.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2837.66,,,,,,,2705.40,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2837.66,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,inpatient,,,3006.00000,1509.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2837.66,,,,,,,2705.40,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2837.66,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,inpatient,,,2004.00000,1006.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1891.78,,,,,,,1803.60,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1891.78,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,inpatient,,,2004.00000,1006.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1891.78,,,,,,,1803.60,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1891.78,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,inpatient,,,3137.00000,1574.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2961.33,,,,,,,2823.30,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2961.33,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,inpatient,,,3137.00000,1574.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2961.33,,,,,,,2823.30,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2961.33,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,inpatient,,,3764.00000,1889.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,3553.22,,,,,,,3387.60,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,3553.22,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,inpatient,,,3764.00000,1889.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,3553.22,,,,,,,3387.60,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,3553.22,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,inpatient,,,2509.00000,1259.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2368.50,,,,,,,2258.10,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2368.50,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,inpatient,,,2509.00000,1259.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2368.50,,,,,,,2258.10,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2368.50,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,inpatient,,,3023.00000,1517.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2853.71,,,,,,,2720.70,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2853.71,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,inpatient,,,3023.00000,1517.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2853.71,,,,,,,2720.70,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2853.71,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,inpatient,,,3627.00000,1820.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,3423.89,,,,,,,3264.30,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,3423.89,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,inpatient,,,3627.00000,1820.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,3423.89,,,,,,,3264.30,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,3423.89,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,inpatient,,,2418.00000,1213.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2282.59,,,,,,,2176.20,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2282.59,,,,,,,628.68,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,inpatient,,,2418.00000,1213.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2282.59,,,,,,,2176.20,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2282.59,,,,,,,628.68,2345.46,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,inpatient,,,870.00000,436.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,821.28,,,,,,,783.00,843.90,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,outpatient,,,870.00000,436.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,821.28,,,,,,,226.20,843.90,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,inpatient,,,1353.00000,679.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1277.23,,,,,,,1217.70,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,outpatient,,,1353.00000,679.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1277.23,,,,,,,351.78,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,inpatient,,,902.00000,452.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,851.49,,,,,,,811.80,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,851.49,,,,,,,234.52,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,inpatient,,,902.00000,452.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,851.49,,,,,,,811.80,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,851.49,,,,,,,234.52,874.94,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,inpatient,,,3489.00000,1751.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3293.62,,,,,,,3140.10,3384.33,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3489.00000,1751.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3293.62,,,,,,,907.14,3384.33,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,inpatient,,,4187.00000,2101.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3952.53,,,,,,,3768.30,4061.39,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,outpatient,,,4187.00000,2101.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3952.53,,,,,,,1088.62,4061.39,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,inpatient,,,2791.00000,1401.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2634.70,,,,,,,2511.90,2707.27,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,outpatient,,,2791.00000,1401.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2634.70,,,,,,,725.66,2707.27,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,inpatient,,,492.00000,246.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,464.45,,,,,,,442.80,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,outpatient,,,492.00000,246.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,464.45,,,,,,,127.92,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,inpatient,,,331.00000,166.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,312.46,,,,,,,297.90,321.07,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,outpatient,,,331.00000,166.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,312.46,,,,,,,86.06,321.07,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,inpatient,,,4440.00000,2357.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4191.36,,,,,,,3996.00,4306.80,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,outpatient,,,4440.00000,2357.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4191.36,,,,,,,1154.40,4306.80,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,inpatient,,,5328.00000,2829.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5029.63,,,,,,,4795.20,5168.16,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,outpatient,,,5328.00000,2829.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5029.63,,,,,,,1385.28,5168.16,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,inpatient,,,3552.00000,1886.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3353.09,,,,,,,3196.80,3445.44,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,outpatient,,,3552.00000,1886.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3353.09,,,,,,,923.52,3445.44,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,inpatient,,,2528.00000,1342.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2386.43,,,,,,,2275.20,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,outpatient,,,2528.00000,1342.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2386.43,,,,,,,657.28,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,inpatient,,,3033.00000,1610.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2863.15,,,,,,,2729.70,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,outpatient,,,3033.00000,1610.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2863.15,,,,,,,788.58,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,inpatient,,,2022.00000,1073.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1908.77,,,,,,,1819.80,1961.34,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,outpatient,,,2022.00000,1073.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1908.77,,,,,,,525.72,1961.34,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,inpatient,,,3610.00000,1909.69000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3407.84,,,,,,,3249.00,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,outpatient,,,3610.00000,1909.69000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3407.84,,,,,,,938.60,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,inpatient,,,4332.00000,2291.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4089.41,,,,,,,3898.80,4202.04,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,outpatient,,,4332.00000,2291.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4089.41,,,,,,,1126.32,4202.04,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,inpatient,,,2888.00000,1527.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2726.27,,,,,,,2599.20,2801.36,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,outpatient,,,2888.00000,1527.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2726.27,,,,,,,750.88,2801.36,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,inpatient,,,4532.00000,2397.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4278.21,,,,,,,4078.80,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,outpatient,,,4532.00000,2397.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4278.21,,,,,,,1178.32,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,inpatient,,,5438.00000,2876.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5133.47,,,,,,,4894.20,5274.86,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,outpatient,,,5438.00000,2876.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5133.47,,,,,,,1413.88,5274.86,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,inpatient,,,3625.00000,1917.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3422.00,,,,,,,3262.50,3516.25,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,outpatient,,,3625.00000,1917.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3422.00,,,,,,,942.50,3516.25,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,inpatient,,,3639.00000,1925.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3435.22,,,,,,,3275.10,3529.83,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,outpatient,,,3639.00000,1925.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3435.22,,,,,,,946.14,3529.83,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,inpatient,,,4367.00000,2310.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4122.45,,,,,,,3930.30,4235.99,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,outpatient,,,4367.00000,2310.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4122.45,,,,,,,1135.42,4235.99,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,inpatient,,,2911.00000,1539.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2747.98,,,,,,,2619.90,2823.67,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,outpatient,,,2911.00000,1539.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2747.98,,,,,,,756.86,2823.67,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,inpatient,,,3494.00000,1719.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3298.34,,,,,,,3144.60,3389.18,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3494.00000,1719.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3298.34,,,,,,,908.44,3389.18,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,inpatient,,,4193.00000,2062.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3958.19,,,,,,,3773.70,4067.21,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,outpatient,,,4193.00000,2062.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3958.19,,,,,,,1090.18,4067.21,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,inpatient,,,2795.00000,1375.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2638.48,,,,,,,2515.50,2711.15,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,outpatient,,,2795.00000,1375.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2638.48,,,,,,,726.70,2711.15,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,inpatient,,,2717.00000,1336.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2564.85,,,,,,,2445.30,2635.49,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,outpatient,,,2717.00000,1336.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2564.85,,,,,,,706.42,2635.49,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,inpatient,,,3260.00000,1603.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3077.44,,,,,,,2934.00,3162.20,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,outpatient,,,3260.00000,1603.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3077.44,,,,,,,847.60,3162.20,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,inpatient,,,2173.00000,1069.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2051.31,,,,,,,1955.70,2107.81,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,outpatient,,,2173.00000,1069.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2051.31,,,,,,,564.98,2107.81,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4051.00000,2301.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,3824.14,,,,,,,3645.90,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,3824.14,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4051.00000,2301.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,3824.14,,,,,,,3645.90,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,3824.14,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4861.00000,2761.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,4588.78,,,,,,,4374.90,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,4588.78,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4861.00000,2761.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,4588.78,,,,,,,4374.90,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,4588.78,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3241.00000,1841.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,3059.50,,,,,,,2916.90,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,3059.50,,,,,,,842.66,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3241.00000,1841.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,3059.50,,,,,,,2916.90,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,3059.50,,,,,,,842.66,3143.77,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,inpatient,,,4260.00000,2420.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4021.44,,,,,,,3834.00,4132.20,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,outpatient,,,4260.00000,2420.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4021.44,,,,,,,1107.60,4132.20,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,inpatient,,,5112.00000,2904.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4825.73,,,,,,,4600.80,4958.64,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,outpatient,,,5112.00000,2904.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4825.73,,,,,,,1329.12,4958.64,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,inpatient,,,3408.00000,1936.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3217.15,,,,,,,3067.20,3305.76,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3408.00000,1936.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3217.15,,,,,,,886.08,3305.76,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,inpatient,,,3343.00000,1899.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3155.79,,,,,,,3008.70,3242.71,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3343.00000,1899.33000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3155.79,,,,,,,869.18,3242.71,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,inpatient,,,4010.00000,2278.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3785.44,,,,,,,3609.00,3889.70,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,outpatient,,,4010.00000,2278.28000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3785.44,,,,,,,1042.60,3889.70,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,inpatient,,,2674.00000,1519.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2524.26,,,,,,,2406.60,2593.78,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,outpatient,,,2674.00000,1519.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2524.26,,,,,,,695.24,2593.78,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3294.00000,1871.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,3109.54,,,,,,,2964.60,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,3109.54,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3294.00000,1871.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,3109.54,,,,,,,2964.60,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,3109.54,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3953.00000,2245.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,3731.63,,,,,,,3557.70,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,3731.63,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3953.00000,2245.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,3731.63,,,,,,,3557.70,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,3731.63,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,inpatient,,,2635.00000,1497.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2487.44,,,,,,,2371.50,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2487.44,,,,,,,685.10,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,inpatient,,,2635.00000,1497.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2487.44,,,,,,,2371.50,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2487.44,,,,,,,685.10,2555.95,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,inpatient,,,3664.00000,2081.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3458.82,,,,,,,3297.60,3554.08,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3664.00000,2081.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3458.82,,,,,,,952.64,3554.08,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,inpatient,,,4397.00000,2498.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,3957.30,4265.09,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,outpatient,,,4397.00000,2498.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4150.77,,,,,,,1143.22,4265.09,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,inpatient,,,2931.00000,1665.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2766.86,,,,,,,2637.90,2843.07,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,outpatient,,,2931.00000,1665.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2766.86,,,,,,,762.06,2843.07,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,inpatient,,,4759.00000,2703.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4492.50,,,,,,,4283.10,4616.23,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,outpatient,,,4759.00000,2703.83000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4492.50,,,,,,,1237.34,4616.23,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,inpatient,,,5710.00000,3244.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5390.24,,,,,,,5139.00,5538.70,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,outpatient,,,5710.00000,3244.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5390.24,,,,,,,1484.60,5538.70,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,inpatient,,,3807.00000,2162.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3593.81,,,,,,,3426.30,3692.79,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3807.00000,2162.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3593.81,,,,,,,989.82,3692.79,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,inpatient,,,2915.00000,1574.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2751.76,,,,,,,2623.50,2827.55,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2915.00000,1574.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2751.76,,,,,,,757.90,2827.55,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,inpatient,,,1918.00000,1035.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1810.59,,,,,,,1726.20,1860.46,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1918.00000,1035.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1810.59,,,,,,,498.68,1860.46,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,inpatient,,,2292.00000,1237.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2163.65,,,,,,,2062.80,2223.24,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2292.00000,1237.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2163.65,,,,,,,595.92,2223.24,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,inpatient,,,2984.00000,1611.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2816.90,,,,,,,2685.60,2894.48,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,outpatient,,,2984.00000,1611.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2816.90,,,,,,,775.84,2894.48,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,inpatient,,,769.00000,415.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,725.94,,,,,,,692.10,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,outpatient,,,769.00000,415.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,725.94,,,,,,,199.94,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,inpatient,,,1280.00000,691.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1208.32,,,,,,,1152.00,1241.60,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,outpatient,,,1280.00000,691.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1208.32,,,,,,,332.80,1241.60,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,inpatient,,,1878.00000,1014.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1772.83,,,,,,,1690.20,1821.66,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,outpatient,,,1878.00000,1014.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1772.83,,,,,,,488.28,1821.66,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,inpatient,,,2196.00000,1185.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2073.02,,,,,,,1976.40,2130.12,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,outpatient,,,2196.00000,1185.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2073.02,,,,,,,570.96,2130.12,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,inpatient,,,844.00000,455.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,796.74,,,,,,,759.60,818.68,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,outpatient,,,844.00000,455.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,796.74,,,,,,,219.44,818.68,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,inpatient,,,1305.00000,704.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1231.92,,,,,,,1174.50,1265.85,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,outpatient,,,1305.00000,704.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1231.92,,,,,,,339.30,1265.85,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,inpatient,,,576.00000,311.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,543.74,,,,,,,518.40,558.72,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,outpatient,,,576.00000,311.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,543.74,,,,,,,149.76,558.72,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,inpatient,,,809.00000,436.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,763.70,,,,,,,728.10,784.73,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,outpatient,,,809.00000,436.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,763.70,,,,,,,210.34,784.73,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,inpatient,,,2462.00000,1329.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2324.13,,,,,,,2215.80,2388.14,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,outpatient,,,2462.00000,1329.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2324.13,,,,,,,640.12,2388.14,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,inpatient,,,918.00000,495.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,866.59,,,,,,,826.20,890.46,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,outpatient,,,918.00000,495.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,866.59,,,,,,,238.68,890.46,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,inpatient,,,1102.00000,595.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1040.29,,,,,,,991.80,1068.94,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,outpatient,,,1102.00000,595.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1040.29,,,,,,,286.52,1068.94,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,inpatient,,,812.00000,438.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,766.53,,,,,,,730.80,787.64,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,outpatient,,,812.00000,438.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,766.53,,,,,,,211.12,787.64,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,inpatient,,,1407.00000,759.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1328.21,,,,,,,1266.30,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,outpatient,,,1407.00000,759.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1328.21,,,,,,,365.82,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,inpatient,,,1980.00000,1069.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1869.12,,,,,,,1782.00,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,outpatient,,,1980.00000,1069.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1869.12,,,,,,,514.80,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,inpatient,,,964.00000,520.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,910.02,,,,,,,867.60,935.08,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,outpatient,,,964.00000,520.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,910.02,,,,,,,250.64,935.08,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,inpatient,,,1040.00000,561.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,981.76,,,,,,,936.00,1008.80,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,outpatient,,,1040.00000,561.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,981.76,,,,,,,270.40,1008.80,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,inpatient,,,795.00000,429.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,750.48,,,,,,,715.50,771.15,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,outpatient,,,795.00000,429.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,750.48,,,,,,,206.70,771.15,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,inpatient,,,1124.00000,606.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1061.06,,,,,,,1011.60,1090.28,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,outpatient,,,1124.00000,606.96000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1061.06,,,,,,,292.24,1090.28,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,inpatient,,,736.00000,397.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,694.78,,,,,,,662.40,713.92,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,outpatient,,,736.00000,397.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,694.78,,,,,,,191.36,713.92,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,inpatient,,,700.00000,378.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,660.80,,,,,,,630.00,679.00,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,outpatient,,,700.00000,378.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,660.80,,,,,,,182.00,679.00,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,inpatient,,,821.00000,443.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,775.02,,,,,,,738.90,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,outpatient,,,821.00000,443.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,775.02,,,,,,,213.46,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,inpatient,,,846.00000,456.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,798.62,,,,,,,761.40,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,outpatient,,,846.00000,456.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,798.62,,,,,,,219.96,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,inpatient,,,958.00000,517.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,904.35,,,,,,,862.20,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,outpatient,,,958.00000,517.32000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,904.35,,,,,,,249.08,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,inpatient,,,1261.00000,680.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1190.38,,,,,,,1134.90,1223.17,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,outpatient,,,1261.00000,680.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1190.38,,,,,,,327.86,1223.17,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,inpatient,,,971.00000,524.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,916.62,,,,,,,873.90,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,outpatient,,,971.00000,524.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,916.62,,,,,,,252.46,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,inpatient,,,1837.00000,991.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1734.13,,,,,,,1653.30,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,outpatient,,,1837.00000,991.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1734.13,,,,,,,477.62,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,inpatient,,,1099.00000,593.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1037.46,,,,,,,989.10,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,outpatient,,,1099.00000,593.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1037.46,,,,,,,285.74,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,inpatient,,,2178.00000,1176.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2056.03,,,,,,,1960.20,2112.66,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,outpatient,,,2178.00000,1176.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2056.03,,,,,,,566.28,2112.66,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,inpatient,,,1226.00000,662.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1157.34,,,,,,,1103.40,1189.22,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,outpatient,,,1226.00000,662.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1157.34,,,,,,,318.76,1189.22,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,inpatient,,,1048.00000,565.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,989.31,,,,,,,943.20,1016.56,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,outpatient,,,1048.00000,565.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,989.31,,,,,,,272.48,1016.56,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,inpatient,,,970.00000,523.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,915.68,,,,,,,873.00,940.90,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,outpatient,,,970.00000,523.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,915.68,,,,,,,252.20,940.90,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,inpatient,,,1803.00000,973.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1702.03,,,,,,,1622.70,1748.91,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,outpatient,,,1803.00000,973.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1702.03,,,,,,,468.78,1748.91,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,inpatient,,,2504.00000,1352.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2363.78,,,,,,,2253.60,2428.88,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,outpatient,,,2504.00000,1352.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2363.78,,,,,,,651.04,2428.88,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,inpatient,,,2457.00000,1326.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2319.41,,,,,,,2211.30,2383.29,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2457.00000,1326.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2319.41,,,,,,,638.82,2383.29,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,inpatient,,,923.00000,498.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,871.31,,,,,,,830.70,895.31,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,outpatient,,,923.00000,498.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,871.31,,,,,,,239.98,895.31,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,inpatient,,,5478.00000,2958.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5171.23,,,,,,,4930.20,5313.66,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,outpatient,,,5478.00000,2958.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5171.23,,,,,,,1424.28,5313.66,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,inpatient,,,4551.00000,2457.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4296.14,,,,,,,4095.90,4414.47,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,outpatient,,,4551.00000,2457.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4296.14,,,,,,,1183.26,4414.47,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,inpatient,,,1360.00000,734.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1283.84,,,,,,,1224.00,1319.20,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,outpatient,,,1360.00000,734.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1283.84,,,,,,,353.60,1319.20,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,inpatient,,,1209.00000,652.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1141.30,,,,,,,1088.10,1172.73,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,outpatient,,,1209.00000,652.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1141.30,,,,,,,314.34,1172.73,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,inpatient,,,848.00000,457.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,800.51,,,,,,,763.20,822.56,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,outpatient,,,848.00000,457.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,800.51,,,,,,,220.48,822.56,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,inpatient,,,1071.00000,578.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1011.02,,,,,,,963.90,1038.87,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,outpatient,,,1071.00000,578.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1011.02,,,,,,,278.46,1038.87,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,inpatient,,,1792.00000,967.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1691.65,,,,,,,1612.80,1738.24,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,outpatient,,,1792.00000,967.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1691.65,,,,,,,465.92,1738.24,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,inpatient,,,35.00000,18.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.04,,,,,,,31.50,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,outpatient,,,35.00000,18.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.04,,,,,,,9.10,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,inpatient,,,285.00000,153.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,269.04,,,,,,,256.50,276.45,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,outpatient,,,285.00000,153.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,269.04,,,,,,,74.10,276.45,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,inpatient,,,1012.00000,546.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,955.33,,,,,,,910.80,981.64,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,outpatient,,,1012.00000,546.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,955.33,,,,,,,263.12,981.64,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,inpatient,,,492.00000,265.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,464.45,,,,,,,442.80,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,outpatient,,,492.00000,265.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,464.45,,,,,,,127.92,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,inpatient,,,739.00000,399.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,697.62,,,,,,,665.10,716.83,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,outpatient,,,739.00000,399.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,697.62,,,,,,,192.14,716.83,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,inpatient,,,515.00000,278.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,486.16,,,,,,,463.50,499.55,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,outpatient,,,515.00000,278.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,486.16,,,,,,,133.90,499.55,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,inpatient,,,1467.00000,792.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1384.85,,,,,,,1320.30,1422.99,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,outpatient,,,1467.00000,792.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1384.85,,,,,,,381.42,1422.99,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,inpatient,,,1683.00000,888.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1588.75,,,,,,,1514.70,1632.51,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,outpatient,,,1683.00000,888.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1588.75,,,,,,,437.58,1632.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,inpatient,,,426.30000,225.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,402.43,,,,,,,383.67,413.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,426.30000,225.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,402.43,,,,,,,110.84,413.51,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,inpatient,,,725.00000,382.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,684.40,,,,,,,652.50,703.25,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,725.00000,382.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,684.40,,,,,,,188.50,1855.42,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,inpatient,,,1852.00000,977.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1748.29,,,,,,,1666.80,1796.44,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,1852.00000,977.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1748.29,,,,,,,481.52,1868.26,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,110.00000,58.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,99.00,106.70,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,110.00000,58.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,103.84,,,,,,,28.60,106.70,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,inpatient,,,98.00000,51.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,88.20,95.06,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,98.00000,51.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,25.48,1662.92,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,inpatient,,,2018.00000,1065.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1904.99,,,,,,,1816.20,1957.46,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,2018.00000,1065.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1904.99,,,,,,,524.68,1957.46,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,inpatient,,,4325.00000,2283.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4082.80,,,,,,,3892.50,4195.25,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,4325.00000,2283.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4082.80,,,,,,,1124.50,4195.25,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,inpatient,,,172.00000,90.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,162.37,,,,,,,154.80,166.84,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,162.37,,,,,,,44.72,166.84,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,inpatient,,,942.00000,497.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,889.25,,,,,,,847.80,913.74,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,942.00000,497.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,889.25,,,,,,,244.92,913.74,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,inpatient,,,413.00000,218.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,389.87,,,,,,,371.70,400.61,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,413.00000,218.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,389.87,,,,,,,107.38,400.61,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,inpatient,,,257.00000,135.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,242.61,,,,,,,231.30,249.29,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,outpatient,,,257.00000,135.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,242.61,,,,,,,66.82,249.29,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,inpatient,,,116.00000,61.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,109.50,,,,,,,104.40,112.52,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,116.00000,61.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,109.50,,,,,,,30.16,112.52,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,inpatient,,,463.20000,244.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,437.26,,,,,,,416.88,449.30,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,463.20000,244.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,437.26,,,,,,,120.43,449.30,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,inpatient,,,804.00000,424.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,758.98,,,,,,,723.60,779.88,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,804.00000,424.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,758.98,,,,,,,209.04,779.88,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,inpatient,,,172.00000,90.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,162.37,,,,,,,154.80,166.84,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,162.37,,,,,,,44.72,166.84,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,inpatient,,,354.30000,187.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,334.46,,,,,,,318.87,343.67,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,354.30000,187.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,334.46,,,,,,,92.12,343.67,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,inpatient,,,277.90000,146.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,262.34,,,,,,,250.11,269.56,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,277.90000,146.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,262.34,,,,,,,72.25,269.56,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,inpatient,,,200.00000,105.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,188.80,,,,,,,180.00,194.00,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,200.00000,105.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,188.80,,,,,,,52.00,194.00,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,inpatient,,,197.00000,63.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,185.97,,,,,,,177.30,191.09,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,outpatient,,,197.00000,63.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,185.97,,,,,,,51.22,191.09,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,inpatient,,,468.00000,151.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,441.79,,,,,,,421.20,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,outpatient,,,468.00000,151.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,441.79,,,,,,,121.68,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,inpatient,,,312.00000,100.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,294.53,,,,,,,280.80,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,294.53,,,,,,,81.12,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,inpatient,,,312.00000,100.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,294.53,,,,,,,280.80,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,294.53,,,,,,,81.12,302.64,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,427.63,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,427.63,,,,,,,117.78,439.41,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,inpatient,,,609.00000,196.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,574.90,,,,,,,548.10,590.73,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,574.90,,,,,,,158.34,590.73,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,inpatient,,,1248.00000,403.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,1178.11,,,,,,,1123.20,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1248.00000,403.10000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,1178.11,,,,,,,324.48,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,inpatient,,,832.00000,268.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,785.41,,,,,,,748.80,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,785.41,,,,,,,216.32,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,inpatient,,,832.00000,268.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,785.41,,,,,,,748.80,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,785.41,,,,,,,216.32,807.04,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,inpatient,,,4235.00000,1367.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,3997.84,,,,,,,3811.50,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,3997.84,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,inpatient,,,4235.00000,1367.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,3997.84,,,,,,,3811.50,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,3997.84,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,inpatient,,,2119.00000,684.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2000.34,,,,,,,1907.10,2055.43,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,outpatient,,,2119.00000,684.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2000.34,,,,,,,550.94,2055.43,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,inpatient,,,1943.00000,627.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1834.19,,,,,,,1748.70,1884.71,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1943.00000,627.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1834.19,,,,,,,505.18,1884.71,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,inpatient,,,1426.00000,460.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1346.14,,,,,,,1283.40,1383.22,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,outpatient,,,1426.00000,460.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1346.14,,,,,,,370.76,1383.22,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,inpatient,,,4202.00000,1357.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,3966.69,,,,,,,3781.80,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,outpatient,,,4202.00000,1357.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,3966.69,,,,,,,1092.52,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,inpatient,,,2801.00000,904.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2644.14,,,,,,,2520.90,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,2644.14,,,,,,,728.26,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,inpatient,,,2801.00000,904.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2644.14,,,,,,,2520.90,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,2644.14,,,,,,,728.26,2716.97,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,inpatient,,,832.00000,268.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,785.41,,,,,,,748.80,807.04,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,outpatient,,,832.00000,268.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,785.41,,,,,,,216.32,807.04,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,inpatient,,,1457.00000,470.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1375.41,,,,,,,1311.30,1413.29,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,outpatient,,,1457.00000,470.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1375.41,,,,,,,378.82,1413.29,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,inpatient,,,743.00000,239.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,701.39,,,,,,,668.70,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,701.39,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,inpatient,,,743.00000,239.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,701.39,,,,,,,668.70,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,701.39,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,inpatient,,,232.00000,74.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,219.01,,,,,,,208.80,225.04,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,outpatient,,,232.00000,74.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,219.01,,,,,,,60.32,225.04,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,inpatient,,,1364.00000,440.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,1287.62,,,,,,,1227.60,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,outpatient,,,1364.00000,440.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,1287.62,,,,,,,354.64,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,inpatient,,,909.00000,293.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,858.10,,,,,,,818.10,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,858.10,,,,,,,236.34,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,inpatient,,,909.00000,293.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,858.10,,,,,,,818.10,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,858.10,,,,,,,236.34,881.73,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,inpatient,,,510.00000,355.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,481.44,,,,,,,459.00,494.70,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,outpatient,,,510.00000,355.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,481.44,,,,,,,132.60,494.70,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,inpatient,,,1001.00000,698.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,944.94,,,,,,,900.90,970.97,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,outpatient,,,1001.00000,698.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,944.94,,,,,,,260.26,970.97,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,inpatient,,,887.00000,619.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,837.33,,,,,,,798.30,860.39,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,outpatient,,,887.00000,619.13000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,837.33,,,,,,,230.62,860.39,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,inpatient,,,1022.00000,713.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,964.77,,,,,,,919.80,991.34,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,outpatient,,,1022.00000,713.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,964.77,,,,,,,265.72,991.34,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,inpatient,,,681.00000,475.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,642.86,,,,,,,612.90,660.57,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,642.86,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,inpatient,,,681.00000,475.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,642.86,,,,,,,612.90,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,642.86,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,inpatient,,,945.00000,659.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,892.08,,,,,,,850.50,916.65,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,outpatient,,,945.00000,659.61000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,892.08,,,,,,,245.70,916.65,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,inpatient,,,630.00000,439.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,594.72,,,,,,,567.00,611.10,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,594.72,,,,,,,163.80,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,inpatient,,,630.00000,439.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,594.72,,,,,,,567.00,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,594.72,,,,,,,163.80,611.10,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,inpatient,,,577.00000,402.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,544.69,,,,,,,519.30,559.69,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,outpatient,,,577.00000,402.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,544.69,,,,,,,150.02,559.69,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,inpatient,,,433.00000,302.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,408.75,,,,,,,389.70,420.01,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,outpatient,,,433.00000,302.23000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,408.75,,,,,,,112.58,420.01,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,inpatient,,,331.00000,231.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,312.46,,,,,,,297.90,321.07,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,outpatient,,,331.00000,231.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,312.46,,,,,,,86.06,321.07,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,inpatient,,,662.00000,462.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,624.93,,,,,,,595.80,642.14,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,outpatient,,,662.00000,462.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,624.93,,,,,,,172.12,642.14,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,inpatient,,,752.00000,524.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,709.89,,,,,,,676.80,729.44,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,outpatient,,,752.00000,524.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,709.89,,,,,,,195.52,729.44,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,inpatient,,,182.00000,127.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,171.81,,,,,,,163.80,176.54,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,171.81,,,,,,,47.32,176.54,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,inpatient,,,420.00000,293.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,396.48,,,,,,,378.00,407.40,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,outpatient,,,420.00000,293.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,396.48,,,,,,,109.20,407.40,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,inpatient,,,253.00000,176.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,238.83,,,,,,,227.70,245.41,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,outpatient,,,253.00000,176.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,238.83,,,,,,,65.78,245.41,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,inpatient,,,168.00000,117.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,158.59,,,,,,,151.20,162.96,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,outpatient,,,168.00000,117.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,158.59,,,,,,,43.68,162.96,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,inpatient,,,695.00000,485.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,656.08,,,,,,,625.50,674.15,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,outpatient,,,695.00000,485.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,656.08,,,,,,,180.70,674.15,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,inpatient,,,474.00000,330.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,447.46,,,,,,,426.60,459.78,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,outpatient,,,474.00000,330.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,447.46,,,,,,,123.24,459.78,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,inpatient,,,930.00000,649.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,877.92,,,,,,,837.00,902.10,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,outpatient,,,930.00000,649.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,877.92,,,,,,,241.80,902.10,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,inpatient,,,786.00000,548.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,741.98,,,,,,,707.40,762.42,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,outpatient,,,786.00000,548.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,741.98,,,,,,,204.36,762.42,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,inpatient,,,620.00000,432.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,585.28,,,,,,,558.00,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,585.28,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,inpatient,,,620.00000,432.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,59,585.28,,,,,,,558.00,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,59,585.28,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,inpatient,,,435.00000,303.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,410.64,,,,,,,391.50,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,410.64,,,,,,,113.10,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,inpatient,,,435.00000,303.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,59,410.64,,,,,,,391.50,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,59,410.64,,,,,,,113.10,421.95,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,inpatient,,,492.00000,343.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,464.45,,,,,,,442.80,477.24,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,outpatient,,,492.00000,343.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,464.45,,,,,,,127.92,477.24,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,inpatient,,,331.00000,231.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,312.46,,,,,,,297.90,321.07,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,outpatient,,,331.00000,231.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,312.46,,,,,,,86.06,321.07,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,inpatient,,,875.00000,610.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,826.00,,,,,,,787.50,848.75,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,outpatient,,,875.00000,610.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,826.00,,,,,,,227.50,848.75,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,inpatient,,,688.00000,480.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,649.47,,,,,,,619.20,667.36,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,outpatient,,,688.00000,480.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,649.47,,,,,,,178.88,667.36,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,inpatient,,,465.00000,324.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,438.96,,,,,,,418.50,451.05,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,outpatient,,,465.00000,324.57000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,438.96,,,,,,,120.90,451.05,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,inpatient,,,846.00000,590.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,798.62,,,,,,,761.40,820.62,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,outpatient,,,846.00000,590.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,798.62,,,,,,,219.96,820.62,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,inpatient,,,482.00000,336.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,455.01,,,,,,,433.80,467.54,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,outpatient,,,482.00000,336.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,455.01,,,,,,,125.32,467.54,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,inpatient,,,926.00000,646.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,874.14,,,,,,,833.40,898.22,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,outpatient,,,926.00000,646.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,874.14,,,,,,,240.76,898.22,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,inpatient,,,292.00000,203.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,275.65,,,,,,,262.80,283.24,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,outpatient,,,292.00000,203.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,275.65,,,,,,,75.92,283.24,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,inpatient,,,827.00000,577.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,780.69,,,,,,,744.30,802.19,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,outpatient,,,827.00000,577.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,780.69,,,,,,,215.02,802.19,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,inpatient,,,253.00000,176.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,238.83,,,,,,,227.70,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,outpatient,,,253.00000,176.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,238.83,,,,,,,65.78,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,inpatient,,,901.00000,628.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,850.54,,,,,,,810.90,873.97,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,outpatient,,,901.00000,628.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,850.54,,,,,,,234.26,873.97,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,inpatient,,,460.00000,321.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,434.24,,,,,,,414.00,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,outpatient,,,460.00000,321.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,434.24,,,,,,,119.60,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,inpatient,,,1029.00000,718.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,971.38,,,,,,,926.10,998.13,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1029.00000,718.24000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,971.38,,,,,,,267.54,998.13,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,inpatient,,,959.00000,669.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,905.30,,,,,,,863.10,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,outpatient,,,959.00000,669.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,905.30,,,,,,,249.34,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,inpatient,,,558.00000,389.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,526.75,,,,,,,502.20,541.26,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,outpatient,,,558.00000,389.48000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,526.75,,,,,,,145.08,541.26,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,inpatient,,,705.00000,492.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,665.52,,,,,,,634.50,683.85,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,outpatient,,,705.00000,492.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,665.52,,,,,,,183.30,683.85,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,inpatient,,,249.00000,173.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,235.06,,,,,,,224.10,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,outpatient,,,249.00000,173.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,235.06,,,,,,,64.74,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,inpatient,,,427.00000,298.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,403.09,,,,,,,384.30,414.19,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,outpatient,,,427.00000,298.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,403.09,,,,,,,111.02,414.19,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,inpatient,,,737.00000,514.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,695.73,,,,,,,663.30,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,695.73,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,inpatient,,,737.00000,514.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,59,695.73,,,,,,,663.30,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,59,695.73,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,inpatient,,,809.00000,564.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,763.70,,,,,,,728.10,784.73,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,outpatient,,,809.00000,564.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,763.70,,,,,,,210.34,784.73,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,inpatient,,,525.00000,366.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,495.60,,,,,,,472.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,outpatient,,,525.00000,366.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,495.60,,,,,,,136.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,inpatient,,,319.00000,222.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,301.14,,,,,,,287.10,309.43,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,outpatient,,,319.00000,222.66000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,301.14,,,,,,,82.94,309.43,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,inpatient,,,1437.00000,678.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1356.53,,,,,,,1293.30,1393.89,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1437.00000,678.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1356.53,,,,,,,373.62,1393.89,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,inpatient,,,2143.00000,1011.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2022.99,,,,,,,1928.70,2078.71,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2143.00000,1011.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2022.99,,,,,,,557.18,2078.71,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,inpatient,,,755.00000,356.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,712.72,,,,,,,679.50,732.35,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,outpatient,,,755.00000,356.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,712.72,,,,,,,196.30,732.35,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,inpatient,,,979.00000,462.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,924.18,,,,,,,881.10,949.63,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,outpatient,,,979.00000,462.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,924.18,,,,,,,254.54,949.63,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,inpatient,,,436.00000,205.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,411.58,,,,,,,392.40,422.92,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,outpatient,,,436.00000,205.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,411.58,,,,,,,113.36,422.92,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,inpatient,,,220.00000,103.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,207.68,,,,,,,198.00,213.40,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,outpatient,,,220.00000,103.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,207.68,,,,,,,57.20,213.40,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,inpatient,,,344.00000,162.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,324.74,,,,,,,309.60,333.68,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,outpatient,,,344.00000,162.37000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,324.74,,,,,,,89.44,333.68,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,inpatient,,,818.00000,393.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,772.19,,,,,,,736.20,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,outpatient,,,818.00000,393.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,772.19,,,,,,,212.68,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,inpatient,,,545.00000,262.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,52,514.48,,,,,,,490.50,528.65,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,outpatient,,,545.00000,262.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,52,514.48,,,,,,,141.70,528.65,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,inpatient,,,1347.00000,647.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1271.57,,,,,,,1212.30,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,outpatient,,,1347.00000,647.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1271.57,,,,,,,350.22,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,inpatient,,,898.00000,431.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,52,847.71,,,,,,,808.20,871.06,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,outpatient,,,898.00000,431.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,52,847.71,,,,,,,233.48,871.06,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,inpatient,,,469.00000,225.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,442.74,,,,,,,422.10,454.93,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,outpatient,,,469.00000,225.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,442.74,,,,,,,121.94,454.93,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,inpatient,,,1762.00000,847.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1663.33,,,,,,,1585.80,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,outpatient,,,1762.00000,847.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1663.33,,,,,,,458.12,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,inpatient,,,627.00000,301.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,591.89,,,,,,,564.30,608.19,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,outpatient,,,627.00000,301.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,591.89,,,,,,,163.02,608.19,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,inpatient,,,590.00000,283.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,556.96,,,,,,,531.00,572.30,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,outpatient,,,590.00000,283.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,556.96,,,,,,,153.40,572.30,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,inpatient,,,1550.00000,745.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1463.20,,,,,,,1395.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,outpatient,,,1550.00000,745.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1463.20,,,,,,,403.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,inpatient,,,990.00000,476.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,934.56,,,,,,,891.00,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,934.56,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,inpatient,,,990.00000,476.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,934.56,,,,,,,891.00,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,934.56,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,inpatient,,,1402.00000,674.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1323.49,,,,,,,1261.80,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,outpatient,,,1402.00000,674.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1323.49,,,,,,,364.52,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,inpatient,,,980.00000,471.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,925.12,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,925.12,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,inpatient,,,980.00000,471.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,925.12,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,925.12,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,inpatient,,,1661.00000,798.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1567.98,,,,,,,1494.90,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,outpatient,,,1661.00000,798.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1567.98,,,,,,,431.86,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,inpatient,,,980.00000,471.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,925.12,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,outpatient,,,980.00000,471.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,925.12,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,inpatient,,,1740.00000,836.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1642.56,,,,,,,1566.00,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1740.00000,836.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1642.56,,,,,,,452.40,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,inpatient,,,1168.00000,561.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1102.59,,,,,,,1051.20,1132.96,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1168.00000,561.81000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1102.59,,,,,,,303.68,1132.96,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,inpatient,,,433.00000,232.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,408.75,,,,,,,389.70,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,outpatient,,,433.00000,232.09000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,408.75,,,,,,,112.58,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,inpatient,,,388.00000,207.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,366.27,,,,,,,349.20,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,366.27,,,,,,,100.88,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,inpatient,,,388.00000,207.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,366.27,,,,,,,349.20,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,366.27,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,inpatient,,,388.00000,207.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,366.27,,,,,,,349.20,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,outpatient,,,388.00000,207.97000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,366.27,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,inpatient,,,604.00000,323.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,570.18,,,,,,,543.60,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,outpatient,,,604.00000,323.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,570.18,,,,,,,157.04,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,inpatient,,,667.00000,357.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,629.65,,,,,,,600.30,646.99,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,outpatient,,,667.00000,357.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,629.65,,,,,,,173.42,646.99,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,inpatient,,,176.00000,94.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,166.14,,,,,,,158.40,170.72,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,outpatient,,,176.00000,94.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,166.14,,,,,,,45.76,170.72,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,inpatient,,,92.00000,29.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,86.85,,,,,,,82.80,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,86.85,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,inpatient,,,92.00000,29.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,86.85,,,,,,,82.80,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,86.85,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,inpatient,,,366.00000,118.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,345.50,,,,,,,329.40,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,345.50,,,,,,,95.16,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,inpatient,,,366.00000,118.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,345.50,,,,,,,329.40,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,345.50,,,,,,,95.16,355.02,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,inpatient,,,1117.00000,360.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1054.45,,,,,,,1005.30,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1054.45,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,inpatient,,,1117.00000,360.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1054.45,,,,,,,1005.30,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1054.45,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,inpatient,,,559.00000,180.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,527.70,,,,,,,503.10,542.23,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,outpatient,,,559.00000,180.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,527.70,,,,,,,145.34,542.23,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,inpatient,,,252.00000,81.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,237.89,,,,,,,226.80,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,outpatient,,,252.00000,81.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,50,237.89,,,,,,,65.52,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,inpatient,,,168.00000,54.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,158.59,,,,,,,151.20,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,158.59,,,,,,,43.68,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,inpatient,,,168.00000,54.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,158.59,,,,,,,151.20,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,158.59,,,,,,,43.68,162.96,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,inpatient,,,1148.00000,370.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1083.71,,,,,,,1033.20,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,1083.71,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,inpatient,,,1148.00000,370.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1083.71,,,,,,,1033.20,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,1083.71,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,inpatient,,,379.00000,122.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,357.78,,,,,,,341.10,367.63,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,outpatient,,,379.00000,122.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,357.78,,,,,,,98.54,367.63,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,inpatient,,,1015.00000,327.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,958.16,,,,,,,913.50,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,outpatient,,,1015.00000,327.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,958.16,,,,,,,263.90,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,inpatient,,,591.00000,190.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,557.90,,,,,,,531.90,573.27,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,outpatient,,,591.00000,190.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,557.90,,,,,,,153.66,573.27,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,inpatient,,,271.00000,169.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,255.82,,,,,,,243.90,262.87,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,outpatient,,,271.00000,169.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,255.82,,,,,,,70.46,262.87,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,inpatient,,,211.00000,132.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,199.18,,,,,,,189.90,204.67,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,LT,199.18,,,,,,,54.86,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,inpatient,,,211.00000,132.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,199.18,,,,,,,189.90,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,RT,199.18,,,,,,,54.86,204.67,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,59.00000,36.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,53.10,57.23,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,59.00000,36.99000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,55.70,,,,,,,15.34,57.23,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,inpatient,,,336.00000,219.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,317.18,,,,,,,302.40,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,outpatient,,,336.00000,219.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,317.18,,,,,,,87.36,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,inpatient,,,224.00000,146.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,52,211.46,,,,,,,201.60,217.28,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,outpatient,,,224.00000,146.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,52,211.46,,,,,,,58.24,217.28,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,inpatient,,,63.00000,41.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,56.70,61.11,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,outpatient,,,63.00000,41.20000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,59.47,,,,,,,16.38,61.11,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,475.78,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,475.78,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,573.95,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,573.95,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,202.02,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,202.02,,,,,,,55.64,207.58,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,inpatient,,,609.00000,196.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,574.90,,,,,,,548.10,590.73,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,574.90,,,,,,,158.34,590.73,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,inpatient,,,863.00000,278.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,814.67,,,,,,,776.70,837.11,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,814.67,,,,,,,224.38,837.11,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,inpatient,,,900.00000,605.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,849.60,,,,,,,810.00,873.00,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,outpatient,,,900.00000,605.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,849.60,,,,,,,234.00,873.00,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,inpatient,,,1940.00000,1102.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1831.36,,,,,,,1746.00,1881.80,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,outpatient,,,1940.00000,1102.21000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1831.36,,,,,,,504.40,1881.80,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,inpatient,,,422.00000,239.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,398.37,,,,,,,379.80,409.34,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,outpatient,,,422.00000,239.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,398.37,,,,,,,109.72,409.34,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,inpatient,,,1430.00000,812.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1349.92,,,,,,,1287.00,1387.10,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,outpatient,,,1430.00000,812.45000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1349.92,,,,,,,371.80,1387.10,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,inpatient,,,745.00000,423.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,703.28,,,,,,,670.50,722.65,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,outpatient,,,745.00000,423.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,703.28,,,,,,,193.70,722.65,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,inpatient,,,2655.00000,2487.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2506.32,,,,,,,2389.50,2575.35,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,outpatient,,,2655.00000,2487.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2506.32,,,,,,,690.30,2575.35,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,inpatient,,,3990.00000,3738.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3766.56,,,,,,,3591.00,3870.30,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,outpatient,,,3990.00000,3738.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3766.56,,,,,,,1037.40,3870.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,inpatient,,,290.00000,271.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,273.76,,,,,,,261.00,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,outpatient,,,290.00000,271.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,273.76,,,,,,,75.40,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,inpatient,,,735.00000,688.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,693.84,,,,,,,661.50,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,outpatient,,,735.00000,688.70000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,693.84,,,,,,,191.10,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,inpatient,,,1475.00000,1382.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1392.40,,,,,,,1327.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1392.40,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,inpatient,,,2275.00000,2131.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2147.60,,,,,,,2047.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,outpatient,,,2275.00000,2131.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2147.60,,,,,,,591.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,inpatient,,,3205.00000,3003.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3025.52,,,,,,,2884.50,3108.85,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,outpatient,,,3205.00000,3003.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3025.52,,,,,,,833.30,3108.85,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,inpatient,,,770.00000,721.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,726.88,,,,,,,693.00,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,outpatient,,,770.00000,721.49000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,726.88,,,,,,,200.20,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,inpatient,,,1475.00000,1382.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1392.40,,,,,,,1327.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1392.40,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,inpatient,,,2210.00000,2070.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2086.24,,,,,,,1989.00,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,outpatient,,,2210.00000,2070.77000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2086.24,,,,,,,574.60,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,inpatient,,,2660.00000,2492.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2511.04,,,,,,,2394.00,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,outpatient,,,2660.00000,2492.42000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2511.04,,,,,,,691.60,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,inpatient,,,3560.00000,3335.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3360.64,,,,,,,3204.00,3453.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,outpatient,,,3560.00000,3335.72000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3360.64,,,,,,,925.60,3453.20,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,inpatient,,,5730.00000,3255.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5409.12,,,,,,,5157.00,5558.10,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,outpatient,,,5730.00000,3255.50000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5409.12,,,,,,,1489.80,5558.10,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,inpatient,,,3875.00000,2201.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3658.00,,,,,,,3487.50,3758.75,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,outpatient,,,3875.00000,2201.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,3658.00,,,,,,,1007.50,3758.75,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,inpatient,,,519.00000,564.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,489.94,,,,,,,467.10,503.43,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,outpatient,,,519.00000,564.15000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,489.94,,,,,,,134.94,503.43,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,inpatient,,,536.00000,582.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,505.98,,,,,,,482.40,519.92,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,outpatient,,,536.00000,582.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,505.98,,,,,,,139.36,519.92,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,427.63,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,427.63,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,135.94,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,135.94,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,101.01,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,101.01,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,135.94,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,135.94,,,,,,,37.44,139.68,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,475.78,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,475.78,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,92.51,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,573.95,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,573.95,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,107.62,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,176.53,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,202.02,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,202.02,,,,,,,55.64,207.58,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,inpatient,,,175.00000,63.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,165.20,,,,,,,157.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,outpatient,,,175.00000,63.18000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,165.20,,,,,,,45.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,inpatient,,,304.00000,109.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,286.98,,,,,,,273.60,294.88,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,outpatient,,,304.00000,109.74000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,286.98,,,,,,,79.04,294.88,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,268.10,,,,,,,255.60,275.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,268.10,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,432.35,,,,,,,412.20,444.26,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,432.35,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,inpatient,,,438.00000,158.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,413.47,,,,,,,394.20,424.86,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,outpatient,,,438.00000,158.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,413.47,,,,,,,113.88,424.86,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,526.75,,,,,,,502.20,541.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,526.75,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,455.01,,,,,,,433.80,467.54,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,455.01,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,223.73,,,,,,,213.30,229.89,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,223.73,,,,,,,61.62,229.89,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,475.78,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,475.78,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,475.78,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,475.78,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,475.78,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,475.78,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,475.78,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,475.78,,,,,,,131.04,488.88,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,794.85,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,794.85,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,994.03,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,994.03,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1192.27,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1192.27,,,,,,,328.38,1225.11,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,inpatient,,,182.00000,127.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,171.81,,,,,,,163.80,176.54,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,171.81,,,,,,,47.32,176.54,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,inpatient,,,210.00000,119.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,198.24,,,,,,,189.00,203.70,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,198.24,,,,,,,54.60,203.70,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,inpatient,,,140.00000,79.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,132.16,,,,,,,126.00,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,outpatient,,,140.00000,79.54000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,132.16,,,,,,,36.40,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,inpatient,,,190.00000,107.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,179.36,,,,,,,171.00,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,outpatient,,,190.00000,107.95000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,179.36,,,,,,,49.40,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,inpatient,,,240.00000,136.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,226.56,,,,,,,216.00,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,outpatient,,,240.00000,136.36000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,226.56,,,,,,,62.40,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,inpatient,,,290.00000,164.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,273.76,,,,,,,261.00,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,outpatient,,,290.00000,164.76000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,273.76,,,,,,,75.40,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,inpatient,,,340.00000,193.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,320.96,,,,,,,306.00,329.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,outpatient,,,340.00000,193.17000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,320.96,,,,,,,88.40,329.80,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,inpatient,,,150.00000,85.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,141.60,,,,,,,135.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,outpatient,,,150.00000,85.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,141.60,,,,,,,39.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,inpatient,,,200.00000,113.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,188.80,,,,,,,180.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,outpatient,,,200.00000,113.63000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,188.80,,,,,,,52.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,inpatient,,,270.00000,153.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,254.88,,,,,,,243.00,261.90,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,outpatient,,,270.00000,153.40000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,254.88,,,,,,,70.20,261.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,inpatient,,,370.00000,210.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,349.28,,,,,,,333.00,358.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,outpatient,,,370.00000,210.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,349.28,,,,,,,96.20,358.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,inpatient,,,470.00000,267.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,443.68,,,,,,,423.00,455.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,outpatient,,,470.00000,267.03000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,443.68,,,,,,,122.20,455.90,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,inpatient,,,248.00000,96.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,234.11,,,,,,,223.20,240.56,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,outpatient,,,248.00000,96.22000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,234.11,,,,,,,64.48,240.56,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,inpatient,,,245.00000,95.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,231.28,,,,,,,220.50,237.65,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,outpatient,,,245.00000,95.06000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,231.28,,,,,,,63.70,237.65,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,inpatient,,,497.00000,192.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,469.17,,,,,,,447.30,482.09,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,outpatient,,,497.00000,192.84000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,469.17,,,,,,,129.22,482.09,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,inpatient,,,357.00000,138.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,337.01,,,,,,,321.30,346.29,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,outpatient,,,357.00000,138.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,337.01,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,inpatient,,,334.00000,129.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,315.30,,,,,,,300.60,323.98,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,outpatient,,,334.00000,129.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,315.30,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,inpatient,,,194.00000,75.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,183.14,,,,,,,174.60,188.18,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,outpatient,,,194.00000,75.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,183.14,,,,,,,50.44,188.18,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,inpatient,,,1035.00000,401.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,977.04,,,,,,,931.50,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,outpatient,,,1035.00000,401.58000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,977.04,,,,,,,269.10,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,inpatient,,,1137.00000,441.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1073.33,,,,,,,1023.30,1102.89,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,outpatient,,,1137.00000,441.16000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,1073.33,,,,,,,295.62,1102.89,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,inpatient,,,963.00000,373.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,909.07,,,,,,,866.70,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,outpatient,,,963.00000,373.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,909.07,,,,,,,250.38,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,inpatient,,,990.00000,384.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,934.56,,,,,,,891.00,960.30,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,outpatient,,,990.00000,384.12000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,934.56,,,,,,,257.40,960.30,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,inpatient,,,112.00000,43.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,105.73,,,,,,,100.80,108.64,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,outpatient,,,112.00000,43.46000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,105.73,,,,,,,29.12,108.64,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,inpatient,,,84.00000,32.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,79.30,,,,,,,75.60,81.48,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,outpatient,,,84.00000,32.59000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,79.30,,,,,,,21.84,81.48,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,inpatient,,,176.00000,68.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,166.14,,,,,,,158.40,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,outpatient,,,176.00000,68.29000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,166.14,,,,,,,45.76,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,inpatient,,,283.00000,109.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,267.15,,,,,,,254.70,274.51,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,outpatient,,,283.00000,109.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,267.15,,,,,,,73.58,274.51,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,72.90,78.57,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,76.46,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,38.70,,,,,,,36.90,39.77,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,38.70,,,,,,,10.66,39.77,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,inpatient,,,35.00000,19.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.04,,,,,,,31.50,33.95,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,35.00000,19.89000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,33.04,,,,,,,9.10,33.95,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,inpatient,,,191.00000,89.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,180.30,,,,,,,171.90,185.27,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,outpatient,,,191.00000,89.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,180.30,,,,,,,49.66,185.27,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,427.63,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,427.63,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,135.94,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,135.94,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,101.01,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,101.01,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,135.94,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,135.94,,,,,,,37.44,139.68,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,inpatient,,,281.00000,131.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,265.26,,,,,,,252.90,272.57,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,outpatient,,,281.00000,131.51000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,265.26,,,,,,,73.06,272.57,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,inpatient,,,192.00000,89.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,181.25,,,,,,,172.80,186.24,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,outpatient,,,192.00000,89.86000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,181.25,,,,,,,49.92,186.24,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,inpatient,,,365.00000,170.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,344.56,,,,,,,328.50,354.05,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,outpatient,,,365.00000,170.82000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,344.56,,,,,,,94.90,354.05,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,inpatient,,,8391.00000,5856.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7921.10,,,,,,,7551.90,8139.27,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,outpatient,,,8391.00000,5856.92000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,7921.10,,,,,,,2181.66,8139.27,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,inpatient,,,6917.00000,4828.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,52,6529.65,,,,,,,6225.30,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,52,6529.65,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,inpatient,,,6000.00000,4188.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5664.00,,,,,,,5400.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5664.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,inpatient,,,6917.00000,4828.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6529.65,,,,,,,6225.30,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6529.65,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,inpatient,,,6000.00000,4188.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,52,5664.00,,,,,,,5400.00,5820.00,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Cigna Healthcare & Life Insurance Company – WY,Commercial,52,5664.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,inpatient,,,8855.00000,9625.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8359.12,,,,,,,7969.50,8589.35,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,outpatient,,,8855.00000,9625.38000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,8359.12,,,,,,,2302.30,8589.35,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,inpatient,,,844.00000,917.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,796.74,,,,,,,759.60,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,796.74,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,inpatient,,,844.00000,917.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,52,796.74,,,,,,,759.60,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,52,796.74,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,inpatient,,,785.00000,853.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,741.04,,,,,,,706.50,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,741.04,,,,,,,204.10,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,inpatient,,,785.00000,853.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,52,741.04,,,,,,,706.50,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Cigna Healthcare & Life Insurance Company – WY,Commercial,52,741.04,,,,,,,204.10,761.45,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4709.00000,5118.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4445.30,,,,,,,4238.10,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,4445.30,,,,,,,1224.34,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4709.00000,5118.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,52,4445.30,,,,,,,4238.10,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Cigna Healthcare & Life Insurance Company – WY,Commercial,52,4445.30,,,,,,,1224.34,4567.73,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,inpatient,,,345.00000,128.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,325.68,,,,,,,310.50,334.65,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,outpatient,,,345.00000,128.34000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,325.68,,,,,,,89.70,334.65,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,inpatient,,,120.00000,99.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,113.28,,,,,,,108.00,116.40,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,outpatient,,,120.00000,99.60000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,113.28,,,,,,,31.20,116.40,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,inpatient,,,106.00000,87.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,95.40,102.82,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,outpatient,,,106.00000,87.98000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,100.06,,,,,,,27.56,102.82,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,inpatient,,,32.00000,26.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,30.21,,,,,,,28.80,31.04,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,outpatient,,,32.00000,26.56000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,30.21,,,,,,,8.32,31.04,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,inpatient,,,60.00000,49.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,54.00,58.20,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,outpatient,,,60.00000,49.80000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,56.64,,,,,,,15.60,58.20,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,inpatient,,,57.00000,47.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,51.30,55.29,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,outpatient,,,57.00000,47.31000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,53.81,,,,,,,14.82,55.29,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,inpatient,1.0,ME,7.40000,0.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6.99,,,,,,,6.66,7.18,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,outpatient,1.0,ME,7.40000,0.65000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,6.99,,,,,,,1.92,7.18,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,inpatient,1.0,EA,6.60000,1.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,6.23,,,,,,,5.94,6.40,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,outpatient,1.0,EA,6.60000,1.43000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,6.23,,,,,,,1.72,6.40,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,inpatient,1.0,EA,2.95000,0.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,2.78,,,,,,,2.65,2.86,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,outpatient,1.0,EA,2.95000,0.64000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,2.78,,,,,,,0.76700,2.86,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,inpatient,1.0,EA,56.08000,12.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,52.94,,,,,,,50.47,54.40,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,56.08000,12.11000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,52.94,,,,,,,14.58,54.40,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,inpatient,1.0,UN,82.10000,28.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,77.50,,,,,,,73.89,79.64,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,outpatient,1.0,UN,82.10000,28.90000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,77.50,,,,,,,15.48,79.64,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.04000,,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,0.03776,,,,,,,0.03600,0.03880,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.04000,,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,0.03776,,,,,,,0.01040,0.03880,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.05000,,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,0.04720,,,,,,,0.04500,0.04850,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.05000,,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,0.04720,,,,,,,0.01300,0.04850,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,inpatient,1.0,ME,6.20000,0.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5.85,,,,,,,5.58,6.01,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,outpatient,1.0,ME,6.20000,0.55000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5.85,,,,,,,1.61,6.01,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.12000,0.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,0.11328,,,,,,,0.10800,0.11640,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.12000,0.01000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,0.11328,,,,,,,0.03120,0.11640,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,inpatient,2.0,ML,5.80000,1.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5.48,,,,,,,5.22,5.63,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,outpatient,2.0,ML,5.80000,1.25000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,5.48,,,,,,,1.51,5.63,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,inpatient,1.0,ME,3.10000,0.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2.93,,,,,,,2.79,3.01,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,outpatient,1.0,ME,3.10000,0.27000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,2.93,,,,,,,0.80600,3.01,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,inpatient,1.0,EA,44.40000,3.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41.91,,,,,,,39.96,43.07,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,outpatient,1.0,EA,44.40000,3.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,41.91,,,,,,,11.54,43.07,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,inpatient,1.0,EA,8.26000,0.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,7.80,,,,,,,7.43,8.01,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,8.26000,0.73000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,7.80,,,,,,,2.15,8.01,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,2.19000,0.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,2.07,,,,,,,1.97,2.12,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,2.19000,0.19000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,2.07,,,,,,,0.56940,2.12,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,inpatient,1.0,EA,28.60000,2.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,27.00,,,,,,,25.74,27.74,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,outpatient,1.0,EA,28.60000,2.52000,Cigna Healthcare & Life Insurance Company – WY,Commercial,,27.00,,,,,,,7.44,27.74,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,inpatient,1.0,EA,2.58000,0.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,2.44,,,,,,,2.32,2.50,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,outpatient,1.0,EA,2.58000,0.91000,Cigna Healthcare & Life Insurance Company – WY,Commercial,UD,2.44,,,,,,,0.67080,2.50,percent of total billed charges,
R&B OBSTETRICS PVT,3012,CDM,112,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Coventry,Commercial,,2669.76,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,23010,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Coventry,Commercial,,2669.76,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ICU,33019,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Coventry,Commercial,,8410.56,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,13011,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Coventry,Commercial,,5607.36,,,,,,,2512.00,5665.77,percent of total billed charges,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,244.00000,77.10000,Coventry,Commercial,,234.24,,,,,,,219.60,236.68,percent of total billed charges,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,244.00000,77.10000,Coventry,Commercial,,234.24,,,,,,,63.44,236.68,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,24075,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Coventry,Commercial,,2669.76,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B OBSTETRICS SEMI-PVT,44073,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Coventry,Commercial,,2669.76,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B NURSERY LEVEL 1,55160,CDM,171,RC,,,,,facility,inpatient,,,3477.00000,1975.46000,Coventry,Commercial,,3337.92,,,,,,,2512.00,3372.69,percent of total billed charges,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,inpatient,,,16.00000,7.71000,Coventry,Commercial,,15.36,,,,,,,14.40,15.52,percent of total billed charges,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,outpatient,,,16.00000,7.71000,Coventry,Commercial,,15.36,,,,,,,4.16,15.52,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,inpatient,,,210.00000,119.31000,Coventry,Commercial,,201.60,,,,,,,189.00,203.70,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Coventry,Commercial,,201.60,,,,,,,54.60,203.70,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,inpatient,,,380.00000,215.90000,Coventry,Commercial,,364.80,,,,,,,342.00,368.60,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,outpatient,,,380.00000,215.90000,Coventry,Commercial,,364.80,,,,,,,98.80,368.60,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Coventry,Commercial,,111.36,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Coventry,Commercial,,111.36,,,,,,,30.16,112.52,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22012,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Coventry,Commercial,,2669.76,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ADMIN DAY SKILLED,82016,CDM,160,RC,,,,,facility,inpatient,,,1923.00000,1092.55000,Coventry,Commercial,,1846.08,,,,,,,1730.70,3111.10,percent of total billed charges,
R&B SWING BED SKILLED,62018,CDM,160,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Coventry,Commercial,,2669.76,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ADMIN DAY INTERMEDIATE,72017,CDM,169,RC,,,,,facility,inpatient,,,1176.00000,668.14000,Coventry,Commercial,,1128.96,,,,,,,1058.40,3111.10,percent of total billed charges,
R&B ICU,32011,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Coventry,Commercial,,8410.56,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,12013,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Coventry,Commercial,,5607.36,,,,,,,2512.00,5665.77,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Coventry,Commercial,,111.36,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Coventry,Commercial,,111.36,,,,,,,30.16,112.52,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Coventry,Commercial,,483.84,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Coventry,Commercial,,483.84,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Coventry,Commercial,,94.08,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Coventry,Commercial,,94.08,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Coventry,Commercial,,583.68,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Coventry,Commercial,,583.68,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Coventry,Commercial,,109.44,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Coventry,Commercial,,109.44,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Coventry,Commercial,,179.52,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Coventry,Commercial,,179.52,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Coventry,Commercial,,205.44,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Coventry,Commercial,,205.44,,,,,,,55.64,207.58,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,84.00000,63.59000,Coventry,Commercial,,80.64,,,,,,,75.60,81.48,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Coventry,Commercial,,80.64,,,,,,,21.84,81.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Coventry,Commercial,,272.64,,,,,,,255.60,275.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Coventry,Commercial,,272.64,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Coventry,Commercial,,439.68,,,,,,,412.20,444.26,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Coventry,Commercial,,439.68,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Coventry,Commercial,,535.68,,,,,,,502.20,541.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Coventry,Commercial,,535.68,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Coventry,Commercial,,462.72,,,,,,,433.80,467.54,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Coventry,Commercial,,462.72,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Coventry,Commercial,,227.52,,,,,,,213.30,229.89,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Coventry,Commercial,,227.52,,,,,,,61.62,229.89,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,inpatient,,,2041.00000,659.24000,Coventry,Commercial,,1959.36,,,,,,,1836.90,1979.77,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,outpatient,,,2041.00000,659.24000,Coventry,Commercial,,1959.36,,,,,,,530.66,1979.77,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,inpatient,,,259.00000,83.66000,Coventry,Commercial,,248.64,,,,,,,233.10,251.23,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,outpatient,,,259.00000,83.66000,Coventry,Commercial,,248.64,,,,,,,67.34,251.23,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,inpatient,,,672.00000,217.06000,Coventry,Commercial,,645.12,,,,,,,604.80,651.84,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,outpatient,,,672.00000,217.06000,Coventry,Commercial,,645.12,,,,,,,174.72,651.84,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,inpatient,,,530.00000,171.19000,Coventry,Commercial,,508.80,,,,,,,477.00,514.10,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,outpatient,,,530.00000,171.19000,Coventry,Commercial,,508.80,,,,,,,137.80,514.10,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,inpatient,,,580.00000,187.34000,Coventry,Commercial,,556.80,,,,,,,522.00,562.60,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,outpatient,,,580.00000,187.34000,Coventry,Commercial,,556.80,,,,,,,150.80,562.60,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,inpatient,,,435.00000,140.50000,Coventry,Commercial,,417.60,,,,,,,391.50,421.95,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,outpatient,,,435.00000,140.50000,Coventry,Commercial,,417.60,,,,,,,113.10,421.95,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,inpatient,,,863.00000,278.75000,Coventry,Commercial,,828.48,,,,,,,776.70,837.11,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Coventry,Commercial,,828.48,,,,,,,224.38,837.11,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,inpatient,,,334.00000,107.88000,Coventry,Commercial,,320.64,,,,,,,300.60,323.98,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,outpatient,,,334.00000,107.88000,Coventry,Commercial,,320.64,,,,,,,86.84,323.98,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,inpatient,,,1188.00000,383.72000,Coventry,Commercial,50,1140.48,,,,,,,1069.20,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,outpatient,,,1188.00000,383.72000,Coventry,Commercial,50,1140.48,,,,,,,308.88,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,inpatient,,,792.00000,255.82000,Coventry,Commercial,LT,760.32,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Coventry,Commercial,LT,760.32,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,inpatient,,,792.00000,255.82000,Coventry,Commercial,RT,760.32,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Coventry,Commercial,RT,760.32,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,inpatient,,,572.00000,184.76000,Coventry,Commercial,50,549.12,,,,,,,514.80,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,outpatient,,,572.00000,184.76000,Coventry,Commercial,50,549.12,,,,,,,148.72,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,inpatient,,,381.00000,123.06000,Coventry,Commercial,LT,365.76,,,,,,,342.90,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Coventry,Commercial,LT,365.76,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,inpatient,,,381.00000,123.06000,Coventry,Commercial,RT,365.76,,,,,,,342.90,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Coventry,Commercial,RT,365.76,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,inpatient,,,455.00000,146.96000,Coventry,Commercial,,436.80,,,,,,,409.50,441.35,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,outpatient,,,455.00000,146.96000,Coventry,Commercial,,436.80,,,,,,,118.30,441.35,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,inpatient,,,403.00000,130.17000,Coventry,Commercial,,386.88,,,,,,,362.70,390.91,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,outpatient,,,403.00000,130.17000,Coventry,Commercial,,386.88,,,,,,,104.78,390.91,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,inpatient,,,370.00000,119.51000,Coventry,Commercial,,355.20,,,,,,,333.00,358.90,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,outpatient,,,370.00000,119.51000,Coventry,Commercial,,355.20,,,,,,,96.20,358.90,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,inpatient,,,357.00000,115.31000,Coventry,Commercial,,342.72,,,,,,,321.30,346.29,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,outpatient,,,357.00000,115.31000,Coventry,Commercial,,342.72,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,inpatient,,,334.00000,107.88000,Coventry,Commercial,,320.64,,,,,,,300.60,323.98,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,outpatient,,,334.00000,107.88000,Coventry,Commercial,,320.64,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,inpatient,,,194.00000,62.66000,Coventry,Commercial,,186.24,,,,,,,174.60,188.18,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,outpatient,,,194.00000,62.66000,Coventry,Commercial,,186.24,,,,,,,50.44,188.18,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,inpatient,,,457.00000,147.61000,Coventry,Commercial,,438.72,,,,,,,411.30,443.29,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,outpatient,,,457.00000,147.61000,Coventry,Commercial,,438.72,,,,,,,118.82,443.29,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,inpatient,,,492.00000,158.92000,Coventry,Commercial,,472.32,,,,,,,442.80,477.24,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,outpatient,,,492.00000,158.92000,Coventry,Commercial,,472.32,,,,,,,127.92,477.24,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,inpatient,,,780.00000,251.94000,Coventry,Commercial,,748.80,,,,,,,702.00,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,outpatient,,,780.00000,251.94000,Coventry,Commercial,,748.80,,,,,,,202.80,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,inpatient,,,1165.00000,376.30000,Coventry,Commercial,,1118.40,,,,,,,1048.50,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,outpatient,,,1165.00000,376.30000,Coventry,Commercial,,1118.40,,,,,,,302.90,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,inpatient,,,2350.00000,759.05000,Coventry,Commercial,,2256.00,,,,,,,2115.00,2279.50,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,outpatient,,,2350.00000,759.05000,Coventry,Commercial,,2256.00,,,,,,,611.00,2279.50,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,inpatient,,,896.00000,289.41000,Coventry,Commercial,,860.16,,,,,,,806.40,869.12,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,outpatient,,,896.00000,289.41000,Coventry,Commercial,,860.16,,,,,,,232.96,869.12,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,inpatient,,,490.00000,158.27000,Coventry,Commercial,,470.40,,,,,,,441.00,475.30,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,outpatient,,,490.00000,158.27000,Coventry,Commercial,,470.40,,,,,,,127.40,475.30,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,inpatient,,,520.00000,167.96000,Coventry,Commercial,,499.20,,,,,,,468.00,504.40,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,outpatient,,,520.00000,167.96000,Coventry,Commercial,,499.20,,,,,,,135.20,504.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,inpatient,,,720.00000,232.56000,Coventry,Commercial,,691.20,,,,,,,648.00,698.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,outpatient,,,720.00000,232.56000,Coventry,Commercial,,691.20,,,,,,,187.20,698.40,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,inpatient,,,215.00000,69.45000,Coventry,Commercial,,206.40,,,,,,,193.50,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,outpatient,,,215.00000,69.45000,Coventry,Commercial,,206.40,,,,,,,55.90,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,inpatient,,,240.00000,77.52000,Coventry,Commercial,,230.40,,,,,,,216.00,232.80,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,outpatient,,,240.00000,77.52000,Coventry,Commercial,,230.40,,,,,,,62.40,232.80,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,inpatient,,,1241.00000,400.84000,Coventry,Commercial,,1191.36,,,,,,,1116.90,1203.77,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,outpatient,,,1241.00000,400.84000,Coventry,Commercial,,1191.36,,,,,,,322.66,1203.77,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Coventry,Commercial,,808.32,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Coventry,Commercial,,808.32,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Coventry,Commercial,,1010.88,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Coventry,Commercial,,1010.88,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Coventry,Commercial,,1212.48,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Coventry,Commercial,,1212.48,,,,,,,328.38,1225.11,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,inpatient,,,668.00000,559.78000,Coventry,Commercial,,641.28,,,,,,,601.20,647.96,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,outpatient,,,668.00000,559.78000,Coventry,Commercial,,641.28,,,,,,,173.68,647.96,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Coventry,Commercial,,77.76,,,,,,,72.90,78.57,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Coventry,Commercial,,77.76,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Coventry,Commercial,,39.36,,,,,,,36.90,39.77,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Coventry,Commercial,,39.36,,,,,,,10.66,39.77,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Coventry,Commercial,,434.88,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Coventry,Commercial,,434.88,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Coventry,Commercial,,138.24,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Coventry,Commercial,,138.24,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Coventry,Commercial,,102.72,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Coventry,Commercial,,102.72,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Coventry,Commercial,,138.24,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Coventry,Commercial,,138.24,,,,,,,37.44,139.68,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Coventry,Commercial,,3.26,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Coventry,Commercial,,3.26,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Coventry,Commercial,,3.26,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Coventry,Commercial,,3.26,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Coventry,Commercial,,3.26,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Coventry,Commercial,,3.26,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,4.90000,2.78000,Coventry,Commercial,,4.70,,,,,,,4.41,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Coventry,Commercial,,4.70,,,,,,,1.27,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,7.90000,4.49000,Coventry,Commercial,,7.58,,,,,,,7.11,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,7.90000,4.49000,Coventry,Commercial,,7.58,,,,,,,2.05,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,4.90000,2.78000,Coventry,Commercial,,4.70,,,,,,,4.41,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Coventry,Commercial,,4.70,,,,,,,1.27,4.75,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Coventry,Commercial,,77.76,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Coventry,Commercial,,77.76,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Coventry,Commercial,,77.76,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Coventry,Commercial,,77.76,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Coventry,Commercial,,77.76,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Coventry,Commercial,,77.76,,,,,,,21.06,78.57,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,inpatient,,,3141500.00000,1784843.22000,Coventry,Commercial,,3015840.00,,,,,,,2827350.00,3047255.00,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,outpatient,,,3141500.00000,1784843.22000,Coventry,Commercial,,3015840.00,,,,,,,816790.00,3047255.00,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Coventry,Commercial,UD,0.21120,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Coventry,Commercial,UD,0.21120,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.52000,0.30000,Coventry,Commercial,UD,0.49920,,,,,,,0.46800,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.52000,0.30000,Coventry,Commercial,UD,0.49920,,,,,,,0.13520,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.56000,0.32000,Coventry,Commercial,UD,0.53760,,,,,,,0.50400,0.54320,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.56000,0.32000,Coventry,Commercial,UD,0.53760,,,,,,,0.14560,0.54320,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Coventry,Commercial,UD,0.21120,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Coventry,Commercial,UD,0.21120,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.85000,0.48000,Coventry,Commercial,UD,0.81600,,,,,,,0.76500,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.85000,0.48000,Coventry,Commercial,UD,0.81600,,,,,,,0.22100,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Coventry,Commercial,UD,0.21120,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Coventry,Commercial,UD,0.21120,,,,,,,0.05720,0.21340,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,inpatient,,,102.00000,65.18000,Coventry,Commercial,,97.92,,,,,,,91.80,98.94,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,outpatient,,,102.00000,65.18000,Coventry,Commercial,,97.92,,,,,,,26.52,98.94,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,inpatient,,,190.00000,121.41000,Coventry,Commercial,,182.40,,,,,,,171.00,184.30,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,outpatient,,,190.00000,121.41000,Coventry,Commercial,,182.40,,,,,,,49.40,184.30,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,inpatient,,,359.00000,229.40000,Coventry,Commercial,,344.64,,,,,,,323.10,348.23,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Coventry,Commercial,,344.64,,,,,,,93.34,348.23,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,inpatient,,,535.00000,341.86000,Coventry,Commercial,,513.60,,,,,,,481.50,518.95,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Coventry,Commercial,,513.60,,,,,,,139.10,518.95,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,inpatient,,,766.00000,489.47000,Coventry,Commercial,,735.36,,,,,,,689.40,743.02,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,outpatient,,,766.00000,489.47000,Coventry,Commercial,,735.36,,,,,,,199.16,743.02,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,inpatient,,,159.00000,101.60000,Coventry,Commercial,,152.64,,,,,,,143.10,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,outpatient,,,159.00000,101.60000,Coventry,Commercial,,152.64,,,,,,,41.34,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,inpatient,,,447.00000,285.63000,Coventry,Commercial,,429.12,,,,,,,402.30,433.59,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,outpatient,,,447.00000,285.63000,Coventry,Commercial,,429.12,,,,,,,116.22,433.59,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,inpatient,,,1413.00000,902.91000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,outpatient,,,1413.00000,902.91000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,inpatient,,,3853.00000,2462.07000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,outpatient,,,3853.00000,2462.07000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,inpatient,,,313.00000,200.01000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,outpatient,,,313.00000,200.01000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,inpatient,,,1132.00000,723.35000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,outpatient,,,1132.00000,723.35000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,inpatient,,,2695.00000,1722.10000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,outpatient,,,2695.00000,1722.10000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,inpatient,,,1619.00000,1034.54000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,outpatient,,,1619.00000,1034.54000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,inpatient,,,535.00000,341.86000,Coventry,Commercial,,513.60,,,,,,,481.50,518.95,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Coventry,Commercial,,513.60,,,,,,,139.10,518.95,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,inpatient,,,850.00000,543.15000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,outpatient,,,850.00000,543.15000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,inpatient,,,32.00000,20.45000,Coventry,Commercial,,30.72,,,,,,,28.80,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,outpatient,,,32.00000,20.45000,Coventry,Commercial,,30.72,,,,,,,8.32,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,inpatient,,,134.00000,85.63000,Coventry,Commercial,,128.64,,,,,,,120.60,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,outpatient,,,134.00000,85.63000,Coventry,Commercial,,128.64,,,,,,,34.84,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,inpatient,,,359.00000,229.40000,Coventry,Commercial,,344.64,,,,,,,323.10,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Coventry,Commercial,,344.64,,,,,,,93.34,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,inpatient,,,709.00000,453.05000,Coventry,Commercial,,680.64,,,,,,,638.10,687.73,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,outpatient,,,709.00000,453.05000,Coventry,Commercial,,680.64,,,,,,,184.34,687.73,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,inpatient,,,4880.00000,2357.04000,Coventry,Commercial,,4684.80,,,,,,,4392.00,4733.60,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,outpatient,,,4880.00000,2357.04000,Coventry,Commercial,,4684.80,,,,,,,1268.80,4733.60,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,inpatient,,,6024.00000,2909.59000,Coventry,Commercial,,5783.04,,,,,,,5421.60,5843.28,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,outpatient,,,6024.00000,2909.59000,Coventry,Commercial,,5783.04,,,,,,,1566.24,5843.28,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Coventry,Commercial,,429.12,,,,,,,402.30,433.59,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Coventry,Commercial,,429.12,,,,,,,116.22,433.59,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Coventry,Commercial,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Coventry,Commercial,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,inpatient,,,7413.00000,3580.48000,Coventry,Commercial,,7116.48,,,,,,,6671.70,7190.61,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,outpatient,,,7413.00000,3580.48000,Coventry,Commercial,,7116.48,,,,,,,1927.38,7190.61,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Coventry,Commercial,,429.12,,,,,,,402.30,433.59,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Coventry,Commercial,,429.12,,,,,,,116.22,433.59,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Coventry,Commercial,,429.12,,,,,,,402.30,433.59,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Coventry,Commercial,,429.12,,,,,,,116.22,433.59,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Coventry,Commercial,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Coventry,Commercial,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,inpatient,,,7181.00000,3468.42000,Coventry,Commercial,,6893.76,,,,,,,6462.90,6965.57,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Coventry,Commercial,,6893.76,,,,,,,1867.06,6965.57,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,inpatient,,,10654.00000,5145.88000,Coventry,Commercial,,10227.84,,,,,,,9588.60,10334.38,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,outpatient,,,10654.00000,5145.88000,Coventry,Commercial,,10227.84,,,,,,,2770.04,10334.38,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,6487.00000,3133.22000,Coventry,Commercial,,6227.52,,,,,,,5838.30,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Coventry,Commercial,,6227.52,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,7413.00000,3580.48000,Coventry,Commercial,,7116.48,,,,,,,6671.70,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Coventry,Commercial,,7116.48,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,11575.00000,5590.72000,Coventry,Commercial,,11112.00,,,,,,,10417.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,11575.00000,5590.72000,Coventry,Commercial,,11112.00,,,,,,,3009.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,13432.00000,6487.66000,Coventry,Commercial,,12894.72,,,,,,,12088.80,13029.04,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,13432.00000,6487.66000,Coventry,Commercial,,12894.72,,,,,,,3492.32,13029.04,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,21904.00000,10579.63000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,21904.00000,10579.63000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,4397.00000,2123.75000,Coventry,Commercial,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Coventry,Commercial,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,7413.00000,3580.48000,Coventry,Commercial,,7116.48,,,,,,,6671.70,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Coventry,Commercial,,7116.48,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,12969.00000,6264.03000,Coventry,Commercial,,12450.24,,,,,,,11672.10,12579.93,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,12969.00000,6264.03000,Coventry,Commercial,,12450.24,,,,,,,3371.94,12579.93,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Coventry,Commercial,,2328.96,,,,,,,2183.40,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Coventry,Commercial,,2328.96,,,,,,,630.76,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Coventry,Commercial,,2713.92,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Coventry,Commercial,,2713.92,,,,,,,735.02,2742.19,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Coventry,Commercial,,97.92,,,,,,,91.80,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Coventry,Commercial,,97.92,,,,,,,26.52,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,inpatient,,,134.00000,64.72000,Coventry,Commercial,,128.64,,,,,,,120.60,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Coventry,Commercial,,128.64,,,,,,,34.84,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,inpatient,,,251.00000,121.23000,Coventry,Commercial,,240.96,,,,,,,225.90,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,outpatient,,,251.00000,121.23000,Coventry,Commercial,,240.96,,,,,,,65.26,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,447.00000,215.90000,Coventry,Commercial,,429.12,,,,,,,402.30,433.59,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,447.00000,215.90000,Coventry,Commercial,,429.12,,,,,,,116.22,433.59,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,2827.00000,1365.44000,Coventry,Commercial,,2713.92,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Coventry,Commercial,,2713.92,,,,,,,735.02,2742.19,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,2690.00000,1299.27000,Coventry,Commercial,,2582.40,,,,,,,2421.00,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Coventry,Commercial,,2582.40,,,,,,,699.40,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,6487.00000,3133.22000,Coventry,Commercial,,6227.52,,,,,,,5838.30,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Coventry,Commercial,,6227.52,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,2426.00000,1171.76000,Coventry,Commercial,,2328.96,,,,,,,2183.40,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,2426.00000,1171.76000,Coventry,Commercial,,2328.96,,,,,,,630.76,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,15334.00000,7406.32000,Coventry,Commercial,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,15334.00000,7406.32000,Coventry,Commercial,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Coventry,Commercial,,2713.92,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Coventry,Commercial,,2713.92,,,,,,,735.02,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,251.00000,121.23000,Coventry,Commercial,,240.96,,,,,,,225.90,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,251.00000,121.23000,Coventry,Commercial,,240.96,,,,,,,65.26,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,2827.00000,1365.44000,Coventry,Commercial,,2713.92,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Coventry,Commercial,,2713.92,,,,,,,735.02,2742.19,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Coventry,Commercial,,30.72,,,,,,,28.80,31.04,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Coventry,Commercial,,30.72,,,,,,,8.32,31.04,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,inpatient,,,15334.00000,7406.32000,Coventry,Commercial,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Coventry,Commercial,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,inpatient,,,1485.00000,717.26000,Coventry,Commercial,,1425.60,,,,,,,1336.50,1440.45,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,outpatient,,,1485.00000,717.26000,Coventry,Commercial,,1425.60,,,,,,,386.10,1440.45,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,inpatient,,,2028.00000,979.52000,Coventry,Commercial,,1946.88,,,,,,,1825.20,1967.16,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,outpatient,,,2028.00000,979.52000,Coventry,Commercial,,1946.88,,,,,,,527.28,1967.16,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,4397.00000,2123.75000,Coventry,Commercial,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Coventry,Commercial,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,8107.00000,3915.68000,Coventry,Commercial,,7782.72,,,,,,,7296.30,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,8107.00000,3915.68000,Coventry,Commercial,,7782.72,,,,,,,2107.82,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,10422.00000,5033.83000,Coventry,Commercial,,10005.12,,,,,,,9379.80,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,10422.00000,5033.83000,Coventry,Commercial,,10005.12,,,,,,,2709.72,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,12737.00000,6151.97000,Coventry,Commercial,,12227.52,,,,,,,11463.30,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,12737.00000,6151.97000,Coventry,Commercial,,12227.52,,,,,,,3311.62,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,14239.00000,6877.44000,Coventry,Commercial,,13669.44,,,,,,,12815.10,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,14239.00000,6877.44000,Coventry,Commercial,,13669.44,,,,,,,3702.14,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,16429.00000,7935.21000,Coventry,Commercial,,15771.84,,,,,,,14786.10,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,16429.00000,7935.21000,Coventry,Commercial,,15771.84,,,,,,,4271.54,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,18619.00000,8992.98000,Coventry,Commercial,,17874.24,,,,,,,16757.10,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,18619.00000,8992.98000,Coventry,Commercial,,17874.24,,,,,,,4840.94,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,20809.00000,10050.75000,Coventry,Commercial,,19976.64,,,,,,,18728.10,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,20809.00000,10050.75000,Coventry,Commercial,,19976.64,,,,,,,5410.34,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,22999.00000,11108.52000,Coventry,Commercial,,22079.04,,,,,,,20699.10,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,22999.00000,11108.52000,Coventry,Commercial,,22079.04,,,,,,,5979.74,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,25189.00000,12166.29000,Coventry,Commercial,,24181.44,,,,,,,22670.10,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,25189.00000,12166.29000,Coventry,Commercial,,24181.44,,,,,,,6549.14,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,27379.00000,13224.06000,Coventry,Commercial,,26283.84,,,,,,,24641.10,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,27379.00000,13224.06000,Coventry,Commercial,,26283.84,,,,,,,7118.54,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,29569.00000,14281.83000,Coventry,Commercial,,28386.24,,,,,,,26612.10,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,29569.00000,14281.83000,Coventry,Commercial,,28386.24,,,,,,,7687.94,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,31759.00000,15339.60000,Coventry,Commercial,,30488.64,,,,,,,28583.10,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,31759.00000,15339.60000,Coventry,Commercial,,30488.64,,,,,,,8257.34,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,36139.00000,17455.14000,Coventry,Commercial,,34693.44,,,,,,,32525.10,35054.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,36139.00000,17455.14000,Coventry,Commercial,,34693.44,,,,,,,9396.14,35054.83,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Coventry,Commercial,,3206.40,,,,,,,3006.00,3239.80,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Coventry,Commercial,,3206.40,,,,,,,868.40,3239.80,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Coventry,Commercial,,30.72,,,,,,,28.80,31.04,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Coventry,Commercial,,30.72,,,,,,,8.32,31.04,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,inpatient,,,134.00000,64.72000,Coventry,Commercial,,128.64,,,,,,,120.60,129.98,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Coventry,Commercial,,128.64,,,,,,,34.84,129.98,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Coventry,Commercial,,182.40,,,,,,,171.00,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Coventry,Commercial,,182.40,,,,,,,49.40,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,inpatient,,,476.00000,229.91000,Coventry,Commercial,,456.96,,,,,,,428.40,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,outpatient,,,476.00000,229.91000,Coventry,Commercial,,456.96,,,,,,,123.76,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Coventry,Commercial,,30.72,,,,,,,28.80,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Coventry,Commercial,,30.72,,,,,,,8.32,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Coventry,Commercial,,429.12,,,,,,,402.30,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Coventry,Commercial,,429.12,,,,,,,116.22,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,inpatient,,,12506.00000,6040.40000,Coventry,Commercial,,12005.76,,,,,,,11255.40,12130.82,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,outpatient,,,12506.00000,6040.40000,Coventry,Commercial,,12005.76,,,,,,,3251.56,12130.82,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,inpatient,,,2404.80000,1161.52000,Coventry,Commercial,,2308.61,,,,,,,2164.32,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,outpatient,,,2404.80000,1161.52000,Coventry,Commercial,,2308.61,,,,,,,625.25,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,inpatient,,,969.00000,468.03000,Coventry,Commercial,,930.24,,,,,,,872.10,939.93,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,outpatient,,,969.00000,468.03000,Coventry,Commercial,,930.24,,,,,,,251.94,939.93,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,inpatient,,,2256.90000,1090.08000,Coventry,Commercial,,2166.62,,,,,,,2031.21,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,outpatient,,,2256.90000,1090.08000,Coventry,Commercial,,2166.62,,,,,,,586.79,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,inpatient,,,644.30000,311.20000,Coventry,Commercial,,618.53,,,,,,,579.87,624.97,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,outpatient,,,644.30000,311.20000,Coventry,Commercial,,618.53,,,,,,,167.52,624.97,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Coventry,Commercial,,97.92,,,,,,,91.80,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Coventry,Commercial,,97.92,,,,,,,26.52,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Coventry,Commercial,,182.40,,,,,,,171.00,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Coventry,Commercial,,182.40,,,,,,,49.40,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,inpatient,,,26284.00000,12695.17000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,inpatient,,,30664.00000,14810.71000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,inpatient,,,35044.00000,16926.25000,Coventry,Commercial,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Coventry,Commercial,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,inpatient,,,43804.00000,21157.33000,Coventry,Commercial,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,outpatient,,,43804.00000,21157.33000,Coventry,Commercial,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,inpatient,,,52564.00000,25388.41000,Coventry,Commercial,,50461.44,,,,,,,47307.60,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,outpatient,,,52564.00000,25388.41000,Coventry,Commercial,,50461.44,,,,,,,13666.64,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,inpatient,,,61324.00000,29619.49000,Coventry,Commercial,,58871.04,,,,,,,55191.60,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,outpatient,,,61324.00000,29619.49000,Coventry,Commercial,,58871.04,,,,,,,15944.24,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,inpatient,,,70084.00000,33850.57000,Coventry,Commercial,,67280.64,,,,,,,63075.60,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,outpatient,,,70084.00000,33850.57000,Coventry,Commercial,,67280.64,,,,,,,18221.84,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,inpatient,,,78844.00000,38081.65000,Coventry,Commercial,,75690.24,,,,,,,70959.60,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,outpatient,,,78844.00000,38081.65000,Coventry,Commercial,,75690.24,,,,,,,20499.44,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,inpatient,,,87604.00000,42312.73000,Coventry,Commercial,,84099.84,,,,,,,78843.60,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,outpatient,,,87604.00000,42312.73000,Coventry,Commercial,,84099.84,,,,,,,22777.04,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,inpatient,,,96364.00000,46543.81000,Coventry,Commercial,,92509.44,,,,,,,86727.60,93473.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,outpatient,,,96364.00000,46543.81000,Coventry,Commercial,,92509.44,,,,,,,25054.64,93473.08,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,inpatient,,,26284.00000,12695.17000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,inpatient,,,30664.00000,14810.71000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,inpatient,,,35044.00000,16926.25000,Coventry,Commercial,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Coventry,Commercial,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,inpatient,,,39424.00000,19041.79000,Coventry,Commercial,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,outpatient,,,39424.00000,19041.79000,Coventry,Commercial,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Coventry,Commercial,,3752.64,,,,,,,3518.10,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Coventry,Commercial,,3752.64,,,,,,,1016.34,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Coventry,Commercial,,182.40,,,,,,,171.00,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Coventry,Commercial,,182.40,,,,,,,49.40,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,inpatient,,,15334.00000,7406.32000,Coventry,Commercial,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Coventry,Commercial,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,2023.00000,977.11000,Coventry,Commercial,,1942.08,,,,,,,1820.70,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2023.00000,977.11000,Coventry,Commercial,,1942.08,,,,,,,525.98,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,inpatient,,,7876.00000,3804.11000,Coventry,Commercial,,7560.96,,,,,,,7088.40,7639.72,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Coventry,Commercial,,7560.96,,,,,,,2047.76,7639.72,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,inpatient,,,10191.00000,4922.25000,Coventry,Commercial,,9783.36,,,,,,,9171.90,9885.27,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,outpatient,,,10191.00000,4922.25000,Coventry,Commercial,,9783.36,,,,,,,2649.66,9885.27,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,96.00000,46.37000,Coventry,Commercial,,92.16,,,,,,,86.40,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,96.00000,46.37000,Coventry,Commercial,,92.16,,,,,,,24.96,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,7876.00000,3804.11000,Coventry,Commercial,,7560.96,,,,,,,7088.40,7639.72,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,7876.00000,3804.11000,Coventry,Commercial,,7560.96,,,,,,,2047.76,7639.72,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Coventry,Commercial,,3752.64,,,,,,,3518.10,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Coventry,Commercial,,3752.64,,,,,,,1016.34,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,inpatient,,,5373.00000,2595.16000,Coventry,Commercial,,5158.08,,,,,,,4835.70,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,outpatient,,,5373.00000,2595.16000,Coventry,Commercial,,5158.08,,,,,,,1396.98,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,inpatient,,,6487.00000,3133.22000,Coventry,Commercial,,6227.52,,,,,,,5838.30,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,outpatient,,,6487.00000,3133.22000,Coventry,Commercial,,6227.52,,,,,,,1686.62,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,inpatient,,,7876.00000,3804.11000,Coventry,Commercial,,7560.96,,,,,,,7088.40,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Coventry,Commercial,,7560.96,,,,,,,2047.76,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Coventry,Commercial,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Coventry,Commercial,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,inpatient,,,1126.00000,543.86000,Coventry,Commercial,,1080.96,,,,,,,1013.40,1092.22,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,outpatient,,,1126.00000,543.86000,Coventry,Commercial,,1080.96,,,,,,,292.76,1092.22,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,2690.00000,1299.27000,Coventry,Commercial,,2582.40,,,,,,,2421.00,2609.30,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Coventry,Commercial,,2582.40,,,,,,,699.40,2609.30,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,4880.00000,2357.04000,Coventry,Commercial,,4684.80,,,,,,,4392.00,4733.60,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,4880.00000,2357.04000,Coventry,Commercial,,4684.80,,,,,,,1268.80,4733.60,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,9260.00000,4472.58000,Coventry,Commercial,,8889.60,,,,,,,8334.00,8982.20,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,9260.00000,4472.58000,Coventry,Commercial,,8889.60,,,,,,,2407.60,8982.20,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,inpatient,,,588.00000,284.00000,Coventry,Commercial,,564.48,,,,,,,529.20,570.36,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,588.00000,284.00000,Coventry,Commercial,,564.48,,,,,,,152.88,570.36,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Coventry,Commercial,,2328.96,,,,,,,2183.40,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Coventry,Commercial,,2328.96,,,,,,,630.76,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Coventry,Commercial,,2713.92,,,,,,,2544.30,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Coventry,Commercial,,2713.92,,,,,,,735.02,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Coventry,Commercial,,3206.40,,,,,,,3006.00,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Coventry,Commercial,,3206.40,,,,,,,868.40,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Coventry,Commercial,,3206.40,,,,,,,3006.00,3239.80,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Coventry,Commercial,,3206.40,,,,,,,868.40,3239.80,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Coventry,Commercial,,429.12,,,,,,,402.30,433.59,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Coventry,Commercial,,429.12,,,,,,,116.22,433.59,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Coventry,Commercial,,3752.64,,,,,,,3518.10,3791.73,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Coventry,Commercial,,3752.64,,,,,,,1016.34,3791.73,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,inpatient,,,159.00000,76.80000,Coventry,Commercial,,152.64,,,,,,,143.10,154.23,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,outpatient,,,159.00000,76.80000,Coventry,Commercial,,152.64,,,,,,,41.34,154.23,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,inpatient,,,588.00000,284.00000,Coventry,Commercial,,564.48,,,,,,,529.20,570.36,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,outpatient,,,588.00000,284.00000,Coventry,Commercial,,564.48,,,,,,,152.88,570.36,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Coventry,Commercial,,2328.96,,,,,,,2183.40,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Coventry,Commercial,,2328.96,,,,,,,630.76,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Coventry,Commercial,,429.12,,,,,,,402.30,433.59,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Coventry,Commercial,,429.12,,,,,,,116.22,433.59,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,inpatient,,,8107.00000,3915.68000,Coventry,Commercial,,7782.72,,,,,,,7296.30,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,outpatient,,,8107.00000,3915.68000,Coventry,Commercial,,7782.72,,,,,,,2107.82,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,inpatient,,,10422.00000,5033.83000,Coventry,Commercial,,10005.12,,,,,,,9379.80,10109.34,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,outpatient,,,10422.00000,5033.83000,Coventry,Commercial,,10005.12,,,,,,,2709.72,10109.34,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Commercial,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Commercial,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Coventry,Commercial,,97.92,,,,,,,91.80,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Coventry,Commercial,,97.92,,,,,,,26.52,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,inpatient,,,221.00000,106.74000,Coventry,Commercial,,212.16,,,,,,,198.90,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,outpatient,,,221.00000,106.74000,Coventry,Commercial,,212.16,,,,,,,57.46,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Coventry,Commercial,,429.12,,,,,,,402.30,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Coventry,Commercial,,429.12,,,,,,,116.22,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Coventry,Commercial,,2328.96,,,,,,,2183.40,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Coventry,Commercial,,2328.96,,,,,,,630.76,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Coventry,Commercial,,3206.40,,,,,,,3006.00,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Coventry,Commercial,,3206.40,,,,,,,868.40,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,inpatient,,,4153.00000,2005.90000,Coventry,Commercial,,3986.88,,,,,,,3737.70,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,outpatient,,,4153.00000,2005.90000,Coventry,Commercial,,3986.88,,,,,,,1079.78,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,inpatient,,,5129.00000,2477.31000,Coventry,Commercial,,4923.84,,,,,,,4616.10,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,outpatient,,,5129.00000,2477.31000,Coventry,Commercial,,4923.84,,,,,,,1333.54,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,inpatient,,,7181.00000,3468.42000,Coventry,Commercial,,6893.76,,,,,,,6462.90,6965.57,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Coventry,Commercial,,6893.76,,,,,,,1867.06,6965.57,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,inpatient,,,52.50000,25.36000,Coventry,Commercial,,50.40,,,,,,,47.25,50.92,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,outpatient,,,52.50000,25.36000,Coventry,Commercial,,50.40,,,,,,,13.65,50.92,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,inpatient,,,50.40000,24.34000,Coventry,Commercial,,48.38,,,,,,,45.36,48.89,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,outpatient,,,50.40000,24.34000,Coventry,Commercial,,48.38,,,,,,,13.10,48.89,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Coventry,Commercial,,2328.96,,,,,,,2183.40,2353.22,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Coventry,Commercial,,2328.96,,,,,,,630.76,2353.22,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Coventry,Commercial,,3752.64,,,,,,,3518.10,3791.73,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Coventry,Commercial,,3752.64,,,,,,,1016.34,3791.73,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Coventry,Commercial,,97.92,,,,,,,91.80,98.94,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Coventry,Commercial,,97.92,,,,,,,26.52,98.94,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Coventry,Commercial,,30.72,,,,,,,28.80,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Coventry,Commercial,,30.72,,,,,,,8.32,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Coventry,Commercial,,429.12,,,,,,,402.30,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Coventry,Commercial,,429.12,,,,,,,116.22,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,inpatient,,,709.00000,342.45000,Coventry,Commercial,,680.64,,,,,,,638.10,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,outpatient,,,709.00000,342.45000,Coventry,Commercial,,680.64,,,,,,,184.34,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Coventry,Commercial,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Coventry,Commercial,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Coventry,Commercial,,84099.84,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Coventry,Commercial,,84099.84,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,109504.00000,62214.70000,Coventry,Commercial,,105123.84,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Coventry,Commercial,,105123.84,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,131404.00000,74657.18000,Coventry,Commercial,,126147.84,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,131404.00000,74657.18000,Coventry,Commercial,,126147.84,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,43800.00000,24884.97000,Coventry,Commercial,,42048.00,,,,,,,39420.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,43800.00000,24884.97000,Coventry,Commercial,,42048.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Coventry,Commercial,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Coventry,Commercial,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Coventry,Commercial,,84099.84,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Coventry,Commercial,,84099.84,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,19714.00000,11200.51000,Coventry,Commercial,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Coventry,Commercial,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,24090.00000,13686.73000,Coventry,Commercial,,23126.40,,,,,,,21681.00,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,24090.00000,13686.73000,Coventry,Commercial,,23126.40,,,,,,,6263.40,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,28474.00000,16177.50000,Coventry,Commercial,,27335.04,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Coventry,Commercial,,27335.04,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,17520.00000,9953.99000,Coventry,Commercial,,16819.20,,,,,,,15768.00,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Coventry,Commercial,,16819.20,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,21904.00000,12444.76000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,26284.00000,14933.25000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,43804.00000,24887.24000,Coventry,Commercial,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Coventry,Commercial,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Coventry,Commercial,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Coventry,Commercial,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Coventry,Commercial,,84099.84,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Coventry,Commercial,,84099.84,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,109504.00000,62214.70000,Coventry,Commercial,,105123.84,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Coventry,Commercial,,105123.84,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,6105.00000,3468.56000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,6105.00000,3468.56000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,13895.00000,7894.44000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,13895.00000,7894.44000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,21900.00000,12442.48000,Coventry,Commercial,,21024.00,,,,,,,19710.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,21900.00000,12442.48000,Coventry,Commercial,,21024.00,,,,,,,5694.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,35040.00000,19907.98000,Coventry,Commercial,,33638.40,,,,,,,31536.00,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,35040.00000,19907.98000,Coventry,Commercial,,33638.40,,,,,,,9110.40,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,43804.00000,24887.24000,Coventry,Commercial,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Coventry,Commercial,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,19714.00000,11200.51000,Coventry,Commercial,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Coventry,Commercial,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,22776.00000,12940.18000,Coventry,Commercial,,21864.96,,,,,,,20498.40,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,22776.00000,12940.18000,Coventry,Commercial,,21864.96,,,,,,,5921.76,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,28474.00000,16177.50000,Coventry,Commercial,,27335.04,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Coventry,Commercial,,27335.04,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,17520.00000,9953.99000,Coventry,Commercial,,16819.20,,,,,,,15768.00,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Coventry,Commercial,,16819.20,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,21904.00000,12444.76000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,26284.00000,14933.25000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,30664.00000,17421.75000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,30664.00000,17421.75000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,35044.00000,19910.25000,Coventry,Commercial,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,35044.00000,19910.25000,Coventry,Commercial,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,2157.00000,864.96000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,2157.00000,864.96000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,2695.00000,1080.70000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2695.00000,1080.70000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,3853.00000,1545.05000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,3853.00000,1545.05000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,inpatient,,,1413.00000,566.61000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,outpatient,,,1413.00000,566.61000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,3229.80000,1857.14000,Coventry,Commercial,,3100.61,,,,,,,2906.82,3132.91,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,3229.80000,1857.14000,Coventry,Commercial,,3100.61,,,,,,,839.75,3132.91,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,854.40000,491.28000,Coventry,Commercial,,820.22,,,,,,,768.96,828.77,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,854.40000,491.28000,Coventry,Commercial,,820.22,,,,,,,222.14,828.77,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1200.50000,690.29000,Coventry,Commercial,,1152.48,,,,,,,1080.45,1164.48,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1200.50000,690.29000,Coventry,Commercial,,1152.48,,,,,,,312.13,1164.48,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1011.00000,581.32000,Coventry,Commercial,,970.56,,,,,,,909.90,980.67,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1011.00000,581.32000,Coventry,Commercial,,970.56,,,,,,,262.86,980.67,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1823.80000,1048.68000,Coventry,Commercial,,1750.85,,,,,,,1641.42,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1823.80000,1048.68000,Coventry,Commercial,,1750.85,,,,,,,474.19,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2028.50000,1166.39000,Coventry,Commercial,,1947.36,,,,,,,1825.65,1967.64,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2028.50000,1166.39000,Coventry,Commercial,,1947.36,,,,,,,527.41,1967.64,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,841.00000,483.58000,Coventry,Commercial,,807.36,,,,,,,756.90,815.77,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,841.00000,483.58000,Coventry,Commercial,,807.36,,,,,,,218.66,815.77,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1366.20000,785.56000,Coventry,Commercial,,1311.55,,,,,,,1229.58,1325.21,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1366.20000,785.56000,Coventry,Commercial,,1311.55,,,,,,,355.21,1325.21,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1384.00000,795.80000,Coventry,Commercial,,1328.64,,,,,,,1245.60,1342.48,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1384.00000,795.80000,Coventry,Commercial,,1328.64,,,,,,,359.84,1342.48,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2458.70000,1413.75000,Coventry,Commercial,,2360.35,,,,,,,2212.83,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2458.70000,1413.75000,Coventry,Commercial,,2360.35,,,,,,,639.26,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2393.50000,1376.26000,Coventry,Commercial,,2297.76,,,,,,,2154.15,2321.70,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2393.50000,1376.26000,Coventry,Commercial,,2297.76,,,,,,,622.31,2321.70,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1369.50000,787.46000,Coventry,Commercial,,1314.72,,,,,,,1232.55,1328.41,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1369.50000,787.46000,Coventry,Commercial,,1314.72,,,,,,,356.07,1328.41,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2697.40000,1551.00000,Coventry,Commercial,,2589.50,,,,,,,2427.66,2616.48,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2697.40000,1551.00000,Coventry,Commercial,,2589.50,,,,,,,701.32,2616.48,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4621.80000,2657.54000,Coventry,Commercial,,4436.93,,,,,,,4159.62,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4621.80000,2657.54000,Coventry,Commercial,,4436.93,,,,,,,1201.67,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2592.50000,1490.69000,Coventry,Commercial,,2488.80,,,,,,,2333.25,2514.72,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2592.50000,1490.69000,Coventry,Commercial,,2488.80,,,,,,,674.05,2514.72,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Coventry,Commercial,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Coventry,Commercial,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Coventry,Commercial,,8005.44,,,,,,,7505.10,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Coventry,Commercial,,8005.44,,,,,,,2168.14,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Coventry,Commercial,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Coventry,Commercial,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,8107.00000,4661.52000,Coventry,Commercial,,7782.72,,,,,,,7296.30,7863.79,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Coventry,Commercial,,7782.72,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Coventry,Commercial,,1080.96,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Coventry,Commercial,,1080.96,,,,,,,292.76,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Coventry,Commercial,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Coventry,Commercial,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Coventry,Commercial,,7116.48,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Coventry,Commercial,,7116.48,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,inpatient,,,20152.00000,11587.40000,Coventry,Commercial,,19345.92,,,,,,,18136.80,19547.44,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,outpatient,,,20152.00000,11587.40000,Coventry,Commercial,,19345.92,,,,,,,5239.52,19547.44,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Coventry,Commercial,,429.12,,,,,,,402.30,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Coventry,Commercial,,429.12,,,,,,,116.22,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Coventry,Commercial,,680.64,,,,,,,638.10,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Coventry,Commercial,,680.64,,,,,,,184.34,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,1272.00000,731.40000,Coventry,Commercial,,1221.12,,,,,,,1144.80,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,1272.00000,731.40000,Coventry,Commercial,,1221.12,,,,,,,330.72,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Coventry,Commercial,,2582.40,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Coventry,Commercial,,2582.40,,,,,,,699.40,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,3078.00000,1769.85000,Coventry,Commercial,,2954.88,,,,,,,2770.20,2985.66,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,3078.00000,1769.85000,Coventry,Commercial,,2954.88,,,,,,,800.28,2985.66,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,70.00000,40.25000,Coventry,Commercial,,67.20,,,,,,,63.00,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,70.00000,40.25000,Coventry,Commercial,,67.20,,,,,,,18.20,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,102.00000,58.65000,Coventry,Commercial,,97.92,,,,,,,91.80,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,102.00000,58.65000,Coventry,Commercial,,97.92,,,,,,,26.52,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,221.00000,127.07000,Coventry,Commercial,,212.16,,,,,,,198.90,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,221.00000,127.07000,Coventry,Commercial,,212.16,,,,,,,57.46,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Coventry,Commercial,,429.12,,,,,,,402.30,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Coventry,Commercial,,429.12,,,,,,,116.22,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Coventry,Commercial,,680.64,,,,,,,638.10,687.73,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Coventry,Commercial,,680.64,,,,,,,184.34,687.73,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Coventry,Commercial,,12005.76,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Coventry,Commercial,,12005.76,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35482.00000,20402.15000,Coventry,Commercial,,34062.72,,,,,,,31933.80,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35482.00000,20402.15000,Coventry,Commercial,,34062.72,,,,,,,9225.32,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39862.00000,22920.65000,Coventry,Commercial,,38267.52,,,,,,,35875.80,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39862.00000,22920.65000,Coventry,Commercial,,38267.52,,,,,,,10364.12,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,44242.00000,25439.15000,Coventry,Commercial,,42472.32,,,,,,,39817.80,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,44242.00000,25439.15000,Coventry,Commercial,,42472.32,,,,,,,11502.92,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,48622.00000,27957.65000,Coventry,Commercial,,46677.12,,,,,,,43759.80,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,48622.00000,27957.65000,Coventry,Commercial,,46677.12,,,,,,,12641.72,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,53002.00000,30476.15000,Coventry,Commercial,,50881.92,,,,,,,47701.80,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,53002.00000,30476.15000,Coventry,Commercial,,50881.92,,,,,,,13780.52,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Coventry,Commercial,,58871.04,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Coventry,Commercial,,58871.04,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Coventry,Commercial,,67280.64,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Coventry,Commercial,,67280.64,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Coventry,Commercial,,75690.24,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Coventry,Commercial,,75690.24,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Coventry,Commercial,,84099.84,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Coventry,Commercial,,84099.84,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Coventry,Commercial,,92509.44,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Coventry,Commercial,,92509.44,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,844.00000,485.30000,Coventry,Commercial,,810.24,,,,,,,759.60,818.68,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,844.00000,485.30000,Coventry,Commercial,,810.24,,,,,,,219.44,818.68,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,11575.00000,6655.62000,Coventry,Commercial,,11112.00,,,,,,,10417.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,11575.00000,6655.62000,Coventry,Commercial,,11112.00,,,,,,,3009.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,14892.00000,8562.90000,Coventry,Commercial,,14296.32,,,,,,,13402.80,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14892.00000,8562.90000,Coventry,Commercial,,14296.32,,,,,,,3871.92,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,24970.00000,14357.75000,Coventry,Commercial,,23971.20,,,,,,,22473.00,24220.90,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,24970.00000,14357.75000,Coventry,Commercial,,23971.20,,,,,,,6492.20,24220.90,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Coventry,Commercial,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Coventry,Commercial,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Coventry,Commercial,,429.12,,,,,,,402.30,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Coventry,Commercial,,429.12,,,,,,,116.22,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Coventry,Commercial,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Coventry,Commercial,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Coventry,Commercial,,3206.40,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Coventry,Commercial,,3206.40,,,,,,,868.40,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,4153.00000,2387.98000,Coventry,Commercial,,3986.88,,,,,,,3737.70,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Coventry,Commercial,,3986.88,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,4641.00000,2668.58000,Coventry,Commercial,,4455.36,,,,,,,4176.90,4501.77,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4641.00000,2668.58000,Coventry,Commercial,,4455.36,,,,,,,1206.66,4501.77,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Coventry,Commercial,,4684.80,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Coventry,Commercial,,4684.80,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Coventry,Commercial,,92509.44,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Coventry,Commercial,,92509.44,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Coventry,Commercial,,105123.84,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Coventry,Commercial,,105123.84,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,131404.00000,75557.30000,Coventry,Commercial,,126147.84,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Coventry,Commercial,,126147.84,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,153304.00000,88149.80000,Coventry,Commercial,,147171.84,,,,,,,137973.60,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,153304.00000,88149.80000,Coventry,Commercial,,147171.84,,,,,,,39859.04,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,175204.00000,100742.30000,Coventry,Commercial,,168195.84,,,,,,,157683.60,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,175204.00000,100742.30000,Coventry,Commercial,,168195.84,,,,,,,45553.04,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,197104.00000,113334.80000,Coventry,Commercial,,189219.84,,,,,,,177393.60,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,197104.00000,113334.80000,Coventry,Commercial,,189219.84,,,,,,,51247.04,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,219004.00000,125927.30000,Coventry,Commercial,,210243.84,,,,,,,197103.60,212433.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,219004.00000,125927.30000,Coventry,Commercial,,210243.84,,,,,,,56941.04,212433.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Coventry,Commercial,,46256.64,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Coventry,Commercial,,46256.64,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Coventry,Commercial,,50461.44,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Coventry,Commercial,,50461.44,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Coventry,Commercial,,54666.24,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Coventry,Commercial,,54666.24,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Coventry,Commercial,,58871.04,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Coventry,Commercial,,58871.04,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Coventry,Commercial,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Coventry,Commercial,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Coventry,Commercial,,50461.44,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Coventry,Commercial,,50461.44,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Coventry,Commercial,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Coventry,Commercial,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Coventry,Commercial,,84099.84,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Coventry,Commercial,,84099.84,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Coventry,Commercial,,105123.84,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Coventry,Commercial,,105123.84,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Coventry,Commercial,,4684.80,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Coventry,Commercial,,4684.80,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Coventry,Commercial,,46256.64,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Coventry,Commercial,,46256.64,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Coventry,Commercial,,50461.44,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Coventry,Commercial,,50461.44,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Coventry,Commercial,,54666.24,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Coventry,Commercial,,54666.24,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Coventry,Commercial,,58871.04,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Coventry,Commercial,,58871.04,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Coventry,Commercial,,67280.64,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Coventry,Commercial,,67280.64,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Coventry,Commercial,,75690.24,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Coventry,Commercial,,75690.24,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Coventry,Commercial,,84099.84,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Coventry,Commercial,,84099.84,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Coventry,Commercial,,92509.44,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Coventry,Commercial,,92509.44,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Coventry,Commercial,,105123.84,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Coventry,Commercial,,105123.84,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,122644.00000,70520.30000,Coventry,Commercial,,117738.24,,,,,,,110379.60,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Coventry,Commercial,,117738.24,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,135784.00000,78075.80000,Coventry,Commercial,,130352.64,,,,,,,122205.60,131710.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,135784.00000,78075.80000,Coventry,Commercial,,130352.64,,,,,,,35303.84,131710.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Coventry,Commercial,,46256.64,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Coventry,Commercial,,46256.64,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,55630.00000,31987.25000,Coventry,Commercial,,53404.80,,,,,,,50067.00,53961.10,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,55630.00000,31987.25000,Coventry,Commercial,,53404.80,,,,,,,14463.80,53961.10,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Coventry,Commercial,,2582.40,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Coventry,Commercial,,2582.40,,,,,,,699.40,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,14020.00000,8061.50000,Coventry,Commercial,,13459.20,,,,,,,12618.00,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Coventry,Commercial,,13459.20,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,17962.00000,10328.15000,Coventry,Commercial,,17243.52,,,,,,,16165.80,17423.14,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,17962.00000,10328.15000,Coventry,Commercial,,17243.52,,,,,,,4670.12,17423.14,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,2421.00000,1392.07000,Coventry,Commercial,,2324.16,,,,,,,2178.90,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,2421.00000,1392.07000,Coventry,Commercial,,2324.16,,,,,,,629.46,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Coventry,Commercial,,2328.96,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Coventry,Commercial,,2328.96,,,,,,,630.76,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Coventry,Commercial,,2582.40,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Coventry,Commercial,,2582.40,,,,,,,699.40,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,27160.00000,15617.00000,Coventry,Commercial,,26073.60,,,,,,,24444.00,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,27160.00000,15617.00000,Coventry,Commercial,,26073.60,,,,,,,7061.60,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Coventry,Commercial,,31539.84,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Coventry,Commercial,,31539.84,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Coventry,Commercial,,50461.44,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Coventry,Commercial,,50461.44,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Coventry,Commercial,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Coventry,Commercial,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Coventry,Commercial,,75690.24,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Coventry,Commercial,,75690.24,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,28470.00000,16370.25000,Coventry,Commercial,,27331.20,,,,,,,25623.00,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,28470.00000,16370.25000,Coventry,Commercial,,27331.20,,,,,,,7402.20,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,43800.00000,25185.00000,Coventry,Commercial,,42048.00,,,,,,,39420.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,43800.00000,25185.00000,Coventry,Commercial,,42048.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Coventry,Commercial,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Coventry,Commercial,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Coventry,Commercial,,84099.84,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Coventry,Commercial,,84099.84,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Coventry,Commercial,,105123.84,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Coventry,Commercial,,105123.84,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Coventry,Commercial,,3752.64,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Coventry,Commercial,,3752.64,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Coventry,Commercial,,31539.84,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Coventry,Commercial,,31539.84,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,54754.00000,31483.55000,Coventry,Commercial,,52563.84,,,,,,,49278.60,53111.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,54754.00000,31483.55000,Coventry,Commercial,,52563.84,,,,,,,14236.04,53111.38,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Coventry,Commercial,,2582.40,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Coventry,Commercial,,2582.40,,,,,,,699.40,2609.30,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,61320.00000,35259.00000,Coventry,Commercial,,58867.20,,,,,,,55188.00,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,61320.00000,35259.00000,Coventry,Commercial,,58867.20,,,,,,,15943.20,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,70080.00000,40296.00000,Coventry,Commercial,,67276.80,,,,,,,63072.00,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,70080.00000,40296.00000,Coventry,Commercial,,67276.80,,,,,,,18220.80,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,78840.00000,45333.00000,Coventry,Commercial,,75686.40,,,,,,,70956.00,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,78840.00000,45333.00000,Coventry,Commercial,,75686.40,,,,,,,20498.40,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Coventry,Commercial,,92509.44,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Coventry,Commercial,,92509.44,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Coventry,Commercial,,105123.84,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Coventry,Commercial,,105123.84,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,122644.00000,70520.30000,Coventry,Commercial,,117738.24,,,,,,,110379.60,118964.68,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Coventry,Commercial,,117738.24,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Coventry,Commercial,,23130.24,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Coventry,Commercial,,23130.24,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Coventry,Commercial,,31539.84,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Coventry,Commercial,,31539.84,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,1883.00000,1082.72000,Coventry,Commercial,,1807.68,,,,,,,1694.70,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1883.00000,1082.72000,Coventry,Commercial,,1807.68,,,,,,,489.58,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Coventry,Commercial,,3752.64,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Coventry,Commercial,,3752.64,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,7644.00000,4395.30000,Coventry,Commercial,,7338.24,,,,,,,6879.60,7414.68,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,7644.00000,4395.30000,Coventry,Commercial,,7338.24,,,,,,,1987.44,7414.68,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Coventry,Commercial,,2582.40,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Coventry,Commercial,,2582.40,,,,,,,699.40,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,inpatient,,,1614.00000,928.05000,Coventry,Commercial,,1549.44,,,,,,,1452.60,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Coventry,Commercial,,1549.44,,,,,,,419.64,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Coventry,Commercial,,23130.24,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Coventry,Commercial,,23130.24,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Coventry,Commercial,,27335.04,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Coventry,Commercial,,27335.04,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Coventry,Commercial,,31539.84,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Coventry,Commercial,,31539.84,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,37234.00000,21409.55000,Coventry,Commercial,,35744.64,,,,,,,33510.60,36116.98,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,37234.00000,21409.55000,Coventry,Commercial,,35744.64,,,,,,,9680.84,36116.98,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Coventry,Commercial,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Coventry,Commercial,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Coventry,Commercial,,50461.44,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Coventry,Commercial,,50461.44,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Coventry,Commercial,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Coventry,Commercial,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Coventry,Commercial,,75690.24,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Coventry,Commercial,,75690.24,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,159.00000,91.42000,Coventry,Commercial,,152.64,,,,,,,143.10,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,159.00000,91.42000,Coventry,Commercial,,152.64,,,,,,,41.34,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Coventry,Commercial,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Coventry,Commercial,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Coventry,Commercial,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Coventry,Commercial,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Coventry,Commercial,,2328.96,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Coventry,Commercial,,2328.96,,,,,,,630.76,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2827.00000,1625.52000,Coventry,Commercial,,2713.92,,,,,,,2544.30,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Coventry,Commercial,,2713.92,,,,,,,735.02,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Coventry,Commercial,,3206.40,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Coventry,Commercial,,3206.40,,,,,,,868.40,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8107.00000,4661.52000,Coventry,Commercial,,7782.72,,,,,,,7296.30,7863.79,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Coventry,Commercial,,7782.72,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Coventry,Commercial,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Coventry,Commercial,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Coventry,Commercial,,84099.84,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Coventry,Commercial,,84099.84,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Coventry,Commercial,,105123.84,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Coventry,Commercial,,105123.84,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,131404.00000,75557.30000,Coventry,Commercial,,126147.84,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Coventry,Commercial,,126147.84,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,18400.00000,10580.00000,Coventry,Commercial,,17664.00,,,,,,,16560.00,17848.00,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,18400.00000,10580.00000,Coventry,Commercial,,17664.00,,,,,,,4784.00,17848.00,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Coventry,Commercial,,23130.24,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Coventry,Commercial,,23130.24,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Coventry,Commercial,,27335.04,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Coventry,Commercial,,27335.04,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Coventry,Commercial,,31539.84,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Coventry,Commercial,,31539.84,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1614.00000,928.05000,Coventry,Commercial,,1549.44,,,,,,,1452.60,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Coventry,Commercial,,1549.44,,,,,,,419.64,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Coventry,Commercial,,54666.24,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Coventry,Commercial,,54666.24,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Coventry,Commercial,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Coventry,Commercial,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,5368.00000,3086.60000,Coventry,Commercial,,5153.28,,,,,,,4831.20,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,5368.00000,3086.60000,Coventry,Commercial,,5153.28,,,,,,,1395.68,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,14020.00000,8061.50000,Coventry,Commercial,,13459.20,,,,,,,12618.00,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Coventry,Commercial,,13459.20,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,25408.00000,14609.60000,Coventry,Commercial,,24391.68,,,,,,,22867.20,24645.76,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,25408.00000,14609.60000,Coventry,Commercial,,24391.68,,,,,,,6606.08,24645.76,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,8112.00000,4664.40000,Coventry,Commercial,,7787.52,,,,,,,7300.80,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,8112.00000,4664.40000,Coventry,Commercial,,7787.52,,,,,,,2109.12,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,10431.00000,5997.82000,Coventry,Commercial,,10013.76,,,,,,,9387.90,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,10431.00000,5997.82000,Coventry,Commercial,,10013.76,,,,,,,2712.06,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Coventry,Commercial,,31539.84,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Coventry,Commercial,,31539.84,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,46870.00000,26950.25000,Coventry,Commercial,,44995.20,,,,,,,42183.00,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,46870.00000,26950.25000,Coventry,Commercial,,44995.20,,,,,,,12186.20,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,51250.00000,29468.75000,Coventry,Commercial,,49200.00,,,,,,,46125.00,49712.50,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,51250.00000,29468.75000,Coventry,Commercial,,49200.00,,,,,,,13325.00,49712.50,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Coventry,Commercial,,50461.44,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Coventry,Commercial,,50461.44,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Coventry,Commercial,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Coventry,Commercial,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Coventry,Commercial,,75690.24,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Coventry,Commercial,,75690.24,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Coventry,Commercial,,84099.84,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Coventry,Commercial,,84099.84,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,588.00000,338.10000,Coventry,Commercial,,564.48,,,,,,,529.20,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,588.00000,338.10000,Coventry,Commercial,,564.48,,,,,,,152.88,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Coventry,Commercial,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Coventry,Commercial,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Coventry,Commercial,,3752.64,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Coventry,Commercial,,3752.64,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Coventry,Commercial,,5158.08,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Coventry,Commercial,,5158.08,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Coventry,Commercial,,6227.52,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Coventry,Commercial,,6227.52,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,7876.00000,4528.70000,Coventry,Commercial,,7560.96,,,,,,,7088.40,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7876.00000,4528.70000,Coventry,Commercial,,7560.96,,,,,,,2047.76,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Coventry,Commercial,,23130.24,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Coventry,Commercial,,23130.24,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5856.00000,3367.20000,Coventry,Commercial,,5621.76,,,,,,,5270.40,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5856.00000,3367.20000,Coventry,Commercial,,5621.76,,,,,,,1522.56,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Coventry,Commercial,,6227.52,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Coventry,Commercial,,6227.52,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Coventry,Commercial,,7116.48,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Coventry,Commercial,,7116.48,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Coventry,Commercial,,8005.44,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Coventry,Commercial,,8005.44,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Coventry,Commercial,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Coventry,Commercial,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Coventry,Commercial,,5158.08,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Coventry,Commercial,,5158.08,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Coventry,Commercial,,5783.04,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Coventry,Commercial,,5783.04,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Coventry,Commercial,,12005.76,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Coventry,Commercial,,12005.76,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Coventry,Commercial,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Coventry,Commercial,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Coventry,Commercial,,5158.08,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Coventry,Commercial,,5158.08,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Coventry,Commercial,,5783.04,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Coventry,Commercial,,5783.04,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Coventry,Commercial,,12005.76,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Coventry,Commercial,,12005.76,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4392.00000,2525.40000,Coventry,Commercial,,4216.32,,,,,,,3952.80,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4392.00000,2525.40000,Coventry,Commercial,,4216.32,,,,,,,1141.92,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Coventry,Commercial,,5158.08,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Coventry,Commercial,,5158.08,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Coventry,Commercial,,6227.52,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Coventry,Commercial,,6227.52,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Coventry,Commercial,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Coventry,Commercial,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Coventry,Commercial,,5158.08,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Coventry,Commercial,,5158.08,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Coventry,Commercial,,6227.52,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Coventry,Commercial,,6227.52,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Coventry,Commercial,,4684.80,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Coventry,Commercial,,4684.80,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Coventry,Commercial,,1080.96,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Coventry,Commercial,,1080.96,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Coventry,Commercial,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Coventry,Commercial,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Coventry,Commercial,,5158.08,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Coventry,Commercial,,5158.08,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Coventry,Commercial,,5783.04,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Coventry,Commercial,,5783.04,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Coventry,Commercial,,12005.76,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Coventry,Commercial,,12005.76,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Coventry,Commercial,,13038.72,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Coventry,Commercial,,13038.72,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2152.00000,1237.40000,Coventry,Commercial,,2065.92,,,,,,,1936.80,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2152.00000,1237.40000,Coventry,Commercial,,2065.92,,,,,,,559.52,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Coventry,Commercial,,4684.80,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Coventry,Commercial,,4684.80,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Coventry,Commercial,,3752.64,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Coventry,Commercial,,3752.64,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Coventry,Commercial,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Coventry,Commercial,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Coventry,Commercial,,5783.04,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Coventry,Commercial,,5783.04,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Coventry,Commercial,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Coventry,Commercial,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Coventry,Commercial,,5158.08,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Coventry,Commercial,,5158.08,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Coventry,Commercial,,5783.04,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Coventry,Commercial,,5783.04,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Coventry,Commercial,,1080.96,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Coventry,Commercial,,1080.96,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Coventry,Commercial,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Coventry,Commercial,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Coventry,Commercial,,5158.08,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Coventry,Commercial,,5158.08,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Coventry,Commercial,,5783.04,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Coventry,Commercial,,5783.04,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Coventry,Commercial,,12005.76,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Coventry,Commercial,,12005.76,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Coventry,Commercial,,13038.72,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Coventry,Commercial,,13038.72,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Coventry,Commercial,,5158.08,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Coventry,Commercial,,5158.08,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8802.00000,5061.15000,Coventry,Commercial,,8449.92,,,,,,,7921.80,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8802.00000,5061.15000,Coventry,Commercial,,8449.92,,,,,,,2288.52,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,10654.00000,6126.05000,Coventry,Commercial,,10227.84,,,,,,,9588.60,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10654.00000,6126.05000,Coventry,Commercial,,10227.84,,,,,,,2770.04,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Coventry,Commercial,,12005.76,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Coventry,Commercial,,12005.76,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Coventry,Commercial,,13038.72,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Coventry,Commercial,,13038.72,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17086.00000,9824.45000,Coventry,Commercial,,16402.56,,,,,,,15377.40,16573.42,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17086.00000,9824.45000,Coventry,Commercial,,16402.56,,,,,,,4442.36,16573.42,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Coventry,Commercial,,4684.80,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Coventry,Commercial,,4684.80,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Coventry,Commercial,,6227.52,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Coventry,Commercial,,6227.52,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Coventry,Commercial,,7116.48,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Coventry,Commercial,,7116.48,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Coventry,Commercial,,8005.44,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Coventry,Commercial,,8005.44,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Coventry,Commercial,,4684.80,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Coventry,Commercial,,4684.80,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Coventry,Commercial,,4684.80,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Coventry,Commercial,,4684.80,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Commercial,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Coventry,Commercial,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Coventry,Commercial,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Commercial,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Coventry,Commercial,,23130.24,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Coventry,Commercial,,23130.24,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Coventry,Commercial,,3752.64,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Coventry,Commercial,,3752.64,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Coventry,Commercial,,6227.52,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Coventry,Commercial,,6227.52,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Coventry,Commercial,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Coventry,Commercial,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Coventry,Commercial,,2328.96,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Coventry,Commercial,,2328.96,,,,,,,630.76,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2827.00000,1625.52000,Coventry,Commercial,,2713.92,,,,,,,2544.30,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Coventry,Commercial,,2713.92,,,,,,,735.02,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Coventry,Commercial,,3206.40,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Coventry,Commercial,,3206.40,,,,,,,868.40,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4153.00000,2387.98000,Coventry,Commercial,,3986.88,,,,,,,3737.70,4028.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Coventry,Commercial,,3986.88,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Coventry,Commercial,,7116.48,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Coventry,Commercial,,7116.48,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Coventry,Commercial,,8005.44,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Coventry,Commercial,,8005.44,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9728.00000,5593.60000,Coventry,Commercial,,9338.88,,,,,,,8755.20,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9728.00000,5593.60000,Coventry,Commercial,,9338.88,,,,,,,2529.28,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11117.00000,6392.28000,Coventry,Commercial,,10672.32,,,,,,,10005.30,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11117.00000,6392.28000,Coventry,Commercial,,10672.32,,,,,,,2890.42,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Coventry,Commercial,,46256.64,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Coventry,Commercial,,46256.64,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Coventry,Commercial,,50461.44,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Coventry,Commercial,,50461.44,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Coventry,Commercial,,54666.24,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Coventry,Commercial,,54666.24,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Coventry,Commercial,,58871.04,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Coventry,Commercial,,58871.04,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Coventry,Commercial,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Coventry,Commercial,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Coventry,Commercial,,67280.64,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Coventry,Commercial,,67280.64,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,74464.00000,42816.80000,Coventry,Commercial,,71485.44,,,,,,,67017.60,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Coventry,Commercial,,71485.44,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Coventry,Commercial,,75690.24,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Coventry,Commercial,,75690.24,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,83224.00000,47853.80000,Coventry,Commercial,,79895.04,,,,,,,74901.60,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Coventry,Commercial,,79895.04,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,111694.00000,64224.05000,Coventry,Commercial,,107226.24,,,,,,,100524.60,108343.18,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,111694.00000,64224.05000,Coventry,Commercial,,107226.24,,,,,,,29040.44,108343.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Coventry,Commercial,,429.12,,,,,,,402.30,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Coventry,Commercial,,429.12,,,,,,,116.22,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Coventry,Commercial,,680.64,,,,,,,638.10,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Coventry,Commercial,,680.64,,,,,,,184.34,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,991.00000,569.82000,Coventry,Commercial,,951.36,,,,,,,891.90,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,991.00000,569.82000,Coventry,Commercial,,951.36,,,,,,,257.66,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1490.00000,856.75000,Coventry,Commercial,,1430.40,,,,,,,1341.00,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1490.00000,856.75000,Coventry,Commercial,,1430.40,,,,,,,387.40,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Coventry,Commercial,,3752.64,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Coventry,Commercial,,3752.64,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Coventry,Commercial,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Coventry,Commercial,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Coventry,Commercial,,6227.52,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Coventry,Commercial,,6227.52,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Coventry,Commercial,,7116.48,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Coventry,Commercial,,7116.48,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Coventry,Commercial,,8005.44,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Coventry,Commercial,,8005.44,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Commercial,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Commercial,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,6945.00000,3993.37000,Coventry,Commercial,,6667.20,,,,,,,6250.50,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,6945.00000,3993.37000,Coventry,Commercial,,6667.20,,,,,,,1805.70,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Coventry,Commercial,,429.12,,,,,,,402.30,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Coventry,Commercial,,429.12,,,,,,,116.22,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Coventry,Commercial,,3752.64,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Coventry,Commercial,,3752.64,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Coventry,Commercial,,5158.08,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Coventry,Commercial,,5158.08,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Commercial,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,50374.00000,28965.05000,Coventry,Commercial,,48359.04,,,,,,,45336.60,48862.78,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,50374.00000,28965.05000,Coventry,Commercial,,48359.04,,,,,,,13097.24,48862.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Commercial,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Coventry,Commercial,,23130.24,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Coventry,Commercial,,23130.24,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Coventry,Commercial,,27335.04,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Coventry,Commercial,,27335.04,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Commercial,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Commercial,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Commercial,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Commercial,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Coventry,Commercial,,46256.64,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Coventry,Commercial,,46256.64,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Commercial,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Coventry,Commercial,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Coventry,Commercial,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Coventry,Commercial,,46256.64,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Coventry,Commercial,,46256.64,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Coventry,Commercial,,50461.44,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Coventry,Commercial,,50461.44,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Coventry,Commercial,,54666.24,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Coventry,Commercial,,54666.24,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Coventry,Commercial,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Coventry,Commercial,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,74464.00000,42816.80000,Coventry,Commercial,,71485.44,,,,,,,67017.60,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Coventry,Commercial,,71485.44,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,83224.00000,47853.80000,Coventry,Commercial,,79895.04,,,,,,,74901.60,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Coventry,Commercial,,79895.04,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,91984.00000,52890.80000,Coventry,Commercial,,88304.64,,,,,,,82785.60,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,91984.00000,52890.80000,Coventry,Commercial,,88304.64,,,,,,,23915.84,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,100744.00000,57927.80000,Coventry,Commercial,,96714.24,,,,,,,90669.60,97721.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,100744.00000,57927.80000,Coventry,Commercial,,96714.24,,,,,,,26193.44,97721.68,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Coventry,Commercial,,159.36,,,,,,,149.40,161.02,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Coventry,Commercial,,159.36,,,,,,,43.16,161.02,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Coventry,Commercial,,429.12,,,,,,,402.30,433.59,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Coventry,Commercial,,429.12,,,,,,,116.22,433.59,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Coventry,Commercial,,680.64,,,,,,,638.10,687.73,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Coventry,Commercial,,680.64,,,,,,,184.34,687.73,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Commercial,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Commercial,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Commercial,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Commercial,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Commercial,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Commercial,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Commercial,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Coventry,Commercial,,50461.44,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Coventry,Commercial,,50461.44,,,,,,,13666.64,50987.08,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Commercial,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Commercial,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Commercial,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2180.20000,1253.61000,Coventry,Commercial,,2092.99,,,,,,,1962.18,2114.79,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2180.20000,1253.61000,Coventry,Commercial,,2092.99,,,,,,,566.85,2114.79,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1880.60000,1081.34000,Coventry,Commercial,,1805.38,,,,,,,1692.54,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1880.60000,1081.34000,Coventry,Commercial,,1805.38,,,,,,,488.96,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2908.70000,1672.50000,Coventry,Commercial,,2792.35,,,,,,,2617.83,2821.44,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2908.70000,1672.50000,Coventry,Commercial,,2792.35,,,,,,,756.26,2821.44,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,inpatient,,,34.00000,25.74000,Coventry,Commercial,,32.64,,,,,,,30.60,32.98,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,outpatient,,,34.00000,25.74000,Coventry,Commercial,,32.64,,,,,,,8.84,32.98,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,inpatient,,,13.00000,9.84000,Coventry,Commercial,,12.48,,,,,,,11.70,12.61,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,outpatient,,,13.00000,9.84000,Coventry,Commercial,,12.48,,,,,,,3.38,12.61,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Coventry,Commercial,,269.76,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Coventry,Commercial,,269.76,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Coventry,Commercial,,269.76,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Coventry,Commercial,,269.76,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Coventry,Commercial,,269.76,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Coventry,Commercial,,269.76,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Coventry,Commercial,,720.96,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Coventry,Commercial,,720.96,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Coventry,Commercial,,720.96,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Coventry,Commercial,,720.96,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Coventry,Commercial,,720.96,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Coventry,Commercial,,720.96,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,inpatient,,,122.00000,92.35000,Coventry,Commercial,,117.12,,,,,,,109.80,118.34,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,outpatient,,,122.00000,92.35000,Coventry,Commercial,,117.12,,,,,,,31.72,118.34,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,inpatient,,,79.00000,59.80000,Coventry,Commercial,,75.84,,,,,,,71.10,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Coventry,Commercial,,75.84,,,,,,,20.54,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,inpatient,,,79.00000,59.80000,Coventry,Commercial,,75.84,,,,,,,71.10,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Coventry,Commercial,,75.84,,,,,,,20.54,76.63,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,inpatient,,,15.00000,11.36000,Coventry,Commercial,,14.40,,,,,,,13.50,14.55,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Coventry,Commercial,,14.40,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,inpatient,,,15.00000,11.36000,Coventry,Commercial,,14.40,,,,,,,13.50,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Coventry,Commercial,,14.40,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,inpatient,,,17.00000,12.87000,Coventry,Commercial,,16.32,,,,,,,15.30,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Coventry,Commercial,,16.32,,,,,,,4.42,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,inpatient,,,17.00000,12.87000,Coventry,Commercial,,16.32,,,,,,,15.30,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Coventry,Commercial,,16.32,,,,,,,4.42,16.49,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,inpatient,,,359.00000,271.76000,Coventry,Commercial,,344.64,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,outpatient,,,359.00000,271.76000,Coventry,Commercial,,344.64,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,inpatient,,,359.00000,271.76000,Coventry,Commercial,,344.64,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,outpatient,,,359.00000,271.76000,Coventry,Commercial,,344.64,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,inpatient,,,359.00000,271.76000,Coventry,Commercial,,344.64,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,outpatient,,,359.00000,271.76000,Coventry,Commercial,,344.64,,,,,,,93.34,348.23,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,inpatient,,,155.00000,117.34000,Coventry,Commercial,,148.80,,,,,,,139.50,150.35,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,outpatient,,,155.00000,117.34000,Coventry,Commercial,,148.80,,,,,,,40.30,150.35,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,inpatient,,,294.00000,222.56000,Coventry,Commercial,,282.24,,,,,,,264.60,285.18,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,outpatient,,,294.00000,222.56000,Coventry,Commercial,,282.24,,,,,,,76.44,285.18,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,inpatient,,,1511.00000,1143.83000,Coventry,Commercial,,1450.56,,,,,,,1359.90,1465.67,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,outpatient,,,1511.00000,1143.83000,Coventry,Commercial,,1450.56,,,,,,,392.86,1465.67,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,inpatient,,,751.00000,568.51000,Coventry,Commercial,,720.96,,,,,,,675.90,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Coventry,Commercial,,720.96,,,,,,,195.26,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,inpatient,,,751.00000,568.51000,Coventry,Commercial,,720.96,,,,,,,675.90,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Coventry,Commercial,,720.96,,,,,,,195.26,728.47,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,inpatient,,,150.00000,113.55000,Coventry,Commercial,,144.00,,,,,,,135.00,145.50,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,outpatient,,,150.00000,113.55000,Coventry,Commercial,,144.00,,,,,,,39.00,145.50,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,inpatient,,,110.00000,83.27000,Coventry,Commercial,,105.60,,,,,,,99.00,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,outpatient,,,110.00000,83.27000,Coventry,Commercial,,105.60,,,,,,,28.60,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,inpatient,,,158.00000,119.61000,Coventry,Commercial,,151.68,,,,,,,142.20,153.26,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,outpatient,,,158.00000,119.61000,Coventry,Commercial,,151.68,,,,,,,41.08,153.26,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,inpatient,,,153.00000,115.82000,Coventry,Commercial,,146.88,,,,,,,137.70,148.41,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,outpatient,,,153.00000,115.82000,Coventry,Commercial,,146.88,,,,,,,39.78,148.41,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,inpatient,,,157.00000,118.85000,Coventry,Commercial,,150.72,,,,,,,141.30,152.29,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,outpatient,,,157.00000,118.85000,Coventry,Commercial,,150.72,,,,,,,40.82,152.29,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,inpatient,,,26.00000,19.68000,Coventry,Commercial,,24.96,,,,,,,23.40,25.22,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,outpatient,,,26.00000,19.68000,Coventry,Commercial,,24.96,,,,,,,6.76,25.22,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,inpatient,,,37.00000,28.01000,Coventry,Commercial,,35.52,,,,,,,33.30,35.89,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,outpatient,,,37.00000,28.01000,Coventry,Commercial,,35.52,,,,,,,9.62,35.89,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,inpatient,,,268.00000,202.88000,Coventry,Commercial,,257.28,,,,,,,241.20,259.96,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,outpatient,,,268.00000,202.88000,Coventry,Commercial,,257.28,,,,,,,69.68,259.96,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,inpatient,,,91.00000,68.89000,Coventry,Commercial,,87.36,,,,,,,81.90,88.27,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,outpatient,,,91.00000,68.89000,Coventry,Commercial,,87.36,,,,,,,23.66,88.27,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,inpatient,,,200.00000,151.40000,Coventry,Commercial,,192.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,outpatient,,,200.00000,151.40000,Coventry,Commercial,,192.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,inpatient,,,152.00000,115.06000,Coventry,Commercial,,145.92,,,,,,,136.80,147.44,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,outpatient,,,152.00000,115.06000,Coventry,Commercial,,145.92,,,,,,,39.52,147.44,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,inpatient,,,359.00000,271.76000,Coventry,Commercial,,344.64,,,,,,,323.10,348.23,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,outpatient,,,359.00000,271.76000,Coventry,Commercial,,344.64,,,,,,,93.34,348.23,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,inpatient,,,69.00000,33.26000,Coventry,Commercial,,66.24,,,,,,,62.10,66.93,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,outpatient,,,69.00000,33.26000,Coventry,Commercial,,66.24,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,inpatient,,,75.00000,36.15000,Coventry,Commercial,,72.00,,,,,,,67.50,72.75,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,outpatient,,,75.00000,36.15000,Coventry,Commercial,,72.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,inpatient,,,45.00000,21.69000,Coventry,Commercial,,43.20,,,,,,,40.50,43.65,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,outpatient,,,45.00000,21.69000,Coventry,Commercial,,43.20,,,,,,,11.70,43.65,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,inpatient,,,68.00000,32.78000,Coventry,Commercial,,65.28,,,,,,,61.20,65.96,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,outpatient,,,68.00000,32.78000,Coventry,Commercial,,65.28,,,,,,,17.68,65.96,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,inpatient,,,61.00000,29.40000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,outpatient,,,61.00000,29.40000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,inpatient,,,64.00000,30.85000,Coventry,Commercial,,61.44,,,,,,,57.60,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,outpatient,,,64.00000,30.85000,Coventry,Commercial,,61.44,,,,,,,16.64,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,inpatient,,,195.00000,93.99000,Coventry,Commercial,,187.20,,,,,,,175.50,189.15,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,outpatient,,,195.00000,93.99000,Coventry,Commercial,,187.20,,,,,,,50.70,189.15,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,inpatient,,,14.00000,6.75000,Coventry,Commercial,,13.44,,,,,,,12.60,13.58,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,outpatient,,,14.00000,6.75000,Coventry,Commercial,,13.44,,,,,,,3.64,13.58,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,inpatient,,,53.00000,25.55000,Coventry,Commercial,,50.88,,,,,,,47.70,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,outpatient,,,53.00000,25.55000,Coventry,Commercial,,50.88,,,,,,,13.78,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,inpatient,,,82.00000,39.52000,Coventry,Commercial,,78.72,,,,,,,73.80,79.54,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,outpatient,,,82.00000,39.52000,Coventry,Commercial,,78.72,,,,,,,21.32,79.54,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,inpatient,,,141.00000,67.96000,Coventry,Commercial,,135.36,,,,,,,126.90,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Coventry,Commercial,,135.36,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,inpatient,,,141.00000,67.96000,Coventry,Commercial,,135.36,,,,,,,126.90,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Coventry,Commercial,,135.36,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,inpatient,,,91.00000,43.86000,Coventry,Commercial,,87.36,,,,,,,81.90,88.27,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,outpatient,,,91.00000,43.86000,Coventry,Commercial,,87.36,,,,,,,23.66,88.27,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,inpatient,,,69.00000,33.26000,Coventry,Commercial,,66.24,,,,,,,62.10,66.93,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,outpatient,,,69.00000,33.26000,Coventry,Commercial,,66.24,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,inpatient,,,205.00000,98.81000,Coventry,Commercial,,196.80,,,,,,,184.50,198.85,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,outpatient,,,205.00000,98.81000,Coventry,Commercial,,196.80,,,,,,,53.30,198.85,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,inpatient,,,50.00000,24.10000,Coventry,Commercial,,48.00,,,,,,,45.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,outpatient,,,50.00000,24.10000,Coventry,Commercial,,48.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,inpatient,,,406.00000,195.69000,Coventry,Commercial,,389.76,,,,,,,365.40,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,outpatient,,,406.00000,195.69000,Coventry,Commercial,,389.76,,,,,,,105.56,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,inpatient,,,101.00000,48.68000,Coventry,Commercial,,96.96,,,,,,,90.90,97.97,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,outpatient,,,101.00000,48.68000,Coventry,Commercial,,96.96,,,,,,,26.26,97.97,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,inpatient,,,375.00000,180.75000,Coventry,Commercial,,360.00,,,,,,,337.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,outpatient,,,375.00000,180.75000,Coventry,Commercial,,360.00,,,,,,,97.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,inpatient,,,362.00000,174.48000,Coventry,Commercial,,347.52,,,,,,,325.80,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,outpatient,,,362.00000,174.48000,Coventry,Commercial,,347.52,,,,,,,94.12,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,inpatient,,,325.00000,156.65000,Coventry,Commercial,,312.00,,,,,,,292.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,outpatient,,,325.00000,156.65000,Coventry,Commercial,,312.00,,,,,,,84.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,inpatient,,,121.00000,58.32000,Coventry,Commercial,,116.16,,,,,,,108.90,117.37,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,outpatient,,,121.00000,58.32000,Coventry,Commercial,,116.16,,,,,,,31.46,117.37,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,inpatient,,,115.00000,55.43000,Coventry,Commercial,,110.40,,,,,,,103.50,111.55,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,outpatient,,,115.00000,55.43000,Coventry,Commercial,,110.40,,,,,,,29.90,111.55,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,inpatient,,,300.00000,144.60000,Coventry,Commercial,,288.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,outpatient,,,300.00000,144.60000,Coventry,Commercial,,288.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,inpatient,,,51.00000,24.58000,Coventry,Commercial,,48.96,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,outpatient,,,51.00000,24.58000,Coventry,Commercial,,48.96,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,inpatient,,,51.00000,24.58000,Coventry,Commercial,,48.96,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Coventry,Commercial,,48.96,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,inpatient,,,51.00000,24.58000,Coventry,Commercial,,48.96,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Coventry,Commercial,,48.96,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,inpatient,,,194.00000,93.51000,Coventry,Commercial,,186.24,,,,,,,174.60,188.18,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,outpatient,,,194.00000,93.51000,Coventry,Commercial,,186.24,,,,,,,50.44,188.18,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,inpatient,,,68.00000,32.78000,Coventry,Commercial,,65.28,,,,,,,61.20,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,outpatient,,,68.00000,32.78000,Coventry,Commercial,,65.28,,,,,,,17.68,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,inpatient,,,329.00000,158.58000,Coventry,Commercial,,315.84,,,,,,,296.10,319.13,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,outpatient,,,329.00000,158.58000,Coventry,Commercial,,315.84,,,,,,,85.54,319.13,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,inpatient,,,24.00000,11.57000,Coventry,Commercial,,23.04,,,,,,,21.60,23.28,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,outpatient,,,24.00000,11.57000,Coventry,Commercial,,23.04,,,,,,,6.24,23.28,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,inpatient,,,30.00000,14.46000,Coventry,Commercial,,28.80,,,,,,,27.00,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,outpatient,,,30.00000,14.46000,Coventry,Commercial,,28.80,,,,,,,7.80,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,inpatient,,,53.00000,25.55000,Coventry,Commercial,,50.88,,,,,,,47.70,51.41,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,outpatient,,,53.00000,25.55000,Coventry,Commercial,,50.88,,,,,,,13.78,51.41,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,inpatient,,,270.00000,130.14000,Coventry,Commercial,,259.20,,,,,,,243.00,261.90,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,outpatient,,,270.00000,130.14000,Coventry,Commercial,,259.20,,,,,,,70.20,261.90,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,inpatient,,,123.00000,59.29000,Coventry,Commercial,,118.08,,,,,,,110.70,119.31,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Coventry,Commercial,,118.08,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,inpatient,,,123.00000,59.29000,Coventry,Commercial,,118.08,,,,,,,110.70,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Coventry,Commercial,,118.08,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,inpatient,,,37.00000,17.83000,Coventry,Commercial,,35.52,,,,,,,33.30,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,outpatient,,,37.00000,17.83000,Coventry,Commercial,,35.52,,,,,,,9.62,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,inpatient,,,41.00000,19.76000,Coventry,Commercial,,39.36,,,,,,,36.90,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,outpatient,,,41.00000,19.76000,Coventry,Commercial,,39.36,,,,,,,10.66,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,inpatient,,,72.00000,34.70000,Coventry,Commercial,,69.12,,,,,,,64.80,69.84,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,outpatient,,,72.00000,34.70000,Coventry,Commercial,,69.12,,,,,,,18.72,69.84,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,inpatient,,,77.00000,37.11000,Coventry,Commercial,,73.92,,,,,,,69.30,74.69,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,outpatient,,,77.00000,37.11000,Coventry,Commercial,,73.92,,,,,,,20.02,74.69,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,inpatient,,,90.00000,43.38000,Coventry,Commercial,,86.40,,,,,,,81.00,87.30,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,outpatient,,,90.00000,43.38000,Coventry,Commercial,,86.40,,,,,,,23.40,87.30,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,inpatient,,,44.00000,21.21000,Coventry,Commercial,,42.24,,,,,,,39.60,42.68,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,outpatient,,,44.00000,21.21000,Coventry,Commercial,,42.24,,,,,,,11.44,42.68,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,inpatient,,,115.00000,55.43000,Coventry,Commercial,,110.40,,,,,,,103.50,111.55,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,outpatient,,,115.00000,55.43000,Coventry,Commercial,,110.40,,,,,,,29.90,111.55,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,inpatient,,,20.00000,9.64000,Coventry,Commercial,,19.20,,,,,,,18.00,19.40,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,outpatient,,,20.00000,9.64000,Coventry,Commercial,,19.20,,,,,,,5.20,19.40,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,46.80,50.44,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,13.52,50.44,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,inpatient,,,341.00000,164.36000,Coventry,Commercial,,327.36,,,,,,,306.90,330.77,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,outpatient,,,341.00000,164.36000,Coventry,Commercial,,327.36,,,,,,,88.66,330.77,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,inpatient,,,54.00000,26.03000,Coventry,Commercial,,51.84,,,,,,,48.60,52.38,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,outpatient,,,54.00000,26.03000,Coventry,Commercial,,51.84,,,,,,,14.04,52.38,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,inpatient,,,53.00000,25.55000,Coventry,Commercial,,50.88,,,,,,,47.70,51.41,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,outpatient,,,53.00000,25.55000,Coventry,Commercial,,50.88,,,,,,,13.78,51.41,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,inpatient,,,88.00000,42.42000,Coventry,Commercial,,84.48,,,,,,,79.20,85.36,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,outpatient,,,88.00000,42.42000,Coventry,Commercial,,84.48,,,,,,,22.88,85.36,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,inpatient,,,89.00000,42.90000,Coventry,Commercial,,85.44,,,,,,,80.10,86.33,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,outpatient,,,89.00000,42.90000,Coventry,Commercial,,85.44,,,,,,,23.14,86.33,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,inpatient,,,61.00000,29.40000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,outpatient,,,61.00000,29.40000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,inpatient,,,77.00000,37.11000,Coventry,Commercial,,73.92,,,,,,,69.30,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Coventry,Commercial,,73.92,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,inpatient,,,77.00000,37.11000,Coventry,Commercial,,73.92,,,,,,,69.30,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Coventry,Commercial,,73.92,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,inpatient,,,64.00000,30.85000,Coventry,Commercial,,61.44,,,,,,,57.60,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Coventry,Commercial,,61.44,,,,,,,16.64,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,inpatient,,,64.00000,30.85000,Coventry,Commercial,,61.44,,,,,,,57.60,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Coventry,Commercial,,61.44,,,,,,,16.64,62.08,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,inpatient,,,95.00000,45.79000,Coventry,Commercial,,91.20,,,,,,,85.50,92.15,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,outpatient,,,95.00000,45.79000,Coventry,Commercial,,91.20,,,,,,,24.70,92.15,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,inpatient,,,132.00000,63.62000,Coventry,Commercial,,126.72,,,,,,,118.80,128.04,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,outpatient,,,132.00000,63.62000,Coventry,Commercial,,126.72,,,,,,,34.32,128.04,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,inpatient,,,83.00000,40.01000,Coventry,Commercial,,79.68,,,,,,,74.70,80.51,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,outpatient,,,83.00000,40.01000,Coventry,Commercial,,79.68,,,,,,,21.58,80.51,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,inpatient,,,387.00000,186.53000,Coventry,Commercial,,371.52,,,,,,,348.30,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,outpatient,,,387.00000,186.53000,Coventry,Commercial,,371.52,,,,,,,100.62,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,inpatient,,,387.00000,186.53000,Coventry,Commercial,,371.52,,,,,,,348.30,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,outpatient,,,387.00000,186.53000,Coventry,Commercial,,371.52,,,,,,,100.62,375.39,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,inpatient,,,31.00000,14.94000,Coventry,Commercial,,29.76,,,,,,,27.90,30.07,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,outpatient,,,31.00000,14.94000,Coventry,Commercial,,29.76,,,,,,,8.06,30.07,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,inpatient,,,36.00000,17.35000,Coventry,Commercial,,34.56,,,,,,,32.40,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,outpatient,,,36.00000,17.35000,Coventry,Commercial,,34.56,,,,,,,9.36,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,inpatient,,,160.00000,77.12000,Coventry,Commercial,,153.60,,,,,,,144.00,155.20,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,outpatient,,,160.00000,77.12000,Coventry,Commercial,,153.60,,,,,,,41.60,155.20,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,inpatient,,,112.00000,53.98000,Coventry,Commercial,,107.52,,,,,,,100.80,108.64,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,outpatient,,,112.00000,53.98000,Coventry,Commercial,,107.52,,,,,,,29.12,108.64,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,inpatient,,,14.00000,6.75000,Coventry,Commercial,,13.44,,,,,,,12.60,13.58,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,outpatient,,,14.00000,6.75000,Coventry,Commercial,,13.44,,,,,,,3.64,13.58,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,inpatient,,,16.00000,7.71000,Coventry,Commercial,,15.36,,,,,,,14.40,15.52,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,outpatient,,,16.00000,7.71000,Coventry,Commercial,,15.36,,,,,,,4.16,15.52,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,inpatient,,,71.00000,34.22000,Coventry,Commercial,,68.16,,,,,,,63.90,68.87,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,outpatient,,,71.00000,34.22000,Coventry,Commercial,,68.16,,,,,,,18.46,68.87,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,inpatient,,,116.00000,55.91000,Coventry,Commercial,,111.36,,,,,,,104.40,112.52,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,outpatient,,,116.00000,55.91000,Coventry,Commercial,,111.36,,,,,,,30.16,112.52,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,inpatient,,,81.00000,39.04000,Coventry,Commercial,,77.76,,,,,,,72.90,78.57,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,outpatient,,,81.00000,39.04000,Coventry,Commercial,,77.76,,,,,,,21.06,78.57,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,inpatient,,,97.00000,46.75000,Coventry,Commercial,,93.12,,,,,,,87.30,94.09,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,outpatient,,,97.00000,46.75000,Coventry,Commercial,,93.12,,,,,,,25.22,94.09,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,inpatient,,,77.00000,37.11000,Coventry,Commercial,,73.92,,,,,,,69.30,74.69,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,outpatient,,,77.00000,37.11000,Coventry,Commercial,,73.92,,,,,,,20.02,74.69,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,inpatient,,,35.00000,16.87000,Coventry,Commercial,,33.60,,,,,,,31.50,33.95,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,outpatient,,,35.00000,16.87000,Coventry,Commercial,,33.60,,,,,,,9.10,33.95,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,inpatient,,,65.00000,31.33000,Coventry,Commercial,,62.40,,,,,,,58.50,63.05,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,outpatient,,,65.00000,31.33000,Coventry,Commercial,,62.40,,,,,,,16.90,63.05,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,inpatient,,,74.00000,35.67000,Coventry,Commercial,,71.04,,,,,,,66.60,71.78,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,outpatient,,,74.00000,35.67000,Coventry,Commercial,,71.04,,,,,,,19.24,71.78,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,inpatient,,,250.00000,120.50000,Coventry,Commercial,,240.00,,,,,,,225.00,242.50,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,outpatient,,,250.00000,120.50000,Coventry,Commercial,,240.00,,,,,,,65.00,242.50,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,inpatient,,,90.00000,43.38000,Coventry,Commercial,,86.40,,,,,,,81.00,87.30,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,outpatient,,,90.00000,43.38000,Coventry,Commercial,,86.40,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,inpatient,,,90.00000,43.38000,Coventry,Commercial,,86.40,,,,,,,81.00,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,outpatient,,,90.00000,43.38000,Coventry,Commercial,,86.40,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,46.80,50.44,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,13.52,50.44,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,inpatient,,,36.00000,17.35000,Coventry,Commercial,,34.56,,,,,,,32.40,34.92,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,outpatient,,,36.00000,17.35000,Coventry,Commercial,,34.56,,,,,,,9.36,34.92,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,inpatient,,,78.00000,37.60000,Coventry,Commercial,,74.88,,,,,,,70.20,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,outpatient,,,78.00000,37.60000,Coventry,Commercial,,74.88,,,,,,,20.28,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,inpatient,,,115.00000,55.43000,Coventry,Commercial,,110.40,,,,,,,103.50,111.55,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,outpatient,,,115.00000,55.43000,Coventry,Commercial,,110.40,,,,,,,29.90,111.55,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,60.30,64.99,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,17.42,64.99,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,inpatient,,,76.00000,36.63000,Coventry,Commercial,,72.96,,,,,,,68.40,73.72,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,outpatient,,,76.00000,36.63000,Coventry,Commercial,,72.96,,,,,,,19.76,73.72,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,inpatient,,,53.00000,25.55000,Coventry,Commercial,,50.88,,,,,,,47.70,51.41,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,outpatient,,,53.00000,25.55000,Coventry,Commercial,,50.88,,,,,,,13.78,51.41,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,inpatient,,,70.00000,33.74000,Coventry,Commercial,,67.20,,,,,,,63.00,67.90,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,outpatient,,,70.00000,33.74000,Coventry,Commercial,,67.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,inpatient,,,169.00000,81.46000,Coventry,Commercial,,162.24,,,,,,,152.10,163.93,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,outpatient,,,169.00000,81.46000,Coventry,Commercial,,162.24,,,,,,,43.94,163.93,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,inpatient,,,28.00000,13.50000,Coventry,Commercial,,26.88,,,,,,,25.20,27.16,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,outpatient,,,28.00000,13.50000,Coventry,Commercial,,26.88,,,,,,,7.28,27.16,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,inpatient,,,51.00000,24.58000,Coventry,Commercial,,48.96,,,,,,,45.90,49.47,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,outpatient,,,51.00000,24.58000,Coventry,Commercial,,48.96,,,,,,,13.26,49.47,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,inpatient,,,15.00000,7.23000,Coventry,Commercial,,14.40,,,,,,,13.50,14.55,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,outpatient,,,15.00000,7.23000,Coventry,Commercial,,14.40,,,,,,,3.90,14.55,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,inpatient,,,18.00000,8.68000,Coventry,Commercial,,17.28,,,,,,,16.20,17.46,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,outpatient,,,18.00000,8.68000,Coventry,Commercial,,17.28,,,,,,,4.68,17.46,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,inpatient,,,61.00000,29.40000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,outpatient,,,61.00000,29.40000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,inpatient,,,550.00000,265.10000,Coventry,Commercial,,528.00,,,,,,,495.00,533.50,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,outpatient,,,550.00000,265.10000,Coventry,Commercial,,528.00,,,,,,,143.00,533.50,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,inpatient,,,73.00000,35.19000,Coventry,Commercial,,70.08,,,,,,,65.70,70.81,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Coventry,Commercial,,70.08,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,inpatient,,,392.00000,188.94000,Coventry,Commercial,,376.32,,,,,,,352.80,380.24,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,outpatient,,,392.00000,188.94000,Coventry,Commercial,,376.32,,,,,,,101.92,380.24,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,inpatient,,,75.00000,36.15000,Coventry,Commercial,,72.00,,,,,,,67.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,outpatient,,,75.00000,36.15000,Coventry,Commercial,,72.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,inpatient,,,73.00000,35.19000,Coventry,Commercial,,70.08,,,,,,,65.70,70.81,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Coventry,Commercial,,70.08,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,inpatient,,,100.00000,48.20000,Coventry,Commercial,,96.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,outpatient,,,100.00000,48.20000,Coventry,Commercial,,96.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,inpatient,,,153.00000,73.75000,Coventry,Commercial,,146.88,,,,,,,137.70,148.41,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,outpatient,,,153.00000,73.75000,Coventry,Commercial,,146.88,,,,,,,39.78,148.41,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,inpatient,,,909.00000,438.14000,Coventry,Commercial,,872.64,,,,,,,818.10,881.73,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,outpatient,,,909.00000,438.14000,Coventry,Commercial,,872.64,,,,,,,236.34,881.73,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,inpatient,,,266.00000,128.21000,Coventry,Commercial,,255.36,,,,,,,239.40,258.02,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,outpatient,,,266.00000,128.21000,Coventry,Commercial,,255.36,,,,,,,69.16,258.02,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,inpatient,,,275.00000,132.55000,Coventry,Commercial,,264.00,,,,,,,247.50,266.75,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,outpatient,,,275.00000,132.55000,Coventry,Commercial,,264.00,,,,,,,71.50,266.75,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,inpatient,,,61.00000,29.40000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,outpatient,,,61.00000,29.40000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,inpatient,,,84.00000,40.49000,Coventry,Commercial,,80.64,,,,,,,75.60,81.48,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,outpatient,,,84.00000,40.49000,Coventry,Commercial,,80.64,,,,,,,21.84,81.48,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,inpatient,,,174.00000,83.87000,Coventry,Commercial,,167.04,,,,,,,156.60,168.78,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,outpatient,,,174.00000,83.87000,Coventry,Commercial,,167.04,,,,,,,45.24,168.78,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,60.30,64.99,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,17.42,64.99,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,inpatient,,,68.00000,32.78000,Coventry,Commercial,,65.28,,,,,,,61.20,65.96,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,outpatient,,,68.00000,32.78000,Coventry,Commercial,,65.28,,,,,,,17.68,65.96,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,inpatient,,,211.00000,101.70000,Coventry,Commercial,,202.56,,,,,,,189.90,204.67,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,outpatient,,,211.00000,101.70000,Coventry,Commercial,,202.56,,,,,,,54.86,204.67,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,inpatient,,,65.00000,31.33000,Coventry,Commercial,,62.40,,,,,,,58.50,63.05,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,outpatient,,,65.00000,31.33000,Coventry,Commercial,,62.40,,,,,,,16.90,63.05,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,inpatient,,,83.00000,40.01000,Coventry,Commercial,,79.68,,,,,,,74.70,80.51,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,outpatient,,,83.00000,40.01000,Coventry,Commercial,,79.68,,,,,,,21.58,80.51,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,inpatient,,,54.00000,26.03000,Coventry,Commercial,,51.84,,,,,,,48.60,52.38,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,outpatient,,,54.00000,26.03000,Coventry,Commercial,,51.84,,,,,,,14.04,52.38,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,inpatient,,,323.00000,155.69000,Coventry,Commercial,,310.08,,,,,,,290.70,313.31,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,outpatient,,,323.00000,155.69000,Coventry,Commercial,,310.08,,,,,,,83.98,313.31,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,inpatient,,,35.00000,16.87000,Coventry,Commercial,,33.60,,,,,,,31.50,33.95,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,outpatient,,,35.00000,16.87000,Coventry,Commercial,,33.60,,,,,,,9.10,33.95,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,inpatient,,,20.00000,9.64000,Coventry,Commercial,,19.20,,,,,,,18.00,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,outpatient,,,20.00000,9.64000,Coventry,Commercial,,19.20,,,,,,,5.20,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,inpatient,,,34.00000,16.39000,Coventry,Commercial,,32.64,,,,,,,30.60,32.98,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,outpatient,,,34.00000,16.39000,Coventry,Commercial,,32.64,,,,,,,8.84,32.98,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,inpatient,,,29.00000,13.98000,Coventry,Commercial,,27.84,,,,,,,26.10,28.13,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,outpatient,,,29.00000,13.98000,Coventry,Commercial,,27.84,,,,,,,7.54,28.13,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,inpatient,,,80.00000,38.56000,Coventry,Commercial,,76.80,,,,,,,72.00,77.60,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,outpatient,,,80.00000,38.56000,Coventry,Commercial,,76.80,,,,,,,20.80,77.60,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,inpatient,,,73.00000,35.19000,Coventry,Commercial,,70.08,,,,,,,65.70,70.81,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,outpatient,,,73.00000,35.19000,Coventry,Commercial,,70.08,,,,,,,18.98,70.81,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,inpatient,,,16.00000,7.71000,Coventry,Commercial,,15.36,,,,,,,14.40,15.52,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,outpatient,,,16.00000,7.71000,Coventry,Commercial,,15.36,,,,,,,4.16,15.52,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,46.80,50.44,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,13.52,50.44,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,inpatient,,,113.00000,54.47000,Coventry,Commercial,,108.48,,,,,,,101.70,109.61,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,outpatient,,,113.00000,54.47000,Coventry,Commercial,,108.48,,,,,,,29.38,109.61,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,inpatient,,,68.00000,32.78000,Coventry,Commercial,,65.28,,,,,,,61.20,65.96,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,outpatient,,,68.00000,32.78000,Coventry,Commercial,,65.28,,,,,,,17.68,65.96,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,inpatient,,,78.00000,37.60000,Coventry,Commercial,,74.88,,,,,,,70.20,75.66,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,outpatient,,,78.00000,37.60000,Coventry,Commercial,,74.88,,,,,,,20.28,75.66,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,inpatient,,,54.00000,26.03000,Coventry,Commercial,,51.84,,,,,,,48.60,52.38,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,outpatient,,,54.00000,26.03000,Coventry,Commercial,,51.84,,,,,,,14.04,52.38,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,inpatient,,,76.00000,36.63000,Coventry,Commercial,,72.96,,,,,,,68.40,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,outpatient,,,76.00000,36.63000,Coventry,Commercial,,72.96,,,,,,,19.76,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,60.30,64.99,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,17.42,64.99,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,inpatient,,,88.00000,42.42000,Coventry,Commercial,,84.48,,,,,,,79.20,85.36,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,outpatient,,,88.00000,42.42000,Coventry,Commercial,,84.48,,,,,,,22.88,85.36,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,60.30,64.99,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,17.42,64.99,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,inpatient,,,53.00000,25.55000,Coventry,Commercial,,50.88,,,,,,,47.70,51.41,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,outpatient,,,53.00000,25.55000,Coventry,Commercial,,50.88,,,,,,,13.78,51.41,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,inpatient,,,88.00000,42.42000,Coventry,Commercial,,84.48,,,,,,,79.20,85.36,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,outpatient,,,88.00000,42.42000,Coventry,Commercial,,84.48,,,,,,,22.88,85.36,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,inpatient,,,105.00000,50.61000,Coventry,Commercial,,100.80,,,,,,,94.50,101.85,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,outpatient,,,105.00000,50.61000,Coventry,Commercial,,100.80,,,,,,,27.30,101.85,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,inpatient,,,73.00000,35.19000,Coventry,Commercial,,70.08,,,,,,,65.70,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Coventry,Commercial,,70.08,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,inpatient,,,83.00000,40.01000,Coventry,Commercial,,79.68,,,,,,,74.70,80.51,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,outpatient,,,83.00000,40.01000,Coventry,Commercial,,79.68,,,,,,,21.58,80.51,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,inpatient,,,154.00000,74.23000,Coventry,Commercial,,147.84,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Coventry,Commercial,,147.84,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,inpatient,,,97.00000,46.75000,Coventry,Commercial,,93.12,,,,,,,87.30,94.09,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,outpatient,,,97.00000,46.75000,Coventry,Commercial,,93.12,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,inpatient,,,154.00000,74.23000,Coventry,Commercial,,147.84,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Coventry,Commercial,,147.84,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,inpatient,,,87.00000,41.93000,Coventry,Commercial,,83.52,,,,,,,78.30,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,outpatient,,,87.00000,41.93000,Coventry,Commercial,,83.52,,,,,,,22.62,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,inpatient,,,68.00000,32.78000,Coventry,Commercial,,65.28,,,,,,,61.20,65.96,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,outpatient,,,68.00000,32.78000,Coventry,Commercial,,65.28,,,,,,,17.68,65.96,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,46.80,50.44,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,13.52,50.44,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,inpatient,,,51.00000,24.58000,Coventry,Commercial,,48.96,,,,,,,45.90,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,outpatient,,,51.00000,24.58000,Coventry,Commercial,,48.96,,,,,,,13.26,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,inpatient,,,97.00000,46.75000,Coventry,Commercial,,93.12,,,,,,,87.30,94.09,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,outpatient,,,97.00000,46.75000,Coventry,Commercial,,93.12,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,inpatient,,,176.00000,84.83000,Coventry,Commercial,,168.96,,,,,,,158.40,170.72,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,outpatient,,,176.00000,84.83000,Coventry,Commercial,,168.96,,,,,,,45.76,170.72,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,inpatient,,,158.00000,76.16000,Coventry,Commercial,,151.68,,,,,,,142.20,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,outpatient,,,158.00000,76.16000,Coventry,Commercial,,151.68,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,inpatient,,,84.00000,40.49000,Coventry,Commercial,,80.64,,,,,,,75.60,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,outpatient,,,84.00000,40.49000,Coventry,Commercial,,80.64,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,inpatient,,,189.00000,91.10000,Coventry,Commercial,,181.44,,,,,,,170.10,183.33,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,outpatient,,,189.00000,91.10000,Coventry,Commercial,,181.44,,,,,,,49.14,183.33,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,inpatient,,,109.00000,52.54000,Coventry,Commercial,,104.64,,,,,,,98.10,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,outpatient,,,109.00000,52.54000,Coventry,Commercial,,104.64,,,,,,,28.34,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,inpatient,,,129.00000,62.18000,Coventry,Commercial,,123.84,,,,,,,116.10,125.13,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,outpatient,,,129.00000,62.18000,Coventry,Commercial,,123.84,,,,,,,33.54,125.13,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,inpatient,,,84.00000,40.49000,Coventry,Commercial,,80.64,,,,,,,75.60,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,outpatient,,,84.00000,40.49000,Coventry,Commercial,,80.64,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,inpatient,,,73.00000,35.19000,Coventry,Commercial,,70.08,,,,,,,65.70,70.81,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Coventry,Commercial,,70.08,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,inpatient,,,149.00000,71.82000,Coventry,Commercial,,143.04,,,,,,,134.10,144.53,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,outpatient,,,149.00000,71.82000,Coventry,Commercial,,143.04,,,,,,,38.74,144.53,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,inpatient,,,130.00000,62.66000,Coventry,Commercial,,124.80,,,,,,,117.00,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,outpatient,,,130.00000,62.66000,Coventry,Commercial,,124.80,,,,,,,33.80,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,inpatient,,,110.00000,53.02000,Coventry,Commercial,,105.60,,,,,,,99.00,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,outpatient,,,110.00000,53.02000,Coventry,Commercial,,105.60,,,,,,,28.60,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,inpatient,,,158.00000,76.16000,Coventry,Commercial,,151.68,,,,,,,142.20,153.26,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,outpatient,,,158.00000,76.16000,Coventry,Commercial,,151.68,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,inpatient,,,117.00000,56.39000,Coventry,Commercial,,112.32,,,,,,,105.30,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,outpatient,,,117.00000,56.39000,Coventry,Commercial,,112.32,,,,,,,30.42,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,inpatient,,,61.00000,29.40000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,outpatient,,,61.00000,29.40000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Coventry,Commercial,,179.52,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Coventry,Commercial,,179.52,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,inpatient,,,145.00000,69.89000,Coventry,Commercial,,139.20,,,,,,,130.50,140.65,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,outpatient,,,145.00000,69.89000,Coventry,Commercial,,139.20,,,,,,,37.70,140.65,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,inpatient,,,165.00000,79.53000,Coventry,Commercial,,158.40,,,,,,,148.50,160.05,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,outpatient,,,165.00000,79.53000,Coventry,Commercial,,158.40,,,,,,,42.90,160.05,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,inpatient,,,70.00000,33.74000,Coventry,Commercial,,67.20,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,outpatient,,,70.00000,33.74000,Coventry,Commercial,,67.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Coventry,Commercial,,179.52,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Coventry,Commercial,,179.52,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,inpatient,,,154.00000,74.23000,Coventry,Commercial,,147.84,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,outpatient,,,154.00000,74.23000,Coventry,Commercial,,147.84,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,inpatient,,,104.00000,50.13000,Coventry,Commercial,,99.84,,,,,,,93.60,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,outpatient,,,104.00000,50.13000,Coventry,Commercial,,99.84,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,inpatient,,,70.00000,33.74000,Coventry,Commercial,,67.20,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,outpatient,,,70.00000,33.74000,Coventry,Commercial,,67.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,inpatient,,,104.00000,50.13000,Coventry,Commercial,,99.84,,,,,,,93.60,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,outpatient,,,104.00000,50.13000,Coventry,Commercial,,99.84,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,inpatient,,,70.00000,33.74000,Coventry,Commercial,,67.20,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,outpatient,,,70.00000,33.74000,Coventry,Commercial,,67.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,inpatient,,,123.00000,59.29000,Coventry,Commercial,,118.08,,,,,,,110.70,119.31,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,outpatient,,,123.00000,59.29000,Coventry,Commercial,,118.08,,,,,,,31.98,119.31,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,inpatient,,,95.00000,45.79000,Coventry,Commercial,,91.20,,,,,,,85.50,92.15,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,outpatient,,,95.00000,45.79000,Coventry,Commercial,,91.20,,,,,,,24.70,92.15,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,inpatient,,,160.00000,77.12000,Coventry,Commercial,,153.60,,,,,,,144.00,155.20,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,outpatient,,,160.00000,77.12000,Coventry,Commercial,,153.60,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,inpatient,,,147.00000,70.85000,Coventry,Commercial,,141.12,,,,,,,132.30,142.59,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,outpatient,,,147.00000,70.85000,Coventry,Commercial,,141.12,,,,,,,38.22,142.59,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,inpatient,,,178.00000,85.80000,Coventry,Commercial,,170.88,,,,,,,160.20,172.66,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,outpatient,,,178.00000,85.80000,Coventry,Commercial,,170.88,,,,,,,46.28,172.66,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,inpatient,,,160.00000,77.12000,Coventry,Commercial,,153.60,,,,,,,144.00,155.20,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,outpatient,,,160.00000,77.12000,Coventry,Commercial,,153.60,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Coventry,Commercial,,179.52,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Coventry,Commercial,,179.52,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,inpatient,,,70.00000,33.74000,Coventry,Commercial,,67.20,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,outpatient,,,70.00000,33.74000,Coventry,Commercial,,67.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Coventry,Commercial,,179.52,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Coventry,Commercial,,179.52,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Coventry,Commercial,,179.52,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Coventry,Commercial,,179.52,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Coventry,Commercial,,179.52,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Coventry,Commercial,,179.52,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Coventry,Commercial,,179.52,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Coventry,Commercial,,179.52,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Coventry,Commercial,,179.52,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Coventry,Commercial,,179.52,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Coventry,Commercial,,179.52,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Coventry,Commercial,,179.52,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Coventry,Commercial,,179.52,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Coventry,Commercial,,179.52,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Coventry,Commercial,,179.52,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Coventry,Commercial,,179.52,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,inpatient,,,449.00000,216.42000,Coventry,Commercial,,431.04,,,,,,,404.10,435.53,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,outpatient,,,449.00000,216.42000,Coventry,Commercial,,431.04,,,,,,,116.74,435.53,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,inpatient,,,104.00000,50.13000,Coventry,Commercial,,99.84,,,,,,,93.60,100.88,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,outpatient,,,104.00000,50.13000,Coventry,Commercial,,99.84,,,,,,,27.04,100.88,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,inpatient,,,185.00000,89.17000,Coventry,Commercial,,177.60,,,,,,,166.50,179.45,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Coventry,Commercial,,177.60,,,,,,,48.10,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,inpatient,,,185.00000,89.17000,Coventry,Commercial,,177.60,,,,,,,166.50,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Coventry,Commercial,,177.60,,,,,,,48.10,179.45,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,inpatient,,,84.00000,40.49000,Coventry,Commercial,,80.64,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,outpatient,,,84.00000,40.49000,Coventry,Commercial,,80.64,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,inpatient,,,84.00000,40.49000,Coventry,Commercial,,80.64,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Coventry,Commercial,,80.64,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,inpatient,,,84.00000,40.49000,Coventry,Commercial,,80.64,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Coventry,Commercial,,80.64,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,inpatient,,,73.00000,35.19000,Coventry,Commercial,,70.08,,,,,,,65.70,70.81,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Coventry,Commercial,,70.08,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,inpatient,,,73.00000,35.19000,Coventry,Commercial,,70.08,,,,,,,65.70,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Coventry,Commercial,,70.08,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,inpatient,,,98.00000,47.24000,Coventry,Commercial,,94.08,,,,,,,88.20,95.06,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,outpatient,,,98.00000,47.24000,Coventry,Commercial,,94.08,,,,,,,25.48,95.06,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,inpatient,,,75.00000,36.15000,Coventry,Commercial,,72.00,,,,,,,67.50,72.75,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,outpatient,,,75.00000,36.15000,Coventry,Commercial,,72.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,inpatient,,,107.00000,51.57000,Coventry,Commercial,,102.72,,,,,,,96.30,103.79,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,outpatient,,,107.00000,51.57000,Coventry,Commercial,,102.72,,,,,,,27.82,103.79,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,inpatient,,,81.00000,39.04000,Coventry,Commercial,,77.76,,,,,,,72.90,78.57,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,outpatient,,,81.00000,39.04000,Coventry,Commercial,,77.76,,,,,,,21.06,78.57,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,inpatient,,,68.00000,32.78000,Coventry,Commercial,,65.28,,,,,,,61.20,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,outpatient,,,68.00000,32.78000,Coventry,Commercial,,65.28,,,,,,,17.68,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,inpatient,,,51.00000,24.58000,Coventry,Commercial,,48.96,,,,,,,45.90,49.47,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,outpatient,,,51.00000,24.58000,Coventry,Commercial,,48.96,,,,,,,13.26,49.47,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,inpatient,,,74.00000,35.67000,Coventry,Commercial,,71.04,,,,,,,66.60,71.78,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,outpatient,,,74.00000,35.67000,Coventry,Commercial,,71.04,,,,,,,19.24,71.78,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,inpatient,,,194.00000,93.51000,Coventry,Commercial,,186.24,,,,,,,174.60,188.18,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,outpatient,,,194.00000,93.51000,Coventry,Commercial,,186.24,,,,,,,50.44,188.18,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,inpatient,,,111.00000,53.50000,Coventry,Commercial,,106.56,,,,,,,99.90,107.67,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,outpatient,,,111.00000,53.50000,Coventry,Commercial,,106.56,,,,,,,28.86,107.67,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,inpatient,,,77.00000,37.11000,Coventry,Commercial,,73.92,,,,,,,69.30,74.69,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,outpatient,,,77.00000,37.11000,Coventry,Commercial,,73.92,,,,,,,20.02,74.69,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Coventry,Commercial,,75.84,,,,,,,71.10,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Coventry,Commercial,,75.84,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Coventry,Commercial,,75.84,,,,,,,71.10,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Coventry,Commercial,,75.84,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,inpatient,,,237.00000,114.23000,Coventry,Commercial,,227.52,,,,,,,213.30,229.89,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Coventry,Commercial,,227.52,,,,,,,61.62,229.89,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,inpatient,,,51.00000,24.58000,Coventry,Commercial,,48.96,,,,,,,45.90,49.47,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,outpatient,,,51.00000,24.58000,Coventry,Commercial,,48.96,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,inpatient,,,82.00000,39.52000,Coventry,Commercial,,78.72,,,,,,,73.80,79.54,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Coventry,Commercial,,78.72,,,,,,,21.32,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,inpatient,,,82.00000,39.52000,Coventry,Commercial,,78.72,,,,,,,73.80,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Coventry,Commercial,,78.72,,,,,,,21.32,79.54,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,60.30,64.99,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,17.42,64.99,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,inpatient,,,131.00000,63.14000,Coventry,Commercial,,125.76,,,,,,,117.90,127.07,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,outpatient,,,131.00000,63.14000,Coventry,Commercial,,125.76,,,,,,,34.06,127.07,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,inpatient,,,15.00000,7.23000,Coventry,Commercial,,14.40,,,,,,,13.50,14.55,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,outpatient,,,15.00000,7.23000,Coventry,Commercial,,14.40,,,,,,,3.90,14.55,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,inpatient,,,39.00000,18.80000,Coventry,Commercial,,37.44,,,,,,,35.10,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,outpatient,,,39.00000,18.80000,Coventry,Commercial,,37.44,,,,,,,10.14,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,inpatient,,,12.00000,5.78000,Coventry,Commercial,,11.52,,,,,,,10.80,11.64,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,outpatient,,,12.00000,5.78000,Coventry,Commercial,,11.52,,,,,,,3.12,11.64,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,inpatient,,,203.00000,97.85000,Coventry,Commercial,,194.88,,,,,,,182.70,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Coventry,Commercial,,194.88,,,,,,,52.78,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,inpatient,,,203.00000,97.85000,Coventry,Commercial,,194.88,,,,,,,182.70,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Coventry,Commercial,,194.88,,,,,,,52.78,196.91,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,inpatient,,,99.00000,47.72000,Coventry,Commercial,,95.04,,,,,,,89.10,96.03,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,outpatient,,,99.00000,47.72000,Coventry,Commercial,,95.04,,,,,,,25.74,96.03,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,inpatient,,,53.00000,25.55000,Coventry,Commercial,,50.88,,,,,,,47.70,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,outpatient,,,53.00000,25.55000,Coventry,Commercial,,50.88,,,,,,,13.78,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,inpatient,,,23.00000,11.09000,Coventry,Commercial,,22.08,,,,,,,20.70,22.31,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,outpatient,,,23.00000,11.09000,Coventry,Commercial,,22.08,,,,,,,5.98,22.31,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,inpatient,,,46.00000,22.17000,Coventry,Commercial,,44.16,,,,,,,41.40,44.62,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,outpatient,,,46.00000,22.17000,Coventry,Commercial,,44.16,,,,,,,11.96,44.62,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,60.30,64.99,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,17.42,64.99,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,inpatient,,,288.00000,138.82000,Coventry,Commercial,,276.48,,,,,,,259.20,279.36,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,outpatient,,,288.00000,138.82000,Coventry,Commercial,,276.48,,,,,,,74.88,279.36,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,inpatient,,,106.00000,51.09000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,outpatient,,,106.00000,51.09000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,inpatient,,,30.00000,14.46000,Coventry,Commercial,,28.80,,,,,,,27.00,29.10,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,outpatient,,,30.00000,14.46000,Coventry,Commercial,,28.80,,,,,,,7.80,29.10,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,inpatient,,,71.00000,34.22000,Coventry,Commercial,,68.16,,,,,,,63.90,68.87,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,outpatient,,,71.00000,34.22000,Coventry,Commercial,,68.16,,,,,,,18.46,68.87,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,60.30,64.99,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,17.42,64.99,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,inpatient,,,89.00000,42.90000,Coventry,Commercial,,85.44,,,,,,,80.10,86.33,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,outpatient,,,89.00000,42.90000,Coventry,Commercial,,85.44,,,,,,,23.14,86.33,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,inpatient,,,116.00000,55.91000,Coventry,Commercial,,111.36,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,outpatient,,,116.00000,55.91000,Coventry,Commercial,,111.36,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,inpatient,,,116.00000,55.91000,Coventry,Commercial,,111.36,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Coventry,Commercial,,111.36,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,inpatient,,,116.00000,55.91000,Coventry,Commercial,,111.36,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Coventry,Commercial,,111.36,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,inpatient,,,51.00000,24.58000,Coventry,Commercial,,48.96,,,,,,,45.90,49.47,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,outpatient,,,51.00000,24.58000,Coventry,Commercial,,48.96,,,,,,,13.26,49.47,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,inpatient,,,174.00000,83.87000,Coventry,Commercial,,167.04,,,,,,,156.60,168.78,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,outpatient,,,174.00000,83.87000,Coventry,Commercial,,167.04,,,,,,,45.24,168.78,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,inpatient,,,82.00000,39.52000,Coventry,Commercial,,78.72,,,,,,,73.80,79.54,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,outpatient,,,82.00000,39.52000,Coventry,Commercial,,78.72,,,,,,,21.32,79.54,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,inpatient,,,112.00000,53.98000,Coventry,Commercial,,107.52,,,,,,,100.80,108.64,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,outpatient,,,112.00000,53.98000,Coventry,Commercial,,107.52,,,,,,,29.12,108.64,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,inpatient,,,61.00000,29.40000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,outpatient,,,61.00000,29.40000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,inpatient,,,69.00000,33.26000,Coventry,Commercial,,66.24,,,,,,,62.10,66.93,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,outpatient,,,69.00000,33.26000,Coventry,Commercial,,66.24,,,,,,,17.94,66.93,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,46.80,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,13.52,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,inpatient,,,286.00000,137.85000,Coventry,Commercial,,274.56,,,,,,,257.40,277.42,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,outpatient,,,286.00000,137.85000,Coventry,Commercial,,274.56,,,,,,,74.36,277.42,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,inpatient,,,300.00000,144.60000,Coventry,Commercial,,288.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,outpatient,,,300.00000,144.60000,Coventry,Commercial,,288.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,inpatient,,,73.00000,35.19000,Coventry,Commercial,,70.08,,,,,,,65.70,70.81,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,outpatient,,,73.00000,35.19000,Coventry,Commercial,,70.08,,,,,,,18.98,70.81,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,inpatient,,,90.00000,43.38000,Coventry,Commercial,,86.40,,,,,,,81.00,87.30,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,outpatient,,,90.00000,43.38000,Coventry,Commercial,,86.40,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,46.80,50.44,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,inpatient,,,315.00000,151.83000,Coventry,Commercial,,302.40,,,,,,,283.50,305.55,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,outpatient,,,315.00000,151.83000,Coventry,Commercial,,302.40,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,inpatient,,,100.00000,48.20000,Coventry,Commercial,,96.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,outpatient,,,100.00000,48.20000,Coventry,Commercial,,96.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,inpatient,,,89.00000,42.90000,Coventry,Commercial,,85.44,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,outpatient,,,89.00000,42.90000,Coventry,Commercial,,85.44,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,inpatient,,,71.00000,34.22000,Coventry,Commercial,,68.16,,,,,,,63.90,68.87,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,outpatient,,,71.00000,34.22000,Coventry,Commercial,,68.16,,,,,,,18.46,68.87,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,inpatient,,,135.00000,65.07000,Coventry,Commercial,,129.60,,,,,,,121.50,130.95,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,outpatient,,,135.00000,65.07000,Coventry,Commercial,,129.60,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,inpatient,,,80.00000,38.56000,Coventry,Commercial,,76.80,,,,,,,72.00,77.60,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,outpatient,,,80.00000,38.56000,Coventry,Commercial,,76.80,,,,,,,20.80,77.60,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,inpatient,,,72.00000,34.70000,Coventry,Commercial,,69.12,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Coventry,Commercial,,69.12,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,inpatient,,,72.00000,34.70000,Coventry,Commercial,,69.12,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Coventry,Commercial,,69.12,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,inpatient,,,100.00000,48.20000,Coventry,Commercial,,96.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,outpatient,,,100.00000,48.20000,Coventry,Commercial,,96.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,inpatient,,,305.00000,147.01000,Coventry,Commercial,,292.80,,,,,,,274.50,295.85,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,outpatient,,,305.00000,147.01000,Coventry,Commercial,,292.80,,,,,,,79.30,295.85,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,inpatient,,,70.00000,33.74000,Coventry,Commercial,,67.20,,,,,,,63.00,67.90,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,outpatient,,,70.00000,33.74000,Coventry,Commercial,,67.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,inpatient,,,69.00000,33.26000,Coventry,Commercial,,66.24,,,,,,,62.10,66.93,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,outpatient,,,69.00000,33.26000,Coventry,Commercial,,66.24,,,,,,,17.94,66.93,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,inpatient,,,64.00000,30.85000,Coventry,Commercial,,61.44,,,,,,,57.60,62.08,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,outpatient,,,64.00000,30.85000,Coventry,Commercial,,61.44,,,,,,,16.64,62.08,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,inpatient,,,368.00000,177.38000,Coventry,Commercial,,353.28,,,,,,,331.20,356.96,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,outpatient,,,368.00000,177.38000,Coventry,Commercial,,353.28,,,,,,,95.68,356.96,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,inpatient,,,104.00000,50.13000,Coventry,Commercial,,99.84,,,,,,,93.60,100.88,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,outpatient,,,104.00000,50.13000,Coventry,Commercial,,99.84,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,inpatient,,,109.00000,52.54000,Coventry,Commercial,,104.64,,,,,,,98.10,105.73,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,outpatient,,,109.00000,52.54000,Coventry,Commercial,,104.64,,,,,,,28.34,105.73,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,inpatient,,,114.00000,54.95000,Coventry,Commercial,,109.44,,,,,,,102.60,110.58,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,outpatient,,,114.00000,54.95000,Coventry,Commercial,,109.44,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,inpatient,,,135.00000,65.07000,Coventry,Commercial,,129.60,,,,,,,121.50,130.95,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,outpatient,,,135.00000,65.07000,Coventry,Commercial,,129.60,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,inpatient,,,105.00000,50.61000,Coventry,Commercial,,100.80,,,,,,,94.50,101.85,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,outpatient,,,105.00000,50.61000,Coventry,Commercial,,100.80,,,,,,,27.30,101.85,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,inpatient,,,315.00000,151.83000,Coventry,Commercial,,302.40,,,,,,,283.50,305.55,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,outpatient,,,315.00000,151.83000,Coventry,Commercial,,302.40,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,inpatient,,,148.00000,71.34000,Coventry,Commercial,,142.08,,,,,,,133.20,143.56,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,outpatient,,,148.00000,71.34000,Coventry,Commercial,,142.08,,,,,,,38.48,143.56,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,60.30,64.99,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,17.42,64.99,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,inpatient,,,107.00000,51.57000,Coventry,Commercial,,102.72,,,,,,,96.30,103.79,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,outpatient,,,107.00000,51.57000,Coventry,Commercial,,102.72,,,,,,,27.82,103.79,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,inpatient,,,35.00000,16.87000,Coventry,Commercial,,33.60,,,,,,,31.50,33.95,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,outpatient,,,35.00000,16.87000,Coventry,Commercial,,33.60,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,inpatient,,,104.00000,50.13000,Coventry,Commercial,,99.84,,,,,,,93.60,100.88,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,outpatient,,,104.00000,50.13000,Coventry,Commercial,,99.84,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,inpatient,,,650.00000,313.30000,Coventry,Commercial,,624.00,,,,,,,585.00,630.50,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,outpatient,,,650.00000,313.30000,Coventry,Commercial,,624.00,,,,,,,169.00,630.50,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,inpatient,,,91.00000,43.86000,Coventry,Commercial,,87.36,,,,,,,81.90,88.27,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,outpatient,,,91.00000,43.86000,Coventry,Commercial,,87.36,,,,,,,23.66,88.27,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,inpatient,,,114.00000,54.95000,Coventry,Commercial,,109.44,,,,,,,102.60,110.58,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,outpatient,,,114.00000,54.95000,Coventry,Commercial,,109.44,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,46.80,50.44,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,inpatient,,,360.00000,173.52000,Coventry,Commercial,,345.60,,,,,,,324.00,349.20,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,outpatient,,,360.00000,173.52000,Coventry,Commercial,,345.60,,,,,,,93.60,349.20,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,inpatient,,,106.00000,51.09000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,outpatient,,,106.00000,51.09000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,inpatient,,,78.00000,37.60000,Coventry,Commercial,,74.88,,,,,,,70.20,75.66,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,outpatient,,,78.00000,37.60000,Coventry,Commercial,,74.88,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,inpatient,,,72.00000,34.70000,Coventry,Commercial,,69.12,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,outpatient,,,72.00000,34.70000,Coventry,Commercial,,69.12,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,inpatient,,,94.00000,45.31000,Coventry,Commercial,,90.24,,,,,,,84.60,91.18,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,outpatient,,,94.00000,45.31000,Coventry,Commercial,,90.24,,,,,,,24.44,91.18,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,inpatient,,,101.00000,48.68000,Coventry,Commercial,,96.96,,,,,,,90.90,97.97,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,outpatient,,,101.00000,48.68000,Coventry,Commercial,,96.96,,,,,,,26.26,97.97,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,inpatient,,,82.00000,39.52000,Coventry,Commercial,,78.72,,,,,,,73.80,79.54,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,outpatient,,,82.00000,39.52000,Coventry,Commercial,,78.72,,,,,,,21.32,79.54,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,inpatient,,,77.00000,37.11000,Coventry,Commercial,,73.92,,,,,,,69.30,74.69,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,outpatient,,,77.00000,37.11000,Coventry,Commercial,,73.92,,,,,,,20.02,74.69,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,inpatient,,,145.00000,69.89000,Coventry,Commercial,,139.20,,,,,,,130.50,140.65,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,outpatient,,,145.00000,69.89000,Coventry,Commercial,,139.20,,,,,,,37.70,140.65,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,inpatient,,,266.00000,128.21000,Coventry,Commercial,,255.36,,,,,,,239.40,258.02,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,outpatient,,,266.00000,128.21000,Coventry,Commercial,,255.36,,,,,,,69.16,258.02,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,inpatient,,,79.00000,38.08000,Coventry,Commercial,,75.84,,,,,,,71.10,76.63,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,outpatient,,,79.00000,38.08000,Coventry,Commercial,,75.84,,,,,,,20.54,76.63,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,inpatient,,,144.00000,69.41000,Coventry,Commercial,,138.24,,,,,,,129.60,139.68,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,outpatient,,,144.00000,69.41000,Coventry,Commercial,,138.24,,,,,,,37.44,139.68,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,inpatient,,,20.00000,9.64000,Coventry,Commercial,,19.20,,,,,,,18.00,19.40,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,outpatient,,,20.00000,9.64000,Coventry,Commercial,,19.20,,,,,,,5.20,19.40,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,inpatient,,,208.00000,100.26000,Coventry,Commercial,,199.68,,,,,,,187.20,201.76,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,outpatient,,,208.00000,100.26000,Coventry,Commercial,,199.68,,,,,,,54.08,201.76,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,inpatient,,,135.00000,65.07000,Coventry,Commercial,,129.60,,,,,,,121.50,130.95,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,outpatient,,,135.00000,65.07000,Coventry,Commercial,,129.60,,,,,,,35.10,130.95,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,inpatient,,,131.00000,63.14000,Coventry,Commercial,,125.76,,,,,,,117.90,127.07,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,outpatient,,,131.00000,63.14000,Coventry,Commercial,,125.76,,,,,,,34.06,127.07,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,inpatient,,,69.00000,33.26000,Coventry,Commercial,,66.24,,,,,,,62.10,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,outpatient,,,69.00000,33.26000,Coventry,Commercial,,66.24,,,,,,,17.94,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,inpatient,,,25.00000,12.05000,Coventry,Commercial,,24.00,,,,,,,22.50,24.25,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,outpatient,,,25.00000,12.05000,Coventry,Commercial,,24.00,,,,,,,6.50,24.25,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,inpatient,,,61.00000,29.40000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,outpatient,,,61.00000,29.40000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,inpatient,,,80.00000,38.56000,Coventry,Commercial,,76.80,,,,,,,72.00,77.60,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,outpatient,,,80.00000,38.56000,Coventry,Commercial,,76.80,,,,,,,20.80,77.60,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,inpatient,,,82.00000,39.52000,Coventry,Commercial,,78.72,,,,,,,73.80,79.54,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,outpatient,,,82.00000,39.52000,Coventry,Commercial,,78.72,,,,,,,21.32,79.54,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,inpatient,,,35.00000,16.87000,Coventry,Commercial,,33.60,,,,,,,31.50,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,outpatient,,,35.00000,16.87000,Coventry,Commercial,,33.60,,,,,,,9.10,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,inpatient,,,88.00000,42.42000,Coventry,Commercial,,84.48,,,,,,,79.20,85.36,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,outpatient,,,88.00000,42.42000,Coventry,Commercial,,84.48,,,,,,,22.88,85.36,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,inpatient,,,98.00000,47.24000,Coventry,Commercial,,94.08,,,,,,,88.20,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,outpatient,,,98.00000,47.24000,Coventry,Commercial,,94.08,,,,,,,25.48,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,inpatient,,,204.00000,98.33000,Coventry,Commercial,,195.84,,,,,,,183.60,197.88,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,outpatient,,,204.00000,98.33000,Coventry,Commercial,,195.84,,,,,,,53.04,197.88,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,inpatient,,,61.00000,29.40000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,outpatient,,,61.00000,29.40000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,inpatient,,,19.00000,9.16000,Coventry,Commercial,,18.24,,,,,,,17.10,18.43,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,outpatient,,,19.00000,9.16000,Coventry,Commercial,,18.24,,,,,,,4.94,18.43,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,inpatient,,,37.00000,17.83000,Coventry,Commercial,,35.52,,,,,,,33.30,35.89,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,outpatient,,,37.00000,17.83000,Coventry,Commercial,,35.52,,,,,,,9.62,35.89,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,inpatient,,,79.00000,38.08000,Coventry,Commercial,,75.84,,,,,,,71.10,76.63,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,outpatient,,,79.00000,38.08000,Coventry,Commercial,,75.84,,,,,,,20.54,76.63,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,inpatient,,,21.00000,10.12000,Coventry,Commercial,,20.16,,,,,,,18.90,20.37,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,outpatient,,,21.00000,10.12000,Coventry,Commercial,,20.16,,,,,,,5.46,20.37,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,46.80,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,13.52,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,inpatient,,,32.00000,15.42000,Coventry,Commercial,,30.72,,,,,,,28.80,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,outpatient,,,32.00000,15.42000,Coventry,Commercial,,30.72,,,,,,,8.32,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,inpatient,,,94.00000,45.31000,Coventry,Commercial,,90.24,,,,,,,84.60,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,outpatient,,,94.00000,45.31000,Coventry,Commercial,,90.24,,,,,,,24.44,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,inpatient,,,103.00000,49.65000,Coventry,Commercial,,98.88,,,,,,,92.70,99.91,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,outpatient,,,103.00000,49.65000,Coventry,Commercial,,98.88,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,inpatient,,,64.00000,30.85000,Coventry,Commercial,,61.44,,,,,,,57.60,62.08,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,outpatient,,,64.00000,30.85000,Coventry,Commercial,,61.44,,,,,,,16.64,62.08,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,inpatient,,,102.00000,49.16000,Coventry,Commercial,,97.92,,,,,,,91.80,98.94,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,outpatient,,,102.00000,49.16000,Coventry,Commercial,,97.92,,,,,,,26.52,98.94,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,inpatient,,,103.00000,49.65000,Coventry,Commercial,,98.88,,,,,,,92.70,99.91,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,outpatient,,,103.00000,49.65000,Coventry,Commercial,,98.88,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,inpatient,,,139.00000,67.00000,Coventry,Commercial,,133.44,,,,,,,125.10,134.83,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,outpatient,,,139.00000,67.00000,Coventry,Commercial,,133.44,,,,,,,36.14,134.83,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,46.80,50.44,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,13.52,50.44,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,inpatient,,,21.00000,10.12000,Coventry,Commercial,,20.16,,,,,,,18.90,20.37,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Coventry,Commercial,,20.16,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,inpatient,,,88.00000,42.42000,Coventry,Commercial,,84.48,,,,,,,79.20,85.36,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,outpatient,,,88.00000,42.42000,Coventry,Commercial,,84.48,,,,,,,22.88,85.36,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,inpatient,,,21.00000,10.12000,Coventry,Commercial,,20.16,,,,,,,18.90,20.37,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Coventry,Commercial,,20.16,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,46.80,50.44,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,13.52,50.44,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,inpatient,,,80.00000,38.56000,Coventry,Commercial,,76.80,,,,,,,72.00,77.60,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,outpatient,,,80.00000,38.56000,Coventry,Commercial,,76.80,,,,,,,20.80,77.60,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,inpatient,,,49.00000,23.62000,Coventry,Commercial,,47.04,,,,,,,44.10,47.53,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,outpatient,,,49.00000,23.62000,Coventry,Commercial,,47.04,,,,,,,12.74,47.53,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,inpatient,,,88.00000,42.42000,Coventry,Commercial,,84.48,,,,,,,79.20,85.36,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,outpatient,,,88.00000,42.42000,Coventry,Commercial,,84.48,,,,,,,22.88,85.36,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,inpatient,,,68.00000,32.78000,Coventry,Commercial,,65.28,,,,,,,61.20,65.96,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,outpatient,,,68.00000,32.78000,Coventry,Commercial,,65.28,,,,,,,17.68,65.96,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,inpatient,,,93.00000,44.83000,Coventry,Commercial,,89.28,,,,,,,83.70,90.21,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,outpatient,,,93.00000,44.83000,Coventry,Commercial,,89.28,,,,,,,24.18,90.21,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,inpatient,,,73.00000,35.19000,Coventry,Commercial,,70.08,,,,,,,65.70,70.81,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,outpatient,,,73.00000,35.19000,Coventry,Commercial,,70.08,,,,,,,18.98,70.81,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,inpatient,,,41.00000,19.76000,Coventry,Commercial,,39.36,,,,,,,36.90,39.77,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,outpatient,,,41.00000,19.76000,Coventry,Commercial,,39.36,,,,,,,10.66,39.77,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,inpatient,,,94.00000,45.31000,Coventry,Commercial,,90.24,,,,,,,84.60,91.18,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,outpatient,,,94.00000,45.31000,Coventry,Commercial,,90.24,,,,,,,24.44,91.18,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,inpatient,,,124.00000,59.77000,Coventry,Commercial,,119.04,,,,,,,111.60,120.28,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,outpatient,,,124.00000,59.77000,Coventry,Commercial,,119.04,,,,,,,32.24,120.28,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,inpatient,,,71.00000,34.22000,Coventry,Commercial,,68.16,,,,,,,63.90,68.87,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,outpatient,,,71.00000,34.22000,Coventry,Commercial,,68.16,,,,,,,18.46,68.87,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,inpatient,,,33.00000,15.91000,Coventry,Commercial,,31.68,,,,,,,29.70,32.01,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,outpatient,,,33.00000,15.91000,Coventry,Commercial,,31.68,,,,,,,8.58,32.01,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,46.80,50.44,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,13.52,50.44,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,inpatient,,,68.00000,32.78000,Coventry,Commercial,,65.28,,,,,,,61.20,65.96,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,outpatient,,,68.00000,32.78000,Coventry,Commercial,,65.28,,,,,,,17.68,65.96,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,inpatient,,,99.00000,47.72000,Coventry,Commercial,,95.04,,,,,,,89.10,96.03,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,outpatient,,,99.00000,47.72000,Coventry,Commercial,,95.04,,,,,,,25.74,96.03,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,inpatient,,,197.00000,94.95000,Coventry,Commercial,,189.12,,,,,,,177.30,191.09,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,outpatient,,,197.00000,94.95000,Coventry,Commercial,,189.12,,,,,,,51.22,191.09,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,inpatient,,,194.00000,93.51000,Coventry,Commercial,,186.24,,,,,,,174.60,188.18,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,outpatient,,,194.00000,93.51000,Coventry,Commercial,,186.24,,,,,,,50.44,188.18,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,inpatient,,,68.00000,32.78000,Coventry,Commercial,,65.28,,,,,,,61.20,65.96,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,outpatient,,,68.00000,32.78000,Coventry,Commercial,,65.28,,,,,,,17.68,65.96,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,inpatient,,,90.00000,43.38000,Coventry,Commercial,,86.40,,,,,,,81.00,87.30,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,outpatient,,,90.00000,43.38000,Coventry,Commercial,,86.40,,,,,,,23.40,87.30,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,inpatient,,,109.00000,52.54000,Coventry,Commercial,,104.64,,,,,,,98.10,105.73,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,outpatient,,,109.00000,52.54000,Coventry,Commercial,,104.64,,,,,,,28.34,105.73,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,inpatient,,,108.00000,52.06000,Coventry,Commercial,,103.68,,,,,,,97.20,104.76,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,outpatient,,,108.00000,52.06000,Coventry,Commercial,,103.68,,,,,,,28.08,104.76,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,60.30,64.99,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Commercial,,64.32,,,,,,,17.42,64.99,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,inpatient,,,69.00000,33.26000,Coventry,Commercial,,66.24,,,,,,,62.10,66.93,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,outpatient,,,69.00000,33.26000,Coventry,Commercial,,66.24,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,inpatient,,,71.00000,34.22000,Coventry,Commercial,,68.16,,,,,,,63.90,68.87,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,outpatient,,,71.00000,34.22000,Coventry,Commercial,,68.16,,,,,,,18.46,68.87,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,inpatient,,,98.00000,47.24000,Coventry,Commercial,,94.08,,,,,,,88.20,95.06,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,outpatient,,,98.00000,47.24000,Coventry,Commercial,,94.08,,,,,,,25.48,95.06,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,inpatient,,,141.00000,67.96000,Coventry,Commercial,,135.36,,,,,,,126.90,136.77,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,outpatient,,,141.00000,67.96000,Coventry,Commercial,,135.36,,,,,,,36.66,136.77,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,inpatient,,,226.00000,108.93000,Coventry,Commercial,,216.96,,,,,,,203.40,219.22,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,outpatient,,,226.00000,108.93000,Coventry,Commercial,,216.96,,,,,,,58.76,219.22,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,inpatient,,,92.00000,44.34000,Coventry,Commercial,,88.32,,,,,,,82.80,89.24,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,outpatient,,,92.00000,44.34000,Coventry,Commercial,,88.32,,,,,,,23.92,89.24,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,inpatient,,,69.00000,33.26000,Coventry,Commercial,,66.24,,,,,,,62.10,66.93,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,outpatient,,,69.00000,33.26000,Coventry,Commercial,,66.24,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,inpatient,,,100.00000,48.20000,Coventry,Commercial,,96.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,outpatient,,,100.00000,48.20000,Coventry,Commercial,,96.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,inpatient,,,124.00000,59.77000,Coventry,Commercial,,119.04,,,,,,,111.60,120.28,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,outpatient,,,124.00000,59.77000,Coventry,Commercial,,119.04,,,,,,,32.24,120.28,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,inpatient,,,69.00000,33.26000,Coventry,Commercial,,66.24,,,,,,,62.10,66.93,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,outpatient,,,69.00000,33.26000,Coventry,Commercial,,66.24,,,,,,,17.94,66.93,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Coventry,Commercial,,119.04,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Coventry,Commercial,,119.04,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Coventry,Commercial,,119.04,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Coventry,Commercial,,119.04,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Coventry,Commercial,,119.04,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Coventry,Commercial,,119.04,,,,,,,32.24,120.28,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,inpatient,,,118.00000,56.88000,Coventry,Commercial,,113.28,,,,,,,106.20,114.46,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,outpatient,,,118.00000,56.88000,Coventry,Commercial,,113.28,,,,,,,30.68,114.46,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,inpatient,,,51.00000,24.58000,Coventry,Commercial,,48.96,,,,,,,45.90,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,outpatient,,,51.00000,24.58000,Coventry,Commercial,,48.96,,,,,,,13.26,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,inpatient,,,104.00000,50.13000,Coventry,Commercial,,99.84,,,,,,,93.60,100.88,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,outpatient,,,104.00000,50.13000,Coventry,Commercial,,99.84,,,,,,,27.04,100.88,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,inpatient,,,72.00000,34.70000,Coventry,Commercial,,69.12,,,,,,,64.80,69.84,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,outpatient,,,72.00000,34.70000,Coventry,Commercial,,69.12,,,,,,,18.72,69.84,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,inpatient,,,54.00000,26.03000,Coventry,Commercial,,51.84,,,,,,,48.60,52.38,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,outpatient,,,54.00000,26.03000,Coventry,Commercial,,51.84,,,,,,,14.04,52.38,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,inpatient,,,17.00000,8.19000,Coventry,Commercial,,16.32,,,,,,,15.30,16.49,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,outpatient,,,17.00000,8.19000,Coventry,Commercial,,16.32,,,,,,,4.42,16.49,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,inpatient,,,36.00000,17.35000,Coventry,Commercial,,34.56,,,,,,,32.40,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,outpatient,,,36.00000,17.35000,Coventry,Commercial,,34.56,,,,,,,9.36,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,46.80,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,13.52,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,inpatient,,,18.00000,8.68000,Coventry,Commercial,,17.28,,,,,,,16.20,17.46,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,outpatient,,,18.00000,8.68000,Coventry,Commercial,,17.28,,,,,,,4.68,17.46,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,inpatient,,,74.00000,35.67000,Coventry,Commercial,,71.04,,,,,,,66.60,71.78,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,outpatient,,,74.00000,35.67000,Coventry,Commercial,,71.04,,,,,,,19.24,71.78,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,inpatient,,,118.00000,56.88000,Coventry,Commercial,,113.28,,,,,,,106.20,114.46,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,outpatient,,,118.00000,56.88000,Coventry,Commercial,,113.28,,,,,,,30.68,114.46,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,inpatient,,,82.00000,39.52000,Coventry,Commercial,,78.72,,,,,,,73.80,79.54,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,outpatient,,,82.00000,39.52000,Coventry,Commercial,,78.72,,,,,,,21.32,79.54,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,inpatient,,,30.00000,14.46000,Coventry,Commercial,,28.80,,,,,,,27.00,29.10,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,outpatient,,,30.00000,14.46000,Coventry,Commercial,,28.80,,,,,,,7.80,29.10,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,inpatient,,,70.00000,33.74000,Coventry,Commercial,,67.20,,,,,,,63.00,67.90,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,outpatient,,,70.00000,33.74000,Coventry,Commercial,,67.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,inpatient,,,54.00000,26.03000,Coventry,Commercial,,51.84,,,,,,,48.60,52.38,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,outpatient,,,54.00000,26.03000,Coventry,Commercial,,51.84,,,,,,,14.04,52.38,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,inpatient,,,51.00000,24.58000,Coventry,Commercial,,48.96,,,,,,,45.90,49.47,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,outpatient,,,51.00000,24.58000,Coventry,Commercial,,48.96,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,inpatient,,,141.00000,67.96000,Coventry,Commercial,,135.36,,,,,,,126.90,136.77,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,outpatient,,,141.00000,67.96000,Coventry,Commercial,,135.36,,,,,,,36.66,136.77,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,inpatient,,,81.00000,39.04000,Coventry,Commercial,,77.76,,,,,,,72.90,78.57,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,outpatient,,,81.00000,39.04000,Coventry,Commercial,,77.76,,,,,,,21.06,78.57,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,inpatient,,,335.00000,161.47000,Coventry,Commercial,,321.60,,,,,,,301.50,324.95,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,outpatient,,,335.00000,161.47000,Coventry,Commercial,,321.60,,,,,,,87.10,324.95,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,46.80,50.44,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Commercial,,49.92,,,,,,,13.52,50.44,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,inpatient,,,54.00000,26.03000,Coventry,Commercial,,51.84,,,,,,,48.60,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Coventry,Commercial,,51.84,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,inpatient,,,54.00000,26.03000,Coventry,Commercial,,51.84,,,,,,,48.60,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Coventry,Commercial,,51.84,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,inpatient,,,53.00000,25.55000,Coventry,Commercial,,50.88,,,,,,,47.70,51.41,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,outpatient,,,53.00000,25.55000,Coventry,Commercial,,50.88,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,inpatient,,,53.00000,25.55000,Coventry,Commercial,,50.88,,,,,,,47.70,51.41,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,outpatient,,,53.00000,25.55000,Coventry,Commercial,,50.88,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,inpatient,,,12.00000,5.78000,Coventry,Commercial,,11.52,,,,,,,10.80,11.64,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,outpatient,,,12.00000,5.78000,Coventry,Commercial,,11.52,,,,,,,3.12,11.64,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,inpatient,,,710.00000,342.22000,Coventry,Commercial,,681.60,,,,,,,639.00,688.70,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,outpatient,,,710.00000,342.22000,Coventry,Commercial,,681.60,,,,,,,184.60,688.70,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,inpatient,,,104.00000,50.13000,Coventry,Commercial,,99.84,,,,,,,93.60,100.88,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,outpatient,,,104.00000,50.13000,Coventry,Commercial,,99.84,,,,,,,27.04,100.88,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,inpatient,,,155.00000,74.71000,Coventry,Commercial,,148.80,,,,,,,139.50,150.35,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,outpatient,,,155.00000,74.71000,Coventry,Commercial,,148.80,,,,,,,40.30,150.35,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,inpatient,,,139.00000,67.00000,Coventry,Commercial,,133.44,,,,,,,125.10,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,outpatient,,,139.00000,67.00000,Coventry,Commercial,,133.44,,,,,,,36.14,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,inpatient,,,89.00000,42.90000,Coventry,Commercial,,85.44,,,,,,,80.10,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,outpatient,,,89.00000,42.90000,Coventry,Commercial,,85.44,,,,,,,23.14,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,inpatient,,,88.00000,42.42000,Coventry,Commercial,,84.48,,,,,,,79.20,85.36,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,outpatient,,,88.00000,42.42000,Coventry,Commercial,,84.48,,,,,,,22.88,85.36,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,inpatient,,,111.00000,53.50000,Coventry,Commercial,,106.56,,,,,,,99.90,107.67,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,outpatient,,,111.00000,53.50000,Coventry,Commercial,,106.56,,,,,,,28.86,107.67,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,inpatient,,,70.00000,33.74000,Coventry,Commercial,,67.20,,,,,,,63.00,67.90,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,outpatient,,,70.00000,33.74000,Coventry,Commercial,,67.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,inpatient,,,85.00000,40.97000,Coventry,Commercial,,81.60,,,,,,,76.50,82.45,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,outpatient,,,85.00000,40.97000,Coventry,Commercial,,81.60,,,,,,,22.10,82.45,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,inpatient,,,110.00000,53.02000,Coventry,Commercial,,105.60,,,,,,,99.00,106.70,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,outpatient,,,110.00000,53.02000,Coventry,Commercial,,105.60,,,,,,,28.60,106.70,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,inpatient,,,500.00000,241.00000,Coventry,Commercial,,480.00,,,,,,,450.00,485.00,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,outpatient,,,500.00000,241.00000,Coventry,Commercial,,480.00,,,,,,,130.00,485.00,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,inpatient,,,140.00000,67.48000,Coventry,Commercial,,134.40,,,,,,,126.00,135.80,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,outpatient,,,140.00000,67.48000,Coventry,Commercial,,134.40,,,,,,,36.40,135.80,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,inpatient,,,74.00000,35.67000,Coventry,Commercial,,71.04,,,,,,,66.60,71.78,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,outpatient,,,74.00000,35.67000,Coventry,Commercial,,71.04,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,inpatient,,,77.00000,37.11000,Coventry,Commercial,,73.92,,,,,,,69.30,74.69,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,outpatient,,,77.00000,37.11000,Coventry,Commercial,,73.92,,,,,,,20.02,74.69,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,inpatient,,,93.00000,44.83000,Coventry,Commercial,,89.28,,,,,,,83.70,90.21,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,outpatient,,,93.00000,44.83000,Coventry,Commercial,,89.28,,,,,,,24.18,90.21,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,inpatient,,,15.00000,7.23000,Coventry,Commercial,,14.40,,,,,,,13.50,14.55,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,outpatient,,,15.00000,7.23000,Coventry,Commercial,,14.40,,,,,,,3.90,14.55,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,inpatient,,,24.00000,11.57000,Coventry,Commercial,,23.04,,,,,,,21.60,23.28,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,outpatient,,,24.00000,11.57000,Coventry,Commercial,,23.04,,,,,,,6.24,23.28,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,inpatient,,,72.00000,34.70000,Coventry,Commercial,,69.12,,,,,,,64.80,69.84,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,outpatient,,,72.00000,34.70000,Coventry,Commercial,,69.12,,,,,,,18.72,69.84,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,inpatient,,,16.00000,7.71000,Coventry,Commercial,,15.36,,,,,,,14.40,15.52,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Coventry,Commercial,,15.36,,,,,,,4.16,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,inpatient,,,16.00000,7.71000,Coventry,Commercial,,15.36,,,,,,,14.40,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Coventry,Commercial,,15.36,,,,,,,4.16,15.52,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,inpatient,,,64.00000,30.85000,Coventry,Commercial,,61.44,,,,,,,57.60,62.08,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,outpatient,,,64.00000,30.85000,Coventry,Commercial,,61.44,,,,,,,16.64,62.08,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,inpatient,,,82.00000,39.52000,Coventry,Commercial,,78.72,,,,,,,73.80,79.54,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,outpatient,,,82.00000,39.52000,Coventry,Commercial,,78.72,,,,,,,21.32,79.54,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,inpatient,,,157.00000,75.67000,Coventry,Commercial,,150.72,,,,,,,141.30,152.29,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,outpatient,,,157.00000,75.67000,Coventry,Commercial,,150.72,,,,,,,40.82,152.29,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,inpatient,,,70.00000,33.74000,Coventry,Commercial,,67.20,,,,,,,63.00,67.90,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,outpatient,,,70.00000,33.74000,Coventry,Commercial,,67.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,inpatient,,,229.00000,110.38000,Coventry,Commercial,,219.84,,,,,,,206.10,222.13,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,outpatient,,,229.00000,110.38000,Coventry,Commercial,,219.84,,,,,,,59.54,222.13,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,inpatient,,,64.00000,30.85000,Coventry,Commercial,,61.44,,,,,,,57.60,62.08,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,outpatient,,,64.00000,30.85000,Coventry,Commercial,,61.44,,,,,,,16.64,62.08,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,inpatient,,,72.00000,34.70000,Coventry,Commercial,,69.12,,,,,,,64.80,69.84,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,outpatient,,,72.00000,34.70000,Coventry,Commercial,,69.12,,,,,,,18.72,69.84,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,inpatient,,,17.00000,8.19000,Coventry,Commercial,,16.32,,,,,,,15.30,16.49,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,outpatient,,,17.00000,8.19000,Coventry,Commercial,,16.32,,,,,,,4.42,16.49,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,inpatient,,,64.00000,30.85000,Coventry,Commercial,,61.44,,,,,,,57.60,62.08,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,outpatient,,,64.00000,30.85000,Coventry,Commercial,,61.44,,,,,,,16.64,62.08,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,inpatient,,,387.00000,186.53000,Coventry,Commercial,,371.52,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,outpatient,,,387.00000,186.53000,Coventry,Commercial,,371.52,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,inpatient,,,387.00000,186.53000,Coventry,Commercial,,371.52,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Coventry,Commercial,,371.52,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,inpatient,,,387.00000,186.53000,Coventry,Commercial,,371.52,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Coventry,Commercial,,371.52,,,,,,,100.62,375.39,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,inpatient,,,77.00000,37.11000,Coventry,Commercial,,73.92,,,,,,,69.30,74.69,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,outpatient,,,77.00000,37.11000,Coventry,Commercial,,73.92,,,,,,,20.02,74.69,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,inpatient,,,78.00000,37.60000,Coventry,Commercial,,74.88,,,,,,,70.20,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Coventry,Commercial,,74.88,,,,,,,20.28,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,inpatient,,,78.00000,37.60000,Coventry,Commercial,,74.88,,,,,,,70.20,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Coventry,Commercial,,74.88,,,,,,,20.28,75.66,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,inpatient,,,43.00000,20.73000,Coventry,Commercial,,41.28,,,,,,,38.70,41.71,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,outpatient,,,43.00000,20.73000,Coventry,Commercial,,41.28,,,,,,,11.18,41.71,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,inpatient,,,64.00000,30.85000,Coventry,Commercial,,61.44,,,,,,,57.60,62.08,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,outpatient,,,64.00000,30.85000,Coventry,Commercial,,61.44,,,,,,,16.64,62.08,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,inpatient,,,160.00000,77.12000,Coventry,Commercial,,153.60,,,,,,,144.00,155.20,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,outpatient,,,160.00000,77.12000,Coventry,Commercial,,153.60,,,,,,,41.60,155.20,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,inpatient,,,112.00000,53.98000,Coventry,Commercial,,107.52,,,,,,,100.80,108.64,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,outpatient,,,112.00000,53.98000,Coventry,Commercial,,107.52,,,,,,,29.12,108.64,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,inpatient,,,82.00000,39.52000,Coventry,Commercial,,78.72,,,,,,,73.80,79.54,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,outpatient,,,82.00000,39.52000,Coventry,Commercial,,78.72,,,,,,,21.32,79.54,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,inpatient,,,54.00000,26.03000,Coventry,Commercial,,51.84,,,,,,,48.60,52.38,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,outpatient,,,54.00000,26.03000,Coventry,Commercial,,51.84,,,,,,,14.04,52.38,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,inpatient,,,153.00000,73.75000,Coventry,Commercial,,146.88,,,,,,,137.70,148.41,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,outpatient,,,153.00000,73.75000,Coventry,Commercial,,146.88,,,,,,,39.78,148.41,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,inpatient,,,45.00000,21.69000,Coventry,Commercial,,43.20,,,,,,,40.50,43.65,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,outpatient,,,45.00000,21.69000,Coventry,Commercial,,43.20,,,,,,,11.70,43.65,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,inpatient,,,28.00000,13.50000,Coventry,Commercial,,26.88,,,,,,,25.20,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,outpatient,,,28.00000,13.50000,Coventry,Commercial,,26.88,,,,,,,7.28,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Coventry,Commercial,,47.04,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Coventry,Commercial,,47.04,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Coventry,Commercial,,47.04,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Coventry,Commercial,,47.04,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Coventry,Commercial,,47.04,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Coventry,Commercial,,47.04,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,inpatient,,,36.00000,17.35000,Coventry,Commercial,,34.56,,,,,,,32.40,34.92,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,outpatient,,,36.00000,17.35000,Coventry,Commercial,,34.56,,,,,,,9.36,34.92,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,inpatient,,,38.00000,18.32000,Coventry,Commercial,,36.48,,,,,,,34.20,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,outpatient,,,38.00000,18.32000,Coventry,Commercial,,36.48,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,inpatient,,,38.00000,18.32000,Coventry,Commercial,,36.48,,,,,,,34.20,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,outpatient,,,38.00000,18.32000,Coventry,Commercial,,36.48,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,inpatient,,,76.00000,36.63000,Coventry,Commercial,,72.96,,,,,,,68.40,73.72,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,outpatient,,,76.00000,36.63000,Coventry,Commercial,,72.96,,,,,,,19.76,73.72,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,inpatient,,,173.00000,83.39000,Coventry,Commercial,,166.08,,,,,,,155.70,167.81,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,outpatient,,,173.00000,83.39000,Coventry,Commercial,,166.08,,,,,,,44.98,167.81,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,inpatient,,,22.00000,10.60000,Coventry,Commercial,,21.12,,,,,,,19.80,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,outpatient,,,22.00000,10.60000,Coventry,Commercial,,21.12,,,,,,,5.72,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,inpatient,,,39.00000,18.80000,Coventry,Commercial,,37.44,,,,,,,35.10,37.83,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,outpatient,,,39.00000,18.80000,Coventry,Commercial,,37.44,,,,,,,10.14,37.83,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,inpatient,,,41.00000,19.76000,Coventry,Commercial,,39.36,,,,,,,36.90,39.77,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,outpatient,,,41.00000,19.76000,Coventry,Commercial,,39.36,,,,,,,10.66,39.77,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,inpatient,,,54.00000,26.03000,Coventry,Commercial,,51.84,,,,,,,48.60,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,outpatient,,,54.00000,26.03000,Coventry,Commercial,,51.84,,,,,,,14.04,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,inpatient,,,71.00000,34.22000,Coventry,Commercial,,68.16,,,,,,,63.90,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,outpatient,,,71.00000,34.22000,Coventry,Commercial,,68.16,,,,,,,18.46,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,inpatient,,,43.00000,20.73000,Coventry,Commercial,,41.28,,,,,,,38.70,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Coventry,Commercial,,41.28,,,,,,,11.18,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,inpatient,,,43.00000,20.73000,Coventry,Commercial,,41.28,,,,,,,38.70,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Coventry,Commercial,,41.28,,,,,,,11.18,41.71,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,inpatient,,,38.00000,18.32000,Coventry,Commercial,,36.48,,,,,,,34.20,36.86,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,outpatient,,,38.00000,18.32000,Coventry,Commercial,,36.48,,,,,,,9.88,36.86,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,inpatient,,,72.00000,34.70000,Coventry,Commercial,,69.12,,,,,,,64.80,69.84,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,outpatient,,,72.00000,34.70000,Coventry,Commercial,,69.12,,,,,,,18.72,69.84,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,inpatient,,,226.00000,108.93000,Coventry,Commercial,,216.96,,,,,,,203.40,219.22,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,outpatient,,,226.00000,108.93000,Coventry,Commercial,,216.96,,,,,,,58.76,219.22,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Coventry,Commercial,,39.36,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Coventry,Commercial,,39.36,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Coventry,Commercial,,39.36,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Coventry,Commercial,,39.36,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Coventry,Commercial,,39.36,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Coventry,Commercial,,39.36,,,,,,,10.66,39.77,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,inpatient,,,160.00000,77.12000,Coventry,Commercial,,153.60,,,,,,,144.00,155.20,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,outpatient,,,160.00000,77.12000,Coventry,Commercial,,153.60,,,,,,,41.60,155.20,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,inpatient,,,102.00000,49.16000,Coventry,Commercial,,97.92,,,,,,,91.80,98.94,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,outpatient,,,102.00000,49.16000,Coventry,Commercial,,97.92,,,,,,,26.52,98.94,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,inpatient,,,317.00000,152.79000,Coventry,Commercial,,304.32,,,,,,,285.30,307.49,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,outpatient,,,317.00000,152.79000,Coventry,Commercial,,304.32,,,,,,,82.42,307.49,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,inpatient,,,116.00000,55.91000,Coventry,Commercial,,111.36,,,,,,,104.40,112.52,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,outpatient,,,116.00000,55.91000,Coventry,Commercial,,111.36,,,,,,,30.16,112.52,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,inpatient,,,89.00000,42.90000,Coventry,Commercial,,85.44,,,,,,,80.10,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Coventry,Commercial,,85.44,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,inpatient,,,89.00000,42.90000,Coventry,Commercial,,85.44,,,,,,,80.10,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Coventry,Commercial,,85.44,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,inpatient,,,85.00000,40.97000,Coventry,Commercial,,81.60,,,,,,,76.50,82.45,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,outpatient,,,85.00000,40.97000,Coventry,Commercial,,81.60,,,,,,,22.10,82.45,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,inpatient,,,184.00000,88.69000,Coventry,Commercial,,176.64,,,,,,,165.60,178.48,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,outpatient,,,184.00000,88.69000,Coventry,Commercial,,176.64,,,,,,,47.84,178.48,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,inpatient,,,127.00000,61.21000,Coventry,Commercial,,121.92,,,,,,,114.30,123.19,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,outpatient,,,127.00000,61.21000,Coventry,Commercial,,121.92,,,,,,,33.02,123.19,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,inpatient,,,61.00000,29.40000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,outpatient,,,61.00000,29.40000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,inpatient,,,35.00000,16.87000,Coventry,Commercial,,33.60,,,,,,,31.50,33.95,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,outpatient,,,35.00000,16.87000,Coventry,Commercial,,33.60,,,,,,,9.10,33.95,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,inpatient,,,79.00000,38.08000,Coventry,Commercial,,75.84,,,,,,,71.10,76.63,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,outpatient,,,79.00000,38.08000,Coventry,Commercial,,75.84,,,,,,,20.54,76.63,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,inpatient,,,57.00000,32.83000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,outpatient,,,57.00000,32.83000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Coventry,Commercial,,146.88,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Coventry,Commercial,,146.88,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,inpatient,,,77.00000,44.35000,Coventry,Commercial,,73.92,,,,,,,69.30,74.69,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,outpatient,,,77.00000,44.35000,Coventry,Commercial,,73.92,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,inpatient,,,70.00000,40.32000,Coventry,Commercial,,67.20,,,,,,,63.00,67.90,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,outpatient,,,70.00000,40.32000,Coventry,Commercial,,67.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,inpatient,,,67.00000,38.59000,Coventry,Commercial,,64.32,,,,,,,60.30,64.99,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,outpatient,,,67.00000,38.59000,Coventry,Commercial,,64.32,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,inpatient,,,40.00000,23.04000,Coventry,Commercial,,38.40,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,outpatient,,,40.00000,23.04000,Coventry,Commercial,,38.40,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,inpatient,,,71.00000,40.90000,Coventry,Commercial,,68.16,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,outpatient,,,71.00000,40.90000,Coventry,Commercial,,68.16,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,inpatient,,,80.00000,46.08000,Coventry,Commercial,,76.80,,,,,,,72.00,77.60,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,outpatient,,,80.00000,46.08000,Coventry,Commercial,,76.80,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,inpatient,,,72.00000,41.47000,Coventry,Commercial,,69.12,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,outpatient,,,72.00000,41.47000,Coventry,Commercial,,69.12,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,inpatient,,,444.00000,255.74000,Coventry,Commercial,,426.24,,,,,,,399.60,430.68,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,outpatient,,,444.00000,255.74000,Coventry,Commercial,,426.24,,,,,,,115.44,430.68,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,inpatient,,,81.00000,46.66000,Coventry,Commercial,,77.76,,,,,,,72.90,78.57,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,outpatient,,,81.00000,46.66000,Coventry,Commercial,,77.76,,,,,,,21.06,78.57,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,inpatient,,,66.00000,38.02000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,outpatient,,,66.00000,38.02000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,inpatient,,,57.00000,32.83000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,outpatient,,,57.00000,32.83000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,inpatient,,,53.00000,30.53000,Coventry,Commercial,,50.88,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,outpatient,,,53.00000,30.53000,Coventry,Commercial,,50.88,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,inpatient,,,60.00000,34.56000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,outpatient,,,60.00000,34.56000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,inpatient,,,40.00000,23.04000,Coventry,Commercial,,38.40,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,outpatient,,,40.00000,23.04000,Coventry,Commercial,,38.40,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,inpatient,,,42.00000,24.19000,Coventry,Commercial,,40.32,,,,,,,37.80,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,outpatient,,,42.00000,24.19000,Coventry,Commercial,,40.32,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,inpatient,,,46.00000,26.50000,Coventry,Commercial,,44.16,,,,,,,41.40,44.62,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,outpatient,,,46.00000,26.50000,Coventry,Commercial,,44.16,,,,,,,11.96,44.62,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,inpatient,,,54.00000,31.10000,Coventry,Commercial,,51.84,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,outpatient,,,54.00000,31.10000,Coventry,Commercial,,51.84,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,inpatient,,,71.00000,40.90000,Coventry,Commercial,,68.16,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,outpatient,,,71.00000,40.90000,Coventry,Commercial,,68.16,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,inpatient,,,54.00000,31.10000,Coventry,Commercial,,51.84,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,outpatient,,,54.00000,31.10000,Coventry,Commercial,,51.84,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,inpatient,,,80.00000,46.08000,Coventry,Commercial,,76.80,,,,,,,72.00,77.60,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,outpatient,,,80.00000,46.08000,Coventry,Commercial,,76.80,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,inpatient,,,60.00000,34.56000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,outpatient,,,60.00000,34.56000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,inpatient,,,124.00000,71.42000,Coventry,Commercial,,119.04,,,,,,,111.60,120.28,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Coventry,Commercial,,119.04,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,inpatient,,,130.00000,74.88000,Coventry,Commercial,,124.80,,,,,,,117.00,126.10,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,outpatient,,,130.00000,74.88000,Coventry,Commercial,,124.80,,,,,,,33.80,126.10,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,inpatient,,,123.00000,70.85000,Coventry,Commercial,,118.08,,,,,,,110.70,119.31,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Coventry,Commercial,,118.08,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,inpatient,,,77.00000,44.35000,Coventry,Commercial,,73.92,,,,,,,69.30,74.69,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,outpatient,,,77.00000,44.35000,Coventry,Commercial,,73.92,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,inpatient,,,115.00000,66.24000,Coventry,Commercial,,110.40,,,,,,,103.50,111.55,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,outpatient,,,115.00000,66.24000,Coventry,Commercial,,110.40,,,,,,,29.90,111.55,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,inpatient,,,123.00000,70.85000,Coventry,Commercial,,118.08,,,,,,,110.70,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Coventry,Commercial,,118.08,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,inpatient,,,161.00000,92.74000,Coventry,Commercial,,154.56,,,,,,,144.90,156.17,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,outpatient,,,161.00000,92.74000,Coventry,Commercial,,154.56,,,,,,,41.86,156.17,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,inpatient,,,124.00000,71.42000,Coventry,Commercial,,119.04,,,,,,,111.60,120.28,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Coventry,Commercial,,119.04,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,inpatient,,,102.00000,58.75000,Coventry,Commercial,,97.92,,,,,,,91.80,98.94,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,outpatient,,,102.00000,58.75000,Coventry,Commercial,,97.92,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,inpatient,,,219.00000,126.14000,Coventry,Commercial,,210.24,,,,,,,197.10,212.43,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,outpatient,,,219.00000,126.14000,Coventry,Commercial,,210.24,,,,,,,56.94,212.43,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,inpatient,,,194.00000,111.74000,Coventry,Commercial,,186.24,,,,,,,174.60,188.18,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Coventry,Commercial,,186.24,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,inpatient,,,103.00000,59.33000,Coventry,Commercial,,98.88,,,,,,,92.70,99.91,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,outpatient,,,103.00000,59.33000,Coventry,Commercial,,98.88,,,,,,,26.78,99.91,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,inpatient,,,60.00000,34.56000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,outpatient,,,60.00000,34.56000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,inpatient,,,837.00000,482.11000,Coventry,Commercial,,803.52,,,,,,,753.30,811.89,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,outpatient,,,837.00000,482.11000,Coventry,Commercial,,803.52,,,,,,,217.62,811.89,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,inpatient,,,194.00000,111.74000,Coventry,Commercial,,186.24,,,,,,,174.60,188.18,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Coventry,Commercial,,186.24,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,inpatient,,,78.00000,44.93000,Coventry,Commercial,,74.88,,,,,,,70.20,75.66,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,outpatient,,,78.00000,44.93000,Coventry,Commercial,,74.88,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,inpatient,,,285.00000,164.16000,Coventry,Commercial,,273.60,,,,,,,256.50,276.45,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,outpatient,,,285.00000,164.16000,Coventry,Commercial,,273.60,,,,,,,74.10,276.45,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,inpatient,,,190.00000,109.44000,Coventry,Commercial,,182.40,,,,,,,171.00,184.30,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,outpatient,,,190.00000,109.44000,Coventry,Commercial,,182.40,,,,,,,49.40,184.30,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,inpatient,,,100.00000,57.60000,Coventry,Commercial,,96.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,outpatient,,,100.00000,57.60000,Coventry,Commercial,,96.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,inpatient,,,40.00000,23.04000,Coventry,Commercial,,38.40,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Coventry,Commercial,,38.40,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,inpatient,,,67.00000,38.59000,Coventry,Commercial,,64.32,,,,,,,60.30,64.99,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,outpatient,,,67.00000,38.59000,Coventry,Commercial,,64.32,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,inpatient,,,78.00000,44.93000,Coventry,Commercial,,74.88,,,,,,,70.20,75.66,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,outpatient,,,78.00000,44.93000,Coventry,Commercial,,74.88,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,inpatient,,,57.00000,32.83000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,outpatient,,,57.00000,32.83000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,inpatient,,,72.00000,41.47000,Coventry,Commercial,,69.12,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,outpatient,,,72.00000,41.47000,Coventry,Commercial,,69.12,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,inpatient,,,59.00000,33.98000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,outpatient,,,59.00000,33.98000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,inpatient,,,72.00000,41.47000,Coventry,Commercial,,69.12,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,outpatient,,,72.00000,41.47000,Coventry,Commercial,,69.12,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,inpatient,,,239.00000,137.66000,Coventry,Commercial,,229.44,,,,,,,215.10,231.83,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,outpatient,,,239.00000,137.66000,Coventry,Commercial,,229.44,,,,,,,62.14,231.83,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,inpatient,,,85.00000,48.96000,Coventry,Commercial,,81.60,,,,,,,76.50,82.45,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,outpatient,,,85.00000,48.96000,Coventry,Commercial,,81.60,,,,,,,22.10,82.45,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,inpatient,,,44.00000,25.34000,Coventry,Commercial,,42.24,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,outpatient,,,44.00000,25.34000,Coventry,Commercial,,42.24,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,inpatient,,,40.00000,23.04000,Coventry,Commercial,,38.40,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,outpatient,,,40.00000,23.04000,Coventry,Commercial,,38.40,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,inpatient,,,53.00000,30.53000,Coventry,Commercial,,50.88,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,outpatient,,,53.00000,30.53000,Coventry,Commercial,,50.88,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,inpatient,,,59.00000,33.98000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,inpatient,,,59.00000,33.98000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,inpatient,,,68.00000,39.17000,Coventry,Commercial,,65.28,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,outpatient,,,68.00000,39.17000,Coventry,Commercial,,65.28,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,inpatient,,,76.00000,43.78000,Coventry,Commercial,,72.96,,,,,,,68.40,73.72,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,outpatient,,,76.00000,43.78000,Coventry,Commercial,,72.96,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,inpatient,,,42.00000,24.19000,Coventry,Commercial,,40.32,,,,,,,37.80,40.74,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,outpatient,,,42.00000,24.19000,Coventry,Commercial,,40.32,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,inpatient,,,87.00000,50.11000,Coventry,Commercial,,83.52,,,,,,,78.30,84.39,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,outpatient,,,87.00000,50.11000,Coventry,Commercial,,83.52,,,,,,,22.62,84.39,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,inpatient,,,503.00000,289.73000,Coventry,Commercial,,482.88,,,,,,,452.70,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,outpatient,,,503.00000,289.73000,Coventry,Commercial,,482.88,,,,,,,130.78,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,inpatient,,,472.00000,271.87000,Coventry,Commercial,,453.12,,,,,,,424.80,457.84,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,outpatient,,,472.00000,271.87000,Coventry,Commercial,,453.12,,,,,,,122.72,457.84,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,inpatient,,,28.00000,16.13000,Coventry,Commercial,,26.88,,,,,,,25.20,27.16,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,outpatient,,,28.00000,16.13000,Coventry,Commercial,,26.88,,,,,,,7.28,27.16,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,inpatient,,,236.00000,135.94000,Coventry,Commercial,,226.56,,,,,,,212.40,228.92,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,outpatient,,,236.00000,135.94000,Coventry,Commercial,,226.56,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,inpatient,,,54.00000,31.10000,Coventry,Commercial,,51.84,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,outpatient,,,54.00000,31.10000,Coventry,Commercial,,51.84,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,inpatient,,,238.00000,137.09000,Coventry,Commercial,,228.48,,,,,,,214.20,230.86,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,outpatient,,,238.00000,137.09000,Coventry,Commercial,,228.48,,,,,,,61.88,230.86,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,inpatient,,,236.00000,135.94000,Coventry,Commercial,,226.56,,,,,,,212.40,228.92,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,outpatient,,,236.00000,135.94000,Coventry,Commercial,,226.56,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,inpatient,,,145.00000,83.52000,Coventry,Commercial,,139.20,,,,,,,130.50,140.65,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,outpatient,,,145.00000,83.52000,Coventry,Commercial,,139.20,,,,,,,37.70,140.65,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,inpatient,,,68.00000,39.17000,Coventry,Commercial,,65.28,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Coventry,Commercial,,65.28,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,inpatient,,,68.00000,39.17000,Coventry,Commercial,,65.28,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Coventry,Commercial,,65.28,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,inpatient,,,66.00000,38.02000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,outpatient,,,66.00000,38.02000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,inpatient,,,59.00000,33.98000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,outpatient,,,59.00000,33.98000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,inpatient,,,158.00000,91.01000,Coventry,Commercial,,151.68,,,,,,,142.20,153.26,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,outpatient,,,158.00000,91.01000,Coventry,Commercial,,151.68,,,,,,,41.08,153.26,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,inpatient,,,71.00000,40.90000,Coventry,Commercial,,68.16,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,outpatient,,,71.00000,40.90000,Coventry,Commercial,,68.16,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,inpatient,,,144.00000,82.94000,Coventry,Commercial,,138.24,,,,,,,129.60,139.68,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,outpatient,,,144.00000,82.94000,Coventry,Commercial,,138.24,,,,,,,37.44,139.68,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,inpatient,,,1448.00000,834.05000,Coventry,Commercial,,1390.08,,,,,,,1303.20,1404.56,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,outpatient,,,1448.00000,834.05000,Coventry,Commercial,,1390.08,,,,,,,376.48,1404.56,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,inpatient,,,72.00000,41.47000,Coventry,Commercial,,69.12,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,outpatient,,,72.00000,41.47000,Coventry,Commercial,,69.12,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,inpatient,,,102.00000,58.75000,Coventry,Commercial,,97.92,,,,,,,91.80,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,outpatient,,,102.00000,58.75000,Coventry,Commercial,,97.92,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,inpatient,,,154.00000,88.70000,Coventry,Commercial,,147.84,,,,,,,138.60,149.38,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,outpatient,,,154.00000,88.70000,Coventry,Commercial,,147.84,,,,,,,40.04,149.38,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Coventry,Commercial,,146.88,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Coventry,Commercial,,146.88,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,inpatient,,,66.00000,38.02000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,outpatient,,,66.00000,38.02000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Coventry,Commercial,,146.88,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Coventry,Commercial,,146.88,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,inpatient,,,44.00000,25.34000,Coventry,Commercial,,42.24,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,outpatient,,,44.00000,25.34000,Coventry,Commercial,,42.24,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,inpatient,,,150.00000,86.40000,Coventry,Commercial,,144.00,,,,,,,135.00,145.50,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,outpatient,,,150.00000,86.40000,Coventry,Commercial,,144.00,,,,,,,39.00,145.50,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,inpatient,,,56.00000,32.26000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,outpatient,,,56.00000,32.26000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,inpatient,,,66.00000,38.02000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,outpatient,,,66.00000,38.02000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,inpatient,,,60.00000,34.56000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,outpatient,,,60.00000,34.56000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,inpatient,,,58.00000,33.41000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,outpatient,,,58.00000,33.41000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,inpatient,,,71.00000,40.90000,Coventry,Commercial,,68.16,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,outpatient,,,71.00000,40.90000,Coventry,Commercial,,68.16,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,inpatient,,,72.00000,41.47000,Coventry,Commercial,,69.12,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,outpatient,,,72.00000,41.47000,Coventry,Commercial,,69.12,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,inpatient,,,56.00000,32.26000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,inpatient,,,56.00000,32.26000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,inpatient,,,60.00000,34.56000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,outpatient,,,60.00000,34.56000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,inpatient,,,56.00000,32.26000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,outpatient,,,56.00000,32.26000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,inpatient,,,39.00000,22.46000,Coventry,Commercial,,37.44,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,outpatient,,,39.00000,22.46000,Coventry,Commercial,,37.44,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Coventry,Commercial,,146.88,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Coventry,Commercial,,146.88,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,inpatient,,,73.00000,42.05000,Coventry,Commercial,,70.08,,,,,,,65.70,70.81,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,outpatient,,,73.00000,42.05000,Coventry,Commercial,,70.08,,,,,,,18.98,70.81,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,inpatient,,,127.00000,73.15000,Coventry,Commercial,,121.92,,,,,,,114.30,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Coventry,Commercial,,121.92,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,inpatient,,,127.00000,73.15000,Coventry,Commercial,,121.92,,,,,,,114.30,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Coventry,Commercial,,121.92,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,inpatient,,,372.00000,214.27000,Coventry,Commercial,,357.12,,,,,,,334.80,360.84,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,outpatient,,,372.00000,214.27000,Coventry,Commercial,,357.12,,,,,,,96.72,360.84,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,inpatient,,,69.00000,39.74000,Coventry,Commercial,,66.24,,,,,,,62.10,66.93,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,outpatient,,,69.00000,39.74000,Coventry,Commercial,,66.24,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Coventry,Commercial,,146.88,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Coventry,Commercial,,146.88,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Coventry,Commercial,,146.88,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Coventry,Commercial,,146.88,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,inpatient,,,57.00000,32.83000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,outpatient,,,57.00000,32.83000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,inpatient,,,96.00000,55.30000,Coventry,Commercial,,92.16,,,,,,,86.40,93.12,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,outpatient,,,96.00000,55.30000,Coventry,Commercial,,92.16,,,,,,,24.96,93.12,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,inpatient,,,44.00000,25.34000,Coventry,Commercial,,42.24,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,outpatient,,,44.00000,25.34000,Coventry,Commercial,,42.24,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,inpatient,,,60.00000,34.56000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,outpatient,,,60.00000,34.56000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,inpatient,,,60.00000,34.56000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,outpatient,,,60.00000,34.56000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,inpatient,,,74.00000,42.62000,Coventry,Commercial,,71.04,,,,,,,66.60,71.78,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,outpatient,,,74.00000,42.62000,Coventry,Commercial,,71.04,,,,,,,19.24,71.78,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,inpatient,,,69.00000,39.74000,Coventry,Commercial,,66.24,,,,,,,62.10,66.93,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,outpatient,,,69.00000,39.74000,Coventry,Commercial,,66.24,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Coventry,Commercial,,37.44,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Coventry,Commercial,,37.44,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,inpatient,,,53.00000,30.53000,Coventry,Commercial,,50.88,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,outpatient,,,53.00000,30.53000,Coventry,Commercial,,50.88,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Coventry,Commercial,,37.44,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Coventry,Commercial,,37.44,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Coventry,Commercial,,37.44,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Coventry,Commercial,,37.44,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,inpatient,,,70.00000,40.32000,Coventry,Commercial,,67.20,,,,,,,63.00,67.90,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,outpatient,,,70.00000,40.32000,Coventry,Commercial,,67.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,inpatient,,,71.00000,40.90000,Coventry,Commercial,,68.16,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,outpatient,,,71.00000,40.90000,Coventry,Commercial,,68.16,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Commercial,,62.40,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,inpatient,,,325.00000,187.20000,Coventry,Commercial,,312.00,,,,,,,292.50,315.25,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,outpatient,,,325.00000,187.20000,Coventry,Commercial,,312.00,,,,,,,84.50,315.25,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,inpatient,,,72.00000,41.47000,Coventry,Commercial,,69.12,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,outpatient,,,72.00000,41.47000,Coventry,Commercial,,69.12,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,inpatient,,,72.00000,41.47000,Coventry,Commercial,,69.12,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,outpatient,,,72.00000,41.47000,Coventry,Commercial,,69.12,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,inpatient,,,76.00000,43.78000,Coventry,Commercial,,72.96,,,,,,,68.40,73.72,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,outpatient,,,76.00000,43.78000,Coventry,Commercial,,72.96,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,inpatient,,,240.00000,138.24000,Coventry,Commercial,,230.40,,,,,,,216.00,232.80,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,outpatient,,,240.00000,138.24000,Coventry,Commercial,,230.40,,,,,,,62.40,232.80,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,inpatient,,,93.00000,53.57000,Coventry,Commercial,,89.28,,,,,,,83.70,90.21,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,outpatient,,,93.00000,53.57000,Coventry,Commercial,,89.28,,,,,,,24.18,90.21,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,inpatient,,,59.00000,33.98000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,outpatient,,,59.00000,33.98000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,inpatient,,,81.00000,46.66000,Coventry,Commercial,,77.76,,,,,,,72.90,78.57,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,outpatient,,,81.00000,46.66000,Coventry,Commercial,,77.76,,,,,,,21.06,78.57,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,inpatient,,,58.00000,33.41000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,outpatient,,,58.00000,33.41000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,inpatient,,,21.00000,12.10000,Coventry,Commercial,,20.16,,,,,,,18.90,20.37,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,outpatient,,,21.00000,12.10000,Coventry,Commercial,,20.16,,,,,,,5.46,20.37,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,inpatient,,,56.00000,32.26000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,outpatient,,,56.00000,32.26000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,inpatient,,,64.00000,36.86000,Coventry,Commercial,,61.44,,,,,,,57.60,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,outpatient,,,64.00000,36.86000,Coventry,Commercial,,61.44,,,,,,,16.64,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,inpatient,,,80.00000,46.08000,Coventry,Commercial,,76.80,,,,,,,72.00,77.60,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,outpatient,,,80.00000,46.08000,Coventry,Commercial,,76.80,,,,,,,20.80,77.60,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,inpatient,,,109.00000,62.78000,Coventry,Commercial,,104.64,,,,,,,98.10,105.73,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,outpatient,,,109.00000,62.78000,Coventry,Commercial,,104.64,,,,,,,28.34,105.73,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,inpatient,,,59.00000,33.98000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,outpatient,,,59.00000,33.98000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,inpatient,,,115.00000,66.24000,Coventry,Commercial,,110.40,,,,,,,103.50,111.55,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,outpatient,,,115.00000,66.24000,Coventry,Commercial,,110.40,,,,,,,29.90,111.55,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,inpatient,,,57.00000,32.83000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,outpatient,,,57.00000,32.83000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,inpatient,,,118.00000,67.97000,Coventry,Commercial,,113.28,,,,,,,106.20,114.46,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,outpatient,,,118.00000,67.97000,Coventry,Commercial,,113.28,,,,,,,30.68,114.46,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,inpatient,,,268.00000,154.37000,Coventry,Commercial,,257.28,,,,,,,241.20,259.96,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,outpatient,,,268.00000,154.37000,Coventry,Commercial,,257.28,,,,,,,69.68,259.96,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,inpatient,,,114.00000,65.66000,Coventry,Commercial,,109.44,,,,,,,102.60,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Coventry,Commercial,,109.44,,,,,,,29.64,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,inpatient,,,114.00000,65.66000,Coventry,Commercial,,109.44,,,,,,,102.60,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Coventry,Commercial,,109.44,,,,,,,29.64,110.58,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,inpatient,,,78.00000,44.93000,Coventry,Commercial,,74.88,,,,,,,70.20,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,outpatient,,,78.00000,44.93000,Coventry,Commercial,,74.88,,,,,,,20.28,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,inpatient,,,91.00000,52.42000,Coventry,Commercial,,87.36,,,,,,,81.90,88.27,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,outpatient,,,91.00000,52.42000,Coventry,Commercial,,87.36,,,,,,,23.66,88.27,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,inpatient,,,66.00000,38.02000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,inpatient,,,66.00000,38.02000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,inpatient,,,300.00000,172.80000,Coventry,Commercial,,288.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,outpatient,,,300.00000,172.80000,Coventry,Commercial,,288.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,inpatient,,,185.00000,106.56000,Coventry,Commercial,,177.60,,,,,,,166.50,179.45,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,outpatient,,,185.00000,106.56000,Coventry,Commercial,,177.60,,,,,,,48.10,179.45,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Coventry,Commercial,,34.56,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Coventry,Commercial,,34.56,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,inpatient,,,76.00000,43.78000,Coventry,Commercial,,72.96,,,,,,,68.40,73.72,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,outpatient,,,76.00000,43.78000,Coventry,Commercial,,72.96,,,,,,,19.76,73.72,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Coventry,Commercial,,34.56,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Coventry,Commercial,,34.56,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Coventry,Commercial,,34.56,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Coventry,Commercial,,34.56,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,inpatient,,,53.00000,30.53000,Coventry,Commercial,,50.88,,,,,,,47.70,51.41,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,outpatient,,,53.00000,30.53000,Coventry,Commercial,,50.88,,,,,,,13.78,51.41,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,inpatient,,,77.00000,44.35000,Coventry,Commercial,,73.92,,,,,,,69.30,74.69,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,outpatient,,,77.00000,44.35000,Coventry,Commercial,,73.92,,,,,,,20.02,74.69,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Coventry,Commercial,,34.56,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Coventry,Commercial,,34.56,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,inpatient,,,222.00000,127.87000,Coventry,Commercial,,213.12,,,,,,,199.80,215.34,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,outpatient,,,222.00000,127.87000,Coventry,Commercial,,213.12,,,,,,,57.72,215.34,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,inpatient,,,292.00000,168.19000,Coventry,Commercial,,280.32,,,,,,,262.80,283.24,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,outpatient,,,292.00000,168.19000,Coventry,Commercial,,280.32,,,,,,,75.92,283.24,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,inpatient,,,125.00000,72.00000,Coventry,Commercial,,120.00,,,,,,,112.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Coventry,Commercial,,120.00,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,inpatient,,,125.00000,72.00000,Coventry,Commercial,,120.00,,,,,,,112.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Coventry,Commercial,,120.00,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,inpatient,,,359.00000,206.78000,Coventry,Commercial,,344.64,,,,,,,323.10,348.23,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,outpatient,,,359.00000,206.78000,Coventry,Commercial,,344.64,,,,,,,93.34,348.23,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,inpatient,,,111.00000,63.94000,Coventry,Commercial,,106.56,,,,,,,99.90,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,outpatient,,,111.00000,63.94000,Coventry,Commercial,,106.56,,,,,,,28.86,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,inpatient,,,141.00000,81.22000,Coventry,Commercial,,135.36,,,,,,,126.90,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Coventry,Commercial,,135.36,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,inpatient,,,141.00000,81.22000,Coventry,Commercial,,135.36,,,,,,,126.90,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Coventry,Commercial,,135.36,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,inpatient,,,114.00000,65.66000,Coventry,Commercial,,109.44,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Coventry,Commercial,,109.44,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,inpatient,,,114.00000,65.66000,Coventry,Commercial,,109.44,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Coventry,Commercial,,109.44,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,inpatient,,,114.00000,65.66000,Coventry,Commercial,,109.44,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Coventry,Commercial,,109.44,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,inpatient,,,114.00000,65.66000,Coventry,Commercial,,109.44,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Coventry,Commercial,,109.44,,,,,,,29.64,110.58,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,inpatient,,,78.00000,44.93000,Coventry,Commercial,,74.88,,,,,,,70.20,75.66,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,outpatient,,,78.00000,44.93000,Coventry,Commercial,,74.88,,,,,,,20.28,75.66,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,inpatient,,,359.00000,206.78000,Coventry,Commercial,,344.64,,,,,,,323.10,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Coventry,Commercial,,344.64,,,,,,,93.34,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,inpatient,,,359.00000,206.78000,Coventry,Commercial,,344.64,,,,,,,323.10,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Coventry,Commercial,,344.64,,,,,,,93.34,348.23,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,inpatient,,,70.00000,40.32000,Coventry,Commercial,,67.20,,,,,,,63.00,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,outpatient,,,70.00000,40.32000,Coventry,Commercial,,67.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,inpatient,,,18.00000,10.37000,Coventry,Commercial,,17.28,,,,,,,16.20,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,outpatient,,,18.00000,10.37000,Coventry,Commercial,,17.28,,,,,,,4.68,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,inpatient,,,408.00000,235.01000,Coventry,Commercial,,391.68,,,,,,,367.20,395.76,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,outpatient,,,408.00000,235.01000,Coventry,Commercial,,391.68,,,,,,,106.08,395.76,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,inpatient,,,102.00000,58.75000,Coventry,Commercial,,97.92,,,,,,,91.80,98.94,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,outpatient,,,102.00000,58.75000,Coventry,Commercial,,97.92,,,,,,,26.52,98.94,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,inpatient,,,330.00000,190.08000,Coventry,Commercial,,316.80,,,,,,,297.00,320.10,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,outpatient,,,330.00000,190.08000,Coventry,Commercial,,316.80,,,,,,,85.80,320.10,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,inpatient,,,56.00000,32.26000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,outpatient,,,56.00000,32.26000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,inpatient,,,136.00000,78.34000,Coventry,Commercial,,130.56,,,,,,,122.40,131.92,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,outpatient,,,136.00000,78.34000,Coventry,Commercial,,130.56,,,,,,,35.36,131.92,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,inpatient,,,83.00000,47.81000,Coventry,Commercial,,79.68,,,,,,,74.70,80.51,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,outpatient,,,83.00000,47.81000,Coventry,Commercial,,79.68,,,,,,,21.58,80.51,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,inpatient,,,142.00000,81.79000,Coventry,Commercial,,136.32,,,,,,,127.80,137.74,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,outpatient,,,142.00000,81.79000,Coventry,Commercial,,136.32,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,inpatient,,,51.00000,29.38000,Coventry,Commercial,,48.96,,,,,,,45.90,49.47,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,outpatient,,,51.00000,29.38000,Coventry,Commercial,,48.96,,,,,,,13.26,49.47,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,inpatient,,,70.00000,40.32000,Coventry,Commercial,,67.20,,,,,,,63.00,67.90,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,outpatient,,,70.00000,40.32000,Coventry,Commercial,,67.20,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,inpatient,,,99.00000,57.02000,Coventry,Commercial,,95.04,,,,,,,89.10,96.03,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,outpatient,,,99.00000,57.02000,Coventry,Commercial,,95.04,,,,,,,25.74,96.03,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,inpatient,,,78.00000,44.93000,Coventry,Commercial,,74.88,,,,,,,70.20,75.66,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,outpatient,,,78.00000,44.93000,Coventry,Commercial,,74.88,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,inpatient,,,75.00000,43.20000,Coventry,Commercial,,72.00,,,,,,,67.50,72.75,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,outpatient,,,75.00000,43.20000,Coventry,Commercial,,72.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,inpatient,,,37.00000,21.31000,Coventry,Commercial,,35.52,,,,,,,33.30,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Coventry,Commercial,,35.52,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,inpatient,,,37.00000,21.31000,Coventry,Commercial,,35.52,,,,,,,33.30,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Coventry,Commercial,,35.52,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,inpatient,,,59.00000,33.98000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,outpatient,,,59.00000,33.98000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,inpatient,,,35.00000,20.16000,Coventry,Commercial,,33.60,,,,,,,31.50,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,outpatient,,,35.00000,20.16000,Coventry,Commercial,,33.60,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,inpatient,,,59.00000,33.98000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,outpatient,,,59.00000,33.98000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,inpatient,,,56.00000,32.26000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,outpatient,,,56.00000,32.26000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,inpatient,,,74.00000,42.62000,Coventry,Commercial,,71.04,,,,,,,66.60,71.78,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,outpatient,,,74.00000,42.62000,Coventry,Commercial,,71.04,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,inpatient,,,90.00000,51.84000,Coventry,Commercial,,86.40,,,,,,,81.00,87.30,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,outpatient,,,90.00000,51.84000,Coventry,Commercial,,86.40,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,inpatient,,,68.00000,39.17000,Coventry,Commercial,,65.28,,,,,,,61.20,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Coventry,Commercial,,65.28,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,inpatient,,,142.00000,81.79000,Coventry,Commercial,,136.32,,,,,,,127.80,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,outpatient,,,142.00000,81.79000,Coventry,Commercial,,136.32,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,inpatient,,,68.00000,39.17000,Coventry,Commercial,,65.28,,,,,,,61.20,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Coventry,Commercial,,65.28,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,inpatient,,,74.00000,42.62000,Coventry,Commercial,,71.04,,,,,,,66.60,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,outpatient,,,74.00000,42.62000,Coventry,Commercial,,71.04,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,inpatient,,,89.00000,51.26000,Coventry,Commercial,,85.44,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Coventry,Commercial,,85.44,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,inpatient,,,89.00000,51.26000,Coventry,Commercial,,85.44,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Coventry,Commercial,,85.44,,,,,,,23.14,86.33,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,inpatient,,,57.00000,32.83000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,outpatient,,,57.00000,32.83000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,inpatient,,,77.00000,44.35000,Coventry,Commercial,,73.92,,,,,,,69.30,74.69,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,outpatient,,,77.00000,44.35000,Coventry,Commercial,,73.92,,,,,,,20.02,74.69,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,inpatient,,,64.00000,36.86000,Coventry,Commercial,,61.44,,,,,,,57.60,62.08,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,outpatient,,,64.00000,36.86000,Coventry,Commercial,,61.44,,,,,,,16.64,62.08,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,inpatient,,,69.00000,39.74000,Coventry,Commercial,,66.24,,,,,,,62.10,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,outpatient,,,69.00000,39.74000,Coventry,Commercial,,66.24,,,,,,,17.94,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,inpatient,,,1178.00000,678.53000,Coventry,Commercial,,1130.88,,,,,,,1060.20,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,outpatient,,,1178.00000,678.53000,Coventry,Commercial,,1130.88,,,,,,,306.28,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,inpatient,,,127.00000,73.15000,Coventry,Commercial,,121.92,,,,,,,114.30,123.19,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,outpatient,,,127.00000,73.15000,Coventry,Commercial,,121.92,,,,,,,33.02,123.19,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,inpatient,,,277.00000,159.55000,Coventry,Commercial,,265.92,,,,,,,249.30,268.69,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,outpatient,,,277.00000,159.55000,Coventry,Commercial,,265.92,,,,,,,72.02,268.69,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,inpatient,,,940.00000,541.44000,Coventry,Commercial,,902.40,,,,,,,846.00,911.80,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,outpatient,,,940.00000,541.44000,Coventry,Commercial,,902.40,,,,,,,244.40,911.80,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,inpatient,,,97.00000,55.87000,Coventry,Commercial,,93.12,,,,,,,87.30,94.09,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,outpatient,,,97.00000,55.87000,Coventry,Commercial,,93.12,,,,,,,25.22,94.09,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,inpatient,,,16.00000,9.22000,Coventry,Commercial,,15.36,,,,,,,14.40,15.52,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,outpatient,,,16.00000,9.22000,Coventry,Commercial,,15.36,,,,,,,4.16,15.52,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,inpatient,,,57.00000,32.83000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,outpatient,,,57.00000,32.83000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,inpatient,,,131.00000,75.46000,Coventry,Commercial,,125.76,,,,,,,117.90,127.07,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,outpatient,,,131.00000,75.46000,Coventry,Commercial,,125.76,,,,,,,34.06,127.07,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,inpatient,,,2160.00000,1244.16000,Coventry,Commercial,,2073.60,,,,,,,1944.00,2095.20,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,outpatient,,,2160.00000,1244.16000,Coventry,Commercial,,2073.60,,,,,,,561.60,2095.20,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,inpatient,,,37.00000,21.31000,Coventry,Commercial,,35.52,,,,,,,33.30,35.89,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,outpatient,,,37.00000,21.31000,Coventry,Commercial,,35.52,,,,,,,9.62,35.89,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,inpatient,,,74.00000,42.62000,Coventry,Commercial,,71.04,,,,,,,66.60,71.78,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Coventry,Commercial,,71.04,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,inpatient,,,54.00000,31.10000,Coventry,Commercial,,51.84,,,,,,,48.60,52.38,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,outpatient,,,54.00000,31.10000,Coventry,Commercial,,51.84,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,inpatient,,,76.00000,43.78000,Coventry,Commercial,,72.96,,,,,,,68.40,73.72,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,outpatient,,,76.00000,43.78000,Coventry,Commercial,,72.96,,,,,,,19.76,73.72,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,inpatient,,,606.00000,349.06000,Coventry,Commercial,,581.76,,,,,,,545.40,587.82,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,outpatient,,,606.00000,349.06000,Coventry,Commercial,,581.76,,,,,,,157.56,587.82,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,inpatient,,,300.00000,172.80000,Coventry,Commercial,,288.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,outpatient,,,300.00000,172.80000,Coventry,Commercial,,288.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,inpatient,,,59.00000,33.98000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,outpatient,,,59.00000,33.98000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,inpatient,,,98.00000,56.45000,Coventry,Commercial,,94.08,,,,,,,88.20,95.06,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,outpatient,,,98.00000,56.45000,Coventry,Commercial,,94.08,,,,,,,25.48,95.06,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,inpatient,,,128.00000,73.73000,Coventry,Commercial,,122.88,,,,,,,115.20,124.16,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,outpatient,,,128.00000,73.73000,Coventry,Commercial,,122.88,,,,,,,33.28,124.16,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Coventry,Commercial,,50.88,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Coventry,Commercial,,50.88,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,inpatient,,,16.00000,9.22000,Coventry,Commercial,,15.36,,,,,,,14.40,15.52,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,outpatient,,,16.00000,9.22000,Coventry,Commercial,,15.36,,,,,,,4.16,15.52,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,inpatient,,,565.00000,325.44000,Coventry,Commercial,,542.40,,,,,,,508.50,548.05,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,outpatient,,,565.00000,325.44000,Coventry,Commercial,,542.40,,,,,,,146.90,548.05,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,inpatient,,,850.00000,489.60000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,outpatient,,,850.00000,489.60000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,inpatient,,,77.00000,44.35000,Coventry,Commercial,,73.92,,,,,,,69.30,74.69,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,outpatient,,,77.00000,44.35000,Coventry,Commercial,,73.92,,,,,,,20.02,74.69,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,inpatient,,,86.00000,49.54000,Coventry,Commercial,,82.56,,,,,,,77.40,83.42,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,outpatient,,,86.00000,49.54000,Coventry,Commercial,,82.56,,,,,,,22.36,83.42,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,inpatient,,,837.00000,482.11000,Coventry,Commercial,,803.52,,,,,,,753.30,811.89,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,outpatient,,,837.00000,482.11000,Coventry,Commercial,,803.52,,,,,,,217.62,811.89,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,inpatient,,,60.00000,34.56000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,outpatient,,,60.00000,34.56000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,inpatient,,,56.00000,32.26000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,outpatient,,,56.00000,32.26000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,inpatient,,,56.00000,32.26000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,outpatient,,,56.00000,32.26000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,inpatient,,,74.00000,42.62000,Coventry,Commercial,,71.04,,,,,,,66.60,71.78,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Coventry,Commercial,,71.04,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Coventry,Commercial,,50.88,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Coventry,Commercial,,50.88,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Coventry,Commercial,,50.88,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Coventry,Commercial,,50.88,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,inpatient,,,167.00000,96.19000,Coventry,Commercial,,160.32,,,,,,,150.30,161.99,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,outpatient,,,167.00000,96.19000,Coventry,Commercial,,160.32,,,,,,,43.42,161.99,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,inpatient,,,200.00000,115.20000,Coventry,Commercial,,192.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,outpatient,,,200.00000,115.20000,Coventry,Commercial,,192.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,inpatient,,,93.00000,53.57000,Coventry,Commercial,,89.28,,,,,,,83.70,90.21,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,outpatient,,,93.00000,53.57000,Coventry,Commercial,,89.28,,,,,,,24.18,90.21,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,49.50,53.35,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Commercial,,52.80,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,inpatient,,,190.00000,109.44000,Coventry,Commercial,,182.40,,,,,,,171.00,184.30,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,outpatient,,,190.00000,109.44000,Coventry,Commercial,,182.40,,,,,,,49.40,184.30,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,inpatient,,,64.00000,36.86000,Coventry,Commercial,,61.44,,,,,,,57.60,62.08,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,outpatient,,,64.00000,36.86000,Coventry,Commercial,,61.44,,,,,,,16.64,62.08,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,inpatient,,,525.00000,302.40000,Coventry,Commercial,,504.00,,,,,,,472.50,509.25,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,outpatient,,,525.00000,302.40000,Coventry,Commercial,,504.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,inpatient,,,54.00000,31.10000,Coventry,Commercial,,51.84,,,,,,,48.60,52.38,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,outpatient,,,54.00000,31.10000,Coventry,Commercial,,51.84,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Coventry,Commercial,,50.88,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Coventry,Commercial,,50.88,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,inpatient,,,53.00000,30.53000,Coventry,Commercial,,50.88,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,outpatient,,,53.00000,30.53000,Coventry,Commercial,,50.88,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,inpatient,,,40.00000,23.04000,Coventry,Commercial,,38.40,,,,,,,36.00,38.80,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Coventry,Commercial,,38.40,,,,,,,10.40,38.80,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,inpatient,,,453.00000,260.93000,Coventry,Commercial,,434.88,,,,,,,407.70,439.41,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,outpatient,,,453.00000,260.93000,Coventry,Commercial,,434.88,,,,,,,117.78,439.41,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,inpatient,,,25.00000,14.40000,Coventry,Commercial,,24.00,,,,,,,22.50,24.25,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,outpatient,,,25.00000,14.40000,Coventry,Commercial,,24.00,,,,,,,6.50,24.25,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,inpatient,,,56.00000,32.26000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,outpatient,,,56.00000,32.26000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,inpatient,,,59.00000,33.98000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,outpatient,,,59.00000,33.98000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,inpatient,,,53.00000,30.53000,Coventry,Commercial,,50.88,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,outpatient,,,53.00000,30.53000,Coventry,Commercial,,50.88,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,inpatient,,,350.00000,201.60000,Coventry,Commercial,,336.00,,,,,,,315.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,outpatient,,,350.00000,201.60000,Coventry,Commercial,,336.00,,,,,,,91.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,inpatient,,,225.00000,129.60000,Coventry,Commercial,,216.00,,,,,,,202.50,218.25,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,outpatient,,,225.00000,129.60000,Coventry,Commercial,,216.00,,,,,,,58.50,218.25,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,inpatient,,,52.00000,29.95000,Coventry,Commercial,,49.92,,,,,,,46.80,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,outpatient,,,52.00000,29.95000,Coventry,Commercial,,49.92,,,,,,,13.52,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,inpatient,,,134.00000,77.18000,Coventry,Commercial,,128.64,,,,,,,120.60,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,outpatient,,,134.00000,77.18000,Coventry,Commercial,,128.64,,,,,,,34.84,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,inpatient,,,52.00000,29.95000,Coventry,Commercial,,49.92,,,,,,,46.80,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,outpatient,,,52.00000,29.95000,Coventry,Commercial,,49.92,,,,,,,13.52,50.44,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,inpatient,,,186.00000,107.14000,Coventry,Commercial,,178.56,,,,,,,167.40,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,outpatient,,,186.00000,107.14000,Coventry,Commercial,,178.56,,,,,,,48.36,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,inpatient,,,300.00000,172.80000,Coventry,Commercial,,288.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Coventry,Commercial,,288.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,inpatient,,,300.00000,172.80000,Coventry,Commercial,,288.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Coventry,Commercial,,288.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,inpatient,,,205.00000,118.08000,Coventry,Commercial,,196.80,,,,,,,184.50,198.85,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,outpatient,,,205.00000,118.08000,Coventry,Commercial,,196.80,,,,,,,53.30,198.85,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,inpatient,,,75.00000,36.15000,Coventry,Commercial,,72.00,,,,,,,67.50,72.75,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,outpatient,,,75.00000,36.15000,Coventry,Commercial,,72.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,inpatient,,,65.00000,31.33000,Coventry,Commercial,,62.40,,,,,,,58.50,63.05,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,outpatient,,,65.00000,31.33000,Coventry,Commercial,,62.40,,,,,,,16.90,63.05,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,inpatient,,,92.00000,44.34000,Coventry,Commercial,,88.32,,,,,,,82.80,89.24,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,outpatient,,,92.00000,44.34000,Coventry,Commercial,,88.32,,,,,,,23.92,89.24,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,inpatient,,,24.00000,11.57000,Coventry,Commercial,,23.04,,,,,,,21.60,23.28,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Coventry,Commercial,,23.04,,,,,,,6.24,23.28,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,inpatient,,,20.00000,9.64000,Coventry,Commercial,,19.20,,,,,,,18.00,19.40,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,outpatient,,,20.00000,9.64000,Coventry,Commercial,,19.20,,,,,,,5.20,19.40,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,inpatient,,,42.00000,20.24000,Coventry,Commercial,,40.32,,,,,,,37.80,40.74,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,outpatient,,,42.00000,20.24000,Coventry,Commercial,,40.32,,,,,,,10.92,40.74,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,inpatient,,,69.00000,33.26000,Coventry,Commercial,,66.24,,,,,,,62.10,66.93,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,outpatient,,,69.00000,33.26000,Coventry,Commercial,,66.24,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,inpatient,,,65.00000,31.33000,Coventry,Commercial,,62.40,,,,,,,58.50,63.05,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,outpatient,,,65.00000,31.33000,Coventry,Commercial,,62.40,,,,,,,16.90,63.05,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,inpatient,,,76.00000,36.63000,Coventry,Commercial,,72.96,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,outpatient,,,76.00000,36.63000,Coventry,Commercial,,72.96,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,inpatient,,,89.00000,42.90000,Coventry,Commercial,,85.44,,,,,,,80.10,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,outpatient,,,89.00000,42.90000,Coventry,Commercial,,85.44,,,,,,,23.14,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,inpatient,,,76.00000,36.63000,Coventry,Commercial,,72.96,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,outpatient,,,76.00000,36.63000,Coventry,Commercial,,72.96,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,inpatient,,,28.00000,13.50000,Coventry,Commercial,,26.88,,,,,,,25.20,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,outpatient,,,28.00000,13.50000,Coventry,Commercial,,26.88,,,,,,,7.28,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,inpatient,,,98.00000,47.24000,Coventry,Commercial,,94.08,,,,,,,88.20,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,outpatient,,,98.00000,47.24000,Coventry,Commercial,,94.08,,,,,,,25.48,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,inpatient,,,64.00000,30.85000,Coventry,Commercial,,61.44,,,,,,,57.60,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,outpatient,,,64.00000,30.85000,Coventry,Commercial,,61.44,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,inpatient,,,75.00000,36.15000,Coventry,Commercial,,72.00,,,,,,,67.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,outpatient,,,75.00000,36.15000,Coventry,Commercial,,72.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,inpatient,,,76.00000,36.63000,Coventry,Commercial,,72.96,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,outpatient,,,76.00000,36.63000,Coventry,Commercial,,72.96,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,inpatient,,,114.00000,54.95000,Coventry,Commercial,,109.44,,,,,,,102.60,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,outpatient,,,114.00000,54.95000,Coventry,Commercial,,109.44,,,,,,,29.64,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,inpatient,,,74.00000,35.67000,Coventry,Commercial,,71.04,,,,,,,66.60,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,outpatient,,,74.00000,35.67000,Coventry,Commercial,,71.04,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,inpatient,,,69.00000,33.26000,Coventry,Commercial,,66.24,,,,,,,62.10,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,outpatient,,,69.00000,33.26000,Coventry,Commercial,,66.24,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,inpatient,,,74.00000,35.67000,Coventry,Commercial,,71.04,,,,,,,66.60,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,outpatient,,,74.00000,35.67000,Coventry,Commercial,,71.04,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,inpatient,,,87.00000,41.93000,Coventry,Commercial,,83.52,,,,,,,78.30,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,outpatient,,,87.00000,41.93000,Coventry,Commercial,,83.52,,,,,,,22.62,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,inpatient,,,79.00000,38.08000,Coventry,Commercial,,75.84,,,,,,,71.10,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,outpatient,,,79.00000,38.08000,Coventry,Commercial,,75.84,,,,,,,20.54,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,inpatient,,,75.00000,36.15000,Coventry,Commercial,,72.00,,,,,,,67.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,outpatient,,,75.00000,36.15000,Coventry,Commercial,,72.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,inpatient,,,64.00000,30.85000,Coventry,Commercial,,61.44,,,,,,,57.60,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,outpatient,,,64.00000,30.85000,Coventry,Commercial,,61.44,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,inpatient,,,164.00000,79.05000,Coventry,Commercial,,157.44,,,,,,,147.60,159.08,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,outpatient,,,164.00000,79.05000,Coventry,Commercial,,157.44,,,,,,,42.64,159.08,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,inpatient,,,54.00000,26.03000,Coventry,Commercial,,51.84,,,,,,,48.60,52.38,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,outpatient,,,54.00000,26.03000,Coventry,Commercial,,51.84,,,,,,,14.04,52.38,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,inpatient,,,8.00000,3.86000,Coventry,Commercial,,7.68,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,outpatient,,,8.00000,3.86000,Coventry,Commercial,,7.68,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,inpatient,,,69.00000,33.26000,Coventry,Commercial,,66.24,,,,,,,62.10,66.93,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,outpatient,,,69.00000,33.26000,Coventry,Commercial,,66.24,,,,,,,17.94,66.93,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,inpatient,,,8.00000,3.86000,Coventry,Commercial,,7.68,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,outpatient,,,8.00000,3.86000,Coventry,Commercial,,7.68,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,inpatient,,,8.00000,3.86000,Coventry,Commercial,,7.68,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,outpatient,,,8.00000,3.86000,Coventry,Commercial,,7.68,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,inpatient,,,14.00000,6.75000,Coventry,Commercial,,13.44,,,,,,,12.60,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,outpatient,,,14.00000,6.75000,Coventry,Commercial,,13.44,,,,,,,3.64,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,inpatient,,,112.00000,53.98000,Coventry,Commercial,,107.52,,,,,,,100.80,108.64,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,outpatient,,,112.00000,53.98000,Coventry,Commercial,,107.52,,,,,,,29.12,108.64,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,inpatient,,,13.00000,6.27000,Coventry,Commercial,,12.48,,,,,,,11.70,12.61,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,outpatient,,,13.00000,6.27000,Coventry,Commercial,,12.48,,,,,,,3.38,12.61,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,inpatient,,,31.00000,14.94000,Coventry,Commercial,,29.76,,,,,,,27.90,30.07,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,outpatient,,,31.00000,14.94000,Coventry,Commercial,,29.76,,,,,,,8.06,30.07,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,inpatient,,,92.00000,44.34000,Coventry,Commercial,,88.32,,,,,,,82.80,89.24,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,outpatient,,,92.00000,44.34000,Coventry,Commercial,,88.32,,,,,,,23.92,89.24,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,inpatient,,,80.00000,38.56000,Coventry,Commercial,,76.80,,,,,,,72.00,77.60,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,outpatient,,,80.00000,38.56000,Coventry,Commercial,,76.80,,,,,,,20.80,77.60,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,inpatient,,,30.00000,14.46000,Coventry,Commercial,,28.80,,,,,,,27.00,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Coventry,Commercial,,28.80,,,,,,,7.80,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,inpatient,,,30.00000,14.46000,Coventry,Commercial,,28.80,,,,,,,27.00,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Coventry,Commercial,,28.80,,,,,,,7.80,29.10,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,inpatient,,,24.00000,11.57000,Coventry,Commercial,,23.04,,,,,,,21.60,23.28,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Coventry,Commercial,,23.04,,,,,,,6.24,23.28,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,inpatient,,,29.00000,13.98000,Coventry,Commercial,,27.84,,,,,,,26.10,28.13,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,outpatient,,,29.00000,13.98000,Coventry,Commercial,,27.84,,,,,,,7.54,28.13,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,inpatient,,,97.00000,46.75000,Coventry,Commercial,,93.12,,,,,,,87.30,94.09,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,outpatient,,,97.00000,46.75000,Coventry,Commercial,,93.12,,,,,,,25.22,94.09,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,inpatient,,,225.00000,108.45000,Coventry,Commercial,,216.00,,,,,,,202.50,218.25,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,outpatient,,,225.00000,108.45000,Coventry,Commercial,,216.00,,,,,,,58.50,218.25,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,inpatient,,,71.00000,34.22000,Coventry,Commercial,,68.16,,,,,,,63.90,68.87,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,outpatient,,,71.00000,34.22000,Coventry,Commercial,,68.16,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,inpatient,,,71.00000,34.22000,Coventry,Commercial,,68.16,,,,,,,63.90,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,outpatient,,,71.00000,34.22000,Coventry,Commercial,,68.16,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,inpatient,,,108.00000,52.06000,Coventry,Commercial,,103.68,,,,,,,97.20,104.76,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,outpatient,,,108.00000,52.06000,Coventry,Commercial,,103.68,,,,,,,28.08,104.76,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,inpatient,,,51.00000,24.58000,Coventry,Commercial,,48.96,,,,,,,45.90,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,outpatient,,,51.00000,24.58000,Coventry,Commercial,,48.96,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,inpatient,,,19.00000,9.16000,Coventry,Commercial,,18.24,,,,,,,17.10,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,outpatient,,,19.00000,9.16000,Coventry,Commercial,,18.24,,,,,,,4.94,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,inpatient,,,54.00000,26.03000,Coventry,Commercial,,51.84,,,,,,,48.60,52.38,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,outpatient,,,54.00000,26.03000,Coventry,Commercial,,51.84,,,,,,,14.04,52.38,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,inpatient,,,103.00000,49.65000,Coventry,Commercial,,98.88,,,,,,,92.70,99.91,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,outpatient,,,103.00000,49.65000,Coventry,Commercial,,98.88,,,,,,,26.78,99.91,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,inpatient,,,9.00000,4.34000,Coventry,Commercial,,8.64,,,,,,,8.10,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,outpatient,,,9.00000,4.34000,Coventry,Commercial,,8.64,,,,,,,2.34,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,inpatient,,,13.00000,6.27000,Coventry,Commercial,,12.48,,,,,,,11.70,12.61,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,outpatient,,,13.00000,6.27000,Coventry,Commercial,,12.48,,,,,,,3.38,12.61,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,inpatient,,,80.00000,38.56000,Coventry,Commercial,,76.80,,,,,,,72.00,77.60,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,outpatient,,,80.00000,38.56000,Coventry,Commercial,,76.80,,,,,,,20.80,77.60,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,inpatient,,,47.00000,22.65000,Coventry,Commercial,,45.12,,,,,,,42.30,45.59,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,outpatient,,,47.00000,22.65000,Coventry,Commercial,,45.12,,,,,,,12.22,45.59,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,inpatient,,,91.00000,43.86000,Coventry,Commercial,,87.36,,,,,,,81.90,88.27,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,outpatient,,,91.00000,43.86000,Coventry,Commercial,,87.36,,,,,,,23.66,88.27,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,inpatient,,,18.00000,8.68000,Coventry,Commercial,,17.28,,,,,,,16.20,17.46,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,outpatient,,,18.00000,8.68000,Coventry,Commercial,,17.28,,,,,,,4.68,17.46,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,inpatient,,,21.00000,11.15000,Coventry,Commercial,,20.16,,,,,,,18.90,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Coventry,Commercial,,20.16,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,inpatient,,,71.00000,37.70000,Coventry,Commercial,,68.16,,,,,,,63.90,68.87,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,outpatient,,,71.00000,37.70000,Coventry,Commercial,,68.16,,,,,,,18.46,68.87,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,inpatient,,,21.00000,11.15000,Coventry,Commercial,,20.16,,,,,,,18.90,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Coventry,Commercial,,20.16,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,inpatient,,,128.00000,67.97000,Coventry,Commercial,,122.88,,,,,,,115.20,124.16,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,outpatient,,,128.00000,67.97000,Coventry,Commercial,,122.88,,,,,,,33.28,124.16,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,inpatient,,,65.00000,34.52000,Coventry,Commercial,,62.40,,,,,,,58.50,63.05,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,outpatient,,,65.00000,34.52000,Coventry,Commercial,,62.40,,,,,,,16.90,63.05,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Coventry,Commercial,,24.96,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Coventry,Commercial,,24.96,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,inpatient,,,31.00000,16.46000,Coventry,Commercial,,29.76,,,,,,,27.90,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,outpatient,,,31.00000,16.46000,Coventry,Commercial,,29.76,,,,,,,8.06,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Coventry,Commercial,,24.96,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Coventry,Commercial,,24.96,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Coventry,Commercial,,24.96,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Coventry,Commercial,,24.96,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Coventry,Commercial,,24.96,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Coventry,Commercial,,24.96,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,inpatient,,,61.00000,32.39000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,outpatient,,,61.00000,32.39000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Coventry,Commercial,,24.96,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Coventry,Commercial,,24.96,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,inpatient,,,25.00000,13.28000,Coventry,Commercial,,24.00,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Coventry,Commercial,,24.00,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,inpatient,,,25.00000,13.28000,Coventry,Commercial,91,24.00,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Coventry,Commercial,91,24.00,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,inpatient,,,103.00000,54.69000,Coventry,Commercial,,98.88,,,,,,,92.70,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,outpatient,,,103.00000,54.69000,Coventry,Commercial,,98.88,,,,,,,26.78,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,inpatient,,,96.00000,50.98000,Coventry,Commercial,,92.16,,,,,,,86.40,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,outpatient,,,96.00000,50.98000,Coventry,Commercial,,92.16,,,,,,,24.96,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,inpatient,,,75.00000,39.83000,Coventry,Commercial,,72.00,,,,,,,67.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,outpatient,,,75.00000,39.83000,Coventry,Commercial,,72.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,inpatient,,,68.00000,36.11000,Coventry,Commercial,,65.28,,,,,,,61.20,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,outpatient,,,68.00000,36.11000,Coventry,Commercial,,65.28,,,,,,,17.68,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,inpatient,,,61.00000,32.39000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,outpatient,,,61.00000,32.39000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Coventry,Commercial,,24.96,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Coventry,Commercial,,24.96,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Coventry,Commercial,,24.96,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Coventry,Commercial,,24.96,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,inpatient,,,29.00000,15.40000,Coventry,Commercial,,27.84,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,outpatient,,,29.00000,15.40000,Coventry,Commercial,,27.84,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Coventry,Commercial,,27.84,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Coventry,Commercial,,27.84,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Coventry,Commercial,,27.84,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Coventry,Commercial,,27.84,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,inpatient,,,63.00000,33.45000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,outpatient,,,63.00000,33.45000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,inpatient,,,79.00000,41.95000,Coventry,Commercial,,75.84,,,,,,,71.10,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,outpatient,,,79.00000,41.95000,Coventry,Commercial,,75.84,,,,,,,20.54,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,inpatient,,,63.00000,33.45000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,outpatient,,,63.00000,33.45000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Coventry,Commercial,,27.84,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Coventry,Commercial,,27.84,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,inpatient,,,112.00000,59.47000,Coventry,Commercial,,107.52,,,,,,,100.80,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,outpatient,,,112.00000,59.47000,Coventry,Commercial,,107.52,,,,,,,29.12,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Coventry,Commercial,,24.96,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Coventry,Commercial,,24.96,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,inpatient,,,25.00000,13.28000,Coventry,Commercial,,24.00,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,outpatient,,,25.00000,13.28000,Coventry,Commercial,,24.00,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,inpatient,,,118.00000,62.66000,Coventry,Commercial,,113.28,,,,,,,106.20,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,outpatient,,,118.00000,62.66000,Coventry,Commercial,,113.28,,,,,,,30.68,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,inpatient,,,29.00000,15.40000,Coventry,Commercial,,27.84,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,outpatient,,,29.00000,15.40000,Coventry,Commercial,,27.84,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,inpatient,,,25.00000,13.28000,Coventry,Commercial,,24.00,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,outpatient,,,25.00000,13.28000,Coventry,Commercial,,24.00,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Coventry,Commercial,,24.96,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Coventry,Commercial,,24.96,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,inpatient,,,25.00000,13.28000,Coventry,Commercial,,24.00,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,outpatient,,,25.00000,13.28000,Coventry,Commercial,,24.00,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,inpatient,,,71.00000,37.70000,Coventry,Commercial,,68.16,,,,,,,63.90,68.87,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,outpatient,,,71.00000,37.70000,Coventry,Commercial,,68.16,,,,,,,18.46,68.87,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,inpatient,,,59.00000,31.33000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,outpatient,,,59.00000,31.33000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,inpatient,,,62.00000,32.92000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,outpatient,,,62.00000,32.92000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,inpatient,,,138.00000,73.28000,Coventry,Commercial,,132.48,,,,,,,124.20,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,outpatient,,,138.00000,73.28000,Coventry,Commercial,,132.48,,,,,,,35.88,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,inpatient,,,62.00000,32.92000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,outpatient,,,62.00000,32.92000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,inpatient,,,78.00000,41.42000,Coventry,Commercial,,74.88,,,,,,,70.20,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,outpatient,,,78.00000,41.42000,Coventry,Commercial,,74.88,,,,,,,20.28,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,inpatient,,,69.00000,36.64000,Coventry,Commercial,,66.24,,,,,,,62.10,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,outpatient,,,69.00000,36.64000,Coventry,Commercial,,66.24,,,,,,,17.94,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,inpatient,,,88.00000,46.73000,Coventry,Commercial,,84.48,,,,,,,79.20,85.36,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,outpatient,,,88.00000,46.73000,Coventry,Commercial,,84.48,,,,,,,22.88,85.36,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,inpatient,,,60.00000,31.86000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,outpatient,,,60.00000,31.86000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,inpatient,,,64.00000,33.98000,Coventry,Commercial,,61.44,,,,,,,57.60,62.08,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,outpatient,,,64.00000,33.98000,Coventry,Commercial,,61.44,,,,,,,16.64,62.08,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,inpatient,,,63.00000,33.45000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,outpatient,,,63.00000,33.45000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,inpatient,,,137.00000,72.75000,Coventry,Commercial,,131.52,,,,,,,123.30,132.89,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,outpatient,,,137.00000,72.75000,Coventry,Commercial,,131.52,,,,,,,35.62,132.89,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,inpatient,,,347.00000,184.26000,Coventry,Commercial,,333.12,,,,,,,312.30,336.59,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,outpatient,,,347.00000,184.26000,Coventry,Commercial,,333.12,,,,,,,90.22,336.59,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,inpatient,,,57.00000,30.27000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,outpatient,,,57.00000,30.27000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,inpatient,,,56.00000,29.74000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,outpatient,,,56.00000,29.74000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,inpatient,,,16.00000,8.50000,Coventry,Commercial,,15.36,,,,,,,14.40,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,outpatient,,,16.00000,8.50000,Coventry,Commercial,,15.36,,,,,,,4.16,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,inpatient,,,85.00000,45.14000,Coventry,Commercial,,81.60,,,,,,,76.50,82.45,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,outpatient,,,85.00000,45.14000,Coventry,Commercial,,81.60,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,inpatient,,,34.00000,18.05000,Coventry,Commercial,,32.64,,,,,,,30.60,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,outpatient,,,34.00000,18.05000,Coventry,Commercial,,32.64,,,,,,,8.84,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,inpatient,,,231.00000,122.66000,Coventry,Commercial,,221.76,,,,,,,207.90,224.07,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,outpatient,,,231.00000,122.66000,Coventry,Commercial,,221.76,,,,,,,60.06,224.07,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,inpatient,,,36.00000,19.12000,Coventry,Commercial,,34.56,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,outpatient,,,36.00000,19.12000,Coventry,Commercial,,34.56,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,inpatient,,,61.00000,32.39000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,outpatient,,,61.00000,32.39000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,inpatient,,,111.00000,58.94000,Coventry,Commercial,,106.56,,,,,,,99.90,107.67,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,outpatient,,,111.00000,58.94000,Coventry,Commercial,,106.56,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,inpatient,,,61.00000,32.39000,Coventry,Commercial,,58.56,,,,,,,54.90,59.17,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,outpatient,,,61.00000,32.39000,Coventry,Commercial,,58.56,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,inpatient,,,60.00000,31.86000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,outpatient,,,60.00000,31.86000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,inpatient,,,60.00000,31.86000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,outpatient,,,60.00000,31.86000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,inpatient,,,60.00000,31.86000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,outpatient,,,60.00000,31.86000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,inpatient,,,60.00000,31.86000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,outpatient,,,60.00000,31.86000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,inpatient,,,60.00000,31.86000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,outpatient,,,60.00000,31.86000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,inpatient,,,36.00000,19.12000,Coventry,Commercial,,34.56,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,outpatient,,,36.00000,19.12000,Coventry,Commercial,,34.56,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,inpatient,,,76.00000,40.36000,Coventry,Commercial,,72.96,,,,,,,68.40,73.72,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,outpatient,,,76.00000,40.36000,Coventry,Commercial,,72.96,,,,,,,19.76,73.72,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,inpatient,,,60.00000,31.86000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,outpatient,,,60.00000,31.86000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,inpatient,,,60.00000,31.86000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,outpatient,,,60.00000,31.86000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,inpatient,,,152.00000,80.71000,Coventry,Commercial,,145.92,,,,,,,136.80,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,outpatient,,,152.00000,80.71000,Coventry,Commercial,,145.92,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,inpatient,,,78.00000,41.42000,Coventry,Commercial,,74.88,,,,,,,70.20,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,outpatient,,,78.00000,41.42000,Coventry,Commercial,,74.88,,,,,,,20.28,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,inpatient,,,42.00000,22.30000,Coventry,Commercial,,40.32,,,,,,,37.80,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,outpatient,,,42.00000,22.30000,Coventry,Commercial,,40.32,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,inpatient,,,73.00000,38.76000,Coventry,Commercial,,70.08,,,,,,,65.70,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,outpatient,,,73.00000,38.76000,Coventry,Commercial,,70.08,,,,,,,18.98,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,inpatient,,,97.00000,51.51000,Coventry,Commercial,,93.12,,,,,,,87.30,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,outpatient,,,97.00000,51.51000,Coventry,Commercial,,93.12,,,,,,,25.22,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,inpatient,,,157.00000,83.37000,Coventry,Commercial,,150.72,,,,,,,141.30,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,outpatient,,,157.00000,83.37000,Coventry,Commercial,,150.72,,,,,,,40.82,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,inpatient,,,36.00000,19.12000,Coventry,Commercial,,34.56,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,outpatient,,,36.00000,19.12000,Coventry,Commercial,,34.56,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,inpatient,,,66.00000,35.05000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,outpatient,,,66.00000,35.05000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,inpatient,,,58.00000,30.80000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,outpatient,,,58.00000,30.80000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,inpatient,,,85.00000,45.14000,Coventry,Commercial,,81.60,,,,,,,76.50,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,outpatient,,,85.00000,45.14000,Coventry,Commercial,,81.60,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,inpatient,,,59.00000,31.33000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,outpatient,,,59.00000,31.33000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,inpatient,,,175.00000,92.93000,Coventry,Commercial,,168.00,,,,,,,157.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,outpatient,,,175.00000,92.93000,Coventry,Commercial,,168.00,,,,,,,45.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,inpatient,,,152.00000,80.71000,Coventry,Commercial,,145.92,,,,,,,136.80,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,outpatient,,,152.00000,80.71000,Coventry,Commercial,,145.92,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,inpatient,,,43.00000,22.83000,Coventry,Commercial,,41.28,,,,,,,38.70,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,outpatient,,,43.00000,22.83000,Coventry,Commercial,,41.28,,,,,,,11.18,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,inpatient,,,66.00000,35.05000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,outpatient,,,66.00000,35.05000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,inpatient,,,36.00000,19.12000,Coventry,Commercial,,34.56,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,outpatient,,,36.00000,19.12000,Coventry,Commercial,,34.56,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,inpatient,,,36.00000,19.12000,Coventry,Commercial,,34.56,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,outpatient,,,36.00000,19.12000,Coventry,Commercial,,34.56,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,inpatient,,,42.00000,22.30000,Coventry,Commercial,,40.32,,,,,,,37.80,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,outpatient,,,42.00000,22.30000,Coventry,Commercial,,40.32,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,inpatient,,,147.00000,78.06000,Coventry,Commercial,,141.12,,,,,,,132.30,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,outpatient,,,147.00000,78.06000,Coventry,Commercial,,141.12,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,inpatient,,,64.00000,33.98000,Coventry,Commercial,,61.44,,,,,,,57.60,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,outpatient,,,64.00000,33.98000,Coventry,Commercial,,61.44,,,,,,,16.64,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,inpatient,,,60.00000,31.86000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,outpatient,,,60.00000,31.86000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,inpatient,,,75.00000,39.83000,Coventry,Commercial,,72.00,,,,,,,67.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,outpatient,,,75.00000,39.83000,Coventry,Commercial,,72.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,inpatient,,,44.00000,23.36000,Coventry,Commercial,,42.24,,,,,,,39.60,42.68,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,outpatient,,,44.00000,23.36000,Coventry,Commercial,,42.24,,,,,,,11.44,42.68,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,inpatient,,,87.00000,46.20000,Coventry,Commercial,,83.52,,,,,,,78.30,84.39,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,outpatient,,,87.00000,46.20000,Coventry,Commercial,,83.52,,,,,,,22.62,84.39,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,inpatient,,,65.00000,34.52000,Coventry,Commercial,,62.40,,,,,,,58.50,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,outpatient,,,65.00000,34.52000,Coventry,Commercial,,62.40,,,,,,,16.90,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,inpatient,,,75.00000,39.83000,Coventry,Commercial,,72.00,,,,,,,67.50,72.75,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,outpatient,,,75.00000,39.83000,Coventry,Commercial,,72.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,inpatient,,,50.00000,26.55000,Coventry,Commercial,,48.00,,,,,,,45.00,48.50,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,outpatient,,,50.00000,26.55000,Coventry,Commercial,,48.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,inpatient,,,40.00000,21.24000,Coventry,Commercial,,38.40,,,,,,,36.00,38.80,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,outpatient,,,40.00000,21.24000,Coventry,Commercial,,38.40,,,,,,,10.40,38.80,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,inpatient,,,50.00000,26.55000,Coventry,Commercial,,48.00,,,,,,,45.00,48.50,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,outpatient,,,50.00000,26.55000,Coventry,Commercial,,48.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,inpatient,,,115.00000,61.07000,Coventry,Commercial,,110.40,,,,,,,103.50,111.55,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,outpatient,,,115.00000,61.07000,Coventry,Commercial,,110.40,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,inpatient,,,1309.00000,695.08000,Coventry,Commercial,,1256.64,,,,,,,1178.10,1269.73,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1309.00000,695.08000,Coventry,Commercial,,1256.64,,,,,,,340.34,1269.73,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,inpatient,,,328.00000,174.17000,Coventry,Commercial,,314.88,,,,,,,295.20,318.16,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,outpatient,,,328.00000,174.17000,Coventry,Commercial,,314.88,,,,,,,85.28,318.16,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,inpatient,,,115.00000,61.07000,Coventry,Commercial,,110.40,,,,,,,103.50,111.55,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,outpatient,,,115.00000,61.07000,Coventry,Commercial,,110.40,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,inpatient,,,1251.00000,664.28000,Coventry,Commercial,,1200.96,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,outpatient,,,1251.00000,664.28000,Coventry,Commercial,,1200.96,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,inpatient,,,154.00000,81.77000,Coventry,Commercial,,147.84,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Coventry,Commercial,,147.84,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,inpatient,,,154.00000,81.77000,Coventry,Commercial,,147.84,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Coventry,Commercial,,147.84,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,inpatient,,,96.00000,50.98000,Coventry,Commercial,,92.16,,,,,,,86.40,93.12,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,outpatient,,,96.00000,50.98000,Coventry,Commercial,,92.16,,,,,,,24.96,93.12,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,inpatient,,,211.00000,112.04000,Coventry,Commercial,,202.56,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,outpatient,,,211.00000,112.04000,Coventry,Commercial,,202.56,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,inpatient,,,290.00000,153.99000,Coventry,Commercial,,278.40,,,,,,,261.00,281.30,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,outpatient,,,290.00000,153.99000,Coventry,Commercial,,278.40,,,,,,,75.40,281.30,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,inpatient,,,411.00000,218.24000,Coventry,Commercial,,394.56,,,,,,,369.90,398.67,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,outpatient,,,411.00000,218.24000,Coventry,Commercial,,394.56,,,,,,,106.86,398.67,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,inpatient,,,139.00000,73.81000,Coventry,Commercial,,133.44,,,,,,,125.10,134.83,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,outpatient,,,139.00000,73.81000,Coventry,Commercial,,133.44,,,,,,,36.14,134.83,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,inpatient,,,288.00000,152.93000,Coventry,Commercial,,276.48,,,,,,,259.20,279.36,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,outpatient,,,288.00000,152.93000,Coventry,Commercial,,276.48,,,,,,,74.88,279.36,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,inpatient,,,1372.00000,728.53000,Coventry,Commercial,,1317.12,,,,,,,1234.80,1330.84,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1372.00000,728.53000,Coventry,Commercial,,1317.12,,,,,,,356.72,1330.84,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,inpatient,,,1251.00000,664.28000,Coventry,Commercial,,1200.96,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,outpatient,,,1251.00000,664.28000,Coventry,Commercial,,1200.96,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,inpatient,,,135.00000,71.68000,Coventry,Commercial,,129.60,,,,,,,121.50,130.95,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,outpatient,,,135.00000,71.68000,Coventry,Commercial,,129.60,,,,,,,35.10,130.95,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,inpatient,,,147.00000,78.06000,Coventry,Commercial,,141.12,,,,,,,132.30,142.59,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,outpatient,,,147.00000,78.06000,Coventry,Commercial,,141.12,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,inpatient,,,126.00000,66.91000,Coventry,Commercial,,120.96,,,,,,,113.40,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,outpatient,,,126.00000,66.91000,Coventry,Commercial,,120.96,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,inpatient,,,120.00000,63.72000,Coventry,Commercial,,115.20,,,,,,,108.00,116.40,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,outpatient,,,120.00000,63.72000,Coventry,Commercial,,115.20,,,,,,,31.20,116.40,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,inpatient,,,124.00000,65.84000,Coventry,Commercial,,119.04,,,,,,,111.60,120.28,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,outpatient,,,124.00000,65.84000,Coventry,Commercial,,119.04,,,,,,,32.24,120.28,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,inpatient,,,108.00000,57.35000,Coventry,Commercial,,103.68,,,,,,,97.20,104.76,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,outpatient,,,108.00000,57.35000,Coventry,Commercial,,103.68,,,,,,,28.08,104.76,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,inpatient,,,256.00000,135.94000,Coventry,Commercial,,245.76,,,,,,,230.40,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Coventry,Commercial,,245.76,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,inpatient,,,256.00000,135.94000,Coventry,Commercial,,245.76,,,,,,,230.40,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Coventry,Commercial,,245.76,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,inpatient,,,122.00000,64.78000,Coventry,Commercial,,117.12,,,,,,,109.80,118.34,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,outpatient,,,122.00000,64.78000,Coventry,Commercial,,117.12,,,,,,,31.72,118.34,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,inpatient,,,123.00000,65.31000,Coventry,Commercial,,118.08,,,,,,,110.70,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,outpatient,,,123.00000,65.31000,Coventry,Commercial,,118.08,,,,,,,31.98,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,inpatient,,,518.00000,275.06000,Coventry,Commercial,,497.28,,,,,,,466.20,502.46,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,outpatient,,,518.00000,275.06000,Coventry,Commercial,,497.28,,,,,,,134.68,502.46,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,inpatient,,,275.00000,146.02000,Coventry,Commercial,,264.00,,,,,,,247.50,266.75,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,outpatient,,,275.00000,146.02000,Coventry,Commercial,,264.00,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,inpatient,,,270.00000,143.37000,Coventry,Commercial,,259.20,,,,,,,243.00,261.90,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,outpatient,,,270.00000,143.37000,Coventry,Commercial,,259.20,,,,,,,70.20,261.90,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,inpatient,,,450.00000,238.95000,Coventry,Commercial,,432.00,,,,,,,405.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,outpatient,,,450.00000,238.95000,Coventry,Commercial,,432.00,,,,,,,117.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,inpatient,,,126.00000,66.91000,Coventry,Commercial,,120.96,,,,,,,113.40,122.22,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,outpatient,,,126.00000,66.91000,Coventry,Commercial,,120.96,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,inpatient,,,362.00000,192.22000,Coventry,Commercial,,347.52,,,,,,,325.80,351.14,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,outpatient,,,362.00000,192.22000,Coventry,Commercial,,347.52,,,,,,,94.12,351.14,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,inpatient,,,109.00000,57.88000,Coventry,Commercial,,104.64,,,,,,,98.10,105.73,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Coventry,Commercial,,104.64,,,,,,,28.34,105.73,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,inpatient,,,638.00000,338.78000,Coventry,Commercial,,612.48,,,,,,,574.20,618.86,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,outpatient,,,638.00000,338.78000,Coventry,Commercial,,612.48,,,,,,,165.88,618.86,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,inpatient,,,211.00000,112.04000,Coventry,Commercial,,202.56,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,outpatient,,,211.00000,112.04000,Coventry,Commercial,,202.56,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,inpatient,,,154.00000,81.77000,Coventry,Commercial,,147.84,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,outpatient,,,154.00000,81.77000,Coventry,Commercial,,147.84,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,inpatient,,,141.00000,74.87000,Coventry,Commercial,,135.36,,,,,,,126.90,136.77,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,outpatient,,,141.00000,74.87000,Coventry,Commercial,,135.36,,,,,,,36.66,136.77,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,inpatient,,,2040.00000,1083.24000,Coventry,Commercial,,1958.40,,,,,,,1836.00,1978.80,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,outpatient,,,2040.00000,1083.24000,Coventry,Commercial,,1958.40,,,,,,,530.40,1978.80,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,inpatient,,,421.00000,223.55000,Coventry,Commercial,,404.16,,,,,,,378.90,408.37,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,outpatient,,,421.00000,223.55000,Coventry,Commercial,,404.16,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,inpatient,,,275.00000,146.02000,Coventry,Commercial,,264.00,,,,,,,247.50,266.75,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,outpatient,,,275.00000,146.02000,Coventry,Commercial,,264.00,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,inpatient,,,1251.00000,664.28000,Coventry,Commercial,,1200.96,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,outpatient,,,1251.00000,664.28000,Coventry,Commercial,,1200.96,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,inpatient,,,428.00000,227.27000,Coventry,Commercial,,410.88,,,,,,,385.20,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Coventry,Commercial,,410.88,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,inpatient,,,428.00000,227.27000,Coventry,Commercial,,410.88,,,,,,,385.20,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Coventry,Commercial,,410.88,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,inpatient,,,655.00000,347.80000,Coventry,Commercial,,628.80,,,,,,,589.50,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Coventry,Commercial,,628.80,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,inpatient,,,655.00000,347.80000,Coventry,Commercial,,628.80,,,,,,,589.50,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Coventry,Commercial,,628.80,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,inpatient,,,211.00000,112.04000,Coventry,Commercial,,202.56,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,outpatient,,,211.00000,112.04000,Coventry,Commercial,,202.56,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,inpatient,,,112.00000,59.47000,Coventry,Commercial,,107.52,,,,,,,100.80,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Coventry,Commercial,,107.52,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,inpatient,,,112.00000,59.47000,Coventry,Commercial,,107.52,,,,,,,100.80,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Coventry,Commercial,,107.52,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,inpatient,,,130.00000,69.03000,Coventry,Commercial,,124.80,,,,,,,117.00,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,outpatient,,,130.00000,69.03000,Coventry,Commercial,,124.80,,,,,,,33.80,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,inpatient,,,421.00000,223.55000,Coventry,Commercial,,404.16,,,,,,,378.90,408.37,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,outpatient,,,421.00000,223.55000,Coventry,Commercial,,404.16,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,inpatient,,,111.00000,58.94000,Coventry,Commercial,,106.56,,,,,,,99.90,107.67,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,outpatient,,,111.00000,58.94000,Coventry,Commercial,,106.56,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,inpatient,,,200.00000,106.20000,Coventry,Commercial,,192.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,outpatient,,,200.00000,106.20000,Coventry,Commercial,,192.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Commercial,,123.84,,,,,,,33.54,125.13,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,inpatient,,,13.00000,6.90000,Coventry,Commercial,,12.48,,,,,,,11.70,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,outpatient,,,13.00000,6.90000,Coventry,Commercial,,12.48,,,,,,,3.38,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,inpatient,,,58.00000,30.80000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,outpatient,,,58.00000,30.80000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,inpatient,,,13.00000,6.90000,Coventry,Commercial,,12.48,,,,,,,11.70,12.61,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,outpatient,,,13.00000,6.90000,Coventry,Commercial,,12.48,,,,,,,3.38,12.61,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,inpatient,,,773.00000,410.46000,Coventry,Commercial,,742.08,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,outpatient,,,773.00000,410.46000,Coventry,Commercial,,742.08,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,inpatient,,,773.00000,410.46000,Coventry,Commercial,,742.08,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,outpatient,,,773.00000,410.46000,Coventry,Commercial,,742.08,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,inpatient,,,773.00000,410.46000,Coventry,Commercial,,742.08,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,outpatient,,,773.00000,410.46000,Coventry,Commercial,,742.08,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,inpatient,,,773.00000,410.46000,Coventry,Commercial,,742.08,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,outpatient,,,773.00000,410.46000,Coventry,Commercial,,742.08,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,inpatient,,,387.00000,205.50000,Coventry,Commercial,,371.52,,,,,,,348.30,375.39,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,outpatient,,,387.00000,205.50000,Coventry,Commercial,,371.52,,,,,,,100.62,375.39,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,inpatient,,,52.00000,27.61000,Coventry,Commercial,,49.92,,,,,,,46.80,50.44,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,outpatient,,,52.00000,27.61000,Coventry,Commercial,,49.92,,,,,,,13.52,50.44,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,inpatient,,,102.00000,54.16000,Coventry,Commercial,,97.92,,,,,,,91.80,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Coventry,Commercial,,97.92,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,inpatient,,,102.00000,54.16000,Coventry,Commercial,,97.92,,,,,,,91.80,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Coventry,Commercial,,97.92,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,inpatient,,,79.00000,41.95000,Coventry,Commercial,,75.84,,,,,,,71.10,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,outpatient,,,79.00000,41.95000,Coventry,Commercial,,75.84,,,,,,,20.54,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,inpatient,,,65.00000,34.52000,Coventry,Commercial,,62.40,,,,,,,58.50,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,outpatient,,,65.00000,34.52000,Coventry,Commercial,,62.40,,,,,,,16.90,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,inpatient,,,100.00000,53.10000,Coventry,Commercial,,96.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,outpatient,,,100.00000,53.10000,Coventry,Commercial,,96.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,inpatient,,,64.00000,33.98000,Coventry,Commercial,,61.44,,,,,,,57.60,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,outpatient,,,64.00000,33.98000,Coventry,Commercial,,61.44,,,,,,,16.64,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,inpatient,,,109.00000,57.88000,Coventry,Commercial,,104.64,,,,,,,98.10,105.73,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Coventry,Commercial,,104.64,,,,,,,28.34,105.73,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,inpatient,,,58.00000,30.80000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,outpatient,,,58.00000,30.80000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Coventry,Commercial,,19.20,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Coventry,Commercial,,19.20,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,inpatient,,,66.00000,35.05000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,outpatient,,,66.00000,35.05000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Coventry,Commercial,,19.20,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Coventry,Commercial,,19.20,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Coventry,Commercial,,19.20,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Coventry,Commercial,,19.20,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Coventry,Commercial,,19.20,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Coventry,Commercial,,19.20,,,,,,,5.20,19.40,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,inpatient,,,13.00000,6.90000,Coventry,Commercial,,12.48,,,,,,,11.70,12.61,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,outpatient,,,13.00000,6.90000,Coventry,Commercial,,12.48,,,,,,,3.38,12.61,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,inpatient,,,53.00000,28.14000,Coventry,Commercial,,50.88,,,,,,,47.70,51.41,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,outpatient,,,53.00000,28.14000,Coventry,Commercial,,50.88,,,,,,,13.78,51.41,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,inpatient,,,18.00000,9.56000,Coventry,Commercial,,17.28,,,,,,,16.20,17.46,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,outpatient,,,18.00000,9.56000,Coventry,Commercial,,17.28,,,,,,,4.68,17.46,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,inpatient,,,17.00000,9.03000,Coventry,Commercial,,16.32,,,,,,,15.30,16.49,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,outpatient,,,17.00000,9.03000,Coventry,Commercial,,16.32,,,,,,,4.42,16.49,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,inpatient,,,71.00000,37.70000,Coventry,Commercial,,68.16,,,,,,,63.90,68.87,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,outpatient,,,71.00000,37.70000,Coventry,Commercial,,68.16,,,,,,,18.46,68.87,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,inpatient,,,57.00000,30.27000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,outpatient,,,57.00000,30.27000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,inpatient,,,68.00000,36.11000,Coventry,Commercial,,65.28,,,,,,,61.20,65.96,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,outpatient,,,68.00000,36.11000,Coventry,Commercial,,65.28,,,,,,,17.68,65.96,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,inpatient,,,58.00000,30.80000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,outpatient,,,58.00000,30.80000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,inpatient,,,27.00000,14.34000,Coventry,Commercial,,25.92,,,,,,,24.30,26.19,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,outpatient,,,27.00000,14.34000,Coventry,Commercial,,25.92,,,,,,,7.02,26.19,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,inpatient,,,56.00000,29.74000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,outpatient,,,56.00000,29.74000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,inpatient,,,56.00000,29.74000,Coventry,Commercial,,53.76,,,,,,,50.40,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,outpatient,,,56.00000,29.74000,Coventry,Commercial,,53.76,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,inpatient,,,58.00000,30.80000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,outpatient,,,58.00000,30.80000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,inpatient,,,115.00000,61.07000,Coventry,Commercial,,110.40,,,,,,,103.50,111.55,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,outpatient,,,115.00000,61.07000,Coventry,Commercial,,110.40,,,,,,,29.90,111.55,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,inpatient,,,23.00000,12.21000,Coventry,Commercial,,22.08,,,,,,,20.70,22.31,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,outpatient,,,23.00000,12.21000,Coventry,Commercial,,22.08,,,,,,,5.98,22.31,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,inpatient,,,255.00000,135.40000,Coventry,Commercial,,244.80,,,,,,,229.50,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,outpatient,,,255.00000,135.40000,Coventry,Commercial,,244.80,,,,,,,66.30,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,inpatient,,,66.00000,35.05000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,outpatient,,,66.00000,35.05000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,inpatient,,,26.00000,13.81000,Coventry,Commercial,,24.96,,,,,,,23.40,25.22,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,outpatient,,,26.00000,13.81000,Coventry,Commercial,,24.96,,,,,,,6.76,25.22,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,inpatient,,,64.00000,33.98000,Coventry,Commercial,,61.44,,,,,,,57.60,62.08,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,outpatient,,,64.00000,33.98000,Coventry,Commercial,,61.44,,,,,,,16.64,62.08,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,inpatient,,,215.00000,114.16000,Coventry,Commercial,,206.40,,,,,,,193.50,208.55,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,outpatient,,,215.00000,114.16000,Coventry,Commercial,,206.40,,,,,,,55.90,208.55,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,inpatient,,,79.00000,41.95000,Coventry,Commercial,,75.84,,,,,,,71.10,76.63,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,outpatient,,,79.00000,41.95000,Coventry,Commercial,,75.84,,,,,,,20.54,76.63,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,inpatient,,,11.00000,5.29000,Coventry,Commercial,,10.56,,,,,,,9.90,10.67,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,outpatient,,,11.00000,5.29000,Coventry,Commercial,,10.56,,,,,,,2.86,10.67,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,inpatient,,,58.00000,27.90000,Coventry,Commercial,,55.68,,,,,,,52.20,56.26,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,outpatient,,,58.00000,27.90000,Coventry,Commercial,,55.68,,,,,,,15.08,56.26,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,inpatient,,,10.00000,4.81000,Coventry,Commercial,,9.60,,,,,,,9.00,9.70,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,outpatient,,,10.00000,4.81000,Coventry,Commercial,,9.60,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,inpatient,,,7.00000,3.37000,Coventry,Commercial,,6.72,,,,,,,6.30,6.79,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,outpatient,,,7.00000,3.37000,Coventry,Commercial,,6.72,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,inpatient,,,53.00000,25.49000,Coventry,Commercial,,50.88,,,,,,,47.70,51.41,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,outpatient,,,53.00000,25.49000,Coventry,Commercial,,50.88,,,,,,,13.78,51.41,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,inpatient,,,10.00000,4.81000,Coventry,Commercial,,9.60,,,,,,,9.00,9.70,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,outpatient,,,10.00000,4.81000,Coventry,Commercial,,9.60,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,inpatient,,,11.00000,5.29000,Coventry,Commercial,,10.56,,,,,,,9.90,10.67,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Coventry,Commercial,,10.56,,,,,,,2.86,10.67,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,inpatient,,,7.00000,3.37000,Coventry,Commercial,,6.72,,,,,,,6.30,6.79,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,outpatient,,,7.00000,3.37000,Coventry,Commercial,,6.72,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,inpatient,,,11.00000,5.29000,Coventry,Commercial,,10.56,,,,,,,9.90,10.67,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Coventry,Commercial,,10.56,,,,,,,2.86,10.67,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,inpatient,,,597.00000,290.14000,Coventry,Commercial,,573.12,,,,,,,537.30,579.09,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,outpatient,,,597.00000,290.14000,Coventry,Commercial,,573.12,,,,,,,155.22,579.09,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,inpatient,,,6379.00000,3100.19000,Coventry,Commercial,,6123.84,,,,,,,5741.10,6187.63,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,outpatient,,,6379.00000,3100.19000,Coventry,Commercial,,6123.84,,,,,,,1658.54,6187.63,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,inpatient,,,471.00000,228.91000,Coventry,Commercial,,452.16,,,,,,,423.90,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,outpatient,,,471.00000,228.91000,Coventry,Commercial,,452.16,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,inpatient,,,471.00000,228.91000,Coventry,Commercial,,452.16,,,,,,,423.90,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,outpatient,,,471.00000,228.91000,Coventry,Commercial,,452.16,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,inpatient,,,1251.00000,607.99000,Coventry,Commercial,,1200.96,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,outpatient,,,1251.00000,607.99000,Coventry,Commercial,,1200.96,,,,,,,325.26,1213.47,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,inpatient,,,260.00000,126.36000,Coventry,Commercial,,249.60,,,,,,,234.00,252.20,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,outpatient,,,260.00000,126.36000,Coventry,Commercial,,249.60,,,,,,,67.60,252.20,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,inpatient,,,785.00000,381.51000,Coventry,Commercial,,753.60,,,,,,,706.50,761.45,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,outpatient,,,785.00000,381.51000,Coventry,Commercial,,753.60,,,,,,,204.10,761.45,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,inpatient,,,529.00000,257.09000,Coventry,Commercial,,507.84,,,,,,,476.10,513.13,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,outpatient,,,529.00000,257.09000,Coventry,Commercial,,507.84,,,,,,,137.54,513.13,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,inpatient,,,1623.00000,788.78000,Coventry,Commercial,,1558.08,,,,,,,1460.70,1574.31,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,outpatient,,,1623.00000,788.78000,Coventry,Commercial,,1558.08,,,,,,,421.98,1574.31,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,inpatient,,,10800.00000,5248.80000,Coventry,Commercial,,10368.00,,,,,,,9720.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,outpatient,,,10800.00000,5248.80000,Coventry,Commercial,,10368.00,,,,,,,2808.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,inpatient,,,25365.00000,12327.39000,Coventry,Commercial,,24350.40,,,,,,,22828.50,24604.05,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,outpatient,,,25365.00000,12327.39000,Coventry,Commercial,,24350.40,,,,,,,6594.90,24604.05,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,inpatient,,,101.00000,21.82000,Coventry,Commercial,,96.96,,,,,,,90.90,97.97,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,outpatient,,,101.00000,21.82000,Coventry,Commercial,,96.96,,,,,,,26.26,97.97,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,inpatient,,,81.00000,17.50000,Coventry,Commercial,,77.76,,,,,,,72.90,78.57,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,outpatient,,,81.00000,17.50000,Coventry,Commercial,,77.76,,,,,,,21.06,78.57,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,inpatient,,,104.00000,22.46000,Coventry,Commercial,,99.84,,,,,,,93.60,100.88,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,outpatient,,,104.00000,22.46000,Coventry,Commercial,,99.84,,,,,,,27.04,100.88,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,inpatient,,,377.00000,81.43000,Coventry,Commercial,,361.92,,,,,,,339.30,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,outpatient,,,377.00000,81.43000,Coventry,Commercial,,361.92,,,,,,,98.02,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,inpatient,,,532.00000,114.91000,Coventry,Commercial,,510.72,,,,,,,478.80,516.04,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,outpatient,,,532.00000,114.91000,Coventry,Commercial,,510.72,,,,,,,138.32,516.04,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,inpatient,,,521.00000,112.54000,Coventry,Commercial,,500.16,,,,,,,468.90,505.37,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,outpatient,,,521.00000,112.54000,Coventry,Commercial,,500.16,,,,,,,135.46,505.37,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,inpatient,,,451.00000,97.42000,Coventry,Commercial,,432.96,,,,,,,405.90,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,outpatient,,,451.00000,97.42000,Coventry,Commercial,,432.96,,,,,,,117.26,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,inpatient,,,1148.00000,247.97000,Coventry,Commercial,,1102.08,,,,,,,1033.20,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,outpatient,,,1148.00000,247.97000,Coventry,Commercial,,1102.08,,,,,,,298.48,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,inpatient,,,350.00000,75.60000,Coventry,Commercial,,336.00,,,,,,,315.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,outpatient,,,350.00000,75.60000,Coventry,Commercial,,336.00,,,,,,,91.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,inpatient,,,423.00000,91.37000,Coventry,Commercial,,406.08,,,,,,,380.70,410.31,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,outpatient,,,423.00000,91.37000,Coventry,Commercial,,406.08,,,,,,,109.98,410.31,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,inpatient,,,751.00000,162.22000,Coventry,Commercial,,720.96,,,,,,,675.90,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Coventry,Commercial,,720.96,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,inpatient,,,751.00000,162.22000,Coventry,Commercial,,720.96,,,,,,,675.90,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Coventry,Commercial,,720.96,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,inpatient,,,119.00000,25.70000,Coventry,Commercial,,114.24,,,,,,,107.10,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,outpatient,,,119.00000,25.70000,Coventry,Commercial,,114.24,,,,,,,30.94,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,inpatient,,,126.00000,27.22000,Coventry,Commercial,,120.96,,,,,,,113.40,122.22,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,outpatient,,,126.00000,27.22000,Coventry,Commercial,,120.96,,,,,,,32.76,122.22,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,inpatient,,,110.00000,23.76000,Coventry,Commercial,,105.60,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Coventry,Commercial,,105.60,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,inpatient,,,110.00000,23.76000,Coventry,Commercial,,105.60,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Coventry,Commercial,,105.60,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,inpatient,,,79.00000,17.06000,Coventry,Commercial,,75.84,,,,,,,71.10,76.63,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,outpatient,,,79.00000,17.06000,Coventry,Commercial,,75.84,,,,,,,20.54,76.63,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,inpatient,,,110.00000,23.76000,Coventry,Commercial,,105.60,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Coventry,Commercial,,105.60,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,inpatient,,,110.00000,23.76000,Coventry,Commercial,,105.60,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Coventry,Commercial,,105.60,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,inpatient,,,79.00000,17.06000,Coventry,Commercial,,75.84,,,,,,,71.10,76.63,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,outpatient,,,79.00000,17.06000,Coventry,Commercial,,75.84,,,,,,,20.54,76.63,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,inpatient,,,335.00000,72.36000,Coventry,Commercial,,321.60,,,,,,,301.50,324.95,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,outpatient,,,335.00000,72.36000,Coventry,Commercial,,321.60,,,,,,,87.10,324.95,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,inpatient,,,154.00000,33.26000,Coventry,Commercial,,147.84,,,,,,,138.60,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Coventry,Commercial,,147.84,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,inpatient,,,154.00000,33.26000,Coventry,Commercial,,147.84,,,,,,,138.60,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Coventry,Commercial,,147.84,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,inpatient,,,128.00000,27.65000,Coventry,Commercial,,122.88,,,,,,,115.20,124.16,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,outpatient,,,128.00000,27.65000,Coventry,Commercial,,122.88,,,,,,,33.28,124.16,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,inpatient,,,65.00000,14.04000,Coventry,Commercial,,62.40,,,,,,,58.50,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,outpatient,,,65.00000,14.04000,Coventry,Commercial,,62.40,,,,,,,16.90,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,inpatient,,,272.00000,58.75000,Coventry,Commercial,,261.12,,,,,,,244.80,263.84,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,outpatient,,,272.00000,58.75000,Coventry,Commercial,,261.12,,,,,,,70.72,263.84,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,inpatient,,,26.00000,11.44000,Coventry,Commercial,,24.96,,,,,,,23.40,25.22,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,outpatient,,,26.00000,11.44000,Coventry,Commercial,,24.96,,,,,,,6.76,25.22,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,inpatient,,,359.00000,157.96000,Coventry,Commercial,,344.64,,,,,,,323.10,348.23,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,outpatient,,,359.00000,157.96000,Coventry,Commercial,,344.64,,,,,,,93.34,348.23,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,inpatient,,,189.00000,83.16000,Coventry,Commercial,,181.44,,,,,,,170.10,183.33,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,outpatient,,,189.00000,83.16000,Coventry,Commercial,,181.44,,,,,,,49.14,183.33,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,inpatient,,,359.00000,157.96000,Coventry,Commercial,,344.64,,,,,,,323.10,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,outpatient,,,359.00000,157.96000,Coventry,Commercial,,344.64,,,,,,,93.34,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,inpatient,,,137.00000,60.28000,Coventry,Commercial,,131.52,,,,,,,123.30,132.89,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,outpatient,,,137.00000,60.28000,Coventry,Commercial,,131.52,,,,,,,35.62,132.89,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,inpatient,,,1665.00000,732.60000,Coventry,Commercial,,1598.40,,,,,,,1498.50,1615.05,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,outpatient,,,1665.00000,732.60000,Coventry,Commercial,,1598.40,,,,,,,432.90,1615.05,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,inpatient,,,751.00000,330.44000,Coventry,Commercial,,720.96,,,,,,,675.90,728.47,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,outpatient,,,751.00000,330.44000,Coventry,Commercial,,720.96,,,,,,,195.26,728.47,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,inpatient,,,374.00000,164.56000,Coventry,Commercial,,359.04,,,,,,,336.60,362.78,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,outpatient,,,374.00000,164.56000,Coventry,Commercial,,359.04,,,,,,,97.24,362.78,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,inpatient,,,553.00000,243.32000,Coventry,Commercial,,530.88,,,,,,,497.70,536.41,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,outpatient,,,553.00000,243.32000,Coventry,Commercial,,530.88,,,,,,,143.78,536.41,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,inpatient,,,359.00000,157.96000,Coventry,Commercial,,344.64,,,,,,,323.10,348.23,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,outpatient,,,359.00000,157.96000,Coventry,Commercial,,344.64,,,,,,,93.34,348.23,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,inpatient,,,62.00000,27.28000,Coventry,Commercial,,59.52,,,,,,,55.80,60.14,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,outpatient,,,62.00000,27.28000,Coventry,Commercial,,59.52,,,,,,,16.12,60.14,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,inpatient,,,79.00000,34.76000,Coventry,Commercial,,75.84,,,,,,,71.10,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,outpatient,,,79.00000,34.76000,Coventry,Commercial,,75.84,,,,,,,20.54,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,inpatient,,,110.00000,48.40000,Coventry,Commercial,,105.60,,,,,,,99.00,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,outpatient,,,110.00000,48.40000,Coventry,Commercial,,105.60,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,inpatient,,,110.00000,48.40000,Coventry,Commercial,,105.60,,,,,,,99.00,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,outpatient,,,110.00000,48.40000,Coventry,Commercial,,105.60,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,inpatient,,,751.00000,330.44000,Coventry,Commercial,,720.96,,,,,,,675.90,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,outpatient,,,751.00000,330.44000,Coventry,Commercial,,720.96,,,,,,,195.26,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,inpatient,,,1665.00000,732.60000,Coventry,Commercial,,1598.40,,,,,,,1498.50,1615.05,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,outpatient,,,1665.00000,732.60000,Coventry,Commercial,,1598.40,,,,,,,432.90,1615.05,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,inpatient,,,110.00000,48.40000,Coventry,Commercial,,105.60,,,,,,,99.00,106.70,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,outpatient,,,110.00000,48.40000,Coventry,Commercial,,105.60,,,,,,,28.60,106.70,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,inpatient,,,281.00000,123.64000,Coventry,Commercial,,269.76,,,,,,,252.90,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Coventry,Commercial,,269.76,,,,,,,73.06,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,inpatient,,,281.00000,123.64000,Coventry,Commercial,,269.76,,,,,,,252.90,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Coventry,Commercial,,269.76,,,,,,,73.06,272.57,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,inpatient,,,451.00000,341.41000,Coventry,Commercial,,432.96,,,,,,,405.90,437.47,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,outpatient,,,451.00000,341.41000,Coventry,Commercial,,432.96,,,,,,,117.26,437.47,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,inpatient,,,300.00000,145.80000,Coventry,Commercial,,288.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,outpatient,,,300.00000,145.80000,Coventry,Commercial,,288.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,inpatient,,,2278.00000,1107.11000,Coventry,Commercial,,2186.88,,,,,,,2050.20,2209.66,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,outpatient,,,2278.00000,1107.11000,Coventry,Commercial,,2186.88,,,,,,,592.28,2209.66,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,inpatient,,,3912.00000,1901.23000,Coventry,Commercial,,3755.52,,,,,,,3520.80,3794.64,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,outpatient,,,3912.00000,1901.23000,Coventry,Commercial,,3755.52,,,,,,,1017.12,3794.64,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,inpatient,,,900.00000,437.40000,Coventry,Commercial,,864.00,,,,,,,810.00,873.00,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,outpatient,,,900.00000,437.40000,Coventry,Commercial,,864.00,,,,,,,234.00,873.00,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,inpatient,,,365.00000,177.39000,Coventry,Commercial,,350.40,,,,,,,328.50,354.05,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,outpatient,,,365.00000,177.39000,Coventry,Commercial,,350.40,,,,,,,94.90,354.05,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,inpatient,,,989.00000,480.65000,Coventry,Commercial,,949.44,,,,,,,890.10,959.33,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,outpatient,,,989.00000,480.65000,Coventry,Commercial,,949.44,,,,,,,257.14,959.33,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Coventry,Commercial,,472.32,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Coventry,Commercial,,472.32,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,inpatient,,,435.00000,211.41000,Coventry,Commercial,,417.60,,,,,,,391.50,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Coventry,Commercial,,417.60,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,inpatient,,,435.00000,211.41000,Coventry,Commercial,,417.60,,,,,,,391.50,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Coventry,Commercial,,417.60,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,inpatient,,,644.00000,312.98000,Coventry,Commercial,,618.24,,,,,,,579.60,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,outpatient,,,644.00000,312.98000,Coventry,Commercial,,618.24,,,,,,,167.44,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Coventry,Commercial,,472.32,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Coventry,Commercial,,472.32,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Coventry,Commercial,,472.32,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Coventry,Commercial,,472.32,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,inpatient,,,527.00000,256.12000,Coventry,Commercial,,505.92,,,,,,,474.30,511.19,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,outpatient,,,527.00000,256.12000,Coventry,Commercial,,505.92,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,inpatient,,,1404.00000,682.34000,Coventry,Commercial,,1347.84,,,,,,,1263.60,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,outpatient,,,1404.00000,682.34000,Coventry,Commercial,,1347.84,,,,,,,365.04,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,inpatient,,,5475.00000,2660.85000,Coventry,Commercial,,5256.00,,,,,,,4927.50,5310.75,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,outpatient,,,5475.00000,2660.85000,Coventry,Commercial,,5256.00,,,,,,,1423.50,5310.75,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,inpatient,,,726.00000,352.84000,Coventry,Commercial,,696.96,,,,,,,653.40,704.22,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,outpatient,,,726.00000,352.84000,Coventry,Commercial,,696.96,,,,,,,188.76,704.22,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,inpatient,,,507.00000,246.40000,Coventry,Commercial,,486.72,,,,,,,456.30,491.79,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,outpatient,,,507.00000,246.40000,Coventry,Commercial,,486.72,,,,,,,131.82,491.79,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,inpatient,,,1670.00000,811.62000,Coventry,Commercial,,1603.20,,,,,,,1503.00,1619.90,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,outpatient,,,1670.00000,811.62000,Coventry,Commercial,,1603.20,,,,,,,434.20,1619.90,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,inpatient,,,1139.00000,553.55000,Coventry,Commercial,,1093.44,,,,,,,1025.10,1104.83,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,outpatient,,,1139.00000,553.55000,Coventry,Commercial,,1093.44,,,,,,,296.14,1104.83,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,inpatient,,,875.00000,425.25000,Coventry,Commercial,,840.00,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,outpatient,,,875.00000,425.25000,Coventry,Commercial,,840.00,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,inpatient,,,525.00000,255.15000,Coventry,Commercial,,504.00,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,outpatient,,,525.00000,255.15000,Coventry,Commercial,,504.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,inpatient,,,1353.00000,657.56000,Coventry,Commercial,,1298.88,,,,,,,1217.70,1312.41,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,outpatient,,,1353.00000,657.56000,Coventry,Commercial,,1298.88,,,,,,,351.78,1312.41,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,inpatient,,,525.00000,255.15000,Coventry,Commercial,,504.00,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,outpatient,,,525.00000,255.15000,Coventry,Commercial,,504.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,inpatient,,,525.00000,255.15000,Coventry,Commercial,,504.00,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,outpatient,,,525.00000,255.15000,Coventry,Commercial,,504.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,inpatient,,,825.00000,400.95000,Coventry,Commercial,,792.00,,,,,,,742.50,800.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,outpatient,,,825.00000,400.95000,Coventry,Commercial,,792.00,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,inpatient,,,525.00000,255.15000,Coventry,Commercial,,504.00,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Coventry,Commercial,,504.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,inpatient,,,525.00000,255.15000,Coventry,Commercial,,504.00,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Coventry,Commercial,,504.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,inpatient,,,974.00000,473.36000,Coventry,Commercial,,935.04,,,,,,,876.60,944.78,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,outpatient,,,974.00000,473.36000,Coventry,Commercial,,935.04,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,inpatient,,,198.00000,96.23000,Coventry,Commercial,,190.08,,,,,,,178.20,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Coventry,Commercial,,190.08,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,inpatient,,,198.00000,96.23000,Coventry,Commercial,,190.08,,,,,,,178.20,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Coventry,Commercial,,190.08,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,inpatient,,,221.00000,107.41000,Coventry,Commercial,,212.16,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Coventry,Commercial,,212.16,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,inpatient,,,221.00000,107.41000,Coventry,Commercial,,212.16,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Coventry,Commercial,,212.16,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,inpatient,,,497.00000,241.54000,Coventry,Commercial,,477.12,,,,,,,447.30,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,outpatient,,,497.00000,241.54000,Coventry,Commercial,,477.12,,,,,,,129.22,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,inpatient,,,2340.00000,1137.24000,Coventry,Commercial,,2246.40,,,,,,,2106.00,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,outpatient,,,2340.00000,1137.24000,Coventry,Commercial,,2246.40,,,,,,,608.40,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,inpatient,,,249.00000,121.01000,Coventry,Commercial,,239.04,,,,,,,224.10,241.53,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,outpatient,,,249.00000,121.01000,Coventry,Commercial,,239.04,,,,,,,64.74,241.53,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,inpatient,,,135.00000,65.61000,Coventry,Commercial,,129.60,,,,,,,121.50,130.95,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,outpatient,,,135.00000,65.61000,Coventry,Commercial,,129.60,,,,,,,35.10,130.95,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,inpatient,,,172.00000,83.59000,Coventry,Commercial,,165.12,,,,,,,154.80,166.84,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,outpatient,,,172.00000,83.59000,Coventry,Commercial,,165.12,,,,,,,44.72,166.84,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,inpatient,,,307.00000,149.20000,Coventry,Commercial,,294.72,,,,,,,276.30,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,outpatient,,,307.00000,149.20000,Coventry,Commercial,,294.72,,,,,,,79.82,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,inpatient,,,1800.00000,874.80000,Coventry,Commercial,,1728.00,,,,,,,1620.00,1746.00,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,outpatient,,,1800.00000,874.80000,Coventry,Commercial,,1728.00,,,,,,,468.00,1746.00,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,inpatient,,,974.00000,473.36000,Coventry,Commercial,,935.04,,,,,,,876.60,944.78,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,outpatient,,,974.00000,473.36000,Coventry,Commercial,,935.04,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,inpatient,,,197.00000,95.74000,Coventry,Commercial,,189.12,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Coventry,Commercial,,189.12,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,inpatient,,,197.00000,95.74000,Coventry,Commercial,,189.12,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Coventry,Commercial,,189.12,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,inpatient,,,411.00000,199.75000,Coventry,Commercial,,394.56,,,,,,,369.90,398.67,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,outpatient,,,411.00000,199.75000,Coventry,Commercial,,394.56,,,,,,,106.86,398.67,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,inpatient,,,221.00000,107.41000,Coventry,Commercial,,212.16,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,outpatient,,,221.00000,107.41000,Coventry,Commercial,,212.16,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,inpatient,,,884.00000,429.62000,Coventry,Commercial,,848.64,,,,,,,795.60,857.48,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,outpatient,,,884.00000,429.62000,Coventry,Commercial,,848.64,,,,,,,229.84,857.48,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,inpatient,,,594.00000,288.68000,Coventry,Commercial,,570.24,,,,,,,534.60,576.18,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,outpatient,,,594.00000,288.68000,Coventry,Commercial,,570.24,,,,,,,154.44,576.18,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,inpatient,,,519.00000,252.23000,Coventry,Commercial,,498.24,,,,,,,467.10,503.43,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,outpatient,,,519.00000,252.23000,Coventry,Commercial,,498.24,,,,,,,134.94,503.43,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,inpatient,,,1046.00000,508.36000,Coventry,Commercial,,1004.16,,,,,,,941.40,1014.62,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,outpatient,,,1046.00000,508.36000,Coventry,Commercial,,1004.16,,,,,,,271.96,1014.62,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,inpatient,,,556.00000,270.22000,Coventry,Commercial,,533.76,,,,,,,500.40,539.32,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,outpatient,,,556.00000,270.22000,Coventry,Commercial,,533.76,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,inpatient,,,275.00000,133.65000,Coventry,Commercial,,264.00,,,,,,,247.50,266.75,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,outpatient,,,275.00000,133.65000,Coventry,Commercial,,264.00,,,,,,,71.50,266.75,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,inpatient,,,580.00000,281.88000,Coventry,Commercial,,556.80,,,,,,,522.00,562.60,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,outpatient,,,580.00000,281.88000,Coventry,Commercial,,556.80,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,inpatient,,,580.00000,281.88000,Coventry,Commercial,,556.80,,,,,,,522.00,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,outpatient,,,580.00000,281.88000,Coventry,Commercial,,556.80,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,inpatient,,,3480.00000,1691.28000,Coventry,Commercial,,3340.80,,,,,,,3132.00,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Coventry,Commercial,,3340.80,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,inpatient,,,3480.00000,1691.28000,Coventry,Commercial,,3340.80,,,,,,,3132.00,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Coventry,Commercial,,3340.80,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,inpatient,,,700.00000,340.20000,Coventry,Commercial,,672.00,,,,,,,630.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,outpatient,,,700.00000,340.20000,Coventry,Commercial,,672.00,,,,,,,182.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,inpatient,,,1427.00000,693.52000,Coventry,Commercial,,1369.92,,,,,,,1284.30,1384.19,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,outpatient,,,1427.00000,693.52000,Coventry,Commercial,,1369.92,,,,,,,371.02,1384.19,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,inpatient,,,614.00000,298.40000,Coventry,Commercial,,589.44,,,,,,,552.60,595.58,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,outpatient,,,614.00000,298.40000,Coventry,Commercial,,589.44,,,,,,,159.64,595.58,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,inpatient,,,2027.00000,985.12000,Coventry,Commercial,,1945.92,,,,,,,1824.30,1966.19,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,outpatient,,,2027.00000,985.12000,Coventry,Commercial,,1945.92,,,,,,,527.02,1966.19,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,inpatient,,,556.00000,270.22000,Coventry,Commercial,,533.76,,,,,,,500.40,539.32,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,outpatient,,,556.00000,270.22000,Coventry,Commercial,,533.76,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,inpatient,,,1146.00000,556.96000,Coventry,Commercial,,1100.16,,,,,,,1031.40,1111.62,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,outpatient,,,1146.00000,556.96000,Coventry,Commercial,,1100.16,,,,,,,297.96,1111.62,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,inpatient,,,197.00000,95.74000,Coventry,Commercial,,189.12,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Coventry,Commercial,,189.12,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,inpatient,,,197.00000,95.74000,Coventry,Commercial,,189.12,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Coventry,Commercial,,189.12,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,inpatient,,,527.00000,256.12000,Coventry,Commercial,,505.92,,,,,,,474.30,511.19,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,outpatient,,,527.00000,256.12000,Coventry,Commercial,,505.92,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,inpatient,,,740.00000,359.64000,Coventry,Commercial,,710.40,,,,,,,666.00,717.80,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,outpatient,,,740.00000,359.64000,Coventry,Commercial,,710.40,,,,,,,192.40,717.80,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,inpatient,,,875.00000,425.25000,Coventry,Commercial,,840.00,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Coventry,Commercial,,840.00,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,inpatient,,,875.00000,425.25000,Coventry,Commercial,,840.00,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Coventry,Commercial,,840.00,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,inpatient,,,1399.00000,679.91000,Coventry,Commercial,,1343.04,,,,,,,1259.10,1357.03,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,outpatient,,,1399.00000,679.91000,Coventry,Commercial,,1343.04,,,,,,,363.74,1357.03,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,inpatient,,,51.00000,24.79000,Coventry,Commercial,,48.96,,,,,,,45.90,49.47,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,outpatient,,,51.00000,24.79000,Coventry,Commercial,,48.96,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,inpatient,,,825.00000,400.95000,Coventry,Commercial,,792.00,,,,,,,742.50,800.25,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,outpatient,,,825.00000,400.95000,Coventry,Commercial,,792.00,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,inpatient,,,576.00000,279.94000,Coventry,Commercial,,552.96,,,,,,,518.40,558.72,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,outpatient,,,576.00000,279.94000,Coventry,Commercial,,552.96,,,,,,,149.76,558.72,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,inpatient,,,224.00000,108.86000,Coventry,Commercial,,215.04,,,,,,,201.60,217.28,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,outpatient,,,224.00000,108.86000,Coventry,Commercial,,215.04,,,,,,,58.24,217.28,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,inpatient,,,346.00000,168.16000,Coventry,Commercial,,332.16,,,,,,,311.40,335.62,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,outpatient,,,346.00000,168.16000,Coventry,Commercial,,332.16,,,,,,,89.96,335.62,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,inpatient,,,525.00000,255.15000,Coventry,Commercial,,504.00,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,outpatient,,,525.00000,255.15000,Coventry,Commercial,,504.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,inpatient,,,525.00000,255.15000,Coventry,Commercial,,504.00,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,outpatient,,,525.00000,255.15000,Coventry,Commercial,,504.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,inpatient,,,525.00000,255.15000,Coventry,Commercial,,504.00,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Coventry,Commercial,,504.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,inpatient,,,525.00000,255.15000,Coventry,Commercial,,504.00,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Coventry,Commercial,,504.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,inpatient,,,627.00000,304.72000,Coventry,Commercial,,601.92,,,,,,,564.30,608.19,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,outpatient,,,627.00000,304.72000,Coventry,Commercial,,601.92,,,,,,,163.02,608.19,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,inpatient,,,605.00000,294.03000,Coventry,Commercial,,580.80,,,,,,,544.50,586.85,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,outpatient,,,605.00000,294.03000,Coventry,Commercial,,580.80,,,,,,,157.30,586.85,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,inpatient,,,510.00000,247.86000,Coventry,Commercial,,489.60,,,,,,,459.00,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,outpatient,,,510.00000,247.86000,Coventry,Commercial,,489.60,,,,,,,132.60,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,inpatient,,,223.00000,108.38000,Coventry,Commercial,,214.08,,,,,,,200.70,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,outpatient,,,223.00000,108.38000,Coventry,Commercial,,214.08,,,,,,,57.98,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,inpatient,,,1211.00000,588.55000,Coventry,Commercial,,1162.56,,,,,,,1089.90,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,outpatient,,,1211.00000,588.55000,Coventry,Commercial,,1162.56,,,,,,,314.86,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,inpatient,,,383.00000,186.14000,Coventry,Commercial,,367.68,,,,,,,344.70,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,outpatient,,,383.00000,186.14000,Coventry,Commercial,,367.68,,,,,,,99.58,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,inpatient,,,1214.00000,590.00000,Coventry,Commercial,,1165.44,,,,,,,1092.60,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,outpatient,,,1214.00000,590.00000,Coventry,Commercial,,1165.44,,,,,,,315.64,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,inpatient,,,328.00000,159.41000,Coventry,Commercial,,314.88,,,,,,,295.20,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,outpatient,,,328.00000,159.41000,Coventry,Commercial,,314.88,,,,,,,85.28,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,inpatient,,,372.00000,180.79000,Coventry,Commercial,,357.12,,,,,,,334.80,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,outpatient,,,372.00000,180.79000,Coventry,Commercial,,357.12,,,,,,,96.72,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,inpatient,,,285.00000,138.51000,Coventry,Commercial,,273.60,,,,,,,256.50,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,outpatient,,,285.00000,138.51000,Coventry,Commercial,,273.60,,,,,,,74.10,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,inpatient,,,367.00000,178.36000,Coventry,Commercial,,352.32,,,,,,,330.30,355.99,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,outpatient,,,367.00000,178.36000,Coventry,Commercial,,352.32,,,,,,,95.42,355.99,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,inpatient,,,702.00000,341.17000,Coventry,Commercial,,673.92,,,,,,,631.80,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Coventry,Commercial,,673.92,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,inpatient,,,702.00000,341.17000,Coventry,Commercial,,673.92,,,,,,,631.80,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Coventry,Commercial,,673.92,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,inpatient,,,265.00000,128.79000,Coventry,Commercial,,254.40,,,,,,,238.50,257.05,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,outpatient,,,265.00000,128.79000,Coventry,Commercial,,254.40,,,,,,,68.90,257.05,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,inpatient,,,2279.00000,1107.59000,Coventry,Commercial,,2187.84,,,,,,,2051.10,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2279.00000,1107.59000,Coventry,Commercial,,2187.84,,,,,,,592.54,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,inpatient,,,2395.00000,1163.97000,Coventry,Commercial,,2299.20,,,,,,,2155.50,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2395.00000,1163.97000,Coventry,Commercial,,2299.20,,,,,,,622.70,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,inpatient,,,8759.00000,4256.87000,Coventry,Commercial,,8408.64,,,,,,,7883.10,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Coventry,Commercial,,8408.64,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,inpatient,,,8759.00000,4256.87000,Coventry,Commercial,,8408.64,,,,,,,7883.10,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Coventry,Commercial,,8408.64,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,inpatient,,,2752.00000,1337.47000,Coventry,Commercial,,2641.92,,,,,,,2476.80,2669.44,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,outpatient,,,2752.00000,1337.47000,Coventry,Commercial,,2641.92,,,,,,,715.52,2669.44,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,inpatient,,,217.00000,105.46000,Coventry,Commercial,,208.32,,,,,,,195.30,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Coventry,Commercial,,208.32,,,,,,,56.42,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,inpatient,,,217.00000,105.46000,Coventry,Commercial,,208.32,,,,,,,195.30,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Coventry,Commercial,,208.32,,,,,,,56.42,210.49,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,inpatient,,,292.00000,141.91000,Coventry,Commercial,,280.32,,,,,,,262.80,283.24,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,outpatient,,,292.00000,141.91000,Coventry,Commercial,,280.32,,,,,,,75.92,283.24,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Coventry,Commercial,,394.56,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Coventry,Commercial,,394.56,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Coventry,Commercial,,394.56,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Coventry,Commercial,,394.56,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Coventry,Commercial,,394.56,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Coventry,Commercial,,394.56,,,,,,,106.86,398.67,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,inpatient,,,2275.00000,1105.65000,Coventry,Commercial,,2184.00,,,,,,,2047.50,2206.75,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,outpatient,,,2275.00000,1105.65000,Coventry,Commercial,,2184.00,,,,,,,591.50,2206.75,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,inpatient,,,192.00000,93.31000,Coventry,Commercial,,184.32,,,,,,,172.80,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,outpatient,,,192.00000,93.31000,Coventry,Commercial,,184.32,,,,,,,49.92,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,inpatient,,,451.00000,219.19000,Coventry,Commercial,,432.96,,,,,,,405.90,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,outpatient,,,451.00000,219.19000,Coventry,Commercial,,432.96,,,,,,,117.26,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,inpatient,,,617.00000,299.86000,Coventry,Commercial,,592.32,,,,,,,555.30,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,outpatient,,,617.00000,299.86000,Coventry,Commercial,,592.32,,,,,,,160.42,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,inpatient,,,825.00000,400.95000,Coventry,Commercial,,792.00,,,,,,,742.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,outpatient,,,825.00000,400.95000,Coventry,Commercial,,792.00,,,,,,,214.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,inpatient,,,905.00000,439.83000,Coventry,Commercial,,868.80,,,,,,,814.50,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,outpatient,,,905.00000,439.83000,Coventry,Commercial,,868.80,,,,,,,235.30,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,inpatient,,,849.00000,412.61000,Coventry,Commercial,,815.04,,,,,,,764.10,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,outpatient,,,849.00000,412.61000,Coventry,Commercial,,815.04,,,,,,,220.74,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,inpatient,,,2539.00000,1233.95000,Coventry,Commercial,,2437.44,,,,,,,2285.10,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,outpatient,,,2539.00000,1233.95000,Coventry,Commercial,,2437.44,,,,,,,660.14,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,inpatient,,,6000.00000,2916.00000,Coventry,Commercial,,5760.00,,,,,,,5400.00,5820.00,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,outpatient,,,6000.00000,2916.00000,Coventry,Commercial,,5760.00,,,,,,,1560.00,5820.00,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,inpatient,,,8260.00000,4014.36000,Coventry,Commercial,,7929.60,,,,,,,7434.00,8012.20,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,outpatient,,,8260.00000,4014.36000,Coventry,Commercial,,7929.60,,,,,,,2147.60,8012.20,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,inpatient,,,202.00000,88.88000,Coventry,Commercial,,193.92,,,,,,,181.80,195.94,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,outpatient,,,202.00000,88.88000,Coventry,Commercial,,193.92,,,,,,,52.52,195.94,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,inpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,59.40,64.02,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,outpatient,,,66.00000,31.81000,Coventry,Commercial,,63.36,,,,,,,17.16,64.02,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,inpatient,,,295.00000,142.19000,Coventry,Commercial,,283.20,,,,,,,265.50,286.15,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,outpatient,,,295.00000,142.19000,Coventry,Commercial,,283.20,,,,,,,76.70,286.15,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,89.00000,26.79000,Coventry,Commercial,,85.44,,,,,,,80.10,86.33,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,89.00000,26.79000,Coventry,Commercial,,85.44,,,,,,,23.14,86.33,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,inpatient,,,93.00000,27.99000,Coventry,Commercial,,89.28,,,,,,,83.70,90.21,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Coventry,Commercial,,89.28,,,,,,,24.18,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,93.00000,27.99000,Coventry,Commercial,,89.28,,,,,,,83.70,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Coventry,Commercial,,89.28,,,,,,,24.18,90.21,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Coventry,Commercial,,1800.00,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Coventry,Commercial,,1800.00,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Coventry,Commercial,,1800.00,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Coventry,Commercial,,1800.00,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1752.00000,527.35000,Coventry,Commercial,,1681.92,,,,,,,1576.80,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Coventry,Commercial,,1681.92,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1752.00000,527.35000,Coventry,Commercial,,1681.92,,,,,,,1576.80,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Coventry,Commercial,,1681.92,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,731.00000,220.03000,Coventry,Commercial,,701.76,,,,,,,657.90,709.07,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,731.00000,220.03000,Coventry,Commercial,,701.76,,,,,,,190.06,709.07,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,787.00000,236.89000,Coventry,Commercial,,755.52,,,,,,,708.30,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,787.00000,236.89000,Coventry,Commercial,,755.52,,,,,,,204.62,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,2042.00000,614.64000,Coventry,Commercial,,1960.32,,,,,,,1837.80,1980.74,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,2042.00000,614.64000,Coventry,Commercial,,1960.32,,,,,,,530.92,1980.74,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Coventry,Commercial,,1800.00,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Coventry,Commercial,,1800.00,,,,,,,487.50,1818.75,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,714.00000,214.91000,Coventry,Commercial,,685.44,,,,,,,642.60,692.58,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,714.00000,214.91000,Coventry,Commercial,,685.44,,,,,,,185.64,692.58,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,294.00000,88.49000,Coventry,Commercial,,282.24,,,,,,,264.60,285.18,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,294.00000,88.49000,Coventry,Commercial,,282.24,,,,,,,76.44,285.18,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,inpatient,,,350.00000,105.35000,Coventry,Commercial,,336.00,,,,,,,315.00,339.50,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,350.00000,105.35000,Coventry,Commercial,,336.00,,,,,,,91.00,339.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,inpatient,,,1350.00000,780.30000,Coventry,Commercial,,1296.00,,,,,,,1215.00,1309.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,outpatient,,,1350.00000,780.30000,Coventry,Commercial,,1296.00,,,,,,,351.00,1309.50,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,inpatient,,,3680.00000,2127.04000,Coventry,Commercial,,3532.80,,,,,,,3312.00,3569.60,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,outpatient,,,3680.00000,2127.04000,Coventry,Commercial,,3532.80,,,,,,,956.80,3569.60,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,inpatient,,,1600.00000,924.80000,Coventry,Commercial,,1536.00,,,,,,,1440.00,1552.00,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,outpatient,,,1600.00000,924.80000,Coventry,Commercial,,1536.00,,,,,,,416.00,1552.00,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,inpatient,,,4680.00000,2705.04000,Coventry,Commercial,,4492.80,,,,,,,4212.00,4539.60,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,outpatient,,,4680.00000,2705.04000,Coventry,Commercial,,4492.80,,,,,,,1216.80,4539.60,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,inpatient,,,2100.00000,1213.80000,Coventry,Commercial,,2016.00,,,,,,,1890.00,2037.00,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,outpatient,,,2100.00000,1213.80000,Coventry,Commercial,,2016.00,,,,,,,546.00,2037.00,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,inpatient,,,5680.00000,3283.04000,Coventry,Commercial,,5452.80,,,,,,,5112.00,5509.60,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,outpatient,,,5680.00000,3283.04000,Coventry,Commercial,,5452.80,,,,,,,1476.80,5509.60,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,inpatient,,,2420.00000,1398.76000,Coventry,Commercial,,2323.20,,,,,,,2178.00,2347.40,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,outpatient,,,2420.00000,1398.76000,Coventry,Commercial,,2323.20,,,,,,,629.20,2347.40,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,inpatient,,,6415.00000,3707.87000,Coventry,Commercial,,6158.40,,,,,,,5773.50,6222.55,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,outpatient,,,6415.00000,3707.87000,Coventry,Commercial,,6158.40,,,,,,,1667.90,6222.55,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,inpatient,,,2920.00000,1687.76000,Coventry,Commercial,,2803.20,,,,,,,2628.00,2832.40,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,outpatient,,,2920.00000,1687.76000,Coventry,Commercial,,2803.20,,,,,,,759.20,2832.40,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,inpatient,,,8915.00000,5152.87000,Coventry,Commercial,,8558.40,,,,,,,8023.50,8647.55,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,outpatient,,,8915.00000,5152.87000,Coventry,Commercial,,8558.40,,,,,,,2317.90,8647.55,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,inpatient,,,3420.00000,1976.76000,Coventry,Commercial,,3283.20,,,,,,,3078.00,3317.40,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,outpatient,,,3420.00000,1976.76000,Coventry,Commercial,,3283.20,,,,,,,889.20,3317.40,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,inpatient,,,11415.00000,6597.87000,Coventry,Commercial,,10958.40,,,,,,,10273.50,11072.55,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,outpatient,,,11415.00000,6597.87000,Coventry,Commercial,,10958.40,,,,,,,2967.90,11072.55,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,inpatient,,,142.00000,154.35000,Coventry,Commercial,,136.32,,,,,,,127.80,137.74,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,outpatient,,,142.00000,154.35000,Coventry,Commercial,,136.32,,,,,,,36.92,137.74,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,inpatient,,,340.00000,228.82000,Coventry,Commercial,,326.40,,,,,,,306.00,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Coventry,Commercial,,326.40,,,,,,,88.40,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,inpatient,,,670.00000,450.91000,Coventry,Commercial,,643.20,,,,,,,603.00,649.90,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Coventry,Commercial,,643.20,,,,,,,174.20,649.90,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,inpatient,,,390.00000,262.47000,Coventry,Commercial,,374.40,,,,,,,351.00,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,outpatient,,,390.00000,262.47000,Coventry,Commercial,,374.40,,,,,,,101.40,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,inpatient,,,1170.00000,787.41000,Coventry,Commercial,,1123.20,,,,,,,1053.00,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,outpatient,,,1170.00000,787.41000,Coventry,Commercial,,1123.20,,,,,,,304.20,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,inpatient,,,440.00000,296.12000,Coventry,Commercial,,422.40,,,,,,,396.00,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,outpatient,,,440.00000,296.12000,Coventry,Commercial,,422.40,,,,,,,114.40,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,inpatient,,,1670.00000,1123.91000,Coventry,Commercial,,1603.20,,,,,,,1503.00,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,outpatient,,,1670.00000,1123.91000,Coventry,Commercial,,1603.20,,,,,,,434.20,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,inpatient,,,640.00000,430.72000,Coventry,Commercial,,614.40,,,,,,,576.00,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,outpatient,,,640.00000,430.72000,Coventry,Commercial,,614.40,,,,,,,166.40,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,inpatient,,,2170.00000,1460.41000,Coventry,Commercial,,2083.20,,,,,,,1953.00,2104.90,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,outpatient,,,2170.00000,1460.41000,Coventry,Commercial,,2083.20,,,,,,,564.20,2104.90,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,inpatient,,,17.00000,10.96000,Coventry,Commercial,,16.32,,,,,,,15.30,16.49,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,outpatient,,,17.00000,10.96000,Coventry,Commercial,,16.32,,,,,,,4.42,16.49,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,inpatient,,,535.00000,345.08000,Coventry,Commercial,,513.60,,,,,,,481.50,518.95,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,outpatient,,,535.00000,345.08000,Coventry,Commercial,,513.60,,,,,,,139.10,518.95,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,inpatient,,,23.00000,14.84000,Coventry,Commercial,,22.08,,,,,,,20.70,22.31,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,outpatient,,,23.00000,14.84000,Coventry,Commercial,,22.08,,,,,,,5.98,22.31,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,inpatient,,,635.00000,409.58000,Coventry,Commercial,,609.60,,,,,,,571.50,615.95,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,outpatient,,,635.00000,409.58000,Coventry,Commercial,,609.60,,,,,,,165.10,615.95,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,inpatient,,,30.00000,19.35000,Coventry,Commercial,,28.80,,,,,,,27.00,29.10,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,outpatient,,,30.00000,19.35000,Coventry,Commercial,,28.80,,,,,,,7.80,29.10,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,inpatient,,,735.00000,474.08000,Coventry,Commercial,,705.60,,,,,,,661.50,712.95,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,outpatient,,,735.00000,474.08000,Coventry,Commercial,,705.60,,,,,,,191.10,712.95,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,inpatient,,,33.00000,21.28000,Coventry,Commercial,,31.68,,,,,,,29.70,32.01,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,outpatient,,,33.00000,21.28000,Coventry,Commercial,,31.68,,,,,,,8.58,32.01,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,inpatient,,,835.00000,538.58000,Coventry,Commercial,,801.60,,,,,,,751.50,809.95,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,outpatient,,,835.00000,538.58000,Coventry,Commercial,,801.60,,,,,,,217.10,809.95,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,inpatient,,,140.00000,80.92000,Coventry,Commercial,,134.40,,,,,,,126.00,135.80,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,outpatient,,,140.00000,80.92000,Coventry,Commercial,,134.40,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,inpatient,,,275.00000,158.95000,Coventry,Commercial,,264.00,,,,,,,247.50,266.75,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,outpatient,,,275.00000,158.95000,Coventry,Commercial,,264.00,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,inpatient,,,295.00000,170.51000,Coventry,Commercial,,283.20,,,,,,,265.50,286.15,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,outpatient,,,295.00000,170.51000,Coventry,Commercial,,283.20,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,inpatient,,,590.00000,341.02000,Coventry,Commercial,,566.40,,,,,,,531.00,572.30,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,outpatient,,,590.00000,341.02000,Coventry,Commercial,,566.40,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,inpatient,,,690.00000,398.82000,Coventry,Commercial,,662.40,,,,,,,621.00,669.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,outpatient,,,690.00000,398.82000,Coventry,Commercial,,662.40,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,inpatient,,,1375.00000,794.75000,Coventry,Commercial,,1320.00,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,outpatient,,,1375.00000,794.75000,Coventry,Commercial,,1320.00,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,inpatient,,,950.00000,549.10000,Coventry,Commercial,,912.00,,,,,,,855.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,outpatient,,,950.00000,549.10000,Coventry,Commercial,,912.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,inpatient,,,1900.00000,1098.20000,Coventry,Commercial,,1824.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,outpatient,,,1900.00000,1098.20000,Coventry,Commercial,,1824.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,inpatient,,,140.00000,45.22000,Coventry,Commercial,,134.40,,,,,,,126.00,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,outpatient,,,140.00000,45.22000,Coventry,Commercial,,134.40,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,inpatient,,,275.00000,88.82000,Coventry,Commercial,,264.00,,,,,,,247.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,outpatient,,,275.00000,88.82000,Coventry,Commercial,,264.00,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,inpatient,,,295.00000,95.28000,Coventry,Commercial,,283.20,,,,,,,265.50,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,outpatient,,,295.00000,95.28000,Coventry,Commercial,,283.20,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,inpatient,,,590.00000,190.57000,Coventry,Commercial,,566.40,,,,,,,531.00,572.30,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,outpatient,,,590.00000,190.57000,Coventry,Commercial,,566.40,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,inpatient,,,690.00000,222.87000,Coventry,Commercial,,662.40,,,,,,,621.00,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,outpatient,,,690.00000,222.87000,Coventry,Commercial,,662.40,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,inpatient,,,1375.00000,444.12000,Coventry,Commercial,,1320.00,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,outpatient,,,1375.00000,444.12000,Coventry,Commercial,,1320.00,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,inpatient,,,950.00000,306.85000,Coventry,Commercial,,912.00,,,,,,,855.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,outpatient,,,950.00000,306.85000,Coventry,Commercial,,912.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,inpatient,,,1900.00000,613.70000,Coventry,Commercial,,1824.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,outpatient,,,1900.00000,613.70000,Coventry,Commercial,,1824.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,inpatient,,,340.00000,228.82000,Coventry,Commercial,,326.40,,,,,,,306.00,329.80,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Coventry,Commercial,,326.40,,,,,,,88.40,329.80,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,inpatient,,,670.00000,450.91000,Coventry,Commercial,,643.20,,,,,,,603.00,649.90,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Coventry,Commercial,,643.20,,,,,,,174.20,649.90,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Coventry,Commercial,,470.40,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Coventry,Commercial,,470.40,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,inpatient,,,490.00000,329.77000,Coventry,Commercial,,470.40,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Coventry,Commercial,,470.40,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Coventry,Commercial,,470.40,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Coventry,Commercial,,470.40,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,inpatient,,,245.00000,164.89000,Coventry,Commercial,,235.20,,,,,,,220.50,237.65,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Coventry,Commercial,,235.20,,,,,,,63.70,237.65,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Coventry,Commercial,,808.32,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Coventry,Commercial,,808.32,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Coventry,Commercial,,1010.88,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Coventry,Commercial,,1010.88,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Coventry,Commercial,,1212.48,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Coventry,Commercial,,1212.48,,,,,,,328.38,1225.11,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,inpatient,,,1178.00000,669.28000,Coventry,Commercial,,1130.88,,,,,,,1060.20,1142.66,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1178.00000,669.28000,Coventry,Commercial,,1130.88,,,,,,,306.28,1142.66,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,inpatient,,,140.00000,102.34000,Coventry,Commercial,,134.40,,,,,,,126.00,135.80,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,outpatient,,,140.00000,102.34000,Coventry,Commercial,,134.40,,,,,,,36.40,135.80,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,inpatient,,,275.00000,201.02000,Coventry,Commercial,,264.00,,,,,,,247.50,266.75,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,outpatient,,,275.00000,201.02000,Coventry,Commercial,,264.00,,,,,,,71.50,266.75,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,inpatient,,,295.00000,215.64000,Coventry,Commercial,,283.20,,,,,,,265.50,286.15,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,outpatient,,,295.00000,215.64000,Coventry,Commercial,,283.20,,,,,,,76.70,286.15,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,inpatient,,,590.00000,431.29000,Coventry,Commercial,,566.40,,,,,,,531.00,572.30,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,outpatient,,,590.00000,431.29000,Coventry,Commercial,,566.40,,,,,,,153.40,572.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,inpatient,,,690.00000,504.39000,Coventry,Commercial,,662.40,,,,,,,621.00,669.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,outpatient,,,690.00000,504.39000,Coventry,Commercial,,662.40,,,,,,,179.40,669.30,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,inpatient,,,1375.00000,1005.12000,Coventry,Commercial,,1320.00,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,outpatient,,,1375.00000,1005.12000,Coventry,Commercial,,1320.00,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,inpatient,,,950.00000,694.45000,Coventry,Commercial,,912.00,,,,,,,855.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,outpatient,,,950.00000,694.45000,Coventry,Commercial,,912.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,inpatient,,,1900.00000,1388.90000,Coventry,Commercial,,1824.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,outpatient,,,1900.00000,1388.90000,Coventry,Commercial,,1824.00,,,,,,,494.00,1843.00,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,inpatient,,,584.00000,426.90000,Coventry,Commercial,,560.64,,,,,,,525.60,566.48,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,outpatient,,,584.00000,426.90000,Coventry,Commercial,,560.64,,,,,,,151.84,566.48,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,inpatient,,,1391.00000,1016.82000,Coventry,Commercial,,1335.36,,,,,,,1251.90,1349.27,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,outpatient,,,1391.00000,1016.82000,Coventry,Commercial,,1335.36,,,,,,,361.66,1349.27,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,inpatient,,,359.00000,271.76000,Coventry,Commercial,,344.64,,,,,,,323.10,348.23,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,outpatient,,,359.00000,271.76000,Coventry,Commercial,,344.64,,,,,,,93.34,348.23,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,inpatient,,,95.00000,71.92000,Coventry,Commercial,,91.20,,,,,,,85.50,92.15,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,outpatient,,,95.00000,71.92000,Coventry,Commercial,,91.20,,,,,,,24.70,92.15,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,inpatient,,,37.00000,17.83000,Coventry,Commercial,,35.52,,,,,,,33.30,35.89,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,outpatient,,,37.00000,17.83000,Coventry,Commercial,,35.52,,,,,,,9.62,35.89,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Coventry,Commercial,,75.84,,,,,,,71.10,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Coventry,Commercial,,75.84,,,,,,,20.54,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,inpatient,,,237.00000,114.23000,Coventry,Commercial,,227.52,,,,,,,213.30,229.89,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Coventry,Commercial,,227.52,,,,,,,61.62,229.89,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,inpatient,,,33.00000,15.91000,Coventry,Commercial,,31.68,,,,,,,29.70,32.01,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,outpatient,,,33.00000,15.91000,Coventry,Commercial,,31.68,,,,,,,8.58,32.01,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,inpatient,,,25.00000,12.05000,Coventry,Commercial,,24.00,,,,,,,22.50,24.25,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,outpatient,,,25.00000,12.05000,Coventry,Commercial,,24.00,,,,,,,6.50,24.25,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,inpatient,,,497.00000,160.53000,Coventry,Commercial,,477.12,,,,,,,447.30,482.09,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,outpatient,,,497.00000,160.53000,Coventry,Commercial,,477.12,,,,,,,129.22,482.09,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Coventry,Commercial,,846.72,,,,,,,793.80,855.54,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Coventry,Commercial,,846.72,,,,,,,229.32,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Coventry,Commercial,,846.72,,,,,,,793.80,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Coventry,Commercial,,846.72,,,,,,,229.32,855.54,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,inpatient,,,98.00000,37.44000,Coventry,Commercial,,94.08,,,,,,,88.20,95.06,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Coventry,Commercial,,94.08,,,,,,,25.48,95.06,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,inpatient,,,96.00000,36.67000,Coventry,Commercial,,92.16,,,,,,,86.40,93.12,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Coventry,Commercial,,92.16,,,,,,,24.96,93.12,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Coventry,Commercial,,846.72,,,,,,,793.80,855.54,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Coventry,Commercial,,846.72,,,,,,,229.32,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Coventry,Commercial,,846.72,,,,,,,793.80,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Coventry,Commercial,,846.72,,,,,,,229.32,855.54,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,inpatient,,,763.00000,291.47000,Coventry,Commercial,,732.48,,,,,,,686.70,740.11,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,outpatient,,,763.00000,291.47000,Coventry,Commercial,,732.48,,,,,,,198.38,740.11,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,inpatient,,,199.00000,76.02000,Coventry,Commercial,,191.04,,,,,,,179.10,193.03,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,outpatient,,,199.00000,76.02000,Coventry,Commercial,,191.04,,,,,,,51.74,193.03,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,inpatient,,,98.00000,37.44000,Coventry,Commercial,,94.08,,,,,,,88.20,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Coventry,Commercial,,94.08,,,,,,,25.48,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,inpatient,,,96.00000,36.67000,Coventry,Commercial,,92.16,,,,,,,86.40,93.12,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Coventry,Commercial,,92.16,,,,,,,24.96,93.12,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,inpatient,,,1265.00000,483.23000,Coventry,Commercial,,1214.40,,,,,,,1138.50,1227.05,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,outpatient,,,1265.00000,483.23000,Coventry,Commercial,,1214.40,,,,,,,328.90,1227.05,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,inpatient,,,924.00000,352.97000,Coventry,Commercial,,887.04,,,,,,,831.60,896.28,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,outpatient,,,924.00000,352.97000,Coventry,Commercial,,887.04,,,,,,,240.24,896.28,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,inpatient,,,580.00000,215.76000,Coventry,Commercial,,556.80,,,,,,,522.00,562.60,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,outpatient,,,580.00000,215.76000,Coventry,Commercial,,556.80,,,,,,,150.80,562.60,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,inpatient,,,110.00000,40.92000,Coventry,Commercial,,105.60,,,,,,,99.00,106.70,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,outpatient,,,110.00000,40.92000,Coventry,Commercial,,105.60,,,,,,,28.60,106.70,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,inpatient,,,373.00000,138.76000,Coventry,Commercial,,358.08,,,,,,,335.70,361.81,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,outpatient,,,373.00000,138.76000,Coventry,Commercial,,358.08,,,,,,,96.98,361.81,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,inpatient,,,337.00000,125.36000,Coventry,Commercial,,323.52,,,,,,,303.30,326.89,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,outpatient,,,337.00000,125.36000,Coventry,Commercial,,323.52,,,,,,,87.62,326.89,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,inpatient,,,784.00000,291.65000,Coventry,Commercial,,752.64,,,,,,,705.60,760.48,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,outpatient,,,784.00000,291.65000,Coventry,Commercial,,752.64,,,,,,,203.84,760.48,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,inpatient,,,341.00000,126.85000,Coventry,Commercial,,327.36,,,,,,,306.90,330.77,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,outpatient,,,341.00000,126.85000,Coventry,Commercial,,327.36,,,,,,,88.66,330.77,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,inpatient,,,252.00000,93.74000,Coventry,Commercial,,241.92,,,,,,,226.80,244.44,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,outpatient,,,252.00000,93.74000,Coventry,Commercial,,241.92,,,,,,,65.52,244.44,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,inpatient,,,282.00000,104.90000,Coventry,Commercial,,270.72,,,,,,,253.80,273.54,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,outpatient,,,282.00000,104.90000,Coventry,Commercial,,270.72,,,,,,,73.32,273.54,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,inpatient,,,404.00000,150.29000,Coventry,Commercial,,387.84,,,,,,,363.60,391.88,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,outpatient,,,404.00000,150.29000,Coventry,Commercial,,387.84,,,,,,,105.04,391.88,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,inpatient,,,306.00000,173.85000,Coventry,Commercial,,293.76,,,,,,,275.40,296.82,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,outpatient,,,306.00000,173.85000,Coventry,Commercial,,293.76,,,,,,,79.56,296.82,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,inpatient,,,158.00000,89.77000,Coventry,Commercial,,151.68,,,,,,,142.20,153.26,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,outpatient,,,158.00000,89.77000,Coventry,Commercial,,151.68,,,,,,,41.08,153.26,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,inpatient,,,147.00000,89.38000,Coventry,Commercial,GP,141.12,,,,,,,132.30,142.59,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Coventry,Commercial,GP,141.12,,,,,,,38.22,142.59,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,inpatient,,,270.00000,164.16000,Coventry,Commercial,GP,259.20,,,,,,,243.00,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Coventry,Commercial,GP,259.20,,,,,,,70.20,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,inpatient,,,84.00000,51.07000,Coventry,Commercial,GP,80.64,,,,,,,75.60,81.48,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Coventry,Commercial,GP,80.64,,,,,,,21.84,81.48,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,inpatient,,,86.00000,52.29000,Coventry,Commercial,GP,82.56,,,,,,,77.40,83.42,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Coventry,Commercial,GP,82.56,,,,,,,22.36,83.42,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,inpatient,,,82.00000,49.86000,Coventry,Commercial,GP,78.72,,,,,,,73.80,79.54,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Coventry,Commercial,GP,78.72,,,,,,,21.32,79.54,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,inpatient,,,85.00000,51.68000,Coventry,Commercial,GP,81.60,,,,,,,76.50,82.45,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Coventry,Commercial,GP,81.60,,,,,,,22.10,82.45,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,inpatient,,,43.00000,26.14000,Coventry,Commercial,GP,41.28,,,,,,,38.70,41.71,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Coventry,Commercial,GP,41.28,,,,,,,11.18,41.71,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,inpatient,,,41.00000,24.93000,Coventry,Commercial,GP,39.36,,,,,,,36.90,39.77,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Coventry,Commercial,GP,39.36,,,,,,,10.66,39.77,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,inpatient,,,79.00000,48.03000,Coventry,Commercial,GP,75.84,,,,,,,71.10,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Coventry,Commercial,GP,75.84,,,,,,,20.54,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Coventry,Commercial,GP,71.04,,,,,,,66.60,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Coventry,Commercial,GP,71.04,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Coventry,Commercial,GP,71.04,,,,,,,66.60,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Coventry,Commercial,GP,71.04,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,inpatient,,,34.00000,20.67000,Coventry,Commercial,GP,32.64,,,,,,,30.60,32.98,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Coventry,Commercial,GP,32.64,,,,,,,8.84,32.98,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,inpatient,,,65.00000,39.52000,Coventry,Commercial,GP,62.40,,,,,,,58.50,63.05,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Coventry,Commercial,GP,62.40,,,,,,,16.90,63.05,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,inpatient,,,113.00000,68.70000,Coventry,Commercial,,108.48,,,,,,,101.70,109.61,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,outpatient,,,113.00000,68.70000,Coventry,Commercial,,108.48,,,,,,,29.38,109.61,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,inpatient,,,80.00000,48.64000,Coventry,Commercial,GP,76.80,,,,,,,72.00,77.60,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Coventry,Commercial,GP,76.80,,,,,,,20.80,77.60,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,inpatient,,,84.00000,51.07000,Coventry,Commercial,GP,80.64,,,,,,,75.60,81.48,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Coventry,Commercial,GP,80.64,,,,,,,21.84,81.48,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,inpatient,,,73.00000,44.38000,Coventry,Commercial,GP,70.08,,,,,,,65.70,70.81,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Coventry,Commercial,GP,70.08,,,,,,,18.98,70.81,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,inpatient,,,100.00000,60.80000,Coventry,Commercial,,96.00,,,,,,,90.00,97.00,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,outpatient,,,100.00000,60.80000,Coventry,Commercial,,96.00,,,,,,,26.00,97.00,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,inpatient,,,167.00000,101.54000,Coventry,Commercial,GP,160.32,,,,,,,150.30,161.99,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,outpatient,,,167.00000,101.54000,Coventry,Commercial,GP,160.32,,,,,,,43.42,161.99,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,inpatient,,,413.00000,251.10000,Coventry,Commercial,"50,GP",396.48,,,,,,,371.70,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Coventry,Commercial,"50,GP",396.48,,,,,,,107.38,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Coventry,Commercial,"LT,GP",264.00,,,,,,,247.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Coventry,Commercial,"LT,GP",264.00,,,,,,,71.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Coventry,Commercial,"RT,GP",264.00,,,,,,,247.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Coventry,Commercial,"RT,GP",264.00,,,,,,,71.50,266.75,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,inpatient,,,95.00000,57.76000,Coventry,Commercial,GP,91.20,,,,,,,85.50,92.15,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Coventry,Commercial,GP,91.20,,,,,,,24.70,92.15,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,inpatient,,,146.00000,88.77000,Coventry,Commercial,GP,140.16,,,,,,,131.40,141.62,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Coventry,Commercial,GP,140.16,,,,,,,37.96,141.62,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,inpatient,,,139.00000,84.51000,Coventry,Commercial,GP,133.44,,,,,,,125.10,134.83,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Coventry,Commercial,GP,133.44,,,,,,,36.14,134.83,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,inpatient,,,75.00000,45.60000,Coventry,Commercial,GP,72.00,,,,,,,67.50,72.75,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Coventry,Commercial,GP,72.00,,,,,,,19.50,72.75,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,inpatient,,,154.00000,93.63000,Coventry,Commercial,GP,147.84,,,,,,,138.60,149.38,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Coventry,Commercial,GP,147.84,,,,,,,40.04,149.38,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,inpatient,,,73.00000,44.38000,Coventry,Commercial,GP,70.08,,,,,,,65.70,70.81,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Coventry,Commercial,GP,70.08,,,,,,,18.98,70.81,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,inpatient,,,160.00000,97.28000,Coventry,Commercial,GP,153.60,,,,,,,144.00,155.20,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Coventry,Commercial,GP,153.60,,,,,,,41.60,155.20,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,inpatient,,,325.00000,197.60000,Coventry,Commercial,GP,312.00,,,,,,,292.50,315.25,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Coventry,Commercial,GP,312.00,,,,,,,84.50,315.25,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,inpatient,,,98.00000,59.58000,Coventry,Commercial,GP,94.08,,,,,,,88.20,95.06,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,outpatient,,,98.00000,59.58000,Coventry,Commercial,GP,94.08,,,,,,,25.48,95.06,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,inpatient,,,303.00000,184.22000,Coventry,Commercial,GP,290.88,,,,,,,272.70,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,outpatient,,,303.00000,184.22000,Coventry,Commercial,GP,290.88,,,,,,,78.78,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,inpatient,,,115.00000,69.92000,Coventry,Commercial,GP,110.40,,,,,,,103.50,111.55,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,outpatient,,,115.00000,69.92000,Coventry,Commercial,GP,110.40,,,,,,,29.90,111.55,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,inpatient,,,74.00000,44.99000,Coventry,Commercial,GP,71.04,,,,,,,66.60,71.78,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Coventry,Commercial,GP,71.04,,,,,,,19.24,71.78,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,inpatient,,,79.00000,48.03000,Coventry,Commercial,GP,75.84,,,,,,,71.10,76.63,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Coventry,Commercial,GP,75.84,,,,,,,20.54,76.63,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,inpatient,,,72.00000,43.78000,Coventry,Commercial,GP,69.12,,,,,,,64.80,69.84,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Coventry,Commercial,GP,69.12,,,,,,,18.72,69.84,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,inpatient,,,147.00000,89.38000,Coventry,Commercial,GP,141.12,,,,,,,132.30,142.59,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Coventry,Commercial,GP,141.12,,,,,,,38.22,142.59,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,inpatient,,,270.00000,164.16000,Coventry,Commercial,GP,259.20,,,,,,,243.00,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Coventry,Commercial,GP,259.20,,,,,,,70.20,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,inpatient,,,84.00000,51.07000,Coventry,Commercial,GP,80.64,,,,,,,75.60,81.48,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Coventry,Commercial,GP,80.64,,,,,,,21.84,81.48,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,inpatient,,,86.00000,52.29000,Coventry,Commercial,GP,82.56,,,,,,,77.40,83.42,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Coventry,Commercial,GP,82.56,,,,,,,22.36,83.42,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,inpatient,,,82.00000,49.86000,Coventry,Commercial,GP,78.72,,,,,,,73.80,79.54,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Coventry,Commercial,GP,78.72,,,,,,,21.32,79.54,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,inpatient,,,85.00000,51.68000,Coventry,Commercial,GP,81.60,,,,,,,76.50,82.45,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Coventry,Commercial,GP,81.60,,,,,,,22.10,82.45,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,inpatient,,,43.00000,26.14000,Coventry,Commercial,GP,41.28,,,,,,,38.70,41.71,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Coventry,Commercial,GP,41.28,,,,,,,11.18,41.71,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,inpatient,,,41.00000,24.93000,Coventry,Commercial,GP,39.36,,,,,,,36.90,39.77,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Coventry,Commercial,GP,39.36,,,,,,,10.66,39.77,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,inpatient,,,79.00000,48.03000,Coventry,Commercial,GP,75.84,,,,,,,71.10,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Coventry,Commercial,GP,75.84,,,,,,,20.54,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Coventry,Commercial,"CQ,GP",71.04,,,,,,,66.60,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Coventry,Commercial,"CQ,GP",71.04,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Coventry,Commercial,"CQ,GP",71.04,,,,,,,66.60,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Coventry,Commercial,"CQ,GP",71.04,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,inpatient,,,34.00000,20.67000,Coventry,Commercial,GP,32.64,,,,,,,30.60,32.98,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Coventry,Commercial,GP,32.64,,,,,,,8.84,32.98,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,inpatient,,,65.00000,39.52000,Coventry,Commercial,GP,62.40,,,,,,,58.50,63.05,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Coventry,Commercial,GP,62.40,,,,,,,16.90,63.05,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,inpatient,,,80.00000,48.64000,Coventry,Commercial,GP,76.80,,,,,,,72.00,77.60,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Coventry,Commercial,GP,76.80,,,,,,,20.80,77.60,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,inpatient,,,84.00000,51.07000,Coventry,Commercial,GP,80.64,,,,,,,75.60,81.48,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Coventry,Commercial,GP,80.64,,,,,,,21.84,81.48,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,inpatient,,,73.00000,44.38000,Coventry,Commercial,GP,70.08,,,,,,,65.70,70.81,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Coventry,Commercial,GP,70.08,,,,,,,18.98,70.81,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,inpatient,,,413.00000,251.10000,Coventry,Commercial,"GP,50",396.48,,,,,,,371.70,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Coventry,Commercial,"GP,50",396.48,,,,,,,107.38,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Coventry,Commercial,"GP,LT",264.00,,,,,,,247.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Coventry,Commercial,"GP,LT",264.00,,,,,,,71.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Coventry,Commercial,"GP,RT",264.00,,,,,,,247.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Coventry,Commercial,"GP,RT",264.00,,,,,,,71.50,266.75,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,inpatient,,,95.00000,57.76000,Coventry,Commercial,GP,91.20,,,,,,,85.50,92.15,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Coventry,Commercial,GP,91.20,,,,,,,24.70,92.15,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,inpatient,,,146.00000,88.77000,Coventry,Commercial,GP,140.16,,,,,,,131.40,141.62,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Coventry,Commercial,GP,140.16,,,,,,,37.96,141.62,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,inpatient,,,139.00000,84.51000,Coventry,Commercial,GP,133.44,,,,,,,125.10,134.83,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Coventry,Commercial,GP,133.44,,,,,,,36.14,134.83,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,inpatient,,,75.00000,45.60000,Coventry,Commercial,GP,72.00,,,,,,,67.50,72.75,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Coventry,Commercial,GP,72.00,,,,,,,19.50,72.75,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,inpatient,,,154.00000,93.63000,Coventry,Commercial,GP,147.84,,,,,,,138.60,149.38,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Coventry,Commercial,GP,147.84,,,,,,,40.04,149.38,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,inpatient,,,73.00000,44.38000,Coventry,Commercial,GP,70.08,,,,,,,65.70,70.81,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Coventry,Commercial,GP,70.08,,,,,,,18.98,70.81,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,inpatient,,,160.00000,97.28000,Coventry,Commercial,GP,153.60,,,,,,,144.00,155.20,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Coventry,Commercial,GP,153.60,,,,,,,41.60,155.20,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,inpatient,,,325.00000,197.60000,Coventry,Commercial,GP,312.00,,,,,,,292.50,315.25,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Coventry,Commercial,GP,312.00,,,,,,,84.50,315.25,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,inpatient,,,74.00000,44.99000,Coventry,Commercial,GP,71.04,,,,,,,66.60,71.78,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Coventry,Commercial,GP,71.04,,,,,,,19.24,71.78,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,inpatient,,,79.00000,48.03000,Coventry,Commercial,GP,75.84,,,,,,,71.10,76.63,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Coventry,Commercial,GP,75.84,,,,,,,20.54,76.63,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,inpatient,,,72.00000,43.78000,Coventry,Commercial,GP,69.12,,,,,,,64.80,69.84,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Coventry,Commercial,GP,69.12,,,,,,,18.72,69.84,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,inpatient,,,445.00000,262.55000,Coventry,Commercial,GP,427.20,,,,,,,400.50,431.65,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,outpatient,,,445.00000,262.55000,Coventry,Commercial,GP,427.20,,,,,,,115.70,431.65,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,inpatient,,,310.00000,182.90000,Coventry,Commercial,GP,297.60,,,,,,,279.00,300.70,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,outpatient,,,310.00000,182.90000,Coventry,Commercial,GP,297.60,,,,,,,80.60,300.70,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,inpatient,,,393.00000,231.87000,Coventry,Commercial,GP,377.28,,,,,,,353.70,381.21,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,outpatient,,,393.00000,231.87000,Coventry,Commercial,GP,377.28,,,,,,,102.18,381.21,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,inpatient,,,310.00000,182.90000,Coventry,Commercial,GP,297.60,,,,,,,279.00,300.70,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,outpatient,,,310.00000,182.90000,Coventry,Commercial,GP,297.60,,,,,,,80.60,300.70,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,inpatient,,,80.00000,30.96000,Coventry,Commercial,GO,76.80,,,,,,,72.00,77.60,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Coventry,Commercial,GO,76.80,,,,,,,20.80,77.60,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,inpatient,,,84.00000,32.51000,Coventry,Commercial,GO,80.64,,,,,,,75.60,81.48,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Coventry,Commercial,GO,80.64,,,,,,,21.84,81.48,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,inpatient,,,126.00000,48.76000,Coventry,Commercial,GO,120.96,,,,,,,113.40,122.22,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Coventry,Commercial,GO,120.96,,,,,,,32.76,122.22,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,inpatient,,,66.00000,25.54000,Coventry,Commercial,GO,63.36,,,,,,,59.40,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Coventry,Commercial,GO,63.36,,,,,,,17.16,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,inpatient,,,62.00000,23.99000,Coventry,Commercial,GO,59.52,,,,,,,55.80,60.14,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Coventry,Commercial,GO,59.52,,,,,,,16.12,60.14,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,inpatient,,,90.00000,34.83000,Coventry,Commercial,GO,86.40,,,,,,,81.00,87.30,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Coventry,Commercial,GO,86.40,,,,,,,23.40,87.30,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,inpatient,,,95.00000,36.76000,Coventry,Commercial,GO,91.20,,,,,,,85.50,92.15,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Coventry,Commercial,GO,91.20,,,,,,,24.70,92.15,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,inpatient,,,146.00000,56.50000,Coventry,Commercial,GO,140.16,,,,,,,131.40,141.62,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Coventry,Commercial,GO,140.16,,,,,,,37.96,141.62,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,inpatient,,,139.00000,53.79000,Coventry,Commercial,GO,133.44,,,,,,,125.10,134.83,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Coventry,Commercial,GO,133.44,,,,,,,36.14,134.83,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,inpatient,,,75.00000,29.02000,Coventry,Commercial,GO,72.00,,,,,,,67.50,72.75,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Coventry,Commercial,GO,72.00,,,,,,,19.50,72.75,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,inpatient,,,154.00000,59.60000,Coventry,Commercial,GO,147.84,,,,,,,138.60,149.38,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Coventry,Commercial,GO,147.84,,,,,,,40.04,149.38,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,inpatient,,,73.00000,28.25000,Coventry,Commercial,GO,70.08,,,,,,,65.70,70.81,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Coventry,Commercial,GO,70.08,,,,,,,18.98,70.81,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,inpatient,,,160.00000,61.92000,Coventry,Commercial,GO,153.60,,,,,,,144.00,155.20,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Coventry,Commercial,GO,153.60,,,,,,,41.60,155.20,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,inpatient,,,98.00000,37.93000,Coventry,Commercial,GO,94.08,,,,,,,88.20,95.06,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,outpatient,,,98.00000,37.93000,Coventry,Commercial,GO,94.08,,,,,,,25.48,95.06,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,inpatient,,,303.00000,117.26000,Coventry,Commercial,GO,290.88,,,,,,,272.70,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,outpatient,,,303.00000,117.26000,Coventry,Commercial,GO,290.88,,,,,,,78.78,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,inpatient,,,115.00000,44.50000,Coventry,Commercial,GO,110.40,,,,,,,103.50,111.55,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,outpatient,,,115.00000,44.50000,Coventry,Commercial,GO,110.40,,,,,,,29.90,111.55,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,inpatient,,,74.00000,28.64000,Coventry,Commercial,GO,71.04,,,,,,,66.60,71.78,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Coventry,Commercial,GO,71.04,,,,,,,19.24,71.78,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,inpatient,,,72.00000,27.86000,Coventry,Commercial,GO,69.12,,,,,,,64.80,69.84,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Coventry,Commercial,GO,69.12,,,,,,,18.72,69.84,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,inpatient,,,80.00000,30.96000,Coventry,Commercial,"CO,GO",76.80,,,,,,,72.00,77.60,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Coventry,Commercial,"CO,GO",76.80,,,,,,,20.80,77.60,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,inpatient,,,84.00000,32.51000,Coventry,Commercial,"CO,GO",80.64,,,,,,,75.60,81.48,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Coventry,Commercial,"CO,GO",80.64,,,,,,,21.84,81.48,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,inpatient,,,126.00000,48.76000,Coventry,Commercial,"CO,GO",120.96,,,,,,,113.40,122.22,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Coventry,Commercial,"CO,GO",120.96,,,,,,,32.76,122.22,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,inpatient,,,62.00000,23.99000,Coventry,Commercial,"CO,GO",59.52,,,,,,,55.80,60.14,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Coventry,Commercial,"CO,GO",59.52,,,,,,,16.12,60.14,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,inpatient,,,66.00000,25.54000,Coventry,Commercial,"CO,GO",63.36,,,,,,,59.40,64.02,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Coventry,Commercial,"CO,GO",63.36,,,,,,,17.16,64.02,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,inpatient,,,90.00000,34.83000,Coventry,Commercial,"CO,GO",86.40,,,,,,,81.00,87.30,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Coventry,Commercial,"CO,GO",86.40,,,,,,,23.40,87.30,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,inpatient,,,95.00000,36.76000,Coventry,Commercial,"CO,GO",91.20,,,,,,,85.50,92.15,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Coventry,Commercial,"CO,GO",91.20,,,,,,,24.70,92.15,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,inpatient,,,146.00000,56.50000,Coventry,Commercial,"CO,GO",140.16,,,,,,,131.40,141.62,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Coventry,Commercial,"CO,GO",140.16,,,,,,,37.96,141.62,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,inpatient,,,139.00000,53.79000,Coventry,Commercial,"CO,GO",133.44,,,,,,,125.10,134.83,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Coventry,Commercial,"CO,GO",133.44,,,,,,,36.14,134.83,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,inpatient,,,75.00000,29.02000,Coventry,Commercial,"CO,GO",72.00,,,,,,,67.50,72.75,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Coventry,Commercial,"CO,GO",72.00,,,,,,,19.50,72.75,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,inpatient,,,154.00000,59.60000,Coventry,Commercial,"CO,GO",147.84,,,,,,,138.60,149.38,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Coventry,Commercial,"CO,GO",147.84,,,,,,,40.04,149.38,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,inpatient,,,73.00000,28.25000,Coventry,Commercial,"CO,GO",70.08,,,,,,,65.70,70.81,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Coventry,Commercial,"CO,GO",70.08,,,,,,,18.98,70.81,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,inpatient,,,160.00000,61.92000,Coventry,Commercial,"CO,GO",153.60,,,,,,,144.00,155.20,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Coventry,Commercial,"CO,GO",153.60,,,,,,,41.60,155.20,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,inpatient,,,74.00000,28.64000,Coventry,Commercial,"CO,GO",71.04,,,,,,,66.60,71.78,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Coventry,Commercial,"CO,GO",71.04,,,,,,,19.24,71.78,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,inpatient,,,72.00000,27.86000,Coventry,Commercial,"CO,GO",69.12,,,,,,,64.80,69.84,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Coventry,Commercial,"CO,GO",69.12,,,,,,,18.72,69.84,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,inpatient,,,47.00000,26.70000,Coventry,Commercial,GO,45.12,,,,,,,42.30,45.59,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Coventry,Commercial,GO,45.12,,,,,,,12.22,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,inpatient,,,47.00000,26.70000,Coventry,Commercial,"CO,GO",45.12,,,,,,,42.30,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Coventry,Commercial,"CO,GO",45.12,,,,,,,12.22,45.59,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,inpatient,,,250.00000,142.04000,Coventry,Commercial,GO,240.00,,,,,,,225.00,242.50,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,outpatient,,,250.00000,142.04000,Coventry,Commercial,GO,240.00,,,,,,,65.00,242.50,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,inpatient,,,175.00000,99.43000,Coventry,Commercial,GO,168.00,,,,,,,157.50,169.75,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,outpatient,,,175.00000,99.43000,Coventry,Commercial,GO,168.00,,,,,,,45.50,169.75,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,inpatient,,,233.00000,132.38000,Coventry,Commercial,GO,223.68,,,,,,,209.70,226.01,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,outpatient,,,233.00000,132.38000,Coventry,Commercial,GO,223.68,,,,,,,60.58,226.01,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,inpatient,,,175.00000,99.43000,Coventry,Commercial,GO,168.00,,,,,,,157.50,169.75,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,outpatient,,,175.00000,99.43000,Coventry,Commercial,GO,168.00,,,,,,,45.50,169.75,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,inpatient,,,291.00000,93.99000,Coventry,Commercial,,279.36,,,,,,,261.90,282.27,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,outpatient,,,291.00000,93.99000,Coventry,Commercial,,279.36,,,,,,,75.66,282.27,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,inpatient,,,273.00000,155.10000,Coventry,Commercial,GN,262.08,,,,,,,245.70,264.81,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,outpatient,,,273.00000,155.10000,Coventry,Commercial,GN,262.08,,,,,,,70.98,264.81,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,inpatient,,,279.00000,158.51000,Coventry,Commercial,GN,267.84,,,,,,,251.10,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,outpatient,,,279.00000,158.51000,Coventry,Commercial,GN,267.84,,,,,,,72.54,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,inpatient,,,426.00000,242.03000,Coventry,Commercial,GN,408.96,,,,,,,383.40,413.22,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,outpatient,,,426.00000,242.03000,Coventry,Commercial,GN,408.96,,,,,,,110.76,413.22,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,inpatient,,,242.00000,137.49000,Coventry,Commercial,GN,232.32,,,,,,,217.80,234.74,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,outpatient,,,242.00000,137.49000,Coventry,Commercial,GN,232.32,,,,,,,62.92,234.74,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,inpatient,,,128.00000,72.72000,Coventry,Commercial,,122.88,,,,,,,115.20,124.16,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,outpatient,,,128.00000,72.72000,Coventry,Commercial,,122.88,,,,,,,33.28,124.16,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,inpatient,,,66.00000,37.50000,Coventry,Commercial,GN,63.36,,,,,,,59.40,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,outpatient,,,66.00000,37.50000,Coventry,Commercial,GN,63.36,,,,,,,17.16,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,inpatient,,,62.00000,35.23000,Coventry,Commercial,GN,59.52,,,,,,,55.80,60.14,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,outpatient,,,62.00000,35.23000,Coventry,Commercial,GN,59.52,,,,,,,16.12,60.14,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,inpatient,,,269.00000,152.83000,Coventry,Commercial,GN,258.24,,,,,,,242.10,260.93,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,outpatient,,,269.00000,152.83000,Coventry,Commercial,GN,258.24,,,,,,,69.94,260.93,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,inpatient,,,153.00000,86.93000,Coventry,Commercial,GN,146.88,,,,,,,137.70,148.41,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,outpatient,,,153.00000,86.93000,Coventry,Commercial,GN,146.88,,,,,,,39.78,148.41,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,inpatient,,,98.00000,55.68000,Coventry,Commercial,GN,94.08,,,,,,,88.20,95.06,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,outpatient,,,98.00000,55.68000,Coventry,Commercial,GN,94.08,,,,,,,25.48,95.06,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,inpatient,,,303.00000,172.15000,Coventry,Commercial,GN,290.88,,,,,,,272.70,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,outpatient,,,303.00000,172.15000,Coventry,Commercial,GN,290.88,,,,,,,78.78,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,inpatient,,,115.00000,65.34000,Coventry,Commercial,GN,110.40,,,,,,,103.50,111.55,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,outpatient,,,115.00000,65.34000,Coventry,Commercial,GN,110.40,,,,,,,29.90,111.55,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,inpatient,,,210.00000,119.31000,Coventry,Commercial,GN,201.60,,,,,,,189.00,203.70,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,outpatient,,,210.00000,119.31000,Coventry,Commercial,GN,201.60,,,,,,,54.60,203.70,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,inpatient,,,250.00000,142.04000,Coventry,Commercial,GN,240.00,,,,,,,225.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,outpatient,,,250.00000,142.04000,Coventry,Commercial,GN,240.00,,,,,,,65.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,inpatient,,,78.00000,44.32000,Coventry,Commercial,GN,74.88,,,,,,,70.20,75.66,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,outpatient,,,78.00000,44.32000,Coventry,Commercial,GN,74.88,,,,,,,20.28,75.66,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,inpatient,,,322.00000,182.94000,Coventry,Commercial,GN,309.12,,,,,,,289.80,312.34,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,outpatient,,,322.00000,182.94000,Coventry,Commercial,GN,309.12,,,,,,,83.72,312.34,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,inpatient,,,309.00000,175.56000,Coventry,Commercial,GN,296.64,,,,,,,278.10,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,outpatient,,,309.00000,175.56000,Coventry,Commercial,GN,296.64,,,,,,,80.34,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,inpatient,,,245.00000,139.20000,Coventry,Commercial,GN,235.20,,,,,,,220.50,237.65,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,outpatient,,,245.00000,139.20000,Coventry,Commercial,GN,235.20,,,,,,,63.70,237.65,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,inpatient,,,313.00000,116.44000,Coventry,Commercial,,300.48,,,,,,,281.70,303.61,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,outpatient,,,313.00000,116.44000,Coventry,Commercial,,300.48,,,,,,,81.38,303.61,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,inpatient,,,1250.00000,632.50000,Coventry,Commercial,,1200.00,,,,,,,1125.00,1212.50,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,outpatient,,,1250.00000,632.50000,Coventry,Commercial,,1200.00,,,,,,,325.00,1212.50,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,inpatient,,,145.00000,75.54000,Coventry,Commercial,,139.20,,,,,,,130.50,140.65,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Coventry,Commercial,,139.20,,,,,,,37.70,140.65,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,inpatient,,,488.00000,254.25000,Coventry,Commercial,,468.48,,,,,,,439.20,473.36,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Coventry,Commercial,,468.48,,,,,,,126.88,473.36,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,inpatient,,,684.00000,337.90000,Coventry,Commercial,,656.64,,,,,,,615.60,663.48,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,outpatient,,,684.00000,337.90000,Coventry,Commercial,,656.64,,,,,,,177.84,663.48,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,inpatient,,,206.00000,101.76000,Coventry,Commercial,,197.76,,,,,,,185.40,199.82,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,outpatient,,,206.00000,101.76000,Coventry,Commercial,,197.76,,,,,,,53.56,199.82,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,inpatient,,,195.00000,96.33000,Coventry,Commercial,,187.20,,,,,,,175.50,189.15,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,outpatient,,,195.00000,96.33000,Coventry,Commercial,,187.20,,,,,,,50.70,189.15,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,inpatient,,,375.00000,185.25000,Coventry,Commercial,,360.00,,,,,,,337.50,363.75,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,outpatient,,,375.00000,185.25000,Coventry,Commercial,,360.00,,,,,,,97.50,363.75,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,inpatient,,,429.00000,211.93000,Coventry,Commercial,,411.84,,,,,,,386.10,416.13,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,outpatient,,,429.00000,211.93000,Coventry,Commercial,,411.84,,,,,,,111.54,416.13,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22475,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Coventry,Commercial,,2669.76,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B OBSTETRICS SEMI-PVT,42473,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Coventry,Commercial,,2669.76,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ICU,32474,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Coventry,Commercial,,8410.56,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,12476,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Coventry,Commercial,,5607.36,,,,,,,2512.00,5665.77,percent of total billed charges,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,84.00000,63.59000,Coventry,Commercial,,80.64,,,,,,,75.60,81.48,percent of total billed charges,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Coventry,Commercial,,80.64,,,,,,,21.84,81.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Coventry,Commercial,,272.64,,,,,,,255.60,275.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Coventry,Commercial,,272.64,,,,,,,73.84,275.48,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Coventry,Commercial,,439.68,,,,,,,412.20,444.26,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Coventry,Commercial,,439.68,,,,,,,119.08,444.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Coventry,Commercial,,535.68,,,,,,,502.20,541.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Coventry,Commercial,,535.68,,,,,,,145.08,541.26,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Coventry,Commercial,,462.72,,,,,,,433.80,467.54,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Coventry,Commercial,,462.72,,,,,,,125.32,467.54,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Coventry,Commercial,,227.52,,,,,,,213.30,229.89,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Coventry,Commercial,,227.52,,,,,,,61.62,229.89,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,inpatient,,,490.00000,329.77000,Coventry,Commercial,,470.40,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,outpatient,,,490.00000,329.77000,Coventry,Commercial,,470.40,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,inpatient,,,490.00000,329.77000,Coventry,Commercial,,470.40,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,outpatient,,,490.00000,329.77000,Coventry,Commercial,,470.40,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,inpatient,,,245.00000,164.89000,Coventry,Commercial,,235.20,,,,,,,220.50,237.65,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,outpatient,,,245.00000,164.89000,Coventry,Commercial,,235.20,,,,,,,63.70,237.65,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,inpatient,,,490.00000,329.77000,Coventry,Commercial,,470.40,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Coventry,Commercial,,470.40,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Coventry,Commercial,,470.40,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Coventry,Commercial,,470.40,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,inpatient,,,245.00000,164.89000,Coventry,Commercial,,235.20,,,,,,,220.50,237.65,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Coventry,Commercial,,235.20,,,,,,,63.70,237.65,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Coventry,Commercial,,808.32,,,,,,,757.80,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Coventry,Commercial,,808.32,,,,,,,218.92,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Coventry,Commercial,,1010.88,,,,,,,947.70,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Coventry,Commercial,,1010.88,,,,,,,273.78,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Coventry,Commercial,,1212.48,,,,,,,1136.70,1225.11,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Coventry,Commercial,,1212.48,,,,,,,328.38,1225.11,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,inpatient,,,2466.00000,986.40000,Coventry,Commercial,,2367.36,,,,,,,2219.40,2392.02,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,outpatient,,,2466.00000,986.40000,Coventry,Commercial,,2367.36,,,,,,,641.16,2392.02,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,inpatient,,,260.00000,104.00000,Coventry,Commercial,,249.60,,,,,,,234.00,252.20,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,outpatient,,,260.00000,104.00000,Coventry,Commercial,,249.60,,,,,,,67.60,252.20,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,inpatient,,,2041.00000,816.40000,Coventry,Commercial,,1959.36,,,,,,,1836.90,1979.77,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,outpatient,,,2041.00000,816.40000,Coventry,Commercial,,1959.36,,,,,,,530.66,1979.77,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,inpatient,,,375.00000,150.00000,Coventry,Commercial,,360.00,,,,,,,337.50,363.75,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,outpatient,,,375.00000,150.00000,Coventry,Commercial,,360.00,,,,,,,97.50,363.75,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,inpatient,,,1178.00000,471.20000,Coventry,Commercial,,1130.88,,,,,,,1060.20,1142.66,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,outpatient,,,1178.00000,471.20000,Coventry,Commercial,,1130.88,,,,,,,306.28,1142.66,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,inpatient,,,245.00000,98.00000,Coventry,Commercial,,235.20,,,,,,,220.50,237.65,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,outpatient,,,245.00000,98.00000,Coventry,Commercial,,235.20,,,,,,,63.70,237.65,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,inpatient,,,280.00000,112.00000,Coventry,Commercial,,268.80,,,,,,,252.00,271.60,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,outpatient,,,280.00000,112.00000,Coventry,Commercial,,268.80,,,,,,,72.80,271.60,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,inpatient,,,336.00000,134.40000,Coventry,Commercial,,322.56,,,,,,,302.40,325.92,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,outpatient,,,336.00000,134.40000,Coventry,Commercial,,322.56,,,,,,,87.36,325.92,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,inpatient,,,380.00000,152.00000,Coventry,Commercial,,364.80,,,,,,,342.00,368.60,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,outpatient,,,380.00000,152.00000,Coventry,Commercial,,364.80,,,,,,,98.80,368.60,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,inpatient,,,530.00000,212.00000,Coventry,Commercial,,508.80,,,,,,,477.00,514.10,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Coventry,Commercial,,508.80,,,,,,,137.80,514.10,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,inpatient,,,264.00000,105.60000,Coventry,Commercial,,253.44,,,,,,,237.60,256.08,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,outpatient,,,264.00000,105.60000,Coventry,Commercial,,253.44,,,,,,,68.64,256.08,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,inpatient,,,763.00000,305.20000,Coventry,Commercial,,732.48,,,,,,,686.70,740.11,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,outpatient,,,763.00000,305.20000,Coventry,Commercial,,732.48,,,,,,,198.38,740.11,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,inpatient,,,672.00000,268.80000,Coventry,Commercial,,645.12,,,,,,,604.80,651.84,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,outpatient,,,672.00000,268.80000,Coventry,Commercial,,645.12,,,,,,,174.72,651.84,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,inpatient,,,1940.00000,776.00000,Coventry,Commercial,,1862.40,,,,,,,1746.00,1881.80,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,outpatient,,,1940.00000,776.00000,Coventry,Commercial,,1862.40,,,,,,,504.40,1881.80,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,inpatient,,,3875.00000,1550.00000,Coventry,Commercial,,3720.00,,,,,,,3487.50,3758.75,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,outpatient,,,3875.00000,1550.00000,Coventry,Commercial,,3720.00,,,,,,,1007.50,3758.75,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,inpatient,,,505.00000,202.00000,Coventry,Commercial,,484.80,,,,,,,454.50,489.85,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,outpatient,,,505.00000,202.00000,Coventry,Commercial,,484.80,,,,,,,131.30,489.85,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,inpatient,,,295.00000,118.00000,Coventry,Commercial,,283.20,,,,,,,265.50,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Coventry,Commercial,,283.20,,,,,,,76.70,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,inpatient,,,585.00000,234.00000,Coventry,Commercial,,561.60,,,,,,,526.50,567.45,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,outpatient,,,585.00000,234.00000,Coventry,Commercial,,561.60,,,,,,,152.10,567.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,inpatient,,,285.00000,114.00000,Coventry,Commercial,,273.60,,,,,,,256.50,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,outpatient,,,285.00000,114.00000,Coventry,Commercial,,273.60,,,,,,,74.10,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,inpatient,,,575.00000,230.00000,Coventry,Commercial,,552.00,,,,,,,517.50,557.75,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,outpatient,,,575.00000,230.00000,Coventry,Commercial,,552.00,,,,,,,149.50,557.75,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,inpatient,,,697.00000,278.80000,Coventry,Commercial,,669.12,,,,,,,627.30,676.09,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,outpatient,,,697.00000,278.80000,Coventry,Commercial,,669.12,,,,,,,181.22,676.09,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,inpatient,,,530.00000,212.00000,Coventry,Commercial,,508.80,,,,,,,477.00,514.10,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Coventry,Commercial,,508.80,,,,,,,137.80,514.10,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,inpatient,,,580.00000,232.00000,Coventry,Commercial,,556.80,,,,,,,522.00,562.60,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,outpatient,,,580.00000,232.00000,Coventry,Commercial,,556.80,,,,,,,150.80,562.60,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,inpatient,,,435.00000,174.00000,Coventry,Commercial,,417.60,,,,,,,391.50,421.95,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,outpatient,,,435.00000,174.00000,Coventry,Commercial,,417.60,,,,,,,113.10,421.95,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,inpatient,,,270.00000,108.00000,Coventry,Commercial,,259.20,,,,,,,243.00,261.90,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,outpatient,,,270.00000,108.00000,Coventry,Commercial,,259.20,,,,,,,70.20,261.90,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,inpatient,,,504.00000,201.60000,Coventry,Commercial,,483.84,,,,,,,453.60,488.88,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,outpatient,,,504.00000,201.60000,Coventry,Commercial,,483.84,,,,,,,131.04,488.88,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,inpatient,,,98.00000,39.20000,Coventry,Commercial,,94.08,,,,,,,88.20,95.06,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,outpatient,,,98.00000,39.20000,Coventry,Commercial,,94.08,,,,,,,25.48,95.06,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,inpatient,,,608.00000,243.20000,Coventry,Commercial,,583.68,,,,,,,547.20,589.76,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,outpatient,,,608.00000,243.20000,Coventry,Commercial,,583.68,,,,,,,158.08,589.76,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,inpatient,,,114.00000,45.60000,Coventry,Commercial,,109.44,,,,,,,102.60,110.58,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,outpatient,,,114.00000,45.60000,Coventry,Commercial,,109.44,,,,,,,29.64,110.58,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,inpatient,,,187.00000,74.80000,Coventry,Commercial,,179.52,,,,,,,168.30,181.39,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,outpatient,,,187.00000,74.80000,Coventry,Commercial,,179.52,,,,,,,48.62,181.39,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,inpatient,,,214.00000,85.60000,Coventry,Commercial,,205.44,,,,,,,192.60,207.58,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,outpatient,,,214.00000,85.60000,Coventry,Commercial,,205.44,,,,,,,55.64,207.58,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,inpatient,,,863.00000,345.20000,Coventry,Commercial,,828.48,,,,,,,776.70,837.11,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,outpatient,,,863.00000,345.20000,Coventry,Commercial,,828.48,,,,,,,224.38,837.11,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,inpatient,,,453.00000,181.20000,Coventry,Commercial,,434.88,,,,,,,407.70,439.41,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,outpatient,,,453.00000,181.20000,Coventry,Commercial,,434.88,,,,,,,117.78,439.41,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,inpatient,,,144.00000,57.60000,Coventry,Commercial,,138.24,,,,,,,129.60,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,outpatient,,,144.00000,57.60000,Coventry,Commercial,,138.24,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,inpatient,,,107.00000,42.80000,Coventry,Commercial,,102.72,,,,,,,96.30,103.79,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,outpatient,,,107.00000,42.80000,Coventry,Commercial,,102.72,,,,,,,27.82,103.79,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,inpatient,,,403.00000,161.20000,Coventry,Commercial,,386.88,,,,,,,362.70,390.91,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,outpatient,,,403.00000,161.20000,Coventry,Commercial,,386.88,,,,,,,104.78,390.91,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,inpatient,,,144.00000,57.60000,Coventry,Commercial,,138.24,,,,,,,129.60,139.68,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,outpatient,,,144.00000,57.60000,Coventry,Commercial,,138.24,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,inpatient,,,370.00000,148.00000,Coventry,Commercial,,355.20,,,,,,,333.00,358.90,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,outpatient,,,370.00000,148.00000,Coventry,Commercial,,355.20,,,,,,,96.20,358.90,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,inpatient,,,334.00000,133.60000,Coventry,Commercial,,320.64,,,,,,,300.60,323.98,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,outpatient,,,334.00000,133.60000,Coventry,Commercial,,320.64,,,,,,,86.84,323.98,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,inpatient,,,1188.00000,475.20000,Coventry,Commercial,50,1140.48,,,,,,,1069.20,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,outpatient,,,1188.00000,475.20000,Coventry,Commercial,50,1140.48,,,,,,,308.88,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,inpatient,,,792.00000,316.80000,Coventry,Commercial,LT,760.32,,,,,,,712.80,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Coventry,Commercial,LT,760.32,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,inpatient,,,792.00000,316.80000,Coventry,Commercial,RT,760.32,,,,,,,712.80,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Coventry,Commercial,RT,760.32,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,inpatient,,,572.00000,228.80000,Coventry,Commercial,50,549.12,,,,,,,514.80,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,outpatient,,,572.00000,228.80000,Coventry,Commercial,50,549.12,,,,,,,148.72,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,inpatient,,,381.00000,152.40000,Coventry,Commercial,LT,365.76,,,,,,,342.90,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Coventry,Commercial,LT,365.76,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,inpatient,,,381.00000,152.40000,Coventry,Commercial,RT,365.76,,,,,,,342.90,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Coventry,Commercial,RT,365.76,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,inpatient,,,683.00000,273.20000,Coventry,Commercial,50,655.68,,,,,,,614.70,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,outpatient,,,683.00000,273.20000,Coventry,Commercial,50,655.68,,,,,,,177.58,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,inpatient,,,455.00000,182.00000,Coventry,Commercial,LT,436.80,,,,,,,409.50,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Coventry,Commercial,LT,436.80,,,,,,,118.30,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,inpatient,,,455.00000,182.00000,Coventry,Commercial,RT,436.80,,,,,,,409.50,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Coventry,Commercial,RT,436.80,,,,,,,118.30,441.35,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,inpatient,,,357.00000,142.80000,Coventry,Commercial,,342.72,,,,,,,321.30,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,outpatient,,,357.00000,142.80000,Coventry,Commercial,,342.72,,,,,,,92.82,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,inpatient,,,334.00000,133.60000,Coventry,Commercial,,320.64,,,,,,,300.60,323.98,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,outpatient,,,334.00000,133.60000,Coventry,Commercial,,320.64,,,,,,,86.84,323.98,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,inpatient,,,194.00000,77.60000,Coventry,Commercial,,186.24,,,,,,,174.60,188.18,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,outpatient,,,194.00000,77.60000,Coventry,Commercial,,186.24,,,,,,,50.44,188.18,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,inpatient,,,608.00000,243.20000,Coventry,Commercial,,583.68,,,,,,,547.20,589.76,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,outpatient,,,608.00000,243.20000,Coventry,Commercial,,583.68,,,,,,,158.08,589.76,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,inpatient,,,257.00000,102.80000,Coventry,Commercial,,246.72,,,,,,,231.30,249.29,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,outpatient,,,257.00000,102.80000,Coventry,Commercial,,246.72,,,,,,,66.82,249.29,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,inpatient,,,343.00000,137.20000,Coventry,Commercial,,329.28,,,,,,,308.70,332.71,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,outpatient,,,343.00000,137.20000,Coventry,Commercial,,329.28,,,,,,,89.18,332.71,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,inpatient,,,457.00000,182.80000,Coventry,Commercial,,438.72,,,,,,,411.30,443.29,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,outpatient,,,457.00000,182.80000,Coventry,Commercial,,438.72,,,,,,,118.82,443.29,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,inpatient,,,630.00000,252.00000,Coventry,Commercial,,604.80,,,,,,,567.00,611.10,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,outpatient,,,630.00000,252.00000,Coventry,Commercial,,604.80,,,,,,,163.80,611.10,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,inpatient,,,623.00000,249.20000,Coventry,Commercial,,598.08,,,,,,,560.70,604.31,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,outpatient,,,623.00000,249.20000,Coventry,Commercial,,598.08,,,,,,,161.98,604.31,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,inpatient,,,1457.00000,582.80000,Coventry,Commercial,,1398.72,,,,,,,1311.30,1413.29,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,outpatient,,,1457.00000,582.80000,Coventry,Commercial,,1398.72,,,,,,,378.82,1413.29,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,inpatient,,,890.00000,356.00000,Coventry,Commercial,,854.40,,,,,,,801.00,863.30,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,outpatient,,,890.00000,356.00000,Coventry,Commercial,,854.40,,,,,,,231.40,863.30,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,inpatient,,,532.00000,212.80000,Coventry,Commercial,,510.72,,,,,,,478.80,516.04,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,outpatient,,,532.00000,212.80000,Coventry,Commercial,,510.72,,,,,,,138.32,516.04,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,inpatient,,,492.00000,196.80000,Coventry,Commercial,,472.32,,,,,,,442.80,477.24,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,outpatient,,,492.00000,196.80000,Coventry,Commercial,,472.32,,,,,,,127.92,477.24,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,inpatient,,,550.00000,220.00000,Coventry,Commercial,,528.00,,,,,,,495.00,533.50,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,outpatient,,,550.00000,220.00000,Coventry,Commercial,,528.00,,,,,,,143.00,533.50,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,inpatient,,,305.00000,122.00000,Coventry,Commercial,,292.80,,,,,,,274.50,295.85,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,outpatient,,,305.00000,122.00000,Coventry,Commercial,,292.80,,,,,,,79.30,295.85,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,inpatient,,,220.00000,88.00000,Coventry,Commercial,,211.20,,,,,,,198.00,213.40,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,outpatient,,,220.00000,88.00000,Coventry,Commercial,,211.20,,,,,,,57.20,213.40,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,inpatient,,,780.00000,312.00000,Coventry,Commercial,,748.80,,,,,,,702.00,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,outpatient,,,780.00000,312.00000,Coventry,Commercial,,748.80,,,,,,,202.80,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,inpatient,,,1165.00000,466.00000,Coventry,Commercial,,1118.40,,,,,,,1048.50,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,outpatient,,,1165.00000,466.00000,Coventry,Commercial,,1118.40,,,,,,,302.90,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,inpatient,,,2350.00000,940.00000,Coventry,Commercial,,2256.00,,,,,,,2115.00,2279.50,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,outpatient,,,2350.00000,940.00000,Coventry,Commercial,,2256.00,,,,,,,611.00,2279.50,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,inpatient,,,896.00000,358.40000,Coventry,Commercial,,860.16,,,,,,,806.40,869.12,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,outpatient,,,896.00000,358.40000,Coventry,Commercial,,860.16,,,,,,,232.96,869.12,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,inpatient,,,385.00000,154.00000,Coventry,Commercial,,369.60,,,,,,,346.50,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,outpatient,,,385.00000,154.00000,Coventry,Commercial,,369.60,,,,,,,100.10,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,inpatient,,,470.00000,188.00000,Coventry,Commercial,,451.20,,,,,,,423.00,455.90,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,outpatient,,,470.00000,188.00000,Coventry,Commercial,,451.20,,,,,,,122.20,455.90,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,inpatient,,,150.00000,60.00000,Coventry,Commercial,,144.00,,,,,,,135.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,outpatient,,,150.00000,60.00000,Coventry,Commercial,,144.00,,,,,,,39.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,inpatient,,,100.00000,40.00000,Coventry,Commercial,,96.00,,,,,,,90.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,outpatient,,,100.00000,40.00000,Coventry,Commercial,,96.00,,,,,,,26.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,inpatient,,,143.00000,57.20000,Coventry,Commercial,,137.28,,,,,,,128.70,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,outpatient,,,143.00000,57.20000,Coventry,Commercial,,137.28,,,,,,,37.18,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,inpatient,,,95.00000,38.00000,Coventry,Commercial,,91.20,,,,,,,85.50,92.15,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,outpatient,,,95.00000,38.00000,Coventry,Commercial,,91.20,,,,,,,24.70,92.15,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,inpatient,,,269.00000,107.60000,Coventry,Commercial,,258.24,,,,,,,242.10,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,outpatient,,,269.00000,107.60000,Coventry,Commercial,,258.24,,,,,,,69.94,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,inpatient,,,388.00000,155.20000,Coventry,Commercial,,372.48,,,,,,,349.20,376.36,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,outpatient,,,388.00000,155.20000,Coventry,Commercial,,372.48,,,,,,,100.88,376.36,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,inpatient,,,344.00000,137.60000,Coventry,Commercial,,330.24,,,,,,,309.60,333.68,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,outpatient,,,344.00000,137.60000,Coventry,Commercial,,330.24,,,,,,,89.44,333.68,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,inpatient,,,321.00000,128.40000,Coventry,Commercial,,308.16,,,,,,,288.90,311.37,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,outpatient,,,321.00000,128.40000,Coventry,Commercial,,308.16,,,,,,,83.46,311.37,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,inpatient,,,155.00000,62.00000,Coventry,Commercial,,148.80,,,,,,,139.50,150.35,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,outpatient,,,155.00000,62.00000,Coventry,Commercial,,148.80,,,,,,,40.30,150.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,inpatient,,,817.00000,326.80000,Coventry,Commercial,,784.32,,,,,,,735.30,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,outpatient,,,817.00000,326.80000,Coventry,Commercial,,784.32,,,,,,,212.42,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,inpatient,,,1255.00000,502.00000,Coventry,Commercial,,1204.80,,,,,,,1129.50,1217.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,outpatient,,,1255.00000,502.00000,Coventry,Commercial,,1204.80,,,,,,,326.30,1217.35,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,inpatient,,,391.00000,156.40000,Coventry,Commercial,,375.36,,,,,,,351.90,379.27,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,outpatient,,,391.00000,156.40000,Coventry,Commercial,,375.36,,,,,,,101.66,379.27,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,inpatient,,,671.00000,268.40000,Coventry,Commercial,,644.16,,,,,,,603.90,650.87,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,outpatient,,,671.00000,268.40000,Coventry,Commercial,,644.16,,,,,,,174.46,650.87,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,inpatient,,,456.00000,182.40000,Coventry,Commercial,,437.76,,,,,,,410.40,442.32,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,outpatient,,,456.00000,182.40000,Coventry,Commercial,,437.76,,,,,,,118.56,442.32,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,inpatient,,,112.00000,44.80000,Coventry,Commercial,,107.52,,,,,,,100.80,108.64,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,outpatient,,,112.00000,44.80000,Coventry,Commercial,,107.52,,,,,,,29.12,108.64,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,inpatient,,,84.00000,33.60000,Coventry,Commercial,,80.64,,,,,,,75.60,81.48,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,outpatient,,,84.00000,33.60000,Coventry,Commercial,,80.64,,,,,,,21.84,81.48,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,inpatient,,,216.00000,86.40000,Coventry,Commercial,,207.36,,,,,,,194.40,209.52,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,outpatient,,,216.00000,86.40000,Coventry,Commercial,,207.36,,,,,,,56.16,209.52,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,inpatient,,,2660.00000,1064.00000,Coventry,Commercial,,2553.60,,,,,,,2394.00,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,outpatient,,,2660.00000,1064.00000,Coventry,Commercial,,2553.60,,,,,,,691.60,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,inpatient,,,2960.00000,1184.00000,Coventry,Commercial,,2841.60,,,,,,,2664.00,2871.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,outpatient,,,2960.00000,1184.00000,Coventry,Commercial,,2841.60,,,,,,,769.60,2871.20,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,inpatient,,,3225.00000,1290.00000,Coventry,Commercial,,3096.00,,,,,,,2902.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,outpatient,,,3225.00000,1290.00000,Coventry,Commercial,,3096.00,,,,,,,838.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,inpatient,,,3395.00000,1358.00000,Coventry,Commercial,,3259.20,,,,,,,3055.50,3293.15,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,outpatient,,,3395.00000,1358.00000,Coventry,Commercial,,3259.20,,,,,,,882.70,3293.15,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,inpatient,,,490.00000,196.00000,Coventry,Commercial,,470.40,,,,,,,441.00,475.30,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,outpatient,,,490.00000,196.00000,Coventry,Commercial,,470.40,,,,,,,127.40,475.30,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,inpatient,,,520.00000,208.00000,Coventry,Commercial,,499.20,,,,,,,468.00,504.40,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,outpatient,,,520.00000,208.00000,Coventry,Commercial,,499.20,,,,,,,135.20,504.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,inpatient,,,720.00000,288.00000,Coventry,Commercial,,691.20,,,,,,,648.00,698.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,outpatient,,,720.00000,288.00000,Coventry,Commercial,,691.20,,,,,,,187.20,698.40,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,inpatient,,,215.00000,86.00000,Coventry,Commercial,,206.40,,,,,,,193.50,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,outpatient,,,215.00000,86.00000,Coventry,Commercial,,206.40,,,,,,,55.90,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,inpatient,,,240.00000,96.00000,Coventry,Commercial,,230.40,,,,,,,216.00,232.80,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,outpatient,,,240.00000,96.00000,Coventry,Commercial,,230.40,,,,,,,62.40,232.80,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,inpatient,,,1241.00000,496.40000,Coventry,Commercial,,1191.36,,,,,,,1116.90,1203.77,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,outpatient,,,1241.00000,496.40000,Coventry,Commercial,,1191.36,,,,,,,322.66,1203.77,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,inpatient,,,850.00000,340.00000,Coventry,Commercial,,816.00,,,,,,,765.00,824.50,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,outpatient,,,850.00000,340.00000,Coventry,Commercial,,816.00,,,,,,,221.00,824.50,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,inpatient,,,1085.00000,434.00000,Coventry,Commercial,,1041.60,,,,,,,976.50,1052.45,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,outpatient,,,1085.00000,434.00000,Coventry,Commercial,,1041.60,,,,,,,282.10,1052.45,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,inpatient,,,295.00000,118.00000,Coventry,Commercial,,283.20,,,,,,,265.50,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Coventry,Commercial,,283.20,,,,,,,76.70,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,inpatient,,,492.00000,196.80000,Coventry,Commercial,,472.32,,,,,,,442.80,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,outpatient,,,492.00000,196.80000,Coventry,Commercial,,472.32,,,,,,,127.92,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,inpatient,,,563.00000,225.20000,Coventry,Commercial,,540.48,,,,,,,506.70,546.11,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,outpatient,,,563.00000,225.20000,Coventry,Commercial,,540.48,,,,,,,146.38,546.11,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,inpatient,,,1612.00000,644.80000,Coventry,Commercial,,1547.52,,,,,,,1450.80,1563.64,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,outpatient,,,1612.00000,644.80000,Coventry,Commercial,,1547.52,,,,,,,419.12,1563.64,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,inpatient,,,1366.00000,546.40000,Coventry,Commercial,,1311.36,,,,,,,1229.40,1325.02,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,outpatient,,,1366.00000,546.40000,Coventry,Commercial,,1311.36,,,,,,,355.16,1325.02,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,inpatient,,,1911.00000,764.40000,Coventry,Commercial,,1834.56,,,,,,,1719.90,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,outpatient,,,1911.00000,764.40000,Coventry,Commercial,,1834.56,,,,,,,496.86,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,inpatient,,,956.00000,382.40000,Coventry,Commercial,,917.76,,,,,,,860.40,927.32,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,outpatient,,,956.00000,382.40000,Coventry,Commercial,,917.76,,,,,,,248.56,927.32,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,inpatient,,,189.00000,123.20000,Coventry,Commercial,,181.44,,,,,,,170.10,183.33,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,outpatient,,,189.00000,123.20000,Coventry,Commercial,,181.44,,,,,,,49.14,183.33,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,inpatient,,,352.00000,256.87000,Coventry,Commercial,,337.92,,,,,,,316.80,341.44,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,outpatient,,,352.00000,256.87000,Coventry,Commercial,,337.92,,,,,,,91.52,341.44,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,inpatient,,,625.00000,738.40000,Coventry,Commercial,,600.00,,,,,,,562.50,606.25,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,outpatient,,,625.00000,738.40000,Coventry,Commercial,,600.00,,,,,,,162.50,606.25,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,inpatient,,,1024.00000,2097.47000,Coventry,Commercial,,983.04,,,,,,,921.60,993.28,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1024.00000,2097.47000,Coventry,Commercial,,983.04,,,,,,,266.24,993.28,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,inpatient,,,1455.00000,2469.72000,Coventry,Commercial,,1396.80,,,,,,,1309.50,1411.35,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,outpatient,,,1455.00000,2469.72000,Coventry,Commercial,,1396.80,,,,,,,378.30,1411.35,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,inpatient,,,145.00000,75.54000,Coventry,Commercial,,139.20,,,,,,,130.50,140.65,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Coventry,Commercial,,139.20,,,,,,,37.70,140.65,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,inpatient,,,488.00000,254.25000,Coventry,Commercial,,468.48,,,,,,,439.20,473.36,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Coventry,Commercial,,468.48,,,,,,,126.88,473.36,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Coventry,Commercial,,111.36,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Coventry,Commercial,,111.36,,,,,,,30.16,112.52,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Coventry,Commercial,,77.76,,,,,,,72.90,78.57,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Coventry,Commercial,,77.76,,,,,,,21.06,78.57,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Coventry,Commercial,,39.36,,,,,,,36.90,39.77,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Coventry,Commercial,,39.36,,,,,,,10.66,39.77,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,inpatient,,,170.00000,73.95000,Coventry,Commercial,,163.20,,,,,,,153.00,164.90,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,outpatient,,,170.00000,73.95000,Coventry,Commercial,,163.20,,,,,,,44.20,164.90,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,2.70000,1.17000,Coventry,Commercial,,2.59,,,,,,,2.43,2.62,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,2.70000,1.17000,Coventry,Commercial,,2.59,,,,,,,0.70200,2.62,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,27.00000,11.74000,Coventry,Commercial,,25.92,,,,,,,24.30,26.19,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,27.00000,11.74000,Coventry,Commercial,,25.92,,,,,,,7.02,26.19,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,inpatient,,,20440.00000,8891.40000,Coventry,Commercial,,19622.40,,,,,,,18396.00,19826.80,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,outpatient,,,20440.00000,8891.40000,Coventry,Commercial,,19622.40,,,,,,,5314.40,19826.80,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,inpatient,,,3322.00000,1445.07000,Coventry,Commercial,,3189.12,,,,,,,2989.80,3222.34,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,3322.00000,1445.07000,Coventry,Commercial,,3189.12,,,,,,,863.72,3222.34,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,inpatient,,,2492.00000,1084.02000,Coventry,Commercial,,2392.32,,,,,,,2242.80,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,2492.00000,1084.02000,Coventry,Commercial,,2392.32,,,,,,,647.92,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,inpatient,,,1814.00000,789.09000,Coventry,Commercial,,1741.44,,,,,,,1632.60,1759.58,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1814.00000,789.09000,Coventry,Commercial,,1741.44,,,,,,,471.64,1759.58,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,inpatient,,,2153.00000,936.56000,Coventry,Commercial,,2066.88,,,,,,,1937.70,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,2153.00000,936.56000,Coventry,Commercial,,2066.88,,,,,,,559.78,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,inpatient,,,1525.00000,663.38000,Coventry,Commercial,,1464.00,,,,,,,1372.50,1479.25,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1525.00000,663.38000,Coventry,Commercial,,1464.00,,,,,,,396.50,1479.25,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,inpatient,,,2716.00000,1181.46000,Coventry,Commercial,,2607.36,,,,,,,2444.40,2634.52,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2716.00000,1181.46000,Coventry,Commercial,,2607.36,,,,,,,706.16,2634.52,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,inpatient,,,2.70000,0.39000,Coventry,Commercial,,2.59,,,,,,,2.43,2.62,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,outpatient,,,2.70000,0.39000,Coventry,Commercial,,2.59,,,,,,,0.70200,2.62,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,inpatient,,,222.00000,32.41000,Coventry,Commercial,,213.12,,,,,,,199.80,215.34,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,outpatient,,,222.00000,32.41000,Coventry,Commercial,,213.12,,,,,,,57.72,215.34,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,inpatient,,,211.00000,113.10000,Coventry,Commercial,,202.56,,,,,,,189.90,204.67,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,outpatient,,,211.00000,113.10000,Coventry,Commercial,,202.56,,,,,,,54.86,204.67,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,inpatient,,,497.00000,266.39000,Coventry,Commercial,,477.12,,,,,,,447.30,482.09,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,outpatient,,,497.00000,266.39000,Coventry,Commercial,,477.12,,,,,,,129.22,482.09,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,inpatient,,,296.00000,158.66000,Coventry,Commercial,,284.16,,,,,,,266.40,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,outpatient,,,296.00000,158.66000,Coventry,Commercial,,284.16,,,,,,,76.96,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,inpatient,,,723.00000,387.53000,Coventry,Commercial,,694.08,,,,,,,650.70,701.31,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,outpatient,,,723.00000,387.53000,Coventry,Commercial,,694.08,,,,,,,187.98,701.31,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,inpatient,,,326.00000,174.74000,Coventry,Commercial,,312.96,,,,,,,293.40,316.22,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,outpatient,,,326.00000,174.74000,Coventry,Commercial,,312.96,,,,,,,84.76,316.22,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,inpatient,,,532.00000,285.15000,Coventry,Commercial,,510.72,,,,,,,478.80,516.04,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,outpatient,,,532.00000,285.15000,Coventry,Commercial,,510.72,,,,,,,138.32,516.04,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,inpatient,,,635.00000,340.36000,Coventry,Commercial,,609.60,,,,,,,571.50,615.95,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,outpatient,,,635.00000,340.36000,Coventry,Commercial,,609.60,,,,,,,165.10,615.95,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,inpatient,,,639.00000,342.50000,Coventry,Commercial,,613.44,,,,,,,575.10,619.83,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,outpatient,,,639.00000,342.50000,Coventry,Commercial,,613.44,,,,,,,166.14,619.83,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,inpatient,,,780.00000,418.08000,Coventry,Commercial,,748.80,,,,,,,702.00,756.60,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,outpatient,,,780.00000,418.08000,Coventry,Commercial,,748.80,,,,,,,202.80,756.60,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,inpatient,,,390.00000,209.04000,Coventry,Commercial,,374.40,,,,,,,351.00,378.30,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,outpatient,,,390.00000,209.04000,Coventry,Commercial,,374.40,,,,,,,101.40,378.30,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,inpatient,,,731.00000,391.82000,Coventry,Commercial,,701.76,,,,,,,657.90,709.07,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,outpatient,,,731.00000,391.82000,Coventry,Commercial,,701.76,,,,,,,190.06,709.07,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,inpatient,,,585.00000,313.56000,Coventry,Commercial,,561.60,,,,,,,526.50,567.45,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,outpatient,,,585.00000,313.56000,Coventry,Commercial,,561.60,,,,,,,152.10,567.45,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,inpatient,,,365.00000,195.64000,Coventry,Commercial,,350.40,,,,,,,328.50,354.05,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,outpatient,,,365.00000,195.64000,Coventry,Commercial,,350.40,,,,,,,94.90,354.05,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,inpatient,,,1086.00000,582.10000,Coventry,Commercial,,1042.56,,,,,,,977.40,1053.42,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,outpatient,,,1086.00000,582.10000,Coventry,Commercial,,1042.56,,,,,,,282.36,1053.42,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,inpatient,,,197.00000,105.59000,Coventry,Commercial,,189.12,,,,,,,177.30,191.09,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,outpatient,,,197.00000,105.59000,Coventry,Commercial,,189.12,,,,,,,51.22,191.09,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,inpatient,,,2774.00000,1486.86000,Coventry,Commercial,,2663.04,,,,,,,2496.60,2690.78,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,outpatient,,,2774.00000,1486.86000,Coventry,Commercial,,2663.04,,,,,,,721.24,2690.78,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,inpatient,,,1456.00000,780.42000,Coventry,Commercial,,1397.76,,,,,,,1310.40,1412.32,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,outpatient,,,1456.00000,780.42000,Coventry,Commercial,,1397.76,,,,,,,378.56,1412.32,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,inpatient,,,2647.00000,1418.79000,Coventry,Commercial,,2541.12,,,,,,,2382.30,2567.59,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,outpatient,,,2647.00000,1418.79000,Coventry,Commercial,,2541.12,,,,,,,688.22,2567.59,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,inpatient,,,1359.00000,728.42000,Coventry,Commercial,,1304.64,,,,,,,1223.10,1318.23,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,outpatient,,,1359.00000,728.42000,Coventry,Commercial,,1304.64,,,,,,,353.34,1318.23,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,inpatient,,,273.00000,146.33000,Coventry,Commercial,,262.08,,,,,,,245.70,264.81,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,outpatient,,,273.00000,146.33000,Coventry,Commercial,,262.08,,,,,,,70.98,264.81,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,inpatient,,,325.00000,174.20000,Coventry,Commercial,,312.00,,,,,,,292.50,315.25,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,outpatient,,,325.00000,174.20000,Coventry,Commercial,,312.00,,,,,,,84.50,315.25,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,inpatient,,,609.00000,326.42000,Coventry,Commercial,,584.64,,,,,,,548.10,590.73,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Coventry,Commercial,,584.64,,,,,,,158.34,590.73,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,inpatient,,,491.00000,263.18000,Coventry,Commercial,,471.36,,,,,,,441.90,476.27,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,outpatient,,,491.00000,263.18000,Coventry,Commercial,,471.36,,,,,,,127.66,476.27,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,inpatient,,,561.00000,300.70000,Coventry,Commercial,,538.56,,,,,,,504.90,544.17,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,outpatient,,,561.00000,300.70000,Coventry,Commercial,,538.56,,,,,,,145.86,544.17,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,inpatient,,,845.00000,452.92000,Coventry,Commercial,,811.20,,,,,,,760.50,819.65,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,outpatient,,,845.00000,452.92000,Coventry,Commercial,,811.20,,,,,,,219.70,819.65,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,inpatient,,,612.00000,328.03000,Coventry,Commercial,,587.52,,,,,,,550.80,593.64,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,outpatient,,,612.00000,328.03000,Coventry,Commercial,,587.52,,,,,,,159.12,593.64,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,inpatient,,,536.00000,287.30000,Coventry,Commercial,,514.56,,,,,,,482.40,519.92,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,outpatient,,,536.00000,287.30000,Coventry,Commercial,,514.56,,,,,,,139.36,519.92,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,inpatient,,,1225.00000,656.60000,Coventry,Commercial,,1176.00,,,,,,,1102.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,outpatient,,,1225.00000,656.60000,Coventry,Commercial,,1176.00,,,,,,,318.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,inpatient,,,816.00000,437.38000,Coventry,Commercial,LT,783.36,,,,,,,734.40,791.52,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Coventry,Commercial,LT,783.36,,,,,,,212.16,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,inpatient,,,816.00000,437.38000,Coventry,Commercial,RT,783.36,,,,,,,734.40,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Coventry,Commercial,RT,783.36,,,,,,,212.16,791.52,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,inpatient,,,250.00000,134.00000,Coventry,Commercial,,240.00,,,,,,,225.00,242.50,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,outpatient,,,250.00000,134.00000,Coventry,Commercial,,240.00,,,,,,,65.00,242.50,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,inpatient,,,302.00000,161.87000,Coventry,Commercial,,289.92,,,,,,,271.80,292.94,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,outpatient,,,302.00000,161.87000,Coventry,Commercial,,289.92,,,,,,,78.52,292.94,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,inpatient,,,354.00000,189.74000,Coventry,Commercial,,339.84,,,,,,,318.60,343.38,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,outpatient,,,354.00000,189.74000,Coventry,Commercial,,339.84,,,,,,,92.04,343.38,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,inpatient,,,409.00000,219.22000,Coventry,Commercial,,392.64,,,,,,,368.10,396.73,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,outpatient,,,409.00000,219.22000,Coventry,Commercial,,392.64,,,,,,,106.34,396.73,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,inpatient,,,593.00000,317.85000,Coventry,Commercial,,569.28,,,,,,,533.70,575.21,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,outpatient,,,593.00000,317.85000,Coventry,Commercial,,569.28,,,,,,,154.18,575.21,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Coventry,Commercial,LT,294.72,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Coventry,Commercial,LT,294.72,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Coventry,Commercial,"52,LT",294.72,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Coventry,Commercial,"52,LT",294.72,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Coventry,Commercial,RT,294.72,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Coventry,Commercial,RT,294.72,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Coventry,Commercial,"52,RT",294.72,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Coventry,Commercial,"52,RT",294.72,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,inpatient,,,330.00000,176.88000,Coventry,Commercial,LT,316.80,,,,,,,297.00,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Coventry,Commercial,LT,316.80,,,,,,,85.80,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,inpatient,,,330.00000,176.88000,Coventry,Commercial,RT,316.80,,,,,,,297.00,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Coventry,Commercial,RT,316.80,,,,,,,85.80,320.10,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,inpatient,,,195.00000,104.52000,Coventry,Commercial,,187.20,,,,,,,175.50,189.15,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,outpatient,,,195.00000,104.52000,Coventry,Commercial,,187.20,,,,,,,50.70,189.15,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,inpatient,,,578.00000,309.81000,Coventry,Commercial,,554.88,,,,,,,520.20,560.66,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,outpatient,,,578.00000,309.81000,Coventry,Commercial,,554.88,,,,,,,150.28,560.66,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,inpatient,,,384.00000,205.82000,Coventry,Commercial,,368.64,,,,,,,345.60,372.48,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,outpatient,,,384.00000,205.82000,Coventry,Commercial,,368.64,,,,,,,99.84,372.48,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,inpatient,,,303.00000,162.41000,Coventry,Commercial,LT,290.88,,,,,,,272.70,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Coventry,Commercial,LT,290.88,,,,,,,78.78,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,inpatient,,,303.00000,162.41000,Coventry,Commercial,RT,290.88,,,,,,,272.70,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Coventry,Commercial,RT,290.88,,,,,,,78.78,293.91,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,inpatient,,,445.00000,238.52000,Coventry,Commercial,LT,427.20,,,,,,,400.50,431.65,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Coventry,Commercial,LT,427.20,,,,,,,115.70,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,inpatient,,,445.00000,238.52000,Coventry,Commercial,RT,427.20,,,,,,,400.50,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Coventry,Commercial,RT,427.20,,,,,,,115.70,431.65,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,inpatient,,,937.00000,502.23000,Coventry,Commercial,,899.52,,,,,,,843.30,908.89,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,outpatient,,,937.00000,502.23000,Coventry,Commercial,,899.52,,,,,,,243.62,908.89,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,inpatient,,,615.00000,329.64000,Coventry,Commercial,,590.40,,,,,,,553.50,596.55,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,outpatient,,,615.00000,329.64000,Coventry,Commercial,,590.40,,,,,,,159.90,596.55,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Coventry,Commercial,LT,275.52,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Coventry,Commercial,LT,275.52,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Coventry,Commercial,"52,LT",275.52,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Coventry,Commercial,"52,LT",275.52,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Coventry,Commercial,RT,275.52,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Coventry,Commercial,RT,275.52,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Coventry,Commercial,"52,RT",275.52,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Coventry,Commercial,"52,RT",275.52,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,inpatient,,,323.00000,173.13000,Coventry,Commercial,LT,310.08,,,,,,,290.70,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Coventry,Commercial,LT,310.08,,,,,,,83.98,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,inpatient,,,323.00000,173.13000,Coventry,Commercial,RT,310.08,,,,,,,290.70,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Coventry,Commercial,RT,310.08,,,,,,,83.98,313.31,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,inpatient,,,694.00000,371.98000,Coventry,Commercial,,666.24,,,,,,,624.60,673.18,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,outpatient,,,694.00000,371.98000,Coventry,Commercial,,666.24,,,,,,,180.44,673.18,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,inpatient,,,276.00000,147.94000,Coventry,Commercial,LT,264.96,,,,,,,248.40,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Coventry,Commercial,LT,264.96,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,inpatient,,,276.00000,147.94000,Coventry,Commercial,RT,264.96,,,,,,,248.40,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Coventry,Commercial,RT,264.96,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,inpatient,,,254.00000,136.14000,Coventry,Commercial,LT,243.84,,,,,,,228.60,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Coventry,Commercial,LT,243.84,,,,,,,66.04,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,inpatient,,,254.00000,136.14000,Coventry,Commercial,RT,243.84,,,,,,,228.60,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Coventry,Commercial,RT,243.84,,,,,,,66.04,246.38,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,inpatient,,,275.00000,147.40000,Coventry,Commercial,LT,264.00,,,,,,,247.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Coventry,Commercial,LT,264.00,,,,,,,71.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,inpatient,,,275.00000,147.40000,Coventry,Commercial,RT,264.00,,,,,,,247.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Coventry,Commercial,RT,264.00,,,,,,,71.50,266.75,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,inpatient,,,173.00000,92.73000,Coventry,Commercial,,166.08,,,,,,,155.70,167.81,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,outpatient,,,173.00000,92.73000,Coventry,Commercial,,166.08,,,,,,,44.98,167.81,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,inpatient,,,483.00000,258.89000,Coventry,Commercial,LT,463.68,,,,,,,434.70,468.51,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Coventry,Commercial,LT,463.68,,,,,,,125.58,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,inpatient,,,483.00000,258.89000,Coventry,Commercial,RT,463.68,,,,,,,434.70,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Coventry,Commercial,RT,463.68,,,,,,,125.58,468.51,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,inpatient,,,191.00000,102.38000,Coventry,Commercial,LT,183.36,,,,,,,171.90,185.27,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Coventry,Commercial,LT,183.36,,,,,,,49.66,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,inpatient,,,191.00000,102.38000,Coventry,Commercial,RT,183.36,,,,,,,171.90,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Coventry,Commercial,RT,183.36,,,,,,,49.66,185.27,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Coventry,Commercial,LT,142.08,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Coventry,Commercial,LT,142.08,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Coventry,Commercial,"52,LT",142.08,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Coventry,Commercial,"52,LT",142.08,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Coventry,Commercial,RT,142.08,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Coventry,Commercial,RT,142.08,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Coventry,Commercial,"52,RT",142.08,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Coventry,Commercial,"52,RT",142.08,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,inpatient,,,481.00000,257.82000,Coventry,Commercial,LT,461.76,,,,,,,432.90,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Coventry,Commercial,LT,461.76,,,,,,,125.06,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,inpatient,,,481.00000,257.82000,Coventry,Commercial,RT,461.76,,,,,,,432.90,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Coventry,Commercial,RT,461.76,,,,,,,125.06,466.57,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,inpatient,,,215.00000,115.24000,Coventry,Commercial,LT,206.40,,,,,,,193.50,208.55,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Coventry,Commercial,LT,206.40,,,,,,,55.90,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,inpatient,,,215.00000,115.24000,Coventry,Commercial,RT,206.40,,,,,,,193.50,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Coventry,Commercial,RT,206.40,,,,,,,55.90,208.55,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Coventry,Commercial,LT,264.00,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Coventry,Commercial,LT,264.00,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Coventry,Commercial,"52,LT",264.00,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Coventry,Commercial,"52,LT",264.00,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Coventry,Commercial,RT,264.00,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Coventry,Commercial,RT,264.00,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Coventry,Commercial,"52,RT",264.00,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Coventry,Commercial,"52,RT",264.00,,,,,,,71.50,266.75,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Coventry,Commercial,LT,436.80,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Coventry,Commercial,LT,436.80,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Coventry,Commercial,"52,LT",436.80,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Coventry,Commercial,"52,LT",436.80,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Coventry,Commercial,RT,436.80,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Coventry,Commercial,RT,436.80,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Coventry,Commercial,"52,RT",436.80,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Coventry,Commercial,"52,RT",436.80,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,inpatient,,,503.00000,269.61000,Coventry,Commercial,LT,482.88,,,,,,,452.70,487.91,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Coventry,Commercial,LT,482.88,,,,,,,130.78,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,inpatient,,,503.00000,269.61000,Coventry,Commercial,RT,482.88,,,,,,,452.70,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Coventry,Commercial,RT,482.88,,,,,,,130.78,487.91,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,inpatient,,,209.00000,112.02000,Coventry,Commercial,LT,200.64,,,,,,,188.10,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Coventry,Commercial,LT,200.64,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,inpatient,,,209.00000,112.02000,Coventry,Commercial,RT,200.64,,,,,,,188.10,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Coventry,Commercial,RT,200.64,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,inpatient,,,566.00000,303.38000,Coventry,Commercial,LT,543.36,,,,,,,509.40,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Coventry,Commercial,LT,543.36,,,,,,,147.16,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,inpatient,,,566.00000,303.38000,Coventry,Commercial,RT,543.36,,,,,,,509.40,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Coventry,Commercial,RT,543.36,,,,,,,147.16,549.02,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,inpatient,,,598.00000,320.53000,Coventry,Commercial,,574.08,,,,,,,538.20,580.06,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,outpatient,,,598.00000,320.53000,Coventry,Commercial,,574.08,,,,,,,155.48,580.06,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Coventry,Commercial,"52,LT",436.80,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Coventry,Commercial,"52,LT",436.80,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Coventry,Commercial,"52,RT",436.80,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Coventry,Commercial,"52,RT",436.80,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Coventry,Commercial,LT,436.80,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Coventry,Commercial,LT,436.80,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Coventry,Commercial,RT,436.80,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Coventry,Commercial,RT,436.80,,,,,,,118.30,441.35,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,inpatient,,,1913.00000,1025.37000,Coventry,Commercial,,1836.48,,,,,,,1721.70,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,outpatient,,,1913.00000,1025.37000,Coventry,Commercial,,1836.48,,,,,,,497.38,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,inpatient,,,312.00000,167.23000,Coventry,Commercial,,299.52,,,,,,,280.80,302.64,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,outpatient,,,312.00000,167.23000,Coventry,Commercial,,299.52,,,,,,,81.12,302.64,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,inpatient,,,327.00000,175.27000,Coventry,Commercial,,313.92,,,,,,,294.30,317.19,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,outpatient,,,327.00000,175.27000,Coventry,Commercial,,313.92,,,,,,,85.02,317.19,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,inpatient,,,425.00000,227.80000,Coventry,Commercial,,408.00,,,,,,,382.50,412.25,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,outpatient,,,425.00000,227.80000,Coventry,Commercial,,408.00,,,,,,,110.50,412.25,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,inpatient,,,210.00000,112.56000,Coventry,Commercial,,201.60,,,,,,,189.00,203.70,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,outpatient,,,210.00000,112.56000,Coventry,Commercial,,201.60,,,,,,,54.60,203.70,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,inpatient,,,495.00000,265.32000,Coventry,Commercial,,475.20,,,,,,,445.50,480.15,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,outpatient,,,495.00000,265.32000,Coventry,Commercial,,475.20,,,,,,,128.70,480.15,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,inpatient,,,541.00000,289.98000,Coventry,Commercial,,519.36,,,,,,,486.90,524.77,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,outpatient,,,541.00000,289.98000,Coventry,Commercial,,519.36,,,,,,,140.66,524.77,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,inpatient,,,345.00000,184.92000,Coventry,Commercial,LT,331.20,,,,,,,310.50,334.65,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Coventry,Commercial,LT,331.20,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,inpatient,,,345.00000,184.92000,Coventry,Commercial,RT,331.20,,,,,,,310.50,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Coventry,Commercial,RT,331.20,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,inpatient,,,419.00000,224.58000,Coventry,Commercial,LT,402.24,,,,,,,377.10,406.43,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Coventry,Commercial,LT,402.24,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,inpatient,,,419.00000,224.58000,Coventry,Commercial,RT,402.24,,,,,,,377.10,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Coventry,Commercial,RT,402.24,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,inpatient,,,618.00000,331.25000,Coventry,Commercial,LT,593.28,,,,,,,556.20,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Coventry,Commercial,LT,593.28,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,inpatient,,,618.00000,331.25000,Coventry,Commercial,RT,593.28,,,,,,,556.20,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Coventry,Commercial,RT,593.28,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,inpatient,,,463.00000,248.17000,Coventry,Commercial,,444.48,,,,,,,416.70,449.11,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,outpatient,,,463.00000,248.17000,Coventry,Commercial,,444.48,,,,,,,120.38,449.11,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,inpatient,,,511.00000,273.90000,Coventry,Commercial,,490.56,,,,,,,459.90,495.67,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,outpatient,,,511.00000,273.90000,Coventry,Commercial,,490.56,,,,,,,132.86,495.67,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,inpatient,,,132.00000,70.75000,Coventry,Commercial,,126.72,,,,,,,118.80,128.04,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,outpatient,,,132.00000,70.75000,Coventry,Commercial,,126.72,,,,,,,34.32,128.04,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,inpatient,,,353.00000,189.21000,Coventry,Commercial,LT,338.88,,,,,,,317.70,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Coventry,Commercial,LT,338.88,,,,,,,91.78,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,inpatient,,,353.00000,189.21000,Coventry,Commercial,RT,338.88,,,,,,,317.70,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Coventry,Commercial,RT,338.88,,,,,,,91.78,342.41,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,inpatient,,,273.00000,146.33000,Coventry,Commercial,,262.08,,,,,,,245.70,264.81,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,outpatient,,,273.00000,146.33000,Coventry,Commercial,,262.08,,,,,,,70.98,264.81,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,inpatient,,,503.00000,269.61000,Coventry,Commercial,,482.88,,,,,,,452.70,487.91,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,outpatient,,,503.00000,269.61000,Coventry,Commercial,,482.88,,,,,,,130.78,487.91,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,inpatient,,,561.00000,300.70000,Coventry,Commercial,,538.56,,,,,,,504.90,544.17,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,outpatient,,,561.00000,300.70000,Coventry,Commercial,,538.56,,,,,,,145.86,544.17,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,inpatient,,,450.00000,241.20000,Coventry,Commercial,LT,432.00,,,,,,,405.00,436.50,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Coventry,Commercial,LT,432.00,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,inpatient,,,450.00000,241.20000,Coventry,Commercial,RT,432.00,,,,,,,405.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Coventry,Commercial,RT,432.00,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,inpatient,,,650.00000,348.40000,Coventry,Commercial,,624.00,,,,,,,585.00,630.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,outpatient,,,650.00000,348.40000,Coventry,Commercial,,624.00,,,,,,,169.00,630.50,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,inpatient,,,642.00000,344.11000,Coventry,Commercial,,616.32,,,,,,,577.80,622.74,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,outpatient,,,642.00000,344.11000,Coventry,Commercial,,616.32,,,,,,,166.92,622.74,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,inpatient,,,777.00000,416.47000,Coventry,Commercial,,745.92,,,,,,,699.30,753.69,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,outpatient,,,777.00000,416.47000,Coventry,Commercial,,745.92,,,,,,,202.02,753.69,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,inpatient,,,381.00000,204.22000,Coventry,Commercial,,365.76,,,,,,,342.90,369.57,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,outpatient,,,381.00000,204.22000,Coventry,Commercial,,365.76,,,,,,,99.06,369.57,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,inpatient,,,374.00000,200.46000,Coventry,Commercial,LT,359.04,,,,,,,336.60,362.78,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Coventry,Commercial,LT,359.04,,,,,,,97.24,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,inpatient,,,374.00000,200.46000,Coventry,Commercial,RT,359.04,,,,,,,336.60,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Coventry,Commercial,RT,359.04,,,,,,,97.24,362.78,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,inpatient,,,161.00000,86.30000,Coventry,Commercial,LT,154.56,,,,,,,144.90,156.17,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Coventry,Commercial,LT,154.56,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,inpatient,,,161.00000,86.30000,Coventry,Commercial,RT,154.56,,,,,,,144.90,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Coventry,Commercial,RT,154.56,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,inpatient,,,499.00000,267.46000,Coventry,Commercial,LT,479.04,,,,,,,449.10,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Coventry,Commercial,LT,479.04,,,,,,,129.74,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,inpatient,,,499.00000,267.46000,Coventry,Commercial,RT,479.04,,,,,,,449.10,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Coventry,Commercial,RT,479.04,,,,,,,129.74,484.03,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,inpatient,,,214.00000,114.70000,Coventry,Commercial,,205.44,,,,,,,192.60,207.58,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,outpatient,,,214.00000,114.70000,Coventry,Commercial,,205.44,,,,,,,55.64,207.58,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,inpatient,,,329.00000,176.34000,Coventry,Commercial,,315.84,,,,,,,296.10,319.13,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,outpatient,,,329.00000,176.34000,Coventry,Commercial,,315.84,,,,,,,85.54,319.13,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,inpatient,,,197.00000,105.59000,Coventry,Commercial,,189.12,,,,,,,177.30,191.09,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,outpatient,,,197.00000,105.59000,Coventry,Commercial,,189.12,,,,,,,51.22,191.09,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,inpatient,,,263.00000,140.97000,Coventry,Commercial,,252.48,,,,,,,236.70,255.11,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,outpatient,,,263.00000,140.97000,Coventry,Commercial,,252.48,,,,,,,68.38,255.11,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,inpatient,,,234.00000,125.42000,Coventry,Commercial,,224.64,,,,,,,210.60,226.98,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,outpatient,,,234.00000,125.42000,Coventry,Commercial,,224.64,,,,,,,60.84,226.98,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,inpatient,,,401.00000,214.94000,Coventry,Commercial,,384.96,,,,,,,360.90,388.97,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,outpatient,,,401.00000,214.94000,Coventry,Commercial,,384.96,,,,,,,104.26,388.97,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,inpatient,,,515.00000,276.04000,Coventry,Commercial,,494.40,,,,,,,463.50,499.55,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,outpatient,,,515.00000,276.04000,Coventry,Commercial,,494.40,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,inpatient,,,747.00000,400.39000,Coventry,Commercial,,717.12,,,,,,,672.30,724.59,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,outpatient,,,747.00000,400.39000,Coventry,Commercial,,717.12,,,,,,,194.22,724.59,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,inpatient,,,854.00000,457.74000,Coventry,Commercial,,819.84,,,,,,,768.60,828.38,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,outpatient,,,854.00000,457.74000,Coventry,Commercial,,819.84,,,,,,,222.04,828.38,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,inpatient,,,589.00000,315.70000,Coventry,Commercial,,565.44,,,,,,,530.10,571.33,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,outpatient,,,589.00000,315.70000,Coventry,Commercial,,565.44,,,,,,,153.14,571.33,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,inpatient,,,613.00000,328.57000,Coventry,Commercial,,588.48,,,,,,,551.70,594.61,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,outpatient,,,613.00000,328.57000,Coventry,Commercial,,588.48,,,,,,,159.38,594.61,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,inpatient,,,806.00000,432.02000,Coventry,Commercial,,773.76,,,,,,,725.40,781.82,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,outpatient,,,806.00000,432.02000,Coventry,Commercial,,773.76,,,,,,,209.56,781.82,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,inpatient,,,529.00000,283.54000,Coventry,Commercial,,507.84,,,,,,,476.10,513.13,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,outpatient,,,529.00000,283.54000,Coventry,Commercial,,507.84,,,,,,,137.54,513.13,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,inpatient,,,939.00000,503.30000,Coventry,Commercial,,901.44,,,,,,,845.10,910.83,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,outpatient,,,939.00000,503.30000,Coventry,Commercial,,901.44,,,,,,,244.14,910.83,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,inpatient,,,515.00000,276.04000,Coventry,Commercial,,494.40,,,,,,,463.50,499.55,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,outpatient,,,515.00000,276.04000,Coventry,Commercial,,494.40,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,inpatient,,,616.00000,330.18000,Coventry,Commercial,,591.36,,,,,,,554.40,597.52,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,outpatient,,,616.00000,330.18000,Coventry,Commercial,,591.36,,,,,,,160.16,597.52,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,inpatient,,,377.00000,202.07000,Coventry,Commercial,,361.92,,,,,,,339.30,365.69,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,outpatient,,,377.00000,202.07000,Coventry,Commercial,,361.92,,,,,,,98.02,365.69,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,inpatient,,,340.00000,182.24000,Coventry,Commercial,,326.40,,,,,,,306.00,329.80,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,outpatient,,,340.00000,182.24000,Coventry,Commercial,,326.40,,,,,,,88.40,329.80,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,inpatient,,,388.00000,207.97000,Coventry,Commercial,,372.48,,,,,,,349.20,376.36,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,outpatient,,,388.00000,207.97000,Coventry,Commercial,,372.48,,,,,,,100.88,376.36,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,inpatient,,,456.00000,244.42000,Coventry,Commercial,,437.76,,,,,,,410.40,442.32,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,outpatient,,,456.00000,244.42000,Coventry,Commercial,,437.76,,,,,,,118.56,442.32,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,inpatient,,,267.00000,143.11000,Coventry,Commercial,,256.32,,,,,,,240.30,258.99,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,outpatient,,,267.00000,143.11000,Coventry,Commercial,,256.32,,,,,,,69.42,258.99,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Coventry,Commercial,LT,293.76,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Coventry,Commercial,LT,293.76,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Coventry,Commercial,"52,LT",293.76,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Coventry,Commercial,"52,LT",293.76,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Coventry,Commercial,RT,293.76,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Coventry,Commercial,RT,293.76,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Coventry,Commercial,"52,RT",293.76,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Coventry,Commercial,"52,RT",293.76,,,,,,,79.56,296.82,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,inpatient,,,456.00000,244.42000,Coventry,Commercial,,437.76,,,,,,,410.40,442.32,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,outpatient,,,456.00000,244.42000,Coventry,Commercial,,437.76,,,,,,,118.56,442.32,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,inpatient,,,381.00000,204.22000,Coventry,Commercial,,365.76,,,,,,,342.90,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,outpatient,,,381.00000,204.22000,Coventry,Commercial,,365.76,,,,,,,99.06,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,inpatient,,,143.00000,76.65000,Coventry,Commercial,LT,137.28,,,,,,,128.70,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Coventry,Commercial,LT,137.28,,,,,,,37.18,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,inpatient,,,143.00000,76.65000,Coventry,Commercial,RT,137.28,,,,,,,128.70,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Coventry,Commercial,RT,137.28,,,,,,,37.18,138.71,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,inpatient,,,331.00000,177.42000,Coventry,Commercial,LT,317.76,,,,,,,297.90,321.07,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Coventry,Commercial,LT,317.76,,,,,,,86.06,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,inpatient,,,331.00000,177.42000,Coventry,Commercial,RT,317.76,,,,,,,297.90,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Coventry,Commercial,RT,317.76,,,,,,,86.06,321.07,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,inpatient,,,1113.00000,596.57000,Coventry,Commercial,,1068.48,,,,,,,1001.70,1079.61,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1113.00000,596.57000,Coventry,Commercial,,1068.48,,,,,,,289.38,1079.61,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,inpatient,,,1043.00000,559.05000,Coventry,Commercial,,1001.28,,,,,,,938.70,1011.71,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,outpatient,,,1043.00000,559.05000,Coventry,Commercial,,1001.28,,,,,,,271.18,1011.71,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Coventry,Commercial,LT,245.76,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Coventry,Commercial,LT,245.76,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Coventry,Commercial,"52,LT",245.76,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Coventry,Commercial,"52,LT",245.76,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Coventry,Commercial,RT,245.76,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Coventry,Commercial,RT,245.76,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Coventry,Commercial,"52,RT",245.76,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Coventry,Commercial,"52,RT",245.76,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,inpatient,,,511.00000,273.90000,Coventry,Commercial,LT,490.56,,,,,,,459.90,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Coventry,Commercial,LT,490.56,,,,,,,132.86,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,inpatient,,,511.00000,273.90000,Coventry,Commercial,RT,490.56,,,,,,,459.90,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Coventry,Commercial,RT,490.56,,,,,,,132.86,495.67,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,inpatient,,,553.00000,314.19000,Coventry,Commercial,LT,530.88,,,,,,,497.70,536.41,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Coventry,Commercial,LT,530.88,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,inpatient,,,553.00000,314.19000,Coventry,Commercial,RT,530.88,,,,,,,497.70,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Coventry,Commercial,RT,530.88,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,inpatient,,,1076.00000,611.33000,Coventry,Commercial,LT,1032.96,,,,,,,968.40,1043.72,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Coventry,Commercial,LT,1032.96,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,inpatient,,,1076.00000,611.33000,Coventry,Commercial,RT,1032.96,,,,,,,968.40,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Coventry,Commercial,RT,1032.96,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,inpatient,,,865.00000,491.45000,Coventry,Commercial,LT,830.40,,,,,,,778.50,839.05,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Coventry,Commercial,LT,830.40,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,inpatient,,,865.00000,491.45000,Coventry,Commercial,RT,830.40,,,,,,,778.50,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Coventry,Commercial,RT,830.40,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,inpatient,,,734.00000,417.02000,Coventry,Commercial,LT,704.64,,,,,,,660.60,711.98,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Coventry,Commercial,LT,704.64,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,inpatient,,,734.00000,417.02000,Coventry,Commercial,RT,704.64,,,,,,,660.60,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Coventry,Commercial,RT,704.64,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,inpatient,,,730.00000,414.75000,Coventry,Commercial,LT,700.80,,,,,,,657.00,708.10,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Coventry,Commercial,LT,700.80,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,inpatient,,,730.00000,414.75000,Coventry,Commercial,RT,700.80,,,,,,,657.00,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Coventry,Commercial,RT,700.80,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,inpatient,,,260.00000,147.72000,Coventry,Commercial,LT,249.60,,,,,,,234.00,252.20,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Coventry,Commercial,LT,249.60,,,,,,,67.60,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,inpatient,,,260.00000,147.72000,Coventry,Commercial,RT,249.60,,,,,,,234.00,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Coventry,Commercial,RT,249.60,,,,,,,67.60,252.20,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,inpatient,,,428.00000,203.73000,Coventry,Commercial,,410.88,,,,,,,385.20,415.16,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,outpatient,,,428.00000,203.73000,Coventry,Commercial,,410.88,,,,,,,111.28,415.16,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,inpatient,,,492.00000,234.19000,Coventry,Commercial,,472.32,,,,,,,442.80,477.24,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,outpatient,,,492.00000,234.19000,Coventry,Commercial,,472.32,,,,,,,127.92,477.24,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,inpatient,,,607.00000,288.93000,Coventry,Commercial,,582.72,,,,,,,546.30,588.79,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,outpatient,,,607.00000,288.93000,Coventry,Commercial,,582.72,,,,,,,157.82,588.79,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,inpatient,,,649.00000,308.92000,Coventry,Commercial,,623.04,,,,,,,584.10,629.53,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,outpatient,,,649.00000,308.92000,Coventry,Commercial,,623.04,,,,,,,168.74,629.53,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,inpatient,,,377.00000,121.77000,Coventry,Commercial,50,361.92,,,,,,,339.30,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,outpatient,,,377.00000,121.77000,Coventry,Commercial,50,361.92,,,,,,,98.02,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,inpatient,,,251.00000,81.07000,Coventry,Commercial,LT,240.96,,,,,,,225.90,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Coventry,Commercial,LT,240.96,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,inpatient,,,251.00000,81.07000,Coventry,Commercial,RT,240.96,,,,,,,225.90,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Coventry,Commercial,RT,240.96,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,inpatient,,,1170.00000,377.91000,Coventry,Commercial,50,1123.20,,,,,,,1053.00,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,outpatient,,,1170.00000,377.91000,Coventry,Commercial,50,1123.20,,,,,,,304.20,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,inpatient,,,780.00000,251.94000,Coventry,Commercial,LT,748.80,,,,,,,702.00,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Coventry,Commercial,LT,748.80,,,,,,,202.80,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,inpatient,,,780.00000,251.94000,Coventry,Commercial,RT,748.80,,,,,,,702.00,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Coventry,Commercial,RT,748.80,,,,,,,202.80,756.60,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,inpatient,,,1389.00000,448.65000,Coventry,Commercial,,1333.44,,,,,,,1250.10,1347.33,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,outpatient,,,1389.00000,448.65000,Coventry,Commercial,,1333.44,,,,,,,361.14,1347.33,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,inpatient,,,345.00000,111.44000,Coventry,Commercial,50,331.20,,,,,,,310.50,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,outpatient,,,345.00000,111.44000,Coventry,Commercial,50,331.20,,,,,,,89.70,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,inpatient,,,230.00000,74.29000,Coventry,Commercial,LT,220.80,,,,,,,207.00,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Coventry,Commercial,LT,220.80,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,inpatient,,,230.00000,74.29000,Coventry,Commercial,RT,220.80,,,,,,,207.00,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Coventry,Commercial,RT,220.80,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,inpatient,,,2102.00000,678.95000,Coventry,Commercial,50,2017.92,,,,,,,1891.80,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,outpatient,,,2102.00000,678.95000,Coventry,Commercial,50,2017.92,,,,,,,546.52,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,inpatient,,,1401.00000,452.52000,Coventry,Commercial,LT,1344.96,,,,,,,1260.90,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Coventry,Commercial,LT,1344.96,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,inpatient,,,1401.00000,452.52000,Coventry,Commercial,RT,1344.96,,,,,,,1260.90,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Coventry,Commercial,RT,1344.96,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,inpatient,,,357.00000,115.31000,Coventry,Commercial,50,342.72,,,,,,,321.30,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,outpatient,,,357.00000,115.31000,Coventry,Commercial,50,342.72,,,,,,,92.82,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,inpatient,,,238.00000,76.87000,Coventry,Commercial,LT,228.48,,,,,,,214.20,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Coventry,Commercial,LT,228.48,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,inpatient,,,238.00000,76.87000,Coventry,Commercial,RT,228.48,,,,,,,214.20,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Coventry,Commercial,RT,228.48,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,inpatient,,,2082.00000,672.49000,Coventry,Commercial,50,1998.72,,,,,,,1873.80,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,outpatient,,,2082.00000,672.49000,Coventry,Commercial,50,1998.72,,,,,,,541.32,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,inpatient,,,1388.00000,448.32000,Coventry,Commercial,LT,1332.48,,,,,,,1249.20,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Coventry,Commercial,LT,1332.48,,,,,,,360.88,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,inpatient,,,1388.00000,448.32000,Coventry,Commercial,RT,1332.48,,,,,,,1249.20,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Coventry,Commercial,RT,1332.48,,,,,,,360.88,1346.36,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,inpatient,,,246.00000,79.46000,Coventry,Commercial,50,236.16,,,,,,,221.40,238.62,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,outpatient,,,246.00000,79.46000,Coventry,Commercial,50,236.16,,,,,,,63.96,238.62,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,inpatient,,,164.00000,52.97000,Coventry,Commercial,LT,157.44,,,,,,,147.60,159.08,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Coventry,Commercial,LT,157.44,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,inpatient,,,164.00000,52.97000,Coventry,Commercial,RT,157.44,,,,,,,147.60,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Coventry,Commercial,RT,157.44,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,inpatient,,,309.00000,99.81000,Coventry,Commercial,50,296.64,,,,,,,278.10,299.73,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,outpatient,,,309.00000,99.81000,Coventry,Commercial,50,296.64,,,,,,,80.34,299.73,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,inpatient,,,206.00000,66.54000,Coventry,Commercial,LT,197.76,,,,,,,185.40,199.82,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Coventry,Commercial,LT,197.76,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,inpatient,,,206.00000,66.54000,Coventry,Commercial,RT,197.76,,,,,,,185.40,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Coventry,Commercial,RT,197.76,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,inpatient,,,471.00000,152.13000,Coventry,Commercial,50,452.16,,,,,,,423.90,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,outpatient,,,471.00000,152.13000,Coventry,Commercial,50,452.16,,,,,,,122.46,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,inpatient,,,314.00000,101.42000,Coventry,Commercial,LT,301.44,,,,,,,282.60,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Coventry,Commercial,LT,301.44,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,inpatient,,,314.00000,101.42000,Coventry,Commercial,RT,301.44,,,,,,,282.60,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Coventry,Commercial,RT,301.44,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,inpatient,,,239.00000,77.20000,Coventry,Commercial,50,229.44,,,,,,,215.10,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,outpatient,,,239.00000,77.20000,Coventry,Commercial,50,229.44,,,,,,,62.14,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,inpatient,,,159.00000,51.36000,Coventry,Commercial,LT,152.64,,,,,,,143.10,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Coventry,Commercial,LT,152.64,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,inpatient,,,159.00000,51.36000,Coventry,Commercial,RT,152.64,,,,,,,143.10,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Coventry,Commercial,RT,152.64,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,inpatient,,,558.00000,180.23000,Coventry,Commercial,50,535.68,,,,,,,502.20,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,outpatient,,,558.00000,180.23000,Coventry,Commercial,50,535.68,,,,,,,145.08,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,inpatient,,,372.00000,120.16000,Coventry,Commercial,LT,357.12,,,,,,,334.80,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Coventry,Commercial,LT,357.12,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,inpatient,,,372.00000,120.16000,Coventry,Commercial,RT,357.12,,,,,,,334.80,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Coventry,Commercial,RT,357.12,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,inpatient,,,413.00000,133.40000,Coventry,Commercial,50,396.48,,,,,,,371.70,400.61,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,outpatient,,,413.00000,133.40000,Coventry,Commercial,50,396.48,,,,,,,107.38,400.61,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,inpatient,,,275.00000,88.82000,Coventry,Commercial,LT,264.00,,,,,,,247.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Coventry,Commercial,LT,264.00,,,,,,,71.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,inpatient,,,275.00000,88.82000,Coventry,Commercial,RT,264.00,,,,,,,247.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Coventry,Commercial,RT,264.00,,,,,,,71.50,266.75,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,inpatient,,,462.00000,149.23000,Coventry,Commercial,,443.52,,,,,,,415.80,448.14,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,outpatient,,,462.00000,149.23000,Coventry,Commercial,,443.52,,,,,,,120.12,448.14,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,inpatient,,,170.00000,54.91000,Coventry,Commercial,,163.20,,,,,,,153.00,164.90,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,outpatient,,,170.00000,54.91000,Coventry,Commercial,,163.20,,,,,,,44.20,164.90,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,inpatient,,,281.00000,90.76000,Coventry,Commercial,,269.76,,,,,,,252.90,272.57,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,outpatient,,,281.00000,90.76000,Coventry,Commercial,,269.76,,,,,,,73.06,272.57,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,inpatient,,,562.00000,181.53000,Coventry,Commercial,,539.52,,,,,,,505.80,545.14,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,outpatient,,,562.00000,181.53000,Coventry,Commercial,,539.52,,,,,,,146.12,545.14,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,inpatient,,,2076.00000,670.55000,Coventry,Commercial,50,1992.96,,,,,,,1868.40,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,outpatient,,,2076.00000,670.55000,Coventry,Commercial,50,1992.96,,,,,,,539.76,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1384.00000,447.03000,Coventry,Commercial,LT,1328.64,,,,,,,1245.60,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Coventry,Commercial,LT,1328.64,,,,,,,359.84,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1384.00000,447.03000,Coventry,Commercial,RT,1328.64,,,,,,,1245.60,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Coventry,Commercial,RT,1328.64,,,,,,,359.84,1342.48,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,inpatient,,,934.00000,301.68000,Coventry,Commercial,,896.64,,,,,,,840.60,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,outpatient,,,934.00000,301.68000,Coventry,Commercial,,896.64,,,,,,,242.84,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,inpatient,,,842.00000,271.97000,Coventry,Commercial,,808.32,,,,,,,757.80,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,outpatient,,,842.00000,271.97000,Coventry,Commercial,,808.32,,,,,,,218.92,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,inpatient,,,846.00000,273.26000,Coventry,Commercial,,812.16,,,,,,,761.40,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,outpatient,,,846.00000,273.26000,Coventry,Commercial,,812.16,,,,,,,219.96,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,inpatient,,,971.00000,313.63000,Coventry,Commercial,,932.16,,,,,,,873.90,941.87,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,outpatient,,,971.00000,313.63000,Coventry,Commercial,,932.16,,,,,,,252.46,941.87,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,inpatient,,,762.00000,246.13000,Coventry,Commercial,,731.52,,,,,,,685.80,739.14,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,outpatient,,,762.00000,246.13000,Coventry,Commercial,,731.52,,,,,,,198.12,739.14,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,inpatient,,,758.00000,244.83000,Coventry,Commercial,,727.68,,,,,,,682.20,735.26,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,outpatient,,,758.00000,244.83000,Coventry,Commercial,,727.68,,,,,,,197.08,735.26,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,inpatient,,,161.00000,52.00000,Coventry,Commercial,,154.56,,,,,,,144.90,156.17,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,outpatient,,,161.00000,52.00000,Coventry,Commercial,,154.56,,,,,,,41.86,156.17,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,inpatient,,,234.00000,75.58000,Coventry,Commercial,50,224.64,,,,,,,210.60,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,outpatient,,,234.00000,75.58000,Coventry,Commercial,50,224.64,,,,,,,60.84,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,inpatient,,,156.00000,50.39000,Coventry,Commercial,LT,149.76,,,,,,,140.40,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Coventry,Commercial,LT,149.76,,,,,,,40.56,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,inpatient,,,156.00000,50.39000,Coventry,Commercial,RT,149.76,,,,,,,140.40,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Coventry,Commercial,RT,149.76,,,,,,,40.56,151.32,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1517.00000,489.99000,Coventry,Commercial,50,1456.32,,,,,,,1365.30,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1517.00000,489.99000,Coventry,Commercial,50,1456.32,,,,,,,394.42,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1011.00000,326.55000,Coventry,Commercial,LT,970.56,,,,,,,909.90,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Coventry,Commercial,LT,970.56,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1011.00000,326.55000,Coventry,Commercial,RT,970.56,,,,,,,909.90,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Coventry,Commercial,RT,970.56,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,inpatient,,,822.00000,265.51000,Coventry,Commercial,50,789.12,,,,,,,739.80,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,outpatient,,,822.00000,265.51000,Coventry,Commercial,50,789.12,,,,,,,213.72,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,inpatient,,,548.00000,177.00000,Coventry,Commercial,LT,526.08,,,,,,,493.20,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Coventry,Commercial,LT,526.08,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,inpatient,,,548.00000,177.00000,Coventry,Commercial,RT,526.08,,,,,,,493.20,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Coventry,Commercial,RT,526.08,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,inpatient,,,2613.00000,844.00000,Coventry,Commercial,,2508.48,,,,,,,2351.70,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,outpatient,,,2613.00000,844.00000,Coventry,Commercial,,2508.48,,,,,,,679.38,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,inpatient,,,903.00000,291.67000,Coventry,Commercial,,866.88,,,,,,,812.70,875.91,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,outpatient,,,903.00000,291.67000,Coventry,Commercial,,866.88,,,,,,,234.78,875.91,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,inpatient,,,1156.00000,373.39000,Coventry,Commercial,,1109.76,,,,,,,1040.40,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,outpatient,,,1156.00000,373.39000,Coventry,Commercial,,1109.76,,,,,,,300.56,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,inpatient,,,677.00000,218.67000,Coventry,Commercial,,649.92,,,,,,,609.30,656.69,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,outpatient,,,677.00000,218.67000,Coventry,Commercial,,649.92,,,,,,,176.02,656.69,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1928.00000,622.74000,Coventry,Commercial,50,1850.88,,,,,,,1735.20,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1928.00000,622.74000,Coventry,Commercial,50,1850.88,,,,,,,501.28,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1285.00000,415.06000,Coventry,Commercial,LT,1233.60,,,,,,,1156.50,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Coventry,Commercial,LT,1233.60,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1285.00000,415.06000,Coventry,Commercial,RT,1233.60,,,,,,,1156.50,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Coventry,Commercial,RT,1233.60,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,inpatient,,,812.00000,262.28000,Coventry,Commercial,50,779.52,,,,,,,730.80,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,outpatient,,,812.00000,262.28000,Coventry,Commercial,50,779.52,,,,,,,211.12,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,inpatient,,,541.00000,174.74000,Coventry,Commercial,LT,519.36,,,,,,,486.90,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Coventry,Commercial,LT,519.36,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,inpatient,,,541.00000,174.74000,Coventry,Commercial,RT,519.36,,,,,,,486.90,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Coventry,Commercial,RT,519.36,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,inpatient,,,825.00000,266.48000,Coventry,Commercial,50,792.00,,,,,,,742.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,outpatient,,,825.00000,266.48000,Coventry,Commercial,50,792.00,,,,,,,214.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,inpatient,,,550.00000,177.65000,Coventry,Commercial,LT,528.00,,,,,,,495.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Coventry,Commercial,LT,528.00,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,inpatient,,,550.00000,177.65000,Coventry,Commercial,RT,528.00,,,,,,,495.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Coventry,Commercial,RT,528.00,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,inpatient,,,3494.00000,1128.56000,Coventry,Commercial,50,3354.24,,,,,,,3144.60,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,outpatient,,,3494.00000,1128.56000,Coventry,Commercial,50,3354.24,,,,,,,908.44,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2329.00000,752.27000,Coventry,Commercial,LT,2235.84,,,,,,,2096.10,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Coventry,Commercial,LT,2235.84,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2329.00000,752.27000,Coventry,Commercial,RT,2235.84,,,,,,,2096.10,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Coventry,Commercial,RT,2235.84,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,inpatient,,,840.00000,271.32000,Coventry,Commercial,50,806.40,,,,,,,756.00,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,outpatient,,,840.00000,271.32000,Coventry,Commercial,50,806.40,,,,,,,218.40,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,inpatient,,,560.00000,180.88000,Coventry,Commercial,LT,537.60,,,,,,,504.00,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Coventry,Commercial,LT,537.60,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,inpatient,,,560.00000,180.88000,Coventry,Commercial,RT,537.60,,,,,,,504.00,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Coventry,Commercial,RT,537.60,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,inpatient,,,792.00000,255.82000,Coventry,Commercial,50,760.32,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,outpatient,,,792.00000,255.82000,Coventry,Commercial,50,760.32,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,inpatient,,,528.00000,170.54000,Coventry,Commercial,LT,506.88,,,,,,,475.20,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Coventry,Commercial,LT,506.88,,,,,,,137.28,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,inpatient,,,528.00000,170.54000,Coventry,Commercial,RT,506.88,,,,,,,475.20,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Coventry,Commercial,RT,506.88,,,,,,,137.28,512.16,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,inpatient,,,272.00000,87.86000,Coventry,Commercial,,261.12,,,,,,,244.80,263.84,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,outpatient,,,272.00000,87.86000,Coventry,Commercial,,261.12,,,,,,,70.72,263.84,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,inpatient,,,1268.00000,409.56000,Coventry,Commercial,,1217.28,,,,,,,1141.20,1229.96,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,outpatient,,,1268.00000,409.56000,Coventry,Commercial,,1217.28,,,,,,,329.68,1229.96,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,inpatient,,,896.00000,289.41000,Coventry,Commercial,,860.16,,,,,,,806.40,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,outpatient,,,896.00000,289.41000,Coventry,Commercial,,860.16,,,,,,,232.96,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,inpatient,,,884.00000,285.53000,Coventry,Commercial,,848.64,,,,,,,795.60,857.48,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,outpatient,,,884.00000,285.53000,Coventry,Commercial,,848.64,,,,,,,229.84,857.48,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,inpatient,,,609.00000,326.42000,Coventry,Commercial,,584.64,,,,,,,548.10,590.73,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Coventry,Commercial,,584.64,,,,,,,158.34,590.73,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,inpatient,,,966.00000,383.50000,Coventry,Commercial,,927.36,,,,,,,869.40,937.02,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,outpatient,,,966.00000,383.50000,Coventry,Commercial,,927.36,,,,,,,251.16,937.02,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,inpatient,,,872.00000,346.18000,Coventry,Commercial,,837.12,,,,,,,784.80,845.84,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,outpatient,,,872.00000,346.18000,Coventry,Commercial,,837.12,,,,,,,226.72,845.84,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,inpatient,,,492.00000,195.32000,Coventry,Commercial,,472.32,,,,,,,442.80,477.24,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,outpatient,,,492.00000,195.32000,Coventry,Commercial,,472.32,,,,,,,127.92,477.24,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,inpatient,,,331.00000,131.41000,Coventry,Commercial,,317.76,,,,,,,297.90,321.07,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,outpatient,,,331.00000,131.41000,Coventry,Commercial,,317.76,,,,,,,86.06,321.07,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,inpatient,,,5215.00000,2070.36000,Coventry,Commercial,,5006.40,,,,,,,4693.50,5058.55,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,outpatient,,,5215.00000,2070.36000,Coventry,Commercial,,5006.40,,,,,,,1355.90,5058.55,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,inpatient,,,5422.00000,2152.53000,Coventry,Commercial,,5205.12,,,,,,,4879.80,5259.34,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,outpatient,,,5422.00000,2152.53000,Coventry,Commercial,,5205.12,,,,,,,1409.72,5259.34,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,inpatient,,,1878.00000,788.76000,Coventry,Commercial,,1802.88,,,,,,,1690.20,1821.66,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1878.00000,788.76000,Coventry,Commercial,,1802.88,,,,,,,488.28,1821.66,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,inpatient,,,2253.00000,946.26000,Coventry,Commercial,,2162.88,,,,,,,2027.70,2185.41,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,outpatient,,,2253.00000,946.26000,Coventry,Commercial,,2162.88,,,,,,,585.78,2185.41,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,inpatient,,,1502.00000,630.84000,Coventry,Commercial,,1441.92,,,,,,,1351.80,1456.94,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1502.00000,630.84000,Coventry,Commercial,,1441.92,,,,,,,390.52,1456.94,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,inpatient,,,2024.00000,850.08000,Coventry,Commercial,,1943.04,,,,,,,1821.60,1963.28,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,outpatient,,,2024.00000,850.08000,Coventry,Commercial,,1943.04,,,,,,,526.24,1963.28,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,inpatient,,,2429.00000,1020.18000,Coventry,Commercial,,2331.84,,,,,,,2186.10,2356.13,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,outpatient,,,2429.00000,1020.18000,Coventry,Commercial,,2331.84,,,,,,,631.54,2356.13,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,inpatient,,,1619.00000,679.98000,Coventry,Commercial,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1619.00000,679.98000,Coventry,Commercial,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,inpatient,,,2425.00000,1018.50000,Coventry,Commercial,,2328.00,,,,,,,2182.50,2352.25,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,outpatient,,,2425.00000,1018.50000,Coventry,Commercial,,2328.00,,,,,,,630.50,2352.25,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,inpatient,,,2910.00000,1222.20000,Coventry,Commercial,,2793.60,,,,,,,2619.00,2822.70,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2910.00000,1222.20000,Coventry,Commercial,,2793.60,,,,,,,756.60,2822.70,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,inpatient,,,1940.00000,814.80000,Coventry,Commercial,,1862.40,,,,,,,1746.00,1881.80,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1940.00000,814.80000,Coventry,Commercial,,1862.40,,,,,,,504.40,1881.80,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,inpatient,,,2317.00000,973.14000,Coventry,Commercial,,2224.32,,,,,,,2085.30,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2317.00000,973.14000,Coventry,Commercial,,2224.32,,,,,,,602.42,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,inpatient,,,2780.00000,1167.60000,Coventry,Commercial,,2668.80,,,,,,,2502.00,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2780.00000,1167.60000,Coventry,Commercial,,2668.80,,,,,,,722.80,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,inpatient,,,1853.00000,778.26000,Coventry,Commercial,,1778.88,,,,,,,1667.70,1797.41,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1853.00000,778.26000,Coventry,Commercial,,1778.88,,,,,,,481.78,1797.41,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,inpatient,,,2366.00000,993.72000,Coventry,Commercial,,2271.36,,,,,,,2129.40,2295.02,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2366.00000,993.72000,Coventry,Commercial,,2271.36,,,,,,,615.16,2295.02,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,inpatient,,,3056.00000,1283.52000,Coventry,Commercial,,2933.76,,,,,,,2750.40,2964.32,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,outpatient,,,3056.00000,1283.52000,Coventry,Commercial,,2933.76,,,,,,,794.56,2964.32,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,inpatient,,,2829.00000,1386.21000,Coventry,Commercial,,2715.84,,,,,,,2546.10,2744.13,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,outpatient,,,2829.00000,1386.21000,Coventry,Commercial,,2715.84,,,,,,,735.54,2744.13,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,inpatient,,,3395.00000,1663.55000,Coventry,Commercial,,3259.20,,,,,,,3055.50,3293.15,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,outpatient,,,3395.00000,1663.55000,Coventry,Commercial,,3259.20,,,,,,,882.70,3293.15,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,inpatient,,,2263.00000,1108.87000,Coventry,Commercial,,2172.48,,,,,,,2036.70,2195.11,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,outpatient,,,2263.00000,1108.87000,Coventry,Commercial,,2172.48,,,,,,,588.38,2195.11,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,inpatient,,,4697.00000,2301.53000,Coventry,Commercial,,4509.12,,,,,,,4227.30,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,outpatient,,,4697.00000,2301.53000,Coventry,Commercial,,4509.12,,,,,,,1221.22,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,inpatient,,,5636.00000,2761.64000,Coventry,Commercial,,5410.56,,,,,,,5072.40,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,outpatient,,,5636.00000,2761.64000,Coventry,Commercial,,5410.56,,,,,,,1465.36,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,inpatient,,,3757.00000,1840.93000,Coventry,Commercial,,3606.72,,,,,,,3381.30,3644.29,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,outpatient,,,3757.00000,1840.93000,Coventry,Commercial,,3606.72,,,,,,,976.82,3644.29,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,inpatient,,,2619.00000,1283.31000,Coventry,Commercial,,2514.24,,,,,,,2357.10,2540.43,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,outpatient,,,2619.00000,1283.31000,Coventry,Commercial,,2514.24,,,,,,,680.94,2540.43,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,inpatient,,,3143.00000,1540.07000,Coventry,Commercial,,3017.28,,,,,,,2828.70,3048.71,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,outpatient,,,3143.00000,1540.07000,Coventry,Commercial,,3017.28,,,,,,,817.18,3048.71,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,inpatient,,,2095.00000,1026.55000,Coventry,Commercial,,2011.20,,,,,,,1885.50,2032.15,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,outpatient,,,2095.00000,1026.55000,Coventry,Commercial,,2011.20,,,,,,,544.70,2032.15,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,inpatient,,,278.00000,136.22000,Coventry,Commercial,,266.88,,,,,,,250.20,269.66,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,outpatient,,,278.00000,136.22000,Coventry,Commercial,,266.88,,,,,,,72.28,269.66,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,inpatient,,,2110.00000,1033.90000,Coventry,Commercial,LT,2025.60,,,,,,,1899.00,2046.70,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Coventry,Commercial,LT,2025.60,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,inpatient,,,2110.00000,1033.90000,Coventry,Commercial,RT,2025.60,,,,,,,1899.00,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Coventry,Commercial,RT,2025.60,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2532.00000,1240.68000,Coventry,Commercial,LT,2430.72,,,,,,,2278.80,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Coventry,Commercial,LT,2430.72,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2532.00000,1240.68000,Coventry,Commercial,RT,2430.72,,,,,,,2278.80,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Coventry,Commercial,RT,2430.72,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1688.00000,827.12000,Coventry,Commercial,LT,1620.48,,,,,,,1519.20,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Coventry,Commercial,LT,1620.48,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1688.00000,827.12000,Coventry,Commercial,RT,1620.48,,,,,,,1519.20,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Coventry,Commercial,RT,1620.48,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,inpatient,,,2024.00000,991.76000,Coventry,Commercial,LT,1943.04,,,,,,,1821.60,1963.28,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Coventry,Commercial,LT,1943.04,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,inpatient,,,2024.00000,991.76000,Coventry,Commercial,RT,1943.04,,,,,,,1821.60,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Coventry,Commercial,RT,1943.04,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2429.00000,1190.21000,Coventry,Commercial,LT,2331.84,,,,,,,2186.10,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Coventry,Commercial,LT,2331.84,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2429.00000,1190.21000,Coventry,Commercial,RT,2331.84,,,,,,,2186.10,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Coventry,Commercial,RT,2331.84,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1619.00000,793.31000,Coventry,Commercial,LT,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Coventry,Commercial,LT,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1619.00000,793.31000,Coventry,Commercial,RT,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Coventry,Commercial,RT,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,inpatient,,,1224.00000,599.76000,Coventry,Commercial,,1175.04,,,,,,,1101.60,1187.28,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,outpatient,,,1224.00000,599.76000,Coventry,Commercial,,1175.04,,,,,,,318.24,1187.28,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,inpatient,,,3020.00000,1479.80000,Coventry,Commercial,,2899.20,,,,,,,2718.00,2929.40,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,outpatient,,,3020.00000,1479.80000,Coventry,Commercial,,2899.20,,,,,,,785.20,2929.40,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,inpatient,,,3624.00000,1775.76000,Coventry,Commercial,,3479.04,,,,,,,3261.60,3515.28,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,outpatient,,,3624.00000,1775.76000,Coventry,Commercial,,3479.04,,,,,,,942.24,3515.28,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,inpatient,,,2416.00000,1183.84000,Coventry,Commercial,,2319.36,,,,,,,2174.40,2343.52,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,outpatient,,,2416.00000,1183.84000,Coventry,Commercial,,2319.36,,,,,,,628.16,2343.52,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,inpatient,,,2728.00000,1336.72000,Coventry,Commercial,,2618.88,,,,,,,2455.20,2646.16,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,outpatient,,,2728.00000,1336.72000,Coventry,Commercial,,2618.88,,,,,,,709.28,2646.16,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,inpatient,,,3273.00000,1603.77000,Coventry,Commercial,,3142.08,,,,,,,2945.70,3174.81,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,outpatient,,,3273.00000,1603.77000,Coventry,Commercial,,3142.08,,,,,,,850.98,3174.81,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,inpatient,,,2182.00000,1069.18000,Coventry,Commercial,,2094.72,,,,,,,1963.80,2116.54,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,outpatient,,,2182.00000,1069.18000,Coventry,Commercial,,2094.72,,,,,,,567.32,2116.54,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,inpatient,,,3133.00000,1535.17000,Coventry,Commercial,,3007.68,,,,,,,2819.70,3039.01,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,outpatient,,,3133.00000,1535.17000,Coventry,Commercial,,3007.68,,,,,,,814.58,3039.01,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,inpatient,,,3759.00000,1841.91000,Coventry,Commercial,,3608.64,,,,,,,3383.10,3646.23,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,outpatient,,,3759.00000,1841.91000,Coventry,Commercial,,3608.64,,,,,,,977.34,3646.23,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,inpatient,,,2506.00000,1227.94000,Coventry,Commercial,,2405.76,,,,,,,2255.40,2430.82,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,outpatient,,,2506.00000,1227.94000,Coventry,Commercial,,2405.76,,,,,,,651.56,2430.82,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,inpatient,,,2857.00000,1399.93000,Coventry,Commercial,,2742.72,,,,,,,2571.30,2771.29,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,outpatient,,,2857.00000,1399.93000,Coventry,Commercial,,2742.72,,,,,,,742.82,2771.29,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,inpatient,,,3428.00000,1679.72000,Coventry,Commercial,,3290.88,,,,,,,3085.20,3325.16,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,outpatient,,,3428.00000,1679.72000,Coventry,Commercial,,3290.88,,,,,,,891.28,3325.16,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,inpatient,,,2285.00000,1119.65000,Coventry,Commercial,,2193.60,,,,,,,2056.50,2216.45,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,outpatient,,,2285.00000,1119.65000,Coventry,Commercial,,2193.60,,,,,,,594.10,2216.45,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,inpatient,,,3565.00000,1746.85000,Coventry,Commercial,,3422.40,,,,,,,3208.50,3458.05,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,outpatient,,,3565.00000,1746.85000,Coventry,Commercial,,3422.40,,,,,,,926.90,3458.05,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,inpatient,,,5918.00000,2899.82000,Coventry,Commercial,,5681.28,,,,,,,5326.20,5740.46,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,outpatient,,,5918.00000,2899.82000,Coventry,Commercial,,5681.28,,,,,,,1538.68,5740.46,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,inpatient,,,3301.00000,1617.49000,Coventry,Commercial,,3168.96,,,,,,,2970.90,3201.97,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,outpatient,,,3301.00000,1617.49000,Coventry,Commercial,,3168.96,,,,,,,858.26,3201.97,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2659.00000,1302.91000,Coventry,Commercial,LT,2552.64,,,,,,,2393.10,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Coventry,Commercial,LT,2552.64,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2659.00000,1302.91000,Coventry,Commercial,RT,2552.64,,,,,,,2393.10,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Coventry,Commercial,RT,2552.64,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2551.00000,1249.99000,Coventry,Commercial,LT,2448.96,,,,,,,2295.90,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Coventry,Commercial,LT,2448.96,,,,,,,663.26,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2551.00000,1249.99000,Coventry,Commercial,RT,2448.96,,,,,,,2295.90,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Coventry,Commercial,RT,2448.96,,,,,,,663.26,2474.47,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,inpatient,,,3806.00000,1864.94000,Coventry,Commercial,,3653.76,,,,,,,3425.40,3691.82,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3806.00000,1864.94000,Coventry,Commercial,,3653.76,,,,,,,989.56,3691.82,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,inpatient,,,2149.00000,694.13000,Coventry,Commercial,,2063.04,,,,,,,1934.10,2084.53,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,outpatient,,,2149.00000,694.13000,Coventry,Commercial,,2063.04,,,,,,,558.74,2084.53,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,inpatient,,,1973.00000,637.28000,Coventry,Commercial,,1894.08,,,,,,,1775.70,1913.81,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,outpatient,,,1973.00000,637.28000,Coventry,Commercial,,1894.08,,,,,,,512.98,1913.81,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1784.00000,576.23000,Coventry,Commercial,50,1712.64,,,,,,,1605.60,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1784.00000,576.23000,Coventry,Commercial,50,1712.64,,,,,,,463.84,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1189.00000,384.05000,Coventry,Commercial,LT,1141.44,,,,,,,1070.10,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Coventry,Commercial,LT,1141.44,,,,,,,309.14,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1189.00000,384.05000,Coventry,Commercial,RT,1141.44,,,,,,,1070.10,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Coventry,Commercial,RT,1141.44,,,,,,,309.14,1153.33,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,inpatient,,,130.00000,69.68000,Coventry,Commercial,,124.80,,,,,,,117.00,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,outpatient,,,130.00000,69.68000,Coventry,Commercial,,124.80,,,,,,,33.80,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,inpatient,,,44.00000,23.58000,Coventry,Commercial,,42.24,,,,,,,39.60,42.68,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,outpatient,,,44.00000,23.58000,Coventry,Commercial,,42.24,,,,,,,11.44,42.68,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,inpatient,,,456.00000,244.42000,Coventry,Commercial,,437.76,,,,,,,410.40,442.32,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,outpatient,,,456.00000,244.42000,Coventry,Commercial,,437.76,,,,,,,118.56,442.32,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,inpatient,,,108.00000,57.89000,Coventry,Commercial,,103.68,,,,,,,97.20,104.76,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,outpatient,,,108.00000,57.89000,Coventry,Commercial,,103.68,,,,,,,28.08,104.76,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,inpatient,,,306.00000,164.02000,Coventry,Commercial,,293.76,,,,,,,275.40,296.82,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,outpatient,,,306.00000,164.02000,Coventry,Commercial,,293.76,,,,,,,79.56,296.82,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,inpatient,,,257.00000,137.75000,Coventry,Commercial,,246.72,,,,,,,231.30,249.29,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,outpatient,,,257.00000,137.75000,Coventry,Commercial,,246.72,,,,,,,66.82,249.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4057.00000,2036.61000,Coventry,Commercial,,3894.72,,,,,,,3651.30,3935.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Coventry,Commercial,,3894.72,,,,,,,1054.82,3935.29,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4868.00000,2443.74000,Coventry,Commercial,,4673.28,,,,,,,4381.20,4721.96,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Coventry,Commercial,,4673.28,,,,,,,1265.68,4721.96,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,inpatient,,,3245.00000,1628.99000,Coventry,Commercial,,3115.20,,,,,,,2920.50,3147.65,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Coventry,Commercial,,3115.20,,,,,,,843.70,3147.65,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4057.00000,2036.61000,Coventry,Commercial,,3894.72,,,,,,,3651.30,3935.29,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Coventry,Commercial,,3894.72,,,,,,,1054.82,3935.29,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4868.00000,2443.74000,Coventry,Commercial,,4673.28,,,,,,,4381.20,4721.96,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Coventry,Commercial,,4673.28,,,,,,,1265.68,4721.96,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,inpatient,,,3245.00000,1628.99000,Coventry,Commercial,,3115.20,,,,,,,2920.50,3147.65,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Coventry,Commercial,,3115.20,,,,,,,843.70,3147.65,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,inpatient,,,1725.00000,865.95000,Coventry,Commercial,,1656.00,,,,,,,1552.50,1673.25,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,outpatient,,,1725.00000,865.95000,Coventry,Commercial,,1656.00,,,,,,,448.50,1673.25,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,inpatient,,,1743.00000,874.99000,Coventry,Commercial,,1673.28,,,,,,,1568.70,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,outpatient,,,1743.00000,874.99000,Coventry,Commercial,,1673.28,,,,,,,453.18,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,inpatient,,,1475.00000,740.45000,Coventry,Commercial,LT,1416.00,,,,,,,1327.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Coventry,Commercial,LT,1416.00,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,inpatient,,,1475.00000,740.45000,Coventry,Commercial,RT,1416.00,,,,,,,1327.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Coventry,Commercial,RT,1416.00,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,inpatient,,,1162.00000,583.32000,Coventry,Commercial,,1115.52,,,,,,,1045.80,1127.14,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,outpatient,,,1162.00000,583.32000,Coventry,Commercial,,1115.52,,,,,,,302.12,1127.14,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,inpatient,,,983.00000,493.47000,Coventry,Commercial,LT,943.68,,,,,,,884.70,953.51,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Coventry,Commercial,LT,943.68,,,,,,,255.58,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,inpatient,,,983.00000,493.47000,Coventry,Commercial,RT,943.68,,,,,,,884.70,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Coventry,Commercial,RT,943.68,,,,,,,255.58,953.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,inpatient,,,3183.00000,1597.87000,Coventry,Commercial,,3055.68,,,,,,,2864.70,3087.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,outpatient,,,3183.00000,1597.87000,Coventry,Commercial,,3055.68,,,,,,,827.58,3087.51,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,inpatient,,,3819.00000,1917.14000,Coventry,Commercial,,3666.24,,,,,,,3437.10,3704.43,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,outpatient,,,3819.00000,1917.14000,Coventry,Commercial,,3666.24,,,,,,,992.94,3704.43,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,inpatient,,,2546.00000,1278.09000,Coventry,Commercial,,2444.16,,,,,,,2291.40,2469.62,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,outpatient,,,2546.00000,1278.09000,Coventry,Commercial,,2444.16,,,,,,,661.96,2469.62,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,inpatient,,,3858.00000,1936.72000,Coventry,Commercial,LT,3703.68,,,,,,,3472.20,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Coventry,Commercial,LT,3703.68,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,inpatient,,,3858.00000,1936.72000,Coventry,Commercial,RT,3703.68,,,,,,,3472.20,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Coventry,Commercial,RT,3703.68,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,inpatient,,,4629.00000,2323.76000,Coventry,Commercial,LT,4443.84,,,,,,,4166.10,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Coventry,Commercial,LT,4443.84,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,inpatient,,,4629.00000,2323.76000,Coventry,Commercial,RT,4443.84,,,,,,,4166.10,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Coventry,Commercial,RT,4443.84,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,inpatient,,,3086.00000,1549.17000,Coventry,Commercial,LT,2962.56,,,,,,,2777.40,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Coventry,Commercial,LT,2962.56,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,inpatient,,,3086.00000,1549.17000,Coventry,Commercial,RT,2962.56,,,,,,,2777.40,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Coventry,Commercial,RT,2962.56,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,inpatient,,,2505.00000,1257.51000,Coventry,Commercial,LT,2404.80,,,,,,,2254.50,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Coventry,Commercial,LT,2404.80,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,inpatient,,,2505.00000,1257.51000,Coventry,Commercial,RT,2404.80,,,,,,,2254.50,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Coventry,Commercial,RT,2404.80,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,inpatient,,,3006.00000,1509.01000,Coventry,Commercial,LT,2885.76,,,,,,,2705.40,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Coventry,Commercial,LT,2885.76,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,inpatient,,,3006.00000,1509.01000,Coventry,Commercial,RT,2885.76,,,,,,,2705.40,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Coventry,Commercial,RT,2885.76,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,inpatient,,,2004.00000,1006.01000,Coventry,Commercial,LT,1923.84,,,,,,,1803.60,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Coventry,Commercial,LT,1923.84,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,inpatient,,,2004.00000,1006.01000,Coventry,Commercial,RT,1923.84,,,,,,,1803.60,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Coventry,Commercial,RT,1923.84,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,inpatient,,,3137.00000,1574.77000,Coventry,Commercial,LT,3011.52,,,,,,,2823.30,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Coventry,Commercial,LT,3011.52,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,inpatient,,,3137.00000,1574.77000,Coventry,Commercial,RT,3011.52,,,,,,,2823.30,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Coventry,Commercial,RT,3011.52,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,inpatient,,,3764.00000,1889.53000,Coventry,Commercial,LT,3613.44,,,,,,,3387.60,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Coventry,Commercial,LT,3613.44,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,inpatient,,,3764.00000,1889.53000,Coventry,Commercial,RT,3613.44,,,,,,,3387.60,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Coventry,Commercial,RT,3613.44,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,inpatient,,,2509.00000,1259.52000,Coventry,Commercial,LT,2408.64,,,,,,,2258.10,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Coventry,Commercial,LT,2408.64,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,inpatient,,,2509.00000,1259.52000,Coventry,Commercial,RT,2408.64,,,,,,,2258.10,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Coventry,Commercial,RT,2408.64,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,inpatient,,,3023.00000,1517.55000,Coventry,Commercial,LT,2902.08,,,,,,,2720.70,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Coventry,Commercial,LT,2902.08,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,inpatient,,,3023.00000,1517.55000,Coventry,Commercial,RT,2902.08,,,,,,,2720.70,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Coventry,Commercial,RT,2902.08,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,inpatient,,,3627.00000,1820.75000,Coventry,Commercial,LT,3481.92,,,,,,,3264.30,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Coventry,Commercial,LT,3481.92,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,inpatient,,,3627.00000,1820.75000,Coventry,Commercial,RT,3481.92,,,,,,,3264.30,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Coventry,Commercial,RT,3481.92,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,inpatient,,,2418.00000,1213.84000,Coventry,Commercial,LT,2321.28,,,,,,,2176.20,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Coventry,Commercial,LT,2321.28,,,,,,,628.68,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,inpatient,,,2418.00000,1213.84000,Coventry,Commercial,RT,2321.28,,,,,,,2176.20,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Coventry,Commercial,RT,2321.28,,,,,,,628.68,2345.46,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,inpatient,,,870.00000,436.74000,Coventry,Commercial,,835.20,,,,,,,783.00,843.90,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,outpatient,,,870.00000,436.74000,Coventry,Commercial,,835.20,,,,,,,226.20,843.90,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,inpatient,,,1353.00000,679.21000,Coventry,Commercial,,1298.88,,,,,,,1217.70,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,outpatient,,,1353.00000,679.21000,Coventry,Commercial,,1298.88,,,,,,,351.78,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,inpatient,,,902.00000,452.80000,Coventry,Commercial,LT,865.92,,,,,,,811.80,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Coventry,Commercial,LT,865.92,,,,,,,234.52,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,inpatient,,,902.00000,452.80000,Coventry,Commercial,RT,865.92,,,,,,,811.80,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Coventry,Commercial,RT,865.92,,,,,,,234.52,874.94,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,inpatient,,,3489.00000,1751.48000,Coventry,Commercial,,3349.44,,,,,,,3140.10,3384.33,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3489.00000,1751.48000,Coventry,Commercial,,3349.44,,,,,,,907.14,3384.33,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,inpatient,,,4187.00000,2101.87000,Coventry,Commercial,,4019.52,,,,,,,3768.30,4061.39,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,outpatient,,,4187.00000,2101.87000,Coventry,Commercial,,4019.52,,,,,,,1088.62,4061.39,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,inpatient,,,2791.00000,1401.08000,Coventry,Commercial,,2679.36,,,,,,,2511.90,2707.27,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,outpatient,,,2791.00000,1401.08000,Coventry,Commercial,,2679.36,,,,,,,725.66,2707.27,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,inpatient,,,492.00000,246.98000,Coventry,Commercial,,472.32,,,,,,,442.80,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,outpatient,,,492.00000,246.98000,Coventry,Commercial,,472.32,,,,,,,127.92,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,inpatient,,,331.00000,166.16000,Coventry,Commercial,,317.76,,,,,,,297.90,321.07,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,outpatient,,,331.00000,166.16000,Coventry,Commercial,,317.76,,,,,,,86.06,321.07,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,inpatient,,,4440.00000,2357.64000,Coventry,Commercial,,4262.40,,,,,,,3996.00,4306.80,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,outpatient,,,4440.00000,2357.64000,Coventry,Commercial,,4262.40,,,,,,,1154.40,4306.80,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,inpatient,,,5328.00000,2829.17000,Coventry,Commercial,,5114.88,,,,,,,4795.20,5168.16,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,outpatient,,,5328.00000,2829.17000,Coventry,Commercial,,5114.88,,,,,,,1385.28,5168.16,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,inpatient,,,3552.00000,1886.11000,Coventry,Commercial,,3409.92,,,,,,,3196.80,3445.44,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,outpatient,,,3552.00000,1886.11000,Coventry,Commercial,,3409.92,,,,,,,923.52,3445.44,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,inpatient,,,2528.00000,1342.37000,Coventry,Commercial,,2426.88,,,,,,,2275.20,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,outpatient,,,2528.00000,1342.37000,Coventry,Commercial,,2426.88,,,,,,,657.28,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,inpatient,,,3033.00000,1610.52000,Coventry,Commercial,,2911.68,,,,,,,2729.70,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,outpatient,,,3033.00000,1610.52000,Coventry,Commercial,,2911.68,,,,,,,788.58,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,inpatient,,,2022.00000,1073.68000,Coventry,Commercial,,1941.12,,,,,,,1819.80,1961.34,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,outpatient,,,2022.00000,1073.68000,Coventry,Commercial,,1941.12,,,,,,,525.72,1961.34,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,inpatient,,,3610.00000,1909.69000,Coventry,Commercial,,3465.60,,,,,,,3249.00,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,outpatient,,,3610.00000,1909.69000,Coventry,Commercial,,3465.60,,,,,,,938.60,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,inpatient,,,4332.00000,2291.63000,Coventry,Commercial,,4158.72,,,,,,,3898.80,4202.04,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,outpatient,,,4332.00000,2291.63000,Coventry,Commercial,,4158.72,,,,,,,1126.32,4202.04,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,inpatient,,,2888.00000,1527.75000,Coventry,Commercial,,2772.48,,,,,,,2599.20,2801.36,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,outpatient,,,2888.00000,1527.75000,Coventry,Commercial,,2772.48,,,,,,,750.88,2801.36,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,inpatient,,,4532.00000,2397.43000,Coventry,Commercial,,4350.72,,,,,,,4078.80,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,outpatient,,,4532.00000,2397.43000,Coventry,Commercial,,4350.72,,,,,,,1178.32,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,inpatient,,,5438.00000,2876.70000,Coventry,Commercial,,5220.48,,,,,,,4894.20,5274.86,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,outpatient,,,5438.00000,2876.70000,Coventry,Commercial,,5220.48,,,,,,,1413.88,5274.86,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,inpatient,,,3625.00000,1917.62000,Coventry,Commercial,,3480.00,,,,,,,3262.50,3516.25,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,outpatient,,,3625.00000,1917.62000,Coventry,Commercial,,3480.00,,,,,,,942.50,3516.25,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,inpatient,,,3639.00000,1925.03000,Coventry,Commercial,,3493.44,,,,,,,3275.10,3529.83,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,outpatient,,,3639.00000,1925.03000,Coventry,Commercial,,3493.44,,,,,,,946.14,3529.83,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,inpatient,,,4367.00000,2310.14000,Coventry,Commercial,,4192.32,,,,,,,3930.30,4235.99,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,outpatient,,,4367.00000,2310.14000,Coventry,Commercial,,4192.32,,,,,,,1135.42,4235.99,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,inpatient,,,2911.00000,1539.92000,Coventry,Commercial,,2794.56,,,,,,,2619.90,2823.67,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,outpatient,,,2911.00000,1539.92000,Coventry,Commercial,,2794.56,,,,,,,756.86,2823.67,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,inpatient,,,3494.00000,1719.05000,Coventry,Commercial,,3354.24,,,,,,,3144.60,3389.18,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3494.00000,1719.05000,Coventry,Commercial,,3354.24,,,,,,,908.44,3389.18,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,inpatient,,,4193.00000,2062.96000,Coventry,Commercial,,4025.28,,,,,,,3773.70,4067.21,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,outpatient,,,4193.00000,2062.96000,Coventry,Commercial,,4025.28,,,,,,,1090.18,4067.21,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,inpatient,,,2795.00000,1375.14000,Coventry,Commercial,,2683.20,,,,,,,2515.50,2711.15,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,outpatient,,,2795.00000,1375.14000,Coventry,Commercial,,2683.20,,,,,,,726.70,2711.15,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,inpatient,,,2717.00000,1336.76000,Coventry,Commercial,,2608.32,,,,,,,2445.30,2635.49,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,outpatient,,,2717.00000,1336.76000,Coventry,Commercial,,2608.32,,,,,,,706.42,2635.49,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,inpatient,,,3260.00000,1603.92000,Coventry,Commercial,,3129.60,,,,,,,2934.00,3162.20,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,outpatient,,,3260.00000,1603.92000,Coventry,Commercial,,3129.60,,,,,,,847.60,3162.20,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,inpatient,,,2173.00000,1069.12000,Coventry,Commercial,,2086.08,,,,,,,1955.70,2107.81,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,outpatient,,,2173.00000,1069.12000,Coventry,Commercial,,2086.08,,,,,,,564.98,2107.81,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4051.00000,2301.58000,Coventry,Commercial,LT,3888.96,,,,,,,3645.90,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Coventry,Commercial,LT,3888.96,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4051.00000,2301.58000,Coventry,Commercial,RT,3888.96,,,,,,,3645.90,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Coventry,Commercial,RT,3888.96,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4861.00000,2761.78000,Coventry,Commercial,LT,4666.56,,,,,,,4374.90,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Coventry,Commercial,LT,4666.56,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4861.00000,2761.78000,Coventry,Commercial,RT,4666.56,,,,,,,4374.90,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Coventry,Commercial,RT,4666.56,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3241.00000,1841.37000,Coventry,Commercial,LT,3111.36,,,,,,,2916.90,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Coventry,Commercial,LT,3111.36,,,,,,,842.66,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3241.00000,1841.37000,Coventry,Commercial,RT,3111.36,,,,,,,2916.90,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Coventry,Commercial,RT,3111.36,,,,,,,842.66,3143.77,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,inpatient,,,4260.00000,2420.32000,Coventry,Commercial,,4089.60,,,,,,,3834.00,4132.20,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,outpatient,,,4260.00000,2420.32000,Coventry,Commercial,,4089.60,,,,,,,1107.60,4132.20,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,inpatient,,,5112.00000,2904.38000,Coventry,Commercial,,4907.52,,,,,,,4600.80,4958.64,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,outpatient,,,5112.00000,2904.38000,Coventry,Commercial,,4907.52,,,,,,,1329.12,4958.64,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,inpatient,,,3408.00000,1936.26000,Coventry,Commercial,,3271.68,,,,,,,3067.20,3305.76,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3408.00000,1936.26000,Coventry,Commercial,,3271.68,,,,,,,886.08,3305.76,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,inpatient,,,3343.00000,1899.33000,Coventry,Commercial,,3209.28,,,,,,,3008.70,3242.71,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3343.00000,1899.33000,Coventry,Commercial,,3209.28,,,,,,,869.18,3242.71,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,inpatient,,,4010.00000,2278.28000,Coventry,Commercial,,3849.60,,,,,,,3609.00,3889.70,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,outpatient,,,4010.00000,2278.28000,Coventry,Commercial,,3849.60,,,,,,,1042.60,3889.70,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,inpatient,,,2674.00000,1519.23000,Coventry,Commercial,,2567.04,,,,,,,2406.60,2593.78,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,outpatient,,,2674.00000,1519.23000,Coventry,Commercial,,2567.04,,,,,,,695.24,2593.78,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3294.00000,1871.49000,Coventry,Commercial,LT,3162.24,,,,,,,2964.60,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Coventry,Commercial,LT,3162.24,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3294.00000,1871.49000,Coventry,Commercial,RT,3162.24,,,,,,,2964.60,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Coventry,Commercial,RT,3162.24,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3953.00000,2245.90000,Coventry,Commercial,LT,3794.88,,,,,,,3557.70,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Coventry,Commercial,LT,3794.88,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3953.00000,2245.90000,Coventry,Commercial,RT,3794.88,,,,,,,3557.70,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Coventry,Commercial,RT,3794.88,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,inpatient,,,2635.00000,1497.08000,Coventry,Commercial,LT,2529.60,,,,,,,2371.50,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Coventry,Commercial,LT,2529.60,,,,,,,685.10,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,inpatient,,,2635.00000,1497.08000,Coventry,Commercial,RT,2529.60,,,,,,,2371.50,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Coventry,Commercial,RT,2529.60,,,,,,,685.10,2555.95,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,inpatient,,,3664.00000,2081.70000,Coventry,Commercial,,3517.44,,,,,,,3297.60,3554.08,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3664.00000,2081.70000,Coventry,Commercial,,3517.44,,,,,,,952.64,3554.08,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,inpatient,,,4397.00000,2498.16000,Coventry,Commercial,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,outpatient,,,4397.00000,2498.16000,Coventry,Commercial,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,inpatient,,,2931.00000,1665.25000,Coventry,Commercial,,2813.76,,,,,,,2637.90,2843.07,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,outpatient,,,2931.00000,1665.25000,Coventry,Commercial,,2813.76,,,,,,,762.06,2843.07,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,inpatient,,,4759.00000,2703.83000,Coventry,Commercial,,4568.64,,,,,,,4283.10,4616.23,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,outpatient,,,4759.00000,2703.83000,Coventry,Commercial,,4568.64,,,,,,,1237.34,4616.23,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,inpatient,,,5710.00000,3244.14000,Coventry,Commercial,,5481.60,,,,,,,5139.00,5538.70,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,outpatient,,,5710.00000,3244.14000,Coventry,Commercial,,5481.60,,,,,,,1484.60,5538.70,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,inpatient,,,3807.00000,2162.95000,Coventry,Commercial,,3654.72,,,,,,,3426.30,3692.79,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3807.00000,2162.95000,Coventry,Commercial,,3654.72,,,,,,,989.82,3692.79,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,inpatient,,,2915.00000,1574.10000,Coventry,Commercial,,2798.40,,,,,,,2623.50,2827.55,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2915.00000,1574.10000,Coventry,Commercial,,2798.40,,,,,,,757.90,2827.55,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,inpatient,,,1918.00000,1035.72000,Coventry,Commercial,,1841.28,,,,,,,1726.20,1860.46,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1918.00000,1035.72000,Coventry,Commercial,,1841.28,,,,,,,498.68,1860.46,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,inpatient,,,2292.00000,1237.68000,Coventry,Commercial,,2200.32,,,,,,,2062.80,2223.24,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2292.00000,1237.68000,Coventry,Commercial,,2200.32,,,,,,,595.92,2223.24,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,inpatient,,,2984.00000,1611.36000,Coventry,Commercial,,2864.64,,,,,,,2685.60,2894.48,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,outpatient,,,2984.00000,1611.36000,Coventry,Commercial,,2864.64,,,,,,,775.84,2894.48,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,inpatient,,,769.00000,415.26000,Coventry,Commercial,,738.24,,,,,,,692.10,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,outpatient,,,769.00000,415.26000,Coventry,Commercial,,738.24,,,,,,,199.94,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,inpatient,,,1280.00000,691.20000,Coventry,Commercial,,1228.80,,,,,,,1152.00,1241.60,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,outpatient,,,1280.00000,691.20000,Coventry,Commercial,,1228.80,,,,,,,332.80,1241.60,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,inpatient,,,1878.00000,1014.12000,Coventry,Commercial,,1802.88,,,,,,,1690.20,1821.66,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,outpatient,,,1878.00000,1014.12000,Coventry,Commercial,,1802.88,,,,,,,488.28,1821.66,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,inpatient,,,2196.00000,1185.84000,Coventry,Commercial,,2108.16,,,,,,,1976.40,2130.12,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,outpatient,,,2196.00000,1185.84000,Coventry,Commercial,,2108.16,,,,,,,570.96,2130.12,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,inpatient,,,844.00000,455.76000,Coventry,Commercial,,810.24,,,,,,,759.60,818.68,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,outpatient,,,844.00000,455.76000,Coventry,Commercial,,810.24,,,,,,,219.44,818.68,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,inpatient,,,1305.00000,704.70000,Coventry,Commercial,,1252.80,,,,,,,1174.50,1265.85,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,outpatient,,,1305.00000,704.70000,Coventry,Commercial,,1252.80,,,,,,,339.30,1265.85,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,inpatient,,,576.00000,311.04000,Coventry,Commercial,,552.96,,,,,,,518.40,558.72,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,outpatient,,,576.00000,311.04000,Coventry,Commercial,,552.96,,,,,,,149.76,558.72,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,inpatient,,,809.00000,436.86000,Coventry,Commercial,,776.64,,,,,,,728.10,784.73,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,outpatient,,,809.00000,436.86000,Coventry,Commercial,,776.64,,,,,,,210.34,784.73,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,inpatient,,,2462.00000,1329.48000,Coventry,Commercial,,2363.52,,,,,,,2215.80,2388.14,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,outpatient,,,2462.00000,1329.48000,Coventry,Commercial,,2363.52,,,,,,,640.12,2388.14,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,inpatient,,,918.00000,495.72000,Coventry,Commercial,,881.28,,,,,,,826.20,890.46,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,outpatient,,,918.00000,495.72000,Coventry,Commercial,,881.28,,,,,,,238.68,890.46,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,inpatient,,,1102.00000,595.08000,Coventry,Commercial,,1057.92,,,,,,,991.80,1068.94,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,outpatient,,,1102.00000,595.08000,Coventry,Commercial,,1057.92,,,,,,,286.52,1068.94,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,inpatient,,,812.00000,438.48000,Coventry,Commercial,,779.52,,,,,,,730.80,787.64,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,outpatient,,,812.00000,438.48000,Coventry,Commercial,,779.52,,,,,,,211.12,787.64,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,inpatient,,,1407.00000,759.78000,Coventry,Commercial,,1350.72,,,,,,,1266.30,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,outpatient,,,1407.00000,759.78000,Coventry,Commercial,,1350.72,,,,,,,365.82,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,inpatient,,,1980.00000,1069.20000,Coventry,Commercial,,1900.80,,,,,,,1782.00,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,outpatient,,,1980.00000,1069.20000,Coventry,Commercial,,1900.80,,,,,,,514.80,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,inpatient,,,964.00000,520.56000,Coventry,Commercial,,925.44,,,,,,,867.60,935.08,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,outpatient,,,964.00000,520.56000,Coventry,Commercial,,925.44,,,,,,,250.64,935.08,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,inpatient,,,1040.00000,561.60000,Coventry,Commercial,,998.40,,,,,,,936.00,1008.80,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,outpatient,,,1040.00000,561.60000,Coventry,Commercial,,998.40,,,,,,,270.40,1008.80,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,inpatient,,,795.00000,429.30000,Coventry,Commercial,,763.20,,,,,,,715.50,771.15,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,outpatient,,,795.00000,429.30000,Coventry,Commercial,,763.20,,,,,,,206.70,771.15,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,inpatient,,,1124.00000,606.96000,Coventry,Commercial,,1079.04,,,,,,,1011.60,1090.28,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,outpatient,,,1124.00000,606.96000,Coventry,Commercial,,1079.04,,,,,,,292.24,1090.28,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,inpatient,,,736.00000,397.44000,Coventry,Commercial,,706.56,,,,,,,662.40,713.92,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,outpatient,,,736.00000,397.44000,Coventry,Commercial,,706.56,,,,,,,191.36,713.92,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,inpatient,,,700.00000,378.00000,Coventry,Commercial,,672.00,,,,,,,630.00,679.00,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,outpatient,,,700.00000,378.00000,Coventry,Commercial,,672.00,,,,,,,182.00,679.00,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,inpatient,,,821.00000,443.34000,Coventry,Commercial,,788.16,,,,,,,738.90,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,outpatient,,,821.00000,443.34000,Coventry,Commercial,,788.16,,,,,,,213.46,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,inpatient,,,846.00000,456.84000,Coventry,Commercial,,812.16,,,,,,,761.40,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,outpatient,,,846.00000,456.84000,Coventry,Commercial,,812.16,,,,,,,219.96,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,inpatient,,,958.00000,517.32000,Coventry,Commercial,,919.68,,,,,,,862.20,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,outpatient,,,958.00000,517.32000,Coventry,Commercial,,919.68,,,,,,,249.08,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,inpatient,,,1261.00000,680.94000,Coventry,Commercial,,1210.56,,,,,,,1134.90,1223.17,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,outpatient,,,1261.00000,680.94000,Coventry,Commercial,,1210.56,,,,,,,327.86,1223.17,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,inpatient,,,971.00000,524.34000,Coventry,Commercial,,932.16,,,,,,,873.90,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,outpatient,,,971.00000,524.34000,Coventry,Commercial,,932.16,,,,,,,252.46,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,inpatient,,,1837.00000,991.98000,Coventry,Commercial,,1763.52,,,,,,,1653.30,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,outpatient,,,1837.00000,991.98000,Coventry,Commercial,,1763.52,,,,,,,477.62,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,inpatient,,,1099.00000,593.46000,Coventry,Commercial,,1055.04,,,,,,,989.10,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,outpatient,,,1099.00000,593.46000,Coventry,Commercial,,1055.04,,,,,,,285.74,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,inpatient,,,2178.00000,1176.12000,Coventry,Commercial,,2090.88,,,,,,,1960.20,2112.66,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,outpatient,,,2178.00000,1176.12000,Coventry,Commercial,,2090.88,,,,,,,566.28,2112.66,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,inpatient,,,1226.00000,662.04000,Coventry,Commercial,,1176.96,,,,,,,1103.40,1189.22,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,outpatient,,,1226.00000,662.04000,Coventry,Commercial,,1176.96,,,,,,,318.76,1189.22,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,inpatient,,,1048.00000,565.92000,Coventry,Commercial,,1006.08,,,,,,,943.20,1016.56,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,outpatient,,,1048.00000,565.92000,Coventry,Commercial,,1006.08,,,,,,,272.48,1016.56,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,inpatient,,,970.00000,523.80000,Coventry,Commercial,,931.20,,,,,,,873.00,940.90,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,outpatient,,,970.00000,523.80000,Coventry,Commercial,,931.20,,,,,,,252.20,940.90,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,inpatient,,,1803.00000,973.62000,Coventry,Commercial,,1730.88,,,,,,,1622.70,1748.91,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,outpatient,,,1803.00000,973.62000,Coventry,Commercial,,1730.88,,,,,,,468.78,1748.91,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,inpatient,,,2504.00000,1352.16000,Coventry,Commercial,,2403.84,,,,,,,2253.60,2428.88,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,outpatient,,,2504.00000,1352.16000,Coventry,Commercial,,2403.84,,,,,,,651.04,2428.88,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,inpatient,,,2457.00000,1326.78000,Coventry,Commercial,,2358.72,,,,,,,2211.30,2383.29,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2457.00000,1326.78000,Coventry,Commercial,,2358.72,,,,,,,638.82,2383.29,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,inpatient,,,923.00000,498.42000,Coventry,Commercial,,886.08,,,,,,,830.70,895.31,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,outpatient,,,923.00000,498.42000,Coventry,Commercial,,886.08,,,,,,,239.98,895.31,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,inpatient,,,5478.00000,2958.12000,Coventry,Commercial,,5258.88,,,,,,,4930.20,5313.66,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,outpatient,,,5478.00000,2958.12000,Coventry,Commercial,,5258.88,,,,,,,1424.28,5313.66,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,inpatient,,,4551.00000,2457.54000,Coventry,Commercial,,4368.96,,,,,,,4095.90,4414.47,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,outpatient,,,4551.00000,2457.54000,Coventry,Commercial,,4368.96,,,,,,,1183.26,4414.47,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,inpatient,,,1360.00000,734.40000,Coventry,Commercial,,1305.60,,,,,,,1224.00,1319.20,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,outpatient,,,1360.00000,734.40000,Coventry,Commercial,,1305.60,,,,,,,353.60,1319.20,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,inpatient,,,1209.00000,652.86000,Coventry,Commercial,,1160.64,,,,,,,1088.10,1172.73,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,outpatient,,,1209.00000,652.86000,Coventry,Commercial,,1160.64,,,,,,,314.34,1172.73,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,inpatient,,,848.00000,457.92000,Coventry,Commercial,,814.08,,,,,,,763.20,822.56,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,outpatient,,,848.00000,457.92000,Coventry,Commercial,,814.08,,,,,,,220.48,822.56,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,inpatient,,,1071.00000,578.34000,Coventry,Commercial,,1028.16,,,,,,,963.90,1038.87,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,outpatient,,,1071.00000,578.34000,Coventry,Commercial,,1028.16,,,,,,,278.46,1038.87,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,inpatient,,,1792.00000,967.68000,Coventry,Commercial,,1720.32,,,,,,,1612.80,1738.24,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,outpatient,,,1792.00000,967.68000,Coventry,Commercial,,1720.32,,,,,,,465.92,1738.24,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,inpatient,,,35.00000,18.90000,Coventry,Commercial,,33.60,,,,,,,31.50,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,outpatient,,,35.00000,18.90000,Coventry,Commercial,,33.60,,,,,,,9.10,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,inpatient,,,285.00000,153.90000,Coventry,Commercial,,273.60,,,,,,,256.50,276.45,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,outpatient,,,285.00000,153.90000,Coventry,Commercial,,273.60,,,,,,,74.10,276.45,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,inpatient,,,1012.00000,546.48000,Coventry,Commercial,,971.52,,,,,,,910.80,981.64,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,outpatient,,,1012.00000,546.48000,Coventry,Commercial,,971.52,,,,,,,263.12,981.64,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,inpatient,,,492.00000,265.68000,Coventry,Commercial,,472.32,,,,,,,442.80,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,outpatient,,,492.00000,265.68000,Coventry,Commercial,,472.32,,,,,,,127.92,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,inpatient,,,739.00000,399.06000,Coventry,Commercial,,709.44,,,,,,,665.10,716.83,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,outpatient,,,739.00000,399.06000,Coventry,Commercial,,709.44,,,,,,,192.14,716.83,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,inpatient,,,515.00000,278.10000,Coventry,Commercial,,494.40,,,,,,,463.50,499.55,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,outpatient,,,515.00000,278.10000,Coventry,Commercial,,494.40,,,,,,,133.90,499.55,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,inpatient,,,1467.00000,792.18000,Coventry,Commercial,,1408.32,,,,,,,1320.30,1422.99,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,outpatient,,,1467.00000,792.18000,Coventry,Commercial,,1408.32,,,,,,,381.42,1422.99,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,inpatient,,,1683.00000,888.62000,Coventry,Commercial,,1615.68,,,,,,,1514.70,1632.51,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,outpatient,,,1683.00000,888.62000,Coventry,Commercial,,1615.68,,,,,,,437.58,1632.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,inpatient,,,426.30000,225.09000,Coventry,Commercial,,409.25,,,,,,,383.67,413.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,426.30000,225.09000,Coventry,Commercial,,409.25,,,,,,,110.84,413.51,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,inpatient,,,725.00000,382.80000,Coventry,Commercial,,696.00,,,,,,,652.50,703.25,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,725.00000,382.80000,Coventry,Commercial,,696.00,,,,,,,188.50,1855.42,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,inpatient,,,1852.00000,977.86000,Coventry,Commercial,,1777.92,,,,,,,1666.80,1796.44,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,1852.00000,977.86000,Coventry,Commercial,,1777.92,,,,,,,481.52,1868.26,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,110.00000,58.08000,Coventry,Commercial,,105.60,,,,,,,99.00,106.70,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,110.00000,58.08000,Coventry,Commercial,,105.60,,,,,,,28.60,106.70,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,inpatient,,,98.00000,51.74000,Coventry,Commercial,,94.08,,,,,,,88.20,95.06,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,98.00000,51.74000,Coventry,Commercial,,94.08,,,,,,,25.48,1662.92,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,inpatient,,,2018.00000,1065.50000,Coventry,Commercial,,1937.28,,,,,,,1816.20,1957.46,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,2018.00000,1065.50000,Coventry,Commercial,,1937.28,,,,,,,524.68,1957.46,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,inpatient,,,4325.00000,2283.60000,Coventry,Commercial,,4152.00,,,,,,,3892.50,4195.25,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,4325.00000,2283.60000,Coventry,Commercial,,4152.00,,,,,,,1124.50,4195.25,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,inpatient,,,172.00000,90.82000,Coventry,Commercial,,165.12,,,,,,,154.80,166.84,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Coventry,Commercial,,165.12,,,,,,,44.72,166.84,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,inpatient,,,942.00000,497.38000,Coventry,Commercial,,904.32,,,,,,,847.80,913.74,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,942.00000,497.38000,Coventry,Commercial,,904.32,,,,,,,244.92,913.74,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,inpatient,,,413.00000,218.06000,Coventry,Commercial,,396.48,,,,,,,371.70,400.61,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,413.00000,218.06000,Coventry,Commercial,,396.48,,,,,,,107.38,400.61,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,inpatient,,,257.00000,135.70000,Coventry,Commercial,,246.72,,,,,,,231.30,249.29,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,outpatient,,,257.00000,135.70000,Coventry,Commercial,,246.72,,,,,,,66.82,249.29,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,inpatient,,,116.00000,61.25000,Coventry,Commercial,,111.36,,,,,,,104.40,112.52,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,116.00000,61.25000,Coventry,Commercial,,111.36,,,,,,,30.16,112.52,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,inpatient,,,463.20000,244.57000,Coventry,Commercial,,444.67,,,,,,,416.88,449.30,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,463.20000,244.57000,Coventry,Commercial,,444.67,,,,,,,120.43,449.30,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,inpatient,,,804.00000,424.51000,Coventry,Commercial,,771.84,,,,,,,723.60,779.88,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,804.00000,424.51000,Coventry,Commercial,,771.84,,,,,,,209.04,779.88,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,inpatient,,,172.00000,90.82000,Coventry,Commercial,,165.12,,,,,,,154.80,166.84,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Coventry,Commercial,,165.12,,,,,,,44.72,166.84,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,inpatient,,,354.30000,187.07000,Coventry,Commercial,,340.13,,,,,,,318.87,343.67,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,354.30000,187.07000,Coventry,Commercial,,340.13,,,,,,,92.12,343.67,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,inpatient,,,277.90000,146.73000,Coventry,Commercial,,266.78,,,,,,,250.11,269.56,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,277.90000,146.73000,Coventry,Commercial,,266.78,,,,,,,72.25,269.56,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,inpatient,,,200.00000,105.60000,Coventry,Commercial,,192.00,,,,,,,180.00,194.00,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,200.00000,105.60000,Coventry,Commercial,,192.00,,,,,,,52.00,194.00,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,inpatient,,,197.00000,63.63000,Coventry,Commercial,,189.12,,,,,,,177.30,191.09,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,outpatient,,,197.00000,63.63000,Coventry,Commercial,,189.12,,,,,,,51.22,191.09,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,inpatient,,,468.00000,151.16000,Coventry,Commercial,50,449.28,,,,,,,421.20,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,outpatient,,,468.00000,151.16000,Coventry,Commercial,50,449.28,,,,,,,121.68,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,inpatient,,,312.00000,100.78000,Coventry,Commercial,LT,299.52,,,,,,,280.80,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Coventry,Commercial,LT,299.52,,,,,,,81.12,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,inpatient,,,312.00000,100.78000,Coventry,Commercial,RT,299.52,,,,,,,280.80,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Coventry,Commercial,RT,299.52,,,,,,,81.12,302.64,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Coventry,Commercial,,434.88,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Coventry,Commercial,,434.88,,,,,,,117.78,439.41,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,inpatient,,,609.00000,196.71000,Coventry,Commercial,,584.64,,,,,,,548.10,590.73,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Coventry,Commercial,,584.64,,,,,,,158.34,590.73,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,inpatient,,,1248.00000,403.10000,Coventry,Commercial,50,1198.08,,,,,,,1123.20,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1248.00000,403.10000,Coventry,Commercial,50,1198.08,,,,,,,324.48,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,inpatient,,,832.00000,268.74000,Coventry,Commercial,LT,798.72,,,,,,,748.80,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Coventry,Commercial,LT,798.72,,,,,,,216.32,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,inpatient,,,832.00000,268.74000,Coventry,Commercial,RT,798.72,,,,,,,748.80,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Coventry,Commercial,RT,798.72,,,,,,,216.32,807.04,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,inpatient,,,4235.00000,1367.90000,Coventry,Commercial,LT,4065.60,,,,,,,3811.50,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Coventry,Commercial,LT,4065.60,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,inpatient,,,4235.00000,1367.90000,Coventry,Commercial,RT,4065.60,,,,,,,3811.50,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Coventry,Commercial,RT,4065.60,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,inpatient,,,2119.00000,684.44000,Coventry,Commercial,,2034.24,,,,,,,1907.10,2055.43,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,outpatient,,,2119.00000,684.44000,Coventry,Commercial,,2034.24,,,,,,,550.94,2055.43,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,inpatient,,,1943.00000,627.59000,Coventry,Commercial,,1865.28,,,,,,,1748.70,1884.71,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1943.00000,627.59000,Coventry,Commercial,,1865.28,,,,,,,505.18,1884.71,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,inpatient,,,1426.00000,460.60000,Coventry,Commercial,,1368.96,,,,,,,1283.40,1383.22,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,outpatient,,,1426.00000,460.60000,Coventry,Commercial,,1368.96,,,,,,,370.76,1383.22,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,inpatient,,,4202.00000,1357.25000,Coventry,Commercial,50,4033.92,,,,,,,3781.80,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,outpatient,,,4202.00000,1357.25000,Coventry,Commercial,50,4033.92,,,,,,,1092.52,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,inpatient,,,2801.00000,904.72000,Coventry,Commercial,LT,2688.96,,,,,,,2520.90,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Coventry,Commercial,LT,2688.96,,,,,,,728.26,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,inpatient,,,2801.00000,904.72000,Coventry,Commercial,RT,2688.96,,,,,,,2520.90,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Coventry,Commercial,RT,2688.96,,,,,,,728.26,2716.97,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,inpatient,,,832.00000,268.74000,Coventry,Commercial,,798.72,,,,,,,748.80,807.04,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,outpatient,,,832.00000,268.74000,Coventry,Commercial,,798.72,,,,,,,216.32,807.04,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,inpatient,,,1457.00000,470.61000,Coventry,Commercial,,1398.72,,,,,,,1311.30,1413.29,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,outpatient,,,1457.00000,470.61000,Coventry,Commercial,,1398.72,,,,,,,378.82,1413.29,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,inpatient,,,743.00000,239.99000,Coventry,Commercial,LT,713.28,,,,,,,668.70,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Coventry,Commercial,LT,713.28,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,inpatient,,,743.00000,239.99000,Coventry,Commercial,RT,713.28,,,,,,,668.70,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Coventry,Commercial,RT,713.28,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,inpatient,,,232.00000,74.94000,Coventry,Commercial,,222.72,,,,,,,208.80,225.04,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,outpatient,,,232.00000,74.94000,Coventry,Commercial,,222.72,,,,,,,60.32,225.04,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,inpatient,,,1364.00000,440.57000,Coventry,Commercial,50,1309.44,,,,,,,1227.60,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,outpatient,,,1364.00000,440.57000,Coventry,Commercial,50,1309.44,,,,,,,354.64,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,inpatient,,,909.00000,293.61000,Coventry,Commercial,LT,872.64,,,,,,,818.10,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Coventry,Commercial,LT,872.64,,,,,,,236.34,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,inpatient,,,909.00000,293.61000,Coventry,Commercial,RT,872.64,,,,,,,818.10,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Coventry,Commercial,RT,872.64,,,,,,,236.34,881.73,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,inpatient,,,510.00000,355.98000,Coventry,Commercial,,489.60,,,,,,,459.00,494.70,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,outpatient,,,510.00000,355.98000,Coventry,Commercial,,489.60,,,,,,,132.60,494.70,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,inpatient,,,1001.00000,698.70000,Coventry,Commercial,,960.96,,,,,,,900.90,970.97,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,outpatient,,,1001.00000,698.70000,Coventry,Commercial,,960.96,,,,,,,260.26,970.97,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,inpatient,,,887.00000,619.13000,Coventry,Commercial,,851.52,,,,,,,798.30,860.39,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,outpatient,,,887.00000,619.13000,Coventry,Commercial,,851.52,,,,,,,230.62,860.39,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,inpatient,,,1022.00000,713.36000,Coventry,Commercial,50,981.12,,,,,,,919.80,991.34,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,outpatient,,,1022.00000,713.36000,Coventry,Commercial,50,981.12,,,,,,,265.72,991.34,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,inpatient,,,681.00000,475.34000,Coventry,Commercial,LT,653.76,,,,,,,612.90,660.57,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Coventry,Commercial,LT,653.76,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,inpatient,,,681.00000,475.34000,Coventry,Commercial,RT,653.76,,,,,,,612.90,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Coventry,Commercial,RT,653.76,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,inpatient,,,945.00000,659.61000,Coventry,Commercial,50,907.20,,,,,,,850.50,916.65,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,outpatient,,,945.00000,659.61000,Coventry,Commercial,50,907.20,,,,,,,245.70,916.65,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,inpatient,,,630.00000,439.74000,Coventry,Commercial,LT,604.80,,,,,,,567.00,611.10,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Coventry,Commercial,LT,604.80,,,,,,,163.80,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,inpatient,,,630.00000,439.74000,Coventry,Commercial,RT,604.80,,,,,,,567.00,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Coventry,Commercial,RT,604.80,,,,,,,163.80,611.10,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,inpatient,,,577.00000,402.75000,Coventry,Commercial,,553.92,,,,,,,519.30,559.69,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,outpatient,,,577.00000,402.75000,Coventry,Commercial,,553.92,,,,,,,150.02,559.69,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,inpatient,,,433.00000,302.23000,Coventry,Commercial,,415.68,,,,,,,389.70,420.01,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,outpatient,,,433.00000,302.23000,Coventry,Commercial,,415.68,,,,,,,112.58,420.01,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,inpatient,,,331.00000,231.04000,Coventry,Commercial,,317.76,,,,,,,297.90,321.07,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,outpatient,,,331.00000,231.04000,Coventry,Commercial,,317.76,,,,,,,86.06,321.07,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,inpatient,,,662.00000,462.08000,Coventry,Commercial,,635.52,,,,,,,595.80,642.14,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,outpatient,,,662.00000,462.08000,Coventry,Commercial,,635.52,,,,,,,172.12,642.14,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,inpatient,,,752.00000,524.90000,Coventry,Commercial,,721.92,,,,,,,676.80,729.44,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,outpatient,,,752.00000,524.90000,Coventry,Commercial,,721.92,,,,,,,195.52,729.44,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,inpatient,,,182.00000,127.04000,Coventry,Commercial,,174.72,,,,,,,163.80,176.54,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Coventry,Commercial,,174.72,,,,,,,47.32,176.54,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,inpatient,,,420.00000,293.16000,Coventry,Commercial,,403.20,,,,,,,378.00,407.40,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,outpatient,,,420.00000,293.16000,Coventry,Commercial,,403.20,,,,,,,109.20,407.40,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,inpatient,,,253.00000,176.59000,Coventry,Commercial,,242.88,,,,,,,227.70,245.41,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,outpatient,,,253.00000,176.59000,Coventry,Commercial,,242.88,,,,,,,65.78,245.41,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,inpatient,,,168.00000,117.26000,Coventry,Commercial,,161.28,,,,,,,151.20,162.96,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,outpatient,,,168.00000,117.26000,Coventry,Commercial,,161.28,,,,,,,43.68,162.96,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,inpatient,,,695.00000,485.11000,Coventry,Commercial,,667.20,,,,,,,625.50,674.15,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,outpatient,,,695.00000,485.11000,Coventry,Commercial,,667.20,,,,,,,180.70,674.15,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,inpatient,,,474.00000,330.85000,Coventry,Commercial,,455.04,,,,,,,426.60,459.78,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,outpatient,,,474.00000,330.85000,Coventry,Commercial,,455.04,,,,,,,123.24,459.78,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,inpatient,,,930.00000,649.14000,Coventry,Commercial,,892.80,,,,,,,837.00,902.10,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,outpatient,,,930.00000,649.14000,Coventry,Commercial,,892.80,,,,,,,241.80,902.10,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,inpatient,,,786.00000,548.63000,Coventry,Commercial,,754.56,,,,,,,707.40,762.42,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,outpatient,,,786.00000,548.63000,Coventry,Commercial,,754.56,,,,,,,204.36,762.42,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,inpatient,,,620.00000,432.76000,Coventry,Commercial,,595.20,,,,,,,558.00,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Coventry,Commercial,,595.20,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,inpatient,,,620.00000,432.76000,Coventry,Commercial,59,595.20,,,,,,,558.00,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Coventry,Commercial,59,595.20,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,inpatient,,,435.00000,303.63000,Coventry,Commercial,,417.60,,,,,,,391.50,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Coventry,Commercial,,417.60,,,,,,,113.10,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,inpatient,,,435.00000,303.63000,Coventry,Commercial,59,417.60,,,,,,,391.50,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Coventry,Commercial,59,417.60,,,,,,,113.10,421.95,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,inpatient,,,492.00000,343.42000,Coventry,Commercial,,472.32,,,,,,,442.80,477.24,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,outpatient,,,492.00000,343.42000,Coventry,Commercial,,472.32,,,,,,,127.92,477.24,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,inpatient,,,331.00000,231.04000,Coventry,Commercial,,317.76,,,,,,,297.90,321.07,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,outpatient,,,331.00000,231.04000,Coventry,Commercial,,317.76,,,,,,,86.06,321.07,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,inpatient,,,875.00000,610.75000,Coventry,Commercial,,840.00,,,,,,,787.50,848.75,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,outpatient,,,875.00000,610.75000,Coventry,Commercial,,840.00,,,,,,,227.50,848.75,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,inpatient,,,688.00000,480.22000,Coventry,Commercial,,660.48,,,,,,,619.20,667.36,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,outpatient,,,688.00000,480.22000,Coventry,Commercial,,660.48,,,,,,,178.88,667.36,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,inpatient,,,465.00000,324.57000,Coventry,Commercial,,446.40,,,,,,,418.50,451.05,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,outpatient,,,465.00000,324.57000,Coventry,Commercial,,446.40,,,,,,,120.90,451.05,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,inpatient,,,846.00000,590.51000,Coventry,Commercial,,812.16,,,,,,,761.40,820.62,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,outpatient,,,846.00000,590.51000,Coventry,Commercial,,812.16,,,,,,,219.96,820.62,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,inpatient,,,482.00000,336.44000,Coventry,Commercial,,462.72,,,,,,,433.80,467.54,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,outpatient,,,482.00000,336.44000,Coventry,Commercial,,462.72,,,,,,,125.32,467.54,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,inpatient,,,926.00000,646.35000,Coventry,Commercial,,888.96,,,,,,,833.40,898.22,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,outpatient,,,926.00000,646.35000,Coventry,Commercial,,888.96,,,,,,,240.76,898.22,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,inpatient,,,292.00000,203.82000,Coventry,Commercial,,280.32,,,,,,,262.80,283.24,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,outpatient,,,292.00000,203.82000,Coventry,Commercial,,280.32,,,,,,,75.92,283.24,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,inpatient,,,827.00000,577.25000,Coventry,Commercial,,793.92,,,,,,,744.30,802.19,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,outpatient,,,827.00000,577.25000,Coventry,Commercial,,793.92,,,,,,,215.02,802.19,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,inpatient,,,253.00000,176.59000,Coventry,Commercial,,242.88,,,,,,,227.70,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,outpatient,,,253.00000,176.59000,Coventry,Commercial,,242.88,,,,,,,65.78,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,inpatient,,,901.00000,628.90000,Coventry,Commercial,,864.96,,,,,,,810.90,873.97,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,outpatient,,,901.00000,628.90000,Coventry,Commercial,,864.96,,,,,,,234.26,873.97,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,inpatient,,,460.00000,321.08000,Coventry,Commercial,,441.60,,,,,,,414.00,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,outpatient,,,460.00000,321.08000,Coventry,Commercial,,441.60,,,,,,,119.60,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,inpatient,,,1029.00000,718.24000,Coventry,Commercial,,987.84,,,,,,,926.10,998.13,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1029.00000,718.24000,Coventry,Commercial,,987.84,,,,,,,267.54,998.13,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,inpatient,,,959.00000,669.38000,Coventry,Commercial,,920.64,,,,,,,863.10,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,outpatient,,,959.00000,669.38000,Coventry,Commercial,,920.64,,,,,,,249.34,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,inpatient,,,558.00000,389.48000,Coventry,Commercial,,535.68,,,,,,,502.20,541.26,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,outpatient,,,558.00000,389.48000,Coventry,Commercial,,535.68,,,,,,,145.08,541.26,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,inpatient,,,705.00000,492.09000,Coventry,Commercial,,676.80,,,,,,,634.50,683.85,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,outpatient,,,705.00000,492.09000,Coventry,Commercial,,676.80,,,,,,,183.30,683.85,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,inpatient,,,249.00000,173.80000,Coventry,Commercial,,239.04,,,,,,,224.10,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,outpatient,,,249.00000,173.80000,Coventry,Commercial,,239.04,,,,,,,64.74,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,inpatient,,,427.00000,298.05000,Coventry,Commercial,,409.92,,,,,,,384.30,414.19,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,outpatient,,,427.00000,298.05000,Coventry,Commercial,,409.92,,,,,,,111.02,414.19,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,inpatient,,,737.00000,514.43000,Coventry,Commercial,,707.52,,,,,,,663.30,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Coventry,Commercial,,707.52,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,inpatient,,,737.00000,514.43000,Coventry,Commercial,59,707.52,,,,,,,663.30,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Coventry,Commercial,59,707.52,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,inpatient,,,809.00000,564.68000,Coventry,Commercial,,776.64,,,,,,,728.10,784.73,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,outpatient,,,809.00000,564.68000,Coventry,Commercial,,776.64,,,,,,,210.34,784.73,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,inpatient,,,525.00000,366.45000,Coventry,Commercial,,504.00,,,,,,,472.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,outpatient,,,525.00000,366.45000,Coventry,Commercial,,504.00,,,,,,,136.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,inpatient,,,319.00000,222.66000,Coventry,Commercial,,306.24,,,,,,,287.10,309.43,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,outpatient,,,319.00000,222.66000,Coventry,Commercial,,306.24,,,,,,,82.94,309.43,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,inpatient,,,1437.00000,678.26000,Coventry,Commercial,,1379.52,,,,,,,1293.30,1393.89,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1437.00000,678.26000,Coventry,Commercial,,1379.52,,,,,,,373.62,1393.89,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,inpatient,,,2143.00000,1011.50000,Coventry,Commercial,,2057.28,,,,,,,1928.70,2078.71,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2143.00000,1011.50000,Coventry,Commercial,,2057.28,,,,,,,557.18,2078.71,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,inpatient,,,755.00000,356.36000,Coventry,Commercial,,724.80,,,,,,,679.50,732.35,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,outpatient,,,755.00000,356.36000,Coventry,Commercial,,724.80,,,,,,,196.30,732.35,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,inpatient,,,979.00000,462.09000,Coventry,Commercial,,939.84,,,,,,,881.10,949.63,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,outpatient,,,979.00000,462.09000,Coventry,Commercial,,939.84,,,,,,,254.54,949.63,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,inpatient,,,436.00000,205.79000,Coventry,Commercial,,418.56,,,,,,,392.40,422.92,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,outpatient,,,436.00000,205.79000,Coventry,Commercial,,418.56,,,,,,,113.36,422.92,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,inpatient,,,220.00000,103.84000,Coventry,Commercial,,211.20,,,,,,,198.00,213.40,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,outpatient,,,220.00000,103.84000,Coventry,Commercial,,211.20,,,,,,,57.20,213.40,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,inpatient,,,344.00000,162.37000,Coventry,Commercial,,330.24,,,,,,,309.60,333.68,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,outpatient,,,344.00000,162.37000,Coventry,Commercial,,330.24,,,,,,,89.44,333.68,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,inpatient,,,818.00000,393.46000,Coventry,Commercial,,785.28,,,,,,,736.20,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,outpatient,,,818.00000,393.46000,Coventry,Commercial,,785.28,,,,,,,212.68,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,inpatient,,,545.00000,262.14000,Coventry,Commercial,52,523.20,,,,,,,490.50,528.65,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,outpatient,,,545.00000,262.14000,Coventry,Commercial,52,523.20,,,,,,,141.70,528.65,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,inpatient,,,1347.00000,647.91000,Coventry,Commercial,,1293.12,,,,,,,1212.30,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,outpatient,,,1347.00000,647.91000,Coventry,Commercial,,1293.12,,,,,,,350.22,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,inpatient,,,898.00000,431.94000,Coventry,Commercial,52,862.08,,,,,,,808.20,871.06,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,outpatient,,,898.00000,431.94000,Coventry,Commercial,52,862.08,,,,,,,233.48,871.06,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,inpatient,,,469.00000,225.59000,Coventry,Commercial,,450.24,,,,,,,422.10,454.93,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,outpatient,,,469.00000,225.59000,Coventry,Commercial,,450.24,,,,,,,121.94,454.93,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,inpatient,,,1762.00000,847.52000,Coventry,Commercial,,1691.52,,,,,,,1585.80,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,outpatient,,,1762.00000,847.52000,Coventry,Commercial,,1691.52,,,,,,,458.12,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,inpatient,,,627.00000,301.59000,Coventry,Commercial,,601.92,,,,,,,564.30,608.19,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,outpatient,,,627.00000,301.59000,Coventry,Commercial,,601.92,,,,,,,163.02,608.19,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,inpatient,,,590.00000,283.79000,Coventry,Commercial,,566.40,,,,,,,531.00,572.30,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,outpatient,,,590.00000,283.79000,Coventry,Commercial,,566.40,,,,,,,153.40,572.30,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,inpatient,,,1550.00000,745.55000,Coventry,Commercial,,1488.00,,,,,,,1395.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,outpatient,,,1550.00000,745.55000,Coventry,Commercial,,1488.00,,,,,,,403.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,inpatient,,,990.00000,476.19000,Coventry,Commercial,LT,950.40,,,,,,,891.00,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Coventry,Commercial,LT,950.40,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,inpatient,,,990.00000,476.19000,Coventry,Commercial,RT,950.40,,,,,,,891.00,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Coventry,Commercial,RT,950.40,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,inpatient,,,1402.00000,674.36000,Coventry,Commercial,,1345.92,,,,,,,1261.80,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,outpatient,,,1402.00000,674.36000,Coventry,Commercial,,1345.92,,,,,,,364.52,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,inpatient,,,980.00000,471.38000,Coventry,Commercial,LT,940.80,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Coventry,Commercial,LT,940.80,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,inpatient,,,980.00000,471.38000,Coventry,Commercial,RT,940.80,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Coventry,Commercial,RT,940.80,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,inpatient,,,1661.00000,798.94000,Coventry,Commercial,,1594.56,,,,,,,1494.90,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,outpatient,,,1661.00000,798.94000,Coventry,Commercial,,1594.56,,,,,,,431.86,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,inpatient,,,980.00000,471.38000,Coventry,Commercial,,940.80,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,outpatient,,,980.00000,471.38000,Coventry,Commercial,,940.80,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,inpatient,,,1740.00000,836.94000,Coventry,Commercial,,1670.40,,,,,,,1566.00,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1740.00000,836.94000,Coventry,Commercial,,1670.40,,,,,,,452.40,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,inpatient,,,1168.00000,561.81000,Coventry,Commercial,,1121.28,,,,,,,1051.20,1132.96,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1168.00000,561.81000,Coventry,Commercial,,1121.28,,,,,,,303.68,1132.96,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,inpatient,,,433.00000,232.09000,Coventry,Commercial,,415.68,,,,,,,389.70,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,outpatient,,,433.00000,232.09000,Coventry,Commercial,,415.68,,,,,,,112.58,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,inpatient,,,388.00000,207.97000,Coventry,Commercial,LT,372.48,,,,,,,349.20,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Coventry,Commercial,LT,372.48,,,,,,,100.88,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,inpatient,,,388.00000,207.97000,Coventry,Commercial,RT,372.48,,,,,,,349.20,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Coventry,Commercial,RT,372.48,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,inpatient,,,388.00000,207.97000,Coventry,Commercial,,372.48,,,,,,,349.20,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,outpatient,,,388.00000,207.97000,Coventry,Commercial,,372.48,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,inpatient,,,604.00000,323.74000,Coventry,Commercial,,579.84,,,,,,,543.60,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,outpatient,,,604.00000,323.74000,Coventry,Commercial,,579.84,,,,,,,157.04,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,inpatient,,,667.00000,357.51000,Coventry,Commercial,,640.32,,,,,,,600.30,646.99,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,outpatient,,,667.00000,357.51000,Coventry,Commercial,,640.32,,,,,,,173.42,646.99,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,inpatient,,,176.00000,94.34000,Coventry,Commercial,,168.96,,,,,,,158.40,170.72,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,outpatient,,,176.00000,94.34000,Coventry,Commercial,,168.96,,,,,,,45.76,170.72,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,inpatient,,,92.00000,29.72000,Coventry,Commercial,LT,88.32,,,,,,,82.80,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Coventry,Commercial,LT,88.32,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,inpatient,,,92.00000,29.72000,Coventry,Commercial,RT,88.32,,,,,,,82.80,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Coventry,Commercial,RT,88.32,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,inpatient,,,366.00000,118.22000,Coventry,Commercial,LT,351.36,,,,,,,329.40,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Coventry,Commercial,LT,351.36,,,,,,,95.16,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,inpatient,,,366.00000,118.22000,Coventry,Commercial,RT,351.36,,,,,,,329.40,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Coventry,Commercial,RT,351.36,,,,,,,95.16,355.02,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,inpatient,,,1117.00000,360.79000,Coventry,Commercial,LT,1072.32,,,,,,,1005.30,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Coventry,Commercial,LT,1072.32,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,inpatient,,,1117.00000,360.79000,Coventry,Commercial,RT,1072.32,,,,,,,1005.30,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Coventry,Commercial,RT,1072.32,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,inpatient,,,559.00000,180.56000,Coventry,Commercial,,536.64,,,,,,,503.10,542.23,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,outpatient,,,559.00000,180.56000,Coventry,Commercial,,536.64,,,,,,,145.34,542.23,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,inpatient,,,252.00000,81.40000,Coventry,Commercial,50,241.92,,,,,,,226.80,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,outpatient,,,252.00000,81.40000,Coventry,Commercial,50,241.92,,,,,,,65.52,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,inpatient,,,168.00000,54.26000,Coventry,Commercial,LT,161.28,,,,,,,151.20,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Coventry,Commercial,LT,161.28,,,,,,,43.68,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,inpatient,,,168.00000,54.26000,Coventry,Commercial,RT,161.28,,,,,,,151.20,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Coventry,Commercial,RT,161.28,,,,,,,43.68,162.96,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,inpatient,,,1148.00000,370.80000,Coventry,Commercial,LT,1102.08,,,,,,,1033.20,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Coventry,Commercial,LT,1102.08,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,inpatient,,,1148.00000,370.80000,Coventry,Commercial,RT,1102.08,,,,,,,1033.20,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Coventry,Commercial,RT,1102.08,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,inpatient,,,379.00000,122.42000,Coventry,Commercial,,363.84,,,,,,,341.10,367.63,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,outpatient,,,379.00000,122.42000,Coventry,Commercial,,363.84,,,,,,,98.54,367.63,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,inpatient,,,1015.00000,327.84000,Coventry,Commercial,,974.40,,,,,,,913.50,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,outpatient,,,1015.00000,327.84000,Coventry,Commercial,,974.40,,,,,,,263.90,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,inpatient,,,591.00000,190.89000,Coventry,Commercial,,567.36,,,,,,,531.90,573.27,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,outpatient,,,591.00000,190.89000,Coventry,Commercial,,567.36,,,,,,,153.66,573.27,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,inpatient,,,271.00000,169.92000,Coventry,Commercial,,260.16,,,,,,,243.90,262.87,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,outpatient,,,271.00000,169.92000,Coventry,Commercial,,260.16,,,,,,,70.46,262.87,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,inpatient,,,211.00000,132.30000,Coventry,Commercial,LT,202.56,,,,,,,189.90,204.67,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Coventry,Commercial,LT,202.56,,,,,,,54.86,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,inpatient,,,211.00000,132.30000,Coventry,Commercial,RT,202.56,,,,,,,189.90,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Coventry,Commercial,RT,202.56,,,,,,,54.86,204.67,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,59.00000,36.99000,Coventry,Commercial,,56.64,,,,,,,53.10,57.23,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,59.00000,36.99000,Coventry,Commercial,,56.64,,,,,,,15.34,57.23,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,inpatient,,,336.00000,219.74000,Coventry,Commercial,,322.56,,,,,,,302.40,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,outpatient,,,336.00000,219.74000,Coventry,Commercial,,322.56,,,,,,,87.36,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,inpatient,,,224.00000,146.50000,Coventry,Commercial,52,215.04,,,,,,,201.60,217.28,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,outpatient,,,224.00000,146.50000,Coventry,Commercial,52,215.04,,,,,,,58.24,217.28,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,inpatient,,,63.00000,41.20000,Coventry,Commercial,,60.48,,,,,,,56.70,61.11,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,outpatient,,,63.00000,41.20000,Coventry,Commercial,,60.48,,,,,,,16.38,61.11,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Coventry,Commercial,,483.84,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Coventry,Commercial,,483.84,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Coventry,Commercial,,94.08,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Coventry,Commercial,,94.08,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Coventry,Commercial,,583.68,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Coventry,Commercial,,583.68,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Coventry,Commercial,,109.44,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Coventry,Commercial,,109.44,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Coventry,Commercial,,179.52,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Coventry,Commercial,,179.52,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Coventry,Commercial,,205.44,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Coventry,Commercial,,205.44,,,,,,,55.64,207.58,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,inpatient,,,609.00000,196.71000,Coventry,Commercial,,584.64,,,,,,,548.10,590.73,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Coventry,Commercial,,584.64,,,,,,,158.34,590.73,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,inpatient,,,863.00000,278.75000,Coventry,Commercial,,828.48,,,,,,,776.70,837.11,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Coventry,Commercial,,828.48,,,,,,,224.38,837.11,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,inpatient,,,900.00000,605.70000,Coventry,Commercial,,864.00,,,,,,,810.00,873.00,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,outpatient,,,900.00000,605.70000,Coventry,Commercial,,864.00,,,,,,,234.00,873.00,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,inpatient,,,1940.00000,1102.21000,Coventry,Commercial,,1862.40,,,,,,,1746.00,1881.80,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,outpatient,,,1940.00000,1102.21000,Coventry,Commercial,,1862.40,,,,,,,504.40,1881.80,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,inpatient,,,422.00000,239.76000,Coventry,Commercial,,405.12,,,,,,,379.80,409.34,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,outpatient,,,422.00000,239.76000,Coventry,Commercial,,405.12,,,,,,,109.72,409.34,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,inpatient,,,1430.00000,812.45000,Coventry,Commercial,,1372.80,,,,,,,1287.00,1387.10,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,outpatient,,,1430.00000,812.45000,Coventry,Commercial,,1372.80,,,,,,,371.80,1387.10,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,inpatient,,,745.00000,423.27000,Coventry,Commercial,,715.20,,,,,,,670.50,722.65,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,outpatient,,,745.00000,423.27000,Coventry,Commercial,,715.20,,,,,,,193.70,722.65,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,inpatient,,,2655.00000,2487.74000,Coventry,Commercial,,2548.80,,,,,,,2389.50,2575.35,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,outpatient,,,2655.00000,2487.74000,Coventry,Commercial,,2548.80,,,,,,,690.30,2575.35,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,inpatient,,,3990.00000,3738.63000,Coventry,Commercial,,3830.40,,,,,,,3591.00,3870.30,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,outpatient,,,3990.00000,3738.63000,Coventry,Commercial,,3830.40,,,,,,,1037.40,3870.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,inpatient,,,290.00000,271.73000,Coventry,Commercial,,278.40,,,,,,,261.00,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,outpatient,,,290.00000,271.73000,Coventry,Commercial,,278.40,,,,,,,75.40,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,inpatient,,,735.00000,688.70000,Coventry,Commercial,,705.60,,,,,,,661.50,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,outpatient,,,735.00000,688.70000,Coventry,Commercial,,705.60,,,,,,,191.10,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,inpatient,,,1475.00000,1382.08000,Coventry,Commercial,,1416.00,,,,,,,1327.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Coventry,Commercial,,1416.00,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,inpatient,,,2275.00000,2131.68000,Coventry,Commercial,,2184.00,,,,,,,2047.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,outpatient,,,2275.00000,2131.68000,Coventry,Commercial,,2184.00,,,,,,,591.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,inpatient,,,3205.00000,3003.08000,Coventry,Commercial,,3076.80,,,,,,,2884.50,3108.85,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,outpatient,,,3205.00000,3003.08000,Coventry,Commercial,,3076.80,,,,,,,833.30,3108.85,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,inpatient,,,770.00000,721.49000,Coventry,Commercial,,739.20,,,,,,,693.00,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,outpatient,,,770.00000,721.49000,Coventry,Commercial,,739.20,,,,,,,200.20,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,inpatient,,,1475.00000,1382.08000,Coventry,Commercial,,1416.00,,,,,,,1327.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Coventry,Commercial,,1416.00,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,inpatient,,,2210.00000,2070.77000,Coventry,Commercial,,2121.60,,,,,,,1989.00,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,outpatient,,,2210.00000,2070.77000,Coventry,Commercial,,2121.60,,,,,,,574.60,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,inpatient,,,2660.00000,2492.42000,Coventry,Commercial,,2553.60,,,,,,,2394.00,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,outpatient,,,2660.00000,2492.42000,Coventry,Commercial,,2553.60,,,,,,,691.60,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,inpatient,,,3560.00000,3335.72000,Coventry,Commercial,,3417.60,,,,,,,3204.00,3453.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,outpatient,,,3560.00000,3335.72000,Coventry,Commercial,,3417.60,,,,,,,925.60,3453.20,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,inpatient,,,5730.00000,3255.50000,Coventry,Commercial,,5500.80,,,,,,,5157.00,5558.10,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,outpatient,,,5730.00000,3255.50000,Coventry,Commercial,,5500.80,,,,,,,1489.80,5558.10,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,inpatient,,,3875.00000,2201.58000,Coventry,Commercial,,3720.00,,,,,,,3487.50,3758.75,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,outpatient,,,3875.00000,2201.58000,Coventry,Commercial,,3720.00,,,,,,,1007.50,3758.75,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,inpatient,,,519.00000,564.15000,Coventry,Commercial,,498.24,,,,,,,467.10,503.43,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,outpatient,,,519.00000,564.15000,Coventry,Commercial,,498.24,,,,,,,134.94,503.43,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,inpatient,,,536.00000,582.63000,Coventry,Commercial,,514.56,,,,,,,482.40,519.92,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,outpatient,,,536.00000,582.63000,Coventry,Commercial,,514.56,,,,,,,139.36,519.92,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Coventry,Commercial,,434.88,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Coventry,Commercial,,434.88,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Coventry,Commercial,,138.24,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Coventry,Commercial,,138.24,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Coventry,Commercial,,102.72,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Coventry,Commercial,,102.72,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Coventry,Commercial,,138.24,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Coventry,Commercial,,138.24,,,,,,,37.44,139.68,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Coventry,Commercial,,483.84,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Coventry,Commercial,,483.84,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Coventry,Commercial,,94.08,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Coventry,Commercial,,94.08,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Coventry,Commercial,,583.68,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Coventry,Commercial,,583.68,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Coventry,Commercial,,109.44,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Coventry,Commercial,,109.44,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Coventry,Commercial,,179.52,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Coventry,Commercial,,179.52,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Coventry,Commercial,,205.44,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Coventry,Commercial,,205.44,,,,,,,55.64,207.58,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,inpatient,,,175.00000,63.18000,Coventry,Commercial,,168.00,,,,,,,157.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,outpatient,,,175.00000,63.18000,Coventry,Commercial,,168.00,,,,,,,45.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,inpatient,,,304.00000,109.74000,Coventry,Commercial,,291.84,,,,,,,273.60,294.88,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,outpatient,,,304.00000,109.74000,Coventry,Commercial,,291.84,,,,,,,79.04,294.88,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Coventry,Commercial,,272.64,,,,,,,255.60,275.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Coventry,Commercial,,272.64,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Coventry,Commercial,,439.68,,,,,,,412.20,444.26,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Coventry,Commercial,,439.68,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,inpatient,,,438.00000,158.12000,Coventry,Commercial,,420.48,,,,,,,394.20,424.86,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,outpatient,,,438.00000,158.12000,Coventry,Commercial,,420.48,,,,,,,113.88,424.86,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Coventry,Commercial,,535.68,,,,,,,502.20,541.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Coventry,Commercial,,535.68,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Coventry,Commercial,,462.72,,,,,,,433.80,467.54,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Coventry,Commercial,,462.72,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Coventry,Commercial,,227.52,,,,,,,213.30,229.89,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Coventry,Commercial,,227.52,,,,,,,61.62,229.89,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Coventry,Commercial,,483.84,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Coventry,Commercial,,483.84,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Coventry,Commercial,,483.84,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Coventry,Commercial,,483.84,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Coventry,Commercial,,483.84,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Coventry,Commercial,,483.84,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Coventry,Commercial,,483.84,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Coventry,Commercial,,483.84,,,,,,,131.04,488.88,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Coventry,Commercial,,808.32,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Coventry,Commercial,,808.32,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Coventry,Commercial,,1010.88,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Coventry,Commercial,,1010.88,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Coventry,Commercial,,1212.48,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Coventry,Commercial,,1212.48,,,,,,,328.38,1225.11,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,inpatient,,,182.00000,127.04000,Coventry,Commercial,,174.72,,,,,,,163.80,176.54,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Coventry,Commercial,,174.72,,,,,,,47.32,176.54,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,inpatient,,,210.00000,119.31000,Coventry,Commercial,,201.60,,,,,,,189.00,203.70,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Coventry,Commercial,,201.60,,,,,,,54.60,203.70,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,inpatient,,,140.00000,79.54000,Coventry,Commercial,,134.40,,,,,,,126.00,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,outpatient,,,140.00000,79.54000,Coventry,Commercial,,134.40,,,,,,,36.40,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,inpatient,,,190.00000,107.95000,Coventry,Commercial,,182.40,,,,,,,171.00,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,outpatient,,,190.00000,107.95000,Coventry,Commercial,,182.40,,,,,,,49.40,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,inpatient,,,240.00000,136.36000,Coventry,Commercial,,230.40,,,,,,,216.00,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,outpatient,,,240.00000,136.36000,Coventry,Commercial,,230.40,,,,,,,62.40,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,inpatient,,,290.00000,164.76000,Coventry,Commercial,,278.40,,,,,,,261.00,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,outpatient,,,290.00000,164.76000,Coventry,Commercial,,278.40,,,,,,,75.40,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,inpatient,,,340.00000,193.17000,Coventry,Commercial,,326.40,,,,,,,306.00,329.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,outpatient,,,340.00000,193.17000,Coventry,Commercial,,326.40,,,,,,,88.40,329.80,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,inpatient,,,150.00000,85.22000,Coventry,Commercial,,144.00,,,,,,,135.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,outpatient,,,150.00000,85.22000,Coventry,Commercial,,144.00,,,,,,,39.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,inpatient,,,200.00000,113.63000,Coventry,Commercial,,192.00,,,,,,,180.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,outpatient,,,200.00000,113.63000,Coventry,Commercial,,192.00,,,,,,,52.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,inpatient,,,270.00000,153.40000,Coventry,Commercial,,259.20,,,,,,,243.00,261.90,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,outpatient,,,270.00000,153.40000,Coventry,Commercial,,259.20,,,,,,,70.20,261.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,inpatient,,,370.00000,210.22000,Coventry,Commercial,,355.20,,,,,,,333.00,358.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,outpatient,,,370.00000,210.22000,Coventry,Commercial,,355.20,,,,,,,96.20,358.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,inpatient,,,470.00000,267.03000,Coventry,Commercial,,451.20,,,,,,,423.00,455.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,outpatient,,,470.00000,267.03000,Coventry,Commercial,,451.20,,,,,,,122.20,455.90,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,inpatient,,,248.00000,96.22000,Coventry,Commercial,,238.08,,,,,,,223.20,240.56,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,outpatient,,,248.00000,96.22000,Coventry,Commercial,,238.08,,,,,,,64.48,240.56,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,inpatient,,,245.00000,95.06000,Coventry,Commercial,,235.20,,,,,,,220.50,237.65,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,outpatient,,,245.00000,95.06000,Coventry,Commercial,,235.20,,,,,,,63.70,237.65,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,inpatient,,,497.00000,192.84000,Coventry,Commercial,,477.12,,,,,,,447.30,482.09,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,outpatient,,,497.00000,192.84000,Coventry,Commercial,,477.12,,,,,,,129.22,482.09,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,inpatient,,,357.00000,138.52000,Coventry,Commercial,,342.72,,,,,,,321.30,346.29,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,outpatient,,,357.00000,138.52000,Coventry,Commercial,,342.72,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,inpatient,,,334.00000,129.59000,Coventry,Commercial,,320.64,,,,,,,300.60,323.98,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,outpatient,,,334.00000,129.59000,Coventry,Commercial,,320.64,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,inpatient,,,194.00000,75.27000,Coventry,Commercial,,186.24,,,,,,,174.60,188.18,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,outpatient,,,194.00000,75.27000,Coventry,Commercial,,186.24,,,,,,,50.44,188.18,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,inpatient,,,1035.00000,401.58000,Coventry,Commercial,,993.60,,,,,,,931.50,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,outpatient,,,1035.00000,401.58000,Coventry,Commercial,,993.60,,,,,,,269.10,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,inpatient,,,1137.00000,441.16000,Coventry,Commercial,,1091.52,,,,,,,1023.30,1102.89,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,outpatient,,,1137.00000,441.16000,Coventry,Commercial,,1091.52,,,,,,,295.62,1102.89,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,inpatient,,,963.00000,373.64000,Coventry,Commercial,,924.48,,,,,,,866.70,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,outpatient,,,963.00000,373.64000,Coventry,Commercial,,924.48,,,,,,,250.38,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,inpatient,,,990.00000,384.12000,Coventry,Commercial,,950.40,,,,,,,891.00,960.30,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,outpatient,,,990.00000,384.12000,Coventry,Commercial,,950.40,,,,,,,257.40,960.30,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,inpatient,,,112.00000,43.46000,Coventry,Commercial,,107.52,,,,,,,100.80,108.64,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,outpatient,,,112.00000,43.46000,Coventry,Commercial,,107.52,,,,,,,29.12,108.64,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,inpatient,,,84.00000,32.59000,Coventry,Commercial,,80.64,,,,,,,75.60,81.48,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,outpatient,,,84.00000,32.59000,Coventry,Commercial,,80.64,,,,,,,21.84,81.48,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,inpatient,,,176.00000,68.29000,Coventry,Commercial,,168.96,,,,,,,158.40,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,outpatient,,,176.00000,68.29000,Coventry,Commercial,,168.96,,,,,,,45.76,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,inpatient,,,283.00000,109.80000,Coventry,Commercial,,271.68,,,,,,,254.70,274.51,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,outpatient,,,283.00000,109.80000,Coventry,Commercial,,271.68,,,,,,,73.58,274.51,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Coventry,Commercial,,77.76,,,,,,,72.90,78.57,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Coventry,Commercial,,77.76,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Coventry,Commercial,,39.36,,,,,,,36.90,39.77,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Coventry,Commercial,,39.36,,,,,,,10.66,39.77,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,inpatient,,,35.00000,19.89000,Coventry,Commercial,,33.60,,,,,,,31.50,33.95,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,35.00000,19.89000,Coventry,Commercial,,33.60,,,,,,,9.10,33.95,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,inpatient,,,191.00000,89.39000,Coventry,Commercial,,183.36,,,,,,,171.90,185.27,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,outpatient,,,191.00000,89.39000,Coventry,Commercial,,183.36,,,,,,,49.66,185.27,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Coventry,Commercial,,434.88,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Coventry,Commercial,,434.88,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Coventry,Commercial,,138.24,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Coventry,Commercial,,138.24,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Coventry,Commercial,,102.72,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Coventry,Commercial,,102.72,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Coventry,Commercial,,138.24,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Coventry,Commercial,,138.24,,,,,,,37.44,139.68,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,inpatient,,,281.00000,131.51000,Coventry,Commercial,,269.76,,,,,,,252.90,272.57,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,outpatient,,,281.00000,131.51000,Coventry,Commercial,,269.76,,,,,,,73.06,272.57,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,inpatient,,,192.00000,89.86000,Coventry,Commercial,,184.32,,,,,,,172.80,186.24,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,outpatient,,,192.00000,89.86000,Coventry,Commercial,,184.32,,,,,,,49.92,186.24,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,inpatient,,,365.00000,170.82000,Coventry,Commercial,,350.40,,,,,,,328.50,354.05,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,outpatient,,,365.00000,170.82000,Coventry,Commercial,,350.40,,,,,,,94.90,354.05,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,inpatient,,,8391.00000,5856.92000,Coventry,Commercial,,8055.36,,,,,,,7551.90,8139.27,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,outpatient,,,8391.00000,5856.92000,Coventry,Commercial,,8055.36,,,,,,,2181.66,8139.27,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,inpatient,,,6917.00000,4828.07000,Coventry,Commercial,52,6640.32,,,,,,,6225.30,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Coventry,Commercial,52,6640.32,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,inpatient,,,6000.00000,4188.00000,Coventry,Commercial,,5760.00,,,,,,,5400.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Coventry,Commercial,,5760.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,inpatient,,,6917.00000,4828.07000,Coventry,Commercial,,6640.32,,,,,,,6225.30,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Coventry,Commercial,,6640.32,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,inpatient,,,6000.00000,4188.00000,Coventry,Commercial,52,5760.00,,,,,,,5400.00,5820.00,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Coventry,Commercial,52,5760.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,inpatient,,,8855.00000,9625.38000,Coventry,Commercial,,8500.80,,,,,,,7969.50,8589.35,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,outpatient,,,8855.00000,9625.38000,Coventry,Commercial,,8500.80,,,,,,,2302.30,8589.35,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,inpatient,,,844.00000,917.43000,Coventry,Commercial,,810.24,,,,,,,759.60,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Coventry,Commercial,,810.24,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,inpatient,,,844.00000,917.43000,Coventry,Commercial,52,810.24,,,,,,,759.60,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Coventry,Commercial,52,810.24,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,inpatient,,,785.00000,853.30000,Coventry,Commercial,,753.60,,,,,,,706.50,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Coventry,Commercial,,753.60,,,,,,,204.10,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,inpatient,,,785.00000,853.30000,Coventry,Commercial,52,753.60,,,,,,,706.50,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Coventry,Commercial,52,753.60,,,,,,,204.10,761.45,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4709.00000,5118.68000,Coventry,Commercial,,4520.64,,,,,,,4238.10,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Coventry,Commercial,,4520.64,,,,,,,1224.34,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4709.00000,5118.68000,Coventry,Commercial,52,4520.64,,,,,,,4238.10,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Coventry,Commercial,52,4520.64,,,,,,,1224.34,4567.73,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,inpatient,,,345.00000,128.34000,Coventry,Commercial,,331.20,,,,,,,310.50,334.65,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,outpatient,,,345.00000,128.34000,Coventry,Commercial,,331.20,,,,,,,89.70,334.65,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,inpatient,,,120.00000,99.60000,Coventry,Commercial,,115.20,,,,,,,108.00,116.40,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,outpatient,,,120.00000,99.60000,Coventry,Commercial,,115.20,,,,,,,31.20,116.40,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,inpatient,,,106.00000,87.98000,Coventry,Commercial,,101.76,,,,,,,95.40,102.82,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,outpatient,,,106.00000,87.98000,Coventry,Commercial,,101.76,,,,,,,27.56,102.82,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,inpatient,,,32.00000,26.56000,Coventry,Commercial,,30.72,,,,,,,28.80,31.04,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,outpatient,,,32.00000,26.56000,Coventry,Commercial,,30.72,,,,,,,8.32,31.04,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,inpatient,,,60.00000,49.80000,Coventry,Commercial,,57.60,,,,,,,54.00,58.20,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,outpatient,,,60.00000,49.80000,Coventry,Commercial,,57.60,,,,,,,15.60,58.20,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,inpatient,,,57.00000,47.31000,Coventry,Commercial,,54.72,,,,,,,51.30,55.29,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,outpatient,,,57.00000,47.31000,Coventry,Commercial,,54.72,,,,,,,14.82,55.29,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,inpatient,1.0,ME,7.40000,0.65000,Coventry,Commercial,,7.10,,,,,,,6.66,7.18,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,outpatient,1.0,ME,7.40000,0.65000,Coventry,Commercial,,7.10,,,,,,,1.92,7.18,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,inpatient,1.0,EA,6.60000,1.43000,Coventry,Commercial,UD,6.34,,,,,,,5.94,6.40,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,outpatient,1.0,EA,6.60000,1.43000,Coventry,Commercial,UD,6.34,,,,,,,1.72,6.40,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,inpatient,1.0,EA,2.95000,0.64000,Coventry,Commercial,UD,2.83,,,,,,,2.65,2.86,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,outpatient,1.0,EA,2.95000,0.64000,Coventry,Commercial,UD,2.83,,,,,,,0.76700,2.86,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,inpatient,1.0,EA,56.08000,12.11000,Coventry,Commercial,UD,53.84,,,,,,,50.47,54.40,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,56.08000,12.11000,Coventry,Commercial,UD,53.84,,,,,,,14.58,54.40,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,inpatient,1.0,UN,82.10000,28.90000,Coventry,Commercial,,78.82,,,,,,,73.89,79.64,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,outpatient,1.0,UN,82.10000,28.90000,Coventry,Commercial,,78.82,,,,,,,15.48,79.64,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.04000,,Coventry,Commercial,UD,0.03840,,,,,,,0.03600,0.03880,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.04000,,Coventry,Commercial,UD,0.03840,,,,,,,0.01040,0.03880,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.05000,,Coventry,Commercial,UD,0.04800,,,,,,,0.04500,0.04850,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.05000,,Coventry,Commercial,UD,0.04800,,,,,,,0.01300,0.04850,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,inpatient,1.0,ME,6.20000,0.55000,Coventry,Commercial,,5.95,,,,,,,5.58,6.01,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,outpatient,1.0,ME,6.20000,0.55000,Coventry,Commercial,,5.95,,,,,,,1.61,6.01,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.12000,0.01000,Coventry,Commercial,UD,0.11520,,,,,,,0.10800,0.11640,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.12000,0.01000,Coventry,Commercial,UD,0.11520,,,,,,,0.03120,0.11640,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,inpatient,2.0,ML,5.80000,1.25000,Coventry,Commercial,,5.57,,,,,,,5.22,5.63,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,outpatient,2.0,ML,5.80000,1.25000,Coventry,Commercial,,5.57,,,,,,,1.51,5.63,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,inpatient,1.0,ME,3.10000,0.27000,Coventry,Commercial,,2.98,,,,,,,2.79,3.01,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,outpatient,1.0,ME,3.10000,0.27000,Coventry,Commercial,,2.98,,,,,,,0.80600,3.01,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,inpatient,1.0,EA,44.40000,3.91000,Coventry,Commercial,,42.62,,,,,,,39.96,43.07,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,outpatient,1.0,EA,44.40000,3.91000,Coventry,Commercial,,42.62,,,,,,,11.54,43.07,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,inpatient,1.0,EA,8.26000,0.73000,Coventry,Commercial,UD,7.93,,,,,,,7.43,8.01,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,8.26000,0.73000,Coventry,Commercial,UD,7.93,,,,,,,2.15,8.01,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,2.19000,0.19000,Coventry,Commercial,UD,2.10,,,,,,,1.97,2.12,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,2.19000,0.19000,Coventry,Commercial,UD,2.10,,,,,,,0.56940,2.12,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,inpatient,1.0,EA,28.60000,2.52000,Coventry,Commercial,,27.46,,,,,,,25.74,27.74,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,outpatient,1.0,EA,28.60000,2.52000,Coventry,Commercial,,27.46,,,,,,,7.44,27.74,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,inpatient,1.0,EA,2.58000,0.91000,Coventry,Commercial,UD,2.48,,,,,,,2.32,2.50,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,outpatient,1.0,EA,2.58000,0.91000,Coventry,Commercial,UD,2.48,,,,,,,0.67080,2.50,percent of total billed charges,
R&B OBSTETRICS PVT,3012,CDM,112,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Coventry,Workers Comp,,2669.76,,,,,,,2502.90,3111.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
R&B MEDICAL/SURGICAL SEMI-PVT,23010,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Coventry,Workers Comp,,2669.76,,,,,,,2502.90,3111.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
R&B ICU,33019,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Coventry,Workers Comp,,8410.56,,,,,,,2512.00,8498.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
R&B ICU INTERMEDIATE,13011,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Coventry,Workers Comp,,5607.36,,,,,,,2512.00,5665.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,244.00000,77.10000,Coventry,Workers Comp,,234.24,,,,,,,219.60,236.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,244.00000,77.10000,Coventry,Workers Comp,,234.24,,,,,,,63.44,236.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
R&B MEDICAL/SURGICAL SEMI-PVT,24075,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Coventry,Workers Comp,,2669.76,,,,,,,2502.90,3111.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
R&B OBSTETRICS SEMI-PVT,44073,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Coventry,Workers Comp,,2669.76,,,,,,,2502.90,3111.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
R&B NURSERY LEVEL 1,55160,CDM,171,RC,,,,,facility,inpatient,,,3477.00000,1975.46000,Coventry,Workers Comp,,3337.92,,,,,,,2512.00,3372.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,inpatient,,,16.00000,7.71000,Coventry,Workers Comp,,15.36,,,,,,,14.40,15.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,outpatient,,,16.00000,7.71000,Coventry,Workers Comp,,15.36,,,,,,,4.16,15.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,inpatient,,,210.00000,119.31000,Coventry,Workers Comp,,201.60,,,,,,,189.00,203.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Coventry,Workers Comp,,201.60,,,,,,,54.60,203.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,inpatient,,,380.00000,215.90000,Coventry,Workers Comp,,364.80,,,,,,,342.00,368.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,outpatient,,,380.00000,215.90000,Coventry,Workers Comp,,364.80,,,,,,,98.80,368.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Coventry,Workers Comp,,111.36,,,,,,,104.40,112.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Coventry,Workers Comp,,111.36,,,,,,,30.16,112.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
R&B MEDICAL/SURGICAL SEMI-PVT,22012,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Coventry,Workers Comp,,2669.76,,,,,,,2502.90,3111.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
R&B ADMIN DAY SKILLED,82016,CDM,160,RC,,,,,facility,inpatient,,,1923.00000,1092.55000,Coventry,Workers Comp,,1846.08,,,,,,,1730.70,3111.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
R&B SWING BED SKILLED,62018,CDM,160,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Coventry,Workers Comp,,2669.76,,,,,,,2502.90,3111.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
R&B ADMIN DAY INTERMEDIATE,72017,CDM,169,RC,,,,,facility,inpatient,,,1176.00000,668.14000,Coventry,Workers Comp,,1128.96,,,,,,,1058.40,3111.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
R&B ICU,32011,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Coventry,Workers Comp,,8410.56,,,,,,,2512.00,8498.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
R&B ICU INTERMEDIATE,12013,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Coventry,Workers Comp,,5607.36,,,,,,,2512.00,5665.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Coventry,Workers Comp,,111.36,,,,,,,104.40,112.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Coventry,Workers Comp,,111.36,,,,,,,30.16,112.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Coventry,Workers Comp,,483.84,,,,,,,453.60,488.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Coventry,Workers Comp,,483.84,,,,,,,131.04,488.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Coventry,Workers Comp,,94.08,,,,,,,88.20,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Coventry,Workers Comp,,94.08,,,,,,,25.48,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Coventry,Workers Comp,,583.68,,,,,,,547.20,589.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Coventry,Workers Comp,,583.68,,,,,,,158.08,589.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Coventry,Workers Comp,,109.44,,,,,,,102.60,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Coventry,Workers Comp,,109.44,,,,,,,29.64,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Coventry,Workers Comp,,179.52,,,,,,,168.30,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Coventry,Workers Comp,,179.52,,,,,,,48.62,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Coventry,Workers Comp,,205.44,,,,,,,192.60,207.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Coventry,Workers Comp,,205.44,,,,,,,55.64,207.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,84.00000,63.59000,Coventry,Workers Comp,,80.64,,,,,,,75.60,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Coventry,Workers Comp,,80.64,,,,,,,21.84,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Coventry,Workers Comp,,272.64,,,,,,,255.60,275.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Coventry,Workers Comp,,272.64,,,,,,,73.84,275.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Coventry,Workers Comp,,439.68,,,,,,,412.20,444.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Coventry,Workers Comp,,439.68,,,,,,,119.08,444.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Coventry,Workers Comp,,535.68,,,,,,,502.20,541.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Coventry,Workers Comp,,535.68,,,,,,,145.08,541.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Coventry,Workers Comp,,462.72,,,,,,,433.80,467.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Coventry,Workers Comp,,462.72,,,,,,,125.32,467.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Coventry,Workers Comp,,227.52,,,,,,,213.30,229.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Coventry,Workers Comp,,227.52,,,,,,,61.62,229.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,inpatient,,,2041.00000,659.24000,Coventry,Workers Comp,,1959.36,,,,,,,1836.90,1979.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,outpatient,,,2041.00000,659.24000,Coventry,Workers Comp,,1959.36,,,,,,,530.66,1979.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,inpatient,,,259.00000,83.66000,Coventry,Workers Comp,,248.64,,,,,,,233.10,251.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,outpatient,,,259.00000,83.66000,Coventry,Workers Comp,,248.64,,,,,,,67.34,251.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,inpatient,,,672.00000,217.06000,Coventry,Workers Comp,,645.12,,,,,,,604.80,651.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,outpatient,,,672.00000,217.06000,Coventry,Workers Comp,,645.12,,,,,,,174.72,651.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,inpatient,,,530.00000,171.19000,Coventry,Workers Comp,,508.80,,,,,,,477.00,514.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,outpatient,,,530.00000,171.19000,Coventry,Workers Comp,,508.80,,,,,,,137.80,514.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,inpatient,,,580.00000,187.34000,Coventry,Workers Comp,,556.80,,,,,,,522.00,562.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,outpatient,,,580.00000,187.34000,Coventry,Workers Comp,,556.80,,,,,,,150.80,562.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,inpatient,,,435.00000,140.50000,Coventry,Workers Comp,,417.60,,,,,,,391.50,421.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,outpatient,,,435.00000,140.50000,Coventry,Workers Comp,,417.60,,,,,,,113.10,421.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,inpatient,,,863.00000,278.75000,Coventry,Workers Comp,,828.48,,,,,,,776.70,837.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Coventry,Workers Comp,,828.48,,,,,,,224.38,837.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,inpatient,,,334.00000,107.88000,Coventry,Workers Comp,,320.64,,,,,,,300.60,323.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,outpatient,,,334.00000,107.88000,Coventry,Workers Comp,,320.64,,,,,,,86.84,323.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,inpatient,,,1188.00000,383.72000,Coventry,Workers Comp,50,1140.48,,,,,,,1069.20,1152.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,outpatient,,,1188.00000,383.72000,Coventry,Workers Comp,50,1140.48,,,,,,,308.88,1152.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,inpatient,,,792.00000,255.82000,Coventry,Workers Comp,LT,760.32,,,,,,,712.80,768.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Coventry,Workers Comp,LT,760.32,,,,,,,205.92,768.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,inpatient,,,792.00000,255.82000,Coventry,Workers Comp,RT,760.32,,,,,,,712.80,768.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Coventry,Workers Comp,RT,760.32,,,,,,,205.92,768.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,inpatient,,,572.00000,184.76000,Coventry,Workers Comp,50,549.12,,,,,,,514.80,554.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,outpatient,,,572.00000,184.76000,Coventry,Workers Comp,50,549.12,,,,,,,148.72,554.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,inpatient,,,381.00000,123.06000,Coventry,Workers Comp,LT,365.76,,,,,,,342.90,369.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Coventry,Workers Comp,LT,365.76,,,,,,,99.06,369.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,inpatient,,,381.00000,123.06000,Coventry,Workers Comp,RT,365.76,,,,,,,342.90,369.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Coventry,Workers Comp,RT,365.76,,,,,,,99.06,369.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,inpatient,,,455.00000,146.96000,Coventry,Workers Comp,,436.80,,,,,,,409.50,441.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,outpatient,,,455.00000,146.96000,Coventry,Workers Comp,,436.80,,,,,,,118.30,441.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,inpatient,,,403.00000,130.17000,Coventry,Workers Comp,,386.88,,,,,,,362.70,390.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,outpatient,,,403.00000,130.17000,Coventry,Workers Comp,,386.88,,,,,,,104.78,390.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,inpatient,,,370.00000,119.51000,Coventry,Workers Comp,,355.20,,,,,,,333.00,358.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,outpatient,,,370.00000,119.51000,Coventry,Workers Comp,,355.20,,,,,,,96.20,358.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,inpatient,,,357.00000,115.31000,Coventry,Workers Comp,,342.72,,,,,,,321.30,346.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,outpatient,,,357.00000,115.31000,Coventry,Workers Comp,,342.72,,,,,,,92.82,346.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,inpatient,,,334.00000,107.88000,Coventry,Workers Comp,,320.64,,,,,,,300.60,323.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,outpatient,,,334.00000,107.88000,Coventry,Workers Comp,,320.64,,,,,,,86.84,323.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,inpatient,,,194.00000,62.66000,Coventry,Workers Comp,,186.24,,,,,,,174.60,188.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,outpatient,,,194.00000,62.66000,Coventry,Workers Comp,,186.24,,,,,,,50.44,188.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,inpatient,,,457.00000,147.61000,Coventry,Workers Comp,,438.72,,,,,,,411.30,443.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,outpatient,,,457.00000,147.61000,Coventry,Workers Comp,,438.72,,,,,,,118.82,443.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,inpatient,,,492.00000,158.92000,Coventry,Workers Comp,,472.32,,,,,,,442.80,477.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,outpatient,,,492.00000,158.92000,Coventry,Workers Comp,,472.32,,,,,,,127.92,477.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,inpatient,,,780.00000,251.94000,Coventry,Workers Comp,,748.80,,,,,,,702.00,756.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,outpatient,,,780.00000,251.94000,Coventry,Workers Comp,,748.80,,,,,,,202.80,756.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,inpatient,,,1165.00000,376.30000,Coventry,Workers Comp,,1118.40,,,,,,,1048.50,1130.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,outpatient,,,1165.00000,376.30000,Coventry,Workers Comp,,1118.40,,,,,,,302.90,1130.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,inpatient,,,2350.00000,759.05000,Coventry,Workers Comp,,2256.00,,,,,,,2115.00,2279.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,outpatient,,,2350.00000,759.05000,Coventry,Workers Comp,,2256.00,,,,,,,611.00,2279.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,inpatient,,,896.00000,289.41000,Coventry,Workers Comp,,860.16,,,,,,,806.40,869.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,outpatient,,,896.00000,289.41000,Coventry,Workers Comp,,860.16,,,,,,,232.96,869.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,inpatient,,,490.00000,158.27000,Coventry,Workers Comp,,470.40,,,,,,,441.00,475.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,outpatient,,,490.00000,158.27000,Coventry,Workers Comp,,470.40,,,,,,,127.40,475.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,inpatient,,,520.00000,167.96000,Coventry,Workers Comp,,499.20,,,,,,,468.00,504.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,outpatient,,,520.00000,167.96000,Coventry,Workers Comp,,499.20,,,,,,,135.20,504.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,inpatient,,,720.00000,232.56000,Coventry,Workers Comp,,691.20,,,,,,,648.00,698.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,outpatient,,,720.00000,232.56000,Coventry,Workers Comp,,691.20,,,,,,,187.20,698.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,inpatient,,,215.00000,69.45000,Coventry,Workers Comp,,206.40,,,,,,,193.50,208.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,outpatient,,,215.00000,69.45000,Coventry,Workers Comp,,206.40,,,,,,,55.90,208.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,inpatient,,,240.00000,77.52000,Coventry,Workers Comp,,230.40,,,,,,,216.00,232.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,outpatient,,,240.00000,77.52000,Coventry,Workers Comp,,230.40,,,,,,,62.40,232.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,inpatient,,,1241.00000,400.84000,Coventry,Workers Comp,,1191.36,,,,,,,1116.90,1203.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,outpatient,,,1241.00000,400.84000,Coventry,Workers Comp,,1191.36,,,,,,,322.66,1203.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Coventry,Workers Comp,,808.32,,,,,,,757.80,816.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Coventry,Workers Comp,,808.32,,,,,,,218.92,816.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Coventry,Workers Comp,,1010.88,,,,,,,947.70,1021.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Coventry,Workers Comp,,1010.88,,,,,,,273.78,1021.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Coventry,Workers Comp,,1212.48,,,,,,,1136.70,1225.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Coventry,Workers Comp,,1212.48,,,,,,,328.38,1225.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,inpatient,,,668.00000,559.78000,Coventry,Workers Comp,,641.28,,,,,,,601.20,647.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,outpatient,,,668.00000,559.78000,Coventry,Workers Comp,,641.28,,,,,,,173.68,647.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Coventry,Workers Comp,,77.76,,,,,,,72.90,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Coventry,Workers Comp,,77.76,,,,,,,21.06,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Coventry,Workers Comp,,39.36,,,,,,,36.90,39.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Coventry,Workers Comp,,39.36,,,,,,,10.66,39.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Coventry,Workers Comp,,434.88,,,,,,,407.70,439.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Coventry,Workers Comp,,434.88,,,,,,,117.78,439.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Coventry,Workers Comp,,138.24,,,,,,,129.60,139.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Coventry,Workers Comp,,138.24,,,,,,,37.44,139.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Coventry,Workers Comp,,102.72,,,,,,,96.30,103.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Coventry,Workers Comp,,102.72,,,,,,,27.82,103.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Coventry,Workers Comp,,138.24,,,,,,,129.60,139.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Coventry,Workers Comp,,138.24,,,,,,,37.44,139.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Coventry,Workers Comp,,3.26,,,,,,,3.06,3.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Coventry,Workers Comp,,3.26,,,,,,,0.88400,3.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Coventry,Workers Comp,,3.26,,,,,,,3.06,3.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Coventry,Workers Comp,,3.26,,,,,,,0.88400,3.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Coventry,Workers Comp,,3.26,,,,,,,3.06,3.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Coventry,Workers Comp,,3.26,,,,,,,0.88400,3.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,4.90000,2.78000,Coventry,Workers Comp,,4.70,,,,,,,4.41,4.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Coventry,Workers Comp,,4.70,,,,,,,1.27,4.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,7.90000,4.49000,Coventry,Workers Comp,,7.58,,,,,,,7.11,7.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,7.90000,4.49000,Coventry,Workers Comp,,7.58,,,,,,,2.05,7.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,4.90000,2.78000,Coventry,Workers Comp,,4.70,,,,,,,4.41,4.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Coventry,Workers Comp,,4.70,,,,,,,1.27,4.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Coventry,Workers Comp,,77.76,,,,,,,72.90,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Coventry,Workers Comp,,77.76,,,,,,,21.06,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Coventry,Workers Comp,,77.76,,,,,,,72.90,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Coventry,Workers Comp,,77.76,,,,,,,21.06,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Coventry,Workers Comp,,77.76,,,,,,,72.90,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Coventry,Workers Comp,,77.76,,,,,,,21.06,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,inpatient,,,3141500.00000,1784843.22000,Coventry,Workers Comp,,3015840.00,,,,,,,2827350.00,3047255.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,outpatient,,,3141500.00000,1784843.22000,Coventry,Workers Comp,,3015840.00,,,,,,,816790.00,3047255.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Coventry,Workers Comp,UD,0.21120,,,,,,,0.19800,0.21340,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Coventry,Workers Comp,UD,0.21120,,,,,,,0.05720,0.21340,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.52000,0.30000,Coventry,Workers Comp,UD,0.49920,,,,,,,0.46800,0.50440,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.52000,0.30000,Coventry,Workers Comp,UD,0.49920,,,,,,,0.13520,0.50440,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.56000,0.32000,Coventry,Workers Comp,UD,0.53760,,,,,,,0.50400,0.54320,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.56000,0.32000,Coventry,Workers Comp,UD,0.53760,,,,,,,0.14560,0.54320,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Coventry,Workers Comp,UD,0.21120,,,,,,,0.19800,0.21340,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Coventry,Workers Comp,UD,0.21120,,,,,,,0.05720,0.21340,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.85000,0.48000,Coventry,Workers Comp,UD,0.81600,,,,,,,0.76500,0.82450,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.85000,0.48000,Coventry,Workers Comp,UD,0.81600,,,,,,,0.22100,0.82450,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Coventry,Workers Comp,UD,0.21120,,,,,,,0.19800,0.21340,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Coventry,Workers Comp,UD,0.21120,,,,,,,0.05720,0.21340,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,inpatient,,,102.00000,65.18000,Coventry,Workers Comp,,97.92,,,,,,,91.80,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,outpatient,,,102.00000,65.18000,Coventry,Workers Comp,,97.92,,,,,,,26.52,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,inpatient,,,190.00000,121.41000,Coventry,Workers Comp,,182.40,,,,,,,171.00,184.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,outpatient,,,190.00000,121.41000,Coventry,Workers Comp,,182.40,,,,,,,49.40,184.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,inpatient,,,359.00000,229.40000,Coventry,Workers Comp,,344.64,,,,,,,323.10,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Coventry,Workers Comp,,344.64,,,,,,,93.34,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,inpatient,,,535.00000,341.86000,Coventry,Workers Comp,,513.60,,,,,,,481.50,518.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Coventry,Workers Comp,,513.60,,,,,,,139.10,518.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,inpatient,,,766.00000,489.47000,Coventry,Workers Comp,,735.36,,,,,,,689.40,743.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,outpatient,,,766.00000,489.47000,Coventry,Workers Comp,,735.36,,,,,,,199.16,743.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,inpatient,,,159.00000,101.60000,Coventry,Workers Comp,,152.64,,,,,,,143.10,154.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,outpatient,,,159.00000,101.60000,Coventry,Workers Comp,,152.64,,,,,,,41.34,154.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,inpatient,,,447.00000,285.63000,Coventry,Workers Comp,,429.12,,,,,,,402.30,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,outpatient,,,447.00000,285.63000,Coventry,Workers Comp,,429.12,,,,,,,116.22,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,inpatient,,,1413.00000,902.91000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,outpatient,,,1413.00000,902.91000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,inpatient,,,3853.00000,2462.07000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,outpatient,,,3853.00000,2462.07000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,inpatient,,,313.00000,200.01000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,outpatient,,,313.00000,200.01000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,inpatient,,,1132.00000,723.35000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,outpatient,,,1132.00000,723.35000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,inpatient,,,2695.00000,1722.10000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,outpatient,,,2695.00000,1722.10000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,inpatient,,,1619.00000,1034.54000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,outpatient,,,1619.00000,1034.54000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,inpatient,,,535.00000,341.86000,Coventry,Workers Comp,,513.60,,,,,,,481.50,518.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Coventry,Workers Comp,,513.60,,,,,,,139.10,518.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,inpatient,,,850.00000,543.15000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,outpatient,,,850.00000,543.15000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,inpatient,,,32.00000,20.45000,Coventry,Workers Comp,,30.72,,,,,,,28.80,31.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,outpatient,,,32.00000,20.45000,Coventry,Workers Comp,,30.72,,,,,,,8.32,31.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,inpatient,,,134.00000,85.63000,Coventry,Workers Comp,,128.64,,,,,,,120.60,129.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,outpatient,,,134.00000,85.63000,Coventry,Workers Comp,,128.64,,,,,,,34.84,129.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,inpatient,,,359.00000,229.40000,Coventry,Workers Comp,,344.64,,,,,,,323.10,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Coventry,Workers Comp,,344.64,,,,,,,93.34,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,inpatient,,,709.00000,453.05000,Coventry,Workers Comp,,680.64,,,,,,,638.10,687.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,outpatient,,,709.00000,453.05000,Coventry,Workers Comp,,680.64,,,,,,,184.34,687.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,inpatient,,,4880.00000,2357.04000,Coventry,Workers Comp,,4684.80,,,,,,,4392.00,4733.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,outpatient,,,4880.00000,2357.04000,Coventry,Workers Comp,,4684.80,,,,,,,1268.80,4733.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,inpatient,,,6024.00000,2909.59000,Coventry,Workers Comp,,5783.04,,,,,,,5421.60,5843.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,outpatient,,,6024.00000,2909.59000,Coventry,Workers Comp,,5783.04,,,,,,,1566.24,5843.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Coventry,Workers Comp,,429.12,,,,,,,402.30,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Coventry,Workers Comp,,429.12,,,,,,,116.22,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Coventry,Workers Comp,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Coventry,Workers Comp,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,inpatient,,,7413.00000,3580.48000,Coventry,Workers Comp,,7116.48,,,,,,,6671.70,7190.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,outpatient,,,7413.00000,3580.48000,Coventry,Workers Comp,,7116.48,,,,,,,1927.38,7190.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Coventry,Workers Comp,,429.12,,,,,,,402.30,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Coventry,Workers Comp,,429.12,,,,,,,116.22,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Coventry,Workers Comp,,429.12,,,,,,,402.30,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Coventry,Workers Comp,,429.12,,,,,,,116.22,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Coventry,Workers Comp,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Coventry,Workers Comp,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,inpatient,,,7181.00000,3468.42000,Coventry,Workers Comp,,6893.76,,,,,,,6462.90,6965.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Coventry,Workers Comp,,6893.76,,,,,,,1867.06,6965.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,inpatient,,,10654.00000,5145.88000,Coventry,Workers Comp,,10227.84,,,,,,,9588.60,10334.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,outpatient,,,10654.00000,5145.88000,Coventry,Workers Comp,,10227.84,,,,,,,2770.04,10334.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,6487.00000,3133.22000,Coventry,Workers Comp,,6227.52,,,,,,,5838.30,6292.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Coventry,Workers Comp,,6227.52,,,,,,,1686.62,6292.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,7413.00000,3580.48000,Coventry,Workers Comp,,7116.48,,,,,,,6671.70,7190.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Coventry,Workers Comp,,7116.48,,,,,,,1927.38,7190.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,11575.00000,5590.72000,Coventry,Workers Comp,,11112.00,,,,,,,10417.50,11227.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,11575.00000,5590.72000,Coventry,Workers Comp,,11112.00,,,,,,,3009.50,11227.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,13432.00000,6487.66000,Coventry,Workers Comp,,12894.72,,,,,,,12088.80,13029.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,13432.00000,6487.66000,Coventry,Workers Comp,,12894.72,,,,,,,3492.32,13029.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,21904.00000,10579.63000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,21904.00000,10579.63000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,4397.00000,2123.75000,Coventry,Workers Comp,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Coventry,Workers Comp,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,7413.00000,3580.48000,Coventry,Workers Comp,,7116.48,,,,,,,6671.70,7190.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Coventry,Workers Comp,,7116.48,,,,,,,1927.38,7190.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,12969.00000,6264.03000,Coventry,Workers Comp,,12450.24,,,,,,,11672.10,12579.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,12969.00000,6264.03000,Coventry,Workers Comp,,12450.24,,,,,,,3371.94,12579.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Coventry,Workers Comp,,2328.96,,,,,,,2183.40,2353.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Coventry,Workers Comp,,2328.96,,,,,,,630.76,2353.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Coventry,Workers Comp,,2713.92,,,,,,,2544.30,2742.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Coventry,Workers Comp,,2713.92,,,,,,,735.02,2742.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Coventry,Workers Comp,,97.92,,,,,,,91.80,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Coventry,Workers Comp,,97.92,,,,,,,26.52,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,inpatient,,,134.00000,64.72000,Coventry,Workers Comp,,128.64,,,,,,,120.60,129.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Coventry,Workers Comp,,128.64,,,,,,,34.84,129.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,inpatient,,,251.00000,121.23000,Coventry,Workers Comp,,240.96,,,,,,,225.90,243.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,outpatient,,,251.00000,121.23000,Coventry,Workers Comp,,240.96,,,,,,,65.26,243.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,447.00000,215.90000,Coventry,Workers Comp,,429.12,,,,,,,402.30,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,447.00000,215.90000,Coventry,Workers Comp,,429.12,,,,,,,116.22,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,2827.00000,1365.44000,Coventry,Workers Comp,,2713.92,,,,,,,2544.30,2742.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Coventry,Workers Comp,,2713.92,,,,,,,735.02,2742.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,2690.00000,1299.27000,Coventry,Workers Comp,,2582.40,,,,,,,2421.00,2609.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Coventry,Workers Comp,,2582.40,,,,,,,699.40,2609.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,6487.00000,3133.22000,Coventry,Workers Comp,,6227.52,,,,,,,5838.30,6292.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Coventry,Workers Comp,,6227.52,,,,,,,1686.62,6292.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,2426.00000,1171.76000,Coventry,Workers Comp,,2328.96,,,,,,,2183.40,2353.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,2426.00000,1171.76000,Coventry,Workers Comp,,2328.96,,,,,,,630.76,2353.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,15334.00000,7406.32000,Coventry,Workers Comp,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,15334.00000,7406.32000,Coventry,Workers Comp,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Coventry,Workers Comp,,2713.92,,,,,,,2544.30,2742.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Coventry,Workers Comp,,2713.92,,,,,,,735.02,2742.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,251.00000,121.23000,Coventry,Workers Comp,,240.96,,,,,,,225.90,243.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,251.00000,121.23000,Coventry,Workers Comp,,240.96,,,,,,,65.26,243.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,2827.00000,1365.44000,Coventry,Workers Comp,,2713.92,,,,,,,2544.30,2742.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Coventry,Workers Comp,,2713.92,,,,,,,735.02,2742.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Coventry,Workers Comp,,30.72,,,,,,,28.80,31.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Coventry,Workers Comp,,30.72,,,,,,,8.32,31.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,inpatient,,,15334.00000,7406.32000,Coventry,Workers Comp,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Coventry,Workers Comp,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,inpatient,,,1485.00000,717.26000,Coventry,Workers Comp,,1425.60,,,,,,,1336.50,1440.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,outpatient,,,1485.00000,717.26000,Coventry,Workers Comp,,1425.60,,,,,,,386.10,1440.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,inpatient,,,2028.00000,979.52000,Coventry,Workers Comp,,1946.88,,,,,,,1825.20,1967.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,outpatient,,,2028.00000,979.52000,Coventry,Workers Comp,,1946.88,,,,,,,527.28,1967.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,4397.00000,2123.75000,Coventry,Workers Comp,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Coventry,Workers Comp,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,8107.00000,3915.68000,Coventry,Workers Comp,,7782.72,,,,,,,7296.30,7863.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,8107.00000,3915.68000,Coventry,Workers Comp,,7782.72,,,,,,,2107.82,7863.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,10422.00000,5033.83000,Coventry,Workers Comp,,10005.12,,,,,,,9379.80,10109.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,10422.00000,5033.83000,Coventry,Workers Comp,,10005.12,,,,,,,2709.72,10109.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,12737.00000,6151.97000,Coventry,Workers Comp,,12227.52,,,,,,,11463.30,12354.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,12737.00000,6151.97000,Coventry,Workers Comp,,12227.52,,,,,,,3311.62,12354.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,14239.00000,6877.44000,Coventry,Workers Comp,,13669.44,,,,,,,12815.10,13811.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,14239.00000,6877.44000,Coventry,Workers Comp,,13669.44,,,,,,,3702.14,13811.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,16429.00000,7935.21000,Coventry,Workers Comp,,15771.84,,,,,,,14786.10,15936.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,16429.00000,7935.21000,Coventry,Workers Comp,,15771.84,,,,,,,4271.54,15936.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,18619.00000,8992.98000,Coventry,Workers Comp,,17874.24,,,,,,,16757.10,18060.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,18619.00000,8992.98000,Coventry,Workers Comp,,17874.24,,,,,,,4840.94,18060.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,20809.00000,10050.75000,Coventry,Workers Comp,,19976.64,,,,,,,18728.10,20184.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,20809.00000,10050.75000,Coventry,Workers Comp,,19976.64,,,,,,,5410.34,20184.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,22999.00000,11108.52000,Coventry,Workers Comp,,22079.04,,,,,,,20699.10,22309.03,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,22999.00000,11108.52000,Coventry,Workers Comp,,22079.04,,,,,,,5979.74,22309.03,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,25189.00000,12166.29000,Coventry,Workers Comp,,24181.44,,,,,,,22670.10,24433.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,25189.00000,12166.29000,Coventry,Workers Comp,,24181.44,,,,,,,6549.14,24433.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,27379.00000,13224.06000,Coventry,Workers Comp,,26283.84,,,,,,,24641.10,26557.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,27379.00000,13224.06000,Coventry,Workers Comp,,26283.84,,,,,,,7118.54,26557.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,29569.00000,14281.83000,Coventry,Workers Comp,,28386.24,,,,,,,26612.10,28681.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,29569.00000,14281.83000,Coventry,Workers Comp,,28386.24,,,,,,,7687.94,28681.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,31759.00000,15339.60000,Coventry,Workers Comp,,30488.64,,,,,,,28583.10,30806.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,31759.00000,15339.60000,Coventry,Workers Comp,,30488.64,,,,,,,8257.34,30806.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,36139.00000,17455.14000,Coventry,Workers Comp,,34693.44,,,,,,,32525.10,35054.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,36139.00000,17455.14000,Coventry,Workers Comp,,34693.44,,,,,,,9396.14,35054.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Coventry,Workers Comp,,3206.40,,,,,,,3006.00,3239.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Coventry,Workers Comp,,3206.40,,,,,,,868.40,3239.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Coventry,Workers Comp,,30.72,,,,,,,28.80,31.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Coventry,Workers Comp,,30.72,,,,,,,8.32,31.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,inpatient,,,134.00000,64.72000,Coventry,Workers Comp,,128.64,,,,,,,120.60,129.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Coventry,Workers Comp,,128.64,,,,,,,34.84,129.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Coventry,Workers Comp,,182.40,,,,,,,171.00,184.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Coventry,Workers Comp,,182.40,,,,,,,49.40,184.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,inpatient,,,476.00000,229.91000,Coventry,Workers Comp,,456.96,,,,,,,428.40,461.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,outpatient,,,476.00000,229.91000,Coventry,Workers Comp,,456.96,,,,,,,123.76,461.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Coventry,Workers Comp,,30.72,,,,,,,28.80,31.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Coventry,Workers Comp,,30.72,,,,,,,8.32,31.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Coventry,Workers Comp,,429.12,,,,,,,402.30,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Coventry,Workers Comp,,429.12,,,,,,,116.22,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,inpatient,,,12506.00000,6040.40000,Coventry,Workers Comp,,12005.76,,,,,,,11255.40,12130.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,outpatient,,,12506.00000,6040.40000,Coventry,Workers Comp,,12005.76,,,,,,,3251.56,12130.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,inpatient,,,2404.80000,1161.52000,Coventry,Workers Comp,,2308.61,,,,,,,2164.32,2332.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,outpatient,,,2404.80000,1161.52000,Coventry,Workers Comp,,2308.61,,,,,,,625.25,2332.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,inpatient,,,969.00000,468.03000,Coventry,Workers Comp,,930.24,,,,,,,872.10,939.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,outpatient,,,969.00000,468.03000,Coventry,Workers Comp,,930.24,,,,,,,251.94,939.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,inpatient,,,2256.90000,1090.08000,Coventry,Workers Comp,,2166.62,,,,,,,2031.21,2189.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,outpatient,,,2256.90000,1090.08000,Coventry,Workers Comp,,2166.62,,,,,,,586.79,2189.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,inpatient,,,644.30000,311.20000,Coventry,Workers Comp,,618.53,,,,,,,579.87,624.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,outpatient,,,644.30000,311.20000,Coventry,Workers Comp,,618.53,,,,,,,167.52,624.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Coventry,Workers Comp,,97.92,,,,,,,91.80,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Coventry,Workers Comp,,97.92,,,,,,,26.52,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Coventry,Workers Comp,,182.40,,,,,,,171.00,184.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Coventry,Workers Comp,,182.40,,,,,,,49.40,184.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,inpatient,,,26284.00000,12695.17000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,inpatient,,,30664.00000,14810.71000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,inpatient,,,35044.00000,16926.25000,Coventry,Workers Comp,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Coventry,Workers Comp,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,inpatient,,,43804.00000,21157.33000,Coventry,Workers Comp,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,outpatient,,,43804.00000,21157.33000,Coventry,Workers Comp,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,inpatient,,,52564.00000,25388.41000,Coventry,Workers Comp,,50461.44,,,,,,,47307.60,50987.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,outpatient,,,52564.00000,25388.41000,Coventry,Workers Comp,,50461.44,,,,,,,13666.64,50987.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,inpatient,,,61324.00000,29619.49000,Coventry,Workers Comp,,58871.04,,,,,,,55191.60,59484.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,outpatient,,,61324.00000,29619.49000,Coventry,Workers Comp,,58871.04,,,,,,,15944.24,59484.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,inpatient,,,70084.00000,33850.57000,Coventry,Workers Comp,,67280.64,,,,,,,63075.60,67981.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,outpatient,,,70084.00000,33850.57000,Coventry,Workers Comp,,67280.64,,,,,,,18221.84,67981.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,inpatient,,,78844.00000,38081.65000,Coventry,Workers Comp,,75690.24,,,,,,,70959.60,76478.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,outpatient,,,78844.00000,38081.65000,Coventry,Workers Comp,,75690.24,,,,,,,20499.44,76478.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,inpatient,,,87604.00000,42312.73000,Coventry,Workers Comp,,84099.84,,,,,,,78843.60,84975.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,outpatient,,,87604.00000,42312.73000,Coventry,Workers Comp,,84099.84,,,,,,,22777.04,84975.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,inpatient,,,96364.00000,46543.81000,Coventry,Workers Comp,,92509.44,,,,,,,86727.60,93473.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,outpatient,,,96364.00000,46543.81000,Coventry,Workers Comp,,92509.44,,,,,,,25054.64,93473.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,inpatient,,,26284.00000,12695.17000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,inpatient,,,30664.00000,14810.71000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,inpatient,,,35044.00000,16926.25000,Coventry,Workers Comp,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Coventry,Workers Comp,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,inpatient,,,39424.00000,19041.79000,Coventry,Workers Comp,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,outpatient,,,39424.00000,19041.79000,Coventry,Workers Comp,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Coventry,Workers Comp,,3752.64,,,,,,,3518.10,3791.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Coventry,Workers Comp,,3752.64,,,,,,,1016.34,3791.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Coventry,Workers Comp,,182.40,,,,,,,171.00,184.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Coventry,Workers Comp,,182.40,,,,,,,49.40,184.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,inpatient,,,15334.00000,7406.32000,Coventry,Workers Comp,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Coventry,Workers Comp,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,2023.00000,977.11000,Coventry,Workers Comp,,1942.08,,,,,,,1820.70,1962.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2023.00000,977.11000,Coventry,Workers Comp,,1942.08,,,,,,,525.98,1962.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,inpatient,,,7876.00000,3804.11000,Coventry,Workers Comp,,7560.96,,,,,,,7088.40,7639.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Coventry,Workers Comp,,7560.96,,,,,,,2047.76,7639.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,inpatient,,,10191.00000,4922.25000,Coventry,Workers Comp,,9783.36,,,,,,,9171.90,9885.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,outpatient,,,10191.00000,4922.25000,Coventry,Workers Comp,,9783.36,,,,,,,2649.66,9885.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,96.00000,46.37000,Coventry,Workers Comp,,92.16,,,,,,,86.40,93.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,96.00000,46.37000,Coventry,Workers Comp,,92.16,,,,,,,24.96,93.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,7876.00000,3804.11000,Coventry,Workers Comp,,7560.96,,,,,,,7088.40,7639.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,7876.00000,3804.11000,Coventry,Workers Comp,,7560.96,,,,,,,2047.76,7639.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Coventry,Workers Comp,,3752.64,,,,,,,3518.10,3791.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Coventry,Workers Comp,,3752.64,,,,,,,1016.34,3791.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,inpatient,,,5373.00000,2595.16000,Coventry,Workers Comp,,5158.08,,,,,,,4835.70,5211.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,outpatient,,,5373.00000,2595.16000,Coventry,Workers Comp,,5158.08,,,,,,,1396.98,5211.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,inpatient,,,6487.00000,3133.22000,Coventry,Workers Comp,,6227.52,,,,,,,5838.30,6292.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,outpatient,,,6487.00000,3133.22000,Coventry,Workers Comp,,6227.52,,,,,,,1686.62,6292.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,inpatient,,,7876.00000,3804.11000,Coventry,Workers Comp,,7560.96,,,,,,,7088.40,7639.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Coventry,Workers Comp,,7560.96,,,,,,,2047.76,7639.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Coventry,Workers Comp,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Coventry,Workers Comp,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,inpatient,,,1126.00000,543.86000,Coventry,Workers Comp,,1080.96,,,,,,,1013.40,1092.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,outpatient,,,1126.00000,543.86000,Coventry,Workers Comp,,1080.96,,,,,,,292.76,1092.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,2690.00000,1299.27000,Coventry,Workers Comp,,2582.40,,,,,,,2421.00,2609.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Coventry,Workers Comp,,2582.40,,,,,,,699.40,2609.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,4880.00000,2357.04000,Coventry,Workers Comp,,4684.80,,,,,,,4392.00,4733.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,4880.00000,2357.04000,Coventry,Workers Comp,,4684.80,,,,,,,1268.80,4733.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,9260.00000,4472.58000,Coventry,Workers Comp,,8889.60,,,,,,,8334.00,8982.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,9260.00000,4472.58000,Coventry,Workers Comp,,8889.60,,,,,,,2407.60,8982.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,inpatient,,,588.00000,284.00000,Coventry,Workers Comp,,564.48,,,,,,,529.20,570.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,588.00000,284.00000,Coventry,Workers Comp,,564.48,,,,,,,152.88,570.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Coventry,Workers Comp,,2328.96,,,,,,,2183.40,2353.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Coventry,Workers Comp,,2328.96,,,,,,,630.76,2353.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Coventry,Workers Comp,,2713.92,,,,,,,2544.30,2742.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Coventry,Workers Comp,,2713.92,,,,,,,735.02,2742.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Coventry,Workers Comp,,3206.40,,,,,,,3006.00,3239.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Coventry,Workers Comp,,3206.40,,,,,,,868.40,3239.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Coventry,Workers Comp,,3206.40,,,,,,,3006.00,3239.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Coventry,Workers Comp,,3206.40,,,,,,,868.40,3239.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Coventry,Workers Comp,,429.12,,,,,,,402.30,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Coventry,Workers Comp,,429.12,,,,,,,116.22,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Coventry,Workers Comp,,3752.64,,,,,,,3518.10,3791.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Coventry,Workers Comp,,3752.64,,,,,,,1016.34,3791.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,inpatient,,,159.00000,76.80000,Coventry,Workers Comp,,152.64,,,,,,,143.10,154.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,outpatient,,,159.00000,76.80000,Coventry,Workers Comp,,152.64,,,,,,,41.34,154.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,inpatient,,,588.00000,284.00000,Coventry,Workers Comp,,564.48,,,,,,,529.20,570.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,outpatient,,,588.00000,284.00000,Coventry,Workers Comp,,564.48,,,,,,,152.88,570.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Coventry,Workers Comp,,2328.96,,,,,,,2183.40,2353.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Coventry,Workers Comp,,2328.96,,,,,,,630.76,2353.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Coventry,Workers Comp,,429.12,,,,,,,402.30,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Coventry,Workers Comp,,429.12,,,,,,,116.22,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,inpatient,,,8107.00000,3915.68000,Coventry,Workers Comp,,7782.72,,,,,,,7296.30,7863.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,outpatient,,,8107.00000,3915.68000,Coventry,Workers Comp,,7782.72,,,,,,,2107.82,7863.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,inpatient,,,10422.00000,5033.83000,Coventry,Workers Comp,,10005.12,,,,,,,9379.80,10109.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,outpatient,,,10422.00000,5033.83000,Coventry,Workers Comp,,10005.12,,,,,,,2709.72,10109.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Coventry,Workers Comp,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Coventry,Workers Comp,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Coventry,Workers Comp,,97.92,,,,,,,91.80,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Coventry,Workers Comp,,97.92,,,,,,,26.52,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,inpatient,,,221.00000,106.74000,Coventry,Workers Comp,,212.16,,,,,,,198.90,214.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,outpatient,,,221.00000,106.74000,Coventry,Workers Comp,,212.16,,,,,,,57.46,214.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Coventry,Workers Comp,,429.12,,,,,,,402.30,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Coventry,Workers Comp,,429.12,,,,,,,116.22,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Coventry,Workers Comp,,2328.96,,,,,,,2183.40,2353.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Coventry,Workers Comp,,2328.96,,,,,,,630.76,2353.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Coventry,Workers Comp,,3206.40,,,,,,,3006.00,3239.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Coventry,Workers Comp,,3206.40,,,,,,,868.40,3239.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,inpatient,,,4153.00000,2005.90000,Coventry,Workers Comp,,3986.88,,,,,,,3737.70,4028.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,outpatient,,,4153.00000,2005.90000,Coventry,Workers Comp,,3986.88,,,,,,,1079.78,4028.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,inpatient,,,5129.00000,2477.31000,Coventry,Workers Comp,,4923.84,,,,,,,4616.10,4975.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,outpatient,,,5129.00000,2477.31000,Coventry,Workers Comp,,4923.84,,,,,,,1333.54,4975.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,inpatient,,,7181.00000,3468.42000,Coventry,Workers Comp,,6893.76,,,,,,,6462.90,6965.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Coventry,Workers Comp,,6893.76,,,,,,,1867.06,6965.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,inpatient,,,52.50000,25.36000,Coventry,Workers Comp,,50.40,,,,,,,47.25,50.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,outpatient,,,52.50000,25.36000,Coventry,Workers Comp,,50.40,,,,,,,13.65,50.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,inpatient,,,50.40000,24.34000,Coventry,Workers Comp,,48.38,,,,,,,45.36,48.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,outpatient,,,50.40000,24.34000,Coventry,Workers Comp,,48.38,,,,,,,13.10,48.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Coventry,Workers Comp,,2328.96,,,,,,,2183.40,2353.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Coventry,Workers Comp,,2328.96,,,,,,,630.76,2353.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Coventry,Workers Comp,,3752.64,,,,,,,3518.10,3791.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Coventry,Workers Comp,,3752.64,,,,,,,1016.34,3791.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Coventry,Workers Comp,,97.92,,,,,,,91.80,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Coventry,Workers Comp,,97.92,,,,,,,26.52,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Coventry,Workers Comp,,30.72,,,,,,,28.80,31.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Coventry,Workers Comp,,30.72,,,,,,,8.32,31.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Coventry,Workers Comp,,429.12,,,,,,,402.30,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Coventry,Workers Comp,,429.12,,,,,,,116.22,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,inpatient,,,709.00000,342.45000,Coventry,Workers Comp,,680.64,,,,,,,638.10,687.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,outpatient,,,709.00000,342.45000,Coventry,Workers Comp,,680.64,,,,,,,184.34,687.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Coventry,Workers Comp,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Coventry,Workers Comp,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Coventry,Workers Comp,,84099.84,,,,,,,78843.60,84975.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Coventry,Workers Comp,,84099.84,,,,,,,22777.04,84975.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,109504.00000,62214.70000,Coventry,Workers Comp,,105123.84,,,,,,,98553.60,106218.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Coventry,Workers Comp,,105123.84,,,,,,,28471.04,106218.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,131404.00000,74657.18000,Coventry,Workers Comp,,126147.84,,,,,,,118263.60,127461.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,131404.00000,74657.18000,Coventry,Workers Comp,,126147.84,,,,,,,34165.04,127461.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,43800.00000,24884.97000,Coventry,Workers Comp,,42048.00,,,,,,,39420.00,42486.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,43800.00000,24884.97000,Coventry,Workers Comp,,42048.00,,,,,,,11388.00,42486.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Coventry,Workers Comp,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Coventry,Workers Comp,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Coventry,Workers Comp,,84099.84,,,,,,,78843.60,84975.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Coventry,Workers Comp,,84099.84,,,,,,,22777.04,84975.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,19714.00000,11200.51000,Coventry,Workers Comp,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Coventry,Workers Comp,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,24090.00000,13686.73000,Coventry,Workers Comp,,23126.40,,,,,,,21681.00,23367.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,24090.00000,13686.73000,Coventry,Workers Comp,,23126.40,,,,,,,6263.40,23367.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,28474.00000,16177.50000,Coventry,Workers Comp,,27335.04,,,,,,,25626.60,27619.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Coventry,Workers Comp,,27335.04,,,,,,,7403.24,27619.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,17520.00000,9953.99000,Coventry,Workers Comp,,16819.20,,,,,,,15768.00,16994.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Coventry,Workers Comp,,16819.20,,,,,,,4555.20,16994.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,21904.00000,12444.76000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,26284.00000,14933.25000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,43804.00000,24887.24000,Coventry,Workers Comp,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Coventry,Workers Comp,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Coventry,Workers Comp,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Coventry,Workers Comp,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Coventry,Workers Comp,,84099.84,,,,,,,78843.60,84975.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Coventry,Workers Comp,,84099.84,,,,,,,22777.04,84975.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,109504.00000,62214.70000,Coventry,Workers Comp,,105123.84,,,,,,,98553.60,106218.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Coventry,Workers Comp,,105123.84,,,,,,,28471.04,106218.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,6105.00000,3468.56000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,6105.00000,3468.56000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,13895.00000,7894.44000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,13895.00000,7894.44000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,21900.00000,12442.48000,Coventry,Workers Comp,,21024.00,,,,,,,19710.00,21243.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,21900.00000,12442.48000,Coventry,Workers Comp,,21024.00,,,,,,,5694.00,21243.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,35040.00000,19907.98000,Coventry,Workers Comp,,33638.40,,,,,,,31536.00,33988.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,35040.00000,19907.98000,Coventry,Workers Comp,,33638.40,,,,,,,9110.40,33988.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,43804.00000,24887.24000,Coventry,Workers Comp,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Coventry,Workers Comp,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,19714.00000,11200.51000,Coventry,Workers Comp,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Coventry,Workers Comp,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,22776.00000,12940.18000,Coventry,Workers Comp,,21864.96,,,,,,,20498.40,22092.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,22776.00000,12940.18000,Coventry,Workers Comp,,21864.96,,,,,,,5921.76,22092.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,28474.00000,16177.50000,Coventry,Workers Comp,,27335.04,,,,,,,25626.60,27619.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Coventry,Workers Comp,,27335.04,,,,,,,7403.24,27619.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,17520.00000,9953.99000,Coventry,Workers Comp,,16819.20,,,,,,,15768.00,16994.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Coventry,Workers Comp,,16819.20,,,,,,,4555.20,16994.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,21904.00000,12444.76000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,26284.00000,14933.25000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,30664.00000,17421.75000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,30664.00000,17421.75000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,35044.00000,19910.25000,Coventry,Workers Comp,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,35044.00000,19910.25000,Coventry,Workers Comp,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,2157.00000,864.96000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,2157.00000,864.96000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,2695.00000,1080.70000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2695.00000,1080.70000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,3853.00000,1545.05000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,3853.00000,1545.05000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,inpatient,,,1413.00000,566.61000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,outpatient,,,1413.00000,566.61000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,3229.80000,1857.14000,Coventry,Workers Comp,,3100.61,,,,,,,2906.82,3132.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,3229.80000,1857.14000,Coventry,Workers Comp,,3100.61,,,,,,,839.75,3132.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,854.40000,491.28000,Coventry,Workers Comp,,820.22,,,,,,,768.96,828.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,854.40000,491.28000,Coventry,Workers Comp,,820.22,,,,,,,222.14,828.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1200.50000,690.29000,Coventry,Workers Comp,,1152.48,,,,,,,1080.45,1164.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1200.50000,690.29000,Coventry,Workers Comp,,1152.48,,,,,,,312.13,1164.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1011.00000,581.32000,Coventry,Workers Comp,,970.56,,,,,,,909.90,980.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1011.00000,581.32000,Coventry,Workers Comp,,970.56,,,,,,,262.86,980.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1823.80000,1048.68000,Coventry,Workers Comp,,1750.85,,,,,,,1641.42,1769.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1823.80000,1048.68000,Coventry,Workers Comp,,1750.85,,,,,,,474.19,1769.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2028.50000,1166.39000,Coventry,Workers Comp,,1947.36,,,,,,,1825.65,1967.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2028.50000,1166.39000,Coventry,Workers Comp,,1947.36,,,,,,,527.41,1967.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,841.00000,483.58000,Coventry,Workers Comp,,807.36,,,,,,,756.90,815.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,841.00000,483.58000,Coventry,Workers Comp,,807.36,,,,,,,218.66,815.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1366.20000,785.56000,Coventry,Workers Comp,,1311.55,,,,,,,1229.58,1325.21,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1366.20000,785.56000,Coventry,Workers Comp,,1311.55,,,,,,,355.21,1325.21,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1384.00000,795.80000,Coventry,Workers Comp,,1328.64,,,,,,,1245.60,1342.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1384.00000,795.80000,Coventry,Workers Comp,,1328.64,,,,,,,359.84,1342.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2458.70000,1413.75000,Coventry,Workers Comp,,2360.35,,,,,,,2212.83,2384.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2458.70000,1413.75000,Coventry,Workers Comp,,2360.35,,,,,,,639.26,2384.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2393.50000,1376.26000,Coventry,Workers Comp,,2297.76,,,,,,,2154.15,2321.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2393.50000,1376.26000,Coventry,Workers Comp,,2297.76,,,,,,,622.31,2321.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1369.50000,787.46000,Coventry,Workers Comp,,1314.72,,,,,,,1232.55,1328.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1369.50000,787.46000,Coventry,Workers Comp,,1314.72,,,,,,,356.07,1328.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2697.40000,1551.00000,Coventry,Workers Comp,,2589.50,,,,,,,2427.66,2616.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2697.40000,1551.00000,Coventry,Workers Comp,,2589.50,,,,,,,701.32,2616.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4621.80000,2657.54000,Coventry,Workers Comp,,4436.93,,,,,,,4159.62,4483.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4621.80000,2657.54000,Coventry,Workers Comp,,4436.93,,,,,,,1201.67,4483.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2592.50000,1490.69000,Coventry,Workers Comp,,2488.80,,,,,,,2333.25,2514.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2592.50000,1490.69000,Coventry,Workers Comp,,2488.80,,,,,,,674.05,2514.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Coventry,Workers Comp,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Coventry,Workers Comp,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Coventry,Workers Comp,,8005.44,,,,,,,7505.10,8088.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Coventry,Workers Comp,,8005.44,,,,,,,2168.14,8088.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Coventry,Workers Comp,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Coventry,Workers Comp,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,8107.00000,4661.52000,Coventry,Workers Comp,,7782.72,,,,,,,7296.30,7863.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Coventry,Workers Comp,,7782.72,,,,,,,2107.82,7863.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Coventry,Workers Comp,,1080.96,,,,,,,1013.40,1092.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Coventry,Workers Comp,,1080.96,,,,,,,292.76,1092.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Coventry,Workers Comp,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Coventry,Workers Comp,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Coventry,Workers Comp,,7116.48,,,,,,,6671.70,7190.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Coventry,Workers Comp,,7116.48,,,,,,,1927.38,7190.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,inpatient,,,20152.00000,11587.40000,Coventry,Workers Comp,,19345.92,,,,,,,18136.80,19547.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,outpatient,,,20152.00000,11587.40000,Coventry,Workers Comp,,19345.92,,,,,,,5239.52,19547.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Coventry,Workers Comp,,429.12,,,,,,,402.30,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Coventry,Workers Comp,,429.12,,,,,,,116.22,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Coventry,Workers Comp,,680.64,,,,,,,638.10,687.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Coventry,Workers Comp,,680.64,,,,,,,184.34,687.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,1272.00000,731.40000,Coventry,Workers Comp,,1221.12,,,,,,,1144.80,1233.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,1272.00000,731.40000,Coventry,Workers Comp,,1221.12,,,,,,,330.72,1233.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Coventry,Workers Comp,,2582.40,,,,,,,2421.00,2609.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Coventry,Workers Comp,,2582.40,,,,,,,699.40,2609.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,3078.00000,1769.85000,Coventry,Workers Comp,,2954.88,,,,,,,2770.20,2985.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,3078.00000,1769.85000,Coventry,Workers Comp,,2954.88,,,,,,,800.28,2985.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,70.00000,40.25000,Coventry,Workers Comp,,67.20,,,,,,,63.00,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,70.00000,40.25000,Coventry,Workers Comp,,67.20,,,,,,,18.20,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,102.00000,58.65000,Coventry,Workers Comp,,97.92,,,,,,,91.80,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,102.00000,58.65000,Coventry,Workers Comp,,97.92,,,,,,,26.52,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,221.00000,127.07000,Coventry,Workers Comp,,212.16,,,,,,,198.90,214.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,221.00000,127.07000,Coventry,Workers Comp,,212.16,,,,,,,57.46,214.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Coventry,Workers Comp,,429.12,,,,,,,402.30,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Coventry,Workers Comp,,429.12,,,,,,,116.22,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Coventry,Workers Comp,,680.64,,,,,,,638.10,687.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Coventry,Workers Comp,,680.64,,,,,,,184.34,687.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Coventry,Workers Comp,,12005.76,,,,,,,11255.40,12130.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Coventry,Workers Comp,,12005.76,,,,,,,3251.56,12130.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35482.00000,20402.15000,Coventry,Workers Comp,,34062.72,,,,,,,31933.80,34417.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35482.00000,20402.15000,Coventry,Workers Comp,,34062.72,,,,,,,9225.32,34417.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39862.00000,22920.65000,Coventry,Workers Comp,,38267.52,,,,,,,35875.80,38666.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39862.00000,22920.65000,Coventry,Workers Comp,,38267.52,,,,,,,10364.12,38666.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,44242.00000,25439.15000,Coventry,Workers Comp,,42472.32,,,,,,,39817.80,42914.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,44242.00000,25439.15000,Coventry,Workers Comp,,42472.32,,,,,,,11502.92,42914.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,48622.00000,27957.65000,Coventry,Workers Comp,,46677.12,,,,,,,43759.80,47163.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,48622.00000,27957.65000,Coventry,Workers Comp,,46677.12,,,,,,,12641.72,47163.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,53002.00000,30476.15000,Coventry,Workers Comp,,50881.92,,,,,,,47701.80,51411.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,53002.00000,30476.15000,Coventry,Workers Comp,,50881.92,,,,,,,13780.52,51411.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Coventry,Workers Comp,,58871.04,,,,,,,55191.60,59484.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Coventry,Workers Comp,,58871.04,,,,,,,15944.24,59484.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Coventry,Workers Comp,,67280.64,,,,,,,63075.60,67981.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Coventry,Workers Comp,,67280.64,,,,,,,18221.84,67981.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Coventry,Workers Comp,,75690.24,,,,,,,70959.60,76478.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Coventry,Workers Comp,,75690.24,,,,,,,20499.44,76478.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Coventry,Workers Comp,,84099.84,,,,,,,78843.60,84975.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Coventry,Workers Comp,,84099.84,,,,,,,22777.04,84975.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Coventry,Workers Comp,,92509.44,,,,,,,86727.60,93473.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Coventry,Workers Comp,,92509.44,,,,,,,25054.64,93473.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,844.00000,485.30000,Coventry,Workers Comp,,810.24,,,,,,,759.60,818.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,844.00000,485.30000,Coventry,Workers Comp,,810.24,,,,,,,219.44,818.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,11575.00000,6655.62000,Coventry,Workers Comp,,11112.00,,,,,,,10417.50,11227.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,11575.00000,6655.62000,Coventry,Workers Comp,,11112.00,,,,,,,3009.50,11227.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,14892.00000,8562.90000,Coventry,Workers Comp,,14296.32,,,,,,,13402.80,14445.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14892.00000,8562.90000,Coventry,Workers Comp,,14296.32,,,,,,,3871.92,14445.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,24970.00000,14357.75000,Coventry,Workers Comp,,23971.20,,,,,,,22473.00,24220.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,24970.00000,14357.75000,Coventry,Workers Comp,,23971.20,,,,,,,6492.20,24220.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Coventry,Workers Comp,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Coventry,Workers Comp,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Coventry,Workers Comp,,429.12,,,,,,,402.30,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Coventry,Workers Comp,,429.12,,,,,,,116.22,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Coventry,Workers Comp,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Coventry,Workers Comp,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Coventry,Workers Comp,,3206.40,,,,,,,3006.00,3239.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Coventry,Workers Comp,,3206.40,,,,,,,868.40,3239.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,4153.00000,2387.98000,Coventry,Workers Comp,,3986.88,,,,,,,3737.70,4028.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Coventry,Workers Comp,,3986.88,,,,,,,1079.78,4028.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,4641.00000,2668.58000,Coventry,Workers Comp,,4455.36,,,,,,,4176.90,4501.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4641.00000,2668.58000,Coventry,Workers Comp,,4455.36,,,,,,,1206.66,4501.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Coventry,Workers Comp,,4684.80,,,,,,,4392.00,4733.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Coventry,Workers Comp,,4684.80,,,,,,,1268.80,4733.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Coventry,Workers Comp,,92509.44,,,,,,,86727.60,93473.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Coventry,Workers Comp,,92509.44,,,,,,,25054.64,93473.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Coventry,Workers Comp,,105123.84,,,,,,,98553.60,106218.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Coventry,Workers Comp,,105123.84,,,,,,,28471.04,106218.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,131404.00000,75557.30000,Coventry,Workers Comp,,126147.84,,,,,,,118263.60,127461.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Coventry,Workers Comp,,126147.84,,,,,,,34165.04,127461.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,153304.00000,88149.80000,Coventry,Workers Comp,,147171.84,,,,,,,137973.60,148704.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,153304.00000,88149.80000,Coventry,Workers Comp,,147171.84,,,,,,,39859.04,148704.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,175204.00000,100742.30000,Coventry,Workers Comp,,168195.84,,,,,,,157683.60,169947.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,175204.00000,100742.30000,Coventry,Workers Comp,,168195.84,,,,,,,45553.04,169947.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,197104.00000,113334.80000,Coventry,Workers Comp,,189219.84,,,,,,,177393.60,191190.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,197104.00000,113334.80000,Coventry,Workers Comp,,189219.84,,,,,,,51247.04,191190.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,219004.00000,125927.30000,Coventry,Workers Comp,,210243.84,,,,,,,197103.60,212433.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,219004.00000,125927.30000,Coventry,Workers Comp,,210243.84,,,,,,,56941.04,212433.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Coventry,Workers Comp,,46256.64,,,,,,,43365.60,46738.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Coventry,Workers Comp,,46256.64,,,,,,,12527.84,46738.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Coventry,Workers Comp,,50461.44,,,,,,,47307.60,50987.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Coventry,Workers Comp,,50461.44,,,,,,,13666.64,50987.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Coventry,Workers Comp,,54666.24,,,,,,,51249.60,55235.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Coventry,Workers Comp,,54666.24,,,,,,,14805.44,55235.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Coventry,Workers Comp,,58871.04,,,,,,,55191.60,59484.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Coventry,Workers Comp,,58871.04,,,,,,,15944.24,59484.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Coventry,Workers Comp,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Coventry,Workers Comp,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Coventry,Workers Comp,,50461.44,,,,,,,47307.60,50987.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Coventry,Workers Comp,,50461.44,,,,,,,13666.64,50987.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Coventry,Workers Comp,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Coventry,Workers Comp,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Coventry,Workers Comp,,84099.84,,,,,,,78843.60,84975.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Coventry,Workers Comp,,84099.84,,,,,,,22777.04,84975.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Coventry,Workers Comp,,105123.84,,,,,,,98553.60,106218.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Coventry,Workers Comp,,105123.84,,,,,,,28471.04,106218.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Coventry,Workers Comp,,4684.80,,,,,,,4392.00,4733.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Coventry,Workers Comp,,4684.80,,,,,,,1268.80,4733.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Coventry,Workers Comp,,46256.64,,,,,,,43365.60,46738.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Coventry,Workers Comp,,46256.64,,,,,,,12527.84,46738.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Coventry,Workers Comp,,50461.44,,,,,,,47307.60,50987.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Coventry,Workers Comp,,50461.44,,,,,,,13666.64,50987.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Coventry,Workers Comp,,54666.24,,,,,,,51249.60,55235.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Coventry,Workers Comp,,54666.24,,,,,,,14805.44,55235.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Coventry,Workers Comp,,58871.04,,,,,,,55191.60,59484.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Coventry,Workers Comp,,58871.04,,,,,,,15944.24,59484.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Coventry,Workers Comp,,67280.64,,,,,,,63075.60,67981.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Coventry,Workers Comp,,67280.64,,,,,,,18221.84,67981.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Coventry,Workers Comp,,75690.24,,,,,,,70959.60,76478.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Coventry,Workers Comp,,75690.24,,,,,,,20499.44,76478.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Coventry,Workers Comp,,84099.84,,,,,,,78843.60,84975.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Coventry,Workers Comp,,84099.84,,,,,,,22777.04,84975.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Coventry,Workers Comp,,92509.44,,,,,,,86727.60,93473.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Coventry,Workers Comp,,92509.44,,,,,,,25054.64,93473.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Coventry,Workers Comp,,105123.84,,,,,,,98553.60,106218.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Coventry,Workers Comp,,105123.84,,,,,,,28471.04,106218.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,122644.00000,70520.30000,Coventry,Workers Comp,,117738.24,,,,,,,110379.60,118964.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Coventry,Workers Comp,,117738.24,,,,,,,31887.44,118964.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,135784.00000,78075.80000,Coventry,Workers Comp,,130352.64,,,,,,,122205.60,131710.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,135784.00000,78075.80000,Coventry,Workers Comp,,130352.64,,,,,,,35303.84,131710.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Coventry,Workers Comp,,46256.64,,,,,,,43365.60,46738.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Coventry,Workers Comp,,46256.64,,,,,,,12527.84,46738.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,55630.00000,31987.25000,Coventry,Workers Comp,,53404.80,,,,,,,50067.00,53961.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,55630.00000,31987.25000,Coventry,Workers Comp,,53404.80,,,,,,,14463.80,53961.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Coventry,Workers Comp,,2582.40,,,,,,,2421.00,2609.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Coventry,Workers Comp,,2582.40,,,,,,,699.40,2609.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,14020.00000,8061.50000,Coventry,Workers Comp,,13459.20,,,,,,,12618.00,13599.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Coventry,Workers Comp,,13459.20,,,,,,,3645.20,13599.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,17962.00000,10328.15000,Coventry,Workers Comp,,17243.52,,,,,,,16165.80,17423.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,17962.00000,10328.15000,Coventry,Workers Comp,,17243.52,,,,,,,4670.12,17423.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,2421.00000,1392.07000,Coventry,Workers Comp,,2324.16,,,,,,,2178.90,2348.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,2421.00000,1392.07000,Coventry,Workers Comp,,2324.16,,,,,,,629.46,2348.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Coventry,Workers Comp,,2328.96,,,,,,,2183.40,2353.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Coventry,Workers Comp,,2328.96,,,,,,,630.76,2353.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Coventry,Workers Comp,,2582.40,,,,,,,2421.00,2609.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Coventry,Workers Comp,,2582.40,,,,,,,699.40,2609.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,27160.00000,15617.00000,Coventry,Workers Comp,,26073.60,,,,,,,24444.00,26345.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,27160.00000,15617.00000,Coventry,Workers Comp,,26073.60,,,,,,,7061.60,26345.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Coventry,Workers Comp,,31539.84,,,,,,,29568.60,31868.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Coventry,Workers Comp,,31539.84,,,,,,,8542.04,31868.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Coventry,Workers Comp,,50461.44,,,,,,,47307.60,50987.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Coventry,Workers Comp,,50461.44,,,,,,,13666.64,50987.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Coventry,Workers Comp,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Coventry,Workers Comp,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Coventry,Workers Comp,,75690.24,,,,,,,70959.60,76478.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Coventry,Workers Comp,,75690.24,,,,,,,20499.44,76478.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,28470.00000,16370.25000,Coventry,Workers Comp,,27331.20,,,,,,,25623.00,27615.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,28470.00000,16370.25000,Coventry,Workers Comp,,27331.20,,,,,,,7402.20,27615.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,43800.00000,25185.00000,Coventry,Workers Comp,,42048.00,,,,,,,39420.00,42486.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,43800.00000,25185.00000,Coventry,Workers Comp,,42048.00,,,,,,,11388.00,42486.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Coventry,Workers Comp,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Coventry,Workers Comp,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Coventry,Workers Comp,,84099.84,,,,,,,78843.60,84975.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Coventry,Workers Comp,,84099.84,,,,,,,22777.04,84975.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Coventry,Workers Comp,,105123.84,,,,,,,98553.60,106218.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Coventry,Workers Comp,,105123.84,,,,,,,28471.04,106218.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Coventry,Workers Comp,,3752.64,,,,,,,3518.10,3791.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Coventry,Workers Comp,,3752.64,,,,,,,1016.34,3791.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Coventry,Workers Comp,,31539.84,,,,,,,29568.60,31868.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Coventry,Workers Comp,,31539.84,,,,,,,8542.04,31868.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,54754.00000,31483.55000,Coventry,Workers Comp,,52563.84,,,,,,,49278.60,53111.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,54754.00000,31483.55000,Coventry,Workers Comp,,52563.84,,,,,,,14236.04,53111.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Coventry,Workers Comp,,2582.40,,,,,,,2421.00,2609.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Coventry,Workers Comp,,2582.40,,,,,,,699.40,2609.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,61320.00000,35259.00000,Coventry,Workers Comp,,58867.20,,,,,,,55188.00,59480.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,61320.00000,35259.00000,Coventry,Workers Comp,,58867.20,,,,,,,15943.20,59480.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,70080.00000,40296.00000,Coventry,Workers Comp,,67276.80,,,,,,,63072.00,67977.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,70080.00000,40296.00000,Coventry,Workers Comp,,67276.80,,,,,,,18220.80,67977.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,78840.00000,45333.00000,Coventry,Workers Comp,,75686.40,,,,,,,70956.00,76474.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,78840.00000,45333.00000,Coventry,Workers Comp,,75686.40,,,,,,,20498.40,76474.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Coventry,Workers Comp,,92509.44,,,,,,,86727.60,93473.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Coventry,Workers Comp,,92509.44,,,,,,,25054.64,93473.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Coventry,Workers Comp,,105123.84,,,,,,,98553.60,106218.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Coventry,Workers Comp,,105123.84,,,,,,,28471.04,106218.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,122644.00000,70520.30000,Coventry,Workers Comp,,117738.24,,,,,,,110379.60,118964.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Coventry,Workers Comp,,117738.24,,,,,,,31887.44,118964.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Coventry,Workers Comp,,23130.24,,,,,,,21684.60,23371.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Coventry,Workers Comp,,23130.24,,,,,,,6264.44,23371.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Coventry,Workers Comp,,31539.84,,,,,,,29568.60,31868.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Coventry,Workers Comp,,31539.84,,,,,,,8542.04,31868.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,1883.00000,1082.72000,Coventry,Workers Comp,,1807.68,,,,,,,1694.70,1826.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1883.00000,1082.72000,Coventry,Workers Comp,,1807.68,,,,,,,489.58,1826.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Coventry,Workers Comp,,3752.64,,,,,,,3518.10,3791.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Coventry,Workers Comp,,3752.64,,,,,,,1016.34,3791.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,7644.00000,4395.30000,Coventry,Workers Comp,,7338.24,,,,,,,6879.60,7414.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,7644.00000,4395.30000,Coventry,Workers Comp,,7338.24,,,,,,,1987.44,7414.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Coventry,Workers Comp,,2582.40,,,,,,,2421.00,2609.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Coventry,Workers Comp,,2582.40,,,,,,,699.40,2609.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,inpatient,,,1614.00000,928.05000,Coventry,Workers Comp,,1549.44,,,,,,,1452.60,1565.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Coventry,Workers Comp,,1549.44,,,,,,,419.64,1565.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Coventry,Workers Comp,,23130.24,,,,,,,21684.60,23371.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Coventry,Workers Comp,,23130.24,,,,,,,6264.44,23371.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Coventry,Workers Comp,,27335.04,,,,,,,25626.60,27619.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Coventry,Workers Comp,,27335.04,,,,,,,7403.24,27619.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Coventry,Workers Comp,,31539.84,,,,,,,29568.60,31868.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Coventry,Workers Comp,,31539.84,,,,,,,8542.04,31868.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,37234.00000,21409.55000,Coventry,Workers Comp,,35744.64,,,,,,,33510.60,36116.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,37234.00000,21409.55000,Coventry,Workers Comp,,35744.64,,,,,,,9680.84,36116.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Coventry,Workers Comp,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Coventry,Workers Comp,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Coventry,Workers Comp,,50461.44,,,,,,,47307.60,50987.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Coventry,Workers Comp,,50461.44,,,,,,,13666.64,50987.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Coventry,Workers Comp,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Coventry,Workers Comp,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Coventry,Workers Comp,,75690.24,,,,,,,70959.60,76478.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Coventry,Workers Comp,,75690.24,,,,,,,20499.44,76478.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,159.00000,91.42000,Coventry,Workers Comp,,152.64,,,,,,,143.10,154.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,159.00000,91.42000,Coventry,Workers Comp,,152.64,,,,,,,41.34,154.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Coventry,Workers Comp,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Coventry,Workers Comp,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Coventry,Workers Comp,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Coventry,Workers Comp,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Coventry,Workers Comp,,2328.96,,,,,,,2183.40,2353.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Coventry,Workers Comp,,2328.96,,,,,,,630.76,2353.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2827.00000,1625.52000,Coventry,Workers Comp,,2713.92,,,,,,,2544.30,2742.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Coventry,Workers Comp,,2713.92,,,,,,,735.02,2742.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Coventry,Workers Comp,,3206.40,,,,,,,3006.00,3239.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Coventry,Workers Comp,,3206.40,,,,,,,868.40,3239.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8107.00000,4661.52000,Coventry,Workers Comp,,7782.72,,,,,,,7296.30,7863.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Coventry,Workers Comp,,7782.72,,,,,,,2107.82,7863.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Coventry,Workers Comp,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Coventry,Workers Comp,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Coventry,Workers Comp,,84099.84,,,,,,,78843.60,84975.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Coventry,Workers Comp,,84099.84,,,,,,,22777.04,84975.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Coventry,Workers Comp,,105123.84,,,,,,,98553.60,106218.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Coventry,Workers Comp,,105123.84,,,,,,,28471.04,106218.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,131404.00000,75557.30000,Coventry,Workers Comp,,126147.84,,,,,,,118263.60,127461.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Coventry,Workers Comp,,126147.84,,,,,,,34165.04,127461.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,18400.00000,10580.00000,Coventry,Workers Comp,,17664.00,,,,,,,16560.00,17848.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,18400.00000,10580.00000,Coventry,Workers Comp,,17664.00,,,,,,,4784.00,17848.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Coventry,Workers Comp,,23130.24,,,,,,,21684.60,23371.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Coventry,Workers Comp,,23130.24,,,,,,,6264.44,23371.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Coventry,Workers Comp,,27335.04,,,,,,,25626.60,27619.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Coventry,Workers Comp,,27335.04,,,,,,,7403.24,27619.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Coventry,Workers Comp,,31539.84,,,,,,,29568.60,31868.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Coventry,Workers Comp,,31539.84,,,,,,,8542.04,31868.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1614.00000,928.05000,Coventry,Workers Comp,,1549.44,,,,,,,1452.60,1565.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Coventry,Workers Comp,,1549.44,,,,,,,419.64,1565.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Coventry,Workers Comp,,54666.24,,,,,,,51249.60,55235.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Coventry,Workers Comp,,54666.24,,,,,,,14805.44,55235.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Coventry,Workers Comp,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Coventry,Workers Comp,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,5368.00000,3086.60000,Coventry,Workers Comp,,5153.28,,,,,,,4831.20,5206.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,5368.00000,3086.60000,Coventry,Workers Comp,,5153.28,,,,,,,1395.68,5206.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,14020.00000,8061.50000,Coventry,Workers Comp,,13459.20,,,,,,,12618.00,13599.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Coventry,Workers Comp,,13459.20,,,,,,,3645.20,13599.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,25408.00000,14609.60000,Coventry,Workers Comp,,24391.68,,,,,,,22867.20,24645.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,25408.00000,14609.60000,Coventry,Workers Comp,,24391.68,,,,,,,6606.08,24645.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,8112.00000,4664.40000,Coventry,Workers Comp,,7787.52,,,,,,,7300.80,7868.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,8112.00000,4664.40000,Coventry,Workers Comp,,7787.52,,,,,,,2109.12,7868.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,10431.00000,5997.82000,Coventry,Workers Comp,,10013.76,,,,,,,9387.90,10118.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,10431.00000,5997.82000,Coventry,Workers Comp,,10013.76,,,,,,,2712.06,10118.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Coventry,Workers Comp,,31539.84,,,,,,,29568.60,31868.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Coventry,Workers Comp,,31539.84,,,,,,,8542.04,31868.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,46870.00000,26950.25000,Coventry,Workers Comp,,44995.20,,,,,,,42183.00,45463.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,46870.00000,26950.25000,Coventry,Workers Comp,,44995.20,,,,,,,12186.20,45463.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,51250.00000,29468.75000,Coventry,Workers Comp,,49200.00,,,,,,,46125.00,49712.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,51250.00000,29468.75000,Coventry,Workers Comp,,49200.00,,,,,,,13325.00,49712.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Coventry,Workers Comp,,50461.44,,,,,,,47307.60,50987.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Coventry,Workers Comp,,50461.44,,,,,,,13666.64,50987.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Coventry,Workers Comp,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Coventry,Workers Comp,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Coventry,Workers Comp,,75690.24,,,,,,,70959.60,76478.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Coventry,Workers Comp,,75690.24,,,,,,,20499.44,76478.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Coventry,Workers Comp,,84099.84,,,,,,,78843.60,84975.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Coventry,Workers Comp,,84099.84,,,,,,,22777.04,84975.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,588.00000,338.10000,Coventry,Workers Comp,,564.48,,,,,,,529.20,570.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,588.00000,338.10000,Coventry,Workers Comp,,564.48,,,,,,,152.88,570.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Coventry,Workers Comp,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Coventry,Workers Comp,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Coventry,Workers Comp,,3752.64,,,,,,,3518.10,3791.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Coventry,Workers Comp,,3752.64,,,,,,,1016.34,3791.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Coventry,Workers Comp,,5158.08,,,,,,,4835.70,5211.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Coventry,Workers Comp,,5158.08,,,,,,,1396.98,5211.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Coventry,Workers Comp,,6227.52,,,,,,,5838.30,6292.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Coventry,Workers Comp,,6227.52,,,,,,,1686.62,6292.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,7876.00000,4528.70000,Coventry,Workers Comp,,7560.96,,,,,,,7088.40,7639.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7876.00000,4528.70000,Coventry,Workers Comp,,7560.96,,,,,,,2047.76,7639.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Coventry,Workers Comp,,23130.24,,,,,,,21684.60,23371.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Coventry,Workers Comp,,23130.24,,,,,,,6264.44,23371.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5856.00000,3367.20000,Coventry,Workers Comp,,5621.76,,,,,,,5270.40,5680.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5856.00000,3367.20000,Coventry,Workers Comp,,5621.76,,,,,,,1522.56,5680.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Coventry,Workers Comp,,6227.52,,,,,,,5838.30,6292.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Coventry,Workers Comp,,6227.52,,,,,,,1686.62,6292.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Coventry,Workers Comp,,7116.48,,,,,,,6671.70,7190.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Coventry,Workers Comp,,7116.48,,,,,,,1927.38,7190.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Coventry,Workers Comp,,8005.44,,,,,,,7505.10,8088.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Coventry,Workers Comp,,8005.44,,,,,,,2168.14,8088.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Coventry,Workers Comp,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Coventry,Workers Comp,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Coventry,Workers Comp,,5158.08,,,,,,,4835.70,5211.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Coventry,Workers Comp,,5158.08,,,,,,,1396.98,5211.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Coventry,Workers Comp,,5783.04,,,,,,,5421.60,5843.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Coventry,Workers Comp,,5783.04,,,,,,,1566.24,5843.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Coventry,Workers Comp,,12005.76,,,,,,,11255.40,12130.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Coventry,Workers Comp,,12005.76,,,,,,,3251.56,12130.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Coventry,Workers Comp,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Coventry,Workers Comp,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Coventry,Workers Comp,,5158.08,,,,,,,4835.70,5211.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Coventry,Workers Comp,,5158.08,,,,,,,1396.98,5211.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Coventry,Workers Comp,,5783.04,,,,,,,5421.60,5843.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Coventry,Workers Comp,,5783.04,,,,,,,1566.24,5843.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Coventry,Workers Comp,,12005.76,,,,,,,11255.40,12130.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Coventry,Workers Comp,,12005.76,,,,,,,3251.56,12130.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4392.00000,2525.40000,Coventry,Workers Comp,,4216.32,,,,,,,3952.80,4260.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4392.00000,2525.40000,Coventry,Workers Comp,,4216.32,,,,,,,1141.92,4260.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Coventry,Workers Comp,,5158.08,,,,,,,4835.70,5211.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Coventry,Workers Comp,,5158.08,,,,,,,1396.98,5211.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Coventry,Workers Comp,,6227.52,,,,,,,5838.30,6292.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Coventry,Workers Comp,,6227.52,,,,,,,1686.62,6292.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Coventry,Workers Comp,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Coventry,Workers Comp,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Coventry,Workers Comp,,5158.08,,,,,,,4835.70,5211.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Coventry,Workers Comp,,5158.08,,,,,,,1396.98,5211.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Coventry,Workers Comp,,6227.52,,,,,,,5838.30,6292.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Coventry,Workers Comp,,6227.52,,,,,,,1686.62,6292.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Coventry,Workers Comp,,4684.80,,,,,,,4392.00,4733.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Coventry,Workers Comp,,4684.80,,,,,,,1268.80,4733.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Coventry,Workers Comp,,1080.96,,,,,,,1013.40,1092.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Coventry,Workers Comp,,1080.96,,,,,,,292.76,1092.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Coventry,Workers Comp,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Coventry,Workers Comp,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Coventry,Workers Comp,,5158.08,,,,,,,4835.70,5211.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Coventry,Workers Comp,,5158.08,,,,,,,1396.98,5211.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Coventry,Workers Comp,,5783.04,,,,,,,5421.60,5843.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Coventry,Workers Comp,,5783.04,,,,,,,1566.24,5843.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Coventry,Workers Comp,,12005.76,,,,,,,11255.40,12130.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Coventry,Workers Comp,,12005.76,,,,,,,3251.56,12130.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Coventry,Workers Comp,,13038.72,,,,,,,12223.80,13174.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Coventry,Workers Comp,,13038.72,,,,,,,3531.32,13174.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2152.00000,1237.40000,Coventry,Workers Comp,,2065.92,,,,,,,1936.80,2087.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2152.00000,1237.40000,Coventry,Workers Comp,,2065.92,,,,,,,559.52,2087.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Coventry,Workers Comp,,4684.80,,,,,,,4392.00,4733.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Coventry,Workers Comp,,4684.80,,,,,,,1268.80,4733.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Coventry,Workers Comp,,3752.64,,,,,,,3518.10,3791.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Coventry,Workers Comp,,3752.64,,,,,,,1016.34,3791.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Coventry,Workers Comp,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Coventry,Workers Comp,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Coventry,Workers Comp,,5783.04,,,,,,,5421.60,5843.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Coventry,Workers Comp,,5783.04,,,,,,,1566.24,5843.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Coventry,Workers Comp,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Coventry,Workers Comp,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Coventry,Workers Comp,,5158.08,,,,,,,4835.70,5211.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Coventry,Workers Comp,,5158.08,,,,,,,1396.98,5211.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Coventry,Workers Comp,,5783.04,,,,,,,5421.60,5843.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Coventry,Workers Comp,,5783.04,,,,,,,1566.24,5843.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Coventry,Workers Comp,,1080.96,,,,,,,1013.40,1092.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Coventry,Workers Comp,,1080.96,,,,,,,292.76,1092.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Coventry,Workers Comp,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Coventry,Workers Comp,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Coventry,Workers Comp,,5158.08,,,,,,,4835.70,5211.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Coventry,Workers Comp,,5158.08,,,,,,,1396.98,5211.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Coventry,Workers Comp,,5783.04,,,,,,,5421.60,5843.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Coventry,Workers Comp,,5783.04,,,,,,,1566.24,5843.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Coventry,Workers Comp,,12005.76,,,,,,,11255.40,12130.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Coventry,Workers Comp,,12005.76,,,,,,,3251.56,12130.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Coventry,Workers Comp,,13038.72,,,,,,,12223.80,13174.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Coventry,Workers Comp,,13038.72,,,,,,,3531.32,13174.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Coventry,Workers Comp,,5158.08,,,,,,,4835.70,5211.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Coventry,Workers Comp,,5158.08,,,,,,,1396.98,5211.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8802.00000,5061.15000,Coventry,Workers Comp,,8449.92,,,,,,,7921.80,8537.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8802.00000,5061.15000,Coventry,Workers Comp,,8449.92,,,,,,,2288.52,8537.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,10654.00000,6126.05000,Coventry,Workers Comp,,10227.84,,,,,,,9588.60,10334.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10654.00000,6126.05000,Coventry,Workers Comp,,10227.84,,,,,,,2770.04,10334.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Coventry,Workers Comp,,12005.76,,,,,,,11255.40,12130.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Coventry,Workers Comp,,12005.76,,,,,,,3251.56,12130.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Coventry,Workers Comp,,13038.72,,,,,,,12223.80,13174.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Coventry,Workers Comp,,13038.72,,,,,,,3531.32,13174.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17086.00000,9824.45000,Coventry,Workers Comp,,16402.56,,,,,,,15377.40,16573.42,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17086.00000,9824.45000,Coventry,Workers Comp,,16402.56,,,,,,,4442.36,16573.42,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Coventry,Workers Comp,,4684.80,,,,,,,4392.00,4733.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Coventry,Workers Comp,,4684.80,,,,,,,1268.80,4733.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Coventry,Workers Comp,,6227.52,,,,,,,5838.30,6292.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Coventry,Workers Comp,,6227.52,,,,,,,1686.62,6292.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Coventry,Workers Comp,,7116.48,,,,,,,6671.70,7190.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Coventry,Workers Comp,,7116.48,,,,,,,1927.38,7190.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Coventry,Workers Comp,,8005.44,,,,,,,7505.10,8088.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Coventry,Workers Comp,,8005.44,,,,,,,2168.14,8088.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Coventry,Workers Comp,,4684.80,,,,,,,4392.00,4733.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Coventry,Workers Comp,,4684.80,,,,,,,1268.80,4733.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Coventry,Workers Comp,,4684.80,,,,,,,4392.00,4733.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Coventry,Workers Comp,,4684.80,,,,,,,1268.80,4733.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,3236.40,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Coventry,Workers Comp,,3452.16,,,,,,,934.96,3488.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Coventry,Workers Comp,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Coventry,Workers Comp,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,5494.50,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Coventry,Workers Comp,,5860.80,,,,,,,1587.30,5921.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Coventry,Workers Comp,,23130.24,,,,,,,21684.60,23371.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Coventry,Workers Comp,,23130.24,,,,,,,6264.44,23371.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Coventry,Workers Comp,,3752.64,,,,,,,3518.10,3791.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Coventry,Workers Comp,,3752.64,,,,,,,1016.34,3791.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Coventry,Workers Comp,,6227.52,,,,,,,5838.30,6292.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Coventry,Workers Comp,,6227.52,,,,,,,1686.62,6292.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Coventry,Workers Comp,,1812.48,,,,,,,1699.20,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Coventry,Workers Comp,,1812.48,,,,,,,490.88,1831.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Coventry,Workers Comp,,2328.96,,,,,,,2183.40,2353.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Coventry,Workers Comp,,2328.96,,,,,,,630.76,2353.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2827.00000,1625.52000,Coventry,Workers Comp,,2713.92,,,,,,,2544.30,2742.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Coventry,Workers Comp,,2713.92,,,,,,,735.02,2742.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Coventry,Workers Comp,,3206.40,,,,,,,3006.00,3239.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Coventry,Workers Comp,,3206.40,,,,,,,868.40,3239.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4153.00000,2387.98000,Coventry,Workers Comp,,3986.88,,,,,,,3737.70,4028.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Coventry,Workers Comp,,3986.88,,,,,,,1079.78,4028.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Coventry,Workers Comp,,7116.48,,,,,,,6671.70,7190.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Coventry,Workers Comp,,7116.48,,,,,,,1927.38,7190.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Coventry,Workers Comp,,8005.44,,,,,,,7505.10,8088.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Coventry,Workers Comp,,8005.44,,,,,,,2168.14,8088.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9728.00000,5593.60000,Coventry,Workers Comp,,9338.88,,,,,,,8755.20,9436.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9728.00000,5593.60000,Coventry,Workers Comp,,9338.88,,,,,,,2529.28,9436.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11117.00000,6392.28000,Coventry,Workers Comp,,10672.32,,,,,,,10005.30,10783.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11117.00000,6392.28000,Coventry,Workers Comp,,10672.32,,,,,,,2890.42,10783.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Coventry,Workers Comp,,46256.64,,,,,,,43365.60,46738.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Coventry,Workers Comp,,46256.64,,,,,,,12527.84,46738.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Coventry,Workers Comp,,50461.44,,,,,,,47307.60,50987.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Coventry,Workers Comp,,50461.44,,,,,,,13666.64,50987.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Coventry,Workers Comp,,54666.24,,,,,,,51249.60,55235.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Coventry,Workers Comp,,54666.24,,,,,,,14805.44,55235.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Coventry,Workers Comp,,58871.04,,,,,,,55191.60,59484.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Coventry,Workers Comp,,58871.04,,,,,,,15944.24,59484.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Coventry,Workers Comp,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Coventry,Workers Comp,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Coventry,Workers Comp,,67280.64,,,,,,,63075.60,67981.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Coventry,Workers Comp,,67280.64,,,,,,,18221.84,67981.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,74464.00000,42816.80000,Coventry,Workers Comp,,71485.44,,,,,,,67017.60,72230.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Coventry,Workers Comp,,71485.44,,,,,,,19360.64,72230.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Coventry,Workers Comp,,75690.24,,,,,,,70959.60,76478.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Coventry,Workers Comp,,75690.24,,,,,,,20499.44,76478.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,83224.00000,47853.80000,Coventry,Workers Comp,,79895.04,,,,,,,74901.60,80727.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Coventry,Workers Comp,,79895.04,,,,,,,21638.24,80727.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,111694.00000,64224.05000,Coventry,Workers Comp,,107226.24,,,,,,,100524.60,108343.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,111694.00000,64224.05000,Coventry,Workers Comp,,107226.24,,,,,,,29040.44,108343.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Coventry,Workers Comp,,429.12,,,,,,,402.30,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Coventry,Workers Comp,,429.12,,,,,,,116.22,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Coventry,Workers Comp,,680.64,,,,,,,638.10,687.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Coventry,Workers Comp,,680.64,,,,,,,184.34,687.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,991.00000,569.82000,Coventry,Workers Comp,,951.36,,,,,,,891.90,961.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,991.00000,569.82000,Coventry,Workers Comp,,951.36,,,,,,,257.66,961.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1490.00000,856.75000,Coventry,Workers Comp,,1430.40,,,,,,,1341.00,1445.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1490.00000,856.75000,Coventry,Workers Comp,,1430.40,,,,,,,387.40,1445.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Coventry,Workers Comp,,3752.64,,,,,,,3518.10,3791.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Coventry,Workers Comp,,3752.64,,,,,,,1016.34,3791.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Coventry,Workers Comp,,5626.56,,,,,,,5274.90,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Coventry,Workers Comp,,5626.56,,,,,,,1523.86,5685.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Coventry,Workers Comp,,6227.52,,,,,,,5838.30,6292.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Coventry,Workers Comp,,6227.52,,,,,,,1686.62,6292.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Coventry,Workers Comp,,7116.48,,,,,,,6671.70,7190.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Coventry,Workers Comp,,7116.48,,,,,,,1927.38,7190.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Coventry,Workers Comp,,8005.44,,,,,,,7505.10,8088.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Coventry,Workers Comp,,8005.44,,,,,,,2168.14,8088.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,1271.70,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Coventry,Workers Comp,,1356.48,,,,,,,367.38,1370.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,3467.70,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Coventry,Workers Comp,,3698.88,,,,,,,1001.78,3737.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,6945.00000,3993.37000,Coventry,Workers Comp,,6667.20,,,,,,,6250.50,6736.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,6945.00000,3993.37000,Coventry,Workers Comp,,6667.20,,,,,,,1805.70,6736.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Coventry,Workers Comp,,429.12,,,,,,,402.30,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Coventry,Workers Comp,,429.12,,,,,,,116.22,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Coventry,Workers Comp,,3752.64,,,,,,,3518.10,3791.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Coventry,Workers Comp,,3752.64,,,,,,,1016.34,3791.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Coventry,Workers Comp,,5158.08,,,,,,,4835.70,5211.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Coventry,Workers Comp,,5158.08,,,,,,,1396.98,5211.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,1018.80,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Coventry,Workers Comp,,1086.72,,,,,,,294.32,1098.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,50374.00000,28965.05000,Coventry,Workers Comp,,48359.04,,,,,,,45336.60,48862.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,50374.00000,28965.05000,Coventry,Workers Comp,,48359.04,,,,,,,13097.24,48862.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,17742.60,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Coventry,Workers Comp,,18925.44,,,,,,,5125.64,19122.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Coventry,Workers Comp,,23130.24,,,,,,,21684.60,23371.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Coventry,Workers Comp,,23130.24,,,,,,,6264.44,23371.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Coventry,Workers Comp,,27335.04,,,,,,,25626.60,27619.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Coventry,Workers Comp,,27335.04,,,,,,,7403.24,27619.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,2425.50,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Coventry,Workers Comp,,2587.20,,,,,,,700.70,2614.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,6255.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Coventry,Workers Comp,,6672.00,,,,,,,1807.00,6741.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,10422.00,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Coventry,Workers Comp,,11116.80,,,,,,,3010.80,11232.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,13800.60,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Coventry,Workers Comp,,14720.64,,,,,,,3986.84,14873.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Coventry,Workers Comp,,46256.64,,,,,,,43365.60,46738.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Coventry,Workers Comp,,46256.64,,,,,,,12527.84,46738.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,1941.30,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Coventry,Workers Comp,,2070.72,,,,,,,560.82,2092.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Coventry,Workers Comp,,2959.68,,,,,,,2774.70,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Coventry,Workers Comp,,2959.68,,,,,,,801.58,2990.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Coventry,Workers Comp,,46256.64,,,,,,,43365.60,46738.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Coventry,Workers Comp,,46256.64,,,,,,,12527.84,46738.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Coventry,Workers Comp,,50461.44,,,,,,,47307.60,50987.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Coventry,Workers Comp,,50461.44,,,,,,,13666.64,50987.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Coventry,Workers Comp,,54666.24,,,,,,,51249.60,55235.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Coventry,Workers Comp,,54666.24,,,,,,,14805.44,55235.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Coventry,Workers Comp,,63075.84,,,,,,,59133.60,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Coventry,Workers Comp,,63075.84,,,,,,,17083.04,63732.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,74464.00000,42816.80000,Coventry,Workers Comp,,71485.44,,,,,,,67017.60,72230.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Coventry,Workers Comp,,71485.44,,,,,,,19360.64,72230.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,83224.00000,47853.80000,Coventry,Workers Comp,,79895.04,,,,,,,74901.60,80727.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Coventry,Workers Comp,,79895.04,,,,,,,21638.24,80727.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,91984.00000,52890.80000,Coventry,Workers Comp,,88304.64,,,,,,,82785.60,89224.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,91984.00000,52890.80000,Coventry,Workers Comp,,88304.64,,,,,,,23915.84,89224.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,100744.00000,57927.80000,Coventry,Workers Comp,,96714.24,,,,,,,90669.60,97721.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,100744.00000,57927.80000,Coventry,Workers Comp,,96714.24,,,,,,,26193.44,97721.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Coventry,Workers Comp,,159.36,,,,,,,149.40,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Coventry,Workers Comp,,159.36,,,,,,,43.16,161.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Coventry,Workers Comp,,429.12,,,,,,,402.30,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Coventry,Workers Comp,,429.12,,,,,,,116.22,433.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Coventry,Workers Comp,,680.64,,,,,,,638.10,687.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Coventry,Workers Comp,,680.64,,,,,,,184.34,687.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,15771.60,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Coventry,Workers Comp,,16823.04,,,,,,,4556.24,16998.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,19713.60,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Coventry,Workers Comp,,21027.84,,,,,,,5695.04,21246.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,23655.60,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Coventry,Workers Comp,,25232.64,,,,,,,6833.84,25495.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,27597.60,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Coventry,Workers Comp,,29437.44,,,,,,,7972.64,29744.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,31539.60,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Coventry,Workers Comp,,33642.24,,,,,,,9111.44,33992.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,35481.60,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Coventry,Workers Comp,,37847.04,,,,,,,10250.24,38241.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,39423.60,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Coventry,Workers Comp,,42051.84,,,,,,,11389.04,42489.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Coventry,Workers Comp,,50461.44,,,,,,,47307.60,50987.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Coventry,Workers Comp,,50461.44,,,,,,,13666.64,50987.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,4396.50,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Coventry,Workers Comp,,4689.60,,,,,,,1270.10,4738.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,8338.50,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Coventry,Workers Comp,,8894.40,,,,,,,2408.90,8987.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,12505.50,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Coventry,Workers Comp,,13339.20,,,,,,,3612.70,13478.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2180.20000,1253.61000,Coventry,Workers Comp,,2092.99,,,,,,,1962.18,2114.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2180.20000,1253.61000,Coventry,Workers Comp,,2092.99,,,,,,,566.85,2114.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1880.60000,1081.34000,Coventry,Workers Comp,,1805.38,,,,,,,1692.54,1824.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1880.60000,1081.34000,Coventry,Workers Comp,,1805.38,,,,,,,488.96,1824.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2908.70000,1672.50000,Coventry,Workers Comp,,2792.35,,,,,,,2617.83,2821.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2908.70000,1672.50000,Coventry,Workers Comp,,2792.35,,,,,,,756.26,2821.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,inpatient,,,34.00000,25.74000,Coventry,Workers Comp,,32.64,,,,,,,30.60,32.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,outpatient,,,34.00000,25.74000,Coventry,Workers Comp,,32.64,,,,,,,8.84,32.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,inpatient,,,13.00000,9.84000,Coventry,Workers Comp,,12.48,,,,,,,11.70,12.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,outpatient,,,13.00000,9.84000,Coventry,Workers Comp,,12.48,,,,,,,3.38,12.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Coventry,Workers Comp,,269.76,,,,,,,252.90,272.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Coventry,Workers Comp,,269.76,,,,,,,73.06,272.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Coventry,Workers Comp,,269.76,,,,,,,252.90,272.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Coventry,Workers Comp,,269.76,,,,,,,73.06,272.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Coventry,Workers Comp,,269.76,,,,,,,252.90,272.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Coventry,Workers Comp,,269.76,,,,,,,73.06,272.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Coventry,Workers Comp,,720.96,,,,,,,675.90,728.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Coventry,Workers Comp,,720.96,,,,,,,195.26,728.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Coventry,Workers Comp,,720.96,,,,,,,675.90,728.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Coventry,Workers Comp,,720.96,,,,,,,195.26,728.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Coventry,Workers Comp,,720.96,,,,,,,675.90,728.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Coventry,Workers Comp,,720.96,,,,,,,195.26,728.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,inpatient,,,122.00000,92.35000,Coventry,Workers Comp,,117.12,,,,,,,109.80,118.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,outpatient,,,122.00000,92.35000,Coventry,Workers Comp,,117.12,,,,,,,31.72,118.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,inpatient,,,79.00000,59.80000,Coventry,Workers Comp,,75.84,,,,,,,71.10,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Coventry,Workers Comp,,75.84,,,,,,,20.54,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,inpatient,,,79.00000,59.80000,Coventry,Workers Comp,,75.84,,,,,,,71.10,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Coventry,Workers Comp,,75.84,,,,,,,20.54,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,inpatient,,,15.00000,11.36000,Coventry,Workers Comp,,14.40,,,,,,,13.50,14.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Coventry,Workers Comp,,14.40,,,,,,,3.90,14.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,inpatient,,,15.00000,11.36000,Coventry,Workers Comp,,14.40,,,,,,,13.50,14.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Coventry,Workers Comp,,14.40,,,,,,,3.90,14.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,inpatient,,,17.00000,12.87000,Coventry,Workers Comp,,16.32,,,,,,,15.30,16.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Coventry,Workers Comp,,16.32,,,,,,,4.42,16.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,inpatient,,,17.00000,12.87000,Coventry,Workers Comp,,16.32,,,,,,,15.30,16.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Coventry,Workers Comp,,16.32,,,,,,,4.42,16.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,inpatient,,,359.00000,271.76000,Coventry,Workers Comp,,344.64,,,,,,,323.10,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,outpatient,,,359.00000,271.76000,Coventry,Workers Comp,,344.64,,,,,,,93.34,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,inpatient,,,359.00000,271.76000,Coventry,Workers Comp,,344.64,,,,,,,323.10,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,outpatient,,,359.00000,271.76000,Coventry,Workers Comp,,344.64,,,,,,,93.34,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,inpatient,,,359.00000,271.76000,Coventry,Workers Comp,,344.64,,,,,,,323.10,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,outpatient,,,359.00000,271.76000,Coventry,Workers Comp,,344.64,,,,,,,93.34,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,inpatient,,,155.00000,117.34000,Coventry,Workers Comp,,148.80,,,,,,,139.50,150.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,outpatient,,,155.00000,117.34000,Coventry,Workers Comp,,148.80,,,,,,,40.30,150.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,inpatient,,,294.00000,222.56000,Coventry,Workers Comp,,282.24,,,,,,,264.60,285.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,outpatient,,,294.00000,222.56000,Coventry,Workers Comp,,282.24,,,,,,,76.44,285.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,inpatient,,,1511.00000,1143.83000,Coventry,Workers Comp,,1450.56,,,,,,,1359.90,1465.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,outpatient,,,1511.00000,1143.83000,Coventry,Workers Comp,,1450.56,,,,,,,392.86,1465.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,inpatient,,,751.00000,568.51000,Coventry,Workers Comp,,720.96,,,,,,,675.90,728.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Coventry,Workers Comp,,720.96,,,,,,,195.26,728.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,inpatient,,,751.00000,568.51000,Coventry,Workers Comp,,720.96,,,,,,,675.90,728.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Coventry,Workers Comp,,720.96,,,,,,,195.26,728.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,inpatient,,,150.00000,113.55000,Coventry,Workers Comp,,144.00,,,,,,,135.00,145.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,outpatient,,,150.00000,113.55000,Coventry,Workers Comp,,144.00,,,,,,,39.00,145.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,inpatient,,,110.00000,83.27000,Coventry,Workers Comp,,105.60,,,,,,,99.00,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,outpatient,,,110.00000,83.27000,Coventry,Workers Comp,,105.60,,,,,,,28.60,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,inpatient,,,158.00000,119.61000,Coventry,Workers Comp,,151.68,,,,,,,142.20,153.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,outpatient,,,158.00000,119.61000,Coventry,Workers Comp,,151.68,,,,,,,41.08,153.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,inpatient,,,153.00000,115.82000,Coventry,Workers Comp,,146.88,,,,,,,137.70,148.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,outpatient,,,153.00000,115.82000,Coventry,Workers Comp,,146.88,,,,,,,39.78,148.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,inpatient,,,157.00000,118.85000,Coventry,Workers Comp,,150.72,,,,,,,141.30,152.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,outpatient,,,157.00000,118.85000,Coventry,Workers Comp,,150.72,,,,,,,40.82,152.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,inpatient,,,26.00000,19.68000,Coventry,Workers Comp,,24.96,,,,,,,23.40,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,outpatient,,,26.00000,19.68000,Coventry,Workers Comp,,24.96,,,,,,,6.76,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,inpatient,,,37.00000,28.01000,Coventry,Workers Comp,,35.52,,,,,,,33.30,35.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,outpatient,,,37.00000,28.01000,Coventry,Workers Comp,,35.52,,,,,,,9.62,35.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,inpatient,,,268.00000,202.88000,Coventry,Workers Comp,,257.28,,,,,,,241.20,259.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,outpatient,,,268.00000,202.88000,Coventry,Workers Comp,,257.28,,,,,,,69.68,259.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,inpatient,,,91.00000,68.89000,Coventry,Workers Comp,,87.36,,,,,,,81.90,88.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,outpatient,,,91.00000,68.89000,Coventry,Workers Comp,,87.36,,,,,,,23.66,88.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,inpatient,,,200.00000,151.40000,Coventry,Workers Comp,,192.00,,,,,,,180.00,194.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,outpatient,,,200.00000,151.40000,Coventry,Workers Comp,,192.00,,,,,,,52.00,194.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,inpatient,,,152.00000,115.06000,Coventry,Workers Comp,,145.92,,,,,,,136.80,147.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,outpatient,,,152.00000,115.06000,Coventry,Workers Comp,,145.92,,,,,,,39.52,147.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,inpatient,,,359.00000,271.76000,Coventry,Workers Comp,,344.64,,,,,,,323.10,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,outpatient,,,359.00000,271.76000,Coventry,Workers Comp,,344.64,,,,,,,93.34,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,inpatient,,,69.00000,33.26000,Coventry,Workers Comp,,66.24,,,,,,,62.10,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,outpatient,,,69.00000,33.26000,Coventry,Workers Comp,,66.24,,,,,,,17.94,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,inpatient,,,75.00000,36.15000,Coventry,Workers Comp,,72.00,,,,,,,67.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,outpatient,,,75.00000,36.15000,Coventry,Workers Comp,,72.00,,,,,,,19.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,inpatient,,,45.00000,21.69000,Coventry,Workers Comp,,43.20,,,,,,,40.50,43.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,outpatient,,,45.00000,21.69000,Coventry,Workers Comp,,43.20,,,,,,,11.70,43.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,inpatient,,,68.00000,32.78000,Coventry,Workers Comp,,65.28,,,,,,,61.20,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,outpatient,,,68.00000,32.78000,Coventry,Workers Comp,,65.28,,,,,,,17.68,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,inpatient,,,61.00000,29.40000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,outpatient,,,61.00000,29.40000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,inpatient,,,64.00000,30.85000,Coventry,Workers Comp,,61.44,,,,,,,57.60,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,outpatient,,,64.00000,30.85000,Coventry,Workers Comp,,61.44,,,,,,,16.64,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,inpatient,,,195.00000,93.99000,Coventry,Workers Comp,,187.20,,,,,,,175.50,189.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,outpatient,,,195.00000,93.99000,Coventry,Workers Comp,,187.20,,,,,,,50.70,189.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,inpatient,,,14.00000,6.75000,Coventry,Workers Comp,,13.44,,,,,,,12.60,13.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,outpatient,,,14.00000,6.75000,Coventry,Workers Comp,,13.44,,,,,,,3.64,13.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,inpatient,,,53.00000,25.55000,Coventry,Workers Comp,,50.88,,,,,,,47.70,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,outpatient,,,53.00000,25.55000,Coventry,Workers Comp,,50.88,,,,,,,13.78,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,inpatient,,,82.00000,39.52000,Coventry,Workers Comp,,78.72,,,,,,,73.80,79.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,outpatient,,,82.00000,39.52000,Coventry,Workers Comp,,78.72,,,,,,,21.32,79.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,inpatient,,,141.00000,67.96000,Coventry,Workers Comp,,135.36,,,,,,,126.90,136.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Coventry,Workers Comp,,135.36,,,,,,,36.66,136.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,inpatient,,,141.00000,67.96000,Coventry,Workers Comp,,135.36,,,,,,,126.90,136.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Coventry,Workers Comp,,135.36,,,,,,,36.66,136.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,inpatient,,,91.00000,43.86000,Coventry,Workers Comp,,87.36,,,,,,,81.90,88.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,outpatient,,,91.00000,43.86000,Coventry,Workers Comp,,87.36,,,,,,,23.66,88.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,inpatient,,,69.00000,33.26000,Coventry,Workers Comp,,66.24,,,,,,,62.10,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,outpatient,,,69.00000,33.26000,Coventry,Workers Comp,,66.24,,,,,,,17.94,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,inpatient,,,205.00000,98.81000,Coventry,Workers Comp,,196.80,,,,,,,184.50,198.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,outpatient,,,205.00000,98.81000,Coventry,Workers Comp,,196.80,,,,,,,53.30,198.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,inpatient,,,50.00000,24.10000,Coventry,Workers Comp,,48.00,,,,,,,45.00,48.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,outpatient,,,50.00000,24.10000,Coventry,Workers Comp,,48.00,,,,,,,13.00,48.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,inpatient,,,406.00000,195.69000,Coventry,Workers Comp,,389.76,,,,,,,365.40,393.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,outpatient,,,406.00000,195.69000,Coventry,Workers Comp,,389.76,,,,,,,105.56,393.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,inpatient,,,101.00000,48.68000,Coventry,Workers Comp,,96.96,,,,,,,90.90,97.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,outpatient,,,101.00000,48.68000,Coventry,Workers Comp,,96.96,,,,,,,26.26,97.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,inpatient,,,375.00000,180.75000,Coventry,Workers Comp,,360.00,,,,,,,337.50,363.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,outpatient,,,375.00000,180.75000,Coventry,Workers Comp,,360.00,,,,,,,97.50,363.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,inpatient,,,362.00000,174.48000,Coventry,Workers Comp,,347.52,,,,,,,325.80,351.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,outpatient,,,362.00000,174.48000,Coventry,Workers Comp,,347.52,,,,,,,94.12,351.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,inpatient,,,325.00000,156.65000,Coventry,Workers Comp,,312.00,,,,,,,292.50,315.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,outpatient,,,325.00000,156.65000,Coventry,Workers Comp,,312.00,,,,,,,84.50,315.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,inpatient,,,121.00000,58.32000,Coventry,Workers Comp,,116.16,,,,,,,108.90,117.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,outpatient,,,121.00000,58.32000,Coventry,Workers Comp,,116.16,,,,,,,31.46,117.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,inpatient,,,115.00000,55.43000,Coventry,Workers Comp,,110.40,,,,,,,103.50,111.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,outpatient,,,115.00000,55.43000,Coventry,Workers Comp,,110.40,,,,,,,29.90,111.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,inpatient,,,300.00000,144.60000,Coventry,Workers Comp,,288.00,,,,,,,270.00,291.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,outpatient,,,300.00000,144.60000,Coventry,Workers Comp,,288.00,,,,,,,78.00,291.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,inpatient,,,51.00000,24.58000,Coventry,Workers Comp,,48.96,,,,,,,45.90,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,outpatient,,,51.00000,24.58000,Coventry,Workers Comp,,48.96,,,,,,,13.26,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,inpatient,,,51.00000,24.58000,Coventry,Workers Comp,,48.96,,,,,,,45.90,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Coventry,Workers Comp,,48.96,,,,,,,13.26,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,inpatient,,,51.00000,24.58000,Coventry,Workers Comp,,48.96,,,,,,,45.90,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Coventry,Workers Comp,,48.96,,,,,,,13.26,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,inpatient,,,194.00000,93.51000,Coventry,Workers Comp,,186.24,,,,,,,174.60,188.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,outpatient,,,194.00000,93.51000,Coventry,Workers Comp,,186.24,,,,,,,50.44,188.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,inpatient,,,68.00000,32.78000,Coventry,Workers Comp,,65.28,,,,,,,61.20,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,outpatient,,,68.00000,32.78000,Coventry,Workers Comp,,65.28,,,,,,,17.68,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,inpatient,,,329.00000,158.58000,Coventry,Workers Comp,,315.84,,,,,,,296.10,319.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,outpatient,,,329.00000,158.58000,Coventry,Workers Comp,,315.84,,,,,,,85.54,319.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,inpatient,,,24.00000,11.57000,Coventry,Workers Comp,,23.04,,,,,,,21.60,23.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,outpatient,,,24.00000,11.57000,Coventry,Workers Comp,,23.04,,,,,,,6.24,23.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,inpatient,,,30.00000,14.46000,Coventry,Workers Comp,,28.80,,,,,,,27.00,29.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,outpatient,,,30.00000,14.46000,Coventry,Workers Comp,,28.80,,,,,,,7.80,29.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,inpatient,,,53.00000,25.55000,Coventry,Workers Comp,,50.88,,,,,,,47.70,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,outpatient,,,53.00000,25.55000,Coventry,Workers Comp,,50.88,,,,,,,13.78,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,inpatient,,,270.00000,130.14000,Coventry,Workers Comp,,259.20,,,,,,,243.00,261.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,outpatient,,,270.00000,130.14000,Coventry,Workers Comp,,259.20,,,,,,,70.20,261.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,inpatient,,,123.00000,59.29000,Coventry,Workers Comp,,118.08,,,,,,,110.70,119.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Coventry,Workers Comp,,118.08,,,,,,,31.98,119.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,inpatient,,,123.00000,59.29000,Coventry,Workers Comp,,118.08,,,,,,,110.70,119.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Coventry,Workers Comp,,118.08,,,,,,,31.98,119.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,inpatient,,,37.00000,17.83000,Coventry,Workers Comp,,35.52,,,,,,,33.30,35.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,outpatient,,,37.00000,17.83000,Coventry,Workers Comp,,35.52,,,,,,,9.62,35.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,inpatient,,,41.00000,19.76000,Coventry,Workers Comp,,39.36,,,,,,,36.90,39.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,outpatient,,,41.00000,19.76000,Coventry,Workers Comp,,39.36,,,,,,,10.66,39.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,inpatient,,,72.00000,34.70000,Coventry,Workers Comp,,69.12,,,,,,,64.80,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,outpatient,,,72.00000,34.70000,Coventry,Workers Comp,,69.12,,,,,,,18.72,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,inpatient,,,77.00000,37.11000,Coventry,Workers Comp,,73.92,,,,,,,69.30,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,outpatient,,,77.00000,37.11000,Coventry,Workers Comp,,73.92,,,,,,,20.02,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,inpatient,,,90.00000,43.38000,Coventry,Workers Comp,,86.40,,,,,,,81.00,87.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,outpatient,,,90.00000,43.38000,Coventry,Workers Comp,,86.40,,,,,,,23.40,87.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,inpatient,,,44.00000,21.21000,Coventry,Workers Comp,,42.24,,,,,,,39.60,42.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,outpatient,,,44.00000,21.21000,Coventry,Workers Comp,,42.24,,,,,,,11.44,42.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,inpatient,,,115.00000,55.43000,Coventry,Workers Comp,,110.40,,,,,,,103.50,111.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,outpatient,,,115.00000,55.43000,Coventry,Workers Comp,,110.40,,,,,,,29.90,111.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,inpatient,,,20.00000,9.64000,Coventry,Workers Comp,,19.20,,,,,,,18.00,19.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,outpatient,,,20.00000,9.64000,Coventry,Workers Comp,,19.20,,,,,,,5.20,19.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,46.80,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,13.52,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,inpatient,,,341.00000,164.36000,Coventry,Workers Comp,,327.36,,,,,,,306.90,330.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,outpatient,,,341.00000,164.36000,Coventry,Workers Comp,,327.36,,,,,,,88.66,330.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,inpatient,,,54.00000,26.03000,Coventry,Workers Comp,,51.84,,,,,,,48.60,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,outpatient,,,54.00000,26.03000,Coventry,Workers Comp,,51.84,,,,,,,14.04,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,inpatient,,,53.00000,25.55000,Coventry,Workers Comp,,50.88,,,,,,,47.70,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,outpatient,,,53.00000,25.55000,Coventry,Workers Comp,,50.88,,,,,,,13.78,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,inpatient,,,88.00000,42.42000,Coventry,Workers Comp,,84.48,,,,,,,79.20,85.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,outpatient,,,88.00000,42.42000,Coventry,Workers Comp,,84.48,,,,,,,22.88,85.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,inpatient,,,89.00000,42.90000,Coventry,Workers Comp,,85.44,,,,,,,80.10,86.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,outpatient,,,89.00000,42.90000,Coventry,Workers Comp,,85.44,,,,,,,23.14,86.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,inpatient,,,61.00000,29.40000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,outpatient,,,61.00000,29.40000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,inpatient,,,77.00000,37.11000,Coventry,Workers Comp,,73.92,,,,,,,69.30,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Coventry,Workers Comp,,73.92,,,,,,,20.02,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,inpatient,,,77.00000,37.11000,Coventry,Workers Comp,,73.92,,,,,,,69.30,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Coventry,Workers Comp,,73.92,,,,,,,20.02,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,inpatient,,,64.00000,30.85000,Coventry,Workers Comp,,61.44,,,,,,,57.60,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Coventry,Workers Comp,,61.44,,,,,,,16.64,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,inpatient,,,64.00000,30.85000,Coventry,Workers Comp,,61.44,,,,,,,57.60,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Coventry,Workers Comp,,61.44,,,,,,,16.64,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,inpatient,,,95.00000,45.79000,Coventry,Workers Comp,,91.20,,,,,,,85.50,92.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,outpatient,,,95.00000,45.79000,Coventry,Workers Comp,,91.20,,,,,,,24.70,92.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,inpatient,,,132.00000,63.62000,Coventry,Workers Comp,,126.72,,,,,,,118.80,128.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,outpatient,,,132.00000,63.62000,Coventry,Workers Comp,,126.72,,,,,,,34.32,128.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,inpatient,,,83.00000,40.01000,Coventry,Workers Comp,,79.68,,,,,,,74.70,80.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,outpatient,,,83.00000,40.01000,Coventry,Workers Comp,,79.68,,,,,,,21.58,80.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,inpatient,,,387.00000,186.53000,Coventry,Workers Comp,,371.52,,,,,,,348.30,375.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,outpatient,,,387.00000,186.53000,Coventry,Workers Comp,,371.52,,,,,,,100.62,375.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,inpatient,,,387.00000,186.53000,Coventry,Workers Comp,,371.52,,,,,,,348.30,375.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,outpatient,,,387.00000,186.53000,Coventry,Workers Comp,,371.52,,,,,,,100.62,375.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,inpatient,,,31.00000,14.94000,Coventry,Workers Comp,,29.76,,,,,,,27.90,30.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,outpatient,,,31.00000,14.94000,Coventry,Workers Comp,,29.76,,,,,,,8.06,30.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,inpatient,,,36.00000,17.35000,Coventry,Workers Comp,,34.56,,,,,,,32.40,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,outpatient,,,36.00000,17.35000,Coventry,Workers Comp,,34.56,,,,,,,9.36,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,inpatient,,,160.00000,77.12000,Coventry,Workers Comp,,153.60,,,,,,,144.00,155.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,outpatient,,,160.00000,77.12000,Coventry,Workers Comp,,153.60,,,,,,,41.60,155.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,inpatient,,,112.00000,53.98000,Coventry,Workers Comp,,107.52,,,,,,,100.80,108.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,outpatient,,,112.00000,53.98000,Coventry,Workers Comp,,107.52,,,,,,,29.12,108.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,inpatient,,,14.00000,6.75000,Coventry,Workers Comp,,13.44,,,,,,,12.60,13.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,outpatient,,,14.00000,6.75000,Coventry,Workers Comp,,13.44,,,,,,,3.64,13.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,inpatient,,,16.00000,7.71000,Coventry,Workers Comp,,15.36,,,,,,,14.40,15.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,outpatient,,,16.00000,7.71000,Coventry,Workers Comp,,15.36,,,,,,,4.16,15.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,inpatient,,,71.00000,34.22000,Coventry,Workers Comp,,68.16,,,,,,,63.90,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,outpatient,,,71.00000,34.22000,Coventry,Workers Comp,,68.16,,,,,,,18.46,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,inpatient,,,116.00000,55.91000,Coventry,Workers Comp,,111.36,,,,,,,104.40,112.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,outpatient,,,116.00000,55.91000,Coventry,Workers Comp,,111.36,,,,,,,30.16,112.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,inpatient,,,81.00000,39.04000,Coventry,Workers Comp,,77.76,,,,,,,72.90,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,outpatient,,,81.00000,39.04000,Coventry,Workers Comp,,77.76,,,,,,,21.06,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,inpatient,,,97.00000,46.75000,Coventry,Workers Comp,,93.12,,,,,,,87.30,94.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,outpatient,,,97.00000,46.75000,Coventry,Workers Comp,,93.12,,,,,,,25.22,94.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,inpatient,,,77.00000,37.11000,Coventry,Workers Comp,,73.92,,,,,,,69.30,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,outpatient,,,77.00000,37.11000,Coventry,Workers Comp,,73.92,,,,,,,20.02,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,inpatient,,,35.00000,16.87000,Coventry,Workers Comp,,33.60,,,,,,,31.50,33.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,outpatient,,,35.00000,16.87000,Coventry,Workers Comp,,33.60,,,,,,,9.10,33.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,inpatient,,,65.00000,31.33000,Coventry,Workers Comp,,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,outpatient,,,65.00000,31.33000,Coventry,Workers Comp,,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,inpatient,,,74.00000,35.67000,Coventry,Workers Comp,,71.04,,,,,,,66.60,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,outpatient,,,74.00000,35.67000,Coventry,Workers Comp,,71.04,,,,,,,19.24,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,inpatient,,,250.00000,120.50000,Coventry,Workers Comp,,240.00,,,,,,,225.00,242.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,outpatient,,,250.00000,120.50000,Coventry,Workers Comp,,240.00,,,,,,,65.00,242.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,inpatient,,,90.00000,43.38000,Coventry,Workers Comp,,86.40,,,,,,,81.00,87.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,outpatient,,,90.00000,43.38000,Coventry,Workers Comp,,86.40,,,,,,,23.40,87.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,inpatient,,,90.00000,43.38000,Coventry,Workers Comp,,86.40,,,,,,,81.00,87.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,outpatient,,,90.00000,43.38000,Coventry,Workers Comp,,86.40,,,,,,,23.40,87.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,46.80,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,13.52,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,inpatient,,,36.00000,17.35000,Coventry,Workers Comp,,34.56,,,,,,,32.40,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,outpatient,,,36.00000,17.35000,Coventry,Workers Comp,,34.56,,,,,,,9.36,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,inpatient,,,78.00000,37.60000,Coventry,Workers Comp,,74.88,,,,,,,70.20,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,outpatient,,,78.00000,37.60000,Coventry,Workers Comp,,74.88,,,,,,,20.28,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,inpatient,,,115.00000,55.43000,Coventry,Workers Comp,,110.40,,,,,,,103.50,111.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,outpatient,,,115.00000,55.43000,Coventry,Workers Comp,,110.40,,,,,,,29.90,111.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,60.30,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,17.42,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,inpatient,,,76.00000,36.63000,Coventry,Workers Comp,,72.96,,,,,,,68.40,73.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,outpatient,,,76.00000,36.63000,Coventry,Workers Comp,,72.96,,,,,,,19.76,73.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,inpatient,,,53.00000,25.55000,Coventry,Workers Comp,,50.88,,,,,,,47.70,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,outpatient,,,53.00000,25.55000,Coventry,Workers Comp,,50.88,,,,,,,13.78,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,inpatient,,,70.00000,33.74000,Coventry,Workers Comp,,67.20,,,,,,,63.00,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,outpatient,,,70.00000,33.74000,Coventry,Workers Comp,,67.20,,,,,,,18.20,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,inpatient,,,169.00000,81.46000,Coventry,Workers Comp,,162.24,,,,,,,152.10,163.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,outpatient,,,169.00000,81.46000,Coventry,Workers Comp,,162.24,,,,,,,43.94,163.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,inpatient,,,28.00000,13.50000,Coventry,Workers Comp,,26.88,,,,,,,25.20,27.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,outpatient,,,28.00000,13.50000,Coventry,Workers Comp,,26.88,,,,,,,7.28,27.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,inpatient,,,51.00000,24.58000,Coventry,Workers Comp,,48.96,,,,,,,45.90,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,outpatient,,,51.00000,24.58000,Coventry,Workers Comp,,48.96,,,,,,,13.26,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,inpatient,,,15.00000,7.23000,Coventry,Workers Comp,,14.40,,,,,,,13.50,14.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,outpatient,,,15.00000,7.23000,Coventry,Workers Comp,,14.40,,,,,,,3.90,14.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,inpatient,,,18.00000,8.68000,Coventry,Workers Comp,,17.28,,,,,,,16.20,17.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,outpatient,,,18.00000,8.68000,Coventry,Workers Comp,,17.28,,,,,,,4.68,17.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,inpatient,,,61.00000,29.40000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,outpatient,,,61.00000,29.40000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,inpatient,,,550.00000,265.10000,Coventry,Workers Comp,,528.00,,,,,,,495.00,533.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,outpatient,,,550.00000,265.10000,Coventry,Workers Comp,,528.00,,,,,,,143.00,533.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,inpatient,,,73.00000,35.19000,Coventry,Workers Comp,,70.08,,,,,,,65.70,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Coventry,Workers Comp,,70.08,,,,,,,18.98,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,inpatient,,,392.00000,188.94000,Coventry,Workers Comp,,376.32,,,,,,,352.80,380.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,outpatient,,,392.00000,188.94000,Coventry,Workers Comp,,376.32,,,,,,,101.92,380.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,inpatient,,,75.00000,36.15000,Coventry,Workers Comp,,72.00,,,,,,,67.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,outpatient,,,75.00000,36.15000,Coventry,Workers Comp,,72.00,,,,,,,19.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,inpatient,,,73.00000,35.19000,Coventry,Workers Comp,,70.08,,,,,,,65.70,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Coventry,Workers Comp,,70.08,,,,,,,18.98,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,inpatient,,,100.00000,48.20000,Coventry,Workers Comp,,96.00,,,,,,,90.00,97.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,outpatient,,,100.00000,48.20000,Coventry,Workers Comp,,96.00,,,,,,,26.00,97.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,inpatient,,,153.00000,73.75000,Coventry,Workers Comp,,146.88,,,,,,,137.70,148.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,outpatient,,,153.00000,73.75000,Coventry,Workers Comp,,146.88,,,,,,,39.78,148.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,inpatient,,,909.00000,438.14000,Coventry,Workers Comp,,872.64,,,,,,,818.10,881.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,outpatient,,,909.00000,438.14000,Coventry,Workers Comp,,872.64,,,,,,,236.34,881.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,inpatient,,,266.00000,128.21000,Coventry,Workers Comp,,255.36,,,,,,,239.40,258.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,outpatient,,,266.00000,128.21000,Coventry,Workers Comp,,255.36,,,,,,,69.16,258.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,inpatient,,,275.00000,132.55000,Coventry,Workers Comp,,264.00,,,,,,,247.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,outpatient,,,275.00000,132.55000,Coventry,Workers Comp,,264.00,,,,,,,71.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,inpatient,,,61.00000,29.40000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,outpatient,,,61.00000,29.40000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,inpatient,,,84.00000,40.49000,Coventry,Workers Comp,,80.64,,,,,,,75.60,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,outpatient,,,84.00000,40.49000,Coventry,Workers Comp,,80.64,,,,,,,21.84,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,inpatient,,,174.00000,83.87000,Coventry,Workers Comp,,167.04,,,,,,,156.60,168.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,outpatient,,,174.00000,83.87000,Coventry,Workers Comp,,167.04,,,,,,,45.24,168.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,60.30,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,17.42,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,inpatient,,,68.00000,32.78000,Coventry,Workers Comp,,65.28,,,,,,,61.20,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,outpatient,,,68.00000,32.78000,Coventry,Workers Comp,,65.28,,,,,,,17.68,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,inpatient,,,211.00000,101.70000,Coventry,Workers Comp,,202.56,,,,,,,189.90,204.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,outpatient,,,211.00000,101.70000,Coventry,Workers Comp,,202.56,,,,,,,54.86,204.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,inpatient,,,65.00000,31.33000,Coventry,Workers Comp,,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,outpatient,,,65.00000,31.33000,Coventry,Workers Comp,,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,inpatient,,,83.00000,40.01000,Coventry,Workers Comp,,79.68,,,,,,,74.70,80.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,outpatient,,,83.00000,40.01000,Coventry,Workers Comp,,79.68,,,,,,,21.58,80.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,inpatient,,,54.00000,26.03000,Coventry,Workers Comp,,51.84,,,,,,,48.60,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,outpatient,,,54.00000,26.03000,Coventry,Workers Comp,,51.84,,,,,,,14.04,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,inpatient,,,323.00000,155.69000,Coventry,Workers Comp,,310.08,,,,,,,290.70,313.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,outpatient,,,323.00000,155.69000,Coventry,Workers Comp,,310.08,,,,,,,83.98,313.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,inpatient,,,35.00000,16.87000,Coventry,Workers Comp,,33.60,,,,,,,31.50,33.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,outpatient,,,35.00000,16.87000,Coventry,Workers Comp,,33.60,,,,,,,9.10,33.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,inpatient,,,20.00000,9.64000,Coventry,Workers Comp,,19.20,,,,,,,18.00,19.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,outpatient,,,20.00000,9.64000,Coventry,Workers Comp,,19.20,,,,,,,5.20,19.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,inpatient,,,34.00000,16.39000,Coventry,Workers Comp,,32.64,,,,,,,30.60,32.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,outpatient,,,34.00000,16.39000,Coventry,Workers Comp,,32.64,,,,,,,8.84,32.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,inpatient,,,29.00000,13.98000,Coventry,Workers Comp,,27.84,,,,,,,26.10,28.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,outpatient,,,29.00000,13.98000,Coventry,Workers Comp,,27.84,,,,,,,7.54,28.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,inpatient,,,80.00000,38.56000,Coventry,Workers Comp,,76.80,,,,,,,72.00,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,outpatient,,,80.00000,38.56000,Coventry,Workers Comp,,76.80,,,,,,,20.80,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,inpatient,,,73.00000,35.19000,Coventry,Workers Comp,,70.08,,,,,,,65.70,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,outpatient,,,73.00000,35.19000,Coventry,Workers Comp,,70.08,,,,,,,18.98,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,inpatient,,,16.00000,7.71000,Coventry,Workers Comp,,15.36,,,,,,,14.40,15.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,outpatient,,,16.00000,7.71000,Coventry,Workers Comp,,15.36,,,,,,,4.16,15.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,46.80,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,13.52,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,inpatient,,,113.00000,54.47000,Coventry,Workers Comp,,108.48,,,,,,,101.70,109.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,outpatient,,,113.00000,54.47000,Coventry,Workers Comp,,108.48,,,,,,,29.38,109.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,inpatient,,,68.00000,32.78000,Coventry,Workers Comp,,65.28,,,,,,,61.20,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,outpatient,,,68.00000,32.78000,Coventry,Workers Comp,,65.28,,,,,,,17.68,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,inpatient,,,78.00000,37.60000,Coventry,Workers Comp,,74.88,,,,,,,70.20,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,outpatient,,,78.00000,37.60000,Coventry,Workers Comp,,74.88,,,,,,,20.28,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,inpatient,,,54.00000,26.03000,Coventry,Workers Comp,,51.84,,,,,,,48.60,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,outpatient,,,54.00000,26.03000,Coventry,Workers Comp,,51.84,,,,,,,14.04,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,inpatient,,,76.00000,36.63000,Coventry,Workers Comp,,72.96,,,,,,,68.40,73.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,outpatient,,,76.00000,36.63000,Coventry,Workers Comp,,72.96,,,,,,,19.76,73.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,60.30,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,17.42,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,inpatient,,,88.00000,42.42000,Coventry,Workers Comp,,84.48,,,,,,,79.20,85.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,outpatient,,,88.00000,42.42000,Coventry,Workers Comp,,84.48,,,,,,,22.88,85.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,60.30,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,17.42,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,inpatient,,,53.00000,25.55000,Coventry,Workers Comp,,50.88,,,,,,,47.70,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,outpatient,,,53.00000,25.55000,Coventry,Workers Comp,,50.88,,,,,,,13.78,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,inpatient,,,88.00000,42.42000,Coventry,Workers Comp,,84.48,,,,,,,79.20,85.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,outpatient,,,88.00000,42.42000,Coventry,Workers Comp,,84.48,,,,,,,22.88,85.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,inpatient,,,105.00000,50.61000,Coventry,Workers Comp,,100.80,,,,,,,94.50,101.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,outpatient,,,105.00000,50.61000,Coventry,Workers Comp,,100.80,,,,,,,27.30,101.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,inpatient,,,73.00000,35.19000,Coventry,Workers Comp,,70.08,,,,,,,65.70,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Coventry,Workers Comp,,70.08,,,,,,,18.98,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,inpatient,,,83.00000,40.01000,Coventry,Workers Comp,,79.68,,,,,,,74.70,80.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,outpatient,,,83.00000,40.01000,Coventry,Workers Comp,,79.68,,,,,,,21.58,80.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,inpatient,,,154.00000,74.23000,Coventry,Workers Comp,,147.84,,,,,,,138.60,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Coventry,Workers Comp,,147.84,,,,,,,40.04,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,inpatient,,,97.00000,46.75000,Coventry,Workers Comp,,93.12,,,,,,,87.30,94.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,outpatient,,,97.00000,46.75000,Coventry,Workers Comp,,93.12,,,,,,,25.22,94.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,inpatient,,,154.00000,74.23000,Coventry,Workers Comp,,147.84,,,,,,,138.60,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Coventry,Workers Comp,,147.84,,,,,,,40.04,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,inpatient,,,87.00000,41.93000,Coventry,Workers Comp,,83.52,,,,,,,78.30,84.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,outpatient,,,87.00000,41.93000,Coventry,Workers Comp,,83.52,,,,,,,22.62,84.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,inpatient,,,68.00000,32.78000,Coventry,Workers Comp,,65.28,,,,,,,61.20,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,outpatient,,,68.00000,32.78000,Coventry,Workers Comp,,65.28,,,,,,,17.68,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,46.80,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,13.52,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,inpatient,,,51.00000,24.58000,Coventry,Workers Comp,,48.96,,,,,,,45.90,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,outpatient,,,51.00000,24.58000,Coventry,Workers Comp,,48.96,,,,,,,13.26,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,inpatient,,,97.00000,46.75000,Coventry,Workers Comp,,93.12,,,,,,,87.30,94.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,outpatient,,,97.00000,46.75000,Coventry,Workers Comp,,93.12,,,,,,,25.22,94.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,inpatient,,,176.00000,84.83000,Coventry,Workers Comp,,168.96,,,,,,,158.40,170.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,outpatient,,,176.00000,84.83000,Coventry,Workers Comp,,168.96,,,,,,,45.76,170.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,inpatient,,,158.00000,76.16000,Coventry,Workers Comp,,151.68,,,,,,,142.20,153.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,outpatient,,,158.00000,76.16000,Coventry,Workers Comp,,151.68,,,,,,,41.08,153.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,60.30,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,17.42,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,60.30,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,17.42,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,inpatient,,,84.00000,40.49000,Coventry,Workers Comp,,80.64,,,,,,,75.60,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,outpatient,,,84.00000,40.49000,Coventry,Workers Comp,,80.64,,,,,,,21.84,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,inpatient,,,189.00000,91.10000,Coventry,Workers Comp,,181.44,,,,,,,170.10,183.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,outpatient,,,189.00000,91.10000,Coventry,Workers Comp,,181.44,,,,,,,49.14,183.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,inpatient,,,109.00000,52.54000,Coventry,Workers Comp,,104.64,,,,,,,98.10,105.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,outpatient,,,109.00000,52.54000,Coventry,Workers Comp,,104.64,,,,,,,28.34,105.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,inpatient,,,129.00000,62.18000,Coventry,Workers Comp,,123.84,,,,,,,116.10,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,outpatient,,,129.00000,62.18000,Coventry,Workers Comp,,123.84,,,,,,,33.54,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,inpatient,,,84.00000,40.49000,Coventry,Workers Comp,,80.64,,,,,,,75.60,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,outpatient,,,84.00000,40.49000,Coventry,Workers Comp,,80.64,,,,,,,21.84,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,inpatient,,,73.00000,35.19000,Coventry,Workers Comp,,70.08,,,,,,,65.70,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Coventry,Workers Comp,,70.08,,,,,,,18.98,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,60.30,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,17.42,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,60.30,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,17.42,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,inpatient,,,149.00000,71.82000,Coventry,Workers Comp,,143.04,,,,,,,134.10,144.53,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,outpatient,,,149.00000,71.82000,Coventry,Workers Comp,,143.04,,,,,,,38.74,144.53,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,inpatient,,,130.00000,62.66000,Coventry,Workers Comp,,124.80,,,,,,,117.00,126.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,outpatient,,,130.00000,62.66000,Coventry,Workers Comp,,124.80,,,,,,,33.80,126.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,inpatient,,,110.00000,53.02000,Coventry,Workers Comp,,105.60,,,,,,,99.00,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,outpatient,,,110.00000,53.02000,Coventry,Workers Comp,,105.60,,,,,,,28.60,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,inpatient,,,158.00000,76.16000,Coventry,Workers Comp,,151.68,,,,,,,142.20,153.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,outpatient,,,158.00000,76.16000,Coventry,Workers Comp,,151.68,,,,,,,41.08,153.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,inpatient,,,117.00000,56.39000,Coventry,Workers Comp,,112.32,,,,,,,105.30,113.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,outpatient,,,117.00000,56.39000,Coventry,Workers Comp,,112.32,,,,,,,30.42,113.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,inpatient,,,61.00000,29.40000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,outpatient,,,61.00000,29.40000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,60.30,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,17.42,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Coventry,Workers Comp,,179.52,,,,,,,168.30,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Coventry,Workers Comp,,179.52,,,,,,,48.62,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,inpatient,,,145.00000,69.89000,Coventry,Workers Comp,,139.20,,,,,,,130.50,140.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,outpatient,,,145.00000,69.89000,Coventry,Workers Comp,,139.20,,,,,,,37.70,140.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,60.30,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,17.42,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,inpatient,,,165.00000,79.53000,Coventry,Workers Comp,,158.40,,,,,,,148.50,160.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,outpatient,,,165.00000,79.53000,Coventry,Workers Comp,,158.40,,,,,,,42.90,160.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,inpatient,,,70.00000,33.74000,Coventry,Workers Comp,,67.20,,,,,,,63.00,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,outpatient,,,70.00000,33.74000,Coventry,Workers Comp,,67.20,,,,,,,18.20,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,60.30,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,17.42,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Coventry,Workers Comp,,179.52,,,,,,,168.30,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Coventry,Workers Comp,,179.52,,,,,,,48.62,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,inpatient,,,154.00000,74.23000,Coventry,Workers Comp,,147.84,,,,,,,138.60,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,outpatient,,,154.00000,74.23000,Coventry,Workers Comp,,147.84,,,,,,,40.04,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,inpatient,,,104.00000,50.13000,Coventry,Workers Comp,,99.84,,,,,,,93.60,100.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,outpatient,,,104.00000,50.13000,Coventry,Workers Comp,,99.84,,,,,,,27.04,100.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,inpatient,,,70.00000,33.74000,Coventry,Workers Comp,,67.20,,,,,,,63.00,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,outpatient,,,70.00000,33.74000,Coventry,Workers Comp,,67.20,,,,,,,18.20,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,inpatient,,,104.00000,50.13000,Coventry,Workers Comp,,99.84,,,,,,,93.60,100.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,outpatient,,,104.00000,50.13000,Coventry,Workers Comp,,99.84,,,,,,,27.04,100.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,inpatient,,,70.00000,33.74000,Coventry,Workers Comp,,67.20,,,,,,,63.00,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,outpatient,,,70.00000,33.74000,Coventry,Workers Comp,,67.20,,,,,,,18.20,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,inpatient,,,123.00000,59.29000,Coventry,Workers Comp,,118.08,,,,,,,110.70,119.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,outpatient,,,123.00000,59.29000,Coventry,Workers Comp,,118.08,,,,,,,31.98,119.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,inpatient,,,95.00000,45.79000,Coventry,Workers Comp,,91.20,,,,,,,85.50,92.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,outpatient,,,95.00000,45.79000,Coventry,Workers Comp,,91.20,,,,,,,24.70,92.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,inpatient,,,160.00000,77.12000,Coventry,Workers Comp,,153.60,,,,,,,144.00,155.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,outpatient,,,160.00000,77.12000,Coventry,Workers Comp,,153.60,,,,,,,41.60,155.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,inpatient,,,147.00000,70.85000,Coventry,Workers Comp,,141.12,,,,,,,132.30,142.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,outpatient,,,147.00000,70.85000,Coventry,Workers Comp,,141.12,,,,,,,38.22,142.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,inpatient,,,178.00000,85.80000,Coventry,Workers Comp,,170.88,,,,,,,160.20,172.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,outpatient,,,178.00000,85.80000,Coventry,Workers Comp,,170.88,,,,,,,46.28,172.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,inpatient,,,160.00000,77.12000,Coventry,Workers Comp,,153.60,,,,,,,144.00,155.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,outpatient,,,160.00000,77.12000,Coventry,Workers Comp,,153.60,,,,,,,41.60,155.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Coventry,Workers Comp,,179.52,,,,,,,168.30,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Coventry,Workers Comp,,179.52,,,,,,,48.62,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,60.30,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,17.42,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,inpatient,,,70.00000,33.74000,Coventry,Workers Comp,,67.20,,,,,,,63.00,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,outpatient,,,70.00000,33.74000,Coventry,Workers Comp,,67.20,,,,,,,18.20,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Coventry,Workers Comp,,179.52,,,,,,,168.30,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Coventry,Workers Comp,,179.52,,,,,,,48.62,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Coventry,Workers Comp,,179.52,,,,,,,168.30,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Coventry,Workers Comp,,179.52,,,,,,,48.62,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Coventry,Workers Comp,,179.52,,,,,,,168.30,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Coventry,Workers Comp,,179.52,,,,,,,48.62,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Coventry,Workers Comp,,179.52,,,,,,,168.30,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Coventry,Workers Comp,,179.52,,,,,,,48.62,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Coventry,Workers Comp,,179.52,,,,,,,168.30,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Coventry,Workers Comp,,179.52,,,,,,,48.62,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Coventry,Workers Comp,,179.52,,,,,,,168.30,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Coventry,Workers Comp,,179.52,,,,,,,48.62,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Coventry,Workers Comp,,179.52,,,,,,,168.30,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Coventry,Workers Comp,,179.52,,,,,,,48.62,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Coventry,Workers Comp,,179.52,,,,,,,168.30,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Coventry,Workers Comp,,179.52,,,,,,,48.62,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,inpatient,,,449.00000,216.42000,Coventry,Workers Comp,,431.04,,,,,,,404.10,435.53,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,outpatient,,,449.00000,216.42000,Coventry,Workers Comp,,431.04,,,,,,,116.74,435.53,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,inpatient,,,104.00000,50.13000,Coventry,Workers Comp,,99.84,,,,,,,93.60,100.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,outpatient,,,104.00000,50.13000,Coventry,Workers Comp,,99.84,,,,,,,27.04,100.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,inpatient,,,185.00000,89.17000,Coventry,Workers Comp,,177.60,,,,,,,166.50,179.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Coventry,Workers Comp,,177.60,,,,,,,48.10,179.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,inpatient,,,185.00000,89.17000,Coventry,Workers Comp,,177.60,,,,,,,166.50,179.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Coventry,Workers Comp,,177.60,,,,,,,48.10,179.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,inpatient,,,84.00000,40.49000,Coventry,Workers Comp,,80.64,,,,,,,75.60,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,outpatient,,,84.00000,40.49000,Coventry,Workers Comp,,80.64,,,,,,,21.84,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,inpatient,,,84.00000,40.49000,Coventry,Workers Comp,,80.64,,,,,,,75.60,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Coventry,Workers Comp,,80.64,,,,,,,21.84,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,inpatient,,,84.00000,40.49000,Coventry,Workers Comp,,80.64,,,,,,,75.60,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Coventry,Workers Comp,,80.64,,,,,,,21.84,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,inpatient,,,73.00000,35.19000,Coventry,Workers Comp,,70.08,,,,,,,65.70,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Coventry,Workers Comp,,70.08,,,,,,,18.98,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,inpatient,,,73.00000,35.19000,Coventry,Workers Comp,,70.08,,,,,,,65.70,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Coventry,Workers Comp,,70.08,,,,,,,18.98,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,inpatient,,,98.00000,47.24000,Coventry,Workers Comp,,94.08,,,,,,,88.20,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,outpatient,,,98.00000,47.24000,Coventry,Workers Comp,,94.08,,,,,,,25.48,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,inpatient,,,75.00000,36.15000,Coventry,Workers Comp,,72.00,,,,,,,67.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,outpatient,,,75.00000,36.15000,Coventry,Workers Comp,,72.00,,,,,,,19.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,inpatient,,,107.00000,51.57000,Coventry,Workers Comp,,102.72,,,,,,,96.30,103.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,outpatient,,,107.00000,51.57000,Coventry,Workers Comp,,102.72,,,,,,,27.82,103.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,inpatient,,,81.00000,39.04000,Coventry,Workers Comp,,77.76,,,,,,,72.90,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,outpatient,,,81.00000,39.04000,Coventry,Workers Comp,,77.76,,,,,,,21.06,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,inpatient,,,68.00000,32.78000,Coventry,Workers Comp,,65.28,,,,,,,61.20,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,outpatient,,,68.00000,32.78000,Coventry,Workers Comp,,65.28,,,,,,,17.68,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,inpatient,,,51.00000,24.58000,Coventry,Workers Comp,,48.96,,,,,,,45.90,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,outpatient,,,51.00000,24.58000,Coventry,Workers Comp,,48.96,,,,,,,13.26,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,inpatient,,,74.00000,35.67000,Coventry,Workers Comp,,71.04,,,,,,,66.60,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,outpatient,,,74.00000,35.67000,Coventry,Workers Comp,,71.04,,,,,,,19.24,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,inpatient,,,194.00000,93.51000,Coventry,Workers Comp,,186.24,,,,,,,174.60,188.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,outpatient,,,194.00000,93.51000,Coventry,Workers Comp,,186.24,,,,,,,50.44,188.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,inpatient,,,111.00000,53.50000,Coventry,Workers Comp,,106.56,,,,,,,99.90,107.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,outpatient,,,111.00000,53.50000,Coventry,Workers Comp,,106.56,,,,,,,28.86,107.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,inpatient,,,77.00000,37.11000,Coventry,Workers Comp,,73.92,,,,,,,69.30,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,outpatient,,,77.00000,37.11000,Coventry,Workers Comp,,73.92,,,,,,,20.02,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Coventry,Workers Comp,,75.84,,,,,,,71.10,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Coventry,Workers Comp,,75.84,,,,,,,20.54,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Coventry,Workers Comp,,75.84,,,,,,,71.10,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Coventry,Workers Comp,,75.84,,,,,,,20.54,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,inpatient,,,237.00000,114.23000,Coventry,Workers Comp,,227.52,,,,,,,213.30,229.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Coventry,Workers Comp,,227.52,,,,,,,61.62,229.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,inpatient,,,51.00000,24.58000,Coventry,Workers Comp,,48.96,,,,,,,45.90,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,outpatient,,,51.00000,24.58000,Coventry,Workers Comp,,48.96,,,,,,,13.26,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,inpatient,,,82.00000,39.52000,Coventry,Workers Comp,,78.72,,,,,,,73.80,79.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Coventry,Workers Comp,,78.72,,,,,,,21.32,79.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,inpatient,,,82.00000,39.52000,Coventry,Workers Comp,,78.72,,,,,,,73.80,79.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Coventry,Workers Comp,,78.72,,,,,,,21.32,79.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,60.30,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,17.42,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,inpatient,,,131.00000,63.14000,Coventry,Workers Comp,,125.76,,,,,,,117.90,127.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,outpatient,,,131.00000,63.14000,Coventry,Workers Comp,,125.76,,,,,,,34.06,127.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,inpatient,,,15.00000,7.23000,Coventry,Workers Comp,,14.40,,,,,,,13.50,14.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,outpatient,,,15.00000,7.23000,Coventry,Workers Comp,,14.40,,,,,,,3.90,14.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,inpatient,,,39.00000,18.80000,Coventry,Workers Comp,,37.44,,,,,,,35.10,37.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,outpatient,,,39.00000,18.80000,Coventry,Workers Comp,,37.44,,,,,,,10.14,37.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,inpatient,,,12.00000,5.78000,Coventry,Workers Comp,,11.52,,,,,,,10.80,11.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,outpatient,,,12.00000,5.78000,Coventry,Workers Comp,,11.52,,,,,,,3.12,11.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,inpatient,,,203.00000,97.85000,Coventry,Workers Comp,,194.88,,,,,,,182.70,196.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Coventry,Workers Comp,,194.88,,,,,,,52.78,196.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,inpatient,,,203.00000,97.85000,Coventry,Workers Comp,,194.88,,,,,,,182.70,196.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Coventry,Workers Comp,,194.88,,,,,,,52.78,196.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,inpatient,,,99.00000,47.72000,Coventry,Workers Comp,,95.04,,,,,,,89.10,96.03,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,outpatient,,,99.00000,47.72000,Coventry,Workers Comp,,95.04,,,,,,,25.74,96.03,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,inpatient,,,53.00000,25.55000,Coventry,Workers Comp,,50.88,,,,,,,47.70,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,outpatient,,,53.00000,25.55000,Coventry,Workers Comp,,50.88,,,,,,,13.78,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,inpatient,,,23.00000,11.09000,Coventry,Workers Comp,,22.08,,,,,,,20.70,22.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,outpatient,,,23.00000,11.09000,Coventry,Workers Comp,,22.08,,,,,,,5.98,22.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,inpatient,,,46.00000,22.17000,Coventry,Workers Comp,,44.16,,,,,,,41.40,44.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,outpatient,,,46.00000,22.17000,Coventry,Workers Comp,,44.16,,,,,,,11.96,44.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,60.30,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,17.42,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,inpatient,,,288.00000,138.82000,Coventry,Workers Comp,,276.48,,,,,,,259.20,279.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,outpatient,,,288.00000,138.82000,Coventry,Workers Comp,,276.48,,,,,,,74.88,279.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,inpatient,,,106.00000,51.09000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,outpatient,,,106.00000,51.09000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,inpatient,,,30.00000,14.46000,Coventry,Workers Comp,,28.80,,,,,,,27.00,29.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,outpatient,,,30.00000,14.46000,Coventry,Workers Comp,,28.80,,,,,,,7.80,29.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,inpatient,,,71.00000,34.22000,Coventry,Workers Comp,,68.16,,,,,,,63.90,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,outpatient,,,71.00000,34.22000,Coventry,Workers Comp,,68.16,,,,,,,18.46,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,60.30,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,17.42,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,inpatient,,,89.00000,42.90000,Coventry,Workers Comp,,85.44,,,,,,,80.10,86.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,outpatient,,,89.00000,42.90000,Coventry,Workers Comp,,85.44,,,,,,,23.14,86.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,inpatient,,,116.00000,55.91000,Coventry,Workers Comp,,111.36,,,,,,,104.40,112.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,outpatient,,,116.00000,55.91000,Coventry,Workers Comp,,111.36,,,,,,,30.16,112.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,inpatient,,,116.00000,55.91000,Coventry,Workers Comp,,111.36,,,,,,,104.40,112.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Coventry,Workers Comp,,111.36,,,,,,,30.16,112.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,inpatient,,,116.00000,55.91000,Coventry,Workers Comp,,111.36,,,,,,,104.40,112.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Coventry,Workers Comp,,111.36,,,,,,,30.16,112.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,inpatient,,,51.00000,24.58000,Coventry,Workers Comp,,48.96,,,,,,,45.90,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,outpatient,,,51.00000,24.58000,Coventry,Workers Comp,,48.96,,,,,,,13.26,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,inpatient,,,174.00000,83.87000,Coventry,Workers Comp,,167.04,,,,,,,156.60,168.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,outpatient,,,174.00000,83.87000,Coventry,Workers Comp,,167.04,,,,,,,45.24,168.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,inpatient,,,82.00000,39.52000,Coventry,Workers Comp,,78.72,,,,,,,73.80,79.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,outpatient,,,82.00000,39.52000,Coventry,Workers Comp,,78.72,,,,,,,21.32,79.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,inpatient,,,112.00000,53.98000,Coventry,Workers Comp,,107.52,,,,,,,100.80,108.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,outpatient,,,112.00000,53.98000,Coventry,Workers Comp,,107.52,,,,,,,29.12,108.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,inpatient,,,61.00000,29.40000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,outpatient,,,61.00000,29.40000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,inpatient,,,69.00000,33.26000,Coventry,Workers Comp,,66.24,,,,,,,62.10,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,outpatient,,,69.00000,33.26000,Coventry,Workers Comp,,66.24,,,,,,,17.94,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,46.80,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,13.52,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,inpatient,,,286.00000,137.85000,Coventry,Workers Comp,,274.56,,,,,,,257.40,277.42,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,outpatient,,,286.00000,137.85000,Coventry,Workers Comp,,274.56,,,,,,,74.36,277.42,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,inpatient,,,300.00000,144.60000,Coventry,Workers Comp,,288.00,,,,,,,270.00,291.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,outpatient,,,300.00000,144.60000,Coventry,Workers Comp,,288.00,,,,,,,78.00,291.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,inpatient,,,73.00000,35.19000,Coventry,Workers Comp,,70.08,,,,,,,65.70,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,outpatient,,,73.00000,35.19000,Coventry,Workers Comp,,70.08,,,,,,,18.98,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,inpatient,,,90.00000,43.38000,Coventry,Workers Comp,,86.40,,,,,,,81.00,87.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,outpatient,,,90.00000,43.38000,Coventry,Workers Comp,,86.40,,,,,,,23.40,87.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,46.80,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,13.52,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,inpatient,,,315.00000,151.83000,Coventry,Workers Comp,,302.40,,,,,,,283.50,305.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,outpatient,,,315.00000,151.83000,Coventry,Workers Comp,,302.40,,,,,,,81.90,305.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,inpatient,,,100.00000,48.20000,Coventry,Workers Comp,,96.00,,,,,,,90.00,97.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,outpatient,,,100.00000,48.20000,Coventry,Workers Comp,,96.00,,,,,,,26.00,97.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,inpatient,,,89.00000,42.90000,Coventry,Workers Comp,,85.44,,,,,,,80.10,86.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,outpatient,,,89.00000,42.90000,Coventry,Workers Comp,,85.44,,,,,,,23.14,86.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,inpatient,,,71.00000,34.22000,Coventry,Workers Comp,,68.16,,,,,,,63.90,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,outpatient,,,71.00000,34.22000,Coventry,Workers Comp,,68.16,,,,,,,18.46,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,inpatient,,,135.00000,65.07000,Coventry,Workers Comp,,129.60,,,,,,,121.50,130.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,outpatient,,,135.00000,65.07000,Coventry,Workers Comp,,129.60,,,,,,,35.10,130.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,inpatient,,,80.00000,38.56000,Coventry,Workers Comp,,76.80,,,,,,,72.00,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,outpatient,,,80.00000,38.56000,Coventry,Workers Comp,,76.80,,,,,,,20.80,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,inpatient,,,72.00000,34.70000,Coventry,Workers Comp,,69.12,,,,,,,64.80,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Coventry,Workers Comp,,69.12,,,,,,,18.72,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,inpatient,,,72.00000,34.70000,Coventry,Workers Comp,,69.12,,,,,,,64.80,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Coventry,Workers Comp,,69.12,,,,,,,18.72,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,inpatient,,,100.00000,48.20000,Coventry,Workers Comp,,96.00,,,,,,,90.00,97.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,outpatient,,,100.00000,48.20000,Coventry,Workers Comp,,96.00,,,,,,,26.00,97.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,inpatient,,,305.00000,147.01000,Coventry,Workers Comp,,292.80,,,,,,,274.50,295.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,outpatient,,,305.00000,147.01000,Coventry,Workers Comp,,292.80,,,,,,,79.30,295.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,inpatient,,,70.00000,33.74000,Coventry,Workers Comp,,67.20,,,,,,,63.00,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,outpatient,,,70.00000,33.74000,Coventry,Workers Comp,,67.20,,,,,,,18.20,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,inpatient,,,69.00000,33.26000,Coventry,Workers Comp,,66.24,,,,,,,62.10,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,outpatient,,,69.00000,33.26000,Coventry,Workers Comp,,66.24,,,,,,,17.94,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,inpatient,,,64.00000,30.85000,Coventry,Workers Comp,,61.44,,,,,,,57.60,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,outpatient,,,64.00000,30.85000,Coventry,Workers Comp,,61.44,,,,,,,16.64,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,inpatient,,,368.00000,177.38000,Coventry,Workers Comp,,353.28,,,,,,,331.20,356.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,outpatient,,,368.00000,177.38000,Coventry,Workers Comp,,353.28,,,,,,,95.68,356.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,inpatient,,,104.00000,50.13000,Coventry,Workers Comp,,99.84,,,,,,,93.60,100.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,outpatient,,,104.00000,50.13000,Coventry,Workers Comp,,99.84,,,,,,,27.04,100.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,inpatient,,,109.00000,52.54000,Coventry,Workers Comp,,104.64,,,,,,,98.10,105.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,outpatient,,,109.00000,52.54000,Coventry,Workers Comp,,104.64,,,,,,,28.34,105.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,inpatient,,,114.00000,54.95000,Coventry,Workers Comp,,109.44,,,,,,,102.60,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,outpatient,,,114.00000,54.95000,Coventry,Workers Comp,,109.44,,,,,,,29.64,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,inpatient,,,135.00000,65.07000,Coventry,Workers Comp,,129.60,,,,,,,121.50,130.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,outpatient,,,135.00000,65.07000,Coventry,Workers Comp,,129.60,,,,,,,35.10,130.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,inpatient,,,105.00000,50.61000,Coventry,Workers Comp,,100.80,,,,,,,94.50,101.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,outpatient,,,105.00000,50.61000,Coventry,Workers Comp,,100.80,,,,,,,27.30,101.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,inpatient,,,315.00000,151.83000,Coventry,Workers Comp,,302.40,,,,,,,283.50,305.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,outpatient,,,315.00000,151.83000,Coventry,Workers Comp,,302.40,,,,,,,81.90,305.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,inpatient,,,148.00000,71.34000,Coventry,Workers Comp,,142.08,,,,,,,133.20,143.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,outpatient,,,148.00000,71.34000,Coventry,Workers Comp,,142.08,,,,,,,38.48,143.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,60.30,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,17.42,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,inpatient,,,107.00000,51.57000,Coventry,Workers Comp,,102.72,,,,,,,96.30,103.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,outpatient,,,107.00000,51.57000,Coventry,Workers Comp,,102.72,,,,,,,27.82,103.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,inpatient,,,35.00000,16.87000,Coventry,Workers Comp,,33.60,,,,,,,31.50,33.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,outpatient,,,35.00000,16.87000,Coventry,Workers Comp,,33.60,,,,,,,9.10,33.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,inpatient,,,104.00000,50.13000,Coventry,Workers Comp,,99.84,,,,,,,93.60,100.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,outpatient,,,104.00000,50.13000,Coventry,Workers Comp,,99.84,,,,,,,27.04,100.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,inpatient,,,650.00000,313.30000,Coventry,Workers Comp,,624.00,,,,,,,585.00,630.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,outpatient,,,650.00000,313.30000,Coventry,Workers Comp,,624.00,,,,,,,169.00,630.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,inpatient,,,91.00000,43.86000,Coventry,Workers Comp,,87.36,,,,,,,81.90,88.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,outpatient,,,91.00000,43.86000,Coventry,Workers Comp,,87.36,,,,,,,23.66,88.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,inpatient,,,114.00000,54.95000,Coventry,Workers Comp,,109.44,,,,,,,102.60,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,outpatient,,,114.00000,54.95000,Coventry,Workers Comp,,109.44,,,,,,,29.64,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,46.80,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,13.52,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,inpatient,,,360.00000,173.52000,Coventry,Workers Comp,,345.60,,,,,,,324.00,349.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,outpatient,,,360.00000,173.52000,Coventry,Workers Comp,,345.60,,,,,,,93.60,349.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,inpatient,,,106.00000,51.09000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,outpatient,,,106.00000,51.09000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,inpatient,,,78.00000,37.60000,Coventry,Workers Comp,,74.88,,,,,,,70.20,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,outpatient,,,78.00000,37.60000,Coventry,Workers Comp,,74.88,,,,,,,20.28,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,inpatient,,,72.00000,34.70000,Coventry,Workers Comp,,69.12,,,,,,,64.80,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,outpatient,,,72.00000,34.70000,Coventry,Workers Comp,,69.12,,,,,,,18.72,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,inpatient,,,94.00000,45.31000,Coventry,Workers Comp,,90.24,,,,,,,84.60,91.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,outpatient,,,94.00000,45.31000,Coventry,Workers Comp,,90.24,,,,,,,24.44,91.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,inpatient,,,101.00000,48.68000,Coventry,Workers Comp,,96.96,,,,,,,90.90,97.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,outpatient,,,101.00000,48.68000,Coventry,Workers Comp,,96.96,,,,,,,26.26,97.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,inpatient,,,82.00000,39.52000,Coventry,Workers Comp,,78.72,,,,,,,73.80,79.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,outpatient,,,82.00000,39.52000,Coventry,Workers Comp,,78.72,,,,,,,21.32,79.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,inpatient,,,77.00000,37.11000,Coventry,Workers Comp,,73.92,,,,,,,69.30,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,outpatient,,,77.00000,37.11000,Coventry,Workers Comp,,73.92,,,,,,,20.02,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,inpatient,,,145.00000,69.89000,Coventry,Workers Comp,,139.20,,,,,,,130.50,140.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,outpatient,,,145.00000,69.89000,Coventry,Workers Comp,,139.20,,,,,,,37.70,140.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,inpatient,,,266.00000,128.21000,Coventry,Workers Comp,,255.36,,,,,,,239.40,258.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,outpatient,,,266.00000,128.21000,Coventry,Workers Comp,,255.36,,,,,,,69.16,258.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,inpatient,,,79.00000,38.08000,Coventry,Workers Comp,,75.84,,,,,,,71.10,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,outpatient,,,79.00000,38.08000,Coventry,Workers Comp,,75.84,,,,,,,20.54,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,inpatient,,,144.00000,69.41000,Coventry,Workers Comp,,138.24,,,,,,,129.60,139.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,outpatient,,,144.00000,69.41000,Coventry,Workers Comp,,138.24,,,,,,,37.44,139.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,inpatient,,,20.00000,9.64000,Coventry,Workers Comp,,19.20,,,,,,,18.00,19.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,outpatient,,,20.00000,9.64000,Coventry,Workers Comp,,19.20,,,,,,,5.20,19.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,inpatient,,,208.00000,100.26000,Coventry,Workers Comp,,199.68,,,,,,,187.20,201.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,outpatient,,,208.00000,100.26000,Coventry,Workers Comp,,199.68,,,,,,,54.08,201.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,inpatient,,,135.00000,65.07000,Coventry,Workers Comp,,129.60,,,,,,,121.50,130.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,outpatient,,,135.00000,65.07000,Coventry,Workers Comp,,129.60,,,,,,,35.10,130.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,inpatient,,,131.00000,63.14000,Coventry,Workers Comp,,125.76,,,,,,,117.90,127.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,outpatient,,,131.00000,63.14000,Coventry,Workers Comp,,125.76,,,,,,,34.06,127.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,inpatient,,,69.00000,33.26000,Coventry,Workers Comp,,66.24,,,,,,,62.10,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,outpatient,,,69.00000,33.26000,Coventry,Workers Comp,,66.24,,,,,,,17.94,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,inpatient,,,25.00000,12.05000,Coventry,Workers Comp,,24.00,,,,,,,22.50,24.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,outpatient,,,25.00000,12.05000,Coventry,Workers Comp,,24.00,,,,,,,6.50,24.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,inpatient,,,61.00000,29.40000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,outpatient,,,61.00000,29.40000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,inpatient,,,80.00000,38.56000,Coventry,Workers Comp,,76.80,,,,,,,72.00,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,outpatient,,,80.00000,38.56000,Coventry,Workers Comp,,76.80,,,,,,,20.80,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,inpatient,,,82.00000,39.52000,Coventry,Workers Comp,,78.72,,,,,,,73.80,79.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,outpatient,,,82.00000,39.52000,Coventry,Workers Comp,,78.72,,,,,,,21.32,79.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,inpatient,,,35.00000,16.87000,Coventry,Workers Comp,,33.60,,,,,,,31.50,33.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,outpatient,,,35.00000,16.87000,Coventry,Workers Comp,,33.60,,,,,,,9.10,33.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,inpatient,,,88.00000,42.42000,Coventry,Workers Comp,,84.48,,,,,,,79.20,85.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,outpatient,,,88.00000,42.42000,Coventry,Workers Comp,,84.48,,,,,,,22.88,85.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,inpatient,,,98.00000,47.24000,Coventry,Workers Comp,,94.08,,,,,,,88.20,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,outpatient,,,98.00000,47.24000,Coventry,Workers Comp,,94.08,,,,,,,25.48,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,inpatient,,,204.00000,98.33000,Coventry,Workers Comp,,195.84,,,,,,,183.60,197.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,outpatient,,,204.00000,98.33000,Coventry,Workers Comp,,195.84,,,,,,,53.04,197.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,inpatient,,,61.00000,29.40000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,outpatient,,,61.00000,29.40000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,inpatient,,,19.00000,9.16000,Coventry,Workers Comp,,18.24,,,,,,,17.10,18.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,outpatient,,,19.00000,9.16000,Coventry,Workers Comp,,18.24,,,,,,,4.94,18.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,inpatient,,,37.00000,17.83000,Coventry,Workers Comp,,35.52,,,,,,,33.30,35.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,outpatient,,,37.00000,17.83000,Coventry,Workers Comp,,35.52,,,,,,,9.62,35.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,inpatient,,,79.00000,38.08000,Coventry,Workers Comp,,75.84,,,,,,,71.10,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,outpatient,,,79.00000,38.08000,Coventry,Workers Comp,,75.84,,,,,,,20.54,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,inpatient,,,21.00000,10.12000,Coventry,Workers Comp,,20.16,,,,,,,18.90,20.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,outpatient,,,21.00000,10.12000,Coventry,Workers Comp,,20.16,,,,,,,5.46,20.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,46.80,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,13.52,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,inpatient,,,32.00000,15.42000,Coventry,Workers Comp,,30.72,,,,,,,28.80,31.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,outpatient,,,32.00000,15.42000,Coventry,Workers Comp,,30.72,,,,,,,8.32,31.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,inpatient,,,94.00000,45.31000,Coventry,Workers Comp,,90.24,,,,,,,84.60,91.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,outpatient,,,94.00000,45.31000,Coventry,Workers Comp,,90.24,,,,,,,24.44,91.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,inpatient,,,103.00000,49.65000,Coventry,Workers Comp,,98.88,,,,,,,92.70,99.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,outpatient,,,103.00000,49.65000,Coventry,Workers Comp,,98.88,,,,,,,26.78,99.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,inpatient,,,64.00000,30.85000,Coventry,Workers Comp,,61.44,,,,,,,57.60,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,outpatient,,,64.00000,30.85000,Coventry,Workers Comp,,61.44,,,,,,,16.64,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,inpatient,,,102.00000,49.16000,Coventry,Workers Comp,,97.92,,,,,,,91.80,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,outpatient,,,102.00000,49.16000,Coventry,Workers Comp,,97.92,,,,,,,26.52,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,inpatient,,,103.00000,49.65000,Coventry,Workers Comp,,98.88,,,,,,,92.70,99.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,outpatient,,,103.00000,49.65000,Coventry,Workers Comp,,98.88,,,,,,,26.78,99.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,inpatient,,,139.00000,67.00000,Coventry,Workers Comp,,133.44,,,,,,,125.10,134.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,outpatient,,,139.00000,67.00000,Coventry,Workers Comp,,133.44,,,,,,,36.14,134.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,46.80,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,13.52,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,inpatient,,,21.00000,10.12000,Coventry,Workers Comp,,20.16,,,,,,,18.90,20.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Coventry,Workers Comp,,20.16,,,,,,,5.46,20.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,inpatient,,,88.00000,42.42000,Coventry,Workers Comp,,84.48,,,,,,,79.20,85.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,outpatient,,,88.00000,42.42000,Coventry,Workers Comp,,84.48,,,,,,,22.88,85.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,inpatient,,,21.00000,10.12000,Coventry,Workers Comp,,20.16,,,,,,,18.90,20.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Coventry,Workers Comp,,20.16,,,,,,,5.46,20.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,46.80,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,13.52,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,inpatient,,,80.00000,38.56000,Coventry,Workers Comp,,76.80,,,,,,,72.00,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,outpatient,,,80.00000,38.56000,Coventry,Workers Comp,,76.80,,,,,,,20.80,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,inpatient,,,49.00000,23.62000,Coventry,Workers Comp,,47.04,,,,,,,44.10,47.53,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,outpatient,,,49.00000,23.62000,Coventry,Workers Comp,,47.04,,,,,,,12.74,47.53,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,inpatient,,,88.00000,42.42000,Coventry,Workers Comp,,84.48,,,,,,,79.20,85.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,outpatient,,,88.00000,42.42000,Coventry,Workers Comp,,84.48,,,,,,,22.88,85.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,inpatient,,,68.00000,32.78000,Coventry,Workers Comp,,65.28,,,,,,,61.20,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,outpatient,,,68.00000,32.78000,Coventry,Workers Comp,,65.28,,,,,,,17.68,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,inpatient,,,93.00000,44.83000,Coventry,Workers Comp,,89.28,,,,,,,83.70,90.21,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,outpatient,,,93.00000,44.83000,Coventry,Workers Comp,,89.28,,,,,,,24.18,90.21,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,inpatient,,,73.00000,35.19000,Coventry,Workers Comp,,70.08,,,,,,,65.70,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,outpatient,,,73.00000,35.19000,Coventry,Workers Comp,,70.08,,,,,,,18.98,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,inpatient,,,41.00000,19.76000,Coventry,Workers Comp,,39.36,,,,,,,36.90,39.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,outpatient,,,41.00000,19.76000,Coventry,Workers Comp,,39.36,,,,,,,10.66,39.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,inpatient,,,94.00000,45.31000,Coventry,Workers Comp,,90.24,,,,,,,84.60,91.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,outpatient,,,94.00000,45.31000,Coventry,Workers Comp,,90.24,,,,,,,24.44,91.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,inpatient,,,124.00000,59.77000,Coventry,Workers Comp,,119.04,,,,,,,111.60,120.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,outpatient,,,124.00000,59.77000,Coventry,Workers Comp,,119.04,,,,,,,32.24,120.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,inpatient,,,71.00000,34.22000,Coventry,Workers Comp,,68.16,,,,,,,63.90,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,outpatient,,,71.00000,34.22000,Coventry,Workers Comp,,68.16,,,,,,,18.46,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,inpatient,,,33.00000,15.91000,Coventry,Workers Comp,,31.68,,,,,,,29.70,32.01,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,outpatient,,,33.00000,15.91000,Coventry,Workers Comp,,31.68,,,,,,,8.58,32.01,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,46.80,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,13.52,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,inpatient,,,68.00000,32.78000,Coventry,Workers Comp,,65.28,,,,,,,61.20,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,outpatient,,,68.00000,32.78000,Coventry,Workers Comp,,65.28,,,,,,,17.68,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,inpatient,,,99.00000,47.72000,Coventry,Workers Comp,,95.04,,,,,,,89.10,96.03,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,outpatient,,,99.00000,47.72000,Coventry,Workers Comp,,95.04,,,,,,,25.74,96.03,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,inpatient,,,197.00000,94.95000,Coventry,Workers Comp,,189.12,,,,,,,177.30,191.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,outpatient,,,197.00000,94.95000,Coventry,Workers Comp,,189.12,,,,,,,51.22,191.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,inpatient,,,194.00000,93.51000,Coventry,Workers Comp,,186.24,,,,,,,174.60,188.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,outpatient,,,194.00000,93.51000,Coventry,Workers Comp,,186.24,,,,,,,50.44,188.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,inpatient,,,68.00000,32.78000,Coventry,Workers Comp,,65.28,,,,,,,61.20,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,outpatient,,,68.00000,32.78000,Coventry,Workers Comp,,65.28,,,,,,,17.68,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,inpatient,,,90.00000,43.38000,Coventry,Workers Comp,,86.40,,,,,,,81.00,87.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,outpatient,,,90.00000,43.38000,Coventry,Workers Comp,,86.40,,,,,,,23.40,87.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,inpatient,,,109.00000,52.54000,Coventry,Workers Comp,,104.64,,,,,,,98.10,105.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,outpatient,,,109.00000,52.54000,Coventry,Workers Comp,,104.64,,,,,,,28.34,105.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,inpatient,,,108.00000,52.06000,Coventry,Workers Comp,,103.68,,,,,,,97.20,104.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,outpatient,,,108.00000,52.06000,Coventry,Workers Comp,,103.68,,,,,,,28.08,104.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,inpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,60.30,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,outpatient,,,67.00000,32.29000,Coventry,Workers Comp,,64.32,,,,,,,17.42,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,inpatient,,,69.00000,33.26000,Coventry,Workers Comp,,66.24,,,,,,,62.10,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,outpatient,,,69.00000,33.26000,Coventry,Workers Comp,,66.24,,,,,,,17.94,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,inpatient,,,71.00000,34.22000,Coventry,Workers Comp,,68.16,,,,,,,63.90,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,outpatient,,,71.00000,34.22000,Coventry,Workers Comp,,68.16,,,,,,,18.46,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,inpatient,,,98.00000,47.24000,Coventry,Workers Comp,,94.08,,,,,,,88.20,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,outpatient,,,98.00000,47.24000,Coventry,Workers Comp,,94.08,,,,,,,25.48,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,inpatient,,,141.00000,67.96000,Coventry,Workers Comp,,135.36,,,,,,,126.90,136.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,outpatient,,,141.00000,67.96000,Coventry,Workers Comp,,135.36,,,,,,,36.66,136.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,inpatient,,,226.00000,108.93000,Coventry,Workers Comp,,216.96,,,,,,,203.40,219.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,outpatient,,,226.00000,108.93000,Coventry,Workers Comp,,216.96,,,,,,,58.76,219.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,inpatient,,,92.00000,44.34000,Coventry,Workers Comp,,88.32,,,,,,,82.80,89.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,outpatient,,,92.00000,44.34000,Coventry,Workers Comp,,88.32,,,,,,,23.92,89.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,inpatient,,,69.00000,33.26000,Coventry,Workers Comp,,66.24,,,,,,,62.10,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,outpatient,,,69.00000,33.26000,Coventry,Workers Comp,,66.24,,,,,,,17.94,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,inpatient,,,100.00000,48.20000,Coventry,Workers Comp,,96.00,,,,,,,90.00,97.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,outpatient,,,100.00000,48.20000,Coventry,Workers Comp,,96.00,,,,,,,26.00,97.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,inpatient,,,124.00000,59.77000,Coventry,Workers Comp,,119.04,,,,,,,111.60,120.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,outpatient,,,124.00000,59.77000,Coventry,Workers Comp,,119.04,,,,,,,32.24,120.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,inpatient,,,69.00000,33.26000,Coventry,Workers Comp,,66.24,,,,,,,62.10,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,outpatient,,,69.00000,33.26000,Coventry,Workers Comp,,66.24,,,,,,,17.94,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Coventry,Workers Comp,,119.04,,,,,,,111.60,120.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Coventry,Workers Comp,,119.04,,,,,,,32.24,120.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Coventry,Workers Comp,,119.04,,,,,,,111.60,120.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Coventry,Workers Comp,,119.04,,,,,,,32.24,120.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Coventry,Workers Comp,,119.04,,,,,,,111.60,120.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Coventry,Workers Comp,,119.04,,,,,,,32.24,120.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,inpatient,,,118.00000,56.88000,Coventry,Workers Comp,,113.28,,,,,,,106.20,114.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,outpatient,,,118.00000,56.88000,Coventry,Workers Comp,,113.28,,,,,,,30.68,114.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,inpatient,,,51.00000,24.58000,Coventry,Workers Comp,,48.96,,,,,,,45.90,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,outpatient,,,51.00000,24.58000,Coventry,Workers Comp,,48.96,,,,,,,13.26,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,inpatient,,,104.00000,50.13000,Coventry,Workers Comp,,99.84,,,,,,,93.60,100.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,outpatient,,,104.00000,50.13000,Coventry,Workers Comp,,99.84,,,,,,,27.04,100.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,inpatient,,,72.00000,34.70000,Coventry,Workers Comp,,69.12,,,,,,,64.80,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,outpatient,,,72.00000,34.70000,Coventry,Workers Comp,,69.12,,,,,,,18.72,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,inpatient,,,54.00000,26.03000,Coventry,Workers Comp,,51.84,,,,,,,48.60,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,outpatient,,,54.00000,26.03000,Coventry,Workers Comp,,51.84,,,,,,,14.04,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,inpatient,,,17.00000,8.19000,Coventry,Workers Comp,,16.32,,,,,,,15.30,16.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,outpatient,,,17.00000,8.19000,Coventry,Workers Comp,,16.32,,,,,,,4.42,16.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,inpatient,,,36.00000,17.35000,Coventry,Workers Comp,,34.56,,,,,,,32.40,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,outpatient,,,36.00000,17.35000,Coventry,Workers Comp,,34.56,,,,,,,9.36,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,46.80,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,13.52,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,inpatient,,,18.00000,8.68000,Coventry,Workers Comp,,17.28,,,,,,,16.20,17.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,outpatient,,,18.00000,8.68000,Coventry,Workers Comp,,17.28,,,,,,,4.68,17.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,inpatient,,,74.00000,35.67000,Coventry,Workers Comp,,71.04,,,,,,,66.60,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,outpatient,,,74.00000,35.67000,Coventry,Workers Comp,,71.04,,,,,,,19.24,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,inpatient,,,118.00000,56.88000,Coventry,Workers Comp,,113.28,,,,,,,106.20,114.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,outpatient,,,118.00000,56.88000,Coventry,Workers Comp,,113.28,,,,,,,30.68,114.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,inpatient,,,82.00000,39.52000,Coventry,Workers Comp,,78.72,,,,,,,73.80,79.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,outpatient,,,82.00000,39.52000,Coventry,Workers Comp,,78.72,,,,,,,21.32,79.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,inpatient,,,30.00000,14.46000,Coventry,Workers Comp,,28.80,,,,,,,27.00,29.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,outpatient,,,30.00000,14.46000,Coventry,Workers Comp,,28.80,,,,,,,7.80,29.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,inpatient,,,70.00000,33.74000,Coventry,Workers Comp,,67.20,,,,,,,63.00,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,outpatient,,,70.00000,33.74000,Coventry,Workers Comp,,67.20,,,,,,,18.20,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,inpatient,,,54.00000,26.03000,Coventry,Workers Comp,,51.84,,,,,,,48.60,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,outpatient,,,54.00000,26.03000,Coventry,Workers Comp,,51.84,,,,,,,14.04,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,inpatient,,,51.00000,24.58000,Coventry,Workers Comp,,48.96,,,,,,,45.90,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,outpatient,,,51.00000,24.58000,Coventry,Workers Comp,,48.96,,,,,,,13.26,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,inpatient,,,141.00000,67.96000,Coventry,Workers Comp,,135.36,,,,,,,126.90,136.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,outpatient,,,141.00000,67.96000,Coventry,Workers Comp,,135.36,,,,,,,36.66,136.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,inpatient,,,81.00000,39.04000,Coventry,Workers Comp,,77.76,,,,,,,72.90,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,outpatient,,,81.00000,39.04000,Coventry,Workers Comp,,77.76,,,,,,,21.06,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,inpatient,,,335.00000,161.47000,Coventry,Workers Comp,,321.60,,,,,,,301.50,324.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,outpatient,,,335.00000,161.47000,Coventry,Workers Comp,,321.60,,,,,,,87.10,324.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,inpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,46.80,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,outpatient,,,52.00000,25.06000,Coventry,Workers Comp,,49.92,,,,,,,13.52,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,inpatient,,,54.00000,26.03000,Coventry,Workers Comp,,51.84,,,,,,,48.60,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Coventry,Workers Comp,,51.84,,,,,,,14.04,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,inpatient,,,54.00000,26.03000,Coventry,Workers Comp,,51.84,,,,,,,48.60,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Coventry,Workers Comp,,51.84,,,,,,,14.04,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,inpatient,,,53.00000,25.55000,Coventry,Workers Comp,,50.88,,,,,,,47.70,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,outpatient,,,53.00000,25.55000,Coventry,Workers Comp,,50.88,,,,,,,13.78,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,inpatient,,,53.00000,25.55000,Coventry,Workers Comp,,50.88,,,,,,,47.70,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,outpatient,,,53.00000,25.55000,Coventry,Workers Comp,,50.88,,,,,,,13.78,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,inpatient,,,12.00000,5.78000,Coventry,Workers Comp,,11.52,,,,,,,10.80,11.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,outpatient,,,12.00000,5.78000,Coventry,Workers Comp,,11.52,,,,,,,3.12,11.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,inpatient,,,710.00000,342.22000,Coventry,Workers Comp,,681.60,,,,,,,639.00,688.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,outpatient,,,710.00000,342.22000,Coventry,Workers Comp,,681.60,,,,,,,184.60,688.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,inpatient,,,104.00000,50.13000,Coventry,Workers Comp,,99.84,,,,,,,93.60,100.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,outpatient,,,104.00000,50.13000,Coventry,Workers Comp,,99.84,,,,,,,27.04,100.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,inpatient,,,155.00000,74.71000,Coventry,Workers Comp,,148.80,,,,,,,139.50,150.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,outpatient,,,155.00000,74.71000,Coventry,Workers Comp,,148.80,,,,,,,40.30,150.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,inpatient,,,139.00000,67.00000,Coventry,Workers Comp,,133.44,,,,,,,125.10,134.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,outpatient,,,139.00000,67.00000,Coventry,Workers Comp,,133.44,,,,,,,36.14,134.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,inpatient,,,89.00000,42.90000,Coventry,Workers Comp,,85.44,,,,,,,80.10,86.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,outpatient,,,89.00000,42.90000,Coventry,Workers Comp,,85.44,,,,,,,23.14,86.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,inpatient,,,88.00000,42.42000,Coventry,Workers Comp,,84.48,,,,,,,79.20,85.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,outpatient,,,88.00000,42.42000,Coventry,Workers Comp,,84.48,,,,,,,22.88,85.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,inpatient,,,111.00000,53.50000,Coventry,Workers Comp,,106.56,,,,,,,99.90,107.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,outpatient,,,111.00000,53.50000,Coventry,Workers Comp,,106.56,,,,,,,28.86,107.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,inpatient,,,70.00000,33.74000,Coventry,Workers Comp,,67.20,,,,,,,63.00,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,outpatient,,,70.00000,33.74000,Coventry,Workers Comp,,67.20,,,,,,,18.20,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,inpatient,,,85.00000,40.97000,Coventry,Workers Comp,,81.60,,,,,,,76.50,82.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,outpatient,,,85.00000,40.97000,Coventry,Workers Comp,,81.60,,,,,,,22.10,82.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,inpatient,,,110.00000,53.02000,Coventry,Workers Comp,,105.60,,,,,,,99.00,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,outpatient,,,110.00000,53.02000,Coventry,Workers Comp,,105.60,,,,,,,28.60,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,inpatient,,,500.00000,241.00000,Coventry,Workers Comp,,480.00,,,,,,,450.00,485.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,outpatient,,,500.00000,241.00000,Coventry,Workers Comp,,480.00,,,,,,,130.00,485.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,inpatient,,,140.00000,67.48000,Coventry,Workers Comp,,134.40,,,,,,,126.00,135.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,outpatient,,,140.00000,67.48000,Coventry,Workers Comp,,134.40,,,,,,,36.40,135.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,inpatient,,,74.00000,35.67000,Coventry,Workers Comp,,71.04,,,,,,,66.60,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,outpatient,,,74.00000,35.67000,Coventry,Workers Comp,,71.04,,,,,,,19.24,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,inpatient,,,77.00000,37.11000,Coventry,Workers Comp,,73.92,,,,,,,69.30,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,outpatient,,,77.00000,37.11000,Coventry,Workers Comp,,73.92,,,,,,,20.02,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,inpatient,,,93.00000,44.83000,Coventry,Workers Comp,,89.28,,,,,,,83.70,90.21,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,outpatient,,,93.00000,44.83000,Coventry,Workers Comp,,89.28,,,,,,,24.18,90.21,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,inpatient,,,15.00000,7.23000,Coventry,Workers Comp,,14.40,,,,,,,13.50,14.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,outpatient,,,15.00000,7.23000,Coventry,Workers Comp,,14.40,,,,,,,3.90,14.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,inpatient,,,24.00000,11.57000,Coventry,Workers Comp,,23.04,,,,,,,21.60,23.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,outpatient,,,24.00000,11.57000,Coventry,Workers Comp,,23.04,,,,,,,6.24,23.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,inpatient,,,72.00000,34.70000,Coventry,Workers Comp,,69.12,,,,,,,64.80,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,outpatient,,,72.00000,34.70000,Coventry,Workers Comp,,69.12,,,,,,,18.72,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,inpatient,,,16.00000,7.71000,Coventry,Workers Comp,,15.36,,,,,,,14.40,15.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Coventry,Workers Comp,,15.36,,,,,,,4.16,15.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,inpatient,,,16.00000,7.71000,Coventry,Workers Comp,,15.36,,,,,,,14.40,15.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Coventry,Workers Comp,,15.36,,,,,,,4.16,15.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,inpatient,,,64.00000,30.85000,Coventry,Workers Comp,,61.44,,,,,,,57.60,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,outpatient,,,64.00000,30.85000,Coventry,Workers Comp,,61.44,,,,,,,16.64,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,inpatient,,,82.00000,39.52000,Coventry,Workers Comp,,78.72,,,,,,,73.80,79.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,outpatient,,,82.00000,39.52000,Coventry,Workers Comp,,78.72,,,,,,,21.32,79.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,inpatient,,,157.00000,75.67000,Coventry,Workers Comp,,150.72,,,,,,,141.30,152.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,outpatient,,,157.00000,75.67000,Coventry,Workers Comp,,150.72,,,,,,,40.82,152.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,inpatient,,,70.00000,33.74000,Coventry,Workers Comp,,67.20,,,,,,,63.00,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,outpatient,,,70.00000,33.74000,Coventry,Workers Comp,,67.20,,,,,,,18.20,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,inpatient,,,229.00000,110.38000,Coventry,Workers Comp,,219.84,,,,,,,206.10,222.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,outpatient,,,229.00000,110.38000,Coventry,Workers Comp,,219.84,,,,,,,59.54,222.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,inpatient,,,64.00000,30.85000,Coventry,Workers Comp,,61.44,,,,,,,57.60,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,outpatient,,,64.00000,30.85000,Coventry,Workers Comp,,61.44,,,,,,,16.64,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,inpatient,,,72.00000,34.70000,Coventry,Workers Comp,,69.12,,,,,,,64.80,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,outpatient,,,72.00000,34.70000,Coventry,Workers Comp,,69.12,,,,,,,18.72,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,inpatient,,,17.00000,8.19000,Coventry,Workers Comp,,16.32,,,,,,,15.30,16.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,outpatient,,,17.00000,8.19000,Coventry,Workers Comp,,16.32,,,,,,,4.42,16.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,inpatient,,,64.00000,30.85000,Coventry,Workers Comp,,61.44,,,,,,,57.60,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,outpatient,,,64.00000,30.85000,Coventry,Workers Comp,,61.44,,,,,,,16.64,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,inpatient,,,387.00000,186.53000,Coventry,Workers Comp,,371.52,,,,,,,348.30,375.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,outpatient,,,387.00000,186.53000,Coventry,Workers Comp,,371.52,,,,,,,100.62,375.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,inpatient,,,387.00000,186.53000,Coventry,Workers Comp,,371.52,,,,,,,348.30,375.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Coventry,Workers Comp,,371.52,,,,,,,100.62,375.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,inpatient,,,387.00000,186.53000,Coventry,Workers Comp,,371.52,,,,,,,348.30,375.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Coventry,Workers Comp,,371.52,,,,,,,100.62,375.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,inpatient,,,77.00000,37.11000,Coventry,Workers Comp,,73.92,,,,,,,69.30,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,outpatient,,,77.00000,37.11000,Coventry,Workers Comp,,73.92,,,,,,,20.02,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,inpatient,,,78.00000,37.60000,Coventry,Workers Comp,,74.88,,,,,,,70.20,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Coventry,Workers Comp,,74.88,,,,,,,20.28,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,inpatient,,,78.00000,37.60000,Coventry,Workers Comp,,74.88,,,,,,,70.20,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Coventry,Workers Comp,,74.88,,,,,,,20.28,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,inpatient,,,43.00000,20.73000,Coventry,Workers Comp,,41.28,,,,,,,38.70,41.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,outpatient,,,43.00000,20.73000,Coventry,Workers Comp,,41.28,,,,,,,11.18,41.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,inpatient,,,64.00000,30.85000,Coventry,Workers Comp,,61.44,,,,,,,57.60,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,outpatient,,,64.00000,30.85000,Coventry,Workers Comp,,61.44,,,,,,,16.64,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,inpatient,,,160.00000,77.12000,Coventry,Workers Comp,,153.60,,,,,,,144.00,155.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,outpatient,,,160.00000,77.12000,Coventry,Workers Comp,,153.60,,,,,,,41.60,155.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,inpatient,,,112.00000,53.98000,Coventry,Workers Comp,,107.52,,,,,,,100.80,108.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,outpatient,,,112.00000,53.98000,Coventry,Workers Comp,,107.52,,,,,,,29.12,108.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,inpatient,,,82.00000,39.52000,Coventry,Workers Comp,,78.72,,,,,,,73.80,79.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,outpatient,,,82.00000,39.52000,Coventry,Workers Comp,,78.72,,,,,,,21.32,79.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,inpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,outpatient,,,55.00000,26.51000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,inpatient,,,54.00000,26.03000,Coventry,Workers Comp,,51.84,,,,,,,48.60,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,outpatient,,,54.00000,26.03000,Coventry,Workers Comp,,51.84,,,,,,,14.04,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,inpatient,,,153.00000,73.75000,Coventry,Workers Comp,,146.88,,,,,,,137.70,148.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,outpatient,,,153.00000,73.75000,Coventry,Workers Comp,,146.88,,,,,,,39.78,148.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,inpatient,,,45.00000,21.69000,Coventry,Workers Comp,,43.20,,,,,,,40.50,43.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,outpatient,,,45.00000,21.69000,Coventry,Workers Comp,,43.20,,,,,,,11.70,43.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,inpatient,,,28.00000,13.50000,Coventry,Workers Comp,,26.88,,,,,,,25.20,27.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,outpatient,,,28.00000,13.50000,Coventry,Workers Comp,,26.88,,,,,,,7.28,27.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Coventry,Workers Comp,,47.04,,,,,,,44.10,47.53,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Coventry,Workers Comp,,47.04,,,,,,,12.74,47.53,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Coventry,Workers Comp,,47.04,,,,,,,44.10,47.53,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Coventry,Workers Comp,,47.04,,,,,,,12.74,47.53,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Coventry,Workers Comp,,47.04,,,,,,,44.10,47.53,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Coventry,Workers Comp,,47.04,,,,,,,12.74,47.53,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,inpatient,,,36.00000,17.35000,Coventry,Workers Comp,,34.56,,,,,,,32.40,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,outpatient,,,36.00000,17.35000,Coventry,Workers Comp,,34.56,,,,,,,9.36,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,inpatient,,,38.00000,18.32000,Coventry,Workers Comp,,36.48,,,,,,,34.20,36.86,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,outpatient,,,38.00000,18.32000,Coventry,Workers Comp,,36.48,,,,,,,9.88,36.86,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,inpatient,,,38.00000,18.32000,Coventry,Workers Comp,,36.48,,,,,,,34.20,36.86,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,outpatient,,,38.00000,18.32000,Coventry,Workers Comp,,36.48,,,,,,,9.88,36.86,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,inpatient,,,76.00000,36.63000,Coventry,Workers Comp,,72.96,,,,,,,68.40,73.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,outpatient,,,76.00000,36.63000,Coventry,Workers Comp,,72.96,,,,,,,19.76,73.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,inpatient,,,173.00000,83.39000,Coventry,Workers Comp,,166.08,,,,,,,155.70,167.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,outpatient,,,173.00000,83.39000,Coventry,Workers Comp,,166.08,,,,,,,44.98,167.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,inpatient,,,22.00000,10.60000,Coventry,Workers Comp,,21.12,,,,,,,19.80,21.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,outpatient,,,22.00000,10.60000,Coventry,Workers Comp,,21.12,,,,,,,5.72,21.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,inpatient,,,39.00000,18.80000,Coventry,Workers Comp,,37.44,,,,,,,35.10,37.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,outpatient,,,39.00000,18.80000,Coventry,Workers Comp,,37.44,,,,,,,10.14,37.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,inpatient,,,41.00000,19.76000,Coventry,Workers Comp,,39.36,,,,,,,36.90,39.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,outpatient,,,41.00000,19.76000,Coventry,Workers Comp,,39.36,,,,,,,10.66,39.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,inpatient,,,54.00000,26.03000,Coventry,Workers Comp,,51.84,,,,,,,48.60,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,outpatient,,,54.00000,26.03000,Coventry,Workers Comp,,51.84,,,,,,,14.04,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,inpatient,,,71.00000,34.22000,Coventry,Workers Comp,,68.16,,,,,,,63.90,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,outpatient,,,71.00000,34.22000,Coventry,Workers Comp,,68.16,,,,,,,18.46,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,inpatient,,,43.00000,20.73000,Coventry,Workers Comp,,41.28,,,,,,,38.70,41.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Coventry,Workers Comp,,41.28,,,,,,,11.18,41.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,inpatient,,,43.00000,20.73000,Coventry,Workers Comp,,41.28,,,,,,,38.70,41.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Coventry,Workers Comp,,41.28,,,,,,,11.18,41.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,inpatient,,,38.00000,18.32000,Coventry,Workers Comp,,36.48,,,,,,,34.20,36.86,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,outpatient,,,38.00000,18.32000,Coventry,Workers Comp,,36.48,,,,,,,9.88,36.86,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,inpatient,,,72.00000,34.70000,Coventry,Workers Comp,,69.12,,,,,,,64.80,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,outpatient,,,72.00000,34.70000,Coventry,Workers Comp,,69.12,,,,,,,18.72,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,inpatient,,,226.00000,108.93000,Coventry,Workers Comp,,216.96,,,,,,,203.40,219.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,outpatient,,,226.00000,108.93000,Coventry,Workers Comp,,216.96,,,,,,,58.76,219.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Coventry,Workers Comp,,39.36,,,,,,,36.90,39.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Coventry,Workers Comp,,39.36,,,,,,,10.66,39.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Coventry,Workers Comp,,39.36,,,,,,,36.90,39.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Coventry,Workers Comp,,39.36,,,,,,,10.66,39.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Coventry,Workers Comp,,39.36,,,,,,,36.90,39.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Coventry,Workers Comp,,39.36,,,,,,,10.66,39.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,inpatient,,,160.00000,77.12000,Coventry,Workers Comp,,153.60,,,,,,,144.00,155.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,outpatient,,,160.00000,77.12000,Coventry,Workers Comp,,153.60,,,,,,,41.60,155.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,inpatient,,,102.00000,49.16000,Coventry,Workers Comp,,97.92,,,,,,,91.80,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,outpatient,,,102.00000,49.16000,Coventry,Workers Comp,,97.92,,,,,,,26.52,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,inpatient,,,317.00000,152.79000,Coventry,Workers Comp,,304.32,,,,,,,285.30,307.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,outpatient,,,317.00000,152.79000,Coventry,Workers Comp,,304.32,,,,,,,82.42,307.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,inpatient,,,116.00000,55.91000,Coventry,Workers Comp,,111.36,,,,,,,104.40,112.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,outpatient,,,116.00000,55.91000,Coventry,Workers Comp,,111.36,,,,,,,30.16,112.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,inpatient,,,89.00000,42.90000,Coventry,Workers Comp,,85.44,,,,,,,80.10,86.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Coventry,Workers Comp,,85.44,,,,,,,23.14,86.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,inpatient,,,89.00000,42.90000,Coventry,Workers Comp,,85.44,,,,,,,80.10,86.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Coventry,Workers Comp,,85.44,,,,,,,23.14,86.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,inpatient,,,85.00000,40.97000,Coventry,Workers Comp,,81.60,,,,,,,76.50,82.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,outpatient,,,85.00000,40.97000,Coventry,Workers Comp,,81.60,,,,,,,22.10,82.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,inpatient,,,184.00000,88.69000,Coventry,Workers Comp,,176.64,,,,,,,165.60,178.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,outpatient,,,184.00000,88.69000,Coventry,Workers Comp,,176.64,,,,,,,47.84,178.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,inpatient,,,127.00000,61.21000,Coventry,Workers Comp,,121.92,,,,,,,114.30,123.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,outpatient,,,127.00000,61.21000,Coventry,Workers Comp,,121.92,,,,,,,33.02,123.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,inpatient,,,61.00000,29.40000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,outpatient,,,61.00000,29.40000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,inpatient,,,35.00000,16.87000,Coventry,Workers Comp,,33.60,,,,,,,31.50,33.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,outpatient,,,35.00000,16.87000,Coventry,Workers Comp,,33.60,,,,,,,9.10,33.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,inpatient,,,79.00000,38.08000,Coventry,Workers Comp,,75.84,,,,,,,71.10,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,outpatient,,,79.00000,38.08000,Coventry,Workers Comp,,75.84,,,,,,,20.54,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,inpatient,,,57.00000,32.83000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,outpatient,,,57.00000,32.83000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Coventry,Workers Comp,,146.88,,,,,,,137.70,148.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Coventry,Workers Comp,,146.88,,,,,,,39.78,148.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,inpatient,,,77.00000,44.35000,Coventry,Workers Comp,,73.92,,,,,,,69.30,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,outpatient,,,77.00000,44.35000,Coventry,Workers Comp,,73.92,,,,,,,20.02,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,inpatient,,,70.00000,40.32000,Coventry,Workers Comp,,67.20,,,,,,,63.00,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,outpatient,,,70.00000,40.32000,Coventry,Workers Comp,,67.20,,,,,,,18.20,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,inpatient,,,67.00000,38.59000,Coventry,Workers Comp,,64.32,,,,,,,60.30,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,outpatient,,,67.00000,38.59000,Coventry,Workers Comp,,64.32,,,,,,,17.42,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,inpatient,,,40.00000,23.04000,Coventry,Workers Comp,,38.40,,,,,,,36.00,38.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,outpatient,,,40.00000,23.04000,Coventry,Workers Comp,,38.40,,,,,,,10.40,38.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,inpatient,,,71.00000,40.90000,Coventry,Workers Comp,,68.16,,,,,,,63.90,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,outpatient,,,71.00000,40.90000,Coventry,Workers Comp,,68.16,,,,,,,18.46,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,inpatient,,,80.00000,46.08000,Coventry,Workers Comp,,76.80,,,,,,,72.00,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,outpatient,,,80.00000,46.08000,Coventry,Workers Comp,,76.80,,,,,,,20.80,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,inpatient,,,72.00000,41.47000,Coventry,Workers Comp,,69.12,,,,,,,64.80,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,outpatient,,,72.00000,41.47000,Coventry,Workers Comp,,69.12,,,,,,,18.72,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,inpatient,,,444.00000,255.74000,Coventry,Workers Comp,,426.24,,,,,,,399.60,430.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,outpatient,,,444.00000,255.74000,Coventry,Workers Comp,,426.24,,,,,,,115.44,430.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,inpatient,,,81.00000,46.66000,Coventry,Workers Comp,,77.76,,,,,,,72.90,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,outpatient,,,81.00000,46.66000,Coventry,Workers Comp,,77.76,,,,,,,21.06,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,inpatient,,,66.00000,38.02000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,outpatient,,,66.00000,38.02000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,inpatient,,,57.00000,32.83000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,outpatient,,,57.00000,32.83000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,inpatient,,,53.00000,30.53000,Coventry,Workers Comp,,50.88,,,,,,,47.70,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,outpatient,,,53.00000,30.53000,Coventry,Workers Comp,,50.88,,,,,,,13.78,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,inpatient,,,60.00000,34.56000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,outpatient,,,60.00000,34.56000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,inpatient,,,40.00000,23.04000,Coventry,Workers Comp,,38.40,,,,,,,36.00,38.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,outpatient,,,40.00000,23.04000,Coventry,Workers Comp,,38.40,,,,,,,10.40,38.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,inpatient,,,42.00000,24.19000,Coventry,Workers Comp,,40.32,,,,,,,37.80,40.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,outpatient,,,42.00000,24.19000,Coventry,Workers Comp,,40.32,,,,,,,10.92,40.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,inpatient,,,46.00000,26.50000,Coventry,Workers Comp,,44.16,,,,,,,41.40,44.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,outpatient,,,46.00000,26.50000,Coventry,Workers Comp,,44.16,,,,,,,11.96,44.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,inpatient,,,54.00000,31.10000,Coventry,Workers Comp,,51.84,,,,,,,48.60,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,outpatient,,,54.00000,31.10000,Coventry,Workers Comp,,51.84,,,,,,,14.04,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,inpatient,,,71.00000,40.90000,Coventry,Workers Comp,,68.16,,,,,,,63.90,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,outpatient,,,71.00000,40.90000,Coventry,Workers Comp,,68.16,,,,,,,18.46,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,inpatient,,,54.00000,31.10000,Coventry,Workers Comp,,51.84,,,,,,,48.60,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,outpatient,,,54.00000,31.10000,Coventry,Workers Comp,,51.84,,,,,,,14.04,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,inpatient,,,80.00000,46.08000,Coventry,Workers Comp,,76.80,,,,,,,72.00,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,outpatient,,,80.00000,46.08000,Coventry,Workers Comp,,76.80,,,,,,,20.80,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,inpatient,,,60.00000,34.56000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,outpatient,,,60.00000,34.56000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,inpatient,,,124.00000,71.42000,Coventry,Workers Comp,,119.04,,,,,,,111.60,120.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Coventry,Workers Comp,,119.04,,,,,,,32.24,120.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,inpatient,,,130.00000,74.88000,Coventry,Workers Comp,,124.80,,,,,,,117.00,126.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,outpatient,,,130.00000,74.88000,Coventry,Workers Comp,,124.80,,,,,,,33.80,126.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,inpatient,,,123.00000,70.85000,Coventry,Workers Comp,,118.08,,,,,,,110.70,119.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Coventry,Workers Comp,,118.08,,,,,,,31.98,119.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,inpatient,,,77.00000,44.35000,Coventry,Workers Comp,,73.92,,,,,,,69.30,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,outpatient,,,77.00000,44.35000,Coventry,Workers Comp,,73.92,,,,,,,20.02,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,inpatient,,,115.00000,66.24000,Coventry,Workers Comp,,110.40,,,,,,,103.50,111.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,outpatient,,,115.00000,66.24000,Coventry,Workers Comp,,110.40,,,,,,,29.90,111.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,inpatient,,,123.00000,70.85000,Coventry,Workers Comp,,118.08,,,,,,,110.70,119.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Coventry,Workers Comp,,118.08,,,,,,,31.98,119.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,inpatient,,,161.00000,92.74000,Coventry,Workers Comp,,154.56,,,,,,,144.90,156.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,outpatient,,,161.00000,92.74000,Coventry,Workers Comp,,154.56,,,,,,,41.86,156.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,inpatient,,,124.00000,71.42000,Coventry,Workers Comp,,119.04,,,,,,,111.60,120.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Coventry,Workers Comp,,119.04,,,,,,,32.24,120.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,inpatient,,,102.00000,58.75000,Coventry,Workers Comp,,97.92,,,,,,,91.80,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,outpatient,,,102.00000,58.75000,Coventry,Workers Comp,,97.92,,,,,,,26.52,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,inpatient,,,219.00000,126.14000,Coventry,Workers Comp,,210.24,,,,,,,197.10,212.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,outpatient,,,219.00000,126.14000,Coventry,Workers Comp,,210.24,,,,,,,56.94,212.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,inpatient,,,194.00000,111.74000,Coventry,Workers Comp,,186.24,,,,,,,174.60,188.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Coventry,Workers Comp,,186.24,,,,,,,50.44,188.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,inpatient,,,103.00000,59.33000,Coventry,Workers Comp,,98.88,,,,,,,92.70,99.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,outpatient,,,103.00000,59.33000,Coventry,Workers Comp,,98.88,,,,,,,26.78,99.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,inpatient,,,60.00000,34.56000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,outpatient,,,60.00000,34.56000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,inpatient,,,837.00000,482.11000,Coventry,Workers Comp,,803.52,,,,,,,753.30,811.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,outpatient,,,837.00000,482.11000,Coventry,Workers Comp,,803.52,,,,,,,217.62,811.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,inpatient,,,194.00000,111.74000,Coventry,Workers Comp,,186.24,,,,,,,174.60,188.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Coventry,Workers Comp,,186.24,,,,,,,50.44,188.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,inpatient,,,78.00000,44.93000,Coventry,Workers Comp,,74.88,,,,,,,70.20,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,outpatient,,,78.00000,44.93000,Coventry,Workers Comp,,74.88,,,,,,,20.28,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,inpatient,,,285.00000,164.16000,Coventry,Workers Comp,,273.60,,,,,,,256.50,276.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,outpatient,,,285.00000,164.16000,Coventry,Workers Comp,,273.60,,,,,,,74.10,276.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,inpatient,,,190.00000,109.44000,Coventry,Workers Comp,,182.40,,,,,,,171.00,184.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,outpatient,,,190.00000,109.44000,Coventry,Workers Comp,,182.40,,,,,,,49.40,184.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,inpatient,,,100.00000,57.60000,Coventry,Workers Comp,,96.00,,,,,,,90.00,97.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,outpatient,,,100.00000,57.60000,Coventry,Workers Comp,,96.00,,,,,,,26.00,97.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,inpatient,,,40.00000,23.04000,Coventry,Workers Comp,,38.40,,,,,,,36.00,38.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Coventry,Workers Comp,,38.40,,,,,,,10.40,38.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,inpatient,,,67.00000,38.59000,Coventry,Workers Comp,,64.32,,,,,,,60.30,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,outpatient,,,67.00000,38.59000,Coventry,Workers Comp,,64.32,,,,,,,17.42,64.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,inpatient,,,78.00000,44.93000,Coventry,Workers Comp,,74.88,,,,,,,70.20,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,outpatient,,,78.00000,44.93000,Coventry,Workers Comp,,74.88,,,,,,,20.28,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,inpatient,,,57.00000,32.83000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,outpatient,,,57.00000,32.83000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,inpatient,,,72.00000,41.47000,Coventry,Workers Comp,,69.12,,,,,,,64.80,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,outpatient,,,72.00000,41.47000,Coventry,Workers Comp,,69.12,,,,,,,18.72,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,inpatient,,,59.00000,33.98000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,outpatient,,,59.00000,33.98000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,inpatient,,,72.00000,41.47000,Coventry,Workers Comp,,69.12,,,,,,,64.80,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,outpatient,,,72.00000,41.47000,Coventry,Workers Comp,,69.12,,,,,,,18.72,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,inpatient,,,239.00000,137.66000,Coventry,Workers Comp,,229.44,,,,,,,215.10,231.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,outpatient,,,239.00000,137.66000,Coventry,Workers Comp,,229.44,,,,,,,62.14,231.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,inpatient,,,85.00000,48.96000,Coventry,Workers Comp,,81.60,,,,,,,76.50,82.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,outpatient,,,85.00000,48.96000,Coventry,Workers Comp,,81.60,,,,,,,22.10,82.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,inpatient,,,44.00000,25.34000,Coventry,Workers Comp,,42.24,,,,,,,39.60,42.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,outpatient,,,44.00000,25.34000,Coventry,Workers Comp,,42.24,,,,,,,11.44,42.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,inpatient,,,40.00000,23.04000,Coventry,Workers Comp,,38.40,,,,,,,36.00,38.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,outpatient,,,40.00000,23.04000,Coventry,Workers Comp,,38.40,,,,,,,10.40,38.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,inpatient,,,53.00000,30.53000,Coventry,Workers Comp,,50.88,,,,,,,47.70,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,outpatient,,,53.00000,30.53000,Coventry,Workers Comp,,50.88,,,,,,,13.78,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,inpatient,,,59.00000,33.98000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,inpatient,,,59.00000,33.98000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,inpatient,,,68.00000,39.17000,Coventry,Workers Comp,,65.28,,,,,,,61.20,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,outpatient,,,68.00000,39.17000,Coventry,Workers Comp,,65.28,,,,,,,17.68,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,inpatient,,,76.00000,43.78000,Coventry,Workers Comp,,72.96,,,,,,,68.40,73.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,outpatient,,,76.00000,43.78000,Coventry,Workers Comp,,72.96,,,,,,,19.76,73.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,inpatient,,,42.00000,24.19000,Coventry,Workers Comp,,40.32,,,,,,,37.80,40.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,outpatient,,,42.00000,24.19000,Coventry,Workers Comp,,40.32,,,,,,,10.92,40.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,inpatient,,,87.00000,50.11000,Coventry,Workers Comp,,83.52,,,,,,,78.30,84.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,outpatient,,,87.00000,50.11000,Coventry,Workers Comp,,83.52,,,,,,,22.62,84.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,inpatient,,,503.00000,289.73000,Coventry,Workers Comp,,482.88,,,,,,,452.70,487.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,outpatient,,,503.00000,289.73000,Coventry,Workers Comp,,482.88,,,,,,,130.78,487.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,inpatient,,,472.00000,271.87000,Coventry,Workers Comp,,453.12,,,,,,,424.80,457.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,outpatient,,,472.00000,271.87000,Coventry,Workers Comp,,453.12,,,,,,,122.72,457.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,inpatient,,,28.00000,16.13000,Coventry,Workers Comp,,26.88,,,,,,,25.20,27.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,outpatient,,,28.00000,16.13000,Coventry,Workers Comp,,26.88,,,,,,,7.28,27.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,inpatient,,,236.00000,135.94000,Coventry,Workers Comp,,226.56,,,,,,,212.40,228.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,outpatient,,,236.00000,135.94000,Coventry,Workers Comp,,226.56,,,,,,,61.36,228.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,inpatient,,,54.00000,31.10000,Coventry,Workers Comp,,51.84,,,,,,,48.60,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,outpatient,,,54.00000,31.10000,Coventry,Workers Comp,,51.84,,,,,,,14.04,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,inpatient,,,238.00000,137.09000,Coventry,Workers Comp,,228.48,,,,,,,214.20,230.86,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,outpatient,,,238.00000,137.09000,Coventry,Workers Comp,,228.48,,,,,,,61.88,230.86,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,inpatient,,,236.00000,135.94000,Coventry,Workers Comp,,226.56,,,,,,,212.40,228.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,outpatient,,,236.00000,135.94000,Coventry,Workers Comp,,226.56,,,,,,,61.36,228.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,inpatient,,,145.00000,83.52000,Coventry,Workers Comp,,139.20,,,,,,,130.50,140.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,outpatient,,,145.00000,83.52000,Coventry,Workers Comp,,139.20,,,,,,,37.70,140.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,inpatient,,,68.00000,39.17000,Coventry,Workers Comp,,65.28,,,,,,,61.20,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Coventry,Workers Comp,,65.28,,,,,,,17.68,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,inpatient,,,68.00000,39.17000,Coventry,Workers Comp,,65.28,,,,,,,61.20,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Coventry,Workers Comp,,65.28,,,,,,,17.68,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,inpatient,,,66.00000,38.02000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,outpatient,,,66.00000,38.02000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,inpatient,,,59.00000,33.98000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,outpatient,,,59.00000,33.98000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,inpatient,,,158.00000,91.01000,Coventry,Workers Comp,,151.68,,,,,,,142.20,153.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,outpatient,,,158.00000,91.01000,Coventry,Workers Comp,,151.68,,,,,,,41.08,153.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,inpatient,,,71.00000,40.90000,Coventry,Workers Comp,,68.16,,,,,,,63.90,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,outpatient,,,71.00000,40.90000,Coventry,Workers Comp,,68.16,,,,,,,18.46,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,inpatient,,,144.00000,82.94000,Coventry,Workers Comp,,138.24,,,,,,,129.60,139.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,outpatient,,,144.00000,82.94000,Coventry,Workers Comp,,138.24,,,,,,,37.44,139.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,inpatient,,,1448.00000,834.05000,Coventry,Workers Comp,,1390.08,,,,,,,1303.20,1404.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,outpatient,,,1448.00000,834.05000,Coventry,Workers Comp,,1390.08,,,,,,,376.48,1404.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,inpatient,,,72.00000,41.47000,Coventry,Workers Comp,,69.12,,,,,,,64.80,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,outpatient,,,72.00000,41.47000,Coventry,Workers Comp,,69.12,,,,,,,18.72,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,inpatient,,,102.00000,58.75000,Coventry,Workers Comp,,97.92,,,,,,,91.80,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,outpatient,,,102.00000,58.75000,Coventry,Workers Comp,,97.92,,,,,,,26.52,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,inpatient,,,154.00000,88.70000,Coventry,Workers Comp,,147.84,,,,,,,138.60,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,outpatient,,,154.00000,88.70000,Coventry,Workers Comp,,147.84,,,,,,,40.04,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Coventry,Workers Comp,,146.88,,,,,,,137.70,148.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Coventry,Workers Comp,,146.88,,,,,,,39.78,148.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,inpatient,,,66.00000,38.02000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,outpatient,,,66.00000,38.02000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Coventry,Workers Comp,,146.88,,,,,,,137.70,148.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Coventry,Workers Comp,,146.88,,,,,,,39.78,148.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,inpatient,,,44.00000,25.34000,Coventry,Workers Comp,,42.24,,,,,,,39.60,42.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,outpatient,,,44.00000,25.34000,Coventry,Workers Comp,,42.24,,,,,,,11.44,42.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,inpatient,,,150.00000,86.40000,Coventry,Workers Comp,,144.00,,,,,,,135.00,145.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,outpatient,,,150.00000,86.40000,Coventry,Workers Comp,,144.00,,,,,,,39.00,145.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,inpatient,,,56.00000,32.26000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,outpatient,,,56.00000,32.26000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,inpatient,,,66.00000,38.02000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,outpatient,,,66.00000,38.02000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,inpatient,,,60.00000,34.56000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,outpatient,,,60.00000,34.56000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,inpatient,,,58.00000,33.41000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,outpatient,,,58.00000,33.41000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,inpatient,,,71.00000,40.90000,Coventry,Workers Comp,,68.16,,,,,,,63.90,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,outpatient,,,71.00000,40.90000,Coventry,Workers Comp,,68.16,,,,,,,18.46,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,inpatient,,,72.00000,41.47000,Coventry,Workers Comp,,69.12,,,,,,,64.80,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,outpatient,,,72.00000,41.47000,Coventry,Workers Comp,,69.12,,,,,,,18.72,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,inpatient,,,56.00000,32.26000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,inpatient,,,56.00000,32.26000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,inpatient,,,60.00000,34.56000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,outpatient,,,60.00000,34.56000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,inpatient,,,56.00000,32.26000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,outpatient,,,56.00000,32.26000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,inpatient,,,39.00000,22.46000,Coventry,Workers Comp,,37.44,,,,,,,35.10,37.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,outpatient,,,39.00000,22.46000,Coventry,Workers Comp,,37.44,,,,,,,10.14,37.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Coventry,Workers Comp,,146.88,,,,,,,137.70,148.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Coventry,Workers Comp,,146.88,,,,,,,39.78,148.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,inpatient,,,73.00000,42.05000,Coventry,Workers Comp,,70.08,,,,,,,65.70,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,outpatient,,,73.00000,42.05000,Coventry,Workers Comp,,70.08,,,,,,,18.98,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,inpatient,,,127.00000,73.15000,Coventry,Workers Comp,,121.92,,,,,,,114.30,123.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Coventry,Workers Comp,,121.92,,,,,,,33.02,123.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,inpatient,,,127.00000,73.15000,Coventry,Workers Comp,,121.92,,,,,,,114.30,123.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Coventry,Workers Comp,,121.92,,,,,,,33.02,123.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,inpatient,,,372.00000,214.27000,Coventry,Workers Comp,,357.12,,,,,,,334.80,360.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,outpatient,,,372.00000,214.27000,Coventry,Workers Comp,,357.12,,,,,,,96.72,360.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,inpatient,,,69.00000,39.74000,Coventry,Workers Comp,,66.24,,,,,,,62.10,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,outpatient,,,69.00000,39.74000,Coventry,Workers Comp,,66.24,,,,,,,17.94,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Coventry,Workers Comp,,146.88,,,,,,,137.70,148.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Coventry,Workers Comp,,146.88,,,,,,,39.78,148.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Coventry,Workers Comp,,146.88,,,,,,,137.70,148.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Coventry,Workers Comp,,146.88,,,,,,,39.78,148.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,inpatient,,,57.00000,32.83000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,outpatient,,,57.00000,32.83000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,inpatient,,,96.00000,55.30000,Coventry,Workers Comp,,92.16,,,,,,,86.40,93.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,outpatient,,,96.00000,55.30000,Coventry,Workers Comp,,92.16,,,,,,,24.96,93.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,inpatient,,,44.00000,25.34000,Coventry,Workers Comp,,42.24,,,,,,,39.60,42.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,outpatient,,,44.00000,25.34000,Coventry,Workers Comp,,42.24,,,,,,,11.44,42.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,inpatient,,,60.00000,34.56000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,outpatient,,,60.00000,34.56000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,inpatient,,,60.00000,34.56000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,outpatient,,,60.00000,34.56000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,inpatient,,,74.00000,42.62000,Coventry,Workers Comp,,71.04,,,,,,,66.60,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,outpatient,,,74.00000,42.62000,Coventry,Workers Comp,,71.04,,,,,,,19.24,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,inpatient,,,69.00000,39.74000,Coventry,Workers Comp,,66.24,,,,,,,62.10,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,outpatient,,,69.00000,39.74000,Coventry,Workers Comp,,66.24,,,,,,,17.94,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Coventry,Workers Comp,,37.44,,,,,,,35.10,37.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Coventry,Workers Comp,,37.44,,,,,,,10.14,37.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,inpatient,,,53.00000,30.53000,Coventry,Workers Comp,,50.88,,,,,,,47.70,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,outpatient,,,53.00000,30.53000,Coventry,Workers Comp,,50.88,,,,,,,13.78,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Coventry,Workers Comp,,37.44,,,,,,,35.10,37.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Coventry,Workers Comp,,37.44,,,,,,,10.14,37.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Coventry,Workers Comp,,37.44,,,,,,,35.10,37.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Coventry,Workers Comp,,37.44,,,,,,,10.14,37.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,inpatient,,,70.00000,40.32000,Coventry,Workers Comp,,67.20,,,,,,,63.00,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,outpatient,,,70.00000,40.32000,Coventry,Workers Comp,,67.20,,,,,,,18.20,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,inpatient,,,71.00000,40.90000,Coventry,Workers Comp,,68.16,,,,,,,63.90,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,outpatient,,,71.00000,40.90000,Coventry,Workers Comp,,68.16,,,,,,,18.46,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,inpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,outpatient,,,65.00000,37.44000,Coventry,Workers Comp,,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,inpatient,,,325.00000,187.20000,Coventry,Workers Comp,,312.00,,,,,,,292.50,315.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,outpatient,,,325.00000,187.20000,Coventry,Workers Comp,,312.00,,,,,,,84.50,315.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,inpatient,,,72.00000,41.47000,Coventry,Workers Comp,,69.12,,,,,,,64.80,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,outpatient,,,72.00000,41.47000,Coventry,Workers Comp,,69.12,,,,,,,18.72,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,inpatient,,,72.00000,41.47000,Coventry,Workers Comp,,69.12,,,,,,,64.80,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,outpatient,,,72.00000,41.47000,Coventry,Workers Comp,,69.12,,,,,,,18.72,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,inpatient,,,76.00000,43.78000,Coventry,Workers Comp,,72.96,,,,,,,68.40,73.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,outpatient,,,76.00000,43.78000,Coventry,Workers Comp,,72.96,,,,,,,19.76,73.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,inpatient,,,240.00000,138.24000,Coventry,Workers Comp,,230.40,,,,,,,216.00,232.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,outpatient,,,240.00000,138.24000,Coventry,Workers Comp,,230.40,,,,,,,62.40,232.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,inpatient,,,93.00000,53.57000,Coventry,Workers Comp,,89.28,,,,,,,83.70,90.21,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,outpatient,,,93.00000,53.57000,Coventry,Workers Comp,,89.28,,,,,,,24.18,90.21,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,inpatient,,,59.00000,33.98000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,outpatient,,,59.00000,33.98000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,inpatient,,,81.00000,46.66000,Coventry,Workers Comp,,77.76,,,,,,,72.90,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,outpatient,,,81.00000,46.66000,Coventry,Workers Comp,,77.76,,,,,,,21.06,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,inpatient,,,58.00000,33.41000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,outpatient,,,58.00000,33.41000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,inpatient,,,21.00000,12.10000,Coventry,Workers Comp,,20.16,,,,,,,18.90,20.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,outpatient,,,21.00000,12.10000,Coventry,Workers Comp,,20.16,,,,,,,5.46,20.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,inpatient,,,56.00000,32.26000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,outpatient,,,56.00000,32.26000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,inpatient,,,64.00000,36.86000,Coventry,Workers Comp,,61.44,,,,,,,57.60,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,outpatient,,,64.00000,36.86000,Coventry,Workers Comp,,61.44,,,,,,,16.64,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,inpatient,,,80.00000,46.08000,Coventry,Workers Comp,,76.80,,,,,,,72.00,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,outpatient,,,80.00000,46.08000,Coventry,Workers Comp,,76.80,,,,,,,20.80,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,inpatient,,,109.00000,62.78000,Coventry,Workers Comp,,104.64,,,,,,,98.10,105.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,outpatient,,,109.00000,62.78000,Coventry,Workers Comp,,104.64,,,,,,,28.34,105.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,inpatient,,,59.00000,33.98000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,outpatient,,,59.00000,33.98000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,inpatient,,,115.00000,66.24000,Coventry,Workers Comp,,110.40,,,,,,,103.50,111.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,outpatient,,,115.00000,66.24000,Coventry,Workers Comp,,110.40,,,,,,,29.90,111.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,inpatient,,,57.00000,32.83000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,outpatient,,,57.00000,32.83000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,inpatient,,,118.00000,67.97000,Coventry,Workers Comp,,113.28,,,,,,,106.20,114.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,outpatient,,,118.00000,67.97000,Coventry,Workers Comp,,113.28,,,,,,,30.68,114.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,inpatient,,,268.00000,154.37000,Coventry,Workers Comp,,257.28,,,,,,,241.20,259.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,outpatient,,,268.00000,154.37000,Coventry,Workers Comp,,257.28,,,,,,,69.68,259.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,inpatient,,,114.00000,65.66000,Coventry,Workers Comp,,109.44,,,,,,,102.60,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Coventry,Workers Comp,,109.44,,,,,,,29.64,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,inpatient,,,114.00000,65.66000,Coventry,Workers Comp,,109.44,,,,,,,102.60,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Coventry,Workers Comp,,109.44,,,,,,,29.64,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,inpatient,,,78.00000,44.93000,Coventry,Workers Comp,,74.88,,,,,,,70.20,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,outpatient,,,78.00000,44.93000,Coventry,Workers Comp,,74.88,,,,,,,20.28,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,inpatient,,,91.00000,52.42000,Coventry,Workers Comp,,87.36,,,,,,,81.90,88.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,outpatient,,,91.00000,52.42000,Coventry,Workers Comp,,87.36,,,,,,,23.66,88.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,inpatient,,,66.00000,38.02000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,inpatient,,,66.00000,38.02000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,inpatient,,,300.00000,172.80000,Coventry,Workers Comp,,288.00,,,,,,,270.00,291.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,outpatient,,,300.00000,172.80000,Coventry,Workers Comp,,288.00,,,,,,,78.00,291.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,inpatient,,,185.00000,106.56000,Coventry,Workers Comp,,177.60,,,,,,,166.50,179.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,outpatient,,,185.00000,106.56000,Coventry,Workers Comp,,177.60,,,,,,,48.10,179.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Coventry,Workers Comp,,34.56,,,,,,,32.40,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Coventry,Workers Comp,,34.56,,,,,,,9.36,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,inpatient,,,76.00000,43.78000,Coventry,Workers Comp,,72.96,,,,,,,68.40,73.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,outpatient,,,76.00000,43.78000,Coventry,Workers Comp,,72.96,,,,,,,19.76,73.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Coventry,Workers Comp,,34.56,,,,,,,32.40,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Coventry,Workers Comp,,34.56,,,,,,,9.36,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Coventry,Workers Comp,,34.56,,,,,,,32.40,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Coventry,Workers Comp,,34.56,,,,,,,9.36,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,inpatient,,,53.00000,30.53000,Coventry,Workers Comp,,50.88,,,,,,,47.70,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,outpatient,,,53.00000,30.53000,Coventry,Workers Comp,,50.88,,,,,,,13.78,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,inpatient,,,77.00000,44.35000,Coventry,Workers Comp,,73.92,,,,,,,69.30,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,outpatient,,,77.00000,44.35000,Coventry,Workers Comp,,73.92,,,,,,,20.02,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Coventry,Workers Comp,,34.56,,,,,,,32.40,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Coventry,Workers Comp,,34.56,,,,,,,9.36,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,inpatient,,,222.00000,127.87000,Coventry,Workers Comp,,213.12,,,,,,,199.80,215.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,outpatient,,,222.00000,127.87000,Coventry,Workers Comp,,213.12,,,,,,,57.72,215.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,inpatient,,,292.00000,168.19000,Coventry,Workers Comp,,280.32,,,,,,,262.80,283.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,outpatient,,,292.00000,168.19000,Coventry,Workers Comp,,280.32,,,,,,,75.92,283.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,inpatient,,,125.00000,72.00000,Coventry,Workers Comp,,120.00,,,,,,,112.50,121.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Coventry,Workers Comp,,120.00,,,,,,,32.50,121.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,inpatient,,,125.00000,72.00000,Coventry,Workers Comp,,120.00,,,,,,,112.50,121.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Coventry,Workers Comp,,120.00,,,,,,,32.50,121.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,inpatient,,,359.00000,206.78000,Coventry,Workers Comp,,344.64,,,,,,,323.10,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,outpatient,,,359.00000,206.78000,Coventry,Workers Comp,,344.64,,,,,,,93.34,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,inpatient,,,111.00000,63.94000,Coventry,Workers Comp,,106.56,,,,,,,99.90,107.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,outpatient,,,111.00000,63.94000,Coventry,Workers Comp,,106.56,,,,,,,28.86,107.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,inpatient,,,141.00000,81.22000,Coventry,Workers Comp,,135.36,,,,,,,126.90,136.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Coventry,Workers Comp,,135.36,,,,,,,36.66,136.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,inpatient,,,141.00000,81.22000,Coventry,Workers Comp,,135.36,,,,,,,126.90,136.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Coventry,Workers Comp,,135.36,,,,,,,36.66,136.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,inpatient,,,114.00000,65.66000,Coventry,Workers Comp,,109.44,,,,,,,102.60,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Coventry,Workers Comp,,109.44,,,,,,,29.64,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,inpatient,,,114.00000,65.66000,Coventry,Workers Comp,,109.44,,,,,,,102.60,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Coventry,Workers Comp,,109.44,,,,,,,29.64,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,inpatient,,,114.00000,65.66000,Coventry,Workers Comp,,109.44,,,,,,,102.60,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Coventry,Workers Comp,,109.44,,,,,,,29.64,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,inpatient,,,114.00000,65.66000,Coventry,Workers Comp,,109.44,,,,,,,102.60,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Coventry,Workers Comp,,109.44,,,,,,,29.64,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,inpatient,,,78.00000,44.93000,Coventry,Workers Comp,,74.88,,,,,,,70.20,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,outpatient,,,78.00000,44.93000,Coventry,Workers Comp,,74.88,,,,,,,20.28,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,inpatient,,,359.00000,206.78000,Coventry,Workers Comp,,344.64,,,,,,,323.10,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Coventry,Workers Comp,,344.64,,,,,,,93.34,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,inpatient,,,359.00000,206.78000,Coventry,Workers Comp,,344.64,,,,,,,323.10,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Coventry,Workers Comp,,344.64,,,,,,,93.34,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,inpatient,,,70.00000,40.32000,Coventry,Workers Comp,,67.20,,,,,,,63.00,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,outpatient,,,70.00000,40.32000,Coventry,Workers Comp,,67.20,,,,,,,18.20,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,inpatient,,,18.00000,10.37000,Coventry,Workers Comp,,17.28,,,,,,,16.20,17.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,outpatient,,,18.00000,10.37000,Coventry,Workers Comp,,17.28,,,,,,,4.68,17.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,inpatient,,,408.00000,235.01000,Coventry,Workers Comp,,391.68,,,,,,,367.20,395.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,outpatient,,,408.00000,235.01000,Coventry,Workers Comp,,391.68,,,,,,,106.08,395.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,inpatient,,,102.00000,58.75000,Coventry,Workers Comp,,97.92,,,,,,,91.80,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,outpatient,,,102.00000,58.75000,Coventry,Workers Comp,,97.92,,,,,,,26.52,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,inpatient,,,330.00000,190.08000,Coventry,Workers Comp,,316.80,,,,,,,297.00,320.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,outpatient,,,330.00000,190.08000,Coventry,Workers Comp,,316.80,,,,,,,85.80,320.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,inpatient,,,56.00000,32.26000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,outpatient,,,56.00000,32.26000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,inpatient,,,136.00000,78.34000,Coventry,Workers Comp,,130.56,,,,,,,122.40,131.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,outpatient,,,136.00000,78.34000,Coventry,Workers Comp,,130.56,,,,,,,35.36,131.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,inpatient,,,83.00000,47.81000,Coventry,Workers Comp,,79.68,,,,,,,74.70,80.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,outpatient,,,83.00000,47.81000,Coventry,Workers Comp,,79.68,,,,,,,21.58,80.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,inpatient,,,142.00000,81.79000,Coventry,Workers Comp,,136.32,,,,,,,127.80,137.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,outpatient,,,142.00000,81.79000,Coventry,Workers Comp,,136.32,,,,,,,36.92,137.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,inpatient,,,51.00000,29.38000,Coventry,Workers Comp,,48.96,,,,,,,45.90,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,outpatient,,,51.00000,29.38000,Coventry,Workers Comp,,48.96,,,,,,,13.26,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,inpatient,,,70.00000,40.32000,Coventry,Workers Comp,,67.20,,,,,,,63.00,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,outpatient,,,70.00000,40.32000,Coventry,Workers Comp,,67.20,,,,,,,18.20,67.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,inpatient,,,99.00000,57.02000,Coventry,Workers Comp,,95.04,,,,,,,89.10,96.03,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,outpatient,,,99.00000,57.02000,Coventry,Workers Comp,,95.04,,,,,,,25.74,96.03,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,inpatient,,,78.00000,44.93000,Coventry,Workers Comp,,74.88,,,,,,,70.20,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,outpatient,,,78.00000,44.93000,Coventry,Workers Comp,,74.88,,,,,,,20.28,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,inpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,inpatient,,,75.00000,43.20000,Coventry,Workers Comp,,72.00,,,,,,,67.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,outpatient,,,75.00000,43.20000,Coventry,Workers Comp,,72.00,,,,,,,19.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,inpatient,,,37.00000,21.31000,Coventry,Workers Comp,,35.52,,,,,,,33.30,35.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Coventry,Workers Comp,,35.52,,,,,,,9.62,35.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,inpatient,,,37.00000,21.31000,Coventry,Workers Comp,,35.52,,,,,,,33.30,35.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Coventry,Workers Comp,,35.52,,,,,,,9.62,35.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,inpatient,,,59.00000,33.98000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,outpatient,,,59.00000,33.98000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,inpatient,,,35.00000,20.16000,Coventry,Workers Comp,,33.60,,,,,,,31.50,33.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,outpatient,,,35.00000,20.16000,Coventry,Workers Comp,,33.60,,,,,,,9.10,33.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,inpatient,,,59.00000,33.98000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,outpatient,,,59.00000,33.98000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,inpatient,,,56.00000,32.26000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,outpatient,,,56.00000,32.26000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,inpatient,,,74.00000,42.62000,Coventry,Workers Comp,,71.04,,,,,,,66.60,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,outpatient,,,74.00000,42.62000,Coventry,Workers Comp,,71.04,,,,,,,19.24,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,inpatient,,,90.00000,51.84000,Coventry,Workers Comp,,86.40,,,,,,,81.00,87.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,outpatient,,,90.00000,51.84000,Coventry,Workers Comp,,86.40,,,,,,,23.40,87.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,inpatient,,,68.00000,39.17000,Coventry,Workers Comp,,65.28,,,,,,,61.20,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Coventry,Workers Comp,,65.28,,,,,,,17.68,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,inpatient,,,142.00000,81.79000,Coventry,Workers Comp,,136.32,,,,,,,127.80,137.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,outpatient,,,142.00000,81.79000,Coventry,Workers Comp,,136.32,,,,,,,36.92,137.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,inpatient,,,68.00000,39.17000,Coventry,Workers Comp,,65.28,,,,,,,61.20,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Coventry,Workers Comp,,65.28,,,,,,,17.68,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,inpatient,,,74.00000,42.62000,Coventry,Workers Comp,,71.04,,,,,,,66.60,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,outpatient,,,74.00000,42.62000,Coventry,Workers Comp,,71.04,,,,,,,19.24,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,inpatient,,,89.00000,51.26000,Coventry,Workers Comp,,85.44,,,,,,,80.10,86.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Coventry,Workers Comp,,85.44,,,,,,,23.14,86.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,inpatient,,,89.00000,51.26000,Coventry,Workers Comp,,85.44,,,,,,,80.10,86.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Coventry,Workers Comp,,85.44,,,,,,,23.14,86.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,inpatient,,,57.00000,32.83000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,outpatient,,,57.00000,32.83000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,inpatient,,,77.00000,44.35000,Coventry,Workers Comp,,73.92,,,,,,,69.30,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,outpatient,,,77.00000,44.35000,Coventry,Workers Comp,,73.92,,,,,,,20.02,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,inpatient,,,64.00000,36.86000,Coventry,Workers Comp,,61.44,,,,,,,57.60,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,outpatient,,,64.00000,36.86000,Coventry,Workers Comp,,61.44,,,,,,,16.64,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,inpatient,,,69.00000,39.74000,Coventry,Workers Comp,,66.24,,,,,,,62.10,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,outpatient,,,69.00000,39.74000,Coventry,Workers Comp,,66.24,,,,,,,17.94,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,inpatient,,,1178.00000,678.53000,Coventry,Workers Comp,,1130.88,,,,,,,1060.20,1142.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,outpatient,,,1178.00000,678.53000,Coventry,Workers Comp,,1130.88,,,,,,,306.28,1142.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,inpatient,,,127.00000,73.15000,Coventry,Workers Comp,,121.92,,,,,,,114.30,123.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,outpatient,,,127.00000,73.15000,Coventry,Workers Comp,,121.92,,,,,,,33.02,123.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,inpatient,,,277.00000,159.55000,Coventry,Workers Comp,,265.92,,,,,,,249.30,268.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,outpatient,,,277.00000,159.55000,Coventry,Workers Comp,,265.92,,,,,,,72.02,268.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,inpatient,,,940.00000,541.44000,Coventry,Workers Comp,,902.40,,,,,,,846.00,911.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,outpatient,,,940.00000,541.44000,Coventry,Workers Comp,,902.40,,,,,,,244.40,911.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,inpatient,,,97.00000,55.87000,Coventry,Workers Comp,,93.12,,,,,,,87.30,94.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,outpatient,,,97.00000,55.87000,Coventry,Workers Comp,,93.12,,,,,,,25.22,94.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,inpatient,,,16.00000,9.22000,Coventry,Workers Comp,,15.36,,,,,,,14.40,15.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,outpatient,,,16.00000,9.22000,Coventry,Workers Comp,,15.36,,,,,,,4.16,15.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,inpatient,,,57.00000,32.83000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,outpatient,,,57.00000,32.83000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,inpatient,,,131.00000,75.46000,Coventry,Workers Comp,,125.76,,,,,,,117.90,127.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,outpatient,,,131.00000,75.46000,Coventry,Workers Comp,,125.76,,,,,,,34.06,127.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,inpatient,,,2160.00000,1244.16000,Coventry,Workers Comp,,2073.60,,,,,,,1944.00,2095.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,outpatient,,,2160.00000,1244.16000,Coventry,Workers Comp,,2073.60,,,,,,,561.60,2095.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,inpatient,,,37.00000,21.31000,Coventry,Workers Comp,,35.52,,,,,,,33.30,35.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,outpatient,,,37.00000,21.31000,Coventry,Workers Comp,,35.52,,,,,,,9.62,35.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,inpatient,,,74.00000,42.62000,Coventry,Workers Comp,,71.04,,,,,,,66.60,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Coventry,Workers Comp,,71.04,,,,,,,19.24,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,inpatient,,,54.00000,31.10000,Coventry,Workers Comp,,51.84,,,,,,,48.60,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,outpatient,,,54.00000,31.10000,Coventry,Workers Comp,,51.84,,,,,,,14.04,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,inpatient,,,76.00000,43.78000,Coventry,Workers Comp,,72.96,,,,,,,68.40,73.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,outpatient,,,76.00000,43.78000,Coventry,Workers Comp,,72.96,,,,,,,19.76,73.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,inpatient,,,606.00000,349.06000,Coventry,Workers Comp,,581.76,,,,,,,545.40,587.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,outpatient,,,606.00000,349.06000,Coventry,Workers Comp,,581.76,,,,,,,157.56,587.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,inpatient,,,300.00000,172.80000,Coventry,Workers Comp,,288.00,,,,,,,270.00,291.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,outpatient,,,300.00000,172.80000,Coventry,Workers Comp,,288.00,,,,,,,78.00,291.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,inpatient,,,59.00000,33.98000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,outpatient,,,59.00000,33.98000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,inpatient,,,98.00000,56.45000,Coventry,Workers Comp,,94.08,,,,,,,88.20,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,outpatient,,,98.00000,56.45000,Coventry,Workers Comp,,94.08,,,,,,,25.48,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,inpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,outpatient,,,61.00000,35.14000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,inpatient,,,128.00000,73.73000,Coventry,Workers Comp,,122.88,,,,,,,115.20,124.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,outpatient,,,128.00000,73.73000,Coventry,Workers Comp,,122.88,,,,,,,33.28,124.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Coventry,Workers Comp,,50.88,,,,,,,47.70,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Coventry,Workers Comp,,50.88,,,,,,,13.78,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,inpatient,,,16.00000,9.22000,Coventry,Workers Comp,,15.36,,,,,,,14.40,15.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,outpatient,,,16.00000,9.22000,Coventry,Workers Comp,,15.36,,,,,,,4.16,15.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,inpatient,,,565.00000,325.44000,Coventry,Workers Comp,,542.40,,,,,,,508.50,548.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,outpatient,,,565.00000,325.44000,Coventry,Workers Comp,,542.40,,,,,,,146.90,548.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,inpatient,,,850.00000,489.60000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,outpatient,,,850.00000,489.60000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,inpatient,,,77.00000,44.35000,Coventry,Workers Comp,,73.92,,,,,,,69.30,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,outpatient,,,77.00000,44.35000,Coventry,Workers Comp,,73.92,,,,,,,20.02,74.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,inpatient,,,86.00000,49.54000,Coventry,Workers Comp,,82.56,,,,,,,77.40,83.42,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,outpatient,,,86.00000,49.54000,Coventry,Workers Comp,,82.56,,,,,,,22.36,83.42,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,inpatient,,,837.00000,482.11000,Coventry,Workers Comp,,803.52,,,,,,,753.30,811.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,outpatient,,,837.00000,482.11000,Coventry,Workers Comp,,803.52,,,,,,,217.62,811.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,inpatient,,,60.00000,34.56000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,outpatient,,,60.00000,34.56000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,inpatient,,,56.00000,32.26000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,outpatient,,,56.00000,32.26000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,inpatient,,,56.00000,32.26000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,outpatient,,,56.00000,32.26000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,inpatient,,,74.00000,42.62000,Coventry,Workers Comp,,71.04,,,,,,,66.60,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Coventry,Workers Comp,,71.04,,,,,,,19.24,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Coventry,Workers Comp,,50.88,,,,,,,47.70,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Coventry,Workers Comp,,50.88,,,,,,,13.78,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Coventry,Workers Comp,,50.88,,,,,,,47.70,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Coventry,Workers Comp,,50.88,,,,,,,13.78,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,inpatient,,,167.00000,96.19000,Coventry,Workers Comp,,160.32,,,,,,,150.30,161.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,outpatient,,,167.00000,96.19000,Coventry,Workers Comp,,160.32,,,,,,,43.42,161.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,inpatient,,,200.00000,115.20000,Coventry,Workers Comp,,192.00,,,,,,,180.00,194.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,outpatient,,,200.00000,115.20000,Coventry,Workers Comp,,192.00,,,,,,,52.00,194.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,inpatient,,,93.00000,53.57000,Coventry,Workers Comp,,89.28,,,,,,,83.70,90.21,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,outpatient,,,93.00000,53.57000,Coventry,Workers Comp,,89.28,,,,,,,24.18,90.21,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,inpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,49.50,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Coventry,Workers Comp,,52.80,,,,,,,14.30,53.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,inpatient,,,190.00000,109.44000,Coventry,Workers Comp,,182.40,,,,,,,171.00,184.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,outpatient,,,190.00000,109.44000,Coventry,Workers Comp,,182.40,,,,,,,49.40,184.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,inpatient,,,64.00000,36.86000,Coventry,Workers Comp,,61.44,,,,,,,57.60,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,outpatient,,,64.00000,36.86000,Coventry,Workers Comp,,61.44,,,,,,,16.64,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,inpatient,,,525.00000,302.40000,Coventry,Workers Comp,,504.00,,,,,,,472.50,509.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,outpatient,,,525.00000,302.40000,Coventry,Workers Comp,,504.00,,,,,,,136.50,509.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,inpatient,,,54.00000,31.10000,Coventry,Workers Comp,,51.84,,,,,,,48.60,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,outpatient,,,54.00000,31.10000,Coventry,Workers Comp,,51.84,,,,,,,14.04,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Coventry,Workers Comp,,50.88,,,,,,,47.70,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Coventry,Workers Comp,,50.88,,,,,,,13.78,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,inpatient,,,53.00000,30.53000,Coventry,Workers Comp,,50.88,,,,,,,47.70,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,outpatient,,,53.00000,30.53000,Coventry,Workers Comp,,50.88,,,,,,,13.78,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,inpatient,,,40.00000,23.04000,Coventry,Workers Comp,,38.40,,,,,,,36.00,38.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Coventry,Workers Comp,,38.40,,,,,,,10.40,38.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,inpatient,,,453.00000,260.93000,Coventry,Workers Comp,,434.88,,,,,,,407.70,439.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,outpatient,,,453.00000,260.93000,Coventry,Workers Comp,,434.88,,,,,,,117.78,439.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,inpatient,,,25.00000,14.40000,Coventry,Workers Comp,,24.00,,,,,,,22.50,24.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,outpatient,,,25.00000,14.40000,Coventry,Workers Comp,,24.00,,,,,,,6.50,24.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,inpatient,,,56.00000,32.26000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,outpatient,,,56.00000,32.26000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,inpatient,,,59.00000,33.98000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,outpatient,,,59.00000,33.98000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,inpatient,,,53.00000,30.53000,Coventry,Workers Comp,,50.88,,,,,,,47.70,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,outpatient,,,53.00000,30.53000,Coventry,Workers Comp,,50.88,,,,,,,13.78,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,inpatient,,,350.00000,201.60000,Coventry,Workers Comp,,336.00,,,,,,,315.00,339.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,outpatient,,,350.00000,201.60000,Coventry,Workers Comp,,336.00,,,,,,,91.00,339.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,inpatient,,,225.00000,129.60000,Coventry,Workers Comp,,216.00,,,,,,,202.50,218.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,outpatient,,,225.00000,129.60000,Coventry,Workers Comp,,216.00,,,,,,,58.50,218.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,inpatient,,,52.00000,29.95000,Coventry,Workers Comp,,49.92,,,,,,,46.80,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,outpatient,,,52.00000,29.95000,Coventry,Workers Comp,,49.92,,,,,,,13.52,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,inpatient,,,134.00000,77.18000,Coventry,Workers Comp,,128.64,,,,,,,120.60,129.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,outpatient,,,134.00000,77.18000,Coventry,Workers Comp,,128.64,,,,,,,34.84,129.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,inpatient,,,52.00000,29.95000,Coventry,Workers Comp,,49.92,,,,,,,46.80,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,outpatient,,,52.00000,29.95000,Coventry,Workers Comp,,49.92,,,,,,,13.52,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,inpatient,,,186.00000,107.14000,Coventry,Workers Comp,,178.56,,,,,,,167.40,180.42,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,outpatient,,,186.00000,107.14000,Coventry,Workers Comp,,178.56,,,,,,,48.36,180.42,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,inpatient,,,300.00000,172.80000,Coventry,Workers Comp,,288.00,,,,,,,270.00,291.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Coventry,Workers Comp,,288.00,,,,,,,78.00,291.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,inpatient,,,300.00000,172.80000,Coventry,Workers Comp,,288.00,,,,,,,270.00,291.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Coventry,Workers Comp,,288.00,,,,,,,78.00,291.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,inpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,outpatient,,,62.00000,35.71000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,inpatient,,,205.00000,118.08000,Coventry,Workers Comp,,196.80,,,,,,,184.50,198.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,outpatient,,,205.00000,118.08000,Coventry,Workers Comp,,196.80,,,,,,,53.30,198.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,inpatient,,,75.00000,36.15000,Coventry,Workers Comp,,72.00,,,,,,,67.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,outpatient,,,75.00000,36.15000,Coventry,Workers Comp,,72.00,,,,,,,19.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,inpatient,,,65.00000,31.33000,Coventry,Workers Comp,,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,outpatient,,,65.00000,31.33000,Coventry,Workers Comp,,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,inpatient,,,92.00000,44.34000,Coventry,Workers Comp,,88.32,,,,,,,82.80,89.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,outpatient,,,92.00000,44.34000,Coventry,Workers Comp,,88.32,,,,,,,23.92,89.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,inpatient,,,24.00000,11.57000,Coventry,Workers Comp,,23.04,,,,,,,21.60,23.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Coventry,Workers Comp,,23.04,,,,,,,6.24,23.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,inpatient,,,20.00000,9.64000,Coventry,Workers Comp,,19.20,,,,,,,18.00,19.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,outpatient,,,20.00000,9.64000,Coventry,Workers Comp,,19.20,,,,,,,5.20,19.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,inpatient,,,42.00000,20.24000,Coventry,Workers Comp,,40.32,,,,,,,37.80,40.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,outpatient,,,42.00000,20.24000,Coventry,Workers Comp,,40.32,,,,,,,10.92,40.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,inpatient,,,69.00000,33.26000,Coventry,Workers Comp,,66.24,,,,,,,62.10,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,outpatient,,,69.00000,33.26000,Coventry,Workers Comp,,66.24,,,,,,,17.94,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,inpatient,,,65.00000,31.33000,Coventry,Workers Comp,,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,outpatient,,,65.00000,31.33000,Coventry,Workers Comp,,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,inpatient,,,76.00000,36.63000,Coventry,Workers Comp,,72.96,,,,,,,68.40,73.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,outpatient,,,76.00000,36.63000,Coventry,Workers Comp,,72.96,,,,,,,19.76,73.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,inpatient,,,89.00000,42.90000,Coventry,Workers Comp,,85.44,,,,,,,80.10,86.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,outpatient,,,89.00000,42.90000,Coventry,Workers Comp,,85.44,,,,,,,23.14,86.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,inpatient,,,76.00000,36.63000,Coventry,Workers Comp,,72.96,,,,,,,68.40,73.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,outpatient,,,76.00000,36.63000,Coventry,Workers Comp,,72.96,,,,,,,19.76,73.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,inpatient,,,28.00000,13.50000,Coventry,Workers Comp,,26.88,,,,,,,25.20,27.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,outpatient,,,28.00000,13.50000,Coventry,Workers Comp,,26.88,,,,,,,7.28,27.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,inpatient,,,98.00000,47.24000,Coventry,Workers Comp,,94.08,,,,,,,88.20,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,outpatient,,,98.00000,47.24000,Coventry,Workers Comp,,94.08,,,,,,,25.48,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,inpatient,,,64.00000,30.85000,Coventry,Workers Comp,,61.44,,,,,,,57.60,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,outpatient,,,64.00000,30.85000,Coventry,Workers Comp,,61.44,,,,,,,16.64,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,inpatient,,,75.00000,36.15000,Coventry,Workers Comp,,72.00,,,,,,,67.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,outpatient,,,75.00000,36.15000,Coventry,Workers Comp,,72.00,,,,,,,19.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,inpatient,,,76.00000,36.63000,Coventry,Workers Comp,,72.96,,,,,,,68.40,73.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,outpatient,,,76.00000,36.63000,Coventry,Workers Comp,,72.96,,,,,,,19.76,73.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,inpatient,,,114.00000,54.95000,Coventry,Workers Comp,,109.44,,,,,,,102.60,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,outpatient,,,114.00000,54.95000,Coventry,Workers Comp,,109.44,,,,,,,29.64,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,inpatient,,,74.00000,35.67000,Coventry,Workers Comp,,71.04,,,,,,,66.60,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,outpatient,,,74.00000,35.67000,Coventry,Workers Comp,,71.04,,,,,,,19.24,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,inpatient,,,69.00000,33.26000,Coventry,Workers Comp,,66.24,,,,,,,62.10,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,outpatient,,,69.00000,33.26000,Coventry,Workers Comp,,66.24,,,,,,,17.94,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,inpatient,,,74.00000,35.67000,Coventry,Workers Comp,,71.04,,,,,,,66.60,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,outpatient,,,74.00000,35.67000,Coventry,Workers Comp,,71.04,,,,,,,19.24,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,inpatient,,,87.00000,41.93000,Coventry,Workers Comp,,83.52,,,,,,,78.30,84.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,outpatient,,,87.00000,41.93000,Coventry,Workers Comp,,83.52,,,,,,,22.62,84.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,inpatient,,,79.00000,38.08000,Coventry,Workers Comp,,75.84,,,,,,,71.10,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,outpatient,,,79.00000,38.08000,Coventry,Workers Comp,,75.84,,,,,,,20.54,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,inpatient,,,75.00000,36.15000,Coventry,Workers Comp,,72.00,,,,,,,67.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,outpatient,,,75.00000,36.15000,Coventry,Workers Comp,,72.00,,,,,,,19.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,inpatient,,,64.00000,30.85000,Coventry,Workers Comp,,61.44,,,,,,,57.60,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,outpatient,,,64.00000,30.85000,Coventry,Workers Comp,,61.44,,,,,,,16.64,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,inpatient,,,164.00000,79.05000,Coventry,Workers Comp,,157.44,,,,,,,147.60,159.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,outpatient,,,164.00000,79.05000,Coventry,Workers Comp,,157.44,,,,,,,42.64,159.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,inpatient,,,54.00000,26.03000,Coventry,Workers Comp,,51.84,,,,,,,48.60,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,outpatient,,,54.00000,26.03000,Coventry,Workers Comp,,51.84,,,,,,,14.04,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,inpatient,,,8.00000,3.86000,Coventry,Workers Comp,,7.68,,,,,,,7.20,7.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,outpatient,,,8.00000,3.86000,Coventry,Workers Comp,,7.68,,,,,,,2.08,7.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,inpatient,,,69.00000,33.26000,Coventry,Workers Comp,,66.24,,,,,,,62.10,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,outpatient,,,69.00000,33.26000,Coventry,Workers Comp,,66.24,,,,,,,17.94,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,inpatient,,,8.00000,3.86000,Coventry,Workers Comp,,7.68,,,,,,,7.20,7.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,outpatient,,,8.00000,3.86000,Coventry,Workers Comp,,7.68,,,,,,,2.08,7.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,inpatient,,,8.00000,3.86000,Coventry,Workers Comp,,7.68,,,,,,,7.20,7.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,outpatient,,,8.00000,3.86000,Coventry,Workers Comp,,7.68,,,,,,,2.08,7.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,inpatient,,,14.00000,6.75000,Coventry,Workers Comp,,13.44,,,,,,,12.60,13.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,outpatient,,,14.00000,6.75000,Coventry,Workers Comp,,13.44,,,,,,,3.64,13.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,inpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,outpatient,,,62.00000,29.88000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,inpatient,,,112.00000,53.98000,Coventry,Workers Comp,,107.52,,,,,,,100.80,108.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,outpatient,,,112.00000,53.98000,Coventry,Workers Comp,,107.52,,,,,,,29.12,108.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,inpatient,,,13.00000,6.27000,Coventry,Workers Comp,,12.48,,,,,,,11.70,12.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,outpatient,,,13.00000,6.27000,Coventry,Workers Comp,,12.48,,,,,,,3.38,12.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,inpatient,,,31.00000,14.94000,Coventry,Workers Comp,,29.76,,,,,,,27.90,30.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,outpatient,,,31.00000,14.94000,Coventry,Workers Comp,,29.76,,,,,,,8.06,30.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,inpatient,,,92.00000,44.34000,Coventry,Workers Comp,,88.32,,,,,,,82.80,89.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,outpatient,,,92.00000,44.34000,Coventry,Workers Comp,,88.32,,,,,,,23.92,89.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,inpatient,,,80.00000,38.56000,Coventry,Workers Comp,,76.80,,,,,,,72.00,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,outpatient,,,80.00000,38.56000,Coventry,Workers Comp,,76.80,,,,,,,20.80,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,inpatient,,,30.00000,14.46000,Coventry,Workers Comp,,28.80,,,,,,,27.00,29.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Coventry,Workers Comp,,28.80,,,,,,,7.80,29.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,inpatient,,,30.00000,14.46000,Coventry,Workers Comp,,28.80,,,,,,,27.00,29.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Coventry,Workers Comp,,28.80,,,,,,,7.80,29.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,inpatient,,,24.00000,11.57000,Coventry,Workers Comp,,23.04,,,,,,,21.60,23.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Coventry,Workers Comp,,23.04,,,,,,,6.24,23.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,inpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,outpatient,,,59.00000,28.44000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,inpatient,,,29.00000,13.98000,Coventry,Workers Comp,,27.84,,,,,,,26.10,28.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,outpatient,,,29.00000,13.98000,Coventry,Workers Comp,,27.84,,,,,,,7.54,28.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,inpatient,,,97.00000,46.75000,Coventry,Workers Comp,,93.12,,,,,,,87.30,94.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,outpatient,,,97.00000,46.75000,Coventry,Workers Comp,,93.12,,,,,,,25.22,94.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,inpatient,,,225.00000,108.45000,Coventry,Workers Comp,,216.00,,,,,,,202.50,218.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,outpatient,,,225.00000,108.45000,Coventry,Workers Comp,,216.00,,,,,,,58.50,218.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,inpatient,,,71.00000,34.22000,Coventry,Workers Comp,,68.16,,,,,,,63.90,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,outpatient,,,71.00000,34.22000,Coventry,Workers Comp,,68.16,,,,,,,18.46,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,inpatient,,,71.00000,34.22000,Coventry,Workers Comp,,68.16,,,,,,,63.90,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,outpatient,,,71.00000,34.22000,Coventry,Workers Comp,,68.16,,,,,,,18.46,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,inpatient,,,108.00000,52.06000,Coventry,Workers Comp,,103.68,,,,,,,97.20,104.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,outpatient,,,108.00000,52.06000,Coventry,Workers Comp,,103.68,,,,,,,28.08,104.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,inpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,outpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,inpatient,,,51.00000,24.58000,Coventry,Workers Comp,,48.96,,,,,,,45.90,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,outpatient,,,51.00000,24.58000,Coventry,Workers Comp,,48.96,,,,,,,13.26,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,inpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,outpatient,,,63.00000,30.37000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,inpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,outpatient,,,58.00000,27.96000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,inpatient,,,19.00000,9.16000,Coventry,Workers Comp,,18.24,,,,,,,17.10,18.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,outpatient,,,19.00000,9.16000,Coventry,Workers Comp,,18.24,,,,,,,4.94,18.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,inpatient,,,54.00000,26.03000,Coventry,Workers Comp,,51.84,,,,,,,48.60,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,outpatient,,,54.00000,26.03000,Coventry,Workers Comp,,51.84,,,,,,,14.04,52.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,inpatient,,,103.00000,49.65000,Coventry,Workers Comp,,98.88,,,,,,,92.70,99.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,outpatient,,,103.00000,49.65000,Coventry,Workers Comp,,98.88,,,,,,,26.78,99.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,inpatient,,,9.00000,4.34000,Coventry,Workers Comp,,8.64,,,,,,,8.10,8.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,outpatient,,,9.00000,4.34000,Coventry,Workers Comp,,8.64,,,,,,,2.34,8.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,inpatient,,,13.00000,6.27000,Coventry,Workers Comp,,12.48,,,,,,,11.70,12.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,outpatient,,,13.00000,6.27000,Coventry,Workers Comp,,12.48,,,,,,,3.38,12.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,inpatient,,,80.00000,38.56000,Coventry,Workers Comp,,76.80,,,,,,,72.00,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,outpatient,,,80.00000,38.56000,Coventry,Workers Comp,,76.80,,,,,,,20.80,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,inpatient,,,47.00000,22.65000,Coventry,Workers Comp,,45.12,,,,,,,42.30,45.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,outpatient,,,47.00000,22.65000,Coventry,Workers Comp,,45.12,,,,,,,12.22,45.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,inpatient,,,91.00000,43.86000,Coventry,Workers Comp,,87.36,,,,,,,81.90,88.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,outpatient,,,91.00000,43.86000,Coventry,Workers Comp,,87.36,,,,,,,23.66,88.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,inpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,outpatient,,,56.00000,26.99000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,inpatient,,,18.00000,8.68000,Coventry,Workers Comp,,17.28,,,,,,,16.20,17.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,outpatient,,,18.00000,8.68000,Coventry,Workers Comp,,17.28,,,,,,,4.68,17.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,inpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,outpatient,,,60.00000,28.92000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,inpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,outpatient,,,57.00000,27.47000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,inpatient,,,21.00000,11.15000,Coventry,Workers Comp,,20.16,,,,,,,18.90,20.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Coventry,Workers Comp,,20.16,,,,,,,5.46,20.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,inpatient,,,71.00000,37.70000,Coventry,Workers Comp,,68.16,,,,,,,63.90,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,outpatient,,,71.00000,37.70000,Coventry,Workers Comp,,68.16,,,,,,,18.46,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,inpatient,,,21.00000,11.15000,Coventry,Workers Comp,,20.16,,,,,,,18.90,20.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Coventry,Workers Comp,,20.16,,,,,,,5.46,20.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,inpatient,,,128.00000,67.97000,Coventry,Workers Comp,,122.88,,,,,,,115.20,124.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,outpatient,,,128.00000,67.97000,Coventry,Workers Comp,,122.88,,,,,,,33.28,124.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,inpatient,,,65.00000,34.52000,Coventry,Workers Comp,,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,outpatient,,,65.00000,34.52000,Coventry,Workers Comp,,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Coventry,Workers Comp,,24.96,,,,,,,23.40,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Coventry,Workers Comp,,24.96,,,,,,,6.76,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,inpatient,,,31.00000,16.46000,Coventry,Workers Comp,,29.76,,,,,,,27.90,30.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,outpatient,,,31.00000,16.46000,Coventry,Workers Comp,,29.76,,,,,,,8.06,30.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Coventry,Workers Comp,,24.96,,,,,,,23.40,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Coventry,Workers Comp,,24.96,,,,,,,6.76,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Coventry,Workers Comp,,24.96,,,,,,,23.40,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Coventry,Workers Comp,,24.96,,,,,,,6.76,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Coventry,Workers Comp,,24.96,,,,,,,23.40,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Coventry,Workers Comp,,24.96,,,,,,,6.76,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,inpatient,,,61.00000,32.39000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,outpatient,,,61.00000,32.39000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Coventry,Workers Comp,,24.96,,,,,,,23.40,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Coventry,Workers Comp,,24.96,,,,,,,6.76,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,inpatient,,,25.00000,13.28000,Coventry,Workers Comp,,24.00,,,,,,,22.50,24.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Coventry,Workers Comp,,24.00,,,,,,,6.50,24.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,inpatient,,,25.00000,13.28000,Coventry,Workers Comp,91,24.00,,,,,,,22.50,24.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Coventry,Workers Comp,91,24.00,,,,,,,6.50,24.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,inpatient,,,103.00000,54.69000,Coventry,Workers Comp,,98.88,,,,,,,92.70,99.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,outpatient,,,103.00000,54.69000,Coventry,Workers Comp,,98.88,,,,,,,26.78,99.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,inpatient,,,96.00000,50.98000,Coventry,Workers Comp,,92.16,,,,,,,86.40,93.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,outpatient,,,96.00000,50.98000,Coventry,Workers Comp,,92.16,,,,,,,24.96,93.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,inpatient,,,75.00000,39.83000,Coventry,Workers Comp,,72.00,,,,,,,67.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,outpatient,,,75.00000,39.83000,Coventry,Workers Comp,,72.00,,,,,,,19.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,inpatient,,,68.00000,36.11000,Coventry,Workers Comp,,65.28,,,,,,,61.20,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,outpatient,,,68.00000,36.11000,Coventry,Workers Comp,,65.28,,,,,,,17.68,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,inpatient,,,61.00000,32.39000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,outpatient,,,61.00000,32.39000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Coventry,Workers Comp,,24.96,,,,,,,23.40,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Coventry,Workers Comp,,24.96,,,,,,,6.76,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Coventry,Workers Comp,,24.96,,,,,,,23.40,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Coventry,Workers Comp,,24.96,,,,,,,6.76,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,inpatient,,,29.00000,15.40000,Coventry,Workers Comp,,27.84,,,,,,,26.10,28.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,outpatient,,,29.00000,15.40000,Coventry,Workers Comp,,27.84,,,,,,,7.54,28.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Coventry,Workers Comp,,27.84,,,,,,,26.10,28.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Coventry,Workers Comp,,27.84,,,,,,,7.54,28.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Coventry,Workers Comp,,27.84,,,,,,,26.10,28.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Coventry,Workers Comp,,27.84,,,,,,,7.54,28.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,inpatient,,,63.00000,33.45000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,outpatient,,,63.00000,33.45000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,inpatient,,,79.00000,41.95000,Coventry,Workers Comp,,75.84,,,,,,,71.10,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,outpatient,,,79.00000,41.95000,Coventry,Workers Comp,,75.84,,,,,,,20.54,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,inpatient,,,63.00000,33.45000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,outpatient,,,63.00000,33.45000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Coventry,Workers Comp,,27.84,,,,,,,26.10,28.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Coventry,Workers Comp,,27.84,,,,,,,7.54,28.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,inpatient,,,112.00000,59.47000,Coventry,Workers Comp,,107.52,,,,,,,100.80,108.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,outpatient,,,112.00000,59.47000,Coventry,Workers Comp,,107.52,,,,,,,29.12,108.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Coventry,Workers Comp,,24.96,,,,,,,23.40,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Coventry,Workers Comp,,24.96,,,,,,,6.76,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,inpatient,,,25.00000,13.28000,Coventry,Workers Comp,,24.00,,,,,,,22.50,24.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,outpatient,,,25.00000,13.28000,Coventry,Workers Comp,,24.00,,,,,,,6.50,24.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,inpatient,,,118.00000,62.66000,Coventry,Workers Comp,,113.28,,,,,,,106.20,114.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,outpatient,,,118.00000,62.66000,Coventry,Workers Comp,,113.28,,,,,,,30.68,114.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,inpatient,,,29.00000,15.40000,Coventry,Workers Comp,,27.84,,,,,,,26.10,28.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,outpatient,,,29.00000,15.40000,Coventry,Workers Comp,,27.84,,,,,,,7.54,28.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,inpatient,,,25.00000,13.28000,Coventry,Workers Comp,,24.00,,,,,,,22.50,24.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,outpatient,,,25.00000,13.28000,Coventry,Workers Comp,,24.00,,,,,,,6.50,24.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Coventry,Workers Comp,,24.96,,,,,,,23.40,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Coventry,Workers Comp,,24.96,,,,,,,6.76,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,inpatient,,,25.00000,13.28000,Coventry,Workers Comp,,24.00,,,,,,,22.50,24.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,outpatient,,,25.00000,13.28000,Coventry,Workers Comp,,24.00,,,,,,,6.50,24.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,inpatient,,,71.00000,37.70000,Coventry,Workers Comp,,68.16,,,,,,,63.90,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,outpatient,,,71.00000,37.70000,Coventry,Workers Comp,,68.16,,,,,,,18.46,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,inpatient,,,59.00000,31.33000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,outpatient,,,59.00000,31.33000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,inpatient,,,62.00000,32.92000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,outpatient,,,62.00000,32.92000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,inpatient,,,138.00000,73.28000,Coventry,Workers Comp,,132.48,,,,,,,124.20,133.86,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,outpatient,,,138.00000,73.28000,Coventry,Workers Comp,,132.48,,,,,,,35.88,133.86,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,inpatient,,,62.00000,32.92000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,outpatient,,,62.00000,32.92000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,inpatient,,,78.00000,41.42000,Coventry,Workers Comp,,74.88,,,,,,,70.20,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,outpatient,,,78.00000,41.42000,Coventry,Workers Comp,,74.88,,,,,,,20.28,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,inpatient,,,69.00000,36.64000,Coventry,Workers Comp,,66.24,,,,,,,62.10,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,outpatient,,,69.00000,36.64000,Coventry,Workers Comp,,66.24,,,,,,,17.94,66.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,inpatient,,,88.00000,46.73000,Coventry,Workers Comp,,84.48,,,,,,,79.20,85.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,outpatient,,,88.00000,46.73000,Coventry,Workers Comp,,84.48,,,,,,,22.88,85.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,inpatient,,,60.00000,31.86000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,outpatient,,,60.00000,31.86000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,inpatient,,,64.00000,33.98000,Coventry,Workers Comp,,61.44,,,,,,,57.60,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,outpatient,,,64.00000,33.98000,Coventry,Workers Comp,,61.44,,,,,,,16.64,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,inpatient,,,63.00000,33.45000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,outpatient,,,63.00000,33.45000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,inpatient,,,137.00000,72.75000,Coventry,Workers Comp,,131.52,,,,,,,123.30,132.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,outpatient,,,137.00000,72.75000,Coventry,Workers Comp,,131.52,,,,,,,35.62,132.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,inpatient,,,347.00000,184.26000,Coventry,Workers Comp,,333.12,,,,,,,312.30,336.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,outpatient,,,347.00000,184.26000,Coventry,Workers Comp,,333.12,,,,,,,90.22,336.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,inpatient,,,57.00000,30.27000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,outpatient,,,57.00000,30.27000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,inpatient,,,56.00000,29.74000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,outpatient,,,56.00000,29.74000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,inpatient,,,16.00000,8.50000,Coventry,Workers Comp,,15.36,,,,,,,14.40,15.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,outpatient,,,16.00000,8.50000,Coventry,Workers Comp,,15.36,,,,,,,4.16,15.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,inpatient,,,85.00000,45.14000,Coventry,Workers Comp,,81.60,,,,,,,76.50,82.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,outpatient,,,85.00000,45.14000,Coventry,Workers Comp,,81.60,,,,,,,22.10,82.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,inpatient,,,34.00000,18.05000,Coventry,Workers Comp,,32.64,,,,,,,30.60,32.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,outpatient,,,34.00000,18.05000,Coventry,Workers Comp,,32.64,,,,,,,8.84,32.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,inpatient,,,231.00000,122.66000,Coventry,Workers Comp,,221.76,,,,,,,207.90,224.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,outpatient,,,231.00000,122.66000,Coventry,Workers Comp,,221.76,,,,,,,60.06,224.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,inpatient,,,36.00000,19.12000,Coventry,Workers Comp,,34.56,,,,,,,32.40,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,outpatient,,,36.00000,19.12000,Coventry,Workers Comp,,34.56,,,,,,,9.36,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,inpatient,,,61.00000,32.39000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,outpatient,,,61.00000,32.39000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,inpatient,,,111.00000,58.94000,Coventry,Workers Comp,,106.56,,,,,,,99.90,107.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,outpatient,,,111.00000,58.94000,Coventry,Workers Comp,,106.56,,,,,,,28.86,107.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,inpatient,,,61.00000,32.39000,Coventry,Workers Comp,,58.56,,,,,,,54.90,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,outpatient,,,61.00000,32.39000,Coventry,Workers Comp,,58.56,,,,,,,15.86,59.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,inpatient,,,60.00000,31.86000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,outpatient,,,60.00000,31.86000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,inpatient,,,60.00000,31.86000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,outpatient,,,60.00000,31.86000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,inpatient,,,60.00000,31.86000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,outpatient,,,60.00000,31.86000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,inpatient,,,60.00000,31.86000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,outpatient,,,60.00000,31.86000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,inpatient,,,60.00000,31.86000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,outpatient,,,60.00000,31.86000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,inpatient,,,36.00000,19.12000,Coventry,Workers Comp,,34.56,,,,,,,32.40,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,outpatient,,,36.00000,19.12000,Coventry,Workers Comp,,34.56,,,,,,,9.36,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,inpatient,,,76.00000,40.36000,Coventry,Workers Comp,,72.96,,,,,,,68.40,73.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,outpatient,,,76.00000,40.36000,Coventry,Workers Comp,,72.96,,,,,,,19.76,73.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,inpatient,,,60.00000,31.86000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,outpatient,,,60.00000,31.86000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,inpatient,,,60.00000,31.86000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,outpatient,,,60.00000,31.86000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,inpatient,,,152.00000,80.71000,Coventry,Workers Comp,,145.92,,,,,,,136.80,147.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,outpatient,,,152.00000,80.71000,Coventry,Workers Comp,,145.92,,,,,,,39.52,147.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,inpatient,,,78.00000,41.42000,Coventry,Workers Comp,,74.88,,,,,,,70.20,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,outpatient,,,78.00000,41.42000,Coventry,Workers Comp,,74.88,,,,,,,20.28,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,inpatient,,,42.00000,22.30000,Coventry,Workers Comp,,40.32,,,,,,,37.80,40.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,outpatient,,,42.00000,22.30000,Coventry,Workers Comp,,40.32,,,,,,,10.92,40.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,inpatient,,,73.00000,38.76000,Coventry,Workers Comp,,70.08,,,,,,,65.70,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,outpatient,,,73.00000,38.76000,Coventry,Workers Comp,,70.08,,,,,,,18.98,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,inpatient,,,97.00000,51.51000,Coventry,Workers Comp,,93.12,,,,,,,87.30,94.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,outpatient,,,97.00000,51.51000,Coventry,Workers Comp,,93.12,,,,,,,25.22,94.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,inpatient,,,157.00000,83.37000,Coventry,Workers Comp,,150.72,,,,,,,141.30,152.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,outpatient,,,157.00000,83.37000,Coventry,Workers Comp,,150.72,,,,,,,40.82,152.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,inpatient,,,36.00000,19.12000,Coventry,Workers Comp,,34.56,,,,,,,32.40,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,outpatient,,,36.00000,19.12000,Coventry,Workers Comp,,34.56,,,,,,,9.36,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,inpatient,,,66.00000,35.05000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,outpatient,,,66.00000,35.05000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,inpatient,,,58.00000,30.80000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,outpatient,,,58.00000,30.80000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,inpatient,,,85.00000,45.14000,Coventry,Workers Comp,,81.60,,,,,,,76.50,82.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,outpatient,,,85.00000,45.14000,Coventry,Workers Comp,,81.60,,,,,,,22.10,82.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,inpatient,,,59.00000,31.33000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,outpatient,,,59.00000,31.33000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,inpatient,,,175.00000,92.93000,Coventry,Workers Comp,,168.00,,,,,,,157.50,169.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,outpatient,,,175.00000,92.93000,Coventry,Workers Comp,,168.00,,,,,,,45.50,169.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,inpatient,,,152.00000,80.71000,Coventry,Workers Comp,,145.92,,,,,,,136.80,147.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,outpatient,,,152.00000,80.71000,Coventry,Workers Comp,,145.92,,,,,,,39.52,147.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,inpatient,,,43.00000,22.83000,Coventry,Workers Comp,,41.28,,,,,,,38.70,41.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,outpatient,,,43.00000,22.83000,Coventry,Workers Comp,,41.28,,,,,,,11.18,41.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,inpatient,,,66.00000,35.05000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,outpatient,,,66.00000,35.05000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,inpatient,,,36.00000,19.12000,Coventry,Workers Comp,,34.56,,,,,,,32.40,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,outpatient,,,36.00000,19.12000,Coventry,Workers Comp,,34.56,,,,,,,9.36,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,inpatient,,,36.00000,19.12000,Coventry,Workers Comp,,34.56,,,,,,,32.40,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,outpatient,,,36.00000,19.12000,Coventry,Workers Comp,,34.56,,,,,,,9.36,34.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,inpatient,,,42.00000,22.30000,Coventry,Workers Comp,,40.32,,,,,,,37.80,40.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,outpatient,,,42.00000,22.30000,Coventry,Workers Comp,,40.32,,,,,,,10.92,40.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,inpatient,,,147.00000,78.06000,Coventry,Workers Comp,,141.12,,,,,,,132.30,142.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,outpatient,,,147.00000,78.06000,Coventry,Workers Comp,,141.12,,,,,,,38.22,142.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,inpatient,,,64.00000,33.98000,Coventry,Workers Comp,,61.44,,,,,,,57.60,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,outpatient,,,64.00000,33.98000,Coventry,Workers Comp,,61.44,,,,,,,16.64,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,inpatient,,,60.00000,31.86000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,outpatient,,,60.00000,31.86000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,inpatient,,,75.00000,39.83000,Coventry,Workers Comp,,72.00,,,,,,,67.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,outpatient,,,75.00000,39.83000,Coventry,Workers Comp,,72.00,,,,,,,19.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,inpatient,,,44.00000,23.36000,Coventry,Workers Comp,,42.24,,,,,,,39.60,42.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,outpatient,,,44.00000,23.36000,Coventry,Workers Comp,,42.24,,,,,,,11.44,42.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,inpatient,,,87.00000,46.20000,Coventry,Workers Comp,,83.52,,,,,,,78.30,84.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,outpatient,,,87.00000,46.20000,Coventry,Workers Comp,,83.52,,,,,,,22.62,84.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,inpatient,,,65.00000,34.52000,Coventry,Workers Comp,,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,outpatient,,,65.00000,34.52000,Coventry,Workers Comp,,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,inpatient,,,75.00000,39.83000,Coventry,Workers Comp,,72.00,,,,,,,67.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,outpatient,,,75.00000,39.83000,Coventry,Workers Comp,,72.00,,,,,,,19.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,inpatient,,,50.00000,26.55000,Coventry,Workers Comp,,48.00,,,,,,,45.00,48.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,outpatient,,,50.00000,26.55000,Coventry,Workers Comp,,48.00,,,,,,,13.00,48.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,inpatient,,,40.00000,21.24000,Coventry,Workers Comp,,38.40,,,,,,,36.00,38.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,outpatient,,,40.00000,21.24000,Coventry,Workers Comp,,38.40,,,,,,,10.40,38.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,inpatient,,,50.00000,26.55000,Coventry,Workers Comp,,48.00,,,,,,,45.00,48.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,outpatient,,,50.00000,26.55000,Coventry,Workers Comp,,48.00,,,,,,,13.00,48.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,116.10,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,33.54,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,inpatient,,,115.00000,61.07000,Coventry,Workers Comp,,110.40,,,,,,,103.50,111.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,outpatient,,,115.00000,61.07000,Coventry,Workers Comp,,110.40,,,,,,,29.90,111.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,inpatient,,,1309.00000,695.08000,Coventry,Workers Comp,,1256.64,,,,,,,1178.10,1269.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1309.00000,695.08000,Coventry,Workers Comp,,1256.64,,,,,,,340.34,1269.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,116.10,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,33.54,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,116.10,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,33.54,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,inpatient,,,328.00000,174.17000,Coventry,Workers Comp,,314.88,,,,,,,295.20,318.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,outpatient,,,328.00000,174.17000,Coventry,Workers Comp,,314.88,,,,,,,85.28,318.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,inpatient,,,115.00000,61.07000,Coventry,Workers Comp,,110.40,,,,,,,103.50,111.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,outpatient,,,115.00000,61.07000,Coventry,Workers Comp,,110.40,,,,,,,29.90,111.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,116.10,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,33.54,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,116.10,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,33.54,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,inpatient,,,1251.00000,664.28000,Coventry,Workers Comp,,1200.96,,,,,,,1125.90,1213.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,outpatient,,,1251.00000,664.28000,Coventry,Workers Comp,,1200.96,,,,,,,325.26,1213.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,inpatient,,,154.00000,81.77000,Coventry,Workers Comp,,147.84,,,,,,,138.60,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Coventry,Workers Comp,,147.84,,,,,,,40.04,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,inpatient,,,154.00000,81.77000,Coventry,Workers Comp,,147.84,,,,,,,138.60,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Coventry,Workers Comp,,147.84,,,,,,,40.04,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,inpatient,,,96.00000,50.98000,Coventry,Workers Comp,,92.16,,,,,,,86.40,93.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,outpatient,,,96.00000,50.98000,Coventry,Workers Comp,,92.16,,,,,,,24.96,93.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,inpatient,,,211.00000,112.04000,Coventry,Workers Comp,,202.56,,,,,,,189.90,204.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,outpatient,,,211.00000,112.04000,Coventry,Workers Comp,,202.56,,,,,,,54.86,204.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,inpatient,,,290.00000,153.99000,Coventry,Workers Comp,,278.40,,,,,,,261.00,281.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,outpatient,,,290.00000,153.99000,Coventry,Workers Comp,,278.40,,,,,,,75.40,281.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,116.10,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,33.54,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,116.10,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,33.54,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,inpatient,,,411.00000,218.24000,Coventry,Workers Comp,,394.56,,,,,,,369.90,398.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,outpatient,,,411.00000,218.24000,Coventry,Workers Comp,,394.56,,,,,,,106.86,398.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,inpatient,,,139.00000,73.81000,Coventry,Workers Comp,,133.44,,,,,,,125.10,134.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,outpatient,,,139.00000,73.81000,Coventry,Workers Comp,,133.44,,,,,,,36.14,134.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,inpatient,,,288.00000,152.93000,Coventry,Workers Comp,,276.48,,,,,,,259.20,279.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,outpatient,,,288.00000,152.93000,Coventry,Workers Comp,,276.48,,,,,,,74.88,279.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,inpatient,,,1372.00000,728.53000,Coventry,Workers Comp,,1317.12,,,,,,,1234.80,1330.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1372.00000,728.53000,Coventry,Workers Comp,,1317.12,,,,,,,356.72,1330.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,inpatient,,,1251.00000,664.28000,Coventry,Workers Comp,,1200.96,,,,,,,1125.90,1213.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,outpatient,,,1251.00000,664.28000,Coventry,Workers Comp,,1200.96,,,,,,,325.26,1213.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,inpatient,,,135.00000,71.68000,Coventry,Workers Comp,,129.60,,,,,,,121.50,130.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,outpatient,,,135.00000,71.68000,Coventry,Workers Comp,,129.60,,,,,,,35.10,130.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,116.10,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,33.54,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,116.10,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,33.54,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,inpatient,,,147.00000,78.06000,Coventry,Workers Comp,,141.12,,,,,,,132.30,142.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,outpatient,,,147.00000,78.06000,Coventry,Workers Comp,,141.12,,,,,,,38.22,142.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,inpatient,,,126.00000,66.91000,Coventry,Workers Comp,,120.96,,,,,,,113.40,122.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,outpatient,,,126.00000,66.91000,Coventry,Workers Comp,,120.96,,,,,,,32.76,122.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,inpatient,,,120.00000,63.72000,Coventry,Workers Comp,,115.20,,,,,,,108.00,116.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,outpatient,,,120.00000,63.72000,Coventry,Workers Comp,,115.20,,,,,,,31.20,116.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,116.10,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,33.54,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,inpatient,,,124.00000,65.84000,Coventry,Workers Comp,,119.04,,,,,,,111.60,120.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,outpatient,,,124.00000,65.84000,Coventry,Workers Comp,,119.04,,,,,,,32.24,120.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,inpatient,,,108.00000,57.35000,Coventry,Workers Comp,,103.68,,,,,,,97.20,104.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,outpatient,,,108.00000,57.35000,Coventry,Workers Comp,,103.68,,,,,,,28.08,104.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,inpatient,,,256.00000,135.94000,Coventry,Workers Comp,,245.76,,,,,,,230.40,248.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Coventry,Workers Comp,,245.76,,,,,,,66.56,248.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,inpatient,,,256.00000,135.94000,Coventry,Workers Comp,,245.76,,,,,,,230.40,248.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Coventry,Workers Comp,,245.76,,,,,,,66.56,248.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,inpatient,,,122.00000,64.78000,Coventry,Workers Comp,,117.12,,,,,,,109.80,118.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,outpatient,,,122.00000,64.78000,Coventry,Workers Comp,,117.12,,,,,,,31.72,118.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,116.10,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,33.54,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,inpatient,,,123.00000,65.31000,Coventry,Workers Comp,,118.08,,,,,,,110.70,119.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,outpatient,,,123.00000,65.31000,Coventry,Workers Comp,,118.08,,,,,,,31.98,119.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,116.10,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,33.54,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,inpatient,,,518.00000,275.06000,Coventry,Workers Comp,,497.28,,,,,,,466.20,502.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,outpatient,,,518.00000,275.06000,Coventry,Workers Comp,,497.28,,,,,,,134.68,502.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,inpatient,,,275.00000,146.02000,Coventry,Workers Comp,,264.00,,,,,,,247.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,outpatient,,,275.00000,146.02000,Coventry,Workers Comp,,264.00,,,,,,,71.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,inpatient,,,270.00000,143.37000,Coventry,Workers Comp,,259.20,,,,,,,243.00,261.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,outpatient,,,270.00000,143.37000,Coventry,Workers Comp,,259.20,,,,,,,70.20,261.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,inpatient,,,450.00000,238.95000,Coventry,Workers Comp,,432.00,,,,,,,405.00,436.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,outpatient,,,450.00000,238.95000,Coventry,Workers Comp,,432.00,,,,,,,117.00,436.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,inpatient,,,126.00000,66.91000,Coventry,Workers Comp,,120.96,,,,,,,113.40,122.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,outpatient,,,126.00000,66.91000,Coventry,Workers Comp,,120.96,,,,,,,32.76,122.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,inpatient,,,362.00000,192.22000,Coventry,Workers Comp,,347.52,,,,,,,325.80,351.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,outpatient,,,362.00000,192.22000,Coventry,Workers Comp,,347.52,,,,,,,94.12,351.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,inpatient,,,109.00000,57.88000,Coventry,Workers Comp,,104.64,,,,,,,98.10,105.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Coventry,Workers Comp,,104.64,,,,,,,28.34,105.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,inpatient,,,638.00000,338.78000,Coventry,Workers Comp,,612.48,,,,,,,574.20,618.86,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,outpatient,,,638.00000,338.78000,Coventry,Workers Comp,,612.48,,,,,,,165.88,618.86,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,inpatient,,,211.00000,112.04000,Coventry,Workers Comp,,202.56,,,,,,,189.90,204.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,outpatient,,,211.00000,112.04000,Coventry,Workers Comp,,202.56,,,,,,,54.86,204.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,inpatient,,,154.00000,81.77000,Coventry,Workers Comp,,147.84,,,,,,,138.60,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,outpatient,,,154.00000,81.77000,Coventry,Workers Comp,,147.84,,,,,,,40.04,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,inpatient,,,141.00000,74.87000,Coventry,Workers Comp,,135.36,,,,,,,126.90,136.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,outpatient,,,141.00000,74.87000,Coventry,Workers Comp,,135.36,,,,,,,36.66,136.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,inpatient,,,2040.00000,1083.24000,Coventry,Workers Comp,,1958.40,,,,,,,1836.00,1978.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,outpatient,,,2040.00000,1083.24000,Coventry,Workers Comp,,1958.40,,,,,,,530.40,1978.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,inpatient,,,421.00000,223.55000,Coventry,Workers Comp,,404.16,,,,,,,378.90,408.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,outpatient,,,421.00000,223.55000,Coventry,Workers Comp,,404.16,,,,,,,109.46,408.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,inpatient,,,275.00000,146.02000,Coventry,Workers Comp,,264.00,,,,,,,247.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,outpatient,,,275.00000,146.02000,Coventry,Workers Comp,,264.00,,,,,,,71.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,inpatient,,,1251.00000,664.28000,Coventry,Workers Comp,,1200.96,,,,,,,1125.90,1213.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,outpatient,,,1251.00000,664.28000,Coventry,Workers Comp,,1200.96,,,,,,,325.26,1213.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,inpatient,,,428.00000,227.27000,Coventry,Workers Comp,,410.88,,,,,,,385.20,415.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Coventry,Workers Comp,,410.88,,,,,,,111.28,415.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,inpatient,,,428.00000,227.27000,Coventry,Workers Comp,,410.88,,,,,,,385.20,415.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Coventry,Workers Comp,,410.88,,,,,,,111.28,415.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,inpatient,,,655.00000,347.80000,Coventry,Workers Comp,,628.80,,,,,,,589.50,635.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Coventry,Workers Comp,,628.80,,,,,,,170.30,635.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,inpatient,,,655.00000,347.80000,Coventry,Workers Comp,,628.80,,,,,,,589.50,635.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Coventry,Workers Comp,,628.80,,,,,,,170.30,635.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,inpatient,,,211.00000,112.04000,Coventry,Workers Comp,,202.56,,,,,,,189.90,204.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,outpatient,,,211.00000,112.04000,Coventry,Workers Comp,,202.56,,,,,,,54.86,204.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,inpatient,,,112.00000,59.47000,Coventry,Workers Comp,,107.52,,,,,,,100.80,108.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Coventry,Workers Comp,,107.52,,,,,,,29.12,108.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,inpatient,,,112.00000,59.47000,Coventry,Workers Comp,,107.52,,,,,,,100.80,108.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Coventry,Workers Comp,,107.52,,,,,,,29.12,108.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,inpatient,,,130.00000,69.03000,Coventry,Workers Comp,,124.80,,,,,,,117.00,126.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,outpatient,,,130.00000,69.03000,Coventry,Workers Comp,,124.80,,,,,,,33.80,126.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,inpatient,,,421.00000,223.55000,Coventry,Workers Comp,,404.16,,,,,,,378.90,408.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,outpatient,,,421.00000,223.55000,Coventry,Workers Comp,,404.16,,,,,,,109.46,408.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,inpatient,,,111.00000,58.94000,Coventry,Workers Comp,,106.56,,,,,,,99.90,107.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,outpatient,,,111.00000,58.94000,Coventry,Workers Comp,,106.56,,,,,,,28.86,107.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,inpatient,,,200.00000,106.20000,Coventry,Workers Comp,,192.00,,,,,,,180.00,194.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,outpatient,,,200.00000,106.20000,Coventry,Workers Comp,,192.00,,,,,,,52.00,194.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,116.10,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Coventry,Workers Comp,,123.84,,,,,,,33.54,125.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,inpatient,,,13.00000,6.90000,Coventry,Workers Comp,,12.48,,,,,,,11.70,12.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,outpatient,,,13.00000,6.90000,Coventry,Workers Comp,,12.48,,,,,,,3.38,12.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,inpatient,,,58.00000,30.80000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,outpatient,,,58.00000,30.80000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,inpatient,,,13.00000,6.90000,Coventry,Workers Comp,,12.48,,,,,,,11.70,12.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,outpatient,,,13.00000,6.90000,Coventry,Workers Comp,,12.48,,,,,,,3.38,12.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,inpatient,,,773.00000,410.46000,Coventry,Workers Comp,,742.08,,,,,,,695.70,749.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,outpatient,,,773.00000,410.46000,Coventry,Workers Comp,,742.08,,,,,,,200.98,749.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,inpatient,,,773.00000,410.46000,Coventry,Workers Comp,,742.08,,,,,,,695.70,749.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,outpatient,,,773.00000,410.46000,Coventry,Workers Comp,,742.08,,,,,,,200.98,749.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,inpatient,,,773.00000,410.46000,Coventry,Workers Comp,,742.08,,,,,,,695.70,749.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,outpatient,,,773.00000,410.46000,Coventry,Workers Comp,,742.08,,,,,,,200.98,749.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,inpatient,,,773.00000,410.46000,Coventry,Workers Comp,,742.08,,,,,,,695.70,749.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,outpatient,,,773.00000,410.46000,Coventry,Workers Comp,,742.08,,,,,,,200.98,749.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,inpatient,,,387.00000,205.50000,Coventry,Workers Comp,,371.52,,,,,,,348.30,375.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,outpatient,,,387.00000,205.50000,Coventry,Workers Comp,,371.52,,,,,,,100.62,375.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,inpatient,,,52.00000,27.61000,Coventry,Workers Comp,,49.92,,,,,,,46.80,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,outpatient,,,52.00000,27.61000,Coventry,Workers Comp,,49.92,,,,,,,13.52,50.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,inpatient,,,102.00000,54.16000,Coventry,Workers Comp,,97.92,,,,,,,91.80,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Coventry,Workers Comp,,97.92,,,,,,,26.52,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,inpatient,,,102.00000,54.16000,Coventry,Workers Comp,,97.92,,,,,,,91.80,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Coventry,Workers Comp,,97.92,,,,,,,26.52,98.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,inpatient,,,79.00000,41.95000,Coventry,Workers Comp,,75.84,,,,,,,71.10,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,outpatient,,,79.00000,41.95000,Coventry,Workers Comp,,75.84,,,,,,,20.54,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,inpatient,,,65.00000,34.52000,Coventry,Workers Comp,,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,outpatient,,,65.00000,34.52000,Coventry,Workers Comp,,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,inpatient,,,100.00000,53.10000,Coventry,Workers Comp,,96.00,,,,,,,90.00,97.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,outpatient,,,100.00000,53.10000,Coventry,Workers Comp,,96.00,,,,,,,26.00,97.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,inpatient,,,64.00000,33.98000,Coventry,Workers Comp,,61.44,,,,,,,57.60,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,outpatient,,,64.00000,33.98000,Coventry,Workers Comp,,61.44,,,,,,,16.64,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,inpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,outpatient,,,106.00000,56.29000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,inpatient,,,109.00000,57.88000,Coventry,Workers Comp,,104.64,,,,,,,98.10,105.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Coventry,Workers Comp,,104.64,,,,,,,28.34,105.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,inpatient,,,58.00000,30.80000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,outpatient,,,58.00000,30.80000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Coventry,Workers Comp,,19.20,,,,,,,18.00,19.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Coventry,Workers Comp,,19.20,,,,,,,5.20,19.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,inpatient,,,66.00000,35.05000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,outpatient,,,66.00000,35.05000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Coventry,Workers Comp,,19.20,,,,,,,18.00,19.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Coventry,Workers Comp,,19.20,,,,,,,5.20,19.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Coventry,Workers Comp,,19.20,,,,,,,18.00,19.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Coventry,Workers Comp,,19.20,,,,,,,5.20,19.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Coventry,Workers Comp,,19.20,,,,,,,18.00,19.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Coventry,Workers Comp,,19.20,,,,,,,5.20,19.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,inpatient,,,13.00000,6.90000,Coventry,Workers Comp,,12.48,,,,,,,11.70,12.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,outpatient,,,13.00000,6.90000,Coventry,Workers Comp,,12.48,,,,,,,3.38,12.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,inpatient,,,53.00000,28.14000,Coventry,Workers Comp,,50.88,,,,,,,47.70,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,outpatient,,,53.00000,28.14000,Coventry,Workers Comp,,50.88,,,,,,,13.78,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,inpatient,,,18.00000,9.56000,Coventry,Workers Comp,,17.28,,,,,,,16.20,17.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,outpatient,,,18.00000,9.56000,Coventry,Workers Comp,,17.28,,,,,,,4.68,17.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,inpatient,,,17.00000,9.03000,Coventry,Workers Comp,,16.32,,,,,,,15.30,16.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,outpatient,,,17.00000,9.03000,Coventry,Workers Comp,,16.32,,,,,,,4.42,16.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,inpatient,,,71.00000,37.70000,Coventry,Workers Comp,,68.16,,,,,,,63.90,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,outpatient,,,71.00000,37.70000,Coventry,Workers Comp,,68.16,,,,,,,18.46,68.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,inpatient,,,57.00000,30.27000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,outpatient,,,57.00000,30.27000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,inpatient,,,68.00000,36.11000,Coventry,Workers Comp,,65.28,,,,,,,61.20,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,outpatient,,,68.00000,36.11000,Coventry,Workers Comp,,65.28,,,,,,,17.68,65.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,inpatient,,,58.00000,30.80000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,outpatient,,,58.00000,30.80000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,inpatient,,,27.00000,14.34000,Coventry,Workers Comp,,25.92,,,,,,,24.30,26.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,outpatient,,,27.00000,14.34000,Coventry,Workers Comp,,25.92,,,,,,,7.02,26.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,inpatient,,,56.00000,29.74000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,outpatient,,,56.00000,29.74000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,inpatient,,,56.00000,29.74000,Coventry,Workers Comp,,53.76,,,,,,,50.40,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,outpatient,,,56.00000,29.74000,Coventry,Workers Comp,,53.76,,,,,,,14.56,54.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,inpatient,,,58.00000,30.80000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,outpatient,,,58.00000,30.80000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,inpatient,,,115.00000,61.07000,Coventry,Workers Comp,,110.40,,,,,,,103.50,111.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,outpatient,,,115.00000,61.07000,Coventry,Workers Comp,,110.40,,,,,,,29.90,111.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,inpatient,,,23.00000,12.21000,Coventry,Workers Comp,,22.08,,,,,,,20.70,22.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,outpatient,,,23.00000,12.21000,Coventry,Workers Comp,,22.08,,,,,,,5.98,22.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,inpatient,,,255.00000,135.40000,Coventry,Workers Comp,,244.80,,,,,,,229.50,247.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,outpatient,,,255.00000,135.40000,Coventry,Workers Comp,,244.80,,,,,,,66.30,247.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,inpatient,,,66.00000,35.05000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,outpatient,,,66.00000,35.05000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,inpatient,,,26.00000,13.81000,Coventry,Workers Comp,,24.96,,,,,,,23.40,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,outpatient,,,26.00000,13.81000,Coventry,Workers Comp,,24.96,,,,,,,6.76,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,inpatient,,,64.00000,33.98000,Coventry,Workers Comp,,61.44,,,,,,,57.60,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,outpatient,,,64.00000,33.98000,Coventry,Workers Comp,,61.44,,,,,,,16.64,62.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,inpatient,,,215.00000,114.16000,Coventry,Workers Comp,,206.40,,,,,,,193.50,208.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,outpatient,,,215.00000,114.16000,Coventry,Workers Comp,,206.40,,,,,,,55.90,208.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,inpatient,,,79.00000,41.95000,Coventry,Workers Comp,,75.84,,,,,,,71.10,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,outpatient,,,79.00000,41.95000,Coventry,Workers Comp,,75.84,,,,,,,20.54,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,inpatient,,,11.00000,5.29000,Coventry,Workers Comp,,10.56,,,,,,,9.90,10.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,outpatient,,,11.00000,5.29000,Coventry,Workers Comp,,10.56,,,,,,,2.86,10.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,inpatient,,,58.00000,27.90000,Coventry,Workers Comp,,55.68,,,,,,,52.20,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,outpatient,,,58.00000,27.90000,Coventry,Workers Comp,,55.68,,,,,,,15.08,56.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,inpatient,,,10.00000,4.81000,Coventry,Workers Comp,,9.60,,,,,,,9.00,9.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,outpatient,,,10.00000,4.81000,Coventry,Workers Comp,,9.60,,,,,,,2.60,9.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,inpatient,,,7.00000,3.37000,Coventry,Workers Comp,,6.72,,,,,,,6.30,6.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,outpatient,,,7.00000,3.37000,Coventry,Workers Comp,,6.72,,,,,,,1.82,6.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,inpatient,,,53.00000,25.49000,Coventry,Workers Comp,,50.88,,,,,,,47.70,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,outpatient,,,53.00000,25.49000,Coventry,Workers Comp,,50.88,,,,,,,13.78,51.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,inpatient,,,10.00000,4.81000,Coventry,Workers Comp,,9.60,,,,,,,9.00,9.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,outpatient,,,10.00000,4.81000,Coventry,Workers Comp,,9.60,,,,,,,2.60,9.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,inpatient,,,11.00000,5.29000,Coventry,Workers Comp,,10.56,,,,,,,9.90,10.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Coventry,Workers Comp,,10.56,,,,,,,2.86,10.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,inpatient,,,7.00000,3.37000,Coventry,Workers Comp,,6.72,,,,,,,6.30,6.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,outpatient,,,7.00000,3.37000,Coventry,Workers Comp,,6.72,,,,,,,1.82,6.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,inpatient,,,11.00000,5.29000,Coventry,Workers Comp,,10.56,,,,,,,9.90,10.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Coventry,Workers Comp,,10.56,,,,,,,2.86,10.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,inpatient,,,597.00000,290.14000,Coventry,Workers Comp,,573.12,,,,,,,537.30,579.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,outpatient,,,597.00000,290.14000,Coventry,Workers Comp,,573.12,,,,,,,155.22,579.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,inpatient,,,6379.00000,3100.19000,Coventry,Workers Comp,,6123.84,,,,,,,5741.10,6187.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,outpatient,,,6379.00000,3100.19000,Coventry,Workers Comp,,6123.84,,,,,,,1658.54,6187.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,inpatient,,,471.00000,228.91000,Coventry,Workers Comp,,452.16,,,,,,,423.90,456.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,outpatient,,,471.00000,228.91000,Coventry,Workers Comp,,452.16,,,,,,,122.46,456.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,inpatient,,,471.00000,228.91000,Coventry,Workers Comp,,452.16,,,,,,,423.90,456.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,outpatient,,,471.00000,228.91000,Coventry,Workers Comp,,452.16,,,,,,,122.46,456.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,inpatient,,,1251.00000,607.99000,Coventry,Workers Comp,,1200.96,,,,,,,1125.90,1213.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,outpatient,,,1251.00000,607.99000,Coventry,Workers Comp,,1200.96,,,,,,,325.26,1213.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,inpatient,,,260.00000,126.36000,Coventry,Workers Comp,,249.60,,,,,,,234.00,252.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,outpatient,,,260.00000,126.36000,Coventry,Workers Comp,,249.60,,,,,,,67.60,252.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,inpatient,,,785.00000,381.51000,Coventry,Workers Comp,,753.60,,,,,,,706.50,761.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,outpatient,,,785.00000,381.51000,Coventry,Workers Comp,,753.60,,,,,,,204.10,761.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,inpatient,,,529.00000,257.09000,Coventry,Workers Comp,,507.84,,,,,,,476.10,513.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,outpatient,,,529.00000,257.09000,Coventry,Workers Comp,,507.84,,,,,,,137.54,513.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,inpatient,,,1623.00000,788.78000,Coventry,Workers Comp,,1558.08,,,,,,,1460.70,1574.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,outpatient,,,1623.00000,788.78000,Coventry,Workers Comp,,1558.08,,,,,,,421.98,1574.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,inpatient,,,10800.00000,5248.80000,Coventry,Workers Comp,,10368.00,,,,,,,9720.00,10476.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,outpatient,,,10800.00000,5248.80000,Coventry,Workers Comp,,10368.00,,,,,,,2808.00,10476.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,inpatient,,,25365.00000,12327.39000,Coventry,Workers Comp,,24350.40,,,,,,,22828.50,24604.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,outpatient,,,25365.00000,12327.39000,Coventry,Workers Comp,,24350.40,,,,,,,6594.90,24604.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,inpatient,,,101.00000,21.82000,Coventry,Workers Comp,,96.96,,,,,,,90.90,97.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,outpatient,,,101.00000,21.82000,Coventry,Workers Comp,,96.96,,,,,,,26.26,97.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,inpatient,,,81.00000,17.50000,Coventry,Workers Comp,,77.76,,,,,,,72.90,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,outpatient,,,81.00000,17.50000,Coventry,Workers Comp,,77.76,,,,,,,21.06,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,inpatient,,,104.00000,22.46000,Coventry,Workers Comp,,99.84,,,,,,,93.60,100.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,outpatient,,,104.00000,22.46000,Coventry,Workers Comp,,99.84,,,,,,,27.04,100.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,inpatient,,,377.00000,81.43000,Coventry,Workers Comp,,361.92,,,,,,,339.30,365.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,outpatient,,,377.00000,81.43000,Coventry,Workers Comp,,361.92,,,,,,,98.02,365.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,inpatient,,,532.00000,114.91000,Coventry,Workers Comp,,510.72,,,,,,,478.80,516.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,outpatient,,,532.00000,114.91000,Coventry,Workers Comp,,510.72,,,,,,,138.32,516.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,inpatient,,,521.00000,112.54000,Coventry,Workers Comp,,500.16,,,,,,,468.90,505.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,outpatient,,,521.00000,112.54000,Coventry,Workers Comp,,500.16,,,,,,,135.46,505.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,inpatient,,,451.00000,97.42000,Coventry,Workers Comp,,432.96,,,,,,,405.90,437.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,outpatient,,,451.00000,97.42000,Coventry,Workers Comp,,432.96,,,,,,,117.26,437.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,inpatient,,,1148.00000,247.97000,Coventry,Workers Comp,,1102.08,,,,,,,1033.20,1113.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,outpatient,,,1148.00000,247.97000,Coventry,Workers Comp,,1102.08,,,,,,,298.48,1113.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,inpatient,,,350.00000,75.60000,Coventry,Workers Comp,,336.00,,,,,,,315.00,339.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,outpatient,,,350.00000,75.60000,Coventry,Workers Comp,,336.00,,,,,,,91.00,339.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,inpatient,,,423.00000,91.37000,Coventry,Workers Comp,,406.08,,,,,,,380.70,410.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,outpatient,,,423.00000,91.37000,Coventry,Workers Comp,,406.08,,,,,,,109.98,410.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,inpatient,,,751.00000,162.22000,Coventry,Workers Comp,,720.96,,,,,,,675.90,728.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Coventry,Workers Comp,,720.96,,,,,,,195.26,728.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,inpatient,,,751.00000,162.22000,Coventry,Workers Comp,,720.96,,,,,,,675.90,728.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Coventry,Workers Comp,,720.96,,,,,,,195.26,728.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,inpatient,,,119.00000,25.70000,Coventry,Workers Comp,,114.24,,,,,,,107.10,115.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,outpatient,,,119.00000,25.70000,Coventry,Workers Comp,,114.24,,,,,,,30.94,115.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,inpatient,,,126.00000,27.22000,Coventry,Workers Comp,,120.96,,,,,,,113.40,122.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,outpatient,,,126.00000,27.22000,Coventry,Workers Comp,,120.96,,,,,,,32.76,122.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,inpatient,,,110.00000,23.76000,Coventry,Workers Comp,,105.60,,,,,,,99.00,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Coventry,Workers Comp,,105.60,,,,,,,28.60,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,inpatient,,,110.00000,23.76000,Coventry,Workers Comp,,105.60,,,,,,,99.00,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Coventry,Workers Comp,,105.60,,,,,,,28.60,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,inpatient,,,79.00000,17.06000,Coventry,Workers Comp,,75.84,,,,,,,71.10,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,outpatient,,,79.00000,17.06000,Coventry,Workers Comp,,75.84,,,,,,,20.54,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,inpatient,,,110.00000,23.76000,Coventry,Workers Comp,,105.60,,,,,,,99.00,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Coventry,Workers Comp,,105.60,,,,,,,28.60,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,inpatient,,,110.00000,23.76000,Coventry,Workers Comp,,105.60,,,,,,,99.00,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Coventry,Workers Comp,,105.60,,,,,,,28.60,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,inpatient,,,79.00000,17.06000,Coventry,Workers Comp,,75.84,,,,,,,71.10,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,outpatient,,,79.00000,17.06000,Coventry,Workers Comp,,75.84,,,,,,,20.54,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,inpatient,,,335.00000,72.36000,Coventry,Workers Comp,,321.60,,,,,,,301.50,324.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,outpatient,,,335.00000,72.36000,Coventry,Workers Comp,,321.60,,,,,,,87.10,324.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,inpatient,,,154.00000,33.26000,Coventry,Workers Comp,,147.84,,,,,,,138.60,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Coventry,Workers Comp,,147.84,,,,,,,40.04,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,inpatient,,,154.00000,33.26000,Coventry,Workers Comp,,147.84,,,,,,,138.60,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Coventry,Workers Comp,,147.84,,,,,,,40.04,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,inpatient,,,128.00000,27.65000,Coventry,Workers Comp,,122.88,,,,,,,115.20,124.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,outpatient,,,128.00000,27.65000,Coventry,Workers Comp,,122.88,,,,,,,33.28,124.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,inpatient,,,65.00000,14.04000,Coventry,Workers Comp,,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,outpatient,,,65.00000,14.04000,Coventry,Workers Comp,,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,inpatient,,,272.00000,58.75000,Coventry,Workers Comp,,261.12,,,,,,,244.80,263.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,outpatient,,,272.00000,58.75000,Coventry,Workers Comp,,261.12,,,,,,,70.72,263.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,inpatient,,,26.00000,11.44000,Coventry,Workers Comp,,24.96,,,,,,,23.40,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,outpatient,,,26.00000,11.44000,Coventry,Workers Comp,,24.96,,,,,,,6.76,25.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,inpatient,,,359.00000,157.96000,Coventry,Workers Comp,,344.64,,,,,,,323.10,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,outpatient,,,359.00000,157.96000,Coventry,Workers Comp,,344.64,,,,,,,93.34,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,inpatient,,,189.00000,83.16000,Coventry,Workers Comp,,181.44,,,,,,,170.10,183.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,outpatient,,,189.00000,83.16000,Coventry,Workers Comp,,181.44,,,,,,,49.14,183.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,inpatient,,,359.00000,157.96000,Coventry,Workers Comp,,344.64,,,,,,,323.10,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,outpatient,,,359.00000,157.96000,Coventry,Workers Comp,,344.64,,,,,,,93.34,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,inpatient,,,137.00000,60.28000,Coventry,Workers Comp,,131.52,,,,,,,123.30,132.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,outpatient,,,137.00000,60.28000,Coventry,Workers Comp,,131.52,,,,,,,35.62,132.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,inpatient,,,1665.00000,732.60000,Coventry,Workers Comp,,1598.40,,,,,,,1498.50,1615.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,outpatient,,,1665.00000,732.60000,Coventry,Workers Comp,,1598.40,,,,,,,432.90,1615.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,inpatient,,,751.00000,330.44000,Coventry,Workers Comp,,720.96,,,,,,,675.90,728.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,outpatient,,,751.00000,330.44000,Coventry,Workers Comp,,720.96,,,,,,,195.26,728.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,inpatient,,,374.00000,164.56000,Coventry,Workers Comp,,359.04,,,,,,,336.60,362.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,outpatient,,,374.00000,164.56000,Coventry,Workers Comp,,359.04,,,,,,,97.24,362.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,inpatient,,,553.00000,243.32000,Coventry,Workers Comp,,530.88,,,,,,,497.70,536.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,outpatient,,,553.00000,243.32000,Coventry,Workers Comp,,530.88,,,,,,,143.78,536.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,inpatient,,,359.00000,157.96000,Coventry,Workers Comp,,344.64,,,,,,,323.10,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,outpatient,,,359.00000,157.96000,Coventry,Workers Comp,,344.64,,,,,,,93.34,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,inpatient,,,62.00000,27.28000,Coventry,Workers Comp,,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,outpatient,,,62.00000,27.28000,Coventry,Workers Comp,,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,inpatient,,,79.00000,34.76000,Coventry,Workers Comp,,75.84,,,,,,,71.10,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,outpatient,,,79.00000,34.76000,Coventry,Workers Comp,,75.84,,,,,,,20.54,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,inpatient,,,110.00000,48.40000,Coventry,Workers Comp,,105.60,,,,,,,99.00,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,outpatient,,,110.00000,48.40000,Coventry,Workers Comp,,105.60,,,,,,,28.60,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,inpatient,,,110.00000,48.40000,Coventry,Workers Comp,,105.60,,,,,,,99.00,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,outpatient,,,110.00000,48.40000,Coventry,Workers Comp,,105.60,,,,,,,28.60,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,inpatient,,,751.00000,330.44000,Coventry,Workers Comp,,720.96,,,,,,,675.90,728.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,outpatient,,,751.00000,330.44000,Coventry,Workers Comp,,720.96,,,,,,,195.26,728.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,inpatient,,,1665.00000,732.60000,Coventry,Workers Comp,,1598.40,,,,,,,1498.50,1615.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,outpatient,,,1665.00000,732.60000,Coventry,Workers Comp,,1598.40,,,,,,,432.90,1615.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,inpatient,,,110.00000,48.40000,Coventry,Workers Comp,,105.60,,,,,,,99.00,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,outpatient,,,110.00000,48.40000,Coventry,Workers Comp,,105.60,,,,,,,28.60,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,inpatient,,,281.00000,123.64000,Coventry,Workers Comp,,269.76,,,,,,,252.90,272.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Coventry,Workers Comp,,269.76,,,,,,,73.06,272.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,inpatient,,,281.00000,123.64000,Coventry,Workers Comp,,269.76,,,,,,,252.90,272.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Coventry,Workers Comp,,269.76,,,,,,,73.06,272.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,inpatient,,,451.00000,341.41000,Coventry,Workers Comp,,432.96,,,,,,,405.90,437.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,outpatient,,,451.00000,341.41000,Coventry,Workers Comp,,432.96,,,,,,,117.26,437.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,inpatient,,,300.00000,145.80000,Coventry,Workers Comp,,288.00,,,,,,,270.00,291.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,outpatient,,,300.00000,145.80000,Coventry,Workers Comp,,288.00,,,,,,,78.00,291.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,inpatient,,,2278.00000,1107.11000,Coventry,Workers Comp,,2186.88,,,,,,,2050.20,2209.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,outpatient,,,2278.00000,1107.11000,Coventry,Workers Comp,,2186.88,,,,,,,592.28,2209.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,inpatient,,,3912.00000,1901.23000,Coventry,Workers Comp,,3755.52,,,,,,,3520.80,3794.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,outpatient,,,3912.00000,1901.23000,Coventry,Workers Comp,,3755.52,,,,,,,1017.12,3794.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,inpatient,,,900.00000,437.40000,Coventry,Workers Comp,,864.00,,,,,,,810.00,873.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,outpatient,,,900.00000,437.40000,Coventry,Workers Comp,,864.00,,,,,,,234.00,873.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,inpatient,,,365.00000,177.39000,Coventry,Workers Comp,,350.40,,,,,,,328.50,354.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,outpatient,,,365.00000,177.39000,Coventry,Workers Comp,,350.40,,,,,,,94.90,354.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,inpatient,,,989.00000,480.65000,Coventry,Workers Comp,,949.44,,,,,,,890.10,959.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,outpatient,,,989.00000,480.65000,Coventry,Workers Comp,,949.44,,,,,,,257.14,959.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Coventry,Workers Comp,,472.32,,,,,,,442.80,477.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Coventry,Workers Comp,,472.32,,,,,,,127.92,477.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,inpatient,,,435.00000,211.41000,Coventry,Workers Comp,,417.60,,,,,,,391.50,421.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Coventry,Workers Comp,,417.60,,,,,,,113.10,421.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,inpatient,,,435.00000,211.41000,Coventry,Workers Comp,,417.60,,,,,,,391.50,421.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Coventry,Workers Comp,,417.60,,,,,,,113.10,421.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,inpatient,,,644.00000,312.98000,Coventry,Workers Comp,,618.24,,,,,,,579.60,624.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,outpatient,,,644.00000,312.98000,Coventry,Workers Comp,,618.24,,,,,,,167.44,624.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Coventry,Workers Comp,,472.32,,,,,,,442.80,477.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Coventry,Workers Comp,,472.32,,,,,,,127.92,477.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Coventry,Workers Comp,,472.32,,,,,,,442.80,477.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Coventry,Workers Comp,,472.32,,,,,,,127.92,477.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,inpatient,,,527.00000,256.12000,Coventry,Workers Comp,,505.92,,,,,,,474.30,511.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,outpatient,,,527.00000,256.12000,Coventry,Workers Comp,,505.92,,,,,,,137.02,511.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,inpatient,,,1404.00000,682.34000,Coventry,Workers Comp,,1347.84,,,,,,,1263.60,1361.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,outpatient,,,1404.00000,682.34000,Coventry,Workers Comp,,1347.84,,,,,,,365.04,1361.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,inpatient,,,5475.00000,2660.85000,Coventry,Workers Comp,,5256.00,,,,,,,4927.50,5310.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,outpatient,,,5475.00000,2660.85000,Coventry,Workers Comp,,5256.00,,,,,,,1423.50,5310.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,inpatient,,,726.00000,352.84000,Coventry,Workers Comp,,696.96,,,,,,,653.40,704.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,outpatient,,,726.00000,352.84000,Coventry,Workers Comp,,696.96,,,,,,,188.76,704.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,inpatient,,,507.00000,246.40000,Coventry,Workers Comp,,486.72,,,,,,,456.30,491.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,outpatient,,,507.00000,246.40000,Coventry,Workers Comp,,486.72,,,,,,,131.82,491.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,inpatient,,,1670.00000,811.62000,Coventry,Workers Comp,,1603.20,,,,,,,1503.00,1619.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,outpatient,,,1670.00000,811.62000,Coventry,Workers Comp,,1603.20,,,,,,,434.20,1619.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,inpatient,,,1139.00000,553.55000,Coventry,Workers Comp,,1093.44,,,,,,,1025.10,1104.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,outpatient,,,1139.00000,553.55000,Coventry,Workers Comp,,1093.44,,,,,,,296.14,1104.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,inpatient,,,875.00000,425.25000,Coventry,Workers Comp,,840.00,,,,,,,787.50,848.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,outpatient,,,875.00000,425.25000,Coventry,Workers Comp,,840.00,,,,,,,227.50,848.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,inpatient,,,525.00000,255.15000,Coventry,Workers Comp,,504.00,,,,,,,472.50,509.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,outpatient,,,525.00000,255.15000,Coventry,Workers Comp,,504.00,,,,,,,136.50,509.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,inpatient,,,1353.00000,657.56000,Coventry,Workers Comp,,1298.88,,,,,,,1217.70,1312.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,outpatient,,,1353.00000,657.56000,Coventry,Workers Comp,,1298.88,,,,,,,351.78,1312.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,inpatient,,,525.00000,255.15000,Coventry,Workers Comp,,504.00,,,,,,,472.50,509.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,outpatient,,,525.00000,255.15000,Coventry,Workers Comp,,504.00,,,,,,,136.50,509.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,inpatient,,,525.00000,255.15000,Coventry,Workers Comp,,504.00,,,,,,,472.50,509.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,outpatient,,,525.00000,255.15000,Coventry,Workers Comp,,504.00,,,,,,,136.50,509.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,inpatient,,,825.00000,400.95000,Coventry,Workers Comp,,792.00,,,,,,,742.50,800.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,outpatient,,,825.00000,400.95000,Coventry,Workers Comp,,792.00,,,,,,,214.50,800.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,inpatient,,,525.00000,255.15000,Coventry,Workers Comp,,504.00,,,,,,,472.50,509.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Coventry,Workers Comp,,504.00,,,,,,,136.50,509.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,inpatient,,,525.00000,255.15000,Coventry,Workers Comp,,504.00,,,,,,,472.50,509.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Coventry,Workers Comp,,504.00,,,,,,,136.50,509.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,inpatient,,,974.00000,473.36000,Coventry,Workers Comp,,935.04,,,,,,,876.60,944.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,outpatient,,,974.00000,473.36000,Coventry,Workers Comp,,935.04,,,,,,,253.24,944.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,inpatient,,,198.00000,96.23000,Coventry,Workers Comp,,190.08,,,,,,,178.20,192.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Coventry,Workers Comp,,190.08,,,,,,,51.48,192.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,inpatient,,,198.00000,96.23000,Coventry,Workers Comp,,190.08,,,,,,,178.20,192.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Coventry,Workers Comp,,190.08,,,,,,,51.48,192.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,inpatient,,,221.00000,107.41000,Coventry,Workers Comp,,212.16,,,,,,,198.90,214.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Coventry,Workers Comp,,212.16,,,,,,,57.46,214.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,inpatient,,,221.00000,107.41000,Coventry,Workers Comp,,212.16,,,,,,,198.90,214.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Coventry,Workers Comp,,212.16,,,,,,,57.46,214.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,inpatient,,,497.00000,241.54000,Coventry,Workers Comp,,477.12,,,,,,,447.30,482.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,outpatient,,,497.00000,241.54000,Coventry,Workers Comp,,477.12,,,,,,,129.22,482.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,inpatient,,,2340.00000,1137.24000,Coventry,Workers Comp,,2246.40,,,,,,,2106.00,2269.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,outpatient,,,2340.00000,1137.24000,Coventry,Workers Comp,,2246.40,,,,,,,608.40,2269.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,inpatient,,,249.00000,121.01000,Coventry,Workers Comp,,239.04,,,,,,,224.10,241.53,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,outpatient,,,249.00000,121.01000,Coventry,Workers Comp,,239.04,,,,,,,64.74,241.53,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,inpatient,,,135.00000,65.61000,Coventry,Workers Comp,,129.60,,,,,,,121.50,130.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,outpatient,,,135.00000,65.61000,Coventry,Workers Comp,,129.60,,,,,,,35.10,130.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,inpatient,,,172.00000,83.59000,Coventry,Workers Comp,,165.12,,,,,,,154.80,166.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,outpatient,,,172.00000,83.59000,Coventry,Workers Comp,,165.12,,,,,,,44.72,166.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,inpatient,,,307.00000,149.20000,Coventry,Workers Comp,,294.72,,,,,,,276.30,297.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,outpatient,,,307.00000,149.20000,Coventry,Workers Comp,,294.72,,,,,,,79.82,297.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,inpatient,,,1800.00000,874.80000,Coventry,Workers Comp,,1728.00,,,,,,,1620.00,1746.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,outpatient,,,1800.00000,874.80000,Coventry,Workers Comp,,1728.00,,,,,,,468.00,1746.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,inpatient,,,974.00000,473.36000,Coventry,Workers Comp,,935.04,,,,,,,876.60,944.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,outpatient,,,974.00000,473.36000,Coventry,Workers Comp,,935.04,,,,,,,253.24,944.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,inpatient,,,197.00000,95.74000,Coventry,Workers Comp,,189.12,,,,,,,177.30,191.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Coventry,Workers Comp,,189.12,,,,,,,51.22,191.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,inpatient,,,197.00000,95.74000,Coventry,Workers Comp,,189.12,,,,,,,177.30,191.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Coventry,Workers Comp,,189.12,,,,,,,51.22,191.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,inpatient,,,411.00000,199.75000,Coventry,Workers Comp,,394.56,,,,,,,369.90,398.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,outpatient,,,411.00000,199.75000,Coventry,Workers Comp,,394.56,,,,,,,106.86,398.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,inpatient,,,221.00000,107.41000,Coventry,Workers Comp,,212.16,,,,,,,198.90,214.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,outpatient,,,221.00000,107.41000,Coventry,Workers Comp,,212.16,,,,,,,57.46,214.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,inpatient,,,884.00000,429.62000,Coventry,Workers Comp,,848.64,,,,,,,795.60,857.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,outpatient,,,884.00000,429.62000,Coventry,Workers Comp,,848.64,,,,,,,229.84,857.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,inpatient,,,594.00000,288.68000,Coventry,Workers Comp,,570.24,,,,,,,534.60,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,outpatient,,,594.00000,288.68000,Coventry,Workers Comp,,570.24,,,,,,,154.44,576.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,inpatient,,,519.00000,252.23000,Coventry,Workers Comp,,498.24,,,,,,,467.10,503.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,outpatient,,,519.00000,252.23000,Coventry,Workers Comp,,498.24,,,,,,,134.94,503.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,inpatient,,,1046.00000,508.36000,Coventry,Workers Comp,,1004.16,,,,,,,941.40,1014.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,outpatient,,,1046.00000,508.36000,Coventry,Workers Comp,,1004.16,,,,,,,271.96,1014.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,inpatient,,,556.00000,270.22000,Coventry,Workers Comp,,533.76,,,,,,,500.40,539.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,outpatient,,,556.00000,270.22000,Coventry,Workers Comp,,533.76,,,,,,,144.56,539.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,inpatient,,,275.00000,133.65000,Coventry,Workers Comp,,264.00,,,,,,,247.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,outpatient,,,275.00000,133.65000,Coventry,Workers Comp,,264.00,,,,,,,71.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,inpatient,,,580.00000,281.88000,Coventry,Workers Comp,,556.80,,,,,,,522.00,562.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,outpatient,,,580.00000,281.88000,Coventry,Workers Comp,,556.80,,,,,,,150.80,562.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,inpatient,,,580.00000,281.88000,Coventry,Workers Comp,,556.80,,,,,,,522.00,562.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,outpatient,,,580.00000,281.88000,Coventry,Workers Comp,,556.80,,,,,,,150.80,562.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,inpatient,,,3480.00000,1691.28000,Coventry,Workers Comp,,3340.80,,,,,,,3132.00,3375.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Coventry,Workers Comp,,3340.80,,,,,,,904.80,3375.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,inpatient,,,3480.00000,1691.28000,Coventry,Workers Comp,,3340.80,,,,,,,3132.00,3375.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Coventry,Workers Comp,,3340.80,,,,,,,904.80,3375.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,inpatient,,,700.00000,340.20000,Coventry,Workers Comp,,672.00,,,,,,,630.00,679.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,outpatient,,,700.00000,340.20000,Coventry,Workers Comp,,672.00,,,,,,,182.00,679.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,inpatient,,,1427.00000,693.52000,Coventry,Workers Comp,,1369.92,,,,,,,1284.30,1384.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,outpatient,,,1427.00000,693.52000,Coventry,Workers Comp,,1369.92,,,,,,,371.02,1384.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,inpatient,,,614.00000,298.40000,Coventry,Workers Comp,,589.44,,,,,,,552.60,595.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,outpatient,,,614.00000,298.40000,Coventry,Workers Comp,,589.44,,,,,,,159.64,595.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,inpatient,,,2027.00000,985.12000,Coventry,Workers Comp,,1945.92,,,,,,,1824.30,1966.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,outpatient,,,2027.00000,985.12000,Coventry,Workers Comp,,1945.92,,,,,,,527.02,1966.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,inpatient,,,556.00000,270.22000,Coventry,Workers Comp,,533.76,,,,,,,500.40,539.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,outpatient,,,556.00000,270.22000,Coventry,Workers Comp,,533.76,,,,,,,144.56,539.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,inpatient,,,1146.00000,556.96000,Coventry,Workers Comp,,1100.16,,,,,,,1031.40,1111.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,outpatient,,,1146.00000,556.96000,Coventry,Workers Comp,,1100.16,,,,,,,297.96,1111.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,inpatient,,,197.00000,95.74000,Coventry,Workers Comp,,189.12,,,,,,,177.30,191.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Coventry,Workers Comp,,189.12,,,,,,,51.22,191.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,inpatient,,,197.00000,95.74000,Coventry,Workers Comp,,189.12,,,,,,,177.30,191.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Coventry,Workers Comp,,189.12,,,,,,,51.22,191.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,inpatient,,,527.00000,256.12000,Coventry,Workers Comp,,505.92,,,,,,,474.30,511.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,outpatient,,,527.00000,256.12000,Coventry,Workers Comp,,505.92,,,,,,,137.02,511.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,inpatient,,,740.00000,359.64000,Coventry,Workers Comp,,710.40,,,,,,,666.00,717.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,outpatient,,,740.00000,359.64000,Coventry,Workers Comp,,710.40,,,,,,,192.40,717.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,inpatient,,,875.00000,425.25000,Coventry,Workers Comp,,840.00,,,,,,,787.50,848.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Coventry,Workers Comp,,840.00,,,,,,,227.50,848.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,inpatient,,,875.00000,425.25000,Coventry,Workers Comp,,840.00,,,,,,,787.50,848.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Coventry,Workers Comp,,840.00,,,,,,,227.50,848.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,inpatient,,,1399.00000,679.91000,Coventry,Workers Comp,,1343.04,,,,,,,1259.10,1357.03,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,outpatient,,,1399.00000,679.91000,Coventry,Workers Comp,,1343.04,,,,,,,363.74,1357.03,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,inpatient,,,51.00000,24.79000,Coventry,Workers Comp,,48.96,,,,,,,45.90,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,outpatient,,,51.00000,24.79000,Coventry,Workers Comp,,48.96,,,,,,,13.26,49.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,inpatient,,,825.00000,400.95000,Coventry,Workers Comp,,792.00,,,,,,,742.50,800.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,outpatient,,,825.00000,400.95000,Coventry,Workers Comp,,792.00,,,,,,,214.50,800.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,inpatient,,,576.00000,279.94000,Coventry,Workers Comp,,552.96,,,,,,,518.40,558.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,outpatient,,,576.00000,279.94000,Coventry,Workers Comp,,552.96,,,,,,,149.76,558.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,inpatient,,,224.00000,108.86000,Coventry,Workers Comp,,215.04,,,,,,,201.60,217.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,outpatient,,,224.00000,108.86000,Coventry,Workers Comp,,215.04,,,,,,,58.24,217.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,inpatient,,,346.00000,168.16000,Coventry,Workers Comp,,332.16,,,,,,,311.40,335.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,outpatient,,,346.00000,168.16000,Coventry,Workers Comp,,332.16,,,,,,,89.96,335.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,inpatient,,,525.00000,255.15000,Coventry,Workers Comp,,504.00,,,,,,,472.50,509.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,outpatient,,,525.00000,255.15000,Coventry,Workers Comp,,504.00,,,,,,,136.50,509.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,inpatient,,,525.00000,255.15000,Coventry,Workers Comp,,504.00,,,,,,,472.50,509.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,outpatient,,,525.00000,255.15000,Coventry,Workers Comp,,504.00,,,,,,,136.50,509.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,inpatient,,,525.00000,255.15000,Coventry,Workers Comp,,504.00,,,,,,,472.50,509.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Coventry,Workers Comp,,504.00,,,,,,,136.50,509.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,inpatient,,,525.00000,255.15000,Coventry,Workers Comp,,504.00,,,,,,,472.50,509.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Coventry,Workers Comp,,504.00,,,,,,,136.50,509.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,inpatient,,,627.00000,304.72000,Coventry,Workers Comp,,601.92,,,,,,,564.30,608.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,outpatient,,,627.00000,304.72000,Coventry,Workers Comp,,601.92,,,,,,,163.02,608.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,inpatient,,,605.00000,294.03000,Coventry,Workers Comp,,580.80,,,,,,,544.50,586.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,outpatient,,,605.00000,294.03000,Coventry,Workers Comp,,580.80,,,,,,,157.30,586.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,inpatient,,,510.00000,247.86000,Coventry,Workers Comp,,489.60,,,,,,,459.00,494.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,outpatient,,,510.00000,247.86000,Coventry,Workers Comp,,489.60,,,,,,,132.60,494.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,inpatient,,,223.00000,108.38000,Coventry,Workers Comp,,214.08,,,,,,,200.70,216.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,outpatient,,,223.00000,108.38000,Coventry,Workers Comp,,214.08,,,,,,,57.98,216.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,inpatient,,,1211.00000,588.55000,Coventry,Workers Comp,,1162.56,,,,,,,1089.90,1174.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,outpatient,,,1211.00000,588.55000,Coventry,Workers Comp,,1162.56,,,,,,,314.86,1174.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,inpatient,,,383.00000,186.14000,Coventry,Workers Comp,,367.68,,,,,,,344.70,371.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,outpatient,,,383.00000,186.14000,Coventry,Workers Comp,,367.68,,,,,,,99.58,371.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,inpatient,,,1214.00000,590.00000,Coventry,Workers Comp,,1165.44,,,,,,,1092.60,1177.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,outpatient,,,1214.00000,590.00000,Coventry,Workers Comp,,1165.44,,,,,,,315.64,1177.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,inpatient,,,328.00000,159.41000,Coventry,Workers Comp,,314.88,,,,,,,295.20,318.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,outpatient,,,328.00000,159.41000,Coventry,Workers Comp,,314.88,,,,,,,85.28,318.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,inpatient,,,372.00000,180.79000,Coventry,Workers Comp,,357.12,,,,,,,334.80,360.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,outpatient,,,372.00000,180.79000,Coventry,Workers Comp,,357.12,,,,,,,96.72,360.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,inpatient,,,285.00000,138.51000,Coventry,Workers Comp,,273.60,,,,,,,256.50,276.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,outpatient,,,285.00000,138.51000,Coventry,Workers Comp,,273.60,,,,,,,74.10,276.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,inpatient,,,367.00000,178.36000,Coventry,Workers Comp,,352.32,,,,,,,330.30,355.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,outpatient,,,367.00000,178.36000,Coventry,Workers Comp,,352.32,,,,,,,95.42,355.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,inpatient,,,702.00000,341.17000,Coventry,Workers Comp,,673.92,,,,,,,631.80,680.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Coventry,Workers Comp,,673.92,,,,,,,182.52,680.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,inpatient,,,702.00000,341.17000,Coventry,Workers Comp,,673.92,,,,,,,631.80,680.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Coventry,Workers Comp,,673.92,,,,,,,182.52,680.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,inpatient,,,265.00000,128.79000,Coventry,Workers Comp,,254.40,,,,,,,238.50,257.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,outpatient,,,265.00000,128.79000,Coventry,Workers Comp,,254.40,,,,,,,68.90,257.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,inpatient,,,2279.00000,1107.59000,Coventry,Workers Comp,,2187.84,,,,,,,2051.10,2210.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2279.00000,1107.59000,Coventry,Workers Comp,,2187.84,,,,,,,592.54,2210.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,inpatient,,,2395.00000,1163.97000,Coventry,Workers Comp,,2299.20,,,,,,,2155.50,2323.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2395.00000,1163.97000,Coventry,Workers Comp,,2299.20,,,,,,,622.70,2323.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,inpatient,,,8759.00000,4256.87000,Coventry,Workers Comp,,8408.64,,,,,,,7883.10,8496.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Coventry,Workers Comp,,8408.64,,,,,,,2277.34,8496.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,inpatient,,,8759.00000,4256.87000,Coventry,Workers Comp,,8408.64,,,,,,,7883.10,8496.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Coventry,Workers Comp,,8408.64,,,,,,,2277.34,8496.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,inpatient,,,2752.00000,1337.47000,Coventry,Workers Comp,,2641.92,,,,,,,2476.80,2669.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,outpatient,,,2752.00000,1337.47000,Coventry,Workers Comp,,2641.92,,,,,,,715.52,2669.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,inpatient,,,217.00000,105.46000,Coventry,Workers Comp,,208.32,,,,,,,195.30,210.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Coventry,Workers Comp,,208.32,,,,,,,56.42,210.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,inpatient,,,217.00000,105.46000,Coventry,Workers Comp,,208.32,,,,,,,195.30,210.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Coventry,Workers Comp,,208.32,,,,,,,56.42,210.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,inpatient,,,292.00000,141.91000,Coventry,Workers Comp,,280.32,,,,,,,262.80,283.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,outpatient,,,292.00000,141.91000,Coventry,Workers Comp,,280.32,,,,,,,75.92,283.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Coventry,Workers Comp,,394.56,,,,,,,369.90,398.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Coventry,Workers Comp,,394.56,,,,,,,106.86,398.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Coventry,Workers Comp,,394.56,,,,,,,369.90,398.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Coventry,Workers Comp,,394.56,,,,,,,106.86,398.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Coventry,Workers Comp,,394.56,,,,,,,369.90,398.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Coventry,Workers Comp,,394.56,,,,,,,106.86,398.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,inpatient,,,2275.00000,1105.65000,Coventry,Workers Comp,,2184.00,,,,,,,2047.50,2206.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,outpatient,,,2275.00000,1105.65000,Coventry,Workers Comp,,2184.00,,,,,,,591.50,2206.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,inpatient,,,192.00000,93.31000,Coventry,Workers Comp,,184.32,,,,,,,172.80,186.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,outpatient,,,192.00000,93.31000,Coventry,Workers Comp,,184.32,,,,,,,49.92,186.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,inpatient,,,451.00000,219.19000,Coventry,Workers Comp,,432.96,,,,,,,405.90,437.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,outpatient,,,451.00000,219.19000,Coventry,Workers Comp,,432.96,,,,,,,117.26,437.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,inpatient,,,617.00000,299.86000,Coventry,Workers Comp,,592.32,,,,,,,555.30,598.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,outpatient,,,617.00000,299.86000,Coventry,Workers Comp,,592.32,,,,,,,160.42,598.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,inpatient,,,825.00000,400.95000,Coventry,Workers Comp,,792.00,,,,,,,742.50,800.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,outpatient,,,825.00000,400.95000,Coventry,Workers Comp,,792.00,,,,,,,214.50,800.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,inpatient,,,905.00000,439.83000,Coventry,Workers Comp,,868.80,,,,,,,814.50,877.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,outpatient,,,905.00000,439.83000,Coventry,Workers Comp,,868.80,,,,,,,235.30,877.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,inpatient,,,849.00000,412.61000,Coventry,Workers Comp,,815.04,,,,,,,764.10,823.53,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,outpatient,,,849.00000,412.61000,Coventry,Workers Comp,,815.04,,,,,,,220.74,823.53,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,inpatient,,,2539.00000,1233.95000,Coventry,Workers Comp,,2437.44,,,,,,,2285.10,2462.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,outpatient,,,2539.00000,1233.95000,Coventry,Workers Comp,,2437.44,,,,,,,660.14,2462.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,inpatient,,,6000.00000,2916.00000,Coventry,Workers Comp,,5760.00,,,,,,,5400.00,5820.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,outpatient,,,6000.00000,2916.00000,Coventry,Workers Comp,,5760.00,,,,,,,1560.00,5820.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,inpatient,,,8260.00000,4014.36000,Coventry,Workers Comp,,7929.60,,,,,,,7434.00,8012.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,outpatient,,,8260.00000,4014.36000,Coventry,Workers Comp,,7929.60,,,,,,,2147.60,8012.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,inpatient,,,202.00000,88.88000,Coventry,Workers Comp,,193.92,,,,,,,181.80,195.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,outpatient,,,202.00000,88.88000,Coventry,Workers Comp,,193.92,,,,,,,52.52,195.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,inpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,outpatient,,,66.00000,31.81000,Coventry,Workers Comp,,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,inpatient,,,295.00000,142.19000,Coventry,Workers Comp,,283.20,,,,,,,265.50,286.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,outpatient,,,295.00000,142.19000,Coventry,Workers Comp,,283.20,,,,,,,76.70,286.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,89.00000,26.79000,Coventry,Workers Comp,,85.44,,,,,,,80.10,86.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,89.00000,26.79000,Coventry,Workers Comp,,85.44,,,,,,,23.14,86.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,inpatient,,,93.00000,27.99000,Coventry,Workers Comp,,89.28,,,,,,,83.70,90.21,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Coventry,Workers Comp,,89.28,,,,,,,24.18,90.21,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,93.00000,27.99000,Coventry,Workers Comp,,89.28,,,,,,,83.70,90.21,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Coventry,Workers Comp,,89.28,,,,,,,24.18,90.21,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Coventry,Workers Comp,,1800.00,,,,,,,1687.50,1818.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Coventry,Workers Comp,,1800.00,,,,,,,487.50,1818.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Coventry,Workers Comp,,1800.00,,,,,,,1687.50,1818.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Coventry,Workers Comp,,1800.00,,,,,,,487.50,1818.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1752.00000,527.35000,Coventry,Workers Comp,,1681.92,,,,,,,1576.80,1699.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Coventry,Workers Comp,,1681.92,,,,,,,455.52,1699.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1752.00000,527.35000,Coventry,Workers Comp,,1681.92,,,,,,,1576.80,1699.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Coventry,Workers Comp,,1681.92,,,,,,,455.52,1699.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,731.00000,220.03000,Coventry,Workers Comp,,701.76,,,,,,,657.90,709.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,731.00000,220.03000,Coventry,Workers Comp,,701.76,,,,,,,190.06,709.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,787.00000,236.89000,Coventry,Workers Comp,,755.52,,,,,,,708.30,763.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,787.00000,236.89000,Coventry,Workers Comp,,755.52,,,,,,,204.62,763.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,2042.00000,614.64000,Coventry,Workers Comp,,1960.32,,,,,,,1837.80,1980.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,2042.00000,614.64000,Coventry,Workers Comp,,1960.32,,,,,,,530.92,1980.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Coventry,Workers Comp,,1800.00,,,,,,,1687.50,1818.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Coventry,Workers Comp,,1800.00,,,,,,,487.50,1818.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,714.00000,214.91000,Coventry,Workers Comp,,685.44,,,,,,,642.60,692.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,714.00000,214.91000,Coventry,Workers Comp,,685.44,,,,,,,185.64,692.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,294.00000,88.49000,Coventry,Workers Comp,,282.24,,,,,,,264.60,285.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,294.00000,88.49000,Coventry,Workers Comp,,282.24,,,,,,,76.44,285.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,inpatient,,,350.00000,105.35000,Coventry,Workers Comp,,336.00,,,,,,,315.00,339.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,350.00000,105.35000,Coventry,Workers Comp,,336.00,,,,,,,91.00,339.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,inpatient,,,1350.00000,780.30000,Coventry,Workers Comp,,1296.00,,,,,,,1215.00,1309.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,outpatient,,,1350.00000,780.30000,Coventry,Workers Comp,,1296.00,,,,,,,351.00,1309.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,inpatient,,,3680.00000,2127.04000,Coventry,Workers Comp,,3532.80,,,,,,,3312.00,3569.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,outpatient,,,3680.00000,2127.04000,Coventry,Workers Comp,,3532.80,,,,,,,956.80,3569.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,inpatient,,,1600.00000,924.80000,Coventry,Workers Comp,,1536.00,,,,,,,1440.00,1552.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,outpatient,,,1600.00000,924.80000,Coventry,Workers Comp,,1536.00,,,,,,,416.00,1552.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,inpatient,,,4680.00000,2705.04000,Coventry,Workers Comp,,4492.80,,,,,,,4212.00,4539.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,outpatient,,,4680.00000,2705.04000,Coventry,Workers Comp,,4492.80,,,,,,,1216.80,4539.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,inpatient,,,2100.00000,1213.80000,Coventry,Workers Comp,,2016.00,,,,,,,1890.00,2037.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,outpatient,,,2100.00000,1213.80000,Coventry,Workers Comp,,2016.00,,,,,,,546.00,2037.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,inpatient,,,5680.00000,3283.04000,Coventry,Workers Comp,,5452.80,,,,,,,5112.00,5509.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,outpatient,,,5680.00000,3283.04000,Coventry,Workers Comp,,5452.80,,,,,,,1476.80,5509.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,inpatient,,,2420.00000,1398.76000,Coventry,Workers Comp,,2323.20,,,,,,,2178.00,2347.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,outpatient,,,2420.00000,1398.76000,Coventry,Workers Comp,,2323.20,,,,,,,629.20,2347.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,inpatient,,,6415.00000,3707.87000,Coventry,Workers Comp,,6158.40,,,,,,,5773.50,6222.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,outpatient,,,6415.00000,3707.87000,Coventry,Workers Comp,,6158.40,,,,,,,1667.90,6222.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,inpatient,,,2920.00000,1687.76000,Coventry,Workers Comp,,2803.20,,,,,,,2628.00,2832.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,outpatient,,,2920.00000,1687.76000,Coventry,Workers Comp,,2803.20,,,,,,,759.20,2832.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,inpatient,,,8915.00000,5152.87000,Coventry,Workers Comp,,8558.40,,,,,,,8023.50,8647.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,outpatient,,,8915.00000,5152.87000,Coventry,Workers Comp,,8558.40,,,,,,,2317.90,8647.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,inpatient,,,3420.00000,1976.76000,Coventry,Workers Comp,,3283.20,,,,,,,3078.00,3317.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,outpatient,,,3420.00000,1976.76000,Coventry,Workers Comp,,3283.20,,,,,,,889.20,3317.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,inpatient,,,11415.00000,6597.87000,Coventry,Workers Comp,,10958.40,,,,,,,10273.50,11072.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,outpatient,,,11415.00000,6597.87000,Coventry,Workers Comp,,10958.40,,,,,,,2967.90,11072.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,inpatient,,,142.00000,154.35000,Coventry,Workers Comp,,136.32,,,,,,,127.80,137.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,outpatient,,,142.00000,154.35000,Coventry,Workers Comp,,136.32,,,,,,,36.92,137.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,inpatient,,,340.00000,228.82000,Coventry,Workers Comp,,326.40,,,,,,,306.00,329.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Coventry,Workers Comp,,326.40,,,,,,,88.40,329.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,inpatient,,,670.00000,450.91000,Coventry,Workers Comp,,643.20,,,,,,,603.00,649.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Coventry,Workers Comp,,643.20,,,,,,,174.20,649.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,inpatient,,,390.00000,262.47000,Coventry,Workers Comp,,374.40,,,,,,,351.00,378.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,outpatient,,,390.00000,262.47000,Coventry,Workers Comp,,374.40,,,,,,,101.40,378.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,inpatient,,,1170.00000,787.41000,Coventry,Workers Comp,,1123.20,,,,,,,1053.00,1134.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,outpatient,,,1170.00000,787.41000,Coventry,Workers Comp,,1123.20,,,,,,,304.20,1134.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,inpatient,,,440.00000,296.12000,Coventry,Workers Comp,,422.40,,,,,,,396.00,426.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,outpatient,,,440.00000,296.12000,Coventry,Workers Comp,,422.40,,,,,,,114.40,426.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,inpatient,,,1670.00000,1123.91000,Coventry,Workers Comp,,1603.20,,,,,,,1503.00,1619.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,outpatient,,,1670.00000,1123.91000,Coventry,Workers Comp,,1603.20,,,,,,,434.20,1619.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,inpatient,,,640.00000,430.72000,Coventry,Workers Comp,,614.40,,,,,,,576.00,620.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,outpatient,,,640.00000,430.72000,Coventry,Workers Comp,,614.40,,,,,,,166.40,620.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,inpatient,,,2170.00000,1460.41000,Coventry,Workers Comp,,2083.20,,,,,,,1953.00,2104.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,outpatient,,,2170.00000,1460.41000,Coventry,Workers Comp,,2083.20,,,,,,,564.20,2104.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,inpatient,,,17.00000,10.96000,Coventry,Workers Comp,,16.32,,,,,,,15.30,16.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,outpatient,,,17.00000,10.96000,Coventry,Workers Comp,,16.32,,,,,,,4.42,16.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,inpatient,,,535.00000,345.08000,Coventry,Workers Comp,,513.60,,,,,,,481.50,518.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,outpatient,,,535.00000,345.08000,Coventry,Workers Comp,,513.60,,,,,,,139.10,518.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,inpatient,,,23.00000,14.84000,Coventry,Workers Comp,,22.08,,,,,,,20.70,22.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,outpatient,,,23.00000,14.84000,Coventry,Workers Comp,,22.08,,,,,,,5.98,22.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,inpatient,,,635.00000,409.58000,Coventry,Workers Comp,,609.60,,,,,,,571.50,615.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,outpatient,,,635.00000,409.58000,Coventry,Workers Comp,,609.60,,,,,,,165.10,615.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,inpatient,,,30.00000,19.35000,Coventry,Workers Comp,,28.80,,,,,,,27.00,29.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,outpatient,,,30.00000,19.35000,Coventry,Workers Comp,,28.80,,,,,,,7.80,29.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,inpatient,,,735.00000,474.08000,Coventry,Workers Comp,,705.60,,,,,,,661.50,712.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,outpatient,,,735.00000,474.08000,Coventry,Workers Comp,,705.60,,,,,,,191.10,712.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,inpatient,,,33.00000,21.28000,Coventry,Workers Comp,,31.68,,,,,,,29.70,32.01,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,outpatient,,,33.00000,21.28000,Coventry,Workers Comp,,31.68,,,,,,,8.58,32.01,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,inpatient,,,835.00000,538.58000,Coventry,Workers Comp,,801.60,,,,,,,751.50,809.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,outpatient,,,835.00000,538.58000,Coventry,Workers Comp,,801.60,,,,,,,217.10,809.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,inpatient,,,140.00000,80.92000,Coventry,Workers Comp,,134.40,,,,,,,126.00,135.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,outpatient,,,140.00000,80.92000,Coventry,Workers Comp,,134.40,,,,,,,36.40,135.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,inpatient,,,275.00000,158.95000,Coventry,Workers Comp,,264.00,,,,,,,247.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,outpatient,,,275.00000,158.95000,Coventry,Workers Comp,,264.00,,,,,,,71.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,inpatient,,,295.00000,170.51000,Coventry,Workers Comp,,283.20,,,,,,,265.50,286.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,outpatient,,,295.00000,170.51000,Coventry,Workers Comp,,283.20,,,,,,,76.70,286.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,inpatient,,,590.00000,341.02000,Coventry,Workers Comp,,566.40,,,,,,,531.00,572.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,outpatient,,,590.00000,341.02000,Coventry,Workers Comp,,566.40,,,,,,,153.40,572.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,inpatient,,,690.00000,398.82000,Coventry,Workers Comp,,662.40,,,,,,,621.00,669.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,outpatient,,,690.00000,398.82000,Coventry,Workers Comp,,662.40,,,,,,,179.40,669.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,inpatient,,,1375.00000,794.75000,Coventry,Workers Comp,,1320.00,,,,,,,1237.50,1333.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,outpatient,,,1375.00000,794.75000,Coventry,Workers Comp,,1320.00,,,,,,,357.50,1333.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,inpatient,,,950.00000,549.10000,Coventry,Workers Comp,,912.00,,,,,,,855.00,921.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,outpatient,,,950.00000,549.10000,Coventry,Workers Comp,,912.00,,,,,,,247.00,921.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,inpatient,,,1900.00000,1098.20000,Coventry,Workers Comp,,1824.00,,,,,,,1710.00,1843.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,outpatient,,,1900.00000,1098.20000,Coventry,Workers Comp,,1824.00,,,,,,,494.00,1843.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,inpatient,,,140.00000,45.22000,Coventry,Workers Comp,,134.40,,,,,,,126.00,135.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,outpatient,,,140.00000,45.22000,Coventry,Workers Comp,,134.40,,,,,,,36.40,135.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,inpatient,,,275.00000,88.82000,Coventry,Workers Comp,,264.00,,,,,,,247.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,outpatient,,,275.00000,88.82000,Coventry,Workers Comp,,264.00,,,,,,,71.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,inpatient,,,295.00000,95.28000,Coventry,Workers Comp,,283.20,,,,,,,265.50,286.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,outpatient,,,295.00000,95.28000,Coventry,Workers Comp,,283.20,,,,,,,76.70,286.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,inpatient,,,590.00000,190.57000,Coventry,Workers Comp,,566.40,,,,,,,531.00,572.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,outpatient,,,590.00000,190.57000,Coventry,Workers Comp,,566.40,,,,,,,153.40,572.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,inpatient,,,690.00000,222.87000,Coventry,Workers Comp,,662.40,,,,,,,621.00,669.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,outpatient,,,690.00000,222.87000,Coventry,Workers Comp,,662.40,,,,,,,179.40,669.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,inpatient,,,1375.00000,444.12000,Coventry,Workers Comp,,1320.00,,,,,,,1237.50,1333.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,outpatient,,,1375.00000,444.12000,Coventry,Workers Comp,,1320.00,,,,,,,357.50,1333.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,inpatient,,,950.00000,306.85000,Coventry,Workers Comp,,912.00,,,,,,,855.00,921.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,outpatient,,,950.00000,306.85000,Coventry,Workers Comp,,912.00,,,,,,,247.00,921.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,inpatient,,,1900.00000,613.70000,Coventry,Workers Comp,,1824.00,,,,,,,1710.00,1843.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,outpatient,,,1900.00000,613.70000,Coventry,Workers Comp,,1824.00,,,,,,,494.00,1843.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,inpatient,,,340.00000,228.82000,Coventry,Workers Comp,,326.40,,,,,,,306.00,329.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Coventry,Workers Comp,,326.40,,,,,,,88.40,329.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,inpatient,,,670.00000,450.91000,Coventry,Workers Comp,,643.20,,,,,,,603.00,649.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Coventry,Workers Comp,,643.20,,,,,,,174.20,649.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Coventry,Workers Comp,,470.40,,,,,,,441.00,475.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Coventry,Workers Comp,,470.40,,,,,,,127.40,475.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,inpatient,,,490.00000,329.77000,Coventry,Workers Comp,,470.40,,,,,,,441.00,475.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Coventry,Workers Comp,,470.40,,,,,,,127.40,475.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Coventry,Workers Comp,,470.40,,,,,,,441.00,475.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Coventry,Workers Comp,,470.40,,,,,,,127.40,475.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,inpatient,,,245.00000,164.89000,Coventry,Workers Comp,,235.20,,,,,,,220.50,237.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Coventry,Workers Comp,,235.20,,,,,,,63.70,237.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Coventry,Workers Comp,,808.32,,,,,,,757.80,816.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Coventry,Workers Comp,,808.32,,,,,,,218.92,816.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Coventry,Workers Comp,,1010.88,,,,,,,947.70,1021.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Coventry,Workers Comp,,1010.88,,,,,,,273.78,1021.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Coventry,Workers Comp,,1212.48,,,,,,,1136.70,1225.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Coventry,Workers Comp,,1212.48,,,,,,,328.38,1225.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,inpatient,,,1178.00000,669.28000,Coventry,Workers Comp,,1130.88,,,,,,,1060.20,1142.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1178.00000,669.28000,Coventry,Workers Comp,,1130.88,,,,,,,306.28,1142.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,inpatient,,,140.00000,102.34000,Coventry,Workers Comp,,134.40,,,,,,,126.00,135.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,outpatient,,,140.00000,102.34000,Coventry,Workers Comp,,134.40,,,,,,,36.40,135.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,inpatient,,,275.00000,201.02000,Coventry,Workers Comp,,264.00,,,,,,,247.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,outpatient,,,275.00000,201.02000,Coventry,Workers Comp,,264.00,,,,,,,71.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,inpatient,,,295.00000,215.64000,Coventry,Workers Comp,,283.20,,,,,,,265.50,286.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,outpatient,,,295.00000,215.64000,Coventry,Workers Comp,,283.20,,,,,,,76.70,286.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,inpatient,,,590.00000,431.29000,Coventry,Workers Comp,,566.40,,,,,,,531.00,572.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,outpatient,,,590.00000,431.29000,Coventry,Workers Comp,,566.40,,,,,,,153.40,572.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,inpatient,,,690.00000,504.39000,Coventry,Workers Comp,,662.40,,,,,,,621.00,669.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,outpatient,,,690.00000,504.39000,Coventry,Workers Comp,,662.40,,,,,,,179.40,669.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,inpatient,,,1375.00000,1005.12000,Coventry,Workers Comp,,1320.00,,,,,,,1237.50,1333.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,outpatient,,,1375.00000,1005.12000,Coventry,Workers Comp,,1320.00,,,,,,,357.50,1333.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,inpatient,,,950.00000,694.45000,Coventry,Workers Comp,,912.00,,,,,,,855.00,921.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,outpatient,,,950.00000,694.45000,Coventry,Workers Comp,,912.00,,,,,,,247.00,921.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,inpatient,,,1900.00000,1388.90000,Coventry,Workers Comp,,1824.00,,,,,,,1710.00,1843.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,outpatient,,,1900.00000,1388.90000,Coventry,Workers Comp,,1824.00,,,,,,,494.00,1843.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,inpatient,,,584.00000,426.90000,Coventry,Workers Comp,,560.64,,,,,,,525.60,566.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,outpatient,,,584.00000,426.90000,Coventry,Workers Comp,,560.64,,,,,,,151.84,566.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,inpatient,,,1391.00000,1016.82000,Coventry,Workers Comp,,1335.36,,,,,,,1251.90,1349.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,outpatient,,,1391.00000,1016.82000,Coventry,Workers Comp,,1335.36,,,,,,,361.66,1349.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,inpatient,,,359.00000,271.76000,Coventry,Workers Comp,,344.64,,,,,,,323.10,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,outpatient,,,359.00000,271.76000,Coventry,Workers Comp,,344.64,,,,,,,93.34,348.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,inpatient,,,95.00000,71.92000,Coventry,Workers Comp,,91.20,,,,,,,85.50,92.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,outpatient,,,95.00000,71.92000,Coventry,Workers Comp,,91.20,,,,,,,24.70,92.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,inpatient,,,37.00000,17.83000,Coventry,Workers Comp,,35.52,,,,,,,33.30,35.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,outpatient,,,37.00000,17.83000,Coventry,Workers Comp,,35.52,,,,,,,9.62,35.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Coventry,Workers Comp,,75.84,,,,,,,71.10,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Coventry,Workers Comp,,75.84,,,,,,,20.54,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,inpatient,,,237.00000,114.23000,Coventry,Workers Comp,,227.52,,,,,,,213.30,229.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Coventry,Workers Comp,,227.52,,,,,,,61.62,229.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,inpatient,,,33.00000,15.91000,Coventry,Workers Comp,,31.68,,,,,,,29.70,32.01,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,outpatient,,,33.00000,15.91000,Coventry,Workers Comp,,31.68,,,,,,,8.58,32.01,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,inpatient,,,25.00000,12.05000,Coventry,Workers Comp,,24.00,,,,,,,22.50,24.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,outpatient,,,25.00000,12.05000,Coventry,Workers Comp,,24.00,,,,,,,6.50,24.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,inpatient,,,497.00000,160.53000,Coventry,Workers Comp,,477.12,,,,,,,447.30,482.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,outpatient,,,497.00000,160.53000,Coventry,Workers Comp,,477.12,,,,,,,129.22,482.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Coventry,Workers Comp,,846.72,,,,,,,793.80,855.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Coventry,Workers Comp,,846.72,,,,,,,229.32,855.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Coventry,Workers Comp,,846.72,,,,,,,793.80,855.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Coventry,Workers Comp,,846.72,,,,,,,229.32,855.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,inpatient,,,98.00000,37.44000,Coventry,Workers Comp,,94.08,,,,,,,88.20,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Coventry,Workers Comp,,94.08,,,,,,,25.48,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,inpatient,,,96.00000,36.67000,Coventry,Workers Comp,,92.16,,,,,,,86.40,93.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Coventry,Workers Comp,,92.16,,,,,,,24.96,93.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Coventry,Workers Comp,,846.72,,,,,,,793.80,855.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Coventry,Workers Comp,,846.72,,,,,,,229.32,855.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Coventry,Workers Comp,,846.72,,,,,,,793.80,855.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Coventry,Workers Comp,,846.72,,,,,,,229.32,855.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,inpatient,,,763.00000,291.47000,Coventry,Workers Comp,,732.48,,,,,,,686.70,740.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,outpatient,,,763.00000,291.47000,Coventry,Workers Comp,,732.48,,,,,,,198.38,740.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,inpatient,,,199.00000,76.02000,Coventry,Workers Comp,,191.04,,,,,,,179.10,193.03,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,outpatient,,,199.00000,76.02000,Coventry,Workers Comp,,191.04,,,,,,,51.74,193.03,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,inpatient,,,98.00000,37.44000,Coventry,Workers Comp,,94.08,,,,,,,88.20,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Coventry,Workers Comp,,94.08,,,,,,,25.48,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,inpatient,,,96.00000,36.67000,Coventry,Workers Comp,,92.16,,,,,,,86.40,93.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Coventry,Workers Comp,,92.16,,,,,,,24.96,93.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,inpatient,,,1265.00000,483.23000,Coventry,Workers Comp,,1214.40,,,,,,,1138.50,1227.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,outpatient,,,1265.00000,483.23000,Coventry,Workers Comp,,1214.40,,,,,,,328.90,1227.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,inpatient,,,924.00000,352.97000,Coventry,Workers Comp,,887.04,,,,,,,831.60,896.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,outpatient,,,924.00000,352.97000,Coventry,Workers Comp,,887.04,,,,,,,240.24,896.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,inpatient,,,580.00000,215.76000,Coventry,Workers Comp,,556.80,,,,,,,522.00,562.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,outpatient,,,580.00000,215.76000,Coventry,Workers Comp,,556.80,,,,,,,150.80,562.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,inpatient,,,110.00000,40.92000,Coventry,Workers Comp,,105.60,,,,,,,99.00,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,outpatient,,,110.00000,40.92000,Coventry,Workers Comp,,105.60,,,,,,,28.60,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,inpatient,,,373.00000,138.76000,Coventry,Workers Comp,,358.08,,,,,,,335.70,361.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,outpatient,,,373.00000,138.76000,Coventry,Workers Comp,,358.08,,,,,,,96.98,361.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,inpatient,,,337.00000,125.36000,Coventry,Workers Comp,,323.52,,,,,,,303.30,326.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,outpatient,,,337.00000,125.36000,Coventry,Workers Comp,,323.52,,,,,,,87.62,326.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,inpatient,,,784.00000,291.65000,Coventry,Workers Comp,,752.64,,,,,,,705.60,760.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,outpatient,,,784.00000,291.65000,Coventry,Workers Comp,,752.64,,,,,,,203.84,760.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,inpatient,,,341.00000,126.85000,Coventry,Workers Comp,,327.36,,,,,,,306.90,330.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,outpatient,,,341.00000,126.85000,Coventry,Workers Comp,,327.36,,,,,,,88.66,330.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,inpatient,,,252.00000,93.74000,Coventry,Workers Comp,,241.92,,,,,,,226.80,244.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,outpatient,,,252.00000,93.74000,Coventry,Workers Comp,,241.92,,,,,,,65.52,244.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,inpatient,,,282.00000,104.90000,Coventry,Workers Comp,,270.72,,,,,,,253.80,273.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,outpatient,,,282.00000,104.90000,Coventry,Workers Comp,,270.72,,,,,,,73.32,273.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,inpatient,,,404.00000,150.29000,Coventry,Workers Comp,,387.84,,,,,,,363.60,391.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,outpatient,,,404.00000,150.29000,Coventry,Workers Comp,,387.84,,,,,,,105.04,391.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,inpatient,,,306.00000,173.85000,Coventry,Workers Comp,,293.76,,,,,,,275.40,296.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,outpatient,,,306.00000,173.85000,Coventry,Workers Comp,,293.76,,,,,,,79.56,296.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,inpatient,,,158.00000,89.77000,Coventry,Workers Comp,,151.68,,,,,,,142.20,153.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,outpatient,,,158.00000,89.77000,Coventry,Workers Comp,,151.68,,,,,,,41.08,153.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,inpatient,,,147.00000,89.38000,Coventry,Workers Comp,GP,141.12,,,,,,,132.30,142.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Coventry,Workers Comp,GP,141.12,,,,,,,38.22,142.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,inpatient,,,270.00000,164.16000,Coventry,Workers Comp,GP,259.20,,,,,,,243.00,261.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Coventry,Workers Comp,GP,259.20,,,,,,,70.20,261.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,inpatient,,,84.00000,51.07000,Coventry,Workers Comp,GP,80.64,,,,,,,75.60,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Coventry,Workers Comp,GP,80.64,,,,,,,21.84,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,inpatient,,,86.00000,52.29000,Coventry,Workers Comp,GP,82.56,,,,,,,77.40,83.42,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Coventry,Workers Comp,GP,82.56,,,,,,,22.36,83.42,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,inpatient,,,82.00000,49.86000,Coventry,Workers Comp,GP,78.72,,,,,,,73.80,79.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Coventry,Workers Comp,GP,78.72,,,,,,,21.32,79.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,inpatient,,,85.00000,51.68000,Coventry,Workers Comp,GP,81.60,,,,,,,76.50,82.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Coventry,Workers Comp,GP,81.60,,,,,,,22.10,82.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,inpatient,,,43.00000,26.14000,Coventry,Workers Comp,GP,41.28,,,,,,,38.70,41.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Coventry,Workers Comp,GP,41.28,,,,,,,11.18,41.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,inpatient,,,41.00000,24.93000,Coventry,Workers Comp,GP,39.36,,,,,,,36.90,39.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Coventry,Workers Comp,GP,39.36,,,,,,,10.66,39.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,inpatient,,,79.00000,48.03000,Coventry,Workers Comp,GP,75.84,,,,,,,71.10,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Coventry,Workers Comp,GP,75.84,,,,,,,20.54,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Coventry,Workers Comp,GP,71.04,,,,,,,66.60,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Coventry,Workers Comp,GP,71.04,,,,,,,19.24,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Coventry,Workers Comp,GP,71.04,,,,,,,66.60,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Coventry,Workers Comp,GP,71.04,,,,,,,19.24,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,inpatient,,,34.00000,20.67000,Coventry,Workers Comp,GP,32.64,,,,,,,30.60,32.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Coventry,Workers Comp,GP,32.64,,,,,,,8.84,32.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,inpatient,,,65.00000,39.52000,Coventry,Workers Comp,GP,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Coventry,Workers Comp,GP,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,inpatient,,,113.00000,68.70000,Coventry,Workers Comp,,108.48,,,,,,,101.70,109.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,outpatient,,,113.00000,68.70000,Coventry,Workers Comp,,108.48,,,,,,,29.38,109.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,inpatient,,,80.00000,48.64000,Coventry,Workers Comp,GP,76.80,,,,,,,72.00,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Coventry,Workers Comp,GP,76.80,,,,,,,20.80,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,inpatient,,,84.00000,51.07000,Coventry,Workers Comp,GP,80.64,,,,,,,75.60,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Coventry,Workers Comp,GP,80.64,,,,,,,21.84,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,inpatient,,,73.00000,44.38000,Coventry,Workers Comp,GP,70.08,,,,,,,65.70,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Coventry,Workers Comp,GP,70.08,,,,,,,18.98,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,inpatient,,,100.00000,60.80000,Coventry,Workers Comp,,96.00,,,,,,,90.00,97.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,outpatient,,,100.00000,60.80000,Coventry,Workers Comp,,96.00,,,,,,,26.00,97.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,inpatient,,,167.00000,101.54000,Coventry,Workers Comp,GP,160.32,,,,,,,150.30,161.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,outpatient,,,167.00000,101.54000,Coventry,Workers Comp,GP,160.32,,,,,,,43.42,161.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,inpatient,,,413.00000,251.10000,Coventry,Workers Comp,"50,GP",396.48,,,,,,,371.70,400.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Coventry,Workers Comp,"50,GP",396.48,,,,,,,107.38,400.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Coventry,Workers Comp,"LT,GP",264.00,,,,,,,247.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Coventry,Workers Comp,"LT,GP",264.00,,,,,,,71.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Coventry,Workers Comp,"RT,GP",264.00,,,,,,,247.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Coventry,Workers Comp,"RT,GP",264.00,,,,,,,71.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,inpatient,,,95.00000,57.76000,Coventry,Workers Comp,GP,91.20,,,,,,,85.50,92.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Coventry,Workers Comp,GP,91.20,,,,,,,24.70,92.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,inpatient,,,146.00000,88.77000,Coventry,Workers Comp,GP,140.16,,,,,,,131.40,141.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Coventry,Workers Comp,GP,140.16,,,,,,,37.96,141.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,inpatient,,,139.00000,84.51000,Coventry,Workers Comp,GP,133.44,,,,,,,125.10,134.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Coventry,Workers Comp,GP,133.44,,,,,,,36.14,134.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,inpatient,,,75.00000,45.60000,Coventry,Workers Comp,GP,72.00,,,,,,,67.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Coventry,Workers Comp,GP,72.00,,,,,,,19.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,inpatient,,,154.00000,93.63000,Coventry,Workers Comp,GP,147.84,,,,,,,138.60,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Coventry,Workers Comp,GP,147.84,,,,,,,40.04,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,inpatient,,,73.00000,44.38000,Coventry,Workers Comp,GP,70.08,,,,,,,65.70,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Coventry,Workers Comp,GP,70.08,,,,,,,18.98,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,inpatient,,,160.00000,97.28000,Coventry,Workers Comp,GP,153.60,,,,,,,144.00,155.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Coventry,Workers Comp,GP,153.60,,,,,,,41.60,155.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,inpatient,,,325.00000,197.60000,Coventry,Workers Comp,GP,312.00,,,,,,,292.50,315.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Coventry,Workers Comp,GP,312.00,,,,,,,84.50,315.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,inpatient,,,98.00000,59.58000,Coventry,Workers Comp,GP,94.08,,,,,,,88.20,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,outpatient,,,98.00000,59.58000,Coventry,Workers Comp,GP,94.08,,,,,,,25.48,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,inpatient,,,303.00000,184.22000,Coventry,Workers Comp,GP,290.88,,,,,,,272.70,293.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,outpatient,,,303.00000,184.22000,Coventry,Workers Comp,GP,290.88,,,,,,,78.78,293.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,inpatient,,,115.00000,69.92000,Coventry,Workers Comp,GP,110.40,,,,,,,103.50,111.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,outpatient,,,115.00000,69.92000,Coventry,Workers Comp,GP,110.40,,,,,,,29.90,111.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,inpatient,,,74.00000,44.99000,Coventry,Workers Comp,GP,71.04,,,,,,,66.60,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Coventry,Workers Comp,GP,71.04,,,,,,,19.24,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,inpatient,,,79.00000,48.03000,Coventry,Workers Comp,GP,75.84,,,,,,,71.10,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Coventry,Workers Comp,GP,75.84,,,,,,,20.54,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,inpatient,,,72.00000,43.78000,Coventry,Workers Comp,GP,69.12,,,,,,,64.80,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Coventry,Workers Comp,GP,69.12,,,,,,,18.72,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,inpatient,,,147.00000,89.38000,Coventry,Workers Comp,GP,141.12,,,,,,,132.30,142.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Coventry,Workers Comp,GP,141.12,,,,,,,38.22,142.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,inpatient,,,270.00000,164.16000,Coventry,Workers Comp,GP,259.20,,,,,,,243.00,261.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Coventry,Workers Comp,GP,259.20,,,,,,,70.20,261.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,inpatient,,,84.00000,51.07000,Coventry,Workers Comp,GP,80.64,,,,,,,75.60,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Coventry,Workers Comp,GP,80.64,,,,,,,21.84,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,inpatient,,,86.00000,52.29000,Coventry,Workers Comp,GP,82.56,,,,,,,77.40,83.42,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Coventry,Workers Comp,GP,82.56,,,,,,,22.36,83.42,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,inpatient,,,82.00000,49.86000,Coventry,Workers Comp,GP,78.72,,,,,,,73.80,79.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Coventry,Workers Comp,GP,78.72,,,,,,,21.32,79.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,inpatient,,,85.00000,51.68000,Coventry,Workers Comp,GP,81.60,,,,,,,76.50,82.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Coventry,Workers Comp,GP,81.60,,,,,,,22.10,82.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,inpatient,,,43.00000,26.14000,Coventry,Workers Comp,GP,41.28,,,,,,,38.70,41.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Coventry,Workers Comp,GP,41.28,,,,,,,11.18,41.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,inpatient,,,41.00000,24.93000,Coventry,Workers Comp,GP,39.36,,,,,,,36.90,39.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Coventry,Workers Comp,GP,39.36,,,,,,,10.66,39.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,inpatient,,,79.00000,48.03000,Coventry,Workers Comp,GP,75.84,,,,,,,71.10,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Coventry,Workers Comp,GP,75.84,,,,,,,20.54,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Coventry,Workers Comp,"CQ,GP",71.04,,,,,,,66.60,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Coventry,Workers Comp,"CQ,GP",71.04,,,,,,,19.24,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Coventry,Workers Comp,"CQ,GP",71.04,,,,,,,66.60,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Coventry,Workers Comp,"CQ,GP",71.04,,,,,,,19.24,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,inpatient,,,34.00000,20.67000,Coventry,Workers Comp,GP,32.64,,,,,,,30.60,32.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Coventry,Workers Comp,GP,32.64,,,,,,,8.84,32.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,inpatient,,,65.00000,39.52000,Coventry,Workers Comp,GP,62.40,,,,,,,58.50,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Coventry,Workers Comp,GP,62.40,,,,,,,16.90,63.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,inpatient,,,80.00000,48.64000,Coventry,Workers Comp,GP,76.80,,,,,,,72.00,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Coventry,Workers Comp,GP,76.80,,,,,,,20.80,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,inpatient,,,84.00000,51.07000,Coventry,Workers Comp,GP,80.64,,,,,,,75.60,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Coventry,Workers Comp,GP,80.64,,,,,,,21.84,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,inpatient,,,73.00000,44.38000,Coventry,Workers Comp,GP,70.08,,,,,,,65.70,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Coventry,Workers Comp,GP,70.08,,,,,,,18.98,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,inpatient,,,413.00000,251.10000,Coventry,Workers Comp,"GP,50",396.48,,,,,,,371.70,400.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Coventry,Workers Comp,"GP,50",396.48,,,,,,,107.38,400.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Coventry,Workers Comp,"GP,LT",264.00,,,,,,,247.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Coventry,Workers Comp,"GP,LT",264.00,,,,,,,71.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Coventry,Workers Comp,"GP,RT",264.00,,,,,,,247.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Coventry,Workers Comp,"GP,RT",264.00,,,,,,,71.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,inpatient,,,95.00000,57.76000,Coventry,Workers Comp,GP,91.20,,,,,,,85.50,92.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Coventry,Workers Comp,GP,91.20,,,,,,,24.70,92.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,inpatient,,,146.00000,88.77000,Coventry,Workers Comp,GP,140.16,,,,,,,131.40,141.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Coventry,Workers Comp,GP,140.16,,,,,,,37.96,141.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,inpatient,,,139.00000,84.51000,Coventry,Workers Comp,GP,133.44,,,,,,,125.10,134.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Coventry,Workers Comp,GP,133.44,,,,,,,36.14,134.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,inpatient,,,75.00000,45.60000,Coventry,Workers Comp,GP,72.00,,,,,,,67.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Coventry,Workers Comp,GP,72.00,,,,,,,19.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,inpatient,,,154.00000,93.63000,Coventry,Workers Comp,GP,147.84,,,,,,,138.60,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Coventry,Workers Comp,GP,147.84,,,,,,,40.04,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,inpatient,,,73.00000,44.38000,Coventry,Workers Comp,GP,70.08,,,,,,,65.70,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Coventry,Workers Comp,GP,70.08,,,,,,,18.98,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,inpatient,,,160.00000,97.28000,Coventry,Workers Comp,GP,153.60,,,,,,,144.00,155.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Coventry,Workers Comp,GP,153.60,,,,,,,41.60,155.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,inpatient,,,325.00000,197.60000,Coventry,Workers Comp,GP,312.00,,,,,,,292.50,315.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Coventry,Workers Comp,GP,312.00,,,,,,,84.50,315.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,inpatient,,,74.00000,44.99000,Coventry,Workers Comp,GP,71.04,,,,,,,66.60,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Coventry,Workers Comp,GP,71.04,,,,,,,19.24,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,inpatient,,,79.00000,48.03000,Coventry,Workers Comp,GP,75.84,,,,,,,71.10,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Coventry,Workers Comp,GP,75.84,,,,,,,20.54,76.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,inpatient,,,72.00000,43.78000,Coventry,Workers Comp,GP,69.12,,,,,,,64.80,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Coventry,Workers Comp,GP,69.12,,,,,,,18.72,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,inpatient,,,445.00000,262.55000,Coventry,Workers Comp,GP,427.20,,,,,,,400.50,431.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,outpatient,,,445.00000,262.55000,Coventry,Workers Comp,GP,427.20,,,,,,,115.70,431.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,inpatient,,,310.00000,182.90000,Coventry,Workers Comp,GP,297.60,,,,,,,279.00,300.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,outpatient,,,310.00000,182.90000,Coventry,Workers Comp,GP,297.60,,,,,,,80.60,300.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,inpatient,,,393.00000,231.87000,Coventry,Workers Comp,GP,377.28,,,,,,,353.70,381.21,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,outpatient,,,393.00000,231.87000,Coventry,Workers Comp,GP,377.28,,,,,,,102.18,381.21,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,inpatient,,,310.00000,182.90000,Coventry,Workers Comp,GP,297.60,,,,,,,279.00,300.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,outpatient,,,310.00000,182.90000,Coventry,Workers Comp,GP,297.60,,,,,,,80.60,300.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,inpatient,,,80.00000,30.96000,Coventry,Workers Comp,GO,76.80,,,,,,,72.00,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Coventry,Workers Comp,GO,76.80,,,,,,,20.80,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,inpatient,,,84.00000,32.51000,Coventry,Workers Comp,GO,80.64,,,,,,,75.60,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Coventry,Workers Comp,GO,80.64,,,,,,,21.84,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,inpatient,,,126.00000,48.76000,Coventry,Workers Comp,GO,120.96,,,,,,,113.40,122.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Coventry,Workers Comp,GO,120.96,,,,,,,32.76,122.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,inpatient,,,66.00000,25.54000,Coventry,Workers Comp,GO,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Coventry,Workers Comp,GO,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,inpatient,,,62.00000,23.99000,Coventry,Workers Comp,GO,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Coventry,Workers Comp,GO,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,inpatient,,,90.00000,34.83000,Coventry,Workers Comp,GO,86.40,,,,,,,81.00,87.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Coventry,Workers Comp,GO,86.40,,,,,,,23.40,87.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,inpatient,,,95.00000,36.76000,Coventry,Workers Comp,GO,91.20,,,,,,,85.50,92.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Coventry,Workers Comp,GO,91.20,,,,,,,24.70,92.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,inpatient,,,146.00000,56.50000,Coventry,Workers Comp,GO,140.16,,,,,,,131.40,141.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Coventry,Workers Comp,GO,140.16,,,,,,,37.96,141.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,inpatient,,,139.00000,53.79000,Coventry,Workers Comp,GO,133.44,,,,,,,125.10,134.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Coventry,Workers Comp,GO,133.44,,,,,,,36.14,134.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,inpatient,,,75.00000,29.02000,Coventry,Workers Comp,GO,72.00,,,,,,,67.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Coventry,Workers Comp,GO,72.00,,,,,,,19.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,inpatient,,,154.00000,59.60000,Coventry,Workers Comp,GO,147.84,,,,,,,138.60,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Coventry,Workers Comp,GO,147.84,,,,,,,40.04,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,inpatient,,,73.00000,28.25000,Coventry,Workers Comp,GO,70.08,,,,,,,65.70,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Coventry,Workers Comp,GO,70.08,,,,,,,18.98,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,inpatient,,,160.00000,61.92000,Coventry,Workers Comp,GO,153.60,,,,,,,144.00,155.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Coventry,Workers Comp,GO,153.60,,,,,,,41.60,155.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,inpatient,,,98.00000,37.93000,Coventry,Workers Comp,GO,94.08,,,,,,,88.20,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,outpatient,,,98.00000,37.93000,Coventry,Workers Comp,GO,94.08,,,,,,,25.48,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,inpatient,,,303.00000,117.26000,Coventry,Workers Comp,GO,290.88,,,,,,,272.70,293.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,outpatient,,,303.00000,117.26000,Coventry,Workers Comp,GO,290.88,,,,,,,78.78,293.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,inpatient,,,115.00000,44.50000,Coventry,Workers Comp,GO,110.40,,,,,,,103.50,111.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,outpatient,,,115.00000,44.50000,Coventry,Workers Comp,GO,110.40,,,,,,,29.90,111.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,inpatient,,,74.00000,28.64000,Coventry,Workers Comp,GO,71.04,,,,,,,66.60,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Coventry,Workers Comp,GO,71.04,,,,,,,19.24,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,inpatient,,,72.00000,27.86000,Coventry,Workers Comp,GO,69.12,,,,,,,64.80,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Coventry,Workers Comp,GO,69.12,,,,,,,18.72,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,inpatient,,,80.00000,30.96000,Coventry,Workers Comp,"CO,GO",76.80,,,,,,,72.00,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Coventry,Workers Comp,"CO,GO",76.80,,,,,,,20.80,77.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,inpatient,,,84.00000,32.51000,Coventry,Workers Comp,"CO,GO",80.64,,,,,,,75.60,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Coventry,Workers Comp,"CO,GO",80.64,,,,,,,21.84,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,inpatient,,,126.00000,48.76000,Coventry,Workers Comp,"CO,GO",120.96,,,,,,,113.40,122.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Coventry,Workers Comp,"CO,GO",120.96,,,,,,,32.76,122.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,inpatient,,,62.00000,23.99000,Coventry,Workers Comp,"CO,GO",59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Coventry,Workers Comp,"CO,GO",59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,inpatient,,,66.00000,25.54000,Coventry,Workers Comp,"CO,GO",63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Coventry,Workers Comp,"CO,GO",63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,inpatient,,,90.00000,34.83000,Coventry,Workers Comp,"CO,GO",86.40,,,,,,,81.00,87.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Coventry,Workers Comp,"CO,GO",86.40,,,,,,,23.40,87.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,inpatient,,,95.00000,36.76000,Coventry,Workers Comp,"CO,GO",91.20,,,,,,,85.50,92.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Coventry,Workers Comp,"CO,GO",91.20,,,,,,,24.70,92.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,inpatient,,,146.00000,56.50000,Coventry,Workers Comp,"CO,GO",140.16,,,,,,,131.40,141.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Coventry,Workers Comp,"CO,GO",140.16,,,,,,,37.96,141.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,inpatient,,,139.00000,53.79000,Coventry,Workers Comp,"CO,GO",133.44,,,,,,,125.10,134.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Coventry,Workers Comp,"CO,GO",133.44,,,,,,,36.14,134.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,inpatient,,,75.00000,29.02000,Coventry,Workers Comp,"CO,GO",72.00,,,,,,,67.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Coventry,Workers Comp,"CO,GO",72.00,,,,,,,19.50,72.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,inpatient,,,154.00000,59.60000,Coventry,Workers Comp,"CO,GO",147.84,,,,,,,138.60,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Coventry,Workers Comp,"CO,GO",147.84,,,,,,,40.04,149.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,inpatient,,,73.00000,28.25000,Coventry,Workers Comp,"CO,GO",70.08,,,,,,,65.70,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Coventry,Workers Comp,"CO,GO",70.08,,,,,,,18.98,70.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,inpatient,,,160.00000,61.92000,Coventry,Workers Comp,"CO,GO",153.60,,,,,,,144.00,155.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Coventry,Workers Comp,"CO,GO",153.60,,,,,,,41.60,155.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,inpatient,,,74.00000,28.64000,Coventry,Workers Comp,"CO,GO",71.04,,,,,,,66.60,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Coventry,Workers Comp,"CO,GO",71.04,,,,,,,19.24,71.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,inpatient,,,72.00000,27.86000,Coventry,Workers Comp,"CO,GO",69.12,,,,,,,64.80,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Coventry,Workers Comp,"CO,GO",69.12,,,,,,,18.72,69.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,inpatient,,,47.00000,26.70000,Coventry,Workers Comp,GO,45.12,,,,,,,42.30,45.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Coventry,Workers Comp,GO,45.12,,,,,,,12.22,45.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,inpatient,,,47.00000,26.70000,Coventry,Workers Comp,"CO,GO",45.12,,,,,,,42.30,45.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Coventry,Workers Comp,"CO,GO",45.12,,,,,,,12.22,45.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,inpatient,,,250.00000,142.04000,Coventry,Workers Comp,GO,240.00,,,,,,,225.00,242.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,outpatient,,,250.00000,142.04000,Coventry,Workers Comp,GO,240.00,,,,,,,65.00,242.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,inpatient,,,175.00000,99.43000,Coventry,Workers Comp,GO,168.00,,,,,,,157.50,169.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,outpatient,,,175.00000,99.43000,Coventry,Workers Comp,GO,168.00,,,,,,,45.50,169.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,inpatient,,,233.00000,132.38000,Coventry,Workers Comp,GO,223.68,,,,,,,209.70,226.01,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,outpatient,,,233.00000,132.38000,Coventry,Workers Comp,GO,223.68,,,,,,,60.58,226.01,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,inpatient,,,175.00000,99.43000,Coventry,Workers Comp,GO,168.00,,,,,,,157.50,169.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,outpatient,,,175.00000,99.43000,Coventry,Workers Comp,GO,168.00,,,,,,,45.50,169.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,inpatient,,,291.00000,93.99000,Coventry,Workers Comp,,279.36,,,,,,,261.90,282.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,outpatient,,,291.00000,93.99000,Coventry,Workers Comp,,279.36,,,,,,,75.66,282.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,inpatient,,,273.00000,155.10000,Coventry,Workers Comp,GN,262.08,,,,,,,245.70,264.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,outpatient,,,273.00000,155.10000,Coventry,Workers Comp,GN,262.08,,,,,,,70.98,264.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,inpatient,,,279.00000,158.51000,Coventry,Workers Comp,GN,267.84,,,,,,,251.10,270.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,outpatient,,,279.00000,158.51000,Coventry,Workers Comp,GN,267.84,,,,,,,72.54,270.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,inpatient,,,426.00000,242.03000,Coventry,Workers Comp,GN,408.96,,,,,,,383.40,413.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,outpatient,,,426.00000,242.03000,Coventry,Workers Comp,GN,408.96,,,,,,,110.76,413.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,inpatient,,,242.00000,137.49000,Coventry,Workers Comp,GN,232.32,,,,,,,217.80,234.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,outpatient,,,242.00000,137.49000,Coventry,Workers Comp,GN,232.32,,,,,,,62.92,234.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,inpatient,,,128.00000,72.72000,Coventry,Workers Comp,,122.88,,,,,,,115.20,124.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,outpatient,,,128.00000,72.72000,Coventry,Workers Comp,,122.88,,,,,,,33.28,124.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,inpatient,,,66.00000,37.50000,Coventry,Workers Comp,GN,63.36,,,,,,,59.40,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,outpatient,,,66.00000,37.50000,Coventry,Workers Comp,GN,63.36,,,,,,,17.16,64.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,inpatient,,,62.00000,35.23000,Coventry,Workers Comp,GN,59.52,,,,,,,55.80,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,outpatient,,,62.00000,35.23000,Coventry,Workers Comp,GN,59.52,,,,,,,16.12,60.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,inpatient,,,269.00000,152.83000,Coventry,Workers Comp,GN,258.24,,,,,,,242.10,260.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,outpatient,,,269.00000,152.83000,Coventry,Workers Comp,GN,258.24,,,,,,,69.94,260.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,inpatient,,,153.00000,86.93000,Coventry,Workers Comp,GN,146.88,,,,,,,137.70,148.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,outpatient,,,153.00000,86.93000,Coventry,Workers Comp,GN,146.88,,,,,,,39.78,148.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,inpatient,,,98.00000,55.68000,Coventry,Workers Comp,GN,94.08,,,,,,,88.20,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,outpatient,,,98.00000,55.68000,Coventry,Workers Comp,GN,94.08,,,,,,,25.48,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,inpatient,,,303.00000,172.15000,Coventry,Workers Comp,GN,290.88,,,,,,,272.70,293.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,outpatient,,,303.00000,172.15000,Coventry,Workers Comp,GN,290.88,,,,,,,78.78,293.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,inpatient,,,115.00000,65.34000,Coventry,Workers Comp,GN,110.40,,,,,,,103.50,111.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,outpatient,,,115.00000,65.34000,Coventry,Workers Comp,GN,110.40,,,,,,,29.90,111.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,inpatient,,,210.00000,119.31000,Coventry,Workers Comp,GN,201.60,,,,,,,189.00,203.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,outpatient,,,210.00000,119.31000,Coventry,Workers Comp,GN,201.60,,,,,,,54.60,203.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,inpatient,,,250.00000,142.04000,Coventry,Workers Comp,GN,240.00,,,,,,,225.00,242.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,outpatient,,,250.00000,142.04000,Coventry,Workers Comp,GN,240.00,,,,,,,65.00,242.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,inpatient,,,78.00000,44.32000,Coventry,Workers Comp,GN,74.88,,,,,,,70.20,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,outpatient,,,78.00000,44.32000,Coventry,Workers Comp,GN,74.88,,,,,,,20.28,75.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,inpatient,,,322.00000,182.94000,Coventry,Workers Comp,GN,309.12,,,,,,,289.80,312.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,outpatient,,,322.00000,182.94000,Coventry,Workers Comp,GN,309.12,,,,,,,83.72,312.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,inpatient,,,309.00000,175.56000,Coventry,Workers Comp,GN,296.64,,,,,,,278.10,299.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,outpatient,,,309.00000,175.56000,Coventry,Workers Comp,GN,296.64,,,,,,,80.34,299.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,inpatient,,,245.00000,139.20000,Coventry,Workers Comp,GN,235.20,,,,,,,220.50,237.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,outpatient,,,245.00000,139.20000,Coventry,Workers Comp,GN,235.20,,,,,,,63.70,237.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,inpatient,,,313.00000,116.44000,Coventry,Workers Comp,,300.48,,,,,,,281.70,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,outpatient,,,313.00000,116.44000,Coventry,Workers Comp,,300.48,,,,,,,81.38,303.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,inpatient,,,1250.00000,632.50000,Coventry,Workers Comp,,1200.00,,,,,,,1125.00,1212.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,outpatient,,,1250.00000,632.50000,Coventry,Workers Comp,,1200.00,,,,,,,325.00,1212.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,inpatient,,,145.00000,75.54000,Coventry,Workers Comp,,139.20,,,,,,,130.50,140.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Coventry,Workers Comp,,139.20,,,,,,,37.70,140.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,inpatient,,,488.00000,254.25000,Coventry,Workers Comp,,468.48,,,,,,,439.20,473.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Coventry,Workers Comp,,468.48,,,,,,,126.88,473.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,inpatient,,,684.00000,337.90000,Coventry,Workers Comp,,656.64,,,,,,,615.60,663.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,outpatient,,,684.00000,337.90000,Coventry,Workers Comp,,656.64,,,,,,,177.84,663.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,inpatient,,,206.00000,101.76000,Coventry,Workers Comp,,197.76,,,,,,,185.40,199.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,outpatient,,,206.00000,101.76000,Coventry,Workers Comp,,197.76,,,,,,,53.56,199.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,inpatient,,,195.00000,96.33000,Coventry,Workers Comp,,187.20,,,,,,,175.50,189.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,outpatient,,,195.00000,96.33000,Coventry,Workers Comp,,187.20,,,,,,,50.70,189.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,inpatient,,,375.00000,185.25000,Coventry,Workers Comp,,360.00,,,,,,,337.50,363.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,outpatient,,,375.00000,185.25000,Coventry,Workers Comp,,360.00,,,,,,,97.50,363.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,inpatient,,,429.00000,211.93000,Coventry,Workers Comp,,411.84,,,,,,,386.10,416.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,outpatient,,,429.00000,211.93000,Coventry,Workers Comp,,411.84,,,,,,,111.54,416.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
R&B MEDICAL/SURGICAL SEMI-PVT,22475,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Coventry,Workers Comp,,2669.76,,,,,,,2502.90,3111.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
R&B OBSTETRICS SEMI-PVT,42473,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Coventry,Workers Comp,,2669.76,,,,,,,2502.90,3111.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
R&B ICU,32474,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Coventry,Workers Comp,,8410.56,,,,,,,2512.00,8498.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
R&B ICU INTERMEDIATE,12476,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Coventry,Workers Comp,,5607.36,,,,,,,2512.00,5665.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,84.00000,63.59000,Coventry,Workers Comp,,80.64,,,,,,,75.60,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Coventry,Workers Comp,,80.64,,,,,,,21.84,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Coventry,Workers Comp,,272.64,,,,,,,255.60,275.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Coventry,Workers Comp,,272.64,,,,,,,73.84,275.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Coventry,Workers Comp,,439.68,,,,,,,412.20,444.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Coventry,Workers Comp,,439.68,,,,,,,119.08,444.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Coventry,Workers Comp,,535.68,,,,,,,502.20,541.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Coventry,Workers Comp,,535.68,,,,,,,145.08,541.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Coventry,Workers Comp,,462.72,,,,,,,433.80,467.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Coventry,Workers Comp,,462.72,,,,,,,125.32,467.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Coventry,Workers Comp,,227.52,,,,,,,213.30,229.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Coventry,Workers Comp,,227.52,,,,,,,61.62,229.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,inpatient,,,490.00000,329.77000,Coventry,Workers Comp,,470.40,,,,,,,441.00,475.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,outpatient,,,490.00000,329.77000,Coventry,Workers Comp,,470.40,,,,,,,127.40,475.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,inpatient,,,490.00000,329.77000,Coventry,Workers Comp,,470.40,,,,,,,441.00,475.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,outpatient,,,490.00000,329.77000,Coventry,Workers Comp,,470.40,,,,,,,127.40,475.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,inpatient,,,245.00000,164.89000,Coventry,Workers Comp,,235.20,,,,,,,220.50,237.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,outpatient,,,245.00000,164.89000,Coventry,Workers Comp,,235.20,,,,,,,63.70,237.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,inpatient,,,490.00000,329.77000,Coventry,Workers Comp,,470.40,,,,,,,441.00,475.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Coventry,Workers Comp,,470.40,,,,,,,127.40,475.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Coventry,Workers Comp,,470.40,,,,,,,441.00,475.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Coventry,Workers Comp,,470.40,,,,,,,127.40,475.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,inpatient,,,245.00000,164.89000,Coventry,Workers Comp,,235.20,,,,,,,220.50,237.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Coventry,Workers Comp,,235.20,,,,,,,63.70,237.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Coventry,Workers Comp,,808.32,,,,,,,757.80,816.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Coventry,Workers Comp,,808.32,,,,,,,218.92,816.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Coventry,Workers Comp,,1010.88,,,,,,,947.70,1021.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Coventry,Workers Comp,,1010.88,,,,,,,273.78,1021.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Coventry,Workers Comp,,1212.48,,,,,,,1136.70,1225.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Coventry,Workers Comp,,1212.48,,,,,,,328.38,1225.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,inpatient,,,2466.00000,986.40000,Coventry,Workers Comp,,2367.36,,,,,,,2219.40,2392.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,outpatient,,,2466.00000,986.40000,Coventry,Workers Comp,,2367.36,,,,,,,641.16,2392.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,inpatient,,,260.00000,104.00000,Coventry,Workers Comp,,249.60,,,,,,,234.00,252.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,outpatient,,,260.00000,104.00000,Coventry,Workers Comp,,249.60,,,,,,,67.60,252.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,inpatient,,,2041.00000,816.40000,Coventry,Workers Comp,,1959.36,,,,,,,1836.90,1979.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,outpatient,,,2041.00000,816.40000,Coventry,Workers Comp,,1959.36,,,,,,,530.66,1979.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,inpatient,,,375.00000,150.00000,Coventry,Workers Comp,,360.00,,,,,,,337.50,363.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,outpatient,,,375.00000,150.00000,Coventry,Workers Comp,,360.00,,,,,,,97.50,363.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,inpatient,,,1178.00000,471.20000,Coventry,Workers Comp,,1130.88,,,,,,,1060.20,1142.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,outpatient,,,1178.00000,471.20000,Coventry,Workers Comp,,1130.88,,,,,,,306.28,1142.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,inpatient,,,245.00000,98.00000,Coventry,Workers Comp,,235.20,,,,,,,220.50,237.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,outpatient,,,245.00000,98.00000,Coventry,Workers Comp,,235.20,,,,,,,63.70,237.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,inpatient,,,280.00000,112.00000,Coventry,Workers Comp,,268.80,,,,,,,252.00,271.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,outpatient,,,280.00000,112.00000,Coventry,Workers Comp,,268.80,,,,,,,72.80,271.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,inpatient,,,336.00000,134.40000,Coventry,Workers Comp,,322.56,,,,,,,302.40,325.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,outpatient,,,336.00000,134.40000,Coventry,Workers Comp,,322.56,,,,,,,87.36,325.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,inpatient,,,380.00000,152.00000,Coventry,Workers Comp,,364.80,,,,,,,342.00,368.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,outpatient,,,380.00000,152.00000,Coventry,Workers Comp,,364.80,,,,,,,98.80,368.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,inpatient,,,530.00000,212.00000,Coventry,Workers Comp,,508.80,,,,,,,477.00,514.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Coventry,Workers Comp,,508.80,,,,,,,137.80,514.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,inpatient,,,264.00000,105.60000,Coventry,Workers Comp,,253.44,,,,,,,237.60,256.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,outpatient,,,264.00000,105.60000,Coventry,Workers Comp,,253.44,,,,,,,68.64,256.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,inpatient,,,763.00000,305.20000,Coventry,Workers Comp,,732.48,,,,,,,686.70,740.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,outpatient,,,763.00000,305.20000,Coventry,Workers Comp,,732.48,,,,,,,198.38,740.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,inpatient,,,672.00000,268.80000,Coventry,Workers Comp,,645.12,,,,,,,604.80,651.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,outpatient,,,672.00000,268.80000,Coventry,Workers Comp,,645.12,,,,,,,174.72,651.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,inpatient,,,1940.00000,776.00000,Coventry,Workers Comp,,1862.40,,,,,,,1746.00,1881.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,outpatient,,,1940.00000,776.00000,Coventry,Workers Comp,,1862.40,,,,,,,504.40,1881.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,inpatient,,,3875.00000,1550.00000,Coventry,Workers Comp,,3720.00,,,,,,,3487.50,3758.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,outpatient,,,3875.00000,1550.00000,Coventry,Workers Comp,,3720.00,,,,,,,1007.50,3758.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,inpatient,,,505.00000,202.00000,Coventry,Workers Comp,,484.80,,,,,,,454.50,489.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,outpatient,,,505.00000,202.00000,Coventry,Workers Comp,,484.80,,,,,,,131.30,489.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,inpatient,,,295.00000,118.00000,Coventry,Workers Comp,,283.20,,,,,,,265.50,286.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Coventry,Workers Comp,,283.20,,,,,,,76.70,286.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,inpatient,,,585.00000,234.00000,Coventry,Workers Comp,,561.60,,,,,,,526.50,567.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,outpatient,,,585.00000,234.00000,Coventry,Workers Comp,,561.60,,,,,,,152.10,567.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,inpatient,,,285.00000,114.00000,Coventry,Workers Comp,,273.60,,,,,,,256.50,276.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,outpatient,,,285.00000,114.00000,Coventry,Workers Comp,,273.60,,,,,,,74.10,276.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,inpatient,,,575.00000,230.00000,Coventry,Workers Comp,,552.00,,,,,,,517.50,557.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,outpatient,,,575.00000,230.00000,Coventry,Workers Comp,,552.00,,,,,,,149.50,557.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,inpatient,,,697.00000,278.80000,Coventry,Workers Comp,,669.12,,,,,,,627.30,676.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,outpatient,,,697.00000,278.80000,Coventry,Workers Comp,,669.12,,,,,,,181.22,676.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,inpatient,,,530.00000,212.00000,Coventry,Workers Comp,,508.80,,,,,,,477.00,514.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Coventry,Workers Comp,,508.80,,,,,,,137.80,514.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,inpatient,,,580.00000,232.00000,Coventry,Workers Comp,,556.80,,,,,,,522.00,562.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,outpatient,,,580.00000,232.00000,Coventry,Workers Comp,,556.80,,,,,,,150.80,562.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,inpatient,,,435.00000,174.00000,Coventry,Workers Comp,,417.60,,,,,,,391.50,421.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,outpatient,,,435.00000,174.00000,Coventry,Workers Comp,,417.60,,,,,,,113.10,421.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,inpatient,,,270.00000,108.00000,Coventry,Workers Comp,,259.20,,,,,,,243.00,261.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,outpatient,,,270.00000,108.00000,Coventry,Workers Comp,,259.20,,,,,,,70.20,261.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,inpatient,,,504.00000,201.60000,Coventry,Workers Comp,,483.84,,,,,,,453.60,488.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,outpatient,,,504.00000,201.60000,Coventry,Workers Comp,,483.84,,,,,,,131.04,488.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,inpatient,,,98.00000,39.20000,Coventry,Workers Comp,,94.08,,,,,,,88.20,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,outpatient,,,98.00000,39.20000,Coventry,Workers Comp,,94.08,,,,,,,25.48,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,inpatient,,,608.00000,243.20000,Coventry,Workers Comp,,583.68,,,,,,,547.20,589.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,outpatient,,,608.00000,243.20000,Coventry,Workers Comp,,583.68,,,,,,,158.08,589.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,inpatient,,,114.00000,45.60000,Coventry,Workers Comp,,109.44,,,,,,,102.60,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,outpatient,,,114.00000,45.60000,Coventry,Workers Comp,,109.44,,,,,,,29.64,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,inpatient,,,187.00000,74.80000,Coventry,Workers Comp,,179.52,,,,,,,168.30,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,outpatient,,,187.00000,74.80000,Coventry,Workers Comp,,179.52,,,,,,,48.62,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,inpatient,,,214.00000,85.60000,Coventry,Workers Comp,,205.44,,,,,,,192.60,207.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,outpatient,,,214.00000,85.60000,Coventry,Workers Comp,,205.44,,,,,,,55.64,207.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,inpatient,,,863.00000,345.20000,Coventry,Workers Comp,,828.48,,,,,,,776.70,837.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,outpatient,,,863.00000,345.20000,Coventry,Workers Comp,,828.48,,,,,,,224.38,837.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,inpatient,,,453.00000,181.20000,Coventry,Workers Comp,,434.88,,,,,,,407.70,439.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,outpatient,,,453.00000,181.20000,Coventry,Workers Comp,,434.88,,,,,,,117.78,439.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,inpatient,,,144.00000,57.60000,Coventry,Workers Comp,,138.24,,,,,,,129.60,139.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,outpatient,,,144.00000,57.60000,Coventry,Workers Comp,,138.24,,,,,,,37.44,139.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,inpatient,,,107.00000,42.80000,Coventry,Workers Comp,,102.72,,,,,,,96.30,103.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,outpatient,,,107.00000,42.80000,Coventry,Workers Comp,,102.72,,,,,,,27.82,103.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,inpatient,,,403.00000,161.20000,Coventry,Workers Comp,,386.88,,,,,,,362.70,390.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,outpatient,,,403.00000,161.20000,Coventry,Workers Comp,,386.88,,,,,,,104.78,390.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,inpatient,,,144.00000,57.60000,Coventry,Workers Comp,,138.24,,,,,,,129.60,139.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,outpatient,,,144.00000,57.60000,Coventry,Workers Comp,,138.24,,,,,,,37.44,139.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,inpatient,,,370.00000,148.00000,Coventry,Workers Comp,,355.20,,,,,,,333.00,358.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,outpatient,,,370.00000,148.00000,Coventry,Workers Comp,,355.20,,,,,,,96.20,358.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,inpatient,,,334.00000,133.60000,Coventry,Workers Comp,,320.64,,,,,,,300.60,323.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,outpatient,,,334.00000,133.60000,Coventry,Workers Comp,,320.64,,,,,,,86.84,323.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,inpatient,,,1188.00000,475.20000,Coventry,Workers Comp,50,1140.48,,,,,,,1069.20,1152.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,outpatient,,,1188.00000,475.20000,Coventry,Workers Comp,50,1140.48,,,,,,,308.88,1152.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,inpatient,,,792.00000,316.80000,Coventry,Workers Comp,LT,760.32,,,,,,,712.80,768.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Coventry,Workers Comp,LT,760.32,,,,,,,205.92,768.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,inpatient,,,792.00000,316.80000,Coventry,Workers Comp,RT,760.32,,,,,,,712.80,768.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Coventry,Workers Comp,RT,760.32,,,,,,,205.92,768.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,inpatient,,,572.00000,228.80000,Coventry,Workers Comp,50,549.12,,,,,,,514.80,554.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,outpatient,,,572.00000,228.80000,Coventry,Workers Comp,50,549.12,,,,,,,148.72,554.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,inpatient,,,381.00000,152.40000,Coventry,Workers Comp,LT,365.76,,,,,,,342.90,369.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Coventry,Workers Comp,LT,365.76,,,,,,,99.06,369.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,inpatient,,,381.00000,152.40000,Coventry,Workers Comp,RT,365.76,,,,,,,342.90,369.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Coventry,Workers Comp,RT,365.76,,,,,,,99.06,369.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,inpatient,,,683.00000,273.20000,Coventry,Workers Comp,50,655.68,,,,,,,614.70,662.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,outpatient,,,683.00000,273.20000,Coventry,Workers Comp,50,655.68,,,,,,,177.58,662.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,inpatient,,,455.00000,182.00000,Coventry,Workers Comp,LT,436.80,,,,,,,409.50,441.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Coventry,Workers Comp,LT,436.80,,,,,,,118.30,441.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,inpatient,,,455.00000,182.00000,Coventry,Workers Comp,RT,436.80,,,,,,,409.50,441.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Coventry,Workers Comp,RT,436.80,,,,,,,118.30,441.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,inpatient,,,357.00000,142.80000,Coventry,Workers Comp,,342.72,,,,,,,321.30,346.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,outpatient,,,357.00000,142.80000,Coventry,Workers Comp,,342.72,,,,,,,92.82,346.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,inpatient,,,334.00000,133.60000,Coventry,Workers Comp,,320.64,,,,,,,300.60,323.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,outpatient,,,334.00000,133.60000,Coventry,Workers Comp,,320.64,,,,,,,86.84,323.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,inpatient,,,194.00000,77.60000,Coventry,Workers Comp,,186.24,,,,,,,174.60,188.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,outpatient,,,194.00000,77.60000,Coventry,Workers Comp,,186.24,,,,,,,50.44,188.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,inpatient,,,608.00000,243.20000,Coventry,Workers Comp,,583.68,,,,,,,547.20,589.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,outpatient,,,608.00000,243.20000,Coventry,Workers Comp,,583.68,,,,,,,158.08,589.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,inpatient,,,257.00000,102.80000,Coventry,Workers Comp,,246.72,,,,,,,231.30,249.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,outpatient,,,257.00000,102.80000,Coventry,Workers Comp,,246.72,,,,,,,66.82,249.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,inpatient,,,343.00000,137.20000,Coventry,Workers Comp,,329.28,,,,,,,308.70,332.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,outpatient,,,343.00000,137.20000,Coventry,Workers Comp,,329.28,,,,,,,89.18,332.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,inpatient,,,457.00000,182.80000,Coventry,Workers Comp,,438.72,,,,,,,411.30,443.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,outpatient,,,457.00000,182.80000,Coventry,Workers Comp,,438.72,,,,,,,118.82,443.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,inpatient,,,630.00000,252.00000,Coventry,Workers Comp,,604.80,,,,,,,567.00,611.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,outpatient,,,630.00000,252.00000,Coventry,Workers Comp,,604.80,,,,,,,163.80,611.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,inpatient,,,623.00000,249.20000,Coventry,Workers Comp,,598.08,,,,,,,560.70,604.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,outpatient,,,623.00000,249.20000,Coventry,Workers Comp,,598.08,,,,,,,161.98,604.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,inpatient,,,1457.00000,582.80000,Coventry,Workers Comp,,1398.72,,,,,,,1311.30,1413.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,outpatient,,,1457.00000,582.80000,Coventry,Workers Comp,,1398.72,,,,,,,378.82,1413.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,inpatient,,,890.00000,356.00000,Coventry,Workers Comp,,854.40,,,,,,,801.00,863.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,outpatient,,,890.00000,356.00000,Coventry,Workers Comp,,854.40,,,,,,,231.40,863.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,inpatient,,,532.00000,212.80000,Coventry,Workers Comp,,510.72,,,,,,,478.80,516.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,outpatient,,,532.00000,212.80000,Coventry,Workers Comp,,510.72,,,,,,,138.32,516.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,inpatient,,,492.00000,196.80000,Coventry,Workers Comp,,472.32,,,,,,,442.80,477.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,outpatient,,,492.00000,196.80000,Coventry,Workers Comp,,472.32,,,,,,,127.92,477.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,inpatient,,,550.00000,220.00000,Coventry,Workers Comp,,528.00,,,,,,,495.00,533.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,outpatient,,,550.00000,220.00000,Coventry,Workers Comp,,528.00,,,,,,,143.00,533.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,inpatient,,,305.00000,122.00000,Coventry,Workers Comp,,292.80,,,,,,,274.50,295.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,outpatient,,,305.00000,122.00000,Coventry,Workers Comp,,292.80,,,,,,,79.30,295.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,inpatient,,,220.00000,88.00000,Coventry,Workers Comp,,211.20,,,,,,,198.00,213.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,outpatient,,,220.00000,88.00000,Coventry,Workers Comp,,211.20,,,,,,,57.20,213.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,inpatient,,,780.00000,312.00000,Coventry,Workers Comp,,748.80,,,,,,,702.00,756.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,outpatient,,,780.00000,312.00000,Coventry,Workers Comp,,748.80,,,,,,,202.80,756.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,inpatient,,,1165.00000,466.00000,Coventry,Workers Comp,,1118.40,,,,,,,1048.50,1130.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,outpatient,,,1165.00000,466.00000,Coventry,Workers Comp,,1118.40,,,,,,,302.90,1130.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,inpatient,,,2350.00000,940.00000,Coventry,Workers Comp,,2256.00,,,,,,,2115.00,2279.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,outpatient,,,2350.00000,940.00000,Coventry,Workers Comp,,2256.00,,,,,,,611.00,2279.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,inpatient,,,896.00000,358.40000,Coventry,Workers Comp,,860.16,,,,,,,806.40,869.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,outpatient,,,896.00000,358.40000,Coventry,Workers Comp,,860.16,,,,,,,232.96,869.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,inpatient,,,385.00000,154.00000,Coventry,Workers Comp,,369.60,,,,,,,346.50,373.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,outpatient,,,385.00000,154.00000,Coventry,Workers Comp,,369.60,,,,,,,100.10,373.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,inpatient,,,470.00000,188.00000,Coventry,Workers Comp,,451.20,,,,,,,423.00,455.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,outpatient,,,470.00000,188.00000,Coventry,Workers Comp,,451.20,,,,,,,122.20,455.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,inpatient,,,150.00000,60.00000,Coventry,Workers Comp,,144.00,,,,,,,135.00,145.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,outpatient,,,150.00000,60.00000,Coventry,Workers Comp,,144.00,,,,,,,39.00,145.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,inpatient,,,100.00000,40.00000,Coventry,Workers Comp,,96.00,,,,,,,90.00,97.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,outpatient,,,100.00000,40.00000,Coventry,Workers Comp,,96.00,,,,,,,26.00,97.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,inpatient,,,143.00000,57.20000,Coventry,Workers Comp,,137.28,,,,,,,128.70,138.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,outpatient,,,143.00000,57.20000,Coventry,Workers Comp,,137.28,,,,,,,37.18,138.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,inpatient,,,95.00000,38.00000,Coventry,Workers Comp,,91.20,,,,,,,85.50,92.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,outpatient,,,95.00000,38.00000,Coventry,Workers Comp,,91.20,,,,,,,24.70,92.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,inpatient,,,269.00000,107.60000,Coventry,Workers Comp,,258.24,,,,,,,242.10,260.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,outpatient,,,269.00000,107.60000,Coventry,Workers Comp,,258.24,,,,,,,69.94,260.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,inpatient,,,388.00000,155.20000,Coventry,Workers Comp,,372.48,,,,,,,349.20,376.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,outpatient,,,388.00000,155.20000,Coventry,Workers Comp,,372.48,,,,,,,100.88,376.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,inpatient,,,344.00000,137.60000,Coventry,Workers Comp,,330.24,,,,,,,309.60,333.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,outpatient,,,344.00000,137.60000,Coventry,Workers Comp,,330.24,,,,,,,89.44,333.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,inpatient,,,321.00000,128.40000,Coventry,Workers Comp,,308.16,,,,,,,288.90,311.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,outpatient,,,321.00000,128.40000,Coventry,Workers Comp,,308.16,,,,,,,83.46,311.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,inpatient,,,155.00000,62.00000,Coventry,Workers Comp,,148.80,,,,,,,139.50,150.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,outpatient,,,155.00000,62.00000,Coventry,Workers Comp,,148.80,,,,,,,40.30,150.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,inpatient,,,817.00000,326.80000,Coventry,Workers Comp,,784.32,,,,,,,735.30,792.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,outpatient,,,817.00000,326.80000,Coventry,Workers Comp,,784.32,,,,,,,212.42,792.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,inpatient,,,1255.00000,502.00000,Coventry,Workers Comp,,1204.80,,,,,,,1129.50,1217.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,outpatient,,,1255.00000,502.00000,Coventry,Workers Comp,,1204.80,,,,,,,326.30,1217.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,inpatient,,,391.00000,156.40000,Coventry,Workers Comp,,375.36,,,,,,,351.90,379.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,outpatient,,,391.00000,156.40000,Coventry,Workers Comp,,375.36,,,,,,,101.66,379.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,inpatient,,,671.00000,268.40000,Coventry,Workers Comp,,644.16,,,,,,,603.90,650.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,outpatient,,,671.00000,268.40000,Coventry,Workers Comp,,644.16,,,,,,,174.46,650.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,inpatient,,,456.00000,182.40000,Coventry,Workers Comp,,437.76,,,,,,,410.40,442.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,outpatient,,,456.00000,182.40000,Coventry,Workers Comp,,437.76,,,,,,,118.56,442.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,inpatient,,,112.00000,44.80000,Coventry,Workers Comp,,107.52,,,,,,,100.80,108.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,outpatient,,,112.00000,44.80000,Coventry,Workers Comp,,107.52,,,,,,,29.12,108.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,inpatient,,,84.00000,33.60000,Coventry,Workers Comp,,80.64,,,,,,,75.60,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,outpatient,,,84.00000,33.60000,Coventry,Workers Comp,,80.64,,,,,,,21.84,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,inpatient,,,216.00000,86.40000,Coventry,Workers Comp,,207.36,,,,,,,194.40,209.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,outpatient,,,216.00000,86.40000,Coventry,Workers Comp,,207.36,,,,,,,56.16,209.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,inpatient,,,2660.00000,1064.00000,Coventry,Workers Comp,,2553.60,,,,,,,2394.00,2580.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,outpatient,,,2660.00000,1064.00000,Coventry,Workers Comp,,2553.60,,,,,,,691.60,2580.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,inpatient,,,2960.00000,1184.00000,Coventry,Workers Comp,,2841.60,,,,,,,2664.00,2871.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,outpatient,,,2960.00000,1184.00000,Coventry,Workers Comp,,2841.60,,,,,,,769.60,2871.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,inpatient,,,3225.00000,1290.00000,Coventry,Workers Comp,,3096.00,,,,,,,2902.50,3128.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,outpatient,,,3225.00000,1290.00000,Coventry,Workers Comp,,3096.00,,,,,,,838.50,3128.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,inpatient,,,3395.00000,1358.00000,Coventry,Workers Comp,,3259.20,,,,,,,3055.50,3293.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,outpatient,,,3395.00000,1358.00000,Coventry,Workers Comp,,3259.20,,,,,,,882.70,3293.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,inpatient,,,490.00000,196.00000,Coventry,Workers Comp,,470.40,,,,,,,441.00,475.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,outpatient,,,490.00000,196.00000,Coventry,Workers Comp,,470.40,,,,,,,127.40,475.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,inpatient,,,520.00000,208.00000,Coventry,Workers Comp,,499.20,,,,,,,468.00,504.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,outpatient,,,520.00000,208.00000,Coventry,Workers Comp,,499.20,,,,,,,135.20,504.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,inpatient,,,720.00000,288.00000,Coventry,Workers Comp,,691.20,,,,,,,648.00,698.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,outpatient,,,720.00000,288.00000,Coventry,Workers Comp,,691.20,,,,,,,187.20,698.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,inpatient,,,215.00000,86.00000,Coventry,Workers Comp,,206.40,,,,,,,193.50,208.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,outpatient,,,215.00000,86.00000,Coventry,Workers Comp,,206.40,,,,,,,55.90,208.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,inpatient,,,240.00000,96.00000,Coventry,Workers Comp,,230.40,,,,,,,216.00,232.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,outpatient,,,240.00000,96.00000,Coventry,Workers Comp,,230.40,,,,,,,62.40,232.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,inpatient,,,1241.00000,496.40000,Coventry,Workers Comp,,1191.36,,,,,,,1116.90,1203.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,outpatient,,,1241.00000,496.40000,Coventry,Workers Comp,,1191.36,,,,,,,322.66,1203.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,inpatient,,,850.00000,340.00000,Coventry,Workers Comp,,816.00,,,,,,,765.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,outpatient,,,850.00000,340.00000,Coventry,Workers Comp,,816.00,,,,,,,221.00,824.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,inpatient,,,1085.00000,434.00000,Coventry,Workers Comp,,1041.60,,,,,,,976.50,1052.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,outpatient,,,1085.00000,434.00000,Coventry,Workers Comp,,1041.60,,,,,,,282.10,1052.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,inpatient,,,295.00000,118.00000,Coventry,Workers Comp,,283.20,,,,,,,265.50,286.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Coventry,Workers Comp,,283.20,,,,,,,76.70,286.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,inpatient,,,492.00000,196.80000,Coventry,Workers Comp,,472.32,,,,,,,442.80,477.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,outpatient,,,492.00000,196.80000,Coventry,Workers Comp,,472.32,,,,,,,127.92,477.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,inpatient,,,563.00000,225.20000,Coventry,Workers Comp,,540.48,,,,,,,506.70,546.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,outpatient,,,563.00000,225.20000,Coventry,Workers Comp,,540.48,,,,,,,146.38,546.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,inpatient,,,1612.00000,644.80000,Coventry,Workers Comp,,1547.52,,,,,,,1450.80,1563.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,outpatient,,,1612.00000,644.80000,Coventry,Workers Comp,,1547.52,,,,,,,419.12,1563.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,inpatient,,,1366.00000,546.40000,Coventry,Workers Comp,,1311.36,,,,,,,1229.40,1325.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,outpatient,,,1366.00000,546.40000,Coventry,Workers Comp,,1311.36,,,,,,,355.16,1325.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,inpatient,,,1911.00000,764.40000,Coventry,Workers Comp,,1834.56,,,,,,,1719.90,1853.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,outpatient,,,1911.00000,764.40000,Coventry,Workers Comp,,1834.56,,,,,,,496.86,1853.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,inpatient,,,956.00000,382.40000,Coventry,Workers Comp,,917.76,,,,,,,860.40,927.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,outpatient,,,956.00000,382.40000,Coventry,Workers Comp,,917.76,,,,,,,248.56,927.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,inpatient,,,189.00000,123.20000,Coventry,Workers Comp,,181.44,,,,,,,170.10,183.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,outpatient,,,189.00000,123.20000,Coventry,Workers Comp,,181.44,,,,,,,49.14,183.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,inpatient,,,352.00000,256.87000,Coventry,Workers Comp,,337.92,,,,,,,316.80,341.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,outpatient,,,352.00000,256.87000,Coventry,Workers Comp,,337.92,,,,,,,91.52,341.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,inpatient,,,625.00000,738.40000,Coventry,Workers Comp,,600.00,,,,,,,562.50,606.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,outpatient,,,625.00000,738.40000,Coventry,Workers Comp,,600.00,,,,,,,162.50,606.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,inpatient,,,1024.00000,2097.47000,Coventry,Workers Comp,,983.04,,,,,,,921.60,993.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1024.00000,2097.47000,Coventry,Workers Comp,,983.04,,,,,,,266.24,993.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,inpatient,,,1455.00000,2469.72000,Coventry,Workers Comp,,1396.80,,,,,,,1309.50,1411.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,outpatient,,,1455.00000,2469.72000,Coventry,Workers Comp,,1396.80,,,,,,,378.30,1411.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,inpatient,,,145.00000,75.54000,Coventry,Workers Comp,,139.20,,,,,,,130.50,140.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Coventry,Workers Comp,,139.20,,,,,,,37.70,140.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,inpatient,,,488.00000,254.25000,Coventry,Workers Comp,,468.48,,,,,,,439.20,473.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Coventry,Workers Comp,,468.48,,,,,,,126.88,473.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Coventry,Workers Comp,,111.36,,,,,,,104.40,112.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Coventry,Workers Comp,,111.36,,,,,,,30.16,112.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Coventry,Workers Comp,,77.76,,,,,,,72.90,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Coventry,Workers Comp,,77.76,,,,,,,21.06,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Coventry,Workers Comp,,39.36,,,,,,,36.90,39.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Coventry,Workers Comp,,39.36,,,,,,,10.66,39.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,inpatient,,,170.00000,73.95000,Coventry,Workers Comp,,163.20,,,,,,,153.00,164.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,outpatient,,,170.00000,73.95000,Coventry,Workers Comp,,163.20,,,,,,,44.20,164.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,2.70000,1.17000,Coventry,Workers Comp,,2.59,,,,,,,2.43,2.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,2.70000,1.17000,Coventry,Workers Comp,,2.59,,,,,,,0.70200,2.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,27.00000,11.74000,Coventry,Workers Comp,,25.92,,,,,,,24.30,26.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,27.00000,11.74000,Coventry,Workers Comp,,25.92,,,,,,,7.02,26.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,inpatient,,,20440.00000,8891.40000,Coventry,Workers Comp,,19622.40,,,,,,,18396.00,19826.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,outpatient,,,20440.00000,8891.40000,Coventry,Workers Comp,,19622.40,,,,,,,5314.40,19826.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,inpatient,,,3322.00000,1445.07000,Coventry,Workers Comp,,3189.12,,,,,,,2989.80,3222.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,3322.00000,1445.07000,Coventry,Workers Comp,,3189.12,,,,,,,863.72,3222.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,inpatient,,,2492.00000,1084.02000,Coventry,Workers Comp,,2392.32,,,,,,,2242.80,2417.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,2492.00000,1084.02000,Coventry,Workers Comp,,2392.32,,,,,,,647.92,2417.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,inpatient,,,1814.00000,789.09000,Coventry,Workers Comp,,1741.44,,,,,,,1632.60,1759.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1814.00000,789.09000,Coventry,Workers Comp,,1741.44,,,,,,,471.64,1759.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,inpatient,,,2153.00000,936.56000,Coventry,Workers Comp,,2066.88,,,,,,,1937.70,2088.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,2153.00000,936.56000,Coventry,Workers Comp,,2066.88,,,,,,,559.78,2088.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,inpatient,,,1525.00000,663.38000,Coventry,Workers Comp,,1464.00,,,,,,,1372.50,1479.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1525.00000,663.38000,Coventry,Workers Comp,,1464.00,,,,,,,396.50,1479.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,inpatient,,,2716.00000,1181.46000,Coventry,Workers Comp,,2607.36,,,,,,,2444.40,2634.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2716.00000,1181.46000,Coventry,Workers Comp,,2607.36,,,,,,,706.16,2634.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,inpatient,,,2.70000,0.39000,Coventry,Workers Comp,,2.59,,,,,,,2.43,2.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,outpatient,,,2.70000,0.39000,Coventry,Workers Comp,,2.59,,,,,,,0.70200,2.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,inpatient,,,222.00000,32.41000,Coventry,Workers Comp,,213.12,,,,,,,199.80,215.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,outpatient,,,222.00000,32.41000,Coventry,Workers Comp,,213.12,,,,,,,57.72,215.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,inpatient,,,211.00000,113.10000,Coventry,Workers Comp,,202.56,,,,,,,189.90,204.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,outpatient,,,211.00000,113.10000,Coventry,Workers Comp,,202.56,,,,,,,54.86,204.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,inpatient,,,497.00000,266.39000,Coventry,Workers Comp,,477.12,,,,,,,447.30,482.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,outpatient,,,497.00000,266.39000,Coventry,Workers Comp,,477.12,,,,,,,129.22,482.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,inpatient,,,296.00000,158.66000,Coventry,Workers Comp,,284.16,,,,,,,266.40,287.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,outpatient,,,296.00000,158.66000,Coventry,Workers Comp,,284.16,,,,,,,76.96,287.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,inpatient,,,723.00000,387.53000,Coventry,Workers Comp,,694.08,,,,,,,650.70,701.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,outpatient,,,723.00000,387.53000,Coventry,Workers Comp,,694.08,,,,,,,187.98,701.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,inpatient,,,326.00000,174.74000,Coventry,Workers Comp,,312.96,,,,,,,293.40,316.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,outpatient,,,326.00000,174.74000,Coventry,Workers Comp,,312.96,,,,,,,84.76,316.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,inpatient,,,532.00000,285.15000,Coventry,Workers Comp,,510.72,,,,,,,478.80,516.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,outpatient,,,532.00000,285.15000,Coventry,Workers Comp,,510.72,,,,,,,138.32,516.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,inpatient,,,635.00000,340.36000,Coventry,Workers Comp,,609.60,,,,,,,571.50,615.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,outpatient,,,635.00000,340.36000,Coventry,Workers Comp,,609.60,,,,,,,165.10,615.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,inpatient,,,639.00000,342.50000,Coventry,Workers Comp,,613.44,,,,,,,575.10,619.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,outpatient,,,639.00000,342.50000,Coventry,Workers Comp,,613.44,,,,,,,166.14,619.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,inpatient,,,780.00000,418.08000,Coventry,Workers Comp,,748.80,,,,,,,702.00,756.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,outpatient,,,780.00000,418.08000,Coventry,Workers Comp,,748.80,,,,,,,202.80,756.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,inpatient,,,390.00000,209.04000,Coventry,Workers Comp,,374.40,,,,,,,351.00,378.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,outpatient,,,390.00000,209.04000,Coventry,Workers Comp,,374.40,,,,,,,101.40,378.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,inpatient,,,731.00000,391.82000,Coventry,Workers Comp,,701.76,,,,,,,657.90,709.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,outpatient,,,731.00000,391.82000,Coventry,Workers Comp,,701.76,,,,,,,190.06,709.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,inpatient,,,585.00000,313.56000,Coventry,Workers Comp,,561.60,,,,,,,526.50,567.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,outpatient,,,585.00000,313.56000,Coventry,Workers Comp,,561.60,,,,,,,152.10,567.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,inpatient,,,365.00000,195.64000,Coventry,Workers Comp,,350.40,,,,,,,328.50,354.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,outpatient,,,365.00000,195.64000,Coventry,Workers Comp,,350.40,,,,,,,94.90,354.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,inpatient,,,1086.00000,582.10000,Coventry,Workers Comp,,1042.56,,,,,,,977.40,1053.42,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,outpatient,,,1086.00000,582.10000,Coventry,Workers Comp,,1042.56,,,,,,,282.36,1053.42,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,inpatient,,,197.00000,105.59000,Coventry,Workers Comp,,189.12,,,,,,,177.30,191.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,outpatient,,,197.00000,105.59000,Coventry,Workers Comp,,189.12,,,,,,,51.22,191.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,inpatient,,,2774.00000,1486.86000,Coventry,Workers Comp,,2663.04,,,,,,,2496.60,2690.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,outpatient,,,2774.00000,1486.86000,Coventry,Workers Comp,,2663.04,,,,,,,721.24,2690.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,inpatient,,,1456.00000,780.42000,Coventry,Workers Comp,,1397.76,,,,,,,1310.40,1412.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,outpatient,,,1456.00000,780.42000,Coventry,Workers Comp,,1397.76,,,,,,,378.56,1412.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,inpatient,,,2647.00000,1418.79000,Coventry,Workers Comp,,2541.12,,,,,,,2382.30,2567.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,outpatient,,,2647.00000,1418.79000,Coventry,Workers Comp,,2541.12,,,,,,,688.22,2567.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,inpatient,,,1359.00000,728.42000,Coventry,Workers Comp,,1304.64,,,,,,,1223.10,1318.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,outpatient,,,1359.00000,728.42000,Coventry,Workers Comp,,1304.64,,,,,,,353.34,1318.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,inpatient,,,273.00000,146.33000,Coventry,Workers Comp,,262.08,,,,,,,245.70,264.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,outpatient,,,273.00000,146.33000,Coventry,Workers Comp,,262.08,,,,,,,70.98,264.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,inpatient,,,325.00000,174.20000,Coventry,Workers Comp,,312.00,,,,,,,292.50,315.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,outpatient,,,325.00000,174.20000,Coventry,Workers Comp,,312.00,,,,,,,84.50,315.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,inpatient,,,609.00000,326.42000,Coventry,Workers Comp,,584.64,,,,,,,548.10,590.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Coventry,Workers Comp,,584.64,,,,,,,158.34,590.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,inpatient,,,491.00000,263.18000,Coventry,Workers Comp,,471.36,,,,,,,441.90,476.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,outpatient,,,491.00000,263.18000,Coventry,Workers Comp,,471.36,,,,,,,127.66,476.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,inpatient,,,561.00000,300.70000,Coventry,Workers Comp,,538.56,,,,,,,504.90,544.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,outpatient,,,561.00000,300.70000,Coventry,Workers Comp,,538.56,,,,,,,145.86,544.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,inpatient,,,845.00000,452.92000,Coventry,Workers Comp,,811.20,,,,,,,760.50,819.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,outpatient,,,845.00000,452.92000,Coventry,Workers Comp,,811.20,,,,,,,219.70,819.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,inpatient,,,612.00000,328.03000,Coventry,Workers Comp,,587.52,,,,,,,550.80,593.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,outpatient,,,612.00000,328.03000,Coventry,Workers Comp,,587.52,,,,,,,159.12,593.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,inpatient,,,536.00000,287.30000,Coventry,Workers Comp,,514.56,,,,,,,482.40,519.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,outpatient,,,536.00000,287.30000,Coventry,Workers Comp,,514.56,,,,,,,139.36,519.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,inpatient,,,1225.00000,656.60000,Coventry,Workers Comp,,1176.00,,,,,,,1102.50,1188.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,outpatient,,,1225.00000,656.60000,Coventry,Workers Comp,,1176.00,,,,,,,318.50,1188.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,inpatient,,,816.00000,437.38000,Coventry,Workers Comp,LT,783.36,,,,,,,734.40,791.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Coventry,Workers Comp,LT,783.36,,,,,,,212.16,791.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,inpatient,,,816.00000,437.38000,Coventry,Workers Comp,RT,783.36,,,,,,,734.40,791.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Coventry,Workers Comp,RT,783.36,,,,,,,212.16,791.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,inpatient,,,250.00000,134.00000,Coventry,Workers Comp,,240.00,,,,,,,225.00,242.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,outpatient,,,250.00000,134.00000,Coventry,Workers Comp,,240.00,,,,,,,65.00,242.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,inpatient,,,302.00000,161.87000,Coventry,Workers Comp,,289.92,,,,,,,271.80,292.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,outpatient,,,302.00000,161.87000,Coventry,Workers Comp,,289.92,,,,,,,78.52,292.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,inpatient,,,354.00000,189.74000,Coventry,Workers Comp,,339.84,,,,,,,318.60,343.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,outpatient,,,354.00000,189.74000,Coventry,Workers Comp,,339.84,,,,,,,92.04,343.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,inpatient,,,409.00000,219.22000,Coventry,Workers Comp,,392.64,,,,,,,368.10,396.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,outpatient,,,409.00000,219.22000,Coventry,Workers Comp,,392.64,,,,,,,106.34,396.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,inpatient,,,593.00000,317.85000,Coventry,Workers Comp,,569.28,,,,,,,533.70,575.21,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,outpatient,,,593.00000,317.85000,Coventry,Workers Comp,,569.28,,,,,,,154.18,575.21,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Coventry,Workers Comp,LT,294.72,,,,,,,276.30,297.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Coventry,Workers Comp,LT,294.72,,,,,,,79.82,297.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Coventry,Workers Comp,"52,LT",294.72,,,,,,,276.30,297.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Coventry,Workers Comp,"52,LT",294.72,,,,,,,79.82,297.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Coventry,Workers Comp,RT,294.72,,,,,,,276.30,297.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Coventry,Workers Comp,RT,294.72,,,,,,,79.82,297.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Coventry,Workers Comp,"52,RT",294.72,,,,,,,276.30,297.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Coventry,Workers Comp,"52,RT",294.72,,,,,,,79.82,297.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,inpatient,,,330.00000,176.88000,Coventry,Workers Comp,LT,316.80,,,,,,,297.00,320.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Coventry,Workers Comp,LT,316.80,,,,,,,85.80,320.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,inpatient,,,330.00000,176.88000,Coventry,Workers Comp,RT,316.80,,,,,,,297.00,320.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Coventry,Workers Comp,RT,316.80,,,,,,,85.80,320.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,inpatient,,,195.00000,104.52000,Coventry,Workers Comp,,187.20,,,,,,,175.50,189.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,outpatient,,,195.00000,104.52000,Coventry,Workers Comp,,187.20,,,,,,,50.70,189.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,inpatient,,,578.00000,309.81000,Coventry,Workers Comp,,554.88,,,,,,,520.20,560.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,outpatient,,,578.00000,309.81000,Coventry,Workers Comp,,554.88,,,,,,,150.28,560.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,inpatient,,,384.00000,205.82000,Coventry,Workers Comp,,368.64,,,,,,,345.60,372.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,outpatient,,,384.00000,205.82000,Coventry,Workers Comp,,368.64,,,,,,,99.84,372.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,inpatient,,,303.00000,162.41000,Coventry,Workers Comp,LT,290.88,,,,,,,272.70,293.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Coventry,Workers Comp,LT,290.88,,,,,,,78.78,293.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,inpatient,,,303.00000,162.41000,Coventry,Workers Comp,RT,290.88,,,,,,,272.70,293.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Coventry,Workers Comp,RT,290.88,,,,,,,78.78,293.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,inpatient,,,445.00000,238.52000,Coventry,Workers Comp,LT,427.20,,,,,,,400.50,431.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Coventry,Workers Comp,LT,427.20,,,,,,,115.70,431.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,inpatient,,,445.00000,238.52000,Coventry,Workers Comp,RT,427.20,,,,,,,400.50,431.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Coventry,Workers Comp,RT,427.20,,,,,,,115.70,431.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,inpatient,,,937.00000,502.23000,Coventry,Workers Comp,,899.52,,,,,,,843.30,908.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,outpatient,,,937.00000,502.23000,Coventry,Workers Comp,,899.52,,,,,,,243.62,908.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,inpatient,,,615.00000,329.64000,Coventry,Workers Comp,,590.40,,,,,,,553.50,596.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,outpatient,,,615.00000,329.64000,Coventry,Workers Comp,,590.40,,,,,,,159.90,596.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Coventry,Workers Comp,LT,275.52,,,,,,,258.30,278.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Coventry,Workers Comp,LT,275.52,,,,,,,74.62,278.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Coventry,Workers Comp,"52,LT",275.52,,,,,,,258.30,278.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Coventry,Workers Comp,"52,LT",275.52,,,,,,,74.62,278.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Coventry,Workers Comp,RT,275.52,,,,,,,258.30,278.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Coventry,Workers Comp,RT,275.52,,,,,,,74.62,278.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Coventry,Workers Comp,"52,RT",275.52,,,,,,,258.30,278.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Coventry,Workers Comp,"52,RT",275.52,,,,,,,74.62,278.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,inpatient,,,323.00000,173.13000,Coventry,Workers Comp,LT,310.08,,,,,,,290.70,313.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Coventry,Workers Comp,LT,310.08,,,,,,,83.98,313.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,inpatient,,,323.00000,173.13000,Coventry,Workers Comp,RT,310.08,,,,,,,290.70,313.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Coventry,Workers Comp,RT,310.08,,,,,,,83.98,313.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,inpatient,,,694.00000,371.98000,Coventry,Workers Comp,,666.24,,,,,,,624.60,673.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,outpatient,,,694.00000,371.98000,Coventry,Workers Comp,,666.24,,,,,,,180.44,673.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,inpatient,,,276.00000,147.94000,Coventry,Workers Comp,LT,264.96,,,,,,,248.40,267.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Coventry,Workers Comp,LT,264.96,,,,,,,71.76,267.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,inpatient,,,276.00000,147.94000,Coventry,Workers Comp,RT,264.96,,,,,,,248.40,267.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Coventry,Workers Comp,RT,264.96,,,,,,,71.76,267.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,inpatient,,,254.00000,136.14000,Coventry,Workers Comp,LT,243.84,,,,,,,228.60,246.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Coventry,Workers Comp,LT,243.84,,,,,,,66.04,246.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,inpatient,,,254.00000,136.14000,Coventry,Workers Comp,RT,243.84,,,,,,,228.60,246.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Coventry,Workers Comp,RT,243.84,,,,,,,66.04,246.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,inpatient,,,275.00000,147.40000,Coventry,Workers Comp,LT,264.00,,,,,,,247.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Coventry,Workers Comp,LT,264.00,,,,,,,71.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,inpatient,,,275.00000,147.40000,Coventry,Workers Comp,RT,264.00,,,,,,,247.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Coventry,Workers Comp,RT,264.00,,,,,,,71.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,inpatient,,,173.00000,92.73000,Coventry,Workers Comp,,166.08,,,,,,,155.70,167.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,outpatient,,,173.00000,92.73000,Coventry,Workers Comp,,166.08,,,,,,,44.98,167.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,inpatient,,,483.00000,258.89000,Coventry,Workers Comp,LT,463.68,,,,,,,434.70,468.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Coventry,Workers Comp,LT,463.68,,,,,,,125.58,468.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,inpatient,,,483.00000,258.89000,Coventry,Workers Comp,RT,463.68,,,,,,,434.70,468.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Coventry,Workers Comp,RT,463.68,,,,,,,125.58,468.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,inpatient,,,191.00000,102.38000,Coventry,Workers Comp,LT,183.36,,,,,,,171.90,185.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Coventry,Workers Comp,LT,183.36,,,,,,,49.66,185.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,inpatient,,,191.00000,102.38000,Coventry,Workers Comp,RT,183.36,,,,,,,171.90,185.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Coventry,Workers Comp,RT,183.36,,,,,,,49.66,185.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Coventry,Workers Comp,LT,142.08,,,,,,,133.20,143.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Coventry,Workers Comp,LT,142.08,,,,,,,38.48,143.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Coventry,Workers Comp,"52,LT",142.08,,,,,,,133.20,143.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Coventry,Workers Comp,"52,LT",142.08,,,,,,,38.48,143.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Coventry,Workers Comp,RT,142.08,,,,,,,133.20,143.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Coventry,Workers Comp,RT,142.08,,,,,,,38.48,143.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Coventry,Workers Comp,"52,RT",142.08,,,,,,,133.20,143.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Coventry,Workers Comp,"52,RT",142.08,,,,,,,38.48,143.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,inpatient,,,481.00000,257.82000,Coventry,Workers Comp,LT,461.76,,,,,,,432.90,466.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Coventry,Workers Comp,LT,461.76,,,,,,,125.06,466.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,inpatient,,,481.00000,257.82000,Coventry,Workers Comp,RT,461.76,,,,,,,432.90,466.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Coventry,Workers Comp,RT,461.76,,,,,,,125.06,466.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,inpatient,,,215.00000,115.24000,Coventry,Workers Comp,LT,206.40,,,,,,,193.50,208.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Coventry,Workers Comp,LT,206.40,,,,,,,55.90,208.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,inpatient,,,215.00000,115.24000,Coventry,Workers Comp,RT,206.40,,,,,,,193.50,208.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Coventry,Workers Comp,RT,206.40,,,,,,,55.90,208.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Coventry,Workers Comp,LT,264.00,,,,,,,247.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Coventry,Workers Comp,LT,264.00,,,,,,,71.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Coventry,Workers Comp,"52,LT",264.00,,,,,,,247.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Coventry,Workers Comp,"52,LT",264.00,,,,,,,71.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Coventry,Workers Comp,RT,264.00,,,,,,,247.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Coventry,Workers Comp,RT,264.00,,,,,,,71.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Coventry,Workers Comp,"52,RT",264.00,,,,,,,247.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Coventry,Workers Comp,"52,RT",264.00,,,,,,,71.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Coventry,Workers Comp,LT,436.80,,,,,,,409.50,441.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Coventry,Workers Comp,LT,436.80,,,,,,,118.30,441.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Coventry,Workers Comp,"52,LT",436.80,,,,,,,409.50,441.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Coventry,Workers Comp,"52,LT",436.80,,,,,,,118.30,441.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Coventry,Workers Comp,RT,436.80,,,,,,,409.50,441.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Coventry,Workers Comp,RT,436.80,,,,,,,118.30,441.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Coventry,Workers Comp,"52,RT",436.80,,,,,,,409.50,441.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Coventry,Workers Comp,"52,RT",436.80,,,,,,,118.30,441.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,inpatient,,,503.00000,269.61000,Coventry,Workers Comp,LT,482.88,,,,,,,452.70,487.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Coventry,Workers Comp,LT,482.88,,,,,,,130.78,487.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,inpatient,,,503.00000,269.61000,Coventry,Workers Comp,RT,482.88,,,,,,,452.70,487.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Coventry,Workers Comp,RT,482.88,,,,,,,130.78,487.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,inpatient,,,209.00000,112.02000,Coventry,Workers Comp,LT,200.64,,,,,,,188.10,202.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Coventry,Workers Comp,LT,200.64,,,,,,,54.34,202.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,inpatient,,,209.00000,112.02000,Coventry,Workers Comp,RT,200.64,,,,,,,188.10,202.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Coventry,Workers Comp,RT,200.64,,,,,,,54.34,202.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,inpatient,,,566.00000,303.38000,Coventry,Workers Comp,LT,543.36,,,,,,,509.40,549.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Coventry,Workers Comp,LT,543.36,,,,,,,147.16,549.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,inpatient,,,566.00000,303.38000,Coventry,Workers Comp,RT,543.36,,,,,,,509.40,549.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Coventry,Workers Comp,RT,543.36,,,,,,,147.16,549.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,inpatient,,,598.00000,320.53000,Coventry,Workers Comp,,574.08,,,,,,,538.20,580.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,outpatient,,,598.00000,320.53000,Coventry,Workers Comp,,574.08,,,,,,,155.48,580.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Coventry,Workers Comp,"52,LT",436.80,,,,,,,409.50,441.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Coventry,Workers Comp,"52,LT",436.80,,,,,,,118.30,441.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Coventry,Workers Comp,"52,RT",436.80,,,,,,,409.50,441.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Coventry,Workers Comp,"52,RT",436.80,,,,,,,118.30,441.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Coventry,Workers Comp,LT,436.80,,,,,,,409.50,441.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Coventry,Workers Comp,LT,436.80,,,,,,,118.30,441.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Coventry,Workers Comp,RT,436.80,,,,,,,409.50,441.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Coventry,Workers Comp,RT,436.80,,,,,,,118.30,441.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,inpatient,,,1913.00000,1025.37000,Coventry,Workers Comp,,1836.48,,,,,,,1721.70,1855.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,outpatient,,,1913.00000,1025.37000,Coventry,Workers Comp,,1836.48,,,,,,,497.38,1855.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,inpatient,,,312.00000,167.23000,Coventry,Workers Comp,,299.52,,,,,,,280.80,302.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,outpatient,,,312.00000,167.23000,Coventry,Workers Comp,,299.52,,,,,,,81.12,302.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,inpatient,,,327.00000,175.27000,Coventry,Workers Comp,,313.92,,,,,,,294.30,317.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,outpatient,,,327.00000,175.27000,Coventry,Workers Comp,,313.92,,,,,,,85.02,317.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,inpatient,,,425.00000,227.80000,Coventry,Workers Comp,,408.00,,,,,,,382.50,412.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,outpatient,,,425.00000,227.80000,Coventry,Workers Comp,,408.00,,,,,,,110.50,412.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,inpatient,,,210.00000,112.56000,Coventry,Workers Comp,,201.60,,,,,,,189.00,203.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,outpatient,,,210.00000,112.56000,Coventry,Workers Comp,,201.60,,,,,,,54.60,203.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,inpatient,,,495.00000,265.32000,Coventry,Workers Comp,,475.20,,,,,,,445.50,480.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,outpatient,,,495.00000,265.32000,Coventry,Workers Comp,,475.20,,,,,,,128.70,480.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,inpatient,,,541.00000,289.98000,Coventry,Workers Comp,,519.36,,,,,,,486.90,524.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,outpatient,,,541.00000,289.98000,Coventry,Workers Comp,,519.36,,,,,,,140.66,524.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,inpatient,,,345.00000,184.92000,Coventry,Workers Comp,LT,331.20,,,,,,,310.50,334.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Coventry,Workers Comp,LT,331.20,,,,,,,89.70,334.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,inpatient,,,345.00000,184.92000,Coventry,Workers Comp,RT,331.20,,,,,,,310.50,334.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Coventry,Workers Comp,RT,331.20,,,,,,,89.70,334.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,inpatient,,,419.00000,224.58000,Coventry,Workers Comp,LT,402.24,,,,,,,377.10,406.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Coventry,Workers Comp,LT,402.24,,,,,,,108.94,406.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,inpatient,,,419.00000,224.58000,Coventry,Workers Comp,RT,402.24,,,,,,,377.10,406.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Coventry,Workers Comp,RT,402.24,,,,,,,108.94,406.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,inpatient,,,618.00000,331.25000,Coventry,Workers Comp,LT,593.28,,,,,,,556.20,599.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Coventry,Workers Comp,LT,593.28,,,,,,,160.68,599.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,inpatient,,,618.00000,331.25000,Coventry,Workers Comp,RT,593.28,,,,,,,556.20,599.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Coventry,Workers Comp,RT,593.28,,,,,,,160.68,599.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,inpatient,,,463.00000,248.17000,Coventry,Workers Comp,,444.48,,,,,,,416.70,449.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,outpatient,,,463.00000,248.17000,Coventry,Workers Comp,,444.48,,,,,,,120.38,449.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,inpatient,,,511.00000,273.90000,Coventry,Workers Comp,,490.56,,,,,,,459.90,495.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,outpatient,,,511.00000,273.90000,Coventry,Workers Comp,,490.56,,,,,,,132.86,495.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,inpatient,,,132.00000,70.75000,Coventry,Workers Comp,,126.72,,,,,,,118.80,128.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,outpatient,,,132.00000,70.75000,Coventry,Workers Comp,,126.72,,,,,,,34.32,128.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,inpatient,,,353.00000,189.21000,Coventry,Workers Comp,LT,338.88,,,,,,,317.70,342.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Coventry,Workers Comp,LT,338.88,,,,,,,91.78,342.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,inpatient,,,353.00000,189.21000,Coventry,Workers Comp,RT,338.88,,,,,,,317.70,342.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Coventry,Workers Comp,RT,338.88,,,,,,,91.78,342.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,inpatient,,,273.00000,146.33000,Coventry,Workers Comp,,262.08,,,,,,,245.70,264.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,outpatient,,,273.00000,146.33000,Coventry,Workers Comp,,262.08,,,,,,,70.98,264.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,inpatient,,,503.00000,269.61000,Coventry,Workers Comp,,482.88,,,,,,,452.70,487.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,outpatient,,,503.00000,269.61000,Coventry,Workers Comp,,482.88,,,,,,,130.78,487.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,inpatient,,,561.00000,300.70000,Coventry,Workers Comp,,538.56,,,,,,,504.90,544.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,outpatient,,,561.00000,300.70000,Coventry,Workers Comp,,538.56,,,,,,,145.86,544.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,inpatient,,,450.00000,241.20000,Coventry,Workers Comp,LT,432.00,,,,,,,405.00,436.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Coventry,Workers Comp,LT,432.00,,,,,,,117.00,436.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,inpatient,,,450.00000,241.20000,Coventry,Workers Comp,RT,432.00,,,,,,,405.00,436.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Coventry,Workers Comp,RT,432.00,,,,,,,117.00,436.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,inpatient,,,650.00000,348.40000,Coventry,Workers Comp,,624.00,,,,,,,585.00,630.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,outpatient,,,650.00000,348.40000,Coventry,Workers Comp,,624.00,,,,,,,169.00,630.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,inpatient,,,642.00000,344.11000,Coventry,Workers Comp,,616.32,,,,,,,577.80,622.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,outpatient,,,642.00000,344.11000,Coventry,Workers Comp,,616.32,,,,,,,166.92,622.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,inpatient,,,777.00000,416.47000,Coventry,Workers Comp,,745.92,,,,,,,699.30,753.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,outpatient,,,777.00000,416.47000,Coventry,Workers Comp,,745.92,,,,,,,202.02,753.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,inpatient,,,381.00000,204.22000,Coventry,Workers Comp,,365.76,,,,,,,342.90,369.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,outpatient,,,381.00000,204.22000,Coventry,Workers Comp,,365.76,,,,,,,99.06,369.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,inpatient,,,374.00000,200.46000,Coventry,Workers Comp,LT,359.04,,,,,,,336.60,362.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Coventry,Workers Comp,LT,359.04,,,,,,,97.24,362.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,inpatient,,,374.00000,200.46000,Coventry,Workers Comp,RT,359.04,,,,,,,336.60,362.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Coventry,Workers Comp,RT,359.04,,,,,,,97.24,362.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,inpatient,,,161.00000,86.30000,Coventry,Workers Comp,LT,154.56,,,,,,,144.90,156.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Coventry,Workers Comp,LT,154.56,,,,,,,41.86,156.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,inpatient,,,161.00000,86.30000,Coventry,Workers Comp,RT,154.56,,,,,,,144.90,156.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Coventry,Workers Comp,RT,154.56,,,,,,,41.86,156.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,inpatient,,,499.00000,267.46000,Coventry,Workers Comp,LT,479.04,,,,,,,449.10,484.03,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Coventry,Workers Comp,LT,479.04,,,,,,,129.74,484.03,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,inpatient,,,499.00000,267.46000,Coventry,Workers Comp,RT,479.04,,,,,,,449.10,484.03,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Coventry,Workers Comp,RT,479.04,,,,,,,129.74,484.03,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,inpatient,,,214.00000,114.70000,Coventry,Workers Comp,,205.44,,,,,,,192.60,207.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,outpatient,,,214.00000,114.70000,Coventry,Workers Comp,,205.44,,,,,,,55.64,207.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,inpatient,,,329.00000,176.34000,Coventry,Workers Comp,,315.84,,,,,,,296.10,319.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,outpatient,,,329.00000,176.34000,Coventry,Workers Comp,,315.84,,,,,,,85.54,319.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,inpatient,,,197.00000,105.59000,Coventry,Workers Comp,,189.12,,,,,,,177.30,191.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,outpatient,,,197.00000,105.59000,Coventry,Workers Comp,,189.12,,,,,,,51.22,191.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,inpatient,,,263.00000,140.97000,Coventry,Workers Comp,,252.48,,,,,,,236.70,255.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,outpatient,,,263.00000,140.97000,Coventry,Workers Comp,,252.48,,,,,,,68.38,255.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,inpatient,,,234.00000,125.42000,Coventry,Workers Comp,,224.64,,,,,,,210.60,226.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,outpatient,,,234.00000,125.42000,Coventry,Workers Comp,,224.64,,,,,,,60.84,226.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,inpatient,,,401.00000,214.94000,Coventry,Workers Comp,,384.96,,,,,,,360.90,388.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,outpatient,,,401.00000,214.94000,Coventry,Workers Comp,,384.96,,,,,,,104.26,388.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,inpatient,,,515.00000,276.04000,Coventry,Workers Comp,,494.40,,,,,,,463.50,499.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,outpatient,,,515.00000,276.04000,Coventry,Workers Comp,,494.40,,,,,,,133.90,499.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,inpatient,,,747.00000,400.39000,Coventry,Workers Comp,,717.12,,,,,,,672.30,724.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,outpatient,,,747.00000,400.39000,Coventry,Workers Comp,,717.12,,,,,,,194.22,724.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,inpatient,,,854.00000,457.74000,Coventry,Workers Comp,,819.84,,,,,,,768.60,828.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,outpatient,,,854.00000,457.74000,Coventry,Workers Comp,,819.84,,,,,,,222.04,828.38,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,inpatient,,,589.00000,315.70000,Coventry,Workers Comp,,565.44,,,,,,,530.10,571.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,outpatient,,,589.00000,315.70000,Coventry,Workers Comp,,565.44,,,,,,,153.14,571.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,inpatient,,,613.00000,328.57000,Coventry,Workers Comp,,588.48,,,,,,,551.70,594.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,outpatient,,,613.00000,328.57000,Coventry,Workers Comp,,588.48,,,,,,,159.38,594.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,inpatient,,,806.00000,432.02000,Coventry,Workers Comp,,773.76,,,,,,,725.40,781.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,outpatient,,,806.00000,432.02000,Coventry,Workers Comp,,773.76,,,,,,,209.56,781.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,inpatient,,,529.00000,283.54000,Coventry,Workers Comp,,507.84,,,,,,,476.10,513.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,outpatient,,,529.00000,283.54000,Coventry,Workers Comp,,507.84,,,,,,,137.54,513.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,inpatient,,,939.00000,503.30000,Coventry,Workers Comp,,901.44,,,,,,,845.10,910.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,outpatient,,,939.00000,503.30000,Coventry,Workers Comp,,901.44,,,,,,,244.14,910.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,inpatient,,,515.00000,276.04000,Coventry,Workers Comp,,494.40,,,,,,,463.50,499.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,outpatient,,,515.00000,276.04000,Coventry,Workers Comp,,494.40,,,,,,,133.90,499.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,inpatient,,,616.00000,330.18000,Coventry,Workers Comp,,591.36,,,,,,,554.40,597.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,outpatient,,,616.00000,330.18000,Coventry,Workers Comp,,591.36,,,,,,,160.16,597.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,inpatient,,,377.00000,202.07000,Coventry,Workers Comp,,361.92,,,,,,,339.30,365.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,outpatient,,,377.00000,202.07000,Coventry,Workers Comp,,361.92,,,,,,,98.02,365.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,inpatient,,,340.00000,182.24000,Coventry,Workers Comp,,326.40,,,,,,,306.00,329.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,outpatient,,,340.00000,182.24000,Coventry,Workers Comp,,326.40,,,,,,,88.40,329.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,inpatient,,,388.00000,207.97000,Coventry,Workers Comp,,372.48,,,,,,,349.20,376.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,outpatient,,,388.00000,207.97000,Coventry,Workers Comp,,372.48,,,,,,,100.88,376.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,inpatient,,,456.00000,244.42000,Coventry,Workers Comp,,437.76,,,,,,,410.40,442.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,outpatient,,,456.00000,244.42000,Coventry,Workers Comp,,437.76,,,,,,,118.56,442.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,inpatient,,,267.00000,143.11000,Coventry,Workers Comp,,256.32,,,,,,,240.30,258.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,outpatient,,,267.00000,143.11000,Coventry,Workers Comp,,256.32,,,,,,,69.42,258.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Coventry,Workers Comp,LT,293.76,,,,,,,275.40,296.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Coventry,Workers Comp,LT,293.76,,,,,,,79.56,296.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Coventry,Workers Comp,"52,LT",293.76,,,,,,,275.40,296.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Coventry,Workers Comp,"52,LT",293.76,,,,,,,79.56,296.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Coventry,Workers Comp,RT,293.76,,,,,,,275.40,296.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Coventry,Workers Comp,RT,293.76,,,,,,,79.56,296.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Coventry,Workers Comp,"52,RT",293.76,,,,,,,275.40,296.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Coventry,Workers Comp,"52,RT",293.76,,,,,,,79.56,296.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,inpatient,,,456.00000,244.42000,Coventry,Workers Comp,,437.76,,,,,,,410.40,442.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,outpatient,,,456.00000,244.42000,Coventry,Workers Comp,,437.76,,,,,,,118.56,442.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,inpatient,,,381.00000,204.22000,Coventry,Workers Comp,,365.76,,,,,,,342.90,369.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,outpatient,,,381.00000,204.22000,Coventry,Workers Comp,,365.76,,,,,,,99.06,369.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,inpatient,,,143.00000,76.65000,Coventry,Workers Comp,LT,137.28,,,,,,,128.70,138.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Coventry,Workers Comp,LT,137.28,,,,,,,37.18,138.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,inpatient,,,143.00000,76.65000,Coventry,Workers Comp,RT,137.28,,,,,,,128.70,138.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Coventry,Workers Comp,RT,137.28,,,,,,,37.18,138.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,inpatient,,,331.00000,177.42000,Coventry,Workers Comp,LT,317.76,,,,,,,297.90,321.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Coventry,Workers Comp,LT,317.76,,,,,,,86.06,321.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,inpatient,,,331.00000,177.42000,Coventry,Workers Comp,RT,317.76,,,,,,,297.90,321.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Coventry,Workers Comp,RT,317.76,,,,,,,86.06,321.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,inpatient,,,1113.00000,596.57000,Coventry,Workers Comp,,1068.48,,,,,,,1001.70,1079.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1113.00000,596.57000,Coventry,Workers Comp,,1068.48,,,,,,,289.38,1079.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,inpatient,,,1043.00000,559.05000,Coventry,Workers Comp,,1001.28,,,,,,,938.70,1011.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,outpatient,,,1043.00000,559.05000,Coventry,Workers Comp,,1001.28,,,,,,,271.18,1011.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Coventry,Workers Comp,LT,245.76,,,,,,,230.40,248.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Coventry,Workers Comp,LT,245.76,,,,,,,66.56,248.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Coventry,Workers Comp,"52,LT",245.76,,,,,,,230.40,248.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Coventry,Workers Comp,"52,LT",245.76,,,,,,,66.56,248.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Coventry,Workers Comp,RT,245.76,,,,,,,230.40,248.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Coventry,Workers Comp,RT,245.76,,,,,,,66.56,248.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Coventry,Workers Comp,"52,RT",245.76,,,,,,,230.40,248.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Coventry,Workers Comp,"52,RT",245.76,,,,,,,66.56,248.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,inpatient,,,511.00000,273.90000,Coventry,Workers Comp,LT,490.56,,,,,,,459.90,495.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Coventry,Workers Comp,LT,490.56,,,,,,,132.86,495.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,inpatient,,,511.00000,273.90000,Coventry,Workers Comp,RT,490.56,,,,,,,459.90,495.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Coventry,Workers Comp,RT,490.56,,,,,,,132.86,495.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,inpatient,,,553.00000,314.19000,Coventry,Workers Comp,LT,530.88,,,,,,,497.70,536.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Coventry,Workers Comp,LT,530.88,,,,,,,143.78,536.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,inpatient,,,553.00000,314.19000,Coventry,Workers Comp,RT,530.88,,,,,,,497.70,536.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Coventry,Workers Comp,RT,530.88,,,,,,,143.78,536.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,inpatient,,,1076.00000,611.33000,Coventry,Workers Comp,LT,1032.96,,,,,,,968.40,1043.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Coventry,Workers Comp,LT,1032.96,,,,,,,279.76,1043.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,inpatient,,,1076.00000,611.33000,Coventry,Workers Comp,RT,1032.96,,,,,,,968.40,1043.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Coventry,Workers Comp,RT,1032.96,,,,,,,279.76,1043.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,inpatient,,,865.00000,491.45000,Coventry,Workers Comp,LT,830.40,,,,,,,778.50,839.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Coventry,Workers Comp,LT,830.40,,,,,,,224.90,839.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,inpatient,,,865.00000,491.45000,Coventry,Workers Comp,RT,830.40,,,,,,,778.50,839.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Coventry,Workers Comp,RT,830.40,,,,,,,224.90,839.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,inpatient,,,734.00000,417.02000,Coventry,Workers Comp,LT,704.64,,,,,,,660.60,711.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Coventry,Workers Comp,LT,704.64,,,,,,,190.84,711.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,inpatient,,,734.00000,417.02000,Coventry,Workers Comp,RT,704.64,,,,,,,660.60,711.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Coventry,Workers Comp,RT,704.64,,,,,,,190.84,711.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,inpatient,,,730.00000,414.75000,Coventry,Workers Comp,LT,700.80,,,,,,,657.00,708.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Coventry,Workers Comp,LT,700.80,,,,,,,189.80,708.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,inpatient,,,730.00000,414.75000,Coventry,Workers Comp,RT,700.80,,,,,,,657.00,708.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Coventry,Workers Comp,RT,700.80,,,,,,,189.80,708.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,inpatient,,,260.00000,147.72000,Coventry,Workers Comp,LT,249.60,,,,,,,234.00,252.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Coventry,Workers Comp,LT,249.60,,,,,,,67.60,252.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,inpatient,,,260.00000,147.72000,Coventry,Workers Comp,RT,249.60,,,,,,,234.00,252.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Coventry,Workers Comp,RT,249.60,,,,,,,67.60,252.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,inpatient,,,428.00000,203.73000,Coventry,Workers Comp,,410.88,,,,,,,385.20,415.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,outpatient,,,428.00000,203.73000,Coventry,Workers Comp,,410.88,,,,,,,111.28,415.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,inpatient,,,492.00000,234.19000,Coventry,Workers Comp,,472.32,,,,,,,442.80,477.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,outpatient,,,492.00000,234.19000,Coventry,Workers Comp,,472.32,,,,,,,127.92,477.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,inpatient,,,607.00000,288.93000,Coventry,Workers Comp,,582.72,,,,,,,546.30,588.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,outpatient,,,607.00000,288.93000,Coventry,Workers Comp,,582.72,,,,,,,157.82,588.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,inpatient,,,649.00000,308.92000,Coventry,Workers Comp,,623.04,,,,,,,584.10,629.53,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,outpatient,,,649.00000,308.92000,Coventry,Workers Comp,,623.04,,,,,,,168.74,629.53,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,inpatient,,,377.00000,121.77000,Coventry,Workers Comp,50,361.92,,,,,,,339.30,365.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,outpatient,,,377.00000,121.77000,Coventry,Workers Comp,50,361.92,,,,,,,98.02,365.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,inpatient,,,251.00000,81.07000,Coventry,Workers Comp,LT,240.96,,,,,,,225.90,243.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Coventry,Workers Comp,LT,240.96,,,,,,,65.26,243.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,inpatient,,,251.00000,81.07000,Coventry,Workers Comp,RT,240.96,,,,,,,225.90,243.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Coventry,Workers Comp,RT,240.96,,,,,,,65.26,243.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,inpatient,,,1170.00000,377.91000,Coventry,Workers Comp,50,1123.20,,,,,,,1053.00,1134.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,outpatient,,,1170.00000,377.91000,Coventry,Workers Comp,50,1123.20,,,,,,,304.20,1134.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,inpatient,,,780.00000,251.94000,Coventry,Workers Comp,LT,748.80,,,,,,,702.00,756.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Coventry,Workers Comp,LT,748.80,,,,,,,202.80,756.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,inpatient,,,780.00000,251.94000,Coventry,Workers Comp,RT,748.80,,,,,,,702.00,756.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Coventry,Workers Comp,RT,748.80,,,,,,,202.80,756.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,inpatient,,,1389.00000,448.65000,Coventry,Workers Comp,,1333.44,,,,,,,1250.10,1347.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,outpatient,,,1389.00000,448.65000,Coventry,Workers Comp,,1333.44,,,,,,,361.14,1347.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,inpatient,,,345.00000,111.44000,Coventry,Workers Comp,50,331.20,,,,,,,310.50,334.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,outpatient,,,345.00000,111.44000,Coventry,Workers Comp,50,331.20,,,,,,,89.70,334.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,inpatient,,,230.00000,74.29000,Coventry,Workers Comp,LT,220.80,,,,,,,207.00,223.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Coventry,Workers Comp,LT,220.80,,,,,,,59.80,223.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,inpatient,,,230.00000,74.29000,Coventry,Workers Comp,RT,220.80,,,,,,,207.00,223.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Coventry,Workers Comp,RT,220.80,,,,,,,59.80,223.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,inpatient,,,2102.00000,678.95000,Coventry,Workers Comp,50,2017.92,,,,,,,1891.80,2038.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,outpatient,,,2102.00000,678.95000,Coventry,Workers Comp,50,2017.92,,,,,,,546.52,2038.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,inpatient,,,1401.00000,452.52000,Coventry,Workers Comp,LT,1344.96,,,,,,,1260.90,1358.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Coventry,Workers Comp,LT,1344.96,,,,,,,364.26,1358.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,inpatient,,,1401.00000,452.52000,Coventry,Workers Comp,RT,1344.96,,,,,,,1260.90,1358.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Coventry,Workers Comp,RT,1344.96,,,,,,,364.26,1358.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,inpatient,,,357.00000,115.31000,Coventry,Workers Comp,50,342.72,,,,,,,321.30,346.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,outpatient,,,357.00000,115.31000,Coventry,Workers Comp,50,342.72,,,,,,,92.82,346.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,inpatient,,,238.00000,76.87000,Coventry,Workers Comp,LT,228.48,,,,,,,214.20,230.86,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Coventry,Workers Comp,LT,228.48,,,,,,,61.88,230.86,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,inpatient,,,238.00000,76.87000,Coventry,Workers Comp,RT,228.48,,,,,,,214.20,230.86,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Coventry,Workers Comp,RT,228.48,,,,,,,61.88,230.86,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,inpatient,,,2082.00000,672.49000,Coventry,Workers Comp,50,1998.72,,,,,,,1873.80,2019.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,outpatient,,,2082.00000,672.49000,Coventry,Workers Comp,50,1998.72,,,,,,,541.32,2019.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,inpatient,,,1388.00000,448.32000,Coventry,Workers Comp,LT,1332.48,,,,,,,1249.20,1346.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Coventry,Workers Comp,LT,1332.48,,,,,,,360.88,1346.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,inpatient,,,1388.00000,448.32000,Coventry,Workers Comp,RT,1332.48,,,,,,,1249.20,1346.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Coventry,Workers Comp,RT,1332.48,,,,,,,360.88,1346.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,inpatient,,,246.00000,79.46000,Coventry,Workers Comp,50,236.16,,,,,,,221.40,238.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,outpatient,,,246.00000,79.46000,Coventry,Workers Comp,50,236.16,,,,,,,63.96,238.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,inpatient,,,164.00000,52.97000,Coventry,Workers Comp,LT,157.44,,,,,,,147.60,159.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Coventry,Workers Comp,LT,157.44,,,,,,,42.64,159.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,inpatient,,,164.00000,52.97000,Coventry,Workers Comp,RT,157.44,,,,,,,147.60,159.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Coventry,Workers Comp,RT,157.44,,,,,,,42.64,159.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,inpatient,,,309.00000,99.81000,Coventry,Workers Comp,50,296.64,,,,,,,278.10,299.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,outpatient,,,309.00000,99.81000,Coventry,Workers Comp,50,296.64,,,,,,,80.34,299.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,inpatient,,,206.00000,66.54000,Coventry,Workers Comp,LT,197.76,,,,,,,185.40,199.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Coventry,Workers Comp,LT,197.76,,,,,,,53.56,199.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,inpatient,,,206.00000,66.54000,Coventry,Workers Comp,RT,197.76,,,,,,,185.40,199.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Coventry,Workers Comp,RT,197.76,,,,,,,53.56,199.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,inpatient,,,471.00000,152.13000,Coventry,Workers Comp,50,452.16,,,,,,,423.90,456.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,outpatient,,,471.00000,152.13000,Coventry,Workers Comp,50,452.16,,,,,,,122.46,456.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,inpatient,,,314.00000,101.42000,Coventry,Workers Comp,LT,301.44,,,,,,,282.60,304.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Coventry,Workers Comp,LT,301.44,,,,,,,81.64,304.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,inpatient,,,314.00000,101.42000,Coventry,Workers Comp,RT,301.44,,,,,,,282.60,304.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Coventry,Workers Comp,RT,301.44,,,,,,,81.64,304.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,inpatient,,,239.00000,77.20000,Coventry,Workers Comp,50,229.44,,,,,,,215.10,231.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,outpatient,,,239.00000,77.20000,Coventry,Workers Comp,50,229.44,,,,,,,62.14,231.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,inpatient,,,159.00000,51.36000,Coventry,Workers Comp,LT,152.64,,,,,,,143.10,154.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Coventry,Workers Comp,LT,152.64,,,,,,,41.34,154.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,inpatient,,,159.00000,51.36000,Coventry,Workers Comp,RT,152.64,,,,,,,143.10,154.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Coventry,Workers Comp,RT,152.64,,,,,,,41.34,154.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,inpatient,,,558.00000,180.23000,Coventry,Workers Comp,50,535.68,,,,,,,502.20,541.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,outpatient,,,558.00000,180.23000,Coventry,Workers Comp,50,535.68,,,,,,,145.08,541.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,inpatient,,,372.00000,120.16000,Coventry,Workers Comp,LT,357.12,,,,,,,334.80,360.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Coventry,Workers Comp,LT,357.12,,,,,,,96.72,360.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,inpatient,,,372.00000,120.16000,Coventry,Workers Comp,RT,357.12,,,,,,,334.80,360.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Coventry,Workers Comp,RT,357.12,,,,,,,96.72,360.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,inpatient,,,413.00000,133.40000,Coventry,Workers Comp,50,396.48,,,,,,,371.70,400.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,outpatient,,,413.00000,133.40000,Coventry,Workers Comp,50,396.48,,,,,,,107.38,400.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,inpatient,,,275.00000,88.82000,Coventry,Workers Comp,LT,264.00,,,,,,,247.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Coventry,Workers Comp,LT,264.00,,,,,,,71.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,inpatient,,,275.00000,88.82000,Coventry,Workers Comp,RT,264.00,,,,,,,247.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Coventry,Workers Comp,RT,264.00,,,,,,,71.50,266.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,inpatient,,,462.00000,149.23000,Coventry,Workers Comp,,443.52,,,,,,,415.80,448.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,outpatient,,,462.00000,149.23000,Coventry,Workers Comp,,443.52,,,,,,,120.12,448.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,inpatient,,,170.00000,54.91000,Coventry,Workers Comp,,163.20,,,,,,,153.00,164.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,outpatient,,,170.00000,54.91000,Coventry,Workers Comp,,163.20,,,,,,,44.20,164.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,inpatient,,,281.00000,90.76000,Coventry,Workers Comp,,269.76,,,,,,,252.90,272.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,outpatient,,,281.00000,90.76000,Coventry,Workers Comp,,269.76,,,,,,,73.06,272.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,inpatient,,,562.00000,181.53000,Coventry,Workers Comp,,539.52,,,,,,,505.80,545.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,outpatient,,,562.00000,181.53000,Coventry,Workers Comp,,539.52,,,,,,,146.12,545.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,inpatient,,,2076.00000,670.55000,Coventry,Workers Comp,50,1992.96,,,,,,,1868.40,2013.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,outpatient,,,2076.00000,670.55000,Coventry,Workers Comp,50,1992.96,,,,,,,539.76,2013.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1384.00000,447.03000,Coventry,Workers Comp,LT,1328.64,,,,,,,1245.60,1342.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Coventry,Workers Comp,LT,1328.64,,,,,,,359.84,1342.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1384.00000,447.03000,Coventry,Workers Comp,RT,1328.64,,,,,,,1245.60,1342.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Coventry,Workers Comp,RT,1328.64,,,,,,,359.84,1342.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,inpatient,,,934.00000,301.68000,Coventry,Workers Comp,,896.64,,,,,,,840.60,905.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,outpatient,,,934.00000,301.68000,Coventry,Workers Comp,,896.64,,,,,,,242.84,905.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,inpatient,,,842.00000,271.97000,Coventry,Workers Comp,,808.32,,,,,,,757.80,816.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,outpatient,,,842.00000,271.97000,Coventry,Workers Comp,,808.32,,,,,,,218.92,816.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,inpatient,,,846.00000,273.26000,Coventry,Workers Comp,,812.16,,,,,,,761.40,820.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,outpatient,,,846.00000,273.26000,Coventry,Workers Comp,,812.16,,,,,,,219.96,820.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,inpatient,,,971.00000,313.63000,Coventry,Workers Comp,,932.16,,,,,,,873.90,941.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,outpatient,,,971.00000,313.63000,Coventry,Workers Comp,,932.16,,,,,,,252.46,941.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,inpatient,,,762.00000,246.13000,Coventry,Workers Comp,,731.52,,,,,,,685.80,739.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,outpatient,,,762.00000,246.13000,Coventry,Workers Comp,,731.52,,,,,,,198.12,739.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,inpatient,,,758.00000,244.83000,Coventry,Workers Comp,,727.68,,,,,,,682.20,735.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,outpatient,,,758.00000,244.83000,Coventry,Workers Comp,,727.68,,,,,,,197.08,735.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,inpatient,,,161.00000,52.00000,Coventry,Workers Comp,,154.56,,,,,,,144.90,156.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,outpatient,,,161.00000,52.00000,Coventry,Workers Comp,,154.56,,,,,,,41.86,156.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,inpatient,,,234.00000,75.58000,Coventry,Workers Comp,50,224.64,,,,,,,210.60,226.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,outpatient,,,234.00000,75.58000,Coventry,Workers Comp,50,224.64,,,,,,,60.84,226.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,inpatient,,,156.00000,50.39000,Coventry,Workers Comp,LT,149.76,,,,,,,140.40,151.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Coventry,Workers Comp,LT,149.76,,,,,,,40.56,151.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,inpatient,,,156.00000,50.39000,Coventry,Workers Comp,RT,149.76,,,,,,,140.40,151.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Coventry,Workers Comp,RT,149.76,,,,,,,40.56,151.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1517.00000,489.99000,Coventry,Workers Comp,50,1456.32,,,,,,,1365.30,1471.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1517.00000,489.99000,Coventry,Workers Comp,50,1456.32,,,,,,,394.42,1471.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1011.00000,326.55000,Coventry,Workers Comp,LT,970.56,,,,,,,909.90,980.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Coventry,Workers Comp,LT,970.56,,,,,,,262.86,980.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1011.00000,326.55000,Coventry,Workers Comp,RT,970.56,,,,,,,909.90,980.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Coventry,Workers Comp,RT,970.56,,,,,,,262.86,980.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,inpatient,,,822.00000,265.51000,Coventry,Workers Comp,50,789.12,,,,,,,739.80,797.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,outpatient,,,822.00000,265.51000,Coventry,Workers Comp,50,789.12,,,,,,,213.72,797.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,inpatient,,,548.00000,177.00000,Coventry,Workers Comp,LT,526.08,,,,,,,493.20,531.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Coventry,Workers Comp,LT,526.08,,,,,,,142.48,531.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,inpatient,,,548.00000,177.00000,Coventry,Workers Comp,RT,526.08,,,,,,,493.20,531.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Coventry,Workers Comp,RT,526.08,,,,,,,142.48,531.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,inpatient,,,2613.00000,844.00000,Coventry,Workers Comp,,2508.48,,,,,,,2351.70,2534.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,outpatient,,,2613.00000,844.00000,Coventry,Workers Comp,,2508.48,,,,,,,679.38,2534.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,inpatient,,,903.00000,291.67000,Coventry,Workers Comp,,866.88,,,,,,,812.70,875.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,outpatient,,,903.00000,291.67000,Coventry,Workers Comp,,866.88,,,,,,,234.78,875.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,inpatient,,,1156.00000,373.39000,Coventry,Workers Comp,,1109.76,,,,,,,1040.40,1121.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,outpatient,,,1156.00000,373.39000,Coventry,Workers Comp,,1109.76,,,,,,,300.56,1121.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,inpatient,,,677.00000,218.67000,Coventry,Workers Comp,,649.92,,,,,,,609.30,656.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,outpatient,,,677.00000,218.67000,Coventry,Workers Comp,,649.92,,,,,,,176.02,656.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1928.00000,622.74000,Coventry,Workers Comp,50,1850.88,,,,,,,1735.20,1870.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1928.00000,622.74000,Coventry,Workers Comp,50,1850.88,,,,,,,501.28,1870.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1285.00000,415.06000,Coventry,Workers Comp,LT,1233.60,,,,,,,1156.50,1246.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Coventry,Workers Comp,LT,1233.60,,,,,,,334.10,1246.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1285.00000,415.06000,Coventry,Workers Comp,RT,1233.60,,,,,,,1156.50,1246.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Coventry,Workers Comp,RT,1233.60,,,,,,,334.10,1246.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,inpatient,,,812.00000,262.28000,Coventry,Workers Comp,50,779.52,,,,,,,730.80,787.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,outpatient,,,812.00000,262.28000,Coventry,Workers Comp,50,779.52,,,,,,,211.12,787.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,inpatient,,,541.00000,174.74000,Coventry,Workers Comp,LT,519.36,,,,,,,486.90,524.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Coventry,Workers Comp,LT,519.36,,,,,,,140.66,524.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,inpatient,,,541.00000,174.74000,Coventry,Workers Comp,RT,519.36,,,,,,,486.90,524.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Coventry,Workers Comp,RT,519.36,,,,,,,140.66,524.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,inpatient,,,825.00000,266.48000,Coventry,Workers Comp,50,792.00,,,,,,,742.50,800.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,outpatient,,,825.00000,266.48000,Coventry,Workers Comp,50,792.00,,,,,,,214.50,800.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,inpatient,,,550.00000,177.65000,Coventry,Workers Comp,LT,528.00,,,,,,,495.00,533.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Coventry,Workers Comp,LT,528.00,,,,,,,143.00,533.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,inpatient,,,550.00000,177.65000,Coventry,Workers Comp,RT,528.00,,,,,,,495.00,533.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Coventry,Workers Comp,RT,528.00,,,,,,,143.00,533.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,inpatient,,,3494.00000,1128.56000,Coventry,Workers Comp,50,3354.24,,,,,,,3144.60,3389.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,outpatient,,,3494.00000,1128.56000,Coventry,Workers Comp,50,3354.24,,,,,,,908.44,3389.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2329.00000,752.27000,Coventry,Workers Comp,LT,2235.84,,,,,,,2096.10,2259.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Coventry,Workers Comp,LT,2235.84,,,,,,,605.54,2259.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2329.00000,752.27000,Coventry,Workers Comp,RT,2235.84,,,,,,,2096.10,2259.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Coventry,Workers Comp,RT,2235.84,,,,,,,605.54,2259.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,inpatient,,,840.00000,271.32000,Coventry,Workers Comp,50,806.40,,,,,,,756.00,814.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,outpatient,,,840.00000,271.32000,Coventry,Workers Comp,50,806.40,,,,,,,218.40,814.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,inpatient,,,560.00000,180.88000,Coventry,Workers Comp,LT,537.60,,,,,,,504.00,543.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Coventry,Workers Comp,LT,537.60,,,,,,,145.60,543.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,inpatient,,,560.00000,180.88000,Coventry,Workers Comp,RT,537.60,,,,,,,504.00,543.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Coventry,Workers Comp,RT,537.60,,,,,,,145.60,543.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,inpatient,,,792.00000,255.82000,Coventry,Workers Comp,50,760.32,,,,,,,712.80,768.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,outpatient,,,792.00000,255.82000,Coventry,Workers Comp,50,760.32,,,,,,,205.92,768.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,inpatient,,,528.00000,170.54000,Coventry,Workers Comp,LT,506.88,,,,,,,475.20,512.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Coventry,Workers Comp,LT,506.88,,,,,,,137.28,512.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,inpatient,,,528.00000,170.54000,Coventry,Workers Comp,RT,506.88,,,,,,,475.20,512.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Coventry,Workers Comp,RT,506.88,,,,,,,137.28,512.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,inpatient,,,272.00000,87.86000,Coventry,Workers Comp,,261.12,,,,,,,244.80,263.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,outpatient,,,272.00000,87.86000,Coventry,Workers Comp,,261.12,,,,,,,70.72,263.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,inpatient,,,1268.00000,409.56000,Coventry,Workers Comp,,1217.28,,,,,,,1141.20,1229.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,outpatient,,,1268.00000,409.56000,Coventry,Workers Comp,,1217.28,,,,,,,329.68,1229.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,inpatient,,,896.00000,289.41000,Coventry,Workers Comp,,860.16,,,,,,,806.40,869.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,outpatient,,,896.00000,289.41000,Coventry,Workers Comp,,860.16,,,,,,,232.96,869.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,inpatient,,,884.00000,285.53000,Coventry,Workers Comp,,848.64,,,,,,,795.60,857.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,outpatient,,,884.00000,285.53000,Coventry,Workers Comp,,848.64,,,,,,,229.84,857.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,inpatient,,,609.00000,326.42000,Coventry,Workers Comp,,584.64,,,,,,,548.10,590.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Coventry,Workers Comp,,584.64,,,,,,,158.34,590.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,inpatient,,,966.00000,383.50000,Coventry,Workers Comp,,927.36,,,,,,,869.40,937.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,outpatient,,,966.00000,383.50000,Coventry,Workers Comp,,927.36,,,,,,,251.16,937.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,inpatient,,,872.00000,346.18000,Coventry,Workers Comp,,837.12,,,,,,,784.80,845.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,outpatient,,,872.00000,346.18000,Coventry,Workers Comp,,837.12,,,,,,,226.72,845.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,inpatient,,,492.00000,195.32000,Coventry,Workers Comp,,472.32,,,,,,,442.80,477.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,outpatient,,,492.00000,195.32000,Coventry,Workers Comp,,472.32,,,,,,,127.92,477.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,inpatient,,,331.00000,131.41000,Coventry,Workers Comp,,317.76,,,,,,,297.90,321.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,outpatient,,,331.00000,131.41000,Coventry,Workers Comp,,317.76,,,,,,,86.06,321.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,inpatient,,,5215.00000,2070.36000,Coventry,Workers Comp,,5006.40,,,,,,,4693.50,5058.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,outpatient,,,5215.00000,2070.36000,Coventry,Workers Comp,,5006.40,,,,,,,1355.90,5058.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,inpatient,,,5422.00000,2152.53000,Coventry,Workers Comp,,5205.12,,,,,,,4879.80,5259.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,outpatient,,,5422.00000,2152.53000,Coventry,Workers Comp,,5205.12,,,,,,,1409.72,5259.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,inpatient,,,1878.00000,788.76000,Coventry,Workers Comp,,1802.88,,,,,,,1690.20,1821.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1878.00000,788.76000,Coventry,Workers Comp,,1802.88,,,,,,,488.28,1821.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,inpatient,,,2253.00000,946.26000,Coventry,Workers Comp,,2162.88,,,,,,,2027.70,2185.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,outpatient,,,2253.00000,946.26000,Coventry,Workers Comp,,2162.88,,,,,,,585.78,2185.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,inpatient,,,1502.00000,630.84000,Coventry,Workers Comp,,1441.92,,,,,,,1351.80,1456.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1502.00000,630.84000,Coventry,Workers Comp,,1441.92,,,,,,,390.52,1456.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,inpatient,,,2024.00000,850.08000,Coventry,Workers Comp,,1943.04,,,,,,,1821.60,1963.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,outpatient,,,2024.00000,850.08000,Coventry,Workers Comp,,1943.04,,,,,,,526.24,1963.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,inpatient,,,2429.00000,1020.18000,Coventry,Workers Comp,,2331.84,,,,,,,2186.10,2356.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,outpatient,,,2429.00000,1020.18000,Coventry,Workers Comp,,2331.84,,,,,,,631.54,2356.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,inpatient,,,1619.00000,679.98000,Coventry,Workers Comp,,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1619.00000,679.98000,Coventry,Workers Comp,,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,inpatient,,,2425.00000,1018.50000,Coventry,Workers Comp,,2328.00,,,,,,,2182.50,2352.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,outpatient,,,2425.00000,1018.50000,Coventry,Workers Comp,,2328.00,,,,,,,630.50,2352.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,inpatient,,,2910.00000,1222.20000,Coventry,Workers Comp,,2793.60,,,,,,,2619.00,2822.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2910.00000,1222.20000,Coventry,Workers Comp,,2793.60,,,,,,,756.60,2822.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,inpatient,,,1940.00000,814.80000,Coventry,Workers Comp,,1862.40,,,,,,,1746.00,1881.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1940.00000,814.80000,Coventry,Workers Comp,,1862.40,,,,,,,504.40,1881.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,inpatient,,,2317.00000,973.14000,Coventry,Workers Comp,,2224.32,,,,,,,2085.30,2247.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2317.00000,973.14000,Coventry,Workers Comp,,2224.32,,,,,,,602.42,2247.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,inpatient,,,2780.00000,1167.60000,Coventry,Workers Comp,,2668.80,,,,,,,2502.00,2696.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2780.00000,1167.60000,Coventry,Workers Comp,,2668.80,,,,,,,722.80,2696.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,inpatient,,,1853.00000,778.26000,Coventry,Workers Comp,,1778.88,,,,,,,1667.70,1797.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1853.00000,778.26000,Coventry,Workers Comp,,1778.88,,,,,,,481.78,1797.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,inpatient,,,2366.00000,993.72000,Coventry,Workers Comp,,2271.36,,,,,,,2129.40,2295.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2366.00000,993.72000,Coventry,Workers Comp,,2271.36,,,,,,,615.16,2295.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,inpatient,,,3056.00000,1283.52000,Coventry,Workers Comp,,2933.76,,,,,,,2750.40,2964.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,outpatient,,,3056.00000,1283.52000,Coventry,Workers Comp,,2933.76,,,,,,,794.56,2964.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,inpatient,,,2829.00000,1386.21000,Coventry,Workers Comp,,2715.84,,,,,,,2546.10,2744.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,outpatient,,,2829.00000,1386.21000,Coventry,Workers Comp,,2715.84,,,,,,,735.54,2744.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,inpatient,,,3395.00000,1663.55000,Coventry,Workers Comp,,3259.20,,,,,,,3055.50,3293.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,outpatient,,,3395.00000,1663.55000,Coventry,Workers Comp,,3259.20,,,,,,,882.70,3293.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,inpatient,,,2263.00000,1108.87000,Coventry,Workers Comp,,2172.48,,,,,,,2036.70,2195.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,outpatient,,,2263.00000,1108.87000,Coventry,Workers Comp,,2172.48,,,,,,,588.38,2195.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,inpatient,,,4697.00000,2301.53000,Coventry,Workers Comp,,4509.12,,,,,,,4227.30,4556.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,outpatient,,,4697.00000,2301.53000,Coventry,Workers Comp,,4509.12,,,,,,,1221.22,4556.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,inpatient,,,5636.00000,2761.64000,Coventry,Workers Comp,,5410.56,,,,,,,5072.40,5466.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,outpatient,,,5636.00000,2761.64000,Coventry,Workers Comp,,5410.56,,,,,,,1465.36,5466.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,inpatient,,,3757.00000,1840.93000,Coventry,Workers Comp,,3606.72,,,,,,,3381.30,3644.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,outpatient,,,3757.00000,1840.93000,Coventry,Workers Comp,,3606.72,,,,,,,976.82,3644.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,inpatient,,,2619.00000,1283.31000,Coventry,Workers Comp,,2514.24,,,,,,,2357.10,2540.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,outpatient,,,2619.00000,1283.31000,Coventry,Workers Comp,,2514.24,,,,,,,680.94,2540.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,inpatient,,,3143.00000,1540.07000,Coventry,Workers Comp,,3017.28,,,,,,,2828.70,3048.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,outpatient,,,3143.00000,1540.07000,Coventry,Workers Comp,,3017.28,,,,,,,817.18,3048.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,inpatient,,,2095.00000,1026.55000,Coventry,Workers Comp,,2011.20,,,,,,,1885.50,2032.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,outpatient,,,2095.00000,1026.55000,Coventry,Workers Comp,,2011.20,,,,,,,544.70,2032.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,inpatient,,,278.00000,136.22000,Coventry,Workers Comp,,266.88,,,,,,,250.20,269.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,outpatient,,,278.00000,136.22000,Coventry,Workers Comp,,266.88,,,,,,,72.28,269.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,inpatient,,,2110.00000,1033.90000,Coventry,Workers Comp,LT,2025.60,,,,,,,1899.00,2046.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Coventry,Workers Comp,LT,2025.60,,,,,,,548.60,2046.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,inpatient,,,2110.00000,1033.90000,Coventry,Workers Comp,RT,2025.60,,,,,,,1899.00,2046.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Coventry,Workers Comp,RT,2025.60,,,,,,,548.60,2046.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2532.00000,1240.68000,Coventry,Workers Comp,LT,2430.72,,,,,,,2278.80,2456.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Coventry,Workers Comp,LT,2430.72,,,,,,,658.32,2456.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2532.00000,1240.68000,Coventry,Workers Comp,RT,2430.72,,,,,,,2278.80,2456.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Coventry,Workers Comp,RT,2430.72,,,,,,,658.32,2456.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1688.00000,827.12000,Coventry,Workers Comp,LT,1620.48,,,,,,,1519.20,1637.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Coventry,Workers Comp,LT,1620.48,,,,,,,438.88,1637.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1688.00000,827.12000,Coventry,Workers Comp,RT,1620.48,,,,,,,1519.20,1637.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Coventry,Workers Comp,RT,1620.48,,,,,,,438.88,1637.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,inpatient,,,2024.00000,991.76000,Coventry,Workers Comp,LT,1943.04,,,,,,,1821.60,1963.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Coventry,Workers Comp,LT,1943.04,,,,,,,526.24,1963.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,inpatient,,,2024.00000,991.76000,Coventry,Workers Comp,RT,1943.04,,,,,,,1821.60,1963.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Coventry,Workers Comp,RT,1943.04,,,,,,,526.24,1963.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2429.00000,1190.21000,Coventry,Workers Comp,LT,2331.84,,,,,,,2186.10,2356.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Coventry,Workers Comp,LT,2331.84,,,,,,,631.54,2356.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2429.00000,1190.21000,Coventry,Workers Comp,RT,2331.84,,,,,,,2186.10,2356.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Coventry,Workers Comp,RT,2331.84,,,,,,,631.54,2356.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1619.00000,793.31000,Coventry,Workers Comp,LT,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Coventry,Workers Comp,LT,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1619.00000,793.31000,Coventry,Workers Comp,RT,1554.24,,,,,,,1457.10,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Coventry,Workers Comp,RT,1554.24,,,,,,,420.94,1570.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,inpatient,,,1224.00000,599.76000,Coventry,Workers Comp,,1175.04,,,,,,,1101.60,1187.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,outpatient,,,1224.00000,599.76000,Coventry,Workers Comp,,1175.04,,,,,,,318.24,1187.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,inpatient,,,3020.00000,1479.80000,Coventry,Workers Comp,,2899.20,,,,,,,2718.00,2929.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,outpatient,,,3020.00000,1479.80000,Coventry,Workers Comp,,2899.20,,,,,,,785.20,2929.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,inpatient,,,3624.00000,1775.76000,Coventry,Workers Comp,,3479.04,,,,,,,3261.60,3515.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,outpatient,,,3624.00000,1775.76000,Coventry,Workers Comp,,3479.04,,,,,,,942.24,3515.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,inpatient,,,2416.00000,1183.84000,Coventry,Workers Comp,,2319.36,,,,,,,2174.40,2343.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,outpatient,,,2416.00000,1183.84000,Coventry,Workers Comp,,2319.36,,,,,,,628.16,2343.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,inpatient,,,2728.00000,1336.72000,Coventry,Workers Comp,,2618.88,,,,,,,2455.20,2646.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,outpatient,,,2728.00000,1336.72000,Coventry,Workers Comp,,2618.88,,,,,,,709.28,2646.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,inpatient,,,3273.00000,1603.77000,Coventry,Workers Comp,,3142.08,,,,,,,2945.70,3174.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,outpatient,,,3273.00000,1603.77000,Coventry,Workers Comp,,3142.08,,,,,,,850.98,3174.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,inpatient,,,2182.00000,1069.18000,Coventry,Workers Comp,,2094.72,,,,,,,1963.80,2116.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,outpatient,,,2182.00000,1069.18000,Coventry,Workers Comp,,2094.72,,,,,,,567.32,2116.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,inpatient,,,3133.00000,1535.17000,Coventry,Workers Comp,,3007.68,,,,,,,2819.70,3039.01,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,outpatient,,,3133.00000,1535.17000,Coventry,Workers Comp,,3007.68,,,,,,,814.58,3039.01,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,inpatient,,,3759.00000,1841.91000,Coventry,Workers Comp,,3608.64,,,,,,,3383.10,3646.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,outpatient,,,3759.00000,1841.91000,Coventry,Workers Comp,,3608.64,,,,,,,977.34,3646.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,inpatient,,,2506.00000,1227.94000,Coventry,Workers Comp,,2405.76,,,,,,,2255.40,2430.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,outpatient,,,2506.00000,1227.94000,Coventry,Workers Comp,,2405.76,,,,,,,651.56,2430.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,inpatient,,,2857.00000,1399.93000,Coventry,Workers Comp,,2742.72,,,,,,,2571.30,2771.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,outpatient,,,2857.00000,1399.93000,Coventry,Workers Comp,,2742.72,,,,,,,742.82,2771.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,inpatient,,,3428.00000,1679.72000,Coventry,Workers Comp,,3290.88,,,,,,,3085.20,3325.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,outpatient,,,3428.00000,1679.72000,Coventry,Workers Comp,,3290.88,,,,,,,891.28,3325.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,inpatient,,,2285.00000,1119.65000,Coventry,Workers Comp,,2193.60,,,,,,,2056.50,2216.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,outpatient,,,2285.00000,1119.65000,Coventry,Workers Comp,,2193.60,,,,,,,594.10,2216.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,inpatient,,,3565.00000,1746.85000,Coventry,Workers Comp,,3422.40,,,,,,,3208.50,3458.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,outpatient,,,3565.00000,1746.85000,Coventry,Workers Comp,,3422.40,,,,,,,926.90,3458.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,inpatient,,,5918.00000,2899.82000,Coventry,Workers Comp,,5681.28,,,,,,,5326.20,5740.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,outpatient,,,5918.00000,2899.82000,Coventry,Workers Comp,,5681.28,,,,,,,1538.68,5740.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,inpatient,,,3301.00000,1617.49000,Coventry,Workers Comp,,3168.96,,,,,,,2970.90,3201.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,outpatient,,,3301.00000,1617.49000,Coventry,Workers Comp,,3168.96,,,,,,,858.26,3201.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2659.00000,1302.91000,Coventry,Workers Comp,LT,2552.64,,,,,,,2393.10,2579.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Coventry,Workers Comp,LT,2552.64,,,,,,,691.34,2579.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2659.00000,1302.91000,Coventry,Workers Comp,RT,2552.64,,,,,,,2393.10,2579.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Coventry,Workers Comp,RT,2552.64,,,,,,,691.34,2579.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2551.00000,1249.99000,Coventry,Workers Comp,LT,2448.96,,,,,,,2295.90,2474.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Coventry,Workers Comp,LT,2448.96,,,,,,,663.26,2474.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2551.00000,1249.99000,Coventry,Workers Comp,RT,2448.96,,,,,,,2295.90,2474.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Coventry,Workers Comp,RT,2448.96,,,,,,,663.26,2474.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,inpatient,,,3806.00000,1864.94000,Coventry,Workers Comp,,3653.76,,,,,,,3425.40,3691.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3806.00000,1864.94000,Coventry,Workers Comp,,3653.76,,,,,,,989.56,3691.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,inpatient,,,2149.00000,694.13000,Coventry,Workers Comp,,2063.04,,,,,,,1934.10,2084.53,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,outpatient,,,2149.00000,694.13000,Coventry,Workers Comp,,2063.04,,,,,,,558.74,2084.53,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,inpatient,,,1973.00000,637.28000,Coventry,Workers Comp,,1894.08,,,,,,,1775.70,1913.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,outpatient,,,1973.00000,637.28000,Coventry,Workers Comp,,1894.08,,,,,,,512.98,1913.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1784.00000,576.23000,Coventry,Workers Comp,50,1712.64,,,,,,,1605.60,1730.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1784.00000,576.23000,Coventry,Workers Comp,50,1712.64,,,,,,,463.84,1730.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1189.00000,384.05000,Coventry,Workers Comp,LT,1141.44,,,,,,,1070.10,1153.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Coventry,Workers Comp,LT,1141.44,,,,,,,309.14,1153.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1189.00000,384.05000,Coventry,Workers Comp,RT,1141.44,,,,,,,1070.10,1153.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Coventry,Workers Comp,RT,1141.44,,,,,,,309.14,1153.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,inpatient,,,130.00000,69.68000,Coventry,Workers Comp,,124.80,,,,,,,117.00,126.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,outpatient,,,130.00000,69.68000,Coventry,Workers Comp,,124.80,,,,,,,33.80,126.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,inpatient,,,44.00000,23.58000,Coventry,Workers Comp,,42.24,,,,,,,39.60,42.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,outpatient,,,44.00000,23.58000,Coventry,Workers Comp,,42.24,,,,,,,11.44,42.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,inpatient,,,456.00000,244.42000,Coventry,Workers Comp,,437.76,,,,,,,410.40,442.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,outpatient,,,456.00000,244.42000,Coventry,Workers Comp,,437.76,,,,,,,118.56,442.32,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,inpatient,,,108.00000,57.89000,Coventry,Workers Comp,,103.68,,,,,,,97.20,104.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,outpatient,,,108.00000,57.89000,Coventry,Workers Comp,,103.68,,,,,,,28.08,104.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,inpatient,,,306.00000,164.02000,Coventry,Workers Comp,,293.76,,,,,,,275.40,296.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,outpatient,,,306.00000,164.02000,Coventry,Workers Comp,,293.76,,,,,,,79.56,296.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,inpatient,,,257.00000,137.75000,Coventry,Workers Comp,,246.72,,,,,,,231.30,249.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,outpatient,,,257.00000,137.75000,Coventry,Workers Comp,,246.72,,,,,,,66.82,249.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4057.00000,2036.61000,Coventry,Workers Comp,,3894.72,,,,,,,3651.30,3935.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Coventry,Workers Comp,,3894.72,,,,,,,1054.82,3935.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4868.00000,2443.74000,Coventry,Workers Comp,,4673.28,,,,,,,4381.20,4721.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Coventry,Workers Comp,,4673.28,,,,,,,1265.68,4721.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,inpatient,,,3245.00000,1628.99000,Coventry,Workers Comp,,3115.20,,,,,,,2920.50,3147.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Coventry,Workers Comp,,3115.20,,,,,,,843.70,3147.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4057.00000,2036.61000,Coventry,Workers Comp,,3894.72,,,,,,,3651.30,3935.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Coventry,Workers Comp,,3894.72,,,,,,,1054.82,3935.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4868.00000,2443.74000,Coventry,Workers Comp,,4673.28,,,,,,,4381.20,4721.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Coventry,Workers Comp,,4673.28,,,,,,,1265.68,4721.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,inpatient,,,3245.00000,1628.99000,Coventry,Workers Comp,,3115.20,,,,,,,2920.50,3147.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Coventry,Workers Comp,,3115.20,,,,,,,843.70,3147.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,inpatient,,,1725.00000,865.95000,Coventry,Workers Comp,,1656.00,,,,,,,1552.50,1673.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,outpatient,,,1725.00000,865.95000,Coventry,Workers Comp,,1656.00,,,,,,,448.50,1673.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,inpatient,,,1743.00000,874.99000,Coventry,Workers Comp,,1673.28,,,,,,,1568.70,1690.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,outpatient,,,1743.00000,874.99000,Coventry,Workers Comp,,1673.28,,,,,,,453.18,1690.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,inpatient,,,1475.00000,740.45000,Coventry,Workers Comp,LT,1416.00,,,,,,,1327.50,1430.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Coventry,Workers Comp,LT,1416.00,,,,,,,383.50,1430.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,inpatient,,,1475.00000,740.45000,Coventry,Workers Comp,RT,1416.00,,,,,,,1327.50,1430.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Coventry,Workers Comp,RT,1416.00,,,,,,,383.50,1430.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,inpatient,,,1162.00000,583.32000,Coventry,Workers Comp,,1115.52,,,,,,,1045.80,1127.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,outpatient,,,1162.00000,583.32000,Coventry,Workers Comp,,1115.52,,,,,,,302.12,1127.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,inpatient,,,983.00000,493.47000,Coventry,Workers Comp,LT,943.68,,,,,,,884.70,953.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Coventry,Workers Comp,LT,943.68,,,,,,,255.58,953.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,inpatient,,,983.00000,493.47000,Coventry,Workers Comp,RT,943.68,,,,,,,884.70,953.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Coventry,Workers Comp,RT,943.68,,,,,,,255.58,953.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,inpatient,,,3183.00000,1597.87000,Coventry,Workers Comp,,3055.68,,,,,,,2864.70,3087.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,outpatient,,,3183.00000,1597.87000,Coventry,Workers Comp,,3055.68,,,,,,,827.58,3087.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,inpatient,,,3819.00000,1917.14000,Coventry,Workers Comp,,3666.24,,,,,,,3437.10,3704.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,outpatient,,,3819.00000,1917.14000,Coventry,Workers Comp,,3666.24,,,,,,,992.94,3704.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,inpatient,,,2546.00000,1278.09000,Coventry,Workers Comp,,2444.16,,,,,,,2291.40,2469.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,outpatient,,,2546.00000,1278.09000,Coventry,Workers Comp,,2444.16,,,,,,,661.96,2469.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,inpatient,,,3858.00000,1936.72000,Coventry,Workers Comp,LT,3703.68,,,,,,,3472.20,3742.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Coventry,Workers Comp,LT,3703.68,,,,,,,1003.08,3742.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,inpatient,,,3858.00000,1936.72000,Coventry,Workers Comp,RT,3703.68,,,,,,,3472.20,3742.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Coventry,Workers Comp,RT,3703.68,,,,,,,1003.08,3742.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,inpatient,,,4629.00000,2323.76000,Coventry,Workers Comp,LT,4443.84,,,,,,,4166.10,4490.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Coventry,Workers Comp,LT,4443.84,,,,,,,1203.54,4490.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,inpatient,,,4629.00000,2323.76000,Coventry,Workers Comp,RT,4443.84,,,,,,,4166.10,4490.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Coventry,Workers Comp,RT,4443.84,,,,,,,1203.54,4490.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,inpatient,,,3086.00000,1549.17000,Coventry,Workers Comp,LT,2962.56,,,,,,,2777.40,2993.42,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Coventry,Workers Comp,LT,2962.56,,,,,,,802.36,2993.42,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,inpatient,,,3086.00000,1549.17000,Coventry,Workers Comp,RT,2962.56,,,,,,,2777.40,2993.42,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Coventry,Workers Comp,RT,2962.56,,,,,,,802.36,2993.42,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,inpatient,,,2505.00000,1257.51000,Coventry,Workers Comp,LT,2404.80,,,,,,,2254.50,2429.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Coventry,Workers Comp,LT,2404.80,,,,,,,651.30,2429.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,inpatient,,,2505.00000,1257.51000,Coventry,Workers Comp,RT,2404.80,,,,,,,2254.50,2429.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Coventry,Workers Comp,RT,2404.80,,,,,,,651.30,2429.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,inpatient,,,3006.00000,1509.01000,Coventry,Workers Comp,LT,2885.76,,,,,,,2705.40,2915.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Coventry,Workers Comp,LT,2885.76,,,,,,,781.56,2915.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,inpatient,,,3006.00000,1509.01000,Coventry,Workers Comp,RT,2885.76,,,,,,,2705.40,2915.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Coventry,Workers Comp,RT,2885.76,,,,,,,781.56,2915.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,inpatient,,,2004.00000,1006.01000,Coventry,Workers Comp,LT,1923.84,,,,,,,1803.60,1943.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Coventry,Workers Comp,LT,1923.84,,,,,,,521.04,1943.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,inpatient,,,2004.00000,1006.01000,Coventry,Workers Comp,RT,1923.84,,,,,,,1803.60,1943.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Coventry,Workers Comp,RT,1923.84,,,,,,,521.04,1943.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,inpatient,,,3137.00000,1574.77000,Coventry,Workers Comp,LT,3011.52,,,,,,,2823.30,3042.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Coventry,Workers Comp,LT,3011.52,,,,,,,815.62,3042.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,inpatient,,,3137.00000,1574.77000,Coventry,Workers Comp,RT,3011.52,,,,,,,2823.30,3042.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Coventry,Workers Comp,RT,3011.52,,,,,,,815.62,3042.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,inpatient,,,3764.00000,1889.53000,Coventry,Workers Comp,LT,3613.44,,,,,,,3387.60,3651.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Coventry,Workers Comp,LT,3613.44,,,,,,,978.64,3651.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,inpatient,,,3764.00000,1889.53000,Coventry,Workers Comp,RT,3613.44,,,,,,,3387.60,3651.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Coventry,Workers Comp,RT,3613.44,,,,,,,978.64,3651.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,inpatient,,,2509.00000,1259.52000,Coventry,Workers Comp,LT,2408.64,,,,,,,2258.10,2433.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Coventry,Workers Comp,LT,2408.64,,,,,,,652.34,2433.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,inpatient,,,2509.00000,1259.52000,Coventry,Workers Comp,RT,2408.64,,,,,,,2258.10,2433.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Coventry,Workers Comp,RT,2408.64,,,,,,,652.34,2433.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,inpatient,,,3023.00000,1517.55000,Coventry,Workers Comp,LT,2902.08,,,,,,,2720.70,2932.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Coventry,Workers Comp,LT,2902.08,,,,,,,785.98,2932.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,inpatient,,,3023.00000,1517.55000,Coventry,Workers Comp,RT,2902.08,,,,,,,2720.70,2932.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Coventry,Workers Comp,RT,2902.08,,,,,,,785.98,2932.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,inpatient,,,3627.00000,1820.75000,Coventry,Workers Comp,LT,3481.92,,,,,,,3264.30,3518.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Coventry,Workers Comp,LT,3481.92,,,,,,,943.02,3518.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,inpatient,,,3627.00000,1820.75000,Coventry,Workers Comp,RT,3481.92,,,,,,,3264.30,3518.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Coventry,Workers Comp,RT,3481.92,,,,,,,943.02,3518.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,inpatient,,,2418.00000,1213.84000,Coventry,Workers Comp,LT,2321.28,,,,,,,2176.20,2345.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Coventry,Workers Comp,LT,2321.28,,,,,,,628.68,2345.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,inpatient,,,2418.00000,1213.84000,Coventry,Workers Comp,RT,2321.28,,,,,,,2176.20,2345.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Coventry,Workers Comp,RT,2321.28,,,,,,,628.68,2345.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,inpatient,,,870.00000,436.74000,Coventry,Workers Comp,,835.20,,,,,,,783.00,843.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,outpatient,,,870.00000,436.74000,Coventry,Workers Comp,,835.20,,,,,,,226.20,843.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,inpatient,,,1353.00000,679.21000,Coventry,Workers Comp,,1298.88,,,,,,,1217.70,1312.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,outpatient,,,1353.00000,679.21000,Coventry,Workers Comp,,1298.88,,,,,,,351.78,1312.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,inpatient,,,902.00000,452.80000,Coventry,Workers Comp,LT,865.92,,,,,,,811.80,874.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Coventry,Workers Comp,LT,865.92,,,,,,,234.52,874.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,inpatient,,,902.00000,452.80000,Coventry,Workers Comp,RT,865.92,,,,,,,811.80,874.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Coventry,Workers Comp,RT,865.92,,,,,,,234.52,874.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,inpatient,,,3489.00000,1751.48000,Coventry,Workers Comp,,3349.44,,,,,,,3140.10,3384.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3489.00000,1751.48000,Coventry,Workers Comp,,3349.44,,,,,,,907.14,3384.33,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,inpatient,,,4187.00000,2101.87000,Coventry,Workers Comp,,4019.52,,,,,,,3768.30,4061.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,outpatient,,,4187.00000,2101.87000,Coventry,Workers Comp,,4019.52,,,,,,,1088.62,4061.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,inpatient,,,2791.00000,1401.08000,Coventry,Workers Comp,,2679.36,,,,,,,2511.90,2707.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,outpatient,,,2791.00000,1401.08000,Coventry,Workers Comp,,2679.36,,,,,,,725.66,2707.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,inpatient,,,492.00000,246.98000,Coventry,Workers Comp,,472.32,,,,,,,442.80,477.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,outpatient,,,492.00000,246.98000,Coventry,Workers Comp,,472.32,,,,,,,127.92,477.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,inpatient,,,331.00000,166.16000,Coventry,Workers Comp,,317.76,,,,,,,297.90,321.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,outpatient,,,331.00000,166.16000,Coventry,Workers Comp,,317.76,,,,,,,86.06,321.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,inpatient,,,4440.00000,2357.64000,Coventry,Workers Comp,,4262.40,,,,,,,3996.00,4306.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,outpatient,,,4440.00000,2357.64000,Coventry,Workers Comp,,4262.40,,,,,,,1154.40,4306.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,inpatient,,,5328.00000,2829.17000,Coventry,Workers Comp,,5114.88,,,,,,,4795.20,5168.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,outpatient,,,5328.00000,2829.17000,Coventry,Workers Comp,,5114.88,,,,,,,1385.28,5168.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,inpatient,,,3552.00000,1886.11000,Coventry,Workers Comp,,3409.92,,,,,,,3196.80,3445.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,outpatient,,,3552.00000,1886.11000,Coventry,Workers Comp,,3409.92,,,,,,,923.52,3445.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,inpatient,,,2528.00000,1342.37000,Coventry,Workers Comp,,2426.88,,,,,,,2275.20,2452.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,outpatient,,,2528.00000,1342.37000,Coventry,Workers Comp,,2426.88,,,,,,,657.28,2452.16,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,inpatient,,,3033.00000,1610.52000,Coventry,Workers Comp,,2911.68,,,,,,,2729.70,2942.01,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,outpatient,,,3033.00000,1610.52000,Coventry,Workers Comp,,2911.68,,,,,,,788.58,2942.01,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,inpatient,,,2022.00000,1073.68000,Coventry,Workers Comp,,1941.12,,,,,,,1819.80,1961.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,outpatient,,,2022.00000,1073.68000,Coventry,Workers Comp,,1941.12,,,,,,,525.72,1961.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,inpatient,,,3610.00000,1909.69000,Coventry,Workers Comp,,3465.60,,,,,,,3249.00,3501.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,outpatient,,,3610.00000,1909.69000,Coventry,Workers Comp,,3465.60,,,,,,,938.60,3501.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,inpatient,,,4332.00000,2291.63000,Coventry,Workers Comp,,4158.72,,,,,,,3898.80,4202.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,outpatient,,,4332.00000,2291.63000,Coventry,Workers Comp,,4158.72,,,,,,,1126.32,4202.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,inpatient,,,2888.00000,1527.75000,Coventry,Workers Comp,,2772.48,,,,,,,2599.20,2801.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,outpatient,,,2888.00000,1527.75000,Coventry,Workers Comp,,2772.48,,,,,,,750.88,2801.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,inpatient,,,4532.00000,2397.43000,Coventry,Workers Comp,,4350.72,,,,,,,4078.80,4396.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,outpatient,,,4532.00000,2397.43000,Coventry,Workers Comp,,4350.72,,,,,,,1178.32,4396.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,inpatient,,,5438.00000,2876.70000,Coventry,Workers Comp,,5220.48,,,,,,,4894.20,5274.86,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,outpatient,,,5438.00000,2876.70000,Coventry,Workers Comp,,5220.48,,,,,,,1413.88,5274.86,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,inpatient,,,3625.00000,1917.62000,Coventry,Workers Comp,,3480.00,,,,,,,3262.50,3516.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,outpatient,,,3625.00000,1917.62000,Coventry,Workers Comp,,3480.00,,,,,,,942.50,3516.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,inpatient,,,3639.00000,1925.03000,Coventry,Workers Comp,,3493.44,,,,,,,3275.10,3529.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,outpatient,,,3639.00000,1925.03000,Coventry,Workers Comp,,3493.44,,,,,,,946.14,3529.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,inpatient,,,4367.00000,2310.14000,Coventry,Workers Comp,,4192.32,,,,,,,3930.30,4235.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,outpatient,,,4367.00000,2310.14000,Coventry,Workers Comp,,4192.32,,,,,,,1135.42,4235.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,inpatient,,,2911.00000,1539.92000,Coventry,Workers Comp,,2794.56,,,,,,,2619.90,2823.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,outpatient,,,2911.00000,1539.92000,Coventry,Workers Comp,,2794.56,,,,,,,756.86,2823.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,inpatient,,,3494.00000,1719.05000,Coventry,Workers Comp,,3354.24,,,,,,,3144.60,3389.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3494.00000,1719.05000,Coventry,Workers Comp,,3354.24,,,,,,,908.44,3389.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,inpatient,,,4193.00000,2062.96000,Coventry,Workers Comp,,4025.28,,,,,,,3773.70,4067.21,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,outpatient,,,4193.00000,2062.96000,Coventry,Workers Comp,,4025.28,,,,,,,1090.18,4067.21,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,inpatient,,,2795.00000,1375.14000,Coventry,Workers Comp,,2683.20,,,,,,,2515.50,2711.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,outpatient,,,2795.00000,1375.14000,Coventry,Workers Comp,,2683.20,,,,,,,726.70,2711.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,inpatient,,,2717.00000,1336.76000,Coventry,Workers Comp,,2608.32,,,,,,,2445.30,2635.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,outpatient,,,2717.00000,1336.76000,Coventry,Workers Comp,,2608.32,,,,,,,706.42,2635.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,inpatient,,,3260.00000,1603.92000,Coventry,Workers Comp,,3129.60,,,,,,,2934.00,3162.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,outpatient,,,3260.00000,1603.92000,Coventry,Workers Comp,,3129.60,,,,,,,847.60,3162.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,inpatient,,,2173.00000,1069.12000,Coventry,Workers Comp,,2086.08,,,,,,,1955.70,2107.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,outpatient,,,2173.00000,1069.12000,Coventry,Workers Comp,,2086.08,,,,,,,564.98,2107.81,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4051.00000,2301.58000,Coventry,Workers Comp,LT,3888.96,,,,,,,3645.90,3929.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Coventry,Workers Comp,LT,3888.96,,,,,,,1053.26,3929.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4051.00000,2301.58000,Coventry,Workers Comp,RT,3888.96,,,,,,,3645.90,3929.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Coventry,Workers Comp,RT,3888.96,,,,,,,1053.26,3929.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4861.00000,2761.78000,Coventry,Workers Comp,LT,4666.56,,,,,,,4374.90,4715.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Coventry,Workers Comp,LT,4666.56,,,,,,,1263.86,4715.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4861.00000,2761.78000,Coventry,Workers Comp,RT,4666.56,,,,,,,4374.90,4715.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Coventry,Workers Comp,RT,4666.56,,,,,,,1263.86,4715.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3241.00000,1841.37000,Coventry,Workers Comp,LT,3111.36,,,,,,,2916.90,3143.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Coventry,Workers Comp,LT,3111.36,,,,,,,842.66,3143.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3241.00000,1841.37000,Coventry,Workers Comp,RT,3111.36,,,,,,,2916.90,3143.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Coventry,Workers Comp,RT,3111.36,,,,,,,842.66,3143.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,inpatient,,,4260.00000,2420.32000,Coventry,Workers Comp,,4089.60,,,,,,,3834.00,4132.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,outpatient,,,4260.00000,2420.32000,Coventry,Workers Comp,,4089.60,,,,,,,1107.60,4132.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,inpatient,,,5112.00000,2904.38000,Coventry,Workers Comp,,4907.52,,,,,,,4600.80,4958.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,outpatient,,,5112.00000,2904.38000,Coventry,Workers Comp,,4907.52,,,,,,,1329.12,4958.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,inpatient,,,3408.00000,1936.26000,Coventry,Workers Comp,,3271.68,,,,,,,3067.20,3305.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3408.00000,1936.26000,Coventry,Workers Comp,,3271.68,,,,,,,886.08,3305.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,inpatient,,,3343.00000,1899.33000,Coventry,Workers Comp,,3209.28,,,,,,,3008.70,3242.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3343.00000,1899.33000,Coventry,Workers Comp,,3209.28,,,,,,,869.18,3242.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,inpatient,,,4010.00000,2278.28000,Coventry,Workers Comp,,3849.60,,,,,,,3609.00,3889.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,outpatient,,,4010.00000,2278.28000,Coventry,Workers Comp,,3849.60,,,,,,,1042.60,3889.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,inpatient,,,2674.00000,1519.23000,Coventry,Workers Comp,,2567.04,,,,,,,2406.60,2593.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,outpatient,,,2674.00000,1519.23000,Coventry,Workers Comp,,2567.04,,,,,,,695.24,2593.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3294.00000,1871.49000,Coventry,Workers Comp,LT,3162.24,,,,,,,2964.60,3195.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Coventry,Workers Comp,LT,3162.24,,,,,,,856.44,3195.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3294.00000,1871.49000,Coventry,Workers Comp,RT,3162.24,,,,,,,2964.60,3195.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Coventry,Workers Comp,RT,3162.24,,,,,,,856.44,3195.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3953.00000,2245.90000,Coventry,Workers Comp,LT,3794.88,,,,,,,3557.70,3834.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Coventry,Workers Comp,LT,3794.88,,,,,,,1027.78,3834.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3953.00000,2245.90000,Coventry,Workers Comp,RT,3794.88,,,,,,,3557.70,3834.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Coventry,Workers Comp,RT,3794.88,,,,,,,1027.78,3834.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,inpatient,,,2635.00000,1497.08000,Coventry,Workers Comp,LT,2529.60,,,,,,,2371.50,2555.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Coventry,Workers Comp,LT,2529.60,,,,,,,685.10,2555.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,inpatient,,,2635.00000,1497.08000,Coventry,Workers Comp,RT,2529.60,,,,,,,2371.50,2555.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Coventry,Workers Comp,RT,2529.60,,,,,,,685.10,2555.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,inpatient,,,3664.00000,2081.70000,Coventry,Workers Comp,,3517.44,,,,,,,3297.60,3554.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3664.00000,2081.70000,Coventry,Workers Comp,,3517.44,,,,,,,952.64,3554.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,inpatient,,,4397.00000,2498.16000,Coventry,Workers Comp,,4221.12,,,,,,,3957.30,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,outpatient,,,4397.00000,2498.16000,Coventry,Workers Comp,,4221.12,,,,,,,1143.22,4265.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,inpatient,,,2931.00000,1665.25000,Coventry,Workers Comp,,2813.76,,,,,,,2637.90,2843.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,outpatient,,,2931.00000,1665.25000,Coventry,Workers Comp,,2813.76,,,,,,,762.06,2843.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,inpatient,,,4759.00000,2703.83000,Coventry,Workers Comp,,4568.64,,,,,,,4283.10,4616.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,outpatient,,,4759.00000,2703.83000,Coventry,Workers Comp,,4568.64,,,,,,,1237.34,4616.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,inpatient,,,5710.00000,3244.14000,Coventry,Workers Comp,,5481.60,,,,,,,5139.00,5538.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,outpatient,,,5710.00000,3244.14000,Coventry,Workers Comp,,5481.60,,,,,,,1484.60,5538.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,inpatient,,,3807.00000,2162.95000,Coventry,Workers Comp,,3654.72,,,,,,,3426.30,3692.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3807.00000,2162.95000,Coventry,Workers Comp,,3654.72,,,,,,,989.82,3692.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,inpatient,,,2915.00000,1574.10000,Coventry,Workers Comp,,2798.40,,,,,,,2623.50,2827.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2915.00000,1574.10000,Coventry,Workers Comp,,2798.40,,,,,,,757.90,2827.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,inpatient,,,1918.00000,1035.72000,Coventry,Workers Comp,,1841.28,,,,,,,1726.20,1860.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1918.00000,1035.72000,Coventry,Workers Comp,,1841.28,,,,,,,498.68,1860.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,inpatient,,,2292.00000,1237.68000,Coventry,Workers Comp,,2200.32,,,,,,,2062.80,2223.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2292.00000,1237.68000,Coventry,Workers Comp,,2200.32,,,,,,,595.92,2223.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,inpatient,,,2984.00000,1611.36000,Coventry,Workers Comp,,2864.64,,,,,,,2685.60,2894.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,outpatient,,,2984.00000,1611.36000,Coventry,Workers Comp,,2864.64,,,,,,,775.84,2894.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,inpatient,,,769.00000,415.26000,Coventry,Workers Comp,,738.24,,,,,,,692.10,745.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,outpatient,,,769.00000,415.26000,Coventry,Workers Comp,,738.24,,,,,,,199.94,745.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,inpatient,,,1280.00000,691.20000,Coventry,Workers Comp,,1228.80,,,,,,,1152.00,1241.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,outpatient,,,1280.00000,691.20000,Coventry,Workers Comp,,1228.80,,,,,,,332.80,1241.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,inpatient,,,1878.00000,1014.12000,Coventry,Workers Comp,,1802.88,,,,,,,1690.20,1821.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,outpatient,,,1878.00000,1014.12000,Coventry,Workers Comp,,1802.88,,,,,,,488.28,1821.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,inpatient,,,2196.00000,1185.84000,Coventry,Workers Comp,,2108.16,,,,,,,1976.40,2130.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,outpatient,,,2196.00000,1185.84000,Coventry,Workers Comp,,2108.16,,,,,,,570.96,2130.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,inpatient,,,844.00000,455.76000,Coventry,Workers Comp,,810.24,,,,,,,759.60,818.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,outpatient,,,844.00000,455.76000,Coventry,Workers Comp,,810.24,,,,,,,219.44,818.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,inpatient,,,1305.00000,704.70000,Coventry,Workers Comp,,1252.80,,,,,,,1174.50,1265.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,outpatient,,,1305.00000,704.70000,Coventry,Workers Comp,,1252.80,,,,,,,339.30,1265.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,inpatient,,,576.00000,311.04000,Coventry,Workers Comp,,552.96,,,,,,,518.40,558.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,outpatient,,,576.00000,311.04000,Coventry,Workers Comp,,552.96,,,,,,,149.76,558.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,inpatient,,,809.00000,436.86000,Coventry,Workers Comp,,776.64,,,,,,,728.10,784.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,outpatient,,,809.00000,436.86000,Coventry,Workers Comp,,776.64,,,,,,,210.34,784.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,inpatient,,,2462.00000,1329.48000,Coventry,Workers Comp,,2363.52,,,,,,,2215.80,2388.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,outpatient,,,2462.00000,1329.48000,Coventry,Workers Comp,,2363.52,,,,,,,640.12,2388.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,inpatient,,,918.00000,495.72000,Coventry,Workers Comp,,881.28,,,,,,,826.20,890.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,outpatient,,,918.00000,495.72000,Coventry,Workers Comp,,881.28,,,,,,,238.68,890.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,inpatient,,,1102.00000,595.08000,Coventry,Workers Comp,,1057.92,,,,,,,991.80,1068.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,outpatient,,,1102.00000,595.08000,Coventry,Workers Comp,,1057.92,,,,,,,286.52,1068.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,inpatient,,,812.00000,438.48000,Coventry,Workers Comp,,779.52,,,,,,,730.80,787.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,outpatient,,,812.00000,438.48000,Coventry,Workers Comp,,779.52,,,,,,,211.12,787.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,inpatient,,,1407.00000,759.78000,Coventry,Workers Comp,,1350.72,,,,,,,1266.30,1364.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,outpatient,,,1407.00000,759.78000,Coventry,Workers Comp,,1350.72,,,,,,,365.82,1364.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,inpatient,,,1980.00000,1069.20000,Coventry,Workers Comp,,1900.80,,,,,,,1782.00,1920.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,outpatient,,,1980.00000,1069.20000,Coventry,Workers Comp,,1900.80,,,,,,,514.80,1920.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,inpatient,,,964.00000,520.56000,Coventry,Workers Comp,,925.44,,,,,,,867.60,935.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,outpatient,,,964.00000,520.56000,Coventry,Workers Comp,,925.44,,,,,,,250.64,935.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,inpatient,,,1040.00000,561.60000,Coventry,Workers Comp,,998.40,,,,,,,936.00,1008.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,outpatient,,,1040.00000,561.60000,Coventry,Workers Comp,,998.40,,,,,,,270.40,1008.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,inpatient,,,795.00000,429.30000,Coventry,Workers Comp,,763.20,,,,,,,715.50,771.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,outpatient,,,795.00000,429.30000,Coventry,Workers Comp,,763.20,,,,,,,206.70,771.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,inpatient,,,1124.00000,606.96000,Coventry,Workers Comp,,1079.04,,,,,,,1011.60,1090.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,outpatient,,,1124.00000,606.96000,Coventry,Workers Comp,,1079.04,,,,,,,292.24,1090.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,inpatient,,,736.00000,397.44000,Coventry,Workers Comp,,706.56,,,,,,,662.40,713.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,outpatient,,,736.00000,397.44000,Coventry,Workers Comp,,706.56,,,,,,,191.36,713.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,inpatient,,,700.00000,378.00000,Coventry,Workers Comp,,672.00,,,,,,,630.00,679.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,outpatient,,,700.00000,378.00000,Coventry,Workers Comp,,672.00,,,,,,,182.00,679.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,inpatient,,,821.00000,443.34000,Coventry,Workers Comp,,788.16,,,,,,,738.90,796.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,outpatient,,,821.00000,443.34000,Coventry,Workers Comp,,788.16,,,,,,,213.46,796.37,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,inpatient,,,846.00000,456.84000,Coventry,Workers Comp,,812.16,,,,,,,761.40,820.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,outpatient,,,846.00000,456.84000,Coventry,Workers Comp,,812.16,,,,,,,219.96,820.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,inpatient,,,958.00000,517.32000,Coventry,Workers Comp,,919.68,,,,,,,862.20,929.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,outpatient,,,958.00000,517.32000,Coventry,Workers Comp,,919.68,,,,,,,249.08,929.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,inpatient,,,1261.00000,680.94000,Coventry,Workers Comp,,1210.56,,,,,,,1134.90,1223.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,outpatient,,,1261.00000,680.94000,Coventry,Workers Comp,,1210.56,,,,,,,327.86,1223.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,inpatient,,,971.00000,524.34000,Coventry,Workers Comp,,932.16,,,,,,,873.90,941.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,outpatient,,,971.00000,524.34000,Coventry,Workers Comp,,932.16,,,,,,,252.46,941.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,inpatient,,,1837.00000,991.98000,Coventry,Workers Comp,,1763.52,,,,,,,1653.30,1781.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,outpatient,,,1837.00000,991.98000,Coventry,Workers Comp,,1763.52,,,,,,,477.62,1781.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,inpatient,,,1099.00000,593.46000,Coventry,Workers Comp,,1055.04,,,,,,,989.10,1066.03,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,outpatient,,,1099.00000,593.46000,Coventry,Workers Comp,,1055.04,,,,,,,285.74,1066.03,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,inpatient,,,2178.00000,1176.12000,Coventry,Workers Comp,,2090.88,,,,,,,1960.20,2112.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,outpatient,,,2178.00000,1176.12000,Coventry,Workers Comp,,2090.88,,,,,,,566.28,2112.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,inpatient,,,1226.00000,662.04000,Coventry,Workers Comp,,1176.96,,,,,,,1103.40,1189.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,outpatient,,,1226.00000,662.04000,Coventry,Workers Comp,,1176.96,,,,,,,318.76,1189.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,inpatient,,,1048.00000,565.92000,Coventry,Workers Comp,,1006.08,,,,,,,943.20,1016.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,outpatient,,,1048.00000,565.92000,Coventry,Workers Comp,,1006.08,,,,,,,272.48,1016.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,inpatient,,,970.00000,523.80000,Coventry,Workers Comp,,931.20,,,,,,,873.00,940.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,outpatient,,,970.00000,523.80000,Coventry,Workers Comp,,931.20,,,,,,,252.20,940.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,inpatient,,,1803.00000,973.62000,Coventry,Workers Comp,,1730.88,,,,,,,1622.70,1748.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,outpatient,,,1803.00000,973.62000,Coventry,Workers Comp,,1730.88,,,,,,,468.78,1748.91,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,inpatient,,,2504.00000,1352.16000,Coventry,Workers Comp,,2403.84,,,,,,,2253.60,2428.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,outpatient,,,2504.00000,1352.16000,Coventry,Workers Comp,,2403.84,,,,,,,651.04,2428.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,inpatient,,,2457.00000,1326.78000,Coventry,Workers Comp,,2358.72,,,,,,,2211.30,2383.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2457.00000,1326.78000,Coventry,Workers Comp,,2358.72,,,,,,,638.82,2383.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,inpatient,,,923.00000,498.42000,Coventry,Workers Comp,,886.08,,,,,,,830.70,895.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,outpatient,,,923.00000,498.42000,Coventry,Workers Comp,,886.08,,,,,,,239.98,895.31,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,inpatient,,,5478.00000,2958.12000,Coventry,Workers Comp,,5258.88,,,,,,,4930.20,5313.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,outpatient,,,5478.00000,2958.12000,Coventry,Workers Comp,,5258.88,,,,,,,1424.28,5313.66,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,inpatient,,,4551.00000,2457.54000,Coventry,Workers Comp,,4368.96,,,,,,,4095.90,4414.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,outpatient,,,4551.00000,2457.54000,Coventry,Workers Comp,,4368.96,,,,,,,1183.26,4414.47,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,inpatient,,,1360.00000,734.40000,Coventry,Workers Comp,,1305.60,,,,,,,1224.00,1319.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,outpatient,,,1360.00000,734.40000,Coventry,Workers Comp,,1305.60,,,,,,,353.60,1319.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,inpatient,,,1209.00000,652.86000,Coventry,Workers Comp,,1160.64,,,,,,,1088.10,1172.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,outpatient,,,1209.00000,652.86000,Coventry,Workers Comp,,1160.64,,,,,,,314.34,1172.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,inpatient,,,848.00000,457.92000,Coventry,Workers Comp,,814.08,,,,,,,763.20,822.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,outpatient,,,848.00000,457.92000,Coventry,Workers Comp,,814.08,,,,,,,220.48,822.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,inpatient,,,1071.00000,578.34000,Coventry,Workers Comp,,1028.16,,,,,,,963.90,1038.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,outpatient,,,1071.00000,578.34000,Coventry,Workers Comp,,1028.16,,,,,,,278.46,1038.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,inpatient,,,1792.00000,967.68000,Coventry,Workers Comp,,1720.32,,,,,,,1612.80,1738.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,outpatient,,,1792.00000,967.68000,Coventry,Workers Comp,,1720.32,,,,,,,465.92,1738.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,inpatient,,,35.00000,18.90000,Coventry,Workers Comp,,33.60,,,,,,,31.50,33.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,outpatient,,,35.00000,18.90000,Coventry,Workers Comp,,33.60,,,,,,,9.10,33.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,inpatient,,,285.00000,153.90000,Coventry,Workers Comp,,273.60,,,,,,,256.50,276.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,outpatient,,,285.00000,153.90000,Coventry,Workers Comp,,273.60,,,,,,,74.10,276.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,inpatient,,,1012.00000,546.48000,Coventry,Workers Comp,,971.52,,,,,,,910.80,981.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,outpatient,,,1012.00000,546.48000,Coventry,Workers Comp,,971.52,,,,,,,263.12,981.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,inpatient,,,492.00000,265.68000,Coventry,Workers Comp,,472.32,,,,,,,442.80,477.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,outpatient,,,492.00000,265.68000,Coventry,Workers Comp,,472.32,,,,,,,127.92,477.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,inpatient,,,739.00000,399.06000,Coventry,Workers Comp,,709.44,,,,,,,665.10,716.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,outpatient,,,739.00000,399.06000,Coventry,Workers Comp,,709.44,,,,,,,192.14,716.83,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,inpatient,,,515.00000,278.10000,Coventry,Workers Comp,,494.40,,,,,,,463.50,499.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,outpatient,,,515.00000,278.10000,Coventry,Workers Comp,,494.40,,,,,,,133.90,499.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,inpatient,,,1467.00000,792.18000,Coventry,Workers Comp,,1408.32,,,,,,,1320.30,1422.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,outpatient,,,1467.00000,792.18000,Coventry,Workers Comp,,1408.32,,,,,,,381.42,1422.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,inpatient,,,1683.00000,888.62000,Coventry,Workers Comp,,1615.68,,,,,,,1514.70,1632.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,outpatient,,,1683.00000,888.62000,Coventry,Workers Comp,,1615.68,,,,,,,437.58,1632.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,inpatient,,,426.30000,225.09000,Coventry,Workers Comp,,409.25,,,,,,,383.67,413.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,426.30000,225.09000,Coventry,Workers Comp,,409.25,,,,,,,110.84,413.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,inpatient,,,725.00000,382.80000,Coventry,Workers Comp,,696.00,,,,,,,652.50,703.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,725.00000,382.80000,Coventry,Workers Comp,,696.00,,,,,,,188.50,1855.42,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,inpatient,,,1852.00000,977.86000,Coventry,Workers Comp,,1777.92,,,,,,,1666.80,1796.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,1852.00000,977.86000,Coventry,Workers Comp,,1777.92,,,,,,,481.52,1868.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,110.00000,58.08000,Coventry,Workers Comp,,105.60,,,,,,,99.00,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,110.00000,58.08000,Coventry,Workers Comp,,105.60,,,,,,,28.60,106.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,inpatient,,,98.00000,51.74000,Coventry,Workers Comp,,94.08,,,,,,,88.20,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,98.00000,51.74000,Coventry,Workers Comp,,94.08,,,,,,,25.48,1662.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,inpatient,,,2018.00000,1065.50000,Coventry,Workers Comp,,1937.28,,,,,,,1816.20,1957.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,2018.00000,1065.50000,Coventry,Workers Comp,,1937.28,,,,,,,524.68,1957.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,inpatient,,,4325.00000,2283.60000,Coventry,Workers Comp,,4152.00,,,,,,,3892.50,4195.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,4325.00000,2283.60000,Coventry,Workers Comp,,4152.00,,,,,,,1124.50,4195.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,inpatient,,,172.00000,90.82000,Coventry,Workers Comp,,165.12,,,,,,,154.80,166.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Coventry,Workers Comp,,165.12,,,,,,,44.72,166.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,inpatient,,,942.00000,497.38000,Coventry,Workers Comp,,904.32,,,,,,,847.80,913.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,942.00000,497.38000,Coventry,Workers Comp,,904.32,,,,,,,244.92,913.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,inpatient,,,413.00000,218.06000,Coventry,Workers Comp,,396.48,,,,,,,371.70,400.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,413.00000,218.06000,Coventry,Workers Comp,,396.48,,,,,,,107.38,400.61,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,inpatient,,,257.00000,135.70000,Coventry,Workers Comp,,246.72,,,,,,,231.30,249.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,outpatient,,,257.00000,135.70000,Coventry,Workers Comp,,246.72,,,,,,,66.82,249.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,inpatient,,,116.00000,61.25000,Coventry,Workers Comp,,111.36,,,,,,,104.40,112.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,116.00000,61.25000,Coventry,Workers Comp,,111.36,,,,,,,30.16,112.52,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,inpatient,,,463.20000,244.57000,Coventry,Workers Comp,,444.67,,,,,,,416.88,449.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,463.20000,244.57000,Coventry,Workers Comp,,444.67,,,,,,,120.43,449.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,inpatient,,,804.00000,424.51000,Coventry,Workers Comp,,771.84,,,,,,,723.60,779.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,804.00000,424.51000,Coventry,Workers Comp,,771.84,,,,,,,209.04,779.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,inpatient,,,172.00000,90.82000,Coventry,Workers Comp,,165.12,,,,,,,154.80,166.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Coventry,Workers Comp,,165.12,,,,,,,44.72,166.84,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,inpatient,,,354.30000,187.07000,Coventry,Workers Comp,,340.13,,,,,,,318.87,343.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,354.30000,187.07000,Coventry,Workers Comp,,340.13,,,,,,,92.12,343.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,inpatient,,,277.90000,146.73000,Coventry,Workers Comp,,266.78,,,,,,,250.11,269.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,277.90000,146.73000,Coventry,Workers Comp,,266.78,,,,,,,72.25,269.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,inpatient,,,200.00000,105.60000,Coventry,Workers Comp,,192.00,,,,,,,180.00,194.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,200.00000,105.60000,Coventry,Workers Comp,,192.00,,,,,,,52.00,194.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,inpatient,,,197.00000,63.63000,Coventry,Workers Comp,,189.12,,,,,,,177.30,191.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,outpatient,,,197.00000,63.63000,Coventry,Workers Comp,,189.12,,,,,,,51.22,191.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,inpatient,,,468.00000,151.16000,Coventry,Workers Comp,50,449.28,,,,,,,421.20,453.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,outpatient,,,468.00000,151.16000,Coventry,Workers Comp,50,449.28,,,,,,,121.68,453.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,inpatient,,,312.00000,100.78000,Coventry,Workers Comp,LT,299.52,,,,,,,280.80,302.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Coventry,Workers Comp,LT,299.52,,,,,,,81.12,302.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,inpatient,,,312.00000,100.78000,Coventry,Workers Comp,RT,299.52,,,,,,,280.80,302.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Coventry,Workers Comp,RT,299.52,,,,,,,81.12,302.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Coventry,Workers Comp,,434.88,,,,,,,407.70,439.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Coventry,Workers Comp,,434.88,,,,,,,117.78,439.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,inpatient,,,609.00000,196.71000,Coventry,Workers Comp,,584.64,,,,,,,548.10,590.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Coventry,Workers Comp,,584.64,,,,,,,158.34,590.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,inpatient,,,1248.00000,403.10000,Coventry,Workers Comp,50,1198.08,,,,,,,1123.20,1210.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1248.00000,403.10000,Coventry,Workers Comp,50,1198.08,,,,,,,324.48,1210.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,inpatient,,,832.00000,268.74000,Coventry,Workers Comp,LT,798.72,,,,,,,748.80,807.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Coventry,Workers Comp,LT,798.72,,,,,,,216.32,807.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,inpatient,,,832.00000,268.74000,Coventry,Workers Comp,RT,798.72,,,,,,,748.80,807.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Coventry,Workers Comp,RT,798.72,,,,,,,216.32,807.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,inpatient,,,4235.00000,1367.90000,Coventry,Workers Comp,LT,4065.60,,,,,,,3811.50,4107.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Coventry,Workers Comp,LT,4065.60,,,,,,,1101.10,4107.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,inpatient,,,4235.00000,1367.90000,Coventry,Workers Comp,RT,4065.60,,,,,,,3811.50,4107.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Coventry,Workers Comp,RT,4065.60,,,,,,,1101.10,4107.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,inpatient,,,2119.00000,684.44000,Coventry,Workers Comp,,2034.24,,,,,,,1907.10,2055.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,outpatient,,,2119.00000,684.44000,Coventry,Workers Comp,,2034.24,,,,,,,550.94,2055.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,inpatient,,,1943.00000,627.59000,Coventry,Workers Comp,,1865.28,,,,,,,1748.70,1884.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1943.00000,627.59000,Coventry,Workers Comp,,1865.28,,,,,,,505.18,1884.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,inpatient,,,1426.00000,460.60000,Coventry,Workers Comp,,1368.96,,,,,,,1283.40,1383.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,outpatient,,,1426.00000,460.60000,Coventry,Workers Comp,,1368.96,,,,,,,370.76,1383.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,inpatient,,,4202.00000,1357.25000,Coventry,Workers Comp,50,4033.92,,,,,,,3781.80,4075.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,outpatient,,,4202.00000,1357.25000,Coventry,Workers Comp,50,4033.92,,,,,,,1092.52,4075.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,inpatient,,,2801.00000,904.72000,Coventry,Workers Comp,LT,2688.96,,,,,,,2520.90,2716.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Coventry,Workers Comp,LT,2688.96,,,,,,,728.26,2716.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,inpatient,,,2801.00000,904.72000,Coventry,Workers Comp,RT,2688.96,,,,,,,2520.90,2716.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Coventry,Workers Comp,RT,2688.96,,,,,,,728.26,2716.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,inpatient,,,832.00000,268.74000,Coventry,Workers Comp,,798.72,,,,,,,748.80,807.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,outpatient,,,832.00000,268.74000,Coventry,Workers Comp,,798.72,,,,,,,216.32,807.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,inpatient,,,1457.00000,470.61000,Coventry,Workers Comp,,1398.72,,,,,,,1311.30,1413.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,outpatient,,,1457.00000,470.61000,Coventry,Workers Comp,,1398.72,,,,,,,378.82,1413.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,inpatient,,,743.00000,239.99000,Coventry,Workers Comp,LT,713.28,,,,,,,668.70,720.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Coventry,Workers Comp,LT,713.28,,,,,,,193.18,720.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,inpatient,,,743.00000,239.99000,Coventry,Workers Comp,RT,713.28,,,,,,,668.70,720.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Coventry,Workers Comp,RT,713.28,,,,,,,193.18,720.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,inpatient,,,232.00000,74.94000,Coventry,Workers Comp,,222.72,,,,,,,208.80,225.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,outpatient,,,232.00000,74.94000,Coventry,Workers Comp,,222.72,,,,,,,60.32,225.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,inpatient,,,1364.00000,440.57000,Coventry,Workers Comp,50,1309.44,,,,,,,1227.60,1323.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,outpatient,,,1364.00000,440.57000,Coventry,Workers Comp,50,1309.44,,,,,,,354.64,1323.08,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,inpatient,,,909.00000,293.61000,Coventry,Workers Comp,LT,872.64,,,,,,,818.10,881.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Coventry,Workers Comp,LT,872.64,,,,,,,236.34,881.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,inpatient,,,909.00000,293.61000,Coventry,Workers Comp,RT,872.64,,,,,,,818.10,881.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Coventry,Workers Comp,RT,872.64,,,,,,,236.34,881.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,inpatient,,,510.00000,355.98000,Coventry,Workers Comp,,489.60,,,,,,,459.00,494.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,outpatient,,,510.00000,355.98000,Coventry,Workers Comp,,489.60,,,,,,,132.60,494.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,inpatient,,,1001.00000,698.70000,Coventry,Workers Comp,,960.96,,,,,,,900.90,970.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,outpatient,,,1001.00000,698.70000,Coventry,Workers Comp,,960.96,,,,,,,260.26,970.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,inpatient,,,887.00000,619.13000,Coventry,Workers Comp,,851.52,,,,,,,798.30,860.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,outpatient,,,887.00000,619.13000,Coventry,Workers Comp,,851.52,,,,,,,230.62,860.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,inpatient,,,1022.00000,713.36000,Coventry,Workers Comp,50,981.12,,,,,,,919.80,991.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,outpatient,,,1022.00000,713.36000,Coventry,Workers Comp,50,981.12,,,,,,,265.72,991.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,inpatient,,,681.00000,475.34000,Coventry,Workers Comp,LT,653.76,,,,,,,612.90,660.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Coventry,Workers Comp,LT,653.76,,,,,,,177.06,660.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,inpatient,,,681.00000,475.34000,Coventry,Workers Comp,RT,653.76,,,,,,,612.90,660.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Coventry,Workers Comp,RT,653.76,,,,,,,177.06,660.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,inpatient,,,945.00000,659.61000,Coventry,Workers Comp,50,907.20,,,,,,,850.50,916.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,outpatient,,,945.00000,659.61000,Coventry,Workers Comp,50,907.20,,,,,,,245.70,916.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,inpatient,,,630.00000,439.74000,Coventry,Workers Comp,LT,604.80,,,,,,,567.00,611.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Coventry,Workers Comp,LT,604.80,,,,,,,163.80,611.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,inpatient,,,630.00000,439.74000,Coventry,Workers Comp,RT,604.80,,,,,,,567.00,611.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Coventry,Workers Comp,RT,604.80,,,,,,,163.80,611.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,inpatient,,,577.00000,402.75000,Coventry,Workers Comp,,553.92,,,,,,,519.30,559.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,outpatient,,,577.00000,402.75000,Coventry,Workers Comp,,553.92,,,,,,,150.02,559.69,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,inpatient,,,433.00000,302.23000,Coventry,Workers Comp,,415.68,,,,,,,389.70,420.01,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,outpatient,,,433.00000,302.23000,Coventry,Workers Comp,,415.68,,,,,,,112.58,420.01,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,inpatient,,,331.00000,231.04000,Coventry,Workers Comp,,317.76,,,,,,,297.90,321.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,outpatient,,,331.00000,231.04000,Coventry,Workers Comp,,317.76,,,,,,,86.06,321.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,inpatient,,,662.00000,462.08000,Coventry,Workers Comp,,635.52,,,,,,,595.80,642.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,outpatient,,,662.00000,462.08000,Coventry,Workers Comp,,635.52,,,,,,,172.12,642.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,inpatient,,,752.00000,524.90000,Coventry,Workers Comp,,721.92,,,,,,,676.80,729.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,outpatient,,,752.00000,524.90000,Coventry,Workers Comp,,721.92,,,,,,,195.52,729.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,inpatient,,,182.00000,127.04000,Coventry,Workers Comp,,174.72,,,,,,,163.80,176.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Coventry,Workers Comp,,174.72,,,,,,,47.32,176.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,inpatient,,,420.00000,293.16000,Coventry,Workers Comp,,403.20,,,,,,,378.00,407.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,outpatient,,,420.00000,293.16000,Coventry,Workers Comp,,403.20,,,,,,,109.20,407.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,inpatient,,,253.00000,176.59000,Coventry,Workers Comp,,242.88,,,,,,,227.70,245.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,outpatient,,,253.00000,176.59000,Coventry,Workers Comp,,242.88,,,,,,,65.78,245.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,inpatient,,,168.00000,117.26000,Coventry,Workers Comp,,161.28,,,,,,,151.20,162.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,outpatient,,,168.00000,117.26000,Coventry,Workers Comp,,161.28,,,,,,,43.68,162.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,inpatient,,,695.00000,485.11000,Coventry,Workers Comp,,667.20,,,,,,,625.50,674.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,outpatient,,,695.00000,485.11000,Coventry,Workers Comp,,667.20,,,,,,,180.70,674.15,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,inpatient,,,474.00000,330.85000,Coventry,Workers Comp,,455.04,,,,,,,426.60,459.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,outpatient,,,474.00000,330.85000,Coventry,Workers Comp,,455.04,,,,,,,123.24,459.78,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,inpatient,,,930.00000,649.14000,Coventry,Workers Comp,,892.80,,,,,,,837.00,902.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,outpatient,,,930.00000,649.14000,Coventry,Workers Comp,,892.80,,,,,,,241.80,902.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,inpatient,,,786.00000,548.63000,Coventry,Workers Comp,,754.56,,,,,,,707.40,762.42,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,outpatient,,,786.00000,548.63000,Coventry,Workers Comp,,754.56,,,,,,,204.36,762.42,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,inpatient,,,620.00000,432.76000,Coventry,Workers Comp,,595.20,,,,,,,558.00,601.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Coventry,Workers Comp,,595.20,,,,,,,161.20,601.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,inpatient,,,620.00000,432.76000,Coventry,Workers Comp,59,595.20,,,,,,,558.00,601.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Coventry,Workers Comp,59,595.20,,,,,,,161.20,601.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,inpatient,,,435.00000,303.63000,Coventry,Workers Comp,,417.60,,,,,,,391.50,421.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Coventry,Workers Comp,,417.60,,,,,,,113.10,421.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,inpatient,,,435.00000,303.63000,Coventry,Workers Comp,59,417.60,,,,,,,391.50,421.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Coventry,Workers Comp,59,417.60,,,,,,,113.10,421.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,inpatient,,,492.00000,343.42000,Coventry,Workers Comp,,472.32,,,,,,,442.80,477.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,outpatient,,,492.00000,343.42000,Coventry,Workers Comp,,472.32,,,,,,,127.92,477.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,inpatient,,,331.00000,231.04000,Coventry,Workers Comp,,317.76,,,,,,,297.90,321.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,outpatient,,,331.00000,231.04000,Coventry,Workers Comp,,317.76,,,,,,,86.06,321.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,inpatient,,,875.00000,610.75000,Coventry,Workers Comp,,840.00,,,,,,,787.50,848.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,outpatient,,,875.00000,610.75000,Coventry,Workers Comp,,840.00,,,,,,,227.50,848.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,inpatient,,,688.00000,480.22000,Coventry,Workers Comp,,660.48,,,,,,,619.20,667.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,outpatient,,,688.00000,480.22000,Coventry,Workers Comp,,660.48,,,,,,,178.88,667.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,inpatient,,,465.00000,324.57000,Coventry,Workers Comp,,446.40,,,,,,,418.50,451.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,outpatient,,,465.00000,324.57000,Coventry,Workers Comp,,446.40,,,,,,,120.90,451.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,inpatient,,,846.00000,590.51000,Coventry,Workers Comp,,812.16,,,,,,,761.40,820.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,outpatient,,,846.00000,590.51000,Coventry,Workers Comp,,812.16,,,,,,,219.96,820.62,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,inpatient,,,482.00000,336.44000,Coventry,Workers Comp,,462.72,,,,,,,433.80,467.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,outpatient,,,482.00000,336.44000,Coventry,Workers Comp,,462.72,,,,,,,125.32,467.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,inpatient,,,926.00000,646.35000,Coventry,Workers Comp,,888.96,,,,,,,833.40,898.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,outpatient,,,926.00000,646.35000,Coventry,Workers Comp,,888.96,,,,,,,240.76,898.22,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,inpatient,,,292.00000,203.82000,Coventry,Workers Comp,,280.32,,,,,,,262.80,283.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,outpatient,,,292.00000,203.82000,Coventry,Workers Comp,,280.32,,,,,,,75.92,283.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,inpatient,,,827.00000,577.25000,Coventry,Workers Comp,,793.92,,,,,,,744.30,802.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,outpatient,,,827.00000,577.25000,Coventry,Workers Comp,,793.92,,,,,,,215.02,802.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,inpatient,,,253.00000,176.59000,Coventry,Workers Comp,,242.88,,,,,,,227.70,245.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,outpatient,,,253.00000,176.59000,Coventry,Workers Comp,,242.88,,,,,,,65.78,245.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,inpatient,,,901.00000,628.90000,Coventry,Workers Comp,,864.96,,,,,,,810.90,873.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,outpatient,,,901.00000,628.90000,Coventry,Workers Comp,,864.96,,,,,,,234.26,873.97,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,inpatient,,,460.00000,321.08000,Coventry,Workers Comp,,441.60,,,,,,,414.00,446.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,outpatient,,,460.00000,321.08000,Coventry,Workers Comp,,441.60,,,,,,,119.60,446.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,inpatient,,,1029.00000,718.24000,Coventry,Workers Comp,,987.84,,,,,,,926.10,998.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1029.00000,718.24000,Coventry,Workers Comp,,987.84,,,,,,,267.54,998.13,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,inpatient,,,959.00000,669.38000,Coventry,Workers Comp,,920.64,,,,,,,863.10,930.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,outpatient,,,959.00000,669.38000,Coventry,Workers Comp,,920.64,,,,,,,249.34,930.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,inpatient,,,558.00000,389.48000,Coventry,Workers Comp,,535.68,,,,,,,502.20,541.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,outpatient,,,558.00000,389.48000,Coventry,Workers Comp,,535.68,,,,,,,145.08,541.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,inpatient,,,705.00000,492.09000,Coventry,Workers Comp,,676.80,,,,,,,634.50,683.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,outpatient,,,705.00000,492.09000,Coventry,Workers Comp,,676.80,,,,,,,183.30,683.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,inpatient,,,249.00000,173.80000,Coventry,Workers Comp,,239.04,,,,,,,224.10,241.53,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,outpatient,,,249.00000,173.80000,Coventry,Workers Comp,,239.04,,,,,,,64.74,241.53,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,inpatient,,,427.00000,298.05000,Coventry,Workers Comp,,409.92,,,,,,,384.30,414.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,outpatient,,,427.00000,298.05000,Coventry,Workers Comp,,409.92,,,,,,,111.02,414.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,inpatient,,,737.00000,514.43000,Coventry,Workers Comp,,707.52,,,,,,,663.30,714.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Coventry,Workers Comp,,707.52,,,,,,,191.62,714.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,inpatient,,,737.00000,514.43000,Coventry,Workers Comp,59,707.52,,,,,,,663.30,714.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Coventry,Workers Comp,59,707.52,,,,,,,191.62,714.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,inpatient,,,809.00000,564.68000,Coventry,Workers Comp,,776.64,,,,,,,728.10,784.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,outpatient,,,809.00000,564.68000,Coventry,Workers Comp,,776.64,,,,,,,210.34,784.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,inpatient,,,525.00000,366.45000,Coventry,Workers Comp,,504.00,,,,,,,472.50,509.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,outpatient,,,525.00000,366.45000,Coventry,Workers Comp,,504.00,,,,,,,136.50,509.25,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,inpatient,,,319.00000,222.66000,Coventry,Workers Comp,,306.24,,,,,,,287.10,309.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,outpatient,,,319.00000,222.66000,Coventry,Workers Comp,,306.24,,,,,,,82.94,309.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,inpatient,,,1437.00000,678.26000,Coventry,Workers Comp,,1379.52,,,,,,,1293.30,1393.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1437.00000,678.26000,Coventry,Workers Comp,,1379.52,,,,,,,373.62,1393.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,inpatient,,,2143.00000,1011.50000,Coventry,Workers Comp,,2057.28,,,,,,,1928.70,2078.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2143.00000,1011.50000,Coventry,Workers Comp,,2057.28,,,,,,,557.18,2078.71,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,inpatient,,,755.00000,356.36000,Coventry,Workers Comp,,724.80,,,,,,,679.50,732.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,outpatient,,,755.00000,356.36000,Coventry,Workers Comp,,724.80,,,,,,,196.30,732.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,inpatient,,,979.00000,462.09000,Coventry,Workers Comp,,939.84,,,,,,,881.10,949.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,outpatient,,,979.00000,462.09000,Coventry,Workers Comp,,939.84,,,,,,,254.54,949.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,inpatient,,,436.00000,205.79000,Coventry,Workers Comp,,418.56,,,,,,,392.40,422.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,outpatient,,,436.00000,205.79000,Coventry,Workers Comp,,418.56,,,,,,,113.36,422.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,inpatient,,,220.00000,103.84000,Coventry,Workers Comp,,211.20,,,,,,,198.00,213.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,outpatient,,,220.00000,103.84000,Coventry,Workers Comp,,211.20,,,,,,,57.20,213.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,inpatient,,,344.00000,162.37000,Coventry,Workers Comp,,330.24,,,,,,,309.60,333.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,outpatient,,,344.00000,162.37000,Coventry,Workers Comp,,330.24,,,,,,,89.44,333.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,inpatient,,,818.00000,393.46000,Coventry,Workers Comp,,785.28,,,,,,,736.20,793.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,outpatient,,,818.00000,393.46000,Coventry,Workers Comp,,785.28,,,,,,,212.68,793.46,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,inpatient,,,545.00000,262.14000,Coventry,Workers Comp,52,523.20,,,,,,,490.50,528.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,outpatient,,,545.00000,262.14000,Coventry,Workers Comp,52,523.20,,,,,,,141.70,528.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,inpatient,,,1347.00000,647.91000,Coventry,Workers Comp,,1293.12,,,,,,,1212.30,1306.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,outpatient,,,1347.00000,647.91000,Coventry,Workers Comp,,1293.12,,,,,,,350.22,1306.59,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,inpatient,,,898.00000,431.94000,Coventry,Workers Comp,52,862.08,,,,,,,808.20,871.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,outpatient,,,898.00000,431.94000,Coventry,Workers Comp,52,862.08,,,,,,,233.48,871.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,inpatient,,,469.00000,225.59000,Coventry,Workers Comp,,450.24,,,,,,,422.10,454.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,outpatient,,,469.00000,225.59000,Coventry,Workers Comp,,450.24,,,,,,,121.94,454.93,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,inpatient,,,1762.00000,847.52000,Coventry,Workers Comp,,1691.52,,,,,,,1585.80,1709.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,outpatient,,,1762.00000,847.52000,Coventry,Workers Comp,,1691.52,,,,,,,458.12,1709.14,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,inpatient,,,627.00000,301.59000,Coventry,Workers Comp,,601.92,,,,,,,564.30,608.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,outpatient,,,627.00000,301.59000,Coventry,Workers Comp,,601.92,,,,,,,163.02,608.19,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,inpatient,,,590.00000,283.79000,Coventry,Workers Comp,,566.40,,,,,,,531.00,572.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,outpatient,,,590.00000,283.79000,Coventry,Workers Comp,,566.40,,,,,,,153.40,572.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,inpatient,,,1550.00000,745.55000,Coventry,Workers Comp,,1488.00,,,,,,,1395.00,1503.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,outpatient,,,1550.00000,745.55000,Coventry,Workers Comp,,1488.00,,,,,,,403.00,1503.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,inpatient,,,990.00000,476.19000,Coventry,Workers Comp,LT,950.40,,,,,,,891.00,960.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Coventry,Workers Comp,LT,950.40,,,,,,,257.40,960.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,inpatient,,,990.00000,476.19000,Coventry,Workers Comp,RT,950.40,,,,,,,891.00,960.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Coventry,Workers Comp,RT,950.40,,,,,,,257.40,960.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,inpatient,,,1402.00000,674.36000,Coventry,Workers Comp,,1345.92,,,,,,,1261.80,1359.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,outpatient,,,1402.00000,674.36000,Coventry,Workers Comp,,1345.92,,,,,,,364.52,1359.94,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,inpatient,,,980.00000,471.38000,Coventry,Workers Comp,LT,940.80,,,,,,,882.00,950.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Coventry,Workers Comp,LT,940.80,,,,,,,254.80,950.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,inpatient,,,980.00000,471.38000,Coventry,Workers Comp,RT,940.80,,,,,,,882.00,950.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Coventry,Workers Comp,RT,940.80,,,,,,,254.80,950.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,inpatient,,,1661.00000,798.94000,Coventry,Workers Comp,,1594.56,,,,,,,1494.90,1611.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,outpatient,,,1661.00000,798.94000,Coventry,Workers Comp,,1594.56,,,,,,,431.86,1611.17,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,inpatient,,,980.00000,471.38000,Coventry,Workers Comp,,940.80,,,,,,,882.00,950.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,outpatient,,,980.00000,471.38000,Coventry,Workers Comp,,940.80,,,,,,,254.80,950.60,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,inpatient,,,1740.00000,836.94000,Coventry,Workers Comp,,1670.40,,,,,,,1566.00,1687.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1740.00000,836.94000,Coventry,Workers Comp,,1670.40,,,,,,,452.40,1687.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,inpatient,,,1168.00000,561.81000,Coventry,Workers Comp,,1121.28,,,,,,,1051.20,1132.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1168.00000,561.81000,Coventry,Workers Comp,,1121.28,,,,,,,303.68,1132.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,inpatient,,,433.00000,232.09000,Coventry,Workers Comp,,415.68,,,,,,,389.70,420.01,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,outpatient,,,433.00000,232.09000,Coventry,Workers Comp,,415.68,,,,,,,112.58,420.01,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,inpatient,,,388.00000,207.97000,Coventry,Workers Comp,LT,372.48,,,,,,,349.20,376.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Coventry,Workers Comp,LT,372.48,,,,,,,100.88,376.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,inpatient,,,388.00000,207.97000,Coventry,Workers Comp,RT,372.48,,,,,,,349.20,376.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Coventry,Workers Comp,RT,372.48,,,,,,,100.88,376.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,inpatient,,,388.00000,207.97000,Coventry,Workers Comp,,372.48,,,,,,,349.20,376.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,outpatient,,,388.00000,207.97000,Coventry,Workers Comp,,372.48,,,,,,,100.88,376.36,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,inpatient,,,604.00000,323.74000,Coventry,Workers Comp,,579.84,,,,,,,543.60,585.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,outpatient,,,604.00000,323.74000,Coventry,Workers Comp,,579.84,,,,,,,157.04,585.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,inpatient,,,667.00000,357.51000,Coventry,Workers Comp,,640.32,,,,,,,600.30,646.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,outpatient,,,667.00000,357.51000,Coventry,Workers Comp,,640.32,,,,,,,173.42,646.99,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,inpatient,,,176.00000,94.34000,Coventry,Workers Comp,,168.96,,,,,,,158.40,170.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,outpatient,,,176.00000,94.34000,Coventry,Workers Comp,,168.96,,,,,,,45.76,170.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,inpatient,,,92.00000,29.72000,Coventry,Workers Comp,LT,88.32,,,,,,,82.80,89.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Coventry,Workers Comp,LT,88.32,,,,,,,23.92,89.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,inpatient,,,92.00000,29.72000,Coventry,Workers Comp,RT,88.32,,,,,,,82.80,89.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Coventry,Workers Comp,RT,88.32,,,,,,,23.92,89.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,inpatient,,,366.00000,118.22000,Coventry,Workers Comp,LT,351.36,,,,,,,329.40,355.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Coventry,Workers Comp,LT,351.36,,,,,,,95.16,355.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,inpatient,,,366.00000,118.22000,Coventry,Workers Comp,RT,351.36,,,,,,,329.40,355.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Coventry,Workers Comp,RT,351.36,,,,,,,95.16,355.02,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,inpatient,,,1117.00000,360.79000,Coventry,Workers Comp,LT,1072.32,,,,,,,1005.30,1083.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Coventry,Workers Comp,LT,1072.32,,,,,,,290.42,1083.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,inpatient,,,1117.00000,360.79000,Coventry,Workers Comp,RT,1072.32,,,,,,,1005.30,1083.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Coventry,Workers Comp,RT,1072.32,,,,,,,290.42,1083.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,inpatient,,,559.00000,180.56000,Coventry,Workers Comp,,536.64,,,,,,,503.10,542.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,outpatient,,,559.00000,180.56000,Coventry,Workers Comp,,536.64,,,,,,,145.34,542.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,inpatient,,,252.00000,81.40000,Coventry,Workers Comp,50,241.92,,,,,,,226.80,244.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,outpatient,,,252.00000,81.40000,Coventry,Workers Comp,50,241.92,,,,,,,65.52,244.44,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,inpatient,,,168.00000,54.26000,Coventry,Workers Comp,LT,161.28,,,,,,,151.20,162.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Coventry,Workers Comp,LT,161.28,,,,,,,43.68,162.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,inpatient,,,168.00000,54.26000,Coventry,Workers Comp,RT,161.28,,,,,,,151.20,162.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Coventry,Workers Comp,RT,161.28,,,,,,,43.68,162.96,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,inpatient,,,1148.00000,370.80000,Coventry,Workers Comp,LT,1102.08,,,,,,,1033.20,1113.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Coventry,Workers Comp,LT,1102.08,,,,,,,298.48,1113.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,inpatient,,,1148.00000,370.80000,Coventry,Workers Comp,RT,1102.08,,,,,,,1033.20,1113.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Coventry,Workers Comp,RT,1102.08,,,,,,,298.48,1113.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,inpatient,,,379.00000,122.42000,Coventry,Workers Comp,,363.84,,,,,,,341.10,367.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,outpatient,,,379.00000,122.42000,Coventry,Workers Comp,,363.84,,,,,,,98.54,367.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,inpatient,,,1015.00000,327.84000,Coventry,Workers Comp,,974.40,,,,,,,913.50,984.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,outpatient,,,1015.00000,327.84000,Coventry,Workers Comp,,974.40,,,,,,,263.90,984.55,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,inpatient,,,591.00000,190.89000,Coventry,Workers Comp,,567.36,,,,,,,531.90,573.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,outpatient,,,591.00000,190.89000,Coventry,Workers Comp,,567.36,,,,,,,153.66,573.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,inpatient,,,271.00000,169.92000,Coventry,Workers Comp,,260.16,,,,,,,243.90,262.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,outpatient,,,271.00000,169.92000,Coventry,Workers Comp,,260.16,,,,,,,70.46,262.87,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,inpatient,,,211.00000,132.30000,Coventry,Workers Comp,LT,202.56,,,,,,,189.90,204.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Coventry,Workers Comp,LT,202.56,,,,,,,54.86,204.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,inpatient,,,211.00000,132.30000,Coventry,Workers Comp,RT,202.56,,,,,,,189.90,204.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Coventry,Workers Comp,RT,202.56,,,,,,,54.86,204.67,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,59.00000,36.99000,Coventry,Workers Comp,,56.64,,,,,,,53.10,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,59.00000,36.99000,Coventry,Workers Comp,,56.64,,,,,,,15.34,57.23,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,inpatient,,,336.00000,219.74000,Coventry,Workers Comp,,322.56,,,,,,,302.40,325.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,outpatient,,,336.00000,219.74000,Coventry,Workers Comp,,322.56,,,,,,,87.36,325.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,inpatient,,,224.00000,146.50000,Coventry,Workers Comp,52,215.04,,,,,,,201.60,217.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,outpatient,,,224.00000,146.50000,Coventry,Workers Comp,52,215.04,,,,,,,58.24,217.28,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,inpatient,,,63.00000,41.20000,Coventry,Workers Comp,,60.48,,,,,,,56.70,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,outpatient,,,63.00000,41.20000,Coventry,Workers Comp,,60.48,,,,,,,16.38,61.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Coventry,Workers Comp,,483.84,,,,,,,453.60,488.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Coventry,Workers Comp,,483.84,,,,,,,131.04,488.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Coventry,Workers Comp,,94.08,,,,,,,88.20,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Coventry,Workers Comp,,94.08,,,,,,,25.48,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Coventry,Workers Comp,,583.68,,,,,,,547.20,589.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Coventry,Workers Comp,,583.68,,,,,,,158.08,589.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Coventry,Workers Comp,,109.44,,,,,,,102.60,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Coventry,Workers Comp,,109.44,,,,,,,29.64,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Coventry,Workers Comp,,179.52,,,,,,,168.30,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Coventry,Workers Comp,,179.52,,,,,,,48.62,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Coventry,Workers Comp,,205.44,,,,,,,192.60,207.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Coventry,Workers Comp,,205.44,,,,,,,55.64,207.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,inpatient,,,609.00000,196.71000,Coventry,Workers Comp,,584.64,,,,,,,548.10,590.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Coventry,Workers Comp,,584.64,,,,,,,158.34,590.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,inpatient,,,863.00000,278.75000,Coventry,Workers Comp,,828.48,,,,,,,776.70,837.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Coventry,Workers Comp,,828.48,,,,,,,224.38,837.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,inpatient,,,900.00000,605.70000,Coventry,Workers Comp,,864.00,,,,,,,810.00,873.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,outpatient,,,900.00000,605.70000,Coventry,Workers Comp,,864.00,,,,,,,234.00,873.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,inpatient,,,1940.00000,1102.21000,Coventry,Workers Comp,,1862.40,,,,,,,1746.00,1881.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,outpatient,,,1940.00000,1102.21000,Coventry,Workers Comp,,1862.40,,,,,,,504.40,1881.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,inpatient,,,422.00000,239.76000,Coventry,Workers Comp,,405.12,,,,,,,379.80,409.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,outpatient,,,422.00000,239.76000,Coventry,Workers Comp,,405.12,,,,,,,109.72,409.34,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,inpatient,,,1430.00000,812.45000,Coventry,Workers Comp,,1372.80,,,,,,,1287.00,1387.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,outpatient,,,1430.00000,812.45000,Coventry,Workers Comp,,1372.80,,,,,,,371.80,1387.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,inpatient,,,745.00000,423.27000,Coventry,Workers Comp,,715.20,,,,,,,670.50,722.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,outpatient,,,745.00000,423.27000,Coventry,Workers Comp,,715.20,,,,,,,193.70,722.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,inpatient,,,2655.00000,2487.74000,Coventry,Workers Comp,,2548.80,,,,,,,2389.50,2575.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,outpatient,,,2655.00000,2487.74000,Coventry,Workers Comp,,2548.80,,,,,,,690.30,2575.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,inpatient,,,3990.00000,3738.63000,Coventry,Workers Comp,,3830.40,,,,,,,3591.00,3870.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,outpatient,,,3990.00000,3738.63000,Coventry,Workers Comp,,3830.40,,,,,,,1037.40,3870.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,inpatient,,,290.00000,271.73000,Coventry,Workers Comp,,278.40,,,,,,,261.00,281.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,outpatient,,,290.00000,271.73000,Coventry,Workers Comp,,278.40,,,,,,,75.40,281.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,inpatient,,,735.00000,688.70000,Coventry,Workers Comp,,705.60,,,,,,,661.50,712.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,outpatient,,,735.00000,688.70000,Coventry,Workers Comp,,705.60,,,,,,,191.10,712.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,inpatient,,,1475.00000,1382.08000,Coventry,Workers Comp,,1416.00,,,,,,,1327.50,1430.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Coventry,Workers Comp,,1416.00,,,,,,,383.50,1430.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,inpatient,,,2275.00000,2131.68000,Coventry,Workers Comp,,2184.00,,,,,,,2047.50,2206.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,outpatient,,,2275.00000,2131.68000,Coventry,Workers Comp,,2184.00,,,,,,,591.50,2206.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,inpatient,,,3205.00000,3003.08000,Coventry,Workers Comp,,3076.80,,,,,,,2884.50,3108.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,outpatient,,,3205.00000,3003.08000,Coventry,Workers Comp,,3076.80,,,,,,,833.30,3108.85,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,inpatient,,,770.00000,721.49000,Coventry,Workers Comp,,739.20,,,,,,,693.00,746.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,outpatient,,,770.00000,721.49000,Coventry,Workers Comp,,739.20,,,,,,,200.20,746.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,inpatient,,,1475.00000,1382.08000,Coventry,Workers Comp,,1416.00,,,,,,,1327.50,1430.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Coventry,Workers Comp,,1416.00,,,,,,,383.50,1430.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,inpatient,,,2210.00000,2070.77000,Coventry,Workers Comp,,2121.60,,,,,,,1989.00,2143.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,outpatient,,,2210.00000,2070.77000,Coventry,Workers Comp,,2121.60,,,,,,,574.60,2143.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,inpatient,,,2660.00000,2492.42000,Coventry,Workers Comp,,2553.60,,,,,,,2394.00,2580.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,outpatient,,,2660.00000,2492.42000,Coventry,Workers Comp,,2553.60,,,,,,,691.60,2580.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,inpatient,,,3560.00000,3335.72000,Coventry,Workers Comp,,3417.60,,,,,,,3204.00,3453.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,outpatient,,,3560.00000,3335.72000,Coventry,Workers Comp,,3417.60,,,,,,,925.60,3453.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,inpatient,,,5730.00000,3255.50000,Coventry,Workers Comp,,5500.80,,,,,,,5157.00,5558.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,outpatient,,,5730.00000,3255.50000,Coventry,Workers Comp,,5500.80,,,,,,,1489.80,5558.10,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,inpatient,,,3875.00000,2201.58000,Coventry,Workers Comp,,3720.00,,,,,,,3487.50,3758.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,outpatient,,,3875.00000,2201.58000,Coventry,Workers Comp,,3720.00,,,,,,,1007.50,3758.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,inpatient,,,519.00000,564.15000,Coventry,Workers Comp,,498.24,,,,,,,467.10,503.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,outpatient,,,519.00000,564.15000,Coventry,Workers Comp,,498.24,,,,,,,134.94,503.43,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,inpatient,,,536.00000,582.63000,Coventry,Workers Comp,,514.56,,,,,,,482.40,519.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,outpatient,,,536.00000,582.63000,Coventry,Workers Comp,,514.56,,,,,,,139.36,519.92,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Coventry,Workers Comp,,434.88,,,,,,,407.70,439.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Coventry,Workers Comp,,434.88,,,,,,,117.78,439.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Coventry,Workers Comp,,138.24,,,,,,,129.60,139.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Coventry,Workers Comp,,138.24,,,,,,,37.44,139.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Coventry,Workers Comp,,102.72,,,,,,,96.30,103.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Coventry,Workers Comp,,102.72,,,,,,,27.82,103.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Coventry,Workers Comp,,138.24,,,,,,,129.60,139.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Coventry,Workers Comp,,138.24,,,,,,,37.44,139.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Coventry,Workers Comp,,483.84,,,,,,,453.60,488.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Coventry,Workers Comp,,483.84,,,,,,,131.04,488.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Coventry,Workers Comp,,94.08,,,,,,,88.20,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Coventry,Workers Comp,,94.08,,,,,,,25.48,95.06,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Coventry,Workers Comp,,583.68,,,,,,,547.20,589.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Coventry,Workers Comp,,583.68,,,,,,,158.08,589.76,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Coventry,Workers Comp,,109.44,,,,,,,102.60,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Coventry,Workers Comp,,109.44,,,,,,,29.64,110.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Coventry,Workers Comp,,179.52,,,,,,,168.30,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Coventry,Workers Comp,,179.52,,,,,,,48.62,181.39,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Coventry,Workers Comp,,205.44,,,,,,,192.60,207.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Coventry,Workers Comp,,205.44,,,,,,,55.64,207.58,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,inpatient,,,175.00000,63.18000,Coventry,Workers Comp,,168.00,,,,,,,157.50,169.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,outpatient,,,175.00000,63.18000,Coventry,Workers Comp,,168.00,,,,,,,45.50,169.75,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,inpatient,,,304.00000,109.74000,Coventry,Workers Comp,,291.84,,,,,,,273.60,294.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,outpatient,,,304.00000,109.74000,Coventry,Workers Comp,,291.84,,,,,,,79.04,294.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Coventry,Workers Comp,,272.64,,,,,,,255.60,275.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Coventry,Workers Comp,,272.64,,,,,,,73.84,275.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Coventry,Workers Comp,,439.68,,,,,,,412.20,444.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Coventry,Workers Comp,,439.68,,,,,,,119.08,444.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,inpatient,,,438.00000,158.12000,Coventry,Workers Comp,,420.48,,,,,,,394.20,424.86,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,outpatient,,,438.00000,158.12000,Coventry,Workers Comp,,420.48,,,,,,,113.88,424.86,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Coventry,Workers Comp,,535.68,,,,,,,502.20,541.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Coventry,Workers Comp,,535.68,,,,,,,145.08,541.26,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Coventry,Workers Comp,,462.72,,,,,,,433.80,467.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Coventry,Workers Comp,,462.72,,,,,,,125.32,467.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Coventry,Workers Comp,,227.52,,,,,,,213.30,229.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Coventry,Workers Comp,,227.52,,,,,,,61.62,229.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Coventry,Workers Comp,,483.84,,,,,,,453.60,488.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Coventry,Workers Comp,,483.84,,,,,,,131.04,488.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Coventry,Workers Comp,,483.84,,,,,,,453.60,488.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Coventry,Workers Comp,,483.84,,,,,,,131.04,488.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Coventry,Workers Comp,,483.84,,,,,,,453.60,488.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Coventry,Workers Comp,,483.84,,,,,,,131.04,488.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Coventry,Workers Comp,,483.84,,,,,,,453.60,488.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Coventry,Workers Comp,,483.84,,,,,,,131.04,488.88,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Coventry,Workers Comp,,808.32,,,,,,,757.80,816.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Coventry,Workers Comp,,808.32,,,,,,,218.92,816.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Coventry,Workers Comp,,1010.88,,,,,,,947.70,1021.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Coventry,Workers Comp,,1010.88,,,,,,,273.78,1021.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Coventry,Workers Comp,,1212.48,,,,,,,1136.70,1225.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Coventry,Workers Comp,,1212.48,,,,,,,328.38,1225.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,inpatient,,,182.00000,127.04000,Coventry,Workers Comp,,174.72,,,,,,,163.80,176.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Coventry,Workers Comp,,174.72,,,,,,,47.32,176.54,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,inpatient,,,210.00000,119.31000,Coventry,Workers Comp,,201.60,,,,,,,189.00,203.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Coventry,Workers Comp,,201.60,,,,,,,54.60,203.70,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,inpatient,,,140.00000,79.54000,Coventry,Workers Comp,,134.40,,,,,,,126.00,135.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,outpatient,,,140.00000,79.54000,Coventry,Workers Comp,,134.40,,,,,,,36.40,135.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,inpatient,,,190.00000,107.95000,Coventry,Workers Comp,,182.40,,,,,,,171.00,184.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,outpatient,,,190.00000,107.95000,Coventry,Workers Comp,,182.40,,,,,,,49.40,184.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,inpatient,,,240.00000,136.36000,Coventry,Workers Comp,,230.40,,,,,,,216.00,232.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,outpatient,,,240.00000,136.36000,Coventry,Workers Comp,,230.40,,,,,,,62.40,232.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,inpatient,,,290.00000,164.76000,Coventry,Workers Comp,,278.40,,,,,,,261.00,281.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,outpatient,,,290.00000,164.76000,Coventry,Workers Comp,,278.40,,,,,,,75.40,281.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,inpatient,,,340.00000,193.17000,Coventry,Workers Comp,,326.40,,,,,,,306.00,329.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,outpatient,,,340.00000,193.17000,Coventry,Workers Comp,,326.40,,,,,,,88.40,329.80,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,inpatient,,,150.00000,85.22000,Coventry,Workers Comp,,144.00,,,,,,,135.00,145.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,outpatient,,,150.00000,85.22000,Coventry,Workers Comp,,144.00,,,,,,,39.00,145.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,inpatient,,,200.00000,113.63000,Coventry,Workers Comp,,192.00,,,,,,,180.00,194.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,outpatient,,,200.00000,113.63000,Coventry,Workers Comp,,192.00,,,,,,,52.00,194.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,inpatient,,,270.00000,153.40000,Coventry,Workers Comp,,259.20,,,,,,,243.00,261.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,outpatient,,,270.00000,153.40000,Coventry,Workers Comp,,259.20,,,,,,,70.20,261.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,inpatient,,,370.00000,210.22000,Coventry,Workers Comp,,355.20,,,,,,,333.00,358.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,outpatient,,,370.00000,210.22000,Coventry,Workers Comp,,355.20,,,,,,,96.20,358.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,inpatient,,,470.00000,267.03000,Coventry,Workers Comp,,451.20,,,,,,,423.00,455.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,outpatient,,,470.00000,267.03000,Coventry,Workers Comp,,451.20,,,,,,,122.20,455.90,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,inpatient,,,248.00000,96.22000,Coventry,Workers Comp,,238.08,,,,,,,223.20,240.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,outpatient,,,248.00000,96.22000,Coventry,Workers Comp,,238.08,,,,,,,64.48,240.56,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,inpatient,,,245.00000,95.06000,Coventry,Workers Comp,,235.20,,,,,,,220.50,237.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,outpatient,,,245.00000,95.06000,Coventry,Workers Comp,,235.20,,,,,,,63.70,237.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,inpatient,,,497.00000,192.84000,Coventry,Workers Comp,,477.12,,,,,,,447.30,482.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,outpatient,,,497.00000,192.84000,Coventry,Workers Comp,,477.12,,,,,,,129.22,482.09,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,inpatient,,,357.00000,138.52000,Coventry,Workers Comp,,342.72,,,,,,,321.30,346.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,outpatient,,,357.00000,138.52000,Coventry,Workers Comp,,342.72,,,,,,,92.82,346.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,inpatient,,,334.00000,129.59000,Coventry,Workers Comp,,320.64,,,,,,,300.60,323.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,outpatient,,,334.00000,129.59000,Coventry,Workers Comp,,320.64,,,,,,,86.84,323.98,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,inpatient,,,194.00000,75.27000,Coventry,Workers Comp,,186.24,,,,,,,174.60,188.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,outpatient,,,194.00000,75.27000,Coventry,Workers Comp,,186.24,,,,,,,50.44,188.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,inpatient,,,1035.00000,401.58000,Coventry,Workers Comp,,993.60,,,,,,,931.50,1003.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,outpatient,,,1035.00000,401.58000,Coventry,Workers Comp,,993.60,,,,,,,269.10,1003.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,inpatient,,,1137.00000,441.16000,Coventry,Workers Comp,,1091.52,,,,,,,1023.30,1102.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,outpatient,,,1137.00000,441.16000,Coventry,Workers Comp,,1091.52,,,,,,,295.62,1102.89,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,inpatient,,,963.00000,373.64000,Coventry,Workers Comp,,924.48,,,,,,,866.70,934.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,outpatient,,,963.00000,373.64000,Coventry,Workers Comp,,924.48,,,,,,,250.38,934.11,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,inpatient,,,990.00000,384.12000,Coventry,Workers Comp,,950.40,,,,,,,891.00,960.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,outpatient,,,990.00000,384.12000,Coventry,Workers Comp,,950.40,,,,,,,257.40,960.30,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,inpatient,,,112.00000,43.46000,Coventry,Workers Comp,,107.52,,,,,,,100.80,108.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,outpatient,,,112.00000,43.46000,Coventry,Workers Comp,,107.52,,,,,,,29.12,108.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,inpatient,,,84.00000,32.59000,Coventry,Workers Comp,,80.64,,,,,,,75.60,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,outpatient,,,84.00000,32.59000,Coventry,Workers Comp,,80.64,,,,,,,21.84,81.48,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,inpatient,,,176.00000,68.29000,Coventry,Workers Comp,,168.96,,,,,,,158.40,170.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,outpatient,,,176.00000,68.29000,Coventry,Workers Comp,,168.96,,,,,,,45.76,170.72,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,inpatient,,,283.00000,109.80000,Coventry,Workers Comp,,271.68,,,,,,,254.70,274.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,outpatient,,,283.00000,109.80000,Coventry,Workers Comp,,271.68,,,,,,,73.58,274.51,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Coventry,Workers Comp,,77.76,,,,,,,72.90,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Coventry,Workers Comp,,77.76,,,,,,,21.06,78.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Coventry,Workers Comp,,39.36,,,,,,,36.90,39.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Coventry,Workers Comp,,39.36,,,,,,,10.66,39.77,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,inpatient,,,35.00000,19.89000,Coventry,Workers Comp,,33.60,,,,,,,31.50,33.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,35.00000,19.89000,Coventry,Workers Comp,,33.60,,,,,,,9.10,33.95,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,inpatient,,,191.00000,89.39000,Coventry,Workers Comp,,183.36,,,,,,,171.90,185.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,outpatient,,,191.00000,89.39000,Coventry,Workers Comp,,183.36,,,,,,,49.66,185.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Coventry,Workers Comp,,434.88,,,,,,,407.70,439.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Coventry,Workers Comp,,434.88,,,,,,,117.78,439.41,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Coventry,Workers Comp,,138.24,,,,,,,129.60,139.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Coventry,Workers Comp,,138.24,,,,,,,37.44,139.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Coventry,Workers Comp,,102.72,,,,,,,96.30,103.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Coventry,Workers Comp,,102.72,,,,,,,27.82,103.79,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Coventry,Workers Comp,,138.24,,,,,,,129.60,139.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Coventry,Workers Comp,,138.24,,,,,,,37.44,139.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,inpatient,,,281.00000,131.51000,Coventry,Workers Comp,,269.76,,,,,,,252.90,272.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,outpatient,,,281.00000,131.51000,Coventry,Workers Comp,,269.76,,,,,,,73.06,272.57,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,inpatient,,,192.00000,89.86000,Coventry,Workers Comp,,184.32,,,,,,,172.80,186.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,outpatient,,,192.00000,89.86000,Coventry,Workers Comp,,184.32,,,,,,,49.92,186.24,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,inpatient,,,365.00000,170.82000,Coventry,Workers Comp,,350.40,,,,,,,328.50,354.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,outpatient,,,365.00000,170.82000,Coventry,Workers Comp,,350.40,,,,,,,94.90,354.05,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,inpatient,,,8391.00000,5856.92000,Coventry,Workers Comp,,8055.36,,,,,,,7551.90,8139.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,outpatient,,,8391.00000,5856.92000,Coventry,Workers Comp,,8055.36,,,,,,,2181.66,8139.27,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,inpatient,,,6917.00000,4828.07000,Coventry,Workers Comp,52,6640.32,,,,,,,6225.30,6709.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Coventry,Workers Comp,52,6640.32,,,,,,,1798.42,6709.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,inpatient,,,6000.00000,4188.00000,Coventry,Workers Comp,,5760.00,,,,,,,5400.00,5820.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Coventry,Workers Comp,,5760.00,,,,,,,1560.00,5820.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,inpatient,,,6917.00000,4828.07000,Coventry,Workers Comp,,6640.32,,,,,,,6225.30,6709.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Coventry,Workers Comp,,6640.32,,,,,,,1798.42,6709.49,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,inpatient,,,6000.00000,4188.00000,Coventry,Workers Comp,52,5760.00,,,,,,,5400.00,5820.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Coventry,Workers Comp,52,5760.00,,,,,,,1560.00,5820.00,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,inpatient,,,8855.00000,9625.38000,Coventry,Workers Comp,,8500.80,,,,,,,7969.50,8589.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,outpatient,,,8855.00000,9625.38000,Coventry,Workers Comp,,8500.80,,,,,,,2302.30,8589.35,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,inpatient,,,844.00000,917.43000,Coventry,Workers Comp,,810.24,,,,,,,759.60,818.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Coventry,Workers Comp,,810.24,,,,,,,219.44,818.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,inpatient,,,844.00000,917.43000,Coventry,Workers Comp,52,810.24,,,,,,,759.60,818.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Coventry,Workers Comp,52,810.24,,,,,,,219.44,818.68,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,inpatient,,,785.00000,853.30000,Coventry,Workers Comp,,753.60,,,,,,,706.50,761.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Coventry,Workers Comp,,753.60,,,,,,,204.10,761.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,inpatient,,,785.00000,853.30000,Coventry,Workers Comp,52,753.60,,,,,,,706.50,761.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Coventry,Workers Comp,52,753.60,,,,,,,204.10,761.45,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4709.00000,5118.68000,Coventry,Workers Comp,,4520.64,,,,,,,4238.10,4567.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Coventry,Workers Comp,,4520.64,,,,,,,1224.34,4567.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4709.00000,5118.68000,Coventry,Workers Comp,52,4520.64,,,,,,,4238.10,4567.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Coventry,Workers Comp,52,4520.64,,,,,,,1224.34,4567.73,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,inpatient,,,345.00000,128.34000,Coventry,Workers Comp,,331.20,,,,,,,310.50,334.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,outpatient,,,345.00000,128.34000,Coventry,Workers Comp,,331.20,,,,,,,89.70,334.65,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,inpatient,,,120.00000,99.60000,Coventry,Workers Comp,,115.20,,,,,,,108.00,116.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,outpatient,,,120.00000,99.60000,Coventry,Workers Comp,,115.20,,,,,,,31.20,116.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,inpatient,,,106.00000,87.98000,Coventry,Workers Comp,,101.76,,,,,,,95.40,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,outpatient,,,106.00000,87.98000,Coventry,Workers Comp,,101.76,,,,,,,27.56,102.82,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,inpatient,,,32.00000,26.56000,Coventry,Workers Comp,,30.72,,,,,,,28.80,31.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,outpatient,,,32.00000,26.56000,Coventry,Workers Comp,,30.72,,,,,,,8.32,31.04,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,inpatient,,,60.00000,49.80000,Coventry,Workers Comp,,57.60,,,,,,,54.00,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,outpatient,,,60.00000,49.80000,Coventry,Workers Comp,,57.60,,,,,,,15.60,58.20,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,inpatient,,,57.00000,47.31000,Coventry,Workers Comp,,54.72,,,,,,,51.30,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,outpatient,,,57.00000,47.31000,Coventry,Workers Comp,,54.72,,,,,,,14.82,55.29,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,inpatient,1.0,ME,7.40000,0.65000,Coventry,Workers Comp,,7.10,,,,,,,6.66,7.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,outpatient,1.0,ME,7.40000,0.65000,Coventry,Workers Comp,,7.10,,,,,,,1.92,7.18,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,inpatient,1.0,EA,6.60000,1.43000,Coventry,Workers Comp,UD,6.34,,,,,,,5.94,6.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,outpatient,1.0,EA,6.60000,1.43000,Coventry,Workers Comp,UD,6.34,,,,,,,1.72,6.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,inpatient,1.0,EA,2.95000,0.64000,Coventry,Workers Comp,UD,2.83,,,,,,,2.65,2.86,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,outpatient,1.0,EA,2.95000,0.64000,Coventry,Workers Comp,UD,2.83,,,,,,,0.76700,2.86,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,inpatient,1.0,EA,56.08000,12.11000,Coventry,Workers Comp,UD,53.84,,,,,,,50.47,54.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,56.08000,12.11000,Coventry,Workers Comp,UD,53.84,,,,,,,14.58,54.40,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,inpatient,1.0,UN,82.10000,28.90000,Coventry,Workers Comp,,78.82,,,,,,,73.89,79.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,outpatient,1.0,UN,82.10000,28.90000,Coventry,Workers Comp,,78.82,,,,,,,15.48,79.64,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.04000,,Coventry,Workers Comp,UD,0.03840,,,,,,,0.03600,0.03880,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.04000,,Coventry,Workers Comp,UD,0.03840,,,,,,,0.01040,0.03880,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.05000,,Coventry,Workers Comp,UD,0.04800,,,,,,,0.04500,0.04850,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.05000,,Coventry,Workers Comp,UD,0.04800,,,,,,,0.01300,0.04850,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,inpatient,1.0,ME,6.20000,0.55000,Coventry,Workers Comp,,5.95,,,,,,,5.58,6.01,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,outpatient,1.0,ME,6.20000,0.55000,Coventry,Workers Comp,,5.95,,,,,,,1.61,6.01,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.12000,0.01000,Coventry,Workers Comp,UD,0.11520,,,,,,,0.10800,0.11640,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.12000,0.01000,Coventry,Workers Comp,UD,0.11520,,,,,,,0.03120,0.11640,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,inpatient,2.0,ML,5.80000,1.25000,Coventry,Workers Comp,,5.57,,,,,,,5.22,5.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,outpatient,2.0,ML,5.80000,1.25000,Coventry,Workers Comp,,5.57,,,,,,,1.51,5.63,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,inpatient,1.0,ME,3.10000,0.27000,Coventry,Workers Comp,,2.98,,,,,,,2.79,3.01,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,outpatient,1.0,ME,3.10000,0.27000,Coventry,Workers Comp,,2.98,,,,,,,0.80600,3.01,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,inpatient,1.0,EA,44.40000,3.91000,Coventry,Workers Comp,,42.62,,,,,,,39.96,43.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,outpatient,1.0,EA,44.40000,3.91000,Coventry,Workers Comp,,42.62,,,,,,,11.54,43.07,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,inpatient,1.0,EA,8.26000,0.73000,Coventry,Workers Comp,UD,7.93,,,,,,,7.43,8.01,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,8.26000,0.73000,Coventry,Workers Comp,UD,7.93,,,,,,,2.15,8.01,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,2.19000,0.19000,Coventry,Workers Comp,UD,2.10,,,,,,,1.97,2.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,2.19000,0.19000,Coventry,Workers Comp,UD,2.10,,,,,,,0.56940,2.12,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,inpatient,1.0,EA,28.60000,2.52000,Coventry,Workers Comp,,27.46,,,,,,,25.74,27.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,outpatient,1.0,EA,28.60000,2.52000,Coventry,Workers Comp,,27.46,,,,,,,7.44,27.74,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,inpatient,1.0,EA,2.58000,0.91000,Coventry,Workers Comp,UD,2.48,,,,,,,2.32,2.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,outpatient,1.0,EA,2.58000,0.91000,Coventry,Workers Comp,UD,2.48,,,,,,,0.67080,2.50,percent of total billed charges,96% of Billed Charges payment not to exceed the max payable under the applicable Workers Compensation law.
R&B OBSTETRICS PVT,3012,CDM,112,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,HMO,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,23010,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,HMO,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ICU,33019,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Hometown Health,HMO,,7884.90,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,13011,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Hometown Health,HMO,,5256.90,,,,,,,2512.00,5665.77,percent of total billed charges,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,244.00000,77.10000,Hometown Health,HMO,,219.60,,,,,,,219.60,236.68,percent of total billed charges,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,244.00000,77.10000,Hometown Health,HMO,,219.60,,,,,,,63.44,236.68,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,24075,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,HMO,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B OBSTETRICS SEMI-PVT,44073,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,HMO,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B NURSERY LEVEL 1,55160,CDM,171,RC,,,,,facility,inpatient,,,3477.00000,1975.46000,Hometown Health,HMO,,3129.30,,,,,,,2512.00,3372.69,percent of total billed charges,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,inpatient,,,16.00000,7.71000,Hometown Health,HMO,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,outpatient,,,16.00000,7.71000,Hometown Health,HMO,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,inpatient,,,210.00000,119.31000,Hometown Health,HMO,,189.00,,,,,,,189.00,203.70,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Hometown Health,HMO,,189.00,,,,,,,54.60,203.70,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,inpatient,,,380.00000,215.90000,Hometown Health,HMO,,342.00,,,,,,,342.00,368.60,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,outpatient,,,380.00000,215.90000,Hometown Health,HMO,,342.00,,,,,,,98.80,368.60,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Hometown Health,HMO,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Hometown Health,HMO,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22012,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,HMO,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ADMIN DAY SKILLED,82016,CDM,160,RC,,,,,facility,inpatient,,,1923.00000,1092.55000,Hometown Health,HMO,,1730.70,,,,,,,1730.70,3111.10,percent of total billed charges,
R&B SWING BED SKILLED,62018,CDM,160,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,HMO,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ADMIN DAY INTERMEDIATE,72017,CDM,169,RC,,,,,facility,inpatient,,,1176.00000,668.14000,Hometown Health,HMO,,1058.40,,,,,,,1058.40,3111.10,percent of total billed charges,
R&B ICU,32011,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Hometown Health,HMO,,7884.90,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,12013,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Hometown Health,HMO,,5256.90,,,,,,,2512.00,5665.77,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Hometown Health,HMO,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Hometown Health,HMO,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Hometown Health,HMO,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Hometown Health,HMO,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Hometown Health,HMO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Hometown Health,HMO,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Hometown Health,HMO,,547.20,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Hometown Health,HMO,,547.20,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Hometown Health,HMO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Hometown Health,HMO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Hometown Health,HMO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Hometown Health,HMO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Hometown Health,HMO,,192.60,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Hometown Health,HMO,,192.60,,,,,,,55.64,207.58,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,84.00000,63.59000,Hometown Health,HMO,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Hometown Health,HMO,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Hometown Health,HMO,,255.60,,,,,,,255.60,275.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Hometown Health,HMO,,255.60,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Hometown Health,HMO,,412.20,,,,,,,412.20,444.26,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Hometown Health,HMO,,412.20,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Hometown Health,HMO,,502.20,,,,,,,502.20,541.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Hometown Health,HMO,,502.20,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Hometown Health,HMO,,433.80,,,,,,,433.80,467.54,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Hometown Health,HMO,,433.80,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Hometown Health,HMO,,213.30,,,,,,,213.30,229.89,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Hometown Health,HMO,,213.30,,,,,,,61.62,229.89,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,inpatient,,,2041.00000,659.24000,Hometown Health,HMO,,1836.90,,,,,,,1836.90,1979.77,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,outpatient,,,2041.00000,659.24000,Hometown Health,HMO,,1836.90,,,,,,,530.66,1979.77,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,inpatient,,,259.00000,83.66000,Hometown Health,HMO,,233.10,,,,,,,233.10,251.23,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,outpatient,,,259.00000,83.66000,Hometown Health,HMO,,233.10,,,,,,,67.34,251.23,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,inpatient,,,672.00000,217.06000,Hometown Health,HMO,,604.80,,,,,,,604.80,651.84,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,outpatient,,,672.00000,217.06000,Hometown Health,HMO,,604.80,,,,,,,174.72,651.84,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,inpatient,,,530.00000,171.19000,Hometown Health,HMO,,477.00,,,,,,,477.00,514.10,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,outpatient,,,530.00000,171.19000,Hometown Health,HMO,,477.00,,,,,,,137.80,514.10,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,inpatient,,,580.00000,187.34000,Hometown Health,HMO,,522.00,,,,,,,522.00,562.60,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,outpatient,,,580.00000,187.34000,Hometown Health,HMO,,522.00,,,,,,,150.80,562.60,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,inpatient,,,435.00000,140.50000,Hometown Health,HMO,,391.50,,,,,,,391.50,421.95,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,outpatient,,,435.00000,140.50000,Hometown Health,HMO,,391.50,,,,,,,113.10,421.95,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,inpatient,,,863.00000,278.75000,Hometown Health,HMO,,776.70,,,,,,,776.70,837.11,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Hometown Health,HMO,,776.70,,,,,,,224.38,837.11,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,inpatient,,,334.00000,107.88000,Hometown Health,HMO,,300.60,,,,,,,300.60,323.98,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,outpatient,,,334.00000,107.88000,Hometown Health,HMO,,300.60,,,,,,,86.84,323.98,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,inpatient,,,1188.00000,383.72000,Hometown Health,HMO,50,1069.20,,,,,,,1069.20,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,outpatient,,,1188.00000,383.72000,Hometown Health,HMO,50,1069.20,,,,,,,308.88,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,inpatient,,,792.00000,255.82000,Hometown Health,HMO,LT,712.80,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Hometown Health,HMO,LT,712.80,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,inpatient,,,792.00000,255.82000,Hometown Health,HMO,RT,712.80,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Hometown Health,HMO,RT,712.80,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,inpatient,,,572.00000,184.76000,Hometown Health,HMO,50,514.80,,,,,,,514.80,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,outpatient,,,572.00000,184.76000,Hometown Health,HMO,50,514.80,,,,,,,148.72,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,inpatient,,,381.00000,123.06000,Hometown Health,HMO,LT,342.90,,,,,,,342.90,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Hometown Health,HMO,LT,342.90,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,inpatient,,,381.00000,123.06000,Hometown Health,HMO,RT,342.90,,,,,,,342.90,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Hometown Health,HMO,RT,342.90,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,inpatient,,,455.00000,146.96000,Hometown Health,HMO,,409.50,,,,,,,409.50,441.35,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,outpatient,,,455.00000,146.96000,Hometown Health,HMO,,409.50,,,,,,,118.30,441.35,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,inpatient,,,403.00000,130.17000,Hometown Health,HMO,,362.70,,,,,,,362.70,390.91,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,outpatient,,,403.00000,130.17000,Hometown Health,HMO,,362.70,,,,,,,104.78,390.91,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,inpatient,,,370.00000,119.51000,Hometown Health,HMO,,333.00,,,,,,,333.00,358.90,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,outpatient,,,370.00000,119.51000,Hometown Health,HMO,,333.00,,,,,,,96.20,358.90,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,inpatient,,,357.00000,115.31000,Hometown Health,HMO,,321.30,,,,,,,321.30,346.29,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,outpatient,,,357.00000,115.31000,Hometown Health,HMO,,321.30,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,inpatient,,,334.00000,107.88000,Hometown Health,HMO,,300.60,,,,,,,300.60,323.98,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,outpatient,,,334.00000,107.88000,Hometown Health,HMO,,300.60,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,inpatient,,,194.00000,62.66000,Hometown Health,HMO,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,outpatient,,,194.00000,62.66000,Hometown Health,HMO,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,inpatient,,,457.00000,147.61000,Hometown Health,HMO,,411.30,,,,,,,411.30,443.29,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,outpatient,,,457.00000,147.61000,Hometown Health,HMO,,411.30,,,,,,,118.82,443.29,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,inpatient,,,492.00000,158.92000,Hometown Health,HMO,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,outpatient,,,492.00000,158.92000,Hometown Health,HMO,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,inpatient,,,780.00000,251.94000,Hometown Health,HMO,,702.00,,,,,,,702.00,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,outpatient,,,780.00000,251.94000,Hometown Health,HMO,,702.00,,,,,,,202.80,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,inpatient,,,1165.00000,376.30000,Hometown Health,HMO,,1048.50,,,,,,,1048.50,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,outpatient,,,1165.00000,376.30000,Hometown Health,HMO,,1048.50,,,,,,,302.90,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,inpatient,,,2350.00000,759.05000,Hometown Health,HMO,,2115.00,,,,,,,2115.00,2279.50,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,outpatient,,,2350.00000,759.05000,Hometown Health,HMO,,2115.00,,,,,,,611.00,2279.50,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,inpatient,,,896.00000,289.41000,Hometown Health,HMO,,806.40,,,,,,,806.40,869.12,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,outpatient,,,896.00000,289.41000,Hometown Health,HMO,,806.40,,,,,,,232.96,869.12,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,inpatient,,,490.00000,158.27000,Hometown Health,HMO,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,outpatient,,,490.00000,158.27000,Hometown Health,HMO,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,inpatient,,,520.00000,167.96000,Hometown Health,HMO,,468.00,,,,,,,468.00,504.40,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,outpatient,,,520.00000,167.96000,Hometown Health,HMO,,468.00,,,,,,,135.20,504.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,inpatient,,,720.00000,232.56000,Hometown Health,HMO,,648.00,,,,,,,648.00,698.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,outpatient,,,720.00000,232.56000,Hometown Health,HMO,,648.00,,,,,,,187.20,698.40,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,inpatient,,,215.00000,69.45000,Hometown Health,HMO,,193.50,,,,,,,193.50,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,outpatient,,,215.00000,69.45000,Hometown Health,HMO,,193.50,,,,,,,55.90,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,inpatient,,,240.00000,77.52000,Hometown Health,HMO,,216.00,,,,,,,216.00,232.80,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,outpatient,,,240.00000,77.52000,Hometown Health,HMO,,216.00,,,,,,,62.40,232.80,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,inpatient,,,1241.00000,400.84000,Hometown Health,HMO,,1116.90,,,,,,,1116.90,1203.77,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,outpatient,,,1241.00000,400.84000,Hometown Health,HMO,,1116.90,,,,,,,322.66,1203.77,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Hometown Health,HMO,,757.80,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Hometown Health,HMO,,757.80,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Hometown Health,HMO,,947.70,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Hometown Health,HMO,,947.70,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Hometown Health,HMO,,1136.70,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Hometown Health,HMO,,1136.70,,,,,,,328.38,1225.11,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,inpatient,,,668.00000,559.78000,Hometown Health,HMO,,601.20,,,,,,,601.20,647.96,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,outpatient,,,668.00000,559.78000,Hometown Health,HMO,,601.20,,,,,,,173.68,647.96,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Hometown Health,HMO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Hometown Health,HMO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Hometown Health,HMO,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Hometown Health,HMO,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Hometown Health,HMO,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Hometown Health,HMO,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Hometown Health,HMO,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Hometown Health,HMO,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Hometown Health,HMO,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Hometown Health,HMO,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Hometown Health,HMO,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Hometown Health,HMO,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Hometown Health,HMO,,3.06,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Hometown Health,HMO,,3.06,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Hometown Health,HMO,,3.06,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Hometown Health,HMO,,3.06,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Hometown Health,HMO,,3.06,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Hometown Health,HMO,,3.06,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,4.90000,2.78000,Hometown Health,HMO,,4.41,,,,,,,4.41,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Hometown Health,HMO,,4.41,,,,,,,1.27,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,7.90000,4.49000,Hometown Health,HMO,,7.11,,,,,,,7.11,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,7.90000,4.49000,Hometown Health,HMO,,7.11,,,,,,,2.05,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,4.90000,2.78000,Hometown Health,HMO,,4.41,,,,,,,4.41,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Hometown Health,HMO,,4.41,,,,,,,1.27,4.75,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Hometown Health,HMO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Hometown Health,HMO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Hometown Health,HMO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Hometown Health,HMO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Hometown Health,HMO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Hometown Health,HMO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,inpatient,,,3141500.00000,1784843.22000,Hometown Health,HMO,,2827350.00,,,,,,,2827350.00,3047255.00,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,outpatient,,,3141500.00000,1784843.22000,Hometown Health,HMO,,2827350.00,,,,,,,816790.00,3047255.00,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Hometown Health,HMO,UD,0.19800,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Hometown Health,HMO,UD,0.19800,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.52000,0.30000,Hometown Health,HMO,UD,0.46800,,,,,,,0.46800,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.52000,0.30000,Hometown Health,HMO,UD,0.46800,,,,,,,0.13520,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.56000,0.32000,Hometown Health,HMO,UD,0.50400,,,,,,,0.50400,0.54320,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.56000,0.32000,Hometown Health,HMO,UD,0.50400,,,,,,,0.14560,0.54320,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Hometown Health,HMO,UD,0.19800,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Hometown Health,HMO,UD,0.19800,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.85000,0.48000,Hometown Health,HMO,UD,0.76500,,,,,,,0.76500,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.85000,0.48000,Hometown Health,HMO,UD,0.76500,,,,,,,0.22100,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Hometown Health,HMO,UD,0.19800,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Hometown Health,HMO,UD,0.19800,,,,,,,0.05720,0.21340,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,inpatient,,,102.00000,65.18000,Hometown Health,HMO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,outpatient,,,102.00000,65.18000,Hometown Health,HMO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,inpatient,,,190.00000,121.41000,Hometown Health,HMO,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,outpatient,,,190.00000,121.41000,Hometown Health,HMO,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,inpatient,,,359.00000,229.40000,Hometown Health,HMO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Hometown Health,HMO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,inpatient,,,535.00000,341.86000,Hometown Health,HMO,,481.50,,,,,,,481.50,518.95,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Hometown Health,HMO,,481.50,,,,,,,139.10,518.95,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,inpatient,,,766.00000,489.47000,Hometown Health,HMO,,689.40,,,,,,,689.40,743.02,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,outpatient,,,766.00000,489.47000,Hometown Health,HMO,,689.40,,,,,,,199.16,743.02,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,inpatient,,,159.00000,101.60000,Hometown Health,HMO,,143.10,,,,,,,143.10,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,outpatient,,,159.00000,101.60000,Hometown Health,HMO,,143.10,,,,,,,41.34,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,inpatient,,,447.00000,285.63000,Hometown Health,HMO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,outpatient,,,447.00000,285.63000,Hometown Health,HMO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,inpatient,,,1413.00000,902.91000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,outpatient,,,1413.00000,902.91000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,inpatient,,,3853.00000,2462.07000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,outpatient,,,3853.00000,2462.07000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,inpatient,,,313.00000,200.01000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,outpatient,,,313.00000,200.01000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,inpatient,,,1132.00000,723.35000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,outpatient,,,1132.00000,723.35000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,inpatient,,,2695.00000,1722.10000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,outpatient,,,2695.00000,1722.10000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,inpatient,,,1619.00000,1034.54000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,outpatient,,,1619.00000,1034.54000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,inpatient,,,535.00000,341.86000,Hometown Health,HMO,,481.50,,,,,,,481.50,518.95,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Hometown Health,HMO,,481.50,,,,,,,139.10,518.95,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,inpatient,,,850.00000,543.15000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,outpatient,,,850.00000,543.15000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,inpatient,,,32.00000,20.45000,Hometown Health,HMO,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,outpatient,,,32.00000,20.45000,Hometown Health,HMO,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,inpatient,,,134.00000,85.63000,Hometown Health,HMO,,120.60,,,,,,,120.60,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,outpatient,,,134.00000,85.63000,Hometown Health,HMO,,120.60,,,,,,,34.84,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,inpatient,,,359.00000,229.40000,Hometown Health,HMO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Hometown Health,HMO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,inpatient,,,709.00000,453.05000,Hometown Health,HMO,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,outpatient,,,709.00000,453.05000,Hometown Health,HMO,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,inpatient,,,4880.00000,2357.04000,Hometown Health,HMO,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,outpatient,,,4880.00000,2357.04000,Hometown Health,HMO,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,inpatient,,,6024.00000,2909.59000,Hometown Health,HMO,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,outpatient,,,6024.00000,2909.59000,Hometown Health,HMO,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,HMO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,HMO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Hometown Health,HMO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Hometown Health,HMO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,inpatient,,,7413.00000,3580.48000,Hometown Health,HMO,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,outpatient,,,7413.00000,3580.48000,Hometown Health,HMO,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,HMO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,HMO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,HMO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,HMO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Hometown Health,HMO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Hometown Health,HMO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,inpatient,,,7181.00000,3468.42000,Hometown Health,HMO,,6462.90,,,,,,,6462.90,6965.57,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Hometown Health,HMO,,6462.90,,,,,,,1867.06,6965.57,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,inpatient,,,10654.00000,5145.88000,Hometown Health,HMO,,9588.60,,,,,,,9588.60,10334.38,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,outpatient,,,10654.00000,5145.88000,Hometown Health,HMO,,9588.60,,,,,,,2770.04,10334.38,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,6487.00000,3133.22000,Hometown Health,HMO,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Hometown Health,HMO,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,7413.00000,3580.48000,Hometown Health,HMO,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Hometown Health,HMO,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,11575.00000,5590.72000,Hometown Health,HMO,,10417.50,,,,,,,10417.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,11575.00000,5590.72000,Hometown Health,HMO,,10417.50,,,,,,,3009.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,13432.00000,6487.66000,Hometown Health,HMO,,12088.80,,,,,,,12088.80,13029.04,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,13432.00000,6487.66000,Hometown Health,HMO,,12088.80,,,,,,,3492.32,13029.04,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,21904.00000,10579.63000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,21904.00000,10579.63000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,4397.00000,2123.75000,Hometown Health,HMO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Hometown Health,HMO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,7413.00000,3580.48000,Hometown Health,HMO,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Hometown Health,HMO,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,12969.00000,6264.03000,Hometown Health,HMO,,11672.10,,,,,,,11672.10,12579.93,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,12969.00000,6264.03000,Hometown Health,HMO,,11672.10,,,,,,,3371.94,12579.93,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Hometown Health,HMO,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Hometown Health,HMO,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Hometown Health,HMO,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Hometown Health,HMO,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Hometown Health,HMO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Hometown Health,HMO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,inpatient,,,134.00000,64.72000,Hometown Health,HMO,,120.60,,,,,,,120.60,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Hometown Health,HMO,,120.60,,,,,,,34.84,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,inpatient,,,251.00000,121.23000,Hometown Health,HMO,,225.90,,,,,,,225.90,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,outpatient,,,251.00000,121.23000,Hometown Health,HMO,,225.90,,,,,,,65.26,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,HMO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,HMO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,2827.00000,1365.44000,Hometown Health,HMO,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Hometown Health,HMO,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,2690.00000,1299.27000,Hometown Health,HMO,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Hometown Health,HMO,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,6487.00000,3133.22000,Hometown Health,HMO,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Hometown Health,HMO,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,2426.00000,1171.76000,Hometown Health,HMO,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,2426.00000,1171.76000,Hometown Health,HMO,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,15334.00000,7406.32000,Hometown Health,HMO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,15334.00000,7406.32000,Hometown Health,HMO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Hometown Health,HMO,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Hometown Health,HMO,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,251.00000,121.23000,Hometown Health,HMO,,225.90,,,,,,,225.90,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,251.00000,121.23000,Hometown Health,HMO,,225.90,,,,,,,65.26,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,2827.00000,1365.44000,Hometown Health,HMO,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Hometown Health,HMO,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Hometown Health,HMO,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Hometown Health,HMO,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,inpatient,,,15334.00000,7406.32000,Hometown Health,HMO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Hometown Health,HMO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,inpatient,,,1485.00000,717.26000,Hometown Health,HMO,,1336.50,,,,,,,1336.50,1440.45,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,outpatient,,,1485.00000,717.26000,Hometown Health,HMO,,1336.50,,,,,,,386.10,1440.45,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,inpatient,,,2028.00000,979.52000,Hometown Health,HMO,,1825.20,,,,,,,1825.20,1967.16,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,outpatient,,,2028.00000,979.52000,Hometown Health,HMO,,1825.20,,,,,,,527.28,1967.16,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,4397.00000,2123.75000,Hometown Health,HMO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Hometown Health,HMO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,8107.00000,3915.68000,Hometown Health,HMO,,7296.30,,,,,,,7296.30,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,8107.00000,3915.68000,Hometown Health,HMO,,7296.30,,,,,,,2107.82,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,10422.00000,5033.83000,Hometown Health,HMO,,9379.80,,,,,,,9379.80,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,10422.00000,5033.83000,Hometown Health,HMO,,9379.80,,,,,,,2709.72,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,12737.00000,6151.97000,Hometown Health,HMO,,11463.30,,,,,,,11463.30,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,12737.00000,6151.97000,Hometown Health,HMO,,11463.30,,,,,,,3311.62,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,14239.00000,6877.44000,Hometown Health,HMO,,12815.10,,,,,,,12815.10,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,14239.00000,6877.44000,Hometown Health,HMO,,12815.10,,,,,,,3702.14,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,16429.00000,7935.21000,Hometown Health,HMO,,14786.10,,,,,,,14786.10,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,16429.00000,7935.21000,Hometown Health,HMO,,14786.10,,,,,,,4271.54,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,18619.00000,8992.98000,Hometown Health,HMO,,16757.10,,,,,,,16757.10,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,18619.00000,8992.98000,Hometown Health,HMO,,16757.10,,,,,,,4840.94,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,20809.00000,10050.75000,Hometown Health,HMO,,18728.10,,,,,,,18728.10,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,20809.00000,10050.75000,Hometown Health,HMO,,18728.10,,,,,,,5410.34,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,22999.00000,11108.52000,Hometown Health,HMO,,20699.10,,,,,,,20699.10,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,22999.00000,11108.52000,Hometown Health,HMO,,20699.10,,,,,,,5979.74,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,25189.00000,12166.29000,Hometown Health,HMO,,22670.10,,,,,,,22670.10,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,25189.00000,12166.29000,Hometown Health,HMO,,22670.10,,,,,,,6549.14,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,27379.00000,13224.06000,Hometown Health,HMO,,24641.10,,,,,,,24641.10,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,27379.00000,13224.06000,Hometown Health,HMO,,24641.10,,,,,,,7118.54,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,29569.00000,14281.83000,Hometown Health,HMO,,26612.10,,,,,,,26612.10,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,29569.00000,14281.83000,Hometown Health,HMO,,26612.10,,,,,,,7687.94,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,31759.00000,15339.60000,Hometown Health,HMO,,28583.10,,,,,,,28583.10,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,31759.00000,15339.60000,Hometown Health,HMO,,28583.10,,,,,,,8257.34,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,36139.00000,17455.14000,Hometown Health,HMO,,32525.10,,,,,,,32525.10,35054.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,36139.00000,17455.14000,Hometown Health,HMO,,32525.10,,,,,,,9396.14,35054.83,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Hometown Health,HMO,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Hometown Health,HMO,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Hometown Health,HMO,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Hometown Health,HMO,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,inpatient,,,134.00000,64.72000,Hometown Health,HMO,,120.60,,,,,,,120.60,129.98,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Hometown Health,HMO,,120.60,,,,,,,34.84,129.98,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Hometown Health,HMO,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Hometown Health,HMO,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,inpatient,,,476.00000,229.91000,Hometown Health,HMO,,428.40,,,,,,,428.40,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,outpatient,,,476.00000,229.91000,Hometown Health,HMO,,428.40,,,,,,,123.76,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Hometown Health,HMO,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Hometown Health,HMO,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,HMO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,HMO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,inpatient,,,12506.00000,6040.40000,Hometown Health,HMO,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,outpatient,,,12506.00000,6040.40000,Hometown Health,HMO,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,inpatient,,,2404.80000,1161.52000,Hometown Health,HMO,,2164.32,,,,,,,2164.32,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,outpatient,,,2404.80000,1161.52000,Hometown Health,HMO,,2164.32,,,,,,,625.25,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,inpatient,,,969.00000,468.03000,Hometown Health,HMO,,872.10,,,,,,,872.10,939.93,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,outpatient,,,969.00000,468.03000,Hometown Health,HMO,,872.10,,,,,,,251.94,939.93,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,inpatient,,,2256.90000,1090.08000,Hometown Health,HMO,,2031.21,,,,,,,2031.21,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,outpatient,,,2256.90000,1090.08000,Hometown Health,HMO,,2031.21,,,,,,,586.79,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,inpatient,,,644.30000,311.20000,Hometown Health,HMO,,579.87,,,,,,,579.87,624.97,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,outpatient,,,644.30000,311.20000,Hometown Health,HMO,,579.87,,,,,,,167.52,624.97,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Hometown Health,HMO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Hometown Health,HMO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Hometown Health,HMO,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Hometown Health,HMO,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,inpatient,,,26284.00000,12695.17000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,inpatient,,,30664.00000,14810.71000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,inpatient,,,35044.00000,16926.25000,Hometown Health,HMO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Hometown Health,HMO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,inpatient,,,43804.00000,21157.33000,Hometown Health,HMO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,outpatient,,,43804.00000,21157.33000,Hometown Health,HMO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,inpatient,,,52564.00000,25388.41000,Hometown Health,HMO,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,outpatient,,,52564.00000,25388.41000,Hometown Health,HMO,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,inpatient,,,61324.00000,29619.49000,Hometown Health,HMO,,55191.60,,,,,,,55191.60,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,outpatient,,,61324.00000,29619.49000,Hometown Health,HMO,,55191.60,,,,,,,15944.24,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,inpatient,,,70084.00000,33850.57000,Hometown Health,HMO,,63075.60,,,,,,,63075.60,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,outpatient,,,70084.00000,33850.57000,Hometown Health,HMO,,63075.60,,,,,,,18221.84,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,inpatient,,,78844.00000,38081.65000,Hometown Health,HMO,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,outpatient,,,78844.00000,38081.65000,Hometown Health,HMO,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,inpatient,,,87604.00000,42312.73000,Hometown Health,HMO,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,outpatient,,,87604.00000,42312.73000,Hometown Health,HMO,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,inpatient,,,96364.00000,46543.81000,Hometown Health,HMO,,86727.60,,,,,,,86727.60,93473.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,outpatient,,,96364.00000,46543.81000,Hometown Health,HMO,,86727.60,,,,,,,25054.64,93473.08,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,inpatient,,,26284.00000,12695.17000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,inpatient,,,30664.00000,14810.71000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,inpatient,,,35044.00000,16926.25000,Hometown Health,HMO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Hometown Health,HMO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,inpatient,,,39424.00000,19041.79000,Hometown Health,HMO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,outpatient,,,39424.00000,19041.79000,Hometown Health,HMO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Hometown Health,HMO,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Hometown Health,HMO,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Hometown Health,HMO,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Hometown Health,HMO,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,inpatient,,,15334.00000,7406.32000,Hometown Health,HMO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Hometown Health,HMO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,2023.00000,977.11000,Hometown Health,HMO,,1820.70,,,,,,,1820.70,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2023.00000,977.11000,Hometown Health,HMO,,1820.70,,,,,,,525.98,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,inpatient,,,7876.00000,3804.11000,Hometown Health,HMO,,7088.40,,,,,,,7088.40,7639.72,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Hometown Health,HMO,,7088.40,,,,,,,2047.76,7639.72,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,inpatient,,,10191.00000,4922.25000,Hometown Health,HMO,,9171.90,,,,,,,9171.90,9885.27,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,outpatient,,,10191.00000,4922.25000,Hometown Health,HMO,,9171.90,,,,,,,2649.66,9885.27,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,96.00000,46.37000,Hometown Health,HMO,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,96.00000,46.37000,Hometown Health,HMO,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,7876.00000,3804.11000,Hometown Health,HMO,,7088.40,,,,,,,7088.40,7639.72,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,7876.00000,3804.11000,Hometown Health,HMO,,7088.40,,,,,,,2047.76,7639.72,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Hometown Health,HMO,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Hometown Health,HMO,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,inpatient,,,5373.00000,2595.16000,Hometown Health,HMO,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,outpatient,,,5373.00000,2595.16000,Hometown Health,HMO,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,inpatient,,,6487.00000,3133.22000,Hometown Health,HMO,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,outpatient,,,6487.00000,3133.22000,Hometown Health,HMO,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,inpatient,,,7876.00000,3804.11000,Hometown Health,HMO,,7088.40,,,,,,,7088.40,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Hometown Health,HMO,,7088.40,,,,,,,2047.76,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Hometown Health,HMO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Hometown Health,HMO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,inpatient,,,1126.00000,543.86000,Hometown Health,HMO,,1013.40,,,,,,,1013.40,1092.22,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,outpatient,,,1126.00000,543.86000,Hometown Health,HMO,,1013.40,,,,,,,292.76,1092.22,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,2690.00000,1299.27000,Hometown Health,HMO,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Hometown Health,HMO,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,4880.00000,2357.04000,Hometown Health,HMO,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,4880.00000,2357.04000,Hometown Health,HMO,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,9260.00000,4472.58000,Hometown Health,HMO,,8334.00,,,,,,,8334.00,8982.20,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,9260.00000,4472.58000,Hometown Health,HMO,,8334.00,,,,,,,2407.60,8982.20,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,inpatient,,,588.00000,284.00000,Hometown Health,HMO,,529.20,,,,,,,529.20,570.36,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,588.00000,284.00000,Hometown Health,HMO,,529.20,,,,,,,152.88,570.36,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Hometown Health,HMO,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Hometown Health,HMO,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Hometown Health,HMO,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Hometown Health,HMO,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Hometown Health,HMO,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Hometown Health,HMO,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Hometown Health,HMO,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Hometown Health,HMO,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,HMO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,HMO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Hometown Health,HMO,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Hometown Health,HMO,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,inpatient,,,159.00000,76.80000,Hometown Health,HMO,,143.10,,,,,,,143.10,154.23,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,outpatient,,,159.00000,76.80000,Hometown Health,HMO,,143.10,,,,,,,41.34,154.23,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,inpatient,,,588.00000,284.00000,Hometown Health,HMO,,529.20,,,,,,,529.20,570.36,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,outpatient,,,588.00000,284.00000,Hometown Health,HMO,,529.20,,,,,,,152.88,570.36,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Hometown Health,HMO,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Hometown Health,HMO,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,HMO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,HMO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,inpatient,,,8107.00000,3915.68000,Hometown Health,HMO,,7296.30,,,,,,,7296.30,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,outpatient,,,8107.00000,3915.68000,Hometown Health,HMO,,7296.30,,,,,,,2107.82,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,inpatient,,,10422.00000,5033.83000,Hometown Health,HMO,,9379.80,,,,,,,9379.80,10109.34,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,outpatient,,,10422.00000,5033.83000,Hometown Health,HMO,,9379.80,,,,,,,2709.72,10109.34,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,HMO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,HMO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Hometown Health,HMO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Hometown Health,HMO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,inpatient,,,221.00000,106.74000,Hometown Health,HMO,,198.90,,,,,,,198.90,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,outpatient,,,221.00000,106.74000,Hometown Health,HMO,,198.90,,,,,,,57.46,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,HMO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,HMO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Hometown Health,HMO,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Hometown Health,HMO,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Hometown Health,HMO,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Hometown Health,HMO,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,inpatient,,,4153.00000,2005.90000,Hometown Health,HMO,,3737.70,,,,,,,3737.70,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,outpatient,,,4153.00000,2005.90000,Hometown Health,HMO,,3737.70,,,,,,,1079.78,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,inpatient,,,5129.00000,2477.31000,Hometown Health,HMO,,4616.10,,,,,,,4616.10,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,outpatient,,,5129.00000,2477.31000,Hometown Health,HMO,,4616.10,,,,,,,1333.54,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,inpatient,,,7181.00000,3468.42000,Hometown Health,HMO,,6462.90,,,,,,,6462.90,6965.57,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Hometown Health,HMO,,6462.90,,,,,,,1867.06,6965.57,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,inpatient,,,52.50000,25.36000,Hometown Health,HMO,,47.25,,,,,,,47.25,50.92,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,outpatient,,,52.50000,25.36000,Hometown Health,HMO,,47.25,,,,,,,13.65,50.92,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,inpatient,,,50.40000,24.34000,Hometown Health,HMO,,45.36,,,,,,,45.36,48.89,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,outpatient,,,50.40000,24.34000,Hometown Health,HMO,,45.36,,,,,,,13.10,48.89,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Hometown Health,HMO,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Hometown Health,HMO,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Hometown Health,HMO,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Hometown Health,HMO,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Hometown Health,HMO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Hometown Health,HMO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Hometown Health,HMO,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Hometown Health,HMO,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,HMO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,HMO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,inpatient,,,709.00000,342.45000,Hometown Health,HMO,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,outpatient,,,709.00000,342.45000,Hometown Health,HMO,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Hometown Health,HMO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Hometown Health,HMO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Hometown Health,HMO,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Hometown Health,HMO,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,109504.00000,62214.70000,Hometown Health,HMO,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Hometown Health,HMO,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,131404.00000,74657.18000,Hometown Health,HMO,,118263.60,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,131404.00000,74657.18000,Hometown Health,HMO,,118263.60,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,43800.00000,24884.97000,Hometown Health,HMO,,39420.00,,,,,,,39420.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,43800.00000,24884.97000,Hometown Health,HMO,,39420.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Hometown Health,HMO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Hometown Health,HMO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Hometown Health,HMO,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Hometown Health,HMO,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,19714.00000,11200.51000,Hometown Health,HMO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Hometown Health,HMO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,24090.00000,13686.73000,Hometown Health,HMO,,21681.00,,,,,,,21681.00,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,24090.00000,13686.73000,Hometown Health,HMO,,21681.00,,,,,,,6263.40,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,28474.00000,16177.50000,Hometown Health,HMO,,25626.60,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Hometown Health,HMO,,25626.60,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,17520.00000,9953.99000,Hometown Health,HMO,,15768.00,,,,,,,15768.00,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Hometown Health,HMO,,15768.00,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,21904.00000,12444.76000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,26284.00000,14933.25000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,43804.00000,24887.24000,Hometown Health,HMO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Hometown Health,HMO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Hometown Health,HMO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Hometown Health,HMO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Hometown Health,HMO,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Hometown Health,HMO,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,109504.00000,62214.70000,Hometown Health,HMO,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Hometown Health,HMO,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,6105.00000,3468.56000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,6105.00000,3468.56000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,13895.00000,7894.44000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,13895.00000,7894.44000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,21900.00000,12442.48000,Hometown Health,HMO,,19710.00,,,,,,,19710.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,21900.00000,12442.48000,Hometown Health,HMO,,19710.00,,,,,,,5694.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,35040.00000,19907.98000,Hometown Health,HMO,,31536.00,,,,,,,31536.00,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,35040.00000,19907.98000,Hometown Health,HMO,,31536.00,,,,,,,9110.40,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,43804.00000,24887.24000,Hometown Health,HMO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Hometown Health,HMO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,19714.00000,11200.51000,Hometown Health,HMO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Hometown Health,HMO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,22776.00000,12940.18000,Hometown Health,HMO,,20498.40,,,,,,,20498.40,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,22776.00000,12940.18000,Hometown Health,HMO,,20498.40,,,,,,,5921.76,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,28474.00000,16177.50000,Hometown Health,HMO,,25626.60,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Hometown Health,HMO,,25626.60,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,17520.00000,9953.99000,Hometown Health,HMO,,15768.00,,,,,,,15768.00,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Hometown Health,HMO,,15768.00,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,21904.00000,12444.76000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,26284.00000,14933.25000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,30664.00000,17421.75000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,30664.00000,17421.75000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,35044.00000,19910.25000,Hometown Health,HMO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,35044.00000,19910.25000,Hometown Health,HMO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,2157.00000,864.96000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,2157.00000,864.96000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,2695.00000,1080.70000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2695.00000,1080.70000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,3853.00000,1545.05000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,3853.00000,1545.05000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,inpatient,,,1413.00000,566.61000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,outpatient,,,1413.00000,566.61000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,3229.80000,1857.14000,Hometown Health,HMO,,2906.82,,,,,,,2906.82,3132.91,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,3229.80000,1857.14000,Hometown Health,HMO,,2906.82,,,,,,,839.75,3132.91,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,854.40000,491.28000,Hometown Health,HMO,,768.96,,,,,,,768.96,828.77,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,854.40000,491.28000,Hometown Health,HMO,,768.96,,,,,,,222.14,828.77,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1200.50000,690.29000,Hometown Health,HMO,,1080.45,,,,,,,1080.45,1164.48,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1200.50000,690.29000,Hometown Health,HMO,,1080.45,,,,,,,312.13,1164.48,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1011.00000,581.32000,Hometown Health,HMO,,909.90,,,,,,,909.90,980.67,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1011.00000,581.32000,Hometown Health,HMO,,909.90,,,,,,,262.86,980.67,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1823.80000,1048.68000,Hometown Health,HMO,,1641.42,,,,,,,1641.42,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1823.80000,1048.68000,Hometown Health,HMO,,1641.42,,,,,,,474.19,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2028.50000,1166.39000,Hometown Health,HMO,,1825.65,,,,,,,1825.65,1967.64,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2028.50000,1166.39000,Hometown Health,HMO,,1825.65,,,,,,,527.41,1967.64,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,841.00000,483.58000,Hometown Health,HMO,,756.90,,,,,,,756.90,815.77,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,841.00000,483.58000,Hometown Health,HMO,,756.90,,,,,,,218.66,815.77,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1366.20000,785.56000,Hometown Health,HMO,,1229.58,,,,,,,1229.58,1325.21,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1366.20000,785.56000,Hometown Health,HMO,,1229.58,,,,,,,355.21,1325.21,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1384.00000,795.80000,Hometown Health,HMO,,1245.60,,,,,,,1245.60,1342.48,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1384.00000,795.80000,Hometown Health,HMO,,1245.60,,,,,,,359.84,1342.48,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2458.70000,1413.75000,Hometown Health,HMO,,2212.83,,,,,,,2212.83,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2458.70000,1413.75000,Hometown Health,HMO,,2212.83,,,,,,,639.26,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2393.50000,1376.26000,Hometown Health,HMO,,2154.15,,,,,,,2154.15,2321.70,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2393.50000,1376.26000,Hometown Health,HMO,,2154.15,,,,,,,622.31,2321.70,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1369.50000,787.46000,Hometown Health,HMO,,1232.55,,,,,,,1232.55,1328.41,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1369.50000,787.46000,Hometown Health,HMO,,1232.55,,,,,,,356.07,1328.41,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2697.40000,1551.00000,Hometown Health,HMO,,2427.66,,,,,,,2427.66,2616.48,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2697.40000,1551.00000,Hometown Health,HMO,,2427.66,,,,,,,701.32,2616.48,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4621.80000,2657.54000,Hometown Health,HMO,,4159.62,,,,,,,4159.62,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4621.80000,2657.54000,Hometown Health,HMO,,4159.62,,,,,,,1201.67,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2592.50000,1490.69000,Hometown Health,HMO,,2333.25,,,,,,,2333.25,2514.72,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2592.50000,1490.69000,Hometown Health,HMO,,2333.25,,,,,,,674.05,2514.72,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Hometown Health,HMO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Hometown Health,HMO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Hometown Health,HMO,,7505.10,,,,,,,7505.10,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Hometown Health,HMO,,7505.10,,,,,,,2168.14,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Hometown Health,HMO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Hometown Health,HMO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,8107.00000,4661.52000,Hometown Health,HMO,,7296.30,,,,,,,7296.30,7863.79,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Hometown Health,HMO,,7296.30,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Hometown Health,HMO,,1013.40,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Hometown Health,HMO,,1013.40,,,,,,,292.76,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,HMO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,HMO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Hometown Health,HMO,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Hometown Health,HMO,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,inpatient,,,20152.00000,11587.40000,Hometown Health,HMO,,18136.80,,,,,,,18136.80,19547.44,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,outpatient,,,20152.00000,11587.40000,Hometown Health,HMO,,18136.80,,,,,,,5239.52,19547.44,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Hometown Health,HMO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Hometown Health,HMO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Hometown Health,HMO,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Hometown Health,HMO,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,1272.00000,731.40000,Hometown Health,HMO,,1144.80,,,,,,,1144.80,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,1272.00000,731.40000,Hometown Health,HMO,,1144.80,,,,,,,330.72,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Hometown Health,HMO,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Hometown Health,HMO,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,3078.00000,1769.85000,Hometown Health,HMO,,2770.20,,,,,,,2770.20,2985.66,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,3078.00000,1769.85000,Hometown Health,HMO,,2770.20,,,,,,,800.28,2985.66,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,70.00000,40.25000,Hometown Health,HMO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,70.00000,40.25000,Hometown Health,HMO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,102.00000,58.65000,Hometown Health,HMO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,102.00000,58.65000,Hometown Health,HMO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,221.00000,127.07000,Hometown Health,HMO,,198.90,,,,,,,198.90,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,221.00000,127.07000,Hometown Health,HMO,,198.90,,,,,,,57.46,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Hometown Health,HMO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Hometown Health,HMO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Hometown Health,HMO,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Hometown Health,HMO,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Hometown Health,HMO,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Hometown Health,HMO,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35482.00000,20402.15000,Hometown Health,HMO,,31933.80,,,,,,,31933.80,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35482.00000,20402.15000,Hometown Health,HMO,,31933.80,,,,,,,9225.32,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39862.00000,22920.65000,Hometown Health,HMO,,35875.80,,,,,,,35875.80,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39862.00000,22920.65000,Hometown Health,HMO,,35875.80,,,,,,,10364.12,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,44242.00000,25439.15000,Hometown Health,HMO,,39817.80,,,,,,,39817.80,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,44242.00000,25439.15000,Hometown Health,HMO,,39817.80,,,,,,,11502.92,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,48622.00000,27957.65000,Hometown Health,HMO,,43759.80,,,,,,,43759.80,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,48622.00000,27957.65000,Hometown Health,HMO,,43759.80,,,,,,,12641.72,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,53002.00000,30476.15000,Hometown Health,HMO,,47701.80,,,,,,,47701.80,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,53002.00000,30476.15000,Hometown Health,HMO,,47701.80,,,,,,,13780.52,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Hometown Health,HMO,,55191.60,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Hometown Health,HMO,,55191.60,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Hometown Health,HMO,,63075.60,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Hometown Health,HMO,,63075.60,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Hometown Health,HMO,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Hometown Health,HMO,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Hometown Health,HMO,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Hometown Health,HMO,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Hometown Health,HMO,,86727.60,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Hometown Health,HMO,,86727.60,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,844.00000,485.30000,Hometown Health,HMO,,759.60,,,,,,,759.60,818.68,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,844.00000,485.30000,Hometown Health,HMO,,759.60,,,,,,,219.44,818.68,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,11575.00000,6655.62000,Hometown Health,HMO,,10417.50,,,,,,,10417.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,11575.00000,6655.62000,Hometown Health,HMO,,10417.50,,,,,,,3009.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,14892.00000,8562.90000,Hometown Health,HMO,,13402.80,,,,,,,13402.80,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14892.00000,8562.90000,Hometown Health,HMO,,13402.80,,,,,,,3871.92,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,24970.00000,14357.75000,Hometown Health,HMO,,22473.00,,,,,,,22473.00,24220.90,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,24970.00000,14357.75000,Hometown Health,HMO,,22473.00,,,,,,,6492.20,24220.90,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Hometown Health,HMO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Hometown Health,HMO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Hometown Health,HMO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Hometown Health,HMO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Hometown Health,HMO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Hometown Health,HMO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Hometown Health,HMO,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Hometown Health,HMO,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,4153.00000,2387.98000,Hometown Health,HMO,,3737.70,,,,,,,3737.70,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Hometown Health,HMO,,3737.70,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,4641.00000,2668.58000,Hometown Health,HMO,,4176.90,,,,,,,4176.90,4501.77,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4641.00000,2668.58000,Hometown Health,HMO,,4176.90,,,,,,,1206.66,4501.77,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Hometown Health,HMO,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Hometown Health,HMO,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Hometown Health,HMO,,86727.60,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Hometown Health,HMO,,86727.60,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Hometown Health,HMO,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Hometown Health,HMO,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,131404.00000,75557.30000,Hometown Health,HMO,,118263.60,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Hometown Health,HMO,,118263.60,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,153304.00000,88149.80000,Hometown Health,HMO,,137973.60,,,,,,,137973.60,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,153304.00000,88149.80000,Hometown Health,HMO,,137973.60,,,,,,,39859.04,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,175204.00000,100742.30000,Hometown Health,HMO,,157683.60,,,,,,,157683.60,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,175204.00000,100742.30000,Hometown Health,HMO,,157683.60,,,,,,,45553.04,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,197104.00000,113334.80000,Hometown Health,HMO,,177393.60,,,,,,,177393.60,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,197104.00000,113334.80000,Hometown Health,HMO,,177393.60,,,,,,,51247.04,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,219004.00000,125927.30000,Hometown Health,HMO,,197103.60,,,,,,,197103.60,212433.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,219004.00000,125927.30000,Hometown Health,HMO,,197103.60,,,,,,,56941.04,212433.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Hometown Health,HMO,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Hometown Health,HMO,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,HMO,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,HMO,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Hometown Health,HMO,,51249.60,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Hometown Health,HMO,,51249.60,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Hometown Health,HMO,,55191.60,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Hometown Health,HMO,,55191.60,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,HMO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,HMO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,HMO,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,HMO,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,HMO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,HMO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Hometown Health,HMO,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Hometown Health,HMO,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Hometown Health,HMO,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Hometown Health,HMO,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Hometown Health,HMO,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Hometown Health,HMO,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Hometown Health,HMO,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Hometown Health,HMO,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,HMO,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,HMO,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Hometown Health,HMO,,51249.60,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Hometown Health,HMO,,51249.60,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Hometown Health,HMO,,55191.60,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Hometown Health,HMO,,55191.60,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Hometown Health,HMO,,63075.60,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Hometown Health,HMO,,63075.60,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Hometown Health,HMO,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Hometown Health,HMO,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Hometown Health,HMO,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Hometown Health,HMO,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Hometown Health,HMO,,86727.60,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Hometown Health,HMO,,86727.60,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Hometown Health,HMO,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Hometown Health,HMO,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,122644.00000,70520.30000,Hometown Health,HMO,,110379.60,,,,,,,110379.60,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Hometown Health,HMO,,110379.60,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,135784.00000,78075.80000,Hometown Health,HMO,,122205.60,,,,,,,122205.60,131710.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,135784.00000,78075.80000,Hometown Health,HMO,,122205.60,,,,,,,35303.84,131710.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Hometown Health,HMO,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Hometown Health,HMO,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,55630.00000,31987.25000,Hometown Health,HMO,,50067.00,,,,,,,50067.00,53961.10,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,55630.00000,31987.25000,Hometown Health,HMO,,50067.00,,,,,,,14463.80,53961.10,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Hometown Health,HMO,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Hometown Health,HMO,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,14020.00000,8061.50000,Hometown Health,HMO,,12618.00,,,,,,,12618.00,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Hometown Health,HMO,,12618.00,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,17962.00000,10328.15000,Hometown Health,HMO,,16165.80,,,,,,,16165.80,17423.14,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,17962.00000,10328.15000,Hometown Health,HMO,,16165.80,,,,,,,4670.12,17423.14,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,2421.00000,1392.07000,Hometown Health,HMO,,2178.90,,,,,,,2178.90,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,2421.00000,1392.07000,Hometown Health,HMO,,2178.90,,,,,,,629.46,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Hometown Health,HMO,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Hometown Health,HMO,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Hometown Health,HMO,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Hometown Health,HMO,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,27160.00000,15617.00000,Hometown Health,HMO,,24444.00,,,,,,,24444.00,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,27160.00000,15617.00000,Hometown Health,HMO,,24444.00,,,,,,,7061.60,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Hometown Health,HMO,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Hometown Health,HMO,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,HMO,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,HMO,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,HMO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,HMO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Hometown Health,HMO,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Hometown Health,HMO,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,28470.00000,16370.25000,Hometown Health,HMO,,25623.00,,,,,,,25623.00,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,28470.00000,16370.25000,Hometown Health,HMO,,25623.00,,,,,,,7402.20,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,43800.00000,25185.00000,Hometown Health,HMO,,39420.00,,,,,,,39420.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,43800.00000,25185.00000,Hometown Health,HMO,,39420.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,HMO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,HMO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Hometown Health,HMO,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Hometown Health,HMO,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Hometown Health,HMO,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Hometown Health,HMO,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Hometown Health,HMO,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Hometown Health,HMO,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Hometown Health,HMO,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Hometown Health,HMO,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,54754.00000,31483.55000,Hometown Health,HMO,,49278.60,,,,,,,49278.60,53111.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,54754.00000,31483.55000,Hometown Health,HMO,,49278.60,,,,,,,14236.04,53111.38,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Hometown Health,HMO,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Hometown Health,HMO,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,61320.00000,35259.00000,Hometown Health,HMO,,55188.00,,,,,,,55188.00,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,61320.00000,35259.00000,Hometown Health,HMO,,55188.00,,,,,,,15943.20,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,70080.00000,40296.00000,Hometown Health,HMO,,63072.00,,,,,,,63072.00,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,70080.00000,40296.00000,Hometown Health,HMO,,63072.00,,,,,,,18220.80,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,78840.00000,45333.00000,Hometown Health,HMO,,70956.00,,,,,,,70956.00,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,78840.00000,45333.00000,Hometown Health,HMO,,70956.00,,,,,,,20498.40,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Hometown Health,HMO,,86727.60,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Hometown Health,HMO,,86727.60,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Hometown Health,HMO,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Hometown Health,HMO,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,122644.00000,70520.30000,Hometown Health,HMO,,110379.60,,,,,,,110379.60,118964.68,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Hometown Health,HMO,,110379.60,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Hometown Health,HMO,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Hometown Health,HMO,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Hometown Health,HMO,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Hometown Health,HMO,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,1883.00000,1082.72000,Hometown Health,HMO,,1694.70,,,,,,,1694.70,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1883.00000,1082.72000,Hometown Health,HMO,,1694.70,,,,,,,489.58,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Hometown Health,HMO,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Hometown Health,HMO,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,7644.00000,4395.30000,Hometown Health,HMO,,6879.60,,,,,,,6879.60,7414.68,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,7644.00000,4395.30000,Hometown Health,HMO,,6879.60,,,,,,,1987.44,7414.68,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Hometown Health,HMO,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Hometown Health,HMO,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,inpatient,,,1614.00000,928.05000,Hometown Health,HMO,,1452.60,,,,,,,1452.60,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Hometown Health,HMO,,1452.60,,,,,,,419.64,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Hometown Health,HMO,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Hometown Health,HMO,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Hometown Health,HMO,,25626.60,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Hometown Health,HMO,,25626.60,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Hometown Health,HMO,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Hometown Health,HMO,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,37234.00000,21409.55000,Hometown Health,HMO,,33510.60,,,,,,,33510.60,36116.98,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,37234.00000,21409.55000,Hometown Health,HMO,,33510.60,,,,,,,9680.84,36116.98,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,HMO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,HMO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,HMO,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,HMO,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,HMO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,HMO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Hometown Health,HMO,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Hometown Health,HMO,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,159.00000,91.42000,Hometown Health,HMO,,143.10,,,,,,,143.10,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,159.00000,91.42000,Hometown Health,HMO,,143.10,,,,,,,41.34,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Hometown Health,HMO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Hometown Health,HMO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Hometown Health,HMO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Hometown Health,HMO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Hometown Health,HMO,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Hometown Health,HMO,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2827.00000,1625.52000,Hometown Health,HMO,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Hometown Health,HMO,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Hometown Health,HMO,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Hometown Health,HMO,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8107.00000,4661.52000,Hometown Health,HMO,,7296.30,,,,,,,7296.30,7863.79,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Hometown Health,HMO,,7296.30,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,HMO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,HMO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Hometown Health,HMO,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Hometown Health,HMO,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Hometown Health,HMO,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Hometown Health,HMO,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,131404.00000,75557.30000,Hometown Health,HMO,,118263.60,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Hometown Health,HMO,,118263.60,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,18400.00000,10580.00000,Hometown Health,HMO,,16560.00,,,,,,,16560.00,17848.00,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,18400.00000,10580.00000,Hometown Health,HMO,,16560.00,,,,,,,4784.00,17848.00,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Hometown Health,HMO,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Hometown Health,HMO,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Hometown Health,HMO,,25626.60,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Hometown Health,HMO,,25626.60,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Hometown Health,HMO,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Hometown Health,HMO,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1614.00000,928.05000,Hometown Health,HMO,,1452.60,,,,,,,1452.60,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Hometown Health,HMO,,1452.60,,,,,,,419.64,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Hometown Health,HMO,,51249.60,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Hometown Health,HMO,,51249.60,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,HMO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,HMO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,5368.00000,3086.60000,Hometown Health,HMO,,4831.20,,,,,,,4831.20,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,5368.00000,3086.60000,Hometown Health,HMO,,4831.20,,,,,,,1395.68,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,14020.00000,8061.50000,Hometown Health,HMO,,12618.00,,,,,,,12618.00,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Hometown Health,HMO,,12618.00,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,25408.00000,14609.60000,Hometown Health,HMO,,22867.20,,,,,,,22867.20,24645.76,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,25408.00000,14609.60000,Hometown Health,HMO,,22867.20,,,,,,,6606.08,24645.76,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,8112.00000,4664.40000,Hometown Health,HMO,,7300.80,,,,,,,7300.80,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,8112.00000,4664.40000,Hometown Health,HMO,,7300.80,,,,,,,2109.12,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,10431.00000,5997.82000,Hometown Health,HMO,,9387.90,,,,,,,9387.90,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,10431.00000,5997.82000,Hometown Health,HMO,,9387.90,,,,,,,2712.06,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Hometown Health,HMO,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Hometown Health,HMO,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,46870.00000,26950.25000,Hometown Health,HMO,,42183.00,,,,,,,42183.00,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,46870.00000,26950.25000,Hometown Health,HMO,,42183.00,,,,,,,12186.20,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,51250.00000,29468.75000,Hometown Health,HMO,,46125.00,,,,,,,46125.00,49712.50,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,51250.00000,29468.75000,Hometown Health,HMO,,46125.00,,,,,,,13325.00,49712.50,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,HMO,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,HMO,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,HMO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,HMO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Hometown Health,HMO,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Hometown Health,HMO,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Hometown Health,HMO,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Hometown Health,HMO,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,588.00000,338.10000,Hometown Health,HMO,,529.20,,,,,,,529.20,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,588.00000,338.10000,Hometown Health,HMO,,529.20,,,,,,,152.88,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,HMO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,HMO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Hometown Health,HMO,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Hometown Health,HMO,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,HMO,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,HMO,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Hometown Health,HMO,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Hometown Health,HMO,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,7876.00000,4528.70000,Hometown Health,HMO,,7088.40,,,,,,,7088.40,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7876.00000,4528.70000,Hometown Health,HMO,,7088.40,,,,,,,2047.76,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Hometown Health,HMO,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Hometown Health,HMO,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5856.00000,3367.20000,Hometown Health,HMO,,5270.40,,,,,,,5270.40,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5856.00000,3367.20000,Hometown Health,HMO,,5270.40,,,,,,,1522.56,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Hometown Health,HMO,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Hometown Health,HMO,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Hometown Health,HMO,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Hometown Health,HMO,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Hometown Health,HMO,,7505.10,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Hometown Health,HMO,,7505.10,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,HMO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,HMO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,HMO,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,HMO,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Hometown Health,HMO,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Hometown Health,HMO,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Hometown Health,HMO,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Hometown Health,HMO,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,HMO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,HMO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,HMO,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,HMO,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Hometown Health,HMO,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Hometown Health,HMO,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Hometown Health,HMO,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Hometown Health,HMO,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4392.00000,2525.40000,Hometown Health,HMO,,3952.80,,,,,,,3952.80,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4392.00000,2525.40000,Hometown Health,HMO,,3952.80,,,,,,,1141.92,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,HMO,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,HMO,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Hometown Health,HMO,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Hometown Health,HMO,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,HMO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,HMO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,HMO,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,HMO,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Hometown Health,HMO,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Hometown Health,HMO,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Hometown Health,HMO,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Hometown Health,HMO,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Hometown Health,HMO,,1013.40,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Hometown Health,HMO,,1013.40,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,HMO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,HMO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,HMO,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,HMO,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Hometown Health,HMO,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Hometown Health,HMO,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Hometown Health,HMO,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Hometown Health,HMO,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Hometown Health,HMO,,12223.80,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Hometown Health,HMO,,12223.80,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2152.00000,1237.40000,Hometown Health,HMO,,1936.80,,,,,,,1936.80,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2152.00000,1237.40000,Hometown Health,HMO,,1936.80,,,,,,,559.52,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Hometown Health,HMO,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Hometown Health,HMO,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Hometown Health,HMO,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Hometown Health,HMO,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Hometown Health,HMO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Hometown Health,HMO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Hometown Health,HMO,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Hometown Health,HMO,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,HMO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,HMO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,HMO,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,HMO,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Hometown Health,HMO,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Hometown Health,HMO,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Hometown Health,HMO,,1013.40,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Hometown Health,HMO,,1013.40,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,HMO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,HMO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,HMO,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,HMO,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Hometown Health,HMO,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Hometown Health,HMO,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Hometown Health,HMO,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Hometown Health,HMO,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Hometown Health,HMO,,12223.80,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Hometown Health,HMO,,12223.80,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,HMO,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,HMO,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8802.00000,5061.15000,Hometown Health,HMO,,7921.80,,,,,,,7921.80,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8802.00000,5061.15000,Hometown Health,HMO,,7921.80,,,,,,,2288.52,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,10654.00000,6126.05000,Hometown Health,HMO,,9588.60,,,,,,,9588.60,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10654.00000,6126.05000,Hometown Health,HMO,,9588.60,,,,,,,2770.04,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Hometown Health,HMO,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Hometown Health,HMO,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Hometown Health,HMO,,12223.80,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Hometown Health,HMO,,12223.80,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17086.00000,9824.45000,Hometown Health,HMO,,15377.40,,,,,,,15377.40,16573.42,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17086.00000,9824.45000,Hometown Health,HMO,,15377.40,,,,,,,4442.36,16573.42,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Hometown Health,HMO,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Hometown Health,HMO,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Hometown Health,HMO,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Hometown Health,HMO,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Hometown Health,HMO,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Hometown Health,HMO,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Hometown Health,HMO,,7505.10,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Hometown Health,HMO,,7505.10,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Hometown Health,HMO,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Hometown Health,HMO,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Hometown Health,HMO,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Hometown Health,HMO,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,HMO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,HMO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,HMO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,HMO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Hometown Health,HMO,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Hometown Health,HMO,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Hometown Health,HMO,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Hometown Health,HMO,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Hometown Health,HMO,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Hometown Health,HMO,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Hometown Health,HMO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Hometown Health,HMO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Hometown Health,HMO,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Hometown Health,HMO,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2827.00000,1625.52000,Hometown Health,HMO,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Hometown Health,HMO,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Hometown Health,HMO,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Hometown Health,HMO,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4153.00000,2387.98000,Hometown Health,HMO,,3737.70,,,,,,,3737.70,4028.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Hometown Health,HMO,,3737.70,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Hometown Health,HMO,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Hometown Health,HMO,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Hometown Health,HMO,,7505.10,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Hometown Health,HMO,,7505.10,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9728.00000,5593.60000,Hometown Health,HMO,,8755.20,,,,,,,8755.20,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9728.00000,5593.60000,Hometown Health,HMO,,8755.20,,,,,,,2529.28,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11117.00000,6392.28000,Hometown Health,HMO,,10005.30,,,,,,,10005.30,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11117.00000,6392.28000,Hometown Health,HMO,,10005.30,,,,,,,2890.42,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Hometown Health,HMO,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Hometown Health,HMO,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,HMO,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,HMO,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Hometown Health,HMO,,51249.60,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Hometown Health,HMO,,51249.60,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Hometown Health,HMO,,55191.60,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Hometown Health,HMO,,55191.60,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,HMO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,HMO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Hometown Health,HMO,,63075.60,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Hometown Health,HMO,,63075.60,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,74464.00000,42816.80000,Hometown Health,HMO,,67017.60,,,,,,,67017.60,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Hometown Health,HMO,,67017.60,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Hometown Health,HMO,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Hometown Health,HMO,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,83224.00000,47853.80000,Hometown Health,HMO,,74901.60,,,,,,,74901.60,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Hometown Health,HMO,,74901.60,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,111694.00000,64224.05000,Hometown Health,HMO,,100524.60,,,,,,,100524.60,108343.18,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,111694.00000,64224.05000,Hometown Health,HMO,,100524.60,,,,,,,29040.44,108343.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Hometown Health,HMO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Hometown Health,HMO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Hometown Health,HMO,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Hometown Health,HMO,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,991.00000,569.82000,Hometown Health,HMO,,891.90,,,,,,,891.90,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,991.00000,569.82000,Hometown Health,HMO,,891.90,,,,,,,257.66,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1490.00000,856.75000,Hometown Health,HMO,,1341.00,,,,,,,1341.00,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1490.00000,856.75000,Hometown Health,HMO,,1341.00,,,,,,,387.40,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Hometown Health,HMO,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Hometown Health,HMO,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Hometown Health,HMO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Hometown Health,HMO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Hometown Health,HMO,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Hometown Health,HMO,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Hometown Health,HMO,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Hometown Health,HMO,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Hometown Health,HMO,,7505.10,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Hometown Health,HMO,,7505.10,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,HMO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,HMO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,6945.00000,3993.37000,Hometown Health,HMO,,6250.50,,,,,,,6250.50,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,6945.00000,3993.37000,Hometown Health,HMO,,6250.50,,,,,,,1805.70,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Hometown Health,HMO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Hometown Health,HMO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Hometown Health,HMO,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Hometown Health,HMO,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,HMO,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,HMO,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,HMO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,50374.00000,28965.05000,Hometown Health,HMO,,45336.60,,,,,,,45336.60,48862.78,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,50374.00000,28965.05000,Hometown Health,HMO,,45336.60,,,,,,,13097.24,48862.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,HMO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Hometown Health,HMO,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Hometown Health,HMO,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Hometown Health,HMO,,25626.60,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Hometown Health,HMO,,25626.60,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,HMO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,HMO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,HMO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,HMO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Hometown Health,HMO,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Hometown Health,HMO,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,HMO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,HMO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,HMO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Hometown Health,HMO,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Hometown Health,HMO,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,HMO,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,HMO,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Hometown Health,HMO,,51249.60,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Hometown Health,HMO,,51249.60,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,HMO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,HMO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,74464.00000,42816.80000,Hometown Health,HMO,,67017.60,,,,,,,67017.60,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Hometown Health,HMO,,67017.60,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,83224.00000,47853.80000,Hometown Health,HMO,,74901.60,,,,,,,74901.60,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Hometown Health,HMO,,74901.60,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,91984.00000,52890.80000,Hometown Health,HMO,,82785.60,,,,,,,82785.60,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,91984.00000,52890.80000,Hometown Health,HMO,,82785.60,,,,,,,23915.84,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,100744.00000,57927.80000,Hometown Health,HMO,,90669.60,,,,,,,90669.60,97721.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,100744.00000,57927.80000,Hometown Health,HMO,,90669.60,,,,,,,26193.44,97721.68,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,HMO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,HMO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Hometown Health,HMO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Hometown Health,HMO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Hometown Health,HMO,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Hometown Health,HMO,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,HMO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,HMO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,HMO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,HMO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,HMO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,HMO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,HMO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,HMO,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,HMO,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,HMO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,HMO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,HMO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2180.20000,1253.61000,Hometown Health,HMO,,1962.18,,,,,,,1962.18,2114.79,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2180.20000,1253.61000,Hometown Health,HMO,,1962.18,,,,,,,566.85,2114.79,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1880.60000,1081.34000,Hometown Health,HMO,,1692.54,,,,,,,1692.54,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1880.60000,1081.34000,Hometown Health,HMO,,1692.54,,,,,,,488.96,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2908.70000,1672.50000,Hometown Health,HMO,,2617.83,,,,,,,2617.83,2821.44,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2908.70000,1672.50000,Hometown Health,HMO,,2617.83,,,,,,,756.26,2821.44,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,inpatient,,,34.00000,25.74000,Hometown Health,HMO,,30.60,,,,,,,30.60,32.98,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,outpatient,,,34.00000,25.74000,Hometown Health,HMO,,30.60,,,,,,,8.84,32.98,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,inpatient,,,13.00000,9.84000,Hometown Health,HMO,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,outpatient,,,13.00000,9.84000,Hometown Health,HMO,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Hometown Health,HMO,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Hometown Health,HMO,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Hometown Health,HMO,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Hometown Health,HMO,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Hometown Health,HMO,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Hometown Health,HMO,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Hometown Health,HMO,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Hometown Health,HMO,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Hometown Health,HMO,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Hometown Health,HMO,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Hometown Health,HMO,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Hometown Health,HMO,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,inpatient,,,122.00000,92.35000,Hometown Health,HMO,,109.80,,,,,,,109.80,118.34,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,outpatient,,,122.00000,92.35000,Hometown Health,HMO,,109.80,,,,,,,31.72,118.34,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,inpatient,,,79.00000,59.80000,Hometown Health,HMO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Hometown Health,HMO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,inpatient,,,79.00000,59.80000,Hometown Health,HMO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Hometown Health,HMO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,inpatient,,,15.00000,11.36000,Hometown Health,HMO,,13.50,,,,,,,13.50,14.55,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Hometown Health,HMO,,13.50,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,inpatient,,,15.00000,11.36000,Hometown Health,HMO,,13.50,,,,,,,13.50,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Hometown Health,HMO,,13.50,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,inpatient,,,17.00000,12.87000,Hometown Health,HMO,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Hometown Health,HMO,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,inpatient,,,17.00000,12.87000,Hometown Health,HMO,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Hometown Health,HMO,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,inpatient,,,359.00000,271.76000,Hometown Health,HMO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,outpatient,,,359.00000,271.76000,Hometown Health,HMO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,inpatient,,,359.00000,271.76000,Hometown Health,HMO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,outpatient,,,359.00000,271.76000,Hometown Health,HMO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,inpatient,,,359.00000,271.76000,Hometown Health,HMO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,outpatient,,,359.00000,271.76000,Hometown Health,HMO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,inpatient,,,155.00000,117.34000,Hometown Health,HMO,,139.50,,,,,,,139.50,150.35,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,outpatient,,,155.00000,117.34000,Hometown Health,HMO,,139.50,,,,,,,40.30,150.35,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,inpatient,,,294.00000,222.56000,Hometown Health,HMO,,264.60,,,,,,,264.60,285.18,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,outpatient,,,294.00000,222.56000,Hometown Health,HMO,,264.60,,,,,,,76.44,285.18,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,inpatient,,,1511.00000,1143.83000,Hometown Health,HMO,,1359.90,,,,,,,1359.90,1465.67,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,outpatient,,,1511.00000,1143.83000,Hometown Health,HMO,,1359.90,,,,,,,392.86,1465.67,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,inpatient,,,751.00000,568.51000,Hometown Health,HMO,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Hometown Health,HMO,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,inpatient,,,751.00000,568.51000,Hometown Health,HMO,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Hometown Health,HMO,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,inpatient,,,150.00000,113.55000,Hometown Health,HMO,,135.00,,,,,,,135.00,145.50,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,outpatient,,,150.00000,113.55000,Hometown Health,HMO,,135.00,,,,,,,39.00,145.50,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,inpatient,,,110.00000,83.27000,Hometown Health,HMO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,outpatient,,,110.00000,83.27000,Hometown Health,HMO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,inpatient,,,158.00000,119.61000,Hometown Health,HMO,,142.20,,,,,,,142.20,153.26,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,outpatient,,,158.00000,119.61000,Hometown Health,HMO,,142.20,,,,,,,41.08,153.26,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,inpatient,,,153.00000,115.82000,Hometown Health,HMO,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,outpatient,,,153.00000,115.82000,Hometown Health,HMO,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,inpatient,,,157.00000,118.85000,Hometown Health,HMO,,141.30,,,,,,,141.30,152.29,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,outpatient,,,157.00000,118.85000,Hometown Health,HMO,,141.30,,,,,,,40.82,152.29,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,inpatient,,,26.00000,19.68000,Hometown Health,HMO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,outpatient,,,26.00000,19.68000,Hometown Health,HMO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,inpatient,,,37.00000,28.01000,Hometown Health,HMO,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,outpatient,,,37.00000,28.01000,Hometown Health,HMO,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,inpatient,,,268.00000,202.88000,Hometown Health,HMO,,241.20,,,,,,,241.20,259.96,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,outpatient,,,268.00000,202.88000,Hometown Health,HMO,,241.20,,,,,,,69.68,259.96,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,inpatient,,,91.00000,68.89000,Hometown Health,HMO,,81.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,outpatient,,,91.00000,68.89000,Hometown Health,HMO,,81.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,inpatient,,,200.00000,151.40000,Hometown Health,HMO,,180.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,outpatient,,,200.00000,151.40000,Hometown Health,HMO,,180.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,inpatient,,,152.00000,115.06000,Hometown Health,HMO,,136.80,,,,,,,136.80,147.44,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,outpatient,,,152.00000,115.06000,Hometown Health,HMO,,136.80,,,,,,,39.52,147.44,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,inpatient,,,359.00000,271.76000,Hometown Health,HMO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,outpatient,,,359.00000,271.76000,Hometown Health,HMO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,HMO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,HMO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,inpatient,,,75.00000,36.15000,Hometown Health,HMO,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,outpatient,,,75.00000,36.15000,Hometown Health,HMO,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,inpatient,,,45.00000,21.69000,Hometown Health,HMO,,40.50,,,,,,,40.50,43.65,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,outpatient,,,45.00000,21.69000,Hometown Health,HMO,,40.50,,,,,,,11.70,43.65,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,HMO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,HMO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,HMO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,HMO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,inpatient,,,195.00000,93.99000,Hometown Health,HMO,,175.50,,,,,,,175.50,189.15,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,outpatient,,,195.00000,93.99000,Hometown Health,HMO,,175.50,,,,,,,50.70,189.15,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,inpatient,,,14.00000,6.75000,Hometown Health,HMO,,12.60,,,,,,,12.60,13.58,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,outpatient,,,14.00000,6.75000,Hometown Health,HMO,,12.60,,,,,,,3.64,13.58,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,HMO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,HMO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,HMO,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,HMO,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,inpatient,,,141.00000,67.96000,Hometown Health,HMO,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Hometown Health,HMO,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,inpatient,,,141.00000,67.96000,Hometown Health,HMO,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Hometown Health,HMO,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,inpatient,,,91.00000,43.86000,Hometown Health,HMO,,81.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,outpatient,,,91.00000,43.86000,Hometown Health,HMO,,81.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,HMO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,HMO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,inpatient,,,205.00000,98.81000,Hometown Health,HMO,,184.50,,,,,,,184.50,198.85,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,outpatient,,,205.00000,98.81000,Hometown Health,HMO,,184.50,,,,,,,53.30,198.85,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,inpatient,,,50.00000,24.10000,Hometown Health,HMO,,45.00,,,,,,,45.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,outpatient,,,50.00000,24.10000,Hometown Health,HMO,,45.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,inpatient,,,406.00000,195.69000,Hometown Health,HMO,,365.40,,,,,,,365.40,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,outpatient,,,406.00000,195.69000,Hometown Health,HMO,,365.40,,,,,,,105.56,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,inpatient,,,101.00000,48.68000,Hometown Health,HMO,,90.90,,,,,,,90.90,97.97,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,outpatient,,,101.00000,48.68000,Hometown Health,HMO,,90.90,,,,,,,26.26,97.97,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,inpatient,,,375.00000,180.75000,Hometown Health,HMO,,337.50,,,,,,,337.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,outpatient,,,375.00000,180.75000,Hometown Health,HMO,,337.50,,,,,,,97.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,inpatient,,,362.00000,174.48000,Hometown Health,HMO,,325.80,,,,,,,325.80,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,outpatient,,,362.00000,174.48000,Hometown Health,HMO,,325.80,,,,,,,94.12,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,inpatient,,,325.00000,156.65000,Hometown Health,HMO,,292.50,,,,,,,292.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,outpatient,,,325.00000,156.65000,Hometown Health,HMO,,292.50,,,,,,,84.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,inpatient,,,121.00000,58.32000,Hometown Health,HMO,,108.90,,,,,,,108.90,117.37,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,outpatient,,,121.00000,58.32000,Hometown Health,HMO,,108.90,,,,,,,31.46,117.37,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,inpatient,,,115.00000,55.43000,Hometown Health,HMO,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,outpatient,,,115.00000,55.43000,Hometown Health,HMO,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,inpatient,,,300.00000,144.60000,Hometown Health,HMO,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,outpatient,,,300.00000,144.60000,Hometown Health,HMO,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,HMO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,HMO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,HMO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,HMO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,HMO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,HMO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,inpatient,,,194.00000,93.51000,Hometown Health,HMO,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,outpatient,,,194.00000,93.51000,Hometown Health,HMO,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,HMO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,HMO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,inpatient,,,329.00000,158.58000,Hometown Health,HMO,,296.10,,,,,,,296.10,319.13,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,outpatient,,,329.00000,158.58000,Hometown Health,HMO,,296.10,,,,,,,85.54,319.13,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,inpatient,,,24.00000,11.57000,Hometown Health,HMO,,21.60,,,,,,,21.60,23.28,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,outpatient,,,24.00000,11.57000,Hometown Health,HMO,,21.60,,,,,,,6.24,23.28,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,inpatient,,,30.00000,14.46000,Hometown Health,HMO,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,outpatient,,,30.00000,14.46000,Hometown Health,HMO,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,HMO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,HMO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,inpatient,,,270.00000,130.14000,Hometown Health,HMO,,243.00,,,,,,,243.00,261.90,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,outpatient,,,270.00000,130.14000,Hometown Health,HMO,,243.00,,,,,,,70.20,261.90,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,inpatient,,,123.00000,59.29000,Hometown Health,HMO,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Hometown Health,HMO,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,inpatient,,,123.00000,59.29000,Hometown Health,HMO,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Hometown Health,HMO,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,inpatient,,,37.00000,17.83000,Hometown Health,HMO,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,outpatient,,,37.00000,17.83000,Hometown Health,HMO,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,inpatient,,,41.00000,19.76000,Hometown Health,HMO,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,outpatient,,,41.00000,19.76000,Hometown Health,HMO,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,HMO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,HMO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,HMO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,HMO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,inpatient,,,90.00000,43.38000,Hometown Health,HMO,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,outpatient,,,90.00000,43.38000,Hometown Health,HMO,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,inpatient,,,44.00000,21.21000,Hometown Health,HMO,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,outpatient,,,44.00000,21.21000,Hometown Health,HMO,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,inpatient,,,115.00000,55.43000,Hometown Health,HMO,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,outpatient,,,115.00000,55.43000,Hometown Health,HMO,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,inpatient,,,20.00000,9.64000,Hometown Health,HMO,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,outpatient,,,20.00000,9.64000,Hometown Health,HMO,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,inpatient,,,341.00000,164.36000,Hometown Health,HMO,,306.90,,,,,,,306.90,330.77,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,outpatient,,,341.00000,164.36000,Hometown Health,HMO,,306.90,,,,,,,88.66,330.77,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,HMO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,HMO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,HMO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,HMO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,inpatient,,,88.00000,42.42000,Hometown Health,HMO,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,outpatient,,,88.00000,42.42000,Hometown Health,HMO,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,inpatient,,,89.00000,42.90000,Hometown Health,HMO,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,outpatient,,,89.00000,42.90000,Hometown Health,HMO,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,HMO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,HMO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,HMO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,HMO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,HMO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,HMO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,HMO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,HMO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,inpatient,,,95.00000,45.79000,Hometown Health,HMO,,85.50,,,,,,,85.50,92.15,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,outpatient,,,95.00000,45.79000,Hometown Health,HMO,,85.50,,,,,,,24.70,92.15,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,inpatient,,,132.00000,63.62000,Hometown Health,HMO,,118.80,,,,,,,118.80,128.04,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,outpatient,,,132.00000,63.62000,Hometown Health,HMO,,118.80,,,,,,,34.32,128.04,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,inpatient,,,83.00000,40.01000,Hometown Health,HMO,,74.70,,,,,,,74.70,80.51,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,outpatient,,,83.00000,40.01000,Hometown Health,HMO,,74.70,,,,,,,21.58,80.51,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,inpatient,,,387.00000,186.53000,Hometown Health,HMO,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,outpatient,,,387.00000,186.53000,Hometown Health,HMO,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,inpatient,,,387.00000,186.53000,Hometown Health,HMO,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,outpatient,,,387.00000,186.53000,Hometown Health,HMO,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,inpatient,,,31.00000,14.94000,Hometown Health,HMO,,27.90,,,,,,,27.90,30.07,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,outpatient,,,31.00000,14.94000,Hometown Health,HMO,,27.90,,,,,,,8.06,30.07,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,inpatient,,,36.00000,17.35000,Hometown Health,HMO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,outpatient,,,36.00000,17.35000,Hometown Health,HMO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,inpatient,,,160.00000,77.12000,Hometown Health,HMO,,144.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,outpatient,,,160.00000,77.12000,Hometown Health,HMO,,144.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,inpatient,,,112.00000,53.98000,Hometown Health,HMO,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,outpatient,,,112.00000,53.98000,Hometown Health,HMO,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,inpatient,,,14.00000,6.75000,Hometown Health,HMO,,12.60,,,,,,,12.60,13.58,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,outpatient,,,14.00000,6.75000,Hometown Health,HMO,,12.60,,,,,,,3.64,13.58,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,inpatient,,,16.00000,7.71000,Hometown Health,HMO,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,outpatient,,,16.00000,7.71000,Hometown Health,HMO,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,HMO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,HMO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,inpatient,,,116.00000,55.91000,Hometown Health,HMO,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,outpatient,,,116.00000,55.91000,Hometown Health,HMO,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,inpatient,,,81.00000,39.04000,Hometown Health,HMO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,outpatient,,,81.00000,39.04000,Hometown Health,HMO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,inpatient,,,97.00000,46.75000,Hometown Health,HMO,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,outpatient,,,97.00000,46.75000,Hometown Health,HMO,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,HMO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,HMO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,inpatient,,,35.00000,16.87000,Hometown Health,HMO,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,outpatient,,,35.00000,16.87000,Hometown Health,HMO,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,inpatient,,,65.00000,31.33000,Hometown Health,HMO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,outpatient,,,65.00000,31.33000,Hometown Health,HMO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,inpatient,,,74.00000,35.67000,Hometown Health,HMO,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,outpatient,,,74.00000,35.67000,Hometown Health,HMO,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,inpatient,,,250.00000,120.50000,Hometown Health,HMO,,225.00,,,,,,,225.00,242.50,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,outpatient,,,250.00000,120.50000,Hometown Health,HMO,,225.00,,,,,,,65.00,242.50,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,inpatient,,,90.00000,43.38000,Hometown Health,HMO,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,outpatient,,,90.00000,43.38000,Hometown Health,HMO,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,inpatient,,,90.00000,43.38000,Hometown Health,HMO,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,outpatient,,,90.00000,43.38000,Hometown Health,HMO,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,inpatient,,,36.00000,17.35000,Hometown Health,HMO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,outpatient,,,36.00000,17.35000,Hometown Health,HMO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,inpatient,,,78.00000,37.60000,Hometown Health,HMO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,outpatient,,,78.00000,37.60000,Hometown Health,HMO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,inpatient,,,115.00000,55.43000,Hometown Health,HMO,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,outpatient,,,115.00000,55.43000,Hometown Health,HMO,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,inpatient,,,76.00000,36.63000,Hometown Health,HMO,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,outpatient,,,76.00000,36.63000,Hometown Health,HMO,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,HMO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,HMO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,HMO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,HMO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,inpatient,,,169.00000,81.46000,Hometown Health,HMO,,152.10,,,,,,,152.10,163.93,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,outpatient,,,169.00000,81.46000,Hometown Health,HMO,,152.10,,,,,,,43.94,163.93,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,inpatient,,,28.00000,13.50000,Hometown Health,HMO,,25.20,,,,,,,25.20,27.16,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,outpatient,,,28.00000,13.50000,Hometown Health,HMO,,25.20,,,,,,,7.28,27.16,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,HMO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,HMO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,inpatient,,,15.00000,7.23000,Hometown Health,HMO,,13.50,,,,,,,13.50,14.55,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,outpatient,,,15.00000,7.23000,Hometown Health,HMO,,13.50,,,,,,,3.90,14.55,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,inpatient,,,18.00000,8.68000,Hometown Health,HMO,,16.20,,,,,,,16.20,17.46,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,outpatient,,,18.00000,8.68000,Hometown Health,HMO,,16.20,,,,,,,4.68,17.46,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,inpatient,,,550.00000,265.10000,Hometown Health,HMO,,495.00,,,,,,,495.00,533.50,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,outpatient,,,550.00000,265.10000,Hometown Health,HMO,,495.00,,,,,,,143.00,533.50,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,HMO,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,HMO,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,inpatient,,,392.00000,188.94000,Hometown Health,HMO,,352.80,,,,,,,352.80,380.24,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,outpatient,,,392.00000,188.94000,Hometown Health,HMO,,352.80,,,,,,,101.92,380.24,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,inpatient,,,75.00000,36.15000,Hometown Health,HMO,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,outpatient,,,75.00000,36.15000,Hometown Health,HMO,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,HMO,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,HMO,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,inpatient,,,100.00000,48.20000,Hometown Health,HMO,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,outpatient,,,100.00000,48.20000,Hometown Health,HMO,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,inpatient,,,153.00000,73.75000,Hometown Health,HMO,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,outpatient,,,153.00000,73.75000,Hometown Health,HMO,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,inpatient,,,909.00000,438.14000,Hometown Health,HMO,,818.10,,,,,,,818.10,881.73,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,outpatient,,,909.00000,438.14000,Hometown Health,HMO,,818.10,,,,,,,236.34,881.73,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,inpatient,,,266.00000,128.21000,Hometown Health,HMO,,239.40,,,,,,,239.40,258.02,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,outpatient,,,266.00000,128.21000,Hometown Health,HMO,,239.40,,,,,,,69.16,258.02,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,inpatient,,,275.00000,132.55000,Hometown Health,HMO,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,outpatient,,,275.00000,132.55000,Hometown Health,HMO,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,inpatient,,,84.00000,40.49000,Hometown Health,HMO,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,outpatient,,,84.00000,40.49000,Hometown Health,HMO,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,inpatient,,,174.00000,83.87000,Hometown Health,HMO,,156.60,,,,,,,156.60,168.78,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,outpatient,,,174.00000,83.87000,Hometown Health,HMO,,156.60,,,,,,,45.24,168.78,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,HMO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,HMO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,inpatient,,,211.00000,101.70000,Hometown Health,HMO,,189.90,,,,,,,189.90,204.67,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,outpatient,,,211.00000,101.70000,Hometown Health,HMO,,189.90,,,,,,,54.86,204.67,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,inpatient,,,65.00000,31.33000,Hometown Health,HMO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,outpatient,,,65.00000,31.33000,Hometown Health,HMO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,inpatient,,,83.00000,40.01000,Hometown Health,HMO,,74.70,,,,,,,74.70,80.51,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,outpatient,,,83.00000,40.01000,Hometown Health,HMO,,74.70,,,,,,,21.58,80.51,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,HMO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,HMO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,inpatient,,,323.00000,155.69000,Hometown Health,HMO,,290.70,,,,,,,290.70,313.31,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,outpatient,,,323.00000,155.69000,Hometown Health,HMO,,290.70,,,,,,,83.98,313.31,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,inpatient,,,35.00000,16.87000,Hometown Health,HMO,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,outpatient,,,35.00000,16.87000,Hometown Health,HMO,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,inpatient,,,20.00000,9.64000,Hometown Health,HMO,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,outpatient,,,20.00000,9.64000,Hometown Health,HMO,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,inpatient,,,34.00000,16.39000,Hometown Health,HMO,,30.60,,,,,,,30.60,32.98,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,outpatient,,,34.00000,16.39000,Hometown Health,HMO,,30.60,,,,,,,8.84,32.98,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,inpatient,,,29.00000,13.98000,Hometown Health,HMO,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,outpatient,,,29.00000,13.98000,Hometown Health,HMO,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,inpatient,,,80.00000,38.56000,Hometown Health,HMO,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,outpatient,,,80.00000,38.56000,Hometown Health,HMO,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,HMO,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,HMO,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,inpatient,,,16.00000,7.71000,Hometown Health,HMO,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,outpatient,,,16.00000,7.71000,Hometown Health,HMO,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,inpatient,,,113.00000,54.47000,Hometown Health,HMO,,101.70,,,,,,,101.70,109.61,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,outpatient,,,113.00000,54.47000,Hometown Health,HMO,,101.70,,,,,,,29.38,109.61,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,HMO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,HMO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,inpatient,,,78.00000,37.60000,Hometown Health,HMO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,outpatient,,,78.00000,37.60000,Hometown Health,HMO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,HMO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,HMO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,inpatient,,,76.00000,36.63000,Hometown Health,HMO,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,outpatient,,,76.00000,36.63000,Hometown Health,HMO,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,inpatient,,,88.00000,42.42000,Hometown Health,HMO,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,outpatient,,,88.00000,42.42000,Hometown Health,HMO,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,HMO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,HMO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,inpatient,,,88.00000,42.42000,Hometown Health,HMO,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,outpatient,,,88.00000,42.42000,Hometown Health,HMO,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,inpatient,,,105.00000,50.61000,Hometown Health,HMO,,94.50,,,,,,,94.50,101.85,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,outpatient,,,105.00000,50.61000,Hometown Health,HMO,,94.50,,,,,,,27.30,101.85,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,HMO,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,HMO,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,inpatient,,,83.00000,40.01000,Hometown Health,HMO,,74.70,,,,,,,74.70,80.51,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,outpatient,,,83.00000,40.01000,Hometown Health,HMO,,74.70,,,,,,,21.58,80.51,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,inpatient,,,154.00000,74.23000,Hometown Health,HMO,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Hometown Health,HMO,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,inpatient,,,97.00000,46.75000,Hometown Health,HMO,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,outpatient,,,97.00000,46.75000,Hometown Health,HMO,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,inpatient,,,154.00000,74.23000,Hometown Health,HMO,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Hometown Health,HMO,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,inpatient,,,87.00000,41.93000,Hometown Health,HMO,,78.30,,,,,,,78.30,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,outpatient,,,87.00000,41.93000,Hometown Health,HMO,,78.30,,,,,,,22.62,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,HMO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,HMO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,HMO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,HMO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,inpatient,,,97.00000,46.75000,Hometown Health,HMO,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,outpatient,,,97.00000,46.75000,Hometown Health,HMO,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,inpatient,,,176.00000,84.83000,Hometown Health,HMO,,158.40,,,,,,,158.40,170.72,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,outpatient,,,176.00000,84.83000,Hometown Health,HMO,,158.40,,,,,,,45.76,170.72,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,inpatient,,,158.00000,76.16000,Hometown Health,HMO,,142.20,,,,,,,142.20,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,outpatient,,,158.00000,76.16000,Hometown Health,HMO,,142.20,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,inpatient,,,84.00000,40.49000,Hometown Health,HMO,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,outpatient,,,84.00000,40.49000,Hometown Health,HMO,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,inpatient,,,189.00000,91.10000,Hometown Health,HMO,,170.10,,,,,,,170.10,183.33,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,outpatient,,,189.00000,91.10000,Hometown Health,HMO,,170.10,,,,,,,49.14,183.33,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,inpatient,,,109.00000,52.54000,Hometown Health,HMO,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,outpatient,,,109.00000,52.54000,Hometown Health,HMO,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,inpatient,,,129.00000,62.18000,Hometown Health,HMO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,outpatient,,,129.00000,62.18000,Hometown Health,HMO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,inpatient,,,84.00000,40.49000,Hometown Health,HMO,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,outpatient,,,84.00000,40.49000,Hometown Health,HMO,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,HMO,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,HMO,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,inpatient,,,149.00000,71.82000,Hometown Health,HMO,,134.10,,,,,,,134.10,144.53,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,outpatient,,,149.00000,71.82000,Hometown Health,HMO,,134.10,,,,,,,38.74,144.53,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,inpatient,,,130.00000,62.66000,Hometown Health,HMO,,117.00,,,,,,,117.00,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,outpatient,,,130.00000,62.66000,Hometown Health,HMO,,117.00,,,,,,,33.80,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,inpatient,,,110.00000,53.02000,Hometown Health,HMO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,outpatient,,,110.00000,53.02000,Hometown Health,HMO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,inpatient,,,158.00000,76.16000,Hometown Health,HMO,,142.20,,,,,,,142.20,153.26,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,outpatient,,,158.00000,76.16000,Hometown Health,HMO,,142.20,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,inpatient,,,117.00000,56.39000,Hometown Health,HMO,,105.30,,,,,,,105.30,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,outpatient,,,117.00000,56.39000,Hometown Health,HMO,,105.30,,,,,,,30.42,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,HMO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,HMO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,inpatient,,,145.00000,69.89000,Hometown Health,HMO,,130.50,,,,,,,130.50,140.65,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,outpatient,,,145.00000,69.89000,Hometown Health,HMO,,130.50,,,,,,,37.70,140.65,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,inpatient,,,165.00000,79.53000,Hometown Health,HMO,,148.50,,,,,,,148.50,160.05,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,outpatient,,,165.00000,79.53000,Hometown Health,HMO,,148.50,,,,,,,42.90,160.05,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,HMO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,HMO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,HMO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,HMO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,inpatient,,,154.00000,74.23000,Hometown Health,HMO,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,outpatient,,,154.00000,74.23000,Hometown Health,HMO,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,inpatient,,,104.00000,50.13000,Hometown Health,HMO,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,outpatient,,,104.00000,50.13000,Hometown Health,HMO,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,HMO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,HMO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,inpatient,,,104.00000,50.13000,Hometown Health,HMO,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,outpatient,,,104.00000,50.13000,Hometown Health,HMO,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,HMO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,HMO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,inpatient,,,123.00000,59.29000,Hometown Health,HMO,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,outpatient,,,123.00000,59.29000,Hometown Health,HMO,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,inpatient,,,95.00000,45.79000,Hometown Health,HMO,,85.50,,,,,,,85.50,92.15,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,outpatient,,,95.00000,45.79000,Hometown Health,HMO,,85.50,,,,,,,24.70,92.15,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,inpatient,,,160.00000,77.12000,Hometown Health,HMO,,144.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,outpatient,,,160.00000,77.12000,Hometown Health,HMO,,144.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,inpatient,,,147.00000,70.85000,Hometown Health,HMO,,132.30,,,,,,,132.30,142.59,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,outpatient,,,147.00000,70.85000,Hometown Health,HMO,,132.30,,,,,,,38.22,142.59,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,inpatient,,,178.00000,85.80000,Hometown Health,HMO,,160.20,,,,,,,160.20,172.66,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,outpatient,,,178.00000,85.80000,Hometown Health,HMO,,160.20,,,,,,,46.28,172.66,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,inpatient,,,160.00000,77.12000,Hometown Health,HMO,,144.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,outpatient,,,160.00000,77.12000,Hometown Health,HMO,,144.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,HMO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,HMO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,HMO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,HMO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,HMO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,HMO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,HMO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,HMO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,HMO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,HMO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,HMO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,HMO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,HMO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,HMO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,HMO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,HMO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,HMO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,HMO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,HMO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,HMO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,inpatient,,,449.00000,216.42000,Hometown Health,HMO,,404.10,,,,,,,404.10,435.53,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,outpatient,,,449.00000,216.42000,Hometown Health,HMO,,404.10,,,,,,,116.74,435.53,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,inpatient,,,104.00000,50.13000,Hometown Health,HMO,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,outpatient,,,104.00000,50.13000,Hometown Health,HMO,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,inpatient,,,185.00000,89.17000,Hometown Health,HMO,,166.50,,,,,,,166.50,179.45,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Hometown Health,HMO,,166.50,,,,,,,48.10,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,inpatient,,,185.00000,89.17000,Hometown Health,HMO,,166.50,,,,,,,166.50,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Hometown Health,HMO,,166.50,,,,,,,48.10,179.45,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,inpatient,,,84.00000,40.49000,Hometown Health,HMO,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,outpatient,,,84.00000,40.49000,Hometown Health,HMO,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,inpatient,,,84.00000,40.49000,Hometown Health,HMO,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Hometown Health,HMO,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,inpatient,,,84.00000,40.49000,Hometown Health,HMO,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Hometown Health,HMO,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,HMO,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,HMO,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,HMO,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,HMO,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,inpatient,,,98.00000,47.24000,Hometown Health,HMO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,outpatient,,,98.00000,47.24000,Hometown Health,HMO,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,inpatient,,,75.00000,36.15000,Hometown Health,HMO,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,outpatient,,,75.00000,36.15000,Hometown Health,HMO,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,inpatient,,,107.00000,51.57000,Hometown Health,HMO,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,outpatient,,,107.00000,51.57000,Hometown Health,HMO,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,inpatient,,,81.00000,39.04000,Hometown Health,HMO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,outpatient,,,81.00000,39.04000,Hometown Health,HMO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,HMO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,HMO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,HMO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,HMO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,inpatient,,,74.00000,35.67000,Hometown Health,HMO,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,outpatient,,,74.00000,35.67000,Hometown Health,HMO,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,inpatient,,,194.00000,93.51000,Hometown Health,HMO,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,outpatient,,,194.00000,93.51000,Hometown Health,HMO,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,inpatient,,,111.00000,53.50000,Hometown Health,HMO,,99.90,,,,,,,99.90,107.67,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,outpatient,,,111.00000,53.50000,Hometown Health,HMO,,99.90,,,,,,,28.86,107.67,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,HMO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,HMO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Hometown Health,HMO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Hometown Health,HMO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Hometown Health,HMO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Hometown Health,HMO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,inpatient,,,237.00000,114.23000,Hometown Health,HMO,,213.30,,,,,,,213.30,229.89,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Hometown Health,HMO,,213.30,,,,,,,61.62,229.89,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,HMO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,HMO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,HMO,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,HMO,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,HMO,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,HMO,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,inpatient,,,131.00000,63.14000,Hometown Health,HMO,,117.90,,,,,,,117.90,127.07,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,outpatient,,,131.00000,63.14000,Hometown Health,HMO,,117.90,,,,,,,34.06,127.07,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,inpatient,,,15.00000,7.23000,Hometown Health,HMO,,13.50,,,,,,,13.50,14.55,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,outpatient,,,15.00000,7.23000,Hometown Health,HMO,,13.50,,,,,,,3.90,14.55,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,inpatient,,,39.00000,18.80000,Hometown Health,HMO,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,outpatient,,,39.00000,18.80000,Hometown Health,HMO,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,inpatient,,,12.00000,5.78000,Hometown Health,HMO,,10.80,,,,,,,10.80,11.64,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,outpatient,,,12.00000,5.78000,Hometown Health,HMO,,10.80,,,,,,,3.12,11.64,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,inpatient,,,203.00000,97.85000,Hometown Health,HMO,,182.70,,,,,,,182.70,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Hometown Health,HMO,,182.70,,,,,,,52.78,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,inpatient,,,203.00000,97.85000,Hometown Health,HMO,,182.70,,,,,,,182.70,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Hometown Health,HMO,,182.70,,,,,,,52.78,196.91,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,inpatient,,,99.00000,47.72000,Hometown Health,HMO,,89.10,,,,,,,89.10,96.03,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,outpatient,,,99.00000,47.72000,Hometown Health,HMO,,89.10,,,,,,,25.74,96.03,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,HMO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,HMO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,inpatient,,,23.00000,11.09000,Hometown Health,HMO,,20.70,,,,,,,20.70,22.31,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,outpatient,,,23.00000,11.09000,Hometown Health,HMO,,20.70,,,,,,,5.98,22.31,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,inpatient,,,46.00000,22.17000,Hometown Health,HMO,,41.40,,,,,,,41.40,44.62,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,outpatient,,,46.00000,22.17000,Hometown Health,HMO,,41.40,,,,,,,11.96,44.62,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,inpatient,,,288.00000,138.82000,Hometown Health,HMO,,259.20,,,,,,,259.20,279.36,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,outpatient,,,288.00000,138.82000,Hometown Health,HMO,,259.20,,,,,,,74.88,279.36,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,inpatient,,,106.00000,51.09000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,outpatient,,,106.00000,51.09000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,inpatient,,,30.00000,14.46000,Hometown Health,HMO,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,outpatient,,,30.00000,14.46000,Hometown Health,HMO,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,HMO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,HMO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,inpatient,,,89.00000,42.90000,Hometown Health,HMO,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,outpatient,,,89.00000,42.90000,Hometown Health,HMO,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,inpatient,,,116.00000,55.91000,Hometown Health,HMO,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,outpatient,,,116.00000,55.91000,Hometown Health,HMO,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,inpatient,,,116.00000,55.91000,Hometown Health,HMO,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Hometown Health,HMO,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,inpatient,,,116.00000,55.91000,Hometown Health,HMO,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Hometown Health,HMO,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,HMO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,HMO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,inpatient,,,174.00000,83.87000,Hometown Health,HMO,,156.60,,,,,,,156.60,168.78,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,outpatient,,,174.00000,83.87000,Hometown Health,HMO,,156.60,,,,,,,45.24,168.78,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,HMO,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,HMO,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,inpatient,,,112.00000,53.98000,Hometown Health,HMO,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,outpatient,,,112.00000,53.98000,Hometown Health,HMO,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,HMO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,HMO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,inpatient,,,286.00000,137.85000,Hometown Health,HMO,,257.40,,,,,,,257.40,277.42,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,outpatient,,,286.00000,137.85000,Hometown Health,HMO,,257.40,,,,,,,74.36,277.42,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,inpatient,,,300.00000,144.60000,Hometown Health,HMO,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,outpatient,,,300.00000,144.60000,Hometown Health,HMO,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,HMO,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,HMO,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,inpatient,,,90.00000,43.38000,Hometown Health,HMO,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,outpatient,,,90.00000,43.38000,Hometown Health,HMO,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,inpatient,,,315.00000,151.83000,Hometown Health,HMO,,283.50,,,,,,,283.50,305.55,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,outpatient,,,315.00000,151.83000,Hometown Health,HMO,,283.50,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,inpatient,,,100.00000,48.20000,Hometown Health,HMO,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,outpatient,,,100.00000,48.20000,Hometown Health,HMO,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,inpatient,,,89.00000,42.90000,Hometown Health,HMO,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,outpatient,,,89.00000,42.90000,Hometown Health,HMO,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,HMO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,HMO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,inpatient,,,135.00000,65.07000,Hometown Health,HMO,,121.50,,,,,,,121.50,130.95,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,outpatient,,,135.00000,65.07000,Hometown Health,HMO,,121.50,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,inpatient,,,80.00000,38.56000,Hometown Health,HMO,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,outpatient,,,80.00000,38.56000,Hometown Health,HMO,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,HMO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,HMO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,HMO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,HMO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,inpatient,,,100.00000,48.20000,Hometown Health,HMO,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,outpatient,,,100.00000,48.20000,Hometown Health,HMO,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,inpatient,,,305.00000,147.01000,Hometown Health,HMO,,274.50,,,,,,,274.50,295.85,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,outpatient,,,305.00000,147.01000,Hometown Health,HMO,,274.50,,,,,,,79.30,295.85,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,HMO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,HMO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,HMO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,HMO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,HMO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,HMO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,inpatient,,,368.00000,177.38000,Hometown Health,HMO,,331.20,,,,,,,331.20,356.96,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,outpatient,,,368.00000,177.38000,Hometown Health,HMO,,331.20,,,,,,,95.68,356.96,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,inpatient,,,104.00000,50.13000,Hometown Health,HMO,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,outpatient,,,104.00000,50.13000,Hometown Health,HMO,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,inpatient,,,109.00000,52.54000,Hometown Health,HMO,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,outpatient,,,109.00000,52.54000,Hometown Health,HMO,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,inpatient,,,114.00000,54.95000,Hometown Health,HMO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,outpatient,,,114.00000,54.95000,Hometown Health,HMO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,inpatient,,,135.00000,65.07000,Hometown Health,HMO,,121.50,,,,,,,121.50,130.95,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,outpatient,,,135.00000,65.07000,Hometown Health,HMO,,121.50,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,inpatient,,,105.00000,50.61000,Hometown Health,HMO,,94.50,,,,,,,94.50,101.85,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,outpatient,,,105.00000,50.61000,Hometown Health,HMO,,94.50,,,,,,,27.30,101.85,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,inpatient,,,315.00000,151.83000,Hometown Health,HMO,,283.50,,,,,,,283.50,305.55,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,outpatient,,,315.00000,151.83000,Hometown Health,HMO,,283.50,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,inpatient,,,148.00000,71.34000,Hometown Health,HMO,,133.20,,,,,,,133.20,143.56,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,outpatient,,,148.00000,71.34000,Hometown Health,HMO,,133.20,,,,,,,38.48,143.56,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,inpatient,,,107.00000,51.57000,Hometown Health,HMO,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,outpatient,,,107.00000,51.57000,Hometown Health,HMO,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,inpatient,,,35.00000,16.87000,Hometown Health,HMO,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,outpatient,,,35.00000,16.87000,Hometown Health,HMO,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,inpatient,,,104.00000,50.13000,Hometown Health,HMO,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,outpatient,,,104.00000,50.13000,Hometown Health,HMO,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,inpatient,,,650.00000,313.30000,Hometown Health,HMO,,585.00,,,,,,,585.00,630.50,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,outpatient,,,650.00000,313.30000,Hometown Health,HMO,,585.00,,,,,,,169.00,630.50,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,inpatient,,,91.00000,43.86000,Hometown Health,HMO,,81.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,outpatient,,,91.00000,43.86000,Hometown Health,HMO,,81.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,inpatient,,,114.00000,54.95000,Hometown Health,HMO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,outpatient,,,114.00000,54.95000,Hometown Health,HMO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,inpatient,,,360.00000,173.52000,Hometown Health,HMO,,324.00,,,,,,,324.00,349.20,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,outpatient,,,360.00000,173.52000,Hometown Health,HMO,,324.00,,,,,,,93.60,349.20,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,inpatient,,,106.00000,51.09000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,outpatient,,,106.00000,51.09000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,inpatient,,,78.00000,37.60000,Hometown Health,HMO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,outpatient,,,78.00000,37.60000,Hometown Health,HMO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,HMO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,HMO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,inpatient,,,94.00000,45.31000,Hometown Health,HMO,,84.60,,,,,,,84.60,91.18,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,outpatient,,,94.00000,45.31000,Hometown Health,HMO,,84.60,,,,,,,24.44,91.18,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,inpatient,,,101.00000,48.68000,Hometown Health,HMO,,90.90,,,,,,,90.90,97.97,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,outpatient,,,101.00000,48.68000,Hometown Health,HMO,,90.90,,,,,,,26.26,97.97,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,HMO,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,HMO,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,HMO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,HMO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,inpatient,,,145.00000,69.89000,Hometown Health,HMO,,130.50,,,,,,,130.50,140.65,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,outpatient,,,145.00000,69.89000,Hometown Health,HMO,,130.50,,,,,,,37.70,140.65,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,inpatient,,,266.00000,128.21000,Hometown Health,HMO,,239.40,,,,,,,239.40,258.02,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,outpatient,,,266.00000,128.21000,Hometown Health,HMO,,239.40,,,,,,,69.16,258.02,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,inpatient,,,79.00000,38.08000,Hometown Health,HMO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,outpatient,,,79.00000,38.08000,Hometown Health,HMO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,inpatient,,,144.00000,69.41000,Hometown Health,HMO,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,outpatient,,,144.00000,69.41000,Hometown Health,HMO,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,inpatient,,,20.00000,9.64000,Hometown Health,HMO,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,outpatient,,,20.00000,9.64000,Hometown Health,HMO,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,inpatient,,,208.00000,100.26000,Hometown Health,HMO,,187.20,,,,,,,187.20,201.76,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,outpatient,,,208.00000,100.26000,Hometown Health,HMO,,187.20,,,,,,,54.08,201.76,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,inpatient,,,135.00000,65.07000,Hometown Health,HMO,,121.50,,,,,,,121.50,130.95,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,outpatient,,,135.00000,65.07000,Hometown Health,HMO,,121.50,,,,,,,35.10,130.95,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,inpatient,,,131.00000,63.14000,Hometown Health,HMO,,117.90,,,,,,,117.90,127.07,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,outpatient,,,131.00000,63.14000,Hometown Health,HMO,,117.90,,,,,,,34.06,127.07,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,HMO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,HMO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,inpatient,,,25.00000,12.05000,Hometown Health,HMO,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,outpatient,,,25.00000,12.05000,Hometown Health,HMO,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,inpatient,,,80.00000,38.56000,Hometown Health,HMO,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,outpatient,,,80.00000,38.56000,Hometown Health,HMO,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,HMO,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,HMO,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,inpatient,,,35.00000,16.87000,Hometown Health,HMO,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,outpatient,,,35.00000,16.87000,Hometown Health,HMO,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,inpatient,,,88.00000,42.42000,Hometown Health,HMO,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,outpatient,,,88.00000,42.42000,Hometown Health,HMO,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,inpatient,,,98.00000,47.24000,Hometown Health,HMO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,outpatient,,,98.00000,47.24000,Hometown Health,HMO,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,inpatient,,,204.00000,98.33000,Hometown Health,HMO,,183.60,,,,,,,183.60,197.88,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,outpatient,,,204.00000,98.33000,Hometown Health,HMO,,183.60,,,,,,,53.04,197.88,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,inpatient,,,19.00000,9.16000,Hometown Health,HMO,,17.10,,,,,,,17.10,18.43,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,outpatient,,,19.00000,9.16000,Hometown Health,HMO,,17.10,,,,,,,4.94,18.43,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,inpatient,,,37.00000,17.83000,Hometown Health,HMO,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,outpatient,,,37.00000,17.83000,Hometown Health,HMO,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,inpatient,,,79.00000,38.08000,Hometown Health,HMO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,outpatient,,,79.00000,38.08000,Hometown Health,HMO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,inpatient,,,21.00000,10.12000,Hometown Health,HMO,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,outpatient,,,21.00000,10.12000,Hometown Health,HMO,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,inpatient,,,32.00000,15.42000,Hometown Health,HMO,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,outpatient,,,32.00000,15.42000,Hometown Health,HMO,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,inpatient,,,94.00000,45.31000,Hometown Health,HMO,,84.60,,,,,,,84.60,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,outpatient,,,94.00000,45.31000,Hometown Health,HMO,,84.60,,,,,,,24.44,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,inpatient,,,103.00000,49.65000,Hometown Health,HMO,,92.70,,,,,,,92.70,99.91,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,outpatient,,,103.00000,49.65000,Hometown Health,HMO,,92.70,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,HMO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,HMO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,inpatient,,,102.00000,49.16000,Hometown Health,HMO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,outpatient,,,102.00000,49.16000,Hometown Health,HMO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,inpatient,,,103.00000,49.65000,Hometown Health,HMO,,92.70,,,,,,,92.70,99.91,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,outpatient,,,103.00000,49.65000,Hometown Health,HMO,,92.70,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,inpatient,,,139.00000,67.00000,Hometown Health,HMO,,125.10,,,,,,,125.10,134.83,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,outpatient,,,139.00000,67.00000,Hometown Health,HMO,,125.10,,,,,,,36.14,134.83,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,inpatient,,,21.00000,10.12000,Hometown Health,HMO,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Hometown Health,HMO,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,inpatient,,,88.00000,42.42000,Hometown Health,HMO,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,outpatient,,,88.00000,42.42000,Hometown Health,HMO,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,inpatient,,,21.00000,10.12000,Hometown Health,HMO,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Hometown Health,HMO,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,inpatient,,,80.00000,38.56000,Hometown Health,HMO,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,outpatient,,,80.00000,38.56000,Hometown Health,HMO,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,inpatient,,,49.00000,23.62000,Hometown Health,HMO,,44.10,,,,,,,44.10,47.53,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,outpatient,,,49.00000,23.62000,Hometown Health,HMO,,44.10,,,,,,,12.74,47.53,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,inpatient,,,88.00000,42.42000,Hometown Health,HMO,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,outpatient,,,88.00000,42.42000,Hometown Health,HMO,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,HMO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,HMO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,inpatient,,,93.00000,44.83000,Hometown Health,HMO,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,outpatient,,,93.00000,44.83000,Hometown Health,HMO,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,HMO,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,HMO,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,inpatient,,,41.00000,19.76000,Hometown Health,HMO,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,outpatient,,,41.00000,19.76000,Hometown Health,HMO,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,inpatient,,,94.00000,45.31000,Hometown Health,HMO,,84.60,,,,,,,84.60,91.18,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,outpatient,,,94.00000,45.31000,Hometown Health,HMO,,84.60,,,,,,,24.44,91.18,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,inpatient,,,124.00000,59.77000,Hometown Health,HMO,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,outpatient,,,124.00000,59.77000,Hometown Health,HMO,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,HMO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,HMO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,inpatient,,,33.00000,15.91000,Hometown Health,HMO,,29.70,,,,,,,29.70,32.01,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,outpatient,,,33.00000,15.91000,Hometown Health,HMO,,29.70,,,,,,,8.58,32.01,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,HMO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,HMO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,inpatient,,,99.00000,47.72000,Hometown Health,HMO,,89.10,,,,,,,89.10,96.03,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,outpatient,,,99.00000,47.72000,Hometown Health,HMO,,89.10,,,,,,,25.74,96.03,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,inpatient,,,197.00000,94.95000,Hometown Health,HMO,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,outpatient,,,197.00000,94.95000,Hometown Health,HMO,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,inpatient,,,194.00000,93.51000,Hometown Health,HMO,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,outpatient,,,194.00000,93.51000,Hometown Health,HMO,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,HMO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,HMO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,inpatient,,,90.00000,43.38000,Hometown Health,HMO,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,outpatient,,,90.00000,43.38000,Hometown Health,HMO,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,inpatient,,,109.00000,52.54000,Hometown Health,HMO,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,outpatient,,,109.00000,52.54000,Hometown Health,HMO,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,inpatient,,,108.00000,52.06000,Hometown Health,HMO,,97.20,,,,,,,97.20,104.76,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,outpatient,,,108.00000,52.06000,Hometown Health,HMO,,97.20,,,,,,,28.08,104.76,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,HMO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,HMO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,HMO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,HMO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,HMO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,inpatient,,,98.00000,47.24000,Hometown Health,HMO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,outpatient,,,98.00000,47.24000,Hometown Health,HMO,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,inpatient,,,141.00000,67.96000,Hometown Health,HMO,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,outpatient,,,141.00000,67.96000,Hometown Health,HMO,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,inpatient,,,226.00000,108.93000,Hometown Health,HMO,,203.40,,,,,,,203.40,219.22,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,outpatient,,,226.00000,108.93000,Hometown Health,HMO,,203.40,,,,,,,58.76,219.22,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,inpatient,,,92.00000,44.34000,Hometown Health,HMO,,82.80,,,,,,,82.80,89.24,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,outpatient,,,92.00000,44.34000,Hometown Health,HMO,,82.80,,,,,,,23.92,89.24,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,HMO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,HMO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,inpatient,,,100.00000,48.20000,Hometown Health,HMO,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,outpatient,,,100.00000,48.20000,Hometown Health,HMO,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,inpatient,,,124.00000,59.77000,Hometown Health,HMO,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,outpatient,,,124.00000,59.77000,Hometown Health,HMO,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,HMO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,HMO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Hometown Health,HMO,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Hometown Health,HMO,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Hometown Health,HMO,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Hometown Health,HMO,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Hometown Health,HMO,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Hometown Health,HMO,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,inpatient,,,118.00000,56.88000,Hometown Health,HMO,,106.20,,,,,,,106.20,114.46,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,outpatient,,,118.00000,56.88000,Hometown Health,HMO,,106.20,,,,,,,30.68,114.46,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,HMO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,HMO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,inpatient,,,104.00000,50.13000,Hometown Health,HMO,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,outpatient,,,104.00000,50.13000,Hometown Health,HMO,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,HMO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,HMO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,HMO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,HMO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,inpatient,,,17.00000,8.19000,Hometown Health,HMO,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,outpatient,,,17.00000,8.19000,Hometown Health,HMO,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,inpatient,,,36.00000,17.35000,Hometown Health,HMO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,outpatient,,,36.00000,17.35000,Hometown Health,HMO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,inpatient,,,18.00000,8.68000,Hometown Health,HMO,,16.20,,,,,,,16.20,17.46,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,outpatient,,,18.00000,8.68000,Hometown Health,HMO,,16.20,,,,,,,4.68,17.46,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,inpatient,,,74.00000,35.67000,Hometown Health,HMO,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,outpatient,,,74.00000,35.67000,Hometown Health,HMO,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,inpatient,,,118.00000,56.88000,Hometown Health,HMO,,106.20,,,,,,,106.20,114.46,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,outpatient,,,118.00000,56.88000,Hometown Health,HMO,,106.20,,,,,,,30.68,114.46,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,HMO,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,HMO,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,inpatient,,,30.00000,14.46000,Hometown Health,HMO,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,outpatient,,,30.00000,14.46000,Hometown Health,HMO,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,HMO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,HMO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,HMO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,HMO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,HMO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,HMO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,inpatient,,,141.00000,67.96000,Hometown Health,HMO,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,outpatient,,,141.00000,67.96000,Hometown Health,HMO,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,inpatient,,,81.00000,39.04000,Hometown Health,HMO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,outpatient,,,81.00000,39.04000,Hometown Health,HMO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,inpatient,,,335.00000,161.47000,Hometown Health,HMO,,301.50,,,,,,,301.50,324.95,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,outpatient,,,335.00000,161.47000,Hometown Health,HMO,,301.50,,,,,,,87.10,324.95,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,HMO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,HMO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,HMO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,HMO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,HMO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,HMO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,HMO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,HMO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,HMO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,inpatient,,,12.00000,5.78000,Hometown Health,HMO,,10.80,,,,,,,10.80,11.64,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,outpatient,,,12.00000,5.78000,Hometown Health,HMO,,10.80,,,,,,,3.12,11.64,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,inpatient,,,710.00000,342.22000,Hometown Health,HMO,,639.00,,,,,,,639.00,688.70,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,outpatient,,,710.00000,342.22000,Hometown Health,HMO,,639.00,,,,,,,184.60,688.70,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,inpatient,,,104.00000,50.13000,Hometown Health,HMO,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,outpatient,,,104.00000,50.13000,Hometown Health,HMO,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,inpatient,,,155.00000,74.71000,Hometown Health,HMO,,139.50,,,,,,,139.50,150.35,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,outpatient,,,155.00000,74.71000,Hometown Health,HMO,,139.50,,,,,,,40.30,150.35,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,inpatient,,,139.00000,67.00000,Hometown Health,HMO,,125.10,,,,,,,125.10,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,outpatient,,,139.00000,67.00000,Hometown Health,HMO,,125.10,,,,,,,36.14,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,inpatient,,,89.00000,42.90000,Hometown Health,HMO,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,outpatient,,,89.00000,42.90000,Hometown Health,HMO,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,inpatient,,,88.00000,42.42000,Hometown Health,HMO,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,outpatient,,,88.00000,42.42000,Hometown Health,HMO,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,inpatient,,,111.00000,53.50000,Hometown Health,HMO,,99.90,,,,,,,99.90,107.67,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,outpatient,,,111.00000,53.50000,Hometown Health,HMO,,99.90,,,,,,,28.86,107.67,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,HMO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,HMO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,inpatient,,,85.00000,40.97000,Hometown Health,HMO,,76.50,,,,,,,76.50,82.45,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,outpatient,,,85.00000,40.97000,Hometown Health,HMO,,76.50,,,,,,,22.10,82.45,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,inpatient,,,110.00000,53.02000,Hometown Health,HMO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,outpatient,,,110.00000,53.02000,Hometown Health,HMO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,inpatient,,,500.00000,241.00000,Hometown Health,HMO,,450.00,,,,,,,450.00,485.00,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,outpatient,,,500.00000,241.00000,Hometown Health,HMO,,450.00,,,,,,,130.00,485.00,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,inpatient,,,140.00000,67.48000,Hometown Health,HMO,,126.00,,,,,,,126.00,135.80,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,outpatient,,,140.00000,67.48000,Hometown Health,HMO,,126.00,,,,,,,36.40,135.80,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,inpatient,,,74.00000,35.67000,Hometown Health,HMO,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,outpatient,,,74.00000,35.67000,Hometown Health,HMO,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,HMO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,HMO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,inpatient,,,93.00000,44.83000,Hometown Health,HMO,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,outpatient,,,93.00000,44.83000,Hometown Health,HMO,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,inpatient,,,15.00000,7.23000,Hometown Health,HMO,,13.50,,,,,,,13.50,14.55,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,outpatient,,,15.00000,7.23000,Hometown Health,HMO,,13.50,,,,,,,3.90,14.55,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,inpatient,,,24.00000,11.57000,Hometown Health,HMO,,21.60,,,,,,,21.60,23.28,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,outpatient,,,24.00000,11.57000,Hometown Health,HMO,,21.60,,,,,,,6.24,23.28,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,HMO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,HMO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,inpatient,,,16.00000,7.71000,Hometown Health,HMO,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Hometown Health,HMO,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,inpatient,,,16.00000,7.71000,Hometown Health,HMO,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Hometown Health,HMO,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,HMO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,HMO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,HMO,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,HMO,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,inpatient,,,157.00000,75.67000,Hometown Health,HMO,,141.30,,,,,,,141.30,152.29,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,outpatient,,,157.00000,75.67000,Hometown Health,HMO,,141.30,,,,,,,40.82,152.29,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,HMO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,HMO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,inpatient,,,229.00000,110.38000,Hometown Health,HMO,,206.10,,,,,,,206.10,222.13,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,outpatient,,,229.00000,110.38000,Hometown Health,HMO,,206.10,,,,,,,59.54,222.13,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,HMO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,HMO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,HMO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,HMO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,inpatient,,,17.00000,8.19000,Hometown Health,HMO,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,outpatient,,,17.00000,8.19000,Hometown Health,HMO,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,HMO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,HMO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,inpatient,,,387.00000,186.53000,Hometown Health,HMO,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,outpatient,,,387.00000,186.53000,Hometown Health,HMO,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,inpatient,,,387.00000,186.53000,Hometown Health,HMO,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Hometown Health,HMO,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,inpatient,,,387.00000,186.53000,Hometown Health,HMO,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Hometown Health,HMO,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,HMO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,HMO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,inpatient,,,78.00000,37.60000,Hometown Health,HMO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Hometown Health,HMO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,inpatient,,,78.00000,37.60000,Hometown Health,HMO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Hometown Health,HMO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,inpatient,,,43.00000,20.73000,Hometown Health,HMO,,38.70,,,,,,,38.70,41.71,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,outpatient,,,43.00000,20.73000,Hometown Health,HMO,,38.70,,,,,,,11.18,41.71,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,HMO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,HMO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,inpatient,,,160.00000,77.12000,Hometown Health,HMO,,144.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,outpatient,,,160.00000,77.12000,Hometown Health,HMO,,144.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,inpatient,,,112.00000,53.98000,Hometown Health,HMO,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,outpatient,,,112.00000,53.98000,Hometown Health,HMO,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,HMO,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,HMO,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,HMO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,HMO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,inpatient,,,153.00000,73.75000,Hometown Health,HMO,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,outpatient,,,153.00000,73.75000,Hometown Health,HMO,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,inpatient,,,45.00000,21.69000,Hometown Health,HMO,,40.50,,,,,,,40.50,43.65,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,outpatient,,,45.00000,21.69000,Hometown Health,HMO,,40.50,,,,,,,11.70,43.65,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,inpatient,,,28.00000,13.50000,Hometown Health,HMO,,25.20,,,,,,,25.20,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,outpatient,,,28.00000,13.50000,Hometown Health,HMO,,25.20,,,,,,,7.28,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Hometown Health,HMO,,44.10,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Hometown Health,HMO,,44.10,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Hometown Health,HMO,,44.10,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Hometown Health,HMO,,44.10,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Hometown Health,HMO,,44.10,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Hometown Health,HMO,,44.10,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,inpatient,,,36.00000,17.35000,Hometown Health,HMO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,outpatient,,,36.00000,17.35000,Hometown Health,HMO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,inpatient,,,38.00000,18.32000,Hometown Health,HMO,,34.20,,,,,,,34.20,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,outpatient,,,38.00000,18.32000,Hometown Health,HMO,,34.20,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,inpatient,,,38.00000,18.32000,Hometown Health,HMO,,34.20,,,,,,,34.20,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,outpatient,,,38.00000,18.32000,Hometown Health,HMO,,34.20,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,inpatient,,,76.00000,36.63000,Hometown Health,HMO,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,outpatient,,,76.00000,36.63000,Hometown Health,HMO,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,inpatient,,,173.00000,83.39000,Hometown Health,HMO,,155.70,,,,,,,155.70,167.81,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,outpatient,,,173.00000,83.39000,Hometown Health,HMO,,155.70,,,,,,,44.98,167.81,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,inpatient,,,22.00000,10.60000,Hometown Health,HMO,,19.80,,,,,,,19.80,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,outpatient,,,22.00000,10.60000,Hometown Health,HMO,,19.80,,,,,,,5.72,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,inpatient,,,39.00000,18.80000,Hometown Health,HMO,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,outpatient,,,39.00000,18.80000,Hometown Health,HMO,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,inpatient,,,41.00000,19.76000,Hometown Health,HMO,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,outpatient,,,41.00000,19.76000,Hometown Health,HMO,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,HMO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,HMO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,HMO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,HMO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,inpatient,,,43.00000,20.73000,Hometown Health,HMO,,38.70,,,,,,,38.70,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Hometown Health,HMO,,38.70,,,,,,,11.18,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,inpatient,,,43.00000,20.73000,Hometown Health,HMO,,38.70,,,,,,,38.70,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Hometown Health,HMO,,38.70,,,,,,,11.18,41.71,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,inpatient,,,38.00000,18.32000,Hometown Health,HMO,,34.20,,,,,,,34.20,36.86,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,outpatient,,,38.00000,18.32000,Hometown Health,HMO,,34.20,,,,,,,9.88,36.86,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,HMO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,HMO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,inpatient,,,226.00000,108.93000,Hometown Health,HMO,,203.40,,,,,,,203.40,219.22,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,outpatient,,,226.00000,108.93000,Hometown Health,HMO,,203.40,,,,,,,58.76,219.22,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Hometown Health,HMO,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Hometown Health,HMO,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Hometown Health,HMO,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Hometown Health,HMO,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Hometown Health,HMO,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Hometown Health,HMO,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,inpatient,,,160.00000,77.12000,Hometown Health,HMO,,144.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,outpatient,,,160.00000,77.12000,Hometown Health,HMO,,144.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,inpatient,,,102.00000,49.16000,Hometown Health,HMO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,outpatient,,,102.00000,49.16000,Hometown Health,HMO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,inpatient,,,317.00000,152.79000,Hometown Health,HMO,,285.30,,,,,,,285.30,307.49,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,outpatient,,,317.00000,152.79000,Hometown Health,HMO,,285.30,,,,,,,82.42,307.49,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,inpatient,,,116.00000,55.91000,Hometown Health,HMO,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,outpatient,,,116.00000,55.91000,Hometown Health,HMO,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,inpatient,,,89.00000,42.90000,Hometown Health,HMO,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Hometown Health,HMO,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,inpatient,,,89.00000,42.90000,Hometown Health,HMO,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Hometown Health,HMO,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,inpatient,,,85.00000,40.97000,Hometown Health,HMO,,76.50,,,,,,,76.50,82.45,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,outpatient,,,85.00000,40.97000,Hometown Health,HMO,,76.50,,,,,,,22.10,82.45,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,inpatient,,,184.00000,88.69000,Hometown Health,HMO,,165.60,,,,,,,165.60,178.48,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,outpatient,,,184.00000,88.69000,Hometown Health,HMO,,165.60,,,,,,,47.84,178.48,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,inpatient,,,127.00000,61.21000,Hometown Health,HMO,,114.30,,,,,,,114.30,123.19,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,outpatient,,,127.00000,61.21000,Hometown Health,HMO,,114.30,,,,,,,33.02,123.19,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,inpatient,,,35.00000,16.87000,Hometown Health,HMO,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,outpatient,,,35.00000,16.87000,Hometown Health,HMO,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,inpatient,,,79.00000,38.08000,Hometown Health,HMO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,outpatient,,,79.00000,38.08000,Hometown Health,HMO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,inpatient,,,57.00000,32.83000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,outpatient,,,57.00000,32.83000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Hometown Health,HMO,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Hometown Health,HMO,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,inpatient,,,77.00000,44.35000,Hometown Health,HMO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,outpatient,,,77.00000,44.35000,Hometown Health,HMO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,inpatient,,,70.00000,40.32000,Hometown Health,HMO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,outpatient,,,70.00000,40.32000,Hometown Health,HMO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,inpatient,,,67.00000,38.59000,Hometown Health,HMO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,outpatient,,,67.00000,38.59000,Hometown Health,HMO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,inpatient,,,40.00000,23.04000,Hometown Health,HMO,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,outpatient,,,40.00000,23.04000,Hometown Health,HMO,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,inpatient,,,71.00000,40.90000,Hometown Health,HMO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,outpatient,,,71.00000,40.90000,Hometown Health,HMO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,inpatient,,,80.00000,46.08000,Hometown Health,HMO,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,outpatient,,,80.00000,46.08000,Hometown Health,HMO,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,inpatient,,,72.00000,41.47000,Hometown Health,HMO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,outpatient,,,72.00000,41.47000,Hometown Health,HMO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,inpatient,,,444.00000,255.74000,Hometown Health,HMO,,399.60,,,,,,,399.60,430.68,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,outpatient,,,444.00000,255.74000,Hometown Health,HMO,,399.60,,,,,,,115.44,430.68,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,inpatient,,,81.00000,46.66000,Hometown Health,HMO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,outpatient,,,81.00000,46.66000,Hometown Health,HMO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,inpatient,,,66.00000,38.02000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,outpatient,,,66.00000,38.02000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,inpatient,,,57.00000,32.83000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,outpatient,,,57.00000,32.83000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,HMO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,HMO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,inpatient,,,40.00000,23.04000,Hometown Health,HMO,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,outpatient,,,40.00000,23.04000,Hometown Health,HMO,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,inpatient,,,42.00000,24.19000,Hometown Health,HMO,,37.80,,,,,,,37.80,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,outpatient,,,42.00000,24.19000,Hometown Health,HMO,,37.80,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,inpatient,,,46.00000,26.50000,Hometown Health,HMO,,41.40,,,,,,,41.40,44.62,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,outpatient,,,46.00000,26.50000,Hometown Health,HMO,,41.40,,,,,,,11.96,44.62,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,inpatient,,,54.00000,31.10000,Hometown Health,HMO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,outpatient,,,54.00000,31.10000,Hometown Health,HMO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,inpatient,,,71.00000,40.90000,Hometown Health,HMO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,outpatient,,,71.00000,40.90000,Hometown Health,HMO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,inpatient,,,54.00000,31.10000,Hometown Health,HMO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,outpatient,,,54.00000,31.10000,Hometown Health,HMO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,inpatient,,,80.00000,46.08000,Hometown Health,HMO,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,outpatient,,,80.00000,46.08000,Hometown Health,HMO,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,inpatient,,,124.00000,71.42000,Hometown Health,HMO,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Hometown Health,HMO,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,inpatient,,,130.00000,74.88000,Hometown Health,HMO,,117.00,,,,,,,117.00,126.10,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,outpatient,,,130.00000,74.88000,Hometown Health,HMO,,117.00,,,,,,,33.80,126.10,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,inpatient,,,123.00000,70.85000,Hometown Health,HMO,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Hometown Health,HMO,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,inpatient,,,77.00000,44.35000,Hometown Health,HMO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,outpatient,,,77.00000,44.35000,Hometown Health,HMO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,inpatient,,,115.00000,66.24000,Hometown Health,HMO,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,outpatient,,,115.00000,66.24000,Hometown Health,HMO,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,inpatient,,,123.00000,70.85000,Hometown Health,HMO,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Hometown Health,HMO,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,inpatient,,,161.00000,92.74000,Hometown Health,HMO,,144.90,,,,,,,144.90,156.17,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,outpatient,,,161.00000,92.74000,Hometown Health,HMO,,144.90,,,,,,,41.86,156.17,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,inpatient,,,124.00000,71.42000,Hometown Health,HMO,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Hometown Health,HMO,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,inpatient,,,102.00000,58.75000,Hometown Health,HMO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,outpatient,,,102.00000,58.75000,Hometown Health,HMO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,inpatient,,,219.00000,126.14000,Hometown Health,HMO,,197.10,,,,,,,197.10,212.43,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,outpatient,,,219.00000,126.14000,Hometown Health,HMO,,197.10,,,,,,,56.94,212.43,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,inpatient,,,194.00000,111.74000,Hometown Health,HMO,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Hometown Health,HMO,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,inpatient,,,103.00000,59.33000,Hometown Health,HMO,,92.70,,,,,,,92.70,99.91,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,outpatient,,,103.00000,59.33000,Hometown Health,HMO,,92.70,,,,,,,26.78,99.91,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,inpatient,,,837.00000,482.11000,Hometown Health,HMO,,753.30,,,,,,,753.30,811.89,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,outpatient,,,837.00000,482.11000,Hometown Health,HMO,,753.30,,,,,,,217.62,811.89,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,inpatient,,,194.00000,111.74000,Hometown Health,HMO,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Hometown Health,HMO,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,inpatient,,,78.00000,44.93000,Hometown Health,HMO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,outpatient,,,78.00000,44.93000,Hometown Health,HMO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,inpatient,,,285.00000,164.16000,Hometown Health,HMO,,256.50,,,,,,,256.50,276.45,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,outpatient,,,285.00000,164.16000,Hometown Health,HMO,,256.50,,,,,,,74.10,276.45,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,inpatient,,,190.00000,109.44000,Hometown Health,HMO,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,outpatient,,,190.00000,109.44000,Hometown Health,HMO,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,inpatient,,,100.00000,57.60000,Hometown Health,HMO,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,outpatient,,,100.00000,57.60000,Hometown Health,HMO,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,inpatient,,,40.00000,23.04000,Hometown Health,HMO,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Hometown Health,HMO,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,inpatient,,,67.00000,38.59000,Hometown Health,HMO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,outpatient,,,67.00000,38.59000,Hometown Health,HMO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,inpatient,,,78.00000,44.93000,Hometown Health,HMO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,outpatient,,,78.00000,44.93000,Hometown Health,HMO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,inpatient,,,57.00000,32.83000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,outpatient,,,57.00000,32.83000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,inpatient,,,72.00000,41.47000,Hometown Health,HMO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,outpatient,,,72.00000,41.47000,Hometown Health,HMO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,inpatient,,,72.00000,41.47000,Hometown Health,HMO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,outpatient,,,72.00000,41.47000,Hometown Health,HMO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,inpatient,,,239.00000,137.66000,Hometown Health,HMO,,215.10,,,,,,,215.10,231.83,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,outpatient,,,239.00000,137.66000,Hometown Health,HMO,,215.10,,,,,,,62.14,231.83,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,inpatient,,,85.00000,48.96000,Hometown Health,HMO,,76.50,,,,,,,76.50,82.45,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,outpatient,,,85.00000,48.96000,Hometown Health,HMO,,76.50,,,,,,,22.10,82.45,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,inpatient,,,44.00000,25.34000,Hometown Health,HMO,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,outpatient,,,44.00000,25.34000,Hometown Health,HMO,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,inpatient,,,40.00000,23.04000,Hometown Health,HMO,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,outpatient,,,40.00000,23.04000,Hometown Health,HMO,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,HMO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,HMO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,inpatient,,,68.00000,39.17000,Hometown Health,HMO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,outpatient,,,68.00000,39.17000,Hometown Health,HMO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,inpatient,,,76.00000,43.78000,Hometown Health,HMO,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,outpatient,,,76.00000,43.78000,Hometown Health,HMO,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,inpatient,,,42.00000,24.19000,Hometown Health,HMO,,37.80,,,,,,,37.80,40.74,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,outpatient,,,42.00000,24.19000,Hometown Health,HMO,,37.80,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,inpatient,,,87.00000,50.11000,Hometown Health,HMO,,78.30,,,,,,,78.30,84.39,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,outpatient,,,87.00000,50.11000,Hometown Health,HMO,,78.30,,,,,,,22.62,84.39,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,inpatient,,,503.00000,289.73000,Hometown Health,HMO,,452.70,,,,,,,452.70,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,outpatient,,,503.00000,289.73000,Hometown Health,HMO,,452.70,,,,,,,130.78,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,inpatient,,,472.00000,271.87000,Hometown Health,HMO,,424.80,,,,,,,424.80,457.84,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,outpatient,,,472.00000,271.87000,Hometown Health,HMO,,424.80,,,,,,,122.72,457.84,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,inpatient,,,28.00000,16.13000,Hometown Health,HMO,,25.20,,,,,,,25.20,27.16,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,outpatient,,,28.00000,16.13000,Hometown Health,HMO,,25.20,,,,,,,7.28,27.16,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,inpatient,,,236.00000,135.94000,Hometown Health,HMO,,212.40,,,,,,,212.40,228.92,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,outpatient,,,236.00000,135.94000,Hometown Health,HMO,,212.40,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,inpatient,,,54.00000,31.10000,Hometown Health,HMO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,outpatient,,,54.00000,31.10000,Hometown Health,HMO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,inpatient,,,238.00000,137.09000,Hometown Health,HMO,,214.20,,,,,,,214.20,230.86,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,outpatient,,,238.00000,137.09000,Hometown Health,HMO,,214.20,,,,,,,61.88,230.86,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,inpatient,,,236.00000,135.94000,Hometown Health,HMO,,212.40,,,,,,,212.40,228.92,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,outpatient,,,236.00000,135.94000,Hometown Health,HMO,,212.40,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,inpatient,,,145.00000,83.52000,Hometown Health,HMO,,130.50,,,,,,,130.50,140.65,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,outpatient,,,145.00000,83.52000,Hometown Health,HMO,,130.50,,,,,,,37.70,140.65,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,inpatient,,,68.00000,39.17000,Hometown Health,HMO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Hometown Health,HMO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,inpatient,,,68.00000,39.17000,Hometown Health,HMO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Hometown Health,HMO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,inpatient,,,66.00000,38.02000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,outpatient,,,66.00000,38.02000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,inpatient,,,158.00000,91.01000,Hometown Health,HMO,,142.20,,,,,,,142.20,153.26,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,outpatient,,,158.00000,91.01000,Hometown Health,HMO,,142.20,,,,,,,41.08,153.26,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,inpatient,,,71.00000,40.90000,Hometown Health,HMO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,outpatient,,,71.00000,40.90000,Hometown Health,HMO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,inpatient,,,144.00000,82.94000,Hometown Health,HMO,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,outpatient,,,144.00000,82.94000,Hometown Health,HMO,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,inpatient,,,1448.00000,834.05000,Hometown Health,HMO,,1303.20,,,,,,,1303.20,1404.56,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,outpatient,,,1448.00000,834.05000,Hometown Health,HMO,,1303.20,,,,,,,376.48,1404.56,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,inpatient,,,72.00000,41.47000,Hometown Health,HMO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,outpatient,,,72.00000,41.47000,Hometown Health,HMO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,inpatient,,,102.00000,58.75000,Hometown Health,HMO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,outpatient,,,102.00000,58.75000,Hometown Health,HMO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,inpatient,,,154.00000,88.70000,Hometown Health,HMO,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,outpatient,,,154.00000,88.70000,Hometown Health,HMO,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Hometown Health,HMO,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Hometown Health,HMO,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,inpatient,,,66.00000,38.02000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,outpatient,,,66.00000,38.02000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Hometown Health,HMO,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Hometown Health,HMO,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,inpatient,,,44.00000,25.34000,Hometown Health,HMO,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,outpatient,,,44.00000,25.34000,Hometown Health,HMO,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,inpatient,,,150.00000,86.40000,Hometown Health,HMO,,135.00,,,,,,,135.00,145.50,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,outpatient,,,150.00000,86.40000,Hometown Health,HMO,,135.00,,,,,,,39.00,145.50,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,inpatient,,,66.00000,38.02000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,outpatient,,,66.00000,38.02000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,inpatient,,,58.00000,33.41000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,outpatient,,,58.00000,33.41000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,inpatient,,,71.00000,40.90000,Hometown Health,HMO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,outpatient,,,71.00000,40.90000,Hometown Health,HMO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,inpatient,,,72.00000,41.47000,Hometown Health,HMO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,outpatient,,,72.00000,41.47000,Hometown Health,HMO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,inpatient,,,39.00000,22.46000,Hometown Health,HMO,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,outpatient,,,39.00000,22.46000,Hometown Health,HMO,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Hometown Health,HMO,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Hometown Health,HMO,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,inpatient,,,73.00000,42.05000,Hometown Health,HMO,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,outpatient,,,73.00000,42.05000,Hometown Health,HMO,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,inpatient,,,127.00000,73.15000,Hometown Health,HMO,,114.30,,,,,,,114.30,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Hometown Health,HMO,,114.30,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,inpatient,,,127.00000,73.15000,Hometown Health,HMO,,114.30,,,,,,,114.30,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Hometown Health,HMO,,114.30,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,inpatient,,,372.00000,214.27000,Hometown Health,HMO,,334.80,,,,,,,334.80,360.84,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,outpatient,,,372.00000,214.27000,Hometown Health,HMO,,334.80,,,,,,,96.72,360.84,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,inpatient,,,69.00000,39.74000,Hometown Health,HMO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,outpatient,,,69.00000,39.74000,Hometown Health,HMO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Hometown Health,HMO,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Hometown Health,HMO,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Hometown Health,HMO,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Hometown Health,HMO,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,inpatient,,,57.00000,32.83000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,outpatient,,,57.00000,32.83000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,inpatient,,,96.00000,55.30000,Hometown Health,HMO,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,outpatient,,,96.00000,55.30000,Hometown Health,HMO,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,inpatient,,,44.00000,25.34000,Hometown Health,HMO,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,outpatient,,,44.00000,25.34000,Hometown Health,HMO,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,inpatient,,,74.00000,42.62000,Hometown Health,HMO,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,outpatient,,,74.00000,42.62000,Hometown Health,HMO,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,inpatient,,,69.00000,39.74000,Hometown Health,HMO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,outpatient,,,69.00000,39.74000,Hometown Health,HMO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Hometown Health,HMO,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Hometown Health,HMO,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,HMO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,HMO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Hometown Health,HMO,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Hometown Health,HMO,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Hometown Health,HMO,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Hometown Health,HMO,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,inpatient,,,70.00000,40.32000,Hometown Health,HMO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,outpatient,,,70.00000,40.32000,Hometown Health,HMO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,inpatient,,,71.00000,40.90000,Hometown Health,HMO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,outpatient,,,71.00000,40.90000,Hometown Health,HMO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,HMO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,inpatient,,,325.00000,187.20000,Hometown Health,HMO,,292.50,,,,,,,292.50,315.25,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,outpatient,,,325.00000,187.20000,Hometown Health,HMO,,292.50,,,,,,,84.50,315.25,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,inpatient,,,72.00000,41.47000,Hometown Health,HMO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,outpatient,,,72.00000,41.47000,Hometown Health,HMO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,inpatient,,,72.00000,41.47000,Hometown Health,HMO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,outpatient,,,72.00000,41.47000,Hometown Health,HMO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,inpatient,,,76.00000,43.78000,Hometown Health,HMO,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,outpatient,,,76.00000,43.78000,Hometown Health,HMO,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,inpatient,,,240.00000,138.24000,Hometown Health,HMO,,216.00,,,,,,,216.00,232.80,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,outpatient,,,240.00000,138.24000,Hometown Health,HMO,,216.00,,,,,,,62.40,232.80,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,inpatient,,,93.00000,53.57000,Hometown Health,HMO,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,outpatient,,,93.00000,53.57000,Hometown Health,HMO,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,inpatient,,,81.00000,46.66000,Hometown Health,HMO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,outpatient,,,81.00000,46.66000,Hometown Health,HMO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,inpatient,,,58.00000,33.41000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,outpatient,,,58.00000,33.41000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,inpatient,,,21.00000,12.10000,Hometown Health,HMO,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,outpatient,,,21.00000,12.10000,Hometown Health,HMO,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,inpatient,,,64.00000,36.86000,Hometown Health,HMO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,outpatient,,,64.00000,36.86000,Hometown Health,HMO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,inpatient,,,80.00000,46.08000,Hometown Health,HMO,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,outpatient,,,80.00000,46.08000,Hometown Health,HMO,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,inpatient,,,109.00000,62.78000,Hometown Health,HMO,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,outpatient,,,109.00000,62.78000,Hometown Health,HMO,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,inpatient,,,115.00000,66.24000,Hometown Health,HMO,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,outpatient,,,115.00000,66.24000,Hometown Health,HMO,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,inpatient,,,57.00000,32.83000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,outpatient,,,57.00000,32.83000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,inpatient,,,118.00000,67.97000,Hometown Health,HMO,,106.20,,,,,,,106.20,114.46,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,outpatient,,,118.00000,67.97000,Hometown Health,HMO,,106.20,,,,,,,30.68,114.46,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,inpatient,,,268.00000,154.37000,Hometown Health,HMO,,241.20,,,,,,,241.20,259.96,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,outpatient,,,268.00000,154.37000,Hometown Health,HMO,,241.20,,,,,,,69.68,259.96,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,inpatient,,,114.00000,65.66000,Hometown Health,HMO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Hometown Health,HMO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,inpatient,,,114.00000,65.66000,Hometown Health,HMO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Hometown Health,HMO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,inpatient,,,78.00000,44.93000,Hometown Health,HMO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,outpatient,,,78.00000,44.93000,Hometown Health,HMO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,inpatient,,,91.00000,52.42000,Hometown Health,HMO,,81.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,outpatient,,,91.00000,52.42000,Hometown Health,HMO,,81.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,inpatient,,,66.00000,38.02000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,inpatient,,,66.00000,38.02000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,inpatient,,,300.00000,172.80000,Hometown Health,HMO,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,outpatient,,,300.00000,172.80000,Hometown Health,HMO,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,inpatient,,,185.00000,106.56000,Hometown Health,HMO,,166.50,,,,,,,166.50,179.45,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,outpatient,,,185.00000,106.56000,Hometown Health,HMO,,166.50,,,,,,,48.10,179.45,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Hometown Health,HMO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Hometown Health,HMO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,inpatient,,,76.00000,43.78000,Hometown Health,HMO,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,outpatient,,,76.00000,43.78000,Hometown Health,HMO,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Hometown Health,HMO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Hometown Health,HMO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Hometown Health,HMO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Hometown Health,HMO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,HMO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,HMO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,inpatient,,,77.00000,44.35000,Hometown Health,HMO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,outpatient,,,77.00000,44.35000,Hometown Health,HMO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Hometown Health,HMO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Hometown Health,HMO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,inpatient,,,222.00000,127.87000,Hometown Health,HMO,,199.80,,,,,,,199.80,215.34,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,outpatient,,,222.00000,127.87000,Hometown Health,HMO,,199.80,,,,,,,57.72,215.34,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,inpatient,,,292.00000,168.19000,Hometown Health,HMO,,262.80,,,,,,,262.80,283.24,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,outpatient,,,292.00000,168.19000,Hometown Health,HMO,,262.80,,,,,,,75.92,283.24,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,inpatient,,,125.00000,72.00000,Hometown Health,HMO,,112.50,,,,,,,112.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Hometown Health,HMO,,112.50,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,inpatient,,,125.00000,72.00000,Hometown Health,HMO,,112.50,,,,,,,112.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Hometown Health,HMO,,112.50,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,inpatient,,,359.00000,206.78000,Hometown Health,HMO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,outpatient,,,359.00000,206.78000,Hometown Health,HMO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,inpatient,,,111.00000,63.94000,Hometown Health,HMO,,99.90,,,,,,,99.90,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,outpatient,,,111.00000,63.94000,Hometown Health,HMO,,99.90,,,,,,,28.86,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,inpatient,,,141.00000,81.22000,Hometown Health,HMO,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Hometown Health,HMO,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,inpatient,,,141.00000,81.22000,Hometown Health,HMO,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Hometown Health,HMO,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,inpatient,,,114.00000,65.66000,Hometown Health,HMO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Hometown Health,HMO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,inpatient,,,114.00000,65.66000,Hometown Health,HMO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Hometown Health,HMO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,inpatient,,,114.00000,65.66000,Hometown Health,HMO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Hometown Health,HMO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,inpatient,,,114.00000,65.66000,Hometown Health,HMO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Hometown Health,HMO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,inpatient,,,78.00000,44.93000,Hometown Health,HMO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,outpatient,,,78.00000,44.93000,Hometown Health,HMO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,inpatient,,,359.00000,206.78000,Hometown Health,HMO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Hometown Health,HMO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,inpatient,,,359.00000,206.78000,Hometown Health,HMO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Hometown Health,HMO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,inpatient,,,70.00000,40.32000,Hometown Health,HMO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,outpatient,,,70.00000,40.32000,Hometown Health,HMO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,inpatient,,,18.00000,10.37000,Hometown Health,HMO,,16.20,,,,,,,16.20,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,outpatient,,,18.00000,10.37000,Hometown Health,HMO,,16.20,,,,,,,4.68,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,inpatient,,,408.00000,235.01000,Hometown Health,HMO,,367.20,,,,,,,367.20,395.76,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,outpatient,,,408.00000,235.01000,Hometown Health,HMO,,367.20,,,,,,,106.08,395.76,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,inpatient,,,102.00000,58.75000,Hometown Health,HMO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,outpatient,,,102.00000,58.75000,Hometown Health,HMO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,inpatient,,,330.00000,190.08000,Hometown Health,HMO,,297.00,,,,,,,297.00,320.10,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,outpatient,,,330.00000,190.08000,Hometown Health,HMO,,297.00,,,,,,,85.80,320.10,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,inpatient,,,136.00000,78.34000,Hometown Health,HMO,,122.40,,,,,,,122.40,131.92,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,outpatient,,,136.00000,78.34000,Hometown Health,HMO,,122.40,,,,,,,35.36,131.92,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,inpatient,,,83.00000,47.81000,Hometown Health,HMO,,74.70,,,,,,,74.70,80.51,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,outpatient,,,83.00000,47.81000,Hometown Health,HMO,,74.70,,,,,,,21.58,80.51,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,inpatient,,,142.00000,81.79000,Hometown Health,HMO,,127.80,,,,,,,127.80,137.74,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,outpatient,,,142.00000,81.79000,Hometown Health,HMO,,127.80,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,inpatient,,,51.00000,29.38000,Hometown Health,HMO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,outpatient,,,51.00000,29.38000,Hometown Health,HMO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,inpatient,,,70.00000,40.32000,Hometown Health,HMO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,outpatient,,,70.00000,40.32000,Hometown Health,HMO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,inpatient,,,99.00000,57.02000,Hometown Health,HMO,,89.10,,,,,,,89.10,96.03,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,outpatient,,,99.00000,57.02000,Hometown Health,HMO,,89.10,,,,,,,25.74,96.03,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,inpatient,,,78.00000,44.93000,Hometown Health,HMO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,outpatient,,,78.00000,44.93000,Hometown Health,HMO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,inpatient,,,75.00000,43.20000,Hometown Health,HMO,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,outpatient,,,75.00000,43.20000,Hometown Health,HMO,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,inpatient,,,37.00000,21.31000,Hometown Health,HMO,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Hometown Health,HMO,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,inpatient,,,37.00000,21.31000,Hometown Health,HMO,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Hometown Health,HMO,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,inpatient,,,35.00000,20.16000,Hometown Health,HMO,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,outpatient,,,35.00000,20.16000,Hometown Health,HMO,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,inpatient,,,74.00000,42.62000,Hometown Health,HMO,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,outpatient,,,74.00000,42.62000,Hometown Health,HMO,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,inpatient,,,90.00000,51.84000,Hometown Health,HMO,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,outpatient,,,90.00000,51.84000,Hometown Health,HMO,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,inpatient,,,68.00000,39.17000,Hometown Health,HMO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Hometown Health,HMO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,inpatient,,,142.00000,81.79000,Hometown Health,HMO,,127.80,,,,,,,127.80,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,outpatient,,,142.00000,81.79000,Hometown Health,HMO,,127.80,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,inpatient,,,68.00000,39.17000,Hometown Health,HMO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Hometown Health,HMO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,inpatient,,,74.00000,42.62000,Hometown Health,HMO,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,outpatient,,,74.00000,42.62000,Hometown Health,HMO,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,inpatient,,,89.00000,51.26000,Hometown Health,HMO,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Hometown Health,HMO,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,inpatient,,,89.00000,51.26000,Hometown Health,HMO,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Hometown Health,HMO,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,inpatient,,,57.00000,32.83000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,outpatient,,,57.00000,32.83000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,inpatient,,,77.00000,44.35000,Hometown Health,HMO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,outpatient,,,77.00000,44.35000,Hometown Health,HMO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,inpatient,,,64.00000,36.86000,Hometown Health,HMO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,outpatient,,,64.00000,36.86000,Hometown Health,HMO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,inpatient,,,69.00000,39.74000,Hometown Health,HMO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,outpatient,,,69.00000,39.74000,Hometown Health,HMO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,inpatient,,,1178.00000,678.53000,Hometown Health,HMO,,1060.20,,,,,,,1060.20,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,outpatient,,,1178.00000,678.53000,Hometown Health,HMO,,1060.20,,,,,,,306.28,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,inpatient,,,127.00000,73.15000,Hometown Health,HMO,,114.30,,,,,,,114.30,123.19,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,outpatient,,,127.00000,73.15000,Hometown Health,HMO,,114.30,,,,,,,33.02,123.19,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,inpatient,,,277.00000,159.55000,Hometown Health,HMO,,249.30,,,,,,,249.30,268.69,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,outpatient,,,277.00000,159.55000,Hometown Health,HMO,,249.30,,,,,,,72.02,268.69,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,inpatient,,,940.00000,541.44000,Hometown Health,HMO,,846.00,,,,,,,846.00,911.80,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,outpatient,,,940.00000,541.44000,Hometown Health,HMO,,846.00,,,,,,,244.40,911.80,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,inpatient,,,97.00000,55.87000,Hometown Health,HMO,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,outpatient,,,97.00000,55.87000,Hometown Health,HMO,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,inpatient,,,16.00000,9.22000,Hometown Health,HMO,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,outpatient,,,16.00000,9.22000,Hometown Health,HMO,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,inpatient,,,57.00000,32.83000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,outpatient,,,57.00000,32.83000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,inpatient,,,131.00000,75.46000,Hometown Health,HMO,,117.90,,,,,,,117.90,127.07,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,outpatient,,,131.00000,75.46000,Hometown Health,HMO,,117.90,,,,,,,34.06,127.07,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,inpatient,,,2160.00000,1244.16000,Hometown Health,HMO,,1944.00,,,,,,,1944.00,2095.20,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,outpatient,,,2160.00000,1244.16000,Hometown Health,HMO,,1944.00,,,,,,,561.60,2095.20,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,inpatient,,,37.00000,21.31000,Hometown Health,HMO,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,outpatient,,,37.00000,21.31000,Hometown Health,HMO,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,inpatient,,,74.00000,42.62000,Hometown Health,HMO,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Hometown Health,HMO,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,inpatient,,,54.00000,31.10000,Hometown Health,HMO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,outpatient,,,54.00000,31.10000,Hometown Health,HMO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,inpatient,,,76.00000,43.78000,Hometown Health,HMO,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,outpatient,,,76.00000,43.78000,Hometown Health,HMO,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,inpatient,,,606.00000,349.06000,Hometown Health,HMO,,545.40,,,,,,,545.40,587.82,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,outpatient,,,606.00000,349.06000,Hometown Health,HMO,,545.40,,,,,,,157.56,587.82,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,inpatient,,,300.00000,172.80000,Hometown Health,HMO,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,outpatient,,,300.00000,172.80000,Hometown Health,HMO,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,inpatient,,,98.00000,56.45000,Hometown Health,HMO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,outpatient,,,98.00000,56.45000,Hometown Health,HMO,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,inpatient,,,128.00000,73.73000,Hometown Health,HMO,,115.20,,,,,,,115.20,124.16,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,outpatient,,,128.00000,73.73000,Hometown Health,HMO,,115.20,,,,,,,33.28,124.16,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,HMO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,HMO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,inpatient,,,16.00000,9.22000,Hometown Health,HMO,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,outpatient,,,16.00000,9.22000,Hometown Health,HMO,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,inpatient,,,565.00000,325.44000,Hometown Health,HMO,,508.50,,,,,,,508.50,548.05,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,outpatient,,,565.00000,325.44000,Hometown Health,HMO,,508.50,,,,,,,146.90,548.05,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,inpatient,,,850.00000,489.60000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,outpatient,,,850.00000,489.60000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,inpatient,,,77.00000,44.35000,Hometown Health,HMO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,outpatient,,,77.00000,44.35000,Hometown Health,HMO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,inpatient,,,86.00000,49.54000,Hometown Health,HMO,,77.40,,,,,,,77.40,83.42,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,outpatient,,,86.00000,49.54000,Hometown Health,HMO,,77.40,,,,,,,22.36,83.42,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,inpatient,,,837.00000,482.11000,Hometown Health,HMO,,753.30,,,,,,,753.30,811.89,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,outpatient,,,837.00000,482.11000,Hometown Health,HMO,,753.30,,,,,,,217.62,811.89,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,inpatient,,,74.00000,42.62000,Hometown Health,HMO,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Hometown Health,HMO,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,HMO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,HMO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,HMO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,HMO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,inpatient,,,167.00000,96.19000,Hometown Health,HMO,,150.30,,,,,,,150.30,161.99,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,outpatient,,,167.00000,96.19000,Hometown Health,HMO,,150.30,,,,,,,43.42,161.99,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,inpatient,,,200.00000,115.20000,Hometown Health,HMO,,180.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,outpatient,,,200.00000,115.20000,Hometown Health,HMO,,180.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,inpatient,,,93.00000,53.57000,Hometown Health,HMO,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,outpatient,,,93.00000,53.57000,Hometown Health,HMO,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,HMO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,inpatient,,,190.00000,109.44000,Hometown Health,HMO,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,outpatient,,,190.00000,109.44000,Hometown Health,HMO,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,inpatient,,,64.00000,36.86000,Hometown Health,HMO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,outpatient,,,64.00000,36.86000,Hometown Health,HMO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,inpatient,,,525.00000,302.40000,Hometown Health,HMO,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,outpatient,,,525.00000,302.40000,Hometown Health,HMO,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,inpatient,,,54.00000,31.10000,Hometown Health,HMO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,outpatient,,,54.00000,31.10000,Hometown Health,HMO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,HMO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,HMO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,HMO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,HMO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,inpatient,,,40.00000,23.04000,Hometown Health,HMO,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Hometown Health,HMO,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,inpatient,,,453.00000,260.93000,Hometown Health,HMO,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,outpatient,,,453.00000,260.93000,Hometown Health,HMO,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,inpatient,,,25.00000,14.40000,Hometown Health,HMO,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,outpatient,,,25.00000,14.40000,Hometown Health,HMO,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,HMO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,HMO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,inpatient,,,350.00000,201.60000,Hometown Health,HMO,,315.00,,,,,,,315.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,outpatient,,,350.00000,201.60000,Hometown Health,HMO,,315.00,,,,,,,91.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,inpatient,,,225.00000,129.60000,Hometown Health,HMO,,202.50,,,,,,,202.50,218.25,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,outpatient,,,225.00000,129.60000,Hometown Health,HMO,,202.50,,,,,,,58.50,218.25,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,inpatient,,,52.00000,29.95000,Hometown Health,HMO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,outpatient,,,52.00000,29.95000,Hometown Health,HMO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,inpatient,,,134.00000,77.18000,Hometown Health,HMO,,120.60,,,,,,,120.60,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,outpatient,,,134.00000,77.18000,Hometown Health,HMO,,120.60,,,,,,,34.84,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,inpatient,,,52.00000,29.95000,Hometown Health,HMO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,outpatient,,,52.00000,29.95000,Hometown Health,HMO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,inpatient,,,186.00000,107.14000,Hometown Health,HMO,,167.40,,,,,,,167.40,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,outpatient,,,186.00000,107.14000,Hometown Health,HMO,,167.40,,,,,,,48.36,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,inpatient,,,300.00000,172.80000,Hometown Health,HMO,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Hometown Health,HMO,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,inpatient,,,300.00000,172.80000,Hometown Health,HMO,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Hometown Health,HMO,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,inpatient,,,205.00000,118.08000,Hometown Health,HMO,,184.50,,,,,,,184.50,198.85,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,outpatient,,,205.00000,118.08000,Hometown Health,HMO,,184.50,,,,,,,53.30,198.85,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,inpatient,,,75.00000,36.15000,Hometown Health,HMO,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,outpatient,,,75.00000,36.15000,Hometown Health,HMO,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,inpatient,,,65.00000,31.33000,Hometown Health,HMO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,outpatient,,,65.00000,31.33000,Hometown Health,HMO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,inpatient,,,92.00000,44.34000,Hometown Health,HMO,,82.80,,,,,,,82.80,89.24,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,outpatient,,,92.00000,44.34000,Hometown Health,HMO,,82.80,,,,,,,23.92,89.24,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,inpatient,,,24.00000,11.57000,Hometown Health,HMO,,21.60,,,,,,,21.60,23.28,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Hometown Health,HMO,,21.60,,,,,,,6.24,23.28,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,inpatient,,,20.00000,9.64000,Hometown Health,HMO,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,outpatient,,,20.00000,9.64000,Hometown Health,HMO,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,inpatient,,,42.00000,20.24000,Hometown Health,HMO,,37.80,,,,,,,37.80,40.74,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,outpatient,,,42.00000,20.24000,Hometown Health,HMO,,37.80,,,,,,,10.92,40.74,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,HMO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,HMO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,inpatient,,,65.00000,31.33000,Hometown Health,HMO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,outpatient,,,65.00000,31.33000,Hometown Health,HMO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,inpatient,,,76.00000,36.63000,Hometown Health,HMO,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,outpatient,,,76.00000,36.63000,Hometown Health,HMO,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,inpatient,,,89.00000,42.90000,Hometown Health,HMO,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,outpatient,,,89.00000,42.90000,Hometown Health,HMO,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,inpatient,,,76.00000,36.63000,Hometown Health,HMO,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,outpatient,,,76.00000,36.63000,Hometown Health,HMO,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,inpatient,,,28.00000,13.50000,Hometown Health,HMO,,25.20,,,,,,,25.20,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,outpatient,,,28.00000,13.50000,Hometown Health,HMO,,25.20,,,,,,,7.28,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,inpatient,,,98.00000,47.24000,Hometown Health,HMO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,outpatient,,,98.00000,47.24000,Hometown Health,HMO,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,HMO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,HMO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,inpatient,,,75.00000,36.15000,Hometown Health,HMO,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,outpatient,,,75.00000,36.15000,Hometown Health,HMO,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,inpatient,,,76.00000,36.63000,Hometown Health,HMO,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,outpatient,,,76.00000,36.63000,Hometown Health,HMO,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,inpatient,,,114.00000,54.95000,Hometown Health,HMO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,outpatient,,,114.00000,54.95000,Hometown Health,HMO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,inpatient,,,74.00000,35.67000,Hometown Health,HMO,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,outpatient,,,74.00000,35.67000,Hometown Health,HMO,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,HMO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,HMO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,inpatient,,,74.00000,35.67000,Hometown Health,HMO,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,outpatient,,,74.00000,35.67000,Hometown Health,HMO,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,inpatient,,,87.00000,41.93000,Hometown Health,HMO,,78.30,,,,,,,78.30,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,outpatient,,,87.00000,41.93000,Hometown Health,HMO,,78.30,,,,,,,22.62,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,inpatient,,,79.00000,38.08000,Hometown Health,HMO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,outpatient,,,79.00000,38.08000,Hometown Health,HMO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,inpatient,,,75.00000,36.15000,Hometown Health,HMO,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,outpatient,,,75.00000,36.15000,Hometown Health,HMO,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,HMO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,HMO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,inpatient,,,164.00000,79.05000,Hometown Health,HMO,,147.60,,,,,,,147.60,159.08,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,outpatient,,,164.00000,79.05000,Hometown Health,HMO,,147.60,,,,,,,42.64,159.08,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,HMO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,HMO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,inpatient,,,8.00000,3.86000,Hometown Health,HMO,,7.20,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,outpatient,,,8.00000,3.86000,Hometown Health,HMO,,7.20,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,HMO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,HMO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,inpatient,,,8.00000,3.86000,Hometown Health,HMO,,7.20,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,outpatient,,,8.00000,3.86000,Hometown Health,HMO,,7.20,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,inpatient,,,8.00000,3.86000,Hometown Health,HMO,,7.20,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,outpatient,,,8.00000,3.86000,Hometown Health,HMO,,7.20,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,inpatient,,,14.00000,6.75000,Hometown Health,HMO,,12.60,,,,,,,12.60,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,outpatient,,,14.00000,6.75000,Hometown Health,HMO,,12.60,,,,,,,3.64,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,inpatient,,,112.00000,53.98000,Hometown Health,HMO,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,outpatient,,,112.00000,53.98000,Hometown Health,HMO,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,inpatient,,,13.00000,6.27000,Hometown Health,HMO,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,outpatient,,,13.00000,6.27000,Hometown Health,HMO,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,inpatient,,,31.00000,14.94000,Hometown Health,HMO,,27.90,,,,,,,27.90,30.07,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,outpatient,,,31.00000,14.94000,Hometown Health,HMO,,27.90,,,,,,,8.06,30.07,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,inpatient,,,92.00000,44.34000,Hometown Health,HMO,,82.80,,,,,,,82.80,89.24,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,outpatient,,,92.00000,44.34000,Hometown Health,HMO,,82.80,,,,,,,23.92,89.24,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,inpatient,,,80.00000,38.56000,Hometown Health,HMO,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,outpatient,,,80.00000,38.56000,Hometown Health,HMO,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,inpatient,,,30.00000,14.46000,Hometown Health,HMO,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Hometown Health,HMO,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,inpatient,,,30.00000,14.46000,Hometown Health,HMO,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Hometown Health,HMO,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,inpatient,,,24.00000,11.57000,Hometown Health,HMO,,21.60,,,,,,,21.60,23.28,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Hometown Health,HMO,,21.60,,,,,,,6.24,23.28,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,inpatient,,,29.00000,13.98000,Hometown Health,HMO,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,outpatient,,,29.00000,13.98000,Hometown Health,HMO,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,inpatient,,,97.00000,46.75000,Hometown Health,HMO,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,outpatient,,,97.00000,46.75000,Hometown Health,HMO,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,inpatient,,,225.00000,108.45000,Hometown Health,HMO,,202.50,,,,,,,202.50,218.25,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,outpatient,,,225.00000,108.45000,Hometown Health,HMO,,202.50,,,,,,,58.50,218.25,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,HMO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,HMO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,HMO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,HMO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,inpatient,,,108.00000,52.06000,Hometown Health,HMO,,97.20,,,,,,,97.20,104.76,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,outpatient,,,108.00000,52.06000,Hometown Health,HMO,,97.20,,,,,,,28.08,104.76,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,HMO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,HMO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,inpatient,,,19.00000,9.16000,Hometown Health,HMO,,17.10,,,,,,,17.10,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,outpatient,,,19.00000,9.16000,Hometown Health,HMO,,17.10,,,,,,,4.94,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,HMO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,HMO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,inpatient,,,103.00000,49.65000,Hometown Health,HMO,,92.70,,,,,,,92.70,99.91,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,outpatient,,,103.00000,49.65000,Hometown Health,HMO,,92.70,,,,,,,26.78,99.91,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,inpatient,,,9.00000,4.34000,Hometown Health,HMO,,8.10,,,,,,,8.10,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,outpatient,,,9.00000,4.34000,Hometown Health,HMO,,8.10,,,,,,,2.34,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,inpatient,,,13.00000,6.27000,Hometown Health,HMO,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,outpatient,,,13.00000,6.27000,Hometown Health,HMO,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,inpatient,,,80.00000,38.56000,Hometown Health,HMO,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,outpatient,,,80.00000,38.56000,Hometown Health,HMO,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,inpatient,,,47.00000,22.65000,Hometown Health,HMO,,42.30,,,,,,,42.30,45.59,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,outpatient,,,47.00000,22.65000,Hometown Health,HMO,,42.30,,,,,,,12.22,45.59,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,inpatient,,,91.00000,43.86000,Hometown Health,HMO,,81.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,outpatient,,,91.00000,43.86000,Hometown Health,HMO,,81.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,inpatient,,,18.00000,8.68000,Hometown Health,HMO,,16.20,,,,,,,16.20,17.46,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,outpatient,,,18.00000,8.68000,Hometown Health,HMO,,16.20,,,,,,,4.68,17.46,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,inpatient,,,21.00000,11.15000,Hometown Health,HMO,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Hometown Health,HMO,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,inpatient,,,71.00000,37.70000,Hometown Health,HMO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,outpatient,,,71.00000,37.70000,Hometown Health,HMO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,inpatient,,,21.00000,11.15000,Hometown Health,HMO,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Hometown Health,HMO,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,inpatient,,,128.00000,67.97000,Hometown Health,HMO,,115.20,,,,,,,115.20,124.16,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,outpatient,,,128.00000,67.97000,Hometown Health,HMO,,115.20,,,,,,,33.28,124.16,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,inpatient,,,65.00000,34.52000,Hometown Health,HMO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,outpatient,,,65.00000,34.52000,Hometown Health,HMO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,HMO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,HMO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,inpatient,,,31.00000,16.46000,Hometown Health,HMO,,27.90,,,,,,,27.90,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,outpatient,,,31.00000,16.46000,Hometown Health,HMO,,27.90,,,,,,,8.06,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,HMO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,HMO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,HMO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,HMO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,HMO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,HMO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,inpatient,,,61.00000,32.39000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,outpatient,,,61.00000,32.39000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,HMO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,HMO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,inpatient,,,25.00000,13.28000,Hometown Health,HMO,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Hometown Health,HMO,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,inpatient,,,25.00000,13.28000,Hometown Health,HMO,91,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Hometown Health,HMO,91,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,inpatient,,,103.00000,54.69000,Hometown Health,HMO,,92.70,,,,,,,92.70,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,outpatient,,,103.00000,54.69000,Hometown Health,HMO,,92.70,,,,,,,26.78,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,inpatient,,,96.00000,50.98000,Hometown Health,HMO,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,outpatient,,,96.00000,50.98000,Hometown Health,HMO,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,inpatient,,,75.00000,39.83000,Hometown Health,HMO,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,outpatient,,,75.00000,39.83000,Hometown Health,HMO,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,inpatient,,,68.00000,36.11000,Hometown Health,HMO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,outpatient,,,68.00000,36.11000,Hometown Health,HMO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,inpatient,,,61.00000,32.39000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,outpatient,,,61.00000,32.39000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,HMO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,HMO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,HMO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,HMO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,inpatient,,,29.00000,15.40000,Hometown Health,HMO,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,outpatient,,,29.00000,15.40000,Hometown Health,HMO,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Hometown Health,HMO,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Hometown Health,HMO,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Hometown Health,HMO,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Hometown Health,HMO,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,inpatient,,,63.00000,33.45000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,outpatient,,,63.00000,33.45000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,inpatient,,,79.00000,41.95000,Hometown Health,HMO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,outpatient,,,79.00000,41.95000,Hometown Health,HMO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,inpatient,,,63.00000,33.45000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,outpatient,,,63.00000,33.45000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Hometown Health,HMO,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Hometown Health,HMO,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,inpatient,,,112.00000,59.47000,Hometown Health,HMO,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,outpatient,,,112.00000,59.47000,Hometown Health,HMO,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,HMO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,HMO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,inpatient,,,25.00000,13.28000,Hometown Health,HMO,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,outpatient,,,25.00000,13.28000,Hometown Health,HMO,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,inpatient,,,118.00000,62.66000,Hometown Health,HMO,,106.20,,,,,,,106.20,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,outpatient,,,118.00000,62.66000,Hometown Health,HMO,,106.20,,,,,,,30.68,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,inpatient,,,29.00000,15.40000,Hometown Health,HMO,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,outpatient,,,29.00000,15.40000,Hometown Health,HMO,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,inpatient,,,25.00000,13.28000,Hometown Health,HMO,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,outpatient,,,25.00000,13.28000,Hometown Health,HMO,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,HMO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,HMO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,inpatient,,,25.00000,13.28000,Hometown Health,HMO,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,outpatient,,,25.00000,13.28000,Hometown Health,HMO,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,inpatient,,,71.00000,37.70000,Hometown Health,HMO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,outpatient,,,71.00000,37.70000,Hometown Health,HMO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,inpatient,,,59.00000,31.33000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,outpatient,,,59.00000,31.33000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,inpatient,,,62.00000,32.92000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,outpatient,,,62.00000,32.92000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,inpatient,,,138.00000,73.28000,Hometown Health,HMO,,124.20,,,,,,,124.20,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,outpatient,,,138.00000,73.28000,Hometown Health,HMO,,124.20,,,,,,,35.88,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,inpatient,,,62.00000,32.92000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,outpatient,,,62.00000,32.92000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,inpatient,,,78.00000,41.42000,Hometown Health,HMO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,outpatient,,,78.00000,41.42000,Hometown Health,HMO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,inpatient,,,69.00000,36.64000,Hometown Health,HMO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,outpatient,,,69.00000,36.64000,Hometown Health,HMO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,inpatient,,,88.00000,46.73000,Hometown Health,HMO,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,outpatient,,,88.00000,46.73000,Hometown Health,HMO,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,inpatient,,,64.00000,33.98000,Hometown Health,HMO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,outpatient,,,64.00000,33.98000,Hometown Health,HMO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,inpatient,,,63.00000,33.45000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,outpatient,,,63.00000,33.45000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,inpatient,,,137.00000,72.75000,Hometown Health,HMO,,123.30,,,,,,,123.30,132.89,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,outpatient,,,137.00000,72.75000,Hometown Health,HMO,,123.30,,,,,,,35.62,132.89,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,inpatient,,,347.00000,184.26000,Hometown Health,HMO,,312.30,,,,,,,312.30,336.59,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,outpatient,,,347.00000,184.26000,Hometown Health,HMO,,312.30,,,,,,,90.22,336.59,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,inpatient,,,57.00000,30.27000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,outpatient,,,57.00000,30.27000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,inpatient,,,56.00000,29.74000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,outpatient,,,56.00000,29.74000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,inpatient,,,16.00000,8.50000,Hometown Health,HMO,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,outpatient,,,16.00000,8.50000,Hometown Health,HMO,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,inpatient,,,85.00000,45.14000,Hometown Health,HMO,,76.50,,,,,,,76.50,82.45,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,outpatient,,,85.00000,45.14000,Hometown Health,HMO,,76.50,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,inpatient,,,34.00000,18.05000,Hometown Health,HMO,,30.60,,,,,,,30.60,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,outpatient,,,34.00000,18.05000,Hometown Health,HMO,,30.60,,,,,,,8.84,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,inpatient,,,231.00000,122.66000,Hometown Health,HMO,,207.90,,,,,,,207.90,224.07,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,outpatient,,,231.00000,122.66000,Hometown Health,HMO,,207.90,,,,,,,60.06,224.07,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,inpatient,,,36.00000,19.12000,Hometown Health,HMO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,outpatient,,,36.00000,19.12000,Hometown Health,HMO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,inpatient,,,61.00000,32.39000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,outpatient,,,61.00000,32.39000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,inpatient,,,111.00000,58.94000,Hometown Health,HMO,,99.90,,,,,,,99.90,107.67,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,outpatient,,,111.00000,58.94000,Hometown Health,HMO,,99.90,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,inpatient,,,61.00000,32.39000,Hometown Health,HMO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,outpatient,,,61.00000,32.39000,Hometown Health,HMO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,inpatient,,,36.00000,19.12000,Hometown Health,HMO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,outpatient,,,36.00000,19.12000,Hometown Health,HMO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,inpatient,,,76.00000,40.36000,Hometown Health,HMO,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,outpatient,,,76.00000,40.36000,Hometown Health,HMO,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,inpatient,,,152.00000,80.71000,Hometown Health,HMO,,136.80,,,,,,,136.80,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,outpatient,,,152.00000,80.71000,Hometown Health,HMO,,136.80,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,inpatient,,,78.00000,41.42000,Hometown Health,HMO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,outpatient,,,78.00000,41.42000,Hometown Health,HMO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,inpatient,,,42.00000,22.30000,Hometown Health,HMO,,37.80,,,,,,,37.80,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,outpatient,,,42.00000,22.30000,Hometown Health,HMO,,37.80,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,inpatient,,,73.00000,38.76000,Hometown Health,HMO,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,outpatient,,,73.00000,38.76000,Hometown Health,HMO,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,inpatient,,,97.00000,51.51000,Hometown Health,HMO,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,outpatient,,,97.00000,51.51000,Hometown Health,HMO,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,inpatient,,,157.00000,83.37000,Hometown Health,HMO,,141.30,,,,,,,141.30,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,outpatient,,,157.00000,83.37000,Hometown Health,HMO,,141.30,,,,,,,40.82,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,inpatient,,,36.00000,19.12000,Hometown Health,HMO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,outpatient,,,36.00000,19.12000,Hometown Health,HMO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,inpatient,,,66.00000,35.05000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,outpatient,,,66.00000,35.05000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,inpatient,,,58.00000,30.80000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,outpatient,,,58.00000,30.80000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,inpatient,,,85.00000,45.14000,Hometown Health,HMO,,76.50,,,,,,,76.50,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,outpatient,,,85.00000,45.14000,Hometown Health,HMO,,76.50,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,inpatient,,,59.00000,31.33000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,outpatient,,,59.00000,31.33000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,inpatient,,,175.00000,92.93000,Hometown Health,HMO,,157.50,,,,,,,157.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,outpatient,,,175.00000,92.93000,Hometown Health,HMO,,157.50,,,,,,,45.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,inpatient,,,152.00000,80.71000,Hometown Health,HMO,,136.80,,,,,,,136.80,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,outpatient,,,152.00000,80.71000,Hometown Health,HMO,,136.80,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,inpatient,,,43.00000,22.83000,Hometown Health,HMO,,38.70,,,,,,,38.70,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,outpatient,,,43.00000,22.83000,Hometown Health,HMO,,38.70,,,,,,,11.18,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,inpatient,,,66.00000,35.05000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,outpatient,,,66.00000,35.05000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,inpatient,,,36.00000,19.12000,Hometown Health,HMO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,outpatient,,,36.00000,19.12000,Hometown Health,HMO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,inpatient,,,36.00000,19.12000,Hometown Health,HMO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,outpatient,,,36.00000,19.12000,Hometown Health,HMO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,inpatient,,,42.00000,22.30000,Hometown Health,HMO,,37.80,,,,,,,37.80,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,outpatient,,,42.00000,22.30000,Hometown Health,HMO,,37.80,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,inpatient,,,147.00000,78.06000,Hometown Health,HMO,,132.30,,,,,,,132.30,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,outpatient,,,147.00000,78.06000,Hometown Health,HMO,,132.30,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,inpatient,,,64.00000,33.98000,Hometown Health,HMO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,outpatient,,,64.00000,33.98000,Hometown Health,HMO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,inpatient,,,75.00000,39.83000,Hometown Health,HMO,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,outpatient,,,75.00000,39.83000,Hometown Health,HMO,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,inpatient,,,44.00000,23.36000,Hometown Health,HMO,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,outpatient,,,44.00000,23.36000,Hometown Health,HMO,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,inpatient,,,87.00000,46.20000,Hometown Health,HMO,,78.30,,,,,,,78.30,84.39,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,outpatient,,,87.00000,46.20000,Hometown Health,HMO,,78.30,,,,,,,22.62,84.39,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,inpatient,,,65.00000,34.52000,Hometown Health,HMO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,outpatient,,,65.00000,34.52000,Hometown Health,HMO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,inpatient,,,75.00000,39.83000,Hometown Health,HMO,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,outpatient,,,75.00000,39.83000,Hometown Health,HMO,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,inpatient,,,50.00000,26.55000,Hometown Health,HMO,,45.00,,,,,,,45.00,48.50,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,outpatient,,,50.00000,26.55000,Hometown Health,HMO,,45.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,inpatient,,,40.00000,21.24000,Hometown Health,HMO,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,outpatient,,,40.00000,21.24000,Hometown Health,HMO,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,inpatient,,,50.00000,26.55000,Hometown Health,HMO,,45.00,,,,,,,45.00,48.50,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,outpatient,,,50.00000,26.55000,Hometown Health,HMO,,45.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,inpatient,,,115.00000,61.07000,Hometown Health,HMO,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,outpatient,,,115.00000,61.07000,Hometown Health,HMO,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,inpatient,,,1309.00000,695.08000,Hometown Health,HMO,,1178.10,,,,,,,1178.10,1269.73,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1309.00000,695.08000,Hometown Health,HMO,,1178.10,,,,,,,340.34,1269.73,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,inpatient,,,328.00000,174.17000,Hometown Health,HMO,,295.20,,,,,,,295.20,318.16,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,outpatient,,,328.00000,174.17000,Hometown Health,HMO,,295.20,,,,,,,85.28,318.16,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,inpatient,,,115.00000,61.07000,Hometown Health,HMO,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,outpatient,,,115.00000,61.07000,Hometown Health,HMO,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,inpatient,,,1251.00000,664.28000,Hometown Health,HMO,,1125.90,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,outpatient,,,1251.00000,664.28000,Hometown Health,HMO,,1125.90,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,inpatient,,,154.00000,81.77000,Hometown Health,HMO,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Hometown Health,HMO,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,inpatient,,,154.00000,81.77000,Hometown Health,HMO,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Hometown Health,HMO,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,inpatient,,,96.00000,50.98000,Hometown Health,HMO,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,outpatient,,,96.00000,50.98000,Hometown Health,HMO,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,inpatient,,,211.00000,112.04000,Hometown Health,HMO,,189.90,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,outpatient,,,211.00000,112.04000,Hometown Health,HMO,,189.90,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,inpatient,,,290.00000,153.99000,Hometown Health,HMO,,261.00,,,,,,,261.00,281.30,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,outpatient,,,290.00000,153.99000,Hometown Health,HMO,,261.00,,,,,,,75.40,281.30,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,inpatient,,,411.00000,218.24000,Hometown Health,HMO,,369.90,,,,,,,369.90,398.67,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,outpatient,,,411.00000,218.24000,Hometown Health,HMO,,369.90,,,,,,,106.86,398.67,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,inpatient,,,139.00000,73.81000,Hometown Health,HMO,,125.10,,,,,,,125.10,134.83,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,outpatient,,,139.00000,73.81000,Hometown Health,HMO,,125.10,,,,,,,36.14,134.83,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,inpatient,,,288.00000,152.93000,Hometown Health,HMO,,259.20,,,,,,,259.20,279.36,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,outpatient,,,288.00000,152.93000,Hometown Health,HMO,,259.20,,,,,,,74.88,279.36,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,inpatient,,,1372.00000,728.53000,Hometown Health,HMO,,1234.80,,,,,,,1234.80,1330.84,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1372.00000,728.53000,Hometown Health,HMO,,1234.80,,,,,,,356.72,1330.84,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,inpatient,,,1251.00000,664.28000,Hometown Health,HMO,,1125.90,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,outpatient,,,1251.00000,664.28000,Hometown Health,HMO,,1125.90,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,inpatient,,,135.00000,71.68000,Hometown Health,HMO,,121.50,,,,,,,121.50,130.95,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,outpatient,,,135.00000,71.68000,Hometown Health,HMO,,121.50,,,,,,,35.10,130.95,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,inpatient,,,147.00000,78.06000,Hometown Health,HMO,,132.30,,,,,,,132.30,142.59,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,outpatient,,,147.00000,78.06000,Hometown Health,HMO,,132.30,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,inpatient,,,126.00000,66.91000,Hometown Health,HMO,,113.40,,,,,,,113.40,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,outpatient,,,126.00000,66.91000,Hometown Health,HMO,,113.40,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,inpatient,,,120.00000,63.72000,Hometown Health,HMO,,108.00,,,,,,,108.00,116.40,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,outpatient,,,120.00000,63.72000,Hometown Health,HMO,,108.00,,,,,,,31.20,116.40,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,inpatient,,,124.00000,65.84000,Hometown Health,HMO,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,outpatient,,,124.00000,65.84000,Hometown Health,HMO,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,inpatient,,,108.00000,57.35000,Hometown Health,HMO,,97.20,,,,,,,97.20,104.76,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,outpatient,,,108.00000,57.35000,Hometown Health,HMO,,97.20,,,,,,,28.08,104.76,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,inpatient,,,256.00000,135.94000,Hometown Health,HMO,,230.40,,,,,,,230.40,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Hometown Health,HMO,,230.40,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,inpatient,,,256.00000,135.94000,Hometown Health,HMO,,230.40,,,,,,,230.40,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Hometown Health,HMO,,230.40,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,inpatient,,,122.00000,64.78000,Hometown Health,HMO,,109.80,,,,,,,109.80,118.34,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,outpatient,,,122.00000,64.78000,Hometown Health,HMO,,109.80,,,,,,,31.72,118.34,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,inpatient,,,123.00000,65.31000,Hometown Health,HMO,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,outpatient,,,123.00000,65.31000,Hometown Health,HMO,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,inpatient,,,518.00000,275.06000,Hometown Health,HMO,,466.20,,,,,,,466.20,502.46,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,outpatient,,,518.00000,275.06000,Hometown Health,HMO,,466.20,,,,,,,134.68,502.46,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,inpatient,,,275.00000,146.02000,Hometown Health,HMO,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,outpatient,,,275.00000,146.02000,Hometown Health,HMO,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,inpatient,,,270.00000,143.37000,Hometown Health,HMO,,243.00,,,,,,,243.00,261.90,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,outpatient,,,270.00000,143.37000,Hometown Health,HMO,,243.00,,,,,,,70.20,261.90,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,inpatient,,,450.00000,238.95000,Hometown Health,HMO,,405.00,,,,,,,405.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,outpatient,,,450.00000,238.95000,Hometown Health,HMO,,405.00,,,,,,,117.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,inpatient,,,126.00000,66.91000,Hometown Health,HMO,,113.40,,,,,,,113.40,122.22,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,outpatient,,,126.00000,66.91000,Hometown Health,HMO,,113.40,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,inpatient,,,362.00000,192.22000,Hometown Health,HMO,,325.80,,,,,,,325.80,351.14,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,outpatient,,,362.00000,192.22000,Hometown Health,HMO,,325.80,,,,,,,94.12,351.14,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,inpatient,,,109.00000,57.88000,Hometown Health,HMO,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Hometown Health,HMO,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,inpatient,,,638.00000,338.78000,Hometown Health,HMO,,574.20,,,,,,,574.20,618.86,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,outpatient,,,638.00000,338.78000,Hometown Health,HMO,,574.20,,,,,,,165.88,618.86,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,inpatient,,,211.00000,112.04000,Hometown Health,HMO,,189.90,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,outpatient,,,211.00000,112.04000,Hometown Health,HMO,,189.90,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,inpatient,,,154.00000,81.77000,Hometown Health,HMO,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,outpatient,,,154.00000,81.77000,Hometown Health,HMO,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,inpatient,,,141.00000,74.87000,Hometown Health,HMO,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,outpatient,,,141.00000,74.87000,Hometown Health,HMO,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,inpatient,,,2040.00000,1083.24000,Hometown Health,HMO,,1836.00,,,,,,,1836.00,1978.80,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,outpatient,,,2040.00000,1083.24000,Hometown Health,HMO,,1836.00,,,,,,,530.40,1978.80,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,inpatient,,,421.00000,223.55000,Hometown Health,HMO,,378.90,,,,,,,378.90,408.37,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,outpatient,,,421.00000,223.55000,Hometown Health,HMO,,378.90,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,inpatient,,,275.00000,146.02000,Hometown Health,HMO,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,outpatient,,,275.00000,146.02000,Hometown Health,HMO,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,inpatient,,,1251.00000,664.28000,Hometown Health,HMO,,1125.90,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,outpatient,,,1251.00000,664.28000,Hometown Health,HMO,,1125.90,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,inpatient,,,428.00000,227.27000,Hometown Health,HMO,,385.20,,,,,,,385.20,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Hometown Health,HMO,,385.20,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,inpatient,,,428.00000,227.27000,Hometown Health,HMO,,385.20,,,,,,,385.20,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Hometown Health,HMO,,385.20,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,inpatient,,,655.00000,347.80000,Hometown Health,HMO,,589.50,,,,,,,589.50,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Hometown Health,HMO,,589.50,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,inpatient,,,655.00000,347.80000,Hometown Health,HMO,,589.50,,,,,,,589.50,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Hometown Health,HMO,,589.50,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,inpatient,,,211.00000,112.04000,Hometown Health,HMO,,189.90,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,outpatient,,,211.00000,112.04000,Hometown Health,HMO,,189.90,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,inpatient,,,112.00000,59.47000,Hometown Health,HMO,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Hometown Health,HMO,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,inpatient,,,112.00000,59.47000,Hometown Health,HMO,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Hometown Health,HMO,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,inpatient,,,130.00000,69.03000,Hometown Health,HMO,,117.00,,,,,,,117.00,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,outpatient,,,130.00000,69.03000,Hometown Health,HMO,,117.00,,,,,,,33.80,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,inpatient,,,421.00000,223.55000,Hometown Health,HMO,,378.90,,,,,,,378.90,408.37,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,outpatient,,,421.00000,223.55000,Hometown Health,HMO,,378.90,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,inpatient,,,111.00000,58.94000,Hometown Health,HMO,,99.90,,,,,,,99.90,107.67,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,outpatient,,,111.00000,58.94000,Hometown Health,HMO,,99.90,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,inpatient,,,200.00000,106.20000,Hometown Health,HMO,,180.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,outpatient,,,200.00000,106.20000,Hometown Health,HMO,,180.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,HMO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,inpatient,,,13.00000,6.90000,Hometown Health,HMO,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,outpatient,,,13.00000,6.90000,Hometown Health,HMO,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,inpatient,,,58.00000,30.80000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,outpatient,,,58.00000,30.80000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,inpatient,,,13.00000,6.90000,Hometown Health,HMO,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,outpatient,,,13.00000,6.90000,Hometown Health,HMO,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,inpatient,,,773.00000,410.46000,Hometown Health,HMO,,695.70,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,outpatient,,,773.00000,410.46000,Hometown Health,HMO,,695.70,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,inpatient,,,773.00000,410.46000,Hometown Health,HMO,,695.70,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,outpatient,,,773.00000,410.46000,Hometown Health,HMO,,695.70,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,inpatient,,,773.00000,410.46000,Hometown Health,HMO,,695.70,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,outpatient,,,773.00000,410.46000,Hometown Health,HMO,,695.70,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,inpatient,,,773.00000,410.46000,Hometown Health,HMO,,695.70,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,outpatient,,,773.00000,410.46000,Hometown Health,HMO,,695.70,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,inpatient,,,387.00000,205.50000,Hometown Health,HMO,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,outpatient,,,387.00000,205.50000,Hometown Health,HMO,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,inpatient,,,52.00000,27.61000,Hometown Health,HMO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,outpatient,,,52.00000,27.61000,Hometown Health,HMO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,inpatient,,,102.00000,54.16000,Hometown Health,HMO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Hometown Health,HMO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,inpatient,,,102.00000,54.16000,Hometown Health,HMO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Hometown Health,HMO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,inpatient,,,79.00000,41.95000,Hometown Health,HMO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,outpatient,,,79.00000,41.95000,Hometown Health,HMO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,inpatient,,,65.00000,34.52000,Hometown Health,HMO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,outpatient,,,65.00000,34.52000,Hometown Health,HMO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,inpatient,,,100.00000,53.10000,Hometown Health,HMO,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,outpatient,,,100.00000,53.10000,Hometown Health,HMO,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,inpatient,,,64.00000,33.98000,Hometown Health,HMO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,outpatient,,,64.00000,33.98000,Hometown Health,HMO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,inpatient,,,109.00000,57.88000,Hometown Health,HMO,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Hometown Health,HMO,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,inpatient,,,58.00000,30.80000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,outpatient,,,58.00000,30.80000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Hometown Health,HMO,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Hometown Health,HMO,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,inpatient,,,66.00000,35.05000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,outpatient,,,66.00000,35.05000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Hometown Health,HMO,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Hometown Health,HMO,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Hometown Health,HMO,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Hometown Health,HMO,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Hometown Health,HMO,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Hometown Health,HMO,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,inpatient,,,13.00000,6.90000,Hometown Health,HMO,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,outpatient,,,13.00000,6.90000,Hometown Health,HMO,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,inpatient,,,53.00000,28.14000,Hometown Health,HMO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,outpatient,,,53.00000,28.14000,Hometown Health,HMO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,inpatient,,,18.00000,9.56000,Hometown Health,HMO,,16.20,,,,,,,16.20,17.46,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,outpatient,,,18.00000,9.56000,Hometown Health,HMO,,16.20,,,,,,,4.68,17.46,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,inpatient,,,17.00000,9.03000,Hometown Health,HMO,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,outpatient,,,17.00000,9.03000,Hometown Health,HMO,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,inpatient,,,71.00000,37.70000,Hometown Health,HMO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,outpatient,,,71.00000,37.70000,Hometown Health,HMO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,inpatient,,,57.00000,30.27000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,outpatient,,,57.00000,30.27000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,inpatient,,,68.00000,36.11000,Hometown Health,HMO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,outpatient,,,68.00000,36.11000,Hometown Health,HMO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,inpatient,,,58.00000,30.80000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,outpatient,,,58.00000,30.80000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,inpatient,,,27.00000,14.34000,Hometown Health,HMO,,24.30,,,,,,,24.30,26.19,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,outpatient,,,27.00000,14.34000,Hometown Health,HMO,,24.30,,,,,,,7.02,26.19,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,inpatient,,,56.00000,29.74000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,outpatient,,,56.00000,29.74000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,inpatient,,,56.00000,29.74000,Hometown Health,HMO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,outpatient,,,56.00000,29.74000,Hometown Health,HMO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,inpatient,,,58.00000,30.80000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,outpatient,,,58.00000,30.80000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,inpatient,,,115.00000,61.07000,Hometown Health,HMO,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,outpatient,,,115.00000,61.07000,Hometown Health,HMO,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,inpatient,,,23.00000,12.21000,Hometown Health,HMO,,20.70,,,,,,,20.70,22.31,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,outpatient,,,23.00000,12.21000,Hometown Health,HMO,,20.70,,,,,,,5.98,22.31,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,inpatient,,,255.00000,135.40000,Hometown Health,HMO,,229.50,,,,,,,229.50,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,outpatient,,,255.00000,135.40000,Hometown Health,HMO,,229.50,,,,,,,66.30,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,inpatient,,,66.00000,35.05000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,outpatient,,,66.00000,35.05000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,HMO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,HMO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,inpatient,,,64.00000,33.98000,Hometown Health,HMO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,outpatient,,,64.00000,33.98000,Hometown Health,HMO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,inpatient,,,215.00000,114.16000,Hometown Health,HMO,,193.50,,,,,,,193.50,208.55,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,outpatient,,,215.00000,114.16000,Hometown Health,HMO,,193.50,,,,,,,55.90,208.55,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,inpatient,,,79.00000,41.95000,Hometown Health,HMO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,outpatient,,,79.00000,41.95000,Hometown Health,HMO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,inpatient,,,11.00000,5.29000,Hometown Health,HMO,,9.90,,,,,,,9.90,10.67,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,outpatient,,,11.00000,5.29000,Hometown Health,HMO,,9.90,,,,,,,2.86,10.67,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,inpatient,,,58.00000,27.90000,Hometown Health,HMO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,outpatient,,,58.00000,27.90000,Hometown Health,HMO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,inpatient,,,10.00000,4.81000,Hometown Health,HMO,,9.00,,,,,,,9.00,9.70,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,outpatient,,,10.00000,4.81000,Hometown Health,HMO,,9.00,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,inpatient,,,7.00000,3.37000,Hometown Health,HMO,,6.30,,,,,,,6.30,6.79,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,outpatient,,,7.00000,3.37000,Hometown Health,HMO,,6.30,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,inpatient,,,53.00000,25.49000,Hometown Health,HMO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,outpatient,,,53.00000,25.49000,Hometown Health,HMO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,inpatient,,,10.00000,4.81000,Hometown Health,HMO,,9.00,,,,,,,9.00,9.70,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,outpatient,,,10.00000,4.81000,Hometown Health,HMO,,9.00,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,inpatient,,,11.00000,5.29000,Hometown Health,HMO,,9.90,,,,,,,9.90,10.67,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Hometown Health,HMO,,9.90,,,,,,,2.86,10.67,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,inpatient,,,7.00000,3.37000,Hometown Health,HMO,,6.30,,,,,,,6.30,6.79,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,outpatient,,,7.00000,3.37000,Hometown Health,HMO,,6.30,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,inpatient,,,11.00000,5.29000,Hometown Health,HMO,,9.90,,,,,,,9.90,10.67,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Hometown Health,HMO,,9.90,,,,,,,2.86,10.67,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,inpatient,,,597.00000,290.14000,Hometown Health,HMO,,537.30,,,,,,,537.30,579.09,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,outpatient,,,597.00000,290.14000,Hometown Health,HMO,,537.30,,,,,,,155.22,579.09,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,inpatient,,,6379.00000,3100.19000,Hometown Health,HMO,,5741.10,,,,,,,5741.10,6187.63,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,outpatient,,,6379.00000,3100.19000,Hometown Health,HMO,,5741.10,,,,,,,1658.54,6187.63,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,inpatient,,,471.00000,228.91000,Hometown Health,HMO,,423.90,,,,,,,423.90,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,outpatient,,,471.00000,228.91000,Hometown Health,HMO,,423.90,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,inpatient,,,471.00000,228.91000,Hometown Health,HMO,,423.90,,,,,,,423.90,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,outpatient,,,471.00000,228.91000,Hometown Health,HMO,,423.90,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,inpatient,,,1251.00000,607.99000,Hometown Health,HMO,,1125.90,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,outpatient,,,1251.00000,607.99000,Hometown Health,HMO,,1125.90,,,,,,,325.26,1213.47,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,inpatient,,,260.00000,126.36000,Hometown Health,HMO,,234.00,,,,,,,234.00,252.20,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,outpatient,,,260.00000,126.36000,Hometown Health,HMO,,234.00,,,,,,,67.60,252.20,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,inpatient,,,785.00000,381.51000,Hometown Health,HMO,,706.50,,,,,,,706.50,761.45,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,outpatient,,,785.00000,381.51000,Hometown Health,HMO,,706.50,,,,,,,204.10,761.45,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,inpatient,,,529.00000,257.09000,Hometown Health,HMO,,476.10,,,,,,,476.10,513.13,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,outpatient,,,529.00000,257.09000,Hometown Health,HMO,,476.10,,,,,,,137.54,513.13,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,inpatient,,,1623.00000,788.78000,Hometown Health,HMO,,1460.70,,,,,,,1460.70,1574.31,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,outpatient,,,1623.00000,788.78000,Hometown Health,HMO,,1460.70,,,,,,,421.98,1574.31,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,inpatient,,,10800.00000,5248.80000,Hometown Health,HMO,,9720.00,,,,,,,9720.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,outpatient,,,10800.00000,5248.80000,Hometown Health,HMO,,9720.00,,,,,,,2808.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,inpatient,,,25365.00000,12327.39000,Hometown Health,HMO,,22828.50,,,,,,,22828.50,24604.05,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,outpatient,,,25365.00000,12327.39000,Hometown Health,HMO,,22828.50,,,,,,,6594.90,24604.05,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,inpatient,,,101.00000,21.82000,Hometown Health,HMO,,90.90,,,,,,,90.90,97.97,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,outpatient,,,101.00000,21.82000,Hometown Health,HMO,,90.90,,,,,,,26.26,97.97,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,inpatient,,,81.00000,17.50000,Hometown Health,HMO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,outpatient,,,81.00000,17.50000,Hometown Health,HMO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,inpatient,,,104.00000,22.46000,Hometown Health,HMO,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,outpatient,,,104.00000,22.46000,Hometown Health,HMO,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,inpatient,,,377.00000,81.43000,Hometown Health,HMO,,339.30,,,,,,,339.30,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,outpatient,,,377.00000,81.43000,Hometown Health,HMO,,339.30,,,,,,,98.02,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,inpatient,,,532.00000,114.91000,Hometown Health,HMO,,478.80,,,,,,,478.80,516.04,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,outpatient,,,532.00000,114.91000,Hometown Health,HMO,,478.80,,,,,,,138.32,516.04,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,inpatient,,,521.00000,112.54000,Hometown Health,HMO,,468.90,,,,,,,468.90,505.37,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,outpatient,,,521.00000,112.54000,Hometown Health,HMO,,468.90,,,,,,,135.46,505.37,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,inpatient,,,451.00000,97.42000,Hometown Health,HMO,,405.90,,,,,,,405.90,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,outpatient,,,451.00000,97.42000,Hometown Health,HMO,,405.90,,,,,,,117.26,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,inpatient,,,1148.00000,247.97000,Hometown Health,HMO,,1033.20,,,,,,,1033.20,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,outpatient,,,1148.00000,247.97000,Hometown Health,HMO,,1033.20,,,,,,,298.48,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,inpatient,,,350.00000,75.60000,Hometown Health,HMO,,315.00,,,,,,,315.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,outpatient,,,350.00000,75.60000,Hometown Health,HMO,,315.00,,,,,,,91.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,inpatient,,,423.00000,91.37000,Hometown Health,HMO,,380.70,,,,,,,380.70,410.31,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,outpatient,,,423.00000,91.37000,Hometown Health,HMO,,380.70,,,,,,,109.98,410.31,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,inpatient,,,751.00000,162.22000,Hometown Health,HMO,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Hometown Health,HMO,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,inpatient,,,751.00000,162.22000,Hometown Health,HMO,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Hometown Health,HMO,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,inpatient,,,119.00000,25.70000,Hometown Health,HMO,,107.10,,,,,,,107.10,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,outpatient,,,119.00000,25.70000,Hometown Health,HMO,,107.10,,,,,,,30.94,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,inpatient,,,126.00000,27.22000,Hometown Health,HMO,,113.40,,,,,,,113.40,122.22,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,outpatient,,,126.00000,27.22000,Hometown Health,HMO,,113.40,,,,,,,32.76,122.22,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,inpatient,,,110.00000,23.76000,Hometown Health,HMO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Hometown Health,HMO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,inpatient,,,110.00000,23.76000,Hometown Health,HMO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Hometown Health,HMO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,inpatient,,,79.00000,17.06000,Hometown Health,HMO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,outpatient,,,79.00000,17.06000,Hometown Health,HMO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,inpatient,,,110.00000,23.76000,Hometown Health,HMO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Hometown Health,HMO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,inpatient,,,110.00000,23.76000,Hometown Health,HMO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Hometown Health,HMO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,inpatient,,,79.00000,17.06000,Hometown Health,HMO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,outpatient,,,79.00000,17.06000,Hometown Health,HMO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,inpatient,,,335.00000,72.36000,Hometown Health,HMO,,301.50,,,,,,,301.50,324.95,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,outpatient,,,335.00000,72.36000,Hometown Health,HMO,,301.50,,,,,,,87.10,324.95,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,inpatient,,,154.00000,33.26000,Hometown Health,HMO,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Hometown Health,HMO,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,inpatient,,,154.00000,33.26000,Hometown Health,HMO,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Hometown Health,HMO,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,inpatient,,,128.00000,27.65000,Hometown Health,HMO,,115.20,,,,,,,115.20,124.16,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,outpatient,,,128.00000,27.65000,Hometown Health,HMO,,115.20,,,,,,,33.28,124.16,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,inpatient,,,65.00000,14.04000,Hometown Health,HMO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,outpatient,,,65.00000,14.04000,Hometown Health,HMO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,inpatient,,,272.00000,58.75000,Hometown Health,HMO,,244.80,,,,,,,244.80,263.84,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,outpatient,,,272.00000,58.75000,Hometown Health,HMO,,244.80,,,,,,,70.72,263.84,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,inpatient,,,26.00000,11.44000,Hometown Health,HMO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,outpatient,,,26.00000,11.44000,Hometown Health,HMO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,inpatient,,,359.00000,157.96000,Hometown Health,HMO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,outpatient,,,359.00000,157.96000,Hometown Health,HMO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,inpatient,,,189.00000,83.16000,Hometown Health,HMO,,170.10,,,,,,,170.10,183.33,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,outpatient,,,189.00000,83.16000,Hometown Health,HMO,,170.10,,,,,,,49.14,183.33,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,inpatient,,,359.00000,157.96000,Hometown Health,HMO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,outpatient,,,359.00000,157.96000,Hometown Health,HMO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,inpatient,,,137.00000,60.28000,Hometown Health,HMO,,123.30,,,,,,,123.30,132.89,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,outpatient,,,137.00000,60.28000,Hometown Health,HMO,,123.30,,,,,,,35.62,132.89,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,inpatient,,,1665.00000,732.60000,Hometown Health,HMO,,1498.50,,,,,,,1498.50,1615.05,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,outpatient,,,1665.00000,732.60000,Hometown Health,HMO,,1498.50,,,,,,,432.90,1615.05,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,inpatient,,,751.00000,330.44000,Hometown Health,HMO,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,outpatient,,,751.00000,330.44000,Hometown Health,HMO,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,inpatient,,,374.00000,164.56000,Hometown Health,HMO,,336.60,,,,,,,336.60,362.78,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,outpatient,,,374.00000,164.56000,Hometown Health,HMO,,336.60,,,,,,,97.24,362.78,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,inpatient,,,553.00000,243.32000,Hometown Health,HMO,,497.70,,,,,,,497.70,536.41,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,outpatient,,,553.00000,243.32000,Hometown Health,HMO,,497.70,,,,,,,143.78,536.41,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,inpatient,,,359.00000,157.96000,Hometown Health,HMO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,outpatient,,,359.00000,157.96000,Hometown Health,HMO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,inpatient,,,62.00000,27.28000,Hometown Health,HMO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,outpatient,,,62.00000,27.28000,Hometown Health,HMO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,inpatient,,,79.00000,34.76000,Hometown Health,HMO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,outpatient,,,79.00000,34.76000,Hometown Health,HMO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,inpatient,,,110.00000,48.40000,Hometown Health,HMO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,outpatient,,,110.00000,48.40000,Hometown Health,HMO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,inpatient,,,110.00000,48.40000,Hometown Health,HMO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,outpatient,,,110.00000,48.40000,Hometown Health,HMO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,inpatient,,,751.00000,330.44000,Hometown Health,HMO,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,outpatient,,,751.00000,330.44000,Hometown Health,HMO,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,inpatient,,,1665.00000,732.60000,Hometown Health,HMO,,1498.50,,,,,,,1498.50,1615.05,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,outpatient,,,1665.00000,732.60000,Hometown Health,HMO,,1498.50,,,,,,,432.90,1615.05,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,inpatient,,,110.00000,48.40000,Hometown Health,HMO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,outpatient,,,110.00000,48.40000,Hometown Health,HMO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,inpatient,,,281.00000,123.64000,Hometown Health,HMO,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Hometown Health,HMO,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,inpatient,,,281.00000,123.64000,Hometown Health,HMO,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Hometown Health,HMO,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,inpatient,,,451.00000,341.41000,Hometown Health,HMO,,405.90,,,,,,,405.90,437.47,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,outpatient,,,451.00000,341.41000,Hometown Health,HMO,,405.90,,,,,,,117.26,437.47,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,inpatient,,,300.00000,145.80000,Hometown Health,HMO,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,outpatient,,,300.00000,145.80000,Hometown Health,HMO,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,inpatient,,,2278.00000,1107.11000,Hometown Health,HMO,,2050.20,,,,,,,2050.20,2209.66,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,outpatient,,,2278.00000,1107.11000,Hometown Health,HMO,,2050.20,,,,,,,592.28,2209.66,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,inpatient,,,3912.00000,1901.23000,Hometown Health,HMO,,3520.80,,,,,,,3520.80,3794.64,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,outpatient,,,3912.00000,1901.23000,Hometown Health,HMO,,3520.80,,,,,,,1017.12,3794.64,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,inpatient,,,900.00000,437.40000,Hometown Health,HMO,,810.00,,,,,,,810.00,873.00,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,outpatient,,,900.00000,437.40000,Hometown Health,HMO,,810.00,,,,,,,234.00,873.00,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,inpatient,,,365.00000,177.39000,Hometown Health,HMO,,328.50,,,,,,,328.50,354.05,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,outpatient,,,365.00000,177.39000,Hometown Health,HMO,,328.50,,,,,,,94.90,354.05,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,inpatient,,,989.00000,480.65000,Hometown Health,HMO,,890.10,,,,,,,890.10,959.33,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,outpatient,,,989.00000,480.65000,Hometown Health,HMO,,890.10,,,,,,,257.14,959.33,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Hometown Health,HMO,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Hometown Health,HMO,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,inpatient,,,435.00000,211.41000,Hometown Health,HMO,,391.50,,,,,,,391.50,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Hometown Health,HMO,,391.50,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,inpatient,,,435.00000,211.41000,Hometown Health,HMO,,391.50,,,,,,,391.50,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Hometown Health,HMO,,391.50,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,inpatient,,,644.00000,312.98000,Hometown Health,HMO,,579.60,,,,,,,579.60,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,outpatient,,,644.00000,312.98000,Hometown Health,HMO,,579.60,,,,,,,167.44,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Hometown Health,HMO,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Hometown Health,HMO,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Hometown Health,HMO,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Hometown Health,HMO,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,inpatient,,,527.00000,256.12000,Hometown Health,HMO,,474.30,,,,,,,474.30,511.19,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,outpatient,,,527.00000,256.12000,Hometown Health,HMO,,474.30,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,inpatient,,,1404.00000,682.34000,Hometown Health,HMO,,1263.60,,,,,,,1263.60,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,outpatient,,,1404.00000,682.34000,Hometown Health,HMO,,1263.60,,,,,,,365.04,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,inpatient,,,5475.00000,2660.85000,Hometown Health,HMO,,4927.50,,,,,,,4927.50,5310.75,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,outpatient,,,5475.00000,2660.85000,Hometown Health,HMO,,4927.50,,,,,,,1423.50,5310.75,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,inpatient,,,726.00000,352.84000,Hometown Health,HMO,,653.40,,,,,,,653.40,704.22,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,outpatient,,,726.00000,352.84000,Hometown Health,HMO,,653.40,,,,,,,188.76,704.22,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,inpatient,,,507.00000,246.40000,Hometown Health,HMO,,456.30,,,,,,,456.30,491.79,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,outpatient,,,507.00000,246.40000,Hometown Health,HMO,,456.30,,,,,,,131.82,491.79,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,inpatient,,,1670.00000,811.62000,Hometown Health,HMO,,1503.00,,,,,,,1503.00,1619.90,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,outpatient,,,1670.00000,811.62000,Hometown Health,HMO,,1503.00,,,,,,,434.20,1619.90,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,inpatient,,,1139.00000,553.55000,Hometown Health,HMO,,1025.10,,,,,,,1025.10,1104.83,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,outpatient,,,1139.00000,553.55000,Hometown Health,HMO,,1025.10,,,,,,,296.14,1104.83,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,inpatient,,,875.00000,425.25000,Hometown Health,HMO,,787.50,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,outpatient,,,875.00000,425.25000,Hometown Health,HMO,,787.50,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,HMO,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,HMO,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,inpatient,,,1353.00000,657.56000,Hometown Health,HMO,,1217.70,,,,,,,1217.70,1312.41,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,outpatient,,,1353.00000,657.56000,Hometown Health,HMO,,1217.70,,,,,,,351.78,1312.41,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,HMO,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,HMO,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,HMO,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,HMO,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,inpatient,,,825.00000,400.95000,Hometown Health,HMO,,742.50,,,,,,,742.50,800.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,outpatient,,,825.00000,400.95000,Hometown Health,HMO,,742.50,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,HMO,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,HMO,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,HMO,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,HMO,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,inpatient,,,974.00000,473.36000,Hometown Health,HMO,,876.60,,,,,,,876.60,944.78,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,outpatient,,,974.00000,473.36000,Hometown Health,HMO,,876.60,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,inpatient,,,198.00000,96.23000,Hometown Health,HMO,,178.20,,,,,,,178.20,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Hometown Health,HMO,,178.20,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,inpatient,,,198.00000,96.23000,Hometown Health,HMO,,178.20,,,,,,,178.20,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Hometown Health,HMO,,178.20,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,inpatient,,,221.00000,107.41000,Hometown Health,HMO,,198.90,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Hometown Health,HMO,,198.90,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,inpatient,,,221.00000,107.41000,Hometown Health,HMO,,198.90,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Hometown Health,HMO,,198.90,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,inpatient,,,497.00000,241.54000,Hometown Health,HMO,,447.30,,,,,,,447.30,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,outpatient,,,497.00000,241.54000,Hometown Health,HMO,,447.30,,,,,,,129.22,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,inpatient,,,2340.00000,1137.24000,Hometown Health,HMO,,2106.00,,,,,,,2106.00,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,outpatient,,,2340.00000,1137.24000,Hometown Health,HMO,,2106.00,,,,,,,608.40,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,inpatient,,,249.00000,121.01000,Hometown Health,HMO,,224.10,,,,,,,224.10,241.53,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,outpatient,,,249.00000,121.01000,Hometown Health,HMO,,224.10,,,,,,,64.74,241.53,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,inpatient,,,135.00000,65.61000,Hometown Health,HMO,,121.50,,,,,,,121.50,130.95,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,outpatient,,,135.00000,65.61000,Hometown Health,HMO,,121.50,,,,,,,35.10,130.95,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,inpatient,,,172.00000,83.59000,Hometown Health,HMO,,154.80,,,,,,,154.80,166.84,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,outpatient,,,172.00000,83.59000,Hometown Health,HMO,,154.80,,,,,,,44.72,166.84,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,inpatient,,,307.00000,149.20000,Hometown Health,HMO,,276.30,,,,,,,276.30,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,outpatient,,,307.00000,149.20000,Hometown Health,HMO,,276.30,,,,,,,79.82,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,inpatient,,,1800.00000,874.80000,Hometown Health,HMO,,1620.00,,,,,,,1620.00,1746.00,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,outpatient,,,1800.00000,874.80000,Hometown Health,HMO,,1620.00,,,,,,,468.00,1746.00,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,inpatient,,,974.00000,473.36000,Hometown Health,HMO,,876.60,,,,,,,876.60,944.78,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,outpatient,,,974.00000,473.36000,Hometown Health,HMO,,876.60,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,inpatient,,,197.00000,95.74000,Hometown Health,HMO,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Hometown Health,HMO,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,inpatient,,,197.00000,95.74000,Hometown Health,HMO,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Hometown Health,HMO,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,inpatient,,,411.00000,199.75000,Hometown Health,HMO,,369.90,,,,,,,369.90,398.67,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,outpatient,,,411.00000,199.75000,Hometown Health,HMO,,369.90,,,,,,,106.86,398.67,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,inpatient,,,221.00000,107.41000,Hometown Health,HMO,,198.90,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,outpatient,,,221.00000,107.41000,Hometown Health,HMO,,198.90,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,inpatient,,,884.00000,429.62000,Hometown Health,HMO,,795.60,,,,,,,795.60,857.48,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,outpatient,,,884.00000,429.62000,Hometown Health,HMO,,795.60,,,,,,,229.84,857.48,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,inpatient,,,594.00000,288.68000,Hometown Health,HMO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,outpatient,,,594.00000,288.68000,Hometown Health,HMO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,inpatient,,,519.00000,252.23000,Hometown Health,HMO,,467.10,,,,,,,467.10,503.43,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,outpatient,,,519.00000,252.23000,Hometown Health,HMO,,467.10,,,,,,,134.94,503.43,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,inpatient,,,1046.00000,508.36000,Hometown Health,HMO,,941.40,,,,,,,941.40,1014.62,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,outpatient,,,1046.00000,508.36000,Hometown Health,HMO,,941.40,,,,,,,271.96,1014.62,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,inpatient,,,556.00000,270.22000,Hometown Health,HMO,,500.40,,,,,,,500.40,539.32,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,outpatient,,,556.00000,270.22000,Hometown Health,HMO,,500.40,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,inpatient,,,275.00000,133.65000,Hometown Health,HMO,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,outpatient,,,275.00000,133.65000,Hometown Health,HMO,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,inpatient,,,580.00000,281.88000,Hometown Health,HMO,,522.00,,,,,,,522.00,562.60,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,outpatient,,,580.00000,281.88000,Hometown Health,HMO,,522.00,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,inpatient,,,580.00000,281.88000,Hometown Health,HMO,,522.00,,,,,,,522.00,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,outpatient,,,580.00000,281.88000,Hometown Health,HMO,,522.00,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,inpatient,,,3480.00000,1691.28000,Hometown Health,HMO,,3132.00,,,,,,,3132.00,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Hometown Health,HMO,,3132.00,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,inpatient,,,3480.00000,1691.28000,Hometown Health,HMO,,3132.00,,,,,,,3132.00,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Hometown Health,HMO,,3132.00,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,inpatient,,,700.00000,340.20000,Hometown Health,HMO,,630.00,,,,,,,630.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,outpatient,,,700.00000,340.20000,Hometown Health,HMO,,630.00,,,,,,,182.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,inpatient,,,1427.00000,693.52000,Hometown Health,HMO,,1284.30,,,,,,,1284.30,1384.19,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,outpatient,,,1427.00000,693.52000,Hometown Health,HMO,,1284.30,,,,,,,371.02,1384.19,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,inpatient,,,614.00000,298.40000,Hometown Health,HMO,,552.60,,,,,,,552.60,595.58,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,outpatient,,,614.00000,298.40000,Hometown Health,HMO,,552.60,,,,,,,159.64,595.58,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,inpatient,,,2027.00000,985.12000,Hometown Health,HMO,,1824.30,,,,,,,1824.30,1966.19,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,outpatient,,,2027.00000,985.12000,Hometown Health,HMO,,1824.30,,,,,,,527.02,1966.19,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,inpatient,,,556.00000,270.22000,Hometown Health,HMO,,500.40,,,,,,,500.40,539.32,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,outpatient,,,556.00000,270.22000,Hometown Health,HMO,,500.40,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,inpatient,,,1146.00000,556.96000,Hometown Health,HMO,,1031.40,,,,,,,1031.40,1111.62,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,outpatient,,,1146.00000,556.96000,Hometown Health,HMO,,1031.40,,,,,,,297.96,1111.62,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,inpatient,,,197.00000,95.74000,Hometown Health,HMO,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Hometown Health,HMO,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,inpatient,,,197.00000,95.74000,Hometown Health,HMO,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Hometown Health,HMO,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,inpatient,,,527.00000,256.12000,Hometown Health,HMO,,474.30,,,,,,,474.30,511.19,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,outpatient,,,527.00000,256.12000,Hometown Health,HMO,,474.30,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,inpatient,,,740.00000,359.64000,Hometown Health,HMO,,666.00,,,,,,,666.00,717.80,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,outpatient,,,740.00000,359.64000,Hometown Health,HMO,,666.00,,,,,,,192.40,717.80,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,inpatient,,,875.00000,425.25000,Hometown Health,HMO,,787.50,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Hometown Health,HMO,,787.50,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,inpatient,,,875.00000,425.25000,Hometown Health,HMO,,787.50,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Hometown Health,HMO,,787.50,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,inpatient,,,1399.00000,679.91000,Hometown Health,HMO,,1259.10,,,,,,,1259.10,1357.03,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,outpatient,,,1399.00000,679.91000,Hometown Health,HMO,,1259.10,,,,,,,363.74,1357.03,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,inpatient,,,51.00000,24.79000,Hometown Health,HMO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,outpatient,,,51.00000,24.79000,Hometown Health,HMO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,inpatient,,,825.00000,400.95000,Hometown Health,HMO,,742.50,,,,,,,742.50,800.25,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,outpatient,,,825.00000,400.95000,Hometown Health,HMO,,742.50,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,inpatient,,,576.00000,279.94000,Hometown Health,HMO,,518.40,,,,,,,518.40,558.72,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,outpatient,,,576.00000,279.94000,Hometown Health,HMO,,518.40,,,,,,,149.76,558.72,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,inpatient,,,224.00000,108.86000,Hometown Health,HMO,,201.60,,,,,,,201.60,217.28,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,outpatient,,,224.00000,108.86000,Hometown Health,HMO,,201.60,,,,,,,58.24,217.28,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,inpatient,,,346.00000,168.16000,Hometown Health,HMO,,311.40,,,,,,,311.40,335.62,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,outpatient,,,346.00000,168.16000,Hometown Health,HMO,,311.40,,,,,,,89.96,335.62,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,HMO,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,HMO,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,HMO,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,HMO,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,HMO,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,HMO,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,HMO,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,HMO,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,inpatient,,,627.00000,304.72000,Hometown Health,HMO,,564.30,,,,,,,564.30,608.19,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,outpatient,,,627.00000,304.72000,Hometown Health,HMO,,564.30,,,,,,,163.02,608.19,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,inpatient,,,605.00000,294.03000,Hometown Health,HMO,,544.50,,,,,,,544.50,586.85,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,outpatient,,,605.00000,294.03000,Hometown Health,HMO,,544.50,,,,,,,157.30,586.85,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,inpatient,,,510.00000,247.86000,Hometown Health,HMO,,459.00,,,,,,,459.00,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,outpatient,,,510.00000,247.86000,Hometown Health,HMO,,459.00,,,,,,,132.60,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,inpatient,,,223.00000,108.38000,Hometown Health,HMO,,200.70,,,,,,,200.70,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,outpatient,,,223.00000,108.38000,Hometown Health,HMO,,200.70,,,,,,,57.98,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,inpatient,,,1211.00000,588.55000,Hometown Health,HMO,,1089.90,,,,,,,1089.90,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,outpatient,,,1211.00000,588.55000,Hometown Health,HMO,,1089.90,,,,,,,314.86,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,inpatient,,,383.00000,186.14000,Hometown Health,HMO,,344.70,,,,,,,344.70,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,outpatient,,,383.00000,186.14000,Hometown Health,HMO,,344.70,,,,,,,99.58,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,inpatient,,,1214.00000,590.00000,Hometown Health,HMO,,1092.60,,,,,,,1092.60,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,outpatient,,,1214.00000,590.00000,Hometown Health,HMO,,1092.60,,,,,,,315.64,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,inpatient,,,328.00000,159.41000,Hometown Health,HMO,,295.20,,,,,,,295.20,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,outpatient,,,328.00000,159.41000,Hometown Health,HMO,,295.20,,,,,,,85.28,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,inpatient,,,372.00000,180.79000,Hometown Health,HMO,,334.80,,,,,,,334.80,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,outpatient,,,372.00000,180.79000,Hometown Health,HMO,,334.80,,,,,,,96.72,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,inpatient,,,285.00000,138.51000,Hometown Health,HMO,,256.50,,,,,,,256.50,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,outpatient,,,285.00000,138.51000,Hometown Health,HMO,,256.50,,,,,,,74.10,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,inpatient,,,367.00000,178.36000,Hometown Health,HMO,,330.30,,,,,,,330.30,355.99,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,outpatient,,,367.00000,178.36000,Hometown Health,HMO,,330.30,,,,,,,95.42,355.99,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,inpatient,,,702.00000,341.17000,Hometown Health,HMO,,631.80,,,,,,,631.80,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Hometown Health,HMO,,631.80,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,inpatient,,,702.00000,341.17000,Hometown Health,HMO,,631.80,,,,,,,631.80,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Hometown Health,HMO,,631.80,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,inpatient,,,265.00000,128.79000,Hometown Health,HMO,,238.50,,,,,,,238.50,257.05,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,outpatient,,,265.00000,128.79000,Hometown Health,HMO,,238.50,,,,,,,68.90,257.05,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,inpatient,,,2279.00000,1107.59000,Hometown Health,HMO,,2051.10,,,,,,,2051.10,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2279.00000,1107.59000,Hometown Health,HMO,,2051.10,,,,,,,592.54,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,inpatient,,,2395.00000,1163.97000,Hometown Health,HMO,,2155.50,,,,,,,2155.50,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2395.00000,1163.97000,Hometown Health,HMO,,2155.50,,,,,,,622.70,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,inpatient,,,8759.00000,4256.87000,Hometown Health,HMO,,7883.10,,,,,,,7883.10,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Hometown Health,HMO,,7883.10,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,inpatient,,,8759.00000,4256.87000,Hometown Health,HMO,,7883.10,,,,,,,7883.10,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Hometown Health,HMO,,7883.10,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,inpatient,,,2752.00000,1337.47000,Hometown Health,HMO,,2476.80,,,,,,,2476.80,2669.44,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,outpatient,,,2752.00000,1337.47000,Hometown Health,HMO,,2476.80,,,,,,,715.52,2669.44,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,inpatient,,,217.00000,105.46000,Hometown Health,HMO,,195.30,,,,,,,195.30,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Hometown Health,HMO,,195.30,,,,,,,56.42,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,inpatient,,,217.00000,105.46000,Hometown Health,HMO,,195.30,,,,,,,195.30,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Hometown Health,HMO,,195.30,,,,,,,56.42,210.49,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,inpatient,,,292.00000,141.91000,Hometown Health,HMO,,262.80,,,,,,,262.80,283.24,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,outpatient,,,292.00000,141.91000,Hometown Health,HMO,,262.80,,,,,,,75.92,283.24,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Hometown Health,HMO,,369.90,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Hometown Health,HMO,,369.90,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Hometown Health,HMO,,369.90,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Hometown Health,HMO,,369.90,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Hometown Health,HMO,,369.90,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Hometown Health,HMO,,369.90,,,,,,,106.86,398.67,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,inpatient,,,2275.00000,1105.65000,Hometown Health,HMO,,2047.50,,,,,,,2047.50,2206.75,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,outpatient,,,2275.00000,1105.65000,Hometown Health,HMO,,2047.50,,,,,,,591.50,2206.75,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,inpatient,,,192.00000,93.31000,Hometown Health,HMO,,172.80,,,,,,,172.80,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,outpatient,,,192.00000,93.31000,Hometown Health,HMO,,172.80,,,,,,,49.92,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,inpatient,,,451.00000,219.19000,Hometown Health,HMO,,405.90,,,,,,,405.90,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,outpatient,,,451.00000,219.19000,Hometown Health,HMO,,405.90,,,,,,,117.26,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,inpatient,,,617.00000,299.86000,Hometown Health,HMO,,555.30,,,,,,,555.30,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,outpatient,,,617.00000,299.86000,Hometown Health,HMO,,555.30,,,,,,,160.42,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,inpatient,,,825.00000,400.95000,Hometown Health,HMO,,742.50,,,,,,,742.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,outpatient,,,825.00000,400.95000,Hometown Health,HMO,,742.50,,,,,,,214.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,inpatient,,,905.00000,439.83000,Hometown Health,HMO,,814.50,,,,,,,814.50,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,outpatient,,,905.00000,439.83000,Hometown Health,HMO,,814.50,,,,,,,235.30,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,inpatient,,,849.00000,412.61000,Hometown Health,HMO,,764.10,,,,,,,764.10,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,outpatient,,,849.00000,412.61000,Hometown Health,HMO,,764.10,,,,,,,220.74,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,inpatient,,,2539.00000,1233.95000,Hometown Health,HMO,,2285.10,,,,,,,2285.10,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,outpatient,,,2539.00000,1233.95000,Hometown Health,HMO,,2285.10,,,,,,,660.14,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,inpatient,,,6000.00000,2916.00000,Hometown Health,HMO,,5400.00,,,,,,,5400.00,5820.00,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,outpatient,,,6000.00000,2916.00000,Hometown Health,HMO,,5400.00,,,,,,,1560.00,5820.00,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,inpatient,,,8260.00000,4014.36000,Hometown Health,HMO,,7434.00,,,,,,,7434.00,8012.20,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,outpatient,,,8260.00000,4014.36000,Hometown Health,HMO,,7434.00,,,,,,,2147.60,8012.20,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,inpatient,,,202.00000,88.88000,Hometown Health,HMO,,181.80,,,,,,,181.80,195.94,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,outpatient,,,202.00000,88.88000,Hometown Health,HMO,,181.80,,,,,,,52.52,195.94,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,HMO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,inpatient,,,295.00000,142.19000,Hometown Health,HMO,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,outpatient,,,295.00000,142.19000,Hometown Health,HMO,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,89.00000,26.79000,Hometown Health,HMO,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,89.00000,26.79000,Hometown Health,HMO,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,inpatient,,,93.00000,27.99000,Hometown Health,HMO,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Hometown Health,HMO,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,93.00000,27.99000,Hometown Health,HMO,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Hometown Health,HMO,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Hometown Health,HMO,,1687.50,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Hometown Health,HMO,,1687.50,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Hometown Health,HMO,,1687.50,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Hometown Health,HMO,,1687.50,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1752.00000,527.35000,Hometown Health,HMO,,1576.80,,,,,,,1576.80,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Hometown Health,HMO,,1576.80,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1752.00000,527.35000,Hometown Health,HMO,,1576.80,,,,,,,1576.80,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Hometown Health,HMO,,1576.80,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,731.00000,220.03000,Hometown Health,HMO,,657.90,,,,,,,657.90,709.07,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,731.00000,220.03000,Hometown Health,HMO,,657.90,,,,,,,190.06,709.07,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,787.00000,236.89000,Hometown Health,HMO,,708.30,,,,,,,708.30,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,787.00000,236.89000,Hometown Health,HMO,,708.30,,,,,,,204.62,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,2042.00000,614.64000,Hometown Health,HMO,,1837.80,,,,,,,1837.80,1980.74,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,2042.00000,614.64000,Hometown Health,HMO,,1837.80,,,,,,,530.92,1980.74,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Hometown Health,HMO,,1687.50,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Hometown Health,HMO,,1687.50,,,,,,,487.50,1818.75,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,714.00000,214.91000,Hometown Health,HMO,,642.60,,,,,,,642.60,692.58,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,714.00000,214.91000,Hometown Health,HMO,,642.60,,,,,,,185.64,692.58,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,294.00000,88.49000,Hometown Health,HMO,,264.60,,,,,,,264.60,285.18,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,294.00000,88.49000,Hometown Health,HMO,,264.60,,,,,,,76.44,285.18,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,inpatient,,,350.00000,105.35000,Hometown Health,HMO,,315.00,,,,,,,315.00,339.50,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,350.00000,105.35000,Hometown Health,HMO,,315.00,,,,,,,91.00,339.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,inpatient,,,1350.00000,780.30000,Hometown Health,HMO,,1215.00,,,,,,,1215.00,1309.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,outpatient,,,1350.00000,780.30000,Hometown Health,HMO,,1215.00,,,,,,,351.00,1309.50,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,inpatient,,,3680.00000,2127.04000,Hometown Health,HMO,,3312.00,,,,,,,3312.00,3569.60,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,outpatient,,,3680.00000,2127.04000,Hometown Health,HMO,,3312.00,,,,,,,956.80,3569.60,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,inpatient,,,1600.00000,924.80000,Hometown Health,HMO,,1440.00,,,,,,,1440.00,1552.00,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,outpatient,,,1600.00000,924.80000,Hometown Health,HMO,,1440.00,,,,,,,416.00,1552.00,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,inpatient,,,4680.00000,2705.04000,Hometown Health,HMO,,4212.00,,,,,,,4212.00,4539.60,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,outpatient,,,4680.00000,2705.04000,Hometown Health,HMO,,4212.00,,,,,,,1216.80,4539.60,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,inpatient,,,2100.00000,1213.80000,Hometown Health,HMO,,1890.00,,,,,,,1890.00,2037.00,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,outpatient,,,2100.00000,1213.80000,Hometown Health,HMO,,1890.00,,,,,,,546.00,2037.00,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,inpatient,,,5680.00000,3283.04000,Hometown Health,HMO,,5112.00,,,,,,,5112.00,5509.60,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,outpatient,,,5680.00000,3283.04000,Hometown Health,HMO,,5112.00,,,,,,,1476.80,5509.60,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,inpatient,,,2420.00000,1398.76000,Hometown Health,HMO,,2178.00,,,,,,,2178.00,2347.40,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,outpatient,,,2420.00000,1398.76000,Hometown Health,HMO,,2178.00,,,,,,,629.20,2347.40,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,inpatient,,,6415.00000,3707.87000,Hometown Health,HMO,,5773.50,,,,,,,5773.50,6222.55,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,outpatient,,,6415.00000,3707.87000,Hometown Health,HMO,,5773.50,,,,,,,1667.90,6222.55,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,inpatient,,,2920.00000,1687.76000,Hometown Health,HMO,,2628.00,,,,,,,2628.00,2832.40,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,outpatient,,,2920.00000,1687.76000,Hometown Health,HMO,,2628.00,,,,,,,759.20,2832.40,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,inpatient,,,8915.00000,5152.87000,Hometown Health,HMO,,8023.50,,,,,,,8023.50,8647.55,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,outpatient,,,8915.00000,5152.87000,Hometown Health,HMO,,8023.50,,,,,,,2317.90,8647.55,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,inpatient,,,3420.00000,1976.76000,Hometown Health,HMO,,3078.00,,,,,,,3078.00,3317.40,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,outpatient,,,3420.00000,1976.76000,Hometown Health,HMO,,3078.00,,,,,,,889.20,3317.40,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,inpatient,,,11415.00000,6597.87000,Hometown Health,HMO,,10273.50,,,,,,,10273.50,11072.55,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,outpatient,,,11415.00000,6597.87000,Hometown Health,HMO,,10273.50,,,,,,,2967.90,11072.55,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,inpatient,,,142.00000,154.35000,Hometown Health,HMO,,127.80,,,,,,,127.80,137.74,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,outpatient,,,142.00000,154.35000,Hometown Health,HMO,,127.80,,,,,,,36.92,137.74,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,inpatient,,,340.00000,228.82000,Hometown Health,HMO,,306.00,,,,,,,306.00,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Hometown Health,HMO,,306.00,,,,,,,88.40,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,inpatient,,,670.00000,450.91000,Hometown Health,HMO,,603.00,,,,,,,603.00,649.90,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Hometown Health,HMO,,603.00,,,,,,,174.20,649.90,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,inpatient,,,390.00000,262.47000,Hometown Health,HMO,,351.00,,,,,,,351.00,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,outpatient,,,390.00000,262.47000,Hometown Health,HMO,,351.00,,,,,,,101.40,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,inpatient,,,1170.00000,787.41000,Hometown Health,HMO,,1053.00,,,,,,,1053.00,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,outpatient,,,1170.00000,787.41000,Hometown Health,HMO,,1053.00,,,,,,,304.20,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,inpatient,,,440.00000,296.12000,Hometown Health,HMO,,396.00,,,,,,,396.00,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,outpatient,,,440.00000,296.12000,Hometown Health,HMO,,396.00,,,,,,,114.40,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,inpatient,,,1670.00000,1123.91000,Hometown Health,HMO,,1503.00,,,,,,,1503.00,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,outpatient,,,1670.00000,1123.91000,Hometown Health,HMO,,1503.00,,,,,,,434.20,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,inpatient,,,640.00000,430.72000,Hometown Health,HMO,,576.00,,,,,,,576.00,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,outpatient,,,640.00000,430.72000,Hometown Health,HMO,,576.00,,,,,,,166.40,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,inpatient,,,2170.00000,1460.41000,Hometown Health,HMO,,1953.00,,,,,,,1953.00,2104.90,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,outpatient,,,2170.00000,1460.41000,Hometown Health,HMO,,1953.00,,,,,,,564.20,2104.90,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,inpatient,,,17.00000,10.96000,Hometown Health,HMO,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,outpatient,,,17.00000,10.96000,Hometown Health,HMO,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,inpatient,,,535.00000,345.08000,Hometown Health,HMO,,481.50,,,,,,,481.50,518.95,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,outpatient,,,535.00000,345.08000,Hometown Health,HMO,,481.50,,,,,,,139.10,518.95,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,inpatient,,,23.00000,14.84000,Hometown Health,HMO,,20.70,,,,,,,20.70,22.31,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,outpatient,,,23.00000,14.84000,Hometown Health,HMO,,20.70,,,,,,,5.98,22.31,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,inpatient,,,635.00000,409.58000,Hometown Health,HMO,,571.50,,,,,,,571.50,615.95,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,outpatient,,,635.00000,409.58000,Hometown Health,HMO,,571.50,,,,,,,165.10,615.95,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,inpatient,,,30.00000,19.35000,Hometown Health,HMO,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,outpatient,,,30.00000,19.35000,Hometown Health,HMO,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,inpatient,,,735.00000,474.08000,Hometown Health,HMO,,661.50,,,,,,,661.50,712.95,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,outpatient,,,735.00000,474.08000,Hometown Health,HMO,,661.50,,,,,,,191.10,712.95,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,inpatient,,,33.00000,21.28000,Hometown Health,HMO,,29.70,,,,,,,29.70,32.01,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,outpatient,,,33.00000,21.28000,Hometown Health,HMO,,29.70,,,,,,,8.58,32.01,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,inpatient,,,835.00000,538.58000,Hometown Health,HMO,,751.50,,,,,,,751.50,809.95,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,outpatient,,,835.00000,538.58000,Hometown Health,HMO,,751.50,,,,,,,217.10,809.95,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,inpatient,,,140.00000,80.92000,Hometown Health,HMO,,126.00,,,,,,,126.00,135.80,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,outpatient,,,140.00000,80.92000,Hometown Health,HMO,,126.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,inpatient,,,275.00000,158.95000,Hometown Health,HMO,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,outpatient,,,275.00000,158.95000,Hometown Health,HMO,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,inpatient,,,295.00000,170.51000,Hometown Health,HMO,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,outpatient,,,295.00000,170.51000,Hometown Health,HMO,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,inpatient,,,590.00000,341.02000,Hometown Health,HMO,,531.00,,,,,,,531.00,572.30,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,outpatient,,,590.00000,341.02000,Hometown Health,HMO,,531.00,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,inpatient,,,690.00000,398.82000,Hometown Health,HMO,,621.00,,,,,,,621.00,669.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,outpatient,,,690.00000,398.82000,Hometown Health,HMO,,621.00,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,inpatient,,,1375.00000,794.75000,Hometown Health,HMO,,1237.50,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,outpatient,,,1375.00000,794.75000,Hometown Health,HMO,,1237.50,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,inpatient,,,950.00000,549.10000,Hometown Health,HMO,,855.00,,,,,,,855.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,outpatient,,,950.00000,549.10000,Hometown Health,HMO,,855.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,inpatient,,,1900.00000,1098.20000,Hometown Health,HMO,,1710.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,outpatient,,,1900.00000,1098.20000,Hometown Health,HMO,,1710.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,inpatient,,,140.00000,45.22000,Hometown Health,HMO,,126.00,,,,,,,126.00,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,outpatient,,,140.00000,45.22000,Hometown Health,HMO,,126.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,inpatient,,,275.00000,88.82000,Hometown Health,HMO,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,outpatient,,,275.00000,88.82000,Hometown Health,HMO,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,inpatient,,,295.00000,95.28000,Hometown Health,HMO,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,outpatient,,,295.00000,95.28000,Hometown Health,HMO,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,inpatient,,,590.00000,190.57000,Hometown Health,HMO,,531.00,,,,,,,531.00,572.30,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,outpatient,,,590.00000,190.57000,Hometown Health,HMO,,531.00,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,inpatient,,,690.00000,222.87000,Hometown Health,HMO,,621.00,,,,,,,621.00,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,outpatient,,,690.00000,222.87000,Hometown Health,HMO,,621.00,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,inpatient,,,1375.00000,444.12000,Hometown Health,HMO,,1237.50,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,outpatient,,,1375.00000,444.12000,Hometown Health,HMO,,1237.50,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,inpatient,,,950.00000,306.85000,Hometown Health,HMO,,855.00,,,,,,,855.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,outpatient,,,950.00000,306.85000,Hometown Health,HMO,,855.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,inpatient,,,1900.00000,613.70000,Hometown Health,HMO,,1710.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,outpatient,,,1900.00000,613.70000,Hometown Health,HMO,,1710.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,inpatient,,,340.00000,228.82000,Hometown Health,HMO,,306.00,,,,,,,306.00,329.80,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Hometown Health,HMO,,306.00,,,,,,,88.40,329.80,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,inpatient,,,670.00000,450.91000,Hometown Health,HMO,,603.00,,,,,,,603.00,649.90,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Hometown Health,HMO,,603.00,,,,,,,174.20,649.90,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Hometown Health,HMO,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Hometown Health,HMO,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,inpatient,,,490.00000,329.77000,Hometown Health,HMO,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Hometown Health,HMO,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Hometown Health,HMO,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Hometown Health,HMO,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,inpatient,,,245.00000,164.89000,Hometown Health,HMO,,220.50,,,,,,,220.50,237.65,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Hometown Health,HMO,,220.50,,,,,,,63.70,237.65,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Hometown Health,HMO,,757.80,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Hometown Health,HMO,,757.80,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Hometown Health,HMO,,947.70,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Hometown Health,HMO,,947.70,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Hometown Health,HMO,,1136.70,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Hometown Health,HMO,,1136.70,,,,,,,328.38,1225.11,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,inpatient,,,1178.00000,669.28000,Hometown Health,HMO,,1060.20,,,,,,,1060.20,1142.66,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1178.00000,669.28000,Hometown Health,HMO,,1060.20,,,,,,,306.28,1142.66,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,inpatient,,,140.00000,102.34000,Hometown Health,HMO,,126.00,,,,,,,126.00,135.80,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,outpatient,,,140.00000,102.34000,Hometown Health,HMO,,126.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,inpatient,,,275.00000,201.02000,Hometown Health,HMO,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,outpatient,,,275.00000,201.02000,Hometown Health,HMO,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,inpatient,,,295.00000,215.64000,Hometown Health,HMO,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,outpatient,,,295.00000,215.64000,Hometown Health,HMO,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,inpatient,,,590.00000,431.29000,Hometown Health,HMO,,531.00,,,,,,,531.00,572.30,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,outpatient,,,590.00000,431.29000,Hometown Health,HMO,,531.00,,,,,,,153.40,572.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,inpatient,,,690.00000,504.39000,Hometown Health,HMO,,621.00,,,,,,,621.00,669.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,outpatient,,,690.00000,504.39000,Hometown Health,HMO,,621.00,,,,,,,179.40,669.30,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,inpatient,,,1375.00000,1005.12000,Hometown Health,HMO,,1237.50,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,outpatient,,,1375.00000,1005.12000,Hometown Health,HMO,,1237.50,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,inpatient,,,950.00000,694.45000,Hometown Health,HMO,,855.00,,,,,,,855.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,outpatient,,,950.00000,694.45000,Hometown Health,HMO,,855.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,inpatient,,,1900.00000,1388.90000,Hometown Health,HMO,,1710.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,outpatient,,,1900.00000,1388.90000,Hometown Health,HMO,,1710.00,,,,,,,494.00,1843.00,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,inpatient,,,584.00000,426.90000,Hometown Health,HMO,,525.60,,,,,,,525.60,566.48,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,outpatient,,,584.00000,426.90000,Hometown Health,HMO,,525.60,,,,,,,151.84,566.48,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,inpatient,,,1391.00000,1016.82000,Hometown Health,HMO,,1251.90,,,,,,,1251.90,1349.27,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,outpatient,,,1391.00000,1016.82000,Hometown Health,HMO,,1251.90,,,,,,,361.66,1349.27,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,inpatient,,,359.00000,271.76000,Hometown Health,HMO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,outpatient,,,359.00000,271.76000,Hometown Health,HMO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,inpatient,,,95.00000,71.92000,Hometown Health,HMO,,85.50,,,,,,,85.50,92.15,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,outpatient,,,95.00000,71.92000,Hometown Health,HMO,,85.50,,,,,,,24.70,92.15,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,inpatient,,,37.00000,17.83000,Hometown Health,HMO,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,outpatient,,,37.00000,17.83000,Hometown Health,HMO,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Hometown Health,HMO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Hometown Health,HMO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,inpatient,,,237.00000,114.23000,Hometown Health,HMO,,213.30,,,,,,,213.30,229.89,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Hometown Health,HMO,,213.30,,,,,,,61.62,229.89,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,inpatient,,,33.00000,15.91000,Hometown Health,HMO,,29.70,,,,,,,29.70,32.01,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,outpatient,,,33.00000,15.91000,Hometown Health,HMO,,29.70,,,,,,,8.58,32.01,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,inpatient,,,25.00000,12.05000,Hometown Health,HMO,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,outpatient,,,25.00000,12.05000,Hometown Health,HMO,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,inpatient,,,497.00000,160.53000,Hometown Health,HMO,,447.30,,,,,,,447.30,482.09,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,outpatient,,,497.00000,160.53000,Hometown Health,HMO,,447.30,,,,,,,129.22,482.09,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Hometown Health,HMO,,793.80,,,,,,,793.80,855.54,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Hometown Health,HMO,,793.80,,,,,,,229.32,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Hometown Health,HMO,,793.80,,,,,,,793.80,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Hometown Health,HMO,,793.80,,,,,,,229.32,855.54,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,inpatient,,,98.00000,37.44000,Hometown Health,HMO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Hometown Health,HMO,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,inpatient,,,96.00000,36.67000,Hometown Health,HMO,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Hometown Health,HMO,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Hometown Health,HMO,,793.80,,,,,,,793.80,855.54,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Hometown Health,HMO,,793.80,,,,,,,229.32,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Hometown Health,HMO,,793.80,,,,,,,793.80,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Hometown Health,HMO,,793.80,,,,,,,229.32,855.54,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,inpatient,,,763.00000,291.47000,Hometown Health,HMO,,686.70,,,,,,,686.70,740.11,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,outpatient,,,763.00000,291.47000,Hometown Health,HMO,,686.70,,,,,,,198.38,740.11,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,inpatient,,,199.00000,76.02000,Hometown Health,HMO,,179.10,,,,,,,179.10,193.03,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,outpatient,,,199.00000,76.02000,Hometown Health,HMO,,179.10,,,,,,,51.74,193.03,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,inpatient,,,98.00000,37.44000,Hometown Health,HMO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Hometown Health,HMO,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,inpatient,,,96.00000,36.67000,Hometown Health,HMO,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Hometown Health,HMO,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,inpatient,,,1265.00000,483.23000,Hometown Health,HMO,,1138.50,,,,,,,1138.50,1227.05,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,outpatient,,,1265.00000,483.23000,Hometown Health,HMO,,1138.50,,,,,,,328.90,1227.05,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,inpatient,,,924.00000,352.97000,Hometown Health,HMO,,831.60,,,,,,,831.60,896.28,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,outpatient,,,924.00000,352.97000,Hometown Health,HMO,,831.60,,,,,,,240.24,896.28,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,inpatient,,,580.00000,215.76000,Hometown Health,HMO,,522.00,,,,,,,522.00,562.60,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,outpatient,,,580.00000,215.76000,Hometown Health,HMO,,522.00,,,,,,,150.80,562.60,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,inpatient,,,110.00000,40.92000,Hometown Health,HMO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,outpatient,,,110.00000,40.92000,Hometown Health,HMO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,inpatient,,,373.00000,138.76000,Hometown Health,HMO,,335.70,,,,,,,335.70,361.81,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,outpatient,,,373.00000,138.76000,Hometown Health,HMO,,335.70,,,,,,,96.98,361.81,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,inpatient,,,337.00000,125.36000,Hometown Health,HMO,,303.30,,,,,,,303.30,326.89,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,outpatient,,,337.00000,125.36000,Hometown Health,HMO,,303.30,,,,,,,87.62,326.89,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,inpatient,,,784.00000,291.65000,Hometown Health,HMO,,705.60,,,,,,,705.60,760.48,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,outpatient,,,784.00000,291.65000,Hometown Health,HMO,,705.60,,,,,,,203.84,760.48,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,inpatient,,,341.00000,126.85000,Hometown Health,HMO,,306.90,,,,,,,306.90,330.77,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,outpatient,,,341.00000,126.85000,Hometown Health,HMO,,306.90,,,,,,,88.66,330.77,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,inpatient,,,252.00000,93.74000,Hometown Health,HMO,,226.80,,,,,,,226.80,244.44,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,outpatient,,,252.00000,93.74000,Hometown Health,HMO,,226.80,,,,,,,65.52,244.44,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,inpatient,,,282.00000,104.90000,Hometown Health,HMO,,253.80,,,,,,,253.80,273.54,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,outpatient,,,282.00000,104.90000,Hometown Health,HMO,,253.80,,,,,,,73.32,273.54,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,inpatient,,,404.00000,150.29000,Hometown Health,HMO,,363.60,,,,,,,363.60,391.88,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,outpatient,,,404.00000,150.29000,Hometown Health,HMO,,363.60,,,,,,,105.04,391.88,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,inpatient,,,306.00000,173.85000,Hometown Health,HMO,,275.40,,,,,,,275.40,296.82,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,outpatient,,,306.00000,173.85000,Hometown Health,HMO,,275.40,,,,,,,79.56,296.82,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,inpatient,,,158.00000,89.77000,Hometown Health,HMO,,142.20,,,,,,,142.20,153.26,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,outpatient,,,158.00000,89.77000,Hometown Health,HMO,,142.20,,,,,,,41.08,153.26,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,inpatient,,,147.00000,89.38000,Hometown Health,HMO,GP,132.30,,,,,,,132.30,142.59,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Hometown Health,HMO,GP,132.30,,,,,,,38.22,142.59,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,inpatient,,,270.00000,164.16000,Hometown Health,HMO,GP,243.00,,,,,,,243.00,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Hometown Health,HMO,GP,243.00,,,,,,,70.20,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,inpatient,,,84.00000,51.07000,Hometown Health,HMO,GP,75.60,,,,,,,75.60,81.48,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Hometown Health,HMO,GP,75.60,,,,,,,21.84,81.48,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,inpatient,,,86.00000,52.29000,Hometown Health,HMO,GP,77.40,,,,,,,77.40,83.42,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Hometown Health,HMO,GP,77.40,,,,,,,22.36,83.42,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,inpatient,,,82.00000,49.86000,Hometown Health,HMO,GP,73.80,,,,,,,73.80,79.54,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Hometown Health,HMO,GP,73.80,,,,,,,21.32,79.54,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,inpatient,,,85.00000,51.68000,Hometown Health,HMO,GP,76.50,,,,,,,76.50,82.45,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Hometown Health,HMO,GP,76.50,,,,,,,22.10,82.45,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,inpatient,,,43.00000,26.14000,Hometown Health,HMO,GP,38.70,,,,,,,38.70,41.71,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Hometown Health,HMO,GP,38.70,,,,,,,11.18,41.71,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,inpatient,,,41.00000,24.93000,Hometown Health,HMO,GP,36.90,,,,,,,36.90,39.77,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Hometown Health,HMO,GP,36.90,,,,,,,10.66,39.77,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,inpatient,,,79.00000,48.03000,Hometown Health,HMO,GP,71.10,,,,,,,71.10,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Hometown Health,HMO,GP,71.10,,,,,,,20.54,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Hometown Health,HMO,GP,66.60,,,,,,,66.60,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Hometown Health,HMO,GP,66.60,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Hometown Health,HMO,GP,66.60,,,,,,,66.60,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Hometown Health,HMO,GP,66.60,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,inpatient,,,34.00000,20.67000,Hometown Health,HMO,GP,30.60,,,,,,,30.60,32.98,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Hometown Health,HMO,GP,30.60,,,,,,,8.84,32.98,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,inpatient,,,65.00000,39.52000,Hometown Health,HMO,GP,58.50,,,,,,,58.50,63.05,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Hometown Health,HMO,GP,58.50,,,,,,,16.90,63.05,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,inpatient,,,113.00000,68.70000,Hometown Health,HMO,,101.70,,,,,,,101.70,109.61,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,outpatient,,,113.00000,68.70000,Hometown Health,HMO,,101.70,,,,,,,29.38,109.61,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,inpatient,,,80.00000,48.64000,Hometown Health,HMO,GP,72.00,,,,,,,72.00,77.60,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Hometown Health,HMO,GP,72.00,,,,,,,20.80,77.60,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,inpatient,,,84.00000,51.07000,Hometown Health,HMO,GP,75.60,,,,,,,75.60,81.48,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Hometown Health,HMO,GP,75.60,,,,,,,21.84,81.48,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,inpatient,,,73.00000,44.38000,Hometown Health,HMO,GP,65.70,,,,,,,65.70,70.81,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Hometown Health,HMO,GP,65.70,,,,,,,18.98,70.81,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,inpatient,,,100.00000,60.80000,Hometown Health,HMO,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,outpatient,,,100.00000,60.80000,Hometown Health,HMO,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,inpatient,,,167.00000,101.54000,Hometown Health,HMO,GP,150.30,,,,,,,150.30,161.99,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,outpatient,,,167.00000,101.54000,Hometown Health,HMO,GP,150.30,,,,,,,43.42,161.99,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,inpatient,,,413.00000,251.10000,Hometown Health,HMO,"50,GP",371.70,,,,,,,371.70,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Hometown Health,HMO,"50,GP",371.70,,,,,,,107.38,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Hometown Health,HMO,"LT,GP",247.50,,,,,,,247.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Hometown Health,HMO,"LT,GP",247.50,,,,,,,71.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Hometown Health,HMO,"RT,GP",247.50,,,,,,,247.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Hometown Health,HMO,"RT,GP",247.50,,,,,,,71.50,266.75,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,inpatient,,,95.00000,57.76000,Hometown Health,HMO,GP,85.50,,,,,,,85.50,92.15,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Hometown Health,HMO,GP,85.50,,,,,,,24.70,92.15,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,inpatient,,,146.00000,88.77000,Hometown Health,HMO,GP,131.40,,,,,,,131.40,141.62,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Hometown Health,HMO,GP,131.40,,,,,,,37.96,141.62,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,inpatient,,,139.00000,84.51000,Hometown Health,HMO,GP,125.10,,,,,,,125.10,134.83,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Hometown Health,HMO,GP,125.10,,,,,,,36.14,134.83,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,inpatient,,,75.00000,45.60000,Hometown Health,HMO,GP,67.50,,,,,,,67.50,72.75,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Hometown Health,HMO,GP,67.50,,,,,,,19.50,72.75,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,inpatient,,,154.00000,93.63000,Hometown Health,HMO,GP,138.60,,,,,,,138.60,149.38,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Hometown Health,HMO,GP,138.60,,,,,,,40.04,149.38,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,inpatient,,,73.00000,44.38000,Hometown Health,HMO,GP,65.70,,,,,,,65.70,70.81,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Hometown Health,HMO,GP,65.70,,,,,,,18.98,70.81,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,inpatient,,,160.00000,97.28000,Hometown Health,HMO,GP,144.00,,,,,,,144.00,155.20,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Hometown Health,HMO,GP,144.00,,,,,,,41.60,155.20,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,inpatient,,,325.00000,197.60000,Hometown Health,HMO,GP,292.50,,,,,,,292.50,315.25,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Hometown Health,HMO,GP,292.50,,,,,,,84.50,315.25,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,inpatient,,,98.00000,59.58000,Hometown Health,HMO,GP,88.20,,,,,,,88.20,95.06,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,outpatient,,,98.00000,59.58000,Hometown Health,HMO,GP,88.20,,,,,,,25.48,95.06,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,inpatient,,,303.00000,184.22000,Hometown Health,HMO,GP,272.70,,,,,,,272.70,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,outpatient,,,303.00000,184.22000,Hometown Health,HMO,GP,272.70,,,,,,,78.78,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,inpatient,,,115.00000,69.92000,Hometown Health,HMO,GP,103.50,,,,,,,103.50,111.55,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,outpatient,,,115.00000,69.92000,Hometown Health,HMO,GP,103.50,,,,,,,29.90,111.55,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,inpatient,,,74.00000,44.99000,Hometown Health,HMO,GP,66.60,,,,,,,66.60,71.78,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Hometown Health,HMO,GP,66.60,,,,,,,19.24,71.78,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,inpatient,,,79.00000,48.03000,Hometown Health,HMO,GP,71.10,,,,,,,71.10,76.63,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Hometown Health,HMO,GP,71.10,,,,,,,20.54,76.63,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,inpatient,,,72.00000,43.78000,Hometown Health,HMO,GP,64.80,,,,,,,64.80,69.84,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Hometown Health,HMO,GP,64.80,,,,,,,18.72,69.84,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,inpatient,,,147.00000,89.38000,Hometown Health,HMO,GP,132.30,,,,,,,132.30,142.59,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Hometown Health,HMO,GP,132.30,,,,,,,38.22,142.59,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,inpatient,,,270.00000,164.16000,Hometown Health,HMO,GP,243.00,,,,,,,243.00,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Hometown Health,HMO,GP,243.00,,,,,,,70.20,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,inpatient,,,84.00000,51.07000,Hometown Health,HMO,GP,75.60,,,,,,,75.60,81.48,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Hometown Health,HMO,GP,75.60,,,,,,,21.84,81.48,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,inpatient,,,86.00000,52.29000,Hometown Health,HMO,GP,77.40,,,,,,,77.40,83.42,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Hometown Health,HMO,GP,77.40,,,,,,,22.36,83.42,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,inpatient,,,82.00000,49.86000,Hometown Health,HMO,GP,73.80,,,,,,,73.80,79.54,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Hometown Health,HMO,GP,73.80,,,,,,,21.32,79.54,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,inpatient,,,85.00000,51.68000,Hometown Health,HMO,GP,76.50,,,,,,,76.50,82.45,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Hometown Health,HMO,GP,76.50,,,,,,,22.10,82.45,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,inpatient,,,43.00000,26.14000,Hometown Health,HMO,GP,38.70,,,,,,,38.70,41.71,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Hometown Health,HMO,GP,38.70,,,,,,,11.18,41.71,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,inpatient,,,41.00000,24.93000,Hometown Health,HMO,GP,36.90,,,,,,,36.90,39.77,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Hometown Health,HMO,GP,36.90,,,,,,,10.66,39.77,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,inpatient,,,79.00000,48.03000,Hometown Health,HMO,GP,71.10,,,,,,,71.10,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Hometown Health,HMO,GP,71.10,,,,,,,20.54,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Hometown Health,HMO,"CQ,GP",66.60,,,,,,,66.60,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Hometown Health,HMO,"CQ,GP",66.60,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Hometown Health,HMO,"CQ,GP",66.60,,,,,,,66.60,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Hometown Health,HMO,"CQ,GP",66.60,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,inpatient,,,34.00000,20.67000,Hometown Health,HMO,GP,30.60,,,,,,,30.60,32.98,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Hometown Health,HMO,GP,30.60,,,,,,,8.84,32.98,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,inpatient,,,65.00000,39.52000,Hometown Health,HMO,GP,58.50,,,,,,,58.50,63.05,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Hometown Health,HMO,GP,58.50,,,,,,,16.90,63.05,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,inpatient,,,80.00000,48.64000,Hometown Health,HMO,GP,72.00,,,,,,,72.00,77.60,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Hometown Health,HMO,GP,72.00,,,,,,,20.80,77.60,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,inpatient,,,84.00000,51.07000,Hometown Health,HMO,GP,75.60,,,,,,,75.60,81.48,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Hometown Health,HMO,GP,75.60,,,,,,,21.84,81.48,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,inpatient,,,73.00000,44.38000,Hometown Health,HMO,GP,65.70,,,,,,,65.70,70.81,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Hometown Health,HMO,GP,65.70,,,,,,,18.98,70.81,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,inpatient,,,413.00000,251.10000,Hometown Health,HMO,"GP,50",371.70,,,,,,,371.70,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Hometown Health,HMO,"GP,50",371.70,,,,,,,107.38,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Hometown Health,HMO,"GP,LT",247.50,,,,,,,247.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Hometown Health,HMO,"GP,LT",247.50,,,,,,,71.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Hometown Health,HMO,"GP,RT",247.50,,,,,,,247.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Hometown Health,HMO,"GP,RT",247.50,,,,,,,71.50,266.75,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,inpatient,,,95.00000,57.76000,Hometown Health,HMO,GP,85.50,,,,,,,85.50,92.15,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Hometown Health,HMO,GP,85.50,,,,,,,24.70,92.15,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,inpatient,,,146.00000,88.77000,Hometown Health,HMO,GP,131.40,,,,,,,131.40,141.62,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Hometown Health,HMO,GP,131.40,,,,,,,37.96,141.62,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,inpatient,,,139.00000,84.51000,Hometown Health,HMO,GP,125.10,,,,,,,125.10,134.83,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Hometown Health,HMO,GP,125.10,,,,,,,36.14,134.83,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,inpatient,,,75.00000,45.60000,Hometown Health,HMO,GP,67.50,,,,,,,67.50,72.75,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Hometown Health,HMO,GP,67.50,,,,,,,19.50,72.75,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,inpatient,,,154.00000,93.63000,Hometown Health,HMO,GP,138.60,,,,,,,138.60,149.38,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Hometown Health,HMO,GP,138.60,,,,,,,40.04,149.38,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,inpatient,,,73.00000,44.38000,Hometown Health,HMO,GP,65.70,,,,,,,65.70,70.81,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Hometown Health,HMO,GP,65.70,,,,,,,18.98,70.81,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,inpatient,,,160.00000,97.28000,Hometown Health,HMO,GP,144.00,,,,,,,144.00,155.20,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Hometown Health,HMO,GP,144.00,,,,,,,41.60,155.20,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,inpatient,,,325.00000,197.60000,Hometown Health,HMO,GP,292.50,,,,,,,292.50,315.25,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Hometown Health,HMO,GP,292.50,,,,,,,84.50,315.25,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,inpatient,,,74.00000,44.99000,Hometown Health,HMO,GP,66.60,,,,,,,66.60,71.78,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Hometown Health,HMO,GP,66.60,,,,,,,19.24,71.78,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,inpatient,,,79.00000,48.03000,Hometown Health,HMO,GP,71.10,,,,,,,71.10,76.63,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Hometown Health,HMO,GP,71.10,,,,,,,20.54,76.63,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,inpatient,,,72.00000,43.78000,Hometown Health,HMO,GP,64.80,,,,,,,64.80,69.84,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Hometown Health,HMO,GP,64.80,,,,,,,18.72,69.84,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,inpatient,,,445.00000,262.55000,Hometown Health,HMO,GP,400.50,,,,,,,400.50,431.65,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,outpatient,,,445.00000,262.55000,Hometown Health,HMO,GP,400.50,,,,,,,115.70,431.65,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,inpatient,,,310.00000,182.90000,Hometown Health,HMO,GP,279.00,,,,,,,279.00,300.70,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,outpatient,,,310.00000,182.90000,Hometown Health,HMO,GP,279.00,,,,,,,80.60,300.70,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,inpatient,,,393.00000,231.87000,Hometown Health,HMO,GP,353.70,,,,,,,353.70,381.21,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,outpatient,,,393.00000,231.87000,Hometown Health,HMO,GP,353.70,,,,,,,102.18,381.21,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,inpatient,,,310.00000,182.90000,Hometown Health,HMO,GP,279.00,,,,,,,279.00,300.70,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,outpatient,,,310.00000,182.90000,Hometown Health,HMO,GP,279.00,,,,,,,80.60,300.70,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,inpatient,,,80.00000,30.96000,Hometown Health,HMO,GO,72.00,,,,,,,72.00,77.60,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Hometown Health,HMO,GO,72.00,,,,,,,20.80,77.60,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,inpatient,,,84.00000,32.51000,Hometown Health,HMO,GO,75.60,,,,,,,75.60,81.48,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Hometown Health,HMO,GO,75.60,,,,,,,21.84,81.48,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,inpatient,,,126.00000,48.76000,Hometown Health,HMO,GO,113.40,,,,,,,113.40,122.22,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Hometown Health,HMO,GO,113.40,,,,,,,32.76,122.22,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,inpatient,,,66.00000,25.54000,Hometown Health,HMO,GO,59.40,,,,,,,59.40,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Hometown Health,HMO,GO,59.40,,,,,,,17.16,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,inpatient,,,62.00000,23.99000,Hometown Health,HMO,GO,55.80,,,,,,,55.80,60.14,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Hometown Health,HMO,GO,55.80,,,,,,,16.12,60.14,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,inpatient,,,90.00000,34.83000,Hometown Health,HMO,GO,81.00,,,,,,,81.00,87.30,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Hometown Health,HMO,GO,81.00,,,,,,,23.40,87.30,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,inpatient,,,95.00000,36.76000,Hometown Health,HMO,GO,85.50,,,,,,,85.50,92.15,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Hometown Health,HMO,GO,85.50,,,,,,,24.70,92.15,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,inpatient,,,146.00000,56.50000,Hometown Health,HMO,GO,131.40,,,,,,,131.40,141.62,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Hometown Health,HMO,GO,131.40,,,,,,,37.96,141.62,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,inpatient,,,139.00000,53.79000,Hometown Health,HMO,GO,125.10,,,,,,,125.10,134.83,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Hometown Health,HMO,GO,125.10,,,,,,,36.14,134.83,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,inpatient,,,75.00000,29.02000,Hometown Health,HMO,GO,67.50,,,,,,,67.50,72.75,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Hometown Health,HMO,GO,67.50,,,,,,,19.50,72.75,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,inpatient,,,154.00000,59.60000,Hometown Health,HMO,GO,138.60,,,,,,,138.60,149.38,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Hometown Health,HMO,GO,138.60,,,,,,,40.04,149.38,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,inpatient,,,73.00000,28.25000,Hometown Health,HMO,GO,65.70,,,,,,,65.70,70.81,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Hometown Health,HMO,GO,65.70,,,,,,,18.98,70.81,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,inpatient,,,160.00000,61.92000,Hometown Health,HMO,GO,144.00,,,,,,,144.00,155.20,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Hometown Health,HMO,GO,144.00,,,,,,,41.60,155.20,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,inpatient,,,98.00000,37.93000,Hometown Health,HMO,GO,88.20,,,,,,,88.20,95.06,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,outpatient,,,98.00000,37.93000,Hometown Health,HMO,GO,88.20,,,,,,,25.48,95.06,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,inpatient,,,303.00000,117.26000,Hometown Health,HMO,GO,272.70,,,,,,,272.70,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,outpatient,,,303.00000,117.26000,Hometown Health,HMO,GO,272.70,,,,,,,78.78,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,inpatient,,,115.00000,44.50000,Hometown Health,HMO,GO,103.50,,,,,,,103.50,111.55,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,outpatient,,,115.00000,44.50000,Hometown Health,HMO,GO,103.50,,,,,,,29.90,111.55,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,inpatient,,,74.00000,28.64000,Hometown Health,HMO,GO,66.60,,,,,,,66.60,71.78,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Hometown Health,HMO,GO,66.60,,,,,,,19.24,71.78,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,inpatient,,,72.00000,27.86000,Hometown Health,HMO,GO,64.80,,,,,,,64.80,69.84,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Hometown Health,HMO,GO,64.80,,,,,,,18.72,69.84,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,inpatient,,,80.00000,30.96000,Hometown Health,HMO,"CO,GO",72.00,,,,,,,72.00,77.60,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Hometown Health,HMO,"CO,GO",72.00,,,,,,,20.80,77.60,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,inpatient,,,84.00000,32.51000,Hometown Health,HMO,"CO,GO",75.60,,,,,,,75.60,81.48,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Hometown Health,HMO,"CO,GO",75.60,,,,,,,21.84,81.48,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,inpatient,,,126.00000,48.76000,Hometown Health,HMO,"CO,GO",113.40,,,,,,,113.40,122.22,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Hometown Health,HMO,"CO,GO",113.40,,,,,,,32.76,122.22,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,inpatient,,,62.00000,23.99000,Hometown Health,HMO,"CO,GO",55.80,,,,,,,55.80,60.14,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Hometown Health,HMO,"CO,GO",55.80,,,,,,,16.12,60.14,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,inpatient,,,66.00000,25.54000,Hometown Health,HMO,"CO,GO",59.40,,,,,,,59.40,64.02,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Hometown Health,HMO,"CO,GO",59.40,,,,,,,17.16,64.02,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,inpatient,,,90.00000,34.83000,Hometown Health,HMO,"CO,GO",81.00,,,,,,,81.00,87.30,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Hometown Health,HMO,"CO,GO",81.00,,,,,,,23.40,87.30,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,inpatient,,,95.00000,36.76000,Hometown Health,HMO,"CO,GO",85.50,,,,,,,85.50,92.15,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Hometown Health,HMO,"CO,GO",85.50,,,,,,,24.70,92.15,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,inpatient,,,146.00000,56.50000,Hometown Health,HMO,"CO,GO",131.40,,,,,,,131.40,141.62,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Hometown Health,HMO,"CO,GO",131.40,,,,,,,37.96,141.62,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,inpatient,,,139.00000,53.79000,Hometown Health,HMO,"CO,GO",125.10,,,,,,,125.10,134.83,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Hometown Health,HMO,"CO,GO",125.10,,,,,,,36.14,134.83,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,inpatient,,,75.00000,29.02000,Hometown Health,HMO,"CO,GO",67.50,,,,,,,67.50,72.75,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Hometown Health,HMO,"CO,GO",67.50,,,,,,,19.50,72.75,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,inpatient,,,154.00000,59.60000,Hometown Health,HMO,"CO,GO",138.60,,,,,,,138.60,149.38,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Hometown Health,HMO,"CO,GO",138.60,,,,,,,40.04,149.38,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,inpatient,,,73.00000,28.25000,Hometown Health,HMO,"CO,GO",65.70,,,,,,,65.70,70.81,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Hometown Health,HMO,"CO,GO",65.70,,,,,,,18.98,70.81,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,inpatient,,,160.00000,61.92000,Hometown Health,HMO,"CO,GO",144.00,,,,,,,144.00,155.20,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Hometown Health,HMO,"CO,GO",144.00,,,,,,,41.60,155.20,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,inpatient,,,74.00000,28.64000,Hometown Health,HMO,"CO,GO",66.60,,,,,,,66.60,71.78,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Hometown Health,HMO,"CO,GO",66.60,,,,,,,19.24,71.78,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,inpatient,,,72.00000,27.86000,Hometown Health,HMO,"CO,GO",64.80,,,,,,,64.80,69.84,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Hometown Health,HMO,"CO,GO",64.80,,,,,,,18.72,69.84,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,inpatient,,,47.00000,26.70000,Hometown Health,HMO,GO,42.30,,,,,,,42.30,45.59,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Hometown Health,HMO,GO,42.30,,,,,,,12.22,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,inpatient,,,47.00000,26.70000,Hometown Health,HMO,"CO,GO",42.30,,,,,,,42.30,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Hometown Health,HMO,"CO,GO",42.30,,,,,,,12.22,45.59,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,inpatient,,,250.00000,142.04000,Hometown Health,HMO,GO,225.00,,,,,,,225.00,242.50,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,outpatient,,,250.00000,142.04000,Hometown Health,HMO,GO,225.00,,,,,,,65.00,242.50,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,inpatient,,,175.00000,99.43000,Hometown Health,HMO,GO,157.50,,,,,,,157.50,169.75,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,outpatient,,,175.00000,99.43000,Hometown Health,HMO,GO,157.50,,,,,,,45.50,169.75,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,inpatient,,,233.00000,132.38000,Hometown Health,HMO,GO,209.70,,,,,,,209.70,226.01,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,outpatient,,,233.00000,132.38000,Hometown Health,HMO,GO,209.70,,,,,,,60.58,226.01,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,inpatient,,,175.00000,99.43000,Hometown Health,HMO,GO,157.50,,,,,,,157.50,169.75,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,outpatient,,,175.00000,99.43000,Hometown Health,HMO,GO,157.50,,,,,,,45.50,169.75,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,inpatient,,,291.00000,93.99000,Hometown Health,HMO,,261.90,,,,,,,261.90,282.27,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,outpatient,,,291.00000,93.99000,Hometown Health,HMO,,261.90,,,,,,,75.66,282.27,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,inpatient,,,273.00000,155.10000,Hometown Health,HMO,GN,245.70,,,,,,,245.70,264.81,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,outpatient,,,273.00000,155.10000,Hometown Health,HMO,GN,245.70,,,,,,,70.98,264.81,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,inpatient,,,279.00000,158.51000,Hometown Health,HMO,GN,251.10,,,,,,,251.10,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,outpatient,,,279.00000,158.51000,Hometown Health,HMO,GN,251.10,,,,,,,72.54,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,inpatient,,,426.00000,242.03000,Hometown Health,HMO,GN,383.40,,,,,,,383.40,413.22,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,outpatient,,,426.00000,242.03000,Hometown Health,HMO,GN,383.40,,,,,,,110.76,413.22,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,inpatient,,,242.00000,137.49000,Hometown Health,HMO,GN,217.80,,,,,,,217.80,234.74,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,outpatient,,,242.00000,137.49000,Hometown Health,HMO,GN,217.80,,,,,,,62.92,234.74,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,inpatient,,,128.00000,72.72000,Hometown Health,HMO,,115.20,,,,,,,115.20,124.16,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,outpatient,,,128.00000,72.72000,Hometown Health,HMO,,115.20,,,,,,,33.28,124.16,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,inpatient,,,66.00000,37.50000,Hometown Health,HMO,GN,59.40,,,,,,,59.40,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,outpatient,,,66.00000,37.50000,Hometown Health,HMO,GN,59.40,,,,,,,17.16,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,inpatient,,,62.00000,35.23000,Hometown Health,HMO,GN,55.80,,,,,,,55.80,60.14,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,outpatient,,,62.00000,35.23000,Hometown Health,HMO,GN,55.80,,,,,,,16.12,60.14,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,inpatient,,,269.00000,152.83000,Hometown Health,HMO,GN,242.10,,,,,,,242.10,260.93,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,outpatient,,,269.00000,152.83000,Hometown Health,HMO,GN,242.10,,,,,,,69.94,260.93,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,inpatient,,,153.00000,86.93000,Hometown Health,HMO,GN,137.70,,,,,,,137.70,148.41,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,outpatient,,,153.00000,86.93000,Hometown Health,HMO,GN,137.70,,,,,,,39.78,148.41,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,inpatient,,,98.00000,55.68000,Hometown Health,HMO,GN,88.20,,,,,,,88.20,95.06,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,outpatient,,,98.00000,55.68000,Hometown Health,HMO,GN,88.20,,,,,,,25.48,95.06,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,inpatient,,,303.00000,172.15000,Hometown Health,HMO,GN,272.70,,,,,,,272.70,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,outpatient,,,303.00000,172.15000,Hometown Health,HMO,GN,272.70,,,,,,,78.78,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,inpatient,,,115.00000,65.34000,Hometown Health,HMO,GN,103.50,,,,,,,103.50,111.55,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,outpatient,,,115.00000,65.34000,Hometown Health,HMO,GN,103.50,,,,,,,29.90,111.55,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,inpatient,,,210.00000,119.31000,Hometown Health,HMO,GN,189.00,,,,,,,189.00,203.70,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,outpatient,,,210.00000,119.31000,Hometown Health,HMO,GN,189.00,,,,,,,54.60,203.70,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,inpatient,,,250.00000,142.04000,Hometown Health,HMO,GN,225.00,,,,,,,225.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,outpatient,,,250.00000,142.04000,Hometown Health,HMO,GN,225.00,,,,,,,65.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,inpatient,,,78.00000,44.32000,Hometown Health,HMO,GN,70.20,,,,,,,70.20,75.66,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,outpatient,,,78.00000,44.32000,Hometown Health,HMO,GN,70.20,,,,,,,20.28,75.66,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,inpatient,,,322.00000,182.94000,Hometown Health,HMO,GN,289.80,,,,,,,289.80,312.34,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,outpatient,,,322.00000,182.94000,Hometown Health,HMO,GN,289.80,,,,,,,83.72,312.34,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,inpatient,,,309.00000,175.56000,Hometown Health,HMO,GN,278.10,,,,,,,278.10,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,outpatient,,,309.00000,175.56000,Hometown Health,HMO,GN,278.10,,,,,,,80.34,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,inpatient,,,245.00000,139.20000,Hometown Health,HMO,GN,220.50,,,,,,,220.50,237.65,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,outpatient,,,245.00000,139.20000,Hometown Health,HMO,GN,220.50,,,,,,,63.70,237.65,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,inpatient,,,313.00000,116.44000,Hometown Health,HMO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,outpatient,,,313.00000,116.44000,Hometown Health,HMO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,inpatient,,,1250.00000,632.50000,Hometown Health,HMO,,1125.00,,,,,,,1125.00,1212.50,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,outpatient,,,1250.00000,632.50000,Hometown Health,HMO,,1125.00,,,,,,,325.00,1212.50,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,inpatient,,,145.00000,75.54000,Hometown Health,HMO,,130.50,,,,,,,130.50,140.65,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Hometown Health,HMO,,130.50,,,,,,,37.70,140.65,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,inpatient,,,488.00000,254.25000,Hometown Health,HMO,,439.20,,,,,,,439.20,473.36,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Hometown Health,HMO,,439.20,,,,,,,126.88,473.36,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,inpatient,,,684.00000,337.90000,Hometown Health,HMO,,615.60,,,,,,,615.60,663.48,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,outpatient,,,684.00000,337.90000,Hometown Health,HMO,,615.60,,,,,,,177.84,663.48,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,inpatient,,,206.00000,101.76000,Hometown Health,HMO,,185.40,,,,,,,185.40,199.82,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,outpatient,,,206.00000,101.76000,Hometown Health,HMO,,185.40,,,,,,,53.56,199.82,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,inpatient,,,195.00000,96.33000,Hometown Health,HMO,,175.50,,,,,,,175.50,189.15,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,outpatient,,,195.00000,96.33000,Hometown Health,HMO,,175.50,,,,,,,50.70,189.15,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,inpatient,,,375.00000,185.25000,Hometown Health,HMO,,337.50,,,,,,,337.50,363.75,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,outpatient,,,375.00000,185.25000,Hometown Health,HMO,,337.50,,,,,,,97.50,363.75,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,inpatient,,,429.00000,211.93000,Hometown Health,HMO,,386.10,,,,,,,386.10,416.13,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,outpatient,,,429.00000,211.93000,Hometown Health,HMO,,386.10,,,,,,,111.54,416.13,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22475,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,HMO,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B OBSTETRICS SEMI-PVT,42473,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,HMO,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ICU,32474,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Hometown Health,HMO,,7884.90,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,12476,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Hometown Health,HMO,,5256.90,,,,,,,2512.00,5665.77,percent of total billed charges,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,84.00000,63.59000,Hometown Health,HMO,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Hometown Health,HMO,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Hometown Health,HMO,,255.60,,,,,,,255.60,275.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Hometown Health,HMO,,255.60,,,,,,,73.84,275.48,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Hometown Health,HMO,,412.20,,,,,,,412.20,444.26,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Hometown Health,HMO,,412.20,,,,,,,119.08,444.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Hometown Health,HMO,,502.20,,,,,,,502.20,541.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Hometown Health,HMO,,502.20,,,,,,,145.08,541.26,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Hometown Health,HMO,,433.80,,,,,,,433.80,467.54,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Hometown Health,HMO,,433.80,,,,,,,125.32,467.54,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Hometown Health,HMO,,213.30,,,,,,,213.30,229.89,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Hometown Health,HMO,,213.30,,,,,,,61.62,229.89,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,inpatient,,,490.00000,329.77000,Hometown Health,HMO,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,outpatient,,,490.00000,329.77000,Hometown Health,HMO,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,inpatient,,,490.00000,329.77000,Hometown Health,HMO,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,outpatient,,,490.00000,329.77000,Hometown Health,HMO,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,inpatient,,,245.00000,164.89000,Hometown Health,HMO,,220.50,,,,,,,220.50,237.65,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,outpatient,,,245.00000,164.89000,Hometown Health,HMO,,220.50,,,,,,,63.70,237.65,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,inpatient,,,490.00000,329.77000,Hometown Health,HMO,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Hometown Health,HMO,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Hometown Health,HMO,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Hometown Health,HMO,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,inpatient,,,245.00000,164.89000,Hometown Health,HMO,,220.50,,,,,,,220.50,237.65,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Hometown Health,HMO,,220.50,,,,,,,63.70,237.65,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Hometown Health,HMO,,757.80,,,,,,,757.80,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Hometown Health,HMO,,757.80,,,,,,,218.92,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Hometown Health,HMO,,947.70,,,,,,,947.70,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Hometown Health,HMO,,947.70,,,,,,,273.78,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Hometown Health,HMO,,1136.70,,,,,,,1136.70,1225.11,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Hometown Health,HMO,,1136.70,,,,,,,328.38,1225.11,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,inpatient,,,2466.00000,986.40000,Hometown Health,HMO,,2219.40,,,,,,,2219.40,2392.02,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,outpatient,,,2466.00000,986.40000,Hometown Health,HMO,,2219.40,,,,,,,641.16,2392.02,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,inpatient,,,260.00000,104.00000,Hometown Health,HMO,,234.00,,,,,,,234.00,252.20,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,outpatient,,,260.00000,104.00000,Hometown Health,HMO,,234.00,,,,,,,67.60,252.20,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,inpatient,,,2041.00000,816.40000,Hometown Health,HMO,,1836.90,,,,,,,1836.90,1979.77,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,outpatient,,,2041.00000,816.40000,Hometown Health,HMO,,1836.90,,,,,,,530.66,1979.77,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,inpatient,,,375.00000,150.00000,Hometown Health,HMO,,337.50,,,,,,,337.50,363.75,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,outpatient,,,375.00000,150.00000,Hometown Health,HMO,,337.50,,,,,,,97.50,363.75,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,inpatient,,,1178.00000,471.20000,Hometown Health,HMO,,1060.20,,,,,,,1060.20,1142.66,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,outpatient,,,1178.00000,471.20000,Hometown Health,HMO,,1060.20,,,,,,,306.28,1142.66,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,inpatient,,,245.00000,98.00000,Hometown Health,HMO,,220.50,,,,,,,220.50,237.65,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,outpatient,,,245.00000,98.00000,Hometown Health,HMO,,220.50,,,,,,,63.70,237.65,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,inpatient,,,280.00000,112.00000,Hometown Health,HMO,,252.00,,,,,,,252.00,271.60,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,outpatient,,,280.00000,112.00000,Hometown Health,HMO,,252.00,,,,,,,72.80,271.60,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,inpatient,,,336.00000,134.40000,Hometown Health,HMO,,302.40,,,,,,,302.40,325.92,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,outpatient,,,336.00000,134.40000,Hometown Health,HMO,,302.40,,,,,,,87.36,325.92,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,inpatient,,,380.00000,152.00000,Hometown Health,HMO,,342.00,,,,,,,342.00,368.60,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,outpatient,,,380.00000,152.00000,Hometown Health,HMO,,342.00,,,,,,,98.80,368.60,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,inpatient,,,530.00000,212.00000,Hometown Health,HMO,,477.00,,,,,,,477.00,514.10,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Hometown Health,HMO,,477.00,,,,,,,137.80,514.10,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,inpatient,,,264.00000,105.60000,Hometown Health,HMO,,237.60,,,,,,,237.60,256.08,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,outpatient,,,264.00000,105.60000,Hometown Health,HMO,,237.60,,,,,,,68.64,256.08,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,inpatient,,,763.00000,305.20000,Hometown Health,HMO,,686.70,,,,,,,686.70,740.11,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,outpatient,,,763.00000,305.20000,Hometown Health,HMO,,686.70,,,,,,,198.38,740.11,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,inpatient,,,672.00000,268.80000,Hometown Health,HMO,,604.80,,,,,,,604.80,651.84,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,outpatient,,,672.00000,268.80000,Hometown Health,HMO,,604.80,,,,,,,174.72,651.84,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,inpatient,,,1940.00000,776.00000,Hometown Health,HMO,,1746.00,,,,,,,1746.00,1881.80,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,outpatient,,,1940.00000,776.00000,Hometown Health,HMO,,1746.00,,,,,,,504.40,1881.80,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,inpatient,,,3875.00000,1550.00000,Hometown Health,HMO,,3487.50,,,,,,,3487.50,3758.75,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,outpatient,,,3875.00000,1550.00000,Hometown Health,HMO,,3487.50,,,,,,,1007.50,3758.75,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,inpatient,,,505.00000,202.00000,Hometown Health,HMO,,454.50,,,,,,,454.50,489.85,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,outpatient,,,505.00000,202.00000,Hometown Health,HMO,,454.50,,,,,,,131.30,489.85,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,inpatient,,,295.00000,118.00000,Hometown Health,HMO,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Hometown Health,HMO,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,inpatient,,,585.00000,234.00000,Hometown Health,HMO,,526.50,,,,,,,526.50,567.45,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,outpatient,,,585.00000,234.00000,Hometown Health,HMO,,526.50,,,,,,,152.10,567.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,inpatient,,,285.00000,114.00000,Hometown Health,HMO,,256.50,,,,,,,256.50,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,outpatient,,,285.00000,114.00000,Hometown Health,HMO,,256.50,,,,,,,74.10,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,inpatient,,,575.00000,230.00000,Hometown Health,HMO,,517.50,,,,,,,517.50,557.75,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,outpatient,,,575.00000,230.00000,Hometown Health,HMO,,517.50,,,,,,,149.50,557.75,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,inpatient,,,697.00000,278.80000,Hometown Health,HMO,,627.30,,,,,,,627.30,676.09,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,outpatient,,,697.00000,278.80000,Hometown Health,HMO,,627.30,,,,,,,181.22,676.09,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,inpatient,,,530.00000,212.00000,Hometown Health,HMO,,477.00,,,,,,,477.00,514.10,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Hometown Health,HMO,,477.00,,,,,,,137.80,514.10,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,inpatient,,,580.00000,232.00000,Hometown Health,HMO,,522.00,,,,,,,522.00,562.60,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,outpatient,,,580.00000,232.00000,Hometown Health,HMO,,522.00,,,,,,,150.80,562.60,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,inpatient,,,435.00000,174.00000,Hometown Health,HMO,,391.50,,,,,,,391.50,421.95,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,outpatient,,,435.00000,174.00000,Hometown Health,HMO,,391.50,,,,,,,113.10,421.95,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,inpatient,,,270.00000,108.00000,Hometown Health,HMO,,243.00,,,,,,,243.00,261.90,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,outpatient,,,270.00000,108.00000,Hometown Health,HMO,,243.00,,,,,,,70.20,261.90,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,inpatient,,,504.00000,201.60000,Hometown Health,HMO,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,outpatient,,,504.00000,201.60000,Hometown Health,HMO,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,inpatient,,,98.00000,39.20000,Hometown Health,HMO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,outpatient,,,98.00000,39.20000,Hometown Health,HMO,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,inpatient,,,608.00000,243.20000,Hometown Health,HMO,,547.20,,,,,,,547.20,589.76,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,outpatient,,,608.00000,243.20000,Hometown Health,HMO,,547.20,,,,,,,158.08,589.76,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,inpatient,,,114.00000,45.60000,Hometown Health,HMO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,outpatient,,,114.00000,45.60000,Hometown Health,HMO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,inpatient,,,187.00000,74.80000,Hometown Health,HMO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,outpatient,,,187.00000,74.80000,Hometown Health,HMO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,inpatient,,,214.00000,85.60000,Hometown Health,HMO,,192.60,,,,,,,192.60,207.58,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,outpatient,,,214.00000,85.60000,Hometown Health,HMO,,192.60,,,,,,,55.64,207.58,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,inpatient,,,863.00000,345.20000,Hometown Health,HMO,,776.70,,,,,,,776.70,837.11,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,outpatient,,,863.00000,345.20000,Hometown Health,HMO,,776.70,,,,,,,224.38,837.11,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,inpatient,,,453.00000,181.20000,Hometown Health,HMO,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,outpatient,,,453.00000,181.20000,Hometown Health,HMO,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,inpatient,,,144.00000,57.60000,Hometown Health,HMO,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,outpatient,,,144.00000,57.60000,Hometown Health,HMO,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,inpatient,,,107.00000,42.80000,Hometown Health,HMO,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,outpatient,,,107.00000,42.80000,Hometown Health,HMO,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,inpatient,,,403.00000,161.20000,Hometown Health,HMO,,362.70,,,,,,,362.70,390.91,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,outpatient,,,403.00000,161.20000,Hometown Health,HMO,,362.70,,,,,,,104.78,390.91,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,inpatient,,,144.00000,57.60000,Hometown Health,HMO,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,outpatient,,,144.00000,57.60000,Hometown Health,HMO,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,inpatient,,,370.00000,148.00000,Hometown Health,HMO,,333.00,,,,,,,333.00,358.90,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,outpatient,,,370.00000,148.00000,Hometown Health,HMO,,333.00,,,,,,,96.20,358.90,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,inpatient,,,334.00000,133.60000,Hometown Health,HMO,,300.60,,,,,,,300.60,323.98,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,outpatient,,,334.00000,133.60000,Hometown Health,HMO,,300.60,,,,,,,86.84,323.98,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,inpatient,,,1188.00000,475.20000,Hometown Health,HMO,50,1069.20,,,,,,,1069.20,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,outpatient,,,1188.00000,475.20000,Hometown Health,HMO,50,1069.20,,,,,,,308.88,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,inpatient,,,792.00000,316.80000,Hometown Health,HMO,LT,712.80,,,,,,,712.80,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Hometown Health,HMO,LT,712.80,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,inpatient,,,792.00000,316.80000,Hometown Health,HMO,RT,712.80,,,,,,,712.80,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Hometown Health,HMO,RT,712.80,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,inpatient,,,572.00000,228.80000,Hometown Health,HMO,50,514.80,,,,,,,514.80,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,outpatient,,,572.00000,228.80000,Hometown Health,HMO,50,514.80,,,,,,,148.72,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,inpatient,,,381.00000,152.40000,Hometown Health,HMO,LT,342.90,,,,,,,342.90,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Hometown Health,HMO,LT,342.90,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,inpatient,,,381.00000,152.40000,Hometown Health,HMO,RT,342.90,,,,,,,342.90,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Hometown Health,HMO,RT,342.90,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,inpatient,,,683.00000,273.20000,Hometown Health,HMO,50,614.70,,,,,,,614.70,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,outpatient,,,683.00000,273.20000,Hometown Health,HMO,50,614.70,,,,,,,177.58,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,inpatient,,,455.00000,182.00000,Hometown Health,HMO,LT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Hometown Health,HMO,LT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,inpatient,,,455.00000,182.00000,Hometown Health,HMO,RT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Hometown Health,HMO,RT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,inpatient,,,357.00000,142.80000,Hometown Health,HMO,,321.30,,,,,,,321.30,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,outpatient,,,357.00000,142.80000,Hometown Health,HMO,,321.30,,,,,,,92.82,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,inpatient,,,334.00000,133.60000,Hometown Health,HMO,,300.60,,,,,,,300.60,323.98,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,outpatient,,,334.00000,133.60000,Hometown Health,HMO,,300.60,,,,,,,86.84,323.98,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,inpatient,,,194.00000,77.60000,Hometown Health,HMO,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,outpatient,,,194.00000,77.60000,Hometown Health,HMO,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,inpatient,,,608.00000,243.20000,Hometown Health,HMO,,547.20,,,,,,,547.20,589.76,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,outpatient,,,608.00000,243.20000,Hometown Health,HMO,,547.20,,,,,,,158.08,589.76,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,inpatient,,,257.00000,102.80000,Hometown Health,HMO,,231.30,,,,,,,231.30,249.29,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,outpatient,,,257.00000,102.80000,Hometown Health,HMO,,231.30,,,,,,,66.82,249.29,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,inpatient,,,343.00000,137.20000,Hometown Health,HMO,,308.70,,,,,,,308.70,332.71,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,outpatient,,,343.00000,137.20000,Hometown Health,HMO,,308.70,,,,,,,89.18,332.71,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,inpatient,,,457.00000,182.80000,Hometown Health,HMO,,411.30,,,,,,,411.30,443.29,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,outpatient,,,457.00000,182.80000,Hometown Health,HMO,,411.30,,,,,,,118.82,443.29,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,inpatient,,,630.00000,252.00000,Hometown Health,HMO,,567.00,,,,,,,567.00,611.10,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,outpatient,,,630.00000,252.00000,Hometown Health,HMO,,567.00,,,,,,,163.80,611.10,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,inpatient,,,623.00000,249.20000,Hometown Health,HMO,,560.70,,,,,,,560.70,604.31,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,outpatient,,,623.00000,249.20000,Hometown Health,HMO,,560.70,,,,,,,161.98,604.31,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,inpatient,,,1457.00000,582.80000,Hometown Health,HMO,,1311.30,,,,,,,1311.30,1413.29,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,outpatient,,,1457.00000,582.80000,Hometown Health,HMO,,1311.30,,,,,,,378.82,1413.29,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,inpatient,,,890.00000,356.00000,Hometown Health,HMO,,801.00,,,,,,,801.00,863.30,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,outpatient,,,890.00000,356.00000,Hometown Health,HMO,,801.00,,,,,,,231.40,863.30,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,inpatient,,,532.00000,212.80000,Hometown Health,HMO,,478.80,,,,,,,478.80,516.04,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,outpatient,,,532.00000,212.80000,Hometown Health,HMO,,478.80,,,,,,,138.32,516.04,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,inpatient,,,492.00000,196.80000,Hometown Health,HMO,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,outpatient,,,492.00000,196.80000,Hometown Health,HMO,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,inpatient,,,550.00000,220.00000,Hometown Health,HMO,,495.00,,,,,,,495.00,533.50,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,outpatient,,,550.00000,220.00000,Hometown Health,HMO,,495.00,,,,,,,143.00,533.50,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,inpatient,,,305.00000,122.00000,Hometown Health,HMO,,274.50,,,,,,,274.50,295.85,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,outpatient,,,305.00000,122.00000,Hometown Health,HMO,,274.50,,,,,,,79.30,295.85,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,inpatient,,,220.00000,88.00000,Hometown Health,HMO,,198.00,,,,,,,198.00,213.40,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,outpatient,,,220.00000,88.00000,Hometown Health,HMO,,198.00,,,,,,,57.20,213.40,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,inpatient,,,780.00000,312.00000,Hometown Health,HMO,,702.00,,,,,,,702.00,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,outpatient,,,780.00000,312.00000,Hometown Health,HMO,,702.00,,,,,,,202.80,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,inpatient,,,1165.00000,466.00000,Hometown Health,HMO,,1048.50,,,,,,,1048.50,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,outpatient,,,1165.00000,466.00000,Hometown Health,HMO,,1048.50,,,,,,,302.90,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,inpatient,,,2350.00000,940.00000,Hometown Health,HMO,,2115.00,,,,,,,2115.00,2279.50,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,outpatient,,,2350.00000,940.00000,Hometown Health,HMO,,2115.00,,,,,,,611.00,2279.50,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,inpatient,,,896.00000,358.40000,Hometown Health,HMO,,806.40,,,,,,,806.40,869.12,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,outpatient,,,896.00000,358.40000,Hometown Health,HMO,,806.40,,,,,,,232.96,869.12,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,inpatient,,,385.00000,154.00000,Hometown Health,HMO,,346.50,,,,,,,346.50,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,outpatient,,,385.00000,154.00000,Hometown Health,HMO,,346.50,,,,,,,100.10,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,inpatient,,,470.00000,188.00000,Hometown Health,HMO,,423.00,,,,,,,423.00,455.90,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,outpatient,,,470.00000,188.00000,Hometown Health,HMO,,423.00,,,,,,,122.20,455.90,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,inpatient,,,150.00000,60.00000,Hometown Health,HMO,,135.00,,,,,,,135.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,outpatient,,,150.00000,60.00000,Hometown Health,HMO,,135.00,,,,,,,39.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,inpatient,,,100.00000,40.00000,Hometown Health,HMO,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,outpatient,,,100.00000,40.00000,Hometown Health,HMO,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,inpatient,,,143.00000,57.20000,Hometown Health,HMO,,128.70,,,,,,,128.70,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,outpatient,,,143.00000,57.20000,Hometown Health,HMO,,128.70,,,,,,,37.18,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,inpatient,,,95.00000,38.00000,Hometown Health,HMO,,85.50,,,,,,,85.50,92.15,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,outpatient,,,95.00000,38.00000,Hometown Health,HMO,,85.50,,,,,,,24.70,92.15,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,inpatient,,,269.00000,107.60000,Hometown Health,HMO,,242.10,,,,,,,242.10,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,outpatient,,,269.00000,107.60000,Hometown Health,HMO,,242.10,,,,,,,69.94,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,inpatient,,,388.00000,155.20000,Hometown Health,HMO,,349.20,,,,,,,349.20,376.36,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,outpatient,,,388.00000,155.20000,Hometown Health,HMO,,349.20,,,,,,,100.88,376.36,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,inpatient,,,344.00000,137.60000,Hometown Health,HMO,,309.60,,,,,,,309.60,333.68,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,outpatient,,,344.00000,137.60000,Hometown Health,HMO,,309.60,,,,,,,89.44,333.68,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,inpatient,,,321.00000,128.40000,Hometown Health,HMO,,288.90,,,,,,,288.90,311.37,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,outpatient,,,321.00000,128.40000,Hometown Health,HMO,,288.90,,,,,,,83.46,311.37,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,inpatient,,,155.00000,62.00000,Hometown Health,HMO,,139.50,,,,,,,139.50,150.35,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,outpatient,,,155.00000,62.00000,Hometown Health,HMO,,139.50,,,,,,,40.30,150.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,inpatient,,,817.00000,326.80000,Hometown Health,HMO,,735.30,,,,,,,735.30,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,outpatient,,,817.00000,326.80000,Hometown Health,HMO,,735.30,,,,,,,212.42,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,inpatient,,,1255.00000,502.00000,Hometown Health,HMO,,1129.50,,,,,,,1129.50,1217.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,outpatient,,,1255.00000,502.00000,Hometown Health,HMO,,1129.50,,,,,,,326.30,1217.35,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,inpatient,,,391.00000,156.40000,Hometown Health,HMO,,351.90,,,,,,,351.90,379.27,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,outpatient,,,391.00000,156.40000,Hometown Health,HMO,,351.90,,,,,,,101.66,379.27,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,inpatient,,,671.00000,268.40000,Hometown Health,HMO,,603.90,,,,,,,603.90,650.87,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,outpatient,,,671.00000,268.40000,Hometown Health,HMO,,603.90,,,,,,,174.46,650.87,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,inpatient,,,456.00000,182.40000,Hometown Health,HMO,,410.40,,,,,,,410.40,442.32,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,outpatient,,,456.00000,182.40000,Hometown Health,HMO,,410.40,,,,,,,118.56,442.32,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,inpatient,,,112.00000,44.80000,Hometown Health,HMO,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,outpatient,,,112.00000,44.80000,Hometown Health,HMO,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,inpatient,,,84.00000,33.60000,Hometown Health,HMO,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,outpatient,,,84.00000,33.60000,Hometown Health,HMO,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,inpatient,,,216.00000,86.40000,Hometown Health,HMO,,194.40,,,,,,,194.40,209.52,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,outpatient,,,216.00000,86.40000,Hometown Health,HMO,,194.40,,,,,,,56.16,209.52,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,inpatient,,,2660.00000,1064.00000,Hometown Health,HMO,,2394.00,,,,,,,2394.00,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,outpatient,,,2660.00000,1064.00000,Hometown Health,HMO,,2394.00,,,,,,,691.60,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,inpatient,,,2960.00000,1184.00000,Hometown Health,HMO,,2664.00,,,,,,,2664.00,2871.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,outpatient,,,2960.00000,1184.00000,Hometown Health,HMO,,2664.00,,,,,,,769.60,2871.20,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,inpatient,,,3225.00000,1290.00000,Hometown Health,HMO,,2902.50,,,,,,,2902.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,outpatient,,,3225.00000,1290.00000,Hometown Health,HMO,,2902.50,,,,,,,838.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,inpatient,,,3395.00000,1358.00000,Hometown Health,HMO,,3055.50,,,,,,,3055.50,3293.15,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,outpatient,,,3395.00000,1358.00000,Hometown Health,HMO,,3055.50,,,,,,,882.70,3293.15,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,inpatient,,,490.00000,196.00000,Hometown Health,HMO,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,outpatient,,,490.00000,196.00000,Hometown Health,HMO,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,inpatient,,,520.00000,208.00000,Hometown Health,HMO,,468.00,,,,,,,468.00,504.40,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,outpatient,,,520.00000,208.00000,Hometown Health,HMO,,468.00,,,,,,,135.20,504.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,inpatient,,,720.00000,288.00000,Hometown Health,HMO,,648.00,,,,,,,648.00,698.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,outpatient,,,720.00000,288.00000,Hometown Health,HMO,,648.00,,,,,,,187.20,698.40,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,inpatient,,,215.00000,86.00000,Hometown Health,HMO,,193.50,,,,,,,193.50,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,outpatient,,,215.00000,86.00000,Hometown Health,HMO,,193.50,,,,,,,55.90,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,inpatient,,,240.00000,96.00000,Hometown Health,HMO,,216.00,,,,,,,216.00,232.80,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,outpatient,,,240.00000,96.00000,Hometown Health,HMO,,216.00,,,,,,,62.40,232.80,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,inpatient,,,1241.00000,496.40000,Hometown Health,HMO,,1116.90,,,,,,,1116.90,1203.77,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,outpatient,,,1241.00000,496.40000,Hometown Health,HMO,,1116.90,,,,,,,322.66,1203.77,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,inpatient,,,850.00000,340.00000,Hometown Health,HMO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,outpatient,,,850.00000,340.00000,Hometown Health,HMO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,inpatient,,,1085.00000,434.00000,Hometown Health,HMO,,976.50,,,,,,,976.50,1052.45,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,outpatient,,,1085.00000,434.00000,Hometown Health,HMO,,976.50,,,,,,,282.10,1052.45,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,inpatient,,,295.00000,118.00000,Hometown Health,HMO,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Hometown Health,HMO,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,inpatient,,,492.00000,196.80000,Hometown Health,HMO,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,outpatient,,,492.00000,196.80000,Hometown Health,HMO,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,inpatient,,,563.00000,225.20000,Hometown Health,HMO,,506.70,,,,,,,506.70,546.11,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,outpatient,,,563.00000,225.20000,Hometown Health,HMO,,506.70,,,,,,,146.38,546.11,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,inpatient,,,1612.00000,644.80000,Hometown Health,HMO,,1450.80,,,,,,,1450.80,1563.64,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,outpatient,,,1612.00000,644.80000,Hometown Health,HMO,,1450.80,,,,,,,419.12,1563.64,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,inpatient,,,1366.00000,546.40000,Hometown Health,HMO,,1229.40,,,,,,,1229.40,1325.02,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,outpatient,,,1366.00000,546.40000,Hometown Health,HMO,,1229.40,,,,,,,355.16,1325.02,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,inpatient,,,1911.00000,764.40000,Hometown Health,HMO,,1719.90,,,,,,,1719.90,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,outpatient,,,1911.00000,764.40000,Hometown Health,HMO,,1719.90,,,,,,,496.86,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,inpatient,,,956.00000,382.40000,Hometown Health,HMO,,860.40,,,,,,,860.40,927.32,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,outpatient,,,956.00000,382.40000,Hometown Health,HMO,,860.40,,,,,,,248.56,927.32,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,inpatient,,,189.00000,123.20000,Hometown Health,HMO,,170.10,,,,,,,170.10,183.33,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,outpatient,,,189.00000,123.20000,Hometown Health,HMO,,170.10,,,,,,,49.14,183.33,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,inpatient,,,352.00000,256.87000,Hometown Health,HMO,,316.80,,,,,,,316.80,341.44,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,outpatient,,,352.00000,256.87000,Hometown Health,HMO,,316.80,,,,,,,91.52,341.44,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,inpatient,,,625.00000,738.40000,Hometown Health,HMO,,562.50,,,,,,,562.50,606.25,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,outpatient,,,625.00000,738.40000,Hometown Health,HMO,,562.50,,,,,,,162.50,606.25,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,inpatient,,,1024.00000,2097.47000,Hometown Health,HMO,,921.60,,,,,,,921.60,993.28,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1024.00000,2097.47000,Hometown Health,HMO,,921.60,,,,,,,266.24,993.28,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,inpatient,,,1455.00000,2469.72000,Hometown Health,HMO,,1309.50,,,,,,,1309.50,1411.35,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,outpatient,,,1455.00000,2469.72000,Hometown Health,HMO,,1309.50,,,,,,,378.30,1411.35,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,inpatient,,,145.00000,75.54000,Hometown Health,HMO,,130.50,,,,,,,130.50,140.65,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Hometown Health,HMO,,130.50,,,,,,,37.70,140.65,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,inpatient,,,488.00000,254.25000,Hometown Health,HMO,,439.20,,,,,,,439.20,473.36,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Hometown Health,HMO,,439.20,,,,,,,126.88,473.36,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Hometown Health,HMO,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Hometown Health,HMO,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Hometown Health,HMO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Hometown Health,HMO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Hometown Health,HMO,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Hometown Health,HMO,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,inpatient,,,170.00000,73.95000,Hometown Health,HMO,,153.00,,,,,,,153.00,164.90,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,outpatient,,,170.00000,73.95000,Hometown Health,HMO,,153.00,,,,,,,44.20,164.90,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,2.70000,1.17000,Hometown Health,HMO,,2.43,,,,,,,2.43,2.62,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,2.70000,1.17000,Hometown Health,HMO,,2.43,,,,,,,0.70200,2.62,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,27.00000,11.74000,Hometown Health,HMO,,24.30,,,,,,,24.30,26.19,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,27.00000,11.74000,Hometown Health,HMO,,24.30,,,,,,,7.02,26.19,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,inpatient,,,20440.00000,8891.40000,Hometown Health,HMO,,18396.00,,,,,,,18396.00,19826.80,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,outpatient,,,20440.00000,8891.40000,Hometown Health,HMO,,18396.00,,,,,,,5314.40,19826.80,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,inpatient,,,3322.00000,1445.07000,Hometown Health,HMO,,2989.80,,,,,,,2989.80,3222.34,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,3322.00000,1445.07000,Hometown Health,HMO,,2989.80,,,,,,,863.72,3222.34,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,inpatient,,,2492.00000,1084.02000,Hometown Health,HMO,,2242.80,,,,,,,2242.80,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,2492.00000,1084.02000,Hometown Health,HMO,,2242.80,,,,,,,647.92,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,inpatient,,,1814.00000,789.09000,Hometown Health,HMO,,1632.60,,,,,,,1632.60,1759.58,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1814.00000,789.09000,Hometown Health,HMO,,1632.60,,,,,,,471.64,1759.58,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,inpatient,,,2153.00000,936.56000,Hometown Health,HMO,,1937.70,,,,,,,1937.70,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,2153.00000,936.56000,Hometown Health,HMO,,1937.70,,,,,,,559.78,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,inpatient,,,1525.00000,663.38000,Hometown Health,HMO,,1372.50,,,,,,,1372.50,1479.25,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1525.00000,663.38000,Hometown Health,HMO,,1372.50,,,,,,,396.50,1479.25,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,inpatient,,,2716.00000,1181.46000,Hometown Health,HMO,,2444.40,,,,,,,2444.40,2634.52,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2716.00000,1181.46000,Hometown Health,HMO,,2444.40,,,,,,,706.16,2634.52,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,inpatient,,,2.70000,0.39000,Hometown Health,HMO,,2.43,,,,,,,2.43,2.62,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,outpatient,,,2.70000,0.39000,Hometown Health,HMO,,2.43,,,,,,,0.70200,2.62,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,inpatient,,,222.00000,32.41000,Hometown Health,HMO,,199.80,,,,,,,199.80,215.34,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,outpatient,,,222.00000,32.41000,Hometown Health,HMO,,199.80,,,,,,,57.72,215.34,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,inpatient,,,211.00000,113.10000,Hometown Health,HMO,,189.90,,,,,,,189.90,204.67,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,outpatient,,,211.00000,113.10000,Hometown Health,HMO,,189.90,,,,,,,54.86,204.67,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,inpatient,,,497.00000,266.39000,Hometown Health,HMO,,447.30,,,,,,,447.30,482.09,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,outpatient,,,497.00000,266.39000,Hometown Health,HMO,,447.30,,,,,,,129.22,482.09,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,inpatient,,,296.00000,158.66000,Hometown Health,HMO,,266.40,,,,,,,266.40,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,outpatient,,,296.00000,158.66000,Hometown Health,HMO,,266.40,,,,,,,76.96,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,inpatient,,,723.00000,387.53000,Hometown Health,HMO,,650.70,,,,,,,650.70,701.31,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,outpatient,,,723.00000,387.53000,Hometown Health,HMO,,650.70,,,,,,,187.98,701.31,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,inpatient,,,326.00000,174.74000,Hometown Health,HMO,,293.40,,,,,,,293.40,316.22,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,outpatient,,,326.00000,174.74000,Hometown Health,HMO,,293.40,,,,,,,84.76,316.22,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,inpatient,,,532.00000,285.15000,Hometown Health,HMO,,478.80,,,,,,,478.80,516.04,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,outpatient,,,532.00000,285.15000,Hometown Health,HMO,,478.80,,,,,,,138.32,516.04,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,inpatient,,,635.00000,340.36000,Hometown Health,HMO,,571.50,,,,,,,571.50,615.95,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,outpatient,,,635.00000,340.36000,Hometown Health,HMO,,571.50,,,,,,,165.10,615.95,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,inpatient,,,639.00000,342.50000,Hometown Health,HMO,,575.10,,,,,,,575.10,619.83,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,outpatient,,,639.00000,342.50000,Hometown Health,HMO,,575.10,,,,,,,166.14,619.83,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,inpatient,,,780.00000,418.08000,Hometown Health,HMO,,702.00,,,,,,,702.00,756.60,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,outpatient,,,780.00000,418.08000,Hometown Health,HMO,,702.00,,,,,,,202.80,756.60,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,inpatient,,,390.00000,209.04000,Hometown Health,HMO,,351.00,,,,,,,351.00,378.30,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,outpatient,,,390.00000,209.04000,Hometown Health,HMO,,351.00,,,,,,,101.40,378.30,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,inpatient,,,731.00000,391.82000,Hometown Health,HMO,,657.90,,,,,,,657.90,709.07,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,outpatient,,,731.00000,391.82000,Hometown Health,HMO,,657.90,,,,,,,190.06,709.07,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,inpatient,,,585.00000,313.56000,Hometown Health,HMO,,526.50,,,,,,,526.50,567.45,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,outpatient,,,585.00000,313.56000,Hometown Health,HMO,,526.50,,,,,,,152.10,567.45,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,inpatient,,,365.00000,195.64000,Hometown Health,HMO,,328.50,,,,,,,328.50,354.05,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,outpatient,,,365.00000,195.64000,Hometown Health,HMO,,328.50,,,,,,,94.90,354.05,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,inpatient,,,1086.00000,582.10000,Hometown Health,HMO,,977.40,,,,,,,977.40,1053.42,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,outpatient,,,1086.00000,582.10000,Hometown Health,HMO,,977.40,,,,,,,282.36,1053.42,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,inpatient,,,197.00000,105.59000,Hometown Health,HMO,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,outpatient,,,197.00000,105.59000,Hometown Health,HMO,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,inpatient,,,2774.00000,1486.86000,Hometown Health,HMO,,2496.60,,,,,,,2496.60,2690.78,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,outpatient,,,2774.00000,1486.86000,Hometown Health,HMO,,2496.60,,,,,,,721.24,2690.78,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,inpatient,,,1456.00000,780.42000,Hometown Health,HMO,,1310.40,,,,,,,1310.40,1412.32,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,outpatient,,,1456.00000,780.42000,Hometown Health,HMO,,1310.40,,,,,,,378.56,1412.32,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,inpatient,,,2647.00000,1418.79000,Hometown Health,HMO,,2382.30,,,,,,,2382.30,2567.59,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,outpatient,,,2647.00000,1418.79000,Hometown Health,HMO,,2382.30,,,,,,,688.22,2567.59,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,inpatient,,,1359.00000,728.42000,Hometown Health,HMO,,1223.10,,,,,,,1223.10,1318.23,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,outpatient,,,1359.00000,728.42000,Hometown Health,HMO,,1223.10,,,,,,,353.34,1318.23,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,inpatient,,,273.00000,146.33000,Hometown Health,HMO,,245.70,,,,,,,245.70,264.81,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,outpatient,,,273.00000,146.33000,Hometown Health,HMO,,245.70,,,,,,,70.98,264.81,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,inpatient,,,325.00000,174.20000,Hometown Health,HMO,,292.50,,,,,,,292.50,315.25,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,outpatient,,,325.00000,174.20000,Hometown Health,HMO,,292.50,,,,,,,84.50,315.25,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,inpatient,,,609.00000,326.42000,Hometown Health,HMO,,548.10,,,,,,,548.10,590.73,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Hometown Health,HMO,,548.10,,,,,,,158.34,590.73,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,inpatient,,,491.00000,263.18000,Hometown Health,HMO,,441.90,,,,,,,441.90,476.27,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,outpatient,,,491.00000,263.18000,Hometown Health,HMO,,441.90,,,,,,,127.66,476.27,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,inpatient,,,561.00000,300.70000,Hometown Health,HMO,,504.90,,,,,,,504.90,544.17,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,outpatient,,,561.00000,300.70000,Hometown Health,HMO,,504.90,,,,,,,145.86,544.17,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,inpatient,,,845.00000,452.92000,Hometown Health,HMO,,760.50,,,,,,,760.50,819.65,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,outpatient,,,845.00000,452.92000,Hometown Health,HMO,,760.50,,,,,,,219.70,819.65,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,inpatient,,,612.00000,328.03000,Hometown Health,HMO,,550.80,,,,,,,550.80,593.64,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,outpatient,,,612.00000,328.03000,Hometown Health,HMO,,550.80,,,,,,,159.12,593.64,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,inpatient,,,536.00000,287.30000,Hometown Health,HMO,,482.40,,,,,,,482.40,519.92,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,outpatient,,,536.00000,287.30000,Hometown Health,HMO,,482.40,,,,,,,139.36,519.92,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,inpatient,,,1225.00000,656.60000,Hometown Health,HMO,,1102.50,,,,,,,1102.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,outpatient,,,1225.00000,656.60000,Hometown Health,HMO,,1102.50,,,,,,,318.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,inpatient,,,816.00000,437.38000,Hometown Health,HMO,LT,734.40,,,,,,,734.40,791.52,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Hometown Health,HMO,LT,734.40,,,,,,,212.16,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,inpatient,,,816.00000,437.38000,Hometown Health,HMO,RT,734.40,,,,,,,734.40,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Hometown Health,HMO,RT,734.40,,,,,,,212.16,791.52,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,inpatient,,,250.00000,134.00000,Hometown Health,HMO,,225.00,,,,,,,225.00,242.50,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,outpatient,,,250.00000,134.00000,Hometown Health,HMO,,225.00,,,,,,,65.00,242.50,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,inpatient,,,302.00000,161.87000,Hometown Health,HMO,,271.80,,,,,,,271.80,292.94,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,outpatient,,,302.00000,161.87000,Hometown Health,HMO,,271.80,,,,,,,78.52,292.94,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,inpatient,,,354.00000,189.74000,Hometown Health,HMO,,318.60,,,,,,,318.60,343.38,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,outpatient,,,354.00000,189.74000,Hometown Health,HMO,,318.60,,,,,,,92.04,343.38,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,inpatient,,,409.00000,219.22000,Hometown Health,HMO,,368.10,,,,,,,368.10,396.73,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,outpatient,,,409.00000,219.22000,Hometown Health,HMO,,368.10,,,,,,,106.34,396.73,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,inpatient,,,593.00000,317.85000,Hometown Health,HMO,,533.70,,,,,,,533.70,575.21,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,outpatient,,,593.00000,317.85000,Hometown Health,HMO,,533.70,,,,,,,154.18,575.21,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Hometown Health,HMO,LT,276.30,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Hometown Health,HMO,LT,276.30,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Hometown Health,HMO,"52,LT",276.30,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Hometown Health,HMO,"52,LT",276.30,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Hometown Health,HMO,RT,276.30,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Hometown Health,HMO,RT,276.30,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Hometown Health,HMO,"52,RT",276.30,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Hometown Health,HMO,"52,RT",276.30,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,inpatient,,,330.00000,176.88000,Hometown Health,HMO,LT,297.00,,,,,,,297.00,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Hometown Health,HMO,LT,297.00,,,,,,,85.80,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,inpatient,,,330.00000,176.88000,Hometown Health,HMO,RT,297.00,,,,,,,297.00,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Hometown Health,HMO,RT,297.00,,,,,,,85.80,320.10,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,inpatient,,,195.00000,104.52000,Hometown Health,HMO,,175.50,,,,,,,175.50,189.15,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,outpatient,,,195.00000,104.52000,Hometown Health,HMO,,175.50,,,,,,,50.70,189.15,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,inpatient,,,578.00000,309.81000,Hometown Health,HMO,,520.20,,,,,,,520.20,560.66,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,outpatient,,,578.00000,309.81000,Hometown Health,HMO,,520.20,,,,,,,150.28,560.66,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,inpatient,,,384.00000,205.82000,Hometown Health,HMO,,345.60,,,,,,,345.60,372.48,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,outpatient,,,384.00000,205.82000,Hometown Health,HMO,,345.60,,,,,,,99.84,372.48,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,inpatient,,,303.00000,162.41000,Hometown Health,HMO,LT,272.70,,,,,,,272.70,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Hometown Health,HMO,LT,272.70,,,,,,,78.78,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,inpatient,,,303.00000,162.41000,Hometown Health,HMO,RT,272.70,,,,,,,272.70,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Hometown Health,HMO,RT,272.70,,,,,,,78.78,293.91,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,inpatient,,,445.00000,238.52000,Hometown Health,HMO,LT,400.50,,,,,,,400.50,431.65,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Hometown Health,HMO,LT,400.50,,,,,,,115.70,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,inpatient,,,445.00000,238.52000,Hometown Health,HMO,RT,400.50,,,,,,,400.50,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Hometown Health,HMO,RT,400.50,,,,,,,115.70,431.65,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,inpatient,,,937.00000,502.23000,Hometown Health,HMO,,843.30,,,,,,,843.30,908.89,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,outpatient,,,937.00000,502.23000,Hometown Health,HMO,,843.30,,,,,,,243.62,908.89,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,inpatient,,,615.00000,329.64000,Hometown Health,HMO,,553.50,,,,,,,553.50,596.55,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,outpatient,,,615.00000,329.64000,Hometown Health,HMO,,553.50,,,,,,,159.90,596.55,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Hometown Health,HMO,LT,258.30,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Hometown Health,HMO,LT,258.30,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Hometown Health,HMO,"52,LT",258.30,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Hometown Health,HMO,"52,LT",258.30,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Hometown Health,HMO,RT,258.30,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Hometown Health,HMO,RT,258.30,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Hometown Health,HMO,"52,RT",258.30,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Hometown Health,HMO,"52,RT",258.30,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,inpatient,,,323.00000,173.13000,Hometown Health,HMO,LT,290.70,,,,,,,290.70,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Hometown Health,HMO,LT,290.70,,,,,,,83.98,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,inpatient,,,323.00000,173.13000,Hometown Health,HMO,RT,290.70,,,,,,,290.70,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Hometown Health,HMO,RT,290.70,,,,,,,83.98,313.31,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,inpatient,,,694.00000,371.98000,Hometown Health,HMO,,624.60,,,,,,,624.60,673.18,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,outpatient,,,694.00000,371.98000,Hometown Health,HMO,,624.60,,,,,,,180.44,673.18,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,inpatient,,,276.00000,147.94000,Hometown Health,HMO,LT,248.40,,,,,,,248.40,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Hometown Health,HMO,LT,248.40,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,inpatient,,,276.00000,147.94000,Hometown Health,HMO,RT,248.40,,,,,,,248.40,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Hometown Health,HMO,RT,248.40,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,inpatient,,,254.00000,136.14000,Hometown Health,HMO,LT,228.60,,,,,,,228.60,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Hometown Health,HMO,LT,228.60,,,,,,,66.04,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,inpatient,,,254.00000,136.14000,Hometown Health,HMO,RT,228.60,,,,,,,228.60,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Hometown Health,HMO,RT,228.60,,,,,,,66.04,246.38,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,inpatient,,,275.00000,147.40000,Hometown Health,HMO,LT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Hometown Health,HMO,LT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,inpatient,,,275.00000,147.40000,Hometown Health,HMO,RT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Hometown Health,HMO,RT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,inpatient,,,173.00000,92.73000,Hometown Health,HMO,,155.70,,,,,,,155.70,167.81,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,outpatient,,,173.00000,92.73000,Hometown Health,HMO,,155.70,,,,,,,44.98,167.81,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,inpatient,,,483.00000,258.89000,Hometown Health,HMO,LT,434.70,,,,,,,434.70,468.51,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Hometown Health,HMO,LT,434.70,,,,,,,125.58,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,inpatient,,,483.00000,258.89000,Hometown Health,HMO,RT,434.70,,,,,,,434.70,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Hometown Health,HMO,RT,434.70,,,,,,,125.58,468.51,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,inpatient,,,191.00000,102.38000,Hometown Health,HMO,LT,171.90,,,,,,,171.90,185.27,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Hometown Health,HMO,LT,171.90,,,,,,,49.66,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,inpatient,,,191.00000,102.38000,Hometown Health,HMO,RT,171.90,,,,,,,171.90,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Hometown Health,HMO,RT,171.90,,,,,,,49.66,185.27,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Hometown Health,HMO,LT,133.20,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Hometown Health,HMO,LT,133.20,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Hometown Health,HMO,"52,LT",133.20,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Hometown Health,HMO,"52,LT",133.20,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Hometown Health,HMO,RT,133.20,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Hometown Health,HMO,RT,133.20,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Hometown Health,HMO,"52,RT",133.20,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Hometown Health,HMO,"52,RT",133.20,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,inpatient,,,481.00000,257.82000,Hometown Health,HMO,LT,432.90,,,,,,,432.90,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Hometown Health,HMO,LT,432.90,,,,,,,125.06,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,inpatient,,,481.00000,257.82000,Hometown Health,HMO,RT,432.90,,,,,,,432.90,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Hometown Health,HMO,RT,432.90,,,,,,,125.06,466.57,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,inpatient,,,215.00000,115.24000,Hometown Health,HMO,LT,193.50,,,,,,,193.50,208.55,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Hometown Health,HMO,LT,193.50,,,,,,,55.90,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,inpatient,,,215.00000,115.24000,Hometown Health,HMO,RT,193.50,,,,,,,193.50,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Hometown Health,HMO,RT,193.50,,,,,,,55.90,208.55,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Hometown Health,HMO,LT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Hometown Health,HMO,LT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Hometown Health,HMO,"52,LT",247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Hometown Health,HMO,"52,LT",247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Hometown Health,HMO,RT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Hometown Health,HMO,RT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Hometown Health,HMO,"52,RT",247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Hometown Health,HMO,"52,RT",247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,HMO,LT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,HMO,LT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,HMO,"52,LT",409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,HMO,"52,LT",409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,HMO,RT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,HMO,RT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,HMO,"52,RT",409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,HMO,"52,RT",409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,inpatient,,,503.00000,269.61000,Hometown Health,HMO,LT,452.70,,,,,,,452.70,487.91,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Hometown Health,HMO,LT,452.70,,,,,,,130.78,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,inpatient,,,503.00000,269.61000,Hometown Health,HMO,RT,452.70,,,,,,,452.70,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Hometown Health,HMO,RT,452.70,,,,,,,130.78,487.91,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,inpatient,,,209.00000,112.02000,Hometown Health,HMO,LT,188.10,,,,,,,188.10,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Hometown Health,HMO,LT,188.10,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,inpatient,,,209.00000,112.02000,Hometown Health,HMO,RT,188.10,,,,,,,188.10,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Hometown Health,HMO,RT,188.10,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,inpatient,,,566.00000,303.38000,Hometown Health,HMO,LT,509.40,,,,,,,509.40,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Hometown Health,HMO,LT,509.40,,,,,,,147.16,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,inpatient,,,566.00000,303.38000,Hometown Health,HMO,RT,509.40,,,,,,,509.40,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Hometown Health,HMO,RT,509.40,,,,,,,147.16,549.02,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,inpatient,,,598.00000,320.53000,Hometown Health,HMO,,538.20,,,,,,,538.20,580.06,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,outpatient,,,598.00000,320.53000,Hometown Health,HMO,,538.20,,,,,,,155.48,580.06,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,HMO,"52,LT",409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,HMO,"52,LT",409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,HMO,"52,RT",409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,HMO,"52,RT",409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,HMO,LT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,HMO,LT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,HMO,RT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,HMO,RT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,inpatient,,,1913.00000,1025.37000,Hometown Health,HMO,,1721.70,,,,,,,1721.70,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,outpatient,,,1913.00000,1025.37000,Hometown Health,HMO,,1721.70,,,,,,,497.38,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,inpatient,,,312.00000,167.23000,Hometown Health,HMO,,280.80,,,,,,,280.80,302.64,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,outpatient,,,312.00000,167.23000,Hometown Health,HMO,,280.80,,,,,,,81.12,302.64,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,inpatient,,,327.00000,175.27000,Hometown Health,HMO,,294.30,,,,,,,294.30,317.19,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,outpatient,,,327.00000,175.27000,Hometown Health,HMO,,294.30,,,,,,,85.02,317.19,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,inpatient,,,425.00000,227.80000,Hometown Health,HMO,,382.50,,,,,,,382.50,412.25,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,outpatient,,,425.00000,227.80000,Hometown Health,HMO,,382.50,,,,,,,110.50,412.25,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,inpatient,,,210.00000,112.56000,Hometown Health,HMO,,189.00,,,,,,,189.00,203.70,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,outpatient,,,210.00000,112.56000,Hometown Health,HMO,,189.00,,,,,,,54.60,203.70,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,inpatient,,,495.00000,265.32000,Hometown Health,HMO,,445.50,,,,,,,445.50,480.15,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,outpatient,,,495.00000,265.32000,Hometown Health,HMO,,445.50,,,,,,,128.70,480.15,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,inpatient,,,541.00000,289.98000,Hometown Health,HMO,,486.90,,,,,,,486.90,524.77,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,outpatient,,,541.00000,289.98000,Hometown Health,HMO,,486.90,,,,,,,140.66,524.77,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,inpatient,,,345.00000,184.92000,Hometown Health,HMO,LT,310.50,,,,,,,310.50,334.65,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Hometown Health,HMO,LT,310.50,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,inpatient,,,345.00000,184.92000,Hometown Health,HMO,RT,310.50,,,,,,,310.50,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Hometown Health,HMO,RT,310.50,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,inpatient,,,419.00000,224.58000,Hometown Health,HMO,LT,377.10,,,,,,,377.10,406.43,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Hometown Health,HMO,LT,377.10,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,inpatient,,,419.00000,224.58000,Hometown Health,HMO,RT,377.10,,,,,,,377.10,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Hometown Health,HMO,RT,377.10,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,inpatient,,,618.00000,331.25000,Hometown Health,HMO,LT,556.20,,,,,,,556.20,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Hometown Health,HMO,LT,556.20,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,inpatient,,,618.00000,331.25000,Hometown Health,HMO,RT,556.20,,,,,,,556.20,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Hometown Health,HMO,RT,556.20,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,inpatient,,,463.00000,248.17000,Hometown Health,HMO,,416.70,,,,,,,416.70,449.11,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,outpatient,,,463.00000,248.17000,Hometown Health,HMO,,416.70,,,,,,,120.38,449.11,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,inpatient,,,511.00000,273.90000,Hometown Health,HMO,,459.90,,,,,,,459.90,495.67,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,outpatient,,,511.00000,273.90000,Hometown Health,HMO,,459.90,,,,,,,132.86,495.67,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,inpatient,,,132.00000,70.75000,Hometown Health,HMO,,118.80,,,,,,,118.80,128.04,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,outpatient,,,132.00000,70.75000,Hometown Health,HMO,,118.80,,,,,,,34.32,128.04,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,inpatient,,,353.00000,189.21000,Hometown Health,HMO,LT,317.70,,,,,,,317.70,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Hometown Health,HMO,LT,317.70,,,,,,,91.78,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,inpatient,,,353.00000,189.21000,Hometown Health,HMO,RT,317.70,,,,,,,317.70,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Hometown Health,HMO,RT,317.70,,,,,,,91.78,342.41,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,inpatient,,,273.00000,146.33000,Hometown Health,HMO,,245.70,,,,,,,245.70,264.81,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,outpatient,,,273.00000,146.33000,Hometown Health,HMO,,245.70,,,,,,,70.98,264.81,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,inpatient,,,503.00000,269.61000,Hometown Health,HMO,,452.70,,,,,,,452.70,487.91,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,outpatient,,,503.00000,269.61000,Hometown Health,HMO,,452.70,,,,,,,130.78,487.91,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,inpatient,,,561.00000,300.70000,Hometown Health,HMO,,504.90,,,,,,,504.90,544.17,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,outpatient,,,561.00000,300.70000,Hometown Health,HMO,,504.90,,,,,,,145.86,544.17,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,inpatient,,,450.00000,241.20000,Hometown Health,HMO,LT,405.00,,,,,,,405.00,436.50,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Hometown Health,HMO,LT,405.00,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,inpatient,,,450.00000,241.20000,Hometown Health,HMO,RT,405.00,,,,,,,405.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Hometown Health,HMO,RT,405.00,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,inpatient,,,650.00000,348.40000,Hometown Health,HMO,,585.00,,,,,,,585.00,630.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,outpatient,,,650.00000,348.40000,Hometown Health,HMO,,585.00,,,,,,,169.00,630.50,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,inpatient,,,642.00000,344.11000,Hometown Health,HMO,,577.80,,,,,,,577.80,622.74,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,outpatient,,,642.00000,344.11000,Hometown Health,HMO,,577.80,,,,,,,166.92,622.74,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,inpatient,,,777.00000,416.47000,Hometown Health,HMO,,699.30,,,,,,,699.30,753.69,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,outpatient,,,777.00000,416.47000,Hometown Health,HMO,,699.30,,,,,,,202.02,753.69,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,inpatient,,,381.00000,204.22000,Hometown Health,HMO,,342.90,,,,,,,342.90,369.57,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,outpatient,,,381.00000,204.22000,Hometown Health,HMO,,342.90,,,,,,,99.06,369.57,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,inpatient,,,374.00000,200.46000,Hometown Health,HMO,LT,336.60,,,,,,,336.60,362.78,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Hometown Health,HMO,LT,336.60,,,,,,,97.24,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,inpatient,,,374.00000,200.46000,Hometown Health,HMO,RT,336.60,,,,,,,336.60,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Hometown Health,HMO,RT,336.60,,,,,,,97.24,362.78,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,inpatient,,,161.00000,86.30000,Hometown Health,HMO,LT,144.90,,,,,,,144.90,156.17,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Hometown Health,HMO,LT,144.90,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,inpatient,,,161.00000,86.30000,Hometown Health,HMO,RT,144.90,,,,,,,144.90,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Hometown Health,HMO,RT,144.90,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,inpatient,,,499.00000,267.46000,Hometown Health,HMO,LT,449.10,,,,,,,449.10,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Hometown Health,HMO,LT,449.10,,,,,,,129.74,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,inpatient,,,499.00000,267.46000,Hometown Health,HMO,RT,449.10,,,,,,,449.10,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Hometown Health,HMO,RT,449.10,,,,,,,129.74,484.03,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,inpatient,,,214.00000,114.70000,Hometown Health,HMO,,192.60,,,,,,,192.60,207.58,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,outpatient,,,214.00000,114.70000,Hometown Health,HMO,,192.60,,,,,,,55.64,207.58,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,inpatient,,,329.00000,176.34000,Hometown Health,HMO,,296.10,,,,,,,296.10,319.13,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,outpatient,,,329.00000,176.34000,Hometown Health,HMO,,296.10,,,,,,,85.54,319.13,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,inpatient,,,197.00000,105.59000,Hometown Health,HMO,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,outpatient,,,197.00000,105.59000,Hometown Health,HMO,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,inpatient,,,263.00000,140.97000,Hometown Health,HMO,,236.70,,,,,,,236.70,255.11,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,outpatient,,,263.00000,140.97000,Hometown Health,HMO,,236.70,,,,,,,68.38,255.11,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,inpatient,,,234.00000,125.42000,Hometown Health,HMO,,210.60,,,,,,,210.60,226.98,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,outpatient,,,234.00000,125.42000,Hometown Health,HMO,,210.60,,,,,,,60.84,226.98,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,inpatient,,,401.00000,214.94000,Hometown Health,HMO,,360.90,,,,,,,360.90,388.97,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,outpatient,,,401.00000,214.94000,Hometown Health,HMO,,360.90,,,,,,,104.26,388.97,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,inpatient,,,515.00000,276.04000,Hometown Health,HMO,,463.50,,,,,,,463.50,499.55,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,outpatient,,,515.00000,276.04000,Hometown Health,HMO,,463.50,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,inpatient,,,747.00000,400.39000,Hometown Health,HMO,,672.30,,,,,,,672.30,724.59,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,outpatient,,,747.00000,400.39000,Hometown Health,HMO,,672.30,,,,,,,194.22,724.59,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,inpatient,,,854.00000,457.74000,Hometown Health,HMO,,768.60,,,,,,,768.60,828.38,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,outpatient,,,854.00000,457.74000,Hometown Health,HMO,,768.60,,,,,,,222.04,828.38,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,inpatient,,,589.00000,315.70000,Hometown Health,HMO,,530.10,,,,,,,530.10,571.33,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,outpatient,,,589.00000,315.70000,Hometown Health,HMO,,530.10,,,,,,,153.14,571.33,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,inpatient,,,613.00000,328.57000,Hometown Health,HMO,,551.70,,,,,,,551.70,594.61,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,outpatient,,,613.00000,328.57000,Hometown Health,HMO,,551.70,,,,,,,159.38,594.61,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,inpatient,,,806.00000,432.02000,Hometown Health,HMO,,725.40,,,,,,,725.40,781.82,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,outpatient,,,806.00000,432.02000,Hometown Health,HMO,,725.40,,,,,,,209.56,781.82,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,inpatient,,,529.00000,283.54000,Hometown Health,HMO,,476.10,,,,,,,476.10,513.13,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,outpatient,,,529.00000,283.54000,Hometown Health,HMO,,476.10,,,,,,,137.54,513.13,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,inpatient,,,939.00000,503.30000,Hometown Health,HMO,,845.10,,,,,,,845.10,910.83,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,outpatient,,,939.00000,503.30000,Hometown Health,HMO,,845.10,,,,,,,244.14,910.83,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,inpatient,,,515.00000,276.04000,Hometown Health,HMO,,463.50,,,,,,,463.50,499.55,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,outpatient,,,515.00000,276.04000,Hometown Health,HMO,,463.50,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,inpatient,,,616.00000,330.18000,Hometown Health,HMO,,554.40,,,,,,,554.40,597.52,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,outpatient,,,616.00000,330.18000,Hometown Health,HMO,,554.40,,,,,,,160.16,597.52,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,inpatient,,,377.00000,202.07000,Hometown Health,HMO,,339.30,,,,,,,339.30,365.69,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,outpatient,,,377.00000,202.07000,Hometown Health,HMO,,339.30,,,,,,,98.02,365.69,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,inpatient,,,340.00000,182.24000,Hometown Health,HMO,,306.00,,,,,,,306.00,329.80,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,outpatient,,,340.00000,182.24000,Hometown Health,HMO,,306.00,,,,,,,88.40,329.80,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,inpatient,,,388.00000,207.97000,Hometown Health,HMO,,349.20,,,,,,,349.20,376.36,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,outpatient,,,388.00000,207.97000,Hometown Health,HMO,,349.20,,,,,,,100.88,376.36,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,inpatient,,,456.00000,244.42000,Hometown Health,HMO,,410.40,,,,,,,410.40,442.32,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,outpatient,,,456.00000,244.42000,Hometown Health,HMO,,410.40,,,,,,,118.56,442.32,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,inpatient,,,267.00000,143.11000,Hometown Health,HMO,,240.30,,,,,,,240.30,258.99,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,outpatient,,,267.00000,143.11000,Hometown Health,HMO,,240.30,,,,,,,69.42,258.99,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Hometown Health,HMO,LT,275.40,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Hometown Health,HMO,LT,275.40,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Hometown Health,HMO,"52,LT",275.40,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Hometown Health,HMO,"52,LT",275.40,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Hometown Health,HMO,RT,275.40,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Hometown Health,HMO,RT,275.40,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Hometown Health,HMO,"52,RT",275.40,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Hometown Health,HMO,"52,RT",275.40,,,,,,,79.56,296.82,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,inpatient,,,456.00000,244.42000,Hometown Health,HMO,,410.40,,,,,,,410.40,442.32,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,outpatient,,,456.00000,244.42000,Hometown Health,HMO,,410.40,,,,,,,118.56,442.32,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,inpatient,,,381.00000,204.22000,Hometown Health,HMO,,342.90,,,,,,,342.90,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,outpatient,,,381.00000,204.22000,Hometown Health,HMO,,342.90,,,,,,,99.06,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,inpatient,,,143.00000,76.65000,Hometown Health,HMO,LT,128.70,,,,,,,128.70,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Hometown Health,HMO,LT,128.70,,,,,,,37.18,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,inpatient,,,143.00000,76.65000,Hometown Health,HMO,RT,128.70,,,,,,,128.70,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Hometown Health,HMO,RT,128.70,,,,,,,37.18,138.71,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,inpatient,,,331.00000,177.42000,Hometown Health,HMO,LT,297.90,,,,,,,297.90,321.07,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Hometown Health,HMO,LT,297.90,,,,,,,86.06,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,inpatient,,,331.00000,177.42000,Hometown Health,HMO,RT,297.90,,,,,,,297.90,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Hometown Health,HMO,RT,297.90,,,,,,,86.06,321.07,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,inpatient,,,1113.00000,596.57000,Hometown Health,HMO,,1001.70,,,,,,,1001.70,1079.61,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1113.00000,596.57000,Hometown Health,HMO,,1001.70,,,,,,,289.38,1079.61,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,inpatient,,,1043.00000,559.05000,Hometown Health,HMO,,938.70,,,,,,,938.70,1011.71,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,outpatient,,,1043.00000,559.05000,Hometown Health,HMO,,938.70,,,,,,,271.18,1011.71,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Hometown Health,HMO,LT,230.40,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Hometown Health,HMO,LT,230.40,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Hometown Health,HMO,"52,LT",230.40,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Hometown Health,HMO,"52,LT",230.40,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Hometown Health,HMO,RT,230.40,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Hometown Health,HMO,RT,230.40,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Hometown Health,HMO,"52,RT",230.40,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Hometown Health,HMO,"52,RT",230.40,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,inpatient,,,511.00000,273.90000,Hometown Health,HMO,LT,459.90,,,,,,,459.90,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Hometown Health,HMO,LT,459.90,,,,,,,132.86,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,inpatient,,,511.00000,273.90000,Hometown Health,HMO,RT,459.90,,,,,,,459.90,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Hometown Health,HMO,RT,459.90,,,,,,,132.86,495.67,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,inpatient,,,553.00000,314.19000,Hometown Health,HMO,LT,497.70,,,,,,,497.70,536.41,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Hometown Health,HMO,LT,497.70,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,inpatient,,,553.00000,314.19000,Hometown Health,HMO,RT,497.70,,,,,,,497.70,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Hometown Health,HMO,RT,497.70,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,inpatient,,,1076.00000,611.33000,Hometown Health,HMO,LT,968.40,,,,,,,968.40,1043.72,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Hometown Health,HMO,LT,968.40,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,inpatient,,,1076.00000,611.33000,Hometown Health,HMO,RT,968.40,,,,,,,968.40,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Hometown Health,HMO,RT,968.40,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,inpatient,,,865.00000,491.45000,Hometown Health,HMO,LT,778.50,,,,,,,778.50,839.05,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Hometown Health,HMO,LT,778.50,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,inpatient,,,865.00000,491.45000,Hometown Health,HMO,RT,778.50,,,,,,,778.50,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Hometown Health,HMO,RT,778.50,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,inpatient,,,734.00000,417.02000,Hometown Health,HMO,LT,660.60,,,,,,,660.60,711.98,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Hometown Health,HMO,LT,660.60,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,inpatient,,,734.00000,417.02000,Hometown Health,HMO,RT,660.60,,,,,,,660.60,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Hometown Health,HMO,RT,660.60,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,inpatient,,,730.00000,414.75000,Hometown Health,HMO,LT,657.00,,,,,,,657.00,708.10,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Hometown Health,HMO,LT,657.00,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,inpatient,,,730.00000,414.75000,Hometown Health,HMO,RT,657.00,,,,,,,657.00,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Hometown Health,HMO,RT,657.00,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,inpatient,,,260.00000,147.72000,Hometown Health,HMO,LT,234.00,,,,,,,234.00,252.20,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Hometown Health,HMO,LT,234.00,,,,,,,67.60,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,inpatient,,,260.00000,147.72000,Hometown Health,HMO,RT,234.00,,,,,,,234.00,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Hometown Health,HMO,RT,234.00,,,,,,,67.60,252.20,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,inpatient,,,428.00000,203.73000,Hometown Health,HMO,,385.20,,,,,,,385.20,415.16,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,outpatient,,,428.00000,203.73000,Hometown Health,HMO,,385.20,,,,,,,111.28,415.16,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,inpatient,,,492.00000,234.19000,Hometown Health,HMO,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,outpatient,,,492.00000,234.19000,Hometown Health,HMO,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,inpatient,,,607.00000,288.93000,Hometown Health,HMO,,546.30,,,,,,,546.30,588.79,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,outpatient,,,607.00000,288.93000,Hometown Health,HMO,,546.30,,,,,,,157.82,588.79,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,inpatient,,,649.00000,308.92000,Hometown Health,HMO,,584.10,,,,,,,584.10,629.53,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,outpatient,,,649.00000,308.92000,Hometown Health,HMO,,584.10,,,,,,,168.74,629.53,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,inpatient,,,377.00000,121.77000,Hometown Health,HMO,50,339.30,,,,,,,339.30,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,outpatient,,,377.00000,121.77000,Hometown Health,HMO,50,339.30,,,,,,,98.02,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,inpatient,,,251.00000,81.07000,Hometown Health,HMO,LT,225.90,,,,,,,225.90,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Hometown Health,HMO,LT,225.90,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,inpatient,,,251.00000,81.07000,Hometown Health,HMO,RT,225.90,,,,,,,225.90,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Hometown Health,HMO,RT,225.90,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,inpatient,,,1170.00000,377.91000,Hometown Health,HMO,50,1053.00,,,,,,,1053.00,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,outpatient,,,1170.00000,377.91000,Hometown Health,HMO,50,1053.00,,,,,,,304.20,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,inpatient,,,780.00000,251.94000,Hometown Health,HMO,LT,702.00,,,,,,,702.00,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Hometown Health,HMO,LT,702.00,,,,,,,202.80,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,inpatient,,,780.00000,251.94000,Hometown Health,HMO,RT,702.00,,,,,,,702.00,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Hometown Health,HMO,RT,702.00,,,,,,,202.80,756.60,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,inpatient,,,1389.00000,448.65000,Hometown Health,HMO,,1250.10,,,,,,,1250.10,1347.33,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,outpatient,,,1389.00000,448.65000,Hometown Health,HMO,,1250.10,,,,,,,361.14,1347.33,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,inpatient,,,345.00000,111.44000,Hometown Health,HMO,50,310.50,,,,,,,310.50,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,outpatient,,,345.00000,111.44000,Hometown Health,HMO,50,310.50,,,,,,,89.70,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,inpatient,,,230.00000,74.29000,Hometown Health,HMO,LT,207.00,,,,,,,207.00,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Hometown Health,HMO,LT,207.00,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,inpatient,,,230.00000,74.29000,Hometown Health,HMO,RT,207.00,,,,,,,207.00,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Hometown Health,HMO,RT,207.00,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,inpatient,,,2102.00000,678.95000,Hometown Health,HMO,50,1891.80,,,,,,,1891.80,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,outpatient,,,2102.00000,678.95000,Hometown Health,HMO,50,1891.80,,,,,,,546.52,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,inpatient,,,1401.00000,452.52000,Hometown Health,HMO,LT,1260.90,,,,,,,1260.90,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Hometown Health,HMO,LT,1260.90,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,inpatient,,,1401.00000,452.52000,Hometown Health,HMO,RT,1260.90,,,,,,,1260.90,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Hometown Health,HMO,RT,1260.90,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,inpatient,,,357.00000,115.31000,Hometown Health,HMO,50,321.30,,,,,,,321.30,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,outpatient,,,357.00000,115.31000,Hometown Health,HMO,50,321.30,,,,,,,92.82,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,inpatient,,,238.00000,76.87000,Hometown Health,HMO,LT,214.20,,,,,,,214.20,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Hometown Health,HMO,LT,214.20,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,inpatient,,,238.00000,76.87000,Hometown Health,HMO,RT,214.20,,,,,,,214.20,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Hometown Health,HMO,RT,214.20,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,inpatient,,,2082.00000,672.49000,Hometown Health,HMO,50,1873.80,,,,,,,1873.80,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,outpatient,,,2082.00000,672.49000,Hometown Health,HMO,50,1873.80,,,,,,,541.32,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,inpatient,,,1388.00000,448.32000,Hometown Health,HMO,LT,1249.20,,,,,,,1249.20,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Hometown Health,HMO,LT,1249.20,,,,,,,360.88,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,inpatient,,,1388.00000,448.32000,Hometown Health,HMO,RT,1249.20,,,,,,,1249.20,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Hometown Health,HMO,RT,1249.20,,,,,,,360.88,1346.36,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,inpatient,,,246.00000,79.46000,Hometown Health,HMO,50,221.40,,,,,,,221.40,238.62,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,outpatient,,,246.00000,79.46000,Hometown Health,HMO,50,221.40,,,,,,,63.96,238.62,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,inpatient,,,164.00000,52.97000,Hometown Health,HMO,LT,147.60,,,,,,,147.60,159.08,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Hometown Health,HMO,LT,147.60,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,inpatient,,,164.00000,52.97000,Hometown Health,HMO,RT,147.60,,,,,,,147.60,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Hometown Health,HMO,RT,147.60,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,inpatient,,,309.00000,99.81000,Hometown Health,HMO,50,278.10,,,,,,,278.10,299.73,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,outpatient,,,309.00000,99.81000,Hometown Health,HMO,50,278.10,,,,,,,80.34,299.73,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,inpatient,,,206.00000,66.54000,Hometown Health,HMO,LT,185.40,,,,,,,185.40,199.82,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Hometown Health,HMO,LT,185.40,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,inpatient,,,206.00000,66.54000,Hometown Health,HMO,RT,185.40,,,,,,,185.40,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Hometown Health,HMO,RT,185.40,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,inpatient,,,471.00000,152.13000,Hometown Health,HMO,50,423.90,,,,,,,423.90,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,outpatient,,,471.00000,152.13000,Hometown Health,HMO,50,423.90,,,,,,,122.46,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,inpatient,,,314.00000,101.42000,Hometown Health,HMO,LT,282.60,,,,,,,282.60,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Hometown Health,HMO,LT,282.60,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,inpatient,,,314.00000,101.42000,Hometown Health,HMO,RT,282.60,,,,,,,282.60,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Hometown Health,HMO,RT,282.60,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,inpatient,,,239.00000,77.20000,Hometown Health,HMO,50,215.10,,,,,,,215.10,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,outpatient,,,239.00000,77.20000,Hometown Health,HMO,50,215.10,,,,,,,62.14,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,inpatient,,,159.00000,51.36000,Hometown Health,HMO,LT,143.10,,,,,,,143.10,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Hometown Health,HMO,LT,143.10,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,inpatient,,,159.00000,51.36000,Hometown Health,HMO,RT,143.10,,,,,,,143.10,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Hometown Health,HMO,RT,143.10,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,inpatient,,,558.00000,180.23000,Hometown Health,HMO,50,502.20,,,,,,,502.20,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,outpatient,,,558.00000,180.23000,Hometown Health,HMO,50,502.20,,,,,,,145.08,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,inpatient,,,372.00000,120.16000,Hometown Health,HMO,LT,334.80,,,,,,,334.80,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Hometown Health,HMO,LT,334.80,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,inpatient,,,372.00000,120.16000,Hometown Health,HMO,RT,334.80,,,,,,,334.80,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Hometown Health,HMO,RT,334.80,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,inpatient,,,413.00000,133.40000,Hometown Health,HMO,50,371.70,,,,,,,371.70,400.61,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,outpatient,,,413.00000,133.40000,Hometown Health,HMO,50,371.70,,,,,,,107.38,400.61,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,inpatient,,,275.00000,88.82000,Hometown Health,HMO,LT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Hometown Health,HMO,LT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,inpatient,,,275.00000,88.82000,Hometown Health,HMO,RT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Hometown Health,HMO,RT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,inpatient,,,462.00000,149.23000,Hometown Health,HMO,,415.80,,,,,,,415.80,448.14,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,outpatient,,,462.00000,149.23000,Hometown Health,HMO,,415.80,,,,,,,120.12,448.14,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,inpatient,,,170.00000,54.91000,Hometown Health,HMO,,153.00,,,,,,,153.00,164.90,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,outpatient,,,170.00000,54.91000,Hometown Health,HMO,,153.00,,,,,,,44.20,164.90,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,inpatient,,,281.00000,90.76000,Hometown Health,HMO,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,outpatient,,,281.00000,90.76000,Hometown Health,HMO,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,inpatient,,,562.00000,181.53000,Hometown Health,HMO,,505.80,,,,,,,505.80,545.14,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,outpatient,,,562.00000,181.53000,Hometown Health,HMO,,505.80,,,,,,,146.12,545.14,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,inpatient,,,2076.00000,670.55000,Hometown Health,HMO,50,1868.40,,,,,,,1868.40,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,outpatient,,,2076.00000,670.55000,Hometown Health,HMO,50,1868.40,,,,,,,539.76,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1384.00000,447.03000,Hometown Health,HMO,LT,1245.60,,,,,,,1245.60,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Hometown Health,HMO,LT,1245.60,,,,,,,359.84,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1384.00000,447.03000,Hometown Health,HMO,RT,1245.60,,,,,,,1245.60,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Hometown Health,HMO,RT,1245.60,,,,,,,359.84,1342.48,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,inpatient,,,934.00000,301.68000,Hometown Health,HMO,,840.60,,,,,,,840.60,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,outpatient,,,934.00000,301.68000,Hometown Health,HMO,,840.60,,,,,,,242.84,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,inpatient,,,842.00000,271.97000,Hometown Health,HMO,,757.80,,,,,,,757.80,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,outpatient,,,842.00000,271.97000,Hometown Health,HMO,,757.80,,,,,,,218.92,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,inpatient,,,846.00000,273.26000,Hometown Health,HMO,,761.40,,,,,,,761.40,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,outpatient,,,846.00000,273.26000,Hometown Health,HMO,,761.40,,,,,,,219.96,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,inpatient,,,971.00000,313.63000,Hometown Health,HMO,,873.90,,,,,,,873.90,941.87,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,outpatient,,,971.00000,313.63000,Hometown Health,HMO,,873.90,,,,,,,252.46,941.87,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,inpatient,,,762.00000,246.13000,Hometown Health,HMO,,685.80,,,,,,,685.80,739.14,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,outpatient,,,762.00000,246.13000,Hometown Health,HMO,,685.80,,,,,,,198.12,739.14,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,inpatient,,,758.00000,244.83000,Hometown Health,HMO,,682.20,,,,,,,682.20,735.26,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,outpatient,,,758.00000,244.83000,Hometown Health,HMO,,682.20,,,,,,,197.08,735.26,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,inpatient,,,161.00000,52.00000,Hometown Health,HMO,,144.90,,,,,,,144.90,156.17,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,outpatient,,,161.00000,52.00000,Hometown Health,HMO,,144.90,,,,,,,41.86,156.17,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,inpatient,,,234.00000,75.58000,Hometown Health,HMO,50,210.60,,,,,,,210.60,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,outpatient,,,234.00000,75.58000,Hometown Health,HMO,50,210.60,,,,,,,60.84,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,inpatient,,,156.00000,50.39000,Hometown Health,HMO,LT,140.40,,,,,,,140.40,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Hometown Health,HMO,LT,140.40,,,,,,,40.56,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,inpatient,,,156.00000,50.39000,Hometown Health,HMO,RT,140.40,,,,,,,140.40,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Hometown Health,HMO,RT,140.40,,,,,,,40.56,151.32,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1517.00000,489.99000,Hometown Health,HMO,50,1365.30,,,,,,,1365.30,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1517.00000,489.99000,Hometown Health,HMO,50,1365.30,,,,,,,394.42,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1011.00000,326.55000,Hometown Health,HMO,LT,909.90,,,,,,,909.90,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Hometown Health,HMO,LT,909.90,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1011.00000,326.55000,Hometown Health,HMO,RT,909.90,,,,,,,909.90,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Hometown Health,HMO,RT,909.90,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,inpatient,,,822.00000,265.51000,Hometown Health,HMO,50,739.80,,,,,,,739.80,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,outpatient,,,822.00000,265.51000,Hometown Health,HMO,50,739.80,,,,,,,213.72,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,inpatient,,,548.00000,177.00000,Hometown Health,HMO,LT,493.20,,,,,,,493.20,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Hometown Health,HMO,LT,493.20,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,inpatient,,,548.00000,177.00000,Hometown Health,HMO,RT,493.20,,,,,,,493.20,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Hometown Health,HMO,RT,493.20,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,inpatient,,,2613.00000,844.00000,Hometown Health,HMO,,2351.70,,,,,,,2351.70,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,outpatient,,,2613.00000,844.00000,Hometown Health,HMO,,2351.70,,,,,,,679.38,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,inpatient,,,903.00000,291.67000,Hometown Health,HMO,,812.70,,,,,,,812.70,875.91,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,outpatient,,,903.00000,291.67000,Hometown Health,HMO,,812.70,,,,,,,234.78,875.91,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,inpatient,,,1156.00000,373.39000,Hometown Health,HMO,,1040.40,,,,,,,1040.40,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,outpatient,,,1156.00000,373.39000,Hometown Health,HMO,,1040.40,,,,,,,300.56,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,inpatient,,,677.00000,218.67000,Hometown Health,HMO,,609.30,,,,,,,609.30,656.69,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,outpatient,,,677.00000,218.67000,Hometown Health,HMO,,609.30,,,,,,,176.02,656.69,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1928.00000,622.74000,Hometown Health,HMO,50,1735.20,,,,,,,1735.20,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1928.00000,622.74000,Hometown Health,HMO,50,1735.20,,,,,,,501.28,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1285.00000,415.06000,Hometown Health,HMO,LT,1156.50,,,,,,,1156.50,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Hometown Health,HMO,LT,1156.50,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1285.00000,415.06000,Hometown Health,HMO,RT,1156.50,,,,,,,1156.50,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Hometown Health,HMO,RT,1156.50,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,inpatient,,,812.00000,262.28000,Hometown Health,HMO,50,730.80,,,,,,,730.80,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,outpatient,,,812.00000,262.28000,Hometown Health,HMO,50,730.80,,,,,,,211.12,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,inpatient,,,541.00000,174.74000,Hometown Health,HMO,LT,486.90,,,,,,,486.90,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Hometown Health,HMO,LT,486.90,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,inpatient,,,541.00000,174.74000,Hometown Health,HMO,RT,486.90,,,,,,,486.90,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Hometown Health,HMO,RT,486.90,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,inpatient,,,825.00000,266.48000,Hometown Health,HMO,50,742.50,,,,,,,742.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,outpatient,,,825.00000,266.48000,Hometown Health,HMO,50,742.50,,,,,,,214.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,inpatient,,,550.00000,177.65000,Hometown Health,HMO,LT,495.00,,,,,,,495.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Hometown Health,HMO,LT,495.00,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,inpatient,,,550.00000,177.65000,Hometown Health,HMO,RT,495.00,,,,,,,495.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Hometown Health,HMO,RT,495.00,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,inpatient,,,3494.00000,1128.56000,Hometown Health,HMO,50,3144.60,,,,,,,3144.60,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,outpatient,,,3494.00000,1128.56000,Hometown Health,HMO,50,3144.60,,,,,,,908.44,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2329.00000,752.27000,Hometown Health,HMO,LT,2096.10,,,,,,,2096.10,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Hometown Health,HMO,LT,2096.10,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2329.00000,752.27000,Hometown Health,HMO,RT,2096.10,,,,,,,2096.10,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Hometown Health,HMO,RT,2096.10,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,inpatient,,,840.00000,271.32000,Hometown Health,HMO,50,756.00,,,,,,,756.00,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,outpatient,,,840.00000,271.32000,Hometown Health,HMO,50,756.00,,,,,,,218.40,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,inpatient,,,560.00000,180.88000,Hometown Health,HMO,LT,504.00,,,,,,,504.00,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Hometown Health,HMO,LT,504.00,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,inpatient,,,560.00000,180.88000,Hometown Health,HMO,RT,504.00,,,,,,,504.00,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Hometown Health,HMO,RT,504.00,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,inpatient,,,792.00000,255.82000,Hometown Health,HMO,50,712.80,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,outpatient,,,792.00000,255.82000,Hometown Health,HMO,50,712.80,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,inpatient,,,528.00000,170.54000,Hometown Health,HMO,LT,475.20,,,,,,,475.20,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Hometown Health,HMO,LT,475.20,,,,,,,137.28,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,inpatient,,,528.00000,170.54000,Hometown Health,HMO,RT,475.20,,,,,,,475.20,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Hometown Health,HMO,RT,475.20,,,,,,,137.28,512.16,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,inpatient,,,272.00000,87.86000,Hometown Health,HMO,,244.80,,,,,,,244.80,263.84,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,outpatient,,,272.00000,87.86000,Hometown Health,HMO,,244.80,,,,,,,70.72,263.84,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,inpatient,,,1268.00000,409.56000,Hometown Health,HMO,,1141.20,,,,,,,1141.20,1229.96,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,outpatient,,,1268.00000,409.56000,Hometown Health,HMO,,1141.20,,,,,,,329.68,1229.96,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,inpatient,,,896.00000,289.41000,Hometown Health,HMO,,806.40,,,,,,,806.40,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,outpatient,,,896.00000,289.41000,Hometown Health,HMO,,806.40,,,,,,,232.96,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,inpatient,,,884.00000,285.53000,Hometown Health,HMO,,795.60,,,,,,,795.60,857.48,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,outpatient,,,884.00000,285.53000,Hometown Health,HMO,,795.60,,,,,,,229.84,857.48,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,inpatient,,,609.00000,326.42000,Hometown Health,HMO,,548.10,,,,,,,548.10,590.73,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Hometown Health,HMO,,548.10,,,,,,,158.34,590.73,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,inpatient,,,966.00000,383.50000,Hometown Health,HMO,,869.40,,,,,,,869.40,937.02,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,outpatient,,,966.00000,383.50000,Hometown Health,HMO,,869.40,,,,,,,251.16,937.02,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,inpatient,,,872.00000,346.18000,Hometown Health,HMO,,784.80,,,,,,,784.80,845.84,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,outpatient,,,872.00000,346.18000,Hometown Health,HMO,,784.80,,,,,,,226.72,845.84,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,inpatient,,,492.00000,195.32000,Hometown Health,HMO,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,outpatient,,,492.00000,195.32000,Hometown Health,HMO,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,inpatient,,,331.00000,131.41000,Hometown Health,HMO,,297.90,,,,,,,297.90,321.07,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,outpatient,,,331.00000,131.41000,Hometown Health,HMO,,297.90,,,,,,,86.06,321.07,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,inpatient,,,5215.00000,2070.36000,Hometown Health,HMO,,4693.50,,,,,,,4693.50,5058.55,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,outpatient,,,5215.00000,2070.36000,Hometown Health,HMO,,4693.50,,,,,,,1355.90,5058.55,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,inpatient,,,5422.00000,2152.53000,Hometown Health,HMO,,4879.80,,,,,,,4879.80,5259.34,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,outpatient,,,5422.00000,2152.53000,Hometown Health,HMO,,4879.80,,,,,,,1409.72,5259.34,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,inpatient,,,1878.00000,788.76000,Hometown Health,HMO,,1690.20,,,,,,,1690.20,1821.66,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1878.00000,788.76000,Hometown Health,HMO,,1690.20,,,,,,,488.28,1821.66,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,inpatient,,,2253.00000,946.26000,Hometown Health,HMO,,2027.70,,,,,,,2027.70,2185.41,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,outpatient,,,2253.00000,946.26000,Hometown Health,HMO,,2027.70,,,,,,,585.78,2185.41,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,inpatient,,,1502.00000,630.84000,Hometown Health,HMO,,1351.80,,,,,,,1351.80,1456.94,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1502.00000,630.84000,Hometown Health,HMO,,1351.80,,,,,,,390.52,1456.94,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,inpatient,,,2024.00000,850.08000,Hometown Health,HMO,,1821.60,,,,,,,1821.60,1963.28,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,outpatient,,,2024.00000,850.08000,Hometown Health,HMO,,1821.60,,,,,,,526.24,1963.28,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,inpatient,,,2429.00000,1020.18000,Hometown Health,HMO,,2186.10,,,,,,,2186.10,2356.13,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,outpatient,,,2429.00000,1020.18000,Hometown Health,HMO,,2186.10,,,,,,,631.54,2356.13,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,inpatient,,,1619.00000,679.98000,Hometown Health,HMO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1619.00000,679.98000,Hometown Health,HMO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,inpatient,,,2425.00000,1018.50000,Hometown Health,HMO,,2182.50,,,,,,,2182.50,2352.25,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,outpatient,,,2425.00000,1018.50000,Hometown Health,HMO,,2182.50,,,,,,,630.50,2352.25,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,inpatient,,,2910.00000,1222.20000,Hometown Health,HMO,,2619.00,,,,,,,2619.00,2822.70,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2910.00000,1222.20000,Hometown Health,HMO,,2619.00,,,,,,,756.60,2822.70,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,inpatient,,,1940.00000,814.80000,Hometown Health,HMO,,1746.00,,,,,,,1746.00,1881.80,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1940.00000,814.80000,Hometown Health,HMO,,1746.00,,,,,,,504.40,1881.80,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,inpatient,,,2317.00000,973.14000,Hometown Health,HMO,,2085.30,,,,,,,2085.30,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2317.00000,973.14000,Hometown Health,HMO,,2085.30,,,,,,,602.42,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,inpatient,,,2780.00000,1167.60000,Hometown Health,HMO,,2502.00,,,,,,,2502.00,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2780.00000,1167.60000,Hometown Health,HMO,,2502.00,,,,,,,722.80,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,inpatient,,,1853.00000,778.26000,Hometown Health,HMO,,1667.70,,,,,,,1667.70,1797.41,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1853.00000,778.26000,Hometown Health,HMO,,1667.70,,,,,,,481.78,1797.41,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,inpatient,,,2366.00000,993.72000,Hometown Health,HMO,,2129.40,,,,,,,2129.40,2295.02,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2366.00000,993.72000,Hometown Health,HMO,,2129.40,,,,,,,615.16,2295.02,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,inpatient,,,3056.00000,1283.52000,Hometown Health,HMO,,2750.40,,,,,,,2750.40,2964.32,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,outpatient,,,3056.00000,1283.52000,Hometown Health,HMO,,2750.40,,,,,,,794.56,2964.32,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,inpatient,,,2829.00000,1386.21000,Hometown Health,HMO,,2546.10,,,,,,,2546.10,2744.13,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,outpatient,,,2829.00000,1386.21000,Hometown Health,HMO,,2546.10,,,,,,,735.54,2744.13,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,inpatient,,,3395.00000,1663.55000,Hometown Health,HMO,,3055.50,,,,,,,3055.50,3293.15,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,outpatient,,,3395.00000,1663.55000,Hometown Health,HMO,,3055.50,,,,,,,882.70,3293.15,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,inpatient,,,2263.00000,1108.87000,Hometown Health,HMO,,2036.70,,,,,,,2036.70,2195.11,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,outpatient,,,2263.00000,1108.87000,Hometown Health,HMO,,2036.70,,,,,,,588.38,2195.11,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,inpatient,,,4697.00000,2301.53000,Hometown Health,HMO,,4227.30,,,,,,,4227.30,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,outpatient,,,4697.00000,2301.53000,Hometown Health,HMO,,4227.30,,,,,,,1221.22,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,inpatient,,,5636.00000,2761.64000,Hometown Health,HMO,,5072.40,,,,,,,5072.40,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,outpatient,,,5636.00000,2761.64000,Hometown Health,HMO,,5072.40,,,,,,,1465.36,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,inpatient,,,3757.00000,1840.93000,Hometown Health,HMO,,3381.30,,,,,,,3381.30,3644.29,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,outpatient,,,3757.00000,1840.93000,Hometown Health,HMO,,3381.30,,,,,,,976.82,3644.29,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,inpatient,,,2619.00000,1283.31000,Hometown Health,HMO,,2357.10,,,,,,,2357.10,2540.43,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,outpatient,,,2619.00000,1283.31000,Hometown Health,HMO,,2357.10,,,,,,,680.94,2540.43,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,inpatient,,,3143.00000,1540.07000,Hometown Health,HMO,,2828.70,,,,,,,2828.70,3048.71,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,outpatient,,,3143.00000,1540.07000,Hometown Health,HMO,,2828.70,,,,,,,817.18,3048.71,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,inpatient,,,2095.00000,1026.55000,Hometown Health,HMO,,1885.50,,,,,,,1885.50,2032.15,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,outpatient,,,2095.00000,1026.55000,Hometown Health,HMO,,1885.50,,,,,,,544.70,2032.15,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,inpatient,,,278.00000,136.22000,Hometown Health,HMO,,250.20,,,,,,,250.20,269.66,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,outpatient,,,278.00000,136.22000,Hometown Health,HMO,,250.20,,,,,,,72.28,269.66,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,inpatient,,,2110.00000,1033.90000,Hometown Health,HMO,LT,1899.00,,,,,,,1899.00,2046.70,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Hometown Health,HMO,LT,1899.00,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,inpatient,,,2110.00000,1033.90000,Hometown Health,HMO,RT,1899.00,,,,,,,1899.00,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Hometown Health,HMO,RT,1899.00,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2532.00000,1240.68000,Hometown Health,HMO,LT,2278.80,,,,,,,2278.80,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Hometown Health,HMO,LT,2278.80,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2532.00000,1240.68000,Hometown Health,HMO,RT,2278.80,,,,,,,2278.80,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Hometown Health,HMO,RT,2278.80,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1688.00000,827.12000,Hometown Health,HMO,LT,1519.20,,,,,,,1519.20,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Hometown Health,HMO,LT,1519.20,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1688.00000,827.12000,Hometown Health,HMO,RT,1519.20,,,,,,,1519.20,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Hometown Health,HMO,RT,1519.20,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,inpatient,,,2024.00000,991.76000,Hometown Health,HMO,LT,1821.60,,,,,,,1821.60,1963.28,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Hometown Health,HMO,LT,1821.60,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,inpatient,,,2024.00000,991.76000,Hometown Health,HMO,RT,1821.60,,,,,,,1821.60,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Hometown Health,HMO,RT,1821.60,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2429.00000,1190.21000,Hometown Health,HMO,LT,2186.10,,,,,,,2186.10,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Hometown Health,HMO,LT,2186.10,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2429.00000,1190.21000,Hometown Health,HMO,RT,2186.10,,,,,,,2186.10,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Hometown Health,HMO,RT,2186.10,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1619.00000,793.31000,Hometown Health,HMO,LT,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Hometown Health,HMO,LT,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1619.00000,793.31000,Hometown Health,HMO,RT,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Hometown Health,HMO,RT,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,inpatient,,,1224.00000,599.76000,Hometown Health,HMO,,1101.60,,,,,,,1101.60,1187.28,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,outpatient,,,1224.00000,599.76000,Hometown Health,HMO,,1101.60,,,,,,,318.24,1187.28,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,inpatient,,,3020.00000,1479.80000,Hometown Health,HMO,,2718.00,,,,,,,2718.00,2929.40,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,outpatient,,,3020.00000,1479.80000,Hometown Health,HMO,,2718.00,,,,,,,785.20,2929.40,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,inpatient,,,3624.00000,1775.76000,Hometown Health,HMO,,3261.60,,,,,,,3261.60,3515.28,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,outpatient,,,3624.00000,1775.76000,Hometown Health,HMO,,3261.60,,,,,,,942.24,3515.28,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,inpatient,,,2416.00000,1183.84000,Hometown Health,HMO,,2174.40,,,,,,,2174.40,2343.52,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,outpatient,,,2416.00000,1183.84000,Hometown Health,HMO,,2174.40,,,,,,,628.16,2343.52,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,inpatient,,,2728.00000,1336.72000,Hometown Health,HMO,,2455.20,,,,,,,2455.20,2646.16,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,outpatient,,,2728.00000,1336.72000,Hometown Health,HMO,,2455.20,,,,,,,709.28,2646.16,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,inpatient,,,3273.00000,1603.77000,Hometown Health,HMO,,2945.70,,,,,,,2945.70,3174.81,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,outpatient,,,3273.00000,1603.77000,Hometown Health,HMO,,2945.70,,,,,,,850.98,3174.81,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,inpatient,,,2182.00000,1069.18000,Hometown Health,HMO,,1963.80,,,,,,,1963.80,2116.54,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,outpatient,,,2182.00000,1069.18000,Hometown Health,HMO,,1963.80,,,,,,,567.32,2116.54,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,inpatient,,,3133.00000,1535.17000,Hometown Health,HMO,,2819.70,,,,,,,2819.70,3039.01,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,outpatient,,,3133.00000,1535.17000,Hometown Health,HMO,,2819.70,,,,,,,814.58,3039.01,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,inpatient,,,3759.00000,1841.91000,Hometown Health,HMO,,3383.10,,,,,,,3383.10,3646.23,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,outpatient,,,3759.00000,1841.91000,Hometown Health,HMO,,3383.10,,,,,,,977.34,3646.23,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,inpatient,,,2506.00000,1227.94000,Hometown Health,HMO,,2255.40,,,,,,,2255.40,2430.82,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,outpatient,,,2506.00000,1227.94000,Hometown Health,HMO,,2255.40,,,,,,,651.56,2430.82,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,inpatient,,,2857.00000,1399.93000,Hometown Health,HMO,,2571.30,,,,,,,2571.30,2771.29,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,outpatient,,,2857.00000,1399.93000,Hometown Health,HMO,,2571.30,,,,,,,742.82,2771.29,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,inpatient,,,3428.00000,1679.72000,Hometown Health,HMO,,3085.20,,,,,,,3085.20,3325.16,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,outpatient,,,3428.00000,1679.72000,Hometown Health,HMO,,3085.20,,,,,,,891.28,3325.16,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,inpatient,,,2285.00000,1119.65000,Hometown Health,HMO,,2056.50,,,,,,,2056.50,2216.45,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,outpatient,,,2285.00000,1119.65000,Hometown Health,HMO,,2056.50,,,,,,,594.10,2216.45,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,inpatient,,,3565.00000,1746.85000,Hometown Health,HMO,,3208.50,,,,,,,3208.50,3458.05,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,outpatient,,,3565.00000,1746.85000,Hometown Health,HMO,,3208.50,,,,,,,926.90,3458.05,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,inpatient,,,5918.00000,2899.82000,Hometown Health,HMO,,5326.20,,,,,,,5326.20,5740.46,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,outpatient,,,5918.00000,2899.82000,Hometown Health,HMO,,5326.20,,,,,,,1538.68,5740.46,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,inpatient,,,3301.00000,1617.49000,Hometown Health,HMO,,2970.90,,,,,,,2970.90,3201.97,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,outpatient,,,3301.00000,1617.49000,Hometown Health,HMO,,2970.90,,,,,,,858.26,3201.97,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2659.00000,1302.91000,Hometown Health,HMO,LT,2393.10,,,,,,,2393.10,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Hometown Health,HMO,LT,2393.10,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2659.00000,1302.91000,Hometown Health,HMO,RT,2393.10,,,,,,,2393.10,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Hometown Health,HMO,RT,2393.10,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2551.00000,1249.99000,Hometown Health,HMO,LT,2295.90,,,,,,,2295.90,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Hometown Health,HMO,LT,2295.90,,,,,,,663.26,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2551.00000,1249.99000,Hometown Health,HMO,RT,2295.90,,,,,,,2295.90,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Hometown Health,HMO,RT,2295.90,,,,,,,663.26,2474.47,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,inpatient,,,3806.00000,1864.94000,Hometown Health,HMO,,3425.40,,,,,,,3425.40,3691.82,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3806.00000,1864.94000,Hometown Health,HMO,,3425.40,,,,,,,989.56,3691.82,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,inpatient,,,2149.00000,694.13000,Hometown Health,HMO,,1934.10,,,,,,,1934.10,2084.53,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,outpatient,,,2149.00000,694.13000,Hometown Health,HMO,,1934.10,,,,,,,558.74,2084.53,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,inpatient,,,1973.00000,637.28000,Hometown Health,HMO,,1775.70,,,,,,,1775.70,1913.81,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,outpatient,,,1973.00000,637.28000,Hometown Health,HMO,,1775.70,,,,,,,512.98,1913.81,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1784.00000,576.23000,Hometown Health,HMO,50,1605.60,,,,,,,1605.60,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1784.00000,576.23000,Hometown Health,HMO,50,1605.60,,,,,,,463.84,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1189.00000,384.05000,Hometown Health,HMO,LT,1070.10,,,,,,,1070.10,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Hometown Health,HMO,LT,1070.10,,,,,,,309.14,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1189.00000,384.05000,Hometown Health,HMO,RT,1070.10,,,,,,,1070.10,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Hometown Health,HMO,RT,1070.10,,,,,,,309.14,1153.33,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,inpatient,,,130.00000,69.68000,Hometown Health,HMO,,117.00,,,,,,,117.00,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,outpatient,,,130.00000,69.68000,Hometown Health,HMO,,117.00,,,,,,,33.80,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,inpatient,,,44.00000,23.58000,Hometown Health,HMO,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,outpatient,,,44.00000,23.58000,Hometown Health,HMO,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,inpatient,,,456.00000,244.42000,Hometown Health,HMO,,410.40,,,,,,,410.40,442.32,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,outpatient,,,456.00000,244.42000,Hometown Health,HMO,,410.40,,,,,,,118.56,442.32,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,inpatient,,,108.00000,57.89000,Hometown Health,HMO,,97.20,,,,,,,97.20,104.76,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,outpatient,,,108.00000,57.89000,Hometown Health,HMO,,97.20,,,,,,,28.08,104.76,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,inpatient,,,306.00000,164.02000,Hometown Health,HMO,,275.40,,,,,,,275.40,296.82,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,outpatient,,,306.00000,164.02000,Hometown Health,HMO,,275.40,,,,,,,79.56,296.82,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,inpatient,,,257.00000,137.75000,Hometown Health,HMO,,231.30,,,,,,,231.30,249.29,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,outpatient,,,257.00000,137.75000,Hometown Health,HMO,,231.30,,,,,,,66.82,249.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4057.00000,2036.61000,Hometown Health,HMO,,3651.30,,,,,,,3651.30,3935.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Hometown Health,HMO,,3651.30,,,,,,,1054.82,3935.29,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4868.00000,2443.74000,Hometown Health,HMO,,4381.20,,,,,,,4381.20,4721.96,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Hometown Health,HMO,,4381.20,,,,,,,1265.68,4721.96,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,inpatient,,,3245.00000,1628.99000,Hometown Health,HMO,,2920.50,,,,,,,2920.50,3147.65,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Hometown Health,HMO,,2920.50,,,,,,,843.70,3147.65,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4057.00000,2036.61000,Hometown Health,HMO,,3651.30,,,,,,,3651.30,3935.29,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Hometown Health,HMO,,3651.30,,,,,,,1054.82,3935.29,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4868.00000,2443.74000,Hometown Health,HMO,,4381.20,,,,,,,4381.20,4721.96,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Hometown Health,HMO,,4381.20,,,,,,,1265.68,4721.96,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,inpatient,,,3245.00000,1628.99000,Hometown Health,HMO,,2920.50,,,,,,,2920.50,3147.65,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Hometown Health,HMO,,2920.50,,,,,,,843.70,3147.65,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,inpatient,,,1725.00000,865.95000,Hometown Health,HMO,,1552.50,,,,,,,1552.50,1673.25,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,outpatient,,,1725.00000,865.95000,Hometown Health,HMO,,1552.50,,,,,,,448.50,1673.25,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,inpatient,,,1743.00000,874.99000,Hometown Health,HMO,,1568.70,,,,,,,1568.70,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,outpatient,,,1743.00000,874.99000,Hometown Health,HMO,,1568.70,,,,,,,453.18,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,inpatient,,,1475.00000,740.45000,Hometown Health,HMO,LT,1327.50,,,,,,,1327.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Hometown Health,HMO,LT,1327.50,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,inpatient,,,1475.00000,740.45000,Hometown Health,HMO,RT,1327.50,,,,,,,1327.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Hometown Health,HMO,RT,1327.50,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,inpatient,,,1162.00000,583.32000,Hometown Health,HMO,,1045.80,,,,,,,1045.80,1127.14,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,outpatient,,,1162.00000,583.32000,Hometown Health,HMO,,1045.80,,,,,,,302.12,1127.14,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,inpatient,,,983.00000,493.47000,Hometown Health,HMO,LT,884.70,,,,,,,884.70,953.51,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Hometown Health,HMO,LT,884.70,,,,,,,255.58,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,inpatient,,,983.00000,493.47000,Hometown Health,HMO,RT,884.70,,,,,,,884.70,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Hometown Health,HMO,RT,884.70,,,,,,,255.58,953.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,inpatient,,,3183.00000,1597.87000,Hometown Health,HMO,,2864.70,,,,,,,2864.70,3087.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,outpatient,,,3183.00000,1597.87000,Hometown Health,HMO,,2864.70,,,,,,,827.58,3087.51,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,inpatient,,,3819.00000,1917.14000,Hometown Health,HMO,,3437.10,,,,,,,3437.10,3704.43,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,outpatient,,,3819.00000,1917.14000,Hometown Health,HMO,,3437.10,,,,,,,992.94,3704.43,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,inpatient,,,2546.00000,1278.09000,Hometown Health,HMO,,2291.40,,,,,,,2291.40,2469.62,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,outpatient,,,2546.00000,1278.09000,Hometown Health,HMO,,2291.40,,,,,,,661.96,2469.62,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,inpatient,,,3858.00000,1936.72000,Hometown Health,HMO,LT,3472.20,,,,,,,3472.20,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Hometown Health,HMO,LT,3472.20,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,inpatient,,,3858.00000,1936.72000,Hometown Health,HMO,RT,3472.20,,,,,,,3472.20,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Hometown Health,HMO,RT,3472.20,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,inpatient,,,4629.00000,2323.76000,Hometown Health,HMO,LT,4166.10,,,,,,,4166.10,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Hometown Health,HMO,LT,4166.10,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,inpatient,,,4629.00000,2323.76000,Hometown Health,HMO,RT,4166.10,,,,,,,4166.10,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Hometown Health,HMO,RT,4166.10,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,inpatient,,,3086.00000,1549.17000,Hometown Health,HMO,LT,2777.40,,,,,,,2777.40,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Hometown Health,HMO,LT,2777.40,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,inpatient,,,3086.00000,1549.17000,Hometown Health,HMO,RT,2777.40,,,,,,,2777.40,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Hometown Health,HMO,RT,2777.40,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,inpatient,,,2505.00000,1257.51000,Hometown Health,HMO,LT,2254.50,,,,,,,2254.50,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Hometown Health,HMO,LT,2254.50,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,inpatient,,,2505.00000,1257.51000,Hometown Health,HMO,RT,2254.50,,,,,,,2254.50,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Hometown Health,HMO,RT,2254.50,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,inpatient,,,3006.00000,1509.01000,Hometown Health,HMO,LT,2705.40,,,,,,,2705.40,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Hometown Health,HMO,LT,2705.40,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,inpatient,,,3006.00000,1509.01000,Hometown Health,HMO,RT,2705.40,,,,,,,2705.40,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Hometown Health,HMO,RT,2705.40,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,inpatient,,,2004.00000,1006.01000,Hometown Health,HMO,LT,1803.60,,,,,,,1803.60,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Hometown Health,HMO,LT,1803.60,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,inpatient,,,2004.00000,1006.01000,Hometown Health,HMO,RT,1803.60,,,,,,,1803.60,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Hometown Health,HMO,RT,1803.60,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,inpatient,,,3137.00000,1574.77000,Hometown Health,HMO,LT,2823.30,,,,,,,2823.30,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Hometown Health,HMO,LT,2823.30,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,inpatient,,,3137.00000,1574.77000,Hometown Health,HMO,RT,2823.30,,,,,,,2823.30,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Hometown Health,HMO,RT,2823.30,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,inpatient,,,3764.00000,1889.53000,Hometown Health,HMO,LT,3387.60,,,,,,,3387.60,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Hometown Health,HMO,LT,3387.60,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,inpatient,,,3764.00000,1889.53000,Hometown Health,HMO,RT,3387.60,,,,,,,3387.60,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Hometown Health,HMO,RT,3387.60,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,inpatient,,,2509.00000,1259.52000,Hometown Health,HMO,LT,2258.10,,,,,,,2258.10,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Hometown Health,HMO,LT,2258.10,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,inpatient,,,2509.00000,1259.52000,Hometown Health,HMO,RT,2258.10,,,,,,,2258.10,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Hometown Health,HMO,RT,2258.10,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,inpatient,,,3023.00000,1517.55000,Hometown Health,HMO,LT,2720.70,,,,,,,2720.70,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Hometown Health,HMO,LT,2720.70,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,inpatient,,,3023.00000,1517.55000,Hometown Health,HMO,RT,2720.70,,,,,,,2720.70,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Hometown Health,HMO,RT,2720.70,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,inpatient,,,3627.00000,1820.75000,Hometown Health,HMO,LT,3264.30,,,,,,,3264.30,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Hometown Health,HMO,LT,3264.30,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,inpatient,,,3627.00000,1820.75000,Hometown Health,HMO,RT,3264.30,,,,,,,3264.30,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Hometown Health,HMO,RT,3264.30,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,inpatient,,,2418.00000,1213.84000,Hometown Health,HMO,LT,2176.20,,,,,,,2176.20,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Hometown Health,HMO,LT,2176.20,,,,,,,628.68,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,inpatient,,,2418.00000,1213.84000,Hometown Health,HMO,RT,2176.20,,,,,,,2176.20,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Hometown Health,HMO,RT,2176.20,,,,,,,628.68,2345.46,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,inpatient,,,870.00000,436.74000,Hometown Health,HMO,,783.00,,,,,,,783.00,843.90,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,outpatient,,,870.00000,436.74000,Hometown Health,HMO,,783.00,,,,,,,226.20,843.90,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,inpatient,,,1353.00000,679.21000,Hometown Health,HMO,,1217.70,,,,,,,1217.70,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,outpatient,,,1353.00000,679.21000,Hometown Health,HMO,,1217.70,,,,,,,351.78,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,inpatient,,,902.00000,452.80000,Hometown Health,HMO,LT,811.80,,,,,,,811.80,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Hometown Health,HMO,LT,811.80,,,,,,,234.52,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,inpatient,,,902.00000,452.80000,Hometown Health,HMO,RT,811.80,,,,,,,811.80,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Hometown Health,HMO,RT,811.80,,,,,,,234.52,874.94,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,inpatient,,,3489.00000,1751.48000,Hometown Health,HMO,,3140.10,,,,,,,3140.10,3384.33,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3489.00000,1751.48000,Hometown Health,HMO,,3140.10,,,,,,,907.14,3384.33,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,inpatient,,,4187.00000,2101.87000,Hometown Health,HMO,,3768.30,,,,,,,3768.30,4061.39,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,outpatient,,,4187.00000,2101.87000,Hometown Health,HMO,,3768.30,,,,,,,1088.62,4061.39,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,inpatient,,,2791.00000,1401.08000,Hometown Health,HMO,,2511.90,,,,,,,2511.90,2707.27,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,outpatient,,,2791.00000,1401.08000,Hometown Health,HMO,,2511.90,,,,,,,725.66,2707.27,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,inpatient,,,492.00000,246.98000,Hometown Health,HMO,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,outpatient,,,492.00000,246.98000,Hometown Health,HMO,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,inpatient,,,331.00000,166.16000,Hometown Health,HMO,,297.90,,,,,,,297.90,321.07,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,outpatient,,,331.00000,166.16000,Hometown Health,HMO,,297.90,,,,,,,86.06,321.07,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,inpatient,,,4440.00000,2357.64000,Hometown Health,HMO,,3996.00,,,,,,,3996.00,4306.80,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,outpatient,,,4440.00000,2357.64000,Hometown Health,HMO,,3996.00,,,,,,,1154.40,4306.80,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,inpatient,,,5328.00000,2829.17000,Hometown Health,HMO,,4795.20,,,,,,,4795.20,5168.16,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,outpatient,,,5328.00000,2829.17000,Hometown Health,HMO,,4795.20,,,,,,,1385.28,5168.16,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,inpatient,,,3552.00000,1886.11000,Hometown Health,HMO,,3196.80,,,,,,,3196.80,3445.44,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,outpatient,,,3552.00000,1886.11000,Hometown Health,HMO,,3196.80,,,,,,,923.52,3445.44,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,inpatient,,,2528.00000,1342.37000,Hometown Health,HMO,,2275.20,,,,,,,2275.20,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,outpatient,,,2528.00000,1342.37000,Hometown Health,HMO,,2275.20,,,,,,,657.28,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,inpatient,,,3033.00000,1610.52000,Hometown Health,HMO,,2729.70,,,,,,,2729.70,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,outpatient,,,3033.00000,1610.52000,Hometown Health,HMO,,2729.70,,,,,,,788.58,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,inpatient,,,2022.00000,1073.68000,Hometown Health,HMO,,1819.80,,,,,,,1819.80,1961.34,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,outpatient,,,2022.00000,1073.68000,Hometown Health,HMO,,1819.80,,,,,,,525.72,1961.34,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,inpatient,,,3610.00000,1909.69000,Hometown Health,HMO,,3249.00,,,,,,,3249.00,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,outpatient,,,3610.00000,1909.69000,Hometown Health,HMO,,3249.00,,,,,,,938.60,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,inpatient,,,4332.00000,2291.63000,Hometown Health,HMO,,3898.80,,,,,,,3898.80,4202.04,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,outpatient,,,4332.00000,2291.63000,Hometown Health,HMO,,3898.80,,,,,,,1126.32,4202.04,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,inpatient,,,2888.00000,1527.75000,Hometown Health,HMO,,2599.20,,,,,,,2599.20,2801.36,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,outpatient,,,2888.00000,1527.75000,Hometown Health,HMO,,2599.20,,,,,,,750.88,2801.36,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,inpatient,,,4532.00000,2397.43000,Hometown Health,HMO,,4078.80,,,,,,,4078.80,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,outpatient,,,4532.00000,2397.43000,Hometown Health,HMO,,4078.80,,,,,,,1178.32,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,inpatient,,,5438.00000,2876.70000,Hometown Health,HMO,,4894.20,,,,,,,4894.20,5274.86,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,outpatient,,,5438.00000,2876.70000,Hometown Health,HMO,,4894.20,,,,,,,1413.88,5274.86,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,inpatient,,,3625.00000,1917.62000,Hometown Health,HMO,,3262.50,,,,,,,3262.50,3516.25,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,outpatient,,,3625.00000,1917.62000,Hometown Health,HMO,,3262.50,,,,,,,942.50,3516.25,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,inpatient,,,3639.00000,1925.03000,Hometown Health,HMO,,3275.10,,,,,,,3275.10,3529.83,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,outpatient,,,3639.00000,1925.03000,Hometown Health,HMO,,3275.10,,,,,,,946.14,3529.83,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,inpatient,,,4367.00000,2310.14000,Hometown Health,HMO,,3930.30,,,,,,,3930.30,4235.99,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,outpatient,,,4367.00000,2310.14000,Hometown Health,HMO,,3930.30,,,,,,,1135.42,4235.99,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,inpatient,,,2911.00000,1539.92000,Hometown Health,HMO,,2619.90,,,,,,,2619.90,2823.67,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,outpatient,,,2911.00000,1539.92000,Hometown Health,HMO,,2619.90,,,,,,,756.86,2823.67,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,inpatient,,,3494.00000,1719.05000,Hometown Health,HMO,,3144.60,,,,,,,3144.60,3389.18,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3494.00000,1719.05000,Hometown Health,HMO,,3144.60,,,,,,,908.44,3389.18,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,inpatient,,,4193.00000,2062.96000,Hometown Health,HMO,,3773.70,,,,,,,3773.70,4067.21,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,outpatient,,,4193.00000,2062.96000,Hometown Health,HMO,,3773.70,,,,,,,1090.18,4067.21,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,inpatient,,,2795.00000,1375.14000,Hometown Health,HMO,,2515.50,,,,,,,2515.50,2711.15,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,outpatient,,,2795.00000,1375.14000,Hometown Health,HMO,,2515.50,,,,,,,726.70,2711.15,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,inpatient,,,2717.00000,1336.76000,Hometown Health,HMO,,2445.30,,,,,,,2445.30,2635.49,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,outpatient,,,2717.00000,1336.76000,Hometown Health,HMO,,2445.30,,,,,,,706.42,2635.49,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,inpatient,,,3260.00000,1603.92000,Hometown Health,HMO,,2934.00,,,,,,,2934.00,3162.20,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,outpatient,,,3260.00000,1603.92000,Hometown Health,HMO,,2934.00,,,,,,,847.60,3162.20,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,inpatient,,,2173.00000,1069.12000,Hometown Health,HMO,,1955.70,,,,,,,1955.70,2107.81,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,outpatient,,,2173.00000,1069.12000,Hometown Health,HMO,,1955.70,,,,,,,564.98,2107.81,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4051.00000,2301.58000,Hometown Health,HMO,LT,3645.90,,,,,,,3645.90,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Hometown Health,HMO,LT,3645.90,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4051.00000,2301.58000,Hometown Health,HMO,RT,3645.90,,,,,,,3645.90,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Hometown Health,HMO,RT,3645.90,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4861.00000,2761.78000,Hometown Health,HMO,LT,4374.90,,,,,,,4374.90,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Hometown Health,HMO,LT,4374.90,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4861.00000,2761.78000,Hometown Health,HMO,RT,4374.90,,,,,,,4374.90,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Hometown Health,HMO,RT,4374.90,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3241.00000,1841.37000,Hometown Health,HMO,LT,2916.90,,,,,,,2916.90,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Hometown Health,HMO,LT,2916.90,,,,,,,842.66,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3241.00000,1841.37000,Hometown Health,HMO,RT,2916.90,,,,,,,2916.90,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Hometown Health,HMO,RT,2916.90,,,,,,,842.66,3143.77,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,inpatient,,,4260.00000,2420.32000,Hometown Health,HMO,,3834.00,,,,,,,3834.00,4132.20,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,outpatient,,,4260.00000,2420.32000,Hometown Health,HMO,,3834.00,,,,,,,1107.60,4132.20,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,inpatient,,,5112.00000,2904.38000,Hometown Health,HMO,,4600.80,,,,,,,4600.80,4958.64,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,outpatient,,,5112.00000,2904.38000,Hometown Health,HMO,,4600.80,,,,,,,1329.12,4958.64,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,inpatient,,,3408.00000,1936.26000,Hometown Health,HMO,,3067.20,,,,,,,3067.20,3305.76,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3408.00000,1936.26000,Hometown Health,HMO,,3067.20,,,,,,,886.08,3305.76,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,inpatient,,,3343.00000,1899.33000,Hometown Health,HMO,,3008.70,,,,,,,3008.70,3242.71,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3343.00000,1899.33000,Hometown Health,HMO,,3008.70,,,,,,,869.18,3242.71,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,inpatient,,,4010.00000,2278.28000,Hometown Health,HMO,,3609.00,,,,,,,3609.00,3889.70,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,outpatient,,,4010.00000,2278.28000,Hometown Health,HMO,,3609.00,,,,,,,1042.60,3889.70,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,inpatient,,,2674.00000,1519.23000,Hometown Health,HMO,,2406.60,,,,,,,2406.60,2593.78,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,outpatient,,,2674.00000,1519.23000,Hometown Health,HMO,,2406.60,,,,,,,695.24,2593.78,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3294.00000,1871.49000,Hometown Health,HMO,LT,2964.60,,,,,,,2964.60,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Hometown Health,HMO,LT,2964.60,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3294.00000,1871.49000,Hometown Health,HMO,RT,2964.60,,,,,,,2964.60,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Hometown Health,HMO,RT,2964.60,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3953.00000,2245.90000,Hometown Health,HMO,LT,3557.70,,,,,,,3557.70,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Hometown Health,HMO,LT,3557.70,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3953.00000,2245.90000,Hometown Health,HMO,RT,3557.70,,,,,,,3557.70,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Hometown Health,HMO,RT,3557.70,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,inpatient,,,2635.00000,1497.08000,Hometown Health,HMO,LT,2371.50,,,,,,,2371.50,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Hometown Health,HMO,LT,2371.50,,,,,,,685.10,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,inpatient,,,2635.00000,1497.08000,Hometown Health,HMO,RT,2371.50,,,,,,,2371.50,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Hometown Health,HMO,RT,2371.50,,,,,,,685.10,2555.95,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,inpatient,,,3664.00000,2081.70000,Hometown Health,HMO,,3297.60,,,,,,,3297.60,3554.08,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3664.00000,2081.70000,Hometown Health,HMO,,3297.60,,,,,,,952.64,3554.08,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,inpatient,,,4397.00000,2498.16000,Hometown Health,HMO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,outpatient,,,4397.00000,2498.16000,Hometown Health,HMO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,inpatient,,,2931.00000,1665.25000,Hometown Health,HMO,,2637.90,,,,,,,2637.90,2843.07,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,outpatient,,,2931.00000,1665.25000,Hometown Health,HMO,,2637.90,,,,,,,762.06,2843.07,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,inpatient,,,4759.00000,2703.83000,Hometown Health,HMO,,4283.10,,,,,,,4283.10,4616.23,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,outpatient,,,4759.00000,2703.83000,Hometown Health,HMO,,4283.10,,,,,,,1237.34,4616.23,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,inpatient,,,5710.00000,3244.14000,Hometown Health,HMO,,5139.00,,,,,,,5139.00,5538.70,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,outpatient,,,5710.00000,3244.14000,Hometown Health,HMO,,5139.00,,,,,,,1484.60,5538.70,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,inpatient,,,3807.00000,2162.95000,Hometown Health,HMO,,3426.30,,,,,,,3426.30,3692.79,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3807.00000,2162.95000,Hometown Health,HMO,,3426.30,,,,,,,989.82,3692.79,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,inpatient,,,2915.00000,1574.10000,Hometown Health,HMO,,2623.50,,,,,,,2623.50,2827.55,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2915.00000,1574.10000,Hometown Health,HMO,,2623.50,,,,,,,757.90,2827.55,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,inpatient,,,1918.00000,1035.72000,Hometown Health,HMO,,1726.20,,,,,,,1726.20,1860.46,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1918.00000,1035.72000,Hometown Health,HMO,,1726.20,,,,,,,498.68,1860.46,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,inpatient,,,2292.00000,1237.68000,Hometown Health,HMO,,2062.80,,,,,,,2062.80,2223.24,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2292.00000,1237.68000,Hometown Health,HMO,,2062.80,,,,,,,595.92,2223.24,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,inpatient,,,2984.00000,1611.36000,Hometown Health,HMO,,2685.60,,,,,,,2685.60,2894.48,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,outpatient,,,2984.00000,1611.36000,Hometown Health,HMO,,2685.60,,,,,,,775.84,2894.48,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,inpatient,,,769.00000,415.26000,Hometown Health,HMO,,692.10,,,,,,,692.10,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,outpatient,,,769.00000,415.26000,Hometown Health,HMO,,692.10,,,,,,,199.94,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,inpatient,,,1280.00000,691.20000,Hometown Health,HMO,,1152.00,,,,,,,1152.00,1241.60,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,outpatient,,,1280.00000,691.20000,Hometown Health,HMO,,1152.00,,,,,,,332.80,1241.60,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,inpatient,,,1878.00000,1014.12000,Hometown Health,HMO,,1690.20,,,,,,,1690.20,1821.66,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,outpatient,,,1878.00000,1014.12000,Hometown Health,HMO,,1690.20,,,,,,,488.28,1821.66,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,inpatient,,,2196.00000,1185.84000,Hometown Health,HMO,,1976.40,,,,,,,1976.40,2130.12,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,outpatient,,,2196.00000,1185.84000,Hometown Health,HMO,,1976.40,,,,,,,570.96,2130.12,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,inpatient,,,844.00000,455.76000,Hometown Health,HMO,,759.60,,,,,,,759.60,818.68,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,outpatient,,,844.00000,455.76000,Hometown Health,HMO,,759.60,,,,,,,219.44,818.68,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,inpatient,,,1305.00000,704.70000,Hometown Health,HMO,,1174.50,,,,,,,1174.50,1265.85,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,outpatient,,,1305.00000,704.70000,Hometown Health,HMO,,1174.50,,,,,,,339.30,1265.85,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,inpatient,,,576.00000,311.04000,Hometown Health,HMO,,518.40,,,,,,,518.40,558.72,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,outpatient,,,576.00000,311.04000,Hometown Health,HMO,,518.40,,,,,,,149.76,558.72,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,inpatient,,,809.00000,436.86000,Hometown Health,HMO,,728.10,,,,,,,728.10,784.73,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,outpatient,,,809.00000,436.86000,Hometown Health,HMO,,728.10,,,,,,,210.34,784.73,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,inpatient,,,2462.00000,1329.48000,Hometown Health,HMO,,2215.80,,,,,,,2215.80,2388.14,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,outpatient,,,2462.00000,1329.48000,Hometown Health,HMO,,2215.80,,,,,,,640.12,2388.14,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,inpatient,,,918.00000,495.72000,Hometown Health,HMO,,826.20,,,,,,,826.20,890.46,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,outpatient,,,918.00000,495.72000,Hometown Health,HMO,,826.20,,,,,,,238.68,890.46,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,inpatient,,,1102.00000,595.08000,Hometown Health,HMO,,991.80,,,,,,,991.80,1068.94,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,outpatient,,,1102.00000,595.08000,Hometown Health,HMO,,991.80,,,,,,,286.52,1068.94,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,inpatient,,,812.00000,438.48000,Hometown Health,HMO,,730.80,,,,,,,730.80,787.64,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,outpatient,,,812.00000,438.48000,Hometown Health,HMO,,730.80,,,,,,,211.12,787.64,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,inpatient,,,1407.00000,759.78000,Hometown Health,HMO,,1266.30,,,,,,,1266.30,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,outpatient,,,1407.00000,759.78000,Hometown Health,HMO,,1266.30,,,,,,,365.82,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,inpatient,,,1980.00000,1069.20000,Hometown Health,HMO,,1782.00,,,,,,,1782.00,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,outpatient,,,1980.00000,1069.20000,Hometown Health,HMO,,1782.00,,,,,,,514.80,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,inpatient,,,964.00000,520.56000,Hometown Health,HMO,,867.60,,,,,,,867.60,935.08,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,outpatient,,,964.00000,520.56000,Hometown Health,HMO,,867.60,,,,,,,250.64,935.08,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,inpatient,,,1040.00000,561.60000,Hometown Health,HMO,,936.00,,,,,,,936.00,1008.80,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,outpatient,,,1040.00000,561.60000,Hometown Health,HMO,,936.00,,,,,,,270.40,1008.80,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,inpatient,,,795.00000,429.30000,Hometown Health,HMO,,715.50,,,,,,,715.50,771.15,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,outpatient,,,795.00000,429.30000,Hometown Health,HMO,,715.50,,,,,,,206.70,771.15,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,inpatient,,,1124.00000,606.96000,Hometown Health,HMO,,1011.60,,,,,,,1011.60,1090.28,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,outpatient,,,1124.00000,606.96000,Hometown Health,HMO,,1011.60,,,,,,,292.24,1090.28,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,inpatient,,,736.00000,397.44000,Hometown Health,HMO,,662.40,,,,,,,662.40,713.92,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,outpatient,,,736.00000,397.44000,Hometown Health,HMO,,662.40,,,,,,,191.36,713.92,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,inpatient,,,700.00000,378.00000,Hometown Health,HMO,,630.00,,,,,,,630.00,679.00,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,outpatient,,,700.00000,378.00000,Hometown Health,HMO,,630.00,,,,,,,182.00,679.00,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,inpatient,,,821.00000,443.34000,Hometown Health,HMO,,738.90,,,,,,,738.90,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,outpatient,,,821.00000,443.34000,Hometown Health,HMO,,738.90,,,,,,,213.46,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,inpatient,,,846.00000,456.84000,Hometown Health,HMO,,761.40,,,,,,,761.40,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,outpatient,,,846.00000,456.84000,Hometown Health,HMO,,761.40,,,,,,,219.96,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,inpatient,,,958.00000,517.32000,Hometown Health,HMO,,862.20,,,,,,,862.20,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,outpatient,,,958.00000,517.32000,Hometown Health,HMO,,862.20,,,,,,,249.08,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,inpatient,,,1261.00000,680.94000,Hometown Health,HMO,,1134.90,,,,,,,1134.90,1223.17,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,outpatient,,,1261.00000,680.94000,Hometown Health,HMO,,1134.90,,,,,,,327.86,1223.17,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,inpatient,,,971.00000,524.34000,Hometown Health,HMO,,873.90,,,,,,,873.90,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,outpatient,,,971.00000,524.34000,Hometown Health,HMO,,873.90,,,,,,,252.46,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,inpatient,,,1837.00000,991.98000,Hometown Health,HMO,,1653.30,,,,,,,1653.30,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,outpatient,,,1837.00000,991.98000,Hometown Health,HMO,,1653.30,,,,,,,477.62,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,inpatient,,,1099.00000,593.46000,Hometown Health,HMO,,989.10,,,,,,,989.10,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,outpatient,,,1099.00000,593.46000,Hometown Health,HMO,,989.10,,,,,,,285.74,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,inpatient,,,2178.00000,1176.12000,Hometown Health,HMO,,1960.20,,,,,,,1960.20,2112.66,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,outpatient,,,2178.00000,1176.12000,Hometown Health,HMO,,1960.20,,,,,,,566.28,2112.66,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,inpatient,,,1226.00000,662.04000,Hometown Health,HMO,,1103.40,,,,,,,1103.40,1189.22,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,outpatient,,,1226.00000,662.04000,Hometown Health,HMO,,1103.40,,,,,,,318.76,1189.22,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,inpatient,,,1048.00000,565.92000,Hometown Health,HMO,,943.20,,,,,,,943.20,1016.56,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,outpatient,,,1048.00000,565.92000,Hometown Health,HMO,,943.20,,,,,,,272.48,1016.56,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,inpatient,,,970.00000,523.80000,Hometown Health,HMO,,873.00,,,,,,,873.00,940.90,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,outpatient,,,970.00000,523.80000,Hometown Health,HMO,,873.00,,,,,,,252.20,940.90,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,inpatient,,,1803.00000,973.62000,Hometown Health,HMO,,1622.70,,,,,,,1622.70,1748.91,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,outpatient,,,1803.00000,973.62000,Hometown Health,HMO,,1622.70,,,,,,,468.78,1748.91,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,inpatient,,,2504.00000,1352.16000,Hometown Health,HMO,,2253.60,,,,,,,2253.60,2428.88,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,outpatient,,,2504.00000,1352.16000,Hometown Health,HMO,,2253.60,,,,,,,651.04,2428.88,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,inpatient,,,2457.00000,1326.78000,Hometown Health,HMO,,2211.30,,,,,,,2211.30,2383.29,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2457.00000,1326.78000,Hometown Health,HMO,,2211.30,,,,,,,638.82,2383.29,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,inpatient,,,923.00000,498.42000,Hometown Health,HMO,,830.70,,,,,,,830.70,895.31,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,outpatient,,,923.00000,498.42000,Hometown Health,HMO,,830.70,,,,,,,239.98,895.31,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,inpatient,,,5478.00000,2958.12000,Hometown Health,HMO,,4930.20,,,,,,,4930.20,5313.66,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,outpatient,,,5478.00000,2958.12000,Hometown Health,HMO,,4930.20,,,,,,,1424.28,5313.66,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,inpatient,,,4551.00000,2457.54000,Hometown Health,HMO,,4095.90,,,,,,,4095.90,4414.47,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,outpatient,,,4551.00000,2457.54000,Hometown Health,HMO,,4095.90,,,,,,,1183.26,4414.47,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,inpatient,,,1360.00000,734.40000,Hometown Health,HMO,,1224.00,,,,,,,1224.00,1319.20,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,outpatient,,,1360.00000,734.40000,Hometown Health,HMO,,1224.00,,,,,,,353.60,1319.20,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,inpatient,,,1209.00000,652.86000,Hometown Health,HMO,,1088.10,,,,,,,1088.10,1172.73,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,outpatient,,,1209.00000,652.86000,Hometown Health,HMO,,1088.10,,,,,,,314.34,1172.73,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,inpatient,,,848.00000,457.92000,Hometown Health,HMO,,763.20,,,,,,,763.20,822.56,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,outpatient,,,848.00000,457.92000,Hometown Health,HMO,,763.20,,,,,,,220.48,822.56,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,inpatient,,,1071.00000,578.34000,Hometown Health,HMO,,963.90,,,,,,,963.90,1038.87,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,outpatient,,,1071.00000,578.34000,Hometown Health,HMO,,963.90,,,,,,,278.46,1038.87,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,inpatient,,,1792.00000,967.68000,Hometown Health,HMO,,1612.80,,,,,,,1612.80,1738.24,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,outpatient,,,1792.00000,967.68000,Hometown Health,HMO,,1612.80,,,,,,,465.92,1738.24,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,inpatient,,,35.00000,18.90000,Hometown Health,HMO,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,outpatient,,,35.00000,18.90000,Hometown Health,HMO,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,inpatient,,,285.00000,153.90000,Hometown Health,HMO,,256.50,,,,,,,256.50,276.45,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,outpatient,,,285.00000,153.90000,Hometown Health,HMO,,256.50,,,,,,,74.10,276.45,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,inpatient,,,1012.00000,546.48000,Hometown Health,HMO,,910.80,,,,,,,910.80,981.64,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,outpatient,,,1012.00000,546.48000,Hometown Health,HMO,,910.80,,,,,,,263.12,981.64,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,inpatient,,,492.00000,265.68000,Hometown Health,HMO,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,outpatient,,,492.00000,265.68000,Hometown Health,HMO,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,inpatient,,,739.00000,399.06000,Hometown Health,HMO,,665.10,,,,,,,665.10,716.83,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,outpatient,,,739.00000,399.06000,Hometown Health,HMO,,665.10,,,,,,,192.14,716.83,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,inpatient,,,515.00000,278.10000,Hometown Health,HMO,,463.50,,,,,,,463.50,499.55,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,outpatient,,,515.00000,278.10000,Hometown Health,HMO,,463.50,,,,,,,133.90,499.55,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,inpatient,,,1467.00000,792.18000,Hometown Health,HMO,,1320.30,,,,,,,1320.30,1422.99,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,outpatient,,,1467.00000,792.18000,Hometown Health,HMO,,1320.30,,,,,,,381.42,1422.99,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,inpatient,,,1683.00000,888.62000,Hometown Health,HMO,,1514.70,,,,,,,1514.70,1632.51,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,outpatient,,,1683.00000,888.62000,Hometown Health,HMO,,1514.70,,,,,,,437.58,1632.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,inpatient,,,426.30000,225.09000,Hometown Health,HMO,,383.67,,,,,,,383.67,413.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,426.30000,225.09000,Hometown Health,HMO,,383.67,,,,,,,110.84,413.51,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,inpatient,,,725.00000,382.80000,Hometown Health,HMO,,652.50,,,,,,,652.50,703.25,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,725.00000,382.80000,Hometown Health,HMO,,652.50,,,,,,,188.50,1855.42,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,inpatient,,,1852.00000,977.86000,Hometown Health,HMO,,1666.80,,,,,,,1666.80,1796.44,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,1852.00000,977.86000,Hometown Health,HMO,,1666.80,,,,,,,481.52,1868.26,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,110.00000,58.08000,Hometown Health,HMO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,110.00000,58.08000,Hometown Health,HMO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,inpatient,,,98.00000,51.74000,Hometown Health,HMO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,98.00000,51.74000,Hometown Health,HMO,,88.20,,,,,,,25.48,1662.92,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,inpatient,,,2018.00000,1065.50000,Hometown Health,HMO,,1816.20,,,,,,,1816.20,1957.46,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,2018.00000,1065.50000,Hometown Health,HMO,,1816.20,,,,,,,524.68,1957.46,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,inpatient,,,4325.00000,2283.60000,Hometown Health,HMO,,3892.50,,,,,,,3892.50,4195.25,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,4325.00000,2283.60000,Hometown Health,HMO,,3892.50,,,,,,,1124.50,4195.25,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,inpatient,,,172.00000,90.82000,Hometown Health,HMO,,154.80,,,,,,,154.80,166.84,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Hometown Health,HMO,,154.80,,,,,,,44.72,166.84,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,inpatient,,,942.00000,497.38000,Hometown Health,HMO,,847.80,,,,,,,847.80,913.74,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,942.00000,497.38000,Hometown Health,HMO,,847.80,,,,,,,244.92,913.74,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,inpatient,,,413.00000,218.06000,Hometown Health,HMO,,371.70,,,,,,,371.70,400.61,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,413.00000,218.06000,Hometown Health,HMO,,371.70,,,,,,,107.38,400.61,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,inpatient,,,257.00000,135.70000,Hometown Health,HMO,,231.30,,,,,,,231.30,249.29,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,outpatient,,,257.00000,135.70000,Hometown Health,HMO,,231.30,,,,,,,66.82,249.29,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,inpatient,,,116.00000,61.25000,Hometown Health,HMO,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,116.00000,61.25000,Hometown Health,HMO,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,inpatient,,,463.20000,244.57000,Hometown Health,HMO,,416.88,,,,,,,416.88,449.30,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,463.20000,244.57000,Hometown Health,HMO,,416.88,,,,,,,120.43,449.30,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,inpatient,,,804.00000,424.51000,Hometown Health,HMO,,723.60,,,,,,,723.60,779.88,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,804.00000,424.51000,Hometown Health,HMO,,723.60,,,,,,,209.04,779.88,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,inpatient,,,172.00000,90.82000,Hometown Health,HMO,,154.80,,,,,,,154.80,166.84,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Hometown Health,HMO,,154.80,,,,,,,44.72,166.84,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,inpatient,,,354.30000,187.07000,Hometown Health,HMO,,318.87,,,,,,,318.87,343.67,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,354.30000,187.07000,Hometown Health,HMO,,318.87,,,,,,,92.12,343.67,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,inpatient,,,277.90000,146.73000,Hometown Health,HMO,,250.11,,,,,,,250.11,269.56,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,277.90000,146.73000,Hometown Health,HMO,,250.11,,,,,,,72.25,269.56,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,inpatient,,,200.00000,105.60000,Hometown Health,HMO,,180.00,,,,,,,180.00,194.00,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,200.00000,105.60000,Hometown Health,HMO,,180.00,,,,,,,52.00,194.00,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,inpatient,,,197.00000,63.63000,Hometown Health,HMO,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,outpatient,,,197.00000,63.63000,Hometown Health,HMO,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,inpatient,,,468.00000,151.16000,Hometown Health,HMO,50,421.20,,,,,,,421.20,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,outpatient,,,468.00000,151.16000,Hometown Health,HMO,50,421.20,,,,,,,121.68,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,inpatient,,,312.00000,100.78000,Hometown Health,HMO,LT,280.80,,,,,,,280.80,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Hometown Health,HMO,LT,280.80,,,,,,,81.12,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,inpatient,,,312.00000,100.78000,Hometown Health,HMO,RT,280.80,,,,,,,280.80,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Hometown Health,HMO,RT,280.80,,,,,,,81.12,302.64,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Hometown Health,HMO,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Hometown Health,HMO,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,inpatient,,,609.00000,196.71000,Hometown Health,HMO,,548.10,,,,,,,548.10,590.73,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Hometown Health,HMO,,548.10,,,,,,,158.34,590.73,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,inpatient,,,1248.00000,403.10000,Hometown Health,HMO,50,1123.20,,,,,,,1123.20,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1248.00000,403.10000,Hometown Health,HMO,50,1123.20,,,,,,,324.48,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,inpatient,,,832.00000,268.74000,Hometown Health,HMO,LT,748.80,,,,,,,748.80,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Hometown Health,HMO,LT,748.80,,,,,,,216.32,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,inpatient,,,832.00000,268.74000,Hometown Health,HMO,RT,748.80,,,,,,,748.80,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Hometown Health,HMO,RT,748.80,,,,,,,216.32,807.04,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,inpatient,,,4235.00000,1367.90000,Hometown Health,HMO,LT,3811.50,,,,,,,3811.50,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Hometown Health,HMO,LT,3811.50,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,inpatient,,,4235.00000,1367.90000,Hometown Health,HMO,RT,3811.50,,,,,,,3811.50,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Hometown Health,HMO,RT,3811.50,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,inpatient,,,2119.00000,684.44000,Hometown Health,HMO,,1907.10,,,,,,,1907.10,2055.43,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,outpatient,,,2119.00000,684.44000,Hometown Health,HMO,,1907.10,,,,,,,550.94,2055.43,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,inpatient,,,1943.00000,627.59000,Hometown Health,HMO,,1748.70,,,,,,,1748.70,1884.71,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1943.00000,627.59000,Hometown Health,HMO,,1748.70,,,,,,,505.18,1884.71,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,inpatient,,,1426.00000,460.60000,Hometown Health,HMO,,1283.40,,,,,,,1283.40,1383.22,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,outpatient,,,1426.00000,460.60000,Hometown Health,HMO,,1283.40,,,,,,,370.76,1383.22,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,inpatient,,,4202.00000,1357.25000,Hometown Health,HMO,50,3781.80,,,,,,,3781.80,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,outpatient,,,4202.00000,1357.25000,Hometown Health,HMO,50,3781.80,,,,,,,1092.52,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,inpatient,,,2801.00000,904.72000,Hometown Health,HMO,LT,2520.90,,,,,,,2520.90,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Hometown Health,HMO,LT,2520.90,,,,,,,728.26,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,inpatient,,,2801.00000,904.72000,Hometown Health,HMO,RT,2520.90,,,,,,,2520.90,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Hometown Health,HMO,RT,2520.90,,,,,,,728.26,2716.97,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,inpatient,,,832.00000,268.74000,Hometown Health,HMO,,748.80,,,,,,,748.80,807.04,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,outpatient,,,832.00000,268.74000,Hometown Health,HMO,,748.80,,,,,,,216.32,807.04,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,inpatient,,,1457.00000,470.61000,Hometown Health,HMO,,1311.30,,,,,,,1311.30,1413.29,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,outpatient,,,1457.00000,470.61000,Hometown Health,HMO,,1311.30,,,,,,,378.82,1413.29,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,inpatient,,,743.00000,239.99000,Hometown Health,HMO,LT,668.70,,,,,,,668.70,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Hometown Health,HMO,LT,668.70,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,inpatient,,,743.00000,239.99000,Hometown Health,HMO,RT,668.70,,,,,,,668.70,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Hometown Health,HMO,RT,668.70,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,inpatient,,,232.00000,74.94000,Hometown Health,HMO,,208.80,,,,,,,208.80,225.04,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,outpatient,,,232.00000,74.94000,Hometown Health,HMO,,208.80,,,,,,,60.32,225.04,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,inpatient,,,1364.00000,440.57000,Hometown Health,HMO,50,1227.60,,,,,,,1227.60,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,outpatient,,,1364.00000,440.57000,Hometown Health,HMO,50,1227.60,,,,,,,354.64,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,inpatient,,,909.00000,293.61000,Hometown Health,HMO,LT,818.10,,,,,,,818.10,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Hometown Health,HMO,LT,818.10,,,,,,,236.34,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,inpatient,,,909.00000,293.61000,Hometown Health,HMO,RT,818.10,,,,,,,818.10,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Hometown Health,HMO,RT,818.10,,,,,,,236.34,881.73,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,inpatient,,,510.00000,355.98000,Hometown Health,HMO,,459.00,,,,,,,459.00,494.70,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,outpatient,,,510.00000,355.98000,Hometown Health,HMO,,459.00,,,,,,,132.60,494.70,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,inpatient,,,1001.00000,698.70000,Hometown Health,HMO,,900.90,,,,,,,900.90,970.97,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,outpatient,,,1001.00000,698.70000,Hometown Health,HMO,,900.90,,,,,,,260.26,970.97,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,inpatient,,,887.00000,619.13000,Hometown Health,HMO,,798.30,,,,,,,798.30,860.39,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,outpatient,,,887.00000,619.13000,Hometown Health,HMO,,798.30,,,,,,,230.62,860.39,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,inpatient,,,1022.00000,713.36000,Hometown Health,HMO,50,919.80,,,,,,,919.80,991.34,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,outpatient,,,1022.00000,713.36000,Hometown Health,HMO,50,919.80,,,,,,,265.72,991.34,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,inpatient,,,681.00000,475.34000,Hometown Health,HMO,LT,612.90,,,,,,,612.90,660.57,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Hometown Health,HMO,LT,612.90,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,inpatient,,,681.00000,475.34000,Hometown Health,HMO,RT,612.90,,,,,,,612.90,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Hometown Health,HMO,RT,612.90,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,inpatient,,,945.00000,659.61000,Hometown Health,HMO,50,850.50,,,,,,,850.50,916.65,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,outpatient,,,945.00000,659.61000,Hometown Health,HMO,50,850.50,,,,,,,245.70,916.65,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,inpatient,,,630.00000,439.74000,Hometown Health,HMO,LT,567.00,,,,,,,567.00,611.10,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Hometown Health,HMO,LT,567.00,,,,,,,163.80,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,inpatient,,,630.00000,439.74000,Hometown Health,HMO,RT,567.00,,,,,,,567.00,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Hometown Health,HMO,RT,567.00,,,,,,,163.80,611.10,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,inpatient,,,577.00000,402.75000,Hometown Health,HMO,,519.30,,,,,,,519.30,559.69,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,outpatient,,,577.00000,402.75000,Hometown Health,HMO,,519.30,,,,,,,150.02,559.69,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,inpatient,,,433.00000,302.23000,Hometown Health,HMO,,389.70,,,,,,,389.70,420.01,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,outpatient,,,433.00000,302.23000,Hometown Health,HMO,,389.70,,,,,,,112.58,420.01,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,inpatient,,,331.00000,231.04000,Hometown Health,HMO,,297.90,,,,,,,297.90,321.07,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,outpatient,,,331.00000,231.04000,Hometown Health,HMO,,297.90,,,,,,,86.06,321.07,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,inpatient,,,662.00000,462.08000,Hometown Health,HMO,,595.80,,,,,,,595.80,642.14,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,outpatient,,,662.00000,462.08000,Hometown Health,HMO,,595.80,,,,,,,172.12,642.14,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,inpatient,,,752.00000,524.90000,Hometown Health,HMO,,676.80,,,,,,,676.80,729.44,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,outpatient,,,752.00000,524.90000,Hometown Health,HMO,,676.80,,,,,,,195.52,729.44,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,inpatient,,,182.00000,127.04000,Hometown Health,HMO,,163.80,,,,,,,163.80,176.54,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Hometown Health,HMO,,163.80,,,,,,,47.32,176.54,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,inpatient,,,420.00000,293.16000,Hometown Health,HMO,,378.00,,,,,,,378.00,407.40,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,outpatient,,,420.00000,293.16000,Hometown Health,HMO,,378.00,,,,,,,109.20,407.40,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,inpatient,,,253.00000,176.59000,Hometown Health,HMO,,227.70,,,,,,,227.70,245.41,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,outpatient,,,253.00000,176.59000,Hometown Health,HMO,,227.70,,,,,,,65.78,245.41,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,inpatient,,,168.00000,117.26000,Hometown Health,HMO,,151.20,,,,,,,151.20,162.96,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,outpatient,,,168.00000,117.26000,Hometown Health,HMO,,151.20,,,,,,,43.68,162.96,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,inpatient,,,695.00000,485.11000,Hometown Health,HMO,,625.50,,,,,,,625.50,674.15,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,outpatient,,,695.00000,485.11000,Hometown Health,HMO,,625.50,,,,,,,180.70,674.15,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,inpatient,,,474.00000,330.85000,Hometown Health,HMO,,426.60,,,,,,,426.60,459.78,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,outpatient,,,474.00000,330.85000,Hometown Health,HMO,,426.60,,,,,,,123.24,459.78,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,inpatient,,,930.00000,649.14000,Hometown Health,HMO,,837.00,,,,,,,837.00,902.10,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,outpatient,,,930.00000,649.14000,Hometown Health,HMO,,837.00,,,,,,,241.80,902.10,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,inpatient,,,786.00000,548.63000,Hometown Health,HMO,,707.40,,,,,,,707.40,762.42,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,outpatient,,,786.00000,548.63000,Hometown Health,HMO,,707.40,,,,,,,204.36,762.42,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,inpatient,,,620.00000,432.76000,Hometown Health,HMO,,558.00,,,,,,,558.00,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Hometown Health,HMO,,558.00,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,inpatient,,,620.00000,432.76000,Hometown Health,HMO,59,558.00,,,,,,,558.00,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Hometown Health,HMO,59,558.00,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,inpatient,,,435.00000,303.63000,Hometown Health,HMO,,391.50,,,,,,,391.50,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Hometown Health,HMO,,391.50,,,,,,,113.10,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,inpatient,,,435.00000,303.63000,Hometown Health,HMO,59,391.50,,,,,,,391.50,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Hometown Health,HMO,59,391.50,,,,,,,113.10,421.95,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,inpatient,,,492.00000,343.42000,Hometown Health,HMO,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,outpatient,,,492.00000,343.42000,Hometown Health,HMO,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,inpatient,,,331.00000,231.04000,Hometown Health,HMO,,297.90,,,,,,,297.90,321.07,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,outpatient,,,331.00000,231.04000,Hometown Health,HMO,,297.90,,,,,,,86.06,321.07,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,inpatient,,,875.00000,610.75000,Hometown Health,HMO,,787.50,,,,,,,787.50,848.75,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,outpatient,,,875.00000,610.75000,Hometown Health,HMO,,787.50,,,,,,,227.50,848.75,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,inpatient,,,688.00000,480.22000,Hometown Health,HMO,,619.20,,,,,,,619.20,667.36,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,outpatient,,,688.00000,480.22000,Hometown Health,HMO,,619.20,,,,,,,178.88,667.36,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,inpatient,,,465.00000,324.57000,Hometown Health,HMO,,418.50,,,,,,,418.50,451.05,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,outpatient,,,465.00000,324.57000,Hometown Health,HMO,,418.50,,,,,,,120.90,451.05,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,inpatient,,,846.00000,590.51000,Hometown Health,HMO,,761.40,,,,,,,761.40,820.62,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,outpatient,,,846.00000,590.51000,Hometown Health,HMO,,761.40,,,,,,,219.96,820.62,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,inpatient,,,482.00000,336.44000,Hometown Health,HMO,,433.80,,,,,,,433.80,467.54,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,outpatient,,,482.00000,336.44000,Hometown Health,HMO,,433.80,,,,,,,125.32,467.54,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,inpatient,,,926.00000,646.35000,Hometown Health,HMO,,833.40,,,,,,,833.40,898.22,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,outpatient,,,926.00000,646.35000,Hometown Health,HMO,,833.40,,,,,,,240.76,898.22,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,inpatient,,,292.00000,203.82000,Hometown Health,HMO,,262.80,,,,,,,262.80,283.24,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,outpatient,,,292.00000,203.82000,Hometown Health,HMO,,262.80,,,,,,,75.92,283.24,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,inpatient,,,827.00000,577.25000,Hometown Health,HMO,,744.30,,,,,,,744.30,802.19,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,outpatient,,,827.00000,577.25000,Hometown Health,HMO,,744.30,,,,,,,215.02,802.19,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,inpatient,,,253.00000,176.59000,Hometown Health,HMO,,227.70,,,,,,,227.70,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,outpatient,,,253.00000,176.59000,Hometown Health,HMO,,227.70,,,,,,,65.78,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,inpatient,,,901.00000,628.90000,Hometown Health,HMO,,810.90,,,,,,,810.90,873.97,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,outpatient,,,901.00000,628.90000,Hometown Health,HMO,,810.90,,,,,,,234.26,873.97,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,inpatient,,,460.00000,321.08000,Hometown Health,HMO,,414.00,,,,,,,414.00,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,outpatient,,,460.00000,321.08000,Hometown Health,HMO,,414.00,,,,,,,119.60,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,inpatient,,,1029.00000,718.24000,Hometown Health,HMO,,926.10,,,,,,,926.10,998.13,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1029.00000,718.24000,Hometown Health,HMO,,926.10,,,,,,,267.54,998.13,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,inpatient,,,959.00000,669.38000,Hometown Health,HMO,,863.10,,,,,,,863.10,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,outpatient,,,959.00000,669.38000,Hometown Health,HMO,,863.10,,,,,,,249.34,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,inpatient,,,558.00000,389.48000,Hometown Health,HMO,,502.20,,,,,,,502.20,541.26,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,outpatient,,,558.00000,389.48000,Hometown Health,HMO,,502.20,,,,,,,145.08,541.26,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,inpatient,,,705.00000,492.09000,Hometown Health,HMO,,634.50,,,,,,,634.50,683.85,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,outpatient,,,705.00000,492.09000,Hometown Health,HMO,,634.50,,,,,,,183.30,683.85,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,inpatient,,,249.00000,173.80000,Hometown Health,HMO,,224.10,,,,,,,224.10,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,outpatient,,,249.00000,173.80000,Hometown Health,HMO,,224.10,,,,,,,64.74,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,inpatient,,,427.00000,298.05000,Hometown Health,HMO,,384.30,,,,,,,384.30,414.19,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,outpatient,,,427.00000,298.05000,Hometown Health,HMO,,384.30,,,,,,,111.02,414.19,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,inpatient,,,737.00000,514.43000,Hometown Health,HMO,,663.30,,,,,,,663.30,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Hometown Health,HMO,,663.30,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,inpatient,,,737.00000,514.43000,Hometown Health,HMO,59,663.30,,,,,,,663.30,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Hometown Health,HMO,59,663.30,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,inpatient,,,809.00000,564.68000,Hometown Health,HMO,,728.10,,,,,,,728.10,784.73,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,outpatient,,,809.00000,564.68000,Hometown Health,HMO,,728.10,,,,,,,210.34,784.73,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,inpatient,,,525.00000,366.45000,Hometown Health,HMO,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,outpatient,,,525.00000,366.45000,Hometown Health,HMO,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,inpatient,,,319.00000,222.66000,Hometown Health,HMO,,287.10,,,,,,,287.10,309.43,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,outpatient,,,319.00000,222.66000,Hometown Health,HMO,,287.10,,,,,,,82.94,309.43,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,inpatient,,,1437.00000,678.26000,Hometown Health,HMO,,1293.30,,,,,,,1293.30,1393.89,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1437.00000,678.26000,Hometown Health,HMO,,1293.30,,,,,,,373.62,1393.89,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,inpatient,,,2143.00000,1011.50000,Hometown Health,HMO,,1928.70,,,,,,,1928.70,2078.71,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2143.00000,1011.50000,Hometown Health,HMO,,1928.70,,,,,,,557.18,2078.71,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,inpatient,,,755.00000,356.36000,Hometown Health,HMO,,679.50,,,,,,,679.50,732.35,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,outpatient,,,755.00000,356.36000,Hometown Health,HMO,,679.50,,,,,,,196.30,732.35,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,inpatient,,,979.00000,462.09000,Hometown Health,HMO,,881.10,,,,,,,881.10,949.63,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,outpatient,,,979.00000,462.09000,Hometown Health,HMO,,881.10,,,,,,,254.54,949.63,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,inpatient,,,436.00000,205.79000,Hometown Health,HMO,,392.40,,,,,,,392.40,422.92,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,outpatient,,,436.00000,205.79000,Hometown Health,HMO,,392.40,,,,,,,113.36,422.92,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,inpatient,,,220.00000,103.84000,Hometown Health,HMO,,198.00,,,,,,,198.00,213.40,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,outpatient,,,220.00000,103.84000,Hometown Health,HMO,,198.00,,,,,,,57.20,213.40,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,inpatient,,,344.00000,162.37000,Hometown Health,HMO,,309.60,,,,,,,309.60,333.68,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,outpatient,,,344.00000,162.37000,Hometown Health,HMO,,309.60,,,,,,,89.44,333.68,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,inpatient,,,818.00000,393.46000,Hometown Health,HMO,,736.20,,,,,,,736.20,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,outpatient,,,818.00000,393.46000,Hometown Health,HMO,,736.20,,,,,,,212.68,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,inpatient,,,545.00000,262.14000,Hometown Health,HMO,52,490.50,,,,,,,490.50,528.65,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,outpatient,,,545.00000,262.14000,Hometown Health,HMO,52,490.50,,,,,,,141.70,528.65,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,inpatient,,,1347.00000,647.91000,Hometown Health,HMO,,1212.30,,,,,,,1212.30,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,outpatient,,,1347.00000,647.91000,Hometown Health,HMO,,1212.30,,,,,,,350.22,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,inpatient,,,898.00000,431.94000,Hometown Health,HMO,52,808.20,,,,,,,808.20,871.06,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,outpatient,,,898.00000,431.94000,Hometown Health,HMO,52,808.20,,,,,,,233.48,871.06,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,inpatient,,,469.00000,225.59000,Hometown Health,HMO,,422.10,,,,,,,422.10,454.93,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,outpatient,,,469.00000,225.59000,Hometown Health,HMO,,422.10,,,,,,,121.94,454.93,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,inpatient,,,1762.00000,847.52000,Hometown Health,HMO,,1585.80,,,,,,,1585.80,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,outpatient,,,1762.00000,847.52000,Hometown Health,HMO,,1585.80,,,,,,,458.12,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,inpatient,,,627.00000,301.59000,Hometown Health,HMO,,564.30,,,,,,,564.30,608.19,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,outpatient,,,627.00000,301.59000,Hometown Health,HMO,,564.30,,,,,,,163.02,608.19,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,inpatient,,,590.00000,283.79000,Hometown Health,HMO,,531.00,,,,,,,531.00,572.30,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,outpatient,,,590.00000,283.79000,Hometown Health,HMO,,531.00,,,,,,,153.40,572.30,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,inpatient,,,1550.00000,745.55000,Hometown Health,HMO,,1395.00,,,,,,,1395.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,outpatient,,,1550.00000,745.55000,Hometown Health,HMO,,1395.00,,,,,,,403.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,inpatient,,,990.00000,476.19000,Hometown Health,HMO,LT,891.00,,,,,,,891.00,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Hometown Health,HMO,LT,891.00,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,inpatient,,,990.00000,476.19000,Hometown Health,HMO,RT,891.00,,,,,,,891.00,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Hometown Health,HMO,RT,891.00,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,inpatient,,,1402.00000,674.36000,Hometown Health,HMO,,1261.80,,,,,,,1261.80,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,outpatient,,,1402.00000,674.36000,Hometown Health,HMO,,1261.80,,,,,,,364.52,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,inpatient,,,980.00000,471.38000,Hometown Health,HMO,LT,882.00,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Hometown Health,HMO,LT,882.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,inpatient,,,980.00000,471.38000,Hometown Health,HMO,RT,882.00,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Hometown Health,HMO,RT,882.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,inpatient,,,1661.00000,798.94000,Hometown Health,HMO,,1494.90,,,,,,,1494.90,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,outpatient,,,1661.00000,798.94000,Hometown Health,HMO,,1494.90,,,,,,,431.86,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,inpatient,,,980.00000,471.38000,Hometown Health,HMO,,882.00,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,outpatient,,,980.00000,471.38000,Hometown Health,HMO,,882.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,inpatient,,,1740.00000,836.94000,Hometown Health,HMO,,1566.00,,,,,,,1566.00,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1740.00000,836.94000,Hometown Health,HMO,,1566.00,,,,,,,452.40,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,inpatient,,,1168.00000,561.81000,Hometown Health,HMO,,1051.20,,,,,,,1051.20,1132.96,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1168.00000,561.81000,Hometown Health,HMO,,1051.20,,,,,,,303.68,1132.96,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,inpatient,,,433.00000,232.09000,Hometown Health,HMO,,389.70,,,,,,,389.70,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,outpatient,,,433.00000,232.09000,Hometown Health,HMO,,389.70,,,,,,,112.58,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,inpatient,,,388.00000,207.97000,Hometown Health,HMO,LT,349.20,,,,,,,349.20,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Hometown Health,HMO,LT,349.20,,,,,,,100.88,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,inpatient,,,388.00000,207.97000,Hometown Health,HMO,RT,349.20,,,,,,,349.20,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Hometown Health,HMO,RT,349.20,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,inpatient,,,388.00000,207.97000,Hometown Health,HMO,,349.20,,,,,,,349.20,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,outpatient,,,388.00000,207.97000,Hometown Health,HMO,,349.20,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,inpatient,,,604.00000,323.74000,Hometown Health,HMO,,543.60,,,,,,,543.60,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,outpatient,,,604.00000,323.74000,Hometown Health,HMO,,543.60,,,,,,,157.04,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,inpatient,,,667.00000,357.51000,Hometown Health,HMO,,600.30,,,,,,,600.30,646.99,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,outpatient,,,667.00000,357.51000,Hometown Health,HMO,,600.30,,,,,,,173.42,646.99,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,inpatient,,,176.00000,94.34000,Hometown Health,HMO,,158.40,,,,,,,158.40,170.72,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,outpatient,,,176.00000,94.34000,Hometown Health,HMO,,158.40,,,,,,,45.76,170.72,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,inpatient,,,92.00000,29.72000,Hometown Health,HMO,LT,82.80,,,,,,,82.80,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Hometown Health,HMO,LT,82.80,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,inpatient,,,92.00000,29.72000,Hometown Health,HMO,RT,82.80,,,,,,,82.80,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Hometown Health,HMO,RT,82.80,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,inpatient,,,366.00000,118.22000,Hometown Health,HMO,LT,329.40,,,,,,,329.40,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Hometown Health,HMO,LT,329.40,,,,,,,95.16,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,inpatient,,,366.00000,118.22000,Hometown Health,HMO,RT,329.40,,,,,,,329.40,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Hometown Health,HMO,RT,329.40,,,,,,,95.16,355.02,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,inpatient,,,1117.00000,360.79000,Hometown Health,HMO,LT,1005.30,,,,,,,1005.30,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Hometown Health,HMO,LT,1005.30,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,inpatient,,,1117.00000,360.79000,Hometown Health,HMO,RT,1005.30,,,,,,,1005.30,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Hometown Health,HMO,RT,1005.30,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,inpatient,,,559.00000,180.56000,Hometown Health,HMO,,503.10,,,,,,,503.10,542.23,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,outpatient,,,559.00000,180.56000,Hometown Health,HMO,,503.10,,,,,,,145.34,542.23,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,inpatient,,,252.00000,81.40000,Hometown Health,HMO,50,226.80,,,,,,,226.80,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,outpatient,,,252.00000,81.40000,Hometown Health,HMO,50,226.80,,,,,,,65.52,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,inpatient,,,168.00000,54.26000,Hometown Health,HMO,LT,151.20,,,,,,,151.20,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Hometown Health,HMO,LT,151.20,,,,,,,43.68,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,inpatient,,,168.00000,54.26000,Hometown Health,HMO,RT,151.20,,,,,,,151.20,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Hometown Health,HMO,RT,151.20,,,,,,,43.68,162.96,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,inpatient,,,1148.00000,370.80000,Hometown Health,HMO,LT,1033.20,,,,,,,1033.20,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Hometown Health,HMO,LT,1033.20,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,inpatient,,,1148.00000,370.80000,Hometown Health,HMO,RT,1033.20,,,,,,,1033.20,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Hometown Health,HMO,RT,1033.20,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,inpatient,,,379.00000,122.42000,Hometown Health,HMO,,341.10,,,,,,,341.10,367.63,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,outpatient,,,379.00000,122.42000,Hometown Health,HMO,,341.10,,,,,,,98.54,367.63,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,inpatient,,,1015.00000,327.84000,Hometown Health,HMO,,913.50,,,,,,,913.50,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,outpatient,,,1015.00000,327.84000,Hometown Health,HMO,,913.50,,,,,,,263.90,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,inpatient,,,591.00000,190.89000,Hometown Health,HMO,,531.90,,,,,,,531.90,573.27,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,outpatient,,,591.00000,190.89000,Hometown Health,HMO,,531.90,,,,,,,153.66,573.27,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,inpatient,,,271.00000,169.92000,Hometown Health,HMO,,243.90,,,,,,,243.90,262.87,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,outpatient,,,271.00000,169.92000,Hometown Health,HMO,,243.90,,,,,,,70.46,262.87,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,inpatient,,,211.00000,132.30000,Hometown Health,HMO,LT,189.90,,,,,,,189.90,204.67,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Hometown Health,HMO,LT,189.90,,,,,,,54.86,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,inpatient,,,211.00000,132.30000,Hometown Health,HMO,RT,189.90,,,,,,,189.90,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Hometown Health,HMO,RT,189.90,,,,,,,54.86,204.67,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,59.00000,36.99000,Hometown Health,HMO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,59.00000,36.99000,Hometown Health,HMO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,inpatient,,,336.00000,219.74000,Hometown Health,HMO,,302.40,,,,,,,302.40,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,outpatient,,,336.00000,219.74000,Hometown Health,HMO,,302.40,,,,,,,87.36,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,inpatient,,,224.00000,146.50000,Hometown Health,HMO,52,201.60,,,,,,,201.60,217.28,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,outpatient,,,224.00000,146.50000,Hometown Health,HMO,52,201.60,,,,,,,58.24,217.28,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,inpatient,,,63.00000,41.20000,Hometown Health,HMO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,outpatient,,,63.00000,41.20000,Hometown Health,HMO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Hometown Health,HMO,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Hometown Health,HMO,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Hometown Health,HMO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Hometown Health,HMO,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Hometown Health,HMO,,547.20,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Hometown Health,HMO,,547.20,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Hometown Health,HMO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Hometown Health,HMO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Hometown Health,HMO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Hometown Health,HMO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Hometown Health,HMO,,192.60,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Hometown Health,HMO,,192.60,,,,,,,55.64,207.58,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,inpatient,,,609.00000,196.71000,Hometown Health,HMO,,548.10,,,,,,,548.10,590.73,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Hometown Health,HMO,,548.10,,,,,,,158.34,590.73,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,inpatient,,,863.00000,278.75000,Hometown Health,HMO,,776.70,,,,,,,776.70,837.11,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Hometown Health,HMO,,776.70,,,,,,,224.38,837.11,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,inpatient,,,900.00000,605.70000,Hometown Health,HMO,,810.00,,,,,,,810.00,873.00,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,outpatient,,,900.00000,605.70000,Hometown Health,HMO,,810.00,,,,,,,234.00,873.00,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,inpatient,,,1940.00000,1102.21000,Hometown Health,HMO,,1746.00,,,,,,,1746.00,1881.80,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,outpatient,,,1940.00000,1102.21000,Hometown Health,HMO,,1746.00,,,,,,,504.40,1881.80,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,inpatient,,,422.00000,239.76000,Hometown Health,HMO,,379.80,,,,,,,379.80,409.34,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,outpatient,,,422.00000,239.76000,Hometown Health,HMO,,379.80,,,,,,,109.72,409.34,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,inpatient,,,1430.00000,812.45000,Hometown Health,HMO,,1287.00,,,,,,,1287.00,1387.10,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,outpatient,,,1430.00000,812.45000,Hometown Health,HMO,,1287.00,,,,,,,371.80,1387.10,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,inpatient,,,745.00000,423.27000,Hometown Health,HMO,,670.50,,,,,,,670.50,722.65,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,outpatient,,,745.00000,423.27000,Hometown Health,HMO,,670.50,,,,,,,193.70,722.65,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,inpatient,,,2655.00000,2487.74000,Hometown Health,HMO,,2389.50,,,,,,,2389.50,2575.35,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,outpatient,,,2655.00000,2487.74000,Hometown Health,HMO,,2389.50,,,,,,,690.30,2575.35,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,inpatient,,,3990.00000,3738.63000,Hometown Health,HMO,,3591.00,,,,,,,3591.00,3870.30,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,outpatient,,,3990.00000,3738.63000,Hometown Health,HMO,,3591.00,,,,,,,1037.40,3870.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,inpatient,,,290.00000,271.73000,Hometown Health,HMO,,261.00,,,,,,,261.00,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,outpatient,,,290.00000,271.73000,Hometown Health,HMO,,261.00,,,,,,,75.40,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,inpatient,,,735.00000,688.70000,Hometown Health,HMO,,661.50,,,,,,,661.50,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,outpatient,,,735.00000,688.70000,Hometown Health,HMO,,661.50,,,,,,,191.10,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,inpatient,,,1475.00000,1382.08000,Hometown Health,HMO,,1327.50,,,,,,,1327.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Hometown Health,HMO,,1327.50,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,inpatient,,,2275.00000,2131.68000,Hometown Health,HMO,,2047.50,,,,,,,2047.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,outpatient,,,2275.00000,2131.68000,Hometown Health,HMO,,2047.50,,,,,,,591.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,inpatient,,,3205.00000,3003.08000,Hometown Health,HMO,,2884.50,,,,,,,2884.50,3108.85,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,outpatient,,,3205.00000,3003.08000,Hometown Health,HMO,,2884.50,,,,,,,833.30,3108.85,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,inpatient,,,770.00000,721.49000,Hometown Health,HMO,,693.00,,,,,,,693.00,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,outpatient,,,770.00000,721.49000,Hometown Health,HMO,,693.00,,,,,,,200.20,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,inpatient,,,1475.00000,1382.08000,Hometown Health,HMO,,1327.50,,,,,,,1327.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Hometown Health,HMO,,1327.50,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,inpatient,,,2210.00000,2070.77000,Hometown Health,HMO,,1989.00,,,,,,,1989.00,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,outpatient,,,2210.00000,2070.77000,Hometown Health,HMO,,1989.00,,,,,,,574.60,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,inpatient,,,2660.00000,2492.42000,Hometown Health,HMO,,2394.00,,,,,,,2394.00,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,outpatient,,,2660.00000,2492.42000,Hometown Health,HMO,,2394.00,,,,,,,691.60,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,inpatient,,,3560.00000,3335.72000,Hometown Health,HMO,,3204.00,,,,,,,3204.00,3453.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,outpatient,,,3560.00000,3335.72000,Hometown Health,HMO,,3204.00,,,,,,,925.60,3453.20,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,inpatient,,,5730.00000,3255.50000,Hometown Health,HMO,,5157.00,,,,,,,5157.00,5558.10,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,outpatient,,,5730.00000,3255.50000,Hometown Health,HMO,,5157.00,,,,,,,1489.80,5558.10,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,inpatient,,,3875.00000,2201.58000,Hometown Health,HMO,,3487.50,,,,,,,3487.50,3758.75,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,outpatient,,,3875.00000,2201.58000,Hometown Health,HMO,,3487.50,,,,,,,1007.50,3758.75,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,inpatient,,,519.00000,564.15000,Hometown Health,HMO,,467.10,,,,,,,467.10,503.43,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,outpatient,,,519.00000,564.15000,Hometown Health,HMO,,467.10,,,,,,,134.94,503.43,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,inpatient,,,536.00000,582.63000,Hometown Health,HMO,,482.40,,,,,,,482.40,519.92,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,outpatient,,,536.00000,582.63000,Hometown Health,HMO,,482.40,,,,,,,139.36,519.92,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Hometown Health,HMO,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Hometown Health,HMO,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Hometown Health,HMO,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Hometown Health,HMO,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Hometown Health,HMO,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Hometown Health,HMO,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Hometown Health,HMO,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Hometown Health,HMO,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Hometown Health,HMO,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Hometown Health,HMO,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Hometown Health,HMO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Hometown Health,HMO,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Hometown Health,HMO,,547.20,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Hometown Health,HMO,,547.20,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Hometown Health,HMO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Hometown Health,HMO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Hometown Health,HMO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Hometown Health,HMO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Hometown Health,HMO,,192.60,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Hometown Health,HMO,,192.60,,,,,,,55.64,207.58,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,inpatient,,,175.00000,63.18000,Hometown Health,HMO,,157.50,,,,,,,157.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,outpatient,,,175.00000,63.18000,Hometown Health,HMO,,157.50,,,,,,,45.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,inpatient,,,304.00000,109.74000,Hometown Health,HMO,,273.60,,,,,,,273.60,294.88,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,outpatient,,,304.00000,109.74000,Hometown Health,HMO,,273.60,,,,,,,79.04,294.88,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Hometown Health,HMO,,255.60,,,,,,,255.60,275.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Hometown Health,HMO,,255.60,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Hometown Health,HMO,,412.20,,,,,,,412.20,444.26,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Hometown Health,HMO,,412.20,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,inpatient,,,438.00000,158.12000,Hometown Health,HMO,,394.20,,,,,,,394.20,424.86,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,outpatient,,,438.00000,158.12000,Hometown Health,HMO,,394.20,,,,,,,113.88,424.86,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Hometown Health,HMO,,502.20,,,,,,,502.20,541.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Hometown Health,HMO,,502.20,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Hometown Health,HMO,,433.80,,,,,,,433.80,467.54,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Hometown Health,HMO,,433.80,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Hometown Health,HMO,,213.30,,,,,,,213.30,229.89,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Hometown Health,HMO,,213.30,,,,,,,61.62,229.89,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Hometown Health,HMO,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Hometown Health,HMO,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Hometown Health,HMO,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Hometown Health,HMO,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Hometown Health,HMO,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Hometown Health,HMO,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Hometown Health,HMO,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Hometown Health,HMO,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Hometown Health,HMO,,757.80,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Hometown Health,HMO,,757.80,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Hometown Health,HMO,,947.70,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Hometown Health,HMO,,947.70,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Hometown Health,HMO,,1136.70,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Hometown Health,HMO,,1136.70,,,,,,,328.38,1225.11,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,inpatient,,,182.00000,127.04000,Hometown Health,HMO,,163.80,,,,,,,163.80,176.54,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Hometown Health,HMO,,163.80,,,,,,,47.32,176.54,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,inpatient,,,210.00000,119.31000,Hometown Health,HMO,,189.00,,,,,,,189.00,203.70,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Hometown Health,HMO,,189.00,,,,,,,54.60,203.70,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,inpatient,,,140.00000,79.54000,Hometown Health,HMO,,126.00,,,,,,,126.00,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,outpatient,,,140.00000,79.54000,Hometown Health,HMO,,126.00,,,,,,,36.40,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,inpatient,,,190.00000,107.95000,Hometown Health,HMO,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,outpatient,,,190.00000,107.95000,Hometown Health,HMO,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,inpatient,,,240.00000,136.36000,Hometown Health,HMO,,216.00,,,,,,,216.00,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,outpatient,,,240.00000,136.36000,Hometown Health,HMO,,216.00,,,,,,,62.40,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,inpatient,,,290.00000,164.76000,Hometown Health,HMO,,261.00,,,,,,,261.00,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,outpatient,,,290.00000,164.76000,Hometown Health,HMO,,261.00,,,,,,,75.40,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,inpatient,,,340.00000,193.17000,Hometown Health,HMO,,306.00,,,,,,,306.00,329.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,outpatient,,,340.00000,193.17000,Hometown Health,HMO,,306.00,,,,,,,88.40,329.80,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,inpatient,,,150.00000,85.22000,Hometown Health,HMO,,135.00,,,,,,,135.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,outpatient,,,150.00000,85.22000,Hometown Health,HMO,,135.00,,,,,,,39.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,inpatient,,,200.00000,113.63000,Hometown Health,HMO,,180.00,,,,,,,180.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,outpatient,,,200.00000,113.63000,Hometown Health,HMO,,180.00,,,,,,,52.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,inpatient,,,270.00000,153.40000,Hometown Health,HMO,,243.00,,,,,,,243.00,261.90,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,outpatient,,,270.00000,153.40000,Hometown Health,HMO,,243.00,,,,,,,70.20,261.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,inpatient,,,370.00000,210.22000,Hometown Health,HMO,,333.00,,,,,,,333.00,358.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,outpatient,,,370.00000,210.22000,Hometown Health,HMO,,333.00,,,,,,,96.20,358.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,inpatient,,,470.00000,267.03000,Hometown Health,HMO,,423.00,,,,,,,423.00,455.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,outpatient,,,470.00000,267.03000,Hometown Health,HMO,,423.00,,,,,,,122.20,455.90,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,inpatient,,,248.00000,96.22000,Hometown Health,HMO,,223.20,,,,,,,223.20,240.56,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,outpatient,,,248.00000,96.22000,Hometown Health,HMO,,223.20,,,,,,,64.48,240.56,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,inpatient,,,245.00000,95.06000,Hometown Health,HMO,,220.50,,,,,,,220.50,237.65,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,outpatient,,,245.00000,95.06000,Hometown Health,HMO,,220.50,,,,,,,63.70,237.65,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,inpatient,,,497.00000,192.84000,Hometown Health,HMO,,447.30,,,,,,,447.30,482.09,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,outpatient,,,497.00000,192.84000,Hometown Health,HMO,,447.30,,,,,,,129.22,482.09,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,inpatient,,,357.00000,138.52000,Hometown Health,HMO,,321.30,,,,,,,321.30,346.29,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,outpatient,,,357.00000,138.52000,Hometown Health,HMO,,321.30,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,inpatient,,,334.00000,129.59000,Hometown Health,HMO,,300.60,,,,,,,300.60,323.98,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,outpatient,,,334.00000,129.59000,Hometown Health,HMO,,300.60,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,inpatient,,,194.00000,75.27000,Hometown Health,HMO,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,outpatient,,,194.00000,75.27000,Hometown Health,HMO,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,inpatient,,,1035.00000,401.58000,Hometown Health,HMO,,931.50,,,,,,,931.50,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,outpatient,,,1035.00000,401.58000,Hometown Health,HMO,,931.50,,,,,,,269.10,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,inpatient,,,1137.00000,441.16000,Hometown Health,HMO,,1023.30,,,,,,,1023.30,1102.89,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,outpatient,,,1137.00000,441.16000,Hometown Health,HMO,,1023.30,,,,,,,295.62,1102.89,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,inpatient,,,963.00000,373.64000,Hometown Health,HMO,,866.70,,,,,,,866.70,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,outpatient,,,963.00000,373.64000,Hometown Health,HMO,,866.70,,,,,,,250.38,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,inpatient,,,990.00000,384.12000,Hometown Health,HMO,,891.00,,,,,,,891.00,960.30,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,outpatient,,,990.00000,384.12000,Hometown Health,HMO,,891.00,,,,,,,257.40,960.30,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,inpatient,,,112.00000,43.46000,Hometown Health,HMO,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,outpatient,,,112.00000,43.46000,Hometown Health,HMO,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,inpatient,,,84.00000,32.59000,Hometown Health,HMO,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,outpatient,,,84.00000,32.59000,Hometown Health,HMO,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,inpatient,,,176.00000,68.29000,Hometown Health,HMO,,158.40,,,,,,,158.40,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,outpatient,,,176.00000,68.29000,Hometown Health,HMO,,158.40,,,,,,,45.76,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,inpatient,,,283.00000,109.80000,Hometown Health,HMO,,254.70,,,,,,,254.70,274.51,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,outpatient,,,283.00000,109.80000,Hometown Health,HMO,,254.70,,,,,,,73.58,274.51,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Hometown Health,HMO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Hometown Health,HMO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Hometown Health,HMO,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Hometown Health,HMO,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,inpatient,,,35.00000,19.89000,Hometown Health,HMO,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,35.00000,19.89000,Hometown Health,HMO,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,inpatient,,,191.00000,89.39000,Hometown Health,HMO,,171.90,,,,,,,171.90,185.27,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,outpatient,,,191.00000,89.39000,Hometown Health,HMO,,171.90,,,,,,,49.66,185.27,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Hometown Health,HMO,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Hometown Health,HMO,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Hometown Health,HMO,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Hometown Health,HMO,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Hometown Health,HMO,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Hometown Health,HMO,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Hometown Health,HMO,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Hometown Health,HMO,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,inpatient,,,281.00000,131.51000,Hometown Health,HMO,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,outpatient,,,281.00000,131.51000,Hometown Health,HMO,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,inpatient,,,192.00000,89.86000,Hometown Health,HMO,,172.80,,,,,,,172.80,186.24,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,outpatient,,,192.00000,89.86000,Hometown Health,HMO,,172.80,,,,,,,49.92,186.24,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,inpatient,,,365.00000,170.82000,Hometown Health,HMO,,328.50,,,,,,,328.50,354.05,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,outpatient,,,365.00000,170.82000,Hometown Health,HMO,,328.50,,,,,,,94.90,354.05,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,inpatient,,,8391.00000,5856.92000,Hometown Health,HMO,,7551.90,,,,,,,7551.90,8139.27,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,outpatient,,,8391.00000,5856.92000,Hometown Health,HMO,,7551.90,,,,,,,2181.66,8139.27,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,inpatient,,,6917.00000,4828.07000,Hometown Health,HMO,52,6225.30,,,,,,,6225.30,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Hometown Health,HMO,52,6225.30,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,inpatient,,,6000.00000,4188.00000,Hometown Health,HMO,,5400.00,,,,,,,5400.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Hometown Health,HMO,,5400.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,inpatient,,,6917.00000,4828.07000,Hometown Health,HMO,,6225.30,,,,,,,6225.30,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Hometown Health,HMO,,6225.30,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,inpatient,,,6000.00000,4188.00000,Hometown Health,HMO,52,5400.00,,,,,,,5400.00,5820.00,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Hometown Health,HMO,52,5400.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,inpatient,,,8855.00000,9625.38000,Hometown Health,HMO,,7969.50,,,,,,,7969.50,8589.35,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,outpatient,,,8855.00000,9625.38000,Hometown Health,HMO,,7969.50,,,,,,,2302.30,8589.35,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,inpatient,,,844.00000,917.43000,Hometown Health,HMO,,759.60,,,,,,,759.60,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Hometown Health,HMO,,759.60,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,inpatient,,,844.00000,917.43000,Hometown Health,HMO,52,759.60,,,,,,,759.60,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Hometown Health,HMO,52,759.60,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,inpatient,,,785.00000,853.30000,Hometown Health,HMO,,706.50,,,,,,,706.50,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Hometown Health,HMO,,706.50,,,,,,,204.10,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,inpatient,,,785.00000,853.30000,Hometown Health,HMO,52,706.50,,,,,,,706.50,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Hometown Health,HMO,52,706.50,,,,,,,204.10,761.45,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4709.00000,5118.68000,Hometown Health,HMO,,4238.10,,,,,,,4238.10,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Hometown Health,HMO,,4238.10,,,,,,,1224.34,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4709.00000,5118.68000,Hometown Health,HMO,52,4238.10,,,,,,,4238.10,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Hometown Health,HMO,52,4238.10,,,,,,,1224.34,4567.73,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,inpatient,,,345.00000,128.34000,Hometown Health,HMO,,310.50,,,,,,,310.50,334.65,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,outpatient,,,345.00000,128.34000,Hometown Health,HMO,,310.50,,,,,,,89.70,334.65,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,inpatient,,,120.00000,99.60000,Hometown Health,HMO,,108.00,,,,,,,108.00,116.40,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,outpatient,,,120.00000,99.60000,Hometown Health,HMO,,108.00,,,,,,,31.20,116.40,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,inpatient,,,106.00000,87.98000,Hometown Health,HMO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,outpatient,,,106.00000,87.98000,Hometown Health,HMO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,inpatient,,,32.00000,26.56000,Hometown Health,HMO,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,outpatient,,,32.00000,26.56000,Hometown Health,HMO,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,inpatient,,,60.00000,49.80000,Hometown Health,HMO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,outpatient,,,60.00000,49.80000,Hometown Health,HMO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,inpatient,,,57.00000,47.31000,Hometown Health,HMO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,outpatient,,,57.00000,47.31000,Hometown Health,HMO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,inpatient,1.0,ME,7.40000,0.65000,Hometown Health,HMO,,6.66,,,,,,,6.66,7.18,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,outpatient,1.0,ME,7.40000,0.65000,Hometown Health,HMO,,6.66,,,,,,,1.92,7.18,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,inpatient,1.0,EA,6.60000,1.43000,Hometown Health,HMO,UD,5.94,,,,,,,5.94,6.40,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,outpatient,1.0,EA,6.60000,1.43000,Hometown Health,HMO,UD,5.94,,,,,,,1.72,6.40,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,inpatient,1.0,EA,2.95000,0.64000,Hometown Health,HMO,UD,2.65,,,,,,,2.65,2.86,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,outpatient,1.0,EA,2.95000,0.64000,Hometown Health,HMO,UD,2.65,,,,,,,0.76700,2.86,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,inpatient,1.0,EA,56.08000,12.11000,Hometown Health,HMO,UD,50.47,,,,,,,50.47,54.40,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,56.08000,12.11000,Hometown Health,HMO,UD,50.47,,,,,,,14.58,54.40,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,inpatient,1.0,UN,82.10000,28.90000,Hometown Health,HMO,,73.89,,,,,,,73.89,79.64,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,outpatient,1.0,UN,82.10000,28.90000,Hometown Health,HMO,,73.89,,,,,,,15.48,79.64,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.04000,,Hometown Health,HMO,UD,0.03600,,,,,,,0.03600,0.03880,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.04000,,Hometown Health,HMO,UD,0.03600,,,,,,,0.01040,0.03880,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.05000,,Hometown Health,HMO,UD,0.04500,,,,,,,0.04500,0.04850,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.05000,,Hometown Health,HMO,UD,0.04500,,,,,,,0.01300,0.04850,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,inpatient,1.0,ME,6.20000,0.55000,Hometown Health,HMO,,5.58,,,,,,,5.58,6.01,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,outpatient,1.0,ME,6.20000,0.55000,Hometown Health,HMO,,5.58,,,,,,,1.61,6.01,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.12000,0.01000,Hometown Health,HMO,UD,0.10800,,,,,,,0.10800,0.11640,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.12000,0.01000,Hometown Health,HMO,UD,0.10800,,,,,,,0.03120,0.11640,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,inpatient,2.0,ML,5.80000,1.25000,Hometown Health,HMO,,5.22,,,,,,,5.22,5.63,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,outpatient,2.0,ML,5.80000,1.25000,Hometown Health,HMO,,5.22,,,,,,,1.51,5.63,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,inpatient,1.0,ME,3.10000,0.27000,Hometown Health,HMO,,2.79,,,,,,,2.79,3.01,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,outpatient,1.0,ME,3.10000,0.27000,Hometown Health,HMO,,2.79,,,,,,,0.80600,3.01,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,inpatient,1.0,EA,44.40000,3.91000,Hometown Health,HMO,,39.96,,,,,,,39.96,43.07,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,outpatient,1.0,EA,44.40000,3.91000,Hometown Health,HMO,,39.96,,,,,,,11.54,43.07,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,inpatient,1.0,EA,8.26000,0.73000,Hometown Health,HMO,UD,7.43,,,,,,,7.43,8.01,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,8.26000,0.73000,Hometown Health,HMO,UD,7.43,,,,,,,2.15,8.01,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,2.19000,0.19000,Hometown Health,HMO,UD,1.97,,,,,,,1.97,2.12,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,2.19000,0.19000,Hometown Health,HMO,UD,1.97,,,,,,,0.56940,2.12,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,inpatient,1.0,EA,28.60000,2.52000,Hometown Health,HMO,,25.74,,,,,,,25.74,27.74,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,outpatient,1.0,EA,28.60000,2.52000,Hometown Health,HMO,,25.74,,,,,,,7.44,27.74,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,inpatient,1.0,EA,2.58000,0.91000,Hometown Health,HMO,UD,2.32,,,,,,,2.32,2.50,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,outpatient,1.0,EA,2.58000,0.91000,Hometown Health,HMO,UD,2.32,,,,,,,0.67080,2.50,percent of total billed charges,
R&B OBSTETRICS PVT,3012,CDM,112,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,Lease Networks,,2641.95,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,23010,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,Lease Networks,,2641.95,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ICU,33019,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Hometown Health,Lease Networks,,8322.95,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,13011,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Hometown Health,Lease Networks,,5548.95,,,,,,,2512.00,5665.77,percent of total billed charges,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,244.00000,77.10000,Hometown Health,Lease Networks,,231.80,,,,,,,219.60,236.68,percent of total billed charges,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,244.00000,77.10000,Hometown Health,Lease Networks,,231.80,,,,,,,63.44,236.68,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,24075,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,Lease Networks,,2641.95,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B OBSTETRICS SEMI-PVT,44073,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,Lease Networks,,2641.95,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B NURSERY LEVEL 1,55160,CDM,171,RC,,,,,facility,inpatient,,,3477.00000,1975.46000,Hometown Health,Lease Networks,,3303.15,,,,,,,2512.00,3372.69,percent of total billed charges,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,inpatient,,,16.00000,7.71000,Hometown Health,Lease Networks,,15.20,,,,,,,14.40,15.52,percent of total billed charges,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,outpatient,,,16.00000,7.71000,Hometown Health,Lease Networks,,15.20,,,,,,,4.16,15.52,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,inpatient,,,210.00000,119.31000,Hometown Health,Lease Networks,,199.50,,,,,,,189.00,203.70,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Hometown Health,Lease Networks,,199.50,,,,,,,54.60,203.70,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,inpatient,,,380.00000,215.90000,Hometown Health,Lease Networks,,361.00,,,,,,,342.00,368.60,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,outpatient,,,380.00000,215.90000,Hometown Health,Lease Networks,,361.00,,,,,,,98.80,368.60,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Hometown Health,Lease Networks,,110.20,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Hometown Health,Lease Networks,,110.20,,,,,,,30.16,112.52,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22012,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,Lease Networks,,2641.95,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ADMIN DAY SKILLED,82016,CDM,160,RC,,,,,facility,inpatient,,,1923.00000,1092.55000,Hometown Health,Lease Networks,,1826.85,,,,,,,1730.70,3111.10,percent of total billed charges,
R&B SWING BED SKILLED,62018,CDM,160,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,Lease Networks,,2641.95,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ADMIN DAY INTERMEDIATE,72017,CDM,169,RC,,,,,facility,inpatient,,,1176.00000,668.14000,Hometown Health,Lease Networks,,1117.20,,,,,,,1058.40,3111.10,percent of total billed charges,
R&B ICU,32011,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Hometown Health,Lease Networks,,8322.95,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,12013,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Hometown Health,Lease Networks,,5548.95,,,,,,,2512.00,5665.77,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Hometown Health,Lease Networks,,110.20,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Hometown Health,Lease Networks,,110.20,,,,,,,30.16,112.52,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Hometown Health,Lease Networks,,478.80,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Hometown Health,Lease Networks,,478.80,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Hometown Health,Lease Networks,,93.10,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Hometown Health,Lease Networks,,93.10,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Hometown Health,Lease Networks,,577.60,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Hometown Health,Lease Networks,,577.60,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Hometown Health,Lease Networks,,108.30,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Hometown Health,Lease Networks,,108.30,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Hometown Health,Lease Networks,,177.65,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Hometown Health,Lease Networks,,177.65,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Hometown Health,Lease Networks,,203.30,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Hometown Health,Lease Networks,,203.30,,,,,,,55.64,207.58,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,84.00000,63.59000,Hometown Health,Lease Networks,,79.80,,,,,,,75.60,81.48,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Hometown Health,Lease Networks,,79.80,,,,,,,21.84,81.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Hometown Health,Lease Networks,,269.80,,,,,,,255.60,275.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Hometown Health,Lease Networks,,269.80,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Hometown Health,Lease Networks,,435.10,,,,,,,412.20,444.26,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Hometown Health,Lease Networks,,435.10,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Hometown Health,Lease Networks,,530.10,,,,,,,502.20,541.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Hometown Health,Lease Networks,,530.10,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Hometown Health,Lease Networks,,457.90,,,,,,,433.80,467.54,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Hometown Health,Lease Networks,,457.90,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Hometown Health,Lease Networks,,225.15,,,,,,,213.30,229.89,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Hometown Health,Lease Networks,,225.15,,,,,,,61.62,229.89,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,inpatient,,,2041.00000,659.24000,Hometown Health,Lease Networks,,1938.95,,,,,,,1836.90,1979.77,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,outpatient,,,2041.00000,659.24000,Hometown Health,Lease Networks,,1938.95,,,,,,,530.66,1979.77,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,inpatient,,,259.00000,83.66000,Hometown Health,Lease Networks,,246.05,,,,,,,233.10,251.23,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,outpatient,,,259.00000,83.66000,Hometown Health,Lease Networks,,246.05,,,,,,,67.34,251.23,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,inpatient,,,672.00000,217.06000,Hometown Health,Lease Networks,,638.40,,,,,,,604.80,651.84,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,outpatient,,,672.00000,217.06000,Hometown Health,Lease Networks,,638.40,,,,,,,174.72,651.84,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,inpatient,,,530.00000,171.19000,Hometown Health,Lease Networks,,503.50,,,,,,,477.00,514.10,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,outpatient,,,530.00000,171.19000,Hometown Health,Lease Networks,,503.50,,,,,,,137.80,514.10,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,inpatient,,,580.00000,187.34000,Hometown Health,Lease Networks,,551.00,,,,,,,522.00,562.60,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,outpatient,,,580.00000,187.34000,Hometown Health,Lease Networks,,551.00,,,,,,,150.80,562.60,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,inpatient,,,435.00000,140.50000,Hometown Health,Lease Networks,,413.25,,,,,,,391.50,421.95,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,outpatient,,,435.00000,140.50000,Hometown Health,Lease Networks,,413.25,,,,,,,113.10,421.95,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,inpatient,,,863.00000,278.75000,Hometown Health,Lease Networks,,819.85,,,,,,,776.70,837.11,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Hometown Health,Lease Networks,,819.85,,,,,,,224.38,837.11,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,inpatient,,,334.00000,107.88000,Hometown Health,Lease Networks,,317.30,,,,,,,300.60,323.98,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,outpatient,,,334.00000,107.88000,Hometown Health,Lease Networks,,317.30,,,,,,,86.84,323.98,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,inpatient,,,1188.00000,383.72000,Hometown Health,Lease Networks,50,1128.60,,,,,,,1069.20,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,outpatient,,,1188.00000,383.72000,Hometown Health,Lease Networks,50,1128.60,,,,,,,308.88,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,inpatient,,,792.00000,255.82000,Hometown Health,Lease Networks,LT,752.40,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Hometown Health,Lease Networks,LT,752.40,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,inpatient,,,792.00000,255.82000,Hometown Health,Lease Networks,RT,752.40,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Hometown Health,Lease Networks,RT,752.40,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,inpatient,,,572.00000,184.76000,Hometown Health,Lease Networks,50,543.40,,,,,,,514.80,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,outpatient,,,572.00000,184.76000,Hometown Health,Lease Networks,50,543.40,,,,,,,148.72,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,inpatient,,,381.00000,123.06000,Hometown Health,Lease Networks,LT,361.95,,,,,,,342.90,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Hometown Health,Lease Networks,LT,361.95,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,inpatient,,,381.00000,123.06000,Hometown Health,Lease Networks,RT,361.95,,,,,,,342.90,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Hometown Health,Lease Networks,RT,361.95,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,inpatient,,,455.00000,146.96000,Hometown Health,Lease Networks,,432.25,,,,,,,409.50,441.35,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,outpatient,,,455.00000,146.96000,Hometown Health,Lease Networks,,432.25,,,,,,,118.30,441.35,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,inpatient,,,403.00000,130.17000,Hometown Health,Lease Networks,,382.85,,,,,,,362.70,390.91,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,outpatient,,,403.00000,130.17000,Hometown Health,Lease Networks,,382.85,,,,,,,104.78,390.91,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,inpatient,,,370.00000,119.51000,Hometown Health,Lease Networks,,351.50,,,,,,,333.00,358.90,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,outpatient,,,370.00000,119.51000,Hometown Health,Lease Networks,,351.50,,,,,,,96.20,358.90,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,inpatient,,,357.00000,115.31000,Hometown Health,Lease Networks,,339.15,,,,,,,321.30,346.29,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,outpatient,,,357.00000,115.31000,Hometown Health,Lease Networks,,339.15,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,inpatient,,,334.00000,107.88000,Hometown Health,Lease Networks,,317.30,,,,,,,300.60,323.98,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,outpatient,,,334.00000,107.88000,Hometown Health,Lease Networks,,317.30,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,inpatient,,,194.00000,62.66000,Hometown Health,Lease Networks,,184.30,,,,,,,174.60,188.18,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,outpatient,,,194.00000,62.66000,Hometown Health,Lease Networks,,184.30,,,,,,,50.44,188.18,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,inpatient,,,457.00000,147.61000,Hometown Health,Lease Networks,,434.15,,,,,,,411.30,443.29,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,outpatient,,,457.00000,147.61000,Hometown Health,Lease Networks,,434.15,,,,,,,118.82,443.29,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,inpatient,,,492.00000,158.92000,Hometown Health,Lease Networks,,467.40,,,,,,,442.80,477.24,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,outpatient,,,492.00000,158.92000,Hometown Health,Lease Networks,,467.40,,,,,,,127.92,477.24,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,inpatient,,,780.00000,251.94000,Hometown Health,Lease Networks,,741.00,,,,,,,702.00,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,outpatient,,,780.00000,251.94000,Hometown Health,Lease Networks,,741.00,,,,,,,202.80,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,inpatient,,,1165.00000,376.30000,Hometown Health,Lease Networks,,1106.75,,,,,,,1048.50,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,outpatient,,,1165.00000,376.30000,Hometown Health,Lease Networks,,1106.75,,,,,,,302.90,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,inpatient,,,2350.00000,759.05000,Hometown Health,Lease Networks,,2232.50,,,,,,,2115.00,2279.50,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,outpatient,,,2350.00000,759.05000,Hometown Health,Lease Networks,,2232.50,,,,,,,611.00,2279.50,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,inpatient,,,896.00000,289.41000,Hometown Health,Lease Networks,,851.20,,,,,,,806.40,869.12,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,outpatient,,,896.00000,289.41000,Hometown Health,Lease Networks,,851.20,,,,,,,232.96,869.12,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,inpatient,,,490.00000,158.27000,Hometown Health,Lease Networks,,465.50,,,,,,,441.00,475.30,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,outpatient,,,490.00000,158.27000,Hometown Health,Lease Networks,,465.50,,,,,,,127.40,475.30,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,inpatient,,,520.00000,167.96000,Hometown Health,Lease Networks,,494.00,,,,,,,468.00,504.40,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,outpatient,,,520.00000,167.96000,Hometown Health,Lease Networks,,494.00,,,,,,,135.20,504.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,inpatient,,,720.00000,232.56000,Hometown Health,Lease Networks,,684.00,,,,,,,648.00,698.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,outpatient,,,720.00000,232.56000,Hometown Health,Lease Networks,,684.00,,,,,,,187.20,698.40,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,inpatient,,,215.00000,69.45000,Hometown Health,Lease Networks,,204.25,,,,,,,193.50,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,outpatient,,,215.00000,69.45000,Hometown Health,Lease Networks,,204.25,,,,,,,55.90,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,inpatient,,,240.00000,77.52000,Hometown Health,Lease Networks,,228.00,,,,,,,216.00,232.80,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,outpatient,,,240.00000,77.52000,Hometown Health,Lease Networks,,228.00,,,,,,,62.40,232.80,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,inpatient,,,1241.00000,400.84000,Hometown Health,Lease Networks,,1178.95,,,,,,,1116.90,1203.77,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,outpatient,,,1241.00000,400.84000,Hometown Health,Lease Networks,,1178.95,,,,,,,322.66,1203.77,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Hometown Health,Lease Networks,,799.90,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Hometown Health,Lease Networks,,799.90,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Hometown Health,Lease Networks,,1000.35,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Hometown Health,Lease Networks,,1000.35,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Hometown Health,Lease Networks,,1199.85,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Hometown Health,Lease Networks,,1199.85,,,,,,,328.38,1225.11,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,inpatient,,,668.00000,559.78000,Hometown Health,Lease Networks,,634.60,,,,,,,601.20,647.96,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,outpatient,,,668.00000,559.78000,Hometown Health,Lease Networks,,634.60,,,,,,,173.68,647.96,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Hometown Health,Lease Networks,,76.95,,,,,,,72.90,78.57,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Hometown Health,Lease Networks,,76.95,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Hometown Health,Lease Networks,,38.95,,,,,,,36.90,39.77,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Hometown Health,Lease Networks,,38.95,,,,,,,10.66,39.77,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Hometown Health,Lease Networks,,430.35,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Hometown Health,Lease Networks,,430.35,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Hometown Health,Lease Networks,,136.80,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Hometown Health,Lease Networks,,136.80,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Hometown Health,Lease Networks,,101.65,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Hometown Health,Lease Networks,,101.65,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Hometown Health,Lease Networks,,136.80,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Hometown Health,Lease Networks,,136.80,,,,,,,37.44,139.68,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Hometown Health,Lease Networks,,3.23,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Hometown Health,Lease Networks,,3.23,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Hometown Health,Lease Networks,,3.23,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Hometown Health,Lease Networks,,3.23,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Hometown Health,Lease Networks,,3.23,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Hometown Health,Lease Networks,,3.23,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,4.90000,2.78000,Hometown Health,Lease Networks,,4.66,,,,,,,4.41,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Hometown Health,Lease Networks,,4.66,,,,,,,1.27,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,7.90000,4.49000,Hometown Health,Lease Networks,,7.50,,,,,,,7.11,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,7.90000,4.49000,Hometown Health,Lease Networks,,7.50,,,,,,,2.05,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,4.90000,2.78000,Hometown Health,Lease Networks,,4.66,,,,,,,4.41,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Hometown Health,Lease Networks,,4.66,,,,,,,1.27,4.75,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Hometown Health,Lease Networks,,76.95,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Hometown Health,Lease Networks,,76.95,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Hometown Health,Lease Networks,,76.95,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Hometown Health,Lease Networks,,76.95,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Hometown Health,Lease Networks,,76.95,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Hometown Health,Lease Networks,,76.95,,,,,,,21.06,78.57,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,inpatient,,,3141500.00000,1784843.22000,Hometown Health,Lease Networks,,2984425.00,,,,,,,2827350.00,3047255.00,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,outpatient,,,3141500.00000,1784843.22000,Hometown Health,Lease Networks,,2984425.00,,,,,,,816790.00,3047255.00,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Hometown Health,Lease Networks,UD,0.20900,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Hometown Health,Lease Networks,UD,0.20900,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.52000,0.30000,Hometown Health,Lease Networks,UD,0.49400,,,,,,,0.46800,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.52000,0.30000,Hometown Health,Lease Networks,UD,0.49400,,,,,,,0.13520,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.56000,0.32000,Hometown Health,Lease Networks,UD,0.53200,,,,,,,0.50400,0.54320,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.56000,0.32000,Hometown Health,Lease Networks,UD,0.53200,,,,,,,0.14560,0.54320,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Hometown Health,Lease Networks,UD,0.20900,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Hometown Health,Lease Networks,UD,0.20900,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.85000,0.48000,Hometown Health,Lease Networks,UD,0.80750,,,,,,,0.76500,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.85000,0.48000,Hometown Health,Lease Networks,UD,0.80750,,,,,,,0.22100,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Hometown Health,Lease Networks,UD,0.20900,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Hometown Health,Lease Networks,UD,0.20900,,,,,,,0.05720,0.21340,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,inpatient,,,102.00000,65.18000,Hometown Health,Lease Networks,,96.90,,,,,,,91.80,98.94,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,outpatient,,,102.00000,65.18000,Hometown Health,Lease Networks,,96.90,,,,,,,26.52,98.94,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,inpatient,,,190.00000,121.41000,Hometown Health,Lease Networks,,180.50,,,,,,,171.00,184.30,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,outpatient,,,190.00000,121.41000,Hometown Health,Lease Networks,,180.50,,,,,,,49.40,184.30,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,inpatient,,,359.00000,229.40000,Hometown Health,Lease Networks,,341.05,,,,,,,323.10,348.23,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Hometown Health,Lease Networks,,341.05,,,,,,,93.34,348.23,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,inpatient,,,535.00000,341.86000,Hometown Health,Lease Networks,,508.25,,,,,,,481.50,518.95,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Hometown Health,Lease Networks,,508.25,,,,,,,139.10,518.95,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,inpatient,,,766.00000,489.47000,Hometown Health,Lease Networks,,727.70,,,,,,,689.40,743.02,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,outpatient,,,766.00000,489.47000,Hometown Health,Lease Networks,,727.70,,,,,,,199.16,743.02,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,inpatient,,,159.00000,101.60000,Hometown Health,Lease Networks,,151.05,,,,,,,143.10,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,outpatient,,,159.00000,101.60000,Hometown Health,Lease Networks,,151.05,,,,,,,41.34,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,inpatient,,,447.00000,285.63000,Hometown Health,Lease Networks,,424.65,,,,,,,402.30,433.59,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,outpatient,,,447.00000,285.63000,Hometown Health,Lease Networks,,424.65,,,,,,,116.22,433.59,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,inpatient,,,1413.00000,902.91000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,outpatient,,,1413.00000,902.91000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,inpatient,,,3853.00000,2462.07000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,outpatient,,,3853.00000,2462.07000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,inpatient,,,313.00000,200.01000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,outpatient,,,313.00000,200.01000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,inpatient,,,1132.00000,723.35000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,outpatient,,,1132.00000,723.35000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,inpatient,,,2695.00000,1722.10000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,outpatient,,,2695.00000,1722.10000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,inpatient,,,1619.00000,1034.54000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,outpatient,,,1619.00000,1034.54000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,inpatient,,,535.00000,341.86000,Hometown Health,Lease Networks,,508.25,,,,,,,481.50,518.95,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Hometown Health,Lease Networks,,508.25,,,,,,,139.10,518.95,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,inpatient,,,850.00000,543.15000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,outpatient,,,850.00000,543.15000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,inpatient,,,32.00000,20.45000,Hometown Health,Lease Networks,,30.40,,,,,,,28.80,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,outpatient,,,32.00000,20.45000,Hometown Health,Lease Networks,,30.40,,,,,,,8.32,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,inpatient,,,134.00000,85.63000,Hometown Health,Lease Networks,,127.30,,,,,,,120.60,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,outpatient,,,134.00000,85.63000,Hometown Health,Lease Networks,,127.30,,,,,,,34.84,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,inpatient,,,359.00000,229.40000,Hometown Health,Lease Networks,,341.05,,,,,,,323.10,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Hometown Health,Lease Networks,,341.05,,,,,,,93.34,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,inpatient,,,709.00000,453.05000,Hometown Health,Lease Networks,,673.55,,,,,,,638.10,687.73,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,outpatient,,,709.00000,453.05000,Hometown Health,Lease Networks,,673.55,,,,,,,184.34,687.73,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,inpatient,,,4880.00000,2357.04000,Hometown Health,Lease Networks,,4636.00,,,,,,,4392.00,4733.60,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,outpatient,,,4880.00000,2357.04000,Hometown Health,Lease Networks,,4636.00,,,,,,,1268.80,4733.60,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,inpatient,,,6024.00000,2909.59000,Hometown Health,Lease Networks,,5722.80,,,,,,,5421.60,5843.28,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,outpatient,,,6024.00000,2909.59000,Hometown Health,Lease Networks,,5722.80,,,,,,,1566.24,5843.28,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,Lease Networks,,424.65,,,,,,,402.30,433.59,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,Lease Networks,,424.65,,,,,,,116.22,433.59,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Hometown Health,Lease Networks,,4177.15,,,,,,,3957.30,4265.09,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Hometown Health,Lease Networks,,4177.15,,,,,,,1143.22,4265.09,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,5274.90,5685.17,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,1523.86,5685.17,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,inpatient,,,7413.00000,3580.48000,Hometown Health,Lease Networks,,7042.35,,,,,,,6671.70,7190.61,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,outpatient,,,7413.00000,3580.48000,Hometown Health,Lease Networks,,7042.35,,,,,,,1927.38,7190.61,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,Lease Networks,,424.65,,,,,,,402.30,433.59,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,Lease Networks,,424.65,,,,,,,116.22,433.59,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,Lease Networks,,424.65,,,,,,,402.30,433.59,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,Lease Networks,,424.65,,,,,,,116.22,433.59,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Hometown Health,Lease Networks,,4177.15,,,,,,,3957.30,4265.09,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Hometown Health,Lease Networks,,4177.15,,,,,,,1143.22,4265.09,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,inpatient,,,7181.00000,3468.42000,Hometown Health,Lease Networks,,6821.95,,,,,,,6462.90,6965.57,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Hometown Health,Lease Networks,,6821.95,,,,,,,1867.06,6965.57,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,inpatient,,,10654.00000,5145.88000,Hometown Health,Lease Networks,,10121.30,,,,,,,9588.60,10334.38,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,outpatient,,,10654.00000,5145.88000,Hometown Health,Lease Networks,,10121.30,,,,,,,2770.04,10334.38,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,6487.00000,3133.22000,Hometown Health,Lease Networks,,6162.65,,,,,,,5838.30,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Hometown Health,Lease Networks,,6162.65,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,7413.00000,3580.48000,Hometown Health,Lease Networks,,7042.35,,,,,,,6671.70,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Hometown Health,Lease Networks,,7042.35,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,11575.00000,5590.72000,Hometown Health,Lease Networks,,10996.25,,,,,,,10417.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,11575.00000,5590.72000,Hometown Health,Lease Networks,,10996.25,,,,,,,3009.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,13432.00000,6487.66000,Hometown Health,Lease Networks,,12760.40,,,,,,,12088.80,13029.04,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,13432.00000,6487.66000,Hometown Health,Lease Networks,,12760.40,,,,,,,3492.32,13029.04,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,21904.00000,10579.63000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,21904.00000,10579.63000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,490.88,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,4397.00000,2123.75000,Hometown Health,Lease Networks,,4177.15,,,,,,,3957.30,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Hometown Health,Lease Networks,,4177.15,,,,,,,1143.22,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,7413.00000,3580.48000,Hometown Health,Lease Networks,,7042.35,,,,,,,6671.70,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Hometown Health,Lease Networks,,7042.35,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,12969.00000,6264.03000,Hometown Health,Lease Networks,,12320.55,,,,,,,11672.10,12579.93,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,12969.00000,6264.03000,Hometown Health,Lease Networks,,12320.55,,,,,,,3371.94,12579.93,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,490.88,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Hometown Health,Lease Networks,,2304.70,,,,,,,2183.40,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Hometown Health,Lease Networks,,2304.70,,,,,,,630.76,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Hometown Health,Lease Networks,,2685.65,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Hometown Health,Lease Networks,,2685.65,,,,,,,735.02,2742.19,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Hometown Health,Lease Networks,,96.90,,,,,,,91.80,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Hometown Health,Lease Networks,,96.90,,,,,,,26.52,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,inpatient,,,134.00000,64.72000,Hometown Health,Lease Networks,,127.30,,,,,,,120.60,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Hometown Health,Lease Networks,,127.30,,,,,,,34.84,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,inpatient,,,251.00000,121.23000,Hometown Health,Lease Networks,,238.45,,,,,,,225.90,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,outpatient,,,251.00000,121.23000,Hometown Health,Lease Networks,,238.45,,,,,,,65.26,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,490.88,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,Lease Networks,,424.65,,,,,,,402.30,433.59,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,Lease Networks,,424.65,,,,,,,116.22,433.59,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,2827.00000,1365.44000,Hometown Health,Lease Networks,,2685.65,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Hometown Health,Lease Networks,,2685.65,,,,,,,735.02,2742.19,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,2690.00000,1299.27000,Hometown Health,Lease Networks,,2555.50,,,,,,,2421.00,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Hometown Health,Lease Networks,,2555.50,,,,,,,699.40,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,6487.00000,3133.22000,Hometown Health,Lease Networks,,6162.65,,,,,,,5838.30,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Hometown Health,Lease Networks,,6162.65,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,2426.00000,1171.76000,Hometown Health,Lease Networks,,2304.70,,,,,,,2183.40,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,2426.00000,1171.76000,Hometown Health,Lease Networks,,2304.70,,,,,,,630.76,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,15334.00000,7406.32000,Hometown Health,Lease Networks,,14567.30,,,,,,,13800.60,14873.98,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,15334.00000,7406.32000,Hometown Health,Lease Networks,,14567.30,,,,,,,3986.84,14873.98,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,490.88,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Hometown Health,Lease Networks,,2685.65,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Hometown Health,Lease Networks,,2685.65,,,,,,,735.02,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,251.00000,121.23000,Hometown Health,Lease Networks,,238.45,,,,,,,225.90,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,251.00000,121.23000,Hometown Health,Lease Networks,,238.45,,,,,,,65.26,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,490.88,1831.36,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,2827.00000,1365.44000,Hometown Health,Lease Networks,,2685.65,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Hometown Health,Lease Networks,,2685.65,,,,,,,735.02,2742.19,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Hometown Health,Lease Networks,,30.40,,,,,,,28.80,31.04,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Hometown Health,Lease Networks,,30.40,,,,,,,8.32,31.04,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,490.88,1831.36,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,inpatient,,,15334.00000,7406.32000,Hometown Health,Lease Networks,,14567.30,,,,,,,13800.60,14873.98,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Hometown Health,Lease Networks,,14567.30,,,,,,,3986.84,14873.98,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,inpatient,,,1485.00000,717.26000,Hometown Health,Lease Networks,,1410.75,,,,,,,1336.50,1440.45,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,outpatient,,,1485.00000,717.26000,Hometown Health,Lease Networks,,1410.75,,,,,,,386.10,1440.45,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,inpatient,,,2028.00000,979.52000,Hometown Health,Lease Networks,,1926.60,,,,,,,1825.20,1967.16,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,outpatient,,,2028.00000,979.52000,Hometown Health,Lease Networks,,1926.60,,,,,,,527.28,1967.16,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,4397.00000,2123.75000,Hometown Health,Lease Networks,,4177.15,,,,,,,3957.30,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Hometown Health,Lease Networks,,4177.15,,,,,,,1143.22,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,8107.00000,3915.68000,Hometown Health,Lease Networks,,7701.65,,,,,,,7296.30,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,8107.00000,3915.68000,Hometown Health,Lease Networks,,7701.65,,,,,,,2107.82,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,10422.00000,5033.83000,Hometown Health,Lease Networks,,9900.90,,,,,,,9379.80,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,10422.00000,5033.83000,Hometown Health,Lease Networks,,9900.90,,,,,,,2709.72,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,12737.00000,6151.97000,Hometown Health,Lease Networks,,12100.15,,,,,,,11463.30,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,12737.00000,6151.97000,Hometown Health,Lease Networks,,12100.15,,,,,,,3311.62,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,14239.00000,6877.44000,Hometown Health,Lease Networks,,13527.05,,,,,,,12815.10,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,14239.00000,6877.44000,Hometown Health,Lease Networks,,13527.05,,,,,,,3702.14,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,16429.00000,7935.21000,Hometown Health,Lease Networks,,15607.55,,,,,,,14786.10,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,16429.00000,7935.21000,Hometown Health,Lease Networks,,15607.55,,,,,,,4271.54,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,18619.00000,8992.98000,Hometown Health,Lease Networks,,17688.05,,,,,,,16757.10,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,18619.00000,8992.98000,Hometown Health,Lease Networks,,17688.05,,,,,,,4840.94,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,20809.00000,10050.75000,Hometown Health,Lease Networks,,19768.55,,,,,,,18728.10,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,20809.00000,10050.75000,Hometown Health,Lease Networks,,19768.55,,,,,,,5410.34,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,22999.00000,11108.52000,Hometown Health,Lease Networks,,21849.05,,,,,,,20699.10,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,22999.00000,11108.52000,Hometown Health,Lease Networks,,21849.05,,,,,,,5979.74,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,25189.00000,12166.29000,Hometown Health,Lease Networks,,23929.55,,,,,,,22670.10,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,25189.00000,12166.29000,Hometown Health,Lease Networks,,23929.55,,,,,,,6549.14,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,27379.00000,13224.06000,Hometown Health,Lease Networks,,26010.05,,,,,,,24641.10,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,27379.00000,13224.06000,Hometown Health,Lease Networks,,26010.05,,,,,,,7118.54,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,29569.00000,14281.83000,Hometown Health,Lease Networks,,28090.55,,,,,,,26612.10,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,29569.00000,14281.83000,Hometown Health,Lease Networks,,28090.55,,,,,,,7687.94,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,31759.00000,15339.60000,Hometown Health,Lease Networks,,30171.05,,,,,,,28583.10,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,31759.00000,15339.60000,Hometown Health,Lease Networks,,30171.05,,,,,,,8257.34,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,36139.00000,17455.14000,Hometown Health,Lease Networks,,34332.05,,,,,,,32525.10,35054.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,36139.00000,17455.14000,Hometown Health,Lease Networks,,34332.05,,,,,,,9396.14,35054.83,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,1699.20,1831.36,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,490.88,1831.36,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Hometown Health,Lease Networks,,3173.00,,,,,,,3006.00,3239.80,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Hometown Health,Lease Networks,,3173.00,,,,,,,868.40,3239.80,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,5274.90,5685.17,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,1523.86,5685.17,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Hometown Health,Lease Networks,,30.40,,,,,,,28.80,31.04,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Hometown Health,Lease Networks,,30.40,,,,,,,8.32,31.04,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,inpatient,,,134.00000,64.72000,Hometown Health,Lease Networks,,127.30,,,,,,,120.60,129.98,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Hometown Health,Lease Networks,,127.30,,,,,,,34.84,129.98,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Hometown Health,Lease Networks,,180.50,,,,,,,171.00,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Hometown Health,Lease Networks,,180.50,,,,,,,49.40,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,inpatient,,,476.00000,229.91000,Hometown Health,Lease Networks,,452.20,,,,,,,428.40,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,outpatient,,,476.00000,229.91000,Hometown Health,Lease Networks,,452.20,,,,,,,123.76,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Hometown Health,Lease Networks,,30.40,,,,,,,28.80,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Hometown Health,Lease Networks,,30.40,,,,,,,8.32,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,Lease Networks,,424.65,,,,,,,402.30,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,Lease Networks,,424.65,,,,,,,116.22,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,1699.20,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,490.88,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,5274.90,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,1523.86,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,inpatient,,,12506.00000,6040.40000,Hometown Health,Lease Networks,,11880.70,,,,,,,11255.40,12130.82,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,outpatient,,,12506.00000,6040.40000,Hometown Health,Lease Networks,,11880.70,,,,,,,3251.56,12130.82,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,inpatient,,,2404.80000,1161.52000,Hometown Health,Lease Networks,,2284.56,,,,,,,2164.32,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,outpatient,,,2404.80000,1161.52000,Hometown Health,Lease Networks,,2284.56,,,,,,,625.25,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,inpatient,,,969.00000,468.03000,Hometown Health,Lease Networks,,920.55,,,,,,,872.10,939.93,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,outpatient,,,969.00000,468.03000,Hometown Health,Lease Networks,,920.55,,,,,,,251.94,939.93,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,inpatient,,,2256.90000,1090.08000,Hometown Health,Lease Networks,,2144.05,,,,,,,2031.21,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,outpatient,,,2256.90000,1090.08000,Hometown Health,Lease Networks,,2144.05,,,,,,,586.79,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,inpatient,,,644.30000,311.20000,Hometown Health,Lease Networks,,612.09,,,,,,,579.87,624.97,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,outpatient,,,644.30000,311.20000,Hometown Health,Lease Networks,,612.09,,,,,,,167.52,624.97,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Hometown Health,Lease Networks,,96.90,,,,,,,91.80,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Hometown Health,Lease Networks,,96.90,,,,,,,26.52,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Hometown Health,Lease Networks,,180.50,,,,,,,171.00,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Hometown Health,Lease Networks,,180.50,,,,,,,49.40,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,inpatient,,,26284.00000,12695.17000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,inpatient,,,30664.00000,14810.71000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,inpatient,,,35044.00000,16926.25000,Hometown Health,Lease Networks,,33291.80,,,,,,,31539.60,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Hometown Health,Lease Networks,,33291.80,,,,,,,9111.44,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,inpatient,,,43804.00000,21157.33000,Hometown Health,Lease Networks,,41613.80,,,,,,,39423.60,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,outpatient,,,43804.00000,21157.33000,Hometown Health,Lease Networks,,41613.80,,,,,,,11389.04,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,inpatient,,,52564.00000,25388.41000,Hometown Health,Lease Networks,,49935.80,,,,,,,47307.60,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,outpatient,,,52564.00000,25388.41000,Hometown Health,Lease Networks,,49935.80,,,,,,,13666.64,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,inpatient,,,61324.00000,29619.49000,Hometown Health,Lease Networks,,58257.80,,,,,,,55191.60,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,outpatient,,,61324.00000,29619.49000,Hometown Health,Lease Networks,,58257.80,,,,,,,15944.24,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,inpatient,,,70084.00000,33850.57000,Hometown Health,Lease Networks,,66579.80,,,,,,,63075.60,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,outpatient,,,70084.00000,33850.57000,Hometown Health,Lease Networks,,66579.80,,,,,,,18221.84,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,inpatient,,,78844.00000,38081.65000,Hometown Health,Lease Networks,,74901.80,,,,,,,70959.60,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,outpatient,,,78844.00000,38081.65000,Hometown Health,Lease Networks,,74901.80,,,,,,,20499.44,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,inpatient,,,87604.00000,42312.73000,Hometown Health,Lease Networks,,83223.80,,,,,,,78843.60,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,outpatient,,,87604.00000,42312.73000,Hometown Health,Lease Networks,,83223.80,,,,,,,22777.04,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,inpatient,,,96364.00000,46543.81000,Hometown Health,Lease Networks,,91545.80,,,,,,,86727.60,93473.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,outpatient,,,96364.00000,46543.81000,Hometown Health,Lease Networks,,91545.80,,,,,,,25054.64,93473.08,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,inpatient,,,26284.00000,12695.17000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,inpatient,,,30664.00000,14810.71000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,inpatient,,,35044.00000,16926.25000,Hometown Health,Lease Networks,,33291.80,,,,,,,31539.60,33992.68,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Hometown Health,Lease Networks,,33291.80,,,,,,,9111.44,33992.68,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,inpatient,,,39424.00000,19041.79000,Hometown Health,Lease Networks,,37452.80,,,,,,,35481.60,38241.28,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,outpatient,,,39424.00000,19041.79000,Hometown Health,Lease Networks,,37452.80,,,,,,,10250.24,38241.28,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Hometown Health,Lease Networks,,3713.55,,,,,,,3518.10,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Hometown Health,Lease Networks,,3713.55,,,,,,,1016.34,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Hometown Health,Lease Networks,,180.50,,,,,,,171.00,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Hometown Health,Lease Networks,,180.50,,,,,,,49.40,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,5274.90,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,1523.86,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,inpatient,,,15334.00000,7406.32000,Hometown Health,Lease Networks,,14567.30,,,,,,,13800.60,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Hometown Health,Lease Networks,,14567.30,,,,,,,3986.84,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,2023.00000,977.11000,Hometown Health,Lease Networks,,1921.85,,,,,,,1820.70,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2023.00000,977.11000,Hometown Health,Lease Networks,,1921.85,,,,,,,525.98,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,5274.90,5685.17,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,inpatient,,,7876.00000,3804.11000,Hometown Health,Lease Networks,,7482.20,,,,,,,7088.40,7639.72,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Hometown Health,Lease Networks,,7482.20,,,,,,,2047.76,7639.72,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,inpatient,,,10191.00000,4922.25000,Hometown Health,Lease Networks,,9681.45,,,,,,,9171.90,9885.27,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,outpatient,,,10191.00000,4922.25000,Hometown Health,Lease Networks,,9681.45,,,,,,,2649.66,9885.27,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,96.00000,46.37000,Hometown Health,Lease Networks,,91.20,,,,,,,86.40,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,96.00000,46.37000,Hometown Health,Lease Networks,,91.20,,,,,,,24.96,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,5274.90,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,7876.00000,3804.11000,Hometown Health,Lease Networks,,7482.20,,,,,,,7088.40,7639.72,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,7876.00000,3804.11000,Hometown Health,Lease Networks,,7482.20,,,,,,,2047.76,7639.72,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Hometown Health,Lease Networks,,3713.55,,,,,,,3518.10,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Hometown Health,Lease Networks,,3713.55,,,,,,,1016.34,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,inpatient,,,5373.00000,2595.16000,Hometown Health,Lease Networks,,5104.35,,,,,,,4835.70,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,outpatient,,,5373.00000,2595.16000,Hometown Health,Lease Networks,,5104.35,,,,,,,1396.98,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,inpatient,,,6487.00000,3133.22000,Hometown Health,Lease Networks,,6162.65,,,,,,,5838.30,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,outpatient,,,6487.00000,3133.22000,Hometown Health,Lease Networks,,6162.65,,,,,,,1686.62,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,inpatient,,,7876.00000,3804.11000,Hometown Health,Lease Networks,,7482.20,,,,,,,7088.40,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Hometown Health,Lease Networks,,7482.20,,,,,,,2047.76,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Hometown Health,Lease Networks,,4177.15,,,,,,,3957.30,4265.09,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Hometown Health,Lease Networks,,4177.15,,,,,,,1143.22,4265.09,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,5274.90,5685.17,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,1523.86,5685.17,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,inpatient,,,1126.00000,543.86000,Hometown Health,Lease Networks,,1069.70,,,,,,,1013.40,1092.22,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,outpatient,,,1126.00000,543.86000,Hometown Health,Lease Networks,,1069.70,,,,,,,292.76,1092.22,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,2690.00000,1299.27000,Hometown Health,Lease Networks,,2555.50,,,,,,,2421.00,2609.30,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Hometown Health,Lease Networks,,2555.50,,,,,,,699.40,2609.30,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,4880.00000,2357.04000,Hometown Health,Lease Networks,,4636.00,,,,,,,4392.00,4733.60,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,4880.00000,2357.04000,Hometown Health,Lease Networks,,4636.00,,,,,,,1268.80,4733.60,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,9260.00000,4472.58000,Hometown Health,Lease Networks,,8797.00,,,,,,,8334.00,8982.20,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,9260.00000,4472.58000,Hometown Health,Lease Networks,,8797.00,,,,,,,2407.60,8982.20,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,5274.90,5685.17,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,1523.86,5685.17,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,inpatient,,,588.00000,284.00000,Hometown Health,Lease Networks,,558.60,,,,,,,529.20,570.36,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,588.00000,284.00000,Hometown Health,Lease Networks,,558.60,,,,,,,152.88,570.36,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,1699.20,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,490.88,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Hometown Health,Lease Networks,,2304.70,,,,,,,2183.40,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Hometown Health,Lease Networks,,2304.70,,,,,,,630.76,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Hometown Health,Lease Networks,,2685.65,,,,,,,2544.30,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Hometown Health,Lease Networks,,2685.65,,,,,,,735.02,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Hometown Health,Lease Networks,,3173.00,,,,,,,3006.00,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Hometown Health,Lease Networks,,3173.00,,,,,,,868.40,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Hometown Health,Lease Networks,,3173.00,,,,,,,3006.00,3239.80,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Hometown Health,Lease Networks,,3173.00,,,,,,,868.40,3239.80,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,Lease Networks,,424.65,,,,,,,402.30,433.59,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,Lease Networks,,424.65,,,,,,,116.22,433.59,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Hometown Health,Lease Networks,,3713.55,,,,,,,3518.10,3791.73,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Hometown Health,Lease Networks,,3713.55,,,,,,,1016.34,3791.73,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,5274.90,5685.17,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,1523.86,5685.17,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,inpatient,,,159.00000,76.80000,Hometown Health,Lease Networks,,151.05,,,,,,,143.10,154.23,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,outpatient,,,159.00000,76.80000,Hometown Health,Lease Networks,,151.05,,,,,,,41.34,154.23,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,inpatient,,,588.00000,284.00000,Hometown Health,Lease Networks,,558.60,,,,,,,529.20,570.36,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,outpatient,,,588.00000,284.00000,Hometown Health,Lease Networks,,558.60,,,,,,,152.88,570.36,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Hometown Health,Lease Networks,,2304.70,,,,,,,2183.40,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Hometown Health,Lease Networks,,2304.70,,,,,,,630.76,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,Lease Networks,,424.65,,,,,,,402.30,433.59,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,Lease Networks,,424.65,,,,,,,116.22,433.59,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,inpatient,,,8107.00000,3915.68000,Hometown Health,Lease Networks,,7701.65,,,,,,,7296.30,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,outpatient,,,8107.00000,3915.68000,Hometown Health,Lease Networks,,7701.65,,,,,,,2107.82,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,inpatient,,,10422.00000,5033.83000,Hometown Health,Lease Networks,,9900.90,,,,,,,9379.80,10109.34,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,outpatient,,,10422.00000,5033.83000,Hometown Health,Lease Networks,,9900.90,,,,,,,2709.72,10109.34,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,5274.90,5685.17,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,Lease Networks,,5567.95,,,,,,,1523.86,5685.17,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,1699.20,1831.36,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,Lease Networks,,1793.60,,,,,,,490.88,1831.36,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Hometown Health,Lease Networks,,96.90,,,,,,,91.80,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Hometown Health,Lease Networks,,96.90,,,,,,,26.52,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,inpatient,,,221.00000,106.74000,Hometown Health,Lease Networks,,209.95,,,,,,,198.90,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,outpatient,,,221.00000,106.74000,Hometown Health,Lease Networks,,209.95,,,,,,,57.46,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,Lease Networks,,424.65,,,,,,,402.30,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,Lease Networks,,424.65,,,,,,,116.22,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Hometown Health,Lease Networks,,2304.70,,,,,,,2183.40,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Hometown Health,Lease Networks,,2304.70,,,,,,,630.76,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Hometown Health,Lease Networks,,3173.00,,,,,,,3006.00,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Hometown Health,Lease Networks,,3173.00,,,,,,,868.40,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,inpatient,,,4153.00000,2005.90000,Hometown Health,Lease Networks,,3945.35,,,,,,,3737.70,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,outpatient,,,4153.00000,2005.90000,Hometown Health,Lease Networks,,3945.35,,,,,,,1079.78,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,inpatient,,,5129.00000,2477.31000,Hometown Health,Lease Networks,,4872.55,,,,,,,4616.10,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,outpatient,,,5129.00000,2477.31000,Hometown Health,Lease Networks,,4872.55,,,,,,,1333.54,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,inpatient,,,7181.00000,3468.42000,Hometown Health,Lease Networks,,6821.95,,,,,,,6462.90,6965.57,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Hometown Health,Lease Networks,,6821.95,,,,,,,1867.06,6965.57,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,inpatient,,,52.50000,25.36000,Hometown Health,Lease Networks,,49.88,,,,,,,47.25,50.92,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,outpatient,,,52.50000,25.36000,Hometown Health,Lease Networks,,49.88,,,,,,,13.65,50.92,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,inpatient,,,50.40000,24.34000,Hometown Health,Lease Networks,,47.88,,,,,,,45.36,48.89,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,outpatient,,,50.40000,24.34000,Hometown Health,Lease Networks,,47.88,,,,,,,13.10,48.89,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Hometown Health,Lease Networks,,2304.70,,,,,,,2183.40,2353.22,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Hometown Health,Lease Networks,,2304.70,,,,,,,630.76,2353.22,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Hometown Health,Lease Networks,,3713.55,,,,,,,3518.10,3791.73,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Hometown Health,Lease Networks,,3713.55,,,,,,,1016.34,3791.73,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Hometown Health,Lease Networks,,96.90,,,,,,,91.80,98.94,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Hometown Health,Lease Networks,,96.90,,,,,,,26.52,98.94,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Hometown Health,Lease Networks,,30.40,,,,,,,28.80,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Hometown Health,Lease Networks,,30.40,,,,,,,8.32,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,Lease Networks,,424.65,,,,,,,402.30,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,Lease Networks,,424.65,,,,,,,116.22,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,inpatient,,,709.00000,342.45000,Hometown Health,Lease Networks,,673.55,,,,,,,638.10,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,outpatient,,,709.00000,342.45000,Hometown Health,Lease Networks,,673.55,,,,,,,184.34,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Hometown Health,Lease Networks,,62418.80,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Hometown Health,Lease Networks,,62418.80,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Hometown Health,Lease Networks,,83223.80,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Hometown Health,Lease Networks,,83223.80,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,109504.00000,62214.70000,Hometown Health,Lease Networks,,104028.80,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Hometown Health,Lease Networks,,104028.80,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,131404.00000,74657.18000,Hometown Health,Lease Networks,,124833.80,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,131404.00000,74657.18000,Hometown Health,Lease Networks,,124833.80,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,43800.00000,24884.97000,Hometown Health,Lease Networks,,41610.00,,,,,,,39420.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,43800.00000,24884.97000,Hometown Health,Lease Networks,,41610.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Hometown Health,Lease Networks,,62418.80,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Hometown Health,Lease Networks,,62418.80,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Hometown Health,Lease Networks,,83223.80,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Hometown Health,Lease Networks,,83223.80,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,19714.00000,11200.51000,Hometown Health,Lease Networks,,18728.30,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Hometown Health,Lease Networks,,18728.30,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,24090.00000,13686.73000,Hometown Health,Lease Networks,,22885.50,,,,,,,21681.00,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,24090.00000,13686.73000,Hometown Health,Lease Networks,,22885.50,,,,,,,6263.40,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,28474.00000,16177.50000,Hometown Health,Lease Networks,,27050.30,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Hometown Health,Lease Networks,,27050.30,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,17520.00000,9953.99000,Hometown Health,Lease Networks,,16644.00,,,,,,,15768.00,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Hometown Health,Lease Networks,,16644.00,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,21904.00000,12444.76000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,26284.00000,14933.25000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,43804.00000,24887.24000,Hometown Health,Lease Networks,,41613.80,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Hometown Health,Lease Networks,,41613.80,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Hometown Health,Lease Networks,,62418.80,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Hometown Health,Lease Networks,,62418.80,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Hometown Health,Lease Networks,,83223.80,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Hometown Health,Lease Networks,,83223.80,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,109504.00000,62214.70000,Hometown Health,Lease Networks,,104028.80,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Hometown Health,Lease Networks,,104028.80,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,6105.00000,3468.56000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,6105.00000,3468.56000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,13895.00000,7894.44000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,13895.00000,7894.44000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,21900.00000,12442.48000,Hometown Health,Lease Networks,,20805.00,,,,,,,19710.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,21900.00000,12442.48000,Hometown Health,Lease Networks,,20805.00,,,,,,,5694.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,35040.00000,19907.98000,Hometown Health,Lease Networks,,33288.00,,,,,,,31536.00,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,35040.00000,19907.98000,Hometown Health,Lease Networks,,33288.00,,,,,,,9110.40,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,43804.00000,24887.24000,Hometown Health,Lease Networks,,41613.80,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Hometown Health,Lease Networks,,41613.80,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,19714.00000,11200.51000,Hometown Health,Lease Networks,,18728.30,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Hometown Health,Lease Networks,,18728.30,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,22776.00000,12940.18000,Hometown Health,Lease Networks,,21637.20,,,,,,,20498.40,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,22776.00000,12940.18000,Hometown Health,Lease Networks,,21637.20,,,,,,,5921.76,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,28474.00000,16177.50000,Hometown Health,Lease Networks,,27050.30,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Hometown Health,Lease Networks,,27050.30,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,17520.00000,9953.99000,Hometown Health,Lease Networks,,16644.00,,,,,,,15768.00,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Hometown Health,Lease Networks,,16644.00,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,21904.00000,12444.76000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,26284.00000,14933.25000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,30664.00000,17421.75000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,30664.00000,17421.75000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,35044.00000,19910.25000,Hometown Health,Lease Networks,,33291.80,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,35044.00000,19910.25000,Hometown Health,Lease Networks,,33291.80,,,,,,,9111.44,33992.68,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,2157.00000,864.96000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,2157.00000,864.96000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,2695.00000,1080.70000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2695.00000,1080.70000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,3853.00000,1545.05000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,3853.00000,1545.05000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,inpatient,,,1413.00000,566.61000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,outpatient,,,1413.00000,566.61000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,3229.80000,1857.14000,Hometown Health,Lease Networks,,3068.31,,,,,,,2906.82,3132.91,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,3229.80000,1857.14000,Hometown Health,Lease Networks,,3068.31,,,,,,,839.75,3132.91,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,854.40000,491.28000,Hometown Health,Lease Networks,,811.68,,,,,,,768.96,828.77,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,854.40000,491.28000,Hometown Health,Lease Networks,,811.68,,,,,,,222.14,828.77,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1200.50000,690.29000,Hometown Health,Lease Networks,,1140.47,,,,,,,1080.45,1164.48,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1200.50000,690.29000,Hometown Health,Lease Networks,,1140.47,,,,,,,312.13,1164.48,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1011.00000,581.32000,Hometown Health,Lease Networks,,960.45,,,,,,,909.90,980.67,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1011.00000,581.32000,Hometown Health,Lease Networks,,960.45,,,,,,,262.86,980.67,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1823.80000,1048.68000,Hometown Health,Lease Networks,,1732.61,,,,,,,1641.42,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1823.80000,1048.68000,Hometown Health,Lease Networks,,1732.61,,,,,,,474.19,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2028.50000,1166.39000,Hometown Health,Lease Networks,,1927.08,,,,,,,1825.65,1967.64,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2028.50000,1166.39000,Hometown Health,Lease Networks,,1927.08,,,,,,,527.41,1967.64,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,841.00000,483.58000,Hometown Health,Lease Networks,,798.95,,,,,,,756.90,815.77,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,841.00000,483.58000,Hometown Health,Lease Networks,,798.95,,,,,,,218.66,815.77,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1366.20000,785.56000,Hometown Health,Lease Networks,,1297.89,,,,,,,1229.58,1325.21,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1366.20000,785.56000,Hometown Health,Lease Networks,,1297.89,,,,,,,355.21,1325.21,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1384.00000,795.80000,Hometown Health,Lease Networks,,1314.80,,,,,,,1245.60,1342.48,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1384.00000,795.80000,Hometown Health,Lease Networks,,1314.80,,,,,,,359.84,1342.48,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2458.70000,1413.75000,Hometown Health,Lease Networks,,2335.76,,,,,,,2212.83,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2458.70000,1413.75000,Hometown Health,Lease Networks,,2335.76,,,,,,,639.26,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2393.50000,1376.26000,Hometown Health,Lease Networks,,2273.82,,,,,,,2154.15,2321.70,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2393.50000,1376.26000,Hometown Health,Lease Networks,,2273.82,,,,,,,622.31,2321.70,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1369.50000,787.46000,Hometown Health,Lease Networks,,1301.03,,,,,,,1232.55,1328.41,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1369.50000,787.46000,Hometown Health,Lease Networks,,1301.03,,,,,,,356.07,1328.41,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2697.40000,1551.00000,Hometown Health,Lease Networks,,2562.53,,,,,,,2427.66,2616.48,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2697.40000,1551.00000,Hometown Health,Lease Networks,,2562.53,,,,,,,701.32,2616.48,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4621.80000,2657.54000,Hometown Health,Lease Networks,,4390.71,,,,,,,4159.62,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4621.80000,2657.54000,Hometown Health,Lease Networks,,4390.71,,,,,,,1201.67,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2592.50000,1490.69000,Hometown Health,Lease Networks,,2462.88,,,,,,,2333.25,2514.72,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2592.50000,1490.69000,Hometown Health,Lease Networks,,2462.88,,,,,,,674.05,2514.72,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Hometown Health,Lease Networks,,5567.95,,,,,,,5274.90,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Hometown Health,Lease Networks,,5567.95,,,,,,,1523.86,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Hometown Health,Lease Networks,,7922.05,,,,,,,7505.10,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Hometown Health,Lease Networks,,7922.05,,,,,,,2168.14,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Hometown Health,Lease Networks,,5567.95,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Hometown Health,Lease Networks,,5567.95,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,8107.00000,4661.52000,Hometown Health,Lease Networks,,7701.65,,,,,,,7296.30,7863.79,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Hometown Health,Lease Networks,,7701.65,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Hometown Health,Lease Networks,,1069.70,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Hometown Health,Lease Networks,,1069.70,,,,,,,292.76,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,Lease Networks,,4177.15,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,Lease Networks,,4177.15,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Hometown Health,Lease Networks,,7042.35,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Hometown Health,Lease Networks,,7042.35,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,inpatient,,,20152.00000,11587.40000,Hometown Health,Lease Networks,,19144.40,,,,,,,18136.80,19547.44,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,outpatient,,,20152.00000,11587.40000,Hometown Health,Lease Networks,,19144.40,,,,,,,5239.52,19547.44,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Hometown Health,Lease Networks,,424.65,,,,,,,402.30,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Hometown Health,Lease Networks,,424.65,,,,,,,116.22,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Hometown Health,Lease Networks,,673.55,,,,,,,638.10,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Hometown Health,Lease Networks,,673.55,,,,,,,184.34,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,1272.00000,731.40000,Hometown Health,Lease Networks,,1208.40,,,,,,,1144.80,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,1272.00000,731.40000,Hometown Health,Lease Networks,,1208.40,,,,,,,330.72,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Hometown Health,Lease Networks,,2555.50,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Hometown Health,Lease Networks,,2555.50,,,,,,,699.40,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,3078.00000,1769.85000,Hometown Health,Lease Networks,,2924.10,,,,,,,2770.20,2985.66,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,3078.00000,1769.85000,Hometown Health,Lease Networks,,2924.10,,,,,,,800.28,2985.66,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,70.00000,40.25000,Hometown Health,Lease Networks,,66.50,,,,,,,63.00,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,70.00000,40.25000,Hometown Health,Lease Networks,,66.50,,,,,,,18.20,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,102.00000,58.65000,Hometown Health,Lease Networks,,96.90,,,,,,,91.80,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,102.00000,58.65000,Hometown Health,Lease Networks,,96.90,,,,,,,26.52,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,221.00000,127.07000,Hometown Health,Lease Networks,,209.95,,,,,,,198.90,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,221.00000,127.07000,Hometown Health,Lease Networks,,209.95,,,,,,,57.46,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Hometown Health,Lease Networks,,424.65,,,,,,,402.30,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Hometown Health,Lease Networks,,424.65,,,,,,,116.22,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Hometown Health,Lease Networks,,673.55,,,,,,,638.10,687.73,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Hometown Health,Lease Networks,,673.55,,,,,,,184.34,687.73,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Hometown Health,Lease Networks,,11880.70,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Hometown Health,Lease Networks,,11880.70,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35482.00000,20402.15000,Hometown Health,Lease Networks,,33707.90,,,,,,,31933.80,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35482.00000,20402.15000,Hometown Health,Lease Networks,,33707.90,,,,,,,9225.32,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39862.00000,22920.65000,Hometown Health,Lease Networks,,37868.90,,,,,,,35875.80,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39862.00000,22920.65000,Hometown Health,Lease Networks,,37868.90,,,,,,,10364.12,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,44242.00000,25439.15000,Hometown Health,Lease Networks,,42029.90,,,,,,,39817.80,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,44242.00000,25439.15000,Hometown Health,Lease Networks,,42029.90,,,,,,,11502.92,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,48622.00000,27957.65000,Hometown Health,Lease Networks,,46190.90,,,,,,,43759.80,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,48622.00000,27957.65000,Hometown Health,Lease Networks,,46190.90,,,,,,,12641.72,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,53002.00000,30476.15000,Hometown Health,Lease Networks,,50351.90,,,,,,,47701.80,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,53002.00000,30476.15000,Hometown Health,Lease Networks,,50351.90,,,,,,,13780.52,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Hometown Health,Lease Networks,,58257.80,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Hometown Health,Lease Networks,,58257.80,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Hometown Health,Lease Networks,,66579.80,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Hometown Health,Lease Networks,,66579.80,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Hometown Health,Lease Networks,,74901.80,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Hometown Health,Lease Networks,,74901.80,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Hometown Health,Lease Networks,,83223.80,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Hometown Health,Lease Networks,,83223.80,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Hometown Health,Lease Networks,,91545.80,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Hometown Health,Lease Networks,,91545.80,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,844.00000,485.30000,Hometown Health,Lease Networks,,801.80,,,,,,,759.60,818.68,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,844.00000,485.30000,Hometown Health,Lease Networks,,801.80,,,,,,,219.44,818.68,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,11575.00000,6655.62000,Hometown Health,Lease Networks,,10996.25,,,,,,,10417.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,11575.00000,6655.62000,Hometown Health,Lease Networks,,10996.25,,,,,,,3009.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,14892.00000,8562.90000,Hometown Health,Lease Networks,,14147.40,,,,,,,13402.80,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14892.00000,8562.90000,Hometown Health,Lease Networks,,14147.40,,,,,,,3871.92,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,24970.00000,14357.75000,Hometown Health,Lease Networks,,23721.50,,,,,,,22473.00,24220.90,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,24970.00000,14357.75000,Hometown Health,Lease Networks,,23721.50,,,,,,,6492.20,24220.90,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Hometown Health,Lease Networks,,1793.60,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Hometown Health,Lease Networks,,1793.60,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Hometown Health,Lease Networks,,424.65,,,,,,,402.30,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Hometown Health,Lease Networks,,424.65,,,,,,,116.22,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Hometown Health,Lease Networks,,1793.60,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Hometown Health,Lease Networks,,1793.60,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Hometown Health,Lease Networks,,3173.00,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Hometown Health,Lease Networks,,3173.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,4153.00000,2387.98000,Hometown Health,Lease Networks,,3945.35,,,,,,,3737.70,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Hometown Health,Lease Networks,,3945.35,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,4641.00000,2668.58000,Hometown Health,Lease Networks,,4408.95,,,,,,,4176.90,4501.77,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4641.00000,2668.58000,Hometown Health,Lease Networks,,4408.95,,,,,,,1206.66,4501.77,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Hometown Health,Lease Networks,,4636.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Hometown Health,Lease Networks,,4636.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Hometown Health,Lease Networks,,91545.80,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Hometown Health,Lease Networks,,91545.80,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Hometown Health,Lease Networks,,104028.80,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Hometown Health,Lease Networks,,104028.80,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,131404.00000,75557.30000,Hometown Health,Lease Networks,,124833.80,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Hometown Health,Lease Networks,,124833.80,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,153304.00000,88149.80000,Hometown Health,Lease Networks,,145638.80,,,,,,,137973.60,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,153304.00000,88149.80000,Hometown Health,Lease Networks,,145638.80,,,,,,,39859.04,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,175204.00000,100742.30000,Hometown Health,Lease Networks,,166443.80,,,,,,,157683.60,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,175204.00000,100742.30000,Hometown Health,Lease Networks,,166443.80,,,,,,,45553.04,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,197104.00000,113334.80000,Hometown Health,Lease Networks,,187248.80,,,,,,,177393.60,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,197104.00000,113334.80000,Hometown Health,Lease Networks,,187248.80,,,,,,,51247.04,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,219004.00000,125927.30000,Hometown Health,Lease Networks,,208053.80,,,,,,,197103.60,212433.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,219004.00000,125927.30000,Hometown Health,Lease Networks,,208053.80,,,,,,,56941.04,212433.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Hometown Health,Lease Networks,,45774.80,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Hometown Health,Lease Networks,,45774.80,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,Lease Networks,,49935.80,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,Lease Networks,,49935.80,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Hometown Health,Lease Networks,,54096.80,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Hometown Health,Lease Networks,,54096.80,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Hometown Health,Lease Networks,,58257.80,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Hometown Health,Lease Networks,,58257.80,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,Lease Networks,,62418.80,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,Lease Networks,,62418.80,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,Lease Networks,,49935.80,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,Lease Networks,,49935.80,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,Lease Networks,,62418.80,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,Lease Networks,,62418.80,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Hometown Health,Lease Networks,,83223.80,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Hometown Health,Lease Networks,,83223.80,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Hometown Health,Lease Networks,,104028.80,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Hometown Health,Lease Networks,,104028.80,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Hometown Health,Lease Networks,,4636.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Hometown Health,Lease Networks,,4636.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Hometown Health,Lease Networks,,45774.80,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Hometown Health,Lease Networks,,45774.80,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,Lease Networks,,49935.80,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,Lease Networks,,49935.80,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Hometown Health,Lease Networks,,54096.80,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Hometown Health,Lease Networks,,54096.80,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Hometown Health,Lease Networks,,58257.80,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Hometown Health,Lease Networks,,58257.80,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Hometown Health,Lease Networks,,66579.80,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Hometown Health,Lease Networks,,66579.80,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Hometown Health,Lease Networks,,74901.80,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Hometown Health,Lease Networks,,74901.80,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Hometown Health,Lease Networks,,83223.80,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Hometown Health,Lease Networks,,83223.80,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Hometown Health,Lease Networks,,91545.80,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Hometown Health,Lease Networks,,91545.80,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Hometown Health,Lease Networks,,104028.80,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Hometown Health,Lease Networks,,104028.80,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,122644.00000,70520.30000,Hometown Health,Lease Networks,,116511.80,,,,,,,110379.60,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Hometown Health,Lease Networks,,116511.80,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,135784.00000,78075.80000,Hometown Health,Lease Networks,,128994.80,,,,,,,122205.60,131710.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,135784.00000,78075.80000,Hometown Health,Lease Networks,,128994.80,,,,,,,35303.84,131710.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Hometown Health,Lease Networks,,45774.80,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Hometown Health,Lease Networks,,45774.80,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,55630.00000,31987.25000,Hometown Health,Lease Networks,,52848.50,,,,,,,50067.00,53961.10,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,55630.00000,31987.25000,Hometown Health,Lease Networks,,52848.50,,,,,,,14463.80,53961.10,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Hometown Health,Lease Networks,,2555.50,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Hometown Health,Lease Networks,,2555.50,,,,,,,699.40,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,14020.00000,8061.50000,Hometown Health,Lease Networks,,13319.00,,,,,,,12618.00,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Hometown Health,Lease Networks,,13319.00,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,17962.00000,10328.15000,Hometown Health,Lease Networks,,17063.90,,,,,,,16165.80,17423.14,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,17962.00000,10328.15000,Hometown Health,Lease Networks,,17063.90,,,,,,,4670.12,17423.14,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,2421.00000,1392.07000,Hometown Health,Lease Networks,,2299.95,,,,,,,2178.90,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,2421.00000,1392.07000,Hometown Health,Lease Networks,,2299.95,,,,,,,629.46,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Hometown Health,Lease Networks,,2304.70,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Hometown Health,Lease Networks,,2304.70,,,,,,,630.76,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Hometown Health,Lease Networks,,2555.50,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Hometown Health,Lease Networks,,2555.50,,,,,,,699.40,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,27160.00000,15617.00000,Hometown Health,Lease Networks,,25802.00,,,,,,,24444.00,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,27160.00000,15617.00000,Hometown Health,Lease Networks,,25802.00,,,,,,,7061.60,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Hometown Health,Lease Networks,,31211.30,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Hometown Health,Lease Networks,,31211.30,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,Lease Networks,,49935.80,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,Lease Networks,,49935.80,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,Lease Networks,,62418.80,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,Lease Networks,,62418.80,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Hometown Health,Lease Networks,,74901.80,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Hometown Health,Lease Networks,,74901.80,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,28470.00000,16370.25000,Hometown Health,Lease Networks,,27046.50,,,,,,,25623.00,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,28470.00000,16370.25000,Hometown Health,Lease Networks,,27046.50,,,,,,,7402.20,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,43800.00000,25185.00000,Hometown Health,Lease Networks,,41610.00,,,,,,,39420.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,43800.00000,25185.00000,Hometown Health,Lease Networks,,41610.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,Lease Networks,,62418.80,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,Lease Networks,,62418.80,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Hometown Health,Lease Networks,,83223.80,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Hometown Health,Lease Networks,,83223.80,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Hometown Health,Lease Networks,,104028.80,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Hometown Health,Lease Networks,,104028.80,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Hometown Health,Lease Networks,,3713.55,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Hometown Health,Lease Networks,,3713.55,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Hometown Health,Lease Networks,,31211.30,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Hometown Health,Lease Networks,,31211.30,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,54754.00000,31483.55000,Hometown Health,Lease Networks,,52016.30,,,,,,,49278.60,53111.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,54754.00000,31483.55000,Hometown Health,Lease Networks,,52016.30,,,,,,,14236.04,53111.38,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Hometown Health,Lease Networks,,2555.50,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Hometown Health,Lease Networks,,2555.50,,,,,,,699.40,2609.30,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,61320.00000,35259.00000,Hometown Health,Lease Networks,,58254.00,,,,,,,55188.00,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,61320.00000,35259.00000,Hometown Health,Lease Networks,,58254.00,,,,,,,15943.20,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,70080.00000,40296.00000,Hometown Health,Lease Networks,,66576.00,,,,,,,63072.00,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,70080.00000,40296.00000,Hometown Health,Lease Networks,,66576.00,,,,,,,18220.80,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,78840.00000,45333.00000,Hometown Health,Lease Networks,,74898.00,,,,,,,70956.00,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,78840.00000,45333.00000,Hometown Health,Lease Networks,,74898.00,,,,,,,20498.40,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Hometown Health,Lease Networks,,91545.80,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Hometown Health,Lease Networks,,91545.80,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Hometown Health,Lease Networks,,104028.80,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Hometown Health,Lease Networks,,104028.80,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,122644.00000,70520.30000,Hometown Health,Lease Networks,,116511.80,,,,,,,110379.60,118964.68,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Hometown Health,Lease Networks,,116511.80,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Hometown Health,Lease Networks,,22889.30,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Hometown Health,Lease Networks,,22889.30,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Hometown Health,Lease Networks,,31211.30,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Hometown Health,Lease Networks,,31211.30,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,1883.00000,1082.72000,Hometown Health,Lease Networks,,1788.85,,,,,,,1694.70,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1883.00000,1082.72000,Hometown Health,Lease Networks,,1788.85,,,,,,,489.58,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Hometown Health,Lease Networks,,3713.55,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Hometown Health,Lease Networks,,3713.55,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,7644.00000,4395.30000,Hometown Health,Lease Networks,,7261.80,,,,,,,6879.60,7414.68,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,7644.00000,4395.30000,Hometown Health,Lease Networks,,7261.80,,,,,,,1987.44,7414.68,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Hometown Health,Lease Networks,,2555.50,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Hometown Health,Lease Networks,,2555.50,,,,,,,699.40,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,inpatient,,,1614.00000,928.05000,Hometown Health,Lease Networks,,1533.30,,,,,,,1452.60,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Hometown Health,Lease Networks,,1533.30,,,,,,,419.64,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Hometown Health,Lease Networks,,22889.30,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Hometown Health,Lease Networks,,22889.30,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Hometown Health,Lease Networks,,27050.30,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Hometown Health,Lease Networks,,27050.30,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Hometown Health,Lease Networks,,31211.30,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Hometown Health,Lease Networks,,31211.30,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,37234.00000,21409.55000,Hometown Health,Lease Networks,,35372.30,,,,,,,33510.60,36116.98,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,37234.00000,21409.55000,Hometown Health,Lease Networks,,35372.30,,,,,,,9680.84,36116.98,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,Lease Networks,,62418.80,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,Lease Networks,,62418.80,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,Lease Networks,,49935.80,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,Lease Networks,,49935.80,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,Lease Networks,,62418.80,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,Lease Networks,,62418.80,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Hometown Health,Lease Networks,,74901.80,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Hometown Health,Lease Networks,,74901.80,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,159.00000,91.42000,Hometown Health,Lease Networks,,151.05,,,,,,,143.10,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,159.00000,91.42000,Hometown Health,Lease Networks,,151.05,,,,,,,41.34,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Hometown Health,Lease Networks,,1793.60,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Hometown Health,Lease Networks,,1793.60,,,,,,,490.88,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Hometown Health,Lease Networks,,1793.60,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Hometown Health,Lease Networks,,1793.60,,,,,,,490.88,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Hometown Health,Lease Networks,,2304.70,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Hometown Health,Lease Networks,,2304.70,,,,,,,630.76,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2827.00000,1625.52000,Hometown Health,Lease Networks,,2685.65,,,,,,,2544.30,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Hometown Health,Lease Networks,,2685.65,,,,,,,735.02,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Hometown Health,Lease Networks,,3173.00,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Hometown Health,Lease Networks,,3173.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8107.00000,4661.52000,Hometown Health,Lease Networks,,7701.65,,,,,,,7296.30,7863.79,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Hometown Health,Lease Networks,,7701.65,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,Lease Networks,,62418.80,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,Lease Networks,,62418.80,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Hometown Health,Lease Networks,,83223.80,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Hometown Health,Lease Networks,,83223.80,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Hometown Health,Lease Networks,,104028.80,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Hometown Health,Lease Networks,,104028.80,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,131404.00000,75557.30000,Hometown Health,Lease Networks,,124833.80,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Hometown Health,Lease Networks,,124833.80,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,18400.00000,10580.00000,Hometown Health,Lease Networks,,17480.00,,,,,,,16560.00,17848.00,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,18400.00000,10580.00000,Hometown Health,Lease Networks,,17480.00,,,,,,,4784.00,17848.00,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Hometown Health,Lease Networks,,22889.30,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Hometown Health,Lease Networks,,22889.30,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Hometown Health,Lease Networks,,27050.30,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Hometown Health,Lease Networks,,27050.30,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Hometown Health,Lease Networks,,31211.30,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Hometown Health,Lease Networks,,31211.30,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1614.00000,928.05000,Hometown Health,Lease Networks,,1533.30,,,,,,,1452.60,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Hometown Health,Lease Networks,,1533.30,,,,,,,419.64,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Hometown Health,Lease Networks,,54096.80,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Hometown Health,Lease Networks,,54096.80,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,Lease Networks,,62418.80,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,Lease Networks,,62418.80,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,5368.00000,3086.60000,Hometown Health,Lease Networks,,5099.60,,,,,,,4831.20,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,5368.00000,3086.60000,Hometown Health,Lease Networks,,5099.60,,,,,,,1395.68,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,14020.00000,8061.50000,Hometown Health,Lease Networks,,13319.00,,,,,,,12618.00,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Hometown Health,Lease Networks,,13319.00,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,25408.00000,14609.60000,Hometown Health,Lease Networks,,24137.60,,,,,,,22867.20,24645.76,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,25408.00000,14609.60000,Hometown Health,Lease Networks,,24137.60,,,,,,,6606.08,24645.76,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,8112.00000,4664.40000,Hometown Health,Lease Networks,,7706.40,,,,,,,7300.80,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,8112.00000,4664.40000,Hometown Health,Lease Networks,,7706.40,,,,,,,2109.12,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,10431.00000,5997.82000,Hometown Health,Lease Networks,,9909.45,,,,,,,9387.90,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,10431.00000,5997.82000,Hometown Health,Lease Networks,,9909.45,,,,,,,2712.06,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Hometown Health,Lease Networks,,31211.30,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Hometown Health,Lease Networks,,31211.30,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,46870.00000,26950.25000,Hometown Health,Lease Networks,,44526.50,,,,,,,42183.00,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,46870.00000,26950.25000,Hometown Health,Lease Networks,,44526.50,,,,,,,12186.20,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,51250.00000,29468.75000,Hometown Health,Lease Networks,,48687.50,,,,,,,46125.00,49712.50,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,51250.00000,29468.75000,Hometown Health,Lease Networks,,48687.50,,,,,,,13325.00,49712.50,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,Lease Networks,,49935.80,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,Lease Networks,,49935.80,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,Lease Networks,,62418.80,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,Lease Networks,,62418.80,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Hometown Health,Lease Networks,,74901.80,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Hometown Health,Lease Networks,,74901.80,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Hometown Health,Lease Networks,,83223.80,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Hometown Health,Lease Networks,,83223.80,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,588.00000,338.10000,Hometown Health,Lease Networks,,558.60,,,,,,,529.20,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,588.00000,338.10000,Hometown Health,Lease Networks,,558.60,,,,,,,152.88,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,Lease Networks,,4177.15,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,Lease Networks,,4177.15,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Hometown Health,Lease Networks,,3713.55,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Hometown Health,Lease Networks,,3713.55,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,Lease Networks,,5104.35,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,Lease Networks,,5104.35,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Hometown Health,Lease Networks,,6162.65,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Hometown Health,Lease Networks,,6162.65,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,7876.00000,4528.70000,Hometown Health,Lease Networks,,7482.20,,,,,,,7088.40,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7876.00000,4528.70000,Hometown Health,Lease Networks,,7482.20,,,,,,,2047.76,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Hometown Health,Lease Networks,,22889.30,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Hometown Health,Lease Networks,,22889.30,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5856.00000,3367.20000,Hometown Health,Lease Networks,,5563.20,,,,,,,5270.40,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5856.00000,3367.20000,Hometown Health,Lease Networks,,5563.20,,,,,,,1522.56,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Hometown Health,Lease Networks,,6162.65,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Hometown Health,Lease Networks,,6162.65,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Hometown Health,Lease Networks,,7042.35,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Hometown Health,Lease Networks,,7042.35,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Hometown Health,Lease Networks,,7922.05,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Hometown Health,Lease Networks,,7922.05,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,Lease Networks,,4177.15,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,Lease Networks,,4177.15,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,Lease Networks,,5104.35,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,Lease Networks,,5104.35,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Hometown Health,Lease Networks,,5722.80,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Hometown Health,Lease Networks,,5722.80,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Hometown Health,Lease Networks,,11880.70,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Hometown Health,Lease Networks,,11880.70,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,Lease Networks,,4177.15,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,Lease Networks,,4177.15,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,Lease Networks,,5104.35,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,Lease Networks,,5104.35,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Hometown Health,Lease Networks,,5722.80,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Hometown Health,Lease Networks,,5722.80,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Hometown Health,Lease Networks,,11880.70,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Hometown Health,Lease Networks,,11880.70,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4392.00000,2525.40000,Hometown Health,Lease Networks,,4172.40,,,,,,,3952.80,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4392.00000,2525.40000,Hometown Health,Lease Networks,,4172.40,,,,,,,1141.92,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,Lease Networks,,5104.35,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,Lease Networks,,5104.35,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Hometown Health,Lease Networks,,6162.65,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Hometown Health,Lease Networks,,6162.65,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,Lease Networks,,4177.15,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,Lease Networks,,4177.15,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,Lease Networks,,5104.35,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,Lease Networks,,5104.35,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Hometown Health,Lease Networks,,6162.65,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Hometown Health,Lease Networks,,6162.65,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Hometown Health,Lease Networks,,4636.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Hometown Health,Lease Networks,,4636.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Hometown Health,Lease Networks,,1069.70,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Hometown Health,Lease Networks,,1069.70,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,Lease Networks,,4177.15,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,Lease Networks,,4177.15,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,Lease Networks,,5104.35,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,Lease Networks,,5104.35,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Hometown Health,Lease Networks,,5722.80,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Hometown Health,Lease Networks,,5722.80,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Hometown Health,Lease Networks,,11880.70,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Hometown Health,Lease Networks,,11880.70,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Hometown Health,Lease Networks,,12902.90,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Hometown Health,Lease Networks,,12902.90,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2152.00000,1237.40000,Hometown Health,Lease Networks,,2044.40,,,,,,,1936.80,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2152.00000,1237.40000,Hometown Health,Lease Networks,,2044.40,,,,,,,559.52,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Hometown Health,Lease Networks,,4636.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Hometown Health,Lease Networks,,4636.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Hometown Health,Lease Networks,,3713.55,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Hometown Health,Lease Networks,,3713.55,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Hometown Health,Lease Networks,,5567.95,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Hometown Health,Lease Networks,,5567.95,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Hometown Health,Lease Networks,,5722.80,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Hometown Health,Lease Networks,,5722.80,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,Lease Networks,,4177.15,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,Lease Networks,,4177.15,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,Lease Networks,,5104.35,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,Lease Networks,,5104.35,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Hometown Health,Lease Networks,,5722.80,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Hometown Health,Lease Networks,,5722.80,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Hometown Health,Lease Networks,,1069.70,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Hometown Health,Lease Networks,,1069.70,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,Lease Networks,,4177.15,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,Lease Networks,,4177.15,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,Lease Networks,,5104.35,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,Lease Networks,,5104.35,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Hometown Health,Lease Networks,,5722.80,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Hometown Health,Lease Networks,,5722.80,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Hometown Health,Lease Networks,,11880.70,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Hometown Health,Lease Networks,,11880.70,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Hometown Health,Lease Networks,,12902.90,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Hometown Health,Lease Networks,,12902.90,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,Lease Networks,,5104.35,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,Lease Networks,,5104.35,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8802.00000,5061.15000,Hometown Health,Lease Networks,,8361.90,,,,,,,7921.80,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8802.00000,5061.15000,Hometown Health,Lease Networks,,8361.90,,,,,,,2288.52,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,10654.00000,6126.05000,Hometown Health,Lease Networks,,10121.30,,,,,,,9588.60,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10654.00000,6126.05000,Hometown Health,Lease Networks,,10121.30,,,,,,,2770.04,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Hometown Health,Lease Networks,,11880.70,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Hometown Health,Lease Networks,,11880.70,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Hometown Health,Lease Networks,,12902.90,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Hometown Health,Lease Networks,,12902.90,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17086.00000,9824.45000,Hometown Health,Lease Networks,,16231.70,,,,,,,15377.40,16573.42,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17086.00000,9824.45000,Hometown Health,Lease Networks,,16231.70,,,,,,,4442.36,16573.42,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Hometown Health,Lease Networks,,4636.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Hometown Health,Lease Networks,,4636.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Hometown Health,Lease Networks,,6162.65,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Hometown Health,Lease Networks,,6162.65,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Hometown Health,Lease Networks,,7042.35,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Hometown Health,Lease Networks,,7042.35,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Hometown Health,Lease Networks,,7922.05,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Hometown Health,Lease Networks,,7922.05,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Hometown Health,Lease Networks,,4636.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Hometown Health,Lease Networks,,4636.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Hometown Health,Lease Networks,,4636.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Hometown Health,Lease Networks,,4636.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,Lease Networks,,3416.20,,,,,,,934.96,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,Lease Networks,,4177.15,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,Lease Networks,,4177.15,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,Lease Networks,,5799.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Hometown Health,Lease Networks,,22889.30,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Hometown Health,Lease Networks,,22889.30,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Hometown Health,Lease Networks,,3713.55,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Hometown Health,Lease Networks,,3713.55,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Hometown Health,Lease Networks,,6162.65,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Hometown Health,Lease Networks,,6162.65,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Hometown Health,Lease Networks,,1793.60,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Hometown Health,Lease Networks,,1793.60,,,,,,,490.88,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Hometown Health,Lease Networks,,2304.70,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Hometown Health,Lease Networks,,2304.70,,,,,,,630.76,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2827.00000,1625.52000,Hometown Health,Lease Networks,,2685.65,,,,,,,2544.30,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Hometown Health,Lease Networks,,2685.65,,,,,,,735.02,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Hometown Health,Lease Networks,,3173.00,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Hometown Health,Lease Networks,,3173.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4153.00000,2387.98000,Hometown Health,Lease Networks,,3945.35,,,,,,,3737.70,4028.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Hometown Health,Lease Networks,,3945.35,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Hometown Health,Lease Networks,,7042.35,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Hometown Health,Lease Networks,,7042.35,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Hometown Health,Lease Networks,,7922.05,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Hometown Health,Lease Networks,,7922.05,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9728.00000,5593.60000,Hometown Health,Lease Networks,,9241.60,,,,,,,8755.20,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9728.00000,5593.60000,Hometown Health,Lease Networks,,9241.60,,,,,,,2529.28,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11117.00000,6392.28000,Hometown Health,Lease Networks,,10561.15,,,,,,,10005.30,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11117.00000,6392.28000,Hometown Health,Lease Networks,,10561.15,,,,,,,2890.42,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Hometown Health,Lease Networks,,45774.80,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Hometown Health,Lease Networks,,45774.80,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,Lease Networks,,49935.80,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,Lease Networks,,49935.80,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Hometown Health,Lease Networks,,54096.80,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Hometown Health,Lease Networks,,54096.80,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Hometown Health,Lease Networks,,58257.80,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Hometown Health,Lease Networks,,58257.80,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,Lease Networks,,62418.80,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,Lease Networks,,62418.80,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Hometown Health,Lease Networks,,66579.80,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Hometown Health,Lease Networks,,66579.80,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,74464.00000,42816.80000,Hometown Health,Lease Networks,,70740.80,,,,,,,67017.60,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Hometown Health,Lease Networks,,70740.80,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Hometown Health,Lease Networks,,74901.80,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Hometown Health,Lease Networks,,74901.80,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,83224.00000,47853.80000,Hometown Health,Lease Networks,,79062.80,,,,,,,74901.60,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Hometown Health,Lease Networks,,79062.80,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,111694.00000,64224.05000,Hometown Health,Lease Networks,,106109.30,,,,,,,100524.60,108343.18,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,111694.00000,64224.05000,Hometown Health,Lease Networks,,106109.30,,,,,,,29040.44,108343.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Hometown Health,Lease Networks,,424.65,,,,,,,402.30,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Hometown Health,Lease Networks,,424.65,,,,,,,116.22,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Hometown Health,Lease Networks,,673.55,,,,,,,638.10,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Hometown Health,Lease Networks,,673.55,,,,,,,184.34,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,991.00000,569.82000,Hometown Health,Lease Networks,,941.45,,,,,,,891.90,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,991.00000,569.82000,Hometown Health,Lease Networks,,941.45,,,,,,,257.66,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1490.00000,856.75000,Hometown Health,Lease Networks,,1415.50,,,,,,,1341.00,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1490.00000,856.75000,Hometown Health,Lease Networks,,1415.50,,,,,,,387.40,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Hometown Health,Lease Networks,,3713.55,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Hometown Health,Lease Networks,,3713.55,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Hometown Health,Lease Networks,,5567.95,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Hometown Health,Lease Networks,,5567.95,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Hometown Health,Lease Networks,,6162.65,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Hometown Health,Lease Networks,,6162.65,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Hometown Health,Lease Networks,,7042.35,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Hometown Health,Lease Networks,,7042.35,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Hometown Health,Lease Networks,,7922.05,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Hometown Health,Lease Networks,,7922.05,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,Lease Networks,,1342.35,,,,,,,367.38,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,Lease Networks,,3660.35,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,6945.00000,3993.37000,Hometown Health,Lease Networks,,6597.75,,,,,,,6250.50,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,6945.00000,3993.37000,Hometown Health,Lease Networks,,6597.75,,,,,,,1805.70,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Hometown Health,Lease Networks,,424.65,,,,,,,402.30,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Hometown Health,Lease Networks,,424.65,,,,,,,116.22,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Hometown Health,Lease Networks,,3713.55,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Hometown Health,Lease Networks,,3713.55,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,Lease Networks,,5104.35,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,Lease Networks,,5104.35,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,Lease Networks,,1075.40,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,50374.00000,28965.05000,Hometown Health,Lease Networks,,47855.30,,,,,,,45336.60,48862.78,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,50374.00000,28965.05000,Hometown Health,Lease Networks,,47855.30,,,,,,,13097.24,48862.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,Lease Networks,,18728.30,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Hometown Health,Lease Networks,,22889.30,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Hometown Health,Lease Networks,,22889.30,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Hometown Health,Lease Networks,,27050.30,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Hometown Health,Lease Networks,,27050.30,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,Lease Networks,,2560.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,Lease Networks,,6602.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,Lease Networks,,11001.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,Lease Networks,,14567.30,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Hometown Health,Lease Networks,,45774.80,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Hometown Health,Lease Networks,,45774.80,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,Lease Networks,,2049.15,,,,,,,560.82,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,Lease Networks,,2928.85,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,Lease Networks,,2928.85,,,,,,,801.58,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Hometown Health,Lease Networks,,45774.80,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Hometown Health,Lease Networks,,45774.80,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,Lease Networks,,49935.80,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,Lease Networks,,49935.80,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Hometown Health,Lease Networks,,54096.80,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Hometown Health,Lease Networks,,54096.80,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,Lease Networks,,62418.80,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,Lease Networks,,62418.80,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,74464.00000,42816.80000,Hometown Health,Lease Networks,,70740.80,,,,,,,67017.60,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Hometown Health,Lease Networks,,70740.80,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,83224.00000,47853.80000,Hometown Health,Lease Networks,,79062.80,,,,,,,74901.60,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Hometown Health,Lease Networks,,79062.80,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,91984.00000,52890.80000,Hometown Health,Lease Networks,,87384.80,,,,,,,82785.60,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,91984.00000,52890.80000,Hometown Health,Lease Networks,,87384.80,,,,,,,23915.84,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,100744.00000,57927.80000,Hometown Health,Lease Networks,,95706.80,,,,,,,90669.60,97721.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,100744.00000,57927.80000,Hometown Health,Lease Networks,,95706.80,,,,,,,26193.44,97721.68,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,Lease Networks,,157.70,,,,,,,149.40,161.02,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,Lease Networks,,157.70,,,,,,,43.16,161.02,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Hometown Health,Lease Networks,,424.65,,,,,,,402.30,433.59,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Hometown Health,Lease Networks,,424.65,,,,,,,116.22,433.59,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Hometown Health,Lease Networks,,673.55,,,,,,,638.10,687.73,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Hometown Health,Lease Networks,,673.55,,,,,,,184.34,687.73,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,Lease Networks,,16647.80,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,Lease Networks,,20808.80,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,Lease Networks,,24969.80,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,Lease Networks,,29130.80,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,Lease Networks,,33291.80,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,Lease Networks,,37452.80,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,Lease Networks,,41613.80,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,Lease Networks,,49935.80,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,Lease Networks,,49935.80,,,,,,,13666.64,50987.08,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,4396.50,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,Lease Networks,,4640.75,,,,,,,1270.10,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,8338.50,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,Lease Networks,,8801.75,,,,,,,2408.90,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,12505.50,13478.15,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,Lease Networks,,13200.25,,,,,,,3612.70,13478.15,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2180.20000,1253.61000,Hometown Health,Lease Networks,,2071.19,,,,,,,1962.18,2114.79,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2180.20000,1253.61000,Hometown Health,Lease Networks,,2071.19,,,,,,,566.85,2114.79,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1880.60000,1081.34000,Hometown Health,Lease Networks,,1786.57,,,,,,,1692.54,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1880.60000,1081.34000,Hometown Health,Lease Networks,,1786.57,,,,,,,488.96,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2908.70000,1672.50000,Hometown Health,Lease Networks,,2763.26,,,,,,,2617.83,2821.44,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2908.70000,1672.50000,Hometown Health,Lease Networks,,2763.26,,,,,,,756.26,2821.44,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,inpatient,,,34.00000,25.74000,Hometown Health,Lease Networks,,32.30,,,,,,,30.60,32.98,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,outpatient,,,34.00000,25.74000,Hometown Health,Lease Networks,,32.30,,,,,,,8.84,32.98,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,inpatient,,,13.00000,9.84000,Hometown Health,Lease Networks,,12.35,,,,,,,11.70,12.61,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,outpatient,,,13.00000,9.84000,Hometown Health,Lease Networks,,12.35,,,,,,,3.38,12.61,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Hometown Health,Lease Networks,,266.95,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Hometown Health,Lease Networks,,266.95,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Hometown Health,Lease Networks,,266.95,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Hometown Health,Lease Networks,,266.95,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Hometown Health,Lease Networks,,266.95,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Hometown Health,Lease Networks,,266.95,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Hometown Health,Lease Networks,,713.45,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Hometown Health,Lease Networks,,713.45,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Hometown Health,Lease Networks,,713.45,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Hometown Health,Lease Networks,,713.45,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Hometown Health,Lease Networks,,713.45,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Hometown Health,Lease Networks,,713.45,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,inpatient,,,122.00000,92.35000,Hometown Health,Lease Networks,,115.90,,,,,,,109.80,118.34,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,outpatient,,,122.00000,92.35000,Hometown Health,Lease Networks,,115.90,,,,,,,31.72,118.34,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,inpatient,,,79.00000,59.80000,Hometown Health,Lease Networks,,75.05,,,,,,,71.10,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Hometown Health,Lease Networks,,75.05,,,,,,,20.54,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,inpatient,,,79.00000,59.80000,Hometown Health,Lease Networks,,75.05,,,,,,,71.10,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Hometown Health,Lease Networks,,75.05,,,,,,,20.54,76.63,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,inpatient,,,15.00000,11.36000,Hometown Health,Lease Networks,,14.25,,,,,,,13.50,14.55,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Hometown Health,Lease Networks,,14.25,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,inpatient,,,15.00000,11.36000,Hometown Health,Lease Networks,,14.25,,,,,,,13.50,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Hometown Health,Lease Networks,,14.25,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,inpatient,,,17.00000,12.87000,Hometown Health,Lease Networks,,16.15,,,,,,,15.30,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Hometown Health,Lease Networks,,16.15,,,,,,,4.42,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,inpatient,,,17.00000,12.87000,Hometown Health,Lease Networks,,16.15,,,,,,,15.30,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Hometown Health,Lease Networks,,16.15,,,,,,,4.42,16.49,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,inpatient,,,359.00000,271.76000,Hometown Health,Lease Networks,,341.05,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,outpatient,,,359.00000,271.76000,Hometown Health,Lease Networks,,341.05,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,inpatient,,,359.00000,271.76000,Hometown Health,Lease Networks,,341.05,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,outpatient,,,359.00000,271.76000,Hometown Health,Lease Networks,,341.05,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,inpatient,,,359.00000,271.76000,Hometown Health,Lease Networks,,341.05,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,outpatient,,,359.00000,271.76000,Hometown Health,Lease Networks,,341.05,,,,,,,93.34,348.23,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,inpatient,,,155.00000,117.34000,Hometown Health,Lease Networks,,147.25,,,,,,,139.50,150.35,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,outpatient,,,155.00000,117.34000,Hometown Health,Lease Networks,,147.25,,,,,,,40.30,150.35,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,inpatient,,,294.00000,222.56000,Hometown Health,Lease Networks,,279.30,,,,,,,264.60,285.18,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,outpatient,,,294.00000,222.56000,Hometown Health,Lease Networks,,279.30,,,,,,,76.44,285.18,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,inpatient,,,1511.00000,1143.83000,Hometown Health,Lease Networks,,1435.45,,,,,,,1359.90,1465.67,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,outpatient,,,1511.00000,1143.83000,Hometown Health,Lease Networks,,1435.45,,,,,,,392.86,1465.67,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,inpatient,,,751.00000,568.51000,Hometown Health,Lease Networks,,713.45,,,,,,,675.90,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Hometown Health,Lease Networks,,713.45,,,,,,,195.26,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,inpatient,,,751.00000,568.51000,Hometown Health,Lease Networks,,713.45,,,,,,,675.90,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Hometown Health,Lease Networks,,713.45,,,,,,,195.26,728.47,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,inpatient,,,150.00000,113.55000,Hometown Health,Lease Networks,,142.50,,,,,,,135.00,145.50,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,outpatient,,,150.00000,113.55000,Hometown Health,Lease Networks,,142.50,,,,,,,39.00,145.50,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,inpatient,,,110.00000,83.27000,Hometown Health,Lease Networks,,104.50,,,,,,,99.00,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,outpatient,,,110.00000,83.27000,Hometown Health,Lease Networks,,104.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,inpatient,,,158.00000,119.61000,Hometown Health,Lease Networks,,150.10,,,,,,,142.20,153.26,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,outpatient,,,158.00000,119.61000,Hometown Health,Lease Networks,,150.10,,,,,,,41.08,153.26,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,inpatient,,,153.00000,115.82000,Hometown Health,Lease Networks,,145.35,,,,,,,137.70,148.41,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,outpatient,,,153.00000,115.82000,Hometown Health,Lease Networks,,145.35,,,,,,,39.78,148.41,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,inpatient,,,157.00000,118.85000,Hometown Health,Lease Networks,,149.15,,,,,,,141.30,152.29,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,outpatient,,,157.00000,118.85000,Hometown Health,Lease Networks,,149.15,,,,,,,40.82,152.29,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,inpatient,,,26.00000,19.68000,Hometown Health,Lease Networks,,24.70,,,,,,,23.40,25.22,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,outpatient,,,26.00000,19.68000,Hometown Health,Lease Networks,,24.70,,,,,,,6.76,25.22,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,inpatient,,,37.00000,28.01000,Hometown Health,Lease Networks,,35.15,,,,,,,33.30,35.89,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,outpatient,,,37.00000,28.01000,Hometown Health,Lease Networks,,35.15,,,,,,,9.62,35.89,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,inpatient,,,268.00000,202.88000,Hometown Health,Lease Networks,,254.60,,,,,,,241.20,259.96,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,outpatient,,,268.00000,202.88000,Hometown Health,Lease Networks,,254.60,,,,,,,69.68,259.96,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,inpatient,,,91.00000,68.89000,Hometown Health,Lease Networks,,86.45,,,,,,,81.90,88.27,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,outpatient,,,91.00000,68.89000,Hometown Health,Lease Networks,,86.45,,,,,,,23.66,88.27,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,inpatient,,,200.00000,151.40000,Hometown Health,Lease Networks,,190.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,outpatient,,,200.00000,151.40000,Hometown Health,Lease Networks,,190.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,inpatient,,,152.00000,115.06000,Hometown Health,Lease Networks,,144.40,,,,,,,136.80,147.44,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,outpatient,,,152.00000,115.06000,Hometown Health,Lease Networks,,144.40,,,,,,,39.52,147.44,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,inpatient,,,359.00000,271.76000,Hometown Health,Lease Networks,,341.05,,,,,,,323.10,348.23,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,outpatient,,,359.00000,271.76000,Hometown Health,Lease Networks,,341.05,,,,,,,93.34,348.23,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,Lease Networks,,65.55,,,,,,,62.10,66.93,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,Lease Networks,,65.55,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,inpatient,,,75.00000,36.15000,Hometown Health,Lease Networks,,71.25,,,,,,,67.50,72.75,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,outpatient,,,75.00000,36.15000,Hometown Health,Lease Networks,,71.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,inpatient,,,45.00000,21.69000,Hometown Health,Lease Networks,,42.75,,,,,,,40.50,43.65,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,outpatient,,,45.00000,21.69000,Hometown Health,Lease Networks,,42.75,,,,,,,11.70,43.65,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,Lease Networks,,64.60,,,,,,,61.20,65.96,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,Lease Networks,,64.60,,,,,,,17.68,65.96,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,Lease Networks,,60.80,,,,,,,57.60,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,Lease Networks,,60.80,,,,,,,16.64,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,inpatient,,,195.00000,93.99000,Hometown Health,Lease Networks,,185.25,,,,,,,175.50,189.15,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,outpatient,,,195.00000,93.99000,Hometown Health,Lease Networks,,185.25,,,,,,,50.70,189.15,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,inpatient,,,14.00000,6.75000,Hometown Health,Lease Networks,,13.30,,,,,,,12.60,13.58,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,outpatient,,,14.00000,6.75000,Hometown Health,Lease Networks,,13.30,,,,,,,3.64,13.58,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,Lease Networks,,50.35,,,,,,,47.70,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,Lease Networks,,50.35,,,,,,,13.78,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,Lease Networks,,77.90,,,,,,,73.80,79.54,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,Lease Networks,,77.90,,,,,,,21.32,79.54,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,inpatient,,,141.00000,67.96000,Hometown Health,Lease Networks,,133.95,,,,,,,126.90,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Hometown Health,Lease Networks,,133.95,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,inpatient,,,141.00000,67.96000,Hometown Health,Lease Networks,,133.95,,,,,,,126.90,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Hometown Health,Lease Networks,,133.95,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,inpatient,,,91.00000,43.86000,Hometown Health,Lease Networks,,86.45,,,,,,,81.90,88.27,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,outpatient,,,91.00000,43.86000,Hometown Health,Lease Networks,,86.45,,,,,,,23.66,88.27,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,Lease Networks,,65.55,,,,,,,62.10,66.93,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,Lease Networks,,65.55,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,inpatient,,,205.00000,98.81000,Hometown Health,Lease Networks,,194.75,,,,,,,184.50,198.85,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,outpatient,,,205.00000,98.81000,Hometown Health,Lease Networks,,194.75,,,,,,,53.30,198.85,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,inpatient,,,50.00000,24.10000,Hometown Health,Lease Networks,,47.50,,,,,,,45.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,outpatient,,,50.00000,24.10000,Hometown Health,Lease Networks,,47.50,,,,,,,13.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,inpatient,,,406.00000,195.69000,Hometown Health,Lease Networks,,385.70,,,,,,,365.40,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,outpatient,,,406.00000,195.69000,Hometown Health,Lease Networks,,385.70,,,,,,,105.56,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,inpatient,,,101.00000,48.68000,Hometown Health,Lease Networks,,95.95,,,,,,,90.90,97.97,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,outpatient,,,101.00000,48.68000,Hometown Health,Lease Networks,,95.95,,,,,,,26.26,97.97,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,inpatient,,,375.00000,180.75000,Hometown Health,Lease Networks,,356.25,,,,,,,337.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,outpatient,,,375.00000,180.75000,Hometown Health,Lease Networks,,356.25,,,,,,,97.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,inpatient,,,362.00000,174.48000,Hometown Health,Lease Networks,,343.90,,,,,,,325.80,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,outpatient,,,362.00000,174.48000,Hometown Health,Lease Networks,,343.90,,,,,,,94.12,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,inpatient,,,325.00000,156.65000,Hometown Health,Lease Networks,,308.75,,,,,,,292.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,outpatient,,,325.00000,156.65000,Hometown Health,Lease Networks,,308.75,,,,,,,84.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,inpatient,,,121.00000,58.32000,Hometown Health,Lease Networks,,114.95,,,,,,,108.90,117.37,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,outpatient,,,121.00000,58.32000,Hometown Health,Lease Networks,,114.95,,,,,,,31.46,117.37,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,inpatient,,,115.00000,55.43000,Hometown Health,Lease Networks,,109.25,,,,,,,103.50,111.55,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,outpatient,,,115.00000,55.43000,Hometown Health,Lease Networks,,109.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,inpatient,,,300.00000,144.60000,Hometown Health,Lease Networks,,285.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,outpatient,,,300.00000,144.60000,Hometown Health,Lease Networks,,285.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,Lease Networks,,48.45,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,Lease Networks,,48.45,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,Lease Networks,,48.45,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,Lease Networks,,48.45,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,Lease Networks,,48.45,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,Lease Networks,,48.45,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,inpatient,,,194.00000,93.51000,Hometown Health,Lease Networks,,184.30,,,,,,,174.60,188.18,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,outpatient,,,194.00000,93.51000,Hometown Health,Lease Networks,,184.30,,,,,,,50.44,188.18,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,Lease Networks,,64.60,,,,,,,61.20,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,Lease Networks,,64.60,,,,,,,17.68,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,inpatient,,,329.00000,158.58000,Hometown Health,Lease Networks,,312.55,,,,,,,296.10,319.13,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,outpatient,,,329.00000,158.58000,Hometown Health,Lease Networks,,312.55,,,,,,,85.54,319.13,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,inpatient,,,24.00000,11.57000,Hometown Health,Lease Networks,,22.80,,,,,,,21.60,23.28,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,outpatient,,,24.00000,11.57000,Hometown Health,Lease Networks,,22.80,,,,,,,6.24,23.28,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,inpatient,,,30.00000,14.46000,Hometown Health,Lease Networks,,28.50,,,,,,,27.00,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,outpatient,,,30.00000,14.46000,Hometown Health,Lease Networks,,28.50,,,,,,,7.80,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,Lease Networks,,50.35,,,,,,,47.70,51.41,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,Lease Networks,,50.35,,,,,,,13.78,51.41,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,inpatient,,,270.00000,130.14000,Hometown Health,Lease Networks,,256.50,,,,,,,243.00,261.90,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,outpatient,,,270.00000,130.14000,Hometown Health,Lease Networks,,256.50,,,,,,,70.20,261.90,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,inpatient,,,123.00000,59.29000,Hometown Health,Lease Networks,,116.85,,,,,,,110.70,119.31,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Hometown Health,Lease Networks,,116.85,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,inpatient,,,123.00000,59.29000,Hometown Health,Lease Networks,,116.85,,,,,,,110.70,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Hometown Health,Lease Networks,,116.85,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,inpatient,,,37.00000,17.83000,Hometown Health,Lease Networks,,35.15,,,,,,,33.30,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,outpatient,,,37.00000,17.83000,Hometown Health,Lease Networks,,35.15,,,,,,,9.62,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,inpatient,,,41.00000,19.76000,Hometown Health,Lease Networks,,38.95,,,,,,,36.90,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,outpatient,,,41.00000,19.76000,Hometown Health,Lease Networks,,38.95,,,,,,,10.66,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,Lease Networks,,68.40,,,,,,,64.80,69.84,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,Lease Networks,,68.40,,,,,,,18.72,69.84,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,Lease Networks,,73.15,,,,,,,69.30,74.69,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,Lease Networks,,73.15,,,,,,,20.02,74.69,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,inpatient,,,90.00000,43.38000,Hometown Health,Lease Networks,,85.50,,,,,,,81.00,87.30,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,outpatient,,,90.00000,43.38000,Hometown Health,Lease Networks,,85.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,inpatient,,,44.00000,21.21000,Hometown Health,Lease Networks,,41.80,,,,,,,39.60,42.68,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,outpatient,,,44.00000,21.21000,Hometown Health,Lease Networks,,41.80,,,,,,,11.44,42.68,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,inpatient,,,115.00000,55.43000,Hometown Health,Lease Networks,,109.25,,,,,,,103.50,111.55,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,outpatient,,,115.00000,55.43000,Hometown Health,Lease Networks,,109.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,inpatient,,,20.00000,9.64000,Hometown Health,Lease Networks,,19.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,outpatient,,,20.00000,9.64000,Hometown Health,Lease Networks,,19.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,46.80,50.44,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,13.52,50.44,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,inpatient,,,341.00000,164.36000,Hometown Health,Lease Networks,,323.95,,,,,,,306.90,330.77,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,outpatient,,,341.00000,164.36000,Hometown Health,Lease Networks,,323.95,,,,,,,88.66,330.77,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,Lease Networks,,51.30,,,,,,,48.60,52.38,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,Lease Networks,,51.30,,,,,,,14.04,52.38,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,Lease Networks,,50.35,,,,,,,47.70,51.41,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,Lease Networks,,50.35,,,,,,,13.78,51.41,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,inpatient,,,88.00000,42.42000,Hometown Health,Lease Networks,,83.60,,,,,,,79.20,85.36,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,outpatient,,,88.00000,42.42000,Hometown Health,Lease Networks,,83.60,,,,,,,22.88,85.36,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,inpatient,,,89.00000,42.90000,Hometown Health,Lease Networks,,84.55,,,,,,,80.10,86.33,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,outpatient,,,89.00000,42.90000,Hometown Health,Lease Networks,,84.55,,,,,,,23.14,86.33,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,Lease Networks,,73.15,,,,,,,69.30,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,Lease Networks,,73.15,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,Lease Networks,,73.15,,,,,,,69.30,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,Lease Networks,,73.15,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,Lease Networks,,60.80,,,,,,,57.60,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,Lease Networks,,60.80,,,,,,,16.64,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,Lease Networks,,60.80,,,,,,,57.60,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,Lease Networks,,60.80,,,,,,,16.64,62.08,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,inpatient,,,95.00000,45.79000,Hometown Health,Lease Networks,,90.25,,,,,,,85.50,92.15,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,outpatient,,,95.00000,45.79000,Hometown Health,Lease Networks,,90.25,,,,,,,24.70,92.15,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,inpatient,,,132.00000,63.62000,Hometown Health,Lease Networks,,125.40,,,,,,,118.80,128.04,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,outpatient,,,132.00000,63.62000,Hometown Health,Lease Networks,,125.40,,,,,,,34.32,128.04,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,inpatient,,,83.00000,40.01000,Hometown Health,Lease Networks,,78.85,,,,,,,74.70,80.51,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,outpatient,,,83.00000,40.01000,Hometown Health,Lease Networks,,78.85,,,,,,,21.58,80.51,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,inpatient,,,387.00000,186.53000,Hometown Health,Lease Networks,,367.65,,,,,,,348.30,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,outpatient,,,387.00000,186.53000,Hometown Health,Lease Networks,,367.65,,,,,,,100.62,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,inpatient,,,387.00000,186.53000,Hometown Health,Lease Networks,,367.65,,,,,,,348.30,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,outpatient,,,387.00000,186.53000,Hometown Health,Lease Networks,,367.65,,,,,,,100.62,375.39,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,inpatient,,,31.00000,14.94000,Hometown Health,Lease Networks,,29.45,,,,,,,27.90,30.07,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,outpatient,,,31.00000,14.94000,Hometown Health,Lease Networks,,29.45,,,,,,,8.06,30.07,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,inpatient,,,36.00000,17.35000,Hometown Health,Lease Networks,,34.20,,,,,,,32.40,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,outpatient,,,36.00000,17.35000,Hometown Health,Lease Networks,,34.20,,,,,,,9.36,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,inpatient,,,160.00000,77.12000,Hometown Health,Lease Networks,,152.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,outpatient,,,160.00000,77.12000,Hometown Health,Lease Networks,,152.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,inpatient,,,112.00000,53.98000,Hometown Health,Lease Networks,,106.40,,,,,,,100.80,108.64,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,outpatient,,,112.00000,53.98000,Hometown Health,Lease Networks,,106.40,,,,,,,29.12,108.64,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,inpatient,,,14.00000,6.75000,Hometown Health,Lease Networks,,13.30,,,,,,,12.60,13.58,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,outpatient,,,14.00000,6.75000,Hometown Health,Lease Networks,,13.30,,,,,,,3.64,13.58,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,inpatient,,,16.00000,7.71000,Hometown Health,Lease Networks,,15.20,,,,,,,14.40,15.52,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,outpatient,,,16.00000,7.71000,Hometown Health,Lease Networks,,15.20,,,,,,,4.16,15.52,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,Lease Networks,,67.45,,,,,,,63.90,68.87,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,Lease Networks,,67.45,,,,,,,18.46,68.87,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,inpatient,,,116.00000,55.91000,Hometown Health,Lease Networks,,110.20,,,,,,,104.40,112.52,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,outpatient,,,116.00000,55.91000,Hometown Health,Lease Networks,,110.20,,,,,,,30.16,112.52,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,inpatient,,,81.00000,39.04000,Hometown Health,Lease Networks,,76.95,,,,,,,72.90,78.57,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,outpatient,,,81.00000,39.04000,Hometown Health,Lease Networks,,76.95,,,,,,,21.06,78.57,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,inpatient,,,97.00000,46.75000,Hometown Health,Lease Networks,,92.15,,,,,,,87.30,94.09,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,outpatient,,,97.00000,46.75000,Hometown Health,Lease Networks,,92.15,,,,,,,25.22,94.09,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,Lease Networks,,73.15,,,,,,,69.30,74.69,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,Lease Networks,,73.15,,,,,,,20.02,74.69,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,inpatient,,,35.00000,16.87000,Hometown Health,Lease Networks,,33.25,,,,,,,31.50,33.95,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,outpatient,,,35.00000,16.87000,Hometown Health,Lease Networks,,33.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,inpatient,,,65.00000,31.33000,Hometown Health,Lease Networks,,61.75,,,,,,,58.50,63.05,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,outpatient,,,65.00000,31.33000,Hometown Health,Lease Networks,,61.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,inpatient,,,74.00000,35.67000,Hometown Health,Lease Networks,,70.30,,,,,,,66.60,71.78,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,outpatient,,,74.00000,35.67000,Hometown Health,Lease Networks,,70.30,,,,,,,19.24,71.78,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,inpatient,,,250.00000,120.50000,Hometown Health,Lease Networks,,237.50,,,,,,,225.00,242.50,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,outpatient,,,250.00000,120.50000,Hometown Health,Lease Networks,,237.50,,,,,,,65.00,242.50,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,inpatient,,,90.00000,43.38000,Hometown Health,Lease Networks,,85.50,,,,,,,81.00,87.30,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,outpatient,,,90.00000,43.38000,Hometown Health,Lease Networks,,85.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,inpatient,,,90.00000,43.38000,Hometown Health,Lease Networks,,85.50,,,,,,,81.00,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,outpatient,,,90.00000,43.38000,Hometown Health,Lease Networks,,85.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,46.80,50.44,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,13.52,50.44,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,inpatient,,,36.00000,17.35000,Hometown Health,Lease Networks,,34.20,,,,,,,32.40,34.92,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,outpatient,,,36.00000,17.35000,Hometown Health,Lease Networks,,34.20,,,,,,,9.36,34.92,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,inpatient,,,78.00000,37.60000,Hometown Health,Lease Networks,,74.10,,,,,,,70.20,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,outpatient,,,78.00000,37.60000,Hometown Health,Lease Networks,,74.10,,,,,,,20.28,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,inpatient,,,115.00000,55.43000,Hometown Health,Lease Networks,,109.25,,,,,,,103.50,111.55,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,outpatient,,,115.00000,55.43000,Hometown Health,Lease Networks,,109.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,60.30,64.99,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,17.42,64.99,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,inpatient,,,76.00000,36.63000,Hometown Health,Lease Networks,,72.20,,,,,,,68.40,73.72,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,outpatient,,,76.00000,36.63000,Hometown Health,Lease Networks,,72.20,,,,,,,19.76,73.72,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,Lease Networks,,50.35,,,,,,,47.70,51.41,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,Lease Networks,,50.35,,,,,,,13.78,51.41,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,Lease Networks,,66.50,,,,,,,63.00,67.90,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,Lease Networks,,66.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,inpatient,,,169.00000,81.46000,Hometown Health,Lease Networks,,160.55,,,,,,,152.10,163.93,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,outpatient,,,169.00000,81.46000,Hometown Health,Lease Networks,,160.55,,,,,,,43.94,163.93,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,inpatient,,,28.00000,13.50000,Hometown Health,Lease Networks,,26.60,,,,,,,25.20,27.16,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,outpatient,,,28.00000,13.50000,Hometown Health,Lease Networks,,26.60,,,,,,,7.28,27.16,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,Lease Networks,,48.45,,,,,,,45.90,49.47,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,Lease Networks,,48.45,,,,,,,13.26,49.47,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,inpatient,,,15.00000,7.23000,Hometown Health,Lease Networks,,14.25,,,,,,,13.50,14.55,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,outpatient,,,15.00000,7.23000,Hometown Health,Lease Networks,,14.25,,,,,,,3.90,14.55,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,inpatient,,,18.00000,8.68000,Hometown Health,Lease Networks,,17.10,,,,,,,16.20,17.46,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,outpatient,,,18.00000,8.68000,Hometown Health,Lease Networks,,17.10,,,,,,,4.68,17.46,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,inpatient,,,550.00000,265.10000,Hometown Health,Lease Networks,,522.50,,,,,,,495.00,533.50,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,outpatient,,,550.00000,265.10000,Hometown Health,Lease Networks,,522.50,,,,,,,143.00,533.50,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,Lease Networks,,69.35,,,,,,,65.70,70.81,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,Lease Networks,,69.35,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,inpatient,,,392.00000,188.94000,Hometown Health,Lease Networks,,372.40,,,,,,,352.80,380.24,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,outpatient,,,392.00000,188.94000,Hometown Health,Lease Networks,,372.40,,,,,,,101.92,380.24,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,inpatient,,,75.00000,36.15000,Hometown Health,Lease Networks,,71.25,,,,,,,67.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,outpatient,,,75.00000,36.15000,Hometown Health,Lease Networks,,71.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,Lease Networks,,69.35,,,,,,,65.70,70.81,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,Lease Networks,,69.35,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,inpatient,,,100.00000,48.20000,Hometown Health,Lease Networks,,95.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,outpatient,,,100.00000,48.20000,Hometown Health,Lease Networks,,95.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,inpatient,,,153.00000,73.75000,Hometown Health,Lease Networks,,145.35,,,,,,,137.70,148.41,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,outpatient,,,153.00000,73.75000,Hometown Health,Lease Networks,,145.35,,,,,,,39.78,148.41,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,inpatient,,,909.00000,438.14000,Hometown Health,Lease Networks,,863.55,,,,,,,818.10,881.73,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,outpatient,,,909.00000,438.14000,Hometown Health,Lease Networks,,863.55,,,,,,,236.34,881.73,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,inpatient,,,266.00000,128.21000,Hometown Health,Lease Networks,,252.70,,,,,,,239.40,258.02,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,outpatient,,,266.00000,128.21000,Hometown Health,Lease Networks,,252.70,,,,,,,69.16,258.02,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,inpatient,,,275.00000,132.55000,Hometown Health,Lease Networks,,261.25,,,,,,,247.50,266.75,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,outpatient,,,275.00000,132.55000,Hometown Health,Lease Networks,,261.25,,,,,,,71.50,266.75,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,inpatient,,,84.00000,40.49000,Hometown Health,Lease Networks,,79.80,,,,,,,75.60,81.48,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,outpatient,,,84.00000,40.49000,Hometown Health,Lease Networks,,79.80,,,,,,,21.84,81.48,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,inpatient,,,174.00000,83.87000,Hometown Health,Lease Networks,,165.30,,,,,,,156.60,168.78,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,outpatient,,,174.00000,83.87000,Hometown Health,Lease Networks,,165.30,,,,,,,45.24,168.78,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,60.30,64.99,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,17.42,64.99,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,Lease Networks,,64.60,,,,,,,61.20,65.96,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,Lease Networks,,64.60,,,,,,,17.68,65.96,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,inpatient,,,211.00000,101.70000,Hometown Health,Lease Networks,,200.45,,,,,,,189.90,204.67,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,outpatient,,,211.00000,101.70000,Hometown Health,Lease Networks,,200.45,,,,,,,54.86,204.67,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,inpatient,,,65.00000,31.33000,Hometown Health,Lease Networks,,61.75,,,,,,,58.50,63.05,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,outpatient,,,65.00000,31.33000,Hometown Health,Lease Networks,,61.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,inpatient,,,83.00000,40.01000,Hometown Health,Lease Networks,,78.85,,,,,,,74.70,80.51,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,outpatient,,,83.00000,40.01000,Hometown Health,Lease Networks,,78.85,,,,,,,21.58,80.51,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,Lease Networks,,51.30,,,,,,,48.60,52.38,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,Lease Networks,,51.30,,,,,,,14.04,52.38,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,inpatient,,,323.00000,155.69000,Hometown Health,Lease Networks,,306.85,,,,,,,290.70,313.31,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,outpatient,,,323.00000,155.69000,Hometown Health,Lease Networks,,306.85,,,,,,,83.98,313.31,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,inpatient,,,35.00000,16.87000,Hometown Health,Lease Networks,,33.25,,,,,,,31.50,33.95,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,outpatient,,,35.00000,16.87000,Hometown Health,Lease Networks,,33.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,inpatient,,,20.00000,9.64000,Hometown Health,Lease Networks,,19.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,outpatient,,,20.00000,9.64000,Hometown Health,Lease Networks,,19.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,inpatient,,,34.00000,16.39000,Hometown Health,Lease Networks,,32.30,,,,,,,30.60,32.98,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,outpatient,,,34.00000,16.39000,Hometown Health,Lease Networks,,32.30,,,,,,,8.84,32.98,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,inpatient,,,29.00000,13.98000,Hometown Health,Lease Networks,,27.55,,,,,,,26.10,28.13,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,outpatient,,,29.00000,13.98000,Hometown Health,Lease Networks,,27.55,,,,,,,7.54,28.13,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,inpatient,,,80.00000,38.56000,Hometown Health,Lease Networks,,76.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,outpatient,,,80.00000,38.56000,Hometown Health,Lease Networks,,76.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,Lease Networks,,69.35,,,,,,,65.70,70.81,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,Lease Networks,,69.35,,,,,,,18.98,70.81,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,inpatient,,,16.00000,7.71000,Hometown Health,Lease Networks,,15.20,,,,,,,14.40,15.52,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,outpatient,,,16.00000,7.71000,Hometown Health,Lease Networks,,15.20,,,,,,,4.16,15.52,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,46.80,50.44,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,13.52,50.44,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,inpatient,,,113.00000,54.47000,Hometown Health,Lease Networks,,107.35,,,,,,,101.70,109.61,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,outpatient,,,113.00000,54.47000,Hometown Health,Lease Networks,,107.35,,,,,,,29.38,109.61,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,Lease Networks,,64.60,,,,,,,61.20,65.96,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,Lease Networks,,64.60,,,,,,,17.68,65.96,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,inpatient,,,78.00000,37.60000,Hometown Health,Lease Networks,,74.10,,,,,,,70.20,75.66,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,outpatient,,,78.00000,37.60000,Hometown Health,Lease Networks,,74.10,,,,,,,20.28,75.66,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,Lease Networks,,51.30,,,,,,,48.60,52.38,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,Lease Networks,,51.30,,,,,,,14.04,52.38,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,inpatient,,,76.00000,36.63000,Hometown Health,Lease Networks,,72.20,,,,,,,68.40,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,outpatient,,,76.00000,36.63000,Hometown Health,Lease Networks,,72.20,,,,,,,19.76,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,60.30,64.99,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,17.42,64.99,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,inpatient,,,88.00000,42.42000,Hometown Health,Lease Networks,,83.60,,,,,,,79.20,85.36,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,outpatient,,,88.00000,42.42000,Hometown Health,Lease Networks,,83.60,,,,,,,22.88,85.36,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,60.30,64.99,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,17.42,64.99,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,Lease Networks,,50.35,,,,,,,47.70,51.41,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,Lease Networks,,50.35,,,,,,,13.78,51.41,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,inpatient,,,88.00000,42.42000,Hometown Health,Lease Networks,,83.60,,,,,,,79.20,85.36,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,outpatient,,,88.00000,42.42000,Hometown Health,Lease Networks,,83.60,,,,,,,22.88,85.36,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,inpatient,,,105.00000,50.61000,Hometown Health,Lease Networks,,99.75,,,,,,,94.50,101.85,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,outpatient,,,105.00000,50.61000,Hometown Health,Lease Networks,,99.75,,,,,,,27.30,101.85,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,Lease Networks,,69.35,,,,,,,65.70,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,Lease Networks,,69.35,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,inpatient,,,83.00000,40.01000,Hometown Health,Lease Networks,,78.85,,,,,,,74.70,80.51,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,outpatient,,,83.00000,40.01000,Hometown Health,Lease Networks,,78.85,,,,,,,21.58,80.51,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,inpatient,,,154.00000,74.23000,Hometown Health,Lease Networks,,146.30,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Hometown Health,Lease Networks,,146.30,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,inpatient,,,97.00000,46.75000,Hometown Health,Lease Networks,,92.15,,,,,,,87.30,94.09,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,outpatient,,,97.00000,46.75000,Hometown Health,Lease Networks,,92.15,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,inpatient,,,154.00000,74.23000,Hometown Health,Lease Networks,,146.30,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Hometown Health,Lease Networks,,146.30,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,inpatient,,,87.00000,41.93000,Hometown Health,Lease Networks,,82.65,,,,,,,78.30,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,outpatient,,,87.00000,41.93000,Hometown Health,Lease Networks,,82.65,,,,,,,22.62,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,Lease Networks,,64.60,,,,,,,61.20,65.96,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,Lease Networks,,64.60,,,,,,,17.68,65.96,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,46.80,50.44,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,13.52,50.44,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,Lease Networks,,48.45,,,,,,,45.90,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,Lease Networks,,48.45,,,,,,,13.26,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,inpatient,,,97.00000,46.75000,Hometown Health,Lease Networks,,92.15,,,,,,,87.30,94.09,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,outpatient,,,97.00000,46.75000,Hometown Health,Lease Networks,,92.15,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,inpatient,,,176.00000,84.83000,Hometown Health,Lease Networks,,167.20,,,,,,,158.40,170.72,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,outpatient,,,176.00000,84.83000,Hometown Health,Lease Networks,,167.20,,,,,,,45.76,170.72,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,inpatient,,,158.00000,76.16000,Hometown Health,Lease Networks,,150.10,,,,,,,142.20,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,outpatient,,,158.00000,76.16000,Hometown Health,Lease Networks,,150.10,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,inpatient,,,84.00000,40.49000,Hometown Health,Lease Networks,,79.80,,,,,,,75.60,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,outpatient,,,84.00000,40.49000,Hometown Health,Lease Networks,,79.80,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,inpatient,,,189.00000,91.10000,Hometown Health,Lease Networks,,179.55,,,,,,,170.10,183.33,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,outpatient,,,189.00000,91.10000,Hometown Health,Lease Networks,,179.55,,,,,,,49.14,183.33,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,inpatient,,,109.00000,52.54000,Hometown Health,Lease Networks,,103.55,,,,,,,98.10,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,outpatient,,,109.00000,52.54000,Hometown Health,Lease Networks,,103.55,,,,,,,28.34,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,inpatient,,,129.00000,62.18000,Hometown Health,Lease Networks,,122.55,,,,,,,116.10,125.13,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,outpatient,,,129.00000,62.18000,Hometown Health,Lease Networks,,122.55,,,,,,,33.54,125.13,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,inpatient,,,84.00000,40.49000,Hometown Health,Lease Networks,,79.80,,,,,,,75.60,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,outpatient,,,84.00000,40.49000,Hometown Health,Lease Networks,,79.80,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,Lease Networks,,69.35,,,,,,,65.70,70.81,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,Lease Networks,,69.35,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,inpatient,,,149.00000,71.82000,Hometown Health,Lease Networks,,141.55,,,,,,,134.10,144.53,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,outpatient,,,149.00000,71.82000,Hometown Health,Lease Networks,,141.55,,,,,,,38.74,144.53,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,inpatient,,,130.00000,62.66000,Hometown Health,Lease Networks,,123.50,,,,,,,117.00,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,outpatient,,,130.00000,62.66000,Hometown Health,Lease Networks,,123.50,,,,,,,33.80,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,inpatient,,,110.00000,53.02000,Hometown Health,Lease Networks,,104.50,,,,,,,99.00,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,outpatient,,,110.00000,53.02000,Hometown Health,Lease Networks,,104.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,inpatient,,,158.00000,76.16000,Hometown Health,Lease Networks,,150.10,,,,,,,142.20,153.26,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,outpatient,,,158.00000,76.16000,Hometown Health,Lease Networks,,150.10,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,inpatient,,,117.00000,56.39000,Hometown Health,Lease Networks,,111.15,,,,,,,105.30,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,outpatient,,,117.00000,56.39000,Hometown Health,Lease Networks,,111.15,,,,,,,30.42,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,Lease Networks,,177.65,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,Lease Networks,,177.65,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,inpatient,,,145.00000,69.89000,Hometown Health,Lease Networks,,137.75,,,,,,,130.50,140.65,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,outpatient,,,145.00000,69.89000,Hometown Health,Lease Networks,,137.75,,,,,,,37.70,140.65,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,inpatient,,,165.00000,79.53000,Hometown Health,Lease Networks,,156.75,,,,,,,148.50,160.05,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,outpatient,,,165.00000,79.53000,Hometown Health,Lease Networks,,156.75,,,,,,,42.90,160.05,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,Lease Networks,,66.50,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,Lease Networks,,66.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,Lease Networks,,177.65,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,Lease Networks,,177.65,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,inpatient,,,154.00000,74.23000,Hometown Health,Lease Networks,,146.30,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,outpatient,,,154.00000,74.23000,Hometown Health,Lease Networks,,146.30,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,inpatient,,,104.00000,50.13000,Hometown Health,Lease Networks,,98.80,,,,,,,93.60,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,outpatient,,,104.00000,50.13000,Hometown Health,Lease Networks,,98.80,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,Lease Networks,,66.50,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,Lease Networks,,66.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,inpatient,,,104.00000,50.13000,Hometown Health,Lease Networks,,98.80,,,,,,,93.60,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,outpatient,,,104.00000,50.13000,Hometown Health,Lease Networks,,98.80,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,Lease Networks,,66.50,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,Lease Networks,,66.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,inpatient,,,123.00000,59.29000,Hometown Health,Lease Networks,,116.85,,,,,,,110.70,119.31,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,outpatient,,,123.00000,59.29000,Hometown Health,Lease Networks,,116.85,,,,,,,31.98,119.31,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,inpatient,,,95.00000,45.79000,Hometown Health,Lease Networks,,90.25,,,,,,,85.50,92.15,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,outpatient,,,95.00000,45.79000,Hometown Health,Lease Networks,,90.25,,,,,,,24.70,92.15,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,inpatient,,,160.00000,77.12000,Hometown Health,Lease Networks,,152.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,outpatient,,,160.00000,77.12000,Hometown Health,Lease Networks,,152.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,inpatient,,,147.00000,70.85000,Hometown Health,Lease Networks,,139.65,,,,,,,132.30,142.59,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,outpatient,,,147.00000,70.85000,Hometown Health,Lease Networks,,139.65,,,,,,,38.22,142.59,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,inpatient,,,178.00000,85.80000,Hometown Health,Lease Networks,,169.10,,,,,,,160.20,172.66,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,outpatient,,,178.00000,85.80000,Hometown Health,Lease Networks,,169.10,,,,,,,46.28,172.66,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,inpatient,,,160.00000,77.12000,Hometown Health,Lease Networks,,152.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,outpatient,,,160.00000,77.12000,Hometown Health,Lease Networks,,152.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,Lease Networks,,177.65,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,Lease Networks,,177.65,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,Lease Networks,,66.50,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,Lease Networks,,66.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,Lease Networks,,177.65,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,Lease Networks,,177.65,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,Lease Networks,,177.65,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,Lease Networks,,177.65,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,Lease Networks,,177.65,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,Lease Networks,,177.65,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,Lease Networks,,177.65,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,Lease Networks,,177.65,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,Lease Networks,,177.65,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,Lease Networks,,177.65,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,Lease Networks,,177.65,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,Lease Networks,,177.65,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,Lease Networks,,177.65,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,Lease Networks,,177.65,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,Lease Networks,,177.65,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,Lease Networks,,177.65,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,inpatient,,,449.00000,216.42000,Hometown Health,Lease Networks,,426.55,,,,,,,404.10,435.53,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,outpatient,,,449.00000,216.42000,Hometown Health,Lease Networks,,426.55,,,,,,,116.74,435.53,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,inpatient,,,104.00000,50.13000,Hometown Health,Lease Networks,,98.80,,,,,,,93.60,100.88,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,outpatient,,,104.00000,50.13000,Hometown Health,Lease Networks,,98.80,,,,,,,27.04,100.88,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,inpatient,,,185.00000,89.17000,Hometown Health,Lease Networks,,175.75,,,,,,,166.50,179.45,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Hometown Health,Lease Networks,,175.75,,,,,,,48.10,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,inpatient,,,185.00000,89.17000,Hometown Health,Lease Networks,,175.75,,,,,,,166.50,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Hometown Health,Lease Networks,,175.75,,,,,,,48.10,179.45,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,inpatient,,,84.00000,40.49000,Hometown Health,Lease Networks,,79.80,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,outpatient,,,84.00000,40.49000,Hometown Health,Lease Networks,,79.80,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,inpatient,,,84.00000,40.49000,Hometown Health,Lease Networks,,79.80,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Hometown Health,Lease Networks,,79.80,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,inpatient,,,84.00000,40.49000,Hometown Health,Lease Networks,,79.80,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Hometown Health,Lease Networks,,79.80,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,Lease Networks,,69.35,,,,,,,65.70,70.81,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,Lease Networks,,69.35,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,Lease Networks,,69.35,,,,,,,65.70,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,Lease Networks,,69.35,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,inpatient,,,98.00000,47.24000,Hometown Health,Lease Networks,,93.10,,,,,,,88.20,95.06,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,outpatient,,,98.00000,47.24000,Hometown Health,Lease Networks,,93.10,,,,,,,25.48,95.06,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,inpatient,,,75.00000,36.15000,Hometown Health,Lease Networks,,71.25,,,,,,,67.50,72.75,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,outpatient,,,75.00000,36.15000,Hometown Health,Lease Networks,,71.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,inpatient,,,107.00000,51.57000,Hometown Health,Lease Networks,,101.65,,,,,,,96.30,103.79,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,outpatient,,,107.00000,51.57000,Hometown Health,Lease Networks,,101.65,,,,,,,27.82,103.79,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,inpatient,,,81.00000,39.04000,Hometown Health,Lease Networks,,76.95,,,,,,,72.90,78.57,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,outpatient,,,81.00000,39.04000,Hometown Health,Lease Networks,,76.95,,,,,,,21.06,78.57,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,Lease Networks,,64.60,,,,,,,61.20,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,Lease Networks,,64.60,,,,,,,17.68,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,Lease Networks,,48.45,,,,,,,45.90,49.47,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,Lease Networks,,48.45,,,,,,,13.26,49.47,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,inpatient,,,74.00000,35.67000,Hometown Health,Lease Networks,,70.30,,,,,,,66.60,71.78,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,outpatient,,,74.00000,35.67000,Hometown Health,Lease Networks,,70.30,,,,,,,19.24,71.78,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,inpatient,,,194.00000,93.51000,Hometown Health,Lease Networks,,184.30,,,,,,,174.60,188.18,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,outpatient,,,194.00000,93.51000,Hometown Health,Lease Networks,,184.30,,,,,,,50.44,188.18,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,inpatient,,,111.00000,53.50000,Hometown Health,Lease Networks,,105.45,,,,,,,99.90,107.67,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,outpatient,,,111.00000,53.50000,Hometown Health,Lease Networks,,105.45,,,,,,,28.86,107.67,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,Lease Networks,,73.15,,,,,,,69.30,74.69,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,Lease Networks,,73.15,,,,,,,20.02,74.69,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Hometown Health,Lease Networks,,75.05,,,,,,,71.10,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Hometown Health,Lease Networks,,75.05,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Hometown Health,Lease Networks,,75.05,,,,,,,71.10,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Hometown Health,Lease Networks,,75.05,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,inpatient,,,237.00000,114.23000,Hometown Health,Lease Networks,,225.15,,,,,,,213.30,229.89,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Hometown Health,Lease Networks,,225.15,,,,,,,61.62,229.89,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,Lease Networks,,48.45,,,,,,,45.90,49.47,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,Lease Networks,,48.45,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,Lease Networks,,77.90,,,,,,,73.80,79.54,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,Lease Networks,,77.90,,,,,,,21.32,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,Lease Networks,,77.90,,,,,,,73.80,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,Lease Networks,,77.90,,,,,,,21.32,79.54,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,60.30,64.99,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,17.42,64.99,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,inpatient,,,131.00000,63.14000,Hometown Health,Lease Networks,,124.45,,,,,,,117.90,127.07,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,outpatient,,,131.00000,63.14000,Hometown Health,Lease Networks,,124.45,,,,,,,34.06,127.07,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,inpatient,,,15.00000,7.23000,Hometown Health,Lease Networks,,14.25,,,,,,,13.50,14.55,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,outpatient,,,15.00000,7.23000,Hometown Health,Lease Networks,,14.25,,,,,,,3.90,14.55,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,inpatient,,,39.00000,18.80000,Hometown Health,Lease Networks,,37.05,,,,,,,35.10,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,outpatient,,,39.00000,18.80000,Hometown Health,Lease Networks,,37.05,,,,,,,10.14,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,inpatient,,,12.00000,5.78000,Hometown Health,Lease Networks,,11.40,,,,,,,10.80,11.64,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,outpatient,,,12.00000,5.78000,Hometown Health,Lease Networks,,11.40,,,,,,,3.12,11.64,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,inpatient,,,203.00000,97.85000,Hometown Health,Lease Networks,,192.85,,,,,,,182.70,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Hometown Health,Lease Networks,,192.85,,,,,,,52.78,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,inpatient,,,203.00000,97.85000,Hometown Health,Lease Networks,,192.85,,,,,,,182.70,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Hometown Health,Lease Networks,,192.85,,,,,,,52.78,196.91,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,inpatient,,,99.00000,47.72000,Hometown Health,Lease Networks,,94.05,,,,,,,89.10,96.03,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,outpatient,,,99.00000,47.72000,Hometown Health,Lease Networks,,94.05,,,,,,,25.74,96.03,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,Lease Networks,,50.35,,,,,,,47.70,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,Lease Networks,,50.35,,,,,,,13.78,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,inpatient,,,23.00000,11.09000,Hometown Health,Lease Networks,,21.85,,,,,,,20.70,22.31,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,outpatient,,,23.00000,11.09000,Hometown Health,Lease Networks,,21.85,,,,,,,5.98,22.31,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,inpatient,,,46.00000,22.17000,Hometown Health,Lease Networks,,43.70,,,,,,,41.40,44.62,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,outpatient,,,46.00000,22.17000,Hometown Health,Lease Networks,,43.70,,,,,,,11.96,44.62,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,60.30,64.99,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,17.42,64.99,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,inpatient,,,288.00000,138.82000,Hometown Health,Lease Networks,,273.60,,,,,,,259.20,279.36,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,outpatient,,,288.00000,138.82000,Hometown Health,Lease Networks,,273.60,,,,,,,74.88,279.36,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,inpatient,,,106.00000,51.09000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,outpatient,,,106.00000,51.09000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,inpatient,,,30.00000,14.46000,Hometown Health,Lease Networks,,28.50,,,,,,,27.00,29.10,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,outpatient,,,30.00000,14.46000,Hometown Health,Lease Networks,,28.50,,,,,,,7.80,29.10,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,Lease Networks,,67.45,,,,,,,63.90,68.87,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,Lease Networks,,67.45,,,,,,,18.46,68.87,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,60.30,64.99,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,17.42,64.99,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,inpatient,,,89.00000,42.90000,Hometown Health,Lease Networks,,84.55,,,,,,,80.10,86.33,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,outpatient,,,89.00000,42.90000,Hometown Health,Lease Networks,,84.55,,,,,,,23.14,86.33,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,inpatient,,,116.00000,55.91000,Hometown Health,Lease Networks,,110.20,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,outpatient,,,116.00000,55.91000,Hometown Health,Lease Networks,,110.20,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,inpatient,,,116.00000,55.91000,Hometown Health,Lease Networks,,110.20,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Hometown Health,Lease Networks,,110.20,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,inpatient,,,116.00000,55.91000,Hometown Health,Lease Networks,,110.20,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Hometown Health,Lease Networks,,110.20,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,Lease Networks,,48.45,,,,,,,45.90,49.47,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,Lease Networks,,48.45,,,,,,,13.26,49.47,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,inpatient,,,174.00000,83.87000,Hometown Health,Lease Networks,,165.30,,,,,,,156.60,168.78,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,outpatient,,,174.00000,83.87000,Hometown Health,Lease Networks,,165.30,,,,,,,45.24,168.78,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,Lease Networks,,77.90,,,,,,,73.80,79.54,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,Lease Networks,,77.90,,,,,,,21.32,79.54,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,inpatient,,,112.00000,53.98000,Hometown Health,Lease Networks,,106.40,,,,,,,100.80,108.64,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,outpatient,,,112.00000,53.98000,Hometown Health,Lease Networks,,106.40,,,,,,,29.12,108.64,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,Lease Networks,,65.55,,,,,,,62.10,66.93,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,Lease Networks,,65.55,,,,,,,17.94,66.93,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,46.80,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,13.52,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,inpatient,,,286.00000,137.85000,Hometown Health,Lease Networks,,271.70,,,,,,,257.40,277.42,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,outpatient,,,286.00000,137.85000,Hometown Health,Lease Networks,,271.70,,,,,,,74.36,277.42,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,inpatient,,,300.00000,144.60000,Hometown Health,Lease Networks,,285.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,outpatient,,,300.00000,144.60000,Hometown Health,Lease Networks,,285.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,Lease Networks,,69.35,,,,,,,65.70,70.81,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,Lease Networks,,69.35,,,,,,,18.98,70.81,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,inpatient,,,90.00000,43.38000,Hometown Health,Lease Networks,,85.50,,,,,,,81.00,87.30,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,outpatient,,,90.00000,43.38000,Hometown Health,Lease Networks,,85.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,46.80,50.44,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,inpatient,,,315.00000,151.83000,Hometown Health,Lease Networks,,299.25,,,,,,,283.50,305.55,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,outpatient,,,315.00000,151.83000,Hometown Health,Lease Networks,,299.25,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,inpatient,,,100.00000,48.20000,Hometown Health,Lease Networks,,95.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,outpatient,,,100.00000,48.20000,Hometown Health,Lease Networks,,95.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,inpatient,,,89.00000,42.90000,Hometown Health,Lease Networks,,84.55,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,outpatient,,,89.00000,42.90000,Hometown Health,Lease Networks,,84.55,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,Lease Networks,,67.45,,,,,,,63.90,68.87,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,Lease Networks,,67.45,,,,,,,18.46,68.87,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,inpatient,,,135.00000,65.07000,Hometown Health,Lease Networks,,128.25,,,,,,,121.50,130.95,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,outpatient,,,135.00000,65.07000,Hometown Health,Lease Networks,,128.25,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,inpatient,,,80.00000,38.56000,Hometown Health,Lease Networks,,76.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,outpatient,,,80.00000,38.56000,Hometown Health,Lease Networks,,76.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,Lease Networks,,68.40,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,Lease Networks,,68.40,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,Lease Networks,,68.40,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,Lease Networks,,68.40,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,inpatient,,,100.00000,48.20000,Hometown Health,Lease Networks,,95.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,outpatient,,,100.00000,48.20000,Hometown Health,Lease Networks,,95.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,inpatient,,,305.00000,147.01000,Hometown Health,Lease Networks,,289.75,,,,,,,274.50,295.85,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,outpatient,,,305.00000,147.01000,Hometown Health,Lease Networks,,289.75,,,,,,,79.30,295.85,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,Lease Networks,,66.50,,,,,,,63.00,67.90,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,Lease Networks,,66.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,Lease Networks,,65.55,,,,,,,62.10,66.93,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,Lease Networks,,65.55,,,,,,,17.94,66.93,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,Lease Networks,,60.80,,,,,,,57.60,62.08,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,Lease Networks,,60.80,,,,,,,16.64,62.08,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,inpatient,,,368.00000,177.38000,Hometown Health,Lease Networks,,349.60,,,,,,,331.20,356.96,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,outpatient,,,368.00000,177.38000,Hometown Health,Lease Networks,,349.60,,,,,,,95.68,356.96,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,inpatient,,,104.00000,50.13000,Hometown Health,Lease Networks,,98.80,,,,,,,93.60,100.88,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,outpatient,,,104.00000,50.13000,Hometown Health,Lease Networks,,98.80,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,inpatient,,,109.00000,52.54000,Hometown Health,Lease Networks,,103.55,,,,,,,98.10,105.73,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,outpatient,,,109.00000,52.54000,Hometown Health,Lease Networks,,103.55,,,,,,,28.34,105.73,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,inpatient,,,114.00000,54.95000,Hometown Health,Lease Networks,,108.30,,,,,,,102.60,110.58,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,outpatient,,,114.00000,54.95000,Hometown Health,Lease Networks,,108.30,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,inpatient,,,135.00000,65.07000,Hometown Health,Lease Networks,,128.25,,,,,,,121.50,130.95,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,outpatient,,,135.00000,65.07000,Hometown Health,Lease Networks,,128.25,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,inpatient,,,105.00000,50.61000,Hometown Health,Lease Networks,,99.75,,,,,,,94.50,101.85,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,outpatient,,,105.00000,50.61000,Hometown Health,Lease Networks,,99.75,,,,,,,27.30,101.85,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,inpatient,,,315.00000,151.83000,Hometown Health,Lease Networks,,299.25,,,,,,,283.50,305.55,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,outpatient,,,315.00000,151.83000,Hometown Health,Lease Networks,,299.25,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,inpatient,,,148.00000,71.34000,Hometown Health,Lease Networks,,140.60,,,,,,,133.20,143.56,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,outpatient,,,148.00000,71.34000,Hometown Health,Lease Networks,,140.60,,,,,,,38.48,143.56,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,60.30,64.99,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,17.42,64.99,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,inpatient,,,107.00000,51.57000,Hometown Health,Lease Networks,,101.65,,,,,,,96.30,103.79,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,outpatient,,,107.00000,51.57000,Hometown Health,Lease Networks,,101.65,,,,,,,27.82,103.79,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,inpatient,,,35.00000,16.87000,Hometown Health,Lease Networks,,33.25,,,,,,,31.50,33.95,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,outpatient,,,35.00000,16.87000,Hometown Health,Lease Networks,,33.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,inpatient,,,104.00000,50.13000,Hometown Health,Lease Networks,,98.80,,,,,,,93.60,100.88,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,outpatient,,,104.00000,50.13000,Hometown Health,Lease Networks,,98.80,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,inpatient,,,650.00000,313.30000,Hometown Health,Lease Networks,,617.50,,,,,,,585.00,630.50,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,outpatient,,,650.00000,313.30000,Hometown Health,Lease Networks,,617.50,,,,,,,169.00,630.50,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,inpatient,,,91.00000,43.86000,Hometown Health,Lease Networks,,86.45,,,,,,,81.90,88.27,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,outpatient,,,91.00000,43.86000,Hometown Health,Lease Networks,,86.45,,,,,,,23.66,88.27,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,inpatient,,,114.00000,54.95000,Hometown Health,Lease Networks,,108.30,,,,,,,102.60,110.58,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,outpatient,,,114.00000,54.95000,Hometown Health,Lease Networks,,108.30,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,46.80,50.44,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,inpatient,,,360.00000,173.52000,Hometown Health,Lease Networks,,342.00,,,,,,,324.00,349.20,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,outpatient,,,360.00000,173.52000,Hometown Health,Lease Networks,,342.00,,,,,,,93.60,349.20,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,inpatient,,,106.00000,51.09000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,outpatient,,,106.00000,51.09000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,inpatient,,,78.00000,37.60000,Hometown Health,Lease Networks,,74.10,,,,,,,70.20,75.66,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,outpatient,,,78.00000,37.60000,Hometown Health,Lease Networks,,74.10,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,Lease Networks,,68.40,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,Lease Networks,,68.40,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,inpatient,,,94.00000,45.31000,Hometown Health,Lease Networks,,89.30,,,,,,,84.60,91.18,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,outpatient,,,94.00000,45.31000,Hometown Health,Lease Networks,,89.30,,,,,,,24.44,91.18,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,inpatient,,,101.00000,48.68000,Hometown Health,Lease Networks,,95.95,,,,,,,90.90,97.97,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,outpatient,,,101.00000,48.68000,Hometown Health,Lease Networks,,95.95,,,,,,,26.26,97.97,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,Lease Networks,,77.90,,,,,,,73.80,79.54,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,Lease Networks,,77.90,,,,,,,21.32,79.54,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,Lease Networks,,73.15,,,,,,,69.30,74.69,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,Lease Networks,,73.15,,,,,,,20.02,74.69,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,inpatient,,,145.00000,69.89000,Hometown Health,Lease Networks,,137.75,,,,,,,130.50,140.65,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,outpatient,,,145.00000,69.89000,Hometown Health,Lease Networks,,137.75,,,,,,,37.70,140.65,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,inpatient,,,266.00000,128.21000,Hometown Health,Lease Networks,,252.70,,,,,,,239.40,258.02,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,outpatient,,,266.00000,128.21000,Hometown Health,Lease Networks,,252.70,,,,,,,69.16,258.02,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,inpatient,,,79.00000,38.08000,Hometown Health,Lease Networks,,75.05,,,,,,,71.10,76.63,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,outpatient,,,79.00000,38.08000,Hometown Health,Lease Networks,,75.05,,,,,,,20.54,76.63,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,inpatient,,,144.00000,69.41000,Hometown Health,Lease Networks,,136.80,,,,,,,129.60,139.68,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,outpatient,,,144.00000,69.41000,Hometown Health,Lease Networks,,136.80,,,,,,,37.44,139.68,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,inpatient,,,20.00000,9.64000,Hometown Health,Lease Networks,,19.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,outpatient,,,20.00000,9.64000,Hometown Health,Lease Networks,,19.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,inpatient,,,208.00000,100.26000,Hometown Health,Lease Networks,,197.60,,,,,,,187.20,201.76,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,outpatient,,,208.00000,100.26000,Hometown Health,Lease Networks,,197.60,,,,,,,54.08,201.76,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,inpatient,,,135.00000,65.07000,Hometown Health,Lease Networks,,128.25,,,,,,,121.50,130.95,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,outpatient,,,135.00000,65.07000,Hometown Health,Lease Networks,,128.25,,,,,,,35.10,130.95,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,inpatient,,,131.00000,63.14000,Hometown Health,Lease Networks,,124.45,,,,,,,117.90,127.07,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,outpatient,,,131.00000,63.14000,Hometown Health,Lease Networks,,124.45,,,,,,,34.06,127.07,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,Lease Networks,,65.55,,,,,,,62.10,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,Lease Networks,,65.55,,,,,,,17.94,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,inpatient,,,25.00000,12.05000,Hometown Health,Lease Networks,,23.75,,,,,,,22.50,24.25,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,outpatient,,,25.00000,12.05000,Hometown Health,Lease Networks,,23.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,inpatient,,,80.00000,38.56000,Hometown Health,Lease Networks,,76.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,outpatient,,,80.00000,38.56000,Hometown Health,Lease Networks,,76.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,Lease Networks,,77.90,,,,,,,73.80,79.54,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,Lease Networks,,77.90,,,,,,,21.32,79.54,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,inpatient,,,35.00000,16.87000,Hometown Health,Lease Networks,,33.25,,,,,,,31.50,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,outpatient,,,35.00000,16.87000,Hometown Health,Lease Networks,,33.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,inpatient,,,88.00000,42.42000,Hometown Health,Lease Networks,,83.60,,,,,,,79.20,85.36,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,outpatient,,,88.00000,42.42000,Hometown Health,Lease Networks,,83.60,,,,,,,22.88,85.36,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,inpatient,,,98.00000,47.24000,Hometown Health,Lease Networks,,93.10,,,,,,,88.20,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,outpatient,,,98.00000,47.24000,Hometown Health,Lease Networks,,93.10,,,,,,,25.48,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,inpatient,,,204.00000,98.33000,Hometown Health,Lease Networks,,193.80,,,,,,,183.60,197.88,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,outpatient,,,204.00000,98.33000,Hometown Health,Lease Networks,,193.80,,,,,,,53.04,197.88,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,inpatient,,,19.00000,9.16000,Hometown Health,Lease Networks,,18.05,,,,,,,17.10,18.43,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,outpatient,,,19.00000,9.16000,Hometown Health,Lease Networks,,18.05,,,,,,,4.94,18.43,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,inpatient,,,37.00000,17.83000,Hometown Health,Lease Networks,,35.15,,,,,,,33.30,35.89,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,outpatient,,,37.00000,17.83000,Hometown Health,Lease Networks,,35.15,,,,,,,9.62,35.89,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,inpatient,,,79.00000,38.08000,Hometown Health,Lease Networks,,75.05,,,,,,,71.10,76.63,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,outpatient,,,79.00000,38.08000,Hometown Health,Lease Networks,,75.05,,,,,,,20.54,76.63,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,inpatient,,,21.00000,10.12000,Hometown Health,Lease Networks,,19.95,,,,,,,18.90,20.37,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,outpatient,,,21.00000,10.12000,Hometown Health,Lease Networks,,19.95,,,,,,,5.46,20.37,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,46.80,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,13.52,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,inpatient,,,32.00000,15.42000,Hometown Health,Lease Networks,,30.40,,,,,,,28.80,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,outpatient,,,32.00000,15.42000,Hometown Health,Lease Networks,,30.40,,,,,,,8.32,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,inpatient,,,94.00000,45.31000,Hometown Health,Lease Networks,,89.30,,,,,,,84.60,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,outpatient,,,94.00000,45.31000,Hometown Health,Lease Networks,,89.30,,,,,,,24.44,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,inpatient,,,103.00000,49.65000,Hometown Health,Lease Networks,,97.85,,,,,,,92.70,99.91,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,outpatient,,,103.00000,49.65000,Hometown Health,Lease Networks,,97.85,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,Lease Networks,,60.80,,,,,,,57.60,62.08,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,Lease Networks,,60.80,,,,,,,16.64,62.08,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,inpatient,,,102.00000,49.16000,Hometown Health,Lease Networks,,96.90,,,,,,,91.80,98.94,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,outpatient,,,102.00000,49.16000,Hometown Health,Lease Networks,,96.90,,,,,,,26.52,98.94,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,inpatient,,,103.00000,49.65000,Hometown Health,Lease Networks,,97.85,,,,,,,92.70,99.91,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,outpatient,,,103.00000,49.65000,Hometown Health,Lease Networks,,97.85,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,inpatient,,,139.00000,67.00000,Hometown Health,Lease Networks,,132.05,,,,,,,125.10,134.83,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,outpatient,,,139.00000,67.00000,Hometown Health,Lease Networks,,132.05,,,,,,,36.14,134.83,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,46.80,50.44,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,13.52,50.44,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,inpatient,,,21.00000,10.12000,Hometown Health,Lease Networks,,19.95,,,,,,,18.90,20.37,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Hometown Health,Lease Networks,,19.95,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,inpatient,,,88.00000,42.42000,Hometown Health,Lease Networks,,83.60,,,,,,,79.20,85.36,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,outpatient,,,88.00000,42.42000,Hometown Health,Lease Networks,,83.60,,,,,,,22.88,85.36,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,inpatient,,,21.00000,10.12000,Hometown Health,Lease Networks,,19.95,,,,,,,18.90,20.37,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Hometown Health,Lease Networks,,19.95,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,46.80,50.44,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,13.52,50.44,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,inpatient,,,80.00000,38.56000,Hometown Health,Lease Networks,,76.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,outpatient,,,80.00000,38.56000,Hometown Health,Lease Networks,,76.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,inpatient,,,49.00000,23.62000,Hometown Health,Lease Networks,,46.55,,,,,,,44.10,47.53,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,outpatient,,,49.00000,23.62000,Hometown Health,Lease Networks,,46.55,,,,,,,12.74,47.53,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,inpatient,,,88.00000,42.42000,Hometown Health,Lease Networks,,83.60,,,,,,,79.20,85.36,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,outpatient,,,88.00000,42.42000,Hometown Health,Lease Networks,,83.60,,,,,,,22.88,85.36,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,Lease Networks,,64.60,,,,,,,61.20,65.96,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,Lease Networks,,64.60,,,,,,,17.68,65.96,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,inpatient,,,93.00000,44.83000,Hometown Health,Lease Networks,,88.35,,,,,,,83.70,90.21,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,outpatient,,,93.00000,44.83000,Hometown Health,Lease Networks,,88.35,,,,,,,24.18,90.21,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,Lease Networks,,69.35,,,,,,,65.70,70.81,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,Lease Networks,,69.35,,,,,,,18.98,70.81,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,inpatient,,,41.00000,19.76000,Hometown Health,Lease Networks,,38.95,,,,,,,36.90,39.77,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,outpatient,,,41.00000,19.76000,Hometown Health,Lease Networks,,38.95,,,,,,,10.66,39.77,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,inpatient,,,94.00000,45.31000,Hometown Health,Lease Networks,,89.30,,,,,,,84.60,91.18,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,outpatient,,,94.00000,45.31000,Hometown Health,Lease Networks,,89.30,,,,,,,24.44,91.18,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,inpatient,,,124.00000,59.77000,Hometown Health,Lease Networks,,117.80,,,,,,,111.60,120.28,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,outpatient,,,124.00000,59.77000,Hometown Health,Lease Networks,,117.80,,,,,,,32.24,120.28,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,Lease Networks,,67.45,,,,,,,63.90,68.87,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,Lease Networks,,67.45,,,,,,,18.46,68.87,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,inpatient,,,33.00000,15.91000,Hometown Health,Lease Networks,,31.35,,,,,,,29.70,32.01,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,outpatient,,,33.00000,15.91000,Hometown Health,Lease Networks,,31.35,,,,,,,8.58,32.01,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,46.80,50.44,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,13.52,50.44,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,Lease Networks,,64.60,,,,,,,61.20,65.96,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,Lease Networks,,64.60,,,,,,,17.68,65.96,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,inpatient,,,99.00000,47.72000,Hometown Health,Lease Networks,,94.05,,,,,,,89.10,96.03,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,outpatient,,,99.00000,47.72000,Hometown Health,Lease Networks,,94.05,,,,,,,25.74,96.03,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,inpatient,,,197.00000,94.95000,Hometown Health,Lease Networks,,187.15,,,,,,,177.30,191.09,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,outpatient,,,197.00000,94.95000,Hometown Health,Lease Networks,,187.15,,,,,,,51.22,191.09,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,inpatient,,,194.00000,93.51000,Hometown Health,Lease Networks,,184.30,,,,,,,174.60,188.18,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,outpatient,,,194.00000,93.51000,Hometown Health,Lease Networks,,184.30,,,,,,,50.44,188.18,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,Lease Networks,,64.60,,,,,,,61.20,65.96,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,Lease Networks,,64.60,,,,,,,17.68,65.96,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,inpatient,,,90.00000,43.38000,Hometown Health,Lease Networks,,85.50,,,,,,,81.00,87.30,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,outpatient,,,90.00000,43.38000,Hometown Health,Lease Networks,,85.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,inpatient,,,109.00000,52.54000,Hometown Health,Lease Networks,,103.55,,,,,,,98.10,105.73,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,outpatient,,,109.00000,52.54000,Hometown Health,Lease Networks,,103.55,,,,,,,28.34,105.73,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,inpatient,,,108.00000,52.06000,Hometown Health,Lease Networks,,102.60,,,,,,,97.20,104.76,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,outpatient,,,108.00000,52.06000,Hometown Health,Lease Networks,,102.60,,,,,,,28.08,104.76,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,60.30,64.99,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,Lease Networks,,63.65,,,,,,,17.42,64.99,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,Lease Networks,,65.55,,,,,,,62.10,66.93,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,Lease Networks,,65.55,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,Lease Networks,,67.45,,,,,,,63.90,68.87,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,Lease Networks,,67.45,,,,,,,18.46,68.87,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,inpatient,,,98.00000,47.24000,Hometown Health,Lease Networks,,93.10,,,,,,,88.20,95.06,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,outpatient,,,98.00000,47.24000,Hometown Health,Lease Networks,,93.10,,,,,,,25.48,95.06,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,inpatient,,,141.00000,67.96000,Hometown Health,Lease Networks,,133.95,,,,,,,126.90,136.77,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,outpatient,,,141.00000,67.96000,Hometown Health,Lease Networks,,133.95,,,,,,,36.66,136.77,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,inpatient,,,226.00000,108.93000,Hometown Health,Lease Networks,,214.70,,,,,,,203.40,219.22,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,outpatient,,,226.00000,108.93000,Hometown Health,Lease Networks,,214.70,,,,,,,58.76,219.22,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,inpatient,,,92.00000,44.34000,Hometown Health,Lease Networks,,87.40,,,,,,,82.80,89.24,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,outpatient,,,92.00000,44.34000,Hometown Health,Lease Networks,,87.40,,,,,,,23.92,89.24,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,Lease Networks,,65.55,,,,,,,62.10,66.93,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,Lease Networks,,65.55,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,inpatient,,,100.00000,48.20000,Hometown Health,Lease Networks,,95.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,outpatient,,,100.00000,48.20000,Hometown Health,Lease Networks,,95.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,inpatient,,,124.00000,59.77000,Hometown Health,Lease Networks,,117.80,,,,,,,111.60,120.28,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,outpatient,,,124.00000,59.77000,Hometown Health,Lease Networks,,117.80,,,,,,,32.24,120.28,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,Lease Networks,,65.55,,,,,,,62.10,66.93,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,Lease Networks,,65.55,,,,,,,17.94,66.93,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Hometown Health,Lease Networks,,117.80,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Hometown Health,Lease Networks,,117.80,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Hometown Health,Lease Networks,,117.80,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Hometown Health,Lease Networks,,117.80,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Hometown Health,Lease Networks,,117.80,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Hometown Health,Lease Networks,,117.80,,,,,,,32.24,120.28,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,inpatient,,,118.00000,56.88000,Hometown Health,Lease Networks,,112.10,,,,,,,106.20,114.46,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,outpatient,,,118.00000,56.88000,Hometown Health,Lease Networks,,112.10,,,,,,,30.68,114.46,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,Lease Networks,,48.45,,,,,,,45.90,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,Lease Networks,,48.45,,,,,,,13.26,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,inpatient,,,104.00000,50.13000,Hometown Health,Lease Networks,,98.80,,,,,,,93.60,100.88,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,outpatient,,,104.00000,50.13000,Hometown Health,Lease Networks,,98.80,,,,,,,27.04,100.88,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,Lease Networks,,68.40,,,,,,,64.80,69.84,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,Lease Networks,,68.40,,,,,,,18.72,69.84,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,Lease Networks,,51.30,,,,,,,48.60,52.38,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,Lease Networks,,51.30,,,,,,,14.04,52.38,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,inpatient,,,17.00000,8.19000,Hometown Health,Lease Networks,,16.15,,,,,,,15.30,16.49,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,outpatient,,,17.00000,8.19000,Hometown Health,Lease Networks,,16.15,,,,,,,4.42,16.49,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,inpatient,,,36.00000,17.35000,Hometown Health,Lease Networks,,34.20,,,,,,,32.40,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,outpatient,,,36.00000,17.35000,Hometown Health,Lease Networks,,34.20,,,,,,,9.36,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,46.80,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,13.52,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,inpatient,,,18.00000,8.68000,Hometown Health,Lease Networks,,17.10,,,,,,,16.20,17.46,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,outpatient,,,18.00000,8.68000,Hometown Health,Lease Networks,,17.10,,,,,,,4.68,17.46,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,inpatient,,,74.00000,35.67000,Hometown Health,Lease Networks,,70.30,,,,,,,66.60,71.78,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,outpatient,,,74.00000,35.67000,Hometown Health,Lease Networks,,70.30,,,,,,,19.24,71.78,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,inpatient,,,118.00000,56.88000,Hometown Health,Lease Networks,,112.10,,,,,,,106.20,114.46,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,outpatient,,,118.00000,56.88000,Hometown Health,Lease Networks,,112.10,,,,,,,30.68,114.46,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,Lease Networks,,77.90,,,,,,,73.80,79.54,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,Lease Networks,,77.90,,,,,,,21.32,79.54,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,inpatient,,,30.00000,14.46000,Hometown Health,Lease Networks,,28.50,,,,,,,27.00,29.10,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,outpatient,,,30.00000,14.46000,Hometown Health,Lease Networks,,28.50,,,,,,,7.80,29.10,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,Lease Networks,,66.50,,,,,,,63.00,67.90,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,Lease Networks,,66.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,Lease Networks,,51.30,,,,,,,48.60,52.38,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,Lease Networks,,51.30,,,,,,,14.04,52.38,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,Lease Networks,,48.45,,,,,,,45.90,49.47,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,Lease Networks,,48.45,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,inpatient,,,141.00000,67.96000,Hometown Health,Lease Networks,,133.95,,,,,,,126.90,136.77,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,outpatient,,,141.00000,67.96000,Hometown Health,Lease Networks,,133.95,,,,,,,36.66,136.77,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,inpatient,,,81.00000,39.04000,Hometown Health,Lease Networks,,76.95,,,,,,,72.90,78.57,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,outpatient,,,81.00000,39.04000,Hometown Health,Lease Networks,,76.95,,,,,,,21.06,78.57,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,inpatient,,,335.00000,161.47000,Hometown Health,Lease Networks,,318.25,,,,,,,301.50,324.95,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,outpatient,,,335.00000,161.47000,Hometown Health,Lease Networks,,318.25,,,,,,,87.10,324.95,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,46.80,50.44,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,Lease Networks,,49.40,,,,,,,13.52,50.44,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,Lease Networks,,51.30,,,,,,,48.60,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,Lease Networks,,51.30,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,Lease Networks,,51.30,,,,,,,48.60,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,Lease Networks,,51.30,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,Lease Networks,,50.35,,,,,,,47.70,51.41,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,Lease Networks,,50.35,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,Lease Networks,,50.35,,,,,,,47.70,51.41,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,Lease Networks,,50.35,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,inpatient,,,12.00000,5.78000,Hometown Health,Lease Networks,,11.40,,,,,,,10.80,11.64,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,outpatient,,,12.00000,5.78000,Hometown Health,Lease Networks,,11.40,,,,,,,3.12,11.64,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,inpatient,,,710.00000,342.22000,Hometown Health,Lease Networks,,674.50,,,,,,,639.00,688.70,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,outpatient,,,710.00000,342.22000,Hometown Health,Lease Networks,,674.50,,,,,,,184.60,688.70,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,inpatient,,,104.00000,50.13000,Hometown Health,Lease Networks,,98.80,,,,,,,93.60,100.88,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,outpatient,,,104.00000,50.13000,Hometown Health,Lease Networks,,98.80,,,,,,,27.04,100.88,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,inpatient,,,155.00000,74.71000,Hometown Health,Lease Networks,,147.25,,,,,,,139.50,150.35,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,outpatient,,,155.00000,74.71000,Hometown Health,Lease Networks,,147.25,,,,,,,40.30,150.35,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,inpatient,,,139.00000,67.00000,Hometown Health,Lease Networks,,132.05,,,,,,,125.10,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,outpatient,,,139.00000,67.00000,Hometown Health,Lease Networks,,132.05,,,,,,,36.14,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,inpatient,,,89.00000,42.90000,Hometown Health,Lease Networks,,84.55,,,,,,,80.10,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,outpatient,,,89.00000,42.90000,Hometown Health,Lease Networks,,84.55,,,,,,,23.14,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,inpatient,,,88.00000,42.42000,Hometown Health,Lease Networks,,83.60,,,,,,,79.20,85.36,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,outpatient,,,88.00000,42.42000,Hometown Health,Lease Networks,,83.60,,,,,,,22.88,85.36,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,inpatient,,,111.00000,53.50000,Hometown Health,Lease Networks,,105.45,,,,,,,99.90,107.67,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,outpatient,,,111.00000,53.50000,Hometown Health,Lease Networks,,105.45,,,,,,,28.86,107.67,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,Lease Networks,,66.50,,,,,,,63.00,67.90,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,Lease Networks,,66.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,inpatient,,,85.00000,40.97000,Hometown Health,Lease Networks,,80.75,,,,,,,76.50,82.45,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,outpatient,,,85.00000,40.97000,Hometown Health,Lease Networks,,80.75,,,,,,,22.10,82.45,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,inpatient,,,110.00000,53.02000,Hometown Health,Lease Networks,,104.50,,,,,,,99.00,106.70,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,outpatient,,,110.00000,53.02000,Hometown Health,Lease Networks,,104.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,inpatient,,,500.00000,241.00000,Hometown Health,Lease Networks,,475.00,,,,,,,450.00,485.00,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,outpatient,,,500.00000,241.00000,Hometown Health,Lease Networks,,475.00,,,,,,,130.00,485.00,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,inpatient,,,140.00000,67.48000,Hometown Health,Lease Networks,,133.00,,,,,,,126.00,135.80,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,outpatient,,,140.00000,67.48000,Hometown Health,Lease Networks,,133.00,,,,,,,36.40,135.80,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,inpatient,,,74.00000,35.67000,Hometown Health,Lease Networks,,70.30,,,,,,,66.60,71.78,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,outpatient,,,74.00000,35.67000,Hometown Health,Lease Networks,,70.30,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,Lease Networks,,73.15,,,,,,,69.30,74.69,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,Lease Networks,,73.15,,,,,,,20.02,74.69,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,inpatient,,,93.00000,44.83000,Hometown Health,Lease Networks,,88.35,,,,,,,83.70,90.21,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,outpatient,,,93.00000,44.83000,Hometown Health,Lease Networks,,88.35,,,,,,,24.18,90.21,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,inpatient,,,15.00000,7.23000,Hometown Health,Lease Networks,,14.25,,,,,,,13.50,14.55,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,outpatient,,,15.00000,7.23000,Hometown Health,Lease Networks,,14.25,,,,,,,3.90,14.55,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,inpatient,,,24.00000,11.57000,Hometown Health,Lease Networks,,22.80,,,,,,,21.60,23.28,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,outpatient,,,24.00000,11.57000,Hometown Health,Lease Networks,,22.80,,,,,,,6.24,23.28,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,Lease Networks,,68.40,,,,,,,64.80,69.84,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,Lease Networks,,68.40,,,,,,,18.72,69.84,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,inpatient,,,16.00000,7.71000,Hometown Health,Lease Networks,,15.20,,,,,,,14.40,15.52,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Hometown Health,Lease Networks,,15.20,,,,,,,4.16,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,inpatient,,,16.00000,7.71000,Hometown Health,Lease Networks,,15.20,,,,,,,14.40,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Hometown Health,Lease Networks,,15.20,,,,,,,4.16,15.52,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,Lease Networks,,60.80,,,,,,,57.60,62.08,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,Lease Networks,,60.80,,,,,,,16.64,62.08,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,Lease Networks,,77.90,,,,,,,73.80,79.54,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,Lease Networks,,77.90,,,,,,,21.32,79.54,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,inpatient,,,157.00000,75.67000,Hometown Health,Lease Networks,,149.15,,,,,,,141.30,152.29,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,outpatient,,,157.00000,75.67000,Hometown Health,Lease Networks,,149.15,,,,,,,40.82,152.29,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,Lease Networks,,66.50,,,,,,,63.00,67.90,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,Lease Networks,,66.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,inpatient,,,229.00000,110.38000,Hometown Health,Lease Networks,,217.55,,,,,,,206.10,222.13,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,outpatient,,,229.00000,110.38000,Hometown Health,Lease Networks,,217.55,,,,,,,59.54,222.13,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,Lease Networks,,60.80,,,,,,,57.60,62.08,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,Lease Networks,,60.80,,,,,,,16.64,62.08,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,Lease Networks,,68.40,,,,,,,64.80,69.84,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,Lease Networks,,68.40,,,,,,,18.72,69.84,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,inpatient,,,17.00000,8.19000,Hometown Health,Lease Networks,,16.15,,,,,,,15.30,16.49,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,outpatient,,,17.00000,8.19000,Hometown Health,Lease Networks,,16.15,,,,,,,4.42,16.49,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,Lease Networks,,60.80,,,,,,,57.60,62.08,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,Lease Networks,,60.80,,,,,,,16.64,62.08,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,inpatient,,,387.00000,186.53000,Hometown Health,Lease Networks,,367.65,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,outpatient,,,387.00000,186.53000,Hometown Health,Lease Networks,,367.65,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,inpatient,,,387.00000,186.53000,Hometown Health,Lease Networks,,367.65,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Hometown Health,Lease Networks,,367.65,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,inpatient,,,387.00000,186.53000,Hometown Health,Lease Networks,,367.65,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Hometown Health,Lease Networks,,367.65,,,,,,,100.62,375.39,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,Lease Networks,,73.15,,,,,,,69.30,74.69,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,Lease Networks,,73.15,,,,,,,20.02,74.69,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,inpatient,,,78.00000,37.60000,Hometown Health,Lease Networks,,74.10,,,,,,,70.20,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Hometown Health,Lease Networks,,74.10,,,,,,,20.28,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,inpatient,,,78.00000,37.60000,Hometown Health,Lease Networks,,74.10,,,,,,,70.20,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Hometown Health,Lease Networks,,74.10,,,,,,,20.28,75.66,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,inpatient,,,43.00000,20.73000,Hometown Health,Lease Networks,,40.85,,,,,,,38.70,41.71,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,outpatient,,,43.00000,20.73000,Hometown Health,Lease Networks,,40.85,,,,,,,11.18,41.71,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,Lease Networks,,60.80,,,,,,,57.60,62.08,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,Lease Networks,,60.80,,,,,,,16.64,62.08,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,inpatient,,,160.00000,77.12000,Hometown Health,Lease Networks,,152.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,outpatient,,,160.00000,77.12000,Hometown Health,Lease Networks,,152.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,inpatient,,,112.00000,53.98000,Hometown Health,Lease Networks,,106.40,,,,,,,100.80,108.64,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,outpatient,,,112.00000,53.98000,Hometown Health,Lease Networks,,106.40,,,,,,,29.12,108.64,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,Lease Networks,,77.90,,,,,,,73.80,79.54,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,Lease Networks,,77.90,,,,,,,21.32,79.54,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,Lease Networks,,51.30,,,,,,,48.60,52.38,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,Lease Networks,,51.30,,,,,,,14.04,52.38,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,inpatient,,,153.00000,73.75000,Hometown Health,Lease Networks,,145.35,,,,,,,137.70,148.41,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,outpatient,,,153.00000,73.75000,Hometown Health,Lease Networks,,145.35,,,,,,,39.78,148.41,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,inpatient,,,45.00000,21.69000,Hometown Health,Lease Networks,,42.75,,,,,,,40.50,43.65,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,outpatient,,,45.00000,21.69000,Hometown Health,Lease Networks,,42.75,,,,,,,11.70,43.65,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,inpatient,,,28.00000,13.50000,Hometown Health,Lease Networks,,26.60,,,,,,,25.20,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,outpatient,,,28.00000,13.50000,Hometown Health,Lease Networks,,26.60,,,,,,,7.28,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Hometown Health,Lease Networks,,46.55,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Hometown Health,Lease Networks,,46.55,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Hometown Health,Lease Networks,,46.55,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Hometown Health,Lease Networks,,46.55,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Hometown Health,Lease Networks,,46.55,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Hometown Health,Lease Networks,,46.55,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,inpatient,,,36.00000,17.35000,Hometown Health,Lease Networks,,34.20,,,,,,,32.40,34.92,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,outpatient,,,36.00000,17.35000,Hometown Health,Lease Networks,,34.20,,,,,,,9.36,34.92,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,inpatient,,,38.00000,18.32000,Hometown Health,Lease Networks,,36.10,,,,,,,34.20,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,outpatient,,,38.00000,18.32000,Hometown Health,Lease Networks,,36.10,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,inpatient,,,38.00000,18.32000,Hometown Health,Lease Networks,,36.10,,,,,,,34.20,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,outpatient,,,38.00000,18.32000,Hometown Health,Lease Networks,,36.10,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,inpatient,,,76.00000,36.63000,Hometown Health,Lease Networks,,72.20,,,,,,,68.40,73.72,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,outpatient,,,76.00000,36.63000,Hometown Health,Lease Networks,,72.20,,,,,,,19.76,73.72,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,inpatient,,,173.00000,83.39000,Hometown Health,Lease Networks,,164.35,,,,,,,155.70,167.81,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,outpatient,,,173.00000,83.39000,Hometown Health,Lease Networks,,164.35,,,,,,,44.98,167.81,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,inpatient,,,22.00000,10.60000,Hometown Health,Lease Networks,,20.90,,,,,,,19.80,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,outpatient,,,22.00000,10.60000,Hometown Health,Lease Networks,,20.90,,,,,,,5.72,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,inpatient,,,39.00000,18.80000,Hometown Health,Lease Networks,,37.05,,,,,,,35.10,37.83,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,outpatient,,,39.00000,18.80000,Hometown Health,Lease Networks,,37.05,,,,,,,10.14,37.83,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,inpatient,,,41.00000,19.76000,Hometown Health,Lease Networks,,38.95,,,,,,,36.90,39.77,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,outpatient,,,41.00000,19.76000,Hometown Health,Lease Networks,,38.95,,,,,,,10.66,39.77,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,Lease Networks,,51.30,,,,,,,48.60,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,Lease Networks,,51.30,,,,,,,14.04,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,Lease Networks,,67.45,,,,,,,63.90,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,Lease Networks,,67.45,,,,,,,18.46,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,inpatient,,,43.00000,20.73000,Hometown Health,Lease Networks,,40.85,,,,,,,38.70,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Hometown Health,Lease Networks,,40.85,,,,,,,11.18,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,inpatient,,,43.00000,20.73000,Hometown Health,Lease Networks,,40.85,,,,,,,38.70,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Hometown Health,Lease Networks,,40.85,,,,,,,11.18,41.71,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,inpatient,,,38.00000,18.32000,Hometown Health,Lease Networks,,36.10,,,,,,,34.20,36.86,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,outpatient,,,38.00000,18.32000,Hometown Health,Lease Networks,,36.10,,,,,,,9.88,36.86,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,Lease Networks,,68.40,,,,,,,64.80,69.84,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,Lease Networks,,68.40,,,,,,,18.72,69.84,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,inpatient,,,226.00000,108.93000,Hometown Health,Lease Networks,,214.70,,,,,,,203.40,219.22,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,outpatient,,,226.00000,108.93000,Hometown Health,Lease Networks,,214.70,,,,,,,58.76,219.22,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Hometown Health,Lease Networks,,38.95,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Hometown Health,Lease Networks,,38.95,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Hometown Health,Lease Networks,,38.95,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Hometown Health,Lease Networks,,38.95,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Hometown Health,Lease Networks,,38.95,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Hometown Health,Lease Networks,,38.95,,,,,,,10.66,39.77,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,inpatient,,,160.00000,77.12000,Hometown Health,Lease Networks,,152.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,outpatient,,,160.00000,77.12000,Hometown Health,Lease Networks,,152.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,inpatient,,,102.00000,49.16000,Hometown Health,Lease Networks,,96.90,,,,,,,91.80,98.94,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,outpatient,,,102.00000,49.16000,Hometown Health,Lease Networks,,96.90,,,,,,,26.52,98.94,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,inpatient,,,317.00000,152.79000,Hometown Health,Lease Networks,,301.15,,,,,,,285.30,307.49,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,outpatient,,,317.00000,152.79000,Hometown Health,Lease Networks,,301.15,,,,,,,82.42,307.49,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,inpatient,,,116.00000,55.91000,Hometown Health,Lease Networks,,110.20,,,,,,,104.40,112.52,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,outpatient,,,116.00000,55.91000,Hometown Health,Lease Networks,,110.20,,,,,,,30.16,112.52,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,inpatient,,,89.00000,42.90000,Hometown Health,Lease Networks,,84.55,,,,,,,80.10,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Hometown Health,Lease Networks,,84.55,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,inpatient,,,89.00000,42.90000,Hometown Health,Lease Networks,,84.55,,,,,,,80.10,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Hometown Health,Lease Networks,,84.55,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,inpatient,,,85.00000,40.97000,Hometown Health,Lease Networks,,80.75,,,,,,,76.50,82.45,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,outpatient,,,85.00000,40.97000,Hometown Health,Lease Networks,,80.75,,,,,,,22.10,82.45,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,inpatient,,,184.00000,88.69000,Hometown Health,Lease Networks,,174.80,,,,,,,165.60,178.48,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,outpatient,,,184.00000,88.69000,Hometown Health,Lease Networks,,174.80,,,,,,,47.84,178.48,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,inpatient,,,127.00000,61.21000,Hometown Health,Lease Networks,,120.65,,,,,,,114.30,123.19,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,outpatient,,,127.00000,61.21000,Hometown Health,Lease Networks,,120.65,,,,,,,33.02,123.19,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,inpatient,,,35.00000,16.87000,Hometown Health,Lease Networks,,33.25,,,,,,,31.50,33.95,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,outpatient,,,35.00000,16.87000,Hometown Health,Lease Networks,,33.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,inpatient,,,79.00000,38.08000,Hometown Health,Lease Networks,,75.05,,,,,,,71.10,76.63,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,outpatient,,,79.00000,38.08000,Hometown Health,Lease Networks,,75.05,,,,,,,20.54,76.63,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,inpatient,,,57.00000,32.83000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,outpatient,,,57.00000,32.83000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Hometown Health,Lease Networks,,145.35,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Hometown Health,Lease Networks,,145.35,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,inpatient,,,77.00000,44.35000,Hometown Health,Lease Networks,,73.15,,,,,,,69.30,74.69,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,outpatient,,,77.00000,44.35000,Hometown Health,Lease Networks,,73.15,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,inpatient,,,70.00000,40.32000,Hometown Health,Lease Networks,,66.50,,,,,,,63.00,67.90,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,outpatient,,,70.00000,40.32000,Hometown Health,Lease Networks,,66.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,inpatient,,,67.00000,38.59000,Hometown Health,Lease Networks,,63.65,,,,,,,60.30,64.99,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,outpatient,,,67.00000,38.59000,Hometown Health,Lease Networks,,63.65,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,inpatient,,,40.00000,23.04000,Hometown Health,Lease Networks,,38.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,outpatient,,,40.00000,23.04000,Hometown Health,Lease Networks,,38.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,inpatient,,,71.00000,40.90000,Hometown Health,Lease Networks,,67.45,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,outpatient,,,71.00000,40.90000,Hometown Health,Lease Networks,,67.45,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,inpatient,,,80.00000,46.08000,Hometown Health,Lease Networks,,76.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,outpatient,,,80.00000,46.08000,Hometown Health,Lease Networks,,76.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,inpatient,,,72.00000,41.47000,Hometown Health,Lease Networks,,68.40,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,outpatient,,,72.00000,41.47000,Hometown Health,Lease Networks,,68.40,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,inpatient,,,444.00000,255.74000,Hometown Health,Lease Networks,,421.80,,,,,,,399.60,430.68,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,outpatient,,,444.00000,255.74000,Hometown Health,Lease Networks,,421.80,,,,,,,115.44,430.68,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,inpatient,,,81.00000,46.66000,Hometown Health,Lease Networks,,76.95,,,,,,,72.90,78.57,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,outpatient,,,81.00000,46.66000,Hometown Health,Lease Networks,,76.95,,,,,,,21.06,78.57,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,inpatient,,,66.00000,38.02000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,outpatient,,,66.00000,38.02000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,inpatient,,,57.00000,32.83000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,outpatient,,,57.00000,32.83000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,Lease Networks,,50.35,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,Lease Networks,,50.35,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,inpatient,,,40.00000,23.04000,Hometown Health,Lease Networks,,38.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,outpatient,,,40.00000,23.04000,Hometown Health,Lease Networks,,38.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,inpatient,,,42.00000,24.19000,Hometown Health,Lease Networks,,39.90,,,,,,,37.80,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,outpatient,,,42.00000,24.19000,Hometown Health,Lease Networks,,39.90,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,inpatient,,,46.00000,26.50000,Hometown Health,Lease Networks,,43.70,,,,,,,41.40,44.62,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,outpatient,,,46.00000,26.50000,Hometown Health,Lease Networks,,43.70,,,,,,,11.96,44.62,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,inpatient,,,54.00000,31.10000,Hometown Health,Lease Networks,,51.30,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,outpatient,,,54.00000,31.10000,Hometown Health,Lease Networks,,51.30,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,inpatient,,,71.00000,40.90000,Hometown Health,Lease Networks,,67.45,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,outpatient,,,71.00000,40.90000,Hometown Health,Lease Networks,,67.45,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,inpatient,,,54.00000,31.10000,Hometown Health,Lease Networks,,51.30,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,outpatient,,,54.00000,31.10000,Hometown Health,Lease Networks,,51.30,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,inpatient,,,80.00000,46.08000,Hometown Health,Lease Networks,,76.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,outpatient,,,80.00000,46.08000,Hometown Health,Lease Networks,,76.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,inpatient,,,124.00000,71.42000,Hometown Health,Lease Networks,,117.80,,,,,,,111.60,120.28,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Hometown Health,Lease Networks,,117.80,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,inpatient,,,130.00000,74.88000,Hometown Health,Lease Networks,,123.50,,,,,,,117.00,126.10,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,outpatient,,,130.00000,74.88000,Hometown Health,Lease Networks,,123.50,,,,,,,33.80,126.10,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,inpatient,,,123.00000,70.85000,Hometown Health,Lease Networks,,116.85,,,,,,,110.70,119.31,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Hometown Health,Lease Networks,,116.85,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,inpatient,,,77.00000,44.35000,Hometown Health,Lease Networks,,73.15,,,,,,,69.30,74.69,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,outpatient,,,77.00000,44.35000,Hometown Health,Lease Networks,,73.15,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,inpatient,,,115.00000,66.24000,Hometown Health,Lease Networks,,109.25,,,,,,,103.50,111.55,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,outpatient,,,115.00000,66.24000,Hometown Health,Lease Networks,,109.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,inpatient,,,123.00000,70.85000,Hometown Health,Lease Networks,,116.85,,,,,,,110.70,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Hometown Health,Lease Networks,,116.85,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,inpatient,,,161.00000,92.74000,Hometown Health,Lease Networks,,152.95,,,,,,,144.90,156.17,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,outpatient,,,161.00000,92.74000,Hometown Health,Lease Networks,,152.95,,,,,,,41.86,156.17,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,inpatient,,,124.00000,71.42000,Hometown Health,Lease Networks,,117.80,,,,,,,111.60,120.28,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Hometown Health,Lease Networks,,117.80,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,inpatient,,,102.00000,58.75000,Hometown Health,Lease Networks,,96.90,,,,,,,91.80,98.94,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,outpatient,,,102.00000,58.75000,Hometown Health,Lease Networks,,96.90,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,inpatient,,,219.00000,126.14000,Hometown Health,Lease Networks,,208.05,,,,,,,197.10,212.43,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,outpatient,,,219.00000,126.14000,Hometown Health,Lease Networks,,208.05,,,,,,,56.94,212.43,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,inpatient,,,194.00000,111.74000,Hometown Health,Lease Networks,,184.30,,,,,,,174.60,188.18,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Hometown Health,Lease Networks,,184.30,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,inpatient,,,103.00000,59.33000,Hometown Health,Lease Networks,,97.85,,,,,,,92.70,99.91,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,outpatient,,,103.00000,59.33000,Hometown Health,Lease Networks,,97.85,,,,,,,26.78,99.91,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,inpatient,,,837.00000,482.11000,Hometown Health,Lease Networks,,795.15,,,,,,,753.30,811.89,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,outpatient,,,837.00000,482.11000,Hometown Health,Lease Networks,,795.15,,,,,,,217.62,811.89,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,inpatient,,,194.00000,111.74000,Hometown Health,Lease Networks,,184.30,,,,,,,174.60,188.18,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Hometown Health,Lease Networks,,184.30,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,inpatient,,,78.00000,44.93000,Hometown Health,Lease Networks,,74.10,,,,,,,70.20,75.66,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,outpatient,,,78.00000,44.93000,Hometown Health,Lease Networks,,74.10,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,inpatient,,,285.00000,164.16000,Hometown Health,Lease Networks,,270.75,,,,,,,256.50,276.45,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,outpatient,,,285.00000,164.16000,Hometown Health,Lease Networks,,270.75,,,,,,,74.10,276.45,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,inpatient,,,190.00000,109.44000,Hometown Health,Lease Networks,,180.50,,,,,,,171.00,184.30,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,outpatient,,,190.00000,109.44000,Hometown Health,Lease Networks,,180.50,,,,,,,49.40,184.30,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,inpatient,,,100.00000,57.60000,Hometown Health,Lease Networks,,95.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,outpatient,,,100.00000,57.60000,Hometown Health,Lease Networks,,95.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,inpatient,,,40.00000,23.04000,Hometown Health,Lease Networks,,38.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Hometown Health,Lease Networks,,38.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,inpatient,,,67.00000,38.59000,Hometown Health,Lease Networks,,63.65,,,,,,,60.30,64.99,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,outpatient,,,67.00000,38.59000,Hometown Health,Lease Networks,,63.65,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,inpatient,,,78.00000,44.93000,Hometown Health,Lease Networks,,74.10,,,,,,,70.20,75.66,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,outpatient,,,78.00000,44.93000,Hometown Health,Lease Networks,,74.10,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,inpatient,,,57.00000,32.83000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,outpatient,,,57.00000,32.83000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,inpatient,,,72.00000,41.47000,Hometown Health,Lease Networks,,68.40,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,outpatient,,,72.00000,41.47000,Hometown Health,Lease Networks,,68.40,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,inpatient,,,72.00000,41.47000,Hometown Health,Lease Networks,,68.40,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,outpatient,,,72.00000,41.47000,Hometown Health,Lease Networks,,68.40,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,inpatient,,,239.00000,137.66000,Hometown Health,Lease Networks,,227.05,,,,,,,215.10,231.83,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,outpatient,,,239.00000,137.66000,Hometown Health,Lease Networks,,227.05,,,,,,,62.14,231.83,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,inpatient,,,85.00000,48.96000,Hometown Health,Lease Networks,,80.75,,,,,,,76.50,82.45,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,outpatient,,,85.00000,48.96000,Hometown Health,Lease Networks,,80.75,,,,,,,22.10,82.45,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,inpatient,,,44.00000,25.34000,Hometown Health,Lease Networks,,41.80,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,outpatient,,,44.00000,25.34000,Hometown Health,Lease Networks,,41.80,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,inpatient,,,40.00000,23.04000,Hometown Health,Lease Networks,,38.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,outpatient,,,40.00000,23.04000,Hometown Health,Lease Networks,,38.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,Lease Networks,,50.35,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,Lease Networks,,50.35,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,inpatient,,,68.00000,39.17000,Hometown Health,Lease Networks,,64.60,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,outpatient,,,68.00000,39.17000,Hometown Health,Lease Networks,,64.60,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,inpatient,,,76.00000,43.78000,Hometown Health,Lease Networks,,72.20,,,,,,,68.40,73.72,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,outpatient,,,76.00000,43.78000,Hometown Health,Lease Networks,,72.20,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,inpatient,,,42.00000,24.19000,Hometown Health,Lease Networks,,39.90,,,,,,,37.80,40.74,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,outpatient,,,42.00000,24.19000,Hometown Health,Lease Networks,,39.90,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,inpatient,,,87.00000,50.11000,Hometown Health,Lease Networks,,82.65,,,,,,,78.30,84.39,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,outpatient,,,87.00000,50.11000,Hometown Health,Lease Networks,,82.65,,,,,,,22.62,84.39,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,inpatient,,,503.00000,289.73000,Hometown Health,Lease Networks,,477.85,,,,,,,452.70,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,outpatient,,,503.00000,289.73000,Hometown Health,Lease Networks,,477.85,,,,,,,130.78,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,inpatient,,,472.00000,271.87000,Hometown Health,Lease Networks,,448.40,,,,,,,424.80,457.84,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,outpatient,,,472.00000,271.87000,Hometown Health,Lease Networks,,448.40,,,,,,,122.72,457.84,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,inpatient,,,28.00000,16.13000,Hometown Health,Lease Networks,,26.60,,,,,,,25.20,27.16,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,outpatient,,,28.00000,16.13000,Hometown Health,Lease Networks,,26.60,,,,,,,7.28,27.16,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,inpatient,,,236.00000,135.94000,Hometown Health,Lease Networks,,224.20,,,,,,,212.40,228.92,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,outpatient,,,236.00000,135.94000,Hometown Health,Lease Networks,,224.20,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,inpatient,,,54.00000,31.10000,Hometown Health,Lease Networks,,51.30,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,outpatient,,,54.00000,31.10000,Hometown Health,Lease Networks,,51.30,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,inpatient,,,238.00000,137.09000,Hometown Health,Lease Networks,,226.10,,,,,,,214.20,230.86,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,outpatient,,,238.00000,137.09000,Hometown Health,Lease Networks,,226.10,,,,,,,61.88,230.86,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,inpatient,,,236.00000,135.94000,Hometown Health,Lease Networks,,224.20,,,,,,,212.40,228.92,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,outpatient,,,236.00000,135.94000,Hometown Health,Lease Networks,,224.20,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,inpatient,,,145.00000,83.52000,Hometown Health,Lease Networks,,137.75,,,,,,,130.50,140.65,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,outpatient,,,145.00000,83.52000,Hometown Health,Lease Networks,,137.75,,,,,,,37.70,140.65,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,inpatient,,,68.00000,39.17000,Hometown Health,Lease Networks,,64.60,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Hometown Health,Lease Networks,,64.60,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,inpatient,,,68.00000,39.17000,Hometown Health,Lease Networks,,64.60,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Hometown Health,Lease Networks,,64.60,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,inpatient,,,66.00000,38.02000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,outpatient,,,66.00000,38.02000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,inpatient,,,158.00000,91.01000,Hometown Health,Lease Networks,,150.10,,,,,,,142.20,153.26,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,outpatient,,,158.00000,91.01000,Hometown Health,Lease Networks,,150.10,,,,,,,41.08,153.26,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,inpatient,,,71.00000,40.90000,Hometown Health,Lease Networks,,67.45,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,outpatient,,,71.00000,40.90000,Hometown Health,Lease Networks,,67.45,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,inpatient,,,144.00000,82.94000,Hometown Health,Lease Networks,,136.80,,,,,,,129.60,139.68,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,outpatient,,,144.00000,82.94000,Hometown Health,Lease Networks,,136.80,,,,,,,37.44,139.68,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,inpatient,,,1448.00000,834.05000,Hometown Health,Lease Networks,,1375.60,,,,,,,1303.20,1404.56,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,outpatient,,,1448.00000,834.05000,Hometown Health,Lease Networks,,1375.60,,,,,,,376.48,1404.56,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,inpatient,,,72.00000,41.47000,Hometown Health,Lease Networks,,68.40,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,outpatient,,,72.00000,41.47000,Hometown Health,Lease Networks,,68.40,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,inpatient,,,102.00000,58.75000,Hometown Health,Lease Networks,,96.90,,,,,,,91.80,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,outpatient,,,102.00000,58.75000,Hometown Health,Lease Networks,,96.90,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,inpatient,,,154.00000,88.70000,Hometown Health,Lease Networks,,146.30,,,,,,,138.60,149.38,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,outpatient,,,154.00000,88.70000,Hometown Health,Lease Networks,,146.30,,,,,,,40.04,149.38,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Hometown Health,Lease Networks,,145.35,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Hometown Health,Lease Networks,,145.35,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,inpatient,,,66.00000,38.02000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,outpatient,,,66.00000,38.02000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Hometown Health,Lease Networks,,145.35,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Hometown Health,Lease Networks,,145.35,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,inpatient,,,44.00000,25.34000,Hometown Health,Lease Networks,,41.80,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,outpatient,,,44.00000,25.34000,Hometown Health,Lease Networks,,41.80,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,inpatient,,,150.00000,86.40000,Hometown Health,Lease Networks,,142.50,,,,,,,135.00,145.50,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,outpatient,,,150.00000,86.40000,Hometown Health,Lease Networks,,142.50,,,,,,,39.00,145.50,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,inpatient,,,66.00000,38.02000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,outpatient,,,66.00000,38.02000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,inpatient,,,58.00000,33.41000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,outpatient,,,58.00000,33.41000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,inpatient,,,71.00000,40.90000,Hometown Health,Lease Networks,,67.45,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,outpatient,,,71.00000,40.90000,Hometown Health,Lease Networks,,67.45,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,inpatient,,,72.00000,41.47000,Hometown Health,Lease Networks,,68.40,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,outpatient,,,72.00000,41.47000,Hometown Health,Lease Networks,,68.40,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,inpatient,,,39.00000,22.46000,Hometown Health,Lease Networks,,37.05,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,outpatient,,,39.00000,22.46000,Hometown Health,Lease Networks,,37.05,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Hometown Health,Lease Networks,,145.35,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Hometown Health,Lease Networks,,145.35,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,inpatient,,,73.00000,42.05000,Hometown Health,Lease Networks,,69.35,,,,,,,65.70,70.81,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,outpatient,,,73.00000,42.05000,Hometown Health,Lease Networks,,69.35,,,,,,,18.98,70.81,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,inpatient,,,127.00000,73.15000,Hometown Health,Lease Networks,,120.65,,,,,,,114.30,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Hometown Health,Lease Networks,,120.65,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,inpatient,,,127.00000,73.15000,Hometown Health,Lease Networks,,120.65,,,,,,,114.30,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Hometown Health,Lease Networks,,120.65,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,inpatient,,,372.00000,214.27000,Hometown Health,Lease Networks,,353.40,,,,,,,334.80,360.84,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,outpatient,,,372.00000,214.27000,Hometown Health,Lease Networks,,353.40,,,,,,,96.72,360.84,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,inpatient,,,69.00000,39.74000,Hometown Health,Lease Networks,,65.55,,,,,,,62.10,66.93,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,outpatient,,,69.00000,39.74000,Hometown Health,Lease Networks,,65.55,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Hometown Health,Lease Networks,,145.35,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Hometown Health,Lease Networks,,145.35,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Hometown Health,Lease Networks,,145.35,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Hometown Health,Lease Networks,,145.35,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,inpatient,,,57.00000,32.83000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,outpatient,,,57.00000,32.83000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,inpatient,,,96.00000,55.30000,Hometown Health,Lease Networks,,91.20,,,,,,,86.40,93.12,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,outpatient,,,96.00000,55.30000,Hometown Health,Lease Networks,,91.20,,,,,,,24.96,93.12,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,inpatient,,,44.00000,25.34000,Hometown Health,Lease Networks,,41.80,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,outpatient,,,44.00000,25.34000,Hometown Health,Lease Networks,,41.80,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,inpatient,,,74.00000,42.62000,Hometown Health,Lease Networks,,70.30,,,,,,,66.60,71.78,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,outpatient,,,74.00000,42.62000,Hometown Health,Lease Networks,,70.30,,,,,,,19.24,71.78,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,inpatient,,,69.00000,39.74000,Hometown Health,Lease Networks,,65.55,,,,,,,62.10,66.93,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,outpatient,,,69.00000,39.74000,Hometown Health,Lease Networks,,65.55,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Hometown Health,Lease Networks,,37.05,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Hometown Health,Lease Networks,,37.05,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,Lease Networks,,50.35,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,Lease Networks,,50.35,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Hometown Health,Lease Networks,,37.05,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Hometown Health,Lease Networks,,37.05,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Hometown Health,Lease Networks,,37.05,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Hometown Health,Lease Networks,,37.05,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,inpatient,,,70.00000,40.32000,Hometown Health,Lease Networks,,66.50,,,,,,,63.00,67.90,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,outpatient,,,70.00000,40.32000,Hometown Health,Lease Networks,,66.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,inpatient,,,71.00000,40.90000,Hometown Health,Lease Networks,,67.45,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,outpatient,,,71.00000,40.90000,Hometown Health,Lease Networks,,67.45,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,Lease Networks,,61.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,inpatient,,,325.00000,187.20000,Hometown Health,Lease Networks,,308.75,,,,,,,292.50,315.25,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,outpatient,,,325.00000,187.20000,Hometown Health,Lease Networks,,308.75,,,,,,,84.50,315.25,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,inpatient,,,72.00000,41.47000,Hometown Health,Lease Networks,,68.40,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,outpatient,,,72.00000,41.47000,Hometown Health,Lease Networks,,68.40,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,inpatient,,,72.00000,41.47000,Hometown Health,Lease Networks,,68.40,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,outpatient,,,72.00000,41.47000,Hometown Health,Lease Networks,,68.40,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,inpatient,,,76.00000,43.78000,Hometown Health,Lease Networks,,72.20,,,,,,,68.40,73.72,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,outpatient,,,76.00000,43.78000,Hometown Health,Lease Networks,,72.20,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,inpatient,,,240.00000,138.24000,Hometown Health,Lease Networks,,228.00,,,,,,,216.00,232.80,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,outpatient,,,240.00000,138.24000,Hometown Health,Lease Networks,,228.00,,,,,,,62.40,232.80,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,inpatient,,,93.00000,53.57000,Hometown Health,Lease Networks,,88.35,,,,,,,83.70,90.21,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,outpatient,,,93.00000,53.57000,Hometown Health,Lease Networks,,88.35,,,,,,,24.18,90.21,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,inpatient,,,81.00000,46.66000,Hometown Health,Lease Networks,,76.95,,,,,,,72.90,78.57,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,outpatient,,,81.00000,46.66000,Hometown Health,Lease Networks,,76.95,,,,,,,21.06,78.57,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,inpatient,,,58.00000,33.41000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,outpatient,,,58.00000,33.41000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,inpatient,,,21.00000,12.10000,Hometown Health,Lease Networks,,19.95,,,,,,,18.90,20.37,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,outpatient,,,21.00000,12.10000,Hometown Health,Lease Networks,,19.95,,,,,,,5.46,20.37,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,inpatient,,,64.00000,36.86000,Hometown Health,Lease Networks,,60.80,,,,,,,57.60,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,outpatient,,,64.00000,36.86000,Hometown Health,Lease Networks,,60.80,,,,,,,16.64,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,inpatient,,,80.00000,46.08000,Hometown Health,Lease Networks,,76.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,outpatient,,,80.00000,46.08000,Hometown Health,Lease Networks,,76.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,inpatient,,,109.00000,62.78000,Hometown Health,Lease Networks,,103.55,,,,,,,98.10,105.73,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,outpatient,,,109.00000,62.78000,Hometown Health,Lease Networks,,103.55,,,,,,,28.34,105.73,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,inpatient,,,115.00000,66.24000,Hometown Health,Lease Networks,,109.25,,,,,,,103.50,111.55,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,outpatient,,,115.00000,66.24000,Hometown Health,Lease Networks,,109.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,inpatient,,,57.00000,32.83000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,outpatient,,,57.00000,32.83000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,inpatient,,,118.00000,67.97000,Hometown Health,Lease Networks,,112.10,,,,,,,106.20,114.46,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,outpatient,,,118.00000,67.97000,Hometown Health,Lease Networks,,112.10,,,,,,,30.68,114.46,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,inpatient,,,268.00000,154.37000,Hometown Health,Lease Networks,,254.60,,,,,,,241.20,259.96,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,outpatient,,,268.00000,154.37000,Hometown Health,Lease Networks,,254.60,,,,,,,69.68,259.96,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,inpatient,,,114.00000,65.66000,Hometown Health,Lease Networks,,108.30,,,,,,,102.60,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Hometown Health,Lease Networks,,108.30,,,,,,,29.64,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,inpatient,,,114.00000,65.66000,Hometown Health,Lease Networks,,108.30,,,,,,,102.60,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Hometown Health,Lease Networks,,108.30,,,,,,,29.64,110.58,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,inpatient,,,78.00000,44.93000,Hometown Health,Lease Networks,,74.10,,,,,,,70.20,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,outpatient,,,78.00000,44.93000,Hometown Health,Lease Networks,,74.10,,,,,,,20.28,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,inpatient,,,91.00000,52.42000,Hometown Health,Lease Networks,,86.45,,,,,,,81.90,88.27,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,outpatient,,,91.00000,52.42000,Hometown Health,Lease Networks,,86.45,,,,,,,23.66,88.27,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,inpatient,,,66.00000,38.02000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,inpatient,,,66.00000,38.02000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,inpatient,,,300.00000,172.80000,Hometown Health,Lease Networks,,285.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,outpatient,,,300.00000,172.80000,Hometown Health,Lease Networks,,285.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,inpatient,,,185.00000,106.56000,Hometown Health,Lease Networks,,175.75,,,,,,,166.50,179.45,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,outpatient,,,185.00000,106.56000,Hometown Health,Lease Networks,,175.75,,,,,,,48.10,179.45,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Hometown Health,Lease Networks,,34.20,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Hometown Health,Lease Networks,,34.20,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,inpatient,,,76.00000,43.78000,Hometown Health,Lease Networks,,72.20,,,,,,,68.40,73.72,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,outpatient,,,76.00000,43.78000,Hometown Health,Lease Networks,,72.20,,,,,,,19.76,73.72,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Hometown Health,Lease Networks,,34.20,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Hometown Health,Lease Networks,,34.20,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Hometown Health,Lease Networks,,34.20,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Hometown Health,Lease Networks,,34.20,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,Lease Networks,,50.35,,,,,,,47.70,51.41,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,Lease Networks,,50.35,,,,,,,13.78,51.41,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,inpatient,,,77.00000,44.35000,Hometown Health,Lease Networks,,73.15,,,,,,,69.30,74.69,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,outpatient,,,77.00000,44.35000,Hometown Health,Lease Networks,,73.15,,,,,,,20.02,74.69,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Hometown Health,Lease Networks,,34.20,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Hometown Health,Lease Networks,,34.20,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,inpatient,,,222.00000,127.87000,Hometown Health,Lease Networks,,210.90,,,,,,,199.80,215.34,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,outpatient,,,222.00000,127.87000,Hometown Health,Lease Networks,,210.90,,,,,,,57.72,215.34,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,inpatient,,,292.00000,168.19000,Hometown Health,Lease Networks,,277.40,,,,,,,262.80,283.24,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,outpatient,,,292.00000,168.19000,Hometown Health,Lease Networks,,277.40,,,,,,,75.92,283.24,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,inpatient,,,125.00000,72.00000,Hometown Health,Lease Networks,,118.75,,,,,,,112.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Hometown Health,Lease Networks,,118.75,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,inpatient,,,125.00000,72.00000,Hometown Health,Lease Networks,,118.75,,,,,,,112.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Hometown Health,Lease Networks,,118.75,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,inpatient,,,359.00000,206.78000,Hometown Health,Lease Networks,,341.05,,,,,,,323.10,348.23,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,outpatient,,,359.00000,206.78000,Hometown Health,Lease Networks,,341.05,,,,,,,93.34,348.23,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,inpatient,,,111.00000,63.94000,Hometown Health,Lease Networks,,105.45,,,,,,,99.90,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,outpatient,,,111.00000,63.94000,Hometown Health,Lease Networks,,105.45,,,,,,,28.86,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,inpatient,,,141.00000,81.22000,Hometown Health,Lease Networks,,133.95,,,,,,,126.90,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Hometown Health,Lease Networks,,133.95,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,inpatient,,,141.00000,81.22000,Hometown Health,Lease Networks,,133.95,,,,,,,126.90,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Hometown Health,Lease Networks,,133.95,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,inpatient,,,114.00000,65.66000,Hometown Health,Lease Networks,,108.30,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Hometown Health,Lease Networks,,108.30,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,inpatient,,,114.00000,65.66000,Hometown Health,Lease Networks,,108.30,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Hometown Health,Lease Networks,,108.30,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,inpatient,,,114.00000,65.66000,Hometown Health,Lease Networks,,108.30,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Hometown Health,Lease Networks,,108.30,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,inpatient,,,114.00000,65.66000,Hometown Health,Lease Networks,,108.30,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Hometown Health,Lease Networks,,108.30,,,,,,,29.64,110.58,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,inpatient,,,78.00000,44.93000,Hometown Health,Lease Networks,,74.10,,,,,,,70.20,75.66,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,outpatient,,,78.00000,44.93000,Hometown Health,Lease Networks,,74.10,,,,,,,20.28,75.66,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,inpatient,,,359.00000,206.78000,Hometown Health,Lease Networks,,341.05,,,,,,,323.10,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Hometown Health,Lease Networks,,341.05,,,,,,,93.34,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,inpatient,,,359.00000,206.78000,Hometown Health,Lease Networks,,341.05,,,,,,,323.10,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Hometown Health,Lease Networks,,341.05,,,,,,,93.34,348.23,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,inpatient,,,70.00000,40.32000,Hometown Health,Lease Networks,,66.50,,,,,,,63.00,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,outpatient,,,70.00000,40.32000,Hometown Health,Lease Networks,,66.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,inpatient,,,18.00000,10.37000,Hometown Health,Lease Networks,,17.10,,,,,,,16.20,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,outpatient,,,18.00000,10.37000,Hometown Health,Lease Networks,,17.10,,,,,,,4.68,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,inpatient,,,408.00000,235.01000,Hometown Health,Lease Networks,,387.60,,,,,,,367.20,395.76,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,outpatient,,,408.00000,235.01000,Hometown Health,Lease Networks,,387.60,,,,,,,106.08,395.76,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,inpatient,,,102.00000,58.75000,Hometown Health,Lease Networks,,96.90,,,,,,,91.80,98.94,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,outpatient,,,102.00000,58.75000,Hometown Health,Lease Networks,,96.90,,,,,,,26.52,98.94,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,inpatient,,,330.00000,190.08000,Hometown Health,Lease Networks,,313.50,,,,,,,297.00,320.10,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,outpatient,,,330.00000,190.08000,Hometown Health,Lease Networks,,313.50,,,,,,,85.80,320.10,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,inpatient,,,136.00000,78.34000,Hometown Health,Lease Networks,,129.20,,,,,,,122.40,131.92,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,outpatient,,,136.00000,78.34000,Hometown Health,Lease Networks,,129.20,,,,,,,35.36,131.92,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,inpatient,,,83.00000,47.81000,Hometown Health,Lease Networks,,78.85,,,,,,,74.70,80.51,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,outpatient,,,83.00000,47.81000,Hometown Health,Lease Networks,,78.85,,,,,,,21.58,80.51,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,inpatient,,,142.00000,81.79000,Hometown Health,Lease Networks,,134.90,,,,,,,127.80,137.74,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,outpatient,,,142.00000,81.79000,Hometown Health,Lease Networks,,134.90,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,inpatient,,,51.00000,29.38000,Hometown Health,Lease Networks,,48.45,,,,,,,45.90,49.47,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,outpatient,,,51.00000,29.38000,Hometown Health,Lease Networks,,48.45,,,,,,,13.26,49.47,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,inpatient,,,70.00000,40.32000,Hometown Health,Lease Networks,,66.50,,,,,,,63.00,67.90,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,outpatient,,,70.00000,40.32000,Hometown Health,Lease Networks,,66.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,inpatient,,,99.00000,57.02000,Hometown Health,Lease Networks,,94.05,,,,,,,89.10,96.03,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,outpatient,,,99.00000,57.02000,Hometown Health,Lease Networks,,94.05,,,,,,,25.74,96.03,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,inpatient,,,78.00000,44.93000,Hometown Health,Lease Networks,,74.10,,,,,,,70.20,75.66,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,outpatient,,,78.00000,44.93000,Hometown Health,Lease Networks,,74.10,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,inpatient,,,75.00000,43.20000,Hometown Health,Lease Networks,,71.25,,,,,,,67.50,72.75,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,outpatient,,,75.00000,43.20000,Hometown Health,Lease Networks,,71.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,inpatient,,,37.00000,21.31000,Hometown Health,Lease Networks,,35.15,,,,,,,33.30,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Hometown Health,Lease Networks,,35.15,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,inpatient,,,37.00000,21.31000,Hometown Health,Lease Networks,,35.15,,,,,,,33.30,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Hometown Health,Lease Networks,,35.15,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,inpatient,,,35.00000,20.16000,Hometown Health,Lease Networks,,33.25,,,,,,,31.50,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,outpatient,,,35.00000,20.16000,Hometown Health,Lease Networks,,33.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,inpatient,,,74.00000,42.62000,Hometown Health,Lease Networks,,70.30,,,,,,,66.60,71.78,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,outpatient,,,74.00000,42.62000,Hometown Health,Lease Networks,,70.30,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,inpatient,,,90.00000,51.84000,Hometown Health,Lease Networks,,85.50,,,,,,,81.00,87.30,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,outpatient,,,90.00000,51.84000,Hometown Health,Lease Networks,,85.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,inpatient,,,68.00000,39.17000,Hometown Health,Lease Networks,,64.60,,,,,,,61.20,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Hometown Health,Lease Networks,,64.60,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,inpatient,,,142.00000,81.79000,Hometown Health,Lease Networks,,134.90,,,,,,,127.80,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,outpatient,,,142.00000,81.79000,Hometown Health,Lease Networks,,134.90,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,inpatient,,,68.00000,39.17000,Hometown Health,Lease Networks,,64.60,,,,,,,61.20,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Hometown Health,Lease Networks,,64.60,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,inpatient,,,74.00000,42.62000,Hometown Health,Lease Networks,,70.30,,,,,,,66.60,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,outpatient,,,74.00000,42.62000,Hometown Health,Lease Networks,,70.30,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,inpatient,,,89.00000,51.26000,Hometown Health,Lease Networks,,84.55,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Hometown Health,Lease Networks,,84.55,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,inpatient,,,89.00000,51.26000,Hometown Health,Lease Networks,,84.55,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Hometown Health,Lease Networks,,84.55,,,,,,,23.14,86.33,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,inpatient,,,57.00000,32.83000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,outpatient,,,57.00000,32.83000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,inpatient,,,77.00000,44.35000,Hometown Health,Lease Networks,,73.15,,,,,,,69.30,74.69,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,outpatient,,,77.00000,44.35000,Hometown Health,Lease Networks,,73.15,,,,,,,20.02,74.69,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,inpatient,,,64.00000,36.86000,Hometown Health,Lease Networks,,60.80,,,,,,,57.60,62.08,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,outpatient,,,64.00000,36.86000,Hometown Health,Lease Networks,,60.80,,,,,,,16.64,62.08,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,inpatient,,,69.00000,39.74000,Hometown Health,Lease Networks,,65.55,,,,,,,62.10,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,outpatient,,,69.00000,39.74000,Hometown Health,Lease Networks,,65.55,,,,,,,17.94,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,inpatient,,,1178.00000,678.53000,Hometown Health,Lease Networks,,1119.10,,,,,,,1060.20,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,outpatient,,,1178.00000,678.53000,Hometown Health,Lease Networks,,1119.10,,,,,,,306.28,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,inpatient,,,127.00000,73.15000,Hometown Health,Lease Networks,,120.65,,,,,,,114.30,123.19,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,outpatient,,,127.00000,73.15000,Hometown Health,Lease Networks,,120.65,,,,,,,33.02,123.19,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,inpatient,,,277.00000,159.55000,Hometown Health,Lease Networks,,263.15,,,,,,,249.30,268.69,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,outpatient,,,277.00000,159.55000,Hometown Health,Lease Networks,,263.15,,,,,,,72.02,268.69,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,inpatient,,,940.00000,541.44000,Hometown Health,Lease Networks,,893.00,,,,,,,846.00,911.80,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,outpatient,,,940.00000,541.44000,Hometown Health,Lease Networks,,893.00,,,,,,,244.40,911.80,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,inpatient,,,97.00000,55.87000,Hometown Health,Lease Networks,,92.15,,,,,,,87.30,94.09,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,outpatient,,,97.00000,55.87000,Hometown Health,Lease Networks,,92.15,,,,,,,25.22,94.09,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,inpatient,,,16.00000,9.22000,Hometown Health,Lease Networks,,15.20,,,,,,,14.40,15.52,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,outpatient,,,16.00000,9.22000,Hometown Health,Lease Networks,,15.20,,,,,,,4.16,15.52,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,inpatient,,,57.00000,32.83000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,outpatient,,,57.00000,32.83000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,inpatient,,,131.00000,75.46000,Hometown Health,Lease Networks,,124.45,,,,,,,117.90,127.07,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,outpatient,,,131.00000,75.46000,Hometown Health,Lease Networks,,124.45,,,,,,,34.06,127.07,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,inpatient,,,2160.00000,1244.16000,Hometown Health,Lease Networks,,2052.00,,,,,,,1944.00,2095.20,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,outpatient,,,2160.00000,1244.16000,Hometown Health,Lease Networks,,2052.00,,,,,,,561.60,2095.20,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,inpatient,,,37.00000,21.31000,Hometown Health,Lease Networks,,35.15,,,,,,,33.30,35.89,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,outpatient,,,37.00000,21.31000,Hometown Health,Lease Networks,,35.15,,,,,,,9.62,35.89,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,inpatient,,,74.00000,42.62000,Hometown Health,Lease Networks,,70.30,,,,,,,66.60,71.78,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Hometown Health,Lease Networks,,70.30,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,inpatient,,,54.00000,31.10000,Hometown Health,Lease Networks,,51.30,,,,,,,48.60,52.38,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,outpatient,,,54.00000,31.10000,Hometown Health,Lease Networks,,51.30,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,inpatient,,,76.00000,43.78000,Hometown Health,Lease Networks,,72.20,,,,,,,68.40,73.72,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,outpatient,,,76.00000,43.78000,Hometown Health,Lease Networks,,72.20,,,,,,,19.76,73.72,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,inpatient,,,606.00000,349.06000,Hometown Health,Lease Networks,,575.70,,,,,,,545.40,587.82,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,outpatient,,,606.00000,349.06000,Hometown Health,Lease Networks,,575.70,,,,,,,157.56,587.82,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,inpatient,,,300.00000,172.80000,Hometown Health,Lease Networks,,285.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,outpatient,,,300.00000,172.80000,Hometown Health,Lease Networks,,285.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,inpatient,,,98.00000,56.45000,Hometown Health,Lease Networks,,93.10,,,,,,,88.20,95.06,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,outpatient,,,98.00000,56.45000,Hometown Health,Lease Networks,,93.10,,,,,,,25.48,95.06,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,inpatient,,,128.00000,73.73000,Hometown Health,Lease Networks,,121.60,,,,,,,115.20,124.16,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,outpatient,,,128.00000,73.73000,Hometown Health,Lease Networks,,121.60,,,,,,,33.28,124.16,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,Lease Networks,,50.35,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,Lease Networks,,50.35,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,inpatient,,,16.00000,9.22000,Hometown Health,Lease Networks,,15.20,,,,,,,14.40,15.52,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,outpatient,,,16.00000,9.22000,Hometown Health,Lease Networks,,15.20,,,,,,,4.16,15.52,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,inpatient,,,565.00000,325.44000,Hometown Health,Lease Networks,,536.75,,,,,,,508.50,548.05,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,outpatient,,,565.00000,325.44000,Hometown Health,Lease Networks,,536.75,,,,,,,146.90,548.05,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,inpatient,,,850.00000,489.60000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,outpatient,,,850.00000,489.60000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,inpatient,,,77.00000,44.35000,Hometown Health,Lease Networks,,73.15,,,,,,,69.30,74.69,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,outpatient,,,77.00000,44.35000,Hometown Health,Lease Networks,,73.15,,,,,,,20.02,74.69,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,inpatient,,,86.00000,49.54000,Hometown Health,Lease Networks,,81.70,,,,,,,77.40,83.42,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,outpatient,,,86.00000,49.54000,Hometown Health,Lease Networks,,81.70,,,,,,,22.36,83.42,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,inpatient,,,837.00000,482.11000,Hometown Health,Lease Networks,,795.15,,,,,,,753.30,811.89,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,outpatient,,,837.00000,482.11000,Hometown Health,Lease Networks,,795.15,,,,,,,217.62,811.89,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,inpatient,,,74.00000,42.62000,Hometown Health,Lease Networks,,70.30,,,,,,,66.60,71.78,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Hometown Health,Lease Networks,,70.30,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,Lease Networks,,50.35,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,Lease Networks,,50.35,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,Lease Networks,,50.35,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,Lease Networks,,50.35,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,inpatient,,,167.00000,96.19000,Hometown Health,Lease Networks,,158.65,,,,,,,150.30,161.99,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,outpatient,,,167.00000,96.19000,Hometown Health,Lease Networks,,158.65,,,,,,,43.42,161.99,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,inpatient,,,200.00000,115.20000,Hometown Health,Lease Networks,,190.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,outpatient,,,200.00000,115.20000,Hometown Health,Lease Networks,,190.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,inpatient,,,93.00000,53.57000,Hometown Health,Lease Networks,,88.35,,,,,,,83.70,90.21,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,outpatient,,,93.00000,53.57000,Hometown Health,Lease Networks,,88.35,,,,,,,24.18,90.21,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,49.50,53.35,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,Lease Networks,,52.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,inpatient,,,190.00000,109.44000,Hometown Health,Lease Networks,,180.50,,,,,,,171.00,184.30,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,outpatient,,,190.00000,109.44000,Hometown Health,Lease Networks,,180.50,,,,,,,49.40,184.30,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,inpatient,,,64.00000,36.86000,Hometown Health,Lease Networks,,60.80,,,,,,,57.60,62.08,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,outpatient,,,64.00000,36.86000,Hometown Health,Lease Networks,,60.80,,,,,,,16.64,62.08,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,inpatient,,,525.00000,302.40000,Hometown Health,Lease Networks,,498.75,,,,,,,472.50,509.25,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,outpatient,,,525.00000,302.40000,Hometown Health,Lease Networks,,498.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,inpatient,,,54.00000,31.10000,Hometown Health,Lease Networks,,51.30,,,,,,,48.60,52.38,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,outpatient,,,54.00000,31.10000,Hometown Health,Lease Networks,,51.30,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,Lease Networks,,50.35,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,Lease Networks,,50.35,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,Lease Networks,,50.35,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,Lease Networks,,50.35,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,inpatient,,,40.00000,23.04000,Hometown Health,Lease Networks,,38.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Hometown Health,Lease Networks,,38.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,inpatient,,,453.00000,260.93000,Hometown Health,Lease Networks,,430.35,,,,,,,407.70,439.41,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,outpatient,,,453.00000,260.93000,Hometown Health,Lease Networks,,430.35,,,,,,,117.78,439.41,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,inpatient,,,25.00000,14.40000,Hometown Health,Lease Networks,,23.75,,,,,,,22.50,24.25,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,outpatient,,,25.00000,14.40000,Hometown Health,Lease Networks,,23.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,Lease Networks,,50.35,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,Lease Networks,,50.35,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,inpatient,,,350.00000,201.60000,Hometown Health,Lease Networks,,332.50,,,,,,,315.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,outpatient,,,350.00000,201.60000,Hometown Health,Lease Networks,,332.50,,,,,,,91.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,inpatient,,,225.00000,129.60000,Hometown Health,Lease Networks,,213.75,,,,,,,202.50,218.25,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,outpatient,,,225.00000,129.60000,Hometown Health,Lease Networks,,213.75,,,,,,,58.50,218.25,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,inpatient,,,52.00000,29.95000,Hometown Health,Lease Networks,,49.40,,,,,,,46.80,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,outpatient,,,52.00000,29.95000,Hometown Health,Lease Networks,,49.40,,,,,,,13.52,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,inpatient,,,134.00000,77.18000,Hometown Health,Lease Networks,,127.30,,,,,,,120.60,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,outpatient,,,134.00000,77.18000,Hometown Health,Lease Networks,,127.30,,,,,,,34.84,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,inpatient,,,52.00000,29.95000,Hometown Health,Lease Networks,,49.40,,,,,,,46.80,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,outpatient,,,52.00000,29.95000,Hometown Health,Lease Networks,,49.40,,,,,,,13.52,50.44,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,inpatient,,,186.00000,107.14000,Hometown Health,Lease Networks,,176.70,,,,,,,167.40,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,outpatient,,,186.00000,107.14000,Hometown Health,Lease Networks,,176.70,,,,,,,48.36,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,inpatient,,,300.00000,172.80000,Hometown Health,Lease Networks,,285.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Hometown Health,Lease Networks,,285.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,inpatient,,,300.00000,172.80000,Hometown Health,Lease Networks,,285.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Hometown Health,Lease Networks,,285.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,inpatient,,,205.00000,118.08000,Hometown Health,Lease Networks,,194.75,,,,,,,184.50,198.85,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,outpatient,,,205.00000,118.08000,Hometown Health,Lease Networks,,194.75,,,,,,,53.30,198.85,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,inpatient,,,75.00000,36.15000,Hometown Health,Lease Networks,,71.25,,,,,,,67.50,72.75,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,outpatient,,,75.00000,36.15000,Hometown Health,Lease Networks,,71.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,inpatient,,,65.00000,31.33000,Hometown Health,Lease Networks,,61.75,,,,,,,58.50,63.05,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,outpatient,,,65.00000,31.33000,Hometown Health,Lease Networks,,61.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,inpatient,,,92.00000,44.34000,Hometown Health,Lease Networks,,87.40,,,,,,,82.80,89.24,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,outpatient,,,92.00000,44.34000,Hometown Health,Lease Networks,,87.40,,,,,,,23.92,89.24,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,inpatient,,,24.00000,11.57000,Hometown Health,Lease Networks,,22.80,,,,,,,21.60,23.28,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Hometown Health,Lease Networks,,22.80,,,,,,,6.24,23.28,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,inpatient,,,20.00000,9.64000,Hometown Health,Lease Networks,,19.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,outpatient,,,20.00000,9.64000,Hometown Health,Lease Networks,,19.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,inpatient,,,42.00000,20.24000,Hometown Health,Lease Networks,,39.90,,,,,,,37.80,40.74,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,outpatient,,,42.00000,20.24000,Hometown Health,Lease Networks,,39.90,,,,,,,10.92,40.74,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,Lease Networks,,65.55,,,,,,,62.10,66.93,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,Lease Networks,,65.55,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,inpatient,,,65.00000,31.33000,Hometown Health,Lease Networks,,61.75,,,,,,,58.50,63.05,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,outpatient,,,65.00000,31.33000,Hometown Health,Lease Networks,,61.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,inpatient,,,76.00000,36.63000,Hometown Health,Lease Networks,,72.20,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,outpatient,,,76.00000,36.63000,Hometown Health,Lease Networks,,72.20,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,inpatient,,,89.00000,42.90000,Hometown Health,Lease Networks,,84.55,,,,,,,80.10,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,outpatient,,,89.00000,42.90000,Hometown Health,Lease Networks,,84.55,,,,,,,23.14,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,inpatient,,,76.00000,36.63000,Hometown Health,Lease Networks,,72.20,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,outpatient,,,76.00000,36.63000,Hometown Health,Lease Networks,,72.20,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,inpatient,,,28.00000,13.50000,Hometown Health,Lease Networks,,26.60,,,,,,,25.20,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,outpatient,,,28.00000,13.50000,Hometown Health,Lease Networks,,26.60,,,,,,,7.28,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,inpatient,,,98.00000,47.24000,Hometown Health,Lease Networks,,93.10,,,,,,,88.20,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,outpatient,,,98.00000,47.24000,Hometown Health,Lease Networks,,93.10,,,,,,,25.48,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,Lease Networks,,60.80,,,,,,,57.60,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,Lease Networks,,60.80,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,inpatient,,,75.00000,36.15000,Hometown Health,Lease Networks,,71.25,,,,,,,67.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,outpatient,,,75.00000,36.15000,Hometown Health,Lease Networks,,71.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,inpatient,,,76.00000,36.63000,Hometown Health,Lease Networks,,72.20,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,outpatient,,,76.00000,36.63000,Hometown Health,Lease Networks,,72.20,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,inpatient,,,114.00000,54.95000,Hometown Health,Lease Networks,,108.30,,,,,,,102.60,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,outpatient,,,114.00000,54.95000,Hometown Health,Lease Networks,,108.30,,,,,,,29.64,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,inpatient,,,74.00000,35.67000,Hometown Health,Lease Networks,,70.30,,,,,,,66.60,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,outpatient,,,74.00000,35.67000,Hometown Health,Lease Networks,,70.30,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,Lease Networks,,65.55,,,,,,,62.10,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,Lease Networks,,65.55,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,inpatient,,,74.00000,35.67000,Hometown Health,Lease Networks,,70.30,,,,,,,66.60,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,outpatient,,,74.00000,35.67000,Hometown Health,Lease Networks,,70.30,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,inpatient,,,87.00000,41.93000,Hometown Health,Lease Networks,,82.65,,,,,,,78.30,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,outpatient,,,87.00000,41.93000,Hometown Health,Lease Networks,,82.65,,,,,,,22.62,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,inpatient,,,79.00000,38.08000,Hometown Health,Lease Networks,,75.05,,,,,,,71.10,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,outpatient,,,79.00000,38.08000,Hometown Health,Lease Networks,,75.05,,,,,,,20.54,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,inpatient,,,75.00000,36.15000,Hometown Health,Lease Networks,,71.25,,,,,,,67.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,outpatient,,,75.00000,36.15000,Hometown Health,Lease Networks,,71.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,Lease Networks,,60.80,,,,,,,57.60,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,Lease Networks,,60.80,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,inpatient,,,164.00000,79.05000,Hometown Health,Lease Networks,,155.80,,,,,,,147.60,159.08,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,outpatient,,,164.00000,79.05000,Hometown Health,Lease Networks,,155.80,,,,,,,42.64,159.08,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,Lease Networks,,51.30,,,,,,,48.60,52.38,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,Lease Networks,,51.30,,,,,,,14.04,52.38,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,inpatient,,,8.00000,3.86000,Hometown Health,Lease Networks,,7.60,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,outpatient,,,8.00000,3.86000,Hometown Health,Lease Networks,,7.60,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,Lease Networks,,65.55,,,,,,,62.10,66.93,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,Lease Networks,,65.55,,,,,,,17.94,66.93,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,inpatient,,,8.00000,3.86000,Hometown Health,Lease Networks,,7.60,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,outpatient,,,8.00000,3.86000,Hometown Health,Lease Networks,,7.60,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,inpatient,,,8.00000,3.86000,Hometown Health,Lease Networks,,7.60,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,outpatient,,,8.00000,3.86000,Hometown Health,Lease Networks,,7.60,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,inpatient,,,14.00000,6.75000,Hometown Health,Lease Networks,,13.30,,,,,,,12.60,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,outpatient,,,14.00000,6.75000,Hometown Health,Lease Networks,,13.30,,,,,,,3.64,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,inpatient,,,112.00000,53.98000,Hometown Health,Lease Networks,,106.40,,,,,,,100.80,108.64,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,outpatient,,,112.00000,53.98000,Hometown Health,Lease Networks,,106.40,,,,,,,29.12,108.64,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,inpatient,,,13.00000,6.27000,Hometown Health,Lease Networks,,12.35,,,,,,,11.70,12.61,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,outpatient,,,13.00000,6.27000,Hometown Health,Lease Networks,,12.35,,,,,,,3.38,12.61,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,inpatient,,,31.00000,14.94000,Hometown Health,Lease Networks,,29.45,,,,,,,27.90,30.07,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,outpatient,,,31.00000,14.94000,Hometown Health,Lease Networks,,29.45,,,,,,,8.06,30.07,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,inpatient,,,92.00000,44.34000,Hometown Health,Lease Networks,,87.40,,,,,,,82.80,89.24,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,outpatient,,,92.00000,44.34000,Hometown Health,Lease Networks,,87.40,,,,,,,23.92,89.24,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,inpatient,,,80.00000,38.56000,Hometown Health,Lease Networks,,76.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,outpatient,,,80.00000,38.56000,Hometown Health,Lease Networks,,76.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,inpatient,,,30.00000,14.46000,Hometown Health,Lease Networks,,28.50,,,,,,,27.00,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Hometown Health,Lease Networks,,28.50,,,,,,,7.80,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,inpatient,,,30.00000,14.46000,Hometown Health,Lease Networks,,28.50,,,,,,,27.00,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Hometown Health,Lease Networks,,28.50,,,,,,,7.80,29.10,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,inpatient,,,24.00000,11.57000,Hometown Health,Lease Networks,,22.80,,,,,,,21.60,23.28,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Hometown Health,Lease Networks,,22.80,,,,,,,6.24,23.28,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,inpatient,,,29.00000,13.98000,Hometown Health,Lease Networks,,27.55,,,,,,,26.10,28.13,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,outpatient,,,29.00000,13.98000,Hometown Health,Lease Networks,,27.55,,,,,,,7.54,28.13,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,inpatient,,,97.00000,46.75000,Hometown Health,Lease Networks,,92.15,,,,,,,87.30,94.09,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,outpatient,,,97.00000,46.75000,Hometown Health,Lease Networks,,92.15,,,,,,,25.22,94.09,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,inpatient,,,225.00000,108.45000,Hometown Health,Lease Networks,,213.75,,,,,,,202.50,218.25,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,outpatient,,,225.00000,108.45000,Hometown Health,Lease Networks,,213.75,,,,,,,58.50,218.25,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,Lease Networks,,67.45,,,,,,,63.90,68.87,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,Lease Networks,,67.45,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,Lease Networks,,67.45,,,,,,,63.90,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,Lease Networks,,67.45,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,inpatient,,,108.00000,52.06000,Hometown Health,Lease Networks,,102.60,,,,,,,97.20,104.76,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,outpatient,,,108.00000,52.06000,Hometown Health,Lease Networks,,102.60,,,,,,,28.08,104.76,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,Lease Networks,,48.45,,,,,,,45.90,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,Lease Networks,,48.45,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,inpatient,,,19.00000,9.16000,Hometown Health,Lease Networks,,18.05,,,,,,,17.10,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,outpatient,,,19.00000,9.16000,Hometown Health,Lease Networks,,18.05,,,,,,,4.94,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,Lease Networks,,51.30,,,,,,,48.60,52.38,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,Lease Networks,,51.30,,,,,,,14.04,52.38,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,inpatient,,,103.00000,49.65000,Hometown Health,Lease Networks,,97.85,,,,,,,92.70,99.91,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,outpatient,,,103.00000,49.65000,Hometown Health,Lease Networks,,97.85,,,,,,,26.78,99.91,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,inpatient,,,9.00000,4.34000,Hometown Health,Lease Networks,,8.55,,,,,,,8.10,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,outpatient,,,9.00000,4.34000,Hometown Health,Lease Networks,,8.55,,,,,,,2.34,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,inpatient,,,13.00000,6.27000,Hometown Health,Lease Networks,,12.35,,,,,,,11.70,12.61,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,outpatient,,,13.00000,6.27000,Hometown Health,Lease Networks,,12.35,,,,,,,3.38,12.61,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,inpatient,,,80.00000,38.56000,Hometown Health,Lease Networks,,76.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,outpatient,,,80.00000,38.56000,Hometown Health,Lease Networks,,76.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,inpatient,,,47.00000,22.65000,Hometown Health,Lease Networks,,44.65,,,,,,,42.30,45.59,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,outpatient,,,47.00000,22.65000,Hometown Health,Lease Networks,,44.65,,,,,,,12.22,45.59,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,inpatient,,,91.00000,43.86000,Hometown Health,Lease Networks,,86.45,,,,,,,81.90,88.27,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,outpatient,,,91.00000,43.86000,Hometown Health,Lease Networks,,86.45,,,,,,,23.66,88.27,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,inpatient,,,18.00000,8.68000,Hometown Health,Lease Networks,,17.10,,,,,,,16.20,17.46,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,outpatient,,,18.00000,8.68000,Hometown Health,Lease Networks,,17.10,,,,,,,4.68,17.46,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,inpatient,,,21.00000,11.15000,Hometown Health,Lease Networks,,19.95,,,,,,,18.90,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Hometown Health,Lease Networks,,19.95,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,inpatient,,,71.00000,37.70000,Hometown Health,Lease Networks,,67.45,,,,,,,63.90,68.87,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,outpatient,,,71.00000,37.70000,Hometown Health,Lease Networks,,67.45,,,,,,,18.46,68.87,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,inpatient,,,21.00000,11.15000,Hometown Health,Lease Networks,,19.95,,,,,,,18.90,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Hometown Health,Lease Networks,,19.95,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,inpatient,,,128.00000,67.97000,Hometown Health,Lease Networks,,121.60,,,,,,,115.20,124.16,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,outpatient,,,128.00000,67.97000,Hometown Health,Lease Networks,,121.60,,,,,,,33.28,124.16,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,inpatient,,,65.00000,34.52000,Hometown Health,Lease Networks,,61.75,,,,,,,58.50,63.05,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,outpatient,,,65.00000,34.52000,Hometown Health,Lease Networks,,61.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,Lease Networks,,24.70,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,Lease Networks,,24.70,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,inpatient,,,31.00000,16.46000,Hometown Health,Lease Networks,,29.45,,,,,,,27.90,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,outpatient,,,31.00000,16.46000,Hometown Health,Lease Networks,,29.45,,,,,,,8.06,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,Lease Networks,,24.70,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,Lease Networks,,24.70,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,Lease Networks,,24.70,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,Lease Networks,,24.70,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,Lease Networks,,24.70,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,Lease Networks,,24.70,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,inpatient,,,61.00000,32.39000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,outpatient,,,61.00000,32.39000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,Lease Networks,,24.70,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,Lease Networks,,24.70,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,inpatient,,,25.00000,13.28000,Hometown Health,Lease Networks,,23.75,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Hometown Health,Lease Networks,,23.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,inpatient,,,25.00000,13.28000,Hometown Health,Lease Networks,91,23.75,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Hometown Health,Lease Networks,91,23.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,inpatient,,,103.00000,54.69000,Hometown Health,Lease Networks,,97.85,,,,,,,92.70,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,outpatient,,,103.00000,54.69000,Hometown Health,Lease Networks,,97.85,,,,,,,26.78,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,inpatient,,,96.00000,50.98000,Hometown Health,Lease Networks,,91.20,,,,,,,86.40,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,outpatient,,,96.00000,50.98000,Hometown Health,Lease Networks,,91.20,,,,,,,24.96,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,inpatient,,,75.00000,39.83000,Hometown Health,Lease Networks,,71.25,,,,,,,67.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,outpatient,,,75.00000,39.83000,Hometown Health,Lease Networks,,71.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,inpatient,,,68.00000,36.11000,Hometown Health,Lease Networks,,64.60,,,,,,,61.20,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,outpatient,,,68.00000,36.11000,Hometown Health,Lease Networks,,64.60,,,,,,,17.68,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,inpatient,,,61.00000,32.39000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,outpatient,,,61.00000,32.39000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,Lease Networks,,24.70,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,Lease Networks,,24.70,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,Lease Networks,,24.70,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,Lease Networks,,24.70,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,inpatient,,,29.00000,15.40000,Hometown Health,Lease Networks,,27.55,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,outpatient,,,29.00000,15.40000,Hometown Health,Lease Networks,,27.55,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Hometown Health,Lease Networks,,27.55,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Hometown Health,Lease Networks,,27.55,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Hometown Health,Lease Networks,,27.55,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Hometown Health,Lease Networks,,27.55,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,inpatient,,,63.00000,33.45000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,outpatient,,,63.00000,33.45000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,inpatient,,,79.00000,41.95000,Hometown Health,Lease Networks,,75.05,,,,,,,71.10,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,outpatient,,,79.00000,41.95000,Hometown Health,Lease Networks,,75.05,,,,,,,20.54,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,inpatient,,,63.00000,33.45000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,outpatient,,,63.00000,33.45000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Hometown Health,Lease Networks,,27.55,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Hometown Health,Lease Networks,,27.55,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,inpatient,,,112.00000,59.47000,Hometown Health,Lease Networks,,106.40,,,,,,,100.80,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,outpatient,,,112.00000,59.47000,Hometown Health,Lease Networks,,106.40,,,,,,,29.12,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,Lease Networks,,24.70,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,Lease Networks,,24.70,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,inpatient,,,25.00000,13.28000,Hometown Health,Lease Networks,,23.75,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,outpatient,,,25.00000,13.28000,Hometown Health,Lease Networks,,23.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,inpatient,,,118.00000,62.66000,Hometown Health,Lease Networks,,112.10,,,,,,,106.20,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,outpatient,,,118.00000,62.66000,Hometown Health,Lease Networks,,112.10,,,,,,,30.68,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,inpatient,,,29.00000,15.40000,Hometown Health,Lease Networks,,27.55,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,outpatient,,,29.00000,15.40000,Hometown Health,Lease Networks,,27.55,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,inpatient,,,25.00000,13.28000,Hometown Health,Lease Networks,,23.75,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,outpatient,,,25.00000,13.28000,Hometown Health,Lease Networks,,23.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,Lease Networks,,24.70,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,Lease Networks,,24.70,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,inpatient,,,25.00000,13.28000,Hometown Health,Lease Networks,,23.75,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,outpatient,,,25.00000,13.28000,Hometown Health,Lease Networks,,23.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,inpatient,,,71.00000,37.70000,Hometown Health,Lease Networks,,67.45,,,,,,,63.90,68.87,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,outpatient,,,71.00000,37.70000,Hometown Health,Lease Networks,,67.45,,,,,,,18.46,68.87,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,inpatient,,,59.00000,31.33000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,outpatient,,,59.00000,31.33000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,inpatient,,,62.00000,32.92000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,outpatient,,,62.00000,32.92000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,inpatient,,,138.00000,73.28000,Hometown Health,Lease Networks,,131.10,,,,,,,124.20,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,outpatient,,,138.00000,73.28000,Hometown Health,Lease Networks,,131.10,,,,,,,35.88,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,inpatient,,,62.00000,32.92000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,outpatient,,,62.00000,32.92000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,inpatient,,,78.00000,41.42000,Hometown Health,Lease Networks,,74.10,,,,,,,70.20,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,outpatient,,,78.00000,41.42000,Hometown Health,Lease Networks,,74.10,,,,,,,20.28,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,inpatient,,,69.00000,36.64000,Hometown Health,Lease Networks,,65.55,,,,,,,62.10,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,outpatient,,,69.00000,36.64000,Hometown Health,Lease Networks,,65.55,,,,,,,17.94,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,inpatient,,,88.00000,46.73000,Hometown Health,Lease Networks,,83.60,,,,,,,79.20,85.36,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,outpatient,,,88.00000,46.73000,Hometown Health,Lease Networks,,83.60,,,,,,,22.88,85.36,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,inpatient,,,64.00000,33.98000,Hometown Health,Lease Networks,,60.80,,,,,,,57.60,62.08,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,outpatient,,,64.00000,33.98000,Hometown Health,Lease Networks,,60.80,,,,,,,16.64,62.08,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,inpatient,,,63.00000,33.45000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,outpatient,,,63.00000,33.45000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,inpatient,,,137.00000,72.75000,Hometown Health,Lease Networks,,130.15,,,,,,,123.30,132.89,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,outpatient,,,137.00000,72.75000,Hometown Health,Lease Networks,,130.15,,,,,,,35.62,132.89,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,inpatient,,,347.00000,184.26000,Hometown Health,Lease Networks,,329.65,,,,,,,312.30,336.59,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,outpatient,,,347.00000,184.26000,Hometown Health,Lease Networks,,329.65,,,,,,,90.22,336.59,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,inpatient,,,57.00000,30.27000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,outpatient,,,57.00000,30.27000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,inpatient,,,56.00000,29.74000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,outpatient,,,56.00000,29.74000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,inpatient,,,16.00000,8.50000,Hometown Health,Lease Networks,,15.20,,,,,,,14.40,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,outpatient,,,16.00000,8.50000,Hometown Health,Lease Networks,,15.20,,,,,,,4.16,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,inpatient,,,85.00000,45.14000,Hometown Health,Lease Networks,,80.75,,,,,,,76.50,82.45,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,outpatient,,,85.00000,45.14000,Hometown Health,Lease Networks,,80.75,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,inpatient,,,34.00000,18.05000,Hometown Health,Lease Networks,,32.30,,,,,,,30.60,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,outpatient,,,34.00000,18.05000,Hometown Health,Lease Networks,,32.30,,,,,,,8.84,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,inpatient,,,231.00000,122.66000,Hometown Health,Lease Networks,,219.45,,,,,,,207.90,224.07,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,outpatient,,,231.00000,122.66000,Hometown Health,Lease Networks,,219.45,,,,,,,60.06,224.07,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,inpatient,,,36.00000,19.12000,Hometown Health,Lease Networks,,34.20,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,outpatient,,,36.00000,19.12000,Hometown Health,Lease Networks,,34.20,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,inpatient,,,61.00000,32.39000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,outpatient,,,61.00000,32.39000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,inpatient,,,111.00000,58.94000,Hometown Health,Lease Networks,,105.45,,,,,,,99.90,107.67,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,outpatient,,,111.00000,58.94000,Hometown Health,Lease Networks,,105.45,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,inpatient,,,61.00000,32.39000,Hometown Health,Lease Networks,,57.95,,,,,,,54.90,59.17,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,outpatient,,,61.00000,32.39000,Hometown Health,Lease Networks,,57.95,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,inpatient,,,36.00000,19.12000,Hometown Health,Lease Networks,,34.20,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,outpatient,,,36.00000,19.12000,Hometown Health,Lease Networks,,34.20,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,inpatient,,,76.00000,40.36000,Hometown Health,Lease Networks,,72.20,,,,,,,68.40,73.72,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,outpatient,,,76.00000,40.36000,Hometown Health,Lease Networks,,72.20,,,,,,,19.76,73.72,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,inpatient,,,152.00000,80.71000,Hometown Health,Lease Networks,,144.40,,,,,,,136.80,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,outpatient,,,152.00000,80.71000,Hometown Health,Lease Networks,,144.40,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,inpatient,,,78.00000,41.42000,Hometown Health,Lease Networks,,74.10,,,,,,,70.20,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,outpatient,,,78.00000,41.42000,Hometown Health,Lease Networks,,74.10,,,,,,,20.28,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,inpatient,,,42.00000,22.30000,Hometown Health,Lease Networks,,39.90,,,,,,,37.80,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,outpatient,,,42.00000,22.30000,Hometown Health,Lease Networks,,39.90,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,inpatient,,,73.00000,38.76000,Hometown Health,Lease Networks,,69.35,,,,,,,65.70,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,outpatient,,,73.00000,38.76000,Hometown Health,Lease Networks,,69.35,,,,,,,18.98,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,inpatient,,,97.00000,51.51000,Hometown Health,Lease Networks,,92.15,,,,,,,87.30,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,outpatient,,,97.00000,51.51000,Hometown Health,Lease Networks,,92.15,,,,,,,25.22,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,inpatient,,,157.00000,83.37000,Hometown Health,Lease Networks,,149.15,,,,,,,141.30,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,outpatient,,,157.00000,83.37000,Hometown Health,Lease Networks,,149.15,,,,,,,40.82,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,inpatient,,,36.00000,19.12000,Hometown Health,Lease Networks,,34.20,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,outpatient,,,36.00000,19.12000,Hometown Health,Lease Networks,,34.20,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,inpatient,,,66.00000,35.05000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,outpatient,,,66.00000,35.05000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,inpatient,,,58.00000,30.80000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,outpatient,,,58.00000,30.80000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,inpatient,,,85.00000,45.14000,Hometown Health,Lease Networks,,80.75,,,,,,,76.50,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,outpatient,,,85.00000,45.14000,Hometown Health,Lease Networks,,80.75,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,inpatient,,,59.00000,31.33000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,outpatient,,,59.00000,31.33000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,inpatient,,,175.00000,92.93000,Hometown Health,Lease Networks,,166.25,,,,,,,157.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,outpatient,,,175.00000,92.93000,Hometown Health,Lease Networks,,166.25,,,,,,,45.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,inpatient,,,152.00000,80.71000,Hometown Health,Lease Networks,,144.40,,,,,,,136.80,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,outpatient,,,152.00000,80.71000,Hometown Health,Lease Networks,,144.40,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,inpatient,,,43.00000,22.83000,Hometown Health,Lease Networks,,40.85,,,,,,,38.70,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,outpatient,,,43.00000,22.83000,Hometown Health,Lease Networks,,40.85,,,,,,,11.18,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,inpatient,,,66.00000,35.05000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,outpatient,,,66.00000,35.05000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,inpatient,,,36.00000,19.12000,Hometown Health,Lease Networks,,34.20,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,outpatient,,,36.00000,19.12000,Hometown Health,Lease Networks,,34.20,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,inpatient,,,36.00000,19.12000,Hometown Health,Lease Networks,,34.20,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,outpatient,,,36.00000,19.12000,Hometown Health,Lease Networks,,34.20,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,inpatient,,,42.00000,22.30000,Hometown Health,Lease Networks,,39.90,,,,,,,37.80,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,outpatient,,,42.00000,22.30000,Hometown Health,Lease Networks,,39.90,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,inpatient,,,147.00000,78.06000,Hometown Health,Lease Networks,,139.65,,,,,,,132.30,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,outpatient,,,147.00000,78.06000,Hometown Health,Lease Networks,,139.65,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,inpatient,,,64.00000,33.98000,Hometown Health,Lease Networks,,60.80,,,,,,,57.60,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,outpatient,,,64.00000,33.98000,Hometown Health,Lease Networks,,60.80,,,,,,,16.64,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,inpatient,,,75.00000,39.83000,Hometown Health,Lease Networks,,71.25,,,,,,,67.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,outpatient,,,75.00000,39.83000,Hometown Health,Lease Networks,,71.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,inpatient,,,44.00000,23.36000,Hometown Health,Lease Networks,,41.80,,,,,,,39.60,42.68,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,outpatient,,,44.00000,23.36000,Hometown Health,Lease Networks,,41.80,,,,,,,11.44,42.68,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,inpatient,,,87.00000,46.20000,Hometown Health,Lease Networks,,82.65,,,,,,,78.30,84.39,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,outpatient,,,87.00000,46.20000,Hometown Health,Lease Networks,,82.65,,,,,,,22.62,84.39,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,inpatient,,,65.00000,34.52000,Hometown Health,Lease Networks,,61.75,,,,,,,58.50,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,outpatient,,,65.00000,34.52000,Hometown Health,Lease Networks,,61.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,inpatient,,,75.00000,39.83000,Hometown Health,Lease Networks,,71.25,,,,,,,67.50,72.75,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,outpatient,,,75.00000,39.83000,Hometown Health,Lease Networks,,71.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,inpatient,,,50.00000,26.55000,Hometown Health,Lease Networks,,47.50,,,,,,,45.00,48.50,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,outpatient,,,50.00000,26.55000,Hometown Health,Lease Networks,,47.50,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,inpatient,,,40.00000,21.24000,Hometown Health,Lease Networks,,38.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,outpatient,,,40.00000,21.24000,Hometown Health,Lease Networks,,38.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,inpatient,,,50.00000,26.55000,Hometown Health,Lease Networks,,47.50,,,,,,,45.00,48.50,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,outpatient,,,50.00000,26.55000,Hometown Health,Lease Networks,,47.50,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,inpatient,,,115.00000,61.07000,Hometown Health,Lease Networks,,109.25,,,,,,,103.50,111.55,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,outpatient,,,115.00000,61.07000,Hometown Health,Lease Networks,,109.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,inpatient,,,1309.00000,695.08000,Hometown Health,Lease Networks,,1243.55,,,,,,,1178.10,1269.73,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1309.00000,695.08000,Hometown Health,Lease Networks,,1243.55,,,,,,,340.34,1269.73,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,inpatient,,,328.00000,174.17000,Hometown Health,Lease Networks,,311.60,,,,,,,295.20,318.16,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,outpatient,,,328.00000,174.17000,Hometown Health,Lease Networks,,311.60,,,,,,,85.28,318.16,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,inpatient,,,115.00000,61.07000,Hometown Health,Lease Networks,,109.25,,,,,,,103.50,111.55,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,outpatient,,,115.00000,61.07000,Hometown Health,Lease Networks,,109.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,inpatient,,,1251.00000,664.28000,Hometown Health,Lease Networks,,1188.45,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,outpatient,,,1251.00000,664.28000,Hometown Health,Lease Networks,,1188.45,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,inpatient,,,154.00000,81.77000,Hometown Health,Lease Networks,,146.30,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Hometown Health,Lease Networks,,146.30,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,inpatient,,,154.00000,81.77000,Hometown Health,Lease Networks,,146.30,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Hometown Health,Lease Networks,,146.30,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,inpatient,,,96.00000,50.98000,Hometown Health,Lease Networks,,91.20,,,,,,,86.40,93.12,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,outpatient,,,96.00000,50.98000,Hometown Health,Lease Networks,,91.20,,,,,,,24.96,93.12,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,inpatient,,,211.00000,112.04000,Hometown Health,Lease Networks,,200.45,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,outpatient,,,211.00000,112.04000,Hometown Health,Lease Networks,,200.45,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,inpatient,,,290.00000,153.99000,Hometown Health,Lease Networks,,275.50,,,,,,,261.00,281.30,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,outpatient,,,290.00000,153.99000,Hometown Health,Lease Networks,,275.50,,,,,,,75.40,281.30,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,inpatient,,,411.00000,218.24000,Hometown Health,Lease Networks,,390.45,,,,,,,369.90,398.67,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,outpatient,,,411.00000,218.24000,Hometown Health,Lease Networks,,390.45,,,,,,,106.86,398.67,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,inpatient,,,139.00000,73.81000,Hometown Health,Lease Networks,,132.05,,,,,,,125.10,134.83,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,outpatient,,,139.00000,73.81000,Hometown Health,Lease Networks,,132.05,,,,,,,36.14,134.83,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,inpatient,,,288.00000,152.93000,Hometown Health,Lease Networks,,273.60,,,,,,,259.20,279.36,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,outpatient,,,288.00000,152.93000,Hometown Health,Lease Networks,,273.60,,,,,,,74.88,279.36,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,inpatient,,,1372.00000,728.53000,Hometown Health,Lease Networks,,1303.40,,,,,,,1234.80,1330.84,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1372.00000,728.53000,Hometown Health,Lease Networks,,1303.40,,,,,,,356.72,1330.84,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,inpatient,,,1251.00000,664.28000,Hometown Health,Lease Networks,,1188.45,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,outpatient,,,1251.00000,664.28000,Hometown Health,Lease Networks,,1188.45,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,inpatient,,,135.00000,71.68000,Hometown Health,Lease Networks,,128.25,,,,,,,121.50,130.95,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,outpatient,,,135.00000,71.68000,Hometown Health,Lease Networks,,128.25,,,,,,,35.10,130.95,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,inpatient,,,147.00000,78.06000,Hometown Health,Lease Networks,,139.65,,,,,,,132.30,142.59,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,outpatient,,,147.00000,78.06000,Hometown Health,Lease Networks,,139.65,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,inpatient,,,126.00000,66.91000,Hometown Health,Lease Networks,,119.70,,,,,,,113.40,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,outpatient,,,126.00000,66.91000,Hometown Health,Lease Networks,,119.70,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,inpatient,,,120.00000,63.72000,Hometown Health,Lease Networks,,114.00,,,,,,,108.00,116.40,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,outpatient,,,120.00000,63.72000,Hometown Health,Lease Networks,,114.00,,,,,,,31.20,116.40,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,inpatient,,,124.00000,65.84000,Hometown Health,Lease Networks,,117.80,,,,,,,111.60,120.28,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,outpatient,,,124.00000,65.84000,Hometown Health,Lease Networks,,117.80,,,,,,,32.24,120.28,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,inpatient,,,108.00000,57.35000,Hometown Health,Lease Networks,,102.60,,,,,,,97.20,104.76,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,outpatient,,,108.00000,57.35000,Hometown Health,Lease Networks,,102.60,,,,,,,28.08,104.76,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,inpatient,,,256.00000,135.94000,Hometown Health,Lease Networks,,243.20,,,,,,,230.40,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Hometown Health,Lease Networks,,243.20,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,inpatient,,,256.00000,135.94000,Hometown Health,Lease Networks,,243.20,,,,,,,230.40,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Hometown Health,Lease Networks,,243.20,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,inpatient,,,122.00000,64.78000,Hometown Health,Lease Networks,,115.90,,,,,,,109.80,118.34,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,outpatient,,,122.00000,64.78000,Hometown Health,Lease Networks,,115.90,,,,,,,31.72,118.34,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,inpatient,,,123.00000,65.31000,Hometown Health,Lease Networks,,116.85,,,,,,,110.70,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,outpatient,,,123.00000,65.31000,Hometown Health,Lease Networks,,116.85,,,,,,,31.98,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,inpatient,,,518.00000,275.06000,Hometown Health,Lease Networks,,492.10,,,,,,,466.20,502.46,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,outpatient,,,518.00000,275.06000,Hometown Health,Lease Networks,,492.10,,,,,,,134.68,502.46,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,inpatient,,,275.00000,146.02000,Hometown Health,Lease Networks,,261.25,,,,,,,247.50,266.75,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,outpatient,,,275.00000,146.02000,Hometown Health,Lease Networks,,261.25,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,inpatient,,,270.00000,143.37000,Hometown Health,Lease Networks,,256.50,,,,,,,243.00,261.90,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,outpatient,,,270.00000,143.37000,Hometown Health,Lease Networks,,256.50,,,,,,,70.20,261.90,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,inpatient,,,450.00000,238.95000,Hometown Health,Lease Networks,,427.50,,,,,,,405.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,outpatient,,,450.00000,238.95000,Hometown Health,Lease Networks,,427.50,,,,,,,117.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,inpatient,,,126.00000,66.91000,Hometown Health,Lease Networks,,119.70,,,,,,,113.40,122.22,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,outpatient,,,126.00000,66.91000,Hometown Health,Lease Networks,,119.70,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,inpatient,,,362.00000,192.22000,Hometown Health,Lease Networks,,343.90,,,,,,,325.80,351.14,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,outpatient,,,362.00000,192.22000,Hometown Health,Lease Networks,,343.90,,,,,,,94.12,351.14,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,inpatient,,,109.00000,57.88000,Hometown Health,Lease Networks,,103.55,,,,,,,98.10,105.73,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Hometown Health,Lease Networks,,103.55,,,,,,,28.34,105.73,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,inpatient,,,638.00000,338.78000,Hometown Health,Lease Networks,,606.10,,,,,,,574.20,618.86,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,outpatient,,,638.00000,338.78000,Hometown Health,Lease Networks,,606.10,,,,,,,165.88,618.86,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,inpatient,,,211.00000,112.04000,Hometown Health,Lease Networks,,200.45,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,outpatient,,,211.00000,112.04000,Hometown Health,Lease Networks,,200.45,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,inpatient,,,154.00000,81.77000,Hometown Health,Lease Networks,,146.30,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,outpatient,,,154.00000,81.77000,Hometown Health,Lease Networks,,146.30,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,inpatient,,,141.00000,74.87000,Hometown Health,Lease Networks,,133.95,,,,,,,126.90,136.77,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,outpatient,,,141.00000,74.87000,Hometown Health,Lease Networks,,133.95,,,,,,,36.66,136.77,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,inpatient,,,2040.00000,1083.24000,Hometown Health,Lease Networks,,1938.00,,,,,,,1836.00,1978.80,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,outpatient,,,2040.00000,1083.24000,Hometown Health,Lease Networks,,1938.00,,,,,,,530.40,1978.80,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,inpatient,,,421.00000,223.55000,Hometown Health,Lease Networks,,399.95,,,,,,,378.90,408.37,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,outpatient,,,421.00000,223.55000,Hometown Health,Lease Networks,,399.95,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,inpatient,,,275.00000,146.02000,Hometown Health,Lease Networks,,261.25,,,,,,,247.50,266.75,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,outpatient,,,275.00000,146.02000,Hometown Health,Lease Networks,,261.25,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,inpatient,,,1251.00000,664.28000,Hometown Health,Lease Networks,,1188.45,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,outpatient,,,1251.00000,664.28000,Hometown Health,Lease Networks,,1188.45,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,inpatient,,,428.00000,227.27000,Hometown Health,Lease Networks,,406.60,,,,,,,385.20,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Hometown Health,Lease Networks,,406.60,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,inpatient,,,428.00000,227.27000,Hometown Health,Lease Networks,,406.60,,,,,,,385.20,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Hometown Health,Lease Networks,,406.60,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,inpatient,,,655.00000,347.80000,Hometown Health,Lease Networks,,622.25,,,,,,,589.50,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Hometown Health,Lease Networks,,622.25,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,inpatient,,,655.00000,347.80000,Hometown Health,Lease Networks,,622.25,,,,,,,589.50,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Hometown Health,Lease Networks,,622.25,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,inpatient,,,211.00000,112.04000,Hometown Health,Lease Networks,,200.45,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,outpatient,,,211.00000,112.04000,Hometown Health,Lease Networks,,200.45,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,inpatient,,,112.00000,59.47000,Hometown Health,Lease Networks,,106.40,,,,,,,100.80,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Hometown Health,Lease Networks,,106.40,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,inpatient,,,112.00000,59.47000,Hometown Health,Lease Networks,,106.40,,,,,,,100.80,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Hometown Health,Lease Networks,,106.40,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,inpatient,,,130.00000,69.03000,Hometown Health,Lease Networks,,123.50,,,,,,,117.00,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,outpatient,,,130.00000,69.03000,Hometown Health,Lease Networks,,123.50,,,,,,,33.80,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,inpatient,,,421.00000,223.55000,Hometown Health,Lease Networks,,399.95,,,,,,,378.90,408.37,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,outpatient,,,421.00000,223.55000,Hometown Health,Lease Networks,,399.95,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,inpatient,,,111.00000,58.94000,Hometown Health,Lease Networks,,105.45,,,,,,,99.90,107.67,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,outpatient,,,111.00000,58.94000,Hometown Health,Lease Networks,,105.45,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,inpatient,,,200.00000,106.20000,Hometown Health,Lease Networks,,190.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,outpatient,,,200.00000,106.20000,Hometown Health,Lease Networks,,190.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,Lease Networks,,122.55,,,,,,,33.54,125.13,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,inpatient,,,13.00000,6.90000,Hometown Health,Lease Networks,,12.35,,,,,,,11.70,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,outpatient,,,13.00000,6.90000,Hometown Health,Lease Networks,,12.35,,,,,,,3.38,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,inpatient,,,58.00000,30.80000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,outpatient,,,58.00000,30.80000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,inpatient,,,13.00000,6.90000,Hometown Health,Lease Networks,,12.35,,,,,,,11.70,12.61,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,outpatient,,,13.00000,6.90000,Hometown Health,Lease Networks,,12.35,,,,,,,3.38,12.61,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,inpatient,,,773.00000,410.46000,Hometown Health,Lease Networks,,734.35,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,outpatient,,,773.00000,410.46000,Hometown Health,Lease Networks,,734.35,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,inpatient,,,773.00000,410.46000,Hometown Health,Lease Networks,,734.35,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,outpatient,,,773.00000,410.46000,Hometown Health,Lease Networks,,734.35,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,inpatient,,,773.00000,410.46000,Hometown Health,Lease Networks,,734.35,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,outpatient,,,773.00000,410.46000,Hometown Health,Lease Networks,,734.35,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,inpatient,,,773.00000,410.46000,Hometown Health,Lease Networks,,734.35,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,outpatient,,,773.00000,410.46000,Hometown Health,Lease Networks,,734.35,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,inpatient,,,387.00000,205.50000,Hometown Health,Lease Networks,,367.65,,,,,,,348.30,375.39,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,outpatient,,,387.00000,205.50000,Hometown Health,Lease Networks,,367.65,,,,,,,100.62,375.39,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,inpatient,,,52.00000,27.61000,Hometown Health,Lease Networks,,49.40,,,,,,,46.80,50.44,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,outpatient,,,52.00000,27.61000,Hometown Health,Lease Networks,,49.40,,,,,,,13.52,50.44,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,inpatient,,,102.00000,54.16000,Hometown Health,Lease Networks,,96.90,,,,,,,91.80,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Hometown Health,Lease Networks,,96.90,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,inpatient,,,102.00000,54.16000,Hometown Health,Lease Networks,,96.90,,,,,,,91.80,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Hometown Health,Lease Networks,,96.90,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,inpatient,,,79.00000,41.95000,Hometown Health,Lease Networks,,75.05,,,,,,,71.10,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,outpatient,,,79.00000,41.95000,Hometown Health,Lease Networks,,75.05,,,,,,,20.54,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,inpatient,,,65.00000,34.52000,Hometown Health,Lease Networks,,61.75,,,,,,,58.50,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,outpatient,,,65.00000,34.52000,Hometown Health,Lease Networks,,61.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,inpatient,,,100.00000,53.10000,Hometown Health,Lease Networks,,95.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,outpatient,,,100.00000,53.10000,Hometown Health,Lease Networks,,95.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,inpatient,,,64.00000,33.98000,Hometown Health,Lease Networks,,60.80,,,,,,,57.60,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,outpatient,,,64.00000,33.98000,Hometown Health,Lease Networks,,60.80,,,,,,,16.64,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,inpatient,,,109.00000,57.88000,Hometown Health,Lease Networks,,103.55,,,,,,,98.10,105.73,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Hometown Health,Lease Networks,,103.55,,,,,,,28.34,105.73,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,inpatient,,,58.00000,30.80000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,outpatient,,,58.00000,30.80000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Hometown Health,Lease Networks,,19.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Hometown Health,Lease Networks,,19.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,inpatient,,,66.00000,35.05000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,outpatient,,,66.00000,35.05000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Hometown Health,Lease Networks,,19.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Hometown Health,Lease Networks,,19.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Hometown Health,Lease Networks,,19.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Hometown Health,Lease Networks,,19.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Hometown Health,Lease Networks,,19.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Hometown Health,Lease Networks,,19.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,inpatient,,,13.00000,6.90000,Hometown Health,Lease Networks,,12.35,,,,,,,11.70,12.61,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,outpatient,,,13.00000,6.90000,Hometown Health,Lease Networks,,12.35,,,,,,,3.38,12.61,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,inpatient,,,53.00000,28.14000,Hometown Health,Lease Networks,,50.35,,,,,,,47.70,51.41,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,outpatient,,,53.00000,28.14000,Hometown Health,Lease Networks,,50.35,,,,,,,13.78,51.41,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,inpatient,,,18.00000,9.56000,Hometown Health,Lease Networks,,17.10,,,,,,,16.20,17.46,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,outpatient,,,18.00000,9.56000,Hometown Health,Lease Networks,,17.10,,,,,,,4.68,17.46,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,inpatient,,,17.00000,9.03000,Hometown Health,Lease Networks,,16.15,,,,,,,15.30,16.49,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,outpatient,,,17.00000,9.03000,Hometown Health,Lease Networks,,16.15,,,,,,,4.42,16.49,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,inpatient,,,71.00000,37.70000,Hometown Health,Lease Networks,,67.45,,,,,,,63.90,68.87,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,outpatient,,,71.00000,37.70000,Hometown Health,Lease Networks,,67.45,,,,,,,18.46,68.87,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,inpatient,,,57.00000,30.27000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,outpatient,,,57.00000,30.27000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,inpatient,,,68.00000,36.11000,Hometown Health,Lease Networks,,64.60,,,,,,,61.20,65.96,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,outpatient,,,68.00000,36.11000,Hometown Health,Lease Networks,,64.60,,,,,,,17.68,65.96,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,inpatient,,,58.00000,30.80000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,outpatient,,,58.00000,30.80000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,inpatient,,,27.00000,14.34000,Hometown Health,Lease Networks,,25.65,,,,,,,24.30,26.19,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,outpatient,,,27.00000,14.34000,Hometown Health,Lease Networks,,25.65,,,,,,,7.02,26.19,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,inpatient,,,56.00000,29.74000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,outpatient,,,56.00000,29.74000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,inpatient,,,56.00000,29.74000,Hometown Health,Lease Networks,,53.20,,,,,,,50.40,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,outpatient,,,56.00000,29.74000,Hometown Health,Lease Networks,,53.20,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,inpatient,,,58.00000,30.80000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,outpatient,,,58.00000,30.80000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,inpatient,,,115.00000,61.07000,Hometown Health,Lease Networks,,109.25,,,,,,,103.50,111.55,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,outpatient,,,115.00000,61.07000,Hometown Health,Lease Networks,,109.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,inpatient,,,23.00000,12.21000,Hometown Health,Lease Networks,,21.85,,,,,,,20.70,22.31,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,outpatient,,,23.00000,12.21000,Hometown Health,Lease Networks,,21.85,,,,,,,5.98,22.31,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,inpatient,,,255.00000,135.40000,Hometown Health,Lease Networks,,242.25,,,,,,,229.50,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,outpatient,,,255.00000,135.40000,Hometown Health,Lease Networks,,242.25,,,,,,,66.30,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,inpatient,,,66.00000,35.05000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,outpatient,,,66.00000,35.05000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,Lease Networks,,24.70,,,,,,,23.40,25.22,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,Lease Networks,,24.70,,,,,,,6.76,25.22,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,inpatient,,,64.00000,33.98000,Hometown Health,Lease Networks,,60.80,,,,,,,57.60,62.08,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,outpatient,,,64.00000,33.98000,Hometown Health,Lease Networks,,60.80,,,,,,,16.64,62.08,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,inpatient,,,215.00000,114.16000,Hometown Health,Lease Networks,,204.25,,,,,,,193.50,208.55,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,outpatient,,,215.00000,114.16000,Hometown Health,Lease Networks,,204.25,,,,,,,55.90,208.55,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,inpatient,,,79.00000,41.95000,Hometown Health,Lease Networks,,75.05,,,,,,,71.10,76.63,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,outpatient,,,79.00000,41.95000,Hometown Health,Lease Networks,,75.05,,,,,,,20.54,76.63,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,inpatient,,,11.00000,5.29000,Hometown Health,Lease Networks,,10.45,,,,,,,9.90,10.67,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,outpatient,,,11.00000,5.29000,Hometown Health,Lease Networks,,10.45,,,,,,,2.86,10.67,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,inpatient,,,58.00000,27.90000,Hometown Health,Lease Networks,,55.10,,,,,,,52.20,56.26,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,outpatient,,,58.00000,27.90000,Hometown Health,Lease Networks,,55.10,,,,,,,15.08,56.26,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,inpatient,,,10.00000,4.81000,Hometown Health,Lease Networks,,9.50,,,,,,,9.00,9.70,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,outpatient,,,10.00000,4.81000,Hometown Health,Lease Networks,,9.50,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,inpatient,,,7.00000,3.37000,Hometown Health,Lease Networks,,6.65,,,,,,,6.30,6.79,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,outpatient,,,7.00000,3.37000,Hometown Health,Lease Networks,,6.65,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,inpatient,,,53.00000,25.49000,Hometown Health,Lease Networks,,50.35,,,,,,,47.70,51.41,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,outpatient,,,53.00000,25.49000,Hometown Health,Lease Networks,,50.35,,,,,,,13.78,51.41,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,inpatient,,,10.00000,4.81000,Hometown Health,Lease Networks,,9.50,,,,,,,9.00,9.70,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,outpatient,,,10.00000,4.81000,Hometown Health,Lease Networks,,9.50,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,inpatient,,,11.00000,5.29000,Hometown Health,Lease Networks,,10.45,,,,,,,9.90,10.67,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Hometown Health,Lease Networks,,10.45,,,,,,,2.86,10.67,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,inpatient,,,7.00000,3.37000,Hometown Health,Lease Networks,,6.65,,,,,,,6.30,6.79,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,outpatient,,,7.00000,3.37000,Hometown Health,Lease Networks,,6.65,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,inpatient,,,11.00000,5.29000,Hometown Health,Lease Networks,,10.45,,,,,,,9.90,10.67,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Hometown Health,Lease Networks,,10.45,,,,,,,2.86,10.67,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,inpatient,,,597.00000,290.14000,Hometown Health,Lease Networks,,567.15,,,,,,,537.30,579.09,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,outpatient,,,597.00000,290.14000,Hometown Health,Lease Networks,,567.15,,,,,,,155.22,579.09,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,inpatient,,,6379.00000,3100.19000,Hometown Health,Lease Networks,,6060.05,,,,,,,5741.10,6187.63,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,outpatient,,,6379.00000,3100.19000,Hometown Health,Lease Networks,,6060.05,,,,,,,1658.54,6187.63,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,inpatient,,,471.00000,228.91000,Hometown Health,Lease Networks,,447.45,,,,,,,423.90,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,outpatient,,,471.00000,228.91000,Hometown Health,Lease Networks,,447.45,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,inpatient,,,471.00000,228.91000,Hometown Health,Lease Networks,,447.45,,,,,,,423.90,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,outpatient,,,471.00000,228.91000,Hometown Health,Lease Networks,,447.45,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,inpatient,,,1251.00000,607.99000,Hometown Health,Lease Networks,,1188.45,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,outpatient,,,1251.00000,607.99000,Hometown Health,Lease Networks,,1188.45,,,,,,,325.26,1213.47,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,inpatient,,,260.00000,126.36000,Hometown Health,Lease Networks,,247.00,,,,,,,234.00,252.20,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,outpatient,,,260.00000,126.36000,Hometown Health,Lease Networks,,247.00,,,,,,,67.60,252.20,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,inpatient,,,785.00000,381.51000,Hometown Health,Lease Networks,,745.75,,,,,,,706.50,761.45,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,outpatient,,,785.00000,381.51000,Hometown Health,Lease Networks,,745.75,,,,,,,204.10,761.45,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,inpatient,,,529.00000,257.09000,Hometown Health,Lease Networks,,502.55,,,,,,,476.10,513.13,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,outpatient,,,529.00000,257.09000,Hometown Health,Lease Networks,,502.55,,,,,,,137.54,513.13,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,inpatient,,,1623.00000,788.78000,Hometown Health,Lease Networks,,1541.85,,,,,,,1460.70,1574.31,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,outpatient,,,1623.00000,788.78000,Hometown Health,Lease Networks,,1541.85,,,,,,,421.98,1574.31,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,inpatient,,,10800.00000,5248.80000,Hometown Health,Lease Networks,,10260.00,,,,,,,9720.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,outpatient,,,10800.00000,5248.80000,Hometown Health,Lease Networks,,10260.00,,,,,,,2808.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,inpatient,,,25365.00000,12327.39000,Hometown Health,Lease Networks,,24096.75,,,,,,,22828.50,24604.05,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,outpatient,,,25365.00000,12327.39000,Hometown Health,Lease Networks,,24096.75,,,,,,,6594.90,24604.05,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,inpatient,,,101.00000,21.82000,Hometown Health,Lease Networks,,95.95,,,,,,,90.90,97.97,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,outpatient,,,101.00000,21.82000,Hometown Health,Lease Networks,,95.95,,,,,,,26.26,97.97,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,inpatient,,,81.00000,17.50000,Hometown Health,Lease Networks,,76.95,,,,,,,72.90,78.57,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,outpatient,,,81.00000,17.50000,Hometown Health,Lease Networks,,76.95,,,,,,,21.06,78.57,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,inpatient,,,104.00000,22.46000,Hometown Health,Lease Networks,,98.80,,,,,,,93.60,100.88,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,outpatient,,,104.00000,22.46000,Hometown Health,Lease Networks,,98.80,,,,,,,27.04,100.88,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,inpatient,,,377.00000,81.43000,Hometown Health,Lease Networks,,358.15,,,,,,,339.30,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,outpatient,,,377.00000,81.43000,Hometown Health,Lease Networks,,358.15,,,,,,,98.02,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,inpatient,,,532.00000,114.91000,Hometown Health,Lease Networks,,505.40,,,,,,,478.80,516.04,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,outpatient,,,532.00000,114.91000,Hometown Health,Lease Networks,,505.40,,,,,,,138.32,516.04,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,inpatient,,,521.00000,112.54000,Hometown Health,Lease Networks,,494.95,,,,,,,468.90,505.37,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,outpatient,,,521.00000,112.54000,Hometown Health,Lease Networks,,494.95,,,,,,,135.46,505.37,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,inpatient,,,451.00000,97.42000,Hometown Health,Lease Networks,,428.45,,,,,,,405.90,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,outpatient,,,451.00000,97.42000,Hometown Health,Lease Networks,,428.45,,,,,,,117.26,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,inpatient,,,1148.00000,247.97000,Hometown Health,Lease Networks,,1090.60,,,,,,,1033.20,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,outpatient,,,1148.00000,247.97000,Hometown Health,Lease Networks,,1090.60,,,,,,,298.48,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,inpatient,,,350.00000,75.60000,Hometown Health,Lease Networks,,332.50,,,,,,,315.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,outpatient,,,350.00000,75.60000,Hometown Health,Lease Networks,,332.50,,,,,,,91.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,inpatient,,,423.00000,91.37000,Hometown Health,Lease Networks,,401.85,,,,,,,380.70,410.31,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,outpatient,,,423.00000,91.37000,Hometown Health,Lease Networks,,401.85,,,,,,,109.98,410.31,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,inpatient,,,751.00000,162.22000,Hometown Health,Lease Networks,,713.45,,,,,,,675.90,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Hometown Health,Lease Networks,,713.45,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,inpatient,,,751.00000,162.22000,Hometown Health,Lease Networks,,713.45,,,,,,,675.90,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Hometown Health,Lease Networks,,713.45,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,inpatient,,,119.00000,25.70000,Hometown Health,Lease Networks,,113.05,,,,,,,107.10,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,outpatient,,,119.00000,25.70000,Hometown Health,Lease Networks,,113.05,,,,,,,30.94,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,inpatient,,,126.00000,27.22000,Hometown Health,Lease Networks,,119.70,,,,,,,113.40,122.22,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,outpatient,,,126.00000,27.22000,Hometown Health,Lease Networks,,119.70,,,,,,,32.76,122.22,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,inpatient,,,110.00000,23.76000,Hometown Health,Lease Networks,,104.50,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Hometown Health,Lease Networks,,104.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,inpatient,,,110.00000,23.76000,Hometown Health,Lease Networks,,104.50,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Hometown Health,Lease Networks,,104.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,inpatient,,,79.00000,17.06000,Hometown Health,Lease Networks,,75.05,,,,,,,71.10,76.63,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,outpatient,,,79.00000,17.06000,Hometown Health,Lease Networks,,75.05,,,,,,,20.54,76.63,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,inpatient,,,110.00000,23.76000,Hometown Health,Lease Networks,,104.50,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Hometown Health,Lease Networks,,104.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,inpatient,,,110.00000,23.76000,Hometown Health,Lease Networks,,104.50,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Hometown Health,Lease Networks,,104.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,inpatient,,,79.00000,17.06000,Hometown Health,Lease Networks,,75.05,,,,,,,71.10,76.63,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,outpatient,,,79.00000,17.06000,Hometown Health,Lease Networks,,75.05,,,,,,,20.54,76.63,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,inpatient,,,335.00000,72.36000,Hometown Health,Lease Networks,,318.25,,,,,,,301.50,324.95,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,outpatient,,,335.00000,72.36000,Hometown Health,Lease Networks,,318.25,,,,,,,87.10,324.95,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,inpatient,,,154.00000,33.26000,Hometown Health,Lease Networks,,146.30,,,,,,,138.60,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Hometown Health,Lease Networks,,146.30,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,inpatient,,,154.00000,33.26000,Hometown Health,Lease Networks,,146.30,,,,,,,138.60,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Hometown Health,Lease Networks,,146.30,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,inpatient,,,128.00000,27.65000,Hometown Health,Lease Networks,,121.60,,,,,,,115.20,124.16,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,outpatient,,,128.00000,27.65000,Hometown Health,Lease Networks,,121.60,,,,,,,33.28,124.16,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,inpatient,,,65.00000,14.04000,Hometown Health,Lease Networks,,61.75,,,,,,,58.50,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,outpatient,,,65.00000,14.04000,Hometown Health,Lease Networks,,61.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,inpatient,,,272.00000,58.75000,Hometown Health,Lease Networks,,258.40,,,,,,,244.80,263.84,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,outpatient,,,272.00000,58.75000,Hometown Health,Lease Networks,,258.40,,,,,,,70.72,263.84,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,inpatient,,,26.00000,11.44000,Hometown Health,Lease Networks,,24.70,,,,,,,23.40,25.22,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,outpatient,,,26.00000,11.44000,Hometown Health,Lease Networks,,24.70,,,,,,,6.76,25.22,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,inpatient,,,359.00000,157.96000,Hometown Health,Lease Networks,,341.05,,,,,,,323.10,348.23,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,outpatient,,,359.00000,157.96000,Hometown Health,Lease Networks,,341.05,,,,,,,93.34,348.23,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,inpatient,,,189.00000,83.16000,Hometown Health,Lease Networks,,179.55,,,,,,,170.10,183.33,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,outpatient,,,189.00000,83.16000,Hometown Health,Lease Networks,,179.55,,,,,,,49.14,183.33,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,inpatient,,,359.00000,157.96000,Hometown Health,Lease Networks,,341.05,,,,,,,323.10,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,outpatient,,,359.00000,157.96000,Hometown Health,Lease Networks,,341.05,,,,,,,93.34,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,inpatient,,,137.00000,60.28000,Hometown Health,Lease Networks,,130.15,,,,,,,123.30,132.89,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,outpatient,,,137.00000,60.28000,Hometown Health,Lease Networks,,130.15,,,,,,,35.62,132.89,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,inpatient,,,1665.00000,732.60000,Hometown Health,Lease Networks,,1581.75,,,,,,,1498.50,1615.05,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,outpatient,,,1665.00000,732.60000,Hometown Health,Lease Networks,,1581.75,,,,,,,432.90,1615.05,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,inpatient,,,751.00000,330.44000,Hometown Health,Lease Networks,,713.45,,,,,,,675.90,728.47,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,outpatient,,,751.00000,330.44000,Hometown Health,Lease Networks,,713.45,,,,,,,195.26,728.47,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,inpatient,,,374.00000,164.56000,Hometown Health,Lease Networks,,355.30,,,,,,,336.60,362.78,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,outpatient,,,374.00000,164.56000,Hometown Health,Lease Networks,,355.30,,,,,,,97.24,362.78,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,inpatient,,,553.00000,243.32000,Hometown Health,Lease Networks,,525.35,,,,,,,497.70,536.41,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,outpatient,,,553.00000,243.32000,Hometown Health,Lease Networks,,525.35,,,,,,,143.78,536.41,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,inpatient,,,359.00000,157.96000,Hometown Health,Lease Networks,,341.05,,,,,,,323.10,348.23,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,outpatient,,,359.00000,157.96000,Hometown Health,Lease Networks,,341.05,,,,,,,93.34,348.23,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,inpatient,,,62.00000,27.28000,Hometown Health,Lease Networks,,58.90,,,,,,,55.80,60.14,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,outpatient,,,62.00000,27.28000,Hometown Health,Lease Networks,,58.90,,,,,,,16.12,60.14,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,inpatient,,,79.00000,34.76000,Hometown Health,Lease Networks,,75.05,,,,,,,71.10,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,outpatient,,,79.00000,34.76000,Hometown Health,Lease Networks,,75.05,,,,,,,20.54,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,inpatient,,,110.00000,48.40000,Hometown Health,Lease Networks,,104.50,,,,,,,99.00,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,outpatient,,,110.00000,48.40000,Hometown Health,Lease Networks,,104.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,inpatient,,,110.00000,48.40000,Hometown Health,Lease Networks,,104.50,,,,,,,99.00,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,outpatient,,,110.00000,48.40000,Hometown Health,Lease Networks,,104.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,inpatient,,,751.00000,330.44000,Hometown Health,Lease Networks,,713.45,,,,,,,675.90,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,outpatient,,,751.00000,330.44000,Hometown Health,Lease Networks,,713.45,,,,,,,195.26,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,inpatient,,,1665.00000,732.60000,Hometown Health,Lease Networks,,1581.75,,,,,,,1498.50,1615.05,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,outpatient,,,1665.00000,732.60000,Hometown Health,Lease Networks,,1581.75,,,,,,,432.90,1615.05,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,inpatient,,,110.00000,48.40000,Hometown Health,Lease Networks,,104.50,,,,,,,99.00,106.70,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,outpatient,,,110.00000,48.40000,Hometown Health,Lease Networks,,104.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,inpatient,,,281.00000,123.64000,Hometown Health,Lease Networks,,266.95,,,,,,,252.90,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Hometown Health,Lease Networks,,266.95,,,,,,,73.06,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,inpatient,,,281.00000,123.64000,Hometown Health,Lease Networks,,266.95,,,,,,,252.90,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Hometown Health,Lease Networks,,266.95,,,,,,,73.06,272.57,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,inpatient,,,451.00000,341.41000,Hometown Health,Lease Networks,,428.45,,,,,,,405.90,437.47,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,outpatient,,,451.00000,341.41000,Hometown Health,Lease Networks,,428.45,,,,,,,117.26,437.47,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,inpatient,,,300.00000,145.80000,Hometown Health,Lease Networks,,285.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,outpatient,,,300.00000,145.80000,Hometown Health,Lease Networks,,285.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,inpatient,,,2278.00000,1107.11000,Hometown Health,Lease Networks,,2164.10,,,,,,,2050.20,2209.66,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,outpatient,,,2278.00000,1107.11000,Hometown Health,Lease Networks,,2164.10,,,,,,,592.28,2209.66,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,inpatient,,,3912.00000,1901.23000,Hometown Health,Lease Networks,,3716.40,,,,,,,3520.80,3794.64,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,outpatient,,,3912.00000,1901.23000,Hometown Health,Lease Networks,,3716.40,,,,,,,1017.12,3794.64,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,inpatient,,,900.00000,437.40000,Hometown Health,Lease Networks,,855.00,,,,,,,810.00,873.00,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,outpatient,,,900.00000,437.40000,Hometown Health,Lease Networks,,855.00,,,,,,,234.00,873.00,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,inpatient,,,365.00000,177.39000,Hometown Health,Lease Networks,,346.75,,,,,,,328.50,354.05,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,outpatient,,,365.00000,177.39000,Hometown Health,Lease Networks,,346.75,,,,,,,94.90,354.05,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,inpatient,,,989.00000,480.65000,Hometown Health,Lease Networks,,939.55,,,,,,,890.10,959.33,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,outpatient,,,989.00000,480.65000,Hometown Health,Lease Networks,,939.55,,,,,,,257.14,959.33,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Hometown Health,Lease Networks,,467.40,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Hometown Health,Lease Networks,,467.40,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,inpatient,,,435.00000,211.41000,Hometown Health,Lease Networks,,413.25,,,,,,,391.50,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Hometown Health,Lease Networks,,413.25,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,inpatient,,,435.00000,211.41000,Hometown Health,Lease Networks,,413.25,,,,,,,391.50,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Hometown Health,Lease Networks,,413.25,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,inpatient,,,644.00000,312.98000,Hometown Health,Lease Networks,,611.80,,,,,,,579.60,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,outpatient,,,644.00000,312.98000,Hometown Health,Lease Networks,,611.80,,,,,,,167.44,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Hometown Health,Lease Networks,,467.40,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Hometown Health,Lease Networks,,467.40,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Hometown Health,Lease Networks,,467.40,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Hometown Health,Lease Networks,,467.40,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,inpatient,,,527.00000,256.12000,Hometown Health,Lease Networks,,500.65,,,,,,,474.30,511.19,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,outpatient,,,527.00000,256.12000,Hometown Health,Lease Networks,,500.65,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,inpatient,,,1404.00000,682.34000,Hometown Health,Lease Networks,,1333.80,,,,,,,1263.60,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,outpatient,,,1404.00000,682.34000,Hometown Health,Lease Networks,,1333.80,,,,,,,365.04,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,inpatient,,,5475.00000,2660.85000,Hometown Health,Lease Networks,,5201.25,,,,,,,4927.50,5310.75,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,outpatient,,,5475.00000,2660.85000,Hometown Health,Lease Networks,,5201.25,,,,,,,1423.50,5310.75,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,inpatient,,,726.00000,352.84000,Hometown Health,Lease Networks,,689.70,,,,,,,653.40,704.22,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,outpatient,,,726.00000,352.84000,Hometown Health,Lease Networks,,689.70,,,,,,,188.76,704.22,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,inpatient,,,507.00000,246.40000,Hometown Health,Lease Networks,,481.65,,,,,,,456.30,491.79,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,outpatient,,,507.00000,246.40000,Hometown Health,Lease Networks,,481.65,,,,,,,131.82,491.79,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,inpatient,,,1670.00000,811.62000,Hometown Health,Lease Networks,,1586.50,,,,,,,1503.00,1619.90,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,outpatient,,,1670.00000,811.62000,Hometown Health,Lease Networks,,1586.50,,,,,,,434.20,1619.90,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,inpatient,,,1139.00000,553.55000,Hometown Health,Lease Networks,,1082.05,,,,,,,1025.10,1104.83,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,outpatient,,,1139.00000,553.55000,Hometown Health,Lease Networks,,1082.05,,,,,,,296.14,1104.83,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,inpatient,,,875.00000,425.25000,Hometown Health,Lease Networks,,831.25,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,outpatient,,,875.00000,425.25000,Hometown Health,Lease Networks,,831.25,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,Lease Networks,,498.75,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,Lease Networks,,498.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,inpatient,,,1353.00000,657.56000,Hometown Health,Lease Networks,,1285.35,,,,,,,1217.70,1312.41,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,outpatient,,,1353.00000,657.56000,Hometown Health,Lease Networks,,1285.35,,,,,,,351.78,1312.41,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,Lease Networks,,498.75,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,Lease Networks,,498.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,Lease Networks,,498.75,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,Lease Networks,,498.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,inpatient,,,825.00000,400.95000,Hometown Health,Lease Networks,,783.75,,,,,,,742.50,800.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,outpatient,,,825.00000,400.95000,Hometown Health,Lease Networks,,783.75,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,Lease Networks,,498.75,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,Lease Networks,,498.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,Lease Networks,,498.75,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,Lease Networks,,498.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,inpatient,,,974.00000,473.36000,Hometown Health,Lease Networks,,925.30,,,,,,,876.60,944.78,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,outpatient,,,974.00000,473.36000,Hometown Health,Lease Networks,,925.30,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,inpatient,,,198.00000,96.23000,Hometown Health,Lease Networks,,188.10,,,,,,,178.20,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Hometown Health,Lease Networks,,188.10,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,inpatient,,,198.00000,96.23000,Hometown Health,Lease Networks,,188.10,,,,,,,178.20,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Hometown Health,Lease Networks,,188.10,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,inpatient,,,221.00000,107.41000,Hometown Health,Lease Networks,,209.95,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Hometown Health,Lease Networks,,209.95,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,inpatient,,,221.00000,107.41000,Hometown Health,Lease Networks,,209.95,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Hometown Health,Lease Networks,,209.95,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,inpatient,,,497.00000,241.54000,Hometown Health,Lease Networks,,472.15,,,,,,,447.30,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,outpatient,,,497.00000,241.54000,Hometown Health,Lease Networks,,472.15,,,,,,,129.22,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,inpatient,,,2340.00000,1137.24000,Hometown Health,Lease Networks,,2223.00,,,,,,,2106.00,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,outpatient,,,2340.00000,1137.24000,Hometown Health,Lease Networks,,2223.00,,,,,,,608.40,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,inpatient,,,249.00000,121.01000,Hometown Health,Lease Networks,,236.55,,,,,,,224.10,241.53,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,outpatient,,,249.00000,121.01000,Hometown Health,Lease Networks,,236.55,,,,,,,64.74,241.53,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,inpatient,,,135.00000,65.61000,Hometown Health,Lease Networks,,128.25,,,,,,,121.50,130.95,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,outpatient,,,135.00000,65.61000,Hometown Health,Lease Networks,,128.25,,,,,,,35.10,130.95,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,inpatient,,,172.00000,83.59000,Hometown Health,Lease Networks,,163.40,,,,,,,154.80,166.84,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,outpatient,,,172.00000,83.59000,Hometown Health,Lease Networks,,163.40,,,,,,,44.72,166.84,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,inpatient,,,307.00000,149.20000,Hometown Health,Lease Networks,,291.65,,,,,,,276.30,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,outpatient,,,307.00000,149.20000,Hometown Health,Lease Networks,,291.65,,,,,,,79.82,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,inpatient,,,1800.00000,874.80000,Hometown Health,Lease Networks,,1710.00,,,,,,,1620.00,1746.00,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,outpatient,,,1800.00000,874.80000,Hometown Health,Lease Networks,,1710.00,,,,,,,468.00,1746.00,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,inpatient,,,974.00000,473.36000,Hometown Health,Lease Networks,,925.30,,,,,,,876.60,944.78,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,outpatient,,,974.00000,473.36000,Hometown Health,Lease Networks,,925.30,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,inpatient,,,197.00000,95.74000,Hometown Health,Lease Networks,,187.15,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Hometown Health,Lease Networks,,187.15,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,inpatient,,,197.00000,95.74000,Hometown Health,Lease Networks,,187.15,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Hometown Health,Lease Networks,,187.15,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,inpatient,,,411.00000,199.75000,Hometown Health,Lease Networks,,390.45,,,,,,,369.90,398.67,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,outpatient,,,411.00000,199.75000,Hometown Health,Lease Networks,,390.45,,,,,,,106.86,398.67,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,inpatient,,,221.00000,107.41000,Hometown Health,Lease Networks,,209.95,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,outpatient,,,221.00000,107.41000,Hometown Health,Lease Networks,,209.95,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,inpatient,,,884.00000,429.62000,Hometown Health,Lease Networks,,839.80,,,,,,,795.60,857.48,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,outpatient,,,884.00000,429.62000,Hometown Health,Lease Networks,,839.80,,,,,,,229.84,857.48,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,inpatient,,,594.00000,288.68000,Hometown Health,Lease Networks,,564.30,,,,,,,534.60,576.18,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,outpatient,,,594.00000,288.68000,Hometown Health,Lease Networks,,564.30,,,,,,,154.44,576.18,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,inpatient,,,519.00000,252.23000,Hometown Health,Lease Networks,,493.05,,,,,,,467.10,503.43,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,outpatient,,,519.00000,252.23000,Hometown Health,Lease Networks,,493.05,,,,,,,134.94,503.43,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,inpatient,,,1046.00000,508.36000,Hometown Health,Lease Networks,,993.70,,,,,,,941.40,1014.62,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,outpatient,,,1046.00000,508.36000,Hometown Health,Lease Networks,,993.70,,,,,,,271.96,1014.62,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,inpatient,,,556.00000,270.22000,Hometown Health,Lease Networks,,528.20,,,,,,,500.40,539.32,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,outpatient,,,556.00000,270.22000,Hometown Health,Lease Networks,,528.20,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,inpatient,,,275.00000,133.65000,Hometown Health,Lease Networks,,261.25,,,,,,,247.50,266.75,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,outpatient,,,275.00000,133.65000,Hometown Health,Lease Networks,,261.25,,,,,,,71.50,266.75,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,inpatient,,,580.00000,281.88000,Hometown Health,Lease Networks,,551.00,,,,,,,522.00,562.60,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,outpatient,,,580.00000,281.88000,Hometown Health,Lease Networks,,551.00,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,inpatient,,,580.00000,281.88000,Hometown Health,Lease Networks,,551.00,,,,,,,522.00,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,outpatient,,,580.00000,281.88000,Hometown Health,Lease Networks,,551.00,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,inpatient,,,3480.00000,1691.28000,Hometown Health,Lease Networks,,3306.00,,,,,,,3132.00,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Hometown Health,Lease Networks,,3306.00,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,inpatient,,,3480.00000,1691.28000,Hometown Health,Lease Networks,,3306.00,,,,,,,3132.00,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Hometown Health,Lease Networks,,3306.00,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,inpatient,,,700.00000,340.20000,Hometown Health,Lease Networks,,665.00,,,,,,,630.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,outpatient,,,700.00000,340.20000,Hometown Health,Lease Networks,,665.00,,,,,,,182.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,inpatient,,,1427.00000,693.52000,Hometown Health,Lease Networks,,1355.65,,,,,,,1284.30,1384.19,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,outpatient,,,1427.00000,693.52000,Hometown Health,Lease Networks,,1355.65,,,,,,,371.02,1384.19,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,inpatient,,,614.00000,298.40000,Hometown Health,Lease Networks,,583.30,,,,,,,552.60,595.58,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,outpatient,,,614.00000,298.40000,Hometown Health,Lease Networks,,583.30,,,,,,,159.64,595.58,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,inpatient,,,2027.00000,985.12000,Hometown Health,Lease Networks,,1925.65,,,,,,,1824.30,1966.19,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,outpatient,,,2027.00000,985.12000,Hometown Health,Lease Networks,,1925.65,,,,,,,527.02,1966.19,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,inpatient,,,556.00000,270.22000,Hometown Health,Lease Networks,,528.20,,,,,,,500.40,539.32,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,outpatient,,,556.00000,270.22000,Hometown Health,Lease Networks,,528.20,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,inpatient,,,1146.00000,556.96000,Hometown Health,Lease Networks,,1088.70,,,,,,,1031.40,1111.62,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,outpatient,,,1146.00000,556.96000,Hometown Health,Lease Networks,,1088.70,,,,,,,297.96,1111.62,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,inpatient,,,197.00000,95.74000,Hometown Health,Lease Networks,,187.15,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Hometown Health,Lease Networks,,187.15,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,inpatient,,,197.00000,95.74000,Hometown Health,Lease Networks,,187.15,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Hometown Health,Lease Networks,,187.15,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,inpatient,,,527.00000,256.12000,Hometown Health,Lease Networks,,500.65,,,,,,,474.30,511.19,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,outpatient,,,527.00000,256.12000,Hometown Health,Lease Networks,,500.65,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,inpatient,,,740.00000,359.64000,Hometown Health,Lease Networks,,703.00,,,,,,,666.00,717.80,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,outpatient,,,740.00000,359.64000,Hometown Health,Lease Networks,,703.00,,,,,,,192.40,717.80,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,inpatient,,,875.00000,425.25000,Hometown Health,Lease Networks,,831.25,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Hometown Health,Lease Networks,,831.25,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,inpatient,,,875.00000,425.25000,Hometown Health,Lease Networks,,831.25,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Hometown Health,Lease Networks,,831.25,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,inpatient,,,1399.00000,679.91000,Hometown Health,Lease Networks,,1329.05,,,,,,,1259.10,1357.03,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,outpatient,,,1399.00000,679.91000,Hometown Health,Lease Networks,,1329.05,,,,,,,363.74,1357.03,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,inpatient,,,51.00000,24.79000,Hometown Health,Lease Networks,,48.45,,,,,,,45.90,49.47,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,outpatient,,,51.00000,24.79000,Hometown Health,Lease Networks,,48.45,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,inpatient,,,825.00000,400.95000,Hometown Health,Lease Networks,,783.75,,,,,,,742.50,800.25,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,outpatient,,,825.00000,400.95000,Hometown Health,Lease Networks,,783.75,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,inpatient,,,576.00000,279.94000,Hometown Health,Lease Networks,,547.20,,,,,,,518.40,558.72,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,outpatient,,,576.00000,279.94000,Hometown Health,Lease Networks,,547.20,,,,,,,149.76,558.72,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,inpatient,,,224.00000,108.86000,Hometown Health,Lease Networks,,212.80,,,,,,,201.60,217.28,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,outpatient,,,224.00000,108.86000,Hometown Health,Lease Networks,,212.80,,,,,,,58.24,217.28,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,inpatient,,,346.00000,168.16000,Hometown Health,Lease Networks,,328.70,,,,,,,311.40,335.62,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,outpatient,,,346.00000,168.16000,Hometown Health,Lease Networks,,328.70,,,,,,,89.96,335.62,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,Lease Networks,,498.75,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,Lease Networks,,498.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,Lease Networks,,498.75,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,Lease Networks,,498.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,Lease Networks,,498.75,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,Lease Networks,,498.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,Lease Networks,,498.75,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,Lease Networks,,498.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,inpatient,,,627.00000,304.72000,Hometown Health,Lease Networks,,595.65,,,,,,,564.30,608.19,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,outpatient,,,627.00000,304.72000,Hometown Health,Lease Networks,,595.65,,,,,,,163.02,608.19,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,inpatient,,,605.00000,294.03000,Hometown Health,Lease Networks,,574.75,,,,,,,544.50,586.85,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,outpatient,,,605.00000,294.03000,Hometown Health,Lease Networks,,574.75,,,,,,,157.30,586.85,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,inpatient,,,510.00000,247.86000,Hometown Health,Lease Networks,,484.50,,,,,,,459.00,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,outpatient,,,510.00000,247.86000,Hometown Health,Lease Networks,,484.50,,,,,,,132.60,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,inpatient,,,223.00000,108.38000,Hometown Health,Lease Networks,,211.85,,,,,,,200.70,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,outpatient,,,223.00000,108.38000,Hometown Health,Lease Networks,,211.85,,,,,,,57.98,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,inpatient,,,1211.00000,588.55000,Hometown Health,Lease Networks,,1150.45,,,,,,,1089.90,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,outpatient,,,1211.00000,588.55000,Hometown Health,Lease Networks,,1150.45,,,,,,,314.86,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,inpatient,,,383.00000,186.14000,Hometown Health,Lease Networks,,363.85,,,,,,,344.70,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,outpatient,,,383.00000,186.14000,Hometown Health,Lease Networks,,363.85,,,,,,,99.58,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,inpatient,,,1214.00000,590.00000,Hometown Health,Lease Networks,,1153.30,,,,,,,1092.60,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,outpatient,,,1214.00000,590.00000,Hometown Health,Lease Networks,,1153.30,,,,,,,315.64,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,inpatient,,,328.00000,159.41000,Hometown Health,Lease Networks,,311.60,,,,,,,295.20,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,outpatient,,,328.00000,159.41000,Hometown Health,Lease Networks,,311.60,,,,,,,85.28,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,inpatient,,,372.00000,180.79000,Hometown Health,Lease Networks,,353.40,,,,,,,334.80,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,outpatient,,,372.00000,180.79000,Hometown Health,Lease Networks,,353.40,,,,,,,96.72,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,inpatient,,,285.00000,138.51000,Hometown Health,Lease Networks,,270.75,,,,,,,256.50,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,outpatient,,,285.00000,138.51000,Hometown Health,Lease Networks,,270.75,,,,,,,74.10,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,inpatient,,,367.00000,178.36000,Hometown Health,Lease Networks,,348.65,,,,,,,330.30,355.99,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,outpatient,,,367.00000,178.36000,Hometown Health,Lease Networks,,348.65,,,,,,,95.42,355.99,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,inpatient,,,702.00000,341.17000,Hometown Health,Lease Networks,,666.90,,,,,,,631.80,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Hometown Health,Lease Networks,,666.90,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,inpatient,,,702.00000,341.17000,Hometown Health,Lease Networks,,666.90,,,,,,,631.80,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Hometown Health,Lease Networks,,666.90,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,inpatient,,,265.00000,128.79000,Hometown Health,Lease Networks,,251.75,,,,,,,238.50,257.05,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,outpatient,,,265.00000,128.79000,Hometown Health,Lease Networks,,251.75,,,,,,,68.90,257.05,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,inpatient,,,2279.00000,1107.59000,Hometown Health,Lease Networks,,2165.05,,,,,,,2051.10,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2279.00000,1107.59000,Hometown Health,Lease Networks,,2165.05,,,,,,,592.54,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,inpatient,,,2395.00000,1163.97000,Hometown Health,Lease Networks,,2275.25,,,,,,,2155.50,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2395.00000,1163.97000,Hometown Health,Lease Networks,,2275.25,,,,,,,622.70,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,inpatient,,,8759.00000,4256.87000,Hometown Health,Lease Networks,,8321.05,,,,,,,7883.10,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Hometown Health,Lease Networks,,8321.05,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,inpatient,,,8759.00000,4256.87000,Hometown Health,Lease Networks,,8321.05,,,,,,,7883.10,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Hometown Health,Lease Networks,,8321.05,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,inpatient,,,2752.00000,1337.47000,Hometown Health,Lease Networks,,2614.40,,,,,,,2476.80,2669.44,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,outpatient,,,2752.00000,1337.47000,Hometown Health,Lease Networks,,2614.40,,,,,,,715.52,2669.44,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,inpatient,,,217.00000,105.46000,Hometown Health,Lease Networks,,206.15,,,,,,,195.30,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Hometown Health,Lease Networks,,206.15,,,,,,,56.42,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,inpatient,,,217.00000,105.46000,Hometown Health,Lease Networks,,206.15,,,,,,,195.30,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Hometown Health,Lease Networks,,206.15,,,,,,,56.42,210.49,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,inpatient,,,292.00000,141.91000,Hometown Health,Lease Networks,,277.40,,,,,,,262.80,283.24,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,outpatient,,,292.00000,141.91000,Hometown Health,Lease Networks,,277.40,,,,,,,75.92,283.24,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Hometown Health,Lease Networks,,390.45,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Hometown Health,Lease Networks,,390.45,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Hometown Health,Lease Networks,,390.45,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Hometown Health,Lease Networks,,390.45,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Hometown Health,Lease Networks,,390.45,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Hometown Health,Lease Networks,,390.45,,,,,,,106.86,398.67,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,inpatient,,,2275.00000,1105.65000,Hometown Health,Lease Networks,,2161.25,,,,,,,2047.50,2206.75,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,outpatient,,,2275.00000,1105.65000,Hometown Health,Lease Networks,,2161.25,,,,,,,591.50,2206.75,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,inpatient,,,192.00000,93.31000,Hometown Health,Lease Networks,,182.40,,,,,,,172.80,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,outpatient,,,192.00000,93.31000,Hometown Health,Lease Networks,,182.40,,,,,,,49.92,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,inpatient,,,451.00000,219.19000,Hometown Health,Lease Networks,,428.45,,,,,,,405.90,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,outpatient,,,451.00000,219.19000,Hometown Health,Lease Networks,,428.45,,,,,,,117.26,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,inpatient,,,617.00000,299.86000,Hometown Health,Lease Networks,,586.15,,,,,,,555.30,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,outpatient,,,617.00000,299.86000,Hometown Health,Lease Networks,,586.15,,,,,,,160.42,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,inpatient,,,825.00000,400.95000,Hometown Health,Lease Networks,,783.75,,,,,,,742.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,outpatient,,,825.00000,400.95000,Hometown Health,Lease Networks,,783.75,,,,,,,214.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,inpatient,,,905.00000,439.83000,Hometown Health,Lease Networks,,859.75,,,,,,,814.50,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,outpatient,,,905.00000,439.83000,Hometown Health,Lease Networks,,859.75,,,,,,,235.30,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,inpatient,,,849.00000,412.61000,Hometown Health,Lease Networks,,806.55,,,,,,,764.10,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,outpatient,,,849.00000,412.61000,Hometown Health,Lease Networks,,806.55,,,,,,,220.74,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,inpatient,,,2539.00000,1233.95000,Hometown Health,Lease Networks,,2412.05,,,,,,,2285.10,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,outpatient,,,2539.00000,1233.95000,Hometown Health,Lease Networks,,2412.05,,,,,,,660.14,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,inpatient,,,6000.00000,2916.00000,Hometown Health,Lease Networks,,5700.00,,,,,,,5400.00,5820.00,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,outpatient,,,6000.00000,2916.00000,Hometown Health,Lease Networks,,5700.00,,,,,,,1560.00,5820.00,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,inpatient,,,8260.00000,4014.36000,Hometown Health,Lease Networks,,7847.00,,,,,,,7434.00,8012.20,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,outpatient,,,8260.00000,4014.36000,Hometown Health,Lease Networks,,7847.00,,,,,,,2147.60,8012.20,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,inpatient,,,202.00000,88.88000,Hometown Health,Lease Networks,,191.90,,,,,,,181.80,195.94,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,outpatient,,,202.00000,88.88000,Hometown Health,Lease Networks,,191.90,,,,,,,52.52,195.94,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,59.40,64.02,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,Lease Networks,,62.70,,,,,,,17.16,64.02,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,inpatient,,,295.00000,142.19000,Hometown Health,Lease Networks,,280.25,,,,,,,265.50,286.15,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,outpatient,,,295.00000,142.19000,Hometown Health,Lease Networks,,280.25,,,,,,,76.70,286.15,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,89.00000,26.79000,Hometown Health,Lease Networks,,84.55,,,,,,,80.10,86.33,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,89.00000,26.79000,Hometown Health,Lease Networks,,84.55,,,,,,,23.14,86.33,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,inpatient,,,93.00000,27.99000,Hometown Health,Lease Networks,,88.35,,,,,,,83.70,90.21,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Hometown Health,Lease Networks,,88.35,,,,,,,24.18,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,93.00000,27.99000,Hometown Health,Lease Networks,,88.35,,,,,,,83.70,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Hometown Health,Lease Networks,,88.35,,,,,,,24.18,90.21,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Hometown Health,Lease Networks,,1781.25,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Hometown Health,Lease Networks,,1781.25,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Hometown Health,Lease Networks,,1781.25,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Hometown Health,Lease Networks,,1781.25,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1752.00000,527.35000,Hometown Health,Lease Networks,,1664.40,,,,,,,1576.80,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Hometown Health,Lease Networks,,1664.40,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1752.00000,527.35000,Hometown Health,Lease Networks,,1664.40,,,,,,,1576.80,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Hometown Health,Lease Networks,,1664.40,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,731.00000,220.03000,Hometown Health,Lease Networks,,694.45,,,,,,,657.90,709.07,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,731.00000,220.03000,Hometown Health,Lease Networks,,694.45,,,,,,,190.06,709.07,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,787.00000,236.89000,Hometown Health,Lease Networks,,747.65,,,,,,,708.30,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,787.00000,236.89000,Hometown Health,Lease Networks,,747.65,,,,,,,204.62,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,2042.00000,614.64000,Hometown Health,Lease Networks,,1939.90,,,,,,,1837.80,1980.74,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,2042.00000,614.64000,Hometown Health,Lease Networks,,1939.90,,,,,,,530.92,1980.74,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Hometown Health,Lease Networks,,1781.25,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Hometown Health,Lease Networks,,1781.25,,,,,,,487.50,1818.75,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,714.00000,214.91000,Hometown Health,Lease Networks,,678.30,,,,,,,642.60,692.58,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,714.00000,214.91000,Hometown Health,Lease Networks,,678.30,,,,,,,185.64,692.58,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,294.00000,88.49000,Hometown Health,Lease Networks,,279.30,,,,,,,264.60,285.18,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,294.00000,88.49000,Hometown Health,Lease Networks,,279.30,,,,,,,76.44,285.18,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,inpatient,,,350.00000,105.35000,Hometown Health,Lease Networks,,332.50,,,,,,,315.00,339.50,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,350.00000,105.35000,Hometown Health,Lease Networks,,332.50,,,,,,,91.00,339.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,inpatient,,,1350.00000,780.30000,Hometown Health,Lease Networks,,1282.50,,,,,,,1215.00,1309.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,outpatient,,,1350.00000,780.30000,Hometown Health,Lease Networks,,1282.50,,,,,,,351.00,1309.50,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,inpatient,,,3680.00000,2127.04000,Hometown Health,Lease Networks,,3496.00,,,,,,,3312.00,3569.60,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,outpatient,,,3680.00000,2127.04000,Hometown Health,Lease Networks,,3496.00,,,,,,,956.80,3569.60,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,inpatient,,,1600.00000,924.80000,Hometown Health,Lease Networks,,1520.00,,,,,,,1440.00,1552.00,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,outpatient,,,1600.00000,924.80000,Hometown Health,Lease Networks,,1520.00,,,,,,,416.00,1552.00,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,inpatient,,,4680.00000,2705.04000,Hometown Health,Lease Networks,,4446.00,,,,,,,4212.00,4539.60,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,outpatient,,,4680.00000,2705.04000,Hometown Health,Lease Networks,,4446.00,,,,,,,1216.80,4539.60,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,inpatient,,,2100.00000,1213.80000,Hometown Health,Lease Networks,,1995.00,,,,,,,1890.00,2037.00,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,outpatient,,,2100.00000,1213.80000,Hometown Health,Lease Networks,,1995.00,,,,,,,546.00,2037.00,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,inpatient,,,5680.00000,3283.04000,Hometown Health,Lease Networks,,5396.00,,,,,,,5112.00,5509.60,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,outpatient,,,5680.00000,3283.04000,Hometown Health,Lease Networks,,5396.00,,,,,,,1476.80,5509.60,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,inpatient,,,2420.00000,1398.76000,Hometown Health,Lease Networks,,2299.00,,,,,,,2178.00,2347.40,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,outpatient,,,2420.00000,1398.76000,Hometown Health,Lease Networks,,2299.00,,,,,,,629.20,2347.40,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,inpatient,,,6415.00000,3707.87000,Hometown Health,Lease Networks,,6094.25,,,,,,,5773.50,6222.55,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,outpatient,,,6415.00000,3707.87000,Hometown Health,Lease Networks,,6094.25,,,,,,,1667.90,6222.55,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,inpatient,,,2920.00000,1687.76000,Hometown Health,Lease Networks,,2774.00,,,,,,,2628.00,2832.40,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,outpatient,,,2920.00000,1687.76000,Hometown Health,Lease Networks,,2774.00,,,,,,,759.20,2832.40,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,inpatient,,,8915.00000,5152.87000,Hometown Health,Lease Networks,,8469.25,,,,,,,8023.50,8647.55,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,outpatient,,,8915.00000,5152.87000,Hometown Health,Lease Networks,,8469.25,,,,,,,2317.90,8647.55,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,inpatient,,,3420.00000,1976.76000,Hometown Health,Lease Networks,,3249.00,,,,,,,3078.00,3317.40,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,outpatient,,,3420.00000,1976.76000,Hometown Health,Lease Networks,,3249.00,,,,,,,889.20,3317.40,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,inpatient,,,11415.00000,6597.87000,Hometown Health,Lease Networks,,10844.25,,,,,,,10273.50,11072.55,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,outpatient,,,11415.00000,6597.87000,Hometown Health,Lease Networks,,10844.25,,,,,,,2967.90,11072.55,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,inpatient,,,142.00000,154.35000,Hometown Health,Lease Networks,,134.90,,,,,,,127.80,137.74,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,outpatient,,,142.00000,154.35000,Hometown Health,Lease Networks,,134.90,,,,,,,36.92,137.74,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,inpatient,,,340.00000,228.82000,Hometown Health,Lease Networks,,323.00,,,,,,,306.00,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Hometown Health,Lease Networks,,323.00,,,,,,,88.40,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,inpatient,,,670.00000,450.91000,Hometown Health,Lease Networks,,636.50,,,,,,,603.00,649.90,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Hometown Health,Lease Networks,,636.50,,,,,,,174.20,649.90,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,inpatient,,,390.00000,262.47000,Hometown Health,Lease Networks,,370.50,,,,,,,351.00,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,outpatient,,,390.00000,262.47000,Hometown Health,Lease Networks,,370.50,,,,,,,101.40,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,inpatient,,,1170.00000,787.41000,Hometown Health,Lease Networks,,1111.50,,,,,,,1053.00,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,outpatient,,,1170.00000,787.41000,Hometown Health,Lease Networks,,1111.50,,,,,,,304.20,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,inpatient,,,440.00000,296.12000,Hometown Health,Lease Networks,,418.00,,,,,,,396.00,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,outpatient,,,440.00000,296.12000,Hometown Health,Lease Networks,,418.00,,,,,,,114.40,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,inpatient,,,1670.00000,1123.91000,Hometown Health,Lease Networks,,1586.50,,,,,,,1503.00,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,outpatient,,,1670.00000,1123.91000,Hometown Health,Lease Networks,,1586.50,,,,,,,434.20,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,inpatient,,,640.00000,430.72000,Hometown Health,Lease Networks,,608.00,,,,,,,576.00,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,outpatient,,,640.00000,430.72000,Hometown Health,Lease Networks,,608.00,,,,,,,166.40,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,inpatient,,,2170.00000,1460.41000,Hometown Health,Lease Networks,,2061.50,,,,,,,1953.00,2104.90,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,outpatient,,,2170.00000,1460.41000,Hometown Health,Lease Networks,,2061.50,,,,,,,564.20,2104.90,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,inpatient,,,17.00000,10.96000,Hometown Health,Lease Networks,,16.15,,,,,,,15.30,16.49,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,outpatient,,,17.00000,10.96000,Hometown Health,Lease Networks,,16.15,,,,,,,4.42,16.49,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,inpatient,,,535.00000,345.08000,Hometown Health,Lease Networks,,508.25,,,,,,,481.50,518.95,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,outpatient,,,535.00000,345.08000,Hometown Health,Lease Networks,,508.25,,,,,,,139.10,518.95,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,inpatient,,,23.00000,14.84000,Hometown Health,Lease Networks,,21.85,,,,,,,20.70,22.31,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,outpatient,,,23.00000,14.84000,Hometown Health,Lease Networks,,21.85,,,,,,,5.98,22.31,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,inpatient,,,635.00000,409.58000,Hometown Health,Lease Networks,,603.25,,,,,,,571.50,615.95,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,outpatient,,,635.00000,409.58000,Hometown Health,Lease Networks,,603.25,,,,,,,165.10,615.95,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,inpatient,,,30.00000,19.35000,Hometown Health,Lease Networks,,28.50,,,,,,,27.00,29.10,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,outpatient,,,30.00000,19.35000,Hometown Health,Lease Networks,,28.50,,,,,,,7.80,29.10,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,inpatient,,,735.00000,474.08000,Hometown Health,Lease Networks,,698.25,,,,,,,661.50,712.95,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,outpatient,,,735.00000,474.08000,Hometown Health,Lease Networks,,698.25,,,,,,,191.10,712.95,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,inpatient,,,33.00000,21.28000,Hometown Health,Lease Networks,,31.35,,,,,,,29.70,32.01,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,outpatient,,,33.00000,21.28000,Hometown Health,Lease Networks,,31.35,,,,,,,8.58,32.01,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,inpatient,,,835.00000,538.58000,Hometown Health,Lease Networks,,793.25,,,,,,,751.50,809.95,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,outpatient,,,835.00000,538.58000,Hometown Health,Lease Networks,,793.25,,,,,,,217.10,809.95,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,inpatient,,,140.00000,80.92000,Hometown Health,Lease Networks,,133.00,,,,,,,126.00,135.80,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,outpatient,,,140.00000,80.92000,Hometown Health,Lease Networks,,133.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,inpatient,,,275.00000,158.95000,Hometown Health,Lease Networks,,261.25,,,,,,,247.50,266.75,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,outpatient,,,275.00000,158.95000,Hometown Health,Lease Networks,,261.25,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,inpatient,,,295.00000,170.51000,Hometown Health,Lease Networks,,280.25,,,,,,,265.50,286.15,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,outpatient,,,295.00000,170.51000,Hometown Health,Lease Networks,,280.25,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,inpatient,,,590.00000,341.02000,Hometown Health,Lease Networks,,560.50,,,,,,,531.00,572.30,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,outpatient,,,590.00000,341.02000,Hometown Health,Lease Networks,,560.50,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,inpatient,,,690.00000,398.82000,Hometown Health,Lease Networks,,655.50,,,,,,,621.00,669.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,outpatient,,,690.00000,398.82000,Hometown Health,Lease Networks,,655.50,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,inpatient,,,1375.00000,794.75000,Hometown Health,Lease Networks,,1306.25,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,outpatient,,,1375.00000,794.75000,Hometown Health,Lease Networks,,1306.25,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,inpatient,,,950.00000,549.10000,Hometown Health,Lease Networks,,902.50,,,,,,,855.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,outpatient,,,950.00000,549.10000,Hometown Health,Lease Networks,,902.50,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,inpatient,,,1900.00000,1098.20000,Hometown Health,Lease Networks,,1805.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,outpatient,,,1900.00000,1098.20000,Hometown Health,Lease Networks,,1805.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,inpatient,,,140.00000,45.22000,Hometown Health,Lease Networks,,133.00,,,,,,,126.00,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,outpatient,,,140.00000,45.22000,Hometown Health,Lease Networks,,133.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,inpatient,,,275.00000,88.82000,Hometown Health,Lease Networks,,261.25,,,,,,,247.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,outpatient,,,275.00000,88.82000,Hometown Health,Lease Networks,,261.25,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,inpatient,,,295.00000,95.28000,Hometown Health,Lease Networks,,280.25,,,,,,,265.50,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,outpatient,,,295.00000,95.28000,Hometown Health,Lease Networks,,280.25,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,inpatient,,,590.00000,190.57000,Hometown Health,Lease Networks,,560.50,,,,,,,531.00,572.30,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,outpatient,,,590.00000,190.57000,Hometown Health,Lease Networks,,560.50,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,inpatient,,,690.00000,222.87000,Hometown Health,Lease Networks,,655.50,,,,,,,621.00,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,outpatient,,,690.00000,222.87000,Hometown Health,Lease Networks,,655.50,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,inpatient,,,1375.00000,444.12000,Hometown Health,Lease Networks,,1306.25,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,outpatient,,,1375.00000,444.12000,Hometown Health,Lease Networks,,1306.25,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,inpatient,,,950.00000,306.85000,Hometown Health,Lease Networks,,902.50,,,,,,,855.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,outpatient,,,950.00000,306.85000,Hometown Health,Lease Networks,,902.50,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,inpatient,,,1900.00000,613.70000,Hometown Health,Lease Networks,,1805.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,outpatient,,,1900.00000,613.70000,Hometown Health,Lease Networks,,1805.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,inpatient,,,340.00000,228.82000,Hometown Health,Lease Networks,,323.00,,,,,,,306.00,329.80,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Hometown Health,Lease Networks,,323.00,,,,,,,88.40,329.80,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,inpatient,,,670.00000,450.91000,Hometown Health,Lease Networks,,636.50,,,,,,,603.00,649.90,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Hometown Health,Lease Networks,,636.50,,,,,,,174.20,649.90,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Hometown Health,Lease Networks,,465.50,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Hometown Health,Lease Networks,,465.50,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,inpatient,,,490.00000,329.77000,Hometown Health,Lease Networks,,465.50,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Hometown Health,Lease Networks,,465.50,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Hometown Health,Lease Networks,,465.50,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Hometown Health,Lease Networks,,465.50,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,inpatient,,,245.00000,164.89000,Hometown Health,Lease Networks,,232.75,,,,,,,220.50,237.65,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Hometown Health,Lease Networks,,232.75,,,,,,,63.70,237.65,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Hometown Health,Lease Networks,,799.90,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Hometown Health,Lease Networks,,799.90,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Hometown Health,Lease Networks,,1000.35,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Hometown Health,Lease Networks,,1000.35,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Hometown Health,Lease Networks,,1199.85,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Hometown Health,Lease Networks,,1199.85,,,,,,,328.38,1225.11,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,inpatient,,,1178.00000,669.28000,Hometown Health,Lease Networks,,1119.10,,,,,,,1060.20,1142.66,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1178.00000,669.28000,Hometown Health,Lease Networks,,1119.10,,,,,,,306.28,1142.66,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,inpatient,,,140.00000,102.34000,Hometown Health,Lease Networks,,133.00,,,,,,,126.00,135.80,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,outpatient,,,140.00000,102.34000,Hometown Health,Lease Networks,,133.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,inpatient,,,275.00000,201.02000,Hometown Health,Lease Networks,,261.25,,,,,,,247.50,266.75,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,outpatient,,,275.00000,201.02000,Hometown Health,Lease Networks,,261.25,,,,,,,71.50,266.75,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,inpatient,,,295.00000,215.64000,Hometown Health,Lease Networks,,280.25,,,,,,,265.50,286.15,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,outpatient,,,295.00000,215.64000,Hometown Health,Lease Networks,,280.25,,,,,,,76.70,286.15,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,inpatient,,,590.00000,431.29000,Hometown Health,Lease Networks,,560.50,,,,,,,531.00,572.30,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,outpatient,,,590.00000,431.29000,Hometown Health,Lease Networks,,560.50,,,,,,,153.40,572.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,inpatient,,,690.00000,504.39000,Hometown Health,Lease Networks,,655.50,,,,,,,621.00,669.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,outpatient,,,690.00000,504.39000,Hometown Health,Lease Networks,,655.50,,,,,,,179.40,669.30,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,inpatient,,,1375.00000,1005.12000,Hometown Health,Lease Networks,,1306.25,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,outpatient,,,1375.00000,1005.12000,Hometown Health,Lease Networks,,1306.25,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,inpatient,,,950.00000,694.45000,Hometown Health,Lease Networks,,902.50,,,,,,,855.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,outpatient,,,950.00000,694.45000,Hometown Health,Lease Networks,,902.50,,,,,,,247.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,inpatient,,,1900.00000,1388.90000,Hometown Health,Lease Networks,,1805.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,outpatient,,,1900.00000,1388.90000,Hometown Health,Lease Networks,,1805.00,,,,,,,494.00,1843.00,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,inpatient,,,584.00000,426.90000,Hometown Health,Lease Networks,,554.80,,,,,,,525.60,566.48,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,outpatient,,,584.00000,426.90000,Hometown Health,Lease Networks,,554.80,,,,,,,151.84,566.48,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,inpatient,,,1391.00000,1016.82000,Hometown Health,Lease Networks,,1321.45,,,,,,,1251.90,1349.27,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,outpatient,,,1391.00000,1016.82000,Hometown Health,Lease Networks,,1321.45,,,,,,,361.66,1349.27,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,inpatient,,,359.00000,271.76000,Hometown Health,Lease Networks,,341.05,,,,,,,323.10,348.23,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,outpatient,,,359.00000,271.76000,Hometown Health,Lease Networks,,341.05,,,,,,,93.34,348.23,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,inpatient,,,95.00000,71.92000,Hometown Health,Lease Networks,,90.25,,,,,,,85.50,92.15,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,outpatient,,,95.00000,71.92000,Hometown Health,Lease Networks,,90.25,,,,,,,24.70,92.15,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,inpatient,,,37.00000,17.83000,Hometown Health,Lease Networks,,35.15,,,,,,,33.30,35.89,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,outpatient,,,37.00000,17.83000,Hometown Health,Lease Networks,,35.15,,,,,,,9.62,35.89,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Hometown Health,Lease Networks,,75.05,,,,,,,71.10,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Hometown Health,Lease Networks,,75.05,,,,,,,20.54,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,inpatient,,,237.00000,114.23000,Hometown Health,Lease Networks,,225.15,,,,,,,213.30,229.89,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Hometown Health,Lease Networks,,225.15,,,,,,,61.62,229.89,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,inpatient,,,33.00000,15.91000,Hometown Health,Lease Networks,,31.35,,,,,,,29.70,32.01,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,outpatient,,,33.00000,15.91000,Hometown Health,Lease Networks,,31.35,,,,,,,8.58,32.01,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,inpatient,,,25.00000,12.05000,Hometown Health,Lease Networks,,23.75,,,,,,,22.50,24.25,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,outpatient,,,25.00000,12.05000,Hometown Health,Lease Networks,,23.75,,,,,,,6.50,24.25,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,inpatient,,,497.00000,160.53000,Hometown Health,Lease Networks,,472.15,,,,,,,447.30,482.09,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,outpatient,,,497.00000,160.53000,Hometown Health,Lease Networks,,472.15,,,,,,,129.22,482.09,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Hometown Health,Lease Networks,,837.90,,,,,,,793.80,855.54,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Hometown Health,Lease Networks,,837.90,,,,,,,229.32,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Hometown Health,Lease Networks,,837.90,,,,,,,793.80,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Hometown Health,Lease Networks,,837.90,,,,,,,229.32,855.54,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,inpatient,,,98.00000,37.44000,Hometown Health,Lease Networks,,93.10,,,,,,,88.20,95.06,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Hometown Health,Lease Networks,,93.10,,,,,,,25.48,95.06,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,inpatient,,,96.00000,36.67000,Hometown Health,Lease Networks,,91.20,,,,,,,86.40,93.12,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Hometown Health,Lease Networks,,91.20,,,,,,,24.96,93.12,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Hometown Health,Lease Networks,,837.90,,,,,,,793.80,855.54,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Hometown Health,Lease Networks,,837.90,,,,,,,229.32,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Hometown Health,Lease Networks,,837.90,,,,,,,793.80,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Hometown Health,Lease Networks,,837.90,,,,,,,229.32,855.54,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,inpatient,,,763.00000,291.47000,Hometown Health,Lease Networks,,724.85,,,,,,,686.70,740.11,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,outpatient,,,763.00000,291.47000,Hometown Health,Lease Networks,,724.85,,,,,,,198.38,740.11,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,inpatient,,,199.00000,76.02000,Hometown Health,Lease Networks,,189.05,,,,,,,179.10,193.03,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,outpatient,,,199.00000,76.02000,Hometown Health,Lease Networks,,189.05,,,,,,,51.74,193.03,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,inpatient,,,98.00000,37.44000,Hometown Health,Lease Networks,,93.10,,,,,,,88.20,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Hometown Health,Lease Networks,,93.10,,,,,,,25.48,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,inpatient,,,96.00000,36.67000,Hometown Health,Lease Networks,,91.20,,,,,,,86.40,93.12,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Hometown Health,Lease Networks,,91.20,,,,,,,24.96,93.12,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,inpatient,,,1265.00000,483.23000,Hometown Health,Lease Networks,,1201.75,,,,,,,1138.50,1227.05,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,outpatient,,,1265.00000,483.23000,Hometown Health,Lease Networks,,1201.75,,,,,,,328.90,1227.05,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,inpatient,,,924.00000,352.97000,Hometown Health,Lease Networks,,877.80,,,,,,,831.60,896.28,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,outpatient,,,924.00000,352.97000,Hometown Health,Lease Networks,,877.80,,,,,,,240.24,896.28,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,inpatient,,,580.00000,215.76000,Hometown Health,Lease Networks,,551.00,,,,,,,522.00,562.60,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,outpatient,,,580.00000,215.76000,Hometown Health,Lease Networks,,551.00,,,,,,,150.80,562.60,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,inpatient,,,110.00000,40.92000,Hometown Health,Lease Networks,,104.50,,,,,,,99.00,106.70,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,outpatient,,,110.00000,40.92000,Hometown Health,Lease Networks,,104.50,,,,,,,28.60,106.70,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,inpatient,,,373.00000,138.76000,Hometown Health,Lease Networks,,354.35,,,,,,,335.70,361.81,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,outpatient,,,373.00000,138.76000,Hometown Health,Lease Networks,,354.35,,,,,,,96.98,361.81,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,inpatient,,,337.00000,125.36000,Hometown Health,Lease Networks,,320.15,,,,,,,303.30,326.89,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,outpatient,,,337.00000,125.36000,Hometown Health,Lease Networks,,320.15,,,,,,,87.62,326.89,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,inpatient,,,784.00000,291.65000,Hometown Health,Lease Networks,,744.80,,,,,,,705.60,760.48,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,outpatient,,,784.00000,291.65000,Hometown Health,Lease Networks,,744.80,,,,,,,203.84,760.48,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,inpatient,,,341.00000,126.85000,Hometown Health,Lease Networks,,323.95,,,,,,,306.90,330.77,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,outpatient,,,341.00000,126.85000,Hometown Health,Lease Networks,,323.95,,,,,,,88.66,330.77,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,inpatient,,,252.00000,93.74000,Hometown Health,Lease Networks,,239.40,,,,,,,226.80,244.44,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,outpatient,,,252.00000,93.74000,Hometown Health,Lease Networks,,239.40,,,,,,,65.52,244.44,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,inpatient,,,282.00000,104.90000,Hometown Health,Lease Networks,,267.90,,,,,,,253.80,273.54,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,outpatient,,,282.00000,104.90000,Hometown Health,Lease Networks,,267.90,,,,,,,73.32,273.54,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,inpatient,,,404.00000,150.29000,Hometown Health,Lease Networks,,383.80,,,,,,,363.60,391.88,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,outpatient,,,404.00000,150.29000,Hometown Health,Lease Networks,,383.80,,,,,,,105.04,391.88,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,inpatient,,,306.00000,173.85000,Hometown Health,Lease Networks,,290.70,,,,,,,275.40,296.82,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,outpatient,,,306.00000,173.85000,Hometown Health,Lease Networks,,290.70,,,,,,,79.56,296.82,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,inpatient,,,158.00000,89.77000,Hometown Health,Lease Networks,,150.10,,,,,,,142.20,153.26,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,outpatient,,,158.00000,89.77000,Hometown Health,Lease Networks,,150.10,,,,,,,41.08,153.26,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,inpatient,,,147.00000,89.38000,Hometown Health,Lease Networks,GP,139.65,,,,,,,132.30,142.59,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Hometown Health,Lease Networks,GP,139.65,,,,,,,38.22,142.59,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,inpatient,,,270.00000,164.16000,Hometown Health,Lease Networks,GP,256.50,,,,,,,243.00,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Hometown Health,Lease Networks,GP,256.50,,,,,,,70.20,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,inpatient,,,84.00000,51.07000,Hometown Health,Lease Networks,GP,79.80,,,,,,,75.60,81.48,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Hometown Health,Lease Networks,GP,79.80,,,,,,,21.84,81.48,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,inpatient,,,86.00000,52.29000,Hometown Health,Lease Networks,GP,81.70,,,,,,,77.40,83.42,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Hometown Health,Lease Networks,GP,81.70,,,,,,,22.36,83.42,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,inpatient,,,82.00000,49.86000,Hometown Health,Lease Networks,GP,77.90,,,,,,,73.80,79.54,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Hometown Health,Lease Networks,GP,77.90,,,,,,,21.32,79.54,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,inpatient,,,85.00000,51.68000,Hometown Health,Lease Networks,GP,80.75,,,,,,,76.50,82.45,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Hometown Health,Lease Networks,GP,80.75,,,,,,,22.10,82.45,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,inpatient,,,43.00000,26.14000,Hometown Health,Lease Networks,GP,40.85,,,,,,,38.70,41.71,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Hometown Health,Lease Networks,GP,40.85,,,,,,,11.18,41.71,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,inpatient,,,41.00000,24.93000,Hometown Health,Lease Networks,GP,38.95,,,,,,,36.90,39.77,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Hometown Health,Lease Networks,GP,38.95,,,,,,,10.66,39.77,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,inpatient,,,79.00000,48.03000,Hometown Health,Lease Networks,GP,75.05,,,,,,,71.10,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Hometown Health,Lease Networks,GP,75.05,,,,,,,20.54,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Hometown Health,Lease Networks,GP,70.30,,,,,,,66.60,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Hometown Health,Lease Networks,GP,70.30,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Hometown Health,Lease Networks,GP,70.30,,,,,,,66.60,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Hometown Health,Lease Networks,GP,70.30,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,inpatient,,,34.00000,20.67000,Hometown Health,Lease Networks,GP,32.30,,,,,,,30.60,32.98,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Hometown Health,Lease Networks,GP,32.30,,,,,,,8.84,32.98,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,inpatient,,,65.00000,39.52000,Hometown Health,Lease Networks,GP,61.75,,,,,,,58.50,63.05,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Hometown Health,Lease Networks,GP,61.75,,,,,,,16.90,63.05,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,inpatient,,,113.00000,68.70000,Hometown Health,Lease Networks,,107.35,,,,,,,101.70,109.61,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,outpatient,,,113.00000,68.70000,Hometown Health,Lease Networks,,107.35,,,,,,,29.38,109.61,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,inpatient,,,80.00000,48.64000,Hometown Health,Lease Networks,GP,76.00,,,,,,,72.00,77.60,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Hometown Health,Lease Networks,GP,76.00,,,,,,,20.80,77.60,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,inpatient,,,84.00000,51.07000,Hometown Health,Lease Networks,GP,79.80,,,,,,,75.60,81.48,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Hometown Health,Lease Networks,GP,79.80,,,,,,,21.84,81.48,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,inpatient,,,73.00000,44.38000,Hometown Health,Lease Networks,GP,69.35,,,,,,,65.70,70.81,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Hometown Health,Lease Networks,GP,69.35,,,,,,,18.98,70.81,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,inpatient,,,100.00000,60.80000,Hometown Health,Lease Networks,,95.00,,,,,,,90.00,97.00,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,outpatient,,,100.00000,60.80000,Hometown Health,Lease Networks,,95.00,,,,,,,26.00,97.00,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,inpatient,,,167.00000,101.54000,Hometown Health,Lease Networks,GP,158.65,,,,,,,150.30,161.99,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,outpatient,,,167.00000,101.54000,Hometown Health,Lease Networks,GP,158.65,,,,,,,43.42,161.99,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,inpatient,,,413.00000,251.10000,Hometown Health,Lease Networks,"50,GP",392.35,,,,,,,371.70,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Hometown Health,Lease Networks,"50,GP",392.35,,,,,,,107.38,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Hometown Health,Lease Networks,"LT,GP",261.25,,,,,,,247.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Hometown Health,Lease Networks,"LT,GP",261.25,,,,,,,71.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Hometown Health,Lease Networks,"RT,GP",261.25,,,,,,,247.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Hometown Health,Lease Networks,"RT,GP",261.25,,,,,,,71.50,266.75,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,inpatient,,,95.00000,57.76000,Hometown Health,Lease Networks,GP,90.25,,,,,,,85.50,92.15,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Hometown Health,Lease Networks,GP,90.25,,,,,,,24.70,92.15,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,inpatient,,,146.00000,88.77000,Hometown Health,Lease Networks,GP,138.70,,,,,,,131.40,141.62,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Hometown Health,Lease Networks,GP,138.70,,,,,,,37.96,141.62,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,inpatient,,,139.00000,84.51000,Hometown Health,Lease Networks,GP,132.05,,,,,,,125.10,134.83,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Hometown Health,Lease Networks,GP,132.05,,,,,,,36.14,134.83,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,inpatient,,,75.00000,45.60000,Hometown Health,Lease Networks,GP,71.25,,,,,,,67.50,72.75,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Hometown Health,Lease Networks,GP,71.25,,,,,,,19.50,72.75,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,inpatient,,,154.00000,93.63000,Hometown Health,Lease Networks,GP,146.30,,,,,,,138.60,149.38,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Hometown Health,Lease Networks,GP,146.30,,,,,,,40.04,149.38,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,inpatient,,,73.00000,44.38000,Hometown Health,Lease Networks,GP,69.35,,,,,,,65.70,70.81,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Hometown Health,Lease Networks,GP,69.35,,,,,,,18.98,70.81,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,inpatient,,,160.00000,97.28000,Hometown Health,Lease Networks,GP,152.00,,,,,,,144.00,155.20,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Hometown Health,Lease Networks,GP,152.00,,,,,,,41.60,155.20,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,inpatient,,,325.00000,197.60000,Hometown Health,Lease Networks,GP,308.75,,,,,,,292.50,315.25,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Hometown Health,Lease Networks,GP,308.75,,,,,,,84.50,315.25,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,inpatient,,,98.00000,59.58000,Hometown Health,Lease Networks,GP,93.10,,,,,,,88.20,95.06,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,outpatient,,,98.00000,59.58000,Hometown Health,Lease Networks,GP,93.10,,,,,,,25.48,95.06,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,inpatient,,,303.00000,184.22000,Hometown Health,Lease Networks,GP,287.85,,,,,,,272.70,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,outpatient,,,303.00000,184.22000,Hometown Health,Lease Networks,GP,287.85,,,,,,,78.78,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,inpatient,,,115.00000,69.92000,Hometown Health,Lease Networks,GP,109.25,,,,,,,103.50,111.55,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,outpatient,,,115.00000,69.92000,Hometown Health,Lease Networks,GP,109.25,,,,,,,29.90,111.55,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,inpatient,,,74.00000,44.99000,Hometown Health,Lease Networks,GP,70.30,,,,,,,66.60,71.78,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Hometown Health,Lease Networks,GP,70.30,,,,,,,19.24,71.78,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,inpatient,,,79.00000,48.03000,Hometown Health,Lease Networks,GP,75.05,,,,,,,71.10,76.63,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Hometown Health,Lease Networks,GP,75.05,,,,,,,20.54,76.63,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,inpatient,,,72.00000,43.78000,Hometown Health,Lease Networks,GP,68.40,,,,,,,64.80,69.84,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Hometown Health,Lease Networks,GP,68.40,,,,,,,18.72,69.84,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,inpatient,,,147.00000,89.38000,Hometown Health,Lease Networks,GP,139.65,,,,,,,132.30,142.59,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Hometown Health,Lease Networks,GP,139.65,,,,,,,38.22,142.59,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,inpatient,,,270.00000,164.16000,Hometown Health,Lease Networks,GP,256.50,,,,,,,243.00,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Hometown Health,Lease Networks,GP,256.50,,,,,,,70.20,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,inpatient,,,84.00000,51.07000,Hometown Health,Lease Networks,GP,79.80,,,,,,,75.60,81.48,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Hometown Health,Lease Networks,GP,79.80,,,,,,,21.84,81.48,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,inpatient,,,86.00000,52.29000,Hometown Health,Lease Networks,GP,81.70,,,,,,,77.40,83.42,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Hometown Health,Lease Networks,GP,81.70,,,,,,,22.36,83.42,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,inpatient,,,82.00000,49.86000,Hometown Health,Lease Networks,GP,77.90,,,,,,,73.80,79.54,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Hometown Health,Lease Networks,GP,77.90,,,,,,,21.32,79.54,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,inpatient,,,85.00000,51.68000,Hometown Health,Lease Networks,GP,80.75,,,,,,,76.50,82.45,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Hometown Health,Lease Networks,GP,80.75,,,,,,,22.10,82.45,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,inpatient,,,43.00000,26.14000,Hometown Health,Lease Networks,GP,40.85,,,,,,,38.70,41.71,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Hometown Health,Lease Networks,GP,40.85,,,,,,,11.18,41.71,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,inpatient,,,41.00000,24.93000,Hometown Health,Lease Networks,GP,38.95,,,,,,,36.90,39.77,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Hometown Health,Lease Networks,GP,38.95,,,,,,,10.66,39.77,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,inpatient,,,79.00000,48.03000,Hometown Health,Lease Networks,GP,75.05,,,,,,,71.10,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Hometown Health,Lease Networks,GP,75.05,,,,,,,20.54,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Hometown Health,Lease Networks,"CQ,GP",70.30,,,,,,,66.60,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Hometown Health,Lease Networks,"CQ,GP",70.30,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Hometown Health,Lease Networks,"CQ,GP",70.30,,,,,,,66.60,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Hometown Health,Lease Networks,"CQ,GP",70.30,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,inpatient,,,34.00000,20.67000,Hometown Health,Lease Networks,GP,32.30,,,,,,,30.60,32.98,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Hometown Health,Lease Networks,GP,32.30,,,,,,,8.84,32.98,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,inpatient,,,65.00000,39.52000,Hometown Health,Lease Networks,GP,61.75,,,,,,,58.50,63.05,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Hometown Health,Lease Networks,GP,61.75,,,,,,,16.90,63.05,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,inpatient,,,80.00000,48.64000,Hometown Health,Lease Networks,GP,76.00,,,,,,,72.00,77.60,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Hometown Health,Lease Networks,GP,76.00,,,,,,,20.80,77.60,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,inpatient,,,84.00000,51.07000,Hometown Health,Lease Networks,GP,79.80,,,,,,,75.60,81.48,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Hometown Health,Lease Networks,GP,79.80,,,,,,,21.84,81.48,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,inpatient,,,73.00000,44.38000,Hometown Health,Lease Networks,GP,69.35,,,,,,,65.70,70.81,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Hometown Health,Lease Networks,GP,69.35,,,,,,,18.98,70.81,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,inpatient,,,413.00000,251.10000,Hometown Health,Lease Networks,"GP,50",392.35,,,,,,,371.70,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Hometown Health,Lease Networks,"GP,50",392.35,,,,,,,107.38,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Hometown Health,Lease Networks,"GP,LT",261.25,,,,,,,247.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Hometown Health,Lease Networks,"GP,LT",261.25,,,,,,,71.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Hometown Health,Lease Networks,"GP,RT",261.25,,,,,,,247.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Hometown Health,Lease Networks,"GP,RT",261.25,,,,,,,71.50,266.75,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,inpatient,,,95.00000,57.76000,Hometown Health,Lease Networks,GP,90.25,,,,,,,85.50,92.15,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Hometown Health,Lease Networks,GP,90.25,,,,,,,24.70,92.15,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,inpatient,,,146.00000,88.77000,Hometown Health,Lease Networks,GP,138.70,,,,,,,131.40,141.62,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Hometown Health,Lease Networks,GP,138.70,,,,,,,37.96,141.62,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,inpatient,,,139.00000,84.51000,Hometown Health,Lease Networks,GP,132.05,,,,,,,125.10,134.83,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Hometown Health,Lease Networks,GP,132.05,,,,,,,36.14,134.83,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,inpatient,,,75.00000,45.60000,Hometown Health,Lease Networks,GP,71.25,,,,,,,67.50,72.75,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Hometown Health,Lease Networks,GP,71.25,,,,,,,19.50,72.75,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,inpatient,,,154.00000,93.63000,Hometown Health,Lease Networks,GP,146.30,,,,,,,138.60,149.38,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Hometown Health,Lease Networks,GP,146.30,,,,,,,40.04,149.38,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,inpatient,,,73.00000,44.38000,Hometown Health,Lease Networks,GP,69.35,,,,,,,65.70,70.81,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Hometown Health,Lease Networks,GP,69.35,,,,,,,18.98,70.81,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,inpatient,,,160.00000,97.28000,Hometown Health,Lease Networks,GP,152.00,,,,,,,144.00,155.20,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Hometown Health,Lease Networks,GP,152.00,,,,,,,41.60,155.20,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,inpatient,,,325.00000,197.60000,Hometown Health,Lease Networks,GP,308.75,,,,,,,292.50,315.25,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Hometown Health,Lease Networks,GP,308.75,,,,,,,84.50,315.25,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,inpatient,,,74.00000,44.99000,Hometown Health,Lease Networks,GP,70.30,,,,,,,66.60,71.78,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Hometown Health,Lease Networks,GP,70.30,,,,,,,19.24,71.78,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,inpatient,,,79.00000,48.03000,Hometown Health,Lease Networks,GP,75.05,,,,,,,71.10,76.63,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Hometown Health,Lease Networks,GP,75.05,,,,,,,20.54,76.63,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,inpatient,,,72.00000,43.78000,Hometown Health,Lease Networks,GP,68.40,,,,,,,64.80,69.84,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Hometown Health,Lease Networks,GP,68.40,,,,,,,18.72,69.84,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,inpatient,,,445.00000,262.55000,Hometown Health,Lease Networks,GP,422.75,,,,,,,400.50,431.65,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,outpatient,,,445.00000,262.55000,Hometown Health,Lease Networks,GP,422.75,,,,,,,115.70,431.65,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,inpatient,,,310.00000,182.90000,Hometown Health,Lease Networks,GP,294.50,,,,,,,279.00,300.70,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,outpatient,,,310.00000,182.90000,Hometown Health,Lease Networks,GP,294.50,,,,,,,80.60,300.70,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,inpatient,,,393.00000,231.87000,Hometown Health,Lease Networks,GP,373.35,,,,,,,353.70,381.21,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,outpatient,,,393.00000,231.87000,Hometown Health,Lease Networks,GP,373.35,,,,,,,102.18,381.21,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,inpatient,,,310.00000,182.90000,Hometown Health,Lease Networks,GP,294.50,,,,,,,279.00,300.70,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,outpatient,,,310.00000,182.90000,Hometown Health,Lease Networks,GP,294.50,,,,,,,80.60,300.70,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,inpatient,,,80.00000,30.96000,Hometown Health,Lease Networks,GO,76.00,,,,,,,72.00,77.60,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Hometown Health,Lease Networks,GO,76.00,,,,,,,20.80,77.60,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,inpatient,,,84.00000,32.51000,Hometown Health,Lease Networks,GO,79.80,,,,,,,75.60,81.48,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Hometown Health,Lease Networks,GO,79.80,,,,,,,21.84,81.48,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,inpatient,,,126.00000,48.76000,Hometown Health,Lease Networks,GO,119.70,,,,,,,113.40,122.22,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Hometown Health,Lease Networks,GO,119.70,,,,,,,32.76,122.22,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,inpatient,,,66.00000,25.54000,Hometown Health,Lease Networks,GO,62.70,,,,,,,59.40,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Hometown Health,Lease Networks,GO,62.70,,,,,,,17.16,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,inpatient,,,62.00000,23.99000,Hometown Health,Lease Networks,GO,58.90,,,,,,,55.80,60.14,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Hometown Health,Lease Networks,GO,58.90,,,,,,,16.12,60.14,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,inpatient,,,90.00000,34.83000,Hometown Health,Lease Networks,GO,85.50,,,,,,,81.00,87.30,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Hometown Health,Lease Networks,GO,85.50,,,,,,,23.40,87.30,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,inpatient,,,95.00000,36.76000,Hometown Health,Lease Networks,GO,90.25,,,,,,,85.50,92.15,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Hometown Health,Lease Networks,GO,90.25,,,,,,,24.70,92.15,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,inpatient,,,146.00000,56.50000,Hometown Health,Lease Networks,GO,138.70,,,,,,,131.40,141.62,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Hometown Health,Lease Networks,GO,138.70,,,,,,,37.96,141.62,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,inpatient,,,139.00000,53.79000,Hometown Health,Lease Networks,GO,132.05,,,,,,,125.10,134.83,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Hometown Health,Lease Networks,GO,132.05,,,,,,,36.14,134.83,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,inpatient,,,75.00000,29.02000,Hometown Health,Lease Networks,GO,71.25,,,,,,,67.50,72.75,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Hometown Health,Lease Networks,GO,71.25,,,,,,,19.50,72.75,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,inpatient,,,154.00000,59.60000,Hometown Health,Lease Networks,GO,146.30,,,,,,,138.60,149.38,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Hometown Health,Lease Networks,GO,146.30,,,,,,,40.04,149.38,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,inpatient,,,73.00000,28.25000,Hometown Health,Lease Networks,GO,69.35,,,,,,,65.70,70.81,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Hometown Health,Lease Networks,GO,69.35,,,,,,,18.98,70.81,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,inpatient,,,160.00000,61.92000,Hometown Health,Lease Networks,GO,152.00,,,,,,,144.00,155.20,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Hometown Health,Lease Networks,GO,152.00,,,,,,,41.60,155.20,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,inpatient,,,98.00000,37.93000,Hometown Health,Lease Networks,GO,93.10,,,,,,,88.20,95.06,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,outpatient,,,98.00000,37.93000,Hometown Health,Lease Networks,GO,93.10,,,,,,,25.48,95.06,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,inpatient,,,303.00000,117.26000,Hometown Health,Lease Networks,GO,287.85,,,,,,,272.70,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,outpatient,,,303.00000,117.26000,Hometown Health,Lease Networks,GO,287.85,,,,,,,78.78,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,inpatient,,,115.00000,44.50000,Hometown Health,Lease Networks,GO,109.25,,,,,,,103.50,111.55,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,outpatient,,,115.00000,44.50000,Hometown Health,Lease Networks,GO,109.25,,,,,,,29.90,111.55,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,inpatient,,,74.00000,28.64000,Hometown Health,Lease Networks,GO,70.30,,,,,,,66.60,71.78,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Hometown Health,Lease Networks,GO,70.30,,,,,,,19.24,71.78,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,inpatient,,,72.00000,27.86000,Hometown Health,Lease Networks,GO,68.40,,,,,,,64.80,69.84,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Hometown Health,Lease Networks,GO,68.40,,,,,,,18.72,69.84,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,inpatient,,,80.00000,30.96000,Hometown Health,Lease Networks,"CO,GO",76.00,,,,,,,72.00,77.60,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Hometown Health,Lease Networks,"CO,GO",76.00,,,,,,,20.80,77.60,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,inpatient,,,84.00000,32.51000,Hometown Health,Lease Networks,"CO,GO",79.80,,,,,,,75.60,81.48,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Hometown Health,Lease Networks,"CO,GO",79.80,,,,,,,21.84,81.48,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,inpatient,,,126.00000,48.76000,Hometown Health,Lease Networks,"CO,GO",119.70,,,,,,,113.40,122.22,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Hometown Health,Lease Networks,"CO,GO",119.70,,,,,,,32.76,122.22,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,inpatient,,,62.00000,23.99000,Hometown Health,Lease Networks,"CO,GO",58.90,,,,,,,55.80,60.14,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Hometown Health,Lease Networks,"CO,GO",58.90,,,,,,,16.12,60.14,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,inpatient,,,66.00000,25.54000,Hometown Health,Lease Networks,"CO,GO",62.70,,,,,,,59.40,64.02,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Hometown Health,Lease Networks,"CO,GO",62.70,,,,,,,17.16,64.02,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,inpatient,,,90.00000,34.83000,Hometown Health,Lease Networks,"CO,GO",85.50,,,,,,,81.00,87.30,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Hometown Health,Lease Networks,"CO,GO",85.50,,,,,,,23.40,87.30,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,inpatient,,,95.00000,36.76000,Hometown Health,Lease Networks,"CO,GO",90.25,,,,,,,85.50,92.15,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Hometown Health,Lease Networks,"CO,GO",90.25,,,,,,,24.70,92.15,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,inpatient,,,146.00000,56.50000,Hometown Health,Lease Networks,"CO,GO",138.70,,,,,,,131.40,141.62,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Hometown Health,Lease Networks,"CO,GO",138.70,,,,,,,37.96,141.62,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,inpatient,,,139.00000,53.79000,Hometown Health,Lease Networks,"CO,GO",132.05,,,,,,,125.10,134.83,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Hometown Health,Lease Networks,"CO,GO",132.05,,,,,,,36.14,134.83,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,inpatient,,,75.00000,29.02000,Hometown Health,Lease Networks,"CO,GO",71.25,,,,,,,67.50,72.75,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Hometown Health,Lease Networks,"CO,GO",71.25,,,,,,,19.50,72.75,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,inpatient,,,154.00000,59.60000,Hometown Health,Lease Networks,"CO,GO",146.30,,,,,,,138.60,149.38,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Hometown Health,Lease Networks,"CO,GO",146.30,,,,,,,40.04,149.38,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,inpatient,,,73.00000,28.25000,Hometown Health,Lease Networks,"CO,GO",69.35,,,,,,,65.70,70.81,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Hometown Health,Lease Networks,"CO,GO",69.35,,,,,,,18.98,70.81,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,inpatient,,,160.00000,61.92000,Hometown Health,Lease Networks,"CO,GO",152.00,,,,,,,144.00,155.20,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Hometown Health,Lease Networks,"CO,GO",152.00,,,,,,,41.60,155.20,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,inpatient,,,74.00000,28.64000,Hometown Health,Lease Networks,"CO,GO",70.30,,,,,,,66.60,71.78,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Hometown Health,Lease Networks,"CO,GO",70.30,,,,,,,19.24,71.78,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,inpatient,,,72.00000,27.86000,Hometown Health,Lease Networks,"CO,GO",68.40,,,,,,,64.80,69.84,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Hometown Health,Lease Networks,"CO,GO",68.40,,,,,,,18.72,69.84,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,inpatient,,,47.00000,26.70000,Hometown Health,Lease Networks,GO,44.65,,,,,,,42.30,45.59,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Hometown Health,Lease Networks,GO,44.65,,,,,,,12.22,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,inpatient,,,47.00000,26.70000,Hometown Health,Lease Networks,"CO,GO",44.65,,,,,,,42.30,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Hometown Health,Lease Networks,"CO,GO",44.65,,,,,,,12.22,45.59,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,inpatient,,,250.00000,142.04000,Hometown Health,Lease Networks,GO,237.50,,,,,,,225.00,242.50,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,outpatient,,,250.00000,142.04000,Hometown Health,Lease Networks,GO,237.50,,,,,,,65.00,242.50,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,inpatient,,,175.00000,99.43000,Hometown Health,Lease Networks,GO,166.25,,,,,,,157.50,169.75,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,outpatient,,,175.00000,99.43000,Hometown Health,Lease Networks,GO,166.25,,,,,,,45.50,169.75,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,inpatient,,,233.00000,132.38000,Hometown Health,Lease Networks,GO,221.35,,,,,,,209.70,226.01,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,outpatient,,,233.00000,132.38000,Hometown Health,Lease Networks,GO,221.35,,,,,,,60.58,226.01,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,inpatient,,,175.00000,99.43000,Hometown Health,Lease Networks,GO,166.25,,,,,,,157.50,169.75,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,outpatient,,,175.00000,99.43000,Hometown Health,Lease Networks,GO,166.25,,,,,,,45.50,169.75,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,inpatient,,,291.00000,93.99000,Hometown Health,Lease Networks,,276.45,,,,,,,261.90,282.27,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,outpatient,,,291.00000,93.99000,Hometown Health,Lease Networks,,276.45,,,,,,,75.66,282.27,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,inpatient,,,273.00000,155.10000,Hometown Health,Lease Networks,GN,259.35,,,,,,,245.70,264.81,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,outpatient,,,273.00000,155.10000,Hometown Health,Lease Networks,GN,259.35,,,,,,,70.98,264.81,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,inpatient,,,279.00000,158.51000,Hometown Health,Lease Networks,GN,265.05,,,,,,,251.10,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,outpatient,,,279.00000,158.51000,Hometown Health,Lease Networks,GN,265.05,,,,,,,72.54,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,inpatient,,,426.00000,242.03000,Hometown Health,Lease Networks,GN,404.70,,,,,,,383.40,413.22,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,outpatient,,,426.00000,242.03000,Hometown Health,Lease Networks,GN,404.70,,,,,,,110.76,413.22,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,inpatient,,,242.00000,137.49000,Hometown Health,Lease Networks,GN,229.90,,,,,,,217.80,234.74,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,outpatient,,,242.00000,137.49000,Hometown Health,Lease Networks,GN,229.90,,,,,,,62.92,234.74,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,inpatient,,,128.00000,72.72000,Hometown Health,Lease Networks,,121.60,,,,,,,115.20,124.16,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,outpatient,,,128.00000,72.72000,Hometown Health,Lease Networks,,121.60,,,,,,,33.28,124.16,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,inpatient,,,66.00000,37.50000,Hometown Health,Lease Networks,GN,62.70,,,,,,,59.40,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,outpatient,,,66.00000,37.50000,Hometown Health,Lease Networks,GN,62.70,,,,,,,17.16,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,inpatient,,,62.00000,35.23000,Hometown Health,Lease Networks,GN,58.90,,,,,,,55.80,60.14,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,outpatient,,,62.00000,35.23000,Hometown Health,Lease Networks,GN,58.90,,,,,,,16.12,60.14,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,inpatient,,,269.00000,152.83000,Hometown Health,Lease Networks,GN,255.55,,,,,,,242.10,260.93,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,outpatient,,,269.00000,152.83000,Hometown Health,Lease Networks,GN,255.55,,,,,,,69.94,260.93,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,inpatient,,,153.00000,86.93000,Hometown Health,Lease Networks,GN,145.35,,,,,,,137.70,148.41,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,outpatient,,,153.00000,86.93000,Hometown Health,Lease Networks,GN,145.35,,,,,,,39.78,148.41,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,inpatient,,,98.00000,55.68000,Hometown Health,Lease Networks,GN,93.10,,,,,,,88.20,95.06,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,outpatient,,,98.00000,55.68000,Hometown Health,Lease Networks,GN,93.10,,,,,,,25.48,95.06,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,inpatient,,,303.00000,172.15000,Hometown Health,Lease Networks,GN,287.85,,,,,,,272.70,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,outpatient,,,303.00000,172.15000,Hometown Health,Lease Networks,GN,287.85,,,,,,,78.78,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,inpatient,,,115.00000,65.34000,Hometown Health,Lease Networks,GN,109.25,,,,,,,103.50,111.55,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,outpatient,,,115.00000,65.34000,Hometown Health,Lease Networks,GN,109.25,,,,,,,29.90,111.55,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,inpatient,,,210.00000,119.31000,Hometown Health,Lease Networks,GN,199.50,,,,,,,189.00,203.70,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,outpatient,,,210.00000,119.31000,Hometown Health,Lease Networks,GN,199.50,,,,,,,54.60,203.70,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,inpatient,,,250.00000,142.04000,Hometown Health,Lease Networks,GN,237.50,,,,,,,225.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,outpatient,,,250.00000,142.04000,Hometown Health,Lease Networks,GN,237.50,,,,,,,65.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,inpatient,,,78.00000,44.32000,Hometown Health,Lease Networks,GN,74.10,,,,,,,70.20,75.66,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,outpatient,,,78.00000,44.32000,Hometown Health,Lease Networks,GN,74.10,,,,,,,20.28,75.66,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,inpatient,,,322.00000,182.94000,Hometown Health,Lease Networks,GN,305.90,,,,,,,289.80,312.34,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,outpatient,,,322.00000,182.94000,Hometown Health,Lease Networks,GN,305.90,,,,,,,83.72,312.34,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,inpatient,,,309.00000,175.56000,Hometown Health,Lease Networks,GN,293.55,,,,,,,278.10,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,outpatient,,,309.00000,175.56000,Hometown Health,Lease Networks,GN,293.55,,,,,,,80.34,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,inpatient,,,245.00000,139.20000,Hometown Health,Lease Networks,GN,232.75,,,,,,,220.50,237.65,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,outpatient,,,245.00000,139.20000,Hometown Health,Lease Networks,GN,232.75,,,,,,,63.70,237.65,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,inpatient,,,313.00000,116.44000,Hometown Health,Lease Networks,,297.35,,,,,,,281.70,303.61,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,outpatient,,,313.00000,116.44000,Hometown Health,Lease Networks,,297.35,,,,,,,81.38,303.61,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,inpatient,,,1250.00000,632.50000,Hometown Health,Lease Networks,,1187.50,,,,,,,1125.00,1212.50,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,outpatient,,,1250.00000,632.50000,Hometown Health,Lease Networks,,1187.50,,,,,,,325.00,1212.50,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,inpatient,,,145.00000,75.54000,Hometown Health,Lease Networks,,137.75,,,,,,,130.50,140.65,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Hometown Health,Lease Networks,,137.75,,,,,,,37.70,140.65,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,inpatient,,,488.00000,254.25000,Hometown Health,Lease Networks,,463.60,,,,,,,439.20,473.36,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Hometown Health,Lease Networks,,463.60,,,,,,,126.88,473.36,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,inpatient,,,684.00000,337.90000,Hometown Health,Lease Networks,,649.80,,,,,,,615.60,663.48,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,outpatient,,,684.00000,337.90000,Hometown Health,Lease Networks,,649.80,,,,,,,177.84,663.48,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,inpatient,,,206.00000,101.76000,Hometown Health,Lease Networks,,195.70,,,,,,,185.40,199.82,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,outpatient,,,206.00000,101.76000,Hometown Health,Lease Networks,,195.70,,,,,,,53.56,199.82,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,inpatient,,,195.00000,96.33000,Hometown Health,Lease Networks,,185.25,,,,,,,175.50,189.15,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,outpatient,,,195.00000,96.33000,Hometown Health,Lease Networks,,185.25,,,,,,,50.70,189.15,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,inpatient,,,375.00000,185.25000,Hometown Health,Lease Networks,,356.25,,,,,,,337.50,363.75,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,outpatient,,,375.00000,185.25000,Hometown Health,Lease Networks,,356.25,,,,,,,97.50,363.75,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,inpatient,,,429.00000,211.93000,Hometown Health,Lease Networks,,407.55,,,,,,,386.10,416.13,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,outpatient,,,429.00000,211.93000,Hometown Health,Lease Networks,,407.55,,,,,,,111.54,416.13,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22475,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,Lease Networks,,2641.95,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B OBSTETRICS SEMI-PVT,42473,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,Lease Networks,,2641.95,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ICU,32474,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Hometown Health,Lease Networks,,8322.95,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,12476,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Hometown Health,Lease Networks,,5548.95,,,,,,,2512.00,5665.77,percent of total billed charges,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,84.00000,63.59000,Hometown Health,Lease Networks,,79.80,,,,,,,75.60,81.48,percent of total billed charges,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Hometown Health,Lease Networks,,79.80,,,,,,,21.84,81.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Hometown Health,Lease Networks,,269.80,,,,,,,255.60,275.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Hometown Health,Lease Networks,,269.80,,,,,,,73.84,275.48,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Hometown Health,Lease Networks,,435.10,,,,,,,412.20,444.26,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Hometown Health,Lease Networks,,435.10,,,,,,,119.08,444.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Hometown Health,Lease Networks,,530.10,,,,,,,502.20,541.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Hometown Health,Lease Networks,,530.10,,,,,,,145.08,541.26,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Hometown Health,Lease Networks,,457.90,,,,,,,433.80,467.54,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Hometown Health,Lease Networks,,457.90,,,,,,,125.32,467.54,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Hometown Health,Lease Networks,,225.15,,,,,,,213.30,229.89,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Hometown Health,Lease Networks,,225.15,,,,,,,61.62,229.89,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,inpatient,,,490.00000,329.77000,Hometown Health,Lease Networks,,465.50,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,outpatient,,,490.00000,329.77000,Hometown Health,Lease Networks,,465.50,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,inpatient,,,490.00000,329.77000,Hometown Health,Lease Networks,,465.50,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,outpatient,,,490.00000,329.77000,Hometown Health,Lease Networks,,465.50,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,inpatient,,,245.00000,164.89000,Hometown Health,Lease Networks,,232.75,,,,,,,220.50,237.65,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,outpatient,,,245.00000,164.89000,Hometown Health,Lease Networks,,232.75,,,,,,,63.70,237.65,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,inpatient,,,490.00000,329.77000,Hometown Health,Lease Networks,,465.50,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Hometown Health,Lease Networks,,465.50,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Hometown Health,Lease Networks,,465.50,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Hometown Health,Lease Networks,,465.50,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,inpatient,,,245.00000,164.89000,Hometown Health,Lease Networks,,232.75,,,,,,,220.50,237.65,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Hometown Health,Lease Networks,,232.75,,,,,,,63.70,237.65,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Hometown Health,Lease Networks,,799.90,,,,,,,757.80,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Hometown Health,Lease Networks,,799.90,,,,,,,218.92,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Hometown Health,Lease Networks,,1000.35,,,,,,,947.70,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Hometown Health,Lease Networks,,1000.35,,,,,,,273.78,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Hometown Health,Lease Networks,,1199.85,,,,,,,1136.70,1225.11,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Hometown Health,Lease Networks,,1199.85,,,,,,,328.38,1225.11,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,inpatient,,,2466.00000,986.40000,Hometown Health,Lease Networks,,2342.70,,,,,,,2219.40,2392.02,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,outpatient,,,2466.00000,986.40000,Hometown Health,Lease Networks,,2342.70,,,,,,,641.16,2392.02,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,inpatient,,,260.00000,104.00000,Hometown Health,Lease Networks,,247.00,,,,,,,234.00,252.20,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,outpatient,,,260.00000,104.00000,Hometown Health,Lease Networks,,247.00,,,,,,,67.60,252.20,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,inpatient,,,2041.00000,816.40000,Hometown Health,Lease Networks,,1938.95,,,,,,,1836.90,1979.77,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,outpatient,,,2041.00000,816.40000,Hometown Health,Lease Networks,,1938.95,,,,,,,530.66,1979.77,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,inpatient,,,375.00000,150.00000,Hometown Health,Lease Networks,,356.25,,,,,,,337.50,363.75,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,outpatient,,,375.00000,150.00000,Hometown Health,Lease Networks,,356.25,,,,,,,97.50,363.75,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,inpatient,,,1178.00000,471.20000,Hometown Health,Lease Networks,,1119.10,,,,,,,1060.20,1142.66,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,outpatient,,,1178.00000,471.20000,Hometown Health,Lease Networks,,1119.10,,,,,,,306.28,1142.66,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,inpatient,,,245.00000,98.00000,Hometown Health,Lease Networks,,232.75,,,,,,,220.50,237.65,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,outpatient,,,245.00000,98.00000,Hometown Health,Lease Networks,,232.75,,,,,,,63.70,237.65,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,inpatient,,,280.00000,112.00000,Hometown Health,Lease Networks,,266.00,,,,,,,252.00,271.60,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,outpatient,,,280.00000,112.00000,Hometown Health,Lease Networks,,266.00,,,,,,,72.80,271.60,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,inpatient,,,336.00000,134.40000,Hometown Health,Lease Networks,,319.20,,,,,,,302.40,325.92,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,outpatient,,,336.00000,134.40000,Hometown Health,Lease Networks,,319.20,,,,,,,87.36,325.92,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,inpatient,,,380.00000,152.00000,Hometown Health,Lease Networks,,361.00,,,,,,,342.00,368.60,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,outpatient,,,380.00000,152.00000,Hometown Health,Lease Networks,,361.00,,,,,,,98.80,368.60,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,inpatient,,,530.00000,212.00000,Hometown Health,Lease Networks,,503.50,,,,,,,477.00,514.10,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Hometown Health,Lease Networks,,503.50,,,,,,,137.80,514.10,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,inpatient,,,264.00000,105.60000,Hometown Health,Lease Networks,,250.80,,,,,,,237.60,256.08,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,outpatient,,,264.00000,105.60000,Hometown Health,Lease Networks,,250.80,,,,,,,68.64,256.08,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,inpatient,,,763.00000,305.20000,Hometown Health,Lease Networks,,724.85,,,,,,,686.70,740.11,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,outpatient,,,763.00000,305.20000,Hometown Health,Lease Networks,,724.85,,,,,,,198.38,740.11,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,inpatient,,,672.00000,268.80000,Hometown Health,Lease Networks,,638.40,,,,,,,604.80,651.84,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,outpatient,,,672.00000,268.80000,Hometown Health,Lease Networks,,638.40,,,,,,,174.72,651.84,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,inpatient,,,1940.00000,776.00000,Hometown Health,Lease Networks,,1843.00,,,,,,,1746.00,1881.80,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,outpatient,,,1940.00000,776.00000,Hometown Health,Lease Networks,,1843.00,,,,,,,504.40,1881.80,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,inpatient,,,3875.00000,1550.00000,Hometown Health,Lease Networks,,3681.25,,,,,,,3487.50,3758.75,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,outpatient,,,3875.00000,1550.00000,Hometown Health,Lease Networks,,3681.25,,,,,,,1007.50,3758.75,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,inpatient,,,505.00000,202.00000,Hometown Health,Lease Networks,,479.75,,,,,,,454.50,489.85,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,outpatient,,,505.00000,202.00000,Hometown Health,Lease Networks,,479.75,,,,,,,131.30,489.85,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,inpatient,,,295.00000,118.00000,Hometown Health,Lease Networks,,280.25,,,,,,,265.50,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Hometown Health,Lease Networks,,280.25,,,,,,,76.70,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,inpatient,,,585.00000,234.00000,Hometown Health,Lease Networks,,555.75,,,,,,,526.50,567.45,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,outpatient,,,585.00000,234.00000,Hometown Health,Lease Networks,,555.75,,,,,,,152.10,567.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,inpatient,,,285.00000,114.00000,Hometown Health,Lease Networks,,270.75,,,,,,,256.50,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,outpatient,,,285.00000,114.00000,Hometown Health,Lease Networks,,270.75,,,,,,,74.10,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,inpatient,,,575.00000,230.00000,Hometown Health,Lease Networks,,546.25,,,,,,,517.50,557.75,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,outpatient,,,575.00000,230.00000,Hometown Health,Lease Networks,,546.25,,,,,,,149.50,557.75,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,inpatient,,,697.00000,278.80000,Hometown Health,Lease Networks,,662.15,,,,,,,627.30,676.09,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,outpatient,,,697.00000,278.80000,Hometown Health,Lease Networks,,662.15,,,,,,,181.22,676.09,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,inpatient,,,530.00000,212.00000,Hometown Health,Lease Networks,,503.50,,,,,,,477.00,514.10,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Hometown Health,Lease Networks,,503.50,,,,,,,137.80,514.10,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,inpatient,,,580.00000,232.00000,Hometown Health,Lease Networks,,551.00,,,,,,,522.00,562.60,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,outpatient,,,580.00000,232.00000,Hometown Health,Lease Networks,,551.00,,,,,,,150.80,562.60,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,inpatient,,,435.00000,174.00000,Hometown Health,Lease Networks,,413.25,,,,,,,391.50,421.95,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,outpatient,,,435.00000,174.00000,Hometown Health,Lease Networks,,413.25,,,,,,,113.10,421.95,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,inpatient,,,270.00000,108.00000,Hometown Health,Lease Networks,,256.50,,,,,,,243.00,261.90,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,outpatient,,,270.00000,108.00000,Hometown Health,Lease Networks,,256.50,,,,,,,70.20,261.90,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,inpatient,,,504.00000,201.60000,Hometown Health,Lease Networks,,478.80,,,,,,,453.60,488.88,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,outpatient,,,504.00000,201.60000,Hometown Health,Lease Networks,,478.80,,,,,,,131.04,488.88,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,inpatient,,,98.00000,39.20000,Hometown Health,Lease Networks,,93.10,,,,,,,88.20,95.06,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,outpatient,,,98.00000,39.20000,Hometown Health,Lease Networks,,93.10,,,,,,,25.48,95.06,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,inpatient,,,608.00000,243.20000,Hometown Health,Lease Networks,,577.60,,,,,,,547.20,589.76,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,outpatient,,,608.00000,243.20000,Hometown Health,Lease Networks,,577.60,,,,,,,158.08,589.76,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,inpatient,,,114.00000,45.60000,Hometown Health,Lease Networks,,108.30,,,,,,,102.60,110.58,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,outpatient,,,114.00000,45.60000,Hometown Health,Lease Networks,,108.30,,,,,,,29.64,110.58,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,inpatient,,,187.00000,74.80000,Hometown Health,Lease Networks,,177.65,,,,,,,168.30,181.39,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,outpatient,,,187.00000,74.80000,Hometown Health,Lease Networks,,177.65,,,,,,,48.62,181.39,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,inpatient,,,214.00000,85.60000,Hometown Health,Lease Networks,,203.30,,,,,,,192.60,207.58,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,outpatient,,,214.00000,85.60000,Hometown Health,Lease Networks,,203.30,,,,,,,55.64,207.58,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,inpatient,,,863.00000,345.20000,Hometown Health,Lease Networks,,819.85,,,,,,,776.70,837.11,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,outpatient,,,863.00000,345.20000,Hometown Health,Lease Networks,,819.85,,,,,,,224.38,837.11,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,inpatient,,,453.00000,181.20000,Hometown Health,Lease Networks,,430.35,,,,,,,407.70,439.41,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,outpatient,,,453.00000,181.20000,Hometown Health,Lease Networks,,430.35,,,,,,,117.78,439.41,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,inpatient,,,144.00000,57.60000,Hometown Health,Lease Networks,,136.80,,,,,,,129.60,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,outpatient,,,144.00000,57.60000,Hometown Health,Lease Networks,,136.80,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,inpatient,,,107.00000,42.80000,Hometown Health,Lease Networks,,101.65,,,,,,,96.30,103.79,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,outpatient,,,107.00000,42.80000,Hometown Health,Lease Networks,,101.65,,,,,,,27.82,103.79,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,inpatient,,,403.00000,161.20000,Hometown Health,Lease Networks,,382.85,,,,,,,362.70,390.91,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,outpatient,,,403.00000,161.20000,Hometown Health,Lease Networks,,382.85,,,,,,,104.78,390.91,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,inpatient,,,144.00000,57.60000,Hometown Health,Lease Networks,,136.80,,,,,,,129.60,139.68,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,outpatient,,,144.00000,57.60000,Hometown Health,Lease Networks,,136.80,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,inpatient,,,370.00000,148.00000,Hometown Health,Lease Networks,,351.50,,,,,,,333.00,358.90,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,outpatient,,,370.00000,148.00000,Hometown Health,Lease Networks,,351.50,,,,,,,96.20,358.90,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,inpatient,,,334.00000,133.60000,Hometown Health,Lease Networks,,317.30,,,,,,,300.60,323.98,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,outpatient,,,334.00000,133.60000,Hometown Health,Lease Networks,,317.30,,,,,,,86.84,323.98,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,inpatient,,,1188.00000,475.20000,Hometown Health,Lease Networks,50,1128.60,,,,,,,1069.20,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,outpatient,,,1188.00000,475.20000,Hometown Health,Lease Networks,50,1128.60,,,,,,,308.88,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,inpatient,,,792.00000,316.80000,Hometown Health,Lease Networks,LT,752.40,,,,,,,712.80,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Hometown Health,Lease Networks,LT,752.40,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,inpatient,,,792.00000,316.80000,Hometown Health,Lease Networks,RT,752.40,,,,,,,712.80,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Hometown Health,Lease Networks,RT,752.40,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,inpatient,,,572.00000,228.80000,Hometown Health,Lease Networks,50,543.40,,,,,,,514.80,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,outpatient,,,572.00000,228.80000,Hometown Health,Lease Networks,50,543.40,,,,,,,148.72,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,inpatient,,,381.00000,152.40000,Hometown Health,Lease Networks,LT,361.95,,,,,,,342.90,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Hometown Health,Lease Networks,LT,361.95,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,inpatient,,,381.00000,152.40000,Hometown Health,Lease Networks,RT,361.95,,,,,,,342.90,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Hometown Health,Lease Networks,RT,361.95,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,inpatient,,,683.00000,273.20000,Hometown Health,Lease Networks,50,648.85,,,,,,,614.70,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,outpatient,,,683.00000,273.20000,Hometown Health,Lease Networks,50,648.85,,,,,,,177.58,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,inpatient,,,455.00000,182.00000,Hometown Health,Lease Networks,LT,432.25,,,,,,,409.50,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Hometown Health,Lease Networks,LT,432.25,,,,,,,118.30,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,inpatient,,,455.00000,182.00000,Hometown Health,Lease Networks,RT,432.25,,,,,,,409.50,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Hometown Health,Lease Networks,RT,432.25,,,,,,,118.30,441.35,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,inpatient,,,357.00000,142.80000,Hometown Health,Lease Networks,,339.15,,,,,,,321.30,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,outpatient,,,357.00000,142.80000,Hometown Health,Lease Networks,,339.15,,,,,,,92.82,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,inpatient,,,334.00000,133.60000,Hometown Health,Lease Networks,,317.30,,,,,,,300.60,323.98,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,outpatient,,,334.00000,133.60000,Hometown Health,Lease Networks,,317.30,,,,,,,86.84,323.98,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,inpatient,,,194.00000,77.60000,Hometown Health,Lease Networks,,184.30,,,,,,,174.60,188.18,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,outpatient,,,194.00000,77.60000,Hometown Health,Lease Networks,,184.30,,,,,,,50.44,188.18,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,inpatient,,,608.00000,243.20000,Hometown Health,Lease Networks,,577.60,,,,,,,547.20,589.76,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,outpatient,,,608.00000,243.20000,Hometown Health,Lease Networks,,577.60,,,,,,,158.08,589.76,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,inpatient,,,257.00000,102.80000,Hometown Health,Lease Networks,,244.15,,,,,,,231.30,249.29,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,outpatient,,,257.00000,102.80000,Hometown Health,Lease Networks,,244.15,,,,,,,66.82,249.29,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,inpatient,,,343.00000,137.20000,Hometown Health,Lease Networks,,325.85,,,,,,,308.70,332.71,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,outpatient,,,343.00000,137.20000,Hometown Health,Lease Networks,,325.85,,,,,,,89.18,332.71,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,inpatient,,,457.00000,182.80000,Hometown Health,Lease Networks,,434.15,,,,,,,411.30,443.29,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,outpatient,,,457.00000,182.80000,Hometown Health,Lease Networks,,434.15,,,,,,,118.82,443.29,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,inpatient,,,630.00000,252.00000,Hometown Health,Lease Networks,,598.50,,,,,,,567.00,611.10,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,outpatient,,,630.00000,252.00000,Hometown Health,Lease Networks,,598.50,,,,,,,163.80,611.10,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,inpatient,,,623.00000,249.20000,Hometown Health,Lease Networks,,591.85,,,,,,,560.70,604.31,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,outpatient,,,623.00000,249.20000,Hometown Health,Lease Networks,,591.85,,,,,,,161.98,604.31,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,inpatient,,,1457.00000,582.80000,Hometown Health,Lease Networks,,1384.15,,,,,,,1311.30,1413.29,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,outpatient,,,1457.00000,582.80000,Hometown Health,Lease Networks,,1384.15,,,,,,,378.82,1413.29,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,inpatient,,,890.00000,356.00000,Hometown Health,Lease Networks,,845.50,,,,,,,801.00,863.30,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,outpatient,,,890.00000,356.00000,Hometown Health,Lease Networks,,845.50,,,,,,,231.40,863.30,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,inpatient,,,532.00000,212.80000,Hometown Health,Lease Networks,,505.40,,,,,,,478.80,516.04,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,outpatient,,,532.00000,212.80000,Hometown Health,Lease Networks,,505.40,,,,,,,138.32,516.04,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,inpatient,,,492.00000,196.80000,Hometown Health,Lease Networks,,467.40,,,,,,,442.80,477.24,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,outpatient,,,492.00000,196.80000,Hometown Health,Lease Networks,,467.40,,,,,,,127.92,477.24,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,inpatient,,,550.00000,220.00000,Hometown Health,Lease Networks,,522.50,,,,,,,495.00,533.50,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,outpatient,,,550.00000,220.00000,Hometown Health,Lease Networks,,522.50,,,,,,,143.00,533.50,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,inpatient,,,305.00000,122.00000,Hometown Health,Lease Networks,,289.75,,,,,,,274.50,295.85,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,outpatient,,,305.00000,122.00000,Hometown Health,Lease Networks,,289.75,,,,,,,79.30,295.85,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,inpatient,,,220.00000,88.00000,Hometown Health,Lease Networks,,209.00,,,,,,,198.00,213.40,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,outpatient,,,220.00000,88.00000,Hometown Health,Lease Networks,,209.00,,,,,,,57.20,213.40,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,inpatient,,,780.00000,312.00000,Hometown Health,Lease Networks,,741.00,,,,,,,702.00,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,outpatient,,,780.00000,312.00000,Hometown Health,Lease Networks,,741.00,,,,,,,202.80,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,inpatient,,,1165.00000,466.00000,Hometown Health,Lease Networks,,1106.75,,,,,,,1048.50,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,outpatient,,,1165.00000,466.00000,Hometown Health,Lease Networks,,1106.75,,,,,,,302.90,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,inpatient,,,2350.00000,940.00000,Hometown Health,Lease Networks,,2232.50,,,,,,,2115.00,2279.50,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,outpatient,,,2350.00000,940.00000,Hometown Health,Lease Networks,,2232.50,,,,,,,611.00,2279.50,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,inpatient,,,896.00000,358.40000,Hometown Health,Lease Networks,,851.20,,,,,,,806.40,869.12,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,outpatient,,,896.00000,358.40000,Hometown Health,Lease Networks,,851.20,,,,,,,232.96,869.12,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,inpatient,,,385.00000,154.00000,Hometown Health,Lease Networks,,365.75,,,,,,,346.50,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,outpatient,,,385.00000,154.00000,Hometown Health,Lease Networks,,365.75,,,,,,,100.10,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,inpatient,,,470.00000,188.00000,Hometown Health,Lease Networks,,446.50,,,,,,,423.00,455.90,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,outpatient,,,470.00000,188.00000,Hometown Health,Lease Networks,,446.50,,,,,,,122.20,455.90,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,inpatient,,,150.00000,60.00000,Hometown Health,Lease Networks,,142.50,,,,,,,135.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,outpatient,,,150.00000,60.00000,Hometown Health,Lease Networks,,142.50,,,,,,,39.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,inpatient,,,100.00000,40.00000,Hometown Health,Lease Networks,,95.00,,,,,,,90.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,outpatient,,,100.00000,40.00000,Hometown Health,Lease Networks,,95.00,,,,,,,26.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,inpatient,,,143.00000,57.20000,Hometown Health,Lease Networks,,135.85,,,,,,,128.70,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,outpatient,,,143.00000,57.20000,Hometown Health,Lease Networks,,135.85,,,,,,,37.18,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,inpatient,,,95.00000,38.00000,Hometown Health,Lease Networks,,90.25,,,,,,,85.50,92.15,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,outpatient,,,95.00000,38.00000,Hometown Health,Lease Networks,,90.25,,,,,,,24.70,92.15,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,inpatient,,,269.00000,107.60000,Hometown Health,Lease Networks,,255.55,,,,,,,242.10,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,outpatient,,,269.00000,107.60000,Hometown Health,Lease Networks,,255.55,,,,,,,69.94,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,inpatient,,,388.00000,155.20000,Hometown Health,Lease Networks,,368.60,,,,,,,349.20,376.36,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,outpatient,,,388.00000,155.20000,Hometown Health,Lease Networks,,368.60,,,,,,,100.88,376.36,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,inpatient,,,344.00000,137.60000,Hometown Health,Lease Networks,,326.80,,,,,,,309.60,333.68,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,outpatient,,,344.00000,137.60000,Hometown Health,Lease Networks,,326.80,,,,,,,89.44,333.68,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,inpatient,,,321.00000,128.40000,Hometown Health,Lease Networks,,304.95,,,,,,,288.90,311.37,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,outpatient,,,321.00000,128.40000,Hometown Health,Lease Networks,,304.95,,,,,,,83.46,311.37,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,inpatient,,,155.00000,62.00000,Hometown Health,Lease Networks,,147.25,,,,,,,139.50,150.35,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,outpatient,,,155.00000,62.00000,Hometown Health,Lease Networks,,147.25,,,,,,,40.30,150.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,inpatient,,,817.00000,326.80000,Hometown Health,Lease Networks,,776.15,,,,,,,735.30,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,outpatient,,,817.00000,326.80000,Hometown Health,Lease Networks,,776.15,,,,,,,212.42,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,inpatient,,,1255.00000,502.00000,Hometown Health,Lease Networks,,1192.25,,,,,,,1129.50,1217.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,outpatient,,,1255.00000,502.00000,Hometown Health,Lease Networks,,1192.25,,,,,,,326.30,1217.35,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,inpatient,,,391.00000,156.40000,Hometown Health,Lease Networks,,371.45,,,,,,,351.90,379.27,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,outpatient,,,391.00000,156.40000,Hometown Health,Lease Networks,,371.45,,,,,,,101.66,379.27,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,inpatient,,,671.00000,268.40000,Hometown Health,Lease Networks,,637.45,,,,,,,603.90,650.87,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,outpatient,,,671.00000,268.40000,Hometown Health,Lease Networks,,637.45,,,,,,,174.46,650.87,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,inpatient,,,456.00000,182.40000,Hometown Health,Lease Networks,,433.20,,,,,,,410.40,442.32,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,outpatient,,,456.00000,182.40000,Hometown Health,Lease Networks,,433.20,,,,,,,118.56,442.32,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,inpatient,,,112.00000,44.80000,Hometown Health,Lease Networks,,106.40,,,,,,,100.80,108.64,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,outpatient,,,112.00000,44.80000,Hometown Health,Lease Networks,,106.40,,,,,,,29.12,108.64,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,inpatient,,,84.00000,33.60000,Hometown Health,Lease Networks,,79.80,,,,,,,75.60,81.48,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,outpatient,,,84.00000,33.60000,Hometown Health,Lease Networks,,79.80,,,,,,,21.84,81.48,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,inpatient,,,216.00000,86.40000,Hometown Health,Lease Networks,,205.20,,,,,,,194.40,209.52,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,outpatient,,,216.00000,86.40000,Hometown Health,Lease Networks,,205.20,,,,,,,56.16,209.52,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,inpatient,,,2660.00000,1064.00000,Hometown Health,Lease Networks,,2527.00,,,,,,,2394.00,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,outpatient,,,2660.00000,1064.00000,Hometown Health,Lease Networks,,2527.00,,,,,,,691.60,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,inpatient,,,2960.00000,1184.00000,Hometown Health,Lease Networks,,2812.00,,,,,,,2664.00,2871.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,outpatient,,,2960.00000,1184.00000,Hometown Health,Lease Networks,,2812.00,,,,,,,769.60,2871.20,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,inpatient,,,3225.00000,1290.00000,Hometown Health,Lease Networks,,3063.75,,,,,,,2902.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,outpatient,,,3225.00000,1290.00000,Hometown Health,Lease Networks,,3063.75,,,,,,,838.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,inpatient,,,3395.00000,1358.00000,Hometown Health,Lease Networks,,3225.25,,,,,,,3055.50,3293.15,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,outpatient,,,3395.00000,1358.00000,Hometown Health,Lease Networks,,3225.25,,,,,,,882.70,3293.15,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,inpatient,,,490.00000,196.00000,Hometown Health,Lease Networks,,465.50,,,,,,,441.00,475.30,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,outpatient,,,490.00000,196.00000,Hometown Health,Lease Networks,,465.50,,,,,,,127.40,475.30,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,inpatient,,,520.00000,208.00000,Hometown Health,Lease Networks,,494.00,,,,,,,468.00,504.40,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,outpatient,,,520.00000,208.00000,Hometown Health,Lease Networks,,494.00,,,,,,,135.20,504.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,inpatient,,,720.00000,288.00000,Hometown Health,Lease Networks,,684.00,,,,,,,648.00,698.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,outpatient,,,720.00000,288.00000,Hometown Health,Lease Networks,,684.00,,,,,,,187.20,698.40,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,inpatient,,,215.00000,86.00000,Hometown Health,Lease Networks,,204.25,,,,,,,193.50,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,outpatient,,,215.00000,86.00000,Hometown Health,Lease Networks,,204.25,,,,,,,55.90,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,inpatient,,,240.00000,96.00000,Hometown Health,Lease Networks,,228.00,,,,,,,216.00,232.80,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,outpatient,,,240.00000,96.00000,Hometown Health,Lease Networks,,228.00,,,,,,,62.40,232.80,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,inpatient,,,1241.00000,496.40000,Hometown Health,Lease Networks,,1178.95,,,,,,,1116.90,1203.77,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,outpatient,,,1241.00000,496.40000,Hometown Health,Lease Networks,,1178.95,,,,,,,322.66,1203.77,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,inpatient,,,850.00000,340.00000,Hometown Health,Lease Networks,,807.50,,,,,,,765.00,824.50,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,outpatient,,,850.00000,340.00000,Hometown Health,Lease Networks,,807.50,,,,,,,221.00,824.50,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,inpatient,,,1085.00000,434.00000,Hometown Health,Lease Networks,,1030.75,,,,,,,976.50,1052.45,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,outpatient,,,1085.00000,434.00000,Hometown Health,Lease Networks,,1030.75,,,,,,,282.10,1052.45,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,inpatient,,,295.00000,118.00000,Hometown Health,Lease Networks,,280.25,,,,,,,265.50,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Hometown Health,Lease Networks,,280.25,,,,,,,76.70,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,inpatient,,,492.00000,196.80000,Hometown Health,Lease Networks,,467.40,,,,,,,442.80,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,outpatient,,,492.00000,196.80000,Hometown Health,Lease Networks,,467.40,,,,,,,127.92,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,inpatient,,,563.00000,225.20000,Hometown Health,Lease Networks,,534.85,,,,,,,506.70,546.11,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,outpatient,,,563.00000,225.20000,Hometown Health,Lease Networks,,534.85,,,,,,,146.38,546.11,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,inpatient,,,1612.00000,644.80000,Hometown Health,Lease Networks,,1531.40,,,,,,,1450.80,1563.64,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,outpatient,,,1612.00000,644.80000,Hometown Health,Lease Networks,,1531.40,,,,,,,419.12,1563.64,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,inpatient,,,1366.00000,546.40000,Hometown Health,Lease Networks,,1297.70,,,,,,,1229.40,1325.02,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,outpatient,,,1366.00000,546.40000,Hometown Health,Lease Networks,,1297.70,,,,,,,355.16,1325.02,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,inpatient,,,1911.00000,764.40000,Hometown Health,Lease Networks,,1815.45,,,,,,,1719.90,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,outpatient,,,1911.00000,764.40000,Hometown Health,Lease Networks,,1815.45,,,,,,,496.86,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,inpatient,,,956.00000,382.40000,Hometown Health,Lease Networks,,908.20,,,,,,,860.40,927.32,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,outpatient,,,956.00000,382.40000,Hometown Health,Lease Networks,,908.20,,,,,,,248.56,927.32,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,inpatient,,,189.00000,123.20000,Hometown Health,Lease Networks,,179.55,,,,,,,170.10,183.33,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,outpatient,,,189.00000,123.20000,Hometown Health,Lease Networks,,179.55,,,,,,,49.14,183.33,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,inpatient,,,352.00000,256.87000,Hometown Health,Lease Networks,,334.40,,,,,,,316.80,341.44,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,outpatient,,,352.00000,256.87000,Hometown Health,Lease Networks,,334.40,,,,,,,91.52,341.44,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,inpatient,,,625.00000,738.40000,Hometown Health,Lease Networks,,593.75,,,,,,,562.50,606.25,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,outpatient,,,625.00000,738.40000,Hometown Health,Lease Networks,,593.75,,,,,,,162.50,606.25,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,inpatient,,,1024.00000,2097.47000,Hometown Health,Lease Networks,,972.80,,,,,,,921.60,993.28,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1024.00000,2097.47000,Hometown Health,Lease Networks,,972.80,,,,,,,266.24,993.28,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,inpatient,,,1455.00000,2469.72000,Hometown Health,Lease Networks,,1382.25,,,,,,,1309.50,1411.35,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,outpatient,,,1455.00000,2469.72000,Hometown Health,Lease Networks,,1382.25,,,,,,,378.30,1411.35,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,inpatient,,,145.00000,75.54000,Hometown Health,Lease Networks,,137.75,,,,,,,130.50,140.65,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Hometown Health,Lease Networks,,137.75,,,,,,,37.70,140.65,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,inpatient,,,488.00000,254.25000,Hometown Health,Lease Networks,,463.60,,,,,,,439.20,473.36,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Hometown Health,Lease Networks,,463.60,,,,,,,126.88,473.36,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Hometown Health,Lease Networks,,110.20,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Hometown Health,Lease Networks,,110.20,,,,,,,30.16,112.52,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Hometown Health,Lease Networks,,76.95,,,,,,,72.90,78.57,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Hometown Health,Lease Networks,,76.95,,,,,,,21.06,78.57,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Hometown Health,Lease Networks,,38.95,,,,,,,36.90,39.77,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Hometown Health,Lease Networks,,38.95,,,,,,,10.66,39.77,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,inpatient,,,170.00000,73.95000,Hometown Health,Lease Networks,,161.50,,,,,,,153.00,164.90,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,outpatient,,,170.00000,73.95000,Hometown Health,Lease Networks,,161.50,,,,,,,44.20,164.90,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,2.70000,1.17000,Hometown Health,Lease Networks,,2.56,,,,,,,2.43,2.62,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,2.70000,1.17000,Hometown Health,Lease Networks,,2.56,,,,,,,0.70200,2.62,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,27.00000,11.74000,Hometown Health,Lease Networks,,25.65,,,,,,,24.30,26.19,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,27.00000,11.74000,Hometown Health,Lease Networks,,25.65,,,,,,,7.02,26.19,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,inpatient,,,20440.00000,8891.40000,Hometown Health,Lease Networks,,19418.00,,,,,,,18396.00,19826.80,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,outpatient,,,20440.00000,8891.40000,Hometown Health,Lease Networks,,19418.00,,,,,,,5314.40,19826.80,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,inpatient,,,3322.00000,1445.07000,Hometown Health,Lease Networks,,3155.90,,,,,,,2989.80,3222.34,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,3322.00000,1445.07000,Hometown Health,Lease Networks,,3155.90,,,,,,,863.72,3222.34,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,inpatient,,,2492.00000,1084.02000,Hometown Health,Lease Networks,,2367.40,,,,,,,2242.80,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,2492.00000,1084.02000,Hometown Health,Lease Networks,,2367.40,,,,,,,647.92,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,inpatient,,,1814.00000,789.09000,Hometown Health,Lease Networks,,1723.30,,,,,,,1632.60,1759.58,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1814.00000,789.09000,Hometown Health,Lease Networks,,1723.30,,,,,,,471.64,1759.58,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,inpatient,,,2153.00000,936.56000,Hometown Health,Lease Networks,,2045.35,,,,,,,1937.70,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,2153.00000,936.56000,Hometown Health,Lease Networks,,2045.35,,,,,,,559.78,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,inpatient,,,1525.00000,663.38000,Hometown Health,Lease Networks,,1448.75,,,,,,,1372.50,1479.25,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1525.00000,663.38000,Hometown Health,Lease Networks,,1448.75,,,,,,,396.50,1479.25,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,inpatient,,,2716.00000,1181.46000,Hometown Health,Lease Networks,,2580.20,,,,,,,2444.40,2634.52,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2716.00000,1181.46000,Hometown Health,Lease Networks,,2580.20,,,,,,,706.16,2634.52,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,inpatient,,,2.70000,0.39000,Hometown Health,Lease Networks,,2.56,,,,,,,2.43,2.62,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,outpatient,,,2.70000,0.39000,Hometown Health,Lease Networks,,2.56,,,,,,,0.70200,2.62,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,inpatient,,,222.00000,32.41000,Hometown Health,Lease Networks,,210.90,,,,,,,199.80,215.34,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,outpatient,,,222.00000,32.41000,Hometown Health,Lease Networks,,210.90,,,,,,,57.72,215.34,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,inpatient,,,211.00000,113.10000,Hometown Health,Lease Networks,,200.45,,,,,,,189.90,204.67,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,outpatient,,,211.00000,113.10000,Hometown Health,Lease Networks,,200.45,,,,,,,54.86,204.67,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,inpatient,,,497.00000,266.39000,Hometown Health,Lease Networks,,472.15,,,,,,,447.30,482.09,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,outpatient,,,497.00000,266.39000,Hometown Health,Lease Networks,,472.15,,,,,,,129.22,482.09,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,inpatient,,,296.00000,158.66000,Hometown Health,Lease Networks,,281.20,,,,,,,266.40,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,outpatient,,,296.00000,158.66000,Hometown Health,Lease Networks,,281.20,,,,,,,76.96,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,inpatient,,,723.00000,387.53000,Hometown Health,Lease Networks,,686.85,,,,,,,650.70,701.31,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,outpatient,,,723.00000,387.53000,Hometown Health,Lease Networks,,686.85,,,,,,,187.98,701.31,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,inpatient,,,326.00000,174.74000,Hometown Health,Lease Networks,,309.70,,,,,,,293.40,316.22,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,outpatient,,,326.00000,174.74000,Hometown Health,Lease Networks,,309.70,,,,,,,84.76,316.22,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,inpatient,,,532.00000,285.15000,Hometown Health,Lease Networks,,505.40,,,,,,,478.80,516.04,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,outpatient,,,532.00000,285.15000,Hometown Health,Lease Networks,,505.40,,,,,,,138.32,516.04,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,inpatient,,,635.00000,340.36000,Hometown Health,Lease Networks,,603.25,,,,,,,571.50,615.95,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,outpatient,,,635.00000,340.36000,Hometown Health,Lease Networks,,603.25,,,,,,,165.10,615.95,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,inpatient,,,639.00000,342.50000,Hometown Health,Lease Networks,,607.05,,,,,,,575.10,619.83,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,outpatient,,,639.00000,342.50000,Hometown Health,Lease Networks,,607.05,,,,,,,166.14,619.83,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,inpatient,,,780.00000,418.08000,Hometown Health,Lease Networks,,741.00,,,,,,,702.00,756.60,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,outpatient,,,780.00000,418.08000,Hometown Health,Lease Networks,,741.00,,,,,,,202.80,756.60,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,inpatient,,,390.00000,209.04000,Hometown Health,Lease Networks,,370.50,,,,,,,351.00,378.30,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,outpatient,,,390.00000,209.04000,Hometown Health,Lease Networks,,370.50,,,,,,,101.40,378.30,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,inpatient,,,731.00000,391.82000,Hometown Health,Lease Networks,,694.45,,,,,,,657.90,709.07,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,outpatient,,,731.00000,391.82000,Hometown Health,Lease Networks,,694.45,,,,,,,190.06,709.07,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,inpatient,,,585.00000,313.56000,Hometown Health,Lease Networks,,555.75,,,,,,,526.50,567.45,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,outpatient,,,585.00000,313.56000,Hometown Health,Lease Networks,,555.75,,,,,,,152.10,567.45,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,inpatient,,,365.00000,195.64000,Hometown Health,Lease Networks,,346.75,,,,,,,328.50,354.05,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,outpatient,,,365.00000,195.64000,Hometown Health,Lease Networks,,346.75,,,,,,,94.90,354.05,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,inpatient,,,1086.00000,582.10000,Hometown Health,Lease Networks,,1031.70,,,,,,,977.40,1053.42,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,outpatient,,,1086.00000,582.10000,Hometown Health,Lease Networks,,1031.70,,,,,,,282.36,1053.42,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,inpatient,,,197.00000,105.59000,Hometown Health,Lease Networks,,187.15,,,,,,,177.30,191.09,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,outpatient,,,197.00000,105.59000,Hometown Health,Lease Networks,,187.15,,,,,,,51.22,191.09,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,inpatient,,,2774.00000,1486.86000,Hometown Health,Lease Networks,,2635.30,,,,,,,2496.60,2690.78,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,outpatient,,,2774.00000,1486.86000,Hometown Health,Lease Networks,,2635.30,,,,,,,721.24,2690.78,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,inpatient,,,1456.00000,780.42000,Hometown Health,Lease Networks,,1383.20,,,,,,,1310.40,1412.32,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,outpatient,,,1456.00000,780.42000,Hometown Health,Lease Networks,,1383.20,,,,,,,378.56,1412.32,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,inpatient,,,2647.00000,1418.79000,Hometown Health,Lease Networks,,2514.65,,,,,,,2382.30,2567.59,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,outpatient,,,2647.00000,1418.79000,Hometown Health,Lease Networks,,2514.65,,,,,,,688.22,2567.59,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,inpatient,,,1359.00000,728.42000,Hometown Health,Lease Networks,,1291.05,,,,,,,1223.10,1318.23,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,outpatient,,,1359.00000,728.42000,Hometown Health,Lease Networks,,1291.05,,,,,,,353.34,1318.23,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,inpatient,,,273.00000,146.33000,Hometown Health,Lease Networks,,259.35,,,,,,,245.70,264.81,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,outpatient,,,273.00000,146.33000,Hometown Health,Lease Networks,,259.35,,,,,,,70.98,264.81,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,inpatient,,,325.00000,174.20000,Hometown Health,Lease Networks,,308.75,,,,,,,292.50,315.25,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,outpatient,,,325.00000,174.20000,Hometown Health,Lease Networks,,308.75,,,,,,,84.50,315.25,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,inpatient,,,609.00000,326.42000,Hometown Health,Lease Networks,,578.55,,,,,,,548.10,590.73,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Hometown Health,Lease Networks,,578.55,,,,,,,158.34,590.73,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,inpatient,,,491.00000,263.18000,Hometown Health,Lease Networks,,466.45,,,,,,,441.90,476.27,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,outpatient,,,491.00000,263.18000,Hometown Health,Lease Networks,,466.45,,,,,,,127.66,476.27,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,inpatient,,,561.00000,300.70000,Hometown Health,Lease Networks,,532.95,,,,,,,504.90,544.17,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,outpatient,,,561.00000,300.70000,Hometown Health,Lease Networks,,532.95,,,,,,,145.86,544.17,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,inpatient,,,845.00000,452.92000,Hometown Health,Lease Networks,,802.75,,,,,,,760.50,819.65,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,outpatient,,,845.00000,452.92000,Hometown Health,Lease Networks,,802.75,,,,,,,219.70,819.65,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,inpatient,,,612.00000,328.03000,Hometown Health,Lease Networks,,581.40,,,,,,,550.80,593.64,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,outpatient,,,612.00000,328.03000,Hometown Health,Lease Networks,,581.40,,,,,,,159.12,593.64,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,inpatient,,,536.00000,287.30000,Hometown Health,Lease Networks,,509.20,,,,,,,482.40,519.92,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,outpatient,,,536.00000,287.30000,Hometown Health,Lease Networks,,509.20,,,,,,,139.36,519.92,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,inpatient,,,1225.00000,656.60000,Hometown Health,Lease Networks,,1163.75,,,,,,,1102.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,outpatient,,,1225.00000,656.60000,Hometown Health,Lease Networks,,1163.75,,,,,,,318.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,inpatient,,,816.00000,437.38000,Hometown Health,Lease Networks,LT,775.20,,,,,,,734.40,791.52,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Hometown Health,Lease Networks,LT,775.20,,,,,,,212.16,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,inpatient,,,816.00000,437.38000,Hometown Health,Lease Networks,RT,775.20,,,,,,,734.40,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Hometown Health,Lease Networks,RT,775.20,,,,,,,212.16,791.52,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,inpatient,,,250.00000,134.00000,Hometown Health,Lease Networks,,237.50,,,,,,,225.00,242.50,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,outpatient,,,250.00000,134.00000,Hometown Health,Lease Networks,,237.50,,,,,,,65.00,242.50,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,inpatient,,,302.00000,161.87000,Hometown Health,Lease Networks,,286.90,,,,,,,271.80,292.94,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,outpatient,,,302.00000,161.87000,Hometown Health,Lease Networks,,286.90,,,,,,,78.52,292.94,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,inpatient,,,354.00000,189.74000,Hometown Health,Lease Networks,,336.30,,,,,,,318.60,343.38,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,outpatient,,,354.00000,189.74000,Hometown Health,Lease Networks,,336.30,,,,,,,92.04,343.38,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,inpatient,,,409.00000,219.22000,Hometown Health,Lease Networks,,388.55,,,,,,,368.10,396.73,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,outpatient,,,409.00000,219.22000,Hometown Health,Lease Networks,,388.55,,,,,,,106.34,396.73,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,inpatient,,,593.00000,317.85000,Hometown Health,Lease Networks,,563.35,,,,,,,533.70,575.21,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,outpatient,,,593.00000,317.85000,Hometown Health,Lease Networks,,563.35,,,,,,,154.18,575.21,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Hometown Health,Lease Networks,LT,291.65,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Hometown Health,Lease Networks,LT,291.65,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Hometown Health,Lease Networks,"52,LT",291.65,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Hometown Health,Lease Networks,"52,LT",291.65,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Hometown Health,Lease Networks,RT,291.65,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Hometown Health,Lease Networks,RT,291.65,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Hometown Health,Lease Networks,"52,RT",291.65,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Hometown Health,Lease Networks,"52,RT",291.65,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,inpatient,,,330.00000,176.88000,Hometown Health,Lease Networks,LT,313.50,,,,,,,297.00,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Hometown Health,Lease Networks,LT,313.50,,,,,,,85.80,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,inpatient,,,330.00000,176.88000,Hometown Health,Lease Networks,RT,313.50,,,,,,,297.00,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Hometown Health,Lease Networks,RT,313.50,,,,,,,85.80,320.10,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,inpatient,,,195.00000,104.52000,Hometown Health,Lease Networks,,185.25,,,,,,,175.50,189.15,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,outpatient,,,195.00000,104.52000,Hometown Health,Lease Networks,,185.25,,,,,,,50.70,189.15,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,inpatient,,,578.00000,309.81000,Hometown Health,Lease Networks,,549.10,,,,,,,520.20,560.66,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,outpatient,,,578.00000,309.81000,Hometown Health,Lease Networks,,549.10,,,,,,,150.28,560.66,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,inpatient,,,384.00000,205.82000,Hometown Health,Lease Networks,,364.80,,,,,,,345.60,372.48,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,outpatient,,,384.00000,205.82000,Hometown Health,Lease Networks,,364.80,,,,,,,99.84,372.48,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,inpatient,,,303.00000,162.41000,Hometown Health,Lease Networks,LT,287.85,,,,,,,272.70,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Hometown Health,Lease Networks,LT,287.85,,,,,,,78.78,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,inpatient,,,303.00000,162.41000,Hometown Health,Lease Networks,RT,287.85,,,,,,,272.70,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Hometown Health,Lease Networks,RT,287.85,,,,,,,78.78,293.91,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,inpatient,,,445.00000,238.52000,Hometown Health,Lease Networks,LT,422.75,,,,,,,400.50,431.65,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Hometown Health,Lease Networks,LT,422.75,,,,,,,115.70,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,inpatient,,,445.00000,238.52000,Hometown Health,Lease Networks,RT,422.75,,,,,,,400.50,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Hometown Health,Lease Networks,RT,422.75,,,,,,,115.70,431.65,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,inpatient,,,937.00000,502.23000,Hometown Health,Lease Networks,,890.15,,,,,,,843.30,908.89,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,outpatient,,,937.00000,502.23000,Hometown Health,Lease Networks,,890.15,,,,,,,243.62,908.89,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,inpatient,,,615.00000,329.64000,Hometown Health,Lease Networks,,584.25,,,,,,,553.50,596.55,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,outpatient,,,615.00000,329.64000,Hometown Health,Lease Networks,,584.25,,,,,,,159.90,596.55,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Hometown Health,Lease Networks,LT,272.65,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Hometown Health,Lease Networks,LT,272.65,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Hometown Health,Lease Networks,"52,LT",272.65,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Hometown Health,Lease Networks,"52,LT",272.65,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Hometown Health,Lease Networks,RT,272.65,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Hometown Health,Lease Networks,RT,272.65,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Hometown Health,Lease Networks,"52,RT",272.65,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Hometown Health,Lease Networks,"52,RT",272.65,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,inpatient,,,323.00000,173.13000,Hometown Health,Lease Networks,LT,306.85,,,,,,,290.70,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Hometown Health,Lease Networks,LT,306.85,,,,,,,83.98,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,inpatient,,,323.00000,173.13000,Hometown Health,Lease Networks,RT,306.85,,,,,,,290.70,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Hometown Health,Lease Networks,RT,306.85,,,,,,,83.98,313.31,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,inpatient,,,694.00000,371.98000,Hometown Health,Lease Networks,,659.30,,,,,,,624.60,673.18,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,outpatient,,,694.00000,371.98000,Hometown Health,Lease Networks,,659.30,,,,,,,180.44,673.18,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,inpatient,,,276.00000,147.94000,Hometown Health,Lease Networks,LT,262.20,,,,,,,248.40,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Hometown Health,Lease Networks,LT,262.20,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,inpatient,,,276.00000,147.94000,Hometown Health,Lease Networks,RT,262.20,,,,,,,248.40,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Hometown Health,Lease Networks,RT,262.20,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,inpatient,,,254.00000,136.14000,Hometown Health,Lease Networks,LT,241.30,,,,,,,228.60,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Hometown Health,Lease Networks,LT,241.30,,,,,,,66.04,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,inpatient,,,254.00000,136.14000,Hometown Health,Lease Networks,RT,241.30,,,,,,,228.60,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Hometown Health,Lease Networks,RT,241.30,,,,,,,66.04,246.38,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,inpatient,,,275.00000,147.40000,Hometown Health,Lease Networks,LT,261.25,,,,,,,247.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Hometown Health,Lease Networks,LT,261.25,,,,,,,71.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,inpatient,,,275.00000,147.40000,Hometown Health,Lease Networks,RT,261.25,,,,,,,247.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Hometown Health,Lease Networks,RT,261.25,,,,,,,71.50,266.75,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,inpatient,,,173.00000,92.73000,Hometown Health,Lease Networks,,164.35,,,,,,,155.70,167.81,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,outpatient,,,173.00000,92.73000,Hometown Health,Lease Networks,,164.35,,,,,,,44.98,167.81,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,inpatient,,,483.00000,258.89000,Hometown Health,Lease Networks,LT,458.85,,,,,,,434.70,468.51,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Hometown Health,Lease Networks,LT,458.85,,,,,,,125.58,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,inpatient,,,483.00000,258.89000,Hometown Health,Lease Networks,RT,458.85,,,,,,,434.70,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Hometown Health,Lease Networks,RT,458.85,,,,,,,125.58,468.51,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,inpatient,,,191.00000,102.38000,Hometown Health,Lease Networks,LT,181.45,,,,,,,171.90,185.27,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Hometown Health,Lease Networks,LT,181.45,,,,,,,49.66,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,inpatient,,,191.00000,102.38000,Hometown Health,Lease Networks,RT,181.45,,,,,,,171.90,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Hometown Health,Lease Networks,RT,181.45,,,,,,,49.66,185.27,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Hometown Health,Lease Networks,LT,140.60,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Hometown Health,Lease Networks,LT,140.60,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Hometown Health,Lease Networks,"52,LT",140.60,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Hometown Health,Lease Networks,"52,LT",140.60,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Hometown Health,Lease Networks,RT,140.60,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Hometown Health,Lease Networks,RT,140.60,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Hometown Health,Lease Networks,"52,RT",140.60,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Hometown Health,Lease Networks,"52,RT",140.60,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,inpatient,,,481.00000,257.82000,Hometown Health,Lease Networks,LT,456.95,,,,,,,432.90,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Hometown Health,Lease Networks,LT,456.95,,,,,,,125.06,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,inpatient,,,481.00000,257.82000,Hometown Health,Lease Networks,RT,456.95,,,,,,,432.90,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Hometown Health,Lease Networks,RT,456.95,,,,,,,125.06,466.57,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,inpatient,,,215.00000,115.24000,Hometown Health,Lease Networks,LT,204.25,,,,,,,193.50,208.55,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Hometown Health,Lease Networks,LT,204.25,,,,,,,55.90,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,inpatient,,,215.00000,115.24000,Hometown Health,Lease Networks,RT,204.25,,,,,,,193.50,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Hometown Health,Lease Networks,RT,204.25,,,,,,,55.90,208.55,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Hometown Health,Lease Networks,LT,261.25,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Hometown Health,Lease Networks,LT,261.25,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Hometown Health,Lease Networks,"52,LT",261.25,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Hometown Health,Lease Networks,"52,LT",261.25,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Hometown Health,Lease Networks,RT,261.25,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Hometown Health,Lease Networks,RT,261.25,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Hometown Health,Lease Networks,"52,RT",261.25,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Hometown Health,Lease Networks,"52,RT",261.25,,,,,,,71.50,266.75,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,Lease Networks,LT,432.25,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,Lease Networks,LT,432.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,Lease Networks,"52,LT",432.25,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,Lease Networks,"52,LT",432.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,Lease Networks,RT,432.25,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,Lease Networks,RT,432.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,Lease Networks,"52,RT",432.25,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,Lease Networks,"52,RT",432.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,inpatient,,,503.00000,269.61000,Hometown Health,Lease Networks,LT,477.85,,,,,,,452.70,487.91,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Hometown Health,Lease Networks,LT,477.85,,,,,,,130.78,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,inpatient,,,503.00000,269.61000,Hometown Health,Lease Networks,RT,477.85,,,,,,,452.70,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Hometown Health,Lease Networks,RT,477.85,,,,,,,130.78,487.91,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,inpatient,,,209.00000,112.02000,Hometown Health,Lease Networks,LT,198.55,,,,,,,188.10,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Hometown Health,Lease Networks,LT,198.55,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,inpatient,,,209.00000,112.02000,Hometown Health,Lease Networks,RT,198.55,,,,,,,188.10,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Hometown Health,Lease Networks,RT,198.55,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,inpatient,,,566.00000,303.38000,Hometown Health,Lease Networks,LT,537.70,,,,,,,509.40,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Hometown Health,Lease Networks,LT,537.70,,,,,,,147.16,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,inpatient,,,566.00000,303.38000,Hometown Health,Lease Networks,RT,537.70,,,,,,,509.40,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Hometown Health,Lease Networks,RT,537.70,,,,,,,147.16,549.02,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,inpatient,,,598.00000,320.53000,Hometown Health,Lease Networks,,568.10,,,,,,,538.20,580.06,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,outpatient,,,598.00000,320.53000,Hometown Health,Lease Networks,,568.10,,,,,,,155.48,580.06,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,Lease Networks,"52,LT",432.25,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,Lease Networks,"52,LT",432.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,Lease Networks,"52,RT",432.25,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,Lease Networks,"52,RT",432.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,Lease Networks,LT,432.25,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,Lease Networks,LT,432.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,Lease Networks,RT,432.25,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,Lease Networks,RT,432.25,,,,,,,118.30,441.35,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,inpatient,,,1913.00000,1025.37000,Hometown Health,Lease Networks,,1817.35,,,,,,,1721.70,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,outpatient,,,1913.00000,1025.37000,Hometown Health,Lease Networks,,1817.35,,,,,,,497.38,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,inpatient,,,312.00000,167.23000,Hometown Health,Lease Networks,,296.40,,,,,,,280.80,302.64,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,outpatient,,,312.00000,167.23000,Hometown Health,Lease Networks,,296.40,,,,,,,81.12,302.64,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,inpatient,,,327.00000,175.27000,Hometown Health,Lease Networks,,310.65,,,,,,,294.30,317.19,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,outpatient,,,327.00000,175.27000,Hometown Health,Lease Networks,,310.65,,,,,,,85.02,317.19,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,inpatient,,,425.00000,227.80000,Hometown Health,Lease Networks,,403.75,,,,,,,382.50,412.25,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,outpatient,,,425.00000,227.80000,Hometown Health,Lease Networks,,403.75,,,,,,,110.50,412.25,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,inpatient,,,210.00000,112.56000,Hometown Health,Lease Networks,,199.50,,,,,,,189.00,203.70,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,outpatient,,,210.00000,112.56000,Hometown Health,Lease Networks,,199.50,,,,,,,54.60,203.70,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,inpatient,,,495.00000,265.32000,Hometown Health,Lease Networks,,470.25,,,,,,,445.50,480.15,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,outpatient,,,495.00000,265.32000,Hometown Health,Lease Networks,,470.25,,,,,,,128.70,480.15,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,inpatient,,,541.00000,289.98000,Hometown Health,Lease Networks,,513.95,,,,,,,486.90,524.77,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,outpatient,,,541.00000,289.98000,Hometown Health,Lease Networks,,513.95,,,,,,,140.66,524.77,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,inpatient,,,345.00000,184.92000,Hometown Health,Lease Networks,LT,327.75,,,,,,,310.50,334.65,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Hometown Health,Lease Networks,LT,327.75,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,inpatient,,,345.00000,184.92000,Hometown Health,Lease Networks,RT,327.75,,,,,,,310.50,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Hometown Health,Lease Networks,RT,327.75,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,inpatient,,,419.00000,224.58000,Hometown Health,Lease Networks,LT,398.05,,,,,,,377.10,406.43,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Hometown Health,Lease Networks,LT,398.05,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,inpatient,,,419.00000,224.58000,Hometown Health,Lease Networks,RT,398.05,,,,,,,377.10,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Hometown Health,Lease Networks,RT,398.05,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,inpatient,,,618.00000,331.25000,Hometown Health,Lease Networks,LT,587.10,,,,,,,556.20,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Hometown Health,Lease Networks,LT,587.10,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,inpatient,,,618.00000,331.25000,Hometown Health,Lease Networks,RT,587.10,,,,,,,556.20,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Hometown Health,Lease Networks,RT,587.10,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,inpatient,,,463.00000,248.17000,Hometown Health,Lease Networks,,439.85,,,,,,,416.70,449.11,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,outpatient,,,463.00000,248.17000,Hometown Health,Lease Networks,,439.85,,,,,,,120.38,449.11,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,inpatient,,,511.00000,273.90000,Hometown Health,Lease Networks,,485.45,,,,,,,459.90,495.67,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,outpatient,,,511.00000,273.90000,Hometown Health,Lease Networks,,485.45,,,,,,,132.86,495.67,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,inpatient,,,132.00000,70.75000,Hometown Health,Lease Networks,,125.40,,,,,,,118.80,128.04,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,outpatient,,,132.00000,70.75000,Hometown Health,Lease Networks,,125.40,,,,,,,34.32,128.04,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,inpatient,,,353.00000,189.21000,Hometown Health,Lease Networks,LT,335.35,,,,,,,317.70,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Hometown Health,Lease Networks,LT,335.35,,,,,,,91.78,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,inpatient,,,353.00000,189.21000,Hometown Health,Lease Networks,RT,335.35,,,,,,,317.70,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Hometown Health,Lease Networks,RT,335.35,,,,,,,91.78,342.41,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,inpatient,,,273.00000,146.33000,Hometown Health,Lease Networks,,259.35,,,,,,,245.70,264.81,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,outpatient,,,273.00000,146.33000,Hometown Health,Lease Networks,,259.35,,,,,,,70.98,264.81,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,inpatient,,,503.00000,269.61000,Hometown Health,Lease Networks,,477.85,,,,,,,452.70,487.91,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,outpatient,,,503.00000,269.61000,Hometown Health,Lease Networks,,477.85,,,,,,,130.78,487.91,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,inpatient,,,561.00000,300.70000,Hometown Health,Lease Networks,,532.95,,,,,,,504.90,544.17,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,outpatient,,,561.00000,300.70000,Hometown Health,Lease Networks,,532.95,,,,,,,145.86,544.17,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,inpatient,,,450.00000,241.20000,Hometown Health,Lease Networks,LT,427.50,,,,,,,405.00,436.50,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Hometown Health,Lease Networks,LT,427.50,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,inpatient,,,450.00000,241.20000,Hometown Health,Lease Networks,RT,427.50,,,,,,,405.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Hometown Health,Lease Networks,RT,427.50,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,inpatient,,,650.00000,348.40000,Hometown Health,Lease Networks,,617.50,,,,,,,585.00,630.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,outpatient,,,650.00000,348.40000,Hometown Health,Lease Networks,,617.50,,,,,,,169.00,630.50,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,inpatient,,,642.00000,344.11000,Hometown Health,Lease Networks,,609.90,,,,,,,577.80,622.74,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,outpatient,,,642.00000,344.11000,Hometown Health,Lease Networks,,609.90,,,,,,,166.92,622.74,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,inpatient,,,777.00000,416.47000,Hometown Health,Lease Networks,,738.15,,,,,,,699.30,753.69,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,outpatient,,,777.00000,416.47000,Hometown Health,Lease Networks,,738.15,,,,,,,202.02,753.69,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,inpatient,,,381.00000,204.22000,Hometown Health,Lease Networks,,361.95,,,,,,,342.90,369.57,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,outpatient,,,381.00000,204.22000,Hometown Health,Lease Networks,,361.95,,,,,,,99.06,369.57,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,inpatient,,,374.00000,200.46000,Hometown Health,Lease Networks,LT,355.30,,,,,,,336.60,362.78,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Hometown Health,Lease Networks,LT,355.30,,,,,,,97.24,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,inpatient,,,374.00000,200.46000,Hometown Health,Lease Networks,RT,355.30,,,,,,,336.60,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Hometown Health,Lease Networks,RT,355.30,,,,,,,97.24,362.78,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,inpatient,,,161.00000,86.30000,Hometown Health,Lease Networks,LT,152.95,,,,,,,144.90,156.17,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Hometown Health,Lease Networks,LT,152.95,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,inpatient,,,161.00000,86.30000,Hometown Health,Lease Networks,RT,152.95,,,,,,,144.90,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Hometown Health,Lease Networks,RT,152.95,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,inpatient,,,499.00000,267.46000,Hometown Health,Lease Networks,LT,474.05,,,,,,,449.10,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Hometown Health,Lease Networks,LT,474.05,,,,,,,129.74,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,inpatient,,,499.00000,267.46000,Hometown Health,Lease Networks,RT,474.05,,,,,,,449.10,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Hometown Health,Lease Networks,RT,474.05,,,,,,,129.74,484.03,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,inpatient,,,214.00000,114.70000,Hometown Health,Lease Networks,,203.30,,,,,,,192.60,207.58,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,outpatient,,,214.00000,114.70000,Hometown Health,Lease Networks,,203.30,,,,,,,55.64,207.58,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,inpatient,,,329.00000,176.34000,Hometown Health,Lease Networks,,312.55,,,,,,,296.10,319.13,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,outpatient,,,329.00000,176.34000,Hometown Health,Lease Networks,,312.55,,,,,,,85.54,319.13,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,inpatient,,,197.00000,105.59000,Hometown Health,Lease Networks,,187.15,,,,,,,177.30,191.09,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,outpatient,,,197.00000,105.59000,Hometown Health,Lease Networks,,187.15,,,,,,,51.22,191.09,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,inpatient,,,263.00000,140.97000,Hometown Health,Lease Networks,,249.85,,,,,,,236.70,255.11,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,outpatient,,,263.00000,140.97000,Hometown Health,Lease Networks,,249.85,,,,,,,68.38,255.11,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,inpatient,,,234.00000,125.42000,Hometown Health,Lease Networks,,222.30,,,,,,,210.60,226.98,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,outpatient,,,234.00000,125.42000,Hometown Health,Lease Networks,,222.30,,,,,,,60.84,226.98,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,inpatient,,,401.00000,214.94000,Hometown Health,Lease Networks,,380.95,,,,,,,360.90,388.97,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,outpatient,,,401.00000,214.94000,Hometown Health,Lease Networks,,380.95,,,,,,,104.26,388.97,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,inpatient,,,515.00000,276.04000,Hometown Health,Lease Networks,,489.25,,,,,,,463.50,499.55,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,outpatient,,,515.00000,276.04000,Hometown Health,Lease Networks,,489.25,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,inpatient,,,747.00000,400.39000,Hometown Health,Lease Networks,,709.65,,,,,,,672.30,724.59,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,outpatient,,,747.00000,400.39000,Hometown Health,Lease Networks,,709.65,,,,,,,194.22,724.59,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,inpatient,,,854.00000,457.74000,Hometown Health,Lease Networks,,811.30,,,,,,,768.60,828.38,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,outpatient,,,854.00000,457.74000,Hometown Health,Lease Networks,,811.30,,,,,,,222.04,828.38,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,inpatient,,,589.00000,315.70000,Hometown Health,Lease Networks,,559.55,,,,,,,530.10,571.33,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,outpatient,,,589.00000,315.70000,Hometown Health,Lease Networks,,559.55,,,,,,,153.14,571.33,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,inpatient,,,613.00000,328.57000,Hometown Health,Lease Networks,,582.35,,,,,,,551.70,594.61,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,outpatient,,,613.00000,328.57000,Hometown Health,Lease Networks,,582.35,,,,,,,159.38,594.61,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,inpatient,,,806.00000,432.02000,Hometown Health,Lease Networks,,765.70,,,,,,,725.40,781.82,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,outpatient,,,806.00000,432.02000,Hometown Health,Lease Networks,,765.70,,,,,,,209.56,781.82,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,inpatient,,,529.00000,283.54000,Hometown Health,Lease Networks,,502.55,,,,,,,476.10,513.13,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,outpatient,,,529.00000,283.54000,Hometown Health,Lease Networks,,502.55,,,,,,,137.54,513.13,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,inpatient,,,939.00000,503.30000,Hometown Health,Lease Networks,,892.05,,,,,,,845.10,910.83,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,outpatient,,,939.00000,503.30000,Hometown Health,Lease Networks,,892.05,,,,,,,244.14,910.83,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,inpatient,,,515.00000,276.04000,Hometown Health,Lease Networks,,489.25,,,,,,,463.50,499.55,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,outpatient,,,515.00000,276.04000,Hometown Health,Lease Networks,,489.25,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,inpatient,,,616.00000,330.18000,Hometown Health,Lease Networks,,585.20,,,,,,,554.40,597.52,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,outpatient,,,616.00000,330.18000,Hometown Health,Lease Networks,,585.20,,,,,,,160.16,597.52,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,inpatient,,,377.00000,202.07000,Hometown Health,Lease Networks,,358.15,,,,,,,339.30,365.69,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,outpatient,,,377.00000,202.07000,Hometown Health,Lease Networks,,358.15,,,,,,,98.02,365.69,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,inpatient,,,340.00000,182.24000,Hometown Health,Lease Networks,,323.00,,,,,,,306.00,329.80,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,outpatient,,,340.00000,182.24000,Hometown Health,Lease Networks,,323.00,,,,,,,88.40,329.80,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,inpatient,,,388.00000,207.97000,Hometown Health,Lease Networks,,368.60,,,,,,,349.20,376.36,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,outpatient,,,388.00000,207.97000,Hometown Health,Lease Networks,,368.60,,,,,,,100.88,376.36,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,inpatient,,,456.00000,244.42000,Hometown Health,Lease Networks,,433.20,,,,,,,410.40,442.32,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,outpatient,,,456.00000,244.42000,Hometown Health,Lease Networks,,433.20,,,,,,,118.56,442.32,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,inpatient,,,267.00000,143.11000,Hometown Health,Lease Networks,,253.65,,,,,,,240.30,258.99,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,outpatient,,,267.00000,143.11000,Hometown Health,Lease Networks,,253.65,,,,,,,69.42,258.99,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Hometown Health,Lease Networks,LT,290.70,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Hometown Health,Lease Networks,LT,290.70,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Hometown Health,Lease Networks,"52,LT",290.70,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Hometown Health,Lease Networks,"52,LT",290.70,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Hometown Health,Lease Networks,RT,290.70,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Hometown Health,Lease Networks,RT,290.70,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Hometown Health,Lease Networks,"52,RT",290.70,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Hometown Health,Lease Networks,"52,RT",290.70,,,,,,,79.56,296.82,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,inpatient,,,456.00000,244.42000,Hometown Health,Lease Networks,,433.20,,,,,,,410.40,442.32,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,outpatient,,,456.00000,244.42000,Hometown Health,Lease Networks,,433.20,,,,,,,118.56,442.32,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,inpatient,,,381.00000,204.22000,Hometown Health,Lease Networks,,361.95,,,,,,,342.90,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,outpatient,,,381.00000,204.22000,Hometown Health,Lease Networks,,361.95,,,,,,,99.06,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,inpatient,,,143.00000,76.65000,Hometown Health,Lease Networks,LT,135.85,,,,,,,128.70,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Hometown Health,Lease Networks,LT,135.85,,,,,,,37.18,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,inpatient,,,143.00000,76.65000,Hometown Health,Lease Networks,RT,135.85,,,,,,,128.70,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Hometown Health,Lease Networks,RT,135.85,,,,,,,37.18,138.71,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,inpatient,,,331.00000,177.42000,Hometown Health,Lease Networks,LT,314.45,,,,,,,297.90,321.07,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Hometown Health,Lease Networks,LT,314.45,,,,,,,86.06,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,inpatient,,,331.00000,177.42000,Hometown Health,Lease Networks,RT,314.45,,,,,,,297.90,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Hometown Health,Lease Networks,RT,314.45,,,,,,,86.06,321.07,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,inpatient,,,1113.00000,596.57000,Hometown Health,Lease Networks,,1057.35,,,,,,,1001.70,1079.61,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1113.00000,596.57000,Hometown Health,Lease Networks,,1057.35,,,,,,,289.38,1079.61,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,inpatient,,,1043.00000,559.05000,Hometown Health,Lease Networks,,990.85,,,,,,,938.70,1011.71,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,outpatient,,,1043.00000,559.05000,Hometown Health,Lease Networks,,990.85,,,,,,,271.18,1011.71,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Hometown Health,Lease Networks,LT,243.20,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Hometown Health,Lease Networks,LT,243.20,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Hometown Health,Lease Networks,"52,LT",243.20,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Hometown Health,Lease Networks,"52,LT",243.20,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Hometown Health,Lease Networks,RT,243.20,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Hometown Health,Lease Networks,RT,243.20,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Hometown Health,Lease Networks,"52,RT",243.20,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Hometown Health,Lease Networks,"52,RT",243.20,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,inpatient,,,511.00000,273.90000,Hometown Health,Lease Networks,LT,485.45,,,,,,,459.90,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Hometown Health,Lease Networks,LT,485.45,,,,,,,132.86,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,inpatient,,,511.00000,273.90000,Hometown Health,Lease Networks,RT,485.45,,,,,,,459.90,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Hometown Health,Lease Networks,RT,485.45,,,,,,,132.86,495.67,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,inpatient,,,553.00000,314.19000,Hometown Health,Lease Networks,LT,525.35,,,,,,,497.70,536.41,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Hometown Health,Lease Networks,LT,525.35,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,inpatient,,,553.00000,314.19000,Hometown Health,Lease Networks,RT,525.35,,,,,,,497.70,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Hometown Health,Lease Networks,RT,525.35,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,inpatient,,,1076.00000,611.33000,Hometown Health,Lease Networks,LT,1022.20,,,,,,,968.40,1043.72,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Hometown Health,Lease Networks,LT,1022.20,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,inpatient,,,1076.00000,611.33000,Hometown Health,Lease Networks,RT,1022.20,,,,,,,968.40,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Hometown Health,Lease Networks,RT,1022.20,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,inpatient,,,865.00000,491.45000,Hometown Health,Lease Networks,LT,821.75,,,,,,,778.50,839.05,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Hometown Health,Lease Networks,LT,821.75,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,inpatient,,,865.00000,491.45000,Hometown Health,Lease Networks,RT,821.75,,,,,,,778.50,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Hometown Health,Lease Networks,RT,821.75,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,inpatient,,,734.00000,417.02000,Hometown Health,Lease Networks,LT,697.30,,,,,,,660.60,711.98,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Hometown Health,Lease Networks,LT,697.30,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,inpatient,,,734.00000,417.02000,Hometown Health,Lease Networks,RT,697.30,,,,,,,660.60,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Hometown Health,Lease Networks,RT,697.30,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,inpatient,,,730.00000,414.75000,Hometown Health,Lease Networks,LT,693.50,,,,,,,657.00,708.10,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Hometown Health,Lease Networks,LT,693.50,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,inpatient,,,730.00000,414.75000,Hometown Health,Lease Networks,RT,693.50,,,,,,,657.00,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Hometown Health,Lease Networks,RT,693.50,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,inpatient,,,260.00000,147.72000,Hometown Health,Lease Networks,LT,247.00,,,,,,,234.00,252.20,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Hometown Health,Lease Networks,LT,247.00,,,,,,,67.60,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,inpatient,,,260.00000,147.72000,Hometown Health,Lease Networks,RT,247.00,,,,,,,234.00,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Hometown Health,Lease Networks,RT,247.00,,,,,,,67.60,252.20,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,inpatient,,,428.00000,203.73000,Hometown Health,Lease Networks,,406.60,,,,,,,385.20,415.16,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,outpatient,,,428.00000,203.73000,Hometown Health,Lease Networks,,406.60,,,,,,,111.28,415.16,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,inpatient,,,492.00000,234.19000,Hometown Health,Lease Networks,,467.40,,,,,,,442.80,477.24,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,outpatient,,,492.00000,234.19000,Hometown Health,Lease Networks,,467.40,,,,,,,127.92,477.24,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,inpatient,,,607.00000,288.93000,Hometown Health,Lease Networks,,576.65,,,,,,,546.30,588.79,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,outpatient,,,607.00000,288.93000,Hometown Health,Lease Networks,,576.65,,,,,,,157.82,588.79,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,inpatient,,,649.00000,308.92000,Hometown Health,Lease Networks,,616.55,,,,,,,584.10,629.53,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,outpatient,,,649.00000,308.92000,Hometown Health,Lease Networks,,616.55,,,,,,,168.74,629.53,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,inpatient,,,377.00000,121.77000,Hometown Health,Lease Networks,50,358.15,,,,,,,339.30,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,outpatient,,,377.00000,121.77000,Hometown Health,Lease Networks,50,358.15,,,,,,,98.02,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,inpatient,,,251.00000,81.07000,Hometown Health,Lease Networks,LT,238.45,,,,,,,225.90,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Hometown Health,Lease Networks,LT,238.45,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,inpatient,,,251.00000,81.07000,Hometown Health,Lease Networks,RT,238.45,,,,,,,225.90,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Hometown Health,Lease Networks,RT,238.45,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,inpatient,,,1170.00000,377.91000,Hometown Health,Lease Networks,50,1111.50,,,,,,,1053.00,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,outpatient,,,1170.00000,377.91000,Hometown Health,Lease Networks,50,1111.50,,,,,,,304.20,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,inpatient,,,780.00000,251.94000,Hometown Health,Lease Networks,LT,741.00,,,,,,,702.00,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Hometown Health,Lease Networks,LT,741.00,,,,,,,202.80,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,inpatient,,,780.00000,251.94000,Hometown Health,Lease Networks,RT,741.00,,,,,,,702.00,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Hometown Health,Lease Networks,RT,741.00,,,,,,,202.80,756.60,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,inpatient,,,1389.00000,448.65000,Hometown Health,Lease Networks,,1319.55,,,,,,,1250.10,1347.33,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,outpatient,,,1389.00000,448.65000,Hometown Health,Lease Networks,,1319.55,,,,,,,361.14,1347.33,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,inpatient,,,345.00000,111.44000,Hometown Health,Lease Networks,50,327.75,,,,,,,310.50,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,outpatient,,,345.00000,111.44000,Hometown Health,Lease Networks,50,327.75,,,,,,,89.70,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,inpatient,,,230.00000,74.29000,Hometown Health,Lease Networks,LT,218.50,,,,,,,207.00,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Hometown Health,Lease Networks,LT,218.50,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,inpatient,,,230.00000,74.29000,Hometown Health,Lease Networks,RT,218.50,,,,,,,207.00,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Hometown Health,Lease Networks,RT,218.50,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,inpatient,,,2102.00000,678.95000,Hometown Health,Lease Networks,50,1996.90,,,,,,,1891.80,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,outpatient,,,2102.00000,678.95000,Hometown Health,Lease Networks,50,1996.90,,,,,,,546.52,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,inpatient,,,1401.00000,452.52000,Hometown Health,Lease Networks,LT,1330.95,,,,,,,1260.90,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Hometown Health,Lease Networks,LT,1330.95,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,inpatient,,,1401.00000,452.52000,Hometown Health,Lease Networks,RT,1330.95,,,,,,,1260.90,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Hometown Health,Lease Networks,RT,1330.95,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,inpatient,,,357.00000,115.31000,Hometown Health,Lease Networks,50,339.15,,,,,,,321.30,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,outpatient,,,357.00000,115.31000,Hometown Health,Lease Networks,50,339.15,,,,,,,92.82,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,inpatient,,,238.00000,76.87000,Hometown Health,Lease Networks,LT,226.10,,,,,,,214.20,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Hometown Health,Lease Networks,LT,226.10,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,inpatient,,,238.00000,76.87000,Hometown Health,Lease Networks,RT,226.10,,,,,,,214.20,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Hometown Health,Lease Networks,RT,226.10,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,inpatient,,,2082.00000,672.49000,Hometown Health,Lease Networks,50,1977.90,,,,,,,1873.80,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,outpatient,,,2082.00000,672.49000,Hometown Health,Lease Networks,50,1977.90,,,,,,,541.32,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,inpatient,,,1388.00000,448.32000,Hometown Health,Lease Networks,LT,1318.60,,,,,,,1249.20,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Hometown Health,Lease Networks,LT,1318.60,,,,,,,360.88,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,inpatient,,,1388.00000,448.32000,Hometown Health,Lease Networks,RT,1318.60,,,,,,,1249.20,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Hometown Health,Lease Networks,RT,1318.60,,,,,,,360.88,1346.36,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,inpatient,,,246.00000,79.46000,Hometown Health,Lease Networks,50,233.70,,,,,,,221.40,238.62,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,outpatient,,,246.00000,79.46000,Hometown Health,Lease Networks,50,233.70,,,,,,,63.96,238.62,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,inpatient,,,164.00000,52.97000,Hometown Health,Lease Networks,LT,155.80,,,,,,,147.60,159.08,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Hometown Health,Lease Networks,LT,155.80,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,inpatient,,,164.00000,52.97000,Hometown Health,Lease Networks,RT,155.80,,,,,,,147.60,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Hometown Health,Lease Networks,RT,155.80,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,inpatient,,,309.00000,99.81000,Hometown Health,Lease Networks,50,293.55,,,,,,,278.10,299.73,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,outpatient,,,309.00000,99.81000,Hometown Health,Lease Networks,50,293.55,,,,,,,80.34,299.73,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,inpatient,,,206.00000,66.54000,Hometown Health,Lease Networks,LT,195.70,,,,,,,185.40,199.82,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Hometown Health,Lease Networks,LT,195.70,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,inpatient,,,206.00000,66.54000,Hometown Health,Lease Networks,RT,195.70,,,,,,,185.40,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Hometown Health,Lease Networks,RT,195.70,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,inpatient,,,471.00000,152.13000,Hometown Health,Lease Networks,50,447.45,,,,,,,423.90,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,outpatient,,,471.00000,152.13000,Hometown Health,Lease Networks,50,447.45,,,,,,,122.46,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,inpatient,,,314.00000,101.42000,Hometown Health,Lease Networks,LT,298.30,,,,,,,282.60,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Hometown Health,Lease Networks,LT,298.30,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,inpatient,,,314.00000,101.42000,Hometown Health,Lease Networks,RT,298.30,,,,,,,282.60,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Hometown Health,Lease Networks,RT,298.30,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,inpatient,,,239.00000,77.20000,Hometown Health,Lease Networks,50,227.05,,,,,,,215.10,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,outpatient,,,239.00000,77.20000,Hometown Health,Lease Networks,50,227.05,,,,,,,62.14,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,inpatient,,,159.00000,51.36000,Hometown Health,Lease Networks,LT,151.05,,,,,,,143.10,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Hometown Health,Lease Networks,LT,151.05,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,inpatient,,,159.00000,51.36000,Hometown Health,Lease Networks,RT,151.05,,,,,,,143.10,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Hometown Health,Lease Networks,RT,151.05,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,inpatient,,,558.00000,180.23000,Hometown Health,Lease Networks,50,530.10,,,,,,,502.20,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,outpatient,,,558.00000,180.23000,Hometown Health,Lease Networks,50,530.10,,,,,,,145.08,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,inpatient,,,372.00000,120.16000,Hometown Health,Lease Networks,LT,353.40,,,,,,,334.80,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Hometown Health,Lease Networks,LT,353.40,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,inpatient,,,372.00000,120.16000,Hometown Health,Lease Networks,RT,353.40,,,,,,,334.80,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Hometown Health,Lease Networks,RT,353.40,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,inpatient,,,413.00000,133.40000,Hometown Health,Lease Networks,50,392.35,,,,,,,371.70,400.61,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,outpatient,,,413.00000,133.40000,Hometown Health,Lease Networks,50,392.35,,,,,,,107.38,400.61,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,inpatient,,,275.00000,88.82000,Hometown Health,Lease Networks,LT,261.25,,,,,,,247.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Hometown Health,Lease Networks,LT,261.25,,,,,,,71.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,inpatient,,,275.00000,88.82000,Hometown Health,Lease Networks,RT,261.25,,,,,,,247.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Hometown Health,Lease Networks,RT,261.25,,,,,,,71.50,266.75,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,inpatient,,,462.00000,149.23000,Hometown Health,Lease Networks,,438.90,,,,,,,415.80,448.14,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,outpatient,,,462.00000,149.23000,Hometown Health,Lease Networks,,438.90,,,,,,,120.12,448.14,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,inpatient,,,170.00000,54.91000,Hometown Health,Lease Networks,,161.50,,,,,,,153.00,164.90,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,outpatient,,,170.00000,54.91000,Hometown Health,Lease Networks,,161.50,,,,,,,44.20,164.90,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,inpatient,,,281.00000,90.76000,Hometown Health,Lease Networks,,266.95,,,,,,,252.90,272.57,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,outpatient,,,281.00000,90.76000,Hometown Health,Lease Networks,,266.95,,,,,,,73.06,272.57,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,inpatient,,,562.00000,181.53000,Hometown Health,Lease Networks,,533.90,,,,,,,505.80,545.14,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,outpatient,,,562.00000,181.53000,Hometown Health,Lease Networks,,533.90,,,,,,,146.12,545.14,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,inpatient,,,2076.00000,670.55000,Hometown Health,Lease Networks,50,1972.20,,,,,,,1868.40,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,outpatient,,,2076.00000,670.55000,Hometown Health,Lease Networks,50,1972.20,,,,,,,539.76,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1384.00000,447.03000,Hometown Health,Lease Networks,LT,1314.80,,,,,,,1245.60,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Hometown Health,Lease Networks,LT,1314.80,,,,,,,359.84,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1384.00000,447.03000,Hometown Health,Lease Networks,RT,1314.80,,,,,,,1245.60,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Hometown Health,Lease Networks,RT,1314.80,,,,,,,359.84,1342.48,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,inpatient,,,934.00000,301.68000,Hometown Health,Lease Networks,,887.30,,,,,,,840.60,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,outpatient,,,934.00000,301.68000,Hometown Health,Lease Networks,,887.30,,,,,,,242.84,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,inpatient,,,842.00000,271.97000,Hometown Health,Lease Networks,,799.90,,,,,,,757.80,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,outpatient,,,842.00000,271.97000,Hometown Health,Lease Networks,,799.90,,,,,,,218.92,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,inpatient,,,846.00000,273.26000,Hometown Health,Lease Networks,,803.70,,,,,,,761.40,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,outpatient,,,846.00000,273.26000,Hometown Health,Lease Networks,,803.70,,,,,,,219.96,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,inpatient,,,971.00000,313.63000,Hometown Health,Lease Networks,,922.45,,,,,,,873.90,941.87,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,outpatient,,,971.00000,313.63000,Hometown Health,Lease Networks,,922.45,,,,,,,252.46,941.87,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,inpatient,,,762.00000,246.13000,Hometown Health,Lease Networks,,723.90,,,,,,,685.80,739.14,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,outpatient,,,762.00000,246.13000,Hometown Health,Lease Networks,,723.90,,,,,,,198.12,739.14,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,inpatient,,,758.00000,244.83000,Hometown Health,Lease Networks,,720.10,,,,,,,682.20,735.26,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,outpatient,,,758.00000,244.83000,Hometown Health,Lease Networks,,720.10,,,,,,,197.08,735.26,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,inpatient,,,161.00000,52.00000,Hometown Health,Lease Networks,,152.95,,,,,,,144.90,156.17,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,outpatient,,,161.00000,52.00000,Hometown Health,Lease Networks,,152.95,,,,,,,41.86,156.17,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,inpatient,,,234.00000,75.58000,Hometown Health,Lease Networks,50,222.30,,,,,,,210.60,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,outpatient,,,234.00000,75.58000,Hometown Health,Lease Networks,50,222.30,,,,,,,60.84,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,inpatient,,,156.00000,50.39000,Hometown Health,Lease Networks,LT,148.20,,,,,,,140.40,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Hometown Health,Lease Networks,LT,148.20,,,,,,,40.56,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,inpatient,,,156.00000,50.39000,Hometown Health,Lease Networks,RT,148.20,,,,,,,140.40,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Hometown Health,Lease Networks,RT,148.20,,,,,,,40.56,151.32,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1517.00000,489.99000,Hometown Health,Lease Networks,50,1441.15,,,,,,,1365.30,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1517.00000,489.99000,Hometown Health,Lease Networks,50,1441.15,,,,,,,394.42,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1011.00000,326.55000,Hometown Health,Lease Networks,LT,960.45,,,,,,,909.90,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Hometown Health,Lease Networks,LT,960.45,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1011.00000,326.55000,Hometown Health,Lease Networks,RT,960.45,,,,,,,909.90,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Hometown Health,Lease Networks,RT,960.45,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,inpatient,,,822.00000,265.51000,Hometown Health,Lease Networks,50,780.90,,,,,,,739.80,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,outpatient,,,822.00000,265.51000,Hometown Health,Lease Networks,50,780.90,,,,,,,213.72,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,inpatient,,,548.00000,177.00000,Hometown Health,Lease Networks,LT,520.60,,,,,,,493.20,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Hometown Health,Lease Networks,LT,520.60,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,inpatient,,,548.00000,177.00000,Hometown Health,Lease Networks,RT,520.60,,,,,,,493.20,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Hometown Health,Lease Networks,RT,520.60,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,inpatient,,,2613.00000,844.00000,Hometown Health,Lease Networks,,2482.35,,,,,,,2351.70,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,outpatient,,,2613.00000,844.00000,Hometown Health,Lease Networks,,2482.35,,,,,,,679.38,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,inpatient,,,903.00000,291.67000,Hometown Health,Lease Networks,,857.85,,,,,,,812.70,875.91,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,outpatient,,,903.00000,291.67000,Hometown Health,Lease Networks,,857.85,,,,,,,234.78,875.91,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,inpatient,,,1156.00000,373.39000,Hometown Health,Lease Networks,,1098.20,,,,,,,1040.40,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,outpatient,,,1156.00000,373.39000,Hometown Health,Lease Networks,,1098.20,,,,,,,300.56,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,inpatient,,,677.00000,218.67000,Hometown Health,Lease Networks,,643.15,,,,,,,609.30,656.69,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,outpatient,,,677.00000,218.67000,Hometown Health,Lease Networks,,643.15,,,,,,,176.02,656.69,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1928.00000,622.74000,Hometown Health,Lease Networks,50,1831.60,,,,,,,1735.20,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1928.00000,622.74000,Hometown Health,Lease Networks,50,1831.60,,,,,,,501.28,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1285.00000,415.06000,Hometown Health,Lease Networks,LT,1220.75,,,,,,,1156.50,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Hometown Health,Lease Networks,LT,1220.75,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1285.00000,415.06000,Hometown Health,Lease Networks,RT,1220.75,,,,,,,1156.50,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Hometown Health,Lease Networks,RT,1220.75,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,inpatient,,,812.00000,262.28000,Hometown Health,Lease Networks,50,771.40,,,,,,,730.80,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,outpatient,,,812.00000,262.28000,Hometown Health,Lease Networks,50,771.40,,,,,,,211.12,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,inpatient,,,541.00000,174.74000,Hometown Health,Lease Networks,LT,513.95,,,,,,,486.90,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Hometown Health,Lease Networks,LT,513.95,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,inpatient,,,541.00000,174.74000,Hometown Health,Lease Networks,RT,513.95,,,,,,,486.90,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Hometown Health,Lease Networks,RT,513.95,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,inpatient,,,825.00000,266.48000,Hometown Health,Lease Networks,50,783.75,,,,,,,742.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,outpatient,,,825.00000,266.48000,Hometown Health,Lease Networks,50,783.75,,,,,,,214.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,inpatient,,,550.00000,177.65000,Hometown Health,Lease Networks,LT,522.50,,,,,,,495.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Hometown Health,Lease Networks,LT,522.50,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,inpatient,,,550.00000,177.65000,Hometown Health,Lease Networks,RT,522.50,,,,,,,495.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Hometown Health,Lease Networks,RT,522.50,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,inpatient,,,3494.00000,1128.56000,Hometown Health,Lease Networks,50,3319.30,,,,,,,3144.60,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,outpatient,,,3494.00000,1128.56000,Hometown Health,Lease Networks,50,3319.30,,,,,,,908.44,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2329.00000,752.27000,Hometown Health,Lease Networks,LT,2212.55,,,,,,,2096.10,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Hometown Health,Lease Networks,LT,2212.55,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2329.00000,752.27000,Hometown Health,Lease Networks,RT,2212.55,,,,,,,2096.10,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Hometown Health,Lease Networks,RT,2212.55,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,inpatient,,,840.00000,271.32000,Hometown Health,Lease Networks,50,798.00,,,,,,,756.00,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,outpatient,,,840.00000,271.32000,Hometown Health,Lease Networks,50,798.00,,,,,,,218.40,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,inpatient,,,560.00000,180.88000,Hometown Health,Lease Networks,LT,532.00,,,,,,,504.00,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Hometown Health,Lease Networks,LT,532.00,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,inpatient,,,560.00000,180.88000,Hometown Health,Lease Networks,RT,532.00,,,,,,,504.00,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Hometown Health,Lease Networks,RT,532.00,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,inpatient,,,792.00000,255.82000,Hometown Health,Lease Networks,50,752.40,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,outpatient,,,792.00000,255.82000,Hometown Health,Lease Networks,50,752.40,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,inpatient,,,528.00000,170.54000,Hometown Health,Lease Networks,LT,501.60,,,,,,,475.20,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Hometown Health,Lease Networks,LT,501.60,,,,,,,137.28,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,inpatient,,,528.00000,170.54000,Hometown Health,Lease Networks,RT,501.60,,,,,,,475.20,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Hometown Health,Lease Networks,RT,501.60,,,,,,,137.28,512.16,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,inpatient,,,272.00000,87.86000,Hometown Health,Lease Networks,,258.40,,,,,,,244.80,263.84,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,outpatient,,,272.00000,87.86000,Hometown Health,Lease Networks,,258.40,,,,,,,70.72,263.84,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,inpatient,,,1268.00000,409.56000,Hometown Health,Lease Networks,,1204.60,,,,,,,1141.20,1229.96,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,outpatient,,,1268.00000,409.56000,Hometown Health,Lease Networks,,1204.60,,,,,,,329.68,1229.96,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,inpatient,,,896.00000,289.41000,Hometown Health,Lease Networks,,851.20,,,,,,,806.40,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,outpatient,,,896.00000,289.41000,Hometown Health,Lease Networks,,851.20,,,,,,,232.96,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,inpatient,,,884.00000,285.53000,Hometown Health,Lease Networks,,839.80,,,,,,,795.60,857.48,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,outpatient,,,884.00000,285.53000,Hometown Health,Lease Networks,,839.80,,,,,,,229.84,857.48,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,inpatient,,,609.00000,326.42000,Hometown Health,Lease Networks,,578.55,,,,,,,548.10,590.73,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Hometown Health,Lease Networks,,578.55,,,,,,,158.34,590.73,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,inpatient,,,966.00000,383.50000,Hometown Health,Lease Networks,,917.70,,,,,,,869.40,937.02,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,outpatient,,,966.00000,383.50000,Hometown Health,Lease Networks,,917.70,,,,,,,251.16,937.02,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,inpatient,,,872.00000,346.18000,Hometown Health,Lease Networks,,828.40,,,,,,,784.80,845.84,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,outpatient,,,872.00000,346.18000,Hometown Health,Lease Networks,,828.40,,,,,,,226.72,845.84,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,inpatient,,,492.00000,195.32000,Hometown Health,Lease Networks,,467.40,,,,,,,442.80,477.24,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,outpatient,,,492.00000,195.32000,Hometown Health,Lease Networks,,467.40,,,,,,,127.92,477.24,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,inpatient,,,331.00000,131.41000,Hometown Health,Lease Networks,,314.45,,,,,,,297.90,321.07,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,outpatient,,,331.00000,131.41000,Hometown Health,Lease Networks,,314.45,,,,,,,86.06,321.07,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,inpatient,,,5215.00000,2070.36000,Hometown Health,Lease Networks,,4954.25,,,,,,,4693.50,5058.55,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,outpatient,,,5215.00000,2070.36000,Hometown Health,Lease Networks,,4954.25,,,,,,,1355.90,5058.55,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,inpatient,,,5422.00000,2152.53000,Hometown Health,Lease Networks,,5150.90,,,,,,,4879.80,5259.34,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,outpatient,,,5422.00000,2152.53000,Hometown Health,Lease Networks,,5150.90,,,,,,,1409.72,5259.34,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,inpatient,,,1878.00000,788.76000,Hometown Health,Lease Networks,,1784.10,,,,,,,1690.20,1821.66,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1878.00000,788.76000,Hometown Health,Lease Networks,,1784.10,,,,,,,488.28,1821.66,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,inpatient,,,2253.00000,946.26000,Hometown Health,Lease Networks,,2140.35,,,,,,,2027.70,2185.41,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,outpatient,,,2253.00000,946.26000,Hometown Health,Lease Networks,,2140.35,,,,,,,585.78,2185.41,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,inpatient,,,1502.00000,630.84000,Hometown Health,Lease Networks,,1426.90,,,,,,,1351.80,1456.94,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1502.00000,630.84000,Hometown Health,Lease Networks,,1426.90,,,,,,,390.52,1456.94,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,inpatient,,,2024.00000,850.08000,Hometown Health,Lease Networks,,1922.80,,,,,,,1821.60,1963.28,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,outpatient,,,2024.00000,850.08000,Hometown Health,Lease Networks,,1922.80,,,,,,,526.24,1963.28,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,inpatient,,,2429.00000,1020.18000,Hometown Health,Lease Networks,,2307.55,,,,,,,2186.10,2356.13,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,outpatient,,,2429.00000,1020.18000,Hometown Health,Lease Networks,,2307.55,,,,,,,631.54,2356.13,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,inpatient,,,1619.00000,679.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1619.00000,679.98000,Hometown Health,Lease Networks,,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,inpatient,,,2425.00000,1018.50000,Hometown Health,Lease Networks,,2303.75,,,,,,,2182.50,2352.25,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,outpatient,,,2425.00000,1018.50000,Hometown Health,Lease Networks,,2303.75,,,,,,,630.50,2352.25,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,inpatient,,,2910.00000,1222.20000,Hometown Health,Lease Networks,,2764.50,,,,,,,2619.00,2822.70,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2910.00000,1222.20000,Hometown Health,Lease Networks,,2764.50,,,,,,,756.60,2822.70,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,inpatient,,,1940.00000,814.80000,Hometown Health,Lease Networks,,1843.00,,,,,,,1746.00,1881.80,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1940.00000,814.80000,Hometown Health,Lease Networks,,1843.00,,,,,,,504.40,1881.80,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,inpatient,,,2317.00000,973.14000,Hometown Health,Lease Networks,,2201.15,,,,,,,2085.30,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2317.00000,973.14000,Hometown Health,Lease Networks,,2201.15,,,,,,,602.42,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,inpatient,,,2780.00000,1167.60000,Hometown Health,Lease Networks,,2641.00,,,,,,,2502.00,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2780.00000,1167.60000,Hometown Health,Lease Networks,,2641.00,,,,,,,722.80,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,inpatient,,,1853.00000,778.26000,Hometown Health,Lease Networks,,1760.35,,,,,,,1667.70,1797.41,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1853.00000,778.26000,Hometown Health,Lease Networks,,1760.35,,,,,,,481.78,1797.41,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,inpatient,,,2366.00000,993.72000,Hometown Health,Lease Networks,,2247.70,,,,,,,2129.40,2295.02,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2366.00000,993.72000,Hometown Health,Lease Networks,,2247.70,,,,,,,615.16,2295.02,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,inpatient,,,3056.00000,1283.52000,Hometown Health,Lease Networks,,2903.20,,,,,,,2750.40,2964.32,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,outpatient,,,3056.00000,1283.52000,Hometown Health,Lease Networks,,2903.20,,,,,,,794.56,2964.32,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,inpatient,,,2829.00000,1386.21000,Hometown Health,Lease Networks,,2687.55,,,,,,,2546.10,2744.13,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,outpatient,,,2829.00000,1386.21000,Hometown Health,Lease Networks,,2687.55,,,,,,,735.54,2744.13,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,inpatient,,,3395.00000,1663.55000,Hometown Health,Lease Networks,,3225.25,,,,,,,3055.50,3293.15,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,outpatient,,,3395.00000,1663.55000,Hometown Health,Lease Networks,,3225.25,,,,,,,882.70,3293.15,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,inpatient,,,2263.00000,1108.87000,Hometown Health,Lease Networks,,2149.85,,,,,,,2036.70,2195.11,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,outpatient,,,2263.00000,1108.87000,Hometown Health,Lease Networks,,2149.85,,,,,,,588.38,2195.11,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,inpatient,,,4697.00000,2301.53000,Hometown Health,Lease Networks,,4462.15,,,,,,,4227.30,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,outpatient,,,4697.00000,2301.53000,Hometown Health,Lease Networks,,4462.15,,,,,,,1221.22,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,inpatient,,,5636.00000,2761.64000,Hometown Health,Lease Networks,,5354.20,,,,,,,5072.40,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,outpatient,,,5636.00000,2761.64000,Hometown Health,Lease Networks,,5354.20,,,,,,,1465.36,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,inpatient,,,3757.00000,1840.93000,Hometown Health,Lease Networks,,3569.15,,,,,,,3381.30,3644.29,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,outpatient,,,3757.00000,1840.93000,Hometown Health,Lease Networks,,3569.15,,,,,,,976.82,3644.29,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,inpatient,,,2619.00000,1283.31000,Hometown Health,Lease Networks,,2488.05,,,,,,,2357.10,2540.43,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,outpatient,,,2619.00000,1283.31000,Hometown Health,Lease Networks,,2488.05,,,,,,,680.94,2540.43,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,inpatient,,,3143.00000,1540.07000,Hometown Health,Lease Networks,,2985.85,,,,,,,2828.70,3048.71,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,outpatient,,,3143.00000,1540.07000,Hometown Health,Lease Networks,,2985.85,,,,,,,817.18,3048.71,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,inpatient,,,2095.00000,1026.55000,Hometown Health,Lease Networks,,1990.25,,,,,,,1885.50,2032.15,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,outpatient,,,2095.00000,1026.55000,Hometown Health,Lease Networks,,1990.25,,,,,,,544.70,2032.15,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,inpatient,,,278.00000,136.22000,Hometown Health,Lease Networks,,264.10,,,,,,,250.20,269.66,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,outpatient,,,278.00000,136.22000,Hometown Health,Lease Networks,,264.10,,,,,,,72.28,269.66,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,inpatient,,,2110.00000,1033.90000,Hometown Health,Lease Networks,LT,2004.50,,,,,,,1899.00,2046.70,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Hometown Health,Lease Networks,LT,2004.50,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,inpatient,,,2110.00000,1033.90000,Hometown Health,Lease Networks,RT,2004.50,,,,,,,1899.00,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Hometown Health,Lease Networks,RT,2004.50,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2532.00000,1240.68000,Hometown Health,Lease Networks,LT,2405.40,,,,,,,2278.80,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Hometown Health,Lease Networks,LT,2405.40,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2532.00000,1240.68000,Hometown Health,Lease Networks,RT,2405.40,,,,,,,2278.80,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Hometown Health,Lease Networks,RT,2405.40,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1688.00000,827.12000,Hometown Health,Lease Networks,LT,1603.60,,,,,,,1519.20,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Hometown Health,Lease Networks,LT,1603.60,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1688.00000,827.12000,Hometown Health,Lease Networks,RT,1603.60,,,,,,,1519.20,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Hometown Health,Lease Networks,RT,1603.60,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,inpatient,,,2024.00000,991.76000,Hometown Health,Lease Networks,LT,1922.80,,,,,,,1821.60,1963.28,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Hometown Health,Lease Networks,LT,1922.80,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,inpatient,,,2024.00000,991.76000,Hometown Health,Lease Networks,RT,1922.80,,,,,,,1821.60,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Hometown Health,Lease Networks,RT,1922.80,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2429.00000,1190.21000,Hometown Health,Lease Networks,LT,2307.55,,,,,,,2186.10,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Hometown Health,Lease Networks,LT,2307.55,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2429.00000,1190.21000,Hometown Health,Lease Networks,RT,2307.55,,,,,,,2186.10,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Hometown Health,Lease Networks,RT,2307.55,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1619.00000,793.31000,Hometown Health,Lease Networks,LT,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Hometown Health,Lease Networks,LT,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1619.00000,793.31000,Hometown Health,Lease Networks,RT,1538.05,,,,,,,1457.10,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Hometown Health,Lease Networks,RT,1538.05,,,,,,,420.94,1570.43,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,inpatient,,,1224.00000,599.76000,Hometown Health,Lease Networks,,1162.80,,,,,,,1101.60,1187.28,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,outpatient,,,1224.00000,599.76000,Hometown Health,Lease Networks,,1162.80,,,,,,,318.24,1187.28,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,inpatient,,,3020.00000,1479.80000,Hometown Health,Lease Networks,,2869.00,,,,,,,2718.00,2929.40,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,outpatient,,,3020.00000,1479.80000,Hometown Health,Lease Networks,,2869.00,,,,,,,785.20,2929.40,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,inpatient,,,3624.00000,1775.76000,Hometown Health,Lease Networks,,3442.80,,,,,,,3261.60,3515.28,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,outpatient,,,3624.00000,1775.76000,Hometown Health,Lease Networks,,3442.80,,,,,,,942.24,3515.28,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,inpatient,,,2416.00000,1183.84000,Hometown Health,Lease Networks,,2295.20,,,,,,,2174.40,2343.52,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,outpatient,,,2416.00000,1183.84000,Hometown Health,Lease Networks,,2295.20,,,,,,,628.16,2343.52,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,inpatient,,,2728.00000,1336.72000,Hometown Health,Lease Networks,,2591.60,,,,,,,2455.20,2646.16,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,outpatient,,,2728.00000,1336.72000,Hometown Health,Lease Networks,,2591.60,,,,,,,709.28,2646.16,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,inpatient,,,3273.00000,1603.77000,Hometown Health,Lease Networks,,3109.35,,,,,,,2945.70,3174.81,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,outpatient,,,3273.00000,1603.77000,Hometown Health,Lease Networks,,3109.35,,,,,,,850.98,3174.81,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,inpatient,,,2182.00000,1069.18000,Hometown Health,Lease Networks,,2072.90,,,,,,,1963.80,2116.54,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,outpatient,,,2182.00000,1069.18000,Hometown Health,Lease Networks,,2072.90,,,,,,,567.32,2116.54,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,inpatient,,,3133.00000,1535.17000,Hometown Health,Lease Networks,,2976.35,,,,,,,2819.70,3039.01,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,outpatient,,,3133.00000,1535.17000,Hometown Health,Lease Networks,,2976.35,,,,,,,814.58,3039.01,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,inpatient,,,3759.00000,1841.91000,Hometown Health,Lease Networks,,3571.05,,,,,,,3383.10,3646.23,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,outpatient,,,3759.00000,1841.91000,Hometown Health,Lease Networks,,3571.05,,,,,,,977.34,3646.23,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,inpatient,,,2506.00000,1227.94000,Hometown Health,Lease Networks,,2380.70,,,,,,,2255.40,2430.82,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,outpatient,,,2506.00000,1227.94000,Hometown Health,Lease Networks,,2380.70,,,,,,,651.56,2430.82,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,inpatient,,,2857.00000,1399.93000,Hometown Health,Lease Networks,,2714.15,,,,,,,2571.30,2771.29,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,outpatient,,,2857.00000,1399.93000,Hometown Health,Lease Networks,,2714.15,,,,,,,742.82,2771.29,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,inpatient,,,3428.00000,1679.72000,Hometown Health,Lease Networks,,3256.60,,,,,,,3085.20,3325.16,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,outpatient,,,3428.00000,1679.72000,Hometown Health,Lease Networks,,3256.60,,,,,,,891.28,3325.16,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,inpatient,,,2285.00000,1119.65000,Hometown Health,Lease Networks,,2170.75,,,,,,,2056.50,2216.45,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,outpatient,,,2285.00000,1119.65000,Hometown Health,Lease Networks,,2170.75,,,,,,,594.10,2216.45,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,inpatient,,,3565.00000,1746.85000,Hometown Health,Lease Networks,,3386.75,,,,,,,3208.50,3458.05,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,outpatient,,,3565.00000,1746.85000,Hometown Health,Lease Networks,,3386.75,,,,,,,926.90,3458.05,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,inpatient,,,5918.00000,2899.82000,Hometown Health,Lease Networks,,5622.10,,,,,,,5326.20,5740.46,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,outpatient,,,5918.00000,2899.82000,Hometown Health,Lease Networks,,5622.10,,,,,,,1538.68,5740.46,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,inpatient,,,3301.00000,1617.49000,Hometown Health,Lease Networks,,3135.95,,,,,,,2970.90,3201.97,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,outpatient,,,3301.00000,1617.49000,Hometown Health,Lease Networks,,3135.95,,,,,,,858.26,3201.97,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2659.00000,1302.91000,Hometown Health,Lease Networks,LT,2526.05,,,,,,,2393.10,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Hometown Health,Lease Networks,LT,2526.05,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2659.00000,1302.91000,Hometown Health,Lease Networks,RT,2526.05,,,,,,,2393.10,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Hometown Health,Lease Networks,RT,2526.05,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2551.00000,1249.99000,Hometown Health,Lease Networks,LT,2423.45,,,,,,,2295.90,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Hometown Health,Lease Networks,LT,2423.45,,,,,,,663.26,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2551.00000,1249.99000,Hometown Health,Lease Networks,RT,2423.45,,,,,,,2295.90,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Hometown Health,Lease Networks,RT,2423.45,,,,,,,663.26,2474.47,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,inpatient,,,3806.00000,1864.94000,Hometown Health,Lease Networks,,3615.70,,,,,,,3425.40,3691.82,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3806.00000,1864.94000,Hometown Health,Lease Networks,,3615.70,,,,,,,989.56,3691.82,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,inpatient,,,2149.00000,694.13000,Hometown Health,Lease Networks,,2041.55,,,,,,,1934.10,2084.53,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,outpatient,,,2149.00000,694.13000,Hometown Health,Lease Networks,,2041.55,,,,,,,558.74,2084.53,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,inpatient,,,1973.00000,637.28000,Hometown Health,Lease Networks,,1874.35,,,,,,,1775.70,1913.81,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,outpatient,,,1973.00000,637.28000,Hometown Health,Lease Networks,,1874.35,,,,,,,512.98,1913.81,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1784.00000,576.23000,Hometown Health,Lease Networks,50,1694.80,,,,,,,1605.60,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1784.00000,576.23000,Hometown Health,Lease Networks,50,1694.80,,,,,,,463.84,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1189.00000,384.05000,Hometown Health,Lease Networks,LT,1129.55,,,,,,,1070.10,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Hometown Health,Lease Networks,LT,1129.55,,,,,,,309.14,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1189.00000,384.05000,Hometown Health,Lease Networks,RT,1129.55,,,,,,,1070.10,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Hometown Health,Lease Networks,RT,1129.55,,,,,,,309.14,1153.33,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,inpatient,,,130.00000,69.68000,Hometown Health,Lease Networks,,123.50,,,,,,,117.00,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,outpatient,,,130.00000,69.68000,Hometown Health,Lease Networks,,123.50,,,,,,,33.80,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,inpatient,,,44.00000,23.58000,Hometown Health,Lease Networks,,41.80,,,,,,,39.60,42.68,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,outpatient,,,44.00000,23.58000,Hometown Health,Lease Networks,,41.80,,,,,,,11.44,42.68,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,inpatient,,,456.00000,244.42000,Hometown Health,Lease Networks,,433.20,,,,,,,410.40,442.32,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,outpatient,,,456.00000,244.42000,Hometown Health,Lease Networks,,433.20,,,,,,,118.56,442.32,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,inpatient,,,108.00000,57.89000,Hometown Health,Lease Networks,,102.60,,,,,,,97.20,104.76,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,outpatient,,,108.00000,57.89000,Hometown Health,Lease Networks,,102.60,,,,,,,28.08,104.76,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,inpatient,,,306.00000,164.02000,Hometown Health,Lease Networks,,290.70,,,,,,,275.40,296.82,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,outpatient,,,306.00000,164.02000,Hometown Health,Lease Networks,,290.70,,,,,,,79.56,296.82,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,inpatient,,,257.00000,137.75000,Hometown Health,Lease Networks,,244.15,,,,,,,231.30,249.29,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,outpatient,,,257.00000,137.75000,Hometown Health,Lease Networks,,244.15,,,,,,,66.82,249.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4057.00000,2036.61000,Hometown Health,Lease Networks,,3854.15,,,,,,,3651.30,3935.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Hometown Health,Lease Networks,,3854.15,,,,,,,1054.82,3935.29,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4868.00000,2443.74000,Hometown Health,Lease Networks,,4624.60,,,,,,,4381.20,4721.96,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Hometown Health,Lease Networks,,4624.60,,,,,,,1265.68,4721.96,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,inpatient,,,3245.00000,1628.99000,Hometown Health,Lease Networks,,3082.75,,,,,,,2920.50,3147.65,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Hometown Health,Lease Networks,,3082.75,,,,,,,843.70,3147.65,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4057.00000,2036.61000,Hometown Health,Lease Networks,,3854.15,,,,,,,3651.30,3935.29,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Hometown Health,Lease Networks,,3854.15,,,,,,,1054.82,3935.29,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4868.00000,2443.74000,Hometown Health,Lease Networks,,4624.60,,,,,,,4381.20,4721.96,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Hometown Health,Lease Networks,,4624.60,,,,,,,1265.68,4721.96,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,inpatient,,,3245.00000,1628.99000,Hometown Health,Lease Networks,,3082.75,,,,,,,2920.50,3147.65,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Hometown Health,Lease Networks,,3082.75,,,,,,,843.70,3147.65,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,inpatient,,,1725.00000,865.95000,Hometown Health,Lease Networks,,1638.75,,,,,,,1552.50,1673.25,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,outpatient,,,1725.00000,865.95000,Hometown Health,Lease Networks,,1638.75,,,,,,,448.50,1673.25,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,inpatient,,,1743.00000,874.99000,Hometown Health,Lease Networks,,1655.85,,,,,,,1568.70,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,outpatient,,,1743.00000,874.99000,Hometown Health,Lease Networks,,1655.85,,,,,,,453.18,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,inpatient,,,1475.00000,740.45000,Hometown Health,Lease Networks,LT,1401.25,,,,,,,1327.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Hometown Health,Lease Networks,LT,1401.25,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,inpatient,,,1475.00000,740.45000,Hometown Health,Lease Networks,RT,1401.25,,,,,,,1327.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Hometown Health,Lease Networks,RT,1401.25,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,inpatient,,,1162.00000,583.32000,Hometown Health,Lease Networks,,1103.90,,,,,,,1045.80,1127.14,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,outpatient,,,1162.00000,583.32000,Hometown Health,Lease Networks,,1103.90,,,,,,,302.12,1127.14,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,inpatient,,,983.00000,493.47000,Hometown Health,Lease Networks,LT,933.85,,,,,,,884.70,953.51,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Hometown Health,Lease Networks,LT,933.85,,,,,,,255.58,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,inpatient,,,983.00000,493.47000,Hometown Health,Lease Networks,RT,933.85,,,,,,,884.70,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Hometown Health,Lease Networks,RT,933.85,,,,,,,255.58,953.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,inpatient,,,3183.00000,1597.87000,Hometown Health,Lease Networks,,3023.85,,,,,,,2864.70,3087.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,outpatient,,,3183.00000,1597.87000,Hometown Health,Lease Networks,,3023.85,,,,,,,827.58,3087.51,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,inpatient,,,3819.00000,1917.14000,Hometown Health,Lease Networks,,3628.05,,,,,,,3437.10,3704.43,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,outpatient,,,3819.00000,1917.14000,Hometown Health,Lease Networks,,3628.05,,,,,,,992.94,3704.43,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,inpatient,,,2546.00000,1278.09000,Hometown Health,Lease Networks,,2418.70,,,,,,,2291.40,2469.62,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,outpatient,,,2546.00000,1278.09000,Hometown Health,Lease Networks,,2418.70,,,,,,,661.96,2469.62,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,inpatient,,,3858.00000,1936.72000,Hometown Health,Lease Networks,LT,3665.10,,,,,,,3472.20,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Hometown Health,Lease Networks,LT,3665.10,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,inpatient,,,3858.00000,1936.72000,Hometown Health,Lease Networks,RT,3665.10,,,,,,,3472.20,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Hometown Health,Lease Networks,RT,3665.10,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,inpatient,,,4629.00000,2323.76000,Hometown Health,Lease Networks,LT,4397.55,,,,,,,4166.10,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Hometown Health,Lease Networks,LT,4397.55,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,inpatient,,,4629.00000,2323.76000,Hometown Health,Lease Networks,RT,4397.55,,,,,,,4166.10,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Hometown Health,Lease Networks,RT,4397.55,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,inpatient,,,3086.00000,1549.17000,Hometown Health,Lease Networks,LT,2931.70,,,,,,,2777.40,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Hometown Health,Lease Networks,LT,2931.70,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,inpatient,,,3086.00000,1549.17000,Hometown Health,Lease Networks,RT,2931.70,,,,,,,2777.40,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Hometown Health,Lease Networks,RT,2931.70,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,inpatient,,,2505.00000,1257.51000,Hometown Health,Lease Networks,LT,2379.75,,,,,,,2254.50,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Hometown Health,Lease Networks,LT,2379.75,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,inpatient,,,2505.00000,1257.51000,Hometown Health,Lease Networks,RT,2379.75,,,,,,,2254.50,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Hometown Health,Lease Networks,RT,2379.75,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,inpatient,,,3006.00000,1509.01000,Hometown Health,Lease Networks,LT,2855.70,,,,,,,2705.40,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Hometown Health,Lease Networks,LT,2855.70,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,inpatient,,,3006.00000,1509.01000,Hometown Health,Lease Networks,RT,2855.70,,,,,,,2705.40,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Hometown Health,Lease Networks,RT,2855.70,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,inpatient,,,2004.00000,1006.01000,Hometown Health,Lease Networks,LT,1903.80,,,,,,,1803.60,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Hometown Health,Lease Networks,LT,1903.80,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,inpatient,,,2004.00000,1006.01000,Hometown Health,Lease Networks,RT,1903.80,,,,,,,1803.60,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Hometown Health,Lease Networks,RT,1903.80,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,inpatient,,,3137.00000,1574.77000,Hometown Health,Lease Networks,LT,2980.15,,,,,,,2823.30,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Hometown Health,Lease Networks,LT,2980.15,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,inpatient,,,3137.00000,1574.77000,Hometown Health,Lease Networks,RT,2980.15,,,,,,,2823.30,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Hometown Health,Lease Networks,RT,2980.15,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,inpatient,,,3764.00000,1889.53000,Hometown Health,Lease Networks,LT,3575.80,,,,,,,3387.60,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Hometown Health,Lease Networks,LT,3575.80,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,inpatient,,,3764.00000,1889.53000,Hometown Health,Lease Networks,RT,3575.80,,,,,,,3387.60,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Hometown Health,Lease Networks,RT,3575.80,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,inpatient,,,2509.00000,1259.52000,Hometown Health,Lease Networks,LT,2383.55,,,,,,,2258.10,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Hometown Health,Lease Networks,LT,2383.55,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,inpatient,,,2509.00000,1259.52000,Hometown Health,Lease Networks,RT,2383.55,,,,,,,2258.10,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Hometown Health,Lease Networks,RT,2383.55,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,inpatient,,,3023.00000,1517.55000,Hometown Health,Lease Networks,LT,2871.85,,,,,,,2720.70,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Hometown Health,Lease Networks,LT,2871.85,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,inpatient,,,3023.00000,1517.55000,Hometown Health,Lease Networks,RT,2871.85,,,,,,,2720.70,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Hometown Health,Lease Networks,RT,2871.85,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,inpatient,,,3627.00000,1820.75000,Hometown Health,Lease Networks,LT,3445.65,,,,,,,3264.30,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Hometown Health,Lease Networks,LT,3445.65,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,inpatient,,,3627.00000,1820.75000,Hometown Health,Lease Networks,RT,3445.65,,,,,,,3264.30,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Hometown Health,Lease Networks,RT,3445.65,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,inpatient,,,2418.00000,1213.84000,Hometown Health,Lease Networks,LT,2297.10,,,,,,,2176.20,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Hometown Health,Lease Networks,LT,2297.10,,,,,,,628.68,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,inpatient,,,2418.00000,1213.84000,Hometown Health,Lease Networks,RT,2297.10,,,,,,,2176.20,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Hometown Health,Lease Networks,RT,2297.10,,,,,,,628.68,2345.46,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,inpatient,,,870.00000,436.74000,Hometown Health,Lease Networks,,826.50,,,,,,,783.00,843.90,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,outpatient,,,870.00000,436.74000,Hometown Health,Lease Networks,,826.50,,,,,,,226.20,843.90,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,inpatient,,,1353.00000,679.21000,Hometown Health,Lease Networks,,1285.35,,,,,,,1217.70,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,outpatient,,,1353.00000,679.21000,Hometown Health,Lease Networks,,1285.35,,,,,,,351.78,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,inpatient,,,902.00000,452.80000,Hometown Health,Lease Networks,LT,856.90,,,,,,,811.80,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Hometown Health,Lease Networks,LT,856.90,,,,,,,234.52,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,inpatient,,,902.00000,452.80000,Hometown Health,Lease Networks,RT,856.90,,,,,,,811.80,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Hometown Health,Lease Networks,RT,856.90,,,,,,,234.52,874.94,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,inpatient,,,3489.00000,1751.48000,Hometown Health,Lease Networks,,3314.55,,,,,,,3140.10,3384.33,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3489.00000,1751.48000,Hometown Health,Lease Networks,,3314.55,,,,,,,907.14,3384.33,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,inpatient,,,4187.00000,2101.87000,Hometown Health,Lease Networks,,3977.65,,,,,,,3768.30,4061.39,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,outpatient,,,4187.00000,2101.87000,Hometown Health,Lease Networks,,3977.65,,,,,,,1088.62,4061.39,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,inpatient,,,2791.00000,1401.08000,Hometown Health,Lease Networks,,2651.45,,,,,,,2511.90,2707.27,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,outpatient,,,2791.00000,1401.08000,Hometown Health,Lease Networks,,2651.45,,,,,,,725.66,2707.27,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,inpatient,,,492.00000,246.98000,Hometown Health,Lease Networks,,467.40,,,,,,,442.80,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,outpatient,,,492.00000,246.98000,Hometown Health,Lease Networks,,467.40,,,,,,,127.92,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,inpatient,,,331.00000,166.16000,Hometown Health,Lease Networks,,314.45,,,,,,,297.90,321.07,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,outpatient,,,331.00000,166.16000,Hometown Health,Lease Networks,,314.45,,,,,,,86.06,321.07,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,inpatient,,,4440.00000,2357.64000,Hometown Health,Lease Networks,,4218.00,,,,,,,3996.00,4306.80,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,outpatient,,,4440.00000,2357.64000,Hometown Health,Lease Networks,,4218.00,,,,,,,1154.40,4306.80,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,inpatient,,,5328.00000,2829.17000,Hometown Health,Lease Networks,,5061.60,,,,,,,4795.20,5168.16,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,outpatient,,,5328.00000,2829.17000,Hometown Health,Lease Networks,,5061.60,,,,,,,1385.28,5168.16,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,inpatient,,,3552.00000,1886.11000,Hometown Health,Lease Networks,,3374.40,,,,,,,3196.80,3445.44,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,outpatient,,,3552.00000,1886.11000,Hometown Health,Lease Networks,,3374.40,,,,,,,923.52,3445.44,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,inpatient,,,2528.00000,1342.37000,Hometown Health,Lease Networks,,2401.60,,,,,,,2275.20,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,outpatient,,,2528.00000,1342.37000,Hometown Health,Lease Networks,,2401.60,,,,,,,657.28,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,inpatient,,,3033.00000,1610.52000,Hometown Health,Lease Networks,,2881.35,,,,,,,2729.70,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,outpatient,,,3033.00000,1610.52000,Hometown Health,Lease Networks,,2881.35,,,,,,,788.58,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,inpatient,,,2022.00000,1073.68000,Hometown Health,Lease Networks,,1920.90,,,,,,,1819.80,1961.34,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,outpatient,,,2022.00000,1073.68000,Hometown Health,Lease Networks,,1920.90,,,,,,,525.72,1961.34,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,inpatient,,,3610.00000,1909.69000,Hometown Health,Lease Networks,,3429.50,,,,,,,3249.00,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,outpatient,,,3610.00000,1909.69000,Hometown Health,Lease Networks,,3429.50,,,,,,,938.60,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,inpatient,,,4332.00000,2291.63000,Hometown Health,Lease Networks,,4115.40,,,,,,,3898.80,4202.04,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,outpatient,,,4332.00000,2291.63000,Hometown Health,Lease Networks,,4115.40,,,,,,,1126.32,4202.04,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,inpatient,,,2888.00000,1527.75000,Hometown Health,Lease Networks,,2743.60,,,,,,,2599.20,2801.36,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,outpatient,,,2888.00000,1527.75000,Hometown Health,Lease Networks,,2743.60,,,,,,,750.88,2801.36,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,inpatient,,,4532.00000,2397.43000,Hometown Health,Lease Networks,,4305.40,,,,,,,4078.80,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,outpatient,,,4532.00000,2397.43000,Hometown Health,Lease Networks,,4305.40,,,,,,,1178.32,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,inpatient,,,5438.00000,2876.70000,Hometown Health,Lease Networks,,5166.10,,,,,,,4894.20,5274.86,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,outpatient,,,5438.00000,2876.70000,Hometown Health,Lease Networks,,5166.10,,,,,,,1413.88,5274.86,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,inpatient,,,3625.00000,1917.62000,Hometown Health,Lease Networks,,3443.75,,,,,,,3262.50,3516.25,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,outpatient,,,3625.00000,1917.62000,Hometown Health,Lease Networks,,3443.75,,,,,,,942.50,3516.25,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,inpatient,,,3639.00000,1925.03000,Hometown Health,Lease Networks,,3457.05,,,,,,,3275.10,3529.83,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,outpatient,,,3639.00000,1925.03000,Hometown Health,Lease Networks,,3457.05,,,,,,,946.14,3529.83,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,inpatient,,,4367.00000,2310.14000,Hometown Health,Lease Networks,,4148.65,,,,,,,3930.30,4235.99,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,outpatient,,,4367.00000,2310.14000,Hometown Health,Lease Networks,,4148.65,,,,,,,1135.42,4235.99,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,inpatient,,,2911.00000,1539.92000,Hometown Health,Lease Networks,,2765.45,,,,,,,2619.90,2823.67,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,outpatient,,,2911.00000,1539.92000,Hometown Health,Lease Networks,,2765.45,,,,,,,756.86,2823.67,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,inpatient,,,3494.00000,1719.05000,Hometown Health,Lease Networks,,3319.30,,,,,,,3144.60,3389.18,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3494.00000,1719.05000,Hometown Health,Lease Networks,,3319.30,,,,,,,908.44,3389.18,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,inpatient,,,4193.00000,2062.96000,Hometown Health,Lease Networks,,3983.35,,,,,,,3773.70,4067.21,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,outpatient,,,4193.00000,2062.96000,Hometown Health,Lease Networks,,3983.35,,,,,,,1090.18,4067.21,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,inpatient,,,2795.00000,1375.14000,Hometown Health,Lease Networks,,2655.25,,,,,,,2515.50,2711.15,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,outpatient,,,2795.00000,1375.14000,Hometown Health,Lease Networks,,2655.25,,,,,,,726.70,2711.15,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,inpatient,,,2717.00000,1336.76000,Hometown Health,Lease Networks,,2581.15,,,,,,,2445.30,2635.49,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,outpatient,,,2717.00000,1336.76000,Hometown Health,Lease Networks,,2581.15,,,,,,,706.42,2635.49,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,inpatient,,,3260.00000,1603.92000,Hometown Health,Lease Networks,,3097.00,,,,,,,2934.00,3162.20,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,outpatient,,,3260.00000,1603.92000,Hometown Health,Lease Networks,,3097.00,,,,,,,847.60,3162.20,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,inpatient,,,2173.00000,1069.12000,Hometown Health,Lease Networks,,2064.35,,,,,,,1955.70,2107.81,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,outpatient,,,2173.00000,1069.12000,Hometown Health,Lease Networks,,2064.35,,,,,,,564.98,2107.81,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4051.00000,2301.58000,Hometown Health,Lease Networks,LT,3848.45,,,,,,,3645.90,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Hometown Health,Lease Networks,LT,3848.45,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4051.00000,2301.58000,Hometown Health,Lease Networks,RT,3848.45,,,,,,,3645.90,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Hometown Health,Lease Networks,RT,3848.45,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4861.00000,2761.78000,Hometown Health,Lease Networks,LT,4617.95,,,,,,,4374.90,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Hometown Health,Lease Networks,LT,4617.95,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4861.00000,2761.78000,Hometown Health,Lease Networks,RT,4617.95,,,,,,,4374.90,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Hometown Health,Lease Networks,RT,4617.95,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3241.00000,1841.37000,Hometown Health,Lease Networks,LT,3078.95,,,,,,,2916.90,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Hometown Health,Lease Networks,LT,3078.95,,,,,,,842.66,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3241.00000,1841.37000,Hometown Health,Lease Networks,RT,3078.95,,,,,,,2916.90,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Hometown Health,Lease Networks,RT,3078.95,,,,,,,842.66,3143.77,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,inpatient,,,4260.00000,2420.32000,Hometown Health,Lease Networks,,4047.00,,,,,,,3834.00,4132.20,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,outpatient,,,4260.00000,2420.32000,Hometown Health,Lease Networks,,4047.00,,,,,,,1107.60,4132.20,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,inpatient,,,5112.00000,2904.38000,Hometown Health,Lease Networks,,4856.40,,,,,,,4600.80,4958.64,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,outpatient,,,5112.00000,2904.38000,Hometown Health,Lease Networks,,4856.40,,,,,,,1329.12,4958.64,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,inpatient,,,3408.00000,1936.26000,Hometown Health,Lease Networks,,3237.60,,,,,,,3067.20,3305.76,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3408.00000,1936.26000,Hometown Health,Lease Networks,,3237.60,,,,,,,886.08,3305.76,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,inpatient,,,3343.00000,1899.33000,Hometown Health,Lease Networks,,3175.85,,,,,,,3008.70,3242.71,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3343.00000,1899.33000,Hometown Health,Lease Networks,,3175.85,,,,,,,869.18,3242.71,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,inpatient,,,4010.00000,2278.28000,Hometown Health,Lease Networks,,3809.50,,,,,,,3609.00,3889.70,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,outpatient,,,4010.00000,2278.28000,Hometown Health,Lease Networks,,3809.50,,,,,,,1042.60,3889.70,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,inpatient,,,2674.00000,1519.23000,Hometown Health,Lease Networks,,2540.30,,,,,,,2406.60,2593.78,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,outpatient,,,2674.00000,1519.23000,Hometown Health,Lease Networks,,2540.30,,,,,,,695.24,2593.78,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3294.00000,1871.49000,Hometown Health,Lease Networks,LT,3129.30,,,,,,,2964.60,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Hometown Health,Lease Networks,LT,3129.30,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3294.00000,1871.49000,Hometown Health,Lease Networks,RT,3129.30,,,,,,,2964.60,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Hometown Health,Lease Networks,RT,3129.30,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3953.00000,2245.90000,Hometown Health,Lease Networks,LT,3755.35,,,,,,,3557.70,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Hometown Health,Lease Networks,LT,3755.35,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3953.00000,2245.90000,Hometown Health,Lease Networks,RT,3755.35,,,,,,,3557.70,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Hometown Health,Lease Networks,RT,3755.35,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,inpatient,,,2635.00000,1497.08000,Hometown Health,Lease Networks,LT,2503.25,,,,,,,2371.50,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Hometown Health,Lease Networks,LT,2503.25,,,,,,,685.10,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,inpatient,,,2635.00000,1497.08000,Hometown Health,Lease Networks,RT,2503.25,,,,,,,2371.50,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Hometown Health,Lease Networks,RT,2503.25,,,,,,,685.10,2555.95,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,inpatient,,,3664.00000,2081.70000,Hometown Health,Lease Networks,,3480.80,,,,,,,3297.60,3554.08,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3664.00000,2081.70000,Hometown Health,Lease Networks,,3480.80,,,,,,,952.64,3554.08,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,inpatient,,,4397.00000,2498.16000,Hometown Health,Lease Networks,,4177.15,,,,,,,3957.30,4265.09,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,outpatient,,,4397.00000,2498.16000,Hometown Health,Lease Networks,,4177.15,,,,,,,1143.22,4265.09,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,inpatient,,,2931.00000,1665.25000,Hometown Health,Lease Networks,,2784.45,,,,,,,2637.90,2843.07,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,outpatient,,,2931.00000,1665.25000,Hometown Health,Lease Networks,,2784.45,,,,,,,762.06,2843.07,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,inpatient,,,4759.00000,2703.83000,Hometown Health,Lease Networks,,4521.05,,,,,,,4283.10,4616.23,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,outpatient,,,4759.00000,2703.83000,Hometown Health,Lease Networks,,4521.05,,,,,,,1237.34,4616.23,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,inpatient,,,5710.00000,3244.14000,Hometown Health,Lease Networks,,5424.50,,,,,,,5139.00,5538.70,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,outpatient,,,5710.00000,3244.14000,Hometown Health,Lease Networks,,5424.50,,,,,,,1484.60,5538.70,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,inpatient,,,3807.00000,2162.95000,Hometown Health,Lease Networks,,3616.65,,,,,,,3426.30,3692.79,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3807.00000,2162.95000,Hometown Health,Lease Networks,,3616.65,,,,,,,989.82,3692.79,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,inpatient,,,2915.00000,1574.10000,Hometown Health,Lease Networks,,2769.25,,,,,,,2623.50,2827.55,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2915.00000,1574.10000,Hometown Health,Lease Networks,,2769.25,,,,,,,757.90,2827.55,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,inpatient,,,1918.00000,1035.72000,Hometown Health,Lease Networks,,1822.10,,,,,,,1726.20,1860.46,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1918.00000,1035.72000,Hometown Health,Lease Networks,,1822.10,,,,,,,498.68,1860.46,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,inpatient,,,2292.00000,1237.68000,Hometown Health,Lease Networks,,2177.40,,,,,,,2062.80,2223.24,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2292.00000,1237.68000,Hometown Health,Lease Networks,,2177.40,,,,,,,595.92,2223.24,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,inpatient,,,2984.00000,1611.36000,Hometown Health,Lease Networks,,2834.80,,,,,,,2685.60,2894.48,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,outpatient,,,2984.00000,1611.36000,Hometown Health,Lease Networks,,2834.80,,,,,,,775.84,2894.48,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,inpatient,,,769.00000,415.26000,Hometown Health,Lease Networks,,730.55,,,,,,,692.10,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,outpatient,,,769.00000,415.26000,Hometown Health,Lease Networks,,730.55,,,,,,,199.94,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,inpatient,,,1280.00000,691.20000,Hometown Health,Lease Networks,,1216.00,,,,,,,1152.00,1241.60,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,outpatient,,,1280.00000,691.20000,Hometown Health,Lease Networks,,1216.00,,,,,,,332.80,1241.60,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,inpatient,,,1878.00000,1014.12000,Hometown Health,Lease Networks,,1784.10,,,,,,,1690.20,1821.66,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,outpatient,,,1878.00000,1014.12000,Hometown Health,Lease Networks,,1784.10,,,,,,,488.28,1821.66,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,inpatient,,,2196.00000,1185.84000,Hometown Health,Lease Networks,,2086.20,,,,,,,1976.40,2130.12,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,outpatient,,,2196.00000,1185.84000,Hometown Health,Lease Networks,,2086.20,,,,,,,570.96,2130.12,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,inpatient,,,844.00000,455.76000,Hometown Health,Lease Networks,,801.80,,,,,,,759.60,818.68,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,outpatient,,,844.00000,455.76000,Hometown Health,Lease Networks,,801.80,,,,,,,219.44,818.68,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,inpatient,,,1305.00000,704.70000,Hometown Health,Lease Networks,,1239.75,,,,,,,1174.50,1265.85,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,outpatient,,,1305.00000,704.70000,Hometown Health,Lease Networks,,1239.75,,,,,,,339.30,1265.85,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,inpatient,,,576.00000,311.04000,Hometown Health,Lease Networks,,547.20,,,,,,,518.40,558.72,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,outpatient,,,576.00000,311.04000,Hometown Health,Lease Networks,,547.20,,,,,,,149.76,558.72,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,inpatient,,,809.00000,436.86000,Hometown Health,Lease Networks,,768.55,,,,,,,728.10,784.73,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,outpatient,,,809.00000,436.86000,Hometown Health,Lease Networks,,768.55,,,,,,,210.34,784.73,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,inpatient,,,2462.00000,1329.48000,Hometown Health,Lease Networks,,2338.90,,,,,,,2215.80,2388.14,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,outpatient,,,2462.00000,1329.48000,Hometown Health,Lease Networks,,2338.90,,,,,,,640.12,2388.14,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,inpatient,,,918.00000,495.72000,Hometown Health,Lease Networks,,872.10,,,,,,,826.20,890.46,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,outpatient,,,918.00000,495.72000,Hometown Health,Lease Networks,,872.10,,,,,,,238.68,890.46,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,inpatient,,,1102.00000,595.08000,Hometown Health,Lease Networks,,1046.90,,,,,,,991.80,1068.94,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,outpatient,,,1102.00000,595.08000,Hometown Health,Lease Networks,,1046.90,,,,,,,286.52,1068.94,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,inpatient,,,812.00000,438.48000,Hometown Health,Lease Networks,,771.40,,,,,,,730.80,787.64,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,outpatient,,,812.00000,438.48000,Hometown Health,Lease Networks,,771.40,,,,,,,211.12,787.64,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,inpatient,,,1407.00000,759.78000,Hometown Health,Lease Networks,,1336.65,,,,,,,1266.30,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,outpatient,,,1407.00000,759.78000,Hometown Health,Lease Networks,,1336.65,,,,,,,365.82,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,inpatient,,,1980.00000,1069.20000,Hometown Health,Lease Networks,,1881.00,,,,,,,1782.00,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,outpatient,,,1980.00000,1069.20000,Hometown Health,Lease Networks,,1881.00,,,,,,,514.80,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,inpatient,,,964.00000,520.56000,Hometown Health,Lease Networks,,915.80,,,,,,,867.60,935.08,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,outpatient,,,964.00000,520.56000,Hometown Health,Lease Networks,,915.80,,,,,,,250.64,935.08,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,inpatient,,,1040.00000,561.60000,Hometown Health,Lease Networks,,988.00,,,,,,,936.00,1008.80,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,outpatient,,,1040.00000,561.60000,Hometown Health,Lease Networks,,988.00,,,,,,,270.40,1008.80,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,inpatient,,,795.00000,429.30000,Hometown Health,Lease Networks,,755.25,,,,,,,715.50,771.15,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,outpatient,,,795.00000,429.30000,Hometown Health,Lease Networks,,755.25,,,,,,,206.70,771.15,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,inpatient,,,1124.00000,606.96000,Hometown Health,Lease Networks,,1067.80,,,,,,,1011.60,1090.28,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,outpatient,,,1124.00000,606.96000,Hometown Health,Lease Networks,,1067.80,,,,,,,292.24,1090.28,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,inpatient,,,736.00000,397.44000,Hometown Health,Lease Networks,,699.20,,,,,,,662.40,713.92,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,outpatient,,,736.00000,397.44000,Hometown Health,Lease Networks,,699.20,,,,,,,191.36,713.92,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,inpatient,,,700.00000,378.00000,Hometown Health,Lease Networks,,665.00,,,,,,,630.00,679.00,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,outpatient,,,700.00000,378.00000,Hometown Health,Lease Networks,,665.00,,,,,,,182.00,679.00,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,inpatient,,,821.00000,443.34000,Hometown Health,Lease Networks,,779.95,,,,,,,738.90,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,outpatient,,,821.00000,443.34000,Hometown Health,Lease Networks,,779.95,,,,,,,213.46,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,inpatient,,,846.00000,456.84000,Hometown Health,Lease Networks,,803.70,,,,,,,761.40,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,outpatient,,,846.00000,456.84000,Hometown Health,Lease Networks,,803.70,,,,,,,219.96,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,inpatient,,,958.00000,517.32000,Hometown Health,Lease Networks,,910.10,,,,,,,862.20,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,outpatient,,,958.00000,517.32000,Hometown Health,Lease Networks,,910.10,,,,,,,249.08,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,inpatient,,,1261.00000,680.94000,Hometown Health,Lease Networks,,1197.95,,,,,,,1134.90,1223.17,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,outpatient,,,1261.00000,680.94000,Hometown Health,Lease Networks,,1197.95,,,,,,,327.86,1223.17,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,inpatient,,,971.00000,524.34000,Hometown Health,Lease Networks,,922.45,,,,,,,873.90,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,outpatient,,,971.00000,524.34000,Hometown Health,Lease Networks,,922.45,,,,,,,252.46,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,inpatient,,,1837.00000,991.98000,Hometown Health,Lease Networks,,1745.15,,,,,,,1653.30,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,outpatient,,,1837.00000,991.98000,Hometown Health,Lease Networks,,1745.15,,,,,,,477.62,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,inpatient,,,1099.00000,593.46000,Hometown Health,Lease Networks,,1044.05,,,,,,,989.10,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,outpatient,,,1099.00000,593.46000,Hometown Health,Lease Networks,,1044.05,,,,,,,285.74,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,inpatient,,,2178.00000,1176.12000,Hometown Health,Lease Networks,,2069.10,,,,,,,1960.20,2112.66,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,outpatient,,,2178.00000,1176.12000,Hometown Health,Lease Networks,,2069.10,,,,,,,566.28,2112.66,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,inpatient,,,1226.00000,662.04000,Hometown Health,Lease Networks,,1164.70,,,,,,,1103.40,1189.22,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,outpatient,,,1226.00000,662.04000,Hometown Health,Lease Networks,,1164.70,,,,,,,318.76,1189.22,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,inpatient,,,1048.00000,565.92000,Hometown Health,Lease Networks,,995.60,,,,,,,943.20,1016.56,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,outpatient,,,1048.00000,565.92000,Hometown Health,Lease Networks,,995.60,,,,,,,272.48,1016.56,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,inpatient,,,970.00000,523.80000,Hometown Health,Lease Networks,,921.50,,,,,,,873.00,940.90,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,outpatient,,,970.00000,523.80000,Hometown Health,Lease Networks,,921.50,,,,,,,252.20,940.90,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,inpatient,,,1803.00000,973.62000,Hometown Health,Lease Networks,,1712.85,,,,,,,1622.70,1748.91,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,outpatient,,,1803.00000,973.62000,Hometown Health,Lease Networks,,1712.85,,,,,,,468.78,1748.91,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,inpatient,,,2504.00000,1352.16000,Hometown Health,Lease Networks,,2378.80,,,,,,,2253.60,2428.88,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,outpatient,,,2504.00000,1352.16000,Hometown Health,Lease Networks,,2378.80,,,,,,,651.04,2428.88,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,inpatient,,,2457.00000,1326.78000,Hometown Health,Lease Networks,,2334.15,,,,,,,2211.30,2383.29,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2457.00000,1326.78000,Hometown Health,Lease Networks,,2334.15,,,,,,,638.82,2383.29,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,inpatient,,,923.00000,498.42000,Hometown Health,Lease Networks,,876.85,,,,,,,830.70,895.31,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,outpatient,,,923.00000,498.42000,Hometown Health,Lease Networks,,876.85,,,,,,,239.98,895.31,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,inpatient,,,5478.00000,2958.12000,Hometown Health,Lease Networks,,5204.10,,,,,,,4930.20,5313.66,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,outpatient,,,5478.00000,2958.12000,Hometown Health,Lease Networks,,5204.10,,,,,,,1424.28,5313.66,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,inpatient,,,4551.00000,2457.54000,Hometown Health,Lease Networks,,4323.45,,,,,,,4095.90,4414.47,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,outpatient,,,4551.00000,2457.54000,Hometown Health,Lease Networks,,4323.45,,,,,,,1183.26,4414.47,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,inpatient,,,1360.00000,734.40000,Hometown Health,Lease Networks,,1292.00,,,,,,,1224.00,1319.20,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,outpatient,,,1360.00000,734.40000,Hometown Health,Lease Networks,,1292.00,,,,,,,353.60,1319.20,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,inpatient,,,1209.00000,652.86000,Hometown Health,Lease Networks,,1148.55,,,,,,,1088.10,1172.73,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,outpatient,,,1209.00000,652.86000,Hometown Health,Lease Networks,,1148.55,,,,,,,314.34,1172.73,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,inpatient,,,848.00000,457.92000,Hometown Health,Lease Networks,,805.60,,,,,,,763.20,822.56,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,outpatient,,,848.00000,457.92000,Hometown Health,Lease Networks,,805.60,,,,,,,220.48,822.56,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,inpatient,,,1071.00000,578.34000,Hometown Health,Lease Networks,,1017.45,,,,,,,963.90,1038.87,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,outpatient,,,1071.00000,578.34000,Hometown Health,Lease Networks,,1017.45,,,,,,,278.46,1038.87,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,inpatient,,,1792.00000,967.68000,Hometown Health,Lease Networks,,1702.40,,,,,,,1612.80,1738.24,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,outpatient,,,1792.00000,967.68000,Hometown Health,Lease Networks,,1702.40,,,,,,,465.92,1738.24,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,inpatient,,,35.00000,18.90000,Hometown Health,Lease Networks,,33.25,,,,,,,31.50,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,outpatient,,,35.00000,18.90000,Hometown Health,Lease Networks,,33.25,,,,,,,9.10,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,inpatient,,,285.00000,153.90000,Hometown Health,Lease Networks,,270.75,,,,,,,256.50,276.45,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,outpatient,,,285.00000,153.90000,Hometown Health,Lease Networks,,270.75,,,,,,,74.10,276.45,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,inpatient,,,1012.00000,546.48000,Hometown Health,Lease Networks,,961.40,,,,,,,910.80,981.64,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,outpatient,,,1012.00000,546.48000,Hometown Health,Lease Networks,,961.40,,,,,,,263.12,981.64,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,inpatient,,,492.00000,265.68000,Hometown Health,Lease Networks,,467.40,,,,,,,442.80,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,outpatient,,,492.00000,265.68000,Hometown Health,Lease Networks,,467.40,,,,,,,127.92,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,inpatient,,,739.00000,399.06000,Hometown Health,Lease Networks,,702.05,,,,,,,665.10,716.83,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,outpatient,,,739.00000,399.06000,Hometown Health,Lease Networks,,702.05,,,,,,,192.14,716.83,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,inpatient,,,515.00000,278.10000,Hometown Health,Lease Networks,,489.25,,,,,,,463.50,499.55,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,outpatient,,,515.00000,278.10000,Hometown Health,Lease Networks,,489.25,,,,,,,133.90,499.55,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,inpatient,,,1467.00000,792.18000,Hometown Health,Lease Networks,,1393.65,,,,,,,1320.30,1422.99,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,outpatient,,,1467.00000,792.18000,Hometown Health,Lease Networks,,1393.65,,,,,,,381.42,1422.99,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,inpatient,,,1683.00000,888.62000,Hometown Health,Lease Networks,,1598.85,,,,,,,1514.70,1632.51,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,outpatient,,,1683.00000,888.62000,Hometown Health,Lease Networks,,1598.85,,,,,,,437.58,1632.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,inpatient,,,426.30000,225.09000,Hometown Health,Lease Networks,,404.99,,,,,,,383.67,413.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,426.30000,225.09000,Hometown Health,Lease Networks,,404.99,,,,,,,110.84,413.51,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,inpatient,,,725.00000,382.80000,Hometown Health,Lease Networks,,688.75,,,,,,,652.50,703.25,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,725.00000,382.80000,Hometown Health,Lease Networks,,688.75,,,,,,,188.50,1855.42,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,inpatient,,,1852.00000,977.86000,Hometown Health,Lease Networks,,1759.40,,,,,,,1666.80,1796.44,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,1852.00000,977.86000,Hometown Health,Lease Networks,,1759.40,,,,,,,481.52,1868.26,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,110.00000,58.08000,Hometown Health,Lease Networks,,104.50,,,,,,,99.00,106.70,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,110.00000,58.08000,Hometown Health,Lease Networks,,104.50,,,,,,,28.60,106.70,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,inpatient,,,98.00000,51.74000,Hometown Health,Lease Networks,,93.10,,,,,,,88.20,95.06,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,98.00000,51.74000,Hometown Health,Lease Networks,,93.10,,,,,,,25.48,1662.92,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,inpatient,,,2018.00000,1065.50000,Hometown Health,Lease Networks,,1917.10,,,,,,,1816.20,1957.46,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,2018.00000,1065.50000,Hometown Health,Lease Networks,,1917.10,,,,,,,524.68,1957.46,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,inpatient,,,4325.00000,2283.60000,Hometown Health,Lease Networks,,4108.75,,,,,,,3892.50,4195.25,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,4325.00000,2283.60000,Hometown Health,Lease Networks,,4108.75,,,,,,,1124.50,4195.25,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,inpatient,,,172.00000,90.82000,Hometown Health,Lease Networks,,163.40,,,,,,,154.80,166.84,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Hometown Health,Lease Networks,,163.40,,,,,,,44.72,166.84,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,inpatient,,,942.00000,497.38000,Hometown Health,Lease Networks,,894.90,,,,,,,847.80,913.74,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,942.00000,497.38000,Hometown Health,Lease Networks,,894.90,,,,,,,244.92,913.74,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,inpatient,,,413.00000,218.06000,Hometown Health,Lease Networks,,392.35,,,,,,,371.70,400.61,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,413.00000,218.06000,Hometown Health,Lease Networks,,392.35,,,,,,,107.38,400.61,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,inpatient,,,257.00000,135.70000,Hometown Health,Lease Networks,,244.15,,,,,,,231.30,249.29,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,outpatient,,,257.00000,135.70000,Hometown Health,Lease Networks,,244.15,,,,,,,66.82,249.29,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,inpatient,,,116.00000,61.25000,Hometown Health,Lease Networks,,110.20,,,,,,,104.40,112.52,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,116.00000,61.25000,Hometown Health,Lease Networks,,110.20,,,,,,,30.16,112.52,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,inpatient,,,463.20000,244.57000,Hometown Health,Lease Networks,,440.04,,,,,,,416.88,449.30,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,463.20000,244.57000,Hometown Health,Lease Networks,,440.04,,,,,,,120.43,449.30,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,inpatient,,,804.00000,424.51000,Hometown Health,Lease Networks,,763.80,,,,,,,723.60,779.88,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,804.00000,424.51000,Hometown Health,Lease Networks,,763.80,,,,,,,209.04,779.88,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,inpatient,,,172.00000,90.82000,Hometown Health,Lease Networks,,163.40,,,,,,,154.80,166.84,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Hometown Health,Lease Networks,,163.40,,,,,,,44.72,166.84,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,inpatient,,,354.30000,187.07000,Hometown Health,Lease Networks,,336.58,,,,,,,318.87,343.67,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,354.30000,187.07000,Hometown Health,Lease Networks,,336.58,,,,,,,92.12,343.67,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,inpatient,,,277.90000,146.73000,Hometown Health,Lease Networks,,264.00,,,,,,,250.11,269.56,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,277.90000,146.73000,Hometown Health,Lease Networks,,264.00,,,,,,,72.25,269.56,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,inpatient,,,200.00000,105.60000,Hometown Health,Lease Networks,,190.00,,,,,,,180.00,194.00,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,200.00000,105.60000,Hometown Health,Lease Networks,,190.00,,,,,,,52.00,194.00,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,inpatient,,,197.00000,63.63000,Hometown Health,Lease Networks,,187.15,,,,,,,177.30,191.09,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,outpatient,,,197.00000,63.63000,Hometown Health,Lease Networks,,187.15,,,,,,,51.22,191.09,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,inpatient,,,468.00000,151.16000,Hometown Health,Lease Networks,50,444.60,,,,,,,421.20,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,outpatient,,,468.00000,151.16000,Hometown Health,Lease Networks,50,444.60,,,,,,,121.68,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,inpatient,,,312.00000,100.78000,Hometown Health,Lease Networks,LT,296.40,,,,,,,280.80,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Hometown Health,Lease Networks,LT,296.40,,,,,,,81.12,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,inpatient,,,312.00000,100.78000,Hometown Health,Lease Networks,RT,296.40,,,,,,,280.80,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Hometown Health,Lease Networks,RT,296.40,,,,,,,81.12,302.64,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Hometown Health,Lease Networks,,430.35,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Hometown Health,Lease Networks,,430.35,,,,,,,117.78,439.41,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,inpatient,,,609.00000,196.71000,Hometown Health,Lease Networks,,578.55,,,,,,,548.10,590.73,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Hometown Health,Lease Networks,,578.55,,,,,,,158.34,590.73,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,inpatient,,,1248.00000,403.10000,Hometown Health,Lease Networks,50,1185.60,,,,,,,1123.20,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1248.00000,403.10000,Hometown Health,Lease Networks,50,1185.60,,,,,,,324.48,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,inpatient,,,832.00000,268.74000,Hometown Health,Lease Networks,LT,790.40,,,,,,,748.80,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Hometown Health,Lease Networks,LT,790.40,,,,,,,216.32,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,inpatient,,,832.00000,268.74000,Hometown Health,Lease Networks,RT,790.40,,,,,,,748.80,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Hometown Health,Lease Networks,RT,790.40,,,,,,,216.32,807.04,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,inpatient,,,4235.00000,1367.90000,Hometown Health,Lease Networks,LT,4023.25,,,,,,,3811.50,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Hometown Health,Lease Networks,LT,4023.25,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,inpatient,,,4235.00000,1367.90000,Hometown Health,Lease Networks,RT,4023.25,,,,,,,3811.50,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Hometown Health,Lease Networks,RT,4023.25,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,inpatient,,,2119.00000,684.44000,Hometown Health,Lease Networks,,2013.05,,,,,,,1907.10,2055.43,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,outpatient,,,2119.00000,684.44000,Hometown Health,Lease Networks,,2013.05,,,,,,,550.94,2055.43,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,inpatient,,,1943.00000,627.59000,Hometown Health,Lease Networks,,1845.85,,,,,,,1748.70,1884.71,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1943.00000,627.59000,Hometown Health,Lease Networks,,1845.85,,,,,,,505.18,1884.71,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,inpatient,,,1426.00000,460.60000,Hometown Health,Lease Networks,,1354.70,,,,,,,1283.40,1383.22,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,outpatient,,,1426.00000,460.60000,Hometown Health,Lease Networks,,1354.70,,,,,,,370.76,1383.22,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,inpatient,,,4202.00000,1357.25000,Hometown Health,Lease Networks,50,3991.90,,,,,,,3781.80,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,outpatient,,,4202.00000,1357.25000,Hometown Health,Lease Networks,50,3991.90,,,,,,,1092.52,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,inpatient,,,2801.00000,904.72000,Hometown Health,Lease Networks,LT,2660.95,,,,,,,2520.90,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Hometown Health,Lease Networks,LT,2660.95,,,,,,,728.26,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,inpatient,,,2801.00000,904.72000,Hometown Health,Lease Networks,RT,2660.95,,,,,,,2520.90,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Hometown Health,Lease Networks,RT,2660.95,,,,,,,728.26,2716.97,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,inpatient,,,832.00000,268.74000,Hometown Health,Lease Networks,,790.40,,,,,,,748.80,807.04,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,outpatient,,,832.00000,268.74000,Hometown Health,Lease Networks,,790.40,,,,,,,216.32,807.04,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,inpatient,,,1457.00000,470.61000,Hometown Health,Lease Networks,,1384.15,,,,,,,1311.30,1413.29,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,outpatient,,,1457.00000,470.61000,Hometown Health,Lease Networks,,1384.15,,,,,,,378.82,1413.29,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,inpatient,,,743.00000,239.99000,Hometown Health,Lease Networks,LT,705.85,,,,,,,668.70,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Hometown Health,Lease Networks,LT,705.85,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,inpatient,,,743.00000,239.99000,Hometown Health,Lease Networks,RT,705.85,,,,,,,668.70,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Hometown Health,Lease Networks,RT,705.85,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,inpatient,,,232.00000,74.94000,Hometown Health,Lease Networks,,220.40,,,,,,,208.80,225.04,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,outpatient,,,232.00000,74.94000,Hometown Health,Lease Networks,,220.40,,,,,,,60.32,225.04,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,inpatient,,,1364.00000,440.57000,Hometown Health,Lease Networks,50,1295.80,,,,,,,1227.60,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,outpatient,,,1364.00000,440.57000,Hometown Health,Lease Networks,50,1295.80,,,,,,,354.64,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,inpatient,,,909.00000,293.61000,Hometown Health,Lease Networks,LT,863.55,,,,,,,818.10,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Hometown Health,Lease Networks,LT,863.55,,,,,,,236.34,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,inpatient,,,909.00000,293.61000,Hometown Health,Lease Networks,RT,863.55,,,,,,,818.10,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Hometown Health,Lease Networks,RT,863.55,,,,,,,236.34,881.73,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,inpatient,,,510.00000,355.98000,Hometown Health,Lease Networks,,484.50,,,,,,,459.00,494.70,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,outpatient,,,510.00000,355.98000,Hometown Health,Lease Networks,,484.50,,,,,,,132.60,494.70,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,inpatient,,,1001.00000,698.70000,Hometown Health,Lease Networks,,950.95,,,,,,,900.90,970.97,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,outpatient,,,1001.00000,698.70000,Hometown Health,Lease Networks,,950.95,,,,,,,260.26,970.97,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,inpatient,,,887.00000,619.13000,Hometown Health,Lease Networks,,842.65,,,,,,,798.30,860.39,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,outpatient,,,887.00000,619.13000,Hometown Health,Lease Networks,,842.65,,,,,,,230.62,860.39,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,inpatient,,,1022.00000,713.36000,Hometown Health,Lease Networks,50,970.90,,,,,,,919.80,991.34,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,outpatient,,,1022.00000,713.36000,Hometown Health,Lease Networks,50,970.90,,,,,,,265.72,991.34,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,inpatient,,,681.00000,475.34000,Hometown Health,Lease Networks,LT,646.95,,,,,,,612.90,660.57,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Hometown Health,Lease Networks,LT,646.95,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,inpatient,,,681.00000,475.34000,Hometown Health,Lease Networks,RT,646.95,,,,,,,612.90,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Hometown Health,Lease Networks,RT,646.95,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,inpatient,,,945.00000,659.61000,Hometown Health,Lease Networks,50,897.75,,,,,,,850.50,916.65,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,outpatient,,,945.00000,659.61000,Hometown Health,Lease Networks,50,897.75,,,,,,,245.70,916.65,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,inpatient,,,630.00000,439.74000,Hometown Health,Lease Networks,LT,598.50,,,,,,,567.00,611.10,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Hometown Health,Lease Networks,LT,598.50,,,,,,,163.80,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,inpatient,,,630.00000,439.74000,Hometown Health,Lease Networks,RT,598.50,,,,,,,567.00,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Hometown Health,Lease Networks,RT,598.50,,,,,,,163.80,611.10,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,inpatient,,,577.00000,402.75000,Hometown Health,Lease Networks,,548.15,,,,,,,519.30,559.69,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,outpatient,,,577.00000,402.75000,Hometown Health,Lease Networks,,548.15,,,,,,,150.02,559.69,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,inpatient,,,433.00000,302.23000,Hometown Health,Lease Networks,,411.35,,,,,,,389.70,420.01,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,outpatient,,,433.00000,302.23000,Hometown Health,Lease Networks,,411.35,,,,,,,112.58,420.01,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,inpatient,,,331.00000,231.04000,Hometown Health,Lease Networks,,314.45,,,,,,,297.90,321.07,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,outpatient,,,331.00000,231.04000,Hometown Health,Lease Networks,,314.45,,,,,,,86.06,321.07,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,inpatient,,,662.00000,462.08000,Hometown Health,Lease Networks,,628.90,,,,,,,595.80,642.14,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,outpatient,,,662.00000,462.08000,Hometown Health,Lease Networks,,628.90,,,,,,,172.12,642.14,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,inpatient,,,752.00000,524.90000,Hometown Health,Lease Networks,,714.40,,,,,,,676.80,729.44,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,outpatient,,,752.00000,524.90000,Hometown Health,Lease Networks,,714.40,,,,,,,195.52,729.44,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,inpatient,,,182.00000,127.04000,Hometown Health,Lease Networks,,172.90,,,,,,,163.80,176.54,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Hometown Health,Lease Networks,,172.90,,,,,,,47.32,176.54,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,inpatient,,,420.00000,293.16000,Hometown Health,Lease Networks,,399.00,,,,,,,378.00,407.40,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,outpatient,,,420.00000,293.16000,Hometown Health,Lease Networks,,399.00,,,,,,,109.20,407.40,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,inpatient,,,253.00000,176.59000,Hometown Health,Lease Networks,,240.35,,,,,,,227.70,245.41,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,outpatient,,,253.00000,176.59000,Hometown Health,Lease Networks,,240.35,,,,,,,65.78,245.41,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,inpatient,,,168.00000,117.26000,Hometown Health,Lease Networks,,159.60,,,,,,,151.20,162.96,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,outpatient,,,168.00000,117.26000,Hometown Health,Lease Networks,,159.60,,,,,,,43.68,162.96,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,inpatient,,,695.00000,485.11000,Hometown Health,Lease Networks,,660.25,,,,,,,625.50,674.15,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,outpatient,,,695.00000,485.11000,Hometown Health,Lease Networks,,660.25,,,,,,,180.70,674.15,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,inpatient,,,474.00000,330.85000,Hometown Health,Lease Networks,,450.30,,,,,,,426.60,459.78,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,outpatient,,,474.00000,330.85000,Hometown Health,Lease Networks,,450.30,,,,,,,123.24,459.78,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,inpatient,,,930.00000,649.14000,Hometown Health,Lease Networks,,883.50,,,,,,,837.00,902.10,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,outpatient,,,930.00000,649.14000,Hometown Health,Lease Networks,,883.50,,,,,,,241.80,902.10,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,inpatient,,,786.00000,548.63000,Hometown Health,Lease Networks,,746.70,,,,,,,707.40,762.42,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,outpatient,,,786.00000,548.63000,Hometown Health,Lease Networks,,746.70,,,,,,,204.36,762.42,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,inpatient,,,620.00000,432.76000,Hometown Health,Lease Networks,,589.00,,,,,,,558.00,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Hometown Health,Lease Networks,,589.00,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,inpatient,,,620.00000,432.76000,Hometown Health,Lease Networks,59,589.00,,,,,,,558.00,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Hometown Health,Lease Networks,59,589.00,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,inpatient,,,435.00000,303.63000,Hometown Health,Lease Networks,,413.25,,,,,,,391.50,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Hometown Health,Lease Networks,,413.25,,,,,,,113.10,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,inpatient,,,435.00000,303.63000,Hometown Health,Lease Networks,59,413.25,,,,,,,391.50,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Hometown Health,Lease Networks,59,413.25,,,,,,,113.10,421.95,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,inpatient,,,492.00000,343.42000,Hometown Health,Lease Networks,,467.40,,,,,,,442.80,477.24,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,outpatient,,,492.00000,343.42000,Hometown Health,Lease Networks,,467.40,,,,,,,127.92,477.24,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,inpatient,,,331.00000,231.04000,Hometown Health,Lease Networks,,314.45,,,,,,,297.90,321.07,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,outpatient,,,331.00000,231.04000,Hometown Health,Lease Networks,,314.45,,,,,,,86.06,321.07,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,inpatient,,,875.00000,610.75000,Hometown Health,Lease Networks,,831.25,,,,,,,787.50,848.75,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,outpatient,,,875.00000,610.75000,Hometown Health,Lease Networks,,831.25,,,,,,,227.50,848.75,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,inpatient,,,688.00000,480.22000,Hometown Health,Lease Networks,,653.60,,,,,,,619.20,667.36,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,outpatient,,,688.00000,480.22000,Hometown Health,Lease Networks,,653.60,,,,,,,178.88,667.36,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,inpatient,,,465.00000,324.57000,Hometown Health,Lease Networks,,441.75,,,,,,,418.50,451.05,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,outpatient,,,465.00000,324.57000,Hometown Health,Lease Networks,,441.75,,,,,,,120.90,451.05,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,inpatient,,,846.00000,590.51000,Hometown Health,Lease Networks,,803.70,,,,,,,761.40,820.62,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,outpatient,,,846.00000,590.51000,Hometown Health,Lease Networks,,803.70,,,,,,,219.96,820.62,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,inpatient,,,482.00000,336.44000,Hometown Health,Lease Networks,,457.90,,,,,,,433.80,467.54,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,outpatient,,,482.00000,336.44000,Hometown Health,Lease Networks,,457.90,,,,,,,125.32,467.54,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,inpatient,,,926.00000,646.35000,Hometown Health,Lease Networks,,879.70,,,,,,,833.40,898.22,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,outpatient,,,926.00000,646.35000,Hometown Health,Lease Networks,,879.70,,,,,,,240.76,898.22,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,inpatient,,,292.00000,203.82000,Hometown Health,Lease Networks,,277.40,,,,,,,262.80,283.24,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,outpatient,,,292.00000,203.82000,Hometown Health,Lease Networks,,277.40,,,,,,,75.92,283.24,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,inpatient,,,827.00000,577.25000,Hometown Health,Lease Networks,,785.65,,,,,,,744.30,802.19,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,outpatient,,,827.00000,577.25000,Hometown Health,Lease Networks,,785.65,,,,,,,215.02,802.19,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,inpatient,,,253.00000,176.59000,Hometown Health,Lease Networks,,240.35,,,,,,,227.70,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,outpatient,,,253.00000,176.59000,Hometown Health,Lease Networks,,240.35,,,,,,,65.78,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,inpatient,,,901.00000,628.90000,Hometown Health,Lease Networks,,855.95,,,,,,,810.90,873.97,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,outpatient,,,901.00000,628.90000,Hometown Health,Lease Networks,,855.95,,,,,,,234.26,873.97,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,inpatient,,,460.00000,321.08000,Hometown Health,Lease Networks,,437.00,,,,,,,414.00,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,outpatient,,,460.00000,321.08000,Hometown Health,Lease Networks,,437.00,,,,,,,119.60,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,inpatient,,,1029.00000,718.24000,Hometown Health,Lease Networks,,977.55,,,,,,,926.10,998.13,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1029.00000,718.24000,Hometown Health,Lease Networks,,977.55,,,,,,,267.54,998.13,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,inpatient,,,959.00000,669.38000,Hometown Health,Lease Networks,,911.05,,,,,,,863.10,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,outpatient,,,959.00000,669.38000,Hometown Health,Lease Networks,,911.05,,,,,,,249.34,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,inpatient,,,558.00000,389.48000,Hometown Health,Lease Networks,,530.10,,,,,,,502.20,541.26,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,outpatient,,,558.00000,389.48000,Hometown Health,Lease Networks,,530.10,,,,,,,145.08,541.26,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,inpatient,,,705.00000,492.09000,Hometown Health,Lease Networks,,669.75,,,,,,,634.50,683.85,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,outpatient,,,705.00000,492.09000,Hometown Health,Lease Networks,,669.75,,,,,,,183.30,683.85,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,inpatient,,,249.00000,173.80000,Hometown Health,Lease Networks,,236.55,,,,,,,224.10,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,outpatient,,,249.00000,173.80000,Hometown Health,Lease Networks,,236.55,,,,,,,64.74,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,inpatient,,,427.00000,298.05000,Hometown Health,Lease Networks,,405.65,,,,,,,384.30,414.19,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,outpatient,,,427.00000,298.05000,Hometown Health,Lease Networks,,405.65,,,,,,,111.02,414.19,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,inpatient,,,737.00000,514.43000,Hometown Health,Lease Networks,,700.15,,,,,,,663.30,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Hometown Health,Lease Networks,,700.15,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,inpatient,,,737.00000,514.43000,Hometown Health,Lease Networks,59,700.15,,,,,,,663.30,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Hometown Health,Lease Networks,59,700.15,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,inpatient,,,809.00000,564.68000,Hometown Health,Lease Networks,,768.55,,,,,,,728.10,784.73,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,outpatient,,,809.00000,564.68000,Hometown Health,Lease Networks,,768.55,,,,,,,210.34,784.73,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,inpatient,,,525.00000,366.45000,Hometown Health,Lease Networks,,498.75,,,,,,,472.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,outpatient,,,525.00000,366.45000,Hometown Health,Lease Networks,,498.75,,,,,,,136.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,inpatient,,,319.00000,222.66000,Hometown Health,Lease Networks,,303.05,,,,,,,287.10,309.43,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,outpatient,,,319.00000,222.66000,Hometown Health,Lease Networks,,303.05,,,,,,,82.94,309.43,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,inpatient,,,1437.00000,678.26000,Hometown Health,Lease Networks,,1365.15,,,,,,,1293.30,1393.89,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1437.00000,678.26000,Hometown Health,Lease Networks,,1365.15,,,,,,,373.62,1393.89,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,inpatient,,,2143.00000,1011.50000,Hometown Health,Lease Networks,,2035.85,,,,,,,1928.70,2078.71,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2143.00000,1011.50000,Hometown Health,Lease Networks,,2035.85,,,,,,,557.18,2078.71,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,inpatient,,,755.00000,356.36000,Hometown Health,Lease Networks,,717.25,,,,,,,679.50,732.35,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,outpatient,,,755.00000,356.36000,Hometown Health,Lease Networks,,717.25,,,,,,,196.30,732.35,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,inpatient,,,979.00000,462.09000,Hometown Health,Lease Networks,,930.05,,,,,,,881.10,949.63,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,outpatient,,,979.00000,462.09000,Hometown Health,Lease Networks,,930.05,,,,,,,254.54,949.63,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,inpatient,,,436.00000,205.79000,Hometown Health,Lease Networks,,414.20,,,,,,,392.40,422.92,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,outpatient,,,436.00000,205.79000,Hometown Health,Lease Networks,,414.20,,,,,,,113.36,422.92,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,inpatient,,,220.00000,103.84000,Hometown Health,Lease Networks,,209.00,,,,,,,198.00,213.40,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,outpatient,,,220.00000,103.84000,Hometown Health,Lease Networks,,209.00,,,,,,,57.20,213.40,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,inpatient,,,344.00000,162.37000,Hometown Health,Lease Networks,,326.80,,,,,,,309.60,333.68,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,outpatient,,,344.00000,162.37000,Hometown Health,Lease Networks,,326.80,,,,,,,89.44,333.68,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,inpatient,,,818.00000,393.46000,Hometown Health,Lease Networks,,777.10,,,,,,,736.20,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,outpatient,,,818.00000,393.46000,Hometown Health,Lease Networks,,777.10,,,,,,,212.68,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,inpatient,,,545.00000,262.14000,Hometown Health,Lease Networks,52,517.75,,,,,,,490.50,528.65,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,outpatient,,,545.00000,262.14000,Hometown Health,Lease Networks,52,517.75,,,,,,,141.70,528.65,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,inpatient,,,1347.00000,647.91000,Hometown Health,Lease Networks,,1279.65,,,,,,,1212.30,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,outpatient,,,1347.00000,647.91000,Hometown Health,Lease Networks,,1279.65,,,,,,,350.22,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,inpatient,,,898.00000,431.94000,Hometown Health,Lease Networks,52,853.10,,,,,,,808.20,871.06,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,outpatient,,,898.00000,431.94000,Hometown Health,Lease Networks,52,853.10,,,,,,,233.48,871.06,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,inpatient,,,469.00000,225.59000,Hometown Health,Lease Networks,,445.55,,,,,,,422.10,454.93,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,outpatient,,,469.00000,225.59000,Hometown Health,Lease Networks,,445.55,,,,,,,121.94,454.93,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,inpatient,,,1762.00000,847.52000,Hometown Health,Lease Networks,,1673.90,,,,,,,1585.80,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,outpatient,,,1762.00000,847.52000,Hometown Health,Lease Networks,,1673.90,,,,,,,458.12,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,inpatient,,,627.00000,301.59000,Hometown Health,Lease Networks,,595.65,,,,,,,564.30,608.19,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,outpatient,,,627.00000,301.59000,Hometown Health,Lease Networks,,595.65,,,,,,,163.02,608.19,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,inpatient,,,590.00000,283.79000,Hometown Health,Lease Networks,,560.50,,,,,,,531.00,572.30,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,outpatient,,,590.00000,283.79000,Hometown Health,Lease Networks,,560.50,,,,,,,153.40,572.30,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,inpatient,,,1550.00000,745.55000,Hometown Health,Lease Networks,,1472.50,,,,,,,1395.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,outpatient,,,1550.00000,745.55000,Hometown Health,Lease Networks,,1472.50,,,,,,,403.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,inpatient,,,990.00000,476.19000,Hometown Health,Lease Networks,LT,940.50,,,,,,,891.00,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Hometown Health,Lease Networks,LT,940.50,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,inpatient,,,990.00000,476.19000,Hometown Health,Lease Networks,RT,940.50,,,,,,,891.00,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Hometown Health,Lease Networks,RT,940.50,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,inpatient,,,1402.00000,674.36000,Hometown Health,Lease Networks,,1331.90,,,,,,,1261.80,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,outpatient,,,1402.00000,674.36000,Hometown Health,Lease Networks,,1331.90,,,,,,,364.52,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,inpatient,,,980.00000,471.38000,Hometown Health,Lease Networks,LT,931.00,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Hometown Health,Lease Networks,LT,931.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,inpatient,,,980.00000,471.38000,Hometown Health,Lease Networks,RT,931.00,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Hometown Health,Lease Networks,RT,931.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,inpatient,,,1661.00000,798.94000,Hometown Health,Lease Networks,,1577.95,,,,,,,1494.90,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,outpatient,,,1661.00000,798.94000,Hometown Health,Lease Networks,,1577.95,,,,,,,431.86,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,inpatient,,,980.00000,471.38000,Hometown Health,Lease Networks,,931.00,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,outpatient,,,980.00000,471.38000,Hometown Health,Lease Networks,,931.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,inpatient,,,1740.00000,836.94000,Hometown Health,Lease Networks,,1653.00,,,,,,,1566.00,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1740.00000,836.94000,Hometown Health,Lease Networks,,1653.00,,,,,,,452.40,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,inpatient,,,1168.00000,561.81000,Hometown Health,Lease Networks,,1109.60,,,,,,,1051.20,1132.96,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1168.00000,561.81000,Hometown Health,Lease Networks,,1109.60,,,,,,,303.68,1132.96,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,inpatient,,,433.00000,232.09000,Hometown Health,Lease Networks,,411.35,,,,,,,389.70,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,outpatient,,,433.00000,232.09000,Hometown Health,Lease Networks,,411.35,,,,,,,112.58,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,inpatient,,,388.00000,207.97000,Hometown Health,Lease Networks,LT,368.60,,,,,,,349.20,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Hometown Health,Lease Networks,LT,368.60,,,,,,,100.88,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,inpatient,,,388.00000,207.97000,Hometown Health,Lease Networks,RT,368.60,,,,,,,349.20,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Hometown Health,Lease Networks,RT,368.60,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,inpatient,,,388.00000,207.97000,Hometown Health,Lease Networks,,368.60,,,,,,,349.20,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,outpatient,,,388.00000,207.97000,Hometown Health,Lease Networks,,368.60,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,inpatient,,,604.00000,323.74000,Hometown Health,Lease Networks,,573.80,,,,,,,543.60,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,outpatient,,,604.00000,323.74000,Hometown Health,Lease Networks,,573.80,,,,,,,157.04,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,inpatient,,,667.00000,357.51000,Hometown Health,Lease Networks,,633.65,,,,,,,600.30,646.99,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,outpatient,,,667.00000,357.51000,Hometown Health,Lease Networks,,633.65,,,,,,,173.42,646.99,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,inpatient,,,176.00000,94.34000,Hometown Health,Lease Networks,,167.20,,,,,,,158.40,170.72,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,outpatient,,,176.00000,94.34000,Hometown Health,Lease Networks,,167.20,,,,,,,45.76,170.72,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,inpatient,,,92.00000,29.72000,Hometown Health,Lease Networks,LT,87.40,,,,,,,82.80,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Hometown Health,Lease Networks,LT,87.40,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,inpatient,,,92.00000,29.72000,Hometown Health,Lease Networks,RT,87.40,,,,,,,82.80,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Hometown Health,Lease Networks,RT,87.40,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,inpatient,,,366.00000,118.22000,Hometown Health,Lease Networks,LT,347.70,,,,,,,329.40,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Hometown Health,Lease Networks,LT,347.70,,,,,,,95.16,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,inpatient,,,366.00000,118.22000,Hometown Health,Lease Networks,RT,347.70,,,,,,,329.40,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Hometown Health,Lease Networks,RT,347.70,,,,,,,95.16,355.02,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,inpatient,,,1117.00000,360.79000,Hometown Health,Lease Networks,LT,1061.15,,,,,,,1005.30,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Hometown Health,Lease Networks,LT,1061.15,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,inpatient,,,1117.00000,360.79000,Hometown Health,Lease Networks,RT,1061.15,,,,,,,1005.30,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Hometown Health,Lease Networks,RT,1061.15,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,inpatient,,,559.00000,180.56000,Hometown Health,Lease Networks,,531.05,,,,,,,503.10,542.23,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,outpatient,,,559.00000,180.56000,Hometown Health,Lease Networks,,531.05,,,,,,,145.34,542.23,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,inpatient,,,252.00000,81.40000,Hometown Health,Lease Networks,50,239.40,,,,,,,226.80,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,outpatient,,,252.00000,81.40000,Hometown Health,Lease Networks,50,239.40,,,,,,,65.52,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,inpatient,,,168.00000,54.26000,Hometown Health,Lease Networks,LT,159.60,,,,,,,151.20,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Hometown Health,Lease Networks,LT,159.60,,,,,,,43.68,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,inpatient,,,168.00000,54.26000,Hometown Health,Lease Networks,RT,159.60,,,,,,,151.20,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Hometown Health,Lease Networks,RT,159.60,,,,,,,43.68,162.96,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,inpatient,,,1148.00000,370.80000,Hometown Health,Lease Networks,LT,1090.60,,,,,,,1033.20,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Hometown Health,Lease Networks,LT,1090.60,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,inpatient,,,1148.00000,370.80000,Hometown Health,Lease Networks,RT,1090.60,,,,,,,1033.20,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Hometown Health,Lease Networks,RT,1090.60,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,inpatient,,,379.00000,122.42000,Hometown Health,Lease Networks,,360.05,,,,,,,341.10,367.63,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,outpatient,,,379.00000,122.42000,Hometown Health,Lease Networks,,360.05,,,,,,,98.54,367.63,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,inpatient,,,1015.00000,327.84000,Hometown Health,Lease Networks,,964.25,,,,,,,913.50,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,outpatient,,,1015.00000,327.84000,Hometown Health,Lease Networks,,964.25,,,,,,,263.90,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,inpatient,,,591.00000,190.89000,Hometown Health,Lease Networks,,561.45,,,,,,,531.90,573.27,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,outpatient,,,591.00000,190.89000,Hometown Health,Lease Networks,,561.45,,,,,,,153.66,573.27,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,inpatient,,,271.00000,169.92000,Hometown Health,Lease Networks,,257.45,,,,,,,243.90,262.87,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,outpatient,,,271.00000,169.92000,Hometown Health,Lease Networks,,257.45,,,,,,,70.46,262.87,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,inpatient,,,211.00000,132.30000,Hometown Health,Lease Networks,LT,200.45,,,,,,,189.90,204.67,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Hometown Health,Lease Networks,LT,200.45,,,,,,,54.86,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,inpatient,,,211.00000,132.30000,Hometown Health,Lease Networks,RT,200.45,,,,,,,189.90,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Hometown Health,Lease Networks,RT,200.45,,,,,,,54.86,204.67,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,59.00000,36.99000,Hometown Health,Lease Networks,,56.05,,,,,,,53.10,57.23,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,59.00000,36.99000,Hometown Health,Lease Networks,,56.05,,,,,,,15.34,57.23,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,inpatient,,,336.00000,219.74000,Hometown Health,Lease Networks,,319.20,,,,,,,302.40,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,outpatient,,,336.00000,219.74000,Hometown Health,Lease Networks,,319.20,,,,,,,87.36,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,inpatient,,,224.00000,146.50000,Hometown Health,Lease Networks,52,212.80,,,,,,,201.60,217.28,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,outpatient,,,224.00000,146.50000,Hometown Health,Lease Networks,52,212.80,,,,,,,58.24,217.28,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,inpatient,,,63.00000,41.20000,Hometown Health,Lease Networks,,59.85,,,,,,,56.70,61.11,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,outpatient,,,63.00000,41.20000,Hometown Health,Lease Networks,,59.85,,,,,,,16.38,61.11,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Hometown Health,Lease Networks,,478.80,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Hometown Health,Lease Networks,,478.80,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Hometown Health,Lease Networks,,93.10,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Hometown Health,Lease Networks,,93.10,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Hometown Health,Lease Networks,,577.60,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Hometown Health,Lease Networks,,577.60,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Hometown Health,Lease Networks,,108.30,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Hometown Health,Lease Networks,,108.30,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Hometown Health,Lease Networks,,177.65,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Hometown Health,Lease Networks,,177.65,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Hometown Health,Lease Networks,,203.30,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Hometown Health,Lease Networks,,203.30,,,,,,,55.64,207.58,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,inpatient,,,609.00000,196.71000,Hometown Health,Lease Networks,,578.55,,,,,,,548.10,590.73,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Hometown Health,Lease Networks,,578.55,,,,,,,158.34,590.73,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,inpatient,,,863.00000,278.75000,Hometown Health,Lease Networks,,819.85,,,,,,,776.70,837.11,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Hometown Health,Lease Networks,,819.85,,,,,,,224.38,837.11,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,inpatient,,,900.00000,605.70000,Hometown Health,Lease Networks,,855.00,,,,,,,810.00,873.00,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,outpatient,,,900.00000,605.70000,Hometown Health,Lease Networks,,855.00,,,,,,,234.00,873.00,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,inpatient,,,1940.00000,1102.21000,Hometown Health,Lease Networks,,1843.00,,,,,,,1746.00,1881.80,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,outpatient,,,1940.00000,1102.21000,Hometown Health,Lease Networks,,1843.00,,,,,,,504.40,1881.80,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,inpatient,,,422.00000,239.76000,Hometown Health,Lease Networks,,400.90,,,,,,,379.80,409.34,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,outpatient,,,422.00000,239.76000,Hometown Health,Lease Networks,,400.90,,,,,,,109.72,409.34,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,inpatient,,,1430.00000,812.45000,Hometown Health,Lease Networks,,1358.50,,,,,,,1287.00,1387.10,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,outpatient,,,1430.00000,812.45000,Hometown Health,Lease Networks,,1358.50,,,,,,,371.80,1387.10,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,inpatient,,,745.00000,423.27000,Hometown Health,Lease Networks,,707.75,,,,,,,670.50,722.65,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,outpatient,,,745.00000,423.27000,Hometown Health,Lease Networks,,707.75,,,,,,,193.70,722.65,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,inpatient,,,2655.00000,2487.74000,Hometown Health,Lease Networks,,2522.25,,,,,,,2389.50,2575.35,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,outpatient,,,2655.00000,2487.74000,Hometown Health,Lease Networks,,2522.25,,,,,,,690.30,2575.35,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,inpatient,,,3990.00000,3738.63000,Hometown Health,Lease Networks,,3790.50,,,,,,,3591.00,3870.30,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,outpatient,,,3990.00000,3738.63000,Hometown Health,Lease Networks,,3790.50,,,,,,,1037.40,3870.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,inpatient,,,290.00000,271.73000,Hometown Health,Lease Networks,,275.50,,,,,,,261.00,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,outpatient,,,290.00000,271.73000,Hometown Health,Lease Networks,,275.50,,,,,,,75.40,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,inpatient,,,735.00000,688.70000,Hometown Health,Lease Networks,,698.25,,,,,,,661.50,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,outpatient,,,735.00000,688.70000,Hometown Health,Lease Networks,,698.25,,,,,,,191.10,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,inpatient,,,1475.00000,1382.08000,Hometown Health,Lease Networks,,1401.25,,,,,,,1327.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Hometown Health,Lease Networks,,1401.25,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,inpatient,,,2275.00000,2131.68000,Hometown Health,Lease Networks,,2161.25,,,,,,,2047.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,outpatient,,,2275.00000,2131.68000,Hometown Health,Lease Networks,,2161.25,,,,,,,591.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,inpatient,,,3205.00000,3003.08000,Hometown Health,Lease Networks,,3044.75,,,,,,,2884.50,3108.85,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,outpatient,,,3205.00000,3003.08000,Hometown Health,Lease Networks,,3044.75,,,,,,,833.30,3108.85,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,inpatient,,,770.00000,721.49000,Hometown Health,Lease Networks,,731.50,,,,,,,693.00,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,outpatient,,,770.00000,721.49000,Hometown Health,Lease Networks,,731.50,,,,,,,200.20,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,inpatient,,,1475.00000,1382.08000,Hometown Health,Lease Networks,,1401.25,,,,,,,1327.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Hometown Health,Lease Networks,,1401.25,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,inpatient,,,2210.00000,2070.77000,Hometown Health,Lease Networks,,2099.50,,,,,,,1989.00,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,outpatient,,,2210.00000,2070.77000,Hometown Health,Lease Networks,,2099.50,,,,,,,574.60,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,inpatient,,,2660.00000,2492.42000,Hometown Health,Lease Networks,,2527.00,,,,,,,2394.00,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,outpatient,,,2660.00000,2492.42000,Hometown Health,Lease Networks,,2527.00,,,,,,,691.60,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,inpatient,,,3560.00000,3335.72000,Hometown Health,Lease Networks,,3382.00,,,,,,,3204.00,3453.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,outpatient,,,3560.00000,3335.72000,Hometown Health,Lease Networks,,3382.00,,,,,,,925.60,3453.20,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,inpatient,,,5730.00000,3255.50000,Hometown Health,Lease Networks,,5443.50,,,,,,,5157.00,5558.10,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,outpatient,,,5730.00000,3255.50000,Hometown Health,Lease Networks,,5443.50,,,,,,,1489.80,5558.10,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,inpatient,,,3875.00000,2201.58000,Hometown Health,Lease Networks,,3681.25,,,,,,,3487.50,3758.75,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,outpatient,,,3875.00000,2201.58000,Hometown Health,Lease Networks,,3681.25,,,,,,,1007.50,3758.75,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,inpatient,,,519.00000,564.15000,Hometown Health,Lease Networks,,493.05,,,,,,,467.10,503.43,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,outpatient,,,519.00000,564.15000,Hometown Health,Lease Networks,,493.05,,,,,,,134.94,503.43,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,inpatient,,,536.00000,582.63000,Hometown Health,Lease Networks,,509.20,,,,,,,482.40,519.92,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,outpatient,,,536.00000,582.63000,Hometown Health,Lease Networks,,509.20,,,,,,,139.36,519.92,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Hometown Health,Lease Networks,,430.35,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Hometown Health,Lease Networks,,430.35,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Hometown Health,Lease Networks,,136.80,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Hometown Health,Lease Networks,,136.80,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Hometown Health,Lease Networks,,101.65,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Hometown Health,Lease Networks,,101.65,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Hometown Health,Lease Networks,,136.80,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Hometown Health,Lease Networks,,136.80,,,,,,,37.44,139.68,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Hometown Health,Lease Networks,,478.80,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Hometown Health,Lease Networks,,478.80,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Hometown Health,Lease Networks,,93.10,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Hometown Health,Lease Networks,,93.10,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Hometown Health,Lease Networks,,577.60,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Hometown Health,Lease Networks,,577.60,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Hometown Health,Lease Networks,,108.30,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Hometown Health,Lease Networks,,108.30,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Hometown Health,Lease Networks,,177.65,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Hometown Health,Lease Networks,,177.65,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Hometown Health,Lease Networks,,203.30,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Hometown Health,Lease Networks,,203.30,,,,,,,55.64,207.58,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,inpatient,,,175.00000,63.18000,Hometown Health,Lease Networks,,166.25,,,,,,,157.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,outpatient,,,175.00000,63.18000,Hometown Health,Lease Networks,,166.25,,,,,,,45.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,inpatient,,,304.00000,109.74000,Hometown Health,Lease Networks,,288.80,,,,,,,273.60,294.88,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,outpatient,,,304.00000,109.74000,Hometown Health,Lease Networks,,288.80,,,,,,,79.04,294.88,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Hometown Health,Lease Networks,,269.80,,,,,,,255.60,275.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Hometown Health,Lease Networks,,269.80,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Hometown Health,Lease Networks,,435.10,,,,,,,412.20,444.26,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Hometown Health,Lease Networks,,435.10,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,inpatient,,,438.00000,158.12000,Hometown Health,Lease Networks,,416.10,,,,,,,394.20,424.86,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,outpatient,,,438.00000,158.12000,Hometown Health,Lease Networks,,416.10,,,,,,,113.88,424.86,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Hometown Health,Lease Networks,,530.10,,,,,,,502.20,541.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Hometown Health,Lease Networks,,530.10,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Hometown Health,Lease Networks,,457.90,,,,,,,433.80,467.54,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Hometown Health,Lease Networks,,457.90,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Hometown Health,Lease Networks,,225.15,,,,,,,213.30,229.89,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Hometown Health,Lease Networks,,225.15,,,,,,,61.62,229.89,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Hometown Health,Lease Networks,,478.80,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Hometown Health,Lease Networks,,478.80,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Hometown Health,Lease Networks,,478.80,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Hometown Health,Lease Networks,,478.80,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Hometown Health,Lease Networks,,478.80,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Hometown Health,Lease Networks,,478.80,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Hometown Health,Lease Networks,,478.80,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Hometown Health,Lease Networks,,478.80,,,,,,,131.04,488.88,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Hometown Health,Lease Networks,,799.90,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Hometown Health,Lease Networks,,799.90,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Hometown Health,Lease Networks,,1000.35,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Hometown Health,Lease Networks,,1000.35,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Hometown Health,Lease Networks,,1199.85,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Hometown Health,Lease Networks,,1199.85,,,,,,,328.38,1225.11,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,inpatient,,,182.00000,127.04000,Hometown Health,Lease Networks,,172.90,,,,,,,163.80,176.54,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Hometown Health,Lease Networks,,172.90,,,,,,,47.32,176.54,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,inpatient,,,210.00000,119.31000,Hometown Health,Lease Networks,,199.50,,,,,,,189.00,203.70,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Hometown Health,Lease Networks,,199.50,,,,,,,54.60,203.70,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,inpatient,,,140.00000,79.54000,Hometown Health,Lease Networks,,133.00,,,,,,,126.00,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,outpatient,,,140.00000,79.54000,Hometown Health,Lease Networks,,133.00,,,,,,,36.40,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,inpatient,,,190.00000,107.95000,Hometown Health,Lease Networks,,180.50,,,,,,,171.00,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,outpatient,,,190.00000,107.95000,Hometown Health,Lease Networks,,180.50,,,,,,,49.40,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,inpatient,,,240.00000,136.36000,Hometown Health,Lease Networks,,228.00,,,,,,,216.00,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,outpatient,,,240.00000,136.36000,Hometown Health,Lease Networks,,228.00,,,,,,,62.40,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,inpatient,,,290.00000,164.76000,Hometown Health,Lease Networks,,275.50,,,,,,,261.00,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,outpatient,,,290.00000,164.76000,Hometown Health,Lease Networks,,275.50,,,,,,,75.40,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,inpatient,,,340.00000,193.17000,Hometown Health,Lease Networks,,323.00,,,,,,,306.00,329.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,outpatient,,,340.00000,193.17000,Hometown Health,Lease Networks,,323.00,,,,,,,88.40,329.80,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,inpatient,,,150.00000,85.22000,Hometown Health,Lease Networks,,142.50,,,,,,,135.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,outpatient,,,150.00000,85.22000,Hometown Health,Lease Networks,,142.50,,,,,,,39.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,inpatient,,,200.00000,113.63000,Hometown Health,Lease Networks,,190.00,,,,,,,180.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,outpatient,,,200.00000,113.63000,Hometown Health,Lease Networks,,190.00,,,,,,,52.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,inpatient,,,270.00000,153.40000,Hometown Health,Lease Networks,,256.50,,,,,,,243.00,261.90,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,outpatient,,,270.00000,153.40000,Hometown Health,Lease Networks,,256.50,,,,,,,70.20,261.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,inpatient,,,370.00000,210.22000,Hometown Health,Lease Networks,,351.50,,,,,,,333.00,358.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,outpatient,,,370.00000,210.22000,Hometown Health,Lease Networks,,351.50,,,,,,,96.20,358.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,inpatient,,,470.00000,267.03000,Hometown Health,Lease Networks,,446.50,,,,,,,423.00,455.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,outpatient,,,470.00000,267.03000,Hometown Health,Lease Networks,,446.50,,,,,,,122.20,455.90,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,inpatient,,,248.00000,96.22000,Hometown Health,Lease Networks,,235.60,,,,,,,223.20,240.56,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,outpatient,,,248.00000,96.22000,Hometown Health,Lease Networks,,235.60,,,,,,,64.48,240.56,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,inpatient,,,245.00000,95.06000,Hometown Health,Lease Networks,,232.75,,,,,,,220.50,237.65,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,outpatient,,,245.00000,95.06000,Hometown Health,Lease Networks,,232.75,,,,,,,63.70,237.65,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,inpatient,,,497.00000,192.84000,Hometown Health,Lease Networks,,472.15,,,,,,,447.30,482.09,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,outpatient,,,497.00000,192.84000,Hometown Health,Lease Networks,,472.15,,,,,,,129.22,482.09,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,inpatient,,,357.00000,138.52000,Hometown Health,Lease Networks,,339.15,,,,,,,321.30,346.29,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,outpatient,,,357.00000,138.52000,Hometown Health,Lease Networks,,339.15,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,inpatient,,,334.00000,129.59000,Hometown Health,Lease Networks,,317.30,,,,,,,300.60,323.98,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,outpatient,,,334.00000,129.59000,Hometown Health,Lease Networks,,317.30,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,inpatient,,,194.00000,75.27000,Hometown Health,Lease Networks,,184.30,,,,,,,174.60,188.18,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,outpatient,,,194.00000,75.27000,Hometown Health,Lease Networks,,184.30,,,,,,,50.44,188.18,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,inpatient,,,1035.00000,401.58000,Hometown Health,Lease Networks,,983.25,,,,,,,931.50,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,outpatient,,,1035.00000,401.58000,Hometown Health,Lease Networks,,983.25,,,,,,,269.10,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,inpatient,,,1137.00000,441.16000,Hometown Health,Lease Networks,,1080.15,,,,,,,1023.30,1102.89,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,outpatient,,,1137.00000,441.16000,Hometown Health,Lease Networks,,1080.15,,,,,,,295.62,1102.89,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,inpatient,,,963.00000,373.64000,Hometown Health,Lease Networks,,914.85,,,,,,,866.70,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,outpatient,,,963.00000,373.64000,Hometown Health,Lease Networks,,914.85,,,,,,,250.38,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,inpatient,,,990.00000,384.12000,Hometown Health,Lease Networks,,940.50,,,,,,,891.00,960.30,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,outpatient,,,990.00000,384.12000,Hometown Health,Lease Networks,,940.50,,,,,,,257.40,960.30,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,inpatient,,,112.00000,43.46000,Hometown Health,Lease Networks,,106.40,,,,,,,100.80,108.64,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,outpatient,,,112.00000,43.46000,Hometown Health,Lease Networks,,106.40,,,,,,,29.12,108.64,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,inpatient,,,84.00000,32.59000,Hometown Health,Lease Networks,,79.80,,,,,,,75.60,81.48,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,outpatient,,,84.00000,32.59000,Hometown Health,Lease Networks,,79.80,,,,,,,21.84,81.48,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,inpatient,,,176.00000,68.29000,Hometown Health,Lease Networks,,167.20,,,,,,,158.40,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,outpatient,,,176.00000,68.29000,Hometown Health,Lease Networks,,167.20,,,,,,,45.76,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,inpatient,,,283.00000,109.80000,Hometown Health,Lease Networks,,268.85,,,,,,,254.70,274.51,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,outpatient,,,283.00000,109.80000,Hometown Health,Lease Networks,,268.85,,,,,,,73.58,274.51,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Hometown Health,Lease Networks,,76.95,,,,,,,72.90,78.57,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Hometown Health,Lease Networks,,76.95,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Hometown Health,Lease Networks,,38.95,,,,,,,36.90,39.77,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Hometown Health,Lease Networks,,38.95,,,,,,,10.66,39.77,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,inpatient,,,35.00000,19.89000,Hometown Health,Lease Networks,,33.25,,,,,,,31.50,33.95,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,35.00000,19.89000,Hometown Health,Lease Networks,,33.25,,,,,,,9.10,33.95,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,inpatient,,,191.00000,89.39000,Hometown Health,Lease Networks,,181.45,,,,,,,171.90,185.27,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,outpatient,,,191.00000,89.39000,Hometown Health,Lease Networks,,181.45,,,,,,,49.66,185.27,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Hometown Health,Lease Networks,,430.35,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Hometown Health,Lease Networks,,430.35,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Hometown Health,Lease Networks,,136.80,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Hometown Health,Lease Networks,,136.80,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Hometown Health,Lease Networks,,101.65,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Hometown Health,Lease Networks,,101.65,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Hometown Health,Lease Networks,,136.80,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Hometown Health,Lease Networks,,136.80,,,,,,,37.44,139.68,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,inpatient,,,281.00000,131.51000,Hometown Health,Lease Networks,,266.95,,,,,,,252.90,272.57,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,outpatient,,,281.00000,131.51000,Hometown Health,Lease Networks,,266.95,,,,,,,73.06,272.57,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,inpatient,,,192.00000,89.86000,Hometown Health,Lease Networks,,182.40,,,,,,,172.80,186.24,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,outpatient,,,192.00000,89.86000,Hometown Health,Lease Networks,,182.40,,,,,,,49.92,186.24,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,inpatient,,,365.00000,170.82000,Hometown Health,Lease Networks,,346.75,,,,,,,328.50,354.05,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,outpatient,,,365.00000,170.82000,Hometown Health,Lease Networks,,346.75,,,,,,,94.90,354.05,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,inpatient,,,8391.00000,5856.92000,Hometown Health,Lease Networks,,7971.45,,,,,,,7551.90,8139.27,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,outpatient,,,8391.00000,5856.92000,Hometown Health,Lease Networks,,7971.45,,,,,,,2181.66,8139.27,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,inpatient,,,6917.00000,4828.07000,Hometown Health,Lease Networks,52,6571.15,,,,,,,6225.30,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Hometown Health,Lease Networks,52,6571.15,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,inpatient,,,6000.00000,4188.00000,Hometown Health,Lease Networks,,5700.00,,,,,,,5400.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Hometown Health,Lease Networks,,5700.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,inpatient,,,6917.00000,4828.07000,Hometown Health,Lease Networks,,6571.15,,,,,,,6225.30,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Hometown Health,Lease Networks,,6571.15,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,inpatient,,,6000.00000,4188.00000,Hometown Health,Lease Networks,52,5700.00,,,,,,,5400.00,5820.00,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Hometown Health,Lease Networks,52,5700.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,inpatient,,,8855.00000,9625.38000,Hometown Health,Lease Networks,,8412.25,,,,,,,7969.50,8589.35,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,outpatient,,,8855.00000,9625.38000,Hometown Health,Lease Networks,,8412.25,,,,,,,2302.30,8589.35,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,inpatient,,,844.00000,917.43000,Hometown Health,Lease Networks,,801.80,,,,,,,759.60,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Hometown Health,Lease Networks,,801.80,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,inpatient,,,844.00000,917.43000,Hometown Health,Lease Networks,52,801.80,,,,,,,759.60,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Hometown Health,Lease Networks,52,801.80,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,inpatient,,,785.00000,853.30000,Hometown Health,Lease Networks,,745.75,,,,,,,706.50,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Hometown Health,Lease Networks,,745.75,,,,,,,204.10,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,inpatient,,,785.00000,853.30000,Hometown Health,Lease Networks,52,745.75,,,,,,,706.50,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Hometown Health,Lease Networks,52,745.75,,,,,,,204.10,761.45,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4709.00000,5118.68000,Hometown Health,Lease Networks,,4473.55,,,,,,,4238.10,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Hometown Health,Lease Networks,,4473.55,,,,,,,1224.34,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4709.00000,5118.68000,Hometown Health,Lease Networks,52,4473.55,,,,,,,4238.10,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Hometown Health,Lease Networks,52,4473.55,,,,,,,1224.34,4567.73,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,inpatient,,,345.00000,128.34000,Hometown Health,Lease Networks,,327.75,,,,,,,310.50,334.65,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,outpatient,,,345.00000,128.34000,Hometown Health,Lease Networks,,327.75,,,,,,,89.70,334.65,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,inpatient,,,120.00000,99.60000,Hometown Health,Lease Networks,,114.00,,,,,,,108.00,116.40,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,outpatient,,,120.00000,99.60000,Hometown Health,Lease Networks,,114.00,,,,,,,31.20,116.40,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,inpatient,,,106.00000,87.98000,Hometown Health,Lease Networks,,100.70,,,,,,,95.40,102.82,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,outpatient,,,106.00000,87.98000,Hometown Health,Lease Networks,,100.70,,,,,,,27.56,102.82,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,inpatient,,,32.00000,26.56000,Hometown Health,Lease Networks,,30.40,,,,,,,28.80,31.04,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,outpatient,,,32.00000,26.56000,Hometown Health,Lease Networks,,30.40,,,,,,,8.32,31.04,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,inpatient,,,60.00000,49.80000,Hometown Health,Lease Networks,,57.00,,,,,,,54.00,58.20,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,outpatient,,,60.00000,49.80000,Hometown Health,Lease Networks,,57.00,,,,,,,15.60,58.20,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,inpatient,,,57.00000,47.31000,Hometown Health,Lease Networks,,54.15,,,,,,,51.30,55.29,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,outpatient,,,57.00000,47.31000,Hometown Health,Lease Networks,,54.15,,,,,,,14.82,55.29,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,inpatient,1.0,ME,7.40000,0.65000,Hometown Health,Lease Networks,,7.03,,,,,,,6.66,7.18,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,outpatient,1.0,ME,7.40000,0.65000,Hometown Health,Lease Networks,,7.03,,,,,,,1.92,7.18,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,inpatient,1.0,EA,6.60000,1.43000,Hometown Health,Lease Networks,UD,6.27,,,,,,,5.94,6.40,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,outpatient,1.0,EA,6.60000,1.43000,Hometown Health,Lease Networks,UD,6.27,,,,,,,1.72,6.40,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,inpatient,1.0,EA,2.95000,0.64000,Hometown Health,Lease Networks,UD,2.80,,,,,,,2.65,2.86,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,outpatient,1.0,EA,2.95000,0.64000,Hometown Health,Lease Networks,UD,2.80,,,,,,,0.76700,2.86,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,inpatient,1.0,EA,56.08000,12.11000,Hometown Health,Lease Networks,UD,53.28,,,,,,,50.47,54.40,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,56.08000,12.11000,Hometown Health,Lease Networks,UD,53.28,,,,,,,14.58,54.40,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,inpatient,1.0,UN,82.10000,28.90000,Hometown Health,Lease Networks,,78.00,,,,,,,73.89,79.64,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,outpatient,1.0,UN,82.10000,28.90000,Hometown Health,Lease Networks,,78.00,,,,,,,15.48,79.64,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.04000,,Hometown Health,Lease Networks,UD,0.03800,,,,,,,0.03600,0.03880,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.04000,,Hometown Health,Lease Networks,UD,0.03800,,,,,,,0.01040,0.03880,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.05000,,Hometown Health,Lease Networks,UD,0.04750,,,,,,,0.04500,0.04850,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.05000,,Hometown Health,Lease Networks,UD,0.04750,,,,,,,0.01300,0.04850,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,inpatient,1.0,ME,6.20000,0.55000,Hometown Health,Lease Networks,,5.89,,,,,,,5.58,6.01,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,outpatient,1.0,ME,6.20000,0.55000,Hometown Health,Lease Networks,,5.89,,,,,,,1.61,6.01,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.12000,0.01000,Hometown Health,Lease Networks,UD,0.11400,,,,,,,0.10800,0.11640,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.12000,0.01000,Hometown Health,Lease Networks,UD,0.11400,,,,,,,0.03120,0.11640,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,inpatient,2.0,ML,5.80000,1.25000,Hometown Health,Lease Networks,,5.51,,,,,,,5.22,5.63,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,outpatient,2.0,ML,5.80000,1.25000,Hometown Health,Lease Networks,,5.51,,,,,,,1.51,5.63,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,inpatient,1.0,ME,3.10000,0.27000,Hometown Health,Lease Networks,,2.94,,,,,,,2.79,3.01,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,outpatient,1.0,ME,3.10000,0.27000,Hometown Health,Lease Networks,,2.94,,,,,,,0.80600,3.01,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,inpatient,1.0,EA,44.40000,3.91000,Hometown Health,Lease Networks,,42.18,,,,,,,39.96,43.07,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,outpatient,1.0,EA,44.40000,3.91000,Hometown Health,Lease Networks,,42.18,,,,,,,11.54,43.07,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,inpatient,1.0,EA,8.26000,0.73000,Hometown Health,Lease Networks,UD,7.85,,,,,,,7.43,8.01,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,8.26000,0.73000,Hometown Health,Lease Networks,UD,7.85,,,,,,,2.15,8.01,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,2.19000,0.19000,Hometown Health,Lease Networks,UD,2.08,,,,,,,1.97,2.12,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,2.19000,0.19000,Hometown Health,Lease Networks,UD,2.08,,,,,,,0.56940,2.12,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,inpatient,1.0,EA,28.60000,2.52000,Hometown Health,Lease Networks,,27.17,,,,,,,25.74,27.74,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,outpatient,1.0,EA,28.60000,2.52000,Hometown Health,Lease Networks,,27.17,,,,,,,7.44,27.74,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,inpatient,1.0,EA,2.58000,0.91000,Hometown Health,Lease Networks,UD,2.45,,,,,,,2.32,2.50,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,outpatient,1.0,EA,2.58000,0.91000,Hometown Health,Lease Networks,UD,2.45,,,,,,,0.67080,2.50,percent of total billed charges,
R&B OBSTETRICS PVT,3012,CDM,112,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,PPO/EPO,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,23010,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,PPO/EPO,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ICU,33019,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Hometown Health,PPO/EPO,,7884.90,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,13011,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Hometown Health,PPO/EPO,,5256.90,,,,,,,2512.00,5665.77,percent of total billed charges,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,244.00000,77.10000,Hometown Health,PPO/EPO,,219.60,,,,,,,219.60,236.68,percent of total billed charges,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,244.00000,77.10000,Hometown Health,PPO/EPO,,219.60,,,,,,,63.44,236.68,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,24075,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,PPO/EPO,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B OBSTETRICS SEMI-PVT,44073,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,PPO/EPO,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B NURSERY LEVEL 1,55160,CDM,171,RC,,,,,facility,inpatient,,,3477.00000,1975.46000,Hometown Health,PPO/EPO,,3129.30,,,,,,,2512.00,3372.69,percent of total billed charges,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,inpatient,,,16.00000,7.71000,Hometown Health,PPO/EPO,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,outpatient,,,16.00000,7.71000,Hometown Health,PPO/EPO,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,inpatient,,,210.00000,119.31000,Hometown Health,PPO/EPO,,189.00,,,,,,,189.00,203.70,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Hometown Health,PPO/EPO,,189.00,,,,,,,54.60,203.70,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,inpatient,,,380.00000,215.90000,Hometown Health,PPO/EPO,,342.00,,,,,,,342.00,368.60,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,outpatient,,,380.00000,215.90000,Hometown Health,PPO/EPO,,342.00,,,,,,,98.80,368.60,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Hometown Health,PPO/EPO,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Hometown Health,PPO/EPO,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22012,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,PPO/EPO,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ADMIN DAY SKILLED,82016,CDM,160,RC,,,,,facility,inpatient,,,1923.00000,1092.55000,Hometown Health,PPO/EPO,,1730.70,,,,,,,1730.70,3111.10,percent of total billed charges,
R&B SWING BED SKILLED,62018,CDM,160,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,PPO/EPO,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ADMIN DAY INTERMEDIATE,72017,CDM,169,RC,,,,,facility,inpatient,,,1176.00000,668.14000,Hometown Health,PPO/EPO,,1058.40,,,,,,,1058.40,3111.10,percent of total billed charges,
R&B ICU,32011,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Hometown Health,PPO/EPO,,7884.90,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,12013,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Hometown Health,PPO/EPO,,5256.90,,,,,,,2512.00,5665.77,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Hometown Health,PPO/EPO,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Hometown Health,PPO/EPO,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Hometown Health,PPO/EPO,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Hometown Health,PPO/EPO,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Hometown Health,PPO/EPO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Hometown Health,PPO/EPO,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Hometown Health,PPO/EPO,,547.20,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Hometown Health,PPO/EPO,,547.20,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Hometown Health,PPO/EPO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Hometown Health,PPO/EPO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Hometown Health,PPO/EPO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Hometown Health,PPO/EPO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Hometown Health,PPO/EPO,,192.60,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Hometown Health,PPO/EPO,,192.60,,,,,,,55.64,207.58,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,84.00000,63.59000,Hometown Health,PPO/EPO,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Hometown Health,PPO/EPO,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Hometown Health,PPO/EPO,,255.60,,,,,,,255.60,275.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Hometown Health,PPO/EPO,,255.60,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Hometown Health,PPO/EPO,,412.20,,,,,,,412.20,444.26,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Hometown Health,PPO/EPO,,412.20,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Hometown Health,PPO/EPO,,502.20,,,,,,,502.20,541.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Hometown Health,PPO/EPO,,502.20,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Hometown Health,PPO/EPO,,433.80,,,,,,,433.80,467.54,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Hometown Health,PPO/EPO,,433.80,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Hometown Health,PPO/EPO,,213.30,,,,,,,213.30,229.89,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Hometown Health,PPO/EPO,,213.30,,,,,,,61.62,229.89,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,inpatient,,,2041.00000,659.24000,Hometown Health,PPO/EPO,,1836.90,,,,,,,1836.90,1979.77,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,outpatient,,,2041.00000,659.24000,Hometown Health,PPO/EPO,,1836.90,,,,,,,530.66,1979.77,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,inpatient,,,259.00000,83.66000,Hometown Health,PPO/EPO,,233.10,,,,,,,233.10,251.23,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,outpatient,,,259.00000,83.66000,Hometown Health,PPO/EPO,,233.10,,,,,,,67.34,251.23,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,inpatient,,,672.00000,217.06000,Hometown Health,PPO/EPO,,604.80,,,,,,,604.80,651.84,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,outpatient,,,672.00000,217.06000,Hometown Health,PPO/EPO,,604.80,,,,,,,174.72,651.84,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,inpatient,,,530.00000,171.19000,Hometown Health,PPO/EPO,,477.00,,,,,,,477.00,514.10,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,outpatient,,,530.00000,171.19000,Hometown Health,PPO/EPO,,477.00,,,,,,,137.80,514.10,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,inpatient,,,580.00000,187.34000,Hometown Health,PPO/EPO,,522.00,,,,,,,522.00,562.60,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,outpatient,,,580.00000,187.34000,Hometown Health,PPO/EPO,,522.00,,,,,,,150.80,562.60,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,inpatient,,,435.00000,140.50000,Hometown Health,PPO/EPO,,391.50,,,,,,,391.50,421.95,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,outpatient,,,435.00000,140.50000,Hometown Health,PPO/EPO,,391.50,,,,,,,113.10,421.95,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,inpatient,,,863.00000,278.75000,Hometown Health,PPO/EPO,,776.70,,,,,,,776.70,837.11,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Hometown Health,PPO/EPO,,776.70,,,,,,,224.38,837.11,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,inpatient,,,334.00000,107.88000,Hometown Health,PPO/EPO,,300.60,,,,,,,300.60,323.98,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,outpatient,,,334.00000,107.88000,Hometown Health,PPO/EPO,,300.60,,,,,,,86.84,323.98,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,inpatient,,,1188.00000,383.72000,Hometown Health,PPO/EPO,50,1069.20,,,,,,,1069.20,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,outpatient,,,1188.00000,383.72000,Hometown Health,PPO/EPO,50,1069.20,,,,,,,308.88,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,inpatient,,,792.00000,255.82000,Hometown Health,PPO/EPO,LT,712.80,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Hometown Health,PPO/EPO,LT,712.80,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,inpatient,,,792.00000,255.82000,Hometown Health,PPO/EPO,RT,712.80,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Hometown Health,PPO/EPO,RT,712.80,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,inpatient,,,572.00000,184.76000,Hometown Health,PPO/EPO,50,514.80,,,,,,,514.80,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,outpatient,,,572.00000,184.76000,Hometown Health,PPO/EPO,50,514.80,,,,,,,148.72,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,inpatient,,,381.00000,123.06000,Hometown Health,PPO/EPO,LT,342.90,,,,,,,342.90,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Hometown Health,PPO/EPO,LT,342.90,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,inpatient,,,381.00000,123.06000,Hometown Health,PPO/EPO,RT,342.90,,,,,,,342.90,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Hometown Health,PPO/EPO,RT,342.90,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,inpatient,,,455.00000,146.96000,Hometown Health,PPO/EPO,,409.50,,,,,,,409.50,441.35,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,outpatient,,,455.00000,146.96000,Hometown Health,PPO/EPO,,409.50,,,,,,,118.30,441.35,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,inpatient,,,403.00000,130.17000,Hometown Health,PPO/EPO,,362.70,,,,,,,362.70,390.91,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,outpatient,,,403.00000,130.17000,Hometown Health,PPO/EPO,,362.70,,,,,,,104.78,390.91,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,inpatient,,,370.00000,119.51000,Hometown Health,PPO/EPO,,333.00,,,,,,,333.00,358.90,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,outpatient,,,370.00000,119.51000,Hometown Health,PPO/EPO,,333.00,,,,,,,96.20,358.90,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,inpatient,,,357.00000,115.31000,Hometown Health,PPO/EPO,,321.30,,,,,,,321.30,346.29,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,outpatient,,,357.00000,115.31000,Hometown Health,PPO/EPO,,321.30,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,inpatient,,,334.00000,107.88000,Hometown Health,PPO/EPO,,300.60,,,,,,,300.60,323.98,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,outpatient,,,334.00000,107.88000,Hometown Health,PPO/EPO,,300.60,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,inpatient,,,194.00000,62.66000,Hometown Health,PPO/EPO,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,outpatient,,,194.00000,62.66000,Hometown Health,PPO/EPO,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,inpatient,,,457.00000,147.61000,Hometown Health,PPO/EPO,,411.30,,,,,,,411.30,443.29,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,outpatient,,,457.00000,147.61000,Hometown Health,PPO/EPO,,411.30,,,,,,,118.82,443.29,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,inpatient,,,492.00000,158.92000,Hometown Health,PPO/EPO,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,outpatient,,,492.00000,158.92000,Hometown Health,PPO/EPO,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,inpatient,,,780.00000,251.94000,Hometown Health,PPO/EPO,,702.00,,,,,,,702.00,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,outpatient,,,780.00000,251.94000,Hometown Health,PPO/EPO,,702.00,,,,,,,202.80,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,inpatient,,,1165.00000,376.30000,Hometown Health,PPO/EPO,,1048.50,,,,,,,1048.50,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,outpatient,,,1165.00000,376.30000,Hometown Health,PPO/EPO,,1048.50,,,,,,,302.90,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,inpatient,,,2350.00000,759.05000,Hometown Health,PPO/EPO,,2115.00,,,,,,,2115.00,2279.50,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,outpatient,,,2350.00000,759.05000,Hometown Health,PPO/EPO,,2115.00,,,,,,,611.00,2279.50,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,inpatient,,,896.00000,289.41000,Hometown Health,PPO/EPO,,806.40,,,,,,,806.40,869.12,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,outpatient,,,896.00000,289.41000,Hometown Health,PPO/EPO,,806.40,,,,,,,232.96,869.12,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,inpatient,,,490.00000,158.27000,Hometown Health,PPO/EPO,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,outpatient,,,490.00000,158.27000,Hometown Health,PPO/EPO,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,inpatient,,,520.00000,167.96000,Hometown Health,PPO/EPO,,468.00,,,,,,,468.00,504.40,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,outpatient,,,520.00000,167.96000,Hometown Health,PPO/EPO,,468.00,,,,,,,135.20,504.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,inpatient,,,720.00000,232.56000,Hometown Health,PPO/EPO,,648.00,,,,,,,648.00,698.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,outpatient,,,720.00000,232.56000,Hometown Health,PPO/EPO,,648.00,,,,,,,187.20,698.40,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,inpatient,,,215.00000,69.45000,Hometown Health,PPO/EPO,,193.50,,,,,,,193.50,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,outpatient,,,215.00000,69.45000,Hometown Health,PPO/EPO,,193.50,,,,,,,55.90,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,inpatient,,,240.00000,77.52000,Hometown Health,PPO/EPO,,216.00,,,,,,,216.00,232.80,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,outpatient,,,240.00000,77.52000,Hometown Health,PPO/EPO,,216.00,,,,,,,62.40,232.80,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,inpatient,,,1241.00000,400.84000,Hometown Health,PPO/EPO,,1116.90,,,,,,,1116.90,1203.77,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,outpatient,,,1241.00000,400.84000,Hometown Health,PPO/EPO,,1116.90,,,,,,,322.66,1203.77,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Hometown Health,PPO/EPO,,757.80,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Hometown Health,PPO/EPO,,757.80,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Hometown Health,PPO/EPO,,947.70,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Hometown Health,PPO/EPO,,947.70,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Hometown Health,PPO/EPO,,1136.70,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Hometown Health,PPO/EPO,,1136.70,,,,,,,328.38,1225.11,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,inpatient,,,668.00000,559.78000,Hometown Health,PPO/EPO,,601.20,,,,,,,601.20,647.96,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,outpatient,,,668.00000,559.78000,Hometown Health,PPO/EPO,,601.20,,,,,,,173.68,647.96,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Hometown Health,PPO/EPO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Hometown Health,PPO/EPO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Hometown Health,PPO/EPO,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Hometown Health,PPO/EPO,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Hometown Health,PPO/EPO,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Hometown Health,PPO/EPO,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Hometown Health,PPO/EPO,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Hometown Health,PPO/EPO,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Hometown Health,PPO/EPO,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Hometown Health,PPO/EPO,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Hometown Health,PPO/EPO,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Hometown Health,PPO/EPO,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Hometown Health,PPO/EPO,,3.06,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Hometown Health,PPO/EPO,,3.06,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Hometown Health,PPO/EPO,,3.06,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Hometown Health,PPO/EPO,,3.06,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Hometown Health,PPO/EPO,,3.06,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Hometown Health,PPO/EPO,,3.06,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,4.90000,2.78000,Hometown Health,PPO/EPO,,4.41,,,,,,,4.41,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Hometown Health,PPO/EPO,,4.41,,,,,,,1.27,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,7.90000,4.49000,Hometown Health,PPO/EPO,,7.11,,,,,,,7.11,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,7.90000,4.49000,Hometown Health,PPO/EPO,,7.11,,,,,,,2.05,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,4.90000,2.78000,Hometown Health,PPO/EPO,,4.41,,,,,,,4.41,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Hometown Health,PPO/EPO,,4.41,,,,,,,1.27,4.75,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Hometown Health,PPO/EPO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Hometown Health,PPO/EPO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Hometown Health,PPO/EPO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Hometown Health,PPO/EPO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Hometown Health,PPO/EPO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Hometown Health,PPO/EPO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,inpatient,,,3141500.00000,1784843.22000,Hometown Health,PPO/EPO,,2827350.00,,,,,,,2827350.00,3047255.00,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,outpatient,,,3141500.00000,1784843.22000,Hometown Health,PPO/EPO,,2827350.00,,,,,,,816790.00,3047255.00,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Hometown Health,PPO/EPO,UD,0.19800,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Hometown Health,PPO/EPO,UD,0.19800,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.52000,0.30000,Hometown Health,PPO/EPO,UD,0.46800,,,,,,,0.46800,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.52000,0.30000,Hometown Health,PPO/EPO,UD,0.46800,,,,,,,0.13520,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.56000,0.32000,Hometown Health,PPO/EPO,UD,0.50400,,,,,,,0.50400,0.54320,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.56000,0.32000,Hometown Health,PPO/EPO,UD,0.50400,,,,,,,0.14560,0.54320,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Hometown Health,PPO/EPO,UD,0.19800,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Hometown Health,PPO/EPO,UD,0.19800,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.85000,0.48000,Hometown Health,PPO/EPO,UD,0.76500,,,,,,,0.76500,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.85000,0.48000,Hometown Health,PPO/EPO,UD,0.76500,,,,,,,0.22100,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Hometown Health,PPO/EPO,UD,0.19800,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Hometown Health,PPO/EPO,UD,0.19800,,,,,,,0.05720,0.21340,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,inpatient,,,102.00000,65.18000,Hometown Health,PPO/EPO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,outpatient,,,102.00000,65.18000,Hometown Health,PPO/EPO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,inpatient,,,190.00000,121.41000,Hometown Health,PPO/EPO,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,outpatient,,,190.00000,121.41000,Hometown Health,PPO/EPO,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,inpatient,,,359.00000,229.40000,Hometown Health,PPO/EPO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Hometown Health,PPO/EPO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,inpatient,,,535.00000,341.86000,Hometown Health,PPO/EPO,,481.50,,,,,,,481.50,518.95,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Hometown Health,PPO/EPO,,481.50,,,,,,,139.10,518.95,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,inpatient,,,766.00000,489.47000,Hometown Health,PPO/EPO,,689.40,,,,,,,689.40,743.02,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,outpatient,,,766.00000,489.47000,Hometown Health,PPO/EPO,,689.40,,,,,,,199.16,743.02,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,inpatient,,,159.00000,101.60000,Hometown Health,PPO/EPO,,143.10,,,,,,,143.10,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,outpatient,,,159.00000,101.60000,Hometown Health,PPO/EPO,,143.10,,,,,,,41.34,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,inpatient,,,447.00000,285.63000,Hometown Health,PPO/EPO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,outpatient,,,447.00000,285.63000,Hometown Health,PPO/EPO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,inpatient,,,1413.00000,902.91000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,outpatient,,,1413.00000,902.91000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,inpatient,,,3853.00000,2462.07000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,outpatient,,,3853.00000,2462.07000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,inpatient,,,313.00000,200.01000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,outpatient,,,313.00000,200.01000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,inpatient,,,1132.00000,723.35000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,outpatient,,,1132.00000,723.35000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,inpatient,,,2695.00000,1722.10000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,outpatient,,,2695.00000,1722.10000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,inpatient,,,1619.00000,1034.54000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,outpatient,,,1619.00000,1034.54000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,inpatient,,,535.00000,341.86000,Hometown Health,PPO/EPO,,481.50,,,,,,,481.50,518.95,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Hometown Health,PPO/EPO,,481.50,,,,,,,139.10,518.95,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,inpatient,,,850.00000,543.15000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,outpatient,,,850.00000,543.15000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,inpatient,,,32.00000,20.45000,Hometown Health,PPO/EPO,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,outpatient,,,32.00000,20.45000,Hometown Health,PPO/EPO,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,inpatient,,,134.00000,85.63000,Hometown Health,PPO/EPO,,120.60,,,,,,,120.60,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,outpatient,,,134.00000,85.63000,Hometown Health,PPO/EPO,,120.60,,,,,,,34.84,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,inpatient,,,359.00000,229.40000,Hometown Health,PPO/EPO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Hometown Health,PPO/EPO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,inpatient,,,709.00000,453.05000,Hometown Health,PPO/EPO,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,outpatient,,,709.00000,453.05000,Hometown Health,PPO/EPO,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,inpatient,,,4880.00000,2357.04000,Hometown Health,PPO/EPO,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,outpatient,,,4880.00000,2357.04000,Hometown Health,PPO/EPO,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,inpatient,,,6024.00000,2909.59000,Hometown Health,PPO/EPO,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,outpatient,,,6024.00000,2909.59000,Hometown Health,PPO/EPO,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,PPO/EPO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,PPO/EPO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Hometown Health,PPO/EPO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Hometown Health,PPO/EPO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,inpatient,,,7413.00000,3580.48000,Hometown Health,PPO/EPO,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,outpatient,,,7413.00000,3580.48000,Hometown Health,PPO/EPO,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,PPO/EPO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,PPO/EPO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,PPO/EPO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,PPO/EPO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Hometown Health,PPO/EPO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Hometown Health,PPO/EPO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,inpatient,,,7181.00000,3468.42000,Hometown Health,PPO/EPO,,6462.90,,,,,,,6462.90,6965.57,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Hometown Health,PPO/EPO,,6462.90,,,,,,,1867.06,6965.57,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,inpatient,,,10654.00000,5145.88000,Hometown Health,PPO/EPO,,9588.60,,,,,,,9588.60,10334.38,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,outpatient,,,10654.00000,5145.88000,Hometown Health,PPO/EPO,,9588.60,,,,,,,2770.04,10334.38,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,6487.00000,3133.22000,Hometown Health,PPO/EPO,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Hometown Health,PPO/EPO,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,7413.00000,3580.48000,Hometown Health,PPO/EPO,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Hometown Health,PPO/EPO,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,11575.00000,5590.72000,Hometown Health,PPO/EPO,,10417.50,,,,,,,10417.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,11575.00000,5590.72000,Hometown Health,PPO/EPO,,10417.50,,,,,,,3009.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,13432.00000,6487.66000,Hometown Health,PPO/EPO,,12088.80,,,,,,,12088.80,13029.04,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,13432.00000,6487.66000,Hometown Health,PPO/EPO,,12088.80,,,,,,,3492.32,13029.04,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,21904.00000,10579.63000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,21904.00000,10579.63000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,4397.00000,2123.75000,Hometown Health,PPO/EPO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Hometown Health,PPO/EPO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,7413.00000,3580.48000,Hometown Health,PPO/EPO,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Hometown Health,PPO/EPO,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,12969.00000,6264.03000,Hometown Health,PPO/EPO,,11672.10,,,,,,,11672.10,12579.93,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,12969.00000,6264.03000,Hometown Health,PPO/EPO,,11672.10,,,,,,,3371.94,12579.93,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Hometown Health,PPO/EPO,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Hometown Health,PPO/EPO,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Hometown Health,PPO/EPO,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Hometown Health,PPO/EPO,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Hometown Health,PPO/EPO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Hometown Health,PPO/EPO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,inpatient,,,134.00000,64.72000,Hometown Health,PPO/EPO,,120.60,,,,,,,120.60,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Hometown Health,PPO/EPO,,120.60,,,,,,,34.84,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,inpatient,,,251.00000,121.23000,Hometown Health,PPO/EPO,,225.90,,,,,,,225.90,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,outpatient,,,251.00000,121.23000,Hometown Health,PPO/EPO,,225.90,,,,,,,65.26,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,PPO/EPO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,PPO/EPO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,2827.00000,1365.44000,Hometown Health,PPO/EPO,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Hometown Health,PPO/EPO,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,2690.00000,1299.27000,Hometown Health,PPO/EPO,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Hometown Health,PPO/EPO,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,6487.00000,3133.22000,Hometown Health,PPO/EPO,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Hometown Health,PPO/EPO,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,2426.00000,1171.76000,Hometown Health,PPO/EPO,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,2426.00000,1171.76000,Hometown Health,PPO/EPO,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,15334.00000,7406.32000,Hometown Health,PPO/EPO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,15334.00000,7406.32000,Hometown Health,PPO/EPO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Hometown Health,PPO/EPO,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Hometown Health,PPO/EPO,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,251.00000,121.23000,Hometown Health,PPO/EPO,,225.90,,,,,,,225.90,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,251.00000,121.23000,Hometown Health,PPO/EPO,,225.90,,,,,,,65.26,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,2827.00000,1365.44000,Hometown Health,PPO/EPO,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Hometown Health,PPO/EPO,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Hometown Health,PPO/EPO,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Hometown Health,PPO/EPO,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,inpatient,,,15334.00000,7406.32000,Hometown Health,PPO/EPO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Hometown Health,PPO/EPO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,inpatient,,,1485.00000,717.26000,Hometown Health,PPO/EPO,,1336.50,,,,,,,1336.50,1440.45,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,outpatient,,,1485.00000,717.26000,Hometown Health,PPO/EPO,,1336.50,,,,,,,386.10,1440.45,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,inpatient,,,2028.00000,979.52000,Hometown Health,PPO/EPO,,1825.20,,,,,,,1825.20,1967.16,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,outpatient,,,2028.00000,979.52000,Hometown Health,PPO/EPO,,1825.20,,,,,,,527.28,1967.16,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,4397.00000,2123.75000,Hometown Health,PPO/EPO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Hometown Health,PPO/EPO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,8107.00000,3915.68000,Hometown Health,PPO/EPO,,7296.30,,,,,,,7296.30,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,8107.00000,3915.68000,Hometown Health,PPO/EPO,,7296.30,,,,,,,2107.82,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,10422.00000,5033.83000,Hometown Health,PPO/EPO,,9379.80,,,,,,,9379.80,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,10422.00000,5033.83000,Hometown Health,PPO/EPO,,9379.80,,,,,,,2709.72,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,12737.00000,6151.97000,Hometown Health,PPO/EPO,,11463.30,,,,,,,11463.30,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,12737.00000,6151.97000,Hometown Health,PPO/EPO,,11463.30,,,,,,,3311.62,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,14239.00000,6877.44000,Hometown Health,PPO/EPO,,12815.10,,,,,,,12815.10,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,14239.00000,6877.44000,Hometown Health,PPO/EPO,,12815.10,,,,,,,3702.14,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,16429.00000,7935.21000,Hometown Health,PPO/EPO,,14786.10,,,,,,,14786.10,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,16429.00000,7935.21000,Hometown Health,PPO/EPO,,14786.10,,,,,,,4271.54,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,18619.00000,8992.98000,Hometown Health,PPO/EPO,,16757.10,,,,,,,16757.10,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,18619.00000,8992.98000,Hometown Health,PPO/EPO,,16757.10,,,,,,,4840.94,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,20809.00000,10050.75000,Hometown Health,PPO/EPO,,18728.10,,,,,,,18728.10,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,20809.00000,10050.75000,Hometown Health,PPO/EPO,,18728.10,,,,,,,5410.34,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,22999.00000,11108.52000,Hometown Health,PPO/EPO,,20699.10,,,,,,,20699.10,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,22999.00000,11108.52000,Hometown Health,PPO/EPO,,20699.10,,,,,,,5979.74,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,25189.00000,12166.29000,Hometown Health,PPO/EPO,,22670.10,,,,,,,22670.10,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,25189.00000,12166.29000,Hometown Health,PPO/EPO,,22670.10,,,,,,,6549.14,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,27379.00000,13224.06000,Hometown Health,PPO/EPO,,24641.10,,,,,,,24641.10,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,27379.00000,13224.06000,Hometown Health,PPO/EPO,,24641.10,,,,,,,7118.54,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,29569.00000,14281.83000,Hometown Health,PPO/EPO,,26612.10,,,,,,,26612.10,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,29569.00000,14281.83000,Hometown Health,PPO/EPO,,26612.10,,,,,,,7687.94,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,31759.00000,15339.60000,Hometown Health,PPO/EPO,,28583.10,,,,,,,28583.10,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,31759.00000,15339.60000,Hometown Health,PPO/EPO,,28583.10,,,,,,,8257.34,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,36139.00000,17455.14000,Hometown Health,PPO/EPO,,32525.10,,,,,,,32525.10,35054.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,36139.00000,17455.14000,Hometown Health,PPO/EPO,,32525.10,,,,,,,9396.14,35054.83,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Hometown Health,PPO/EPO,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Hometown Health,PPO/EPO,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Hometown Health,PPO/EPO,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Hometown Health,PPO/EPO,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,inpatient,,,134.00000,64.72000,Hometown Health,PPO/EPO,,120.60,,,,,,,120.60,129.98,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Hometown Health,PPO/EPO,,120.60,,,,,,,34.84,129.98,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Hometown Health,PPO/EPO,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Hometown Health,PPO/EPO,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,inpatient,,,476.00000,229.91000,Hometown Health,PPO/EPO,,428.40,,,,,,,428.40,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,outpatient,,,476.00000,229.91000,Hometown Health,PPO/EPO,,428.40,,,,,,,123.76,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Hometown Health,PPO/EPO,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Hometown Health,PPO/EPO,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,PPO/EPO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,PPO/EPO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,inpatient,,,12506.00000,6040.40000,Hometown Health,PPO/EPO,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,outpatient,,,12506.00000,6040.40000,Hometown Health,PPO/EPO,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,inpatient,,,2404.80000,1161.52000,Hometown Health,PPO/EPO,,2164.32,,,,,,,2164.32,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,outpatient,,,2404.80000,1161.52000,Hometown Health,PPO/EPO,,2164.32,,,,,,,625.25,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,inpatient,,,969.00000,468.03000,Hometown Health,PPO/EPO,,872.10,,,,,,,872.10,939.93,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,outpatient,,,969.00000,468.03000,Hometown Health,PPO/EPO,,872.10,,,,,,,251.94,939.93,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,inpatient,,,2256.90000,1090.08000,Hometown Health,PPO/EPO,,2031.21,,,,,,,2031.21,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,outpatient,,,2256.90000,1090.08000,Hometown Health,PPO/EPO,,2031.21,,,,,,,586.79,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,inpatient,,,644.30000,311.20000,Hometown Health,PPO/EPO,,579.87,,,,,,,579.87,624.97,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,outpatient,,,644.30000,311.20000,Hometown Health,PPO/EPO,,579.87,,,,,,,167.52,624.97,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Hometown Health,PPO/EPO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Hometown Health,PPO/EPO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Hometown Health,PPO/EPO,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Hometown Health,PPO/EPO,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,inpatient,,,26284.00000,12695.17000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,inpatient,,,30664.00000,14810.71000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,inpatient,,,35044.00000,16926.25000,Hometown Health,PPO/EPO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Hometown Health,PPO/EPO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,inpatient,,,43804.00000,21157.33000,Hometown Health,PPO/EPO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,outpatient,,,43804.00000,21157.33000,Hometown Health,PPO/EPO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,inpatient,,,52564.00000,25388.41000,Hometown Health,PPO/EPO,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,outpatient,,,52564.00000,25388.41000,Hometown Health,PPO/EPO,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,inpatient,,,61324.00000,29619.49000,Hometown Health,PPO/EPO,,55191.60,,,,,,,55191.60,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,outpatient,,,61324.00000,29619.49000,Hometown Health,PPO/EPO,,55191.60,,,,,,,15944.24,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,inpatient,,,70084.00000,33850.57000,Hometown Health,PPO/EPO,,63075.60,,,,,,,63075.60,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,outpatient,,,70084.00000,33850.57000,Hometown Health,PPO/EPO,,63075.60,,,,,,,18221.84,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,inpatient,,,78844.00000,38081.65000,Hometown Health,PPO/EPO,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,outpatient,,,78844.00000,38081.65000,Hometown Health,PPO/EPO,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,inpatient,,,87604.00000,42312.73000,Hometown Health,PPO/EPO,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,outpatient,,,87604.00000,42312.73000,Hometown Health,PPO/EPO,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,inpatient,,,96364.00000,46543.81000,Hometown Health,PPO/EPO,,86727.60,,,,,,,86727.60,93473.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,outpatient,,,96364.00000,46543.81000,Hometown Health,PPO/EPO,,86727.60,,,,,,,25054.64,93473.08,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,inpatient,,,26284.00000,12695.17000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,inpatient,,,30664.00000,14810.71000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,inpatient,,,35044.00000,16926.25000,Hometown Health,PPO/EPO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Hometown Health,PPO/EPO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,inpatient,,,39424.00000,19041.79000,Hometown Health,PPO/EPO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,outpatient,,,39424.00000,19041.79000,Hometown Health,PPO/EPO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Hometown Health,PPO/EPO,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Hometown Health,PPO/EPO,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Hometown Health,PPO/EPO,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Hometown Health,PPO/EPO,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,inpatient,,,15334.00000,7406.32000,Hometown Health,PPO/EPO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Hometown Health,PPO/EPO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,2023.00000,977.11000,Hometown Health,PPO/EPO,,1820.70,,,,,,,1820.70,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2023.00000,977.11000,Hometown Health,PPO/EPO,,1820.70,,,,,,,525.98,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,inpatient,,,7876.00000,3804.11000,Hometown Health,PPO/EPO,,7088.40,,,,,,,7088.40,7639.72,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Hometown Health,PPO/EPO,,7088.40,,,,,,,2047.76,7639.72,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,inpatient,,,10191.00000,4922.25000,Hometown Health,PPO/EPO,,9171.90,,,,,,,9171.90,9885.27,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,outpatient,,,10191.00000,4922.25000,Hometown Health,PPO/EPO,,9171.90,,,,,,,2649.66,9885.27,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,96.00000,46.37000,Hometown Health,PPO/EPO,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,96.00000,46.37000,Hometown Health,PPO/EPO,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,7876.00000,3804.11000,Hometown Health,PPO/EPO,,7088.40,,,,,,,7088.40,7639.72,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,7876.00000,3804.11000,Hometown Health,PPO/EPO,,7088.40,,,,,,,2047.76,7639.72,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Hometown Health,PPO/EPO,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Hometown Health,PPO/EPO,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,inpatient,,,5373.00000,2595.16000,Hometown Health,PPO/EPO,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,outpatient,,,5373.00000,2595.16000,Hometown Health,PPO/EPO,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,inpatient,,,6487.00000,3133.22000,Hometown Health,PPO/EPO,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,outpatient,,,6487.00000,3133.22000,Hometown Health,PPO/EPO,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,inpatient,,,7876.00000,3804.11000,Hometown Health,PPO/EPO,,7088.40,,,,,,,7088.40,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Hometown Health,PPO/EPO,,7088.40,,,,,,,2047.76,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Hometown Health,PPO/EPO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Hometown Health,PPO/EPO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,inpatient,,,1126.00000,543.86000,Hometown Health,PPO/EPO,,1013.40,,,,,,,1013.40,1092.22,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,outpatient,,,1126.00000,543.86000,Hometown Health,PPO/EPO,,1013.40,,,,,,,292.76,1092.22,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,2690.00000,1299.27000,Hometown Health,PPO/EPO,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Hometown Health,PPO/EPO,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,4880.00000,2357.04000,Hometown Health,PPO/EPO,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,4880.00000,2357.04000,Hometown Health,PPO/EPO,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,9260.00000,4472.58000,Hometown Health,PPO/EPO,,8334.00,,,,,,,8334.00,8982.20,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,9260.00000,4472.58000,Hometown Health,PPO/EPO,,8334.00,,,,,,,2407.60,8982.20,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,inpatient,,,588.00000,284.00000,Hometown Health,PPO/EPO,,529.20,,,,,,,529.20,570.36,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,588.00000,284.00000,Hometown Health,PPO/EPO,,529.20,,,,,,,152.88,570.36,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Hometown Health,PPO/EPO,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Hometown Health,PPO/EPO,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Hometown Health,PPO/EPO,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Hometown Health,PPO/EPO,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Hometown Health,PPO/EPO,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Hometown Health,PPO/EPO,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Hometown Health,PPO/EPO,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Hometown Health,PPO/EPO,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,PPO/EPO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,PPO/EPO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Hometown Health,PPO/EPO,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Hometown Health,PPO/EPO,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,inpatient,,,159.00000,76.80000,Hometown Health,PPO/EPO,,143.10,,,,,,,143.10,154.23,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,outpatient,,,159.00000,76.80000,Hometown Health,PPO/EPO,,143.10,,,,,,,41.34,154.23,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,inpatient,,,588.00000,284.00000,Hometown Health,PPO/EPO,,529.20,,,,,,,529.20,570.36,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,outpatient,,,588.00000,284.00000,Hometown Health,PPO/EPO,,529.20,,,,,,,152.88,570.36,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Hometown Health,PPO/EPO,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Hometown Health,PPO/EPO,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,PPO/EPO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,PPO/EPO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,inpatient,,,8107.00000,3915.68000,Hometown Health,PPO/EPO,,7296.30,,,,,,,7296.30,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,outpatient,,,8107.00000,3915.68000,Hometown Health,PPO/EPO,,7296.30,,,,,,,2107.82,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,inpatient,,,10422.00000,5033.83000,Hometown Health,PPO/EPO,,9379.80,,,,,,,9379.80,10109.34,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,outpatient,,,10422.00000,5033.83000,Hometown Health,PPO/EPO,,9379.80,,,,,,,2709.72,10109.34,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Hometown Health,PPO/EPO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Hometown Health,PPO/EPO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Hometown Health,PPO/EPO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Hometown Health,PPO/EPO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,inpatient,,,221.00000,106.74000,Hometown Health,PPO/EPO,,198.90,,,,,,,198.90,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,outpatient,,,221.00000,106.74000,Hometown Health,PPO/EPO,,198.90,,,,,,,57.46,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,PPO/EPO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,PPO/EPO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Hometown Health,PPO/EPO,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Hometown Health,PPO/EPO,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Hometown Health,PPO/EPO,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Hometown Health,PPO/EPO,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,inpatient,,,4153.00000,2005.90000,Hometown Health,PPO/EPO,,3737.70,,,,,,,3737.70,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,outpatient,,,4153.00000,2005.90000,Hometown Health,PPO/EPO,,3737.70,,,,,,,1079.78,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,inpatient,,,5129.00000,2477.31000,Hometown Health,PPO/EPO,,4616.10,,,,,,,4616.10,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,outpatient,,,5129.00000,2477.31000,Hometown Health,PPO/EPO,,4616.10,,,,,,,1333.54,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,inpatient,,,7181.00000,3468.42000,Hometown Health,PPO/EPO,,6462.90,,,,,,,6462.90,6965.57,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Hometown Health,PPO/EPO,,6462.90,,,,,,,1867.06,6965.57,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,inpatient,,,52.50000,25.36000,Hometown Health,PPO/EPO,,47.25,,,,,,,47.25,50.92,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,outpatient,,,52.50000,25.36000,Hometown Health,PPO/EPO,,47.25,,,,,,,13.65,50.92,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,inpatient,,,50.40000,24.34000,Hometown Health,PPO/EPO,,45.36,,,,,,,45.36,48.89,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,outpatient,,,50.40000,24.34000,Hometown Health,PPO/EPO,,45.36,,,,,,,13.10,48.89,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Hometown Health,PPO/EPO,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Hometown Health,PPO/EPO,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Hometown Health,PPO/EPO,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Hometown Health,PPO/EPO,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Hometown Health,PPO/EPO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Hometown Health,PPO/EPO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Hometown Health,PPO/EPO,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Hometown Health,PPO/EPO,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Hometown Health,PPO/EPO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Hometown Health,PPO/EPO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,inpatient,,,709.00000,342.45000,Hometown Health,PPO/EPO,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,outpatient,,,709.00000,342.45000,Hometown Health,PPO/EPO,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Hometown Health,PPO/EPO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Hometown Health,PPO/EPO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Hometown Health,PPO/EPO,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Hometown Health,PPO/EPO,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,109504.00000,62214.70000,Hometown Health,PPO/EPO,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Hometown Health,PPO/EPO,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,131404.00000,74657.18000,Hometown Health,PPO/EPO,,118263.60,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,131404.00000,74657.18000,Hometown Health,PPO/EPO,,118263.60,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,43800.00000,24884.97000,Hometown Health,PPO/EPO,,39420.00,,,,,,,39420.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,43800.00000,24884.97000,Hometown Health,PPO/EPO,,39420.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Hometown Health,PPO/EPO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Hometown Health,PPO/EPO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Hometown Health,PPO/EPO,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Hometown Health,PPO/EPO,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,19714.00000,11200.51000,Hometown Health,PPO/EPO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Hometown Health,PPO/EPO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,24090.00000,13686.73000,Hometown Health,PPO/EPO,,21681.00,,,,,,,21681.00,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,24090.00000,13686.73000,Hometown Health,PPO/EPO,,21681.00,,,,,,,6263.40,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,28474.00000,16177.50000,Hometown Health,PPO/EPO,,25626.60,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Hometown Health,PPO/EPO,,25626.60,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,17520.00000,9953.99000,Hometown Health,PPO/EPO,,15768.00,,,,,,,15768.00,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Hometown Health,PPO/EPO,,15768.00,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,21904.00000,12444.76000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,26284.00000,14933.25000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,43804.00000,24887.24000,Hometown Health,PPO/EPO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Hometown Health,PPO/EPO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Hometown Health,PPO/EPO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Hometown Health,PPO/EPO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Hometown Health,PPO/EPO,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Hometown Health,PPO/EPO,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,109504.00000,62214.70000,Hometown Health,PPO/EPO,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Hometown Health,PPO/EPO,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,6105.00000,3468.56000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,6105.00000,3468.56000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,13895.00000,7894.44000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,13895.00000,7894.44000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,21900.00000,12442.48000,Hometown Health,PPO/EPO,,19710.00,,,,,,,19710.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,21900.00000,12442.48000,Hometown Health,PPO/EPO,,19710.00,,,,,,,5694.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,35040.00000,19907.98000,Hometown Health,PPO/EPO,,31536.00,,,,,,,31536.00,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,35040.00000,19907.98000,Hometown Health,PPO/EPO,,31536.00,,,,,,,9110.40,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,43804.00000,24887.24000,Hometown Health,PPO/EPO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Hometown Health,PPO/EPO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,19714.00000,11200.51000,Hometown Health,PPO/EPO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Hometown Health,PPO/EPO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,22776.00000,12940.18000,Hometown Health,PPO/EPO,,20498.40,,,,,,,20498.40,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,22776.00000,12940.18000,Hometown Health,PPO/EPO,,20498.40,,,,,,,5921.76,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,28474.00000,16177.50000,Hometown Health,PPO/EPO,,25626.60,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Hometown Health,PPO/EPO,,25626.60,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,17520.00000,9953.99000,Hometown Health,PPO/EPO,,15768.00,,,,,,,15768.00,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Hometown Health,PPO/EPO,,15768.00,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,21904.00000,12444.76000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,26284.00000,14933.25000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,30664.00000,17421.75000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,30664.00000,17421.75000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,35044.00000,19910.25000,Hometown Health,PPO/EPO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,35044.00000,19910.25000,Hometown Health,PPO/EPO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,2157.00000,864.96000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,2157.00000,864.96000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,2695.00000,1080.70000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2695.00000,1080.70000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,3853.00000,1545.05000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,3853.00000,1545.05000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,inpatient,,,1413.00000,566.61000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,outpatient,,,1413.00000,566.61000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,3229.80000,1857.14000,Hometown Health,PPO/EPO,,2906.82,,,,,,,2906.82,3132.91,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,3229.80000,1857.14000,Hometown Health,PPO/EPO,,2906.82,,,,,,,839.75,3132.91,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,854.40000,491.28000,Hometown Health,PPO/EPO,,768.96,,,,,,,768.96,828.77,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,854.40000,491.28000,Hometown Health,PPO/EPO,,768.96,,,,,,,222.14,828.77,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1200.50000,690.29000,Hometown Health,PPO/EPO,,1080.45,,,,,,,1080.45,1164.48,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1200.50000,690.29000,Hometown Health,PPO/EPO,,1080.45,,,,,,,312.13,1164.48,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1011.00000,581.32000,Hometown Health,PPO/EPO,,909.90,,,,,,,909.90,980.67,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1011.00000,581.32000,Hometown Health,PPO/EPO,,909.90,,,,,,,262.86,980.67,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1823.80000,1048.68000,Hometown Health,PPO/EPO,,1641.42,,,,,,,1641.42,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1823.80000,1048.68000,Hometown Health,PPO/EPO,,1641.42,,,,,,,474.19,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2028.50000,1166.39000,Hometown Health,PPO/EPO,,1825.65,,,,,,,1825.65,1967.64,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2028.50000,1166.39000,Hometown Health,PPO/EPO,,1825.65,,,,,,,527.41,1967.64,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,841.00000,483.58000,Hometown Health,PPO/EPO,,756.90,,,,,,,756.90,815.77,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,841.00000,483.58000,Hometown Health,PPO/EPO,,756.90,,,,,,,218.66,815.77,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1366.20000,785.56000,Hometown Health,PPO/EPO,,1229.58,,,,,,,1229.58,1325.21,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1366.20000,785.56000,Hometown Health,PPO/EPO,,1229.58,,,,,,,355.21,1325.21,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1384.00000,795.80000,Hometown Health,PPO/EPO,,1245.60,,,,,,,1245.60,1342.48,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1384.00000,795.80000,Hometown Health,PPO/EPO,,1245.60,,,,,,,359.84,1342.48,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2458.70000,1413.75000,Hometown Health,PPO/EPO,,2212.83,,,,,,,2212.83,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2458.70000,1413.75000,Hometown Health,PPO/EPO,,2212.83,,,,,,,639.26,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2393.50000,1376.26000,Hometown Health,PPO/EPO,,2154.15,,,,,,,2154.15,2321.70,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2393.50000,1376.26000,Hometown Health,PPO/EPO,,2154.15,,,,,,,622.31,2321.70,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1369.50000,787.46000,Hometown Health,PPO/EPO,,1232.55,,,,,,,1232.55,1328.41,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1369.50000,787.46000,Hometown Health,PPO/EPO,,1232.55,,,,,,,356.07,1328.41,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2697.40000,1551.00000,Hometown Health,PPO/EPO,,2427.66,,,,,,,2427.66,2616.48,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2697.40000,1551.00000,Hometown Health,PPO/EPO,,2427.66,,,,,,,701.32,2616.48,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4621.80000,2657.54000,Hometown Health,PPO/EPO,,4159.62,,,,,,,4159.62,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4621.80000,2657.54000,Hometown Health,PPO/EPO,,4159.62,,,,,,,1201.67,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2592.50000,1490.69000,Hometown Health,PPO/EPO,,2333.25,,,,,,,2333.25,2514.72,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2592.50000,1490.69000,Hometown Health,PPO/EPO,,2333.25,,,,,,,674.05,2514.72,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Hometown Health,PPO/EPO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Hometown Health,PPO/EPO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Hometown Health,PPO/EPO,,7505.10,,,,,,,7505.10,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Hometown Health,PPO/EPO,,7505.10,,,,,,,2168.14,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Hometown Health,PPO/EPO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Hometown Health,PPO/EPO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,8107.00000,4661.52000,Hometown Health,PPO/EPO,,7296.30,,,,,,,7296.30,7863.79,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Hometown Health,PPO/EPO,,7296.30,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Hometown Health,PPO/EPO,,1013.40,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Hometown Health,PPO/EPO,,1013.40,,,,,,,292.76,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,PPO/EPO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,PPO/EPO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Hometown Health,PPO/EPO,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Hometown Health,PPO/EPO,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,inpatient,,,20152.00000,11587.40000,Hometown Health,PPO/EPO,,18136.80,,,,,,,18136.80,19547.44,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,outpatient,,,20152.00000,11587.40000,Hometown Health,PPO/EPO,,18136.80,,,,,,,5239.52,19547.44,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Hometown Health,PPO/EPO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Hometown Health,PPO/EPO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Hometown Health,PPO/EPO,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Hometown Health,PPO/EPO,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,1272.00000,731.40000,Hometown Health,PPO/EPO,,1144.80,,,,,,,1144.80,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,1272.00000,731.40000,Hometown Health,PPO/EPO,,1144.80,,,,,,,330.72,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Hometown Health,PPO/EPO,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Hometown Health,PPO/EPO,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,3078.00000,1769.85000,Hometown Health,PPO/EPO,,2770.20,,,,,,,2770.20,2985.66,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,3078.00000,1769.85000,Hometown Health,PPO/EPO,,2770.20,,,,,,,800.28,2985.66,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,70.00000,40.25000,Hometown Health,PPO/EPO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,70.00000,40.25000,Hometown Health,PPO/EPO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,102.00000,58.65000,Hometown Health,PPO/EPO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,102.00000,58.65000,Hometown Health,PPO/EPO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,221.00000,127.07000,Hometown Health,PPO/EPO,,198.90,,,,,,,198.90,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,221.00000,127.07000,Hometown Health,PPO/EPO,,198.90,,,,,,,57.46,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Hometown Health,PPO/EPO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Hometown Health,PPO/EPO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Hometown Health,PPO/EPO,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Hometown Health,PPO/EPO,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Hometown Health,PPO/EPO,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Hometown Health,PPO/EPO,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35482.00000,20402.15000,Hometown Health,PPO/EPO,,31933.80,,,,,,,31933.80,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35482.00000,20402.15000,Hometown Health,PPO/EPO,,31933.80,,,,,,,9225.32,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39862.00000,22920.65000,Hometown Health,PPO/EPO,,35875.80,,,,,,,35875.80,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39862.00000,22920.65000,Hometown Health,PPO/EPO,,35875.80,,,,,,,10364.12,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,44242.00000,25439.15000,Hometown Health,PPO/EPO,,39817.80,,,,,,,39817.80,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,44242.00000,25439.15000,Hometown Health,PPO/EPO,,39817.80,,,,,,,11502.92,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,48622.00000,27957.65000,Hometown Health,PPO/EPO,,43759.80,,,,,,,43759.80,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,48622.00000,27957.65000,Hometown Health,PPO/EPO,,43759.80,,,,,,,12641.72,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,53002.00000,30476.15000,Hometown Health,PPO/EPO,,47701.80,,,,,,,47701.80,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,53002.00000,30476.15000,Hometown Health,PPO/EPO,,47701.80,,,,,,,13780.52,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Hometown Health,PPO/EPO,,55191.60,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Hometown Health,PPO/EPO,,55191.60,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Hometown Health,PPO/EPO,,63075.60,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Hometown Health,PPO/EPO,,63075.60,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Hometown Health,PPO/EPO,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Hometown Health,PPO/EPO,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Hometown Health,PPO/EPO,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Hometown Health,PPO/EPO,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Hometown Health,PPO/EPO,,86727.60,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Hometown Health,PPO/EPO,,86727.60,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,844.00000,485.30000,Hometown Health,PPO/EPO,,759.60,,,,,,,759.60,818.68,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,844.00000,485.30000,Hometown Health,PPO/EPO,,759.60,,,,,,,219.44,818.68,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,11575.00000,6655.62000,Hometown Health,PPO/EPO,,10417.50,,,,,,,10417.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,11575.00000,6655.62000,Hometown Health,PPO/EPO,,10417.50,,,,,,,3009.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,14892.00000,8562.90000,Hometown Health,PPO/EPO,,13402.80,,,,,,,13402.80,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14892.00000,8562.90000,Hometown Health,PPO/EPO,,13402.80,,,,,,,3871.92,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,24970.00000,14357.75000,Hometown Health,PPO/EPO,,22473.00,,,,,,,22473.00,24220.90,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,24970.00000,14357.75000,Hometown Health,PPO/EPO,,22473.00,,,,,,,6492.20,24220.90,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Hometown Health,PPO/EPO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Hometown Health,PPO/EPO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Hometown Health,PPO/EPO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Hometown Health,PPO/EPO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Hometown Health,PPO/EPO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Hometown Health,PPO/EPO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Hometown Health,PPO/EPO,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Hometown Health,PPO/EPO,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,4153.00000,2387.98000,Hometown Health,PPO/EPO,,3737.70,,,,,,,3737.70,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Hometown Health,PPO/EPO,,3737.70,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,4641.00000,2668.58000,Hometown Health,PPO/EPO,,4176.90,,,,,,,4176.90,4501.77,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4641.00000,2668.58000,Hometown Health,PPO/EPO,,4176.90,,,,,,,1206.66,4501.77,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Hometown Health,PPO/EPO,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Hometown Health,PPO/EPO,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Hometown Health,PPO/EPO,,86727.60,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Hometown Health,PPO/EPO,,86727.60,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Hometown Health,PPO/EPO,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Hometown Health,PPO/EPO,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,131404.00000,75557.30000,Hometown Health,PPO/EPO,,118263.60,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Hometown Health,PPO/EPO,,118263.60,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,153304.00000,88149.80000,Hometown Health,PPO/EPO,,137973.60,,,,,,,137973.60,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,153304.00000,88149.80000,Hometown Health,PPO/EPO,,137973.60,,,,,,,39859.04,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,175204.00000,100742.30000,Hometown Health,PPO/EPO,,157683.60,,,,,,,157683.60,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,175204.00000,100742.30000,Hometown Health,PPO/EPO,,157683.60,,,,,,,45553.04,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,197104.00000,113334.80000,Hometown Health,PPO/EPO,,177393.60,,,,,,,177393.60,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,197104.00000,113334.80000,Hometown Health,PPO/EPO,,177393.60,,,,,,,51247.04,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,219004.00000,125927.30000,Hometown Health,PPO/EPO,,197103.60,,,,,,,197103.60,212433.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,219004.00000,125927.30000,Hometown Health,PPO/EPO,,197103.60,,,,,,,56941.04,212433.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Hometown Health,PPO/EPO,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Hometown Health,PPO/EPO,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,PPO/EPO,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,PPO/EPO,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Hometown Health,PPO/EPO,,51249.60,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Hometown Health,PPO/EPO,,51249.60,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Hometown Health,PPO/EPO,,55191.60,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Hometown Health,PPO/EPO,,55191.60,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,PPO/EPO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,PPO/EPO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,PPO/EPO,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,PPO/EPO,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,PPO/EPO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,PPO/EPO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Hometown Health,PPO/EPO,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Hometown Health,PPO/EPO,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Hometown Health,PPO/EPO,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Hometown Health,PPO/EPO,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Hometown Health,PPO/EPO,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Hometown Health,PPO/EPO,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Hometown Health,PPO/EPO,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Hometown Health,PPO/EPO,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,PPO/EPO,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,PPO/EPO,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Hometown Health,PPO/EPO,,51249.60,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Hometown Health,PPO/EPO,,51249.60,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Hometown Health,PPO/EPO,,55191.60,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Hometown Health,PPO/EPO,,55191.60,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Hometown Health,PPO/EPO,,63075.60,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Hometown Health,PPO/EPO,,63075.60,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Hometown Health,PPO/EPO,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Hometown Health,PPO/EPO,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Hometown Health,PPO/EPO,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Hometown Health,PPO/EPO,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Hometown Health,PPO/EPO,,86727.60,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Hometown Health,PPO/EPO,,86727.60,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Hometown Health,PPO/EPO,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Hometown Health,PPO/EPO,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,122644.00000,70520.30000,Hometown Health,PPO/EPO,,110379.60,,,,,,,110379.60,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Hometown Health,PPO/EPO,,110379.60,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,135784.00000,78075.80000,Hometown Health,PPO/EPO,,122205.60,,,,,,,122205.60,131710.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,135784.00000,78075.80000,Hometown Health,PPO/EPO,,122205.60,,,,,,,35303.84,131710.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Hometown Health,PPO/EPO,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Hometown Health,PPO/EPO,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,55630.00000,31987.25000,Hometown Health,PPO/EPO,,50067.00,,,,,,,50067.00,53961.10,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,55630.00000,31987.25000,Hometown Health,PPO/EPO,,50067.00,,,,,,,14463.80,53961.10,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Hometown Health,PPO/EPO,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Hometown Health,PPO/EPO,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,14020.00000,8061.50000,Hometown Health,PPO/EPO,,12618.00,,,,,,,12618.00,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Hometown Health,PPO/EPO,,12618.00,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,17962.00000,10328.15000,Hometown Health,PPO/EPO,,16165.80,,,,,,,16165.80,17423.14,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,17962.00000,10328.15000,Hometown Health,PPO/EPO,,16165.80,,,,,,,4670.12,17423.14,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,2421.00000,1392.07000,Hometown Health,PPO/EPO,,2178.90,,,,,,,2178.90,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,2421.00000,1392.07000,Hometown Health,PPO/EPO,,2178.90,,,,,,,629.46,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Hometown Health,PPO/EPO,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Hometown Health,PPO/EPO,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Hometown Health,PPO/EPO,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Hometown Health,PPO/EPO,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,27160.00000,15617.00000,Hometown Health,PPO/EPO,,24444.00,,,,,,,24444.00,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,27160.00000,15617.00000,Hometown Health,PPO/EPO,,24444.00,,,,,,,7061.60,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Hometown Health,PPO/EPO,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Hometown Health,PPO/EPO,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,PPO/EPO,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,PPO/EPO,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,PPO/EPO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,PPO/EPO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Hometown Health,PPO/EPO,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Hometown Health,PPO/EPO,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,28470.00000,16370.25000,Hometown Health,PPO/EPO,,25623.00,,,,,,,25623.00,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,28470.00000,16370.25000,Hometown Health,PPO/EPO,,25623.00,,,,,,,7402.20,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,43800.00000,25185.00000,Hometown Health,PPO/EPO,,39420.00,,,,,,,39420.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,43800.00000,25185.00000,Hometown Health,PPO/EPO,,39420.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,PPO/EPO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,PPO/EPO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Hometown Health,PPO/EPO,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Hometown Health,PPO/EPO,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Hometown Health,PPO/EPO,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Hometown Health,PPO/EPO,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Hometown Health,PPO/EPO,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Hometown Health,PPO/EPO,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Hometown Health,PPO/EPO,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Hometown Health,PPO/EPO,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,54754.00000,31483.55000,Hometown Health,PPO/EPO,,49278.60,,,,,,,49278.60,53111.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,54754.00000,31483.55000,Hometown Health,PPO/EPO,,49278.60,,,,,,,14236.04,53111.38,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Hometown Health,PPO/EPO,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Hometown Health,PPO/EPO,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,61320.00000,35259.00000,Hometown Health,PPO/EPO,,55188.00,,,,,,,55188.00,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,61320.00000,35259.00000,Hometown Health,PPO/EPO,,55188.00,,,,,,,15943.20,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,70080.00000,40296.00000,Hometown Health,PPO/EPO,,63072.00,,,,,,,63072.00,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,70080.00000,40296.00000,Hometown Health,PPO/EPO,,63072.00,,,,,,,18220.80,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,78840.00000,45333.00000,Hometown Health,PPO/EPO,,70956.00,,,,,,,70956.00,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,78840.00000,45333.00000,Hometown Health,PPO/EPO,,70956.00,,,,,,,20498.40,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Hometown Health,PPO/EPO,,86727.60,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Hometown Health,PPO/EPO,,86727.60,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Hometown Health,PPO/EPO,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Hometown Health,PPO/EPO,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,122644.00000,70520.30000,Hometown Health,PPO/EPO,,110379.60,,,,,,,110379.60,118964.68,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Hometown Health,PPO/EPO,,110379.60,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Hometown Health,PPO/EPO,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Hometown Health,PPO/EPO,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Hometown Health,PPO/EPO,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Hometown Health,PPO/EPO,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,1883.00000,1082.72000,Hometown Health,PPO/EPO,,1694.70,,,,,,,1694.70,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1883.00000,1082.72000,Hometown Health,PPO/EPO,,1694.70,,,,,,,489.58,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Hometown Health,PPO/EPO,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Hometown Health,PPO/EPO,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,7644.00000,4395.30000,Hometown Health,PPO/EPO,,6879.60,,,,,,,6879.60,7414.68,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,7644.00000,4395.30000,Hometown Health,PPO/EPO,,6879.60,,,,,,,1987.44,7414.68,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Hometown Health,PPO/EPO,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Hometown Health,PPO/EPO,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,inpatient,,,1614.00000,928.05000,Hometown Health,PPO/EPO,,1452.60,,,,,,,1452.60,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Hometown Health,PPO/EPO,,1452.60,,,,,,,419.64,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Hometown Health,PPO/EPO,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Hometown Health,PPO/EPO,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Hometown Health,PPO/EPO,,25626.60,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Hometown Health,PPO/EPO,,25626.60,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Hometown Health,PPO/EPO,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Hometown Health,PPO/EPO,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,37234.00000,21409.55000,Hometown Health,PPO/EPO,,33510.60,,,,,,,33510.60,36116.98,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,37234.00000,21409.55000,Hometown Health,PPO/EPO,,33510.60,,,,,,,9680.84,36116.98,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,PPO/EPO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,PPO/EPO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,PPO/EPO,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,PPO/EPO,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,PPO/EPO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,PPO/EPO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Hometown Health,PPO/EPO,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Hometown Health,PPO/EPO,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,159.00000,91.42000,Hometown Health,PPO/EPO,,143.10,,,,,,,143.10,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,159.00000,91.42000,Hometown Health,PPO/EPO,,143.10,,,,,,,41.34,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Hometown Health,PPO/EPO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Hometown Health,PPO/EPO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Hometown Health,PPO/EPO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Hometown Health,PPO/EPO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Hometown Health,PPO/EPO,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Hometown Health,PPO/EPO,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2827.00000,1625.52000,Hometown Health,PPO/EPO,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Hometown Health,PPO/EPO,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Hometown Health,PPO/EPO,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Hometown Health,PPO/EPO,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8107.00000,4661.52000,Hometown Health,PPO/EPO,,7296.30,,,,,,,7296.30,7863.79,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Hometown Health,PPO/EPO,,7296.30,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,PPO/EPO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,PPO/EPO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Hometown Health,PPO/EPO,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Hometown Health,PPO/EPO,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Hometown Health,PPO/EPO,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Hometown Health,PPO/EPO,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,131404.00000,75557.30000,Hometown Health,PPO/EPO,,118263.60,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Hometown Health,PPO/EPO,,118263.60,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,18400.00000,10580.00000,Hometown Health,PPO/EPO,,16560.00,,,,,,,16560.00,17848.00,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,18400.00000,10580.00000,Hometown Health,PPO/EPO,,16560.00,,,,,,,4784.00,17848.00,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Hometown Health,PPO/EPO,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Hometown Health,PPO/EPO,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Hometown Health,PPO/EPO,,25626.60,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Hometown Health,PPO/EPO,,25626.60,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Hometown Health,PPO/EPO,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Hometown Health,PPO/EPO,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1614.00000,928.05000,Hometown Health,PPO/EPO,,1452.60,,,,,,,1452.60,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Hometown Health,PPO/EPO,,1452.60,,,,,,,419.64,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Hometown Health,PPO/EPO,,51249.60,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Hometown Health,PPO/EPO,,51249.60,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,PPO/EPO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,PPO/EPO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,5368.00000,3086.60000,Hometown Health,PPO/EPO,,4831.20,,,,,,,4831.20,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,5368.00000,3086.60000,Hometown Health,PPO/EPO,,4831.20,,,,,,,1395.68,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,14020.00000,8061.50000,Hometown Health,PPO/EPO,,12618.00,,,,,,,12618.00,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Hometown Health,PPO/EPO,,12618.00,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,25408.00000,14609.60000,Hometown Health,PPO/EPO,,22867.20,,,,,,,22867.20,24645.76,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,25408.00000,14609.60000,Hometown Health,PPO/EPO,,22867.20,,,,,,,6606.08,24645.76,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,8112.00000,4664.40000,Hometown Health,PPO/EPO,,7300.80,,,,,,,7300.80,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,8112.00000,4664.40000,Hometown Health,PPO/EPO,,7300.80,,,,,,,2109.12,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,10431.00000,5997.82000,Hometown Health,PPO/EPO,,9387.90,,,,,,,9387.90,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,10431.00000,5997.82000,Hometown Health,PPO/EPO,,9387.90,,,,,,,2712.06,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Hometown Health,PPO/EPO,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Hometown Health,PPO/EPO,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,46870.00000,26950.25000,Hometown Health,PPO/EPO,,42183.00,,,,,,,42183.00,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,46870.00000,26950.25000,Hometown Health,PPO/EPO,,42183.00,,,,,,,12186.20,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,51250.00000,29468.75000,Hometown Health,PPO/EPO,,46125.00,,,,,,,46125.00,49712.50,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,51250.00000,29468.75000,Hometown Health,PPO/EPO,,46125.00,,,,,,,13325.00,49712.50,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,PPO/EPO,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,PPO/EPO,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,PPO/EPO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,PPO/EPO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Hometown Health,PPO/EPO,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Hometown Health,PPO/EPO,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Hometown Health,PPO/EPO,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Hometown Health,PPO/EPO,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,588.00000,338.10000,Hometown Health,PPO/EPO,,529.20,,,,,,,529.20,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,588.00000,338.10000,Hometown Health,PPO/EPO,,529.20,,,,,,,152.88,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,PPO/EPO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,PPO/EPO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Hometown Health,PPO/EPO,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Hometown Health,PPO/EPO,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,PPO/EPO,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,PPO/EPO,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Hometown Health,PPO/EPO,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Hometown Health,PPO/EPO,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,7876.00000,4528.70000,Hometown Health,PPO/EPO,,7088.40,,,,,,,7088.40,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7876.00000,4528.70000,Hometown Health,PPO/EPO,,7088.40,,,,,,,2047.76,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Hometown Health,PPO/EPO,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Hometown Health,PPO/EPO,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5856.00000,3367.20000,Hometown Health,PPO/EPO,,5270.40,,,,,,,5270.40,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5856.00000,3367.20000,Hometown Health,PPO/EPO,,5270.40,,,,,,,1522.56,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Hometown Health,PPO/EPO,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Hometown Health,PPO/EPO,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Hometown Health,PPO/EPO,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Hometown Health,PPO/EPO,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Hometown Health,PPO/EPO,,7505.10,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Hometown Health,PPO/EPO,,7505.10,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,PPO/EPO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,PPO/EPO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,PPO/EPO,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,PPO/EPO,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Hometown Health,PPO/EPO,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Hometown Health,PPO/EPO,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Hometown Health,PPO/EPO,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Hometown Health,PPO/EPO,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,PPO/EPO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,PPO/EPO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,PPO/EPO,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,PPO/EPO,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Hometown Health,PPO/EPO,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Hometown Health,PPO/EPO,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Hometown Health,PPO/EPO,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Hometown Health,PPO/EPO,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4392.00000,2525.40000,Hometown Health,PPO/EPO,,3952.80,,,,,,,3952.80,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4392.00000,2525.40000,Hometown Health,PPO/EPO,,3952.80,,,,,,,1141.92,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,PPO/EPO,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,PPO/EPO,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Hometown Health,PPO/EPO,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Hometown Health,PPO/EPO,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,PPO/EPO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,PPO/EPO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,PPO/EPO,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,PPO/EPO,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Hometown Health,PPO/EPO,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Hometown Health,PPO/EPO,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Hometown Health,PPO/EPO,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Hometown Health,PPO/EPO,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Hometown Health,PPO/EPO,,1013.40,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Hometown Health,PPO/EPO,,1013.40,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,PPO/EPO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,PPO/EPO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,PPO/EPO,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,PPO/EPO,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Hometown Health,PPO/EPO,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Hometown Health,PPO/EPO,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Hometown Health,PPO/EPO,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Hometown Health,PPO/EPO,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Hometown Health,PPO/EPO,,12223.80,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Hometown Health,PPO/EPO,,12223.80,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2152.00000,1237.40000,Hometown Health,PPO/EPO,,1936.80,,,,,,,1936.80,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2152.00000,1237.40000,Hometown Health,PPO/EPO,,1936.80,,,,,,,559.52,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Hometown Health,PPO/EPO,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Hometown Health,PPO/EPO,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Hometown Health,PPO/EPO,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Hometown Health,PPO/EPO,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Hometown Health,PPO/EPO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Hometown Health,PPO/EPO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Hometown Health,PPO/EPO,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Hometown Health,PPO/EPO,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,PPO/EPO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,PPO/EPO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,PPO/EPO,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,PPO/EPO,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Hometown Health,PPO/EPO,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Hometown Health,PPO/EPO,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Hometown Health,PPO/EPO,,1013.40,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Hometown Health,PPO/EPO,,1013.40,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,PPO/EPO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,PPO/EPO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,PPO/EPO,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,PPO/EPO,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Hometown Health,PPO/EPO,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Hometown Health,PPO/EPO,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Hometown Health,PPO/EPO,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Hometown Health,PPO/EPO,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Hometown Health,PPO/EPO,,12223.80,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Hometown Health,PPO/EPO,,12223.80,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,PPO/EPO,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,PPO/EPO,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8802.00000,5061.15000,Hometown Health,PPO/EPO,,7921.80,,,,,,,7921.80,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8802.00000,5061.15000,Hometown Health,PPO/EPO,,7921.80,,,,,,,2288.52,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,10654.00000,6126.05000,Hometown Health,PPO/EPO,,9588.60,,,,,,,9588.60,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10654.00000,6126.05000,Hometown Health,PPO/EPO,,9588.60,,,,,,,2770.04,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Hometown Health,PPO/EPO,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Hometown Health,PPO/EPO,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Hometown Health,PPO/EPO,,12223.80,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Hometown Health,PPO/EPO,,12223.80,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17086.00000,9824.45000,Hometown Health,PPO/EPO,,15377.40,,,,,,,15377.40,16573.42,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17086.00000,9824.45000,Hometown Health,PPO/EPO,,15377.40,,,,,,,4442.36,16573.42,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Hometown Health,PPO/EPO,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Hometown Health,PPO/EPO,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Hometown Health,PPO/EPO,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Hometown Health,PPO/EPO,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Hometown Health,PPO/EPO,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Hometown Health,PPO/EPO,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Hometown Health,PPO/EPO,,7505.10,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Hometown Health,PPO/EPO,,7505.10,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Hometown Health,PPO/EPO,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Hometown Health,PPO/EPO,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Hometown Health,PPO/EPO,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Hometown Health,PPO/EPO,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Hometown Health,PPO/EPO,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Hometown Health,PPO/EPO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Hometown Health,PPO/EPO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Hometown Health,PPO/EPO,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Hometown Health,PPO/EPO,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Hometown Health,PPO/EPO,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Hometown Health,PPO/EPO,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Hometown Health,PPO/EPO,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Hometown Health,PPO/EPO,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Hometown Health,PPO/EPO,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Hometown Health,PPO/EPO,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Hometown Health,PPO/EPO,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Hometown Health,PPO/EPO,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Hometown Health,PPO/EPO,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2827.00000,1625.52000,Hometown Health,PPO/EPO,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Hometown Health,PPO/EPO,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Hometown Health,PPO/EPO,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Hometown Health,PPO/EPO,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4153.00000,2387.98000,Hometown Health,PPO/EPO,,3737.70,,,,,,,3737.70,4028.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Hometown Health,PPO/EPO,,3737.70,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Hometown Health,PPO/EPO,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Hometown Health,PPO/EPO,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Hometown Health,PPO/EPO,,7505.10,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Hometown Health,PPO/EPO,,7505.10,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9728.00000,5593.60000,Hometown Health,PPO/EPO,,8755.20,,,,,,,8755.20,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9728.00000,5593.60000,Hometown Health,PPO/EPO,,8755.20,,,,,,,2529.28,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11117.00000,6392.28000,Hometown Health,PPO/EPO,,10005.30,,,,,,,10005.30,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11117.00000,6392.28000,Hometown Health,PPO/EPO,,10005.30,,,,,,,2890.42,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Hometown Health,PPO/EPO,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Hometown Health,PPO/EPO,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,PPO/EPO,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,PPO/EPO,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Hometown Health,PPO/EPO,,51249.60,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Hometown Health,PPO/EPO,,51249.60,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Hometown Health,PPO/EPO,,55191.60,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Hometown Health,PPO/EPO,,55191.60,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,PPO/EPO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,PPO/EPO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Hometown Health,PPO/EPO,,63075.60,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Hometown Health,PPO/EPO,,63075.60,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,74464.00000,42816.80000,Hometown Health,PPO/EPO,,67017.60,,,,,,,67017.60,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Hometown Health,PPO/EPO,,67017.60,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Hometown Health,PPO/EPO,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Hometown Health,PPO/EPO,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,83224.00000,47853.80000,Hometown Health,PPO/EPO,,74901.60,,,,,,,74901.60,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Hometown Health,PPO/EPO,,74901.60,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,111694.00000,64224.05000,Hometown Health,PPO/EPO,,100524.60,,,,,,,100524.60,108343.18,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,111694.00000,64224.05000,Hometown Health,PPO/EPO,,100524.60,,,,,,,29040.44,108343.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Hometown Health,PPO/EPO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Hometown Health,PPO/EPO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Hometown Health,PPO/EPO,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Hometown Health,PPO/EPO,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,991.00000,569.82000,Hometown Health,PPO/EPO,,891.90,,,,,,,891.90,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,991.00000,569.82000,Hometown Health,PPO/EPO,,891.90,,,,,,,257.66,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1490.00000,856.75000,Hometown Health,PPO/EPO,,1341.00,,,,,,,1341.00,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1490.00000,856.75000,Hometown Health,PPO/EPO,,1341.00,,,,,,,387.40,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Hometown Health,PPO/EPO,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Hometown Health,PPO/EPO,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Hometown Health,PPO/EPO,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Hometown Health,PPO/EPO,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Hometown Health,PPO/EPO,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Hometown Health,PPO/EPO,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Hometown Health,PPO/EPO,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Hometown Health,PPO/EPO,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Hometown Health,PPO/EPO,,7505.10,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Hometown Health,PPO/EPO,,7505.10,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Hometown Health,PPO/EPO,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Hometown Health,PPO/EPO,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,6945.00000,3993.37000,Hometown Health,PPO/EPO,,6250.50,,,,,,,6250.50,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,6945.00000,3993.37000,Hometown Health,PPO/EPO,,6250.50,,,,,,,1805.70,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Hometown Health,PPO/EPO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Hometown Health,PPO/EPO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Hometown Health,PPO/EPO,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Hometown Health,PPO/EPO,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Hometown Health,PPO/EPO,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Hometown Health,PPO/EPO,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Hometown Health,PPO/EPO,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,50374.00000,28965.05000,Hometown Health,PPO/EPO,,45336.60,,,,,,,45336.60,48862.78,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,50374.00000,28965.05000,Hometown Health,PPO/EPO,,45336.60,,,,,,,13097.24,48862.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Hometown Health,PPO/EPO,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Hometown Health,PPO/EPO,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Hometown Health,PPO/EPO,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Hometown Health,PPO/EPO,,25626.60,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Hometown Health,PPO/EPO,,25626.60,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Hometown Health,PPO/EPO,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Hometown Health,PPO/EPO,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Hometown Health,PPO/EPO,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Hometown Health,PPO/EPO,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Hometown Health,PPO/EPO,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Hometown Health,PPO/EPO,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Hometown Health,PPO/EPO,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Hometown Health,PPO/EPO,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Hometown Health,PPO/EPO,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Hometown Health,PPO/EPO,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Hometown Health,PPO/EPO,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,PPO/EPO,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,PPO/EPO,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Hometown Health,PPO/EPO,,51249.60,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Hometown Health,PPO/EPO,,51249.60,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Hometown Health,PPO/EPO,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Hometown Health,PPO/EPO,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,74464.00000,42816.80000,Hometown Health,PPO/EPO,,67017.60,,,,,,,67017.60,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Hometown Health,PPO/EPO,,67017.60,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,83224.00000,47853.80000,Hometown Health,PPO/EPO,,74901.60,,,,,,,74901.60,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Hometown Health,PPO/EPO,,74901.60,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,91984.00000,52890.80000,Hometown Health,PPO/EPO,,82785.60,,,,,,,82785.60,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,91984.00000,52890.80000,Hometown Health,PPO/EPO,,82785.60,,,,,,,23915.84,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,100744.00000,57927.80000,Hometown Health,PPO/EPO,,90669.60,,,,,,,90669.60,97721.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,100744.00000,57927.80000,Hometown Health,PPO/EPO,,90669.60,,,,,,,26193.44,97721.68,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Hometown Health,PPO/EPO,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Hometown Health,PPO/EPO,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Hometown Health,PPO/EPO,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Hometown Health,PPO/EPO,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Hometown Health,PPO/EPO,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Hometown Health,PPO/EPO,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Hometown Health,PPO/EPO,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Hometown Health,PPO/EPO,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Hometown Health,PPO/EPO,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Hometown Health,PPO/EPO,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Hometown Health,PPO/EPO,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Hometown Health,PPO/EPO,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Hometown Health,PPO/EPO,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Hometown Health,PPO/EPO,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Hometown Health,PPO/EPO,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Hometown Health,PPO/EPO,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Hometown Health,PPO/EPO,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Hometown Health,PPO/EPO,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2180.20000,1253.61000,Hometown Health,PPO/EPO,,1962.18,,,,,,,1962.18,2114.79,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2180.20000,1253.61000,Hometown Health,PPO/EPO,,1962.18,,,,,,,566.85,2114.79,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1880.60000,1081.34000,Hometown Health,PPO/EPO,,1692.54,,,,,,,1692.54,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1880.60000,1081.34000,Hometown Health,PPO/EPO,,1692.54,,,,,,,488.96,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2908.70000,1672.50000,Hometown Health,PPO/EPO,,2617.83,,,,,,,2617.83,2821.44,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2908.70000,1672.50000,Hometown Health,PPO/EPO,,2617.83,,,,,,,756.26,2821.44,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,inpatient,,,34.00000,25.74000,Hometown Health,PPO/EPO,,30.60,,,,,,,30.60,32.98,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,outpatient,,,34.00000,25.74000,Hometown Health,PPO/EPO,,30.60,,,,,,,8.84,32.98,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,inpatient,,,13.00000,9.84000,Hometown Health,PPO/EPO,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,outpatient,,,13.00000,9.84000,Hometown Health,PPO/EPO,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Hometown Health,PPO/EPO,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Hometown Health,PPO/EPO,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Hometown Health,PPO/EPO,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Hometown Health,PPO/EPO,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Hometown Health,PPO/EPO,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Hometown Health,PPO/EPO,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Hometown Health,PPO/EPO,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Hometown Health,PPO/EPO,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Hometown Health,PPO/EPO,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Hometown Health,PPO/EPO,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Hometown Health,PPO/EPO,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Hometown Health,PPO/EPO,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,inpatient,,,122.00000,92.35000,Hometown Health,PPO/EPO,,109.80,,,,,,,109.80,118.34,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,outpatient,,,122.00000,92.35000,Hometown Health,PPO/EPO,,109.80,,,,,,,31.72,118.34,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,inpatient,,,79.00000,59.80000,Hometown Health,PPO/EPO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Hometown Health,PPO/EPO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,inpatient,,,79.00000,59.80000,Hometown Health,PPO/EPO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Hometown Health,PPO/EPO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,inpatient,,,15.00000,11.36000,Hometown Health,PPO/EPO,,13.50,,,,,,,13.50,14.55,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Hometown Health,PPO/EPO,,13.50,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,inpatient,,,15.00000,11.36000,Hometown Health,PPO/EPO,,13.50,,,,,,,13.50,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Hometown Health,PPO/EPO,,13.50,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,inpatient,,,17.00000,12.87000,Hometown Health,PPO/EPO,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Hometown Health,PPO/EPO,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,inpatient,,,17.00000,12.87000,Hometown Health,PPO/EPO,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Hometown Health,PPO/EPO,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,inpatient,,,359.00000,271.76000,Hometown Health,PPO/EPO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,outpatient,,,359.00000,271.76000,Hometown Health,PPO/EPO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,inpatient,,,359.00000,271.76000,Hometown Health,PPO/EPO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,outpatient,,,359.00000,271.76000,Hometown Health,PPO/EPO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,inpatient,,,359.00000,271.76000,Hometown Health,PPO/EPO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,outpatient,,,359.00000,271.76000,Hometown Health,PPO/EPO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,inpatient,,,155.00000,117.34000,Hometown Health,PPO/EPO,,139.50,,,,,,,139.50,150.35,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,outpatient,,,155.00000,117.34000,Hometown Health,PPO/EPO,,139.50,,,,,,,40.30,150.35,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,inpatient,,,294.00000,222.56000,Hometown Health,PPO/EPO,,264.60,,,,,,,264.60,285.18,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,outpatient,,,294.00000,222.56000,Hometown Health,PPO/EPO,,264.60,,,,,,,76.44,285.18,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,inpatient,,,1511.00000,1143.83000,Hometown Health,PPO/EPO,,1359.90,,,,,,,1359.90,1465.67,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,outpatient,,,1511.00000,1143.83000,Hometown Health,PPO/EPO,,1359.90,,,,,,,392.86,1465.67,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,inpatient,,,751.00000,568.51000,Hometown Health,PPO/EPO,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Hometown Health,PPO/EPO,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,inpatient,,,751.00000,568.51000,Hometown Health,PPO/EPO,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Hometown Health,PPO/EPO,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,inpatient,,,150.00000,113.55000,Hometown Health,PPO/EPO,,135.00,,,,,,,135.00,145.50,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,outpatient,,,150.00000,113.55000,Hometown Health,PPO/EPO,,135.00,,,,,,,39.00,145.50,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,inpatient,,,110.00000,83.27000,Hometown Health,PPO/EPO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,outpatient,,,110.00000,83.27000,Hometown Health,PPO/EPO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,inpatient,,,158.00000,119.61000,Hometown Health,PPO/EPO,,142.20,,,,,,,142.20,153.26,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,outpatient,,,158.00000,119.61000,Hometown Health,PPO/EPO,,142.20,,,,,,,41.08,153.26,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,inpatient,,,153.00000,115.82000,Hometown Health,PPO/EPO,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,outpatient,,,153.00000,115.82000,Hometown Health,PPO/EPO,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,inpatient,,,157.00000,118.85000,Hometown Health,PPO/EPO,,141.30,,,,,,,141.30,152.29,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,outpatient,,,157.00000,118.85000,Hometown Health,PPO/EPO,,141.30,,,,,,,40.82,152.29,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,inpatient,,,26.00000,19.68000,Hometown Health,PPO/EPO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,outpatient,,,26.00000,19.68000,Hometown Health,PPO/EPO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,inpatient,,,37.00000,28.01000,Hometown Health,PPO/EPO,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,outpatient,,,37.00000,28.01000,Hometown Health,PPO/EPO,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,inpatient,,,268.00000,202.88000,Hometown Health,PPO/EPO,,241.20,,,,,,,241.20,259.96,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,outpatient,,,268.00000,202.88000,Hometown Health,PPO/EPO,,241.20,,,,,,,69.68,259.96,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,inpatient,,,91.00000,68.89000,Hometown Health,PPO/EPO,,81.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,outpatient,,,91.00000,68.89000,Hometown Health,PPO/EPO,,81.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,inpatient,,,200.00000,151.40000,Hometown Health,PPO/EPO,,180.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,outpatient,,,200.00000,151.40000,Hometown Health,PPO/EPO,,180.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,inpatient,,,152.00000,115.06000,Hometown Health,PPO/EPO,,136.80,,,,,,,136.80,147.44,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,outpatient,,,152.00000,115.06000,Hometown Health,PPO/EPO,,136.80,,,,,,,39.52,147.44,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,inpatient,,,359.00000,271.76000,Hometown Health,PPO/EPO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,outpatient,,,359.00000,271.76000,Hometown Health,PPO/EPO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,PPO/EPO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,PPO/EPO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,inpatient,,,75.00000,36.15000,Hometown Health,PPO/EPO,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,outpatient,,,75.00000,36.15000,Hometown Health,PPO/EPO,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,inpatient,,,45.00000,21.69000,Hometown Health,PPO/EPO,,40.50,,,,,,,40.50,43.65,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,outpatient,,,45.00000,21.69000,Hometown Health,PPO/EPO,,40.50,,,,,,,11.70,43.65,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,PPO/EPO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,PPO/EPO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,PPO/EPO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,PPO/EPO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,inpatient,,,195.00000,93.99000,Hometown Health,PPO/EPO,,175.50,,,,,,,175.50,189.15,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,outpatient,,,195.00000,93.99000,Hometown Health,PPO/EPO,,175.50,,,,,,,50.70,189.15,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,inpatient,,,14.00000,6.75000,Hometown Health,PPO/EPO,,12.60,,,,,,,12.60,13.58,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,outpatient,,,14.00000,6.75000,Hometown Health,PPO/EPO,,12.60,,,,,,,3.64,13.58,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,PPO/EPO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,PPO/EPO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,PPO/EPO,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,PPO/EPO,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,inpatient,,,141.00000,67.96000,Hometown Health,PPO/EPO,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Hometown Health,PPO/EPO,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,inpatient,,,141.00000,67.96000,Hometown Health,PPO/EPO,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Hometown Health,PPO/EPO,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,inpatient,,,91.00000,43.86000,Hometown Health,PPO/EPO,,81.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,outpatient,,,91.00000,43.86000,Hometown Health,PPO/EPO,,81.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,PPO/EPO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,PPO/EPO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,inpatient,,,205.00000,98.81000,Hometown Health,PPO/EPO,,184.50,,,,,,,184.50,198.85,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,outpatient,,,205.00000,98.81000,Hometown Health,PPO/EPO,,184.50,,,,,,,53.30,198.85,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,inpatient,,,50.00000,24.10000,Hometown Health,PPO/EPO,,45.00,,,,,,,45.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,outpatient,,,50.00000,24.10000,Hometown Health,PPO/EPO,,45.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,inpatient,,,406.00000,195.69000,Hometown Health,PPO/EPO,,365.40,,,,,,,365.40,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,outpatient,,,406.00000,195.69000,Hometown Health,PPO/EPO,,365.40,,,,,,,105.56,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,inpatient,,,101.00000,48.68000,Hometown Health,PPO/EPO,,90.90,,,,,,,90.90,97.97,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,outpatient,,,101.00000,48.68000,Hometown Health,PPO/EPO,,90.90,,,,,,,26.26,97.97,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,inpatient,,,375.00000,180.75000,Hometown Health,PPO/EPO,,337.50,,,,,,,337.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,outpatient,,,375.00000,180.75000,Hometown Health,PPO/EPO,,337.50,,,,,,,97.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,inpatient,,,362.00000,174.48000,Hometown Health,PPO/EPO,,325.80,,,,,,,325.80,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,outpatient,,,362.00000,174.48000,Hometown Health,PPO/EPO,,325.80,,,,,,,94.12,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,inpatient,,,325.00000,156.65000,Hometown Health,PPO/EPO,,292.50,,,,,,,292.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,outpatient,,,325.00000,156.65000,Hometown Health,PPO/EPO,,292.50,,,,,,,84.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,inpatient,,,121.00000,58.32000,Hometown Health,PPO/EPO,,108.90,,,,,,,108.90,117.37,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,outpatient,,,121.00000,58.32000,Hometown Health,PPO/EPO,,108.90,,,,,,,31.46,117.37,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,inpatient,,,115.00000,55.43000,Hometown Health,PPO/EPO,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,outpatient,,,115.00000,55.43000,Hometown Health,PPO/EPO,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,inpatient,,,300.00000,144.60000,Hometown Health,PPO/EPO,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,outpatient,,,300.00000,144.60000,Hometown Health,PPO/EPO,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,PPO/EPO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,PPO/EPO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,PPO/EPO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,PPO/EPO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,PPO/EPO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,PPO/EPO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,inpatient,,,194.00000,93.51000,Hometown Health,PPO/EPO,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,outpatient,,,194.00000,93.51000,Hometown Health,PPO/EPO,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,PPO/EPO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,PPO/EPO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,inpatient,,,329.00000,158.58000,Hometown Health,PPO/EPO,,296.10,,,,,,,296.10,319.13,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,outpatient,,,329.00000,158.58000,Hometown Health,PPO/EPO,,296.10,,,,,,,85.54,319.13,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,inpatient,,,24.00000,11.57000,Hometown Health,PPO/EPO,,21.60,,,,,,,21.60,23.28,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,outpatient,,,24.00000,11.57000,Hometown Health,PPO/EPO,,21.60,,,,,,,6.24,23.28,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,inpatient,,,30.00000,14.46000,Hometown Health,PPO/EPO,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,outpatient,,,30.00000,14.46000,Hometown Health,PPO/EPO,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,PPO/EPO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,PPO/EPO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,inpatient,,,270.00000,130.14000,Hometown Health,PPO/EPO,,243.00,,,,,,,243.00,261.90,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,outpatient,,,270.00000,130.14000,Hometown Health,PPO/EPO,,243.00,,,,,,,70.20,261.90,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,inpatient,,,123.00000,59.29000,Hometown Health,PPO/EPO,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Hometown Health,PPO/EPO,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,inpatient,,,123.00000,59.29000,Hometown Health,PPO/EPO,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Hometown Health,PPO/EPO,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,inpatient,,,37.00000,17.83000,Hometown Health,PPO/EPO,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,outpatient,,,37.00000,17.83000,Hometown Health,PPO/EPO,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,inpatient,,,41.00000,19.76000,Hometown Health,PPO/EPO,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,outpatient,,,41.00000,19.76000,Hometown Health,PPO/EPO,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,PPO/EPO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,PPO/EPO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,PPO/EPO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,PPO/EPO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,inpatient,,,90.00000,43.38000,Hometown Health,PPO/EPO,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,outpatient,,,90.00000,43.38000,Hometown Health,PPO/EPO,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,inpatient,,,44.00000,21.21000,Hometown Health,PPO/EPO,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,outpatient,,,44.00000,21.21000,Hometown Health,PPO/EPO,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,inpatient,,,115.00000,55.43000,Hometown Health,PPO/EPO,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,outpatient,,,115.00000,55.43000,Hometown Health,PPO/EPO,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,inpatient,,,20.00000,9.64000,Hometown Health,PPO/EPO,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,outpatient,,,20.00000,9.64000,Hometown Health,PPO/EPO,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,inpatient,,,341.00000,164.36000,Hometown Health,PPO/EPO,,306.90,,,,,,,306.90,330.77,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,outpatient,,,341.00000,164.36000,Hometown Health,PPO/EPO,,306.90,,,,,,,88.66,330.77,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,PPO/EPO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,PPO/EPO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,PPO/EPO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,PPO/EPO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,inpatient,,,88.00000,42.42000,Hometown Health,PPO/EPO,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,outpatient,,,88.00000,42.42000,Hometown Health,PPO/EPO,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,inpatient,,,89.00000,42.90000,Hometown Health,PPO/EPO,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,outpatient,,,89.00000,42.90000,Hometown Health,PPO/EPO,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,PPO/EPO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,PPO/EPO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,PPO/EPO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,PPO/EPO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,PPO/EPO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,PPO/EPO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,PPO/EPO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,PPO/EPO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,inpatient,,,95.00000,45.79000,Hometown Health,PPO/EPO,,85.50,,,,,,,85.50,92.15,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,outpatient,,,95.00000,45.79000,Hometown Health,PPO/EPO,,85.50,,,,,,,24.70,92.15,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,inpatient,,,132.00000,63.62000,Hometown Health,PPO/EPO,,118.80,,,,,,,118.80,128.04,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,outpatient,,,132.00000,63.62000,Hometown Health,PPO/EPO,,118.80,,,,,,,34.32,128.04,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,inpatient,,,83.00000,40.01000,Hometown Health,PPO/EPO,,74.70,,,,,,,74.70,80.51,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,outpatient,,,83.00000,40.01000,Hometown Health,PPO/EPO,,74.70,,,,,,,21.58,80.51,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,inpatient,,,387.00000,186.53000,Hometown Health,PPO/EPO,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,outpatient,,,387.00000,186.53000,Hometown Health,PPO/EPO,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,inpatient,,,387.00000,186.53000,Hometown Health,PPO/EPO,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,outpatient,,,387.00000,186.53000,Hometown Health,PPO/EPO,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,inpatient,,,31.00000,14.94000,Hometown Health,PPO/EPO,,27.90,,,,,,,27.90,30.07,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,outpatient,,,31.00000,14.94000,Hometown Health,PPO/EPO,,27.90,,,,,,,8.06,30.07,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,inpatient,,,36.00000,17.35000,Hometown Health,PPO/EPO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,outpatient,,,36.00000,17.35000,Hometown Health,PPO/EPO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,inpatient,,,160.00000,77.12000,Hometown Health,PPO/EPO,,144.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,outpatient,,,160.00000,77.12000,Hometown Health,PPO/EPO,,144.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,inpatient,,,112.00000,53.98000,Hometown Health,PPO/EPO,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,outpatient,,,112.00000,53.98000,Hometown Health,PPO/EPO,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,inpatient,,,14.00000,6.75000,Hometown Health,PPO/EPO,,12.60,,,,,,,12.60,13.58,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,outpatient,,,14.00000,6.75000,Hometown Health,PPO/EPO,,12.60,,,,,,,3.64,13.58,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,inpatient,,,16.00000,7.71000,Hometown Health,PPO/EPO,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,outpatient,,,16.00000,7.71000,Hometown Health,PPO/EPO,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,PPO/EPO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,PPO/EPO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,inpatient,,,116.00000,55.91000,Hometown Health,PPO/EPO,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,outpatient,,,116.00000,55.91000,Hometown Health,PPO/EPO,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,inpatient,,,81.00000,39.04000,Hometown Health,PPO/EPO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,outpatient,,,81.00000,39.04000,Hometown Health,PPO/EPO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,inpatient,,,97.00000,46.75000,Hometown Health,PPO/EPO,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,outpatient,,,97.00000,46.75000,Hometown Health,PPO/EPO,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,PPO/EPO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,PPO/EPO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,inpatient,,,35.00000,16.87000,Hometown Health,PPO/EPO,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,outpatient,,,35.00000,16.87000,Hometown Health,PPO/EPO,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,inpatient,,,65.00000,31.33000,Hometown Health,PPO/EPO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,outpatient,,,65.00000,31.33000,Hometown Health,PPO/EPO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,inpatient,,,74.00000,35.67000,Hometown Health,PPO/EPO,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,outpatient,,,74.00000,35.67000,Hometown Health,PPO/EPO,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,inpatient,,,250.00000,120.50000,Hometown Health,PPO/EPO,,225.00,,,,,,,225.00,242.50,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,outpatient,,,250.00000,120.50000,Hometown Health,PPO/EPO,,225.00,,,,,,,65.00,242.50,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,inpatient,,,90.00000,43.38000,Hometown Health,PPO/EPO,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,outpatient,,,90.00000,43.38000,Hometown Health,PPO/EPO,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,inpatient,,,90.00000,43.38000,Hometown Health,PPO/EPO,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,outpatient,,,90.00000,43.38000,Hometown Health,PPO/EPO,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,inpatient,,,36.00000,17.35000,Hometown Health,PPO/EPO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,outpatient,,,36.00000,17.35000,Hometown Health,PPO/EPO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,inpatient,,,78.00000,37.60000,Hometown Health,PPO/EPO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,outpatient,,,78.00000,37.60000,Hometown Health,PPO/EPO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,inpatient,,,115.00000,55.43000,Hometown Health,PPO/EPO,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,outpatient,,,115.00000,55.43000,Hometown Health,PPO/EPO,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,inpatient,,,76.00000,36.63000,Hometown Health,PPO/EPO,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,outpatient,,,76.00000,36.63000,Hometown Health,PPO/EPO,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,PPO/EPO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,PPO/EPO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,PPO/EPO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,PPO/EPO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,inpatient,,,169.00000,81.46000,Hometown Health,PPO/EPO,,152.10,,,,,,,152.10,163.93,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,outpatient,,,169.00000,81.46000,Hometown Health,PPO/EPO,,152.10,,,,,,,43.94,163.93,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,inpatient,,,28.00000,13.50000,Hometown Health,PPO/EPO,,25.20,,,,,,,25.20,27.16,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,outpatient,,,28.00000,13.50000,Hometown Health,PPO/EPO,,25.20,,,,,,,7.28,27.16,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,PPO/EPO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,PPO/EPO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,inpatient,,,15.00000,7.23000,Hometown Health,PPO/EPO,,13.50,,,,,,,13.50,14.55,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,outpatient,,,15.00000,7.23000,Hometown Health,PPO/EPO,,13.50,,,,,,,3.90,14.55,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,inpatient,,,18.00000,8.68000,Hometown Health,PPO/EPO,,16.20,,,,,,,16.20,17.46,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,outpatient,,,18.00000,8.68000,Hometown Health,PPO/EPO,,16.20,,,,,,,4.68,17.46,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,inpatient,,,550.00000,265.10000,Hometown Health,PPO/EPO,,495.00,,,,,,,495.00,533.50,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,outpatient,,,550.00000,265.10000,Hometown Health,PPO/EPO,,495.00,,,,,,,143.00,533.50,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,PPO/EPO,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,PPO/EPO,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,inpatient,,,392.00000,188.94000,Hometown Health,PPO/EPO,,352.80,,,,,,,352.80,380.24,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,outpatient,,,392.00000,188.94000,Hometown Health,PPO/EPO,,352.80,,,,,,,101.92,380.24,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,inpatient,,,75.00000,36.15000,Hometown Health,PPO/EPO,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,outpatient,,,75.00000,36.15000,Hometown Health,PPO/EPO,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,PPO/EPO,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,PPO/EPO,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,inpatient,,,100.00000,48.20000,Hometown Health,PPO/EPO,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,outpatient,,,100.00000,48.20000,Hometown Health,PPO/EPO,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,inpatient,,,153.00000,73.75000,Hometown Health,PPO/EPO,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,outpatient,,,153.00000,73.75000,Hometown Health,PPO/EPO,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,inpatient,,,909.00000,438.14000,Hometown Health,PPO/EPO,,818.10,,,,,,,818.10,881.73,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,outpatient,,,909.00000,438.14000,Hometown Health,PPO/EPO,,818.10,,,,,,,236.34,881.73,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,inpatient,,,266.00000,128.21000,Hometown Health,PPO/EPO,,239.40,,,,,,,239.40,258.02,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,outpatient,,,266.00000,128.21000,Hometown Health,PPO/EPO,,239.40,,,,,,,69.16,258.02,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,inpatient,,,275.00000,132.55000,Hometown Health,PPO/EPO,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,outpatient,,,275.00000,132.55000,Hometown Health,PPO/EPO,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,inpatient,,,84.00000,40.49000,Hometown Health,PPO/EPO,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,outpatient,,,84.00000,40.49000,Hometown Health,PPO/EPO,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,inpatient,,,174.00000,83.87000,Hometown Health,PPO/EPO,,156.60,,,,,,,156.60,168.78,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,outpatient,,,174.00000,83.87000,Hometown Health,PPO/EPO,,156.60,,,,,,,45.24,168.78,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,PPO/EPO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,PPO/EPO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,inpatient,,,211.00000,101.70000,Hometown Health,PPO/EPO,,189.90,,,,,,,189.90,204.67,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,outpatient,,,211.00000,101.70000,Hometown Health,PPO/EPO,,189.90,,,,,,,54.86,204.67,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,inpatient,,,65.00000,31.33000,Hometown Health,PPO/EPO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,outpatient,,,65.00000,31.33000,Hometown Health,PPO/EPO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,inpatient,,,83.00000,40.01000,Hometown Health,PPO/EPO,,74.70,,,,,,,74.70,80.51,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,outpatient,,,83.00000,40.01000,Hometown Health,PPO/EPO,,74.70,,,,,,,21.58,80.51,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,PPO/EPO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,PPO/EPO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,inpatient,,,323.00000,155.69000,Hometown Health,PPO/EPO,,290.70,,,,,,,290.70,313.31,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,outpatient,,,323.00000,155.69000,Hometown Health,PPO/EPO,,290.70,,,,,,,83.98,313.31,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,inpatient,,,35.00000,16.87000,Hometown Health,PPO/EPO,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,outpatient,,,35.00000,16.87000,Hometown Health,PPO/EPO,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,inpatient,,,20.00000,9.64000,Hometown Health,PPO/EPO,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,outpatient,,,20.00000,9.64000,Hometown Health,PPO/EPO,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,inpatient,,,34.00000,16.39000,Hometown Health,PPO/EPO,,30.60,,,,,,,30.60,32.98,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,outpatient,,,34.00000,16.39000,Hometown Health,PPO/EPO,,30.60,,,,,,,8.84,32.98,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,inpatient,,,29.00000,13.98000,Hometown Health,PPO/EPO,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,outpatient,,,29.00000,13.98000,Hometown Health,PPO/EPO,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,inpatient,,,80.00000,38.56000,Hometown Health,PPO/EPO,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,outpatient,,,80.00000,38.56000,Hometown Health,PPO/EPO,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,PPO/EPO,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,PPO/EPO,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,inpatient,,,16.00000,7.71000,Hometown Health,PPO/EPO,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,outpatient,,,16.00000,7.71000,Hometown Health,PPO/EPO,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,inpatient,,,113.00000,54.47000,Hometown Health,PPO/EPO,,101.70,,,,,,,101.70,109.61,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,outpatient,,,113.00000,54.47000,Hometown Health,PPO/EPO,,101.70,,,,,,,29.38,109.61,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,PPO/EPO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,PPO/EPO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,inpatient,,,78.00000,37.60000,Hometown Health,PPO/EPO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,outpatient,,,78.00000,37.60000,Hometown Health,PPO/EPO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,PPO/EPO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,PPO/EPO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,inpatient,,,76.00000,36.63000,Hometown Health,PPO/EPO,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,outpatient,,,76.00000,36.63000,Hometown Health,PPO/EPO,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,inpatient,,,88.00000,42.42000,Hometown Health,PPO/EPO,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,outpatient,,,88.00000,42.42000,Hometown Health,PPO/EPO,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,PPO/EPO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,PPO/EPO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,inpatient,,,88.00000,42.42000,Hometown Health,PPO/EPO,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,outpatient,,,88.00000,42.42000,Hometown Health,PPO/EPO,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,inpatient,,,105.00000,50.61000,Hometown Health,PPO/EPO,,94.50,,,,,,,94.50,101.85,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,outpatient,,,105.00000,50.61000,Hometown Health,PPO/EPO,,94.50,,,,,,,27.30,101.85,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,PPO/EPO,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,PPO/EPO,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,inpatient,,,83.00000,40.01000,Hometown Health,PPO/EPO,,74.70,,,,,,,74.70,80.51,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,outpatient,,,83.00000,40.01000,Hometown Health,PPO/EPO,,74.70,,,,,,,21.58,80.51,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,inpatient,,,154.00000,74.23000,Hometown Health,PPO/EPO,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Hometown Health,PPO/EPO,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,inpatient,,,97.00000,46.75000,Hometown Health,PPO/EPO,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,outpatient,,,97.00000,46.75000,Hometown Health,PPO/EPO,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,inpatient,,,154.00000,74.23000,Hometown Health,PPO/EPO,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Hometown Health,PPO/EPO,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,inpatient,,,87.00000,41.93000,Hometown Health,PPO/EPO,,78.30,,,,,,,78.30,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,outpatient,,,87.00000,41.93000,Hometown Health,PPO/EPO,,78.30,,,,,,,22.62,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,PPO/EPO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,PPO/EPO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,PPO/EPO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,PPO/EPO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,inpatient,,,97.00000,46.75000,Hometown Health,PPO/EPO,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,outpatient,,,97.00000,46.75000,Hometown Health,PPO/EPO,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,inpatient,,,176.00000,84.83000,Hometown Health,PPO/EPO,,158.40,,,,,,,158.40,170.72,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,outpatient,,,176.00000,84.83000,Hometown Health,PPO/EPO,,158.40,,,,,,,45.76,170.72,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,inpatient,,,158.00000,76.16000,Hometown Health,PPO/EPO,,142.20,,,,,,,142.20,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,outpatient,,,158.00000,76.16000,Hometown Health,PPO/EPO,,142.20,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,inpatient,,,84.00000,40.49000,Hometown Health,PPO/EPO,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,outpatient,,,84.00000,40.49000,Hometown Health,PPO/EPO,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,inpatient,,,189.00000,91.10000,Hometown Health,PPO/EPO,,170.10,,,,,,,170.10,183.33,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,outpatient,,,189.00000,91.10000,Hometown Health,PPO/EPO,,170.10,,,,,,,49.14,183.33,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,inpatient,,,109.00000,52.54000,Hometown Health,PPO/EPO,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,outpatient,,,109.00000,52.54000,Hometown Health,PPO/EPO,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,inpatient,,,129.00000,62.18000,Hometown Health,PPO/EPO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,outpatient,,,129.00000,62.18000,Hometown Health,PPO/EPO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,inpatient,,,84.00000,40.49000,Hometown Health,PPO/EPO,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,outpatient,,,84.00000,40.49000,Hometown Health,PPO/EPO,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,PPO/EPO,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,PPO/EPO,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,inpatient,,,149.00000,71.82000,Hometown Health,PPO/EPO,,134.10,,,,,,,134.10,144.53,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,outpatient,,,149.00000,71.82000,Hometown Health,PPO/EPO,,134.10,,,,,,,38.74,144.53,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,inpatient,,,130.00000,62.66000,Hometown Health,PPO/EPO,,117.00,,,,,,,117.00,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,outpatient,,,130.00000,62.66000,Hometown Health,PPO/EPO,,117.00,,,,,,,33.80,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,inpatient,,,110.00000,53.02000,Hometown Health,PPO/EPO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,outpatient,,,110.00000,53.02000,Hometown Health,PPO/EPO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,inpatient,,,158.00000,76.16000,Hometown Health,PPO/EPO,,142.20,,,,,,,142.20,153.26,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,outpatient,,,158.00000,76.16000,Hometown Health,PPO/EPO,,142.20,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,inpatient,,,117.00000,56.39000,Hometown Health,PPO/EPO,,105.30,,,,,,,105.30,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,outpatient,,,117.00000,56.39000,Hometown Health,PPO/EPO,,105.30,,,,,,,30.42,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,PPO/EPO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,PPO/EPO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,inpatient,,,145.00000,69.89000,Hometown Health,PPO/EPO,,130.50,,,,,,,130.50,140.65,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,outpatient,,,145.00000,69.89000,Hometown Health,PPO/EPO,,130.50,,,,,,,37.70,140.65,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,inpatient,,,165.00000,79.53000,Hometown Health,PPO/EPO,,148.50,,,,,,,148.50,160.05,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,outpatient,,,165.00000,79.53000,Hometown Health,PPO/EPO,,148.50,,,,,,,42.90,160.05,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,PPO/EPO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,PPO/EPO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,PPO/EPO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,PPO/EPO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,inpatient,,,154.00000,74.23000,Hometown Health,PPO/EPO,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,outpatient,,,154.00000,74.23000,Hometown Health,PPO/EPO,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,inpatient,,,104.00000,50.13000,Hometown Health,PPO/EPO,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,outpatient,,,104.00000,50.13000,Hometown Health,PPO/EPO,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,PPO/EPO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,PPO/EPO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,inpatient,,,104.00000,50.13000,Hometown Health,PPO/EPO,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,outpatient,,,104.00000,50.13000,Hometown Health,PPO/EPO,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,PPO/EPO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,PPO/EPO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,inpatient,,,123.00000,59.29000,Hometown Health,PPO/EPO,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,outpatient,,,123.00000,59.29000,Hometown Health,PPO/EPO,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,inpatient,,,95.00000,45.79000,Hometown Health,PPO/EPO,,85.50,,,,,,,85.50,92.15,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,outpatient,,,95.00000,45.79000,Hometown Health,PPO/EPO,,85.50,,,,,,,24.70,92.15,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,inpatient,,,160.00000,77.12000,Hometown Health,PPO/EPO,,144.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,outpatient,,,160.00000,77.12000,Hometown Health,PPO/EPO,,144.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,inpatient,,,147.00000,70.85000,Hometown Health,PPO/EPO,,132.30,,,,,,,132.30,142.59,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,outpatient,,,147.00000,70.85000,Hometown Health,PPO/EPO,,132.30,,,,,,,38.22,142.59,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,inpatient,,,178.00000,85.80000,Hometown Health,PPO/EPO,,160.20,,,,,,,160.20,172.66,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,outpatient,,,178.00000,85.80000,Hometown Health,PPO/EPO,,160.20,,,,,,,46.28,172.66,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,inpatient,,,160.00000,77.12000,Hometown Health,PPO/EPO,,144.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,outpatient,,,160.00000,77.12000,Hometown Health,PPO/EPO,,144.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,PPO/EPO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,PPO/EPO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,PPO/EPO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,PPO/EPO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,PPO/EPO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,PPO/EPO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,PPO/EPO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,PPO/EPO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,PPO/EPO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,PPO/EPO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,PPO/EPO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,PPO/EPO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,PPO/EPO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,PPO/EPO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,PPO/EPO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,PPO/EPO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,PPO/EPO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,PPO/EPO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Hometown Health,PPO/EPO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Hometown Health,PPO/EPO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,inpatient,,,449.00000,216.42000,Hometown Health,PPO/EPO,,404.10,,,,,,,404.10,435.53,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,outpatient,,,449.00000,216.42000,Hometown Health,PPO/EPO,,404.10,,,,,,,116.74,435.53,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,inpatient,,,104.00000,50.13000,Hometown Health,PPO/EPO,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,outpatient,,,104.00000,50.13000,Hometown Health,PPO/EPO,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,inpatient,,,185.00000,89.17000,Hometown Health,PPO/EPO,,166.50,,,,,,,166.50,179.45,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Hometown Health,PPO/EPO,,166.50,,,,,,,48.10,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,inpatient,,,185.00000,89.17000,Hometown Health,PPO/EPO,,166.50,,,,,,,166.50,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Hometown Health,PPO/EPO,,166.50,,,,,,,48.10,179.45,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,inpatient,,,84.00000,40.49000,Hometown Health,PPO/EPO,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,outpatient,,,84.00000,40.49000,Hometown Health,PPO/EPO,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,inpatient,,,84.00000,40.49000,Hometown Health,PPO/EPO,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Hometown Health,PPO/EPO,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,inpatient,,,84.00000,40.49000,Hometown Health,PPO/EPO,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Hometown Health,PPO/EPO,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,PPO/EPO,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,PPO/EPO,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,PPO/EPO,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,PPO/EPO,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,inpatient,,,98.00000,47.24000,Hometown Health,PPO/EPO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,outpatient,,,98.00000,47.24000,Hometown Health,PPO/EPO,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,inpatient,,,75.00000,36.15000,Hometown Health,PPO/EPO,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,outpatient,,,75.00000,36.15000,Hometown Health,PPO/EPO,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,inpatient,,,107.00000,51.57000,Hometown Health,PPO/EPO,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,outpatient,,,107.00000,51.57000,Hometown Health,PPO/EPO,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,inpatient,,,81.00000,39.04000,Hometown Health,PPO/EPO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,outpatient,,,81.00000,39.04000,Hometown Health,PPO/EPO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,PPO/EPO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,PPO/EPO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,PPO/EPO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,PPO/EPO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,inpatient,,,74.00000,35.67000,Hometown Health,PPO/EPO,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,outpatient,,,74.00000,35.67000,Hometown Health,PPO/EPO,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,inpatient,,,194.00000,93.51000,Hometown Health,PPO/EPO,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,outpatient,,,194.00000,93.51000,Hometown Health,PPO/EPO,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,inpatient,,,111.00000,53.50000,Hometown Health,PPO/EPO,,99.90,,,,,,,99.90,107.67,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,outpatient,,,111.00000,53.50000,Hometown Health,PPO/EPO,,99.90,,,,,,,28.86,107.67,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,PPO/EPO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,PPO/EPO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Hometown Health,PPO/EPO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Hometown Health,PPO/EPO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Hometown Health,PPO/EPO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Hometown Health,PPO/EPO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,inpatient,,,237.00000,114.23000,Hometown Health,PPO/EPO,,213.30,,,,,,,213.30,229.89,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Hometown Health,PPO/EPO,,213.30,,,,,,,61.62,229.89,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,PPO/EPO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,PPO/EPO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,PPO/EPO,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,PPO/EPO,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,PPO/EPO,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,PPO/EPO,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,inpatient,,,131.00000,63.14000,Hometown Health,PPO/EPO,,117.90,,,,,,,117.90,127.07,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,outpatient,,,131.00000,63.14000,Hometown Health,PPO/EPO,,117.90,,,,,,,34.06,127.07,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,inpatient,,,15.00000,7.23000,Hometown Health,PPO/EPO,,13.50,,,,,,,13.50,14.55,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,outpatient,,,15.00000,7.23000,Hometown Health,PPO/EPO,,13.50,,,,,,,3.90,14.55,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,inpatient,,,39.00000,18.80000,Hometown Health,PPO/EPO,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,outpatient,,,39.00000,18.80000,Hometown Health,PPO/EPO,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,inpatient,,,12.00000,5.78000,Hometown Health,PPO/EPO,,10.80,,,,,,,10.80,11.64,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,outpatient,,,12.00000,5.78000,Hometown Health,PPO/EPO,,10.80,,,,,,,3.12,11.64,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,inpatient,,,203.00000,97.85000,Hometown Health,PPO/EPO,,182.70,,,,,,,182.70,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Hometown Health,PPO/EPO,,182.70,,,,,,,52.78,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,inpatient,,,203.00000,97.85000,Hometown Health,PPO/EPO,,182.70,,,,,,,182.70,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Hometown Health,PPO/EPO,,182.70,,,,,,,52.78,196.91,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,inpatient,,,99.00000,47.72000,Hometown Health,PPO/EPO,,89.10,,,,,,,89.10,96.03,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,outpatient,,,99.00000,47.72000,Hometown Health,PPO/EPO,,89.10,,,,,,,25.74,96.03,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,PPO/EPO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,PPO/EPO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,inpatient,,,23.00000,11.09000,Hometown Health,PPO/EPO,,20.70,,,,,,,20.70,22.31,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,outpatient,,,23.00000,11.09000,Hometown Health,PPO/EPO,,20.70,,,,,,,5.98,22.31,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,inpatient,,,46.00000,22.17000,Hometown Health,PPO/EPO,,41.40,,,,,,,41.40,44.62,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,outpatient,,,46.00000,22.17000,Hometown Health,PPO/EPO,,41.40,,,,,,,11.96,44.62,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,inpatient,,,288.00000,138.82000,Hometown Health,PPO/EPO,,259.20,,,,,,,259.20,279.36,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,outpatient,,,288.00000,138.82000,Hometown Health,PPO/EPO,,259.20,,,,,,,74.88,279.36,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,inpatient,,,106.00000,51.09000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,outpatient,,,106.00000,51.09000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,inpatient,,,30.00000,14.46000,Hometown Health,PPO/EPO,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,outpatient,,,30.00000,14.46000,Hometown Health,PPO/EPO,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,PPO/EPO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,PPO/EPO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,inpatient,,,89.00000,42.90000,Hometown Health,PPO/EPO,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,outpatient,,,89.00000,42.90000,Hometown Health,PPO/EPO,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,inpatient,,,116.00000,55.91000,Hometown Health,PPO/EPO,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,outpatient,,,116.00000,55.91000,Hometown Health,PPO/EPO,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,inpatient,,,116.00000,55.91000,Hometown Health,PPO/EPO,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Hometown Health,PPO/EPO,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,inpatient,,,116.00000,55.91000,Hometown Health,PPO/EPO,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Hometown Health,PPO/EPO,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,PPO/EPO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,PPO/EPO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,inpatient,,,174.00000,83.87000,Hometown Health,PPO/EPO,,156.60,,,,,,,156.60,168.78,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,outpatient,,,174.00000,83.87000,Hometown Health,PPO/EPO,,156.60,,,,,,,45.24,168.78,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,PPO/EPO,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,PPO/EPO,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,inpatient,,,112.00000,53.98000,Hometown Health,PPO/EPO,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,outpatient,,,112.00000,53.98000,Hometown Health,PPO/EPO,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,PPO/EPO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,PPO/EPO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,inpatient,,,286.00000,137.85000,Hometown Health,PPO/EPO,,257.40,,,,,,,257.40,277.42,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,outpatient,,,286.00000,137.85000,Hometown Health,PPO/EPO,,257.40,,,,,,,74.36,277.42,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,inpatient,,,300.00000,144.60000,Hometown Health,PPO/EPO,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,outpatient,,,300.00000,144.60000,Hometown Health,PPO/EPO,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,PPO/EPO,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,PPO/EPO,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,inpatient,,,90.00000,43.38000,Hometown Health,PPO/EPO,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,outpatient,,,90.00000,43.38000,Hometown Health,PPO/EPO,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,inpatient,,,315.00000,151.83000,Hometown Health,PPO/EPO,,283.50,,,,,,,283.50,305.55,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,outpatient,,,315.00000,151.83000,Hometown Health,PPO/EPO,,283.50,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,inpatient,,,100.00000,48.20000,Hometown Health,PPO/EPO,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,outpatient,,,100.00000,48.20000,Hometown Health,PPO/EPO,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,inpatient,,,89.00000,42.90000,Hometown Health,PPO/EPO,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,outpatient,,,89.00000,42.90000,Hometown Health,PPO/EPO,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,PPO/EPO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,PPO/EPO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,inpatient,,,135.00000,65.07000,Hometown Health,PPO/EPO,,121.50,,,,,,,121.50,130.95,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,outpatient,,,135.00000,65.07000,Hometown Health,PPO/EPO,,121.50,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,inpatient,,,80.00000,38.56000,Hometown Health,PPO/EPO,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,outpatient,,,80.00000,38.56000,Hometown Health,PPO/EPO,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,PPO/EPO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,PPO/EPO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,PPO/EPO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,PPO/EPO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,inpatient,,,100.00000,48.20000,Hometown Health,PPO/EPO,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,outpatient,,,100.00000,48.20000,Hometown Health,PPO/EPO,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,inpatient,,,305.00000,147.01000,Hometown Health,PPO/EPO,,274.50,,,,,,,274.50,295.85,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,outpatient,,,305.00000,147.01000,Hometown Health,PPO/EPO,,274.50,,,,,,,79.30,295.85,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,PPO/EPO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,PPO/EPO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,PPO/EPO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,PPO/EPO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,PPO/EPO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,PPO/EPO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,inpatient,,,368.00000,177.38000,Hometown Health,PPO/EPO,,331.20,,,,,,,331.20,356.96,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,outpatient,,,368.00000,177.38000,Hometown Health,PPO/EPO,,331.20,,,,,,,95.68,356.96,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,inpatient,,,104.00000,50.13000,Hometown Health,PPO/EPO,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,outpatient,,,104.00000,50.13000,Hometown Health,PPO/EPO,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,inpatient,,,109.00000,52.54000,Hometown Health,PPO/EPO,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,outpatient,,,109.00000,52.54000,Hometown Health,PPO/EPO,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,inpatient,,,114.00000,54.95000,Hometown Health,PPO/EPO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,outpatient,,,114.00000,54.95000,Hometown Health,PPO/EPO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,inpatient,,,135.00000,65.07000,Hometown Health,PPO/EPO,,121.50,,,,,,,121.50,130.95,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,outpatient,,,135.00000,65.07000,Hometown Health,PPO/EPO,,121.50,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,inpatient,,,105.00000,50.61000,Hometown Health,PPO/EPO,,94.50,,,,,,,94.50,101.85,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,outpatient,,,105.00000,50.61000,Hometown Health,PPO/EPO,,94.50,,,,,,,27.30,101.85,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,inpatient,,,315.00000,151.83000,Hometown Health,PPO/EPO,,283.50,,,,,,,283.50,305.55,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,outpatient,,,315.00000,151.83000,Hometown Health,PPO/EPO,,283.50,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,inpatient,,,148.00000,71.34000,Hometown Health,PPO/EPO,,133.20,,,,,,,133.20,143.56,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,outpatient,,,148.00000,71.34000,Hometown Health,PPO/EPO,,133.20,,,,,,,38.48,143.56,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,inpatient,,,107.00000,51.57000,Hometown Health,PPO/EPO,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,outpatient,,,107.00000,51.57000,Hometown Health,PPO/EPO,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,inpatient,,,35.00000,16.87000,Hometown Health,PPO/EPO,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,outpatient,,,35.00000,16.87000,Hometown Health,PPO/EPO,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,inpatient,,,104.00000,50.13000,Hometown Health,PPO/EPO,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,outpatient,,,104.00000,50.13000,Hometown Health,PPO/EPO,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,inpatient,,,650.00000,313.30000,Hometown Health,PPO/EPO,,585.00,,,,,,,585.00,630.50,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,outpatient,,,650.00000,313.30000,Hometown Health,PPO/EPO,,585.00,,,,,,,169.00,630.50,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,inpatient,,,91.00000,43.86000,Hometown Health,PPO/EPO,,81.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,outpatient,,,91.00000,43.86000,Hometown Health,PPO/EPO,,81.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,inpatient,,,114.00000,54.95000,Hometown Health,PPO/EPO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,outpatient,,,114.00000,54.95000,Hometown Health,PPO/EPO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,inpatient,,,360.00000,173.52000,Hometown Health,PPO/EPO,,324.00,,,,,,,324.00,349.20,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,outpatient,,,360.00000,173.52000,Hometown Health,PPO/EPO,,324.00,,,,,,,93.60,349.20,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,inpatient,,,106.00000,51.09000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,outpatient,,,106.00000,51.09000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,inpatient,,,78.00000,37.60000,Hometown Health,PPO/EPO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,outpatient,,,78.00000,37.60000,Hometown Health,PPO/EPO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,PPO/EPO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,PPO/EPO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,inpatient,,,94.00000,45.31000,Hometown Health,PPO/EPO,,84.60,,,,,,,84.60,91.18,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,outpatient,,,94.00000,45.31000,Hometown Health,PPO/EPO,,84.60,,,,,,,24.44,91.18,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,inpatient,,,101.00000,48.68000,Hometown Health,PPO/EPO,,90.90,,,,,,,90.90,97.97,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,outpatient,,,101.00000,48.68000,Hometown Health,PPO/EPO,,90.90,,,,,,,26.26,97.97,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,PPO/EPO,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,PPO/EPO,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,PPO/EPO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,PPO/EPO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,inpatient,,,145.00000,69.89000,Hometown Health,PPO/EPO,,130.50,,,,,,,130.50,140.65,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,outpatient,,,145.00000,69.89000,Hometown Health,PPO/EPO,,130.50,,,,,,,37.70,140.65,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,inpatient,,,266.00000,128.21000,Hometown Health,PPO/EPO,,239.40,,,,,,,239.40,258.02,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,outpatient,,,266.00000,128.21000,Hometown Health,PPO/EPO,,239.40,,,,,,,69.16,258.02,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,inpatient,,,79.00000,38.08000,Hometown Health,PPO/EPO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,outpatient,,,79.00000,38.08000,Hometown Health,PPO/EPO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,inpatient,,,144.00000,69.41000,Hometown Health,PPO/EPO,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,outpatient,,,144.00000,69.41000,Hometown Health,PPO/EPO,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,inpatient,,,20.00000,9.64000,Hometown Health,PPO/EPO,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,outpatient,,,20.00000,9.64000,Hometown Health,PPO/EPO,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,inpatient,,,208.00000,100.26000,Hometown Health,PPO/EPO,,187.20,,,,,,,187.20,201.76,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,outpatient,,,208.00000,100.26000,Hometown Health,PPO/EPO,,187.20,,,,,,,54.08,201.76,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,inpatient,,,135.00000,65.07000,Hometown Health,PPO/EPO,,121.50,,,,,,,121.50,130.95,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,outpatient,,,135.00000,65.07000,Hometown Health,PPO/EPO,,121.50,,,,,,,35.10,130.95,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,inpatient,,,131.00000,63.14000,Hometown Health,PPO/EPO,,117.90,,,,,,,117.90,127.07,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,outpatient,,,131.00000,63.14000,Hometown Health,PPO/EPO,,117.90,,,,,,,34.06,127.07,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,PPO/EPO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,PPO/EPO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,inpatient,,,25.00000,12.05000,Hometown Health,PPO/EPO,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,outpatient,,,25.00000,12.05000,Hometown Health,PPO/EPO,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,inpatient,,,80.00000,38.56000,Hometown Health,PPO/EPO,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,outpatient,,,80.00000,38.56000,Hometown Health,PPO/EPO,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,PPO/EPO,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,PPO/EPO,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,inpatient,,,35.00000,16.87000,Hometown Health,PPO/EPO,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,outpatient,,,35.00000,16.87000,Hometown Health,PPO/EPO,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,inpatient,,,88.00000,42.42000,Hometown Health,PPO/EPO,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,outpatient,,,88.00000,42.42000,Hometown Health,PPO/EPO,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,inpatient,,,98.00000,47.24000,Hometown Health,PPO/EPO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,outpatient,,,98.00000,47.24000,Hometown Health,PPO/EPO,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,inpatient,,,204.00000,98.33000,Hometown Health,PPO/EPO,,183.60,,,,,,,183.60,197.88,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,outpatient,,,204.00000,98.33000,Hometown Health,PPO/EPO,,183.60,,,,,,,53.04,197.88,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,inpatient,,,19.00000,9.16000,Hometown Health,PPO/EPO,,17.10,,,,,,,17.10,18.43,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,outpatient,,,19.00000,9.16000,Hometown Health,PPO/EPO,,17.10,,,,,,,4.94,18.43,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,inpatient,,,37.00000,17.83000,Hometown Health,PPO/EPO,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,outpatient,,,37.00000,17.83000,Hometown Health,PPO/EPO,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,inpatient,,,79.00000,38.08000,Hometown Health,PPO/EPO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,outpatient,,,79.00000,38.08000,Hometown Health,PPO/EPO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,inpatient,,,21.00000,10.12000,Hometown Health,PPO/EPO,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,outpatient,,,21.00000,10.12000,Hometown Health,PPO/EPO,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,inpatient,,,32.00000,15.42000,Hometown Health,PPO/EPO,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,outpatient,,,32.00000,15.42000,Hometown Health,PPO/EPO,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,inpatient,,,94.00000,45.31000,Hometown Health,PPO/EPO,,84.60,,,,,,,84.60,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,outpatient,,,94.00000,45.31000,Hometown Health,PPO/EPO,,84.60,,,,,,,24.44,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,inpatient,,,103.00000,49.65000,Hometown Health,PPO/EPO,,92.70,,,,,,,92.70,99.91,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,outpatient,,,103.00000,49.65000,Hometown Health,PPO/EPO,,92.70,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,PPO/EPO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,PPO/EPO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,inpatient,,,102.00000,49.16000,Hometown Health,PPO/EPO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,outpatient,,,102.00000,49.16000,Hometown Health,PPO/EPO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,inpatient,,,103.00000,49.65000,Hometown Health,PPO/EPO,,92.70,,,,,,,92.70,99.91,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,outpatient,,,103.00000,49.65000,Hometown Health,PPO/EPO,,92.70,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,inpatient,,,139.00000,67.00000,Hometown Health,PPO/EPO,,125.10,,,,,,,125.10,134.83,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,outpatient,,,139.00000,67.00000,Hometown Health,PPO/EPO,,125.10,,,,,,,36.14,134.83,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,inpatient,,,21.00000,10.12000,Hometown Health,PPO/EPO,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Hometown Health,PPO/EPO,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,inpatient,,,88.00000,42.42000,Hometown Health,PPO/EPO,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,outpatient,,,88.00000,42.42000,Hometown Health,PPO/EPO,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,inpatient,,,21.00000,10.12000,Hometown Health,PPO/EPO,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Hometown Health,PPO/EPO,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,inpatient,,,80.00000,38.56000,Hometown Health,PPO/EPO,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,outpatient,,,80.00000,38.56000,Hometown Health,PPO/EPO,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,inpatient,,,49.00000,23.62000,Hometown Health,PPO/EPO,,44.10,,,,,,,44.10,47.53,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,outpatient,,,49.00000,23.62000,Hometown Health,PPO/EPO,,44.10,,,,,,,12.74,47.53,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,inpatient,,,88.00000,42.42000,Hometown Health,PPO/EPO,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,outpatient,,,88.00000,42.42000,Hometown Health,PPO/EPO,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,PPO/EPO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,PPO/EPO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,inpatient,,,93.00000,44.83000,Hometown Health,PPO/EPO,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,outpatient,,,93.00000,44.83000,Hometown Health,PPO/EPO,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,inpatient,,,73.00000,35.19000,Hometown Health,PPO/EPO,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,outpatient,,,73.00000,35.19000,Hometown Health,PPO/EPO,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,inpatient,,,41.00000,19.76000,Hometown Health,PPO/EPO,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,outpatient,,,41.00000,19.76000,Hometown Health,PPO/EPO,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,inpatient,,,94.00000,45.31000,Hometown Health,PPO/EPO,,84.60,,,,,,,84.60,91.18,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,outpatient,,,94.00000,45.31000,Hometown Health,PPO/EPO,,84.60,,,,,,,24.44,91.18,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,inpatient,,,124.00000,59.77000,Hometown Health,PPO/EPO,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,outpatient,,,124.00000,59.77000,Hometown Health,PPO/EPO,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,PPO/EPO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,PPO/EPO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,inpatient,,,33.00000,15.91000,Hometown Health,PPO/EPO,,29.70,,,,,,,29.70,32.01,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,outpatient,,,33.00000,15.91000,Hometown Health,PPO/EPO,,29.70,,,,,,,8.58,32.01,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,PPO/EPO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,PPO/EPO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,inpatient,,,99.00000,47.72000,Hometown Health,PPO/EPO,,89.10,,,,,,,89.10,96.03,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,outpatient,,,99.00000,47.72000,Hometown Health,PPO/EPO,,89.10,,,,,,,25.74,96.03,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,inpatient,,,197.00000,94.95000,Hometown Health,PPO/EPO,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,outpatient,,,197.00000,94.95000,Hometown Health,PPO/EPO,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,inpatient,,,194.00000,93.51000,Hometown Health,PPO/EPO,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,outpatient,,,194.00000,93.51000,Hometown Health,PPO/EPO,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,inpatient,,,68.00000,32.78000,Hometown Health,PPO/EPO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,outpatient,,,68.00000,32.78000,Hometown Health,PPO/EPO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,inpatient,,,90.00000,43.38000,Hometown Health,PPO/EPO,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,outpatient,,,90.00000,43.38000,Hometown Health,PPO/EPO,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,inpatient,,,109.00000,52.54000,Hometown Health,PPO/EPO,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,outpatient,,,109.00000,52.54000,Hometown Health,PPO/EPO,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,inpatient,,,108.00000,52.06000,Hometown Health,PPO/EPO,,97.20,,,,,,,97.20,104.76,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,outpatient,,,108.00000,52.06000,Hometown Health,PPO/EPO,,97.20,,,,,,,28.08,104.76,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,inpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,outpatient,,,67.00000,32.29000,Hometown Health,PPO/EPO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,PPO/EPO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,PPO/EPO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,PPO/EPO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,PPO/EPO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,inpatient,,,98.00000,47.24000,Hometown Health,PPO/EPO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,outpatient,,,98.00000,47.24000,Hometown Health,PPO/EPO,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,inpatient,,,141.00000,67.96000,Hometown Health,PPO/EPO,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,outpatient,,,141.00000,67.96000,Hometown Health,PPO/EPO,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,inpatient,,,226.00000,108.93000,Hometown Health,PPO/EPO,,203.40,,,,,,,203.40,219.22,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,outpatient,,,226.00000,108.93000,Hometown Health,PPO/EPO,,203.40,,,,,,,58.76,219.22,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,inpatient,,,92.00000,44.34000,Hometown Health,PPO/EPO,,82.80,,,,,,,82.80,89.24,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,outpatient,,,92.00000,44.34000,Hometown Health,PPO/EPO,,82.80,,,,,,,23.92,89.24,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,PPO/EPO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,PPO/EPO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,inpatient,,,100.00000,48.20000,Hometown Health,PPO/EPO,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,outpatient,,,100.00000,48.20000,Hometown Health,PPO/EPO,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,inpatient,,,124.00000,59.77000,Hometown Health,PPO/EPO,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,outpatient,,,124.00000,59.77000,Hometown Health,PPO/EPO,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,PPO/EPO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,PPO/EPO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Hometown Health,PPO/EPO,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Hometown Health,PPO/EPO,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Hometown Health,PPO/EPO,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Hometown Health,PPO/EPO,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Hometown Health,PPO/EPO,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Hometown Health,PPO/EPO,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,inpatient,,,118.00000,56.88000,Hometown Health,PPO/EPO,,106.20,,,,,,,106.20,114.46,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,outpatient,,,118.00000,56.88000,Hometown Health,PPO/EPO,,106.20,,,,,,,30.68,114.46,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,PPO/EPO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,PPO/EPO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,inpatient,,,104.00000,50.13000,Hometown Health,PPO/EPO,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,outpatient,,,104.00000,50.13000,Hometown Health,PPO/EPO,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,PPO/EPO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,PPO/EPO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,PPO/EPO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,PPO/EPO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,inpatient,,,17.00000,8.19000,Hometown Health,PPO/EPO,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,outpatient,,,17.00000,8.19000,Hometown Health,PPO/EPO,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,inpatient,,,36.00000,17.35000,Hometown Health,PPO/EPO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,outpatient,,,36.00000,17.35000,Hometown Health,PPO/EPO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,inpatient,,,18.00000,8.68000,Hometown Health,PPO/EPO,,16.20,,,,,,,16.20,17.46,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,outpatient,,,18.00000,8.68000,Hometown Health,PPO/EPO,,16.20,,,,,,,4.68,17.46,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,inpatient,,,74.00000,35.67000,Hometown Health,PPO/EPO,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,outpatient,,,74.00000,35.67000,Hometown Health,PPO/EPO,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,inpatient,,,118.00000,56.88000,Hometown Health,PPO/EPO,,106.20,,,,,,,106.20,114.46,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,outpatient,,,118.00000,56.88000,Hometown Health,PPO/EPO,,106.20,,,,,,,30.68,114.46,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,PPO/EPO,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,PPO/EPO,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,inpatient,,,30.00000,14.46000,Hometown Health,PPO/EPO,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,outpatient,,,30.00000,14.46000,Hometown Health,PPO/EPO,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,PPO/EPO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,PPO/EPO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,PPO/EPO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,PPO/EPO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,PPO/EPO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,PPO/EPO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,inpatient,,,141.00000,67.96000,Hometown Health,PPO/EPO,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,outpatient,,,141.00000,67.96000,Hometown Health,PPO/EPO,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,inpatient,,,81.00000,39.04000,Hometown Health,PPO/EPO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,outpatient,,,81.00000,39.04000,Hometown Health,PPO/EPO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,inpatient,,,335.00000,161.47000,Hometown Health,PPO/EPO,,301.50,,,,,,,301.50,324.95,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,outpatient,,,335.00000,161.47000,Hometown Health,PPO/EPO,,301.50,,,,,,,87.10,324.95,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,inpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,outpatient,,,52.00000,25.06000,Hometown Health,PPO/EPO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,PPO/EPO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,PPO/EPO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,PPO/EPO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,PPO/EPO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,PPO/EPO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,PPO/EPO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,inpatient,,,53.00000,25.55000,Hometown Health,PPO/EPO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,outpatient,,,53.00000,25.55000,Hometown Health,PPO/EPO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,inpatient,,,12.00000,5.78000,Hometown Health,PPO/EPO,,10.80,,,,,,,10.80,11.64,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,outpatient,,,12.00000,5.78000,Hometown Health,PPO/EPO,,10.80,,,,,,,3.12,11.64,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,inpatient,,,710.00000,342.22000,Hometown Health,PPO/EPO,,639.00,,,,,,,639.00,688.70,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,outpatient,,,710.00000,342.22000,Hometown Health,PPO/EPO,,639.00,,,,,,,184.60,688.70,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,inpatient,,,104.00000,50.13000,Hometown Health,PPO/EPO,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,outpatient,,,104.00000,50.13000,Hometown Health,PPO/EPO,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,inpatient,,,155.00000,74.71000,Hometown Health,PPO/EPO,,139.50,,,,,,,139.50,150.35,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,outpatient,,,155.00000,74.71000,Hometown Health,PPO/EPO,,139.50,,,,,,,40.30,150.35,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,inpatient,,,139.00000,67.00000,Hometown Health,PPO/EPO,,125.10,,,,,,,125.10,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,outpatient,,,139.00000,67.00000,Hometown Health,PPO/EPO,,125.10,,,,,,,36.14,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,inpatient,,,89.00000,42.90000,Hometown Health,PPO/EPO,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,outpatient,,,89.00000,42.90000,Hometown Health,PPO/EPO,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,inpatient,,,88.00000,42.42000,Hometown Health,PPO/EPO,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,outpatient,,,88.00000,42.42000,Hometown Health,PPO/EPO,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,inpatient,,,111.00000,53.50000,Hometown Health,PPO/EPO,,99.90,,,,,,,99.90,107.67,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,outpatient,,,111.00000,53.50000,Hometown Health,PPO/EPO,,99.90,,,,,,,28.86,107.67,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,PPO/EPO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,PPO/EPO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,inpatient,,,85.00000,40.97000,Hometown Health,PPO/EPO,,76.50,,,,,,,76.50,82.45,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,outpatient,,,85.00000,40.97000,Hometown Health,PPO/EPO,,76.50,,,,,,,22.10,82.45,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,inpatient,,,110.00000,53.02000,Hometown Health,PPO/EPO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,outpatient,,,110.00000,53.02000,Hometown Health,PPO/EPO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,inpatient,,,500.00000,241.00000,Hometown Health,PPO/EPO,,450.00,,,,,,,450.00,485.00,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,outpatient,,,500.00000,241.00000,Hometown Health,PPO/EPO,,450.00,,,,,,,130.00,485.00,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,inpatient,,,140.00000,67.48000,Hometown Health,PPO/EPO,,126.00,,,,,,,126.00,135.80,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,outpatient,,,140.00000,67.48000,Hometown Health,PPO/EPO,,126.00,,,,,,,36.40,135.80,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,inpatient,,,74.00000,35.67000,Hometown Health,PPO/EPO,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,outpatient,,,74.00000,35.67000,Hometown Health,PPO/EPO,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,PPO/EPO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,PPO/EPO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,inpatient,,,93.00000,44.83000,Hometown Health,PPO/EPO,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,outpatient,,,93.00000,44.83000,Hometown Health,PPO/EPO,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,inpatient,,,15.00000,7.23000,Hometown Health,PPO/EPO,,13.50,,,,,,,13.50,14.55,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,outpatient,,,15.00000,7.23000,Hometown Health,PPO/EPO,,13.50,,,,,,,3.90,14.55,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,inpatient,,,24.00000,11.57000,Hometown Health,PPO/EPO,,21.60,,,,,,,21.60,23.28,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,outpatient,,,24.00000,11.57000,Hometown Health,PPO/EPO,,21.60,,,,,,,6.24,23.28,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,PPO/EPO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,PPO/EPO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,inpatient,,,16.00000,7.71000,Hometown Health,PPO/EPO,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Hometown Health,PPO/EPO,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,inpatient,,,16.00000,7.71000,Hometown Health,PPO/EPO,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Hometown Health,PPO/EPO,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,PPO/EPO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,PPO/EPO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,PPO/EPO,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,PPO/EPO,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,inpatient,,,157.00000,75.67000,Hometown Health,PPO/EPO,,141.30,,,,,,,141.30,152.29,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,outpatient,,,157.00000,75.67000,Hometown Health,PPO/EPO,,141.30,,,,,,,40.82,152.29,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,inpatient,,,70.00000,33.74000,Hometown Health,PPO/EPO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,outpatient,,,70.00000,33.74000,Hometown Health,PPO/EPO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,inpatient,,,229.00000,110.38000,Hometown Health,PPO/EPO,,206.10,,,,,,,206.10,222.13,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,outpatient,,,229.00000,110.38000,Hometown Health,PPO/EPO,,206.10,,,,,,,59.54,222.13,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,PPO/EPO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,PPO/EPO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,PPO/EPO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,PPO/EPO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,inpatient,,,17.00000,8.19000,Hometown Health,PPO/EPO,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,outpatient,,,17.00000,8.19000,Hometown Health,PPO/EPO,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,PPO/EPO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,PPO/EPO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,inpatient,,,387.00000,186.53000,Hometown Health,PPO/EPO,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,outpatient,,,387.00000,186.53000,Hometown Health,PPO/EPO,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,inpatient,,,387.00000,186.53000,Hometown Health,PPO/EPO,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Hometown Health,PPO/EPO,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,inpatient,,,387.00000,186.53000,Hometown Health,PPO/EPO,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Hometown Health,PPO/EPO,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,inpatient,,,77.00000,37.11000,Hometown Health,PPO/EPO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,outpatient,,,77.00000,37.11000,Hometown Health,PPO/EPO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,inpatient,,,78.00000,37.60000,Hometown Health,PPO/EPO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Hometown Health,PPO/EPO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,inpatient,,,78.00000,37.60000,Hometown Health,PPO/EPO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Hometown Health,PPO/EPO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,inpatient,,,43.00000,20.73000,Hometown Health,PPO/EPO,,38.70,,,,,,,38.70,41.71,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,outpatient,,,43.00000,20.73000,Hometown Health,PPO/EPO,,38.70,,,,,,,11.18,41.71,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,PPO/EPO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,PPO/EPO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,inpatient,,,160.00000,77.12000,Hometown Health,PPO/EPO,,144.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,outpatient,,,160.00000,77.12000,Hometown Health,PPO/EPO,,144.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,inpatient,,,112.00000,53.98000,Hometown Health,PPO/EPO,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,outpatient,,,112.00000,53.98000,Hometown Health,PPO/EPO,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,inpatient,,,82.00000,39.52000,Hometown Health,PPO/EPO,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,outpatient,,,82.00000,39.52000,Hometown Health,PPO/EPO,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,inpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,outpatient,,,55.00000,26.51000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,PPO/EPO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,PPO/EPO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,inpatient,,,153.00000,73.75000,Hometown Health,PPO/EPO,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,outpatient,,,153.00000,73.75000,Hometown Health,PPO/EPO,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,inpatient,,,45.00000,21.69000,Hometown Health,PPO/EPO,,40.50,,,,,,,40.50,43.65,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,outpatient,,,45.00000,21.69000,Hometown Health,PPO/EPO,,40.50,,,,,,,11.70,43.65,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,inpatient,,,28.00000,13.50000,Hometown Health,PPO/EPO,,25.20,,,,,,,25.20,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,outpatient,,,28.00000,13.50000,Hometown Health,PPO/EPO,,25.20,,,,,,,7.28,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Hometown Health,PPO/EPO,,44.10,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Hometown Health,PPO/EPO,,44.10,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Hometown Health,PPO/EPO,,44.10,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Hometown Health,PPO/EPO,,44.10,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Hometown Health,PPO/EPO,,44.10,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Hometown Health,PPO/EPO,,44.10,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,inpatient,,,36.00000,17.35000,Hometown Health,PPO/EPO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,outpatient,,,36.00000,17.35000,Hometown Health,PPO/EPO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,inpatient,,,38.00000,18.32000,Hometown Health,PPO/EPO,,34.20,,,,,,,34.20,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,outpatient,,,38.00000,18.32000,Hometown Health,PPO/EPO,,34.20,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,inpatient,,,38.00000,18.32000,Hometown Health,PPO/EPO,,34.20,,,,,,,34.20,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,outpatient,,,38.00000,18.32000,Hometown Health,PPO/EPO,,34.20,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,inpatient,,,76.00000,36.63000,Hometown Health,PPO/EPO,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,outpatient,,,76.00000,36.63000,Hometown Health,PPO/EPO,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,inpatient,,,173.00000,83.39000,Hometown Health,PPO/EPO,,155.70,,,,,,,155.70,167.81,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,outpatient,,,173.00000,83.39000,Hometown Health,PPO/EPO,,155.70,,,,,,,44.98,167.81,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,inpatient,,,22.00000,10.60000,Hometown Health,PPO/EPO,,19.80,,,,,,,19.80,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,outpatient,,,22.00000,10.60000,Hometown Health,PPO/EPO,,19.80,,,,,,,5.72,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,inpatient,,,39.00000,18.80000,Hometown Health,PPO/EPO,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,outpatient,,,39.00000,18.80000,Hometown Health,PPO/EPO,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,inpatient,,,41.00000,19.76000,Hometown Health,PPO/EPO,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,outpatient,,,41.00000,19.76000,Hometown Health,PPO/EPO,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,PPO/EPO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,PPO/EPO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,PPO/EPO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,PPO/EPO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,inpatient,,,43.00000,20.73000,Hometown Health,PPO/EPO,,38.70,,,,,,,38.70,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Hometown Health,PPO/EPO,,38.70,,,,,,,11.18,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,inpatient,,,43.00000,20.73000,Hometown Health,PPO/EPO,,38.70,,,,,,,38.70,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Hometown Health,PPO/EPO,,38.70,,,,,,,11.18,41.71,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,inpatient,,,38.00000,18.32000,Hometown Health,PPO/EPO,,34.20,,,,,,,34.20,36.86,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,outpatient,,,38.00000,18.32000,Hometown Health,PPO/EPO,,34.20,,,,,,,9.88,36.86,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,inpatient,,,72.00000,34.70000,Hometown Health,PPO/EPO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,outpatient,,,72.00000,34.70000,Hometown Health,PPO/EPO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,inpatient,,,226.00000,108.93000,Hometown Health,PPO/EPO,,203.40,,,,,,,203.40,219.22,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,outpatient,,,226.00000,108.93000,Hometown Health,PPO/EPO,,203.40,,,,,,,58.76,219.22,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Hometown Health,PPO/EPO,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Hometown Health,PPO/EPO,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Hometown Health,PPO/EPO,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Hometown Health,PPO/EPO,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Hometown Health,PPO/EPO,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Hometown Health,PPO/EPO,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,inpatient,,,160.00000,77.12000,Hometown Health,PPO/EPO,,144.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,outpatient,,,160.00000,77.12000,Hometown Health,PPO/EPO,,144.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,inpatient,,,102.00000,49.16000,Hometown Health,PPO/EPO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,outpatient,,,102.00000,49.16000,Hometown Health,PPO/EPO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,inpatient,,,317.00000,152.79000,Hometown Health,PPO/EPO,,285.30,,,,,,,285.30,307.49,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,outpatient,,,317.00000,152.79000,Hometown Health,PPO/EPO,,285.30,,,,,,,82.42,307.49,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,inpatient,,,116.00000,55.91000,Hometown Health,PPO/EPO,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,outpatient,,,116.00000,55.91000,Hometown Health,PPO/EPO,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,inpatient,,,89.00000,42.90000,Hometown Health,PPO/EPO,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Hometown Health,PPO/EPO,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,inpatient,,,89.00000,42.90000,Hometown Health,PPO/EPO,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Hometown Health,PPO/EPO,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,inpatient,,,85.00000,40.97000,Hometown Health,PPO/EPO,,76.50,,,,,,,76.50,82.45,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,outpatient,,,85.00000,40.97000,Hometown Health,PPO/EPO,,76.50,,,,,,,22.10,82.45,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,inpatient,,,184.00000,88.69000,Hometown Health,PPO/EPO,,165.60,,,,,,,165.60,178.48,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,outpatient,,,184.00000,88.69000,Hometown Health,PPO/EPO,,165.60,,,,,,,47.84,178.48,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,inpatient,,,127.00000,61.21000,Hometown Health,PPO/EPO,,114.30,,,,,,,114.30,123.19,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,outpatient,,,127.00000,61.21000,Hometown Health,PPO/EPO,,114.30,,,,,,,33.02,123.19,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,inpatient,,,61.00000,29.40000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,outpatient,,,61.00000,29.40000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,inpatient,,,35.00000,16.87000,Hometown Health,PPO/EPO,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,outpatient,,,35.00000,16.87000,Hometown Health,PPO/EPO,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,inpatient,,,79.00000,38.08000,Hometown Health,PPO/EPO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,outpatient,,,79.00000,38.08000,Hometown Health,PPO/EPO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,inpatient,,,57.00000,32.83000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,outpatient,,,57.00000,32.83000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Hometown Health,PPO/EPO,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Hometown Health,PPO/EPO,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,inpatient,,,77.00000,44.35000,Hometown Health,PPO/EPO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,outpatient,,,77.00000,44.35000,Hometown Health,PPO/EPO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,inpatient,,,70.00000,40.32000,Hometown Health,PPO/EPO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,outpatient,,,70.00000,40.32000,Hometown Health,PPO/EPO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,inpatient,,,67.00000,38.59000,Hometown Health,PPO/EPO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,outpatient,,,67.00000,38.59000,Hometown Health,PPO/EPO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,inpatient,,,40.00000,23.04000,Hometown Health,PPO/EPO,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,outpatient,,,40.00000,23.04000,Hometown Health,PPO/EPO,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,inpatient,,,71.00000,40.90000,Hometown Health,PPO/EPO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,outpatient,,,71.00000,40.90000,Hometown Health,PPO/EPO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,inpatient,,,80.00000,46.08000,Hometown Health,PPO/EPO,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,outpatient,,,80.00000,46.08000,Hometown Health,PPO/EPO,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,inpatient,,,72.00000,41.47000,Hometown Health,PPO/EPO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,outpatient,,,72.00000,41.47000,Hometown Health,PPO/EPO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,inpatient,,,444.00000,255.74000,Hometown Health,PPO/EPO,,399.60,,,,,,,399.60,430.68,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,outpatient,,,444.00000,255.74000,Hometown Health,PPO/EPO,,399.60,,,,,,,115.44,430.68,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,inpatient,,,81.00000,46.66000,Hometown Health,PPO/EPO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,outpatient,,,81.00000,46.66000,Hometown Health,PPO/EPO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,inpatient,,,66.00000,38.02000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,outpatient,,,66.00000,38.02000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,inpatient,,,57.00000,32.83000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,outpatient,,,57.00000,32.83000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,PPO/EPO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,PPO/EPO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,inpatient,,,40.00000,23.04000,Hometown Health,PPO/EPO,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,outpatient,,,40.00000,23.04000,Hometown Health,PPO/EPO,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,inpatient,,,42.00000,24.19000,Hometown Health,PPO/EPO,,37.80,,,,,,,37.80,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,outpatient,,,42.00000,24.19000,Hometown Health,PPO/EPO,,37.80,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,inpatient,,,46.00000,26.50000,Hometown Health,PPO/EPO,,41.40,,,,,,,41.40,44.62,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,outpatient,,,46.00000,26.50000,Hometown Health,PPO/EPO,,41.40,,,,,,,11.96,44.62,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,inpatient,,,54.00000,31.10000,Hometown Health,PPO/EPO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,outpatient,,,54.00000,31.10000,Hometown Health,PPO/EPO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,inpatient,,,71.00000,40.90000,Hometown Health,PPO/EPO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,outpatient,,,71.00000,40.90000,Hometown Health,PPO/EPO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,inpatient,,,54.00000,31.10000,Hometown Health,PPO/EPO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,outpatient,,,54.00000,31.10000,Hometown Health,PPO/EPO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,inpatient,,,80.00000,46.08000,Hometown Health,PPO/EPO,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,outpatient,,,80.00000,46.08000,Hometown Health,PPO/EPO,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,inpatient,,,124.00000,71.42000,Hometown Health,PPO/EPO,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Hometown Health,PPO/EPO,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,inpatient,,,130.00000,74.88000,Hometown Health,PPO/EPO,,117.00,,,,,,,117.00,126.10,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,outpatient,,,130.00000,74.88000,Hometown Health,PPO/EPO,,117.00,,,,,,,33.80,126.10,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,inpatient,,,123.00000,70.85000,Hometown Health,PPO/EPO,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Hometown Health,PPO/EPO,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,inpatient,,,77.00000,44.35000,Hometown Health,PPO/EPO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,outpatient,,,77.00000,44.35000,Hometown Health,PPO/EPO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,inpatient,,,115.00000,66.24000,Hometown Health,PPO/EPO,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,outpatient,,,115.00000,66.24000,Hometown Health,PPO/EPO,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,inpatient,,,123.00000,70.85000,Hometown Health,PPO/EPO,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Hometown Health,PPO/EPO,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,inpatient,,,161.00000,92.74000,Hometown Health,PPO/EPO,,144.90,,,,,,,144.90,156.17,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,outpatient,,,161.00000,92.74000,Hometown Health,PPO/EPO,,144.90,,,,,,,41.86,156.17,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,inpatient,,,124.00000,71.42000,Hometown Health,PPO/EPO,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Hometown Health,PPO/EPO,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,inpatient,,,102.00000,58.75000,Hometown Health,PPO/EPO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,outpatient,,,102.00000,58.75000,Hometown Health,PPO/EPO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,inpatient,,,219.00000,126.14000,Hometown Health,PPO/EPO,,197.10,,,,,,,197.10,212.43,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,outpatient,,,219.00000,126.14000,Hometown Health,PPO/EPO,,197.10,,,,,,,56.94,212.43,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,inpatient,,,194.00000,111.74000,Hometown Health,PPO/EPO,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Hometown Health,PPO/EPO,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,inpatient,,,103.00000,59.33000,Hometown Health,PPO/EPO,,92.70,,,,,,,92.70,99.91,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,outpatient,,,103.00000,59.33000,Hometown Health,PPO/EPO,,92.70,,,,,,,26.78,99.91,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,inpatient,,,837.00000,482.11000,Hometown Health,PPO/EPO,,753.30,,,,,,,753.30,811.89,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,outpatient,,,837.00000,482.11000,Hometown Health,PPO/EPO,,753.30,,,,,,,217.62,811.89,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,inpatient,,,194.00000,111.74000,Hometown Health,PPO/EPO,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Hometown Health,PPO/EPO,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,inpatient,,,78.00000,44.93000,Hometown Health,PPO/EPO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,outpatient,,,78.00000,44.93000,Hometown Health,PPO/EPO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,inpatient,,,285.00000,164.16000,Hometown Health,PPO/EPO,,256.50,,,,,,,256.50,276.45,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,outpatient,,,285.00000,164.16000,Hometown Health,PPO/EPO,,256.50,,,,,,,74.10,276.45,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,inpatient,,,190.00000,109.44000,Hometown Health,PPO/EPO,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,outpatient,,,190.00000,109.44000,Hometown Health,PPO/EPO,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,inpatient,,,100.00000,57.60000,Hometown Health,PPO/EPO,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,outpatient,,,100.00000,57.60000,Hometown Health,PPO/EPO,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,inpatient,,,40.00000,23.04000,Hometown Health,PPO/EPO,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Hometown Health,PPO/EPO,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,inpatient,,,67.00000,38.59000,Hometown Health,PPO/EPO,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,outpatient,,,67.00000,38.59000,Hometown Health,PPO/EPO,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,inpatient,,,78.00000,44.93000,Hometown Health,PPO/EPO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,outpatient,,,78.00000,44.93000,Hometown Health,PPO/EPO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,inpatient,,,57.00000,32.83000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,outpatient,,,57.00000,32.83000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,inpatient,,,72.00000,41.47000,Hometown Health,PPO/EPO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,outpatient,,,72.00000,41.47000,Hometown Health,PPO/EPO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,inpatient,,,72.00000,41.47000,Hometown Health,PPO/EPO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,outpatient,,,72.00000,41.47000,Hometown Health,PPO/EPO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,inpatient,,,239.00000,137.66000,Hometown Health,PPO/EPO,,215.10,,,,,,,215.10,231.83,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,outpatient,,,239.00000,137.66000,Hometown Health,PPO/EPO,,215.10,,,,,,,62.14,231.83,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,inpatient,,,85.00000,48.96000,Hometown Health,PPO/EPO,,76.50,,,,,,,76.50,82.45,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,outpatient,,,85.00000,48.96000,Hometown Health,PPO/EPO,,76.50,,,,,,,22.10,82.45,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,inpatient,,,44.00000,25.34000,Hometown Health,PPO/EPO,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,outpatient,,,44.00000,25.34000,Hometown Health,PPO/EPO,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,inpatient,,,40.00000,23.04000,Hometown Health,PPO/EPO,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,outpatient,,,40.00000,23.04000,Hometown Health,PPO/EPO,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,PPO/EPO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,PPO/EPO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,inpatient,,,68.00000,39.17000,Hometown Health,PPO/EPO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,outpatient,,,68.00000,39.17000,Hometown Health,PPO/EPO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,inpatient,,,76.00000,43.78000,Hometown Health,PPO/EPO,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,outpatient,,,76.00000,43.78000,Hometown Health,PPO/EPO,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,inpatient,,,42.00000,24.19000,Hometown Health,PPO/EPO,,37.80,,,,,,,37.80,40.74,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,outpatient,,,42.00000,24.19000,Hometown Health,PPO/EPO,,37.80,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,inpatient,,,87.00000,50.11000,Hometown Health,PPO/EPO,,78.30,,,,,,,78.30,84.39,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,outpatient,,,87.00000,50.11000,Hometown Health,PPO/EPO,,78.30,,,,,,,22.62,84.39,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,inpatient,,,503.00000,289.73000,Hometown Health,PPO/EPO,,452.70,,,,,,,452.70,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,outpatient,,,503.00000,289.73000,Hometown Health,PPO/EPO,,452.70,,,,,,,130.78,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,inpatient,,,472.00000,271.87000,Hometown Health,PPO/EPO,,424.80,,,,,,,424.80,457.84,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,outpatient,,,472.00000,271.87000,Hometown Health,PPO/EPO,,424.80,,,,,,,122.72,457.84,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,inpatient,,,28.00000,16.13000,Hometown Health,PPO/EPO,,25.20,,,,,,,25.20,27.16,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,outpatient,,,28.00000,16.13000,Hometown Health,PPO/EPO,,25.20,,,,,,,7.28,27.16,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,inpatient,,,236.00000,135.94000,Hometown Health,PPO/EPO,,212.40,,,,,,,212.40,228.92,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,outpatient,,,236.00000,135.94000,Hometown Health,PPO/EPO,,212.40,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,inpatient,,,54.00000,31.10000,Hometown Health,PPO/EPO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,outpatient,,,54.00000,31.10000,Hometown Health,PPO/EPO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,inpatient,,,238.00000,137.09000,Hometown Health,PPO/EPO,,214.20,,,,,,,214.20,230.86,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,outpatient,,,238.00000,137.09000,Hometown Health,PPO/EPO,,214.20,,,,,,,61.88,230.86,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,inpatient,,,236.00000,135.94000,Hometown Health,PPO/EPO,,212.40,,,,,,,212.40,228.92,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,outpatient,,,236.00000,135.94000,Hometown Health,PPO/EPO,,212.40,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,inpatient,,,145.00000,83.52000,Hometown Health,PPO/EPO,,130.50,,,,,,,130.50,140.65,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,outpatient,,,145.00000,83.52000,Hometown Health,PPO/EPO,,130.50,,,,,,,37.70,140.65,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,inpatient,,,68.00000,39.17000,Hometown Health,PPO/EPO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Hometown Health,PPO/EPO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,inpatient,,,68.00000,39.17000,Hometown Health,PPO/EPO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Hometown Health,PPO/EPO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,inpatient,,,66.00000,38.02000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,outpatient,,,66.00000,38.02000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,inpatient,,,158.00000,91.01000,Hometown Health,PPO/EPO,,142.20,,,,,,,142.20,153.26,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,outpatient,,,158.00000,91.01000,Hometown Health,PPO/EPO,,142.20,,,,,,,41.08,153.26,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,inpatient,,,71.00000,40.90000,Hometown Health,PPO/EPO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,outpatient,,,71.00000,40.90000,Hometown Health,PPO/EPO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,inpatient,,,144.00000,82.94000,Hometown Health,PPO/EPO,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,outpatient,,,144.00000,82.94000,Hometown Health,PPO/EPO,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,inpatient,,,1448.00000,834.05000,Hometown Health,PPO/EPO,,1303.20,,,,,,,1303.20,1404.56,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,outpatient,,,1448.00000,834.05000,Hometown Health,PPO/EPO,,1303.20,,,,,,,376.48,1404.56,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,inpatient,,,72.00000,41.47000,Hometown Health,PPO/EPO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,outpatient,,,72.00000,41.47000,Hometown Health,PPO/EPO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,inpatient,,,102.00000,58.75000,Hometown Health,PPO/EPO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,outpatient,,,102.00000,58.75000,Hometown Health,PPO/EPO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,inpatient,,,154.00000,88.70000,Hometown Health,PPO/EPO,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,outpatient,,,154.00000,88.70000,Hometown Health,PPO/EPO,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Hometown Health,PPO/EPO,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Hometown Health,PPO/EPO,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,inpatient,,,66.00000,38.02000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,outpatient,,,66.00000,38.02000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Hometown Health,PPO/EPO,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Hometown Health,PPO/EPO,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,inpatient,,,44.00000,25.34000,Hometown Health,PPO/EPO,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,outpatient,,,44.00000,25.34000,Hometown Health,PPO/EPO,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,inpatient,,,150.00000,86.40000,Hometown Health,PPO/EPO,,135.00,,,,,,,135.00,145.50,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,outpatient,,,150.00000,86.40000,Hometown Health,PPO/EPO,,135.00,,,,,,,39.00,145.50,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,inpatient,,,66.00000,38.02000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,outpatient,,,66.00000,38.02000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,inpatient,,,58.00000,33.41000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,outpatient,,,58.00000,33.41000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,inpatient,,,71.00000,40.90000,Hometown Health,PPO/EPO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,outpatient,,,71.00000,40.90000,Hometown Health,PPO/EPO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,inpatient,,,72.00000,41.47000,Hometown Health,PPO/EPO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,outpatient,,,72.00000,41.47000,Hometown Health,PPO/EPO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,inpatient,,,39.00000,22.46000,Hometown Health,PPO/EPO,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,outpatient,,,39.00000,22.46000,Hometown Health,PPO/EPO,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Hometown Health,PPO/EPO,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Hometown Health,PPO/EPO,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,inpatient,,,73.00000,42.05000,Hometown Health,PPO/EPO,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,outpatient,,,73.00000,42.05000,Hometown Health,PPO/EPO,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,inpatient,,,127.00000,73.15000,Hometown Health,PPO/EPO,,114.30,,,,,,,114.30,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Hometown Health,PPO/EPO,,114.30,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,inpatient,,,127.00000,73.15000,Hometown Health,PPO/EPO,,114.30,,,,,,,114.30,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Hometown Health,PPO/EPO,,114.30,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,inpatient,,,372.00000,214.27000,Hometown Health,PPO/EPO,,334.80,,,,,,,334.80,360.84,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,outpatient,,,372.00000,214.27000,Hometown Health,PPO/EPO,,334.80,,,,,,,96.72,360.84,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,inpatient,,,69.00000,39.74000,Hometown Health,PPO/EPO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,outpatient,,,69.00000,39.74000,Hometown Health,PPO/EPO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Hometown Health,PPO/EPO,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Hometown Health,PPO/EPO,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Hometown Health,PPO/EPO,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Hometown Health,PPO/EPO,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,inpatient,,,57.00000,32.83000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,outpatient,,,57.00000,32.83000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,inpatient,,,96.00000,55.30000,Hometown Health,PPO/EPO,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,outpatient,,,96.00000,55.30000,Hometown Health,PPO/EPO,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,inpatient,,,44.00000,25.34000,Hometown Health,PPO/EPO,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,outpatient,,,44.00000,25.34000,Hometown Health,PPO/EPO,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,inpatient,,,74.00000,42.62000,Hometown Health,PPO/EPO,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,outpatient,,,74.00000,42.62000,Hometown Health,PPO/EPO,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,inpatient,,,69.00000,39.74000,Hometown Health,PPO/EPO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,outpatient,,,69.00000,39.74000,Hometown Health,PPO/EPO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Hometown Health,PPO/EPO,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Hometown Health,PPO/EPO,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,PPO/EPO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,PPO/EPO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Hometown Health,PPO/EPO,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Hometown Health,PPO/EPO,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Hometown Health,PPO/EPO,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Hometown Health,PPO/EPO,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,inpatient,,,70.00000,40.32000,Hometown Health,PPO/EPO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,outpatient,,,70.00000,40.32000,Hometown Health,PPO/EPO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,inpatient,,,71.00000,40.90000,Hometown Health,PPO/EPO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,outpatient,,,71.00000,40.90000,Hometown Health,PPO/EPO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,inpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,outpatient,,,65.00000,37.44000,Hometown Health,PPO/EPO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,inpatient,,,325.00000,187.20000,Hometown Health,PPO/EPO,,292.50,,,,,,,292.50,315.25,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,outpatient,,,325.00000,187.20000,Hometown Health,PPO/EPO,,292.50,,,,,,,84.50,315.25,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,inpatient,,,72.00000,41.47000,Hometown Health,PPO/EPO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,outpatient,,,72.00000,41.47000,Hometown Health,PPO/EPO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,inpatient,,,72.00000,41.47000,Hometown Health,PPO/EPO,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,outpatient,,,72.00000,41.47000,Hometown Health,PPO/EPO,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,inpatient,,,76.00000,43.78000,Hometown Health,PPO/EPO,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,outpatient,,,76.00000,43.78000,Hometown Health,PPO/EPO,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,inpatient,,,240.00000,138.24000,Hometown Health,PPO/EPO,,216.00,,,,,,,216.00,232.80,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,outpatient,,,240.00000,138.24000,Hometown Health,PPO/EPO,,216.00,,,,,,,62.40,232.80,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,inpatient,,,93.00000,53.57000,Hometown Health,PPO/EPO,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,outpatient,,,93.00000,53.57000,Hometown Health,PPO/EPO,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,inpatient,,,81.00000,46.66000,Hometown Health,PPO/EPO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,outpatient,,,81.00000,46.66000,Hometown Health,PPO/EPO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,inpatient,,,58.00000,33.41000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,outpatient,,,58.00000,33.41000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,inpatient,,,21.00000,12.10000,Hometown Health,PPO/EPO,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,outpatient,,,21.00000,12.10000,Hometown Health,PPO/EPO,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,inpatient,,,64.00000,36.86000,Hometown Health,PPO/EPO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,outpatient,,,64.00000,36.86000,Hometown Health,PPO/EPO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,inpatient,,,80.00000,46.08000,Hometown Health,PPO/EPO,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,outpatient,,,80.00000,46.08000,Hometown Health,PPO/EPO,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,inpatient,,,109.00000,62.78000,Hometown Health,PPO/EPO,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,outpatient,,,109.00000,62.78000,Hometown Health,PPO/EPO,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,inpatient,,,115.00000,66.24000,Hometown Health,PPO/EPO,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,outpatient,,,115.00000,66.24000,Hometown Health,PPO/EPO,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,inpatient,,,57.00000,32.83000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,outpatient,,,57.00000,32.83000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,inpatient,,,118.00000,67.97000,Hometown Health,PPO/EPO,,106.20,,,,,,,106.20,114.46,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,outpatient,,,118.00000,67.97000,Hometown Health,PPO/EPO,,106.20,,,,,,,30.68,114.46,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,inpatient,,,268.00000,154.37000,Hometown Health,PPO/EPO,,241.20,,,,,,,241.20,259.96,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,outpatient,,,268.00000,154.37000,Hometown Health,PPO/EPO,,241.20,,,,,,,69.68,259.96,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,inpatient,,,114.00000,65.66000,Hometown Health,PPO/EPO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Hometown Health,PPO/EPO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,inpatient,,,114.00000,65.66000,Hometown Health,PPO/EPO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Hometown Health,PPO/EPO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,inpatient,,,78.00000,44.93000,Hometown Health,PPO/EPO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,outpatient,,,78.00000,44.93000,Hometown Health,PPO/EPO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,inpatient,,,91.00000,52.42000,Hometown Health,PPO/EPO,,81.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,outpatient,,,91.00000,52.42000,Hometown Health,PPO/EPO,,81.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,inpatient,,,66.00000,38.02000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,inpatient,,,66.00000,38.02000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,inpatient,,,300.00000,172.80000,Hometown Health,PPO/EPO,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,outpatient,,,300.00000,172.80000,Hometown Health,PPO/EPO,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,inpatient,,,185.00000,106.56000,Hometown Health,PPO/EPO,,166.50,,,,,,,166.50,179.45,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,outpatient,,,185.00000,106.56000,Hometown Health,PPO/EPO,,166.50,,,,,,,48.10,179.45,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Hometown Health,PPO/EPO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Hometown Health,PPO/EPO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,inpatient,,,76.00000,43.78000,Hometown Health,PPO/EPO,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,outpatient,,,76.00000,43.78000,Hometown Health,PPO/EPO,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Hometown Health,PPO/EPO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Hometown Health,PPO/EPO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Hometown Health,PPO/EPO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Hometown Health,PPO/EPO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,PPO/EPO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,PPO/EPO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,inpatient,,,77.00000,44.35000,Hometown Health,PPO/EPO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,outpatient,,,77.00000,44.35000,Hometown Health,PPO/EPO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Hometown Health,PPO/EPO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Hometown Health,PPO/EPO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,inpatient,,,222.00000,127.87000,Hometown Health,PPO/EPO,,199.80,,,,,,,199.80,215.34,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,outpatient,,,222.00000,127.87000,Hometown Health,PPO/EPO,,199.80,,,,,,,57.72,215.34,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,inpatient,,,292.00000,168.19000,Hometown Health,PPO/EPO,,262.80,,,,,,,262.80,283.24,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,outpatient,,,292.00000,168.19000,Hometown Health,PPO/EPO,,262.80,,,,,,,75.92,283.24,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,inpatient,,,125.00000,72.00000,Hometown Health,PPO/EPO,,112.50,,,,,,,112.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Hometown Health,PPO/EPO,,112.50,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,inpatient,,,125.00000,72.00000,Hometown Health,PPO/EPO,,112.50,,,,,,,112.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Hometown Health,PPO/EPO,,112.50,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,inpatient,,,359.00000,206.78000,Hometown Health,PPO/EPO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,outpatient,,,359.00000,206.78000,Hometown Health,PPO/EPO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,inpatient,,,111.00000,63.94000,Hometown Health,PPO/EPO,,99.90,,,,,,,99.90,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,outpatient,,,111.00000,63.94000,Hometown Health,PPO/EPO,,99.90,,,,,,,28.86,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,inpatient,,,141.00000,81.22000,Hometown Health,PPO/EPO,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Hometown Health,PPO/EPO,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,inpatient,,,141.00000,81.22000,Hometown Health,PPO/EPO,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Hometown Health,PPO/EPO,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,inpatient,,,114.00000,65.66000,Hometown Health,PPO/EPO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Hometown Health,PPO/EPO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,inpatient,,,114.00000,65.66000,Hometown Health,PPO/EPO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Hometown Health,PPO/EPO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,inpatient,,,114.00000,65.66000,Hometown Health,PPO/EPO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Hometown Health,PPO/EPO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,inpatient,,,114.00000,65.66000,Hometown Health,PPO/EPO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Hometown Health,PPO/EPO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,inpatient,,,78.00000,44.93000,Hometown Health,PPO/EPO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,outpatient,,,78.00000,44.93000,Hometown Health,PPO/EPO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,inpatient,,,359.00000,206.78000,Hometown Health,PPO/EPO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Hometown Health,PPO/EPO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,inpatient,,,359.00000,206.78000,Hometown Health,PPO/EPO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Hometown Health,PPO/EPO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,inpatient,,,70.00000,40.32000,Hometown Health,PPO/EPO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,outpatient,,,70.00000,40.32000,Hometown Health,PPO/EPO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,inpatient,,,18.00000,10.37000,Hometown Health,PPO/EPO,,16.20,,,,,,,16.20,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,outpatient,,,18.00000,10.37000,Hometown Health,PPO/EPO,,16.20,,,,,,,4.68,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,inpatient,,,408.00000,235.01000,Hometown Health,PPO/EPO,,367.20,,,,,,,367.20,395.76,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,outpatient,,,408.00000,235.01000,Hometown Health,PPO/EPO,,367.20,,,,,,,106.08,395.76,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,inpatient,,,102.00000,58.75000,Hometown Health,PPO/EPO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,outpatient,,,102.00000,58.75000,Hometown Health,PPO/EPO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,inpatient,,,330.00000,190.08000,Hometown Health,PPO/EPO,,297.00,,,,,,,297.00,320.10,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,outpatient,,,330.00000,190.08000,Hometown Health,PPO/EPO,,297.00,,,,,,,85.80,320.10,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,inpatient,,,136.00000,78.34000,Hometown Health,PPO/EPO,,122.40,,,,,,,122.40,131.92,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,outpatient,,,136.00000,78.34000,Hometown Health,PPO/EPO,,122.40,,,,,,,35.36,131.92,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,inpatient,,,83.00000,47.81000,Hometown Health,PPO/EPO,,74.70,,,,,,,74.70,80.51,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,outpatient,,,83.00000,47.81000,Hometown Health,PPO/EPO,,74.70,,,,,,,21.58,80.51,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,inpatient,,,142.00000,81.79000,Hometown Health,PPO/EPO,,127.80,,,,,,,127.80,137.74,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,outpatient,,,142.00000,81.79000,Hometown Health,PPO/EPO,,127.80,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,inpatient,,,51.00000,29.38000,Hometown Health,PPO/EPO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,outpatient,,,51.00000,29.38000,Hometown Health,PPO/EPO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,inpatient,,,70.00000,40.32000,Hometown Health,PPO/EPO,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,outpatient,,,70.00000,40.32000,Hometown Health,PPO/EPO,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,inpatient,,,99.00000,57.02000,Hometown Health,PPO/EPO,,89.10,,,,,,,89.10,96.03,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,outpatient,,,99.00000,57.02000,Hometown Health,PPO/EPO,,89.10,,,,,,,25.74,96.03,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,inpatient,,,78.00000,44.93000,Hometown Health,PPO/EPO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,outpatient,,,78.00000,44.93000,Hometown Health,PPO/EPO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,inpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,inpatient,,,75.00000,43.20000,Hometown Health,PPO/EPO,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,outpatient,,,75.00000,43.20000,Hometown Health,PPO/EPO,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,inpatient,,,37.00000,21.31000,Hometown Health,PPO/EPO,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Hometown Health,PPO/EPO,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,inpatient,,,37.00000,21.31000,Hometown Health,PPO/EPO,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Hometown Health,PPO/EPO,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,inpatient,,,35.00000,20.16000,Hometown Health,PPO/EPO,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,outpatient,,,35.00000,20.16000,Hometown Health,PPO/EPO,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,inpatient,,,74.00000,42.62000,Hometown Health,PPO/EPO,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,outpatient,,,74.00000,42.62000,Hometown Health,PPO/EPO,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,inpatient,,,90.00000,51.84000,Hometown Health,PPO/EPO,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,outpatient,,,90.00000,51.84000,Hometown Health,PPO/EPO,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,inpatient,,,68.00000,39.17000,Hometown Health,PPO/EPO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Hometown Health,PPO/EPO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,inpatient,,,142.00000,81.79000,Hometown Health,PPO/EPO,,127.80,,,,,,,127.80,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,outpatient,,,142.00000,81.79000,Hometown Health,PPO/EPO,,127.80,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,inpatient,,,68.00000,39.17000,Hometown Health,PPO/EPO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Hometown Health,PPO/EPO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,inpatient,,,74.00000,42.62000,Hometown Health,PPO/EPO,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,outpatient,,,74.00000,42.62000,Hometown Health,PPO/EPO,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,inpatient,,,89.00000,51.26000,Hometown Health,PPO/EPO,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Hometown Health,PPO/EPO,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,inpatient,,,89.00000,51.26000,Hometown Health,PPO/EPO,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Hometown Health,PPO/EPO,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,inpatient,,,57.00000,32.83000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,outpatient,,,57.00000,32.83000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,inpatient,,,77.00000,44.35000,Hometown Health,PPO/EPO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,outpatient,,,77.00000,44.35000,Hometown Health,PPO/EPO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,inpatient,,,64.00000,36.86000,Hometown Health,PPO/EPO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,outpatient,,,64.00000,36.86000,Hometown Health,PPO/EPO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,inpatient,,,69.00000,39.74000,Hometown Health,PPO/EPO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,outpatient,,,69.00000,39.74000,Hometown Health,PPO/EPO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,inpatient,,,1178.00000,678.53000,Hometown Health,PPO/EPO,,1060.20,,,,,,,1060.20,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,outpatient,,,1178.00000,678.53000,Hometown Health,PPO/EPO,,1060.20,,,,,,,306.28,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,inpatient,,,127.00000,73.15000,Hometown Health,PPO/EPO,,114.30,,,,,,,114.30,123.19,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,outpatient,,,127.00000,73.15000,Hometown Health,PPO/EPO,,114.30,,,,,,,33.02,123.19,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,inpatient,,,277.00000,159.55000,Hometown Health,PPO/EPO,,249.30,,,,,,,249.30,268.69,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,outpatient,,,277.00000,159.55000,Hometown Health,PPO/EPO,,249.30,,,,,,,72.02,268.69,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,inpatient,,,940.00000,541.44000,Hometown Health,PPO/EPO,,846.00,,,,,,,846.00,911.80,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,outpatient,,,940.00000,541.44000,Hometown Health,PPO/EPO,,846.00,,,,,,,244.40,911.80,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,inpatient,,,97.00000,55.87000,Hometown Health,PPO/EPO,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,outpatient,,,97.00000,55.87000,Hometown Health,PPO/EPO,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,inpatient,,,16.00000,9.22000,Hometown Health,PPO/EPO,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,outpatient,,,16.00000,9.22000,Hometown Health,PPO/EPO,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,inpatient,,,57.00000,32.83000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,outpatient,,,57.00000,32.83000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,inpatient,,,131.00000,75.46000,Hometown Health,PPO/EPO,,117.90,,,,,,,117.90,127.07,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,outpatient,,,131.00000,75.46000,Hometown Health,PPO/EPO,,117.90,,,,,,,34.06,127.07,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,inpatient,,,2160.00000,1244.16000,Hometown Health,PPO/EPO,,1944.00,,,,,,,1944.00,2095.20,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,outpatient,,,2160.00000,1244.16000,Hometown Health,PPO/EPO,,1944.00,,,,,,,561.60,2095.20,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,inpatient,,,37.00000,21.31000,Hometown Health,PPO/EPO,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,outpatient,,,37.00000,21.31000,Hometown Health,PPO/EPO,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,inpatient,,,74.00000,42.62000,Hometown Health,PPO/EPO,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Hometown Health,PPO/EPO,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,inpatient,,,54.00000,31.10000,Hometown Health,PPO/EPO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,outpatient,,,54.00000,31.10000,Hometown Health,PPO/EPO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,inpatient,,,76.00000,43.78000,Hometown Health,PPO/EPO,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,outpatient,,,76.00000,43.78000,Hometown Health,PPO/EPO,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,inpatient,,,606.00000,349.06000,Hometown Health,PPO/EPO,,545.40,,,,,,,545.40,587.82,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,outpatient,,,606.00000,349.06000,Hometown Health,PPO/EPO,,545.40,,,,,,,157.56,587.82,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,inpatient,,,300.00000,172.80000,Hometown Health,PPO/EPO,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,outpatient,,,300.00000,172.80000,Hometown Health,PPO/EPO,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,inpatient,,,98.00000,56.45000,Hometown Health,PPO/EPO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,outpatient,,,98.00000,56.45000,Hometown Health,PPO/EPO,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,inpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,outpatient,,,61.00000,35.14000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,inpatient,,,128.00000,73.73000,Hometown Health,PPO/EPO,,115.20,,,,,,,115.20,124.16,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,outpatient,,,128.00000,73.73000,Hometown Health,PPO/EPO,,115.20,,,,,,,33.28,124.16,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,PPO/EPO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,PPO/EPO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,inpatient,,,16.00000,9.22000,Hometown Health,PPO/EPO,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,outpatient,,,16.00000,9.22000,Hometown Health,PPO/EPO,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,inpatient,,,565.00000,325.44000,Hometown Health,PPO/EPO,,508.50,,,,,,,508.50,548.05,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,outpatient,,,565.00000,325.44000,Hometown Health,PPO/EPO,,508.50,,,,,,,146.90,548.05,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,inpatient,,,850.00000,489.60000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,outpatient,,,850.00000,489.60000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,inpatient,,,77.00000,44.35000,Hometown Health,PPO/EPO,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,outpatient,,,77.00000,44.35000,Hometown Health,PPO/EPO,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,inpatient,,,86.00000,49.54000,Hometown Health,PPO/EPO,,77.40,,,,,,,77.40,83.42,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,outpatient,,,86.00000,49.54000,Hometown Health,PPO/EPO,,77.40,,,,,,,22.36,83.42,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,inpatient,,,837.00000,482.11000,Hometown Health,PPO/EPO,,753.30,,,,,,,753.30,811.89,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,outpatient,,,837.00000,482.11000,Hometown Health,PPO/EPO,,753.30,,,,,,,217.62,811.89,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,inpatient,,,60.00000,34.56000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,outpatient,,,60.00000,34.56000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,inpatient,,,74.00000,42.62000,Hometown Health,PPO/EPO,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Hometown Health,PPO/EPO,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,PPO/EPO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,PPO/EPO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,PPO/EPO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,PPO/EPO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,inpatient,,,167.00000,96.19000,Hometown Health,PPO/EPO,,150.30,,,,,,,150.30,161.99,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,outpatient,,,167.00000,96.19000,Hometown Health,PPO/EPO,,150.30,,,,,,,43.42,161.99,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,inpatient,,,200.00000,115.20000,Hometown Health,PPO/EPO,,180.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,outpatient,,,200.00000,115.20000,Hometown Health,PPO/EPO,,180.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,inpatient,,,93.00000,53.57000,Hometown Health,PPO/EPO,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,outpatient,,,93.00000,53.57000,Hometown Health,PPO/EPO,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,inpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Hometown Health,PPO/EPO,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,inpatient,,,190.00000,109.44000,Hometown Health,PPO/EPO,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,outpatient,,,190.00000,109.44000,Hometown Health,PPO/EPO,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,inpatient,,,64.00000,36.86000,Hometown Health,PPO/EPO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,outpatient,,,64.00000,36.86000,Hometown Health,PPO/EPO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,inpatient,,,525.00000,302.40000,Hometown Health,PPO/EPO,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,outpatient,,,525.00000,302.40000,Hometown Health,PPO/EPO,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,inpatient,,,54.00000,31.10000,Hometown Health,PPO/EPO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,outpatient,,,54.00000,31.10000,Hometown Health,PPO/EPO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,PPO/EPO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,PPO/EPO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,PPO/EPO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,PPO/EPO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,inpatient,,,40.00000,23.04000,Hometown Health,PPO/EPO,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Hometown Health,PPO/EPO,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,inpatient,,,453.00000,260.93000,Hometown Health,PPO/EPO,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,outpatient,,,453.00000,260.93000,Hometown Health,PPO/EPO,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,inpatient,,,25.00000,14.40000,Hometown Health,PPO/EPO,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,outpatient,,,25.00000,14.40000,Hometown Health,PPO/EPO,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,inpatient,,,56.00000,32.26000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,outpatient,,,56.00000,32.26000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,inpatient,,,59.00000,33.98000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,outpatient,,,59.00000,33.98000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,inpatient,,,53.00000,30.53000,Hometown Health,PPO/EPO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,outpatient,,,53.00000,30.53000,Hometown Health,PPO/EPO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,inpatient,,,350.00000,201.60000,Hometown Health,PPO/EPO,,315.00,,,,,,,315.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,outpatient,,,350.00000,201.60000,Hometown Health,PPO/EPO,,315.00,,,,,,,91.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,inpatient,,,225.00000,129.60000,Hometown Health,PPO/EPO,,202.50,,,,,,,202.50,218.25,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,outpatient,,,225.00000,129.60000,Hometown Health,PPO/EPO,,202.50,,,,,,,58.50,218.25,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,inpatient,,,52.00000,29.95000,Hometown Health,PPO/EPO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,outpatient,,,52.00000,29.95000,Hometown Health,PPO/EPO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,inpatient,,,134.00000,77.18000,Hometown Health,PPO/EPO,,120.60,,,,,,,120.60,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,outpatient,,,134.00000,77.18000,Hometown Health,PPO/EPO,,120.60,,,,,,,34.84,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,inpatient,,,52.00000,29.95000,Hometown Health,PPO/EPO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,outpatient,,,52.00000,29.95000,Hometown Health,PPO/EPO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,inpatient,,,186.00000,107.14000,Hometown Health,PPO/EPO,,167.40,,,,,,,167.40,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,outpatient,,,186.00000,107.14000,Hometown Health,PPO/EPO,,167.40,,,,,,,48.36,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,inpatient,,,300.00000,172.80000,Hometown Health,PPO/EPO,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Hometown Health,PPO/EPO,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,inpatient,,,300.00000,172.80000,Hometown Health,PPO/EPO,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Hometown Health,PPO/EPO,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,inpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,outpatient,,,62.00000,35.71000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,inpatient,,,205.00000,118.08000,Hometown Health,PPO/EPO,,184.50,,,,,,,184.50,198.85,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,outpatient,,,205.00000,118.08000,Hometown Health,PPO/EPO,,184.50,,,,,,,53.30,198.85,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,inpatient,,,75.00000,36.15000,Hometown Health,PPO/EPO,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,outpatient,,,75.00000,36.15000,Hometown Health,PPO/EPO,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,inpatient,,,65.00000,31.33000,Hometown Health,PPO/EPO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,outpatient,,,65.00000,31.33000,Hometown Health,PPO/EPO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,inpatient,,,92.00000,44.34000,Hometown Health,PPO/EPO,,82.80,,,,,,,82.80,89.24,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,outpatient,,,92.00000,44.34000,Hometown Health,PPO/EPO,,82.80,,,,,,,23.92,89.24,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,inpatient,,,24.00000,11.57000,Hometown Health,PPO/EPO,,21.60,,,,,,,21.60,23.28,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Hometown Health,PPO/EPO,,21.60,,,,,,,6.24,23.28,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,inpatient,,,20.00000,9.64000,Hometown Health,PPO/EPO,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,outpatient,,,20.00000,9.64000,Hometown Health,PPO/EPO,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,inpatient,,,42.00000,20.24000,Hometown Health,PPO/EPO,,37.80,,,,,,,37.80,40.74,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,outpatient,,,42.00000,20.24000,Hometown Health,PPO/EPO,,37.80,,,,,,,10.92,40.74,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,PPO/EPO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,PPO/EPO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,inpatient,,,65.00000,31.33000,Hometown Health,PPO/EPO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,outpatient,,,65.00000,31.33000,Hometown Health,PPO/EPO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,inpatient,,,76.00000,36.63000,Hometown Health,PPO/EPO,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,outpatient,,,76.00000,36.63000,Hometown Health,PPO/EPO,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,inpatient,,,89.00000,42.90000,Hometown Health,PPO/EPO,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,outpatient,,,89.00000,42.90000,Hometown Health,PPO/EPO,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,inpatient,,,76.00000,36.63000,Hometown Health,PPO/EPO,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,outpatient,,,76.00000,36.63000,Hometown Health,PPO/EPO,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,inpatient,,,28.00000,13.50000,Hometown Health,PPO/EPO,,25.20,,,,,,,25.20,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,outpatient,,,28.00000,13.50000,Hometown Health,PPO/EPO,,25.20,,,,,,,7.28,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,inpatient,,,98.00000,47.24000,Hometown Health,PPO/EPO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,outpatient,,,98.00000,47.24000,Hometown Health,PPO/EPO,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,PPO/EPO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,PPO/EPO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,inpatient,,,75.00000,36.15000,Hometown Health,PPO/EPO,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,outpatient,,,75.00000,36.15000,Hometown Health,PPO/EPO,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,inpatient,,,76.00000,36.63000,Hometown Health,PPO/EPO,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,outpatient,,,76.00000,36.63000,Hometown Health,PPO/EPO,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,inpatient,,,114.00000,54.95000,Hometown Health,PPO/EPO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,outpatient,,,114.00000,54.95000,Hometown Health,PPO/EPO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,inpatient,,,74.00000,35.67000,Hometown Health,PPO/EPO,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,outpatient,,,74.00000,35.67000,Hometown Health,PPO/EPO,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,PPO/EPO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,PPO/EPO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,inpatient,,,74.00000,35.67000,Hometown Health,PPO/EPO,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,outpatient,,,74.00000,35.67000,Hometown Health,PPO/EPO,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,inpatient,,,87.00000,41.93000,Hometown Health,PPO/EPO,,78.30,,,,,,,78.30,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,outpatient,,,87.00000,41.93000,Hometown Health,PPO/EPO,,78.30,,,,,,,22.62,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,inpatient,,,79.00000,38.08000,Hometown Health,PPO/EPO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,outpatient,,,79.00000,38.08000,Hometown Health,PPO/EPO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,inpatient,,,75.00000,36.15000,Hometown Health,PPO/EPO,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,outpatient,,,75.00000,36.15000,Hometown Health,PPO/EPO,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,inpatient,,,64.00000,30.85000,Hometown Health,PPO/EPO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,outpatient,,,64.00000,30.85000,Hometown Health,PPO/EPO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,inpatient,,,164.00000,79.05000,Hometown Health,PPO/EPO,,147.60,,,,,,,147.60,159.08,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,outpatient,,,164.00000,79.05000,Hometown Health,PPO/EPO,,147.60,,,,,,,42.64,159.08,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,PPO/EPO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,PPO/EPO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,inpatient,,,8.00000,3.86000,Hometown Health,PPO/EPO,,7.20,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,outpatient,,,8.00000,3.86000,Hometown Health,PPO/EPO,,7.20,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,inpatient,,,69.00000,33.26000,Hometown Health,PPO/EPO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,outpatient,,,69.00000,33.26000,Hometown Health,PPO/EPO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,inpatient,,,8.00000,3.86000,Hometown Health,PPO/EPO,,7.20,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,outpatient,,,8.00000,3.86000,Hometown Health,PPO/EPO,,7.20,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,inpatient,,,8.00000,3.86000,Hometown Health,PPO/EPO,,7.20,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,outpatient,,,8.00000,3.86000,Hometown Health,PPO/EPO,,7.20,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,inpatient,,,14.00000,6.75000,Hometown Health,PPO/EPO,,12.60,,,,,,,12.60,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,outpatient,,,14.00000,6.75000,Hometown Health,PPO/EPO,,12.60,,,,,,,3.64,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,inpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,outpatient,,,62.00000,29.88000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,inpatient,,,112.00000,53.98000,Hometown Health,PPO/EPO,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,outpatient,,,112.00000,53.98000,Hometown Health,PPO/EPO,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,inpatient,,,13.00000,6.27000,Hometown Health,PPO/EPO,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,outpatient,,,13.00000,6.27000,Hometown Health,PPO/EPO,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,inpatient,,,31.00000,14.94000,Hometown Health,PPO/EPO,,27.90,,,,,,,27.90,30.07,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,outpatient,,,31.00000,14.94000,Hometown Health,PPO/EPO,,27.90,,,,,,,8.06,30.07,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,inpatient,,,92.00000,44.34000,Hometown Health,PPO/EPO,,82.80,,,,,,,82.80,89.24,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,outpatient,,,92.00000,44.34000,Hometown Health,PPO/EPO,,82.80,,,,,,,23.92,89.24,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,inpatient,,,80.00000,38.56000,Hometown Health,PPO/EPO,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,outpatient,,,80.00000,38.56000,Hometown Health,PPO/EPO,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,inpatient,,,30.00000,14.46000,Hometown Health,PPO/EPO,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Hometown Health,PPO/EPO,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,inpatient,,,30.00000,14.46000,Hometown Health,PPO/EPO,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Hometown Health,PPO/EPO,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,inpatient,,,24.00000,11.57000,Hometown Health,PPO/EPO,,21.60,,,,,,,21.60,23.28,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Hometown Health,PPO/EPO,,21.60,,,,,,,6.24,23.28,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,inpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,outpatient,,,59.00000,28.44000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,inpatient,,,29.00000,13.98000,Hometown Health,PPO/EPO,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,outpatient,,,29.00000,13.98000,Hometown Health,PPO/EPO,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,inpatient,,,97.00000,46.75000,Hometown Health,PPO/EPO,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,outpatient,,,97.00000,46.75000,Hometown Health,PPO/EPO,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,inpatient,,,225.00000,108.45000,Hometown Health,PPO/EPO,,202.50,,,,,,,202.50,218.25,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,outpatient,,,225.00000,108.45000,Hometown Health,PPO/EPO,,202.50,,,,,,,58.50,218.25,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,PPO/EPO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,PPO/EPO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,inpatient,,,71.00000,34.22000,Hometown Health,PPO/EPO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,outpatient,,,71.00000,34.22000,Hometown Health,PPO/EPO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,inpatient,,,108.00000,52.06000,Hometown Health,PPO/EPO,,97.20,,,,,,,97.20,104.76,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,outpatient,,,108.00000,52.06000,Hometown Health,PPO/EPO,,97.20,,,,,,,28.08,104.76,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,inpatient,,,51.00000,24.58000,Hometown Health,PPO/EPO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,outpatient,,,51.00000,24.58000,Hometown Health,PPO/EPO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,inpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,outpatient,,,63.00000,30.37000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,inpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,outpatient,,,58.00000,27.96000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,inpatient,,,19.00000,9.16000,Hometown Health,PPO/EPO,,17.10,,,,,,,17.10,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,outpatient,,,19.00000,9.16000,Hometown Health,PPO/EPO,,17.10,,,,,,,4.94,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,inpatient,,,54.00000,26.03000,Hometown Health,PPO/EPO,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,outpatient,,,54.00000,26.03000,Hometown Health,PPO/EPO,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,inpatient,,,103.00000,49.65000,Hometown Health,PPO/EPO,,92.70,,,,,,,92.70,99.91,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,outpatient,,,103.00000,49.65000,Hometown Health,PPO/EPO,,92.70,,,,,,,26.78,99.91,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,inpatient,,,9.00000,4.34000,Hometown Health,PPO/EPO,,8.10,,,,,,,8.10,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,outpatient,,,9.00000,4.34000,Hometown Health,PPO/EPO,,8.10,,,,,,,2.34,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,inpatient,,,13.00000,6.27000,Hometown Health,PPO/EPO,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,outpatient,,,13.00000,6.27000,Hometown Health,PPO/EPO,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,inpatient,,,80.00000,38.56000,Hometown Health,PPO/EPO,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,outpatient,,,80.00000,38.56000,Hometown Health,PPO/EPO,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,inpatient,,,47.00000,22.65000,Hometown Health,PPO/EPO,,42.30,,,,,,,42.30,45.59,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,outpatient,,,47.00000,22.65000,Hometown Health,PPO/EPO,,42.30,,,,,,,12.22,45.59,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,inpatient,,,91.00000,43.86000,Hometown Health,PPO/EPO,,81.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,outpatient,,,91.00000,43.86000,Hometown Health,PPO/EPO,,81.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,inpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,outpatient,,,56.00000,26.99000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,inpatient,,,18.00000,8.68000,Hometown Health,PPO/EPO,,16.20,,,,,,,16.20,17.46,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,outpatient,,,18.00000,8.68000,Hometown Health,PPO/EPO,,16.20,,,,,,,4.68,17.46,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,inpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,outpatient,,,60.00000,28.92000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,inpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,outpatient,,,57.00000,27.47000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,inpatient,,,21.00000,11.15000,Hometown Health,PPO/EPO,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Hometown Health,PPO/EPO,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,inpatient,,,71.00000,37.70000,Hometown Health,PPO/EPO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,outpatient,,,71.00000,37.70000,Hometown Health,PPO/EPO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,inpatient,,,21.00000,11.15000,Hometown Health,PPO/EPO,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Hometown Health,PPO/EPO,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,inpatient,,,128.00000,67.97000,Hometown Health,PPO/EPO,,115.20,,,,,,,115.20,124.16,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,outpatient,,,128.00000,67.97000,Hometown Health,PPO/EPO,,115.20,,,,,,,33.28,124.16,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,inpatient,,,65.00000,34.52000,Hometown Health,PPO/EPO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,outpatient,,,65.00000,34.52000,Hometown Health,PPO/EPO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,PPO/EPO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,PPO/EPO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,inpatient,,,31.00000,16.46000,Hometown Health,PPO/EPO,,27.90,,,,,,,27.90,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,outpatient,,,31.00000,16.46000,Hometown Health,PPO/EPO,,27.90,,,,,,,8.06,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,PPO/EPO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,PPO/EPO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,PPO/EPO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,PPO/EPO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,PPO/EPO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,PPO/EPO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,inpatient,,,61.00000,32.39000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,outpatient,,,61.00000,32.39000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,PPO/EPO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,PPO/EPO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,inpatient,,,25.00000,13.28000,Hometown Health,PPO/EPO,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Hometown Health,PPO/EPO,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,inpatient,,,25.00000,13.28000,Hometown Health,PPO/EPO,91,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Hometown Health,PPO/EPO,91,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,inpatient,,,103.00000,54.69000,Hometown Health,PPO/EPO,,92.70,,,,,,,92.70,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,outpatient,,,103.00000,54.69000,Hometown Health,PPO/EPO,,92.70,,,,,,,26.78,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,inpatient,,,96.00000,50.98000,Hometown Health,PPO/EPO,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,outpatient,,,96.00000,50.98000,Hometown Health,PPO/EPO,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,inpatient,,,75.00000,39.83000,Hometown Health,PPO/EPO,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,outpatient,,,75.00000,39.83000,Hometown Health,PPO/EPO,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,inpatient,,,68.00000,36.11000,Hometown Health,PPO/EPO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,outpatient,,,68.00000,36.11000,Hometown Health,PPO/EPO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,inpatient,,,61.00000,32.39000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,outpatient,,,61.00000,32.39000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,PPO/EPO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,PPO/EPO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,PPO/EPO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,PPO/EPO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,inpatient,,,29.00000,15.40000,Hometown Health,PPO/EPO,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,outpatient,,,29.00000,15.40000,Hometown Health,PPO/EPO,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Hometown Health,PPO/EPO,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Hometown Health,PPO/EPO,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Hometown Health,PPO/EPO,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Hometown Health,PPO/EPO,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,inpatient,,,63.00000,33.45000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,outpatient,,,63.00000,33.45000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,inpatient,,,79.00000,41.95000,Hometown Health,PPO/EPO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,outpatient,,,79.00000,41.95000,Hometown Health,PPO/EPO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,inpatient,,,63.00000,33.45000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,outpatient,,,63.00000,33.45000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Hometown Health,PPO/EPO,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Hometown Health,PPO/EPO,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,inpatient,,,112.00000,59.47000,Hometown Health,PPO/EPO,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,outpatient,,,112.00000,59.47000,Hometown Health,PPO/EPO,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,PPO/EPO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,PPO/EPO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,inpatient,,,25.00000,13.28000,Hometown Health,PPO/EPO,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,outpatient,,,25.00000,13.28000,Hometown Health,PPO/EPO,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,inpatient,,,118.00000,62.66000,Hometown Health,PPO/EPO,,106.20,,,,,,,106.20,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,outpatient,,,118.00000,62.66000,Hometown Health,PPO/EPO,,106.20,,,,,,,30.68,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,inpatient,,,29.00000,15.40000,Hometown Health,PPO/EPO,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,outpatient,,,29.00000,15.40000,Hometown Health,PPO/EPO,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,inpatient,,,25.00000,13.28000,Hometown Health,PPO/EPO,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,outpatient,,,25.00000,13.28000,Hometown Health,PPO/EPO,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,PPO/EPO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,PPO/EPO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,inpatient,,,25.00000,13.28000,Hometown Health,PPO/EPO,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,outpatient,,,25.00000,13.28000,Hometown Health,PPO/EPO,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,inpatient,,,71.00000,37.70000,Hometown Health,PPO/EPO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,outpatient,,,71.00000,37.70000,Hometown Health,PPO/EPO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,inpatient,,,59.00000,31.33000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,outpatient,,,59.00000,31.33000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,inpatient,,,62.00000,32.92000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,outpatient,,,62.00000,32.92000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,inpatient,,,138.00000,73.28000,Hometown Health,PPO/EPO,,124.20,,,,,,,124.20,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,outpatient,,,138.00000,73.28000,Hometown Health,PPO/EPO,,124.20,,,,,,,35.88,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,inpatient,,,62.00000,32.92000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,outpatient,,,62.00000,32.92000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,inpatient,,,78.00000,41.42000,Hometown Health,PPO/EPO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,outpatient,,,78.00000,41.42000,Hometown Health,PPO/EPO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,inpatient,,,69.00000,36.64000,Hometown Health,PPO/EPO,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,outpatient,,,69.00000,36.64000,Hometown Health,PPO/EPO,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,inpatient,,,88.00000,46.73000,Hometown Health,PPO/EPO,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,outpatient,,,88.00000,46.73000,Hometown Health,PPO/EPO,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,inpatient,,,64.00000,33.98000,Hometown Health,PPO/EPO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,outpatient,,,64.00000,33.98000,Hometown Health,PPO/EPO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,inpatient,,,63.00000,33.45000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,outpatient,,,63.00000,33.45000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,inpatient,,,137.00000,72.75000,Hometown Health,PPO/EPO,,123.30,,,,,,,123.30,132.89,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,outpatient,,,137.00000,72.75000,Hometown Health,PPO/EPO,,123.30,,,,,,,35.62,132.89,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,inpatient,,,347.00000,184.26000,Hometown Health,PPO/EPO,,312.30,,,,,,,312.30,336.59,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,outpatient,,,347.00000,184.26000,Hometown Health,PPO/EPO,,312.30,,,,,,,90.22,336.59,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,inpatient,,,57.00000,30.27000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,outpatient,,,57.00000,30.27000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,inpatient,,,56.00000,29.74000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,outpatient,,,56.00000,29.74000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,inpatient,,,16.00000,8.50000,Hometown Health,PPO/EPO,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,outpatient,,,16.00000,8.50000,Hometown Health,PPO/EPO,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,inpatient,,,85.00000,45.14000,Hometown Health,PPO/EPO,,76.50,,,,,,,76.50,82.45,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,outpatient,,,85.00000,45.14000,Hometown Health,PPO/EPO,,76.50,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,inpatient,,,34.00000,18.05000,Hometown Health,PPO/EPO,,30.60,,,,,,,30.60,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,outpatient,,,34.00000,18.05000,Hometown Health,PPO/EPO,,30.60,,,,,,,8.84,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,inpatient,,,231.00000,122.66000,Hometown Health,PPO/EPO,,207.90,,,,,,,207.90,224.07,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,outpatient,,,231.00000,122.66000,Hometown Health,PPO/EPO,,207.90,,,,,,,60.06,224.07,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,inpatient,,,36.00000,19.12000,Hometown Health,PPO/EPO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,outpatient,,,36.00000,19.12000,Hometown Health,PPO/EPO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,inpatient,,,61.00000,32.39000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,outpatient,,,61.00000,32.39000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,inpatient,,,111.00000,58.94000,Hometown Health,PPO/EPO,,99.90,,,,,,,99.90,107.67,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,outpatient,,,111.00000,58.94000,Hometown Health,PPO/EPO,,99.90,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,inpatient,,,61.00000,32.39000,Hometown Health,PPO/EPO,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,outpatient,,,61.00000,32.39000,Hometown Health,PPO/EPO,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,inpatient,,,36.00000,19.12000,Hometown Health,PPO/EPO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,outpatient,,,36.00000,19.12000,Hometown Health,PPO/EPO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,inpatient,,,76.00000,40.36000,Hometown Health,PPO/EPO,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,outpatient,,,76.00000,40.36000,Hometown Health,PPO/EPO,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,inpatient,,,152.00000,80.71000,Hometown Health,PPO/EPO,,136.80,,,,,,,136.80,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,outpatient,,,152.00000,80.71000,Hometown Health,PPO/EPO,,136.80,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,inpatient,,,78.00000,41.42000,Hometown Health,PPO/EPO,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,outpatient,,,78.00000,41.42000,Hometown Health,PPO/EPO,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,inpatient,,,42.00000,22.30000,Hometown Health,PPO/EPO,,37.80,,,,,,,37.80,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,outpatient,,,42.00000,22.30000,Hometown Health,PPO/EPO,,37.80,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,inpatient,,,73.00000,38.76000,Hometown Health,PPO/EPO,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,outpatient,,,73.00000,38.76000,Hometown Health,PPO/EPO,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,inpatient,,,97.00000,51.51000,Hometown Health,PPO/EPO,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,outpatient,,,97.00000,51.51000,Hometown Health,PPO/EPO,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,inpatient,,,157.00000,83.37000,Hometown Health,PPO/EPO,,141.30,,,,,,,141.30,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,outpatient,,,157.00000,83.37000,Hometown Health,PPO/EPO,,141.30,,,,,,,40.82,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,inpatient,,,36.00000,19.12000,Hometown Health,PPO/EPO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,outpatient,,,36.00000,19.12000,Hometown Health,PPO/EPO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,inpatient,,,66.00000,35.05000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,outpatient,,,66.00000,35.05000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,inpatient,,,58.00000,30.80000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,outpatient,,,58.00000,30.80000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,inpatient,,,85.00000,45.14000,Hometown Health,PPO/EPO,,76.50,,,,,,,76.50,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,outpatient,,,85.00000,45.14000,Hometown Health,PPO/EPO,,76.50,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,inpatient,,,59.00000,31.33000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,outpatient,,,59.00000,31.33000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,inpatient,,,175.00000,92.93000,Hometown Health,PPO/EPO,,157.50,,,,,,,157.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,outpatient,,,175.00000,92.93000,Hometown Health,PPO/EPO,,157.50,,,,,,,45.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,inpatient,,,152.00000,80.71000,Hometown Health,PPO/EPO,,136.80,,,,,,,136.80,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,outpatient,,,152.00000,80.71000,Hometown Health,PPO/EPO,,136.80,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,inpatient,,,43.00000,22.83000,Hometown Health,PPO/EPO,,38.70,,,,,,,38.70,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,outpatient,,,43.00000,22.83000,Hometown Health,PPO/EPO,,38.70,,,,,,,11.18,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,inpatient,,,66.00000,35.05000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,outpatient,,,66.00000,35.05000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,inpatient,,,36.00000,19.12000,Hometown Health,PPO/EPO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,outpatient,,,36.00000,19.12000,Hometown Health,PPO/EPO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,inpatient,,,36.00000,19.12000,Hometown Health,PPO/EPO,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,outpatient,,,36.00000,19.12000,Hometown Health,PPO/EPO,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,inpatient,,,42.00000,22.30000,Hometown Health,PPO/EPO,,37.80,,,,,,,37.80,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,outpatient,,,42.00000,22.30000,Hometown Health,PPO/EPO,,37.80,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,inpatient,,,147.00000,78.06000,Hometown Health,PPO/EPO,,132.30,,,,,,,132.30,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,outpatient,,,147.00000,78.06000,Hometown Health,PPO/EPO,,132.30,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,inpatient,,,64.00000,33.98000,Hometown Health,PPO/EPO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,outpatient,,,64.00000,33.98000,Hometown Health,PPO/EPO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,inpatient,,,60.00000,31.86000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,outpatient,,,60.00000,31.86000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,inpatient,,,75.00000,39.83000,Hometown Health,PPO/EPO,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,outpatient,,,75.00000,39.83000,Hometown Health,PPO/EPO,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,inpatient,,,44.00000,23.36000,Hometown Health,PPO/EPO,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,outpatient,,,44.00000,23.36000,Hometown Health,PPO/EPO,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,inpatient,,,87.00000,46.20000,Hometown Health,PPO/EPO,,78.30,,,,,,,78.30,84.39,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,outpatient,,,87.00000,46.20000,Hometown Health,PPO/EPO,,78.30,,,,,,,22.62,84.39,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,inpatient,,,65.00000,34.52000,Hometown Health,PPO/EPO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,outpatient,,,65.00000,34.52000,Hometown Health,PPO/EPO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,inpatient,,,75.00000,39.83000,Hometown Health,PPO/EPO,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,outpatient,,,75.00000,39.83000,Hometown Health,PPO/EPO,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,inpatient,,,50.00000,26.55000,Hometown Health,PPO/EPO,,45.00,,,,,,,45.00,48.50,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,outpatient,,,50.00000,26.55000,Hometown Health,PPO/EPO,,45.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,inpatient,,,40.00000,21.24000,Hometown Health,PPO/EPO,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,outpatient,,,40.00000,21.24000,Hometown Health,PPO/EPO,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,inpatient,,,50.00000,26.55000,Hometown Health,PPO/EPO,,45.00,,,,,,,45.00,48.50,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,outpatient,,,50.00000,26.55000,Hometown Health,PPO/EPO,,45.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,inpatient,,,115.00000,61.07000,Hometown Health,PPO/EPO,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,outpatient,,,115.00000,61.07000,Hometown Health,PPO/EPO,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,inpatient,,,1309.00000,695.08000,Hometown Health,PPO/EPO,,1178.10,,,,,,,1178.10,1269.73,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1309.00000,695.08000,Hometown Health,PPO/EPO,,1178.10,,,,,,,340.34,1269.73,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,inpatient,,,328.00000,174.17000,Hometown Health,PPO/EPO,,295.20,,,,,,,295.20,318.16,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,outpatient,,,328.00000,174.17000,Hometown Health,PPO/EPO,,295.20,,,,,,,85.28,318.16,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,inpatient,,,115.00000,61.07000,Hometown Health,PPO/EPO,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,outpatient,,,115.00000,61.07000,Hometown Health,PPO/EPO,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,inpatient,,,1251.00000,664.28000,Hometown Health,PPO/EPO,,1125.90,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,outpatient,,,1251.00000,664.28000,Hometown Health,PPO/EPO,,1125.90,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,inpatient,,,154.00000,81.77000,Hometown Health,PPO/EPO,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Hometown Health,PPO/EPO,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,inpatient,,,154.00000,81.77000,Hometown Health,PPO/EPO,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Hometown Health,PPO/EPO,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,inpatient,,,96.00000,50.98000,Hometown Health,PPO/EPO,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,outpatient,,,96.00000,50.98000,Hometown Health,PPO/EPO,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,inpatient,,,211.00000,112.04000,Hometown Health,PPO/EPO,,189.90,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,outpatient,,,211.00000,112.04000,Hometown Health,PPO/EPO,,189.90,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,inpatient,,,290.00000,153.99000,Hometown Health,PPO/EPO,,261.00,,,,,,,261.00,281.30,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,outpatient,,,290.00000,153.99000,Hometown Health,PPO/EPO,,261.00,,,,,,,75.40,281.30,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,inpatient,,,411.00000,218.24000,Hometown Health,PPO/EPO,,369.90,,,,,,,369.90,398.67,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,outpatient,,,411.00000,218.24000,Hometown Health,PPO/EPO,,369.90,,,,,,,106.86,398.67,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,inpatient,,,139.00000,73.81000,Hometown Health,PPO/EPO,,125.10,,,,,,,125.10,134.83,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,outpatient,,,139.00000,73.81000,Hometown Health,PPO/EPO,,125.10,,,,,,,36.14,134.83,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,inpatient,,,288.00000,152.93000,Hometown Health,PPO/EPO,,259.20,,,,,,,259.20,279.36,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,outpatient,,,288.00000,152.93000,Hometown Health,PPO/EPO,,259.20,,,,,,,74.88,279.36,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,inpatient,,,1372.00000,728.53000,Hometown Health,PPO/EPO,,1234.80,,,,,,,1234.80,1330.84,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1372.00000,728.53000,Hometown Health,PPO/EPO,,1234.80,,,,,,,356.72,1330.84,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,inpatient,,,1251.00000,664.28000,Hometown Health,PPO/EPO,,1125.90,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,outpatient,,,1251.00000,664.28000,Hometown Health,PPO/EPO,,1125.90,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,inpatient,,,135.00000,71.68000,Hometown Health,PPO/EPO,,121.50,,,,,,,121.50,130.95,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,outpatient,,,135.00000,71.68000,Hometown Health,PPO/EPO,,121.50,,,,,,,35.10,130.95,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,inpatient,,,147.00000,78.06000,Hometown Health,PPO/EPO,,132.30,,,,,,,132.30,142.59,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,outpatient,,,147.00000,78.06000,Hometown Health,PPO/EPO,,132.30,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,inpatient,,,126.00000,66.91000,Hometown Health,PPO/EPO,,113.40,,,,,,,113.40,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,outpatient,,,126.00000,66.91000,Hometown Health,PPO/EPO,,113.40,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,inpatient,,,120.00000,63.72000,Hometown Health,PPO/EPO,,108.00,,,,,,,108.00,116.40,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,outpatient,,,120.00000,63.72000,Hometown Health,PPO/EPO,,108.00,,,,,,,31.20,116.40,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,inpatient,,,124.00000,65.84000,Hometown Health,PPO/EPO,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,outpatient,,,124.00000,65.84000,Hometown Health,PPO/EPO,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,inpatient,,,108.00000,57.35000,Hometown Health,PPO/EPO,,97.20,,,,,,,97.20,104.76,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,outpatient,,,108.00000,57.35000,Hometown Health,PPO/EPO,,97.20,,,,,,,28.08,104.76,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,inpatient,,,256.00000,135.94000,Hometown Health,PPO/EPO,,230.40,,,,,,,230.40,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Hometown Health,PPO/EPO,,230.40,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,inpatient,,,256.00000,135.94000,Hometown Health,PPO/EPO,,230.40,,,,,,,230.40,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Hometown Health,PPO/EPO,,230.40,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,inpatient,,,122.00000,64.78000,Hometown Health,PPO/EPO,,109.80,,,,,,,109.80,118.34,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,outpatient,,,122.00000,64.78000,Hometown Health,PPO/EPO,,109.80,,,,,,,31.72,118.34,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,inpatient,,,123.00000,65.31000,Hometown Health,PPO/EPO,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,outpatient,,,123.00000,65.31000,Hometown Health,PPO/EPO,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,inpatient,,,518.00000,275.06000,Hometown Health,PPO/EPO,,466.20,,,,,,,466.20,502.46,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,outpatient,,,518.00000,275.06000,Hometown Health,PPO/EPO,,466.20,,,,,,,134.68,502.46,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,inpatient,,,275.00000,146.02000,Hometown Health,PPO/EPO,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,outpatient,,,275.00000,146.02000,Hometown Health,PPO/EPO,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,inpatient,,,270.00000,143.37000,Hometown Health,PPO/EPO,,243.00,,,,,,,243.00,261.90,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,outpatient,,,270.00000,143.37000,Hometown Health,PPO/EPO,,243.00,,,,,,,70.20,261.90,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,inpatient,,,450.00000,238.95000,Hometown Health,PPO/EPO,,405.00,,,,,,,405.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,outpatient,,,450.00000,238.95000,Hometown Health,PPO/EPO,,405.00,,,,,,,117.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,inpatient,,,126.00000,66.91000,Hometown Health,PPO/EPO,,113.40,,,,,,,113.40,122.22,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,outpatient,,,126.00000,66.91000,Hometown Health,PPO/EPO,,113.40,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,inpatient,,,362.00000,192.22000,Hometown Health,PPO/EPO,,325.80,,,,,,,325.80,351.14,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,outpatient,,,362.00000,192.22000,Hometown Health,PPO/EPO,,325.80,,,,,,,94.12,351.14,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,inpatient,,,109.00000,57.88000,Hometown Health,PPO/EPO,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Hometown Health,PPO/EPO,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,inpatient,,,638.00000,338.78000,Hometown Health,PPO/EPO,,574.20,,,,,,,574.20,618.86,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,outpatient,,,638.00000,338.78000,Hometown Health,PPO/EPO,,574.20,,,,,,,165.88,618.86,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,inpatient,,,211.00000,112.04000,Hometown Health,PPO/EPO,,189.90,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,outpatient,,,211.00000,112.04000,Hometown Health,PPO/EPO,,189.90,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,inpatient,,,154.00000,81.77000,Hometown Health,PPO/EPO,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,outpatient,,,154.00000,81.77000,Hometown Health,PPO/EPO,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,inpatient,,,141.00000,74.87000,Hometown Health,PPO/EPO,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,outpatient,,,141.00000,74.87000,Hometown Health,PPO/EPO,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,inpatient,,,2040.00000,1083.24000,Hometown Health,PPO/EPO,,1836.00,,,,,,,1836.00,1978.80,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,outpatient,,,2040.00000,1083.24000,Hometown Health,PPO/EPO,,1836.00,,,,,,,530.40,1978.80,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,inpatient,,,421.00000,223.55000,Hometown Health,PPO/EPO,,378.90,,,,,,,378.90,408.37,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,outpatient,,,421.00000,223.55000,Hometown Health,PPO/EPO,,378.90,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,inpatient,,,275.00000,146.02000,Hometown Health,PPO/EPO,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,outpatient,,,275.00000,146.02000,Hometown Health,PPO/EPO,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,inpatient,,,1251.00000,664.28000,Hometown Health,PPO/EPO,,1125.90,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,outpatient,,,1251.00000,664.28000,Hometown Health,PPO/EPO,,1125.90,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,inpatient,,,428.00000,227.27000,Hometown Health,PPO/EPO,,385.20,,,,,,,385.20,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Hometown Health,PPO/EPO,,385.20,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,inpatient,,,428.00000,227.27000,Hometown Health,PPO/EPO,,385.20,,,,,,,385.20,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Hometown Health,PPO/EPO,,385.20,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,inpatient,,,655.00000,347.80000,Hometown Health,PPO/EPO,,589.50,,,,,,,589.50,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Hometown Health,PPO/EPO,,589.50,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,inpatient,,,655.00000,347.80000,Hometown Health,PPO/EPO,,589.50,,,,,,,589.50,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Hometown Health,PPO/EPO,,589.50,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,inpatient,,,211.00000,112.04000,Hometown Health,PPO/EPO,,189.90,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,outpatient,,,211.00000,112.04000,Hometown Health,PPO/EPO,,189.90,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,inpatient,,,112.00000,59.47000,Hometown Health,PPO/EPO,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Hometown Health,PPO/EPO,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,inpatient,,,112.00000,59.47000,Hometown Health,PPO/EPO,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Hometown Health,PPO/EPO,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,inpatient,,,130.00000,69.03000,Hometown Health,PPO/EPO,,117.00,,,,,,,117.00,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,outpatient,,,130.00000,69.03000,Hometown Health,PPO/EPO,,117.00,,,,,,,33.80,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,inpatient,,,421.00000,223.55000,Hometown Health,PPO/EPO,,378.90,,,,,,,378.90,408.37,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,outpatient,,,421.00000,223.55000,Hometown Health,PPO/EPO,,378.90,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,inpatient,,,111.00000,58.94000,Hometown Health,PPO/EPO,,99.90,,,,,,,99.90,107.67,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,outpatient,,,111.00000,58.94000,Hometown Health,PPO/EPO,,99.90,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,inpatient,,,200.00000,106.20000,Hometown Health,PPO/EPO,,180.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,outpatient,,,200.00000,106.20000,Hometown Health,PPO/EPO,,180.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Hometown Health,PPO/EPO,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,inpatient,,,13.00000,6.90000,Hometown Health,PPO/EPO,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,outpatient,,,13.00000,6.90000,Hometown Health,PPO/EPO,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,inpatient,,,58.00000,30.80000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,outpatient,,,58.00000,30.80000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,inpatient,,,13.00000,6.90000,Hometown Health,PPO/EPO,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,outpatient,,,13.00000,6.90000,Hometown Health,PPO/EPO,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,inpatient,,,773.00000,410.46000,Hometown Health,PPO/EPO,,695.70,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,outpatient,,,773.00000,410.46000,Hometown Health,PPO/EPO,,695.70,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,inpatient,,,773.00000,410.46000,Hometown Health,PPO/EPO,,695.70,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,outpatient,,,773.00000,410.46000,Hometown Health,PPO/EPO,,695.70,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,inpatient,,,773.00000,410.46000,Hometown Health,PPO/EPO,,695.70,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,outpatient,,,773.00000,410.46000,Hometown Health,PPO/EPO,,695.70,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,inpatient,,,773.00000,410.46000,Hometown Health,PPO/EPO,,695.70,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,outpatient,,,773.00000,410.46000,Hometown Health,PPO/EPO,,695.70,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,inpatient,,,387.00000,205.50000,Hometown Health,PPO/EPO,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,outpatient,,,387.00000,205.50000,Hometown Health,PPO/EPO,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,inpatient,,,52.00000,27.61000,Hometown Health,PPO/EPO,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,outpatient,,,52.00000,27.61000,Hometown Health,PPO/EPO,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,inpatient,,,102.00000,54.16000,Hometown Health,PPO/EPO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Hometown Health,PPO/EPO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,inpatient,,,102.00000,54.16000,Hometown Health,PPO/EPO,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Hometown Health,PPO/EPO,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,inpatient,,,79.00000,41.95000,Hometown Health,PPO/EPO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,outpatient,,,79.00000,41.95000,Hometown Health,PPO/EPO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,inpatient,,,65.00000,34.52000,Hometown Health,PPO/EPO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,outpatient,,,65.00000,34.52000,Hometown Health,PPO/EPO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,inpatient,,,100.00000,53.10000,Hometown Health,PPO/EPO,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,outpatient,,,100.00000,53.10000,Hometown Health,PPO/EPO,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,inpatient,,,64.00000,33.98000,Hometown Health,PPO/EPO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,outpatient,,,64.00000,33.98000,Hometown Health,PPO/EPO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,inpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,outpatient,,,106.00000,56.29000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,inpatient,,,109.00000,57.88000,Hometown Health,PPO/EPO,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Hometown Health,PPO/EPO,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,inpatient,,,58.00000,30.80000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,outpatient,,,58.00000,30.80000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Hometown Health,PPO/EPO,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Hometown Health,PPO/EPO,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,inpatient,,,66.00000,35.05000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,outpatient,,,66.00000,35.05000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Hometown Health,PPO/EPO,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Hometown Health,PPO/EPO,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Hometown Health,PPO/EPO,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Hometown Health,PPO/EPO,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Hometown Health,PPO/EPO,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Hometown Health,PPO/EPO,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,inpatient,,,13.00000,6.90000,Hometown Health,PPO/EPO,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,outpatient,,,13.00000,6.90000,Hometown Health,PPO/EPO,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,inpatient,,,53.00000,28.14000,Hometown Health,PPO/EPO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,outpatient,,,53.00000,28.14000,Hometown Health,PPO/EPO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,inpatient,,,18.00000,9.56000,Hometown Health,PPO/EPO,,16.20,,,,,,,16.20,17.46,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,outpatient,,,18.00000,9.56000,Hometown Health,PPO/EPO,,16.20,,,,,,,4.68,17.46,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,inpatient,,,17.00000,9.03000,Hometown Health,PPO/EPO,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,outpatient,,,17.00000,9.03000,Hometown Health,PPO/EPO,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,inpatient,,,71.00000,37.70000,Hometown Health,PPO/EPO,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,outpatient,,,71.00000,37.70000,Hometown Health,PPO/EPO,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,inpatient,,,57.00000,30.27000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,outpatient,,,57.00000,30.27000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,inpatient,,,68.00000,36.11000,Hometown Health,PPO/EPO,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,outpatient,,,68.00000,36.11000,Hometown Health,PPO/EPO,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,inpatient,,,58.00000,30.80000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,outpatient,,,58.00000,30.80000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,inpatient,,,27.00000,14.34000,Hometown Health,PPO/EPO,,24.30,,,,,,,24.30,26.19,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,outpatient,,,27.00000,14.34000,Hometown Health,PPO/EPO,,24.30,,,,,,,7.02,26.19,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,inpatient,,,56.00000,29.74000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,outpatient,,,56.00000,29.74000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,inpatient,,,56.00000,29.74000,Hometown Health,PPO/EPO,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,outpatient,,,56.00000,29.74000,Hometown Health,PPO/EPO,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,inpatient,,,58.00000,30.80000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,outpatient,,,58.00000,30.80000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,inpatient,,,115.00000,61.07000,Hometown Health,PPO/EPO,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,outpatient,,,115.00000,61.07000,Hometown Health,PPO/EPO,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,inpatient,,,23.00000,12.21000,Hometown Health,PPO/EPO,,20.70,,,,,,,20.70,22.31,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,outpatient,,,23.00000,12.21000,Hometown Health,PPO/EPO,,20.70,,,,,,,5.98,22.31,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,inpatient,,,255.00000,135.40000,Hometown Health,PPO/EPO,,229.50,,,,,,,229.50,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,outpatient,,,255.00000,135.40000,Hometown Health,PPO/EPO,,229.50,,,,,,,66.30,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,inpatient,,,66.00000,35.05000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,outpatient,,,66.00000,35.05000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,inpatient,,,26.00000,13.81000,Hometown Health,PPO/EPO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,outpatient,,,26.00000,13.81000,Hometown Health,PPO/EPO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,inpatient,,,64.00000,33.98000,Hometown Health,PPO/EPO,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,outpatient,,,64.00000,33.98000,Hometown Health,PPO/EPO,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,inpatient,,,215.00000,114.16000,Hometown Health,PPO/EPO,,193.50,,,,,,,193.50,208.55,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,outpatient,,,215.00000,114.16000,Hometown Health,PPO/EPO,,193.50,,,,,,,55.90,208.55,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,inpatient,,,79.00000,41.95000,Hometown Health,PPO/EPO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,outpatient,,,79.00000,41.95000,Hometown Health,PPO/EPO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,inpatient,,,11.00000,5.29000,Hometown Health,PPO/EPO,,9.90,,,,,,,9.90,10.67,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,outpatient,,,11.00000,5.29000,Hometown Health,PPO/EPO,,9.90,,,,,,,2.86,10.67,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,inpatient,,,58.00000,27.90000,Hometown Health,PPO/EPO,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,outpatient,,,58.00000,27.90000,Hometown Health,PPO/EPO,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,inpatient,,,10.00000,4.81000,Hometown Health,PPO/EPO,,9.00,,,,,,,9.00,9.70,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,outpatient,,,10.00000,4.81000,Hometown Health,PPO/EPO,,9.00,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,inpatient,,,7.00000,3.37000,Hometown Health,PPO/EPO,,6.30,,,,,,,6.30,6.79,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,outpatient,,,7.00000,3.37000,Hometown Health,PPO/EPO,,6.30,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,inpatient,,,53.00000,25.49000,Hometown Health,PPO/EPO,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,outpatient,,,53.00000,25.49000,Hometown Health,PPO/EPO,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,inpatient,,,10.00000,4.81000,Hometown Health,PPO/EPO,,9.00,,,,,,,9.00,9.70,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,outpatient,,,10.00000,4.81000,Hometown Health,PPO/EPO,,9.00,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,inpatient,,,11.00000,5.29000,Hometown Health,PPO/EPO,,9.90,,,,,,,9.90,10.67,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Hometown Health,PPO/EPO,,9.90,,,,,,,2.86,10.67,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,inpatient,,,7.00000,3.37000,Hometown Health,PPO/EPO,,6.30,,,,,,,6.30,6.79,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,outpatient,,,7.00000,3.37000,Hometown Health,PPO/EPO,,6.30,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,inpatient,,,11.00000,5.29000,Hometown Health,PPO/EPO,,9.90,,,,,,,9.90,10.67,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Hometown Health,PPO/EPO,,9.90,,,,,,,2.86,10.67,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,inpatient,,,597.00000,290.14000,Hometown Health,PPO/EPO,,537.30,,,,,,,537.30,579.09,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,outpatient,,,597.00000,290.14000,Hometown Health,PPO/EPO,,537.30,,,,,,,155.22,579.09,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,inpatient,,,6379.00000,3100.19000,Hometown Health,PPO/EPO,,5741.10,,,,,,,5741.10,6187.63,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,outpatient,,,6379.00000,3100.19000,Hometown Health,PPO/EPO,,5741.10,,,,,,,1658.54,6187.63,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,inpatient,,,471.00000,228.91000,Hometown Health,PPO/EPO,,423.90,,,,,,,423.90,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,outpatient,,,471.00000,228.91000,Hometown Health,PPO/EPO,,423.90,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,inpatient,,,471.00000,228.91000,Hometown Health,PPO/EPO,,423.90,,,,,,,423.90,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,outpatient,,,471.00000,228.91000,Hometown Health,PPO/EPO,,423.90,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,inpatient,,,1251.00000,607.99000,Hometown Health,PPO/EPO,,1125.90,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,outpatient,,,1251.00000,607.99000,Hometown Health,PPO/EPO,,1125.90,,,,,,,325.26,1213.47,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,inpatient,,,260.00000,126.36000,Hometown Health,PPO/EPO,,234.00,,,,,,,234.00,252.20,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,outpatient,,,260.00000,126.36000,Hometown Health,PPO/EPO,,234.00,,,,,,,67.60,252.20,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,inpatient,,,785.00000,381.51000,Hometown Health,PPO/EPO,,706.50,,,,,,,706.50,761.45,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,outpatient,,,785.00000,381.51000,Hometown Health,PPO/EPO,,706.50,,,,,,,204.10,761.45,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,inpatient,,,529.00000,257.09000,Hometown Health,PPO/EPO,,476.10,,,,,,,476.10,513.13,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,outpatient,,,529.00000,257.09000,Hometown Health,PPO/EPO,,476.10,,,,,,,137.54,513.13,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,inpatient,,,1623.00000,788.78000,Hometown Health,PPO/EPO,,1460.70,,,,,,,1460.70,1574.31,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,outpatient,,,1623.00000,788.78000,Hometown Health,PPO/EPO,,1460.70,,,,,,,421.98,1574.31,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,inpatient,,,10800.00000,5248.80000,Hometown Health,PPO/EPO,,9720.00,,,,,,,9720.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,outpatient,,,10800.00000,5248.80000,Hometown Health,PPO/EPO,,9720.00,,,,,,,2808.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,inpatient,,,25365.00000,12327.39000,Hometown Health,PPO/EPO,,22828.50,,,,,,,22828.50,24604.05,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,outpatient,,,25365.00000,12327.39000,Hometown Health,PPO/EPO,,22828.50,,,,,,,6594.90,24604.05,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,inpatient,,,101.00000,21.82000,Hometown Health,PPO/EPO,,90.90,,,,,,,90.90,97.97,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,outpatient,,,101.00000,21.82000,Hometown Health,PPO/EPO,,90.90,,,,,,,26.26,97.97,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,inpatient,,,81.00000,17.50000,Hometown Health,PPO/EPO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,outpatient,,,81.00000,17.50000,Hometown Health,PPO/EPO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,inpatient,,,104.00000,22.46000,Hometown Health,PPO/EPO,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,outpatient,,,104.00000,22.46000,Hometown Health,PPO/EPO,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,inpatient,,,377.00000,81.43000,Hometown Health,PPO/EPO,,339.30,,,,,,,339.30,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,outpatient,,,377.00000,81.43000,Hometown Health,PPO/EPO,,339.30,,,,,,,98.02,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,inpatient,,,532.00000,114.91000,Hometown Health,PPO/EPO,,478.80,,,,,,,478.80,516.04,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,outpatient,,,532.00000,114.91000,Hometown Health,PPO/EPO,,478.80,,,,,,,138.32,516.04,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,inpatient,,,521.00000,112.54000,Hometown Health,PPO/EPO,,468.90,,,,,,,468.90,505.37,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,outpatient,,,521.00000,112.54000,Hometown Health,PPO/EPO,,468.90,,,,,,,135.46,505.37,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,inpatient,,,451.00000,97.42000,Hometown Health,PPO/EPO,,405.90,,,,,,,405.90,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,outpatient,,,451.00000,97.42000,Hometown Health,PPO/EPO,,405.90,,,,,,,117.26,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,inpatient,,,1148.00000,247.97000,Hometown Health,PPO/EPO,,1033.20,,,,,,,1033.20,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,outpatient,,,1148.00000,247.97000,Hometown Health,PPO/EPO,,1033.20,,,,,,,298.48,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,inpatient,,,350.00000,75.60000,Hometown Health,PPO/EPO,,315.00,,,,,,,315.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,outpatient,,,350.00000,75.60000,Hometown Health,PPO/EPO,,315.00,,,,,,,91.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,inpatient,,,423.00000,91.37000,Hometown Health,PPO/EPO,,380.70,,,,,,,380.70,410.31,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,outpatient,,,423.00000,91.37000,Hometown Health,PPO/EPO,,380.70,,,,,,,109.98,410.31,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,inpatient,,,751.00000,162.22000,Hometown Health,PPO/EPO,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Hometown Health,PPO/EPO,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,inpatient,,,751.00000,162.22000,Hometown Health,PPO/EPO,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Hometown Health,PPO/EPO,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,inpatient,,,119.00000,25.70000,Hometown Health,PPO/EPO,,107.10,,,,,,,107.10,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,outpatient,,,119.00000,25.70000,Hometown Health,PPO/EPO,,107.10,,,,,,,30.94,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,inpatient,,,126.00000,27.22000,Hometown Health,PPO/EPO,,113.40,,,,,,,113.40,122.22,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,outpatient,,,126.00000,27.22000,Hometown Health,PPO/EPO,,113.40,,,,,,,32.76,122.22,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,inpatient,,,110.00000,23.76000,Hometown Health,PPO/EPO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Hometown Health,PPO/EPO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,inpatient,,,110.00000,23.76000,Hometown Health,PPO/EPO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Hometown Health,PPO/EPO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,inpatient,,,79.00000,17.06000,Hometown Health,PPO/EPO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,outpatient,,,79.00000,17.06000,Hometown Health,PPO/EPO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,inpatient,,,110.00000,23.76000,Hometown Health,PPO/EPO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Hometown Health,PPO/EPO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,inpatient,,,110.00000,23.76000,Hometown Health,PPO/EPO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Hometown Health,PPO/EPO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,inpatient,,,79.00000,17.06000,Hometown Health,PPO/EPO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,outpatient,,,79.00000,17.06000,Hometown Health,PPO/EPO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,inpatient,,,335.00000,72.36000,Hometown Health,PPO/EPO,,301.50,,,,,,,301.50,324.95,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,outpatient,,,335.00000,72.36000,Hometown Health,PPO/EPO,,301.50,,,,,,,87.10,324.95,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,inpatient,,,154.00000,33.26000,Hometown Health,PPO/EPO,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Hometown Health,PPO/EPO,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,inpatient,,,154.00000,33.26000,Hometown Health,PPO/EPO,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Hometown Health,PPO/EPO,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,inpatient,,,128.00000,27.65000,Hometown Health,PPO/EPO,,115.20,,,,,,,115.20,124.16,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,outpatient,,,128.00000,27.65000,Hometown Health,PPO/EPO,,115.20,,,,,,,33.28,124.16,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,inpatient,,,65.00000,14.04000,Hometown Health,PPO/EPO,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,outpatient,,,65.00000,14.04000,Hometown Health,PPO/EPO,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,inpatient,,,272.00000,58.75000,Hometown Health,PPO/EPO,,244.80,,,,,,,244.80,263.84,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,outpatient,,,272.00000,58.75000,Hometown Health,PPO/EPO,,244.80,,,,,,,70.72,263.84,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,inpatient,,,26.00000,11.44000,Hometown Health,PPO/EPO,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,outpatient,,,26.00000,11.44000,Hometown Health,PPO/EPO,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,inpatient,,,359.00000,157.96000,Hometown Health,PPO/EPO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,outpatient,,,359.00000,157.96000,Hometown Health,PPO/EPO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,inpatient,,,189.00000,83.16000,Hometown Health,PPO/EPO,,170.10,,,,,,,170.10,183.33,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,outpatient,,,189.00000,83.16000,Hometown Health,PPO/EPO,,170.10,,,,,,,49.14,183.33,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,inpatient,,,359.00000,157.96000,Hometown Health,PPO/EPO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,outpatient,,,359.00000,157.96000,Hometown Health,PPO/EPO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,inpatient,,,137.00000,60.28000,Hometown Health,PPO/EPO,,123.30,,,,,,,123.30,132.89,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,outpatient,,,137.00000,60.28000,Hometown Health,PPO/EPO,,123.30,,,,,,,35.62,132.89,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,inpatient,,,1665.00000,732.60000,Hometown Health,PPO/EPO,,1498.50,,,,,,,1498.50,1615.05,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,outpatient,,,1665.00000,732.60000,Hometown Health,PPO/EPO,,1498.50,,,,,,,432.90,1615.05,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,inpatient,,,751.00000,330.44000,Hometown Health,PPO/EPO,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,outpatient,,,751.00000,330.44000,Hometown Health,PPO/EPO,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,inpatient,,,374.00000,164.56000,Hometown Health,PPO/EPO,,336.60,,,,,,,336.60,362.78,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,outpatient,,,374.00000,164.56000,Hometown Health,PPO/EPO,,336.60,,,,,,,97.24,362.78,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,inpatient,,,553.00000,243.32000,Hometown Health,PPO/EPO,,497.70,,,,,,,497.70,536.41,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,outpatient,,,553.00000,243.32000,Hometown Health,PPO/EPO,,497.70,,,,,,,143.78,536.41,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,inpatient,,,359.00000,157.96000,Hometown Health,PPO/EPO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,outpatient,,,359.00000,157.96000,Hometown Health,PPO/EPO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,inpatient,,,62.00000,27.28000,Hometown Health,PPO/EPO,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,outpatient,,,62.00000,27.28000,Hometown Health,PPO/EPO,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,inpatient,,,79.00000,34.76000,Hometown Health,PPO/EPO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,outpatient,,,79.00000,34.76000,Hometown Health,PPO/EPO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,inpatient,,,110.00000,48.40000,Hometown Health,PPO/EPO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,outpatient,,,110.00000,48.40000,Hometown Health,PPO/EPO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,inpatient,,,110.00000,48.40000,Hometown Health,PPO/EPO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,outpatient,,,110.00000,48.40000,Hometown Health,PPO/EPO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,inpatient,,,751.00000,330.44000,Hometown Health,PPO/EPO,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,outpatient,,,751.00000,330.44000,Hometown Health,PPO/EPO,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,inpatient,,,1665.00000,732.60000,Hometown Health,PPO/EPO,,1498.50,,,,,,,1498.50,1615.05,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,outpatient,,,1665.00000,732.60000,Hometown Health,PPO/EPO,,1498.50,,,,,,,432.90,1615.05,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,inpatient,,,110.00000,48.40000,Hometown Health,PPO/EPO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,outpatient,,,110.00000,48.40000,Hometown Health,PPO/EPO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,inpatient,,,281.00000,123.64000,Hometown Health,PPO/EPO,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Hometown Health,PPO/EPO,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,inpatient,,,281.00000,123.64000,Hometown Health,PPO/EPO,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Hometown Health,PPO/EPO,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,inpatient,,,451.00000,341.41000,Hometown Health,PPO/EPO,,405.90,,,,,,,405.90,437.47,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,outpatient,,,451.00000,341.41000,Hometown Health,PPO/EPO,,405.90,,,,,,,117.26,437.47,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,inpatient,,,300.00000,145.80000,Hometown Health,PPO/EPO,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,outpatient,,,300.00000,145.80000,Hometown Health,PPO/EPO,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,inpatient,,,2278.00000,1107.11000,Hometown Health,PPO/EPO,,2050.20,,,,,,,2050.20,2209.66,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,outpatient,,,2278.00000,1107.11000,Hometown Health,PPO/EPO,,2050.20,,,,,,,592.28,2209.66,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,inpatient,,,3912.00000,1901.23000,Hometown Health,PPO/EPO,,3520.80,,,,,,,3520.80,3794.64,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,outpatient,,,3912.00000,1901.23000,Hometown Health,PPO/EPO,,3520.80,,,,,,,1017.12,3794.64,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,inpatient,,,900.00000,437.40000,Hometown Health,PPO/EPO,,810.00,,,,,,,810.00,873.00,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,outpatient,,,900.00000,437.40000,Hometown Health,PPO/EPO,,810.00,,,,,,,234.00,873.00,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,inpatient,,,365.00000,177.39000,Hometown Health,PPO/EPO,,328.50,,,,,,,328.50,354.05,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,outpatient,,,365.00000,177.39000,Hometown Health,PPO/EPO,,328.50,,,,,,,94.90,354.05,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,inpatient,,,989.00000,480.65000,Hometown Health,PPO/EPO,,890.10,,,,,,,890.10,959.33,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,outpatient,,,989.00000,480.65000,Hometown Health,PPO/EPO,,890.10,,,,,,,257.14,959.33,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Hometown Health,PPO/EPO,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Hometown Health,PPO/EPO,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,inpatient,,,435.00000,211.41000,Hometown Health,PPO/EPO,,391.50,,,,,,,391.50,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Hometown Health,PPO/EPO,,391.50,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,inpatient,,,435.00000,211.41000,Hometown Health,PPO/EPO,,391.50,,,,,,,391.50,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Hometown Health,PPO/EPO,,391.50,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,inpatient,,,644.00000,312.98000,Hometown Health,PPO/EPO,,579.60,,,,,,,579.60,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,outpatient,,,644.00000,312.98000,Hometown Health,PPO/EPO,,579.60,,,,,,,167.44,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Hometown Health,PPO/EPO,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Hometown Health,PPO/EPO,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Hometown Health,PPO/EPO,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Hometown Health,PPO/EPO,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,inpatient,,,527.00000,256.12000,Hometown Health,PPO/EPO,,474.30,,,,,,,474.30,511.19,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,outpatient,,,527.00000,256.12000,Hometown Health,PPO/EPO,,474.30,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,inpatient,,,1404.00000,682.34000,Hometown Health,PPO/EPO,,1263.60,,,,,,,1263.60,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,outpatient,,,1404.00000,682.34000,Hometown Health,PPO/EPO,,1263.60,,,,,,,365.04,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,inpatient,,,5475.00000,2660.85000,Hometown Health,PPO/EPO,,4927.50,,,,,,,4927.50,5310.75,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,outpatient,,,5475.00000,2660.85000,Hometown Health,PPO/EPO,,4927.50,,,,,,,1423.50,5310.75,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,inpatient,,,726.00000,352.84000,Hometown Health,PPO/EPO,,653.40,,,,,,,653.40,704.22,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,outpatient,,,726.00000,352.84000,Hometown Health,PPO/EPO,,653.40,,,,,,,188.76,704.22,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,inpatient,,,507.00000,246.40000,Hometown Health,PPO/EPO,,456.30,,,,,,,456.30,491.79,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,outpatient,,,507.00000,246.40000,Hometown Health,PPO/EPO,,456.30,,,,,,,131.82,491.79,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,inpatient,,,1670.00000,811.62000,Hometown Health,PPO/EPO,,1503.00,,,,,,,1503.00,1619.90,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,outpatient,,,1670.00000,811.62000,Hometown Health,PPO/EPO,,1503.00,,,,,,,434.20,1619.90,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,inpatient,,,1139.00000,553.55000,Hometown Health,PPO/EPO,,1025.10,,,,,,,1025.10,1104.83,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,outpatient,,,1139.00000,553.55000,Hometown Health,PPO/EPO,,1025.10,,,,,,,296.14,1104.83,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,inpatient,,,875.00000,425.25000,Hometown Health,PPO/EPO,,787.50,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,outpatient,,,875.00000,425.25000,Hometown Health,PPO/EPO,,787.50,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,PPO/EPO,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,PPO/EPO,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,inpatient,,,1353.00000,657.56000,Hometown Health,PPO/EPO,,1217.70,,,,,,,1217.70,1312.41,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,outpatient,,,1353.00000,657.56000,Hometown Health,PPO/EPO,,1217.70,,,,,,,351.78,1312.41,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,PPO/EPO,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,PPO/EPO,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,PPO/EPO,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,PPO/EPO,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,inpatient,,,825.00000,400.95000,Hometown Health,PPO/EPO,,742.50,,,,,,,742.50,800.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,outpatient,,,825.00000,400.95000,Hometown Health,PPO/EPO,,742.50,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,PPO/EPO,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,PPO/EPO,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,PPO/EPO,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,PPO/EPO,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,inpatient,,,974.00000,473.36000,Hometown Health,PPO/EPO,,876.60,,,,,,,876.60,944.78,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,outpatient,,,974.00000,473.36000,Hometown Health,PPO/EPO,,876.60,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,inpatient,,,198.00000,96.23000,Hometown Health,PPO/EPO,,178.20,,,,,,,178.20,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Hometown Health,PPO/EPO,,178.20,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,inpatient,,,198.00000,96.23000,Hometown Health,PPO/EPO,,178.20,,,,,,,178.20,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Hometown Health,PPO/EPO,,178.20,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,inpatient,,,221.00000,107.41000,Hometown Health,PPO/EPO,,198.90,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Hometown Health,PPO/EPO,,198.90,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,inpatient,,,221.00000,107.41000,Hometown Health,PPO/EPO,,198.90,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Hometown Health,PPO/EPO,,198.90,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,inpatient,,,497.00000,241.54000,Hometown Health,PPO/EPO,,447.30,,,,,,,447.30,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,outpatient,,,497.00000,241.54000,Hometown Health,PPO/EPO,,447.30,,,,,,,129.22,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,inpatient,,,2340.00000,1137.24000,Hometown Health,PPO/EPO,,2106.00,,,,,,,2106.00,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,outpatient,,,2340.00000,1137.24000,Hometown Health,PPO/EPO,,2106.00,,,,,,,608.40,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,inpatient,,,249.00000,121.01000,Hometown Health,PPO/EPO,,224.10,,,,,,,224.10,241.53,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,outpatient,,,249.00000,121.01000,Hometown Health,PPO/EPO,,224.10,,,,,,,64.74,241.53,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,inpatient,,,135.00000,65.61000,Hometown Health,PPO/EPO,,121.50,,,,,,,121.50,130.95,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,outpatient,,,135.00000,65.61000,Hometown Health,PPO/EPO,,121.50,,,,,,,35.10,130.95,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,inpatient,,,172.00000,83.59000,Hometown Health,PPO/EPO,,154.80,,,,,,,154.80,166.84,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,outpatient,,,172.00000,83.59000,Hometown Health,PPO/EPO,,154.80,,,,,,,44.72,166.84,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,inpatient,,,307.00000,149.20000,Hometown Health,PPO/EPO,,276.30,,,,,,,276.30,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,outpatient,,,307.00000,149.20000,Hometown Health,PPO/EPO,,276.30,,,,,,,79.82,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,inpatient,,,1800.00000,874.80000,Hometown Health,PPO/EPO,,1620.00,,,,,,,1620.00,1746.00,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,outpatient,,,1800.00000,874.80000,Hometown Health,PPO/EPO,,1620.00,,,,,,,468.00,1746.00,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,inpatient,,,974.00000,473.36000,Hometown Health,PPO/EPO,,876.60,,,,,,,876.60,944.78,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,outpatient,,,974.00000,473.36000,Hometown Health,PPO/EPO,,876.60,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,inpatient,,,197.00000,95.74000,Hometown Health,PPO/EPO,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Hometown Health,PPO/EPO,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,inpatient,,,197.00000,95.74000,Hometown Health,PPO/EPO,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Hometown Health,PPO/EPO,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,inpatient,,,411.00000,199.75000,Hometown Health,PPO/EPO,,369.90,,,,,,,369.90,398.67,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,outpatient,,,411.00000,199.75000,Hometown Health,PPO/EPO,,369.90,,,,,,,106.86,398.67,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,inpatient,,,221.00000,107.41000,Hometown Health,PPO/EPO,,198.90,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,outpatient,,,221.00000,107.41000,Hometown Health,PPO/EPO,,198.90,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,inpatient,,,884.00000,429.62000,Hometown Health,PPO/EPO,,795.60,,,,,,,795.60,857.48,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,outpatient,,,884.00000,429.62000,Hometown Health,PPO/EPO,,795.60,,,,,,,229.84,857.48,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,inpatient,,,594.00000,288.68000,Hometown Health,PPO/EPO,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,outpatient,,,594.00000,288.68000,Hometown Health,PPO/EPO,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,inpatient,,,519.00000,252.23000,Hometown Health,PPO/EPO,,467.10,,,,,,,467.10,503.43,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,outpatient,,,519.00000,252.23000,Hometown Health,PPO/EPO,,467.10,,,,,,,134.94,503.43,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,inpatient,,,1046.00000,508.36000,Hometown Health,PPO/EPO,,941.40,,,,,,,941.40,1014.62,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,outpatient,,,1046.00000,508.36000,Hometown Health,PPO/EPO,,941.40,,,,,,,271.96,1014.62,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,inpatient,,,556.00000,270.22000,Hometown Health,PPO/EPO,,500.40,,,,,,,500.40,539.32,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,outpatient,,,556.00000,270.22000,Hometown Health,PPO/EPO,,500.40,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,inpatient,,,275.00000,133.65000,Hometown Health,PPO/EPO,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,outpatient,,,275.00000,133.65000,Hometown Health,PPO/EPO,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,inpatient,,,580.00000,281.88000,Hometown Health,PPO/EPO,,522.00,,,,,,,522.00,562.60,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,outpatient,,,580.00000,281.88000,Hometown Health,PPO/EPO,,522.00,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,inpatient,,,580.00000,281.88000,Hometown Health,PPO/EPO,,522.00,,,,,,,522.00,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,outpatient,,,580.00000,281.88000,Hometown Health,PPO/EPO,,522.00,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,inpatient,,,3480.00000,1691.28000,Hometown Health,PPO/EPO,,3132.00,,,,,,,3132.00,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Hometown Health,PPO/EPO,,3132.00,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,inpatient,,,3480.00000,1691.28000,Hometown Health,PPO/EPO,,3132.00,,,,,,,3132.00,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Hometown Health,PPO/EPO,,3132.00,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,inpatient,,,700.00000,340.20000,Hometown Health,PPO/EPO,,630.00,,,,,,,630.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,outpatient,,,700.00000,340.20000,Hometown Health,PPO/EPO,,630.00,,,,,,,182.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,inpatient,,,1427.00000,693.52000,Hometown Health,PPO/EPO,,1284.30,,,,,,,1284.30,1384.19,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,outpatient,,,1427.00000,693.52000,Hometown Health,PPO/EPO,,1284.30,,,,,,,371.02,1384.19,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,inpatient,,,614.00000,298.40000,Hometown Health,PPO/EPO,,552.60,,,,,,,552.60,595.58,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,outpatient,,,614.00000,298.40000,Hometown Health,PPO/EPO,,552.60,,,,,,,159.64,595.58,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,inpatient,,,2027.00000,985.12000,Hometown Health,PPO/EPO,,1824.30,,,,,,,1824.30,1966.19,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,outpatient,,,2027.00000,985.12000,Hometown Health,PPO/EPO,,1824.30,,,,,,,527.02,1966.19,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,inpatient,,,556.00000,270.22000,Hometown Health,PPO/EPO,,500.40,,,,,,,500.40,539.32,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,outpatient,,,556.00000,270.22000,Hometown Health,PPO/EPO,,500.40,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,inpatient,,,1146.00000,556.96000,Hometown Health,PPO/EPO,,1031.40,,,,,,,1031.40,1111.62,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,outpatient,,,1146.00000,556.96000,Hometown Health,PPO/EPO,,1031.40,,,,,,,297.96,1111.62,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,inpatient,,,197.00000,95.74000,Hometown Health,PPO/EPO,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Hometown Health,PPO/EPO,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,inpatient,,,197.00000,95.74000,Hometown Health,PPO/EPO,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Hometown Health,PPO/EPO,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,inpatient,,,527.00000,256.12000,Hometown Health,PPO/EPO,,474.30,,,,,,,474.30,511.19,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,outpatient,,,527.00000,256.12000,Hometown Health,PPO/EPO,,474.30,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,inpatient,,,740.00000,359.64000,Hometown Health,PPO/EPO,,666.00,,,,,,,666.00,717.80,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,outpatient,,,740.00000,359.64000,Hometown Health,PPO/EPO,,666.00,,,,,,,192.40,717.80,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,inpatient,,,875.00000,425.25000,Hometown Health,PPO/EPO,,787.50,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Hometown Health,PPO/EPO,,787.50,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,inpatient,,,875.00000,425.25000,Hometown Health,PPO/EPO,,787.50,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Hometown Health,PPO/EPO,,787.50,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,inpatient,,,1399.00000,679.91000,Hometown Health,PPO/EPO,,1259.10,,,,,,,1259.10,1357.03,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,outpatient,,,1399.00000,679.91000,Hometown Health,PPO/EPO,,1259.10,,,,,,,363.74,1357.03,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,inpatient,,,51.00000,24.79000,Hometown Health,PPO/EPO,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,outpatient,,,51.00000,24.79000,Hometown Health,PPO/EPO,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,inpatient,,,825.00000,400.95000,Hometown Health,PPO/EPO,,742.50,,,,,,,742.50,800.25,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,outpatient,,,825.00000,400.95000,Hometown Health,PPO/EPO,,742.50,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,inpatient,,,576.00000,279.94000,Hometown Health,PPO/EPO,,518.40,,,,,,,518.40,558.72,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,outpatient,,,576.00000,279.94000,Hometown Health,PPO/EPO,,518.40,,,,,,,149.76,558.72,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,inpatient,,,224.00000,108.86000,Hometown Health,PPO/EPO,,201.60,,,,,,,201.60,217.28,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,outpatient,,,224.00000,108.86000,Hometown Health,PPO/EPO,,201.60,,,,,,,58.24,217.28,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,inpatient,,,346.00000,168.16000,Hometown Health,PPO/EPO,,311.40,,,,,,,311.40,335.62,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,outpatient,,,346.00000,168.16000,Hometown Health,PPO/EPO,,311.40,,,,,,,89.96,335.62,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,PPO/EPO,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,PPO/EPO,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,PPO/EPO,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,PPO/EPO,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,PPO/EPO,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,PPO/EPO,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,inpatient,,,525.00000,255.15000,Hometown Health,PPO/EPO,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Hometown Health,PPO/EPO,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,inpatient,,,627.00000,304.72000,Hometown Health,PPO/EPO,,564.30,,,,,,,564.30,608.19,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,outpatient,,,627.00000,304.72000,Hometown Health,PPO/EPO,,564.30,,,,,,,163.02,608.19,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,inpatient,,,605.00000,294.03000,Hometown Health,PPO/EPO,,544.50,,,,,,,544.50,586.85,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,outpatient,,,605.00000,294.03000,Hometown Health,PPO/EPO,,544.50,,,,,,,157.30,586.85,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,inpatient,,,510.00000,247.86000,Hometown Health,PPO/EPO,,459.00,,,,,,,459.00,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,outpatient,,,510.00000,247.86000,Hometown Health,PPO/EPO,,459.00,,,,,,,132.60,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,inpatient,,,223.00000,108.38000,Hometown Health,PPO/EPO,,200.70,,,,,,,200.70,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,outpatient,,,223.00000,108.38000,Hometown Health,PPO/EPO,,200.70,,,,,,,57.98,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,inpatient,,,1211.00000,588.55000,Hometown Health,PPO/EPO,,1089.90,,,,,,,1089.90,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,outpatient,,,1211.00000,588.55000,Hometown Health,PPO/EPO,,1089.90,,,,,,,314.86,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,inpatient,,,383.00000,186.14000,Hometown Health,PPO/EPO,,344.70,,,,,,,344.70,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,outpatient,,,383.00000,186.14000,Hometown Health,PPO/EPO,,344.70,,,,,,,99.58,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,inpatient,,,1214.00000,590.00000,Hometown Health,PPO/EPO,,1092.60,,,,,,,1092.60,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,outpatient,,,1214.00000,590.00000,Hometown Health,PPO/EPO,,1092.60,,,,,,,315.64,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,inpatient,,,328.00000,159.41000,Hometown Health,PPO/EPO,,295.20,,,,,,,295.20,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,outpatient,,,328.00000,159.41000,Hometown Health,PPO/EPO,,295.20,,,,,,,85.28,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,inpatient,,,372.00000,180.79000,Hometown Health,PPO/EPO,,334.80,,,,,,,334.80,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,outpatient,,,372.00000,180.79000,Hometown Health,PPO/EPO,,334.80,,,,,,,96.72,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,inpatient,,,285.00000,138.51000,Hometown Health,PPO/EPO,,256.50,,,,,,,256.50,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,outpatient,,,285.00000,138.51000,Hometown Health,PPO/EPO,,256.50,,,,,,,74.10,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,inpatient,,,367.00000,178.36000,Hometown Health,PPO/EPO,,330.30,,,,,,,330.30,355.99,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,outpatient,,,367.00000,178.36000,Hometown Health,PPO/EPO,,330.30,,,,,,,95.42,355.99,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,inpatient,,,702.00000,341.17000,Hometown Health,PPO/EPO,,631.80,,,,,,,631.80,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Hometown Health,PPO/EPO,,631.80,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,inpatient,,,702.00000,341.17000,Hometown Health,PPO/EPO,,631.80,,,,,,,631.80,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Hometown Health,PPO/EPO,,631.80,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,inpatient,,,265.00000,128.79000,Hometown Health,PPO/EPO,,238.50,,,,,,,238.50,257.05,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,outpatient,,,265.00000,128.79000,Hometown Health,PPO/EPO,,238.50,,,,,,,68.90,257.05,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,inpatient,,,2279.00000,1107.59000,Hometown Health,PPO/EPO,,2051.10,,,,,,,2051.10,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2279.00000,1107.59000,Hometown Health,PPO/EPO,,2051.10,,,,,,,592.54,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,inpatient,,,2395.00000,1163.97000,Hometown Health,PPO/EPO,,2155.50,,,,,,,2155.50,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2395.00000,1163.97000,Hometown Health,PPO/EPO,,2155.50,,,,,,,622.70,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,inpatient,,,8759.00000,4256.87000,Hometown Health,PPO/EPO,,7883.10,,,,,,,7883.10,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Hometown Health,PPO/EPO,,7883.10,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,inpatient,,,8759.00000,4256.87000,Hometown Health,PPO/EPO,,7883.10,,,,,,,7883.10,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Hometown Health,PPO/EPO,,7883.10,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,inpatient,,,2752.00000,1337.47000,Hometown Health,PPO/EPO,,2476.80,,,,,,,2476.80,2669.44,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,outpatient,,,2752.00000,1337.47000,Hometown Health,PPO/EPO,,2476.80,,,,,,,715.52,2669.44,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,inpatient,,,217.00000,105.46000,Hometown Health,PPO/EPO,,195.30,,,,,,,195.30,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Hometown Health,PPO/EPO,,195.30,,,,,,,56.42,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,inpatient,,,217.00000,105.46000,Hometown Health,PPO/EPO,,195.30,,,,,,,195.30,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Hometown Health,PPO/EPO,,195.30,,,,,,,56.42,210.49,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,inpatient,,,292.00000,141.91000,Hometown Health,PPO/EPO,,262.80,,,,,,,262.80,283.24,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,outpatient,,,292.00000,141.91000,Hometown Health,PPO/EPO,,262.80,,,,,,,75.92,283.24,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Hometown Health,PPO/EPO,,369.90,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Hometown Health,PPO/EPO,,369.90,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Hometown Health,PPO/EPO,,369.90,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Hometown Health,PPO/EPO,,369.90,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Hometown Health,PPO/EPO,,369.90,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Hometown Health,PPO/EPO,,369.90,,,,,,,106.86,398.67,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,inpatient,,,2275.00000,1105.65000,Hometown Health,PPO/EPO,,2047.50,,,,,,,2047.50,2206.75,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,outpatient,,,2275.00000,1105.65000,Hometown Health,PPO/EPO,,2047.50,,,,,,,591.50,2206.75,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,inpatient,,,192.00000,93.31000,Hometown Health,PPO/EPO,,172.80,,,,,,,172.80,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,outpatient,,,192.00000,93.31000,Hometown Health,PPO/EPO,,172.80,,,,,,,49.92,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,inpatient,,,451.00000,219.19000,Hometown Health,PPO/EPO,,405.90,,,,,,,405.90,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,outpatient,,,451.00000,219.19000,Hometown Health,PPO/EPO,,405.90,,,,,,,117.26,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,inpatient,,,617.00000,299.86000,Hometown Health,PPO/EPO,,555.30,,,,,,,555.30,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,outpatient,,,617.00000,299.86000,Hometown Health,PPO/EPO,,555.30,,,,,,,160.42,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,inpatient,,,825.00000,400.95000,Hometown Health,PPO/EPO,,742.50,,,,,,,742.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,outpatient,,,825.00000,400.95000,Hometown Health,PPO/EPO,,742.50,,,,,,,214.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,inpatient,,,905.00000,439.83000,Hometown Health,PPO/EPO,,814.50,,,,,,,814.50,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,outpatient,,,905.00000,439.83000,Hometown Health,PPO/EPO,,814.50,,,,,,,235.30,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,inpatient,,,849.00000,412.61000,Hometown Health,PPO/EPO,,764.10,,,,,,,764.10,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,outpatient,,,849.00000,412.61000,Hometown Health,PPO/EPO,,764.10,,,,,,,220.74,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,inpatient,,,2539.00000,1233.95000,Hometown Health,PPO/EPO,,2285.10,,,,,,,2285.10,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,outpatient,,,2539.00000,1233.95000,Hometown Health,PPO/EPO,,2285.10,,,,,,,660.14,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,inpatient,,,6000.00000,2916.00000,Hometown Health,PPO/EPO,,5400.00,,,,,,,5400.00,5820.00,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,outpatient,,,6000.00000,2916.00000,Hometown Health,PPO/EPO,,5400.00,,,,,,,1560.00,5820.00,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,inpatient,,,8260.00000,4014.36000,Hometown Health,PPO/EPO,,7434.00,,,,,,,7434.00,8012.20,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,outpatient,,,8260.00000,4014.36000,Hometown Health,PPO/EPO,,7434.00,,,,,,,2147.60,8012.20,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,inpatient,,,202.00000,88.88000,Hometown Health,PPO/EPO,,181.80,,,,,,,181.80,195.94,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,outpatient,,,202.00000,88.88000,Hometown Health,PPO/EPO,,181.80,,,,,,,52.52,195.94,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,inpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,outpatient,,,66.00000,31.81000,Hometown Health,PPO/EPO,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,inpatient,,,295.00000,142.19000,Hometown Health,PPO/EPO,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,outpatient,,,295.00000,142.19000,Hometown Health,PPO/EPO,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,89.00000,26.79000,Hometown Health,PPO/EPO,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,89.00000,26.79000,Hometown Health,PPO/EPO,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,inpatient,,,93.00000,27.99000,Hometown Health,PPO/EPO,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Hometown Health,PPO/EPO,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,93.00000,27.99000,Hometown Health,PPO/EPO,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Hometown Health,PPO/EPO,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Hometown Health,PPO/EPO,,1687.50,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Hometown Health,PPO/EPO,,1687.50,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Hometown Health,PPO/EPO,,1687.50,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Hometown Health,PPO/EPO,,1687.50,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1752.00000,527.35000,Hometown Health,PPO/EPO,,1576.80,,,,,,,1576.80,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Hometown Health,PPO/EPO,,1576.80,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1752.00000,527.35000,Hometown Health,PPO/EPO,,1576.80,,,,,,,1576.80,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Hometown Health,PPO/EPO,,1576.80,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,731.00000,220.03000,Hometown Health,PPO/EPO,,657.90,,,,,,,657.90,709.07,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,731.00000,220.03000,Hometown Health,PPO/EPO,,657.90,,,,,,,190.06,709.07,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,787.00000,236.89000,Hometown Health,PPO/EPO,,708.30,,,,,,,708.30,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,787.00000,236.89000,Hometown Health,PPO/EPO,,708.30,,,,,,,204.62,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,2042.00000,614.64000,Hometown Health,PPO/EPO,,1837.80,,,,,,,1837.80,1980.74,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,2042.00000,614.64000,Hometown Health,PPO/EPO,,1837.80,,,,,,,530.92,1980.74,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Hometown Health,PPO/EPO,,1687.50,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Hometown Health,PPO/EPO,,1687.50,,,,,,,487.50,1818.75,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,714.00000,214.91000,Hometown Health,PPO/EPO,,642.60,,,,,,,642.60,692.58,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,714.00000,214.91000,Hometown Health,PPO/EPO,,642.60,,,,,,,185.64,692.58,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,294.00000,88.49000,Hometown Health,PPO/EPO,,264.60,,,,,,,264.60,285.18,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,294.00000,88.49000,Hometown Health,PPO/EPO,,264.60,,,,,,,76.44,285.18,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,inpatient,,,350.00000,105.35000,Hometown Health,PPO/EPO,,315.00,,,,,,,315.00,339.50,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,350.00000,105.35000,Hometown Health,PPO/EPO,,315.00,,,,,,,91.00,339.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,inpatient,,,1350.00000,780.30000,Hometown Health,PPO/EPO,,1215.00,,,,,,,1215.00,1309.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,outpatient,,,1350.00000,780.30000,Hometown Health,PPO/EPO,,1215.00,,,,,,,351.00,1309.50,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,inpatient,,,3680.00000,2127.04000,Hometown Health,PPO/EPO,,3312.00,,,,,,,3312.00,3569.60,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,outpatient,,,3680.00000,2127.04000,Hometown Health,PPO/EPO,,3312.00,,,,,,,956.80,3569.60,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,inpatient,,,1600.00000,924.80000,Hometown Health,PPO/EPO,,1440.00,,,,,,,1440.00,1552.00,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,outpatient,,,1600.00000,924.80000,Hometown Health,PPO/EPO,,1440.00,,,,,,,416.00,1552.00,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,inpatient,,,4680.00000,2705.04000,Hometown Health,PPO/EPO,,4212.00,,,,,,,4212.00,4539.60,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,outpatient,,,4680.00000,2705.04000,Hometown Health,PPO/EPO,,4212.00,,,,,,,1216.80,4539.60,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,inpatient,,,2100.00000,1213.80000,Hometown Health,PPO/EPO,,1890.00,,,,,,,1890.00,2037.00,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,outpatient,,,2100.00000,1213.80000,Hometown Health,PPO/EPO,,1890.00,,,,,,,546.00,2037.00,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,inpatient,,,5680.00000,3283.04000,Hometown Health,PPO/EPO,,5112.00,,,,,,,5112.00,5509.60,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,outpatient,,,5680.00000,3283.04000,Hometown Health,PPO/EPO,,5112.00,,,,,,,1476.80,5509.60,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,inpatient,,,2420.00000,1398.76000,Hometown Health,PPO/EPO,,2178.00,,,,,,,2178.00,2347.40,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,outpatient,,,2420.00000,1398.76000,Hometown Health,PPO/EPO,,2178.00,,,,,,,629.20,2347.40,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,inpatient,,,6415.00000,3707.87000,Hometown Health,PPO/EPO,,5773.50,,,,,,,5773.50,6222.55,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,outpatient,,,6415.00000,3707.87000,Hometown Health,PPO/EPO,,5773.50,,,,,,,1667.90,6222.55,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,inpatient,,,2920.00000,1687.76000,Hometown Health,PPO/EPO,,2628.00,,,,,,,2628.00,2832.40,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,outpatient,,,2920.00000,1687.76000,Hometown Health,PPO/EPO,,2628.00,,,,,,,759.20,2832.40,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,inpatient,,,8915.00000,5152.87000,Hometown Health,PPO/EPO,,8023.50,,,,,,,8023.50,8647.55,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,outpatient,,,8915.00000,5152.87000,Hometown Health,PPO/EPO,,8023.50,,,,,,,2317.90,8647.55,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,inpatient,,,3420.00000,1976.76000,Hometown Health,PPO/EPO,,3078.00,,,,,,,3078.00,3317.40,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,outpatient,,,3420.00000,1976.76000,Hometown Health,PPO/EPO,,3078.00,,,,,,,889.20,3317.40,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,inpatient,,,11415.00000,6597.87000,Hometown Health,PPO/EPO,,10273.50,,,,,,,10273.50,11072.55,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,outpatient,,,11415.00000,6597.87000,Hometown Health,PPO/EPO,,10273.50,,,,,,,2967.90,11072.55,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,inpatient,,,142.00000,154.35000,Hometown Health,PPO/EPO,,127.80,,,,,,,127.80,137.74,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,outpatient,,,142.00000,154.35000,Hometown Health,PPO/EPO,,127.80,,,,,,,36.92,137.74,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,inpatient,,,340.00000,228.82000,Hometown Health,PPO/EPO,,306.00,,,,,,,306.00,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Hometown Health,PPO/EPO,,306.00,,,,,,,88.40,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,inpatient,,,670.00000,450.91000,Hometown Health,PPO/EPO,,603.00,,,,,,,603.00,649.90,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Hometown Health,PPO/EPO,,603.00,,,,,,,174.20,649.90,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,inpatient,,,390.00000,262.47000,Hometown Health,PPO/EPO,,351.00,,,,,,,351.00,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,outpatient,,,390.00000,262.47000,Hometown Health,PPO/EPO,,351.00,,,,,,,101.40,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,inpatient,,,1170.00000,787.41000,Hometown Health,PPO/EPO,,1053.00,,,,,,,1053.00,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,outpatient,,,1170.00000,787.41000,Hometown Health,PPO/EPO,,1053.00,,,,,,,304.20,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,inpatient,,,440.00000,296.12000,Hometown Health,PPO/EPO,,396.00,,,,,,,396.00,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,outpatient,,,440.00000,296.12000,Hometown Health,PPO/EPO,,396.00,,,,,,,114.40,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,inpatient,,,1670.00000,1123.91000,Hometown Health,PPO/EPO,,1503.00,,,,,,,1503.00,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,outpatient,,,1670.00000,1123.91000,Hometown Health,PPO/EPO,,1503.00,,,,,,,434.20,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,inpatient,,,640.00000,430.72000,Hometown Health,PPO/EPO,,576.00,,,,,,,576.00,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,outpatient,,,640.00000,430.72000,Hometown Health,PPO/EPO,,576.00,,,,,,,166.40,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,inpatient,,,2170.00000,1460.41000,Hometown Health,PPO/EPO,,1953.00,,,,,,,1953.00,2104.90,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,outpatient,,,2170.00000,1460.41000,Hometown Health,PPO/EPO,,1953.00,,,,,,,564.20,2104.90,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,inpatient,,,17.00000,10.96000,Hometown Health,PPO/EPO,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,outpatient,,,17.00000,10.96000,Hometown Health,PPO/EPO,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,inpatient,,,535.00000,345.08000,Hometown Health,PPO/EPO,,481.50,,,,,,,481.50,518.95,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,outpatient,,,535.00000,345.08000,Hometown Health,PPO/EPO,,481.50,,,,,,,139.10,518.95,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,inpatient,,,23.00000,14.84000,Hometown Health,PPO/EPO,,20.70,,,,,,,20.70,22.31,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,outpatient,,,23.00000,14.84000,Hometown Health,PPO/EPO,,20.70,,,,,,,5.98,22.31,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,inpatient,,,635.00000,409.58000,Hometown Health,PPO/EPO,,571.50,,,,,,,571.50,615.95,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,outpatient,,,635.00000,409.58000,Hometown Health,PPO/EPO,,571.50,,,,,,,165.10,615.95,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,inpatient,,,30.00000,19.35000,Hometown Health,PPO/EPO,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,outpatient,,,30.00000,19.35000,Hometown Health,PPO/EPO,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,inpatient,,,735.00000,474.08000,Hometown Health,PPO/EPO,,661.50,,,,,,,661.50,712.95,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,outpatient,,,735.00000,474.08000,Hometown Health,PPO/EPO,,661.50,,,,,,,191.10,712.95,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,inpatient,,,33.00000,21.28000,Hometown Health,PPO/EPO,,29.70,,,,,,,29.70,32.01,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,outpatient,,,33.00000,21.28000,Hometown Health,PPO/EPO,,29.70,,,,,,,8.58,32.01,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,inpatient,,,835.00000,538.58000,Hometown Health,PPO/EPO,,751.50,,,,,,,751.50,809.95,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,outpatient,,,835.00000,538.58000,Hometown Health,PPO/EPO,,751.50,,,,,,,217.10,809.95,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,inpatient,,,140.00000,80.92000,Hometown Health,PPO/EPO,,126.00,,,,,,,126.00,135.80,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,outpatient,,,140.00000,80.92000,Hometown Health,PPO/EPO,,126.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,inpatient,,,275.00000,158.95000,Hometown Health,PPO/EPO,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,outpatient,,,275.00000,158.95000,Hometown Health,PPO/EPO,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,inpatient,,,295.00000,170.51000,Hometown Health,PPO/EPO,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,outpatient,,,295.00000,170.51000,Hometown Health,PPO/EPO,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,inpatient,,,590.00000,341.02000,Hometown Health,PPO/EPO,,531.00,,,,,,,531.00,572.30,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,outpatient,,,590.00000,341.02000,Hometown Health,PPO/EPO,,531.00,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,inpatient,,,690.00000,398.82000,Hometown Health,PPO/EPO,,621.00,,,,,,,621.00,669.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,outpatient,,,690.00000,398.82000,Hometown Health,PPO/EPO,,621.00,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,inpatient,,,1375.00000,794.75000,Hometown Health,PPO/EPO,,1237.50,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,outpatient,,,1375.00000,794.75000,Hometown Health,PPO/EPO,,1237.50,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,inpatient,,,950.00000,549.10000,Hometown Health,PPO/EPO,,855.00,,,,,,,855.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,outpatient,,,950.00000,549.10000,Hometown Health,PPO/EPO,,855.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,inpatient,,,1900.00000,1098.20000,Hometown Health,PPO/EPO,,1710.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,outpatient,,,1900.00000,1098.20000,Hometown Health,PPO/EPO,,1710.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,inpatient,,,140.00000,45.22000,Hometown Health,PPO/EPO,,126.00,,,,,,,126.00,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,outpatient,,,140.00000,45.22000,Hometown Health,PPO/EPO,,126.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,inpatient,,,275.00000,88.82000,Hometown Health,PPO/EPO,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,outpatient,,,275.00000,88.82000,Hometown Health,PPO/EPO,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,inpatient,,,295.00000,95.28000,Hometown Health,PPO/EPO,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,outpatient,,,295.00000,95.28000,Hometown Health,PPO/EPO,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,inpatient,,,590.00000,190.57000,Hometown Health,PPO/EPO,,531.00,,,,,,,531.00,572.30,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,outpatient,,,590.00000,190.57000,Hometown Health,PPO/EPO,,531.00,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,inpatient,,,690.00000,222.87000,Hometown Health,PPO/EPO,,621.00,,,,,,,621.00,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,outpatient,,,690.00000,222.87000,Hometown Health,PPO/EPO,,621.00,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,inpatient,,,1375.00000,444.12000,Hometown Health,PPO/EPO,,1237.50,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,outpatient,,,1375.00000,444.12000,Hometown Health,PPO/EPO,,1237.50,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,inpatient,,,950.00000,306.85000,Hometown Health,PPO/EPO,,855.00,,,,,,,855.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,outpatient,,,950.00000,306.85000,Hometown Health,PPO/EPO,,855.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,inpatient,,,1900.00000,613.70000,Hometown Health,PPO/EPO,,1710.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,outpatient,,,1900.00000,613.70000,Hometown Health,PPO/EPO,,1710.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,inpatient,,,340.00000,228.82000,Hometown Health,PPO/EPO,,306.00,,,,,,,306.00,329.80,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Hometown Health,PPO/EPO,,306.00,,,,,,,88.40,329.80,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,inpatient,,,670.00000,450.91000,Hometown Health,PPO/EPO,,603.00,,,,,,,603.00,649.90,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Hometown Health,PPO/EPO,,603.00,,,,,,,174.20,649.90,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Hometown Health,PPO/EPO,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Hometown Health,PPO/EPO,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,inpatient,,,490.00000,329.77000,Hometown Health,PPO/EPO,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Hometown Health,PPO/EPO,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Hometown Health,PPO/EPO,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Hometown Health,PPO/EPO,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,inpatient,,,245.00000,164.89000,Hometown Health,PPO/EPO,,220.50,,,,,,,220.50,237.65,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Hometown Health,PPO/EPO,,220.50,,,,,,,63.70,237.65,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Hometown Health,PPO/EPO,,757.80,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Hometown Health,PPO/EPO,,757.80,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Hometown Health,PPO/EPO,,947.70,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Hometown Health,PPO/EPO,,947.70,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Hometown Health,PPO/EPO,,1136.70,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Hometown Health,PPO/EPO,,1136.70,,,,,,,328.38,1225.11,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,inpatient,,,1178.00000,669.28000,Hometown Health,PPO/EPO,,1060.20,,,,,,,1060.20,1142.66,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1178.00000,669.28000,Hometown Health,PPO/EPO,,1060.20,,,,,,,306.28,1142.66,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,inpatient,,,140.00000,102.34000,Hometown Health,PPO/EPO,,126.00,,,,,,,126.00,135.80,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,outpatient,,,140.00000,102.34000,Hometown Health,PPO/EPO,,126.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,inpatient,,,275.00000,201.02000,Hometown Health,PPO/EPO,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,outpatient,,,275.00000,201.02000,Hometown Health,PPO/EPO,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,inpatient,,,295.00000,215.64000,Hometown Health,PPO/EPO,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,outpatient,,,295.00000,215.64000,Hometown Health,PPO/EPO,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,inpatient,,,590.00000,431.29000,Hometown Health,PPO/EPO,,531.00,,,,,,,531.00,572.30,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,outpatient,,,590.00000,431.29000,Hometown Health,PPO/EPO,,531.00,,,,,,,153.40,572.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,inpatient,,,690.00000,504.39000,Hometown Health,PPO/EPO,,621.00,,,,,,,621.00,669.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,outpatient,,,690.00000,504.39000,Hometown Health,PPO/EPO,,621.00,,,,,,,179.40,669.30,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,inpatient,,,1375.00000,1005.12000,Hometown Health,PPO/EPO,,1237.50,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,outpatient,,,1375.00000,1005.12000,Hometown Health,PPO/EPO,,1237.50,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,inpatient,,,950.00000,694.45000,Hometown Health,PPO/EPO,,855.00,,,,,,,855.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,outpatient,,,950.00000,694.45000,Hometown Health,PPO/EPO,,855.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,inpatient,,,1900.00000,1388.90000,Hometown Health,PPO/EPO,,1710.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,outpatient,,,1900.00000,1388.90000,Hometown Health,PPO/EPO,,1710.00,,,,,,,494.00,1843.00,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,inpatient,,,584.00000,426.90000,Hometown Health,PPO/EPO,,525.60,,,,,,,525.60,566.48,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,outpatient,,,584.00000,426.90000,Hometown Health,PPO/EPO,,525.60,,,,,,,151.84,566.48,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,inpatient,,,1391.00000,1016.82000,Hometown Health,PPO/EPO,,1251.90,,,,,,,1251.90,1349.27,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,outpatient,,,1391.00000,1016.82000,Hometown Health,PPO/EPO,,1251.90,,,,,,,361.66,1349.27,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,inpatient,,,359.00000,271.76000,Hometown Health,PPO/EPO,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,outpatient,,,359.00000,271.76000,Hometown Health,PPO/EPO,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,inpatient,,,95.00000,71.92000,Hometown Health,PPO/EPO,,85.50,,,,,,,85.50,92.15,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,outpatient,,,95.00000,71.92000,Hometown Health,PPO/EPO,,85.50,,,,,,,24.70,92.15,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,inpatient,,,37.00000,17.83000,Hometown Health,PPO/EPO,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,outpatient,,,37.00000,17.83000,Hometown Health,PPO/EPO,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Hometown Health,PPO/EPO,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Hometown Health,PPO/EPO,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,inpatient,,,237.00000,114.23000,Hometown Health,PPO/EPO,,213.30,,,,,,,213.30,229.89,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Hometown Health,PPO/EPO,,213.30,,,,,,,61.62,229.89,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,inpatient,,,33.00000,15.91000,Hometown Health,PPO/EPO,,29.70,,,,,,,29.70,32.01,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,outpatient,,,33.00000,15.91000,Hometown Health,PPO/EPO,,29.70,,,,,,,8.58,32.01,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,inpatient,,,25.00000,12.05000,Hometown Health,PPO/EPO,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,outpatient,,,25.00000,12.05000,Hometown Health,PPO/EPO,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,inpatient,,,497.00000,160.53000,Hometown Health,PPO/EPO,,447.30,,,,,,,447.30,482.09,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,outpatient,,,497.00000,160.53000,Hometown Health,PPO/EPO,,447.30,,,,,,,129.22,482.09,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Hometown Health,PPO/EPO,,793.80,,,,,,,793.80,855.54,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Hometown Health,PPO/EPO,,793.80,,,,,,,229.32,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Hometown Health,PPO/EPO,,793.80,,,,,,,793.80,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Hometown Health,PPO/EPO,,793.80,,,,,,,229.32,855.54,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,inpatient,,,98.00000,37.44000,Hometown Health,PPO/EPO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Hometown Health,PPO/EPO,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,inpatient,,,96.00000,36.67000,Hometown Health,PPO/EPO,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Hometown Health,PPO/EPO,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Hometown Health,PPO/EPO,,793.80,,,,,,,793.80,855.54,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Hometown Health,PPO/EPO,,793.80,,,,,,,229.32,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Hometown Health,PPO/EPO,,793.80,,,,,,,793.80,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Hometown Health,PPO/EPO,,793.80,,,,,,,229.32,855.54,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,inpatient,,,763.00000,291.47000,Hometown Health,PPO/EPO,,686.70,,,,,,,686.70,740.11,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,outpatient,,,763.00000,291.47000,Hometown Health,PPO/EPO,,686.70,,,,,,,198.38,740.11,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,inpatient,,,199.00000,76.02000,Hometown Health,PPO/EPO,,179.10,,,,,,,179.10,193.03,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,outpatient,,,199.00000,76.02000,Hometown Health,PPO/EPO,,179.10,,,,,,,51.74,193.03,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,inpatient,,,98.00000,37.44000,Hometown Health,PPO/EPO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Hometown Health,PPO/EPO,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,inpatient,,,96.00000,36.67000,Hometown Health,PPO/EPO,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Hometown Health,PPO/EPO,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,inpatient,,,1265.00000,483.23000,Hometown Health,PPO/EPO,,1138.50,,,,,,,1138.50,1227.05,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,outpatient,,,1265.00000,483.23000,Hometown Health,PPO/EPO,,1138.50,,,,,,,328.90,1227.05,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,inpatient,,,924.00000,352.97000,Hometown Health,PPO/EPO,,831.60,,,,,,,831.60,896.28,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,outpatient,,,924.00000,352.97000,Hometown Health,PPO/EPO,,831.60,,,,,,,240.24,896.28,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,inpatient,,,580.00000,215.76000,Hometown Health,PPO/EPO,,522.00,,,,,,,522.00,562.60,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,outpatient,,,580.00000,215.76000,Hometown Health,PPO/EPO,,522.00,,,,,,,150.80,562.60,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,inpatient,,,110.00000,40.92000,Hometown Health,PPO/EPO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,outpatient,,,110.00000,40.92000,Hometown Health,PPO/EPO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,inpatient,,,373.00000,138.76000,Hometown Health,PPO/EPO,,335.70,,,,,,,335.70,361.81,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,outpatient,,,373.00000,138.76000,Hometown Health,PPO/EPO,,335.70,,,,,,,96.98,361.81,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,inpatient,,,337.00000,125.36000,Hometown Health,PPO/EPO,,303.30,,,,,,,303.30,326.89,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,outpatient,,,337.00000,125.36000,Hometown Health,PPO/EPO,,303.30,,,,,,,87.62,326.89,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,inpatient,,,784.00000,291.65000,Hometown Health,PPO/EPO,,705.60,,,,,,,705.60,760.48,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,outpatient,,,784.00000,291.65000,Hometown Health,PPO/EPO,,705.60,,,,,,,203.84,760.48,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,inpatient,,,341.00000,126.85000,Hometown Health,PPO/EPO,,306.90,,,,,,,306.90,330.77,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,outpatient,,,341.00000,126.85000,Hometown Health,PPO/EPO,,306.90,,,,,,,88.66,330.77,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,inpatient,,,252.00000,93.74000,Hometown Health,PPO/EPO,,226.80,,,,,,,226.80,244.44,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,outpatient,,,252.00000,93.74000,Hometown Health,PPO/EPO,,226.80,,,,,,,65.52,244.44,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,inpatient,,,282.00000,104.90000,Hometown Health,PPO/EPO,,253.80,,,,,,,253.80,273.54,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,outpatient,,,282.00000,104.90000,Hometown Health,PPO/EPO,,253.80,,,,,,,73.32,273.54,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,inpatient,,,404.00000,150.29000,Hometown Health,PPO/EPO,,363.60,,,,,,,363.60,391.88,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,outpatient,,,404.00000,150.29000,Hometown Health,PPO/EPO,,363.60,,,,,,,105.04,391.88,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,inpatient,,,306.00000,173.85000,Hometown Health,PPO/EPO,,275.40,,,,,,,275.40,296.82,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,outpatient,,,306.00000,173.85000,Hometown Health,PPO/EPO,,275.40,,,,,,,79.56,296.82,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,inpatient,,,158.00000,89.77000,Hometown Health,PPO/EPO,,142.20,,,,,,,142.20,153.26,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,outpatient,,,158.00000,89.77000,Hometown Health,PPO/EPO,,142.20,,,,,,,41.08,153.26,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,inpatient,,,147.00000,89.38000,Hometown Health,PPO/EPO,GP,132.30,,,,,,,132.30,142.59,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Hometown Health,PPO/EPO,GP,132.30,,,,,,,38.22,142.59,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,inpatient,,,270.00000,164.16000,Hometown Health,PPO/EPO,GP,243.00,,,,,,,243.00,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Hometown Health,PPO/EPO,GP,243.00,,,,,,,70.20,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,inpatient,,,84.00000,51.07000,Hometown Health,PPO/EPO,GP,75.60,,,,,,,75.60,81.48,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Hometown Health,PPO/EPO,GP,75.60,,,,,,,21.84,81.48,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,inpatient,,,86.00000,52.29000,Hometown Health,PPO/EPO,GP,77.40,,,,,,,77.40,83.42,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Hometown Health,PPO/EPO,GP,77.40,,,,,,,22.36,83.42,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,inpatient,,,82.00000,49.86000,Hometown Health,PPO/EPO,GP,73.80,,,,,,,73.80,79.54,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Hometown Health,PPO/EPO,GP,73.80,,,,,,,21.32,79.54,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,inpatient,,,85.00000,51.68000,Hometown Health,PPO/EPO,GP,76.50,,,,,,,76.50,82.45,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Hometown Health,PPO/EPO,GP,76.50,,,,,,,22.10,82.45,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,inpatient,,,43.00000,26.14000,Hometown Health,PPO/EPO,GP,38.70,,,,,,,38.70,41.71,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Hometown Health,PPO/EPO,GP,38.70,,,,,,,11.18,41.71,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,inpatient,,,41.00000,24.93000,Hometown Health,PPO/EPO,GP,36.90,,,,,,,36.90,39.77,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Hometown Health,PPO/EPO,GP,36.90,,,,,,,10.66,39.77,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,inpatient,,,79.00000,48.03000,Hometown Health,PPO/EPO,GP,71.10,,,,,,,71.10,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Hometown Health,PPO/EPO,GP,71.10,,,,,,,20.54,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Hometown Health,PPO/EPO,GP,66.60,,,,,,,66.60,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Hometown Health,PPO/EPO,GP,66.60,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Hometown Health,PPO/EPO,GP,66.60,,,,,,,66.60,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Hometown Health,PPO/EPO,GP,66.60,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,inpatient,,,34.00000,20.67000,Hometown Health,PPO/EPO,GP,30.60,,,,,,,30.60,32.98,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Hometown Health,PPO/EPO,GP,30.60,,,,,,,8.84,32.98,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,inpatient,,,65.00000,39.52000,Hometown Health,PPO/EPO,GP,58.50,,,,,,,58.50,63.05,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Hometown Health,PPO/EPO,GP,58.50,,,,,,,16.90,63.05,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,inpatient,,,113.00000,68.70000,Hometown Health,PPO/EPO,,101.70,,,,,,,101.70,109.61,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,outpatient,,,113.00000,68.70000,Hometown Health,PPO/EPO,,101.70,,,,,,,29.38,109.61,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,inpatient,,,80.00000,48.64000,Hometown Health,PPO/EPO,GP,72.00,,,,,,,72.00,77.60,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Hometown Health,PPO/EPO,GP,72.00,,,,,,,20.80,77.60,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,inpatient,,,84.00000,51.07000,Hometown Health,PPO/EPO,GP,75.60,,,,,,,75.60,81.48,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Hometown Health,PPO/EPO,GP,75.60,,,,,,,21.84,81.48,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,inpatient,,,73.00000,44.38000,Hometown Health,PPO/EPO,GP,65.70,,,,,,,65.70,70.81,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Hometown Health,PPO/EPO,GP,65.70,,,,,,,18.98,70.81,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,inpatient,,,100.00000,60.80000,Hometown Health,PPO/EPO,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,outpatient,,,100.00000,60.80000,Hometown Health,PPO/EPO,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,inpatient,,,167.00000,101.54000,Hometown Health,PPO/EPO,GP,150.30,,,,,,,150.30,161.99,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,outpatient,,,167.00000,101.54000,Hometown Health,PPO/EPO,GP,150.30,,,,,,,43.42,161.99,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,inpatient,,,413.00000,251.10000,Hometown Health,PPO/EPO,"50,GP",371.70,,,,,,,371.70,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Hometown Health,PPO/EPO,"50,GP",371.70,,,,,,,107.38,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Hometown Health,PPO/EPO,"LT,GP",247.50,,,,,,,247.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Hometown Health,PPO/EPO,"LT,GP",247.50,,,,,,,71.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Hometown Health,PPO/EPO,"RT,GP",247.50,,,,,,,247.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Hometown Health,PPO/EPO,"RT,GP",247.50,,,,,,,71.50,266.75,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,inpatient,,,95.00000,57.76000,Hometown Health,PPO/EPO,GP,85.50,,,,,,,85.50,92.15,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Hometown Health,PPO/EPO,GP,85.50,,,,,,,24.70,92.15,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,inpatient,,,146.00000,88.77000,Hometown Health,PPO/EPO,GP,131.40,,,,,,,131.40,141.62,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Hometown Health,PPO/EPO,GP,131.40,,,,,,,37.96,141.62,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,inpatient,,,139.00000,84.51000,Hometown Health,PPO/EPO,GP,125.10,,,,,,,125.10,134.83,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Hometown Health,PPO/EPO,GP,125.10,,,,,,,36.14,134.83,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,inpatient,,,75.00000,45.60000,Hometown Health,PPO/EPO,GP,67.50,,,,,,,67.50,72.75,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Hometown Health,PPO/EPO,GP,67.50,,,,,,,19.50,72.75,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,inpatient,,,154.00000,93.63000,Hometown Health,PPO/EPO,GP,138.60,,,,,,,138.60,149.38,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Hometown Health,PPO/EPO,GP,138.60,,,,,,,40.04,149.38,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,inpatient,,,73.00000,44.38000,Hometown Health,PPO/EPO,GP,65.70,,,,,,,65.70,70.81,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Hometown Health,PPO/EPO,GP,65.70,,,,,,,18.98,70.81,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,inpatient,,,160.00000,97.28000,Hometown Health,PPO/EPO,GP,144.00,,,,,,,144.00,155.20,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Hometown Health,PPO/EPO,GP,144.00,,,,,,,41.60,155.20,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,inpatient,,,325.00000,197.60000,Hometown Health,PPO/EPO,GP,292.50,,,,,,,292.50,315.25,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Hometown Health,PPO/EPO,GP,292.50,,,,,,,84.50,315.25,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,inpatient,,,98.00000,59.58000,Hometown Health,PPO/EPO,GP,88.20,,,,,,,88.20,95.06,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,outpatient,,,98.00000,59.58000,Hometown Health,PPO/EPO,GP,88.20,,,,,,,25.48,95.06,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,inpatient,,,303.00000,184.22000,Hometown Health,PPO/EPO,GP,272.70,,,,,,,272.70,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,outpatient,,,303.00000,184.22000,Hometown Health,PPO/EPO,GP,272.70,,,,,,,78.78,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,inpatient,,,115.00000,69.92000,Hometown Health,PPO/EPO,GP,103.50,,,,,,,103.50,111.55,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,outpatient,,,115.00000,69.92000,Hometown Health,PPO/EPO,GP,103.50,,,,,,,29.90,111.55,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,inpatient,,,74.00000,44.99000,Hometown Health,PPO/EPO,GP,66.60,,,,,,,66.60,71.78,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Hometown Health,PPO/EPO,GP,66.60,,,,,,,19.24,71.78,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,inpatient,,,79.00000,48.03000,Hometown Health,PPO/EPO,GP,71.10,,,,,,,71.10,76.63,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Hometown Health,PPO/EPO,GP,71.10,,,,,,,20.54,76.63,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,inpatient,,,72.00000,43.78000,Hometown Health,PPO/EPO,GP,64.80,,,,,,,64.80,69.84,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Hometown Health,PPO/EPO,GP,64.80,,,,,,,18.72,69.84,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,inpatient,,,147.00000,89.38000,Hometown Health,PPO/EPO,GP,132.30,,,,,,,132.30,142.59,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Hometown Health,PPO/EPO,GP,132.30,,,,,,,38.22,142.59,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,inpatient,,,270.00000,164.16000,Hometown Health,PPO/EPO,GP,243.00,,,,,,,243.00,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Hometown Health,PPO/EPO,GP,243.00,,,,,,,70.20,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,inpatient,,,84.00000,51.07000,Hometown Health,PPO/EPO,GP,75.60,,,,,,,75.60,81.48,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Hometown Health,PPO/EPO,GP,75.60,,,,,,,21.84,81.48,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,inpatient,,,86.00000,52.29000,Hometown Health,PPO/EPO,GP,77.40,,,,,,,77.40,83.42,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Hometown Health,PPO/EPO,GP,77.40,,,,,,,22.36,83.42,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,inpatient,,,82.00000,49.86000,Hometown Health,PPO/EPO,GP,73.80,,,,,,,73.80,79.54,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Hometown Health,PPO/EPO,GP,73.80,,,,,,,21.32,79.54,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,inpatient,,,85.00000,51.68000,Hometown Health,PPO/EPO,GP,76.50,,,,,,,76.50,82.45,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Hometown Health,PPO/EPO,GP,76.50,,,,,,,22.10,82.45,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,inpatient,,,43.00000,26.14000,Hometown Health,PPO/EPO,GP,38.70,,,,,,,38.70,41.71,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Hometown Health,PPO/EPO,GP,38.70,,,,,,,11.18,41.71,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,inpatient,,,41.00000,24.93000,Hometown Health,PPO/EPO,GP,36.90,,,,,,,36.90,39.77,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Hometown Health,PPO/EPO,GP,36.90,,,,,,,10.66,39.77,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,inpatient,,,79.00000,48.03000,Hometown Health,PPO/EPO,GP,71.10,,,,,,,71.10,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Hometown Health,PPO/EPO,GP,71.10,,,,,,,20.54,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Hometown Health,PPO/EPO,"CQ,GP",66.60,,,,,,,66.60,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Hometown Health,PPO/EPO,"CQ,GP",66.60,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Hometown Health,PPO/EPO,"CQ,GP",66.60,,,,,,,66.60,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Hometown Health,PPO/EPO,"CQ,GP",66.60,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,inpatient,,,34.00000,20.67000,Hometown Health,PPO/EPO,GP,30.60,,,,,,,30.60,32.98,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Hometown Health,PPO/EPO,GP,30.60,,,,,,,8.84,32.98,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,inpatient,,,65.00000,39.52000,Hometown Health,PPO/EPO,GP,58.50,,,,,,,58.50,63.05,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Hometown Health,PPO/EPO,GP,58.50,,,,,,,16.90,63.05,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,inpatient,,,80.00000,48.64000,Hometown Health,PPO/EPO,GP,72.00,,,,,,,72.00,77.60,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Hometown Health,PPO/EPO,GP,72.00,,,,,,,20.80,77.60,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,inpatient,,,84.00000,51.07000,Hometown Health,PPO/EPO,GP,75.60,,,,,,,75.60,81.48,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Hometown Health,PPO/EPO,GP,75.60,,,,,,,21.84,81.48,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,inpatient,,,73.00000,44.38000,Hometown Health,PPO/EPO,GP,65.70,,,,,,,65.70,70.81,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Hometown Health,PPO/EPO,GP,65.70,,,,,,,18.98,70.81,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,inpatient,,,413.00000,251.10000,Hometown Health,PPO/EPO,"GP,50",371.70,,,,,,,371.70,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Hometown Health,PPO/EPO,"GP,50",371.70,,,,,,,107.38,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Hometown Health,PPO/EPO,"GP,LT",247.50,,,,,,,247.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Hometown Health,PPO/EPO,"GP,LT",247.50,,,,,,,71.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Hometown Health,PPO/EPO,"GP,RT",247.50,,,,,,,247.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Hometown Health,PPO/EPO,"GP,RT",247.50,,,,,,,71.50,266.75,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,inpatient,,,95.00000,57.76000,Hometown Health,PPO/EPO,GP,85.50,,,,,,,85.50,92.15,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Hometown Health,PPO/EPO,GP,85.50,,,,,,,24.70,92.15,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,inpatient,,,146.00000,88.77000,Hometown Health,PPO/EPO,GP,131.40,,,,,,,131.40,141.62,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Hometown Health,PPO/EPO,GP,131.40,,,,,,,37.96,141.62,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,inpatient,,,139.00000,84.51000,Hometown Health,PPO/EPO,GP,125.10,,,,,,,125.10,134.83,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Hometown Health,PPO/EPO,GP,125.10,,,,,,,36.14,134.83,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,inpatient,,,75.00000,45.60000,Hometown Health,PPO/EPO,GP,67.50,,,,,,,67.50,72.75,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Hometown Health,PPO/EPO,GP,67.50,,,,,,,19.50,72.75,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,inpatient,,,154.00000,93.63000,Hometown Health,PPO/EPO,GP,138.60,,,,,,,138.60,149.38,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Hometown Health,PPO/EPO,GP,138.60,,,,,,,40.04,149.38,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,inpatient,,,73.00000,44.38000,Hometown Health,PPO/EPO,GP,65.70,,,,,,,65.70,70.81,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Hometown Health,PPO/EPO,GP,65.70,,,,,,,18.98,70.81,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,inpatient,,,160.00000,97.28000,Hometown Health,PPO/EPO,GP,144.00,,,,,,,144.00,155.20,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Hometown Health,PPO/EPO,GP,144.00,,,,,,,41.60,155.20,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,inpatient,,,325.00000,197.60000,Hometown Health,PPO/EPO,GP,292.50,,,,,,,292.50,315.25,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Hometown Health,PPO/EPO,GP,292.50,,,,,,,84.50,315.25,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,inpatient,,,74.00000,44.99000,Hometown Health,PPO/EPO,GP,66.60,,,,,,,66.60,71.78,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Hometown Health,PPO/EPO,GP,66.60,,,,,,,19.24,71.78,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,inpatient,,,79.00000,48.03000,Hometown Health,PPO/EPO,GP,71.10,,,,,,,71.10,76.63,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Hometown Health,PPO/EPO,GP,71.10,,,,,,,20.54,76.63,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,inpatient,,,72.00000,43.78000,Hometown Health,PPO/EPO,GP,64.80,,,,,,,64.80,69.84,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Hometown Health,PPO/EPO,GP,64.80,,,,,,,18.72,69.84,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,inpatient,,,445.00000,262.55000,Hometown Health,PPO/EPO,GP,400.50,,,,,,,400.50,431.65,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,outpatient,,,445.00000,262.55000,Hometown Health,PPO/EPO,GP,400.50,,,,,,,115.70,431.65,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,inpatient,,,310.00000,182.90000,Hometown Health,PPO/EPO,GP,279.00,,,,,,,279.00,300.70,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,outpatient,,,310.00000,182.90000,Hometown Health,PPO/EPO,GP,279.00,,,,,,,80.60,300.70,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,inpatient,,,393.00000,231.87000,Hometown Health,PPO/EPO,GP,353.70,,,,,,,353.70,381.21,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,outpatient,,,393.00000,231.87000,Hometown Health,PPO/EPO,GP,353.70,,,,,,,102.18,381.21,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,inpatient,,,310.00000,182.90000,Hometown Health,PPO/EPO,GP,279.00,,,,,,,279.00,300.70,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,outpatient,,,310.00000,182.90000,Hometown Health,PPO/EPO,GP,279.00,,,,,,,80.60,300.70,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,inpatient,,,80.00000,30.96000,Hometown Health,PPO/EPO,GO,72.00,,,,,,,72.00,77.60,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Hometown Health,PPO/EPO,GO,72.00,,,,,,,20.80,77.60,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,inpatient,,,84.00000,32.51000,Hometown Health,PPO/EPO,GO,75.60,,,,,,,75.60,81.48,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Hometown Health,PPO/EPO,GO,75.60,,,,,,,21.84,81.48,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,inpatient,,,126.00000,48.76000,Hometown Health,PPO/EPO,GO,113.40,,,,,,,113.40,122.22,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Hometown Health,PPO/EPO,GO,113.40,,,,,,,32.76,122.22,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,inpatient,,,66.00000,25.54000,Hometown Health,PPO/EPO,GO,59.40,,,,,,,59.40,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Hometown Health,PPO/EPO,GO,59.40,,,,,,,17.16,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,inpatient,,,62.00000,23.99000,Hometown Health,PPO/EPO,GO,55.80,,,,,,,55.80,60.14,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Hometown Health,PPO/EPO,GO,55.80,,,,,,,16.12,60.14,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,inpatient,,,90.00000,34.83000,Hometown Health,PPO/EPO,GO,81.00,,,,,,,81.00,87.30,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Hometown Health,PPO/EPO,GO,81.00,,,,,,,23.40,87.30,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,inpatient,,,95.00000,36.76000,Hometown Health,PPO/EPO,GO,85.50,,,,,,,85.50,92.15,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Hometown Health,PPO/EPO,GO,85.50,,,,,,,24.70,92.15,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,inpatient,,,146.00000,56.50000,Hometown Health,PPO/EPO,GO,131.40,,,,,,,131.40,141.62,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Hometown Health,PPO/EPO,GO,131.40,,,,,,,37.96,141.62,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,inpatient,,,139.00000,53.79000,Hometown Health,PPO/EPO,GO,125.10,,,,,,,125.10,134.83,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Hometown Health,PPO/EPO,GO,125.10,,,,,,,36.14,134.83,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,inpatient,,,75.00000,29.02000,Hometown Health,PPO/EPO,GO,67.50,,,,,,,67.50,72.75,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Hometown Health,PPO/EPO,GO,67.50,,,,,,,19.50,72.75,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,inpatient,,,154.00000,59.60000,Hometown Health,PPO/EPO,GO,138.60,,,,,,,138.60,149.38,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Hometown Health,PPO/EPO,GO,138.60,,,,,,,40.04,149.38,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,inpatient,,,73.00000,28.25000,Hometown Health,PPO/EPO,GO,65.70,,,,,,,65.70,70.81,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Hometown Health,PPO/EPO,GO,65.70,,,,,,,18.98,70.81,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,inpatient,,,160.00000,61.92000,Hometown Health,PPO/EPO,GO,144.00,,,,,,,144.00,155.20,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Hometown Health,PPO/EPO,GO,144.00,,,,,,,41.60,155.20,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,inpatient,,,98.00000,37.93000,Hometown Health,PPO/EPO,GO,88.20,,,,,,,88.20,95.06,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,outpatient,,,98.00000,37.93000,Hometown Health,PPO/EPO,GO,88.20,,,,,,,25.48,95.06,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,inpatient,,,303.00000,117.26000,Hometown Health,PPO/EPO,GO,272.70,,,,,,,272.70,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,outpatient,,,303.00000,117.26000,Hometown Health,PPO/EPO,GO,272.70,,,,,,,78.78,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,inpatient,,,115.00000,44.50000,Hometown Health,PPO/EPO,GO,103.50,,,,,,,103.50,111.55,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,outpatient,,,115.00000,44.50000,Hometown Health,PPO/EPO,GO,103.50,,,,,,,29.90,111.55,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,inpatient,,,74.00000,28.64000,Hometown Health,PPO/EPO,GO,66.60,,,,,,,66.60,71.78,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Hometown Health,PPO/EPO,GO,66.60,,,,,,,19.24,71.78,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,inpatient,,,72.00000,27.86000,Hometown Health,PPO/EPO,GO,64.80,,,,,,,64.80,69.84,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Hometown Health,PPO/EPO,GO,64.80,,,,,,,18.72,69.84,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,inpatient,,,80.00000,30.96000,Hometown Health,PPO/EPO,"CO,GO",72.00,,,,,,,72.00,77.60,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Hometown Health,PPO/EPO,"CO,GO",72.00,,,,,,,20.80,77.60,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,inpatient,,,84.00000,32.51000,Hometown Health,PPO/EPO,"CO,GO",75.60,,,,,,,75.60,81.48,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Hometown Health,PPO/EPO,"CO,GO",75.60,,,,,,,21.84,81.48,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,inpatient,,,126.00000,48.76000,Hometown Health,PPO/EPO,"CO,GO",113.40,,,,,,,113.40,122.22,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Hometown Health,PPO/EPO,"CO,GO",113.40,,,,,,,32.76,122.22,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,inpatient,,,62.00000,23.99000,Hometown Health,PPO/EPO,"CO,GO",55.80,,,,,,,55.80,60.14,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Hometown Health,PPO/EPO,"CO,GO",55.80,,,,,,,16.12,60.14,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,inpatient,,,66.00000,25.54000,Hometown Health,PPO/EPO,"CO,GO",59.40,,,,,,,59.40,64.02,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Hometown Health,PPO/EPO,"CO,GO",59.40,,,,,,,17.16,64.02,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,inpatient,,,90.00000,34.83000,Hometown Health,PPO/EPO,"CO,GO",81.00,,,,,,,81.00,87.30,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Hometown Health,PPO/EPO,"CO,GO",81.00,,,,,,,23.40,87.30,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,inpatient,,,95.00000,36.76000,Hometown Health,PPO/EPO,"CO,GO",85.50,,,,,,,85.50,92.15,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Hometown Health,PPO/EPO,"CO,GO",85.50,,,,,,,24.70,92.15,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,inpatient,,,146.00000,56.50000,Hometown Health,PPO/EPO,"CO,GO",131.40,,,,,,,131.40,141.62,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Hometown Health,PPO/EPO,"CO,GO",131.40,,,,,,,37.96,141.62,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,inpatient,,,139.00000,53.79000,Hometown Health,PPO/EPO,"CO,GO",125.10,,,,,,,125.10,134.83,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Hometown Health,PPO/EPO,"CO,GO",125.10,,,,,,,36.14,134.83,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,inpatient,,,75.00000,29.02000,Hometown Health,PPO/EPO,"CO,GO",67.50,,,,,,,67.50,72.75,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Hometown Health,PPO/EPO,"CO,GO",67.50,,,,,,,19.50,72.75,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,inpatient,,,154.00000,59.60000,Hometown Health,PPO/EPO,"CO,GO",138.60,,,,,,,138.60,149.38,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Hometown Health,PPO/EPO,"CO,GO",138.60,,,,,,,40.04,149.38,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,inpatient,,,73.00000,28.25000,Hometown Health,PPO/EPO,"CO,GO",65.70,,,,,,,65.70,70.81,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Hometown Health,PPO/EPO,"CO,GO",65.70,,,,,,,18.98,70.81,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,inpatient,,,160.00000,61.92000,Hometown Health,PPO/EPO,"CO,GO",144.00,,,,,,,144.00,155.20,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Hometown Health,PPO/EPO,"CO,GO",144.00,,,,,,,41.60,155.20,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,inpatient,,,74.00000,28.64000,Hometown Health,PPO/EPO,"CO,GO",66.60,,,,,,,66.60,71.78,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Hometown Health,PPO/EPO,"CO,GO",66.60,,,,,,,19.24,71.78,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,inpatient,,,72.00000,27.86000,Hometown Health,PPO/EPO,"CO,GO",64.80,,,,,,,64.80,69.84,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Hometown Health,PPO/EPO,"CO,GO",64.80,,,,,,,18.72,69.84,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,inpatient,,,47.00000,26.70000,Hometown Health,PPO/EPO,GO,42.30,,,,,,,42.30,45.59,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Hometown Health,PPO/EPO,GO,42.30,,,,,,,12.22,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,inpatient,,,47.00000,26.70000,Hometown Health,PPO/EPO,"CO,GO",42.30,,,,,,,42.30,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Hometown Health,PPO/EPO,"CO,GO",42.30,,,,,,,12.22,45.59,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,inpatient,,,250.00000,142.04000,Hometown Health,PPO/EPO,GO,225.00,,,,,,,225.00,242.50,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,outpatient,,,250.00000,142.04000,Hometown Health,PPO/EPO,GO,225.00,,,,,,,65.00,242.50,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,inpatient,,,175.00000,99.43000,Hometown Health,PPO/EPO,GO,157.50,,,,,,,157.50,169.75,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,outpatient,,,175.00000,99.43000,Hometown Health,PPO/EPO,GO,157.50,,,,,,,45.50,169.75,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,inpatient,,,233.00000,132.38000,Hometown Health,PPO/EPO,GO,209.70,,,,,,,209.70,226.01,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,outpatient,,,233.00000,132.38000,Hometown Health,PPO/EPO,GO,209.70,,,,,,,60.58,226.01,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,inpatient,,,175.00000,99.43000,Hometown Health,PPO/EPO,GO,157.50,,,,,,,157.50,169.75,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,outpatient,,,175.00000,99.43000,Hometown Health,PPO/EPO,GO,157.50,,,,,,,45.50,169.75,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,inpatient,,,291.00000,93.99000,Hometown Health,PPO/EPO,,261.90,,,,,,,261.90,282.27,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,outpatient,,,291.00000,93.99000,Hometown Health,PPO/EPO,,261.90,,,,,,,75.66,282.27,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,inpatient,,,273.00000,155.10000,Hometown Health,PPO/EPO,GN,245.70,,,,,,,245.70,264.81,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,outpatient,,,273.00000,155.10000,Hometown Health,PPO/EPO,GN,245.70,,,,,,,70.98,264.81,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,inpatient,,,279.00000,158.51000,Hometown Health,PPO/EPO,GN,251.10,,,,,,,251.10,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,outpatient,,,279.00000,158.51000,Hometown Health,PPO/EPO,GN,251.10,,,,,,,72.54,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,inpatient,,,426.00000,242.03000,Hometown Health,PPO/EPO,GN,383.40,,,,,,,383.40,413.22,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,outpatient,,,426.00000,242.03000,Hometown Health,PPO/EPO,GN,383.40,,,,,,,110.76,413.22,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,inpatient,,,242.00000,137.49000,Hometown Health,PPO/EPO,GN,217.80,,,,,,,217.80,234.74,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,outpatient,,,242.00000,137.49000,Hometown Health,PPO/EPO,GN,217.80,,,,,,,62.92,234.74,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,inpatient,,,128.00000,72.72000,Hometown Health,PPO/EPO,,115.20,,,,,,,115.20,124.16,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,outpatient,,,128.00000,72.72000,Hometown Health,PPO/EPO,,115.20,,,,,,,33.28,124.16,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,inpatient,,,66.00000,37.50000,Hometown Health,PPO/EPO,GN,59.40,,,,,,,59.40,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,outpatient,,,66.00000,37.50000,Hometown Health,PPO/EPO,GN,59.40,,,,,,,17.16,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,inpatient,,,62.00000,35.23000,Hometown Health,PPO/EPO,GN,55.80,,,,,,,55.80,60.14,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,outpatient,,,62.00000,35.23000,Hometown Health,PPO/EPO,GN,55.80,,,,,,,16.12,60.14,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,inpatient,,,269.00000,152.83000,Hometown Health,PPO/EPO,GN,242.10,,,,,,,242.10,260.93,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,outpatient,,,269.00000,152.83000,Hometown Health,PPO/EPO,GN,242.10,,,,,,,69.94,260.93,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,inpatient,,,153.00000,86.93000,Hometown Health,PPO/EPO,GN,137.70,,,,,,,137.70,148.41,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,outpatient,,,153.00000,86.93000,Hometown Health,PPO/EPO,GN,137.70,,,,,,,39.78,148.41,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,inpatient,,,98.00000,55.68000,Hometown Health,PPO/EPO,GN,88.20,,,,,,,88.20,95.06,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,outpatient,,,98.00000,55.68000,Hometown Health,PPO/EPO,GN,88.20,,,,,,,25.48,95.06,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,inpatient,,,303.00000,172.15000,Hometown Health,PPO/EPO,GN,272.70,,,,,,,272.70,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,outpatient,,,303.00000,172.15000,Hometown Health,PPO/EPO,GN,272.70,,,,,,,78.78,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,inpatient,,,115.00000,65.34000,Hometown Health,PPO/EPO,GN,103.50,,,,,,,103.50,111.55,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,outpatient,,,115.00000,65.34000,Hometown Health,PPO/EPO,GN,103.50,,,,,,,29.90,111.55,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,inpatient,,,210.00000,119.31000,Hometown Health,PPO/EPO,GN,189.00,,,,,,,189.00,203.70,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,outpatient,,,210.00000,119.31000,Hometown Health,PPO/EPO,GN,189.00,,,,,,,54.60,203.70,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,inpatient,,,250.00000,142.04000,Hometown Health,PPO/EPO,GN,225.00,,,,,,,225.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,outpatient,,,250.00000,142.04000,Hometown Health,PPO/EPO,GN,225.00,,,,,,,65.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,inpatient,,,78.00000,44.32000,Hometown Health,PPO/EPO,GN,70.20,,,,,,,70.20,75.66,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,outpatient,,,78.00000,44.32000,Hometown Health,PPO/EPO,GN,70.20,,,,,,,20.28,75.66,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,inpatient,,,322.00000,182.94000,Hometown Health,PPO/EPO,GN,289.80,,,,,,,289.80,312.34,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,outpatient,,,322.00000,182.94000,Hometown Health,PPO/EPO,GN,289.80,,,,,,,83.72,312.34,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,inpatient,,,309.00000,175.56000,Hometown Health,PPO/EPO,GN,278.10,,,,,,,278.10,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,outpatient,,,309.00000,175.56000,Hometown Health,PPO/EPO,GN,278.10,,,,,,,80.34,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,inpatient,,,245.00000,139.20000,Hometown Health,PPO/EPO,GN,220.50,,,,,,,220.50,237.65,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,outpatient,,,245.00000,139.20000,Hometown Health,PPO/EPO,GN,220.50,,,,,,,63.70,237.65,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,inpatient,,,313.00000,116.44000,Hometown Health,PPO/EPO,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,outpatient,,,313.00000,116.44000,Hometown Health,PPO/EPO,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,inpatient,,,1250.00000,632.50000,Hometown Health,PPO/EPO,,1125.00,,,,,,,1125.00,1212.50,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,outpatient,,,1250.00000,632.50000,Hometown Health,PPO/EPO,,1125.00,,,,,,,325.00,1212.50,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,inpatient,,,145.00000,75.54000,Hometown Health,PPO/EPO,,130.50,,,,,,,130.50,140.65,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Hometown Health,PPO/EPO,,130.50,,,,,,,37.70,140.65,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,inpatient,,,488.00000,254.25000,Hometown Health,PPO/EPO,,439.20,,,,,,,439.20,473.36,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Hometown Health,PPO/EPO,,439.20,,,,,,,126.88,473.36,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,inpatient,,,684.00000,337.90000,Hometown Health,PPO/EPO,,615.60,,,,,,,615.60,663.48,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,outpatient,,,684.00000,337.90000,Hometown Health,PPO/EPO,,615.60,,,,,,,177.84,663.48,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,inpatient,,,206.00000,101.76000,Hometown Health,PPO/EPO,,185.40,,,,,,,185.40,199.82,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,outpatient,,,206.00000,101.76000,Hometown Health,PPO/EPO,,185.40,,,,,,,53.56,199.82,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,inpatient,,,195.00000,96.33000,Hometown Health,PPO/EPO,,175.50,,,,,,,175.50,189.15,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,outpatient,,,195.00000,96.33000,Hometown Health,PPO/EPO,,175.50,,,,,,,50.70,189.15,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,inpatient,,,375.00000,185.25000,Hometown Health,PPO/EPO,,337.50,,,,,,,337.50,363.75,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,outpatient,,,375.00000,185.25000,Hometown Health,PPO/EPO,,337.50,,,,,,,97.50,363.75,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,inpatient,,,429.00000,211.93000,Hometown Health,PPO/EPO,,386.10,,,,,,,386.10,416.13,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,outpatient,,,429.00000,211.93000,Hometown Health,PPO/EPO,,386.10,,,,,,,111.54,416.13,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22475,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,PPO/EPO,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B OBSTETRICS SEMI-PVT,42473,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Hometown Health,PPO/EPO,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ICU,32474,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Hometown Health,PPO/EPO,,7884.90,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,12476,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Hometown Health,PPO/EPO,,5256.90,,,,,,,2512.00,5665.77,percent of total billed charges,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,84.00000,63.59000,Hometown Health,PPO/EPO,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Hometown Health,PPO/EPO,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Hometown Health,PPO/EPO,,255.60,,,,,,,255.60,275.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Hometown Health,PPO/EPO,,255.60,,,,,,,73.84,275.48,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Hometown Health,PPO/EPO,,412.20,,,,,,,412.20,444.26,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Hometown Health,PPO/EPO,,412.20,,,,,,,119.08,444.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Hometown Health,PPO/EPO,,502.20,,,,,,,502.20,541.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Hometown Health,PPO/EPO,,502.20,,,,,,,145.08,541.26,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Hometown Health,PPO/EPO,,433.80,,,,,,,433.80,467.54,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Hometown Health,PPO/EPO,,433.80,,,,,,,125.32,467.54,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Hometown Health,PPO/EPO,,213.30,,,,,,,213.30,229.89,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Hometown Health,PPO/EPO,,213.30,,,,,,,61.62,229.89,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,inpatient,,,490.00000,329.77000,Hometown Health,PPO/EPO,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,outpatient,,,490.00000,329.77000,Hometown Health,PPO/EPO,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,inpatient,,,490.00000,329.77000,Hometown Health,PPO/EPO,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,outpatient,,,490.00000,329.77000,Hometown Health,PPO/EPO,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,inpatient,,,245.00000,164.89000,Hometown Health,PPO/EPO,,220.50,,,,,,,220.50,237.65,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,outpatient,,,245.00000,164.89000,Hometown Health,PPO/EPO,,220.50,,,,,,,63.70,237.65,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,inpatient,,,490.00000,329.77000,Hometown Health,PPO/EPO,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Hometown Health,PPO/EPO,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Hometown Health,PPO/EPO,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Hometown Health,PPO/EPO,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,inpatient,,,245.00000,164.89000,Hometown Health,PPO/EPO,,220.50,,,,,,,220.50,237.65,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Hometown Health,PPO/EPO,,220.50,,,,,,,63.70,237.65,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Hometown Health,PPO/EPO,,757.80,,,,,,,757.80,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Hometown Health,PPO/EPO,,757.80,,,,,,,218.92,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Hometown Health,PPO/EPO,,947.70,,,,,,,947.70,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Hometown Health,PPO/EPO,,947.70,,,,,,,273.78,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Hometown Health,PPO/EPO,,1136.70,,,,,,,1136.70,1225.11,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Hometown Health,PPO/EPO,,1136.70,,,,,,,328.38,1225.11,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,inpatient,,,2466.00000,986.40000,Hometown Health,PPO/EPO,,2219.40,,,,,,,2219.40,2392.02,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,outpatient,,,2466.00000,986.40000,Hometown Health,PPO/EPO,,2219.40,,,,,,,641.16,2392.02,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,inpatient,,,260.00000,104.00000,Hometown Health,PPO/EPO,,234.00,,,,,,,234.00,252.20,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,outpatient,,,260.00000,104.00000,Hometown Health,PPO/EPO,,234.00,,,,,,,67.60,252.20,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,inpatient,,,2041.00000,816.40000,Hometown Health,PPO/EPO,,1836.90,,,,,,,1836.90,1979.77,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,outpatient,,,2041.00000,816.40000,Hometown Health,PPO/EPO,,1836.90,,,,,,,530.66,1979.77,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,inpatient,,,375.00000,150.00000,Hometown Health,PPO/EPO,,337.50,,,,,,,337.50,363.75,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,outpatient,,,375.00000,150.00000,Hometown Health,PPO/EPO,,337.50,,,,,,,97.50,363.75,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,inpatient,,,1178.00000,471.20000,Hometown Health,PPO/EPO,,1060.20,,,,,,,1060.20,1142.66,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,outpatient,,,1178.00000,471.20000,Hometown Health,PPO/EPO,,1060.20,,,,,,,306.28,1142.66,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,inpatient,,,245.00000,98.00000,Hometown Health,PPO/EPO,,220.50,,,,,,,220.50,237.65,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,outpatient,,,245.00000,98.00000,Hometown Health,PPO/EPO,,220.50,,,,,,,63.70,237.65,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,inpatient,,,280.00000,112.00000,Hometown Health,PPO/EPO,,252.00,,,,,,,252.00,271.60,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,outpatient,,,280.00000,112.00000,Hometown Health,PPO/EPO,,252.00,,,,,,,72.80,271.60,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,inpatient,,,336.00000,134.40000,Hometown Health,PPO/EPO,,302.40,,,,,,,302.40,325.92,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,outpatient,,,336.00000,134.40000,Hometown Health,PPO/EPO,,302.40,,,,,,,87.36,325.92,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,inpatient,,,380.00000,152.00000,Hometown Health,PPO/EPO,,342.00,,,,,,,342.00,368.60,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,outpatient,,,380.00000,152.00000,Hometown Health,PPO/EPO,,342.00,,,,,,,98.80,368.60,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,inpatient,,,530.00000,212.00000,Hometown Health,PPO/EPO,,477.00,,,,,,,477.00,514.10,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Hometown Health,PPO/EPO,,477.00,,,,,,,137.80,514.10,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,inpatient,,,264.00000,105.60000,Hometown Health,PPO/EPO,,237.60,,,,,,,237.60,256.08,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,outpatient,,,264.00000,105.60000,Hometown Health,PPO/EPO,,237.60,,,,,,,68.64,256.08,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,inpatient,,,763.00000,305.20000,Hometown Health,PPO/EPO,,686.70,,,,,,,686.70,740.11,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,outpatient,,,763.00000,305.20000,Hometown Health,PPO/EPO,,686.70,,,,,,,198.38,740.11,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,inpatient,,,672.00000,268.80000,Hometown Health,PPO/EPO,,604.80,,,,,,,604.80,651.84,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,outpatient,,,672.00000,268.80000,Hometown Health,PPO/EPO,,604.80,,,,,,,174.72,651.84,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,inpatient,,,1940.00000,776.00000,Hometown Health,PPO/EPO,,1746.00,,,,,,,1746.00,1881.80,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,outpatient,,,1940.00000,776.00000,Hometown Health,PPO/EPO,,1746.00,,,,,,,504.40,1881.80,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,inpatient,,,3875.00000,1550.00000,Hometown Health,PPO/EPO,,3487.50,,,,,,,3487.50,3758.75,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,outpatient,,,3875.00000,1550.00000,Hometown Health,PPO/EPO,,3487.50,,,,,,,1007.50,3758.75,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,inpatient,,,505.00000,202.00000,Hometown Health,PPO/EPO,,454.50,,,,,,,454.50,489.85,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,outpatient,,,505.00000,202.00000,Hometown Health,PPO/EPO,,454.50,,,,,,,131.30,489.85,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,inpatient,,,295.00000,118.00000,Hometown Health,PPO/EPO,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Hometown Health,PPO/EPO,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,inpatient,,,585.00000,234.00000,Hometown Health,PPO/EPO,,526.50,,,,,,,526.50,567.45,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,outpatient,,,585.00000,234.00000,Hometown Health,PPO/EPO,,526.50,,,,,,,152.10,567.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,inpatient,,,285.00000,114.00000,Hometown Health,PPO/EPO,,256.50,,,,,,,256.50,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,outpatient,,,285.00000,114.00000,Hometown Health,PPO/EPO,,256.50,,,,,,,74.10,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,inpatient,,,575.00000,230.00000,Hometown Health,PPO/EPO,,517.50,,,,,,,517.50,557.75,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,outpatient,,,575.00000,230.00000,Hometown Health,PPO/EPO,,517.50,,,,,,,149.50,557.75,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,inpatient,,,697.00000,278.80000,Hometown Health,PPO/EPO,,627.30,,,,,,,627.30,676.09,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,outpatient,,,697.00000,278.80000,Hometown Health,PPO/EPO,,627.30,,,,,,,181.22,676.09,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,inpatient,,,530.00000,212.00000,Hometown Health,PPO/EPO,,477.00,,,,,,,477.00,514.10,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Hometown Health,PPO/EPO,,477.00,,,,,,,137.80,514.10,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,inpatient,,,580.00000,232.00000,Hometown Health,PPO/EPO,,522.00,,,,,,,522.00,562.60,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,outpatient,,,580.00000,232.00000,Hometown Health,PPO/EPO,,522.00,,,,,,,150.80,562.60,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,inpatient,,,435.00000,174.00000,Hometown Health,PPO/EPO,,391.50,,,,,,,391.50,421.95,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,outpatient,,,435.00000,174.00000,Hometown Health,PPO/EPO,,391.50,,,,,,,113.10,421.95,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,inpatient,,,270.00000,108.00000,Hometown Health,PPO/EPO,,243.00,,,,,,,243.00,261.90,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,outpatient,,,270.00000,108.00000,Hometown Health,PPO/EPO,,243.00,,,,,,,70.20,261.90,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,inpatient,,,504.00000,201.60000,Hometown Health,PPO/EPO,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,outpatient,,,504.00000,201.60000,Hometown Health,PPO/EPO,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,inpatient,,,98.00000,39.20000,Hometown Health,PPO/EPO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,outpatient,,,98.00000,39.20000,Hometown Health,PPO/EPO,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,inpatient,,,608.00000,243.20000,Hometown Health,PPO/EPO,,547.20,,,,,,,547.20,589.76,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,outpatient,,,608.00000,243.20000,Hometown Health,PPO/EPO,,547.20,,,,,,,158.08,589.76,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,inpatient,,,114.00000,45.60000,Hometown Health,PPO/EPO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,outpatient,,,114.00000,45.60000,Hometown Health,PPO/EPO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,inpatient,,,187.00000,74.80000,Hometown Health,PPO/EPO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,outpatient,,,187.00000,74.80000,Hometown Health,PPO/EPO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,inpatient,,,214.00000,85.60000,Hometown Health,PPO/EPO,,192.60,,,,,,,192.60,207.58,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,outpatient,,,214.00000,85.60000,Hometown Health,PPO/EPO,,192.60,,,,,,,55.64,207.58,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,inpatient,,,863.00000,345.20000,Hometown Health,PPO/EPO,,776.70,,,,,,,776.70,837.11,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,outpatient,,,863.00000,345.20000,Hometown Health,PPO/EPO,,776.70,,,,,,,224.38,837.11,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,inpatient,,,453.00000,181.20000,Hometown Health,PPO/EPO,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,outpatient,,,453.00000,181.20000,Hometown Health,PPO/EPO,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,inpatient,,,144.00000,57.60000,Hometown Health,PPO/EPO,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,outpatient,,,144.00000,57.60000,Hometown Health,PPO/EPO,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,inpatient,,,107.00000,42.80000,Hometown Health,PPO/EPO,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,outpatient,,,107.00000,42.80000,Hometown Health,PPO/EPO,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,inpatient,,,403.00000,161.20000,Hometown Health,PPO/EPO,,362.70,,,,,,,362.70,390.91,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,outpatient,,,403.00000,161.20000,Hometown Health,PPO/EPO,,362.70,,,,,,,104.78,390.91,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,inpatient,,,144.00000,57.60000,Hometown Health,PPO/EPO,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,outpatient,,,144.00000,57.60000,Hometown Health,PPO/EPO,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,inpatient,,,370.00000,148.00000,Hometown Health,PPO/EPO,,333.00,,,,,,,333.00,358.90,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,outpatient,,,370.00000,148.00000,Hometown Health,PPO/EPO,,333.00,,,,,,,96.20,358.90,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,inpatient,,,334.00000,133.60000,Hometown Health,PPO/EPO,,300.60,,,,,,,300.60,323.98,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,outpatient,,,334.00000,133.60000,Hometown Health,PPO/EPO,,300.60,,,,,,,86.84,323.98,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,inpatient,,,1188.00000,475.20000,Hometown Health,PPO/EPO,50,1069.20,,,,,,,1069.20,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,outpatient,,,1188.00000,475.20000,Hometown Health,PPO/EPO,50,1069.20,,,,,,,308.88,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,inpatient,,,792.00000,316.80000,Hometown Health,PPO/EPO,LT,712.80,,,,,,,712.80,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Hometown Health,PPO/EPO,LT,712.80,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,inpatient,,,792.00000,316.80000,Hometown Health,PPO/EPO,RT,712.80,,,,,,,712.80,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Hometown Health,PPO/EPO,RT,712.80,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,inpatient,,,572.00000,228.80000,Hometown Health,PPO/EPO,50,514.80,,,,,,,514.80,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,outpatient,,,572.00000,228.80000,Hometown Health,PPO/EPO,50,514.80,,,,,,,148.72,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,inpatient,,,381.00000,152.40000,Hometown Health,PPO/EPO,LT,342.90,,,,,,,342.90,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Hometown Health,PPO/EPO,LT,342.90,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,inpatient,,,381.00000,152.40000,Hometown Health,PPO/EPO,RT,342.90,,,,,,,342.90,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Hometown Health,PPO/EPO,RT,342.90,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,inpatient,,,683.00000,273.20000,Hometown Health,PPO/EPO,50,614.70,,,,,,,614.70,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,outpatient,,,683.00000,273.20000,Hometown Health,PPO/EPO,50,614.70,,,,,,,177.58,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,inpatient,,,455.00000,182.00000,Hometown Health,PPO/EPO,LT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Hometown Health,PPO/EPO,LT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,inpatient,,,455.00000,182.00000,Hometown Health,PPO/EPO,RT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Hometown Health,PPO/EPO,RT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,inpatient,,,357.00000,142.80000,Hometown Health,PPO/EPO,,321.30,,,,,,,321.30,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,outpatient,,,357.00000,142.80000,Hometown Health,PPO/EPO,,321.30,,,,,,,92.82,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,inpatient,,,334.00000,133.60000,Hometown Health,PPO/EPO,,300.60,,,,,,,300.60,323.98,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,outpatient,,,334.00000,133.60000,Hometown Health,PPO/EPO,,300.60,,,,,,,86.84,323.98,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,inpatient,,,194.00000,77.60000,Hometown Health,PPO/EPO,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,outpatient,,,194.00000,77.60000,Hometown Health,PPO/EPO,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,inpatient,,,608.00000,243.20000,Hometown Health,PPO/EPO,,547.20,,,,,,,547.20,589.76,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,outpatient,,,608.00000,243.20000,Hometown Health,PPO/EPO,,547.20,,,,,,,158.08,589.76,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,inpatient,,,257.00000,102.80000,Hometown Health,PPO/EPO,,231.30,,,,,,,231.30,249.29,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,outpatient,,,257.00000,102.80000,Hometown Health,PPO/EPO,,231.30,,,,,,,66.82,249.29,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,inpatient,,,343.00000,137.20000,Hometown Health,PPO/EPO,,308.70,,,,,,,308.70,332.71,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,outpatient,,,343.00000,137.20000,Hometown Health,PPO/EPO,,308.70,,,,,,,89.18,332.71,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,inpatient,,,457.00000,182.80000,Hometown Health,PPO/EPO,,411.30,,,,,,,411.30,443.29,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,outpatient,,,457.00000,182.80000,Hometown Health,PPO/EPO,,411.30,,,,,,,118.82,443.29,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,inpatient,,,630.00000,252.00000,Hometown Health,PPO/EPO,,567.00,,,,,,,567.00,611.10,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,outpatient,,,630.00000,252.00000,Hometown Health,PPO/EPO,,567.00,,,,,,,163.80,611.10,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,inpatient,,,623.00000,249.20000,Hometown Health,PPO/EPO,,560.70,,,,,,,560.70,604.31,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,outpatient,,,623.00000,249.20000,Hometown Health,PPO/EPO,,560.70,,,,,,,161.98,604.31,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,inpatient,,,1457.00000,582.80000,Hometown Health,PPO/EPO,,1311.30,,,,,,,1311.30,1413.29,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,outpatient,,,1457.00000,582.80000,Hometown Health,PPO/EPO,,1311.30,,,,,,,378.82,1413.29,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,inpatient,,,890.00000,356.00000,Hometown Health,PPO/EPO,,801.00,,,,,,,801.00,863.30,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,outpatient,,,890.00000,356.00000,Hometown Health,PPO/EPO,,801.00,,,,,,,231.40,863.30,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,inpatient,,,532.00000,212.80000,Hometown Health,PPO/EPO,,478.80,,,,,,,478.80,516.04,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,outpatient,,,532.00000,212.80000,Hometown Health,PPO/EPO,,478.80,,,,,,,138.32,516.04,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,inpatient,,,492.00000,196.80000,Hometown Health,PPO/EPO,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,outpatient,,,492.00000,196.80000,Hometown Health,PPO/EPO,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,inpatient,,,550.00000,220.00000,Hometown Health,PPO/EPO,,495.00,,,,,,,495.00,533.50,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,outpatient,,,550.00000,220.00000,Hometown Health,PPO/EPO,,495.00,,,,,,,143.00,533.50,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,inpatient,,,305.00000,122.00000,Hometown Health,PPO/EPO,,274.50,,,,,,,274.50,295.85,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,outpatient,,,305.00000,122.00000,Hometown Health,PPO/EPO,,274.50,,,,,,,79.30,295.85,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,inpatient,,,220.00000,88.00000,Hometown Health,PPO/EPO,,198.00,,,,,,,198.00,213.40,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,outpatient,,,220.00000,88.00000,Hometown Health,PPO/EPO,,198.00,,,,,,,57.20,213.40,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,inpatient,,,780.00000,312.00000,Hometown Health,PPO/EPO,,702.00,,,,,,,702.00,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,outpatient,,,780.00000,312.00000,Hometown Health,PPO/EPO,,702.00,,,,,,,202.80,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,inpatient,,,1165.00000,466.00000,Hometown Health,PPO/EPO,,1048.50,,,,,,,1048.50,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,outpatient,,,1165.00000,466.00000,Hometown Health,PPO/EPO,,1048.50,,,,,,,302.90,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,inpatient,,,2350.00000,940.00000,Hometown Health,PPO/EPO,,2115.00,,,,,,,2115.00,2279.50,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,outpatient,,,2350.00000,940.00000,Hometown Health,PPO/EPO,,2115.00,,,,,,,611.00,2279.50,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,inpatient,,,896.00000,358.40000,Hometown Health,PPO/EPO,,806.40,,,,,,,806.40,869.12,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,outpatient,,,896.00000,358.40000,Hometown Health,PPO/EPO,,806.40,,,,,,,232.96,869.12,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,inpatient,,,385.00000,154.00000,Hometown Health,PPO/EPO,,346.50,,,,,,,346.50,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,outpatient,,,385.00000,154.00000,Hometown Health,PPO/EPO,,346.50,,,,,,,100.10,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,inpatient,,,470.00000,188.00000,Hometown Health,PPO/EPO,,423.00,,,,,,,423.00,455.90,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,outpatient,,,470.00000,188.00000,Hometown Health,PPO/EPO,,423.00,,,,,,,122.20,455.90,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,inpatient,,,150.00000,60.00000,Hometown Health,PPO/EPO,,135.00,,,,,,,135.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,outpatient,,,150.00000,60.00000,Hometown Health,PPO/EPO,,135.00,,,,,,,39.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,inpatient,,,100.00000,40.00000,Hometown Health,PPO/EPO,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,outpatient,,,100.00000,40.00000,Hometown Health,PPO/EPO,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,inpatient,,,143.00000,57.20000,Hometown Health,PPO/EPO,,128.70,,,,,,,128.70,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,outpatient,,,143.00000,57.20000,Hometown Health,PPO/EPO,,128.70,,,,,,,37.18,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,inpatient,,,95.00000,38.00000,Hometown Health,PPO/EPO,,85.50,,,,,,,85.50,92.15,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,outpatient,,,95.00000,38.00000,Hometown Health,PPO/EPO,,85.50,,,,,,,24.70,92.15,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,inpatient,,,269.00000,107.60000,Hometown Health,PPO/EPO,,242.10,,,,,,,242.10,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,outpatient,,,269.00000,107.60000,Hometown Health,PPO/EPO,,242.10,,,,,,,69.94,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,inpatient,,,388.00000,155.20000,Hometown Health,PPO/EPO,,349.20,,,,,,,349.20,376.36,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,outpatient,,,388.00000,155.20000,Hometown Health,PPO/EPO,,349.20,,,,,,,100.88,376.36,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,inpatient,,,344.00000,137.60000,Hometown Health,PPO/EPO,,309.60,,,,,,,309.60,333.68,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,outpatient,,,344.00000,137.60000,Hometown Health,PPO/EPO,,309.60,,,,,,,89.44,333.68,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,inpatient,,,321.00000,128.40000,Hometown Health,PPO/EPO,,288.90,,,,,,,288.90,311.37,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,outpatient,,,321.00000,128.40000,Hometown Health,PPO/EPO,,288.90,,,,,,,83.46,311.37,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,inpatient,,,155.00000,62.00000,Hometown Health,PPO/EPO,,139.50,,,,,,,139.50,150.35,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,outpatient,,,155.00000,62.00000,Hometown Health,PPO/EPO,,139.50,,,,,,,40.30,150.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,inpatient,,,817.00000,326.80000,Hometown Health,PPO/EPO,,735.30,,,,,,,735.30,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,outpatient,,,817.00000,326.80000,Hometown Health,PPO/EPO,,735.30,,,,,,,212.42,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,inpatient,,,1255.00000,502.00000,Hometown Health,PPO/EPO,,1129.50,,,,,,,1129.50,1217.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,outpatient,,,1255.00000,502.00000,Hometown Health,PPO/EPO,,1129.50,,,,,,,326.30,1217.35,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,inpatient,,,391.00000,156.40000,Hometown Health,PPO/EPO,,351.90,,,,,,,351.90,379.27,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,outpatient,,,391.00000,156.40000,Hometown Health,PPO/EPO,,351.90,,,,,,,101.66,379.27,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,inpatient,,,671.00000,268.40000,Hometown Health,PPO/EPO,,603.90,,,,,,,603.90,650.87,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,outpatient,,,671.00000,268.40000,Hometown Health,PPO/EPO,,603.90,,,,,,,174.46,650.87,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,inpatient,,,456.00000,182.40000,Hometown Health,PPO/EPO,,410.40,,,,,,,410.40,442.32,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,outpatient,,,456.00000,182.40000,Hometown Health,PPO/EPO,,410.40,,,,,,,118.56,442.32,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,inpatient,,,112.00000,44.80000,Hometown Health,PPO/EPO,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,outpatient,,,112.00000,44.80000,Hometown Health,PPO/EPO,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,inpatient,,,84.00000,33.60000,Hometown Health,PPO/EPO,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,outpatient,,,84.00000,33.60000,Hometown Health,PPO/EPO,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,inpatient,,,216.00000,86.40000,Hometown Health,PPO/EPO,,194.40,,,,,,,194.40,209.52,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,outpatient,,,216.00000,86.40000,Hometown Health,PPO/EPO,,194.40,,,,,,,56.16,209.52,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,inpatient,,,2660.00000,1064.00000,Hometown Health,PPO/EPO,,2394.00,,,,,,,2394.00,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,outpatient,,,2660.00000,1064.00000,Hometown Health,PPO/EPO,,2394.00,,,,,,,691.60,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,inpatient,,,2960.00000,1184.00000,Hometown Health,PPO/EPO,,2664.00,,,,,,,2664.00,2871.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,outpatient,,,2960.00000,1184.00000,Hometown Health,PPO/EPO,,2664.00,,,,,,,769.60,2871.20,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,inpatient,,,3225.00000,1290.00000,Hometown Health,PPO/EPO,,2902.50,,,,,,,2902.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,outpatient,,,3225.00000,1290.00000,Hometown Health,PPO/EPO,,2902.50,,,,,,,838.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,inpatient,,,3395.00000,1358.00000,Hometown Health,PPO/EPO,,3055.50,,,,,,,3055.50,3293.15,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,outpatient,,,3395.00000,1358.00000,Hometown Health,PPO/EPO,,3055.50,,,,,,,882.70,3293.15,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,inpatient,,,490.00000,196.00000,Hometown Health,PPO/EPO,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,outpatient,,,490.00000,196.00000,Hometown Health,PPO/EPO,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,inpatient,,,520.00000,208.00000,Hometown Health,PPO/EPO,,468.00,,,,,,,468.00,504.40,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,outpatient,,,520.00000,208.00000,Hometown Health,PPO/EPO,,468.00,,,,,,,135.20,504.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,inpatient,,,720.00000,288.00000,Hometown Health,PPO/EPO,,648.00,,,,,,,648.00,698.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,outpatient,,,720.00000,288.00000,Hometown Health,PPO/EPO,,648.00,,,,,,,187.20,698.40,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,inpatient,,,215.00000,86.00000,Hometown Health,PPO/EPO,,193.50,,,,,,,193.50,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,outpatient,,,215.00000,86.00000,Hometown Health,PPO/EPO,,193.50,,,,,,,55.90,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,inpatient,,,240.00000,96.00000,Hometown Health,PPO/EPO,,216.00,,,,,,,216.00,232.80,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,outpatient,,,240.00000,96.00000,Hometown Health,PPO/EPO,,216.00,,,,,,,62.40,232.80,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,inpatient,,,1241.00000,496.40000,Hometown Health,PPO/EPO,,1116.90,,,,,,,1116.90,1203.77,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,outpatient,,,1241.00000,496.40000,Hometown Health,PPO/EPO,,1116.90,,,,,,,322.66,1203.77,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,inpatient,,,850.00000,340.00000,Hometown Health,PPO/EPO,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,outpatient,,,850.00000,340.00000,Hometown Health,PPO/EPO,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,inpatient,,,1085.00000,434.00000,Hometown Health,PPO/EPO,,976.50,,,,,,,976.50,1052.45,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,outpatient,,,1085.00000,434.00000,Hometown Health,PPO/EPO,,976.50,,,,,,,282.10,1052.45,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,inpatient,,,295.00000,118.00000,Hometown Health,PPO/EPO,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Hometown Health,PPO/EPO,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,inpatient,,,492.00000,196.80000,Hometown Health,PPO/EPO,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,outpatient,,,492.00000,196.80000,Hometown Health,PPO/EPO,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,inpatient,,,563.00000,225.20000,Hometown Health,PPO/EPO,,506.70,,,,,,,506.70,546.11,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,outpatient,,,563.00000,225.20000,Hometown Health,PPO/EPO,,506.70,,,,,,,146.38,546.11,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,inpatient,,,1612.00000,644.80000,Hometown Health,PPO/EPO,,1450.80,,,,,,,1450.80,1563.64,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,outpatient,,,1612.00000,644.80000,Hometown Health,PPO/EPO,,1450.80,,,,,,,419.12,1563.64,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,inpatient,,,1366.00000,546.40000,Hometown Health,PPO/EPO,,1229.40,,,,,,,1229.40,1325.02,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,outpatient,,,1366.00000,546.40000,Hometown Health,PPO/EPO,,1229.40,,,,,,,355.16,1325.02,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,inpatient,,,1911.00000,764.40000,Hometown Health,PPO/EPO,,1719.90,,,,,,,1719.90,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,outpatient,,,1911.00000,764.40000,Hometown Health,PPO/EPO,,1719.90,,,,,,,496.86,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,inpatient,,,956.00000,382.40000,Hometown Health,PPO/EPO,,860.40,,,,,,,860.40,927.32,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,outpatient,,,956.00000,382.40000,Hometown Health,PPO/EPO,,860.40,,,,,,,248.56,927.32,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,inpatient,,,189.00000,123.20000,Hometown Health,PPO/EPO,,170.10,,,,,,,170.10,183.33,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,outpatient,,,189.00000,123.20000,Hometown Health,PPO/EPO,,170.10,,,,,,,49.14,183.33,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,inpatient,,,352.00000,256.87000,Hometown Health,PPO/EPO,,316.80,,,,,,,316.80,341.44,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,outpatient,,,352.00000,256.87000,Hometown Health,PPO/EPO,,316.80,,,,,,,91.52,341.44,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,inpatient,,,625.00000,738.40000,Hometown Health,PPO/EPO,,562.50,,,,,,,562.50,606.25,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,outpatient,,,625.00000,738.40000,Hometown Health,PPO/EPO,,562.50,,,,,,,162.50,606.25,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,inpatient,,,1024.00000,2097.47000,Hometown Health,PPO/EPO,,921.60,,,,,,,921.60,993.28,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1024.00000,2097.47000,Hometown Health,PPO/EPO,,921.60,,,,,,,266.24,993.28,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,inpatient,,,1455.00000,2469.72000,Hometown Health,PPO/EPO,,1309.50,,,,,,,1309.50,1411.35,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,outpatient,,,1455.00000,2469.72000,Hometown Health,PPO/EPO,,1309.50,,,,,,,378.30,1411.35,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,inpatient,,,145.00000,75.54000,Hometown Health,PPO/EPO,,130.50,,,,,,,130.50,140.65,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Hometown Health,PPO/EPO,,130.50,,,,,,,37.70,140.65,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,inpatient,,,488.00000,254.25000,Hometown Health,PPO/EPO,,439.20,,,,,,,439.20,473.36,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Hometown Health,PPO/EPO,,439.20,,,,,,,126.88,473.36,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Hometown Health,PPO/EPO,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Hometown Health,PPO/EPO,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Hometown Health,PPO/EPO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Hometown Health,PPO/EPO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Hometown Health,PPO/EPO,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Hometown Health,PPO/EPO,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,inpatient,,,170.00000,73.95000,Hometown Health,PPO/EPO,,153.00,,,,,,,153.00,164.90,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,outpatient,,,170.00000,73.95000,Hometown Health,PPO/EPO,,153.00,,,,,,,44.20,164.90,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,2.70000,1.17000,Hometown Health,PPO/EPO,,2.43,,,,,,,2.43,2.62,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,2.70000,1.17000,Hometown Health,PPO/EPO,,2.43,,,,,,,0.70200,2.62,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,27.00000,11.74000,Hometown Health,PPO/EPO,,24.30,,,,,,,24.30,26.19,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,27.00000,11.74000,Hometown Health,PPO/EPO,,24.30,,,,,,,7.02,26.19,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,inpatient,,,20440.00000,8891.40000,Hometown Health,PPO/EPO,,18396.00,,,,,,,18396.00,19826.80,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,outpatient,,,20440.00000,8891.40000,Hometown Health,PPO/EPO,,18396.00,,,,,,,5314.40,19826.80,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,inpatient,,,3322.00000,1445.07000,Hometown Health,PPO/EPO,,2989.80,,,,,,,2989.80,3222.34,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,3322.00000,1445.07000,Hometown Health,PPO/EPO,,2989.80,,,,,,,863.72,3222.34,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,inpatient,,,2492.00000,1084.02000,Hometown Health,PPO/EPO,,2242.80,,,,,,,2242.80,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,2492.00000,1084.02000,Hometown Health,PPO/EPO,,2242.80,,,,,,,647.92,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,inpatient,,,1814.00000,789.09000,Hometown Health,PPO/EPO,,1632.60,,,,,,,1632.60,1759.58,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1814.00000,789.09000,Hometown Health,PPO/EPO,,1632.60,,,,,,,471.64,1759.58,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,inpatient,,,2153.00000,936.56000,Hometown Health,PPO/EPO,,1937.70,,,,,,,1937.70,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,2153.00000,936.56000,Hometown Health,PPO/EPO,,1937.70,,,,,,,559.78,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,inpatient,,,1525.00000,663.38000,Hometown Health,PPO/EPO,,1372.50,,,,,,,1372.50,1479.25,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1525.00000,663.38000,Hometown Health,PPO/EPO,,1372.50,,,,,,,396.50,1479.25,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,inpatient,,,2716.00000,1181.46000,Hometown Health,PPO/EPO,,2444.40,,,,,,,2444.40,2634.52,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2716.00000,1181.46000,Hometown Health,PPO/EPO,,2444.40,,,,,,,706.16,2634.52,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,inpatient,,,2.70000,0.39000,Hometown Health,PPO/EPO,,2.43,,,,,,,2.43,2.62,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,outpatient,,,2.70000,0.39000,Hometown Health,PPO/EPO,,2.43,,,,,,,0.70200,2.62,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,inpatient,,,222.00000,32.41000,Hometown Health,PPO/EPO,,199.80,,,,,,,199.80,215.34,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,outpatient,,,222.00000,32.41000,Hometown Health,PPO/EPO,,199.80,,,,,,,57.72,215.34,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,inpatient,,,211.00000,113.10000,Hometown Health,PPO/EPO,,189.90,,,,,,,189.90,204.67,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,outpatient,,,211.00000,113.10000,Hometown Health,PPO/EPO,,189.90,,,,,,,54.86,204.67,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,inpatient,,,497.00000,266.39000,Hometown Health,PPO/EPO,,447.30,,,,,,,447.30,482.09,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,outpatient,,,497.00000,266.39000,Hometown Health,PPO/EPO,,447.30,,,,,,,129.22,482.09,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,inpatient,,,296.00000,158.66000,Hometown Health,PPO/EPO,,266.40,,,,,,,266.40,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,outpatient,,,296.00000,158.66000,Hometown Health,PPO/EPO,,266.40,,,,,,,76.96,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,inpatient,,,723.00000,387.53000,Hometown Health,PPO/EPO,,650.70,,,,,,,650.70,701.31,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,outpatient,,,723.00000,387.53000,Hometown Health,PPO/EPO,,650.70,,,,,,,187.98,701.31,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,inpatient,,,326.00000,174.74000,Hometown Health,PPO/EPO,,293.40,,,,,,,293.40,316.22,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,outpatient,,,326.00000,174.74000,Hometown Health,PPO/EPO,,293.40,,,,,,,84.76,316.22,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,inpatient,,,532.00000,285.15000,Hometown Health,PPO/EPO,,478.80,,,,,,,478.80,516.04,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,outpatient,,,532.00000,285.15000,Hometown Health,PPO/EPO,,478.80,,,,,,,138.32,516.04,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,inpatient,,,635.00000,340.36000,Hometown Health,PPO/EPO,,571.50,,,,,,,571.50,615.95,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,outpatient,,,635.00000,340.36000,Hometown Health,PPO/EPO,,571.50,,,,,,,165.10,615.95,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,inpatient,,,639.00000,342.50000,Hometown Health,PPO/EPO,,575.10,,,,,,,575.10,619.83,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,outpatient,,,639.00000,342.50000,Hometown Health,PPO/EPO,,575.10,,,,,,,166.14,619.83,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,inpatient,,,780.00000,418.08000,Hometown Health,PPO/EPO,,702.00,,,,,,,702.00,756.60,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,outpatient,,,780.00000,418.08000,Hometown Health,PPO/EPO,,702.00,,,,,,,202.80,756.60,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,inpatient,,,390.00000,209.04000,Hometown Health,PPO/EPO,,351.00,,,,,,,351.00,378.30,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,outpatient,,,390.00000,209.04000,Hometown Health,PPO/EPO,,351.00,,,,,,,101.40,378.30,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,inpatient,,,731.00000,391.82000,Hometown Health,PPO/EPO,,657.90,,,,,,,657.90,709.07,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,outpatient,,,731.00000,391.82000,Hometown Health,PPO/EPO,,657.90,,,,,,,190.06,709.07,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,inpatient,,,585.00000,313.56000,Hometown Health,PPO/EPO,,526.50,,,,,,,526.50,567.45,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,outpatient,,,585.00000,313.56000,Hometown Health,PPO/EPO,,526.50,,,,,,,152.10,567.45,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,inpatient,,,365.00000,195.64000,Hometown Health,PPO/EPO,,328.50,,,,,,,328.50,354.05,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,outpatient,,,365.00000,195.64000,Hometown Health,PPO/EPO,,328.50,,,,,,,94.90,354.05,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,inpatient,,,1086.00000,582.10000,Hometown Health,PPO/EPO,,977.40,,,,,,,977.40,1053.42,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,outpatient,,,1086.00000,582.10000,Hometown Health,PPO/EPO,,977.40,,,,,,,282.36,1053.42,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,inpatient,,,197.00000,105.59000,Hometown Health,PPO/EPO,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,outpatient,,,197.00000,105.59000,Hometown Health,PPO/EPO,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,inpatient,,,2774.00000,1486.86000,Hometown Health,PPO/EPO,,2496.60,,,,,,,2496.60,2690.78,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,outpatient,,,2774.00000,1486.86000,Hometown Health,PPO/EPO,,2496.60,,,,,,,721.24,2690.78,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,inpatient,,,1456.00000,780.42000,Hometown Health,PPO/EPO,,1310.40,,,,,,,1310.40,1412.32,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,outpatient,,,1456.00000,780.42000,Hometown Health,PPO/EPO,,1310.40,,,,,,,378.56,1412.32,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,inpatient,,,2647.00000,1418.79000,Hometown Health,PPO/EPO,,2382.30,,,,,,,2382.30,2567.59,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,outpatient,,,2647.00000,1418.79000,Hometown Health,PPO/EPO,,2382.30,,,,,,,688.22,2567.59,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,inpatient,,,1359.00000,728.42000,Hometown Health,PPO/EPO,,1223.10,,,,,,,1223.10,1318.23,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,outpatient,,,1359.00000,728.42000,Hometown Health,PPO/EPO,,1223.10,,,,,,,353.34,1318.23,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,inpatient,,,273.00000,146.33000,Hometown Health,PPO/EPO,,245.70,,,,,,,245.70,264.81,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,outpatient,,,273.00000,146.33000,Hometown Health,PPO/EPO,,245.70,,,,,,,70.98,264.81,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,inpatient,,,325.00000,174.20000,Hometown Health,PPO/EPO,,292.50,,,,,,,292.50,315.25,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,outpatient,,,325.00000,174.20000,Hometown Health,PPO/EPO,,292.50,,,,,,,84.50,315.25,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,inpatient,,,609.00000,326.42000,Hometown Health,PPO/EPO,,548.10,,,,,,,548.10,590.73,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Hometown Health,PPO/EPO,,548.10,,,,,,,158.34,590.73,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,inpatient,,,491.00000,263.18000,Hometown Health,PPO/EPO,,441.90,,,,,,,441.90,476.27,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,outpatient,,,491.00000,263.18000,Hometown Health,PPO/EPO,,441.90,,,,,,,127.66,476.27,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,inpatient,,,561.00000,300.70000,Hometown Health,PPO/EPO,,504.90,,,,,,,504.90,544.17,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,outpatient,,,561.00000,300.70000,Hometown Health,PPO/EPO,,504.90,,,,,,,145.86,544.17,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,inpatient,,,845.00000,452.92000,Hometown Health,PPO/EPO,,760.50,,,,,,,760.50,819.65,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,outpatient,,,845.00000,452.92000,Hometown Health,PPO/EPO,,760.50,,,,,,,219.70,819.65,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,inpatient,,,612.00000,328.03000,Hometown Health,PPO/EPO,,550.80,,,,,,,550.80,593.64,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,outpatient,,,612.00000,328.03000,Hometown Health,PPO/EPO,,550.80,,,,,,,159.12,593.64,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,inpatient,,,536.00000,287.30000,Hometown Health,PPO/EPO,,482.40,,,,,,,482.40,519.92,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,outpatient,,,536.00000,287.30000,Hometown Health,PPO/EPO,,482.40,,,,,,,139.36,519.92,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,inpatient,,,1225.00000,656.60000,Hometown Health,PPO/EPO,,1102.50,,,,,,,1102.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,outpatient,,,1225.00000,656.60000,Hometown Health,PPO/EPO,,1102.50,,,,,,,318.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,inpatient,,,816.00000,437.38000,Hometown Health,PPO/EPO,LT,734.40,,,,,,,734.40,791.52,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Hometown Health,PPO/EPO,LT,734.40,,,,,,,212.16,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,inpatient,,,816.00000,437.38000,Hometown Health,PPO/EPO,RT,734.40,,,,,,,734.40,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Hometown Health,PPO/EPO,RT,734.40,,,,,,,212.16,791.52,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,inpatient,,,250.00000,134.00000,Hometown Health,PPO/EPO,,225.00,,,,,,,225.00,242.50,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,outpatient,,,250.00000,134.00000,Hometown Health,PPO/EPO,,225.00,,,,,,,65.00,242.50,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,inpatient,,,302.00000,161.87000,Hometown Health,PPO/EPO,,271.80,,,,,,,271.80,292.94,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,outpatient,,,302.00000,161.87000,Hometown Health,PPO/EPO,,271.80,,,,,,,78.52,292.94,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,inpatient,,,354.00000,189.74000,Hometown Health,PPO/EPO,,318.60,,,,,,,318.60,343.38,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,outpatient,,,354.00000,189.74000,Hometown Health,PPO/EPO,,318.60,,,,,,,92.04,343.38,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,inpatient,,,409.00000,219.22000,Hometown Health,PPO/EPO,,368.10,,,,,,,368.10,396.73,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,outpatient,,,409.00000,219.22000,Hometown Health,PPO/EPO,,368.10,,,,,,,106.34,396.73,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,inpatient,,,593.00000,317.85000,Hometown Health,PPO/EPO,,533.70,,,,,,,533.70,575.21,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,outpatient,,,593.00000,317.85000,Hometown Health,PPO/EPO,,533.70,,,,,,,154.18,575.21,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Hometown Health,PPO/EPO,LT,276.30,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Hometown Health,PPO/EPO,LT,276.30,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Hometown Health,PPO/EPO,"52,LT",276.30,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Hometown Health,PPO/EPO,"52,LT",276.30,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Hometown Health,PPO/EPO,RT,276.30,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Hometown Health,PPO/EPO,RT,276.30,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Hometown Health,PPO/EPO,"52,RT",276.30,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Hometown Health,PPO/EPO,"52,RT",276.30,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,inpatient,,,330.00000,176.88000,Hometown Health,PPO/EPO,LT,297.00,,,,,,,297.00,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Hometown Health,PPO/EPO,LT,297.00,,,,,,,85.80,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,inpatient,,,330.00000,176.88000,Hometown Health,PPO/EPO,RT,297.00,,,,,,,297.00,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Hometown Health,PPO/EPO,RT,297.00,,,,,,,85.80,320.10,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,inpatient,,,195.00000,104.52000,Hometown Health,PPO/EPO,,175.50,,,,,,,175.50,189.15,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,outpatient,,,195.00000,104.52000,Hometown Health,PPO/EPO,,175.50,,,,,,,50.70,189.15,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,inpatient,,,578.00000,309.81000,Hometown Health,PPO/EPO,,520.20,,,,,,,520.20,560.66,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,outpatient,,,578.00000,309.81000,Hometown Health,PPO/EPO,,520.20,,,,,,,150.28,560.66,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,inpatient,,,384.00000,205.82000,Hometown Health,PPO/EPO,,345.60,,,,,,,345.60,372.48,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,outpatient,,,384.00000,205.82000,Hometown Health,PPO/EPO,,345.60,,,,,,,99.84,372.48,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,inpatient,,,303.00000,162.41000,Hometown Health,PPO/EPO,LT,272.70,,,,,,,272.70,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Hometown Health,PPO/EPO,LT,272.70,,,,,,,78.78,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,inpatient,,,303.00000,162.41000,Hometown Health,PPO/EPO,RT,272.70,,,,,,,272.70,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Hometown Health,PPO/EPO,RT,272.70,,,,,,,78.78,293.91,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,inpatient,,,445.00000,238.52000,Hometown Health,PPO/EPO,LT,400.50,,,,,,,400.50,431.65,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Hometown Health,PPO/EPO,LT,400.50,,,,,,,115.70,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,inpatient,,,445.00000,238.52000,Hometown Health,PPO/EPO,RT,400.50,,,,,,,400.50,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Hometown Health,PPO/EPO,RT,400.50,,,,,,,115.70,431.65,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,inpatient,,,937.00000,502.23000,Hometown Health,PPO/EPO,,843.30,,,,,,,843.30,908.89,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,outpatient,,,937.00000,502.23000,Hometown Health,PPO/EPO,,843.30,,,,,,,243.62,908.89,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,inpatient,,,615.00000,329.64000,Hometown Health,PPO/EPO,,553.50,,,,,,,553.50,596.55,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,outpatient,,,615.00000,329.64000,Hometown Health,PPO/EPO,,553.50,,,,,,,159.90,596.55,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Hometown Health,PPO/EPO,LT,258.30,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Hometown Health,PPO/EPO,LT,258.30,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Hometown Health,PPO/EPO,"52,LT",258.30,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Hometown Health,PPO/EPO,"52,LT",258.30,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Hometown Health,PPO/EPO,RT,258.30,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Hometown Health,PPO/EPO,RT,258.30,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Hometown Health,PPO/EPO,"52,RT",258.30,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Hometown Health,PPO/EPO,"52,RT",258.30,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,inpatient,,,323.00000,173.13000,Hometown Health,PPO/EPO,LT,290.70,,,,,,,290.70,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Hometown Health,PPO/EPO,LT,290.70,,,,,,,83.98,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,inpatient,,,323.00000,173.13000,Hometown Health,PPO/EPO,RT,290.70,,,,,,,290.70,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Hometown Health,PPO/EPO,RT,290.70,,,,,,,83.98,313.31,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,inpatient,,,694.00000,371.98000,Hometown Health,PPO/EPO,,624.60,,,,,,,624.60,673.18,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,outpatient,,,694.00000,371.98000,Hometown Health,PPO/EPO,,624.60,,,,,,,180.44,673.18,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,inpatient,,,276.00000,147.94000,Hometown Health,PPO/EPO,LT,248.40,,,,,,,248.40,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Hometown Health,PPO/EPO,LT,248.40,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,inpatient,,,276.00000,147.94000,Hometown Health,PPO/EPO,RT,248.40,,,,,,,248.40,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Hometown Health,PPO/EPO,RT,248.40,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,inpatient,,,254.00000,136.14000,Hometown Health,PPO/EPO,LT,228.60,,,,,,,228.60,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Hometown Health,PPO/EPO,LT,228.60,,,,,,,66.04,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,inpatient,,,254.00000,136.14000,Hometown Health,PPO/EPO,RT,228.60,,,,,,,228.60,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Hometown Health,PPO/EPO,RT,228.60,,,,,,,66.04,246.38,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,inpatient,,,275.00000,147.40000,Hometown Health,PPO/EPO,LT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Hometown Health,PPO/EPO,LT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,inpatient,,,275.00000,147.40000,Hometown Health,PPO/EPO,RT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Hometown Health,PPO/EPO,RT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,inpatient,,,173.00000,92.73000,Hometown Health,PPO/EPO,,155.70,,,,,,,155.70,167.81,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,outpatient,,,173.00000,92.73000,Hometown Health,PPO/EPO,,155.70,,,,,,,44.98,167.81,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,inpatient,,,483.00000,258.89000,Hometown Health,PPO/EPO,LT,434.70,,,,,,,434.70,468.51,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Hometown Health,PPO/EPO,LT,434.70,,,,,,,125.58,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,inpatient,,,483.00000,258.89000,Hometown Health,PPO/EPO,RT,434.70,,,,,,,434.70,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Hometown Health,PPO/EPO,RT,434.70,,,,,,,125.58,468.51,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,inpatient,,,191.00000,102.38000,Hometown Health,PPO/EPO,LT,171.90,,,,,,,171.90,185.27,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Hometown Health,PPO/EPO,LT,171.90,,,,,,,49.66,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,inpatient,,,191.00000,102.38000,Hometown Health,PPO/EPO,RT,171.90,,,,,,,171.90,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Hometown Health,PPO/EPO,RT,171.90,,,,,,,49.66,185.27,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Hometown Health,PPO/EPO,LT,133.20,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Hometown Health,PPO/EPO,LT,133.20,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Hometown Health,PPO/EPO,"52,LT",133.20,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Hometown Health,PPO/EPO,"52,LT",133.20,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Hometown Health,PPO/EPO,RT,133.20,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Hometown Health,PPO/EPO,RT,133.20,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Hometown Health,PPO/EPO,"52,RT",133.20,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Hometown Health,PPO/EPO,"52,RT",133.20,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,inpatient,,,481.00000,257.82000,Hometown Health,PPO/EPO,LT,432.90,,,,,,,432.90,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Hometown Health,PPO/EPO,LT,432.90,,,,,,,125.06,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,inpatient,,,481.00000,257.82000,Hometown Health,PPO/EPO,RT,432.90,,,,,,,432.90,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Hometown Health,PPO/EPO,RT,432.90,,,,,,,125.06,466.57,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,inpatient,,,215.00000,115.24000,Hometown Health,PPO/EPO,LT,193.50,,,,,,,193.50,208.55,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Hometown Health,PPO/EPO,LT,193.50,,,,,,,55.90,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,inpatient,,,215.00000,115.24000,Hometown Health,PPO/EPO,RT,193.50,,,,,,,193.50,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Hometown Health,PPO/EPO,RT,193.50,,,,,,,55.90,208.55,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Hometown Health,PPO/EPO,LT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Hometown Health,PPO/EPO,LT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Hometown Health,PPO/EPO,"52,LT",247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Hometown Health,PPO/EPO,"52,LT",247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Hometown Health,PPO/EPO,RT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Hometown Health,PPO/EPO,RT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Hometown Health,PPO/EPO,"52,RT",247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Hometown Health,PPO/EPO,"52,RT",247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,PPO/EPO,LT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,PPO/EPO,LT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,PPO/EPO,"52,LT",409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,PPO/EPO,"52,LT",409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,PPO/EPO,RT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,PPO/EPO,RT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,PPO/EPO,"52,RT",409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,PPO/EPO,"52,RT",409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,inpatient,,,503.00000,269.61000,Hometown Health,PPO/EPO,LT,452.70,,,,,,,452.70,487.91,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Hometown Health,PPO/EPO,LT,452.70,,,,,,,130.78,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,inpatient,,,503.00000,269.61000,Hometown Health,PPO/EPO,RT,452.70,,,,,,,452.70,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Hometown Health,PPO/EPO,RT,452.70,,,,,,,130.78,487.91,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,inpatient,,,209.00000,112.02000,Hometown Health,PPO/EPO,LT,188.10,,,,,,,188.10,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Hometown Health,PPO/EPO,LT,188.10,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,inpatient,,,209.00000,112.02000,Hometown Health,PPO/EPO,RT,188.10,,,,,,,188.10,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Hometown Health,PPO/EPO,RT,188.10,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,inpatient,,,566.00000,303.38000,Hometown Health,PPO/EPO,LT,509.40,,,,,,,509.40,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Hometown Health,PPO/EPO,LT,509.40,,,,,,,147.16,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,inpatient,,,566.00000,303.38000,Hometown Health,PPO/EPO,RT,509.40,,,,,,,509.40,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Hometown Health,PPO/EPO,RT,509.40,,,,,,,147.16,549.02,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,inpatient,,,598.00000,320.53000,Hometown Health,PPO/EPO,,538.20,,,,,,,538.20,580.06,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,outpatient,,,598.00000,320.53000,Hometown Health,PPO/EPO,,538.20,,,,,,,155.48,580.06,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,PPO/EPO,"52,LT",409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,PPO/EPO,"52,LT",409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,PPO/EPO,"52,RT",409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,PPO/EPO,"52,RT",409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,PPO/EPO,LT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,PPO/EPO,LT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Hometown Health,PPO/EPO,RT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Hometown Health,PPO/EPO,RT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,inpatient,,,1913.00000,1025.37000,Hometown Health,PPO/EPO,,1721.70,,,,,,,1721.70,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,outpatient,,,1913.00000,1025.37000,Hometown Health,PPO/EPO,,1721.70,,,,,,,497.38,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,inpatient,,,312.00000,167.23000,Hometown Health,PPO/EPO,,280.80,,,,,,,280.80,302.64,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,outpatient,,,312.00000,167.23000,Hometown Health,PPO/EPO,,280.80,,,,,,,81.12,302.64,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,inpatient,,,327.00000,175.27000,Hometown Health,PPO/EPO,,294.30,,,,,,,294.30,317.19,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,outpatient,,,327.00000,175.27000,Hometown Health,PPO/EPO,,294.30,,,,,,,85.02,317.19,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,inpatient,,,425.00000,227.80000,Hometown Health,PPO/EPO,,382.50,,,,,,,382.50,412.25,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,outpatient,,,425.00000,227.80000,Hometown Health,PPO/EPO,,382.50,,,,,,,110.50,412.25,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,inpatient,,,210.00000,112.56000,Hometown Health,PPO/EPO,,189.00,,,,,,,189.00,203.70,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,outpatient,,,210.00000,112.56000,Hometown Health,PPO/EPO,,189.00,,,,,,,54.60,203.70,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,inpatient,,,495.00000,265.32000,Hometown Health,PPO/EPO,,445.50,,,,,,,445.50,480.15,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,outpatient,,,495.00000,265.32000,Hometown Health,PPO/EPO,,445.50,,,,,,,128.70,480.15,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,inpatient,,,541.00000,289.98000,Hometown Health,PPO/EPO,,486.90,,,,,,,486.90,524.77,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,outpatient,,,541.00000,289.98000,Hometown Health,PPO/EPO,,486.90,,,,,,,140.66,524.77,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,inpatient,,,345.00000,184.92000,Hometown Health,PPO/EPO,LT,310.50,,,,,,,310.50,334.65,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Hometown Health,PPO/EPO,LT,310.50,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,inpatient,,,345.00000,184.92000,Hometown Health,PPO/EPO,RT,310.50,,,,,,,310.50,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Hometown Health,PPO/EPO,RT,310.50,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,inpatient,,,419.00000,224.58000,Hometown Health,PPO/EPO,LT,377.10,,,,,,,377.10,406.43,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Hometown Health,PPO/EPO,LT,377.10,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,inpatient,,,419.00000,224.58000,Hometown Health,PPO/EPO,RT,377.10,,,,,,,377.10,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Hometown Health,PPO/EPO,RT,377.10,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,inpatient,,,618.00000,331.25000,Hometown Health,PPO/EPO,LT,556.20,,,,,,,556.20,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Hometown Health,PPO/EPO,LT,556.20,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,inpatient,,,618.00000,331.25000,Hometown Health,PPO/EPO,RT,556.20,,,,,,,556.20,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Hometown Health,PPO/EPO,RT,556.20,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,inpatient,,,463.00000,248.17000,Hometown Health,PPO/EPO,,416.70,,,,,,,416.70,449.11,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,outpatient,,,463.00000,248.17000,Hometown Health,PPO/EPO,,416.70,,,,,,,120.38,449.11,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,inpatient,,,511.00000,273.90000,Hometown Health,PPO/EPO,,459.90,,,,,,,459.90,495.67,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,outpatient,,,511.00000,273.90000,Hometown Health,PPO/EPO,,459.90,,,,,,,132.86,495.67,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,inpatient,,,132.00000,70.75000,Hometown Health,PPO/EPO,,118.80,,,,,,,118.80,128.04,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,outpatient,,,132.00000,70.75000,Hometown Health,PPO/EPO,,118.80,,,,,,,34.32,128.04,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,inpatient,,,353.00000,189.21000,Hometown Health,PPO/EPO,LT,317.70,,,,,,,317.70,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Hometown Health,PPO/EPO,LT,317.70,,,,,,,91.78,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,inpatient,,,353.00000,189.21000,Hometown Health,PPO/EPO,RT,317.70,,,,,,,317.70,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Hometown Health,PPO/EPO,RT,317.70,,,,,,,91.78,342.41,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,inpatient,,,273.00000,146.33000,Hometown Health,PPO/EPO,,245.70,,,,,,,245.70,264.81,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,outpatient,,,273.00000,146.33000,Hometown Health,PPO/EPO,,245.70,,,,,,,70.98,264.81,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,inpatient,,,503.00000,269.61000,Hometown Health,PPO/EPO,,452.70,,,,,,,452.70,487.91,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,outpatient,,,503.00000,269.61000,Hometown Health,PPO/EPO,,452.70,,,,,,,130.78,487.91,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,inpatient,,,561.00000,300.70000,Hometown Health,PPO/EPO,,504.90,,,,,,,504.90,544.17,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,outpatient,,,561.00000,300.70000,Hometown Health,PPO/EPO,,504.90,,,,,,,145.86,544.17,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,inpatient,,,450.00000,241.20000,Hometown Health,PPO/EPO,LT,405.00,,,,,,,405.00,436.50,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Hometown Health,PPO/EPO,LT,405.00,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,inpatient,,,450.00000,241.20000,Hometown Health,PPO/EPO,RT,405.00,,,,,,,405.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Hometown Health,PPO/EPO,RT,405.00,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,inpatient,,,650.00000,348.40000,Hometown Health,PPO/EPO,,585.00,,,,,,,585.00,630.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,outpatient,,,650.00000,348.40000,Hometown Health,PPO/EPO,,585.00,,,,,,,169.00,630.50,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,inpatient,,,642.00000,344.11000,Hometown Health,PPO/EPO,,577.80,,,,,,,577.80,622.74,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,outpatient,,,642.00000,344.11000,Hometown Health,PPO/EPO,,577.80,,,,,,,166.92,622.74,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,inpatient,,,777.00000,416.47000,Hometown Health,PPO/EPO,,699.30,,,,,,,699.30,753.69,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,outpatient,,,777.00000,416.47000,Hometown Health,PPO/EPO,,699.30,,,,,,,202.02,753.69,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,inpatient,,,381.00000,204.22000,Hometown Health,PPO/EPO,,342.90,,,,,,,342.90,369.57,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,outpatient,,,381.00000,204.22000,Hometown Health,PPO/EPO,,342.90,,,,,,,99.06,369.57,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,inpatient,,,374.00000,200.46000,Hometown Health,PPO/EPO,LT,336.60,,,,,,,336.60,362.78,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Hometown Health,PPO/EPO,LT,336.60,,,,,,,97.24,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,inpatient,,,374.00000,200.46000,Hometown Health,PPO/EPO,RT,336.60,,,,,,,336.60,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Hometown Health,PPO/EPO,RT,336.60,,,,,,,97.24,362.78,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,inpatient,,,161.00000,86.30000,Hometown Health,PPO/EPO,LT,144.90,,,,,,,144.90,156.17,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Hometown Health,PPO/EPO,LT,144.90,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,inpatient,,,161.00000,86.30000,Hometown Health,PPO/EPO,RT,144.90,,,,,,,144.90,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Hometown Health,PPO/EPO,RT,144.90,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,inpatient,,,499.00000,267.46000,Hometown Health,PPO/EPO,LT,449.10,,,,,,,449.10,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Hometown Health,PPO/EPO,LT,449.10,,,,,,,129.74,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,inpatient,,,499.00000,267.46000,Hometown Health,PPO/EPO,RT,449.10,,,,,,,449.10,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Hometown Health,PPO/EPO,RT,449.10,,,,,,,129.74,484.03,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,inpatient,,,214.00000,114.70000,Hometown Health,PPO/EPO,,192.60,,,,,,,192.60,207.58,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,outpatient,,,214.00000,114.70000,Hometown Health,PPO/EPO,,192.60,,,,,,,55.64,207.58,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,inpatient,,,329.00000,176.34000,Hometown Health,PPO/EPO,,296.10,,,,,,,296.10,319.13,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,outpatient,,,329.00000,176.34000,Hometown Health,PPO/EPO,,296.10,,,,,,,85.54,319.13,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,inpatient,,,197.00000,105.59000,Hometown Health,PPO/EPO,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,outpatient,,,197.00000,105.59000,Hometown Health,PPO/EPO,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,inpatient,,,263.00000,140.97000,Hometown Health,PPO/EPO,,236.70,,,,,,,236.70,255.11,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,outpatient,,,263.00000,140.97000,Hometown Health,PPO/EPO,,236.70,,,,,,,68.38,255.11,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,inpatient,,,234.00000,125.42000,Hometown Health,PPO/EPO,,210.60,,,,,,,210.60,226.98,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,outpatient,,,234.00000,125.42000,Hometown Health,PPO/EPO,,210.60,,,,,,,60.84,226.98,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,inpatient,,,401.00000,214.94000,Hometown Health,PPO/EPO,,360.90,,,,,,,360.90,388.97,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,outpatient,,,401.00000,214.94000,Hometown Health,PPO/EPO,,360.90,,,,,,,104.26,388.97,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,inpatient,,,515.00000,276.04000,Hometown Health,PPO/EPO,,463.50,,,,,,,463.50,499.55,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,outpatient,,,515.00000,276.04000,Hometown Health,PPO/EPO,,463.50,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,inpatient,,,747.00000,400.39000,Hometown Health,PPO/EPO,,672.30,,,,,,,672.30,724.59,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,outpatient,,,747.00000,400.39000,Hometown Health,PPO/EPO,,672.30,,,,,,,194.22,724.59,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,inpatient,,,854.00000,457.74000,Hometown Health,PPO/EPO,,768.60,,,,,,,768.60,828.38,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,outpatient,,,854.00000,457.74000,Hometown Health,PPO/EPO,,768.60,,,,,,,222.04,828.38,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,inpatient,,,589.00000,315.70000,Hometown Health,PPO/EPO,,530.10,,,,,,,530.10,571.33,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,outpatient,,,589.00000,315.70000,Hometown Health,PPO/EPO,,530.10,,,,,,,153.14,571.33,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,inpatient,,,613.00000,328.57000,Hometown Health,PPO/EPO,,551.70,,,,,,,551.70,594.61,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,outpatient,,,613.00000,328.57000,Hometown Health,PPO/EPO,,551.70,,,,,,,159.38,594.61,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,inpatient,,,806.00000,432.02000,Hometown Health,PPO/EPO,,725.40,,,,,,,725.40,781.82,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,outpatient,,,806.00000,432.02000,Hometown Health,PPO/EPO,,725.40,,,,,,,209.56,781.82,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,inpatient,,,529.00000,283.54000,Hometown Health,PPO/EPO,,476.10,,,,,,,476.10,513.13,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,outpatient,,,529.00000,283.54000,Hometown Health,PPO/EPO,,476.10,,,,,,,137.54,513.13,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,inpatient,,,939.00000,503.30000,Hometown Health,PPO/EPO,,845.10,,,,,,,845.10,910.83,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,outpatient,,,939.00000,503.30000,Hometown Health,PPO/EPO,,845.10,,,,,,,244.14,910.83,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,inpatient,,,515.00000,276.04000,Hometown Health,PPO/EPO,,463.50,,,,,,,463.50,499.55,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,outpatient,,,515.00000,276.04000,Hometown Health,PPO/EPO,,463.50,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,inpatient,,,616.00000,330.18000,Hometown Health,PPO/EPO,,554.40,,,,,,,554.40,597.52,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,outpatient,,,616.00000,330.18000,Hometown Health,PPO/EPO,,554.40,,,,,,,160.16,597.52,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,inpatient,,,377.00000,202.07000,Hometown Health,PPO/EPO,,339.30,,,,,,,339.30,365.69,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,outpatient,,,377.00000,202.07000,Hometown Health,PPO/EPO,,339.30,,,,,,,98.02,365.69,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,inpatient,,,340.00000,182.24000,Hometown Health,PPO/EPO,,306.00,,,,,,,306.00,329.80,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,outpatient,,,340.00000,182.24000,Hometown Health,PPO/EPO,,306.00,,,,,,,88.40,329.80,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,inpatient,,,388.00000,207.97000,Hometown Health,PPO/EPO,,349.20,,,,,,,349.20,376.36,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,outpatient,,,388.00000,207.97000,Hometown Health,PPO/EPO,,349.20,,,,,,,100.88,376.36,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,inpatient,,,456.00000,244.42000,Hometown Health,PPO/EPO,,410.40,,,,,,,410.40,442.32,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,outpatient,,,456.00000,244.42000,Hometown Health,PPO/EPO,,410.40,,,,,,,118.56,442.32,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,inpatient,,,267.00000,143.11000,Hometown Health,PPO/EPO,,240.30,,,,,,,240.30,258.99,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,outpatient,,,267.00000,143.11000,Hometown Health,PPO/EPO,,240.30,,,,,,,69.42,258.99,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Hometown Health,PPO/EPO,LT,275.40,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Hometown Health,PPO/EPO,LT,275.40,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Hometown Health,PPO/EPO,"52,LT",275.40,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Hometown Health,PPO/EPO,"52,LT",275.40,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Hometown Health,PPO/EPO,RT,275.40,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Hometown Health,PPO/EPO,RT,275.40,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Hometown Health,PPO/EPO,"52,RT",275.40,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Hometown Health,PPO/EPO,"52,RT",275.40,,,,,,,79.56,296.82,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,inpatient,,,456.00000,244.42000,Hometown Health,PPO/EPO,,410.40,,,,,,,410.40,442.32,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,outpatient,,,456.00000,244.42000,Hometown Health,PPO/EPO,,410.40,,,,,,,118.56,442.32,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,inpatient,,,381.00000,204.22000,Hometown Health,PPO/EPO,,342.90,,,,,,,342.90,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,outpatient,,,381.00000,204.22000,Hometown Health,PPO/EPO,,342.90,,,,,,,99.06,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,inpatient,,,143.00000,76.65000,Hometown Health,PPO/EPO,LT,128.70,,,,,,,128.70,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Hometown Health,PPO/EPO,LT,128.70,,,,,,,37.18,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,inpatient,,,143.00000,76.65000,Hometown Health,PPO/EPO,RT,128.70,,,,,,,128.70,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Hometown Health,PPO/EPO,RT,128.70,,,,,,,37.18,138.71,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,inpatient,,,331.00000,177.42000,Hometown Health,PPO/EPO,LT,297.90,,,,,,,297.90,321.07,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Hometown Health,PPO/EPO,LT,297.90,,,,,,,86.06,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,inpatient,,,331.00000,177.42000,Hometown Health,PPO/EPO,RT,297.90,,,,,,,297.90,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Hometown Health,PPO/EPO,RT,297.90,,,,,,,86.06,321.07,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,inpatient,,,1113.00000,596.57000,Hometown Health,PPO/EPO,,1001.70,,,,,,,1001.70,1079.61,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1113.00000,596.57000,Hometown Health,PPO/EPO,,1001.70,,,,,,,289.38,1079.61,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,inpatient,,,1043.00000,559.05000,Hometown Health,PPO/EPO,,938.70,,,,,,,938.70,1011.71,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,outpatient,,,1043.00000,559.05000,Hometown Health,PPO/EPO,,938.70,,,,,,,271.18,1011.71,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Hometown Health,PPO/EPO,LT,230.40,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Hometown Health,PPO/EPO,LT,230.40,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Hometown Health,PPO/EPO,"52,LT",230.40,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Hometown Health,PPO/EPO,"52,LT",230.40,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Hometown Health,PPO/EPO,RT,230.40,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Hometown Health,PPO/EPO,RT,230.40,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Hometown Health,PPO/EPO,"52,RT",230.40,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Hometown Health,PPO/EPO,"52,RT",230.40,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,inpatient,,,511.00000,273.90000,Hometown Health,PPO/EPO,LT,459.90,,,,,,,459.90,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Hometown Health,PPO/EPO,LT,459.90,,,,,,,132.86,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,inpatient,,,511.00000,273.90000,Hometown Health,PPO/EPO,RT,459.90,,,,,,,459.90,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Hometown Health,PPO/EPO,RT,459.90,,,,,,,132.86,495.67,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,inpatient,,,553.00000,314.19000,Hometown Health,PPO/EPO,LT,497.70,,,,,,,497.70,536.41,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Hometown Health,PPO/EPO,LT,497.70,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,inpatient,,,553.00000,314.19000,Hometown Health,PPO/EPO,RT,497.70,,,,,,,497.70,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Hometown Health,PPO/EPO,RT,497.70,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,inpatient,,,1076.00000,611.33000,Hometown Health,PPO/EPO,LT,968.40,,,,,,,968.40,1043.72,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Hometown Health,PPO/EPO,LT,968.40,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,inpatient,,,1076.00000,611.33000,Hometown Health,PPO/EPO,RT,968.40,,,,,,,968.40,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Hometown Health,PPO/EPO,RT,968.40,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,inpatient,,,865.00000,491.45000,Hometown Health,PPO/EPO,LT,778.50,,,,,,,778.50,839.05,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Hometown Health,PPO/EPO,LT,778.50,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,inpatient,,,865.00000,491.45000,Hometown Health,PPO/EPO,RT,778.50,,,,,,,778.50,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Hometown Health,PPO/EPO,RT,778.50,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,inpatient,,,734.00000,417.02000,Hometown Health,PPO/EPO,LT,660.60,,,,,,,660.60,711.98,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Hometown Health,PPO/EPO,LT,660.60,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,inpatient,,,734.00000,417.02000,Hometown Health,PPO/EPO,RT,660.60,,,,,,,660.60,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Hometown Health,PPO/EPO,RT,660.60,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,inpatient,,,730.00000,414.75000,Hometown Health,PPO/EPO,LT,657.00,,,,,,,657.00,708.10,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Hometown Health,PPO/EPO,LT,657.00,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,inpatient,,,730.00000,414.75000,Hometown Health,PPO/EPO,RT,657.00,,,,,,,657.00,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Hometown Health,PPO/EPO,RT,657.00,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,inpatient,,,260.00000,147.72000,Hometown Health,PPO/EPO,LT,234.00,,,,,,,234.00,252.20,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Hometown Health,PPO/EPO,LT,234.00,,,,,,,67.60,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,inpatient,,,260.00000,147.72000,Hometown Health,PPO/EPO,RT,234.00,,,,,,,234.00,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Hometown Health,PPO/EPO,RT,234.00,,,,,,,67.60,252.20,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,inpatient,,,428.00000,203.73000,Hometown Health,PPO/EPO,,385.20,,,,,,,385.20,415.16,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,outpatient,,,428.00000,203.73000,Hometown Health,PPO/EPO,,385.20,,,,,,,111.28,415.16,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,inpatient,,,492.00000,234.19000,Hometown Health,PPO/EPO,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,outpatient,,,492.00000,234.19000,Hometown Health,PPO/EPO,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,inpatient,,,607.00000,288.93000,Hometown Health,PPO/EPO,,546.30,,,,,,,546.30,588.79,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,outpatient,,,607.00000,288.93000,Hometown Health,PPO/EPO,,546.30,,,,,,,157.82,588.79,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,inpatient,,,649.00000,308.92000,Hometown Health,PPO/EPO,,584.10,,,,,,,584.10,629.53,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,outpatient,,,649.00000,308.92000,Hometown Health,PPO/EPO,,584.10,,,,,,,168.74,629.53,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,inpatient,,,377.00000,121.77000,Hometown Health,PPO/EPO,50,339.30,,,,,,,339.30,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,outpatient,,,377.00000,121.77000,Hometown Health,PPO/EPO,50,339.30,,,,,,,98.02,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,inpatient,,,251.00000,81.07000,Hometown Health,PPO/EPO,LT,225.90,,,,,,,225.90,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Hometown Health,PPO/EPO,LT,225.90,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,inpatient,,,251.00000,81.07000,Hometown Health,PPO/EPO,RT,225.90,,,,,,,225.90,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Hometown Health,PPO/EPO,RT,225.90,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,inpatient,,,1170.00000,377.91000,Hometown Health,PPO/EPO,50,1053.00,,,,,,,1053.00,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,outpatient,,,1170.00000,377.91000,Hometown Health,PPO/EPO,50,1053.00,,,,,,,304.20,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,inpatient,,,780.00000,251.94000,Hometown Health,PPO/EPO,LT,702.00,,,,,,,702.00,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Hometown Health,PPO/EPO,LT,702.00,,,,,,,202.80,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,inpatient,,,780.00000,251.94000,Hometown Health,PPO/EPO,RT,702.00,,,,,,,702.00,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Hometown Health,PPO/EPO,RT,702.00,,,,,,,202.80,756.60,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,inpatient,,,1389.00000,448.65000,Hometown Health,PPO/EPO,,1250.10,,,,,,,1250.10,1347.33,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,outpatient,,,1389.00000,448.65000,Hometown Health,PPO/EPO,,1250.10,,,,,,,361.14,1347.33,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,inpatient,,,345.00000,111.44000,Hometown Health,PPO/EPO,50,310.50,,,,,,,310.50,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,outpatient,,,345.00000,111.44000,Hometown Health,PPO/EPO,50,310.50,,,,,,,89.70,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,inpatient,,,230.00000,74.29000,Hometown Health,PPO/EPO,LT,207.00,,,,,,,207.00,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Hometown Health,PPO/EPO,LT,207.00,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,inpatient,,,230.00000,74.29000,Hometown Health,PPO/EPO,RT,207.00,,,,,,,207.00,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Hometown Health,PPO/EPO,RT,207.00,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,inpatient,,,2102.00000,678.95000,Hometown Health,PPO/EPO,50,1891.80,,,,,,,1891.80,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,outpatient,,,2102.00000,678.95000,Hometown Health,PPO/EPO,50,1891.80,,,,,,,546.52,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,inpatient,,,1401.00000,452.52000,Hometown Health,PPO/EPO,LT,1260.90,,,,,,,1260.90,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Hometown Health,PPO/EPO,LT,1260.90,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,inpatient,,,1401.00000,452.52000,Hometown Health,PPO/EPO,RT,1260.90,,,,,,,1260.90,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Hometown Health,PPO/EPO,RT,1260.90,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,inpatient,,,357.00000,115.31000,Hometown Health,PPO/EPO,50,321.30,,,,,,,321.30,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,outpatient,,,357.00000,115.31000,Hometown Health,PPO/EPO,50,321.30,,,,,,,92.82,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,inpatient,,,238.00000,76.87000,Hometown Health,PPO/EPO,LT,214.20,,,,,,,214.20,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Hometown Health,PPO/EPO,LT,214.20,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,inpatient,,,238.00000,76.87000,Hometown Health,PPO/EPO,RT,214.20,,,,,,,214.20,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Hometown Health,PPO/EPO,RT,214.20,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,inpatient,,,2082.00000,672.49000,Hometown Health,PPO/EPO,50,1873.80,,,,,,,1873.80,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,outpatient,,,2082.00000,672.49000,Hometown Health,PPO/EPO,50,1873.80,,,,,,,541.32,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,inpatient,,,1388.00000,448.32000,Hometown Health,PPO/EPO,LT,1249.20,,,,,,,1249.20,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Hometown Health,PPO/EPO,LT,1249.20,,,,,,,360.88,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,inpatient,,,1388.00000,448.32000,Hometown Health,PPO/EPO,RT,1249.20,,,,,,,1249.20,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Hometown Health,PPO/EPO,RT,1249.20,,,,,,,360.88,1346.36,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,inpatient,,,246.00000,79.46000,Hometown Health,PPO/EPO,50,221.40,,,,,,,221.40,238.62,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,outpatient,,,246.00000,79.46000,Hometown Health,PPO/EPO,50,221.40,,,,,,,63.96,238.62,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,inpatient,,,164.00000,52.97000,Hometown Health,PPO/EPO,LT,147.60,,,,,,,147.60,159.08,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Hometown Health,PPO/EPO,LT,147.60,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,inpatient,,,164.00000,52.97000,Hometown Health,PPO/EPO,RT,147.60,,,,,,,147.60,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Hometown Health,PPO/EPO,RT,147.60,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,inpatient,,,309.00000,99.81000,Hometown Health,PPO/EPO,50,278.10,,,,,,,278.10,299.73,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,outpatient,,,309.00000,99.81000,Hometown Health,PPO/EPO,50,278.10,,,,,,,80.34,299.73,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,inpatient,,,206.00000,66.54000,Hometown Health,PPO/EPO,LT,185.40,,,,,,,185.40,199.82,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Hometown Health,PPO/EPO,LT,185.40,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,inpatient,,,206.00000,66.54000,Hometown Health,PPO/EPO,RT,185.40,,,,,,,185.40,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Hometown Health,PPO/EPO,RT,185.40,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,inpatient,,,471.00000,152.13000,Hometown Health,PPO/EPO,50,423.90,,,,,,,423.90,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,outpatient,,,471.00000,152.13000,Hometown Health,PPO/EPO,50,423.90,,,,,,,122.46,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,inpatient,,,314.00000,101.42000,Hometown Health,PPO/EPO,LT,282.60,,,,,,,282.60,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Hometown Health,PPO/EPO,LT,282.60,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,inpatient,,,314.00000,101.42000,Hometown Health,PPO/EPO,RT,282.60,,,,,,,282.60,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Hometown Health,PPO/EPO,RT,282.60,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,inpatient,,,239.00000,77.20000,Hometown Health,PPO/EPO,50,215.10,,,,,,,215.10,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,outpatient,,,239.00000,77.20000,Hometown Health,PPO/EPO,50,215.10,,,,,,,62.14,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,inpatient,,,159.00000,51.36000,Hometown Health,PPO/EPO,LT,143.10,,,,,,,143.10,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Hometown Health,PPO/EPO,LT,143.10,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,inpatient,,,159.00000,51.36000,Hometown Health,PPO/EPO,RT,143.10,,,,,,,143.10,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Hometown Health,PPO/EPO,RT,143.10,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,inpatient,,,558.00000,180.23000,Hometown Health,PPO/EPO,50,502.20,,,,,,,502.20,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,outpatient,,,558.00000,180.23000,Hometown Health,PPO/EPO,50,502.20,,,,,,,145.08,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,inpatient,,,372.00000,120.16000,Hometown Health,PPO/EPO,LT,334.80,,,,,,,334.80,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Hometown Health,PPO/EPO,LT,334.80,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,inpatient,,,372.00000,120.16000,Hometown Health,PPO/EPO,RT,334.80,,,,,,,334.80,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Hometown Health,PPO/EPO,RT,334.80,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,inpatient,,,413.00000,133.40000,Hometown Health,PPO/EPO,50,371.70,,,,,,,371.70,400.61,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,outpatient,,,413.00000,133.40000,Hometown Health,PPO/EPO,50,371.70,,,,,,,107.38,400.61,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,inpatient,,,275.00000,88.82000,Hometown Health,PPO/EPO,LT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Hometown Health,PPO/EPO,LT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,inpatient,,,275.00000,88.82000,Hometown Health,PPO/EPO,RT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Hometown Health,PPO/EPO,RT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,inpatient,,,462.00000,149.23000,Hometown Health,PPO/EPO,,415.80,,,,,,,415.80,448.14,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,outpatient,,,462.00000,149.23000,Hometown Health,PPO/EPO,,415.80,,,,,,,120.12,448.14,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,inpatient,,,170.00000,54.91000,Hometown Health,PPO/EPO,,153.00,,,,,,,153.00,164.90,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,outpatient,,,170.00000,54.91000,Hometown Health,PPO/EPO,,153.00,,,,,,,44.20,164.90,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,inpatient,,,281.00000,90.76000,Hometown Health,PPO/EPO,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,outpatient,,,281.00000,90.76000,Hometown Health,PPO/EPO,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,inpatient,,,562.00000,181.53000,Hometown Health,PPO/EPO,,505.80,,,,,,,505.80,545.14,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,outpatient,,,562.00000,181.53000,Hometown Health,PPO/EPO,,505.80,,,,,,,146.12,545.14,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,inpatient,,,2076.00000,670.55000,Hometown Health,PPO/EPO,50,1868.40,,,,,,,1868.40,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,outpatient,,,2076.00000,670.55000,Hometown Health,PPO/EPO,50,1868.40,,,,,,,539.76,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1384.00000,447.03000,Hometown Health,PPO/EPO,LT,1245.60,,,,,,,1245.60,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Hometown Health,PPO/EPO,LT,1245.60,,,,,,,359.84,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1384.00000,447.03000,Hometown Health,PPO/EPO,RT,1245.60,,,,,,,1245.60,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Hometown Health,PPO/EPO,RT,1245.60,,,,,,,359.84,1342.48,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,inpatient,,,934.00000,301.68000,Hometown Health,PPO/EPO,,840.60,,,,,,,840.60,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,outpatient,,,934.00000,301.68000,Hometown Health,PPO/EPO,,840.60,,,,,,,242.84,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,inpatient,,,842.00000,271.97000,Hometown Health,PPO/EPO,,757.80,,,,,,,757.80,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,outpatient,,,842.00000,271.97000,Hometown Health,PPO/EPO,,757.80,,,,,,,218.92,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,inpatient,,,846.00000,273.26000,Hometown Health,PPO/EPO,,761.40,,,,,,,761.40,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,outpatient,,,846.00000,273.26000,Hometown Health,PPO/EPO,,761.40,,,,,,,219.96,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,inpatient,,,971.00000,313.63000,Hometown Health,PPO/EPO,,873.90,,,,,,,873.90,941.87,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,outpatient,,,971.00000,313.63000,Hometown Health,PPO/EPO,,873.90,,,,,,,252.46,941.87,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,inpatient,,,762.00000,246.13000,Hometown Health,PPO/EPO,,685.80,,,,,,,685.80,739.14,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,outpatient,,,762.00000,246.13000,Hometown Health,PPO/EPO,,685.80,,,,,,,198.12,739.14,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,inpatient,,,758.00000,244.83000,Hometown Health,PPO/EPO,,682.20,,,,,,,682.20,735.26,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,outpatient,,,758.00000,244.83000,Hometown Health,PPO/EPO,,682.20,,,,,,,197.08,735.26,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,inpatient,,,161.00000,52.00000,Hometown Health,PPO/EPO,,144.90,,,,,,,144.90,156.17,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,outpatient,,,161.00000,52.00000,Hometown Health,PPO/EPO,,144.90,,,,,,,41.86,156.17,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,inpatient,,,234.00000,75.58000,Hometown Health,PPO/EPO,50,210.60,,,,,,,210.60,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,outpatient,,,234.00000,75.58000,Hometown Health,PPO/EPO,50,210.60,,,,,,,60.84,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,inpatient,,,156.00000,50.39000,Hometown Health,PPO/EPO,LT,140.40,,,,,,,140.40,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Hometown Health,PPO/EPO,LT,140.40,,,,,,,40.56,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,inpatient,,,156.00000,50.39000,Hometown Health,PPO/EPO,RT,140.40,,,,,,,140.40,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Hometown Health,PPO/EPO,RT,140.40,,,,,,,40.56,151.32,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1517.00000,489.99000,Hometown Health,PPO/EPO,50,1365.30,,,,,,,1365.30,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1517.00000,489.99000,Hometown Health,PPO/EPO,50,1365.30,,,,,,,394.42,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1011.00000,326.55000,Hometown Health,PPO/EPO,LT,909.90,,,,,,,909.90,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Hometown Health,PPO/EPO,LT,909.90,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1011.00000,326.55000,Hometown Health,PPO/EPO,RT,909.90,,,,,,,909.90,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Hometown Health,PPO/EPO,RT,909.90,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,inpatient,,,822.00000,265.51000,Hometown Health,PPO/EPO,50,739.80,,,,,,,739.80,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,outpatient,,,822.00000,265.51000,Hometown Health,PPO/EPO,50,739.80,,,,,,,213.72,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,inpatient,,,548.00000,177.00000,Hometown Health,PPO/EPO,LT,493.20,,,,,,,493.20,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Hometown Health,PPO/EPO,LT,493.20,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,inpatient,,,548.00000,177.00000,Hometown Health,PPO/EPO,RT,493.20,,,,,,,493.20,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Hometown Health,PPO/EPO,RT,493.20,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,inpatient,,,2613.00000,844.00000,Hometown Health,PPO/EPO,,2351.70,,,,,,,2351.70,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,outpatient,,,2613.00000,844.00000,Hometown Health,PPO/EPO,,2351.70,,,,,,,679.38,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,inpatient,,,903.00000,291.67000,Hometown Health,PPO/EPO,,812.70,,,,,,,812.70,875.91,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,outpatient,,,903.00000,291.67000,Hometown Health,PPO/EPO,,812.70,,,,,,,234.78,875.91,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,inpatient,,,1156.00000,373.39000,Hometown Health,PPO/EPO,,1040.40,,,,,,,1040.40,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,outpatient,,,1156.00000,373.39000,Hometown Health,PPO/EPO,,1040.40,,,,,,,300.56,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,inpatient,,,677.00000,218.67000,Hometown Health,PPO/EPO,,609.30,,,,,,,609.30,656.69,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,outpatient,,,677.00000,218.67000,Hometown Health,PPO/EPO,,609.30,,,,,,,176.02,656.69,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1928.00000,622.74000,Hometown Health,PPO/EPO,50,1735.20,,,,,,,1735.20,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1928.00000,622.74000,Hometown Health,PPO/EPO,50,1735.20,,,,,,,501.28,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1285.00000,415.06000,Hometown Health,PPO/EPO,LT,1156.50,,,,,,,1156.50,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Hometown Health,PPO/EPO,LT,1156.50,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1285.00000,415.06000,Hometown Health,PPO/EPO,RT,1156.50,,,,,,,1156.50,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Hometown Health,PPO/EPO,RT,1156.50,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,inpatient,,,812.00000,262.28000,Hometown Health,PPO/EPO,50,730.80,,,,,,,730.80,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,outpatient,,,812.00000,262.28000,Hometown Health,PPO/EPO,50,730.80,,,,,,,211.12,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,inpatient,,,541.00000,174.74000,Hometown Health,PPO/EPO,LT,486.90,,,,,,,486.90,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Hometown Health,PPO/EPO,LT,486.90,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,inpatient,,,541.00000,174.74000,Hometown Health,PPO/EPO,RT,486.90,,,,,,,486.90,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Hometown Health,PPO/EPO,RT,486.90,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,inpatient,,,825.00000,266.48000,Hometown Health,PPO/EPO,50,742.50,,,,,,,742.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,outpatient,,,825.00000,266.48000,Hometown Health,PPO/EPO,50,742.50,,,,,,,214.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,inpatient,,,550.00000,177.65000,Hometown Health,PPO/EPO,LT,495.00,,,,,,,495.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Hometown Health,PPO/EPO,LT,495.00,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,inpatient,,,550.00000,177.65000,Hometown Health,PPO/EPO,RT,495.00,,,,,,,495.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Hometown Health,PPO/EPO,RT,495.00,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,inpatient,,,3494.00000,1128.56000,Hometown Health,PPO/EPO,50,3144.60,,,,,,,3144.60,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,outpatient,,,3494.00000,1128.56000,Hometown Health,PPO/EPO,50,3144.60,,,,,,,908.44,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2329.00000,752.27000,Hometown Health,PPO/EPO,LT,2096.10,,,,,,,2096.10,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Hometown Health,PPO/EPO,LT,2096.10,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2329.00000,752.27000,Hometown Health,PPO/EPO,RT,2096.10,,,,,,,2096.10,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Hometown Health,PPO/EPO,RT,2096.10,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,inpatient,,,840.00000,271.32000,Hometown Health,PPO/EPO,50,756.00,,,,,,,756.00,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,outpatient,,,840.00000,271.32000,Hometown Health,PPO/EPO,50,756.00,,,,,,,218.40,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,inpatient,,,560.00000,180.88000,Hometown Health,PPO/EPO,LT,504.00,,,,,,,504.00,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Hometown Health,PPO/EPO,LT,504.00,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,inpatient,,,560.00000,180.88000,Hometown Health,PPO/EPO,RT,504.00,,,,,,,504.00,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Hometown Health,PPO/EPO,RT,504.00,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,inpatient,,,792.00000,255.82000,Hometown Health,PPO/EPO,50,712.80,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,outpatient,,,792.00000,255.82000,Hometown Health,PPO/EPO,50,712.80,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,inpatient,,,528.00000,170.54000,Hometown Health,PPO/EPO,LT,475.20,,,,,,,475.20,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Hometown Health,PPO/EPO,LT,475.20,,,,,,,137.28,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,inpatient,,,528.00000,170.54000,Hometown Health,PPO/EPO,RT,475.20,,,,,,,475.20,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Hometown Health,PPO/EPO,RT,475.20,,,,,,,137.28,512.16,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,inpatient,,,272.00000,87.86000,Hometown Health,PPO/EPO,,244.80,,,,,,,244.80,263.84,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,outpatient,,,272.00000,87.86000,Hometown Health,PPO/EPO,,244.80,,,,,,,70.72,263.84,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,inpatient,,,1268.00000,409.56000,Hometown Health,PPO/EPO,,1141.20,,,,,,,1141.20,1229.96,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,outpatient,,,1268.00000,409.56000,Hometown Health,PPO/EPO,,1141.20,,,,,,,329.68,1229.96,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,inpatient,,,896.00000,289.41000,Hometown Health,PPO/EPO,,806.40,,,,,,,806.40,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,outpatient,,,896.00000,289.41000,Hometown Health,PPO/EPO,,806.40,,,,,,,232.96,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,inpatient,,,884.00000,285.53000,Hometown Health,PPO/EPO,,795.60,,,,,,,795.60,857.48,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,outpatient,,,884.00000,285.53000,Hometown Health,PPO/EPO,,795.60,,,,,,,229.84,857.48,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,inpatient,,,609.00000,326.42000,Hometown Health,PPO/EPO,,548.10,,,,,,,548.10,590.73,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Hometown Health,PPO/EPO,,548.10,,,,,,,158.34,590.73,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,inpatient,,,966.00000,383.50000,Hometown Health,PPO/EPO,,869.40,,,,,,,869.40,937.02,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,outpatient,,,966.00000,383.50000,Hometown Health,PPO/EPO,,869.40,,,,,,,251.16,937.02,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,inpatient,,,872.00000,346.18000,Hometown Health,PPO/EPO,,784.80,,,,,,,784.80,845.84,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,outpatient,,,872.00000,346.18000,Hometown Health,PPO/EPO,,784.80,,,,,,,226.72,845.84,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,inpatient,,,492.00000,195.32000,Hometown Health,PPO/EPO,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,outpatient,,,492.00000,195.32000,Hometown Health,PPO/EPO,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,inpatient,,,331.00000,131.41000,Hometown Health,PPO/EPO,,297.90,,,,,,,297.90,321.07,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,outpatient,,,331.00000,131.41000,Hometown Health,PPO/EPO,,297.90,,,,,,,86.06,321.07,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,inpatient,,,5215.00000,2070.36000,Hometown Health,PPO/EPO,,4693.50,,,,,,,4693.50,5058.55,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,outpatient,,,5215.00000,2070.36000,Hometown Health,PPO/EPO,,4693.50,,,,,,,1355.90,5058.55,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,inpatient,,,5422.00000,2152.53000,Hometown Health,PPO/EPO,,4879.80,,,,,,,4879.80,5259.34,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,outpatient,,,5422.00000,2152.53000,Hometown Health,PPO/EPO,,4879.80,,,,,,,1409.72,5259.34,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,inpatient,,,1878.00000,788.76000,Hometown Health,PPO/EPO,,1690.20,,,,,,,1690.20,1821.66,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1878.00000,788.76000,Hometown Health,PPO/EPO,,1690.20,,,,,,,488.28,1821.66,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,inpatient,,,2253.00000,946.26000,Hometown Health,PPO/EPO,,2027.70,,,,,,,2027.70,2185.41,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,outpatient,,,2253.00000,946.26000,Hometown Health,PPO/EPO,,2027.70,,,,,,,585.78,2185.41,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,inpatient,,,1502.00000,630.84000,Hometown Health,PPO/EPO,,1351.80,,,,,,,1351.80,1456.94,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1502.00000,630.84000,Hometown Health,PPO/EPO,,1351.80,,,,,,,390.52,1456.94,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,inpatient,,,2024.00000,850.08000,Hometown Health,PPO/EPO,,1821.60,,,,,,,1821.60,1963.28,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,outpatient,,,2024.00000,850.08000,Hometown Health,PPO/EPO,,1821.60,,,,,,,526.24,1963.28,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,inpatient,,,2429.00000,1020.18000,Hometown Health,PPO/EPO,,2186.10,,,,,,,2186.10,2356.13,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,outpatient,,,2429.00000,1020.18000,Hometown Health,PPO/EPO,,2186.10,,,,,,,631.54,2356.13,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,inpatient,,,1619.00000,679.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1619.00000,679.98000,Hometown Health,PPO/EPO,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,inpatient,,,2425.00000,1018.50000,Hometown Health,PPO/EPO,,2182.50,,,,,,,2182.50,2352.25,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,outpatient,,,2425.00000,1018.50000,Hometown Health,PPO/EPO,,2182.50,,,,,,,630.50,2352.25,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,inpatient,,,2910.00000,1222.20000,Hometown Health,PPO/EPO,,2619.00,,,,,,,2619.00,2822.70,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2910.00000,1222.20000,Hometown Health,PPO/EPO,,2619.00,,,,,,,756.60,2822.70,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,inpatient,,,1940.00000,814.80000,Hometown Health,PPO/EPO,,1746.00,,,,,,,1746.00,1881.80,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1940.00000,814.80000,Hometown Health,PPO/EPO,,1746.00,,,,,,,504.40,1881.80,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,inpatient,,,2317.00000,973.14000,Hometown Health,PPO/EPO,,2085.30,,,,,,,2085.30,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2317.00000,973.14000,Hometown Health,PPO/EPO,,2085.30,,,,,,,602.42,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,inpatient,,,2780.00000,1167.60000,Hometown Health,PPO/EPO,,2502.00,,,,,,,2502.00,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2780.00000,1167.60000,Hometown Health,PPO/EPO,,2502.00,,,,,,,722.80,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,inpatient,,,1853.00000,778.26000,Hometown Health,PPO/EPO,,1667.70,,,,,,,1667.70,1797.41,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1853.00000,778.26000,Hometown Health,PPO/EPO,,1667.70,,,,,,,481.78,1797.41,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,inpatient,,,2366.00000,993.72000,Hometown Health,PPO/EPO,,2129.40,,,,,,,2129.40,2295.02,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2366.00000,993.72000,Hometown Health,PPO/EPO,,2129.40,,,,,,,615.16,2295.02,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,inpatient,,,3056.00000,1283.52000,Hometown Health,PPO/EPO,,2750.40,,,,,,,2750.40,2964.32,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,outpatient,,,3056.00000,1283.52000,Hometown Health,PPO/EPO,,2750.40,,,,,,,794.56,2964.32,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,inpatient,,,2829.00000,1386.21000,Hometown Health,PPO/EPO,,2546.10,,,,,,,2546.10,2744.13,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,outpatient,,,2829.00000,1386.21000,Hometown Health,PPO/EPO,,2546.10,,,,,,,735.54,2744.13,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,inpatient,,,3395.00000,1663.55000,Hometown Health,PPO/EPO,,3055.50,,,,,,,3055.50,3293.15,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,outpatient,,,3395.00000,1663.55000,Hometown Health,PPO/EPO,,3055.50,,,,,,,882.70,3293.15,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,inpatient,,,2263.00000,1108.87000,Hometown Health,PPO/EPO,,2036.70,,,,,,,2036.70,2195.11,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,outpatient,,,2263.00000,1108.87000,Hometown Health,PPO/EPO,,2036.70,,,,,,,588.38,2195.11,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,inpatient,,,4697.00000,2301.53000,Hometown Health,PPO/EPO,,4227.30,,,,,,,4227.30,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,outpatient,,,4697.00000,2301.53000,Hometown Health,PPO/EPO,,4227.30,,,,,,,1221.22,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,inpatient,,,5636.00000,2761.64000,Hometown Health,PPO/EPO,,5072.40,,,,,,,5072.40,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,outpatient,,,5636.00000,2761.64000,Hometown Health,PPO/EPO,,5072.40,,,,,,,1465.36,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,inpatient,,,3757.00000,1840.93000,Hometown Health,PPO/EPO,,3381.30,,,,,,,3381.30,3644.29,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,outpatient,,,3757.00000,1840.93000,Hometown Health,PPO/EPO,,3381.30,,,,,,,976.82,3644.29,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,inpatient,,,2619.00000,1283.31000,Hometown Health,PPO/EPO,,2357.10,,,,,,,2357.10,2540.43,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,outpatient,,,2619.00000,1283.31000,Hometown Health,PPO/EPO,,2357.10,,,,,,,680.94,2540.43,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,inpatient,,,3143.00000,1540.07000,Hometown Health,PPO/EPO,,2828.70,,,,,,,2828.70,3048.71,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,outpatient,,,3143.00000,1540.07000,Hometown Health,PPO/EPO,,2828.70,,,,,,,817.18,3048.71,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,inpatient,,,2095.00000,1026.55000,Hometown Health,PPO/EPO,,1885.50,,,,,,,1885.50,2032.15,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,outpatient,,,2095.00000,1026.55000,Hometown Health,PPO/EPO,,1885.50,,,,,,,544.70,2032.15,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,inpatient,,,278.00000,136.22000,Hometown Health,PPO/EPO,,250.20,,,,,,,250.20,269.66,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,outpatient,,,278.00000,136.22000,Hometown Health,PPO/EPO,,250.20,,,,,,,72.28,269.66,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,inpatient,,,2110.00000,1033.90000,Hometown Health,PPO/EPO,LT,1899.00,,,,,,,1899.00,2046.70,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Hometown Health,PPO/EPO,LT,1899.00,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,inpatient,,,2110.00000,1033.90000,Hometown Health,PPO/EPO,RT,1899.00,,,,,,,1899.00,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Hometown Health,PPO/EPO,RT,1899.00,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2532.00000,1240.68000,Hometown Health,PPO/EPO,LT,2278.80,,,,,,,2278.80,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Hometown Health,PPO/EPO,LT,2278.80,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2532.00000,1240.68000,Hometown Health,PPO/EPO,RT,2278.80,,,,,,,2278.80,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Hometown Health,PPO/EPO,RT,2278.80,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1688.00000,827.12000,Hometown Health,PPO/EPO,LT,1519.20,,,,,,,1519.20,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Hometown Health,PPO/EPO,LT,1519.20,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1688.00000,827.12000,Hometown Health,PPO/EPO,RT,1519.20,,,,,,,1519.20,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Hometown Health,PPO/EPO,RT,1519.20,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,inpatient,,,2024.00000,991.76000,Hometown Health,PPO/EPO,LT,1821.60,,,,,,,1821.60,1963.28,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Hometown Health,PPO/EPO,LT,1821.60,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,inpatient,,,2024.00000,991.76000,Hometown Health,PPO/EPO,RT,1821.60,,,,,,,1821.60,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Hometown Health,PPO/EPO,RT,1821.60,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2429.00000,1190.21000,Hometown Health,PPO/EPO,LT,2186.10,,,,,,,2186.10,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Hometown Health,PPO/EPO,LT,2186.10,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2429.00000,1190.21000,Hometown Health,PPO/EPO,RT,2186.10,,,,,,,2186.10,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Hometown Health,PPO/EPO,RT,2186.10,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1619.00000,793.31000,Hometown Health,PPO/EPO,LT,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Hometown Health,PPO/EPO,LT,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1619.00000,793.31000,Hometown Health,PPO/EPO,RT,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Hometown Health,PPO/EPO,RT,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,inpatient,,,1224.00000,599.76000,Hometown Health,PPO/EPO,,1101.60,,,,,,,1101.60,1187.28,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,outpatient,,,1224.00000,599.76000,Hometown Health,PPO/EPO,,1101.60,,,,,,,318.24,1187.28,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,inpatient,,,3020.00000,1479.80000,Hometown Health,PPO/EPO,,2718.00,,,,,,,2718.00,2929.40,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,outpatient,,,3020.00000,1479.80000,Hometown Health,PPO/EPO,,2718.00,,,,,,,785.20,2929.40,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,inpatient,,,3624.00000,1775.76000,Hometown Health,PPO/EPO,,3261.60,,,,,,,3261.60,3515.28,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,outpatient,,,3624.00000,1775.76000,Hometown Health,PPO/EPO,,3261.60,,,,,,,942.24,3515.28,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,inpatient,,,2416.00000,1183.84000,Hometown Health,PPO/EPO,,2174.40,,,,,,,2174.40,2343.52,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,outpatient,,,2416.00000,1183.84000,Hometown Health,PPO/EPO,,2174.40,,,,,,,628.16,2343.52,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,inpatient,,,2728.00000,1336.72000,Hometown Health,PPO/EPO,,2455.20,,,,,,,2455.20,2646.16,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,outpatient,,,2728.00000,1336.72000,Hometown Health,PPO/EPO,,2455.20,,,,,,,709.28,2646.16,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,inpatient,,,3273.00000,1603.77000,Hometown Health,PPO/EPO,,2945.70,,,,,,,2945.70,3174.81,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,outpatient,,,3273.00000,1603.77000,Hometown Health,PPO/EPO,,2945.70,,,,,,,850.98,3174.81,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,inpatient,,,2182.00000,1069.18000,Hometown Health,PPO/EPO,,1963.80,,,,,,,1963.80,2116.54,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,outpatient,,,2182.00000,1069.18000,Hometown Health,PPO/EPO,,1963.80,,,,,,,567.32,2116.54,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,inpatient,,,3133.00000,1535.17000,Hometown Health,PPO/EPO,,2819.70,,,,,,,2819.70,3039.01,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,outpatient,,,3133.00000,1535.17000,Hometown Health,PPO/EPO,,2819.70,,,,,,,814.58,3039.01,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,inpatient,,,3759.00000,1841.91000,Hometown Health,PPO/EPO,,3383.10,,,,,,,3383.10,3646.23,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,outpatient,,,3759.00000,1841.91000,Hometown Health,PPO/EPO,,3383.10,,,,,,,977.34,3646.23,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,inpatient,,,2506.00000,1227.94000,Hometown Health,PPO/EPO,,2255.40,,,,,,,2255.40,2430.82,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,outpatient,,,2506.00000,1227.94000,Hometown Health,PPO/EPO,,2255.40,,,,,,,651.56,2430.82,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,inpatient,,,2857.00000,1399.93000,Hometown Health,PPO/EPO,,2571.30,,,,,,,2571.30,2771.29,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,outpatient,,,2857.00000,1399.93000,Hometown Health,PPO/EPO,,2571.30,,,,,,,742.82,2771.29,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,inpatient,,,3428.00000,1679.72000,Hometown Health,PPO/EPO,,3085.20,,,,,,,3085.20,3325.16,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,outpatient,,,3428.00000,1679.72000,Hometown Health,PPO/EPO,,3085.20,,,,,,,891.28,3325.16,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,inpatient,,,2285.00000,1119.65000,Hometown Health,PPO/EPO,,2056.50,,,,,,,2056.50,2216.45,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,outpatient,,,2285.00000,1119.65000,Hometown Health,PPO/EPO,,2056.50,,,,,,,594.10,2216.45,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,inpatient,,,3565.00000,1746.85000,Hometown Health,PPO/EPO,,3208.50,,,,,,,3208.50,3458.05,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,outpatient,,,3565.00000,1746.85000,Hometown Health,PPO/EPO,,3208.50,,,,,,,926.90,3458.05,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,inpatient,,,5918.00000,2899.82000,Hometown Health,PPO/EPO,,5326.20,,,,,,,5326.20,5740.46,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,outpatient,,,5918.00000,2899.82000,Hometown Health,PPO/EPO,,5326.20,,,,,,,1538.68,5740.46,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,inpatient,,,3301.00000,1617.49000,Hometown Health,PPO/EPO,,2970.90,,,,,,,2970.90,3201.97,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,outpatient,,,3301.00000,1617.49000,Hometown Health,PPO/EPO,,2970.90,,,,,,,858.26,3201.97,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2659.00000,1302.91000,Hometown Health,PPO/EPO,LT,2393.10,,,,,,,2393.10,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Hometown Health,PPO/EPO,LT,2393.10,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2659.00000,1302.91000,Hometown Health,PPO/EPO,RT,2393.10,,,,,,,2393.10,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Hometown Health,PPO/EPO,RT,2393.10,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2551.00000,1249.99000,Hometown Health,PPO/EPO,LT,2295.90,,,,,,,2295.90,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Hometown Health,PPO/EPO,LT,2295.90,,,,,,,663.26,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2551.00000,1249.99000,Hometown Health,PPO/EPO,RT,2295.90,,,,,,,2295.90,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Hometown Health,PPO/EPO,RT,2295.90,,,,,,,663.26,2474.47,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,inpatient,,,3806.00000,1864.94000,Hometown Health,PPO/EPO,,3425.40,,,,,,,3425.40,3691.82,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3806.00000,1864.94000,Hometown Health,PPO/EPO,,3425.40,,,,,,,989.56,3691.82,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,inpatient,,,2149.00000,694.13000,Hometown Health,PPO/EPO,,1934.10,,,,,,,1934.10,2084.53,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,outpatient,,,2149.00000,694.13000,Hometown Health,PPO/EPO,,1934.10,,,,,,,558.74,2084.53,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,inpatient,,,1973.00000,637.28000,Hometown Health,PPO/EPO,,1775.70,,,,,,,1775.70,1913.81,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,outpatient,,,1973.00000,637.28000,Hometown Health,PPO/EPO,,1775.70,,,,,,,512.98,1913.81,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1784.00000,576.23000,Hometown Health,PPO/EPO,50,1605.60,,,,,,,1605.60,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1784.00000,576.23000,Hometown Health,PPO/EPO,50,1605.60,,,,,,,463.84,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1189.00000,384.05000,Hometown Health,PPO/EPO,LT,1070.10,,,,,,,1070.10,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Hometown Health,PPO/EPO,LT,1070.10,,,,,,,309.14,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1189.00000,384.05000,Hometown Health,PPO/EPO,RT,1070.10,,,,,,,1070.10,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Hometown Health,PPO/EPO,RT,1070.10,,,,,,,309.14,1153.33,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,inpatient,,,130.00000,69.68000,Hometown Health,PPO/EPO,,117.00,,,,,,,117.00,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,outpatient,,,130.00000,69.68000,Hometown Health,PPO/EPO,,117.00,,,,,,,33.80,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,inpatient,,,44.00000,23.58000,Hometown Health,PPO/EPO,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,outpatient,,,44.00000,23.58000,Hometown Health,PPO/EPO,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,inpatient,,,456.00000,244.42000,Hometown Health,PPO/EPO,,410.40,,,,,,,410.40,442.32,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,outpatient,,,456.00000,244.42000,Hometown Health,PPO/EPO,,410.40,,,,,,,118.56,442.32,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,inpatient,,,108.00000,57.89000,Hometown Health,PPO/EPO,,97.20,,,,,,,97.20,104.76,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,outpatient,,,108.00000,57.89000,Hometown Health,PPO/EPO,,97.20,,,,,,,28.08,104.76,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,inpatient,,,306.00000,164.02000,Hometown Health,PPO/EPO,,275.40,,,,,,,275.40,296.82,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,outpatient,,,306.00000,164.02000,Hometown Health,PPO/EPO,,275.40,,,,,,,79.56,296.82,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,inpatient,,,257.00000,137.75000,Hometown Health,PPO/EPO,,231.30,,,,,,,231.30,249.29,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,outpatient,,,257.00000,137.75000,Hometown Health,PPO/EPO,,231.30,,,,,,,66.82,249.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4057.00000,2036.61000,Hometown Health,PPO/EPO,,3651.30,,,,,,,3651.30,3935.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Hometown Health,PPO/EPO,,3651.30,,,,,,,1054.82,3935.29,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4868.00000,2443.74000,Hometown Health,PPO/EPO,,4381.20,,,,,,,4381.20,4721.96,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Hometown Health,PPO/EPO,,4381.20,,,,,,,1265.68,4721.96,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,inpatient,,,3245.00000,1628.99000,Hometown Health,PPO/EPO,,2920.50,,,,,,,2920.50,3147.65,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Hometown Health,PPO/EPO,,2920.50,,,,,,,843.70,3147.65,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4057.00000,2036.61000,Hometown Health,PPO/EPO,,3651.30,,,,,,,3651.30,3935.29,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Hometown Health,PPO/EPO,,3651.30,,,,,,,1054.82,3935.29,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4868.00000,2443.74000,Hometown Health,PPO/EPO,,4381.20,,,,,,,4381.20,4721.96,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Hometown Health,PPO/EPO,,4381.20,,,,,,,1265.68,4721.96,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,inpatient,,,3245.00000,1628.99000,Hometown Health,PPO/EPO,,2920.50,,,,,,,2920.50,3147.65,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Hometown Health,PPO/EPO,,2920.50,,,,,,,843.70,3147.65,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,inpatient,,,1725.00000,865.95000,Hometown Health,PPO/EPO,,1552.50,,,,,,,1552.50,1673.25,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,outpatient,,,1725.00000,865.95000,Hometown Health,PPO/EPO,,1552.50,,,,,,,448.50,1673.25,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,inpatient,,,1743.00000,874.99000,Hometown Health,PPO/EPO,,1568.70,,,,,,,1568.70,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,outpatient,,,1743.00000,874.99000,Hometown Health,PPO/EPO,,1568.70,,,,,,,453.18,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,inpatient,,,1475.00000,740.45000,Hometown Health,PPO/EPO,LT,1327.50,,,,,,,1327.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Hometown Health,PPO/EPO,LT,1327.50,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,inpatient,,,1475.00000,740.45000,Hometown Health,PPO/EPO,RT,1327.50,,,,,,,1327.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Hometown Health,PPO/EPO,RT,1327.50,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,inpatient,,,1162.00000,583.32000,Hometown Health,PPO/EPO,,1045.80,,,,,,,1045.80,1127.14,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,outpatient,,,1162.00000,583.32000,Hometown Health,PPO/EPO,,1045.80,,,,,,,302.12,1127.14,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,inpatient,,,983.00000,493.47000,Hometown Health,PPO/EPO,LT,884.70,,,,,,,884.70,953.51,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Hometown Health,PPO/EPO,LT,884.70,,,,,,,255.58,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,inpatient,,,983.00000,493.47000,Hometown Health,PPO/EPO,RT,884.70,,,,,,,884.70,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Hometown Health,PPO/EPO,RT,884.70,,,,,,,255.58,953.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,inpatient,,,3183.00000,1597.87000,Hometown Health,PPO/EPO,,2864.70,,,,,,,2864.70,3087.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,outpatient,,,3183.00000,1597.87000,Hometown Health,PPO/EPO,,2864.70,,,,,,,827.58,3087.51,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,inpatient,,,3819.00000,1917.14000,Hometown Health,PPO/EPO,,3437.10,,,,,,,3437.10,3704.43,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,outpatient,,,3819.00000,1917.14000,Hometown Health,PPO/EPO,,3437.10,,,,,,,992.94,3704.43,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,inpatient,,,2546.00000,1278.09000,Hometown Health,PPO/EPO,,2291.40,,,,,,,2291.40,2469.62,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,outpatient,,,2546.00000,1278.09000,Hometown Health,PPO/EPO,,2291.40,,,,,,,661.96,2469.62,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,inpatient,,,3858.00000,1936.72000,Hometown Health,PPO/EPO,LT,3472.20,,,,,,,3472.20,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Hometown Health,PPO/EPO,LT,3472.20,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,inpatient,,,3858.00000,1936.72000,Hometown Health,PPO/EPO,RT,3472.20,,,,,,,3472.20,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Hometown Health,PPO/EPO,RT,3472.20,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,inpatient,,,4629.00000,2323.76000,Hometown Health,PPO/EPO,LT,4166.10,,,,,,,4166.10,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Hometown Health,PPO/EPO,LT,4166.10,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,inpatient,,,4629.00000,2323.76000,Hometown Health,PPO/EPO,RT,4166.10,,,,,,,4166.10,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Hometown Health,PPO/EPO,RT,4166.10,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,inpatient,,,3086.00000,1549.17000,Hometown Health,PPO/EPO,LT,2777.40,,,,,,,2777.40,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Hometown Health,PPO/EPO,LT,2777.40,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,inpatient,,,3086.00000,1549.17000,Hometown Health,PPO/EPO,RT,2777.40,,,,,,,2777.40,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Hometown Health,PPO/EPO,RT,2777.40,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,inpatient,,,2505.00000,1257.51000,Hometown Health,PPO/EPO,LT,2254.50,,,,,,,2254.50,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Hometown Health,PPO/EPO,LT,2254.50,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,inpatient,,,2505.00000,1257.51000,Hometown Health,PPO/EPO,RT,2254.50,,,,,,,2254.50,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Hometown Health,PPO/EPO,RT,2254.50,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,inpatient,,,3006.00000,1509.01000,Hometown Health,PPO/EPO,LT,2705.40,,,,,,,2705.40,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Hometown Health,PPO/EPO,LT,2705.40,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,inpatient,,,3006.00000,1509.01000,Hometown Health,PPO/EPO,RT,2705.40,,,,,,,2705.40,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Hometown Health,PPO/EPO,RT,2705.40,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,inpatient,,,2004.00000,1006.01000,Hometown Health,PPO/EPO,LT,1803.60,,,,,,,1803.60,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Hometown Health,PPO/EPO,LT,1803.60,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,inpatient,,,2004.00000,1006.01000,Hometown Health,PPO/EPO,RT,1803.60,,,,,,,1803.60,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Hometown Health,PPO/EPO,RT,1803.60,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,inpatient,,,3137.00000,1574.77000,Hometown Health,PPO/EPO,LT,2823.30,,,,,,,2823.30,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Hometown Health,PPO/EPO,LT,2823.30,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,inpatient,,,3137.00000,1574.77000,Hometown Health,PPO/EPO,RT,2823.30,,,,,,,2823.30,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Hometown Health,PPO/EPO,RT,2823.30,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,inpatient,,,3764.00000,1889.53000,Hometown Health,PPO/EPO,LT,3387.60,,,,,,,3387.60,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Hometown Health,PPO/EPO,LT,3387.60,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,inpatient,,,3764.00000,1889.53000,Hometown Health,PPO/EPO,RT,3387.60,,,,,,,3387.60,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Hometown Health,PPO/EPO,RT,3387.60,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,inpatient,,,2509.00000,1259.52000,Hometown Health,PPO/EPO,LT,2258.10,,,,,,,2258.10,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Hometown Health,PPO/EPO,LT,2258.10,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,inpatient,,,2509.00000,1259.52000,Hometown Health,PPO/EPO,RT,2258.10,,,,,,,2258.10,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Hometown Health,PPO/EPO,RT,2258.10,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,inpatient,,,3023.00000,1517.55000,Hometown Health,PPO/EPO,LT,2720.70,,,,,,,2720.70,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Hometown Health,PPO/EPO,LT,2720.70,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,inpatient,,,3023.00000,1517.55000,Hometown Health,PPO/EPO,RT,2720.70,,,,,,,2720.70,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Hometown Health,PPO/EPO,RT,2720.70,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,inpatient,,,3627.00000,1820.75000,Hometown Health,PPO/EPO,LT,3264.30,,,,,,,3264.30,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Hometown Health,PPO/EPO,LT,3264.30,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,inpatient,,,3627.00000,1820.75000,Hometown Health,PPO/EPO,RT,3264.30,,,,,,,3264.30,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Hometown Health,PPO/EPO,RT,3264.30,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,inpatient,,,2418.00000,1213.84000,Hometown Health,PPO/EPO,LT,2176.20,,,,,,,2176.20,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Hometown Health,PPO/EPO,LT,2176.20,,,,,,,628.68,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,inpatient,,,2418.00000,1213.84000,Hometown Health,PPO/EPO,RT,2176.20,,,,,,,2176.20,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Hometown Health,PPO/EPO,RT,2176.20,,,,,,,628.68,2345.46,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,inpatient,,,870.00000,436.74000,Hometown Health,PPO/EPO,,783.00,,,,,,,783.00,843.90,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,outpatient,,,870.00000,436.74000,Hometown Health,PPO/EPO,,783.00,,,,,,,226.20,843.90,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,inpatient,,,1353.00000,679.21000,Hometown Health,PPO/EPO,,1217.70,,,,,,,1217.70,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,outpatient,,,1353.00000,679.21000,Hometown Health,PPO/EPO,,1217.70,,,,,,,351.78,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,inpatient,,,902.00000,452.80000,Hometown Health,PPO/EPO,LT,811.80,,,,,,,811.80,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Hometown Health,PPO/EPO,LT,811.80,,,,,,,234.52,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,inpatient,,,902.00000,452.80000,Hometown Health,PPO/EPO,RT,811.80,,,,,,,811.80,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Hometown Health,PPO/EPO,RT,811.80,,,,,,,234.52,874.94,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,inpatient,,,3489.00000,1751.48000,Hometown Health,PPO/EPO,,3140.10,,,,,,,3140.10,3384.33,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3489.00000,1751.48000,Hometown Health,PPO/EPO,,3140.10,,,,,,,907.14,3384.33,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,inpatient,,,4187.00000,2101.87000,Hometown Health,PPO/EPO,,3768.30,,,,,,,3768.30,4061.39,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,outpatient,,,4187.00000,2101.87000,Hometown Health,PPO/EPO,,3768.30,,,,,,,1088.62,4061.39,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,inpatient,,,2791.00000,1401.08000,Hometown Health,PPO/EPO,,2511.90,,,,,,,2511.90,2707.27,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,outpatient,,,2791.00000,1401.08000,Hometown Health,PPO/EPO,,2511.90,,,,,,,725.66,2707.27,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,inpatient,,,492.00000,246.98000,Hometown Health,PPO/EPO,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,outpatient,,,492.00000,246.98000,Hometown Health,PPO/EPO,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,inpatient,,,331.00000,166.16000,Hometown Health,PPO/EPO,,297.90,,,,,,,297.90,321.07,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,outpatient,,,331.00000,166.16000,Hometown Health,PPO/EPO,,297.90,,,,,,,86.06,321.07,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,inpatient,,,4440.00000,2357.64000,Hometown Health,PPO/EPO,,3996.00,,,,,,,3996.00,4306.80,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,outpatient,,,4440.00000,2357.64000,Hometown Health,PPO/EPO,,3996.00,,,,,,,1154.40,4306.80,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,inpatient,,,5328.00000,2829.17000,Hometown Health,PPO/EPO,,4795.20,,,,,,,4795.20,5168.16,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,outpatient,,,5328.00000,2829.17000,Hometown Health,PPO/EPO,,4795.20,,,,,,,1385.28,5168.16,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,inpatient,,,3552.00000,1886.11000,Hometown Health,PPO/EPO,,3196.80,,,,,,,3196.80,3445.44,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,outpatient,,,3552.00000,1886.11000,Hometown Health,PPO/EPO,,3196.80,,,,,,,923.52,3445.44,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,inpatient,,,2528.00000,1342.37000,Hometown Health,PPO/EPO,,2275.20,,,,,,,2275.20,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,outpatient,,,2528.00000,1342.37000,Hometown Health,PPO/EPO,,2275.20,,,,,,,657.28,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,inpatient,,,3033.00000,1610.52000,Hometown Health,PPO/EPO,,2729.70,,,,,,,2729.70,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,outpatient,,,3033.00000,1610.52000,Hometown Health,PPO/EPO,,2729.70,,,,,,,788.58,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,inpatient,,,2022.00000,1073.68000,Hometown Health,PPO/EPO,,1819.80,,,,,,,1819.80,1961.34,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,outpatient,,,2022.00000,1073.68000,Hometown Health,PPO/EPO,,1819.80,,,,,,,525.72,1961.34,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,inpatient,,,3610.00000,1909.69000,Hometown Health,PPO/EPO,,3249.00,,,,,,,3249.00,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,outpatient,,,3610.00000,1909.69000,Hometown Health,PPO/EPO,,3249.00,,,,,,,938.60,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,inpatient,,,4332.00000,2291.63000,Hometown Health,PPO/EPO,,3898.80,,,,,,,3898.80,4202.04,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,outpatient,,,4332.00000,2291.63000,Hometown Health,PPO/EPO,,3898.80,,,,,,,1126.32,4202.04,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,inpatient,,,2888.00000,1527.75000,Hometown Health,PPO/EPO,,2599.20,,,,,,,2599.20,2801.36,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,outpatient,,,2888.00000,1527.75000,Hometown Health,PPO/EPO,,2599.20,,,,,,,750.88,2801.36,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,inpatient,,,4532.00000,2397.43000,Hometown Health,PPO/EPO,,4078.80,,,,,,,4078.80,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,outpatient,,,4532.00000,2397.43000,Hometown Health,PPO/EPO,,4078.80,,,,,,,1178.32,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,inpatient,,,5438.00000,2876.70000,Hometown Health,PPO/EPO,,4894.20,,,,,,,4894.20,5274.86,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,outpatient,,,5438.00000,2876.70000,Hometown Health,PPO/EPO,,4894.20,,,,,,,1413.88,5274.86,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,inpatient,,,3625.00000,1917.62000,Hometown Health,PPO/EPO,,3262.50,,,,,,,3262.50,3516.25,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,outpatient,,,3625.00000,1917.62000,Hometown Health,PPO/EPO,,3262.50,,,,,,,942.50,3516.25,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,inpatient,,,3639.00000,1925.03000,Hometown Health,PPO/EPO,,3275.10,,,,,,,3275.10,3529.83,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,outpatient,,,3639.00000,1925.03000,Hometown Health,PPO/EPO,,3275.10,,,,,,,946.14,3529.83,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,inpatient,,,4367.00000,2310.14000,Hometown Health,PPO/EPO,,3930.30,,,,,,,3930.30,4235.99,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,outpatient,,,4367.00000,2310.14000,Hometown Health,PPO/EPO,,3930.30,,,,,,,1135.42,4235.99,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,inpatient,,,2911.00000,1539.92000,Hometown Health,PPO/EPO,,2619.90,,,,,,,2619.90,2823.67,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,outpatient,,,2911.00000,1539.92000,Hometown Health,PPO/EPO,,2619.90,,,,,,,756.86,2823.67,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,inpatient,,,3494.00000,1719.05000,Hometown Health,PPO/EPO,,3144.60,,,,,,,3144.60,3389.18,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3494.00000,1719.05000,Hometown Health,PPO/EPO,,3144.60,,,,,,,908.44,3389.18,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,inpatient,,,4193.00000,2062.96000,Hometown Health,PPO/EPO,,3773.70,,,,,,,3773.70,4067.21,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,outpatient,,,4193.00000,2062.96000,Hometown Health,PPO/EPO,,3773.70,,,,,,,1090.18,4067.21,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,inpatient,,,2795.00000,1375.14000,Hometown Health,PPO/EPO,,2515.50,,,,,,,2515.50,2711.15,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,outpatient,,,2795.00000,1375.14000,Hometown Health,PPO/EPO,,2515.50,,,,,,,726.70,2711.15,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,inpatient,,,2717.00000,1336.76000,Hometown Health,PPO/EPO,,2445.30,,,,,,,2445.30,2635.49,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,outpatient,,,2717.00000,1336.76000,Hometown Health,PPO/EPO,,2445.30,,,,,,,706.42,2635.49,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,inpatient,,,3260.00000,1603.92000,Hometown Health,PPO/EPO,,2934.00,,,,,,,2934.00,3162.20,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,outpatient,,,3260.00000,1603.92000,Hometown Health,PPO/EPO,,2934.00,,,,,,,847.60,3162.20,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,inpatient,,,2173.00000,1069.12000,Hometown Health,PPO/EPO,,1955.70,,,,,,,1955.70,2107.81,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,outpatient,,,2173.00000,1069.12000,Hometown Health,PPO/EPO,,1955.70,,,,,,,564.98,2107.81,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4051.00000,2301.58000,Hometown Health,PPO/EPO,LT,3645.90,,,,,,,3645.90,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Hometown Health,PPO/EPO,LT,3645.90,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4051.00000,2301.58000,Hometown Health,PPO/EPO,RT,3645.90,,,,,,,3645.90,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Hometown Health,PPO/EPO,RT,3645.90,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4861.00000,2761.78000,Hometown Health,PPO/EPO,LT,4374.90,,,,,,,4374.90,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Hometown Health,PPO/EPO,LT,4374.90,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4861.00000,2761.78000,Hometown Health,PPO/EPO,RT,4374.90,,,,,,,4374.90,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Hometown Health,PPO/EPO,RT,4374.90,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3241.00000,1841.37000,Hometown Health,PPO/EPO,LT,2916.90,,,,,,,2916.90,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Hometown Health,PPO/EPO,LT,2916.90,,,,,,,842.66,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3241.00000,1841.37000,Hometown Health,PPO/EPO,RT,2916.90,,,,,,,2916.90,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Hometown Health,PPO/EPO,RT,2916.90,,,,,,,842.66,3143.77,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,inpatient,,,4260.00000,2420.32000,Hometown Health,PPO/EPO,,3834.00,,,,,,,3834.00,4132.20,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,outpatient,,,4260.00000,2420.32000,Hometown Health,PPO/EPO,,3834.00,,,,,,,1107.60,4132.20,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,inpatient,,,5112.00000,2904.38000,Hometown Health,PPO/EPO,,4600.80,,,,,,,4600.80,4958.64,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,outpatient,,,5112.00000,2904.38000,Hometown Health,PPO/EPO,,4600.80,,,,,,,1329.12,4958.64,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,inpatient,,,3408.00000,1936.26000,Hometown Health,PPO/EPO,,3067.20,,,,,,,3067.20,3305.76,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3408.00000,1936.26000,Hometown Health,PPO/EPO,,3067.20,,,,,,,886.08,3305.76,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,inpatient,,,3343.00000,1899.33000,Hometown Health,PPO/EPO,,3008.70,,,,,,,3008.70,3242.71,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3343.00000,1899.33000,Hometown Health,PPO/EPO,,3008.70,,,,,,,869.18,3242.71,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,inpatient,,,4010.00000,2278.28000,Hometown Health,PPO/EPO,,3609.00,,,,,,,3609.00,3889.70,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,outpatient,,,4010.00000,2278.28000,Hometown Health,PPO/EPO,,3609.00,,,,,,,1042.60,3889.70,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,inpatient,,,2674.00000,1519.23000,Hometown Health,PPO/EPO,,2406.60,,,,,,,2406.60,2593.78,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,outpatient,,,2674.00000,1519.23000,Hometown Health,PPO/EPO,,2406.60,,,,,,,695.24,2593.78,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3294.00000,1871.49000,Hometown Health,PPO/EPO,LT,2964.60,,,,,,,2964.60,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Hometown Health,PPO/EPO,LT,2964.60,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3294.00000,1871.49000,Hometown Health,PPO/EPO,RT,2964.60,,,,,,,2964.60,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Hometown Health,PPO/EPO,RT,2964.60,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3953.00000,2245.90000,Hometown Health,PPO/EPO,LT,3557.70,,,,,,,3557.70,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Hometown Health,PPO/EPO,LT,3557.70,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3953.00000,2245.90000,Hometown Health,PPO/EPO,RT,3557.70,,,,,,,3557.70,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Hometown Health,PPO/EPO,RT,3557.70,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,inpatient,,,2635.00000,1497.08000,Hometown Health,PPO/EPO,LT,2371.50,,,,,,,2371.50,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Hometown Health,PPO/EPO,LT,2371.50,,,,,,,685.10,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,inpatient,,,2635.00000,1497.08000,Hometown Health,PPO/EPO,RT,2371.50,,,,,,,2371.50,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Hometown Health,PPO/EPO,RT,2371.50,,,,,,,685.10,2555.95,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,inpatient,,,3664.00000,2081.70000,Hometown Health,PPO/EPO,,3297.60,,,,,,,3297.60,3554.08,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3664.00000,2081.70000,Hometown Health,PPO/EPO,,3297.60,,,,,,,952.64,3554.08,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,inpatient,,,4397.00000,2498.16000,Hometown Health,PPO/EPO,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,outpatient,,,4397.00000,2498.16000,Hometown Health,PPO/EPO,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,inpatient,,,2931.00000,1665.25000,Hometown Health,PPO/EPO,,2637.90,,,,,,,2637.90,2843.07,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,outpatient,,,2931.00000,1665.25000,Hometown Health,PPO/EPO,,2637.90,,,,,,,762.06,2843.07,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,inpatient,,,4759.00000,2703.83000,Hometown Health,PPO/EPO,,4283.10,,,,,,,4283.10,4616.23,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,outpatient,,,4759.00000,2703.83000,Hometown Health,PPO/EPO,,4283.10,,,,,,,1237.34,4616.23,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,inpatient,,,5710.00000,3244.14000,Hometown Health,PPO/EPO,,5139.00,,,,,,,5139.00,5538.70,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,outpatient,,,5710.00000,3244.14000,Hometown Health,PPO/EPO,,5139.00,,,,,,,1484.60,5538.70,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,inpatient,,,3807.00000,2162.95000,Hometown Health,PPO/EPO,,3426.30,,,,,,,3426.30,3692.79,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3807.00000,2162.95000,Hometown Health,PPO/EPO,,3426.30,,,,,,,989.82,3692.79,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,inpatient,,,2915.00000,1574.10000,Hometown Health,PPO/EPO,,2623.50,,,,,,,2623.50,2827.55,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2915.00000,1574.10000,Hometown Health,PPO/EPO,,2623.50,,,,,,,757.90,2827.55,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,inpatient,,,1918.00000,1035.72000,Hometown Health,PPO/EPO,,1726.20,,,,,,,1726.20,1860.46,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1918.00000,1035.72000,Hometown Health,PPO/EPO,,1726.20,,,,,,,498.68,1860.46,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,inpatient,,,2292.00000,1237.68000,Hometown Health,PPO/EPO,,2062.80,,,,,,,2062.80,2223.24,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2292.00000,1237.68000,Hometown Health,PPO/EPO,,2062.80,,,,,,,595.92,2223.24,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,inpatient,,,2984.00000,1611.36000,Hometown Health,PPO/EPO,,2685.60,,,,,,,2685.60,2894.48,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,outpatient,,,2984.00000,1611.36000,Hometown Health,PPO/EPO,,2685.60,,,,,,,775.84,2894.48,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,inpatient,,,769.00000,415.26000,Hometown Health,PPO/EPO,,692.10,,,,,,,692.10,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,outpatient,,,769.00000,415.26000,Hometown Health,PPO/EPO,,692.10,,,,,,,199.94,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,inpatient,,,1280.00000,691.20000,Hometown Health,PPO/EPO,,1152.00,,,,,,,1152.00,1241.60,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,outpatient,,,1280.00000,691.20000,Hometown Health,PPO/EPO,,1152.00,,,,,,,332.80,1241.60,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,inpatient,,,1878.00000,1014.12000,Hometown Health,PPO/EPO,,1690.20,,,,,,,1690.20,1821.66,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,outpatient,,,1878.00000,1014.12000,Hometown Health,PPO/EPO,,1690.20,,,,,,,488.28,1821.66,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,inpatient,,,2196.00000,1185.84000,Hometown Health,PPO/EPO,,1976.40,,,,,,,1976.40,2130.12,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,outpatient,,,2196.00000,1185.84000,Hometown Health,PPO/EPO,,1976.40,,,,,,,570.96,2130.12,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,inpatient,,,844.00000,455.76000,Hometown Health,PPO/EPO,,759.60,,,,,,,759.60,818.68,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,outpatient,,,844.00000,455.76000,Hometown Health,PPO/EPO,,759.60,,,,,,,219.44,818.68,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,inpatient,,,1305.00000,704.70000,Hometown Health,PPO/EPO,,1174.50,,,,,,,1174.50,1265.85,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,outpatient,,,1305.00000,704.70000,Hometown Health,PPO/EPO,,1174.50,,,,,,,339.30,1265.85,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,inpatient,,,576.00000,311.04000,Hometown Health,PPO/EPO,,518.40,,,,,,,518.40,558.72,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,outpatient,,,576.00000,311.04000,Hometown Health,PPO/EPO,,518.40,,,,,,,149.76,558.72,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,inpatient,,,809.00000,436.86000,Hometown Health,PPO/EPO,,728.10,,,,,,,728.10,784.73,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,outpatient,,,809.00000,436.86000,Hometown Health,PPO/EPO,,728.10,,,,,,,210.34,784.73,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,inpatient,,,2462.00000,1329.48000,Hometown Health,PPO/EPO,,2215.80,,,,,,,2215.80,2388.14,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,outpatient,,,2462.00000,1329.48000,Hometown Health,PPO/EPO,,2215.80,,,,,,,640.12,2388.14,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,inpatient,,,918.00000,495.72000,Hometown Health,PPO/EPO,,826.20,,,,,,,826.20,890.46,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,outpatient,,,918.00000,495.72000,Hometown Health,PPO/EPO,,826.20,,,,,,,238.68,890.46,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,inpatient,,,1102.00000,595.08000,Hometown Health,PPO/EPO,,991.80,,,,,,,991.80,1068.94,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,outpatient,,,1102.00000,595.08000,Hometown Health,PPO/EPO,,991.80,,,,,,,286.52,1068.94,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,inpatient,,,812.00000,438.48000,Hometown Health,PPO/EPO,,730.80,,,,,,,730.80,787.64,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,outpatient,,,812.00000,438.48000,Hometown Health,PPO/EPO,,730.80,,,,,,,211.12,787.64,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,inpatient,,,1407.00000,759.78000,Hometown Health,PPO/EPO,,1266.30,,,,,,,1266.30,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,outpatient,,,1407.00000,759.78000,Hometown Health,PPO/EPO,,1266.30,,,,,,,365.82,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,inpatient,,,1980.00000,1069.20000,Hometown Health,PPO/EPO,,1782.00,,,,,,,1782.00,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,outpatient,,,1980.00000,1069.20000,Hometown Health,PPO/EPO,,1782.00,,,,,,,514.80,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,inpatient,,,964.00000,520.56000,Hometown Health,PPO/EPO,,867.60,,,,,,,867.60,935.08,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,outpatient,,,964.00000,520.56000,Hometown Health,PPO/EPO,,867.60,,,,,,,250.64,935.08,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,inpatient,,,1040.00000,561.60000,Hometown Health,PPO/EPO,,936.00,,,,,,,936.00,1008.80,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,outpatient,,,1040.00000,561.60000,Hometown Health,PPO/EPO,,936.00,,,,,,,270.40,1008.80,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,inpatient,,,795.00000,429.30000,Hometown Health,PPO/EPO,,715.50,,,,,,,715.50,771.15,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,outpatient,,,795.00000,429.30000,Hometown Health,PPO/EPO,,715.50,,,,,,,206.70,771.15,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,inpatient,,,1124.00000,606.96000,Hometown Health,PPO/EPO,,1011.60,,,,,,,1011.60,1090.28,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,outpatient,,,1124.00000,606.96000,Hometown Health,PPO/EPO,,1011.60,,,,,,,292.24,1090.28,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,inpatient,,,736.00000,397.44000,Hometown Health,PPO/EPO,,662.40,,,,,,,662.40,713.92,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,outpatient,,,736.00000,397.44000,Hometown Health,PPO/EPO,,662.40,,,,,,,191.36,713.92,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,inpatient,,,700.00000,378.00000,Hometown Health,PPO/EPO,,630.00,,,,,,,630.00,679.00,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,outpatient,,,700.00000,378.00000,Hometown Health,PPO/EPO,,630.00,,,,,,,182.00,679.00,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,inpatient,,,821.00000,443.34000,Hometown Health,PPO/EPO,,738.90,,,,,,,738.90,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,outpatient,,,821.00000,443.34000,Hometown Health,PPO/EPO,,738.90,,,,,,,213.46,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,inpatient,,,846.00000,456.84000,Hometown Health,PPO/EPO,,761.40,,,,,,,761.40,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,outpatient,,,846.00000,456.84000,Hometown Health,PPO/EPO,,761.40,,,,,,,219.96,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,inpatient,,,958.00000,517.32000,Hometown Health,PPO/EPO,,862.20,,,,,,,862.20,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,outpatient,,,958.00000,517.32000,Hometown Health,PPO/EPO,,862.20,,,,,,,249.08,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,inpatient,,,1261.00000,680.94000,Hometown Health,PPO/EPO,,1134.90,,,,,,,1134.90,1223.17,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,outpatient,,,1261.00000,680.94000,Hometown Health,PPO/EPO,,1134.90,,,,,,,327.86,1223.17,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,inpatient,,,971.00000,524.34000,Hometown Health,PPO/EPO,,873.90,,,,,,,873.90,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,outpatient,,,971.00000,524.34000,Hometown Health,PPO/EPO,,873.90,,,,,,,252.46,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,inpatient,,,1837.00000,991.98000,Hometown Health,PPO/EPO,,1653.30,,,,,,,1653.30,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,outpatient,,,1837.00000,991.98000,Hometown Health,PPO/EPO,,1653.30,,,,,,,477.62,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,inpatient,,,1099.00000,593.46000,Hometown Health,PPO/EPO,,989.10,,,,,,,989.10,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,outpatient,,,1099.00000,593.46000,Hometown Health,PPO/EPO,,989.10,,,,,,,285.74,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,inpatient,,,2178.00000,1176.12000,Hometown Health,PPO/EPO,,1960.20,,,,,,,1960.20,2112.66,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,outpatient,,,2178.00000,1176.12000,Hometown Health,PPO/EPO,,1960.20,,,,,,,566.28,2112.66,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,inpatient,,,1226.00000,662.04000,Hometown Health,PPO/EPO,,1103.40,,,,,,,1103.40,1189.22,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,outpatient,,,1226.00000,662.04000,Hometown Health,PPO/EPO,,1103.40,,,,,,,318.76,1189.22,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,inpatient,,,1048.00000,565.92000,Hometown Health,PPO/EPO,,943.20,,,,,,,943.20,1016.56,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,outpatient,,,1048.00000,565.92000,Hometown Health,PPO/EPO,,943.20,,,,,,,272.48,1016.56,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,inpatient,,,970.00000,523.80000,Hometown Health,PPO/EPO,,873.00,,,,,,,873.00,940.90,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,outpatient,,,970.00000,523.80000,Hometown Health,PPO/EPO,,873.00,,,,,,,252.20,940.90,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,inpatient,,,1803.00000,973.62000,Hometown Health,PPO/EPO,,1622.70,,,,,,,1622.70,1748.91,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,outpatient,,,1803.00000,973.62000,Hometown Health,PPO/EPO,,1622.70,,,,,,,468.78,1748.91,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,inpatient,,,2504.00000,1352.16000,Hometown Health,PPO/EPO,,2253.60,,,,,,,2253.60,2428.88,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,outpatient,,,2504.00000,1352.16000,Hometown Health,PPO/EPO,,2253.60,,,,,,,651.04,2428.88,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,inpatient,,,2457.00000,1326.78000,Hometown Health,PPO/EPO,,2211.30,,,,,,,2211.30,2383.29,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2457.00000,1326.78000,Hometown Health,PPO/EPO,,2211.30,,,,,,,638.82,2383.29,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,inpatient,,,923.00000,498.42000,Hometown Health,PPO/EPO,,830.70,,,,,,,830.70,895.31,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,outpatient,,,923.00000,498.42000,Hometown Health,PPO/EPO,,830.70,,,,,,,239.98,895.31,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,inpatient,,,5478.00000,2958.12000,Hometown Health,PPO/EPO,,4930.20,,,,,,,4930.20,5313.66,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,outpatient,,,5478.00000,2958.12000,Hometown Health,PPO/EPO,,4930.20,,,,,,,1424.28,5313.66,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,inpatient,,,4551.00000,2457.54000,Hometown Health,PPO/EPO,,4095.90,,,,,,,4095.90,4414.47,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,outpatient,,,4551.00000,2457.54000,Hometown Health,PPO/EPO,,4095.90,,,,,,,1183.26,4414.47,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,inpatient,,,1360.00000,734.40000,Hometown Health,PPO/EPO,,1224.00,,,,,,,1224.00,1319.20,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,outpatient,,,1360.00000,734.40000,Hometown Health,PPO/EPO,,1224.00,,,,,,,353.60,1319.20,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,inpatient,,,1209.00000,652.86000,Hometown Health,PPO/EPO,,1088.10,,,,,,,1088.10,1172.73,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,outpatient,,,1209.00000,652.86000,Hometown Health,PPO/EPO,,1088.10,,,,,,,314.34,1172.73,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,inpatient,,,848.00000,457.92000,Hometown Health,PPO/EPO,,763.20,,,,,,,763.20,822.56,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,outpatient,,,848.00000,457.92000,Hometown Health,PPO/EPO,,763.20,,,,,,,220.48,822.56,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,inpatient,,,1071.00000,578.34000,Hometown Health,PPO/EPO,,963.90,,,,,,,963.90,1038.87,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,outpatient,,,1071.00000,578.34000,Hometown Health,PPO/EPO,,963.90,,,,,,,278.46,1038.87,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,inpatient,,,1792.00000,967.68000,Hometown Health,PPO/EPO,,1612.80,,,,,,,1612.80,1738.24,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,outpatient,,,1792.00000,967.68000,Hometown Health,PPO/EPO,,1612.80,,,,,,,465.92,1738.24,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,inpatient,,,35.00000,18.90000,Hometown Health,PPO/EPO,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,outpatient,,,35.00000,18.90000,Hometown Health,PPO/EPO,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,inpatient,,,285.00000,153.90000,Hometown Health,PPO/EPO,,256.50,,,,,,,256.50,276.45,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,outpatient,,,285.00000,153.90000,Hometown Health,PPO/EPO,,256.50,,,,,,,74.10,276.45,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,inpatient,,,1012.00000,546.48000,Hometown Health,PPO/EPO,,910.80,,,,,,,910.80,981.64,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,outpatient,,,1012.00000,546.48000,Hometown Health,PPO/EPO,,910.80,,,,,,,263.12,981.64,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,inpatient,,,492.00000,265.68000,Hometown Health,PPO/EPO,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,outpatient,,,492.00000,265.68000,Hometown Health,PPO/EPO,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,inpatient,,,739.00000,399.06000,Hometown Health,PPO/EPO,,665.10,,,,,,,665.10,716.83,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,outpatient,,,739.00000,399.06000,Hometown Health,PPO/EPO,,665.10,,,,,,,192.14,716.83,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,inpatient,,,515.00000,278.10000,Hometown Health,PPO/EPO,,463.50,,,,,,,463.50,499.55,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,outpatient,,,515.00000,278.10000,Hometown Health,PPO/EPO,,463.50,,,,,,,133.90,499.55,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,inpatient,,,1467.00000,792.18000,Hometown Health,PPO/EPO,,1320.30,,,,,,,1320.30,1422.99,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,outpatient,,,1467.00000,792.18000,Hometown Health,PPO/EPO,,1320.30,,,,,,,381.42,1422.99,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,inpatient,,,1683.00000,888.62000,Hometown Health,PPO/EPO,,1514.70,,,,,,,1514.70,1632.51,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,outpatient,,,1683.00000,888.62000,Hometown Health,PPO/EPO,,1514.70,,,,,,,437.58,1632.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,inpatient,,,426.30000,225.09000,Hometown Health,PPO/EPO,,383.67,,,,,,,383.67,413.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,426.30000,225.09000,Hometown Health,PPO/EPO,,383.67,,,,,,,110.84,413.51,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,inpatient,,,725.00000,382.80000,Hometown Health,PPO/EPO,,652.50,,,,,,,652.50,703.25,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,725.00000,382.80000,Hometown Health,PPO/EPO,,652.50,,,,,,,188.50,1855.42,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,inpatient,,,1852.00000,977.86000,Hometown Health,PPO/EPO,,1666.80,,,,,,,1666.80,1796.44,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,1852.00000,977.86000,Hometown Health,PPO/EPO,,1666.80,,,,,,,481.52,1868.26,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,110.00000,58.08000,Hometown Health,PPO/EPO,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,110.00000,58.08000,Hometown Health,PPO/EPO,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,inpatient,,,98.00000,51.74000,Hometown Health,PPO/EPO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,98.00000,51.74000,Hometown Health,PPO/EPO,,88.20,,,,,,,25.48,1662.92,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,inpatient,,,2018.00000,1065.50000,Hometown Health,PPO/EPO,,1816.20,,,,,,,1816.20,1957.46,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,2018.00000,1065.50000,Hometown Health,PPO/EPO,,1816.20,,,,,,,524.68,1957.46,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,inpatient,,,4325.00000,2283.60000,Hometown Health,PPO/EPO,,3892.50,,,,,,,3892.50,4195.25,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,4325.00000,2283.60000,Hometown Health,PPO/EPO,,3892.50,,,,,,,1124.50,4195.25,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,inpatient,,,172.00000,90.82000,Hometown Health,PPO/EPO,,154.80,,,,,,,154.80,166.84,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Hometown Health,PPO/EPO,,154.80,,,,,,,44.72,166.84,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,inpatient,,,942.00000,497.38000,Hometown Health,PPO/EPO,,847.80,,,,,,,847.80,913.74,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,942.00000,497.38000,Hometown Health,PPO/EPO,,847.80,,,,,,,244.92,913.74,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,inpatient,,,413.00000,218.06000,Hometown Health,PPO/EPO,,371.70,,,,,,,371.70,400.61,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,413.00000,218.06000,Hometown Health,PPO/EPO,,371.70,,,,,,,107.38,400.61,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,inpatient,,,257.00000,135.70000,Hometown Health,PPO/EPO,,231.30,,,,,,,231.30,249.29,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,outpatient,,,257.00000,135.70000,Hometown Health,PPO/EPO,,231.30,,,,,,,66.82,249.29,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,inpatient,,,116.00000,61.25000,Hometown Health,PPO/EPO,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,116.00000,61.25000,Hometown Health,PPO/EPO,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,inpatient,,,463.20000,244.57000,Hometown Health,PPO/EPO,,416.88,,,,,,,416.88,449.30,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,463.20000,244.57000,Hometown Health,PPO/EPO,,416.88,,,,,,,120.43,449.30,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,inpatient,,,804.00000,424.51000,Hometown Health,PPO/EPO,,723.60,,,,,,,723.60,779.88,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,804.00000,424.51000,Hometown Health,PPO/EPO,,723.60,,,,,,,209.04,779.88,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,inpatient,,,172.00000,90.82000,Hometown Health,PPO/EPO,,154.80,,,,,,,154.80,166.84,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Hometown Health,PPO/EPO,,154.80,,,,,,,44.72,166.84,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,inpatient,,,354.30000,187.07000,Hometown Health,PPO/EPO,,318.87,,,,,,,318.87,343.67,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,354.30000,187.07000,Hometown Health,PPO/EPO,,318.87,,,,,,,92.12,343.67,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,inpatient,,,277.90000,146.73000,Hometown Health,PPO/EPO,,250.11,,,,,,,250.11,269.56,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,277.90000,146.73000,Hometown Health,PPO/EPO,,250.11,,,,,,,72.25,269.56,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,inpatient,,,200.00000,105.60000,Hometown Health,PPO/EPO,,180.00,,,,,,,180.00,194.00,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,200.00000,105.60000,Hometown Health,PPO/EPO,,180.00,,,,,,,52.00,194.00,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,inpatient,,,197.00000,63.63000,Hometown Health,PPO/EPO,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,outpatient,,,197.00000,63.63000,Hometown Health,PPO/EPO,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,inpatient,,,468.00000,151.16000,Hometown Health,PPO/EPO,50,421.20,,,,,,,421.20,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,outpatient,,,468.00000,151.16000,Hometown Health,PPO/EPO,50,421.20,,,,,,,121.68,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,inpatient,,,312.00000,100.78000,Hometown Health,PPO/EPO,LT,280.80,,,,,,,280.80,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Hometown Health,PPO/EPO,LT,280.80,,,,,,,81.12,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,inpatient,,,312.00000,100.78000,Hometown Health,PPO/EPO,RT,280.80,,,,,,,280.80,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Hometown Health,PPO/EPO,RT,280.80,,,,,,,81.12,302.64,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Hometown Health,PPO/EPO,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Hometown Health,PPO/EPO,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,inpatient,,,609.00000,196.71000,Hometown Health,PPO/EPO,,548.10,,,,,,,548.10,590.73,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Hometown Health,PPO/EPO,,548.10,,,,,,,158.34,590.73,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,inpatient,,,1248.00000,403.10000,Hometown Health,PPO/EPO,50,1123.20,,,,,,,1123.20,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1248.00000,403.10000,Hometown Health,PPO/EPO,50,1123.20,,,,,,,324.48,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,inpatient,,,832.00000,268.74000,Hometown Health,PPO/EPO,LT,748.80,,,,,,,748.80,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Hometown Health,PPO/EPO,LT,748.80,,,,,,,216.32,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,inpatient,,,832.00000,268.74000,Hometown Health,PPO/EPO,RT,748.80,,,,,,,748.80,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Hometown Health,PPO/EPO,RT,748.80,,,,,,,216.32,807.04,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,inpatient,,,4235.00000,1367.90000,Hometown Health,PPO/EPO,LT,3811.50,,,,,,,3811.50,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Hometown Health,PPO/EPO,LT,3811.50,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,inpatient,,,4235.00000,1367.90000,Hometown Health,PPO/EPO,RT,3811.50,,,,,,,3811.50,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Hometown Health,PPO/EPO,RT,3811.50,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,inpatient,,,2119.00000,684.44000,Hometown Health,PPO/EPO,,1907.10,,,,,,,1907.10,2055.43,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,outpatient,,,2119.00000,684.44000,Hometown Health,PPO/EPO,,1907.10,,,,,,,550.94,2055.43,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,inpatient,,,1943.00000,627.59000,Hometown Health,PPO/EPO,,1748.70,,,,,,,1748.70,1884.71,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1943.00000,627.59000,Hometown Health,PPO/EPO,,1748.70,,,,,,,505.18,1884.71,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,inpatient,,,1426.00000,460.60000,Hometown Health,PPO/EPO,,1283.40,,,,,,,1283.40,1383.22,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,outpatient,,,1426.00000,460.60000,Hometown Health,PPO/EPO,,1283.40,,,,,,,370.76,1383.22,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,inpatient,,,4202.00000,1357.25000,Hometown Health,PPO/EPO,50,3781.80,,,,,,,3781.80,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,outpatient,,,4202.00000,1357.25000,Hometown Health,PPO/EPO,50,3781.80,,,,,,,1092.52,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,inpatient,,,2801.00000,904.72000,Hometown Health,PPO/EPO,LT,2520.90,,,,,,,2520.90,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Hometown Health,PPO/EPO,LT,2520.90,,,,,,,728.26,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,inpatient,,,2801.00000,904.72000,Hometown Health,PPO/EPO,RT,2520.90,,,,,,,2520.90,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Hometown Health,PPO/EPO,RT,2520.90,,,,,,,728.26,2716.97,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,inpatient,,,832.00000,268.74000,Hometown Health,PPO/EPO,,748.80,,,,,,,748.80,807.04,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,outpatient,,,832.00000,268.74000,Hometown Health,PPO/EPO,,748.80,,,,,,,216.32,807.04,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,inpatient,,,1457.00000,470.61000,Hometown Health,PPO/EPO,,1311.30,,,,,,,1311.30,1413.29,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,outpatient,,,1457.00000,470.61000,Hometown Health,PPO/EPO,,1311.30,,,,,,,378.82,1413.29,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,inpatient,,,743.00000,239.99000,Hometown Health,PPO/EPO,LT,668.70,,,,,,,668.70,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Hometown Health,PPO/EPO,LT,668.70,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,inpatient,,,743.00000,239.99000,Hometown Health,PPO/EPO,RT,668.70,,,,,,,668.70,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Hometown Health,PPO/EPO,RT,668.70,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,inpatient,,,232.00000,74.94000,Hometown Health,PPO/EPO,,208.80,,,,,,,208.80,225.04,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,outpatient,,,232.00000,74.94000,Hometown Health,PPO/EPO,,208.80,,,,,,,60.32,225.04,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,inpatient,,,1364.00000,440.57000,Hometown Health,PPO/EPO,50,1227.60,,,,,,,1227.60,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,outpatient,,,1364.00000,440.57000,Hometown Health,PPO/EPO,50,1227.60,,,,,,,354.64,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,inpatient,,,909.00000,293.61000,Hometown Health,PPO/EPO,LT,818.10,,,,,,,818.10,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Hometown Health,PPO/EPO,LT,818.10,,,,,,,236.34,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,inpatient,,,909.00000,293.61000,Hometown Health,PPO/EPO,RT,818.10,,,,,,,818.10,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Hometown Health,PPO/EPO,RT,818.10,,,,,,,236.34,881.73,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,inpatient,,,510.00000,355.98000,Hometown Health,PPO/EPO,,459.00,,,,,,,459.00,494.70,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,outpatient,,,510.00000,355.98000,Hometown Health,PPO/EPO,,459.00,,,,,,,132.60,494.70,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,inpatient,,,1001.00000,698.70000,Hometown Health,PPO/EPO,,900.90,,,,,,,900.90,970.97,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,outpatient,,,1001.00000,698.70000,Hometown Health,PPO/EPO,,900.90,,,,,,,260.26,970.97,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,inpatient,,,887.00000,619.13000,Hometown Health,PPO/EPO,,798.30,,,,,,,798.30,860.39,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,outpatient,,,887.00000,619.13000,Hometown Health,PPO/EPO,,798.30,,,,,,,230.62,860.39,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,inpatient,,,1022.00000,713.36000,Hometown Health,PPO/EPO,50,919.80,,,,,,,919.80,991.34,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,outpatient,,,1022.00000,713.36000,Hometown Health,PPO/EPO,50,919.80,,,,,,,265.72,991.34,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,inpatient,,,681.00000,475.34000,Hometown Health,PPO/EPO,LT,612.90,,,,,,,612.90,660.57,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Hometown Health,PPO/EPO,LT,612.90,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,inpatient,,,681.00000,475.34000,Hometown Health,PPO/EPO,RT,612.90,,,,,,,612.90,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Hometown Health,PPO/EPO,RT,612.90,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,inpatient,,,945.00000,659.61000,Hometown Health,PPO/EPO,50,850.50,,,,,,,850.50,916.65,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,outpatient,,,945.00000,659.61000,Hometown Health,PPO/EPO,50,850.50,,,,,,,245.70,916.65,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,inpatient,,,630.00000,439.74000,Hometown Health,PPO/EPO,LT,567.00,,,,,,,567.00,611.10,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Hometown Health,PPO/EPO,LT,567.00,,,,,,,163.80,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,inpatient,,,630.00000,439.74000,Hometown Health,PPO/EPO,RT,567.00,,,,,,,567.00,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Hometown Health,PPO/EPO,RT,567.00,,,,,,,163.80,611.10,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,inpatient,,,577.00000,402.75000,Hometown Health,PPO/EPO,,519.30,,,,,,,519.30,559.69,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,outpatient,,,577.00000,402.75000,Hometown Health,PPO/EPO,,519.30,,,,,,,150.02,559.69,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,inpatient,,,433.00000,302.23000,Hometown Health,PPO/EPO,,389.70,,,,,,,389.70,420.01,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,outpatient,,,433.00000,302.23000,Hometown Health,PPO/EPO,,389.70,,,,,,,112.58,420.01,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,inpatient,,,331.00000,231.04000,Hometown Health,PPO/EPO,,297.90,,,,,,,297.90,321.07,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,outpatient,,,331.00000,231.04000,Hometown Health,PPO/EPO,,297.90,,,,,,,86.06,321.07,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,inpatient,,,662.00000,462.08000,Hometown Health,PPO/EPO,,595.80,,,,,,,595.80,642.14,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,outpatient,,,662.00000,462.08000,Hometown Health,PPO/EPO,,595.80,,,,,,,172.12,642.14,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,inpatient,,,752.00000,524.90000,Hometown Health,PPO/EPO,,676.80,,,,,,,676.80,729.44,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,outpatient,,,752.00000,524.90000,Hometown Health,PPO/EPO,,676.80,,,,,,,195.52,729.44,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,inpatient,,,182.00000,127.04000,Hometown Health,PPO/EPO,,163.80,,,,,,,163.80,176.54,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Hometown Health,PPO/EPO,,163.80,,,,,,,47.32,176.54,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,inpatient,,,420.00000,293.16000,Hometown Health,PPO/EPO,,378.00,,,,,,,378.00,407.40,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,outpatient,,,420.00000,293.16000,Hometown Health,PPO/EPO,,378.00,,,,,,,109.20,407.40,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,inpatient,,,253.00000,176.59000,Hometown Health,PPO/EPO,,227.70,,,,,,,227.70,245.41,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,outpatient,,,253.00000,176.59000,Hometown Health,PPO/EPO,,227.70,,,,,,,65.78,245.41,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,inpatient,,,168.00000,117.26000,Hometown Health,PPO/EPO,,151.20,,,,,,,151.20,162.96,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,outpatient,,,168.00000,117.26000,Hometown Health,PPO/EPO,,151.20,,,,,,,43.68,162.96,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,inpatient,,,695.00000,485.11000,Hometown Health,PPO/EPO,,625.50,,,,,,,625.50,674.15,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,outpatient,,,695.00000,485.11000,Hometown Health,PPO/EPO,,625.50,,,,,,,180.70,674.15,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,inpatient,,,474.00000,330.85000,Hometown Health,PPO/EPO,,426.60,,,,,,,426.60,459.78,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,outpatient,,,474.00000,330.85000,Hometown Health,PPO/EPO,,426.60,,,,,,,123.24,459.78,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,inpatient,,,930.00000,649.14000,Hometown Health,PPO/EPO,,837.00,,,,,,,837.00,902.10,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,outpatient,,,930.00000,649.14000,Hometown Health,PPO/EPO,,837.00,,,,,,,241.80,902.10,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,inpatient,,,786.00000,548.63000,Hometown Health,PPO/EPO,,707.40,,,,,,,707.40,762.42,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,outpatient,,,786.00000,548.63000,Hometown Health,PPO/EPO,,707.40,,,,,,,204.36,762.42,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,inpatient,,,620.00000,432.76000,Hometown Health,PPO/EPO,,558.00,,,,,,,558.00,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Hometown Health,PPO/EPO,,558.00,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,inpatient,,,620.00000,432.76000,Hometown Health,PPO/EPO,59,558.00,,,,,,,558.00,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Hometown Health,PPO/EPO,59,558.00,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,inpatient,,,435.00000,303.63000,Hometown Health,PPO/EPO,,391.50,,,,,,,391.50,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Hometown Health,PPO/EPO,,391.50,,,,,,,113.10,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,inpatient,,,435.00000,303.63000,Hometown Health,PPO/EPO,59,391.50,,,,,,,391.50,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Hometown Health,PPO/EPO,59,391.50,,,,,,,113.10,421.95,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,inpatient,,,492.00000,343.42000,Hometown Health,PPO/EPO,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,outpatient,,,492.00000,343.42000,Hometown Health,PPO/EPO,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,inpatient,,,331.00000,231.04000,Hometown Health,PPO/EPO,,297.90,,,,,,,297.90,321.07,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,outpatient,,,331.00000,231.04000,Hometown Health,PPO/EPO,,297.90,,,,,,,86.06,321.07,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,inpatient,,,875.00000,610.75000,Hometown Health,PPO/EPO,,787.50,,,,,,,787.50,848.75,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,outpatient,,,875.00000,610.75000,Hometown Health,PPO/EPO,,787.50,,,,,,,227.50,848.75,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,inpatient,,,688.00000,480.22000,Hometown Health,PPO/EPO,,619.20,,,,,,,619.20,667.36,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,outpatient,,,688.00000,480.22000,Hometown Health,PPO/EPO,,619.20,,,,,,,178.88,667.36,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,inpatient,,,465.00000,324.57000,Hometown Health,PPO/EPO,,418.50,,,,,,,418.50,451.05,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,outpatient,,,465.00000,324.57000,Hometown Health,PPO/EPO,,418.50,,,,,,,120.90,451.05,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,inpatient,,,846.00000,590.51000,Hometown Health,PPO/EPO,,761.40,,,,,,,761.40,820.62,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,outpatient,,,846.00000,590.51000,Hometown Health,PPO/EPO,,761.40,,,,,,,219.96,820.62,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,inpatient,,,482.00000,336.44000,Hometown Health,PPO/EPO,,433.80,,,,,,,433.80,467.54,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,outpatient,,,482.00000,336.44000,Hometown Health,PPO/EPO,,433.80,,,,,,,125.32,467.54,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,inpatient,,,926.00000,646.35000,Hometown Health,PPO/EPO,,833.40,,,,,,,833.40,898.22,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,outpatient,,,926.00000,646.35000,Hometown Health,PPO/EPO,,833.40,,,,,,,240.76,898.22,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,inpatient,,,292.00000,203.82000,Hometown Health,PPO/EPO,,262.80,,,,,,,262.80,283.24,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,outpatient,,,292.00000,203.82000,Hometown Health,PPO/EPO,,262.80,,,,,,,75.92,283.24,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,inpatient,,,827.00000,577.25000,Hometown Health,PPO/EPO,,744.30,,,,,,,744.30,802.19,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,outpatient,,,827.00000,577.25000,Hometown Health,PPO/EPO,,744.30,,,,,,,215.02,802.19,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,inpatient,,,253.00000,176.59000,Hometown Health,PPO/EPO,,227.70,,,,,,,227.70,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,outpatient,,,253.00000,176.59000,Hometown Health,PPO/EPO,,227.70,,,,,,,65.78,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,inpatient,,,901.00000,628.90000,Hometown Health,PPO/EPO,,810.90,,,,,,,810.90,873.97,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,outpatient,,,901.00000,628.90000,Hometown Health,PPO/EPO,,810.90,,,,,,,234.26,873.97,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,inpatient,,,460.00000,321.08000,Hometown Health,PPO/EPO,,414.00,,,,,,,414.00,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,outpatient,,,460.00000,321.08000,Hometown Health,PPO/EPO,,414.00,,,,,,,119.60,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,inpatient,,,1029.00000,718.24000,Hometown Health,PPO/EPO,,926.10,,,,,,,926.10,998.13,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1029.00000,718.24000,Hometown Health,PPO/EPO,,926.10,,,,,,,267.54,998.13,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,inpatient,,,959.00000,669.38000,Hometown Health,PPO/EPO,,863.10,,,,,,,863.10,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,outpatient,,,959.00000,669.38000,Hometown Health,PPO/EPO,,863.10,,,,,,,249.34,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,inpatient,,,558.00000,389.48000,Hometown Health,PPO/EPO,,502.20,,,,,,,502.20,541.26,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,outpatient,,,558.00000,389.48000,Hometown Health,PPO/EPO,,502.20,,,,,,,145.08,541.26,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,inpatient,,,705.00000,492.09000,Hometown Health,PPO/EPO,,634.50,,,,,,,634.50,683.85,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,outpatient,,,705.00000,492.09000,Hometown Health,PPO/EPO,,634.50,,,,,,,183.30,683.85,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,inpatient,,,249.00000,173.80000,Hometown Health,PPO/EPO,,224.10,,,,,,,224.10,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,outpatient,,,249.00000,173.80000,Hometown Health,PPO/EPO,,224.10,,,,,,,64.74,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,inpatient,,,427.00000,298.05000,Hometown Health,PPO/EPO,,384.30,,,,,,,384.30,414.19,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,outpatient,,,427.00000,298.05000,Hometown Health,PPO/EPO,,384.30,,,,,,,111.02,414.19,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,inpatient,,,737.00000,514.43000,Hometown Health,PPO/EPO,,663.30,,,,,,,663.30,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Hometown Health,PPO/EPO,,663.30,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,inpatient,,,737.00000,514.43000,Hometown Health,PPO/EPO,59,663.30,,,,,,,663.30,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Hometown Health,PPO/EPO,59,663.30,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,inpatient,,,809.00000,564.68000,Hometown Health,PPO/EPO,,728.10,,,,,,,728.10,784.73,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,outpatient,,,809.00000,564.68000,Hometown Health,PPO/EPO,,728.10,,,,,,,210.34,784.73,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,inpatient,,,525.00000,366.45000,Hometown Health,PPO/EPO,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,outpatient,,,525.00000,366.45000,Hometown Health,PPO/EPO,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,inpatient,,,319.00000,222.66000,Hometown Health,PPO/EPO,,287.10,,,,,,,287.10,309.43,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,outpatient,,,319.00000,222.66000,Hometown Health,PPO/EPO,,287.10,,,,,,,82.94,309.43,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,inpatient,,,1437.00000,678.26000,Hometown Health,PPO/EPO,,1293.30,,,,,,,1293.30,1393.89,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1437.00000,678.26000,Hometown Health,PPO/EPO,,1293.30,,,,,,,373.62,1393.89,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,inpatient,,,2143.00000,1011.50000,Hometown Health,PPO/EPO,,1928.70,,,,,,,1928.70,2078.71,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2143.00000,1011.50000,Hometown Health,PPO/EPO,,1928.70,,,,,,,557.18,2078.71,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,inpatient,,,755.00000,356.36000,Hometown Health,PPO/EPO,,679.50,,,,,,,679.50,732.35,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,outpatient,,,755.00000,356.36000,Hometown Health,PPO/EPO,,679.50,,,,,,,196.30,732.35,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,inpatient,,,979.00000,462.09000,Hometown Health,PPO/EPO,,881.10,,,,,,,881.10,949.63,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,outpatient,,,979.00000,462.09000,Hometown Health,PPO/EPO,,881.10,,,,,,,254.54,949.63,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,inpatient,,,436.00000,205.79000,Hometown Health,PPO/EPO,,392.40,,,,,,,392.40,422.92,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,outpatient,,,436.00000,205.79000,Hometown Health,PPO/EPO,,392.40,,,,,,,113.36,422.92,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,inpatient,,,220.00000,103.84000,Hometown Health,PPO/EPO,,198.00,,,,,,,198.00,213.40,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,outpatient,,,220.00000,103.84000,Hometown Health,PPO/EPO,,198.00,,,,,,,57.20,213.40,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,inpatient,,,344.00000,162.37000,Hometown Health,PPO/EPO,,309.60,,,,,,,309.60,333.68,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,outpatient,,,344.00000,162.37000,Hometown Health,PPO/EPO,,309.60,,,,,,,89.44,333.68,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,inpatient,,,818.00000,393.46000,Hometown Health,PPO/EPO,,736.20,,,,,,,736.20,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,outpatient,,,818.00000,393.46000,Hometown Health,PPO/EPO,,736.20,,,,,,,212.68,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,inpatient,,,545.00000,262.14000,Hometown Health,PPO/EPO,52,490.50,,,,,,,490.50,528.65,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,outpatient,,,545.00000,262.14000,Hometown Health,PPO/EPO,52,490.50,,,,,,,141.70,528.65,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,inpatient,,,1347.00000,647.91000,Hometown Health,PPO/EPO,,1212.30,,,,,,,1212.30,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,outpatient,,,1347.00000,647.91000,Hometown Health,PPO/EPO,,1212.30,,,,,,,350.22,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,inpatient,,,898.00000,431.94000,Hometown Health,PPO/EPO,52,808.20,,,,,,,808.20,871.06,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,outpatient,,,898.00000,431.94000,Hometown Health,PPO/EPO,52,808.20,,,,,,,233.48,871.06,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,inpatient,,,469.00000,225.59000,Hometown Health,PPO/EPO,,422.10,,,,,,,422.10,454.93,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,outpatient,,,469.00000,225.59000,Hometown Health,PPO/EPO,,422.10,,,,,,,121.94,454.93,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,inpatient,,,1762.00000,847.52000,Hometown Health,PPO/EPO,,1585.80,,,,,,,1585.80,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,outpatient,,,1762.00000,847.52000,Hometown Health,PPO/EPO,,1585.80,,,,,,,458.12,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,inpatient,,,627.00000,301.59000,Hometown Health,PPO/EPO,,564.30,,,,,,,564.30,608.19,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,outpatient,,,627.00000,301.59000,Hometown Health,PPO/EPO,,564.30,,,,,,,163.02,608.19,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,inpatient,,,590.00000,283.79000,Hometown Health,PPO/EPO,,531.00,,,,,,,531.00,572.30,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,outpatient,,,590.00000,283.79000,Hometown Health,PPO/EPO,,531.00,,,,,,,153.40,572.30,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,inpatient,,,1550.00000,745.55000,Hometown Health,PPO/EPO,,1395.00,,,,,,,1395.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,outpatient,,,1550.00000,745.55000,Hometown Health,PPO/EPO,,1395.00,,,,,,,403.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,inpatient,,,990.00000,476.19000,Hometown Health,PPO/EPO,LT,891.00,,,,,,,891.00,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Hometown Health,PPO/EPO,LT,891.00,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,inpatient,,,990.00000,476.19000,Hometown Health,PPO/EPO,RT,891.00,,,,,,,891.00,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Hometown Health,PPO/EPO,RT,891.00,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,inpatient,,,1402.00000,674.36000,Hometown Health,PPO/EPO,,1261.80,,,,,,,1261.80,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,outpatient,,,1402.00000,674.36000,Hometown Health,PPO/EPO,,1261.80,,,,,,,364.52,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,inpatient,,,980.00000,471.38000,Hometown Health,PPO/EPO,LT,882.00,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Hometown Health,PPO/EPO,LT,882.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,inpatient,,,980.00000,471.38000,Hometown Health,PPO/EPO,RT,882.00,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Hometown Health,PPO/EPO,RT,882.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,inpatient,,,1661.00000,798.94000,Hometown Health,PPO/EPO,,1494.90,,,,,,,1494.90,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,outpatient,,,1661.00000,798.94000,Hometown Health,PPO/EPO,,1494.90,,,,,,,431.86,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,inpatient,,,980.00000,471.38000,Hometown Health,PPO/EPO,,882.00,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,outpatient,,,980.00000,471.38000,Hometown Health,PPO/EPO,,882.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,inpatient,,,1740.00000,836.94000,Hometown Health,PPO/EPO,,1566.00,,,,,,,1566.00,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1740.00000,836.94000,Hometown Health,PPO/EPO,,1566.00,,,,,,,452.40,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,inpatient,,,1168.00000,561.81000,Hometown Health,PPO/EPO,,1051.20,,,,,,,1051.20,1132.96,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1168.00000,561.81000,Hometown Health,PPO/EPO,,1051.20,,,,,,,303.68,1132.96,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,inpatient,,,433.00000,232.09000,Hometown Health,PPO/EPO,,389.70,,,,,,,389.70,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,outpatient,,,433.00000,232.09000,Hometown Health,PPO/EPO,,389.70,,,,,,,112.58,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,inpatient,,,388.00000,207.97000,Hometown Health,PPO/EPO,LT,349.20,,,,,,,349.20,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Hometown Health,PPO/EPO,LT,349.20,,,,,,,100.88,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,inpatient,,,388.00000,207.97000,Hometown Health,PPO/EPO,RT,349.20,,,,,,,349.20,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Hometown Health,PPO/EPO,RT,349.20,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,inpatient,,,388.00000,207.97000,Hometown Health,PPO/EPO,,349.20,,,,,,,349.20,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,outpatient,,,388.00000,207.97000,Hometown Health,PPO/EPO,,349.20,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,inpatient,,,604.00000,323.74000,Hometown Health,PPO/EPO,,543.60,,,,,,,543.60,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,outpatient,,,604.00000,323.74000,Hometown Health,PPO/EPO,,543.60,,,,,,,157.04,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,inpatient,,,667.00000,357.51000,Hometown Health,PPO/EPO,,600.30,,,,,,,600.30,646.99,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,outpatient,,,667.00000,357.51000,Hometown Health,PPO/EPO,,600.30,,,,,,,173.42,646.99,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,inpatient,,,176.00000,94.34000,Hometown Health,PPO/EPO,,158.40,,,,,,,158.40,170.72,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,outpatient,,,176.00000,94.34000,Hometown Health,PPO/EPO,,158.40,,,,,,,45.76,170.72,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,inpatient,,,92.00000,29.72000,Hometown Health,PPO/EPO,LT,82.80,,,,,,,82.80,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Hometown Health,PPO/EPO,LT,82.80,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,inpatient,,,92.00000,29.72000,Hometown Health,PPO/EPO,RT,82.80,,,,,,,82.80,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Hometown Health,PPO/EPO,RT,82.80,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,inpatient,,,366.00000,118.22000,Hometown Health,PPO/EPO,LT,329.40,,,,,,,329.40,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Hometown Health,PPO/EPO,LT,329.40,,,,,,,95.16,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,inpatient,,,366.00000,118.22000,Hometown Health,PPO/EPO,RT,329.40,,,,,,,329.40,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Hometown Health,PPO/EPO,RT,329.40,,,,,,,95.16,355.02,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,inpatient,,,1117.00000,360.79000,Hometown Health,PPO/EPO,LT,1005.30,,,,,,,1005.30,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Hometown Health,PPO/EPO,LT,1005.30,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,inpatient,,,1117.00000,360.79000,Hometown Health,PPO/EPO,RT,1005.30,,,,,,,1005.30,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Hometown Health,PPO/EPO,RT,1005.30,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,inpatient,,,559.00000,180.56000,Hometown Health,PPO/EPO,,503.10,,,,,,,503.10,542.23,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,outpatient,,,559.00000,180.56000,Hometown Health,PPO/EPO,,503.10,,,,,,,145.34,542.23,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,inpatient,,,252.00000,81.40000,Hometown Health,PPO/EPO,50,226.80,,,,,,,226.80,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,outpatient,,,252.00000,81.40000,Hometown Health,PPO/EPO,50,226.80,,,,,,,65.52,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,inpatient,,,168.00000,54.26000,Hometown Health,PPO/EPO,LT,151.20,,,,,,,151.20,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Hometown Health,PPO/EPO,LT,151.20,,,,,,,43.68,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,inpatient,,,168.00000,54.26000,Hometown Health,PPO/EPO,RT,151.20,,,,,,,151.20,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Hometown Health,PPO/EPO,RT,151.20,,,,,,,43.68,162.96,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,inpatient,,,1148.00000,370.80000,Hometown Health,PPO/EPO,LT,1033.20,,,,,,,1033.20,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Hometown Health,PPO/EPO,LT,1033.20,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,inpatient,,,1148.00000,370.80000,Hometown Health,PPO/EPO,RT,1033.20,,,,,,,1033.20,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Hometown Health,PPO/EPO,RT,1033.20,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,inpatient,,,379.00000,122.42000,Hometown Health,PPO/EPO,,341.10,,,,,,,341.10,367.63,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,outpatient,,,379.00000,122.42000,Hometown Health,PPO/EPO,,341.10,,,,,,,98.54,367.63,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,inpatient,,,1015.00000,327.84000,Hometown Health,PPO/EPO,,913.50,,,,,,,913.50,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,outpatient,,,1015.00000,327.84000,Hometown Health,PPO/EPO,,913.50,,,,,,,263.90,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,inpatient,,,591.00000,190.89000,Hometown Health,PPO/EPO,,531.90,,,,,,,531.90,573.27,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,outpatient,,,591.00000,190.89000,Hometown Health,PPO/EPO,,531.90,,,,,,,153.66,573.27,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,inpatient,,,271.00000,169.92000,Hometown Health,PPO/EPO,,243.90,,,,,,,243.90,262.87,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,outpatient,,,271.00000,169.92000,Hometown Health,PPO/EPO,,243.90,,,,,,,70.46,262.87,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,inpatient,,,211.00000,132.30000,Hometown Health,PPO/EPO,LT,189.90,,,,,,,189.90,204.67,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Hometown Health,PPO/EPO,LT,189.90,,,,,,,54.86,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,inpatient,,,211.00000,132.30000,Hometown Health,PPO/EPO,RT,189.90,,,,,,,189.90,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Hometown Health,PPO/EPO,RT,189.90,,,,,,,54.86,204.67,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,59.00000,36.99000,Hometown Health,PPO/EPO,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,59.00000,36.99000,Hometown Health,PPO/EPO,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,inpatient,,,336.00000,219.74000,Hometown Health,PPO/EPO,,302.40,,,,,,,302.40,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,outpatient,,,336.00000,219.74000,Hometown Health,PPO/EPO,,302.40,,,,,,,87.36,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,inpatient,,,224.00000,146.50000,Hometown Health,PPO/EPO,52,201.60,,,,,,,201.60,217.28,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,outpatient,,,224.00000,146.50000,Hometown Health,PPO/EPO,52,201.60,,,,,,,58.24,217.28,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,inpatient,,,63.00000,41.20000,Hometown Health,PPO/EPO,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,outpatient,,,63.00000,41.20000,Hometown Health,PPO/EPO,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Hometown Health,PPO/EPO,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Hometown Health,PPO/EPO,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Hometown Health,PPO/EPO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Hometown Health,PPO/EPO,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Hometown Health,PPO/EPO,,547.20,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Hometown Health,PPO/EPO,,547.20,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Hometown Health,PPO/EPO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Hometown Health,PPO/EPO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Hometown Health,PPO/EPO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Hometown Health,PPO/EPO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Hometown Health,PPO/EPO,,192.60,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Hometown Health,PPO/EPO,,192.60,,,,,,,55.64,207.58,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,inpatient,,,609.00000,196.71000,Hometown Health,PPO/EPO,,548.10,,,,,,,548.10,590.73,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Hometown Health,PPO/EPO,,548.10,,,,,,,158.34,590.73,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,inpatient,,,863.00000,278.75000,Hometown Health,PPO/EPO,,776.70,,,,,,,776.70,837.11,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Hometown Health,PPO/EPO,,776.70,,,,,,,224.38,837.11,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,inpatient,,,900.00000,605.70000,Hometown Health,PPO/EPO,,810.00,,,,,,,810.00,873.00,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,outpatient,,,900.00000,605.70000,Hometown Health,PPO/EPO,,810.00,,,,,,,234.00,873.00,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,inpatient,,,1940.00000,1102.21000,Hometown Health,PPO/EPO,,1746.00,,,,,,,1746.00,1881.80,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,outpatient,,,1940.00000,1102.21000,Hometown Health,PPO/EPO,,1746.00,,,,,,,504.40,1881.80,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,inpatient,,,422.00000,239.76000,Hometown Health,PPO/EPO,,379.80,,,,,,,379.80,409.34,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,outpatient,,,422.00000,239.76000,Hometown Health,PPO/EPO,,379.80,,,,,,,109.72,409.34,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,inpatient,,,1430.00000,812.45000,Hometown Health,PPO/EPO,,1287.00,,,,,,,1287.00,1387.10,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,outpatient,,,1430.00000,812.45000,Hometown Health,PPO/EPO,,1287.00,,,,,,,371.80,1387.10,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,inpatient,,,745.00000,423.27000,Hometown Health,PPO/EPO,,670.50,,,,,,,670.50,722.65,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,outpatient,,,745.00000,423.27000,Hometown Health,PPO/EPO,,670.50,,,,,,,193.70,722.65,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,inpatient,,,2655.00000,2487.74000,Hometown Health,PPO/EPO,,2389.50,,,,,,,2389.50,2575.35,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,outpatient,,,2655.00000,2487.74000,Hometown Health,PPO/EPO,,2389.50,,,,,,,690.30,2575.35,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,inpatient,,,3990.00000,3738.63000,Hometown Health,PPO/EPO,,3591.00,,,,,,,3591.00,3870.30,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,outpatient,,,3990.00000,3738.63000,Hometown Health,PPO/EPO,,3591.00,,,,,,,1037.40,3870.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,inpatient,,,290.00000,271.73000,Hometown Health,PPO/EPO,,261.00,,,,,,,261.00,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,outpatient,,,290.00000,271.73000,Hometown Health,PPO/EPO,,261.00,,,,,,,75.40,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,inpatient,,,735.00000,688.70000,Hometown Health,PPO/EPO,,661.50,,,,,,,661.50,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,outpatient,,,735.00000,688.70000,Hometown Health,PPO/EPO,,661.50,,,,,,,191.10,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,inpatient,,,1475.00000,1382.08000,Hometown Health,PPO/EPO,,1327.50,,,,,,,1327.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Hometown Health,PPO/EPO,,1327.50,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,inpatient,,,2275.00000,2131.68000,Hometown Health,PPO/EPO,,2047.50,,,,,,,2047.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,outpatient,,,2275.00000,2131.68000,Hometown Health,PPO/EPO,,2047.50,,,,,,,591.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,inpatient,,,3205.00000,3003.08000,Hometown Health,PPO/EPO,,2884.50,,,,,,,2884.50,3108.85,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,outpatient,,,3205.00000,3003.08000,Hometown Health,PPO/EPO,,2884.50,,,,,,,833.30,3108.85,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,inpatient,,,770.00000,721.49000,Hometown Health,PPO/EPO,,693.00,,,,,,,693.00,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,outpatient,,,770.00000,721.49000,Hometown Health,PPO/EPO,,693.00,,,,,,,200.20,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,inpatient,,,1475.00000,1382.08000,Hometown Health,PPO/EPO,,1327.50,,,,,,,1327.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Hometown Health,PPO/EPO,,1327.50,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,inpatient,,,2210.00000,2070.77000,Hometown Health,PPO/EPO,,1989.00,,,,,,,1989.00,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,outpatient,,,2210.00000,2070.77000,Hometown Health,PPO/EPO,,1989.00,,,,,,,574.60,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,inpatient,,,2660.00000,2492.42000,Hometown Health,PPO/EPO,,2394.00,,,,,,,2394.00,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,outpatient,,,2660.00000,2492.42000,Hometown Health,PPO/EPO,,2394.00,,,,,,,691.60,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,inpatient,,,3560.00000,3335.72000,Hometown Health,PPO/EPO,,3204.00,,,,,,,3204.00,3453.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,outpatient,,,3560.00000,3335.72000,Hometown Health,PPO/EPO,,3204.00,,,,,,,925.60,3453.20,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,inpatient,,,5730.00000,3255.50000,Hometown Health,PPO/EPO,,5157.00,,,,,,,5157.00,5558.10,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,outpatient,,,5730.00000,3255.50000,Hometown Health,PPO/EPO,,5157.00,,,,,,,1489.80,5558.10,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,inpatient,,,3875.00000,2201.58000,Hometown Health,PPO/EPO,,3487.50,,,,,,,3487.50,3758.75,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,outpatient,,,3875.00000,2201.58000,Hometown Health,PPO/EPO,,3487.50,,,,,,,1007.50,3758.75,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,inpatient,,,519.00000,564.15000,Hometown Health,PPO/EPO,,467.10,,,,,,,467.10,503.43,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,outpatient,,,519.00000,564.15000,Hometown Health,PPO/EPO,,467.10,,,,,,,134.94,503.43,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,inpatient,,,536.00000,582.63000,Hometown Health,PPO/EPO,,482.40,,,,,,,482.40,519.92,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,outpatient,,,536.00000,582.63000,Hometown Health,PPO/EPO,,482.40,,,,,,,139.36,519.92,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Hometown Health,PPO/EPO,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Hometown Health,PPO/EPO,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Hometown Health,PPO/EPO,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Hometown Health,PPO/EPO,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Hometown Health,PPO/EPO,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Hometown Health,PPO/EPO,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Hometown Health,PPO/EPO,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Hometown Health,PPO/EPO,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Hometown Health,PPO/EPO,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Hometown Health,PPO/EPO,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Hometown Health,PPO/EPO,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Hometown Health,PPO/EPO,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Hometown Health,PPO/EPO,,547.20,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Hometown Health,PPO/EPO,,547.20,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Hometown Health,PPO/EPO,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Hometown Health,PPO/EPO,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Hometown Health,PPO/EPO,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Hometown Health,PPO/EPO,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Hometown Health,PPO/EPO,,192.60,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Hometown Health,PPO/EPO,,192.60,,,,,,,55.64,207.58,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,inpatient,,,175.00000,63.18000,Hometown Health,PPO/EPO,,157.50,,,,,,,157.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,outpatient,,,175.00000,63.18000,Hometown Health,PPO/EPO,,157.50,,,,,,,45.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,inpatient,,,304.00000,109.74000,Hometown Health,PPO/EPO,,273.60,,,,,,,273.60,294.88,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,outpatient,,,304.00000,109.74000,Hometown Health,PPO/EPO,,273.60,,,,,,,79.04,294.88,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Hometown Health,PPO/EPO,,255.60,,,,,,,255.60,275.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Hometown Health,PPO/EPO,,255.60,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Hometown Health,PPO/EPO,,412.20,,,,,,,412.20,444.26,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Hometown Health,PPO/EPO,,412.20,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,inpatient,,,438.00000,158.12000,Hometown Health,PPO/EPO,,394.20,,,,,,,394.20,424.86,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,outpatient,,,438.00000,158.12000,Hometown Health,PPO/EPO,,394.20,,,,,,,113.88,424.86,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Hometown Health,PPO/EPO,,502.20,,,,,,,502.20,541.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Hometown Health,PPO/EPO,,502.20,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Hometown Health,PPO/EPO,,433.80,,,,,,,433.80,467.54,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Hometown Health,PPO/EPO,,433.80,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Hometown Health,PPO/EPO,,213.30,,,,,,,213.30,229.89,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Hometown Health,PPO/EPO,,213.30,,,,,,,61.62,229.89,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Hometown Health,PPO/EPO,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Hometown Health,PPO/EPO,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Hometown Health,PPO/EPO,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Hometown Health,PPO/EPO,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Hometown Health,PPO/EPO,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Hometown Health,PPO/EPO,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Hometown Health,PPO/EPO,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Hometown Health,PPO/EPO,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Hometown Health,PPO/EPO,,757.80,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Hometown Health,PPO/EPO,,757.80,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Hometown Health,PPO/EPO,,947.70,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Hometown Health,PPO/EPO,,947.70,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Hometown Health,PPO/EPO,,1136.70,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Hometown Health,PPO/EPO,,1136.70,,,,,,,328.38,1225.11,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,inpatient,,,182.00000,127.04000,Hometown Health,PPO/EPO,,163.80,,,,,,,163.80,176.54,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Hometown Health,PPO/EPO,,163.80,,,,,,,47.32,176.54,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,inpatient,,,210.00000,119.31000,Hometown Health,PPO/EPO,,189.00,,,,,,,189.00,203.70,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Hometown Health,PPO/EPO,,189.00,,,,,,,54.60,203.70,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,inpatient,,,140.00000,79.54000,Hometown Health,PPO/EPO,,126.00,,,,,,,126.00,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,outpatient,,,140.00000,79.54000,Hometown Health,PPO/EPO,,126.00,,,,,,,36.40,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,inpatient,,,190.00000,107.95000,Hometown Health,PPO/EPO,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,outpatient,,,190.00000,107.95000,Hometown Health,PPO/EPO,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,inpatient,,,240.00000,136.36000,Hometown Health,PPO/EPO,,216.00,,,,,,,216.00,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,outpatient,,,240.00000,136.36000,Hometown Health,PPO/EPO,,216.00,,,,,,,62.40,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,inpatient,,,290.00000,164.76000,Hometown Health,PPO/EPO,,261.00,,,,,,,261.00,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,outpatient,,,290.00000,164.76000,Hometown Health,PPO/EPO,,261.00,,,,,,,75.40,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,inpatient,,,340.00000,193.17000,Hometown Health,PPO/EPO,,306.00,,,,,,,306.00,329.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,outpatient,,,340.00000,193.17000,Hometown Health,PPO/EPO,,306.00,,,,,,,88.40,329.80,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,inpatient,,,150.00000,85.22000,Hometown Health,PPO/EPO,,135.00,,,,,,,135.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,outpatient,,,150.00000,85.22000,Hometown Health,PPO/EPO,,135.00,,,,,,,39.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,inpatient,,,200.00000,113.63000,Hometown Health,PPO/EPO,,180.00,,,,,,,180.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,outpatient,,,200.00000,113.63000,Hometown Health,PPO/EPO,,180.00,,,,,,,52.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,inpatient,,,270.00000,153.40000,Hometown Health,PPO/EPO,,243.00,,,,,,,243.00,261.90,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,outpatient,,,270.00000,153.40000,Hometown Health,PPO/EPO,,243.00,,,,,,,70.20,261.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,inpatient,,,370.00000,210.22000,Hometown Health,PPO/EPO,,333.00,,,,,,,333.00,358.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,outpatient,,,370.00000,210.22000,Hometown Health,PPO/EPO,,333.00,,,,,,,96.20,358.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,inpatient,,,470.00000,267.03000,Hometown Health,PPO/EPO,,423.00,,,,,,,423.00,455.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,outpatient,,,470.00000,267.03000,Hometown Health,PPO/EPO,,423.00,,,,,,,122.20,455.90,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,inpatient,,,248.00000,96.22000,Hometown Health,PPO/EPO,,223.20,,,,,,,223.20,240.56,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,outpatient,,,248.00000,96.22000,Hometown Health,PPO/EPO,,223.20,,,,,,,64.48,240.56,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,inpatient,,,245.00000,95.06000,Hometown Health,PPO/EPO,,220.50,,,,,,,220.50,237.65,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,outpatient,,,245.00000,95.06000,Hometown Health,PPO/EPO,,220.50,,,,,,,63.70,237.65,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,inpatient,,,497.00000,192.84000,Hometown Health,PPO/EPO,,447.30,,,,,,,447.30,482.09,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,outpatient,,,497.00000,192.84000,Hometown Health,PPO/EPO,,447.30,,,,,,,129.22,482.09,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,inpatient,,,357.00000,138.52000,Hometown Health,PPO/EPO,,321.30,,,,,,,321.30,346.29,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,outpatient,,,357.00000,138.52000,Hometown Health,PPO/EPO,,321.30,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,inpatient,,,334.00000,129.59000,Hometown Health,PPO/EPO,,300.60,,,,,,,300.60,323.98,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,outpatient,,,334.00000,129.59000,Hometown Health,PPO/EPO,,300.60,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,inpatient,,,194.00000,75.27000,Hometown Health,PPO/EPO,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,outpatient,,,194.00000,75.27000,Hometown Health,PPO/EPO,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,inpatient,,,1035.00000,401.58000,Hometown Health,PPO/EPO,,931.50,,,,,,,931.50,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,outpatient,,,1035.00000,401.58000,Hometown Health,PPO/EPO,,931.50,,,,,,,269.10,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,inpatient,,,1137.00000,441.16000,Hometown Health,PPO/EPO,,1023.30,,,,,,,1023.30,1102.89,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,outpatient,,,1137.00000,441.16000,Hometown Health,PPO/EPO,,1023.30,,,,,,,295.62,1102.89,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,inpatient,,,963.00000,373.64000,Hometown Health,PPO/EPO,,866.70,,,,,,,866.70,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,outpatient,,,963.00000,373.64000,Hometown Health,PPO/EPO,,866.70,,,,,,,250.38,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,inpatient,,,990.00000,384.12000,Hometown Health,PPO/EPO,,891.00,,,,,,,891.00,960.30,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,outpatient,,,990.00000,384.12000,Hometown Health,PPO/EPO,,891.00,,,,,,,257.40,960.30,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,inpatient,,,112.00000,43.46000,Hometown Health,PPO/EPO,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,outpatient,,,112.00000,43.46000,Hometown Health,PPO/EPO,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,inpatient,,,84.00000,32.59000,Hometown Health,PPO/EPO,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,outpatient,,,84.00000,32.59000,Hometown Health,PPO/EPO,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,inpatient,,,176.00000,68.29000,Hometown Health,PPO/EPO,,158.40,,,,,,,158.40,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,outpatient,,,176.00000,68.29000,Hometown Health,PPO/EPO,,158.40,,,,,,,45.76,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,inpatient,,,283.00000,109.80000,Hometown Health,PPO/EPO,,254.70,,,,,,,254.70,274.51,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,outpatient,,,283.00000,109.80000,Hometown Health,PPO/EPO,,254.70,,,,,,,73.58,274.51,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Hometown Health,PPO/EPO,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Hometown Health,PPO/EPO,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Hometown Health,PPO/EPO,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Hometown Health,PPO/EPO,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,inpatient,,,35.00000,19.89000,Hometown Health,PPO/EPO,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,35.00000,19.89000,Hometown Health,PPO/EPO,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,inpatient,,,191.00000,89.39000,Hometown Health,PPO/EPO,,171.90,,,,,,,171.90,185.27,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,outpatient,,,191.00000,89.39000,Hometown Health,PPO/EPO,,171.90,,,,,,,49.66,185.27,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Hometown Health,PPO/EPO,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Hometown Health,PPO/EPO,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Hometown Health,PPO/EPO,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Hometown Health,PPO/EPO,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Hometown Health,PPO/EPO,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Hometown Health,PPO/EPO,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Hometown Health,PPO/EPO,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Hometown Health,PPO/EPO,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,inpatient,,,281.00000,131.51000,Hometown Health,PPO/EPO,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,outpatient,,,281.00000,131.51000,Hometown Health,PPO/EPO,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,inpatient,,,192.00000,89.86000,Hometown Health,PPO/EPO,,172.80,,,,,,,172.80,186.24,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,outpatient,,,192.00000,89.86000,Hometown Health,PPO/EPO,,172.80,,,,,,,49.92,186.24,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,inpatient,,,365.00000,170.82000,Hometown Health,PPO/EPO,,328.50,,,,,,,328.50,354.05,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,outpatient,,,365.00000,170.82000,Hometown Health,PPO/EPO,,328.50,,,,,,,94.90,354.05,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,inpatient,,,8391.00000,5856.92000,Hometown Health,PPO/EPO,,7551.90,,,,,,,7551.90,8139.27,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,outpatient,,,8391.00000,5856.92000,Hometown Health,PPO/EPO,,7551.90,,,,,,,2181.66,8139.27,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,inpatient,,,6917.00000,4828.07000,Hometown Health,PPO/EPO,52,6225.30,,,,,,,6225.30,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Hometown Health,PPO/EPO,52,6225.30,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,inpatient,,,6000.00000,4188.00000,Hometown Health,PPO/EPO,,5400.00,,,,,,,5400.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Hometown Health,PPO/EPO,,5400.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,inpatient,,,6917.00000,4828.07000,Hometown Health,PPO/EPO,,6225.30,,,,,,,6225.30,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Hometown Health,PPO/EPO,,6225.30,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,inpatient,,,6000.00000,4188.00000,Hometown Health,PPO/EPO,52,5400.00,,,,,,,5400.00,5820.00,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Hometown Health,PPO/EPO,52,5400.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,inpatient,,,8855.00000,9625.38000,Hometown Health,PPO/EPO,,7969.50,,,,,,,7969.50,8589.35,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,outpatient,,,8855.00000,9625.38000,Hometown Health,PPO/EPO,,7969.50,,,,,,,2302.30,8589.35,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,inpatient,,,844.00000,917.43000,Hometown Health,PPO/EPO,,759.60,,,,,,,759.60,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Hometown Health,PPO/EPO,,759.60,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,inpatient,,,844.00000,917.43000,Hometown Health,PPO/EPO,52,759.60,,,,,,,759.60,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Hometown Health,PPO/EPO,52,759.60,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,inpatient,,,785.00000,853.30000,Hometown Health,PPO/EPO,,706.50,,,,,,,706.50,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Hometown Health,PPO/EPO,,706.50,,,,,,,204.10,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,inpatient,,,785.00000,853.30000,Hometown Health,PPO/EPO,52,706.50,,,,,,,706.50,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Hometown Health,PPO/EPO,52,706.50,,,,,,,204.10,761.45,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4709.00000,5118.68000,Hometown Health,PPO/EPO,,4238.10,,,,,,,4238.10,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Hometown Health,PPO/EPO,,4238.10,,,,,,,1224.34,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4709.00000,5118.68000,Hometown Health,PPO/EPO,52,4238.10,,,,,,,4238.10,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Hometown Health,PPO/EPO,52,4238.10,,,,,,,1224.34,4567.73,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,inpatient,,,345.00000,128.34000,Hometown Health,PPO/EPO,,310.50,,,,,,,310.50,334.65,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,outpatient,,,345.00000,128.34000,Hometown Health,PPO/EPO,,310.50,,,,,,,89.70,334.65,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,inpatient,,,120.00000,99.60000,Hometown Health,PPO/EPO,,108.00,,,,,,,108.00,116.40,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,outpatient,,,120.00000,99.60000,Hometown Health,PPO/EPO,,108.00,,,,,,,31.20,116.40,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,inpatient,,,106.00000,87.98000,Hometown Health,PPO/EPO,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,outpatient,,,106.00000,87.98000,Hometown Health,PPO/EPO,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,inpatient,,,32.00000,26.56000,Hometown Health,PPO/EPO,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,outpatient,,,32.00000,26.56000,Hometown Health,PPO/EPO,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,inpatient,,,60.00000,49.80000,Hometown Health,PPO/EPO,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,outpatient,,,60.00000,49.80000,Hometown Health,PPO/EPO,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,inpatient,,,57.00000,47.31000,Hometown Health,PPO/EPO,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,outpatient,,,57.00000,47.31000,Hometown Health,PPO/EPO,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,inpatient,1.0,ME,7.40000,0.65000,Hometown Health,PPO/EPO,,6.66,,,,,,,6.66,7.18,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,outpatient,1.0,ME,7.40000,0.65000,Hometown Health,PPO/EPO,,6.66,,,,,,,1.92,7.18,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,inpatient,1.0,EA,6.60000,1.43000,Hometown Health,PPO/EPO,UD,5.94,,,,,,,5.94,6.40,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,outpatient,1.0,EA,6.60000,1.43000,Hometown Health,PPO/EPO,UD,5.94,,,,,,,1.72,6.40,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,inpatient,1.0,EA,2.95000,0.64000,Hometown Health,PPO/EPO,UD,2.65,,,,,,,2.65,2.86,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,outpatient,1.0,EA,2.95000,0.64000,Hometown Health,PPO/EPO,UD,2.65,,,,,,,0.76700,2.86,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,inpatient,1.0,EA,56.08000,12.11000,Hometown Health,PPO/EPO,UD,50.47,,,,,,,50.47,54.40,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,56.08000,12.11000,Hometown Health,PPO/EPO,UD,50.47,,,,,,,14.58,54.40,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,inpatient,1.0,UN,82.10000,28.90000,Hometown Health,PPO/EPO,,73.89,,,,,,,73.89,79.64,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,outpatient,1.0,UN,82.10000,28.90000,Hometown Health,PPO/EPO,,73.89,,,,,,,15.48,79.64,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.04000,,Hometown Health,PPO/EPO,UD,0.03600,,,,,,,0.03600,0.03880,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.04000,,Hometown Health,PPO/EPO,UD,0.03600,,,,,,,0.01040,0.03880,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.05000,,Hometown Health,PPO/EPO,UD,0.04500,,,,,,,0.04500,0.04850,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.05000,,Hometown Health,PPO/EPO,UD,0.04500,,,,,,,0.01300,0.04850,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,inpatient,1.0,ME,6.20000,0.55000,Hometown Health,PPO/EPO,,5.58,,,,,,,5.58,6.01,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,outpatient,1.0,ME,6.20000,0.55000,Hometown Health,PPO/EPO,,5.58,,,,,,,1.61,6.01,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.12000,0.01000,Hometown Health,PPO/EPO,UD,0.10800,,,,,,,0.10800,0.11640,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.12000,0.01000,Hometown Health,PPO/EPO,UD,0.10800,,,,,,,0.03120,0.11640,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,inpatient,2.0,ML,5.80000,1.25000,Hometown Health,PPO/EPO,,5.22,,,,,,,5.22,5.63,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,outpatient,2.0,ML,5.80000,1.25000,Hometown Health,PPO/EPO,,5.22,,,,,,,1.51,5.63,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,inpatient,1.0,ME,3.10000,0.27000,Hometown Health,PPO/EPO,,2.79,,,,,,,2.79,3.01,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,outpatient,1.0,ME,3.10000,0.27000,Hometown Health,PPO/EPO,,2.79,,,,,,,0.80600,3.01,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,inpatient,1.0,EA,44.40000,3.91000,Hometown Health,PPO/EPO,,39.96,,,,,,,39.96,43.07,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,outpatient,1.0,EA,44.40000,3.91000,Hometown Health,PPO/EPO,,39.96,,,,,,,11.54,43.07,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,inpatient,1.0,EA,8.26000,0.73000,Hometown Health,PPO/EPO,UD,7.43,,,,,,,7.43,8.01,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,8.26000,0.73000,Hometown Health,PPO/EPO,UD,7.43,,,,,,,2.15,8.01,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,2.19000,0.19000,Hometown Health,PPO/EPO,UD,1.97,,,,,,,1.97,2.12,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,2.19000,0.19000,Hometown Health,PPO/EPO,UD,1.97,,,,,,,0.56940,2.12,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,inpatient,1.0,EA,28.60000,2.52000,Hometown Health,PPO/EPO,,25.74,,,,,,,25.74,27.74,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,outpatient,1.0,EA,28.60000,2.52000,Hometown Health,PPO/EPO,,25.74,,,,,,,7.44,27.74,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,inpatient,1.0,EA,2.58000,0.91000,Hometown Health,PPO/EPO,UD,2.32,,,,,,,2.32,2.50,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,outpatient,1.0,EA,2.58000,0.91000,Hometown Health,PPO/EPO,UD,2.32,,,,,,,0.67080,2.50,percent of total billed charges,
R&B OBSTETRICS PVT,3012,CDM,112,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Humana,Medicare Advantage,,3111.10,,,,,,,2502.90,3111.10,per diem,
R&B MEDICAL/SURGICAL SEMI-PVT,23010,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Humana,Medicare Advantage,,3111.10,,,,,,,2502.90,3111.10,per diem,
R&B ICU,33019,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Humana,Medicare Advantage,,3111.10,,,,,,,2512.00,8498.17,per diem,
R&B ICU INTERMEDIATE,13011,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Humana,Medicare Advantage,,3111.10,,,,,,,2512.00,5665.77,per diem,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,244.00000,77.10000,Humana,Medicare Advantage,,90.52,,,,,,,63.44,236.68,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,24075,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Humana,Medicare Advantage,,3111.10,,,,,,,2502.90,3111.10,per diem,
R&B OBSTETRICS SEMI-PVT,44073,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Humana,Medicare Advantage,,3111.10,,,,,,,2502.90,3111.10,per diem,
R&B NURSERY LEVEL 1,55160,CDM,171,RC,,,,,facility,inpatient,,,3477.00000,1975.46000,Humana,Medicare Advantage,,3111.10,,,,,,,2512.00,3372.69,per diem,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,outpatient,,,16.00000,7.71000,Humana,Medicare Advantage,,5.94,,,,,,,4.16,15.52,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Humana,Medicare Advantage,,77.91,,,,,,,54.60,203.70,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,outpatient,,,380.00000,215.90000,Humana,Medicare Advantage,,140.98,,,,,,,98.80,368.60,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Humana,Medicare Advantage,,43.04,,,,,,,30.16,112.52,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22012,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Humana,Medicare Advantage,,3111.10,,,,,,,2502.90,3111.10,per diem,
R&B ADMIN DAY SKILLED,82016,CDM,160,RC,,,,,facility,inpatient,,,1923.00000,1092.55000,Humana,Medicare Advantage,,3111.10,,,,,,,1730.70,3111.10,per diem,
R&B SWING BED SKILLED,62018,CDM,160,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Humana,Medicare Advantage,,3111.10,,,,,,,2502.90,3111.10,per diem,
R&B ADMIN DAY INTERMEDIATE,72017,CDM,169,RC,,,,,facility,inpatient,,,1176.00000,668.14000,Humana,Medicare Advantage,,3111.10,,,,,,,1058.40,3111.10,per diem,
R&B ICU,32011,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Humana,Medicare Advantage,,3111.10,,,,,,,2512.00,8498.17,per diem,
R&B ICU INTERMEDIATE,12013,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Humana,Medicare Advantage,,3111.10,,,,,,,2512.00,5665.77,per diem,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Humana,Medicare Advantage,,43.04,,,,,,,30.16,112.52,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Humana,Medicare Advantage,,186.98,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Humana,Medicare Advantage,,36.36,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Humana,Medicare Advantage,,225.57,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Humana,Medicare Advantage,,42.29,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Humana,Medicare Advantage,,69.38,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Humana,Medicare Advantage,,79.39,,,,,,,55.64,207.58,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Humana,Medicare Advantage,,31.16,,,,,,,21.84,81.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Humana,Medicare Advantage,,105.36,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Humana,Medicare Advantage,,169.92,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Humana,Medicare Advantage,,207.02,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Humana,Medicare Advantage,,178.82,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Humana,Medicare Advantage,,87.93,,,,,,,61.62,229.89,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,outpatient,,,2041.00000,659.24000,Humana,Medicare Advantage,,757.21,,,,,,,530.66,1979.77,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,outpatient,,,259.00000,83.66000,Humana,Medicare Advantage,,96.09,,,,,,,67.34,251.23,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,outpatient,,,672.00000,217.06000,Humana,Medicare Advantage,,249.31,,,,,,,174.72,651.84,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,outpatient,,,530.00000,171.19000,Humana,Medicare Advantage,,196.63,,,,,,,137.80,514.10,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,outpatient,,,580.00000,187.34000,Humana,Medicare Advantage,,215.18,,,,,,,150.80,562.60,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,outpatient,,,435.00000,140.50000,Humana,Medicare Advantage,,161.38,,,,,,,113.10,421.95,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Humana,Medicare Advantage,,320.17,,,,,,,224.38,837.11,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,outpatient,,,334.00000,107.88000,Humana,Medicare Advantage,,123.91,,,,,,,86.84,323.98,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,outpatient,,,1188.00000,383.72000,Humana,Medicare Advantage,50,440.75,,,,,,,308.88,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Humana,Medicare Advantage,LT,293.83,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Humana,Medicare Advantage,RT,293.83,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,outpatient,,,572.00000,184.76000,Humana,Medicare Advantage,50,212.21,,,,,,,148.72,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Humana,Medicare Advantage,LT,141.35,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Humana,Medicare Advantage,RT,141.35,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,outpatient,,,455.00000,146.96000,Humana,Medicare Advantage,,168.81,,,,,,,118.30,441.35,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,outpatient,,,403.00000,130.17000,Humana,Medicare Advantage,,149.51,,,,,,,104.78,390.91,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,outpatient,,,370.00000,119.51000,Humana,Medicare Advantage,,137.27,,,,,,,96.20,358.90,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,outpatient,,,357.00000,115.31000,Humana,Medicare Advantage,,132.45,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,outpatient,,,334.00000,107.88000,Humana,Medicare Advantage,,123.91,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,outpatient,,,194.00000,62.66000,Humana,Medicare Advantage,,71.97,,,,,,,50.44,188.18,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,outpatient,,,457.00000,147.61000,Humana,Medicare Advantage,,169.55,,,,,,,118.82,443.29,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,outpatient,,,492.00000,158.92000,Humana,Medicare Advantage,,182.53,,,,,,,127.92,477.24,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,outpatient,,,780.00000,251.94000,Humana,Medicare Advantage,,289.38,,,,,,,202.80,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,outpatient,,,1165.00000,376.30000,Humana,Medicare Advantage,,432.21,,,,,,,302.90,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,outpatient,,,2350.00000,759.05000,Humana,Medicare Advantage,,871.85,,,,,,,611.00,2279.50,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,outpatient,,,896.00000,289.41000,Humana,Medicare Advantage,,332.42,,,,,,,232.96,869.12,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,outpatient,,,490.00000,158.27000,Humana,Medicare Advantage,,181.79,,,,,,,127.40,475.30,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,outpatient,,,520.00000,167.96000,Humana,Medicare Advantage,,192.92,,,,,,,135.20,504.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,outpatient,,,720.00000,232.56000,Humana,Medicare Advantage,,267.12,,,,,,,187.20,698.40,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,outpatient,,,215.00000,69.45000,Humana,Medicare Advantage,,79.77,,,,,,,55.90,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,outpatient,,,240.00000,77.52000,Humana,Medicare Advantage,,89.04,,,,,,,62.40,232.80,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,outpatient,,,1241.00000,400.84000,Humana,Medicare Advantage,,460.41,,,,,,,322.66,1203.77,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Humana,Medicare Advantage,,312.38,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Humana,Medicare Advantage,,390.66,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Humana,Medicare Advantage,,468.57,,,,,,,328.38,1225.11,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,outpatient,,,668.00000,559.78000,Humana,Medicare Advantage,,247.83,,,,,,,173.68,647.96,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Humana,Medicare Advantage,,30.05,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Humana,Medicare Advantage,,15.21,,,,,,,10.66,39.77,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Humana,Medicare Advantage,,168.06,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Humana,Medicare Advantage,,53.42,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Humana,Medicare Advantage,,39.70,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Humana,Medicare Advantage,,53.42,,,,,,,37.44,139.68,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Humana,Medicare Advantage,,1.26,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Humana,Medicare Advantage,,1.26,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Humana,Medicare Advantage,,1.26,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Humana,Medicare Advantage,,1.82,,,,,,,1.27,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,7.90000,4.49000,Humana,Medicare Advantage,,2.93,,,,,,,2.05,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Humana,Medicare Advantage,,1.82,,,,,,,1.27,4.75,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Humana,Medicare Advantage,,30.05,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Humana,Medicare Advantage,,30.05,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Humana,Medicare Advantage,,30.05,,,,,,,21.06,78.57,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,outpatient,,,3141500.00000,1784843.22000,Humana,Medicare Advantage,,1165496.50,,,,,,,816790.00,3047255.00,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Humana,Medicare Advantage,UD,0.08162,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.52000,0.30000,Humana,Medicare Advantage,UD,0.19292,,,,,,,0.13520,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.56000,0.32000,Humana,Medicare Advantage,UD,0.20776,,,,,,,0.14560,0.54320,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Humana,Medicare Advantage,UD,0.08162,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.85000,0.48000,Humana,Medicare Advantage,UD,0.31535,,,,,,,0.22100,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Humana,Medicare Advantage,UD,0.08162,,,,,,,0.05720,0.21340,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,outpatient,,,102.00000,65.18000,Humana,Medicare Advantage,,37.84,,,,,,,26.52,98.94,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,outpatient,,,190.00000,121.41000,Humana,Medicare Advantage,,70.49,,,,,,,49.40,184.30,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Humana,Medicare Advantage,,133.19,,,,,,,93.34,348.23,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Humana,Medicare Advantage,,198.49,,,,,,,139.10,518.95,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,outpatient,,,766.00000,489.47000,Humana,Medicare Advantage,,284.19,,,,,,,199.16,743.02,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,outpatient,,,159.00000,101.60000,Humana,Medicare Advantage,,58.99,,,,,,,41.34,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,outpatient,,,447.00000,285.63000,Humana,Medicare Advantage,,165.84,,,,,,,116.22,433.59,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,outpatient,,,1413.00000,902.91000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,outpatient,,,3853.00000,2462.07000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,outpatient,,,313.00000,200.01000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,outpatient,,,1132.00000,723.35000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,outpatient,,,2695.00000,1722.10000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,outpatient,,,1619.00000,1034.54000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Humana,Medicare Advantage,,198.49,,,,,,,139.10,518.95,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,outpatient,,,850.00000,543.15000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,outpatient,,,32.00000,20.45000,Humana,Medicare Advantage,,11.87,,,,,,,8.32,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,outpatient,,,134.00000,85.63000,Humana,Medicare Advantage,,49.71,,,,,,,34.84,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Humana,Medicare Advantage,,133.19,,,,,,,93.34,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,outpatient,,,709.00000,453.05000,Humana,Medicare Advantage,,263.04,,,,,,,184.34,687.73,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,outpatient,,,4880.00000,2357.04000,Humana,Medicare Advantage,,1810.48,,,,,,,1268.80,4733.60,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,outpatient,,,6024.00000,2909.59000,Humana,Medicare Advantage,,2234.90,,,,,,,1566.24,5843.28,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Humana,Medicare Advantage,,165.84,,,,,,,116.22,433.59,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Humana,Medicare Advantage,,1631.29,,,,,,,1143.22,4265.09,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Humana,Medicare Advantage,,2174.43,,,,,,,1523.86,5685.17,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,outpatient,,,7413.00000,3580.48000,Humana,Medicare Advantage,,2750.22,,,,,,,1927.38,7190.61,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Humana,Medicare Advantage,,165.84,,,,,,,116.22,433.59,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Humana,Medicare Advantage,,165.84,,,,,,,116.22,433.59,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Humana,Medicare Advantage,,1631.29,,,,,,,1143.22,4265.09,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Humana,Medicare Advantage,,2664.15,,,,,,,1867.06,6965.57,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,outpatient,,,10654.00000,5145.88000,Humana,Medicare Advantage,,3952.63,,,,,,,2770.04,10334.38,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Humana,Medicare Advantage,,2174.43,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Humana,Medicare Advantage,,2406.68,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Humana,Medicare Advantage,,2750.22,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,11575.00000,5590.72000,Humana,Medicare Advantage,,4294.32,,,,,,,3009.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,13432.00000,6487.66000,Humana,Medicare Advantage,,4983.27,,,,,,,3492.32,13029.04,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,21904.00000,10579.63000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Humana,Medicare Advantage,,700.45,,,,,,,490.88,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Humana,Medicare Advantage,,1631.29,,,,,,,1143.22,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Humana,Medicare Advantage,,2174.43,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Humana,Medicare Advantage,,2750.22,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,12969.00000,6264.03000,Humana,Medicare Advantage,,4811.50,,,,,,,3371.94,12579.93,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Humana,Medicare Advantage,,700.45,,,,,,,490.88,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Humana,Medicare Advantage,,900.05,,,,,,,630.76,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Humana,Medicare Advantage,,1048.82,,,,,,,735.02,2742.19,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Humana,Medicare Advantage,,37.84,,,,,,,26.52,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Humana,Medicare Advantage,,49.71,,,,,,,34.84,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,outpatient,,,251.00000,121.23000,Humana,Medicare Advantage,,93.12,,,,,,,65.26,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Humana,Medicare Advantage,,2174.43,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Humana,Medicare Advantage,,700.45,,,,,,,490.88,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Humana,Medicare Advantage,,2174.43,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,447.00000,215.90000,Humana,Medicare Advantage,,165.84,,,,,,,116.22,433.59,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Humana,Medicare Advantage,,1048.82,,,,,,,735.02,2742.19,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Humana,Medicare Advantage,,997.99,,,,,,,699.40,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Humana,Medicare Advantage,,2406.68,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,2426.00000,1171.76000,Humana,Medicare Advantage,,900.05,,,,,,,630.76,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,15334.00000,7406.32000,Humana,Medicare Advantage,,5688.91,,,,,,,3986.84,14873.98,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Humana,Medicare Advantage,,700.45,,,,,,,490.88,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Humana,Medicare Advantage,,1048.82,,,,,,,735.02,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,251.00000,121.23000,Humana,Medicare Advantage,,93.12,,,,,,,65.26,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Humana,Medicare Advantage,,700.45,,,,,,,490.88,1831.36,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Humana,Medicare Advantage,,1048.82,,,,,,,735.02,2742.19,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Humana,Medicare Advantage,,11.87,,,,,,,8.32,31.04,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Humana,Medicare Advantage,,700.45,,,,,,,490.88,1831.36,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Humana,Medicare Advantage,,5688.91,,,,,,,3986.84,14873.98,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,outpatient,,,1485.00000,717.26000,Humana,Medicare Advantage,,550.93,,,,,,,386.10,1440.45,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,outpatient,,,2028.00000,979.52000,Humana,Medicare Advantage,,752.39,,,,,,,527.28,1967.16,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Humana,Medicare Advantage,,1631.29,,,,,,,1143.22,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,8107.00000,3915.68000,Humana,Medicare Advantage,,3007.70,,,,,,,2107.82,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,10422.00000,5033.83000,Humana,Medicare Advantage,,3866.56,,,,,,,2709.72,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,12737.00000,6151.97000,Humana,Medicare Advantage,,4725.43,,,,,,,3311.62,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,14239.00000,6877.44000,Humana,Medicare Advantage,,5282.67,,,,,,,3702.14,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,16429.00000,7935.21000,Humana,Medicare Advantage,,6095.16,,,,,,,4271.54,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,18619.00000,8992.98000,Humana,Medicare Advantage,,6907.65,,,,,,,4840.94,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,20809.00000,10050.75000,Humana,Medicare Advantage,,7720.14,,,,,,,5410.34,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,22999.00000,11108.52000,Humana,Medicare Advantage,,8532.63,,,,,,,5979.74,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,25189.00000,12166.29000,Humana,Medicare Advantage,,9345.12,,,,,,,6549.14,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,27379.00000,13224.06000,Humana,Medicare Advantage,,10157.61,,,,,,,7118.54,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,29569.00000,14281.83000,Humana,Medicare Advantage,,10970.10,,,,,,,7687.94,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,31759.00000,15339.60000,Humana,Medicare Advantage,,11782.59,,,,,,,8257.34,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,36139.00000,17455.14000,Humana,Medicare Advantage,,13407.57,,,,,,,9396.14,35054.83,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Humana,Medicare Advantage,,700.45,,,,,,,490.88,1831.36,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Humana,Medicare Advantage,,1239.14,,,,,,,868.40,3239.80,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Humana,Medicare Advantage,,2174.43,,,,,,,1523.86,5685.17,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Humana,Medicare Advantage,,11.87,,,,,,,8.32,31.04,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Humana,Medicare Advantage,,49.71,,,,,,,34.84,129.98,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Humana,Medicare Advantage,,70.49,,,,,,,49.40,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,outpatient,,,476.00000,229.91000,Humana,Medicare Advantage,,176.60,,,,,,,123.76,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Humana,Medicare Advantage,,11.87,,,,,,,8.32,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Humana,Medicare Advantage,,165.84,,,,,,,116.22,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Humana,Medicare Advantage,,700.45,,,,,,,490.88,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Humana,Medicare Advantage,,2174.43,,,,,,,1523.86,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,outpatient,,,12506.00000,6040.40000,Humana,Medicare Advantage,,4639.73,,,,,,,3251.56,12130.82,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,outpatient,,,2404.80000,1161.52000,Humana,Medicare Advantage,,892.18,,,,,,,625.25,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,outpatient,,,969.00000,468.03000,Humana,Medicare Advantage,,359.50,,,,,,,251.94,939.93,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,outpatient,,,2256.90000,1090.08000,Humana,Medicare Advantage,,837.31,,,,,,,586.79,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,outpatient,,,644.30000,311.20000,Humana,Medicare Advantage,,239.04,,,,,,,167.52,624.97,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Humana,Medicare Advantage,,37.84,,,,,,,26.52,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Humana,Medicare Advantage,,70.49,,,,,,,49.40,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Humana,Medicare Advantage,,13001.32,,,,,,,9111.44,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,outpatient,,,43804.00000,21157.33000,Humana,Medicare Advantage,,16251.28,,,,,,,11389.04,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,outpatient,,,52564.00000,25388.41000,Humana,Medicare Advantage,,19501.24,,,,,,,13666.64,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,outpatient,,,61324.00000,29619.49000,Humana,Medicare Advantage,,22751.20,,,,,,,15944.24,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,outpatient,,,70084.00000,33850.57000,Humana,Medicare Advantage,,26001.16,,,,,,,18221.84,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,outpatient,,,78844.00000,38081.65000,Humana,Medicare Advantage,,29251.12,,,,,,,20499.44,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,outpatient,,,87604.00000,42312.73000,Humana,Medicare Advantage,,32501.08,,,,,,,22777.04,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,outpatient,,,96364.00000,46543.81000,Humana,Medicare Advantage,,35751.04,,,,,,,25054.64,93473.08,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Humana,Medicare Advantage,,13001.32,,,,,,,9111.44,33992.68,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,outpatient,,,39424.00000,19041.79000,Humana,Medicare Advantage,,14626.30,,,,,,,10250.24,38241.28,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Humana,Medicare Advantage,,1450.24,,,,,,,1016.34,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Humana,Medicare Advantage,,70.49,,,,,,,49.40,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Humana,Medicare Advantage,,2174.43,,,,,,,1523.86,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Humana,Medicare Advantage,,5688.91,,,,,,,3986.84,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Humana,Medicare Advantage,,700.45,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2023.00000,977.11000,Humana,Medicare Advantage,,750.53,,,,,,,525.98,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Humana,Medicare Advantage,,700.45,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Humana,Medicare Advantage,,700.45,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Humana,Medicare Advantage,,2174.43,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Humana,Medicare Advantage,,2922.00,,,,,,,2047.76,7639.72,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,outpatient,,,10191.00000,4922.25000,Humana,Medicare Advantage,,3780.86,,,,,,,2649.66,9885.27,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,96.00000,46.37000,Humana,Medicare Advantage,,35.62,,,,,,,24.96,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Humana,Medicare Advantage,,2174.43,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,7876.00000,3804.11000,Humana,Medicare Advantage,,2922.00,,,,,,,2047.76,7639.72,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Humana,Medicare Advantage,,1450.24,,,,,,,1016.34,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,outpatient,,,5373.00000,2595.16000,Humana,Medicare Advantage,,1993.38,,,,,,,1396.98,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,outpatient,,,6487.00000,3133.22000,Humana,Medicare Advantage,,2406.68,,,,,,,1686.62,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Humana,Medicare Advantage,,2922.00,,,,,,,2047.76,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Humana,Medicare Advantage,,1631.29,,,,,,,1143.22,4265.09,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Humana,Medicare Advantage,,2174.43,,,,,,,1523.86,5685.17,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,outpatient,,,1126.00000,543.86000,Humana,Medicare Advantage,,417.75,,,,,,,292.76,1092.22,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Humana,Medicare Advantage,,997.99,,,,,,,699.40,2609.30,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,4880.00000,2357.04000,Humana,Medicare Advantage,,1810.48,,,,,,,1268.80,4733.60,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,9260.00000,4472.58000,Humana,Medicare Advantage,,3435.46,,,,,,,2407.60,8982.20,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Humana,Medicare Advantage,,2174.43,,,,,,,1523.86,5685.17,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,588.00000,284.00000,Humana,Medicare Advantage,,218.15,,,,,,,152.88,570.36,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Humana,Medicare Advantage,,700.45,,,,,,,490.88,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Humana,Medicare Advantage,,900.05,,,,,,,630.76,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Humana,Medicare Advantage,,1048.82,,,,,,,735.02,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Humana,Medicare Advantage,,1239.14,,,,,,,868.40,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Humana,Medicare Advantage,,1239.14,,,,,,,868.40,3239.80,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Humana,Medicare Advantage,,165.84,,,,,,,116.22,433.59,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Humana,Medicare Advantage,,1450.24,,,,,,,1016.34,3791.73,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Humana,Medicare Advantage,,2174.43,,,,,,,1523.86,5685.17,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,outpatient,,,159.00000,76.80000,Humana,Medicare Advantage,,58.99,,,,,,,41.34,154.23,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,outpatient,,,588.00000,284.00000,Humana,Medicare Advantage,,218.15,,,,,,,152.88,570.36,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Humana,Medicare Advantage,,900.05,,,,,,,630.76,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Humana,Medicare Advantage,,165.84,,,,,,,116.22,433.59,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,outpatient,,,8107.00000,3915.68000,Humana,Medicare Advantage,,3007.70,,,,,,,2107.82,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,outpatient,,,10422.00000,5033.83000,Humana,Medicare Advantage,,3866.56,,,,,,,2709.72,10109.34,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Humana,Medicare Advantage,,2174.43,,,,,,,1523.86,5685.17,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Humana,Medicare Advantage,,700.45,,,,,,,490.88,1831.36,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Humana,Medicare Advantage,,37.84,,,,,,,26.52,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,outpatient,,,221.00000,106.74000,Humana,Medicare Advantage,,81.99,,,,,,,57.46,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Humana,Medicare Advantage,,165.84,,,,,,,116.22,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Humana,Medicare Advantage,,900.05,,,,,,,630.76,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Humana,Medicare Advantage,,1239.14,,,,,,,868.40,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,outpatient,,,4153.00000,2005.90000,Humana,Medicare Advantage,,1540.76,,,,,,,1079.78,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,outpatient,,,5129.00000,2477.31000,Humana,Medicare Advantage,,1902.86,,,,,,,1333.54,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Humana,Medicare Advantage,,2664.15,,,,,,,1867.06,6965.57,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,outpatient,,,52.50000,25.36000,Humana,Medicare Advantage,,19.48,,,,,,,13.65,50.92,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,outpatient,,,50.40000,24.34000,Humana,Medicare Advantage,,18.70,,,,,,,13.10,48.89,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Humana,Medicare Advantage,,900.05,,,,,,,630.76,2353.22,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Humana,Medicare Advantage,,1450.24,,,,,,,1016.34,3791.73,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Humana,Medicare Advantage,,37.84,,,,,,,26.52,98.94,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Humana,Medicare Advantage,,11.87,,,,,,,8.32,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Humana,Medicare Advantage,,165.84,,,,,,,116.22,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,outpatient,,,709.00000,342.45000,Humana,Medicare Advantage,,263.04,,,,,,,184.34,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Humana,Medicare Advantage,,24376.18,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Humana,Medicare Advantage,,32501.08,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Humana,Medicare Advantage,,40625.98,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,131404.00000,74657.18000,Humana,Medicare Advantage,,48750.88,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,43800.00000,24884.97000,Humana,Medicare Advantage,,16249.80,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Humana,Medicare Advantage,,24376.18,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Humana,Medicare Advantage,,32501.08,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Humana,Medicare Advantage,,7313.89,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,24090.00000,13686.73000,Humana,Medicare Advantage,,8937.39,,,,,,,6263.40,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Humana,Medicare Advantage,,10563.85,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Humana,Medicare Advantage,,6499.92,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Humana,Medicare Advantage,,16251.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Humana,Medicare Advantage,,24376.18,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Humana,Medicare Advantage,,32501.08,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Humana,Medicare Advantage,,40625.98,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,6105.00000,3468.56000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,13895.00000,7894.44000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,21900.00000,12442.48000,Humana,Medicare Advantage,,8124.90,,,,,,,5694.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,35040.00000,19907.98000,Humana,Medicare Advantage,,12999.84,,,,,,,9110.40,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Humana,Medicare Advantage,,16251.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Humana,Medicare Advantage,,7313.89,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,22776.00000,12940.18000,Humana,Medicare Advantage,,8449.90,,,,,,,5921.76,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Humana,Medicare Advantage,,10563.85,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Humana,Medicare Advantage,,6499.92,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,30664.00000,17421.75000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,35044.00000,19910.25000,Humana,Medicare Advantage,,13001.32,,,,,,,9111.44,33992.68,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2695.00000,1080.70000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,3853.00000,1545.05000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,outpatient,,,1413.00000,566.61000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,3229.80000,1857.14000,Humana,Medicare Advantage,,1198.26,,,,,,,839.75,3132.91,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,854.40000,491.28000,Humana,Medicare Advantage,,316.98,,,,,,,222.14,828.77,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1200.50000,690.29000,Humana,Medicare Advantage,,445.39,,,,,,,312.13,1164.48,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1011.00000,581.32000,Humana,Medicare Advantage,,375.08,,,,,,,262.86,980.67,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1823.80000,1048.68000,Humana,Medicare Advantage,,676.63,,,,,,,474.19,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2028.50000,1166.39000,Humana,Medicare Advantage,,752.57,,,,,,,527.41,1967.64,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,841.00000,483.58000,Humana,Medicare Advantage,,312.01,,,,,,,218.66,815.77,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1366.20000,785.56000,Humana,Medicare Advantage,,506.86,,,,,,,355.21,1325.21,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1384.00000,795.80000,Humana,Medicare Advantage,,513.46,,,,,,,359.84,1342.48,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2458.70000,1413.75000,Humana,Medicare Advantage,,912.18,,,,,,,639.26,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2393.50000,1376.26000,Humana,Medicare Advantage,,887.99,,,,,,,622.31,2321.70,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1369.50000,787.46000,Humana,Medicare Advantage,,508.08,,,,,,,356.07,1328.41,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2697.40000,1551.00000,Humana,Medicare Advantage,,1000.74,,,,,,,701.32,2616.48,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4621.80000,2657.54000,Humana,Medicare Advantage,,1714.69,,,,,,,1201.67,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2592.50000,1490.69000,Humana,Medicare Advantage,,961.82,,,,,,,674.05,2514.72,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Humana,Medicare Advantage,,2174.43,,,,,,,1523.86,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Humana,Medicare Advantage,,3093.77,,,,,,,2168.14,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Humana,Medicare Advantage,,2174.43,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Humana,Medicare Advantage,,3007.70,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Humana,Medicare Advantage,,417.75,,,,,,,292.76,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Humana,Medicare Advantage,,1631.29,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Humana,Medicare Advantage,,2750.22,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,outpatient,,,20152.00000,11587.40000,Humana,Medicare Advantage,,7476.39,,,,,,,5239.52,19547.44,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Humana,Medicare Advantage,,165.84,,,,,,,116.22,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Humana,Medicare Advantage,,263.04,,,,,,,184.34,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,1272.00000,731.40000,Humana,Medicare Advantage,,471.91,,,,,,,330.72,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Humana,Medicare Advantage,,997.99,,,,,,,699.40,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,3078.00000,1769.85000,Humana,Medicare Advantage,,1141.94,,,,,,,800.28,2985.66,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,70.00000,40.25000,Humana,Medicare Advantage,,25.97,,,,,,,18.20,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,102.00000,58.65000,Humana,Medicare Advantage,,37.84,,,,,,,26.52,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,221.00000,127.07000,Humana,Medicare Advantage,,81.99,,,,,,,57.46,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Humana,Medicare Advantage,,165.84,,,,,,,116.22,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Humana,Medicare Advantage,,263.04,,,,,,,184.34,687.73,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Humana,Medicare Advantage,,4639.73,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35482.00000,20402.15000,Humana,Medicare Advantage,,13163.82,,,,,,,9225.32,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39862.00000,22920.65000,Humana,Medicare Advantage,,14788.80,,,,,,,10364.12,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,44242.00000,25439.15000,Humana,Medicare Advantage,,16413.78,,,,,,,11502.92,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,48622.00000,27957.65000,Humana,Medicare Advantage,,18038.76,,,,,,,12641.72,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,53002.00000,30476.15000,Humana,Medicare Advantage,,19663.74,,,,,,,13780.52,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Humana,Medicare Advantage,,22751.20,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Humana,Medicare Advantage,,26001.16,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Humana,Medicare Advantage,,29251.12,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Humana,Medicare Advantage,,32501.08,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Humana,Medicare Advantage,,35751.04,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,844.00000,485.30000,Humana,Medicare Advantage,,313.12,,,,,,,219.44,818.68,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,11575.00000,6655.62000,Humana,Medicare Advantage,,4294.32,,,,,,,3009.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14892.00000,8562.90000,Humana,Medicare Advantage,,5524.93,,,,,,,3871.92,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,24970.00000,14357.75000,Humana,Medicare Advantage,,9263.87,,,,,,,6492.20,24220.90,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Humana,Medicare Advantage,,700.45,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Humana,Medicare Advantage,,165.84,,,,,,,116.22,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Humana,Medicare Advantage,,700.45,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Humana,Medicare Advantage,,1239.14,,,,,,,868.40,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Humana,Medicare Advantage,,1540.76,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4641.00000,2668.58000,Humana,Medicare Advantage,,1721.81,,,,,,,1206.66,4501.77,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Humana,Medicare Advantage,,1810.48,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Humana,Medicare Advantage,,5688.91,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Humana,Medicare Advantage,,35751.04,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Humana,Medicare Advantage,,40625.98,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Humana,Medicare Advantage,,48750.88,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,153304.00000,88149.80000,Humana,Medicare Advantage,,56875.78,,,,,,,39859.04,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,175204.00000,100742.30000,Humana,Medicare Advantage,,65000.68,,,,,,,45553.04,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,197104.00000,113334.80000,Humana,Medicare Advantage,,73125.58,,,,,,,51247.04,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,219004.00000,125927.30000,Humana,Medicare Advantage,,81250.48,,,,,,,56941.04,212433.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Humana,Medicare Advantage,,13001.32,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Humana,Medicare Advantage,,13001.32,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Humana,Medicare Advantage,,14626.30,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Humana,Medicare Advantage,,16251.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Humana,Medicare Advantage,,17876.26,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Humana,Medicare Advantage,,19501.24,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Humana,Medicare Advantage,,21126.22,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Humana,Medicare Advantage,,22751.20,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Humana,Medicare Advantage,,24376.18,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Humana,Medicare Advantage,,13001.32,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Humana,Medicare Advantage,,16251.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Humana,Medicare Advantage,,19501.24,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Humana,Medicare Advantage,,24376.18,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Humana,Medicare Advantage,,32501.08,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Humana,Medicare Advantage,,40625.98,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Humana,Medicare Advantage,,1810.48,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Humana,Medicare Advantage,,13001.32,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Humana,Medicare Advantage,,14626.30,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Humana,Medicare Advantage,,16251.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Humana,Medicare Advantage,,17876.26,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Humana,Medicare Advantage,,19501.24,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Humana,Medicare Advantage,,21126.22,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Humana,Medicare Advantage,,22751.20,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Humana,Medicare Advantage,,26001.16,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Humana,Medicare Advantage,,29251.12,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Humana,Medicare Advantage,,32501.08,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Humana,Medicare Advantage,,35751.04,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Humana,Medicare Advantage,,40625.98,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Humana,Medicare Advantage,,45500.92,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,135784.00000,78075.80000,Humana,Medicare Advantage,,50375.86,,,,,,,35303.84,131710.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Humana,Medicare Advantage,,13001.32,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Humana,Medicare Advantage,,14626.30,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Humana,Medicare Advantage,,16251.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Humana,Medicare Advantage,,17876.26,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,55630.00000,31987.25000,Humana,Medicare Advantage,,20638.73,,,,,,,14463.80,53961.10,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Humana,Medicare Advantage,,997.99,,,,,,,699.40,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Humana,Medicare Advantage,,5201.42,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,17962.00000,10328.15000,Humana,Medicare Advantage,,6663.90,,,,,,,4670.12,17423.14,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,2421.00000,1392.07000,Humana,Medicare Advantage,,898.19,,,,,,,629.46,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Humana,Medicare Advantage,,5688.91,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Humana,Medicare Advantage,,900.05,,,,,,,630.76,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Humana,Medicare Advantage,,997.99,,,,,,,699.40,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,27160.00000,15617.00000,Humana,Medicare Advantage,,10076.36,,,,,,,7061.60,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Humana,Medicare Advantage,,12188.83,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Humana,Medicare Advantage,,14626.30,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Humana,Medicare Advantage,,19501.24,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Humana,Medicare Advantage,,24376.18,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Humana,Medicare Advantage,,29251.12,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,28470.00000,16370.25000,Humana,Medicare Advantage,,10562.37,,,,,,,7402.20,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,43800.00000,25185.00000,Humana,Medicare Advantage,,16249.80,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Humana,Medicare Advantage,,24376.18,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Humana,Medicare Advantage,,32501.08,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Humana,Medicare Advantage,,40625.98,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Humana,Medicare Advantage,,1450.24,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Humana,Medicare Advantage,,12188.83,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Humana,Medicare Advantage,,16251.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,54754.00000,31483.55000,Humana,Medicare Advantage,,20313.73,,,,,,,14236.04,53111.38,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Humana,Medicare Advantage,,997.99,,,,,,,699.40,2609.30,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,61320.00000,35259.00000,Humana,Medicare Advantage,,22749.72,,,,,,,15943.20,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,70080.00000,40296.00000,Humana,Medicare Advantage,,25999.68,,,,,,,18220.80,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,78840.00000,45333.00000,Humana,Medicare Advantage,,29249.64,,,,,,,20498.40,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Humana,Medicare Advantage,,35751.04,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Humana,Medicare Advantage,,40625.98,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Humana,Medicare Advantage,,45500.92,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Humana,Medicare Advantage,,5688.91,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Humana,Medicare Advantage,,7313.89,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Humana,Medicare Advantage,,8938.87,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Humana,Medicare Advantage,,12188.83,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Humana,Medicare Advantage,,5688.91,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Humana,Medicare Advantage,,7313.89,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1883.00000,1082.72000,Humana,Medicare Advantage,,698.59,,,,,,,489.58,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Humana,Medicare Advantage,,1450.24,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,7644.00000,4395.30000,Humana,Medicare Advantage,,2835.92,,,,,,,1987.44,7414.68,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Humana,Medicare Advantage,,997.99,,,,,,,699.40,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Humana,Medicare Advantage,,5688.91,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Humana,Medicare Advantage,,7313.89,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Humana,Medicare Advantage,,598.79,,,,,,,419.64,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Humana,Medicare Advantage,,5688.91,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Humana,Medicare Advantage,,7313.89,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Humana,Medicare Advantage,,8938.87,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Humana,Medicare Advantage,,10563.85,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Humana,Medicare Advantage,,12188.83,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,37234.00000,21409.55000,Humana,Medicare Advantage,,13813.81,,,,,,,9680.84,36116.98,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Humana,Medicare Advantage,,16251.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Humana,Medicare Advantage,,24376.18,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Humana,Medicare Advantage,,13001.32,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Humana,Medicare Advantage,,14626.30,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Humana,Medicare Advantage,,19501.24,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Humana,Medicare Advantage,,24376.18,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Humana,Medicare Advantage,,29251.12,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,159.00000,91.42000,Humana,Medicare Advantage,,58.99,,,,,,,41.34,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Humana,Medicare Advantage,,700.45,,,,,,,490.88,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Humana,Medicare Advantage,,700.45,,,,,,,490.88,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Humana,Medicare Advantage,,900.05,,,,,,,630.76,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Humana,Medicare Advantage,,1048.82,,,,,,,735.02,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Humana,Medicare Advantage,,1239.14,,,,,,,868.40,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Humana,Medicare Advantage,,3007.70,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Humana,Medicare Advantage,,24376.18,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Humana,Medicare Advantage,,32501.08,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Humana,Medicare Advantage,,40625.98,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Humana,Medicare Advantage,,48750.88,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Humana,Medicare Advantage,,5688.91,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,18400.00000,10580.00000,Humana,Medicare Advantage,,6826.40,,,,,,,4784.00,17848.00,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Humana,Medicare Advantage,,8938.87,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Humana,Medicare Advantage,,10563.85,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Humana,Medicare Advantage,,12188.83,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Humana,Medicare Advantage,,13001.32,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Humana,Medicare Advantage,,13001.32,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Humana,Medicare Advantage,,14626.30,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Humana,Medicare Advantage,,16251.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Humana,Medicare Advantage,,598.79,,,,,,,419.64,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Humana,Medicare Advantage,,16251.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Humana,Medicare Advantage,,21126.22,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Humana,Medicare Advantage,,24376.18,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,5368.00000,3086.60000,Humana,Medicare Advantage,,1991.53,,,,,,,1395.68,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Humana,Medicare Advantage,,5688.91,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Humana,Medicare Advantage,,7313.89,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Humana,Medicare Advantage,,5201.42,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Humana,Medicare Advantage,,7313.89,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,25408.00000,14609.60000,Humana,Medicare Advantage,,9426.37,,,,,,,6606.08,24645.76,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Humana,Medicare Advantage,,13001.32,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Humana,Medicare Advantage,,16251.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,8112.00000,4664.40000,Humana,Medicare Advantage,,3009.55,,,,,,,2109.12,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,10431.00000,5997.82000,Humana,Medicare Advantage,,3869.90,,,,,,,2712.06,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Humana,Medicare Advantage,,7313.89,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Humana,Medicare Advantage,,12188.83,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Humana,Medicare Advantage,,14626.30,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,46870.00000,26950.25000,Humana,Medicare Advantage,,17388.77,,,,,,,12186.20,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,51250.00000,29468.75000,Humana,Medicare Advantage,,19013.75,,,,,,,13325.00,49712.50,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Humana,Medicare Advantage,,14626.30,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Humana,Medicare Advantage,,19501.24,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Humana,Medicare Advantage,,24376.18,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Humana,Medicare Advantage,,29251.12,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Humana,Medicare Advantage,,32501.08,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,588.00000,338.10000,Humana,Medicare Advantage,,218.15,,,,,,,152.88,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Humana,Medicare Advantage,,1631.29,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Humana,Medicare Advantage,,1450.24,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Humana,Medicare Advantage,,1993.38,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Humana,Medicare Advantage,,2406.68,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7876.00000,4528.70000,Humana,Medicare Advantage,,2922.00,,,,,,,2047.76,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Humana,Medicare Advantage,,5688.91,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Humana,Medicare Advantage,,7313.89,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Humana,Medicare Advantage,,8938.87,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5856.00000,3367.20000,Humana,Medicare Advantage,,2172.58,,,,,,,1522.56,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Humana,Medicare Advantage,,2406.68,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Humana,Medicare Advantage,,2750.22,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Humana,Medicare Advantage,,3093.77,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Humana,Medicare Advantage,,1631.29,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Humana,Medicare Advantage,,1993.38,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Humana,Medicare Advantage,,2234.90,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Humana,Medicare Advantage,,4639.73,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Humana,Medicare Advantage,,1631.29,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Humana,Medicare Advantage,,1993.38,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Humana,Medicare Advantage,,2234.90,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Humana,Medicare Advantage,,4639.73,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4392.00000,2525.40000,Humana,Medicare Advantage,,1629.43,,,,,,,1141.92,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Humana,Medicare Advantage,,1993.38,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Humana,Medicare Advantage,,2406.68,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Humana,Medicare Advantage,,1631.29,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Humana,Medicare Advantage,,1993.38,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Humana,Medicare Advantage,,2406.68,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Humana,Medicare Advantage,,1810.48,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Humana,Medicare Advantage,,417.75,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Humana,Medicare Advantage,,1631.29,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Humana,Medicare Advantage,,1993.38,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Humana,Medicare Advantage,,2234.90,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Humana,Medicare Advantage,,4639.73,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Humana,Medicare Advantage,,5038.92,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Humana,Medicare Advantage,,5688.91,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Humana,Medicare Advantage,,7313.89,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2152.00000,1237.40000,Humana,Medicare Advantage,,798.39,,,,,,,559.52,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Humana,Medicare Advantage,,1810.48,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Humana,Medicare Advantage,,1450.24,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Humana,Medicare Advantage,,2174.43,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Humana,Medicare Advantage,,2234.90,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Humana,Medicare Advantage,,7313.89,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Humana,Medicare Advantage,,1631.29,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Humana,Medicare Advantage,,1993.38,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Humana,Medicare Advantage,,2234.90,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Humana,Medicare Advantage,,417.75,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Humana,Medicare Advantage,,1631.29,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Humana,Medicare Advantage,,1993.38,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Humana,Medicare Advantage,,2234.90,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Humana,Medicare Advantage,,4639.73,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Humana,Medicare Advantage,,5038.92,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Humana,Medicare Advantage,,5688.91,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Humana,Medicare Advantage,,7313.89,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Humana,Medicare Advantage,,1993.38,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8802.00000,5061.15000,Humana,Medicare Advantage,,3265.54,,,,,,,2288.52,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10654.00000,6126.05000,Humana,Medicare Advantage,,3952.63,,,,,,,2770.04,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Humana,Medicare Advantage,,4639.73,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Humana,Medicare Advantage,,5038.92,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Humana,Medicare Advantage,,5688.91,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17086.00000,9824.45000,Humana,Medicare Advantage,,6338.91,,,,,,,4442.36,16573.42,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Humana,Medicare Advantage,,1810.48,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Humana,Medicare Advantage,,2406.68,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Humana,Medicare Advantage,,2750.22,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Humana,Medicare Advantage,,3093.77,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Humana,Medicare Advantage,,1810.48,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Humana,Medicare Advantage,,1810.48,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Humana,Medicare Advantage,,1334.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Humana,Medicare Advantage,,1631.29,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Humana,Medicare Advantage,,2264.95,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Humana,Medicare Advantage,,5688.91,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Humana,Medicare Advantage,,7313.89,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Humana,Medicare Advantage,,8938.87,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Humana,Medicare Advantage,,1450.24,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Humana,Medicare Advantage,,2406.68,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Humana,Medicare Advantage,,700.45,,,,,,,490.88,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Humana,Medicare Advantage,,900.05,,,,,,,630.76,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Humana,Medicare Advantage,,1048.82,,,,,,,735.02,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Humana,Medicare Advantage,,1239.14,,,,,,,868.40,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Humana,Medicare Advantage,,1540.76,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Humana,Medicare Advantage,,2750.22,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Humana,Medicare Advantage,,3093.77,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9728.00000,5593.60000,Humana,Medicare Advantage,,3609.09,,,,,,,2529.28,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11117.00000,6392.28000,Humana,Medicare Advantage,,4124.41,,,,,,,2890.42,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Humana,Medicare Advantage,,13001.32,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Humana,Medicare Advantage,,14626.30,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Humana,Medicare Advantage,,16251.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Humana,Medicare Advantage,,17876.26,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Humana,Medicare Advantage,,19501.24,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Humana,Medicare Advantage,,21126.22,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Humana,Medicare Advantage,,22751.20,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Humana,Medicare Advantage,,24376.18,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Humana,Medicare Advantage,,26001.16,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Humana,Medicare Advantage,,27626.14,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Humana,Medicare Advantage,,29251.12,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Humana,Medicare Advantage,,30876.10,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,111694.00000,64224.05000,Humana,Medicare Advantage,,41438.47,,,,,,,29040.44,108343.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Humana,Medicare Advantage,,165.84,,,,,,,116.22,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Humana,Medicare Advantage,,263.04,,,,,,,184.34,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,991.00000,569.82000,Humana,Medicare Advantage,,367.66,,,,,,,257.66,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1490.00000,856.75000,Humana,Medicare Advantage,,552.79,,,,,,,387.40,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Humana,Medicare Advantage,,1450.24,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Humana,Medicare Advantage,,2174.43,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Humana,Medicare Advantage,,2406.68,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Humana,Medicare Advantage,,2750.22,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Humana,Medicare Advantage,,3093.77,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Humana,Medicare Advantage,,5688.91,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Humana,Medicare Advantage,,13001.32,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Humana,Medicare Advantage,,14626.30,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Humana,Medicare Advantage,,16251.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Humana,Medicare Advantage,,524.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Humana,Medicare Advantage,,1429.46,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,6945.00000,3993.37000,Humana,Medicare Advantage,,2576.59,,,,,,,1805.70,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Humana,Medicare Advantage,,13001.32,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Humana,Medicare Advantage,,165.84,,,,,,,116.22,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Humana,Medicare Advantage,,13001.32,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Humana,Medicare Advantage,,1450.24,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Humana,Medicare Advantage,,1993.38,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Humana,Medicare Advantage,,419.97,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Humana,Medicare Advantage,,13001.32,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Humana,Medicare Advantage,,14626.30,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Humana,Medicare Advantage,,16251.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,50374.00000,28965.05000,Humana,Medicare Advantage,,18688.75,,,,,,,13097.24,48862.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Humana,Medicare Advantage,,7313.89,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Humana,Medicare Advantage,,8938.87,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Humana,Medicare Advantage,,10563.85,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Humana,Medicare Advantage,,999.85,,,,,,,700.70,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Humana,Medicare Advantage,,2578.45,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Humana,Medicare Advantage,,4296.18,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Humana,Medicare Advantage,,5688.91,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Humana,Medicare Advantage,,13001.32,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Humana,Medicare Advantage,,14626.30,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Humana,Medicare Advantage,,16251.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Humana,Medicare Advantage,,17876.26,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Humana,Medicare Advantage,,800.25,,,,,,,560.82,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Humana,Medicare Advantage,,1143.79,,,,,,,801.58,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Humana,Medicare Advantage,,14626.30,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Humana,Medicare Advantage,,16251.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Humana,Medicare Advantage,,17876.26,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Humana,Medicare Advantage,,19501.24,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Humana,Medicare Advantage,,21126.22,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Humana,Medicare Advantage,,24376.18,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Humana,Medicare Advantage,,27626.14,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Humana,Medicare Advantage,,30876.10,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,91984.00000,52890.80000,Humana,Medicare Advantage,,34126.06,,,,,,,23915.84,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,100744.00000,57927.80000,Humana,Medicare Advantage,,37376.02,,,,,,,26193.44,97721.68,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Humana,Medicare Advantage,,61.59,,,,,,,43.16,161.02,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Humana,Medicare Advantage,,165.84,,,,,,,116.22,433.59,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Humana,Medicare Advantage,,263.04,,,,,,,184.34,687.73,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Humana,Medicare Advantage,,6501.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Humana,Medicare Advantage,,8126.38,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Humana,Medicare Advantage,,9751.36,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Humana,Medicare Advantage,,11376.34,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Humana,Medicare Advantage,,13001.32,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Humana,Medicare Advantage,,14626.30,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Humana,Medicare Advantage,,16251.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Humana,Medicare Advantage,,19501.24,,,,,,,13666.64,50987.08,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Humana,Medicare Advantage,,1812.34,,,,,,,1270.10,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Humana,Medicare Advantage,,3437.32,,,,,,,2408.90,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Humana,Medicare Advantage,,5155.05,,,,,,,3612.70,13478.15,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2180.20000,1253.61000,Humana,Medicare Advantage,,808.85,,,,,,,566.85,2114.79,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1880.60000,1081.34000,Humana,Medicare Advantage,,697.70,,,,,,,488.96,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2908.70000,1672.50000,Humana,Medicare Advantage,,1079.13,,,,,,,756.26,2821.44,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,outpatient,,,34.00000,25.74000,Humana,Medicare Advantage,,12.61,,,,,,,8.84,32.98,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,outpatient,,,13.00000,9.84000,Humana,Medicare Advantage,,4.82,,,,,,,3.38,12.61,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Humana,Medicare Advantage,,104.25,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Humana,Medicare Advantage,,104.25,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Humana,Medicare Advantage,,104.25,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Humana,Medicare Advantage,,278.62,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Humana,Medicare Advantage,,278.62,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Humana,Medicare Advantage,,278.62,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,outpatient,,,122.00000,92.35000,Humana,Medicare Advantage,,45.26,,,,,,,31.72,118.34,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Humana,Medicare Advantage,,29.31,,,,,,,20.54,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Humana,Medicare Advantage,,29.31,,,,,,,20.54,76.63,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Humana,Medicare Advantage,,5.57,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Humana,Medicare Advantage,,5.57,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Humana,Medicare Advantage,,6.31,,,,,,,4.42,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Humana,Medicare Advantage,,6.31,,,,,,,4.42,16.49,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,outpatient,,,359.00000,271.76000,Humana,Medicare Advantage,,133.19,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,outpatient,,,359.00000,271.76000,Humana,Medicare Advantage,,133.19,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,outpatient,,,359.00000,271.76000,Humana,Medicare Advantage,,133.19,,,,,,,93.34,348.23,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,outpatient,,,155.00000,117.34000,Humana,Medicare Advantage,,57.51,,,,,,,40.30,150.35,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,outpatient,,,294.00000,222.56000,Humana,Medicare Advantage,,109.07,,,,,,,76.44,285.18,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,outpatient,,,1511.00000,1143.83000,Humana,Medicare Advantage,,560.58,,,,,,,392.86,1465.67,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Humana,Medicare Advantage,,278.62,,,,,,,195.26,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Humana,Medicare Advantage,,278.62,,,,,,,195.26,728.47,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,outpatient,,,150.00000,113.55000,Humana,Medicare Advantage,,55.65,,,,,,,39.00,145.50,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,outpatient,,,110.00000,83.27000,Humana,Medicare Advantage,,40.81,,,,,,,28.60,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,outpatient,,,158.00000,119.61000,Humana,Medicare Advantage,,58.62,,,,,,,41.08,153.26,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,outpatient,,,153.00000,115.82000,Humana,Medicare Advantage,,56.76,,,,,,,39.78,148.41,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,outpatient,,,157.00000,118.85000,Humana,Medicare Advantage,,58.25,,,,,,,40.82,152.29,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,outpatient,,,26.00000,19.68000,Humana,Medicare Advantage,,9.65,,,,,,,6.76,25.22,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,outpatient,,,37.00000,28.01000,Humana,Medicare Advantage,,13.73,,,,,,,9.62,35.89,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,outpatient,,,268.00000,202.88000,Humana,Medicare Advantage,,99.43,,,,,,,69.68,259.96,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,outpatient,,,91.00000,68.89000,Humana,Medicare Advantage,,33.76,,,,,,,23.66,88.27,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,outpatient,,,200.00000,151.40000,Humana,Medicare Advantage,,74.20,,,,,,,52.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,outpatient,,,152.00000,115.06000,Humana,Medicare Advantage,,56.39,,,,,,,39.52,147.44,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,outpatient,,,359.00000,271.76000,Humana,Medicare Advantage,,133.19,,,,,,,93.34,348.23,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,outpatient,,,69.00000,33.26000,Humana,Medicare Advantage,,25.60,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,outpatient,,,75.00000,36.15000,Humana,Medicare Advantage,,27.82,,,,,,,19.50,72.75,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,outpatient,,,55.00000,26.51000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,outpatient,,,45.00000,21.69000,Humana,Medicare Advantage,,16.70,,,,,,,11.70,43.65,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,outpatient,,,68.00000,32.78000,Humana,Medicare Advantage,,25.23,,,,,,,17.68,65.96,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,outpatient,,,61.00000,29.40000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,outpatient,,,64.00000,30.85000,Humana,Medicare Advantage,,23.74,,,,,,,16.64,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,outpatient,,,195.00000,93.99000,Humana,Medicare Advantage,,72.34,,,,,,,50.70,189.15,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,outpatient,,,60.00000,28.92000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,outpatient,,,63.00000,30.37000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,outpatient,,,14.00000,6.75000,Humana,Medicare Advantage,,5.19,,,,,,,3.64,13.58,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,outpatient,,,66.00000,31.81000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,outpatient,,,53.00000,25.55000,Humana,Medicare Advantage,,19.66,,,,,,,13.78,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,outpatient,,,66.00000,31.81000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,outpatient,,,82.00000,39.52000,Humana,Medicare Advantage,,30.42,,,,,,,21.32,79.54,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Humana,Medicare Advantage,,52.31,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Humana,Medicare Advantage,,52.31,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,outpatient,,,91.00000,43.86000,Humana,Medicare Advantage,,33.76,,,,,,,23.66,88.27,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,outpatient,,,63.00000,30.37000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,outpatient,,,69.00000,33.26000,Humana,Medicare Advantage,,25.60,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,outpatient,,,205.00000,98.81000,Humana,Medicare Advantage,,76.06,,,,,,,53.30,198.85,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,outpatient,,,50.00000,24.10000,Humana,Medicare Advantage,,18.55,,,,,,,13.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,outpatient,,,406.00000,195.69000,Humana,Medicare Advantage,,150.63,,,,,,,105.56,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,outpatient,,,101.00000,48.68000,Humana,Medicare Advantage,,37.47,,,,,,,26.26,97.97,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,outpatient,,,375.00000,180.75000,Humana,Medicare Advantage,,139.12,,,,,,,97.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,outpatient,,,362.00000,174.48000,Humana,Medicare Advantage,,134.30,,,,,,,94.12,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,outpatient,,,325.00000,156.65000,Humana,Medicare Advantage,,120.58,,,,,,,84.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,outpatient,,,121.00000,58.32000,Humana,Medicare Advantage,,44.89,,,,,,,31.46,117.37,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,outpatient,,,115.00000,55.43000,Humana,Medicare Advantage,,42.66,,,,,,,29.90,111.55,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,outpatient,,,300.00000,144.60000,Humana,Medicare Advantage,,111.30,,,,,,,78.00,291.00,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,outpatient,,,51.00000,24.58000,Humana,Medicare Advantage,,18.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Humana,Medicare Advantage,,18.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Humana,Medicare Advantage,,18.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,outpatient,,,194.00000,93.51000,Humana,Medicare Advantage,,71.97,,,,,,,50.44,188.18,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,outpatient,,,57.00000,27.47000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,outpatient,,,68.00000,32.78000,Humana,Medicare Advantage,,25.23,,,,,,,17.68,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,outpatient,,,329.00000,158.58000,Humana,Medicare Advantage,,122.06,,,,,,,85.54,319.13,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,outpatient,,,24.00000,11.57000,Humana,Medicare Advantage,,8.90,,,,,,,6.24,23.28,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,outpatient,,,30.00000,14.46000,Humana,Medicare Advantage,,11.13,,,,,,,7.80,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,outpatient,,,63.00000,30.37000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,outpatient,,,53.00000,25.55000,Humana,Medicare Advantage,,19.66,,,,,,,13.78,51.41,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,outpatient,,,270.00000,130.14000,Humana,Medicare Advantage,,100.17,,,,,,,70.20,261.90,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Humana,Medicare Advantage,,45.63,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Humana,Medicare Advantage,,45.63,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,outpatient,,,37.00000,17.83000,Humana,Medicare Advantage,,13.73,,,,,,,9.62,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,outpatient,,,57.00000,27.47000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,outpatient,,,57.00000,27.47000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,outpatient,,,63.00000,30.37000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,outpatient,,,41.00000,19.76000,Humana,Medicare Advantage,,15.21,,,,,,,10.66,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,outpatient,,,72.00000,34.70000,Humana,Medicare Advantage,,26.71,,,,,,,18.72,69.84,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,outpatient,,,77.00000,37.11000,Humana,Medicare Advantage,,28.57,,,,,,,20.02,74.69,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,outpatient,,,90.00000,43.38000,Humana,Medicare Advantage,,33.39,,,,,,,23.40,87.30,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,outpatient,,,44.00000,21.21000,Humana,Medicare Advantage,,16.32,,,,,,,11.44,42.68,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,outpatient,,,115.00000,55.43000,Humana,Medicare Advantage,,42.66,,,,,,,29.90,111.55,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,outpatient,,,20.00000,9.64000,Humana,Medicare Advantage,,7.42,,,,,,,5.20,19.40,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,outpatient,,,52.00000,25.06000,Humana,Medicare Advantage,,19.29,,,,,,,13.52,50.44,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,outpatient,,,341.00000,164.36000,Humana,Medicare Advantage,,126.51,,,,,,,88.66,330.77,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,outpatient,,,54.00000,26.03000,Humana,Medicare Advantage,,20.03,,,,,,,14.04,52.38,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,outpatient,,,53.00000,25.55000,Humana,Medicare Advantage,,19.66,,,,,,,13.78,51.41,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,outpatient,,,88.00000,42.42000,Humana,Medicare Advantage,,32.65,,,,,,,22.88,85.36,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,outpatient,,,89.00000,42.90000,Humana,Medicare Advantage,,33.02,,,,,,,23.14,86.33,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,outpatient,,,61.00000,29.40000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Humana,Medicare Advantage,,28.57,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Humana,Medicare Advantage,,28.57,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Humana,Medicare Advantage,,23.74,,,,,,,16.64,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Humana,Medicare Advantage,,23.74,,,,,,,16.64,62.08,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,outpatient,,,63.00000,30.37000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,outpatient,,,95.00000,45.79000,Humana,Medicare Advantage,,35.24,,,,,,,24.70,92.15,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,outpatient,,,132.00000,63.62000,Humana,Medicare Advantage,,48.97,,,,,,,34.32,128.04,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,outpatient,,,83.00000,40.01000,Humana,Medicare Advantage,,30.79,,,,,,,21.58,80.51,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,outpatient,,,387.00000,186.53000,Humana,Medicare Advantage,,143.58,,,,,,,100.62,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,outpatient,,,387.00000,186.53000,Humana,Medicare Advantage,,143.58,,,,,,,100.62,375.39,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,outpatient,,,31.00000,14.94000,Humana,Medicare Advantage,,11.50,,,,,,,8.06,30.07,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,outpatient,,,36.00000,17.35000,Humana,Medicare Advantage,,13.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,outpatient,,,160.00000,77.12000,Humana,Medicare Advantage,,59.36,,,,,,,41.60,155.20,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,outpatient,,,112.00000,53.98000,Humana,Medicare Advantage,,41.55,,,,,,,29.12,108.64,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,outpatient,,,14.00000,6.75000,Humana,Medicare Advantage,,5.19,,,,,,,3.64,13.58,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,outpatient,,,16.00000,7.71000,Humana,Medicare Advantage,,5.94,,,,,,,4.16,15.52,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,outpatient,,,71.00000,34.22000,Humana,Medicare Advantage,,26.34,,,,,,,18.46,68.87,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,outpatient,,,116.00000,55.91000,Humana,Medicare Advantage,,43.04,,,,,,,30.16,112.52,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,outpatient,,,81.00000,39.04000,Humana,Medicare Advantage,,30.05,,,,,,,21.06,78.57,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,outpatient,,,97.00000,46.75000,Humana,Medicare Advantage,,35.99,,,,,,,25.22,94.09,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,outpatient,,,77.00000,37.11000,Humana,Medicare Advantage,,28.57,,,,,,,20.02,74.69,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,outpatient,,,35.00000,16.87000,Humana,Medicare Advantage,,12.98,,,,,,,9.10,33.95,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,outpatient,,,65.00000,31.33000,Humana,Medicare Advantage,,24.11,,,,,,,16.90,63.05,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,outpatient,,,74.00000,35.67000,Humana,Medicare Advantage,,27.45,,,,,,,19.24,71.78,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,outpatient,,,250.00000,120.50000,Humana,Medicare Advantage,,92.75,,,,,,,65.00,242.50,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,outpatient,,,90.00000,43.38000,Humana,Medicare Advantage,,33.39,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,outpatient,,,90.00000,43.38000,Humana,Medicare Advantage,,33.39,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,outpatient,,,52.00000,25.06000,Humana,Medicare Advantage,,19.29,,,,,,,13.52,50.44,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,outpatient,,,36.00000,17.35000,Humana,Medicare Advantage,,13.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,outpatient,,,78.00000,37.60000,Humana,Medicare Advantage,,28.94,,,,,,,20.28,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,outpatient,,,115.00000,55.43000,Humana,Medicare Advantage,,42.66,,,,,,,29.90,111.55,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,outpatient,,,67.00000,32.29000,Humana,Medicare Advantage,,24.86,,,,,,,17.42,64.99,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,outpatient,,,76.00000,36.63000,Humana,Medicare Advantage,,28.20,,,,,,,19.76,73.72,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,outpatient,,,53.00000,25.55000,Humana,Medicare Advantage,,19.66,,,,,,,13.78,51.41,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,outpatient,,,70.00000,33.74000,Humana,Medicare Advantage,,25.97,,,,,,,18.20,67.90,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,outpatient,,,169.00000,81.46000,Humana,Medicare Advantage,,62.70,,,,,,,43.94,163.93,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,outpatient,,,28.00000,13.50000,Humana,Medicare Advantage,,10.39,,,,,,,7.28,27.16,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,outpatient,,,51.00000,24.58000,Humana,Medicare Advantage,,18.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,outpatient,,,15.00000,7.23000,Humana,Medicare Advantage,,5.57,,,,,,,3.90,14.55,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,outpatient,,,18.00000,8.68000,Humana,Medicare Advantage,,6.68,,,,,,,4.68,17.46,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,outpatient,,,55.00000,26.51000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,outpatient,,,55.00000,26.51000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,outpatient,,,61.00000,29.40000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,outpatient,,,550.00000,265.10000,Humana,Medicare Advantage,,204.05,,,,,,,143.00,533.50,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Humana,Medicare Advantage,,27.08,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,outpatient,,,392.00000,188.94000,Humana,Medicare Advantage,,145.43,,,,,,,101.92,380.24,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,outpatient,,,75.00000,36.15000,Humana,Medicare Advantage,,27.82,,,,,,,19.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Humana,Medicare Advantage,,27.08,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,outpatient,,,100.00000,48.20000,Humana,Medicare Advantage,,37.10,,,,,,,26.00,97.00,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,outpatient,,,153.00000,73.75000,Humana,Medicare Advantage,,56.76,,,,,,,39.78,148.41,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,outpatient,,,909.00000,438.14000,Humana,Medicare Advantage,,337.24,,,,,,,236.34,881.73,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,outpatient,,,266.00000,128.21000,Humana,Medicare Advantage,,98.69,,,,,,,69.16,258.02,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,outpatient,,,275.00000,132.55000,Humana,Medicare Advantage,,102.03,,,,,,,71.50,266.75,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,outpatient,,,61.00000,29.40000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,outpatient,,,84.00000,40.49000,Humana,Medicare Advantage,,31.16,,,,,,,21.84,81.48,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,outpatient,,,174.00000,83.87000,Humana,Medicare Advantage,,64.55,,,,,,,45.24,168.78,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,outpatient,,,62.00000,29.88000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,outpatient,,,67.00000,32.29000,Humana,Medicare Advantage,,24.86,,,,,,,17.42,64.99,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,outpatient,,,68.00000,32.78000,Humana,Medicare Advantage,,25.23,,,,,,,17.68,65.96,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,outpatient,,,63.00000,30.37000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,outpatient,,,211.00000,101.70000,Humana,Medicare Advantage,,78.28,,,,,,,54.86,204.67,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,outpatient,,,65.00000,31.33000,Humana,Medicare Advantage,,24.11,,,,,,,16.90,63.05,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,outpatient,,,83.00000,40.01000,Humana,Medicare Advantage,,30.79,,,,,,,21.58,80.51,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,outpatient,,,54.00000,26.03000,Humana,Medicare Advantage,,20.03,,,,,,,14.04,52.38,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,outpatient,,,55.00000,26.51000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,outpatient,,,323.00000,155.69000,Humana,Medicare Advantage,,119.83,,,,,,,83.98,313.31,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,outpatient,,,63.00000,30.37000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,outpatient,,,35.00000,16.87000,Humana,Medicare Advantage,,12.98,,,,,,,9.10,33.95,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,outpatient,,,20.00000,9.64000,Humana,Medicare Advantage,,7.42,,,,,,,5.20,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,outpatient,,,55.00000,26.51000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,outpatient,,,34.00000,16.39000,Humana,Medicare Advantage,,12.61,,,,,,,8.84,32.98,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,outpatient,,,29.00000,13.98000,Humana,Medicare Advantage,,10.76,,,,,,,7.54,28.13,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,outpatient,,,80.00000,38.56000,Humana,Medicare Advantage,,29.68,,,,,,,20.80,77.60,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,outpatient,,,73.00000,35.19000,Humana,Medicare Advantage,,27.08,,,,,,,18.98,70.81,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,outpatient,,,16.00000,7.71000,Humana,Medicare Advantage,,5.94,,,,,,,4.16,15.52,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,outpatient,,,52.00000,25.06000,Humana,Medicare Advantage,,19.29,,,,,,,13.52,50.44,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,outpatient,,,113.00000,54.47000,Humana,Medicare Advantage,,41.92,,,,,,,29.38,109.61,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,outpatient,,,68.00000,32.78000,Humana,Medicare Advantage,,25.23,,,,,,,17.68,65.96,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,outpatient,,,78.00000,37.60000,Humana,Medicare Advantage,,28.94,,,,,,,20.28,75.66,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,outpatient,,,54.00000,26.03000,Humana,Medicare Advantage,,20.03,,,,,,,14.04,52.38,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,outpatient,,,76.00000,36.63000,Humana,Medicare Advantage,,28.20,,,,,,,19.76,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,outpatient,,,67.00000,32.29000,Humana,Medicare Advantage,,24.86,,,,,,,17.42,64.99,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,outpatient,,,88.00000,42.42000,Humana,Medicare Advantage,,32.65,,,,,,,22.88,85.36,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,outpatient,,,60.00000,28.92000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,outpatient,,,67.00000,32.29000,Humana,Medicare Advantage,,24.86,,,,,,,17.42,64.99,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,outpatient,,,53.00000,25.55000,Humana,Medicare Advantage,,19.66,,,,,,,13.78,51.41,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,outpatient,,,88.00000,42.42000,Humana,Medicare Advantage,,32.65,,,,,,,22.88,85.36,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,outpatient,,,105.00000,50.61000,Humana,Medicare Advantage,,38.95,,,,,,,27.30,101.85,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Humana,Medicare Advantage,,27.08,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,outpatient,,,83.00000,40.01000,Humana,Medicare Advantage,,30.79,,,,,,,21.58,80.51,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Humana,Medicare Advantage,,57.13,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,outpatient,,,57.00000,27.47000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,outpatient,,,97.00000,46.75000,Humana,Medicare Advantage,,35.99,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Humana,Medicare Advantage,,57.13,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,outpatient,,,87.00000,41.93000,Humana,Medicare Advantage,,32.28,,,,,,,22.62,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,outpatient,,,68.00000,32.78000,Humana,Medicare Advantage,,25.23,,,,,,,17.68,65.96,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,outpatient,,,52.00000,25.06000,Humana,Medicare Advantage,,19.29,,,,,,,13.52,50.44,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,outpatient,,,51.00000,24.58000,Humana,Medicare Advantage,,18.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,outpatient,,,97.00000,46.75000,Humana,Medicare Advantage,,35.99,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,outpatient,,,176.00000,84.83000,Humana,Medicare Advantage,,65.30,,,,,,,45.76,170.72,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,outpatient,,,57.00000,27.47000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,outpatient,,,158.00000,76.16000,Humana,Medicare Advantage,,58.62,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,outpatient,,,67.00000,32.29000,Humana,Medicare Advantage,,24.86,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,outpatient,,,67.00000,32.29000,Humana,Medicare Advantage,,24.86,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,outpatient,,,84.00000,40.49000,Humana,Medicare Advantage,,31.16,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,outpatient,,,189.00000,91.10000,Humana,Medicare Advantage,,70.12,,,,,,,49.14,183.33,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,outpatient,,,109.00000,52.54000,Humana,Medicare Advantage,,40.44,,,,,,,28.34,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,outpatient,,,129.00000,62.18000,Humana,Medicare Advantage,,47.86,,,,,,,33.54,125.13,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,outpatient,,,84.00000,40.49000,Humana,Medicare Advantage,,31.16,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Humana,Medicare Advantage,,27.08,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,outpatient,,,67.00000,32.29000,Humana,Medicare Advantage,,24.86,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,outpatient,,,67.00000,32.29000,Humana,Medicare Advantage,,24.86,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,outpatient,,,149.00000,71.82000,Humana,Medicare Advantage,,55.28,,,,,,,38.74,144.53,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,outpatient,,,130.00000,62.66000,Humana,Medicare Advantage,,48.23,,,,,,,33.80,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,outpatient,,,110.00000,53.02000,Humana,Medicare Advantage,,40.81,,,,,,,28.60,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,outpatient,,,158.00000,76.16000,Humana,Medicare Advantage,,58.62,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,outpatient,,,117.00000,56.39000,Humana,Medicare Advantage,,43.41,,,,,,,30.42,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,outpatient,,,61.00000,29.40000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,outpatient,,,67.00000,32.29000,Humana,Medicare Advantage,,24.86,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Humana,Medicare Advantage,,69.38,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,outpatient,,,145.00000,69.89000,Humana,Medicare Advantage,,53.80,,,,,,,37.70,140.65,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,outpatient,,,67.00000,32.29000,Humana,Medicare Advantage,,24.86,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,outpatient,,,165.00000,79.53000,Humana,Medicare Advantage,,61.22,,,,,,,42.90,160.05,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,outpatient,,,70.00000,33.74000,Humana,Medicare Advantage,,25.97,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,outpatient,,,67.00000,32.29000,Humana,Medicare Advantage,,24.86,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Humana,Medicare Advantage,,69.38,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,outpatient,,,154.00000,74.23000,Humana,Medicare Advantage,,57.13,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,outpatient,,,104.00000,50.13000,Humana,Medicare Advantage,,38.58,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,outpatient,,,70.00000,33.74000,Humana,Medicare Advantage,,25.97,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,outpatient,,,104.00000,50.13000,Humana,Medicare Advantage,,38.58,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,outpatient,,,70.00000,33.74000,Humana,Medicare Advantage,,25.97,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,outpatient,,,123.00000,59.29000,Humana,Medicare Advantage,,45.63,,,,,,,31.98,119.31,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,outpatient,,,95.00000,45.79000,Humana,Medicare Advantage,,35.24,,,,,,,24.70,92.15,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,outpatient,,,160.00000,77.12000,Humana,Medicare Advantage,,59.36,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,outpatient,,,147.00000,70.85000,Humana,Medicare Advantage,,54.54,,,,,,,38.22,142.59,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,outpatient,,,178.00000,85.80000,Humana,Medicare Advantage,,66.04,,,,,,,46.28,172.66,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,outpatient,,,160.00000,77.12000,Humana,Medicare Advantage,,59.36,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Humana,Medicare Advantage,,69.38,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,outpatient,,,67.00000,32.29000,Humana,Medicare Advantage,,24.86,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,outpatient,,,70.00000,33.74000,Humana,Medicare Advantage,,25.97,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Humana,Medicare Advantage,,69.38,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Humana,Medicare Advantage,,69.38,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Humana,Medicare Advantage,,69.38,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Humana,Medicare Advantage,,69.38,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Humana,Medicare Advantage,,69.38,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Humana,Medicare Advantage,,69.38,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Humana,Medicare Advantage,,69.38,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Humana,Medicare Advantage,,69.38,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,outpatient,,,449.00000,216.42000,Humana,Medicare Advantage,,166.58,,,,,,,116.74,435.53,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,outpatient,,,104.00000,50.13000,Humana,Medicare Advantage,,38.58,,,,,,,27.04,100.88,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Humana,Medicare Advantage,,68.64,,,,,,,48.10,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Humana,Medicare Advantage,,68.64,,,,,,,48.10,179.45,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,outpatient,,,57.00000,27.47000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,outpatient,,,84.00000,40.49000,Humana,Medicare Advantage,,31.16,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Humana,Medicare Advantage,,31.16,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Humana,Medicare Advantage,,31.16,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Humana,Medicare Advantage,,27.08,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Humana,Medicare Advantage,,27.08,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,outpatient,,,98.00000,47.24000,Humana,Medicare Advantage,,36.36,,,,,,,25.48,95.06,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,outpatient,,,75.00000,36.15000,Humana,Medicare Advantage,,27.82,,,,,,,19.50,72.75,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,outpatient,,,107.00000,51.57000,Humana,Medicare Advantage,,39.70,,,,,,,27.82,103.79,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,outpatient,,,81.00000,39.04000,Humana,Medicare Advantage,,30.05,,,,,,,21.06,78.57,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,outpatient,,,60.00000,28.92000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,outpatient,,,68.00000,32.78000,Humana,Medicare Advantage,,25.23,,,,,,,17.68,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,outpatient,,,51.00000,24.58000,Humana,Medicare Advantage,,18.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,outpatient,,,74.00000,35.67000,Humana,Medicare Advantage,,27.45,,,,,,,19.24,71.78,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,outpatient,,,60.00000,28.92000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,outpatient,,,194.00000,93.51000,Humana,Medicare Advantage,,71.97,,,,,,,50.44,188.18,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,outpatient,,,111.00000,53.50000,Humana,Medicare Advantage,,41.18,,,,,,,28.86,107.67,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,outpatient,,,77.00000,37.11000,Humana,Medicare Advantage,,28.57,,,,,,,20.02,74.69,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Humana,Medicare Advantage,,29.31,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Humana,Medicare Advantage,,29.31,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Humana,Medicare Advantage,,87.93,,,,,,,61.62,229.89,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,outpatient,,,51.00000,24.58000,Humana,Medicare Advantage,,18.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Humana,Medicare Advantage,,30.42,,,,,,,21.32,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Humana,Medicare Advantage,,30.42,,,,,,,21.32,79.54,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,outpatient,,,67.00000,32.29000,Humana,Medicare Advantage,,24.86,,,,,,,17.42,64.99,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,outpatient,,,131.00000,63.14000,Humana,Medicare Advantage,,48.60,,,,,,,34.06,127.07,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,outpatient,,,15.00000,7.23000,Humana,Medicare Advantage,,5.57,,,,,,,3.90,14.55,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,outpatient,,,39.00000,18.80000,Humana,Medicare Advantage,,14.47,,,,,,,10.14,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,outpatient,,,12.00000,5.78000,Humana,Medicare Advantage,,4.45,,,,,,,3.12,11.64,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,outpatient,,,57.00000,27.47000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Humana,Medicare Advantage,,75.31,,,,,,,52.78,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Humana,Medicare Advantage,,75.31,,,,,,,52.78,196.91,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,outpatient,,,99.00000,47.72000,Humana,Medicare Advantage,,36.73,,,,,,,25.74,96.03,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,outpatient,,,53.00000,25.55000,Humana,Medicare Advantage,,19.66,,,,,,,13.78,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,outpatient,,,23.00000,11.09000,Humana,Medicare Advantage,,8.53,,,,,,,5.98,22.31,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,outpatient,,,46.00000,22.17000,Humana,Medicare Advantage,,17.07,,,,,,,11.96,44.62,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,outpatient,,,67.00000,32.29000,Humana,Medicare Advantage,,24.86,,,,,,,17.42,64.99,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,outpatient,,,57.00000,27.47000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,outpatient,,,288.00000,138.82000,Humana,Medicare Advantage,,106.85,,,,,,,74.88,279.36,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,outpatient,,,106.00000,51.09000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,outpatient,,,30.00000,14.46000,Humana,Medicare Advantage,,11.13,,,,,,,7.80,29.10,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,outpatient,,,55.00000,26.51000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,outpatient,,,71.00000,34.22000,Humana,Medicare Advantage,,26.34,,,,,,,18.46,68.87,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,outpatient,,,67.00000,32.29000,Humana,Medicare Advantage,,24.86,,,,,,,17.42,64.99,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,outpatient,,,89.00000,42.90000,Humana,Medicare Advantage,,33.02,,,,,,,23.14,86.33,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,outpatient,,,116.00000,55.91000,Humana,Medicare Advantage,,43.04,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Humana,Medicare Advantage,,43.04,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Humana,Medicare Advantage,,43.04,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,outpatient,,,51.00000,24.58000,Humana,Medicare Advantage,,18.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,outpatient,,,66.00000,31.81000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,outpatient,,,174.00000,83.87000,Humana,Medicare Advantage,,64.55,,,,,,,45.24,168.78,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,outpatient,,,82.00000,39.52000,Humana,Medicare Advantage,,30.42,,,,,,,21.32,79.54,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,outpatient,,,112.00000,53.98000,Humana,Medicare Advantage,,41.55,,,,,,,29.12,108.64,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,outpatient,,,61.00000,29.40000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,outpatient,,,69.00000,33.26000,Humana,Medicare Advantage,,25.60,,,,,,,17.94,66.93,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,outpatient,,,52.00000,25.06000,Humana,Medicare Advantage,,19.29,,,,,,,13.52,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,outpatient,,,286.00000,137.85000,Humana,Medicare Advantage,,106.11,,,,,,,74.36,277.42,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,outpatient,,,300.00000,144.60000,Humana,Medicare Advantage,,111.30,,,,,,,78.00,291.00,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,outpatient,,,73.00000,35.19000,Humana,Medicare Advantage,,27.08,,,,,,,18.98,70.81,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,outpatient,,,90.00000,43.38000,Humana,Medicare Advantage,,33.39,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,outpatient,,,60.00000,28.92000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Humana,Medicare Advantage,,19.29,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,outpatient,,,315.00000,151.83000,Humana,Medicare Advantage,,116.86,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,outpatient,,,100.00000,48.20000,Humana,Medicare Advantage,,37.10,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,outpatient,,,89.00000,42.90000,Humana,Medicare Advantage,,33.02,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,outpatient,,,71.00000,34.22000,Humana,Medicare Advantage,,26.34,,,,,,,18.46,68.87,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,outpatient,,,135.00000,65.07000,Humana,Medicare Advantage,,50.09,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,outpatient,,,80.00000,38.56000,Humana,Medicare Advantage,,29.68,,,,,,,20.80,77.60,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Humana,Medicare Advantage,,26.71,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Humana,Medicare Advantage,,26.71,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,outpatient,,,100.00000,48.20000,Humana,Medicare Advantage,,37.10,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,outpatient,,,305.00000,147.01000,Humana,Medicare Advantage,,113.16,,,,,,,79.30,295.85,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,outpatient,,,70.00000,33.74000,Humana,Medicare Advantage,,25.97,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,outpatient,,,69.00000,33.26000,Humana,Medicare Advantage,,25.60,,,,,,,17.94,66.93,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,outpatient,,,64.00000,30.85000,Humana,Medicare Advantage,,23.74,,,,,,,16.64,62.08,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,outpatient,,,368.00000,177.38000,Humana,Medicare Advantage,,136.53,,,,,,,95.68,356.96,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,outpatient,,,104.00000,50.13000,Humana,Medicare Advantage,,38.58,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,outpatient,,,109.00000,52.54000,Humana,Medicare Advantage,,40.44,,,,,,,28.34,105.73,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,outpatient,,,114.00000,54.95000,Humana,Medicare Advantage,,42.29,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,outpatient,,,135.00000,65.07000,Humana,Medicare Advantage,,50.09,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,outpatient,,,105.00000,50.61000,Humana,Medicare Advantage,,38.95,,,,,,,27.30,101.85,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,outpatient,,,315.00000,151.83000,Humana,Medicare Advantage,,116.86,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,outpatient,,,148.00000,71.34000,Humana,Medicare Advantage,,54.91,,,,,,,38.48,143.56,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,outpatient,,,62.00000,29.88000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,outpatient,,,67.00000,32.29000,Humana,Medicare Advantage,,24.86,,,,,,,17.42,64.99,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,outpatient,,,107.00000,51.57000,Humana,Medicare Advantage,,39.70,,,,,,,27.82,103.79,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,outpatient,,,57.00000,27.47000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,outpatient,,,35.00000,16.87000,Humana,Medicare Advantage,,12.98,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,outpatient,,,104.00000,50.13000,Humana,Medicare Advantage,,38.58,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,outpatient,,,650.00000,313.30000,Humana,Medicare Advantage,,241.15,,,,,,,169.00,630.50,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,outpatient,,,91.00000,43.86000,Humana,Medicare Advantage,,33.76,,,,,,,23.66,88.27,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,outpatient,,,114.00000,54.95000,Humana,Medicare Advantage,,42.29,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Humana,Medicare Advantage,,19.29,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,outpatient,,,360.00000,173.52000,Humana,Medicare Advantage,,133.56,,,,,,,93.60,349.20,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,outpatient,,,106.00000,51.09000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,outpatient,,,78.00000,37.60000,Humana,Medicare Advantage,,28.94,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,outpatient,,,72.00000,34.70000,Humana,Medicare Advantage,,26.71,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,outpatient,,,94.00000,45.31000,Humana,Medicare Advantage,,34.87,,,,,,,24.44,91.18,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,outpatient,,,101.00000,48.68000,Humana,Medicare Advantage,,37.47,,,,,,,26.26,97.97,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,outpatient,,,82.00000,39.52000,Humana,Medicare Advantage,,30.42,,,,,,,21.32,79.54,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,outpatient,,,77.00000,37.11000,Humana,Medicare Advantage,,28.57,,,,,,,20.02,74.69,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,outpatient,,,145.00000,69.89000,Humana,Medicare Advantage,,53.80,,,,,,,37.70,140.65,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,outpatient,,,266.00000,128.21000,Humana,Medicare Advantage,,98.69,,,,,,,69.16,258.02,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,outpatient,,,79.00000,38.08000,Humana,Medicare Advantage,,29.31,,,,,,,20.54,76.63,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,outpatient,,,57.00000,27.47000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,outpatient,,,144.00000,69.41000,Humana,Medicare Advantage,,53.42,,,,,,,37.44,139.68,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,outpatient,,,20.00000,9.64000,Humana,Medicare Advantage,,7.42,,,,,,,5.20,19.40,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,outpatient,,,208.00000,100.26000,Humana,Medicare Advantage,,77.17,,,,,,,54.08,201.76,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,outpatient,,,135.00000,65.07000,Humana,Medicare Advantage,,50.09,,,,,,,35.10,130.95,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,outpatient,,,131.00000,63.14000,Humana,Medicare Advantage,,48.60,,,,,,,34.06,127.07,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,outpatient,,,69.00000,33.26000,Humana,Medicare Advantage,,25.60,,,,,,,17.94,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,outpatient,,,55.00000,26.51000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,outpatient,,,25.00000,12.05000,Humana,Medicare Advantage,,9.28,,,,,,,6.50,24.25,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,outpatient,,,61.00000,29.40000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,outpatient,,,80.00000,38.56000,Humana,Medicare Advantage,,29.68,,,,,,,20.80,77.60,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,outpatient,,,82.00000,39.52000,Humana,Medicare Advantage,,30.42,,,,,,,21.32,79.54,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,outpatient,,,35.00000,16.87000,Humana,Medicare Advantage,,12.98,,,,,,,9.10,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,outpatient,,,88.00000,42.42000,Humana,Medicare Advantage,,32.65,,,,,,,22.88,85.36,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,outpatient,,,98.00000,47.24000,Humana,Medicare Advantage,,36.36,,,,,,,25.48,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,outpatient,,,204.00000,98.33000,Humana,Medicare Advantage,,75.68,,,,,,,53.04,197.88,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,outpatient,,,61.00000,29.40000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,outpatient,,,19.00000,9.16000,Humana,Medicare Advantage,,7.05,,,,,,,4.94,18.43,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,outpatient,,,57.00000,27.47000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,outpatient,,,55.00000,26.51000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,outpatient,,,37.00000,17.83000,Humana,Medicare Advantage,,13.73,,,,,,,9.62,35.89,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,outpatient,,,79.00000,38.08000,Humana,Medicare Advantage,,29.31,,,,,,,20.54,76.63,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,outpatient,,,63.00000,30.37000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,outpatient,,,21.00000,10.12000,Humana,Medicare Advantage,,7.79,,,,,,,5.46,20.37,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,outpatient,,,52.00000,25.06000,Humana,Medicare Advantage,,19.29,,,,,,,13.52,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,outpatient,,,57.00000,27.47000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,outpatient,,,60.00000,28.92000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,outpatient,,,32.00000,15.42000,Humana,Medicare Advantage,,11.87,,,,,,,8.32,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,outpatient,,,94.00000,45.31000,Humana,Medicare Advantage,,34.87,,,,,,,24.44,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,outpatient,,,103.00000,49.65000,Humana,Medicare Advantage,,38.21,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,outpatient,,,64.00000,30.85000,Humana,Medicare Advantage,,23.74,,,,,,,16.64,62.08,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,outpatient,,,102.00000,49.16000,Humana,Medicare Advantage,,37.84,,,,,,,26.52,98.94,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,outpatient,,,103.00000,49.65000,Humana,Medicare Advantage,,38.21,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,outpatient,,,139.00000,67.00000,Humana,Medicare Advantage,,51.57,,,,,,,36.14,134.83,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,outpatient,,,52.00000,25.06000,Humana,Medicare Advantage,,19.29,,,,,,,13.52,50.44,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Humana,Medicare Advantage,,7.79,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,outpatient,,,88.00000,42.42000,Humana,Medicare Advantage,,32.65,,,,,,,22.88,85.36,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Humana,Medicare Advantage,,7.79,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,outpatient,,,52.00000,25.06000,Humana,Medicare Advantage,,19.29,,,,,,,13.52,50.44,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,outpatient,,,80.00000,38.56000,Humana,Medicare Advantage,,29.68,,,,,,,20.80,77.60,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,outpatient,,,49.00000,23.62000,Humana,Medicare Advantage,,18.18,,,,,,,12.74,47.53,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,outpatient,,,88.00000,42.42000,Humana,Medicare Advantage,,32.65,,,,,,,22.88,85.36,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,outpatient,,,66.00000,31.81000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,outpatient,,,68.00000,32.78000,Humana,Medicare Advantage,,25.23,,,,,,,17.68,65.96,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,outpatient,,,93.00000,44.83000,Humana,Medicare Advantage,,34.50,,,,,,,24.18,90.21,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,outpatient,,,73.00000,35.19000,Humana,Medicare Advantage,,27.08,,,,,,,18.98,70.81,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,outpatient,,,41.00000,19.76000,Humana,Medicare Advantage,,15.21,,,,,,,10.66,39.77,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,outpatient,,,94.00000,45.31000,Humana,Medicare Advantage,,34.87,,,,,,,24.44,91.18,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,outpatient,,,124.00000,59.77000,Humana,Medicare Advantage,,46.00,,,,,,,32.24,120.28,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,outpatient,,,71.00000,34.22000,Humana,Medicare Advantage,,26.34,,,,,,,18.46,68.87,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,outpatient,,,33.00000,15.91000,Humana,Medicare Advantage,,12.24,,,,,,,8.58,32.01,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,outpatient,,,52.00000,25.06000,Humana,Medicare Advantage,,19.29,,,,,,,13.52,50.44,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,outpatient,,,68.00000,32.78000,Humana,Medicare Advantage,,25.23,,,,,,,17.68,65.96,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,outpatient,,,99.00000,47.72000,Humana,Medicare Advantage,,36.73,,,,,,,25.74,96.03,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,outpatient,,,197.00000,94.95000,Humana,Medicare Advantage,,73.09,,,,,,,51.22,191.09,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,outpatient,,,194.00000,93.51000,Humana,Medicare Advantage,,71.97,,,,,,,50.44,188.18,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,outpatient,,,68.00000,32.78000,Humana,Medicare Advantage,,25.23,,,,,,,17.68,65.96,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,outpatient,,,90.00000,43.38000,Humana,Medicare Advantage,,33.39,,,,,,,23.40,87.30,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,outpatient,,,109.00000,52.54000,Humana,Medicare Advantage,,40.44,,,,,,,28.34,105.73,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,outpatient,,,108.00000,52.06000,Humana,Medicare Advantage,,40.07,,,,,,,28.08,104.76,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,outpatient,,,67.00000,32.29000,Humana,Medicare Advantage,,24.86,,,,,,,17.42,64.99,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,outpatient,,,69.00000,33.26000,Humana,Medicare Advantage,,25.60,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,outpatient,,,71.00000,34.22000,Humana,Medicare Advantage,,26.34,,,,,,,18.46,68.87,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,outpatient,,,98.00000,47.24000,Humana,Medicare Advantage,,36.36,,,,,,,25.48,95.06,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,outpatient,,,141.00000,67.96000,Humana,Medicare Advantage,,52.31,,,,,,,36.66,136.77,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,outpatient,,,226.00000,108.93000,Humana,Medicare Advantage,,83.85,,,,,,,58.76,219.22,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,outpatient,,,92.00000,44.34000,Humana,Medicare Advantage,,34.13,,,,,,,23.92,89.24,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,outpatient,,,69.00000,33.26000,Humana,Medicare Advantage,,25.60,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,outpatient,,,100.00000,48.20000,Humana,Medicare Advantage,,37.10,,,,,,,26.00,97.00,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,outpatient,,,124.00000,59.77000,Humana,Medicare Advantage,,46.00,,,,,,,32.24,120.28,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,outpatient,,,69.00000,33.26000,Humana,Medicare Advantage,,25.60,,,,,,,17.94,66.93,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Humana,Medicare Advantage,,46.00,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Humana,Medicare Advantage,,46.00,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Humana,Medicare Advantage,,46.00,,,,,,,32.24,120.28,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,outpatient,,,118.00000,56.88000,Humana,Medicare Advantage,,43.78,,,,,,,30.68,114.46,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,outpatient,,,51.00000,24.58000,Humana,Medicare Advantage,,18.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,outpatient,,,104.00000,50.13000,Humana,Medicare Advantage,,38.58,,,,,,,27.04,100.88,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,outpatient,,,66.00000,31.81000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,outpatient,,,72.00000,34.70000,Humana,Medicare Advantage,,26.71,,,,,,,18.72,69.84,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,outpatient,,,54.00000,26.03000,Humana,Medicare Advantage,,20.03,,,,,,,14.04,52.38,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,outpatient,,,17.00000,8.19000,Humana,Medicare Advantage,,6.31,,,,,,,4.42,16.49,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,outpatient,,,63.00000,30.37000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,outpatient,,,36.00000,17.35000,Humana,Medicare Advantage,,13.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,outpatient,,,52.00000,25.06000,Humana,Medicare Advantage,,19.29,,,,,,,13.52,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,outpatient,,,18.00000,8.68000,Humana,Medicare Advantage,,6.68,,,,,,,4.68,17.46,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,outpatient,,,74.00000,35.67000,Humana,Medicare Advantage,,27.45,,,,,,,19.24,71.78,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,outpatient,,,62.00000,29.88000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,outpatient,,,62.00000,29.88000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,outpatient,,,118.00000,56.88000,Humana,Medicare Advantage,,43.78,,,,,,,30.68,114.46,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,outpatient,,,82.00000,39.52000,Humana,Medicare Advantage,,30.42,,,,,,,21.32,79.54,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,outpatient,,,30.00000,14.46000,Humana,Medicare Advantage,,11.13,,,,,,,7.80,29.10,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,outpatient,,,55.00000,26.51000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,outpatient,,,70.00000,33.74000,Humana,Medicare Advantage,,25.97,,,,,,,18.20,67.90,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,outpatient,,,54.00000,26.03000,Humana,Medicare Advantage,,20.03,,,,,,,14.04,52.38,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,outpatient,,,63.00000,30.37000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,outpatient,,,51.00000,24.58000,Humana,Medicare Advantage,,18.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,outpatient,,,141.00000,67.96000,Humana,Medicare Advantage,,52.31,,,,,,,36.66,136.77,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,outpatient,,,63.00000,30.37000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,outpatient,,,81.00000,39.04000,Humana,Medicare Advantage,,30.05,,,,,,,21.06,78.57,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,outpatient,,,335.00000,161.47000,Humana,Medicare Advantage,,124.28,,,,,,,87.10,324.95,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,outpatient,,,52.00000,25.06000,Humana,Medicare Advantage,,19.29,,,,,,,13.52,50.44,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Humana,Medicare Advantage,,20.03,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,outpatient,,,57.00000,27.47000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Humana,Medicare Advantage,,20.03,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,outpatient,,,53.00000,25.55000,Humana,Medicare Advantage,,19.66,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,outpatient,,,63.00000,30.37000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,outpatient,,,53.00000,25.55000,Humana,Medicare Advantage,,19.66,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,outpatient,,,12.00000,5.78000,Humana,Medicare Advantage,,4.45,,,,,,,3.12,11.64,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,outpatient,,,710.00000,342.22000,Humana,Medicare Advantage,,263.41,,,,,,,184.60,688.70,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,outpatient,,,104.00000,50.13000,Humana,Medicare Advantage,,38.58,,,,,,,27.04,100.88,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,outpatient,,,155.00000,74.71000,Humana,Medicare Advantage,,57.51,,,,,,,40.30,150.35,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,outpatient,,,139.00000,67.00000,Humana,Medicare Advantage,,51.57,,,,,,,36.14,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,outpatient,,,89.00000,42.90000,Humana,Medicare Advantage,,33.02,,,,,,,23.14,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,outpatient,,,88.00000,42.42000,Humana,Medicare Advantage,,32.65,,,,,,,22.88,85.36,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,outpatient,,,111.00000,53.50000,Humana,Medicare Advantage,,41.18,,,,,,,28.86,107.67,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,outpatient,,,70.00000,33.74000,Humana,Medicare Advantage,,25.97,,,,,,,18.20,67.90,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,outpatient,,,85.00000,40.97000,Humana,Medicare Advantage,,31.54,,,,,,,22.10,82.45,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,outpatient,,,60.00000,28.92000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,outpatient,,,110.00000,53.02000,Humana,Medicare Advantage,,40.81,,,,,,,28.60,106.70,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,outpatient,,,500.00000,241.00000,Humana,Medicare Advantage,,185.50,,,,,,,130.00,485.00,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,outpatient,,,140.00000,67.48000,Humana,Medicare Advantage,,51.94,,,,,,,36.40,135.80,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,outpatient,,,66.00000,31.81000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,outpatient,,,74.00000,35.67000,Humana,Medicare Advantage,,27.45,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,outpatient,,,77.00000,37.11000,Humana,Medicare Advantage,,28.57,,,,,,,20.02,74.69,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,outpatient,,,93.00000,44.83000,Humana,Medicare Advantage,,34.50,,,,,,,24.18,90.21,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,outpatient,,,57.00000,27.47000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,outpatient,,,15.00000,7.23000,Humana,Medicare Advantage,,5.57,,,,,,,3.90,14.55,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,outpatient,,,24.00000,11.57000,Humana,Medicare Advantage,,8.90,,,,,,,6.24,23.28,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,outpatient,,,72.00000,34.70000,Humana,Medicare Advantage,,26.71,,,,,,,18.72,69.84,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Humana,Medicare Advantage,,5.94,,,,,,,4.16,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Humana,Medicare Advantage,,5.94,,,,,,,4.16,15.52,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,outpatient,,,64.00000,30.85000,Humana,Medicare Advantage,,23.74,,,,,,,16.64,62.08,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,outpatient,,,82.00000,39.52000,Humana,Medicare Advantage,,30.42,,,,,,,21.32,79.54,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,outpatient,,,157.00000,75.67000,Humana,Medicare Advantage,,58.25,,,,,,,40.82,152.29,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,outpatient,,,70.00000,33.74000,Humana,Medicare Advantage,,25.97,,,,,,,18.20,67.90,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,outpatient,,,229.00000,110.38000,Humana,Medicare Advantage,,84.96,,,,,,,59.54,222.13,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,outpatient,,,64.00000,30.85000,Humana,Medicare Advantage,,23.74,,,,,,,16.64,62.08,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,outpatient,,,72.00000,34.70000,Humana,Medicare Advantage,,26.71,,,,,,,18.72,69.84,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,outpatient,,,17.00000,8.19000,Humana,Medicare Advantage,,6.31,,,,,,,4.42,16.49,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,outpatient,,,57.00000,27.47000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,outpatient,,,64.00000,30.85000,Humana,Medicare Advantage,,23.74,,,,,,,16.64,62.08,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,outpatient,,,387.00000,186.53000,Humana,Medicare Advantage,,143.58,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Humana,Medicare Advantage,,143.58,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Humana,Medicare Advantage,,143.58,,,,,,,100.62,375.39,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,outpatient,,,77.00000,37.11000,Humana,Medicare Advantage,,28.57,,,,,,,20.02,74.69,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Humana,Medicare Advantage,,28.94,,,,,,,20.28,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Humana,Medicare Advantage,,28.94,,,,,,,20.28,75.66,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,outpatient,,,43.00000,20.73000,Humana,Medicare Advantage,,15.95,,,,,,,11.18,41.71,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,outpatient,,,64.00000,30.85000,Humana,Medicare Advantage,,23.74,,,,,,,16.64,62.08,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,outpatient,,,160.00000,77.12000,Humana,Medicare Advantage,,59.36,,,,,,,41.60,155.20,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,outpatient,,,112.00000,53.98000,Humana,Medicare Advantage,,41.55,,,,,,,29.12,108.64,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,outpatient,,,82.00000,39.52000,Humana,Medicare Advantage,,30.42,,,,,,,21.32,79.54,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,outpatient,,,57.00000,27.47000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,outpatient,,,55.00000,26.51000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,outpatient,,,54.00000,26.03000,Humana,Medicare Advantage,,20.03,,,,,,,14.04,52.38,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,outpatient,,,153.00000,73.75000,Humana,Medicare Advantage,,56.76,,,,,,,39.78,148.41,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,outpatient,,,45.00000,21.69000,Humana,Medicare Advantage,,16.70,,,,,,,11.70,43.65,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,outpatient,,,28.00000,13.50000,Humana,Medicare Advantage,,10.39,,,,,,,7.28,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,outpatient,,,66.00000,31.81000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Humana,Medicare Advantage,,18.18,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Humana,Medicare Advantage,,18.18,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Humana,Medicare Advantage,,18.18,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,outpatient,,,62.00000,29.88000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,outpatient,,,36.00000,17.35000,Humana,Medicare Advantage,,13.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,outpatient,,,38.00000,18.32000,Humana,Medicare Advantage,,14.10,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,outpatient,,,38.00000,18.32000,Humana,Medicare Advantage,,14.10,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,outpatient,,,76.00000,36.63000,Humana,Medicare Advantage,,28.20,,,,,,,19.76,73.72,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,outpatient,,,173.00000,83.39000,Humana,Medicare Advantage,,64.18,,,,,,,44.98,167.81,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,outpatient,,,22.00000,10.60000,Humana,Medicare Advantage,,8.16,,,,,,,5.72,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,outpatient,,,62.00000,29.88000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,outpatient,,,39.00000,18.80000,Humana,Medicare Advantage,,14.47,,,,,,,10.14,37.83,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,outpatient,,,41.00000,19.76000,Humana,Medicare Advantage,,15.21,,,,,,,10.66,39.77,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,outpatient,,,57.00000,27.47000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,outpatient,,,54.00000,26.03000,Humana,Medicare Advantage,,20.03,,,,,,,14.04,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,outpatient,,,71.00000,34.22000,Humana,Medicare Advantage,,26.34,,,,,,,18.46,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Humana,Medicare Advantage,,15.95,,,,,,,11.18,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Humana,Medicare Advantage,,15.95,,,,,,,11.18,41.71,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,outpatient,,,38.00000,18.32000,Humana,Medicare Advantage,,14.10,,,,,,,9.88,36.86,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,outpatient,,,72.00000,34.70000,Humana,Medicare Advantage,,26.71,,,,,,,18.72,69.84,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,outpatient,,,226.00000,108.93000,Humana,Medicare Advantage,,83.85,,,,,,,58.76,219.22,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Humana,Medicare Advantage,,15.21,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Humana,Medicare Advantage,,15.21,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Humana,Medicare Advantage,,15.21,,,,,,,10.66,39.77,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,outpatient,,,160.00000,77.12000,Humana,Medicare Advantage,,59.36,,,,,,,41.60,155.20,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,outpatient,,,102.00000,49.16000,Humana,Medicare Advantage,,37.84,,,,,,,26.52,98.94,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,outpatient,,,317.00000,152.79000,Humana,Medicare Advantage,,117.61,,,,,,,82.42,307.49,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,outpatient,,,62.00000,29.88000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,outpatient,,,66.00000,31.81000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,outpatient,,,116.00000,55.91000,Humana,Medicare Advantage,,43.04,,,,,,,30.16,112.52,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Humana,Medicare Advantage,,33.02,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Humana,Medicare Advantage,,33.02,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,outpatient,,,85.00000,40.97000,Humana,Medicare Advantage,,31.54,,,,,,,22.10,82.45,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,outpatient,,,184.00000,88.69000,Humana,Medicare Advantage,,68.26,,,,,,,47.84,178.48,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,outpatient,,,127.00000,61.21000,Humana,Medicare Advantage,,47.12,,,,,,,33.02,123.19,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,outpatient,,,61.00000,29.40000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,outpatient,,,35.00000,16.87000,Humana,Medicare Advantage,,12.98,,,,,,,9.10,33.95,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,outpatient,,,79.00000,38.08000,Humana,Medicare Advantage,,29.31,,,,,,,20.54,76.63,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,outpatient,,,61.00000,35.14000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,outpatient,,,65.00000,37.44000,Humana,Medicare Advantage,,24.11,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,outpatient,,,57.00000,32.83000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Humana,Medicare Advantage,,56.76,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,outpatient,,,62.00000,35.71000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,outpatient,,,77.00000,44.35000,Humana,Medicare Advantage,,28.57,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,outpatient,,,70.00000,40.32000,Humana,Medicare Advantage,,25.97,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,outpatient,,,67.00000,38.59000,Humana,Medicare Advantage,,24.86,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,outpatient,,,40.00000,23.04000,Humana,Medicare Advantage,,14.84,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,outpatient,,,71.00000,40.90000,Humana,Medicare Advantage,,26.34,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,outpatient,,,80.00000,46.08000,Humana,Medicare Advantage,,29.68,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,outpatient,,,72.00000,41.47000,Humana,Medicare Advantage,,26.71,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,outpatient,,,444.00000,255.74000,Humana,Medicare Advantage,,164.72,,,,,,,115.44,430.68,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,outpatient,,,81.00000,46.66000,Humana,Medicare Advantage,,30.05,,,,,,,21.06,78.57,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,outpatient,,,62.00000,35.71000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,outpatient,,,66.00000,38.02000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,outpatient,,,57.00000,32.83000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,outpatient,,,53.00000,30.53000,Humana,Medicare Advantage,,19.66,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Humana,Medicare Advantage,,24.11,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Humana,Medicare Advantage,,24.11,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,outpatient,,,60.00000,34.56000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,outpatient,,,61.00000,35.14000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,outpatient,,,40.00000,23.04000,Humana,Medicare Advantage,,14.84,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,outpatient,,,63.00000,36.29000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,outpatient,,,42.00000,24.19000,Humana,Medicare Advantage,,15.58,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,outpatient,,,62.00000,35.71000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,outpatient,,,46.00000,26.50000,Humana,Medicare Advantage,,17.07,,,,,,,11.96,44.62,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,outpatient,,,54.00000,31.10000,Humana,Medicare Advantage,,20.03,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,outpatient,,,62.00000,35.71000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,outpatient,,,71.00000,40.90000,Humana,Medicare Advantage,,26.34,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,outpatient,,,54.00000,31.10000,Humana,Medicare Advantage,,20.03,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,outpatient,,,80.00000,46.08000,Humana,Medicare Advantage,,29.68,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,outpatient,,,60.00000,34.56000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Humana,Medicare Advantage,,46.00,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,outpatient,,,130.00000,74.88000,Humana,Medicare Advantage,,48.23,,,,,,,33.80,126.10,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Humana,Medicare Advantage,,45.63,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,outpatient,,,77.00000,44.35000,Humana,Medicare Advantage,,28.57,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,outpatient,,,65.00000,37.44000,Humana,Medicare Advantage,,24.11,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,outpatient,,,115.00000,66.24000,Humana,Medicare Advantage,,42.66,,,,,,,29.90,111.55,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Humana,Medicare Advantage,,45.63,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,outpatient,,,161.00000,92.74000,Humana,Medicare Advantage,,59.73,,,,,,,41.86,156.17,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Humana,Medicare Advantage,,46.00,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,outpatient,,,65.00000,37.44000,Humana,Medicare Advantage,,24.11,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,outpatient,,,65.00000,37.44000,Humana,Medicare Advantage,,24.11,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,outpatient,,,65.00000,37.44000,Humana,Medicare Advantage,,24.11,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,outpatient,,,65.00000,37.44000,Humana,Medicare Advantage,,24.11,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,outpatient,,,102.00000,58.75000,Humana,Medicare Advantage,,37.84,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,outpatient,,,219.00000,126.14000,Humana,Medicare Advantage,,81.25,,,,,,,56.94,212.43,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Humana,Medicare Advantage,,71.97,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,outpatient,,,103.00000,59.33000,Humana,Medicare Advantage,,38.21,,,,,,,26.78,99.91,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,outpatient,,,60.00000,34.56000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,outpatient,,,837.00000,482.11000,Humana,Medicare Advantage,,310.53,,,,,,,217.62,811.89,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Humana,Medicare Advantage,,24.11,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Humana,Medicare Advantage,,24.11,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Humana,Medicare Advantage,,71.97,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,outpatient,,,78.00000,44.93000,Humana,Medicare Advantage,,28.94,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,outpatient,,,285.00000,164.16000,Humana,Medicare Advantage,,105.73,,,,,,,74.10,276.45,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,outpatient,,,190.00000,109.44000,Humana,Medicare Advantage,,70.49,,,,,,,49.40,184.30,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,outpatient,,,100.00000,57.60000,Humana,Medicare Advantage,,37.10,,,,,,,26.00,97.00,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Humana,Medicare Advantage,,14.84,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,outpatient,,,67.00000,38.59000,Humana,Medicare Advantage,,24.86,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,outpatient,,,62.00000,35.71000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,outpatient,,,78.00000,44.93000,Humana,Medicare Advantage,,28.94,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Humana,Medicare Advantage,,24.11,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,outpatient,,,65.00000,37.44000,Humana,Medicare Advantage,,24.11,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,outpatient,,,57.00000,32.83000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,outpatient,,,72.00000,41.47000,Humana,Medicare Advantage,,26.71,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,outpatient,,,59.00000,33.98000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,outpatient,,,72.00000,41.47000,Humana,Medicare Advantage,,26.71,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,outpatient,,,239.00000,137.66000,Humana,Medicare Advantage,,88.67,,,,,,,62.14,231.83,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,outpatient,,,85.00000,48.96000,Humana,Medicare Advantage,,31.54,,,,,,,22.10,82.45,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,outpatient,,,44.00000,25.34000,Humana,Medicare Advantage,,16.32,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,outpatient,,,40.00000,23.04000,Humana,Medicare Advantage,,14.84,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,outpatient,,,53.00000,30.53000,Humana,Medicare Advantage,,19.66,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,outpatient,,,63.00000,36.29000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,outpatient,,,68.00000,39.17000,Humana,Medicare Advantage,,25.23,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,outpatient,,,76.00000,43.78000,Humana,Medicare Advantage,,28.20,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,outpatient,,,42.00000,24.19000,Humana,Medicare Advantage,,15.58,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,outpatient,,,87.00000,50.11000,Humana,Medicare Advantage,,32.28,,,,,,,22.62,84.39,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,outpatient,,,503.00000,289.73000,Humana,Medicare Advantage,,186.61,,,,,,,130.78,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,outpatient,,,472.00000,271.87000,Humana,Medicare Advantage,,175.11,,,,,,,122.72,457.84,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,outpatient,,,28.00000,16.13000,Humana,Medicare Advantage,,10.39,,,,,,,7.28,27.16,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,outpatient,,,236.00000,135.94000,Humana,Medicare Advantage,,87.56,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,outpatient,,,54.00000,31.10000,Humana,Medicare Advantage,,20.03,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,outpatient,,,238.00000,137.09000,Humana,Medicare Advantage,,88.30,,,,,,,61.88,230.86,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,outpatient,,,236.00000,135.94000,Humana,Medicare Advantage,,87.56,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,outpatient,,,145.00000,83.52000,Humana,Medicare Advantage,,53.80,,,,,,,37.70,140.65,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Humana,Medicare Advantage,,25.23,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Humana,Medicare Advantage,,25.23,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,outpatient,,,66.00000,38.02000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,outpatient,,,59.00000,33.98000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,outpatient,,,158.00000,91.01000,Humana,Medicare Advantage,,58.62,,,,,,,41.08,153.26,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,outpatient,,,71.00000,40.90000,Humana,Medicare Advantage,,26.34,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,outpatient,,,144.00000,82.94000,Humana,Medicare Advantage,,53.42,,,,,,,37.44,139.68,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,outpatient,,,1448.00000,834.05000,Humana,Medicare Advantage,,537.21,,,,,,,376.48,1404.56,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,outpatient,,,72.00000,41.47000,Humana,Medicare Advantage,,26.71,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,outpatient,,,102.00000,58.75000,Humana,Medicare Advantage,,37.84,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,outpatient,,,154.00000,88.70000,Humana,Medicare Advantage,,57.13,,,,,,,40.04,149.38,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Humana,Medicare Advantage,,56.76,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,outpatient,,,61.00000,35.14000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,outpatient,,,66.00000,38.02000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Humana,Medicare Advantage,,56.76,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,outpatient,,,44.00000,25.34000,Humana,Medicare Advantage,,16.32,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,outpatient,,,63.00000,36.29000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,outpatient,,,150.00000,86.40000,Humana,Medicare Advantage,,55.65,,,,,,,39.00,145.50,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,outpatient,,,61.00000,35.14000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,outpatient,,,56.00000,32.26000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,outpatient,,,62.00000,35.71000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,outpatient,,,66.00000,38.02000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,outpatient,,,60.00000,34.56000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,outpatient,,,58.00000,33.41000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,outpatient,,,71.00000,40.90000,Humana,Medicare Advantage,,26.34,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,outpatient,,,72.00000,41.47000,Humana,Medicare Advantage,,26.71,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,outpatient,,,60.00000,34.56000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,outpatient,,,56.00000,32.26000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,outpatient,,,39.00000,22.46000,Humana,Medicare Advantage,,14.47,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Humana,Medicare Advantage,,56.76,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,outpatient,,,73.00000,42.05000,Humana,Medicare Advantage,,27.08,,,,,,,18.98,70.81,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Humana,Medicare Advantage,,47.12,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Humana,Medicare Advantage,,47.12,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Humana,Medicare Advantage,,24.11,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,outpatient,,,372.00000,214.27000,Humana,Medicare Advantage,,138.01,,,,,,,96.72,360.84,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,outpatient,,,69.00000,39.74000,Humana,Medicare Advantage,,25.60,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Humana,Medicare Advantage,,56.76,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Humana,Medicare Advantage,,56.76,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,outpatient,,,63.00000,36.29000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,outpatient,,,57.00000,32.83000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,outpatient,,,96.00000,55.30000,Humana,Medicare Advantage,,35.62,,,,,,,24.96,93.12,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,outpatient,,,44.00000,25.34000,Humana,Medicare Advantage,,16.32,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,outpatient,,,60.00000,34.56000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,outpatient,,,63.00000,36.29000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,outpatient,,,60.00000,34.56000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,outpatient,,,63.00000,36.29000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,outpatient,,,74.00000,42.62000,Humana,Medicare Advantage,,27.45,,,,,,,19.24,71.78,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,outpatient,,,69.00000,39.74000,Humana,Medicare Advantage,,25.60,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Humana,Medicare Advantage,,14.47,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,outpatient,,,53.00000,30.53000,Humana,Medicare Advantage,,19.66,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Humana,Medicare Advantage,,14.47,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Humana,Medicare Advantage,,14.47,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,outpatient,,,70.00000,40.32000,Humana,Medicare Advantage,,25.97,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,outpatient,,,71.00000,40.90000,Humana,Medicare Advantage,,26.34,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,outpatient,,,65.00000,37.44000,Humana,Medicare Advantage,,24.11,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,outpatient,,,325.00000,187.20000,Humana,Medicare Advantage,,120.58,,,,,,,84.50,315.25,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,outpatient,,,72.00000,41.47000,Humana,Medicare Advantage,,26.71,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,outpatient,,,72.00000,41.47000,Humana,Medicare Advantage,,26.71,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,outpatient,,,76.00000,43.78000,Humana,Medicare Advantage,,28.20,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,outpatient,,,240.00000,138.24000,Humana,Medicare Advantage,,89.04,,,,,,,62.40,232.80,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,outpatient,,,93.00000,53.57000,Humana,Medicare Advantage,,34.50,,,,,,,24.18,90.21,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,outpatient,,,59.00000,33.98000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,outpatient,,,81.00000,46.66000,Humana,Medicare Advantage,,30.05,,,,,,,21.06,78.57,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,outpatient,,,58.00000,33.41000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,outpatient,,,21.00000,12.10000,Humana,Medicare Advantage,,7.79,,,,,,,5.46,20.37,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,outpatient,,,56.00000,32.26000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,outpatient,,,64.00000,36.86000,Humana,Medicare Advantage,,23.74,,,,,,,16.64,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,outpatient,,,80.00000,46.08000,Humana,Medicare Advantage,,29.68,,,,,,,20.80,77.60,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,outpatient,,,109.00000,62.78000,Humana,Medicare Advantage,,40.44,,,,,,,28.34,105.73,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,outpatient,,,59.00000,33.98000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,outpatient,,,115.00000,66.24000,Humana,Medicare Advantage,,42.66,,,,,,,29.90,111.55,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,outpatient,,,57.00000,32.83000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,outpatient,,,118.00000,67.97000,Humana,Medicare Advantage,,43.78,,,,,,,30.68,114.46,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,outpatient,,,268.00000,154.37000,Humana,Medicare Advantage,,99.43,,,,,,,69.68,259.96,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Humana,Medicare Advantage,,42.29,,,,,,,29.64,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Humana,Medicare Advantage,,42.29,,,,,,,29.64,110.58,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,outpatient,,,78.00000,44.93000,Humana,Medicare Advantage,,28.94,,,,,,,20.28,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,outpatient,,,91.00000,52.42000,Humana,Medicare Advantage,,33.76,,,,,,,23.66,88.27,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,outpatient,,,300.00000,172.80000,Humana,Medicare Advantage,,111.30,,,,,,,78.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,outpatient,,,185.00000,106.56000,Humana,Medicare Advantage,,68.64,,,,,,,48.10,179.45,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Humana,Medicare Advantage,,13.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,outpatient,,,76.00000,43.78000,Humana,Medicare Advantage,,28.20,,,,,,,19.76,73.72,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Humana,Medicare Advantage,,13.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Humana,Medicare Advantage,,13.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,outpatient,,,53.00000,30.53000,Humana,Medicare Advantage,,19.66,,,,,,,13.78,51.41,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,outpatient,,,77.00000,44.35000,Humana,Medicare Advantage,,28.57,,,,,,,20.02,74.69,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Humana,Medicare Advantage,,13.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,outpatient,,,222.00000,127.87000,Humana,Medicare Advantage,,82.36,,,,,,,57.72,215.34,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,outpatient,,,292.00000,168.19000,Humana,Medicare Advantage,,108.33,,,,,,,75.92,283.24,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,outpatient,,,61.00000,35.14000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Humana,Medicare Advantage,,46.38,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Humana,Medicare Advantage,,46.38,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,outpatient,,,359.00000,206.78000,Humana,Medicare Advantage,,133.19,,,,,,,93.34,348.23,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,outpatient,,,111.00000,63.94000,Humana,Medicare Advantage,,41.18,,,,,,,28.86,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Humana,Medicare Advantage,,52.31,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Humana,Medicare Advantage,,52.31,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Humana,Medicare Advantage,,42.29,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Humana,Medicare Advantage,,42.29,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Humana,Medicare Advantage,,42.29,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Humana,Medicare Advantage,,42.29,,,,,,,29.64,110.58,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,outpatient,,,78.00000,44.93000,Humana,Medicare Advantage,,28.94,,,,,,,20.28,75.66,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Humana,Medicare Advantage,,133.19,,,,,,,93.34,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Humana,Medicare Advantage,,133.19,,,,,,,93.34,348.23,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,outpatient,,,70.00000,40.32000,Humana,Medicare Advantage,,25.97,,,,,,,18.20,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,outpatient,,,18.00000,10.37000,Humana,Medicare Advantage,,6.68,,,,,,,4.68,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,outpatient,,,408.00000,235.01000,Humana,Medicare Advantage,,151.37,,,,,,,106.08,395.76,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,outpatient,,,102.00000,58.75000,Humana,Medicare Advantage,,37.84,,,,,,,26.52,98.94,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,outpatient,,,330.00000,190.08000,Humana,Medicare Advantage,,122.43,,,,,,,85.80,320.10,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,outpatient,,,56.00000,32.26000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,outpatient,,,136.00000,78.34000,Humana,Medicare Advantage,,50.46,,,,,,,35.36,131.92,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,outpatient,,,83.00000,47.81000,Humana,Medicare Advantage,,30.79,,,,,,,21.58,80.51,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,outpatient,,,63.00000,36.29000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,outpatient,,,142.00000,81.79000,Humana,Medicare Advantage,,52.68,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,outpatient,,,51.00000,29.38000,Humana,Medicare Advantage,,18.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,outpatient,,,70.00000,40.32000,Humana,Medicare Advantage,,25.97,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,outpatient,,,99.00000,57.02000,Humana,Medicare Advantage,,36.73,,,,,,,25.74,96.03,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,outpatient,,,78.00000,44.93000,Humana,Medicare Advantage,,28.94,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,outpatient,,,63.00000,36.29000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,outpatient,,,63.00000,36.29000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,outpatient,,,75.00000,43.20000,Humana,Medicare Advantage,,27.82,,,,,,,19.50,72.75,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Humana,Medicare Advantage,,13.73,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Humana,Medicare Advantage,,13.73,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,outpatient,,,59.00000,33.98000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,outpatient,,,35.00000,20.16000,Humana,Medicare Advantage,,12.98,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,outpatient,,,59.00000,33.98000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,outpatient,,,56.00000,32.26000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,outpatient,,,74.00000,42.62000,Humana,Medicare Advantage,,27.45,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,outpatient,,,90.00000,51.84000,Humana,Medicare Advantage,,33.39,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Humana,Medicare Advantage,,25.23,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,outpatient,,,142.00000,81.79000,Humana,Medicare Advantage,,52.68,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Humana,Medicare Advantage,,25.23,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,outpatient,,,74.00000,42.62000,Humana,Medicare Advantage,,27.45,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Humana,Medicare Advantage,,33.02,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Humana,Medicare Advantage,,33.02,,,,,,,23.14,86.33,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,outpatient,,,57.00000,32.83000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,outpatient,,,77.00000,44.35000,Humana,Medicare Advantage,,28.57,,,,,,,20.02,74.69,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,outpatient,,,64.00000,36.86000,Humana,Medicare Advantage,,23.74,,,,,,,16.64,62.08,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,outpatient,,,69.00000,39.74000,Humana,Medicare Advantage,,25.60,,,,,,,17.94,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,outpatient,,,1178.00000,678.53000,Humana,Medicare Advantage,,437.04,,,,,,,306.28,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,outpatient,,,127.00000,73.15000,Humana,Medicare Advantage,,47.12,,,,,,,33.02,123.19,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,outpatient,,,277.00000,159.55000,Humana,Medicare Advantage,,102.77,,,,,,,72.02,268.69,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,outpatient,,,940.00000,541.44000,Humana,Medicare Advantage,,348.74,,,,,,,244.40,911.80,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,outpatient,,,97.00000,55.87000,Humana,Medicare Advantage,,35.99,,,,,,,25.22,94.09,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,outpatient,,,16.00000,9.22000,Humana,Medicare Advantage,,5.94,,,,,,,4.16,15.52,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,outpatient,,,57.00000,32.83000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,outpatient,,,131.00000,75.46000,Humana,Medicare Advantage,,48.60,,,,,,,34.06,127.07,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,outpatient,,,2160.00000,1244.16000,Humana,Medicare Advantage,,801.36,,,,,,,561.60,2095.20,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,outpatient,,,37.00000,21.31000,Humana,Medicare Advantage,,13.73,,,,,,,9.62,35.89,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Humana,Medicare Advantage,,27.45,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,outpatient,,,54.00000,31.10000,Humana,Medicare Advantage,,20.03,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,outpatient,,,76.00000,43.78000,Humana,Medicare Advantage,,28.20,,,,,,,19.76,73.72,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,outpatient,,,606.00000,349.06000,Humana,Medicare Advantage,,224.83,,,,,,,157.56,587.82,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,outpatient,,,62.00000,35.71000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,outpatient,,,300.00000,172.80000,Humana,Medicare Advantage,,111.30,,,,,,,78.00,291.00,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,outpatient,,,59.00000,33.98000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,outpatient,,,98.00000,56.45000,Humana,Medicare Advantage,,36.36,,,,,,,25.48,95.06,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,outpatient,,,61.00000,35.14000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,outpatient,,,128.00000,73.73000,Humana,Medicare Advantage,,47.49,,,,,,,33.28,124.16,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Humana,Medicare Advantage,,19.66,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,outpatient,,,16.00000,9.22000,Humana,Medicare Advantage,,5.94,,,,,,,4.16,15.52,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,outpatient,,,565.00000,325.44000,Humana,Medicare Advantage,,209.62,,,,,,,146.90,548.05,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,outpatient,,,850.00000,489.60000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,outpatient,,,77.00000,44.35000,Humana,Medicare Advantage,,28.57,,,,,,,20.02,74.69,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,outpatient,,,86.00000,49.54000,Humana,Medicare Advantage,,31.91,,,,,,,22.36,83.42,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,outpatient,,,837.00000,482.11000,Humana,Medicare Advantage,,310.53,,,,,,,217.62,811.89,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,outpatient,,,60.00000,34.56000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,outpatient,,,56.00000,32.26000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,outpatient,,,56.00000,32.26000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Humana,Medicare Advantage,,27.45,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Humana,Medicare Advantage,,19.66,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Humana,Medicare Advantage,,19.66,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,outpatient,,,167.00000,96.19000,Humana,Medicare Advantage,,61.96,,,,,,,43.42,161.99,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,outpatient,,,200.00000,115.20000,Humana,Medicare Advantage,,74.20,,,,,,,52.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,outpatient,,,93.00000,53.57000,Humana,Medicare Advantage,,34.50,,,,,,,24.18,90.21,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Humana,Medicare Advantage,,20.41,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,outpatient,,,190.00000,109.44000,Humana,Medicare Advantage,,70.49,,,,,,,49.40,184.30,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,outpatient,,,64.00000,36.86000,Humana,Medicare Advantage,,23.74,,,,,,,16.64,62.08,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,outpatient,,,525.00000,302.40000,Humana,Medicare Advantage,,194.78,,,,,,,136.50,509.25,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,outpatient,,,54.00000,31.10000,Humana,Medicare Advantage,,20.03,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Humana,Medicare Advantage,,19.66,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,outpatient,,,53.00000,30.53000,Humana,Medicare Advantage,,19.66,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Humana,Medicare Advantage,,14.84,,,,,,,10.40,38.80,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,outpatient,,,453.00000,260.93000,Humana,Medicare Advantage,,168.06,,,,,,,117.78,439.41,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,outpatient,,,25.00000,14.40000,Humana,Medicare Advantage,,9.28,,,,,,,6.50,24.25,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,outpatient,,,56.00000,32.26000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,outpatient,,,59.00000,33.98000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,outpatient,,,53.00000,30.53000,Humana,Medicare Advantage,,19.66,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,outpatient,,,62.00000,35.71000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,outpatient,,,350.00000,201.60000,Humana,Medicare Advantage,,129.85,,,,,,,91.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,outpatient,,,225.00000,129.60000,Humana,Medicare Advantage,,83.47,,,,,,,58.50,218.25,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,outpatient,,,52.00000,29.95000,Humana,Medicare Advantage,,19.29,,,,,,,13.52,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,outpatient,,,62.00000,35.71000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,outpatient,,,134.00000,77.18000,Humana,Medicare Advantage,,49.71,,,,,,,34.84,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,outpatient,,,52.00000,29.95000,Humana,Medicare Advantage,,19.29,,,,,,,13.52,50.44,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,outpatient,,,186.00000,107.14000,Humana,Medicare Advantage,,69.01,,,,,,,48.36,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Humana,Medicare Advantage,,111.30,,,,,,,78.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Humana,Medicare Advantage,,111.30,,,,,,,78.00,291.00,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,outpatient,,,62.00000,35.71000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,outpatient,,,205.00000,118.08000,Humana,Medicare Advantage,,76.06,,,,,,,53.30,198.85,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,outpatient,,,75.00000,36.15000,Humana,Medicare Advantage,,27.82,,,,,,,19.50,72.75,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,outpatient,,,65.00000,31.33000,Humana,Medicare Advantage,,24.11,,,,,,,16.90,63.05,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,outpatient,,,92.00000,44.34000,Humana,Medicare Advantage,,34.13,,,,,,,23.92,89.24,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Humana,Medicare Advantage,,8.90,,,,,,,6.24,23.28,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,outpatient,,,20.00000,9.64000,Humana,Medicare Advantage,,7.42,,,,,,,5.20,19.40,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,outpatient,,,63.00000,30.37000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,outpatient,,,42.00000,20.24000,Humana,Medicare Advantage,,15.58,,,,,,,10.92,40.74,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,outpatient,,,69.00000,33.26000,Humana,Medicare Advantage,,25.60,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,outpatient,,,65.00000,31.33000,Humana,Medicare Advantage,,24.11,,,,,,,16.90,63.05,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,outpatient,,,76.00000,36.63000,Humana,Medicare Advantage,,28.20,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,outpatient,,,89.00000,42.90000,Humana,Medicare Advantage,,33.02,,,,,,,23.14,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,outpatient,,,76.00000,36.63000,Humana,Medicare Advantage,,28.20,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,outpatient,,,28.00000,13.50000,Humana,Medicare Advantage,,10.39,,,,,,,7.28,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,outpatient,,,98.00000,47.24000,Humana,Medicare Advantage,,36.36,,,,,,,25.48,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,outpatient,,,64.00000,30.85000,Humana,Medicare Advantage,,23.74,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,outpatient,,,75.00000,36.15000,Humana,Medicare Advantage,,27.82,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,outpatient,,,76.00000,36.63000,Humana,Medicare Advantage,,28.20,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,outpatient,,,66.00000,31.81000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,outpatient,,,114.00000,54.95000,Humana,Medicare Advantage,,42.29,,,,,,,29.64,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,outpatient,,,74.00000,35.67000,Humana,Medicare Advantage,,27.45,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,outpatient,,,69.00000,33.26000,Humana,Medicare Advantage,,25.60,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,outpatient,,,74.00000,35.67000,Humana,Medicare Advantage,,27.45,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,outpatient,,,87.00000,41.93000,Humana,Medicare Advantage,,32.28,,,,,,,22.62,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,outpatient,,,79.00000,38.08000,Humana,Medicare Advantage,,29.31,,,,,,,20.54,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,outpatient,,,75.00000,36.15000,Humana,Medicare Advantage,,27.82,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,outpatient,,,66.00000,31.81000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,outpatient,,,60.00000,28.92000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,outpatient,,,64.00000,30.85000,Humana,Medicare Advantage,,23.74,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,outpatient,,,164.00000,79.05000,Humana,Medicare Advantage,,60.84,,,,,,,42.64,159.08,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,outpatient,,,54.00000,26.03000,Humana,Medicare Advantage,,20.03,,,,,,,14.04,52.38,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,outpatient,,,8.00000,3.86000,Humana,Medicare Advantage,,2.97,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,outpatient,,,69.00000,33.26000,Humana,Medicare Advantage,,25.60,,,,,,,17.94,66.93,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,outpatient,,,8.00000,3.86000,Humana,Medicare Advantage,,2.97,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,outpatient,,,60.00000,28.92000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,outpatient,,,8.00000,3.86000,Humana,Medicare Advantage,,2.97,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,outpatient,,,14.00000,6.75000,Humana,Medicare Advantage,,5.19,,,,,,,3.64,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,outpatient,,,62.00000,29.88000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,outpatient,,,63.00000,30.37000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,outpatient,,,112.00000,53.98000,Humana,Medicare Advantage,,41.55,,,,,,,29.12,108.64,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,outpatient,,,13.00000,6.27000,Humana,Medicare Advantage,,4.82,,,,,,,3.38,12.61,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,outpatient,,,57.00000,27.47000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,outpatient,,,31.00000,14.94000,Humana,Medicare Advantage,,11.50,,,,,,,8.06,30.07,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,outpatient,,,92.00000,44.34000,Humana,Medicare Advantage,,34.13,,,,,,,23.92,89.24,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,outpatient,,,80.00000,38.56000,Humana,Medicare Advantage,,29.68,,,,,,,20.80,77.60,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Humana,Medicare Advantage,,11.13,,,,,,,7.80,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Humana,Medicare Advantage,,11.13,,,,,,,7.80,29.10,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,outpatient,,,57.00000,27.47000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Humana,Medicare Advantage,,8.90,,,,,,,6.24,23.28,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,outpatient,,,59.00000,28.44000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,outpatient,,,29.00000,13.98000,Humana,Medicare Advantage,,10.76,,,,,,,7.54,28.13,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,outpatient,,,97.00000,46.75000,Humana,Medicare Advantage,,35.99,,,,,,,25.22,94.09,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,outpatient,,,225.00000,108.45000,Humana,Medicare Advantage,,83.47,,,,,,,58.50,218.25,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,outpatient,,,57.00000,27.47000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,outpatient,,,71.00000,34.22000,Humana,Medicare Advantage,,26.34,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,outpatient,,,57.00000,27.47000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,outpatient,,,71.00000,34.22000,Humana,Medicare Advantage,,26.34,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,outpatient,,,108.00000,52.06000,Humana,Medicare Advantage,,40.07,,,,,,,28.08,104.76,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,outpatient,,,66.00000,31.81000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,outpatient,,,51.00000,24.58000,Humana,Medicare Advantage,,18.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,outpatient,,,63.00000,30.37000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,outpatient,,,58.00000,27.96000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,outpatient,,,19.00000,9.16000,Humana,Medicare Advantage,,7.05,,,,,,,4.94,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,outpatient,,,54.00000,26.03000,Humana,Medicare Advantage,,20.03,,,,,,,14.04,52.38,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,outpatient,,,103.00000,49.65000,Humana,Medicare Advantage,,38.21,,,,,,,26.78,99.91,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,outpatient,,,9.00000,4.34000,Humana,Medicare Advantage,,3.34,,,,,,,2.34,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,outpatient,,,13.00000,6.27000,Humana,Medicare Advantage,,4.82,,,,,,,3.38,12.61,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,outpatient,,,80.00000,38.56000,Humana,Medicare Advantage,,29.68,,,,,,,20.80,77.60,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,outpatient,,,47.00000,22.65000,Humana,Medicare Advantage,,17.44,,,,,,,12.22,45.59,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,outpatient,,,91.00000,43.86000,Humana,Medicare Advantage,,33.76,,,,,,,23.66,88.27,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,outpatient,,,56.00000,26.99000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,outpatient,,,18.00000,8.68000,Humana,Medicare Advantage,,6.68,,,,,,,4.68,17.46,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,outpatient,,,60.00000,28.92000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,outpatient,,,57.00000,27.47000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Humana,Medicare Advantage,,7.79,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,outpatient,,,71.00000,37.70000,Humana,Medicare Advantage,,26.34,,,,,,,18.46,68.87,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Humana,Medicare Advantage,,7.79,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,outpatient,,,128.00000,67.97000,Humana,Medicare Advantage,,47.49,,,,,,,33.28,124.16,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,outpatient,,,65.00000,34.52000,Humana,Medicare Advantage,,24.11,,,,,,,16.90,63.05,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Humana,Medicare Advantage,,9.65,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,outpatient,,,31.00000,16.46000,Humana,Medicare Advantage,,11.50,,,,,,,8.06,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Humana,Medicare Advantage,,9.65,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Humana,Medicare Advantage,,9.65,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Humana,Medicare Advantage,,9.65,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,outpatient,,,61.00000,32.39000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Humana,Medicare Advantage,,9.65,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Humana,Medicare Advantage,,9.28,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Humana,Medicare Advantage,91,9.28,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,outpatient,,,103.00000,54.69000,Humana,Medicare Advantage,,38.21,,,,,,,26.78,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,outpatient,,,96.00000,50.98000,Humana,Medicare Advantage,,35.62,,,,,,,24.96,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,outpatient,,,75.00000,39.83000,Humana,Medicare Advantage,,27.82,,,,,,,19.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,outpatient,,,68.00000,36.11000,Humana,Medicare Advantage,,25.23,,,,,,,17.68,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,outpatient,,,61.00000,32.39000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Humana,Medicare Advantage,,9.65,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Humana,Medicare Advantage,,9.65,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,outpatient,,,29.00000,15.40000,Humana,Medicare Advantage,,10.76,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Humana,Medicare Advantage,,10.76,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Humana,Medicare Advantage,,10.76,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,outpatient,,,63.00000,33.45000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,outpatient,,,79.00000,41.95000,Humana,Medicare Advantage,,29.31,,,,,,,20.54,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,outpatient,,,63.00000,33.45000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Humana,Medicare Advantage,,10.76,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,outpatient,,,112.00000,59.47000,Humana,Medicare Advantage,,41.55,,,,,,,29.12,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Humana,Medicare Advantage,,9.65,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,outpatient,,,25.00000,13.28000,Humana,Medicare Advantage,,9.28,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,outpatient,,,118.00000,62.66000,Humana,Medicare Advantage,,43.78,,,,,,,30.68,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,outpatient,,,29.00000,15.40000,Humana,Medicare Advantage,,10.76,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,outpatient,,,25.00000,13.28000,Humana,Medicare Advantage,,9.28,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Humana,Medicare Advantage,,9.65,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,outpatient,,,25.00000,13.28000,Humana,Medicare Advantage,,9.28,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,outpatient,,,71.00000,37.70000,Humana,Medicare Advantage,,26.34,,,,,,,18.46,68.87,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,outpatient,,,59.00000,31.33000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,outpatient,,,62.00000,32.92000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,outpatient,,,138.00000,73.28000,Humana,Medicare Advantage,,51.20,,,,,,,35.88,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,outpatient,,,62.00000,32.92000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,outpatient,,,78.00000,41.42000,Humana,Medicare Advantage,,28.94,,,,,,,20.28,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,outpatient,,,69.00000,36.64000,Humana,Medicare Advantage,,25.60,,,,,,,17.94,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,outpatient,,,88.00000,46.73000,Humana,Medicare Advantage,,32.65,,,,,,,22.88,85.36,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,outpatient,,,60.00000,31.86000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,outpatient,,,64.00000,33.98000,Humana,Medicare Advantage,,23.74,,,,,,,16.64,62.08,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,outpatient,,,63.00000,33.45000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,outpatient,,,137.00000,72.75000,Humana,Medicare Advantage,,50.83,,,,,,,35.62,132.89,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,outpatient,,,347.00000,184.26000,Humana,Medicare Advantage,,128.74,,,,,,,90.22,336.59,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,outpatient,,,57.00000,30.27000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,outpatient,,,56.00000,29.74000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,outpatient,,,16.00000,8.50000,Humana,Medicare Advantage,,5.94,,,,,,,4.16,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,outpatient,,,85.00000,45.14000,Humana,Medicare Advantage,,31.54,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,outpatient,,,34.00000,18.05000,Humana,Medicare Advantage,,12.61,,,,,,,8.84,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,outpatient,,,231.00000,122.66000,Humana,Medicare Advantage,,85.70,,,,,,,60.06,224.07,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,outpatient,,,36.00000,19.12000,Humana,Medicare Advantage,,13.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,outpatient,,,61.00000,32.39000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,outpatient,,,111.00000,58.94000,Humana,Medicare Advantage,,41.18,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,outpatient,,,61.00000,32.39000,Humana,Medicare Advantage,,22.63,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,outpatient,,,60.00000,31.86000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,outpatient,,,60.00000,31.86000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,outpatient,,,60.00000,31.86000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,outpatient,,,60.00000,31.86000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,outpatient,,,60.00000,31.86000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,outpatient,,,36.00000,19.12000,Humana,Medicare Advantage,,13.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,outpatient,,,76.00000,40.36000,Humana,Medicare Advantage,,28.20,,,,,,,19.76,73.72,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,outpatient,,,60.00000,31.86000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,outpatient,,,60.00000,31.86000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,outpatient,,,152.00000,80.71000,Humana,Medicare Advantage,,56.39,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,outpatient,,,78.00000,41.42000,Humana,Medicare Advantage,,28.94,,,,,,,20.28,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,outpatient,,,42.00000,22.30000,Humana,Medicare Advantage,,15.58,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,outpatient,,,73.00000,38.76000,Humana,Medicare Advantage,,27.08,,,,,,,18.98,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,outpatient,,,97.00000,51.51000,Humana,Medicare Advantage,,35.99,,,,,,,25.22,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,outpatient,,,157.00000,83.37000,Humana,Medicare Advantage,,58.25,,,,,,,40.82,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,outpatient,,,36.00000,19.12000,Humana,Medicare Advantage,,13.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,outpatient,,,66.00000,35.05000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,outpatient,,,58.00000,30.80000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,outpatient,,,85.00000,45.14000,Humana,Medicare Advantage,,31.54,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,outpatient,,,59.00000,31.33000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,outpatient,,,175.00000,92.93000,Humana,Medicare Advantage,,64.92,,,,,,,45.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,outpatient,,,152.00000,80.71000,Humana,Medicare Advantage,,56.39,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,outpatient,,,43.00000,22.83000,Humana,Medicare Advantage,,15.95,,,,,,,11.18,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,outpatient,,,66.00000,35.05000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,outpatient,,,36.00000,19.12000,Humana,Medicare Advantage,,13.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,outpatient,,,36.00000,19.12000,Humana,Medicare Advantage,,13.36,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,outpatient,,,42.00000,22.30000,Humana,Medicare Advantage,,15.58,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,outpatient,,,147.00000,78.06000,Humana,Medicare Advantage,,54.54,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,outpatient,,,64.00000,33.98000,Humana,Medicare Advantage,,23.74,,,,,,,16.64,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,outpatient,,,60.00000,31.86000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,outpatient,,,75.00000,39.83000,Humana,Medicare Advantage,,27.82,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,outpatient,,,44.00000,23.36000,Humana,Medicare Advantage,,16.32,,,,,,,11.44,42.68,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,outpatient,,,87.00000,46.20000,Humana,Medicare Advantage,,32.28,,,,,,,22.62,84.39,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,outpatient,,,65.00000,34.52000,Humana,Medicare Advantage,,24.11,,,,,,,16.90,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,outpatient,,,75.00000,39.83000,Humana,Medicare Advantage,,27.82,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,outpatient,,,50.00000,26.55000,Humana,Medicare Advantage,,18.55,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,outpatient,,,40.00000,21.24000,Humana,Medicare Advantage,,14.84,,,,,,,10.40,38.80,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,outpatient,,,50.00000,26.55000,Humana,Medicare Advantage,,18.55,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Humana,Medicare Advantage,,47.86,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,outpatient,,,115.00000,61.07000,Humana,Medicare Advantage,,42.66,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1309.00000,695.08000,Humana,Medicare Advantage,,485.64,,,,,,,340.34,1269.73,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Humana,Medicare Advantage,,47.86,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Humana,Medicare Advantage,,47.86,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,outpatient,,,328.00000,174.17000,Humana,Medicare Advantage,,121.69,,,,,,,85.28,318.16,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,outpatient,,,115.00000,61.07000,Humana,Medicare Advantage,,42.66,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Humana,Medicare Advantage,,47.86,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Humana,Medicare Advantage,,47.86,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,outpatient,,,1251.00000,664.28000,Humana,Medicare Advantage,,464.12,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Humana,Medicare Advantage,,57.13,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Humana,Medicare Advantage,,57.13,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,outpatient,,,96.00000,50.98000,Humana,Medicare Advantage,,35.62,,,,,,,24.96,93.12,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,outpatient,,,211.00000,112.04000,Humana,Medicare Advantage,,78.28,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,outpatient,,,290.00000,153.99000,Humana,Medicare Advantage,,107.59,,,,,,,75.40,281.30,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Humana,Medicare Advantage,,47.86,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Humana,Medicare Advantage,,47.86,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,outpatient,,,411.00000,218.24000,Humana,Medicare Advantage,,152.48,,,,,,,106.86,398.67,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,outpatient,,,139.00000,73.81000,Humana,Medicare Advantage,,51.57,,,,,,,36.14,134.83,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,outpatient,,,288.00000,152.93000,Humana,Medicare Advantage,,106.85,,,,,,,74.88,279.36,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1372.00000,728.53000,Humana,Medicare Advantage,,509.01,,,,,,,356.72,1330.84,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,outpatient,,,1251.00000,664.28000,Humana,Medicare Advantage,,464.12,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,outpatient,,,135.00000,71.68000,Humana,Medicare Advantage,,50.09,,,,,,,35.10,130.95,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,outpatient,,,129.00000,68.50000,Humana,Medicare Advantage,,47.86,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,outpatient,,,129.00000,68.50000,Humana,Medicare Advantage,,47.86,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,outpatient,,,147.00000,78.06000,Humana,Medicare Advantage,,54.54,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,outpatient,,,126.00000,66.91000,Humana,Medicare Advantage,,46.75,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,outpatient,,,120.00000,63.72000,Humana,Medicare Advantage,,44.52,,,,,,,31.20,116.40,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Humana,Medicare Advantage,,47.86,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,outpatient,,,124.00000,65.84000,Humana,Medicare Advantage,,46.00,,,,,,,32.24,120.28,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,outpatient,,,108.00000,57.35000,Humana,Medicare Advantage,,40.07,,,,,,,28.08,104.76,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Humana,Medicare Advantage,,94.98,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Humana,Medicare Advantage,,94.98,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,outpatient,,,122.00000,64.78000,Humana,Medicare Advantage,,45.26,,,,,,,31.72,118.34,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,outpatient,,,129.00000,68.50000,Humana,Medicare Advantage,,47.86,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,outpatient,,,123.00000,65.31000,Humana,Medicare Advantage,,45.63,,,,,,,31.98,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Humana,Medicare Advantage,,47.86,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,outpatient,,,518.00000,275.06000,Humana,Medicare Advantage,,192.18,,,,,,,134.68,502.46,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,outpatient,,,275.00000,146.02000,Humana,Medicare Advantage,,102.03,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,outpatient,,,270.00000,143.37000,Humana,Medicare Advantage,,100.17,,,,,,,70.20,261.90,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,outpatient,,,450.00000,238.95000,Humana,Medicare Advantage,,166.95,,,,,,,117.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,outpatient,,,126.00000,66.91000,Humana,Medicare Advantage,,46.75,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,outpatient,,,362.00000,192.22000,Humana,Medicare Advantage,,134.30,,,,,,,94.12,351.14,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Humana,Medicare Advantage,,40.44,,,,,,,28.34,105.73,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,outpatient,,,638.00000,338.78000,Humana,Medicare Advantage,,236.70,,,,,,,165.88,618.86,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,outpatient,,,211.00000,112.04000,Humana,Medicare Advantage,,78.28,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,outpatient,,,154.00000,81.77000,Humana,Medicare Advantage,,57.13,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,outpatient,,,141.00000,74.87000,Humana,Medicare Advantage,,52.31,,,,,,,36.66,136.77,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,outpatient,,,2040.00000,1083.24000,Humana,Medicare Advantage,,756.84,,,,,,,530.40,1978.80,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,outpatient,,,421.00000,223.55000,Humana,Medicare Advantage,,156.19,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,outpatient,,,275.00000,146.02000,Humana,Medicare Advantage,,102.03,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,outpatient,,,1251.00000,664.28000,Humana,Medicare Advantage,,464.12,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Humana,Medicare Advantage,,158.79,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Humana,Medicare Advantage,,158.79,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Humana,Medicare Advantage,,243.00,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Humana,Medicare Advantage,,243.00,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,outpatient,,,211.00000,112.04000,Humana,Medicare Advantage,,78.28,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Humana,Medicare Advantage,,41.55,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Humana,Medicare Advantage,,41.55,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,outpatient,,,130.00000,69.03000,Humana,Medicare Advantage,,48.23,,,,,,,33.80,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,outpatient,,,421.00000,223.55000,Humana,Medicare Advantage,,156.19,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,outpatient,,,111.00000,58.94000,Humana,Medicare Advantage,,41.18,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,outpatient,,,200.00000,106.20000,Humana,Medicare Advantage,,74.20,,,,,,,52.00,194.00,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Humana,Medicare Advantage,,47.86,,,,,,,33.54,125.13,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,outpatient,,,13.00000,6.90000,Humana,Medicare Advantage,,4.82,,,,,,,3.38,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,outpatient,,,58.00000,30.80000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,outpatient,,,13.00000,6.90000,Humana,Medicare Advantage,,4.82,,,,,,,3.38,12.61,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,outpatient,,,773.00000,410.46000,Humana,Medicare Advantage,,286.78,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,outpatient,,,773.00000,410.46000,Humana,Medicare Advantage,,286.78,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,outpatient,,,773.00000,410.46000,Humana,Medicare Advantage,,286.78,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,outpatient,,,773.00000,410.46000,Humana,Medicare Advantage,,286.78,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,outpatient,,,387.00000,205.50000,Humana,Medicare Advantage,,143.58,,,,,,,100.62,375.39,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,outpatient,,,52.00000,27.61000,Humana,Medicare Advantage,,19.29,,,,,,,13.52,50.44,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Humana,Medicare Advantage,,37.84,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Humana,Medicare Advantage,,37.84,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,outpatient,,,79.00000,41.95000,Humana,Medicare Advantage,,29.31,,,,,,,20.54,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,outpatient,,,65.00000,34.52000,Humana,Medicare Advantage,,24.11,,,,,,,16.90,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,outpatient,,,100.00000,53.10000,Humana,Medicare Advantage,,37.10,,,,,,,26.00,97.00,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,outpatient,,,64.00000,33.98000,Humana,Medicare Advantage,,23.74,,,,,,,16.64,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,outpatient,,,106.00000,56.29000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Humana,Medicare Advantage,,40.44,,,,,,,28.34,105.73,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,outpatient,,,58.00000,30.80000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Humana,Medicare Advantage,,7.42,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,outpatient,,,66.00000,35.05000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Humana,Medicare Advantage,,7.42,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Humana,Medicare Advantage,,7.42,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Humana,Medicare Advantage,,7.42,,,,,,,5.20,19.40,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,outpatient,,,13.00000,6.90000,Humana,Medicare Advantage,,4.82,,,,,,,3.38,12.61,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,outpatient,,,53.00000,28.14000,Humana,Medicare Advantage,,19.66,,,,,,,13.78,51.41,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,outpatient,,,18.00000,9.56000,Humana,Medicare Advantage,,6.68,,,,,,,4.68,17.46,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,outpatient,,,17.00000,9.03000,Humana,Medicare Advantage,,6.31,,,,,,,4.42,16.49,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,outpatient,,,71.00000,37.70000,Humana,Medicare Advantage,,26.34,,,,,,,18.46,68.87,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,outpatient,,,57.00000,30.27000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,outpatient,,,68.00000,36.11000,Humana,Medicare Advantage,,25.23,,,,,,,17.68,65.96,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,outpatient,,,58.00000,30.80000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,outpatient,,,27.00000,14.34000,Humana,Medicare Advantage,,10.02,,,,,,,7.02,26.19,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,outpatient,,,56.00000,29.74000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,outpatient,,,56.00000,29.74000,Humana,Medicare Advantage,,20.78,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,outpatient,,,58.00000,30.80000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,outpatient,,,115.00000,61.07000,Humana,Medicare Advantage,,42.66,,,,,,,29.90,111.55,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,outpatient,,,23.00000,12.21000,Humana,Medicare Advantage,,8.53,,,,,,,5.98,22.31,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,outpatient,,,255.00000,135.40000,Humana,Medicare Advantage,,94.61,,,,,,,66.30,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,outpatient,,,66.00000,35.05000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,outpatient,,,26.00000,13.81000,Humana,Medicare Advantage,,9.65,,,,,,,6.76,25.22,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,outpatient,,,64.00000,33.98000,Humana,Medicare Advantage,,23.74,,,,,,,16.64,62.08,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,outpatient,,,215.00000,114.16000,Humana,Medicare Advantage,,79.77,,,,,,,55.90,208.55,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,outpatient,,,79.00000,41.95000,Humana,Medicare Advantage,,29.31,,,,,,,20.54,76.63,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,outpatient,,,11.00000,5.29000,Humana,Medicare Advantage,,4.08,,,,,,,2.86,10.67,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,outpatient,,,58.00000,27.90000,Humana,Medicare Advantage,,21.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,outpatient,,,10.00000,4.81000,Humana,Medicare Advantage,,3.71,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,outpatient,,,7.00000,3.37000,Humana,Medicare Advantage,,2.60,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,outpatient,,,53.00000,25.49000,Humana,Medicare Advantage,,19.66,,,,,,,13.78,51.41,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,outpatient,,,10.00000,4.81000,Humana,Medicare Advantage,,3.71,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Humana,Medicare Advantage,,4.08,,,,,,,2.86,10.67,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,outpatient,,,7.00000,3.37000,Humana,Medicare Advantage,,2.60,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Humana,Medicare Advantage,,4.08,,,,,,,2.86,10.67,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,outpatient,,,597.00000,290.14000,Humana,Medicare Advantage,,221.49,,,,,,,155.22,579.09,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,outpatient,,,6379.00000,3100.19000,Humana,Medicare Advantage,,2366.61,,,,,,,1658.54,6187.63,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,outpatient,,,471.00000,228.91000,Humana,Medicare Advantage,,174.74,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,outpatient,,,471.00000,228.91000,Humana,Medicare Advantage,,174.74,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,outpatient,,,1251.00000,607.99000,Humana,Medicare Advantage,,464.12,,,,,,,325.26,1213.47,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,outpatient,,,260.00000,126.36000,Humana,Medicare Advantage,,96.46,,,,,,,67.60,252.20,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,outpatient,,,785.00000,381.51000,Humana,Medicare Advantage,,291.24,,,,,,,204.10,761.45,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,outpatient,,,529.00000,257.09000,Humana,Medicare Advantage,,196.26,,,,,,,137.54,513.13,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,outpatient,,,1623.00000,788.78000,Humana,Medicare Advantage,,602.13,,,,,,,421.98,1574.31,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,outpatient,,,10800.00000,5248.80000,Humana,Medicare Advantage,,4006.80,,,,,,,2808.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,outpatient,,,25365.00000,12327.39000,Humana,Medicare Advantage,,9410.42,,,,,,,6594.90,24604.05,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,outpatient,,,101.00000,21.82000,Humana,Medicare Advantage,,37.47,,,,,,,26.26,97.97,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,outpatient,,,81.00000,17.50000,Humana,Medicare Advantage,,30.05,,,,,,,21.06,78.57,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,outpatient,,,104.00000,22.46000,Humana,Medicare Advantage,,38.58,,,,,,,27.04,100.88,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,outpatient,,,377.00000,81.43000,Humana,Medicare Advantage,,139.87,,,,,,,98.02,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,outpatient,,,532.00000,114.91000,Humana,Medicare Advantage,,197.37,,,,,,,138.32,516.04,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,outpatient,,,521.00000,112.54000,Humana,Medicare Advantage,,193.29,,,,,,,135.46,505.37,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,outpatient,,,451.00000,97.42000,Humana,Medicare Advantage,,167.32,,,,,,,117.26,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,outpatient,,,1148.00000,247.97000,Humana,Medicare Advantage,,425.91,,,,,,,298.48,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,outpatient,,,350.00000,75.60000,Humana,Medicare Advantage,,129.85,,,,,,,91.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,outpatient,,,423.00000,91.37000,Humana,Medicare Advantage,,156.93,,,,,,,109.98,410.31,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Humana,Medicare Advantage,,278.62,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Humana,Medicare Advantage,,278.62,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,outpatient,,,119.00000,25.70000,Humana,Medicare Advantage,,44.15,,,,,,,30.94,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,outpatient,,,126.00000,27.22000,Humana,Medicare Advantage,,46.75,,,,,,,32.76,122.22,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Humana,Medicare Advantage,,40.81,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Humana,Medicare Advantage,,40.81,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,outpatient,,,79.00000,17.06000,Humana,Medicare Advantage,,29.31,,,,,,,20.54,76.63,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Humana,Medicare Advantage,,40.81,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Humana,Medicare Advantage,,40.81,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,outpatient,,,79.00000,17.06000,Humana,Medicare Advantage,,29.31,,,,,,,20.54,76.63,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,outpatient,,,335.00000,72.36000,Humana,Medicare Advantage,,124.28,,,,,,,87.10,324.95,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Humana,Medicare Advantage,,57.13,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Humana,Medicare Advantage,,57.13,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,outpatient,,,128.00000,27.65000,Humana,Medicare Advantage,,47.49,,,,,,,33.28,124.16,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,outpatient,,,65.00000,14.04000,Humana,Medicare Advantage,,24.11,,,,,,,16.90,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,outpatient,,,272.00000,58.75000,Humana,Medicare Advantage,,100.91,,,,,,,70.72,263.84,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,outpatient,,,26.00000,11.44000,Humana,Medicare Advantage,,9.65,,,,,,,6.76,25.22,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,outpatient,,,359.00000,157.96000,Humana,Medicare Advantage,,133.19,,,,,,,93.34,348.23,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,outpatient,,,189.00000,83.16000,Humana,Medicare Advantage,,70.12,,,,,,,49.14,183.33,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,outpatient,,,359.00000,157.96000,Humana,Medicare Advantage,,133.19,,,,,,,93.34,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,outpatient,,,137.00000,60.28000,Humana,Medicare Advantage,,50.83,,,,,,,35.62,132.89,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,outpatient,,,1665.00000,732.60000,Humana,Medicare Advantage,,617.72,,,,,,,432.90,1615.05,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,outpatient,,,751.00000,330.44000,Humana,Medicare Advantage,,278.62,,,,,,,195.26,728.47,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,outpatient,,,374.00000,164.56000,Humana,Medicare Advantage,,138.75,,,,,,,97.24,362.78,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,outpatient,,,553.00000,243.32000,Humana,Medicare Advantage,,205.16,,,,,,,143.78,536.41,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,outpatient,,,359.00000,157.96000,Humana,Medicare Advantage,,133.19,,,,,,,93.34,348.23,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,outpatient,,,62.00000,27.28000,Humana,Medicare Advantage,,23.00,,,,,,,16.12,60.14,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,outpatient,,,79.00000,34.76000,Humana,Medicare Advantage,,29.31,,,,,,,20.54,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,outpatient,,,110.00000,48.40000,Humana,Medicare Advantage,,40.81,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,outpatient,,,110.00000,48.40000,Humana,Medicare Advantage,,40.81,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,outpatient,,,751.00000,330.44000,Humana,Medicare Advantage,,278.62,,,,,,,195.26,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,outpatient,,,1665.00000,732.60000,Humana,Medicare Advantage,,617.72,,,,,,,432.90,1615.05,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,outpatient,,,110.00000,48.40000,Humana,Medicare Advantage,,40.81,,,,,,,28.60,106.70,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Humana,Medicare Advantage,,104.25,,,,,,,73.06,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Humana,Medicare Advantage,,104.25,,,,,,,73.06,272.57,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,outpatient,,,451.00000,341.41000,Humana,Medicare Advantage,,167.32,,,,,,,117.26,437.47,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,outpatient,,,300.00000,145.80000,Humana,Medicare Advantage,,111.30,,,,,,,78.00,291.00,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,outpatient,,,2278.00000,1107.11000,Humana,Medicare Advantage,,845.14,,,,,,,592.28,2209.66,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,outpatient,,,3912.00000,1901.23000,Humana,Medicare Advantage,,1451.35,,,,,,,1017.12,3794.64,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,outpatient,,,900.00000,437.40000,Humana,Medicare Advantage,,333.90,,,,,,,234.00,873.00,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,outpatient,,,365.00000,177.39000,Humana,Medicare Advantage,,135.41,,,,,,,94.90,354.05,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,outpatient,,,989.00000,480.65000,Humana,Medicare Advantage,,366.92,,,,,,,257.14,959.33,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Humana,Medicare Advantage,,182.53,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Humana,Medicare Advantage,,161.38,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Humana,Medicare Advantage,,161.38,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,outpatient,,,644.00000,312.98000,Humana,Medicare Advantage,,238.92,,,,,,,167.44,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Humana,Medicare Advantage,,182.53,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Humana,Medicare Advantage,,182.53,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,outpatient,,,527.00000,256.12000,Humana,Medicare Advantage,,195.52,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,outpatient,,,1404.00000,682.34000,Humana,Medicare Advantage,,520.88,,,,,,,365.04,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,outpatient,,,5475.00000,2660.85000,Humana,Medicare Advantage,,2031.22,,,,,,,1423.50,5310.75,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,outpatient,,,726.00000,352.84000,Humana,Medicare Advantage,,269.35,,,,,,,188.76,704.22,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,outpatient,,,507.00000,246.40000,Humana,Medicare Advantage,,188.10,,,,,,,131.82,491.79,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,outpatient,,,1670.00000,811.62000,Humana,Medicare Advantage,,619.57,,,,,,,434.20,1619.90,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,outpatient,,,1139.00000,553.55000,Humana,Medicare Advantage,,422.57,,,,,,,296.14,1104.83,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,outpatient,,,875.00000,425.25000,Humana,Medicare Advantage,,324.62,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,outpatient,,,525.00000,255.15000,Humana,Medicare Advantage,,194.78,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,outpatient,,,1353.00000,657.56000,Humana,Medicare Advantage,,501.96,,,,,,,351.78,1312.41,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,outpatient,,,525.00000,255.15000,Humana,Medicare Advantage,,194.78,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,outpatient,,,525.00000,255.15000,Humana,Medicare Advantage,,194.78,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,outpatient,,,825.00000,400.95000,Humana,Medicare Advantage,,306.07,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Humana,Medicare Advantage,,194.78,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Humana,Medicare Advantage,,194.78,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,outpatient,,,974.00000,473.36000,Humana,Medicare Advantage,,361.35,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Humana,Medicare Advantage,,73.46,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Humana,Medicare Advantage,,73.46,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Humana,Medicare Advantage,,81.99,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Humana,Medicare Advantage,,81.99,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,outpatient,,,497.00000,241.54000,Humana,Medicare Advantage,,184.39,,,,,,,129.22,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,outpatient,,,2340.00000,1137.24000,Humana,Medicare Advantage,,868.14,,,,,,,608.40,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,outpatient,,,249.00000,121.01000,Humana,Medicare Advantage,,92.38,,,,,,,64.74,241.53,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,outpatient,,,135.00000,65.61000,Humana,Medicare Advantage,,50.09,,,,,,,35.10,130.95,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,outpatient,,,172.00000,83.59000,Humana,Medicare Advantage,,63.81,,,,,,,44.72,166.84,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,outpatient,,,307.00000,149.20000,Humana,Medicare Advantage,,113.90,,,,,,,79.82,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,outpatient,,,1800.00000,874.80000,Humana,Medicare Advantage,,667.80,,,,,,,468.00,1746.00,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,outpatient,,,974.00000,473.36000,Humana,Medicare Advantage,,361.35,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Humana,Medicare Advantage,,73.09,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Humana,Medicare Advantage,,73.09,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,outpatient,,,411.00000,199.75000,Humana,Medicare Advantage,,152.48,,,,,,,106.86,398.67,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,outpatient,,,221.00000,107.41000,Humana,Medicare Advantage,,81.99,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,outpatient,,,884.00000,429.62000,Humana,Medicare Advantage,,327.96,,,,,,,229.84,857.48,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,outpatient,,,594.00000,288.68000,Humana,Medicare Advantage,,220.37,,,,,,,154.44,576.18,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,outpatient,,,519.00000,252.23000,Humana,Medicare Advantage,,192.55,,,,,,,134.94,503.43,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,outpatient,,,1046.00000,508.36000,Humana,Medicare Advantage,,388.07,,,,,,,271.96,1014.62,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,outpatient,,,556.00000,270.22000,Humana,Medicare Advantage,,206.28,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,outpatient,,,275.00000,133.65000,Humana,Medicare Advantage,,102.03,,,,,,,71.50,266.75,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,outpatient,,,580.00000,281.88000,Humana,Medicare Advantage,,215.18,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,outpatient,,,580.00000,281.88000,Humana,Medicare Advantage,,215.18,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Humana,Medicare Advantage,,1291.08,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Humana,Medicare Advantage,,1291.08,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,outpatient,,,700.00000,340.20000,Humana,Medicare Advantage,,259.70,,,,,,,182.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,outpatient,,,1427.00000,693.52000,Humana,Medicare Advantage,,529.42,,,,,,,371.02,1384.19,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,outpatient,,,614.00000,298.40000,Humana,Medicare Advantage,,227.79,,,,,,,159.64,595.58,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,outpatient,,,2027.00000,985.12000,Humana,Medicare Advantage,,752.02,,,,,,,527.02,1966.19,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,outpatient,,,556.00000,270.22000,Humana,Medicare Advantage,,206.28,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,outpatient,,,1146.00000,556.96000,Humana,Medicare Advantage,,425.17,,,,,,,297.96,1111.62,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Humana,Medicare Advantage,,73.09,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Humana,Medicare Advantage,,73.09,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,outpatient,,,527.00000,256.12000,Humana,Medicare Advantage,,195.52,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,outpatient,,,740.00000,359.64000,Humana,Medicare Advantage,,274.54,,,,,,,192.40,717.80,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Humana,Medicare Advantage,,324.62,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Humana,Medicare Advantage,,324.62,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,outpatient,,,1399.00000,679.91000,Humana,Medicare Advantage,,519.03,,,,,,,363.74,1357.03,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,outpatient,,,51.00000,24.79000,Humana,Medicare Advantage,,18.92,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,outpatient,,,825.00000,400.95000,Humana,Medicare Advantage,,306.07,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,outpatient,,,576.00000,279.94000,Humana,Medicare Advantage,,213.70,,,,,,,149.76,558.72,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,outpatient,,,224.00000,108.86000,Humana,Medicare Advantage,,83.10,,,,,,,58.24,217.28,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,outpatient,,,346.00000,168.16000,Humana,Medicare Advantage,,128.37,,,,,,,89.96,335.62,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,outpatient,,,525.00000,255.15000,Humana,Medicare Advantage,,194.78,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,outpatient,,,525.00000,255.15000,Humana,Medicare Advantage,,194.78,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Humana,Medicare Advantage,,194.78,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Humana,Medicare Advantage,,194.78,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,outpatient,,,627.00000,304.72000,Humana,Medicare Advantage,,232.62,,,,,,,163.02,608.19,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,outpatient,,,605.00000,294.03000,Humana,Medicare Advantage,,224.46,,,,,,,157.30,586.85,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,outpatient,,,510.00000,247.86000,Humana,Medicare Advantage,,189.21,,,,,,,132.60,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,outpatient,,,223.00000,108.38000,Humana,Medicare Advantage,,82.73,,,,,,,57.98,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,outpatient,,,1211.00000,588.55000,Humana,Medicare Advantage,,449.28,,,,,,,314.86,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,outpatient,,,383.00000,186.14000,Humana,Medicare Advantage,,142.09,,,,,,,99.58,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,outpatient,,,1214.00000,590.00000,Humana,Medicare Advantage,,450.39,,,,,,,315.64,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,outpatient,,,328.00000,159.41000,Humana,Medicare Advantage,,121.69,,,,,,,85.28,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,outpatient,,,372.00000,180.79000,Humana,Medicare Advantage,,138.01,,,,,,,96.72,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,outpatient,,,285.00000,138.51000,Humana,Medicare Advantage,,105.73,,,,,,,74.10,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,outpatient,,,367.00000,178.36000,Humana,Medicare Advantage,,136.16,,,,,,,95.42,355.99,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Humana,Medicare Advantage,,260.44,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Humana,Medicare Advantage,,260.44,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,outpatient,,,265.00000,128.79000,Humana,Medicare Advantage,,98.31,,,,,,,68.90,257.05,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2279.00000,1107.59000,Humana,Medicare Advantage,,845.51,,,,,,,592.54,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2395.00000,1163.97000,Humana,Medicare Advantage,,888.54,,,,,,,622.70,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Humana,Medicare Advantage,,3249.59,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Humana,Medicare Advantage,,3249.59,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,outpatient,,,2752.00000,1337.47000,Humana,Medicare Advantage,,1020.99,,,,,,,715.52,2669.44,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Humana,Medicare Advantage,,80.51,,,,,,,56.42,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Humana,Medicare Advantage,,80.51,,,,,,,56.42,210.49,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,outpatient,,,292.00000,141.91000,Humana,Medicare Advantage,,108.33,,,,,,,75.92,283.24,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Humana,Medicare Advantage,,152.48,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Humana,Medicare Advantage,,152.48,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Humana,Medicare Advantage,,152.48,,,,,,,106.86,398.67,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,outpatient,,,2275.00000,1105.65000,Humana,Medicare Advantage,,844.02,,,,,,,591.50,2206.75,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,outpatient,,,192.00000,93.31000,Humana,Medicare Advantage,,71.23,,,,,,,49.92,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,outpatient,,,451.00000,219.19000,Humana,Medicare Advantage,,167.32,,,,,,,117.26,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,outpatient,,,617.00000,299.86000,Humana,Medicare Advantage,,228.91,,,,,,,160.42,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,outpatient,,,825.00000,400.95000,Humana,Medicare Advantage,,306.07,,,,,,,214.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,outpatient,,,905.00000,439.83000,Humana,Medicare Advantage,,335.75,,,,,,,235.30,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,outpatient,,,849.00000,412.61000,Humana,Medicare Advantage,,314.98,,,,,,,220.74,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,outpatient,,,2539.00000,1233.95000,Humana,Medicare Advantage,,941.97,,,,,,,660.14,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,outpatient,,,6000.00000,2916.00000,Humana,Medicare Advantage,,2226.00,,,,,,,1560.00,5820.00,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,outpatient,,,8260.00000,4014.36000,Humana,Medicare Advantage,,3064.46,,,,,,,2147.60,8012.20,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,outpatient,,,202.00000,88.88000,Humana,Medicare Advantage,,74.94,,,,,,,52.52,195.94,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,outpatient,,,66.00000,31.81000,Humana,Medicare Advantage,,24.49,,,,,,,17.16,64.02,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,outpatient,,,295.00000,142.19000,Humana,Medicare Advantage,,109.44,,,,,,,76.70,286.15,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,89.00000,26.79000,Humana,Medicare Advantage,,33.02,,,,,,,23.14,86.33,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Humana,Medicare Advantage,,34.50,,,,,,,24.18,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Humana,Medicare Advantage,,34.50,,,,,,,24.18,90.21,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Humana,Medicare Advantage,,695.62,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Humana,Medicare Advantage,,695.62,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Humana,Medicare Advantage,,649.99,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Humana,Medicare Advantage,,649.99,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,731.00000,220.03000,Humana,Medicare Advantage,,271.20,,,,,,,190.06,709.07,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,787.00000,236.89000,Humana,Medicare Advantage,,291.98,,,,,,,204.62,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,2042.00000,614.64000,Humana,Medicare Advantage,,757.58,,,,,,,530.92,1980.74,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Humana,Medicare Advantage,,695.62,,,,,,,487.50,1818.75,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,714.00000,214.91000,Humana,Medicare Advantage,,264.89,,,,,,,185.64,692.58,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,294.00000,88.49000,Humana,Medicare Advantage,,109.07,,,,,,,76.44,285.18,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,350.00000,105.35000,Humana,Medicare Advantage,,129.85,,,,,,,91.00,339.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,outpatient,,,1350.00000,780.30000,Humana,Medicare Advantage,,500.85,,,,,,,351.00,1309.50,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,outpatient,,,3680.00000,2127.04000,Humana,Medicare Advantage,,1365.28,,,,,,,956.80,3569.60,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,outpatient,,,1600.00000,924.80000,Humana,Medicare Advantage,,593.60,,,,,,,416.00,1552.00,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,outpatient,,,4680.00000,2705.04000,Humana,Medicare Advantage,,1736.28,,,,,,,1216.80,4539.60,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,outpatient,,,2100.00000,1213.80000,Humana,Medicare Advantage,,779.10,,,,,,,546.00,2037.00,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,outpatient,,,5680.00000,3283.04000,Humana,Medicare Advantage,,2107.28,,,,,,,1476.80,5509.60,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,outpatient,,,2420.00000,1398.76000,Humana,Medicare Advantage,,897.82,,,,,,,629.20,2347.40,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,outpatient,,,6415.00000,3707.87000,Humana,Medicare Advantage,,2379.97,,,,,,,1667.90,6222.55,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,outpatient,,,2920.00000,1687.76000,Humana,Medicare Advantage,,1083.32,,,,,,,759.20,2832.40,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,outpatient,,,8915.00000,5152.87000,Humana,Medicare Advantage,,3307.47,,,,,,,2317.90,8647.55,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,outpatient,,,3420.00000,1976.76000,Humana,Medicare Advantage,,1268.82,,,,,,,889.20,3317.40,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,outpatient,,,11415.00000,6597.87000,Humana,Medicare Advantage,,4234.97,,,,,,,2967.90,11072.55,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,outpatient,,,142.00000,154.35000,Humana,Medicare Advantage,,52.68,,,,,,,36.92,137.74,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Humana,Medicare Advantage,,126.14,,,,,,,88.40,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Humana,Medicare Advantage,,248.57,,,,,,,174.20,649.90,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,outpatient,,,390.00000,262.47000,Humana,Medicare Advantage,,144.69,,,,,,,101.40,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,outpatient,,,1170.00000,787.41000,Humana,Medicare Advantage,,434.07,,,,,,,304.20,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,outpatient,,,440.00000,296.12000,Humana,Medicare Advantage,,163.24,,,,,,,114.40,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,outpatient,,,1670.00000,1123.91000,Humana,Medicare Advantage,,619.57,,,,,,,434.20,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,outpatient,,,640.00000,430.72000,Humana,Medicare Advantage,,237.44,,,,,,,166.40,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,outpatient,,,2170.00000,1460.41000,Humana,Medicare Advantage,,805.07,,,,,,,564.20,2104.90,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,outpatient,,,17.00000,10.96000,Humana,Medicare Advantage,,6.31,,,,,,,4.42,16.49,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,outpatient,,,535.00000,345.08000,Humana,Medicare Advantage,,198.49,,,,,,,139.10,518.95,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,outpatient,,,23.00000,14.84000,Humana,Medicare Advantage,,8.53,,,,,,,5.98,22.31,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,outpatient,,,635.00000,409.58000,Humana,Medicare Advantage,,235.59,,,,,,,165.10,615.95,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,outpatient,,,30.00000,19.35000,Humana,Medicare Advantage,,11.13,,,,,,,7.80,29.10,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,outpatient,,,735.00000,474.08000,Humana,Medicare Advantage,,272.69,,,,,,,191.10,712.95,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,outpatient,,,33.00000,21.28000,Humana,Medicare Advantage,,12.24,,,,,,,8.58,32.01,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,outpatient,,,835.00000,538.58000,Humana,Medicare Advantage,,309.79,,,,,,,217.10,809.95,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,outpatient,,,140.00000,80.92000,Humana,Medicare Advantage,,51.94,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,outpatient,,,275.00000,158.95000,Humana,Medicare Advantage,,102.03,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,outpatient,,,295.00000,170.51000,Humana,Medicare Advantage,,109.44,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,outpatient,,,590.00000,341.02000,Humana,Medicare Advantage,,218.89,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,outpatient,,,690.00000,398.82000,Humana,Medicare Advantage,,255.99,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,outpatient,,,1375.00000,794.75000,Humana,Medicare Advantage,,510.12,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,outpatient,,,950.00000,549.10000,Humana,Medicare Advantage,,352.45,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,outpatient,,,1900.00000,1098.20000,Humana,Medicare Advantage,,704.90,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,outpatient,,,140.00000,45.22000,Humana,Medicare Advantage,,51.94,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,outpatient,,,275.00000,88.82000,Humana,Medicare Advantage,,102.03,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,outpatient,,,295.00000,95.28000,Humana,Medicare Advantage,,109.44,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,outpatient,,,590.00000,190.57000,Humana,Medicare Advantage,,218.89,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,outpatient,,,690.00000,222.87000,Humana,Medicare Advantage,,255.99,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,outpatient,,,1375.00000,444.12000,Humana,Medicare Advantage,,510.12,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,outpatient,,,950.00000,306.85000,Humana,Medicare Advantage,,352.45,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,outpatient,,,1900.00000,613.70000,Humana,Medicare Advantage,,704.90,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Humana,Medicare Advantage,,126.14,,,,,,,88.40,329.80,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Humana,Medicare Advantage,,248.57,,,,,,,174.20,649.90,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Humana,Medicare Advantage,,181.79,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Humana,Medicare Advantage,,181.79,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Humana,Medicare Advantage,,181.79,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Humana,Medicare Advantage,,90.89,,,,,,,63.70,237.65,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Humana,Medicare Advantage,,312.38,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Humana,Medicare Advantage,,390.66,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Humana,Medicare Advantage,,468.57,,,,,,,328.38,1225.11,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1178.00000,669.28000,Humana,Medicare Advantage,,437.04,,,,,,,306.28,1142.66,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,outpatient,,,140.00000,102.34000,Humana,Medicare Advantage,,51.94,,,,,,,36.40,135.80,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,outpatient,,,275.00000,201.02000,Humana,Medicare Advantage,,102.03,,,,,,,71.50,266.75,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,outpatient,,,295.00000,215.64000,Humana,Medicare Advantage,,109.44,,,,,,,76.70,286.15,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,outpatient,,,590.00000,431.29000,Humana,Medicare Advantage,,218.89,,,,,,,153.40,572.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,outpatient,,,690.00000,504.39000,Humana,Medicare Advantage,,255.99,,,,,,,179.40,669.30,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,outpatient,,,1375.00000,1005.12000,Humana,Medicare Advantage,,510.12,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,outpatient,,,950.00000,694.45000,Humana,Medicare Advantage,,352.45,,,,,,,247.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,outpatient,,,1900.00000,1388.90000,Humana,Medicare Advantage,,704.90,,,,,,,494.00,1843.00,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,outpatient,,,584.00000,426.90000,Humana,Medicare Advantage,,216.66,,,,,,,151.84,566.48,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,outpatient,,,1391.00000,1016.82000,Humana,Medicare Advantage,,516.06,,,,,,,361.66,1349.27,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,outpatient,,,359.00000,271.76000,Humana,Medicare Advantage,,133.19,,,,,,,93.34,348.23,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,outpatient,,,95.00000,71.92000,Humana,Medicare Advantage,,35.24,,,,,,,24.70,92.15,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,outpatient,,,37.00000,17.83000,Humana,Medicare Advantage,,13.73,,,,,,,9.62,35.89,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Humana,Medicare Advantage,,29.31,,,,,,,20.54,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Humana,Medicare Advantage,,87.93,,,,,,,61.62,229.89,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,outpatient,,,33.00000,15.91000,Humana,Medicare Advantage,,12.24,,,,,,,8.58,32.01,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,outpatient,,,25.00000,12.05000,Humana,Medicare Advantage,,9.28,,,,,,,6.50,24.25,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,outpatient,,,497.00000,160.53000,Humana,Medicare Advantage,,184.39,,,,,,,129.22,482.09,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Humana,Medicare Advantage,,327.22,,,,,,,229.32,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Humana,Medicare Advantage,,327.22,,,,,,,229.32,855.54,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Humana,Medicare Advantage,,36.36,,,,,,,25.48,95.06,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Humana,Medicare Advantage,,35.62,,,,,,,24.96,93.12,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Humana,Medicare Advantage,,327.22,,,,,,,229.32,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Humana,Medicare Advantage,,327.22,,,,,,,229.32,855.54,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,outpatient,,,763.00000,291.47000,Humana,Medicare Advantage,,283.07,,,,,,,198.38,740.11,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,outpatient,,,199.00000,76.02000,Humana,Medicare Advantage,,73.83,,,,,,,51.74,193.03,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Humana,Medicare Advantage,,36.36,,,,,,,25.48,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Humana,Medicare Advantage,,35.62,,,,,,,24.96,93.12,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,outpatient,,,1265.00000,483.23000,Humana,Medicare Advantage,,469.31,,,,,,,328.90,1227.05,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,outpatient,,,924.00000,352.97000,Humana,Medicare Advantage,,342.80,,,,,,,240.24,896.28,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,outpatient,,,580.00000,215.76000,Humana,Medicare Advantage,,215.18,,,,,,,150.80,562.60,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,outpatient,,,110.00000,40.92000,Humana,Medicare Advantage,,40.81,,,,,,,28.60,106.70,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,outpatient,,,373.00000,138.76000,Humana,Medicare Advantage,,138.38,,,,,,,96.98,361.81,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,outpatient,,,337.00000,125.36000,Humana,Medicare Advantage,,125.03,,,,,,,87.62,326.89,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,outpatient,,,784.00000,291.65000,Humana,Medicare Advantage,,290.86,,,,,,,203.84,760.48,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,outpatient,,,341.00000,126.85000,Humana,Medicare Advantage,,126.51,,,,,,,88.66,330.77,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,outpatient,,,252.00000,93.74000,Humana,Medicare Advantage,,93.49,,,,,,,65.52,244.44,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,outpatient,,,282.00000,104.90000,Humana,Medicare Advantage,,104.62,,,,,,,73.32,273.54,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,outpatient,,,404.00000,150.29000,Humana,Medicare Advantage,,149.88,,,,,,,105.04,391.88,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,outpatient,,,306.00000,173.85000,Humana,Medicare Advantage,,113.53,,,,,,,79.56,296.82,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,outpatient,,,158.00000,89.77000,Humana,Medicare Advantage,,58.62,,,,,,,41.08,153.26,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Humana,Medicare Advantage,GP,54.54,,,,,,,38.22,142.59,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Humana,Medicare Advantage,GP,100.17,,,,,,,70.20,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Humana,Medicare Advantage,GP,31.16,,,,,,,21.84,81.48,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Humana,Medicare Advantage,GP,31.91,,,,,,,22.36,83.42,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Humana,Medicare Advantage,GP,30.42,,,,,,,21.32,79.54,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Humana,Medicare Advantage,GP,31.54,,,,,,,22.10,82.45,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Humana,Medicare Advantage,GP,15.95,,,,,,,11.18,41.71,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Humana,Medicare Advantage,GP,15.21,,,,,,,10.66,39.77,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Humana,Medicare Advantage,GP,29.31,,,,,,,20.54,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Humana,Medicare Advantage,GP,27.45,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Humana,Medicare Advantage,GP,27.45,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Humana,Medicare Advantage,GP,12.61,,,,,,,8.84,32.98,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Humana,Medicare Advantage,GP,24.11,,,,,,,16.90,63.05,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,outpatient,,,113.00000,68.70000,Humana,Medicare Advantage,,41.92,,,,,,,29.38,109.61,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Humana,Medicare Advantage,GP,29.68,,,,,,,20.80,77.60,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Humana,Medicare Advantage,GP,31.16,,,,,,,21.84,81.48,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Humana,Medicare Advantage,GP,27.08,,,,,,,18.98,70.81,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,outpatient,,,100.00000,60.80000,Humana,Medicare Advantage,,37.10,,,,,,,26.00,97.00,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,outpatient,,,167.00000,101.54000,Humana,Medicare Advantage,GP,61.96,,,,,,,43.42,161.99,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Humana,Medicare Advantage,"50,GP",153.22,,,,,,,107.38,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Humana,Medicare Advantage,"LT,GP",102.03,,,,,,,71.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Humana,Medicare Advantage,"RT,GP",102.03,,,,,,,71.50,266.75,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Humana,Medicare Advantage,GP,35.24,,,,,,,24.70,92.15,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Humana,Medicare Advantage,GP,54.17,,,,,,,37.96,141.62,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Humana,Medicare Advantage,GP,51.57,,,,,,,36.14,134.83,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Humana,Medicare Advantage,GP,27.82,,,,,,,19.50,72.75,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Humana,Medicare Advantage,GP,57.13,,,,,,,40.04,149.38,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Humana,Medicare Advantage,GP,27.08,,,,,,,18.98,70.81,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Humana,Medicare Advantage,GP,59.36,,,,,,,41.60,155.20,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Humana,Medicare Advantage,GP,120.58,,,,,,,84.50,315.25,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,outpatient,,,98.00000,59.58000,Humana,Medicare Advantage,GP,36.36,,,,,,,25.48,95.06,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,outpatient,,,303.00000,184.22000,Humana,Medicare Advantage,GP,112.41,,,,,,,78.78,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,outpatient,,,115.00000,69.92000,Humana,Medicare Advantage,GP,42.66,,,,,,,29.90,111.55,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Humana,Medicare Advantage,GP,27.45,,,,,,,19.24,71.78,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Humana,Medicare Advantage,GP,29.31,,,,,,,20.54,76.63,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Humana,Medicare Advantage,GP,26.71,,,,,,,18.72,69.84,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Humana,Medicare Advantage,GP,54.54,,,,,,,38.22,142.59,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Humana,Medicare Advantage,GP,100.17,,,,,,,70.20,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Humana,Medicare Advantage,GP,31.16,,,,,,,21.84,81.48,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Humana,Medicare Advantage,GP,31.91,,,,,,,22.36,83.42,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Humana,Medicare Advantage,GP,30.42,,,,,,,21.32,79.54,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Humana,Medicare Advantage,GP,31.54,,,,,,,22.10,82.45,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Humana,Medicare Advantage,GP,15.95,,,,,,,11.18,41.71,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Humana,Medicare Advantage,GP,15.21,,,,,,,10.66,39.77,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Humana,Medicare Advantage,GP,29.31,,,,,,,20.54,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Humana,Medicare Advantage,"CQ,GP",27.45,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Humana,Medicare Advantage,"CQ,GP",27.45,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Humana,Medicare Advantage,GP,12.61,,,,,,,8.84,32.98,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Humana,Medicare Advantage,GP,24.11,,,,,,,16.90,63.05,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Humana,Medicare Advantage,GP,29.68,,,,,,,20.80,77.60,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Humana,Medicare Advantage,GP,31.16,,,,,,,21.84,81.48,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Humana,Medicare Advantage,GP,27.08,,,,,,,18.98,70.81,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Humana,Medicare Advantage,"GP,50",153.22,,,,,,,107.38,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Humana,Medicare Advantage,"GP,LT",102.03,,,,,,,71.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Humana,Medicare Advantage,"GP,RT",102.03,,,,,,,71.50,266.75,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Humana,Medicare Advantage,GP,35.24,,,,,,,24.70,92.15,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Humana,Medicare Advantage,GP,54.17,,,,,,,37.96,141.62,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Humana,Medicare Advantage,GP,51.57,,,,,,,36.14,134.83,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Humana,Medicare Advantage,GP,27.82,,,,,,,19.50,72.75,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Humana,Medicare Advantage,GP,57.13,,,,,,,40.04,149.38,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Humana,Medicare Advantage,GP,27.08,,,,,,,18.98,70.81,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Humana,Medicare Advantage,GP,59.36,,,,,,,41.60,155.20,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Humana,Medicare Advantage,GP,120.58,,,,,,,84.50,315.25,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Humana,Medicare Advantage,GP,27.45,,,,,,,19.24,71.78,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Humana,Medicare Advantage,GP,29.31,,,,,,,20.54,76.63,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Humana,Medicare Advantage,GP,26.71,,,,,,,18.72,69.84,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,outpatient,,,445.00000,262.55000,Humana,Medicare Advantage,GP,165.09,,,,,,,115.70,431.65,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,outpatient,,,310.00000,182.90000,Humana,Medicare Advantage,GP,115.01,,,,,,,80.60,300.70,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,outpatient,,,393.00000,231.87000,Humana,Medicare Advantage,GP,145.80,,,,,,,102.18,381.21,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,outpatient,,,310.00000,182.90000,Humana,Medicare Advantage,GP,115.01,,,,,,,80.60,300.70,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Humana,Medicare Advantage,GO,29.68,,,,,,,20.80,77.60,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Humana,Medicare Advantage,GO,31.16,,,,,,,21.84,81.48,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Humana,Medicare Advantage,GO,46.75,,,,,,,32.76,122.22,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Humana,Medicare Advantage,GO,24.49,,,,,,,17.16,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Humana,Medicare Advantage,GO,23.00,,,,,,,16.12,60.14,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Humana,Medicare Advantage,GO,33.39,,,,,,,23.40,87.30,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Humana,Medicare Advantage,GO,35.24,,,,,,,24.70,92.15,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Humana,Medicare Advantage,GO,54.17,,,,,,,37.96,141.62,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Humana,Medicare Advantage,GO,51.57,,,,,,,36.14,134.83,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Humana,Medicare Advantage,GO,27.82,,,,,,,19.50,72.75,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Humana,Medicare Advantage,GO,57.13,,,,,,,40.04,149.38,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Humana,Medicare Advantage,GO,27.08,,,,,,,18.98,70.81,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Humana,Medicare Advantage,GO,59.36,,,,,,,41.60,155.20,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,outpatient,,,98.00000,37.93000,Humana,Medicare Advantage,GO,36.36,,,,,,,25.48,95.06,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,outpatient,,,303.00000,117.26000,Humana,Medicare Advantage,GO,112.41,,,,,,,78.78,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,outpatient,,,115.00000,44.50000,Humana,Medicare Advantage,GO,42.66,,,,,,,29.90,111.55,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Humana,Medicare Advantage,GO,27.45,,,,,,,19.24,71.78,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Humana,Medicare Advantage,GO,26.71,,,,,,,18.72,69.84,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Humana,Medicare Advantage,"CO,GO",29.68,,,,,,,20.80,77.60,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Humana,Medicare Advantage,"CO,GO",31.16,,,,,,,21.84,81.48,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Humana,Medicare Advantage,"CO,GO",46.75,,,,,,,32.76,122.22,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Humana,Medicare Advantage,"CO,GO",23.00,,,,,,,16.12,60.14,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Humana,Medicare Advantage,"CO,GO",24.49,,,,,,,17.16,64.02,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Humana,Medicare Advantage,"CO,GO",33.39,,,,,,,23.40,87.30,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Humana,Medicare Advantage,"CO,GO",35.24,,,,,,,24.70,92.15,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Humana,Medicare Advantage,"CO,GO",54.17,,,,,,,37.96,141.62,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Humana,Medicare Advantage,"CO,GO",51.57,,,,,,,36.14,134.83,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Humana,Medicare Advantage,"CO,GO",27.82,,,,,,,19.50,72.75,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Humana,Medicare Advantage,"CO,GO",57.13,,,,,,,40.04,149.38,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Humana,Medicare Advantage,"CO,GO",27.08,,,,,,,18.98,70.81,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Humana,Medicare Advantage,"CO,GO",59.36,,,,,,,41.60,155.20,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Humana,Medicare Advantage,"CO,GO",27.45,,,,,,,19.24,71.78,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Humana,Medicare Advantage,"CO,GO",26.71,,,,,,,18.72,69.84,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Humana,Medicare Advantage,GO,17.44,,,,,,,12.22,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Humana,Medicare Advantage,"CO,GO",17.44,,,,,,,12.22,45.59,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,outpatient,,,250.00000,142.04000,Humana,Medicare Advantage,GO,92.75,,,,,,,65.00,242.50,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,outpatient,,,175.00000,99.43000,Humana,Medicare Advantage,GO,64.92,,,,,,,45.50,169.75,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,outpatient,,,233.00000,132.38000,Humana,Medicare Advantage,GO,86.44,,,,,,,60.58,226.01,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,outpatient,,,175.00000,99.43000,Humana,Medicare Advantage,GO,64.92,,,,,,,45.50,169.75,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,outpatient,,,291.00000,93.99000,Humana,Medicare Advantage,,107.96,,,,,,,75.66,282.27,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,outpatient,,,273.00000,155.10000,Humana,Medicare Advantage,GN,101.28,,,,,,,70.98,264.81,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,outpatient,,,279.00000,158.51000,Humana,Medicare Advantage,GN,103.51,,,,,,,72.54,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,outpatient,,,426.00000,242.03000,Humana,Medicare Advantage,GN,158.05,,,,,,,110.76,413.22,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,outpatient,,,242.00000,137.49000,Humana,Medicare Advantage,GN,89.78,,,,,,,62.92,234.74,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,outpatient,,,128.00000,72.72000,Humana,Medicare Advantage,,47.49,,,,,,,33.28,124.16,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,outpatient,,,66.00000,37.50000,Humana,Medicare Advantage,GN,24.49,,,,,,,17.16,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,outpatient,,,62.00000,35.23000,Humana,Medicare Advantage,GN,23.00,,,,,,,16.12,60.14,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,outpatient,,,269.00000,152.83000,Humana,Medicare Advantage,GN,99.80,,,,,,,69.94,260.93,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,outpatient,,,153.00000,86.93000,Humana,Medicare Advantage,GN,56.76,,,,,,,39.78,148.41,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,outpatient,,,98.00000,55.68000,Humana,Medicare Advantage,GN,36.36,,,,,,,25.48,95.06,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,outpatient,,,303.00000,172.15000,Humana,Medicare Advantage,GN,112.41,,,,,,,78.78,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,outpatient,,,115.00000,65.34000,Humana,Medicare Advantage,GN,42.66,,,,,,,29.90,111.55,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,outpatient,,,210.00000,119.31000,Humana,Medicare Advantage,GN,77.91,,,,,,,54.60,203.70,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,outpatient,,,250.00000,142.04000,Humana,Medicare Advantage,GN,92.75,,,,,,,65.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,outpatient,,,78.00000,44.32000,Humana,Medicare Advantage,GN,28.94,,,,,,,20.28,75.66,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,outpatient,,,322.00000,182.94000,Humana,Medicare Advantage,GN,119.46,,,,,,,83.72,312.34,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,outpatient,,,309.00000,175.56000,Humana,Medicare Advantage,GN,114.64,,,,,,,80.34,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,outpatient,,,245.00000,139.20000,Humana,Medicare Advantage,GN,90.89,,,,,,,63.70,237.65,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,outpatient,,,313.00000,116.44000,Humana,Medicare Advantage,,116.12,,,,,,,81.38,303.61,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,outpatient,,,1250.00000,632.50000,Humana,Medicare Advantage,,463.75,,,,,,,325.00,1212.50,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Humana,Medicare Advantage,,53.80,,,,,,,37.70,140.65,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Humana,Medicare Advantage,,181.05,,,,,,,126.88,473.36,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,outpatient,,,684.00000,337.90000,Humana,Medicare Advantage,,253.76,,,,,,,177.84,663.48,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,outpatient,,,206.00000,101.76000,Humana,Medicare Advantage,,76.43,,,,,,,53.56,199.82,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,outpatient,,,195.00000,96.33000,Humana,Medicare Advantage,,72.34,,,,,,,50.70,189.15,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,outpatient,,,375.00000,185.25000,Humana,Medicare Advantage,,139.12,,,,,,,97.50,363.75,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,outpatient,,,429.00000,211.93000,Humana,Medicare Advantage,,159.16,,,,,,,111.54,416.13,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22475,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Humana,Medicare Advantage,,3111.10,,,,,,,2502.90,3111.10,per diem,
R&B OBSTETRICS SEMI-PVT,42473,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Humana,Medicare Advantage,,3111.10,,,,,,,2502.90,3111.10,per diem,
R&B ICU,32474,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Humana,Medicare Advantage,,3111.10,,,,,,,2512.00,8498.17,per diem,
R&B ICU INTERMEDIATE,12476,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Humana,Medicare Advantage,,3111.10,,,,,,,2512.00,5665.77,per diem,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Humana,Medicare Advantage,,31.16,,,,,,,21.84,81.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Humana,Medicare Advantage,,105.36,,,,,,,73.84,275.48,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Humana,Medicare Advantage,,169.92,,,,,,,119.08,444.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Humana,Medicare Advantage,,207.02,,,,,,,145.08,541.26,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Humana,Medicare Advantage,,178.82,,,,,,,125.32,467.54,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Humana,Medicare Advantage,,87.93,,,,,,,61.62,229.89,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,outpatient,,,490.00000,329.77000,Humana,Medicare Advantage,,181.79,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,outpatient,,,490.00000,329.77000,Humana,Medicare Advantage,,181.79,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,outpatient,,,245.00000,164.89000,Humana,Medicare Advantage,,90.89,,,,,,,63.70,237.65,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Humana,Medicare Advantage,,181.79,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Humana,Medicare Advantage,,181.79,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Humana,Medicare Advantage,,90.89,,,,,,,63.70,237.65,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Humana,Medicare Advantage,,312.38,,,,,,,218.92,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Humana,Medicare Advantage,,390.66,,,,,,,273.78,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Humana,Medicare Advantage,,468.57,,,,,,,328.38,1225.11,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,outpatient,,,2466.00000,986.40000,Humana,Medicare Advantage,,914.89,,,,,,,641.16,2392.02,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,outpatient,,,260.00000,104.00000,Humana,Medicare Advantage,,96.46,,,,,,,67.60,252.20,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,outpatient,,,2041.00000,816.40000,Humana,Medicare Advantage,,757.21,,,,,,,530.66,1979.77,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,outpatient,,,375.00000,150.00000,Humana,Medicare Advantage,,139.12,,,,,,,97.50,363.75,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,outpatient,,,1178.00000,471.20000,Humana,Medicare Advantage,,437.04,,,,,,,306.28,1142.66,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,outpatient,,,245.00000,98.00000,Humana,Medicare Advantage,,90.89,,,,,,,63.70,237.65,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,outpatient,,,280.00000,112.00000,Humana,Medicare Advantage,,103.88,,,,,,,72.80,271.60,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,outpatient,,,336.00000,134.40000,Humana,Medicare Advantage,,124.66,,,,,,,87.36,325.92,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,outpatient,,,380.00000,152.00000,Humana,Medicare Advantage,,140.98,,,,,,,98.80,368.60,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Humana,Medicare Advantage,,196.63,,,,,,,137.80,514.10,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,outpatient,,,264.00000,105.60000,Humana,Medicare Advantage,,97.94,,,,,,,68.64,256.08,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,outpatient,,,763.00000,305.20000,Humana,Medicare Advantage,,283.07,,,,,,,198.38,740.11,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,outpatient,,,672.00000,268.80000,Humana,Medicare Advantage,,249.31,,,,,,,174.72,651.84,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,outpatient,,,1940.00000,776.00000,Humana,Medicare Advantage,,719.74,,,,,,,504.40,1881.80,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,outpatient,,,3875.00000,1550.00000,Humana,Medicare Advantage,,1437.62,,,,,,,1007.50,3758.75,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,outpatient,,,505.00000,202.00000,Humana,Medicare Advantage,,187.35,,,,,,,131.30,489.85,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Humana,Medicare Advantage,,109.44,,,,,,,76.70,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,outpatient,,,585.00000,234.00000,Humana,Medicare Advantage,,217.03,,,,,,,152.10,567.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,outpatient,,,285.00000,114.00000,Humana,Medicare Advantage,,105.73,,,,,,,74.10,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,outpatient,,,575.00000,230.00000,Humana,Medicare Advantage,,213.32,,,,,,,149.50,557.75,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,outpatient,,,697.00000,278.80000,Humana,Medicare Advantage,,258.59,,,,,,,181.22,676.09,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Humana,Medicare Advantage,,196.63,,,,,,,137.80,514.10,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,outpatient,,,580.00000,232.00000,Humana,Medicare Advantage,,215.18,,,,,,,150.80,562.60,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,outpatient,,,435.00000,174.00000,Humana,Medicare Advantage,,161.38,,,,,,,113.10,421.95,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,outpatient,,,270.00000,108.00000,Humana,Medicare Advantage,,100.17,,,,,,,70.20,261.90,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,outpatient,,,504.00000,201.60000,Humana,Medicare Advantage,,186.98,,,,,,,131.04,488.88,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,outpatient,,,98.00000,39.20000,Humana,Medicare Advantage,,36.36,,,,,,,25.48,95.06,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,outpatient,,,608.00000,243.20000,Humana,Medicare Advantage,,225.57,,,,,,,158.08,589.76,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,outpatient,,,114.00000,45.60000,Humana,Medicare Advantage,,42.29,,,,,,,29.64,110.58,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,outpatient,,,187.00000,74.80000,Humana,Medicare Advantage,,69.38,,,,,,,48.62,181.39,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,outpatient,,,214.00000,85.60000,Humana,Medicare Advantage,,79.39,,,,,,,55.64,207.58,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,outpatient,,,863.00000,345.20000,Humana,Medicare Advantage,,320.17,,,,,,,224.38,837.11,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,outpatient,,,453.00000,181.20000,Humana,Medicare Advantage,,168.06,,,,,,,117.78,439.41,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,outpatient,,,144.00000,57.60000,Humana,Medicare Advantage,,53.42,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,outpatient,,,107.00000,42.80000,Humana,Medicare Advantage,,39.70,,,,,,,27.82,103.79,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,outpatient,,,403.00000,161.20000,Humana,Medicare Advantage,,149.51,,,,,,,104.78,390.91,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,outpatient,,,144.00000,57.60000,Humana,Medicare Advantage,,53.42,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,outpatient,,,370.00000,148.00000,Humana,Medicare Advantage,,137.27,,,,,,,96.20,358.90,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,outpatient,,,334.00000,133.60000,Humana,Medicare Advantage,,123.91,,,,,,,86.84,323.98,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,outpatient,,,1188.00000,475.20000,Humana,Medicare Advantage,50,440.75,,,,,,,308.88,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Humana,Medicare Advantage,LT,293.83,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Humana,Medicare Advantage,RT,293.83,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,outpatient,,,572.00000,228.80000,Humana,Medicare Advantage,50,212.21,,,,,,,148.72,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Humana,Medicare Advantage,LT,141.35,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Humana,Medicare Advantage,RT,141.35,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,outpatient,,,683.00000,273.20000,Humana,Medicare Advantage,50,253.39,,,,,,,177.58,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Humana,Medicare Advantage,LT,168.81,,,,,,,118.30,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Humana,Medicare Advantage,RT,168.81,,,,,,,118.30,441.35,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,outpatient,,,357.00000,142.80000,Humana,Medicare Advantage,,132.45,,,,,,,92.82,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,outpatient,,,334.00000,133.60000,Humana,Medicare Advantage,,123.91,,,,,,,86.84,323.98,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,outpatient,,,194.00000,77.60000,Humana,Medicare Advantage,,71.97,,,,,,,50.44,188.18,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,outpatient,,,608.00000,243.20000,Humana,Medicare Advantage,,225.57,,,,,,,158.08,589.76,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,outpatient,,,257.00000,102.80000,Humana,Medicare Advantage,,95.35,,,,,,,66.82,249.29,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,outpatient,,,343.00000,137.20000,Humana,Medicare Advantage,,127.25,,,,,,,89.18,332.71,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,outpatient,,,457.00000,182.80000,Humana,Medicare Advantage,,169.55,,,,,,,118.82,443.29,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,outpatient,,,630.00000,252.00000,Humana,Medicare Advantage,,233.73,,,,,,,163.80,611.10,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,outpatient,,,623.00000,249.20000,Humana,Medicare Advantage,,231.13,,,,,,,161.98,604.31,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,outpatient,,,1457.00000,582.80000,Humana,Medicare Advantage,,540.55,,,,,,,378.82,1413.29,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,outpatient,,,890.00000,356.00000,Humana,Medicare Advantage,,330.19,,,,,,,231.40,863.30,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,outpatient,,,532.00000,212.80000,Humana,Medicare Advantage,,197.37,,,,,,,138.32,516.04,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,outpatient,,,492.00000,196.80000,Humana,Medicare Advantage,,182.53,,,,,,,127.92,477.24,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,outpatient,,,550.00000,220.00000,Humana,Medicare Advantage,,204.05,,,,,,,143.00,533.50,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,outpatient,,,305.00000,122.00000,Humana,Medicare Advantage,,113.16,,,,,,,79.30,295.85,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,outpatient,,,220.00000,88.00000,Humana,Medicare Advantage,,81.62,,,,,,,57.20,213.40,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,outpatient,,,780.00000,312.00000,Humana,Medicare Advantage,,289.38,,,,,,,202.80,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,outpatient,,,1165.00000,466.00000,Humana,Medicare Advantage,,432.21,,,,,,,302.90,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,outpatient,,,2350.00000,940.00000,Humana,Medicare Advantage,,871.85,,,,,,,611.00,2279.50,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,outpatient,,,896.00000,358.40000,Humana,Medicare Advantage,,332.42,,,,,,,232.96,869.12,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,outpatient,,,385.00000,154.00000,Humana,Medicare Advantage,,142.84,,,,,,,100.10,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,outpatient,,,470.00000,188.00000,Humana,Medicare Advantage,,174.37,,,,,,,122.20,455.90,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,outpatient,,,150.00000,60.00000,Humana,Medicare Advantage,,55.65,,,,,,,39.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,outpatient,,,100.00000,40.00000,Humana,Medicare Advantage,,37.10,,,,,,,26.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,outpatient,,,143.00000,57.20000,Humana,Medicare Advantage,,53.05,,,,,,,37.18,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,outpatient,,,95.00000,38.00000,Humana,Medicare Advantage,,35.24,,,,,,,24.70,92.15,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,outpatient,,,269.00000,107.60000,Humana,Medicare Advantage,,99.80,,,,,,,69.94,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,outpatient,,,388.00000,155.20000,Humana,Medicare Advantage,,143.95,,,,,,,100.88,376.36,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,outpatient,,,344.00000,137.60000,Humana,Medicare Advantage,,127.62,,,,,,,89.44,333.68,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,outpatient,,,321.00000,128.40000,Humana,Medicare Advantage,,119.09,,,,,,,83.46,311.37,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,outpatient,,,155.00000,62.00000,Humana,Medicare Advantage,,57.51,,,,,,,40.30,150.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,outpatient,,,817.00000,326.80000,Humana,Medicare Advantage,,303.11,,,,,,,212.42,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,outpatient,,,1255.00000,502.00000,Humana,Medicare Advantage,,465.61,,,,,,,326.30,1217.35,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,outpatient,,,391.00000,156.40000,Humana,Medicare Advantage,,145.06,,,,,,,101.66,379.27,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,outpatient,,,671.00000,268.40000,Humana,Medicare Advantage,,248.94,,,,,,,174.46,650.87,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,outpatient,,,456.00000,182.40000,Humana,Medicare Advantage,,169.18,,,,,,,118.56,442.32,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,outpatient,,,112.00000,44.80000,Humana,Medicare Advantage,,41.55,,,,,,,29.12,108.64,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,outpatient,,,84.00000,33.60000,Humana,Medicare Advantage,,31.16,,,,,,,21.84,81.48,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,outpatient,,,216.00000,86.40000,Humana,Medicare Advantage,,80.14,,,,,,,56.16,209.52,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,outpatient,,,2660.00000,1064.00000,Humana,Medicare Advantage,,986.86,,,,,,,691.60,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,outpatient,,,2960.00000,1184.00000,Humana,Medicare Advantage,,1098.16,,,,,,,769.60,2871.20,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,outpatient,,,3225.00000,1290.00000,Humana,Medicare Advantage,,1196.47,,,,,,,838.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,outpatient,,,3395.00000,1358.00000,Humana,Medicare Advantage,,1259.55,,,,,,,882.70,3293.15,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,outpatient,,,490.00000,196.00000,Humana,Medicare Advantage,,181.79,,,,,,,127.40,475.30,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,outpatient,,,520.00000,208.00000,Humana,Medicare Advantage,,192.92,,,,,,,135.20,504.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,outpatient,,,720.00000,288.00000,Humana,Medicare Advantage,,267.12,,,,,,,187.20,698.40,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,outpatient,,,215.00000,86.00000,Humana,Medicare Advantage,,79.77,,,,,,,55.90,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,outpatient,,,240.00000,96.00000,Humana,Medicare Advantage,,89.04,,,,,,,62.40,232.80,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,outpatient,,,1241.00000,496.40000,Humana,Medicare Advantage,,460.41,,,,,,,322.66,1203.77,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,outpatient,,,850.00000,340.00000,Humana,Medicare Advantage,,315.35,,,,,,,221.00,824.50,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,outpatient,,,1085.00000,434.00000,Humana,Medicare Advantage,,402.54,,,,,,,282.10,1052.45,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Humana,Medicare Advantage,,109.44,,,,,,,76.70,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,outpatient,,,492.00000,196.80000,Humana,Medicare Advantage,,182.53,,,,,,,127.92,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,outpatient,,,563.00000,225.20000,Humana,Medicare Advantage,,208.87,,,,,,,146.38,546.11,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,outpatient,,,1612.00000,644.80000,Humana,Medicare Advantage,,598.05,,,,,,,419.12,1563.64,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,outpatient,,,1366.00000,546.40000,Humana,Medicare Advantage,,506.79,,,,,,,355.16,1325.02,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,outpatient,,,1911.00000,764.40000,Humana,Medicare Advantage,,708.98,,,,,,,496.86,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,outpatient,,,956.00000,382.40000,Humana,Medicare Advantage,,354.68,,,,,,,248.56,927.32,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,outpatient,,,189.00000,123.20000,Humana,Medicare Advantage,,70.12,,,,,,,49.14,183.33,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,outpatient,,,352.00000,256.87000,Humana,Medicare Advantage,,130.59,,,,,,,91.52,341.44,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,outpatient,,,625.00000,738.40000,Humana,Medicare Advantage,,231.88,,,,,,,162.50,606.25,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1024.00000,2097.47000,Humana,Medicare Advantage,,379.90,,,,,,,266.24,993.28,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,outpatient,,,1455.00000,2469.72000,Humana,Medicare Advantage,,539.80,,,,,,,378.30,1411.35,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Humana,Medicare Advantage,,53.80,,,,,,,37.70,140.65,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Humana,Medicare Advantage,,181.05,,,,,,,126.88,473.36,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Humana,Medicare Advantage,,43.04,,,,,,,30.16,112.52,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Humana,Medicare Advantage,,30.05,,,,,,,21.06,78.57,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Humana,Medicare Advantage,,15.21,,,,,,,10.66,39.77,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,outpatient,,,170.00000,73.95000,Humana,Medicare Advantage,,63.07,,,,,,,44.20,164.90,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,2.70000,1.17000,Humana,Medicare Advantage,,1.00,,,,,,,0.70200,2.62,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,27.00000,11.74000,Humana,Medicare Advantage,,10.02,,,,,,,7.02,26.19,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,outpatient,,,20440.00000,8891.40000,Humana,Medicare Advantage,,7583.24,,,,,,,5314.40,19826.80,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,3322.00000,1445.07000,Humana,Medicare Advantage,,1232.46,,,,,,,863.72,3222.34,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,2492.00000,1084.02000,Humana,Medicare Advantage,,924.53,,,,,,,647.92,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1814.00000,789.09000,Humana,Medicare Advantage,,672.99,,,,,,,471.64,1759.58,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,2153.00000,936.56000,Humana,Medicare Advantage,,798.76,,,,,,,559.78,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1525.00000,663.38000,Humana,Medicare Advantage,,565.77,,,,,,,396.50,1479.25,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2716.00000,1181.46000,Humana,Medicare Advantage,,1007.64,,,,,,,706.16,2634.52,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,outpatient,,,2.70000,0.39000,Humana,Medicare Advantage,,1.00,,,,,,,0.70200,2.62,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,outpatient,,,222.00000,32.41000,Humana,Medicare Advantage,,82.36,,,,,,,57.72,215.34,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,outpatient,,,211.00000,113.10000,Humana,Medicare Advantage,,78.28,,,,,,,54.86,204.67,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,outpatient,,,497.00000,266.39000,Humana,Medicare Advantage,,184.39,,,,,,,129.22,482.09,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,outpatient,,,296.00000,158.66000,Humana,Medicare Advantage,,109.82,,,,,,,76.96,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,outpatient,,,723.00000,387.53000,Humana,Medicare Advantage,,268.23,,,,,,,187.98,701.31,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,outpatient,,,326.00000,174.74000,Humana,Medicare Advantage,,120.95,,,,,,,84.76,316.22,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,outpatient,,,532.00000,285.15000,Humana,Medicare Advantage,,197.37,,,,,,,138.32,516.04,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,outpatient,,,635.00000,340.36000,Humana,Medicare Advantage,,235.59,,,,,,,165.10,615.95,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,outpatient,,,639.00000,342.50000,Humana,Medicare Advantage,,237.07,,,,,,,166.14,619.83,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,outpatient,,,780.00000,418.08000,Humana,Medicare Advantage,,289.38,,,,,,,202.80,756.60,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,outpatient,,,390.00000,209.04000,Humana,Medicare Advantage,,144.69,,,,,,,101.40,378.30,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,outpatient,,,731.00000,391.82000,Humana,Medicare Advantage,,271.20,,,,,,,190.06,709.07,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,outpatient,,,585.00000,313.56000,Humana,Medicare Advantage,,217.03,,,,,,,152.10,567.45,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,outpatient,,,365.00000,195.64000,Humana,Medicare Advantage,,135.41,,,,,,,94.90,354.05,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,outpatient,,,1086.00000,582.10000,Humana,Medicare Advantage,,402.91,,,,,,,282.36,1053.42,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,outpatient,,,197.00000,105.59000,Humana,Medicare Advantage,,73.09,,,,,,,51.22,191.09,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,outpatient,,,2774.00000,1486.86000,Humana,Medicare Advantage,,1029.15,,,,,,,721.24,2690.78,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,outpatient,,,1456.00000,780.42000,Humana,Medicare Advantage,,540.18,,,,,,,378.56,1412.32,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,outpatient,,,2647.00000,1418.79000,Humana,Medicare Advantage,,982.04,,,,,,,688.22,2567.59,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,outpatient,,,1359.00000,728.42000,Humana,Medicare Advantage,,504.19,,,,,,,353.34,1318.23,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,outpatient,,,273.00000,146.33000,Humana,Medicare Advantage,,101.28,,,,,,,70.98,264.81,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,outpatient,,,325.00000,174.20000,Humana,Medicare Advantage,,120.58,,,,,,,84.50,315.25,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Humana,Medicare Advantage,,225.94,,,,,,,158.34,590.73,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,outpatient,,,491.00000,263.18000,Humana,Medicare Advantage,,182.16,,,,,,,127.66,476.27,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,outpatient,,,561.00000,300.70000,Humana,Medicare Advantage,,208.13,,,,,,,145.86,544.17,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,outpatient,,,845.00000,452.92000,Humana,Medicare Advantage,,313.50,,,,,,,219.70,819.65,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,outpatient,,,612.00000,328.03000,Humana,Medicare Advantage,,227.05,,,,,,,159.12,593.64,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,outpatient,,,536.00000,287.30000,Humana,Medicare Advantage,,198.86,,,,,,,139.36,519.92,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,outpatient,,,1225.00000,656.60000,Humana,Medicare Advantage,,454.48,,,,,,,318.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Humana,Medicare Advantage,LT,302.74,,,,,,,212.16,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Humana,Medicare Advantage,RT,302.74,,,,,,,212.16,791.52,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,outpatient,,,250.00000,134.00000,Humana,Medicare Advantage,,92.75,,,,,,,65.00,242.50,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,outpatient,,,302.00000,161.87000,Humana,Medicare Advantage,,112.04,,,,,,,78.52,292.94,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,outpatient,,,354.00000,189.74000,Humana,Medicare Advantage,,131.33,,,,,,,92.04,343.38,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,outpatient,,,409.00000,219.22000,Humana,Medicare Advantage,,151.74,,,,,,,106.34,396.73,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,outpatient,,,593.00000,317.85000,Humana,Medicare Advantage,,220.00,,,,,,,154.18,575.21,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Humana,Medicare Advantage,LT,113.90,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Humana,Medicare Advantage,"52,LT",113.90,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Humana,Medicare Advantage,RT,113.90,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Humana,Medicare Advantage,"52,RT",113.90,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Humana,Medicare Advantage,LT,122.43,,,,,,,85.80,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Humana,Medicare Advantage,RT,122.43,,,,,,,85.80,320.10,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,outpatient,,,195.00000,104.52000,Humana,Medicare Advantage,,72.34,,,,,,,50.70,189.15,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,outpatient,,,578.00000,309.81000,Humana,Medicare Advantage,,214.44,,,,,,,150.28,560.66,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,outpatient,,,384.00000,205.82000,Humana,Medicare Advantage,,142.46,,,,,,,99.84,372.48,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Humana,Medicare Advantage,LT,112.41,,,,,,,78.78,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Humana,Medicare Advantage,RT,112.41,,,,,,,78.78,293.91,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Humana,Medicare Advantage,LT,165.09,,,,,,,115.70,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Humana,Medicare Advantage,RT,165.09,,,,,,,115.70,431.65,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,outpatient,,,937.00000,502.23000,Humana,Medicare Advantage,,347.63,,,,,,,243.62,908.89,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,outpatient,,,615.00000,329.64000,Humana,Medicare Advantage,,228.16,,,,,,,159.90,596.55,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Humana,Medicare Advantage,LT,106.48,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Humana,Medicare Advantage,"52,LT",106.48,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Humana,Medicare Advantage,RT,106.48,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Humana,Medicare Advantage,"52,RT",106.48,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Humana,Medicare Advantage,LT,119.83,,,,,,,83.98,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Humana,Medicare Advantage,RT,119.83,,,,,,,83.98,313.31,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,outpatient,,,694.00000,371.98000,Humana,Medicare Advantage,,257.47,,,,,,,180.44,673.18,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Humana,Medicare Advantage,LT,102.40,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Humana,Medicare Advantage,RT,102.40,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Humana,Medicare Advantage,LT,94.23,,,,,,,66.04,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Humana,Medicare Advantage,RT,94.23,,,,,,,66.04,246.38,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Humana,Medicare Advantage,LT,102.03,,,,,,,71.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Humana,Medicare Advantage,RT,102.03,,,,,,,71.50,266.75,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,outpatient,,,173.00000,92.73000,Humana,Medicare Advantage,,64.18,,,,,,,44.98,167.81,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Humana,Medicare Advantage,LT,179.19,,,,,,,125.58,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Humana,Medicare Advantage,RT,179.19,,,,,,,125.58,468.51,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Humana,Medicare Advantage,LT,70.86,,,,,,,49.66,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Humana,Medicare Advantage,RT,70.86,,,,,,,49.66,185.27,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Humana,Medicare Advantage,LT,54.91,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Humana,Medicare Advantage,"52,LT",54.91,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Humana,Medicare Advantage,RT,54.91,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Humana,Medicare Advantage,"52,RT",54.91,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Humana,Medicare Advantage,LT,178.45,,,,,,,125.06,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Humana,Medicare Advantage,RT,178.45,,,,,,,125.06,466.57,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Humana,Medicare Advantage,LT,79.77,,,,,,,55.90,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Humana,Medicare Advantage,RT,79.77,,,,,,,55.90,208.55,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Humana,Medicare Advantage,LT,102.03,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Humana,Medicare Advantage,"52,LT",102.03,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Humana,Medicare Advantage,RT,102.03,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Humana,Medicare Advantage,"52,RT",102.03,,,,,,,71.50,266.75,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Humana,Medicare Advantage,LT,168.81,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Humana,Medicare Advantage,"52,LT",168.81,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Humana,Medicare Advantage,RT,168.81,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Humana,Medicare Advantage,"52,RT",168.81,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Humana,Medicare Advantage,LT,186.61,,,,,,,130.78,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Humana,Medicare Advantage,RT,186.61,,,,,,,130.78,487.91,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Humana,Medicare Advantage,LT,77.54,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Humana,Medicare Advantage,RT,77.54,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Humana,Medicare Advantage,LT,209.99,,,,,,,147.16,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Humana,Medicare Advantage,RT,209.99,,,,,,,147.16,549.02,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,outpatient,,,598.00000,320.53000,Humana,Medicare Advantage,,221.86,,,,,,,155.48,580.06,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Humana,Medicare Advantage,"52,LT",168.81,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Humana,Medicare Advantage,"52,RT",168.81,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Humana,Medicare Advantage,LT,168.81,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Humana,Medicare Advantage,RT,168.81,,,,,,,118.30,441.35,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,outpatient,,,1913.00000,1025.37000,Humana,Medicare Advantage,,709.72,,,,,,,497.38,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,outpatient,,,312.00000,167.23000,Humana,Medicare Advantage,,115.75,,,,,,,81.12,302.64,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,outpatient,,,327.00000,175.27000,Humana,Medicare Advantage,,121.32,,,,,,,85.02,317.19,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,outpatient,,,425.00000,227.80000,Humana,Medicare Advantage,,157.68,,,,,,,110.50,412.25,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,outpatient,,,210.00000,112.56000,Humana,Medicare Advantage,,77.91,,,,,,,54.60,203.70,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,outpatient,,,495.00000,265.32000,Humana,Medicare Advantage,,183.65,,,,,,,128.70,480.15,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,outpatient,,,541.00000,289.98000,Humana,Medicare Advantage,,200.71,,,,,,,140.66,524.77,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Humana,Medicare Advantage,LT,128.00,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Humana,Medicare Advantage,RT,128.00,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Humana,Medicare Advantage,LT,155.45,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Humana,Medicare Advantage,RT,155.45,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Humana,Medicare Advantage,LT,229.28,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Humana,Medicare Advantage,RT,229.28,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,outpatient,,,463.00000,248.17000,Humana,Medicare Advantage,,171.77,,,,,,,120.38,449.11,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,outpatient,,,511.00000,273.90000,Humana,Medicare Advantage,,189.58,,,,,,,132.86,495.67,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,outpatient,,,132.00000,70.75000,Humana,Medicare Advantage,,48.97,,,,,,,34.32,128.04,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Humana,Medicare Advantage,LT,130.96,,,,,,,91.78,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Humana,Medicare Advantage,RT,130.96,,,,,,,91.78,342.41,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,outpatient,,,273.00000,146.33000,Humana,Medicare Advantage,,101.28,,,,,,,70.98,264.81,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,outpatient,,,503.00000,269.61000,Humana,Medicare Advantage,,186.61,,,,,,,130.78,487.91,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,outpatient,,,561.00000,300.70000,Humana,Medicare Advantage,,208.13,,,,,,,145.86,544.17,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Humana,Medicare Advantage,LT,166.95,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Humana,Medicare Advantage,RT,166.95,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,outpatient,,,650.00000,348.40000,Humana,Medicare Advantage,,241.15,,,,,,,169.00,630.50,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,outpatient,,,642.00000,344.11000,Humana,Medicare Advantage,,238.18,,,,,,,166.92,622.74,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,outpatient,,,777.00000,416.47000,Humana,Medicare Advantage,,288.27,,,,,,,202.02,753.69,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,outpatient,,,381.00000,204.22000,Humana,Medicare Advantage,,141.35,,,,,,,99.06,369.57,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Humana,Medicare Advantage,LT,138.75,,,,,,,97.24,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Humana,Medicare Advantage,RT,138.75,,,,,,,97.24,362.78,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Humana,Medicare Advantage,LT,59.73,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Humana,Medicare Advantage,RT,59.73,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Humana,Medicare Advantage,LT,185.13,,,,,,,129.74,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Humana,Medicare Advantage,RT,185.13,,,,,,,129.74,484.03,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,outpatient,,,214.00000,114.70000,Humana,Medicare Advantage,,79.39,,,,,,,55.64,207.58,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,outpatient,,,329.00000,176.34000,Humana,Medicare Advantage,,122.06,,,,,,,85.54,319.13,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,outpatient,,,197.00000,105.59000,Humana,Medicare Advantage,,73.09,,,,,,,51.22,191.09,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,outpatient,,,263.00000,140.97000,Humana,Medicare Advantage,,97.57,,,,,,,68.38,255.11,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,outpatient,,,234.00000,125.42000,Humana,Medicare Advantage,,86.81,,,,,,,60.84,226.98,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,outpatient,,,401.00000,214.94000,Humana,Medicare Advantage,,148.77,,,,,,,104.26,388.97,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,outpatient,,,515.00000,276.04000,Humana,Medicare Advantage,,191.06,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,outpatient,,,747.00000,400.39000,Humana,Medicare Advantage,,277.14,,,,,,,194.22,724.59,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,outpatient,,,854.00000,457.74000,Humana,Medicare Advantage,,316.83,,,,,,,222.04,828.38,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,outpatient,,,589.00000,315.70000,Humana,Medicare Advantage,,218.52,,,,,,,153.14,571.33,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,outpatient,,,613.00000,328.57000,Humana,Medicare Advantage,,227.42,,,,,,,159.38,594.61,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,outpatient,,,806.00000,432.02000,Humana,Medicare Advantage,,299.03,,,,,,,209.56,781.82,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,outpatient,,,529.00000,283.54000,Humana,Medicare Advantage,,196.26,,,,,,,137.54,513.13,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,outpatient,,,939.00000,503.30000,Humana,Medicare Advantage,,348.37,,,,,,,244.14,910.83,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,outpatient,,,515.00000,276.04000,Humana,Medicare Advantage,,191.06,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,outpatient,,,616.00000,330.18000,Humana,Medicare Advantage,,228.54,,,,,,,160.16,597.52,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,outpatient,,,377.00000,202.07000,Humana,Medicare Advantage,,139.87,,,,,,,98.02,365.69,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,outpatient,,,340.00000,182.24000,Humana,Medicare Advantage,,126.14,,,,,,,88.40,329.80,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,outpatient,,,388.00000,207.97000,Humana,Medicare Advantage,,143.95,,,,,,,100.88,376.36,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,outpatient,,,456.00000,244.42000,Humana,Medicare Advantage,,169.18,,,,,,,118.56,442.32,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,outpatient,,,267.00000,143.11000,Humana,Medicare Advantage,,99.06,,,,,,,69.42,258.99,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Humana,Medicare Advantage,LT,113.53,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Humana,Medicare Advantage,"52,LT",113.53,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Humana,Medicare Advantage,RT,113.53,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Humana,Medicare Advantage,"52,RT",113.53,,,,,,,79.56,296.82,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,outpatient,,,456.00000,244.42000,Humana,Medicare Advantage,,169.18,,,,,,,118.56,442.32,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,outpatient,,,381.00000,204.22000,Humana,Medicare Advantage,,141.35,,,,,,,99.06,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Humana,Medicare Advantage,LT,53.05,,,,,,,37.18,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Humana,Medicare Advantage,RT,53.05,,,,,,,37.18,138.71,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Humana,Medicare Advantage,LT,122.80,,,,,,,86.06,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Humana,Medicare Advantage,RT,122.80,,,,,,,86.06,321.07,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1113.00000,596.57000,Humana,Medicare Advantage,,412.92,,,,,,,289.38,1079.61,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,outpatient,,,1043.00000,559.05000,Humana,Medicare Advantage,,386.95,,,,,,,271.18,1011.71,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Humana,Medicare Advantage,LT,94.98,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Humana,Medicare Advantage,"52,LT",94.98,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Humana,Medicare Advantage,RT,94.98,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Humana,Medicare Advantage,"52,RT",94.98,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Humana,Medicare Advantage,LT,189.58,,,,,,,132.86,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Humana,Medicare Advantage,RT,189.58,,,,,,,132.86,495.67,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Humana,Medicare Advantage,LT,205.16,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Humana,Medicare Advantage,RT,205.16,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Humana,Medicare Advantage,LT,399.20,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Humana,Medicare Advantage,RT,399.20,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Humana,Medicare Advantage,LT,320.92,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Humana,Medicare Advantage,RT,320.92,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Humana,Medicare Advantage,LT,272.31,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Humana,Medicare Advantage,RT,272.31,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Humana,Medicare Advantage,LT,270.83,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Humana,Medicare Advantage,RT,270.83,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Humana,Medicare Advantage,LT,96.46,,,,,,,67.60,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Humana,Medicare Advantage,RT,96.46,,,,,,,67.60,252.20,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,outpatient,,,428.00000,203.73000,Humana,Medicare Advantage,,158.79,,,,,,,111.28,415.16,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,outpatient,,,492.00000,234.19000,Humana,Medicare Advantage,,182.53,,,,,,,127.92,477.24,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,outpatient,,,607.00000,288.93000,Humana,Medicare Advantage,,225.20,,,,,,,157.82,588.79,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,outpatient,,,649.00000,308.92000,Humana,Medicare Advantage,,240.78,,,,,,,168.74,629.53,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,outpatient,,,377.00000,121.77000,Humana,Medicare Advantage,50,139.87,,,,,,,98.02,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Humana,Medicare Advantage,LT,93.12,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Humana,Medicare Advantage,RT,93.12,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,outpatient,,,1170.00000,377.91000,Humana,Medicare Advantage,50,434.07,,,,,,,304.20,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Humana,Medicare Advantage,LT,289.38,,,,,,,202.80,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Humana,Medicare Advantage,RT,289.38,,,,,,,202.80,756.60,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,outpatient,,,1389.00000,448.65000,Humana,Medicare Advantage,,515.32,,,,,,,361.14,1347.33,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,outpatient,,,345.00000,111.44000,Humana,Medicare Advantage,50,128.00,,,,,,,89.70,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Humana,Medicare Advantage,LT,85.33,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Humana,Medicare Advantage,RT,85.33,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,outpatient,,,2102.00000,678.95000,Humana,Medicare Advantage,50,779.84,,,,,,,546.52,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Humana,Medicare Advantage,LT,519.77,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Humana,Medicare Advantage,RT,519.77,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,outpatient,,,357.00000,115.31000,Humana,Medicare Advantage,50,132.45,,,,,,,92.82,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Humana,Medicare Advantage,LT,88.30,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Humana,Medicare Advantage,RT,88.30,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,outpatient,,,2082.00000,672.49000,Humana,Medicare Advantage,50,772.42,,,,,,,541.32,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Humana,Medicare Advantage,LT,514.95,,,,,,,360.88,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Humana,Medicare Advantage,RT,514.95,,,,,,,360.88,1346.36,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,outpatient,,,246.00000,79.46000,Humana,Medicare Advantage,50,91.27,,,,,,,63.96,238.62,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Humana,Medicare Advantage,LT,60.84,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Humana,Medicare Advantage,RT,60.84,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,outpatient,,,309.00000,99.81000,Humana,Medicare Advantage,50,114.64,,,,,,,80.34,299.73,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Humana,Medicare Advantage,LT,76.43,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Humana,Medicare Advantage,RT,76.43,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,outpatient,,,471.00000,152.13000,Humana,Medicare Advantage,50,174.74,,,,,,,122.46,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Humana,Medicare Advantage,LT,116.49,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Humana,Medicare Advantage,RT,116.49,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,outpatient,,,239.00000,77.20000,Humana,Medicare Advantage,50,88.67,,,,,,,62.14,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Humana,Medicare Advantage,LT,58.99,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Humana,Medicare Advantage,RT,58.99,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,outpatient,,,558.00000,180.23000,Humana,Medicare Advantage,50,207.02,,,,,,,145.08,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Humana,Medicare Advantage,LT,138.01,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Humana,Medicare Advantage,RT,138.01,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,outpatient,,,413.00000,133.40000,Humana,Medicare Advantage,50,153.22,,,,,,,107.38,400.61,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Humana,Medicare Advantage,LT,102.03,,,,,,,71.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Humana,Medicare Advantage,RT,102.03,,,,,,,71.50,266.75,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,outpatient,,,462.00000,149.23000,Humana,Medicare Advantage,,171.40,,,,,,,120.12,448.14,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,outpatient,,,170.00000,54.91000,Humana,Medicare Advantage,,63.07,,,,,,,44.20,164.90,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,outpatient,,,281.00000,90.76000,Humana,Medicare Advantage,,104.25,,,,,,,73.06,272.57,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,outpatient,,,562.00000,181.53000,Humana,Medicare Advantage,,208.50,,,,,,,146.12,545.14,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,outpatient,,,2076.00000,670.55000,Humana,Medicare Advantage,50,770.20,,,,,,,539.76,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Humana,Medicare Advantage,LT,513.46,,,,,,,359.84,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Humana,Medicare Advantage,RT,513.46,,,,,,,359.84,1342.48,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,outpatient,,,934.00000,301.68000,Humana,Medicare Advantage,,346.51,,,,,,,242.84,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,outpatient,,,842.00000,271.97000,Humana,Medicare Advantage,,312.38,,,,,,,218.92,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,outpatient,,,846.00000,273.26000,Humana,Medicare Advantage,,313.87,,,,,,,219.96,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,outpatient,,,971.00000,313.63000,Humana,Medicare Advantage,,360.24,,,,,,,252.46,941.87,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,outpatient,,,762.00000,246.13000,Humana,Medicare Advantage,,282.70,,,,,,,198.12,739.14,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,outpatient,,,758.00000,244.83000,Humana,Medicare Advantage,,281.22,,,,,,,197.08,735.26,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,outpatient,,,161.00000,52.00000,Humana,Medicare Advantage,,59.73,,,,,,,41.86,156.17,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,outpatient,,,234.00000,75.58000,Humana,Medicare Advantage,50,86.81,,,,,,,60.84,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Humana,Medicare Advantage,LT,57.88,,,,,,,40.56,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Humana,Medicare Advantage,RT,57.88,,,,,,,40.56,151.32,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1517.00000,489.99000,Humana,Medicare Advantage,50,562.81,,,,,,,394.42,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Humana,Medicare Advantage,LT,375.08,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Humana,Medicare Advantage,RT,375.08,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,outpatient,,,822.00000,265.51000,Humana,Medicare Advantage,50,304.96,,,,,,,213.72,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Humana,Medicare Advantage,LT,203.31,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Humana,Medicare Advantage,RT,203.31,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,outpatient,,,2613.00000,844.00000,Humana,Medicare Advantage,,969.42,,,,,,,679.38,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,outpatient,,,903.00000,291.67000,Humana,Medicare Advantage,,335.01,,,,,,,234.78,875.91,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,outpatient,,,1156.00000,373.39000,Humana,Medicare Advantage,,428.88,,,,,,,300.56,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,outpatient,,,677.00000,218.67000,Humana,Medicare Advantage,,251.17,,,,,,,176.02,656.69,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1928.00000,622.74000,Humana,Medicare Advantage,50,715.29,,,,,,,501.28,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Humana,Medicare Advantage,LT,476.74,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Humana,Medicare Advantage,RT,476.74,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,outpatient,,,812.00000,262.28000,Humana,Medicare Advantage,50,301.25,,,,,,,211.12,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Humana,Medicare Advantage,LT,200.71,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Humana,Medicare Advantage,RT,200.71,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,outpatient,,,825.00000,266.48000,Humana,Medicare Advantage,50,306.07,,,,,,,214.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Humana,Medicare Advantage,LT,204.05,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Humana,Medicare Advantage,RT,204.05,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,outpatient,,,3494.00000,1128.56000,Humana,Medicare Advantage,50,1296.27,,,,,,,908.44,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Humana,Medicare Advantage,LT,864.06,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Humana,Medicare Advantage,RT,864.06,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,outpatient,,,840.00000,271.32000,Humana,Medicare Advantage,50,311.64,,,,,,,218.40,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Humana,Medicare Advantage,LT,207.76,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Humana,Medicare Advantage,RT,207.76,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,outpatient,,,792.00000,255.82000,Humana,Medicare Advantage,50,293.83,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Humana,Medicare Advantage,LT,195.89,,,,,,,137.28,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Humana,Medicare Advantage,RT,195.89,,,,,,,137.28,512.16,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,outpatient,,,272.00000,87.86000,Humana,Medicare Advantage,,100.91,,,,,,,70.72,263.84,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,outpatient,,,1268.00000,409.56000,Humana,Medicare Advantage,,470.43,,,,,,,329.68,1229.96,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,outpatient,,,896.00000,289.41000,Humana,Medicare Advantage,,332.42,,,,,,,232.96,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,outpatient,,,884.00000,285.53000,Humana,Medicare Advantage,,327.96,,,,,,,229.84,857.48,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Humana,Medicare Advantage,,225.94,,,,,,,158.34,590.73,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,outpatient,,,966.00000,383.50000,Humana,Medicare Advantage,,358.39,,,,,,,251.16,937.02,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,outpatient,,,872.00000,346.18000,Humana,Medicare Advantage,,323.51,,,,,,,226.72,845.84,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,outpatient,,,492.00000,195.32000,Humana,Medicare Advantage,,182.53,,,,,,,127.92,477.24,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,outpatient,,,331.00000,131.41000,Humana,Medicare Advantage,,122.80,,,,,,,86.06,321.07,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,outpatient,,,5215.00000,2070.36000,Humana,Medicare Advantage,,1934.77,,,,,,,1355.90,5058.55,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,outpatient,,,5422.00000,2152.53000,Humana,Medicare Advantage,,2011.56,,,,,,,1409.72,5259.34,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1878.00000,788.76000,Humana,Medicare Advantage,,696.74,,,,,,,488.28,1821.66,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,outpatient,,,2253.00000,946.26000,Humana,Medicare Advantage,,835.86,,,,,,,585.78,2185.41,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1502.00000,630.84000,Humana,Medicare Advantage,,557.24,,,,,,,390.52,1456.94,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,outpatient,,,2024.00000,850.08000,Humana,Medicare Advantage,,750.90,,,,,,,526.24,1963.28,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,outpatient,,,2429.00000,1020.18000,Humana,Medicare Advantage,,901.16,,,,,,,631.54,2356.13,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1619.00000,679.98000,Humana,Medicare Advantage,,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,outpatient,,,2425.00000,1018.50000,Humana,Medicare Advantage,,899.67,,,,,,,630.50,2352.25,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2910.00000,1222.20000,Humana,Medicare Advantage,,1079.61,,,,,,,756.60,2822.70,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1940.00000,814.80000,Humana,Medicare Advantage,,719.74,,,,,,,504.40,1881.80,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2317.00000,973.14000,Humana,Medicare Advantage,,859.61,,,,,,,602.42,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2780.00000,1167.60000,Humana,Medicare Advantage,,1031.38,,,,,,,722.80,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1853.00000,778.26000,Humana,Medicare Advantage,,687.46,,,,,,,481.78,1797.41,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2366.00000,993.72000,Humana,Medicare Advantage,,877.79,,,,,,,615.16,2295.02,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,outpatient,,,3056.00000,1283.52000,Humana,Medicare Advantage,,1133.78,,,,,,,794.56,2964.32,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,outpatient,,,2829.00000,1386.21000,Humana,Medicare Advantage,,1049.56,,,,,,,735.54,2744.13,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,outpatient,,,3395.00000,1663.55000,Humana,Medicare Advantage,,1259.55,,,,,,,882.70,3293.15,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,outpatient,,,2263.00000,1108.87000,Humana,Medicare Advantage,,839.57,,,,,,,588.38,2195.11,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,outpatient,,,4697.00000,2301.53000,Humana,Medicare Advantage,,1742.59,,,,,,,1221.22,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,outpatient,,,5636.00000,2761.64000,Humana,Medicare Advantage,,2090.96,,,,,,,1465.36,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,outpatient,,,3757.00000,1840.93000,Humana,Medicare Advantage,,1393.85,,,,,,,976.82,3644.29,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,outpatient,,,2619.00000,1283.31000,Humana,Medicare Advantage,,971.65,,,,,,,680.94,2540.43,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,outpatient,,,3143.00000,1540.07000,Humana,Medicare Advantage,,1166.05,,,,,,,817.18,3048.71,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,outpatient,,,2095.00000,1026.55000,Humana,Medicare Advantage,,777.25,,,,,,,544.70,2032.15,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,outpatient,,,278.00000,136.22000,Humana,Medicare Advantage,,103.14,,,,,,,72.28,269.66,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Humana,Medicare Advantage,LT,782.81,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Humana,Medicare Advantage,RT,782.81,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Humana,Medicare Advantage,LT,939.37,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Humana,Medicare Advantage,RT,939.37,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Humana,Medicare Advantage,LT,626.25,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Humana,Medicare Advantage,RT,626.25,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Humana,Medicare Advantage,LT,750.90,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Humana,Medicare Advantage,RT,750.90,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Humana,Medicare Advantage,LT,901.16,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Humana,Medicare Advantage,RT,901.16,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Humana,Medicare Advantage,LT,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Humana,Medicare Advantage,RT,600.65,,,,,,,420.94,1570.43,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,outpatient,,,1224.00000,599.76000,Humana,Medicare Advantage,,454.10,,,,,,,318.24,1187.28,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,outpatient,,,3020.00000,1479.80000,Humana,Medicare Advantage,,1120.42,,,,,,,785.20,2929.40,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,outpatient,,,3624.00000,1775.76000,Humana,Medicare Advantage,,1344.50,,,,,,,942.24,3515.28,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,outpatient,,,2416.00000,1183.84000,Humana,Medicare Advantage,,896.34,,,,,,,628.16,2343.52,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,outpatient,,,2728.00000,1336.72000,Humana,Medicare Advantage,,1012.09,,,,,,,709.28,2646.16,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,outpatient,,,3273.00000,1603.77000,Humana,Medicare Advantage,,1214.28,,,,,,,850.98,3174.81,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,outpatient,,,2182.00000,1069.18000,Humana,Medicare Advantage,,809.52,,,,,,,567.32,2116.54,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,outpatient,,,3133.00000,1535.17000,Humana,Medicare Advantage,,1162.34,,,,,,,814.58,3039.01,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,outpatient,,,3759.00000,1841.91000,Humana,Medicare Advantage,,1394.59,,,,,,,977.34,3646.23,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,outpatient,,,2506.00000,1227.94000,Humana,Medicare Advantage,,929.73,,,,,,,651.56,2430.82,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,outpatient,,,2857.00000,1399.93000,Humana,Medicare Advantage,,1059.95,,,,,,,742.82,2771.29,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,outpatient,,,3428.00000,1679.72000,Humana,Medicare Advantage,,1271.79,,,,,,,891.28,3325.16,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,outpatient,,,2285.00000,1119.65000,Humana,Medicare Advantage,,847.74,,,,,,,594.10,2216.45,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,outpatient,,,3565.00000,1746.85000,Humana,Medicare Advantage,,1322.62,,,,,,,926.90,3458.05,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,outpatient,,,5918.00000,2899.82000,Humana,Medicare Advantage,,2195.58,,,,,,,1538.68,5740.46,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,outpatient,,,3301.00000,1617.49000,Humana,Medicare Advantage,,1224.67,,,,,,,858.26,3201.97,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Humana,Medicare Advantage,LT,986.49,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Humana,Medicare Advantage,RT,986.49,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Humana,Medicare Advantage,LT,946.42,,,,,,,663.26,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Humana,Medicare Advantage,RT,946.42,,,,,,,663.26,2474.47,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3806.00000,1864.94000,Humana,Medicare Advantage,,1412.03,,,,,,,989.56,3691.82,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,outpatient,,,2149.00000,694.13000,Humana,Medicare Advantage,,797.28,,,,,,,558.74,2084.53,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,outpatient,,,1973.00000,637.28000,Humana,Medicare Advantage,,731.98,,,,,,,512.98,1913.81,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1784.00000,576.23000,Humana,Medicare Advantage,50,661.86,,,,,,,463.84,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Humana,Medicare Advantage,LT,441.12,,,,,,,309.14,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Humana,Medicare Advantage,RT,441.12,,,,,,,309.14,1153.33,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,outpatient,,,130.00000,69.68000,Humana,Medicare Advantage,,48.23,,,,,,,33.80,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,outpatient,,,44.00000,23.58000,Humana,Medicare Advantage,,16.32,,,,,,,11.44,42.68,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,outpatient,,,456.00000,244.42000,Humana,Medicare Advantage,,169.18,,,,,,,118.56,442.32,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,outpatient,,,108.00000,57.89000,Humana,Medicare Advantage,,40.07,,,,,,,28.08,104.76,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,outpatient,,,306.00000,164.02000,Humana,Medicare Advantage,,113.53,,,,,,,79.56,296.82,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,outpatient,,,257.00000,137.75000,Humana,Medicare Advantage,,95.35,,,,,,,66.82,249.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Humana,Medicare Advantage,,1505.15,,,,,,,1054.82,3935.29,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Humana,Medicare Advantage,,1806.03,,,,,,,1265.68,4721.96,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Humana,Medicare Advantage,,1203.89,,,,,,,843.70,3147.65,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Humana,Medicare Advantage,,1505.15,,,,,,,1054.82,3935.29,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Humana,Medicare Advantage,,1806.03,,,,,,,1265.68,4721.96,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Humana,Medicare Advantage,,1203.89,,,,,,,843.70,3147.65,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,outpatient,,,1725.00000,865.95000,Humana,Medicare Advantage,,639.98,,,,,,,448.50,1673.25,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,outpatient,,,1743.00000,874.99000,Humana,Medicare Advantage,,646.65,,,,,,,453.18,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Humana,Medicare Advantage,LT,547.23,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Humana,Medicare Advantage,RT,547.23,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,outpatient,,,1162.00000,583.32000,Humana,Medicare Advantage,,431.10,,,,,,,302.12,1127.14,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Humana,Medicare Advantage,LT,364.69,,,,,,,255.58,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Humana,Medicare Advantage,RT,364.69,,,,,,,255.58,953.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,outpatient,,,3183.00000,1597.87000,Humana,Medicare Advantage,,1180.89,,,,,,,827.58,3087.51,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,outpatient,,,3819.00000,1917.14000,Humana,Medicare Advantage,,1416.85,,,,,,,992.94,3704.43,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,outpatient,,,2546.00000,1278.09000,Humana,Medicare Advantage,,944.57,,,,,,,661.96,2469.62,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Humana,Medicare Advantage,LT,1431.32,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Humana,Medicare Advantage,RT,1431.32,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Humana,Medicare Advantage,LT,1717.36,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Humana,Medicare Advantage,RT,1717.36,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Humana,Medicare Advantage,LT,1144.91,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Humana,Medicare Advantage,RT,1144.91,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Humana,Medicare Advantage,LT,929.36,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Humana,Medicare Advantage,RT,929.36,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Humana,Medicare Advantage,LT,1115.23,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Humana,Medicare Advantage,RT,1115.23,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Humana,Medicare Advantage,LT,743.48,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Humana,Medicare Advantage,RT,743.48,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Humana,Medicare Advantage,LT,1163.83,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Humana,Medicare Advantage,RT,1163.83,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Humana,Medicare Advantage,LT,1396.44,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Humana,Medicare Advantage,RT,1396.44,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Humana,Medicare Advantage,LT,930.84,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Humana,Medicare Advantage,RT,930.84,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Humana,Medicare Advantage,LT,1121.53,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Humana,Medicare Advantage,RT,1121.53,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Humana,Medicare Advantage,LT,1345.62,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Humana,Medicare Advantage,RT,1345.62,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Humana,Medicare Advantage,LT,897.08,,,,,,,628.68,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Humana,Medicare Advantage,RT,897.08,,,,,,,628.68,2345.46,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,outpatient,,,870.00000,436.74000,Humana,Medicare Advantage,,322.77,,,,,,,226.20,843.90,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,outpatient,,,1353.00000,679.21000,Humana,Medicare Advantage,,501.96,,,,,,,351.78,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Humana,Medicare Advantage,LT,334.64,,,,,,,234.52,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Humana,Medicare Advantage,RT,334.64,,,,,,,234.52,874.94,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3489.00000,1751.48000,Humana,Medicare Advantage,,1294.42,,,,,,,907.14,3384.33,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,outpatient,,,4187.00000,2101.87000,Humana,Medicare Advantage,,1553.38,,,,,,,1088.62,4061.39,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,outpatient,,,2791.00000,1401.08000,Humana,Medicare Advantage,,1035.46,,,,,,,725.66,2707.27,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,outpatient,,,492.00000,246.98000,Humana,Medicare Advantage,,182.53,,,,,,,127.92,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,outpatient,,,331.00000,166.16000,Humana,Medicare Advantage,,122.80,,,,,,,86.06,321.07,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,outpatient,,,4440.00000,2357.64000,Humana,Medicare Advantage,,1647.24,,,,,,,1154.40,4306.80,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,outpatient,,,5328.00000,2829.17000,Humana,Medicare Advantage,,1976.69,,,,,,,1385.28,5168.16,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,outpatient,,,3552.00000,1886.11000,Humana,Medicare Advantage,,1317.79,,,,,,,923.52,3445.44,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,outpatient,,,2528.00000,1342.37000,Humana,Medicare Advantage,,937.89,,,,,,,657.28,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,outpatient,,,3033.00000,1610.52000,Humana,Medicare Advantage,,1125.24,,,,,,,788.58,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,outpatient,,,2022.00000,1073.68000,Humana,Medicare Advantage,,750.16,,,,,,,525.72,1961.34,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,outpatient,,,3610.00000,1909.69000,Humana,Medicare Advantage,,1339.31,,,,,,,938.60,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,outpatient,,,4332.00000,2291.63000,Humana,Medicare Advantage,,1607.17,,,,,,,1126.32,4202.04,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,outpatient,,,2888.00000,1527.75000,Humana,Medicare Advantage,,1071.45,,,,,,,750.88,2801.36,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,outpatient,,,4532.00000,2397.43000,Humana,Medicare Advantage,,1681.37,,,,,,,1178.32,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,outpatient,,,5438.00000,2876.70000,Humana,Medicare Advantage,,2017.50,,,,,,,1413.88,5274.86,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,outpatient,,,3625.00000,1917.62000,Humana,Medicare Advantage,,1344.88,,,,,,,942.50,3516.25,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,outpatient,,,3639.00000,1925.03000,Humana,Medicare Advantage,,1350.07,,,,,,,946.14,3529.83,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,outpatient,,,4367.00000,2310.14000,Humana,Medicare Advantage,,1620.16,,,,,,,1135.42,4235.99,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,outpatient,,,2911.00000,1539.92000,Humana,Medicare Advantage,,1079.98,,,,,,,756.86,2823.67,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3494.00000,1719.05000,Humana,Medicare Advantage,,1296.27,,,,,,,908.44,3389.18,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,outpatient,,,4193.00000,2062.96000,Humana,Medicare Advantage,,1555.60,,,,,,,1090.18,4067.21,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,outpatient,,,2795.00000,1375.14000,Humana,Medicare Advantage,,1036.94,,,,,,,726.70,2711.15,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,outpatient,,,2717.00000,1336.76000,Humana,Medicare Advantage,,1008.01,,,,,,,706.42,2635.49,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,outpatient,,,3260.00000,1603.92000,Humana,Medicare Advantage,,1209.46,,,,,,,847.60,3162.20,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,outpatient,,,2173.00000,1069.12000,Humana,Medicare Advantage,,806.18,,,,,,,564.98,2107.81,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Humana,Medicare Advantage,LT,1502.92,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Humana,Medicare Advantage,RT,1502.92,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Humana,Medicare Advantage,LT,1803.43,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Humana,Medicare Advantage,RT,1803.43,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Humana,Medicare Advantage,LT,1202.41,,,,,,,842.66,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Humana,Medicare Advantage,RT,1202.41,,,,,,,842.66,3143.77,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,outpatient,,,4260.00000,2420.32000,Humana,Medicare Advantage,,1580.46,,,,,,,1107.60,4132.20,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,outpatient,,,5112.00000,2904.38000,Humana,Medicare Advantage,,1896.55,,,,,,,1329.12,4958.64,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3408.00000,1936.26000,Humana,Medicare Advantage,,1264.37,,,,,,,886.08,3305.76,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3343.00000,1899.33000,Humana,Medicare Advantage,,1240.25,,,,,,,869.18,3242.71,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,outpatient,,,4010.00000,2278.28000,Humana,Medicare Advantage,,1487.71,,,,,,,1042.60,3889.70,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,outpatient,,,2674.00000,1519.23000,Humana,Medicare Advantage,,992.05,,,,,,,695.24,2593.78,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Humana,Medicare Advantage,LT,1222.07,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Humana,Medicare Advantage,RT,1222.07,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Humana,Medicare Advantage,LT,1466.56,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Humana,Medicare Advantage,RT,1466.56,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Humana,Medicare Advantage,LT,977.59,,,,,,,685.10,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Humana,Medicare Advantage,RT,977.59,,,,,,,685.10,2555.95,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3664.00000,2081.70000,Humana,Medicare Advantage,,1359.34,,,,,,,952.64,3554.08,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,outpatient,,,4397.00000,2498.16000,Humana,Medicare Advantage,,1631.29,,,,,,,1143.22,4265.09,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,outpatient,,,2931.00000,1665.25000,Humana,Medicare Advantage,,1087.40,,,,,,,762.06,2843.07,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,outpatient,,,4759.00000,2703.83000,Humana,Medicare Advantage,,1765.59,,,,,,,1237.34,4616.23,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,outpatient,,,5710.00000,3244.14000,Humana,Medicare Advantage,,2118.41,,,,,,,1484.60,5538.70,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3807.00000,2162.95000,Humana,Medicare Advantage,,1412.40,,,,,,,989.82,3692.79,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2915.00000,1574.10000,Humana,Medicare Advantage,,1081.46,,,,,,,757.90,2827.55,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1918.00000,1035.72000,Humana,Medicare Advantage,,711.58,,,,,,,498.68,1860.46,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2292.00000,1237.68000,Humana,Medicare Advantage,,850.33,,,,,,,595.92,2223.24,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,outpatient,,,2984.00000,1611.36000,Humana,Medicare Advantage,,1107.06,,,,,,,775.84,2894.48,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,outpatient,,,769.00000,415.26000,Humana,Medicare Advantage,,285.30,,,,,,,199.94,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,outpatient,,,1280.00000,691.20000,Humana,Medicare Advantage,,474.88,,,,,,,332.80,1241.60,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,outpatient,,,1878.00000,1014.12000,Humana,Medicare Advantage,,696.74,,,,,,,488.28,1821.66,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,outpatient,,,2196.00000,1185.84000,Humana,Medicare Advantage,,814.72,,,,,,,570.96,2130.12,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,outpatient,,,844.00000,455.76000,Humana,Medicare Advantage,,313.12,,,,,,,219.44,818.68,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,outpatient,,,1305.00000,704.70000,Humana,Medicare Advantage,,484.15,,,,,,,339.30,1265.85,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,outpatient,,,576.00000,311.04000,Humana,Medicare Advantage,,213.70,,,,,,,149.76,558.72,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,outpatient,,,809.00000,436.86000,Humana,Medicare Advantage,,300.14,,,,,,,210.34,784.73,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,outpatient,,,2462.00000,1329.48000,Humana,Medicare Advantage,,913.40,,,,,,,640.12,2388.14,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,outpatient,,,918.00000,495.72000,Humana,Medicare Advantage,,340.58,,,,,,,238.68,890.46,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,outpatient,,,1102.00000,595.08000,Humana,Medicare Advantage,,408.84,,,,,,,286.52,1068.94,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,outpatient,,,812.00000,438.48000,Humana,Medicare Advantage,,301.25,,,,,,,211.12,787.64,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,outpatient,,,1407.00000,759.78000,Humana,Medicare Advantage,,522.00,,,,,,,365.82,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,outpatient,,,1980.00000,1069.20000,Humana,Medicare Advantage,,734.58,,,,,,,514.80,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,outpatient,,,964.00000,520.56000,Humana,Medicare Advantage,,357.64,,,,,,,250.64,935.08,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,outpatient,,,1040.00000,561.60000,Humana,Medicare Advantage,,385.84,,,,,,,270.40,1008.80,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,outpatient,,,795.00000,429.30000,Humana,Medicare Advantage,,294.94,,,,,,,206.70,771.15,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,outpatient,,,1124.00000,606.96000,Humana,Medicare Advantage,,417.00,,,,,,,292.24,1090.28,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,outpatient,,,736.00000,397.44000,Humana,Medicare Advantage,,273.06,,,,,,,191.36,713.92,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,outpatient,,,700.00000,378.00000,Humana,Medicare Advantage,,259.70,,,,,,,182.00,679.00,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,outpatient,,,821.00000,443.34000,Humana,Medicare Advantage,,304.59,,,,,,,213.46,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,outpatient,,,846.00000,456.84000,Humana,Medicare Advantage,,313.87,,,,,,,219.96,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,outpatient,,,958.00000,517.32000,Humana,Medicare Advantage,,355.42,,,,,,,249.08,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,outpatient,,,1261.00000,680.94000,Humana,Medicare Advantage,,467.83,,,,,,,327.86,1223.17,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,outpatient,,,971.00000,524.34000,Humana,Medicare Advantage,,360.24,,,,,,,252.46,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,outpatient,,,1837.00000,991.98000,Humana,Medicare Advantage,,681.53,,,,,,,477.62,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,outpatient,,,1099.00000,593.46000,Humana,Medicare Advantage,,407.73,,,,,,,285.74,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,outpatient,,,2178.00000,1176.12000,Humana,Medicare Advantage,,808.04,,,,,,,566.28,2112.66,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,outpatient,,,1226.00000,662.04000,Humana,Medicare Advantage,,454.85,,,,,,,318.76,1189.22,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,outpatient,,,1048.00000,565.92000,Humana,Medicare Advantage,,388.81,,,,,,,272.48,1016.56,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,outpatient,,,970.00000,523.80000,Humana,Medicare Advantage,,359.87,,,,,,,252.20,940.90,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,outpatient,,,1803.00000,973.62000,Humana,Medicare Advantage,,668.91,,,,,,,468.78,1748.91,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,outpatient,,,2504.00000,1352.16000,Humana,Medicare Advantage,,928.98,,,,,,,651.04,2428.88,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2457.00000,1326.78000,Humana,Medicare Advantage,,911.55,,,,,,,638.82,2383.29,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,outpatient,,,923.00000,498.42000,Humana,Medicare Advantage,,342.43,,,,,,,239.98,895.31,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,outpatient,,,5478.00000,2958.12000,Humana,Medicare Advantage,,2032.34,,,,,,,1424.28,5313.66,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,outpatient,,,4551.00000,2457.54000,Humana,Medicare Advantage,,1688.42,,,,,,,1183.26,4414.47,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,outpatient,,,1360.00000,734.40000,Humana,Medicare Advantage,,504.56,,,,,,,353.60,1319.20,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,outpatient,,,1209.00000,652.86000,Humana,Medicare Advantage,,448.54,,,,,,,314.34,1172.73,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,outpatient,,,848.00000,457.92000,Humana,Medicare Advantage,,314.61,,,,,,,220.48,822.56,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,outpatient,,,1071.00000,578.34000,Humana,Medicare Advantage,,397.34,,,,,,,278.46,1038.87,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,outpatient,,,1792.00000,967.68000,Humana,Medicare Advantage,,664.83,,,,,,,465.92,1738.24,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,outpatient,,,35.00000,18.90000,Humana,Medicare Advantage,,12.98,,,,,,,9.10,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,outpatient,,,285.00000,153.90000,Humana,Medicare Advantage,,105.73,,,,,,,74.10,276.45,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,outpatient,,,1012.00000,546.48000,Humana,Medicare Advantage,,375.45,,,,,,,263.12,981.64,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,outpatient,,,492.00000,265.68000,Humana,Medicare Advantage,,182.53,,,,,,,127.92,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,outpatient,,,739.00000,399.06000,Humana,Medicare Advantage,,274.17,,,,,,,192.14,716.83,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,outpatient,,,515.00000,278.10000,Humana,Medicare Advantage,,191.06,,,,,,,133.90,499.55,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,outpatient,,,1467.00000,792.18000,Humana,Medicare Advantage,,544.26,,,,,,,381.42,1422.99,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,outpatient,,,1683.00000,888.62000,Humana,Medicare Advantage,,624.39,,,,,,,437.58,1632.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,426.30000,225.09000,Humana,Medicare Advantage,,158.16,,,,,,,110.84,413.51,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,725.00000,382.80000,Humana,Medicare Advantage,,268.98,,,,,,,188.50,1855.42,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,1852.00000,977.86000,Humana,Medicare Advantage,,687.09,,,,,,,481.52,1868.26,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,110.00000,58.08000,Humana,Medicare Advantage,,40.81,,,,,,,28.60,106.70,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,98.00000,51.74000,Humana,Medicare Advantage,,36.36,,,,,,,25.48,1662.92,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,2018.00000,1065.50000,Humana,Medicare Advantage,,748.68,,,,,,,524.68,1957.46,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,4325.00000,2283.60000,Humana,Medicare Advantage,,1604.58,,,,,,,1124.50,4195.25,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Humana,Medicare Advantage,,63.81,,,,,,,44.72,166.84,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,942.00000,497.38000,Humana,Medicare Advantage,,349.48,,,,,,,244.92,913.74,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,413.00000,218.06000,Humana,Medicare Advantage,,153.22,,,,,,,107.38,400.61,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,outpatient,,,257.00000,135.70000,Humana,Medicare Advantage,,95.35,,,,,,,66.82,249.29,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,116.00000,61.25000,Humana,Medicare Advantage,,43.04,,,,,,,30.16,112.52,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,463.20000,244.57000,Humana,Medicare Advantage,,171.85,,,,,,,120.43,449.30,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,804.00000,424.51000,Humana,Medicare Advantage,,298.28,,,,,,,209.04,779.88,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Humana,Medicare Advantage,,63.81,,,,,,,44.72,166.84,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,354.30000,187.07000,Humana,Medicare Advantage,,131.45,,,,,,,92.12,343.67,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,277.90000,146.73000,Humana,Medicare Advantage,,103.10,,,,,,,72.25,269.56,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,200.00000,105.60000,Humana,Medicare Advantage,,74.20,,,,,,,52.00,194.00,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,outpatient,,,197.00000,63.63000,Humana,Medicare Advantage,,73.09,,,,,,,51.22,191.09,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,outpatient,,,468.00000,151.16000,Humana,Medicare Advantage,50,173.63,,,,,,,121.68,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Humana,Medicare Advantage,LT,115.75,,,,,,,81.12,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Humana,Medicare Advantage,RT,115.75,,,,,,,81.12,302.64,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Humana,Medicare Advantage,,168.06,,,,,,,117.78,439.41,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Humana,Medicare Advantage,,225.94,,,,,,,158.34,590.73,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1248.00000,403.10000,Humana,Medicare Advantage,50,463.01,,,,,,,324.48,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Humana,Medicare Advantage,LT,308.67,,,,,,,216.32,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Humana,Medicare Advantage,RT,308.67,,,,,,,216.32,807.04,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Humana,Medicare Advantage,LT,1571.18,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Humana,Medicare Advantage,RT,1571.18,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,outpatient,,,2119.00000,684.44000,Humana,Medicare Advantage,,786.15,,,,,,,550.94,2055.43,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1943.00000,627.59000,Humana,Medicare Advantage,,720.85,,,,,,,505.18,1884.71,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,outpatient,,,1426.00000,460.60000,Humana,Medicare Advantage,,529.05,,,,,,,370.76,1383.22,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,outpatient,,,4202.00000,1357.25000,Humana,Medicare Advantage,50,1558.94,,,,,,,1092.52,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Humana,Medicare Advantage,LT,1039.17,,,,,,,728.26,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Humana,Medicare Advantage,RT,1039.17,,,,,,,728.26,2716.97,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,outpatient,,,832.00000,268.74000,Humana,Medicare Advantage,,308.67,,,,,,,216.32,807.04,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,outpatient,,,1457.00000,470.61000,Humana,Medicare Advantage,,540.55,,,,,,,378.82,1413.29,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Humana,Medicare Advantage,LT,275.65,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Humana,Medicare Advantage,RT,275.65,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,outpatient,,,232.00000,74.94000,Humana,Medicare Advantage,,86.07,,,,,,,60.32,225.04,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,outpatient,,,1364.00000,440.57000,Humana,Medicare Advantage,50,506.04,,,,,,,354.64,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Humana,Medicare Advantage,LT,337.24,,,,,,,236.34,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Humana,Medicare Advantage,RT,337.24,,,,,,,236.34,881.73,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,outpatient,,,510.00000,355.98000,Humana,Medicare Advantage,,189.21,,,,,,,132.60,494.70,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,outpatient,,,1001.00000,698.70000,Humana,Medicare Advantage,,371.37,,,,,,,260.26,970.97,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,outpatient,,,887.00000,619.13000,Humana,Medicare Advantage,,329.08,,,,,,,230.62,860.39,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,outpatient,,,1022.00000,713.36000,Humana,Medicare Advantage,50,379.16,,,,,,,265.72,991.34,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Humana,Medicare Advantage,LT,252.65,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Humana,Medicare Advantage,RT,252.65,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,outpatient,,,945.00000,659.61000,Humana,Medicare Advantage,50,350.60,,,,,,,245.70,916.65,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Humana,Medicare Advantage,LT,233.73,,,,,,,163.80,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Humana,Medicare Advantage,RT,233.73,,,,,,,163.80,611.10,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,outpatient,,,577.00000,402.75000,Humana,Medicare Advantage,,214.07,,,,,,,150.02,559.69,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,outpatient,,,433.00000,302.23000,Humana,Medicare Advantage,,160.64,,,,,,,112.58,420.01,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,outpatient,,,331.00000,231.04000,Humana,Medicare Advantage,,122.80,,,,,,,86.06,321.07,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,outpatient,,,662.00000,462.08000,Humana,Medicare Advantage,,245.60,,,,,,,172.12,642.14,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,outpatient,,,752.00000,524.90000,Humana,Medicare Advantage,,278.99,,,,,,,195.52,729.44,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Humana,Medicare Advantage,,67.52,,,,,,,47.32,176.54,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,outpatient,,,420.00000,293.16000,Humana,Medicare Advantage,,155.82,,,,,,,109.20,407.40,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,outpatient,,,253.00000,176.59000,Humana,Medicare Advantage,,93.86,,,,,,,65.78,245.41,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,outpatient,,,168.00000,117.26000,Humana,Medicare Advantage,,62.33,,,,,,,43.68,162.96,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,outpatient,,,695.00000,485.11000,Humana,Medicare Advantage,,257.85,,,,,,,180.70,674.15,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,outpatient,,,474.00000,330.85000,Humana,Medicare Advantage,,175.85,,,,,,,123.24,459.78,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,outpatient,,,930.00000,649.14000,Humana,Medicare Advantage,,345.03,,,,,,,241.80,902.10,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,outpatient,,,786.00000,548.63000,Humana,Medicare Advantage,,291.61,,,,,,,204.36,762.42,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Humana,Medicare Advantage,,230.02,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Humana,Medicare Advantage,59,230.02,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Humana,Medicare Advantage,,161.38,,,,,,,113.10,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Humana,Medicare Advantage,59,161.38,,,,,,,113.10,421.95,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,outpatient,,,492.00000,343.42000,Humana,Medicare Advantage,,182.53,,,,,,,127.92,477.24,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,outpatient,,,331.00000,231.04000,Humana,Medicare Advantage,,122.80,,,,,,,86.06,321.07,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,outpatient,,,875.00000,610.75000,Humana,Medicare Advantage,,324.62,,,,,,,227.50,848.75,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,outpatient,,,688.00000,480.22000,Humana,Medicare Advantage,,255.25,,,,,,,178.88,667.36,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,outpatient,,,465.00000,324.57000,Humana,Medicare Advantage,,172.51,,,,,,,120.90,451.05,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,outpatient,,,846.00000,590.51000,Humana,Medicare Advantage,,313.87,,,,,,,219.96,820.62,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,outpatient,,,482.00000,336.44000,Humana,Medicare Advantage,,178.82,,,,,,,125.32,467.54,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,outpatient,,,926.00000,646.35000,Humana,Medicare Advantage,,343.55,,,,,,,240.76,898.22,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,outpatient,,,292.00000,203.82000,Humana,Medicare Advantage,,108.33,,,,,,,75.92,283.24,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,outpatient,,,827.00000,577.25000,Humana,Medicare Advantage,,306.82,,,,,,,215.02,802.19,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,outpatient,,,253.00000,176.59000,Humana,Medicare Advantage,,93.86,,,,,,,65.78,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,outpatient,,,901.00000,628.90000,Humana,Medicare Advantage,,334.27,,,,,,,234.26,873.97,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,outpatient,,,460.00000,321.08000,Humana,Medicare Advantage,,170.66,,,,,,,119.60,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1029.00000,718.24000,Humana,Medicare Advantage,,381.76,,,,,,,267.54,998.13,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,outpatient,,,959.00000,669.38000,Humana,Medicare Advantage,,355.79,,,,,,,249.34,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,outpatient,,,558.00000,389.48000,Humana,Medicare Advantage,,207.02,,,,,,,145.08,541.26,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,outpatient,,,705.00000,492.09000,Humana,Medicare Advantage,,261.56,,,,,,,183.30,683.85,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,outpatient,,,249.00000,173.80000,Humana,Medicare Advantage,,92.38,,,,,,,64.74,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,outpatient,,,427.00000,298.05000,Humana,Medicare Advantage,,158.42,,,,,,,111.02,414.19,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Humana,Medicare Advantage,,273.43,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Humana,Medicare Advantage,59,273.43,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,outpatient,,,809.00000,564.68000,Humana,Medicare Advantage,,300.14,,,,,,,210.34,784.73,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,outpatient,,,525.00000,366.45000,Humana,Medicare Advantage,,194.78,,,,,,,136.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,outpatient,,,319.00000,222.66000,Humana,Medicare Advantage,,118.35,,,,,,,82.94,309.43,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1437.00000,678.26000,Humana,Medicare Advantage,,533.13,,,,,,,373.62,1393.89,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2143.00000,1011.50000,Humana,Medicare Advantage,,795.05,,,,,,,557.18,2078.71,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,outpatient,,,755.00000,356.36000,Humana,Medicare Advantage,,280.11,,,,,,,196.30,732.35,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,outpatient,,,979.00000,462.09000,Humana,Medicare Advantage,,363.21,,,,,,,254.54,949.63,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,outpatient,,,436.00000,205.79000,Humana,Medicare Advantage,,161.76,,,,,,,113.36,422.92,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,outpatient,,,220.00000,103.84000,Humana,Medicare Advantage,,81.62,,,,,,,57.20,213.40,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,outpatient,,,344.00000,162.37000,Humana,Medicare Advantage,,127.62,,,,,,,89.44,333.68,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,outpatient,,,818.00000,393.46000,Humana,Medicare Advantage,,303.48,,,,,,,212.68,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,outpatient,,,545.00000,262.14000,Humana,Medicare Advantage,52,202.19,,,,,,,141.70,528.65,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,outpatient,,,1347.00000,647.91000,Humana,Medicare Advantage,,499.74,,,,,,,350.22,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,outpatient,,,898.00000,431.94000,Humana,Medicare Advantage,52,333.16,,,,,,,233.48,871.06,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,outpatient,,,469.00000,225.59000,Humana,Medicare Advantage,,174.00,,,,,,,121.94,454.93,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,outpatient,,,1762.00000,847.52000,Humana,Medicare Advantage,,653.70,,,,,,,458.12,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,outpatient,,,627.00000,301.59000,Humana,Medicare Advantage,,232.62,,,,,,,163.02,608.19,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,outpatient,,,590.00000,283.79000,Humana,Medicare Advantage,,218.89,,,,,,,153.40,572.30,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,outpatient,,,1550.00000,745.55000,Humana,Medicare Advantage,,575.05,,,,,,,403.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Humana,Medicare Advantage,LT,367.29,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Humana,Medicare Advantage,RT,367.29,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,outpatient,,,1402.00000,674.36000,Humana,Medicare Advantage,,520.14,,,,,,,364.52,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Humana,Medicare Advantage,LT,363.58,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Humana,Medicare Advantage,RT,363.58,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,outpatient,,,1661.00000,798.94000,Humana,Medicare Advantage,,616.23,,,,,,,431.86,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,outpatient,,,980.00000,471.38000,Humana,Medicare Advantage,,363.58,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1740.00000,836.94000,Humana,Medicare Advantage,,645.54,,,,,,,452.40,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1168.00000,561.81000,Humana,Medicare Advantage,,433.33,,,,,,,303.68,1132.96,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,outpatient,,,433.00000,232.09000,Humana,Medicare Advantage,,160.64,,,,,,,112.58,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Humana,Medicare Advantage,LT,143.95,,,,,,,100.88,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Humana,Medicare Advantage,RT,143.95,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,outpatient,,,388.00000,207.97000,Humana,Medicare Advantage,,143.95,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,outpatient,,,604.00000,323.74000,Humana,Medicare Advantage,,224.08,,,,,,,157.04,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,outpatient,,,667.00000,357.51000,Humana,Medicare Advantage,,247.46,,,,,,,173.42,646.99,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,outpatient,,,176.00000,94.34000,Humana,Medicare Advantage,,65.30,,,,,,,45.76,170.72,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Humana,Medicare Advantage,LT,34.13,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Humana,Medicare Advantage,RT,34.13,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Humana,Medicare Advantage,LT,135.79,,,,,,,95.16,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Humana,Medicare Advantage,RT,135.79,,,,,,,95.16,355.02,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Humana,Medicare Advantage,LT,414.41,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Humana,Medicare Advantage,RT,414.41,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,outpatient,,,559.00000,180.56000,Humana,Medicare Advantage,,207.39,,,,,,,145.34,542.23,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,outpatient,,,252.00000,81.40000,Humana,Medicare Advantage,50,93.49,,,,,,,65.52,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Humana,Medicare Advantage,LT,62.33,,,,,,,43.68,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Humana,Medicare Advantage,RT,62.33,,,,,,,43.68,162.96,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Humana,Medicare Advantage,LT,425.91,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Humana,Medicare Advantage,RT,425.91,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,outpatient,,,379.00000,122.42000,Humana,Medicare Advantage,,140.61,,,,,,,98.54,367.63,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,outpatient,,,1015.00000,327.84000,Humana,Medicare Advantage,,376.56,,,,,,,263.90,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,outpatient,,,591.00000,190.89000,Humana,Medicare Advantage,,219.26,,,,,,,153.66,573.27,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,outpatient,,,271.00000,169.92000,Humana,Medicare Advantage,,100.54,,,,,,,70.46,262.87,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Humana,Medicare Advantage,LT,78.28,,,,,,,54.86,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Humana,Medicare Advantage,RT,78.28,,,,,,,54.86,204.67,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,59.00000,36.99000,Humana,Medicare Advantage,,21.89,,,,,,,15.34,57.23,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,outpatient,,,336.00000,219.74000,Humana,Medicare Advantage,,124.66,,,,,,,87.36,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,outpatient,,,224.00000,146.50000,Humana,Medicare Advantage,52,83.10,,,,,,,58.24,217.28,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,outpatient,,,63.00000,41.20000,Humana,Medicare Advantage,,23.37,,,,,,,16.38,61.11,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Humana,Medicare Advantage,,186.98,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Humana,Medicare Advantage,,36.36,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Humana,Medicare Advantage,,225.57,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Humana,Medicare Advantage,,42.29,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Humana,Medicare Advantage,,69.38,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Humana,Medicare Advantage,,79.39,,,,,,,55.64,207.58,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Humana,Medicare Advantage,,225.94,,,,,,,158.34,590.73,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Humana,Medicare Advantage,,320.17,,,,,,,224.38,837.11,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,outpatient,,,900.00000,605.70000,Humana,Medicare Advantage,,333.90,,,,,,,234.00,873.00,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,outpatient,,,1940.00000,1102.21000,Humana,Medicare Advantage,,719.74,,,,,,,504.40,1881.80,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,outpatient,,,422.00000,239.76000,Humana,Medicare Advantage,,156.56,,,,,,,109.72,409.34,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,outpatient,,,1430.00000,812.45000,Humana,Medicare Advantage,,530.53,,,,,,,371.80,1387.10,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,outpatient,,,745.00000,423.27000,Humana,Medicare Advantage,,276.39,,,,,,,193.70,722.65,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,outpatient,,,2655.00000,2487.74000,Humana,Medicare Advantage,,985.00,,,,,,,690.30,2575.35,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,outpatient,,,3990.00000,3738.63000,Humana,Medicare Advantage,,1480.29,,,,,,,1037.40,3870.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,outpatient,,,290.00000,271.73000,Humana,Medicare Advantage,,107.59,,,,,,,75.40,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,outpatient,,,735.00000,688.70000,Humana,Medicare Advantage,,272.69,,,,,,,191.10,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Humana,Medicare Advantage,,547.23,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,outpatient,,,2275.00000,2131.68000,Humana,Medicare Advantage,,844.02,,,,,,,591.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,outpatient,,,3205.00000,3003.08000,Humana,Medicare Advantage,,1189.06,,,,,,,833.30,3108.85,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,outpatient,,,770.00000,721.49000,Humana,Medicare Advantage,,285.67,,,,,,,200.20,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Humana,Medicare Advantage,,547.23,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,outpatient,,,2210.00000,2070.77000,Humana,Medicare Advantage,,819.91,,,,,,,574.60,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,outpatient,,,2660.00000,2492.42000,Humana,Medicare Advantage,,986.86,,,,,,,691.60,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,outpatient,,,3560.00000,3335.72000,Humana,Medicare Advantage,,1320.76,,,,,,,925.60,3453.20,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,outpatient,,,5730.00000,3255.50000,Humana,Medicare Advantage,,2125.83,,,,,,,1489.80,5558.10,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,outpatient,,,3875.00000,2201.58000,Humana,Medicare Advantage,,1437.62,,,,,,,1007.50,3758.75,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,outpatient,,,519.00000,564.15000,Humana,Medicare Advantage,,192.55,,,,,,,134.94,503.43,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,outpatient,,,536.00000,582.63000,Humana,Medicare Advantage,,198.86,,,,,,,139.36,519.92,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Humana,Medicare Advantage,,168.06,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Humana,Medicare Advantage,,53.42,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Humana,Medicare Advantage,,39.70,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Humana,Medicare Advantage,,53.42,,,,,,,37.44,139.68,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Humana,Medicare Advantage,,186.98,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Humana,Medicare Advantage,,36.36,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Humana,Medicare Advantage,,225.57,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Humana,Medicare Advantage,,42.29,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Humana,Medicare Advantage,,69.38,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Humana,Medicare Advantage,,79.39,,,,,,,55.64,207.58,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,outpatient,,,175.00000,63.18000,Humana,Medicare Advantage,,64.92,,,,,,,45.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,outpatient,,,304.00000,109.74000,Humana,Medicare Advantage,,112.78,,,,,,,79.04,294.88,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Humana,Medicare Advantage,,105.36,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Humana,Medicare Advantage,,169.92,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,outpatient,,,438.00000,158.12000,Humana,Medicare Advantage,,162.50,,,,,,,113.88,424.86,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Humana,Medicare Advantage,,207.02,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Humana,Medicare Advantage,,178.82,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Humana,Medicare Advantage,,87.93,,,,,,,61.62,229.89,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Humana,Medicare Advantage,,186.98,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Humana,Medicare Advantage,,186.98,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Humana,Medicare Advantage,,186.98,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Humana,Medicare Advantage,,186.98,,,,,,,131.04,488.88,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Humana,Medicare Advantage,,312.38,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Humana,Medicare Advantage,,390.66,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Humana,Medicare Advantage,,468.57,,,,,,,328.38,1225.11,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Humana,Medicare Advantage,,67.52,,,,,,,47.32,176.54,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Humana,Medicare Advantage,,77.91,,,,,,,54.60,203.70,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,outpatient,,,140.00000,79.54000,Humana,Medicare Advantage,,51.94,,,,,,,36.40,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,outpatient,,,190.00000,107.95000,Humana,Medicare Advantage,,70.49,,,,,,,49.40,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,outpatient,,,240.00000,136.36000,Humana,Medicare Advantage,,89.04,,,,,,,62.40,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,outpatient,,,290.00000,164.76000,Humana,Medicare Advantage,,107.59,,,,,,,75.40,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,outpatient,,,340.00000,193.17000,Humana,Medicare Advantage,,126.14,,,,,,,88.40,329.80,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,outpatient,,,150.00000,85.22000,Humana,Medicare Advantage,,55.65,,,,,,,39.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,outpatient,,,200.00000,113.63000,Humana,Medicare Advantage,,74.20,,,,,,,52.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,outpatient,,,270.00000,153.40000,Humana,Medicare Advantage,,100.17,,,,,,,70.20,261.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,outpatient,,,370.00000,210.22000,Humana,Medicare Advantage,,137.27,,,,,,,96.20,358.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,outpatient,,,470.00000,267.03000,Humana,Medicare Advantage,,174.37,,,,,,,122.20,455.90,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,outpatient,,,248.00000,96.22000,Humana,Medicare Advantage,,92.01,,,,,,,64.48,240.56,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,outpatient,,,245.00000,95.06000,Humana,Medicare Advantage,,90.89,,,,,,,63.70,237.65,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,outpatient,,,497.00000,192.84000,Humana,Medicare Advantage,,184.39,,,,,,,129.22,482.09,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,outpatient,,,357.00000,138.52000,Humana,Medicare Advantage,,132.45,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,outpatient,,,334.00000,129.59000,Humana,Medicare Advantage,,123.91,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,outpatient,,,194.00000,75.27000,Humana,Medicare Advantage,,71.97,,,,,,,50.44,188.18,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,outpatient,,,1035.00000,401.58000,Humana,Medicare Advantage,,383.99,,,,,,,269.10,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,outpatient,,,1137.00000,441.16000,Humana,Medicare Advantage,,421.83,,,,,,,295.62,1102.89,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,outpatient,,,963.00000,373.64000,Humana,Medicare Advantage,,357.27,,,,,,,250.38,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,outpatient,,,990.00000,384.12000,Humana,Medicare Advantage,,367.29,,,,,,,257.40,960.30,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,outpatient,,,112.00000,43.46000,Humana,Medicare Advantage,,41.55,,,,,,,29.12,108.64,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,outpatient,,,84.00000,32.59000,Humana,Medicare Advantage,,31.16,,,,,,,21.84,81.48,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,outpatient,,,176.00000,68.29000,Humana,Medicare Advantage,,65.30,,,,,,,45.76,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,outpatient,,,283.00000,109.80000,Humana,Medicare Advantage,,104.99,,,,,,,73.58,274.51,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Humana,Medicare Advantage,,30.05,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Humana,Medicare Advantage,,15.21,,,,,,,10.66,39.77,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,35.00000,19.89000,Humana,Medicare Advantage,,12.98,,,,,,,9.10,33.95,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,outpatient,,,191.00000,89.39000,Humana,Medicare Advantage,,70.86,,,,,,,49.66,185.27,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Humana,Medicare Advantage,,168.06,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Humana,Medicare Advantage,,53.42,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Humana,Medicare Advantage,,39.70,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Humana,Medicare Advantage,,53.42,,,,,,,37.44,139.68,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,outpatient,,,281.00000,131.51000,Humana,Medicare Advantage,,104.25,,,,,,,73.06,272.57,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,outpatient,,,192.00000,89.86000,Humana,Medicare Advantage,,71.23,,,,,,,49.92,186.24,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,outpatient,,,365.00000,170.82000,Humana,Medicare Advantage,,135.41,,,,,,,94.90,354.05,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,outpatient,,,8391.00000,5856.92000,Humana,Medicare Advantage,,3113.06,,,,,,,2181.66,8139.27,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Humana,Medicare Advantage,52,2566.21,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Humana,Medicare Advantage,,2226.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Humana,Medicare Advantage,,2566.21,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Humana,Medicare Advantage,52,2226.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,outpatient,,,8855.00000,9625.38000,Humana,Medicare Advantage,,3285.20,,,,,,,2302.30,8589.35,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Humana,Medicare Advantage,,313.12,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Humana,Medicare Advantage,52,313.12,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Humana,Medicare Advantage,,291.24,,,,,,,204.10,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Humana,Medicare Advantage,52,291.24,,,,,,,204.10,761.45,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Humana,Medicare Advantage,,1747.04,,,,,,,1224.34,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Humana,Medicare Advantage,52,1747.04,,,,,,,1224.34,4567.73,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,outpatient,,,345.00000,128.34000,Humana,Medicare Advantage,,128.00,,,,,,,89.70,334.65,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,outpatient,,,120.00000,99.60000,Humana,Medicare Advantage,,44.52,,,,,,,31.20,116.40,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,outpatient,,,106.00000,87.98000,Humana,Medicare Advantage,,39.33,,,,,,,27.56,102.82,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,outpatient,,,32.00000,26.56000,Humana,Medicare Advantage,,11.87,,,,,,,8.32,31.04,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,outpatient,,,60.00000,49.80000,Humana,Medicare Advantage,,22.26,,,,,,,15.60,58.20,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,outpatient,,,57.00000,47.31000,Humana,Medicare Advantage,,21.15,,,,,,,14.82,55.29,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,outpatient,1.0,ME,7.40000,0.65000,Humana,Medicare Advantage,,2.75,,,,,,,1.92,7.18,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,outpatient,1.0,EA,6.60000,1.43000,Humana,Medicare Advantage,UD,2.45,,,,,,,1.72,6.40,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,outpatient,1.0,EA,2.95000,0.64000,Humana,Medicare Advantage,UD,1.09,,,,,,,0.76700,2.86,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,56.08000,12.11000,Humana,Medicare Advantage,UD,20.81,,,,,,,14.58,54.40,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,outpatient,1.0,UN,82.10000,28.90000,Humana,Medicare Advantage,,30.46,,,,,,,15.48,79.64,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.04000,,Humana,Medicare Advantage,UD,0.01484,,,,,,,0.01040,0.03880,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.05000,,Humana,Medicare Advantage,UD,0.01855,,,,,,,0.01300,0.04850,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,outpatient,1.0,ME,6.20000,0.55000,Humana,Medicare Advantage,,2.30,,,,,,,1.61,6.01,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.12000,0.01000,Humana,Medicare Advantage,UD,0.04452,,,,,,,0.03120,0.11640,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,outpatient,2.0,ML,5.80000,1.25000,Humana,Medicare Advantage,,2.15,,,,,,,1.51,5.63,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,outpatient,1.0,ME,3.10000,0.27000,Humana,Medicare Advantage,,1.15,,,,,,,0.80600,3.01,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,outpatient,1.0,EA,44.40000,3.91000,Humana,Medicare Advantage,,16.47,,,,,,,11.54,43.07,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,8.26000,0.73000,Humana,Medicare Advantage,UD,3.06,,,,,,,2.15,8.01,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,2.19000,0.19000,Humana,Medicare Advantage,UD,0.81249,,,,,,,0.56940,2.12,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,outpatient,1.0,EA,28.60000,2.52000,Humana,Medicare Advantage,,10.61,,,,,,,7.44,27.74,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,outpatient,1.0,EA,2.58000,0.91000,Humana,Medicare Advantage,UD,0.95718,,,,,,,0.67080,2.50,percent of total billed charges,
R&B OBSTETRICS PVT,3012,CDM,112,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Multiplan,Commercial,,2614.14,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,23010,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Multiplan,Commercial,,2614.14,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ICU,33019,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Multiplan,Commercial,,8235.34,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,13011,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Multiplan,Commercial,,5490.54,,,,,,,2512.00,5665.77,percent of total billed charges,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,244.00000,77.10000,Multiplan,Commercial,,229.36,,,,,,,219.60,236.68,percent of total billed charges,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,244.00000,77.10000,Multiplan,Commercial,,229.36,,,,,,,63.44,236.68,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,24075,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Multiplan,Commercial,,2614.14,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B OBSTETRICS SEMI-PVT,44073,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Multiplan,Commercial,,2614.14,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B NURSERY LEVEL 1,55160,CDM,171,RC,,,,,facility,inpatient,,,3477.00000,1975.46000,Multiplan,Commercial,,3268.38,,,,,,,2512.00,3372.69,percent of total billed charges,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,inpatient,,,16.00000,7.71000,Multiplan,Commercial,,15.04,,,,,,,14.40,15.52,percent of total billed charges,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,outpatient,,,16.00000,7.71000,Multiplan,Commercial,,15.04,,,,,,,4.16,15.52,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,inpatient,,,210.00000,119.31000,Multiplan,Commercial,,197.40,,,,,,,189.00,203.70,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Multiplan,Commercial,,197.40,,,,,,,54.60,203.70,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,inpatient,,,380.00000,215.90000,Multiplan,Commercial,,357.20,,,,,,,342.00,368.60,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,outpatient,,,380.00000,215.90000,Multiplan,Commercial,,357.20,,,,,,,98.80,368.60,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Multiplan,Commercial,,109.04,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Multiplan,Commercial,,109.04,,,,,,,30.16,112.52,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22012,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Multiplan,Commercial,,2614.14,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ADMIN DAY SKILLED,82016,CDM,160,RC,,,,,facility,inpatient,,,1923.00000,1092.55000,Multiplan,Commercial,,1807.62,,,,,,,1730.70,3111.10,percent of total billed charges,
R&B SWING BED SKILLED,62018,CDM,160,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Multiplan,Commercial,,2614.14,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ADMIN DAY INTERMEDIATE,72017,CDM,169,RC,,,,,facility,inpatient,,,1176.00000,668.14000,Multiplan,Commercial,,1105.44,,,,,,,1058.40,3111.10,percent of total billed charges,
R&B ICU,32011,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Multiplan,Commercial,,8235.34,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,12013,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Multiplan,Commercial,,5490.54,,,,,,,2512.00,5665.77,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Multiplan,Commercial,,109.04,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Multiplan,Commercial,,109.04,,,,,,,30.16,112.52,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Multiplan,Commercial,,473.76,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Multiplan,Commercial,,473.76,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Multiplan,Commercial,,92.12,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Multiplan,Commercial,,92.12,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Multiplan,Commercial,,571.52,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Multiplan,Commercial,,571.52,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Multiplan,Commercial,,107.16,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Multiplan,Commercial,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Multiplan,Commercial,,175.78,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Multiplan,Commercial,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Multiplan,Commercial,,201.16,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Multiplan,Commercial,,201.16,,,,,,,55.64,207.58,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,84.00000,63.59000,Multiplan,Commercial,,78.96,,,,,,,75.60,81.48,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Multiplan,Commercial,,78.96,,,,,,,21.84,81.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Multiplan,Commercial,,266.96,,,,,,,255.60,275.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Multiplan,Commercial,,266.96,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Multiplan,Commercial,,430.52,,,,,,,412.20,444.26,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Multiplan,Commercial,,430.52,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Multiplan,Commercial,,524.52,,,,,,,502.20,541.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Multiplan,Commercial,,524.52,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Multiplan,Commercial,,453.08,,,,,,,433.80,467.54,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Multiplan,Commercial,,453.08,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Multiplan,Commercial,,222.78,,,,,,,213.30,229.89,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Multiplan,Commercial,,222.78,,,,,,,61.62,229.89,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,inpatient,,,2041.00000,659.24000,Multiplan,Commercial,,1918.54,,,,,,,1836.90,1979.77,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,outpatient,,,2041.00000,659.24000,Multiplan,Commercial,,1918.54,,,,,,,530.66,1979.77,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,inpatient,,,259.00000,83.66000,Multiplan,Commercial,,243.46,,,,,,,233.10,251.23,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,outpatient,,,259.00000,83.66000,Multiplan,Commercial,,243.46,,,,,,,67.34,251.23,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,inpatient,,,672.00000,217.06000,Multiplan,Commercial,,631.68,,,,,,,604.80,651.84,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,outpatient,,,672.00000,217.06000,Multiplan,Commercial,,631.68,,,,,,,174.72,651.84,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,inpatient,,,530.00000,171.19000,Multiplan,Commercial,,498.20,,,,,,,477.00,514.10,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,outpatient,,,530.00000,171.19000,Multiplan,Commercial,,498.20,,,,,,,137.80,514.10,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,inpatient,,,580.00000,187.34000,Multiplan,Commercial,,545.20,,,,,,,522.00,562.60,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,outpatient,,,580.00000,187.34000,Multiplan,Commercial,,545.20,,,,,,,150.80,562.60,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,inpatient,,,435.00000,140.50000,Multiplan,Commercial,,408.90,,,,,,,391.50,421.95,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,outpatient,,,435.00000,140.50000,Multiplan,Commercial,,408.90,,,,,,,113.10,421.95,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,inpatient,,,863.00000,278.75000,Multiplan,Commercial,,811.22,,,,,,,776.70,837.11,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Multiplan,Commercial,,811.22,,,,,,,224.38,837.11,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,inpatient,,,334.00000,107.88000,Multiplan,Commercial,,313.96,,,,,,,300.60,323.98,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,outpatient,,,334.00000,107.88000,Multiplan,Commercial,,313.96,,,,,,,86.84,323.98,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,inpatient,,,1188.00000,383.72000,Multiplan,Commercial,50,1116.72,,,,,,,1069.20,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,outpatient,,,1188.00000,383.72000,Multiplan,Commercial,50,1116.72,,,,,,,308.88,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,inpatient,,,792.00000,255.82000,Multiplan,Commercial,LT,744.48,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Multiplan,Commercial,LT,744.48,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,inpatient,,,792.00000,255.82000,Multiplan,Commercial,RT,744.48,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Multiplan,Commercial,RT,744.48,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,inpatient,,,572.00000,184.76000,Multiplan,Commercial,50,537.68,,,,,,,514.80,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,outpatient,,,572.00000,184.76000,Multiplan,Commercial,50,537.68,,,,,,,148.72,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,inpatient,,,381.00000,123.06000,Multiplan,Commercial,LT,358.14,,,,,,,342.90,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Multiplan,Commercial,LT,358.14,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,inpatient,,,381.00000,123.06000,Multiplan,Commercial,RT,358.14,,,,,,,342.90,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Multiplan,Commercial,RT,358.14,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,inpatient,,,455.00000,146.96000,Multiplan,Commercial,,427.70,,,,,,,409.50,441.35,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,outpatient,,,455.00000,146.96000,Multiplan,Commercial,,427.70,,,,,,,118.30,441.35,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,inpatient,,,403.00000,130.17000,Multiplan,Commercial,,378.82,,,,,,,362.70,390.91,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,outpatient,,,403.00000,130.17000,Multiplan,Commercial,,378.82,,,,,,,104.78,390.91,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,inpatient,,,370.00000,119.51000,Multiplan,Commercial,,347.80,,,,,,,333.00,358.90,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,outpatient,,,370.00000,119.51000,Multiplan,Commercial,,347.80,,,,,,,96.20,358.90,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,inpatient,,,357.00000,115.31000,Multiplan,Commercial,,335.58,,,,,,,321.30,346.29,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,outpatient,,,357.00000,115.31000,Multiplan,Commercial,,335.58,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,inpatient,,,334.00000,107.88000,Multiplan,Commercial,,313.96,,,,,,,300.60,323.98,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,outpatient,,,334.00000,107.88000,Multiplan,Commercial,,313.96,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,inpatient,,,194.00000,62.66000,Multiplan,Commercial,,182.36,,,,,,,174.60,188.18,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,outpatient,,,194.00000,62.66000,Multiplan,Commercial,,182.36,,,,,,,50.44,188.18,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,inpatient,,,457.00000,147.61000,Multiplan,Commercial,,429.58,,,,,,,411.30,443.29,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,outpatient,,,457.00000,147.61000,Multiplan,Commercial,,429.58,,,,,,,118.82,443.29,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,inpatient,,,492.00000,158.92000,Multiplan,Commercial,,462.48,,,,,,,442.80,477.24,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,outpatient,,,492.00000,158.92000,Multiplan,Commercial,,462.48,,,,,,,127.92,477.24,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,inpatient,,,780.00000,251.94000,Multiplan,Commercial,,733.20,,,,,,,702.00,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,outpatient,,,780.00000,251.94000,Multiplan,Commercial,,733.20,,,,,,,202.80,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,inpatient,,,1165.00000,376.30000,Multiplan,Commercial,,1095.10,,,,,,,1048.50,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,outpatient,,,1165.00000,376.30000,Multiplan,Commercial,,1095.10,,,,,,,302.90,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,inpatient,,,2350.00000,759.05000,Multiplan,Commercial,,2209.00,,,,,,,2115.00,2279.50,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,outpatient,,,2350.00000,759.05000,Multiplan,Commercial,,2209.00,,,,,,,611.00,2279.50,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,inpatient,,,896.00000,289.41000,Multiplan,Commercial,,842.24,,,,,,,806.40,869.12,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,outpatient,,,896.00000,289.41000,Multiplan,Commercial,,842.24,,,,,,,232.96,869.12,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,inpatient,,,490.00000,158.27000,Multiplan,Commercial,,460.60,,,,,,,441.00,475.30,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,outpatient,,,490.00000,158.27000,Multiplan,Commercial,,460.60,,,,,,,127.40,475.30,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,inpatient,,,520.00000,167.96000,Multiplan,Commercial,,488.80,,,,,,,468.00,504.40,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,outpatient,,,520.00000,167.96000,Multiplan,Commercial,,488.80,,,,,,,135.20,504.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,inpatient,,,720.00000,232.56000,Multiplan,Commercial,,676.80,,,,,,,648.00,698.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,outpatient,,,720.00000,232.56000,Multiplan,Commercial,,676.80,,,,,,,187.20,698.40,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,inpatient,,,215.00000,69.45000,Multiplan,Commercial,,202.10,,,,,,,193.50,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,outpatient,,,215.00000,69.45000,Multiplan,Commercial,,202.10,,,,,,,55.90,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,inpatient,,,240.00000,77.52000,Multiplan,Commercial,,225.60,,,,,,,216.00,232.80,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,outpatient,,,240.00000,77.52000,Multiplan,Commercial,,225.60,,,,,,,62.40,232.80,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,inpatient,,,1241.00000,400.84000,Multiplan,Commercial,,1166.54,,,,,,,1116.90,1203.77,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,outpatient,,,1241.00000,400.84000,Multiplan,Commercial,,1166.54,,,,,,,322.66,1203.77,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Multiplan,Commercial,,791.48,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Multiplan,Commercial,,791.48,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Multiplan,Commercial,,989.82,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Multiplan,Commercial,,989.82,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Multiplan,Commercial,,1187.22,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Multiplan,Commercial,,1187.22,,,,,,,328.38,1225.11,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,inpatient,,,668.00000,559.78000,Multiplan,Commercial,,627.92,,,,,,,601.20,647.96,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,outpatient,,,668.00000,559.78000,Multiplan,Commercial,,627.92,,,,,,,173.68,647.96,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Multiplan,Commercial,,76.14,,,,,,,72.90,78.57,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Multiplan,Commercial,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Multiplan,Commercial,,38.54,,,,,,,36.90,39.77,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Multiplan,Commercial,,38.54,,,,,,,10.66,39.77,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Multiplan,Commercial,,425.82,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Multiplan,Commercial,,425.82,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Multiplan,Commercial,,135.36,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Multiplan,Commercial,,135.36,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Multiplan,Commercial,,100.58,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Multiplan,Commercial,,100.58,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Multiplan,Commercial,,135.36,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Multiplan,Commercial,,135.36,,,,,,,37.44,139.68,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Multiplan,Commercial,,3.20,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Multiplan,Commercial,,3.20,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Multiplan,Commercial,,3.20,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Multiplan,Commercial,,3.20,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Multiplan,Commercial,,3.20,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Multiplan,Commercial,,3.20,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,4.90000,2.78000,Multiplan,Commercial,,4.61,,,,,,,4.41,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Multiplan,Commercial,,4.61,,,,,,,1.27,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,7.90000,4.49000,Multiplan,Commercial,,7.43,,,,,,,7.11,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,7.90000,4.49000,Multiplan,Commercial,,7.43,,,,,,,2.05,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,4.90000,2.78000,Multiplan,Commercial,,4.61,,,,,,,4.41,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Multiplan,Commercial,,4.61,,,,,,,1.27,4.75,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Multiplan,Commercial,,76.14,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Multiplan,Commercial,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Multiplan,Commercial,,76.14,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Multiplan,Commercial,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Multiplan,Commercial,,76.14,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Multiplan,Commercial,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,inpatient,,,3141500.00000,1784843.22000,Multiplan,Commercial,,2953010.00,,,,,,,2827350.00,3047255.00,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,outpatient,,,3141500.00000,1784843.22000,Multiplan,Commercial,,2953010.00,,,,,,,816790.00,3047255.00,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Multiplan,Commercial,UD,0.20680,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Multiplan,Commercial,UD,0.20680,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.52000,0.30000,Multiplan,Commercial,UD,0.48880,,,,,,,0.46800,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.52000,0.30000,Multiplan,Commercial,UD,0.48880,,,,,,,0.13520,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.56000,0.32000,Multiplan,Commercial,UD,0.52640,,,,,,,0.50400,0.54320,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.56000,0.32000,Multiplan,Commercial,UD,0.52640,,,,,,,0.14560,0.54320,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Multiplan,Commercial,UD,0.20680,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Multiplan,Commercial,UD,0.20680,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.85000,0.48000,Multiplan,Commercial,UD,0.79900,,,,,,,0.76500,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.85000,0.48000,Multiplan,Commercial,UD,0.79900,,,,,,,0.22100,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Multiplan,Commercial,UD,0.20680,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Multiplan,Commercial,UD,0.20680,,,,,,,0.05720,0.21340,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,inpatient,,,102.00000,65.18000,Multiplan,Commercial,,95.88,,,,,,,91.80,98.94,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,outpatient,,,102.00000,65.18000,Multiplan,Commercial,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,inpatient,,,190.00000,121.41000,Multiplan,Commercial,,178.60,,,,,,,171.00,184.30,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,outpatient,,,190.00000,121.41000,Multiplan,Commercial,,178.60,,,,,,,49.40,184.30,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,inpatient,,,359.00000,229.40000,Multiplan,Commercial,,337.46,,,,,,,323.10,348.23,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Multiplan,Commercial,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,inpatient,,,535.00000,341.86000,Multiplan,Commercial,,502.90,,,,,,,481.50,518.95,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Multiplan,Commercial,,502.90,,,,,,,139.10,518.95,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,inpatient,,,766.00000,489.47000,Multiplan,Commercial,,720.04,,,,,,,689.40,743.02,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,outpatient,,,766.00000,489.47000,Multiplan,Commercial,,720.04,,,,,,,199.16,743.02,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,inpatient,,,159.00000,101.60000,Multiplan,Commercial,,149.46,,,,,,,143.10,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,outpatient,,,159.00000,101.60000,Multiplan,Commercial,,149.46,,,,,,,41.34,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,inpatient,,,447.00000,285.63000,Multiplan,Commercial,,420.18,,,,,,,402.30,433.59,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,outpatient,,,447.00000,285.63000,Multiplan,Commercial,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,inpatient,,,1413.00000,902.91000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,outpatient,,,1413.00000,902.91000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,inpatient,,,3853.00000,2462.07000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,outpatient,,,3853.00000,2462.07000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,inpatient,,,313.00000,200.01000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,outpatient,,,313.00000,200.01000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,inpatient,,,1132.00000,723.35000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,outpatient,,,1132.00000,723.35000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,inpatient,,,2695.00000,1722.10000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,outpatient,,,2695.00000,1722.10000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,inpatient,,,1619.00000,1034.54000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,outpatient,,,1619.00000,1034.54000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,inpatient,,,535.00000,341.86000,Multiplan,Commercial,,502.90,,,,,,,481.50,518.95,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Multiplan,Commercial,,502.90,,,,,,,139.10,518.95,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,inpatient,,,850.00000,543.15000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,outpatient,,,850.00000,543.15000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,inpatient,,,32.00000,20.45000,Multiplan,Commercial,,30.08,,,,,,,28.80,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,outpatient,,,32.00000,20.45000,Multiplan,Commercial,,30.08,,,,,,,8.32,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,inpatient,,,134.00000,85.63000,Multiplan,Commercial,,125.96,,,,,,,120.60,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,outpatient,,,134.00000,85.63000,Multiplan,Commercial,,125.96,,,,,,,34.84,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,inpatient,,,359.00000,229.40000,Multiplan,Commercial,,337.46,,,,,,,323.10,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Multiplan,Commercial,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,inpatient,,,709.00000,453.05000,Multiplan,Commercial,,666.46,,,,,,,638.10,687.73,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,outpatient,,,709.00000,453.05000,Multiplan,Commercial,,666.46,,,,,,,184.34,687.73,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,inpatient,,,4880.00000,2357.04000,Multiplan,Commercial,,4587.20,,,,,,,4392.00,4733.60,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,outpatient,,,4880.00000,2357.04000,Multiplan,Commercial,,4587.20,,,,,,,1268.80,4733.60,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,inpatient,,,6024.00000,2909.59000,Multiplan,Commercial,,5662.56,,,,,,,5421.60,5843.28,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,outpatient,,,6024.00000,2909.59000,Multiplan,Commercial,,5662.56,,,,,,,1566.24,5843.28,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Multiplan,Commercial,,420.18,,,,,,,402.30,433.59,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Multiplan,Commercial,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Multiplan,Commercial,,4133.18,,,,,,,3957.30,4265.09,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Multiplan,Commercial,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,5274.90,5685.17,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,inpatient,,,7413.00000,3580.48000,Multiplan,Commercial,,6968.22,,,,,,,6671.70,7190.61,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,outpatient,,,7413.00000,3580.48000,Multiplan,Commercial,,6968.22,,,,,,,1927.38,7190.61,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Multiplan,Commercial,,420.18,,,,,,,402.30,433.59,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Multiplan,Commercial,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Multiplan,Commercial,,420.18,,,,,,,402.30,433.59,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Multiplan,Commercial,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Multiplan,Commercial,,4133.18,,,,,,,3957.30,4265.09,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Multiplan,Commercial,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,inpatient,,,7181.00000,3468.42000,Multiplan,Commercial,,6750.14,,,,,,,6462.90,6965.57,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Multiplan,Commercial,,6750.14,,,,,,,1867.06,6965.57,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,inpatient,,,10654.00000,5145.88000,Multiplan,Commercial,,10014.76,,,,,,,9588.60,10334.38,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,outpatient,,,10654.00000,5145.88000,Multiplan,Commercial,,10014.76,,,,,,,2770.04,10334.38,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,6487.00000,3133.22000,Multiplan,Commercial,,6097.78,,,,,,,5838.30,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Multiplan,Commercial,,6097.78,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,7413.00000,3580.48000,Multiplan,Commercial,,6968.22,,,,,,,6671.70,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Multiplan,Commercial,,6968.22,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,11575.00000,5590.72000,Multiplan,Commercial,,10880.50,,,,,,,10417.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,11575.00000,5590.72000,Multiplan,Commercial,,10880.50,,,,,,,3009.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,13432.00000,6487.66000,Multiplan,Commercial,,12626.08,,,,,,,12088.80,13029.04,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,13432.00000,6487.66000,Multiplan,Commercial,,12626.08,,,,,,,3492.32,13029.04,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,21904.00000,10579.63000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,21904.00000,10579.63000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,4397.00000,2123.75000,Multiplan,Commercial,,4133.18,,,,,,,3957.30,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Multiplan,Commercial,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,7413.00000,3580.48000,Multiplan,Commercial,,6968.22,,,,,,,6671.70,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Multiplan,Commercial,,6968.22,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,12969.00000,6264.03000,Multiplan,Commercial,,12190.86,,,,,,,11672.10,12579.93,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,12969.00000,6264.03000,Multiplan,Commercial,,12190.86,,,,,,,3371.94,12579.93,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Multiplan,Commercial,,2280.44,,,,,,,2183.40,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Multiplan,Commercial,,2280.44,,,,,,,630.76,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Multiplan,Commercial,,2657.38,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Multiplan,Commercial,,2657.38,,,,,,,735.02,2742.19,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Multiplan,Commercial,,95.88,,,,,,,91.80,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Multiplan,Commercial,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,inpatient,,,134.00000,64.72000,Multiplan,Commercial,,125.96,,,,,,,120.60,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Multiplan,Commercial,,125.96,,,,,,,34.84,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,inpatient,,,251.00000,121.23000,Multiplan,Commercial,,235.94,,,,,,,225.90,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,outpatient,,,251.00000,121.23000,Multiplan,Commercial,,235.94,,,,,,,65.26,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,447.00000,215.90000,Multiplan,Commercial,,420.18,,,,,,,402.30,433.59,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,447.00000,215.90000,Multiplan,Commercial,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,2827.00000,1365.44000,Multiplan,Commercial,,2657.38,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Multiplan,Commercial,,2657.38,,,,,,,735.02,2742.19,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,2690.00000,1299.27000,Multiplan,Commercial,,2528.60,,,,,,,2421.00,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Multiplan,Commercial,,2528.60,,,,,,,699.40,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,6487.00000,3133.22000,Multiplan,Commercial,,6097.78,,,,,,,5838.30,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Multiplan,Commercial,,6097.78,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,2426.00000,1171.76000,Multiplan,Commercial,,2280.44,,,,,,,2183.40,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,2426.00000,1171.76000,Multiplan,Commercial,,2280.44,,,,,,,630.76,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,15334.00000,7406.32000,Multiplan,Commercial,,14413.96,,,,,,,13800.60,14873.98,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,15334.00000,7406.32000,Multiplan,Commercial,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Multiplan,Commercial,,2657.38,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Multiplan,Commercial,,2657.38,,,,,,,735.02,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,251.00000,121.23000,Multiplan,Commercial,,235.94,,,,,,,225.90,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,251.00000,121.23000,Multiplan,Commercial,,235.94,,,,,,,65.26,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,2827.00000,1365.44000,Multiplan,Commercial,,2657.38,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Multiplan,Commercial,,2657.38,,,,,,,735.02,2742.19,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Multiplan,Commercial,,30.08,,,,,,,28.80,31.04,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Multiplan,Commercial,,30.08,,,,,,,8.32,31.04,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,inpatient,,,15334.00000,7406.32000,Multiplan,Commercial,,14413.96,,,,,,,13800.60,14873.98,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Multiplan,Commercial,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,inpatient,,,1485.00000,717.26000,Multiplan,Commercial,,1395.90,,,,,,,1336.50,1440.45,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,outpatient,,,1485.00000,717.26000,Multiplan,Commercial,,1395.90,,,,,,,386.10,1440.45,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,inpatient,,,2028.00000,979.52000,Multiplan,Commercial,,1906.32,,,,,,,1825.20,1967.16,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,outpatient,,,2028.00000,979.52000,Multiplan,Commercial,,1906.32,,,,,,,527.28,1967.16,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,4397.00000,2123.75000,Multiplan,Commercial,,4133.18,,,,,,,3957.30,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Multiplan,Commercial,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,8107.00000,3915.68000,Multiplan,Commercial,,7620.58,,,,,,,7296.30,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,8107.00000,3915.68000,Multiplan,Commercial,,7620.58,,,,,,,2107.82,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,10422.00000,5033.83000,Multiplan,Commercial,,9796.68,,,,,,,9379.80,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,10422.00000,5033.83000,Multiplan,Commercial,,9796.68,,,,,,,2709.72,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,12737.00000,6151.97000,Multiplan,Commercial,,11972.78,,,,,,,11463.30,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,12737.00000,6151.97000,Multiplan,Commercial,,11972.78,,,,,,,3311.62,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,14239.00000,6877.44000,Multiplan,Commercial,,13384.66,,,,,,,12815.10,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,14239.00000,6877.44000,Multiplan,Commercial,,13384.66,,,,,,,3702.14,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,16429.00000,7935.21000,Multiplan,Commercial,,15443.26,,,,,,,14786.10,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,16429.00000,7935.21000,Multiplan,Commercial,,15443.26,,,,,,,4271.54,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,18619.00000,8992.98000,Multiplan,Commercial,,17501.86,,,,,,,16757.10,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,18619.00000,8992.98000,Multiplan,Commercial,,17501.86,,,,,,,4840.94,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,20809.00000,10050.75000,Multiplan,Commercial,,19560.46,,,,,,,18728.10,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,20809.00000,10050.75000,Multiplan,Commercial,,19560.46,,,,,,,5410.34,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,22999.00000,11108.52000,Multiplan,Commercial,,21619.06,,,,,,,20699.10,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,22999.00000,11108.52000,Multiplan,Commercial,,21619.06,,,,,,,5979.74,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,25189.00000,12166.29000,Multiplan,Commercial,,23677.66,,,,,,,22670.10,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,25189.00000,12166.29000,Multiplan,Commercial,,23677.66,,,,,,,6549.14,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,27379.00000,13224.06000,Multiplan,Commercial,,25736.26,,,,,,,24641.10,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,27379.00000,13224.06000,Multiplan,Commercial,,25736.26,,,,,,,7118.54,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,29569.00000,14281.83000,Multiplan,Commercial,,27794.86,,,,,,,26612.10,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,29569.00000,14281.83000,Multiplan,Commercial,,27794.86,,,,,,,7687.94,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,31759.00000,15339.60000,Multiplan,Commercial,,29853.46,,,,,,,28583.10,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,31759.00000,15339.60000,Multiplan,Commercial,,29853.46,,,,,,,8257.34,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,36139.00000,17455.14000,Multiplan,Commercial,,33970.66,,,,,,,32525.10,35054.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,36139.00000,17455.14000,Multiplan,Commercial,,33970.66,,,,,,,9396.14,35054.83,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,1699.20,1831.36,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Multiplan,Commercial,,3139.60,,,,,,,3006.00,3239.80,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Multiplan,Commercial,,3139.60,,,,,,,868.40,3239.80,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,5274.90,5685.17,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Multiplan,Commercial,,30.08,,,,,,,28.80,31.04,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Multiplan,Commercial,,30.08,,,,,,,8.32,31.04,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,inpatient,,,134.00000,64.72000,Multiplan,Commercial,,125.96,,,,,,,120.60,129.98,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Multiplan,Commercial,,125.96,,,,,,,34.84,129.98,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Multiplan,Commercial,,178.60,,,,,,,171.00,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Multiplan,Commercial,,178.60,,,,,,,49.40,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,inpatient,,,476.00000,229.91000,Multiplan,Commercial,,447.44,,,,,,,428.40,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,outpatient,,,476.00000,229.91000,Multiplan,Commercial,,447.44,,,,,,,123.76,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Multiplan,Commercial,,30.08,,,,,,,28.80,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Multiplan,Commercial,,30.08,,,,,,,8.32,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Multiplan,Commercial,,420.18,,,,,,,402.30,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Multiplan,Commercial,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,1699.20,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,5274.90,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,inpatient,,,12506.00000,6040.40000,Multiplan,Commercial,,11755.64,,,,,,,11255.40,12130.82,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,outpatient,,,12506.00000,6040.40000,Multiplan,Commercial,,11755.64,,,,,,,3251.56,12130.82,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,inpatient,,,2404.80000,1161.52000,Multiplan,Commercial,,2260.51,,,,,,,2164.32,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,outpatient,,,2404.80000,1161.52000,Multiplan,Commercial,,2260.51,,,,,,,625.25,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,inpatient,,,969.00000,468.03000,Multiplan,Commercial,,910.86,,,,,,,872.10,939.93,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,outpatient,,,969.00000,468.03000,Multiplan,Commercial,,910.86,,,,,,,251.94,939.93,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,inpatient,,,2256.90000,1090.08000,Multiplan,Commercial,,2121.49,,,,,,,2031.21,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,outpatient,,,2256.90000,1090.08000,Multiplan,Commercial,,2121.49,,,,,,,586.79,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,inpatient,,,644.30000,311.20000,Multiplan,Commercial,,605.64,,,,,,,579.87,624.97,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,outpatient,,,644.30000,311.20000,Multiplan,Commercial,,605.64,,,,,,,167.52,624.97,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Multiplan,Commercial,,95.88,,,,,,,91.80,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Multiplan,Commercial,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Multiplan,Commercial,,178.60,,,,,,,171.00,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Multiplan,Commercial,,178.60,,,,,,,49.40,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,inpatient,,,26284.00000,12695.17000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,inpatient,,,30664.00000,14810.71000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,inpatient,,,35044.00000,16926.25000,Multiplan,Commercial,,32941.36,,,,,,,31539.60,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Multiplan,Commercial,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,inpatient,,,43804.00000,21157.33000,Multiplan,Commercial,,41175.76,,,,,,,39423.60,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,outpatient,,,43804.00000,21157.33000,Multiplan,Commercial,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,inpatient,,,52564.00000,25388.41000,Multiplan,Commercial,,49410.16,,,,,,,47307.60,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,outpatient,,,52564.00000,25388.41000,Multiplan,Commercial,,49410.16,,,,,,,13666.64,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,inpatient,,,61324.00000,29619.49000,Multiplan,Commercial,,57644.56,,,,,,,55191.60,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,outpatient,,,61324.00000,29619.49000,Multiplan,Commercial,,57644.56,,,,,,,15944.24,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,inpatient,,,70084.00000,33850.57000,Multiplan,Commercial,,65878.96,,,,,,,63075.60,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,outpatient,,,70084.00000,33850.57000,Multiplan,Commercial,,65878.96,,,,,,,18221.84,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,inpatient,,,78844.00000,38081.65000,Multiplan,Commercial,,74113.36,,,,,,,70959.60,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,outpatient,,,78844.00000,38081.65000,Multiplan,Commercial,,74113.36,,,,,,,20499.44,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,inpatient,,,87604.00000,42312.73000,Multiplan,Commercial,,82347.76,,,,,,,78843.60,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,outpatient,,,87604.00000,42312.73000,Multiplan,Commercial,,82347.76,,,,,,,22777.04,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,inpatient,,,96364.00000,46543.81000,Multiplan,Commercial,,90582.16,,,,,,,86727.60,93473.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,outpatient,,,96364.00000,46543.81000,Multiplan,Commercial,,90582.16,,,,,,,25054.64,93473.08,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,inpatient,,,26284.00000,12695.17000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,inpatient,,,30664.00000,14810.71000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,inpatient,,,35044.00000,16926.25000,Multiplan,Commercial,,32941.36,,,,,,,31539.60,33992.68,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Multiplan,Commercial,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,inpatient,,,39424.00000,19041.79000,Multiplan,Commercial,,37058.56,,,,,,,35481.60,38241.28,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,outpatient,,,39424.00000,19041.79000,Multiplan,Commercial,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Multiplan,Commercial,,3674.46,,,,,,,3518.10,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Multiplan,Commercial,,3674.46,,,,,,,1016.34,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Multiplan,Commercial,,178.60,,,,,,,171.00,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Multiplan,Commercial,,178.60,,,,,,,49.40,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,5274.90,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,inpatient,,,15334.00000,7406.32000,Multiplan,Commercial,,14413.96,,,,,,,13800.60,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Multiplan,Commercial,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,2023.00000,977.11000,Multiplan,Commercial,,1901.62,,,,,,,1820.70,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2023.00000,977.11000,Multiplan,Commercial,,1901.62,,,,,,,525.98,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,5274.90,5685.17,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,inpatient,,,7876.00000,3804.11000,Multiplan,Commercial,,7403.44,,,,,,,7088.40,7639.72,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Multiplan,Commercial,,7403.44,,,,,,,2047.76,7639.72,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,inpatient,,,10191.00000,4922.25000,Multiplan,Commercial,,9579.54,,,,,,,9171.90,9885.27,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,outpatient,,,10191.00000,4922.25000,Multiplan,Commercial,,9579.54,,,,,,,2649.66,9885.27,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,96.00000,46.37000,Multiplan,Commercial,,90.24,,,,,,,86.40,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,96.00000,46.37000,Multiplan,Commercial,,90.24,,,,,,,24.96,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,5274.90,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,7876.00000,3804.11000,Multiplan,Commercial,,7403.44,,,,,,,7088.40,7639.72,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,7876.00000,3804.11000,Multiplan,Commercial,,7403.44,,,,,,,2047.76,7639.72,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Multiplan,Commercial,,3674.46,,,,,,,3518.10,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Multiplan,Commercial,,3674.46,,,,,,,1016.34,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,inpatient,,,5373.00000,2595.16000,Multiplan,Commercial,,5050.62,,,,,,,4835.70,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,outpatient,,,5373.00000,2595.16000,Multiplan,Commercial,,5050.62,,,,,,,1396.98,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,inpatient,,,6487.00000,3133.22000,Multiplan,Commercial,,6097.78,,,,,,,5838.30,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,outpatient,,,6487.00000,3133.22000,Multiplan,Commercial,,6097.78,,,,,,,1686.62,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,inpatient,,,7876.00000,3804.11000,Multiplan,Commercial,,7403.44,,,,,,,7088.40,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Multiplan,Commercial,,7403.44,,,,,,,2047.76,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Multiplan,Commercial,,4133.18,,,,,,,3957.30,4265.09,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Multiplan,Commercial,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,5274.90,5685.17,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,inpatient,,,1126.00000,543.86000,Multiplan,Commercial,,1058.44,,,,,,,1013.40,1092.22,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,outpatient,,,1126.00000,543.86000,Multiplan,Commercial,,1058.44,,,,,,,292.76,1092.22,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,2690.00000,1299.27000,Multiplan,Commercial,,2528.60,,,,,,,2421.00,2609.30,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Multiplan,Commercial,,2528.60,,,,,,,699.40,2609.30,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,4880.00000,2357.04000,Multiplan,Commercial,,4587.20,,,,,,,4392.00,4733.60,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,4880.00000,2357.04000,Multiplan,Commercial,,4587.20,,,,,,,1268.80,4733.60,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,9260.00000,4472.58000,Multiplan,Commercial,,8704.40,,,,,,,8334.00,8982.20,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,9260.00000,4472.58000,Multiplan,Commercial,,8704.40,,,,,,,2407.60,8982.20,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,5274.90,5685.17,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,inpatient,,,588.00000,284.00000,Multiplan,Commercial,,552.72,,,,,,,529.20,570.36,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,588.00000,284.00000,Multiplan,Commercial,,552.72,,,,,,,152.88,570.36,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,1699.20,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Multiplan,Commercial,,2280.44,,,,,,,2183.40,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Multiplan,Commercial,,2280.44,,,,,,,630.76,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Multiplan,Commercial,,2657.38,,,,,,,2544.30,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Multiplan,Commercial,,2657.38,,,,,,,735.02,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Multiplan,Commercial,,3139.60,,,,,,,3006.00,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Multiplan,Commercial,,3139.60,,,,,,,868.40,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Multiplan,Commercial,,3139.60,,,,,,,3006.00,3239.80,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Multiplan,Commercial,,3139.60,,,,,,,868.40,3239.80,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Multiplan,Commercial,,420.18,,,,,,,402.30,433.59,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Multiplan,Commercial,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Multiplan,Commercial,,3674.46,,,,,,,3518.10,3791.73,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Multiplan,Commercial,,3674.46,,,,,,,1016.34,3791.73,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,5274.90,5685.17,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,inpatient,,,159.00000,76.80000,Multiplan,Commercial,,149.46,,,,,,,143.10,154.23,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,outpatient,,,159.00000,76.80000,Multiplan,Commercial,,149.46,,,,,,,41.34,154.23,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,inpatient,,,588.00000,284.00000,Multiplan,Commercial,,552.72,,,,,,,529.20,570.36,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,outpatient,,,588.00000,284.00000,Multiplan,Commercial,,552.72,,,,,,,152.88,570.36,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Multiplan,Commercial,,2280.44,,,,,,,2183.40,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Multiplan,Commercial,,2280.44,,,,,,,630.76,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Multiplan,Commercial,,420.18,,,,,,,402.30,433.59,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Multiplan,Commercial,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,inpatient,,,8107.00000,3915.68000,Multiplan,Commercial,,7620.58,,,,,,,7296.30,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,outpatient,,,8107.00000,3915.68000,Multiplan,Commercial,,7620.58,,,,,,,2107.82,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,inpatient,,,10422.00000,5033.83000,Multiplan,Commercial,,9796.68,,,,,,,9379.80,10109.34,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,outpatient,,,10422.00000,5033.83000,Multiplan,Commercial,,9796.68,,,,,,,2709.72,10109.34,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,5274.90,5685.17,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Multiplan,Commercial,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,1699.20,1831.36,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Multiplan,Commercial,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Multiplan,Commercial,,95.88,,,,,,,91.80,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Multiplan,Commercial,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,inpatient,,,221.00000,106.74000,Multiplan,Commercial,,207.74,,,,,,,198.90,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,outpatient,,,221.00000,106.74000,Multiplan,Commercial,,207.74,,,,,,,57.46,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Multiplan,Commercial,,420.18,,,,,,,402.30,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Multiplan,Commercial,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Multiplan,Commercial,,2280.44,,,,,,,2183.40,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Multiplan,Commercial,,2280.44,,,,,,,630.76,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Multiplan,Commercial,,3139.60,,,,,,,3006.00,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Multiplan,Commercial,,3139.60,,,,,,,868.40,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,inpatient,,,4153.00000,2005.90000,Multiplan,Commercial,,3903.82,,,,,,,3737.70,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,outpatient,,,4153.00000,2005.90000,Multiplan,Commercial,,3903.82,,,,,,,1079.78,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,inpatient,,,5129.00000,2477.31000,Multiplan,Commercial,,4821.26,,,,,,,4616.10,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,outpatient,,,5129.00000,2477.31000,Multiplan,Commercial,,4821.26,,,,,,,1333.54,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,inpatient,,,7181.00000,3468.42000,Multiplan,Commercial,,6750.14,,,,,,,6462.90,6965.57,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Multiplan,Commercial,,6750.14,,,,,,,1867.06,6965.57,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,inpatient,,,52.50000,25.36000,Multiplan,Commercial,,49.35,,,,,,,47.25,50.92,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,outpatient,,,52.50000,25.36000,Multiplan,Commercial,,49.35,,,,,,,13.65,50.92,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,inpatient,,,50.40000,24.34000,Multiplan,Commercial,,47.38,,,,,,,45.36,48.89,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,outpatient,,,50.40000,24.34000,Multiplan,Commercial,,47.38,,,,,,,13.10,48.89,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Multiplan,Commercial,,2280.44,,,,,,,2183.40,2353.22,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Multiplan,Commercial,,2280.44,,,,,,,630.76,2353.22,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Multiplan,Commercial,,3674.46,,,,,,,3518.10,3791.73,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Multiplan,Commercial,,3674.46,,,,,,,1016.34,3791.73,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Multiplan,Commercial,,95.88,,,,,,,91.80,98.94,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Multiplan,Commercial,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Multiplan,Commercial,,30.08,,,,,,,28.80,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Multiplan,Commercial,,30.08,,,,,,,8.32,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Multiplan,Commercial,,420.18,,,,,,,402.30,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Multiplan,Commercial,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,inpatient,,,709.00000,342.45000,Multiplan,Commercial,,666.46,,,,,,,638.10,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,outpatient,,,709.00000,342.45000,Multiplan,Commercial,,666.46,,,,,,,184.34,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Multiplan,Commercial,,61761.76,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Multiplan,Commercial,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Multiplan,Commercial,,82347.76,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Multiplan,Commercial,,82347.76,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,109504.00000,62214.70000,Multiplan,Commercial,,102933.76,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Multiplan,Commercial,,102933.76,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,131404.00000,74657.18000,Multiplan,Commercial,,123519.76,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,131404.00000,74657.18000,Multiplan,Commercial,,123519.76,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,43800.00000,24884.97000,Multiplan,Commercial,,41172.00,,,,,,,39420.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,43800.00000,24884.97000,Multiplan,Commercial,,41172.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Multiplan,Commercial,,61761.76,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Multiplan,Commercial,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Multiplan,Commercial,,82347.76,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Multiplan,Commercial,,82347.76,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,19714.00000,11200.51000,Multiplan,Commercial,,18531.16,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Multiplan,Commercial,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,24090.00000,13686.73000,Multiplan,Commercial,,22644.60,,,,,,,21681.00,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,24090.00000,13686.73000,Multiplan,Commercial,,22644.60,,,,,,,6263.40,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,28474.00000,16177.50000,Multiplan,Commercial,,26765.56,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Multiplan,Commercial,,26765.56,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,17520.00000,9953.99000,Multiplan,Commercial,,16468.80,,,,,,,15768.00,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Multiplan,Commercial,,16468.80,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,21904.00000,12444.76000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,26284.00000,14933.25000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,43804.00000,24887.24000,Multiplan,Commercial,,41175.76,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Multiplan,Commercial,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Multiplan,Commercial,,61761.76,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Multiplan,Commercial,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Multiplan,Commercial,,82347.76,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Multiplan,Commercial,,82347.76,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,109504.00000,62214.70000,Multiplan,Commercial,,102933.76,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Multiplan,Commercial,,102933.76,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,6105.00000,3468.56000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,6105.00000,3468.56000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,13895.00000,7894.44000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,13895.00000,7894.44000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,21900.00000,12442.48000,Multiplan,Commercial,,20586.00,,,,,,,19710.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,21900.00000,12442.48000,Multiplan,Commercial,,20586.00,,,,,,,5694.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,35040.00000,19907.98000,Multiplan,Commercial,,32937.60,,,,,,,31536.00,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,35040.00000,19907.98000,Multiplan,Commercial,,32937.60,,,,,,,9110.40,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,43804.00000,24887.24000,Multiplan,Commercial,,41175.76,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Multiplan,Commercial,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,19714.00000,11200.51000,Multiplan,Commercial,,18531.16,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Multiplan,Commercial,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,22776.00000,12940.18000,Multiplan,Commercial,,21409.44,,,,,,,20498.40,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,22776.00000,12940.18000,Multiplan,Commercial,,21409.44,,,,,,,5921.76,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,28474.00000,16177.50000,Multiplan,Commercial,,26765.56,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Multiplan,Commercial,,26765.56,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,17520.00000,9953.99000,Multiplan,Commercial,,16468.80,,,,,,,15768.00,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Multiplan,Commercial,,16468.80,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,21904.00000,12444.76000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,26284.00000,14933.25000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,30664.00000,17421.75000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,30664.00000,17421.75000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,35044.00000,19910.25000,Multiplan,Commercial,,32941.36,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,35044.00000,19910.25000,Multiplan,Commercial,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,2157.00000,864.96000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,2157.00000,864.96000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,2695.00000,1080.70000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2695.00000,1080.70000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,3853.00000,1545.05000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,3853.00000,1545.05000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,inpatient,,,1413.00000,566.61000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,outpatient,,,1413.00000,566.61000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,3229.80000,1857.14000,Multiplan,Commercial,,3036.01,,,,,,,2906.82,3132.91,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,3229.80000,1857.14000,Multiplan,Commercial,,3036.01,,,,,,,839.75,3132.91,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,854.40000,491.28000,Multiplan,Commercial,,803.14,,,,,,,768.96,828.77,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,854.40000,491.28000,Multiplan,Commercial,,803.14,,,,,,,222.14,828.77,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1200.50000,690.29000,Multiplan,Commercial,,1128.47,,,,,,,1080.45,1164.48,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1200.50000,690.29000,Multiplan,Commercial,,1128.47,,,,,,,312.13,1164.48,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1011.00000,581.32000,Multiplan,Commercial,,950.34,,,,,,,909.90,980.67,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1011.00000,581.32000,Multiplan,Commercial,,950.34,,,,,,,262.86,980.67,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1823.80000,1048.68000,Multiplan,Commercial,,1714.37,,,,,,,1641.42,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1823.80000,1048.68000,Multiplan,Commercial,,1714.37,,,,,,,474.19,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2028.50000,1166.39000,Multiplan,Commercial,,1906.79,,,,,,,1825.65,1967.64,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2028.50000,1166.39000,Multiplan,Commercial,,1906.79,,,,,,,527.41,1967.64,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,841.00000,483.58000,Multiplan,Commercial,,790.54,,,,,,,756.90,815.77,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,841.00000,483.58000,Multiplan,Commercial,,790.54,,,,,,,218.66,815.77,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1366.20000,785.56000,Multiplan,Commercial,,1284.23,,,,,,,1229.58,1325.21,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1366.20000,785.56000,Multiplan,Commercial,,1284.23,,,,,,,355.21,1325.21,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1384.00000,795.80000,Multiplan,Commercial,,1300.96,,,,,,,1245.60,1342.48,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1384.00000,795.80000,Multiplan,Commercial,,1300.96,,,,,,,359.84,1342.48,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2458.70000,1413.75000,Multiplan,Commercial,,2311.18,,,,,,,2212.83,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2458.70000,1413.75000,Multiplan,Commercial,,2311.18,,,,,,,639.26,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2393.50000,1376.26000,Multiplan,Commercial,,2249.89,,,,,,,2154.15,2321.70,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2393.50000,1376.26000,Multiplan,Commercial,,2249.89,,,,,,,622.31,2321.70,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1369.50000,787.46000,Multiplan,Commercial,,1287.33,,,,,,,1232.55,1328.41,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1369.50000,787.46000,Multiplan,Commercial,,1287.33,,,,,,,356.07,1328.41,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2697.40000,1551.00000,Multiplan,Commercial,,2535.56,,,,,,,2427.66,2616.48,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2697.40000,1551.00000,Multiplan,Commercial,,2535.56,,,,,,,701.32,2616.48,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4621.80000,2657.54000,Multiplan,Commercial,,4344.49,,,,,,,4159.62,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4621.80000,2657.54000,Multiplan,Commercial,,4344.49,,,,,,,1201.67,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2592.50000,1490.69000,Multiplan,Commercial,,2436.95,,,,,,,2333.25,2514.72,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2592.50000,1490.69000,Multiplan,Commercial,,2436.95,,,,,,,674.05,2514.72,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Multiplan,Commercial,,5509.34,,,,,,,5274.90,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Multiplan,Commercial,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Multiplan,Commercial,,7838.66,,,,,,,7505.10,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Multiplan,Commercial,,7838.66,,,,,,,2168.14,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Multiplan,Commercial,,5509.34,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Multiplan,Commercial,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,8107.00000,4661.52000,Multiplan,Commercial,,7620.58,,,,,,,7296.30,7863.79,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Multiplan,Commercial,,7620.58,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Multiplan,Commercial,,1058.44,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Multiplan,Commercial,,1058.44,,,,,,,292.76,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Multiplan,Commercial,,4133.18,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Multiplan,Commercial,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Multiplan,Commercial,,6968.22,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Multiplan,Commercial,,6968.22,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,inpatient,,,20152.00000,11587.40000,Multiplan,Commercial,,18942.88,,,,,,,18136.80,19547.44,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,outpatient,,,20152.00000,11587.40000,Multiplan,Commercial,,18942.88,,,,,,,5239.52,19547.44,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Multiplan,Commercial,,420.18,,,,,,,402.30,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Multiplan,Commercial,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Multiplan,Commercial,,666.46,,,,,,,638.10,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Multiplan,Commercial,,666.46,,,,,,,184.34,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,1272.00000,731.40000,Multiplan,Commercial,,1195.68,,,,,,,1144.80,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,1272.00000,731.40000,Multiplan,Commercial,,1195.68,,,,,,,330.72,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Multiplan,Commercial,,2528.60,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Multiplan,Commercial,,2528.60,,,,,,,699.40,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,3078.00000,1769.85000,Multiplan,Commercial,,2893.32,,,,,,,2770.20,2985.66,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,3078.00000,1769.85000,Multiplan,Commercial,,2893.32,,,,,,,800.28,2985.66,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,70.00000,40.25000,Multiplan,Commercial,,65.80,,,,,,,63.00,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,70.00000,40.25000,Multiplan,Commercial,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,102.00000,58.65000,Multiplan,Commercial,,95.88,,,,,,,91.80,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,102.00000,58.65000,Multiplan,Commercial,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,221.00000,127.07000,Multiplan,Commercial,,207.74,,,,,,,198.90,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,221.00000,127.07000,Multiplan,Commercial,,207.74,,,,,,,57.46,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Multiplan,Commercial,,420.18,,,,,,,402.30,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Multiplan,Commercial,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Multiplan,Commercial,,666.46,,,,,,,638.10,687.73,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Multiplan,Commercial,,666.46,,,,,,,184.34,687.73,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Multiplan,Commercial,,11755.64,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Multiplan,Commercial,,11755.64,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35482.00000,20402.15000,Multiplan,Commercial,,33353.08,,,,,,,31933.80,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35482.00000,20402.15000,Multiplan,Commercial,,33353.08,,,,,,,9225.32,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39862.00000,22920.65000,Multiplan,Commercial,,37470.28,,,,,,,35875.80,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39862.00000,22920.65000,Multiplan,Commercial,,37470.28,,,,,,,10364.12,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,44242.00000,25439.15000,Multiplan,Commercial,,41587.48,,,,,,,39817.80,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,44242.00000,25439.15000,Multiplan,Commercial,,41587.48,,,,,,,11502.92,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,48622.00000,27957.65000,Multiplan,Commercial,,45704.68,,,,,,,43759.80,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,48622.00000,27957.65000,Multiplan,Commercial,,45704.68,,,,,,,12641.72,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,53002.00000,30476.15000,Multiplan,Commercial,,49821.88,,,,,,,47701.80,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,53002.00000,30476.15000,Multiplan,Commercial,,49821.88,,,,,,,13780.52,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Multiplan,Commercial,,57644.56,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Multiplan,Commercial,,57644.56,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Multiplan,Commercial,,65878.96,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Multiplan,Commercial,,65878.96,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Multiplan,Commercial,,74113.36,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Multiplan,Commercial,,74113.36,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Multiplan,Commercial,,82347.76,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Multiplan,Commercial,,82347.76,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Multiplan,Commercial,,90582.16,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Multiplan,Commercial,,90582.16,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,844.00000,485.30000,Multiplan,Commercial,,793.36,,,,,,,759.60,818.68,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,844.00000,485.30000,Multiplan,Commercial,,793.36,,,,,,,219.44,818.68,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,11575.00000,6655.62000,Multiplan,Commercial,,10880.50,,,,,,,10417.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,11575.00000,6655.62000,Multiplan,Commercial,,10880.50,,,,,,,3009.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,14892.00000,8562.90000,Multiplan,Commercial,,13998.48,,,,,,,13402.80,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14892.00000,8562.90000,Multiplan,Commercial,,13998.48,,,,,,,3871.92,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,24970.00000,14357.75000,Multiplan,Commercial,,23471.80,,,,,,,22473.00,24220.90,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,24970.00000,14357.75000,Multiplan,Commercial,,23471.80,,,,,,,6492.20,24220.90,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Multiplan,Commercial,,1774.72,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Multiplan,Commercial,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Multiplan,Commercial,,420.18,,,,,,,402.30,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Multiplan,Commercial,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Multiplan,Commercial,,1774.72,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Multiplan,Commercial,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Multiplan,Commercial,,3139.60,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Multiplan,Commercial,,3139.60,,,,,,,868.40,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,4153.00000,2387.98000,Multiplan,Commercial,,3903.82,,,,,,,3737.70,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Multiplan,Commercial,,3903.82,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,4641.00000,2668.58000,Multiplan,Commercial,,4362.54,,,,,,,4176.90,4501.77,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4641.00000,2668.58000,Multiplan,Commercial,,4362.54,,,,,,,1206.66,4501.77,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Multiplan,Commercial,,4587.20,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Multiplan,Commercial,,4587.20,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Multiplan,Commercial,,90582.16,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Multiplan,Commercial,,90582.16,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Multiplan,Commercial,,102933.76,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Multiplan,Commercial,,102933.76,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,131404.00000,75557.30000,Multiplan,Commercial,,123519.76,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Multiplan,Commercial,,123519.76,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,153304.00000,88149.80000,Multiplan,Commercial,,144105.76,,,,,,,137973.60,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,153304.00000,88149.80000,Multiplan,Commercial,,144105.76,,,,,,,39859.04,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,175204.00000,100742.30000,Multiplan,Commercial,,164691.76,,,,,,,157683.60,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,175204.00000,100742.30000,Multiplan,Commercial,,164691.76,,,,,,,45553.04,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,197104.00000,113334.80000,Multiplan,Commercial,,185277.76,,,,,,,177393.60,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,197104.00000,113334.80000,Multiplan,Commercial,,185277.76,,,,,,,51247.04,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,219004.00000,125927.30000,Multiplan,Commercial,,205863.76,,,,,,,197103.60,212433.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,219004.00000,125927.30000,Multiplan,Commercial,,205863.76,,,,,,,56941.04,212433.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Multiplan,Commercial,,45292.96,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Multiplan,Commercial,,45292.96,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Multiplan,Commercial,,49410.16,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Multiplan,Commercial,,49410.16,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Multiplan,Commercial,,53527.36,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Multiplan,Commercial,,53527.36,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Multiplan,Commercial,,57644.56,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Multiplan,Commercial,,57644.56,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Multiplan,Commercial,,61761.76,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Multiplan,Commercial,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Multiplan,Commercial,,49410.16,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Multiplan,Commercial,,49410.16,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Multiplan,Commercial,,61761.76,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Multiplan,Commercial,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Multiplan,Commercial,,82347.76,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Multiplan,Commercial,,82347.76,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Multiplan,Commercial,,102933.76,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Multiplan,Commercial,,102933.76,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Multiplan,Commercial,,4587.20,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Multiplan,Commercial,,4587.20,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Multiplan,Commercial,,45292.96,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Multiplan,Commercial,,45292.96,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Multiplan,Commercial,,49410.16,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Multiplan,Commercial,,49410.16,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Multiplan,Commercial,,53527.36,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Multiplan,Commercial,,53527.36,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Multiplan,Commercial,,57644.56,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Multiplan,Commercial,,57644.56,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Multiplan,Commercial,,65878.96,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Multiplan,Commercial,,65878.96,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Multiplan,Commercial,,74113.36,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Multiplan,Commercial,,74113.36,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Multiplan,Commercial,,82347.76,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Multiplan,Commercial,,82347.76,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Multiplan,Commercial,,90582.16,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Multiplan,Commercial,,90582.16,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Multiplan,Commercial,,102933.76,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Multiplan,Commercial,,102933.76,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,122644.00000,70520.30000,Multiplan,Commercial,,115285.36,,,,,,,110379.60,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Multiplan,Commercial,,115285.36,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,135784.00000,78075.80000,Multiplan,Commercial,,127636.96,,,,,,,122205.60,131710.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,135784.00000,78075.80000,Multiplan,Commercial,,127636.96,,,,,,,35303.84,131710.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Multiplan,Commercial,,45292.96,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Multiplan,Commercial,,45292.96,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,55630.00000,31987.25000,Multiplan,Commercial,,52292.20,,,,,,,50067.00,53961.10,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,55630.00000,31987.25000,Multiplan,Commercial,,52292.20,,,,,,,14463.80,53961.10,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Multiplan,Commercial,,2528.60,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Multiplan,Commercial,,2528.60,,,,,,,699.40,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,14020.00000,8061.50000,Multiplan,Commercial,,13178.80,,,,,,,12618.00,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Multiplan,Commercial,,13178.80,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,17962.00000,10328.15000,Multiplan,Commercial,,16884.28,,,,,,,16165.80,17423.14,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,17962.00000,10328.15000,Multiplan,Commercial,,16884.28,,,,,,,4670.12,17423.14,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,2421.00000,1392.07000,Multiplan,Commercial,,2275.74,,,,,,,2178.90,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,2421.00000,1392.07000,Multiplan,Commercial,,2275.74,,,,,,,629.46,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Multiplan,Commercial,,2280.44,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Multiplan,Commercial,,2280.44,,,,,,,630.76,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Multiplan,Commercial,,2528.60,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Multiplan,Commercial,,2528.60,,,,,,,699.40,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,27160.00000,15617.00000,Multiplan,Commercial,,25530.40,,,,,,,24444.00,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,27160.00000,15617.00000,Multiplan,Commercial,,25530.40,,,,,,,7061.60,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Multiplan,Commercial,,30882.76,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Multiplan,Commercial,,30882.76,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Multiplan,Commercial,,49410.16,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Multiplan,Commercial,,49410.16,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Multiplan,Commercial,,61761.76,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Multiplan,Commercial,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Multiplan,Commercial,,74113.36,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Multiplan,Commercial,,74113.36,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,28470.00000,16370.25000,Multiplan,Commercial,,26761.80,,,,,,,25623.00,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,28470.00000,16370.25000,Multiplan,Commercial,,26761.80,,,,,,,7402.20,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,43800.00000,25185.00000,Multiplan,Commercial,,41172.00,,,,,,,39420.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,43800.00000,25185.00000,Multiplan,Commercial,,41172.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Multiplan,Commercial,,61761.76,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Multiplan,Commercial,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Multiplan,Commercial,,82347.76,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Multiplan,Commercial,,82347.76,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Multiplan,Commercial,,102933.76,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Multiplan,Commercial,,102933.76,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Multiplan,Commercial,,3674.46,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Multiplan,Commercial,,3674.46,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Multiplan,Commercial,,30882.76,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Multiplan,Commercial,,30882.76,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,54754.00000,31483.55000,Multiplan,Commercial,,51468.76,,,,,,,49278.60,53111.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,54754.00000,31483.55000,Multiplan,Commercial,,51468.76,,,,,,,14236.04,53111.38,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Multiplan,Commercial,,2528.60,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Multiplan,Commercial,,2528.60,,,,,,,699.40,2609.30,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,61320.00000,35259.00000,Multiplan,Commercial,,57640.80,,,,,,,55188.00,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,61320.00000,35259.00000,Multiplan,Commercial,,57640.80,,,,,,,15943.20,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,70080.00000,40296.00000,Multiplan,Commercial,,65875.20,,,,,,,63072.00,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,70080.00000,40296.00000,Multiplan,Commercial,,65875.20,,,,,,,18220.80,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,78840.00000,45333.00000,Multiplan,Commercial,,74109.60,,,,,,,70956.00,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,78840.00000,45333.00000,Multiplan,Commercial,,74109.60,,,,,,,20498.40,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Multiplan,Commercial,,90582.16,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Multiplan,Commercial,,90582.16,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Multiplan,Commercial,,102933.76,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Multiplan,Commercial,,102933.76,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,122644.00000,70520.30000,Multiplan,Commercial,,115285.36,,,,,,,110379.60,118964.68,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Multiplan,Commercial,,115285.36,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Multiplan,Commercial,,22648.36,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Multiplan,Commercial,,22648.36,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Multiplan,Commercial,,30882.76,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Multiplan,Commercial,,30882.76,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,1883.00000,1082.72000,Multiplan,Commercial,,1770.02,,,,,,,1694.70,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1883.00000,1082.72000,Multiplan,Commercial,,1770.02,,,,,,,489.58,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Multiplan,Commercial,,3674.46,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Multiplan,Commercial,,3674.46,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,7644.00000,4395.30000,Multiplan,Commercial,,7185.36,,,,,,,6879.60,7414.68,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,7644.00000,4395.30000,Multiplan,Commercial,,7185.36,,,,,,,1987.44,7414.68,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Multiplan,Commercial,,2528.60,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Multiplan,Commercial,,2528.60,,,,,,,699.40,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,inpatient,,,1614.00000,928.05000,Multiplan,Commercial,,1517.16,,,,,,,1452.60,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Multiplan,Commercial,,1517.16,,,,,,,419.64,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Multiplan,Commercial,,22648.36,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Multiplan,Commercial,,22648.36,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Multiplan,Commercial,,26765.56,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Multiplan,Commercial,,26765.56,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Multiplan,Commercial,,30882.76,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Multiplan,Commercial,,30882.76,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,37234.00000,21409.55000,Multiplan,Commercial,,34999.96,,,,,,,33510.60,36116.98,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,37234.00000,21409.55000,Multiplan,Commercial,,34999.96,,,,,,,9680.84,36116.98,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Multiplan,Commercial,,61761.76,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Multiplan,Commercial,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Multiplan,Commercial,,49410.16,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Multiplan,Commercial,,49410.16,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Multiplan,Commercial,,61761.76,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Multiplan,Commercial,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Multiplan,Commercial,,74113.36,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Multiplan,Commercial,,74113.36,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,159.00000,91.42000,Multiplan,Commercial,,149.46,,,,,,,143.10,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,159.00000,91.42000,Multiplan,Commercial,,149.46,,,,,,,41.34,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Multiplan,Commercial,,1774.72,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Multiplan,Commercial,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Multiplan,Commercial,,1774.72,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Multiplan,Commercial,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Multiplan,Commercial,,2280.44,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Multiplan,Commercial,,2280.44,,,,,,,630.76,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2827.00000,1625.52000,Multiplan,Commercial,,2657.38,,,,,,,2544.30,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Multiplan,Commercial,,2657.38,,,,,,,735.02,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Multiplan,Commercial,,3139.60,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Multiplan,Commercial,,3139.60,,,,,,,868.40,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8107.00000,4661.52000,Multiplan,Commercial,,7620.58,,,,,,,7296.30,7863.79,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Multiplan,Commercial,,7620.58,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Multiplan,Commercial,,61761.76,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Multiplan,Commercial,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Multiplan,Commercial,,82347.76,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Multiplan,Commercial,,82347.76,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Multiplan,Commercial,,102933.76,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Multiplan,Commercial,,102933.76,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,131404.00000,75557.30000,Multiplan,Commercial,,123519.76,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Multiplan,Commercial,,123519.76,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,18400.00000,10580.00000,Multiplan,Commercial,,17296.00,,,,,,,16560.00,17848.00,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,18400.00000,10580.00000,Multiplan,Commercial,,17296.00,,,,,,,4784.00,17848.00,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Multiplan,Commercial,,22648.36,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Multiplan,Commercial,,22648.36,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Multiplan,Commercial,,26765.56,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Multiplan,Commercial,,26765.56,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Multiplan,Commercial,,30882.76,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Multiplan,Commercial,,30882.76,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1614.00000,928.05000,Multiplan,Commercial,,1517.16,,,,,,,1452.60,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Multiplan,Commercial,,1517.16,,,,,,,419.64,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Multiplan,Commercial,,53527.36,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Multiplan,Commercial,,53527.36,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Multiplan,Commercial,,61761.76,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Multiplan,Commercial,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,5368.00000,3086.60000,Multiplan,Commercial,,5045.92,,,,,,,4831.20,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,5368.00000,3086.60000,Multiplan,Commercial,,5045.92,,,,,,,1395.68,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,14020.00000,8061.50000,Multiplan,Commercial,,13178.80,,,,,,,12618.00,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Multiplan,Commercial,,13178.80,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,25408.00000,14609.60000,Multiplan,Commercial,,23883.52,,,,,,,22867.20,24645.76,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,25408.00000,14609.60000,Multiplan,Commercial,,23883.52,,,,,,,6606.08,24645.76,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,8112.00000,4664.40000,Multiplan,Commercial,,7625.28,,,,,,,7300.80,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,8112.00000,4664.40000,Multiplan,Commercial,,7625.28,,,,,,,2109.12,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,10431.00000,5997.82000,Multiplan,Commercial,,9805.14,,,,,,,9387.90,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,10431.00000,5997.82000,Multiplan,Commercial,,9805.14,,,,,,,2712.06,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Multiplan,Commercial,,30882.76,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Multiplan,Commercial,,30882.76,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,46870.00000,26950.25000,Multiplan,Commercial,,44057.80,,,,,,,42183.00,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,46870.00000,26950.25000,Multiplan,Commercial,,44057.80,,,,,,,12186.20,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,51250.00000,29468.75000,Multiplan,Commercial,,48175.00,,,,,,,46125.00,49712.50,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,51250.00000,29468.75000,Multiplan,Commercial,,48175.00,,,,,,,13325.00,49712.50,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Multiplan,Commercial,,49410.16,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Multiplan,Commercial,,49410.16,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Multiplan,Commercial,,61761.76,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Multiplan,Commercial,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Multiplan,Commercial,,74113.36,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Multiplan,Commercial,,74113.36,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Multiplan,Commercial,,82347.76,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Multiplan,Commercial,,82347.76,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,588.00000,338.10000,Multiplan,Commercial,,552.72,,,,,,,529.20,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,588.00000,338.10000,Multiplan,Commercial,,552.72,,,,,,,152.88,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Multiplan,Commercial,,4133.18,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Multiplan,Commercial,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Multiplan,Commercial,,3674.46,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Multiplan,Commercial,,3674.46,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Multiplan,Commercial,,5050.62,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Multiplan,Commercial,,5050.62,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Multiplan,Commercial,,6097.78,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Multiplan,Commercial,,6097.78,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,7876.00000,4528.70000,Multiplan,Commercial,,7403.44,,,,,,,7088.40,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7876.00000,4528.70000,Multiplan,Commercial,,7403.44,,,,,,,2047.76,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Multiplan,Commercial,,22648.36,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Multiplan,Commercial,,22648.36,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5856.00000,3367.20000,Multiplan,Commercial,,5504.64,,,,,,,5270.40,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5856.00000,3367.20000,Multiplan,Commercial,,5504.64,,,,,,,1522.56,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Multiplan,Commercial,,6097.78,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Multiplan,Commercial,,6097.78,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Multiplan,Commercial,,6968.22,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Multiplan,Commercial,,6968.22,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Multiplan,Commercial,,7838.66,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Multiplan,Commercial,,7838.66,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Multiplan,Commercial,,4133.18,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Multiplan,Commercial,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Multiplan,Commercial,,5050.62,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Multiplan,Commercial,,5050.62,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Multiplan,Commercial,,5662.56,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Multiplan,Commercial,,5662.56,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Multiplan,Commercial,,11755.64,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Multiplan,Commercial,,11755.64,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Multiplan,Commercial,,4133.18,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Multiplan,Commercial,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Multiplan,Commercial,,5050.62,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Multiplan,Commercial,,5050.62,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Multiplan,Commercial,,5662.56,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Multiplan,Commercial,,5662.56,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Multiplan,Commercial,,11755.64,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Multiplan,Commercial,,11755.64,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4392.00000,2525.40000,Multiplan,Commercial,,4128.48,,,,,,,3952.80,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4392.00000,2525.40000,Multiplan,Commercial,,4128.48,,,,,,,1141.92,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Multiplan,Commercial,,5050.62,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Multiplan,Commercial,,5050.62,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Multiplan,Commercial,,6097.78,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Multiplan,Commercial,,6097.78,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Multiplan,Commercial,,4133.18,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Multiplan,Commercial,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Multiplan,Commercial,,5050.62,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Multiplan,Commercial,,5050.62,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Multiplan,Commercial,,6097.78,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Multiplan,Commercial,,6097.78,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Multiplan,Commercial,,4587.20,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Multiplan,Commercial,,4587.20,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Multiplan,Commercial,,1058.44,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Multiplan,Commercial,,1058.44,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Multiplan,Commercial,,4133.18,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Multiplan,Commercial,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Multiplan,Commercial,,5050.62,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Multiplan,Commercial,,5050.62,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Multiplan,Commercial,,5662.56,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Multiplan,Commercial,,5662.56,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Multiplan,Commercial,,11755.64,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Multiplan,Commercial,,11755.64,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Multiplan,Commercial,,12767.08,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Multiplan,Commercial,,12767.08,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2152.00000,1237.40000,Multiplan,Commercial,,2022.88,,,,,,,1936.80,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2152.00000,1237.40000,Multiplan,Commercial,,2022.88,,,,,,,559.52,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Multiplan,Commercial,,4587.20,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Multiplan,Commercial,,4587.20,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Multiplan,Commercial,,3674.46,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Multiplan,Commercial,,3674.46,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Multiplan,Commercial,,5509.34,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Multiplan,Commercial,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Multiplan,Commercial,,5662.56,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Multiplan,Commercial,,5662.56,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Multiplan,Commercial,,4133.18,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Multiplan,Commercial,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Multiplan,Commercial,,5050.62,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Multiplan,Commercial,,5050.62,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Multiplan,Commercial,,5662.56,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Multiplan,Commercial,,5662.56,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Multiplan,Commercial,,1058.44,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Multiplan,Commercial,,1058.44,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Multiplan,Commercial,,4133.18,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Multiplan,Commercial,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Multiplan,Commercial,,5050.62,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Multiplan,Commercial,,5050.62,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Multiplan,Commercial,,5662.56,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Multiplan,Commercial,,5662.56,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Multiplan,Commercial,,11755.64,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Multiplan,Commercial,,11755.64,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Multiplan,Commercial,,12767.08,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Multiplan,Commercial,,12767.08,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Multiplan,Commercial,,5050.62,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Multiplan,Commercial,,5050.62,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8802.00000,5061.15000,Multiplan,Commercial,,8273.88,,,,,,,7921.80,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8802.00000,5061.15000,Multiplan,Commercial,,8273.88,,,,,,,2288.52,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,10654.00000,6126.05000,Multiplan,Commercial,,10014.76,,,,,,,9588.60,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10654.00000,6126.05000,Multiplan,Commercial,,10014.76,,,,,,,2770.04,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Multiplan,Commercial,,11755.64,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Multiplan,Commercial,,11755.64,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Multiplan,Commercial,,12767.08,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Multiplan,Commercial,,12767.08,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17086.00000,9824.45000,Multiplan,Commercial,,16060.84,,,,,,,15377.40,16573.42,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17086.00000,9824.45000,Multiplan,Commercial,,16060.84,,,,,,,4442.36,16573.42,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Multiplan,Commercial,,4587.20,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Multiplan,Commercial,,4587.20,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Multiplan,Commercial,,6097.78,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Multiplan,Commercial,,6097.78,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Multiplan,Commercial,,6968.22,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Multiplan,Commercial,,6968.22,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Multiplan,Commercial,,7838.66,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Multiplan,Commercial,,7838.66,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Multiplan,Commercial,,4587.20,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Multiplan,Commercial,,4587.20,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Multiplan,Commercial,,4587.20,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Multiplan,Commercial,,4587.20,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Multiplan,Commercial,,3380.24,,,,,,,934.96,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Multiplan,Commercial,,4133.18,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Multiplan,Commercial,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Multiplan,Commercial,,5738.70,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Multiplan,Commercial,,22648.36,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Multiplan,Commercial,,22648.36,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Multiplan,Commercial,,3674.46,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Multiplan,Commercial,,3674.46,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Multiplan,Commercial,,6097.78,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Multiplan,Commercial,,6097.78,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Multiplan,Commercial,,1774.72,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Multiplan,Commercial,,1774.72,,,,,,,490.88,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Multiplan,Commercial,,2280.44,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Multiplan,Commercial,,2280.44,,,,,,,630.76,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2827.00000,1625.52000,Multiplan,Commercial,,2657.38,,,,,,,2544.30,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Multiplan,Commercial,,2657.38,,,,,,,735.02,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Multiplan,Commercial,,3139.60,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Multiplan,Commercial,,3139.60,,,,,,,868.40,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4153.00000,2387.98000,Multiplan,Commercial,,3903.82,,,,,,,3737.70,4028.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Multiplan,Commercial,,3903.82,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Multiplan,Commercial,,6968.22,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Multiplan,Commercial,,6968.22,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Multiplan,Commercial,,7838.66,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Multiplan,Commercial,,7838.66,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9728.00000,5593.60000,Multiplan,Commercial,,9144.32,,,,,,,8755.20,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9728.00000,5593.60000,Multiplan,Commercial,,9144.32,,,,,,,2529.28,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11117.00000,6392.28000,Multiplan,Commercial,,10449.98,,,,,,,10005.30,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11117.00000,6392.28000,Multiplan,Commercial,,10449.98,,,,,,,2890.42,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Multiplan,Commercial,,45292.96,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Multiplan,Commercial,,45292.96,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Multiplan,Commercial,,49410.16,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Multiplan,Commercial,,49410.16,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Multiplan,Commercial,,53527.36,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Multiplan,Commercial,,53527.36,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Multiplan,Commercial,,57644.56,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Multiplan,Commercial,,57644.56,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Multiplan,Commercial,,61761.76,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Multiplan,Commercial,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Multiplan,Commercial,,65878.96,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Multiplan,Commercial,,65878.96,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,74464.00000,42816.80000,Multiplan,Commercial,,69996.16,,,,,,,67017.60,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Multiplan,Commercial,,69996.16,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Multiplan,Commercial,,74113.36,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Multiplan,Commercial,,74113.36,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,83224.00000,47853.80000,Multiplan,Commercial,,78230.56,,,,,,,74901.60,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Multiplan,Commercial,,78230.56,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,111694.00000,64224.05000,Multiplan,Commercial,,104992.36,,,,,,,100524.60,108343.18,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,111694.00000,64224.05000,Multiplan,Commercial,,104992.36,,,,,,,29040.44,108343.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Multiplan,Commercial,,420.18,,,,,,,402.30,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Multiplan,Commercial,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Multiplan,Commercial,,666.46,,,,,,,638.10,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Multiplan,Commercial,,666.46,,,,,,,184.34,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,991.00000,569.82000,Multiplan,Commercial,,931.54,,,,,,,891.90,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,991.00000,569.82000,Multiplan,Commercial,,931.54,,,,,,,257.66,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1490.00000,856.75000,Multiplan,Commercial,,1400.60,,,,,,,1341.00,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1490.00000,856.75000,Multiplan,Commercial,,1400.60,,,,,,,387.40,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Multiplan,Commercial,,3674.46,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Multiplan,Commercial,,3674.46,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Multiplan,Commercial,,5509.34,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Multiplan,Commercial,,5509.34,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Multiplan,Commercial,,6097.78,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Multiplan,Commercial,,6097.78,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Multiplan,Commercial,,6968.22,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Multiplan,Commercial,,6968.22,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Multiplan,Commercial,,7838.66,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Multiplan,Commercial,,7838.66,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Multiplan,Commercial,,1328.22,,,,,,,367.38,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Multiplan,Commercial,,3621.82,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,6945.00000,3993.37000,Multiplan,Commercial,,6528.30,,,,,,,6250.50,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,6945.00000,3993.37000,Multiplan,Commercial,,6528.30,,,,,,,1805.70,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Multiplan,Commercial,,420.18,,,,,,,402.30,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Multiplan,Commercial,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Multiplan,Commercial,,3674.46,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Multiplan,Commercial,,3674.46,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Multiplan,Commercial,,5050.62,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Multiplan,Commercial,,5050.62,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Multiplan,Commercial,,1064.08,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,50374.00000,28965.05000,Multiplan,Commercial,,47351.56,,,,,,,45336.60,48862.78,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,50374.00000,28965.05000,Multiplan,Commercial,,47351.56,,,,,,,13097.24,48862.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Multiplan,Commercial,,18531.16,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Multiplan,Commercial,,22648.36,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Multiplan,Commercial,,22648.36,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Multiplan,Commercial,,26765.56,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Multiplan,Commercial,,26765.56,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Multiplan,Commercial,,2533.30,,,,,,,700.70,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Multiplan,Commercial,,6533.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Multiplan,Commercial,,10885.20,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Multiplan,Commercial,,14413.96,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Multiplan,Commercial,,45292.96,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Multiplan,Commercial,,45292.96,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Multiplan,Commercial,,2027.58,,,,,,,560.82,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Multiplan,Commercial,,2898.02,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Multiplan,Commercial,,2898.02,,,,,,,801.58,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Multiplan,Commercial,,45292.96,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Multiplan,Commercial,,45292.96,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Multiplan,Commercial,,49410.16,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Multiplan,Commercial,,49410.16,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Multiplan,Commercial,,53527.36,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Multiplan,Commercial,,53527.36,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Multiplan,Commercial,,61761.76,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Multiplan,Commercial,,61761.76,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,74464.00000,42816.80000,Multiplan,Commercial,,69996.16,,,,,,,67017.60,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Multiplan,Commercial,,69996.16,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,83224.00000,47853.80000,Multiplan,Commercial,,78230.56,,,,,,,74901.60,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Multiplan,Commercial,,78230.56,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,91984.00000,52890.80000,Multiplan,Commercial,,86464.96,,,,,,,82785.60,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,91984.00000,52890.80000,Multiplan,Commercial,,86464.96,,,,,,,23915.84,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,100744.00000,57927.80000,Multiplan,Commercial,,94699.36,,,,,,,90669.60,97721.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,100744.00000,57927.80000,Multiplan,Commercial,,94699.36,,,,,,,26193.44,97721.68,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Multiplan,Commercial,,156.04,,,,,,,149.40,161.02,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Multiplan,Commercial,,156.04,,,,,,,43.16,161.02,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Multiplan,Commercial,,420.18,,,,,,,402.30,433.59,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Multiplan,Commercial,,420.18,,,,,,,116.22,433.59,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Multiplan,Commercial,,666.46,,,,,,,638.10,687.73,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Multiplan,Commercial,,666.46,,,,,,,184.34,687.73,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Multiplan,Commercial,,16472.56,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Multiplan,Commercial,,20589.76,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Multiplan,Commercial,,24706.96,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Multiplan,Commercial,,28824.16,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Multiplan,Commercial,,32941.36,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Multiplan,Commercial,,37058.56,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Multiplan,Commercial,,41175.76,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Multiplan,Commercial,,49410.16,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Multiplan,Commercial,,49410.16,,,,,,,13666.64,50987.08,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,4396.50,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Multiplan,Commercial,,4591.90,,,,,,,1270.10,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,8338.50,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Multiplan,Commercial,,8709.10,,,,,,,2408.90,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,12505.50,13478.15,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Multiplan,Commercial,,13061.30,,,,,,,3612.70,13478.15,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2180.20000,1253.61000,Multiplan,Commercial,,2049.39,,,,,,,1962.18,2114.79,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2180.20000,1253.61000,Multiplan,Commercial,,2049.39,,,,,,,566.85,2114.79,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1880.60000,1081.34000,Multiplan,Commercial,,1767.76,,,,,,,1692.54,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1880.60000,1081.34000,Multiplan,Commercial,,1767.76,,,,,,,488.96,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2908.70000,1672.50000,Multiplan,Commercial,,2734.18,,,,,,,2617.83,2821.44,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2908.70000,1672.50000,Multiplan,Commercial,,2734.18,,,,,,,756.26,2821.44,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,inpatient,,,34.00000,25.74000,Multiplan,Commercial,,31.96,,,,,,,30.60,32.98,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,outpatient,,,34.00000,25.74000,Multiplan,Commercial,,31.96,,,,,,,8.84,32.98,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,inpatient,,,13.00000,9.84000,Multiplan,Commercial,,12.22,,,,,,,11.70,12.61,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,outpatient,,,13.00000,9.84000,Multiplan,Commercial,,12.22,,,,,,,3.38,12.61,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Multiplan,Commercial,,264.14,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Multiplan,Commercial,,264.14,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Multiplan,Commercial,,264.14,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Multiplan,Commercial,,264.14,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Multiplan,Commercial,,264.14,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Multiplan,Commercial,,264.14,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Multiplan,Commercial,,705.94,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Multiplan,Commercial,,705.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Multiplan,Commercial,,705.94,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Multiplan,Commercial,,705.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Multiplan,Commercial,,705.94,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Multiplan,Commercial,,705.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,inpatient,,,122.00000,92.35000,Multiplan,Commercial,,114.68,,,,,,,109.80,118.34,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,outpatient,,,122.00000,92.35000,Multiplan,Commercial,,114.68,,,,,,,31.72,118.34,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,inpatient,,,79.00000,59.80000,Multiplan,Commercial,,74.26,,,,,,,71.10,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Multiplan,Commercial,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,inpatient,,,79.00000,59.80000,Multiplan,Commercial,,74.26,,,,,,,71.10,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Multiplan,Commercial,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,inpatient,,,15.00000,11.36000,Multiplan,Commercial,,14.10,,,,,,,13.50,14.55,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Multiplan,Commercial,,14.10,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,inpatient,,,15.00000,11.36000,Multiplan,Commercial,,14.10,,,,,,,13.50,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Multiplan,Commercial,,14.10,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,inpatient,,,17.00000,12.87000,Multiplan,Commercial,,15.98,,,,,,,15.30,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Multiplan,Commercial,,15.98,,,,,,,4.42,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,inpatient,,,17.00000,12.87000,Multiplan,Commercial,,15.98,,,,,,,15.30,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Multiplan,Commercial,,15.98,,,,,,,4.42,16.49,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,inpatient,,,359.00000,271.76000,Multiplan,Commercial,,337.46,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,outpatient,,,359.00000,271.76000,Multiplan,Commercial,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,inpatient,,,359.00000,271.76000,Multiplan,Commercial,,337.46,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,outpatient,,,359.00000,271.76000,Multiplan,Commercial,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,inpatient,,,359.00000,271.76000,Multiplan,Commercial,,337.46,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,outpatient,,,359.00000,271.76000,Multiplan,Commercial,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,inpatient,,,155.00000,117.34000,Multiplan,Commercial,,145.70,,,,,,,139.50,150.35,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,outpatient,,,155.00000,117.34000,Multiplan,Commercial,,145.70,,,,,,,40.30,150.35,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,inpatient,,,294.00000,222.56000,Multiplan,Commercial,,276.36,,,,,,,264.60,285.18,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,outpatient,,,294.00000,222.56000,Multiplan,Commercial,,276.36,,,,,,,76.44,285.18,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,inpatient,,,1511.00000,1143.83000,Multiplan,Commercial,,1420.34,,,,,,,1359.90,1465.67,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,outpatient,,,1511.00000,1143.83000,Multiplan,Commercial,,1420.34,,,,,,,392.86,1465.67,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,inpatient,,,751.00000,568.51000,Multiplan,Commercial,,705.94,,,,,,,675.90,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Multiplan,Commercial,,705.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,inpatient,,,751.00000,568.51000,Multiplan,Commercial,,705.94,,,,,,,675.90,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Multiplan,Commercial,,705.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,inpatient,,,150.00000,113.55000,Multiplan,Commercial,,141.00,,,,,,,135.00,145.50,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,outpatient,,,150.00000,113.55000,Multiplan,Commercial,,141.00,,,,,,,39.00,145.50,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,inpatient,,,110.00000,83.27000,Multiplan,Commercial,,103.40,,,,,,,99.00,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,outpatient,,,110.00000,83.27000,Multiplan,Commercial,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,inpatient,,,158.00000,119.61000,Multiplan,Commercial,,148.52,,,,,,,142.20,153.26,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,outpatient,,,158.00000,119.61000,Multiplan,Commercial,,148.52,,,,,,,41.08,153.26,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,inpatient,,,153.00000,115.82000,Multiplan,Commercial,,143.82,,,,,,,137.70,148.41,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,outpatient,,,153.00000,115.82000,Multiplan,Commercial,,143.82,,,,,,,39.78,148.41,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,inpatient,,,157.00000,118.85000,Multiplan,Commercial,,147.58,,,,,,,141.30,152.29,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,outpatient,,,157.00000,118.85000,Multiplan,Commercial,,147.58,,,,,,,40.82,152.29,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,inpatient,,,26.00000,19.68000,Multiplan,Commercial,,24.44,,,,,,,23.40,25.22,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,outpatient,,,26.00000,19.68000,Multiplan,Commercial,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,inpatient,,,37.00000,28.01000,Multiplan,Commercial,,34.78,,,,,,,33.30,35.89,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,outpatient,,,37.00000,28.01000,Multiplan,Commercial,,34.78,,,,,,,9.62,35.89,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,inpatient,,,268.00000,202.88000,Multiplan,Commercial,,251.92,,,,,,,241.20,259.96,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,outpatient,,,268.00000,202.88000,Multiplan,Commercial,,251.92,,,,,,,69.68,259.96,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,inpatient,,,91.00000,68.89000,Multiplan,Commercial,,85.54,,,,,,,81.90,88.27,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,outpatient,,,91.00000,68.89000,Multiplan,Commercial,,85.54,,,,,,,23.66,88.27,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,inpatient,,,200.00000,151.40000,Multiplan,Commercial,,188.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,outpatient,,,200.00000,151.40000,Multiplan,Commercial,,188.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,inpatient,,,152.00000,115.06000,Multiplan,Commercial,,142.88,,,,,,,136.80,147.44,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,outpatient,,,152.00000,115.06000,Multiplan,Commercial,,142.88,,,,,,,39.52,147.44,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,inpatient,,,359.00000,271.76000,Multiplan,Commercial,,337.46,,,,,,,323.10,348.23,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,outpatient,,,359.00000,271.76000,Multiplan,Commercial,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,inpatient,,,69.00000,33.26000,Multiplan,Commercial,,64.86,,,,,,,62.10,66.93,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,outpatient,,,69.00000,33.26000,Multiplan,Commercial,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,inpatient,,,75.00000,36.15000,Multiplan,Commercial,,70.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,outpatient,,,75.00000,36.15000,Multiplan,Commercial,,70.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,inpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,outpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,inpatient,,,45.00000,21.69000,Multiplan,Commercial,,42.30,,,,,,,40.50,43.65,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,outpatient,,,45.00000,21.69000,Multiplan,Commercial,,42.30,,,,,,,11.70,43.65,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,inpatient,,,68.00000,32.78000,Multiplan,Commercial,,63.92,,,,,,,61.20,65.96,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,outpatient,,,68.00000,32.78000,Multiplan,Commercial,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,inpatient,,,61.00000,29.40000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,outpatient,,,61.00000,29.40000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,inpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,inpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,inpatient,,,64.00000,30.85000,Multiplan,Commercial,,60.16,,,,,,,57.60,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,outpatient,,,64.00000,30.85000,Multiplan,Commercial,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,inpatient,,,195.00000,93.99000,Multiplan,Commercial,,183.30,,,,,,,175.50,189.15,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,outpatient,,,195.00000,93.99000,Multiplan,Commercial,,183.30,,,,,,,50.70,189.15,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,inpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,outpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,inpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,outpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,inpatient,,,14.00000,6.75000,Multiplan,Commercial,,13.16,,,,,,,12.60,13.58,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,outpatient,,,14.00000,6.75000,Multiplan,Commercial,,13.16,,,,,,,3.64,13.58,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,inpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,outpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,inpatient,,,53.00000,25.55000,Multiplan,Commercial,,49.82,,,,,,,47.70,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,outpatient,,,53.00000,25.55000,Multiplan,Commercial,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,inpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,outpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,inpatient,,,82.00000,39.52000,Multiplan,Commercial,,77.08,,,,,,,73.80,79.54,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,outpatient,,,82.00000,39.52000,Multiplan,Commercial,,77.08,,,,,,,21.32,79.54,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,inpatient,,,141.00000,67.96000,Multiplan,Commercial,,132.54,,,,,,,126.90,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Multiplan,Commercial,,132.54,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,inpatient,,,141.00000,67.96000,Multiplan,Commercial,,132.54,,,,,,,126.90,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Multiplan,Commercial,,132.54,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,inpatient,,,91.00000,43.86000,Multiplan,Commercial,,85.54,,,,,,,81.90,88.27,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,outpatient,,,91.00000,43.86000,Multiplan,Commercial,,85.54,,,,,,,23.66,88.27,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,inpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,outpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,inpatient,,,69.00000,33.26000,Multiplan,Commercial,,64.86,,,,,,,62.10,66.93,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,outpatient,,,69.00000,33.26000,Multiplan,Commercial,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,inpatient,,,205.00000,98.81000,Multiplan,Commercial,,192.70,,,,,,,184.50,198.85,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,outpatient,,,205.00000,98.81000,Multiplan,Commercial,,192.70,,,,,,,53.30,198.85,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,inpatient,,,50.00000,24.10000,Multiplan,Commercial,,47.00,,,,,,,45.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,outpatient,,,50.00000,24.10000,Multiplan,Commercial,,47.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,inpatient,,,406.00000,195.69000,Multiplan,Commercial,,381.64,,,,,,,365.40,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,outpatient,,,406.00000,195.69000,Multiplan,Commercial,,381.64,,,,,,,105.56,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,inpatient,,,101.00000,48.68000,Multiplan,Commercial,,94.94,,,,,,,90.90,97.97,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,outpatient,,,101.00000,48.68000,Multiplan,Commercial,,94.94,,,,,,,26.26,97.97,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,inpatient,,,375.00000,180.75000,Multiplan,Commercial,,352.50,,,,,,,337.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,outpatient,,,375.00000,180.75000,Multiplan,Commercial,,352.50,,,,,,,97.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,inpatient,,,362.00000,174.48000,Multiplan,Commercial,,340.28,,,,,,,325.80,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,outpatient,,,362.00000,174.48000,Multiplan,Commercial,,340.28,,,,,,,94.12,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,inpatient,,,325.00000,156.65000,Multiplan,Commercial,,305.50,,,,,,,292.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,outpatient,,,325.00000,156.65000,Multiplan,Commercial,,305.50,,,,,,,84.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,inpatient,,,121.00000,58.32000,Multiplan,Commercial,,113.74,,,,,,,108.90,117.37,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,outpatient,,,121.00000,58.32000,Multiplan,Commercial,,113.74,,,,,,,31.46,117.37,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,inpatient,,,115.00000,55.43000,Multiplan,Commercial,,108.10,,,,,,,103.50,111.55,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,outpatient,,,115.00000,55.43000,Multiplan,Commercial,,108.10,,,,,,,29.90,111.55,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,inpatient,,,300.00000,144.60000,Multiplan,Commercial,,282.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,outpatient,,,300.00000,144.60000,Multiplan,Commercial,,282.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,inpatient,,,51.00000,24.58000,Multiplan,Commercial,,47.94,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,outpatient,,,51.00000,24.58000,Multiplan,Commercial,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,inpatient,,,51.00000,24.58000,Multiplan,Commercial,,47.94,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Multiplan,Commercial,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,inpatient,,,51.00000,24.58000,Multiplan,Commercial,,47.94,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Multiplan,Commercial,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,inpatient,,,194.00000,93.51000,Multiplan,Commercial,,182.36,,,,,,,174.60,188.18,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,outpatient,,,194.00000,93.51000,Multiplan,Commercial,,182.36,,,,,,,50.44,188.18,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,inpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,outpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,inpatient,,,68.00000,32.78000,Multiplan,Commercial,,63.92,,,,,,,61.20,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,outpatient,,,68.00000,32.78000,Multiplan,Commercial,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,inpatient,,,329.00000,158.58000,Multiplan,Commercial,,309.26,,,,,,,296.10,319.13,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,outpatient,,,329.00000,158.58000,Multiplan,Commercial,,309.26,,,,,,,85.54,319.13,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,inpatient,,,24.00000,11.57000,Multiplan,Commercial,,22.56,,,,,,,21.60,23.28,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,outpatient,,,24.00000,11.57000,Multiplan,Commercial,,22.56,,,,,,,6.24,23.28,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,inpatient,,,30.00000,14.46000,Multiplan,Commercial,,28.20,,,,,,,27.00,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,outpatient,,,30.00000,14.46000,Multiplan,Commercial,,28.20,,,,,,,7.80,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,inpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,outpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,inpatient,,,53.00000,25.55000,Multiplan,Commercial,,49.82,,,,,,,47.70,51.41,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,outpatient,,,53.00000,25.55000,Multiplan,Commercial,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,inpatient,,,270.00000,130.14000,Multiplan,Commercial,,253.80,,,,,,,243.00,261.90,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,outpatient,,,270.00000,130.14000,Multiplan,Commercial,,253.80,,,,,,,70.20,261.90,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,inpatient,,,123.00000,59.29000,Multiplan,Commercial,,115.62,,,,,,,110.70,119.31,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Multiplan,Commercial,,115.62,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,inpatient,,,123.00000,59.29000,Multiplan,Commercial,,115.62,,,,,,,110.70,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Multiplan,Commercial,,115.62,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,inpatient,,,37.00000,17.83000,Multiplan,Commercial,,34.78,,,,,,,33.30,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,outpatient,,,37.00000,17.83000,Multiplan,Commercial,,34.78,,,,,,,9.62,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,inpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,outpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,inpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,outpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,inpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,outpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,inpatient,,,41.00000,19.76000,Multiplan,Commercial,,38.54,,,,,,,36.90,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,outpatient,,,41.00000,19.76000,Multiplan,Commercial,,38.54,,,,,,,10.66,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,inpatient,,,72.00000,34.70000,Multiplan,Commercial,,67.68,,,,,,,64.80,69.84,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,outpatient,,,72.00000,34.70000,Multiplan,Commercial,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,inpatient,,,77.00000,37.11000,Multiplan,Commercial,,72.38,,,,,,,69.30,74.69,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,outpatient,,,77.00000,37.11000,Multiplan,Commercial,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,inpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,inpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,inpatient,,,90.00000,43.38000,Multiplan,Commercial,,84.60,,,,,,,81.00,87.30,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,outpatient,,,90.00000,43.38000,Multiplan,Commercial,,84.60,,,,,,,23.40,87.30,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,inpatient,,,44.00000,21.21000,Multiplan,Commercial,,41.36,,,,,,,39.60,42.68,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,outpatient,,,44.00000,21.21000,Multiplan,Commercial,,41.36,,,,,,,11.44,42.68,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,inpatient,,,115.00000,55.43000,Multiplan,Commercial,,108.10,,,,,,,103.50,111.55,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,outpatient,,,115.00000,55.43000,Multiplan,Commercial,,108.10,,,,,,,29.90,111.55,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,inpatient,,,20.00000,9.64000,Multiplan,Commercial,,18.80,,,,,,,18.00,19.40,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,outpatient,,,20.00000,9.64000,Multiplan,Commercial,,18.80,,,,,,,5.20,19.40,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,inpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,46.80,50.44,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,outpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,inpatient,,,341.00000,164.36000,Multiplan,Commercial,,320.54,,,,,,,306.90,330.77,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,outpatient,,,341.00000,164.36000,Multiplan,Commercial,,320.54,,,,,,,88.66,330.77,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,inpatient,,,54.00000,26.03000,Multiplan,Commercial,,50.76,,,,,,,48.60,52.38,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,outpatient,,,54.00000,26.03000,Multiplan,Commercial,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,inpatient,,,53.00000,25.55000,Multiplan,Commercial,,49.82,,,,,,,47.70,51.41,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,outpatient,,,53.00000,25.55000,Multiplan,Commercial,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,inpatient,,,88.00000,42.42000,Multiplan,Commercial,,82.72,,,,,,,79.20,85.36,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,outpatient,,,88.00000,42.42000,Multiplan,Commercial,,82.72,,,,,,,22.88,85.36,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,inpatient,,,89.00000,42.90000,Multiplan,Commercial,,83.66,,,,,,,80.10,86.33,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,outpatient,,,89.00000,42.90000,Multiplan,Commercial,,83.66,,,,,,,23.14,86.33,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,inpatient,,,61.00000,29.40000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,outpatient,,,61.00000,29.40000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,inpatient,,,77.00000,37.11000,Multiplan,Commercial,,72.38,,,,,,,69.30,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Multiplan,Commercial,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,inpatient,,,77.00000,37.11000,Multiplan,Commercial,,72.38,,,,,,,69.30,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Multiplan,Commercial,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,inpatient,,,64.00000,30.85000,Multiplan,Commercial,,60.16,,,,,,,57.60,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Multiplan,Commercial,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,inpatient,,,64.00000,30.85000,Multiplan,Commercial,,60.16,,,,,,,57.60,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Multiplan,Commercial,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,inpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,outpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,inpatient,,,95.00000,45.79000,Multiplan,Commercial,,89.30,,,,,,,85.50,92.15,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,outpatient,,,95.00000,45.79000,Multiplan,Commercial,,89.30,,,,,,,24.70,92.15,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,inpatient,,,132.00000,63.62000,Multiplan,Commercial,,124.08,,,,,,,118.80,128.04,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,outpatient,,,132.00000,63.62000,Multiplan,Commercial,,124.08,,,,,,,34.32,128.04,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,inpatient,,,83.00000,40.01000,Multiplan,Commercial,,78.02,,,,,,,74.70,80.51,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,outpatient,,,83.00000,40.01000,Multiplan,Commercial,,78.02,,,,,,,21.58,80.51,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,inpatient,,,387.00000,186.53000,Multiplan,Commercial,,363.78,,,,,,,348.30,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,outpatient,,,387.00000,186.53000,Multiplan,Commercial,,363.78,,,,,,,100.62,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,inpatient,,,387.00000,186.53000,Multiplan,Commercial,,363.78,,,,,,,348.30,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,outpatient,,,387.00000,186.53000,Multiplan,Commercial,,363.78,,,,,,,100.62,375.39,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,inpatient,,,31.00000,14.94000,Multiplan,Commercial,,29.14,,,,,,,27.90,30.07,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,outpatient,,,31.00000,14.94000,Multiplan,Commercial,,29.14,,,,,,,8.06,30.07,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,inpatient,,,36.00000,17.35000,Multiplan,Commercial,,33.84,,,,,,,32.40,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,outpatient,,,36.00000,17.35000,Multiplan,Commercial,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,inpatient,,,160.00000,77.12000,Multiplan,Commercial,,150.40,,,,,,,144.00,155.20,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,outpatient,,,160.00000,77.12000,Multiplan,Commercial,,150.40,,,,,,,41.60,155.20,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,inpatient,,,112.00000,53.98000,Multiplan,Commercial,,105.28,,,,,,,100.80,108.64,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,outpatient,,,112.00000,53.98000,Multiplan,Commercial,,105.28,,,,,,,29.12,108.64,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,inpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,inpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,inpatient,,,14.00000,6.75000,Multiplan,Commercial,,13.16,,,,,,,12.60,13.58,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,outpatient,,,14.00000,6.75000,Multiplan,Commercial,,13.16,,,,,,,3.64,13.58,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,inpatient,,,16.00000,7.71000,Multiplan,Commercial,,15.04,,,,,,,14.40,15.52,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,outpatient,,,16.00000,7.71000,Multiplan,Commercial,,15.04,,,,,,,4.16,15.52,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,inpatient,,,71.00000,34.22000,Multiplan,Commercial,,66.74,,,,,,,63.90,68.87,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,outpatient,,,71.00000,34.22000,Multiplan,Commercial,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,inpatient,,,116.00000,55.91000,Multiplan,Commercial,,109.04,,,,,,,104.40,112.52,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,outpatient,,,116.00000,55.91000,Multiplan,Commercial,,109.04,,,,,,,30.16,112.52,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,inpatient,,,81.00000,39.04000,Multiplan,Commercial,,76.14,,,,,,,72.90,78.57,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,outpatient,,,81.00000,39.04000,Multiplan,Commercial,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,inpatient,,,97.00000,46.75000,Multiplan,Commercial,,91.18,,,,,,,87.30,94.09,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,outpatient,,,97.00000,46.75000,Multiplan,Commercial,,91.18,,,,,,,25.22,94.09,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,inpatient,,,77.00000,37.11000,Multiplan,Commercial,,72.38,,,,,,,69.30,74.69,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,outpatient,,,77.00000,37.11000,Multiplan,Commercial,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,inpatient,,,35.00000,16.87000,Multiplan,Commercial,,32.90,,,,,,,31.50,33.95,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,outpatient,,,35.00000,16.87000,Multiplan,Commercial,,32.90,,,,,,,9.10,33.95,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,inpatient,,,65.00000,31.33000,Multiplan,Commercial,,61.10,,,,,,,58.50,63.05,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,outpatient,,,65.00000,31.33000,Multiplan,Commercial,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,inpatient,,,74.00000,35.67000,Multiplan,Commercial,,69.56,,,,,,,66.60,71.78,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,outpatient,,,74.00000,35.67000,Multiplan,Commercial,,69.56,,,,,,,19.24,71.78,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,inpatient,,,250.00000,120.50000,Multiplan,Commercial,,235.00,,,,,,,225.00,242.50,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,outpatient,,,250.00000,120.50000,Multiplan,Commercial,,235.00,,,,,,,65.00,242.50,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,inpatient,,,90.00000,43.38000,Multiplan,Commercial,,84.60,,,,,,,81.00,87.30,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,outpatient,,,90.00000,43.38000,Multiplan,Commercial,,84.60,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,inpatient,,,90.00000,43.38000,Multiplan,Commercial,,84.60,,,,,,,81.00,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,outpatient,,,90.00000,43.38000,Multiplan,Commercial,,84.60,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,inpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,46.80,50.44,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,outpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,inpatient,,,36.00000,17.35000,Multiplan,Commercial,,33.84,,,,,,,32.40,34.92,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,outpatient,,,36.00000,17.35000,Multiplan,Commercial,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,inpatient,,,78.00000,37.60000,Multiplan,Commercial,,73.32,,,,,,,70.20,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,outpatient,,,78.00000,37.60000,Multiplan,Commercial,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,inpatient,,,115.00000,55.43000,Multiplan,Commercial,,108.10,,,,,,,103.50,111.55,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,outpatient,,,115.00000,55.43000,Multiplan,Commercial,,108.10,,,,,,,29.90,111.55,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,inpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,60.30,64.99,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,outpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,inpatient,,,76.00000,36.63000,Multiplan,Commercial,,71.44,,,,,,,68.40,73.72,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,outpatient,,,76.00000,36.63000,Multiplan,Commercial,,71.44,,,,,,,19.76,73.72,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,inpatient,,,53.00000,25.55000,Multiplan,Commercial,,49.82,,,,,,,47.70,51.41,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,outpatient,,,53.00000,25.55000,Multiplan,Commercial,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,inpatient,,,70.00000,33.74000,Multiplan,Commercial,,65.80,,,,,,,63.00,67.90,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,outpatient,,,70.00000,33.74000,Multiplan,Commercial,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,inpatient,,,169.00000,81.46000,Multiplan,Commercial,,158.86,,,,,,,152.10,163.93,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,outpatient,,,169.00000,81.46000,Multiplan,Commercial,,158.86,,,,,,,43.94,163.93,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,inpatient,,,28.00000,13.50000,Multiplan,Commercial,,26.32,,,,,,,25.20,27.16,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,outpatient,,,28.00000,13.50000,Multiplan,Commercial,,26.32,,,,,,,7.28,27.16,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,inpatient,,,51.00000,24.58000,Multiplan,Commercial,,47.94,,,,,,,45.90,49.47,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,outpatient,,,51.00000,24.58000,Multiplan,Commercial,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,inpatient,,,15.00000,7.23000,Multiplan,Commercial,,14.10,,,,,,,13.50,14.55,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,outpatient,,,15.00000,7.23000,Multiplan,Commercial,,14.10,,,,,,,3.90,14.55,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,inpatient,,,18.00000,8.68000,Multiplan,Commercial,,16.92,,,,,,,16.20,17.46,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,outpatient,,,18.00000,8.68000,Multiplan,Commercial,,16.92,,,,,,,4.68,17.46,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,inpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,outpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,inpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,outpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,inpatient,,,61.00000,29.40000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,outpatient,,,61.00000,29.40000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,inpatient,,,550.00000,265.10000,Multiplan,Commercial,,517.00,,,,,,,495.00,533.50,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,outpatient,,,550.00000,265.10000,Multiplan,Commercial,,517.00,,,,,,,143.00,533.50,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,inpatient,,,73.00000,35.19000,Multiplan,Commercial,,68.62,,,,,,,65.70,70.81,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Multiplan,Commercial,,68.62,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,inpatient,,,392.00000,188.94000,Multiplan,Commercial,,368.48,,,,,,,352.80,380.24,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,outpatient,,,392.00000,188.94000,Multiplan,Commercial,,368.48,,,,,,,101.92,380.24,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,inpatient,,,75.00000,36.15000,Multiplan,Commercial,,70.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,outpatient,,,75.00000,36.15000,Multiplan,Commercial,,70.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,inpatient,,,73.00000,35.19000,Multiplan,Commercial,,68.62,,,,,,,65.70,70.81,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Multiplan,Commercial,,68.62,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,inpatient,,,100.00000,48.20000,Multiplan,Commercial,,94.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,outpatient,,,100.00000,48.20000,Multiplan,Commercial,,94.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,inpatient,,,153.00000,73.75000,Multiplan,Commercial,,143.82,,,,,,,137.70,148.41,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,outpatient,,,153.00000,73.75000,Multiplan,Commercial,,143.82,,,,,,,39.78,148.41,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,inpatient,,,909.00000,438.14000,Multiplan,Commercial,,854.46,,,,,,,818.10,881.73,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,outpatient,,,909.00000,438.14000,Multiplan,Commercial,,854.46,,,,,,,236.34,881.73,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,inpatient,,,266.00000,128.21000,Multiplan,Commercial,,250.04,,,,,,,239.40,258.02,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,outpatient,,,266.00000,128.21000,Multiplan,Commercial,,250.04,,,,,,,69.16,258.02,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,inpatient,,,275.00000,132.55000,Multiplan,Commercial,,258.50,,,,,,,247.50,266.75,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,outpatient,,,275.00000,132.55000,Multiplan,Commercial,,258.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,inpatient,,,61.00000,29.40000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,outpatient,,,61.00000,29.40000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,inpatient,,,84.00000,40.49000,Multiplan,Commercial,,78.96,,,,,,,75.60,81.48,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,outpatient,,,84.00000,40.49000,Multiplan,Commercial,,78.96,,,,,,,21.84,81.48,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,inpatient,,,174.00000,83.87000,Multiplan,Commercial,,163.56,,,,,,,156.60,168.78,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,outpatient,,,174.00000,83.87000,Multiplan,Commercial,,163.56,,,,,,,45.24,168.78,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,inpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,outpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,inpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,60.30,64.99,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,outpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,inpatient,,,68.00000,32.78000,Multiplan,Commercial,,63.92,,,,,,,61.20,65.96,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,outpatient,,,68.00000,32.78000,Multiplan,Commercial,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,inpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,outpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,inpatient,,,211.00000,101.70000,Multiplan,Commercial,,198.34,,,,,,,189.90,204.67,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,outpatient,,,211.00000,101.70000,Multiplan,Commercial,,198.34,,,,,,,54.86,204.67,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,inpatient,,,65.00000,31.33000,Multiplan,Commercial,,61.10,,,,,,,58.50,63.05,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,outpatient,,,65.00000,31.33000,Multiplan,Commercial,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,inpatient,,,83.00000,40.01000,Multiplan,Commercial,,78.02,,,,,,,74.70,80.51,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,outpatient,,,83.00000,40.01000,Multiplan,Commercial,,78.02,,,,,,,21.58,80.51,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,inpatient,,,54.00000,26.03000,Multiplan,Commercial,,50.76,,,,,,,48.60,52.38,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,outpatient,,,54.00000,26.03000,Multiplan,Commercial,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,inpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,outpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,inpatient,,,323.00000,155.69000,Multiplan,Commercial,,303.62,,,,,,,290.70,313.31,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,outpatient,,,323.00000,155.69000,Multiplan,Commercial,,303.62,,,,,,,83.98,313.31,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,inpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,outpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,inpatient,,,35.00000,16.87000,Multiplan,Commercial,,32.90,,,,,,,31.50,33.95,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,outpatient,,,35.00000,16.87000,Multiplan,Commercial,,32.90,,,,,,,9.10,33.95,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,inpatient,,,20.00000,9.64000,Multiplan,Commercial,,18.80,,,,,,,18.00,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,outpatient,,,20.00000,9.64000,Multiplan,Commercial,,18.80,,,,,,,5.20,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,inpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,outpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,inpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,inpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,inpatient,,,34.00000,16.39000,Multiplan,Commercial,,31.96,,,,,,,30.60,32.98,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,outpatient,,,34.00000,16.39000,Multiplan,Commercial,,31.96,,,,,,,8.84,32.98,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,inpatient,,,29.00000,13.98000,Multiplan,Commercial,,27.26,,,,,,,26.10,28.13,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,outpatient,,,29.00000,13.98000,Multiplan,Commercial,,27.26,,,,,,,7.54,28.13,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,inpatient,,,80.00000,38.56000,Multiplan,Commercial,,75.20,,,,,,,72.00,77.60,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,outpatient,,,80.00000,38.56000,Multiplan,Commercial,,75.20,,,,,,,20.80,77.60,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,inpatient,,,73.00000,35.19000,Multiplan,Commercial,,68.62,,,,,,,65.70,70.81,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,outpatient,,,73.00000,35.19000,Multiplan,Commercial,,68.62,,,,,,,18.98,70.81,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,inpatient,,,16.00000,7.71000,Multiplan,Commercial,,15.04,,,,,,,14.40,15.52,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,outpatient,,,16.00000,7.71000,Multiplan,Commercial,,15.04,,,,,,,4.16,15.52,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,inpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,46.80,50.44,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,outpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,inpatient,,,113.00000,54.47000,Multiplan,Commercial,,106.22,,,,,,,101.70,109.61,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,outpatient,,,113.00000,54.47000,Multiplan,Commercial,,106.22,,,,,,,29.38,109.61,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,inpatient,,,68.00000,32.78000,Multiplan,Commercial,,63.92,,,,,,,61.20,65.96,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,outpatient,,,68.00000,32.78000,Multiplan,Commercial,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,inpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,inpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,inpatient,,,78.00000,37.60000,Multiplan,Commercial,,73.32,,,,,,,70.20,75.66,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,outpatient,,,78.00000,37.60000,Multiplan,Commercial,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,inpatient,,,54.00000,26.03000,Multiplan,Commercial,,50.76,,,,,,,48.60,52.38,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,outpatient,,,54.00000,26.03000,Multiplan,Commercial,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,inpatient,,,76.00000,36.63000,Multiplan,Commercial,,71.44,,,,,,,68.40,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,outpatient,,,76.00000,36.63000,Multiplan,Commercial,,71.44,,,,,,,19.76,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,inpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,60.30,64.99,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,outpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,inpatient,,,88.00000,42.42000,Multiplan,Commercial,,82.72,,,,,,,79.20,85.36,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,outpatient,,,88.00000,42.42000,Multiplan,Commercial,,82.72,,,,,,,22.88,85.36,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,inpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,outpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,inpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,60.30,64.99,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,outpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,inpatient,,,53.00000,25.55000,Multiplan,Commercial,,49.82,,,,,,,47.70,51.41,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,outpatient,,,53.00000,25.55000,Multiplan,Commercial,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,inpatient,,,88.00000,42.42000,Multiplan,Commercial,,82.72,,,,,,,79.20,85.36,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,outpatient,,,88.00000,42.42000,Multiplan,Commercial,,82.72,,,,,,,22.88,85.36,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,inpatient,,,105.00000,50.61000,Multiplan,Commercial,,98.70,,,,,,,94.50,101.85,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,outpatient,,,105.00000,50.61000,Multiplan,Commercial,,98.70,,,,,,,27.30,101.85,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,inpatient,,,73.00000,35.19000,Multiplan,Commercial,,68.62,,,,,,,65.70,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Multiplan,Commercial,,68.62,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,inpatient,,,83.00000,40.01000,Multiplan,Commercial,,78.02,,,,,,,74.70,80.51,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,outpatient,,,83.00000,40.01000,Multiplan,Commercial,,78.02,,,,,,,21.58,80.51,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,inpatient,,,154.00000,74.23000,Multiplan,Commercial,,144.76,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Multiplan,Commercial,,144.76,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,inpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,outpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,inpatient,,,97.00000,46.75000,Multiplan,Commercial,,91.18,,,,,,,87.30,94.09,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,outpatient,,,97.00000,46.75000,Multiplan,Commercial,,91.18,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,inpatient,,,154.00000,74.23000,Multiplan,Commercial,,144.76,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Multiplan,Commercial,,144.76,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,inpatient,,,87.00000,41.93000,Multiplan,Commercial,,81.78,,,,,,,78.30,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,outpatient,,,87.00000,41.93000,Multiplan,Commercial,,81.78,,,,,,,22.62,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,inpatient,,,68.00000,32.78000,Multiplan,Commercial,,63.92,,,,,,,61.20,65.96,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,outpatient,,,68.00000,32.78000,Multiplan,Commercial,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,inpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,46.80,50.44,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,outpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,inpatient,,,51.00000,24.58000,Multiplan,Commercial,,47.94,,,,,,,45.90,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,outpatient,,,51.00000,24.58000,Multiplan,Commercial,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,inpatient,,,97.00000,46.75000,Multiplan,Commercial,,91.18,,,,,,,87.30,94.09,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,outpatient,,,97.00000,46.75000,Multiplan,Commercial,,91.18,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,inpatient,,,176.00000,84.83000,Multiplan,Commercial,,165.44,,,,,,,158.40,170.72,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,outpatient,,,176.00000,84.83000,Multiplan,Commercial,,165.44,,,,,,,45.76,170.72,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,inpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,outpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,inpatient,,,158.00000,76.16000,Multiplan,Commercial,,148.52,,,,,,,142.20,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,outpatient,,,158.00000,76.16000,Multiplan,Commercial,,148.52,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,inpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,outpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,inpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,outpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,inpatient,,,84.00000,40.49000,Multiplan,Commercial,,78.96,,,,,,,75.60,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,outpatient,,,84.00000,40.49000,Multiplan,Commercial,,78.96,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,inpatient,,,189.00000,91.10000,Multiplan,Commercial,,177.66,,,,,,,170.10,183.33,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,outpatient,,,189.00000,91.10000,Multiplan,Commercial,,177.66,,,,,,,49.14,183.33,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,inpatient,,,109.00000,52.54000,Multiplan,Commercial,,102.46,,,,,,,98.10,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,outpatient,,,109.00000,52.54000,Multiplan,Commercial,,102.46,,,,,,,28.34,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,inpatient,,,129.00000,62.18000,Multiplan,Commercial,,121.26,,,,,,,116.10,125.13,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,outpatient,,,129.00000,62.18000,Multiplan,Commercial,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,inpatient,,,84.00000,40.49000,Multiplan,Commercial,,78.96,,,,,,,75.60,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,outpatient,,,84.00000,40.49000,Multiplan,Commercial,,78.96,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,inpatient,,,73.00000,35.19000,Multiplan,Commercial,,68.62,,,,,,,65.70,70.81,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Multiplan,Commercial,,68.62,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,inpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,outpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,inpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,outpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,inpatient,,,149.00000,71.82000,Multiplan,Commercial,,140.06,,,,,,,134.10,144.53,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,outpatient,,,149.00000,71.82000,Multiplan,Commercial,,140.06,,,,,,,38.74,144.53,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,inpatient,,,130.00000,62.66000,Multiplan,Commercial,,122.20,,,,,,,117.00,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,outpatient,,,130.00000,62.66000,Multiplan,Commercial,,122.20,,,,,,,33.80,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,inpatient,,,110.00000,53.02000,Multiplan,Commercial,,103.40,,,,,,,99.00,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,outpatient,,,110.00000,53.02000,Multiplan,Commercial,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,inpatient,,,158.00000,76.16000,Multiplan,Commercial,,148.52,,,,,,,142.20,153.26,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,outpatient,,,158.00000,76.16000,Multiplan,Commercial,,148.52,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,inpatient,,,117.00000,56.39000,Multiplan,Commercial,,109.98,,,,,,,105.30,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,outpatient,,,117.00000,56.39000,Multiplan,Commercial,,109.98,,,,,,,30.42,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,inpatient,,,61.00000,29.40000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,outpatient,,,61.00000,29.40000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,inpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,outpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Multiplan,Commercial,,175.78,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Multiplan,Commercial,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,inpatient,,,145.00000,69.89000,Multiplan,Commercial,,136.30,,,,,,,130.50,140.65,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,outpatient,,,145.00000,69.89000,Multiplan,Commercial,,136.30,,,,,,,37.70,140.65,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,inpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,outpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,inpatient,,,165.00000,79.53000,Multiplan,Commercial,,155.10,,,,,,,148.50,160.05,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,outpatient,,,165.00000,79.53000,Multiplan,Commercial,,155.10,,,,,,,42.90,160.05,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,inpatient,,,70.00000,33.74000,Multiplan,Commercial,,65.80,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,outpatient,,,70.00000,33.74000,Multiplan,Commercial,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,inpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,outpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Multiplan,Commercial,,175.78,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Multiplan,Commercial,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,inpatient,,,154.00000,74.23000,Multiplan,Commercial,,144.76,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,outpatient,,,154.00000,74.23000,Multiplan,Commercial,,144.76,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,inpatient,,,104.00000,50.13000,Multiplan,Commercial,,97.76,,,,,,,93.60,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,outpatient,,,104.00000,50.13000,Multiplan,Commercial,,97.76,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,inpatient,,,70.00000,33.74000,Multiplan,Commercial,,65.80,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,outpatient,,,70.00000,33.74000,Multiplan,Commercial,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,inpatient,,,104.00000,50.13000,Multiplan,Commercial,,97.76,,,,,,,93.60,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,outpatient,,,104.00000,50.13000,Multiplan,Commercial,,97.76,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,inpatient,,,70.00000,33.74000,Multiplan,Commercial,,65.80,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,outpatient,,,70.00000,33.74000,Multiplan,Commercial,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,inpatient,,,123.00000,59.29000,Multiplan,Commercial,,115.62,,,,,,,110.70,119.31,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,outpatient,,,123.00000,59.29000,Multiplan,Commercial,,115.62,,,,,,,31.98,119.31,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,inpatient,,,95.00000,45.79000,Multiplan,Commercial,,89.30,,,,,,,85.50,92.15,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,outpatient,,,95.00000,45.79000,Multiplan,Commercial,,89.30,,,,,,,24.70,92.15,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,inpatient,,,160.00000,77.12000,Multiplan,Commercial,,150.40,,,,,,,144.00,155.20,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,outpatient,,,160.00000,77.12000,Multiplan,Commercial,,150.40,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,inpatient,,,147.00000,70.85000,Multiplan,Commercial,,138.18,,,,,,,132.30,142.59,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,outpatient,,,147.00000,70.85000,Multiplan,Commercial,,138.18,,,,,,,38.22,142.59,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,inpatient,,,178.00000,85.80000,Multiplan,Commercial,,167.32,,,,,,,160.20,172.66,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,outpatient,,,178.00000,85.80000,Multiplan,Commercial,,167.32,,,,,,,46.28,172.66,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,inpatient,,,160.00000,77.12000,Multiplan,Commercial,,150.40,,,,,,,144.00,155.20,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,outpatient,,,160.00000,77.12000,Multiplan,Commercial,,150.40,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Multiplan,Commercial,,175.78,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Multiplan,Commercial,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,inpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,outpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,inpatient,,,70.00000,33.74000,Multiplan,Commercial,,65.80,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,outpatient,,,70.00000,33.74000,Multiplan,Commercial,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Multiplan,Commercial,,175.78,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Multiplan,Commercial,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Multiplan,Commercial,,175.78,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Multiplan,Commercial,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Multiplan,Commercial,,175.78,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Multiplan,Commercial,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Multiplan,Commercial,,175.78,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Multiplan,Commercial,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Multiplan,Commercial,,175.78,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Multiplan,Commercial,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Multiplan,Commercial,,175.78,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Multiplan,Commercial,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Multiplan,Commercial,,175.78,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Multiplan,Commercial,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Multiplan,Commercial,,175.78,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Multiplan,Commercial,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,inpatient,,,449.00000,216.42000,Multiplan,Commercial,,422.06,,,,,,,404.10,435.53,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,outpatient,,,449.00000,216.42000,Multiplan,Commercial,,422.06,,,,,,,116.74,435.53,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,inpatient,,,104.00000,50.13000,Multiplan,Commercial,,97.76,,,,,,,93.60,100.88,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,outpatient,,,104.00000,50.13000,Multiplan,Commercial,,97.76,,,,,,,27.04,100.88,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,inpatient,,,185.00000,89.17000,Multiplan,Commercial,,173.90,,,,,,,166.50,179.45,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Multiplan,Commercial,,173.90,,,,,,,48.10,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,inpatient,,,185.00000,89.17000,Multiplan,Commercial,,173.90,,,,,,,166.50,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Multiplan,Commercial,,173.90,,,,,,,48.10,179.45,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,inpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,outpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,inpatient,,,84.00000,40.49000,Multiplan,Commercial,,78.96,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,outpatient,,,84.00000,40.49000,Multiplan,Commercial,,78.96,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,inpatient,,,84.00000,40.49000,Multiplan,Commercial,,78.96,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Multiplan,Commercial,,78.96,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,inpatient,,,84.00000,40.49000,Multiplan,Commercial,,78.96,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Multiplan,Commercial,,78.96,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,inpatient,,,73.00000,35.19000,Multiplan,Commercial,,68.62,,,,,,,65.70,70.81,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Multiplan,Commercial,,68.62,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,inpatient,,,73.00000,35.19000,Multiplan,Commercial,,68.62,,,,,,,65.70,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Multiplan,Commercial,,68.62,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,inpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,inpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,inpatient,,,98.00000,47.24000,Multiplan,Commercial,,92.12,,,,,,,88.20,95.06,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,outpatient,,,98.00000,47.24000,Multiplan,Commercial,,92.12,,,,,,,25.48,95.06,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,inpatient,,,75.00000,36.15000,Multiplan,Commercial,,70.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,outpatient,,,75.00000,36.15000,Multiplan,Commercial,,70.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,inpatient,,,107.00000,51.57000,Multiplan,Commercial,,100.58,,,,,,,96.30,103.79,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,outpatient,,,107.00000,51.57000,Multiplan,Commercial,,100.58,,,,,,,27.82,103.79,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,inpatient,,,81.00000,39.04000,Multiplan,Commercial,,76.14,,,,,,,72.90,78.57,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,outpatient,,,81.00000,39.04000,Multiplan,Commercial,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,inpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,outpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,inpatient,,,68.00000,32.78000,Multiplan,Commercial,,63.92,,,,,,,61.20,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,outpatient,,,68.00000,32.78000,Multiplan,Commercial,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,inpatient,,,51.00000,24.58000,Multiplan,Commercial,,47.94,,,,,,,45.90,49.47,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,outpatient,,,51.00000,24.58000,Multiplan,Commercial,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,inpatient,,,74.00000,35.67000,Multiplan,Commercial,,69.56,,,,,,,66.60,71.78,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,outpatient,,,74.00000,35.67000,Multiplan,Commercial,,69.56,,,,,,,19.24,71.78,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,inpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,outpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,inpatient,,,194.00000,93.51000,Multiplan,Commercial,,182.36,,,,,,,174.60,188.18,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,outpatient,,,194.00000,93.51000,Multiplan,Commercial,,182.36,,,,,,,50.44,188.18,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,inpatient,,,111.00000,53.50000,Multiplan,Commercial,,104.34,,,,,,,99.90,107.67,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,outpatient,,,111.00000,53.50000,Multiplan,Commercial,,104.34,,,,,,,28.86,107.67,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,inpatient,,,77.00000,37.11000,Multiplan,Commercial,,72.38,,,,,,,69.30,74.69,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,outpatient,,,77.00000,37.11000,Multiplan,Commercial,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Multiplan,Commercial,,74.26,,,,,,,71.10,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Multiplan,Commercial,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Multiplan,Commercial,,74.26,,,,,,,71.10,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Multiplan,Commercial,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,inpatient,,,237.00000,114.23000,Multiplan,Commercial,,222.78,,,,,,,213.30,229.89,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Multiplan,Commercial,,222.78,,,,,,,61.62,229.89,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,inpatient,,,51.00000,24.58000,Multiplan,Commercial,,47.94,,,,,,,45.90,49.47,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,outpatient,,,51.00000,24.58000,Multiplan,Commercial,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,inpatient,,,82.00000,39.52000,Multiplan,Commercial,,77.08,,,,,,,73.80,79.54,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Multiplan,Commercial,,77.08,,,,,,,21.32,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,inpatient,,,82.00000,39.52000,Multiplan,Commercial,,77.08,,,,,,,73.80,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Multiplan,Commercial,,77.08,,,,,,,21.32,79.54,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,inpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,60.30,64.99,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,outpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,inpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,inpatient,,,131.00000,63.14000,Multiplan,Commercial,,123.14,,,,,,,117.90,127.07,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,outpatient,,,131.00000,63.14000,Multiplan,Commercial,,123.14,,,,,,,34.06,127.07,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,inpatient,,,15.00000,7.23000,Multiplan,Commercial,,14.10,,,,,,,13.50,14.55,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,outpatient,,,15.00000,7.23000,Multiplan,Commercial,,14.10,,,,,,,3.90,14.55,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,inpatient,,,39.00000,18.80000,Multiplan,Commercial,,36.66,,,,,,,35.10,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,outpatient,,,39.00000,18.80000,Multiplan,Commercial,,36.66,,,,,,,10.14,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,inpatient,,,12.00000,5.78000,Multiplan,Commercial,,11.28,,,,,,,10.80,11.64,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,outpatient,,,12.00000,5.78000,Multiplan,Commercial,,11.28,,,,,,,3.12,11.64,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,inpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,inpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,outpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,inpatient,,,203.00000,97.85000,Multiplan,Commercial,,190.82,,,,,,,182.70,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Multiplan,Commercial,,190.82,,,,,,,52.78,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,inpatient,,,203.00000,97.85000,Multiplan,Commercial,,190.82,,,,,,,182.70,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Multiplan,Commercial,,190.82,,,,,,,52.78,196.91,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,inpatient,,,99.00000,47.72000,Multiplan,Commercial,,93.06,,,,,,,89.10,96.03,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,outpatient,,,99.00000,47.72000,Multiplan,Commercial,,93.06,,,,,,,25.74,96.03,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,inpatient,,,53.00000,25.55000,Multiplan,Commercial,,49.82,,,,,,,47.70,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,outpatient,,,53.00000,25.55000,Multiplan,Commercial,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,inpatient,,,23.00000,11.09000,Multiplan,Commercial,,21.62,,,,,,,20.70,22.31,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,outpatient,,,23.00000,11.09000,Multiplan,Commercial,,21.62,,,,,,,5.98,22.31,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,inpatient,,,46.00000,22.17000,Multiplan,Commercial,,43.24,,,,,,,41.40,44.62,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,outpatient,,,46.00000,22.17000,Multiplan,Commercial,,43.24,,,,,,,11.96,44.62,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,inpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,60.30,64.99,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,outpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,inpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,outpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,inpatient,,,288.00000,138.82000,Multiplan,Commercial,,270.72,,,,,,,259.20,279.36,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,outpatient,,,288.00000,138.82000,Multiplan,Commercial,,270.72,,,,,,,74.88,279.36,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,inpatient,,,106.00000,51.09000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,outpatient,,,106.00000,51.09000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,inpatient,,,30.00000,14.46000,Multiplan,Commercial,,28.20,,,,,,,27.00,29.10,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,outpatient,,,30.00000,14.46000,Multiplan,Commercial,,28.20,,,,,,,7.80,29.10,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,inpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,outpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,inpatient,,,71.00000,34.22000,Multiplan,Commercial,,66.74,,,,,,,63.90,68.87,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,outpatient,,,71.00000,34.22000,Multiplan,Commercial,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,inpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,60.30,64.99,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,outpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,inpatient,,,89.00000,42.90000,Multiplan,Commercial,,83.66,,,,,,,80.10,86.33,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,outpatient,,,89.00000,42.90000,Multiplan,Commercial,,83.66,,,,,,,23.14,86.33,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,inpatient,,,116.00000,55.91000,Multiplan,Commercial,,109.04,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,outpatient,,,116.00000,55.91000,Multiplan,Commercial,,109.04,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,inpatient,,,116.00000,55.91000,Multiplan,Commercial,,109.04,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Multiplan,Commercial,,109.04,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,inpatient,,,116.00000,55.91000,Multiplan,Commercial,,109.04,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Multiplan,Commercial,,109.04,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,inpatient,,,51.00000,24.58000,Multiplan,Commercial,,47.94,,,,,,,45.90,49.47,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,outpatient,,,51.00000,24.58000,Multiplan,Commercial,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,inpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,outpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,inpatient,,,174.00000,83.87000,Multiplan,Commercial,,163.56,,,,,,,156.60,168.78,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,outpatient,,,174.00000,83.87000,Multiplan,Commercial,,163.56,,,,,,,45.24,168.78,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,inpatient,,,82.00000,39.52000,Multiplan,Commercial,,77.08,,,,,,,73.80,79.54,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,outpatient,,,82.00000,39.52000,Multiplan,Commercial,,77.08,,,,,,,21.32,79.54,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,inpatient,,,112.00000,53.98000,Multiplan,Commercial,,105.28,,,,,,,100.80,108.64,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,outpatient,,,112.00000,53.98000,Multiplan,Commercial,,105.28,,,,,,,29.12,108.64,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,inpatient,,,61.00000,29.40000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,outpatient,,,61.00000,29.40000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,inpatient,,,69.00000,33.26000,Multiplan,Commercial,,64.86,,,,,,,62.10,66.93,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,outpatient,,,69.00000,33.26000,Multiplan,Commercial,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,inpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,inpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,46.80,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,outpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,inpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,inpatient,,,286.00000,137.85000,Multiplan,Commercial,,268.84,,,,,,,257.40,277.42,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,outpatient,,,286.00000,137.85000,Multiplan,Commercial,,268.84,,,,,,,74.36,277.42,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,inpatient,,,300.00000,144.60000,Multiplan,Commercial,,282.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,outpatient,,,300.00000,144.60000,Multiplan,Commercial,,282.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,inpatient,,,73.00000,35.19000,Multiplan,Commercial,,68.62,,,,,,,65.70,70.81,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,outpatient,,,73.00000,35.19000,Multiplan,Commercial,,68.62,,,,,,,18.98,70.81,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,inpatient,,,90.00000,43.38000,Multiplan,Commercial,,84.60,,,,,,,81.00,87.30,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,outpatient,,,90.00000,43.38000,Multiplan,Commercial,,84.60,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,inpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,outpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,inpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,46.80,50.44,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,inpatient,,,315.00000,151.83000,Multiplan,Commercial,,296.10,,,,,,,283.50,305.55,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,outpatient,,,315.00000,151.83000,Multiplan,Commercial,,296.10,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,inpatient,,,100.00000,48.20000,Multiplan,Commercial,,94.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,outpatient,,,100.00000,48.20000,Multiplan,Commercial,,94.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,inpatient,,,89.00000,42.90000,Multiplan,Commercial,,83.66,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,outpatient,,,89.00000,42.90000,Multiplan,Commercial,,83.66,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,inpatient,,,71.00000,34.22000,Multiplan,Commercial,,66.74,,,,,,,63.90,68.87,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,outpatient,,,71.00000,34.22000,Multiplan,Commercial,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,inpatient,,,135.00000,65.07000,Multiplan,Commercial,,126.90,,,,,,,121.50,130.95,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,outpatient,,,135.00000,65.07000,Multiplan,Commercial,,126.90,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,inpatient,,,80.00000,38.56000,Multiplan,Commercial,,75.20,,,,,,,72.00,77.60,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,outpatient,,,80.00000,38.56000,Multiplan,Commercial,,75.20,,,,,,,20.80,77.60,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,inpatient,,,72.00000,34.70000,Multiplan,Commercial,,67.68,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Multiplan,Commercial,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,inpatient,,,72.00000,34.70000,Multiplan,Commercial,,67.68,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Multiplan,Commercial,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,inpatient,,,100.00000,48.20000,Multiplan,Commercial,,94.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,outpatient,,,100.00000,48.20000,Multiplan,Commercial,,94.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,inpatient,,,305.00000,147.01000,Multiplan,Commercial,,286.70,,,,,,,274.50,295.85,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,outpatient,,,305.00000,147.01000,Multiplan,Commercial,,286.70,,,,,,,79.30,295.85,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,inpatient,,,70.00000,33.74000,Multiplan,Commercial,,65.80,,,,,,,63.00,67.90,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,outpatient,,,70.00000,33.74000,Multiplan,Commercial,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,inpatient,,,69.00000,33.26000,Multiplan,Commercial,,64.86,,,,,,,62.10,66.93,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,outpatient,,,69.00000,33.26000,Multiplan,Commercial,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,inpatient,,,64.00000,30.85000,Multiplan,Commercial,,60.16,,,,,,,57.60,62.08,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,outpatient,,,64.00000,30.85000,Multiplan,Commercial,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,inpatient,,,368.00000,177.38000,Multiplan,Commercial,,345.92,,,,,,,331.20,356.96,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,outpatient,,,368.00000,177.38000,Multiplan,Commercial,,345.92,,,,,,,95.68,356.96,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,inpatient,,,104.00000,50.13000,Multiplan,Commercial,,97.76,,,,,,,93.60,100.88,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,outpatient,,,104.00000,50.13000,Multiplan,Commercial,,97.76,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,inpatient,,,109.00000,52.54000,Multiplan,Commercial,,102.46,,,,,,,98.10,105.73,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,outpatient,,,109.00000,52.54000,Multiplan,Commercial,,102.46,,,,,,,28.34,105.73,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,inpatient,,,114.00000,54.95000,Multiplan,Commercial,,107.16,,,,,,,102.60,110.58,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,outpatient,,,114.00000,54.95000,Multiplan,Commercial,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,inpatient,,,135.00000,65.07000,Multiplan,Commercial,,126.90,,,,,,,121.50,130.95,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,outpatient,,,135.00000,65.07000,Multiplan,Commercial,,126.90,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,inpatient,,,105.00000,50.61000,Multiplan,Commercial,,98.70,,,,,,,94.50,101.85,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,outpatient,,,105.00000,50.61000,Multiplan,Commercial,,98.70,,,,,,,27.30,101.85,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,inpatient,,,315.00000,151.83000,Multiplan,Commercial,,296.10,,,,,,,283.50,305.55,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,outpatient,,,315.00000,151.83000,Multiplan,Commercial,,296.10,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,inpatient,,,148.00000,71.34000,Multiplan,Commercial,,139.12,,,,,,,133.20,143.56,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,outpatient,,,148.00000,71.34000,Multiplan,Commercial,,139.12,,,,,,,38.48,143.56,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,inpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,outpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,inpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,60.30,64.99,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,outpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,inpatient,,,107.00000,51.57000,Multiplan,Commercial,,100.58,,,,,,,96.30,103.79,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,outpatient,,,107.00000,51.57000,Multiplan,Commercial,,100.58,,,,,,,27.82,103.79,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,inpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,outpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,inpatient,,,35.00000,16.87000,Multiplan,Commercial,,32.90,,,,,,,31.50,33.95,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,outpatient,,,35.00000,16.87000,Multiplan,Commercial,,32.90,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,inpatient,,,104.00000,50.13000,Multiplan,Commercial,,97.76,,,,,,,93.60,100.88,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,outpatient,,,104.00000,50.13000,Multiplan,Commercial,,97.76,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,inpatient,,,650.00000,313.30000,Multiplan,Commercial,,611.00,,,,,,,585.00,630.50,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,outpatient,,,650.00000,313.30000,Multiplan,Commercial,,611.00,,,,,,,169.00,630.50,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,inpatient,,,91.00000,43.86000,Multiplan,Commercial,,85.54,,,,,,,81.90,88.27,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,outpatient,,,91.00000,43.86000,Multiplan,Commercial,,85.54,,,,,,,23.66,88.27,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,inpatient,,,114.00000,54.95000,Multiplan,Commercial,,107.16,,,,,,,102.60,110.58,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,outpatient,,,114.00000,54.95000,Multiplan,Commercial,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,inpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,46.80,50.44,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,inpatient,,,360.00000,173.52000,Multiplan,Commercial,,338.40,,,,,,,324.00,349.20,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,outpatient,,,360.00000,173.52000,Multiplan,Commercial,,338.40,,,,,,,93.60,349.20,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,inpatient,,,106.00000,51.09000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,outpatient,,,106.00000,51.09000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,inpatient,,,78.00000,37.60000,Multiplan,Commercial,,73.32,,,,,,,70.20,75.66,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,outpatient,,,78.00000,37.60000,Multiplan,Commercial,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,inpatient,,,72.00000,34.70000,Multiplan,Commercial,,67.68,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,outpatient,,,72.00000,34.70000,Multiplan,Commercial,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,inpatient,,,94.00000,45.31000,Multiplan,Commercial,,88.36,,,,,,,84.60,91.18,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,outpatient,,,94.00000,45.31000,Multiplan,Commercial,,88.36,,,,,,,24.44,91.18,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,inpatient,,,101.00000,48.68000,Multiplan,Commercial,,94.94,,,,,,,90.90,97.97,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,outpatient,,,101.00000,48.68000,Multiplan,Commercial,,94.94,,,,,,,26.26,97.97,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,inpatient,,,82.00000,39.52000,Multiplan,Commercial,,77.08,,,,,,,73.80,79.54,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,outpatient,,,82.00000,39.52000,Multiplan,Commercial,,77.08,,,,,,,21.32,79.54,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,inpatient,,,77.00000,37.11000,Multiplan,Commercial,,72.38,,,,,,,69.30,74.69,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,outpatient,,,77.00000,37.11000,Multiplan,Commercial,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,inpatient,,,145.00000,69.89000,Multiplan,Commercial,,136.30,,,,,,,130.50,140.65,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,outpatient,,,145.00000,69.89000,Multiplan,Commercial,,136.30,,,,,,,37.70,140.65,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,inpatient,,,266.00000,128.21000,Multiplan,Commercial,,250.04,,,,,,,239.40,258.02,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,outpatient,,,266.00000,128.21000,Multiplan,Commercial,,250.04,,,,,,,69.16,258.02,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,inpatient,,,79.00000,38.08000,Multiplan,Commercial,,74.26,,,,,,,71.10,76.63,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,outpatient,,,79.00000,38.08000,Multiplan,Commercial,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,inpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,outpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,inpatient,,,144.00000,69.41000,Multiplan,Commercial,,135.36,,,,,,,129.60,139.68,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,outpatient,,,144.00000,69.41000,Multiplan,Commercial,,135.36,,,,,,,37.44,139.68,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,inpatient,,,20.00000,9.64000,Multiplan,Commercial,,18.80,,,,,,,18.00,19.40,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,outpatient,,,20.00000,9.64000,Multiplan,Commercial,,18.80,,,,,,,5.20,19.40,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,inpatient,,,208.00000,100.26000,Multiplan,Commercial,,195.52,,,,,,,187.20,201.76,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,outpatient,,,208.00000,100.26000,Multiplan,Commercial,,195.52,,,,,,,54.08,201.76,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,inpatient,,,135.00000,65.07000,Multiplan,Commercial,,126.90,,,,,,,121.50,130.95,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,outpatient,,,135.00000,65.07000,Multiplan,Commercial,,126.90,,,,,,,35.10,130.95,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,inpatient,,,131.00000,63.14000,Multiplan,Commercial,,123.14,,,,,,,117.90,127.07,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,outpatient,,,131.00000,63.14000,Multiplan,Commercial,,123.14,,,,,,,34.06,127.07,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,inpatient,,,69.00000,33.26000,Multiplan,Commercial,,64.86,,,,,,,62.10,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,outpatient,,,69.00000,33.26000,Multiplan,Commercial,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,inpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,outpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,inpatient,,,25.00000,12.05000,Multiplan,Commercial,,23.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,outpatient,,,25.00000,12.05000,Multiplan,Commercial,,23.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,inpatient,,,61.00000,29.40000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,outpatient,,,61.00000,29.40000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,inpatient,,,80.00000,38.56000,Multiplan,Commercial,,75.20,,,,,,,72.00,77.60,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,outpatient,,,80.00000,38.56000,Multiplan,Commercial,,75.20,,,,,,,20.80,77.60,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,inpatient,,,82.00000,39.52000,Multiplan,Commercial,,77.08,,,,,,,73.80,79.54,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,outpatient,,,82.00000,39.52000,Multiplan,Commercial,,77.08,,,,,,,21.32,79.54,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,inpatient,,,35.00000,16.87000,Multiplan,Commercial,,32.90,,,,,,,31.50,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,outpatient,,,35.00000,16.87000,Multiplan,Commercial,,32.90,,,,,,,9.10,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,inpatient,,,88.00000,42.42000,Multiplan,Commercial,,82.72,,,,,,,79.20,85.36,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,outpatient,,,88.00000,42.42000,Multiplan,Commercial,,82.72,,,,,,,22.88,85.36,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,inpatient,,,98.00000,47.24000,Multiplan,Commercial,,92.12,,,,,,,88.20,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,outpatient,,,98.00000,47.24000,Multiplan,Commercial,,92.12,,,,,,,25.48,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,inpatient,,,204.00000,98.33000,Multiplan,Commercial,,191.76,,,,,,,183.60,197.88,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,outpatient,,,204.00000,98.33000,Multiplan,Commercial,,191.76,,,,,,,53.04,197.88,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,inpatient,,,61.00000,29.40000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,outpatient,,,61.00000,29.40000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,inpatient,,,19.00000,9.16000,Multiplan,Commercial,,17.86,,,,,,,17.10,18.43,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,outpatient,,,19.00000,9.16000,Multiplan,Commercial,,17.86,,,,,,,4.94,18.43,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,inpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,outpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,inpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,outpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,inpatient,,,37.00000,17.83000,Multiplan,Commercial,,34.78,,,,,,,33.30,35.89,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,outpatient,,,37.00000,17.83000,Multiplan,Commercial,,34.78,,,,,,,9.62,35.89,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,inpatient,,,79.00000,38.08000,Multiplan,Commercial,,74.26,,,,,,,71.10,76.63,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,outpatient,,,79.00000,38.08000,Multiplan,Commercial,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,inpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,outpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,inpatient,,,21.00000,10.12000,Multiplan,Commercial,,19.74,,,,,,,18.90,20.37,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,outpatient,,,21.00000,10.12000,Multiplan,Commercial,,19.74,,,,,,,5.46,20.37,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,inpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,46.80,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,outpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,inpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,outpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,inpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,outpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,inpatient,,,32.00000,15.42000,Multiplan,Commercial,,30.08,,,,,,,28.80,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,outpatient,,,32.00000,15.42000,Multiplan,Commercial,,30.08,,,,,,,8.32,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,inpatient,,,94.00000,45.31000,Multiplan,Commercial,,88.36,,,,,,,84.60,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,outpatient,,,94.00000,45.31000,Multiplan,Commercial,,88.36,,,,,,,24.44,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,inpatient,,,103.00000,49.65000,Multiplan,Commercial,,96.82,,,,,,,92.70,99.91,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,outpatient,,,103.00000,49.65000,Multiplan,Commercial,,96.82,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,inpatient,,,64.00000,30.85000,Multiplan,Commercial,,60.16,,,,,,,57.60,62.08,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,outpatient,,,64.00000,30.85000,Multiplan,Commercial,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,inpatient,,,102.00000,49.16000,Multiplan,Commercial,,95.88,,,,,,,91.80,98.94,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,outpatient,,,102.00000,49.16000,Multiplan,Commercial,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,inpatient,,,103.00000,49.65000,Multiplan,Commercial,,96.82,,,,,,,92.70,99.91,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,outpatient,,,103.00000,49.65000,Multiplan,Commercial,,96.82,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,inpatient,,,139.00000,67.00000,Multiplan,Commercial,,130.66,,,,,,,125.10,134.83,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,outpatient,,,139.00000,67.00000,Multiplan,Commercial,,130.66,,,,,,,36.14,134.83,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,inpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,46.80,50.44,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,outpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,inpatient,,,21.00000,10.12000,Multiplan,Commercial,,19.74,,,,,,,18.90,20.37,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Multiplan,Commercial,,19.74,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,inpatient,,,88.00000,42.42000,Multiplan,Commercial,,82.72,,,,,,,79.20,85.36,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,outpatient,,,88.00000,42.42000,Multiplan,Commercial,,82.72,,,,,,,22.88,85.36,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,inpatient,,,21.00000,10.12000,Multiplan,Commercial,,19.74,,,,,,,18.90,20.37,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Multiplan,Commercial,,19.74,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,inpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,46.80,50.44,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,outpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,inpatient,,,80.00000,38.56000,Multiplan,Commercial,,75.20,,,,,,,72.00,77.60,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,outpatient,,,80.00000,38.56000,Multiplan,Commercial,,75.20,,,,,,,20.80,77.60,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,inpatient,,,49.00000,23.62000,Multiplan,Commercial,,46.06,,,,,,,44.10,47.53,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,outpatient,,,49.00000,23.62000,Multiplan,Commercial,,46.06,,,,,,,12.74,47.53,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,inpatient,,,88.00000,42.42000,Multiplan,Commercial,,82.72,,,,,,,79.20,85.36,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,outpatient,,,88.00000,42.42000,Multiplan,Commercial,,82.72,,,,,,,22.88,85.36,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,inpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,outpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,inpatient,,,68.00000,32.78000,Multiplan,Commercial,,63.92,,,,,,,61.20,65.96,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,outpatient,,,68.00000,32.78000,Multiplan,Commercial,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,inpatient,,,93.00000,44.83000,Multiplan,Commercial,,87.42,,,,,,,83.70,90.21,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,outpatient,,,93.00000,44.83000,Multiplan,Commercial,,87.42,,,,,,,24.18,90.21,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,inpatient,,,73.00000,35.19000,Multiplan,Commercial,,68.62,,,,,,,65.70,70.81,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,outpatient,,,73.00000,35.19000,Multiplan,Commercial,,68.62,,,,,,,18.98,70.81,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,inpatient,,,41.00000,19.76000,Multiplan,Commercial,,38.54,,,,,,,36.90,39.77,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,outpatient,,,41.00000,19.76000,Multiplan,Commercial,,38.54,,,,,,,10.66,39.77,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,inpatient,,,94.00000,45.31000,Multiplan,Commercial,,88.36,,,,,,,84.60,91.18,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,outpatient,,,94.00000,45.31000,Multiplan,Commercial,,88.36,,,,,,,24.44,91.18,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,inpatient,,,124.00000,59.77000,Multiplan,Commercial,,116.56,,,,,,,111.60,120.28,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,outpatient,,,124.00000,59.77000,Multiplan,Commercial,,116.56,,,,,,,32.24,120.28,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,inpatient,,,71.00000,34.22000,Multiplan,Commercial,,66.74,,,,,,,63.90,68.87,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,outpatient,,,71.00000,34.22000,Multiplan,Commercial,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,inpatient,,,33.00000,15.91000,Multiplan,Commercial,,31.02,,,,,,,29.70,32.01,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,outpatient,,,33.00000,15.91000,Multiplan,Commercial,,31.02,,,,,,,8.58,32.01,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,inpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,46.80,50.44,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,outpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,inpatient,,,68.00000,32.78000,Multiplan,Commercial,,63.92,,,,,,,61.20,65.96,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,outpatient,,,68.00000,32.78000,Multiplan,Commercial,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,inpatient,,,99.00000,47.72000,Multiplan,Commercial,,93.06,,,,,,,89.10,96.03,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,outpatient,,,99.00000,47.72000,Multiplan,Commercial,,93.06,,,,,,,25.74,96.03,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,inpatient,,,197.00000,94.95000,Multiplan,Commercial,,185.18,,,,,,,177.30,191.09,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,outpatient,,,197.00000,94.95000,Multiplan,Commercial,,185.18,,,,,,,51.22,191.09,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,inpatient,,,194.00000,93.51000,Multiplan,Commercial,,182.36,,,,,,,174.60,188.18,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,outpatient,,,194.00000,93.51000,Multiplan,Commercial,,182.36,,,,,,,50.44,188.18,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,inpatient,,,68.00000,32.78000,Multiplan,Commercial,,63.92,,,,,,,61.20,65.96,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,outpatient,,,68.00000,32.78000,Multiplan,Commercial,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,inpatient,,,90.00000,43.38000,Multiplan,Commercial,,84.60,,,,,,,81.00,87.30,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,outpatient,,,90.00000,43.38000,Multiplan,Commercial,,84.60,,,,,,,23.40,87.30,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,inpatient,,,109.00000,52.54000,Multiplan,Commercial,,102.46,,,,,,,98.10,105.73,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,outpatient,,,109.00000,52.54000,Multiplan,Commercial,,102.46,,,,,,,28.34,105.73,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,inpatient,,,108.00000,52.06000,Multiplan,Commercial,,101.52,,,,,,,97.20,104.76,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,outpatient,,,108.00000,52.06000,Multiplan,Commercial,,101.52,,,,,,,28.08,104.76,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,inpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,60.30,64.99,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,outpatient,,,67.00000,32.29000,Multiplan,Commercial,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,inpatient,,,69.00000,33.26000,Multiplan,Commercial,,64.86,,,,,,,62.10,66.93,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,outpatient,,,69.00000,33.26000,Multiplan,Commercial,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,inpatient,,,71.00000,34.22000,Multiplan,Commercial,,66.74,,,,,,,63.90,68.87,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,outpatient,,,71.00000,34.22000,Multiplan,Commercial,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,inpatient,,,98.00000,47.24000,Multiplan,Commercial,,92.12,,,,,,,88.20,95.06,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,outpatient,,,98.00000,47.24000,Multiplan,Commercial,,92.12,,,,,,,25.48,95.06,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,inpatient,,,141.00000,67.96000,Multiplan,Commercial,,132.54,,,,,,,126.90,136.77,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,outpatient,,,141.00000,67.96000,Multiplan,Commercial,,132.54,,,,,,,36.66,136.77,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,inpatient,,,226.00000,108.93000,Multiplan,Commercial,,212.44,,,,,,,203.40,219.22,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,outpatient,,,226.00000,108.93000,Multiplan,Commercial,,212.44,,,,,,,58.76,219.22,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,inpatient,,,92.00000,44.34000,Multiplan,Commercial,,86.48,,,,,,,82.80,89.24,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,outpatient,,,92.00000,44.34000,Multiplan,Commercial,,86.48,,,,,,,23.92,89.24,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,inpatient,,,69.00000,33.26000,Multiplan,Commercial,,64.86,,,,,,,62.10,66.93,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,outpatient,,,69.00000,33.26000,Multiplan,Commercial,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,inpatient,,,100.00000,48.20000,Multiplan,Commercial,,94.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,outpatient,,,100.00000,48.20000,Multiplan,Commercial,,94.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,inpatient,,,124.00000,59.77000,Multiplan,Commercial,,116.56,,,,,,,111.60,120.28,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,outpatient,,,124.00000,59.77000,Multiplan,Commercial,,116.56,,,,,,,32.24,120.28,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,inpatient,,,69.00000,33.26000,Multiplan,Commercial,,64.86,,,,,,,62.10,66.93,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,outpatient,,,69.00000,33.26000,Multiplan,Commercial,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Multiplan,Commercial,,116.56,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Multiplan,Commercial,,116.56,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Multiplan,Commercial,,116.56,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Multiplan,Commercial,,116.56,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Multiplan,Commercial,,116.56,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Multiplan,Commercial,,116.56,,,,,,,32.24,120.28,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,inpatient,,,118.00000,56.88000,Multiplan,Commercial,,110.92,,,,,,,106.20,114.46,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,outpatient,,,118.00000,56.88000,Multiplan,Commercial,,110.92,,,,,,,30.68,114.46,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,inpatient,,,51.00000,24.58000,Multiplan,Commercial,,47.94,,,,,,,45.90,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,outpatient,,,51.00000,24.58000,Multiplan,Commercial,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,inpatient,,,104.00000,50.13000,Multiplan,Commercial,,97.76,,,,,,,93.60,100.88,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,outpatient,,,104.00000,50.13000,Multiplan,Commercial,,97.76,,,,,,,27.04,100.88,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,inpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,outpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,inpatient,,,72.00000,34.70000,Multiplan,Commercial,,67.68,,,,,,,64.80,69.84,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,outpatient,,,72.00000,34.70000,Multiplan,Commercial,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,inpatient,,,54.00000,26.03000,Multiplan,Commercial,,50.76,,,,,,,48.60,52.38,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,outpatient,,,54.00000,26.03000,Multiplan,Commercial,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,inpatient,,,17.00000,8.19000,Multiplan,Commercial,,15.98,,,,,,,15.30,16.49,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,outpatient,,,17.00000,8.19000,Multiplan,Commercial,,15.98,,,,,,,4.42,16.49,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,inpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,outpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,inpatient,,,36.00000,17.35000,Multiplan,Commercial,,33.84,,,,,,,32.40,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,outpatient,,,36.00000,17.35000,Multiplan,Commercial,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,inpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,46.80,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,outpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,inpatient,,,18.00000,8.68000,Multiplan,Commercial,,16.92,,,,,,,16.20,17.46,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,outpatient,,,18.00000,8.68000,Multiplan,Commercial,,16.92,,,,,,,4.68,17.46,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,inpatient,,,74.00000,35.67000,Multiplan,Commercial,,69.56,,,,,,,66.60,71.78,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,outpatient,,,74.00000,35.67000,Multiplan,Commercial,,69.56,,,,,,,19.24,71.78,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,inpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,outpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,inpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,outpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,inpatient,,,118.00000,56.88000,Multiplan,Commercial,,110.92,,,,,,,106.20,114.46,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,outpatient,,,118.00000,56.88000,Multiplan,Commercial,,110.92,,,,,,,30.68,114.46,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,inpatient,,,82.00000,39.52000,Multiplan,Commercial,,77.08,,,,,,,73.80,79.54,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,outpatient,,,82.00000,39.52000,Multiplan,Commercial,,77.08,,,,,,,21.32,79.54,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,inpatient,,,30.00000,14.46000,Multiplan,Commercial,,28.20,,,,,,,27.00,29.10,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,outpatient,,,30.00000,14.46000,Multiplan,Commercial,,28.20,,,,,,,7.80,29.10,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,inpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,outpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,inpatient,,,70.00000,33.74000,Multiplan,Commercial,,65.80,,,,,,,63.00,67.90,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,outpatient,,,70.00000,33.74000,Multiplan,Commercial,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,inpatient,,,54.00000,26.03000,Multiplan,Commercial,,50.76,,,,,,,48.60,52.38,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,outpatient,,,54.00000,26.03000,Multiplan,Commercial,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,inpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,outpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,inpatient,,,51.00000,24.58000,Multiplan,Commercial,,47.94,,,,,,,45.90,49.47,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,outpatient,,,51.00000,24.58000,Multiplan,Commercial,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,inpatient,,,141.00000,67.96000,Multiplan,Commercial,,132.54,,,,,,,126.90,136.77,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,outpatient,,,141.00000,67.96000,Multiplan,Commercial,,132.54,,,,,,,36.66,136.77,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,inpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,outpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,inpatient,,,81.00000,39.04000,Multiplan,Commercial,,76.14,,,,,,,72.90,78.57,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,outpatient,,,81.00000,39.04000,Multiplan,Commercial,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,inpatient,,,335.00000,161.47000,Multiplan,Commercial,,314.90,,,,,,,301.50,324.95,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,outpatient,,,335.00000,161.47000,Multiplan,Commercial,,314.90,,,,,,,87.10,324.95,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,inpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,46.80,50.44,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,outpatient,,,52.00000,25.06000,Multiplan,Commercial,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,inpatient,,,54.00000,26.03000,Multiplan,Commercial,,50.76,,,,,,,48.60,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Multiplan,Commercial,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,inpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,outpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,inpatient,,,54.00000,26.03000,Multiplan,Commercial,,50.76,,,,,,,48.60,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Multiplan,Commercial,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,inpatient,,,53.00000,25.55000,Multiplan,Commercial,,49.82,,,,,,,47.70,51.41,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,outpatient,,,53.00000,25.55000,Multiplan,Commercial,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,inpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,outpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,inpatient,,,53.00000,25.55000,Multiplan,Commercial,,49.82,,,,,,,47.70,51.41,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,outpatient,,,53.00000,25.55000,Multiplan,Commercial,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,inpatient,,,12.00000,5.78000,Multiplan,Commercial,,11.28,,,,,,,10.80,11.64,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,outpatient,,,12.00000,5.78000,Multiplan,Commercial,,11.28,,,,,,,3.12,11.64,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,inpatient,,,710.00000,342.22000,Multiplan,Commercial,,667.40,,,,,,,639.00,688.70,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,outpatient,,,710.00000,342.22000,Multiplan,Commercial,,667.40,,,,,,,184.60,688.70,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,inpatient,,,104.00000,50.13000,Multiplan,Commercial,,97.76,,,,,,,93.60,100.88,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,outpatient,,,104.00000,50.13000,Multiplan,Commercial,,97.76,,,,,,,27.04,100.88,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,inpatient,,,155.00000,74.71000,Multiplan,Commercial,,145.70,,,,,,,139.50,150.35,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,outpatient,,,155.00000,74.71000,Multiplan,Commercial,,145.70,,,,,,,40.30,150.35,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,inpatient,,,139.00000,67.00000,Multiplan,Commercial,,130.66,,,,,,,125.10,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,outpatient,,,139.00000,67.00000,Multiplan,Commercial,,130.66,,,,,,,36.14,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,inpatient,,,89.00000,42.90000,Multiplan,Commercial,,83.66,,,,,,,80.10,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,outpatient,,,89.00000,42.90000,Multiplan,Commercial,,83.66,,,,,,,23.14,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,inpatient,,,88.00000,42.42000,Multiplan,Commercial,,82.72,,,,,,,79.20,85.36,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,outpatient,,,88.00000,42.42000,Multiplan,Commercial,,82.72,,,,,,,22.88,85.36,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,inpatient,,,111.00000,53.50000,Multiplan,Commercial,,104.34,,,,,,,99.90,107.67,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,outpatient,,,111.00000,53.50000,Multiplan,Commercial,,104.34,,,,,,,28.86,107.67,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,inpatient,,,70.00000,33.74000,Multiplan,Commercial,,65.80,,,,,,,63.00,67.90,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,outpatient,,,70.00000,33.74000,Multiplan,Commercial,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,inpatient,,,85.00000,40.97000,Multiplan,Commercial,,79.90,,,,,,,76.50,82.45,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,outpatient,,,85.00000,40.97000,Multiplan,Commercial,,79.90,,,,,,,22.10,82.45,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,inpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,outpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,inpatient,,,110.00000,53.02000,Multiplan,Commercial,,103.40,,,,,,,99.00,106.70,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,outpatient,,,110.00000,53.02000,Multiplan,Commercial,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,inpatient,,,500.00000,241.00000,Multiplan,Commercial,,470.00,,,,,,,450.00,485.00,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,outpatient,,,500.00000,241.00000,Multiplan,Commercial,,470.00,,,,,,,130.00,485.00,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,inpatient,,,140.00000,67.48000,Multiplan,Commercial,,131.60,,,,,,,126.00,135.80,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,outpatient,,,140.00000,67.48000,Multiplan,Commercial,,131.60,,,,,,,36.40,135.80,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,inpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,outpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,inpatient,,,74.00000,35.67000,Multiplan,Commercial,,69.56,,,,,,,66.60,71.78,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,outpatient,,,74.00000,35.67000,Multiplan,Commercial,,69.56,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,inpatient,,,77.00000,37.11000,Multiplan,Commercial,,72.38,,,,,,,69.30,74.69,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,outpatient,,,77.00000,37.11000,Multiplan,Commercial,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,inpatient,,,93.00000,44.83000,Multiplan,Commercial,,87.42,,,,,,,83.70,90.21,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,outpatient,,,93.00000,44.83000,Multiplan,Commercial,,87.42,,,,,,,24.18,90.21,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,inpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,outpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,inpatient,,,15.00000,7.23000,Multiplan,Commercial,,14.10,,,,,,,13.50,14.55,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,outpatient,,,15.00000,7.23000,Multiplan,Commercial,,14.10,,,,,,,3.90,14.55,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,inpatient,,,24.00000,11.57000,Multiplan,Commercial,,22.56,,,,,,,21.60,23.28,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,outpatient,,,24.00000,11.57000,Multiplan,Commercial,,22.56,,,,,,,6.24,23.28,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,inpatient,,,72.00000,34.70000,Multiplan,Commercial,,67.68,,,,,,,64.80,69.84,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,outpatient,,,72.00000,34.70000,Multiplan,Commercial,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,inpatient,,,16.00000,7.71000,Multiplan,Commercial,,15.04,,,,,,,14.40,15.52,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Multiplan,Commercial,,15.04,,,,,,,4.16,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,inpatient,,,16.00000,7.71000,Multiplan,Commercial,,15.04,,,,,,,14.40,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Multiplan,Commercial,,15.04,,,,,,,4.16,15.52,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,inpatient,,,64.00000,30.85000,Multiplan,Commercial,,60.16,,,,,,,57.60,62.08,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,outpatient,,,64.00000,30.85000,Multiplan,Commercial,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,inpatient,,,82.00000,39.52000,Multiplan,Commercial,,77.08,,,,,,,73.80,79.54,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,outpatient,,,82.00000,39.52000,Multiplan,Commercial,,77.08,,,,,,,21.32,79.54,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,inpatient,,,157.00000,75.67000,Multiplan,Commercial,,147.58,,,,,,,141.30,152.29,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,outpatient,,,157.00000,75.67000,Multiplan,Commercial,,147.58,,,,,,,40.82,152.29,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,inpatient,,,70.00000,33.74000,Multiplan,Commercial,,65.80,,,,,,,63.00,67.90,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,outpatient,,,70.00000,33.74000,Multiplan,Commercial,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,inpatient,,,229.00000,110.38000,Multiplan,Commercial,,215.26,,,,,,,206.10,222.13,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,outpatient,,,229.00000,110.38000,Multiplan,Commercial,,215.26,,,,,,,59.54,222.13,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,inpatient,,,64.00000,30.85000,Multiplan,Commercial,,60.16,,,,,,,57.60,62.08,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,outpatient,,,64.00000,30.85000,Multiplan,Commercial,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,inpatient,,,72.00000,34.70000,Multiplan,Commercial,,67.68,,,,,,,64.80,69.84,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,outpatient,,,72.00000,34.70000,Multiplan,Commercial,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,inpatient,,,17.00000,8.19000,Multiplan,Commercial,,15.98,,,,,,,15.30,16.49,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,outpatient,,,17.00000,8.19000,Multiplan,Commercial,,15.98,,,,,,,4.42,16.49,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,inpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,outpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,inpatient,,,64.00000,30.85000,Multiplan,Commercial,,60.16,,,,,,,57.60,62.08,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,outpatient,,,64.00000,30.85000,Multiplan,Commercial,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,inpatient,,,387.00000,186.53000,Multiplan,Commercial,,363.78,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,outpatient,,,387.00000,186.53000,Multiplan,Commercial,,363.78,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,inpatient,,,387.00000,186.53000,Multiplan,Commercial,,363.78,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Multiplan,Commercial,,363.78,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,inpatient,,,387.00000,186.53000,Multiplan,Commercial,,363.78,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Multiplan,Commercial,,363.78,,,,,,,100.62,375.39,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,inpatient,,,77.00000,37.11000,Multiplan,Commercial,,72.38,,,,,,,69.30,74.69,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,outpatient,,,77.00000,37.11000,Multiplan,Commercial,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,inpatient,,,78.00000,37.60000,Multiplan,Commercial,,73.32,,,,,,,70.20,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Multiplan,Commercial,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,inpatient,,,78.00000,37.60000,Multiplan,Commercial,,73.32,,,,,,,70.20,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Multiplan,Commercial,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,inpatient,,,43.00000,20.73000,Multiplan,Commercial,,40.42,,,,,,,38.70,41.71,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,outpatient,,,43.00000,20.73000,Multiplan,Commercial,,40.42,,,,,,,11.18,41.71,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,inpatient,,,64.00000,30.85000,Multiplan,Commercial,,60.16,,,,,,,57.60,62.08,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,outpatient,,,64.00000,30.85000,Multiplan,Commercial,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,inpatient,,,160.00000,77.12000,Multiplan,Commercial,,150.40,,,,,,,144.00,155.20,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,outpatient,,,160.00000,77.12000,Multiplan,Commercial,,150.40,,,,,,,41.60,155.20,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,inpatient,,,112.00000,53.98000,Multiplan,Commercial,,105.28,,,,,,,100.80,108.64,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,outpatient,,,112.00000,53.98000,Multiplan,Commercial,,105.28,,,,,,,29.12,108.64,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,inpatient,,,82.00000,39.52000,Multiplan,Commercial,,77.08,,,,,,,73.80,79.54,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,outpatient,,,82.00000,39.52000,Multiplan,Commercial,,77.08,,,,,,,21.32,79.54,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,inpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,outpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,inpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,outpatient,,,55.00000,26.51000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,inpatient,,,54.00000,26.03000,Multiplan,Commercial,,50.76,,,,,,,48.60,52.38,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,outpatient,,,54.00000,26.03000,Multiplan,Commercial,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,inpatient,,,153.00000,73.75000,Multiplan,Commercial,,143.82,,,,,,,137.70,148.41,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,outpatient,,,153.00000,73.75000,Multiplan,Commercial,,143.82,,,,,,,39.78,148.41,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,inpatient,,,45.00000,21.69000,Multiplan,Commercial,,42.30,,,,,,,40.50,43.65,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,outpatient,,,45.00000,21.69000,Multiplan,Commercial,,42.30,,,,,,,11.70,43.65,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,inpatient,,,28.00000,13.50000,Multiplan,Commercial,,26.32,,,,,,,25.20,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,outpatient,,,28.00000,13.50000,Multiplan,Commercial,,26.32,,,,,,,7.28,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,inpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,outpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Multiplan,Commercial,,46.06,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Multiplan,Commercial,,46.06,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Multiplan,Commercial,,46.06,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Multiplan,Commercial,,46.06,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Multiplan,Commercial,,46.06,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Multiplan,Commercial,,46.06,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,inpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,outpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,inpatient,,,36.00000,17.35000,Multiplan,Commercial,,33.84,,,,,,,32.40,34.92,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,outpatient,,,36.00000,17.35000,Multiplan,Commercial,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,inpatient,,,38.00000,18.32000,Multiplan,Commercial,,35.72,,,,,,,34.20,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,outpatient,,,38.00000,18.32000,Multiplan,Commercial,,35.72,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,inpatient,,,38.00000,18.32000,Multiplan,Commercial,,35.72,,,,,,,34.20,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,outpatient,,,38.00000,18.32000,Multiplan,Commercial,,35.72,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,inpatient,,,76.00000,36.63000,Multiplan,Commercial,,71.44,,,,,,,68.40,73.72,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,outpatient,,,76.00000,36.63000,Multiplan,Commercial,,71.44,,,,,,,19.76,73.72,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,inpatient,,,173.00000,83.39000,Multiplan,Commercial,,162.62,,,,,,,155.70,167.81,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,outpatient,,,173.00000,83.39000,Multiplan,Commercial,,162.62,,,,,,,44.98,167.81,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,inpatient,,,22.00000,10.60000,Multiplan,Commercial,,20.68,,,,,,,19.80,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,outpatient,,,22.00000,10.60000,Multiplan,Commercial,,20.68,,,,,,,5.72,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,inpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,outpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,inpatient,,,39.00000,18.80000,Multiplan,Commercial,,36.66,,,,,,,35.10,37.83,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,outpatient,,,39.00000,18.80000,Multiplan,Commercial,,36.66,,,,,,,10.14,37.83,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,inpatient,,,41.00000,19.76000,Multiplan,Commercial,,38.54,,,,,,,36.90,39.77,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,outpatient,,,41.00000,19.76000,Multiplan,Commercial,,38.54,,,,,,,10.66,39.77,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,inpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,outpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,inpatient,,,54.00000,26.03000,Multiplan,Commercial,,50.76,,,,,,,48.60,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,outpatient,,,54.00000,26.03000,Multiplan,Commercial,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,inpatient,,,71.00000,34.22000,Multiplan,Commercial,,66.74,,,,,,,63.90,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,outpatient,,,71.00000,34.22000,Multiplan,Commercial,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,inpatient,,,43.00000,20.73000,Multiplan,Commercial,,40.42,,,,,,,38.70,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Multiplan,Commercial,,40.42,,,,,,,11.18,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,inpatient,,,43.00000,20.73000,Multiplan,Commercial,,40.42,,,,,,,38.70,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Multiplan,Commercial,,40.42,,,,,,,11.18,41.71,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,inpatient,,,38.00000,18.32000,Multiplan,Commercial,,35.72,,,,,,,34.20,36.86,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,outpatient,,,38.00000,18.32000,Multiplan,Commercial,,35.72,,,,,,,9.88,36.86,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,inpatient,,,72.00000,34.70000,Multiplan,Commercial,,67.68,,,,,,,64.80,69.84,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,outpatient,,,72.00000,34.70000,Multiplan,Commercial,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,inpatient,,,226.00000,108.93000,Multiplan,Commercial,,212.44,,,,,,,203.40,219.22,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,outpatient,,,226.00000,108.93000,Multiplan,Commercial,,212.44,,,,,,,58.76,219.22,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Multiplan,Commercial,,38.54,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Multiplan,Commercial,,38.54,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Multiplan,Commercial,,38.54,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Multiplan,Commercial,,38.54,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Multiplan,Commercial,,38.54,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Multiplan,Commercial,,38.54,,,,,,,10.66,39.77,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,inpatient,,,160.00000,77.12000,Multiplan,Commercial,,150.40,,,,,,,144.00,155.20,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,outpatient,,,160.00000,77.12000,Multiplan,Commercial,,150.40,,,,,,,41.60,155.20,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,inpatient,,,102.00000,49.16000,Multiplan,Commercial,,95.88,,,,,,,91.80,98.94,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,outpatient,,,102.00000,49.16000,Multiplan,Commercial,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,inpatient,,,317.00000,152.79000,Multiplan,Commercial,,297.98,,,,,,,285.30,307.49,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,outpatient,,,317.00000,152.79000,Multiplan,Commercial,,297.98,,,,,,,82.42,307.49,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,inpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,outpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,inpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,outpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,inpatient,,,116.00000,55.91000,Multiplan,Commercial,,109.04,,,,,,,104.40,112.52,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,outpatient,,,116.00000,55.91000,Multiplan,Commercial,,109.04,,,,,,,30.16,112.52,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,inpatient,,,89.00000,42.90000,Multiplan,Commercial,,83.66,,,,,,,80.10,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Multiplan,Commercial,,83.66,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,inpatient,,,89.00000,42.90000,Multiplan,Commercial,,83.66,,,,,,,80.10,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Multiplan,Commercial,,83.66,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,inpatient,,,85.00000,40.97000,Multiplan,Commercial,,79.90,,,,,,,76.50,82.45,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,outpatient,,,85.00000,40.97000,Multiplan,Commercial,,79.90,,,,,,,22.10,82.45,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,inpatient,,,184.00000,88.69000,Multiplan,Commercial,,172.96,,,,,,,165.60,178.48,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,outpatient,,,184.00000,88.69000,Multiplan,Commercial,,172.96,,,,,,,47.84,178.48,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,inpatient,,,127.00000,61.21000,Multiplan,Commercial,,119.38,,,,,,,114.30,123.19,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,outpatient,,,127.00000,61.21000,Multiplan,Commercial,,119.38,,,,,,,33.02,123.19,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,inpatient,,,61.00000,29.40000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,outpatient,,,61.00000,29.40000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,inpatient,,,35.00000,16.87000,Multiplan,Commercial,,32.90,,,,,,,31.50,33.95,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,outpatient,,,35.00000,16.87000,Multiplan,Commercial,,32.90,,,,,,,9.10,33.95,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,inpatient,,,79.00000,38.08000,Multiplan,Commercial,,74.26,,,,,,,71.10,76.63,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,outpatient,,,79.00000,38.08000,Multiplan,Commercial,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,inpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,outpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,inpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,outpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,inpatient,,,57.00000,32.83000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,outpatient,,,57.00000,32.83000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Multiplan,Commercial,,143.82,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Multiplan,Commercial,,143.82,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,inpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,outpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,inpatient,,,77.00000,44.35000,Multiplan,Commercial,,72.38,,,,,,,69.30,74.69,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,outpatient,,,77.00000,44.35000,Multiplan,Commercial,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,inpatient,,,70.00000,40.32000,Multiplan,Commercial,,65.80,,,,,,,63.00,67.90,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,outpatient,,,70.00000,40.32000,Multiplan,Commercial,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,inpatient,,,67.00000,38.59000,Multiplan,Commercial,,62.98,,,,,,,60.30,64.99,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,outpatient,,,67.00000,38.59000,Multiplan,Commercial,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,inpatient,,,40.00000,23.04000,Multiplan,Commercial,,37.60,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,outpatient,,,40.00000,23.04000,Multiplan,Commercial,,37.60,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,inpatient,,,71.00000,40.90000,Multiplan,Commercial,,66.74,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,outpatient,,,71.00000,40.90000,Multiplan,Commercial,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,inpatient,,,80.00000,46.08000,Multiplan,Commercial,,75.20,,,,,,,72.00,77.60,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,outpatient,,,80.00000,46.08000,Multiplan,Commercial,,75.20,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,inpatient,,,72.00000,41.47000,Multiplan,Commercial,,67.68,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,outpatient,,,72.00000,41.47000,Multiplan,Commercial,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,inpatient,,,444.00000,255.74000,Multiplan,Commercial,,417.36,,,,,,,399.60,430.68,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,outpatient,,,444.00000,255.74000,Multiplan,Commercial,,417.36,,,,,,,115.44,430.68,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,inpatient,,,81.00000,46.66000,Multiplan,Commercial,,76.14,,,,,,,72.90,78.57,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,outpatient,,,81.00000,46.66000,Multiplan,Commercial,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,inpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,outpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,inpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,inpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,inpatient,,,66.00000,38.02000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,outpatient,,,66.00000,38.02000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,inpatient,,,57.00000,32.83000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,outpatient,,,57.00000,32.83000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,inpatient,,,53.00000,30.53000,Multiplan,Commercial,,49.82,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,outpatient,,,53.00000,30.53000,Multiplan,Commercial,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,inpatient,,,60.00000,34.56000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,outpatient,,,60.00000,34.56000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,inpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,outpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,inpatient,,,40.00000,23.04000,Multiplan,Commercial,,37.60,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,outpatient,,,40.00000,23.04000,Multiplan,Commercial,,37.60,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,inpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,outpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,inpatient,,,42.00000,24.19000,Multiplan,Commercial,,39.48,,,,,,,37.80,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,outpatient,,,42.00000,24.19000,Multiplan,Commercial,,39.48,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,inpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,outpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,inpatient,,,46.00000,26.50000,Multiplan,Commercial,,43.24,,,,,,,41.40,44.62,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,outpatient,,,46.00000,26.50000,Multiplan,Commercial,,43.24,,,,,,,11.96,44.62,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,inpatient,,,54.00000,31.10000,Multiplan,Commercial,,50.76,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,outpatient,,,54.00000,31.10000,Multiplan,Commercial,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,inpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,outpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,inpatient,,,71.00000,40.90000,Multiplan,Commercial,,66.74,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,outpatient,,,71.00000,40.90000,Multiplan,Commercial,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,inpatient,,,54.00000,31.10000,Multiplan,Commercial,,50.76,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,outpatient,,,54.00000,31.10000,Multiplan,Commercial,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,inpatient,,,80.00000,46.08000,Multiplan,Commercial,,75.20,,,,,,,72.00,77.60,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,outpatient,,,80.00000,46.08000,Multiplan,Commercial,,75.20,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,inpatient,,,60.00000,34.56000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,outpatient,,,60.00000,34.56000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,inpatient,,,124.00000,71.42000,Multiplan,Commercial,,116.56,,,,,,,111.60,120.28,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Multiplan,Commercial,,116.56,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,inpatient,,,130.00000,74.88000,Multiplan,Commercial,,122.20,,,,,,,117.00,126.10,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,outpatient,,,130.00000,74.88000,Multiplan,Commercial,,122.20,,,,,,,33.80,126.10,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,inpatient,,,123.00000,70.85000,Multiplan,Commercial,,115.62,,,,,,,110.70,119.31,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Multiplan,Commercial,,115.62,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,inpatient,,,77.00000,44.35000,Multiplan,Commercial,,72.38,,,,,,,69.30,74.69,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,outpatient,,,77.00000,44.35000,Multiplan,Commercial,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,inpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,outpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,inpatient,,,115.00000,66.24000,Multiplan,Commercial,,108.10,,,,,,,103.50,111.55,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,outpatient,,,115.00000,66.24000,Multiplan,Commercial,,108.10,,,,,,,29.90,111.55,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,inpatient,,,123.00000,70.85000,Multiplan,Commercial,,115.62,,,,,,,110.70,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Multiplan,Commercial,,115.62,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,inpatient,,,161.00000,92.74000,Multiplan,Commercial,,151.34,,,,,,,144.90,156.17,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,outpatient,,,161.00000,92.74000,Multiplan,Commercial,,151.34,,,,,,,41.86,156.17,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,inpatient,,,124.00000,71.42000,Multiplan,Commercial,,116.56,,,,,,,111.60,120.28,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Multiplan,Commercial,,116.56,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,inpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,outpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,inpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,outpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,inpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,outpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,inpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,outpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,inpatient,,,102.00000,58.75000,Multiplan,Commercial,,95.88,,,,,,,91.80,98.94,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,outpatient,,,102.00000,58.75000,Multiplan,Commercial,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,inpatient,,,219.00000,126.14000,Multiplan,Commercial,,205.86,,,,,,,197.10,212.43,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,outpatient,,,219.00000,126.14000,Multiplan,Commercial,,205.86,,,,,,,56.94,212.43,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,inpatient,,,194.00000,111.74000,Multiplan,Commercial,,182.36,,,,,,,174.60,188.18,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Multiplan,Commercial,,182.36,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,inpatient,,,103.00000,59.33000,Multiplan,Commercial,,96.82,,,,,,,92.70,99.91,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,outpatient,,,103.00000,59.33000,Multiplan,Commercial,,96.82,,,,,,,26.78,99.91,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,inpatient,,,60.00000,34.56000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,outpatient,,,60.00000,34.56000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,inpatient,,,837.00000,482.11000,Multiplan,Commercial,,786.78,,,,,,,753.30,811.89,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,outpatient,,,837.00000,482.11000,Multiplan,Commercial,,786.78,,,,,,,217.62,811.89,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,inpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,inpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,inpatient,,,194.00000,111.74000,Multiplan,Commercial,,182.36,,,,,,,174.60,188.18,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Multiplan,Commercial,,182.36,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,inpatient,,,78.00000,44.93000,Multiplan,Commercial,,73.32,,,,,,,70.20,75.66,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,outpatient,,,78.00000,44.93000,Multiplan,Commercial,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,inpatient,,,285.00000,164.16000,Multiplan,Commercial,,267.90,,,,,,,256.50,276.45,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,outpatient,,,285.00000,164.16000,Multiplan,Commercial,,267.90,,,,,,,74.10,276.45,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,inpatient,,,190.00000,109.44000,Multiplan,Commercial,,178.60,,,,,,,171.00,184.30,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,outpatient,,,190.00000,109.44000,Multiplan,Commercial,,178.60,,,,,,,49.40,184.30,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,inpatient,,,100.00000,57.60000,Multiplan,Commercial,,94.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,outpatient,,,100.00000,57.60000,Multiplan,Commercial,,94.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,inpatient,,,40.00000,23.04000,Multiplan,Commercial,,37.60,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Multiplan,Commercial,,37.60,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,inpatient,,,67.00000,38.59000,Multiplan,Commercial,,62.98,,,,,,,60.30,64.99,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,outpatient,,,67.00000,38.59000,Multiplan,Commercial,,62.98,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,inpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,outpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,inpatient,,,78.00000,44.93000,Multiplan,Commercial,,73.32,,,,,,,70.20,75.66,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,outpatient,,,78.00000,44.93000,Multiplan,Commercial,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,inpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,outpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,inpatient,,,57.00000,32.83000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,outpatient,,,57.00000,32.83000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,inpatient,,,72.00000,41.47000,Multiplan,Commercial,,67.68,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,outpatient,,,72.00000,41.47000,Multiplan,Commercial,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,inpatient,,,59.00000,33.98000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,outpatient,,,59.00000,33.98000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,inpatient,,,72.00000,41.47000,Multiplan,Commercial,,67.68,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,outpatient,,,72.00000,41.47000,Multiplan,Commercial,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,inpatient,,,239.00000,137.66000,Multiplan,Commercial,,224.66,,,,,,,215.10,231.83,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,outpatient,,,239.00000,137.66000,Multiplan,Commercial,,224.66,,,,,,,62.14,231.83,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,inpatient,,,85.00000,48.96000,Multiplan,Commercial,,79.90,,,,,,,76.50,82.45,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,outpatient,,,85.00000,48.96000,Multiplan,Commercial,,79.90,,,,,,,22.10,82.45,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,inpatient,,,44.00000,25.34000,Multiplan,Commercial,,41.36,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,outpatient,,,44.00000,25.34000,Multiplan,Commercial,,41.36,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,inpatient,,,40.00000,23.04000,Multiplan,Commercial,,37.60,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,outpatient,,,40.00000,23.04000,Multiplan,Commercial,,37.60,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,inpatient,,,53.00000,30.53000,Multiplan,Commercial,,49.82,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,outpatient,,,53.00000,30.53000,Multiplan,Commercial,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,inpatient,,,59.00000,33.98000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,inpatient,,,59.00000,33.98000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,inpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,outpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,inpatient,,,68.00000,39.17000,Multiplan,Commercial,,63.92,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,outpatient,,,68.00000,39.17000,Multiplan,Commercial,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,inpatient,,,76.00000,43.78000,Multiplan,Commercial,,71.44,,,,,,,68.40,73.72,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,outpatient,,,76.00000,43.78000,Multiplan,Commercial,,71.44,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,inpatient,,,42.00000,24.19000,Multiplan,Commercial,,39.48,,,,,,,37.80,40.74,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,outpatient,,,42.00000,24.19000,Multiplan,Commercial,,39.48,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,inpatient,,,87.00000,50.11000,Multiplan,Commercial,,81.78,,,,,,,78.30,84.39,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,outpatient,,,87.00000,50.11000,Multiplan,Commercial,,81.78,,,,,,,22.62,84.39,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,inpatient,,,503.00000,289.73000,Multiplan,Commercial,,472.82,,,,,,,452.70,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,outpatient,,,503.00000,289.73000,Multiplan,Commercial,,472.82,,,,,,,130.78,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,inpatient,,,472.00000,271.87000,Multiplan,Commercial,,443.68,,,,,,,424.80,457.84,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,outpatient,,,472.00000,271.87000,Multiplan,Commercial,,443.68,,,,,,,122.72,457.84,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,inpatient,,,28.00000,16.13000,Multiplan,Commercial,,26.32,,,,,,,25.20,27.16,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,outpatient,,,28.00000,16.13000,Multiplan,Commercial,,26.32,,,,,,,7.28,27.16,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,inpatient,,,236.00000,135.94000,Multiplan,Commercial,,221.84,,,,,,,212.40,228.92,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,outpatient,,,236.00000,135.94000,Multiplan,Commercial,,221.84,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,inpatient,,,54.00000,31.10000,Multiplan,Commercial,,50.76,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,outpatient,,,54.00000,31.10000,Multiplan,Commercial,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,inpatient,,,238.00000,137.09000,Multiplan,Commercial,,223.72,,,,,,,214.20,230.86,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,outpatient,,,238.00000,137.09000,Multiplan,Commercial,,223.72,,,,,,,61.88,230.86,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,inpatient,,,236.00000,135.94000,Multiplan,Commercial,,221.84,,,,,,,212.40,228.92,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,outpatient,,,236.00000,135.94000,Multiplan,Commercial,,221.84,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,inpatient,,,145.00000,83.52000,Multiplan,Commercial,,136.30,,,,,,,130.50,140.65,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,outpatient,,,145.00000,83.52000,Multiplan,Commercial,,136.30,,,,,,,37.70,140.65,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,inpatient,,,68.00000,39.17000,Multiplan,Commercial,,63.92,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Multiplan,Commercial,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,inpatient,,,68.00000,39.17000,Multiplan,Commercial,,63.92,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Multiplan,Commercial,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,inpatient,,,66.00000,38.02000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,outpatient,,,66.00000,38.02000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,inpatient,,,59.00000,33.98000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,outpatient,,,59.00000,33.98000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,inpatient,,,158.00000,91.01000,Multiplan,Commercial,,148.52,,,,,,,142.20,153.26,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,outpatient,,,158.00000,91.01000,Multiplan,Commercial,,148.52,,,,,,,41.08,153.26,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,inpatient,,,71.00000,40.90000,Multiplan,Commercial,,66.74,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,outpatient,,,71.00000,40.90000,Multiplan,Commercial,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,inpatient,,,144.00000,82.94000,Multiplan,Commercial,,135.36,,,,,,,129.60,139.68,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,outpatient,,,144.00000,82.94000,Multiplan,Commercial,,135.36,,,,,,,37.44,139.68,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,inpatient,,,1448.00000,834.05000,Multiplan,Commercial,,1361.12,,,,,,,1303.20,1404.56,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,outpatient,,,1448.00000,834.05000,Multiplan,Commercial,,1361.12,,,,,,,376.48,1404.56,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,inpatient,,,72.00000,41.47000,Multiplan,Commercial,,67.68,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,outpatient,,,72.00000,41.47000,Multiplan,Commercial,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,inpatient,,,102.00000,58.75000,Multiplan,Commercial,,95.88,,,,,,,91.80,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,outpatient,,,102.00000,58.75000,Multiplan,Commercial,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,inpatient,,,154.00000,88.70000,Multiplan,Commercial,,144.76,,,,,,,138.60,149.38,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,outpatient,,,154.00000,88.70000,Multiplan,Commercial,,144.76,,,,,,,40.04,149.38,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Multiplan,Commercial,,143.82,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Multiplan,Commercial,,143.82,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,inpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,outpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,inpatient,,,66.00000,38.02000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,outpatient,,,66.00000,38.02000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Multiplan,Commercial,,143.82,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Multiplan,Commercial,,143.82,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,inpatient,,,44.00000,25.34000,Multiplan,Commercial,,41.36,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,outpatient,,,44.00000,25.34000,Multiplan,Commercial,,41.36,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,inpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,outpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,inpatient,,,150.00000,86.40000,Multiplan,Commercial,,141.00,,,,,,,135.00,145.50,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,outpatient,,,150.00000,86.40000,Multiplan,Commercial,,141.00,,,,,,,39.00,145.50,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,inpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,outpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,inpatient,,,56.00000,32.26000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,outpatient,,,56.00000,32.26000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,inpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,outpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,inpatient,,,66.00000,38.02000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,outpatient,,,66.00000,38.02000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,inpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,inpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,inpatient,,,60.00000,34.56000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,outpatient,,,60.00000,34.56000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,inpatient,,,58.00000,33.41000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,outpatient,,,58.00000,33.41000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,inpatient,,,71.00000,40.90000,Multiplan,Commercial,,66.74,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,outpatient,,,71.00000,40.90000,Multiplan,Commercial,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,inpatient,,,72.00000,41.47000,Multiplan,Commercial,,67.68,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,outpatient,,,72.00000,41.47000,Multiplan,Commercial,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,inpatient,,,56.00000,32.26000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,inpatient,,,56.00000,32.26000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,inpatient,,,60.00000,34.56000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,outpatient,,,60.00000,34.56000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,inpatient,,,56.00000,32.26000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,outpatient,,,56.00000,32.26000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,inpatient,,,39.00000,22.46000,Multiplan,Commercial,,36.66,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,outpatient,,,39.00000,22.46000,Multiplan,Commercial,,36.66,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Multiplan,Commercial,,143.82,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Multiplan,Commercial,,143.82,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,inpatient,,,73.00000,42.05000,Multiplan,Commercial,,68.62,,,,,,,65.70,70.81,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,outpatient,,,73.00000,42.05000,Multiplan,Commercial,,68.62,,,,,,,18.98,70.81,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,inpatient,,,127.00000,73.15000,Multiplan,Commercial,,119.38,,,,,,,114.30,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Multiplan,Commercial,,119.38,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,inpatient,,,127.00000,73.15000,Multiplan,Commercial,,119.38,,,,,,,114.30,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Multiplan,Commercial,,119.38,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,inpatient,,,372.00000,214.27000,Multiplan,Commercial,,349.68,,,,,,,334.80,360.84,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,outpatient,,,372.00000,214.27000,Multiplan,Commercial,,349.68,,,,,,,96.72,360.84,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,inpatient,,,69.00000,39.74000,Multiplan,Commercial,,64.86,,,,,,,62.10,66.93,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,outpatient,,,69.00000,39.74000,Multiplan,Commercial,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Multiplan,Commercial,,143.82,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Multiplan,Commercial,,143.82,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Multiplan,Commercial,,143.82,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Multiplan,Commercial,,143.82,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,inpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,outpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,inpatient,,,57.00000,32.83000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,outpatient,,,57.00000,32.83000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,inpatient,,,96.00000,55.30000,Multiplan,Commercial,,90.24,,,,,,,86.40,93.12,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,outpatient,,,96.00000,55.30000,Multiplan,Commercial,,90.24,,,,,,,24.96,93.12,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,inpatient,,,44.00000,25.34000,Multiplan,Commercial,,41.36,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,outpatient,,,44.00000,25.34000,Multiplan,Commercial,,41.36,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,inpatient,,,60.00000,34.56000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,outpatient,,,60.00000,34.56000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,inpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,outpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,inpatient,,,60.00000,34.56000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,outpatient,,,60.00000,34.56000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,inpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,outpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,inpatient,,,74.00000,42.62000,Multiplan,Commercial,,69.56,,,,,,,66.60,71.78,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,outpatient,,,74.00000,42.62000,Multiplan,Commercial,,69.56,,,,,,,19.24,71.78,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,inpatient,,,69.00000,39.74000,Multiplan,Commercial,,64.86,,,,,,,62.10,66.93,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,outpatient,,,69.00000,39.74000,Multiplan,Commercial,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Multiplan,Commercial,,36.66,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Multiplan,Commercial,,36.66,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,inpatient,,,53.00000,30.53000,Multiplan,Commercial,,49.82,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,outpatient,,,53.00000,30.53000,Multiplan,Commercial,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Multiplan,Commercial,,36.66,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Multiplan,Commercial,,36.66,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Multiplan,Commercial,,36.66,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Multiplan,Commercial,,36.66,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,inpatient,,,70.00000,40.32000,Multiplan,Commercial,,65.80,,,,,,,63.00,67.90,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,outpatient,,,70.00000,40.32000,Multiplan,Commercial,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,inpatient,,,71.00000,40.90000,Multiplan,Commercial,,66.74,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,outpatient,,,71.00000,40.90000,Multiplan,Commercial,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,inpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,outpatient,,,65.00000,37.44000,Multiplan,Commercial,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,inpatient,,,325.00000,187.20000,Multiplan,Commercial,,305.50,,,,,,,292.50,315.25,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,outpatient,,,325.00000,187.20000,Multiplan,Commercial,,305.50,,,,,,,84.50,315.25,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,inpatient,,,72.00000,41.47000,Multiplan,Commercial,,67.68,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,outpatient,,,72.00000,41.47000,Multiplan,Commercial,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,inpatient,,,72.00000,41.47000,Multiplan,Commercial,,67.68,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,outpatient,,,72.00000,41.47000,Multiplan,Commercial,,67.68,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,inpatient,,,76.00000,43.78000,Multiplan,Commercial,,71.44,,,,,,,68.40,73.72,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,outpatient,,,76.00000,43.78000,Multiplan,Commercial,,71.44,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,inpatient,,,240.00000,138.24000,Multiplan,Commercial,,225.60,,,,,,,216.00,232.80,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,outpatient,,,240.00000,138.24000,Multiplan,Commercial,,225.60,,,,,,,62.40,232.80,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,inpatient,,,93.00000,53.57000,Multiplan,Commercial,,87.42,,,,,,,83.70,90.21,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,outpatient,,,93.00000,53.57000,Multiplan,Commercial,,87.42,,,,,,,24.18,90.21,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,inpatient,,,59.00000,33.98000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,outpatient,,,59.00000,33.98000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,inpatient,,,81.00000,46.66000,Multiplan,Commercial,,76.14,,,,,,,72.90,78.57,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,outpatient,,,81.00000,46.66000,Multiplan,Commercial,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,inpatient,,,58.00000,33.41000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,outpatient,,,58.00000,33.41000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,inpatient,,,21.00000,12.10000,Multiplan,Commercial,,19.74,,,,,,,18.90,20.37,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,outpatient,,,21.00000,12.10000,Multiplan,Commercial,,19.74,,,,,,,5.46,20.37,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,inpatient,,,56.00000,32.26000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,outpatient,,,56.00000,32.26000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,inpatient,,,64.00000,36.86000,Multiplan,Commercial,,60.16,,,,,,,57.60,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,outpatient,,,64.00000,36.86000,Multiplan,Commercial,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,inpatient,,,80.00000,46.08000,Multiplan,Commercial,,75.20,,,,,,,72.00,77.60,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,outpatient,,,80.00000,46.08000,Multiplan,Commercial,,75.20,,,,,,,20.80,77.60,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,inpatient,,,109.00000,62.78000,Multiplan,Commercial,,102.46,,,,,,,98.10,105.73,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,outpatient,,,109.00000,62.78000,Multiplan,Commercial,,102.46,,,,,,,28.34,105.73,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,inpatient,,,59.00000,33.98000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,outpatient,,,59.00000,33.98000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,inpatient,,,115.00000,66.24000,Multiplan,Commercial,,108.10,,,,,,,103.50,111.55,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,outpatient,,,115.00000,66.24000,Multiplan,Commercial,,108.10,,,,,,,29.90,111.55,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,inpatient,,,57.00000,32.83000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,outpatient,,,57.00000,32.83000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,inpatient,,,118.00000,67.97000,Multiplan,Commercial,,110.92,,,,,,,106.20,114.46,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,outpatient,,,118.00000,67.97000,Multiplan,Commercial,,110.92,,,,,,,30.68,114.46,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,inpatient,,,268.00000,154.37000,Multiplan,Commercial,,251.92,,,,,,,241.20,259.96,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,outpatient,,,268.00000,154.37000,Multiplan,Commercial,,251.92,,,,,,,69.68,259.96,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,inpatient,,,114.00000,65.66000,Multiplan,Commercial,,107.16,,,,,,,102.60,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Multiplan,Commercial,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,inpatient,,,114.00000,65.66000,Multiplan,Commercial,,107.16,,,,,,,102.60,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Multiplan,Commercial,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,inpatient,,,78.00000,44.93000,Multiplan,Commercial,,73.32,,,,,,,70.20,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,outpatient,,,78.00000,44.93000,Multiplan,Commercial,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,inpatient,,,91.00000,52.42000,Multiplan,Commercial,,85.54,,,,,,,81.90,88.27,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,outpatient,,,91.00000,52.42000,Multiplan,Commercial,,85.54,,,,,,,23.66,88.27,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,inpatient,,,66.00000,38.02000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,inpatient,,,66.00000,38.02000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,inpatient,,,300.00000,172.80000,Multiplan,Commercial,,282.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,outpatient,,,300.00000,172.80000,Multiplan,Commercial,,282.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,inpatient,,,185.00000,106.56000,Multiplan,Commercial,,173.90,,,,,,,166.50,179.45,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,outpatient,,,185.00000,106.56000,Multiplan,Commercial,,173.90,,,,,,,48.10,179.45,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Multiplan,Commercial,,33.84,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Multiplan,Commercial,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,inpatient,,,76.00000,43.78000,Multiplan,Commercial,,71.44,,,,,,,68.40,73.72,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,outpatient,,,76.00000,43.78000,Multiplan,Commercial,,71.44,,,,,,,19.76,73.72,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Multiplan,Commercial,,33.84,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Multiplan,Commercial,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Multiplan,Commercial,,33.84,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Multiplan,Commercial,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,inpatient,,,53.00000,30.53000,Multiplan,Commercial,,49.82,,,,,,,47.70,51.41,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,outpatient,,,53.00000,30.53000,Multiplan,Commercial,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,inpatient,,,77.00000,44.35000,Multiplan,Commercial,,72.38,,,,,,,69.30,74.69,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,outpatient,,,77.00000,44.35000,Multiplan,Commercial,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Multiplan,Commercial,,33.84,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Multiplan,Commercial,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,inpatient,,,222.00000,127.87000,Multiplan,Commercial,,208.68,,,,,,,199.80,215.34,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,outpatient,,,222.00000,127.87000,Multiplan,Commercial,,208.68,,,,,,,57.72,215.34,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,inpatient,,,292.00000,168.19000,Multiplan,Commercial,,274.48,,,,,,,262.80,283.24,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,outpatient,,,292.00000,168.19000,Multiplan,Commercial,,274.48,,,,,,,75.92,283.24,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,inpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,outpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,inpatient,,,125.00000,72.00000,Multiplan,Commercial,,117.50,,,,,,,112.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Multiplan,Commercial,,117.50,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,inpatient,,,125.00000,72.00000,Multiplan,Commercial,,117.50,,,,,,,112.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Multiplan,Commercial,,117.50,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,inpatient,,,359.00000,206.78000,Multiplan,Commercial,,337.46,,,,,,,323.10,348.23,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,outpatient,,,359.00000,206.78000,Multiplan,Commercial,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,inpatient,,,111.00000,63.94000,Multiplan,Commercial,,104.34,,,,,,,99.90,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,outpatient,,,111.00000,63.94000,Multiplan,Commercial,,104.34,,,,,,,28.86,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,inpatient,,,141.00000,81.22000,Multiplan,Commercial,,132.54,,,,,,,126.90,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Multiplan,Commercial,,132.54,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,inpatient,,,141.00000,81.22000,Multiplan,Commercial,,132.54,,,,,,,126.90,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Multiplan,Commercial,,132.54,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,inpatient,,,114.00000,65.66000,Multiplan,Commercial,,107.16,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Multiplan,Commercial,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,inpatient,,,114.00000,65.66000,Multiplan,Commercial,,107.16,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Multiplan,Commercial,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,inpatient,,,114.00000,65.66000,Multiplan,Commercial,,107.16,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Multiplan,Commercial,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,inpatient,,,114.00000,65.66000,Multiplan,Commercial,,107.16,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Multiplan,Commercial,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,inpatient,,,78.00000,44.93000,Multiplan,Commercial,,73.32,,,,,,,70.20,75.66,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,outpatient,,,78.00000,44.93000,Multiplan,Commercial,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,inpatient,,,359.00000,206.78000,Multiplan,Commercial,,337.46,,,,,,,323.10,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Multiplan,Commercial,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,inpatient,,,359.00000,206.78000,Multiplan,Commercial,,337.46,,,,,,,323.10,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Multiplan,Commercial,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,inpatient,,,70.00000,40.32000,Multiplan,Commercial,,65.80,,,,,,,63.00,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,outpatient,,,70.00000,40.32000,Multiplan,Commercial,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,inpatient,,,18.00000,10.37000,Multiplan,Commercial,,16.92,,,,,,,16.20,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,outpatient,,,18.00000,10.37000,Multiplan,Commercial,,16.92,,,,,,,4.68,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,inpatient,,,408.00000,235.01000,Multiplan,Commercial,,383.52,,,,,,,367.20,395.76,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,outpatient,,,408.00000,235.01000,Multiplan,Commercial,,383.52,,,,,,,106.08,395.76,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,inpatient,,,102.00000,58.75000,Multiplan,Commercial,,95.88,,,,,,,91.80,98.94,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,outpatient,,,102.00000,58.75000,Multiplan,Commercial,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,inpatient,,,330.00000,190.08000,Multiplan,Commercial,,310.20,,,,,,,297.00,320.10,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,outpatient,,,330.00000,190.08000,Multiplan,Commercial,,310.20,,,,,,,85.80,320.10,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,inpatient,,,56.00000,32.26000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,outpatient,,,56.00000,32.26000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,inpatient,,,136.00000,78.34000,Multiplan,Commercial,,127.84,,,,,,,122.40,131.92,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,outpatient,,,136.00000,78.34000,Multiplan,Commercial,,127.84,,,,,,,35.36,131.92,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,inpatient,,,83.00000,47.81000,Multiplan,Commercial,,78.02,,,,,,,74.70,80.51,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,outpatient,,,83.00000,47.81000,Multiplan,Commercial,,78.02,,,,,,,21.58,80.51,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,inpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,outpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,inpatient,,,142.00000,81.79000,Multiplan,Commercial,,133.48,,,,,,,127.80,137.74,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,outpatient,,,142.00000,81.79000,Multiplan,Commercial,,133.48,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,inpatient,,,51.00000,29.38000,Multiplan,Commercial,,47.94,,,,,,,45.90,49.47,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,outpatient,,,51.00000,29.38000,Multiplan,Commercial,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,inpatient,,,70.00000,40.32000,Multiplan,Commercial,,65.80,,,,,,,63.00,67.90,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,outpatient,,,70.00000,40.32000,Multiplan,Commercial,,65.80,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,inpatient,,,99.00000,57.02000,Multiplan,Commercial,,93.06,,,,,,,89.10,96.03,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,outpatient,,,99.00000,57.02000,Multiplan,Commercial,,93.06,,,,,,,25.74,96.03,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,inpatient,,,78.00000,44.93000,Multiplan,Commercial,,73.32,,,,,,,70.20,75.66,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,outpatient,,,78.00000,44.93000,Multiplan,Commercial,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,inpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,outpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,inpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,inpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,outpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,inpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,inpatient,,,75.00000,43.20000,Multiplan,Commercial,,70.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,outpatient,,,75.00000,43.20000,Multiplan,Commercial,,70.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,inpatient,,,37.00000,21.31000,Multiplan,Commercial,,34.78,,,,,,,33.30,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Multiplan,Commercial,,34.78,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,inpatient,,,37.00000,21.31000,Multiplan,Commercial,,34.78,,,,,,,33.30,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Multiplan,Commercial,,34.78,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,inpatient,,,59.00000,33.98000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,outpatient,,,59.00000,33.98000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,inpatient,,,35.00000,20.16000,Multiplan,Commercial,,32.90,,,,,,,31.50,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,outpatient,,,35.00000,20.16000,Multiplan,Commercial,,32.90,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,inpatient,,,59.00000,33.98000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,outpatient,,,59.00000,33.98000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,inpatient,,,56.00000,32.26000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,outpatient,,,56.00000,32.26000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,inpatient,,,74.00000,42.62000,Multiplan,Commercial,,69.56,,,,,,,66.60,71.78,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,outpatient,,,74.00000,42.62000,Multiplan,Commercial,,69.56,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,inpatient,,,90.00000,51.84000,Multiplan,Commercial,,84.60,,,,,,,81.00,87.30,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,outpatient,,,90.00000,51.84000,Multiplan,Commercial,,84.60,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,inpatient,,,68.00000,39.17000,Multiplan,Commercial,,63.92,,,,,,,61.20,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Multiplan,Commercial,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,inpatient,,,142.00000,81.79000,Multiplan,Commercial,,133.48,,,,,,,127.80,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,outpatient,,,142.00000,81.79000,Multiplan,Commercial,,133.48,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,inpatient,,,68.00000,39.17000,Multiplan,Commercial,,63.92,,,,,,,61.20,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Multiplan,Commercial,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,inpatient,,,74.00000,42.62000,Multiplan,Commercial,,69.56,,,,,,,66.60,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,outpatient,,,74.00000,42.62000,Multiplan,Commercial,,69.56,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,inpatient,,,89.00000,51.26000,Multiplan,Commercial,,83.66,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Multiplan,Commercial,,83.66,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,inpatient,,,89.00000,51.26000,Multiplan,Commercial,,83.66,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Multiplan,Commercial,,83.66,,,,,,,23.14,86.33,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,inpatient,,,57.00000,32.83000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,outpatient,,,57.00000,32.83000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,inpatient,,,77.00000,44.35000,Multiplan,Commercial,,72.38,,,,,,,69.30,74.69,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,outpatient,,,77.00000,44.35000,Multiplan,Commercial,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,inpatient,,,64.00000,36.86000,Multiplan,Commercial,,60.16,,,,,,,57.60,62.08,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,outpatient,,,64.00000,36.86000,Multiplan,Commercial,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,inpatient,,,69.00000,39.74000,Multiplan,Commercial,,64.86,,,,,,,62.10,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,outpatient,,,69.00000,39.74000,Multiplan,Commercial,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,inpatient,,,1178.00000,678.53000,Multiplan,Commercial,,1107.32,,,,,,,1060.20,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,outpatient,,,1178.00000,678.53000,Multiplan,Commercial,,1107.32,,,,,,,306.28,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,inpatient,,,127.00000,73.15000,Multiplan,Commercial,,119.38,,,,,,,114.30,123.19,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,outpatient,,,127.00000,73.15000,Multiplan,Commercial,,119.38,,,,,,,33.02,123.19,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,inpatient,,,277.00000,159.55000,Multiplan,Commercial,,260.38,,,,,,,249.30,268.69,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,outpatient,,,277.00000,159.55000,Multiplan,Commercial,,260.38,,,,,,,72.02,268.69,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,inpatient,,,940.00000,541.44000,Multiplan,Commercial,,883.60,,,,,,,846.00,911.80,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,outpatient,,,940.00000,541.44000,Multiplan,Commercial,,883.60,,,,,,,244.40,911.80,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,inpatient,,,97.00000,55.87000,Multiplan,Commercial,,91.18,,,,,,,87.30,94.09,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,outpatient,,,97.00000,55.87000,Multiplan,Commercial,,91.18,,,,,,,25.22,94.09,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,inpatient,,,16.00000,9.22000,Multiplan,Commercial,,15.04,,,,,,,14.40,15.52,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,outpatient,,,16.00000,9.22000,Multiplan,Commercial,,15.04,,,,,,,4.16,15.52,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,inpatient,,,57.00000,32.83000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,outpatient,,,57.00000,32.83000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,inpatient,,,131.00000,75.46000,Multiplan,Commercial,,123.14,,,,,,,117.90,127.07,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,outpatient,,,131.00000,75.46000,Multiplan,Commercial,,123.14,,,,,,,34.06,127.07,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,inpatient,,,2160.00000,1244.16000,Multiplan,Commercial,,2030.40,,,,,,,1944.00,2095.20,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,outpatient,,,2160.00000,1244.16000,Multiplan,Commercial,,2030.40,,,,,,,561.60,2095.20,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,inpatient,,,37.00000,21.31000,Multiplan,Commercial,,34.78,,,,,,,33.30,35.89,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,outpatient,,,37.00000,21.31000,Multiplan,Commercial,,34.78,,,,,,,9.62,35.89,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,inpatient,,,74.00000,42.62000,Multiplan,Commercial,,69.56,,,,,,,66.60,71.78,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Multiplan,Commercial,,69.56,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,inpatient,,,54.00000,31.10000,Multiplan,Commercial,,50.76,,,,,,,48.60,52.38,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,outpatient,,,54.00000,31.10000,Multiplan,Commercial,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,inpatient,,,76.00000,43.78000,Multiplan,Commercial,,71.44,,,,,,,68.40,73.72,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,outpatient,,,76.00000,43.78000,Multiplan,Commercial,,71.44,,,,,,,19.76,73.72,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,inpatient,,,606.00000,349.06000,Multiplan,Commercial,,569.64,,,,,,,545.40,587.82,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,outpatient,,,606.00000,349.06000,Multiplan,Commercial,,569.64,,,,,,,157.56,587.82,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,inpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,outpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,inpatient,,,300.00000,172.80000,Multiplan,Commercial,,282.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,outpatient,,,300.00000,172.80000,Multiplan,Commercial,,282.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,inpatient,,,59.00000,33.98000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,outpatient,,,59.00000,33.98000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,inpatient,,,98.00000,56.45000,Multiplan,Commercial,,92.12,,,,,,,88.20,95.06,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,outpatient,,,98.00000,56.45000,Multiplan,Commercial,,92.12,,,,,,,25.48,95.06,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,inpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,outpatient,,,61.00000,35.14000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,inpatient,,,128.00000,73.73000,Multiplan,Commercial,,120.32,,,,,,,115.20,124.16,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,outpatient,,,128.00000,73.73000,Multiplan,Commercial,,120.32,,,,,,,33.28,124.16,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Multiplan,Commercial,,49.82,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Multiplan,Commercial,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,inpatient,,,16.00000,9.22000,Multiplan,Commercial,,15.04,,,,,,,14.40,15.52,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,outpatient,,,16.00000,9.22000,Multiplan,Commercial,,15.04,,,,,,,4.16,15.52,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,inpatient,,,565.00000,325.44000,Multiplan,Commercial,,531.10,,,,,,,508.50,548.05,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,outpatient,,,565.00000,325.44000,Multiplan,Commercial,,531.10,,,,,,,146.90,548.05,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,inpatient,,,850.00000,489.60000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,outpatient,,,850.00000,489.60000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,inpatient,,,77.00000,44.35000,Multiplan,Commercial,,72.38,,,,,,,69.30,74.69,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,outpatient,,,77.00000,44.35000,Multiplan,Commercial,,72.38,,,,,,,20.02,74.69,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,inpatient,,,86.00000,49.54000,Multiplan,Commercial,,80.84,,,,,,,77.40,83.42,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,outpatient,,,86.00000,49.54000,Multiplan,Commercial,,80.84,,,,,,,22.36,83.42,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,inpatient,,,837.00000,482.11000,Multiplan,Commercial,,786.78,,,,,,,753.30,811.89,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,outpatient,,,837.00000,482.11000,Multiplan,Commercial,,786.78,,,,,,,217.62,811.89,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,inpatient,,,60.00000,34.56000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,outpatient,,,60.00000,34.56000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,inpatient,,,56.00000,32.26000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,outpatient,,,56.00000,32.26000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,inpatient,,,56.00000,32.26000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,outpatient,,,56.00000,32.26000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,inpatient,,,74.00000,42.62000,Multiplan,Commercial,,69.56,,,,,,,66.60,71.78,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Multiplan,Commercial,,69.56,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Multiplan,Commercial,,49.82,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Multiplan,Commercial,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Multiplan,Commercial,,49.82,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Multiplan,Commercial,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,inpatient,,,167.00000,96.19000,Multiplan,Commercial,,156.98,,,,,,,150.30,161.99,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,outpatient,,,167.00000,96.19000,Multiplan,Commercial,,156.98,,,,,,,43.42,161.99,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,inpatient,,,200.00000,115.20000,Multiplan,Commercial,,188.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,outpatient,,,200.00000,115.20000,Multiplan,Commercial,,188.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,inpatient,,,93.00000,53.57000,Multiplan,Commercial,,87.42,,,,,,,83.70,90.21,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,outpatient,,,93.00000,53.57000,Multiplan,Commercial,,87.42,,,,,,,24.18,90.21,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,inpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,49.50,53.35,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Multiplan,Commercial,,51.70,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,inpatient,,,190.00000,109.44000,Multiplan,Commercial,,178.60,,,,,,,171.00,184.30,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,outpatient,,,190.00000,109.44000,Multiplan,Commercial,,178.60,,,,,,,49.40,184.30,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,inpatient,,,64.00000,36.86000,Multiplan,Commercial,,60.16,,,,,,,57.60,62.08,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,outpatient,,,64.00000,36.86000,Multiplan,Commercial,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,inpatient,,,525.00000,302.40000,Multiplan,Commercial,,493.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,outpatient,,,525.00000,302.40000,Multiplan,Commercial,,493.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,inpatient,,,54.00000,31.10000,Multiplan,Commercial,,50.76,,,,,,,48.60,52.38,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,outpatient,,,54.00000,31.10000,Multiplan,Commercial,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Multiplan,Commercial,,49.82,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Multiplan,Commercial,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,inpatient,,,53.00000,30.53000,Multiplan,Commercial,,49.82,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,outpatient,,,53.00000,30.53000,Multiplan,Commercial,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,inpatient,,,40.00000,23.04000,Multiplan,Commercial,,37.60,,,,,,,36.00,38.80,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Multiplan,Commercial,,37.60,,,,,,,10.40,38.80,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,inpatient,,,453.00000,260.93000,Multiplan,Commercial,,425.82,,,,,,,407.70,439.41,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,outpatient,,,453.00000,260.93000,Multiplan,Commercial,,425.82,,,,,,,117.78,439.41,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,inpatient,,,25.00000,14.40000,Multiplan,Commercial,,23.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,outpatient,,,25.00000,14.40000,Multiplan,Commercial,,23.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,inpatient,,,56.00000,32.26000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,outpatient,,,56.00000,32.26000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,inpatient,,,59.00000,33.98000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,outpatient,,,59.00000,33.98000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,inpatient,,,53.00000,30.53000,Multiplan,Commercial,,49.82,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,outpatient,,,53.00000,30.53000,Multiplan,Commercial,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,inpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,outpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,inpatient,,,350.00000,201.60000,Multiplan,Commercial,,329.00,,,,,,,315.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,outpatient,,,350.00000,201.60000,Multiplan,Commercial,,329.00,,,,,,,91.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,inpatient,,,225.00000,129.60000,Multiplan,Commercial,,211.50,,,,,,,202.50,218.25,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,outpatient,,,225.00000,129.60000,Multiplan,Commercial,,211.50,,,,,,,58.50,218.25,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,inpatient,,,52.00000,29.95000,Multiplan,Commercial,,48.88,,,,,,,46.80,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,outpatient,,,52.00000,29.95000,Multiplan,Commercial,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,inpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,outpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,inpatient,,,134.00000,77.18000,Multiplan,Commercial,,125.96,,,,,,,120.60,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,outpatient,,,134.00000,77.18000,Multiplan,Commercial,,125.96,,,,,,,34.84,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,inpatient,,,52.00000,29.95000,Multiplan,Commercial,,48.88,,,,,,,46.80,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,outpatient,,,52.00000,29.95000,Multiplan,Commercial,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,inpatient,,,186.00000,107.14000,Multiplan,Commercial,,174.84,,,,,,,167.40,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,outpatient,,,186.00000,107.14000,Multiplan,Commercial,,174.84,,,,,,,48.36,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,inpatient,,,300.00000,172.80000,Multiplan,Commercial,,282.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Multiplan,Commercial,,282.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,inpatient,,,300.00000,172.80000,Multiplan,Commercial,,282.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Multiplan,Commercial,,282.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,inpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,outpatient,,,62.00000,35.71000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,inpatient,,,205.00000,118.08000,Multiplan,Commercial,,192.70,,,,,,,184.50,198.85,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,outpatient,,,205.00000,118.08000,Multiplan,Commercial,,192.70,,,,,,,53.30,198.85,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,inpatient,,,75.00000,36.15000,Multiplan,Commercial,,70.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,outpatient,,,75.00000,36.15000,Multiplan,Commercial,,70.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,inpatient,,,65.00000,31.33000,Multiplan,Commercial,,61.10,,,,,,,58.50,63.05,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,outpatient,,,65.00000,31.33000,Multiplan,Commercial,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,inpatient,,,92.00000,44.34000,Multiplan,Commercial,,86.48,,,,,,,82.80,89.24,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,outpatient,,,92.00000,44.34000,Multiplan,Commercial,,86.48,,,,,,,23.92,89.24,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,inpatient,,,24.00000,11.57000,Multiplan,Commercial,,22.56,,,,,,,21.60,23.28,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Multiplan,Commercial,,22.56,,,,,,,6.24,23.28,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,inpatient,,,20.00000,9.64000,Multiplan,Commercial,,18.80,,,,,,,18.00,19.40,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,outpatient,,,20.00000,9.64000,Multiplan,Commercial,,18.80,,,,,,,5.20,19.40,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,inpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,outpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,inpatient,,,42.00000,20.24000,Multiplan,Commercial,,39.48,,,,,,,37.80,40.74,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,outpatient,,,42.00000,20.24000,Multiplan,Commercial,,39.48,,,,,,,10.92,40.74,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,inpatient,,,69.00000,33.26000,Multiplan,Commercial,,64.86,,,,,,,62.10,66.93,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,outpatient,,,69.00000,33.26000,Multiplan,Commercial,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,inpatient,,,65.00000,31.33000,Multiplan,Commercial,,61.10,,,,,,,58.50,63.05,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,outpatient,,,65.00000,31.33000,Multiplan,Commercial,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,inpatient,,,76.00000,36.63000,Multiplan,Commercial,,71.44,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,outpatient,,,76.00000,36.63000,Multiplan,Commercial,,71.44,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,inpatient,,,89.00000,42.90000,Multiplan,Commercial,,83.66,,,,,,,80.10,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,outpatient,,,89.00000,42.90000,Multiplan,Commercial,,83.66,,,,,,,23.14,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,inpatient,,,76.00000,36.63000,Multiplan,Commercial,,71.44,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,outpatient,,,76.00000,36.63000,Multiplan,Commercial,,71.44,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,inpatient,,,28.00000,13.50000,Multiplan,Commercial,,26.32,,,,,,,25.20,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,outpatient,,,28.00000,13.50000,Multiplan,Commercial,,26.32,,,,,,,7.28,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,inpatient,,,98.00000,47.24000,Multiplan,Commercial,,92.12,,,,,,,88.20,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,outpatient,,,98.00000,47.24000,Multiplan,Commercial,,92.12,,,,,,,25.48,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,inpatient,,,64.00000,30.85000,Multiplan,Commercial,,60.16,,,,,,,57.60,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,outpatient,,,64.00000,30.85000,Multiplan,Commercial,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,inpatient,,,75.00000,36.15000,Multiplan,Commercial,,70.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,outpatient,,,75.00000,36.15000,Multiplan,Commercial,,70.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,inpatient,,,76.00000,36.63000,Multiplan,Commercial,,71.44,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,outpatient,,,76.00000,36.63000,Multiplan,Commercial,,71.44,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,inpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,outpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,inpatient,,,114.00000,54.95000,Multiplan,Commercial,,107.16,,,,,,,102.60,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,outpatient,,,114.00000,54.95000,Multiplan,Commercial,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,inpatient,,,74.00000,35.67000,Multiplan,Commercial,,69.56,,,,,,,66.60,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,outpatient,,,74.00000,35.67000,Multiplan,Commercial,,69.56,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,inpatient,,,69.00000,33.26000,Multiplan,Commercial,,64.86,,,,,,,62.10,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,outpatient,,,69.00000,33.26000,Multiplan,Commercial,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,inpatient,,,74.00000,35.67000,Multiplan,Commercial,,69.56,,,,,,,66.60,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,outpatient,,,74.00000,35.67000,Multiplan,Commercial,,69.56,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,inpatient,,,87.00000,41.93000,Multiplan,Commercial,,81.78,,,,,,,78.30,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,outpatient,,,87.00000,41.93000,Multiplan,Commercial,,81.78,,,,,,,22.62,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,inpatient,,,79.00000,38.08000,Multiplan,Commercial,,74.26,,,,,,,71.10,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,outpatient,,,79.00000,38.08000,Multiplan,Commercial,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,inpatient,,,75.00000,36.15000,Multiplan,Commercial,,70.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,outpatient,,,75.00000,36.15000,Multiplan,Commercial,,70.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,inpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,outpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,inpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,outpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,inpatient,,,64.00000,30.85000,Multiplan,Commercial,,60.16,,,,,,,57.60,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,outpatient,,,64.00000,30.85000,Multiplan,Commercial,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,inpatient,,,164.00000,79.05000,Multiplan,Commercial,,154.16,,,,,,,147.60,159.08,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,outpatient,,,164.00000,79.05000,Multiplan,Commercial,,154.16,,,,,,,42.64,159.08,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,inpatient,,,54.00000,26.03000,Multiplan,Commercial,,50.76,,,,,,,48.60,52.38,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,outpatient,,,54.00000,26.03000,Multiplan,Commercial,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,inpatient,,,8.00000,3.86000,Multiplan,Commercial,,7.52,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,outpatient,,,8.00000,3.86000,Multiplan,Commercial,,7.52,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,inpatient,,,69.00000,33.26000,Multiplan,Commercial,,64.86,,,,,,,62.10,66.93,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,outpatient,,,69.00000,33.26000,Multiplan,Commercial,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,inpatient,,,8.00000,3.86000,Multiplan,Commercial,,7.52,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,outpatient,,,8.00000,3.86000,Multiplan,Commercial,,7.52,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,inpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,outpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,inpatient,,,8.00000,3.86000,Multiplan,Commercial,,7.52,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,outpatient,,,8.00000,3.86000,Multiplan,Commercial,,7.52,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,inpatient,,,14.00000,6.75000,Multiplan,Commercial,,13.16,,,,,,,12.60,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,outpatient,,,14.00000,6.75000,Multiplan,Commercial,,13.16,,,,,,,3.64,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,inpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,outpatient,,,62.00000,29.88000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,inpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,outpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,inpatient,,,112.00000,53.98000,Multiplan,Commercial,,105.28,,,,,,,100.80,108.64,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,outpatient,,,112.00000,53.98000,Multiplan,Commercial,,105.28,,,,,,,29.12,108.64,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,inpatient,,,13.00000,6.27000,Multiplan,Commercial,,12.22,,,,,,,11.70,12.61,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,outpatient,,,13.00000,6.27000,Multiplan,Commercial,,12.22,,,,,,,3.38,12.61,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,inpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,outpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,inpatient,,,31.00000,14.94000,Multiplan,Commercial,,29.14,,,,,,,27.90,30.07,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,outpatient,,,31.00000,14.94000,Multiplan,Commercial,,29.14,,,,,,,8.06,30.07,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,inpatient,,,92.00000,44.34000,Multiplan,Commercial,,86.48,,,,,,,82.80,89.24,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,outpatient,,,92.00000,44.34000,Multiplan,Commercial,,86.48,,,,,,,23.92,89.24,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,inpatient,,,80.00000,38.56000,Multiplan,Commercial,,75.20,,,,,,,72.00,77.60,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,outpatient,,,80.00000,38.56000,Multiplan,Commercial,,75.20,,,,,,,20.80,77.60,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,inpatient,,,30.00000,14.46000,Multiplan,Commercial,,28.20,,,,,,,27.00,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Multiplan,Commercial,,28.20,,,,,,,7.80,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,inpatient,,,30.00000,14.46000,Multiplan,Commercial,,28.20,,,,,,,27.00,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Multiplan,Commercial,,28.20,,,,,,,7.80,29.10,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,inpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,outpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,inpatient,,,24.00000,11.57000,Multiplan,Commercial,,22.56,,,,,,,21.60,23.28,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Multiplan,Commercial,,22.56,,,,,,,6.24,23.28,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,inpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,outpatient,,,59.00000,28.44000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,inpatient,,,29.00000,13.98000,Multiplan,Commercial,,27.26,,,,,,,26.10,28.13,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,outpatient,,,29.00000,13.98000,Multiplan,Commercial,,27.26,,,,,,,7.54,28.13,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,inpatient,,,97.00000,46.75000,Multiplan,Commercial,,91.18,,,,,,,87.30,94.09,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,outpatient,,,97.00000,46.75000,Multiplan,Commercial,,91.18,,,,,,,25.22,94.09,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,inpatient,,,225.00000,108.45000,Multiplan,Commercial,,211.50,,,,,,,202.50,218.25,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,outpatient,,,225.00000,108.45000,Multiplan,Commercial,,211.50,,,,,,,58.50,218.25,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,inpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,outpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,inpatient,,,71.00000,34.22000,Multiplan,Commercial,,66.74,,,,,,,63.90,68.87,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,outpatient,,,71.00000,34.22000,Multiplan,Commercial,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,inpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,outpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,inpatient,,,71.00000,34.22000,Multiplan,Commercial,,66.74,,,,,,,63.90,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,outpatient,,,71.00000,34.22000,Multiplan,Commercial,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,inpatient,,,108.00000,52.06000,Multiplan,Commercial,,101.52,,,,,,,97.20,104.76,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,outpatient,,,108.00000,52.06000,Multiplan,Commercial,,101.52,,,,,,,28.08,104.76,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,inpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,outpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,inpatient,,,51.00000,24.58000,Multiplan,Commercial,,47.94,,,,,,,45.90,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,outpatient,,,51.00000,24.58000,Multiplan,Commercial,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,inpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,outpatient,,,63.00000,30.37000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,inpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,outpatient,,,58.00000,27.96000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,inpatient,,,19.00000,9.16000,Multiplan,Commercial,,17.86,,,,,,,17.10,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,outpatient,,,19.00000,9.16000,Multiplan,Commercial,,17.86,,,,,,,4.94,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,inpatient,,,54.00000,26.03000,Multiplan,Commercial,,50.76,,,,,,,48.60,52.38,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,outpatient,,,54.00000,26.03000,Multiplan,Commercial,,50.76,,,,,,,14.04,52.38,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,inpatient,,,103.00000,49.65000,Multiplan,Commercial,,96.82,,,,,,,92.70,99.91,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,outpatient,,,103.00000,49.65000,Multiplan,Commercial,,96.82,,,,,,,26.78,99.91,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,inpatient,,,9.00000,4.34000,Multiplan,Commercial,,8.46,,,,,,,8.10,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,outpatient,,,9.00000,4.34000,Multiplan,Commercial,,8.46,,,,,,,2.34,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,inpatient,,,13.00000,6.27000,Multiplan,Commercial,,12.22,,,,,,,11.70,12.61,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,outpatient,,,13.00000,6.27000,Multiplan,Commercial,,12.22,,,,,,,3.38,12.61,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,inpatient,,,80.00000,38.56000,Multiplan,Commercial,,75.20,,,,,,,72.00,77.60,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,outpatient,,,80.00000,38.56000,Multiplan,Commercial,,75.20,,,,,,,20.80,77.60,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,inpatient,,,47.00000,22.65000,Multiplan,Commercial,,44.18,,,,,,,42.30,45.59,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,outpatient,,,47.00000,22.65000,Multiplan,Commercial,,44.18,,,,,,,12.22,45.59,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,inpatient,,,91.00000,43.86000,Multiplan,Commercial,,85.54,,,,,,,81.90,88.27,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,outpatient,,,91.00000,43.86000,Multiplan,Commercial,,85.54,,,,,,,23.66,88.27,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,inpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,outpatient,,,56.00000,26.99000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,inpatient,,,18.00000,8.68000,Multiplan,Commercial,,16.92,,,,,,,16.20,17.46,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,outpatient,,,18.00000,8.68000,Multiplan,Commercial,,16.92,,,,,,,4.68,17.46,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,inpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,outpatient,,,60.00000,28.92000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,inpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,outpatient,,,57.00000,27.47000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,inpatient,,,21.00000,11.15000,Multiplan,Commercial,,19.74,,,,,,,18.90,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Multiplan,Commercial,,19.74,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,inpatient,,,71.00000,37.70000,Multiplan,Commercial,,66.74,,,,,,,63.90,68.87,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,outpatient,,,71.00000,37.70000,Multiplan,Commercial,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,inpatient,,,21.00000,11.15000,Multiplan,Commercial,,19.74,,,,,,,18.90,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Multiplan,Commercial,,19.74,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,inpatient,,,128.00000,67.97000,Multiplan,Commercial,,120.32,,,,,,,115.20,124.16,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,outpatient,,,128.00000,67.97000,Multiplan,Commercial,,120.32,,,,,,,33.28,124.16,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,inpatient,,,65.00000,34.52000,Multiplan,Commercial,,61.10,,,,,,,58.50,63.05,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,outpatient,,,65.00000,34.52000,Multiplan,Commercial,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Multiplan,Commercial,,24.44,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Multiplan,Commercial,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,inpatient,,,31.00000,16.46000,Multiplan,Commercial,,29.14,,,,,,,27.90,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,outpatient,,,31.00000,16.46000,Multiplan,Commercial,,29.14,,,,,,,8.06,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Multiplan,Commercial,,24.44,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Multiplan,Commercial,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Multiplan,Commercial,,24.44,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Multiplan,Commercial,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Multiplan,Commercial,,24.44,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Multiplan,Commercial,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,inpatient,,,61.00000,32.39000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,outpatient,,,61.00000,32.39000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Multiplan,Commercial,,24.44,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Multiplan,Commercial,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,inpatient,,,25.00000,13.28000,Multiplan,Commercial,,23.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Multiplan,Commercial,,23.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,inpatient,,,25.00000,13.28000,Multiplan,Commercial,91,23.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Multiplan,Commercial,91,23.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,inpatient,,,103.00000,54.69000,Multiplan,Commercial,,96.82,,,,,,,92.70,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,outpatient,,,103.00000,54.69000,Multiplan,Commercial,,96.82,,,,,,,26.78,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,inpatient,,,96.00000,50.98000,Multiplan,Commercial,,90.24,,,,,,,86.40,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,outpatient,,,96.00000,50.98000,Multiplan,Commercial,,90.24,,,,,,,24.96,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,inpatient,,,75.00000,39.83000,Multiplan,Commercial,,70.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,outpatient,,,75.00000,39.83000,Multiplan,Commercial,,70.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,inpatient,,,68.00000,36.11000,Multiplan,Commercial,,63.92,,,,,,,61.20,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,outpatient,,,68.00000,36.11000,Multiplan,Commercial,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,inpatient,,,61.00000,32.39000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,outpatient,,,61.00000,32.39000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Multiplan,Commercial,,24.44,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Multiplan,Commercial,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Multiplan,Commercial,,24.44,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Multiplan,Commercial,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,inpatient,,,29.00000,15.40000,Multiplan,Commercial,,27.26,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,outpatient,,,29.00000,15.40000,Multiplan,Commercial,,27.26,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Multiplan,Commercial,,27.26,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Multiplan,Commercial,,27.26,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Multiplan,Commercial,,27.26,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Multiplan,Commercial,,27.26,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,inpatient,,,63.00000,33.45000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,outpatient,,,63.00000,33.45000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,inpatient,,,79.00000,41.95000,Multiplan,Commercial,,74.26,,,,,,,71.10,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,outpatient,,,79.00000,41.95000,Multiplan,Commercial,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,inpatient,,,63.00000,33.45000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,outpatient,,,63.00000,33.45000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Multiplan,Commercial,,27.26,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Multiplan,Commercial,,27.26,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,inpatient,,,112.00000,59.47000,Multiplan,Commercial,,105.28,,,,,,,100.80,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,outpatient,,,112.00000,59.47000,Multiplan,Commercial,,105.28,,,,,,,29.12,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Multiplan,Commercial,,24.44,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Multiplan,Commercial,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,inpatient,,,25.00000,13.28000,Multiplan,Commercial,,23.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,outpatient,,,25.00000,13.28000,Multiplan,Commercial,,23.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,inpatient,,,118.00000,62.66000,Multiplan,Commercial,,110.92,,,,,,,106.20,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,outpatient,,,118.00000,62.66000,Multiplan,Commercial,,110.92,,,,,,,30.68,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,inpatient,,,29.00000,15.40000,Multiplan,Commercial,,27.26,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,outpatient,,,29.00000,15.40000,Multiplan,Commercial,,27.26,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,inpatient,,,25.00000,13.28000,Multiplan,Commercial,,23.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,outpatient,,,25.00000,13.28000,Multiplan,Commercial,,23.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Multiplan,Commercial,,24.44,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Multiplan,Commercial,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,inpatient,,,25.00000,13.28000,Multiplan,Commercial,,23.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,outpatient,,,25.00000,13.28000,Multiplan,Commercial,,23.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,inpatient,,,71.00000,37.70000,Multiplan,Commercial,,66.74,,,,,,,63.90,68.87,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,outpatient,,,71.00000,37.70000,Multiplan,Commercial,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,inpatient,,,59.00000,31.33000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,outpatient,,,59.00000,31.33000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,inpatient,,,62.00000,32.92000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,outpatient,,,62.00000,32.92000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,inpatient,,,138.00000,73.28000,Multiplan,Commercial,,129.72,,,,,,,124.20,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,outpatient,,,138.00000,73.28000,Multiplan,Commercial,,129.72,,,,,,,35.88,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,inpatient,,,62.00000,32.92000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,outpatient,,,62.00000,32.92000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,inpatient,,,78.00000,41.42000,Multiplan,Commercial,,73.32,,,,,,,70.20,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,outpatient,,,78.00000,41.42000,Multiplan,Commercial,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,inpatient,,,69.00000,36.64000,Multiplan,Commercial,,64.86,,,,,,,62.10,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,outpatient,,,69.00000,36.64000,Multiplan,Commercial,,64.86,,,,,,,17.94,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,inpatient,,,88.00000,46.73000,Multiplan,Commercial,,82.72,,,,,,,79.20,85.36,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,outpatient,,,88.00000,46.73000,Multiplan,Commercial,,82.72,,,,,,,22.88,85.36,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,inpatient,,,60.00000,31.86000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,outpatient,,,60.00000,31.86000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,inpatient,,,64.00000,33.98000,Multiplan,Commercial,,60.16,,,,,,,57.60,62.08,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,outpatient,,,64.00000,33.98000,Multiplan,Commercial,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,inpatient,,,63.00000,33.45000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,outpatient,,,63.00000,33.45000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,inpatient,,,137.00000,72.75000,Multiplan,Commercial,,128.78,,,,,,,123.30,132.89,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,outpatient,,,137.00000,72.75000,Multiplan,Commercial,,128.78,,,,,,,35.62,132.89,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,inpatient,,,347.00000,184.26000,Multiplan,Commercial,,326.18,,,,,,,312.30,336.59,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,outpatient,,,347.00000,184.26000,Multiplan,Commercial,,326.18,,,,,,,90.22,336.59,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,inpatient,,,57.00000,30.27000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,outpatient,,,57.00000,30.27000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,inpatient,,,56.00000,29.74000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,outpatient,,,56.00000,29.74000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,inpatient,,,16.00000,8.50000,Multiplan,Commercial,,15.04,,,,,,,14.40,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,outpatient,,,16.00000,8.50000,Multiplan,Commercial,,15.04,,,,,,,4.16,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,inpatient,,,85.00000,45.14000,Multiplan,Commercial,,79.90,,,,,,,76.50,82.45,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,outpatient,,,85.00000,45.14000,Multiplan,Commercial,,79.90,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,inpatient,,,34.00000,18.05000,Multiplan,Commercial,,31.96,,,,,,,30.60,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,outpatient,,,34.00000,18.05000,Multiplan,Commercial,,31.96,,,,,,,8.84,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,inpatient,,,231.00000,122.66000,Multiplan,Commercial,,217.14,,,,,,,207.90,224.07,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,outpatient,,,231.00000,122.66000,Multiplan,Commercial,,217.14,,,,,,,60.06,224.07,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,inpatient,,,36.00000,19.12000,Multiplan,Commercial,,33.84,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,outpatient,,,36.00000,19.12000,Multiplan,Commercial,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,inpatient,,,61.00000,32.39000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,outpatient,,,61.00000,32.39000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,inpatient,,,111.00000,58.94000,Multiplan,Commercial,,104.34,,,,,,,99.90,107.67,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,outpatient,,,111.00000,58.94000,Multiplan,Commercial,,104.34,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,inpatient,,,61.00000,32.39000,Multiplan,Commercial,,57.34,,,,,,,54.90,59.17,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,outpatient,,,61.00000,32.39000,Multiplan,Commercial,,57.34,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,inpatient,,,60.00000,31.86000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,outpatient,,,60.00000,31.86000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,inpatient,,,60.00000,31.86000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,outpatient,,,60.00000,31.86000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,inpatient,,,60.00000,31.86000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,outpatient,,,60.00000,31.86000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,inpatient,,,60.00000,31.86000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,outpatient,,,60.00000,31.86000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,inpatient,,,60.00000,31.86000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,outpatient,,,60.00000,31.86000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,inpatient,,,36.00000,19.12000,Multiplan,Commercial,,33.84,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,outpatient,,,36.00000,19.12000,Multiplan,Commercial,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,inpatient,,,76.00000,40.36000,Multiplan,Commercial,,71.44,,,,,,,68.40,73.72,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,outpatient,,,76.00000,40.36000,Multiplan,Commercial,,71.44,,,,,,,19.76,73.72,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,inpatient,,,60.00000,31.86000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,outpatient,,,60.00000,31.86000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,inpatient,,,60.00000,31.86000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,outpatient,,,60.00000,31.86000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,inpatient,,,152.00000,80.71000,Multiplan,Commercial,,142.88,,,,,,,136.80,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,outpatient,,,152.00000,80.71000,Multiplan,Commercial,,142.88,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,inpatient,,,78.00000,41.42000,Multiplan,Commercial,,73.32,,,,,,,70.20,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,outpatient,,,78.00000,41.42000,Multiplan,Commercial,,73.32,,,,,,,20.28,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,inpatient,,,42.00000,22.30000,Multiplan,Commercial,,39.48,,,,,,,37.80,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,outpatient,,,42.00000,22.30000,Multiplan,Commercial,,39.48,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,inpatient,,,73.00000,38.76000,Multiplan,Commercial,,68.62,,,,,,,65.70,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,outpatient,,,73.00000,38.76000,Multiplan,Commercial,,68.62,,,,,,,18.98,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,inpatient,,,97.00000,51.51000,Multiplan,Commercial,,91.18,,,,,,,87.30,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,outpatient,,,97.00000,51.51000,Multiplan,Commercial,,91.18,,,,,,,25.22,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,inpatient,,,157.00000,83.37000,Multiplan,Commercial,,147.58,,,,,,,141.30,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,outpatient,,,157.00000,83.37000,Multiplan,Commercial,,147.58,,,,,,,40.82,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,inpatient,,,36.00000,19.12000,Multiplan,Commercial,,33.84,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,outpatient,,,36.00000,19.12000,Multiplan,Commercial,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,inpatient,,,66.00000,35.05000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,outpatient,,,66.00000,35.05000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,inpatient,,,58.00000,30.80000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,outpatient,,,58.00000,30.80000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,inpatient,,,85.00000,45.14000,Multiplan,Commercial,,79.90,,,,,,,76.50,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,outpatient,,,85.00000,45.14000,Multiplan,Commercial,,79.90,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,inpatient,,,59.00000,31.33000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,outpatient,,,59.00000,31.33000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,inpatient,,,175.00000,92.93000,Multiplan,Commercial,,164.50,,,,,,,157.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,outpatient,,,175.00000,92.93000,Multiplan,Commercial,,164.50,,,,,,,45.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,inpatient,,,152.00000,80.71000,Multiplan,Commercial,,142.88,,,,,,,136.80,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,outpatient,,,152.00000,80.71000,Multiplan,Commercial,,142.88,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,inpatient,,,43.00000,22.83000,Multiplan,Commercial,,40.42,,,,,,,38.70,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,outpatient,,,43.00000,22.83000,Multiplan,Commercial,,40.42,,,,,,,11.18,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,inpatient,,,66.00000,35.05000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,outpatient,,,66.00000,35.05000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,inpatient,,,36.00000,19.12000,Multiplan,Commercial,,33.84,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,outpatient,,,36.00000,19.12000,Multiplan,Commercial,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,inpatient,,,36.00000,19.12000,Multiplan,Commercial,,33.84,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,outpatient,,,36.00000,19.12000,Multiplan,Commercial,,33.84,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,inpatient,,,42.00000,22.30000,Multiplan,Commercial,,39.48,,,,,,,37.80,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,outpatient,,,42.00000,22.30000,Multiplan,Commercial,,39.48,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,inpatient,,,147.00000,78.06000,Multiplan,Commercial,,138.18,,,,,,,132.30,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,outpatient,,,147.00000,78.06000,Multiplan,Commercial,,138.18,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,inpatient,,,64.00000,33.98000,Multiplan,Commercial,,60.16,,,,,,,57.60,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,outpatient,,,64.00000,33.98000,Multiplan,Commercial,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,inpatient,,,60.00000,31.86000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,outpatient,,,60.00000,31.86000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,inpatient,,,75.00000,39.83000,Multiplan,Commercial,,70.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,outpatient,,,75.00000,39.83000,Multiplan,Commercial,,70.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,inpatient,,,44.00000,23.36000,Multiplan,Commercial,,41.36,,,,,,,39.60,42.68,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,outpatient,,,44.00000,23.36000,Multiplan,Commercial,,41.36,,,,,,,11.44,42.68,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,inpatient,,,87.00000,46.20000,Multiplan,Commercial,,81.78,,,,,,,78.30,84.39,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,outpatient,,,87.00000,46.20000,Multiplan,Commercial,,81.78,,,,,,,22.62,84.39,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,inpatient,,,65.00000,34.52000,Multiplan,Commercial,,61.10,,,,,,,58.50,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,outpatient,,,65.00000,34.52000,Multiplan,Commercial,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,inpatient,,,75.00000,39.83000,Multiplan,Commercial,,70.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,outpatient,,,75.00000,39.83000,Multiplan,Commercial,,70.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,inpatient,,,50.00000,26.55000,Multiplan,Commercial,,47.00,,,,,,,45.00,48.50,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,outpatient,,,50.00000,26.55000,Multiplan,Commercial,,47.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,inpatient,,,40.00000,21.24000,Multiplan,Commercial,,37.60,,,,,,,36.00,38.80,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,outpatient,,,40.00000,21.24000,Multiplan,Commercial,,37.60,,,,,,,10.40,38.80,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,inpatient,,,50.00000,26.55000,Multiplan,Commercial,,47.00,,,,,,,45.00,48.50,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,outpatient,,,50.00000,26.55000,Multiplan,Commercial,,47.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,inpatient,,,115.00000,61.07000,Multiplan,Commercial,,108.10,,,,,,,103.50,111.55,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,outpatient,,,115.00000,61.07000,Multiplan,Commercial,,108.10,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,inpatient,,,1309.00000,695.08000,Multiplan,Commercial,,1230.46,,,,,,,1178.10,1269.73,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1309.00000,695.08000,Multiplan,Commercial,,1230.46,,,,,,,340.34,1269.73,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,inpatient,,,328.00000,174.17000,Multiplan,Commercial,,308.32,,,,,,,295.20,318.16,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,outpatient,,,328.00000,174.17000,Multiplan,Commercial,,308.32,,,,,,,85.28,318.16,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,inpatient,,,115.00000,61.07000,Multiplan,Commercial,,108.10,,,,,,,103.50,111.55,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,outpatient,,,115.00000,61.07000,Multiplan,Commercial,,108.10,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,inpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,inpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,inpatient,,,1251.00000,664.28000,Multiplan,Commercial,,1175.94,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,outpatient,,,1251.00000,664.28000,Multiplan,Commercial,,1175.94,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,inpatient,,,154.00000,81.77000,Multiplan,Commercial,,144.76,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Multiplan,Commercial,,144.76,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,inpatient,,,154.00000,81.77000,Multiplan,Commercial,,144.76,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Multiplan,Commercial,,144.76,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,inpatient,,,96.00000,50.98000,Multiplan,Commercial,,90.24,,,,,,,86.40,93.12,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,outpatient,,,96.00000,50.98000,Multiplan,Commercial,,90.24,,,,,,,24.96,93.12,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,inpatient,,,211.00000,112.04000,Multiplan,Commercial,,198.34,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,outpatient,,,211.00000,112.04000,Multiplan,Commercial,,198.34,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,inpatient,,,290.00000,153.99000,Multiplan,Commercial,,272.60,,,,,,,261.00,281.30,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,outpatient,,,290.00000,153.99000,Multiplan,Commercial,,272.60,,,,,,,75.40,281.30,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,inpatient,,,411.00000,218.24000,Multiplan,Commercial,,386.34,,,,,,,369.90,398.67,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,outpatient,,,411.00000,218.24000,Multiplan,Commercial,,386.34,,,,,,,106.86,398.67,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,inpatient,,,139.00000,73.81000,Multiplan,Commercial,,130.66,,,,,,,125.10,134.83,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,outpatient,,,139.00000,73.81000,Multiplan,Commercial,,130.66,,,,,,,36.14,134.83,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,inpatient,,,288.00000,152.93000,Multiplan,Commercial,,270.72,,,,,,,259.20,279.36,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,outpatient,,,288.00000,152.93000,Multiplan,Commercial,,270.72,,,,,,,74.88,279.36,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,inpatient,,,1372.00000,728.53000,Multiplan,Commercial,,1289.68,,,,,,,1234.80,1330.84,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1372.00000,728.53000,Multiplan,Commercial,,1289.68,,,,,,,356.72,1330.84,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,inpatient,,,1251.00000,664.28000,Multiplan,Commercial,,1175.94,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,outpatient,,,1251.00000,664.28000,Multiplan,Commercial,,1175.94,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,inpatient,,,135.00000,71.68000,Multiplan,Commercial,,126.90,,,,,,,121.50,130.95,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,outpatient,,,135.00000,71.68000,Multiplan,Commercial,,126.90,,,,,,,35.10,130.95,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,inpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,outpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,inpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,outpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,inpatient,,,147.00000,78.06000,Multiplan,Commercial,,138.18,,,,,,,132.30,142.59,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,outpatient,,,147.00000,78.06000,Multiplan,Commercial,,138.18,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,inpatient,,,126.00000,66.91000,Multiplan,Commercial,,118.44,,,,,,,113.40,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,outpatient,,,126.00000,66.91000,Multiplan,Commercial,,118.44,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,inpatient,,,120.00000,63.72000,Multiplan,Commercial,,112.80,,,,,,,108.00,116.40,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,outpatient,,,120.00000,63.72000,Multiplan,Commercial,,112.80,,,,,,,31.20,116.40,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,inpatient,,,124.00000,65.84000,Multiplan,Commercial,,116.56,,,,,,,111.60,120.28,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,outpatient,,,124.00000,65.84000,Multiplan,Commercial,,116.56,,,,,,,32.24,120.28,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,inpatient,,,108.00000,57.35000,Multiplan,Commercial,,101.52,,,,,,,97.20,104.76,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,outpatient,,,108.00000,57.35000,Multiplan,Commercial,,101.52,,,,,,,28.08,104.76,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,inpatient,,,256.00000,135.94000,Multiplan,Commercial,,240.64,,,,,,,230.40,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Multiplan,Commercial,,240.64,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,inpatient,,,256.00000,135.94000,Multiplan,Commercial,,240.64,,,,,,,230.40,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Multiplan,Commercial,,240.64,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,inpatient,,,122.00000,64.78000,Multiplan,Commercial,,114.68,,,,,,,109.80,118.34,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,outpatient,,,122.00000,64.78000,Multiplan,Commercial,,114.68,,,,,,,31.72,118.34,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,inpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,outpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,inpatient,,,123.00000,65.31000,Multiplan,Commercial,,115.62,,,,,,,110.70,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,outpatient,,,123.00000,65.31000,Multiplan,Commercial,,115.62,,,,,,,31.98,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,inpatient,,,518.00000,275.06000,Multiplan,Commercial,,486.92,,,,,,,466.20,502.46,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,outpatient,,,518.00000,275.06000,Multiplan,Commercial,,486.92,,,,,,,134.68,502.46,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,inpatient,,,275.00000,146.02000,Multiplan,Commercial,,258.50,,,,,,,247.50,266.75,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,outpatient,,,275.00000,146.02000,Multiplan,Commercial,,258.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,inpatient,,,270.00000,143.37000,Multiplan,Commercial,,253.80,,,,,,,243.00,261.90,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,outpatient,,,270.00000,143.37000,Multiplan,Commercial,,253.80,,,,,,,70.20,261.90,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,inpatient,,,450.00000,238.95000,Multiplan,Commercial,,423.00,,,,,,,405.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,outpatient,,,450.00000,238.95000,Multiplan,Commercial,,423.00,,,,,,,117.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,inpatient,,,126.00000,66.91000,Multiplan,Commercial,,118.44,,,,,,,113.40,122.22,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,outpatient,,,126.00000,66.91000,Multiplan,Commercial,,118.44,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,inpatient,,,362.00000,192.22000,Multiplan,Commercial,,340.28,,,,,,,325.80,351.14,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,outpatient,,,362.00000,192.22000,Multiplan,Commercial,,340.28,,,,,,,94.12,351.14,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,inpatient,,,109.00000,57.88000,Multiplan,Commercial,,102.46,,,,,,,98.10,105.73,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Multiplan,Commercial,,102.46,,,,,,,28.34,105.73,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,inpatient,,,638.00000,338.78000,Multiplan,Commercial,,599.72,,,,,,,574.20,618.86,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,outpatient,,,638.00000,338.78000,Multiplan,Commercial,,599.72,,,,,,,165.88,618.86,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,inpatient,,,211.00000,112.04000,Multiplan,Commercial,,198.34,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,outpatient,,,211.00000,112.04000,Multiplan,Commercial,,198.34,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,inpatient,,,154.00000,81.77000,Multiplan,Commercial,,144.76,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,outpatient,,,154.00000,81.77000,Multiplan,Commercial,,144.76,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,inpatient,,,141.00000,74.87000,Multiplan,Commercial,,132.54,,,,,,,126.90,136.77,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,outpatient,,,141.00000,74.87000,Multiplan,Commercial,,132.54,,,,,,,36.66,136.77,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,inpatient,,,2040.00000,1083.24000,Multiplan,Commercial,,1917.60,,,,,,,1836.00,1978.80,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,outpatient,,,2040.00000,1083.24000,Multiplan,Commercial,,1917.60,,,,,,,530.40,1978.80,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,inpatient,,,421.00000,223.55000,Multiplan,Commercial,,395.74,,,,,,,378.90,408.37,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,outpatient,,,421.00000,223.55000,Multiplan,Commercial,,395.74,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,inpatient,,,275.00000,146.02000,Multiplan,Commercial,,258.50,,,,,,,247.50,266.75,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,outpatient,,,275.00000,146.02000,Multiplan,Commercial,,258.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,inpatient,,,1251.00000,664.28000,Multiplan,Commercial,,1175.94,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,outpatient,,,1251.00000,664.28000,Multiplan,Commercial,,1175.94,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,inpatient,,,428.00000,227.27000,Multiplan,Commercial,,402.32,,,,,,,385.20,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Multiplan,Commercial,,402.32,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,inpatient,,,428.00000,227.27000,Multiplan,Commercial,,402.32,,,,,,,385.20,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Multiplan,Commercial,,402.32,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,inpatient,,,655.00000,347.80000,Multiplan,Commercial,,615.70,,,,,,,589.50,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Multiplan,Commercial,,615.70,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,inpatient,,,655.00000,347.80000,Multiplan,Commercial,,615.70,,,,,,,589.50,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Multiplan,Commercial,,615.70,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,inpatient,,,211.00000,112.04000,Multiplan,Commercial,,198.34,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,outpatient,,,211.00000,112.04000,Multiplan,Commercial,,198.34,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,inpatient,,,112.00000,59.47000,Multiplan,Commercial,,105.28,,,,,,,100.80,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Multiplan,Commercial,,105.28,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,inpatient,,,112.00000,59.47000,Multiplan,Commercial,,105.28,,,,,,,100.80,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Multiplan,Commercial,,105.28,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,inpatient,,,130.00000,69.03000,Multiplan,Commercial,,122.20,,,,,,,117.00,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,outpatient,,,130.00000,69.03000,Multiplan,Commercial,,122.20,,,,,,,33.80,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,inpatient,,,421.00000,223.55000,Multiplan,Commercial,,395.74,,,,,,,378.90,408.37,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,outpatient,,,421.00000,223.55000,Multiplan,Commercial,,395.74,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,inpatient,,,111.00000,58.94000,Multiplan,Commercial,,104.34,,,,,,,99.90,107.67,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,outpatient,,,111.00000,58.94000,Multiplan,Commercial,,104.34,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,inpatient,,,200.00000,106.20000,Multiplan,Commercial,,188.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,outpatient,,,200.00000,106.20000,Multiplan,Commercial,,188.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Multiplan,Commercial,,121.26,,,,,,,33.54,125.13,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,inpatient,,,13.00000,6.90000,Multiplan,Commercial,,12.22,,,,,,,11.70,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,outpatient,,,13.00000,6.90000,Multiplan,Commercial,,12.22,,,,,,,3.38,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,inpatient,,,58.00000,30.80000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,outpatient,,,58.00000,30.80000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,inpatient,,,13.00000,6.90000,Multiplan,Commercial,,12.22,,,,,,,11.70,12.61,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,outpatient,,,13.00000,6.90000,Multiplan,Commercial,,12.22,,,,,,,3.38,12.61,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,inpatient,,,773.00000,410.46000,Multiplan,Commercial,,726.62,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,outpatient,,,773.00000,410.46000,Multiplan,Commercial,,726.62,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,inpatient,,,773.00000,410.46000,Multiplan,Commercial,,726.62,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,outpatient,,,773.00000,410.46000,Multiplan,Commercial,,726.62,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,inpatient,,,773.00000,410.46000,Multiplan,Commercial,,726.62,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,outpatient,,,773.00000,410.46000,Multiplan,Commercial,,726.62,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,inpatient,,,773.00000,410.46000,Multiplan,Commercial,,726.62,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,outpatient,,,773.00000,410.46000,Multiplan,Commercial,,726.62,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,inpatient,,,387.00000,205.50000,Multiplan,Commercial,,363.78,,,,,,,348.30,375.39,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,outpatient,,,387.00000,205.50000,Multiplan,Commercial,,363.78,,,,,,,100.62,375.39,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,inpatient,,,52.00000,27.61000,Multiplan,Commercial,,48.88,,,,,,,46.80,50.44,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,outpatient,,,52.00000,27.61000,Multiplan,Commercial,,48.88,,,,,,,13.52,50.44,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,inpatient,,,102.00000,54.16000,Multiplan,Commercial,,95.88,,,,,,,91.80,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Multiplan,Commercial,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,inpatient,,,102.00000,54.16000,Multiplan,Commercial,,95.88,,,,,,,91.80,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Multiplan,Commercial,,95.88,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,inpatient,,,79.00000,41.95000,Multiplan,Commercial,,74.26,,,,,,,71.10,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,outpatient,,,79.00000,41.95000,Multiplan,Commercial,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,inpatient,,,65.00000,34.52000,Multiplan,Commercial,,61.10,,,,,,,58.50,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,outpatient,,,65.00000,34.52000,Multiplan,Commercial,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,inpatient,,,100.00000,53.10000,Multiplan,Commercial,,94.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,outpatient,,,100.00000,53.10000,Multiplan,Commercial,,94.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,inpatient,,,64.00000,33.98000,Multiplan,Commercial,,60.16,,,,,,,57.60,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,outpatient,,,64.00000,33.98000,Multiplan,Commercial,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,inpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,outpatient,,,106.00000,56.29000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,inpatient,,,109.00000,57.88000,Multiplan,Commercial,,102.46,,,,,,,98.10,105.73,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Multiplan,Commercial,,102.46,,,,,,,28.34,105.73,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,inpatient,,,58.00000,30.80000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,outpatient,,,58.00000,30.80000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Multiplan,Commercial,,18.80,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Multiplan,Commercial,,18.80,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,inpatient,,,66.00000,35.05000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,outpatient,,,66.00000,35.05000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Multiplan,Commercial,,18.80,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Multiplan,Commercial,,18.80,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Multiplan,Commercial,,18.80,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Multiplan,Commercial,,18.80,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Multiplan,Commercial,,18.80,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Multiplan,Commercial,,18.80,,,,,,,5.20,19.40,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,inpatient,,,13.00000,6.90000,Multiplan,Commercial,,12.22,,,,,,,11.70,12.61,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,outpatient,,,13.00000,6.90000,Multiplan,Commercial,,12.22,,,,,,,3.38,12.61,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,inpatient,,,53.00000,28.14000,Multiplan,Commercial,,49.82,,,,,,,47.70,51.41,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,outpatient,,,53.00000,28.14000,Multiplan,Commercial,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,inpatient,,,18.00000,9.56000,Multiplan,Commercial,,16.92,,,,,,,16.20,17.46,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,outpatient,,,18.00000,9.56000,Multiplan,Commercial,,16.92,,,,,,,4.68,17.46,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,inpatient,,,17.00000,9.03000,Multiplan,Commercial,,15.98,,,,,,,15.30,16.49,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,outpatient,,,17.00000,9.03000,Multiplan,Commercial,,15.98,,,,,,,4.42,16.49,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,inpatient,,,71.00000,37.70000,Multiplan,Commercial,,66.74,,,,,,,63.90,68.87,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,outpatient,,,71.00000,37.70000,Multiplan,Commercial,,66.74,,,,,,,18.46,68.87,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,inpatient,,,57.00000,30.27000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,outpatient,,,57.00000,30.27000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,inpatient,,,68.00000,36.11000,Multiplan,Commercial,,63.92,,,,,,,61.20,65.96,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,outpatient,,,68.00000,36.11000,Multiplan,Commercial,,63.92,,,,,,,17.68,65.96,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,inpatient,,,58.00000,30.80000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,outpatient,,,58.00000,30.80000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,inpatient,,,27.00000,14.34000,Multiplan,Commercial,,25.38,,,,,,,24.30,26.19,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,outpatient,,,27.00000,14.34000,Multiplan,Commercial,,25.38,,,,,,,7.02,26.19,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,inpatient,,,56.00000,29.74000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,outpatient,,,56.00000,29.74000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,inpatient,,,56.00000,29.74000,Multiplan,Commercial,,52.64,,,,,,,50.40,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,outpatient,,,56.00000,29.74000,Multiplan,Commercial,,52.64,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,inpatient,,,58.00000,30.80000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,outpatient,,,58.00000,30.80000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,inpatient,,,115.00000,61.07000,Multiplan,Commercial,,108.10,,,,,,,103.50,111.55,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,outpatient,,,115.00000,61.07000,Multiplan,Commercial,,108.10,,,,,,,29.90,111.55,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,inpatient,,,23.00000,12.21000,Multiplan,Commercial,,21.62,,,,,,,20.70,22.31,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,outpatient,,,23.00000,12.21000,Multiplan,Commercial,,21.62,,,,,,,5.98,22.31,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,inpatient,,,255.00000,135.40000,Multiplan,Commercial,,239.70,,,,,,,229.50,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,outpatient,,,255.00000,135.40000,Multiplan,Commercial,,239.70,,,,,,,66.30,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,inpatient,,,66.00000,35.05000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,outpatient,,,66.00000,35.05000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,inpatient,,,26.00000,13.81000,Multiplan,Commercial,,24.44,,,,,,,23.40,25.22,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,outpatient,,,26.00000,13.81000,Multiplan,Commercial,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,inpatient,,,64.00000,33.98000,Multiplan,Commercial,,60.16,,,,,,,57.60,62.08,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,outpatient,,,64.00000,33.98000,Multiplan,Commercial,,60.16,,,,,,,16.64,62.08,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,inpatient,,,215.00000,114.16000,Multiplan,Commercial,,202.10,,,,,,,193.50,208.55,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,outpatient,,,215.00000,114.16000,Multiplan,Commercial,,202.10,,,,,,,55.90,208.55,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,inpatient,,,79.00000,41.95000,Multiplan,Commercial,,74.26,,,,,,,71.10,76.63,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,outpatient,,,79.00000,41.95000,Multiplan,Commercial,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,inpatient,,,11.00000,5.29000,Multiplan,Commercial,,10.34,,,,,,,9.90,10.67,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,outpatient,,,11.00000,5.29000,Multiplan,Commercial,,10.34,,,,,,,2.86,10.67,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,inpatient,,,58.00000,27.90000,Multiplan,Commercial,,54.52,,,,,,,52.20,56.26,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,outpatient,,,58.00000,27.90000,Multiplan,Commercial,,54.52,,,,,,,15.08,56.26,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,inpatient,,,10.00000,4.81000,Multiplan,Commercial,,9.40,,,,,,,9.00,9.70,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,outpatient,,,10.00000,4.81000,Multiplan,Commercial,,9.40,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,inpatient,,,7.00000,3.37000,Multiplan,Commercial,,6.58,,,,,,,6.30,6.79,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,outpatient,,,7.00000,3.37000,Multiplan,Commercial,,6.58,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,inpatient,,,53.00000,25.49000,Multiplan,Commercial,,49.82,,,,,,,47.70,51.41,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,outpatient,,,53.00000,25.49000,Multiplan,Commercial,,49.82,,,,,,,13.78,51.41,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,inpatient,,,10.00000,4.81000,Multiplan,Commercial,,9.40,,,,,,,9.00,9.70,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,outpatient,,,10.00000,4.81000,Multiplan,Commercial,,9.40,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,inpatient,,,11.00000,5.29000,Multiplan,Commercial,,10.34,,,,,,,9.90,10.67,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Multiplan,Commercial,,10.34,,,,,,,2.86,10.67,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,inpatient,,,7.00000,3.37000,Multiplan,Commercial,,6.58,,,,,,,6.30,6.79,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,outpatient,,,7.00000,3.37000,Multiplan,Commercial,,6.58,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,inpatient,,,11.00000,5.29000,Multiplan,Commercial,,10.34,,,,,,,9.90,10.67,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Multiplan,Commercial,,10.34,,,,,,,2.86,10.67,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,inpatient,,,597.00000,290.14000,Multiplan,Commercial,,561.18,,,,,,,537.30,579.09,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,outpatient,,,597.00000,290.14000,Multiplan,Commercial,,561.18,,,,,,,155.22,579.09,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,inpatient,,,6379.00000,3100.19000,Multiplan,Commercial,,5996.26,,,,,,,5741.10,6187.63,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,outpatient,,,6379.00000,3100.19000,Multiplan,Commercial,,5996.26,,,,,,,1658.54,6187.63,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,inpatient,,,471.00000,228.91000,Multiplan,Commercial,,442.74,,,,,,,423.90,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,outpatient,,,471.00000,228.91000,Multiplan,Commercial,,442.74,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,inpatient,,,471.00000,228.91000,Multiplan,Commercial,,442.74,,,,,,,423.90,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,outpatient,,,471.00000,228.91000,Multiplan,Commercial,,442.74,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,inpatient,,,1251.00000,607.99000,Multiplan,Commercial,,1175.94,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,outpatient,,,1251.00000,607.99000,Multiplan,Commercial,,1175.94,,,,,,,325.26,1213.47,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,inpatient,,,260.00000,126.36000,Multiplan,Commercial,,244.40,,,,,,,234.00,252.20,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,outpatient,,,260.00000,126.36000,Multiplan,Commercial,,244.40,,,,,,,67.60,252.20,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,inpatient,,,785.00000,381.51000,Multiplan,Commercial,,737.90,,,,,,,706.50,761.45,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,outpatient,,,785.00000,381.51000,Multiplan,Commercial,,737.90,,,,,,,204.10,761.45,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,inpatient,,,529.00000,257.09000,Multiplan,Commercial,,497.26,,,,,,,476.10,513.13,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,outpatient,,,529.00000,257.09000,Multiplan,Commercial,,497.26,,,,,,,137.54,513.13,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,inpatient,,,1623.00000,788.78000,Multiplan,Commercial,,1525.62,,,,,,,1460.70,1574.31,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,outpatient,,,1623.00000,788.78000,Multiplan,Commercial,,1525.62,,,,,,,421.98,1574.31,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,inpatient,,,10800.00000,5248.80000,Multiplan,Commercial,,10152.00,,,,,,,9720.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,outpatient,,,10800.00000,5248.80000,Multiplan,Commercial,,10152.00,,,,,,,2808.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,inpatient,,,25365.00000,12327.39000,Multiplan,Commercial,,23843.10,,,,,,,22828.50,24604.05,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,outpatient,,,25365.00000,12327.39000,Multiplan,Commercial,,23843.10,,,,,,,6594.90,24604.05,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,inpatient,,,101.00000,21.82000,Multiplan,Commercial,,94.94,,,,,,,90.90,97.97,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,outpatient,,,101.00000,21.82000,Multiplan,Commercial,,94.94,,,,,,,26.26,97.97,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,inpatient,,,81.00000,17.50000,Multiplan,Commercial,,76.14,,,,,,,72.90,78.57,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,outpatient,,,81.00000,17.50000,Multiplan,Commercial,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,inpatient,,,104.00000,22.46000,Multiplan,Commercial,,97.76,,,,,,,93.60,100.88,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,outpatient,,,104.00000,22.46000,Multiplan,Commercial,,97.76,,,,,,,27.04,100.88,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,inpatient,,,377.00000,81.43000,Multiplan,Commercial,,354.38,,,,,,,339.30,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,outpatient,,,377.00000,81.43000,Multiplan,Commercial,,354.38,,,,,,,98.02,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,inpatient,,,532.00000,114.91000,Multiplan,Commercial,,500.08,,,,,,,478.80,516.04,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,outpatient,,,532.00000,114.91000,Multiplan,Commercial,,500.08,,,,,,,138.32,516.04,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,inpatient,,,521.00000,112.54000,Multiplan,Commercial,,489.74,,,,,,,468.90,505.37,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,outpatient,,,521.00000,112.54000,Multiplan,Commercial,,489.74,,,,,,,135.46,505.37,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,inpatient,,,451.00000,97.42000,Multiplan,Commercial,,423.94,,,,,,,405.90,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,outpatient,,,451.00000,97.42000,Multiplan,Commercial,,423.94,,,,,,,117.26,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,inpatient,,,1148.00000,247.97000,Multiplan,Commercial,,1079.12,,,,,,,1033.20,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,outpatient,,,1148.00000,247.97000,Multiplan,Commercial,,1079.12,,,,,,,298.48,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,inpatient,,,350.00000,75.60000,Multiplan,Commercial,,329.00,,,,,,,315.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,outpatient,,,350.00000,75.60000,Multiplan,Commercial,,329.00,,,,,,,91.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,inpatient,,,423.00000,91.37000,Multiplan,Commercial,,397.62,,,,,,,380.70,410.31,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,outpatient,,,423.00000,91.37000,Multiplan,Commercial,,397.62,,,,,,,109.98,410.31,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,inpatient,,,751.00000,162.22000,Multiplan,Commercial,,705.94,,,,,,,675.90,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Multiplan,Commercial,,705.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,inpatient,,,751.00000,162.22000,Multiplan,Commercial,,705.94,,,,,,,675.90,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Multiplan,Commercial,,705.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,inpatient,,,119.00000,25.70000,Multiplan,Commercial,,111.86,,,,,,,107.10,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,outpatient,,,119.00000,25.70000,Multiplan,Commercial,,111.86,,,,,,,30.94,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,inpatient,,,126.00000,27.22000,Multiplan,Commercial,,118.44,,,,,,,113.40,122.22,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,outpatient,,,126.00000,27.22000,Multiplan,Commercial,,118.44,,,,,,,32.76,122.22,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,inpatient,,,110.00000,23.76000,Multiplan,Commercial,,103.40,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Multiplan,Commercial,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,inpatient,,,110.00000,23.76000,Multiplan,Commercial,,103.40,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Multiplan,Commercial,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,inpatient,,,79.00000,17.06000,Multiplan,Commercial,,74.26,,,,,,,71.10,76.63,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,outpatient,,,79.00000,17.06000,Multiplan,Commercial,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,inpatient,,,110.00000,23.76000,Multiplan,Commercial,,103.40,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Multiplan,Commercial,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,inpatient,,,110.00000,23.76000,Multiplan,Commercial,,103.40,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Multiplan,Commercial,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,inpatient,,,79.00000,17.06000,Multiplan,Commercial,,74.26,,,,,,,71.10,76.63,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,outpatient,,,79.00000,17.06000,Multiplan,Commercial,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,inpatient,,,335.00000,72.36000,Multiplan,Commercial,,314.90,,,,,,,301.50,324.95,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,outpatient,,,335.00000,72.36000,Multiplan,Commercial,,314.90,,,,,,,87.10,324.95,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,inpatient,,,154.00000,33.26000,Multiplan,Commercial,,144.76,,,,,,,138.60,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Multiplan,Commercial,,144.76,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,inpatient,,,154.00000,33.26000,Multiplan,Commercial,,144.76,,,,,,,138.60,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Multiplan,Commercial,,144.76,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,inpatient,,,128.00000,27.65000,Multiplan,Commercial,,120.32,,,,,,,115.20,124.16,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,outpatient,,,128.00000,27.65000,Multiplan,Commercial,,120.32,,,,,,,33.28,124.16,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,inpatient,,,65.00000,14.04000,Multiplan,Commercial,,61.10,,,,,,,58.50,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,outpatient,,,65.00000,14.04000,Multiplan,Commercial,,61.10,,,,,,,16.90,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,inpatient,,,272.00000,58.75000,Multiplan,Commercial,,255.68,,,,,,,244.80,263.84,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,outpatient,,,272.00000,58.75000,Multiplan,Commercial,,255.68,,,,,,,70.72,263.84,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,inpatient,,,26.00000,11.44000,Multiplan,Commercial,,24.44,,,,,,,23.40,25.22,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,outpatient,,,26.00000,11.44000,Multiplan,Commercial,,24.44,,,,,,,6.76,25.22,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,inpatient,,,359.00000,157.96000,Multiplan,Commercial,,337.46,,,,,,,323.10,348.23,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,outpatient,,,359.00000,157.96000,Multiplan,Commercial,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,inpatient,,,189.00000,83.16000,Multiplan,Commercial,,177.66,,,,,,,170.10,183.33,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,outpatient,,,189.00000,83.16000,Multiplan,Commercial,,177.66,,,,,,,49.14,183.33,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,inpatient,,,359.00000,157.96000,Multiplan,Commercial,,337.46,,,,,,,323.10,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,outpatient,,,359.00000,157.96000,Multiplan,Commercial,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,inpatient,,,137.00000,60.28000,Multiplan,Commercial,,128.78,,,,,,,123.30,132.89,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,outpatient,,,137.00000,60.28000,Multiplan,Commercial,,128.78,,,,,,,35.62,132.89,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,inpatient,,,1665.00000,732.60000,Multiplan,Commercial,,1565.10,,,,,,,1498.50,1615.05,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,outpatient,,,1665.00000,732.60000,Multiplan,Commercial,,1565.10,,,,,,,432.90,1615.05,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,inpatient,,,751.00000,330.44000,Multiplan,Commercial,,705.94,,,,,,,675.90,728.47,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,outpatient,,,751.00000,330.44000,Multiplan,Commercial,,705.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,inpatient,,,374.00000,164.56000,Multiplan,Commercial,,351.56,,,,,,,336.60,362.78,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,outpatient,,,374.00000,164.56000,Multiplan,Commercial,,351.56,,,,,,,97.24,362.78,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,inpatient,,,553.00000,243.32000,Multiplan,Commercial,,519.82,,,,,,,497.70,536.41,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,outpatient,,,553.00000,243.32000,Multiplan,Commercial,,519.82,,,,,,,143.78,536.41,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,inpatient,,,359.00000,157.96000,Multiplan,Commercial,,337.46,,,,,,,323.10,348.23,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,outpatient,,,359.00000,157.96000,Multiplan,Commercial,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,inpatient,,,62.00000,27.28000,Multiplan,Commercial,,58.28,,,,,,,55.80,60.14,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,outpatient,,,62.00000,27.28000,Multiplan,Commercial,,58.28,,,,,,,16.12,60.14,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,inpatient,,,79.00000,34.76000,Multiplan,Commercial,,74.26,,,,,,,71.10,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,outpatient,,,79.00000,34.76000,Multiplan,Commercial,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,inpatient,,,110.00000,48.40000,Multiplan,Commercial,,103.40,,,,,,,99.00,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,outpatient,,,110.00000,48.40000,Multiplan,Commercial,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,inpatient,,,110.00000,48.40000,Multiplan,Commercial,,103.40,,,,,,,99.00,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,outpatient,,,110.00000,48.40000,Multiplan,Commercial,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,inpatient,,,751.00000,330.44000,Multiplan,Commercial,,705.94,,,,,,,675.90,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,outpatient,,,751.00000,330.44000,Multiplan,Commercial,,705.94,,,,,,,195.26,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,inpatient,,,1665.00000,732.60000,Multiplan,Commercial,,1565.10,,,,,,,1498.50,1615.05,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,outpatient,,,1665.00000,732.60000,Multiplan,Commercial,,1565.10,,,,,,,432.90,1615.05,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,inpatient,,,110.00000,48.40000,Multiplan,Commercial,,103.40,,,,,,,99.00,106.70,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,outpatient,,,110.00000,48.40000,Multiplan,Commercial,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,inpatient,,,281.00000,123.64000,Multiplan,Commercial,,264.14,,,,,,,252.90,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Multiplan,Commercial,,264.14,,,,,,,73.06,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,inpatient,,,281.00000,123.64000,Multiplan,Commercial,,264.14,,,,,,,252.90,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Multiplan,Commercial,,264.14,,,,,,,73.06,272.57,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,inpatient,,,451.00000,341.41000,Multiplan,Commercial,,423.94,,,,,,,405.90,437.47,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,outpatient,,,451.00000,341.41000,Multiplan,Commercial,,423.94,,,,,,,117.26,437.47,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,inpatient,,,300.00000,145.80000,Multiplan,Commercial,,282.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,outpatient,,,300.00000,145.80000,Multiplan,Commercial,,282.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,inpatient,,,2278.00000,1107.11000,Multiplan,Commercial,,2141.32,,,,,,,2050.20,2209.66,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,outpatient,,,2278.00000,1107.11000,Multiplan,Commercial,,2141.32,,,,,,,592.28,2209.66,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,inpatient,,,3912.00000,1901.23000,Multiplan,Commercial,,3677.28,,,,,,,3520.80,3794.64,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,outpatient,,,3912.00000,1901.23000,Multiplan,Commercial,,3677.28,,,,,,,1017.12,3794.64,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,inpatient,,,900.00000,437.40000,Multiplan,Commercial,,846.00,,,,,,,810.00,873.00,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,outpatient,,,900.00000,437.40000,Multiplan,Commercial,,846.00,,,,,,,234.00,873.00,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,inpatient,,,365.00000,177.39000,Multiplan,Commercial,,343.10,,,,,,,328.50,354.05,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,outpatient,,,365.00000,177.39000,Multiplan,Commercial,,343.10,,,,,,,94.90,354.05,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,inpatient,,,989.00000,480.65000,Multiplan,Commercial,,929.66,,,,,,,890.10,959.33,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,outpatient,,,989.00000,480.65000,Multiplan,Commercial,,929.66,,,,,,,257.14,959.33,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Multiplan,Commercial,,462.48,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Multiplan,Commercial,,462.48,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,inpatient,,,435.00000,211.41000,Multiplan,Commercial,,408.90,,,,,,,391.50,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Multiplan,Commercial,,408.90,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,inpatient,,,435.00000,211.41000,Multiplan,Commercial,,408.90,,,,,,,391.50,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Multiplan,Commercial,,408.90,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,inpatient,,,644.00000,312.98000,Multiplan,Commercial,,605.36,,,,,,,579.60,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,outpatient,,,644.00000,312.98000,Multiplan,Commercial,,605.36,,,,,,,167.44,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Multiplan,Commercial,,462.48,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Multiplan,Commercial,,462.48,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Multiplan,Commercial,,462.48,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Multiplan,Commercial,,462.48,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,inpatient,,,527.00000,256.12000,Multiplan,Commercial,,495.38,,,,,,,474.30,511.19,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,outpatient,,,527.00000,256.12000,Multiplan,Commercial,,495.38,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,inpatient,,,1404.00000,682.34000,Multiplan,Commercial,,1319.76,,,,,,,1263.60,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,outpatient,,,1404.00000,682.34000,Multiplan,Commercial,,1319.76,,,,,,,365.04,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,inpatient,,,5475.00000,2660.85000,Multiplan,Commercial,,5146.50,,,,,,,4927.50,5310.75,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,outpatient,,,5475.00000,2660.85000,Multiplan,Commercial,,5146.50,,,,,,,1423.50,5310.75,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,inpatient,,,726.00000,352.84000,Multiplan,Commercial,,682.44,,,,,,,653.40,704.22,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,outpatient,,,726.00000,352.84000,Multiplan,Commercial,,682.44,,,,,,,188.76,704.22,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,inpatient,,,507.00000,246.40000,Multiplan,Commercial,,476.58,,,,,,,456.30,491.79,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,outpatient,,,507.00000,246.40000,Multiplan,Commercial,,476.58,,,,,,,131.82,491.79,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,inpatient,,,1670.00000,811.62000,Multiplan,Commercial,,1569.80,,,,,,,1503.00,1619.90,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,outpatient,,,1670.00000,811.62000,Multiplan,Commercial,,1569.80,,,,,,,434.20,1619.90,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,inpatient,,,1139.00000,553.55000,Multiplan,Commercial,,1070.66,,,,,,,1025.10,1104.83,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,outpatient,,,1139.00000,553.55000,Multiplan,Commercial,,1070.66,,,,,,,296.14,1104.83,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,inpatient,,,875.00000,425.25000,Multiplan,Commercial,,822.50,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,outpatient,,,875.00000,425.25000,Multiplan,Commercial,,822.50,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,inpatient,,,525.00000,255.15000,Multiplan,Commercial,,493.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,outpatient,,,525.00000,255.15000,Multiplan,Commercial,,493.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,inpatient,,,1353.00000,657.56000,Multiplan,Commercial,,1271.82,,,,,,,1217.70,1312.41,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,outpatient,,,1353.00000,657.56000,Multiplan,Commercial,,1271.82,,,,,,,351.78,1312.41,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,inpatient,,,525.00000,255.15000,Multiplan,Commercial,,493.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,outpatient,,,525.00000,255.15000,Multiplan,Commercial,,493.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,inpatient,,,525.00000,255.15000,Multiplan,Commercial,,493.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,outpatient,,,525.00000,255.15000,Multiplan,Commercial,,493.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,inpatient,,,825.00000,400.95000,Multiplan,Commercial,,775.50,,,,,,,742.50,800.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,outpatient,,,825.00000,400.95000,Multiplan,Commercial,,775.50,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,inpatient,,,525.00000,255.15000,Multiplan,Commercial,,493.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Multiplan,Commercial,,493.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,inpatient,,,525.00000,255.15000,Multiplan,Commercial,,493.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Multiplan,Commercial,,493.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,inpatient,,,974.00000,473.36000,Multiplan,Commercial,,915.56,,,,,,,876.60,944.78,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,outpatient,,,974.00000,473.36000,Multiplan,Commercial,,915.56,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,inpatient,,,198.00000,96.23000,Multiplan,Commercial,,186.12,,,,,,,178.20,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Multiplan,Commercial,,186.12,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,inpatient,,,198.00000,96.23000,Multiplan,Commercial,,186.12,,,,,,,178.20,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Multiplan,Commercial,,186.12,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,inpatient,,,221.00000,107.41000,Multiplan,Commercial,,207.74,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Multiplan,Commercial,,207.74,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,inpatient,,,221.00000,107.41000,Multiplan,Commercial,,207.74,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Multiplan,Commercial,,207.74,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,inpatient,,,497.00000,241.54000,Multiplan,Commercial,,467.18,,,,,,,447.30,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,outpatient,,,497.00000,241.54000,Multiplan,Commercial,,467.18,,,,,,,129.22,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,inpatient,,,2340.00000,1137.24000,Multiplan,Commercial,,2199.60,,,,,,,2106.00,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,outpatient,,,2340.00000,1137.24000,Multiplan,Commercial,,2199.60,,,,,,,608.40,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,inpatient,,,249.00000,121.01000,Multiplan,Commercial,,234.06,,,,,,,224.10,241.53,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,outpatient,,,249.00000,121.01000,Multiplan,Commercial,,234.06,,,,,,,64.74,241.53,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,inpatient,,,135.00000,65.61000,Multiplan,Commercial,,126.90,,,,,,,121.50,130.95,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,outpatient,,,135.00000,65.61000,Multiplan,Commercial,,126.90,,,,,,,35.10,130.95,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,inpatient,,,172.00000,83.59000,Multiplan,Commercial,,161.68,,,,,,,154.80,166.84,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,outpatient,,,172.00000,83.59000,Multiplan,Commercial,,161.68,,,,,,,44.72,166.84,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,inpatient,,,307.00000,149.20000,Multiplan,Commercial,,288.58,,,,,,,276.30,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,outpatient,,,307.00000,149.20000,Multiplan,Commercial,,288.58,,,,,,,79.82,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,inpatient,,,1800.00000,874.80000,Multiplan,Commercial,,1692.00,,,,,,,1620.00,1746.00,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,outpatient,,,1800.00000,874.80000,Multiplan,Commercial,,1692.00,,,,,,,468.00,1746.00,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,inpatient,,,974.00000,473.36000,Multiplan,Commercial,,915.56,,,,,,,876.60,944.78,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,outpatient,,,974.00000,473.36000,Multiplan,Commercial,,915.56,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,inpatient,,,197.00000,95.74000,Multiplan,Commercial,,185.18,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Multiplan,Commercial,,185.18,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,inpatient,,,197.00000,95.74000,Multiplan,Commercial,,185.18,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Multiplan,Commercial,,185.18,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,inpatient,,,411.00000,199.75000,Multiplan,Commercial,,386.34,,,,,,,369.90,398.67,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,outpatient,,,411.00000,199.75000,Multiplan,Commercial,,386.34,,,,,,,106.86,398.67,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,inpatient,,,221.00000,107.41000,Multiplan,Commercial,,207.74,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,outpatient,,,221.00000,107.41000,Multiplan,Commercial,,207.74,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,inpatient,,,884.00000,429.62000,Multiplan,Commercial,,830.96,,,,,,,795.60,857.48,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,outpatient,,,884.00000,429.62000,Multiplan,Commercial,,830.96,,,,,,,229.84,857.48,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,inpatient,,,594.00000,288.68000,Multiplan,Commercial,,558.36,,,,,,,534.60,576.18,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,outpatient,,,594.00000,288.68000,Multiplan,Commercial,,558.36,,,,,,,154.44,576.18,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,inpatient,,,519.00000,252.23000,Multiplan,Commercial,,487.86,,,,,,,467.10,503.43,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,outpatient,,,519.00000,252.23000,Multiplan,Commercial,,487.86,,,,,,,134.94,503.43,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,inpatient,,,1046.00000,508.36000,Multiplan,Commercial,,983.24,,,,,,,941.40,1014.62,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,outpatient,,,1046.00000,508.36000,Multiplan,Commercial,,983.24,,,,,,,271.96,1014.62,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,inpatient,,,556.00000,270.22000,Multiplan,Commercial,,522.64,,,,,,,500.40,539.32,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,outpatient,,,556.00000,270.22000,Multiplan,Commercial,,522.64,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,inpatient,,,275.00000,133.65000,Multiplan,Commercial,,258.50,,,,,,,247.50,266.75,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,outpatient,,,275.00000,133.65000,Multiplan,Commercial,,258.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,inpatient,,,580.00000,281.88000,Multiplan,Commercial,,545.20,,,,,,,522.00,562.60,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,outpatient,,,580.00000,281.88000,Multiplan,Commercial,,545.20,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,inpatient,,,580.00000,281.88000,Multiplan,Commercial,,545.20,,,,,,,522.00,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,outpatient,,,580.00000,281.88000,Multiplan,Commercial,,545.20,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,inpatient,,,3480.00000,1691.28000,Multiplan,Commercial,,3271.20,,,,,,,3132.00,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Multiplan,Commercial,,3271.20,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,inpatient,,,3480.00000,1691.28000,Multiplan,Commercial,,3271.20,,,,,,,3132.00,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Multiplan,Commercial,,3271.20,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,inpatient,,,700.00000,340.20000,Multiplan,Commercial,,658.00,,,,,,,630.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,outpatient,,,700.00000,340.20000,Multiplan,Commercial,,658.00,,,,,,,182.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,inpatient,,,1427.00000,693.52000,Multiplan,Commercial,,1341.38,,,,,,,1284.30,1384.19,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,outpatient,,,1427.00000,693.52000,Multiplan,Commercial,,1341.38,,,,,,,371.02,1384.19,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,inpatient,,,614.00000,298.40000,Multiplan,Commercial,,577.16,,,,,,,552.60,595.58,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,outpatient,,,614.00000,298.40000,Multiplan,Commercial,,577.16,,,,,,,159.64,595.58,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,inpatient,,,2027.00000,985.12000,Multiplan,Commercial,,1905.38,,,,,,,1824.30,1966.19,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,outpatient,,,2027.00000,985.12000,Multiplan,Commercial,,1905.38,,,,,,,527.02,1966.19,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,inpatient,,,556.00000,270.22000,Multiplan,Commercial,,522.64,,,,,,,500.40,539.32,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,outpatient,,,556.00000,270.22000,Multiplan,Commercial,,522.64,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,inpatient,,,1146.00000,556.96000,Multiplan,Commercial,,1077.24,,,,,,,1031.40,1111.62,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,outpatient,,,1146.00000,556.96000,Multiplan,Commercial,,1077.24,,,,,,,297.96,1111.62,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,inpatient,,,197.00000,95.74000,Multiplan,Commercial,,185.18,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Multiplan,Commercial,,185.18,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,inpatient,,,197.00000,95.74000,Multiplan,Commercial,,185.18,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Multiplan,Commercial,,185.18,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,inpatient,,,527.00000,256.12000,Multiplan,Commercial,,495.38,,,,,,,474.30,511.19,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,outpatient,,,527.00000,256.12000,Multiplan,Commercial,,495.38,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,inpatient,,,740.00000,359.64000,Multiplan,Commercial,,695.60,,,,,,,666.00,717.80,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,outpatient,,,740.00000,359.64000,Multiplan,Commercial,,695.60,,,,,,,192.40,717.80,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,inpatient,,,875.00000,425.25000,Multiplan,Commercial,,822.50,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Multiplan,Commercial,,822.50,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,inpatient,,,875.00000,425.25000,Multiplan,Commercial,,822.50,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Multiplan,Commercial,,822.50,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,inpatient,,,1399.00000,679.91000,Multiplan,Commercial,,1315.06,,,,,,,1259.10,1357.03,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,outpatient,,,1399.00000,679.91000,Multiplan,Commercial,,1315.06,,,,,,,363.74,1357.03,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,inpatient,,,51.00000,24.79000,Multiplan,Commercial,,47.94,,,,,,,45.90,49.47,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,outpatient,,,51.00000,24.79000,Multiplan,Commercial,,47.94,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,inpatient,,,825.00000,400.95000,Multiplan,Commercial,,775.50,,,,,,,742.50,800.25,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,outpatient,,,825.00000,400.95000,Multiplan,Commercial,,775.50,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,inpatient,,,576.00000,279.94000,Multiplan,Commercial,,541.44,,,,,,,518.40,558.72,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,outpatient,,,576.00000,279.94000,Multiplan,Commercial,,541.44,,,,,,,149.76,558.72,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,inpatient,,,224.00000,108.86000,Multiplan,Commercial,,210.56,,,,,,,201.60,217.28,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,outpatient,,,224.00000,108.86000,Multiplan,Commercial,,210.56,,,,,,,58.24,217.28,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,inpatient,,,346.00000,168.16000,Multiplan,Commercial,,325.24,,,,,,,311.40,335.62,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,outpatient,,,346.00000,168.16000,Multiplan,Commercial,,325.24,,,,,,,89.96,335.62,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,inpatient,,,525.00000,255.15000,Multiplan,Commercial,,493.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,outpatient,,,525.00000,255.15000,Multiplan,Commercial,,493.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,inpatient,,,525.00000,255.15000,Multiplan,Commercial,,493.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,outpatient,,,525.00000,255.15000,Multiplan,Commercial,,493.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,inpatient,,,525.00000,255.15000,Multiplan,Commercial,,493.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Multiplan,Commercial,,493.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,inpatient,,,525.00000,255.15000,Multiplan,Commercial,,493.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Multiplan,Commercial,,493.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,inpatient,,,627.00000,304.72000,Multiplan,Commercial,,589.38,,,,,,,564.30,608.19,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,outpatient,,,627.00000,304.72000,Multiplan,Commercial,,589.38,,,,,,,163.02,608.19,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,inpatient,,,605.00000,294.03000,Multiplan,Commercial,,568.70,,,,,,,544.50,586.85,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,outpatient,,,605.00000,294.03000,Multiplan,Commercial,,568.70,,,,,,,157.30,586.85,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,inpatient,,,510.00000,247.86000,Multiplan,Commercial,,479.40,,,,,,,459.00,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,outpatient,,,510.00000,247.86000,Multiplan,Commercial,,479.40,,,,,,,132.60,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,inpatient,,,223.00000,108.38000,Multiplan,Commercial,,209.62,,,,,,,200.70,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,outpatient,,,223.00000,108.38000,Multiplan,Commercial,,209.62,,,,,,,57.98,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,inpatient,,,1211.00000,588.55000,Multiplan,Commercial,,1138.34,,,,,,,1089.90,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,outpatient,,,1211.00000,588.55000,Multiplan,Commercial,,1138.34,,,,,,,314.86,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,inpatient,,,383.00000,186.14000,Multiplan,Commercial,,360.02,,,,,,,344.70,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,outpatient,,,383.00000,186.14000,Multiplan,Commercial,,360.02,,,,,,,99.58,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,inpatient,,,1214.00000,590.00000,Multiplan,Commercial,,1141.16,,,,,,,1092.60,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,outpatient,,,1214.00000,590.00000,Multiplan,Commercial,,1141.16,,,,,,,315.64,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,inpatient,,,328.00000,159.41000,Multiplan,Commercial,,308.32,,,,,,,295.20,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,outpatient,,,328.00000,159.41000,Multiplan,Commercial,,308.32,,,,,,,85.28,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,inpatient,,,372.00000,180.79000,Multiplan,Commercial,,349.68,,,,,,,334.80,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,outpatient,,,372.00000,180.79000,Multiplan,Commercial,,349.68,,,,,,,96.72,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,inpatient,,,285.00000,138.51000,Multiplan,Commercial,,267.90,,,,,,,256.50,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,outpatient,,,285.00000,138.51000,Multiplan,Commercial,,267.90,,,,,,,74.10,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,inpatient,,,367.00000,178.36000,Multiplan,Commercial,,344.98,,,,,,,330.30,355.99,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,outpatient,,,367.00000,178.36000,Multiplan,Commercial,,344.98,,,,,,,95.42,355.99,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,inpatient,,,702.00000,341.17000,Multiplan,Commercial,,659.88,,,,,,,631.80,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Multiplan,Commercial,,659.88,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,inpatient,,,702.00000,341.17000,Multiplan,Commercial,,659.88,,,,,,,631.80,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Multiplan,Commercial,,659.88,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,inpatient,,,265.00000,128.79000,Multiplan,Commercial,,249.10,,,,,,,238.50,257.05,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,outpatient,,,265.00000,128.79000,Multiplan,Commercial,,249.10,,,,,,,68.90,257.05,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,inpatient,,,2279.00000,1107.59000,Multiplan,Commercial,,2142.26,,,,,,,2051.10,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2279.00000,1107.59000,Multiplan,Commercial,,2142.26,,,,,,,592.54,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,inpatient,,,2395.00000,1163.97000,Multiplan,Commercial,,2251.30,,,,,,,2155.50,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2395.00000,1163.97000,Multiplan,Commercial,,2251.30,,,,,,,622.70,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,inpatient,,,8759.00000,4256.87000,Multiplan,Commercial,,8233.46,,,,,,,7883.10,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Multiplan,Commercial,,8233.46,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,inpatient,,,8759.00000,4256.87000,Multiplan,Commercial,,8233.46,,,,,,,7883.10,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Multiplan,Commercial,,8233.46,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,inpatient,,,2752.00000,1337.47000,Multiplan,Commercial,,2586.88,,,,,,,2476.80,2669.44,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,outpatient,,,2752.00000,1337.47000,Multiplan,Commercial,,2586.88,,,,,,,715.52,2669.44,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,inpatient,,,217.00000,105.46000,Multiplan,Commercial,,203.98,,,,,,,195.30,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Multiplan,Commercial,,203.98,,,,,,,56.42,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,inpatient,,,217.00000,105.46000,Multiplan,Commercial,,203.98,,,,,,,195.30,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Multiplan,Commercial,,203.98,,,,,,,56.42,210.49,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,inpatient,,,292.00000,141.91000,Multiplan,Commercial,,274.48,,,,,,,262.80,283.24,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,outpatient,,,292.00000,141.91000,Multiplan,Commercial,,274.48,,,,,,,75.92,283.24,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Multiplan,Commercial,,386.34,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Multiplan,Commercial,,386.34,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Multiplan,Commercial,,386.34,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Multiplan,Commercial,,386.34,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Multiplan,Commercial,,386.34,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Multiplan,Commercial,,386.34,,,,,,,106.86,398.67,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,inpatient,,,2275.00000,1105.65000,Multiplan,Commercial,,2138.50,,,,,,,2047.50,2206.75,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,outpatient,,,2275.00000,1105.65000,Multiplan,Commercial,,2138.50,,,,,,,591.50,2206.75,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,inpatient,,,192.00000,93.31000,Multiplan,Commercial,,180.48,,,,,,,172.80,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,outpatient,,,192.00000,93.31000,Multiplan,Commercial,,180.48,,,,,,,49.92,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,inpatient,,,451.00000,219.19000,Multiplan,Commercial,,423.94,,,,,,,405.90,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,outpatient,,,451.00000,219.19000,Multiplan,Commercial,,423.94,,,,,,,117.26,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,inpatient,,,617.00000,299.86000,Multiplan,Commercial,,579.98,,,,,,,555.30,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,outpatient,,,617.00000,299.86000,Multiplan,Commercial,,579.98,,,,,,,160.42,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,inpatient,,,825.00000,400.95000,Multiplan,Commercial,,775.50,,,,,,,742.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,outpatient,,,825.00000,400.95000,Multiplan,Commercial,,775.50,,,,,,,214.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,inpatient,,,905.00000,439.83000,Multiplan,Commercial,,850.70,,,,,,,814.50,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,outpatient,,,905.00000,439.83000,Multiplan,Commercial,,850.70,,,,,,,235.30,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,inpatient,,,849.00000,412.61000,Multiplan,Commercial,,798.06,,,,,,,764.10,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,outpatient,,,849.00000,412.61000,Multiplan,Commercial,,798.06,,,,,,,220.74,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,inpatient,,,2539.00000,1233.95000,Multiplan,Commercial,,2386.66,,,,,,,2285.10,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,outpatient,,,2539.00000,1233.95000,Multiplan,Commercial,,2386.66,,,,,,,660.14,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,inpatient,,,6000.00000,2916.00000,Multiplan,Commercial,,5640.00,,,,,,,5400.00,5820.00,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,outpatient,,,6000.00000,2916.00000,Multiplan,Commercial,,5640.00,,,,,,,1560.00,5820.00,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,inpatient,,,8260.00000,4014.36000,Multiplan,Commercial,,7764.40,,,,,,,7434.00,8012.20,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,outpatient,,,8260.00000,4014.36000,Multiplan,Commercial,,7764.40,,,,,,,2147.60,8012.20,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,inpatient,,,202.00000,88.88000,Multiplan,Commercial,,189.88,,,,,,,181.80,195.94,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,outpatient,,,202.00000,88.88000,Multiplan,Commercial,,189.88,,,,,,,52.52,195.94,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,inpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,59.40,64.02,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,outpatient,,,66.00000,31.81000,Multiplan,Commercial,,62.04,,,,,,,17.16,64.02,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,inpatient,,,295.00000,142.19000,Multiplan,Commercial,,277.30,,,,,,,265.50,286.15,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,outpatient,,,295.00000,142.19000,Multiplan,Commercial,,277.30,,,,,,,76.70,286.15,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,89.00000,26.79000,Multiplan,Commercial,,83.66,,,,,,,80.10,86.33,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,89.00000,26.79000,Multiplan,Commercial,,83.66,,,,,,,23.14,86.33,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,inpatient,,,93.00000,27.99000,Multiplan,Commercial,,87.42,,,,,,,83.70,90.21,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Multiplan,Commercial,,87.42,,,,,,,24.18,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,93.00000,27.99000,Multiplan,Commercial,,87.42,,,,,,,83.70,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Multiplan,Commercial,,87.42,,,,,,,24.18,90.21,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Multiplan,Commercial,,1762.50,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Multiplan,Commercial,,1762.50,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Multiplan,Commercial,,1762.50,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Multiplan,Commercial,,1762.50,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1752.00000,527.35000,Multiplan,Commercial,,1646.88,,,,,,,1576.80,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Multiplan,Commercial,,1646.88,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1752.00000,527.35000,Multiplan,Commercial,,1646.88,,,,,,,1576.80,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Multiplan,Commercial,,1646.88,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,731.00000,220.03000,Multiplan,Commercial,,687.14,,,,,,,657.90,709.07,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,731.00000,220.03000,Multiplan,Commercial,,687.14,,,,,,,190.06,709.07,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,787.00000,236.89000,Multiplan,Commercial,,739.78,,,,,,,708.30,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,787.00000,236.89000,Multiplan,Commercial,,739.78,,,,,,,204.62,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,2042.00000,614.64000,Multiplan,Commercial,,1919.48,,,,,,,1837.80,1980.74,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,2042.00000,614.64000,Multiplan,Commercial,,1919.48,,,,,,,530.92,1980.74,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Multiplan,Commercial,,1762.50,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Multiplan,Commercial,,1762.50,,,,,,,487.50,1818.75,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,714.00000,214.91000,Multiplan,Commercial,,671.16,,,,,,,642.60,692.58,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,714.00000,214.91000,Multiplan,Commercial,,671.16,,,,,,,185.64,692.58,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,294.00000,88.49000,Multiplan,Commercial,,276.36,,,,,,,264.60,285.18,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,294.00000,88.49000,Multiplan,Commercial,,276.36,,,,,,,76.44,285.18,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,inpatient,,,350.00000,105.35000,Multiplan,Commercial,,329.00,,,,,,,315.00,339.50,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,350.00000,105.35000,Multiplan,Commercial,,329.00,,,,,,,91.00,339.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,inpatient,,,1350.00000,780.30000,Multiplan,Commercial,,1269.00,,,,,,,1215.00,1309.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,outpatient,,,1350.00000,780.30000,Multiplan,Commercial,,1269.00,,,,,,,351.00,1309.50,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,inpatient,,,3680.00000,2127.04000,Multiplan,Commercial,,3459.20,,,,,,,3312.00,3569.60,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,outpatient,,,3680.00000,2127.04000,Multiplan,Commercial,,3459.20,,,,,,,956.80,3569.60,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,inpatient,,,1600.00000,924.80000,Multiplan,Commercial,,1504.00,,,,,,,1440.00,1552.00,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,outpatient,,,1600.00000,924.80000,Multiplan,Commercial,,1504.00,,,,,,,416.00,1552.00,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,inpatient,,,4680.00000,2705.04000,Multiplan,Commercial,,4399.20,,,,,,,4212.00,4539.60,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,outpatient,,,4680.00000,2705.04000,Multiplan,Commercial,,4399.20,,,,,,,1216.80,4539.60,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,inpatient,,,2100.00000,1213.80000,Multiplan,Commercial,,1974.00,,,,,,,1890.00,2037.00,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,outpatient,,,2100.00000,1213.80000,Multiplan,Commercial,,1974.00,,,,,,,546.00,2037.00,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,inpatient,,,5680.00000,3283.04000,Multiplan,Commercial,,5339.20,,,,,,,5112.00,5509.60,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,outpatient,,,5680.00000,3283.04000,Multiplan,Commercial,,5339.20,,,,,,,1476.80,5509.60,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,inpatient,,,2420.00000,1398.76000,Multiplan,Commercial,,2274.80,,,,,,,2178.00,2347.40,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,outpatient,,,2420.00000,1398.76000,Multiplan,Commercial,,2274.80,,,,,,,629.20,2347.40,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,inpatient,,,6415.00000,3707.87000,Multiplan,Commercial,,6030.10,,,,,,,5773.50,6222.55,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,outpatient,,,6415.00000,3707.87000,Multiplan,Commercial,,6030.10,,,,,,,1667.90,6222.55,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,inpatient,,,2920.00000,1687.76000,Multiplan,Commercial,,2744.80,,,,,,,2628.00,2832.40,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,outpatient,,,2920.00000,1687.76000,Multiplan,Commercial,,2744.80,,,,,,,759.20,2832.40,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,inpatient,,,8915.00000,5152.87000,Multiplan,Commercial,,8380.10,,,,,,,8023.50,8647.55,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,outpatient,,,8915.00000,5152.87000,Multiplan,Commercial,,8380.10,,,,,,,2317.90,8647.55,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,inpatient,,,3420.00000,1976.76000,Multiplan,Commercial,,3214.80,,,,,,,3078.00,3317.40,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,outpatient,,,3420.00000,1976.76000,Multiplan,Commercial,,3214.80,,,,,,,889.20,3317.40,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,inpatient,,,11415.00000,6597.87000,Multiplan,Commercial,,10730.10,,,,,,,10273.50,11072.55,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,outpatient,,,11415.00000,6597.87000,Multiplan,Commercial,,10730.10,,,,,,,2967.90,11072.55,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,inpatient,,,142.00000,154.35000,Multiplan,Commercial,,133.48,,,,,,,127.80,137.74,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,outpatient,,,142.00000,154.35000,Multiplan,Commercial,,133.48,,,,,,,36.92,137.74,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,inpatient,,,340.00000,228.82000,Multiplan,Commercial,,319.60,,,,,,,306.00,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Multiplan,Commercial,,319.60,,,,,,,88.40,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,inpatient,,,670.00000,450.91000,Multiplan,Commercial,,629.80,,,,,,,603.00,649.90,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Multiplan,Commercial,,629.80,,,,,,,174.20,649.90,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,inpatient,,,390.00000,262.47000,Multiplan,Commercial,,366.60,,,,,,,351.00,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,outpatient,,,390.00000,262.47000,Multiplan,Commercial,,366.60,,,,,,,101.40,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,inpatient,,,1170.00000,787.41000,Multiplan,Commercial,,1099.80,,,,,,,1053.00,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,outpatient,,,1170.00000,787.41000,Multiplan,Commercial,,1099.80,,,,,,,304.20,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,inpatient,,,440.00000,296.12000,Multiplan,Commercial,,413.60,,,,,,,396.00,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,outpatient,,,440.00000,296.12000,Multiplan,Commercial,,413.60,,,,,,,114.40,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,inpatient,,,1670.00000,1123.91000,Multiplan,Commercial,,1569.80,,,,,,,1503.00,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,outpatient,,,1670.00000,1123.91000,Multiplan,Commercial,,1569.80,,,,,,,434.20,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,inpatient,,,640.00000,430.72000,Multiplan,Commercial,,601.60,,,,,,,576.00,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,outpatient,,,640.00000,430.72000,Multiplan,Commercial,,601.60,,,,,,,166.40,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,inpatient,,,2170.00000,1460.41000,Multiplan,Commercial,,2039.80,,,,,,,1953.00,2104.90,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,outpatient,,,2170.00000,1460.41000,Multiplan,Commercial,,2039.80,,,,,,,564.20,2104.90,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,inpatient,,,17.00000,10.96000,Multiplan,Commercial,,15.98,,,,,,,15.30,16.49,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,outpatient,,,17.00000,10.96000,Multiplan,Commercial,,15.98,,,,,,,4.42,16.49,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,inpatient,,,535.00000,345.08000,Multiplan,Commercial,,502.90,,,,,,,481.50,518.95,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,outpatient,,,535.00000,345.08000,Multiplan,Commercial,,502.90,,,,,,,139.10,518.95,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,inpatient,,,23.00000,14.84000,Multiplan,Commercial,,21.62,,,,,,,20.70,22.31,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,outpatient,,,23.00000,14.84000,Multiplan,Commercial,,21.62,,,,,,,5.98,22.31,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,inpatient,,,635.00000,409.58000,Multiplan,Commercial,,596.90,,,,,,,571.50,615.95,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,outpatient,,,635.00000,409.58000,Multiplan,Commercial,,596.90,,,,,,,165.10,615.95,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,inpatient,,,30.00000,19.35000,Multiplan,Commercial,,28.20,,,,,,,27.00,29.10,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,outpatient,,,30.00000,19.35000,Multiplan,Commercial,,28.20,,,,,,,7.80,29.10,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,inpatient,,,735.00000,474.08000,Multiplan,Commercial,,690.90,,,,,,,661.50,712.95,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,outpatient,,,735.00000,474.08000,Multiplan,Commercial,,690.90,,,,,,,191.10,712.95,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,inpatient,,,33.00000,21.28000,Multiplan,Commercial,,31.02,,,,,,,29.70,32.01,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,outpatient,,,33.00000,21.28000,Multiplan,Commercial,,31.02,,,,,,,8.58,32.01,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,inpatient,,,835.00000,538.58000,Multiplan,Commercial,,784.90,,,,,,,751.50,809.95,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,outpatient,,,835.00000,538.58000,Multiplan,Commercial,,784.90,,,,,,,217.10,809.95,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,inpatient,,,140.00000,80.92000,Multiplan,Commercial,,131.60,,,,,,,126.00,135.80,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,outpatient,,,140.00000,80.92000,Multiplan,Commercial,,131.60,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,inpatient,,,275.00000,158.95000,Multiplan,Commercial,,258.50,,,,,,,247.50,266.75,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,outpatient,,,275.00000,158.95000,Multiplan,Commercial,,258.50,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,inpatient,,,295.00000,170.51000,Multiplan,Commercial,,277.30,,,,,,,265.50,286.15,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,outpatient,,,295.00000,170.51000,Multiplan,Commercial,,277.30,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,inpatient,,,590.00000,341.02000,Multiplan,Commercial,,554.60,,,,,,,531.00,572.30,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,outpatient,,,590.00000,341.02000,Multiplan,Commercial,,554.60,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,inpatient,,,690.00000,398.82000,Multiplan,Commercial,,648.60,,,,,,,621.00,669.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,outpatient,,,690.00000,398.82000,Multiplan,Commercial,,648.60,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,inpatient,,,1375.00000,794.75000,Multiplan,Commercial,,1292.50,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,outpatient,,,1375.00000,794.75000,Multiplan,Commercial,,1292.50,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,inpatient,,,950.00000,549.10000,Multiplan,Commercial,,893.00,,,,,,,855.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,outpatient,,,950.00000,549.10000,Multiplan,Commercial,,893.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,inpatient,,,1900.00000,1098.20000,Multiplan,Commercial,,1786.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,outpatient,,,1900.00000,1098.20000,Multiplan,Commercial,,1786.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,inpatient,,,140.00000,45.22000,Multiplan,Commercial,,131.60,,,,,,,126.00,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,outpatient,,,140.00000,45.22000,Multiplan,Commercial,,131.60,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,inpatient,,,275.00000,88.82000,Multiplan,Commercial,,258.50,,,,,,,247.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,outpatient,,,275.00000,88.82000,Multiplan,Commercial,,258.50,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,inpatient,,,295.00000,95.28000,Multiplan,Commercial,,277.30,,,,,,,265.50,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,outpatient,,,295.00000,95.28000,Multiplan,Commercial,,277.30,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,inpatient,,,590.00000,190.57000,Multiplan,Commercial,,554.60,,,,,,,531.00,572.30,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,outpatient,,,590.00000,190.57000,Multiplan,Commercial,,554.60,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,inpatient,,,690.00000,222.87000,Multiplan,Commercial,,648.60,,,,,,,621.00,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,outpatient,,,690.00000,222.87000,Multiplan,Commercial,,648.60,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,inpatient,,,1375.00000,444.12000,Multiplan,Commercial,,1292.50,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,outpatient,,,1375.00000,444.12000,Multiplan,Commercial,,1292.50,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,inpatient,,,950.00000,306.85000,Multiplan,Commercial,,893.00,,,,,,,855.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,outpatient,,,950.00000,306.85000,Multiplan,Commercial,,893.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,inpatient,,,1900.00000,613.70000,Multiplan,Commercial,,1786.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,outpatient,,,1900.00000,613.70000,Multiplan,Commercial,,1786.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,inpatient,,,340.00000,228.82000,Multiplan,Commercial,,319.60,,,,,,,306.00,329.80,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Multiplan,Commercial,,319.60,,,,,,,88.40,329.80,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,inpatient,,,670.00000,450.91000,Multiplan,Commercial,,629.80,,,,,,,603.00,649.90,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Multiplan,Commercial,,629.80,,,,,,,174.20,649.90,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Multiplan,Commercial,,460.60,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Multiplan,Commercial,,460.60,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,inpatient,,,490.00000,329.77000,Multiplan,Commercial,,460.60,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Multiplan,Commercial,,460.60,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Multiplan,Commercial,,460.60,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Multiplan,Commercial,,460.60,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,inpatient,,,245.00000,164.89000,Multiplan,Commercial,,230.30,,,,,,,220.50,237.65,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Multiplan,Commercial,,230.30,,,,,,,63.70,237.65,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Multiplan,Commercial,,791.48,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Multiplan,Commercial,,791.48,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Multiplan,Commercial,,989.82,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Multiplan,Commercial,,989.82,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Multiplan,Commercial,,1187.22,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Multiplan,Commercial,,1187.22,,,,,,,328.38,1225.11,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,inpatient,,,1178.00000,669.28000,Multiplan,Commercial,,1107.32,,,,,,,1060.20,1142.66,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1178.00000,669.28000,Multiplan,Commercial,,1107.32,,,,,,,306.28,1142.66,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,inpatient,,,140.00000,102.34000,Multiplan,Commercial,,131.60,,,,,,,126.00,135.80,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,outpatient,,,140.00000,102.34000,Multiplan,Commercial,,131.60,,,,,,,36.40,135.80,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,inpatient,,,275.00000,201.02000,Multiplan,Commercial,,258.50,,,,,,,247.50,266.75,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,outpatient,,,275.00000,201.02000,Multiplan,Commercial,,258.50,,,,,,,71.50,266.75,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,inpatient,,,295.00000,215.64000,Multiplan,Commercial,,277.30,,,,,,,265.50,286.15,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,outpatient,,,295.00000,215.64000,Multiplan,Commercial,,277.30,,,,,,,76.70,286.15,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,inpatient,,,590.00000,431.29000,Multiplan,Commercial,,554.60,,,,,,,531.00,572.30,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,outpatient,,,590.00000,431.29000,Multiplan,Commercial,,554.60,,,,,,,153.40,572.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,inpatient,,,690.00000,504.39000,Multiplan,Commercial,,648.60,,,,,,,621.00,669.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,outpatient,,,690.00000,504.39000,Multiplan,Commercial,,648.60,,,,,,,179.40,669.30,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,inpatient,,,1375.00000,1005.12000,Multiplan,Commercial,,1292.50,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,outpatient,,,1375.00000,1005.12000,Multiplan,Commercial,,1292.50,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,inpatient,,,950.00000,694.45000,Multiplan,Commercial,,893.00,,,,,,,855.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,outpatient,,,950.00000,694.45000,Multiplan,Commercial,,893.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,inpatient,,,1900.00000,1388.90000,Multiplan,Commercial,,1786.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,outpatient,,,1900.00000,1388.90000,Multiplan,Commercial,,1786.00,,,,,,,494.00,1843.00,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,inpatient,,,584.00000,426.90000,Multiplan,Commercial,,548.96,,,,,,,525.60,566.48,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,outpatient,,,584.00000,426.90000,Multiplan,Commercial,,548.96,,,,,,,151.84,566.48,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,inpatient,,,1391.00000,1016.82000,Multiplan,Commercial,,1307.54,,,,,,,1251.90,1349.27,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,outpatient,,,1391.00000,1016.82000,Multiplan,Commercial,,1307.54,,,,,,,361.66,1349.27,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,inpatient,,,359.00000,271.76000,Multiplan,Commercial,,337.46,,,,,,,323.10,348.23,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,outpatient,,,359.00000,271.76000,Multiplan,Commercial,,337.46,,,,,,,93.34,348.23,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,inpatient,,,95.00000,71.92000,Multiplan,Commercial,,89.30,,,,,,,85.50,92.15,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,outpatient,,,95.00000,71.92000,Multiplan,Commercial,,89.30,,,,,,,24.70,92.15,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,inpatient,,,37.00000,17.83000,Multiplan,Commercial,,34.78,,,,,,,33.30,35.89,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,outpatient,,,37.00000,17.83000,Multiplan,Commercial,,34.78,,,,,,,9.62,35.89,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Multiplan,Commercial,,74.26,,,,,,,71.10,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Multiplan,Commercial,,74.26,,,,,,,20.54,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,inpatient,,,237.00000,114.23000,Multiplan,Commercial,,222.78,,,,,,,213.30,229.89,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Multiplan,Commercial,,222.78,,,,,,,61.62,229.89,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,inpatient,,,33.00000,15.91000,Multiplan,Commercial,,31.02,,,,,,,29.70,32.01,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,outpatient,,,33.00000,15.91000,Multiplan,Commercial,,31.02,,,,,,,8.58,32.01,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,inpatient,,,25.00000,12.05000,Multiplan,Commercial,,23.50,,,,,,,22.50,24.25,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,outpatient,,,25.00000,12.05000,Multiplan,Commercial,,23.50,,,,,,,6.50,24.25,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,inpatient,,,497.00000,160.53000,Multiplan,Commercial,,467.18,,,,,,,447.30,482.09,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,outpatient,,,497.00000,160.53000,Multiplan,Commercial,,467.18,,,,,,,129.22,482.09,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Multiplan,Commercial,,829.08,,,,,,,793.80,855.54,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Multiplan,Commercial,,829.08,,,,,,,229.32,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Multiplan,Commercial,,829.08,,,,,,,793.80,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Multiplan,Commercial,,829.08,,,,,,,229.32,855.54,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,inpatient,,,98.00000,37.44000,Multiplan,Commercial,,92.12,,,,,,,88.20,95.06,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Multiplan,Commercial,,92.12,,,,,,,25.48,95.06,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,inpatient,,,96.00000,36.67000,Multiplan,Commercial,,90.24,,,,,,,86.40,93.12,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Multiplan,Commercial,,90.24,,,,,,,24.96,93.12,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Multiplan,Commercial,,829.08,,,,,,,793.80,855.54,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Multiplan,Commercial,,829.08,,,,,,,229.32,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Multiplan,Commercial,,829.08,,,,,,,793.80,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Multiplan,Commercial,,829.08,,,,,,,229.32,855.54,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,inpatient,,,763.00000,291.47000,Multiplan,Commercial,,717.22,,,,,,,686.70,740.11,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,outpatient,,,763.00000,291.47000,Multiplan,Commercial,,717.22,,,,,,,198.38,740.11,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,inpatient,,,199.00000,76.02000,Multiplan,Commercial,,187.06,,,,,,,179.10,193.03,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,outpatient,,,199.00000,76.02000,Multiplan,Commercial,,187.06,,,,,,,51.74,193.03,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,inpatient,,,98.00000,37.44000,Multiplan,Commercial,,92.12,,,,,,,88.20,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Multiplan,Commercial,,92.12,,,,,,,25.48,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,inpatient,,,96.00000,36.67000,Multiplan,Commercial,,90.24,,,,,,,86.40,93.12,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Multiplan,Commercial,,90.24,,,,,,,24.96,93.12,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,inpatient,,,1265.00000,483.23000,Multiplan,Commercial,,1189.10,,,,,,,1138.50,1227.05,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,outpatient,,,1265.00000,483.23000,Multiplan,Commercial,,1189.10,,,,,,,328.90,1227.05,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,inpatient,,,924.00000,352.97000,Multiplan,Commercial,,868.56,,,,,,,831.60,896.28,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,outpatient,,,924.00000,352.97000,Multiplan,Commercial,,868.56,,,,,,,240.24,896.28,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,inpatient,,,580.00000,215.76000,Multiplan,Commercial,,545.20,,,,,,,522.00,562.60,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,outpatient,,,580.00000,215.76000,Multiplan,Commercial,,545.20,,,,,,,150.80,562.60,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,inpatient,,,110.00000,40.92000,Multiplan,Commercial,,103.40,,,,,,,99.00,106.70,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,outpatient,,,110.00000,40.92000,Multiplan,Commercial,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,inpatient,,,373.00000,138.76000,Multiplan,Commercial,,350.62,,,,,,,335.70,361.81,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,outpatient,,,373.00000,138.76000,Multiplan,Commercial,,350.62,,,,,,,96.98,361.81,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,inpatient,,,337.00000,125.36000,Multiplan,Commercial,,316.78,,,,,,,303.30,326.89,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,outpatient,,,337.00000,125.36000,Multiplan,Commercial,,316.78,,,,,,,87.62,326.89,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,inpatient,,,784.00000,291.65000,Multiplan,Commercial,,736.96,,,,,,,705.60,760.48,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,outpatient,,,784.00000,291.65000,Multiplan,Commercial,,736.96,,,,,,,203.84,760.48,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,inpatient,,,341.00000,126.85000,Multiplan,Commercial,,320.54,,,,,,,306.90,330.77,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,outpatient,,,341.00000,126.85000,Multiplan,Commercial,,320.54,,,,,,,88.66,330.77,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,inpatient,,,252.00000,93.74000,Multiplan,Commercial,,236.88,,,,,,,226.80,244.44,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,outpatient,,,252.00000,93.74000,Multiplan,Commercial,,236.88,,,,,,,65.52,244.44,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,inpatient,,,282.00000,104.90000,Multiplan,Commercial,,265.08,,,,,,,253.80,273.54,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,outpatient,,,282.00000,104.90000,Multiplan,Commercial,,265.08,,,,,,,73.32,273.54,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,inpatient,,,404.00000,150.29000,Multiplan,Commercial,,379.76,,,,,,,363.60,391.88,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,outpatient,,,404.00000,150.29000,Multiplan,Commercial,,379.76,,,,,,,105.04,391.88,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,inpatient,,,306.00000,173.85000,Multiplan,Commercial,,287.64,,,,,,,275.40,296.82,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,outpatient,,,306.00000,173.85000,Multiplan,Commercial,,287.64,,,,,,,79.56,296.82,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,inpatient,,,158.00000,89.77000,Multiplan,Commercial,,148.52,,,,,,,142.20,153.26,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,outpatient,,,158.00000,89.77000,Multiplan,Commercial,,148.52,,,,,,,41.08,153.26,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,inpatient,,,147.00000,89.38000,Multiplan,Commercial,GP,138.18,,,,,,,132.30,142.59,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Multiplan,Commercial,GP,138.18,,,,,,,38.22,142.59,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,inpatient,,,270.00000,164.16000,Multiplan,Commercial,GP,253.80,,,,,,,243.00,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Multiplan,Commercial,GP,253.80,,,,,,,70.20,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,inpatient,,,84.00000,51.07000,Multiplan,Commercial,GP,78.96,,,,,,,75.60,81.48,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Multiplan,Commercial,GP,78.96,,,,,,,21.84,81.48,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,inpatient,,,86.00000,52.29000,Multiplan,Commercial,GP,80.84,,,,,,,77.40,83.42,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Multiplan,Commercial,GP,80.84,,,,,,,22.36,83.42,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,inpatient,,,82.00000,49.86000,Multiplan,Commercial,GP,77.08,,,,,,,73.80,79.54,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Multiplan,Commercial,GP,77.08,,,,,,,21.32,79.54,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,inpatient,,,85.00000,51.68000,Multiplan,Commercial,GP,79.90,,,,,,,76.50,82.45,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Multiplan,Commercial,GP,79.90,,,,,,,22.10,82.45,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,inpatient,,,43.00000,26.14000,Multiplan,Commercial,GP,40.42,,,,,,,38.70,41.71,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Multiplan,Commercial,GP,40.42,,,,,,,11.18,41.71,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,inpatient,,,41.00000,24.93000,Multiplan,Commercial,GP,38.54,,,,,,,36.90,39.77,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Multiplan,Commercial,GP,38.54,,,,,,,10.66,39.77,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,inpatient,,,79.00000,48.03000,Multiplan,Commercial,GP,74.26,,,,,,,71.10,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Multiplan,Commercial,GP,74.26,,,,,,,20.54,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Multiplan,Commercial,GP,69.56,,,,,,,66.60,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Multiplan,Commercial,GP,69.56,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Multiplan,Commercial,GP,69.56,,,,,,,66.60,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Multiplan,Commercial,GP,69.56,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,inpatient,,,34.00000,20.67000,Multiplan,Commercial,GP,31.96,,,,,,,30.60,32.98,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Multiplan,Commercial,GP,31.96,,,,,,,8.84,32.98,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,inpatient,,,65.00000,39.52000,Multiplan,Commercial,GP,61.10,,,,,,,58.50,63.05,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Multiplan,Commercial,GP,61.10,,,,,,,16.90,63.05,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,inpatient,,,113.00000,68.70000,Multiplan,Commercial,,106.22,,,,,,,101.70,109.61,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,outpatient,,,113.00000,68.70000,Multiplan,Commercial,,106.22,,,,,,,29.38,109.61,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,inpatient,,,80.00000,48.64000,Multiplan,Commercial,GP,75.20,,,,,,,72.00,77.60,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Multiplan,Commercial,GP,75.20,,,,,,,20.80,77.60,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,inpatient,,,84.00000,51.07000,Multiplan,Commercial,GP,78.96,,,,,,,75.60,81.48,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Multiplan,Commercial,GP,78.96,,,,,,,21.84,81.48,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,inpatient,,,73.00000,44.38000,Multiplan,Commercial,GP,68.62,,,,,,,65.70,70.81,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Multiplan,Commercial,GP,68.62,,,,,,,18.98,70.81,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,inpatient,,,100.00000,60.80000,Multiplan,Commercial,,94.00,,,,,,,90.00,97.00,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,outpatient,,,100.00000,60.80000,Multiplan,Commercial,,94.00,,,,,,,26.00,97.00,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,inpatient,,,167.00000,101.54000,Multiplan,Commercial,GP,156.98,,,,,,,150.30,161.99,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,outpatient,,,167.00000,101.54000,Multiplan,Commercial,GP,156.98,,,,,,,43.42,161.99,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,inpatient,,,413.00000,251.10000,Multiplan,Commercial,"50,GP",388.22,,,,,,,371.70,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Multiplan,Commercial,"50,GP",388.22,,,,,,,107.38,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Multiplan,Commercial,"LT,GP",258.50,,,,,,,247.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Multiplan,Commercial,"LT,GP",258.50,,,,,,,71.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Multiplan,Commercial,"RT,GP",258.50,,,,,,,247.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Multiplan,Commercial,"RT,GP",258.50,,,,,,,71.50,266.75,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,inpatient,,,95.00000,57.76000,Multiplan,Commercial,GP,89.30,,,,,,,85.50,92.15,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Multiplan,Commercial,GP,89.30,,,,,,,24.70,92.15,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,inpatient,,,146.00000,88.77000,Multiplan,Commercial,GP,137.24,,,,,,,131.40,141.62,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Multiplan,Commercial,GP,137.24,,,,,,,37.96,141.62,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,inpatient,,,139.00000,84.51000,Multiplan,Commercial,GP,130.66,,,,,,,125.10,134.83,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Multiplan,Commercial,GP,130.66,,,,,,,36.14,134.83,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,inpatient,,,75.00000,45.60000,Multiplan,Commercial,GP,70.50,,,,,,,67.50,72.75,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Multiplan,Commercial,GP,70.50,,,,,,,19.50,72.75,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,inpatient,,,154.00000,93.63000,Multiplan,Commercial,GP,144.76,,,,,,,138.60,149.38,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Multiplan,Commercial,GP,144.76,,,,,,,40.04,149.38,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,inpatient,,,73.00000,44.38000,Multiplan,Commercial,GP,68.62,,,,,,,65.70,70.81,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Multiplan,Commercial,GP,68.62,,,,,,,18.98,70.81,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,inpatient,,,160.00000,97.28000,Multiplan,Commercial,GP,150.40,,,,,,,144.00,155.20,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Multiplan,Commercial,GP,150.40,,,,,,,41.60,155.20,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,inpatient,,,325.00000,197.60000,Multiplan,Commercial,GP,305.50,,,,,,,292.50,315.25,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Multiplan,Commercial,GP,305.50,,,,,,,84.50,315.25,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,inpatient,,,98.00000,59.58000,Multiplan,Commercial,GP,92.12,,,,,,,88.20,95.06,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,outpatient,,,98.00000,59.58000,Multiplan,Commercial,GP,92.12,,,,,,,25.48,95.06,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,inpatient,,,303.00000,184.22000,Multiplan,Commercial,GP,284.82,,,,,,,272.70,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,outpatient,,,303.00000,184.22000,Multiplan,Commercial,GP,284.82,,,,,,,78.78,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,inpatient,,,115.00000,69.92000,Multiplan,Commercial,GP,108.10,,,,,,,103.50,111.55,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,outpatient,,,115.00000,69.92000,Multiplan,Commercial,GP,108.10,,,,,,,29.90,111.55,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,inpatient,,,74.00000,44.99000,Multiplan,Commercial,GP,69.56,,,,,,,66.60,71.78,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Multiplan,Commercial,GP,69.56,,,,,,,19.24,71.78,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,inpatient,,,79.00000,48.03000,Multiplan,Commercial,GP,74.26,,,,,,,71.10,76.63,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Multiplan,Commercial,GP,74.26,,,,,,,20.54,76.63,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,inpatient,,,72.00000,43.78000,Multiplan,Commercial,GP,67.68,,,,,,,64.80,69.84,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Multiplan,Commercial,GP,67.68,,,,,,,18.72,69.84,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,inpatient,,,147.00000,89.38000,Multiplan,Commercial,GP,138.18,,,,,,,132.30,142.59,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Multiplan,Commercial,GP,138.18,,,,,,,38.22,142.59,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,inpatient,,,270.00000,164.16000,Multiplan,Commercial,GP,253.80,,,,,,,243.00,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Multiplan,Commercial,GP,253.80,,,,,,,70.20,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,inpatient,,,84.00000,51.07000,Multiplan,Commercial,GP,78.96,,,,,,,75.60,81.48,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Multiplan,Commercial,GP,78.96,,,,,,,21.84,81.48,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,inpatient,,,86.00000,52.29000,Multiplan,Commercial,GP,80.84,,,,,,,77.40,83.42,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Multiplan,Commercial,GP,80.84,,,,,,,22.36,83.42,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,inpatient,,,82.00000,49.86000,Multiplan,Commercial,GP,77.08,,,,,,,73.80,79.54,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Multiplan,Commercial,GP,77.08,,,,,,,21.32,79.54,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,inpatient,,,85.00000,51.68000,Multiplan,Commercial,GP,79.90,,,,,,,76.50,82.45,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Multiplan,Commercial,GP,79.90,,,,,,,22.10,82.45,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,inpatient,,,43.00000,26.14000,Multiplan,Commercial,GP,40.42,,,,,,,38.70,41.71,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Multiplan,Commercial,GP,40.42,,,,,,,11.18,41.71,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,inpatient,,,41.00000,24.93000,Multiplan,Commercial,GP,38.54,,,,,,,36.90,39.77,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Multiplan,Commercial,GP,38.54,,,,,,,10.66,39.77,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,inpatient,,,79.00000,48.03000,Multiplan,Commercial,GP,74.26,,,,,,,71.10,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Multiplan,Commercial,GP,74.26,,,,,,,20.54,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Multiplan,Commercial,"CQ,GP",69.56,,,,,,,66.60,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Multiplan,Commercial,"CQ,GP",69.56,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Multiplan,Commercial,"CQ,GP",69.56,,,,,,,66.60,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Multiplan,Commercial,"CQ,GP",69.56,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,inpatient,,,34.00000,20.67000,Multiplan,Commercial,GP,31.96,,,,,,,30.60,32.98,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Multiplan,Commercial,GP,31.96,,,,,,,8.84,32.98,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,inpatient,,,65.00000,39.52000,Multiplan,Commercial,GP,61.10,,,,,,,58.50,63.05,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Multiplan,Commercial,GP,61.10,,,,,,,16.90,63.05,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,inpatient,,,80.00000,48.64000,Multiplan,Commercial,GP,75.20,,,,,,,72.00,77.60,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Multiplan,Commercial,GP,75.20,,,,,,,20.80,77.60,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,inpatient,,,84.00000,51.07000,Multiplan,Commercial,GP,78.96,,,,,,,75.60,81.48,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Multiplan,Commercial,GP,78.96,,,,,,,21.84,81.48,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,inpatient,,,73.00000,44.38000,Multiplan,Commercial,GP,68.62,,,,,,,65.70,70.81,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Multiplan,Commercial,GP,68.62,,,,,,,18.98,70.81,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,inpatient,,,413.00000,251.10000,Multiplan,Commercial,"GP,50",388.22,,,,,,,371.70,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Multiplan,Commercial,"GP,50",388.22,,,,,,,107.38,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Multiplan,Commercial,"GP,LT",258.50,,,,,,,247.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Multiplan,Commercial,"GP,LT",258.50,,,,,,,71.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Multiplan,Commercial,"GP,RT",258.50,,,,,,,247.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Multiplan,Commercial,"GP,RT",258.50,,,,,,,71.50,266.75,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,inpatient,,,95.00000,57.76000,Multiplan,Commercial,GP,89.30,,,,,,,85.50,92.15,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Multiplan,Commercial,GP,89.30,,,,,,,24.70,92.15,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,inpatient,,,146.00000,88.77000,Multiplan,Commercial,GP,137.24,,,,,,,131.40,141.62,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Multiplan,Commercial,GP,137.24,,,,,,,37.96,141.62,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,inpatient,,,139.00000,84.51000,Multiplan,Commercial,GP,130.66,,,,,,,125.10,134.83,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Multiplan,Commercial,GP,130.66,,,,,,,36.14,134.83,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,inpatient,,,75.00000,45.60000,Multiplan,Commercial,GP,70.50,,,,,,,67.50,72.75,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Multiplan,Commercial,GP,70.50,,,,,,,19.50,72.75,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,inpatient,,,154.00000,93.63000,Multiplan,Commercial,GP,144.76,,,,,,,138.60,149.38,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Multiplan,Commercial,GP,144.76,,,,,,,40.04,149.38,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,inpatient,,,73.00000,44.38000,Multiplan,Commercial,GP,68.62,,,,,,,65.70,70.81,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Multiplan,Commercial,GP,68.62,,,,,,,18.98,70.81,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,inpatient,,,160.00000,97.28000,Multiplan,Commercial,GP,150.40,,,,,,,144.00,155.20,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Multiplan,Commercial,GP,150.40,,,,,,,41.60,155.20,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,inpatient,,,325.00000,197.60000,Multiplan,Commercial,GP,305.50,,,,,,,292.50,315.25,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Multiplan,Commercial,GP,305.50,,,,,,,84.50,315.25,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,inpatient,,,74.00000,44.99000,Multiplan,Commercial,GP,69.56,,,,,,,66.60,71.78,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Multiplan,Commercial,GP,69.56,,,,,,,19.24,71.78,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,inpatient,,,79.00000,48.03000,Multiplan,Commercial,GP,74.26,,,,,,,71.10,76.63,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Multiplan,Commercial,GP,74.26,,,,,,,20.54,76.63,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,inpatient,,,72.00000,43.78000,Multiplan,Commercial,GP,67.68,,,,,,,64.80,69.84,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Multiplan,Commercial,GP,67.68,,,,,,,18.72,69.84,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,inpatient,,,445.00000,262.55000,Multiplan,Commercial,GP,418.30,,,,,,,400.50,431.65,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,outpatient,,,445.00000,262.55000,Multiplan,Commercial,GP,418.30,,,,,,,115.70,431.65,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,inpatient,,,310.00000,182.90000,Multiplan,Commercial,GP,291.40,,,,,,,279.00,300.70,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,outpatient,,,310.00000,182.90000,Multiplan,Commercial,GP,291.40,,,,,,,80.60,300.70,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,inpatient,,,393.00000,231.87000,Multiplan,Commercial,GP,369.42,,,,,,,353.70,381.21,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,outpatient,,,393.00000,231.87000,Multiplan,Commercial,GP,369.42,,,,,,,102.18,381.21,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,inpatient,,,310.00000,182.90000,Multiplan,Commercial,GP,291.40,,,,,,,279.00,300.70,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,outpatient,,,310.00000,182.90000,Multiplan,Commercial,GP,291.40,,,,,,,80.60,300.70,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,inpatient,,,80.00000,30.96000,Multiplan,Commercial,GO,75.20,,,,,,,72.00,77.60,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Multiplan,Commercial,GO,75.20,,,,,,,20.80,77.60,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,inpatient,,,84.00000,32.51000,Multiplan,Commercial,GO,78.96,,,,,,,75.60,81.48,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Multiplan,Commercial,GO,78.96,,,,,,,21.84,81.48,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,inpatient,,,126.00000,48.76000,Multiplan,Commercial,GO,118.44,,,,,,,113.40,122.22,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Multiplan,Commercial,GO,118.44,,,,,,,32.76,122.22,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,inpatient,,,66.00000,25.54000,Multiplan,Commercial,GO,62.04,,,,,,,59.40,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Multiplan,Commercial,GO,62.04,,,,,,,17.16,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,inpatient,,,62.00000,23.99000,Multiplan,Commercial,GO,58.28,,,,,,,55.80,60.14,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Multiplan,Commercial,GO,58.28,,,,,,,16.12,60.14,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,inpatient,,,90.00000,34.83000,Multiplan,Commercial,GO,84.60,,,,,,,81.00,87.30,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Multiplan,Commercial,GO,84.60,,,,,,,23.40,87.30,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,inpatient,,,95.00000,36.76000,Multiplan,Commercial,GO,89.30,,,,,,,85.50,92.15,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Multiplan,Commercial,GO,89.30,,,,,,,24.70,92.15,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,inpatient,,,146.00000,56.50000,Multiplan,Commercial,GO,137.24,,,,,,,131.40,141.62,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Multiplan,Commercial,GO,137.24,,,,,,,37.96,141.62,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,inpatient,,,139.00000,53.79000,Multiplan,Commercial,GO,130.66,,,,,,,125.10,134.83,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Multiplan,Commercial,GO,130.66,,,,,,,36.14,134.83,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,inpatient,,,75.00000,29.02000,Multiplan,Commercial,GO,70.50,,,,,,,67.50,72.75,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Multiplan,Commercial,GO,70.50,,,,,,,19.50,72.75,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,inpatient,,,154.00000,59.60000,Multiplan,Commercial,GO,144.76,,,,,,,138.60,149.38,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Multiplan,Commercial,GO,144.76,,,,,,,40.04,149.38,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,inpatient,,,73.00000,28.25000,Multiplan,Commercial,GO,68.62,,,,,,,65.70,70.81,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Multiplan,Commercial,GO,68.62,,,,,,,18.98,70.81,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,inpatient,,,160.00000,61.92000,Multiplan,Commercial,GO,150.40,,,,,,,144.00,155.20,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Multiplan,Commercial,GO,150.40,,,,,,,41.60,155.20,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,inpatient,,,98.00000,37.93000,Multiplan,Commercial,GO,92.12,,,,,,,88.20,95.06,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,outpatient,,,98.00000,37.93000,Multiplan,Commercial,GO,92.12,,,,,,,25.48,95.06,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,inpatient,,,303.00000,117.26000,Multiplan,Commercial,GO,284.82,,,,,,,272.70,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,outpatient,,,303.00000,117.26000,Multiplan,Commercial,GO,284.82,,,,,,,78.78,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,inpatient,,,115.00000,44.50000,Multiplan,Commercial,GO,108.10,,,,,,,103.50,111.55,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,outpatient,,,115.00000,44.50000,Multiplan,Commercial,GO,108.10,,,,,,,29.90,111.55,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,inpatient,,,74.00000,28.64000,Multiplan,Commercial,GO,69.56,,,,,,,66.60,71.78,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Multiplan,Commercial,GO,69.56,,,,,,,19.24,71.78,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,inpatient,,,72.00000,27.86000,Multiplan,Commercial,GO,67.68,,,,,,,64.80,69.84,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Multiplan,Commercial,GO,67.68,,,,,,,18.72,69.84,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,inpatient,,,80.00000,30.96000,Multiplan,Commercial,"CO,GO",75.20,,,,,,,72.00,77.60,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Multiplan,Commercial,"CO,GO",75.20,,,,,,,20.80,77.60,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,inpatient,,,84.00000,32.51000,Multiplan,Commercial,"CO,GO",78.96,,,,,,,75.60,81.48,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Multiplan,Commercial,"CO,GO",78.96,,,,,,,21.84,81.48,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,inpatient,,,126.00000,48.76000,Multiplan,Commercial,"CO,GO",118.44,,,,,,,113.40,122.22,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Multiplan,Commercial,"CO,GO",118.44,,,,,,,32.76,122.22,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,inpatient,,,62.00000,23.99000,Multiplan,Commercial,"CO,GO",58.28,,,,,,,55.80,60.14,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Multiplan,Commercial,"CO,GO",58.28,,,,,,,16.12,60.14,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,inpatient,,,66.00000,25.54000,Multiplan,Commercial,"CO,GO",62.04,,,,,,,59.40,64.02,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Multiplan,Commercial,"CO,GO",62.04,,,,,,,17.16,64.02,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,inpatient,,,90.00000,34.83000,Multiplan,Commercial,"CO,GO",84.60,,,,,,,81.00,87.30,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Multiplan,Commercial,"CO,GO",84.60,,,,,,,23.40,87.30,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,inpatient,,,95.00000,36.76000,Multiplan,Commercial,"CO,GO",89.30,,,,,,,85.50,92.15,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Multiplan,Commercial,"CO,GO",89.30,,,,,,,24.70,92.15,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,inpatient,,,146.00000,56.50000,Multiplan,Commercial,"CO,GO",137.24,,,,,,,131.40,141.62,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Multiplan,Commercial,"CO,GO",137.24,,,,,,,37.96,141.62,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,inpatient,,,139.00000,53.79000,Multiplan,Commercial,"CO,GO",130.66,,,,,,,125.10,134.83,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Multiplan,Commercial,"CO,GO",130.66,,,,,,,36.14,134.83,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,inpatient,,,75.00000,29.02000,Multiplan,Commercial,"CO,GO",70.50,,,,,,,67.50,72.75,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Multiplan,Commercial,"CO,GO",70.50,,,,,,,19.50,72.75,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,inpatient,,,154.00000,59.60000,Multiplan,Commercial,"CO,GO",144.76,,,,,,,138.60,149.38,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Multiplan,Commercial,"CO,GO",144.76,,,,,,,40.04,149.38,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,inpatient,,,73.00000,28.25000,Multiplan,Commercial,"CO,GO",68.62,,,,,,,65.70,70.81,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Multiplan,Commercial,"CO,GO",68.62,,,,,,,18.98,70.81,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,inpatient,,,160.00000,61.92000,Multiplan,Commercial,"CO,GO",150.40,,,,,,,144.00,155.20,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Multiplan,Commercial,"CO,GO",150.40,,,,,,,41.60,155.20,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,inpatient,,,74.00000,28.64000,Multiplan,Commercial,"CO,GO",69.56,,,,,,,66.60,71.78,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Multiplan,Commercial,"CO,GO",69.56,,,,,,,19.24,71.78,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,inpatient,,,72.00000,27.86000,Multiplan,Commercial,"CO,GO",67.68,,,,,,,64.80,69.84,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Multiplan,Commercial,"CO,GO",67.68,,,,,,,18.72,69.84,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,inpatient,,,47.00000,26.70000,Multiplan,Commercial,GO,44.18,,,,,,,42.30,45.59,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Multiplan,Commercial,GO,44.18,,,,,,,12.22,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,inpatient,,,47.00000,26.70000,Multiplan,Commercial,"CO,GO",44.18,,,,,,,42.30,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Multiplan,Commercial,"CO,GO",44.18,,,,,,,12.22,45.59,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,inpatient,,,250.00000,142.04000,Multiplan,Commercial,GO,235.00,,,,,,,225.00,242.50,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,outpatient,,,250.00000,142.04000,Multiplan,Commercial,GO,235.00,,,,,,,65.00,242.50,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,inpatient,,,175.00000,99.43000,Multiplan,Commercial,GO,164.50,,,,,,,157.50,169.75,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,outpatient,,,175.00000,99.43000,Multiplan,Commercial,GO,164.50,,,,,,,45.50,169.75,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,inpatient,,,233.00000,132.38000,Multiplan,Commercial,GO,219.02,,,,,,,209.70,226.01,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,outpatient,,,233.00000,132.38000,Multiplan,Commercial,GO,219.02,,,,,,,60.58,226.01,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,inpatient,,,175.00000,99.43000,Multiplan,Commercial,GO,164.50,,,,,,,157.50,169.75,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,outpatient,,,175.00000,99.43000,Multiplan,Commercial,GO,164.50,,,,,,,45.50,169.75,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,inpatient,,,291.00000,93.99000,Multiplan,Commercial,,273.54,,,,,,,261.90,282.27,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,outpatient,,,291.00000,93.99000,Multiplan,Commercial,,273.54,,,,,,,75.66,282.27,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,inpatient,,,273.00000,155.10000,Multiplan,Commercial,GN,256.62,,,,,,,245.70,264.81,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,outpatient,,,273.00000,155.10000,Multiplan,Commercial,GN,256.62,,,,,,,70.98,264.81,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,inpatient,,,279.00000,158.51000,Multiplan,Commercial,GN,262.26,,,,,,,251.10,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,outpatient,,,279.00000,158.51000,Multiplan,Commercial,GN,262.26,,,,,,,72.54,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,inpatient,,,426.00000,242.03000,Multiplan,Commercial,GN,400.44,,,,,,,383.40,413.22,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,outpatient,,,426.00000,242.03000,Multiplan,Commercial,GN,400.44,,,,,,,110.76,413.22,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,inpatient,,,242.00000,137.49000,Multiplan,Commercial,GN,227.48,,,,,,,217.80,234.74,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,outpatient,,,242.00000,137.49000,Multiplan,Commercial,GN,227.48,,,,,,,62.92,234.74,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,inpatient,,,128.00000,72.72000,Multiplan,Commercial,,120.32,,,,,,,115.20,124.16,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,outpatient,,,128.00000,72.72000,Multiplan,Commercial,,120.32,,,,,,,33.28,124.16,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,inpatient,,,66.00000,37.50000,Multiplan,Commercial,GN,62.04,,,,,,,59.40,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,outpatient,,,66.00000,37.50000,Multiplan,Commercial,GN,62.04,,,,,,,17.16,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,inpatient,,,62.00000,35.23000,Multiplan,Commercial,GN,58.28,,,,,,,55.80,60.14,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,outpatient,,,62.00000,35.23000,Multiplan,Commercial,GN,58.28,,,,,,,16.12,60.14,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,inpatient,,,269.00000,152.83000,Multiplan,Commercial,GN,252.86,,,,,,,242.10,260.93,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,outpatient,,,269.00000,152.83000,Multiplan,Commercial,GN,252.86,,,,,,,69.94,260.93,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,inpatient,,,153.00000,86.93000,Multiplan,Commercial,GN,143.82,,,,,,,137.70,148.41,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,outpatient,,,153.00000,86.93000,Multiplan,Commercial,GN,143.82,,,,,,,39.78,148.41,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,inpatient,,,98.00000,55.68000,Multiplan,Commercial,GN,92.12,,,,,,,88.20,95.06,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,outpatient,,,98.00000,55.68000,Multiplan,Commercial,GN,92.12,,,,,,,25.48,95.06,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,inpatient,,,303.00000,172.15000,Multiplan,Commercial,GN,284.82,,,,,,,272.70,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,outpatient,,,303.00000,172.15000,Multiplan,Commercial,GN,284.82,,,,,,,78.78,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,inpatient,,,115.00000,65.34000,Multiplan,Commercial,GN,108.10,,,,,,,103.50,111.55,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,outpatient,,,115.00000,65.34000,Multiplan,Commercial,GN,108.10,,,,,,,29.90,111.55,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,inpatient,,,210.00000,119.31000,Multiplan,Commercial,GN,197.40,,,,,,,189.00,203.70,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,outpatient,,,210.00000,119.31000,Multiplan,Commercial,GN,197.40,,,,,,,54.60,203.70,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,inpatient,,,250.00000,142.04000,Multiplan,Commercial,GN,235.00,,,,,,,225.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,outpatient,,,250.00000,142.04000,Multiplan,Commercial,GN,235.00,,,,,,,65.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,inpatient,,,78.00000,44.32000,Multiplan,Commercial,GN,73.32,,,,,,,70.20,75.66,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,outpatient,,,78.00000,44.32000,Multiplan,Commercial,GN,73.32,,,,,,,20.28,75.66,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,inpatient,,,322.00000,182.94000,Multiplan,Commercial,GN,302.68,,,,,,,289.80,312.34,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,outpatient,,,322.00000,182.94000,Multiplan,Commercial,GN,302.68,,,,,,,83.72,312.34,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,inpatient,,,309.00000,175.56000,Multiplan,Commercial,GN,290.46,,,,,,,278.10,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,outpatient,,,309.00000,175.56000,Multiplan,Commercial,GN,290.46,,,,,,,80.34,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,inpatient,,,245.00000,139.20000,Multiplan,Commercial,GN,230.30,,,,,,,220.50,237.65,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,outpatient,,,245.00000,139.20000,Multiplan,Commercial,GN,230.30,,,,,,,63.70,237.65,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,inpatient,,,313.00000,116.44000,Multiplan,Commercial,,294.22,,,,,,,281.70,303.61,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,outpatient,,,313.00000,116.44000,Multiplan,Commercial,,294.22,,,,,,,81.38,303.61,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,inpatient,,,1250.00000,632.50000,Multiplan,Commercial,,1175.00,,,,,,,1125.00,1212.50,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,outpatient,,,1250.00000,632.50000,Multiplan,Commercial,,1175.00,,,,,,,325.00,1212.50,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,inpatient,,,145.00000,75.54000,Multiplan,Commercial,,136.30,,,,,,,130.50,140.65,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Multiplan,Commercial,,136.30,,,,,,,37.70,140.65,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,inpatient,,,488.00000,254.25000,Multiplan,Commercial,,458.72,,,,,,,439.20,473.36,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Multiplan,Commercial,,458.72,,,,,,,126.88,473.36,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,inpatient,,,684.00000,337.90000,Multiplan,Commercial,,642.96,,,,,,,615.60,663.48,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,outpatient,,,684.00000,337.90000,Multiplan,Commercial,,642.96,,,,,,,177.84,663.48,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,inpatient,,,206.00000,101.76000,Multiplan,Commercial,,193.64,,,,,,,185.40,199.82,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,outpatient,,,206.00000,101.76000,Multiplan,Commercial,,193.64,,,,,,,53.56,199.82,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,inpatient,,,195.00000,96.33000,Multiplan,Commercial,,183.30,,,,,,,175.50,189.15,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,outpatient,,,195.00000,96.33000,Multiplan,Commercial,,183.30,,,,,,,50.70,189.15,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,inpatient,,,375.00000,185.25000,Multiplan,Commercial,,352.50,,,,,,,337.50,363.75,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,outpatient,,,375.00000,185.25000,Multiplan,Commercial,,352.50,,,,,,,97.50,363.75,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,inpatient,,,429.00000,211.93000,Multiplan,Commercial,,403.26,,,,,,,386.10,416.13,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,outpatient,,,429.00000,211.93000,Multiplan,Commercial,,403.26,,,,,,,111.54,416.13,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22475,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Multiplan,Commercial,,2614.14,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B OBSTETRICS SEMI-PVT,42473,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Multiplan,Commercial,,2614.14,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ICU,32474,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Multiplan,Commercial,,8235.34,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,12476,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Multiplan,Commercial,,5490.54,,,,,,,2512.00,5665.77,percent of total billed charges,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,84.00000,63.59000,Multiplan,Commercial,,78.96,,,,,,,75.60,81.48,percent of total billed charges,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Multiplan,Commercial,,78.96,,,,,,,21.84,81.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Multiplan,Commercial,,266.96,,,,,,,255.60,275.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Multiplan,Commercial,,266.96,,,,,,,73.84,275.48,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Multiplan,Commercial,,430.52,,,,,,,412.20,444.26,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Multiplan,Commercial,,430.52,,,,,,,119.08,444.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Multiplan,Commercial,,524.52,,,,,,,502.20,541.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Multiplan,Commercial,,524.52,,,,,,,145.08,541.26,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Multiplan,Commercial,,453.08,,,,,,,433.80,467.54,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Multiplan,Commercial,,453.08,,,,,,,125.32,467.54,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Multiplan,Commercial,,222.78,,,,,,,213.30,229.89,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Multiplan,Commercial,,222.78,,,,,,,61.62,229.89,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,inpatient,,,490.00000,329.77000,Multiplan,Commercial,,460.60,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,outpatient,,,490.00000,329.77000,Multiplan,Commercial,,460.60,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,inpatient,,,490.00000,329.77000,Multiplan,Commercial,,460.60,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,outpatient,,,490.00000,329.77000,Multiplan,Commercial,,460.60,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,inpatient,,,245.00000,164.89000,Multiplan,Commercial,,230.30,,,,,,,220.50,237.65,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,outpatient,,,245.00000,164.89000,Multiplan,Commercial,,230.30,,,,,,,63.70,237.65,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,inpatient,,,490.00000,329.77000,Multiplan,Commercial,,460.60,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Multiplan,Commercial,,460.60,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Multiplan,Commercial,,460.60,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Multiplan,Commercial,,460.60,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,inpatient,,,245.00000,164.89000,Multiplan,Commercial,,230.30,,,,,,,220.50,237.65,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Multiplan,Commercial,,230.30,,,,,,,63.70,237.65,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Multiplan,Commercial,,791.48,,,,,,,757.80,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Multiplan,Commercial,,791.48,,,,,,,218.92,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Multiplan,Commercial,,989.82,,,,,,,947.70,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Multiplan,Commercial,,989.82,,,,,,,273.78,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Multiplan,Commercial,,1187.22,,,,,,,1136.70,1225.11,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Multiplan,Commercial,,1187.22,,,,,,,328.38,1225.11,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,inpatient,,,2466.00000,986.40000,Multiplan,Commercial,,2318.04,,,,,,,2219.40,2392.02,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,outpatient,,,2466.00000,986.40000,Multiplan,Commercial,,2318.04,,,,,,,641.16,2392.02,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,inpatient,,,260.00000,104.00000,Multiplan,Commercial,,244.40,,,,,,,234.00,252.20,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,outpatient,,,260.00000,104.00000,Multiplan,Commercial,,244.40,,,,,,,67.60,252.20,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,inpatient,,,2041.00000,816.40000,Multiplan,Commercial,,1918.54,,,,,,,1836.90,1979.77,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,outpatient,,,2041.00000,816.40000,Multiplan,Commercial,,1918.54,,,,,,,530.66,1979.77,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,inpatient,,,375.00000,150.00000,Multiplan,Commercial,,352.50,,,,,,,337.50,363.75,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,outpatient,,,375.00000,150.00000,Multiplan,Commercial,,352.50,,,,,,,97.50,363.75,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,inpatient,,,1178.00000,471.20000,Multiplan,Commercial,,1107.32,,,,,,,1060.20,1142.66,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,outpatient,,,1178.00000,471.20000,Multiplan,Commercial,,1107.32,,,,,,,306.28,1142.66,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,inpatient,,,245.00000,98.00000,Multiplan,Commercial,,230.30,,,,,,,220.50,237.65,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,outpatient,,,245.00000,98.00000,Multiplan,Commercial,,230.30,,,,,,,63.70,237.65,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,inpatient,,,280.00000,112.00000,Multiplan,Commercial,,263.20,,,,,,,252.00,271.60,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,outpatient,,,280.00000,112.00000,Multiplan,Commercial,,263.20,,,,,,,72.80,271.60,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,inpatient,,,336.00000,134.40000,Multiplan,Commercial,,315.84,,,,,,,302.40,325.92,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,outpatient,,,336.00000,134.40000,Multiplan,Commercial,,315.84,,,,,,,87.36,325.92,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,inpatient,,,380.00000,152.00000,Multiplan,Commercial,,357.20,,,,,,,342.00,368.60,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,outpatient,,,380.00000,152.00000,Multiplan,Commercial,,357.20,,,,,,,98.80,368.60,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,inpatient,,,530.00000,212.00000,Multiplan,Commercial,,498.20,,,,,,,477.00,514.10,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Multiplan,Commercial,,498.20,,,,,,,137.80,514.10,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,inpatient,,,264.00000,105.60000,Multiplan,Commercial,,248.16,,,,,,,237.60,256.08,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,outpatient,,,264.00000,105.60000,Multiplan,Commercial,,248.16,,,,,,,68.64,256.08,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,inpatient,,,763.00000,305.20000,Multiplan,Commercial,,717.22,,,,,,,686.70,740.11,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,outpatient,,,763.00000,305.20000,Multiplan,Commercial,,717.22,,,,,,,198.38,740.11,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,inpatient,,,672.00000,268.80000,Multiplan,Commercial,,631.68,,,,,,,604.80,651.84,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,outpatient,,,672.00000,268.80000,Multiplan,Commercial,,631.68,,,,,,,174.72,651.84,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,inpatient,,,1940.00000,776.00000,Multiplan,Commercial,,1823.60,,,,,,,1746.00,1881.80,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,outpatient,,,1940.00000,776.00000,Multiplan,Commercial,,1823.60,,,,,,,504.40,1881.80,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,inpatient,,,3875.00000,1550.00000,Multiplan,Commercial,,3642.50,,,,,,,3487.50,3758.75,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,outpatient,,,3875.00000,1550.00000,Multiplan,Commercial,,3642.50,,,,,,,1007.50,3758.75,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,inpatient,,,505.00000,202.00000,Multiplan,Commercial,,474.70,,,,,,,454.50,489.85,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,outpatient,,,505.00000,202.00000,Multiplan,Commercial,,474.70,,,,,,,131.30,489.85,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,inpatient,,,295.00000,118.00000,Multiplan,Commercial,,277.30,,,,,,,265.50,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Multiplan,Commercial,,277.30,,,,,,,76.70,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,inpatient,,,585.00000,234.00000,Multiplan,Commercial,,549.90,,,,,,,526.50,567.45,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,outpatient,,,585.00000,234.00000,Multiplan,Commercial,,549.90,,,,,,,152.10,567.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,inpatient,,,285.00000,114.00000,Multiplan,Commercial,,267.90,,,,,,,256.50,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,outpatient,,,285.00000,114.00000,Multiplan,Commercial,,267.90,,,,,,,74.10,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,inpatient,,,575.00000,230.00000,Multiplan,Commercial,,540.50,,,,,,,517.50,557.75,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,outpatient,,,575.00000,230.00000,Multiplan,Commercial,,540.50,,,,,,,149.50,557.75,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,inpatient,,,697.00000,278.80000,Multiplan,Commercial,,655.18,,,,,,,627.30,676.09,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,outpatient,,,697.00000,278.80000,Multiplan,Commercial,,655.18,,,,,,,181.22,676.09,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,inpatient,,,530.00000,212.00000,Multiplan,Commercial,,498.20,,,,,,,477.00,514.10,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Multiplan,Commercial,,498.20,,,,,,,137.80,514.10,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,inpatient,,,580.00000,232.00000,Multiplan,Commercial,,545.20,,,,,,,522.00,562.60,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,outpatient,,,580.00000,232.00000,Multiplan,Commercial,,545.20,,,,,,,150.80,562.60,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,inpatient,,,435.00000,174.00000,Multiplan,Commercial,,408.90,,,,,,,391.50,421.95,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,outpatient,,,435.00000,174.00000,Multiplan,Commercial,,408.90,,,,,,,113.10,421.95,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,inpatient,,,270.00000,108.00000,Multiplan,Commercial,,253.80,,,,,,,243.00,261.90,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,outpatient,,,270.00000,108.00000,Multiplan,Commercial,,253.80,,,,,,,70.20,261.90,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,inpatient,,,504.00000,201.60000,Multiplan,Commercial,,473.76,,,,,,,453.60,488.88,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,outpatient,,,504.00000,201.60000,Multiplan,Commercial,,473.76,,,,,,,131.04,488.88,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,inpatient,,,98.00000,39.20000,Multiplan,Commercial,,92.12,,,,,,,88.20,95.06,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,outpatient,,,98.00000,39.20000,Multiplan,Commercial,,92.12,,,,,,,25.48,95.06,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,inpatient,,,608.00000,243.20000,Multiplan,Commercial,,571.52,,,,,,,547.20,589.76,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,outpatient,,,608.00000,243.20000,Multiplan,Commercial,,571.52,,,,,,,158.08,589.76,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,inpatient,,,114.00000,45.60000,Multiplan,Commercial,,107.16,,,,,,,102.60,110.58,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,outpatient,,,114.00000,45.60000,Multiplan,Commercial,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,inpatient,,,187.00000,74.80000,Multiplan,Commercial,,175.78,,,,,,,168.30,181.39,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,outpatient,,,187.00000,74.80000,Multiplan,Commercial,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,inpatient,,,214.00000,85.60000,Multiplan,Commercial,,201.16,,,,,,,192.60,207.58,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,outpatient,,,214.00000,85.60000,Multiplan,Commercial,,201.16,,,,,,,55.64,207.58,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,inpatient,,,863.00000,345.20000,Multiplan,Commercial,,811.22,,,,,,,776.70,837.11,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,outpatient,,,863.00000,345.20000,Multiplan,Commercial,,811.22,,,,,,,224.38,837.11,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,inpatient,,,453.00000,181.20000,Multiplan,Commercial,,425.82,,,,,,,407.70,439.41,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,outpatient,,,453.00000,181.20000,Multiplan,Commercial,,425.82,,,,,,,117.78,439.41,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,inpatient,,,144.00000,57.60000,Multiplan,Commercial,,135.36,,,,,,,129.60,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,outpatient,,,144.00000,57.60000,Multiplan,Commercial,,135.36,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,inpatient,,,107.00000,42.80000,Multiplan,Commercial,,100.58,,,,,,,96.30,103.79,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,outpatient,,,107.00000,42.80000,Multiplan,Commercial,,100.58,,,,,,,27.82,103.79,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,inpatient,,,403.00000,161.20000,Multiplan,Commercial,,378.82,,,,,,,362.70,390.91,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,outpatient,,,403.00000,161.20000,Multiplan,Commercial,,378.82,,,,,,,104.78,390.91,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,inpatient,,,144.00000,57.60000,Multiplan,Commercial,,135.36,,,,,,,129.60,139.68,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,outpatient,,,144.00000,57.60000,Multiplan,Commercial,,135.36,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,inpatient,,,370.00000,148.00000,Multiplan,Commercial,,347.80,,,,,,,333.00,358.90,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,outpatient,,,370.00000,148.00000,Multiplan,Commercial,,347.80,,,,,,,96.20,358.90,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,inpatient,,,334.00000,133.60000,Multiplan,Commercial,,313.96,,,,,,,300.60,323.98,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,outpatient,,,334.00000,133.60000,Multiplan,Commercial,,313.96,,,,,,,86.84,323.98,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,inpatient,,,1188.00000,475.20000,Multiplan,Commercial,50,1116.72,,,,,,,1069.20,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,outpatient,,,1188.00000,475.20000,Multiplan,Commercial,50,1116.72,,,,,,,308.88,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,inpatient,,,792.00000,316.80000,Multiplan,Commercial,LT,744.48,,,,,,,712.80,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Multiplan,Commercial,LT,744.48,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,inpatient,,,792.00000,316.80000,Multiplan,Commercial,RT,744.48,,,,,,,712.80,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Multiplan,Commercial,RT,744.48,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,inpatient,,,572.00000,228.80000,Multiplan,Commercial,50,537.68,,,,,,,514.80,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,outpatient,,,572.00000,228.80000,Multiplan,Commercial,50,537.68,,,,,,,148.72,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,inpatient,,,381.00000,152.40000,Multiplan,Commercial,LT,358.14,,,,,,,342.90,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Multiplan,Commercial,LT,358.14,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,inpatient,,,381.00000,152.40000,Multiplan,Commercial,RT,358.14,,,,,,,342.90,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Multiplan,Commercial,RT,358.14,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,inpatient,,,683.00000,273.20000,Multiplan,Commercial,50,642.02,,,,,,,614.70,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,outpatient,,,683.00000,273.20000,Multiplan,Commercial,50,642.02,,,,,,,177.58,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,inpatient,,,455.00000,182.00000,Multiplan,Commercial,LT,427.70,,,,,,,409.50,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Multiplan,Commercial,LT,427.70,,,,,,,118.30,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,inpatient,,,455.00000,182.00000,Multiplan,Commercial,RT,427.70,,,,,,,409.50,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Multiplan,Commercial,RT,427.70,,,,,,,118.30,441.35,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,inpatient,,,357.00000,142.80000,Multiplan,Commercial,,335.58,,,,,,,321.30,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,outpatient,,,357.00000,142.80000,Multiplan,Commercial,,335.58,,,,,,,92.82,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,inpatient,,,334.00000,133.60000,Multiplan,Commercial,,313.96,,,,,,,300.60,323.98,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,outpatient,,,334.00000,133.60000,Multiplan,Commercial,,313.96,,,,,,,86.84,323.98,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,inpatient,,,194.00000,77.60000,Multiplan,Commercial,,182.36,,,,,,,174.60,188.18,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,outpatient,,,194.00000,77.60000,Multiplan,Commercial,,182.36,,,,,,,50.44,188.18,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,inpatient,,,608.00000,243.20000,Multiplan,Commercial,,571.52,,,,,,,547.20,589.76,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,outpatient,,,608.00000,243.20000,Multiplan,Commercial,,571.52,,,,,,,158.08,589.76,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,inpatient,,,257.00000,102.80000,Multiplan,Commercial,,241.58,,,,,,,231.30,249.29,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,outpatient,,,257.00000,102.80000,Multiplan,Commercial,,241.58,,,,,,,66.82,249.29,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,inpatient,,,343.00000,137.20000,Multiplan,Commercial,,322.42,,,,,,,308.70,332.71,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,outpatient,,,343.00000,137.20000,Multiplan,Commercial,,322.42,,,,,,,89.18,332.71,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,inpatient,,,457.00000,182.80000,Multiplan,Commercial,,429.58,,,,,,,411.30,443.29,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,outpatient,,,457.00000,182.80000,Multiplan,Commercial,,429.58,,,,,,,118.82,443.29,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,inpatient,,,630.00000,252.00000,Multiplan,Commercial,,592.20,,,,,,,567.00,611.10,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,outpatient,,,630.00000,252.00000,Multiplan,Commercial,,592.20,,,,,,,163.80,611.10,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,inpatient,,,623.00000,249.20000,Multiplan,Commercial,,585.62,,,,,,,560.70,604.31,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,outpatient,,,623.00000,249.20000,Multiplan,Commercial,,585.62,,,,,,,161.98,604.31,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,inpatient,,,1457.00000,582.80000,Multiplan,Commercial,,1369.58,,,,,,,1311.30,1413.29,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,outpatient,,,1457.00000,582.80000,Multiplan,Commercial,,1369.58,,,,,,,378.82,1413.29,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,inpatient,,,890.00000,356.00000,Multiplan,Commercial,,836.60,,,,,,,801.00,863.30,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,outpatient,,,890.00000,356.00000,Multiplan,Commercial,,836.60,,,,,,,231.40,863.30,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,inpatient,,,532.00000,212.80000,Multiplan,Commercial,,500.08,,,,,,,478.80,516.04,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,outpatient,,,532.00000,212.80000,Multiplan,Commercial,,500.08,,,,,,,138.32,516.04,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,inpatient,,,492.00000,196.80000,Multiplan,Commercial,,462.48,,,,,,,442.80,477.24,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,outpatient,,,492.00000,196.80000,Multiplan,Commercial,,462.48,,,,,,,127.92,477.24,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,inpatient,,,550.00000,220.00000,Multiplan,Commercial,,517.00,,,,,,,495.00,533.50,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,outpatient,,,550.00000,220.00000,Multiplan,Commercial,,517.00,,,,,,,143.00,533.50,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,inpatient,,,305.00000,122.00000,Multiplan,Commercial,,286.70,,,,,,,274.50,295.85,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,outpatient,,,305.00000,122.00000,Multiplan,Commercial,,286.70,,,,,,,79.30,295.85,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,inpatient,,,220.00000,88.00000,Multiplan,Commercial,,206.80,,,,,,,198.00,213.40,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,outpatient,,,220.00000,88.00000,Multiplan,Commercial,,206.80,,,,,,,57.20,213.40,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,inpatient,,,780.00000,312.00000,Multiplan,Commercial,,733.20,,,,,,,702.00,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,outpatient,,,780.00000,312.00000,Multiplan,Commercial,,733.20,,,,,,,202.80,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,inpatient,,,1165.00000,466.00000,Multiplan,Commercial,,1095.10,,,,,,,1048.50,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,outpatient,,,1165.00000,466.00000,Multiplan,Commercial,,1095.10,,,,,,,302.90,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,inpatient,,,2350.00000,940.00000,Multiplan,Commercial,,2209.00,,,,,,,2115.00,2279.50,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,outpatient,,,2350.00000,940.00000,Multiplan,Commercial,,2209.00,,,,,,,611.00,2279.50,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,inpatient,,,896.00000,358.40000,Multiplan,Commercial,,842.24,,,,,,,806.40,869.12,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,outpatient,,,896.00000,358.40000,Multiplan,Commercial,,842.24,,,,,,,232.96,869.12,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,inpatient,,,385.00000,154.00000,Multiplan,Commercial,,361.90,,,,,,,346.50,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,outpatient,,,385.00000,154.00000,Multiplan,Commercial,,361.90,,,,,,,100.10,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,inpatient,,,470.00000,188.00000,Multiplan,Commercial,,441.80,,,,,,,423.00,455.90,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,outpatient,,,470.00000,188.00000,Multiplan,Commercial,,441.80,,,,,,,122.20,455.90,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,inpatient,,,150.00000,60.00000,Multiplan,Commercial,,141.00,,,,,,,135.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,outpatient,,,150.00000,60.00000,Multiplan,Commercial,,141.00,,,,,,,39.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,inpatient,,,100.00000,40.00000,Multiplan,Commercial,,94.00,,,,,,,90.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,outpatient,,,100.00000,40.00000,Multiplan,Commercial,,94.00,,,,,,,26.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,inpatient,,,143.00000,57.20000,Multiplan,Commercial,,134.42,,,,,,,128.70,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,outpatient,,,143.00000,57.20000,Multiplan,Commercial,,134.42,,,,,,,37.18,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,inpatient,,,95.00000,38.00000,Multiplan,Commercial,,89.30,,,,,,,85.50,92.15,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,outpatient,,,95.00000,38.00000,Multiplan,Commercial,,89.30,,,,,,,24.70,92.15,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,inpatient,,,269.00000,107.60000,Multiplan,Commercial,,252.86,,,,,,,242.10,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,outpatient,,,269.00000,107.60000,Multiplan,Commercial,,252.86,,,,,,,69.94,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,inpatient,,,388.00000,155.20000,Multiplan,Commercial,,364.72,,,,,,,349.20,376.36,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,outpatient,,,388.00000,155.20000,Multiplan,Commercial,,364.72,,,,,,,100.88,376.36,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,inpatient,,,344.00000,137.60000,Multiplan,Commercial,,323.36,,,,,,,309.60,333.68,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,outpatient,,,344.00000,137.60000,Multiplan,Commercial,,323.36,,,,,,,89.44,333.68,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,inpatient,,,321.00000,128.40000,Multiplan,Commercial,,301.74,,,,,,,288.90,311.37,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,outpatient,,,321.00000,128.40000,Multiplan,Commercial,,301.74,,,,,,,83.46,311.37,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,inpatient,,,155.00000,62.00000,Multiplan,Commercial,,145.70,,,,,,,139.50,150.35,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,outpatient,,,155.00000,62.00000,Multiplan,Commercial,,145.70,,,,,,,40.30,150.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,inpatient,,,817.00000,326.80000,Multiplan,Commercial,,767.98,,,,,,,735.30,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,outpatient,,,817.00000,326.80000,Multiplan,Commercial,,767.98,,,,,,,212.42,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,inpatient,,,1255.00000,502.00000,Multiplan,Commercial,,1179.70,,,,,,,1129.50,1217.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,outpatient,,,1255.00000,502.00000,Multiplan,Commercial,,1179.70,,,,,,,326.30,1217.35,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,inpatient,,,391.00000,156.40000,Multiplan,Commercial,,367.54,,,,,,,351.90,379.27,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,outpatient,,,391.00000,156.40000,Multiplan,Commercial,,367.54,,,,,,,101.66,379.27,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,inpatient,,,671.00000,268.40000,Multiplan,Commercial,,630.74,,,,,,,603.90,650.87,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,outpatient,,,671.00000,268.40000,Multiplan,Commercial,,630.74,,,,,,,174.46,650.87,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,inpatient,,,456.00000,182.40000,Multiplan,Commercial,,428.64,,,,,,,410.40,442.32,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,outpatient,,,456.00000,182.40000,Multiplan,Commercial,,428.64,,,,,,,118.56,442.32,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,inpatient,,,112.00000,44.80000,Multiplan,Commercial,,105.28,,,,,,,100.80,108.64,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,outpatient,,,112.00000,44.80000,Multiplan,Commercial,,105.28,,,,,,,29.12,108.64,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,inpatient,,,84.00000,33.60000,Multiplan,Commercial,,78.96,,,,,,,75.60,81.48,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,outpatient,,,84.00000,33.60000,Multiplan,Commercial,,78.96,,,,,,,21.84,81.48,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,inpatient,,,216.00000,86.40000,Multiplan,Commercial,,203.04,,,,,,,194.40,209.52,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,outpatient,,,216.00000,86.40000,Multiplan,Commercial,,203.04,,,,,,,56.16,209.52,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,inpatient,,,2660.00000,1064.00000,Multiplan,Commercial,,2500.40,,,,,,,2394.00,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,outpatient,,,2660.00000,1064.00000,Multiplan,Commercial,,2500.40,,,,,,,691.60,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,inpatient,,,2960.00000,1184.00000,Multiplan,Commercial,,2782.40,,,,,,,2664.00,2871.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,outpatient,,,2960.00000,1184.00000,Multiplan,Commercial,,2782.40,,,,,,,769.60,2871.20,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,inpatient,,,3225.00000,1290.00000,Multiplan,Commercial,,3031.50,,,,,,,2902.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,outpatient,,,3225.00000,1290.00000,Multiplan,Commercial,,3031.50,,,,,,,838.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,inpatient,,,3395.00000,1358.00000,Multiplan,Commercial,,3191.30,,,,,,,3055.50,3293.15,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,outpatient,,,3395.00000,1358.00000,Multiplan,Commercial,,3191.30,,,,,,,882.70,3293.15,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,inpatient,,,490.00000,196.00000,Multiplan,Commercial,,460.60,,,,,,,441.00,475.30,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,outpatient,,,490.00000,196.00000,Multiplan,Commercial,,460.60,,,,,,,127.40,475.30,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,inpatient,,,520.00000,208.00000,Multiplan,Commercial,,488.80,,,,,,,468.00,504.40,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,outpatient,,,520.00000,208.00000,Multiplan,Commercial,,488.80,,,,,,,135.20,504.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,inpatient,,,720.00000,288.00000,Multiplan,Commercial,,676.80,,,,,,,648.00,698.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,outpatient,,,720.00000,288.00000,Multiplan,Commercial,,676.80,,,,,,,187.20,698.40,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,inpatient,,,215.00000,86.00000,Multiplan,Commercial,,202.10,,,,,,,193.50,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,outpatient,,,215.00000,86.00000,Multiplan,Commercial,,202.10,,,,,,,55.90,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,inpatient,,,240.00000,96.00000,Multiplan,Commercial,,225.60,,,,,,,216.00,232.80,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,outpatient,,,240.00000,96.00000,Multiplan,Commercial,,225.60,,,,,,,62.40,232.80,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,inpatient,,,1241.00000,496.40000,Multiplan,Commercial,,1166.54,,,,,,,1116.90,1203.77,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,outpatient,,,1241.00000,496.40000,Multiplan,Commercial,,1166.54,,,,,,,322.66,1203.77,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,inpatient,,,850.00000,340.00000,Multiplan,Commercial,,799.00,,,,,,,765.00,824.50,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,outpatient,,,850.00000,340.00000,Multiplan,Commercial,,799.00,,,,,,,221.00,824.50,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,inpatient,,,1085.00000,434.00000,Multiplan,Commercial,,1019.90,,,,,,,976.50,1052.45,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,outpatient,,,1085.00000,434.00000,Multiplan,Commercial,,1019.90,,,,,,,282.10,1052.45,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,inpatient,,,295.00000,118.00000,Multiplan,Commercial,,277.30,,,,,,,265.50,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Multiplan,Commercial,,277.30,,,,,,,76.70,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,inpatient,,,492.00000,196.80000,Multiplan,Commercial,,462.48,,,,,,,442.80,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,outpatient,,,492.00000,196.80000,Multiplan,Commercial,,462.48,,,,,,,127.92,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,inpatient,,,563.00000,225.20000,Multiplan,Commercial,,529.22,,,,,,,506.70,546.11,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,outpatient,,,563.00000,225.20000,Multiplan,Commercial,,529.22,,,,,,,146.38,546.11,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,inpatient,,,1612.00000,644.80000,Multiplan,Commercial,,1515.28,,,,,,,1450.80,1563.64,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,outpatient,,,1612.00000,644.80000,Multiplan,Commercial,,1515.28,,,,,,,419.12,1563.64,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,inpatient,,,1366.00000,546.40000,Multiplan,Commercial,,1284.04,,,,,,,1229.40,1325.02,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,outpatient,,,1366.00000,546.40000,Multiplan,Commercial,,1284.04,,,,,,,355.16,1325.02,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,inpatient,,,1911.00000,764.40000,Multiplan,Commercial,,1796.34,,,,,,,1719.90,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,outpatient,,,1911.00000,764.40000,Multiplan,Commercial,,1796.34,,,,,,,496.86,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,inpatient,,,956.00000,382.40000,Multiplan,Commercial,,898.64,,,,,,,860.40,927.32,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,outpatient,,,956.00000,382.40000,Multiplan,Commercial,,898.64,,,,,,,248.56,927.32,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,inpatient,,,189.00000,123.20000,Multiplan,Commercial,,177.66,,,,,,,170.10,183.33,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,outpatient,,,189.00000,123.20000,Multiplan,Commercial,,177.66,,,,,,,49.14,183.33,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,inpatient,,,352.00000,256.87000,Multiplan,Commercial,,330.88,,,,,,,316.80,341.44,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,outpatient,,,352.00000,256.87000,Multiplan,Commercial,,330.88,,,,,,,91.52,341.44,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,inpatient,,,625.00000,738.40000,Multiplan,Commercial,,587.50,,,,,,,562.50,606.25,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,outpatient,,,625.00000,738.40000,Multiplan,Commercial,,587.50,,,,,,,162.50,606.25,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,inpatient,,,1024.00000,2097.47000,Multiplan,Commercial,,962.56,,,,,,,921.60,993.28,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1024.00000,2097.47000,Multiplan,Commercial,,962.56,,,,,,,266.24,993.28,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,inpatient,,,1455.00000,2469.72000,Multiplan,Commercial,,1367.70,,,,,,,1309.50,1411.35,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,outpatient,,,1455.00000,2469.72000,Multiplan,Commercial,,1367.70,,,,,,,378.30,1411.35,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,inpatient,,,145.00000,75.54000,Multiplan,Commercial,,136.30,,,,,,,130.50,140.65,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Multiplan,Commercial,,136.30,,,,,,,37.70,140.65,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,inpatient,,,488.00000,254.25000,Multiplan,Commercial,,458.72,,,,,,,439.20,473.36,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Multiplan,Commercial,,458.72,,,,,,,126.88,473.36,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Multiplan,Commercial,,109.04,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Multiplan,Commercial,,109.04,,,,,,,30.16,112.52,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Multiplan,Commercial,,76.14,,,,,,,72.90,78.57,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Multiplan,Commercial,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Multiplan,Commercial,,38.54,,,,,,,36.90,39.77,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Multiplan,Commercial,,38.54,,,,,,,10.66,39.77,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,inpatient,,,170.00000,73.95000,Multiplan,Commercial,,159.80,,,,,,,153.00,164.90,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,outpatient,,,170.00000,73.95000,Multiplan,Commercial,,159.80,,,,,,,44.20,164.90,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,2.70000,1.17000,Multiplan,Commercial,,2.54,,,,,,,2.43,2.62,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,2.70000,1.17000,Multiplan,Commercial,,2.54,,,,,,,0.70200,2.62,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,27.00000,11.74000,Multiplan,Commercial,,25.38,,,,,,,24.30,26.19,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,27.00000,11.74000,Multiplan,Commercial,,25.38,,,,,,,7.02,26.19,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,inpatient,,,20440.00000,8891.40000,Multiplan,Commercial,,19213.60,,,,,,,18396.00,19826.80,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,outpatient,,,20440.00000,8891.40000,Multiplan,Commercial,,19213.60,,,,,,,5314.40,19826.80,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,inpatient,,,3322.00000,1445.07000,Multiplan,Commercial,,3122.68,,,,,,,2989.80,3222.34,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,3322.00000,1445.07000,Multiplan,Commercial,,3122.68,,,,,,,863.72,3222.34,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,inpatient,,,2492.00000,1084.02000,Multiplan,Commercial,,2342.48,,,,,,,2242.80,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,2492.00000,1084.02000,Multiplan,Commercial,,2342.48,,,,,,,647.92,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,inpatient,,,1814.00000,789.09000,Multiplan,Commercial,,1705.16,,,,,,,1632.60,1759.58,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1814.00000,789.09000,Multiplan,Commercial,,1705.16,,,,,,,471.64,1759.58,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,inpatient,,,2153.00000,936.56000,Multiplan,Commercial,,2023.82,,,,,,,1937.70,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,2153.00000,936.56000,Multiplan,Commercial,,2023.82,,,,,,,559.78,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,inpatient,,,1525.00000,663.38000,Multiplan,Commercial,,1433.50,,,,,,,1372.50,1479.25,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1525.00000,663.38000,Multiplan,Commercial,,1433.50,,,,,,,396.50,1479.25,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,inpatient,,,2716.00000,1181.46000,Multiplan,Commercial,,2553.04,,,,,,,2444.40,2634.52,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2716.00000,1181.46000,Multiplan,Commercial,,2553.04,,,,,,,706.16,2634.52,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,inpatient,,,2.70000,0.39000,Multiplan,Commercial,,2.54,,,,,,,2.43,2.62,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,outpatient,,,2.70000,0.39000,Multiplan,Commercial,,2.54,,,,,,,0.70200,2.62,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,inpatient,,,222.00000,32.41000,Multiplan,Commercial,,208.68,,,,,,,199.80,215.34,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,outpatient,,,222.00000,32.41000,Multiplan,Commercial,,208.68,,,,,,,57.72,215.34,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,inpatient,,,211.00000,113.10000,Multiplan,Commercial,,198.34,,,,,,,189.90,204.67,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,outpatient,,,211.00000,113.10000,Multiplan,Commercial,,198.34,,,,,,,54.86,204.67,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,inpatient,,,497.00000,266.39000,Multiplan,Commercial,,467.18,,,,,,,447.30,482.09,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,outpatient,,,497.00000,266.39000,Multiplan,Commercial,,467.18,,,,,,,129.22,482.09,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,inpatient,,,296.00000,158.66000,Multiplan,Commercial,,278.24,,,,,,,266.40,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,outpatient,,,296.00000,158.66000,Multiplan,Commercial,,278.24,,,,,,,76.96,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,inpatient,,,723.00000,387.53000,Multiplan,Commercial,,679.62,,,,,,,650.70,701.31,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,outpatient,,,723.00000,387.53000,Multiplan,Commercial,,679.62,,,,,,,187.98,701.31,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,inpatient,,,326.00000,174.74000,Multiplan,Commercial,,306.44,,,,,,,293.40,316.22,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,outpatient,,,326.00000,174.74000,Multiplan,Commercial,,306.44,,,,,,,84.76,316.22,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,inpatient,,,532.00000,285.15000,Multiplan,Commercial,,500.08,,,,,,,478.80,516.04,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,outpatient,,,532.00000,285.15000,Multiplan,Commercial,,500.08,,,,,,,138.32,516.04,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,inpatient,,,635.00000,340.36000,Multiplan,Commercial,,596.90,,,,,,,571.50,615.95,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,outpatient,,,635.00000,340.36000,Multiplan,Commercial,,596.90,,,,,,,165.10,615.95,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,inpatient,,,639.00000,342.50000,Multiplan,Commercial,,600.66,,,,,,,575.10,619.83,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,outpatient,,,639.00000,342.50000,Multiplan,Commercial,,600.66,,,,,,,166.14,619.83,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,inpatient,,,780.00000,418.08000,Multiplan,Commercial,,733.20,,,,,,,702.00,756.60,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,outpatient,,,780.00000,418.08000,Multiplan,Commercial,,733.20,,,,,,,202.80,756.60,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,inpatient,,,390.00000,209.04000,Multiplan,Commercial,,366.60,,,,,,,351.00,378.30,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,outpatient,,,390.00000,209.04000,Multiplan,Commercial,,366.60,,,,,,,101.40,378.30,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,inpatient,,,731.00000,391.82000,Multiplan,Commercial,,687.14,,,,,,,657.90,709.07,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,outpatient,,,731.00000,391.82000,Multiplan,Commercial,,687.14,,,,,,,190.06,709.07,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,inpatient,,,585.00000,313.56000,Multiplan,Commercial,,549.90,,,,,,,526.50,567.45,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,outpatient,,,585.00000,313.56000,Multiplan,Commercial,,549.90,,,,,,,152.10,567.45,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,inpatient,,,365.00000,195.64000,Multiplan,Commercial,,343.10,,,,,,,328.50,354.05,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,outpatient,,,365.00000,195.64000,Multiplan,Commercial,,343.10,,,,,,,94.90,354.05,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,inpatient,,,1086.00000,582.10000,Multiplan,Commercial,,1020.84,,,,,,,977.40,1053.42,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,outpatient,,,1086.00000,582.10000,Multiplan,Commercial,,1020.84,,,,,,,282.36,1053.42,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,inpatient,,,197.00000,105.59000,Multiplan,Commercial,,185.18,,,,,,,177.30,191.09,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,outpatient,,,197.00000,105.59000,Multiplan,Commercial,,185.18,,,,,,,51.22,191.09,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,inpatient,,,2774.00000,1486.86000,Multiplan,Commercial,,2607.56,,,,,,,2496.60,2690.78,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,outpatient,,,2774.00000,1486.86000,Multiplan,Commercial,,2607.56,,,,,,,721.24,2690.78,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,inpatient,,,1456.00000,780.42000,Multiplan,Commercial,,1368.64,,,,,,,1310.40,1412.32,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,outpatient,,,1456.00000,780.42000,Multiplan,Commercial,,1368.64,,,,,,,378.56,1412.32,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,inpatient,,,2647.00000,1418.79000,Multiplan,Commercial,,2488.18,,,,,,,2382.30,2567.59,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,outpatient,,,2647.00000,1418.79000,Multiplan,Commercial,,2488.18,,,,,,,688.22,2567.59,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,inpatient,,,1359.00000,728.42000,Multiplan,Commercial,,1277.46,,,,,,,1223.10,1318.23,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,outpatient,,,1359.00000,728.42000,Multiplan,Commercial,,1277.46,,,,,,,353.34,1318.23,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,inpatient,,,273.00000,146.33000,Multiplan,Commercial,,256.62,,,,,,,245.70,264.81,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,outpatient,,,273.00000,146.33000,Multiplan,Commercial,,256.62,,,,,,,70.98,264.81,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,inpatient,,,325.00000,174.20000,Multiplan,Commercial,,305.50,,,,,,,292.50,315.25,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,outpatient,,,325.00000,174.20000,Multiplan,Commercial,,305.50,,,,,,,84.50,315.25,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,inpatient,,,609.00000,326.42000,Multiplan,Commercial,,572.46,,,,,,,548.10,590.73,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Multiplan,Commercial,,572.46,,,,,,,158.34,590.73,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,inpatient,,,491.00000,263.18000,Multiplan,Commercial,,461.54,,,,,,,441.90,476.27,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,outpatient,,,491.00000,263.18000,Multiplan,Commercial,,461.54,,,,,,,127.66,476.27,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,inpatient,,,561.00000,300.70000,Multiplan,Commercial,,527.34,,,,,,,504.90,544.17,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,outpatient,,,561.00000,300.70000,Multiplan,Commercial,,527.34,,,,,,,145.86,544.17,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,inpatient,,,845.00000,452.92000,Multiplan,Commercial,,794.30,,,,,,,760.50,819.65,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,outpatient,,,845.00000,452.92000,Multiplan,Commercial,,794.30,,,,,,,219.70,819.65,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,inpatient,,,612.00000,328.03000,Multiplan,Commercial,,575.28,,,,,,,550.80,593.64,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,outpatient,,,612.00000,328.03000,Multiplan,Commercial,,575.28,,,,,,,159.12,593.64,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,inpatient,,,536.00000,287.30000,Multiplan,Commercial,,503.84,,,,,,,482.40,519.92,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,outpatient,,,536.00000,287.30000,Multiplan,Commercial,,503.84,,,,,,,139.36,519.92,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,inpatient,,,1225.00000,656.60000,Multiplan,Commercial,,1151.50,,,,,,,1102.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,outpatient,,,1225.00000,656.60000,Multiplan,Commercial,,1151.50,,,,,,,318.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,inpatient,,,816.00000,437.38000,Multiplan,Commercial,LT,767.04,,,,,,,734.40,791.52,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Multiplan,Commercial,LT,767.04,,,,,,,212.16,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,inpatient,,,816.00000,437.38000,Multiplan,Commercial,RT,767.04,,,,,,,734.40,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Multiplan,Commercial,RT,767.04,,,,,,,212.16,791.52,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,inpatient,,,250.00000,134.00000,Multiplan,Commercial,,235.00,,,,,,,225.00,242.50,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,outpatient,,,250.00000,134.00000,Multiplan,Commercial,,235.00,,,,,,,65.00,242.50,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,inpatient,,,302.00000,161.87000,Multiplan,Commercial,,283.88,,,,,,,271.80,292.94,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,outpatient,,,302.00000,161.87000,Multiplan,Commercial,,283.88,,,,,,,78.52,292.94,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,inpatient,,,354.00000,189.74000,Multiplan,Commercial,,332.76,,,,,,,318.60,343.38,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,outpatient,,,354.00000,189.74000,Multiplan,Commercial,,332.76,,,,,,,92.04,343.38,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,inpatient,,,409.00000,219.22000,Multiplan,Commercial,,384.46,,,,,,,368.10,396.73,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,outpatient,,,409.00000,219.22000,Multiplan,Commercial,,384.46,,,,,,,106.34,396.73,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,inpatient,,,593.00000,317.85000,Multiplan,Commercial,,557.42,,,,,,,533.70,575.21,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,outpatient,,,593.00000,317.85000,Multiplan,Commercial,,557.42,,,,,,,154.18,575.21,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Multiplan,Commercial,LT,288.58,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Multiplan,Commercial,LT,288.58,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Multiplan,Commercial,"52,LT",288.58,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Multiplan,Commercial,"52,LT",288.58,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Multiplan,Commercial,RT,288.58,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Multiplan,Commercial,RT,288.58,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Multiplan,Commercial,"52,RT",288.58,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Multiplan,Commercial,"52,RT",288.58,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,inpatient,,,330.00000,176.88000,Multiplan,Commercial,LT,310.20,,,,,,,297.00,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Multiplan,Commercial,LT,310.20,,,,,,,85.80,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,inpatient,,,330.00000,176.88000,Multiplan,Commercial,RT,310.20,,,,,,,297.00,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Multiplan,Commercial,RT,310.20,,,,,,,85.80,320.10,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,inpatient,,,195.00000,104.52000,Multiplan,Commercial,,183.30,,,,,,,175.50,189.15,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,outpatient,,,195.00000,104.52000,Multiplan,Commercial,,183.30,,,,,,,50.70,189.15,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,inpatient,,,578.00000,309.81000,Multiplan,Commercial,,543.32,,,,,,,520.20,560.66,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,outpatient,,,578.00000,309.81000,Multiplan,Commercial,,543.32,,,,,,,150.28,560.66,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,inpatient,,,384.00000,205.82000,Multiplan,Commercial,,360.96,,,,,,,345.60,372.48,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,outpatient,,,384.00000,205.82000,Multiplan,Commercial,,360.96,,,,,,,99.84,372.48,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,inpatient,,,303.00000,162.41000,Multiplan,Commercial,LT,284.82,,,,,,,272.70,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Multiplan,Commercial,LT,284.82,,,,,,,78.78,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,inpatient,,,303.00000,162.41000,Multiplan,Commercial,RT,284.82,,,,,,,272.70,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Multiplan,Commercial,RT,284.82,,,,,,,78.78,293.91,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,inpatient,,,445.00000,238.52000,Multiplan,Commercial,LT,418.30,,,,,,,400.50,431.65,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Multiplan,Commercial,LT,418.30,,,,,,,115.70,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,inpatient,,,445.00000,238.52000,Multiplan,Commercial,RT,418.30,,,,,,,400.50,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Multiplan,Commercial,RT,418.30,,,,,,,115.70,431.65,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,inpatient,,,937.00000,502.23000,Multiplan,Commercial,,880.78,,,,,,,843.30,908.89,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,outpatient,,,937.00000,502.23000,Multiplan,Commercial,,880.78,,,,,,,243.62,908.89,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,inpatient,,,615.00000,329.64000,Multiplan,Commercial,,578.10,,,,,,,553.50,596.55,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,outpatient,,,615.00000,329.64000,Multiplan,Commercial,,578.10,,,,,,,159.90,596.55,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Multiplan,Commercial,LT,269.78,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Multiplan,Commercial,LT,269.78,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Multiplan,Commercial,"52,LT",269.78,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Multiplan,Commercial,"52,LT",269.78,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Multiplan,Commercial,RT,269.78,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Multiplan,Commercial,RT,269.78,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Multiplan,Commercial,"52,RT",269.78,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Multiplan,Commercial,"52,RT",269.78,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,inpatient,,,323.00000,173.13000,Multiplan,Commercial,LT,303.62,,,,,,,290.70,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Multiplan,Commercial,LT,303.62,,,,,,,83.98,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,inpatient,,,323.00000,173.13000,Multiplan,Commercial,RT,303.62,,,,,,,290.70,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Multiplan,Commercial,RT,303.62,,,,,,,83.98,313.31,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,inpatient,,,694.00000,371.98000,Multiplan,Commercial,,652.36,,,,,,,624.60,673.18,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,outpatient,,,694.00000,371.98000,Multiplan,Commercial,,652.36,,,,,,,180.44,673.18,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,inpatient,,,276.00000,147.94000,Multiplan,Commercial,LT,259.44,,,,,,,248.40,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Multiplan,Commercial,LT,259.44,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,inpatient,,,276.00000,147.94000,Multiplan,Commercial,RT,259.44,,,,,,,248.40,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Multiplan,Commercial,RT,259.44,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,inpatient,,,254.00000,136.14000,Multiplan,Commercial,LT,238.76,,,,,,,228.60,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Multiplan,Commercial,LT,238.76,,,,,,,66.04,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,inpatient,,,254.00000,136.14000,Multiplan,Commercial,RT,238.76,,,,,,,228.60,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Multiplan,Commercial,RT,238.76,,,,,,,66.04,246.38,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,inpatient,,,275.00000,147.40000,Multiplan,Commercial,LT,258.50,,,,,,,247.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Multiplan,Commercial,LT,258.50,,,,,,,71.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,inpatient,,,275.00000,147.40000,Multiplan,Commercial,RT,258.50,,,,,,,247.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Multiplan,Commercial,RT,258.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,inpatient,,,173.00000,92.73000,Multiplan,Commercial,,162.62,,,,,,,155.70,167.81,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,outpatient,,,173.00000,92.73000,Multiplan,Commercial,,162.62,,,,,,,44.98,167.81,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,inpatient,,,483.00000,258.89000,Multiplan,Commercial,LT,454.02,,,,,,,434.70,468.51,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Multiplan,Commercial,LT,454.02,,,,,,,125.58,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,inpatient,,,483.00000,258.89000,Multiplan,Commercial,RT,454.02,,,,,,,434.70,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Multiplan,Commercial,RT,454.02,,,,,,,125.58,468.51,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,inpatient,,,191.00000,102.38000,Multiplan,Commercial,LT,179.54,,,,,,,171.90,185.27,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Multiplan,Commercial,LT,179.54,,,,,,,49.66,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,inpatient,,,191.00000,102.38000,Multiplan,Commercial,RT,179.54,,,,,,,171.90,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Multiplan,Commercial,RT,179.54,,,,,,,49.66,185.27,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Multiplan,Commercial,LT,139.12,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Multiplan,Commercial,LT,139.12,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Multiplan,Commercial,"52,LT",139.12,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Multiplan,Commercial,"52,LT",139.12,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Multiplan,Commercial,RT,139.12,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Multiplan,Commercial,RT,139.12,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Multiplan,Commercial,"52,RT",139.12,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Multiplan,Commercial,"52,RT",139.12,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,inpatient,,,481.00000,257.82000,Multiplan,Commercial,LT,452.14,,,,,,,432.90,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Multiplan,Commercial,LT,452.14,,,,,,,125.06,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,inpatient,,,481.00000,257.82000,Multiplan,Commercial,RT,452.14,,,,,,,432.90,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Multiplan,Commercial,RT,452.14,,,,,,,125.06,466.57,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,inpatient,,,215.00000,115.24000,Multiplan,Commercial,LT,202.10,,,,,,,193.50,208.55,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Multiplan,Commercial,LT,202.10,,,,,,,55.90,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,inpatient,,,215.00000,115.24000,Multiplan,Commercial,RT,202.10,,,,,,,193.50,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Multiplan,Commercial,RT,202.10,,,,,,,55.90,208.55,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Multiplan,Commercial,LT,258.50,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Multiplan,Commercial,LT,258.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Multiplan,Commercial,"52,LT",258.50,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Multiplan,Commercial,"52,LT",258.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Multiplan,Commercial,RT,258.50,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Multiplan,Commercial,RT,258.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Multiplan,Commercial,"52,RT",258.50,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Multiplan,Commercial,"52,RT",258.50,,,,,,,71.50,266.75,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Multiplan,Commercial,LT,427.70,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Multiplan,Commercial,LT,427.70,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Multiplan,Commercial,"52,LT",427.70,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Multiplan,Commercial,"52,LT",427.70,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Multiplan,Commercial,RT,427.70,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Multiplan,Commercial,RT,427.70,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Multiplan,Commercial,"52,RT",427.70,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Multiplan,Commercial,"52,RT",427.70,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,inpatient,,,503.00000,269.61000,Multiplan,Commercial,LT,472.82,,,,,,,452.70,487.91,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Multiplan,Commercial,LT,472.82,,,,,,,130.78,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,inpatient,,,503.00000,269.61000,Multiplan,Commercial,RT,472.82,,,,,,,452.70,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Multiplan,Commercial,RT,472.82,,,,,,,130.78,487.91,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,inpatient,,,209.00000,112.02000,Multiplan,Commercial,LT,196.46,,,,,,,188.10,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Multiplan,Commercial,LT,196.46,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,inpatient,,,209.00000,112.02000,Multiplan,Commercial,RT,196.46,,,,,,,188.10,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Multiplan,Commercial,RT,196.46,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,inpatient,,,566.00000,303.38000,Multiplan,Commercial,LT,532.04,,,,,,,509.40,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Multiplan,Commercial,LT,532.04,,,,,,,147.16,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,inpatient,,,566.00000,303.38000,Multiplan,Commercial,RT,532.04,,,,,,,509.40,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Multiplan,Commercial,RT,532.04,,,,,,,147.16,549.02,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,inpatient,,,598.00000,320.53000,Multiplan,Commercial,,562.12,,,,,,,538.20,580.06,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,outpatient,,,598.00000,320.53000,Multiplan,Commercial,,562.12,,,,,,,155.48,580.06,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Multiplan,Commercial,"52,LT",427.70,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Multiplan,Commercial,"52,LT",427.70,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Multiplan,Commercial,"52,RT",427.70,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Multiplan,Commercial,"52,RT",427.70,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Multiplan,Commercial,LT,427.70,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Multiplan,Commercial,LT,427.70,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Multiplan,Commercial,RT,427.70,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Multiplan,Commercial,RT,427.70,,,,,,,118.30,441.35,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,inpatient,,,1913.00000,1025.37000,Multiplan,Commercial,,1798.22,,,,,,,1721.70,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,outpatient,,,1913.00000,1025.37000,Multiplan,Commercial,,1798.22,,,,,,,497.38,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,inpatient,,,312.00000,167.23000,Multiplan,Commercial,,293.28,,,,,,,280.80,302.64,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,outpatient,,,312.00000,167.23000,Multiplan,Commercial,,293.28,,,,,,,81.12,302.64,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,inpatient,,,327.00000,175.27000,Multiplan,Commercial,,307.38,,,,,,,294.30,317.19,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,outpatient,,,327.00000,175.27000,Multiplan,Commercial,,307.38,,,,,,,85.02,317.19,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,inpatient,,,425.00000,227.80000,Multiplan,Commercial,,399.50,,,,,,,382.50,412.25,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,outpatient,,,425.00000,227.80000,Multiplan,Commercial,,399.50,,,,,,,110.50,412.25,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,inpatient,,,210.00000,112.56000,Multiplan,Commercial,,197.40,,,,,,,189.00,203.70,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,outpatient,,,210.00000,112.56000,Multiplan,Commercial,,197.40,,,,,,,54.60,203.70,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,inpatient,,,495.00000,265.32000,Multiplan,Commercial,,465.30,,,,,,,445.50,480.15,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,outpatient,,,495.00000,265.32000,Multiplan,Commercial,,465.30,,,,,,,128.70,480.15,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,inpatient,,,541.00000,289.98000,Multiplan,Commercial,,508.54,,,,,,,486.90,524.77,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,outpatient,,,541.00000,289.98000,Multiplan,Commercial,,508.54,,,,,,,140.66,524.77,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,inpatient,,,345.00000,184.92000,Multiplan,Commercial,LT,324.30,,,,,,,310.50,334.65,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Multiplan,Commercial,LT,324.30,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,inpatient,,,345.00000,184.92000,Multiplan,Commercial,RT,324.30,,,,,,,310.50,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Multiplan,Commercial,RT,324.30,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,inpatient,,,419.00000,224.58000,Multiplan,Commercial,LT,393.86,,,,,,,377.10,406.43,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Multiplan,Commercial,LT,393.86,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,inpatient,,,419.00000,224.58000,Multiplan,Commercial,RT,393.86,,,,,,,377.10,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Multiplan,Commercial,RT,393.86,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,inpatient,,,618.00000,331.25000,Multiplan,Commercial,LT,580.92,,,,,,,556.20,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Multiplan,Commercial,LT,580.92,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,inpatient,,,618.00000,331.25000,Multiplan,Commercial,RT,580.92,,,,,,,556.20,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Multiplan,Commercial,RT,580.92,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,inpatient,,,463.00000,248.17000,Multiplan,Commercial,,435.22,,,,,,,416.70,449.11,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,outpatient,,,463.00000,248.17000,Multiplan,Commercial,,435.22,,,,,,,120.38,449.11,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,inpatient,,,511.00000,273.90000,Multiplan,Commercial,,480.34,,,,,,,459.90,495.67,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,outpatient,,,511.00000,273.90000,Multiplan,Commercial,,480.34,,,,,,,132.86,495.67,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,inpatient,,,132.00000,70.75000,Multiplan,Commercial,,124.08,,,,,,,118.80,128.04,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,outpatient,,,132.00000,70.75000,Multiplan,Commercial,,124.08,,,,,,,34.32,128.04,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,inpatient,,,353.00000,189.21000,Multiplan,Commercial,LT,331.82,,,,,,,317.70,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Multiplan,Commercial,LT,331.82,,,,,,,91.78,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,inpatient,,,353.00000,189.21000,Multiplan,Commercial,RT,331.82,,,,,,,317.70,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Multiplan,Commercial,RT,331.82,,,,,,,91.78,342.41,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,inpatient,,,273.00000,146.33000,Multiplan,Commercial,,256.62,,,,,,,245.70,264.81,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,outpatient,,,273.00000,146.33000,Multiplan,Commercial,,256.62,,,,,,,70.98,264.81,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,inpatient,,,503.00000,269.61000,Multiplan,Commercial,,472.82,,,,,,,452.70,487.91,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,outpatient,,,503.00000,269.61000,Multiplan,Commercial,,472.82,,,,,,,130.78,487.91,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,inpatient,,,561.00000,300.70000,Multiplan,Commercial,,527.34,,,,,,,504.90,544.17,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,outpatient,,,561.00000,300.70000,Multiplan,Commercial,,527.34,,,,,,,145.86,544.17,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,inpatient,,,450.00000,241.20000,Multiplan,Commercial,LT,423.00,,,,,,,405.00,436.50,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Multiplan,Commercial,LT,423.00,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,inpatient,,,450.00000,241.20000,Multiplan,Commercial,RT,423.00,,,,,,,405.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Multiplan,Commercial,RT,423.00,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,inpatient,,,650.00000,348.40000,Multiplan,Commercial,,611.00,,,,,,,585.00,630.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,outpatient,,,650.00000,348.40000,Multiplan,Commercial,,611.00,,,,,,,169.00,630.50,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,inpatient,,,642.00000,344.11000,Multiplan,Commercial,,603.48,,,,,,,577.80,622.74,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,outpatient,,,642.00000,344.11000,Multiplan,Commercial,,603.48,,,,,,,166.92,622.74,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,inpatient,,,777.00000,416.47000,Multiplan,Commercial,,730.38,,,,,,,699.30,753.69,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,outpatient,,,777.00000,416.47000,Multiplan,Commercial,,730.38,,,,,,,202.02,753.69,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,inpatient,,,381.00000,204.22000,Multiplan,Commercial,,358.14,,,,,,,342.90,369.57,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,outpatient,,,381.00000,204.22000,Multiplan,Commercial,,358.14,,,,,,,99.06,369.57,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,inpatient,,,374.00000,200.46000,Multiplan,Commercial,LT,351.56,,,,,,,336.60,362.78,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Multiplan,Commercial,LT,351.56,,,,,,,97.24,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,inpatient,,,374.00000,200.46000,Multiplan,Commercial,RT,351.56,,,,,,,336.60,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Multiplan,Commercial,RT,351.56,,,,,,,97.24,362.78,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,inpatient,,,161.00000,86.30000,Multiplan,Commercial,LT,151.34,,,,,,,144.90,156.17,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Multiplan,Commercial,LT,151.34,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,inpatient,,,161.00000,86.30000,Multiplan,Commercial,RT,151.34,,,,,,,144.90,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Multiplan,Commercial,RT,151.34,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,inpatient,,,499.00000,267.46000,Multiplan,Commercial,LT,469.06,,,,,,,449.10,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Multiplan,Commercial,LT,469.06,,,,,,,129.74,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,inpatient,,,499.00000,267.46000,Multiplan,Commercial,RT,469.06,,,,,,,449.10,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Multiplan,Commercial,RT,469.06,,,,,,,129.74,484.03,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,inpatient,,,214.00000,114.70000,Multiplan,Commercial,,201.16,,,,,,,192.60,207.58,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,outpatient,,,214.00000,114.70000,Multiplan,Commercial,,201.16,,,,,,,55.64,207.58,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,inpatient,,,329.00000,176.34000,Multiplan,Commercial,,309.26,,,,,,,296.10,319.13,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,outpatient,,,329.00000,176.34000,Multiplan,Commercial,,309.26,,,,,,,85.54,319.13,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,inpatient,,,197.00000,105.59000,Multiplan,Commercial,,185.18,,,,,,,177.30,191.09,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,outpatient,,,197.00000,105.59000,Multiplan,Commercial,,185.18,,,,,,,51.22,191.09,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,inpatient,,,263.00000,140.97000,Multiplan,Commercial,,247.22,,,,,,,236.70,255.11,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,outpatient,,,263.00000,140.97000,Multiplan,Commercial,,247.22,,,,,,,68.38,255.11,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,inpatient,,,234.00000,125.42000,Multiplan,Commercial,,219.96,,,,,,,210.60,226.98,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,outpatient,,,234.00000,125.42000,Multiplan,Commercial,,219.96,,,,,,,60.84,226.98,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,inpatient,,,401.00000,214.94000,Multiplan,Commercial,,376.94,,,,,,,360.90,388.97,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,outpatient,,,401.00000,214.94000,Multiplan,Commercial,,376.94,,,,,,,104.26,388.97,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,inpatient,,,515.00000,276.04000,Multiplan,Commercial,,484.10,,,,,,,463.50,499.55,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,outpatient,,,515.00000,276.04000,Multiplan,Commercial,,484.10,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,inpatient,,,747.00000,400.39000,Multiplan,Commercial,,702.18,,,,,,,672.30,724.59,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,outpatient,,,747.00000,400.39000,Multiplan,Commercial,,702.18,,,,,,,194.22,724.59,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,inpatient,,,854.00000,457.74000,Multiplan,Commercial,,802.76,,,,,,,768.60,828.38,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,outpatient,,,854.00000,457.74000,Multiplan,Commercial,,802.76,,,,,,,222.04,828.38,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,inpatient,,,589.00000,315.70000,Multiplan,Commercial,,553.66,,,,,,,530.10,571.33,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,outpatient,,,589.00000,315.70000,Multiplan,Commercial,,553.66,,,,,,,153.14,571.33,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,inpatient,,,613.00000,328.57000,Multiplan,Commercial,,576.22,,,,,,,551.70,594.61,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,outpatient,,,613.00000,328.57000,Multiplan,Commercial,,576.22,,,,,,,159.38,594.61,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,inpatient,,,806.00000,432.02000,Multiplan,Commercial,,757.64,,,,,,,725.40,781.82,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,outpatient,,,806.00000,432.02000,Multiplan,Commercial,,757.64,,,,,,,209.56,781.82,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,inpatient,,,529.00000,283.54000,Multiplan,Commercial,,497.26,,,,,,,476.10,513.13,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,outpatient,,,529.00000,283.54000,Multiplan,Commercial,,497.26,,,,,,,137.54,513.13,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,inpatient,,,939.00000,503.30000,Multiplan,Commercial,,882.66,,,,,,,845.10,910.83,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,outpatient,,,939.00000,503.30000,Multiplan,Commercial,,882.66,,,,,,,244.14,910.83,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,inpatient,,,515.00000,276.04000,Multiplan,Commercial,,484.10,,,,,,,463.50,499.55,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,outpatient,,,515.00000,276.04000,Multiplan,Commercial,,484.10,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,inpatient,,,616.00000,330.18000,Multiplan,Commercial,,579.04,,,,,,,554.40,597.52,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,outpatient,,,616.00000,330.18000,Multiplan,Commercial,,579.04,,,,,,,160.16,597.52,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,inpatient,,,377.00000,202.07000,Multiplan,Commercial,,354.38,,,,,,,339.30,365.69,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,outpatient,,,377.00000,202.07000,Multiplan,Commercial,,354.38,,,,,,,98.02,365.69,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,inpatient,,,340.00000,182.24000,Multiplan,Commercial,,319.60,,,,,,,306.00,329.80,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,outpatient,,,340.00000,182.24000,Multiplan,Commercial,,319.60,,,,,,,88.40,329.80,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,inpatient,,,388.00000,207.97000,Multiplan,Commercial,,364.72,,,,,,,349.20,376.36,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,outpatient,,,388.00000,207.97000,Multiplan,Commercial,,364.72,,,,,,,100.88,376.36,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,inpatient,,,456.00000,244.42000,Multiplan,Commercial,,428.64,,,,,,,410.40,442.32,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,outpatient,,,456.00000,244.42000,Multiplan,Commercial,,428.64,,,,,,,118.56,442.32,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,inpatient,,,267.00000,143.11000,Multiplan,Commercial,,250.98,,,,,,,240.30,258.99,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,outpatient,,,267.00000,143.11000,Multiplan,Commercial,,250.98,,,,,,,69.42,258.99,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Multiplan,Commercial,LT,287.64,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Multiplan,Commercial,LT,287.64,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Multiplan,Commercial,"52,LT",287.64,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Multiplan,Commercial,"52,LT",287.64,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Multiplan,Commercial,RT,287.64,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Multiplan,Commercial,RT,287.64,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Multiplan,Commercial,"52,RT",287.64,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Multiplan,Commercial,"52,RT",287.64,,,,,,,79.56,296.82,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,inpatient,,,456.00000,244.42000,Multiplan,Commercial,,428.64,,,,,,,410.40,442.32,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,outpatient,,,456.00000,244.42000,Multiplan,Commercial,,428.64,,,,,,,118.56,442.32,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,inpatient,,,381.00000,204.22000,Multiplan,Commercial,,358.14,,,,,,,342.90,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,outpatient,,,381.00000,204.22000,Multiplan,Commercial,,358.14,,,,,,,99.06,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,inpatient,,,143.00000,76.65000,Multiplan,Commercial,LT,134.42,,,,,,,128.70,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Multiplan,Commercial,LT,134.42,,,,,,,37.18,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,inpatient,,,143.00000,76.65000,Multiplan,Commercial,RT,134.42,,,,,,,128.70,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Multiplan,Commercial,RT,134.42,,,,,,,37.18,138.71,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,inpatient,,,331.00000,177.42000,Multiplan,Commercial,LT,311.14,,,,,,,297.90,321.07,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Multiplan,Commercial,LT,311.14,,,,,,,86.06,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,inpatient,,,331.00000,177.42000,Multiplan,Commercial,RT,311.14,,,,,,,297.90,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Multiplan,Commercial,RT,311.14,,,,,,,86.06,321.07,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,inpatient,,,1113.00000,596.57000,Multiplan,Commercial,,1046.22,,,,,,,1001.70,1079.61,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1113.00000,596.57000,Multiplan,Commercial,,1046.22,,,,,,,289.38,1079.61,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,inpatient,,,1043.00000,559.05000,Multiplan,Commercial,,980.42,,,,,,,938.70,1011.71,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,outpatient,,,1043.00000,559.05000,Multiplan,Commercial,,980.42,,,,,,,271.18,1011.71,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Multiplan,Commercial,LT,240.64,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Multiplan,Commercial,LT,240.64,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Multiplan,Commercial,"52,LT",240.64,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Multiplan,Commercial,"52,LT",240.64,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Multiplan,Commercial,RT,240.64,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Multiplan,Commercial,RT,240.64,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Multiplan,Commercial,"52,RT",240.64,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Multiplan,Commercial,"52,RT",240.64,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,inpatient,,,511.00000,273.90000,Multiplan,Commercial,LT,480.34,,,,,,,459.90,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Multiplan,Commercial,LT,480.34,,,,,,,132.86,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,inpatient,,,511.00000,273.90000,Multiplan,Commercial,RT,480.34,,,,,,,459.90,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Multiplan,Commercial,RT,480.34,,,,,,,132.86,495.67,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,inpatient,,,553.00000,314.19000,Multiplan,Commercial,LT,519.82,,,,,,,497.70,536.41,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Multiplan,Commercial,LT,519.82,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,inpatient,,,553.00000,314.19000,Multiplan,Commercial,RT,519.82,,,,,,,497.70,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Multiplan,Commercial,RT,519.82,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,inpatient,,,1076.00000,611.33000,Multiplan,Commercial,LT,1011.44,,,,,,,968.40,1043.72,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Multiplan,Commercial,LT,1011.44,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,inpatient,,,1076.00000,611.33000,Multiplan,Commercial,RT,1011.44,,,,,,,968.40,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Multiplan,Commercial,RT,1011.44,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,inpatient,,,865.00000,491.45000,Multiplan,Commercial,LT,813.10,,,,,,,778.50,839.05,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Multiplan,Commercial,LT,813.10,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,inpatient,,,865.00000,491.45000,Multiplan,Commercial,RT,813.10,,,,,,,778.50,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Multiplan,Commercial,RT,813.10,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,inpatient,,,734.00000,417.02000,Multiplan,Commercial,LT,689.96,,,,,,,660.60,711.98,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Multiplan,Commercial,LT,689.96,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,inpatient,,,734.00000,417.02000,Multiplan,Commercial,RT,689.96,,,,,,,660.60,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Multiplan,Commercial,RT,689.96,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,inpatient,,,730.00000,414.75000,Multiplan,Commercial,LT,686.20,,,,,,,657.00,708.10,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Multiplan,Commercial,LT,686.20,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,inpatient,,,730.00000,414.75000,Multiplan,Commercial,RT,686.20,,,,,,,657.00,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Multiplan,Commercial,RT,686.20,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,inpatient,,,260.00000,147.72000,Multiplan,Commercial,LT,244.40,,,,,,,234.00,252.20,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Multiplan,Commercial,LT,244.40,,,,,,,67.60,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,inpatient,,,260.00000,147.72000,Multiplan,Commercial,RT,244.40,,,,,,,234.00,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Multiplan,Commercial,RT,244.40,,,,,,,67.60,252.20,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,inpatient,,,428.00000,203.73000,Multiplan,Commercial,,402.32,,,,,,,385.20,415.16,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,outpatient,,,428.00000,203.73000,Multiplan,Commercial,,402.32,,,,,,,111.28,415.16,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,inpatient,,,492.00000,234.19000,Multiplan,Commercial,,462.48,,,,,,,442.80,477.24,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,outpatient,,,492.00000,234.19000,Multiplan,Commercial,,462.48,,,,,,,127.92,477.24,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,inpatient,,,607.00000,288.93000,Multiplan,Commercial,,570.58,,,,,,,546.30,588.79,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,outpatient,,,607.00000,288.93000,Multiplan,Commercial,,570.58,,,,,,,157.82,588.79,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,inpatient,,,649.00000,308.92000,Multiplan,Commercial,,610.06,,,,,,,584.10,629.53,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,outpatient,,,649.00000,308.92000,Multiplan,Commercial,,610.06,,,,,,,168.74,629.53,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,inpatient,,,377.00000,121.77000,Multiplan,Commercial,50,354.38,,,,,,,339.30,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,outpatient,,,377.00000,121.77000,Multiplan,Commercial,50,354.38,,,,,,,98.02,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,inpatient,,,251.00000,81.07000,Multiplan,Commercial,LT,235.94,,,,,,,225.90,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Multiplan,Commercial,LT,235.94,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,inpatient,,,251.00000,81.07000,Multiplan,Commercial,RT,235.94,,,,,,,225.90,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Multiplan,Commercial,RT,235.94,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,inpatient,,,1170.00000,377.91000,Multiplan,Commercial,50,1099.80,,,,,,,1053.00,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,outpatient,,,1170.00000,377.91000,Multiplan,Commercial,50,1099.80,,,,,,,304.20,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,inpatient,,,780.00000,251.94000,Multiplan,Commercial,LT,733.20,,,,,,,702.00,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Multiplan,Commercial,LT,733.20,,,,,,,202.80,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,inpatient,,,780.00000,251.94000,Multiplan,Commercial,RT,733.20,,,,,,,702.00,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Multiplan,Commercial,RT,733.20,,,,,,,202.80,756.60,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,inpatient,,,1389.00000,448.65000,Multiplan,Commercial,,1305.66,,,,,,,1250.10,1347.33,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,outpatient,,,1389.00000,448.65000,Multiplan,Commercial,,1305.66,,,,,,,361.14,1347.33,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,inpatient,,,345.00000,111.44000,Multiplan,Commercial,50,324.30,,,,,,,310.50,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,outpatient,,,345.00000,111.44000,Multiplan,Commercial,50,324.30,,,,,,,89.70,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,inpatient,,,230.00000,74.29000,Multiplan,Commercial,LT,216.20,,,,,,,207.00,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Multiplan,Commercial,LT,216.20,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,inpatient,,,230.00000,74.29000,Multiplan,Commercial,RT,216.20,,,,,,,207.00,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Multiplan,Commercial,RT,216.20,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,inpatient,,,2102.00000,678.95000,Multiplan,Commercial,50,1975.88,,,,,,,1891.80,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,outpatient,,,2102.00000,678.95000,Multiplan,Commercial,50,1975.88,,,,,,,546.52,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,inpatient,,,1401.00000,452.52000,Multiplan,Commercial,LT,1316.94,,,,,,,1260.90,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Multiplan,Commercial,LT,1316.94,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,inpatient,,,1401.00000,452.52000,Multiplan,Commercial,RT,1316.94,,,,,,,1260.90,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Multiplan,Commercial,RT,1316.94,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,inpatient,,,357.00000,115.31000,Multiplan,Commercial,50,335.58,,,,,,,321.30,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,outpatient,,,357.00000,115.31000,Multiplan,Commercial,50,335.58,,,,,,,92.82,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,inpatient,,,238.00000,76.87000,Multiplan,Commercial,LT,223.72,,,,,,,214.20,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Multiplan,Commercial,LT,223.72,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,inpatient,,,238.00000,76.87000,Multiplan,Commercial,RT,223.72,,,,,,,214.20,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Multiplan,Commercial,RT,223.72,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,inpatient,,,2082.00000,672.49000,Multiplan,Commercial,50,1957.08,,,,,,,1873.80,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,outpatient,,,2082.00000,672.49000,Multiplan,Commercial,50,1957.08,,,,,,,541.32,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,inpatient,,,1388.00000,448.32000,Multiplan,Commercial,LT,1304.72,,,,,,,1249.20,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Multiplan,Commercial,LT,1304.72,,,,,,,360.88,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,inpatient,,,1388.00000,448.32000,Multiplan,Commercial,RT,1304.72,,,,,,,1249.20,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Multiplan,Commercial,RT,1304.72,,,,,,,360.88,1346.36,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,inpatient,,,246.00000,79.46000,Multiplan,Commercial,50,231.24,,,,,,,221.40,238.62,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,outpatient,,,246.00000,79.46000,Multiplan,Commercial,50,231.24,,,,,,,63.96,238.62,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,inpatient,,,164.00000,52.97000,Multiplan,Commercial,LT,154.16,,,,,,,147.60,159.08,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Multiplan,Commercial,LT,154.16,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,inpatient,,,164.00000,52.97000,Multiplan,Commercial,RT,154.16,,,,,,,147.60,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Multiplan,Commercial,RT,154.16,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,inpatient,,,309.00000,99.81000,Multiplan,Commercial,50,290.46,,,,,,,278.10,299.73,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,outpatient,,,309.00000,99.81000,Multiplan,Commercial,50,290.46,,,,,,,80.34,299.73,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,inpatient,,,206.00000,66.54000,Multiplan,Commercial,LT,193.64,,,,,,,185.40,199.82,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Multiplan,Commercial,LT,193.64,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,inpatient,,,206.00000,66.54000,Multiplan,Commercial,RT,193.64,,,,,,,185.40,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Multiplan,Commercial,RT,193.64,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,inpatient,,,471.00000,152.13000,Multiplan,Commercial,50,442.74,,,,,,,423.90,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,outpatient,,,471.00000,152.13000,Multiplan,Commercial,50,442.74,,,,,,,122.46,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,inpatient,,,314.00000,101.42000,Multiplan,Commercial,LT,295.16,,,,,,,282.60,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Multiplan,Commercial,LT,295.16,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,inpatient,,,314.00000,101.42000,Multiplan,Commercial,RT,295.16,,,,,,,282.60,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Multiplan,Commercial,RT,295.16,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,inpatient,,,239.00000,77.20000,Multiplan,Commercial,50,224.66,,,,,,,215.10,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,outpatient,,,239.00000,77.20000,Multiplan,Commercial,50,224.66,,,,,,,62.14,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,inpatient,,,159.00000,51.36000,Multiplan,Commercial,LT,149.46,,,,,,,143.10,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Multiplan,Commercial,LT,149.46,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,inpatient,,,159.00000,51.36000,Multiplan,Commercial,RT,149.46,,,,,,,143.10,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Multiplan,Commercial,RT,149.46,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,inpatient,,,558.00000,180.23000,Multiplan,Commercial,50,524.52,,,,,,,502.20,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,outpatient,,,558.00000,180.23000,Multiplan,Commercial,50,524.52,,,,,,,145.08,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,inpatient,,,372.00000,120.16000,Multiplan,Commercial,LT,349.68,,,,,,,334.80,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Multiplan,Commercial,LT,349.68,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,inpatient,,,372.00000,120.16000,Multiplan,Commercial,RT,349.68,,,,,,,334.80,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Multiplan,Commercial,RT,349.68,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,inpatient,,,413.00000,133.40000,Multiplan,Commercial,50,388.22,,,,,,,371.70,400.61,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,outpatient,,,413.00000,133.40000,Multiplan,Commercial,50,388.22,,,,,,,107.38,400.61,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,inpatient,,,275.00000,88.82000,Multiplan,Commercial,LT,258.50,,,,,,,247.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Multiplan,Commercial,LT,258.50,,,,,,,71.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,inpatient,,,275.00000,88.82000,Multiplan,Commercial,RT,258.50,,,,,,,247.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Multiplan,Commercial,RT,258.50,,,,,,,71.50,266.75,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,inpatient,,,462.00000,149.23000,Multiplan,Commercial,,434.28,,,,,,,415.80,448.14,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,outpatient,,,462.00000,149.23000,Multiplan,Commercial,,434.28,,,,,,,120.12,448.14,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,inpatient,,,170.00000,54.91000,Multiplan,Commercial,,159.80,,,,,,,153.00,164.90,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,outpatient,,,170.00000,54.91000,Multiplan,Commercial,,159.80,,,,,,,44.20,164.90,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,inpatient,,,281.00000,90.76000,Multiplan,Commercial,,264.14,,,,,,,252.90,272.57,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,outpatient,,,281.00000,90.76000,Multiplan,Commercial,,264.14,,,,,,,73.06,272.57,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,inpatient,,,562.00000,181.53000,Multiplan,Commercial,,528.28,,,,,,,505.80,545.14,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,outpatient,,,562.00000,181.53000,Multiplan,Commercial,,528.28,,,,,,,146.12,545.14,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,inpatient,,,2076.00000,670.55000,Multiplan,Commercial,50,1951.44,,,,,,,1868.40,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,outpatient,,,2076.00000,670.55000,Multiplan,Commercial,50,1951.44,,,,,,,539.76,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1384.00000,447.03000,Multiplan,Commercial,LT,1300.96,,,,,,,1245.60,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Multiplan,Commercial,LT,1300.96,,,,,,,359.84,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1384.00000,447.03000,Multiplan,Commercial,RT,1300.96,,,,,,,1245.60,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Multiplan,Commercial,RT,1300.96,,,,,,,359.84,1342.48,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,inpatient,,,934.00000,301.68000,Multiplan,Commercial,,877.96,,,,,,,840.60,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,outpatient,,,934.00000,301.68000,Multiplan,Commercial,,877.96,,,,,,,242.84,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,inpatient,,,842.00000,271.97000,Multiplan,Commercial,,791.48,,,,,,,757.80,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,outpatient,,,842.00000,271.97000,Multiplan,Commercial,,791.48,,,,,,,218.92,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,inpatient,,,846.00000,273.26000,Multiplan,Commercial,,795.24,,,,,,,761.40,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,outpatient,,,846.00000,273.26000,Multiplan,Commercial,,795.24,,,,,,,219.96,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,inpatient,,,971.00000,313.63000,Multiplan,Commercial,,912.74,,,,,,,873.90,941.87,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,outpatient,,,971.00000,313.63000,Multiplan,Commercial,,912.74,,,,,,,252.46,941.87,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,inpatient,,,762.00000,246.13000,Multiplan,Commercial,,716.28,,,,,,,685.80,739.14,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,outpatient,,,762.00000,246.13000,Multiplan,Commercial,,716.28,,,,,,,198.12,739.14,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,inpatient,,,758.00000,244.83000,Multiplan,Commercial,,712.52,,,,,,,682.20,735.26,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,outpatient,,,758.00000,244.83000,Multiplan,Commercial,,712.52,,,,,,,197.08,735.26,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,inpatient,,,161.00000,52.00000,Multiplan,Commercial,,151.34,,,,,,,144.90,156.17,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,outpatient,,,161.00000,52.00000,Multiplan,Commercial,,151.34,,,,,,,41.86,156.17,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,inpatient,,,234.00000,75.58000,Multiplan,Commercial,50,219.96,,,,,,,210.60,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,outpatient,,,234.00000,75.58000,Multiplan,Commercial,50,219.96,,,,,,,60.84,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,inpatient,,,156.00000,50.39000,Multiplan,Commercial,LT,146.64,,,,,,,140.40,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Multiplan,Commercial,LT,146.64,,,,,,,40.56,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,inpatient,,,156.00000,50.39000,Multiplan,Commercial,RT,146.64,,,,,,,140.40,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Multiplan,Commercial,RT,146.64,,,,,,,40.56,151.32,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1517.00000,489.99000,Multiplan,Commercial,50,1425.98,,,,,,,1365.30,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1517.00000,489.99000,Multiplan,Commercial,50,1425.98,,,,,,,394.42,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1011.00000,326.55000,Multiplan,Commercial,LT,950.34,,,,,,,909.90,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Multiplan,Commercial,LT,950.34,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1011.00000,326.55000,Multiplan,Commercial,RT,950.34,,,,,,,909.90,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Multiplan,Commercial,RT,950.34,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,inpatient,,,822.00000,265.51000,Multiplan,Commercial,50,772.68,,,,,,,739.80,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,outpatient,,,822.00000,265.51000,Multiplan,Commercial,50,772.68,,,,,,,213.72,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,inpatient,,,548.00000,177.00000,Multiplan,Commercial,LT,515.12,,,,,,,493.20,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Multiplan,Commercial,LT,515.12,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,inpatient,,,548.00000,177.00000,Multiplan,Commercial,RT,515.12,,,,,,,493.20,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Multiplan,Commercial,RT,515.12,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,inpatient,,,2613.00000,844.00000,Multiplan,Commercial,,2456.22,,,,,,,2351.70,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,outpatient,,,2613.00000,844.00000,Multiplan,Commercial,,2456.22,,,,,,,679.38,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,inpatient,,,903.00000,291.67000,Multiplan,Commercial,,848.82,,,,,,,812.70,875.91,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,outpatient,,,903.00000,291.67000,Multiplan,Commercial,,848.82,,,,,,,234.78,875.91,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,inpatient,,,1156.00000,373.39000,Multiplan,Commercial,,1086.64,,,,,,,1040.40,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,outpatient,,,1156.00000,373.39000,Multiplan,Commercial,,1086.64,,,,,,,300.56,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,inpatient,,,677.00000,218.67000,Multiplan,Commercial,,636.38,,,,,,,609.30,656.69,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,outpatient,,,677.00000,218.67000,Multiplan,Commercial,,636.38,,,,,,,176.02,656.69,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1928.00000,622.74000,Multiplan,Commercial,50,1812.32,,,,,,,1735.20,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1928.00000,622.74000,Multiplan,Commercial,50,1812.32,,,,,,,501.28,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1285.00000,415.06000,Multiplan,Commercial,LT,1207.90,,,,,,,1156.50,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Multiplan,Commercial,LT,1207.90,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1285.00000,415.06000,Multiplan,Commercial,RT,1207.90,,,,,,,1156.50,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Multiplan,Commercial,RT,1207.90,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,inpatient,,,812.00000,262.28000,Multiplan,Commercial,50,763.28,,,,,,,730.80,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,outpatient,,,812.00000,262.28000,Multiplan,Commercial,50,763.28,,,,,,,211.12,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,inpatient,,,541.00000,174.74000,Multiplan,Commercial,LT,508.54,,,,,,,486.90,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Multiplan,Commercial,LT,508.54,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,inpatient,,,541.00000,174.74000,Multiplan,Commercial,RT,508.54,,,,,,,486.90,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Multiplan,Commercial,RT,508.54,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,inpatient,,,825.00000,266.48000,Multiplan,Commercial,50,775.50,,,,,,,742.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,outpatient,,,825.00000,266.48000,Multiplan,Commercial,50,775.50,,,,,,,214.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,inpatient,,,550.00000,177.65000,Multiplan,Commercial,LT,517.00,,,,,,,495.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Multiplan,Commercial,LT,517.00,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,inpatient,,,550.00000,177.65000,Multiplan,Commercial,RT,517.00,,,,,,,495.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Multiplan,Commercial,RT,517.00,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,inpatient,,,3494.00000,1128.56000,Multiplan,Commercial,50,3284.36,,,,,,,3144.60,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,outpatient,,,3494.00000,1128.56000,Multiplan,Commercial,50,3284.36,,,,,,,908.44,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2329.00000,752.27000,Multiplan,Commercial,LT,2189.26,,,,,,,2096.10,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Multiplan,Commercial,LT,2189.26,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2329.00000,752.27000,Multiplan,Commercial,RT,2189.26,,,,,,,2096.10,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Multiplan,Commercial,RT,2189.26,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,inpatient,,,840.00000,271.32000,Multiplan,Commercial,50,789.60,,,,,,,756.00,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,outpatient,,,840.00000,271.32000,Multiplan,Commercial,50,789.60,,,,,,,218.40,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,inpatient,,,560.00000,180.88000,Multiplan,Commercial,LT,526.40,,,,,,,504.00,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Multiplan,Commercial,LT,526.40,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,inpatient,,,560.00000,180.88000,Multiplan,Commercial,RT,526.40,,,,,,,504.00,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Multiplan,Commercial,RT,526.40,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,inpatient,,,792.00000,255.82000,Multiplan,Commercial,50,744.48,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,outpatient,,,792.00000,255.82000,Multiplan,Commercial,50,744.48,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,inpatient,,,528.00000,170.54000,Multiplan,Commercial,LT,496.32,,,,,,,475.20,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Multiplan,Commercial,LT,496.32,,,,,,,137.28,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,inpatient,,,528.00000,170.54000,Multiplan,Commercial,RT,496.32,,,,,,,475.20,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Multiplan,Commercial,RT,496.32,,,,,,,137.28,512.16,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,inpatient,,,272.00000,87.86000,Multiplan,Commercial,,255.68,,,,,,,244.80,263.84,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,outpatient,,,272.00000,87.86000,Multiplan,Commercial,,255.68,,,,,,,70.72,263.84,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,inpatient,,,1268.00000,409.56000,Multiplan,Commercial,,1191.92,,,,,,,1141.20,1229.96,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,outpatient,,,1268.00000,409.56000,Multiplan,Commercial,,1191.92,,,,,,,329.68,1229.96,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,inpatient,,,896.00000,289.41000,Multiplan,Commercial,,842.24,,,,,,,806.40,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,outpatient,,,896.00000,289.41000,Multiplan,Commercial,,842.24,,,,,,,232.96,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,inpatient,,,884.00000,285.53000,Multiplan,Commercial,,830.96,,,,,,,795.60,857.48,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,outpatient,,,884.00000,285.53000,Multiplan,Commercial,,830.96,,,,,,,229.84,857.48,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,inpatient,,,609.00000,326.42000,Multiplan,Commercial,,572.46,,,,,,,548.10,590.73,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Multiplan,Commercial,,572.46,,,,,,,158.34,590.73,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,inpatient,,,966.00000,383.50000,Multiplan,Commercial,,908.04,,,,,,,869.40,937.02,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,outpatient,,,966.00000,383.50000,Multiplan,Commercial,,908.04,,,,,,,251.16,937.02,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,inpatient,,,872.00000,346.18000,Multiplan,Commercial,,819.68,,,,,,,784.80,845.84,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,outpatient,,,872.00000,346.18000,Multiplan,Commercial,,819.68,,,,,,,226.72,845.84,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,inpatient,,,492.00000,195.32000,Multiplan,Commercial,,462.48,,,,,,,442.80,477.24,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,outpatient,,,492.00000,195.32000,Multiplan,Commercial,,462.48,,,,,,,127.92,477.24,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,inpatient,,,331.00000,131.41000,Multiplan,Commercial,,311.14,,,,,,,297.90,321.07,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,outpatient,,,331.00000,131.41000,Multiplan,Commercial,,311.14,,,,,,,86.06,321.07,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,inpatient,,,5215.00000,2070.36000,Multiplan,Commercial,,4902.10,,,,,,,4693.50,5058.55,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,outpatient,,,5215.00000,2070.36000,Multiplan,Commercial,,4902.10,,,,,,,1355.90,5058.55,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,inpatient,,,5422.00000,2152.53000,Multiplan,Commercial,,5096.68,,,,,,,4879.80,5259.34,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,outpatient,,,5422.00000,2152.53000,Multiplan,Commercial,,5096.68,,,,,,,1409.72,5259.34,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,inpatient,,,1878.00000,788.76000,Multiplan,Commercial,,1765.32,,,,,,,1690.20,1821.66,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1878.00000,788.76000,Multiplan,Commercial,,1765.32,,,,,,,488.28,1821.66,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,inpatient,,,2253.00000,946.26000,Multiplan,Commercial,,2117.82,,,,,,,2027.70,2185.41,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,outpatient,,,2253.00000,946.26000,Multiplan,Commercial,,2117.82,,,,,,,585.78,2185.41,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,inpatient,,,1502.00000,630.84000,Multiplan,Commercial,,1411.88,,,,,,,1351.80,1456.94,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1502.00000,630.84000,Multiplan,Commercial,,1411.88,,,,,,,390.52,1456.94,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,inpatient,,,2024.00000,850.08000,Multiplan,Commercial,,1902.56,,,,,,,1821.60,1963.28,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,outpatient,,,2024.00000,850.08000,Multiplan,Commercial,,1902.56,,,,,,,526.24,1963.28,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,inpatient,,,2429.00000,1020.18000,Multiplan,Commercial,,2283.26,,,,,,,2186.10,2356.13,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,outpatient,,,2429.00000,1020.18000,Multiplan,Commercial,,2283.26,,,,,,,631.54,2356.13,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,inpatient,,,1619.00000,679.98000,Multiplan,Commercial,,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1619.00000,679.98000,Multiplan,Commercial,,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,inpatient,,,2425.00000,1018.50000,Multiplan,Commercial,,2279.50,,,,,,,2182.50,2352.25,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,outpatient,,,2425.00000,1018.50000,Multiplan,Commercial,,2279.50,,,,,,,630.50,2352.25,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,inpatient,,,2910.00000,1222.20000,Multiplan,Commercial,,2735.40,,,,,,,2619.00,2822.70,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2910.00000,1222.20000,Multiplan,Commercial,,2735.40,,,,,,,756.60,2822.70,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,inpatient,,,1940.00000,814.80000,Multiplan,Commercial,,1823.60,,,,,,,1746.00,1881.80,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1940.00000,814.80000,Multiplan,Commercial,,1823.60,,,,,,,504.40,1881.80,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,inpatient,,,2317.00000,973.14000,Multiplan,Commercial,,2177.98,,,,,,,2085.30,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2317.00000,973.14000,Multiplan,Commercial,,2177.98,,,,,,,602.42,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,inpatient,,,2780.00000,1167.60000,Multiplan,Commercial,,2613.20,,,,,,,2502.00,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2780.00000,1167.60000,Multiplan,Commercial,,2613.20,,,,,,,722.80,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,inpatient,,,1853.00000,778.26000,Multiplan,Commercial,,1741.82,,,,,,,1667.70,1797.41,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1853.00000,778.26000,Multiplan,Commercial,,1741.82,,,,,,,481.78,1797.41,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,inpatient,,,2366.00000,993.72000,Multiplan,Commercial,,2224.04,,,,,,,2129.40,2295.02,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2366.00000,993.72000,Multiplan,Commercial,,2224.04,,,,,,,615.16,2295.02,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,inpatient,,,3056.00000,1283.52000,Multiplan,Commercial,,2872.64,,,,,,,2750.40,2964.32,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,outpatient,,,3056.00000,1283.52000,Multiplan,Commercial,,2872.64,,,,,,,794.56,2964.32,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,inpatient,,,2829.00000,1386.21000,Multiplan,Commercial,,2659.26,,,,,,,2546.10,2744.13,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,outpatient,,,2829.00000,1386.21000,Multiplan,Commercial,,2659.26,,,,,,,735.54,2744.13,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,inpatient,,,3395.00000,1663.55000,Multiplan,Commercial,,3191.30,,,,,,,3055.50,3293.15,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,outpatient,,,3395.00000,1663.55000,Multiplan,Commercial,,3191.30,,,,,,,882.70,3293.15,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,inpatient,,,2263.00000,1108.87000,Multiplan,Commercial,,2127.22,,,,,,,2036.70,2195.11,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,outpatient,,,2263.00000,1108.87000,Multiplan,Commercial,,2127.22,,,,,,,588.38,2195.11,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,inpatient,,,4697.00000,2301.53000,Multiplan,Commercial,,4415.18,,,,,,,4227.30,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,outpatient,,,4697.00000,2301.53000,Multiplan,Commercial,,4415.18,,,,,,,1221.22,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,inpatient,,,5636.00000,2761.64000,Multiplan,Commercial,,5297.84,,,,,,,5072.40,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,outpatient,,,5636.00000,2761.64000,Multiplan,Commercial,,5297.84,,,,,,,1465.36,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,inpatient,,,3757.00000,1840.93000,Multiplan,Commercial,,3531.58,,,,,,,3381.30,3644.29,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,outpatient,,,3757.00000,1840.93000,Multiplan,Commercial,,3531.58,,,,,,,976.82,3644.29,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,inpatient,,,2619.00000,1283.31000,Multiplan,Commercial,,2461.86,,,,,,,2357.10,2540.43,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,outpatient,,,2619.00000,1283.31000,Multiplan,Commercial,,2461.86,,,,,,,680.94,2540.43,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,inpatient,,,3143.00000,1540.07000,Multiplan,Commercial,,2954.42,,,,,,,2828.70,3048.71,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,outpatient,,,3143.00000,1540.07000,Multiplan,Commercial,,2954.42,,,,,,,817.18,3048.71,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,inpatient,,,2095.00000,1026.55000,Multiplan,Commercial,,1969.30,,,,,,,1885.50,2032.15,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,outpatient,,,2095.00000,1026.55000,Multiplan,Commercial,,1969.30,,,,,,,544.70,2032.15,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,inpatient,,,278.00000,136.22000,Multiplan,Commercial,,261.32,,,,,,,250.20,269.66,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,outpatient,,,278.00000,136.22000,Multiplan,Commercial,,261.32,,,,,,,72.28,269.66,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,inpatient,,,2110.00000,1033.90000,Multiplan,Commercial,LT,1983.40,,,,,,,1899.00,2046.70,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Multiplan,Commercial,LT,1983.40,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,inpatient,,,2110.00000,1033.90000,Multiplan,Commercial,RT,1983.40,,,,,,,1899.00,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Multiplan,Commercial,RT,1983.40,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2532.00000,1240.68000,Multiplan,Commercial,LT,2380.08,,,,,,,2278.80,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Multiplan,Commercial,LT,2380.08,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2532.00000,1240.68000,Multiplan,Commercial,RT,2380.08,,,,,,,2278.80,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Multiplan,Commercial,RT,2380.08,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1688.00000,827.12000,Multiplan,Commercial,LT,1586.72,,,,,,,1519.20,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Multiplan,Commercial,LT,1586.72,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1688.00000,827.12000,Multiplan,Commercial,RT,1586.72,,,,,,,1519.20,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Multiplan,Commercial,RT,1586.72,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,inpatient,,,2024.00000,991.76000,Multiplan,Commercial,LT,1902.56,,,,,,,1821.60,1963.28,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Multiplan,Commercial,LT,1902.56,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,inpatient,,,2024.00000,991.76000,Multiplan,Commercial,RT,1902.56,,,,,,,1821.60,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Multiplan,Commercial,RT,1902.56,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2429.00000,1190.21000,Multiplan,Commercial,LT,2283.26,,,,,,,2186.10,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Multiplan,Commercial,LT,2283.26,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2429.00000,1190.21000,Multiplan,Commercial,RT,2283.26,,,,,,,2186.10,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Multiplan,Commercial,RT,2283.26,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1619.00000,793.31000,Multiplan,Commercial,LT,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Multiplan,Commercial,LT,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1619.00000,793.31000,Multiplan,Commercial,RT,1521.86,,,,,,,1457.10,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Multiplan,Commercial,RT,1521.86,,,,,,,420.94,1570.43,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,inpatient,,,1224.00000,599.76000,Multiplan,Commercial,,1150.56,,,,,,,1101.60,1187.28,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,outpatient,,,1224.00000,599.76000,Multiplan,Commercial,,1150.56,,,,,,,318.24,1187.28,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,inpatient,,,3020.00000,1479.80000,Multiplan,Commercial,,2838.80,,,,,,,2718.00,2929.40,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,outpatient,,,3020.00000,1479.80000,Multiplan,Commercial,,2838.80,,,,,,,785.20,2929.40,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,inpatient,,,3624.00000,1775.76000,Multiplan,Commercial,,3406.56,,,,,,,3261.60,3515.28,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,outpatient,,,3624.00000,1775.76000,Multiplan,Commercial,,3406.56,,,,,,,942.24,3515.28,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,inpatient,,,2416.00000,1183.84000,Multiplan,Commercial,,2271.04,,,,,,,2174.40,2343.52,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,outpatient,,,2416.00000,1183.84000,Multiplan,Commercial,,2271.04,,,,,,,628.16,2343.52,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,inpatient,,,2728.00000,1336.72000,Multiplan,Commercial,,2564.32,,,,,,,2455.20,2646.16,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,outpatient,,,2728.00000,1336.72000,Multiplan,Commercial,,2564.32,,,,,,,709.28,2646.16,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,inpatient,,,3273.00000,1603.77000,Multiplan,Commercial,,3076.62,,,,,,,2945.70,3174.81,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,outpatient,,,3273.00000,1603.77000,Multiplan,Commercial,,3076.62,,,,,,,850.98,3174.81,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,inpatient,,,2182.00000,1069.18000,Multiplan,Commercial,,2051.08,,,,,,,1963.80,2116.54,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,outpatient,,,2182.00000,1069.18000,Multiplan,Commercial,,2051.08,,,,,,,567.32,2116.54,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,inpatient,,,3133.00000,1535.17000,Multiplan,Commercial,,2945.02,,,,,,,2819.70,3039.01,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,outpatient,,,3133.00000,1535.17000,Multiplan,Commercial,,2945.02,,,,,,,814.58,3039.01,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,inpatient,,,3759.00000,1841.91000,Multiplan,Commercial,,3533.46,,,,,,,3383.10,3646.23,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,outpatient,,,3759.00000,1841.91000,Multiplan,Commercial,,3533.46,,,,,,,977.34,3646.23,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,inpatient,,,2506.00000,1227.94000,Multiplan,Commercial,,2355.64,,,,,,,2255.40,2430.82,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,outpatient,,,2506.00000,1227.94000,Multiplan,Commercial,,2355.64,,,,,,,651.56,2430.82,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,inpatient,,,2857.00000,1399.93000,Multiplan,Commercial,,2685.58,,,,,,,2571.30,2771.29,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,outpatient,,,2857.00000,1399.93000,Multiplan,Commercial,,2685.58,,,,,,,742.82,2771.29,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,inpatient,,,3428.00000,1679.72000,Multiplan,Commercial,,3222.32,,,,,,,3085.20,3325.16,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,outpatient,,,3428.00000,1679.72000,Multiplan,Commercial,,3222.32,,,,,,,891.28,3325.16,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,inpatient,,,2285.00000,1119.65000,Multiplan,Commercial,,2147.90,,,,,,,2056.50,2216.45,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,outpatient,,,2285.00000,1119.65000,Multiplan,Commercial,,2147.90,,,,,,,594.10,2216.45,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,inpatient,,,3565.00000,1746.85000,Multiplan,Commercial,,3351.10,,,,,,,3208.50,3458.05,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,outpatient,,,3565.00000,1746.85000,Multiplan,Commercial,,3351.10,,,,,,,926.90,3458.05,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,inpatient,,,5918.00000,2899.82000,Multiplan,Commercial,,5562.92,,,,,,,5326.20,5740.46,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,outpatient,,,5918.00000,2899.82000,Multiplan,Commercial,,5562.92,,,,,,,1538.68,5740.46,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,inpatient,,,3301.00000,1617.49000,Multiplan,Commercial,,3102.94,,,,,,,2970.90,3201.97,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,outpatient,,,3301.00000,1617.49000,Multiplan,Commercial,,3102.94,,,,,,,858.26,3201.97,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2659.00000,1302.91000,Multiplan,Commercial,LT,2499.46,,,,,,,2393.10,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Multiplan,Commercial,LT,2499.46,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2659.00000,1302.91000,Multiplan,Commercial,RT,2499.46,,,,,,,2393.10,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Multiplan,Commercial,RT,2499.46,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2551.00000,1249.99000,Multiplan,Commercial,LT,2397.94,,,,,,,2295.90,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Multiplan,Commercial,LT,2397.94,,,,,,,663.26,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2551.00000,1249.99000,Multiplan,Commercial,RT,2397.94,,,,,,,2295.90,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Multiplan,Commercial,RT,2397.94,,,,,,,663.26,2474.47,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,inpatient,,,3806.00000,1864.94000,Multiplan,Commercial,,3577.64,,,,,,,3425.40,3691.82,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3806.00000,1864.94000,Multiplan,Commercial,,3577.64,,,,,,,989.56,3691.82,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,inpatient,,,2149.00000,694.13000,Multiplan,Commercial,,2020.06,,,,,,,1934.10,2084.53,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,outpatient,,,2149.00000,694.13000,Multiplan,Commercial,,2020.06,,,,,,,558.74,2084.53,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,inpatient,,,1973.00000,637.28000,Multiplan,Commercial,,1854.62,,,,,,,1775.70,1913.81,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,outpatient,,,1973.00000,637.28000,Multiplan,Commercial,,1854.62,,,,,,,512.98,1913.81,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1784.00000,576.23000,Multiplan,Commercial,50,1676.96,,,,,,,1605.60,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1784.00000,576.23000,Multiplan,Commercial,50,1676.96,,,,,,,463.84,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1189.00000,384.05000,Multiplan,Commercial,LT,1117.66,,,,,,,1070.10,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Multiplan,Commercial,LT,1117.66,,,,,,,309.14,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1189.00000,384.05000,Multiplan,Commercial,RT,1117.66,,,,,,,1070.10,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Multiplan,Commercial,RT,1117.66,,,,,,,309.14,1153.33,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,inpatient,,,130.00000,69.68000,Multiplan,Commercial,,122.20,,,,,,,117.00,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,outpatient,,,130.00000,69.68000,Multiplan,Commercial,,122.20,,,,,,,33.80,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,inpatient,,,44.00000,23.58000,Multiplan,Commercial,,41.36,,,,,,,39.60,42.68,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,outpatient,,,44.00000,23.58000,Multiplan,Commercial,,41.36,,,,,,,11.44,42.68,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,inpatient,,,456.00000,244.42000,Multiplan,Commercial,,428.64,,,,,,,410.40,442.32,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,outpatient,,,456.00000,244.42000,Multiplan,Commercial,,428.64,,,,,,,118.56,442.32,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,inpatient,,,108.00000,57.89000,Multiplan,Commercial,,101.52,,,,,,,97.20,104.76,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,outpatient,,,108.00000,57.89000,Multiplan,Commercial,,101.52,,,,,,,28.08,104.76,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,inpatient,,,306.00000,164.02000,Multiplan,Commercial,,287.64,,,,,,,275.40,296.82,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,outpatient,,,306.00000,164.02000,Multiplan,Commercial,,287.64,,,,,,,79.56,296.82,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,inpatient,,,257.00000,137.75000,Multiplan,Commercial,,241.58,,,,,,,231.30,249.29,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,outpatient,,,257.00000,137.75000,Multiplan,Commercial,,241.58,,,,,,,66.82,249.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4057.00000,2036.61000,Multiplan,Commercial,,3813.58,,,,,,,3651.30,3935.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Multiplan,Commercial,,3813.58,,,,,,,1054.82,3935.29,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4868.00000,2443.74000,Multiplan,Commercial,,4575.92,,,,,,,4381.20,4721.96,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Multiplan,Commercial,,4575.92,,,,,,,1265.68,4721.96,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,inpatient,,,3245.00000,1628.99000,Multiplan,Commercial,,3050.30,,,,,,,2920.50,3147.65,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Multiplan,Commercial,,3050.30,,,,,,,843.70,3147.65,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4057.00000,2036.61000,Multiplan,Commercial,,3813.58,,,,,,,3651.30,3935.29,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Multiplan,Commercial,,3813.58,,,,,,,1054.82,3935.29,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4868.00000,2443.74000,Multiplan,Commercial,,4575.92,,,,,,,4381.20,4721.96,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Multiplan,Commercial,,4575.92,,,,,,,1265.68,4721.96,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,inpatient,,,3245.00000,1628.99000,Multiplan,Commercial,,3050.30,,,,,,,2920.50,3147.65,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Multiplan,Commercial,,3050.30,,,,,,,843.70,3147.65,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,inpatient,,,1725.00000,865.95000,Multiplan,Commercial,,1621.50,,,,,,,1552.50,1673.25,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,outpatient,,,1725.00000,865.95000,Multiplan,Commercial,,1621.50,,,,,,,448.50,1673.25,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,inpatient,,,1743.00000,874.99000,Multiplan,Commercial,,1638.42,,,,,,,1568.70,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,outpatient,,,1743.00000,874.99000,Multiplan,Commercial,,1638.42,,,,,,,453.18,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,inpatient,,,1475.00000,740.45000,Multiplan,Commercial,LT,1386.50,,,,,,,1327.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Multiplan,Commercial,LT,1386.50,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,inpatient,,,1475.00000,740.45000,Multiplan,Commercial,RT,1386.50,,,,,,,1327.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Multiplan,Commercial,RT,1386.50,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,inpatient,,,1162.00000,583.32000,Multiplan,Commercial,,1092.28,,,,,,,1045.80,1127.14,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,outpatient,,,1162.00000,583.32000,Multiplan,Commercial,,1092.28,,,,,,,302.12,1127.14,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,inpatient,,,983.00000,493.47000,Multiplan,Commercial,LT,924.02,,,,,,,884.70,953.51,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Multiplan,Commercial,LT,924.02,,,,,,,255.58,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,inpatient,,,983.00000,493.47000,Multiplan,Commercial,RT,924.02,,,,,,,884.70,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Multiplan,Commercial,RT,924.02,,,,,,,255.58,953.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,inpatient,,,3183.00000,1597.87000,Multiplan,Commercial,,2992.02,,,,,,,2864.70,3087.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,outpatient,,,3183.00000,1597.87000,Multiplan,Commercial,,2992.02,,,,,,,827.58,3087.51,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,inpatient,,,3819.00000,1917.14000,Multiplan,Commercial,,3589.86,,,,,,,3437.10,3704.43,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,outpatient,,,3819.00000,1917.14000,Multiplan,Commercial,,3589.86,,,,,,,992.94,3704.43,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,inpatient,,,2546.00000,1278.09000,Multiplan,Commercial,,2393.24,,,,,,,2291.40,2469.62,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,outpatient,,,2546.00000,1278.09000,Multiplan,Commercial,,2393.24,,,,,,,661.96,2469.62,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,inpatient,,,3858.00000,1936.72000,Multiplan,Commercial,LT,3626.52,,,,,,,3472.20,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Multiplan,Commercial,LT,3626.52,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,inpatient,,,3858.00000,1936.72000,Multiplan,Commercial,RT,3626.52,,,,,,,3472.20,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Multiplan,Commercial,RT,3626.52,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,inpatient,,,4629.00000,2323.76000,Multiplan,Commercial,LT,4351.26,,,,,,,4166.10,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Multiplan,Commercial,LT,4351.26,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,inpatient,,,4629.00000,2323.76000,Multiplan,Commercial,RT,4351.26,,,,,,,4166.10,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Multiplan,Commercial,RT,4351.26,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,inpatient,,,3086.00000,1549.17000,Multiplan,Commercial,LT,2900.84,,,,,,,2777.40,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Multiplan,Commercial,LT,2900.84,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,inpatient,,,3086.00000,1549.17000,Multiplan,Commercial,RT,2900.84,,,,,,,2777.40,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Multiplan,Commercial,RT,2900.84,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,inpatient,,,2505.00000,1257.51000,Multiplan,Commercial,LT,2354.70,,,,,,,2254.50,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Multiplan,Commercial,LT,2354.70,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,inpatient,,,2505.00000,1257.51000,Multiplan,Commercial,RT,2354.70,,,,,,,2254.50,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Multiplan,Commercial,RT,2354.70,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,inpatient,,,3006.00000,1509.01000,Multiplan,Commercial,LT,2825.64,,,,,,,2705.40,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Multiplan,Commercial,LT,2825.64,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,inpatient,,,3006.00000,1509.01000,Multiplan,Commercial,RT,2825.64,,,,,,,2705.40,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Multiplan,Commercial,RT,2825.64,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,inpatient,,,2004.00000,1006.01000,Multiplan,Commercial,LT,1883.76,,,,,,,1803.60,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Multiplan,Commercial,LT,1883.76,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,inpatient,,,2004.00000,1006.01000,Multiplan,Commercial,RT,1883.76,,,,,,,1803.60,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Multiplan,Commercial,RT,1883.76,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,inpatient,,,3137.00000,1574.77000,Multiplan,Commercial,LT,2948.78,,,,,,,2823.30,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Multiplan,Commercial,LT,2948.78,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,inpatient,,,3137.00000,1574.77000,Multiplan,Commercial,RT,2948.78,,,,,,,2823.30,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Multiplan,Commercial,RT,2948.78,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,inpatient,,,3764.00000,1889.53000,Multiplan,Commercial,LT,3538.16,,,,,,,3387.60,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Multiplan,Commercial,LT,3538.16,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,inpatient,,,3764.00000,1889.53000,Multiplan,Commercial,RT,3538.16,,,,,,,3387.60,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Multiplan,Commercial,RT,3538.16,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,inpatient,,,2509.00000,1259.52000,Multiplan,Commercial,LT,2358.46,,,,,,,2258.10,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Multiplan,Commercial,LT,2358.46,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,inpatient,,,2509.00000,1259.52000,Multiplan,Commercial,RT,2358.46,,,,,,,2258.10,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Multiplan,Commercial,RT,2358.46,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,inpatient,,,3023.00000,1517.55000,Multiplan,Commercial,LT,2841.62,,,,,,,2720.70,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Multiplan,Commercial,LT,2841.62,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,inpatient,,,3023.00000,1517.55000,Multiplan,Commercial,RT,2841.62,,,,,,,2720.70,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Multiplan,Commercial,RT,2841.62,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,inpatient,,,3627.00000,1820.75000,Multiplan,Commercial,LT,3409.38,,,,,,,3264.30,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Multiplan,Commercial,LT,3409.38,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,inpatient,,,3627.00000,1820.75000,Multiplan,Commercial,RT,3409.38,,,,,,,3264.30,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Multiplan,Commercial,RT,3409.38,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,inpatient,,,2418.00000,1213.84000,Multiplan,Commercial,LT,2272.92,,,,,,,2176.20,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Multiplan,Commercial,LT,2272.92,,,,,,,628.68,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,inpatient,,,2418.00000,1213.84000,Multiplan,Commercial,RT,2272.92,,,,,,,2176.20,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Multiplan,Commercial,RT,2272.92,,,,,,,628.68,2345.46,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,inpatient,,,870.00000,436.74000,Multiplan,Commercial,,817.80,,,,,,,783.00,843.90,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,outpatient,,,870.00000,436.74000,Multiplan,Commercial,,817.80,,,,,,,226.20,843.90,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,inpatient,,,1353.00000,679.21000,Multiplan,Commercial,,1271.82,,,,,,,1217.70,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,outpatient,,,1353.00000,679.21000,Multiplan,Commercial,,1271.82,,,,,,,351.78,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,inpatient,,,902.00000,452.80000,Multiplan,Commercial,LT,847.88,,,,,,,811.80,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Multiplan,Commercial,LT,847.88,,,,,,,234.52,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,inpatient,,,902.00000,452.80000,Multiplan,Commercial,RT,847.88,,,,,,,811.80,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Multiplan,Commercial,RT,847.88,,,,,,,234.52,874.94,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,inpatient,,,3489.00000,1751.48000,Multiplan,Commercial,,3279.66,,,,,,,3140.10,3384.33,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3489.00000,1751.48000,Multiplan,Commercial,,3279.66,,,,,,,907.14,3384.33,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,inpatient,,,4187.00000,2101.87000,Multiplan,Commercial,,3935.78,,,,,,,3768.30,4061.39,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,outpatient,,,4187.00000,2101.87000,Multiplan,Commercial,,3935.78,,,,,,,1088.62,4061.39,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,inpatient,,,2791.00000,1401.08000,Multiplan,Commercial,,2623.54,,,,,,,2511.90,2707.27,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,outpatient,,,2791.00000,1401.08000,Multiplan,Commercial,,2623.54,,,,,,,725.66,2707.27,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,inpatient,,,492.00000,246.98000,Multiplan,Commercial,,462.48,,,,,,,442.80,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,outpatient,,,492.00000,246.98000,Multiplan,Commercial,,462.48,,,,,,,127.92,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,inpatient,,,331.00000,166.16000,Multiplan,Commercial,,311.14,,,,,,,297.90,321.07,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,outpatient,,,331.00000,166.16000,Multiplan,Commercial,,311.14,,,,,,,86.06,321.07,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,inpatient,,,4440.00000,2357.64000,Multiplan,Commercial,,4173.60,,,,,,,3996.00,4306.80,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,outpatient,,,4440.00000,2357.64000,Multiplan,Commercial,,4173.60,,,,,,,1154.40,4306.80,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,inpatient,,,5328.00000,2829.17000,Multiplan,Commercial,,5008.32,,,,,,,4795.20,5168.16,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,outpatient,,,5328.00000,2829.17000,Multiplan,Commercial,,5008.32,,,,,,,1385.28,5168.16,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,inpatient,,,3552.00000,1886.11000,Multiplan,Commercial,,3338.88,,,,,,,3196.80,3445.44,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,outpatient,,,3552.00000,1886.11000,Multiplan,Commercial,,3338.88,,,,,,,923.52,3445.44,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,inpatient,,,2528.00000,1342.37000,Multiplan,Commercial,,2376.32,,,,,,,2275.20,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,outpatient,,,2528.00000,1342.37000,Multiplan,Commercial,,2376.32,,,,,,,657.28,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,inpatient,,,3033.00000,1610.52000,Multiplan,Commercial,,2851.02,,,,,,,2729.70,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,outpatient,,,3033.00000,1610.52000,Multiplan,Commercial,,2851.02,,,,,,,788.58,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,inpatient,,,2022.00000,1073.68000,Multiplan,Commercial,,1900.68,,,,,,,1819.80,1961.34,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,outpatient,,,2022.00000,1073.68000,Multiplan,Commercial,,1900.68,,,,,,,525.72,1961.34,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,inpatient,,,3610.00000,1909.69000,Multiplan,Commercial,,3393.40,,,,,,,3249.00,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,outpatient,,,3610.00000,1909.69000,Multiplan,Commercial,,3393.40,,,,,,,938.60,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,inpatient,,,4332.00000,2291.63000,Multiplan,Commercial,,4072.08,,,,,,,3898.80,4202.04,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,outpatient,,,4332.00000,2291.63000,Multiplan,Commercial,,4072.08,,,,,,,1126.32,4202.04,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,inpatient,,,2888.00000,1527.75000,Multiplan,Commercial,,2714.72,,,,,,,2599.20,2801.36,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,outpatient,,,2888.00000,1527.75000,Multiplan,Commercial,,2714.72,,,,,,,750.88,2801.36,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,inpatient,,,4532.00000,2397.43000,Multiplan,Commercial,,4260.08,,,,,,,4078.80,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,outpatient,,,4532.00000,2397.43000,Multiplan,Commercial,,4260.08,,,,,,,1178.32,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,inpatient,,,5438.00000,2876.70000,Multiplan,Commercial,,5111.72,,,,,,,4894.20,5274.86,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,outpatient,,,5438.00000,2876.70000,Multiplan,Commercial,,5111.72,,,,,,,1413.88,5274.86,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,inpatient,,,3625.00000,1917.62000,Multiplan,Commercial,,3407.50,,,,,,,3262.50,3516.25,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,outpatient,,,3625.00000,1917.62000,Multiplan,Commercial,,3407.50,,,,,,,942.50,3516.25,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,inpatient,,,3639.00000,1925.03000,Multiplan,Commercial,,3420.66,,,,,,,3275.10,3529.83,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,outpatient,,,3639.00000,1925.03000,Multiplan,Commercial,,3420.66,,,,,,,946.14,3529.83,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,inpatient,,,4367.00000,2310.14000,Multiplan,Commercial,,4104.98,,,,,,,3930.30,4235.99,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,outpatient,,,4367.00000,2310.14000,Multiplan,Commercial,,4104.98,,,,,,,1135.42,4235.99,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,inpatient,,,2911.00000,1539.92000,Multiplan,Commercial,,2736.34,,,,,,,2619.90,2823.67,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,outpatient,,,2911.00000,1539.92000,Multiplan,Commercial,,2736.34,,,,,,,756.86,2823.67,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,inpatient,,,3494.00000,1719.05000,Multiplan,Commercial,,3284.36,,,,,,,3144.60,3389.18,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3494.00000,1719.05000,Multiplan,Commercial,,3284.36,,,,,,,908.44,3389.18,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,inpatient,,,4193.00000,2062.96000,Multiplan,Commercial,,3941.42,,,,,,,3773.70,4067.21,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,outpatient,,,4193.00000,2062.96000,Multiplan,Commercial,,3941.42,,,,,,,1090.18,4067.21,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,inpatient,,,2795.00000,1375.14000,Multiplan,Commercial,,2627.30,,,,,,,2515.50,2711.15,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,outpatient,,,2795.00000,1375.14000,Multiplan,Commercial,,2627.30,,,,,,,726.70,2711.15,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,inpatient,,,2717.00000,1336.76000,Multiplan,Commercial,,2553.98,,,,,,,2445.30,2635.49,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,outpatient,,,2717.00000,1336.76000,Multiplan,Commercial,,2553.98,,,,,,,706.42,2635.49,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,inpatient,,,3260.00000,1603.92000,Multiplan,Commercial,,3064.40,,,,,,,2934.00,3162.20,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,outpatient,,,3260.00000,1603.92000,Multiplan,Commercial,,3064.40,,,,,,,847.60,3162.20,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,inpatient,,,2173.00000,1069.12000,Multiplan,Commercial,,2042.62,,,,,,,1955.70,2107.81,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,outpatient,,,2173.00000,1069.12000,Multiplan,Commercial,,2042.62,,,,,,,564.98,2107.81,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4051.00000,2301.58000,Multiplan,Commercial,LT,3807.94,,,,,,,3645.90,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Multiplan,Commercial,LT,3807.94,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4051.00000,2301.58000,Multiplan,Commercial,RT,3807.94,,,,,,,3645.90,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Multiplan,Commercial,RT,3807.94,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4861.00000,2761.78000,Multiplan,Commercial,LT,4569.34,,,,,,,4374.90,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Multiplan,Commercial,LT,4569.34,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4861.00000,2761.78000,Multiplan,Commercial,RT,4569.34,,,,,,,4374.90,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Multiplan,Commercial,RT,4569.34,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3241.00000,1841.37000,Multiplan,Commercial,LT,3046.54,,,,,,,2916.90,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Multiplan,Commercial,LT,3046.54,,,,,,,842.66,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3241.00000,1841.37000,Multiplan,Commercial,RT,3046.54,,,,,,,2916.90,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Multiplan,Commercial,RT,3046.54,,,,,,,842.66,3143.77,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,inpatient,,,4260.00000,2420.32000,Multiplan,Commercial,,4004.40,,,,,,,3834.00,4132.20,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,outpatient,,,4260.00000,2420.32000,Multiplan,Commercial,,4004.40,,,,,,,1107.60,4132.20,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,inpatient,,,5112.00000,2904.38000,Multiplan,Commercial,,4805.28,,,,,,,4600.80,4958.64,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,outpatient,,,5112.00000,2904.38000,Multiplan,Commercial,,4805.28,,,,,,,1329.12,4958.64,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,inpatient,,,3408.00000,1936.26000,Multiplan,Commercial,,3203.52,,,,,,,3067.20,3305.76,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3408.00000,1936.26000,Multiplan,Commercial,,3203.52,,,,,,,886.08,3305.76,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,inpatient,,,3343.00000,1899.33000,Multiplan,Commercial,,3142.42,,,,,,,3008.70,3242.71,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3343.00000,1899.33000,Multiplan,Commercial,,3142.42,,,,,,,869.18,3242.71,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,inpatient,,,4010.00000,2278.28000,Multiplan,Commercial,,3769.40,,,,,,,3609.00,3889.70,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,outpatient,,,4010.00000,2278.28000,Multiplan,Commercial,,3769.40,,,,,,,1042.60,3889.70,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,inpatient,,,2674.00000,1519.23000,Multiplan,Commercial,,2513.56,,,,,,,2406.60,2593.78,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,outpatient,,,2674.00000,1519.23000,Multiplan,Commercial,,2513.56,,,,,,,695.24,2593.78,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3294.00000,1871.49000,Multiplan,Commercial,LT,3096.36,,,,,,,2964.60,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Multiplan,Commercial,LT,3096.36,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3294.00000,1871.49000,Multiplan,Commercial,RT,3096.36,,,,,,,2964.60,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Multiplan,Commercial,RT,3096.36,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3953.00000,2245.90000,Multiplan,Commercial,LT,3715.82,,,,,,,3557.70,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Multiplan,Commercial,LT,3715.82,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3953.00000,2245.90000,Multiplan,Commercial,RT,3715.82,,,,,,,3557.70,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Multiplan,Commercial,RT,3715.82,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,inpatient,,,2635.00000,1497.08000,Multiplan,Commercial,LT,2476.90,,,,,,,2371.50,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Multiplan,Commercial,LT,2476.90,,,,,,,685.10,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,inpatient,,,2635.00000,1497.08000,Multiplan,Commercial,RT,2476.90,,,,,,,2371.50,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Multiplan,Commercial,RT,2476.90,,,,,,,685.10,2555.95,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,inpatient,,,3664.00000,2081.70000,Multiplan,Commercial,,3444.16,,,,,,,3297.60,3554.08,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3664.00000,2081.70000,Multiplan,Commercial,,3444.16,,,,,,,952.64,3554.08,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,inpatient,,,4397.00000,2498.16000,Multiplan,Commercial,,4133.18,,,,,,,3957.30,4265.09,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,outpatient,,,4397.00000,2498.16000,Multiplan,Commercial,,4133.18,,,,,,,1143.22,4265.09,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,inpatient,,,2931.00000,1665.25000,Multiplan,Commercial,,2755.14,,,,,,,2637.90,2843.07,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,outpatient,,,2931.00000,1665.25000,Multiplan,Commercial,,2755.14,,,,,,,762.06,2843.07,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,inpatient,,,4759.00000,2703.83000,Multiplan,Commercial,,4473.46,,,,,,,4283.10,4616.23,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,outpatient,,,4759.00000,2703.83000,Multiplan,Commercial,,4473.46,,,,,,,1237.34,4616.23,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,inpatient,,,5710.00000,3244.14000,Multiplan,Commercial,,5367.40,,,,,,,5139.00,5538.70,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,outpatient,,,5710.00000,3244.14000,Multiplan,Commercial,,5367.40,,,,,,,1484.60,5538.70,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,inpatient,,,3807.00000,2162.95000,Multiplan,Commercial,,3578.58,,,,,,,3426.30,3692.79,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3807.00000,2162.95000,Multiplan,Commercial,,3578.58,,,,,,,989.82,3692.79,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,inpatient,,,2915.00000,1574.10000,Multiplan,Commercial,,2740.10,,,,,,,2623.50,2827.55,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2915.00000,1574.10000,Multiplan,Commercial,,2740.10,,,,,,,757.90,2827.55,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,inpatient,,,1918.00000,1035.72000,Multiplan,Commercial,,1802.92,,,,,,,1726.20,1860.46,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1918.00000,1035.72000,Multiplan,Commercial,,1802.92,,,,,,,498.68,1860.46,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,inpatient,,,2292.00000,1237.68000,Multiplan,Commercial,,2154.48,,,,,,,2062.80,2223.24,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2292.00000,1237.68000,Multiplan,Commercial,,2154.48,,,,,,,595.92,2223.24,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,inpatient,,,2984.00000,1611.36000,Multiplan,Commercial,,2804.96,,,,,,,2685.60,2894.48,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,outpatient,,,2984.00000,1611.36000,Multiplan,Commercial,,2804.96,,,,,,,775.84,2894.48,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,inpatient,,,769.00000,415.26000,Multiplan,Commercial,,722.86,,,,,,,692.10,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,outpatient,,,769.00000,415.26000,Multiplan,Commercial,,722.86,,,,,,,199.94,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,inpatient,,,1280.00000,691.20000,Multiplan,Commercial,,1203.20,,,,,,,1152.00,1241.60,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,outpatient,,,1280.00000,691.20000,Multiplan,Commercial,,1203.20,,,,,,,332.80,1241.60,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,inpatient,,,1878.00000,1014.12000,Multiplan,Commercial,,1765.32,,,,,,,1690.20,1821.66,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,outpatient,,,1878.00000,1014.12000,Multiplan,Commercial,,1765.32,,,,,,,488.28,1821.66,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,inpatient,,,2196.00000,1185.84000,Multiplan,Commercial,,2064.24,,,,,,,1976.40,2130.12,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,outpatient,,,2196.00000,1185.84000,Multiplan,Commercial,,2064.24,,,,,,,570.96,2130.12,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,inpatient,,,844.00000,455.76000,Multiplan,Commercial,,793.36,,,,,,,759.60,818.68,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,outpatient,,,844.00000,455.76000,Multiplan,Commercial,,793.36,,,,,,,219.44,818.68,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,inpatient,,,1305.00000,704.70000,Multiplan,Commercial,,1226.70,,,,,,,1174.50,1265.85,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,outpatient,,,1305.00000,704.70000,Multiplan,Commercial,,1226.70,,,,,,,339.30,1265.85,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,inpatient,,,576.00000,311.04000,Multiplan,Commercial,,541.44,,,,,,,518.40,558.72,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,outpatient,,,576.00000,311.04000,Multiplan,Commercial,,541.44,,,,,,,149.76,558.72,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,inpatient,,,809.00000,436.86000,Multiplan,Commercial,,760.46,,,,,,,728.10,784.73,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,outpatient,,,809.00000,436.86000,Multiplan,Commercial,,760.46,,,,,,,210.34,784.73,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,inpatient,,,2462.00000,1329.48000,Multiplan,Commercial,,2314.28,,,,,,,2215.80,2388.14,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,outpatient,,,2462.00000,1329.48000,Multiplan,Commercial,,2314.28,,,,,,,640.12,2388.14,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,inpatient,,,918.00000,495.72000,Multiplan,Commercial,,862.92,,,,,,,826.20,890.46,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,outpatient,,,918.00000,495.72000,Multiplan,Commercial,,862.92,,,,,,,238.68,890.46,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,inpatient,,,1102.00000,595.08000,Multiplan,Commercial,,1035.88,,,,,,,991.80,1068.94,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,outpatient,,,1102.00000,595.08000,Multiplan,Commercial,,1035.88,,,,,,,286.52,1068.94,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,inpatient,,,812.00000,438.48000,Multiplan,Commercial,,763.28,,,,,,,730.80,787.64,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,outpatient,,,812.00000,438.48000,Multiplan,Commercial,,763.28,,,,,,,211.12,787.64,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,inpatient,,,1407.00000,759.78000,Multiplan,Commercial,,1322.58,,,,,,,1266.30,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,outpatient,,,1407.00000,759.78000,Multiplan,Commercial,,1322.58,,,,,,,365.82,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,inpatient,,,1980.00000,1069.20000,Multiplan,Commercial,,1861.20,,,,,,,1782.00,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,outpatient,,,1980.00000,1069.20000,Multiplan,Commercial,,1861.20,,,,,,,514.80,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,inpatient,,,964.00000,520.56000,Multiplan,Commercial,,906.16,,,,,,,867.60,935.08,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,outpatient,,,964.00000,520.56000,Multiplan,Commercial,,906.16,,,,,,,250.64,935.08,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,inpatient,,,1040.00000,561.60000,Multiplan,Commercial,,977.60,,,,,,,936.00,1008.80,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,outpatient,,,1040.00000,561.60000,Multiplan,Commercial,,977.60,,,,,,,270.40,1008.80,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,inpatient,,,795.00000,429.30000,Multiplan,Commercial,,747.30,,,,,,,715.50,771.15,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,outpatient,,,795.00000,429.30000,Multiplan,Commercial,,747.30,,,,,,,206.70,771.15,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,inpatient,,,1124.00000,606.96000,Multiplan,Commercial,,1056.56,,,,,,,1011.60,1090.28,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,outpatient,,,1124.00000,606.96000,Multiplan,Commercial,,1056.56,,,,,,,292.24,1090.28,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,inpatient,,,736.00000,397.44000,Multiplan,Commercial,,691.84,,,,,,,662.40,713.92,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,outpatient,,,736.00000,397.44000,Multiplan,Commercial,,691.84,,,,,,,191.36,713.92,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,inpatient,,,700.00000,378.00000,Multiplan,Commercial,,658.00,,,,,,,630.00,679.00,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,outpatient,,,700.00000,378.00000,Multiplan,Commercial,,658.00,,,,,,,182.00,679.00,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,inpatient,,,821.00000,443.34000,Multiplan,Commercial,,771.74,,,,,,,738.90,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,outpatient,,,821.00000,443.34000,Multiplan,Commercial,,771.74,,,,,,,213.46,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,inpatient,,,846.00000,456.84000,Multiplan,Commercial,,795.24,,,,,,,761.40,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,outpatient,,,846.00000,456.84000,Multiplan,Commercial,,795.24,,,,,,,219.96,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,inpatient,,,958.00000,517.32000,Multiplan,Commercial,,900.52,,,,,,,862.20,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,outpatient,,,958.00000,517.32000,Multiplan,Commercial,,900.52,,,,,,,249.08,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,inpatient,,,1261.00000,680.94000,Multiplan,Commercial,,1185.34,,,,,,,1134.90,1223.17,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,outpatient,,,1261.00000,680.94000,Multiplan,Commercial,,1185.34,,,,,,,327.86,1223.17,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,inpatient,,,971.00000,524.34000,Multiplan,Commercial,,912.74,,,,,,,873.90,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,outpatient,,,971.00000,524.34000,Multiplan,Commercial,,912.74,,,,,,,252.46,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,inpatient,,,1837.00000,991.98000,Multiplan,Commercial,,1726.78,,,,,,,1653.30,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,outpatient,,,1837.00000,991.98000,Multiplan,Commercial,,1726.78,,,,,,,477.62,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,inpatient,,,1099.00000,593.46000,Multiplan,Commercial,,1033.06,,,,,,,989.10,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,outpatient,,,1099.00000,593.46000,Multiplan,Commercial,,1033.06,,,,,,,285.74,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,inpatient,,,2178.00000,1176.12000,Multiplan,Commercial,,2047.32,,,,,,,1960.20,2112.66,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,outpatient,,,2178.00000,1176.12000,Multiplan,Commercial,,2047.32,,,,,,,566.28,2112.66,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,inpatient,,,1226.00000,662.04000,Multiplan,Commercial,,1152.44,,,,,,,1103.40,1189.22,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,outpatient,,,1226.00000,662.04000,Multiplan,Commercial,,1152.44,,,,,,,318.76,1189.22,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,inpatient,,,1048.00000,565.92000,Multiplan,Commercial,,985.12,,,,,,,943.20,1016.56,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,outpatient,,,1048.00000,565.92000,Multiplan,Commercial,,985.12,,,,,,,272.48,1016.56,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,inpatient,,,970.00000,523.80000,Multiplan,Commercial,,911.80,,,,,,,873.00,940.90,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,outpatient,,,970.00000,523.80000,Multiplan,Commercial,,911.80,,,,,,,252.20,940.90,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,inpatient,,,1803.00000,973.62000,Multiplan,Commercial,,1694.82,,,,,,,1622.70,1748.91,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,outpatient,,,1803.00000,973.62000,Multiplan,Commercial,,1694.82,,,,,,,468.78,1748.91,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,inpatient,,,2504.00000,1352.16000,Multiplan,Commercial,,2353.76,,,,,,,2253.60,2428.88,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,outpatient,,,2504.00000,1352.16000,Multiplan,Commercial,,2353.76,,,,,,,651.04,2428.88,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,inpatient,,,2457.00000,1326.78000,Multiplan,Commercial,,2309.58,,,,,,,2211.30,2383.29,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2457.00000,1326.78000,Multiplan,Commercial,,2309.58,,,,,,,638.82,2383.29,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,inpatient,,,923.00000,498.42000,Multiplan,Commercial,,867.62,,,,,,,830.70,895.31,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,outpatient,,,923.00000,498.42000,Multiplan,Commercial,,867.62,,,,,,,239.98,895.31,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,inpatient,,,5478.00000,2958.12000,Multiplan,Commercial,,5149.32,,,,,,,4930.20,5313.66,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,outpatient,,,5478.00000,2958.12000,Multiplan,Commercial,,5149.32,,,,,,,1424.28,5313.66,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,inpatient,,,4551.00000,2457.54000,Multiplan,Commercial,,4277.94,,,,,,,4095.90,4414.47,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,outpatient,,,4551.00000,2457.54000,Multiplan,Commercial,,4277.94,,,,,,,1183.26,4414.47,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,inpatient,,,1360.00000,734.40000,Multiplan,Commercial,,1278.40,,,,,,,1224.00,1319.20,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,outpatient,,,1360.00000,734.40000,Multiplan,Commercial,,1278.40,,,,,,,353.60,1319.20,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,inpatient,,,1209.00000,652.86000,Multiplan,Commercial,,1136.46,,,,,,,1088.10,1172.73,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,outpatient,,,1209.00000,652.86000,Multiplan,Commercial,,1136.46,,,,,,,314.34,1172.73,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,inpatient,,,848.00000,457.92000,Multiplan,Commercial,,797.12,,,,,,,763.20,822.56,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,outpatient,,,848.00000,457.92000,Multiplan,Commercial,,797.12,,,,,,,220.48,822.56,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,inpatient,,,1071.00000,578.34000,Multiplan,Commercial,,1006.74,,,,,,,963.90,1038.87,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,outpatient,,,1071.00000,578.34000,Multiplan,Commercial,,1006.74,,,,,,,278.46,1038.87,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,inpatient,,,1792.00000,967.68000,Multiplan,Commercial,,1684.48,,,,,,,1612.80,1738.24,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,outpatient,,,1792.00000,967.68000,Multiplan,Commercial,,1684.48,,,,,,,465.92,1738.24,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,inpatient,,,35.00000,18.90000,Multiplan,Commercial,,32.90,,,,,,,31.50,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,outpatient,,,35.00000,18.90000,Multiplan,Commercial,,32.90,,,,,,,9.10,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,inpatient,,,285.00000,153.90000,Multiplan,Commercial,,267.90,,,,,,,256.50,276.45,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,outpatient,,,285.00000,153.90000,Multiplan,Commercial,,267.90,,,,,,,74.10,276.45,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,inpatient,,,1012.00000,546.48000,Multiplan,Commercial,,951.28,,,,,,,910.80,981.64,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,outpatient,,,1012.00000,546.48000,Multiplan,Commercial,,951.28,,,,,,,263.12,981.64,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,inpatient,,,492.00000,265.68000,Multiplan,Commercial,,462.48,,,,,,,442.80,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,outpatient,,,492.00000,265.68000,Multiplan,Commercial,,462.48,,,,,,,127.92,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,inpatient,,,739.00000,399.06000,Multiplan,Commercial,,694.66,,,,,,,665.10,716.83,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,outpatient,,,739.00000,399.06000,Multiplan,Commercial,,694.66,,,,,,,192.14,716.83,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,inpatient,,,515.00000,278.10000,Multiplan,Commercial,,484.10,,,,,,,463.50,499.55,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,outpatient,,,515.00000,278.10000,Multiplan,Commercial,,484.10,,,,,,,133.90,499.55,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,inpatient,,,1467.00000,792.18000,Multiplan,Commercial,,1378.98,,,,,,,1320.30,1422.99,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,outpatient,,,1467.00000,792.18000,Multiplan,Commercial,,1378.98,,,,,,,381.42,1422.99,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,inpatient,,,1683.00000,888.62000,Multiplan,Commercial,,1582.02,,,,,,,1514.70,1632.51,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,outpatient,,,1683.00000,888.62000,Multiplan,Commercial,,1582.02,,,,,,,437.58,1632.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,inpatient,,,426.30000,225.09000,Multiplan,Commercial,,400.72,,,,,,,383.67,413.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,426.30000,225.09000,Multiplan,Commercial,,400.72,,,,,,,110.84,413.51,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,inpatient,,,725.00000,382.80000,Multiplan,Commercial,,681.50,,,,,,,652.50,703.25,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,725.00000,382.80000,Multiplan,Commercial,,681.50,,,,,,,188.50,1855.42,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,inpatient,,,1852.00000,977.86000,Multiplan,Commercial,,1740.88,,,,,,,1666.80,1796.44,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,1852.00000,977.86000,Multiplan,Commercial,,1740.88,,,,,,,481.52,1868.26,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,110.00000,58.08000,Multiplan,Commercial,,103.40,,,,,,,99.00,106.70,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,110.00000,58.08000,Multiplan,Commercial,,103.40,,,,,,,28.60,106.70,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,inpatient,,,98.00000,51.74000,Multiplan,Commercial,,92.12,,,,,,,88.20,95.06,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,98.00000,51.74000,Multiplan,Commercial,,92.12,,,,,,,25.48,1662.92,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,inpatient,,,2018.00000,1065.50000,Multiplan,Commercial,,1896.92,,,,,,,1816.20,1957.46,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,2018.00000,1065.50000,Multiplan,Commercial,,1896.92,,,,,,,524.68,1957.46,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,inpatient,,,4325.00000,2283.60000,Multiplan,Commercial,,4065.50,,,,,,,3892.50,4195.25,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,4325.00000,2283.60000,Multiplan,Commercial,,4065.50,,,,,,,1124.50,4195.25,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,inpatient,,,172.00000,90.82000,Multiplan,Commercial,,161.68,,,,,,,154.80,166.84,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Multiplan,Commercial,,161.68,,,,,,,44.72,166.84,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,inpatient,,,942.00000,497.38000,Multiplan,Commercial,,885.48,,,,,,,847.80,913.74,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,942.00000,497.38000,Multiplan,Commercial,,885.48,,,,,,,244.92,913.74,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,inpatient,,,413.00000,218.06000,Multiplan,Commercial,,388.22,,,,,,,371.70,400.61,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,413.00000,218.06000,Multiplan,Commercial,,388.22,,,,,,,107.38,400.61,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,inpatient,,,257.00000,135.70000,Multiplan,Commercial,,241.58,,,,,,,231.30,249.29,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,outpatient,,,257.00000,135.70000,Multiplan,Commercial,,241.58,,,,,,,66.82,249.29,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,inpatient,,,116.00000,61.25000,Multiplan,Commercial,,109.04,,,,,,,104.40,112.52,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,116.00000,61.25000,Multiplan,Commercial,,109.04,,,,,,,30.16,112.52,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,inpatient,,,463.20000,244.57000,Multiplan,Commercial,,435.41,,,,,,,416.88,449.30,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,463.20000,244.57000,Multiplan,Commercial,,435.41,,,,,,,120.43,449.30,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,inpatient,,,804.00000,424.51000,Multiplan,Commercial,,755.76,,,,,,,723.60,779.88,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,804.00000,424.51000,Multiplan,Commercial,,755.76,,,,,,,209.04,779.88,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,inpatient,,,172.00000,90.82000,Multiplan,Commercial,,161.68,,,,,,,154.80,166.84,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Multiplan,Commercial,,161.68,,,,,,,44.72,166.84,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,inpatient,,,354.30000,187.07000,Multiplan,Commercial,,333.04,,,,,,,318.87,343.67,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,354.30000,187.07000,Multiplan,Commercial,,333.04,,,,,,,92.12,343.67,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,inpatient,,,277.90000,146.73000,Multiplan,Commercial,,261.23,,,,,,,250.11,269.56,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,277.90000,146.73000,Multiplan,Commercial,,261.23,,,,,,,72.25,269.56,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,inpatient,,,200.00000,105.60000,Multiplan,Commercial,,188.00,,,,,,,180.00,194.00,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,200.00000,105.60000,Multiplan,Commercial,,188.00,,,,,,,52.00,194.00,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,inpatient,,,197.00000,63.63000,Multiplan,Commercial,,185.18,,,,,,,177.30,191.09,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,outpatient,,,197.00000,63.63000,Multiplan,Commercial,,185.18,,,,,,,51.22,191.09,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,inpatient,,,468.00000,151.16000,Multiplan,Commercial,50,439.92,,,,,,,421.20,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,outpatient,,,468.00000,151.16000,Multiplan,Commercial,50,439.92,,,,,,,121.68,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,inpatient,,,312.00000,100.78000,Multiplan,Commercial,LT,293.28,,,,,,,280.80,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Multiplan,Commercial,LT,293.28,,,,,,,81.12,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,inpatient,,,312.00000,100.78000,Multiplan,Commercial,RT,293.28,,,,,,,280.80,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Multiplan,Commercial,RT,293.28,,,,,,,81.12,302.64,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Multiplan,Commercial,,425.82,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Multiplan,Commercial,,425.82,,,,,,,117.78,439.41,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,inpatient,,,609.00000,196.71000,Multiplan,Commercial,,572.46,,,,,,,548.10,590.73,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Multiplan,Commercial,,572.46,,,,,,,158.34,590.73,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,inpatient,,,1248.00000,403.10000,Multiplan,Commercial,50,1173.12,,,,,,,1123.20,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1248.00000,403.10000,Multiplan,Commercial,50,1173.12,,,,,,,324.48,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,inpatient,,,832.00000,268.74000,Multiplan,Commercial,LT,782.08,,,,,,,748.80,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Multiplan,Commercial,LT,782.08,,,,,,,216.32,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,inpatient,,,832.00000,268.74000,Multiplan,Commercial,RT,782.08,,,,,,,748.80,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Multiplan,Commercial,RT,782.08,,,,,,,216.32,807.04,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,inpatient,,,4235.00000,1367.90000,Multiplan,Commercial,LT,3980.90,,,,,,,3811.50,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Multiplan,Commercial,LT,3980.90,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,inpatient,,,4235.00000,1367.90000,Multiplan,Commercial,RT,3980.90,,,,,,,3811.50,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Multiplan,Commercial,RT,3980.90,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,inpatient,,,2119.00000,684.44000,Multiplan,Commercial,,1991.86,,,,,,,1907.10,2055.43,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,outpatient,,,2119.00000,684.44000,Multiplan,Commercial,,1991.86,,,,,,,550.94,2055.43,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,inpatient,,,1943.00000,627.59000,Multiplan,Commercial,,1826.42,,,,,,,1748.70,1884.71,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1943.00000,627.59000,Multiplan,Commercial,,1826.42,,,,,,,505.18,1884.71,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,inpatient,,,1426.00000,460.60000,Multiplan,Commercial,,1340.44,,,,,,,1283.40,1383.22,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,outpatient,,,1426.00000,460.60000,Multiplan,Commercial,,1340.44,,,,,,,370.76,1383.22,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,inpatient,,,4202.00000,1357.25000,Multiplan,Commercial,50,3949.88,,,,,,,3781.80,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,outpatient,,,4202.00000,1357.25000,Multiplan,Commercial,50,3949.88,,,,,,,1092.52,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,inpatient,,,2801.00000,904.72000,Multiplan,Commercial,LT,2632.94,,,,,,,2520.90,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Multiplan,Commercial,LT,2632.94,,,,,,,728.26,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,inpatient,,,2801.00000,904.72000,Multiplan,Commercial,RT,2632.94,,,,,,,2520.90,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Multiplan,Commercial,RT,2632.94,,,,,,,728.26,2716.97,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,inpatient,,,832.00000,268.74000,Multiplan,Commercial,,782.08,,,,,,,748.80,807.04,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,outpatient,,,832.00000,268.74000,Multiplan,Commercial,,782.08,,,,,,,216.32,807.04,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,inpatient,,,1457.00000,470.61000,Multiplan,Commercial,,1369.58,,,,,,,1311.30,1413.29,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,outpatient,,,1457.00000,470.61000,Multiplan,Commercial,,1369.58,,,,,,,378.82,1413.29,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,inpatient,,,743.00000,239.99000,Multiplan,Commercial,LT,698.42,,,,,,,668.70,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Multiplan,Commercial,LT,698.42,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,inpatient,,,743.00000,239.99000,Multiplan,Commercial,RT,698.42,,,,,,,668.70,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Multiplan,Commercial,RT,698.42,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,inpatient,,,232.00000,74.94000,Multiplan,Commercial,,218.08,,,,,,,208.80,225.04,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,outpatient,,,232.00000,74.94000,Multiplan,Commercial,,218.08,,,,,,,60.32,225.04,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,inpatient,,,1364.00000,440.57000,Multiplan,Commercial,50,1282.16,,,,,,,1227.60,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,outpatient,,,1364.00000,440.57000,Multiplan,Commercial,50,1282.16,,,,,,,354.64,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,inpatient,,,909.00000,293.61000,Multiplan,Commercial,LT,854.46,,,,,,,818.10,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Multiplan,Commercial,LT,854.46,,,,,,,236.34,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,inpatient,,,909.00000,293.61000,Multiplan,Commercial,RT,854.46,,,,,,,818.10,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Multiplan,Commercial,RT,854.46,,,,,,,236.34,881.73,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,inpatient,,,510.00000,355.98000,Multiplan,Commercial,,479.40,,,,,,,459.00,494.70,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,outpatient,,,510.00000,355.98000,Multiplan,Commercial,,479.40,,,,,,,132.60,494.70,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,inpatient,,,1001.00000,698.70000,Multiplan,Commercial,,940.94,,,,,,,900.90,970.97,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,outpatient,,,1001.00000,698.70000,Multiplan,Commercial,,940.94,,,,,,,260.26,970.97,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,inpatient,,,887.00000,619.13000,Multiplan,Commercial,,833.78,,,,,,,798.30,860.39,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,outpatient,,,887.00000,619.13000,Multiplan,Commercial,,833.78,,,,,,,230.62,860.39,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,inpatient,,,1022.00000,713.36000,Multiplan,Commercial,50,960.68,,,,,,,919.80,991.34,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,outpatient,,,1022.00000,713.36000,Multiplan,Commercial,50,960.68,,,,,,,265.72,991.34,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,inpatient,,,681.00000,475.34000,Multiplan,Commercial,LT,640.14,,,,,,,612.90,660.57,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Multiplan,Commercial,LT,640.14,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,inpatient,,,681.00000,475.34000,Multiplan,Commercial,RT,640.14,,,,,,,612.90,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Multiplan,Commercial,RT,640.14,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,inpatient,,,945.00000,659.61000,Multiplan,Commercial,50,888.30,,,,,,,850.50,916.65,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,outpatient,,,945.00000,659.61000,Multiplan,Commercial,50,888.30,,,,,,,245.70,916.65,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,inpatient,,,630.00000,439.74000,Multiplan,Commercial,LT,592.20,,,,,,,567.00,611.10,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Multiplan,Commercial,LT,592.20,,,,,,,163.80,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,inpatient,,,630.00000,439.74000,Multiplan,Commercial,RT,592.20,,,,,,,567.00,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Multiplan,Commercial,RT,592.20,,,,,,,163.80,611.10,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,inpatient,,,577.00000,402.75000,Multiplan,Commercial,,542.38,,,,,,,519.30,559.69,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,outpatient,,,577.00000,402.75000,Multiplan,Commercial,,542.38,,,,,,,150.02,559.69,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,inpatient,,,433.00000,302.23000,Multiplan,Commercial,,407.02,,,,,,,389.70,420.01,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,outpatient,,,433.00000,302.23000,Multiplan,Commercial,,407.02,,,,,,,112.58,420.01,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,inpatient,,,331.00000,231.04000,Multiplan,Commercial,,311.14,,,,,,,297.90,321.07,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,outpatient,,,331.00000,231.04000,Multiplan,Commercial,,311.14,,,,,,,86.06,321.07,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,inpatient,,,662.00000,462.08000,Multiplan,Commercial,,622.28,,,,,,,595.80,642.14,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,outpatient,,,662.00000,462.08000,Multiplan,Commercial,,622.28,,,,,,,172.12,642.14,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,inpatient,,,752.00000,524.90000,Multiplan,Commercial,,706.88,,,,,,,676.80,729.44,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,outpatient,,,752.00000,524.90000,Multiplan,Commercial,,706.88,,,,,,,195.52,729.44,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,inpatient,,,182.00000,127.04000,Multiplan,Commercial,,171.08,,,,,,,163.80,176.54,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Multiplan,Commercial,,171.08,,,,,,,47.32,176.54,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,inpatient,,,420.00000,293.16000,Multiplan,Commercial,,394.80,,,,,,,378.00,407.40,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,outpatient,,,420.00000,293.16000,Multiplan,Commercial,,394.80,,,,,,,109.20,407.40,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,inpatient,,,253.00000,176.59000,Multiplan,Commercial,,237.82,,,,,,,227.70,245.41,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,outpatient,,,253.00000,176.59000,Multiplan,Commercial,,237.82,,,,,,,65.78,245.41,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,inpatient,,,168.00000,117.26000,Multiplan,Commercial,,157.92,,,,,,,151.20,162.96,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,outpatient,,,168.00000,117.26000,Multiplan,Commercial,,157.92,,,,,,,43.68,162.96,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,inpatient,,,695.00000,485.11000,Multiplan,Commercial,,653.30,,,,,,,625.50,674.15,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,outpatient,,,695.00000,485.11000,Multiplan,Commercial,,653.30,,,,,,,180.70,674.15,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,inpatient,,,474.00000,330.85000,Multiplan,Commercial,,445.56,,,,,,,426.60,459.78,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,outpatient,,,474.00000,330.85000,Multiplan,Commercial,,445.56,,,,,,,123.24,459.78,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,inpatient,,,930.00000,649.14000,Multiplan,Commercial,,874.20,,,,,,,837.00,902.10,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,outpatient,,,930.00000,649.14000,Multiplan,Commercial,,874.20,,,,,,,241.80,902.10,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,inpatient,,,786.00000,548.63000,Multiplan,Commercial,,738.84,,,,,,,707.40,762.42,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,outpatient,,,786.00000,548.63000,Multiplan,Commercial,,738.84,,,,,,,204.36,762.42,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,inpatient,,,620.00000,432.76000,Multiplan,Commercial,,582.80,,,,,,,558.00,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Multiplan,Commercial,,582.80,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,inpatient,,,620.00000,432.76000,Multiplan,Commercial,59,582.80,,,,,,,558.00,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Multiplan,Commercial,59,582.80,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,inpatient,,,435.00000,303.63000,Multiplan,Commercial,,408.90,,,,,,,391.50,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Multiplan,Commercial,,408.90,,,,,,,113.10,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,inpatient,,,435.00000,303.63000,Multiplan,Commercial,59,408.90,,,,,,,391.50,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Multiplan,Commercial,59,408.90,,,,,,,113.10,421.95,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,inpatient,,,492.00000,343.42000,Multiplan,Commercial,,462.48,,,,,,,442.80,477.24,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,outpatient,,,492.00000,343.42000,Multiplan,Commercial,,462.48,,,,,,,127.92,477.24,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,inpatient,,,331.00000,231.04000,Multiplan,Commercial,,311.14,,,,,,,297.90,321.07,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,outpatient,,,331.00000,231.04000,Multiplan,Commercial,,311.14,,,,,,,86.06,321.07,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,inpatient,,,875.00000,610.75000,Multiplan,Commercial,,822.50,,,,,,,787.50,848.75,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,outpatient,,,875.00000,610.75000,Multiplan,Commercial,,822.50,,,,,,,227.50,848.75,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,inpatient,,,688.00000,480.22000,Multiplan,Commercial,,646.72,,,,,,,619.20,667.36,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,outpatient,,,688.00000,480.22000,Multiplan,Commercial,,646.72,,,,,,,178.88,667.36,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,inpatient,,,465.00000,324.57000,Multiplan,Commercial,,437.10,,,,,,,418.50,451.05,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,outpatient,,,465.00000,324.57000,Multiplan,Commercial,,437.10,,,,,,,120.90,451.05,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,inpatient,,,846.00000,590.51000,Multiplan,Commercial,,795.24,,,,,,,761.40,820.62,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,outpatient,,,846.00000,590.51000,Multiplan,Commercial,,795.24,,,,,,,219.96,820.62,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,inpatient,,,482.00000,336.44000,Multiplan,Commercial,,453.08,,,,,,,433.80,467.54,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,outpatient,,,482.00000,336.44000,Multiplan,Commercial,,453.08,,,,,,,125.32,467.54,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,inpatient,,,926.00000,646.35000,Multiplan,Commercial,,870.44,,,,,,,833.40,898.22,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,outpatient,,,926.00000,646.35000,Multiplan,Commercial,,870.44,,,,,,,240.76,898.22,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,inpatient,,,292.00000,203.82000,Multiplan,Commercial,,274.48,,,,,,,262.80,283.24,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,outpatient,,,292.00000,203.82000,Multiplan,Commercial,,274.48,,,,,,,75.92,283.24,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,inpatient,,,827.00000,577.25000,Multiplan,Commercial,,777.38,,,,,,,744.30,802.19,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,outpatient,,,827.00000,577.25000,Multiplan,Commercial,,777.38,,,,,,,215.02,802.19,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,inpatient,,,253.00000,176.59000,Multiplan,Commercial,,237.82,,,,,,,227.70,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,outpatient,,,253.00000,176.59000,Multiplan,Commercial,,237.82,,,,,,,65.78,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,inpatient,,,901.00000,628.90000,Multiplan,Commercial,,846.94,,,,,,,810.90,873.97,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,outpatient,,,901.00000,628.90000,Multiplan,Commercial,,846.94,,,,,,,234.26,873.97,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,inpatient,,,460.00000,321.08000,Multiplan,Commercial,,432.40,,,,,,,414.00,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,outpatient,,,460.00000,321.08000,Multiplan,Commercial,,432.40,,,,,,,119.60,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,inpatient,,,1029.00000,718.24000,Multiplan,Commercial,,967.26,,,,,,,926.10,998.13,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1029.00000,718.24000,Multiplan,Commercial,,967.26,,,,,,,267.54,998.13,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,inpatient,,,959.00000,669.38000,Multiplan,Commercial,,901.46,,,,,,,863.10,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,outpatient,,,959.00000,669.38000,Multiplan,Commercial,,901.46,,,,,,,249.34,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,inpatient,,,558.00000,389.48000,Multiplan,Commercial,,524.52,,,,,,,502.20,541.26,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,outpatient,,,558.00000,389.48000,Multiplan,Commercial,,524.52,,,,,,,145.08,541.26,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,inpatient,,,705.00000,492.09000,Multiplan,Commercial,,662.70,,,,,,,634.50,683.85,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,outpatient,,,705.00000,492.09000,Multiplan,Commercial,,662.70,,,,,,,183.30,683.85,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,inpatient,,,249.00000,173.80000,Multiplan,Commercial,,234.06,,,,,,,224.10,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,outpatient,,,249.00000,173.80000,Multiplan,Commercial,,234.06,,,,,,,64.74,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,inpatient,,,427.00000,298.05000,Multiplan,Commercial,,401.38,,,,,,,384.30,414.19,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,outpatient,,,427.00000,298.05000,Multiplan,Commercial,,401.38,,,,,,,111.02,414.19,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,inpatient,,,737.00000,514.43000,Multiplan,Commercial,,692.78,,,,,,,663.30,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Multiplan,Commercial,,692.78,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,inpatient,,,737.00000,514.43000,Multiplan,Commercial,59,692.78,,,,,,,663.30,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Multiplan,Commercial,59,692.78,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,inpatient,,,809.00000,564.68000,Multiplan,Commercial,,760.46,,,,,,,728.10,784.73,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,outpatient,,,809.00000,564.68000,Multiplan,Commercial,,760.46,,,,,,,210.34,784.73,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,inpatient,,,525.00000,366.45000,Multiplan,Commercial,,493.50,,,,,,,472.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,outpatient,,,525.00000,366.45000,Multiplan,Commercial,,493.50,,,,,,,136.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,inpatient,,,319.00000,222.66000,Multiplan,Commercial,,299.86,,,,,,,287.10,309.43,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,outpatient,,,319.00000,222.66000,Multiplan,Commercial,,299.86,,,,,,,82.94,309.43,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,inpatient,,,1437.00000,678.26000,Multiplan,Commercial,,1350.78,,,,,,,1293.30,1393.89,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1437.00000,678.26000,Multiplan,Commercial,,1350.78,,,,,,,373.62,1393.89,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,inpatient,,,2143.00000,1011.50000,Multiplan,Commercial,,2014.42,,,,,,,1928.70,2078.71,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2143.00000,1011.50000,Multiplan,Commercial,,2014.42,,,,,,,557.18,2078.71,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,inpatient,,,755.00000,356.36000,Multiplan,Commercial,,709.70,,,,,,,679.50,732.35,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,outpatient,,,755.00000,356.36000,Multiplan,Commercial,,709.70,,,,,,,196.30,732.35,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,inpatient,,,979.00000,462.09000,Multiplan,Commercial,,920.26,,,,,,,881.10,949.63,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,outpatient,,,979.00000,462.09000,Multiplan,Commercial,,920.26,,,,,,,254.54,949.63,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,inpatient,,,436.00000,205.79000,Multiplan,Commercial,,409.84,,,,,,,392.40,422.92,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,outpatient,,,436.00000,205.79000,Multiplan,Commercial,,409.84,,,,,,,113.36,422.92,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,inpatient,,,220.00000,103.84000,Multiplan,Commercial,,206.80,,,,,,,198.00,213.40,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,outpatient,,,220.00000,103.84000,Multiplan,Commercial,,206.80,,,,,,,57.20,213.40,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,inpatient,,,344.00000,162.37000,Multiplan,Commercial,,323.36,,,,,,,309.60,333.68,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,outpatient,,,344.00000,162.37000,Multiplan,Commercial,,323.36,,,,,,,89.44,333.68,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,inpatient,,,818.00000,393.46000,Multiplan,Commercial,,768.92,,,,,,,736.20,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,outpatient,,,818.00000,393.46000,Multiplan,Commercial,,768.92,,,,,,,212.68,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,inpatient,,,545.00000,262.14000,Multiplan,Commercial,52,512.30,,,,,,,490.50,528.65,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,outpatient,,,545.00000,262.14000,Multiplan,Commercial,52,512.30,,,,,,,141.70,528.65,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,inpatient,,,1347.00000,647.91000,Multiplan,Commercial,,1266.18,,,,,,,1212.30,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,outpatient,,,1347.00000,647.91000,Multiplan,Commercial,,1266.18,,,,,,,350.22,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,inpatient,,,898.00000,431.94000,Multiplan,Commercial,52,844.12,,,,,,,808.20,871.06,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,outpatient,,,898.00000,431.94000,Multiplan,Commercial,52,844.12,,,,,,,233.48,871.06,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,inpatient,,,469.00000,225.59000,Multiplan,Commercial,,440.86,,,,,,,422.10,454.93,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,outpatient,,,469.00000,225.59000,Multiplan,Commercial,,440.86,,,,,,,121.94,454.93,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,inpatient,,,1762.00000,847.52000,Multiplan,Commercial,,1656.28,,,,,,,1585.80,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,outpatient,,,1762.00000,847.52000,Multiplan,Commercial,,1656.28,,,,,,,458.12,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,inpatient,,,627.00000,301.59000,Multiplan,Commercial,,589.38,,,,,,,564.30,608.19,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,outpatient,,,627.00000,301.59000,Multiplan,Commercial,,589.38,,,,,,,163.02,608.19,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,inpatient,,,590.00000,283.79000,Multiplan,Commercial,,554.60,,,,,,,531.00,572.30,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,outpatient,,,590.00000,283.79000,Multiplan,Commercial,,554.60,,,,,,,153.40,572.30,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,inpatient,,,1550.00000,745.55000,Multiplan,Commercial,,1457.00,,,,,,,1395.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,outpatient,,,1550.00000,745.55000,Multiplan,Commercial,,1457.00,,,,,,,403.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,inpatient,,,990.00000,476.19000,Multiplan,Commercial,LT,930.60,,,,,,,891.00,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Multiplan,Commercial,LT,930.60,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,inpatient,,,990.00000,476.19000,Multiplan,Commercial,RT,930.60,,,,,,,891.00,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Multiplan,Commercial,RT,930.60,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,inpatient,,,1402.00000,674.36000,Multiplan,Commercial,,1317.88,,,,,,,1261.80,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,outpatient,,,1402.00000,674.36000,Multiplan,Commercial,,1317.88,,,,,,,364.52,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,inpatient,,,980.00000,471.38000,Multiplan,Commercial,LT,921.20,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Multiplan,Commercial,LT,921.20,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,inpatient,,,980.00000,471.38000,Multiplan,Commercial,RT,921.20,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Multiplan,Commercial,RT,921.20,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,inpatient,,,1661.00000,798.94000,Multiplan,Commercial,,1561.34,,,,,,,1494.90,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,outpatient,,,1661.00000,798.94000,Multiplan,Commercial,,1561.34,,,,,,,431.86,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,inpatient,,,980.00000,471.38000,Multiplan,Commercial,,921.20,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,outpatient,,,980.00000,471.38000,Multiplan,Commercial,,921.20,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,inpatient,,,1740.00000,836.94000,Multiplan,Commercial,,1635.60,,,,,,,1566.00,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1740.00000,836.94000,Multiplan,Commercial,,1635.60,,,,,,,452.40,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,inpatient,,,1168.00000,561.81000,Multiplan,Commercial,,1097.92,,,,,,,1051.20,1132.96,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1168.00000,561.81000,Multiplan,Commercial,,1097.92,,,,,,,303.68,1132.96,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,inpatient,,,433.00000,232.09000,Multiplan,Commercial,,407.02,,,,,,,389.70,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,outpatient,,,433.00000,232.09000,Multiplan,Commercial,,407.02,,,,,,,112.58,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,inpatient,,,388.00000,207.97000,Multiplan,Commercial,LT,364.72,,,,,,,349.20,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Multiplan,Commercial,LT,364.72,,,,,,,100.88,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,inpatient,,,388.00000,207.97000,Multiplan,Commercial,RT,364.72,,,,,,,349.20,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Multiplan,Commercial,RT,364.72,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,inpatient,,,388.00000,207.97000,Multiplan,Commercial,,364.72,,,,,,,349.20,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,outpatient,,,388.00000,207.97000,Multiplan,Commercial,,364.72,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,inpatient,,,604.00000,323.74000,Multiplan,Commercial,,567.76,,,,,,,543.60,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,outpatient,,,604.00000,323.74000,Multiplan,Commercial,,567.76,,,,,,,157.04,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,inpatient,,,667.00000,357.51000,Multiplan,Commercial,,626.98,,,,,,,600.30,646.99,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,outpatient,,,667.00000,357.51000,Multiplan,Commercial,,626.98,,,,,,,173.42,646.99,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,inpatient,,,176.00000,94.34000,Multiplan,Commercial,,165.44,,,,,,,158.40,170.72,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,outpatient,,,176.00000,94.34000,Multiplan,Commercial,,165.44,,,,,,,45.76,170.72,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,inpatient,,,92.00000,29.72000,Multiplan,Commercial,LT,86.48,,,,,,,82.80,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Multiplan,Commercial,LT,86.48,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,inpatient,,,92.00000,29.72000,Multiplan,Commercial,RT,86.48,,,,,,,82.80,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Multiplan,Commercial,RT,86.48,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,inpatient,,,366.00000,118.22000,Multiplan,Commercial,LT,344.04,,,,,,,329.40,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Multiplan,Commercial,LT,344.04,,,,,,,95.16,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,inpatient,,,366.00000,118.22000,Multiplan,Commercial,RT,344.04,,,,,,,329.40,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Multiplan,Commercial,RT,344.04,,,,,,,95.16,355.02,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,inpatient,,,1117.00000,360.79000,Multiplan,Commercial,LT,1049.98,,,,,,,1005.30,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Multiplan,Commercial,LT,1049.98,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,inpatient,,,1117.00000,360.79000,Multiplan,Commercial,RT,1049.98,,,,,,,1005.30,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Multiplan,Commercial,RT,1049.98,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,inpatient,,,559.00000,180.56000,Multiplan,Commercial,,525.46,,,,,,,503.10,542.23,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,outpatient,,,559.00000,180.56000,Multiplan,Commercial,,525.46,,,,,,,145.34,542.23,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,inpatient,,,252.00000,81.40000,Multiplan,Commercial,50,236.88,,,,,,,226.80,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,outpatient,,,252.00000,81.40000,Multiplan,Commercial,50,236.88,,,,,,,65.52,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,inpatient,,,168.00000,54.26000,Multiplan,Commercial,LT,157.92,,,,,,,151.20,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Multiplan,Commercial,LT,157.92,,,,,,,43.68,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,inpatient,,,168.00000,54.26000,Multiplan,Commercial,RT,157.92,,,,,,,151.20,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Multiplan,Commercial,RT,157.92,,,,,,,43.68,162.96,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,inpatient,,,1148.00000,370.80000,Multiplan,Commercial,LT,1079.12,,,,,,,1033.20,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Multiplan,Commercial,LT,1079.12,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,inpatient,,,1148.00000,370.80000,Multiplan,Commercial,RT,1079.12,,,,,,,1033.20,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Multiplan,Commercial,RT,1079.12,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,inpatient,,,379.00000,122.42000,Multiplan,Commercial,,356.26,,,,,,,341.10,367.63,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,outpatient,,,379.00000,122.42000,Multiplan,Commercial,,356.26,,,,,,,98.54,367.63,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,inpatient,,,1015.00000,327.84000,Multiplan,Commercial,,954.10,,,,,,,913.50,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,outpatient,,,1015.00000,327.84000,Multiplan,Commercial,,954.10,,,,,,,263.90,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,inpatient,,,591.00000,190.89000,Multiplan,Commercial,,555.54,,,,,,,531.90,573.27,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,outpatient,,,591.00000,190.89000,Multiplan,Commercial,,555.54,,,,,,,153.66,573.27,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,inpatient,,,271.00000,169.92000,Multiplan,Commercial,,254.74,,,,,,,243.90,262.87,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,outpatient,,,271.00000,169.92000,Multiplan,Commercial,,254.74,,,,,,,70.46,262.87,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,inpatient,,,211.00000,132.30000,Multiplan,Commercial,LT,198.34,,,,,,,189.90,204.67,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Multiplan,Commercial,LT,198.34,,,,,,,54.86,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,inpatient,,,211.00000,132.30000,Multiplan,Commercial,RT,198.34,,,,,,,189.90,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Multiplan,Commercial,RT,198.34,,,,,,,54.86,204.67,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,59.00000,36.99000,Multiplan,Commercial,,55.46,,,,,,,53.10,57.23,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,59.00000,36.99000,Multiplan,Commercial,,55.46,,,,,,,15.34,57.23,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,inpatient,,,336.00000,219.74000,Multiplan,Commercial,,315.84,,,,,,,302.40,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,outpatient,,,336.00000,219.74000,Multiplan,Commercial,,315.84,,,,,,,87.36,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,inpatient,,,224.00000,146.50000,Multiplan,Commercial,52,210.56,,,,,,,201.60,217.28,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,outpatient,,,224.00000,146.50000,Multiplan,Commercial,52,210.56,,,,,,,58.24,217.28,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,inpatient,,,63.00000,41.20000,Multiplan,Commercial,,59.22,,,,,,,56.70,61.11,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,outpatient,,,63.00000,41.20000,Multiplan,Commercial,,59.22,,,,,,,16.38,61.11,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Multiplan,Commercial,,473.76,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Multiplan,Commercial,,473.76,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Multiplan,Commercial,,92.12,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Multiplan,Commercial,,92.12,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Multiplan,Commercial,,571.52,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Multiplan,Commercial,,571.52,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Multiplan,Commercial,,107.16,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Multiplan,Commercial,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Multiplan,Commercial,,175.78,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Multiplan,Commercial,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Multiplan,Commercial,,201.16,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Multiplan,Commercial,,201.16,,,,,,,55.64,207.58,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,inpatient,,,609.00000,196.71000,Multiplan,Commercial,,572.46,,,,,,,548.10,590.73,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Multiplan,Commercial,,572.46,,,,,,,158.34,590.73,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,inpatient,,,863.00000,278.75000,Multiplan,Commercial,,811.22,,,,,,,776.70,837.11,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Multiplan,Commercial,,811.22,,,,,,,224.38,837.11,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,inpatient,,,900.00000,605.70000,Multiplan,Commercial,,846.00,,,,,,,810.00,873.00,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,outpatient,,,900.00000,605.70000,Multiplan,Commercial,,846.00,,,,,,,234.00,873.00,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,inpatient,,,1940.00000,1102.21000,Multiplan,Commercial,,1823.60,,,,,,,1746.00,1881.80,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,outpatient,,,1940.00000,1102.21000,Multiplan,Commercial,,1823.60,,,,,,,504.40,1881.80,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,inpatient,,,422.00000,239.76000,Multiplan,Commercial,,396.68,,,,,,,379.80,409.34,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,outpatient,,,422.00000,239.76000,Multiplan,Commercial,,396.68,,,,,,,109.72,409.34,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,inpatient,,,1430.00000,812.45000,Multiplan,Commercial,,1344.20,,,,,,,1287.00,1387.10,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,outpatient,,,1430.00000,812.45000,Multiplan,Commercial,,1344.20,,,,,,,371.80,1387.10,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,inpatient,,,745.00000,423.27000,Multiplan,Commercial,,700.30,,,,,,,670.50,722.65,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,outpatient,,,745.00000,423.27000,Multiplan,Commercial,,700.30,,,,,,,193.70,722.65,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,inpatient,,,2655.00000,2487.74000,Multiplan,Commercial,,2495.70,,,,,,,2389.50,2575.35,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,outpatient,,,2655.00000,2487.74000,Multiplan,Commercial,,2495.70,,,,,,,690.30,2575.35,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,inpatient,,,3990.00000,3738.63000,Multiplan,Commercial,,3750.60,,,,,,,3591.00,3870.30,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,outpatient,,,3990.00000,3738.63000,Multiplan,Commercial,,3750.60,,,,,,,1037.40,3870.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,inpatient,,,290.00000,271.73000,Multiplan,Commercial,,272.60,,,,,,,261.00,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,outpatient,,,290.00000,271.73000,Multiplan,Commercial,,272.60,,,,,,,75.40,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,inpatient,,,735.00000,688.70000,Multiplan,Commercial,,690.90,,,,,,,661.50,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,outpatient,,,735.00000,688.70000,Multiplan,Commercial,,690.90,,,,,,,191.10,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,inpatient,,,1475.00000,1382.08000,Multiplan,Commercial,,1386.50,,,,,,,1327.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Multiplan,Commercial,,1386.50,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,inpatient,,,2275.00000,2131.68000,Multiplan,Commercial,,2138.50,,,,,,,2047.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,outpatient,,,2275.00000,2131.68000,Multiplan,Commercial,,2138.50,,,,,,,591.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,inpatient,,,3205.00000,3003.08000,Multiplan,Commercial,,3012.70,,,,,,,2884.50,3108.85,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,outpatient,,,3205.00000,3003.08000,Multiplan,Commercial,,3012.70,,,,,,,833.30,3108.85,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,inpatient,,,770.00000,721.49000,Multiplan,Commercial,,723.80,,,,,,,693.00,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,outpatient,,,770.00000,721.49000,Multiplan,Commercial,,723.80,,,,,,,200.20,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,inpatient,,,1475.00000,1382.08000,Multiplan,Commercial,,1386.50,,,,,,,1327.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Multiplan,Commercial,,1386.50,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,inpatient,,,2210.00000,2070.77000,Multiplan,Commercial,,2077.40,,,,,,,1989.00,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,outpatient,,,2210.00000,2070.77000,Multiplan,Commercial,,2077.40,,,,,,,574.60,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,inpatient,,,2660.00000,2492.42000,Multiplan,Commercial,,2500.40,,,,,,,2394.00,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,outpatient,,,2660.00000,2492.42000,Multiplan,Commercial,,2500.40,,,,,,,691.60,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,inpatient,,,3560.00000,3335.72000,Multiplan,Commercial,,3346.40,,,,,,,3204.00,3453.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,outpatient,,,3560.00000,3335.72000,Multiplan,Commercial,,3346.40,,,,,,,925.60,3453.20,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,inpatient,,,5730.00000,3255.50000,Multiplan,Commercial,,5386.20,,,,,,,5157.00,5558.10,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,outpatient,,,5730.00000,3255.50000,Multiplan,Commercial,,5386.20,,,,,,,1489.80,5558.10,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,inpatient,,,3875.00000,2201.58000,Multiplan,Commercial,,3642.50,,,,,,,3487.50,3758.75,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,outpatient,,,3875.00000,2201.58000,Multiplan,Commercial,,3642.50,,,,,,,1007.50,3758.75,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,inpatient,,,519.00000,564.15000,Multiplan,Commercial,,487.86,,,,,,,467.10,503.43,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,outpatient,,,519.00000,564.15000,Multiplan,Commercial,,487.86,,,,,,,134.94,503.43,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,inpatient,,,536.00000,582.63000,Multiplan,Commercial,,503.84,,,,,,,482.40,519.92,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,outpatient,,,536.00000,582.63000,Multiplan,Commercial,,503.84,,,,,,,139.36,519.92,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Multiplan,Commercial,,425.82,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Multiplan,Commercial,,425.82,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Multiplan,Commercial,,135.36,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Multiplan,Commercial,,135.36,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Multiplan,Commercial,,100.58,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Multiplan,Commercial,,100.58,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Multiplan,Commercial,,135.36,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Multiplan,Commercial,,135.36,,,,,,,37.44,139.68,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Multiplan,Commercial,,473.76,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Multiplan,Commercial,,473.76,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Multiplan,Commercial,,92.12,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Multiplan,Commercial,,92.12,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Multiplan,Commercial,,571.52,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Multiplan,Commercial,,571.52,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Multiplan,Commercial,,107.16,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Multiplan,Commercial,,107.16,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Multiplan,Commercial,,175.78,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Multiplan,Commercial,,175.78,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Multiplan,Commercial,,201.16,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Multiplan,Commercial,,201.16,,,,,,,55.64,207.58,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,inpatient,,,175.00000,63.18000,Multiplan,Commercial,,164.50,,,,,,,157.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,outpatient,,,175.00000,63.18000,Multiplan,Commercial,,164.50,,,,,,,45.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,inpatient,,,304.00000,109.74000,Multiplan,Commercial,,285.76,,,,,,,273.60,294.88,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,outpatient,,,304.00000,109.74000,Multiplan,Commercial,,285.76,,,,,,,79.04,294.88,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Multiplan,Commercial,,266.96,,,,,,,255.60,275.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Multiplan,Commercial,,266.96,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Multiplan,Commercial,,430.52,,,,,,,412.20,444.26,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Multiplan,Commercial,,430.52,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,inpatient,,,438.00000,158.12000,Multiplan,Commercial,,411.72,,,,,,,394.20,424.86,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,outpatient,,,438.00000,158.12000,Multiplan,Commercial,,411.72,,,,,,,113.88,424.86,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Multiplan,Commercial,,524.52,,,,,,,502.20,541.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Multiplan,Commercial,,524.52,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Multiplan,Commercial,,453.08,,,,,,,433.80,467.54,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Multiplan,Commercial,,453.08,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Multiplan,Commercial,,222.78,,,,,,,213.30,229.89,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Multiplan,Commercial,,222.78,,,,,,,61.62,229.89,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Multiplan,Commercial,,473.76,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Multiplan,Commercial,,473.76,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Multiplan,Commercial,,473.76,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Multiplan,Commercial,,473.76,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Multiplan,Commercial,,473.76,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Multiplan,Commercial,,473.76,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Multiplan,Commercial,,473.76,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Multiplan,Commercial,,473.76,,,,,,,131.04,488.88,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Multiplan,Commercial,,791.48,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Multiplan,Commercial,,791.48,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Multiplan,Commercial,,989.82,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Multiplan,Commercial,,989.82,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Multiplan,Commercial,,1187.22,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Multiplan,Commercial,,1187.22,,,,,,,328.38,1225.11,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,inpatient,,,182.00000,127.04000,Multiplan,Commercial,,171.08,,,,,,,163.80,176.54,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Multiplan,Commercial,,171.08,,,,,,,47.32,176.54,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,inpatient,,,210.00000,119.31000,Multiplan,Commercial,,197.40,,,,,,,189.00,203.70,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Multiplan,Commercial,,197.40,,,,,,,54.60,203.70,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,inpatient,,,140.00000,79.54000,Multiplan,Commercial,,131.60,,,,,,,126.00,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,outpatient,,,140.00000,79.54000,Multiplan,Commercial,,131.60,,,,,,,36.40,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,inpatient,,,190.00000,107.95000,Multiplan,Commercial,,178.60,,,,,,,171.00,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,outpatient,,,190.00000,107.95000,Multiplan,Commercial,,178.60,,,,,,,49.40,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,inpatient,,,240.00000,136.36000,Multiplan,Commercial,,225.60,,,,,,,216.00,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,outpatient,,,240.00000,136.36000,Multiplan,Commercial,,225.60,,,,,,,62.40,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,inpatient,,,290.00000,164.76000,Multiplan,Commercial,,272.60,,,,,,,261.00,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,outpatient,,,290.00000,164.76000,Multiplan,Commercial,,272.60,,,,,,,75.40,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,inpatient,,,340.00000,193.17000,Multiplan,Commercial,,319.60,,,,,,,306.00,329.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,outpatient,,,340.00000,193.17000,Multiplan,Commercial,,319.60,,,,,,,88.40,329.80,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,inpatient,,,150.00000,85.22000,Multiplan,Commercial,,141.00,,,,,,,135.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,outpatient,,,150.00000,85.22000,Multiplan,Commercial,,141.00,,,,,,,39.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,inpatient,,,200.00000,113.63000,Multiplan,Commercial,,188.00,,,,,,,180.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,outpatient,,,200.00000,113.63000,Multiplan,Commercial,,188.00,,,,,,,52.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,inpatient,,,270.00000,153.40000,Multiplan,Commercial,,253.80,,,,,,,243.00,261.90,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,outpatient,,,270.00000,153.40000,Multiplan,Commercial,,253.80,,,,,,,70.20,261.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,inpatient,,,370.00000,210.22000,Multiplan,Commercial,,347.80,,,,,,,333.00,358.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,outpatient,,,370.00000,210.22000,Multiplan,Commercial,,347.80,,,,,,,96.20,358.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,inpatient,,,470.00000,267.03000,Multiplan,Commercial,,441.80,,,,,,,423.00,455.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,outpatient,,,470.00000,267.03000,Multiplan,Commercial,,441.80,,,,,,,122.20,455.90,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,inpatient,,,248.00000,96.22000,Multiplan,Commercial,,233.12,,,,,,,223.20,240.56,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,outpatient,,,248.00000,96.22000,Multiplan,Commercial,,233.12,,,,,,,64.48,240.56,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,inpatient,,,245.00000,95.06000,Multiplan,Commercial,,230.30,,,,,,,220.50,237.65,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,outpatient,,,245.00000,95.06000,Multiplan,Commercial,,230.30,,,,,,,63.70,237.65,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,inpatient,,,497.00000,192.84000,Multiplan,Commercial,,467.18,,,,,,,447.30,482.09,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,outpatient,,,497.00000,192.84000,Multiplan,Commercial,,467.18,,,,,,,129.22,482.09,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,inpatient,,,357.00000,138.52000,Multiplan,Commercial,,335.58,,,,,,,321.30,346.29,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,outpatient,,,357.00000,138.52000,Multiplan,Commercial,,335.58,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,inpatient,,,334.00000,129.59000,Multiplan,Commercial,,313.96,,,,,,,300.60,323.98,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,outpatient,,,334.00000,129.59000,Multiplan,Commercial,,313.96,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,inpatient,,,194.00000,75.27000,Multiplan,Commercial,,182.36,,,,,,,174.60,188.18,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,outpatient,,,194.00000,75.27000,Multiplan,Commercial,,182.36,,,,,,,50.44,188.18,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,inpatient,,,1035.00000,401.58000,Multiplan,Commercial,,972.90,,,,,,,931.50,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,outpatient,,,1035.00000,401.58000,Multiplan,Commercial,,972.90,,,,,,,269.10,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,inpatient,,,1137.00000,441.16000,Multiplan,Commercial,,1068.78,,,,,,,1023.30,1102.89,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,outpatient,,,1137.00000,441.16000,Multiplan,Commercial,,1068.78,,,,,,,295.62,1102.89,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,inpatient,,,963.00000,373.64000,Multiplan,Commercial,,905.22,,,,,,,866.70,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,outpatient,,,963.00000,373.64000,Multiplan,Commercial,,905.22,,,,,,,250.38,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,inpatient,,,990.00000,384.12000,Multiplan,Commercial,,930.60,,,,,,,891.00,960.30,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,outpatient,,,990.00000,384.12000,Multiplan,Commercial,,930.60,,,,,,,257.40,960.30,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,inpatient,,,112.00000,43.46000,Multiplan,Commercial,,105.28,,,,,,,100.80,108.64,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,outpatient,,,112.00000,43.46000,Multiplan,Commercial,,105.28,,,,,,,29.12,108.64,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,inpatient,,,84.00000,32.59000,Multiplan,Commercial,,78.96,,,,,,,75.60,81.48,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,outpatient,,,84.00000,32.59000,Multiplan,Commercial,,78.96,,,,,,,21.84,81.48,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,inpatient,,,176.00000,68.29000,Multiplan,Commercial,,165.44,,,,,,,158.40,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,outpatient,,,176.00000,68.29000,Multiplan,Commercial,,165.44,,,,,,,45.76,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,inpatient,,,283.00000,109.80000,Multiplan,Commercial,,266.02,,,,,,,254.70,274.51,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,outpatient,,,283.00000,109.80000,Multiplan,Commercial,,266.02,,,,,,,73.58,274.51,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Multiplan,Commercial,,76.14,,,,,,,72.90,78.57,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Multiplan,Commercial,,76.14,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Multiplan,Commercial,,38.54,,,,,,,36.90,39.77,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Multiplan,Commercial,,38.54,,,,,,,10.66,39.77,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,inpatient,,,35.00000,19.89000,Multiplan,Commercial,,32.90,,,,,,,31.50,33.95,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,35.00000,19.89000,Multiplan,Commercial,,32.90,,,,,,,9.10,33.95,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,inpatient,,,191.00000,89.39000,Multiplan,Commercial,,179.54,,,,,,,171.90,185.27,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,outpatient,,,191.00000,89.39000,Multiplan,Commercial,,179.54,,,,,,,49.66,185.27,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Multiplan,Commercial,,425.82,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Multiplan,Commercial,,425.82,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Multiplan,Commercial,,135.36,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Multiplan,Commercial,,135.36,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Multiplan,Commercial,,100.58,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Multiplan,Commercial,,100.58,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Multiplan,Commercial,,135.36,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Multiplan,Commercial,,135.36,,,,,,,37.44,139.68,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,inpatient,,,281.00000,131.51000,Multiplan,Commercial,,264.14,,,,,,,252.90,272.57,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,outpatient,,,281.00000,131.51000,Multiplan,Commercial,,264.14,,,,,,,73.06,272.57,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,inpatient,,,192.00000,89.86000,Multiplan,Commercial,,180.48,,,,,,,172.80,186.24,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,outpatient,,,192.00000,89.86000,Multiplan,Commercial,,180.48,,,,,,,49.92,186.24,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,inpatient,,,365.00000,170.82000,Multiplan,Commercial,,343.10,,,,,,,328.50,354.05,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,outpatient,,,365.00000,170.82000,Multiplan,Commercial,,343.10,,,,,,,94.90,354.05,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,inpatient,,,8391.00000,5856.92000,Multiplan,Commercial,,7887.54,,,,,,,7551.90,8139.27,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,outpatient,,,8391.00000,5856.92000,Multiplan,Commercial,,7887.54,,,,,,,2181.66,8139.27,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,inpatient,,,6917.00000,4828.07000,Multiplan,Commercial,52,6501.98,,,,,,,6225.30,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Multiplan,Commercial,52,6501.98,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,inpatient,,,6000.00000,4188.00000,Multiplan,Commercial,,5640.00,,,,,,,5400.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Multiplan,Commercial,,5640.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,inpatient,,,6917.00000,4828.07000,Multiplan,Commercial,,6501.98,,,,,,,6225.30,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Multiplan,Commercial,,6501.98,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,inpatient,,,6000.00000,4188.00000,Multiplan,Commercial,52,5640.00,,,,,,,5400.00,5820.00,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Multiplan,Commercial,52,5640.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,inpatient,,,8855.00000,9625.38000,Multiplan,Commercial,,8323.70,,,,,,,7969.50,8589.35,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,outpatient,,,8855.00000,9625.38000,Multiplan,Commercial,,8323.70,,,,,,,2302.30,8589.35,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,inpatient,,,844.00000,917.43000,Multiplan,Commercial,,793.36,,,,,,,759.60,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Multiplan,Commercial,,793.36,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,inpatient,,,844.00000,917.43000,Multiplan,Commercial,52,793.36,,,,,,,759.60,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Multiplan,Commercial,52,793.36,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,inpatient,,,785.00000,853.30000,Multiplan,Commercial,,737.90,,,,,,,706.50,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Multiplan,Commercial,,737.90,,,,,,,204.10,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,inpatient,,,785.00000,853.30000,Multiplan,Commercial,52,737.90,,,,,,,706.50,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Multiplan,Commercial,52,737.90,,,,,,,204.10,761.45,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4709.00000,5118.68000,Multiplan,Commercial,,4426.46,,,,,,,4238.10,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Multiplan,Commercial,,4426.46,,,,,,,1224.34,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4709.00000,5118.68000,Multiplan,Commercial,52,4426.46,,,,,,,4238.10,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Multiplan,Commercial,52,4426.46,,,,,,,1224.34,4567.73,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,inpatient,,,345.00000,128.34000,Multiplan,Commercial,,324.30,,,,,,,310.50,334.65,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,outpatient,,,345.00000,128.34000,Multiplan,Commercial,,324.30,,,,,,,89.70,334.65,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,inpatient,,,120.00000,99.60000,Multiplan,Commercial,,112.80,,,,,,,108.00,116.40,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,outpatient,,,120.00000,99.60000,Multiplan,Commercial,,112.80,,,,,,,31.20,116.40,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,inpatient,,,106.00000,87.98000,Multiplan,Commercial,,99.64,,,,,,,95.40,102.82,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,outpatient,,,106.00000,87.98000,Multiplan,Commercial,,99.64,,,,,,,27.56,102.82,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,inpatient,,,32.00000,26.56000,Multiplan,Commercial,,30.08,,,,,,,28.80,31.04,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,outpatient,,,32.00000,26.56000,Multiplan,Commercial,,30.08,,,,,,,8.32,31.04,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,inpatient,,,60.00000,49.80000,Multiplan,Commercial,,56.40,,,,,,,54.00,58.20,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,outpatient,,,60.00000,49.80000,Multiplan,Commercial,,56.40,,,,,,,15.60,58.20,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,inpatient,,,57.00000,47.31000,Multiplan,Commercial,,53.58,,,,,,,51.30,55.29,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,outpatient,,,57.00000,47.31000,Multiplan,Commercial,,53.58,,,,,,,14.82,55.29,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,inpatient,1.0,ME,7.40000,0.65000,Multiplan,Commercial,,6.96,,,,,,,6.66,7.18,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,outpatient,1.0,ME,7.40000,0.65000,Multiplan,Commercial,,6.96,,,,,,,1.92,7.18,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,inpatient,1.0,EA,6.60000,1.43000,Multiplan,Commercial,UD,6.20,,,,,,,5.94,6.40,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,outpatient,1.0,EA,6.60000,1.43000,Multiplan,Commercial,UD,6.20,,,,,,,1.72,6.40,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,inpatient,1.0,EA,2.95000,0.64000,Multiplan,Commercial,UD,2.77,,,,,,,2.65,2.86,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,outpatient,1.0,EA,2.95000,0.64000,Multiplan,Commercial,UD,2.77,,,,,,,0.76700,2.86,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,inpatient,1.0,EA,56.08000,12.11000,Multiplan,Commercial,UD,52.72,,,,,,,50.47,54.40,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,56.08000,12.11000,Multiplan,Commercial,UD,52.72,,,,,,,14.58,54.40,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,inpatient,1.0,UN,82.10000,28.90000,Multiplan,Commercial,,77.17,,,,,,,73.89,79.64,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,outpatient,1.0,UN,82.10000,28.90000,Multiplan,Commercial,,77.17,,,,,,,15.48,79.64,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.04000,,Multiplan,Commercial,UD,0.03760,,,,,,,0.03600,0.03880,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.04000,,Multiplan,Commercial,UD,0.03760,,,,,,,0.01040,0.03880,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.05000,,Multiplan,Commercial,UD,0.04700,,,,,,,0.04500,0.04850,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.05000,,Multiplan,Commercial,UD,0.04700,,,,,,,0.01300,0.04850,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,inpatient,1.0,ME,6.20000,0.55000,Multiplan,Commercial,,5.83,,,,,,,5.58,6.01,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,outpatient,1.0,ME,6.20000,0.55000,Multiplan,Commercial,,5.83,,,,,,,1.61,6.01,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.12000,0.01000,Multiplan,Commercial,UD,0.11280,,,,,,,0.10800,0.11640,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.12000,0.01000,Multiplan,Commercial,UD,0.11280,,,,,,,0.03120,0.11640,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,inpatient,2.0,ML,5.80000,1.25000,Multiplan,Commercial,,5.45,,,,,,,5.22,5.63,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,outpatient,2.0,ML,5.80000,1.25000,Multiplan,Commercial,,5.45,,,,,,,1.51,5.63,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,inpatient,1.0,ME,3.10000,0.27000,Multiplan,Commercial,,2.91,,,,,,,2.79,3.01,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,outpatient,1.0,ME,3.10000,0.27000,Multiplan,Commercial,,2.91,,,,,,,0.80600,3.01,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,inpatient,1.0,EA,44.40000,3.91000,Multiplan,Commercial,,41.74,,,,,,,39.96,43.07,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,outpatient,1.0,EA,44.40000,3.91000,Multiplan,Commercial,,41.74,,,,,,,11.54,43.07,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,inpatient,1.0,EA,8.26000,0.73000,Multiplan,Commercial,UD,7.76,,,,,,,7.43,8.01,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,8.26000,0.73000,Multiplan,Commercial,UD,7.76,,,,,,,2.15,8.01,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,2.19000,0.19000,Multiplan,Commercial,UD,2.06,,,,,,,1.97,2.12,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,2.19000,0.19000,Multiplan,Commercial,UD,2.06,,,,,,,0.56940,2.12,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,inpatient,1.0,EA,28.60000,2.52000,Multiplan,Commercial,,26.88,,,,,,,25.74,27.74,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,outpatient,1.0,EA,28.60000,2.52000,Multiplan,Commercial,,26.88,,,,,,,7.44,27.74,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,inpatient,1.0,EA,2.58000,0.91000,Multiplan,Commercial,UD,2.43,,,,,,,2.32,2.50,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,outpatient,1.0,EA,2.58000,0.91000,Multiplan,Commercial,UD,2.43,,,,,,,0.67080,2.50,percent of total billed charges,
R&B OBSTETRICS PVT,3012,CDM,112,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Optum,Medicare,,2658.00,,,,,,,2502.90,3111.10,per diem,
R&B MEDICAL/SURGICAL SEMI-PVT,23010,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Optum,Medicare,,2658.00,,,,,,,2502.90,3111.10,per diem,
R&B ICU,33019,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Optum,Medicare,,2658.00,,,,,,,2512.00,8498.17,per diem,
R&B ICU INTERMEDIATE,13011,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Optum,Medicare,,2658.00,,,,,,,2512.00,5665.77,per diem,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,244.00000,77.10000,Optum,Medicare,,78.08,,,,,,,63.44,236.68,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,24075,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Optum,Medicare,,2658.00,,,,,,,2502.90,3111.10,per diem,
R&B OBSTETRICS SEMI-PVT,44073,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Optum,Medicare,,2658.00,,,,,,,2502.90,3111.10,per diem,
R&B NURSERY LEVEL 1,55160,CDM,171,RC,,,,,facility,inpatient,,,3477.00000,1975.46000,Optum,Medicare,,2658.00,,,,,,,2512.00,3372.69,per diem,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,outpatient,,,16.00000,7.71000,Optum,Medicare,,5.12,,,,,,,4.16,15.52,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Optum,Medicare,,67.20,,,,,,,54.60,203.70,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,outpatient,,,380.00000,215.90000,Optum,Medicare,,121.60,,,,,,,98.80,368.60,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Optum,Medicare,,37.12,,,,,,,30.16,112.52,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22012,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Optum,Medicare,,2658.00,,,,,,,2502.90,3111.10,per diem,
R&B ADMIN DAY SKILLED,82016,CDM,160,RC,,,,,facility,inpatient,,,1923.00000,1092.55000,Optum,Medicare,,2658.00,,,,,,,1730.70,3111.10,per diem,
R&B SWING BED SKILLED,62018,CDM,160,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Optum,Medicare,,2658.00,,,,,,,2502.90,3111.10,per diem,
R&B ADMIN DAY INTERMEDIATE,72017,CDM,169,RC,,,,,facility,inpatient,,,1176.00000,668.14000,Optum,Medicare,,2658.00,,,,,,,1058.40,3111.10,per diem,
R&B ICU,32011,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Optum,Medicare,,2658.00,,,,,,,2512.00,8498.17,per diem,
R&B ICU INTERMEDIATE,12013,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Optum,Medicare,,2658.00,,,,,,,2512.00,5665.77,per diem,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Optum,Medicare,,37.12,,,,,,,30.16,112.52,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Optum,Medicare,,161.28,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Optum,Medicare,,31.36,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Optum,Medicare,,194.56,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Optum,Medicare,,36.48,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Optum,Medicare,,59.84,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Optum,Medicare,,68.48,,,,,,,55.64,207.58,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Optum,Medicare,,26.88,,,,,,,21.84,81.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Optum,Medicare,,90.88,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Optum,Medicare,,146.56,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Optum,Medicare,,178.56,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Optum,Medicare,,154.24,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Optum,Medicare,,75.84,,,,,,,61.62,229.89,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,outpatient,,,2041.00000,659.24000,Optum,Medicare,,653.12,,,,,,,530.66,1979.77,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,outpatient,,,259.00000,83.66000,Optum,Medicare,,82.88,,,,,,,67.34,251.23,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,outpatient,,,672.00000,217.06000,Optum,Medicare,,215.04,,,,,,,174.72,651.84,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,outpatient,,,530.00000,171.19000,Optum,Medicare,,169.60,,,,,,,137.80,514.10,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,outpatient,,,580.00000,187.34000,Optum,Medicare,,185.60,,,,,,,150.80,562.60,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,outpatient,,,435.00000,140.50000,Optum,Medicare,,139.20,,,,,,,113.10,421.95,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Optum,Medicare,,276.16,,,,,,,224.38,837.11,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,outpatient,,,334.00000,107.88000,Optum,Medicare,,106.88,,,,,,,86.84,323.98,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,outpatient,,,1188.00000,383.72000,Optum,Medicare,50,380.16,,,,,,,308.88,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Optum,Medicare,LT,253.44,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Optum,Medicare,RT,253.44,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,outpatient,,,572.00000,184.76000,Optum,Medicare,50,183.04,,,,,,,148.72,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Optum,Medicare,LT,121.92,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Optum,Medicare,RT,121.92,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,outpatient,,,455.00000,146.96000,Optum,Medicare,,145.60,,,,,,,118.30,441.35,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,outpatient,,,403.00000,130.17000,Optum,Medicare,,128.96,,,,,,,104.78,390.91,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,outpatient,,,370.00000,119.51000,Optum,Medicare,,118.40,,,,,,,96.20,358.90,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,outpatient,,,357.00000,115.31000,Optum,Medicare,,114.24,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,outpatient,,,334.00000,107.88000,Optum,Medicare,,106.88,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,outpatient,,,194.00000,62.66000,Optum,Medicare,,62.08,,,,,,,50.44,188.18,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,outpatient,,,457.00000,147.61000,Optum,Medicare,,146.24,,,,,,,118.82,443.29,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,outpatient,,,492.00000,158.92000,Optum,Medicare,,157.44,,,,,,,127.92,477.24,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,outpatient,,,780.00000,251.94000,Optum,Medicare,,249.60,,,,,,,202.80,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,outpatient,,,1165.00000,376.30000,Optum,Medicare,,372.80,,,,,,,302.90,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,outpatient,,,2350.00000,759.05000,Optum,Medicare,,752.00,,,,,,,611.00,2279.50,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,outpatient,,,896.00000,289.41000,Optum,Medicare,,286.72,,,,,,,232.96,869.12,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,outpatient,,,490.00000,158.27000,Optum,Medicare,,156.80,,,,,,,127.40,475.30,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,outpatient,,,520.00000,167.96000,Optum,Medicare,,166.40,,,,,,,135.20,504.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,outpatient,,,720.00000,232.56000,Optum,Medicare,,230.40,,,,,,,187.20,698.40,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,outpatient,,,215.00000,69.45000,Optum,Medicare,,68.80,,,,,,,55.90,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,outpatient,,,240.00000,77.52000,Optum,Medicare,,76.80,,,,,,,62.40,232.80,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,outpatient,,,1241.00000,400.84000,Optum,Medicare,,397.12,,,,,,,322.66,1203.77,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Optum,Medicare,,269.44,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Optum,Medicare,,336.96,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Optum,Medicare,,404.16,,,,,,,328.38,1225.11,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,outpatient,,,668.00000,559.78000,Optum,Medicare,,213.76,,,,,,,173.68,647.96,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Optum,Medicare,,25.92,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Optum,Medicare,,13.12,,,,,,,10.66,39.77,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Optum,Medicare,,144.96,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Optum,Medicare,,46.08,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Optum,Medicare,,34.24,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Optum,Medicare,,46.08,,,,,,,37.44,139.68,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Optum,Medicare,,1.09,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Optum,Medicare,,1.09,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Optum,Medicare,,1.09,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Optum,Medicare,,1.57,,,,,,,1.27,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,7.90000,4.49000,Optum,Medicare,,2.53,,,,,,,2.05,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Optum,Medicare,,1.57,,,,,,,1.27,4.75,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Optum,Medicare,,25.92,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Optum,Medicare,,25.92,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Optum,Medicare,,25.92,,,,,,,21.06,78.57,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,outpatient,,,3141500.00000,1784843.22000,Optum,Medicare,,1005280.00,,,,,,,816790.00,3047255.00,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Optum,Medicare,UD,0.07040,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.52000,0.30000,Optum,Medicare,UD,0.16640,,,,,,,0.13520,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.56000,0.32000,Optum,Medicare,UD,0.17920,,,,,,,0.14560,0.54320,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Optum,Medicare,UD,0.07040,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.85000,0.48000,Optum,Medicare,UD,0.27200,,,,,,,0.22100,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Optum,Medicare,UD,0.07040,,,,,,,0.05720,0.21340,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,outpatient,,,102.00000,65.18000,Optum,Medicare,,32.64,,,,,,,26.52,98.94,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,outpatient,,,190.00000,121.41000,Optum,Medicare,,60.80,,,,,,,49.40,184.30,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Optum,Medicare,,114.88,,,,,,,93.34,348.23,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Optum,Medicare,,171.20,,,,,,,139.10,518.95,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,outpatient,,,766.00000,489.47000,Optum,Medicare,,245.12,,,,,,,199.16,743.02,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,outpatient,,,159.00000,101.60000,Optum,Medicare,,50.88,,,,,,,41.34,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,outpatient,,,447.00000,285.63000,Optum,Medicare,,143.04,,,,,,,116.22,433.59,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,outpatient,,,1413.00000,902.91000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,outpatient,,,3853.00000,2462.07000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,outpatient,,,313.00000,200.01000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,outpatient,,,1132.00000,723.35000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,outpatient,,,2695.00000,1722.10000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,outpatient,,,1619.00000,1034.54000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Optum,Medicare,,171.20,,,,,,,139.10,518.95,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,outpatient,,,850.00000,543.15000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,outpatient,,,32.00000,20.45000,Optum,Medicare,,10.24,,,,,,,8.32,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,outpatient,,,134.00000,85.63000,Optum,Medicare,,42.88,,,,,,,34.84,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Optum,Medicare,,114.88,,,,,,,93.34,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,outpatient,,,709.00000,453.05000,Optum,Medicare,,226.88,,,,,,,184.34,687.73,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,outpatient,,,4880.00000,2357.04000,Optum,Medicare,,1561.60,,,,,,,1268.80,4733.60,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,outpatient,,,6024.00000,2909.59000,Optum,Medicare,,1927.68,,,,,,,1566.24,5843.28,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Optum,Medicare,,143.04,,,,,,,116.22,433.59,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Optum,Medicare,,1407.04,,,,,,,1143.22,4265.09,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Optum,Medicare,,1875.52,,,,,,,1523.86,5685.17,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,outpatient,,,7413.00000,3580.48000,Optum,Medicare,,2372.16,,,,,,,1927.38,7190.61,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Optum,Medicare,,143.04,,,,,,,116.22,433.59,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Optum,Medicare,,143.04,,,,,,,116.22,433.59,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Optum,Medicare,,1407.04,,,,,,,1143.22,4265.09,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Optum,Medicare,,2297.92,,,,,,,1867.06,6965.57,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,outpatient,,,10654.00000,5145.88000,Optum,Medicare,,3409.28,,,,,,,2770.04,10334.38,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Optum,Medicare,,1875.52,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Optum,Medicare,,2075.84,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Optum,Medicare,,2372.16,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,11575.00000,5590.72000,Optum,Medicare,,3704.00,,,,,,,3009.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,13432.00000,6487.66000,Optum,Medicare,,4298.24,,,,,,,3492.32,13029.04,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,21904.00000,10579.63000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Optum,Medicare,,604.16,,,,,,,490.88,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Optum,Medicare,,1407.04,,,,,,,1143.22,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Optum,Medicare,,1875.52,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Optum,Medicare,,2372.16,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,12969.00000,6264.03000,Optum,Medicare,,4150.08,,,,,,,3371.94,12579.93,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Optum,Medicare,,604.16,,,,,,,490.88,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Optum,Medicare,,776.32,,,,,,,630.76,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Optum,Medicare,,904.64,,,,,,,735.02,2742.19,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Optum,Medicare,,32.64,,,,,,,26.52,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Optum,Medicare,,42.88,,,,,,,34.84,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,outpatient,,,251.00000,121.23000,Optum,Medicare,,80.32,,,,,,,65.26,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Optum,Medicare,,1875.52,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Optum,Medicare,,604.16,,,,,,,490.88,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Optum,Medicare,,1875.52,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,447.00000,215.90000,Optum,Medicare,,143.04,,,,,,,116.22,433.59,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Optum,Medicare,,904.64,,,,,,,735.02,2742.19,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Optum,Medicare,,860.80,,,,,,,699.40,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Optum,Medicare,,2075.84,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,2426.00000,1171.76000,Optum,Medicare,,776.32,,,,,,,630.76,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,15334.00000,7406.32000,Optum,Medicare,,4906.88,,,,,,,3986.84,14873.98,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Optum,Medicare,,604.16,,,,,,,490.88,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Optum,Medicare,,904.64,,,,,,,735.02,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,251.00000,121.23000,Optum,Medicare,,80.32,,,,,,,65.26,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Optum,Medicare,,604.16,,,,,,,490.88,1831.36,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Optum,Medicare,,904.64,,,,,,,735.02,2742.19,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Optum,Medicare,,10.24,,,,,,,8.32,31.04,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Optum,Medicare,,604.16,,,,,,,490.88,1831.36,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Optum,Medicare,,4906.88,,,,,,,3986.84,14873.98,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,outpatient,,,1485.00000,717.26000,Optum,Medicare,,475.20,,,,,,,386.10,1440.45,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,outpatient,,,2028.00000,979.52000,Optum,Medicare,,648.96,,,,,,,527.28,1967.16,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Optum,Medicare,,1407.04,,,,,,,1143.22,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,8107.00000,3915.68000,Optum,Medicare,,2594.24,,,,,,,2107.82,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,10422.00000,5033.83000,Optum,Medicare,,3335.04,,,,,,,2709.72,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,12737.00000,6151.97000,Optum,Medicare,,4075.84,,,,,,,3311.62,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,14239.00000,6877.44000,Optum,Medicare,,4556.48,,,,,,,3702.14,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,16429.00000,7935.21000,Optum,Medicare,,5257.28,,,,,,,4271.54,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,18619.00000,8992.98000,Optum,Medicare,,5958.08,,,,,,,4840.94,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,20809.00000,10050.75000,Optum,Medicare,,6658.88,,,,,,,5410.34,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,22999.00000,11108.52000,Optum,Medicare,,7359.68,,,,,,,5979.74,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,25189.00000,12166.29000,Optum,Medicare,,8060.48,,,,,,,6549.14,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,27379.00000,13224.06000,Optum,Medicare,,8761.28,,,,,,,7118.54,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,29569.00000,14281.83000,Optum,Medicare,,9462.08,,,,,,,7687.94,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,31759.00000,15339.60000,Optum,Medicare,,10162.88,,,,,,,8257.34,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,36139.00000,17455.14000,Optum,Medicare,,11564.48,,,,,,,9396.14,35054.83,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Optum,Medicare,,604.16,,,,,,,490.88,1831.36,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Optum,Medicare,,1068.80,,,,,,,868.40,3239.80,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Optum,Medicare,,1875.52,,,,,,,1523.86,5685.17,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Optum,Medicare,,10.24,,,,,,,8.32,31.04,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Optum,Medicare,,42.88,,,,,,,34.84,129.98,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Optum,Medicare,,60.80,,,,,,,49.40,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,outpatient,,,476.00000,229.91000,Optum,Medicare,,152.32,,,,,,,123.76,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Optum,Medicare,,10.24,,,,,,,8.32,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Optum,Medicare,,143.04,,,,,,,116.22,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Optum,Medicare,,604.16,,,,,,,490.88,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Optum,Medicare,,1875.52,,,,,,,1523.86,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,outpatient,,,12506.00000,6040.40000,Optum,Medicare,,4001.92,,,,,,,3251.56,12130.82,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,outpatient,,,2404.80000,1161.52000,Optum,Medicare,,769.54,,,,,,,625.25,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,outpatient,,,969.00000,468.03000,Optum,Medicare,,310.08,,,,,,,251.94,939.93,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,outpatient,,,2256.90000,1090.08000,Optum,Medicare,,722.21,,,,,,,586.79,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,outpatient,,,644.30000,311.20000,Optum,Medicare,,206.18,,,,,,,167.52,624.97,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Optum,Medicare,,32.64,,,,,,,26.52,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Optum,Medicare,,60.80,,,,,,,49.40,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Optum,Medicare,,11214.08,,,,,,,9111.44,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,outpatient,,,43804.00000,21157.33000,Optum,Medicare,,14017.28,,,,,,,11389.04,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,outpatient,,,52564.00000,25388.41000,Optum,Medicare,,16820.48,,,,,,,13666.64,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,outpatient,,,61324.00000,29619.49000,Optum,Medicare,,19623.68,,,,,,,15944.24,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,outpatient,,,70084.00000,33850.57000,Optum,Medicare,,22426.88,,,,,,,18221.84,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,outpatient,,,78844.00000,38081.65000,Optum,Medicare,,25230.08,,,,,,,20499.44,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,outpatient,,,87604.00000,42312.73000,Optum,Medicare,,28033.28,,,,,,,22777.04,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,outpatient,,,96364.00000,46543.81000,Optum,Medicare,,30836.48,,,,,,,25054.64,93473.08,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Optum,Medicare,,11214.08,,,,,,,9111.44,33992.68,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,outpatient,,,39424.00000,19041.79000,Optum,Medicare,,12615.68,,,,,,,10250.24,38241.28,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Optum,Medicare,,1250.88,,,,,,,1016.34,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Optum,Medicare,,60.80,,,,,,,49.40,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Optum,Medicare,,1875.52,,,,,,,1523.86,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Optum,Medicare,,4906.88,,,,,,,3986.84,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Optum,Medicare,,604.16,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2023.00000,977.11000,Optum,Medicare,,647.36,,,,,,,525.98,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Optum,Medicare,,604.16,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Optum,Medicare,,604.16,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Optum,Medicare,,1875.52,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Optum,Medicare,,2520.32,,,,,,,2047.76,7639.72,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,outpatient,,,10191.00000,4922.25000,Optum,Medicare,,3261.12,,,,,,,2649.66,9885.27,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,96.00000,46.37000,Optum,Medicare,,30.72,,,,,,,24.96,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Optum,Medicare,,1875.52,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,7876.00000,3804.11000,Optum,Medicare,,2520.32,,,,,,,2047.76,7639.72,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Optum,Medicare,,1250.88,,,,,,,1016.34,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,outpatient,,,5373.00000,2595.16000,Optum,Medicare,,1719.36,,,,,,,1396.98,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,outpatient,,,6487.00000,3133.22000,Optum,Medicare,,2075.84,,,,,,,1686.62,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Optum,Medicare,,2520.32,,,,,,,2047.76,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Optum,Medicare,,1407.04,,,,,,,1143.22,4265.09,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Optum,Medicare,,1875.52,,,,,,,1523.86,5685.17,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,outpatient,,,1126.00000,543.86000,Optum,Medicare,,360.32,,,,,,,292.76,1092.22,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Optum,Medicare,,860.80,,,,,,,699.40,2609.30,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,4880.00000,2357.04000,Optum,Medicare,,1561.60,,,,,,,1268.80,4733.60,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,9260.00000,4472.58000,Optum,Medicare,,2963.20,,,,,,,2407.60,8982.20,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Optum,Medicare,,1875.52,,,,,,,1523.86,5685.17,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,588.00000,284.00000,Optum,Medicare,,188.16,,,,,,,152.88,570.36,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Optum,Medicare,,604.16,,,,,,,490.88,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Optum,Medicare,,776.32,,,,,,,630.76,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Optum,Medicare,,904.64,,,,,,,735.02,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Optum,Medicare,,1068.80,,,,,,,868.40,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Optum,Medicare,,1068.80,,,,,,,868.40,3239.80,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Optum,Medicare,,143.04,,,,,,,116.22,433.59,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Optum,Medicare,,1250.88,,,,,,,1016.34,3791.73,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Optum,Medicare,,1875.52,,,,,,,1523.86,5685.17,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,outpatient,,,159.00000,76.80000,Optum,Medicare,,50.88,,,,,,,41.34,154.23,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,outpatient,,,588.00000,284.00000,Optum,Medicare,,188.16,,,,,,,152.88,570.36,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Optum,Medicare,,776.32,,,,,,,630.76,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Optum,Medicare,,143.04,,,,,,,116.22,433.59,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,outpatient,,,8107.00000,3915.68000,Optum,Medicare,,2594.24,,,,,,,2107.82,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,outpatient,,,10422.00000,5033.83000,Optum,Medicare,,3335.04,,,,,,,2709.72,10109.34,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Optum,Medicare,,1875.52,,,,,,,1523.86,5685.17,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Optum,Medicare,,604.16,,,,,,,490.88,1831.36,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Optum,Medicare,,32.64,,,,,,,26.52,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,outpatient,,,221.00000,106.74000,Optum,Medicare,,70.72,,,,,,,57.46,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Optum,Medicare,,143.04,,,,,,,116.22,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Optum,Medicare,,776.32,,,,,,,630.76,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Optum,Medicare,,1068.80,,,,,,,868.40,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,outpatient,,,4153.00000,2005.90000,Optum,Medicare,,1328.96,,,,,,,1079.78,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,outpatient,,,5129.00000,2477.31000,Optum,Medicare,,1641.28,,,,,,,1333.54,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Optum,Medicare,,2297.92,,,,,,,1867.06,6965.57,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,outpatient,,,52.50000,25.36000,Optum,Medicare,,16.80,,,,,,,13.65,50.92,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,outpatient,,,50.40000,24.34000,Optum,Medicare,,16.13,,,,,,,13.10,48.89,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Optum,Medicare,,776.32,,,,,,,630.76,2353.22,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Optum,Medicare,,1250.88,,,,,,,1016.34,3791.73,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Optum,Medicare,,32.64,,,,,,,26.52,98.94,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Optum,Medicare,,10.24,,,,,,,8.32,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Optum,Medicare,,143.04,,,,,,,116.22,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,outpatient,,,709.00000,342.45000,Optum,Medicare,,226.88,,,,,,,184.34,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Optum,Medicare,,21025.28,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Optum,Medicare,,28033.28,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Optum,Medicare,,35041.28,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,131404.00000,74657.18000,Optum,Medicare,,42049.28,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,43800.00000,24884.97000,Optum,Medicare,,14016.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Optum,Medicare,,21025.28,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Optum,Medicare,,28033.28,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Optum,Medicare,,6308.48,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,24090.00000,13686.73000,Optum,Medicare,,7708.80,,,,,,,6263.40,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Optum,Medicare,,9111.68,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Optum,Medicare,,5606.40,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Optum,Medicare,,14017.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Optum,Medicare,,21025.28,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Optum,Medicare,,28033.28,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Optum,Medicare,,35041.28,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,6105.00000,3468.56000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,13895.00000,7894.44000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,21900.00000,12442.48000,Optum,Medicare,,7008.00,,,,,,,5694.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,35040.00000,19907.98000,Optum,Medicare,,11212.80,,,,,,,9110.40,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Optum,Medicare,,14017.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Optum,Medicare,,6308.48,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,22776.00000,12940.18000,Optum,Medicare,,7288.32,,,,,,,5921.76,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Optum,Medicare,,9111.68,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Optum,Medicare,,5606.40,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,30664.00000,17421.75000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,35044.00000,19910.25000,Optum,Medicare,,11214.08,,,,,,,9111.44,33992.68,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2695.00000,1080.70000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,3853.00000,1545.05000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,outpatient,,,1413.00000,566.61000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,3229.80000,1857.14000,Optum,Medicare,,1033.54,,,,,,,839.75,3132.91,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,854.40000,491.28000,Optum,Medicare,,273.41,,,,,,,222.14,828.77,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1200.50000,690.29000,Optum,Medicare,,384.16,,,,,,,312.13,1164.48,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1011.00000,581.32000,Optum,Medicare,,323.52,,,,,,,262.86,980.67,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1823.80000,1048.68000,Optum,Medicare,,583.62,,,,,,,474.19,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2028.50000,1166.39000,Optum,Medicare,,649.12,,,,,,,527.41,1967.64,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,841.00000,483.58000,Optum,Medicare,,269.12,,,,,,,218.66,815.77,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1366.20000,785.56000,Optum,Medicare,,437.18,,,,,,,355.21,1325.21,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1384.00000,795.80000,Optum,Medicare,,442.88,,,,,,,359.84,1342.48,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2458.70000,1413.75000,Optum,Medicare,,786.78,,,,,,,639.26,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2393.50000,1376.26000,Optum,Medicare,,765.92,,,,,,,622.31,2321.70,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1369.50000,787.46000,Optum,Medicare,,438.24,,,,,,,356.07,1328.41,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2697.40000,1551.00000,Optum,Medicare,,863.17,,,,,,,701.32,2616.48,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4621.80000,2657.54000,Optum,Medicare,,1478.98,,,,,,,1201.67,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2592.50000,1490.69000,Optum,Medicare,,829.60,,,,,,,674.05,2514.72,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Optum,Medicare,,1875.52,,,,,,,1523.86,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Optum,Medicare,,2668.48,,,,,,,2168.14,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Optum,Medicare,,1875.52,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Optum,Medicare,,2594.24,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Optum,Medicare,,360.32,,,,,,,292.76,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Optum,Medicare,,1407.04,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Optum,Medicare,,2372.16,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,outpatient,,,20152.00000,11587.40000,Optum,Medicare,,6448.64,,,,,,,5239.52,19547.44,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Optum,Medicare,,143.04,,,,,,,116.22,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Optum,Medicare,,226.88,,,,,,,184.34,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,1272.00000,731.40000,Optum,Medicare,,407.04,,,,,,,330.72,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Optum,Medicare,,860.80,,,,,,,699.40,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,3078.00000,1769.85000,Optum,Medicare,,984.96,,,,,,,800.28,2985.66,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,70.00000,40.25000,Optum,Medicare,,22.40,,,,,,,18.20,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,102.00000,58.65000,Optum,Medicare,,32.64,,,,,,,26.52,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,221.00000,127.07000,Optum,Medicare,,70.72,,,,,,,57.46,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Optum,Medicare,,143.04,,,,,,,116.22,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Optum,Medicare,,226.88,,,,,,,184.34,687.73,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Optum,Medicare,,4001.92,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35482.00000,20402.15000,Optum,Medicare,,11354.24,,,,,,,9225.32,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39862.00000,22920.65000,Optum,Medicare,,12755.84,,,,,,,10364.12,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,44242.00000,25439.15000,Optum,Medicare,,14157.44,,,,,,,11502.92,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,48622.00000,27957.65000,Optum,Medicare,,15559.04,,,,,,,12641.72,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,53002.00000,30476.15000,Optum,Medicare,,16960.64,,,,,,,13780.52,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Optum,Medicare,,19623.68,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Optum,Medicare,,22426.88,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Optum,Medicare,,25230.08,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Optum,Medicare,,28033.28,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Optum,Medicare,,30836.48,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,844.00000,485.30000,Optum,Medicare,,270.08,,,,,,,219.44,818.68,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,11575.00000,6655.62000,Optum,Medicare,,3704.00,,,,,,,3009.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14892.00000,8562.90000,Optum,Medicare,,4765.44,,,,,,,3871.92,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,24970.00000,14357.75000,Optum,Medicare,,7990.40,,,,,,,6492.20,24220.90,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Optum,Medicare,,604.16,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Optum,Medicare,,143.04,,,,,,,116.22,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Optum,Medicare,,604.16,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Optum,Medicare,,1068.80,,,,,,,868.40,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Optum,Medicare,,1328.96,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4641.00000,2668.58000,Optum,Medicare,,1485.12,,,,,,,1206.66,4501.77,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Optum,Medicare,,1561.60,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Optum,Medicare,,4906.88,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Optum,Medicare,,30836.48,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Optum,Medicare,,35041.28,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Optum,Medicare,,42049.28,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,153304.00000,88149.80000,Optum,Medicare,,49057.28,,,,,,,39859.04,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,175204.00000,100742.30000,Optum,Medicare,,56065.28,,,,,,,45553.04,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,197104.00000,113334.80000,Optum,Medicare,,63073.28,,,,,,,51247.04,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,219004.00000,125927.30000,Optum,Medicare,,70081.28,,,,,,,56941.04,212433.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Optum,Medicare,,11214.08,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Optum,Medicare,,11214.08,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Optum,Medicare,,12615.68,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Optum,Medicare,,14017.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Optum,Medicare,,15418.88,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Optum,Medicare,,16820.48,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Optum,Medicare,,18222.08,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Optum,Medicare,,19623.68,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Optum,Medicare,,21025.28,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Optum,Medicare,,11214.08,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Optum,Medicare,,14017.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Optum,Medicare,,16820.48,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Optum,Medicare,,21025.28,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Optum,Medicare,,28033.28,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Optum,Medicare,,35041.28,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Optum,Medicare,,1561.60,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Optum,Medicare,,11214.08,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Optum,Medicare,,12615.68,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Optum,Medicare,,14017.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Optum,Medicare,,15418.88,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Optum,Medicare,,16820.48,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Optum,Medicare,,18222.08,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Optum,Medicare,,19623.68,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Optum,Medicare,,22426.88,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Optum,Medicare,,25230.08,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Optum,Medicare,,28033.28,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Optum,Medicare,,30836.48,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Optum,Medicare,,35041.28,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Optum,Medicare,,39246.08,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,135784.00000,78075.80000,Optum,Medicare,,43450.88,,,,,,,35303.84,131710.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Optum,Medicare,,11214.08,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Optum,Medicare,,12615.68,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Optum,Medicare,,14017.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Optum,Medicare,,15418.88,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,55630.00000,31987.25000,Optum,Medicare,,17801.60,,,,,,,14463.80,53961.10,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Optum,Medicare,,860.80,,,,,,,699.40,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Optum,Medicare,,4486.40,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,17962.00000,10328.15000,Optum,Medicare,,5747.84,,,,,,,4670.12,17423.14,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,2421.00000,1392.07000,Optum,Medicare,,774.72,,,,,,,629.46,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Optum,Medicare,,4906.88,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Optum,Medicare,,776.32,,,,,,,630.76,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Optum,Medicare,,860.80,,,,,,,699.40,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,27160.00000,15617.00000,Optum,Medicare,,8691.20,,,,,,,7061.60,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Optum,Medicare,,10513.28,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Optum,Medicare,,12615.68,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Optum,Medicare,,16820.48,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Optum,Medicare,,21025.28,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Optum,Medicare,,25230.08,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,28470.00000,16370.25000,Optum,Medicare,,9110.40,,,,,,,7402.20,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,43800.00000,25185.00000,Optum,Medicare,,14016.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Optum,Medicare,,21025.28,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Optum,Medicare,,28033.28,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Optum,Medicare,,35041.28,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Optum,Medicare,,1250.88,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Optum,Medicare,,10513.28,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Optum,Medicare,,14017.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,54754.00000,31483.55000,Optum,Medicare,,17521.28,,,,,,,14236.04,53111.38,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Optum,Medicare,,860.80,,,,,,,699.40,2609.30,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,61320.00000,35259.00000,Optum,Medicare,,19622.40,,,,,,,15943.20,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,70080.00000,40296.00000,Optum,Medicare,,22425.60,,,,,,,18220.80,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,78840.00000,45333.00000,Optum,Medicare,,25228.80,,,,,,,20498.40,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Optum,Medicare,,30836.48,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Optum,Medicare,,35041.28,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Optum,Medicare,,39246.08,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Optum,Medicare,,4906.88,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Optum,Medicare,,6308.48,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Optum,Medicare,,7710.08,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Optum,Medicare,,10513.28,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Optum,Medicare,,4906.88,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Optum,Medicare,,6308.48,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1883.00000,1082.72000,Optum,Medicare,,602.56,,,,,,,489.58,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Optum,Medicare,,1250.88,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,7644.00000,4395.30000,Optum,Medicare,,2446.08,,,,,,,1987.44,7414.68,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Optum,Medicare,,860.80,,,,,,,699.40,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Optum,Medicare,,4906.88,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Optum,Medicare,,6308.48,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Optum,Medicare,,516.48,,,,,,,419.64,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Optum,Medicare,,4906.88,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Optum,Medicare,,6308.48,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Optum,Medicare,,7710.08,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Optum,Medicare,,9111.68,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Optum,Medicare,,10513.28,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,37234.00000,21409.55000,Optum,Medicare,,11914.88,,,,,,,9680.84,36116.98,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Optum,Medicare,,14017.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Optum,Medicare,,21025.28,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Optum,Medicare,,11214.08,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Optum,Medicare,,12615.68,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Optum,Medicare,,16820.48,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Optum,Medicare,,21025.28,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Optum,Medicare,,25230.08,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,159.00000,91.42000,Optum,Medicare,,50.88,,,,,,,41.34,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Optum,Medicare,,604.16,,,,,,,490.88,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Optum,Medicare,,604.16,,,,,,,490.88,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Optum,Medicare,,776.32,,,,,,,630.76,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Optum,Medicare,,904.64,,,,,,,735.02,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Optum,Medicare,,1068.80,,,,,,,868.40,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Optum,Medicare,,2594.24,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Optum,Medicare,,21025.28,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Optum,Medicare,,28033.28,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Optum,Medicare,,35041.28,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Optum,Medicare,,42049.28,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Optum,Medicare,,4906.88,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,18400.00000,10580.00000,Optum,Medicare,,5888.00,,,,,,,4784.00,17848.00,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Optum,Medicare,,7710.08,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Optum,Medicare,,9111.68,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Optum,Medicare,,10513.28,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Optum,Medicare,,11214.08,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Optum,Medicare,,11214.08,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Optum,Medicare,,12615.68,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Optum,Medicare,,14017.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Optum,Medicare,,516.48,,,,,,,419.64,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Optum,Medicare,,14017.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Optum,Medicare,,18222.08,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Optum,Medicare,,21025.28,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,5368.00000,3086.60000,Optum,Medicare,,1717.76,,,,,,,1395.68,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Optum,Medicare,,4906.88,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Optum,Medicare,,6308.48,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Optum,Medicare,,4486.40,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Optum,Medicare,,6308.48,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,25408.00000,14609.60000,Optum,Medicare,,8130.56,,,,,,,6606.08,24645.76,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Optum,Medicare,,11214.08,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Optum,Medicare,,14017.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,8112.00000,4664.40000,Optum,Medicare,,2595.84,,,,,,,2109.12,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,10431.00000,5997.82000,Optum,Medicare,,3337.92,,,,,,,2712.06,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Optum,Medicare,,6308.48,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Optum,Medicare,,10513.28,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Optum,Medicare,,12615.68,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,46870.00000,26950.25000,Optum,Medicare,,14998.40,,,,,,,12186.20,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,51250.00000,29468.75000,Optum,Medicare,,16400.00,,,,,,,13325.00,49712.50,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Optum,Medicare,,12615.68,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Optum,Medicare,,16820.48,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Optum,Medicare,,21025.28,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Optum,Medicare,,25230.08,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Optum,Medicare,,28033.28,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,588.00000,338.10000,Optum,Medicare,,188.16,,,,,,,152.88,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Optum,Medicare,,1407.04,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Optum,Medicare,,1250.88,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Optum,Medicare,,1719.36,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Optum,Medicare,,2075.84,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7876.00000,4528.70000,Optum,Medicare,,2520.32,,,,,,,2047.76,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Optum,Medicare,,4906.88,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Optum,Medicare,,6308.48,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Optum,Medicare,,7710.08,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5856.00000,3367.20000,Optum,Medicare,,1873.92,,,,,,,1522.56,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Optum,Medicare,,2075.84,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Optum,Medicare,,2372.16,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Optum,Medicare,,2668.48,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Optum,Medicare,,1407.04,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Optum,Medicare,,1719.36,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Optum,Medicare,,1927.68,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Optum,Medicare,,4001.92,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Optum,Medicare,,1407.04,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Optum,Medicare,,1719.36,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Optum,Medicare,,1927.68,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Optum,Medicare,,4001.92,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4392.00000,2525.40000,Optum,Medicare,,1405.44,,,,,,,1141.92,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Optum,Medicare,,1719.36,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Optum,Medicare,,2075.84,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Optum,Medicare,,1407.04,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Optum,Medicare,,1719.36,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Optum,Medicare,,2075.84,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Optum,Medicare,,1561.60,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Optum,Medicare,,360.32,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Optum,Medicare,,1407.04,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Optum,Medicare,,1719.36,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Optum,Medicare,,1927.68,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Optum,Medicare,,4001.92,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Optum,Medicare,,4346.24,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Optum,Medicare,,4906.88,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Optum,Medicare,,6308.48,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2152.00000,1237.40000,Optum,Medicare,,688.64,,,,,,,559.52,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Optum,Medicare,,1561.60,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Optum,Medicare,,1250.88,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Optum,Medicare,,1875.52,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Optum,Medicare,,1927.68,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Optum,Medicare,,6308.48,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Optum,Medicare,,1407.04,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Optum,Medicare,,1719.36,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Optum,Medicare,,1927.68,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Optum,Medicare,,360.32,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Optum,Medicare,,1407.04,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Optum,Medicare,,1719.36,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Optum,Medicare,,1927.68,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Optum,Medicare,,4001.92,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Optum,Medicare,,4346.24,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Optum,Medicare,,4906.88,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Optum,Medicare,,6308.48,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Optum,Medicare,,1719.36,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8802.00000,5061.15000,Optum,Medicare,,2816.64,,,,,,,2288.52,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10654.00000,6126.05000,Optum,Medicare,,3409.28,,,,,,,2770.04,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Optum,Medicare,,4001.92,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Optum,Medicare,,4346.24,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Optum,Medicare,,4906.88,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17086.00000,9824.45000,Optum,Medicare,,5467.52,,,,,,,4442.36,16573.42,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Optum,Medicare,,1561.60,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Optum,Medicare,,2075.84,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Optum,Medicare,,2372.16,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Optum,Medicare,,2668.48,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Optum,Medicare,,1561.60,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Optum,Medicare,,1561.60,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Optum,Medicare,,1150.72,,,,,,,934.96,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Optum,Medicare,,1407.04,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Optum,Medicare,,1953.60,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Optum,Medicare,,4906.88,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Optum,Medicare,,6308.48,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Optum,Medicare,,7710.08,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Optum,Medicare,,1250.88,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Optum,Medicare,,2075.84,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Optum,Medicare,,604.16,,,,,,,490.88,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Optum,Medicare,,776.32,,,,,,,630.76,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Optum,Medicare,,904.64,,,,,,,735.02,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Optum,Medicare,,1068.80,,,,,,,868.40,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Optum,Medicare,,1328.96,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Optum,Medicare,,2372.16,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Optum,Medicare,,2668.48,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9728.00000,5593.60000,Optum,Medicare,,3112.96,,,,,,,2529.28,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11117.00000,6392.28000,Optum,Medicare,,3557.44,,,,,,,2890.42,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Optum,Medicare,,11214.08,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Optum,Medicare,,12615.68,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Optum,Medicare,,14017.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Optum,Medicare,,15418.88,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Optum,Medicare,,16820.48,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Optum,Medicare,,18222.08,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Optum,Medicare,,19623.68,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Optum,Medicare,,21025.28,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Optum,Medicare,,22426.88,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Optum,Medicare,,23828.48,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Optum,Medicare,,25230.08,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Optum,Medicare,,26631.68,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,111694.00000,64224.05000,Optum,Medicare,,35742.08,,,,,,,29040.44,108343.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Optum,Medicare,,143.04,,,,,,,116.22,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Optum,Medicare,,226.88,,,,,,,184.34,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,991.00000,569.82000,Optum,Medicare,,317.12,,,,,,,257.66,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1490.00000,856.75000,Optum,Medicare,,476.80,,,,,,,387.40,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Optum,Medicare,,1250.88,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Optum,Medicare,,1875.52,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Optum,Medicare,,2075.84,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Optum,Medicare,,2372.16,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Optum,Medicare,,2668.48,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Optum,Medicare,,4906.88,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Optum,Medicare,,11214.08,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Optum,Medicare,,12615.68,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Optum,Medicare,,14017.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Optum,Medicare,,452.16,,,,,,,367.38,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Optum,Medicare,,1232.96,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,6945.00000,3993.37000,Optum,Medicare,,2222.40,,,,,,,1805.70,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Optum,Medicare,,11214.08,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Optum,Medicare,,143.04,,,,,,,116.22,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Optum,Medicare,,11214.08,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Optum,Medicare,,1250.88,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Optum,Medicare,,1719.36,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Optum,Medicare,,362.24,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Optum,Medicare,,11214.08,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Optum,Medicare,,12615.68,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Optum,Medicare,,14017.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,50374.00000,28965.05000,Optum,Medicare,,16119.68,,,,,,,13097.24,48862.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Optum,Medicare,,6308.48,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Optum,Medicare,,7710.08,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Optum,Medicare,,9111.68,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Optum,Medicare,,862.40,,,,,,,700.70,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Optum,Medicare,,2224.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Optum,Medicare,,3705.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Optum,Medicare,,4906.88,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Optum,Medicare,,11214.08,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Optum,Medicare,,12615.68,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Optum,Medicare,,14017.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Optum,Medicare,,15418.88,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Optum,Medicare,,690.24,,,,,,,560.82,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Optum,Medicare,,986.56,,,,,,,801.58,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Optum,Medicare,,12615.68,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Optum,Medicare,,14017.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Optum,Medicare,,15418.88,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Optum,Medicare,,16820.48,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Optum,Medicare,,18222.08,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Optum,Medicare,,21025.28,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Optum,Medicare,,23828.48,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Optum,Medicare,,26631.68,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,91984.00000,52890.80000,Optum,Medicare,,29434.88,,,,,,,23915.84,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,100744.00000,57927.80000,Optum,Medicare,,32238.08,,,,,,,26193.44,97721.68,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Optum,Medicare,,53.12,,,,,,,43.16,161.02,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Optum,Medicare,,143.04,,,,,,,116.22,433.59,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Optum,Medicare,,226.88,,,,,,,184.34,687.73,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Optum,Medicare,,5607.68,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Optum,Medicare,,7009.28,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Optum,Medicare,,8410.88,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Optum,Medicare,,9812.48,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Optum,Medicare,,11214.08,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Optum,Medicare,,12615.68,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Optum,Medicare,,14017.28,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Optum,Medicare,,16820.48,,,,,,,13666.64,50987.08,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Optum,Medicare,,1563.20,,,,,,,1270.10,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Optum,Medicare,,2964.80,,,,,,,2408.90,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Optum,Medicare,,4446.40,,,,,,,3612.70,13478.15,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2180.20000,1253.61000,Optum,Medicare,,697.66,,,,,,,566.85,2114.79,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1880.60000,1081.34000,Optum,Medicare,,601.79,,,,,,,488.96,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2908.70000,1672.50000,Optum,Medicare,,930.78,,,,,,,756.26,2821.44,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,outpatient,,,34.00000,25.74000,Optum,Medicare,,10.88,,,,,,,8.84,32.98,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,outpatient,,,13.00000,9.84000,Optum,Medicare,,4.16,,,,,,,3.38,12.61,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Optum,Medicare,,89.92,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Optum,Medicare,,89.92,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Optum,Medicare,,89.92,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Optum,Medicare,,240.32,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Optum,Medicare,,240.32,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Optum,Medicare,,240.32,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,outpatient,,,122.00000,92.35000,Optum,Medicare,,39.04,,,,,,,31.72,118.34,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Optum,Medicare,,25.28,,,,,,,20.54,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Optum,Medicare,,25.28,,,,,,,20.54,76.63,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Optum,Medicare,,4.80,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Optum,Medicare,,4.80,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Optum,Medicare,,5.44,,,,,,,4.42,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Optum,Medicare,,5.44,,,,,,,4.42,16.49,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,outpatient,,,359.00000,271.76000,Optum,Medicare,,114.88,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,outpatient,,,359.00000,271.76000,Optum,Medicare,,114.88,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,outpatient,,,359.00000,271.76000,Optum,Medicare,,114.88,,,,,,,93.34,348.23,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,outpatient,,,155.00000,117.34000,Optum,Medicare,,49.60,,,,,,,40.30,150.35,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,outpatient,,,294.00000,222.56000,Optum,Medicare,,94.08,,,,,,,76.44,285.18,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,outpatient,,,1511.00000,1143.83000,Optum,Medicare,,483.52,,,,,,,392.86,1465.67,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Optum,Medicare,,240.32,,,,,,,195.26,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Optum,Medicare,,240.32,,,,,,,195.26,728.47,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,outpatient,,,150.00000,113.55000,Optum,Medicare,,48.00,,,,,,,39.00,145.50,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,outpatient,,,110.00000,83.27000,Optum,Medicare,,35.20,,,,,,,28.60,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,outpatient,,,158.00000,119.61000,Optum,Medicare,,50.56,,,,,,,41.08,153.26,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,outpatient,,,153.00000,115.82000,Optum,Medicare,,48.96,,,,,,,39.78,148.41,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,outpatient,,,157.00000,118.85000,Optum,Medicare,,50.24,,,,,,,40.82,152.29,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,outpatient,,,26.00000,19.68000,Optum,Medicare,,8.32,,,,,,,6.76,25.22,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,outpatient,,,37.00000,28.01000,Optum,Medicare,,11.84,,,,,,,9.62,35.89,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,outpatient,,,268.00000,202.88000,Optum,Medicare,,85.76,,,,,,,69.68,259.96,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,outpatient,,,91.00000,68.89000,Optum,Medicare,,29.12,,,,,,,23.66,88.27,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,outpatient,,,200.00000,151.40000,Optum,Medicare,,64.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,outpatient,,,152.00000,115.06000,Optum,Medicare,,48.64,,,,,,,39.52,147.44,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,outpatient,,,359.00000,271.76000,Optum,Medicare,,114.88,,,,,,,93.34,348.23,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,outpatient,,,69.00000,33.26000,Optum,Medicare,,22.08,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,outpatient,,,75.00000,36.15000,Optum,Medicare,,24.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,outpatient,,,55.00000,26.51000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,outpatient,,,45.00000,21.69000,Optum,Medicare,,14.40,,,,,,,11.70,43.65,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,outpatient,,,68.00000,32.78000,Optum,Medicare,,21.76,,,,,,,17.68,65.96,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,outpatient,,,61.00000,29.40000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,outpatient,,,64.00000,30.85000,Optum,Medicare,,20.48,,,,,,,16.64,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,outpatient,,,195.00000,93.99000,Optum,Medicare,,62.40,,,,,,,50.70,189.15,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,outpatient,,,60.00000,28.92000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,outpatient,,,63.00000,30.37000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,outpatient,,,14.00000,6.75000,Optum,Medicare,,4.48,,,,,,,3.64,13.58,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,outpatient,,,66.00000,31.81000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,outpatient,,,53.00000,25.55000,Optum,Medicare,,16.96,,,,,,,13.78,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,outpatient,,,66.00000,31.81000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,outpatient,,,82.00000,39.52000,Optum,Medicare,,26.24,,,,,,,21.32,79.54,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Optum,Medicare,,45.12,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Optum,Medicare,,45.12,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,outpatient,,,91.00000,43.86000,Optum,Medicare,,29.12,,,,,,,23.66,88.27,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,outpatient,,,63.00000,30.37000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,outpatient,,,69.00000,33.26000,Optum,Medicare,,22.08,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,outpatient,,,205.00000,98.81000,Optum,Medicare,,65.60,,,,,,,53.30,198.85,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,outpatient,,,50.00000,24.10000,Optum,Medicare,,16.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,outpatient,,,406.00000,195.69000,Optum,Medicare,,129.92,,,,,,,105.56,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,outpatient,,,101.00000,48.68000,Optum,Medicare,,32.32,,,,,,,26.26,97.97,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,outpatient,,,375.00000,180.75000,Optum,Medicare,,120.00,,,,,,,97.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,outpatient,,,362.00000,174.48000,Optum,Medicare,,115.84,,,,,,,94.12,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,outpatient,,,325.00000,156.65000,Optum,Medicare,,104.00,,,,,,,84.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,outpatient,,,121.00000,58.32000,Optum,Medicare,,38.72,,,,,,,31.46,117.37,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,outpatient,,,115.00000,55.43000,Optum,Medicare,,36.80,,,,,,,29.90,111.55,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,outpatient,,,300.00000,144.60000,Optum,Medicare,,96.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,outpatient,,,51.00000,24.58000,Optum,Medicare,,16.32,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Optum,Medicare,,16.32,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Optum,Medicare,,16.32,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,outpatient,,,194.00000,93.51000,Optum,Medicare,,62.08,,,,,,,50.44,188.18,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,outpatient,,,57.00000,27.47000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,outpatient,,,68.00000,32.78000,Optum,Medicare,,21.76,,,,,,,17.68,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,outpatient,,,329.00000,158.58000,Optum,Medicare,,105.28,,,,,,,85.54,319.13,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,outpatient,,,24.00000,11.57000,Optum,Medicare,,7.68,,,,,,,6.24,23.28,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,outpatient,,,30.00000,14.46000,Optum,Medicare,,9.60,,,,,,,7.80,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,outpatient,,,63.00000,30.37000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,outpatient,,,53.00000,25.55000,Optum,Medicare,,16.96,,,,,,,13.78,51.41,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,outpatient,,,270.00000,130.14000,Optum,Medicare,,86.40,,,,,,,70.20,261.90,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Optum,Medicare,,39.36,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Optum,Medicare,,39.36,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,outpatient,,,37.00000,17.83000,Optum,Medicare,,11.84,,,,,,,9.62,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,outpatient,,,57.00000,27.47000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,outpatient,,,57.00000,27.47000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,outpatient,,,63.00000,30.37000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,outpatient,,,41.00000,19.76000,Optum,Medicare,,13.12,,,,,,,10.66,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,outpatient,,,72.00000,34.70000,Optum,Medicare,,23.04,,,,,,,18.72,69.84,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,outpatient,,,77.00000,37.11000,Optum,Medicare,,24.64,,,,,,,20.02,74.69,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,outpatient,,,90.00000,43.38000,Optum,Medicare,,28.80,,,,,,,23.40,87.30,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,outpatient,,,44.00000,21.21000,Optum,Medicare,,14.08,,,,,,,11.44,42.68,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,outpatient,,,115.00000,55.43000,Optum,Medicare,,36.80,,,,,,,29.90,111.55,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,outpatient,,,20.00000,9.64000,Optum,Medicare,,6.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,outpatient,,,52.00000,25.06000,Optum,Medicare,,16.64,,,,,,,13.52,50.44,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,outpatient,,,341.00000,164.36000,Optum,Medicare,,109.12,,,,,,,88.66,330.77,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,outpatient,,,54.00000,26.03000,Optum,Medicare,,17.28,,,,,,,14.04,52.38,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,outpatient,,,53.00000,25.55000,Optum,Medicare,,16.96,,,,,,,13.78,51.41,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,outpatient,,,88.00000,42.42000,Optum,Medicare,,28.16,,,,,,,22.88,85.36,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,outpatient,,,89.00000,42.90000,Optum,Medicare,,28.48,,,,,,,23.14,86.33,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,outpatient,,,61.00000,29.40000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Optum,Medicare,,24.64,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Optum,Medicare,,24.64,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Optum,Medicare,,20.48,,,,,,,16.64,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Optum,Medicare,,20.48,,,,,,,16.64,62.08,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,outpatient,,,63.00000,30.37000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,outpatient,,,95.00000,45.79000,Optum,Medicare,,30.40,,,,,,,24.70,92.15,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,outpatient,,,132.00000,63.62000,Optum,Medicare,,42.24,,,,,,,34.32,128.04,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,outpatient,,,83.00000,40.01000,Optum,Medicare,,26.56,,,,,,,21.58,80.51,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,outpatient,,,387.00000,186.53000,Optum,Medicare,,123.84,,,,,,,100.62,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,outpatient,,,387.00000,186.53000,Optum,Medicare,,123.84,,,,,,,100.62,375.39,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,outpatient,,,31.00000,14.94000,Optum,Medicare,,9.92,,,,,,,8.06,30.07,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,outpatient,,,36.00000,17.35000,Optum,Medicare,,11.52,,,,,,,9.36,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,outpatient,,,160.00000,77.12000,Optum,Medicare,,51.20,,,,,,,41.60,155.20,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,outpatient,,,112.00000,53.98000,Optum,Medicare,,35.84,,,,,,,29.12,108.64,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,outpatient,,,14.00000,6.75000,Optum,Medicare,,4.48,,,,,,,3.64,13.58,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,outpatient,,,16.00000,7.71000,Optum,Medicare,,5.12,,,,,,,4.16,15.52,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,outpatient,,,71.00000,34.22000,Optum,Medicare,,22.72,,,,,,,18.46,68.87,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,outpatient,,,116.00000,55.91000,Optum,Medicare,,37.12,,,,,,,30.16,112.52,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,outpatient,,,81.00000,39.04000,Optum,Medicare,,25.92,,,,,,,21.06,78.57,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,outpatient,,,97.00000,46.75000,Optum,Medicare,,31.04,,,,,,,25.22,94.09,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,outpatient,,,77.00000,37.11000,Optum,Medicare,,24.64,,,,,,,20.02,74.69,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,outpatient,,,35.00000,16.87000,Optum,Medicare,,11.20,,,,,,,9.10,33.95,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,outpatient,,,65.00000,31.33000,Optum,Medicare,,20.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,outpatient,,,74.00000,35.67000,Optum,Medicare,,23.68,,,,,,,19.24,71.78,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,outpatient,,,250.00000,120.50000,Optum,Medicare,,80.00,,,,,,,65.00,242.50,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,outpatient,,,90.00000,43.38000,Optum,Medicare,,28.80,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,outpatient,,,90.00000,43.38000,Optum,Medicare,,28.80,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,outpatient,,,52.00000,25.06000,Optum,Medicare,,16.64,,,,,,,13.52,50.44,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,outpatient,,,36.00000,17.35000,Optum,Medicare,,11.52,,,,,,,9.36,34.92,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,outpatient,,,78.00000,37.60000,Optum,Medicare,,24.96,,,,,,,20.28,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,outpatient,,,115.00000,55.43000,Optum,Medicare,,36.80,,,,,,,29.90,111.55,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,outpatient,,,67.00000,32.29000,Optum,Medicare,,21.44,,,,,,,17.42,64.99,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,outpatient,,,76.00000,36.63000,Optum,Medicare,,24.32,,,,,,,19.76,73.72,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,outpatient,,,53.00000,25.55000,Optum,Medicare,,16.96,,,,,,,13.78,51.41,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,outpatient,,,70.00000,33.74000,Optum,Medicare,,22.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,outpatient,,,169.00000,81.46000,Optum,Medicare,,54.08,,,,,,,43.94,163.93,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,outpatient,,,28.00000,13.50000,Optum,Medicare,,8.96,,,,,,,7.28,27.16,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,outpatient,,,51.00000,24.58000,Optum,Medicare,,16.32,,,,,,,13.26,49.47,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,outpatient,,,15.00000,7.23000,Optum,Medicare,,4.80,,,,,,,3.90,14.55,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,outpatient,,,18.00000,8.68000,Optum,Medicare,,5.76,,,,,,,4.68,17.46,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,outpatient,,,55.00000,26.51000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,outpatient,,,55.00000,26.51000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,outpatient,,,61.00000,29.40000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,outpatient,,,550.00000,265.10000,Optum,Medicare,,176.00,,,,,,,143.00,533.50,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Optum,Medicare,,23.36,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,outpatient,,,392.00000,188.94000,Optum,Medicare,,125.44,,,,,,,101.92,380.24,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,outpatient,,,75.00000,36.15000,Optum,Medicare,,24.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Optum,Medicare,,23.36,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,outpatient,,,100.00000,48.20000,Optum,Medicare,,32.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,outpatient,,,153.00000,73.75000,Optum,Medicare,,48.96,,,,,,,39.78,148.41,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,outpatient,,,909.00000,438.14000,Optum,Medicare,,290.88,,,,,,,236.34,881.73,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,outpatient,,,266.00000,128.21000,Optum,Medicare,,85.12,,,,,,,69.16,258.02,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,outpatient,,,275.00000,132.55000,Optum,Medicare,,88.00,,,,,,,71.50,266.75,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,outpatient,,,61.00000,29.40000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,outpatient,,,84.00000,40.49000,Optum,Medicare,,26.88,,,,,,,21.84,81.48,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,outpatient,,,174.00000,83.87000,Optum,Medicare,,55.68,,,,,,,45.24,168.78,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,outpatient,,,62.00000,29.88000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,outpatient,,,67.00000,32.29000,Optum,Medicare,,21.44,,,,,,,17.42,64.99,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,outpatient,,,68.00000,32.78000,Optum,Medicare,,21.76,,,,,,,17.68,65.96,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,outpatient,,,63.00000,30.37000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,outpatient,,,211.00000,101.70000,Optum,Medicare,,67.52,,,,,,,54.86,204.67,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,outpatient,,,65.00000,31.33000,Optum,Medicare,,20.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,outpatient,,,83.00000,40.01000,Optum,Medicare,,26.56,,,,,,,21.58,80.51,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,outpatient,,,54.00000,26.03000,Optum,Medicare,,17.28,,,,,,,14.04,52.38,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,outpatient,,,55.00000,26.51000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,outpatient,,,323.00000,155.69000,Optum,Medicare,,103.36,,,,,,,83.98,313.31,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,outpatient,,,63.00000,30.37000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,outpatient,,,35.00000,16.87000,Optum,Medicare,,11.20,,,,,,,9.10,33.95,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,outpatient,,,20.00000,9.64000,Optum,Medicare,,6.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,outpatient,,,55.00000,26.51000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,outpatient,,,34.00000,16.39000,Optum,Medicare,,10.88,,,,,,,8.84,32.98,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,outpatient,,,29.00000,13.98000,Optum,Medicare,,9.28,,,,,,,7.54,28.13,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,outpatient,,,80.00000,38.56000,Optum,Medicare,,25.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,outpatient,,,73.00000,35.19000,Optum,Medicare,,23.36,,,,,,,18.98,70.81,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,outpatient,,,16.00000,7.71000,Optum,Medicare,,5.12,,,,,,,4.16,15.52,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,outpatient,,,52.00000,25.06000,Optum,Medicare,,16.64,,,,,,,13.52,50.44,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,outpatient,,,113.00000,54.47000,Optum,Medicare,,36.16,,,,,,,29.38,109.61,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,outpatient,,,68.00000,32.78000,Optum,Medicare,,21.76,,,,,,,17.68,65.96,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,outpatient,,,78.00000,37.60000,Optum,Medicare,,24.96,,,,,,,20.28,75.66,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,outpatient,,,54.00000,26.03000,Optum,Medicare,,17.28,,,,,,,14.04,52.38,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,outpatient,,,76.00000,36.63000,Optum,Medicare,,24.32,,,,,,,19.76,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,outpatient,,,67.00000,32.29000,Optum,Medicare,,21.44,,,,,,,17.42,64.99,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,outpatient,,,88.00000,42.42000,Optum,Medicare,,28.16,,,,,,,22.88,85.36,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,outpatient,,,60.00000,28.92000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,outpatient,,,67.00000,32.29000,Optum,Medicare,,21.44,,,,,,,17.42,64.99,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,outpatient,,,53.00000,25.55000,Optum,Medicare,,16.96,,,,,,,13.78,51.41,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,outpatient,,,88.00000,42.42000,Optum,Medicare,,28.16,,,,,,,22.88,85.36,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,outpatient,,,105.00000,50.61000,Optum,Medicare,,33.60,,,,,,,27.30,101.85,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Optum,Medicare,,23.36,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,outpatient,,,83.00000,40.01000,Optum,Medicare,,26.56,,,,,,,21.58,80.51,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Optum,Medicare,,49.28,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,outpatient,,,57.00000,27.47000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,outpatient,,,97.00000,46.75000,Optum,Medicare,,31.04,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Optum,Medicare,,49.28,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,outpatient,,,87.00000,41.93000,Optum,Medicare,,27.84,,,,,,,22.62,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,outpatient,,,68.00000,32.78000,Optum,Medicare,,21.76,,,,,,,17.68,65.96,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,outpatient,,,52.00000,25.06000,Optum,Medicare,,16.64,,,,,,,13.52,50.44,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,outpatient,,,51.00000,24.58000,Optum,Medicare,,16.32,,,,,,,13.26,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,outpatient,,,97.00000,46.75000,Optum,Medicare,,31.04,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,outpatient,,,176.00000,84.83000,Optum,Medicare,,56.32,,,,,,,45.76,170.72,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,outpatient,,,57.00000,27.47000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,outpatient,,,158.00000,76.16000,Optum,Medicare,,50.56,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,outpatient,,,67.00000,32.29000,Optum,Medicare,,21.44,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,outpatient,,,67.00000,32.29000,Optum,Medicare,,21.44,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,outpatient,,,84.00000,40.49000,Optum,Medicare,,26.88,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,outpatient,,,189.00000,91.10000,Optum,Medicare,,60.48,,,,,,,49.14,183.33,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,outpatient,,,109.00000,52.54000,Optum,Medicare,,34.88,,,,,,,28.34,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,outpatient,,,129.00000,62.18000,Optum,Medicare,,41.28,,,,,,,33.54,125.13,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,outpatient,,,84.00000,40.49000,Optum,Medicare,,26.88,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Optum,Medicare,,23.36,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,outpatient,,,67.00000,32.29000,Optum,Medicare,,21.44,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,outpatient,,,67.00000,32.29000,Optum,Medicare,,21.44,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,outpatient,,,149.00000,71.82000,Optum,Medicare,,47.68,,,,,,,38.74,144.53,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,outpatient,,,130.00000,62.66000,Optum,Medicare,,41.60,,,,,,,33.80,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,outpatient,,,110.00000,53.02000,Optum,Medicare,,35.20,,,,,,,28.60,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,outpatient,,,158.00000,76.16000,Optum,Medicare,,50.56,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,outpatient,,,117.00000,56.39000,Optum,Medicare,,37.44,,,,,,,30.42,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,outpatient,,,61.00000,29.40000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,outpatient,,,67.00000,32.29000,Optum,Medicare,,21.44,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Optum,Medicare,,59.84,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,outpatient,,,145.00000,69.89000,Optum,Medicare,,46.40,,,,,,,37.70,140.65,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,outpatient,,,67.00000,32.29000,Optum,Medicare,,21.44,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,outpatient,,,165.00000,79.53000,Optum,Medicare,,52.80,,,,,,,42.90,160.05,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,outpatient,,,70.00000,33.74000,Optum,Medicare,,22.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,outpatient,,,67.00000,32.29000,Optum,Medicare,,21.44,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Optum,Medicare,,59.84,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,outpatient,,,154.00000,74.23000,Optum,Medicare,,49.28,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,outpatient,,,104.00000,50.13000,Optum,Medicare,,33.28,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,outpatient,,,70.00000,33.74000,Optum,Medicare,,22.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,outpatient,,,104.00000,50.13000,Optum,Medicare,,33.28,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,outpatient,,,70.00000,33.74000,Optum,Medicare,,22.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,outpatient,,,123.00000,59.29000,Optum,Medicare,,39.36,,,,,,,31.98,119.31,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,outpatient,,,95.00000,45.79000,Optum,Medicare,,30.40,,,,,,,24.70,92.15,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,outpatient,,,160.00000,77.12000,Optum,Medicare,,51.20,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,outpatient,,,147.00000,70.85000,Optum,Medicare,,47.04,,,,,,,38.22,142.59,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,outpatient,,,178.00000,85.80000,Optum,Medicare,,56.96,,,,,,,46.28,172.66,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,outpatient,,,160.00000,77.12000,Optum,Medicare,,51.20,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Optum,Medicare,,59.84,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,outpatient,,,67.00000,32.29000,Optum,Medicare,,21.44,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,outpatient,,,70.00000,33.74000,Optum,Medicare,,22.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Optum,Medicare,,59.84,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Optum,Medicare,,59.84,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Optum,Medicare,,59.84,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Optum,Medicare,,59.84,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Optum,Medicare,,59.84,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Optum,Medicare,,59.84,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Optum,Medicare,,59.84,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Optum,Medicare,,59.84,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,outpatient,,,449.00000,216.42000,Optum,Medicare,,143.68,,,,,,,116.74,435.53,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,outpatient,,,104.00000,50.13000,Optum,Medicare,,33.28,,,,,,,27.04,100.88,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Optum,Medicare,,59.20,,,,,,,48.10,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Optum,Medicare,,59.20,,,,,,,48.10,179.45,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,outpatient,,,57.00000,27.47000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,outpatient,,,84.00000,40.49000,Optum,Medicare,,26.88,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Optum,Medicare,,26.88,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Optum,Medicare,,26.88,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Optum,Medicare,,23.36,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Optum,Medicare,,23.36,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,outpatient,,,98.00000,47.24000,Optum,Medicare,,31.36,,,,,,,25.48,95.06,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,outpatient,,,75.00000,36.15000,Optum,Medicare,,24.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,outpatient,,,107.00000,51.57000,Optum,Medicare,,34.24,,,,,,,27.82,103.79,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,outpatient,,,81.00000,39.04000,Optum,Medicare,,25.92,,,,,,,21.06,78.57,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,outpatient,,,60.00000,28.92000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,outpatient,,,68.00000,32.78000,Optum,Medicare,,21.76,,,,,,,17.68,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,outpatient,,,51.00000,24.58000,Optum,Medicare,,16.32,,,,,,,13.26,49.47,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,outpatient,,,74.00000,35.67000,Optum,Medicare,,23.68,,,,,,,19.24,71.78,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,outpatient,,,60.00000,28.92000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,outpatient,,,194.00000,93.51000,Optum,Medicare,,62.08,,,,,,,50.44,188.18,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,outpatient,,,111.00000,53.50000,Optum,Medicare,,35.52,,,,,,,28.86,107.67,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,outpatient,,,77.00000,37.11000,Optum,Medicare,,24.64,,,,,,,20.02,74.69,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Optum,Medicare,,25.28,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Optum,Medicare,,25.28,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Optum,Medicare,,75.84,,,,,,,61.62,229.89,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,outpatient,,,51.00000,24.58000,Optum,Medicare,,16.32,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Optum,Medicare,,26.24,,,,,,,21.32,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Optum,Medicare,,26.24,,,,,,,21.32,79.54,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,outpatient,,,67.00000,32.29000,Optum,Medicare,,21.44,,,,,,,17.42,64.99,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,outpatient,,,131.00000,63.14000,Optum,Medicare,,41.92,,,,,,,34.06,127.07,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,outpatient,,,15.00000,7.23000,Optum,Medicare,,4.80,,,,,,,3.90,14.55,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,outpatient,,,39.00000,18.80000,Optum,Medicare,,12.48,,,,,,,10.14,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,outpatient,,,12.00000,5.78000,Optum,Medicare,,3.84,,,,,,,3.12,11.64,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,outpatient,,,57.00000,27.47000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Optum,Medicare,,64.96,,,,,,,52.78,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Optum,Medicare,,64.96,,,,,,,52.78,196.91,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,outpatient,,,99.00000,47.72000,Optum,Medicare,,31.68,,,,,,,25.74,96.03,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,outpatient,,,53.00000,25.55000,Optum,Medicare,,16.96,,,,,,,13.78,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,outpatient,,,23.00000,11.09000,Optum,Medicare,,7.36,,,,,,,5.98,22.31,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,outpatient,,,46.00000,22.17000,Optum,Medicare,,14.72,,,,,,,11.96,44.62,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,outpatient,,,67.00000,32.29000,Optum,Medicare,,21.44,,,,,,,17.42,64.99,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,outpatient,,,57.00000,27.47000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,outpatient,,,288.00000,138.82000,Optum,Medicare,,92.16,,,,,,,74.88,279.36,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,outpatient,,,106.00000,51.09000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,outpatient,,,30.00000,14.46000,Optum,Medicare,,9.60,,,,,,,7.80,29.10,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,outpatient,,,55.00000,26.51000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,outpatient,,,71.00000,34.22000,Optum,Medicare,,22.72,,,,,,,18.46,68.87,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,outpatient,,,67.00000,32.29000,Optum,Medicare,,21.44,,,,,,,17.42,64.99,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,outpatient,,,89.00000,42.90000,Optum,Medicare,,28.48,,,,,,,23.14,86.33,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,outpatient,,,116.00000,55.91000,Optum,Medicare,,37.12,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Optum,Medicare,,37.12,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Optum,Medicare,,37.12,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,outpatient,,,51.00000,24.58000,Optum,Medicare,,16.32,,,,,,,13.26,49.47,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,outpatient,,,66.00000,31.81000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,outpatient,,,174.00000,83.87000,Optum,Medicare,,55.68,,,,,,,45.24,168.78,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,outpatient,,,82.00000,39.52000,Optum,Medicare,,26.24,,,,,,,21.32,79.54,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,outpatient,,,112.00000,53.98000,Optum,Medicare,,35.84,,,,,,,29.12,108.64,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,outpatient,,,61.00000,29.40000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,outpatient,,,69.00000,33.26000,Optum,Medicare,,22.08,,,,,,,17.94,66.93,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,outpatient,,,52.00000,25.06000,Optum,Medicare,,16.64,,,,,,,13.52,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,outpatient,,,286.00000,137.85000,Optum,Medicare,,91.52,,,,,,,74.36,277.42,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,outpatient,,,300.00000,144.60000,Optum,Medicare,,96.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,outpatient,,,73.00000,35.19000,Optum,Medicare,,23.36,,,,,,,18.98,70.81,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,outpatient,,,90.00000,43.38000,Optum,Medicare,,28.80,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,outpatient,,,60.00000,28.92000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Optum,Medicare,,16.64,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,outpatient,,,315.00000,151.83000,Optum,Medicare,,100.80,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,outpatient,,,100.00000,48.20000,Optum,Medicare,,32.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,outpatient,,,89.00000,42.90000,Optum,Medicare,,28.48,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,outpatient,,,71.00000,34.22000,Optum,Medicare,,22.72,,,,,,,18.46,68.87,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,outpatient,,,135.00000,65.07000,Optum,Medicare,,43.20,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,outpatient,,,80.00000,38.56000,Optum,Medicare,,25.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Optum,Medicare,,23.04,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Optum,Medicare,,23.04,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,outpatient,,,100.00000,48.20000,Optum,Medicare,,32.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,outpatient,,,305.00000,147.01000,Optum,Medicare,,97.60,,,,,,,79.30,295.85,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,outpatient,,,70.00000,33.74000,Optum,Medicare,,22.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,outpatient,,,69.00000,33.26000,Optum,Medicare,,22.08,,,,,,,17.94,66.93,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,outpatient,,,64.00000,30.85000,Optum,Medicare,,20.48,,,,,,,16.64,62.08,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,outpatient,,,368.00000,177.38000,Optum,Medicare,,117.76,,,,,,,95.68,356.96,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,outpatient,,,104.00000,50.13000,Optum,Medicare,,33.28,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,outpatient,,,109.00000,52.54000,Optum,Medicare,,34.88,,,,,,,28.34,105.73,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,outpatient,,,114.00000,54.95000,Optum,Medicare,,36.48,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,outpatient,,,135.00000,65.07000,Optum,Medicare,,43.20,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,outpatient,,,105.00000,50.61000,Optum,Medicare,,33.60,,,,,,,27.30,101.85,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,outpatient,,,315.00000,151.83000,Optum,Medicare,,100.80,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,outpatient,,,148.00000,71.34000,Optum,Medicare,,47.36,,,,,,,38.48,143.56,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,outpatient,,,62.00000,29.88000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,outpatient,,,67.00000,32.29000,Optum,Medicare,,21.44,,,,,,,17.42,64.99,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,outpatient,,,107.00000,51.57000,Optum,Medicare,,34.24,,,,,,,27.82,103.79,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,outpatient,,,57.00000,27.47000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,outpatient,,,35.00000,16.87000,Optum,Medicare,,11.20,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,outpatient,,,104.00000,50.13000,Optum,Medicare,,33.28,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,outpatient,,,650.00000,313.30000,Optum,Medicare,,208.00,,,,,,,169.00,630.50,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,outpatient,,,91.00000,43.86000,Optum,Medicare,,29.12,,,,,,,23.66,88.27,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,outpatient,,,114.00000,54.95000,Optum,Medicare,,36.48,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Optum,Medicare,,16.64,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,outpatient,,,360.00000,173.52000,Optum,Medicare,,115.20,,,,,,,93.60,349.20,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,outpatient,,,106.00000,51.09000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,outpatient,,,78.00000,37.60000,Optum,Medicare,,24.96,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,outpatient,,,72.00000,34.70000,Optum,Medicare,,23.04,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,outpatient,,,94.00000,45.31000,Optum,Medicare,,30.08,,,,,,,24.44,91.18,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,outpatient,,,101.00000,48.68000,Optum,Medicare,,32.32,,,,,,,26.26,97.97,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,outpatient,,,82.00000,39.52000,Optum,Medicare,,26.24,,,,,,,21.32,79.54,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,outpatient,,,77.00000,37.11000,Optum,Medicare,,24.64,,,,,,,20.02,74.69,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,outpatient,,,145.00000,69.89000,Optum,Medicare,,46.40,,,,,,,37.70,140.65,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,outpatient,,,266.00000,128.21000,Optum,Medicare,,85.12,,,,,,,69.16,258.02,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,outpatient,,,79.00000,38.08000,Optum,Medicare,,25.28,,,,,,,20.54,76.63,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,outpatient,,,57.00000,27.47000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,outpatient,,,144.00000,69.41000,Optum,Medicare,,46.08,,,,,,,37.44,139.68,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,outpatient,,,20.00000,9.64000,Optum,Medicare,,6.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,outpatient,,,208.00000,100.26000,Optum,Medicare,,66.56,,,,,,,54.08,201.76,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,outpatient,,,135.00000,65.07000,Optum,Medicare,,43.20,,,,,,,35.10,130.95,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,outpatient,,,131.00000,63.14000,Optum,Medicare,,41.92,,,,,,,34.06,127.07,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,outpatient,,,69.00000,33.26000,Optum,Medicare,,22.08,,,,,,,17.94,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,outpatient,,,55.00000,26.51000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,outpatient,,,25.00000,12.05000,Optum,Medicare,,8.00,,,,,,,6.50,24.25,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,outpatient,,,61.00000,29.40000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,outpatient,,,80.00000,38.56000,Optum,Medicare,,25.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,outpatient,,,82.00000,39.52000,Optum,Medicare,,26.24,,,,,,,21.32,79.54,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,outpatient,,,35.00000,16.87000,Optum,Medicare,,11.20,,,,,,,9.10,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,outpatient,,,88.00000,42.42000,Optum,Medicare,,28.16,,,,,,,22.88,85.36,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,outpatient,,,98.00000,47.24000,Optum,Medicare,,31.36,,,,,,,25.48,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,outpatient,,,204.00000,98.33000,Optum,Medicare,,65.28,,,,,,,53.04,197.88,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,outpatient,,,61.00000,29.40000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,outpatient,,,19.00000,9.16000,Optum,Medicare,,6.08,,,,,,,4.94,18.43,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,outpatient,,,57.00000,27.47000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,outpatient,,,55.00000,26.51000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,outpatient,,,37.00000,17.83000,Optum,Medicare,,11.84,,,,,,,9.62,35.89,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,outpatient,,,79.00000,38.08000,Optum,Medicare,,25.28,,,,,,,20.54,76.63,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,outpatient,,,63.00000,30.37000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,outpatient,,,21.00000,10.12000,Optum,Medicare,,6.72,,,,,,,5.46,20.37,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,outpatient,,,52.00000,25.06000,Optum,Medicare,,16.64,,,,,,,13.52,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,outpatient,,,57.00000,27.47000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,outpatient,,,60.00000,28.92000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,outpatient,,,32.00000,15.42000,Optum,Medicare,,10.24,,,,,,,8.32,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,outpatient,,,94.00000,45.31000,Optum,Medicare,,30.08,,,,,,,24.44,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,outpatient,,,103.00000,49.65000,Optum,Medicare,,32.96,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,outpatient,,,64.00000,30.85000,Optum,Medicare,,20.48,,,,,,,16.64,62.08,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,outpatient,,,102.00000,49.16000,Optum,Medicare,,32.64,,,,,,,26.52,98.94,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,outpatient,,,103.00000,49.65000,Optum,Medicare,,32.96,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,outpatient,,,139.00000,67.00000,Optum,Medicare,,44.48,,,,,,,36.14,134.83,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,outpatient,,,52.00000,25.06000,Optum,Medicare,,16.64,,,,,,,13.52,50.44,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Optum,Medicare,,6.72,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,outpatient,,,88.00000,42.42000,Optum,Medicare,,28.16,,,,,,,22.88,85.36,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Optum,Medicare,,6.72,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,outpatient,,,52.00000,25.06000,Optum,Medicare,,16.64,,,,,,,13.52,50.44,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,outpatient,,,80.00000,38.56000,Optum,Medicare,,25.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,outpatient,,,49.00000,23.62000,Optum,Medicare,,15.68,,,,,,,12.74,47.53,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,outpatient,,,88.00000,42.42000,Optum,Medicare,,28.16,,,,,,,22.88,85.36,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,outpatient,,,66.00000,31.81000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,outpatient,,,68.00000,32.78000,Optum,Medicare,,21.76,,,,,,,17.68,65.96,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,outpatient,,,93.00000,44.83000,Optum,Medicare,,29.76,,,,,,,24.18,90.21,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,outpatient,,,73.00000,35.19000,Optum,Medicare,,23.36,,,,,,,18.98,70.81,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,outpatient,,,41.00000,19.76000,Optum,Medicare,,13.12,,,,,,,10.66,39.77,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,outpatient,,,94.00000,45.31000,Optum,Medicare,,30.08,,,,,,,24.44,91.18,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,outpatient,,,124.00000,59.77000,Optum,Medicare,,39.68,,,,,,,32.24,120.28,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,outpatient,,,71.00000,34.22000,Optum,Medicare,,22.72,,,,,,,18.46,68.87,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,outpatient,,,33.00000,15.91000,Optum,Medicare,,10.56,,,,,,,8.58,32.01,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,outpatient,,,52.00000,25.06000,Optum,Medicare,,16.64,,,,,,,13.52,50.44,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,outpatient,,,68.00000,32.78000,Optum,Medicare,,21.76,,,,,,,17.68,65.96,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,outpatient,,,99.00000,47.72000,Optum,Medicare,,31.68,,,,,,,25.74,96.03,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,outpatient,,,197.00000,94.95000,Optum,Medicare,,63.04,,,,,,,51.22,191.09,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,outpatient,,,194.00000,93.51000,Optum,Medicare,,62.08,,,,,,,50.44,188.18,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,outpatient,,,68.00000,32.78000,Optum,Medicare,,21.76,,,,,,,17.68,65.96,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,outpatient,,,90.00000,43.38000,Optum,Medicare,,28.80,,,,,,,23.40,87.30,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,outpatient,,,109.00000,52.54000,Optum,Medicare,,34.88,,,,,,,28.34,105.73,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,outpatient,,,108.00000,52.06000,Optum,Medicare,,34.56,,,,,,,28.08,104.76,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,outpatient,,,67.00000,32.29000,Optum,Medicare,,21.44,,,,,,,17.42,64.99,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,outpatient,,,69.00000,33.26000,Optum,Medicare,,22.08,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,outpatient,,,71.00000,34.22000,Optum,Medicare,,22.72,,,,,,,18.46,68.87,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,outpatient,,,98.00000,47.24000,Optum,Medicare,,31.36,,,,,,,25.48,95.06,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,outpatient,,,141.00000,67.96000,Optum,Medicare,,45.12,,,,,,,36.66,136.77,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,outpatient,,,226.00000,108.93000,Optum,Medicare,,72.32,,,,,,,58.76,219.22,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,outpatient,,,92.00000,44.34000,Optum,Medicare,,29.44,,,,,,,23.92,89.24,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,outpatient,,,69.00000,33.26000,Optum,Medicare,,22.08,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,outpatient,,,100.00000,48.20000,Optum,Medicare,,32.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,outpatient,,,124.00000,59.77000,Optum,Medicare,,39.68,,,,,,,32.24,120.28,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,outpatient,,,69.00000,33.26000,Optum,Medicare,,22.08,,,,,,,17.94,66.93,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Optum,Medicare,,39.68,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Optum,Medicare,,39.68,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Optum,Medicare,,39.68,,,,,,,32.24,120.28,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,outpatient,,,118.00000,56.88000,Optum,Medicare,,37.76,,,,,,,30.68,114.46,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,outpatient,,,51.00000,24.58000,Optum,Medicare,,16.32,,,,,,,13.26,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,outpatient,,,104.00000,50.13000,Optum,Medicare,,33.28,,,,,,,27.04,100.88,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,outpatient,,,66.00000,31.81000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,outpatient,,,72.00000,34.70000,Optum,Medicare,,23.04,,,,,,,18.72,69.84,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,outpatient,,,54.00000,26.03000,Optum,Medicare,,17.28,,,,,,,14.04,52.38,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,outpatient,,,17.00000,8.19000,Optum,Medicare,,5.44,,,,,,,4.42,16.49,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,outpatient,,,63.00000,30.37000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,outpatient,,,36.00000,17.35000,Optum,Medicare,,11.52,,,,,,,9.36,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,outpatient,,,52.00000,25.06000,Optum,Medicare,,16.64,,,,,,,13.52,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,outpatient,,,18.00000,8.68000,Optum,Medicare,,5.76,,,,,,,4.68,17.46,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,outpatient,,,74.00000,35.67000,Optum,Medicare,,23.68,,,,,,,19.24,71.78,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,outpatient,,,62.00000,29.88000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,outpatient,,,62.00000,29.88000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,outpatient,,,118.00000,56.88000,Optum,Medicare,,37.76,,,,,,,30.68,114.46,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,outpatient,,,82.00000,39.52000,Optum,Medicare,,26.24,,,,,,,21.32,79.54,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,outpatient,,,30.00000,14.46000,Optum,Medicare,,9.60,,,,,,,7.80,29.10,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,outpatient,,,55.00000,26.51000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,outpatient,,,70.00000,33.74000,Optum,Medicare,,22.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,outpatient,,,54.00000,26.03000,Optum,Medicare,,17.28,,,,,,,14.04,52.38,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,outpatient,,,63.00000,30.37000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,outpatient,,,51.00000,24.58000,Optum,Medicare,,16.32,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,outpatient,,,141.00000,67.96000,Optum,Medicare,,45.12,,,,,,,36.66,136.77,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,outpatient,,,63.00000,30.37000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,outpatient,,,81.00000,39.04000,Optum,Medicare,,25.92,,,,,,,21.06,78.57,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,outpatient,,,335.00000,161.47000,Optum,Medicare,,107.20,,,,,,,87.10,324.95,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,outpatient,,,52.00000,25.06000,Optum,Medicare,,16.64,,,,,,,13.52,50.44,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Optum,Medicare,,17.28,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,outpatient,,,57.00000,27.47000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Optum,Medicare,,17.28,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,outpatient,,,53.00000,25.55000,Optum,Medicare,,16.96,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,outpatient,,,63.00000,30.37000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,outpatient,,,53.00000,25.55000,Optum,Medicare,,16.96,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,outpatient,,,12.00000,5.78000,Optum,Medicare,,3.84,,,,,,,3.12,11.64,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,outpatient,,,710.00000,342.22000,Optum,Medicare,,227.20,,,,,,,184.60,688.70,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,outpatient,,,104.00000,50.13000,Optum,Medicare,,33.28,,,,,,,27.04,100.88,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,outpatient,,,155.00000,74.71000,Optum,Medicare,,49.60,,,,,,,40.30,150.35,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,outpatient,,,139.00000,67.00000,Optum,Medicare,,44.48,,,,,,,36.14,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,outpatient,,,89.00000,42.90000,Optum,Medicare,,28.48,,,,,,,23.14,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,outpatient,,,88.00000,42.42000,Optum,Medicare,,28.16,,,,,,,22.88,85.36,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,outpatient,,,111.00000,53.50000,Optum,Medicare,,35.52,,,,,,,28.86,107.67,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,outpatient,,,70.00000,33.74000,Optum,Medicare,,22.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,outpatient,,,85.00000,40.97000,Optum,Medicare,,27.20,,,,,,,22.10,82.45,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,outpatient,,,60.00000,28.92000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,outpatient,,,110.00000,53.02000,Optum,Medicare,,35.20,,,,,,,28.60,106.70,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,outpatient,,,500.00000,241.00000,Optum,Medicare,,160.00,,,,,,,130.00,485.00,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,outpatient,,,140.00000,67.48000,Optum,Medicare,,44.80,,,,,,,36.40,135.80,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,outpatient,,,66.00000,31.81000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,outpatient,,,74.00000,35.67000,Optum,Medicare,,23.68,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,outpatient,,,77.00000,37.11000,Optum,Medicare,,24.64,,,,,,,20.02,74.69,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,outpatient,,,93.00000,44.83000,Optum,Medicare,,29.76,,,,,,,24.18,90.21,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,outpatient,,,57.00000,27.47000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,outpatient,,,15.00000,7.23000,Optum,Medicare,,4.80,,,,,,,3.90,14.55,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,outpatient,,,24.00000,11.57000,Optum,Medicare,,7.68,,,,,,,6.24,23.28,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,outpatient,,,72.00000,34.70000,Optum,Medicare,,23.04,,,,,,,18.72,69.84,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Optum,Medicare,,5.12,,,,,,,4.16,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Optum,Medicare,,5.12,,,,,,,4.16,15.52,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,outpatient,,,64.00000,30.85000,Optum,Medicare,,20.48,,,,,,,16.64,62.08,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,outpatient,,,82.00000,39.52000,Optum,Medicare,,26.24,,,,,,,21.32,79.54,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,outpatient,,,157.00000,75.67000,Optum,Medicare,,50.24,,,,,,,40.82,152.29,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,outpatient,,,70.00000,33.74000,Optum,Medicare,,22.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,outpatient,,,229.00000,110.38000,Optum,Medicare,,73.28,,,,,,,59.54,222.13,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,outpatient,,,64.00000,30.85000,Optum,Medicare,,20.48,,,,,,,16.64,62.08,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,outpatient,,,72.00000,34.70000,Optum,Medicare,,23.04,,,,,,,18.72,69.84,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,outpatient,,,17.00000,8.19000,Optum,Medicare,,5.44,,,,,,,4.42,16.49,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,outpatient,,,57.00000,27.47000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,outpatient,,,64.00000,30.85000,Optum,Medicare,,20.48,,,,,,,16.64,62.08,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,outpatient,,,387.00000,186.53000,Optum,Medicare,,123.84,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Optum,Medicare,,123.84,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Optum,Medicare,,123.84,,,,,,,100.62,375.39,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,outpatient,,,77.00000,37.11000,Optum,Medicare,,24.64,,,,,,,20.02,74.69,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Optum,Medicare,,24.96,,,,,,,20.28,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Optum,Medicare,,24.96,,,,,,,20.28,75.66,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,outpatient,,,43.00000,20.73000,Optum,Medicare,,13.76,,,,,,,11.18,41.71,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,outpatient,,,64.00000,30.85000,Optum,Medicare,,20.48,,,,,,,16.64,62.08,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,outpatient,,,160.00000,77.12000,Optum,Medicare,,51.20,,,,,,,41.60,155.20,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,outpatient,,,112.00000,53.98000,Optum,Medicare,,35.84,,,,,,,29.12,108.64,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,outpatient,,,82.00000,39.52000,Optum,Medicare,,26.24,,,,,,,21.32,79.54,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,outpatient,,,57.00000,27.47000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,outpatient,,,55.00000,26.51000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,outpatient,,,54.00000,26.03000,Optum,Medicare,,17.28,,,,,,,14.04,52.38,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,outpatient,,,153.00000,73.75000,Optum,Medicare,,48.96,,,,,,,39.78,148.41,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,outpatient,,,45.00000,21.69000,Optum,Medicare,,14.40,,,,,,,11.70,43.65,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,outpatient,,,28.00000,13.50000,Optum,Medicare,,8.96,,,,,,,7.28,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,outpatient,,,66.00000,31.81000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Optum,Medicare,,15.68,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Optum,Medicare,,15.68,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Optum,Medicare,,15.68,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,outpatient,,,62.00000,29.88000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,outpatient,,,36.00000,17.35000,Optum,Medicare,,11.52,,,,,,,9.36,34.92,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,outpatient,,,38.00000,18.32000,Optum,Medicare,,12.16,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,outpatient,,,38.00000,18.32000,Optum,Medicare,,12.16,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,outpatient,,,76.00000,36.63000,Optum,Medicare,,24.32,,,,,,,19.76,73.72,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,outpatient,,,173.00000,83.39000,Optum,Medicare,,55.36,,,,,,,44.98,167.81,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,outpatient,,,22.00000,10.60000,Optum,Medicare,,7.04,,,,,,,5.72,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,outpatient,,,62.00000,29.88000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,outpatient,,,39.00000,18.80000,Optum,Medicare,,12.48,,,,,,,10.14,37.83,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,outpatient,,,41.00000,19.76000,Optum,Medicare,,13.12,,,,,,,10.66,39.77,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,outpatient,,,57.00000,27.47000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,outpatient,,,54.00000,26.03000,Optum,Medicare,,17.28,,,,,,,14.04,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,outpatient,,,71.00000,34.22000,Optum,Medicare,,22.72,,,,,,,18.46,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Optum,Medicare,,13.76,,,,,,,11.18,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Optum,Medicare,,13.76,,,,,,,11.18,41.71,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,outpatient,,,38.00000,18.32000,Optum,Medicare,,12.16,,,,,,,9.88,36.86,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,outpatient,,,72.00000,34.70000,Optum,Medicare,,23.04,,,,,,,18.72,69.84,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,outpatient,,,226.00000,108.93000,Optum,Medicare,,72.32,,,,,,,58.76,219.22,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Optum,Medicare,,13.12,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Optum,Medicare,,13.12,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Optum,Medicare,,13.12,,,,,,,10.66,39.77,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,outpatient,,,160.00000,77.12000,Optum,Medicare,,51.20,,,,,,,41.60,155.20,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,outpatient,,,102.00000,49.16000,Optum,Medicare,,32.64,,,,,,,26.52,98.94,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,outpatient,,,317.00000,152.79000,Optum,Medicare,,101.44,,,,,,,82.42,307.49,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,outpatient,,,62.00000,29.88000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,outpatient,,,66.00000,31.81000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,outpatient,,,116.00000,55.91000,Optum,Medicare,,37.12,,,,,,,30.16,112.52,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Optum,Medicare,,28.48,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Optum,Medicare,,28.48,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,outpatient,,,85.00000,40.97000,Optum,Medicare,,27.20,,,,,,,22.10,82.45,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,outpatient,,,184.00000,88.69000,Optum,Medicare,,58.88,,,,,,,47.84,178.48,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,outpatient,,,127.00000,61.21000,Optum,Medicare,,40.64,,,,,,,33.02,123.19,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,outpatient,,,61.00000,29.40000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,outpatient,,,35.00000,16.87000,Optum,Medicare,,11.20,,,,,,,9.10,33.95,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,outpatient,,,79.00000,38.08000,Optum,Medicare,,25.28,,,,,,,20.54,76.63,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,outpatient,,,61.00000,35.14000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,outpatient,,,65.00000,37.44000,Optum,Medicare,,20.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,outpatient,,,57.00000,32.83000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Optum,Medicare,,48.96,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,outpatient,,,62.00000,35.71000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,outpatient,,,77.00000,44.35000,Optum,Medicare,,24.64,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,outpatient,,,70.00000,40.32000,Optum,Medicare,,22.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,outpatient,,,67.00000,38.59000,Optum,Medicare,,21.44,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,outpatient,,,40.00000,23.04000,Optum,Medicare,,12.80,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,outpatient,,,71.00000,40.90000,Optum,Medicare,,22.72,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,outpatient,,,80.00000,46.08000,Optum,Medicare,,25.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,outpatient,,,72.00000,41.47000,Optum,Medicare,,23.04,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,outpatient,,,444.00000,255.74000,Optum,Medicare,,142.08,,,,,,,115.44,430.68,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,outpatient,,,81.00000,46.66000,Optum,Medicare,,25.92,,,,,,,21.06,78.57,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,outpatient,,,62.00000,35.71000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,outpatient,,,66.00000,38.02000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,outpatient,,,57.00000,32.83000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,outpatient,,,53.00000,30.53000,Optum,Medicare,,16.96,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Optum,Medicare,,20.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Optum,Medicare,,20.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,outpatient,,,60.00000,34.56000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,outpatient,,,61.00000,35.14000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,outpatient,,,40.00000,23.04000,Optum,Medicare,,12.80,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,outpatient,,,63.00000,36.29000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,outpatient,,,42.00000,24.19000,Optum,Medicare,,13.44,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,outpatient,,,62.00000,35.71000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,outpatient,,,46.00000,26.50000,Optum,Medicare,,14.72,,,,,,,11.96,44.62,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,outpatient,,,54.00000,31.10000,Optum,Medicare,,17.28,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,outpatient,,,62.00000,35.71000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,outpatient,,,71.00000,40.90000,Optum,Medicare,,22.72,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,outpatient,,,54.00000,31.10000,Optum,Medicare,,17.28,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,outpatient,,,80.00000,46.08000,Optum,Medicare,,25.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,outpatient,,,60.00000,34.56000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Optum,Medicare,,39.68,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,outpatient,,,130.00000,74.88000,Optum,Medicare,,41.60,,,,,,,33.80,126.10,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Optum,Medicare,,39.36,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,outpatient,,,77.00000,44.35000,Optum,Medicare,,24.64,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,outpatient,,,65.00000,37.44000,Optum,Medicare,,20.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,outpatient,,,115.00000,66.24000,Optum,Medicare,,36.80,,,,,,,29.90,111.55,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Optum,Medicare,,39.36,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,outpatient,,,161.00000,92.74000,Optum,Medicare,,51.52,,,,,,,41.86,156.17,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Optum,Medicare,,39.68,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,outpatient,,,65.00000,37.44000,Optum,Medicare,,20.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,outpatient,,,65.00000,37.44000,Optum,Medicare,,20.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,outpatient,,,65.00000,37.44000,Optum,Medicare,,20.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,outpatient,,,65.00000,37.44000,Optum,Medicare,,20.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,outpatient,,,102.00000,58.75000,Optum,Medicare,,32.64,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,outpatient,,,219.00000,126.14000,Optum,Medicare,,70.08,,,,,,,56.94,212.43,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Optum,Medicare,,62.08,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,outpatient,,,103.00000,59.33000,Optum,Medicare,,32.96,,,,,,,26.78,99.91,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,outpatient,,,60.00000,34.56000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,outpatient,,,837.00000,482.11000,Optum,Medicare,,267.84,,,,,,,217.62,811.89,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Optum,Medicare,,20.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Optum,Medicare,,20.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Optum,Medicare,,62.08,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,outpatient,,,78.00000,44.93000,Optum,Medicare,,24.96,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,outpatient,,,285.00000,164.16000,Optum,Medicare,,91.20,,,,,,,74.10,276.45,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,outpatient,,,190.00000,109.44000,Optum,Medicare,,60.80,,,,,,,49.40,184.30,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,outpatient,,,100.00000,57.60000,Optum,Medicare,,32.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Optum,Medicare,,12.80,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,outpatient,,,67.00000,38.59000,Optum,Medicare,,21.44,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,outpatient,,,62.00000,35.71000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,outpatient,,,78.00000,44.93000,Optum,Medicare,,24.96,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Optum,Medicare,,20.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,outpatient,,,65.00000,37.44000,Optum,Medicare,,20.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,outpatient,,,57.00000,32.83000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,outpatient,,,72.00000,41.47000,Optum,Medicare,,23.04,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,outpatient,,,59.00000,33.98000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,outpatient,,,72.00000,41.47000,Optum,Medicare,,23.04,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,outpatient,,,239.00000,137.66000,Optum,Medicare,,76.48,,,,,,,62.14,231.83,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,outpatient,,,85.00000,48.96000,Optum,Medicare,,27.20,,,,,,,22.10,82.45,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,outpatient,,,44.00000,25.34000,Optum,Medicare,,14.08,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,outpatient,,,40.00000,23.04000,Optum,Medicare,,12.80,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,outpatient,,,53.00000,30.53000,Optum,Medicare,,16.96,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,outpatient,,,63.00000,36.29000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,outpatient,,,68.00000,39.17000,Optum,Medicare,,21.76,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,outpatient,,,76.00000,43.78000,Optum,Medicare,,24.32,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,outpatient,,,42.00000,24.19000,Optum,Medicare,,13.44,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,outpatient,,,87.00000,50.11000,Optum,Medicare,,27.84,,,,,,,22.62,84.39,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,outpatient,,,503.00000,289.73000,Optum,Medicare,,160.96,,,,,,,130.78,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,outpatient,,,472.00000,271.87000,Optum,Medicare,,151.04,,,,,,,122.72,457.84,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,outpatient,,,28.00000,16.13000,Optum,Medicare,,8.96,,,,,,,7.28,27.16,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,outpatient,,,236.00000,135.94000,Optum,Medicare,,75.52,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,outpatient,,,54.00000,31.10000,Optum,Medicare,,17.28,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,outpatient,,,238.00000,137.09000,Optum,Medicare,,76.16,,,,,,,61.88,230.86,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,outpatient,,,236.00000,135.94000,Optum,Medicare,,75.52,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,outpatient,,,145.00000,83.52000,Optum,Medicare,,46.40,,,,,,,37.70,140.65,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Optum,Medicare,,21.76,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Optum,Medicare,,21.76,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,outpatient,,,66.00000,38.02000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,outpatient,,,59.00000,33.98000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,outpatient,,,158.00000,91.01000,Optum,Medicare,,50.56,,,,,,,41.08,153.26,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,outpatient,,,71.00000,40.90000,Optum,Medicare,,22.72,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,outpatient,,,144.00000,82.94000,Optum,Medicare,,46.08,,,,,,,37.44,139.68,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,outpatient,,,1448.00000,834.05000,Optum,Medicare,,463.36,,,,,,,376.48,1404.56,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,outpatient,,,72.00000,41.47000,Optum,Medicare,,23.04,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,outpatient,,,102.00000,58.75000,Optum,Medicare,,32.64,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,outpatient,,,154.00000,88.70000,Optum,Medicare,,49.28,,,,,,,40.04,149.38,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Optum,Medicare,,48.96,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,outpatient,,,61.00000,35.14000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,outpatient,,,66.00000,38.02000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Optum,Medicare,,48.96,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,outpatient,,,44.00000,25.34000,Optum,Medicare,,14.08,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,outpatient,,,63.00000,36.29000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,outpatient,,,150.00000,86.40000,Optum,Medicare,,48.00,,,,,,,39.00,145.50,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,outpatient,,,61.00000,35.14000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,outpatient,,,56.00000,32.26000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,outpatient,,,62.00000,35.71000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,outpatient,,,66.00000,38.02000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,outpatient,,,60.00000,34.56000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,outpatient,,,58.00000,33.41000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,outpatient,,,71.00000,40.90000,Optum,Medicare,,22.72,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,outpatient,,,72.00000,41.47000,Optum,Medicare,,23.04,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,outpatient,,,60.00000,34.56000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,outpatient,,,56.00000,32.26000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,outpatient,,,39.00000,22.46000,Optum,Medicare,,12.48,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Optum,Medicare,,48.96,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,outpatient,,,73.00000,42.05000,Optum,Medicare,,23.36,,,,,,,18.98,70.81,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Optum,Medicare,,40.64,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Optum,Medicare,,40.64,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Optum,Medicare,,20.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,outpatient,,,372.00000,214.27000,Optum,Medicare,,119.04,,,,,,,96.72,360.84,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,outpatient,,,69.00000,39.74000,Optum,Medicare,,22.08,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Optum,Medicare,,48.96,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Optum,Medicare,,48.96,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,outpatient,,,63.00000,36.29000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,outpatient,,,57.00000,32.83000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,outpatient,,,96.00000,55.30000,Optum,Medicare,,30.72,,,,,,,24.96,93.12,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,outpatient,,,44.00000,25.34000,Optum,Medicare,,14.08,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,outpatient,,,60.00000,34.56000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,outpatient,,,63.00000,36.29000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,outpatient,,,60.00000,34.56000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,outpatient,,,63.00000,36.29000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,outpatient,,,74.00000,42.62000,Optum,Medicare,,23.68,,,,,,,19.24,71.78,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,outpatient,,,69.00000,39.74000,Optum,Medicare,,22.08,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Optum,Medicare,,12.48,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,outpatient,,,53.00000,30.53000,Optum,Medicare,,16.96,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Optum,Medicare,,12.48,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Optum,Medicare,,12.48,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,outpatient,,,70.00000,40.32000,Optum,Medicare,,22.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,outpatient,,,71.00000,40.90000,Optum,Medicare,,22.72,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,outpatient,,,65.00000,37.44000,Optum,Medicare,,20.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,outpatient,,,325.00000,187.20000,Optum,Medicare,,104.00,,,,,,,84.50,315.25,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,outpatient,,,72.00000,41.47000,Optum,Medicare,,23.04,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,outpatient,,,72.00000,41.47000,Optum,Medicare,,23.04,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,outpatient,,,76.00000,43.78000,Optum,Medicare,,24.32,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,outpatient,,,240.00000,138.24000,Optum,Medicare,,76.80,,,,,,,62.40,232.80,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,outpatient,,,93.00000,53.57000,Optum,Medicare,,29.76,,,,,,,24.18,90.21,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,outpatient,,,59.00000,33.98000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,outpatient,,,81.00000,46.66000,Optum,Medicare,,25.92,,,,,,,21.06,78.57,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,outpatient,,,58.00000,33.41000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,outpatient,,,21.00000,12.10000,Optum,Medicare,,6.72,,,,,,,5.46,20.37,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,outpatient,,,56.00000,32.26000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,outpatient,,,64.00000,36.86000,Optum,Medicare,,20.48,,,,,,,16.64,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,outpatient,,,80.00000,46.08000,Optum,Medicare,,25.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,outpatient,,,109.00000,62.78000,Optum,Medicare,,34.88,,,,,,,28.34,105.73,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,outpatient,,,59.00000,33.98000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,outpatient,,,115.00000,66.24000,Optum,Medicare,,36.80,,,,,,,29.90,111.55,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,outpatient,,,57.00000,32.83000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,outpatient,,,118.00000,67.97000,Optum,Medicare,,37.76,,,,,,,30.68,114.46,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,outpatient,,,268.00000,154.37000,Optum,Medicare,,85.76,,,,,,,69.68,259.96,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Optum,Medicare,,36.48,,,,,,,29.64,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Optum,Medicare,,36.48,,,,,,,29.64,110.58,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,outpatient,,,78.00000,44.93000,Optum,Medicare,,24.96,,,,,,,20.28,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,outpatient,,,91.00000,52.42000,Optum,Medicare,,29.12,,,,,,,23.66,88.27,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,outpatient,,,300.00000,172.80000,Optum,Medicare,,96.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,outpatient,,,185.00000,106.56000,Optum,Medicare,,59.20,,,,,,,48.10,179.45,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Optum,Medicare,,11.52,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,outpatient,,,76.00000,43.78000,Optum,Medicare,,24.32,,,,,,,19.76,73.72,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Optum,Medicare,,11.52,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Optum,Medicare,,11.52,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,outpatient,,,53.00000,30.53000,Optum,Medicare,,16.96,,,,,,,13.78,51.41,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,outpatient,,,77.00000,44.35000,Optum,Medicare,,24.64,,,,,,,20.02,74.69,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Optum,Medicare,,11.52,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,outpatient,,,222.00000,127.87000,Optum,Medicare,,71.04,,,,,,,57.72,215.34,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,outpatient,,,292.00000,168.19000,Optum,Medicare,,93.44,,,,,,,75.92,283.24,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,outpatient,,,61.00000,35.14000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Optum,Medicare,,40.00,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Optum,Medicare,,40.00,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,outpatient,,,359.00000,206.78000,Optum,Medicare,,114.88,,,,,,,93.34,348.23,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,outpatient,,,111.00000,63.94000,Optum,Medicare,,35.52,,,,,,,28.86,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Optum,Medicare,,45.12,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Optum,Medicare,,45.12,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Optum,Medicare,,36.48,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Optum,Medicare,,36.48,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Optum,Medicare,,36.48,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Optum,Medicare,,36.48,,,,,,,29.64,110.58,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,outpatient,,,78.00000,44.93000,Optum,Medicare,,24.96,,,,,,,20.28,75.66,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Optum,Medicare,,114.88,,,,,,,93.34,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Optum,Medicare,,114.88,,,,,,,93.34,348.23,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,outpatient,,,70.00000,40.32000,Optum,Medicare,,22.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,outpatient,,,18.00000,10.37000,Optum,Medicare,,5.76,,,,,,,4.68,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,outpatient,,,408.00000,235.01000,Optum,Medicare,,130.56,,,,,,,106.08,395.76,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,outpatient,,,102.00000,58.75000,Optum,Medicare,,32.64,,,,,,,26.52,98.94,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,outpatient,,,330.00000,190.08000,Optum,Medicare,,105.60,,,,,,,85.80,320.10,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,outpatient,,,56.00000,32.26000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,outpatient,,,136.00000,78.34000,Optum,Medicare,,43.52,,,,,,,35.36,131.92,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,outpatient,,,83.00000,47.81000,Optum,Medicare,,26.56,,,,,,,21.58,80.51,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,outpatient,,,63.00000,36.29000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,outpatient,,,142.00000,81.79000,Optum,Medicare,,45.44,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,outpatient,,,51.00000,29.38000,Optum,Medicare,,16.32,,,,,,,13.26,49.47,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,outpatient,,,70.00000,40.32000,Optum,Medicare,,22.40,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,outpatient,,,99.00000,57.02000,Optum,Medicare,,31.68,,,,,,,25.74,96.03,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,outpatient,,,78.00000,44.93000,Optum,Medicare,,24.96,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,outpatient,,,63.00000,36.29000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,outpatient,,,63.00000,36.29000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,outpatient,,,75.00000,43.20000,Optum,Medicare,,24.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Optum,Medicare,,11.84,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Optum,Medicare,,11.84,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,outpatient,,,59.00000,33.98000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,outpatient,,,35.00000,20.16000,Optum,Medicare,,11.20,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,outpatient,,,59.00000,33.98000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,outpatient,,,56.00000,32.26000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,outpatient,,,74.00000,42.62000,Optum,Medicare,,23.68,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,outpatient,,,90.00000,51.84000,Optum,Medicare,,28.80,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Optum,Medicare,,21.76,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,outpatient,,,142.00000,81.79000,Optum,Medicare,,45.44,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Optum,Medicare,,21.76,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,outpatient,,,74.00000,42.62000,Optum,Medicare,,23.68,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Optum,Medicare,,28.48,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Optum,Medicare,,28.48,,,,,,,23.14,86.33,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,outpatient,,,57.00000,32.83000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,outpatient,,,77.00000,44.35000,Optum,Medicare,,24.64,,,,,,,20.02,74.69,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,outpatient,,,64.00000,36.86000,Optum,Medicare,,20.48,,,,,,,16.64,62.08,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,outpatient,,,69.00000,39.74000,Optum,Medicare,,22.08,,,,,,,17.94,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,outpatient,,,1178.00000,678.53000,Optum,Medicare,,376.96,,,,,,,306.28,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,outpatient,,,127.00000,73.15000,Optum,Medicare,,40.64,,,,,,,33.02,123.19,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,outpatient,,,277.00000,159.55000,Optum,Medicare,,88.64,,,,,,,72.02,268.69,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,outpatient,,,940.00000,541.44000,Optum,Medicare,,300.80,,,,,,,244.40,911.80,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,outpatient,,,97.00000,55.87000,Optum,Medicare,,31.04,,,,,,,25.22,94.09,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,outpatient,,,16.00000,9.22000,Optum,Medicare,,5.12,,,,,,,4.16,15.52,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,outpatient,,,57.00000,32.83000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,outpatient,,,131.00000,75.46000,Optum,Medicare,,41.92,,,,,,,34.06,127.07,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,outpatient,,,2160.00000,1244.16000,Optum,Medicare,,691.20,,,,,,,561.60,2095.20,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,outpatient,,,37.00000,21.31000,Optum,Medicare,,11.84,,,,,,,9.62,35.89,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Optum,Medicare,,23.68,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,outpatient,,,54.00000,31.10000,Optum,Medicare,,17.28,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,outpatient,,,76.00000,43.78000,Optum,Medicare,,24.32,,,,,,,19.76,73.72,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,outpatient,,,606.00000,349.06000,Optum,Medicare,,193.92,,,,,,,157.56,587.82,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,outpatient,,,62.00000,35.71000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,outpatient,,,300.00000,172.80000,Optum,Medicare,,96.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,outpatient,,,59.00000,33.98000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,outpatient,,,98.00000,56.45000,Optum,Medicare,,31.36,,,,,,,25.48,95.06,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,outpatient,,,61.00000,35.14000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,outpatient,,,128.00000,73.73000,Optum,Medicare,,40.96,,,,,,,33.28,124.16,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Optum,Medicare,,16.96,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,outpatient,,,16.00000,9.22000,Optum,Medicare,,5.12,,,,,,,4.16,15.52,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,outpatient,,,565.00000,325.44000,Optum,Medicare,,180.80,,,,,,,146.90,548.05,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,outpatient,,,850.00000,489.60000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,outpatient,,,77.00000,44.35000,Optum,Medicare,,24.64,,,,,,,20.02,74.69,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,outpatient,,,86.00000,49.54000,Optum,Medicare,,27.52,,,,,,,22.36,83.42,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,outpatient,,,837.00000,482.11000,Optum,Medicare,,267.84,,,,,,,217.62,811.89,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,outpatient,,,60.00000,34.56000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,outpatient,,,56.00000,32.26000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,outpatient,,,56.00000,32.26000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Optum,Medicare,,23.68,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Optum,Medicare,,16.96,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Optum,Medicare,,16.96,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,outpatient,,,167.00000,96.19000,Optum,Medicare,,53.44,,,,,,,43.42,161.99,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,outpatient,,,200.00000,115.20000,Optum,Medicare,,64.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,outpatient,,,93.00000,53.57000,Optum,Medicare,,29.76,,,,,,,24.18,90.21,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Optum,Medicare,,17.60,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,outpatient,,,190.00000,109.44000,Optum,Medicare,,60.80,,,,,,,49.40,184.30,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,outpatient,,,64.00000,36.86000,Optum,Medicare,,20.48,,,,,,,16.64,62.08,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,outpatient,,,525.00000,302.40000,Optum,Medicare,,168.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,outpatient,,,54.00000,31.10000,Optum,Medicare,,17.28,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Optum,Medicare,,16.96,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,outpatient,,,53.00000,30.53000,Optum,Medicare,,16.96,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Optum,Medicare,,12.80,,,,,,,10.40,38.80,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,outpatient,,,453.00000,260.93000,Optum,Medicare,,144.96,,,,,,,117.78,439.41,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,outpatient,,,25.00000,14.40000,Optum,Medicare,,8.00,,,,,,,6.50,24.25,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,outpatient,,,56.00000,32.26000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,outpatient,,,59.00000,33.98000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,outpatient,,,53.00000,30.53000,Optum,Medicare,,16.96,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,outpatient,,,62.00000,35.71000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,outpatient,,,350.00000,201.60000,Optum,Medicare,,112.00,,,,,,,91.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,outpatient,,,225.00000,129.60000,Optum,Medicare,,72.00,,,,,,,58.50,218.25,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,outpatient,,,52.00000,29.95000,Optum,Medicare,,16.64,,,,,,,13.52,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,outpatient,,,62.00000,35.71000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,outpatient,,,134.00000,77.18000,Optum,Medicare,,42.88,,,,,,,34.84,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,outpatient,,,52.00000,29.95000,Optum,Medicare,,16.64,,,,,,,13.52,50.44,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,outpatient,,,186.00000,107.14000,Optum,Medicare,,59.52,,,,,,,48.36,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Optum,Medicare,,96.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Optum,Medicare,,96.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,outpatient,,,62.00000,35.71000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,outpatient,,,205.00000,118.08000,Optum,Medicare,,65.60,,,,,,,53.30,198.85,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,outpatient,,,75.00000,36.15000,Optum,Medicare,,24.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,outpatient,,,65.00000,31.33000,Optum,Medicare,,20.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,outpatient,,,92.00000,44.34000,Optum,Medicare,,29.44,,,,,,,23.92,89.24,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Optum,Medicare,,7.68,,,,,,,6.24,23.28,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,outpatient,,,20.00000,9.64000,Optum,Medicare,,6.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,outpatient,,,63.00000,30.37000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,outpatient,,,42.00000,20.24000,Optum,Medicare,,13.44,,,,,,,10.92,40.74,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,outpatient,,,69.00000,33.26000,Optum,Medicare,,22.08,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,outpatient,,,65.00000,31.33000,Optum,Medicare,,20.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,outpatient,,,76.00000,36.63000,Optum,Medicare,,24.32,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,outpatient,,,89.00000,42.90000,Optum,Medicare,,28.48,,,,,,,23.14,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,outpatient,,,76.00000,36.63000,Optum,Medicare,,24.32,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,outpatient,,,28.00000,13.50000,Optum,Medicare,,8.96,,,,,,,7.28,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,outpatient,,,98.00000,47.24000,Optum,Medicare,,31.36,,,,,,,25.48,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,outpatient,,,64.00000,30.85000,Optum,Medicare,,20.48,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,outpatient,,,75.00000,36.15000,Optum,Medicare,,24.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,outpatient,,,76.00000,36.63000,Optum,Medicare,,24.32,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,outpatient,,,66.00000,31.81000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,outpatient,,,114.00000,54.95000,Optum,Medicare,,36.48,,,,,,,29.64,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,outpatient,,,74.00000,35.67000,Optum,Medicare,,23.68,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,outpatient,,,69.00000,33.26000,Optum,Medicare,,22.08,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,outpatient,,,74.00000,35.67000,Optum,Medicare,,23.68,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,outpatient,,,87.00000,41.93000,Optum,Medicare,,27.84,,,,,,,22.62,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,outpatient,,,79.00000,38.08000,Optum,Medicare,,25.28,,,,,,,20.54,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,outpatient,,,75.00000,36.15000,Optum,Medicare,,24.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,outpatient,,,66.00000,31.81000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,outpatient,,,60.00000,28.92000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,outpatient,,,64.00000,30.85000,Optum,Medicare,,20.48,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,outpatient,,,164.00000,79.05000,Optum,Medicare,,52.48,,,,,,,42.64,159.08,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,outpatient,,,54.00000,26.03000,Optum,Medicare,,17.28,,,,,,,14.04,52.38,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,outpatient,,,8.00000,3.86000,Optum,Medicare,,2.56,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,outpatient,,,69.00000,33.26000,Optum,Medicare,,22.08,,,,,,,17.94,66.93,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,outpatient,,,8.00000,3.86000,Optum,Medicare,,2.56,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,outpatient,,,60.00000,28.92000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,outpatient,,,8.00000,3.86000,Optum,Medicare,,2.56,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,outpatient,,,14.00000,6.75000,Optum,Medicare,,4.48,,,,,,,3.64,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,outpatient,,,62.00000,29.88000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,outpatient,,,63.00000,30.37000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,outpatient,,,112.00000,53.98000,Optum,Medicare,,35.84,,,,,,,29.12,108.64,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,outpatient,,,13.00000,6.27000,Optum,Medicare,,4.16,,,,,,,3.38,12.61,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,outpatient,,,57.00000,27.47000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,outpatient,,,31.00000,14.94000,Optum,Medicare,,9.92,,,,,,,8.06,30.07,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,outpatient,,,92.00000,44.34000,Optum,Medicare,,29.44,,,,,,,23.92,89.24,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,outpatient,,,80.00000,38.56000,Optum,Medicare,,25.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Optum,Medicare,,9.60,,,,,,,7.80,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Optum,Medicare,,9.60,,,,,,,7.80,29.10,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,outpatient,,,57.00000,27.47000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Optum,Medicare,,7.68,,,,,,,6.24,23.28,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,outpatient,,,59.00000,28.44000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,outpatient,,,29.00000,13.98000,Optum,Medicare,,9.28,,,,,,,7.54,28.13,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,outpatient,,,97.00000,46.75000,Optum,Medicare,,31.04,,,,,,,25.22,94.09,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,outpatient,,,225.00000,108.45000,Optum,Medicare,,72.00,,,,,,,58.50,218.25,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,outpatient,,,57.00000,27.47000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,outpatient,,,71.00000,34.22000,Optum,Medicare,,22.72,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,outpatient,,,57.00000,27.47000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,outpatient,,,71.00000,34.22000,Optum,Medicare,,22.72,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,outpatient,,,108.00000,52.06000,Optum,Medicare,,34.56,,,,,,,28.08,104.76,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,outpatient,,,66.00000,31.81000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,outpatient,,,51.00000,24.58000,Optum,Medicare,,16.32,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,outpatient,,,63.00000,30.37000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,outpatient,,,58.00000,27.96000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,outpatient,,,19.00000,9.16000,Optum,Medicare,,6.08,,,,,,,4.94,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,outpatient,,,54.00000,26.03000,Optum,Medicare,,17.28,,,,,,,14.04,52.38,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,outpatient,,,103.00000,49.65000,Optum,Medicare,,32.96,,,,,,,26.78,99.91,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,outpatient,,,9.00000,4.34000,Optum,Medicare,,2.88,,,,,,,2.34,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,outpatient,,,13.00000,6.27000,Optum,Medicare,,4.16,,,,,,,3.38,12.61,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,outpatient,,,80.00000,38.56000,Optum,Medicare,,25.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,outpatient,,,47.00000,22.65000,Optum,Medicare,,15.04,,,,,,,12.22,45.59,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,outpatient,,,91.00000,43.86000,Optum,Medicare,,29.12,,,,,,,23.66,88.27,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,outpatient,,,56.00000,26.99000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,outpatient,,,18.00000,8.68000,Optum,Medicare,,5.76,,,,,,,4.68,17.46,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,outpatient,,,60.00000,28.92000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,outpatient,,,57.00000,27.47000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Optum,Medicare,,6.72,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,outpatient,,,71.00000,37.70000,Optum,Medicare,,22.72,,,,,,,18.46,68.87,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Optum,Medicare,,6.72,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,outpatient,,,128.00000,67.97000,Optum,Medicare,,40.96,,,,,,,33.28,124.16,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,outpatient,,,65.00000,34.52000,Optum,Medicare,,20.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Optum,Medicare,,8.32,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,outpatient,,,31.00000,16.46000,Optum,Medicare,,9.92,,,,,,,8.06,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Optum,Medicare,,8.32,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Optum,Medicare,,8.32,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Optum,Medicare,,8.32,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,outpatient,,,61.00000,32.39000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Optum,Medicare,,8.32,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Optum,Medicare,,8.00,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Optum,Medicare,91,8.00,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,outpatient,,,103.00000,54.69000,Optum,Medicare,,32.96,,,,,,,26.78,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,outpatient,,,96.00000,50.98000,Optum,Medicare,,30.72,,,,,,,24.96,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,outpatient,,,75.00000,39.83000,Optum,Medicare,,24.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,outpatient,,,68.00000,36.11000,Optum,Medicare,,21.76,,,,,,,17.68,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,outpatient,,,61.00000,32.39000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Optum,Medicare,,8.32,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Optum,Medicare,,8.32,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,outpatient,,,29.00000,15.40000,Optum,Medicare,,9.28,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Optum,Medicare,,9.28,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Optum,Medicare,,9.28,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,outpatient,,,63.00000,33.45000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,outpatient,,,79.00000,41.95000,Optum,Medicare,,25.28,,,,,,,20.54,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,outpatient,,,63.00000,33.45000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Optum,Medicare,,9.28,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,outpatient,,,112.00000,59.47000,Optum,Medicare,,35.84,,,,,,,29.12,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Optum,Medicare,,8.32,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,outpatient,,,25.00000,13.28000,Optum,Medicare,,8.00,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,outpatient,,,118.00000,62.66000,Optum,Medicare,,37.76,,,,,,,30.68,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,outpatient,,,29.00000,15.40000,Optum,Medicare,,9.28,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,outpatient,,,25.00000,13.28000,Optum,Medicare,,8.00,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Optum,Medicare,,8.32,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,outpatient,,,25.00000,13.28000,Optum,Medicare,,8.00,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,outpatient,,,71.00000,37.70000,Optum,Medicare,,22.72,,,,,,,18.46,68.87,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,outpatient,,,59.00000,31.33000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,outpatient,,,62.00000,32.92000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,outpatient,,,138.00000,73.28000,Optum,Medicare,,44.16,,,,,,,35.88,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,outpatient,,,62.00000,32.92000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,outpatient,,,78.00000,41.42000,Optum,Medicare,,24.96,,,,,,,20.28,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,outpatient,,,69.00000,36.64000,Optum,Medicare,,22.08,,,,,,,17.94,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,outpatient,,,88.00000,46.73000,Optum,Medicare,,28.16,,,,,,,22.88,85.36,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,outpatient,,,60.00000,31.86000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,outpatient,,,64.00000,33.98000,Optum,Medicare,,20.48,,,,,,,16.64,62.08,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,outpatient,,,63.00000,33.45000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,outpatient,,,137.00000,72.75000,Optum,Medicare,,43.84,,,,,,,35.62,132.89,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,outpatient,,,347.00000,184.26000,Optum,Medicare,,111.04,,,,,,,90.22,336.59,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,outpatient,,,57.00000,30.27000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,outpatient,,,56.00000,29.74000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,outpatient,,,16.00000,8.50000,Optum,Medicare,,5.12,,,,,,,4.16,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,outpatient,,,85.00000,45.14000,Optum,Medicare,,27.20,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,outpatient,,,34.00000,18.05000,Optum,Medicare,,10.88,,,,,,,8.84,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,outpatient,,,231.00000,122.66000,Optum,Medicare,,73.92,,,,,,,60.06,224.07,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,outpatient,,,36.00000,19.12000,Optum,Medicare,,11.52,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,outpatient,,,61.00000,32.39000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,outpatient,,,111.00000,58.94000,Optum,Medicare,,35.52,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,outpatient,,,61.00000,32.39000,Optum,Medicare,,19.52,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,outpatient,,,60.00000,31.86000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,outpatient,,,60.00000,31.86000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,outpatient,,,60.00000,31.86000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,outpatient,,,60.00000,31.86000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,outpatient,,,60.00000,31.86000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,outpatient,,,36.00000,19.12000,Optum,Medicare,,11.52,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,outpatient,,,76.00000,40.36000,Optum,Medicare,,24.32,,,,,,,19.76,73.72,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,outpatient,,,60.00000,31.86000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,outpatient,,,60.00000,31.86000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,outpatient,,,152.00000,80.71000,Optum,Medicare,,48.64,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,outpatient,,,78.00000,41.42000,Optum,Medicare,,24.96,,,,,,,20.28,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,outpatient,,,42.00000,22.30000,Optum,Medicare,,13.44,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,outpatient,,,73.00000,38.76000,Optum,Medicare,,23.36,,,,,,,18.98,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,outpatient,,,97.00000,51.51000,Optum,Medicare,,31.04,,,,,,,25.22,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,outpatient,,,157.00000,83.37000,Optum,Medicare,,50.24,,,,,,,40.82,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,outpatient,,,36.00000,19.12000,Optum,Medicare,,11.52,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,outpatient,,,66.00000,35.05000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,outpatient,,,58.00000,30.80000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,outpatient,,,85.00000,45.14000,Optum,Medicare,,27.20,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,outpatient,,,59.00000,31.33000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,outpatient,,,175.00000,92.93000,Optum,Medicare,,56.00,,,,,,,45.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,outpatient,,,152.00000,80.71000,Optum,Medicare,,48.64,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,outpatient,,,43.00000,22.83000,Optum,Medicare,,13.76,,,,,,,11.18,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,outpatient,,,66.00000,35.05000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,outpatient,,,36.00000,19.12000,Optum,Medicare,,11.52,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,outpatient,,,36.00000,19.12000,Optum,Medicare,,11.52,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,outpatient,,,42.00000,22.30000,Optum,Medicare,,13.44,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,outpatient,,,147.00000,78.06000,Optum,Medicare,,47.04,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,outpatient,,,64.00000,33.98000,Optum,Medicare,,20.48,,,,,,,16.64,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,outpatient,,,60.00000,31.86000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,outpatient,,,75.00000,39.83000,Optum,Medicare,,24.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,outpatient,,,44.00000,23.36000,Optum,Medicare,,14.08,,,,,,,11.44,42.68,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,outpatient,,,87.00000,46.20000,Optum,Medicare,,27.84,,,,,,,22.62,84.39,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,outpatient,,,65.00000,34.52000,Optum,Medicare,,20.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,outpatient,,,75.00000,39.83000,Optum,Medicare,,24.00,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,outpatient,,,50.00000,26.55000,Optum,Medicare,,16.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,outpatient,,,40.00000,21.24000,Optum,Medicare,,12.80,,,,,,,10.40,38.80,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,outpatient,,,50.00000,26.55000,Optum,Medicare,,16.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Optum,Medicare,,41.28,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,outpatient,,,115.00000,61.07000,Optum,Medicare,,36.80,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1309.00000,695.08000,Optum,Medicare,,418.88,,,,,,,340.34,1269.73,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Optum,Medicare,,41.28,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Optum,Medicare,,41.28,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,outpatient,,,328.00000,174.17000,Optum,Medicare,,104.96,,,,,,,85.28,318.16,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,outpatient,,,115.00000,61.07000,Optum,Medicare,,36.80,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Optum,Medicare,,41.28,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Optum,Medicare,,41.28,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,outpatient,,,1251.00000,664.28000,Optum,Medicare,,400.32,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Optum,Medicare,,49.28,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Optum,Medicare,,49.28,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,outpatient,,,96.00000,50.98000,Optum,Medicare,,30.72,,,,,,,24.96,93.12,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,outpatient,,,211.00000,112.04000,Optum,Medicare,,67.52,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,outpatient,,,290.00000,153.99000,Optum,Medicare,,92.80,,,,,,,75.40,281.30,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Optum,Medicare,,41.28,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Optum,Medicare,,41.28,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,outpatient,,,411.00000,218.24000,Optum,Medicare,,131.52,,,,,,,106.86,398.67,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,outpatient,,,139.00000,73.81000,Optum,Medicare,,44.48,,,,,,,36.14,134.83,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,outpatient,,,288.00000,152.93000,Optum,Medicare,,92.16,,,,,,,74.88,279.36,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1372.00000,728.53000,Optum,Medicare,,439.04,,,,,,,356.72,1330.84,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,outpatient,,,1251.00000,664.28000,Optum,Medicare,,400.32,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,outpatient,,,135.00000,71.68000,Optum,Medicare,,43.20,,,,,,,35.10,130.95,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,outpatient,,,129.00000,68.50000,Optum,Medicare,,41.28,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,outpatient,,,129.00000,68.50000,Optum,Medicare,,41.28,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,outpatient,,,147.00000,78.06000,Optum,Medicare,,47.04,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,outpatient,,,126.00000,66.91000,Optum,Medicare,,40.32,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,outpatient,,,120.00000,63.72000,Optum,Medicare,,38.40,,,,,,,31.20,116.40,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Optum,Medicare,,41.28,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,outpatient,,,124.00000,65.84000,Optum,Medicare,,39.68,,,,,,,32.24,120.28,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,outpatient,,,108.00000,57.35000,Optum,Medicare,,34.56,,,,,,,28.08,104.76,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Optum,Medicare,,81.92,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Optum,Medicare,,81.92,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,outpatient,,,122.00000,64.78000,Optum,Medicare,,39.04,,,,,,,31.72,118.34,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,outpatient,,,129.00000,68.50000,Optum,Medicare,,41.28,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,outpatient,,,123.00000,65.31000,Optum,Medicare,,39.36,,,,,,,31.98,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Optum,Medicare,,41.28,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,outpatient,,,518.00000,275.06000,Optum,Medicare,,165.76,,,,,,,134.68,502.46,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,outpatient,,,275.00000,146.02000,Optum,Medicare,,88.00,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,outpatient,,,270.00000,143.37000,Optum,Medicare,,86.40,,,,,,,70.20,261.90,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,outpatient,,,450.00000,238.95000,Optum,Medicare,,144.00,,,,,,,117.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,outpatient,,,126.00000,66.91000,Optum,Medicare,,40.32,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,outpatient,,,362.00000,192.22000,Optum,Medicare,,115.84,,,,,,,94.12,351.14,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Optum,Medicare,,34.88,,,,,,,28.34,105.73,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,outpatient,,,638.00000,338.78000,Optum,Medicare,,204.16,,,,,,,165.88,618.86,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,outpatient,,,211.00000,112.04000,Optum,Medicare,,67.52,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,outpatient,,,154.00000,81.77000,Optum,Medicare,,49.28,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,outpatient,,,141.00000,74.87000,Optum,Medicare,,45.12,,,,,,,36.66,136.77,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,outpatient,,,2040.00000,1083.24000,Optum,Medicare,,652.80,,,,,,,530.40,1978.80,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,outpatient,,,421.00000,223.55000,Optum,Medicare,,134.72,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,outpatient,,,275.00000,146.02000,Optum,Medicare,,88.00,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,outpatient,,,1251.00000,664.28000,Optum,Medicare,,400.32,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Optum,Medicare,,136.96,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Optum,Medicare,,136.96,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Optum,Medicare,,209.60,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Optum,Medicare,,209.60,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,outpatient,,,211.00000,112.04000,Optum,Medicare,,67.52,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Optum,Medicare,,35.84,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Optum,Medicare,,35.84,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,outpatient,,,130.00000,69.03000,Optum,Medicare,,41.60,,,,,,,33.80,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,outpatient,,,421.00000,223.55000,Optum,Medicare,,134.72,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,outpatient,,,111.00000,58.94000,Optum,Medicare,,35.52,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,outpatient,,,200.00000,106.20000,Optum,Medicare,,64.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Optum,Medicare,,41.28,,,,,,,33.54,125.13,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,outpatient,,,13.00000,6.90000,Optum,Medicare,,4.16,,,,,,,3.38,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,outpatient,,,58.00000,30.80000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,outpatient,,,13.00000,6.90000,Optum,Medicare,,4.16,,,,,,,3.38,12.61,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,outpatient,,,773.00000,410.46000,Optum,Medicare,,247.36,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,outpatient,,,773.00000,410.46000,Optum,Medicare,,247.36,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,outpatient,,,773.00000,410.46000,Optum,Medicare,,247.36,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,outpatient,,,773.00000,410.46000,Optum,Medicare,,247.36,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,outpatient,,,387.00000,205.50000,Optum,Medicare,,123.84,,,,,,,100.62,375.39,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,outpatient,,,52.00000,27.61000,Optum,Medicare,,16.64,,,,,,,13.52,50.44,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Optum,Medicare,,32.64,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Optum,Medicare,,32.64,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,outpatient,,,79.00000,41.95000,Optum,Medicare,,25.28,,,,,,,20.54,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,outpatient,,,65.00000,34.52000,Optum,Medicare,,20.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,outpatient,,,100.00000,53.10000,Optum,Medicare,,32.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,outpatient,,,64.00000,33.98000,Optum,Medicare,,20.48,,,,,,,16.64,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,outpatient,,,106.00000,56.29000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Optum,Medicare,,34.88,,,,,,,28.34,105.73,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,outpatient,,,58.00000,30.80000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Optum,Medicare,,6.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,outpatient,,,66.00000,35.05000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Optum,Medicare,,6.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Optum,Medicare,,6.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Optum,Medicare,,6.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,outpatient,,,13.00000,6.90000,Optum,Medicare,,4.16,,,,,,,3.38,12.61,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,outpatient,,,53.00000,28.14000,Optum,Medicare,,16.96,,,,,,,13.78,51.41,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,outpatient,,,18.00000,9.56000,Optum,Medicare,,5.76,,,,,,,4.68,17.46,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,outpatient,,,17.00000,9.03000,Optum,Medicare,,5.44,,,,,,,4.42,16.49,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,outpatient,,,71.00000,37.70000,Optum,Medicare,,22.72,,,,,,,18.46,68.87,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,outpatient,,,57.00000,30.27000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,outpatient,,,68.00000,36.11000,Optum,Medicare,,21.76,,,,,,,17.68,65.96,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,outpatient,,,58.00000,30.80000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,outpatient,,,27.00000,14.34000,Optum,Medicare,,8.64,,,,,,,7.02,26.19,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,outpatient,,,56.00000,29.74000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,outpatient,,,56.00000,29.74000,Optum,Medicare,,17.92,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,outpatient,,,58.00000,30.80000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,outpatient,,,115.00000,61.07000,Optum,Medicare,,36.80,,,,,,,29.90,111.55,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,outpatient,,,23.00000,12.21000,Optum,Medicare,,7.36,,,,,,,5.98,22.31,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,outpatient,,,255.00000,135.40000,Optum,Medicare,,81.60,,,,,,,66.30,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,outpatient,,,66.00000,35.05000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,outpatient,,,26.00000,13.81000,Optum,Medicare,,8.32,,,,,,,6.76,25.22,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,outpatient,,,64.00000,33.98000,Optum,Medicare,,20.48,,,,,,,16.64,62.08,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,outpatient,,,215.00000,114.16000,Optum,Medicare,,68.80,,,,,,,55.90,208.55,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,outpatient,,,79.00000,41.95000,Optum,Medicare,,25.28,,,,,,,20.54,76.63,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,outpatient,,,11.00000,5.29000,Optum,Medicare,,3.52,,,,,,,2.86,10.67,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,outpatient,,,58.00000,27.90000,Optum,Medicare,,18.56,,,,,,,15.08,56.26,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,outpatient,,,10.00000,4.81000,Optum,Medicare,,3.20,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,outpatient,,,7.00000,3.37000,Optum,Medicare,,2.24,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,outpatient,,,53.00000,25.49000,Optum,Medicare,,16.96,,,,,,,13.78,51.41,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,outpatient,,,10.00000,4.81000,Optum,Medicare,,3.20,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Optum,Medicare,,3.52,,,,,,,2.86,10.67,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,outpatient,,,7.00000,3.37000,Optum,Medicare,,2.24,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Optum,Medicare,,3.52,,,,,,,2.86,10.67,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,outpatient,,,597.00000,290.14000,Optum,Medicare,,191.04,,,,,,,155.22,579.09,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,outpatient,,,6379.00000,3100.19000,Optum,Medicare,,2041.28,,,,,,,1658.54,6187.63,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,outpatient,,,471.00000,228.91000,Optum,Medicare,,150.72,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,outpatient,,,471.00000,228.91000,Optum,Medicare,,150.72,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,outpatient,,,1251.00000,607.99000,Optum,Medicare,,400.32,,,,,,,325.26,1213.47,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,outpatient,,,260.00000,126.36000,Optum,Medicare,,83.20,,,,,,,67.60,252.20,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,outpatient,,,785.00000,381.51000,Optum,Medicare,,251.20,,,,,,,204.10,761.45,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,outpatient,,,529.00000,257.09000,Optum,Medicare,,169.28,,,,,,,137.54,513.13,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,outpatient,,,1623.00000,788.78000,Optum,Medicare,,519.36,,,,,,,421.98,1574.31,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,outpatient,,,10800.00000,5248.80000,Optum,Medicare,,3456.00,,,,,,,2808.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,outpatient,,,25365.00000,12327.39000,Optum,Medicare,,8116.80,,,,,,,6594.90,24604.05,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,outpatient,,,101.00000,21.82000,Optum,Medicare,,32.32,,,,,,,26.26,97.97,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,outpatient,,,81.00000,17.50000,Optum,Medicare,,25.92,,,,,,,21.06,78.57,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,outpatient,,,104.00000,22.46000,Optum,Medicare,,33.28,,,,,,,27.04,100.88,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,outpatient,,,377.00000,81.43000,Optum,Medicare,,120.64,,,,,,,98.02,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,outpatient,,,532.00000,114.91000,Optum,Medicare,,170.24,,,,,,,138.32,516.04,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,outpatient,,,521.00000,112.54000,Optum,Medicare,,166.72,,,,,,,135.46,505.37,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,outpatient,,,451.00000,97.42000,Optum,Medicare,,144.32,,,,,,,117.26,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,outpatient,,,1148.00000,247.97000,Optum,Medicare,,367.36,,,,,,,298.48,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,outpatient,,,350.00000,75.60000,Optum,Medicare,,112.00,,,,,,,91.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,outpatient,,,423.00000,91.37000,Optum,Medicare,,135.36,,,,,,,109.98,410.31,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Optum,Medicare,,240.32,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Optum,Medicare,,240.32,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,outpatient,,,119.00000,25.70000,Optum,Medicare,,38.08,,,,,,,30.94,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,outpatient,,,126.00000,27.22000,Optum,Medicare,,40.32,,,,,,,32.76,122.22,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Optum,Medicare,,35.20,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Optum,Medicare,,35.20,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,outpatient,,,79.00000,17.06000,Optum,Medicare,,25.28,,,,,,,20.54,76.63,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Optum,Medicare,,35.20,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Optum,Medicare,,35.20,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,outpatient,,,79.00000,17.06000,Optum,Medicare,,25.28,,,,,,,20.54,76.63,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,outpatient,,,335.00000,72.36000,Optum,Medicare,,107.20,,,,,,,87.10,324.95,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Optum,Medicare,,49.28,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Optum,Medicare,,49.28,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,outpatient,,,128.00000,27.65000,Optum,Medicare,,40.96,,,,,,,33.28,124.16,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,outpatient,,,65.00000,14.04000,Optum,Medicare,,20.80,,,,,,,16.90,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,outpatient,,,272.00000,58.75000,Optum,Medicare,,87.04,,,,,,,70.72,263.84,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,outpatient,,,26.00000,11.44000,Optum,Medicare,,8.32,,,,,,,6.76,25.22,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,outpatient,,,359.00000,157.96000,Optum,Medicare,,114.88,,,,,,,93.34,348.23,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,outpatient,,,189.00000,83.16000,Optum,Medicare,,60.48,,,,,,,49.14,183.33,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,outpatient,,,359.00000,157.96000,Optum,Medicare,,114.88,,,,,,,93.34,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,outpatient,,,137.00000,60.28000,Optum,Medicare,,43.84,,,,,,,35.62,132.89,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,outpatient,,,1665.00000,732.60000,Optum,Medicare,,532.80,,,,,,,432.90,1615.05,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,outpatient,,,751.00000,330.44000,Optum,Medicare,,240.32,,,,,,,195.26,728.47,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,outpatient,,,374.00000,164.56000,Optum,Medicare,,119.68,,,,,,,97.24,362.78,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,outpatient,,,553.00000,243.32000,Optum,Medicare,,176.96,,,,,,,143.78,536.41,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,outpatient,,,359.00000,157.96000,Optum,Medicare,,114.88,,,,,,,93.34,348.23,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,outpatient,,,62.00000,27.28000,Optum,Medicare,,19.84,,,,,,,16.12,60.14,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,outpatient,,,79.00000,34.76000,Optum,Medicare,,25.28,,,,,,,20.54,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,outpatient,,,110.00000,48.40000,Optum,Medicare,,35.20,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,outpatient,,,110.00000,48.40000,Optum,Medicare,,35.20,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,outpatient,,,751.00000,330.44000,Optum,Medicare,,240.32,,,,,,,195.26,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,outpatient,,,1665.00000,732.60000,Optum,Medicare,,532.80,,,,,,,432.90,1615.05,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,outpatient,,,110.00000,48.40000,Optum,Medicare,,35.20,,,,,,,28.60,106.70,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Optum,Medicare,,89.92,,,,,,,73.06,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Optum,Medicare,,89.92,,,,,,,73.06,272.57,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,outpatient,,,451.00000,341.41000,Optum,Medicare,,144.32,,,,,,,117.26,437.47,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,outpatient,,,300.00000,145.80000,Optum,Medicare,,96.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,outpatient,,,2278.00000,1107.11000,Optum,Medicare,,728.96,,,,,,,592.28,2209.66,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,outpatient,,,3912.00000,1901.23000,Optum,Medicare,,1251.84,,,,,,,1017.12,3794.64,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,outpatient,,,900.00000,437.40000,Optum,Medicare,,288.00,,,,,,,234.00,873.00,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,outpatient,,,365.00000,177.39000,Optum,Medicare,,116.80,,,,,,,94.90,354.05,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,outpatient,,,989.00000,480.65000,Optum,Medicare,,316.48,,,,,,,257.14,959.33,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Optum,Medicare,,157.44,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Optum,Medicare,,139.20,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Optum,Medicare,,139.20,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,outpatient,,,644.00000,312.98000,Optum,Medicare,,206.08,,,,,,,167.44,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Optum,Medicare,,157.44,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Optum,Medicare,,157.44,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,outpatient,,,527.00000,256.12000,Optum,Medicare,,168.64,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,outpatient,,,1404.00000,682.34000,Optum,Medicare,,449.28,,,,,,,365.04,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,outpatient,,,5475.00000,2660.85000,Optum,Medicare,,1752.00,,,,,,,1423.50,5310.75,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,outpatient,,,726.00000,352.84000,Optum,Medicare,,232.32,,,,,,,188.76,704.22,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,outpatient,,,507.00000,246.40000,Optum,Medicare,,162.24,,,,,,,131.82,491.79,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,outpatient,,,1670.00000,811.62000,Optum,Medicare,,534.40,,,,,,,434.20,1619.90,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,outpatient,,,1139.00000,553.55000,Optum,Medicare,,364.48,,,,,,,296.14,1104.83,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,outpatient,,,875.00000,425.25000,Optum,Medicare,,280.00,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,outpatient,,,525.00000,255.15000,Optum,Medicare,,168.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,outpatient,,,1353.00000,657.56000,Optum,Medicare,,432.96,,,,,,,351.78,1312.41,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,outpatient,,,525.00000,255.15000,Optum,Medicare,,168.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,outpatient,,,525.00000,255.15000,Optum,Medicare,,168.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,outpatient,,,825.00000,400.95000,Optum,Medicare,,264.00,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Optum,Medicare,,168.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Optum,Medicare,,168.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,outpatient,,,974.00000,473.36000,Optum,Medicare,,311.68,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Optum,Medicare,,63.36,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Optum,Medicare,,63.36,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Optum,Medicare,,70.72,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Optum,Medicare,,70.72,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,outpatient,,,497.00000,241.54000,Optum,Medicare,,159.04,,,,,,,129.22,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,outpatient,,,2340.00000,1137.24000,Optum,Medicare,,748.80,,,,,,,608.40,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,outpatient,,,249.00000,121.01000,Optum,Medicare,,79.68,,,,,,,64.74,241.53,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,outpatient,,,135.00000,65.61000,Optum,Medicare,,43.20,,,,,,,35.10,130.95,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,outpatient,,,172.00000,83.59000,Optum,Medicare,,55.04,,,,,,,44.72,166.84,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,outpatient,,,307.00000,149.20000,Optum,Medicare,,98.24,,,,,,,79.82,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,outpatient,,,1800.00000,874.80000,Optum,Medicare,,576.00,,,,,,,468.00,1746.00,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,outpatient,,,974.00000,473.36000,Optum,Medicare,,311.68,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Optum,Medicare,,63.04,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Optum,Medicare,,63.04,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,outpatient,,,411.00000,199.75000,Optum,Medicare,,131.52,,,,,,,106.86,398.67,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,outpatient,,,221.00000,107.41000,Optum,Medicare,,70.72,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,outpatient,,,884.00000,429.62000,Optum,Medicare,,282.88,,,,,,,229.84,857.48,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,outpatient,,,594.00000,288.68000,Optum,Medicare,,190.08,,,,,,,154.44,576.18,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,outpatient,,,519.00000,252.23000,Optum,Medicare,,166.08,,,,,,,134.94,503.43,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,outpatient,,,1046.00000,508.36000,Optum,Medicare,,334.72,,,,,,,271.96,1014.62,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,outpatient,,,556.00000,270.22000,Optum,Medicare,,177.92,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,outpatient,,,275.00000,133.65000,Optum,Medicare,,88.00,,,,,,,71.50,266.75,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,outpatient,,,580.00000,281.88000,Optum,Medicare,,185.60,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,outpatient,,,580.00000,281.88000,Optum,Medicare,,185.60,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Optum,Medicare,,1113.60,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Optum,Medicare,,1113.60,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,outpatient,,,700.00000,340.20000,Optum,Medicare,,224.00,,,,,,,182.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,outpatient,,,1427.00000,693.52000,Optum,Medicare,,456.64,,,,,,,371.02,1384.19,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,outpatient,,,614.00000,298.40000,Optum,Medicare,,196.48,,,,,,,159.64,595.58,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,outpatient,,,2027.00000,985.12000,Optum,Medicare,,648.64,,,,,,,527.02,1966.19,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,outpatient,,,556.00000,270.22000,Optum,Medicare,,177.92,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,outpatient,,,1146.00000,556.96000,Optum,Medicare,,366.72,,,,,,,297.96,1111.62,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Optum,Medicare,,63.04,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Optum,Medicare,,63.04,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,outpatient,,,527.00000,256.12000,Optum,Medicare,,168.64,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,outpatient,,,740.00000,359.64000,Optum,Medicare,,236.80,,,,,,,192.40,717.80,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Optum,Medicare,,280.00,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Optum,Medicare,,280.00,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,outpatient,,,1399.00000,679.91000,Optum,Medicare,,447.68,,,,,,,363.74,1357.03,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,outpatient,,,51.00000,24.79000,Optum,Medicare,,16.32,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,outpatient,,,825.00000,400.95000,Optum,Medicare,,264.00,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,outpatient,,,576.00000,279.94000,Optum,Medicare,,184.32,,,,,,,149.76,558.72,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,outpatient,,,224.00000,108.86000,Optum,Medicare,,71.68,,,,,,,58.24,217.28,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,outpatient,,,346.00000,168.16000,Optum,Medicare,,110.72,,,,,,,89.96,335.62,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,outpatient,,,525.00000,255.15000,Optum,Medicare,,168.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,outpatient,,,525.00000,255.15000,Optum,Medicare,,168.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Optum,Medicare,,168.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Optum,Medicare,,168.00,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,outpatient,,,627.00000,304.72000,Optum,Medicare,,200.64,,,,,,,163.02,608.19,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,outpatient,,,605.00000,294.03000,Optum,Medicare,,193.60,,,,,,,157.30,586.85,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,outpatient,,,510.00000,247.86000,Optum,Medicare,,163.20,,,,,,,132.60,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,outpatient,,,223.00000,108.38000,Optum,Medicare,,71.36,,,,,,,57.98,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,outpatient,,,1211.00000,588.55000,Optum,Medicare,,387.52,,,,,,,314.86,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,outpatient,,,383.00000,186.14000,Optum,Medicare,,122.56,,,,,,,99.58,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,outpatient,,,1214.00000,590.00000,Optum,Medicare,,388.48,,,,,,,315.64,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,outpatient,,,328.00000,159.41000,Optum,Medicare,,104.96,,,,,,,85.28,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,outpatient,,,372.00000,180.79000,Optum,Medicare,,119.04,,,,,,,96.72,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,outpatient,,,285.00000,138.51000,Optum,Medicare,,91.20,,,,,,,74.10,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,outpatient,,,367.00000,178.36000,Optum,Medicare,,117.44,,,,,,,95.42,355.99,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Optum,Medicare,,224.64,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Optum,Medicare,,224.64,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,outpatient,,,265.00000,128.79000,Optum,Medicare,,84.80,,,,,,,68.90,257.05,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2279.00000,1107.59000,Optum,Medicare,,729.28,,,,,,,592.54,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2395.00000,1163.97000,Optum,Medicare,,766.40,,,,,,,622.70,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Optum,Medicare,,2802.88,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Optum,Medicare,,2802.88,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,outpatient,,,2752.00000,1337.47000,Optum,Medicare,,880.64,,,,,,,715.52,2669.44,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Optum,Medicare,,69.44,,,,,,,56.42,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Optum,Medicare,,69.44,,,,,,,56.42,210.49,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,outpatient,,,292.00000,141.91000,Optum,Medicare,,93.44,,,,,,,75.92,283.24,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Optum,Medicare,,131.52,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Optum,Medicare,,131.52,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Optum,Medicare,,131.52,,,,,,,106.86,398.67,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,outpatient,,,2275.00000,1105.65000,Optum,Medicare,,728.00,,,,,,,591.50,2206.75,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,outpatient,,,192.00000,93.31000,Optum,Medicare,,61.44,,,,,,,49.92,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,outpatient,,,451.00000,219.19000,Optum,Medicare,,144.32,,,,,,,117.26,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,outpatient,,,617.00000,299.86000,Optum,Medicare,,197.44,,,,,,,160.42,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,outpatient,,,825.00000,400.95000,Optum,Medicare,,264.00,,,,,,,214.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,outpatient,,,905.00000,439.83000,Optum,Medicare,,289.60,,,,,,,235.30,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,outpatient,,,849.00000,412.61000,Optum,Medicare,,271.68,,,,,,,220.74,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,outpatient,,,2539.00000,1233.95000,Optum,Medicare,,812.48,,,,,,,660.14,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,outpatient,,,6000.00000,2916.00000,Optum,Medicare,,1920.00,,,,,,,1560.00,5820.00,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,outpatient,,,8260.00000,4014.36000,Optum,Medicare,,2643.20,,,,,,,2147.60,8012.20,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,outpatient,,,202.00000,88.88000,Optum,Medicare,,64.64,,,,,,,52.52,195.94,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,outpatient,,,66.00000,31.81000,Optum,Medicare,,21.12,,,,,,,17.16,64.02,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,outpatient,,,295.00000,142.19000,Optum,Medicare,,94.40,,,,,,,76.70,286.15,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,89.00000,26.79000,Optum,Medicare,,28.48,,,,,,,23.14,86.33,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Optum,Medicare,,29.76,,,,,,,24.18,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Optum,Medicare,,29.76,,,,,,,24.18,90.21,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Optum,Medicare,,600.00,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Optum,Medicare,,600.00,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Optum,Medicare,,560.64,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Optum,Medicare,,560.64,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,731.00000,220.03000,Optum,Medicare,,233.92,,,,,,,190.06,709.07,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,787.00000,236.89000,Optum,Medicare,,251.84,,,,,,,204.62,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,2042.00000,614.64000,Optum,Medicare,,653.44,,,,,,,530.92,1980.74,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Optum,Medicare,,600.00,,,,,,,487.50,1818.75,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,714.00000,214.91000,Optum,Medicare,,228.48,,,,,,,185.64,692.58,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,294.00000,88.49000,Optum,Medicare,,94.08,,,,,,,76.44,285.18,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,350.00000,105.35000,Optum,Medicare,,112.00,,,,,,,91.00,339.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,outpatient,,,1350.00000,780.30000,Optum,Medicare,,432.00,,,,,,,351.00,1309.50,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,outpatient,,,3680.00000,2127.04000,Optum,Medicare,,1177.60,,,,,,,956.80,3569.60,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,outpatient,,,1600.00000,924.80000,Optum,Medicare,,512.00,,,,,,,416.00,1552.00,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,outpatient,,,4680.00000,2705.04000,Optum,Medicare,,1497.60,,,,,,,1216.80,4539.60,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,outpatient,,,2100.00000,1213.80000,Optum,Medicare,,672.00,,,,,,,546.00,2037.00,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,outpatient,,,5680.00000,3283.04000,Optum,Medicare,,1817.60,,,,,,,1476.80,5509.60,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,outpatient,,,2420.00000,1398.76000,Optum,Medicare,,774.40,,,,,,,629.20,2347.40,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,outpatient,,,6415.00000,3707.87000,Optum,Medicare,,2052.80,,,,,,,1667.90,6222.55,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,outpatient,,,2920.00000,1687.76000,Optum,Medicare,,934.40,,,,,,,759.20,2832.40,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,outpatient,,,8915.00000,5152.87000,Optum,Medicare,,2852.80,,,,,,,2317.90,8647.55,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,outpatient,,,3420.00000,1976.76000,Optum,Medicare,,1094.40,,,,,,,889.20,3317.40,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,outpatient,,,11415.00000,6597.87000,Optum,Medicare,,3652.80,,,,,,,2967.90,11072.55,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,outpatient,,,142.00000,154.35000,Optum,Medicare,,45.44,,,,,,,36.92,137.74,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Optum,Medicare,,108.80,,,,,,,88.40,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Optum,Medicare,,214.40,,,,,,,174.20,649.90,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,outpatient,,,390.00000,262.47000,Optum,Medicare,,124.80,,,,,,,101.40,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,outpatient,,,1170.00000,787.41000,Optum,Medicare,,374.40,,,,,,,304.20,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,outpatient,,,440.00000,296.12000,Optum,Medicare,,140.80,,,,,,,114.40,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,outpatient,,,1670.00000,1123.91000,Optum,Medicare,,534.40,,,,,,,434.20,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,outpatient,,,640.00000,430.72000,Optum,Medicare,,204.80,,,,,,,166.40,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,outpatient,,,2170.00000,1460.41000,Optum,Medicare,,694.40,,,,,,,564.20,2104.90,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,outpatient,,,17.00000,10.96000,Optum,Medicare,,5.44,,,,,,,4.42,16.49,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,outpatient,,,535.00000,345.08000,Optum,Medicare,,171.20,,,,,,,139.10,518.95,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,outpatient,,,23.00000,14.84000,Optum,Medicare,,7.36,,,,,,,5.98,22.31,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,outpatient,,,635.00000,409.58000,Optum,Medicare,,203.20,,,,,,,165.10,615.95,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,outpatient,,,30.00000,19.35000,Optum,Medicare,,9.60,,,,,,,7.80,29.10,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,outpatient,,,735.00000,474.08000,Optum,Medicare,,235.20,,,,,,,191.10,712.95,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,outpatient,,,33.00000,21.28000,Optum,Medicare,,10.56,,,,,,,8.58,32.01,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,outpatient,,,835.00000,538.58000,Optum,Medicare,,267.20,,,,,,,217.10,809.95,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,outpatient,,,140.00000,80.92000,Optum,Medicare,,44.80,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,outpatient,,,275.00000,158.95000,Optum,Medicare,,88.00,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,outpatient,,,295.00000,170.51000,Optum,Medicare,,94.40,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,outpatient,,,590.00000,341.02000,Optum,Medicare,,188.80,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,outpatient,,,690.00000,398.82000,Optum,Medicare,,220.80,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,outpatient,,,1375.00000,794.75000,Optum,Medicare,,440.00,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,outpatient,,,950.00000,549.10000,Optum,Medicare,,304.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,outpatient,,,1900.00000,1098.20000,Optum,Medicare,,608.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,outpatient,,,140.00000,45.22000,Optum,Medicare,,44.80,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,outpatient,,,275.00000,88.82000,Optum,Medicare,,88.00,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,outpatient,,,295.00000,95.28000,Optum,Medicare,,94.40,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,outpatient,,,590.00000,190.57000,Optum,Medicare,,188.80,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,outpatient,,,690.00000,222.87000,Optum,Medicare,,220.80,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,outpatient,,,1375.00000,444.12000,Optum,Medicare,,440.00,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,outpatient,,,950.00000,306.85000,Optum,Medicare,,304.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,outpatient,,,1900.00000,613.70000,Optum,Medicare,,608.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Optum,Medicare,,108.80,,,,,,,88.40,329.80,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Optum,Medicare,,214.40,,,,,,,174.20,649.90,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Optum,Medicare,,156.80,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Optum,Medicare,,156.80,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Optum,Medicare,,156.80,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Optum,Medicare,,78.40,,,,,,,63.70,237.65,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Optum,Medicare,,269.44,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Optum,Medicare,,336.96,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Optum,Medicare,,404.16,,,,,,,328.38,1225.11,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1178.00000,669.28000,Optum,Medicare,,376.96,,,,,,,306.28,1142.66,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,outpatient,,,140.00000,102.34000,Optum,Medicare,,44.80,,,,,,,36.40,135.80,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,outpatient,,,275.00000,201.02000,Optum,Medicare,,88.00,,,,,,,71.50,266.75,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,outpatient,,,295.00000,215.64000,Optum,Medicare,,94.40,,,,,,,76.70,286.15,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,outpatient,,,590.00000,431.29000,Optum,Medicare,,188.80,,,,,,,153.40,572.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,outpatient,,,690.00000,504.39000,Optum,Medicare,,220.80,,,,,,,179.40,669.30,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,outpatient,,,1375.00000,1005.12000,Optum,Medicare,,440.00,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,outpatient,,,950.00000,694.45000,Optum,Medicare,,304.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,outpatient,,,1900.00000,1388.90000,Optum,Medicare,,608.00,,,,,,,494.00,1843.00,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,outpatient,,,584.00000,426.90000,Optum,Medicare,,186.88,,,,,,,151.84,566.48,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,outpatient,,,1391.00000,1016.82000,Optum,Medicare,,445.12,,,,,,,361.66,1349.27,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,outpatient,,,359.00000,271.76000,Optum,Medicare,,114.88,,,,,,,93.34,348.23,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,outpatient,,,95.00000,71.92000,Optum,Medicare,,30.40,,,,,,,24.70,92.15,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,outpatient,,,37.00000,17.83000,Optum,Medicare,,11.84,,,,,,,9.62,35.89,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Optum,Medicare,,25.28,,,,,,,20.54,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Optum,Medicare,,75.84,,,,,,,61.62,229.89,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,outpatient,,,33.00000,15.91000,Optum,Medicare,,10.56,,,,,,,8.58,32.01,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,outpatient,,,25.00000,12.05000,Optum,Medicare,,8.00,,,,,,,6.50,24.25,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,outpatient,,,497.00000,160.53000,Optum,Medicare,,159.04,,,,,,,129.22,482.09,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Optum,Medicare,,282.24,,,,,,,229.32,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Optum,Medicare,,282.24,,,,,,,229.32,855.54,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Optum,Medicare,,31.36,,,,,,,25.48,95.06,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Optum,Medicare,,30.72,,,,,,,24.96,93.12,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Optum,Medicare,,282.24,,,,,,,229.32,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Optum,Medicare,,282.24,,,,,,,229.32,855.54,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,outpatient,,,763.00000,291.47000,Optum,Medicare,,244.16,,,,,,,198.38,740.11,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,outpatient,,,199.00000,76.02000,Optum,Medicare,,63.68,,,,,,,51.74,193.03,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Optum,Medicare,,31.36,,,,,,,25.48,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Optum,Medicare,,30.72,,,,,,,24.96,93.12,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,outpatient,,,1265.00000,483.23000,Optum,Medicare,,404.80,,,,,,,328.90,1227.05,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,outpatient,,,924.00000,352.97000,Optum,Medicare,,295.68,,,,,,,240.24,896.28,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,outpatient,,,580.00000,215.76000,Optum,Medicare,,185.60,,,,,,,150.80,562.60,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,outpatient,,,110.00000,40.92000,Optum,Medicare,,35.20,,,,,,,28.60,106.70,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,outpatient,,,373.00000,138.76000,Optum,Medicare,,119.36,,,,,,,96.98,361.81,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,outpatient,,,337.00000,125.36000,Optum,Medicare,,107.84,,,,,,,87.62,326.89,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,outpatient,,,784.00000,291.65000,Optum,Medicare,,250.88,,,,,,,203.84,760.48,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,outpatient,,,341.00000,126.85000,Optum,Medicare,,109.12,,,,,,,88.66,330.77,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,outpatient,,,252.00000,93.74000,Optum,Medicare,,80.64,,,,,,,65.52,244.44,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,outpatient,,,282.00000,104.90000,Optum,Medicare,,90.24,,,,,,,73.32,273.54,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,outpatient,,,404.00000,150.29000,Optum,Medicare,,129.28,,,,,,,105.04,391.88,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,outpatient,,,306.00000,173.85000,Optum,Medicare,,97.92,,,,,,,79.56,296.82,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,outpatient,,,158.00000,89.77000,Optum,Medicare,,50.56,,,,,,,41.08,153.26,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Optum,Medicare,GP,47.04,,,,,,,38.22,142.59,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Optum,Medicare,GP,86.40,,,,,,,70.20,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Optum,Medicare,GP,26.88,,,,,,,21.84,81.48,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Optum,Medicare,GP,27.52,,,,,,,22.36,83.42,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Optum,Medicare,GP,26.24,,,,,,,21.32,79.54,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Optum,Medicare,GP,27.20,,,,,,,22.10,82.45,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Optum,Medicare,GP,13.76,,,,,,,11.18,41.71,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Optum,Medicare,GP,13.12,,,,,,,10.66,39.77,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Optum,Medicare,GP,25.28,,,,,,,20.54,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Optum,Medicare,GP,23.68,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Optum,Medicare,GP,23.68,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Optum,Medicare,GP,10.88,,,,,,,8.84,32.98,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Optum,Medicare,GP,20.80,,,,,,,16.90,63.05,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,outpatient,,,113.00000,68.70000,Optum,Medicare,,36.16,,,,,,,29.38,109.61,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Optum,Medicare,GP,25.60,,,,,,,20.80,77.60,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Optum,Medicare,GP,26.88,,,,,,,21.84,81.48,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Optum,Medicare,GP,23.36,,,,,,,18.98,70.81,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,outpatient,,,100.00000,60.80000,Optum,Medicare,,32.00,,,,,,,26.00,97.00,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,outpatient,,,167.00000,101.54000,Optum,Medicare,GP,53.44,,,,,,,43.42,161.99,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Optum,Medicare,"50,GP",132.16,,,,,,,107.38,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Optum,Medicare,"LT,GP",88.00,,,,,,,71.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Optum,Medicare,"RT,GP",88.00,,,,,,,71.50,266.75,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Optum,Medicare,GP,30.40,,,,,,,24.70,92.15,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Optum,Medicare,GP,46.72,,,,,,,37.96,141.62,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Optum,Medicare,GP,44.48,,,,,,,36.14,134.83,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Optum,Medicare,GP,24.00,,,,,,,19.50,72.75,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Optum,Medicare,GP,49.28,,,,,,,40.04,149.38,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Optum,Medicare,GP,23.36,,,,,,,18.98,70.81,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Optum,Medicare,GP,51.20,,,,,,,41.60,155.20,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Optum,Medicare,GP,104.00,,,,,,,84.50,315.25,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,outpatient,,,98.00000,59.58000,Optum,Medicare,GP,31.36,,,,,,,25.48,95.06,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,outpatient,,,303.00000,184.22000,Optum,Medicare,GP,96.96,,,,,,,78.78,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,outpatient,,,115.00000,69.92000,Optum,Medicare,GP,36.80,,,,,,,29.90,111.55,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Optum,Medicare,GP,23.68,,,,,,,19.24,71.78,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Optum,Medicare,GP,25.28,,,,,,,20.54,76.63,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Optum,Medicare,GP,23.04,,,,,,,18.72,69.84,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Optum,Medicare,GP,47.04,,,,,,,38.22,142.59,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Optum,Medicare,GP,86.40,,,,,,,70.20,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Optum,Medicare,GP,26.88,,,,,,,21.84,81.48,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Optum,Medicare,GP,27.52,,,,,,,22.36,83.42,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Optum,Medicare,GP,26.24,,,,,,,21.32,79.54,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Optum,Medicare,GP,27.20,,,,,,,22.10,82.45,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Optum,Medicare,GP,13.76,,,,,,,11.18,41.71,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Optum,Medicare,GP,13.12,,,,,,,10.66,39.77,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Optum,Medicare,GP,25.28,,,,,,,20.54,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Optum,Medicare,"CQ,GP",23.68,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Optum,Medicare,"CQ,GP",23.68,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Optum,Medicare,GP,10.88,,,,,,,8.84,32.98,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Optum,Medicare,GP,20.80,,,,,,,16.90,63.05,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Optum,Medicare,GP,25.60,,,,,,,20.80,77.60,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Optum,Medicare,GP,26.88,,,,,,,21.84,81.48,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Optum,Medicare,GP,23.36,,,,,,,18.98,70.81,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Optum,Medicare,"GP,50",132.16,,,,,,,107.38,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Optum,Medicare,"GP,LT",88.00,,,,,,,71.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Optum,Medicare,"GP,RT",88.00,,,,,,,71.50,266.75,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Optum,Medicare,GP,30.40,,,,,,,24.70,92.15,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Optum,Medicare,GP,46.72,,,,,,,37.96,141.62,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Optum,Medicare,GP,44.48,,,,,,,36.14,134.83,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Optum,Medicare,GP,24.00,,,,,,,19.50,72.75,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Optum,Medicare,GP,49.28,,,,,,,40.04,149.38,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Optum,Medicare,GP,23.36,,,,,,,18.98,70.81,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Optum,Medicare,GP,51.20,,,,,,,41.60,155.20,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Optum,Medicare,GP,104.00,,,,,,,84.50,315.25,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Optum,Medicare,GP,23.68,,,,,,,19.24,71.78,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Optum,Medicare,GP,25.28,,,,,,,20.54,76.63,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Optum,Medicare,GP,23.04,,,,,,,18.72,69.84,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,outpatient,,,445.00000,262.55000,Optum,Medicare,GP,142.40,,,,,,,115.70,431.65,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,outpatient,,,310.00000,182.90000,Optum,Medicare,GP,99.20,,,,,,,80.60,300.70,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,outpatient,,,393.00000,231.87000,Optum,Medicare,GP,125.76,,,,,,,102.18,381.21,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,outpatient,,,310.00000,182.90000,Optum,Medicare,GP,99.20,,,,,,,80.60,300.70,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Optum,Medicare,GO,25.60,,,,,,,20.80,77.60,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Optum,Medicare,GO,26.88,,,,,,,21.84,81.48,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Optum,Medicare,GO,40.32,,,,,,,32.76,122.22,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Optum,Medicare,GO,21.12,,,,,,,17.16,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Optum,Medicare,GO,19.84,,,,,,,16.12,60.14,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Optum,Medicare,GO,28.80,,,,,,,23.40,87.30,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Optum,Medicare,GO,30.40,,,,,,,24.70,92.15,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Optum,Medicare,GO,46.72,,,,,,,37.96,141.62,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Optum,Medicare,GO,44.48,,,,,,,36.14,134.83,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Optum,Medicare,GO,24.00,,,,,,,19.50,72.75,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Optum,Medicare,GO,49.28,,,,,,,40.04,149.38,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Optum,Medicare,GO,23.36,,,,,,,18.98,70.81,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Optum,Medicare,GO,51.20,,,,,,,41.60,155.20,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,outpatient,,,98.00000,37.93000,Optum,Medicare,GO,31.36,,,,,,,25.48,95.06,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,outpatient,,,303.00000,117.26000,Optum,Medicare,GO,96.96,,,,,,,78.78,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,outpatient,,,115.00000,44.50000,Optum,Medicare,GO,36.80,,,,,,,29.90,111.55,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Optum,Medicare,GO,23.68,,,,,,,19.24,71.78,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Optum,Medicare,GO,23.04,,,,,,,18.72,69.84,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Optum,Medicare,"CO,GO",25.60,,,,,,,20.80,77.60,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Optum,Medicare,"CO,GO",26.88,,,,,,,21.84,81.48,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Optum,Medicare,"CO,GO",40.32,,,,,,,32.76,122.22,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Optum,Medicare,"CO,GO",19.84,,,,,,,16.12,60.14,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Optum,Medicare,"CO,GO",21.12,,,,,,,17.16,64.02,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Optum,Medicare,"CO,GO",28.80,,,,,,,23.40,87.30,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Optum,Medicare,"CO,GO",30.40,,,,,,,24.70,92.15,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Optum,Medicare,"CO,GO",46.72,,,,,,,37.96,141.62,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Optum,Medicare,"CO,GO",44.48,,,,,,,36.14,134.83,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Optum,Medicare,"CO,GO",24.00,,,,,,,19.50,72.75,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Optum,Medicare,"CO,GO",49.28,,,,,,,40.04,149.38,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Optum,Medicare,"CO,GO",23.36,,,,,,,18.98,70.81,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Optum,Medicare,"CO,GO",51.20,,,,,,,41.60,155.20,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Optum,Medicare,"CO,GO",23.68,,,,,,,19.24,71.78,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Optum,Medicare,"CO,GO",23.04,,,,,,,18.72,69.84,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Optum,Medicare,GO,15.04,,,,,,,12.22,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Optum,Medicare,"CO,GO",15.04,,,,,,,12.22,45.59,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,outpatient,,,250.00000,142.04000,Optum,Medicare,GO,80.00,,,,,,,65.00,242.50,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,outpatient,,,175.00000,99.43000,Optum,Medicare,GO,56.00,,,,,,,45.50,169.75,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,outpatient,,,233.00000,132.38000,Optum,Medicare,GO,74.56,,,,,,,60.58,226.01,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,outpatient,,,175.00000,99.43000,Optum,Medicare,GO,56.00,,,,,,,45.50,169.75,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,outpatient,,,291.00000,93.99000,Optum,Medicare,,93.12,,,,,,,75.66,282.27,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,outpatient,,,273.00000,155.10000,Optum,Medicare,GN,87.36,,,,,,,70.98,264.81,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,outpatient,,,279.00000,158.51000,Optum,Medicare,GN,89.28,,,,,,,72.54,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,outpatient,,,426.00000,242.03000,Optum,Medicare,GN,136.32,,,,,,,110.76,413.22,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,outpatient,,,242.00000,137.49000,Optum,Medicare,GN,77.44,,,,,,,62.92,234.74,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,outpatient,,,128.00000,72.72000,Optum,Medicare,,40.96,,,,,,,33.28,124.16,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,outpatient,,,66.00000,37.50000,Optum,Medicare,GN,21.12,,,,,,,17.16,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,outpatient,,,62.00000,35.23000,Optum,Medicare,GN,19.84,,,,,,,16.12,60.14,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,outpatient,,,269.00000,152.83000,Optum,Medicare,GN,86.08,,,,,,,69.94,260.93,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,outpatient,,,153.00000,86.93000,Optum,Medicare,GN,48.96,,,,,,,39.78,148.41,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,outpatient,,,98.00000,55.68000,Optum,Medicare,GN,31.36,,,,,,,25.48,95.06,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,outpatient,,,303.00000,172.15000,Optum,Medicare,GN,96.96,,,,,,,78.78,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,outpatient,,,115.00000,65.34000,Optum,Medicare,GN,36.80,,,,,,,29.90,111.55,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,outpatient,,,210.00000,119.31000,Optum,Medicare,GN,67.20,,,,,,,54.60,203.70,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,outpatient,,,250.00000,142.04000,Optum,Medicare,GN,80.00,,,,,,,65.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,outpatient,,,78.00000,44.32000,Optum,Medicare,GN,24.96,,,,,,,20.28,75.66,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,outpatient,,,322.00000,182.94000,Optum,Medicare,GN,103.04,,,,,,,83.72,312.34,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,outpatient,,,309.00000,175.56000,Optum,Medicare,GN,98.88,,,,,,,80.34,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,outpatient,,,245.00000,139.20000,Optum,Medicare,GN,78.40,,,,,,,63.70,237.65,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,outpatient,,,313.00000,116.44000,Optum,Medicare,,100.16,,,,,,,81.38,303.61,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,outpatient,,,1250.00000,632.50000,Optum,Medicare,,400.00,,,,,,,325.00,1212.50,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Optum,Medicare,,46.40,,,,,,,37.70,140.65,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Optum,Medicare,,156.16,,,,,,,126.88,473.36,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,outpatient,,,684.00000,337.90000,Optum,Medicare,,218.88,,,,,,,177.84,663.48,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,outpatient,,,206.00000,101.76000,Optum,Medicare,,65.92,,,,,,,53.56,199.82,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,outpatient,,,195.00000,96.33000,Optum,Medicare,,62.40,,,,,,,50.70,189.15,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,outpatient,,,375.00000,185.25000,Optum,Medicare,,120.00,,,,,,,97.50,363.75,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,outpatient,,,429.00000,211.93000,Optum,Medicare,,137.28,,,,,,,111.54,416.13,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22475,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Optum,Medicare,,2658.00,,,,,,,2502.90,3111.10,per diem,
R&B OBSTETRICS SEMI-PVT,42473,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Optum,Medicare,,2658.00,,,,,,,2502.90,3111.10,per diem,
R&B ICU,32474,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Optum,Medicare,,2658.00,,,,,,,2512.00,8498.17,per diem,
R&B ICU INTERMEDIATE,12476,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Optum,Medicare,,2658.00,,,,,,,2512.00,5665.77,per diem,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Optum,Medicare,,26.88,,,,,,,21.84,81.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Optum,Medicare,,90.88,,,,,,,73.84,275.48,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Optum,Medicare,,146.56,,,,,,,119.08,444.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Optum,Medicare,,178.56,,,,,,,145.08,541.26,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Optum,Medicare,,154.24,,,,,,,125.32,467.54,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Optum,Medicare,,75.84,,,,,,,61.62,229.89,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,outpatient,,,490.00000,329.77000,Optum,Medicare,,156.80,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,outpatient,,,490.00000,329.77000,Optum,Medicare,,156.80,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,outpatient,,,245.00000,164.89000,Optum,Medicare,,78.40,,,,,,,63.70,237.65,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Optum,Medicare,,156.80,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Optum,Medicare,,156.80,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Optum,Medicare,,78.40,,,,,,,63.70,237.65,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Optum,Medicare,,269.44,,,,,,,218.92,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Optum,Medicare,,336.96,,,,,,,273.78,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Optum,Medicare,,404.16,,,,,,,328.38,1225.11,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,outpatient,,,2466.00000,986.40000,Optum,Medicare,,789.12,,,,,,,641.16,2392.02,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,outpatient,,,260.00000,104.00000,Optum,Medicare,,83.20,,,,,,,67.60,252.20,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,outpatient,,,2041.00000,816.40000,Optum,Medicare,,653.12,,,,,,,530.66,1979.77,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,outpatient,,,375.00000,150.00000,Optum,Medicare,,120.00,,,,,,,97.50,363.75,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,outpatient,,,1178.00000,471.20000,Optum,Medicare,,376.96,,,,,,,306.28,1142.66,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,outpatient,,,245.00000,98.00000,Optum,Medicare,,78.40,,,,,,,63.70,237.65,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,outpatient,,,280.00000,112.00000,Optum,Medicare,,89.60,,,,,,,72.80,271.60,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,outpatient,,,336.00000,134.40000,Optum,Medicare,,107.52,,,,,,,87.36,325.92,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,outpatient,,,380.00000,152.00000,Optum,Medicare,,121.60,,,,,,,98.80,368.60,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Optum,Medicare,,169.60,,,,,,,137.80,514.10,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,outpatient,,,264.00000,105.60000,Optum,Medicare,,84.48,,,,,,,68.64,256.08,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,outpatient,,,763.00000,305.20000,Optum,Medicare,,244.16,,,,,,,198.38,740.11,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,outpatient,,,672.00000,268.80000,Optum,Medicare,,215.04,,,,,,,174.72,651.84,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,outpatient,,,1940.00000,776.00000,Optum,Medicare,,620.80,,,,,,,504.40,1881.80,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,outpatient,,,3875.00000,1550.00000,Optum,Medicare,,1240.00,,,,,,,1007.50,3758.75,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,outpatient,,,505.00000,202.00000,Optum,Medicare,,161.60,,,,,,,131.30,489.85,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Optum,Medicare,,94.40,,,,,,,76.70,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,outpatient,,,585.00000,234.00000,Optum,Medicare,,187.20,,,,,,,152.10,567.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,outpatient,,,285.00000,114.00000,Optum,Medicare,,91.20,,,,,,,74.10,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,outpatient,,,575.00000,230.00000,Optum,Medicare,,184.00,,,,,,,149.50,557.75,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,outpatient,,,697.00000,278.80000,Optum,Medicare,,223.04,,,,,,,181.22,676.09,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Optum,Medicare,,169.60,,,,,,,137.80,514.10,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,outpatient,,,580.00000,232.00000,Optum,Medicare,,185.60,,,,,,,150.80,562.60,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,outpatient,,,435.00000,174.00000,Optum,Medicare,,139.20,,,,,,,113.10,421.95,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,outpatient,,,270.00000,108.00000,Optum,Medicare,,86.40,,,,,,,70.20,261.90,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,outpatient,,,504.00000,201.60000,Optum,Medicare,,161.28,,,,,,,131.04,488.88,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,outpatient,,,98.00000,39.20000,Optum,Medicare,,31.36,,,,,,,25.48,95.06,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,outpatient,,,608.00000,243.20000,Optum,Medicare,,194.56,,,,,,,158.08,589.76,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,outpatient,,,114.00000,45.60000,Optum,Medicare,,36.48,,,,,,,29.64,110.58,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,outpatient,,,187.00000,74.80000,Optum,Medicare,,59.84,,,,,,,48.62,181.39,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,outpatient,,,214.00000,85.60000,Optum,Medicare,,68.48,,,,,,,55.64,207.58,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,outpatient,,,863.00000,345.20000,Optum,Medicare,,276.16,,,,,,,224.38,837.11,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,outpatient,,,453.00000,181.20000,Optum,Medicare,,144.96,,,,,,,117.78,439.41,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,outpatient,,,144.00000,57.60000,Optum,Medicare,,46.08,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,outpatient,,,107.00000,42.80000,Optum,Medicare,,34.24,,,,,,,27.82,103.79,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,outpatient,,,403.00000,161.20000,Optum,Medicare,,128.96,,,,,,,104.78,390.91,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,outpatient,,,144.00000,57.60000,Optum,Medicare,,46.08,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,outpatient,,,370.00000,148.00000,Optum,Medicare,,118.40,,,,,,,96.20,358.90,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,outpatient,,,334.00000,133.60000,Optum,Medicare,,106.88,,,,,,,86.84,323.98,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,outpatient,,,1188.00000,475.20000,Optum,Medicare,50,380.16,,,,,,,308.88,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Optum,Medicare,LT,253.44,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Optum,Medicare,RT,253.44,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,outpatient,,,572.00000,228.80000,Optum,Medicare,50,183.04,,,,,,,148.72,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Optum,Medicare,LT,121.92,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Optum,Medicare,RT,121.92,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,outpatient,,,683.00000,273.20000,Optum,Medicare,50,218.56,,,,,,,177.58,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Optum,Medicare,LT,145.60,,,,,,,118.30,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Optum,Medicare,RT,145.60,,,,,,,118.30,441.35,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,outpatient,,,357.00000,142.80000,Optum,Medicare,,114.24,,,,,,,92.82,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,outpatient,,,334.00000,133.60000,Optum,Medicare,,106.88,,,,,,,86.84,323.98,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,outpatient,,,194.00000,77.60000,Optum,Medicare,,62.08,,,,,,,50.44,188.18,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,outpatient,,,608.00000,243.20000,Optum,Medicare,,194.56,,,,,,,158.08,589.76,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,outpatient,,,257.00000,102.80000,Optum,Medicare,,82.24,,,,,,,66.82,249.29,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,outpatient,,,343.00000,137.20000,Optum,Medicare,,109.76,,,,,,,89.18,332.71,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,outpatient,,,457.00000,182.80000,Optum,Medicare,,146.24,,,,,,,118.82,443.29,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,outpatient,,,630.00000,252.00000,Optum,Medicare,,201.60,,,,,,,163.80,611.10,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,outpatient,,,623.00000,249.20000,Optum,Medicare,,199.36,,,,,,,161.98,604.31,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,outpatient,,,1457.00000,582.80000,Optum,Medicare,,466.24,,,,,,,378.82,1413.29,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,outpatient,,,890.00000,356.00000,Optum,Medicare,,284.80,,,,,,,231.40,863.30,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,outpatient,,,532.00000,212.80000,Optum,Medicare,,170.24,,,,,,,138.32,516.04,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,outpatient,,,492.00000,196.80000,Optum,Medicare,,157.44,,,,,,,127.92,477.24,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,outpatient,,,550.00000,220.00000,Optum,Medicare,,176.00,,,,,,,143.00,533.50,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,outpatient,,,305.00000,122.00000,Optum,Medicare,,97.60,,,,,,,79.30,295.85,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,outpatient,,,220.00000,88.00000,Optum,Medicare,,70.40,,,,,,,57.20,213.40,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,outpatient,,,780.00000,312.00000,Optum,Medicare,,249.60,,,,,,,202.80,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,outpatient,,,1165.00000,466.00000,Optum,Medicare,,372.80,,,,,,,302.90,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,outpatient,,,2350.00000,940.00000,Optum,Medicare,,752.00,,,,,,,611.00,2279.50,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,outpatient,,,896.00000,358.40000,Optum,Medicare,,286.72,,,,,,,232.96,869.12,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,outpatient,,,385.00000,154.00000,Optum,Medicare,,123.20,,,,,,,100.10,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,outpatient,,,470.00000,188.00000,Optum,Medicare,,150.40,,,,,,,122.20,455.90,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,outpatient,,,150.00000,60.00000,Optum,Medicare,,48.00,,,,,,,39.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,outpatient,,,100.00000,40.00000,Optum,Medicare,,32.00,,,,,,,26.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,outpatient,,,143.00000,57.20000,Optum,Medicare,,45.76,,,,,,,37.18,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,outpatient,,,95.00000,38.00000,Optum,Medicare,,30.40,,,,,,,24.70,92.15,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,outpatient,,,269.00000,107.60000,Optum,Medicare,,86.08,,,,,,,69.94,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,outpatient,,,388.00000,155.20000,Optum,Medicare,,124.16,,,,,,,100.88,376.36,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,outpatient,,,344.00000,137.60000,Optum,Medicare,,110.08,,,,,,,89.44,333.68,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,outpatient,,,321.00000,128.40000,Optum,Medicare,,102.72,,,,,,,83.46,311.37,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,outpatient,,,155.00000,62.00000,Optum,Medicare,,49.60,,,,,,,40.30,150.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,outpatient,,,817.00000,326.80000,Optum,Medicare,,261.44,,,,,,,212.42,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,outpatient,,,1255.00000,502.00000,Optum,Medicare,,401.60,,,,,,,326.30,1217.35,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,outpatient,,,391.00000,156.40000,Optum,Medicare,,125.12,,,,,,,101.66,379.27,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,outpatient,,,671.00000,268.40000,Optum,Medicare,,214.72,,,,,,,174.46,650.87,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,outpatient,,,456.00000,182.40000,Optum,Medicare,,145.92,,,,,,,118.56,442.32,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,outpatient,,,112.00000,44.80000,Optum,Medicare,,35.84,,,,,,,29.12,108.64,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,outpatient,,,84.00000,33.60000,Optum,Medicare,,26.88,,,,,,,21.84,81.48,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,outpatient,,,216.00000,86.40000,Optum,Medicare,,69.12,,,,,,,56.16,209.52,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,outpatient,,,2660.00000,1064.00000,Optum,Medicare,,851.20,,,,,,,691.60,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,outpatient,,,2960.00000,1184.00000,Optum,Medicare,,947.20,,,,,,,769.60,2871.20,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,outpatient,,,3225.00000,1290.00000,Optum,Medicare,,1032.00,,,,,,,838.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,outpatient,,,3395.00000,1358.00000,Optum,Medicare,,1086.40,,,,,,,882.70,3293.15,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,outpatient,,,490.00000,196.00000,Optum,Medicare,,156.80,,,,,,,127.40,475.30,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,outpatient,,,520.00000,208.00000,Optum,Medicare,,166.40,,,,,,,135.20,504.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,outpatient,,,720.00000,288.00000,Optum,Medicare,,230.40,,,,,,,187.20,698.40,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,outpatient,,,215.00000,86.00000,Optum,Medicare,,68.80,,,,,,,55.90,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,outpatient,,,240.00000,96.00000,Optum,Medicare,,76.80,,,,,,,62.40,232.80,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,outpatient,,,1241.00000,496.40000,Optum,Medicare,,397.12,,,,,,,322.66,1203.77,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,outpatient,,,850.00000,340.00000,Optum,Medicare,,272.00,,,,,,,221.00,824.50,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,outpatient,,,1085.00000,434.00000,Optum,Medicare,,347.20,,,,,,,282.10,1052.45,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Optum,Medicare,,94.40,,,,,,,76.70,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,outpatient,,,492.00000,196.80000,Optum,Medicare,,157.44,,,,,,,127.92,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,outpatient,,,563.00000,225.20000,Optum,Medicare,,180.16,,,,,,,146.38,546.11,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,outpatient,,,1612.00000,644.80000,Optum,Medicare,,515.84,,,,,,,419.12,1563.64,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,outpatient,,,1366.00000,546.40000,Optum,Medicare,,437.12,,,,,,,355.16,1325.02,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,outpatient,,,1911.00000,764.40000,Optum,Medicare,,611.52,,,,,,,496.86,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,outpatient,,,956.00000,382.40000,Optum,Medicare,,305.92,,,,,,,248.56,927.32,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,outpatient,,,189.00000,123.20000,Optum,Medicare,,60.48,,,,,,,49.14,183.33,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,outpatient,,,352.00000,256.87000,Optum,Medicare,,112.64,,,,,,,91.52,341.44,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,outpatient,,,625.00000,738.40000,Optum,Medicare,,200.00,,,,,,,162.50,606.25,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1024.00000,2097.47000,Optum,Medicare,,327.68,,,,,,,266.24,993.28,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,outpatient,,,1455.00000,2469.72000,Optum,Medicare,,465.60,,,,,,,378.30,1411.35,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Optum,Medicare,,46.40,,,,,,,37.70,140.65,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Optum,Medicare,,156.16,,,,,,,126.88,473.36,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Optum,Medicare,,37.12,,,,,,,30.16,112.52,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Optum,Medicare,,25.92,,,,,,,21.06,78.57,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Optum,Medicare,,13.12,,,,,,,10.66,39.77,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,outpatient,,,170.00000,73.95000,Optum,Medicare,,54.40,,,,,,,44.20,164.90,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,2.70000,1.17000,Optum,Medicare,,0.86400,,,,,,,0.70200,2.62,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,27.00000,11.74000,Optum,Medicare,,8.64,,,,,,,7.02,26.19,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,outpatient,,,20440.00000,8891.40000,Optum,Medicare,,6540.80,,,,,,,5314.40,19826.80,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,3322.00000,1445.07000,Optum,Medicare,,1063.04,,,,,,,863.72,3222.34,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,2492.00000,1084.02000,Optum,Medicare,,797.44,,,,,,,647.92,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1814.00000,789.09000,Optum,Medicare,,580.48,,,,,,,471.64,1759.58,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,2153.00000,936.56000,Optum,Medicare,,688.96,,,,,,,559.78,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1525.00000,663.38000,Optum,Medicare,,488.00,,,,,,,396.50,1479.25,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2716.00000,1181.46000,Optum,Medicare,,869.12,,,,,,,706.16,2634.52,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,outpatient,,,2.70000,0.39000,Optum,Medicare,,0.86400,,,,,,,0.70200,2.62,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,outpatient,,,222.00000,32.41000,Optum,Medicare,,71.04,,,,,,,57.72,215.34,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,outpatient,,,211.00000,113.10000,Optum,Medicare,,67.52,,,,,,,54.86,204.67,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,outpatient,,,497.00000,266.39000,Optum,Medicare,,159.04,,,,,,,129.22,482.09,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,outpatient,,,296.00000,158.66000,Optum,Medicare,,94.72,,,,,,,76.96,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,outpatient,,,723.00000,387.53000,Optum,Medicare,,231.36,,,,,,,187.98,701.31,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,outpatient,,,326.00000,174.74000,Optum,Medicare,,104.32,,,,,,,84.76,316.22,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,outpatient,,,532.00000,285.15000,Optum,Medicare,,170.24,,,,,,,138.32,516.04,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,outpatient,,,635.00000,340.36000,Optum,Medicare,,203.20,,,,,,,165.10,615.95,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,outpatient,,,639.00000,342.50000,Optum,Medicare,,204.48,,,,,,,166.14,619.83,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,outpatient,,,780.00000,418.08000,Optum,Medicare,,249.60,,,,,,,202.80,756.60,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,outpatient,,,390.00000,209.04000,Optum,Medicare,,124.80,,,,,,,101.40,378.30,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,outpatient,,,731.00000,391.82000,Optum,Medicare,,233.92,,,,,,,190.06,709.07,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,outpatient,,,585.00000,313.56000,Optum,Medicare,,187.20,,,,,,,152.10,567.45,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,outpatient,,,365.00000,195.64000,Optum,Medicare,,116.80,,,,,,,94.90,354.05,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,outpatient,,,1086.00000,582.10000,Optum,Medicare,,347.52,,,,,,,282.36,1053.42,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,outpatient,,,197.00000,105.59000,Optum,Medicare,,63.04,,,,,,,51.22,191.09,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,outpatient,,,2774.00000,1486.86000,Optum,Medicare,,887.68,,,,,,,721.24,2690.78,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,outpatient,,,1456.00000,780.42000,Optum,Medicare,,465.92,,,,,,,378.56,1412.32,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,outpatient,,,2647.00000,1418.79000,Optum,Medicare,,847.04,,,,,,,688.22,2567.59,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,outpatient,,,1359.00000,728.42000,Optum,Medicare,,434.88,,,,,,,353.34,1318.23,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,outpatient,,,273.00000,146.33000,Optum,Medicare,,87.36,,,,,,,70.98,264.81,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,outpatient,,,325.00000,174.20000,Optum,Medicare,,104.00,,,,,,,84.50,315.25,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Optum,Medicare,,194.88,,,,,,,158.34,590.73,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,outpatient,,,491.00000,263.18000,Optum,Medicare,,157.12,,,,,,,127.66,476.27,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,outpatient,,,561.00000,300.70000,Optum,Medicare,,179.52,,,,,,,145.86,544.17,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,outpatient,,,845.00000,452.92000,Optum,Medicare,,270.40,,,,,,,219.70,819.65,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,outpatient,,,612.00000,328.03000,Optum,Medicare,,195.84,,,,,,,159.12,593.64,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,outpatient,,,536.00000,287.30000,Optum,Medicare,,171.52,,,,,,,139.36,519.92,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,outpatient,,,1225.00000,656.60000,Optum,Medicare,,392.00,,,,,,,318.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Optum,Medicare,LT,261.12,,,,,,,212.16,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Optum,Medicare,RT,261.12,,,,,,,212.16,791.52,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,outpatient,,,250.00000,134.00000,Optum,Medicare,,80.00,,,,,,,65.00,242.50,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,outpatient,,,302.00000,161.87000,Optum,Medicare,,96.64,,,,,,,78.52,292.94,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,outpatient,,,354.00000,189.74000,Optum,Medicare,,113.28,,,,,,,92.04,343.38,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,outpatient,,,409.00000,219.22000,Optum,Medicare,,130.88,,,,,,,106.34,396.73,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,outpatient,,,593.00000,317.85000,Optum,Medicare,,189.76,,,,,,,154.18,575.21,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Optum,Medicare,LT,98.24,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Optum,Medicare,"52,LT",98.24,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Optum,Medicare,RT,98.24,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Optum,Medicare,"52,RT",98.24,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Optum,Medicare,LT,105.60,,,,,,,85.80,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Optum,Medicare,RT,105.60,,,,,,,85.80,320.10,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,outpatient,,,195.00000,104.52000,Optum,Medicare,,62.40,,,,,,,50.70,189.15,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,outpatient,,,578.00000,309.81000,Optum,Medicare,,184.96,,,,,,,150.28,560.66,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,outpatient,,,384.00000,205.82000,Optum,Medicare,,122.88,,,,,,,99.84,372.48,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Optum,Medicare,LT,96.96,,,,,,,78.78,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Optum,Medicare,RT,96.96,,,,,,,78.78,293.91,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Optum,Medicare,LT,142.40,,,,,,,115.70,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Optum,Medicare,RT,142.40,,,,,,,115.70,431.65,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,outpatient,,,937.00000,502.23000,Optum,Medicare,,299.84,,,,,,,243.62,908.89,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,outpatient,,,615.00000,329.64000,Optum,Medicare,,196.80,,,,,,,159.90,596.55,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Optum,Medicare,LT,91.84,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Optum,Medicare,"52,LT",91.84,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Optum,Medicare,RT,91.84,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Optum,Medicare,"52,RT",91.84,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Optum,Medicare,LT,103.36,,,,,,,83.98,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Optum,Medicare,RT,103.36,,,,,,,83.98,313.31,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,outpatient,,,694.00000,371.98000,Optum,Medicare,,222.08,,,,,,,180.44,673.18,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Optum,Medicare,LT,88.32,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Optum,Medicare,RT,88.32,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Optum,Medicare,LT,81.28,,,,,,,66.04,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Optum,Medicare,RT,81.28,,,,,,,66.04,246.38,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Optum,Medicare,LT,88.00,,,,,,,71.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Optum,Medicare,RT,88.00,,,,,,,71.50,266.75,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,outpatient,,,173.00000,92.73000,Optum,Medicare,,55.36,,,,,,,44.98,167.81,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Optum,Medicare,LT,154.56,,,,,,,125.58,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Optum,Medicare,RT,154.56,,,,,,,125.58,468.51,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Optum,Medicare,LT,61.12,,,,,,,49.66,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Optum,Medicare,RT,61.12,,,,,,,49.66,185.27,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Optum,Medicare,LT,47.36,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Optum,Medicare,"52,LT",47.36,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Optum,Medicare,RT,47.36,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Optum,Medicare,"52,RT",47.36,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Optum,Medicare,LT,153.92,,,,,,,125.06,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Optum,Medicare,RT,153.92,,,,,,,125.06,466.57,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Optum,Medicare,LT,68.80,,,,,,,55.90,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Optum,Medicare,RT,68.80,,,,,,,55.90,208.55,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Optum,Medicare,LT,88.00,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Optum,Medicare,"52,LT",88.00,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Optum,Medicare,RT,88.00,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Optum,Medicare,"52,RT",88.00,,,,,,,71.50,266.75,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Optum,Medicare,LT,145.60,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Optum,Medicare,"52,LT",145.60,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Optum,Medicare,RT,145.60,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Optum,Medicare,"52,RT",145.60,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Optum,Medicare,LT,160.96,,,,,,,130.78,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Optum,Medicare,RT,160.96,,,,,,,130.78,487.91,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Optum,Medicare,LT,66.88,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Optum,Medicare,RT,66.88,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Optum,Medicare,LT,181.12,,,,,,,147.16,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Optum,Medicare,RT,181.12,,,,,,,147.16,549.02,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,outpatient,,,598.00000,320.53000,Optum,Medicare,,191.36,,,,,,,155.48,580.06,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Optum,Medicare,"52,LT",145.60,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Optum,Medicare,"52,RT",145.60,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Optum,Medicare,LT,145.60,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Optum,Medicare,RT,145.60,,,,,,,118.30,441.35,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,outpatient,,,1913.00000,1025.37000,Optum,Medicare,,612.16,,,,,,,497.38,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,outpatient,,,312.00000,167.23000,Optum,Medicare,,99.84,,,,,,,81.12,302.64,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,outpatient,,,327.00000,175.27000,Optum,Medicare,,104.64,,,,,,,85.02,317.19,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,outpatient,,,425.00000,227.80000,Optum,Medicare,,136.00,,,,,,,110.50,412.25,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,outpatient,,,210.00000,112.56000,Optum,Medicare,,67.20,,,,,,,54.60,203.70,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,outpatient,,,495.00000,265.32000,Optum,Medicare,,158.40,,,,,,,128.70,480.15,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,outpatient,,,541.00000,289.98000,Optum,Medicare,,173.12,,,,,,,140.66,524.77,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Optum,Medicare,LT,110.40,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Optum,Medicare,RT,110.40,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Optum,Medicare,LT,134.08,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Optum,Medicare,RT,134.08,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Optum,Medicare,LT,197.76,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Optum,Medicare,RT,197.76,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,outpatient,,,463.00000,248.17000,Optum,Medicare,,148.16,,,,,,,120.38,449.11,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,outpatient,,,511.00000,273.90000,Optum,Medicare,,163.52,,,,,,,132.86,495.67,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,outpatient,,,132.00000,70.75000,Optum,Medicare,,42.24,,,,,,,34.32,128.04,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Optum,Medicare,LT,112.96,,,,,,,91.78,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Optum,Medicare,RT,112.96,,,,,,,91.78,342.41,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,outpatient,,,273.00000,146.33000,Optum,Medicare,,87.36,,,,,,,70.98,264.81,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,outpatient,,,503.00000,269.61000,Optum,Medicare,,160.96,,,,,,,130.78,487.91,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,outpatient,,,561.00000,300.70000,Optum,Medicare,,179.52,,,,,,,145.86,544.17,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Optum,Medicare,LT,144.00,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Optum,Medicare,RT,144.00,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,outpatient,,,650.00000,348.40000,Optum,Medicare,,208.00,,,,,,,169.00,630.50,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,outpatient,,,642.00000,344.11000,Optum,Medicare,,205.44,,,,,,,166.92,622.74,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,outpatient,,,777.00000,416.47000,Optum,Medicare,,248.64,,,,,,,202.02,753.69,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,outpatient,,,381.00000,204.22000,Optum,Medicare,,121.92,,,,,,,99.06,369.57,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Optum,Medicare,LT,119.68,,,,,,,97.24,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Optum,Medicare,RT,119.68,,,,,,,97.24,362.78,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Optum,Medicare,LT,51.52,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Optum,Medicare,RT,51.52,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Optum,Medicare,LT,159.68,,,,,,,129.74,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Optum,Medicare,RT,159.68,,,,,,,129.74,484.03,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,outpatient,,,214.00000,114.70000,Optum,Medicare,,68.48,,,,,,,55.64,207.58,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,outpatient,,,329.00000,176.34000,Optum,Medicare,,105.28,,,,,,,85.54,319.13,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,outpatient,,,197.00000,105.59000,Optum,Medicare,,63.04,,,,,,,51.22,191.09,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,outpatient,,,263.00000,140.97000,Optum,Medicare,,84.16,,,,,,,68.38,255.11,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,outpatient,,,234.00000,125.42000,Optum,Medicare,,74.88,,,,,,,60.84,226.98,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,outpatient,,,401.00000,214.94000,Optum,Medicare,,128.32,,,,,,,104.26,388.97,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,outpatient,,,515.00000,276.04000,Optum,Medicare,,164.80,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,outpatient,,,747.00000,400.39000,Optum,Medicare,,239.04,,,,,,,194.22,724.59,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,outpatient,,,854.00000,457.74000,Optum,Medicare,,273.28,,,,,,,222.04,828.38,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,outpatient,,,589.00000,315.70000,Optum,Medicare,,188.48,,,,,,,153.14,571.33,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,outpatient,,,613.00000,328.57000,Optum,Medicare,,196.16,,,,,,,159.38,594.61,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,outpatient,,,806.00000,432.02000,Optum,Medicare,,257.92,,,,,,,209.56,781.82,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,outpatient,,,529.00000,283.54000,Optum,Medicare,,169.28,,,,,,,137.54,513.13,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,outpatient,,,939.00000,503.30000,Optum,Medicare,,300.48,,,,,,,244.14,910.83,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,outpatient,,,515.00000,276.04000,Optum,Medicare,,164.80,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,outpatient,,,616.00000,330.18000,Optum,Medicare,,197.12,,,,,,,160.16,597.52,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,outpatient,,,377.00000,202.07000,Optum,Medicare,,120.64,,,,,,,98.02,365.69,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,outpatient,,,340.00000,182.24000,Optum,Medicare,,108.80,,,,,,,88.40,329.80,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,outpatient,,,388.00000,207.97000,Optum,Medicare,,124.16,,,,,,,100.88,376.36,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,outpatient,,,456.00000,244.42000,Optum,Medicare,,145.92,,,,,,,118.56,442.32,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,outpatient,,,267.00000,143.11000,Optum,Medicare,,85.44,,,,,,,69.42,258.99,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Optum,Medicare,LT,97.92,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Optum,Medicare,"52,LT",97.92,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Optum,Medicare,RT,97.92,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Optum,Medicare,"52,RT",97.92,,,,,,,79.56,296.82,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,outpatient,,,456.00000,244.42000,Optum,Medicare,,145.92,,,,,,,118.56,442.32,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,outpatient,,,381.00000,204.22000,Optum,Medicare,,121.92,,,,,,,99.06,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Optum,Medicare,LT,45.76,,,,,,,37.18,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Optum,Medicare,RT,45.76,,,,,,,37.18,138.71,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Optum,Medicare,LT,105.92,,,,,,,86.06,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Optum,Medicare,RT,105.92,,,,,,,86.06,321.07,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1113.00000,596.57000,Optum,Medicare,,356.16,,,,,,,289.38,1079.61,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,outpatient,,,1043.00000,559.05000,Optum,Medicare,,333.76,,,,,,,271.18,1011.71,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Optum,Medicare,LT,81.92,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Optum,Medicare,"52,LT",81.92,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Optum,Medicare,RT,81.92,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Optum,Medicare,"52,RT",81.92,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Optum,Medicare,LT,163.52,,,,,,,132.86,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Optum,Medicare,RT,163.52,,,,,,,132.86,495.67,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Optum,Medicare,LT,176.96,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Optum,Medicare,RT,176.96,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Optum,Medicare,LT,344.32,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Optum,Medicare,RT,344.32,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Optum,Medicare,LT,276.80,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Optum,Medicare,RT,276.80,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Optum,Medicare,LT,234.88,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Optum,Medicare,RT,234.88,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Optum,Medicare,LT,233.60,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Optum,Medicare,RT,233.60,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Optum,Medicare,LT,83.20,,,,,,,67.60,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Optum,Medicare,RT,83.20,,,,,,,67.60,252.20,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,outpatient,,,428.00000,203.73000,Optum,Medicare,,136.96,,,,,,,111.28,415.16,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,outpatient,,,492.00000,234.19000,Optum,Medicare,,157.44,,,,,,,127.92,477.24,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,outpatient,,,607.00000,288.93000,Optum,Medicare,,194.24,,,,,,,157.82,588.79,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,outpatient,,,649.00000,308.92000,Optum,Medicare,,207.68,,,,,,,168.74,629.53,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,outpatient,,,377.00000,121.77000,Optum,Medicare,50,120.64,,,,,,,98.02,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Optum,Medicare,LT,80.32,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Optum,Medicare,RT,80.32,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,outpatient,,,1170.00000,377.91000,Optum,Medicare,50,374.40,,,,,,,304.20,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Optum,Medicare,LT,249.60,,,,,,,202.80,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Optum,Medicare,RT,249.60,,,,,,,202.80,756.60,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,outpatient,,,1389.00000,448.65000,Optum,Medicare,,444.48,,,,,,,361.14,1347.33,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,outpatient,,,345.00000,111.44000,Optum,Medicare,50,110.40,,,,,,,89.70,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Optum,Medicare,LT,73.60,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Optum,Medicare,RT,73.60,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,outpatient,,,2102.00000,678.95000,Optum,Medicare,50,672.64,,,,,,,546.52,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Optum,Medicare,LT,448.32,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Optum,Medicare,RT,448.32,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,outpatient,,,357.00000,115.31000,Optum,Medicare,50,114.24,,,,,,,92.82,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Optum,Medicare,LT,76.16,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Optum,Medicare,RT,76.16,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,outpatient,,,2082.00000,672.49000,Optum,Medicare,50,666.24,,,,,,,541.32,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Optum,Medicare,LT,444.16,,,,,,,360.88,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Optum,Medicare,RT,444.16,,,,,,,360.88,1346.36,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,outpatient,,,246.00000,79.46000,Optum,Medicare,50,78.72,,,,,,,63.96,238.62,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Optum,Medicare,LT,52.48,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Optum,Medicare,RT,52.48,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,outpatient,,,309.00000,99.81000,Optum,Medicare,50,98.88,,,,,,,80.34,299.73,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Optum,Medicare,LT,65.92,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Optum,Medicare,RT,65.92,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,outpatient,,,471.00000,152.13000,Optum,Medicare,50,150.72,,,,,,,122.46,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Optum,Medicare,LT,100.48,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Optum,Medicare,RT,100.48,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,outpatient,,,239.00000,77.20000,Optum,Medicare,50,76.48,,,,,,,62.14,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Optum,Medicare,LT,50.88,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Optum,Medicare,RT,50.88,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,outpatient,,,558.00000,180.23000,Optum,Medicare,50,178.56,,,,,,,145.08,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Optum,Medicare,LT,119.04,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Optum,Medicare,RT,119.04,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,outpatient,,,413.00000,133.40000,Optum,Medicare,50,132.16,,,,,,,107.38,400.61,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Optum,Medicare,LT,88.00,,,,,,,71.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Optum,Medicare,RT,88.00,,,,,,,71.50,266.75,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,outpatient,,,462.00000,149.23000,Optum,Medicare,,147.84,,,,,,,120.12,448.14,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,outpatient,,,170.00000,54.91000,Optum,Medicare,,54.40,,,,,,,44.20,164.90,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,outpatient,,,281.00000,90.76000,Optum,Medicare,,89.92,,,,,,,73.06,272.57,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,outpatient,,,562.00000,181.53000,Optum,Medicare,,179.84,,,,,,,146.12,545.14,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,outpatient,,,2076.00000,670.55000,Optum,Medicare,50,664.32,,,,,,,539.76,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Optum,Medicare,LT,442.88,,,,,,,359.84,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Optum,Medicare,RT,442.88,,,,,,,359.84,1342.48,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,outpatient,,,934.00000,301.68000,Optum,Medicare,,298.88,,,,,,,242.84,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,outpatient,,,842.00000,271.97000,Optum,Medicare,,269.44,,,,,,,218.92,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,outpatient,,,846.00000,273.26000,Optum,Medicare,,270.72,,,,,,,219.96,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,outpatient,,,971.00000,313.63000,Optum,Medicare,,310.72,,,,,,,252.46,941.87,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,outpatient,,,762.00000,246.13000,Optum,Medicare,,243.84,,,,,,,198.12,739.14,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,outpatient,,,758.00000,244.83000,Optum,Medicare,,242.56,,,,,,,197.08,735.26,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,outpatient,,,161.00000,52.00000,Optum,Medicare,,51.52,,,,,,,41.86,156.17,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,outpatient,,,234.00000,75.58000,Optum,Medicare,50,74.88,,,,,,,60.84,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Optum,Medicare,LT,49.92,,,,,,,40.56,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Optum,Medicare,RT,49.92,,,,,,,40.56,151.32,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1517.00000,489.99000,Optum,Medicare,50,485.44,,,,,,,394.42,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Optum,Medicare,LT,323.52,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Optum,Medicare,RT,323.52,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,outpatient,,,822.00000,265.51000,Optum,Medicare,50,263.04,,,,,,,213.72,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Optum,Medicare,LT,175.36,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Optum,Medicare,RT,175.36,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,outpatient,,,2613.00000,844.00000,Optum,Medicare,,836.16,,,,,,,679.38,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,outpatient,,,903.00000,291.67000,Optum,Medicare,,288.96,,,,,,,234.78,875.91,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,outpatient,,,1156.00000,373.39000,Optum,Medicare,,369.92,,,,,,,300.56,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,outpatient,,,677.00000,218.67000,Optum,Medicare,,216.64,,,,,,,176.02,656.69,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1928.00000,622.74000,Optum,Medicare,50,616.96,,,,,,,501.28,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Optum,Medicare,LT,411.20,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Optum,Medicare,RT,411.20,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,outpatient,,,812.00000,262.28000,Optum,Medicare,50,259.84,,,,,,,211.12,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Optum,Medicare,LT,173.12,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Optum,Medicare,RT,173.12,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,outpatient,,,825.00000,266.48000,Optum,Medicare,50,264.00,,,,,,,214.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Optum,Medicare,LT,176.00,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Optum,Medicare,RT,176.00,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,outpatient,,,3494.00000,1128.56000,Optum,Medicare,50,1118.08,,,,,,,908.44,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Optum,Medicare,LT,745.28,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Optum,Medicare,RT,745.28,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,outpatient,,,840.00000,271.32000,Optum,Medicare,50,268.80,,,,,,,218.40,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Optum,Medicare,LT,179.20,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Optum,Medicare,RT,179.20,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,outpatient,,,792.00000,255.82000,Optum,Medicare,50,253.44,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Optum,Medicare,LT,168.96,,,,,,,137.28,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Optum,Medicare,RT,168.96,,,,,,,137.28,512.16,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,outpatient,,,272.00000,87.86000,Optum,Medicare,,87.04,,,,,,,70.72,263.84,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,outpatient,,,1268.00000,409.56000,Optum,Medicare,,405.76,,,,,,,329.68,1229.96,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,outpatient,,,896.00000,289.41000,Optum,Medicare,,286.72,,,,,,,232.96,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,outpatient,,,884.00000,285.53000,Optum,Medicare,,282.88,,,,,,,229.84,857.48,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Optum,Medicare,,194.88,,,,,,,158.34,590.73,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,outpatient,,,966.00000,383.50000,Optum,Medicare,,309.12,,,,,,,251.16,937.02,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,outpatient,,,872.00000,346.18000,Optum,Medicare,,279.04,,,,,,,226.72,845.84,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,outpatient,,,492.00000,195.32000,Optum,Medicare,,157.44,,,,,,,127.92,477.24,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,outpatient,,,331.00000,131.41000,Optum,Medicare,,105.92,,,,,,,86.06,321.07,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,outpatient,,,5215.00000,2070.36000,Optum,Medicare,,1668.80,,,,,,,1355.90,5058.55,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,outpatient,,,5422.00000,2152.53000,Optum,Medicare,,1735.04,,,,,,,1409.72,5259.34,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1878.00000,788.76000,Optum,Medicare,,600.96,,,,,,,488.28,1821.66,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,outpatient,,,2253.00000,946.26000,Optum,Medicare,,720.96,,,,,,,585.78,2185.41,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1502.00000,630.84000,Optum,Medicare,,480.64,,,,,,,390.52,1456.94,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,outpatient,,,2024.00000,850.08000,Optum,Medicare,,647.68,,,,,,,526.24,1963.28,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,outpatient,,,2429.00000,1020.18000,Optum,Medicare,,777.28,,,,,,,631.54,2356.13,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1619.00000,679.98000,Optum,Medicare,,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,outpatient,,,2425.00000,1018.50000,Optum,Medicare,,776.00,,,,,,,630.50,2352.25,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2910.00000,1222.20000,Optum,Medicare,,931.20,,,,,,,756.60,2822.70,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1940.00000,814.80000,Optum,Medicare,,620.80,,,,,,,504.40,1881.80,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2317.00000,973.14000,Optum,Medicare,,741.44,,,,,,,602.42,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2780.00000,1167.60000,Optum,Medicare,,889.60,,,,,,,722.80,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1853.00000,778.26000,Optum,Medicare,,592.96,,,,,,,481.78,1797.41,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2366.00000,993.72000,Optum,Medicare,,757.12,,,,,,,615.16,2295.02,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,outpatient,,,3056.00000,1283.52000,Optum,Medicare,,977.92,,,,,,,794.56,2964.32,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,outpatient,,,2829.00000,1386.21000,Optum,Medicare,,905.28,,,,,,,735.54,2744.13,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,outpatient,,,3395.00000,1663.55000,Optum,Medicare,,1086.40,,,,,,,882.70,3293.15,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,outpatient,,,2263.00000,1108.87000,Optum,Medicare,,724.16,,,,,,,588.38,2195.11,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,outpatient,,,4697.00000,2301.53000,Optum,Medicare,,1503.04,,,,,,,1221.22,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,outpatient,,,5636.00000,2761.64000,Optum,Medicare,,1803.52,,,,,,,1465.36,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,outpatient,,,3757.00000,1840.93000,Optum,Medicare,,1202.24,,,,,,,976.82,3644.29,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,outpatient,,,2619.00000,1283.31000,Optum,Medicare,,838.08,,,,,,,680.94,2540.43,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,outpatient,,,3143.00000,1540.07000,Optum,Medicare,,1005.76,,,,,,,817.18,3048.71,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,outpatient,,,2095.00000,1026.55000,Optum,Medicare,,670.40,,,,,,,544.70,2032.15,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,outpatient,,,278.00000,136.22000,Optum,Medicare,,88.96,,,,,,,72.28,269.66,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Optum,Medicare,LT,675.20,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Optum,Medicare,RT,675.20,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Optum,Medicare,LT,810.24,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Optum,Medicare,RT,810.24,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Optum,Medicare,LT,540.16,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Optum,Medicare,RT,540.16,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Optum,Medicare,LT,647.68,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Optum,Medicare,RT,647.68,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Optum,Medicare,LT,777.28,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Optum,Medicare,RT,777.28,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Optum,Medicare,LT,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Optum,Medicare,RT,518.08,,,,,,,420.94,1570.43,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,outpatient,,,1224.00000,599.76000,Optum,Medicare,,391.68,,,,,,,318.24,1187.28,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,outpatient,,,3020.00000,1479.80000,Optum,Medicare,,966.40,,,,,,,785.20,2929.40,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,outpatient,,,3624.00000,1775.76000,Optum,Medicare,,1159.68,,,,,,,942.24,3515.28,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,outpatient,,,2416.00000,1183.84000,Optum,Medicare,,773.12,,,,,,,628.16,2343.52,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,outpatient,,,2728.00000,1336.72000,Optum,Medicare,,872.96,,,,,,,709.28,2646.16,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,outpatient,,,3273.00000,1603.77000,Optum,Medicare,,1047.36,,,,,,,850.98,3174.81,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,outpatient,,,2182.00000,1069.18000,Optum,Medicare,,698.24,,,,,,,567.32,2116.54,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,outpatient,,,3133.00000,1535.17000,Optum,Medicare,,1002.56,,,,,,,814.58,3039.01,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,outpatient,,,3759.00000,1841.91000,Optum,Medicare,,1202.88,,,,,,,977.34,3646.23,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,outpatient,,,2506.00000,1227.94000,Optum,Medicare,,801.92,,,,,,,651.56,2430.82,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,outpatient,,,2857.00000,1399.93000,Optum,Medicare,,914.24,,,,,,,742.82,2771.29,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,outpatient,,,3428.00000,1679.72000,Optum,Medicare,,1096.96,,,,,,,891.28,3325.16,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,outpatient,,,2285.00000,1119.65000,Optum,Medicare,,731.20,,,,,,,594.10,2216.45,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,outpatient,,,3565.00000,1746.85000,Optum,Medicare,,1140.80,,,,,,,926.90,3458.05,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,outpatient,,,5918.00000,2899.82000,Optum,Medicare,,1893.76,,,,,,,1538.68,5740.46,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,outpatient,,,3301.00000,1617.49000,Optum,Medicare,,1056.32,,,,,,,858.26,3201.97,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Optum,Medicare,LT,850.88,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Optum,Medicare,RT,850.88,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Optum,Medicare,LT,816.32,,,,,,,663.26,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Optum,Medicare,RT,816.32,,,,,,,663.26,2474.47,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3806.00000,1864.94000,Optum,Medicare,,1217.92,,,,,,,989.56,3691.82,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,outpatient,,,2149.00000,694.13000,Optum,Medicare,,687.68,,,,,,,558.74,2084.53,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,outpatient,,,1973.00000,637.28000,Optum,Medicare,,631.36,,,,,,,512.98,1913.81,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1784.00000,576.23000,Optum,Medicare,50,570.88,,,,,,,463.84,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Optum,Medicare,LT,380.48,,,,,,,309.14,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Optum,Medicare,RT,380.48,,,,,,,309.14,1153.33,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,outpatient,,,130.00000,69.68000,Optum,Medicare,,41.60,,,,,,,33.80,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,outpatient,,,44.00000,23.58000,Optum,Medicare,,14.08,,,,,,,11.44,42.68,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,outpatient,,,456.00000,244.42000,Optum,Medicare,,145.92,,,,,,,118.56,442.32,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,outpatient,,,108.00000,57.89000,Optum,Medicare,,34.56,,,,,,,28.08,104.76,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,outpatient,,,306.00000,164.02000,Optum,Medicare,,97.92,,,,,,,79.56,296.82,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,outpatient,,,257.00000,137.75000,Optum,Medicare,,82.24,,,,,,,66.82,249.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Optum,Medicare,,1298.24,,,,,,,1054.82,3935.29,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Optum,Medicare,,1557.76,,,,,,,1265.68,4721.96,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Optum,Medicare,,1038.40,,,,,,,843.70,3147.65,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Optum,Medicare,,1298.24,,,,,,,1054.82,3935.29,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Optum,Medicare,,1557.76,,,,,,,1265.68,4721.96,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Optum,Medicare,,1038.40,,,,,,,843.70,3147.65,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,outpatient,,,1725.00000,865.95000,Optum,Medicare,,552.00,,,,,,,448.50,1673.25,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,outpatient,,,1743.00000,874.99000,Optum,Medicare,,557.76,,,,,,,453.18,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Optum,Medicare,LT,472.00,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Optum,Medicare,RT,472.00,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,outpatient,,,1162.00000,583.32000,Optum,Medicare,,371.84,,,,,,,302.12,1127.14,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Optum,Medicare,LT,314.56,,,,,,,255.58,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Optum,Medicare,RT,314.56,,,,,,,255.58,953.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,outpatient,,,3183.00000,1597.87000,Optum,Medicare,,1018.56,,,,,,,827.58,3087.51,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,outpatient,,,3819.00000,1917.14000,Optum,Medicare,,1222.08,,,,,,,992.94,3704.43,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,outpatient,,,2546.00000,1278.09000,Optum,Medicare,,814.72,,,,,,,661.96,2469.62,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Optum,Medicare,LT,1234.56,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Optum,Medicare,RT,1234.56,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Optum,Medicare,LT,1481.28,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Optum,Medicare,RT,1481.28,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Optum,Medicare,LT,987.52,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Optum,Medicare,RT,987.52,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Optum,Medicare,LT,801.60,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Optum,Medicare,RT,801.60,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Optum,Medicare,LT,961.92,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Optum,Medicare,RT,961.92,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Optum,Medicare,LT,641.28,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Optum,Medicare,RT,641.28,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Optum,Medicare,LT,1003.84,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Optum,Medicare,RT,1003.84,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Optum,Medicare,LT,1204.48,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Optum,Medicare,RT,1204.48,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Optum,Medicare,LT,802.88,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Optum,Medicare,RT,802.88,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Optum,Medicare,LT,967.36,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Optum,Medicare,RT,967.36,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Optum,Medicare,LT,1160.64,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Optum,Medicare,RT,1160.64,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Optum,Medicare,LT,773.76,,,,,,,628.68,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Optum,Medicare,RT,773.76,,,,,,,628.68,2345.46,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,outpatient,,,870.00000,436.74000,Optum,Medicare,,278.40,,,,,,,226.20,843.90,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,outpatient,,,1353.00000,679.21000,Optum,Medicare,,432.96,,,,,,,351.78,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Optum,Medicare,LT,288.64,,,,,,,234.52,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Optum,Medicare,RT,288.64,,,,,,,234.52,874.94,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3489.00000,1751.48000,Optum,Medicare,,1116.48,,,,,,,907.14,3384.33,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,outpatient,,,4187.00000,2101.87000,Optum,Medicare,,1339.84,,,,,,,1088.62,4061.39,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,outpatient,,,2791.00000,1401.08000,Optum,Medicare,,893.12,,,,,,,725.66,2707.27,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,outpatient,,,492.00000,246.98000,Optum,Medicare,,157.44,,,,,,,127.92,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,outpatient,,,331.00000,166.16000,Optum,Medicare,,105.92,,,,,,,86.06,321.07,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,outpatient,,,4440.00000,2357.64000,Optum,Medicare,,1420.80,,,,,,,1154.40,4306.80,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,outpatient,,,5328.00000,2829.17000,Optum,Medicare,,1704.96,,,,,,,1385.28,5168.16,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,outpatient,,,3552.00000,1886.11000,Optum,Medicare,,1136.64,,,,,,,923.52,3445.44,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,outpatient,,,2528.00000,1342.37000,Optum,Medicare,,808.96,,,,,,,657.28,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,outpatient,,,3033.00000,1610.52000,Optum,Medicare,,970.56,,,,,,,788.58,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,outpatient,,,2022.00000,1073.68000,Optum,Medicare,,647.04,,,,,,,525.72,1961.34,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,outpatient,,,3610.00000,1909.69000,Optum,Medicare,,1155.20,,,,,,,938.60,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,outpatient,,,4332.00000,2291.63000,Optum,Medicare,,1386.24,,,,,,,1126.32,4202.04,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,outpatient,,,2888.00000,1527.75000,Optum,Medicare,,924.16,,,,,,,750.88,2801.36,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,outpatient,,,4532.00000,2397.43000,Optum,Medicare,,1450.24,,,,,,,1178.32,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,outpatient,,,5438.00000,2876.70000,Optum,Medicare,,1740.16,,,,,,,1413.88,5274.86,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,outpatient,,,3625.00000,1917.62000,Optum,Medicare,,1160.00,,,,,,,942.50,3516.25,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,outpatient,,,3639.00000,1925.03000,Optum,Medicare,,1164.48,,,,,,,946.14,3529.83,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,outpatient,,,4367.00000,2310.14000,Optum,Medicare,,1397.44,,,,,,,1135.42,4235.99,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,outpatient,,,2911.00000,1539.92000,Optum,Medicare,,931.52,,,,,,,756.86,2823.67,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3494.00000,1719.05000,Optum,Medicare,,1118.08,,,,,,,908.44,3389.18,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,outpatient,,,4193.00000,2062.96000,Optum,Medicare,,1341.76,,,,,,,1090.18,4067.21,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,outpatient,,,2795.00000,1375.14000,Optum,Medicare,,894.40,,,,,,,726.70,2711.15,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,outpatient,,,2717.00000,1336.76000,Optum,Medicare,,869.44,,,,,,,706.42,2635.49,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,outpatient,,,3260.00000,1603.92000,Optum,Medicare,,1043.20,,,,,,,847.60,3162.20,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,outpatient,,,2173.00000,1069.12000,Optum,Medicare,,695.36,,,,,,,564.98,2107.81,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Optum,Medicare,LT,1296.32,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Optum,Medicare,RT,1296.32,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Optum,Medicare,LT,1555.52,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Optum,Medicare,RT,1555.52,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Optum,Medicare,LT,1037.12,,,,,,,842.66,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Optum,Medicare,RT,1037.12,,,,,,,842.66,3143.77,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,outpatient,,,4260.00000,2420.32000,Optum,Medicare,,1363.20,,,,,,,1107.60,4132.20,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,outpatient,,,5112.00000,2904.38000,Optum,Medicare,,1635.84,,,,,,,1329.12,4958.64,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3408.00000,1936.26000,Optum,Medicare,,1090.56,,,,,,,886.08,3305.76,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3343.00000,1899.33000,Optum,Medicare,,1069.76,,,,,,,869.18,3242.71,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,outpatient,,,4010.00000,2278.28000,Optum,Medicare,,1283.20,,,,,,,1042.60,3889.70,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,outpatient,,,2674.00000,1519.23000,Optum,Medicare,,855.68,,,,,,,695.24,2593.78,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Optum,Medicare,LT,1054.08,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Optum,Medicare,RT,1054.08,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Optum,Medicare,LT,1264.96,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Optum,Medicare,RT,1264.96,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Optum,Medicare,LT,843.20,,,,,,,685.10,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Optum,Medicare,RT,843.20,,,,,,,685.10,2555.95,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3664.00000,2081.70000,Optum,Medicare,,1172.48,,,,,,,952.64,3554.08,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,outpatient,,,4397.00000,2498.16000,Optum,Medicare,,1407.04,,,,,,,1143.22,4265.09,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,outpatient,,,2931.00000,1665.25000,Optum,Medicare,,937.92,,,,,,,762.06,2843.07,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,outpatient,,,4759.00000,2703.83000,Optum,Medicare,,1522.88,,,,,,,1237.34,4616.23,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,outpatient,,,5710.00000,3244.14000,Optum,Medicare,,1827.20,,,,,,,1484.60,5538.70,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3807.00000,2162.95000,Optum,Medicare,,1218.24,,,,,,,989.82,3692.79,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2915.00000,1574.10000,Optum,Medicare,,932.80,,,,,,,757.90,2827.55,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1918.00000,1035.72000,Optum,Medicare,,613.76,,,,,,,498.68,1860.46,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2292.00000,1237.68000,Optum,Medicare,,733.44,,,,,,,595.92,2223.24,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,outpatient,,,2984.00000,1611.36000,Optum,Medicare,,954.88,,,,,,,775.84,2894.48,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,outpatient,,,769.00000,415.26000,Optum,Medicare,,246.08,,,,,,,199.94,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,outpatient,,,1280.00000,691.20000,Optum,Medicare,,409.60,,,,,,,332.80,1241.60,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,outpatient,,,1878.00000,1014.12000,Optum,Medicare,,600.96,,,,,,,488.28,1821.66,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,outpatient,,,2196.00000,1185.84000,Optum,Medicare,,702.72,,,,,,,570.96,2130.12,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,outpatient,,,844.00000,455.76000,Optum,Medicare,,270.08,,,,,,,219.44,818.68,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,outpatient,,,1305.00000,704.70000,Optum,Medicare,,417.60,,,,,,,339.30,1265.85,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,outpatient,,,576.00000,311.04000,Optum,Medicare,,184.32,,,,,,,149.76,558.72,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,outpatient,,,809.00000,436.86000,Optum,Medicare,,258.88,,,,,,,210.34,784.73,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,outpatient,,,2462.00000,1329.48000,Optum,Medicare,,787.84,,,,,,,640.12,2388.14,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,outpatient,,,918.00000,495.72000,Optum,Medicare,,293.76,,,,,,,238.68,890.46,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,outpatient,,,1102.00000,595.08000,Optum,Medicare,,352.64,,,,,,,286.52,1068.94,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,outpatient,,,812.00000,438.48000,Optum,Medicare,,259.84,,,,,,,211.12,787.64,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,outpatient,,,1407.00000,759.78000,Optum,Medicare,,450.24,,,,,,,365.82,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,outpatient,,,1980.00000,1069.20000,Optum,Medicare,,633.60,,,,,,,514.80,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,outpatient,,,964.00000,520.56000,Optum,Medicare,,308.48,,,,,,,250.64,935.08,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,outpatient,,,1040.00000,561.60000,Optum,Medicare,,332.80,,,,,,,270.40,1008.80,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,outpatient,,,795.00000,429.30000,Optum,Medicare,,254.40,,,,,,,206.70,771.15,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,outpatient,,,1124.00000,606.96000,Optum,Medicare,,359.68,,,,,,,292.24,1090.28,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,outpatient,,,736.00000,397.44000,Optum,Medicare,,235.52,,,,,,,191.36,713.92,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,outpatient,,,700.00000,378.00000,Optum,Medicare,,224.00,,,,,,,182.00,679.00,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,outpatient,,,821.00000,443.34000,Optum,Medicare,,262.72,,,,,,,213.46,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,outpatient,,,846.00000,456.84000,Optum,Medicare,,270.72,,,,,,,219.96,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,outpatient,,,958.00000,517.32000,Optum,Medicare,,306.56,,,,,,,249.08,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,outpatient,,,1261.00000,680.94000,Optum,Medicare,,403.52,,,,,,,327.86,1223.17,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,outpatient,,,971.00000,524.34000,Optum,Medicare,,310.72,,,,,,,252.46,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,outpatient,,,1837.00000,991.98000,Optum,Medicare,,587.84,,,,,,,477.62,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,outpatient,,,1099.00000,593.46000,Optum,Medicare,,351.68,,,,,,,285.74,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,outpatient,,,2178.00000,1176.12000,Optum,Medicare,,696.96,,,,,,,566.28,2112.66,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,outpatient,,,1226.00000,662.04000,Optum,Medicare,,392.32,,,,,,,318.76,1189.22,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,outpatient,,,1048.00000,565.92000,Optum,Medicare,,335.36,,,,,,,272.48,1016.56,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,outpatient,,,970.00000,523.80000,Optum,Medicare,,310.40,,,,,,,252.20,940.90,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,outpatient,,,1803.00000,973.62000,Optum,Medicare,,576.96,,,,,,,468.78,1748.91,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,outpatient,,,2504.00000,1352.16000,Optum,Medicare,,801.28,,,,,,,651.04,2428.88,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2457.00000,1326.78000,Optum,Medicare,,786.24,,,,,,,638.82,2383.29,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,outpatient,,,923.00000,498.42000,Optum,Medicare,,295.36,,,,,,,239.98,895.31,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,outpatient,,,5478.00000,2958.12000,Optum,Medicare,,1752.96,,,,,,,1424.28,5313.66,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,outpatient,,,4551.00000,2457.54000,Optum,Medicare,,1456.32,,,,,,,1183.26,4414.47,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,outpatient,,,1360.00000,734.40000,Optum,Medicare,,435.20,,,,,,,353.60,1319.20,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,outpatient,,,1209.00000,652.86000,Optum,Medicare,,386.88,,,,,,,314.34,1172.73,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,outpatient,,,848.00000,457.92000,Optum,Medicare,,271.36,,,,,,,220.48,822.56,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,outpatient,,,1071.00000,578.34000,Optum,Medicare,,342.72,,,,,,,278.46,1038.87,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,outpatient,,,1792.00000,967.68000,Optum,Medicare,,573.44,,,,,,,465.92,1738.24,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,outpatient,,,35.00000,18.90000,Optum,Medicare,,11.20,,,,,,,9.10,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,outpatient,,,285.00000,153.90000,Optum,Medicare,,91.20,,,,,,,74.10,276.45,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,outpatient,,,1012.00000,546.48000,Optum,Medicare,,323.84,,,,,,,263.12,981.64,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,outpatient,,,492.00000,265.68000,Optum,Medicare,,157.44,,,,,,,127.92,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,outpatient,,,739.00000,399.06000,Optum,Medicare,,236.48,,,,,,,192.14,716.83,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,outpatient,,,515.00000,278.10000,Optum,Medicare,,164.80,,,,,,,133.90,499.55,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,outpatient,,,1467.00000,792.18000,Optum,Medicare,,469.44,,,,,,,381.42,1422.99,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,outpatient,,,1683.00000,888.62000,Optum,Medicare,,538.56,,,,,,,437.58,1632.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,426.30000,225.09000,Optum,Medicare,,136.42,,,,,,,110.84,413.51,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,725.00000,382.80000,Optum,Medicare,,232.00,,,,,,,188.50,1855.42,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,1852.00000,977.86000,Optum,Medicare,,592.64,,,,,,,481.52,1868.26,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,110.00000,58.08000,Optum,Medicare,,35.20,,,,,,,28.60,106.70,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,98.00000,51.74000,Optum,Medicare,,31.36,,,,,,,25.48,1662.92,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,2018.00000,1065.50000,Optum,Medicare,,645.76,,,,,,,524.68,1957.46,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,4325.00000,2283.60000,Optum,Medicare,,1384.00,,,,,,,1124.50,4195.25,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Optum,Medicare,,55.04,,,,,,,44.72,166.84,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,942.00000,497.38000,Optum,Medicare,,301.44,,,,,,,244.92,913.74,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,413.00000,218.06000,Optum,Medicare,,132.16,,,,,,,107.38,400.61,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,outpatient,,,257.00000,135.70000,Optum,Medicare,,82.24,,,,,,,66.82,249.29,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,116.00000,61.25000,Optum,Medicare,,37.12,,,,,,,30.16,112.52,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,463.20000,244.57000,Optum,Medicare,,148.22,,,,,,,120.43,449.30,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,804.00000,424.51000,Optum,Medicare,,257.28,,,,,,,209.04,779.88,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Optum,Medicare,,55.04,,,,,,,44.72,166.84,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,354.30000,187.07000,Optum,Medicare,,113.38,,,,,,,92.12,343.67,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,277.90000,146.73000,Optum,Medicare,,88.93,,,,,,,72.25,269.56,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,200.00000,105.60000,Optum,Medicare,,64.00,,,,,,,52.00,194.00,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,outpatient,,,197.00000,63.63000,Optum,Medicare,,63.04,,,,,,,51.22,191.09,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,outpatient,,,468.00000,151.16000,Optum,Medicare,50,149.76,,,,,,,121.68,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Optum,Medicare,LT,99.84,,,,,,,81.12,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Optum,Medicare,RT,99.84,,,,,,,81.12,302.64,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Optum,Medicare,,144.96,,,,,,,117.78,439.41,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Optum,Medicare,,194.88,,,,,,,158.34,590.73,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1248.00000,403.10000,Optum,Medicare,50,399.36,,,,,,,324.48,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Optum,Medicare,LT,266.24,,,,,,,216.32,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Optum,Medicare,RT,266.24,,,,,,,216.32,807.04,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Optum,Medicare,LT,1355.20,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Optum,Medicare,RT,1355.20,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,outpatient,,,2119.00000,684.44000,Optum,Medicare,,678.08,,,,,,,550.94,2055.43,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1943.00000,627.59000,Optum,Medicare,,621.76,,,,,,,505.18,1884.71,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,outpatient,,,1426.00000,460.60000,Optum,Medicare,,456.32,,,,,,,370.76,1383.22,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,outpatient,,,4202.00000,1357.25000,Optum,Medicare,50,1344.64,,,,,,,1092.52,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Optum,Medicare,LT,896.32,,,,,,,728.26,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Optum,Medicare,RT,896.32,,,,,,,728.26,2716.97,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,outpatient,,,832.00000,268.74000,Optum,Medicare,,266.24,,,,,,,216.32,807.04,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,outpatient,,,1457.00000,470.61000,Optum,Medicare,,466.24,,,,,,,378.82,1413.29,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Optum,Medicare,LT,237.76,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Optum,Medicare,RT,237.76,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,outpatient,,,232.00000,74.94000,Optum,Medicare,,74.24,,,,,,,60.32,225.04,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,outpatient,,,1364.00000,440.57000,Optum,Medicare,50,436.48,,,,,,,354.64,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Optum,Medicare,LT,290.88,,,,,,,236.34,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Optum,Medicare,RT,290.88,,,,,,,236.34,881.73,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,outpatient,,,510.00000,355.98000,Optum,Medicare,,163.20,,,,,,,132.60,494.70,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,outpatient,,,1001.00000,698.70000,Optum,Medicare,,320.32,,,,,,,260.26,970.97,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,outpatient,,,887.00000,619.13000,Optum,Medicare,,283.84,,,,,,,230.62,860.39,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,outpatient,,,1022.00000,713.36000,Optum,Medicare,50,327.04,,,,,,,265.72,991.34,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Optum,Medicare,LT,217.92,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Optum,Medicare,RT,217.92,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,outpatient,,,945.00000,659.61000,Optum,Medicare,50,302.40,,,,,,,245.70,916.65,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Optum,Medicare,LT,201.60,,,,,,,163.80,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Optum,Medicare,RT,201.60,,,,,,,163.80,611.10,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,outpatient,,,577.00000,402.75000,Optum,Medicare,,184.64,,,,,,,150.02,559.69,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,outpatient,,,433.00000,302.23000,Optum,Medicare,,138.56,,,,,,,112.58,420.01,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,outpatient,,,331.00000,231.04000,Optum,Medicare,,105.92,,,,,,,86.06,321.07,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,outpatient,,,662.00000,462.08000,Optum,Medicare,,211.84,,,,,,,172.12,642.14,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,outpatient,,,752.00000,524.90000,Optum,Medicare,,240.64,,,,,,,195.52,729.44,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Optum,Medicare,,58.24,,,,,,,47.32,176.54,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,outpatient,,,420.00000,293.16000,Optum,Medicare,,134.40,,,,,,,109.20,407.40,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,outpatient,,,253.00000,176.59000,Optum,Medicare,,80.96,,,,,,,65.78,245.41,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,outpatient,,,168.00000,117.26000,Optum,Medicare,,53.76,,,,,,,43.68,162.96,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,outpatient,,,695.00000,485.11000,Optum,Medicare,,222.40,,,,,,,180.70,674.15,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,outpatient,,,474.00000,330.85000,Optum,Medicare,,151.68,,,,,,,123.24,459.78,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,outpatient,,,930.00000,649.14000,Optum,Medicare,,297.60,,,,,,,241.80,902.10,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,outpatient,,,786.00000,548.63000,Optum,Medicare,,251.52,,,,,,,204.36,762.42,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Optum,Medicare,,198.40,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Optum,Medicare,59,198.40,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Optum,Medicare,,139.20,,,,,,,113.10,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Optum,Medicare,59,139.20,,,,,,,113.10,421.95,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,outpatient,,,492.00000,343.42000,Optum,Medicare,,157.44,,,,,,,127.92,477.24,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,outpatient,,,331.00000,231.04000,Optum,Medicare,,105.92,,,,,,,86.06,321.07,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,outpatient,,,875.00000,610.75000,Optum,Medicare,,280.00,,,,,,,227.50,848.75,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,outpatient,,,688.00000,480.22000,Optum,Medicare,,220.16,,,,,,,178.88,667.36,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,outpatient,,,465.00000,324.57000,Optum,Medicare,,148.80,,,,,,,120.90,451.05,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,outpatient,,,846.00000,590.51000,Optum,Medicare,,270.72,,,,,,,219.96,820.62,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,outpatient,,,482.00000,336.44000,Optum,Medicare,,154.24,,,,,,,125.32,467.54,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,outpatient,,,926.00000,646.35000,Optum,Medicare,,296.32,,,,,,,240.76,898.22,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,outpatient,,,292.00000,203.82000,Optum,Medicare,,93.44,,,,,,,75.92,283.24,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,outpatient,,,827.00000,577.25000,Optum,Medicare,,264.64,,,,,,,215.02,802.19,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,outpatient,,,253.00000,176.59000,Optum,Medicare,,80.96,,,,,,,65.78,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,outpatient,,,901.00000,628.90000,Optum,Medicare,,288.32,,,,,,,234.26,873.97,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,outpatient,,,460.00000,321.08000,Optum,Medicare,,147.20,,,,,,,119.60,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1029.00000,718.24000,Optum,Medicare,,329.28,,,,,,,267.54,998.13,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,outpatient,,,959.00000,669.38000,Optum,Medicare,,306.88,,,,,,,249.34,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,outpatient,,,558.00000,389.48000,Optum,Medicare,,178.56,,,,,,,145.08,541.26,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,outpatient,,,705.00000,492.09000,Optum,Medicare,,225.60,,,,,,,183.30,683.85,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,outpatient,,,249.00000,173.80000,Optum,Medicare,,79.68,,,,,,,64.74,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,outpatient,,,427.00000,298.05000,Optum,Medicare,,136.64,,,,,,,111.02,414.19,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Optum,Medicare,,235.84,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Optum,Medicare,59,235.84,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,outpatient,,,809.00000,564.68000,Optum,Medicare,,258.88,,,,,,,210.34,784.73,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,outpatient,,,525.00000,366.45000,Optum,Medicare,,168.00,,,,,,,136.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,outpatient,,,319.00000,222.66000,Optum,Medicare,,102.08,,,,,,,82.94,309.43,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1437.00000,678.26000,Optum,Medicare,,459.84,,,,,,,373.62,1393.89,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2143.00000,1011.50000,Optum,Medicare,,685.76,,,,,,,557.18,2078.71,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,outpatient,,,755.00000,356.36000,Optum,Medicare,,241.60,,,,,,,196.30,732.35,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,outpatient,,,979.00000,462.09000,Optum,Medicare,,313.28,,,,,,,254.54,949.63,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,outpatient,,,436.00000,205.79000,Optum,Medicare,,139.52,,,,,,,113.36,422.92,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,outpatient,,,220.00000,103.84000,Optum,Medicare,,70.40,,,,,,,57.20,213.40,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,outpatient,,,344.00000,162.37000,Optum,Medicare,,110.08,,,,,,,89.44,333.68,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,outpatient,,,818.00000,393.46000,Optum,Medicare,,261.76,,,,,,,212.68,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,outpatient,,,545.00000,262.14000,Optum,Medicare,52,174.40,,,,,,,141.70,528.65,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,outpatient,,,1347.00000,647.91000,Optum,Medicare,,431.04,,,,,,,350.22,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,outpatient,,,898.00000,431.94000,Optum,Medicare,52,287.36,,,,,,,233.48,871.06,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,outpatient,,,469.00000,225.59000,Optum,Medicare,,150.08,,,,,,,121.94,454.93,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,outpatient,,,1762.00000,847.52000,Optum,Medicare,,563.84,,,,,,,458.12,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,outpatient,,,627.00000,301.59000,Optum,Medicare,,200.64,,,,,,,163.02,608.19,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,outpatient,,,590.00000,283.79000,Optum,Medicare,,188.80,,,,,,,153.40,572.30,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,outpatient,,,1550.00000,745.55000,Optum,Medicare,,496.00,,,,,,,403.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Optum,Medicare,LT,316.80,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Optum,Medicare,RT,316.80,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,outpatient,,,1402.00000,674.36000,Optum,Medicare,,448.64,,,,,,,364.52,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Optum,Medicare,LT,313.60,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Optum,Medicare,RT,313.60,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,outpatient,,,1661.00000,798.94000,Optum,Medicare,,531.52,,,,,,,431.86,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,outpatient,,,980.00000,471.38000,Optum,Medicare,,313.60,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1740.00000,836.94000,Optum,Medicare,,556.80,,,,,,,452.40,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1168.00000,561.81000,Optum,Medicare,,373.76,,,,,,,303.68,1132.96,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,outpatient,,,433.00000,232.09000,Optum,Medicare,,138.56,,,,,,,112.58,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Optum,Medicare,LT,124.16,,,,,,,100.88,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Optum,Medicare,RT,124.16,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,outpatient,,,388.00000,207.97000,Optum,Medicare,,124.16,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,outpatient,,,604.00000,323.74000,Optum,Medicare,,193.28,,,,,,,157.04,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,outpatient,,,667.00000,357.51000,Optum,Medicare,,213.44,,,,,,,173.42,646.99,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,outpatient,,,176.00000,94.34000,Optum,Medicare,,56.32,,,,,,,45.76,170.72,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Optum,Medicare,LT,29.44,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Optum,Medicare,RT,29.44,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Optum,Medicare,LT,117.12,,,,,,,95.16,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Optum,Medicare,RT,117.12,,,,,,,95.16,355.02,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Optum,Medicare,LT,357.44,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Optum,Medicare,RT,357.44,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,outpatient,,,559.00000,180.56000,Optum,Medicare,,178.88,,,,,,,145.34,542.23,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,outpatient,,,252.00000,81.40000,Optum,Medicare,50,80.64,,,,,,,65.52,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Optum,Medicare,LT,53.76,,,,,,,43.68,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Optum,Medicare,RT,53.76,,,,,,,43.68,162.96,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Optum,Medicare,LT,367.36,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Optum,Medicare,RT,367.36,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,outpatient,,,379.00000,122.42000,Optum,Medicare,,121.28,,,,,,,98.54,367.63,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,outpatient,,,1015.00000,327.84000,Optum,Medicare,,324.80,,,,,,,263.90,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,outpatient,,,591.00000,190.89000,Optum,Medicare,,189.12,,,,,,,153.66,573.27,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,outpatient,,,271.00000,169.92000,Optum,Medicare,,86.72,,,,,,,70.46,262.87,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Optum,Medicare,LT,67.52,,,,,,,54.86,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Optum,Medicare,RT,67.52,,,,,,,54.86,204.67,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,59.00000,36.99000,Optum,Medicare,,18.88,,,,,,,15.34,57.23,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,outpatient,,,336.00000,219.74000,Optum,Medicare,,107.52,,,,,,,87.36,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,outpatient,,,224.00000,146.50000,Optum,Medicare,52,71.68,,,,,,,58.24,217.28,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,outpatient,,,63.00000,41.20000,Optum,Medicare,,20.16,,,,,,,16.38,61.11,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Optum,Medicare,,161.28,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Optum,Medicare,,31.36,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Optum,Medicare,,194.56,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Optum,Medicare,,36.48,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Optum,Medicare,,59.84,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Optum,Medicare,,68.48,,,,,,,55.64,207.58,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Optum,Medicare,,194.88,,,,,,,158.34,590.73,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Optum,Medicare,,276.16,,,,,,,224.38,837.11,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,outpatient,,,900.00000,605.70000,Optum,Medicare,,288.00,,,,,,,234.00,873.00,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,outpatient,,,1940.00000,1102.21000,Optum,Medicare,,620.80,,,,,,,504.40,1881.80,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,outpatient,,,422.00000,239.76000,Optum,Medicare,,135.04,,,,,,,109.72,409.34,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,outpatient,,,1430.00000,812.45000,Optum,Medicare,,457.60,,,,,,,371.80,1387.10,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,outpatient,,,745.00000,423.27000,Optum,Medicare,,238.40,,,,,,,193.70,722.65,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,outpatient,,,2655.00000,2487.74000,Optum,Medicare,,849.60,,,,,,,690.30,2575.35,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,outpatient,,,3990.00000,3738.63000,Optum,Medicare,,1276.80,,,,,,,1037.40,3870.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,outpatient,,,290.00000,271.73000,Optum,Medicare,,92.80,,,,,,,75.40,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,outpatient,,,735.00000,688.70000,Optum,Medicare,,235.20,,,,,,,191.10,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Optum,Medicare,,472.00,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,outpatient,,,2275.00000,2131.68000,Optum,Medicare,,728.00,,,,,,,591.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,outpatient,,,3205.00000,3003.08000,Optum,Medicare,,1025.60,,,,,,,833.30,3108.85,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,outpatient,,,770.00000,721.49000,Optum,Medicare,,246.40,,,,,,,200.20,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Optum,Medicare,,472.00,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,outpatient,,,2210.00000,2070.77000,Optum,Medicare,,707.20,,,,,,,574.60,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,outpatient,,,2660.00000,2492.42000,Optum,Medicare,,851.20,,,,,,,691.60,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,outpatient,,,3560.00000,3335.72000,Optum,Medicare,,1139.20,,,,,,,925.60,3453.20,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,outpatient,,,5730.00000,3255.50000,Optum,Medicare,,1833.60,,,,,,,1489.80,5558.10,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,outpatient,,,3875.00000,2201.58000,Optum,Medicare,,1240.00,,,,,,,1007.50,3758.75,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,outpatient,,,519.00000,564.15000,Optum,Medicare,,166.08,,,,,,,134.94,503.43,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,outpatient,,,536.00000,582.63000,Optum,Medicare,,171.52,,,,,,,139.36,519.92,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Optum,Medicare,,144.96,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Optum,Medicare,,46.08,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Optum,Medicare,,34.24,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Optum,Medicare,,46.08,,,,,,,37.44,139.68,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Optum,Medicare,,161.28,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Optum,Medicare,,31.36,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Optum,Medicare,,194.56,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Optum,Medicare,,36.48,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Optum,Medicare,,59.84,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Optum,Medicare,,68.48,,,,,,,55.64,207.58,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,outpatient,,,175.00000,63.18000,Optum,Medicare,,56.00,,,,,,,45.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,outpatient,,,304.00000,109.74000,Optum,Medicare,,97.28,,,,,,,79.04,294.88,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Optum,Medicare,,90.88,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Optum,Medicare,,146.56,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,outpatient,,,438.00000,158.12000,Optum,Medicare,,140.16,,,,,,,113.88,424.86,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Optum,Medicare,,178.56,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Optum,Medicare,,154.24,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Optum,Medicare,,75.84,,,,,,,61.62,229.89,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Optum,Medicare,,161.28,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Optum,Medicare,,161.28,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Optum,Medicare,,161.28,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Optum,Medicare,,161.28,,,,,,,131.04,488.88,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Optum,Medicare,,269.44,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Optum,Medicare,,336.96,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Optum,Medicare,,404.16,,,,,,,328.38,1225.11,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Optum,Medicare,,58.24,,,,,,,47.32,176.54,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Optum,Medicare,,67.20,,,,,,,54.60,203.70,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,outpatient,,,140.00000,79.54000,Optum,Medicare,,44.80,,,,,,,36.40,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,outpatient,,,190.00000,107.95000,Optum,Medicare,,60.80,,,,,,,49.40,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,outpatient,,,240.00000,136.36000,Optum,Medicare,,76.80,,,,,,,62.40,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,outpatient,,,290.00000,164.76000,Optum,Medicare,,92.80,,,,,,,75.40,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,outpatient,,,340.00000,193.17000,Optum,Medicare,,108.80,,,,,,,88.40,329.80,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,outpatient,,,150.00000,85.22000,Optum,Medicare,,48.00,,,,,,,39.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,outpatient,,,200.00000,113.63000,Optum,Medicare,,64.00,,,,,,,52.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,outpatient,,,270.00000,153.40000,Optum,Medicare,,86.40,,,,,,,70.20,261.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,outpatient,,,370.00000,210.22000,Optum,Medicare,,118.40,,,,,,,96.20,358.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,outpatient,,,470.00000,267.03000,Optum,Medicare,,150.40,,,,,,,122.20,455.90,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,outpatient,,,248.00000,96.22000,Optum,Medicare,,79.36,,,,,,,64.48,240.56,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,outpatient,,,245.00000,95.06000,Optum,Medicare,,78.40,,,,,,,63.70,237.65,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,outpatient,,,497.00000,192.84000,Optum,Medicare,,159.04,,,,,,,129.22,482.09,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,outpatient,,,357.00000,138.52000,Optum,Medicare,,114.24,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,outpatient,,,334.00000,129.59000,Optum,Medicare,,106.88,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,outpatient,,,194.00000,75.27000,Optum,Medicare,,62.08,,,,,,,50.44,188.18,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,outpatient,,,1035.00000,401.58000,Optum,Medicare,,331.20,,,,,,,269.10,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,outpatient,,,1137.00000,441.16000,Optum,Medicare,,363.84,,,,,,,295.62,1102.89,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,outpatient,,,963.00000,373.64000,Optum,Medicare,,308.16,,,,,,,250.38,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,outpatient,,,990.00000,384.12000,Optum,Medicare,,316.80,,,,,,,257.40,960.30,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,outpatient,,,112.00000,43.46000,Optum,Medicare,,35.84,,,,,,,29.12,108.64,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,outpatient,,,84.00000,32.59000,Optum,Medicare,,26.88,,,,,,,21.84,81.48,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,outpatient,,,176.00000,68.29000,Optum,Medicare,,56.32,,,,,,,45.76,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,outpatient,,,283.00000,109.80000,Optum,Medicare,,90.56,,,,,,,73.58,274.51,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Optum,Medicare,,25.92,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Optum,Medicare,,13.12,,,,,,,10.66,39.77,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,35.00000,19.89000,Optum,Medicare,,11.20,,,,,,,9.10,33.95,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,outpatient,,,191.00000,89.39000,Optum,Medicare,,61.12,,,,,,,49.66,185.27,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Optum,Medicare,,144.96,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Optum,Medicare,,46.08,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Optum,Medicare,,34.24,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Optum,Medicare,,46.08,,,,,,,37.44,139.68,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,outpatient,,,281.00000,131.51000,Optum,Medicare,,89.92,,,,,,,73.06,272.57,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,outpatient,,,192.00000,89.86000,Optum,Medicare,,61.44,,,,,,,49.92,186.24,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,outpatient,,,365.00000,170.82000,Optum,Medicare,,116.80,,,,,,,94.90,354.05,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,outpatient,,,8391.00000,5856.92000,Optum,Medicare,,2685.12,,,,,,,2181.66,8139.27,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Optum,Medicare,52,2213.44,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Optum,Medicare,,1920.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Optum,Medicare,,2213.44,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Optum,Medicare,52,1920.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,outpatient,,,8855.00000,9625.38000,Optum,Medicare,,2833.60,,,,,,,2302.30,8589.35,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Optum,Medicare,,270.08,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Optum,Medicare,52,270.08,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Optum,Medicare,,251.20,,,,,,,204.10,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Optum,Medicare,52,251.20,,,,,,,204.10,761.45,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Optum,Medicare,,1506.88,,,,,,,1224.34,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Optum,Medicare,52,1506.88,,,,,,,1224.34,4567.73,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,outpatient,,,345.00000,128.34000,Optum,Medicare,,110.40,,,,,,,89.70,334.65,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,outpatient,,,120.00000,99.60000,Optum,Medicare,,38.40,,,,,,,31.20,116.40,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,outpatient,,,106.00000,87.98000,Optum,Medicare,,33.92,,,,,,,27.56,102.82,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,outpatient,,,32.00000,26.56000,Optum,Medicare,,10.24,,,,,,,8.32,31.04,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,outpatient,,,60.00000,49.80000,Optum,Medicare,,19.20,,,,,,,15.60,58.20,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,outpatient,,,57.00000,47.31000,Optum,Medicare,,18.24,,,,,,,14.82,55.29,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,outpatient,1.0,ME,7.40000,0.65000,Optum,Medicare,,2.37,,,,,,,1.92,7.18,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,outpatient,1.0,EA,6.60000,1.43000,Optum,Medicare,UD,2.11,,,,,,,1.72,6.40,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,outpatient,1.0,EA,2.95000,0.64000,Optum,Medicare,UD,0.94400,,,,,,,0.76700,2.86,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,56.08000,12.11000,Optum,Medicare,UD,17.95,,,,,,,14.58,54.40,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,outpatient,1.0,UN,82.10000,28.90000,Optum,Medicare,,26.27,,,,,,,15.48,79.64,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.04000,,Optum,Medicare,UD,0.01280,,,,,,,0.01040,0.03880,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.05000,,Optum,Medicare,UD,0.01600,,,,,,,0.01300,0.04850,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,outpatient,1.0,ME,6.20000,0.55000,Optum,Medicare,,1.98,,,,,,,1.61,6.01,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.12000,0.01000,Optum,Medicare,UD,0.03840,,,,,,,0.03120,0.11640,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,outpatient,2.0,ML,5.80000,1.25000,Optum,Medicare,,1.86,,,,,,,1.51,5.63,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,outpatient,1.0,ME,3.10000,0.27000,Optum,Medicare,,0.99200,,,,,,,0.80600,3.01,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,outpatient,1.0,EA,44.40000,3.91000,Optum,Medicare,,14.21,,,,,,,11.54,43.07,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,8.26000,0.73000,Optum,Medicare,UD,2.64,,,,,,,2.15,8.01,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,2.19000,0.19000,Optum,Medicare,UD,0.70080,,,,,,,0.56940,2.12,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,outpatient,1.0,EA,28.60000,2.52000,Optum,Medicare,,9.15,,,,,,,7.44,27.74,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,outpatient,1.0,EA,2.58000,0.91000,Optum,Medicare,UD,0.82560,,,,,,,0.67080,2.50,percent of total billed charges,
R&B OBSTETRICS PVT,3012,CDM,112,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2697.57,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,23010,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2697.57,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ICU,33019,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8498.17,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,13011,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5665.77,,,,,,,2512.00,5665.77,percent of total billed charges,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,244.00000,77.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,236.68,,,,,,,219.60,236.68,percent of total billed charges,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,244.00000,77.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,236.68,,,,,,,63.44,236.68,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,24075,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2697.57,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B OBSTETRICS SEMI-PVT,44073,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2697.57,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B NURSERY LEVEL 1,55160,CDM,171,RC,,,,,facility,inpatient,,,3477.00000,1975.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3372.69,,,,,,,2512.00,3372.69,percent of total billed charges,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,inpatient,,,16.00000,7.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,15.52,,,,,,,14.40,15.52,percent of total billed charges,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,outpatient,,,16.00000,7.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,15.52,,,,,,,4.16,15.52,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,inpatient,,,210.00000,119.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,203.70,,,,,,,189.00,203.70,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,203.70,,,,,,,54.60,203.70,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,inpatient,,,380.00000,215.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,368.60,,,,,,,342.00,368.60,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,outpatient,,,380.00000,215.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,368.60,,,,,,,98.80,368.60,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,112.52,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,112.52,,,,,,,30.16,112.52,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22012,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2697.57,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ADMIN DAY SKILLED,82016,CDM,160,RC,,,,,facility,inpatient,,,1923.00000,1092.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1865.31,,,,,,,1730.70,3111.10,percent of total billed charges,
R&B SWING BED SKILLED,62018,CDM,160,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2697.57,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ADMIN DAY INTERMEDIATE,72017,CDM,169,RC,,,,,facility,inpatient,,,1176.00000,668.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1140.72,,,,,,,1058.40,3111.10,percent of total billed charges,
R&B ICU,32011,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8498.17,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,12013,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5665.77,,,,,,,2512.00,5665.77,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,112.52,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,112.52,,,,,,,30.16,112.52,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,488.88,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,488.88,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,589.76,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,589.76,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,207.58,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,207.58,,,,,,,55.64,207.58,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,84.00000,63.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,81.48,,,,,,,75.60,81.48,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,81.48,,,,,,,21.84,81.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,275.48,,,,,,,255.60,275.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,275.48,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,444.26,,,,,,,412.20,444.26,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,444.26,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,541.26,,,,,,,502.20,541.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,541.26,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,467.54,,,,,,,433.80,467.54,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,467.54,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,229.89,,,,,,,213.30,229.89,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,229.89,,,,,,,61.62,229.89,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,inpatient,,,2041.00000,659.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1979.77,,,,,,,1836.90,1979.77,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,outpatient,,,2041.00000,659.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1979.77,,,,,,,530.66,1979.77,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,inpatient,,,259.00000,83.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,251.23,,,,,,,233.10,251.23,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,outpatient,,,259.00000,83.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,251.23,,,,,,,67.34,251.23,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,inpatient,,,672.00000,217.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,651.84,,,,,,,604.80,651.84,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,outpatient,,,672.00000,217.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,651.84,,,,,,,174.72,651.84,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,inpatient,,,530.00000,171.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,514.10,,,,,,,477.00,514.10,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,outpatient,,,530.00000,171.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,514.10,,,,,,,137.80,514.10,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,inpatient,,,580.00000,187.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,562.60,,,,,,,522.00,562.60,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,outpatient,,,580.00000,187.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,562.60,,,,,,,150.80,562.60,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,inpatient,,,435.00000,140.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,421.95,,,,,,,391.50,421.95,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,outpatient,,,435.00000,140.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,421.95,,,,,,,113.10,421.95,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,inpatient,,,863.00000,278.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,837.11,,,,,,,776.70,837.11,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,837.11,,,,,,,224.38,837.11,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,inpatient,,,334.00000,107.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,323.98,,,,,,,300.60,323.98,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,outpatient,,,334.00000,107.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,323.98,,,,,,,86.84,323.98,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,inpatient,,,1188.00000,383.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,1152.36,,,,,,,1069.20,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,outpatient,,,1188.00000,383.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,1152.36,,,,,,,308.88,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,inpatient,,,792.00000,255.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,768.24,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,768.24,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,inpatient,,,792.00000,255.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,768.24,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,768.24,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,inpatient,,,572.00000,184.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,554.84,,,,,,,514.80,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,outpatient,,,572.00000,184.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,554.84,,,,,,,148.72,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,inpatient,,,381.00000,123.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,369.57,,,,,,,342.90,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,369.57,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,inpatient,,,381.00000,123.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,369.57,,,,,,,342.90,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,369.57,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,inpatient,,,455.00000,146.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,441.35,,,,,,,409.50,441.35,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,outpatient,,,455.00000,146.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,441.35,,,,,,,118.30,441.35,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,inpatient,,,403.00000,130.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,390.91,,,,,,,362.70,390.91,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,outpatient,,,403.00000,130.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,390.91,,,,,,,104.78,390.91,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,inpatient,,,370.00000,119.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,358.90,,,,,,,333.00,358.90,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,outpatient,,,370.00000,119.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,358.90,,,,,,,96.20,358.90,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,inpatient,,,357.00000,115.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,346.29,,,,,,,321.30,346.29,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,outpatient,,,357.00000,115.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,346.29,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,inpatient,,,334.00000,107.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,323.98,,,,,,,300.60,323.98,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,outpatient,,,334.00000,107.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,323.98,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,inpatient,,,194.00000,62.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,188.18,,,,,,,174.60,188.18,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,outpatient,,,194.00000,62.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,188.18,,,,,,,50.44,188.18,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,inpatient,,,457.00000,147.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,443.29,,,,,,,411.30,443.29,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,outpatient,,,457.00000,147.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,443.29,,,,,,,118.82,443.29,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,inpatient,,,492.00000,158.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,477.24,,,,,,,442.80,477.24,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,outpatient,,,492.00000,158.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,477.24,,,,,,,127.92,477.24,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,inpatient,,,780.00000,251.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,756.60,,,,,,,702.00,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,outpatient,,,780.00000,251.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,756.60,,,,,,,202.80,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,inpatient,,,1165.00000,376.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1130.05,,,,,,,1048.50,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,outpatient,,,1165.00000,376.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1130.05,,,,,,,302.90,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,inpatient,,,2350.00000,759.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2279.50,,,,,,,2115.00,2279.50,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,outpatient,,,2350.00000,759.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2279.50,,,,,,,611.00,2279.50,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,inpatient,,,896.00000,289.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,869.12,,,,,,,806.40,869.12,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,outpatient,,,896.00000,289.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,869.12,,,,,,,232.96,869.12,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,inpatient,,,490.00000,158.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,475.30,,,,,,,441.00,475.30,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,outpatient,,,490.00000,158.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,475.30,,,,,,,127.40,475.30,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,inpatient,,,520.00000,167.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,504.40,,,,,,,468.00,504.40,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,outpatient,,,520.00000,167.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,504.40,,,,,,,135.20,504.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,inpatient,,,720.00000,232.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,698.40,,,,,,,648.00,698.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,outpatient,,,720.00000,232.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,698.40,,,,,,,187.20,698.40,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,inpatient,,,215.00000,69.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,208.55,,,,,,,193.50,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,outpatient,,,215.00000,69.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,208.55,,,,,,,55.90,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,inpatient,,,240.00000,77.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,232.80,,,,,,,216.00,232.80,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,outpatient,,,240.00000,77.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,232.80,,,,,,,62.40,232.80,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,inpatient,,,1241.00000,400.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1203.77,,,,,,,1116.90,1203.77,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,outpatient,,,1241.00000,400.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1203.77,,,,,,,322.66,1203.77,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,816.74,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,816.74,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1021.41,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1021.41,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1225.11,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1225.11,,,,,,,328.38,1225.11,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,inpatient,,,668.00000,559.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,647.96,,,,,,,601.20,647.96,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,outpatient,,,668.00000,559.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,647.96,,,,,,,173.68,647.96,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,72.90,78.57,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,39.77,,,,,,,36.90,39.77,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,39.77,,,,,,,10.66,39.77,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,439.41,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,439.41,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,139.68,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,139.68,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,103.79,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,103.79,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,139.68,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,139.68,,,,,,,37.44,139.68,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3.30,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3.30,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3.30,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3.30,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3.30,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3.30,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,4.90000,2.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4.75,,,,,,,4.41,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4.75,,,,,,,1.27,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,7.90000,4.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7.66,,,,,,,7.11,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,7.90000,4.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7.66,,,,,,,2.05,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,4.90000,2.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4.75,,,,,,,4.41,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4.75,,,,,,,1.27,4.75,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,inpatient,,,81.00000,44.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,81.00000,44.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,21.06,78.57,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,inpatient,,,3141500.00000,1784843.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3047255.00,,,,,,,2827350.00,3047255.00,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,outpatient,,,3141500.00000,1784843.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3047255.00,,,,,,,816790.00,3047255.00,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,0.21340,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,0.21340,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.52000,0.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,0.50440,,,,,,,0.46800,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.52000,0.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,0.50440,,,,,,,0.13520,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.56000,0.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,0.54320,,,,,,,0.50400,0.54320,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.56000,0.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,0.54320,,,,,,,0.14560,0.54320,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,0.21340,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,0.21340,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.85000,0.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,0.82450,,,,,,,0.76500,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.85000,0.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,0.82450,,,,,,,0.22100,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.22000,0.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,0.21340,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,0.21340,,,,,,,0.05720,0.21340,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,inpatient,,,102.00000,65.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,91.80,98.94,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,outpatient,,,102.00000,65.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,26.52,98.94,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,inpatient,,,190.00000,121.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,184.30,,,,,,,171.00,184.30,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,outpatient,,,190.00000,121.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,184.30,,,,,,,49.40,184.30,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,inpatient,,,359.00000,229.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,323.10,348.23,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,93.34,348.23,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,inpatient,,,535.00000,341.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,518.95,,,,,,,481.50,518.95,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,518.95,,,,,,,139.10,518.95,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,inpatient,,,766.00000,489.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,743.02,,,,,,,689.40,743.02,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,outpatient,,,766.00000,489.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,743.02,,,,,,,199.16,743.02,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,inpatient,,,159.00000,101.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,154.23,,,,,,,143.10,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,outpatient,,,159.00000,101.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,154.23,,,,,,,41.34,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,inpatient,,,447.00000,285.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,402.30,433.59,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,outpatient,,,447.00000,285.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,116.22,433.59,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,inpatient,,,1413.00000,902.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,outpatient,,,1413.00000,902.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,inpatient,,,3853.00000,2462.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,outpatient,,,3853.00000,2462.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,inpatient,,,313.00000,200.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,outpatient,,,313.00000,200.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,inpatient,,,1132.00000,723.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,outpatient,,,1132.00000,723.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,inpatient,,,2695.00000,1722.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,outpatient,,,2695.00000,1722.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,inpatient,,,1619.00000,1034.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,outpatient,,,1619.00000,1034.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,inpatient,,,535.00000,341.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,518.95,,,,,,,481.50,518.95,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,518.95,,,,,,,139.10,518.95,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,inpatient,,,850.00000,543.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,outpatient,,,850.00000,543.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,inpatient,,,32.00000,20.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31.04,,,,,,,28.80,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,outpatient,,,32.00000,20.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31.04,,,,,,,8.32,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,inpatient,,,134.00000,85.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,129.98,,,,,,,120.60,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,outpatient,,,134.00000,85.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,129.98,,,,,,,34.84,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,inpatient,,,359.00000,229.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,323.10,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,93.34,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,inpatient,,,709.00000,453.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,687.73,,,,,,,638.10,687.73,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,outpatient,,,709.00000,453.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,687.73,,,,,,,184.34,687.73,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,inpatient,,,4880.00000,2357.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4733.60,,,,,,,4392.00,4733.60,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,outpatient,,,4880.00000,2357.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4733.60,,,,,,,1268.80,4733.60,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,inpatient,,,6024.00000,2909.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5843.28,,,,,,,5421.60,5843.28,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,outpatient,,,6024.00000,2909.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5843.28,,,,,,,1566.24,5843.28,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,402.30,433.59,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,116.22,433.59,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,3957.30,4265.09,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,1143.22,4265.09,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,5274.90,5685.17,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,1523.86,5685.17,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,inpatient,,,7413.00000,3580.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7190.61,,,,,,,6671.70,7190.61,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,outpatient,,,7413.00000,3580.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7190.61,,,,,,,1927.38,7190.61,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,402.30,433.59,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,116.22,433.59,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,402.30,433.59,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,116.22,433.59,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,3957.30,4265.09,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,1143.22,4265.09,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,inpatient,,,7181.00000,3468.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6965.57,,,,,,,6462.90,6965.57,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6965.57,,,,,,,1867.06,6965.57,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,inpatient,,,10654.00000,5145.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,10334.38,,,,,,,9588.60,10334.38,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,outpatient,,,10654.00000,5145.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,10334.38,,,,,,,2770.04,10334.38,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,6487.00000,3133.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6292.39,,,,,,,5838.30,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6292.39,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,7413.00000,3580.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7190.61,,,,,,,6671.70,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7190.61,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,11575.00000,5590.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11227.75,,,,,,,10417.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,11575.00000,5590.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11227.75,,,,,,,3009.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,13432.00000,6487.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13029.04,,,,,,,12088.80,13029.04,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,13432.00000,6487.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13029.04,,,,,,,3492.32,13029.04,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,21904.00000,10579.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,21904.00000,10579.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,490.88,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,4397.00000,2123.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,3957.30,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,1143.22,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,7413.00000,3580.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7190.61,,,,,,,6671.70,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7190.61,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,12969.00000,6264.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12579.93,,,,,,,11672.10,12579.93,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,12969.00000,6264.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12579.93,,,,,,,3371.94,12579.93,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,490.88,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2353.22,,,,,,,2183.40,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2353.22,,,,,,,630.76,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2742.19,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2742.19,,,,,,,735.02,2742.19,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,91.80,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,26.52,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,inpatient,,,134.00000,64.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,129.98,,,,,,,120.60,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,129.98,,,,,,,34.84,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,inpatient,,,251.00000,121.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,243.47,,,,,,,225.90,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,outpatient,,,251.00000,121.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,243.47,,,,,,,65.26,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,490.88,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,447.00000,215.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,402.30,433.59,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,447.00000,215.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,116.22,433.59,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,2827.00000,1365.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2742.19,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2742.19,,,,,,,735.02,2742.19,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,2690.00000,1299.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2609.30,,,,,,,2421.00,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2609.30,,,,,,,699.40,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,6487.00000,3133.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6292.39,,,,,,,5838.30,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6292.39,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,2426.00000,1171.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2353.22,,,,,,,2183.40,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,2426.00000,1171.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2353.22,,,,,,,630.76,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,15334.00000,7406.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,13800.60,14873.98,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,15334.00000,7406.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,3986.84,14873.98,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,490.88,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2742.19,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2742.19,,,,,,,735.02,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,251.00000,121.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,243.47,,,,,,,225.90,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,251.00000,121.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,243.47,,,,,,,65.26,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,490.88,1831.36,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,2827.00000,1365.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2742.19,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2742.19,,,,,,,735.02,2742.19,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31.04,,,,,,,28.80,31.04,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31.04,,,,,,,8.32,31.04,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,490.88,1831.36,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,inpatient,,,15334.00000,7406.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,13800.60,14873.98,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,3986.84,14873.98,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,inpatient,,,1485.00000,717.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1440.45,,,,,,,1336.50,1440.45,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,outpatient,,,1485.00000,717.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1440.45,,,,,,,386.10,1440.45,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,inpatient,,,2028.00000,979.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1967.16,,,,,,,1825.20,1967.16,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,outpatient,,,2028.00000,979.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1967.16,,,,,,,527.28,1967.16,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,4397.00000,2123.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,3957.30,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,1143.22,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,8107.00000,3915.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7863.79,,,,,,,7296.30,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,8107.00000,3915.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7863.79,,,,,,,2107.82,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,10422.00000,5033.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,10109.34,,,,,,,9379.80,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,10422.00000,5033.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,10109.34,,,,,,,2709.72,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,12737.00000,6151.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12354.89,,,,,,,11463.30,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,12737.00000,6151.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12354.89,,,,,,,3311.62,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,14239.00000,6877.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13811.83,,,,,,,12815.10,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,14239.00000,6877.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13811.83,,,,,,,3702.14,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,16429.00000,7935.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,15936.13,,,,,,,14786.10,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,16429.00000,7935.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,15936.13,,,,,,,4271.54,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,18619.00000,8992.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,18060.43,,,,,,,16757.10,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,18619.00000,8992.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,18060.43,,,,,,,4840.94,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,20809.00000,10050.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,20184.73,,,,,,,18728.10,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,20809.00000,10050.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,20184.73,,,,,,,5410.34,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,22999.00000,11108.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,22309.03,,,,,,,20699.10,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,22999.00000,11108.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,22309.03,,,,,,,5979.74,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,25189.00000,12166.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,24433.33,,,,,,,22670.10,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,25189.00000,12166.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,24433.33,,,,,,,6549.14,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,27379.00000,13224.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,26557.63,,,,,,,24641.10,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,27379.00000,13224.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,26557.63,,,,,,,7118.54,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,29569.00000,14281.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,28681.93,,,,,,,26612.10,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,29569.00000,14281.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,28681.93,,,,,,,7687.94,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,31759.00000,15339.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,30806.23,,,,,,,28583.10,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,31759.00000,15339.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,30806.23,,,,,,,8257.34,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,36139.00000,17455.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,35054.83,,,,,,,32525.10,35054.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,36139.00000,17455.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,35054.83,,,,,,,9396.14,35054.83,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,1699.20,1831.36,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,490.88,1831.36,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3239.80,,,,,,,3006.00,3239.80,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3239.80,,,,,,,868.40,3239.80,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,5274.90,5685.17,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,1523.86,5685.17,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31.04,,,,,,,28.80,31.04,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31.04,,,,,,,8.32,31.04,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,inpatient,,,134.00000,64.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,129.98,,,,,,,120.60,129.98,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,129.98,,,,,,,34.84,129.98,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,184.30,,,,,,,171.00,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,184.30,,,,,,,49.40,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,inpatient,,,476.00000,229.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,461.72,,,,,,,428.40,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,outpatient,,,476.00000,229.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,461.72,,,,,,,123.76,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31.04,,,,,,,28.80,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31.04,,,,,,,8.32,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,402.30,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,116.22,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,1699.20,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,490.88,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,5274.90,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,1523.86,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,inpatient,,,12506.00000,6040.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12130.82,,,,,,,11255.40,12130.82,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,outpatient,,,12506.00000,6040.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12130.82,,,,,,,3251.56,12130.82,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,inpatient,,,2404.80000,1161.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2332.66,,,,,,,2164.32,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,outpatient,,,2404.80000,1161.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2332.66,,,,,,,625.25,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,inpatient,,,969.00000,468.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,939.93,,,,,,,872.10,939.93,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,outpatient,,,969.00000,468.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,939.93,,,,,,,251.94,939.93,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,inpatient,,,2256.90000,1090.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2189.19,,,,,,,2031.21,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,outpatient,,,2256.90000,1090.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2189.19,,,,,,,586.79,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,inpatient,,,644.30000,311.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,624.97,,,,,,,579.87,624.97,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,outpatient,,,644.30000,311.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,624.97,,,,,,,167.52,624.97,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,91.80,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,26.52,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,184.30,,,,,,,171.00,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,184.30,,,,,,,49.40,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,inpatient,,,26284.00000,12695.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,inpatient,,,30664.00000,14810.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,inpatient,,,35044.00000,16926.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,31539.60,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,9111.44,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,inpatient,,,43804.00000,21157.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,39423.60,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,outpatient,,,43804.00000,21157.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,11389.04,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,inpatient,,,52564.00000,25388.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50987.08,,,,,,,47307.60,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,outpatient,,,52564.00000,25388.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50987.08,,,,,,,13666.64,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,inpatient,,,61324.00000,29619.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59484.28,,,,,,,55191.60,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,outpatient,,,61324.00000,29619.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59484.28,,,,,,,15944.24,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,inpatient,,,70084.00000,33850.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67981.48,,,,,,,63075.60,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,outpatient,,,70084.00000,33850.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67981.48,,,,,,,18221.84,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,inpatient,,,78844.00000,38081.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76478.68,,,,,,,70959.60,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,outpatient,,,78844.00000,38081.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76478.68,,,,,,,20499.44,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,inpatient,,,87604.00000,42312.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84975.88,,,,,,,78843.60,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,outpatient,,,87604.00000,42312.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84975.88,,,,,,,22777.04,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,inpatient,,,96364.00000,46543.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,93473.08,,,,,,,86727.60,93473.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,outpatient,,,96364.00000,46543.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,93473.08,,,,,,,25054.64,93473.08,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,inpatient,,,26284.00000,12695.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,inpatient,,,30664.00000,14810.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,inpatient,,,35044.00000,16926.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,31539.60,33992.68,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,9111.44,33992.68,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,inpatient,,,39424.00000,19041.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,35481.60,38241.28,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,outpatient,,,39424.00000,19041.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,10250.24,38241.28,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3791.73,,,,,,,3518.10,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3791.73,,,,,,,1016.34,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,184.30,,,,,,,171.00,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,184.30,,,,,,,49.40,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,5274.90,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,1523.86,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,inpatient,,,15334.00000,7406.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,13800.60,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,3986.84,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,2023.00000,977.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1962.31,,,,,,,1820.70,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2023.00000,977.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1962.31,,,,,,,525.98,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,5274.90,5685.17,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,inpatient,,,7876.00000,3804.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7639.72,,,,,,,7088.40,7639.72,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7639.72,,,,,,,2047.76,7639.72,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,inpatient,,,10191.00000,4922.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,9885.27,,,,,,,9171.90,9885.27,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,outpatient,,,10191.00000,4922.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,9885.27,,,,,,,2649.66,9885.27,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,96.00000,46.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,93.12,,,,,,,86.40,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,96.00000,46.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,93.12,,,,,,,24.96,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,5274.90,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,7876.00000,3804.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7639.72,,,,,,,7088.40,7639.72,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,7876.00000,3804.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7639.72,,,,,,,2047.76,7639.72,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3791.73,,,,,,,3518.10,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3791.73,,,,,,,1016.34,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,inpatient,,,5373.00000,2595.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5211.81,,,,,,,4835.70,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,outpatient,,,5373.00000,2595.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5211.81,,,,,,,1396.98,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,inpatient,,,6487.00000,3133.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6292.39,,,,,,,5838.30,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,outpatient,,,6487.00000,3133.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6292.39,,,,,,,1686.62,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,inpatient,,,7876.00000,3804.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7639.72,,,,,,,7088.40,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7639.72,,,,,,,2047.76,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,3957.30,4265.09,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,1143.22,4265.09,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,5274.90,5685.17,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,1523.86,5685.17,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,inpatient,,,1126.00000,543.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1092.22,,,,,,,1013.40,1092.22,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,outpatient,,,1126.00000,543.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1092.22,,,,,,,292.76,1092.22,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,2690.00000,1299.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2609.30,,,,,,,2421.00,2609.30,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2609.30,,,,,,,699.40,2609.30,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,4880.00000,2357.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4733.60,,,,,,,4392.00,4733.60,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,4880.00000,2357.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4733.60,,,,,,,1268.80,4733.60,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,9260.00000,4472.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8982.20,,,,,,,8334.00,8982.20,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,9260.00000,4472.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8982.20,,,,,,,2407.60,8982.20,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,5274.90,5685.17,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,1523.86,5685.17,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,inpatient,,,588.00000,284.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,570.36,,,,,,,529.20,570.36,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,588.00000,284.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,570.36,,,,,,,152.88,570.36,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,1699.20,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,490.88,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2353.22,,,,,,,2183.40,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2353.22,,,,,,,630.76,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2742.19,,,,,,,2544.30,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2742.19,,,,,,,735.02,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3239.80,,,,,,,3006.00,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3239.80,,,,,,,868.40,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3239.80,,,,,,,3006.00,3239.80,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3239.80,,,,,,,868.40,3239.80,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,402.30,433.59,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,116.22,433.59,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3791.73,,,,,,,3518.10,3791.73,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3791.73,,,,,,,1016.34,3791.73,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,5274.90,5685.17,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,1523.86,5685.17,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,inpatient,,,159.00000,76.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,154.23,,,,,,,143.10,154.23,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,outpatient,,,159.00000,76.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,154.23,,,,,,,41.34,154.23,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,inpatient,,,588.00000,284.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,570.36,,,,,,,529.20,570.36,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,outpatient,,,588.00000,284.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,570.36,,,,,,,152.88,570.36,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2353.22,,,,,,,2183.40,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2353.22,,,,,,,630.76,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,402.30,433.59,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,116.22,433.59,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,inpatient,,,8107.00000,3915.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7863.79,,,,,,,7296.30,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,outpatient,,,8107.00000,3915.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7863.79,,,,,,,2107.82,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,inpatient,,,10422.00000,5033.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,10109.34,,,,,,,9379.80,10109.34,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,outpatient,,,10422.00000,5033.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,10109.34,,,,,,,2709.72,10109.34,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,5274.90,5685.17,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,1523.86,5685.17,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,1699.20,1831.36,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,490.88,1831.36,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,91.80,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,26.52,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,inpatient,,,221.00000,106.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,214.37,,,,,,,198.90,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,outpatient,,,221.00000,106.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,214.37,,,,,,,57.46,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,402.30,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,116.22,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2353.22,,,,,,,2183.40,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2353.22,,,,,,,630.76,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3239.80,,,,,,,3006.00,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3239.80,,,,,,,868.40,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,inpatient,,,4153.00000,2005.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4028.41,,,,,,,3737.70,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,outpatient,,,4153.00000,2005.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4028.41,,,,,,,1079.78,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,inpatient,,,5129.00000,2477.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4975.13,,,,,,,4616.10,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,outpatient,,,5129.00000,2477.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4975.13,,,,,,,1333.54,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,inpatient,,,7181.00000,3468.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6965.57,,,,,,,6462.90,6965.57,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6965.57,,,,,,,1867.06,6965.57,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,inpatient,,,52.50000,25.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.92,,,,,,,47.25,50.92,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,outpatient,,,52.50000,25.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.92,,,,,,,13.65,50.92,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,inpatient,,,50.40000,24.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,48.89,,,,,,,45.36,48.89,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,outpatient,,,50.40000,24.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,48.89,,,,,,,13.10,48.89,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2353.22,,,,,,,2183.40,2353.22,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2353.22,,,,,,,630.76,2353.22,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3791.73,,,,,,,3518.10,3791.73,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3791.73,,,,,,,1016.34,3791.73,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,91.80,98.94,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,26.52,98.94,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31.04,,,,,,,28.80,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31.04,,,,,,,8.32,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,402.30,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,116.22,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,inpatient,,,709.00000,342.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,687.73,,,,,,,638.10,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,outpatient,,,709.00000,342.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,687.73,,,,,,,184.34,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,166.00000,80.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84975.88,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84975.88,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,109504.00000,62214.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106218.88,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106218.88,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,131404.00000,74657.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,127461.88,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,131404.00000,74657.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,127461.88,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,43800.00000,24884.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42486.00,,,,,,,39420.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,43800.00000,24884.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42486.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84975.88,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84975.88,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,19714.00000,11200.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,24090.00000,13686.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,23367.30,,,,,,,21681.00,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,24090.00000,13686.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,23367.30,,,,,,,6263.40,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,28474.00000,16177.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,27619.78,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,27619.78,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,17520.00000,9953.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16994.40,,,,,,,15768.00,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16994.40,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,21904.00000,12444.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,26284.00000,14933.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,43804.00000,24887.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84975.88,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84975.88,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,109504.00000,62214.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106218.88,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106218.88,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,6105.00000,3468.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,6105.00000,3468.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,13895.00000,7894.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,13895.00000,7894.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,21900.00000,12442.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21243.00,,,,,,,19710.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,21900.00000,12442.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21243.00,,,,,,,5694.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,35040.00000,19907.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33988.80,,,,,,,31536.00,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,35040.00000,19907.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33988.80,,,,,,,9110.40,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,43804.00000,24887.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,19714.00000,11200.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,22776.00000,12940.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,22092.72,,,,,,,20498.40,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,22776.00000,12940.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,22092.72,,,,,,,5921.76,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,28474.00000,16177.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,27619.78,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,27619.78,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,17520.00000,9953.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16994.40,,,,,,,15768.00,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16994.40,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,21904.00000,12444.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,26284.00000,14933.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,30664.00000,17421.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,30664.00000,17421.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,35044.00000,19910.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,35044.00000,19910.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,9111.44,33992.68,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,2157.00000,864.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,2157.00000,864.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,2695.00000,1080.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2695.00000,1080.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,3853.00000,1545.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,3853.00000,1545.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,inpatient,,,1413.00000,566.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,outpatient,,,1413.00000,566.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,inpatient,,,594.00000,238.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,594.00000,238.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,3229.80000,1857.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3132.91,,,,,,,2906.82,3132.91,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,3229.80000,1857.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3132.91,,,,,,,839.75,3132.91,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,854.40000,491.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,828.77,,,,,,,768.96,828.77,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,854.40000,491.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,828.77,,,,,,,222.14,828.77,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1200.50000,690.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1164.48,,,,,,,1080.45,1164.48,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1200.50000,690.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1164.48,,,,,,,312.13,1164.48,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1011.00000,581.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,980.67,,,,,,,909.90,980.67,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1011.00000,581.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,980.67,,,,,,,262.86,980.67,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1823.80000,1048.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1769.09,,,,,,,1641.42,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1823.80000,1048.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1769.09,,,,,,,474.19,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2028.50000,1166.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1967.64,,,,,,,1825.65,1967.64,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2028.50000,1166.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1967.64,,,,,,,527.41,1967.64,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,841.00000,483.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,815.77,,,,,,,756.90,815.77,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,841.00000,483.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,815.77,,,,,,,218.66,815.77,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1366.20000,785.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1325.21,,,,,,,1229.58,1325.21,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1366.20000,785.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1325.21,,,,,,,355.21,1325.21,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1384.00000,795.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1342.48,,,,,,,1245.60,1342.48,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1384.00000,795.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1342.48,,,,,,,359.84,1342.48,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2458.70000,1413.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2384.94,,,,,,,2212.83,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2458.70000,1413.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2384.94,,,,,,,639.26,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2393.50000,1376.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2321.70,,,,,,,2154.15,2321.70,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2393.50000,1376.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2321.70,,,,,,,622.31,2321.70,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1369.50000,787.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1328.41,,,,,,,1232.55,1328.41,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1369.50000,787.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1328.41,,,,,,,356.07,1328.41,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2697.40000,1551.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2616.48,,,,,,,2427.66,2616.48,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2697.40000,1551.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2616.48,,,,,,,701.32,2616.48,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4621.80000,2657.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4483.15,,,,,,,4159.62,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4621.80000,2657.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4483.15,,,,,,,1201.67,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2592.50000,1490.69000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2514.72,,,,,,,2333.25,2514.72,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2592.50000,1490.69000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2514.72,,,,,,,674.05,2514.72,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,5274.90,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,1523.86,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8088.83,,,,,,,7505.10,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8088.83,,,,,,,2168.14,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,8107.00000,4661.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7863.79,,,,,,,7296.30,7863.79,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7863.79,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1092.22,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1092.22,,,,,,,292.76,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7190.61,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7190.61,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,inpatient,,,20152.00000,11587.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19547.44,,,,,,,18136.80,19547.44,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,outpatient,,,20152.00000,11587.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19547.44,,,,,,,5239.52,19547.44,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,402.30,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,116.22,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,687.73,,,,,,,638.10,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,687.73,,,,,,,184.34,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,1272.00000,731.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1233.84,,,,,,,1144.80,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,1272.00000,731.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1233.84,,,,,,,330.72,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2609.30,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2609.30,,,,,,,699.40,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,3078.00000,1769.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2985.66,,,,,,,2770.20,2985.66,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,3078.00000,1769.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2985.66,,,,,,,800.28,2985.66,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,70.00000,40.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,63.00,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,70.00000,40.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,18.20,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,102.00000,58.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,91.80,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,102.00000,58.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,26.52,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,221.00000,127.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,214.37,,,,,,,198.90,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,221.00000,127.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,214.37,,,,,,,57.46,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,402.30,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,116.22,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,687.73,,,,,,,638.10,687.73,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,687.73,,,,,,,184.34,687.73,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12130.82,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12130.82,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35482.00000,20402.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34417.54,,,,,,,31933.80,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35482.00000,20402.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34417.54,,,,,,,9225.32,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39862.00000,22920.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38666.14,,,,,,,35875.80,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39862.00000,22920.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38666.14,,,,,,,10364.12,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,44242.00000,25439.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42914.74,,,,,,,39817.80,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,44242.00000,25439.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42914.74,,,,,,,11502.92,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,48622.00000,27957.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,47163.34,,,,,,,43759.80,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,48622.00000,27957.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,47163.34,,,,,,,12641.72,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,53002.00000,30476.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51411.94,,,,,,,47701.80,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,53002.00000,30476.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51411.94,,,,,,,13780.52,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59484.28,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59484.28,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67981.48,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67981.48,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76478.68,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76478.68,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84975.88,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84975.88,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,93473.08,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,93473.08,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,844.00000,485.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,818.68,,,,,,,759.60,818.68,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,844.00000,485.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,818.68,,,,,,,219.44,818.68,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,11575.00000,6655.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11227.75,,,,,,,10417.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,11575.00000,6655.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11227.75,,,,,,,3009.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,14892.00000,8562.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14445.24,,,,,,,13402.80,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14892.00000,8562.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14445.24,,,,,,,3871.92,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,24970.00000,14357.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,24220.90,,,,,,,22473.00,24220.90,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,24970.00000,14357.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,24220.90,,,,,,,6492.20,24220.90,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,402.30,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,116.22,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3239.80,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3239.80,,,,,,,868.40,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,4153.00000,2387.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4028.41,,,,,,,3737.70,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4028.41,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,4641.00000,2668.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4501.77,,,,,,,4176.90,4501.77,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4641.00000,2668.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4501.77,,,,,,,1206.66,4501.77,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4733.60,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4733.60,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,93473.08,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,93473.08,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106218.88,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106218.88,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,131404.00000,75557.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,127461.88,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,127461.88,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,153304.00000,88149.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,148704.88,,,,,,,137973.60,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,153304.00000,88149.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,148704.88,,,,,,,39859.04,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,175204.00000,100742.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,169947.88,,,,,,,157683.60,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,175204.00000,100742.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,169947.88,,,,,,,45553.04,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,197104.00000,113334.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,191190.88,,,,,,,177393.60,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,197104.00000,113334.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,191190.88,,,,,,,51247.04,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,219004.00000,125927.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,212433.88,,,,,,,197103.60,212433.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,219004.00000,125927.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,212433.88,,,,,,,56941.04,212433.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,46738.48,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,46738.48,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50987.08,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50987.08,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55235.68,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55235.68,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59484.28,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59484.28,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50987.08,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50987.08,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84975.88,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84975.88,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106218.88,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106218.88,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4733.60,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4733.60,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,46738.48,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,46738.48,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50987.08,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50987.08,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55235.68,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55235.68,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59484.28,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59484.28,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67981.48,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67981.48,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76478.68,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76478.68,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84975.88,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84975.88,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,93473.08,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,93473.08,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106218.88,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106218.88,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,122644.00000,70520.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,118964.68,,,,,,,110379.60,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,118964.68,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,135784.00000,78075.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,131710.48,,,,,,,122205.60,131710.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,135784.00000,78075.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,131710.48,,,,,,,35303.84,131710.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,46738.48,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,46738.48,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,55630.00000,31987.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53961.10,,,,,,,50067.00,53961.10,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,55630.00000,31987.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53961.10,,,,,,,14463.80,53961.10,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2609.30,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2609.30,,,,,,,699.40,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,14020.00000,8061.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13599.40,,,,,,,12618.00,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13599.40,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,17962.00000,10328.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,17423.14,,,,,,,16165.80,17423.14,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,17962.00000,10328.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,17423.14,,,,,,,4670.12,17423.14,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,2421.00000,1392.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2348.37,,,,,,,2178.90,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,2421.00000,1392.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2348.37,,,,,,,629.46,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2353.22,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2353.22,,,,,,,630.76,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2609.30,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2609.30,,,,,,,699.40,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,27160.00000,15617.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,26345.20,,,,,,,24444.00,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,27160.00000,15617.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,26345.20,,,,,,,7061.60,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31868.38,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31868.38,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50987.08,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50987.08,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76478.68,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76478.68,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,28470.00000,16370.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,27615.90,,,,,,,25623.00,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,28470.00000,16370.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,27615.90,,,,,,,7402.20,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,43800.00000,25185.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42486.00,,,,,,,39420.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,43800.00000,25185.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42486.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84975.88,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84975.88,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106218.88,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106218.88,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3791.73,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3791.73,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31868.38,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31868.38,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,54754.00000,31483.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53111.38,,,,,,,49278.60,53111.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,54754.00000,31483.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53111.38,,,,,,,14236.04,53111.38,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2609.30,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2609.30,,,,,,,699.40,2609.30,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,61320.00000,35259.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59480.40,,,,,,,55188.00,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,61320.00000,35259.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59480.40,,,,,,,15943.20,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,70080.00000,40296.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67977.60,,,,,,,63072.00,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,70080.00000,40296.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67977.60,,,,,,,18220.80,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,78840.00000,45333.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76474.80,,,,,,,70956.00,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,78840.00000,45333.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76474.80,,,,,,,20498.40,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,93473.08,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,93473.08,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106218.88,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106218.88,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,122644.00000,70520.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,118964.68,,,,,,,110379.60,118964.68,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,118964.68,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,23371.18,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,23371.18,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31868.38,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31868.38,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,1883.00000,1082.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1826.51,,,,,,,1694.70,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1883.00000,1082.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1826.51,,,,,,,489.58,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3791.73,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3791.73,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,7644.00000,4395.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7414.68,,,,,,,6879.60,7414.68,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,7644.00000,4395.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7414.68,,,,,,,1987.44,7414.68,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2609.30,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2609.30,,,,,,,699.40,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,inpatient,,,1614.00000,928.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1565.58,,,,,,,1452.60,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1565.58,,,,,,,419.64,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,23371.18,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,23371.18,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,27619.78,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,27619.78,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31868.38,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31868.38,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,37234.00000,21409.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,36116.98,,,,,,,33510.60,36116.98,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,37234.00000,21409.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,36116.98,,,,,,,9680.84,36116.98,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50987.08,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50987.08,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76478.68,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76478.68,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,159.00000,91.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,154.23,,,,,,,143.10,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,159.00000,91.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,154.23,,,,,,,41.34,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,490.88,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,490.88,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2353.22,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2353.22,,,,,,,630.76,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2827.00000,1625.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2742.19,,,,,,,2544.30,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2742.19,,,,,,,735.02,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3239.80,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3239.80,,,,,,,868.40,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8107.00000,4661.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7863.79,,,,,,,7296.30,7863.79,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7863.79,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84975.88,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84975.88,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106218.88,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106218.88,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,131404.00000,75557.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,127461.88,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,127461.88,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,18400.00000,10580.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,17848.00,,,,,,,16560.00,17848.00,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,18400.00000,10580.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,17848.00,,,,,,,4784.00,17848.00,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,23371.18,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,23371.18,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,27619.78,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,27619.78,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31868.38,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31868.38,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1614.00000,928.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1565.58,,,,,,,1452.60,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1565.58,,,,,,,419.64,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55235.68,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55235.68,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,5368.00000,3086.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5206.96,,,,,,,4831.20,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,5368.00000,3086.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5206.96,,,,,,,1395.68,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,14020.00000,8061.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13599.40,,,,,,,12618.00,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13599.40,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,25408.00000,14609.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,24645.76,,,,,,,22867.20,24645.76,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,25408.00000,14609.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,24645.76,,,,,,,6606.08,24645.76,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,8112.00000,4664.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7868.64,,,,,,,7300.80,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,8112.00000,4664.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7868.64,,,,,,,2109.12,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,10431.00000,5997.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,10118.07,,,,,,,9387.90,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,10431.00000,5997.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,10118.07,,,,,,,2712.06,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31868.38,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31868.38,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,46870.00000,26950.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,45463.90,,,,,,,42183.00,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,46870.00000,26950.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,45463.90,,,,,,,12186.20,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,51250.00000,29468.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49712.50,,,,,,,46125.00,49712.50,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,51250.00000,29468.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49712.50,,,,,,,13325.00,49712.50,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50987.08,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50987.08,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76478.68,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76478.68,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84975.88,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84975.88,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,588.00000,338.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,570.36,,,,,,,529.20,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,588.00000,338.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,570.36,,,,,,,152.88,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3791.73,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3791.73,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5211.81,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5211.81,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6292.39,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6292.39,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,7876.00000,4528.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7639.72,,,,,,,7088.40,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7876.00000,4528.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7639.72,,,,,,,2047.76,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,23371.18,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,23371.18,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5856.00000,3367.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5680.32,,,,,,,5270.40,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5856.00000,3367.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5680.32,,,,,,,1522.56,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6292.39,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6292.39,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7190.61,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7190.61,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8088.83,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8088.83,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5211.81,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5211.81,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5843.28,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5843.28,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12130.82,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12130.82,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5211.81,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5211.81,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5843.28,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5843.28,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12130.82,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12130.82,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4392.00000,2525.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4260.24,,,,,,,3952.80,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4392.00000,2525.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4260.24,,,,,,,1141.92,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5211.81,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5211.81,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6292.39,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6292.39,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5211.81,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5211.81,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6292.39,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6292.39,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4733.60,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4733.60,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1092.22,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1092.22,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5211.81,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5211.81,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5843.28,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5843.28,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12130.82,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12130.82,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13174.54,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13174.54,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2152.00000,1237.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2087.44,,,,,,,1936.80,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2152.00000,1237.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2087.44,,,,,,,559.52,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4733.60,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4733.60,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3791.73,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3791.73,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5843.28,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5843.28,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5211.81,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5211.81,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5843.28,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5843.28,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1092.22,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1092.22,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5211.81,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5211.81,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5843.28,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5843.28,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12130.82,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12130.82,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13174.54,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13174.54,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5211.81,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5211.81,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8802.00000,5061.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8537.94,,,,,,,7921.80,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8802.00000,5061.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8537.94,,,,,,,2288.52,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,10654.00000,6126.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,10334.38,,,,,,,9588.60,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10654.00000,6126.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,10334.38,,,,,,,2770.04,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12130.82,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12130.82,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13174.54,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13174.54,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17086.00000,9824.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16573.42,,,,,,,15377.40,16573.42,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17086.00000,9824.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16573.42,,,,,,,4442.36,16573.42,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4733.60,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4733.60,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6292.39,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6292.39,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7190.61,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7190.61,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8088.83,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8088.83,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4733.60,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4733.60,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4733.60,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4733.60,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3488.12,,,,,,,934.96,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5921.85,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,23371.18,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,23371.18,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3791.73,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3791.73,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6292.39,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6292.39,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1831.36,,,,,,,490.88,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2353.22,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2353.22,,,,,,,630.76,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2827.00000,1625.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2742.19,,,,,,,2544.30,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2742.19,,,,,,,735.02,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3239.80,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3239.80,,,,,,,868.40,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4153.00000,2387.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4028.41,,,,,,,3737.70,4028.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4028.41,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7190.61,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7190.61,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8088.83,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8088.83,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9728.00000,5593.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,9436.16,,,,,,,8755.20,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9728.00000,5593.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,9436.16,,,,,,,2529.28,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11117.00000,6392.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,10783.49,,,,,,,10005.30,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11117.00000,6392.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,10783.49,,,,,,,2890.42,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,46738.48,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,46738.48,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50987.08,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50987.08,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55235.68,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55235.68,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59484.28,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59484.28,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67981.48,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67981.48,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,74464.00000,42816.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72230.08,,,,,,,67017.60,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72230.08,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76478.68,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76478.68,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,83224.00000,47853.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,80727.28,,,,,,,74901.60,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,80727.28,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,111694.00000,64224.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,108343.18,,,,,,,100524.60,108343.18,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,111694.00000,64224.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,108343.18,,,,,,,29040.44,108343.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,402.30,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,116.22,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,687.73,,,,,,,638.10,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,687.73,,,,,,,184.34,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,991.00000,569.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,961.27,,,,,,,891.90,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,991.00000,569.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,961.27,,,,,,,257.66,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1490.00000,856.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1445.30,,,,,,,1341.00,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1490.00000,856.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1445.30,,,,,,,387.40,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3791.73,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3791.73,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5685.17,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6292.39,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6292.39,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7190.61,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7190.61,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8088.83,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8088.83,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1370.61,,,,,,,367.38,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3737.41,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,6945.00000,3993.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6736.65,,,,,,,6250.50,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,6945.00000,3993.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6736.65,,,,,,,1805.70,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,402.30,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,116.22,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3791.73,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3791.73,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5211.81,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5211.81,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1098.04,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,50374.00000,28965.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,48862.78,,,,,,,45336.60,48862.78,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,50374.00000,28965.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,48862.78,,,,,,,13097.24,48862.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19122.58,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,23371.18,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,23371.18,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,27619.78,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,27619.78,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2614.15,,,,,,,700.70,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6741.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11232.60,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14873.98,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,46738.48,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,46738.48,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,850.00000,488.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2092.29,,,,,,,560.82,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2990.51,,,,,,,801.58,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,46738.48,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,46738.48,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50987.08,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50987.08,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55235.68,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55235.68,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63732.88,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,74464.00000,42816.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72230.08,,,,,,,67017.60,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72230.08,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,83224.00000,47853.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,80727.28,,,,,,,74901.60,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,80727.28,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,91984.00000,52890.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,89224.48,,,,,,,82785.60,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,91984.00000,52890.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,89224.48,,,,,,,23915.84,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,100744.00000,57927.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97721.68,,,,,,,90669.60,97721.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,100744.00000,57927.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97721.68,,,,,,,26193.44,97721.68,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,166.00000,95.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,149.40,161.02,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,166.00000,95.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.02,,,,,,,43.16,161.02,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,447.00000,257.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,402.30,433.59,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,447.00000,257.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,433.59,,,,,,,116.22,433.59,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,709.00000,407.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,687.73,,,,,,,638.10,687.73,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,709.00000,407.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,687.73,,,,,,,184.34,687.73,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16998.28,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21246.88,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25495.48,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29744.08,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33992.68,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38241.28,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42489.88,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50987.08,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50987.08,,,,,,,13666.64,50987.08,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,4396.50,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4738.45,,,,,,,1270.10,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,8338.50,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8987.05,,,,,,,2408.90,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,12505.50,13478.15,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13478.15,,,,,,,3612.70,13478.15,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2180.20000,1253.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2114.79,,,,,,,1962.18,2114.79,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2180.20000,1253.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2114.79,,,,,,,566.85,2114.79,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1880.60000,1081.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1824.18,,,,,,,1692.54,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1880.60000,1081.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1824.18,,,,,,,488.96,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2908.70000,1672.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2821.44,,,,,,,2617.83,2821.44,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2908.70000,1672.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2821.44,,,,,,,756.26,2821.44,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,inpatient,,,34.00000,25.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,32.98,,,,,,,30.60,32.98,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,outpatient,,,34.00000,25.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,32.98,,,,,,,8.84,32.98,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,inpatient,,,13.00000,9.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12.61,,,,,,,11.70,12.61,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,outpatient,,,13.00000,9.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12.61,,,,,,,3.38,12.61,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,272.57,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,272.57,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,272.57,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,272.57,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,272.57,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,272.57,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,728.47,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,728.47,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,728.47,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,728.47,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,728.47,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,728.47,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,inpatient,,,122.00000,92.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,118.34,,,,,,,109.80,118.34,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,outpatient,,,122.00000,92.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,118.34,,,,,,,31.72,118.34,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,inpatient,,,79.00000,59.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,71.10,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,20.54,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,inpatient,,,79.00000,59.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,71.10,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,20.54,76.63,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,inpatient,,,15.00000,11.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14.55,,,,,,,13.50,14.55,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14.55,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,inpatient,,,15.00000,11.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14.55,,,,,,,13.50,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14.55,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,inpatient,,,17.00000,12.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16.49,,,,,,,15.30,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16.49,,,,,,,4.42,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,inpatient,,,17.00000,12.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16.49,,,,,,,15.30,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16.49,,,,,,,4.42,16.49,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,inpatient,,,359.00000,271.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,outpatient,,,359.00000,271.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,inpatient,,,359.00000,271.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,outpatient,,,359.00000,271.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,inpatient,,,359.00000,271.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,outpatient,,,359.00000,271.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,93.34,348.23,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,inpatient,,,155.00000,117.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,150.35,,,,,,,139.50,150.35,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,outpatient,,,155.00000,117.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,150.35,,,,,,,40.30,150.35,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,inpatient,,,294.00000,222.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,285.18,,,,,,,264.60,285.18,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,outpatient,,,294.00000,222.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,285.18,,,,,,,76.44,285.18,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,inpatient,,,1511.00000,1143.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1465.67,,,,,,,1359.90,1465.67,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,outpatient,,,1511.00000,1143.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1465.67,,,,,,,392.86,1465.67,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,inpatient,,,751.00000,568.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,728.47,,,,,,,675.90,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,728.47,,,,,,,195.26,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,inpatient,,,751.00000,568.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,728.47,,,,,,,675.90,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,728.47,,,,,,,195.26,728.47,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,inpatient,,,150.00000,113.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,145.50,,,,,,,135.00,145.50,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,outpatient,,,150.00000,113.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,145.50,,,,,,,39.00,145.50,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,inpatient,,,110.00000,83.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,99.00,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,outpatient,,,110.00000,83.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,28.60,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,inpatient,,,158.00000,119.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,153.26,,,,,,,142.20,153.26,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,outpatient,,,158.00000,119.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,153.26,,,,,,,41.08,153.26,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,inpatient,,,153.00000,115.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,148.41,,,,,,,137.70,148.41,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,outpatient,,,153.00000,115.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,148.41,,,,,,,39.78,148.41,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,inpatient,,,157.00000,118.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,152.29,,,,,,,141.30,152.29,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,outpatient,,,157.00000,118.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,152.29,,,,,,,40.82,152.29,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,inpatient,,,26.00000,19.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,23.40,25.22,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,outpatient,,,26.00000,19.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,6.76,25.22,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,inpatient,,,37.00000,28.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,35.89,,,,,,,33.30,35.89,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,outpatient,,,37.00000,28.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,35.89,,,,,,,9.62,35.89,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,inpatient,,,268.00000,202.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,259.96,,,,,,,241.20,259.96,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,outpatient,,,268.00000,202.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,259.96,,,,,,,69.68,259.96,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,inpatient,,,91.00000,68.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,88.27,,,,,,,81.90,88.27,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,outpatient,,,91.00000,68.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,88.27,,,,,,,23.66,88.27,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,inpatient,,,200.00000,151.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,194.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,outpatient,,,200.00000,151.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,194.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,inpatient,,,152.00000,115.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,147.44,,,,,,,136.80,147.44,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,outpatient,,,152.00000,115.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,147.44,,,,,,,39.52,147.44,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,inpatient,,,359.00000,271.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,323.10,348.23,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,outpatient,,,359.00000,271.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,93.34,348.23,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,inpatient,,,69.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,62.10,66.93,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,outpatient,,,69.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,inpatient,,,75.00000,36.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72.75,,,,,,,67.50,72.75,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,outpatient,,,75.00000,36.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72.75,,,,,,,19.50,72.75,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,inpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,outpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,inpatient,,,45.00000,21.69000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,43.65,,,,,,,40.50,43.65,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,outpatient,,,45.00000,21.69000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,43.65,,,,,,,11.70,43.65,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,inpatient,,,68.00000,32.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,61.20,65.96,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,outpatient,,,68.00000,32.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,17.68,65.96,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,inpatient,,,61.00000,29.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,outpatient,,,61.00000,29.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,inpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,inpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,inpatient,,,64.00000,30.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,57.60,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,outpatient,,,64.00000,30.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,16.64,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,inpatient,,,195.00000,93.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,189.15,,,,,,,175.50,189.15,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,outpatient,,,195.00000,93.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,189.15,,,,,,,50.70,189.15,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,inpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,outpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,inpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,outpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,inpatient,,,14.00000,6.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13.58,,,,,,,12.60,13.58,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,outpatient,,,14.00000,6.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13.58,,,,,,,3.64,13.58,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,inpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,outpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,inpatient,,,53.00000,25.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,47.70,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,outpatient,,,53.00000,25.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,13.78,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,inpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,outpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,inpatient,,,82.00000,39.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,79.54,,,,,,,73.80,79.54,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,outpatient,,,82.00000,39.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,79.54,,,,,,,21.32,79.54,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,inpatient,,,141.00000,67.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,136.77,,,,,,,126.90,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,136.77,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,inpatient,,,141.00000,67.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,136.77,,,,,,,126.90,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,136.77,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,inpatient,,,91.00000,43.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,88.27,,,,,,,81.90,88.27,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,outpatient,,,91.00000,43.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,88.27,,,,,,,23.66,88.27,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,inpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,outpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,inpatient,,,69.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,62.10,66.93,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,outpatient,,,69.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,inpatient,,,205.00000,98.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,198.85,,,,,,,184.50,198.85,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,outpatient,,,205.00000,98.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,198.85,,,,,,,53.30,198.85,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,inpatient,,,50.00000,24.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,48.50,,,,,,,45.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,outpatient,,,50.00000,24.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,48.50,,,,,,,13.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,inpatient,,,406.00000,195.69000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,393.82,,,,,,,365.40,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,outpatient,,,406.00000,195.69000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,393.82,,,,,,,105.56,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,inpatient,,,101.00000,48.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97.97,,,,,,,90.90,97.97,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,outpatient,,,101.00000,48.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97.97,,,,,,,26.26,97.97,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,inpatient,,,375.00000,180.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,363.75,,,,,,,337.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,outpatient,,,375.00000,180.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,363.75,,,,,,,97.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,inpatient,,,362.00000,174.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,351.14,,,,,,,325.80,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,outpatient,,,362.00000,174.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,351.14,,,,,,,94.12,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,inpatient,,,325.00000,156.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,315.25,,,,,,,292.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,outpatient,,,325.00000,156.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,315.25,,,,,,,84.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,inpatient,,,121.00000,58.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,117.37,,,,,,,108.90,117.37,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,outpatient,,,121.00000,58.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,117.37,,,,,,,31.46,117.37,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,inpatient,,,115.00000,55.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,111.55,,,,,,,103.50,111.55,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,outpatient,,,115.00000,55.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,111.55,,,,,,,29.90,111.55,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,inpatient,,,300.00000,144.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,291.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,outpatient,,,300.00000,144.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,291.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,inpatient,,,51.00000,24.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,outpatient,,,51.00000,24.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,inpatient,,,51.00000,24.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,inpatient,,,51.00000,24.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,inpatient,,,194.00000,93.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,188.18,,,,,,,174.60,188.18,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,outpatient,,,194.00000,93.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,188.18,,,,,,,50.44,188.18,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,inpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,outpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,inpatient,,,68.00000,32.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,61.20,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,outpatient,,,68.00000,32.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,17.68,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,inpatient,,,329.00000,158.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,319.13,,,,,,,296.10,319.13,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,outpatient,,,329.00000,158.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,319.13,,,,,,,85.54,319.13,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,inpatient,,,24.00000,11.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,23.28,,,,,,,21.60,23.28,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,outpatient,,,24.00000,11.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,23.28,,,,,,,6.24,23.28,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,inpatient,,,30.00000,14.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29.10,,,,,,,27.00,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,outpatient,,,30.00000,14.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29.10,,,,,,,7.80,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,inpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,outpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,inpatient,,,53.00000,25.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,47.70,51.41,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,outpatient,,,53.00000,25.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,13.78,51.41,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,inpatient,,,270.00000,130.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,261.90,,,,,,,243.00,261.90,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,outpatient,,,270.00000,130.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,261.90,,,,,,,70.20,261.90,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,inpatient,,,123.00000,59.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,119.31,,,,,,,110.70,119.31,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,119.31,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,inpatient,,,123.00000,59.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,119.31,,,,,,,110.70,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,119.31,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,inpatient,,,37.00000,17.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,35.89,,,,,,,33.30,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,outpatient,,,37.00000,17.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,35.89,,,,,,,9.62,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,inpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,outpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,inpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,outpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,inpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,outpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,inpatient,,,41.00000,19.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,39.77,,,,,,,36.90,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,outpatient,,,41.00000,19.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,39.77,,,,,,,10.66,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,inpatient,,,72.00000,34.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,64.80,69.84,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,outpatient,,,72.00000,34.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,18.72,69.84,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,inpatient,,,77.00000,37.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,outpatient,,,77.00000,37.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,inpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,inpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,inpatient,,,90.00000,43.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,87.30,,,,,,,81.00,87.30,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,outpatient,,,90.00000,43.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,87.30,,,,,,,23.40,87.30,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,inpatient,,,44.00000,21.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42.68,,,,,,,39.60,42.68,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,outpatient,,,44.00000,21.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42.68,,,,,,,11.44,42.68,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,inpatient,,,115.00000,55.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,111.55,,,,,,,103.50,111.55,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,outpatient,,,115.00000,55.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,111.55,,,,,,,29.90,111.55,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,inpatient,,,20.00000,9.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19.40,,,,,,,18.00,19.40,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,outpatient,,,20.00000,9.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,inpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,46.80,50.44,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,outpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,13.52,50.44,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,inpatient,,,341.00000,164.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,330.77,,,,,,,306.90,330.77,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,outpatient,,,341.00000,164.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,330.77,,,,,,,88.66,330.77,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,inpatient,,,54.00000,26.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,48.60,52.38,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,outpatient,,,54.00000,26.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,14.04,52.38,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,inpatient,,,53.00000,25.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,47.70,51.41,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,outpatient,,,53.00000,25.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,13.78,51.41,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,inpatient,,,88.00000,42.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,85.36,,,,,,,79.20,85.36,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,outpatient,,,88.00000,42.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,85.36,,,,,,,22.88,85.36,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,inpatient,,,89.00000,42.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,86.33,,,,,,,80.10,86.33,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,outpatient,,,89.00000,42.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,86.33,,,,,,,23.14,86.33,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,inpatient,,,61.00000,29.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,outpatient,,,61.00000,29.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,inpatient,,,77.00000,37.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,inpatient,,,77.00000,37.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,inpatient,,,64.00000,30.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,57.60,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,16.64,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,inpatient,,,64.00000,30.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,57.60,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,16.64,62.08,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,inpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,outpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,inpatient,,,95.00000,45.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,92.15,,,,,,,85.50,92.15,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,outpatient,,,95.00000,45.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,92.15,,,,,,,24.70,92.15,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,inpatient,,,132.00000,63.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,128.04,,,,,,,118.80,128.04,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,outpatient,,,132.00000,63.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,128.04,,,,,,,34.32,128.04,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,inpatient,,,83.00000,40.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,80.51,,,,,,,74.70,80.51,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,outpatient,,,83.00000,40.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,80.51,,,,,,,21.58,80.51,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,inpatient,,,387.00000,186.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,375.39,,,,,,,348.30,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,outpatient,,,387.00000,186.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,375.39,,,,,,,100.62,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,inpatient,,,387.00000,186.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,375.39,,,,,,,348.30,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,outpatient,,,387.00000,186.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,375.39,,,,,,,100.62,375.39,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,inpatient,,,31.00000,14.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,30.07,,,,,,,27.90,30.07,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,outpatient,,,31.00000,14.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,30.07,,,,,,,8.06,30.07,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,inpatient,,,36.00000,17.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,32.40,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,outpatient,,,36.00000,17.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,9.36,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,inpatient,,,160.00000,77.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,155.20,,,,,,,144.00,155.20,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,outpatient,,,160.00000,77.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,155.20,,,,,,,41.60,155.20,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,inpatient,,,112.00000,53.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,108.64,,,,,,,100.80,108.64,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,outpatient,,,112.00000,53.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,108.64,,,,,,,29.12,108.64,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,inpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,inpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,inpatient,,,14.00000,6.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13.58,,,,,,,12.60,13.58,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,outpatient,,,14.00000,6.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13.58,,,,,,,3.64,13.58,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,inpatient,,,16.00000,7.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,15.52,,,,,,,14.40,15.52,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,outpatient,,,16.00000,7.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,15.52,,,,,,,4.16,15.52,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,inpatient,,,71.00000,34.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,63.90,68.87,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,outpatient,,,71.00000,34.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,18.46,68.87,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,inpatient,,,116.00000,55.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,112.52,,,,,,,104.40,112.52,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,outpatient,,,116.00000,55.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,112.52,,,,,,,30.16,112.52,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,inpatient,,,81.00000,39.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,72.90,78.57,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,outpatient,,,81.00000,39.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,21.06,78.57,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,inpatient,,,97.00000,46.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,94.09,,,,,,,87.30,94.09,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,outpatient,,,97.00000,46.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,94.09,,,,,,,25.22,94.09,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,inpatient,,,77.00000,37.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,outpatient,,,77.00000,37.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,inpatient,,,35.00000,16.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33.95,,,,,,,31.50,33.95,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,outpatient,,,35.00000,16.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33.95,,,,,,,9.10,33.95,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,inpatient,,,65.00000,31.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,58.50,63.05,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,outpatient,,,65.00000,31.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,16.90,63.05,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,inpatient,,,74.00000,35.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,71.78,,,,,,,66.60,71.78,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,outpatient,,,74.00000,35.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,71.78,,,,,,,19.24,71.78,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,inpatient,,,250.00000,120.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,242.50,,,,,,,225.00,242.50,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,outpatient,,,250.00000,120.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,242.50,,,,,,,65.00,242.50,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,inpatient,,,90.00000,43.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,87.30,,,,,,,81.00,87.30,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,outpatient,,,90.00000,43.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,87.30,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,inpatient,,,90.00000,43.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,87.30,,,,,,,81.00,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,outpatient,,,90.00000,43.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,87.30,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,inpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,46.80,50.44,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,outpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,13.52,50.44,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,inpatient,,,36.00000,17.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,32.40,34.92,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,outpatient,,,36.00000,17.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,9.36,34.92,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,inpatient,,,78.00000,37.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,70.20,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,outpatient,,,78.00000,37.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,20.28,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,inpatient,,,115.00000,55.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,111.55,,,,,,,103.50,111.55,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,outpatient,,,115.00000,55.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,111.55,,,,,,,29.90,111.55,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,inpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,60.30,64.99,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,outpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,17.42,64.99,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,inpatient,,,76.00000,36.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,73.72,,,,,,,68.40,73.72,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,outpatient,,,76.00000,36.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,73.72,,,,,,,19.76,73.72,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,inpatient,,,53.00000,25.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,47.70,51.41,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,outpatient,,,53.00000,25.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,13.78,51.41,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,inpatient,,,70.00000,33.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,63.00,67.90,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,outpatient,,,70.00000,33.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,18.20,67.90,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,inpatient,,,169.00000,81.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,163.93,,,,,,,152.10,163.93,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,outpatient,,,169.00000,81.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,163.93,,,,,,,43.94,163.93,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,inpatient,,,28.00000,13.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,27.16,,,,,,,25.20,27.16,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,outpatient,,,28.00000,13.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,27.16,,,,,,,7.28,27.16,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,inpatient,,,51.00000,24.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,45.90,49.47,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,outpatient,,,51.00000,24.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,13.26,49.47,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,inpatient,,,15.00000,7.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14.55,,,,,,,13.50,14.55,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,outpatient,,,15.00000,7.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14.55,,,,,,,3.90,14.55,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,inpatient,,,18.00000,8.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,17.46,,,,,,,16.20,17.46,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,outpatient,,,18.00000,8.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,17.46,,,,,,,4.68,17.46,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,inpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,outpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,inpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,outpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,inpatient,,,61.00000,29.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,outpatient,,,61.00000,29.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,inpatient,,,550.00000,265.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,533.50,,,,,,,495.00,533.50,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,outpatient,,,550.00000,265.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,533.50,,,,,,,143.00,533.50,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,inpatient,,,73.00000,35.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,70.81,,,,,,,65.70,70.81,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,70.81,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,inpatient,,,392.00000,188.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,380.24,,,,,,,352.80,380.24,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,outpatient,,,392.00000,188.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,380.24,,,,,,,101.92,380.24,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,inpatient,,,75.00000,36.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72.75,,,,,,,67.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,outpatient,,,75.00000,36.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72.75,,,,,,,19.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,inpatient,,,73.00000,35.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,70.81,,,,,,,65.70,70.81,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,70.81,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,inpatient,,,100.00000,48.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,outpatient,,,100.00000,48.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,inpatient,,,153.00000,73.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,148.41,,,,,,,137.70,148.41,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,outpatient,,,153.00000,73.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,148.41,,,,,,,39.78,148.41,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,inpatient,,,909.00000,438.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,881.73,,,,,,,818.10,881.73,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,outpatient,,,909.00000,438.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,881.73,,,,,,,236.34,881.73,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,inpatient,,,266.00000,128.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,258.02,,,,,,,239.40,258.02,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,outpatient,,,266.00000,128.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,258.02,,,,,,,69.16,258.02,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,inpatient,,,275.00000,132.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,266.75,,,,,,,247.50,266.75,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,outpatient,,,275.00000,132.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,266.75,,,,,,,71.50,266.75,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,inpatient,,,61.00000,29.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,outpatient,,,61.00000,29.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,inpatient,,,84.00000,40.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,81.48,,,,,,,75.60,81.48,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,outpatient,,,84.00000,40.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,81.48,,,,,,,21.84,81.48,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,inpatient,,,174.00000,83.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,168.78,,,,,,,156.60,168.78,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,outpatient,,,174.00000,83.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,168.78,,,,,,,45.24,168.78,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,inpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,outpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,inpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,60.30,64.99,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,outpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,17.42,64.99,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,inpatient,,,68.00000,32.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,61.20,65.96,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,outpatient,,,68.00000,32.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,17.68,65.96,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,inpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,outpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,inpatient,,,211.00000,101.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,204.67,,,,,,,189.90,204.67,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,outpatient,,,211.00000,101.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,204.67,,,,,,,54.86,204.67,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,inpatient,,,65.00000,31.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,58.50,63.05,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,outpatient,,,65.00000,31.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,16.90,63.05,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,inpatient,,,83.00000,40.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,80.51,,,,,,,74.70,80.51,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,outpatient,,,83.00000,40.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,80.51,,,,,,,21.58,80.51,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,inpatient,,,54.00000,26.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,48.60,52.38,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,outpatient,,,54.00000,26.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,14.04,52.38,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,inpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,outpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,inpatient,,,323.00000,155.69000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,313.31,,,,,,,290.70,313.31,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,outpatient,,,323.00000,155.69000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,313.31,,,,,,,83.98,313.31,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,inpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,outpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,inpatient,,,35.00000,16.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33.95,,,,,,,31.50,33.95,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,outpatient,,,35.00000,16.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33.95,,,,,,,9.10,33.95,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,inpatient,,,20.00000,9.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19.40,,,,,,,18.00,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,outpatient,,,20.00000,9.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,inpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,outpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,inpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,inpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,inpatient,,,34.00000,16.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,32.98,,,,,,,30.60,32.98,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,outpatient,,,34.00000,16.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,32.98,,,,,,,8.84,32.98,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,inpatient,,,29.00000,13.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,28.13,,,,,,,26.10,28.13,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,outpatient,,,29.00000,13.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,28.13,,,,,,,7.54,28.13,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,inpatient,,,80.00000,38.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,77.60,,,,,,,72.00,77.60,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,outpatient,,,80.00000,38.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,77.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,inpatient,,,73.00000,35.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,70.81,,,,,,,65.70,70.81,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,outpatient,,,73.00000,35.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,70.81,,,,,,,18.98,70.81,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,inpatient,,,16.00000,7.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,15.52,,,,,,,14.40,15.52,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,outpatient,,,16.00000,7.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,15.52,,,,,,,4.16,15.52,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,inpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,46.80,50.44,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,outpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,13.52,50.44,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,inpatient,,,113.00000,54.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,109.61,,,,,,,101.70,109.61,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,outpatient,,,113.00000,54.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,109.61,,,,,,,29.38,109.61,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,inpatient,,,68.00000,32.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,61.20,65.96,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,outpatient,,,68.00000,32.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,17.68,65.96,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,inpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,inpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,inpatient,,,78.00000,37.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,70.20,75.66,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,outpatient,,,78.00000,37.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,20.28,75.66,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,inpatient,,,54.00000,26.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,48.60,52.38,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,outpatient,,,54.00000,26.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,14.04,52.38,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,inpatient,,,76.00000,36.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,73.72,,,,,,,68.40,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,outpatient,,,76.00000,36.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,73.72,,,,,,,19.76,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,inpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,60.30,64.99,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,outpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,17.42,64.99,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,inpatient,,,88.00000,42.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,85.36,,,,,,,79.20,85.36,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,outpatient,,,88.00000,42.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,85.36,,,,,,,22.88,85.36,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,inpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,outpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,inpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,60.30,64.99,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,outpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,17.42,64.99,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,inpatient,,,53.00000,25.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,47.70,51.41,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,outpatient,,,53.00000,25.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,13.78,51.41,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,inpatient,,,88.00000,42.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,85.36,,,,,,,79.20,85.36,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,outpatient,,,88.00000,42.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,85.36,,,,,,,22.88,85.36,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,inpatient,,,105.00000,50.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,101.85,,,,,,,94.50,101.85,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,outpatient,,,105.00000,50.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,101.85,,,,,,,27.30,101.85,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,inpatient,,,73.00000,35.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,70.81,,,,,,,65.70,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,70.81,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,inpatient,,,83.00000,40.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,80.51,,,,,,,74.70,80.51,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,outpatient,,,83.00000,40.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,80.51,,,,,,,21.58,80.51,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,inpatient,,,154.00000,74.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,149.38,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,149.38,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,inpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,outpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,inpatient,,,97.00000,46.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,94.09,,,,,,,87.30,94.09,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,outpatient,,,97.00000,46.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,94.09,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,inpatient,,,154.00000,74.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,149.38,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,149.38,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,inpatient,,,87.00000,41.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84.39,,,,,,,78.30,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,outpatient,,,87.00000,41.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84.39,,,,,,,22.62,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,inpatient,,,68.00000,32.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,61.20,65.96,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,outpatient,,,68.00000,32.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,17.68,65.96,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,inpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,46.80,50.44,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,outpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,13.52,50.44,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,inpatient,,,51.00000,24.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,45.90,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,outpatient,,,51.00000,24.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,13.26,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,inpatient,,,97.00000,46.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,94.09,,,,,,,87.30,94.09,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,outpatient,,,97.00000,46.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,94.09,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,inpatient,,,176.00000,84.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,170.72,,,,,,,158.40,170.72,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,outpatient,,,176.00000,84.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,170.72,,,,,,,45.76,170.72,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,inpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,outpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,inpatient,,,158.00000,76.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,153.26,,,,,,,142.20,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,outpatient,,,158.00000,76.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,153.26,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,inpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,outpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,inpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,outpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,inpatient,,,84.00000,40.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,81.48,,,,,,,75.60,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,outpatient,,,84.00000,40.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,81.48,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,inpatient,,,189.00000,91.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,183.33,,,,,,,170.10,183.33,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,outpatient,,,189.00000,91.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,183.33,,,,,,,49.14,183.33,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,inpatient,,,109.00000,52.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,105.73,,,,,,,98.10,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,outpatient,,,109.00000,52.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,105.73,,,,,,,28.34,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,inpatient,,,129.00000,62.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,116.10,125.13,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,outpatient,,,129.00000,62.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,33.54,125.13,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,inpatient,,,84.00000,40.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,81.48,,,,,,,75.60,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,outpatient,,,84.00000,40.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,81.48,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,inpatient,,,73.00000,35.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,70.81,,,,,,,65.70,70.81,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,70.81,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,inpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,outpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,inpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,outpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,inpatient,,,149.00000,71.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,144.53,,,,,,,134.10,144.53,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,outpatient,,,149.00000,71.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,144.53,,,,,,,38.74,144.53,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,inpatient,,,130.00000,62.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,126.10,,,,,,,117.00,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,outpatient,,,130.00000,62.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,126.10,,,,,,,33.80,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,inpatient,,,110.00000,53.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,99.00,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,outpatient,,,110.00000,53.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,28.60,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,inpatient,,,158.00000,76.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,153.26,,,,,,,142.20,153.26,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,outpatient,,,158.00000,76.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,153.26,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,inpatient,,,117.00000,56.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,113.49,,,,,,,105.30,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,outpatient,,,117.00000,56.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,113.49,,,,,,,30.42,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,inpatient,,,61.00000,29.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,outpatient,,,61.00000,29.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,inpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,outpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,inpatient,,,145.00000,69.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,140.65,,,,,,,130.50,140.65,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,outpatient,,,145.00000,69.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,140.65,,,,,,,37.70,140.65,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,inpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,outpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,inpatient,,,165.00000,79.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,160.05,,,,,,,148.50,160.05,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,outpatient,,,165.00000,79.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,160.05,,,,,,,42.90,160.05,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,inpatient,,,70.00000,33.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,outpatient,,,70.00000,33.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,inpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,outpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,inpatient,,,154.00000,74.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,149.38,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,outpatient,,,154.00000,74.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,149.38,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,inpatient,,,104.00000,50.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,100.88,,,,,,,93.60,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,outpatient,,,104.00000,50.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,100.88,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,inpatient,,,70.00000,33.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,outpatient,,,70.00000,33.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,inpatient,,,104.00000,50.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,100.88,,,,,,,93.60,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,outpatient,,,104.00000,50.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,100.88,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,inpatient,,,70.00000,33.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,outpatient,,,70.00000,33.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,inpatient,,,123.00000,59.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,119.31,,,,,,,110.70,119.31,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,outpatient,,,123.00000,59.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,119.31,,,,,,,31.98,119.31,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,inpatient,,,95.00000,45.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,92.15,,,,,,,85.50,92.15,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,outpatient,,,95.00000,45.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,92.15,,,,,,,24.70,92.15,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,inpatient,,,160.00000,77.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,155.20,,,,,,,144.00,155.20,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,outpatient,,,160.00000,77.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,155.20,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,inpatient,,,147.00000,70.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,142.59,,,,,,,132.30,142.59,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,outpatient,,,147.00000,70.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,142.59,,,,,,,38.22,142.59,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,inpatient,,,178.00000,85.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,172.66,,,,,,,160.20,172.66,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,outpatient,,,178.00000,85.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,172.66,,,,,,,46.28,172.66,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,inpatient,,,160.00000,77.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,155.20,,,,,,,144.00,155.20,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,outpatient,,,160.00000,77.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,155.20,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,inpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,outpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,inpatient,,,70.00000,33.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,outpatient,,,70.00000,33.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,inpatient,,,449.00000,216.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,435.53,,,,,,,404.10,435.53,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,outpatient,,,449.00000,216.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,435.53,,,,,,,116.74,435.53,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,inpatient,,,104.00000,50.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,100.88,,,,,,,93.60,100.88,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,outpatient,,,104.00000,50.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,100.88,,,,,,,27.04,100.88,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,inpatient,,,185.00000,89.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,179.45,,,,,,,166.50,179.45,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,179.45,,,,,,,48.10,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,inpatient,,,185.00000,89.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,179.45,,,,,,,166.50,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,179.45,,,,,,,48.10,179.45,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,inpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,outpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,inpatient,,,84.00000,40.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,81.48,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,outpatient,,,84.00000,40.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,81.48,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,inpatient,,,84.00000,40.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,81.48,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,81.48,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,inpatient,,,84.00000,40.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,81.48,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,81.48,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,inpatient,,,73.00000,35.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,70.81,,,,,,,65.70,70.81,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,70.81,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,inpatient,,,73.00000,35.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,70.81,,,,,,,65.70,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,70.81,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,inpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,inpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,inpatient,,,98.00000,47.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,88.20,95.06,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,outpatient,,,98.00000,47.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,25.48,95.06,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,inpatient,,,75.00000,36.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72.75,,,,,,,67.50,72.75,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,outpatient,,,75.00000,36.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72.75,,,,,,,19.50,72.75,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,inpatient,,,107.00000,51.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,103.79,,,,,,,96.30,103.79,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,outpatient,,,107.00000,51.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,103.79,,,,,,,27.82,103.79,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,inpatient,,,81.00000,39.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,72.90,78.57,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,outpatient,,,81.00000,39.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,21.06,78.57,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,inpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,outpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,inpatient,,,68.00000,32.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,61.20,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,outpatient,,,68.00000,32.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,17.68,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,inpatient,,,51.00000,24.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,45.90,49.47,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,outpatient,,,51.00000,24.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,13.26,49.47,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,inpatient,,,74.00000,35.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,71.78,,,,,,,66.60,71.78,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,outpatient,,,74.00000,35.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,71.78,,,,,,,19.24,71.78,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,inpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,outpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,inpatient,,,194.00000,93.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,188.18,,,,,,,174.60,188.18,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,outpatient,,,194.00000,93.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,188.18,,,,,,,50.44,188.18,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,inpatient,,,111.00000,53.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,107.67,,,,,,,99.90,107.67,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,outpatient,,,111.00000,53.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,107.67,,,,,,,28.86,107.67,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,inpatient,,,77.00000,37.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,outpatient,,,77.00000,37.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,71.10,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,71.10,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,inpatient,,,237.00000,114.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,229.89,,,,,,,213.30,229.89,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,229.89,,,,,,,61.62,229.89,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,inpatient,,,51.00000,24.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,45.90,49.47,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,outpatient,,,51.00000,24.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,inpatient,,,82.00000,39.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,79.54,,,,,,,73.80,79.54,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,79.54,,,,,,,21.32,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,inpatient,,,82.00000,39.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,79.54,,,,,,,73.80,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,79.54,,,,,,,21.32,79.54,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,inpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,60.30,64.99,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,outpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,17.42,64.99,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,inpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,inpatient,,,131.00000,63.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,127.07,,,,,,,117.90,127.07,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,outpatient,,,131.00000,63.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,127.07,,,,,,,34.06,127.07,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,inpatient,,,15.00000,7.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14.55,,,,,,,13.50,14.55,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,outpatient,,,15.00000,7.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14.55,,,,,,,3.90,14.55,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,inpatient,,,39.00000,18.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,37.83,,,,,,,35.10,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,outpatient,,,39.00000,18.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,37.83,,,,,,,10.14,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,inpatient,,,12.00000,5.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11.64,,,,,,,10.80,11.64,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,outpatient,,,12.00000,5.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11.64,,,,,,,3.12,11.64,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,inpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,inpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,outpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,inpatient,,,203.00000,97.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,196.91,,,,,,,182.70,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,196.91,,,,,,,52.78,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,inpatient,,,203.00000,97.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,196.91,,,,,,,182.70,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,196.91,,,,,,,52.78,196.91,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,inpatient,,,99.00000,47.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,96.03,,,,,,,89.10,96.03,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,outpatient,,,99.00000,47.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,96.03,,,,,,,25.74,96.03,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,inpatient,,,53.00000,25.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,47.70,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,outpatient,,,53.00000,25.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,13.78,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,inpatient,,,23.00000,11.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,22.31,,,,,,,20.70,22.31,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,outpatient,,,23.00000,11.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,22.31,,,,,,,5.98,22.31,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,inpatient,,,46.00000,22.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,44.62,,,,,,,41.40,44.62,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,outpatient,,,46.00000,22.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,44.62,,,,,,,11.96,44.62,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,inpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,60.30,64.99,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,outpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,17.42,64.99,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,inpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,outpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,inpatient,,,288.00000,138.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,279.36,,,,,,,259.20,279.36,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,outpatient,,,288.00000,138.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,279.36,,,,,,,74.88,279.36,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,inpatient,,,106.00000,51.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,outpatient,,,106.00000,51.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,inpatient,,,30.00000,14.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29.10,,,,,,,27.00,29.10,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,outpatient,,,30.00000,14.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29.10,,,,,,,7.80,29.10,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,inpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,outpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,inpatient,,,71.00000,34.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,63.90,68.87,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,outpatient,,,71.00000,34.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,18.46,68.87,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,inpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,60.30,64.99,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,outpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,17.42,64.99,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,inpatient,,,89.00000,42.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,86.33,,,,,,,80.10,86.33,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,outpatient,,,89.00000,42.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,86.33,,,,,,,23.14,86.33,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,inpatient,,,116.00000,55.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,112.52,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,outpatient,,,116.00000,55.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,112.52,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,inpatient,,,116.00000,55.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,112.52,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,112.52,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,inpatient,,,116.00000,55.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,112.52,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,112.52,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,inpatient,,,51.00000,24.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,45.90,49.47,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,outpatient,,,51.00000,24.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,13.26,49.47,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,inpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,outpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,inpatient,,,174.00000,83.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,168.78,,,,,,,156.60,168.78,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,outpatient,,,174.00000,83.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,168.78,,,,,,,45.24,168.78,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,inpatient,,,82.00000,39.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,79.54,,,,,,,73.80,79.54,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,outpatient,,,82.00000,39.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,79.54,,,,,,,21.32,79.54,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,inpatient,,,112.00000,53.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,108.64,,,,,,,100.80,108.64,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,outpatient,,,112.00000,53.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,108.64,,,,,,,29.12,108.64,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,inpatient,,,61.00000,29.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,outpatient,,,61.00000,29.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,inpatient,,,69.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,62.10,66.93,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,outpatient,,,69.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,17.94,66.93,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,inpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,inpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,46.80,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,outpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,13.52,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,inpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,inpatient,,,286.00000,137.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,277.42,,,,,,,257.40,277.42,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,outpatient,,,286.00000,137.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,277.42,,,,,,,74.36,277.42,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,inpatient,,,300.00000,144.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,291.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,outpatient,,,300.00000,144.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,291.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,inpatient,,,73.00000,35.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,70.81,,,,,,,65.70,70.81,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,outpatient,,,73.00000,35.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,70.81,,,,,,,18.98,70.81,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,inpatient,,,90.00000,43.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,87.30,,,,,,,81.00,87.30,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,outpatient,,,90.00000,43.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,87.30,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,inpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,outpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,inpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,46.80,50.44,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,inpatient,,,315.00000,151.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,305.55,,,,,,,283.50,305.55,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,outpatient,,,315.00000,151.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,305.55,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,inpatient,,,100.00000,48.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,outpatient,,,100.00000,48.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,inpatient,,,89.00000,42.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,86.33,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,outpatient,,,89.00000,42.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,86.33,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,inpatient,,,71.00000,34.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,63.90,68.87,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,outpatient,,,71.00000,34.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,18.46,68.87,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,inpatient,,,135.00000,65.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,130.95,,,,,,,121.50,130.95,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,outpatient,,,135.00000,65.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,130.95,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,inpatient,,,80.00000,38.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,77.60,,,,,,,72.00,77.60,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,outpatient,,,80.00000,38.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,77.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,inpatient,,,72.00000,34.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,inpatient,,,72.00000,34.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,inpatient,,,100.00000,48.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,outpatient,,,100.00000,48.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,inpatient,,,305.00000,147.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,295.85,,,,,,,274.50,295.85,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,outpatient,,,305.00000,147.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,295.85,,,,,,,79.30,295.85,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,inpatient,,,70.00000,33.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,63.00,67.90,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,outpatient,,,70.00000,33.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,inpatient,,,69.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,62.10,66.93,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,outpatient,,,69.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,17.94,66.93,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,inpatient,,,64.00000,30.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,57.60,62.08,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,outpatient,,,64.00000,30.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,16.64,62.08,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,inpatient,,,368.00000,177.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,356.96,,,,,,,331.20,356.96,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,outpatient,,,368.00000,177.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,356.96,,,,,,,95.68,356.96,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,inpatient,,,104.00000,50.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,100.88,,,,,,,93.60,100.88,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,outpatient,,,104.00000,50.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,100.88,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,inpatient,,,109.00000,52.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,105.73,,,,,,,98.10,105.73,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,outpatient,,,109.00000,52.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,105.73,,,,,,,28.34,105.73,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,inpatient,,,114.00000,54.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,102.60,110.58,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,outpatient,,,114.00000,54.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,inpatient,,,135.00000,65.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,130.95,,,,,,,121.50,130.95,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,outpatient,,,135.00000,65.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,130.95,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,inpatient,,,105.00000,50.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,101.85,,,,,,,94.50,101.85,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,outpatient,,,105.00000,50.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,101.85,,,,,,,27.30,101.85,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,inpatient,,,315.00000,151.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,305.55,,,,,,,283.50,305.55,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,outpatient,,,315.00000,151.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,305.55,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,inpatient,,,148.00000,71.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,143.56,,,,,,,133.20,143.56,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,outpatient,,,148.00000,71.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,143.56,,,,,,,38.48,143.56,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,inpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,outpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,inpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,60.30,64.99,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,outpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,17.42,64.99,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,inpatient,,,107.00000,51.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,103.79,,,,,,,96.30,103.79,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,outpatient,,,107.00000,51.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,103.79,,,,,,,27.82,103.79,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,inpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,outpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,inpatient,,,35.00000,16.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33.95,,,,,,,31.50,33.95,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,outpatient,,,35.00000,16.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33.95,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,inpatient,,,104.00000,50.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,100.88,,,,,,,93.60,100.88,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,outpatient,,,104.00000,50.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,100.88,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,inpatient,,,650.00000,313.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,630.50,,,,,,,585.00,630.50,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,outpatient,,,650.00000,313.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,630.50,,,,,,,169.00,630.50,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,inpatient,,,91.00000,43.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,88.27,,,,,,,81.90,88.27,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,outpatient,,,91.00000,43.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,88.27,,,,,,,23.66,88.27,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,inpatient,,,114.00000,54.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,102.60,110.58,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,outpatient,,,114.00000,54.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,inpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,46.80,50.44,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,inpatient,,,360.00000,173.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,349.20,,,,,,,324.00,349.20,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,outpatient,,,360.00000,173.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,349.20,,,,,,,93.60,349.20,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,inpatient,,,106.00000,51.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,outpatient,,,106.00000,51.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,inpatient,,,78.00000,37.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,70.20,75.66,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,outpatient,,,78.00000,37.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,inpatient,,,72.00000,34.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,outpatient,,,72.00000,34.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,inpatient,,,94.00000,45.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,91.18,,,,,,,84.60,91.18,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,outpatient,,,94.00000,45.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,91.18,,,,,,,24.44,91.18,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,inpatient,,,101.00000,48.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97.97,,,,,,,90.90,97.97,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,outpatient,,,101.00000,48.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97.97,,,,,,,26.26,97.97,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,inpatient,,,82.00000,39.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,79.54,,,,,,,73.80,79.54,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,outpatient,,,82.00000,39.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,79.54,,,,,,,21.32,79.54,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,inpatient,,,77.00000,37.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,outpatient,,,77.00000,37.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,inpatient,,,145.00000,69.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,140.65,,,,,,,130.50,140.65,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,outpatient,,,145.00000,69.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,140.65,,,,,,,37.70,140.65,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,inpatient,,,266.00000,128.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,258.02,,,,,,,239.40,258.02,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,outpatient,,,266.00000,128.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,258.02,,,,,,,69.16,258.02,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,inpatient,,,79.00000,38.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,71.10,76.63,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,outpatient,,,79.00000,38.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,20.54,76.63,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,inpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,outpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,inpatient,,,144.00000,69.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,139.68,,,,,,,129.60,139.68,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,outpatient,,,144.00000,69.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,139.68,,,,,,,37.44,139.68,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,inpatient,,,20.00000,9.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19.40,,,,,,,18.00,19.40,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,outpatient,,,20.00000,9.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,inpatient,,,208.00000,100.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,201.76,,,,,,,187.20,201.76,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,outpatient,,,208.00000,100.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,201.76,,,,,,,54.08,201.76,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,inpatient,,,135.00000,65.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,130.95,,,,,,,121.50,130.95,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,outpatient,,,135.00000,65.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,130.95,,,,,,,35.10,130.95,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,inpatient,,,131.00000,63.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,127.07,,,,,,,117.90,127.07,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,outpatient,,,131.00000,63.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,127.07,,,,,,,34.06,127.07,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,inpatient,,,69.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,62.10,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,outpatient,,,69.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,17.94,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,inpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,outpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,inpatient,,,25.00000,12.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,24.25,,,,,,,22.50,24.25,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,outpatient,,,25.00000,12.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,24.25,,,,,,,6.50,24.25,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,inpatient,,,61.00000,29.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,outpatient,,,61.00000,29.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,inpatient,,,80.00000,38.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,77.60,,,,,,,72.00,77.60,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,outpatient,,,80.00000,38.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,77.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,inpatient,,,82.00000,39.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,79.54,,,,,,,73.80,79.54,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,outpatient,,,82.00000,39.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,79.54,,,,,,,21.32,79.54,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,inpatient,,,35.00000,16.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33.95,,,,,,,31.50,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,outpatient,,,35.00000,16.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33.95,,,,,,,9.10,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,inpatient,,,88.00000,42.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,85.36,,,,,,,79.20,85.36,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,outpatient,,,88.00000,42.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,85.36,,,,,,,22.88,85.36,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,inpatient,,,98.00000,47.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,88.20,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,outpatient,,,98.00000,47.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,25.48,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,inpatient,,,204.00000,98.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,197.88,,,,,,,183.60,197.88,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,outpatient,,,204.00000,98.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,197.88,,,,,,,53.04,197.88,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,inpatient,,,61.00000,29.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,outpatient,,,61.00000,29.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,inpatient,,,19.00000,9.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,18.43,,,,,,,17.10,18.43,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,outpatient,,,19.00000,9.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,18.43,,,,,,,4.94,18.43,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,inpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,outpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,inpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,outpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,inpatient,,,37.00000,17.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,35.89,,,,,,,33.30,35.89,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,outpatient,,,37.00000,17.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,35.89,,,,,,,9.62,35.89,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,inpatient,,,79.00000,38.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,71.10,76.63,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,outpatient,,,79.00000,38.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,20.54,76.63,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,inpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,outpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,inpatient,,,21.00000,10.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,20.37,,,,,,,18.90,20.37,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,outpatient,,,21.00000,10.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,20.37,,,,,,,5.46,20.37,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,inpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,46.80,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,outpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,13.52,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,inpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,outpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,inpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,outpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,inpatient,,,32.00000,15.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31.04,,,,,,,28.80,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,outpatient,,,32.00000,15.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31.04,,,,,,,8.32,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,inpatient,,,94.00000,45.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,91.18,,,,,,,84.60,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,outpatient,,,94.00000,45.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,91.18,,,,,,,24.44,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,inpatient,,,103.00000,49.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,99.91,,,,,,,92.70,99.91,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,outpatient,,,103.00000,49.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,99.91,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,inpatient,,,64.00000,30.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,57.60,62.08,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,outpatient,,,64.00000,30.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,16.64,62.08,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,inpatient,,,102.00000,49.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,91.80,98.94,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,outpatient,,,102.00000,49.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,26.52,98.94,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,inpatient,,,103.00000,49.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,99.91,,,,,,,92.70,99.91,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,outpatient,,,103.00000,49.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,99.91,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,inpatient,,,139.00000,67.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,134.83,,,,,,,125.10,134.83,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,outpatient,,,139.00000,67.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,134.83,,,,,,,36.14,134.83,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,inpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,46.80,50.44,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,outpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,13.52,50.44,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,inpatient,,,21.00000,10.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,20.37,,,,,,,18.90,20.37,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,20.37,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,inpatient,,,88.00000,42.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,85.36,,,,,,,79.20,85.36,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,outpatient,,,88.00000,42.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,85.36,,,,,,,22.88,85.36,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,inpatient,,,21.00000,10.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,20.37,,,,,,,18.90,20.37,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,20.37,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,inpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,46.80,50.44,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,outpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,13.52,50.44,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,inpatient,,,80.00000,38.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,77.60,,,,,,,72.00,77.60,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,outpatient,,,80.00000,38.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,77.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,inpatient,,,49.00000,23.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,47.53,,,,,,,44.10,47.53,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,outpatient,,,49.00000,23.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,47.53,,,,,,,12.74,47.53,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,inpatient,,,88.00000,42.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,85.36,,,,,,,79.20,85.36,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,outpatient,,,88.00000,42.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,85.36,,,,,,,22.88,85.36,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,inpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,outpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,inpatient,,,68.00000,32.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,61.20,65.96,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,outpatient,,,68.00000,32.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,17.68,65.96,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,inpatient,,,93.00000,44.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,90.21,,,,,,,83.70,90.21,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,outpatient,,,93.00000,44.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,90.21,,,,,,,24.18,90.21,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,inpatient,,,73.00000,35.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,70.81,,,,,,,65.70,70.81,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,outpatient,,,73.00000,35.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,70.81,,,,,,,18.98,70.81,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,inpatient,,,41.00000,19.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,39.77,,,,,,,36.90,39.77,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,outpatient,,,41.00000,19.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,39.77,,,,,,,10.66,39.77,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,inpatient,,,94.00000,45.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,91.18,,,,,,,84.60,91.18,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,outpatient,,,94.00000,45.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,91.18,,,,,,,24.44,91.18,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,inpatient,,,124.00000,59.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,120.28,,,,,,,111.60,120.28,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,outpatient,,,124.00000,59.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,120.28,,,,,,,32.24,120.28,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,inpatient,,,71.00000,34.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,63.90,68.87,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,outpatient,,,71.00000,34.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,18.46,68.87,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,inpatient,,,33.00000,15.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,32.01,,,,,,,29.70,32.01,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,outpatient,,,33.00000,15.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,32.01,,,,,,,8.58,32.01,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,inpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,46.80,50.44,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,outpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,13.52,50.44,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,inpatient,,,68.00000,32.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,61.20,65.96,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,outpatient,,,68.00000,32.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,17.68,65.96,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,inpatient,,,99.00000,47.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,96.03,,,,,,,89.10,96.03,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,outpatient,,,99.00000,47.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,96.03,,,,,,,25.74,96.03,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,inpatient,,,197.00000,94.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,191.09,,,,,,,177.30,191.09,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,outpatient,,,197.00000,94.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,191.09,,,,,,,51.22,191.09,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,inpatient,,,194.00000,93.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,188.18,,,,,,,174.60,188.18,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,outpatient,,,194.00000,93.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,188.18,,,,,,,50.44,188.18,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,inpatient,,,68.00000,32.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,61.20,65.96,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,outpatient,,,68.00000,32.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,17.68,65.96,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,inpatient,,,90.00000,43.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,87.30,,,,,,,81.00,87.30,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,outpatient,,,90.00000,43.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,87.30,,,,,,,23.40,87.30,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,inpatient,,,109.00000,52.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,105.73,,,,,,,98.10,105.73,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,outpatient,,,109.00000,52.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,105.73,,,,,,,28.34,105.73,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,inpatient,,,108.00000,52.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,104.76,,,,,,,97.20,104.76,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,outpatient,,,108.00000,52.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,104.76,,,,,,,28.08,104.76,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,inpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,60.30,64.99,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,outpatient,,,67.00000,32.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,17.42,64.99,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,inpatient,,,69.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,62.10,66.93,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,outpatient,,,69.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,inpatient,,,71.00000,34.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,63.90,68.87,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,outpatient,,,71.00000,34.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,18.46,68.87,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,inpatient,,,98.00000,47.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,88.20,95.06,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,outpatient,,,98.00000,47.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,25.48,95.06,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,inpatient,,,141.00000,67.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,136.77,,,,,,,126.90,136.77,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,outpatient,,,141.00000,67.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,136.77,,,,,,,36.66,136.77,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,inpatient,,,226.00000,108.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,219.22,,,,,,,203.40,219.22,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,outpatient,,,226.00000,108.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,219.22,,,,,,,58.76,219.22,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,inpatient,,,92.00000,44.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,89.24,,,,,,,82.80,89.24,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,outpatient,,,92.00000,44.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,89.24,,,,,,,23.92,89.24,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,inpatient,,,69.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,62.10,66.93,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,outpatient,,,69.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,inpatient,,,100.00000,48.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,outpatient,,,100.00000,48.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,inpatient,,,124.00000,59.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,120.28,,,,,,,111.60,120.28,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,outpatient,,,124.00000,59.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,120.28,,,,,,,32.24,120.28,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,inpatient,,,69.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,62.10,66.93,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,outpatient,,,69.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,17.94,66.93,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,120.28,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,120.28,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,120.28,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,120.28,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,120.28,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,120.28,,,,,,,32.24,120.28,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,inpatient,,,118.00000,56.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,114.46,,,,,,,106.20,114.46,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,outpatient,,,118.00000,56.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,114.46,,,,,,,30.68,114.46,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,inpatient,,,51.00000,24.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,45.90,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,outpatient,,,51.00000,24.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,13.26,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,inpatient,,,104.00000,50.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,100.88,,,,,,,93.60,100.88,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,outpatient,,,104.00000,50.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,100.88,,,,,,,27.04,100.88,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,inpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,outpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,inpatient,,,72.00000,34.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,64.80,69.84,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,outpatient,,,72.00000,34.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,18.72,69.84,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,inpatient,,,54.00000,26.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,48.60,52.38,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,outpatient,,,54.00000,26.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,14.04,52.38,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,inpatient,,,17.00000,8.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16.49,,,,,,,15.30,16.49,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,outpatient,,,17.00000,8.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16.49,,,,,,,4.42,16.49,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,inpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,outpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,inpatient,,,36.00000,17.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,32.40,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,outpatient,,,36.00000,17.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,9.36,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,inpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,46.80,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,outpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,13.52,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,inpatient,,,18.00000,8.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,17.46,,,,,,,16.20,17.46,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,outpatient,,,18.00000,8.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,17.46,,,,,,,4.68,17.46,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,inpatient,,,74.00000,35.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,71.78,,,,,,,66.60,71.78,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,outpatient,,,74.00000,35.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,71.78,,,,,,,19.24,71.78,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,inpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,outpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,inpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,outpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,inpatient,,,118.00000,56.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,114.46,,,,,,,106.20,114.46,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,outpatient,,,118.00000,56.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,114.46,,,,,,,30.68,114.46,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,inpatient,,,82.00000,39.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,79.54,,,,,,,73.80,79.54,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,outpatient,,,82.00000,39.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,79.54,,,,,,,21.32,79.54,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,inpatient,,,30.00000,14.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29.10,,,,,,,27.00,29.10,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,outpatient,,,30.00000,14.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29.10,,,,,,,7.80,29.10,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,inpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,outpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,inpatient,,,70.00000,33.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,63.00,67.90,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,outpatient,,,70.00000,33.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,18.20,67.90,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,inpatient,,,54.00000,26.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,48.60,52.38,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,outpatient,,,54.00000,26.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,14.04,52.38,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,inpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,outpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,inpatient,,,51.00000,24.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,45.90,49.47,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,outpatient,,,51.00000,24.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,inpatient,,,141.00000,67.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,136.77,,,,,,,126.90,136.77,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,outpatient,,,141.00000,67.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,136.77,,,,,,,36.66,136.77,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,inpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,outpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,inpatient,,,81.00000,39.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,72.90,78.57,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,outpatient,,,81.00000,39.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,21.06,78.57,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,inpatient,,,335.00000,161.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,324.95,,,,,,,301.50,324.95,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,outpatient,,,335.00000,161.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,324.95,,,,,,,87.10,324.95,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,inpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,46.80,50.44,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,outpatient,,,52.00000,25.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,13.52,50.44,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,inpatient,,,54.00000,26.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,48.60,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,inpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,outpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,inpatient,,,54.00000,26.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,48.60,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,inpatient,,,53.00000,25.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,47.70,51.41,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,outpatient,,,53.00000,25.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,inpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,outpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,inpatient,,,53.00000,25.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,47.70,51.41,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,outpatient,,,53.00000,25.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,inpatient,,,12.00000,5.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11.64,,,,,,,10.80,11.64,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,outpatient,,,12.00000,5.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11.64,,,,,,,3.12,11.64,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,inpatient,,,710.00000,342.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,688.70,,,,,,,639.00,688.70,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,outpatient,,,710.00000,342.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,688.70,,,,,,,184.60,688.70,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,inpatient,,,104.00000,50.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,100.88,,,,,,,93.60,100.88,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,outpatient,,,104.00000,50.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,100.88,,,,,,,27.04,100.88,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,inpatient,,,155.00000,74.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,150.35,,,,,,,139.50,150.35,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,outpatient,,,155.00000,74.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,150.35,,,,,,,40.30,150.35,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,inpatient,,,139.00000,67.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,134.83,,,,,,,125.10,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,outpatient,,,139.00000,67.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,134.83,,,,,,,36.14,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,inpatient,,,89.00000,42.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,86.33,,,,,,,80.10,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,outpatient,,,89.00000,42.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,86.33,,,,,,,23.14,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,inpatient,,,88.00000,42.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,85.36,,,,,,,79.20,85.36,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,outpatient,,,88.00000,42.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,85.36,,,,,,,22.88,85.36,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,inpatient,,,111.00000,53.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,107.67,,,,,,,99.90,107.67,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,outpatient,,,111.00000,53.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,107.67,,,,,,,28.86,107.67,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,inpatient,,,70.00000,33.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,63.00,67.90,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,outpatient,,,70.00000,33.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,18.20,67.90,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,inpatient,,,85.00000,40.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,82.45,,,,,,,76.50,82.45,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,outpatient,,,85.00000,40.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,82.45,,,,,,,22.10,82.45,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,inpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,outpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,inpatient,,,110.00000,53.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,99.00,106.70,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,outpatient,,,110.00000,53.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,28.60,106.70,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,inpatient,,,500.00000,241.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,485.00,,,,,,,450.00,485.00,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,outpatient,,,500.00000,241.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,485.00,,,,,,,130.00,485.00,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,inpatient,,,140.00000,67.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,135.80,,,,,,,126.00,135.80,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,outpatient,,,140.00000,67.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,135.80,,,,,,,36.40,135.80,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,inpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,outpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,inpatient,,,74.00000,35.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,71.78,,,,,,,66.60,71.78,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,outpatient,,,74.00000,35.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,71.78,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,inpatient,,,77.00000,37.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,outpatient,,,77.00000,37.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,inpatient,,,93.00000,44.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,90.21,,,,,,,83.70,90.21,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,outpatient,,,93.00000,44.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,90.21,,,,,,,24.18,90.21,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,inpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,outpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,inpatient,,,15.00000,7.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14.55,,,,,,,13.50,14.55,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,outpatient,,,15.00000,7.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,14.55,,,,,,,3.90,14.55,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,inpatient,,,24.00000,11.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,23.28,,,,,,,21.60,23.28,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,outpatient,,,24.00000,11.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,23.28,,,,,,,6.24,23.28,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,inpatient,,,72.00000,34.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,64.80,69.84,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,outpatient,,,72.00000,34.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,18.72,69.84,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,inpatient,,,16.00000,7.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,15.52,,,,,,,14.40,15.52,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,15.52,,,,,,,4.16,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,inpatient,,,16.00000,7.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,15.52,,,,,,,14.40,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,15.52,,,,,,,4.16,15.52,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,inpatient,,,64.00000,30.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,57.60,62.08,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,outpatient,,,64.00000,30.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,16.64,62.08,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,inpatient,,,82.00000,39.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,79.54,,,,,,,73.80,79.54,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,outpatient,,,82.00000,39.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,79.54,,,,,,,21.32,79.54,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,inpatient,,,157.00000,75.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,152.29,,,,,,,141.30,152.29,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,outpatient,,,157.00000,75.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,152.29,,,,,,,40.82,152.29,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,inpatient,,,70.00000,33.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,63.00,67.90,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,outpatient,,,70.00000,33.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,18.20,67.90,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,inpatient,,,229.00000,110.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,222.13,,,,,,,206.10,222.13,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,outpatient,,,229.00000,110.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,222.13,,,,,,,59.54,222.13,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,inpatient,,,64.00000,30.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,57.60,62.08,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,outpatient,,,64.00000,30.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,16.64,62.08,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,inpatient,,,72.00000,34.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,64.80,69.84,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,outpatient,,,72.00000,34.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,18.72,69.84,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,inpatient,,,17.00000,8.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16.49,,,,,,,15.30,16.49,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,outpatient,,,17.00000,8.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16.49,,,,,,,4.42,16.49,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,inpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,outpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,inpatient,,,64.00000,30.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,57.60,62.08,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,outpatient,,,64.00000,30.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,16.64,62.08,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,inpatient,,,387.00000,186.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,375.39,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,outpatient,,,387.00000,186.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,375.39,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,inpatient,,,387.00000,186.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,375.39,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,375.39,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,inpatient,,,387.00000,186.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,375.39,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,375.39,,,,,,,100.62,375.39,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,inpatient,,,77.00000,37.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,outpatient,,,77.00000,37.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,inpatient,,,78.00000,37.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,70.20,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,20.28,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,inpatient,,,78.00000,37.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,70.20,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,20.28,75.66,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,inpatient,,,43.00000,20.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,41.71,,,,,,,38.70,41.71,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,outpatient,,,43.00000,20.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,41.71,,,,,,,11.18,41.71,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,inpatient,,,64.00000,30.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,57.60,62.08,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,outpatient,,,64.00000,30.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,16.64,62.08,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,inpatient,,,160.00000,77.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,155.20,,,,,,,144.00,155.20,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,outpatient,,,160.00000,77.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,155.20,,,,,,,41.60,155.20,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,inpatient,,,112.00000,53.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,108.64,,,,,,,100.80,108.64,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,outpatient,,,112.00000,53.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,108.64,,,,,,,29.12,108.64,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,inpatient,,,82.00000,39.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,79.54,,,,,,,73.80,79.54,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,outpatient,,,82.00000,39.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,79.54,,,,,,,21.32,79.54,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,inpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,outpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,inpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,outpatient,,,55.00000,26.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,inpatient,,,54.00000,26.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,48.60,52.38,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,outpatient,,,54.00000,26.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,14.04,52.38,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,inpatient,,,153.00000,73.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,148.41,,,,,,,137.70,148.41,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,outpatient,,,153.00000,73.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,148.41,,,,,,,39.78,148.41,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,inpatient,,,45.00000,21.69000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,43.65,,,,,,,40.50,43.65,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,outpatient,,,45.00000,21.69000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,43.65,,,,,,,11.70,43.65,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,inpatient,,,28.00000,13.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,27.16,,,,,,,25.20,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,outpatient,,,28.00000,13.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,27.16,,,,,,,7.28,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,inpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,outpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,47.53,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,47.53,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,47.53,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,47.53,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,47.53,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,47.53,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,inpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,outpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,inpatient,,,36.00000,17.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,32.40,34.92,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,outpatient,,,36.00000,17.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,9.36,34.92,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,inpatient,,,38.00000,18.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,36.86,,,,,,,34.20,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,outpatient,,,38.00000,18.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,36.86,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,inpatient,,,38.00000,18.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,36.86,,,,,,,34.20,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,outpatient,,,38.00000,18.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,36.86,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,inpatient,,,76.00000,36.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,73.72,,,,,,,68.40,73.72,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,outpatient,,,76.00000,36.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,73.72,,,,,,,19.76,73.72,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,inpatient,,,173.00000,83.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,167.81,,,,,,,155.70,167.81,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,outpatient,,,173.00000,83.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,167.81,,,,,,,44.98,167.81,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,inpatient,,,22.00000,10.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21.34,,,,,,,19.80,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,outpatient,,,22.00000,10.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,21.34,,,,,,,5.72,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,inpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,outpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,inpatient,,,39.00000,18.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,37.83,,,,,,,35.10,37.83,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,outpatient,,,39.00000,18.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,37.83,,,,,,,10.14,37.83,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,inpatient,,,41.00000,19.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,39.77,,,,,,,36.90,39.77,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,outpatient,,,41.00000,19.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,39.77,,,,,,,10.66,39.77,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,inpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,outpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,inpatient,,,54.00000,26.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,48.60,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,outpatient,,,54.00000,26.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,14.04,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,inpatient,,,71.00000,34.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,63.90,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,outpatient,,,71.00000,34.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,18.46,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,inpatient,,,43.00000,20.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,41.71,,,,,,,38.70,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,41.71,,,,,,,11.18,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,inpatient,,,43.00000,20.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,41.71,,,,,,,38.70,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,41.71,,,,,,,11.18,41.71,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,inpatient,,,38.00000,18.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,36.86,,,,,,,34.20,36.86,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,outpatient,,,38.00000,18.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,36.86,,,,,,,9.88,36.86,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,inpatient,,,72.00000,34.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,64.80,69.84,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,outpatient,,,72.00000,34.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,18.72,69.84,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,inpatient,,,226.00000,108.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,219.22,,,,,,,203.40,219.22,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,outpatient,,,226.00000,108.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,219.22,,,,,,,58.76,219.22,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,39.77,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,39.77,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,39.77,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,39.77,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,39.77,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,39.77,,,,,,,10.66,39.77,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,inpatient,,,160.00000,77.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,155.20,,,,,,,144.00,155.20,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,outpatient,,,160.00000,77.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,155.20,,,,,,,41.60,155.20,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,inpatient,,,102.00000,49.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,91.80,98.94,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,outpatient,,,102.00000,49.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,26.52,98.94,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,inpatient,,,317.00000,152.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,307.49,,,,,,,285.30,307.49,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,outpatient,,,317.00000,152.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,307.49,,,,,,,82.42,307.49,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,inpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,outpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,inpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,outpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,inpatient,,,116.00000,55.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,112.52,,,,,,,104.40,112.52,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,outpatient,,,116.00000,55.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,112.52,,,,,,,30.16,112.52,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,inpatient,,,89.00000,42.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,86.33,,,,,,,80.10,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,86.33,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,inpatient,,,89.00000,42.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,86.33,,,,,,,80.10,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,86.33,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,inpatient,,,85.00000,40.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,82.45,,,,,,,76.50,82.45,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,outpatient,,,85.00000,40.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,82.45,,,,,,,22.10,82.45,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,inpatient,,,184.00000,88.69000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,178.48,,,,,,,165.60,178.48,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,outpatient,,,184.00000,88.69000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,178.48,,,,,,,47.84,178.48,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,inpatient,,,127.00000,61.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,123.19,,,,,,,114.30,123.19,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,outpatient,,,127.00000,61.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,123.19,,,,,,,33.02,123.19,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,inpatient,,,61.00000,29.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,outpatient,,,61.00000,29.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,inpatient,,,35.00000,16.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33.95,,,,,,,31.50,33.95,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,outpatient,,,35.00000,16.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33.95,,,,,,,9.10,33.95,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,inpatient,,,79.00000,38.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,71.10,76.63,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,outpatient,,,79.00000,38.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,20.54,76.63,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,inpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,outpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,inpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,outpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,inpatient,,,57.00000,32.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,outpatient,,,57.00000,32.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,148.41,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,148.41,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,inpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,outpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,inpatient,,,77.00000,44.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,outpatient,,,77.00000,44.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,inpatient,,,70.00000,40.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,63.00,67.90,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,outpatient,,,70.00000,40.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,inpatient,,,67.00000,38.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,60.30,64.99,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,outpatient,,,67.00000,38.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,inpatient,,,40.00000,23.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38.80,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,outpatient,,,40.00000,23.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38.80,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,inpatient,,,71.00000,40.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,outpatient,,,71.00000,40.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,inpatient,,,80.00000,46.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,77.60,,,,,,,72.00,77.60,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,outpatient,,,80.00000,46.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,77.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,inpatient,,,72.00000,41.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,outpatient,,,72.00000,41.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,inpatient,,,444.00000,255.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,430.68,,,,,,,399.60,430.68,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,outpatient,,,444.00000,255.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,430.68,,,,,,,115.44,430.68,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,inpatient,,,81.00000,46.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,72.90,78.57,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,outpatient,,,81.00000,46.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,21.06,78.57,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,inpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,outpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,inpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,inpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,inpatient,,,66.00000,38.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,outpatient,,,66.00000,38.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,inpatient,,,57.00000,32.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,outpatient,,,57.00000,32.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,inpatient,,,53.00000,30.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,outpatient,,,53.00000,30.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,inpatient,,,60.00000,34.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,outpatient,,,60.00000,34.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,inpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,outpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,inpatient,,,40.00000,23.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38.80,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,outpatient,,,40.00000,23.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38.80,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,inpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,outpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,inpatient,,,42.00000,24.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,40.74,,,,,,,37.80,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,outpatient,,,42.00000,24.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,40.74,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,inpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,outpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,inpatient,,,46.00000,26.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,44.62,,,,,,,41.40,44.62,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,outpatient,,,46.00000,26.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,44.62,,,,,,,11.96,44.62,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,inpatient,,,54.00000,31.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,outpatient,,,54.00000,31.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,inpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,outpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,inpatient,,,71.00000,40.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,outpatient,,,71.00000,40.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,inpatient,,,54.00000,31.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,outpatient,,,54.00000,31.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,inpatient,,,80.00000,46.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,77.60,,,,,,,72.00,77.60,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,outpatient,,,80.00000,46.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,77.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,inpatient,,,60.00000,34.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,outpatient,,,60.00000,34.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,inpatient,,,124.00000,71.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,120.28,,,,,,,111.60,120.28,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,120.28,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,inpatient,,,130.00000,74.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,126.10,,,,,,,117.00,126.10,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,outpatient,,,130.00000,74.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,126.10,,,,,,,33.80,126.10,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,inpatient,,,123.00000,70.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,119.31,,,,,,,110.70,119.31,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,119.31,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,inpatient,,,77.00000,44.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,outpatient,,,77.00000,44.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,inpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,outpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,inpatient,,,115.00000,66.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,111.55,,,,,,,103.50,111.55,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,outpatient,,,115.00000,66.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,111.55,,,,,,,29.90,111.55,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,inpatient,,,123.00000,70.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,119.31,,,,,,,110.70,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,119.31,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,inpatient,,,161.00000,92.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,156.17,,,,,,,144.90,156.17,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,outpatient,,,161.00000,92.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,156.17,,,,,,,41.86,156.17,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,inpatient,,,124.00000,71.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,120.28,,,,,,,111.60,120.28,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,120.28,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,inpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,outpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,inpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,outpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,inpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,outpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,inpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,outpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,inpatient,,,102.00000,58.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,91.80,98.94,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,outpatient,,,102.00000,58.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,inpatient,,,219.00000,126.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,212.43,,,,,,,197.10,212.43,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,outpatient,,,219.00000,126.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,212.43,,,,,,,56.94,212.43,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,inpatient,,,194.00000,111.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,188.18,,,,,,,174.60,188.18,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,188.18,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,inpatient,,,103.00000,59.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,99.91,,,,,,,92.70,99.91,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,outpatient,,,103.00000,59.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,99.91,,,,,,,26.78,99.91,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,inpatient,,,60.00000,34.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,outpatient,,,60.00000,34.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,inpatient,,,837.00000,482.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,811.89,,,,,,,753.30,811.89,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,outpatient,,,837.00000,482.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,811.89,,,,,,,217.62,811.89,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,inpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,inpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,inpatient,,,194.00000,111.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,188.18,,,,,,,174.60,188.18,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,188.18,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,inpatient,,,78.00000,44.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,70.20,75.66,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,outpatient,,,78.00000,44.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,inpatient,,,285.00000,164.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,276.45,,,,,,,256.50,276.45,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,outpatient,,,285.00000,164.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,276.45,,,,,,,74.10,276.45,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,inpatient,,,190.00000,109.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,184.30,,,,,,,171.00,184.30,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,outpatient,,,190.00000,109.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,184.30,,,,,,,49.40,184.30,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,inpatient,,,100.00000,57.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,outpatient,,,100.00000,57.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,inpatient,,,40.00000,23.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38.80,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38.80,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,inpatient,,,67.00000,38.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,60.30,64.99,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,outpatient,,,67.00000,38.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.99,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,inpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,outpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,inpatient,,,78.00000,44.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,70.20,75.66,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,outpatient,,,78.00000,44.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,inpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,outpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,inpatient,,,57.00000,32.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,outpatient,,,57.00000,32.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,inpatient,,,72.00000,41.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,outpatient,,,72.00000,41.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,inpatient,,,59.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,outpatient,,,59.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,inpatient,,,72.00000,41.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,outpatient,,,72.00000,41.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,inpatient,,,239.00000,137.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,231.83,,,,,,,215.10,231.83,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,outpatient,,,239.00000,137.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,231.83,,,,,,,62.14,231.83,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,inpatient,,,85.00000,48.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,82.45,,,,,,,76.50,82.45,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,outpatient,,,85.00000,48.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,82.45,,,,,,,22.10,82.45,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,inpatient,,,44.00000,25.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42.68,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,outpatient,,,44.00000,25.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42.68,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,inpatient,,,40.00000,23.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38.80,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,outpatient,,,40.00000,23.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38.80,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,inpatient,,,53.00000,30.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,outpatient,,,53.00000,30.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,inpatient,,,59.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,inpatient,,,59.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,inpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,outpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,inpatient,,,68.00000,39.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,outpatient,,,68.00000,39.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,inpatient,,,76.00000,43.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,73.72,,,,,,,68.40,73.72,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,outpatient,,,76.00000,43.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,73.72,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,inpatient,,,42.00000,24.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,40.74,,,,,,,37.80,40.74,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,outpatient,,,42.00000,24.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,40.74,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,inpatient,,,87.00000,50.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84.39,,,,,,,78.30,84.39,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,outpatient,,,87.00000,50.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84.39,,,,,,,22.62,84.39,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,inpatient,,,503.00000,289.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,487.91,,,,,,,452.70,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,outpatient,,,503.00000,289.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,487.91,,,,,,,130.78,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,inpatient,,,472.00000,271.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,457.84,,,,,,,424.80,457.84,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,outpatient,,,472.00000,271.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,457.84,,,,,,,122.72,457.84,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,inpatient,,,28.00000,16.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,27.16,,,,,,,25.20,27.16,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,outpatient,,,28.00000,16.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,27.16,,,,,,,7.28,27.16,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,inpatient,,,236.00000,135.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,228.92,,,,,,,212.40,228.92,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,outpatient,,,236.00000,135.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,228.92,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,inpatient,,,54.00000,31.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,outpatient,,,54.00000,31.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,inpatient,,,238.00000,137.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,230.86,,,,,,,214.20,230.86,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,outpatient,,,238.00000,137.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,230.86,,,,,,,61.88,230.86,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,inpatient,,,236.00000,135.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,228.92,,,,,,,212.40,228.92,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,outpatient,,,236.00000,135.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,228.92,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,inpatient,,,145.00000,83.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,140.65,,,,,,,130.50,140.65,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,outpatient,,,145.00000,83.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,140.65,,,,,,,37.70,140.65,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,inpatient,,,68.00000,39.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,inpatient,,,68.00000,39.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,inpatient,,,66.00000,38.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,outpatient,,,66.00000,38.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,inpatient,,,59.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,outpatient,,,59.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,inpatient,,,158.00000,91.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,153.26,,,,,,,142.20,153.26,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,outpatient,,,158.00000,91.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,153.26,,,,,,,41.08,153.26,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,inpatient,,,71.00000,40.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,outpatient,,,71.00000,40.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,inpatient,,,144.00000,82.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,139.68,,,,,,,129.60,139.68,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,outpatient,,,144.00000,82.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,139.68,,,,,,,37.44,139.68,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,inpatient,,,1448.00000,834.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1404.56,,,,,,,1303.20,1404.56,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,outpatient,,,1448.00000,834.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1404.56,,,,,,,376.48,1404.56,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,inpatient,,,72.00000,41.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,outpatient,,,72.00000,41.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,inpatient,,,102.00000,58.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,91.80,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,outpatient,,,102.00000,58.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,inpatient,,,154.00000,88.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,149.38,,,,,,,138.60,149.38,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,outpatient,,,154.00000,88.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,149.38,,,,,,,40.04,149.38,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,148.41,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,148.41,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,inpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,outpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,inpatient,,,66.00000,38.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,outpatient,,,66.00000,38.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,148.41,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,148.41,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,inpatient,,,44.00000,25.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42.68,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,outpatient,,,44.00000,25.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42.68,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,inpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,outpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,inpatient,,,150.00000,86.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,145.50,,,,,,,135.00,145.50,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,outpatient,,,150.00000,86.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,145.50,,,,,,,39.00,145.50,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,inpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,outpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,inpatient,,,56.00000,32.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,outpatient,,,56.00000,32.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,inpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,outpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,inpatient,,,66.00000,38.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,outpatient,,,66.00000,38.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,inpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,inpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,inpatient,,,60.00000,34.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,outpatient,,,60.00000,34.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,inpatient,,,58.00000,33.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,outpatient,,,58.00000,33.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,inpatient,,,71.00000,40.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,outpatient,,,71.00000,40.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,inpatient,,,72.00000,41.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,outpatient,,,72.00000,41.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,inpatient,,,56.00000,32.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,inpatient,,,56.00000,32.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,inpatient,,,60.00000,34.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,outpatient,,,60.00000,34.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,inpatient,,,56.00000,32.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,outpatient,,,56.00000,32.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,inpatient,,,39.00000,22.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,37.83,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,outpatient,,,39.00000,22.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,37.83,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,148.41,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,148.41,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,inpatient,,,73.00000,42.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,70.81,,,,,,,65.70,70.81,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,outpatient,,,73.00000,42.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,70.81,,,,,,,18.98,70.81,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,inpatient,,,127.00000,73.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,123.19,,,,,,,114.30,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,123.19,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,inpatient,,,127.00000,73.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,123.19,,,,,,,114.30,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,123.19,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,inpatient,,,372.00000,214.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,360.84,,,,,,,334.80,360.84,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,outpatient,,,372.00000,214.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,360.84,,,,,,,96.72,360.84,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,inpatient,,,69.00000,39.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,62.10,66.93,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,outpatient,,,69.00000,39.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,148.41,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,148.41,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,148.41,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,148.41,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,inpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,outpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,inpatient,,,57.00000,32.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,outpatient,,,57.00000,32.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,inpatient,,,96.00000,55.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,93.12,,,,,,,86.40,93.12,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,outpatient,,,96.00000,55.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,93.12,,,,,,,24.96,93.12,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,inpatient,,,44.00000,25.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42.68,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,outpatient,,,44.00000,25.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42.68,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,inpatient,,,60.00000,34.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,outpatient,,,60.00000,34.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,inpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,outpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,inpatient,,,60.00000,34.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,outpatient,,,60.00000,34.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,inpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,outpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,inpatient,,,74.00000,42.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,71.78,,,,,,,66.60,71.78,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,outpatient,,,74.00000,42.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,71.78,,,,,,,19.24,71.78,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,inpatient,,,69.00000,39.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,62.10,66.93,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,outpatient,,,69.00000,39.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,37.83,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,37.83,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,inpatient,,,53.00000,30.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,outpatient,,,53.00000,30.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,37.83,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,37.83,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,37.83,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,37.83,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,inpatient,,,70.00000,40.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,63.00,67.90,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,outpatient,,,70.00000,40.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,inpatient,,,71.00000,40.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,outpatient,,,71.00000,40.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,inpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,outpatient,,,65.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,inpatient,,,325.00000,187.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,315.25,,,,,,,292.50,315.25,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,outpatient,,,325.00000,187.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,315.25,,,,,,,84.50,315.25,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,inpatient,,,72.00000,41.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,outpatient,,,72.00000,41.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,inpatient,,,72.00000,41.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,outpatient,,,72.00000,41.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,69.84,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,inpatient,,,76.00000,43.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,73.72,,,,,,,68.40,73.72,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,outpatient,,,76.00000,43.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,73.72,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,inpatient,,,240.00000,138.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,232.80,,,,,,,216.00,232.80,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,outpatient,,,240.00000,138.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,232.80,,,,,,,62.40,232.80,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,inpatient,,,93.00000,53.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,90.21,,,,,,,83.70,90.21,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,outpatient,,,93.00000,53.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,90.21,,,,,,,24.18,90.21,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,inpatient,,,59.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,outpatient,,,59.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,inpatient,,,81.00000,46.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,72.90,78.57,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,outpatient,,,81.00000,46.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,21.06,78.57,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,inpatient,,,58.00000,33.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,outpatient,,,58.00000,33.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,inpatient,,,21.00000,12.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,20.37,,,,,,,18.90,20.37,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,outpatient,,,21.00000,12.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,20.37,,,,,,,5.46,20.37,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,inpatient,,,56.00000,32.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,outpatient,,,56.00000,32.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,inpatient,,,64.00000,36.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,57.60,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,outpatient,,,64.00000,36.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,16.64,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,inpatient,,,80.00000,46.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,77.60,,,,,,,72.00,77.60,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,outpatient,,,80.00000,46.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,77.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,inpatient,,,109.00000,62.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,105.73,,,,,,,98.10,105.73,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,outpatient,,,109.00000,62.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,105.73,,,,,,,28.34,105.73,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,inpatient,,,59.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,outpatient,,,59.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,inpatient,,,115.00000,66.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,111.55,,,,,,,103.50,111.55,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,outpatient,,,115.00000,66.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,111.55,,,,,,,29.90,111.55,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,inpatient,,,57.00000,32.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,outpatient,,,57.00000,32.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,inpatient,,,118.00000,67.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,114.46,,,,,,,106.20,114.46,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,outpatient,,,118.00000,67.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,114.46,,,,,,,30.68,114.46,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,inpatient,,,268.00000,154.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,259.96,,,,,,,241.20,259.96,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,outpatient,,,268.00000,154.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,259.96,,,,,,,69.68,259.96,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,inpatient,,,114.00000,65.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,102.60,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,29.64,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,inpatient,,,114.00000,65.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,102.60,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,29.64,110.58,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,inpatient,,,78.00000,44.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,70.20,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,outpatient,,,78.00000,44.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,20.28,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,inpatient,,,91.00000,52.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,88.27,,,,,,,81.90,88.27,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,outpatient,,,91.00000,52.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,88.27,,,,,,,23.66,88.27,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,inpatient,,,66.00000,38.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,inpatient,,,66.00000,38.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,inpatient,,,300.00000,172.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,291.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,outpatient,,,300.00000,172.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,291.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,inpatient,,,185.00000,106.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,179.45,,,,,,,166.50,179.45,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,outpatient,,,185.00000,106.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,179.45,,,,,,,48.10,179.45,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,inpatient,,,76.00000,43.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,73.72,,,,,,,68.40,73.72,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,outpatient,,,76.00000,43.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,73.72,,,,,,,19.76,73.72,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,inpatient,,,53.00000,30.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,47.70,51.41,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,outpatient,,,53.00000,30.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,13.78,51.41,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,inpatient,,,77.00000,44.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,outpatient,,,77.00000,44.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,inpatient,,,222.00000,127.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,215.34,,,,,,,199.80,215.34,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,outpatient,,,222.00000,127.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,215.34,,,,,,,57.72,215.34,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,inpatient,,,292.00000,168.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,283.24,,,,,,,262.80,283.24,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,outpatient,,,292.00000,168.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,283.24,,,,,,,75.92,283.24,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,inpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,outpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,inpatient,,,125.00000,72.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,121.25,,,,,,,112.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,121.25,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,inpatient,,,125.00000,72.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,121.25,,,,,,,112.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,121.25,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,inpatient,,,359.00000,206.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,323.10,348.23,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,outpatient,,,359.00000,206.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,93.34,348.23,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,inpatient,,,111.00000,63.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,107.67,,,,,,,99.90,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,outpatient,,,111.00000,63.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,107.67,,,,,,,28.86,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,inpatient,,,141.00000,81.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,136.77,,,,,,,126.90,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,136.77,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,inpatient,,,141.00000,81.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,136.77,,,,,,,126.90,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,136.77,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,inpatient,,,114.00000,65.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,inpatient,,,114.00000,65.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,inpatient,,,114.00000,65.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,inpatient,,,114.00000,65.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,29.64,110.58,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,inpatient,,,78.00000,44.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,70.20,75.66,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,outpatient,,,78.00000,44.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,20.28,75.66,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,inpatient,,,359.00000,206.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,323.10,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,93.34,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,inpatient,,,359.00000,206.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,323.10,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,93.34,348.23,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,inpatient,,,70.00000,40.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,63.00,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,outpatient,,,70.00000,40.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,18.20,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,inpatient,,,18.00000,10.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,17.46,,,,,,,16.20,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,outpatient,,,18.00000,10.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,17.46,,,,,,,4.68,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,inpatient,,,408.00000,235.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,395.76,,,,,,,367.20,395.76,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,outpatient,,,408.00000,235.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,395.76,,,,,,,106.08,395.76,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,inpatient,,,102.00000,58.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,91.80,98.94,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,outpatient,,,102.00000,58.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,26.52,98.94,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,inpatient,,,330.00000,190.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,320.10,,,,,,,297.00,320.10,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,outpatient,,,330.00000,190.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,320.10,,,,,,,85.80,320.10,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,inpatient,,,56.00000,32.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,outpatient,,,56.00000,32.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,inpatient,,,136.00000,78.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,131.92,,,,,,,122.40,131.92,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,outpatient,,,136.00000,78.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,131.92,,,,,,,35.36,131.92,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,inpatient,,,83.00000,47.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,80.51,,,,,,,74.70,80.51,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,outpatient,,,83.00000,47.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,80.51,,,,,,,21.58,80.51,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,inpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,outpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,inpatient,,,142.00000,81.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,137.74,,,,,,,127.80,137.74,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,outpatient,,,142.00000,81.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,137.74,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,inpatient,,,51.00000,29.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,45.90,49.47,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,outpatient,,,51.00000,29.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,13.26,49.47,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,inpatient,,,70.00000,40.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,63.00,67.90,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,outpatient,,,70.00000,40.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,67.90,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,inpatient,,,99.00000,57.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,96.03,,,,,,,89.10,96.03,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,outpatient,,,99.00000,57.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,96.03,,,,,,,25.74,96.03,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,inpatient,,,78.00000,44.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,70.20,75.66,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,outpatient,,,78.00000,44.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,inpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,outpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,inpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,inpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,outpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,inpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,inpatient,,,75.00000,43.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72.75,,,,,,,67.50,72.75,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,outpatient,,,75.00000,43.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72.75,,,,,,,19.50,72.75,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,inpatient,,,37.00000,21.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,35.89,,,,,,,33.30,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,35.89,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,inpatient,,,37.00000,21.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,35.89,,,,,,,33.30,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,35.89,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,inpatient,,,59.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,outpatient,,,59.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,inpatient,,,35.00000,20.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33.95,,,,,,,31.50,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,outpatient,,,35.00000,20.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33.95,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,inpatient,,,59.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,outpatient,,,59.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,inpatient,,,56.00000,32.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,outpatient,,,56.00000,32.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,inpatient,,,74.00000,42.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,71.78,,,,,,,66.60,71.78,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,outpatient,,,74.00000,42.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,71.78,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,inpatient,,,90.00000,51.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,87.30,,,,,,,81.00,87.30,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,outpatient,,,90.00000,51.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,87.30,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,inpatient,,,68.00000,39.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,61.20,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,inpatient,,,142.00000,81.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,137.74,,,,,,,127.80,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,outpatient,,,142.00000,81.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,137.74,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,inpatient,,,68.00000,39.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,61.20,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,inpatient,,,74.00000,42.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,71.78,,,,,,,66.60,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,outpatient,,,74.00000,42.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,71.78,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,inpatient,,,89.00000,51.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,86.33,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,86.33,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,inpatient,,,89.00000,51.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,86.33,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,86.33,,,,,,,23.14,86.33,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,inpatient,,,57.00000,32.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,outpatient,,,57.00000,32.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,inpatient,,,77.00000,44.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,outpatient,,,77.00000,44.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,inpatient,,,64.00000,36.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,57.60,62.08,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,outpatient,,,64.00000,36.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,16.64,62.08,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,inpatient,,,69.00000,39.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,62.10,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,outpatient,,,69.00000,39.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,17.94,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,inpatient,,,1178.00000,678.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1142.66,,,,,,,1060.20,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,outpatient,,,1178.00000,678.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1142.66,,,,,,,306.28,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,inpatient,,,127.00000,73.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,123.19,,,,,,,114.30,123.19,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,outpatient,,,127.00000,73.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,123.19,,,,,,,33.02,123.19,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,inpatient,,,277.00000,159.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,268.69,,,,,,,249.30,268.69,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,outpatient,,,277.00000,159.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,268.69,,,,,,,72.02,268.69,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,inpatient,,,940.00000,541.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,911.80,,,,,,,846.00,911.80,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,outpatient,,,940.00000,541.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,911.80,,,,,,,244.40,911.80,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,inpatient,,,97.00000,55.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,94.09,,,,,,,87.30,94.09,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,outpatient,,,97.00000,55.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,94.09,,,,,,,25.22,94.09,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,inpatient,,,16.00000,9.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,15.52,,,,,,,14.40,15.52,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,outpatient,,,16.00000,9.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,15.52,,,,,,,4.16,15.52,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,inpatient,,,57.00000,32.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,outpatient,,,57.00000,32.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,inpatient,,,131.00000,75.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,127.07,,,,,,,117.90,127.07,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,outpatient,,,131.00000,75.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,127.07,,,,,,,34.06,127.07,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,inpatient,,,2160.00000,1244.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2095.20,,,,,,,1944.00,2095.20,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,outpatient,,,2160.00000,1244.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2095.20,,,,,,,561.60,2095.20,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,inpatient,,,37.00000,21.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,35.89,,,,,,,33.30,35.89,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,outpatient,,,37.00000,21.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,35.89,,,,,,,9.62,35.89,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,inpatient,,,74.00000,42.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,71.78,,,,,,,66.60,71.78,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,71.78,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,inpatient,,,54.00000,31.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,48.60,52.38,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,outpatient,,,54.00000,31.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,inpatient,,,76.00000,43.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,73.72,,,,,,,68.40,73.72,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,outpatient,,,76.00000,43.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,73.72,,,,,,,19.76,73.72,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,inpatient,,,606.00000,349.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,587.82,,,,,,,545.40,587.82,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,outpatient,,,606.00000,349.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,587.82,,,,,,,157.56,587.82,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,inpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,outpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,inpatient,,,300.00000,172.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,291.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,outpatient,,,300.00000,172.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,291.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,inpatient,,,59.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,outpatient,,,59.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,inpatient,,,98.00000,56.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,88.20,95.06,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,outpatient,,,98.00000,56.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,25.48,95.06,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,inpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,outpatient,,,61.00000,35.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,inpatient,,,128.00000,73.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,124.16,,,,,,,115.20,124.16,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,outpatient,,,128.00000,73.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,124.16,,,,,,,33.28,124.16,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,inpatient,,,16.00000,9.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,15.52,,,,,,,14.40,15.52,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,outpatient,,,16.00000,9.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,15.52,,,,,,,4.16,15.52,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,inpatient,,,565.00000,325.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,548.05,,,,,,,508.50,548.05,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,outpatient,,,565.00000,325.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,548.05,,,,,,,146.90,548.05,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,inpatient,,,850.00000,489.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,outpatient,,,850.00000,489.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,inpatient,,,77.00000,44.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,69.30,74.69,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,outpatient,,,77.00000,44.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,74.69,,,,,,,20.02,74.69,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,inpatient,,,86.00000,49.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,83.42,,,,,,,77.40,83.42,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,outpatient,,,86.00000,49.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,83.42,,,,,,,22.36,83.42,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,inpatient,,,837.00000,482.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,811.89,,,,,,,753.30,811.89,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,outpatient,,,837.00000,482.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,811.89,,,,,,,217.62,811.89,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,inpatient,,,60.00000,34.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,outpatient,,,60.00000,34.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,inpatient,,,56.00000,32.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,outpatient,,,56.00000,32.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,inpatient,,,56.00000,32.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,outpatient,,,56.00000,32.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,inpatient,,,74.00000,42.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,71.78,,,,,,,66.60,71.78,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,71.78,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,inpatient,,,167.00000,96.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.99,,,,,,,150.30,161.99,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,outpatient,,,167.00000,96.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,161.99,,,,,,,43.42,161.99,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,inpatient,,,200.00000,115.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,194.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,outpatient,,,200.00000,115.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,194.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,inpatient,,,93.00000,53.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,90.21,,,,,,,83.70,90.21,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,outpatient,,,93.00000,53.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,90.21,,,,,,,24.18,90.21,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,inpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,49.50,53.35,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,53.35,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,inpatient,,,190.00000,109.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,184.30,,,,,,,171.00,184.30,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,outpatient,,,190.00000,109.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,184.30,,,,,,,49.40,184.30,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,inpatient,,,64.00000,36.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,57.60,62.08,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,outpatient,,,64.00000,36.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,16.64,62.08,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,inpatient,,,525.00000,302.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,509.25,,,,,,,472.50,509.25,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,outpatient,,,525.00000,302.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,509.25,,,,,,,136.50,509.25,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,inpatient,,,54.00000,31.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,48.60,52.38,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,outpatient,,,54.00000,31.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,inpatient,,,53.00000,30.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,outpatient,,,53.00000,30.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,inpatient,,,40.00000,23.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38.80,,,,,,,36.00,38.80,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38.80,,,,,,,10.40,38.80,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,inpatient,,,453.00000,260.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,439.41,,,,,,,407.70,439.41,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,outpatient,,,453.00000,260.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,439.41,,,,,,,117.78,439.41,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,inpatient,,,25.00000,14.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,24.25,,,,,,,22.50,24.25,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,outpatient,,,25.00000,14.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,24.25,,,,,,,6.50,24.25,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,inpatient,,,56.00000,32.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,outpatient,,,56.00000,32.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,inpatient,,,59.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,outpatient,,,59.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,inpatient,,,53.00000,30.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,outpatient,,,53.00000,30.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,inpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,outpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,inpatient,,,350.00000,201.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,339.50,,,,,,,315.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,outpatient,,,350.00000,201.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,339.50,,,,,,,91.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,inpatient,,,225.00000,129.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,218.25,,,,,,,202.50,218.25,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,outpatient,,,225.00000,129.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,218.25,,,,,,,58.50,218.25,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,inpatient,,,52.00000,29.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,46.80,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,outpatient,,,52.00000,29.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,13.52,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,inpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,outpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,inpatient,,,134.00000,77.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,129.98,,,,,,,120.60,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,outpatient,,,134.00000,77.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,129.98,,,,,,,34.84,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,inpatient,,,52.00000,29.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,46.80,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,outpatient,,,52.00000,29.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,13.52,50.44,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,inpatient,,,186.00000,107.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,180.42,,,,,,,167.40,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,outpatient,,,186.00000,107.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,180.42,,,,,,,48.36,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,inpatient,,,300.00000,172.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,291.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,291.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,inpatient,,,300.00000,172.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,291.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,291.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,inpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,outpatient,,,62.00000,35.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,inpatient,,,205.00000,118.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,198.85,,,,,,,184.50,198.85,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,outpatient,,,205.00000,118.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,198.85,,,,,,,53.30,198.85,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,inpatient,,,75.00000,36.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72.75,,,,,,,67.50,72.75,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,outpatient,,,75.00000,36.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72.75,,,,,,,19.50,72.75,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,inpatient,,,65.00000,31.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,58.50,63.05,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,outpatient,,,65.00000,31.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,16.90,63.05,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,inpatient,,,92.00000,44.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,89.24,,,,,,,82.80,89.24,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,outpatient,,,92.00000,44.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,89.24,,,,,,,23.92,89.24,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,inpatient,,,24.00000,11.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,23.28,,,,,,,21.60,23.28,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,23.28,,,,,,,6.24,23.28,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,inpatient,,,20.00000,9.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19.40,,,,,,,18.00,19.40,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,outpatient,,,20.00000,9.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,inpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,outpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,inpatient,,,42.00000,20.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,40.74,,,,,,,37.80,40.74,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,outpatient,,,42.00000,20.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,40.74,,,,,,,10.92,40.74,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,inpatient,,,69.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,62.10,66.93,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,outpatient,,,69.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,inpatient,,,65.00000,31.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,58.50,63.05,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,outpatient,,,65.00000,31.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,16.90,63.05,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,inpatient,,,76.00000,36.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,73.72,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,outpatient,,,76.00000,36.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,73.72,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,inpatient,,,89.00000,42.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,86.33,,,,,,,80.10,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,outpatient,,,89.00000,42.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,86.33,,,,,,,23.14,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,inpatient,,,76.00000,36.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,73.72,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,outpatient,,,76.00000,36.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,73.72,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,inpatient,,,28.00000,13.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,27.16,,,,,,,25.20,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,outpatient,,,28.00000,13.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,27.16,,,,,,,7.28,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,inpatient,,,98.00000,47.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,88.20,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,outpatient,,,98.00000,47.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,25.48,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,inpatient,,,64.00000,30.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,57.60,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,outpatient,,,64.00000,30.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,inpatient,,,75.00000,36.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72.75,,,,,,,67.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,outpatient,,,75.00000,36.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72.75,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,inpatient,,,76.00000,36.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,73.72,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,outpatient,,,76.00000,36.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,73.72,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,inpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,outpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,inpatient,,,114.00000,54.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,102.60,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,outpatient,,,114.00000,54.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,29.64,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,inpatient,,,74.00000,35.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,71.78,,,,,,,66.60,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,outpatient,,,74.00000,35.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,71.78,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,inpatient,,,69.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,62.10,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,outpatient,,,69.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,inpatient,,,74.00000,35.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,71.78,,,,,,,66.60,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,outpatient,,,74.00000,35.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,71.78,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,inpatient,,,87.00000,41.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84.39,,,,,,,78.30,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,outpatient,,,87.00000,41.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84.39,,,,,,,22.62,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,inpatient,,,79.00000,38.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,71.10,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,outpatient,,,79.00000,38.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,20.54,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,inpatient,,,75.00000,36.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72.75,,,,,,,67.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,outpatient,,,75.00000,36.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72.75,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,inpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,outpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,inpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,outpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,inpatient,,,64.00000,30.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,57.60,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,outpatient,,,64.00000,30.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,inpatient,,,164.00000,79.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,159.08,,,,,,,147.60,159.08,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,outpatient,,,164.00000,79.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,159.08,,,,,,,42.64,159.08,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,inpatient,,,54.00000,26.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,48.60,52.38,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,outpatient,,,54.00000,26.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,14.04,52.38,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,inpatient,,,8.00000,3.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7.76,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,outpatient,,,8.00000,3.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7.76,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,inpatient,,,69.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,62.10,66.93,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,outpatient,,,69.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,17.94,66.93,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,inpatient,,,8.00000,3.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7.76,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,outpatient,,,8.00000,3.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7.76,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,inpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,outpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,inpatient,,,8.00000,3.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7.76,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,outpatient,,,8.00000,3.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7.76,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,inpatient,,,14.00000,6.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13.58,,,,,,,12.60,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,outpatient,,,14.00000,6.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,13.58,,,,,,,3.64,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,inpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,outpatient,,,62.00000,29.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,inpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,outpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,inpatient,,,112.00000,53.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,108.64,,,,,,,100.80,108.64,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,outpatient,,,112.00000,53.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,108.64,,,,,,,29.12,108.64,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,inpatient,,,13.00000,6.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12.61,,,,,,,11.70,12.61,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,outpatient,,,13.00000,6.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12.61,,,,,,,3.38,12.61,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,inpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,outpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,inpatient,,,31.00000,14.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,30.07,,,,,,,27.90,30.07,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,outpatient,,,31.00000,14.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,30.07,,,,,,,8.06,30.07,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,inpatient,,,92.00000,44.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,89.24,,,,,,,82.80,89.24,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,outpatient,,,92.00000,44.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,89.24,,,,,,,23.92,89.24,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,inpatient,,,80.00000,38.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,77.60,,,,,,,72.00,77.60,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,outpatient,,,80.00000,38.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,77.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,inpatient,,,30.00000,14.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29.10,,,,,,,27.00,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29.10,,,,,,,7.80,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,inpatient,,,30.00000,14.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29.10,,,,,,,27.00,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29.10,,,,,,,7.80,29.10,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,inpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,outpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,inpatient,,,24.00000,11.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,23.28,,,,,,,21.60,23.28,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,23.28,,,,,,,6.24,23.28,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,inpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,outpatient,,,59.00000,28.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,inpatient,,,29.00000,13.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,28.13,,,,,,,26.10,28.13,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,outpatient,,,29.00000,13.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,28.13,,,,,,,7.54,28.13,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,inpatient,,,97.00000,46.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,94.09,,,,,,,87.30,94.09,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,outpatient,,,97.00000,46.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,94.09,,,,,,,25.22,94.09,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,inpatient,,,225.00000,108.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,218.25,,,,,,,202.50,218.25,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,outpatient,,,225.00000,108.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,218.25,,,,,,,58.50,218.25,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,inpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,outpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,inpatient,,,71.00000,34.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,63.90,68.87,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,outpatient,,,71.00000,34.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,inpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,outpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,inpatient,,,71.00000,34.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,63.90,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,outpatient,,,71.00000,34.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,inpatient,,,108.00000,52.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,104.76,,,,,,,97.20,104.76,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,outpatient,,,108.00000,52.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,104.76,,,,,,,28.08,104.76,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,inpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,outpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,inpatient,,,51.00000,24.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,45.90,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,outpatient,,,51.00000,24.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,inpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,outpatient,,,63.00000,30.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,inpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,outpatient,,,58.00000,27.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,inpatient,,,19.00000,9.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,18.43,,,,,,,17.10,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,outpatient,,,19.00000,9.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,18.43,,,,,,,4.94,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,inpatient,,,54.00000,26.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,48.60,52.38,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,outpatient,,,54.00000,26.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,52.38,,,,,,,14.04,52.38,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,inpatient,,,103.00000,49.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,99.91,,,,,,,92.70,99.91,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,outpatient,,,103.00000,49.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,99.91,,,,,,,26.78,99.91,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,inpatient,,,9.00000,4.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8.73,,,,,,,8.10,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,outpatient,,,9.00000,4.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8.73,,,,,,,2.34,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,inpatient,,,13.00000,6.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12.61,,,,,,,11.70,12.61,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,outpatient,,,13.00000,6.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12.61,,,,,,,3.38,12.61,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,inpatient,,,80.00000,38.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,77.60,,,,,,,72.00,77.60,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,outpatient,,,80.00000,38.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,77.60,,,,,,,20.80,77.60,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,inpatient,,,47.00000,22.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,45.59,,,,,,,42.30,45.59,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,outpatient,,,47.00000,22.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,45.59,,,,,,,12.22,45.59,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,inpatient,,,91.00000,43.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,88.27,,,,,,,81.90,88.27,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,outpatient,,,91.00000,43.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,88.27,,,,,,,23.66,88.27,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,inpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,outpatient,,,56.00000,26.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,inpatient,,,18.00000,8.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,17.46,,,,,,,16.20,17.46,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,outpatient,,,18.00000,8.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,17.46,,,,,,,4.68,17.46,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,inpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,outpatient,,,60.00000,28.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,inpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,outpatient,,,57.00000,27.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,inpatient,,,21.00000,11.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,20.37,,,,,,,18.90,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,20.37,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,inpatient,,,71.00000,37.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,63.90,68.87,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,outpatient,,,71.00000,37.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,18.46,68.87,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,inpatient,,,21.00000,11.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,20.37,,,,,,,18.90,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,20.37,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,inpatient,,,128.00000,67.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,124.16,,,,,,,115.20,124.16,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,outpatient,,,128.00000,67.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,124.16,,,,,,,33.28,124.16,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,inpatient,,,65.00000,34.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,58.50,63.05,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,outpatient,,,65.00000,34.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,16.90,63.05,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,inpatient,,,31.00000,16.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,30.07,,,,,,,27.90,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,outpatient,,,31.00000,16.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,30.07,,,,,,,8.06,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,inpatient,,,61.00000,32.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,outpatient,,,61.00000,32.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,inpatient,,,25.00000,13.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,24.25,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,24.25,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,inpatient,,,25.00000,13.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,91,24.25,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,91,24.25,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,inpatient,,,103.00000,54.69000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,99.91,,,,,,,92.70,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,outpatient,,,103.00000,54.69000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,99.91,,,,,,,26.78,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,inpatient,,,96.00000,50.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,93.12,,,,,,,86.40,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,outpatient,,,96.00000,50.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,93.12,,,,,,,24.96,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,inpatient,,,75.00000,39.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72.75,,,,,,,67.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,outpatient,,,75.00000,39.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72.75,,,,,,,19.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,inpatient,,,68.00000,36.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,61.20,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,outpatient,,,68.00000,36.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,17.68,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,inpatient,,,61.00000,32.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,outpatient,,,61.00000,32.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,inpatient,,,29.00000,15.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,28.13,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,outpatient,,,29.00000,15.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,28.13,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,28.13,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,28.13,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,28.13,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,28.13,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,inpatient,,,63.00000,33.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,outpatient,,,63.00000,33.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,inpatient,,,79.00000,41.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,71.10,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,outpatient,,,79.00000,41.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,20.54,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,inpatient,,,63.00000,33.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,outpatient,,,63.00000,33.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,28.13,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,28.13,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,inpatient,,,112.00000,59.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,108.64,,,,,,,100.80,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,outpatient,,,112.00000,59.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,108.64,,,,,,,29.12,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,inpatient,,,25.00000,13.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,24.25,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,outpatient,,,25.00000,13.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,24.25,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,inpatient,,,118.00000,62.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,114.46,,,,,,,106.20,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,outpatient,,,118.00000,62.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,114.46,,,,,,,30.68,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,inpatient,,,29.00000,15.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,28.13,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,outpatient,,,29.00000,15.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,28.13,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,inpatient,,,25.00000,13.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,24.25,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,outpatient,,,25.00000,13.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,24.25,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,inpatient,,,25.00000,13.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,24.25,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,outpatient,,,25.00000,13.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,24.25,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,inpatient,,,71.00000,37.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,63.90,68.87,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,outpatient,,,71.00000,37.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,18.46,68.87,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,inpatient,,,59.00000,31.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,outpatient,,,59.00000,31.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,inpatient,,,62.00000,32.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,outpatient,,,62.00000,32.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,inpatient,,,138.00000,73.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,133.86,,,,,,,124.20,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,outpatient,,,138.00000,73.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,133.86,,,,,,,35.88,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,inpatient,,,62.00000,32.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,outpatient,,,62.00000,32.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,inpatient,,,78.00000,41.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,70.20,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,outpatient,,,78.00000,41.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,20.28,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,inpatient,,,69.00000,36.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,62.10,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,outpatient,,,69.00000,36.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,66.93,,,,,,,17.94,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,inpatient,,,88.00000,46.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,85.36,,,,,,,79.20,85.36,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,outpatient,,,88.00000,46.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,85.36,,,,,,,22.88,85.36,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,inpatient,,,60.00000,31.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,outpatient,,,60.00000,31.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,inpatient,,,64.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,57.60,62.08,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,outpatient,,,64.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,16.64,62.08,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,inpatient,,,63.00000,33.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,outpatient,,,63.00000,33.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,inpatient,,,137.00000,72.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,132.89,,,,,,,123.30,132.89,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,outpatient,,,137.00000,72.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,132.89,,,,,,,35.62,132.89,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,inpatient,,,347.00000,184.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,336.59,,,,,,,312.30,336.59,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,outpatient,,,347.00000,184.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,336.59,,,,,,,90.22,336.59,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,inpatient,,,57.00000,30.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,outpatient,,,57.00000,30.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,inpatient,,,56.00000,29.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,outpatient,,,56.00000,29.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,inpatient,,,16.00000,8.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,15.52,,,,,,,14.40,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,outpatient,,,16.00000,8.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,15.52,,,,,,,4.16,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,inpatient,,,85.00000,45.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,82.45,,,,,,,76.50,82.45,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,outpatient,,,85.00000,45.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,82.45,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,inpatient,,,34.00000,18.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,32.98,,,,,,,30.60,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,outpatient,,,34.00000,18.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,32.98,,,,,,,8.84,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,inpatient,,,231.00000,122.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,224.07,,,,,,,207.90,224.07,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,outpatient,,,231.00000,122.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,224.07,,,,,,,60.06,224.07,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,inpatient,,,36.00000,19.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,outpatient,,,36.00000,19.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,inpatient,,,61.00000,32.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,outpatient,,,61.00000,32.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,inpatient,,,111.00000,58.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,107.67,,,,,,,99.90,107.67,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,outpatient,,,111.00000,58.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,107.67,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,inpatient,,,61.00000,32.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,54.90,59.17,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,outpatient,,,61.00000,32.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,59.17,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,inpatient,,,60.00000,31.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,outpatient,,,60.00000,31.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,inpatient,,,60.00000,31.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,outpatient,,,60.00000,31.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,inpatient,,,60.00000,31.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,outpatient,,,60.00000,31.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,inpatient,,,60.00000,31.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,outpatient,,,60.00000,31.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,inpatient,,,60.00000,31.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,outpatient,,,60.00000,31.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,inpatient,,,36.00000,19.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,outpatient,,,36.00000,19.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,inpatient,,,76.00000,40.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,73.72,,,,,,,68.40,73.72,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,outpatient,,,76.00000,40.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,73.72,,,,,,,19.76,73.72,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,inpatient,,,60.00000,31.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,outpatient,,,60.00000,31.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,inpatient,,,60.00000,31.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,outpatient,,,60.00000,31.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,inpatient,,,152.00000,80.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,147.44,,,,,,,136.80,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,outpatient,,,152.00000,80.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,147.44,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,inpatient,,,78.00000,41.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,70.20,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,outpatient,,,78.00000,41.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,75.66,,,,,,,20.28,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,inpatient,,,42.00000,22.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,40.74,,,,,,,37.80,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,outpatient,,,42.00000,22.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,40.74,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,inpatient,,,73.00000,38.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,70.81,,,,,,,65.70,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,outpatient,,,73.00000,38.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,70.81,,,,,,,18.98,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,inpatient,,,97.00000,51.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,94.09,,,,,,,87.30,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,outpatient,,,97.00000,51.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,94.09,,,,,,,25.22,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,inpatient,,,157.00000,83.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,152.29,,,,,,,141.30,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,outpatient,,,157.00000,83.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,152.29,,,,,,,40.82,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,inpatient,,,36.00000,19.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,outpatient,,,36.00000,19.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,inpatient,,,66.00000,35.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,outpatient,,,66.00000,35.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,inpatient,,,58.00000,30.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,outpatient,,,58.00000,30.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,inpatient,,,85.00000,45.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,82.45,,,,,,,76.50,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,outpatient,,,85.00000,45.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,82.45,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,inpatient,,,59.00000,31.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,outpatient,,,59.00000,31.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,inpatient,,,175.00000,92.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,169.75,,,,,,,157.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,outpatient,,,175.00000,92.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,169.75,,,,,,,45.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,inpatient,,,152.00000,80.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,147.44,,,,,,,136.80,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,outpatient,,,152.00000,80.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,147.44,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,inpatient,,,43.00000,22.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,41.71,,,,,,,38.70,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,outpatient,,,43.00000,22.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,41.71,,,,,,,11.18,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,inpatient,,,66.00000,35.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,outpatient,,,66.00000,35.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,inpatient,,,36.00000,19.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,outpatient,,,36.00000,19.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,inpatient,,,36.00000,19.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,outpatient,,,36.00000,19.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,34.92,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,inpatient,,,42.00000,22.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,40.74,,,,,,,37.80,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,outpatient,,,42.00000,22.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,40.74,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,inpatient,,,147.00000,78.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,142.59,,,,,,,132.30,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,outpatient,,,147.00000,78.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,142.59,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,inpatient,,,64.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,57.60,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,outpatient,,,64.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,16.64,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,inpatient,,,60.00000,31.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,outpatient,,,60.00000,31.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,inpatient,,,75.00000,39.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72.75,,,,,,,67.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,outpatient,,,75.00000,39.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72.75,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,inpatient,,,44.00000,23.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42.68,,,,,,,39.60,42.68,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,outpatient,,,44.00000,23.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42.68,,,,,,,11.44,42.68,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,inpatient,,,87.00000,46.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84.39,,,,,,,78.30,84.39,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,outpatient,,,87.00000,46.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,84.39,,,,,,,22.62,84.39,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,inpatient,,,65.00000,34.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,58.50,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,outpatient,,,65.00000,34.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,16.90,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,inpatient,,,75.00000,39.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72.75,,,,,,,67.50,72.75,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,outpatient,,,75.00000,39.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,72.75,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,inpatient,,,50.00000,26.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,48.50,,,,,,,45.00,48.50,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,outpatient,,,50.00000,26.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,48.50,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,inpatient,,,40.00000,21.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38.80,,,,,,,36.00,38.80,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,outpatient,,,40.00000,21.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,38.80,,,,,,,10.40,38.80,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,inpatient,,,50.00000,26.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,48.50,,,,,,,45.00,48.50,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,outpatient,,,50.00000,26.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,48.50,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,inpatient,,,115.00000,61.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,111.55,,,,,,,103.50,111.55,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,outpatient,,,115.00000,61.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,111.55,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,inpatient,,,1309.00000,695.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1269.73,,,,,,,1178.10,1269.73,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1309.00000,695.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1269.73,,,,,,,340.34,1269.73,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,inpatient,,,328.00000,174.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,318.16,,,,,,,295.20,318.16,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,outpatient,,,328.00000,174.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,318.16,,,,,,,85.28,318.16,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,inpatient,,,115.00000,61.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,111.55,,,,,,,103.50,111.55,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,outpatient,,,115.00000,61.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,111.55,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,inpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,inpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,inpatient,,,1251.00000,664.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1213.47,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,outpatient,,,1251.00000,664.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1213.47,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,inpatient,,,154.00000,81.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,149.38,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,149.38,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,inpatient,,,154.00000,81.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,149.38,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,149.38,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,inpatient,,,96.00000,50.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,93.12,,,,,,,86.40,93.12,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,outpatient,,,96.00000,50.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,93.12,,,,,,,24.96,93.12,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,inpatient,,,211.00000,112.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,204.67,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,outpatient,,,211.00000,112.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,204.67,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,inpatient,,,290.00000,153.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,281.30,,,,,,,261.00,281.30,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,outpatient,,,290.00000,153.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,281.30,,,,,,,75.40,281.30,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,inpatient,,,411.00000,218.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,398.67,,,,,,,369.90,398.67,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,outpatient,,,411.00000,218.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,398.67,,,,,,,106.86,398.67,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,inpatient,,,139.00000,73.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,134.83,,,,,,,125.10,134.83,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,outpatient,,,139.00000,73.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,134.83,,,,,,,36.14,134.83,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,inpatient,,,288.00000,152.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,279.36,,,,,,,259.20,279.36,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,outpatient,,,288.00000,152.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,279.36,,,,,,,74.88,279.36,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,inpatient,,,1372.00000,728.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1330.84,,,,,,,1234.80,1330.84,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1372.00000,728.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1330.84,,,,,,,356.72,1330.84,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,inpatient,,,1251.00000,664.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1213.47,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,outpatient,,,1251.00000,664.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1213.47,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,inpatient,,,135.00000,71.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,130.95,,,,,,,121.50,130.95,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,outpatient,,,135.00000,71.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,130.95,,,,,,,35.10,130.95,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,inpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,outpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,inpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,outpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,inpatient,,,147.00000,78.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,142.59,,,,,,,132.30,142.59,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,outpatient,,,147.00000,78.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,142.59,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,inpatient,,,126.00000,66.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,122.22,,,,,,,113.40,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,outpatient,,,126.00000,66.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,122.22,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,inpatient,,,120.00000,63.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,116.40,,,,,,,108.00,116.40,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,outpatient,,,120.00000,63.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,116.40,,,,,,,31.20,116.40,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,inpatient,,,124.00000,65.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,120.28,,,,,,,111.60,120.28,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,outpatient,,,124.00000,65.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,120.28,,,,,,,32.24,120.28,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,inpatient,,,108.00000,57.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,104.76,,,,,,,97.20,104.76,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,outpatient,,,108.00000,57.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,104.76,,,,,,,28.08,104.76,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,inpatient,,,256.00000,135.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,248.32,,,,,,,230.40,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,248.32,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,inpatient,,,256.00000,135.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,248.32,,,,,,,230.40,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,248.32,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,inpatient,,,122.00000,64.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,118.34,,,,,,,109.80,118.34,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,outpatient,,,122.00000,64.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,118.34,,,,,,,31.72,118.34,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,inpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,outpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,inpatient,,,123.00000,65.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,119.31,,,,,,,110.70,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,outpatient,,,123.00000,65.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,119.31,,,,,,,31.98,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,inpatient,,,518.00000,275.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,502.46,,,,,,,466.20,502.46,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,outpatient,,,518.00000,275.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,502.46,,,,,,,134.68,502.46,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,inpatient,,,275.00000,146.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,266.75,,,,,,,247.50,266.75,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,outpatient,,,275.00000,146.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,266.75,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,inpatient,,,270.00000,143.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,261.90,,,,,,,243.00,261.90,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,outpatient,,,270.00000,143.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,261.90,,,,,,,70.20,261.90,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,inpatient,,,450.00000,238.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,436.50,,,,,,,405.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,outpatient,,,450.00000,238.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,436.50,,,,,,,117.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,inpatient,,,126.00000,66.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,122.22,,,,,,,113.40,122.22,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,outpatient,,,126.00000,66.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,122.22,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,inpatient,,,362.00000,192.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,351.14,,,,,,,325.80,351.14,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,outpatient,,,362.00000,192.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,351.14,,,,,,,94.12,351.14,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,inpatient,,,109.00000,57.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,105.73,,,,,,,98.10,105.73,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,105.73,,,,,,,28.34,105.73,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,inpatient,,,638.00000,338.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,618.86,,,,,,,574.20,618.86,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,outpatient,,,638.00000,338.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,618.86,,,,,,,165.88,618.86,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,inpatient,,,211.00000,112.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,204.67,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,outpatient,,,211.00000,112.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,204.67,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,inpatient,,,154.00000,81.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,149.38,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,outpatient,,,154.00000,81.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,149.38,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,inpatient,,,141.00000,74.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,136.77,,,,,,,126.90,136.77,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,outpatient,,,141.00000,74.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,136.77,,,,,,,36.66,136.77,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,inpatient,,,2040.00000,1083.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1978.80,,,,,,,1836.00,1978.80,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,outpatient,,,2040.00000,1083.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1978.80,,,,,,,530.40,1978.80,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,inpatient,,,421.00000,223.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,408.37,,,,,,,378.90,408.37,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,outpatient,,,421.00000,223.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,408.37,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,inpatient,,,275.00000,146.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,266.75,,,,,,,247.50,266.75,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,outpatient,,,275.00000,146.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,266.75,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,inpatient,,,1251.00000,664.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1213.47,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,outpatient,,,1251.00000,664.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1213.47,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,inpatient,,,428.00000,227.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,415.16,,,,,,,385.20,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,415.16,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,inpatient,,,428.00000,227.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,415.16,,,,,,,385.20,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,415.16,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,inpatient,,,655.00000,347.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,635.35,,,,,,,589.50,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,635.35,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,inpatient,,,655.00000,347.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,635.35,,,,,,,589.50,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,635.35,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,inpatient,,,211.00000,112.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,204.67,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,outpatient,,,211.00000,112.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,204.67,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,inpatient,,,112.00000,59.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,108.64,,,,,,,100.80,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,108.64,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,inpatient,,,112.00000,59.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,108.64,,,,,,,100.80,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,108.64,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,inpatient,,,130.00000,69.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,126.10,,,,,,,117.00,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,outpatient,,,130.00000,69.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,126.10,,,,,,,33.80,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,inpatient,,,421.00000,223.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,408.37,,,,,,,378.90,408.37,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,outpatient,,,421.00000,223.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,408.37,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,inpatient,,,111.00000,58.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,107.67,,,,,,,99.90,107.67,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,outpatient,,,111.00000,58.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,107.67,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,inpatient,,,200.00000,106.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,194.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,outpatient,,,200.00000,106.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,194.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,125.13,,,,,,,33.54,125.13,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,inpatient,,,13.00000,6.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12.61,,,,,,,11.70,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,outpatient,,,13.00000,6.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12.61,,,,,,,3.38,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,inpatient,,,58.00000,30.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,outpatient,,,58.00000,30.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,inpatient,,,13.00000,6.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12.61,,,,,,,11.70,12.61,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,outpatient,,,13.00000,6.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12.61,,,,,,,3.38,12.61,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,inpatient,,,773.00000,410.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,749.81,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,outpatient,,,773.00000,410.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,749.81,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,inpatient,,,773.00000,410.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,749.81,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,outpatient,,,773.00000,410.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,749.81,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,inpatient,,,773.00000,410.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,749.81,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,outpatient,,,773.00000,410.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,749.81,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,inpatient,,,773.00000,410.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,749.81,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,outpatient,,,773.00000,410.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,749.81,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,inpatient,,,387.00000,205.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,375.39,,,,,,,348.30,375.39,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,outpatient,,,387.00000,205.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,375.39,,,,,,,100.62,375.39,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,inpatient,,,52.00000,27.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,46.80,50.44,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,outpatient,,,52.00000,27.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,50.44,,,,,,,13.52,50.44,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,inpatient,,,102.00000,54.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,91.80,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,inpatient,,,102.00000,54.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,91.80,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,98.94,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,inpatient,,,79.00000,41.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,71.10,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,outpatient,,,79.00000,41.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,20.54,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,inpatient,,,65.00000,34.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,58.50,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,outpatient,,,65.00000,34.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,16.90,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,inpatient,,,100.00000,53.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,outpatient,,,100.00000,53.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,inpatient,,,64.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,57.60,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,outpatient,,,64.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,16.64,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,inpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,outpatient,,,106.00000,56.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,inpatient,,,109.00000,57.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,105.73,,,,,,,98.10,105.73,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,105.73,,,,,,,28.34,105.73,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,inpatient,,,58.00000,30.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,outpatient,,,58.00000,30.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19.40,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,inpatient,,,66.00000,35.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,outpatient,,,66.00000,35.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19.40,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19.40,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19.40,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19.40,,,,,,,5.20,19.40,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,inpatient,,,13.00000,6.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12.61,,,,,,,11.70,12.61,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,outpatient,,,13.00000,6.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,12.61,,,,,,,3.38,12.61,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,inpatient,,,53.00000,28.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,47.70,51.41,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,outpatient,,,53.00000,28.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,13.78,51.41,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,inpatient,,,18.00000,9.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,17.46,,,,,,,16.20,17.46,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,outpatient,,,18.00000,9.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,17.46,,,,,,,4.68,17.46,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,inpatient,,,17.00000,9.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16.49,,,,,,,15.30,16.49,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,outpatient,,,17.00000,9.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16.49,,,,,,,4.42,16.49,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,inpatient,,,71.00000,37.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,63.90,68.87,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,outpatient,,,71.00000,37.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,68.87,,,,,,,18.46,68.87,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,inpatient,,,57.00000,30.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,outpatient,,,57.00000,30.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,inpatient,,,68.00000,36.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,61.20,65.96,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,outpatient,,,68.00000,36.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,65.96,,,,,,,17.68,65.96,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,inpatient,,,58.00000,30.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,outpatient,,,58.00000,30.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,inpatient,,,27.00000,14.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,26.19,,,,,,,24.30,26.19,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,outpatient,,,27.00000,14.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,26.19,,,,,,,7.02,26.19,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,inpatient,,,56.00000,29.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,outpatient,,,56.00000,29.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,inpatient,,,56.00000,29.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,50.40,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,outpatient,,,56.00000,29.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,54.32,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,inpatient,,,58.00000,30.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,outpatient,,,58.00000,30.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,inpatient,,,115.00000,61.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,111.55,,,,,,,103.50,111.55,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,outpatient,,,115.00000,61.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,111.55,,,,,,,29.90,111.55,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,inpatient,,,23.00000,12.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,22.31,,,,,,,20.70,22.31,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,outpatient,,,23.00000,12.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,22.31,,,,,,,5.98,22.31,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,inpatient,,,255.00000,135.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,247.35,,,,,,,229.50,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,outpatient,,,255.00000,135.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,247.35,,,,,,,66.30,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,inpatient,,,66.00000,35.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,outpatient,,,66.00000,35.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,inpatient,,,26.00000,13.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,23.40,25.22,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,outpatient,,,26.00000,13.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,6.76,25.22,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,inpatient,,,64.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,57.60,62.08,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,outpatient,,,64.00000,33.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,62.08,,,,,,,16.64,62.08,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,inpatient,,,215.00000,114.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,208.55,,,,,,,193.50,208.55,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,outpatient,,,215.00000,114.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,208.55,,,,,,,55.90,208.55,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,inpatient,,,79.00000,41.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,71.10,76.63,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,outpatient,,,79.00000,41.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,20.54,76.63,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,inpatient,,,11.00000,5.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,10.67,,,,,,,9.90,10.67,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,outpatient,,,11.00000,5.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,10.67,,,,,,,2.86,10.67,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,inpatient,,,58.00000,27.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,52.20,56.26,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,outpatient,,,58.00000,27.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,56.26,,,,,,,15.08,56.26,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,inpatient,,,10.00000,4.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,9.70,,,,,,,9.00,9.70,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,outpatient,,,10.00000,4.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,9.70,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,inpatient,,,7.00000,3.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6.79,,,,,,,6.30,6.79,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,outpatient,,,7.00000,3.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6.79,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,inpatient,,,53.00000,25.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,47.70,51.41,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,outpatient,,,53.00000,25.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,51.41,,,,,,,13.78,51.41,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,inpatient,,,10.00000,4.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,9.70,,,,,,,9.00,9.70,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,outpatient,,,10.00000,4.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,9.70,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,inpatient,,,11.00000,5.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,10.67,,,,,,,9.90,10.67,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,10.67,,,,,,,2.86,10.67,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,inpatient,,,7.00000,3.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6.79,,,,,,,6.30,6.79,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,outpatient,,,7.00000,3.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6.79,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,inpatient,,,11.00000,5.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,10.67,,,,,,,9.90,10.67,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,10.67,,,,,,,2.86,10.67,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,inpatient,,,597.00000,290.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,579.09,,,,,,,537.30,579.09,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,outpatient,,,597.00000,290.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,579.09,,,,,,,155.22,579.09,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,inpatient,,,6379.00000,3100.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6187.63,,,,,,,5741.10,6187.63,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,outpatient,,,6379.00000,3100.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6187.63,,,,,,,1658.54,6187.63,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,inpatient,,,471.00000,228.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,456.87,,,,,,,423.90,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,outpatient,,,471.00000,228.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,456.87,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,inpatient,,,471.00000,228.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,456.87,,,,,,,423.90,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,outpatient,,,471.00000,228.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,456.87,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,inpatient,,,1251.00000,607.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1213.47,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,outpatient,,,1251.00000,607.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1213.47,,,,,,,325.26,1213.47,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,inpatient,,,260.00000,126.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,252.20,,,,,,,234.00,252.20,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,outpatient,,,260.00000,126.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,252.20,,,,,,,67.60,252.20,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,inpatient,,,785.00000,381.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,761.45,,,,,,,706.50,761.45,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,outpatient,,,785.00000,381.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,761.45,,,,,,,204.10,761.45,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,inpatient,,,529.00000,257.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,513.13,,,,,,,476.10,513.13,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,outpatient,,,529.00000,257.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,513.13,,,,,,,137.54,513.13,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,inpatient,,,1623.00000,788.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1574.31,,,,,,,1460.70,1574.31,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,outpatient,,,1623.00000,788.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1574.31,,,,,,,421.98,1574.31,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,inpatient,,,10800.00000,5248.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,10476.00,,,,,,,9720.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,outpatient,,,10800.00000,5248.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,10476.00,,,,,,,2808.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,inpatient,,,25365.00000,12327.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,24604.05,,,,,,,22828.50,24604.05,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,outpatient,,,25365.00000,12327.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,24604.05,,,,,,,6594.90,24604.05,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,inpatient,,,101.00000,21.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97.97,,,,,,,90.90,97.97,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,outpatient,,,101.00000,21.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97.97,,,,,,,26.26,97.97,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,inpatient,,,81.00000,17.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,72.90,78.57,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,outpatient,,,81.00000,17.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,21.06,78.57,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,inpatient,,,104.00000,22.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,100.88,,,,,,,93.60,100.88,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,outpatient,,,104.00000,22.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,100.88,,,,,,,27.04,100.88,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,inpatient,,,377.00000,81.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,365.69,,,,,,,339.30,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,outpatient,,,377.00000,81.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,365.69,,,,,,,98.02,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,inpatient,,,532.00000,114.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,516.04,,,,,,,478.80,516.04,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,outpatient,,,532.00000,114.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,516.04,,,,,,,138.32,516.04,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,inpatient,,,521.00000,112.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,505.37,,,,,,,468.90,505.37,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,outpatient,,,521.00000,112.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,505.37,,,,,,,135.46,505.37,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,inpatient,,,451.00000,97.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,437.47,,,,,,,405.90,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,outpatient,,,451.00000,97.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,437.47,,,,,,,117.26,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,inpatient,,,1148.00000,247.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1113.56,,,,,,,1033.20,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,outpatient,,,1148.00000,247.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1113.56,,,,,,,298.48,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,inpatient,,,350.00000,75.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,339.50,,,,,,,315.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,outpatient,,,350.00000,75.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,339.50,,,,,,,91.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,inpatient,,,423.00000,91.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,410.31,,,,,,,380.70,410.31,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,outpatient,,,423.00000,91.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,410.31,,,,,,,109.98,410.31,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,inpatient,,,751.00000,162.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,728.47,,,,,,,675.90,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,728.47,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,inpatient,,,751.00000,162.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,728.47,,,,,,,675.90,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,728.47,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,inpatient,,,119.00000,25.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,115.43,,,,,,,107.10,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,outpatient,,,119.00000,25.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,115.43,,,,,,,30.94,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,inpatient,,,126.00000,27.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,122.22,,,,,,,113.40,122.22,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,outpatient,,,126.00000,27.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,122.22,,,,,,,32.76,122.22,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,inpatient,,,110.00000,23.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,inpatient,,,110.00000,23.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,inpatient,,,79.00000,17.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,71.10,76.63,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,outpatient,,,79.00000,17.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,20.54,76.63,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,inpatient,,,110.00000,23.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,inpatient,,,110.00000,23.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,inpatient,,,79.00000,17.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,71.10,76.63,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,outpatient,,,79.00000,17.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,20.54,76.63,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,inpatient,,,335.00000,72.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,324.95,,,,,,,301.50,324.95,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,outpatient,,,335.00000,72.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,324.95,,,,,,,87.10,324.95,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,inpatient,,,154.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,149.38,,,,,,,138.60,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,149.38,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,inpatient,,,154.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,149.38,,,,,,,138.60,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,149.38,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,inpatient,,,128.00000,27.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,124.16,,,,,,,115.20,124.16,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,outpatient,,,128.00000,27.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,124.16,,,,,,,33.28,124.16,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,inpatient,,,65.00000,14.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,58.50,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,outpatient,,,65.00000,14.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,63.05,,,,,,,16.90,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,inpatient,,,272.00000,58.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,263.84,,,,,,,244.80,263.84,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,outpatient,,,272.00000,58.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,263.84,,,,,,,70.72,263.84,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,inpatient,,,26.00000,11.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,23.40,25.22,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,outpatient,,,26.00000,11.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,25.22,,,,,,,6.76,25.22,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,inpatient,,,359.00000,157.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,323.10,348.23,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,outpatient,,,359.00000,157.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,93.34,348.23,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,inpatient,,,189.00000,83.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,183.33,,,,,,,170.10,183.33,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,outpatient,,,189.00000,83.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,183.33,,,,,,,49.14,183.33,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,inpatient,,,359.00000,157.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,323.10,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,outpatient,,,359.00000,157.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,93.34,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,inpatient,,,137.00000,60.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,132.89,,,,,,,123.30,132.89,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,outpatient,,,137.00000,60.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,132.89,,,,,,,35.62,132.89,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,inpatient,,,1665.00000,732.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1615.05,,,,,,,1498.50,1615.05,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,outpatient,,,1665.00000,732.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1615.05,,,,,,,432.90,1615.05,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,inpatient,,,751.00000,330.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,728.47,,,,,,,675.90,728.47,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,outpatient,,,751.00000,330.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,728.47,,,,,,,195.26,728.47,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,inpatient,,,374.00000,164.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,362.78,,,,,,,336.60,362.78,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,outpatient,,,374.00000,164.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,362.78,,,,,,,97.24,362.78,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,inpatient,,,553.00000,243.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,536.41,,,,,,,497.70,536.41,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,outpatient,,,553.00000,243.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,536.41,,,,,,,143.78,536.41,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,inpatient,,,359.00000,157.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,323.10,348.23,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,outpatient,,,359.00000,157.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,93.34,348.23,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,inpatient,,,62.00000,27.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,55.80,60.14,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,outpatient,,,62.00000,27.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,60.14,,,,,,,16.12,60.14,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,inpatient,,,79.00000,34.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,71.10,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,outpatient,,,79.00000,34.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,20.54,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,inpatient,,,110.00000,48.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,99.00,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,outpatient,,,110.00000,48.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,inpatient,,,110.00000,48.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,99.00,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,outpatient,,,110.00000,48.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,inpatient,,,751.00000,330.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,728.47,,,,,,,675.90,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,outpatient,,,751.00000,330.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,728.47,,,,,,,195.26,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,inpatient,,,1665.00000,732.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1615.05,,,,,,,1498.50,1615.05,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,outpatient,,,1665.00000,732.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1615.05,,,,,,,432.90,1615.05,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,inpatient,,,110.00000,48.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,99.00,106.70,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,outpatient,,,110.00000,48.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,28.60,106.70,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,inpatient,,,281.00000,123.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,272.57,,,,,,,252.90,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,272.57,,,,,,,73.06,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,inpatient,,,281.00000,123.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,272.57,,,,,,,252.90,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,272.57,,,,,,,73.06,272.57,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,inpatient,,,451.00000,341.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,437.47,,,,,,,405.90,437.47,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,outpatient,,,451.00000,341.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,437.47,,,,,,,117.26,437.47,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,inpatient,,,300.00000,145.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,291.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,outpatient,,,300.00000,145.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,291.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,inpatient,,,2278.00000,1107.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2209.66,,,,,,,2050.20,2209.66,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,outpatient,,,2278.00000,1107.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2209.66,,,,,,,592.28,2209.66,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,inpatient,,,3912.00000,1901.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3794.64,,,,,,,3520.80,3794.64,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,outpatient,,,3912.00000,1901.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3794.64,,,,,,,1017.12,3794.64,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,inpatient,,,900.00000,437.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,873.00,,,,,,,810.00,873.00,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,outpatient,,,900.00000,437.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,873.00,,,,,,,234.00,873.00,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,inpatient,,,365.00000,177.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,354.05,,,,,,,328.50,354.05,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,outpatient,,,365.00000,177.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,354.05,,,,,,,94.90,354.05,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,inpatient,,,989.00000,480.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,959.33,,,,,,,890.10,959.33,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,outpatient,,,989.00000,480.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,959.33,,,,,,,257.14,959.33,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,477.24,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,477.24,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,inpatient,,,435.00000,211.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,421.95,,,,,,,391.50,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,421.95,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,inpatient,,,435.00000,211.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,421.95,,,,,,,391.50,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,421.95,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,inpatient,,,644.00000,312.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,624.68,,,,,,,579.60,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,outpatient,,,644.00000,312.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,624.68,,,,,,,167.44,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,477.24,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,477.24,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,477.24,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,477.24,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,inpatient,,,527.00000,256.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,511.19,,,,,,,474.30,511.19,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,outpatient,,,527.00000,256.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,511.19,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,inpatient,,,1404.00000,682.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1361.88,,,,,,,1263.60,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,outpatient,,,1404.00000,682.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1361.88,,,,,,,365.04,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,inpatient,,,5475.00000,2660.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5310.75,,,,,,,4927.50,5310.75,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,outpatient,,,5475.00000,2660.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5310.75,,,,,,,1423.50,5310.75,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,inpatient,,,726.00000,352.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,704.22,,,,,,,653.40,704.22,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,outpatient,,,726.00000,352.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,704.22,,,,,,,188.76,704.22,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,inpatient,,,507.00000,246.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,491.79,,,,,,,456.30,491.79,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,outpatient,,,507.00000,246.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,491.79,,,,,,,131.82,491.79,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,inpatient,,,1670.00000,811.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1619.90,,,,,,,1503.00,1619.90,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,outpatient,,,1670.00000,811.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1619.90,,,,,,,434.20,1619.90,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,inpatient,,,1139.00000,553.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1104.83,,,,,,,1025.10,1104.83,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,outpatient,,,1139.00000,553.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1104.83,,,,,,,296.14,1104.83,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,inpatient,,,875.00000,425.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,848.75,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,outpatient,,,875.00000,425.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,848.75,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,inpatient,,,525.00000,255.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,509.25,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,outpatient,,,525.00000,255.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,509.25,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,inpatient,,,1353.00000,657.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1312.41,,,,,,,1217.70,1312.41,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,outpatient,,,1353.00000,657.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1312.41,,,,,,,351.78,1312.41,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,inpatient,,,525.00000,255.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,509.25,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,outpatient,,,525.00000,255.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,509.25,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,inpatient,,,525.00000,255.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,509.25,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,outpatient,,,525.00000,255.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,509.25,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,inpatient,,,825.00000,400.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,800.25,,,,,,,742.50,800.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,outpatient,,,825.00000,400.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,800.25,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,inpatient,,,525.00000,255.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,509.25,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,509.25,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,inpatient,,,525.00000,255.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,509.25,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,509.25,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,inpatient,,,974.00000,473.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,944.78,,,,,,,876.60,944.78,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,outpatient,,,974.00000,473.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,944.78,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,inpatient,,,198.00000,96.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,192.06,,,,,,,178.20,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,192.06,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,inpatient,,,198.00000,96.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,192.06,,,,,,,178.20,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,192.06,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,inpatient,,,221.00000,107.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,214.37,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,214.37,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,inpatient,,,221.00000,107.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,214.37,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,214.37,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,inpatient,,,497.00000,241.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,482.09,,,,,,,447.30,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,outpatient,,,497.00000,241.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,482.09,,,,,,,129.22,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,inpatient,,,2340.00000,1137.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2269.80,,,,,,,2106.00,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,outpatient,,,2340.00000,1137.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2269.80,,,,,,,608.40,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,inpatient,,,249.00000,121.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,241.53,,,,,,,224.10,241.53,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,outpatient,,,249.00000,121.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,241.53,,,,,,,64.74,241.53,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,inpatient,,,135.00000,65.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,130.95,,,,,,,121.50,130.95,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,outpatient,,,135.00000,65.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,130.95,,,,,,,35.10,130.95,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,inpatient,,,172.00000,83.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,166.84,,,,,,,154.80,166.84,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,outpatient,,,172.00000,83.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,166.84,,,,,,,44.72,166.84,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,inpatient,,,307.00000,149.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,297.79,,,,,,,276.30,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,outpatient,,,307.00000,149.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,297.79,,,,,,,79.82,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,inpatient,,,1800.00000,874.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1746.00,,,,,,,1620.00,1746.00,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,outpatient,,,1800.00000,874.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1746.00,,,,,,,468.00,1746.00,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,inpatient,,,974.00000,473.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,944.78,,,,,,,876.60,944.78,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,outpatient,,,974.00000,473.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,944.78,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,inpatient,,,197.00000,95.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,191.09,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,191.09,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,inpatient,,,197.00000,95.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,191.09,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,191.09,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,inpatient,,,411.00000,199.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,398.67,,,,,,,369.90,398.67,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,outpatient,,,411.00000,199.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,398.67,,,,,,,106.86,398.67,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,inpatient,,,221.00000,107.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,214.37,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,outpatient,,,221.00000,107.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,214.37,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,inpatient,,,884.00000,429.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,857.48,,,,,,,795.60,857.48,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,outpatient,,,884.00000,429.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,857.48,,,,,,,229.84,857.48,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,inpatient,,,594.00000,288.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,534.60,576.18,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,outpatient,,,594.00000,288.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,576.18,,,,,,,154.44,576.18,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,inpatient,,,519.00000,252.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,503.43,,,,,,,467.10,503.43,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,outpatient,,,519.00000,252.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,503.43,,,,,,,134.94,503.43,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,inpatient,,,1046.00000,508.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1014.62,,,,,,,941.40,1014.62,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,outpatient,,,1046.00000,508.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1014.62,,,,,,,271.96,1014.62,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,inpatient,,,556.00000,270.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,539.32,,,,,,,500.40,539.32,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,outpatient,,,556.00000,270.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,539.32,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,inpatient,,,275.00000,133.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,266.75,,,,,,,247.50,266.75,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,outpatient,,,275.00000,133.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,266.75,,,,,,,71.50,266.75,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,inpatient,,,580.00000,281.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,562.60,,,,,,,522.00,562.60,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,outpatient,,,580.00000,281.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,562.60,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,inpatient,,,580.00000,281.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,562.60,,,,,,,522.00,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,outpatient,,,580.00000,281.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,562.60,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,inpatient,,,3480.00000,1691.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3375.60,,,,,,,3132.00,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3375.60,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,inpatient,,,3480.00000,1691.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3375.60,,,,,,,3132.00,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3375.60,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,inpatient,,,700.00000,340.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,679.00,,,,,,,630.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,outpatient,,,700.00000,340.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,679.00,,,,,,,182.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,inpatient,,,1427.00000,693.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1384.19,,,,,,,1284.30,1384.19,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,outpatient,,,1427.00000,693.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1384.19,,,,,,,371.02,1384.19,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,inpatient,,,614.00000,298.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,595.58,,,,,,,552.60,595.58,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,outpatient,,,614.00000,298.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,595.58,,,,,,,159.64,595.58,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,inpatient,,,2027.00000,985.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1966.19,,,,,,,1824.30,1966.19,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,outpatient,,,2027.00000,985.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1966.19,,,,,,,527.02,1966.19,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,inpatient,,,556.00000,270.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,539.32,,,,,,,500.40,539.32,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,outpatient,,,556.00000,270.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,539.32,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,inpatient,,,1146.00000,556.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1111.62,,,,,,,1031.40,1111.62,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,outpatient,,,1146.00000,556.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1111.62,,,,,,,297.96,1111.62,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,inpatient,,,197.00000,95.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,191.09,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,191.09,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,inpatient,,,197.00000,95.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,191.09,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,191.09,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,inpatient,,,527.00000,256.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,511.19,,,,,,,474.30,511.19,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,outpatient,,,527.00000,256.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,511.19,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,inpatient,,,740.00000,359.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,717.80,,,,,,,666.00,717.80,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,outpatient,,,740.00000,359.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,717.80,,,,,,,192.40,717.80,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,inpatient,,,875.00000,425.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,848.75,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,848.75,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,inpatient,,,875.00000,425.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,848.75,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,848.75,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,inpatient,,,1399.00000,679.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1357.03,,,,,,,1259.10,1357.03,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,outpatient,,,1399.00000,679.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1357.03,,,,,,,363.74,1357.03,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,inpatient,,,51.00000,24.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,45.90,49.47,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,outpatient,,,51.00000,24.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,49.47,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,inpatient,,,825.00000,400.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,800.25,,,,,,,742.50,800.25,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,outpatient,,,825.00000,400.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,800.25,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,inpatient,,,576.00000,279.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,558.72,,,,,,,518.40,558.72,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,outpatient,,,576.00000,279.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,558.72,,,,,,,149.76,558.72,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,inpatient,,,224.00000,108.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,217.28,,,,,,,201.60,217.28,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,outpatient,,,224.00000,108.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,217.28,,,,,,,58.24,217.28,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,inpatient,,,346.00000,168.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,335.62,,,,,,,311.40,335.62,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,outpatient,,,346.00000,168.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,335.62,,,,,,,89.96,335.62,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,inpatient,,,525.00000,255.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,509.25,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,outpatient,,,525.00000,255.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,509.25,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,inpatient,,,525.00000,255.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,509.25,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,outpatient,,,525.00000,255.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,509.25,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,inpatient,,,525.00000,255.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,509.25,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,509.25,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,inpatient,,,525.00000,255.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,509.25,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,509.25,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,inpatient,,,627.00000,304.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,608.19,,,,,,,564.30,608.19,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,outpatient,,,627.00000,304.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,608.19,,,,,,,163.02,608.19,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,inpatient,,,605.00000,294.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,586.85,,,,,,,544.50,586.85,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,outpatient,,,605.00000,294.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,586.85,,,,,,,157.30,586.85,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,inpatient,,,510.00000,247.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,494.70,,,,,,,459.00,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,outpatient,,,510.00000,247.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,494.70,,,,,,,132.60,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,inpatient,,,223.00000,108.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,216.31,,,,,,,200.70,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,outpatient,,,223.00000,108.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,216.31,,,,,,,57.98,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,inpatient,,,1211.00000,588.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1174.67,,,,,,,1089.90,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,outpatient,,,1211.00000,588.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1174.67,,,,,,,314.86,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,inpatient,,,383.00000,186.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,371.51,,,,,,,344.70,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,outpatient,,,383.00000,186.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,371.51,,,,,,,99.58,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,inpatient,,,1214.00000,590.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1177.58,,,,,,,1092.60,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,outpatient,,,1214.00000,590.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1177.58,,,,,,,315.64,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,inpatient,,,328.00000,159.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,318.16,,,,,,,295.20,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,outpatient,,,328.00000,159.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,318.16,,,,,,,85.28,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,inpatient,,,372.00000,180.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,360.84,,,,,,,334.80,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,outpatient,,,372.00000,180.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,360.84,,,,,,,96.72,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,inpatient,,,285.00000,138.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,276.45,,,,,,,256.50,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,outpatient,,,285.00000,138.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,276.45,,,,,,,74.10,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,inpatient,,,367.00000,178.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,355.99,,,,,,,330.30,355.99,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,outpatient,,,367.00000,178.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,355.99,,,,,,,95.42,355.99,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,inpatient,,,702.00000,341.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,680.94,,,,,,,631.80,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,680.94,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,inpatient,,,702.00000,341.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,680.94,,,,,,,631.80,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,680.94,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,inpatient,,,265.00000,128.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,257.05,,,,,,,238.50,257.05,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,outpatient,,,265.00000,128.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,257.05,,,,,,,68.90,257.05,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,inpatient,,,2279.00000,1107.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2210.63,,,,,,,2051.10,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2279.00000,1107.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2210.63,,,,,,,592.54,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,inpatient,,,2395.00000,1163.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2323.15,,,,,,,2155.50,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2395.00000,1163.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2323.15,,,,,,,622.70,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,inpatient,,,8759.00000,4256.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8496.23,,,,,,,7883.10,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8496.23,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,inpatient,,,8759.00000,4256.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8496.23,,,,,,,7883.10,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8496.23,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,inpatient,,,2752.00000,1337.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2669.44,,,,,,,2476.80,2669.44,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,outpatient,,,2752.00000,1337.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2669.44,,,,,,,715.52,2669.44,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,inpatient,,,217.00000,105.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,210.49,,,,,,,195.30,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,210.49,,,,,,,56.42,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,inpatient,,,217.00000,105.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,210.49,,,,,,,195.30,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,210.49,,,,,,,56.42,210.49,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,inpatient,,,292.00000,141.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,283.24,,,,,,,262.80,283.24,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,outpatient,,,292.00000,141.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,283.24,,,,,,,75.92,283.24,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,398.67,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,398.67,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,398.67,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,398.67,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,398.67,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,398.67,,,,,,,106.86,398.67,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,inpatient,,,2275.00000,1105.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2206.75,,,,,,,2047.50,2206.75,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,outpatient,,,2275.00000,1105.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2206.75,,,,,,,591.50,2206.75,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,inpatient,,,192.00000,93.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,186.24,,,,,,,172.80,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,outpatient,,,192.00000,93.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,186.24,,,,,,,49.92,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,inpatient,,,451.00000,219.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,437.47,,,,,,,405.90,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,outpatient,,,451.00000,219.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,437.47,,,,,,,117.26,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,inpatient,,,617.00000,299.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,598.49,,,,,,,555.30,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,outpatient,,,617.00000,299.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,598.49,,,,,,,160.42,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,inpatient,,,825.00000,400.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,800.25,,,,,,,742.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,outpatient,,,825.00000,400.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,800.25,,,,,,,214.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,inpatient,,,905.00000,439.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,877.85,,,,,,,814.50,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,outpatient,,,905.00000,439.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,877.85,,,,,,,235.30,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,inpatient,,,849.00000,412.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,823.53,,,,,,,764.10,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,outpatient,,,849.00000,412.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,823.53,,,,,,,220.74,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,inpatient,,,2539.00000,1233.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2462.83,,,,,,,2285.10,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,outpatient,,,2539.00000,1233.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2462.83,,,,,,,660.14,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,inpatient,,,6000.00000,2916.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5820.00,,,,,,,5400.00,5820.00,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,outpatient,,,6000.00000,2916.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5820.00,,,,,,,1560.00,5820.00,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,inpatient,,,8260.00000,4014.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8012.20,,,,,,,7434.00,8012.20,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,outpatient,,,8260.00000,4014.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8012.20,,,,,,,2147.60,8012.20,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,inpatient,,,202.00000,88.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,195.94,,,,,,,181.80,195.94,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,outpatient,,,202.00000,88.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,195.94,,,,,,,52.52,195.94,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,inpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,59.40,64.02,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,outpatient,,,66.00000,31.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,64.02,,,,,,,17.16,64.02,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,inpatient,,,295.00000,142.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,286.15,,,,,,,265.50,286.15,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,outpatient,,,295.00000,142.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,286.15,,,,,,,76.70,286.15,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,89.00000,26.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,86.33,,,,,,,80.10,86.33,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,89.00000,26.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,86.33,,,,,,,23.14,86.33,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,inpatient,,,93.00000,27.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,90.21,,,,,,,83.70,90.21,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,90.21,,,,,,,24.18,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,93.00000,27.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,90.21,,,,,,,83.70,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,93.00000,27.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,90.21,,,,,,,24.18,90.21,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1818.75,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1818.75,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1818.75,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1818.75,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1752.00000,527.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1699.44,,,,,,,1576.80,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1699.44,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1752.00000,527.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1699.44,,,,,,,1576.80,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1699.44,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,731.00000,220.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,709.07,,,,,,,657.90,709.07,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,731.00000,220.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,709.07,,,,,,,190.06,709.07,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,787.00000,236.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,763.39,,,,,,,708.30,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,787.00000,236.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,763.39,,,,,,,204.62,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,2042.00000,614.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1980.74,,,,,,,1837.80,1980.74,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,2042.00000,614.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1980.74,,,,,,,530.92,1980.74,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1818.75,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1818.75,,,,,,,487.50,1818.75,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,714.00000,214.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,692.58,,,,,,,642.60,692.58,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,714.00000,214.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,692.58,,,,,,,185.64,692.58,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,294.00000,88.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,285.18,,,,,,,264.60,285.18,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,294.00000,88.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,285.18,,,,,,,76.44,285.18,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,inpatient,,,350.00000,105.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,339.50,,,,,,,315.00,339.50,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,350.00000,105.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,339.50,,,,,,,91.00,339.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,inpatient,,,1350.00000,780.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1309.50,,,,,,,1215.00,1309.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,outpatient,,,1350.00000,780.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1309.50,,,,,,,351.00,1309.50,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,inpatient,,,3680.00000,2127.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3569.60,,,,,,,3312.00,3569.60,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,outpatient,,,3680.00000,2127.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3569.60,,,,,,,956.80,3569.60,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,inpatient,,,1600.00000,924.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1552.00,,,,,,,1440.00,1552.00,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,outpatient,,,1600.00000,924.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1552.00,,,,,,,416.00,1552.00,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,inpatient,,,4680.00000,2705.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4539.60,,,,,,,4212.00,4539.60,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,outpatient,,,4680.00000,2705.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4539.60,,,,,,,1216.80,4539.60,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,inpatient,,,2100.00000,1213.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2037.00,,,,,,,1890.00,2037.00,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,outpatient,,,2100.00000,1213.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2037.00,,,,,,,546.00,2037.00,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,inpatient,,,5680.00000,3283.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5509.60,,,,,,,5112.00,5509.60,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,outpatient,,,5680.00000,3283.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5509.60,,,,,,,1476.80,5509.60,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,inpatient,,,2420.00000,1398.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2347.40,,,,,,,2178.00,2347.40,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,outpatient,,,2420.00000,1398.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2347.40,,,,,,,629.20,2347.40,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,inpatient,,,6415.00000,3707.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6222.55,,,,,,,5773.50,6222.55,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,outpatient,,,6415.00000,3707.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6222.55,,,,,,,1667.90,6222.55,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,inpatient,,,2920.00000,1687.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2832.40,,,,,,,2628.00,2832.40,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,outpatient,,,2920.00000,1687.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2832.40,,,,,,,759.20,2832.40,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,inpatient,,,8915.00000,5152.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8647.55,,,,,,,8023.50,8647.55,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,outpatient,,,8915.00000,5152.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8647.55,,,,,,,2317.90,8647.55,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,inpatient,,,3420.00000,1976.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3317.40,,,,,,,3078.00,3317.40,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,outpatient,,,3420.00000,1976.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3317.40,,,,,,,889.20,3317.40,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,inpatient,,,11415.00000,6597.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11072.55,,,,,,,10273.50,11072.55,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,outpatient,,,11415.00000,6597.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,11072.55,,,,,,,2967.90,11072.55,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,inpatient,,,142.00000,154.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,137.74,,,,,,,127.80,137.74,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,outpatient,,,142.00000,154.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,137.74,,,,,,,36.92,137.74,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,inpatient,,,340.00000,228.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,329.80,,,,,,,306.00,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,329.80,,,,,,,88.40,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,inpatient,,,670.00000,450.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,649.90,,,,,,,603.00,649.90,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,649.90,,,,,,,174.20,649.90,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,inpatient,,,390.00000,262.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,378.30,,,,,,,351.00,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,outpatient,,,390.00000,262.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,378.30,,,,,,,101.40,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,inpatient,,,1170.00000,787.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1134.90,,,,,,,1053.00,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,outpatient,,,1170.00000,787.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1134.90,,,,,,,304.20,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,inpatient,,,440.00000,296.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,426.80,,,,,,,396.00,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,outpatient,,,440.00000,296.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,426.80,,,,,,,114.40,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,inpatient,,,1670.00000,1123.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1619.90,,,,,,,1503.00,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,outpatient,,,1670.00000,1123.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1619.90,,,,,,,434.20,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,inpatient,,,640.00000,430.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,620.80,,,,,,,576.00,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,outpatient,,,640.00000,430.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,620.80,,,,,,,166.40,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,inpatient,,,2170.00000,1460.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2104.90,,,,,,,1953.00,2104.90,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,outpatient,,,2170.00000,1460.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2104.90,,,,,,,564.20,2104.90,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,inpatient,,,17.00000,10.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16.49,,,,,,,15.30,16.49,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,outpatient,,,17.00000,10.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,16.49,,,,,,,4.42,16.49,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,inpatient,,,535.00000,345.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,518.95,,,,,,,481.50,518.95,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,outpatient,,,535.00000,345.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,518.95,,,,,,,139.10,518.95,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,inpatient,,,23.00000,14.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,22.31,,,,,,,20.70,22.31,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,outpatient,,,23.00000,14.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,22.31,,,,,,,5.98,22.31,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,inpatient,,,635.00000,409.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,615.95,,,,,,,571.50,615.95,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,outpatient,,,635.00000,409.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,615.95,,,,,,,165.10,615.95,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,inpatient,,,30.00000,19.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29.10,,,,,,,27.00,29.10,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,outpatient,,,30.00000,19.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,29.10,,,,,,,7.80,29.10,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,inpatient,,,735.00000,474.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,712.95,,,,,,,661.50,712.95,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,outpatient,,,735.00000,474.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,712.95,,,,,,,191.10,712.95,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,inpatient,,,33.00000,21.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,32.01,,,,,,,29.70,32.01,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,outpatient,,,33.00000,21.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,32.01,,,,,,,8.58,32.01,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,inpatient,,,835.00000,538.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,809.95,,,,,,,751.50,809.95,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,outpatient,,,835.00000,538.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,809.95,,,,,,,217.10,809.95,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,inpatient,,,140.00000,80.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,135.80,,,,,,,126.00,135.80,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,outpatient,,,140.00000,80.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,135.80,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,inpatient,,,275.00000,158.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,266.75,,,,,,,247.50,266.75,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,outpatient,,,275.00000,158.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,266.75,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,inpatient,,,295.00000,170.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,286.15,,,,,,,265.50,286.15,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,outpatient,,,295.00000,170.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,286.15,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,inpatient,,,590.00000,341.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,572.30,,,,,,,531.00,572.30,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,outpatient,,,590.00000,341.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,572.30,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,inpatient,,,690.00000,398.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,669.30,,,,,,,621.00,669.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,outpatient,,,690.00000,398.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,669.30,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,inpatient,,,1375.00000,794.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1333.75,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,outpatient,,,1375.00000,794.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1333.75,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,inpatient,,,950.00000,549.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,921.50,,,,,,,855.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,outpatient,,,950.00000,549.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,921.50,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,inpatient,,,1900.00000,1098.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1843.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,outpatient,,,1900.00000,1098.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1843.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,inpatient,,,140.00000,45.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,135.80,,,,,,,126.00,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,outpatient,,,140.00000,45.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,135.80,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,inpatient,,,275.00000,88.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,266.75,,,,,,,247.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,outpatient,,,275.00000,88.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,266.75,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,inpatient,,,295.00000,95.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,286.15,,,,,,,265.50,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,outpatient,,,295.00000,95.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,286.15,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,inpatient,,,590.00000,190.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,572.30,,,,,,,531.00,572.30,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,outpatient,,,590.00000,190.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,572.30,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,inpatient,,,690.00000,222.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,669.30,,,,,,,621.00,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,outpatient,,,690.00000,222.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,669.30,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,inpatient,,,1375.00000,444.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1333.75,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,outpatient,,,1375.00000,444.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1333.75,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,inpatient,,,950.00000,306.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,921.50,,,,,,,855.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,outpatient,,,950.00000,306.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,921.50,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,inpatient,,,1900.00000,613.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1843.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,outpatient,,,1900.00000,613.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1843.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,inpatient,,,340.00000,228.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,329.80,,,,,,,306.00,329.80,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,329.80,,,,,,,88.40,329.80,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,inpatient,,,670.00000,450.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,649.90,,,,,,,603.00,649.90,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,649.90,,,,,,,174.20,649.90,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,475.30,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,475.30,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,inpatient,,,490.00000,329.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,475.30,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,475.30,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,475.30,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,475.30,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,inpatient,,,245.00000,164.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,237.65,,,,,,,220.50,237.65,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,237.65,,,,,,,63.70,237.65,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,816.74,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,816.74,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1021.41,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1021.41,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1225.11,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1225.11,,,,,,,328.38,1225.11,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,inpatient,,,1178.00000,669.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1142.66,,,,,,,1060.20,1142.66,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1178.00000,669.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1142.66,,,,,,,306.28,1142.66,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,inpatient,,,140.00000,102.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,135.80,,,,,,,126.00,135.80,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,outpatient,,,140.00000,102.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,135.80,,,,,,,36.40,135.80,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,inpatient,,,275.00000,201.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,266.75,,,,,,,247.50,266.75,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,outpatient,,,275.00000,201.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,266.75,,,,,,,71.50,266.75,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,inpatient,,,295.00000,215.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,286.15,,,,,,,265.50,286.15,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,outpatient,,,295.00000,215.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,286.15,,,,,,,76.70,286.15,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,inpatient,,,590.00000,431.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,572.30,,,,,,,531.00,572.30,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,outpatient,,,590.00000,431.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,572.30,,,,,,,153.40,572.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,inpatient,,,690.00000,504.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,669.30,,,,,,,621.00,669.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,outpatient,,,690.00000,504.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,669.30,,,,,,,179.40,669.30,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,inpatient,,,1375.00000,1005.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1333.75,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,outpatient,,,1375.00000,1005.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1333.75,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,inpatient,,,950.00000,694.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,921.50,,,,,,,855.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,outpatient,,,950.00000,694.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,921.50,,,,,,,247.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,inpatient,,,1900.00000,1388.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1843.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,outpatient,,,1900.00000,1388.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1843.00,,,,,,,494.00,1843.00,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,inpatient,,,584.00000,426.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,566.48,,,,,,,525.60,566.48,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,outpatient,,,584.00000,426.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,566.48,,,,,,,151.84,566.48,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,inpatient,,,1391.00000,1016.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1349.27,,,,,,,1251.90,1349.27,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,outpatient,,,1391.00000,1016.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1349.27,,,,,,,361.66,1349.27,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,inpatient,,,359.00000,271.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,323.10,348.23,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,outpatient,,,359.00000,271.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,348.23,,,,,,,93.34,348.23,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,inpatient,,,95.00000,71.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,92.15,,,,,,,85.50,92.15,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,outpatient,,,95.00000,71.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,92.15,,,,,,,24.70,92.15,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,inpatient,,,37.00000,17.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,35.89,,,,,,,33.30,35.89,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,outpatient,,,37.00000,17.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,35.89,,,,,,,9.62,35.89,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,71.10,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,76.63,,,,,,,20.54,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,inpatient,,,237.00000,114.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,229.89,,,,,,,213.30,229.89,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,229.89,,,,,,,61.62,229.89,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,inpatient,,,33.00000,15.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,32.01,,,,,,,29.70,32.01,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,outpatient,,,33.00000,15.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,32.01,,,,,,,8.58,32.01,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,inpatient,,,25.00000,12.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,24.25,,,,,,,22.50,24.25,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,outpatient,,,25.00000,12.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,24.25,,,,,,,6.50,24.25,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,inpatient,,,497.00000,160.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,482.09,,,,,,,447.30,482.09,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,outpatient,,,497.00000,160.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,482.09,,,,,,,129.22,482.09,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,855.54,,,,,,,793.80,855.54,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,855.54,,,,,,,229.32,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,855.54,,,,,,,793.80,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,855.54,,,,,,,229.32,855.54,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,inpatient,,,98.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,88.20,95.06,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,25.48,95.06,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,inpatient,,,96.00000,36.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,93.12,,,,,,,86.40,93.12,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,93.12,,,,,,,24.96,93.12,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,855.54,,,,,,,793.80,855.54,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,855.54,,,,,,,229.32,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,855.54,,,,,,,793.80,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,855.54,,,,,,,229.32,855.54,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,inpatient,,,763.00000,291.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,740.11,,,,,,,686.70,740.11,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,outpatient,,,763.00000,291.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,740.11,,,,,,,198.38,740.11,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,inpatient,,,199.00000,76.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,193.03,,,,,,,179.10,193.03,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,outpatient,,,199.00000,76.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,193.03,,,,,,,51.74,193.03,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,inpatient,,,98.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,88.20,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,25.48,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,inpatient,,,96.00000,36.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,93.12,,,,,,,86.40,93.12,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,93.12,,,,,,,24.96,93.12,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,inpatient,,,1265.00000,483.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1227.05,,,,,,,1138.50,1227.05,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,outpatient,,,1265.00000,483.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1227.05,,,,,,,328.90,1227.05,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,inpatient,,,924.00000,352.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,896.28,,,,,,,831.60,896.28,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,outpatient,,,924.00000,352.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,896.28,,,,,,,240.24,896.28,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,inpatient,,,580.00000,215.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,562.60,,,,,,,522.00,562.60,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,outpatient,,,580.00000,215.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,562.60,,,,,,,150.80,562.60,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,inpatient,,,110.00000,40.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,99.00,106.70,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,outpatient,,,110.00000,40.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,28.60,106.70,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,inpatient,,,373.00000,138.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,361.81,,,,,,,335.70,361.81,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,outpatient,,,373.00000,138.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,361.81,,,,,,,96.98,361.81,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,inpatient,,,337.00000,125.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,326.89,,,,,,,303.30,326.89,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,outpatient,,,337.00000,125.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,326.89,,,,,,,87.62,326.89,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,inpatient,,,784.00000,291.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,760.48,,,,,,,705.60,760.48,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,outpatient,,,784.00000,291.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,760.48,,,,,,,203.84,760.48,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,inpatient,,,341.00000,126.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,330.77,,,,,,,306.90,330.77,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,outpatient,,,341.00000,126.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,330.77,,,,,,,88.66,330.77,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,inpatient,,,252.00000,93.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,244.44,,,,,,,226.80,244.44,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,outpatient,,,252.00000,93.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,244.44,,,,,,,65.52,244.44,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,inpatient,,,282.00000,104.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,273.54,,,,,,,253.80,273.54,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,outpatient,,,282.00000,104.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,273.54,,,,,,,73.32,273.54,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,inpatient,,,404.00000,150.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,391.88,,,,,,,363.60,391.88,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,outpatient,,,404.00000,150.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,391.88,,,,,,,105.04,391.88,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,inpatient,,,306.00000,173.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,296.82,,,,,,,275.40,296.82,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,outpatient,,,306.00000,173.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,296.82,,,,,,,79.56,296.82,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,inpatient,,,158.00000,89.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,153.26,,,,,,,142.20,153.26,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,outpatient,,,158.00000,89.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,153.26,,,,,,,41.08,153.26,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,inpatient,,,147.00000,89.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,142.59,,,,,,,132.30,142.59,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,142.59,,,,,,,38.22,142.59,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,inpatient,,,270.00000,164.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,261.90,,,,,,,243.00,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,261.90,,,,,,,70.20,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,inpatient,,,84.00000,51.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,81.48,,,,,,,75.60,81.48,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,81.48,,,,,,,21.84,81.48,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,inpatient,,,86.00000,52.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,83.42,,,,,,,77.40,83.42,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,83.42,,,,,,,22.36,83.42,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,inpatient,,,82.00000,49.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,79.54,,,,,,,73.80,79.54,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,79.54,,,,,,,21.32,79.54,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,inpatient,,,85.00000,51.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,82.45,,,,,,,76.50,82.45,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,82.45,,,,,,,22.10,82.45,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,inpatient,,,43.00000,26.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,41.71,,,,,,,38.70,41.71,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,41.71,,,,,,,11.18,41.71,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,inpatient,,,41.00000,24.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,39.77,,,,,,,36.90,39.77,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,39.77,,,,,,,10.66,39.77,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,inpatient,,,79.00000,48.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,76.63,,,,,,,71.10,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,76.63,,,,,,,20.54,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,71.78,,,,,,,66.60,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,71.78,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,71.78,,,,,,,66.60,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,71.78,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,inpatient,,,34.00000,20.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,32.98,,,,,,,30.60,32.98,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,32.98,,,,,,,8.84,32.98,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,inpatient,,,65.00000,39.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,63.05,,,,,,,58.50,63.05,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,63.05,,,,,,,16.90,63.05,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,inpatient,,,113.00000,68.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,109.61,,,,,,,101.70,109.61,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,outpatient,,,113.00000,68.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,109.61,,,,,,,29.38,109.61,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,inpatient,,,80.00000,48.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,77.60,,,,,,,72.00,77.60,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,77.60,,,,,,,20.80,77.60,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,inpatient,,,84.00000,51.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,81.48,,,,,,,75.60,81.48,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,81.48,,,,,,,21.84,81.48,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,inpatient,,,73.00000,44.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,70.81,,,,,,,65.70,70.81,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,70.81,,,,,,,18.98,70.81,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,inpatient,,,100.00000,60.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97.00,,,,,,,90.00,97.00,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,outpatient,,,100.00000,60.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97.00,,,,,,,26.00,97.00,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,inpatient,,,167.00000,101.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,161.99,,,,,,,150.30,161.99,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,outpatient,,,167.00000,101.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,161.99,,,,,,,43.42,161.99,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,inpatient,,,413.00000,251.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"50,GP",400.61,,,,,,,371.70,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"50,GP",400.61,,,,,,,107.38,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"LT,GP",266.75,,,,,,,247.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"LT,GP",266.75,,,,,,,71.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"RT,GP",266.75,,,,,,,247.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"RT,GP",266.75,,,,,,,71.50,266.75,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,inpatient,,,95.00000,57.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,92.15,,,,,,,85.50,92.15,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,92.15,,,,,,,24.70,92.15,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,inpatient,,,146.00000,88.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,141.62,,,,,,,131.40,141.62,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,141.62,,,,,,,37.96,141.62,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,inpatient,,,139.00000,84.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,134.83,,,,,,,125.10,134.83,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,134.83,,,,,,,36.14,134.83,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,inpatient,,,75.00000,45.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,72.75,,,,,,,67.50,72.75,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,72.75,,,,,,,19.50,72.75,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,inpatient,,,154.00000,93.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,149.38,,,,,,,138.60,149.38,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,149.38,,,,,,,40.04,149.38,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,inpatient,,,73.00000,44.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,70.81,,,,,,,65.70,70.81,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,70.81,,,,,,,18.98,70.81,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,inpatient,,,160.00000,97.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,155.20,,,,,,,144.00,155.20,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,155.20,,,,,,,41.60,155.20,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,inpatient,,,325.00000,197.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,315.25,,,,,,,292.50,315.25,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,315.25,,,,,,,84.50,315.25,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,inpatient,,,98.00000,59.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,95.06,,,,,,,88.20,95.06,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,outpatient,,,98.00000,59.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,95.06,,,,,,,25.48,95.06,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,inpatient,,,303.00000,184.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,293.91,,,,,,,272.70,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,outpatient,,,303.00000,184.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,293.91,,,,,,,78.78,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,inpatient,,,115.00000,69.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,111.55,,,,,,,103.50,111.55,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,outpatient,,,115.00000,69.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,111.55,,,,,,,29.90,111.55,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,inpatient,,,74.00000,44.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,71.78,,,,,,,66.60,71.78,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,71.78,,,,,,,19.24,71.78,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,inpatient,,,79.00000,48.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,76.63,,,,,,,71.10,76.63,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,76.63,,,,,,,20.54,76.63,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,inpatient,,,72.00000,43.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,69.84,,,,,,,64.80,69.84,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,69.84,,,,,,,18.72,69.84,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,inpatient,,,147.00000,89.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,142.59,,,,,,,132.30,142.59,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,142.59,,,,,,,38.22,142.59,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,inpatient,,,270.00000,164.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,261.90,,,,,,,243.00,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,261.90,,,,,,,70.20,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,inpatient,,,84.00000,51.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,81.48,,,,,,,75.60,81.48,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,81.48,,,,,,,21.84,81.48,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,inpatient,,,86.00000,52.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,83.42,,,,,,,77.40,83.42,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,83.42,,,,,,,22.36,83.42,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,inpatient,,,82.00000,49.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,79.54,,,,,,,73.80,79.54,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,79.54,,,,,,,21.32,79.54,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,inpatient,,,85.00000,51.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,82.45,,,,,,,76.50,82.45,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,82.45,,,,,,,22.10,82.45,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,inpatient,,,43.00000,26.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,41.71,,,,,,,38.70,41.71,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,41.71,,,,,,,11.18,41.71,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,inpatient,,,41.00000,24.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,39.77,,,,,,,36.90,39.77,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,39.77,,,,,,,10.66,39.77,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,inpatient,,,79.00000,48.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,76.63,,,,,,,71.10,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,76.63,,,,,,,20.54,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CQ,GP",71.78,,,,,,,66.60,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CQ,GP",71.78,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CQ,GP",71.78,,,,,,,66.60,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CQ,GP",71.78,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,inpatient,,,34.00000,20.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,32.98,,,,,,,30.60,32.98,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,32.98,,,,,,,8.84,32.98,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,inpatient,,,65.00000,39.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,63.05,,,,,,,58.50,63.05,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,63.05,,,,,,,16.90,63.05,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,inpatient,,,80.00000,48.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,77.60,,,,,,,72.00,77.60,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,77.60,,,,,,,20.80,77.60,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,inpatient,,,84.00000,51.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,81.48,,,,,,,75.60,81.48,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,81.48,,,,,,,21.84,81.48,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,inpatient,,,73.00000,44.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,70.81,,,,,,,65.70,70.81,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,70.81,,,,,,,18.98,70.81,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,inpatient,,,413.00000,251.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"GP,50",400.61,,,,,,,371.70,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"GP,50",400.61,,,,,,,107.38,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"GP,LT",266.75,,,,,,,247.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"GP,LT",266.75,,,,,,,71.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"GP,RT",266.75,,,,,,,247.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"GP,RT",266.75,,,,,,,71.50,266.75,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,inpatient,,,95.00000,57.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,92.15,,,,,,,85.50,92.15,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,92.15,,,,,,,24.70,92.15,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,inpatient,,,146.00000,88.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,141.62,,,,,,,131.40,141.62,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,141.62,,,,,,,37.96,141.62,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,inpatient,,,139.00000,84.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,134.83,,,,,,,125.10,134.83,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,134.83,,,,,,,36.14,134.83,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,inpatient,,,75.00000,45.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,72.75,,,,,,,67.50,72.75,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,72.75,,,,,,,19.50,72.75,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,inpatient,,,154.00000,93.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,149.38,,,,,,,138.60,149.38,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,149.38,,,,,,,40.04,149.38,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,inpatient,,,73.00000,44.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,70.81,,,,,,,65.70,70.81,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,70.81,,,,,,,18.98,70.81,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,inpatient,,,160.00000,97.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,155.20,,,,,,,144.00,155.20,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,155.20,,,,,,,41.60,155.20,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,inpatient,,,325.00000,197.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,315.25,,,,,,,292.50,315.25,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,315.25,,,,,,,84.50,315.25,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,inpatient,,,74.00000,44.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,71.78,,,,,,,66.60,71.78,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,71.78,,,,,,,19.24,71.78,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,inpatient,,,79.00000,48.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,76.63,,,,,,,71.10,76.63,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,76.63,,,,,,,20.54,76.63,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,inpatient,,,72.00000,43.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,69.84,,,,,,,64.80,69.84,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,69.84,,,,,,,18.72,69.84,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,inpatient,,,445.00000,262.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,431.65,,,,,,,400.50,431.65,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,outpatient,,,445.00000,262.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,431.65,,,,,,,115.70,431.65,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,inpatient,,,310.00000,182.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,300.70,,,,,,,279.00,300.70,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,outpatient,,,310.00000,182.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,300.70,,,,,,,80.60,300.70,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,inpatient,,,393.00000,231.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,381.21,,,,,,,353.70,381.21,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,outpatient,,,393.00000,231.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,381.21,,,,,,,102.18,381.21,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,inpatient,,,310.00000,182.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,300.70,,,,,,,279.00,300.70,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,outpatient,,,310.00000,182.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GP,300.70,,,,,,,80.60,300.70,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,inpatient,,,80.00000,30.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,77.60,,,,,,,72.00,77.60,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,77.60,,,,,,,20.80,77.60,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,inpatient,,,84.00000,32.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,81.48,,,,,,,75.60,81.48,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,81.48,,,,,,,21.84,81.48,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,inpatient,,,126.00000,48.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,122.22,,,,,,,113.40,122.22,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,122.22,,,,,,,32.76,122.22,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,inpatient,,,66.00000,25.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,64.02,,,,,,,59.40,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,64.02,,,,,,,17.16,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,inpatient,,,62.00000,23.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,60.14,,,,,,,55.80,60.14,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,60.14,,,,,,,16.12,60.14,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,inpatient,,,90.00000,34.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,87.30,,,,,,,81.00,87.30,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,87.30,,,,,,,23.40,87.30,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,inpatient,,,95.00000,36.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,92.15,,,,,,,85.50,92.15,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,92.15,,,,,,,24.70,92.15,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,inpatient,,,146.00000,56.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,141.62,,,,,,,131.40,141.62,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,141.62,,,,,,,37.96,141.62,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,inpatient,,,139.00000,53.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,134.83,,,,,,,125.10,134.83,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,134.83,,,,,,,36.14,134.83,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,inpatient,,,75.00000,29.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,72.75,,,,,,,67.50,72.75,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,72.75,,,,,,,19.50,72.75,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,inpatient,,,154.00000,59.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,149.38,,,,,,,138.60,149.38,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,149.38,,,,,,,40.04,149.38,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,inpatient,,,73.00000,28.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,70.81,,,,,,,65.70,70.81,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,70.81,,,,,,,18.98,70.81,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,inpatient,,,160.00000,61.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,155.20,,,,,,,144.00,155.20,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,155.20,,,,,,,41.60,155.20,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,inpatient,,,98.00000,37.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,95.06,,,,,,,88.20,95.06,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,outpatient,,,98.00000,37.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,95.06,,,,,,,25.48,95.06,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,inpatient,,,303.00000,117.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,293.91,,,,,,,272.70,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,outpatient,,,303.00000,117.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,293.91,,,,,,,78.78,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,inpatient,,,115.00000,44.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,111.55,,,,,,,103.50,111.55,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,outpatient,,,115.00000,44.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,111.55,,,,,,,29.90,111.55,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,inpatient,,,74.00000,28.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,71.78,,,,,,,66.60,71.78,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,71.78,,,,,,,19.24,71.78,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,inpatient,,,72.00000,27.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,69.84,,,,,,,64.80,69.84,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,69.84,,,,,,,18.72,69.84,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,inpatient,,,80.00000,30.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",77.60,,,,,,,72.00,77.60,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",77.60,,,,,,,20.80,77.60,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,inpatient,,,84.00000,32.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",81.48,,,,,,,75.60,81.48,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",81.48,,,,,,,21.84,81.48,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,inpatient,,,126.00000,48.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",122.22,,,,,,,113.40,122.22,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",122.22,,,,,,,32.76,122.22,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,inpatient,,,62.00000,23.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",60.14,,,,,,,55.80,60.14,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",60.14,,,,,,,16.12,60.14,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,inpatient,,,66.00000,25.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",64.02,,,,,,,59.40,64.02,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",64.02,,,,,,,17.16,64.02,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,inpatient,,,90.00000,34.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",87.30,,,,,,,81.00,87.30,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",87.30,,,,,,,23.40,87.30,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,inpatient,,,95.00000,36.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",92.15,,,,,,,85.50,92.15,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",92.15,,,,,,,24.70,92.15,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,inpatient,,,146.00000,56.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",141.62,,,,,,,131.40,141.62,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",141.62,,,,,,,37.96,141.62,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,inpatient,,,139.00000,53.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",134.83,,,,,,,125.10,134.83,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",134.83,,,,,,,36.14,134.83,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,inpatient,,,75.00000,29.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",72.75,,,,,,,67.50,72.75,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",72.75,,,,,,,19.50,72.75,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,inpatient,,,154.00000,59.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",149.38,,,,,,,138.60,149.38,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",149.38,,,,,,,40.04,149.38,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,inpatient,,,73.00000,28.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",70.81,,,,,,,65.70,70.81,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",70.81,,,,,,,18.98,70.81,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,inpatient,,,160.00000,61.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",155.20,,,,,,,144.00,155.20,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",155.20,,,,,,,41.60,155.20,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,inpatient,,,74.00000,28.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",71.78,,,,,,,66.60,71.78,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",71.78,,,,,,,19.24,71.78,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,inpatient,,,72.00000,27.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",69.84,,,,,,,64.80,69.84,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",69.84,,,,,,,18.72,69.84,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,inpatient,,,47.00000,26.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,45.59,,,,,,,42.30,45.59,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,45.59,,,,,,,12.22,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,inpatient,,,47.00000,26.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",45.59,,,,,,,42.30,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"CO,GO",45.59,,,,,,,12.22,45.59,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,inpatient,,,250.00000,142.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,242.50,,,,,,,225.00,242.50,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,outpatient,,,250.00000,142.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,242.50,,,,,,,65.00,242.50,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,inpatient,,,175.00000,99.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,169.75,,,,,,,157.50,169.75,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,outpatient,,,175.00000,99.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,169.75,,,,,,,45.50,169.75,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,inpatient,,,233.00000,132.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,226.01,,,,,,,209.70,226.01,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,outpatient,,,233.00000,132.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,226.01,,,,,,,60.58,226.01,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,inpatient,,,175.00000,99.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,169.75,,,,,,,157.50,169.75,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,outpatient,,,175.00000,99.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GO,169.75,,,,,,,45.50,169.75,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,inpatient,,,291.00000,93.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,282.27,,,,,,,261.90,282.27,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,outpatient,,,291.00000,93.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,282.27,,,,,,,75.66,282.27,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,inpatient,,,273.00000,155.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,264.81,,,,,,,245.70,264.81,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,outpatient,,,273.00000,155.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,264.81,,,,,,,70.98,264.81,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,inpatient,,,279.00000,158.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,270.63,,,,,,,251.10,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,outpatient,,,279.00000,158.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,270.63,,,,,,,72.54,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,inpatient,,,426.00000,242.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,413.22,,,,,,,383.40,413.22,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,outpatient,,,426.00000,242.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,413.22,,,,,,,110.76,413.22,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,inpatient,,,242.00000,137.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,234.74,,,,,,,217.80,234.74,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,outpatient,,,242.00000,137.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,234.74,,,,,,,62.92,234.74,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,inpatient,,,128.00000,72.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,124.16,,,,,,,115.20,124.16,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,outpatient,,,128.00000,72.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,124.16,,,,,,,33.28,124.16,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,inpatient,,,66.00000,37.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,64.02,,,,,,,59.40,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,outpatient,,,66.00000,37.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,64.02,,,,,,,17.16,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,inpatient,,,62.00000,35.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,60.14,,,,,,,55.80,60.14,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,outpatient,,,62.00000,35.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,60.14,,,,,,,16.12,60.14,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,inpatient,,,269.00000,152.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,260.93,,,,,,,242.10,260.93,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,outpatient,,,269.00000,152.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,260.93,,,,,,,69.94,260.93,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,inpatient,,,153.00000,86.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,148.41,,,,,,,137.70,148.41,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,outpatient,,,153.00000,86.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,148.41,,,,,,,39.78,148.41,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,inpatient,,,98.00000,55.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,95.06,,,,,,,88.20,95.06,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,outpatient,,,98.00000,55.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,95.06,,,,,,,25.48,95.06,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,inpatient,,,303.00000,172.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,293.91,,,,,,,272.70,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,outpatient,,,303.00000,172.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,293.91,,,,,,,78.78,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,inpatient,,,115.00000,65.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,111.55,,,,,,,103.50,111.55,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,outpatient,,,115.00000,65.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,111.55,,,,,,,29.90,111.55,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,inpatient,,,210.00000,119.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,203.70,,,,,,,189.00,203.70,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,outpatient,,,210.00000,119.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,203.70,,,,,,,54.60,203.70,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,inpatient,,,250.00000,142.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,242.50,,,,,,,225.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,outpatient,,,250.00000,142.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,242.50,,,,,,,65.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,inpatient,,,78.00000,44.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,75.66,,,,,,,70.20,75.66,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,outpatient,,,78.00000,44.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,75.66,,,,,,,20.28,75.66,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,inpatient,,,322.00000,182.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,312.34,,,,,,,289.80,312.34,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,outpatient,,,322.00000,182.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,312.34,,,,,,,83.72,312.34,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,inpatient,,,309.00000,175.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,299.73,,,,,,,278.10,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,outpatient,,,309.00000,175.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,299.73,,,,,,,80.34,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,inpatient,,,245.00000,139.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,237.65,,,,,,,220.50,237.65,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,outpatient,,,245.00000,139.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,GN,237.65,,,,,,,63.70,237.65,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,inpatient,,,313.00000,116.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,281.70,303.61,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,outpatient,,,313.00000,116.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,303.61,,,,,,,81.38,303.61,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,inpatient,,,1250.00000,632.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1212.50,,,,,,,1125.00,1212.50,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,outpatient,,,1250.00000,632.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1212.50,,,,,,,325.00,1212.50,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,inpatient,,,145.00000,75.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,140.65,,,,,,,130.50,140.65,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,140.65,,,,,,,37.70,140.65,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,inpatient,,,488.00000,254.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,473.36,,,,,,,439.20,473.36,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,473.36,,,,,,,126.88,473.36,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,inpatient,,,684.00000,337.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,663.48,,,,,,,615.60,663.48,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,outpatient,,,684.00000,337.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,663.48,,,,,,,177.84,663.48,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,inpatient,,,206.00000,101.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,199.82,,,,,,,185.40,199.82,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,outpatient,,,206.00000,101.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,199.82,,,,,,,53.56,199.82,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,inpatient,,,195.00000,96.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,189.15,,,,,,,175.50,189.15,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,outpatient,,,195.00000,96.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,189.15,,,,,,,50.70,189.15,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,inpatient,,,375.00000,185.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,363.75,,,,,,,337.50,363.75,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,outpatient,,,375.00000,185.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,363.75,,,,,,,97.50,363.75,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,inpatient,,,429.00000,211.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,416.13,,,,,,,386.10,416.13,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,outpatient,,,429.00000,211.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,416.13,,,,,,,111.54,416.13,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22475,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2697.57,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B OBSTETRICS SEMI-PVT,42473,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2697.57,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ICU,32474,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8498.17,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,12476,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5665.77,,,,,,,2512.00,5665.77,percent of total billed charges,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,84.00000,63.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,81.48,,,,,,,75.60,81.48,percent of total billed charges,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,81.48,,,,,,,21.84,81.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,275.48,,,,,,,255.60,275.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,275.48,,,,,,,73.84,275.48,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,444.26,,,,,,,412.20,444.26,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,444.26,,,,,,,119.08,444.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,541.26,,,,,,,502.20,541.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,541.26,,,,,,,145.08,541.26,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,467.54,,,,,,,433.80,467.54,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,467.54,,,,,,,125.32,467.54,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,229.89,,,,,,,213.30,229.89,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,229.89,,,,,,,61.62,229.89,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,inpatient,,,490.00000,329.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,475.30,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,outpatient,,,490.00000,329.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,475.30,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,inpatient,,,490.00000,329.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,475.30,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,outpatient,,,490.00000,329.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,475.30,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,inpatient,,,245.00000,164.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,237.65,,,,,,,220.50,237.65,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,outpatient,,,245.00000,164.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,237.65,,,,,,,63.70,237.65,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,inpatient,,,490.00000,329.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,475.30,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,475.30,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,475.30,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,475.30,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,inpatient,,,245.00000,164.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,237.65,,,,,,,220.50,237.65,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,237.65,,,,,,,63.70,237.65,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,816.74,,,,,,,757.80,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,816.74,,,,,,,218.92,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1021.41,,,,,,,947.70,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1021.41,,,,,,,273.78,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1225.11,,,,,,,1136.70,1225.11,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1225.11,,,,,,,328.38,1225.11,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,inpatient,,,2466.00000,986.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2392.02,,,,,,,2219.40,2392.02,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,outpatient,,,2466.00000,986.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2392.02,,,,,,,641.16,2392.02,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,inpatient,,,260.00000,104.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,252.20,,,,,,,234.00,252.20,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,outpatient,,,260.00000,104.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,252.20,,,,,,,67.60,252.20,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,inpatient,,,2041.00000,816.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1979.77,,,,,,,1836.90,1979.77,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,outpatient,,,2041.00000,816.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1979.77,,,,,,,530.66,1979.77,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,inpatient,,,375.00000,150.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,363.75,,,,,,,337.50,363.75,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,outpatient,,,375.00000,150.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,363.75,,,,,,,97.50,363.75,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,inpatient,,,1178.00000,471.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1142.66,,,,,,,1060.20,1142.66,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,outpatient,,,1178.00000,471.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1142.66,,,,,,,306.28,1142.66,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,inpatient,,,245.00000,98.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,237.65,,,,,,,220.50,237.65,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,outpatient,,,245.00000,98.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,237.65,,,,,,,63.70,237.65,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,inpatient,,,280.00000,112.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,271.60,,,,,,,252.00,271.60,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,outpatient,,,280.00000,112.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,271.60,,,,,,,72.80,271.60,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,inpatient,,,336.00000,134.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,325.92,,,,,,,302.40,325.92,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,outpatient,,,336.00000,134.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,325.92,,,,,,,87.36,325.92,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,inpatient,,,380.00000,152.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,368.60,,,,,,,342.00,368.60,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,outpatient,,,380.00000,152.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,368.60,,,,,,,98.80,368.60,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,inpatient,,,530.00000,212.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,514.10,,,,,,,477.00,514.10,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,514.10,,,,,,,137.80,514.10,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,inpatient,,,264.00000,105.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,256.08,,,,,,,237.60,256.08,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,outpatient,,,264.00000,105.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,256.08,,,,,,,68.64,256.08,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,inpatient,,,763.00000,305.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,740.11,,,,,,,686.70,740.11,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,outpatient,,,763.00000,305.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,740.11,,,,,,,198.38,740.11,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,inpatient,,,672.00000,268.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,651.84,,,,,,,604.80,651.84,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,outpatient,,,672.00000,268.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,651.84,,,,,,,174.72,651.84,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,inpatient,,,1940.00000,776.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1881.80,,,,,,,1746.00,1881.80,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,outpatient,,,1940.00000,776.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1881.80,,,,,,,504.40,1881.80,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,inpatient,,,3875.00000,1550.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3758.75,,,,,,,3487.50,3758.75,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,outpatient,,,3875.00000,1550.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3758.75,,,,,,,1007.50,3758.75,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,inpatient,,,505.00000,202.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,489.85,,,,,,,454.50,489.85,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,outpatient,,,505.00000,202.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,489.85,,,,,,,131.30,489.85,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,inpatient,,,295.00000,118.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,286.15,,,,,,,265.50,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,286.15,,,,,,,76.70,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,inpatient,,,585.00000,234.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,567.45,,,,,,,526.50,567.45,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,outpatient,,,585.00000,234.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,567.45,,,,,,,152.10,567.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,inpatient,,,285.00000,114.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,276.45,,,,,,,256.50,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,outpatient,,,285.00000,114.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,276.45,,,,,,,74.10,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,inpatient,,,575.00000,230.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,557.75,,,,,,,517.50,557.75,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,outpatient,,,575.00000,230.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,557.75,,,,,,,149.50,557.75,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,inpatient,,,697.00000,278.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,676.09,,,,,,,627.30,676.09,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,outpatient,,,697.00000,278.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,676.09,,,,,,,181.22,676.09,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,inpatient,,,530.00000,212.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,514.10,,,,,,,477.00,514.10,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,514.10,,,,,,,137.80,514.10,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,inpatient,,,580.00000,232.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,562.60,,,,,,,522.00,562.60,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,outpatient,,,580.00000,232.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,562.60,,,,,,,150.80,562.60,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,inpatient,,,435.00000,174.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,421.95,,,,,,,391.50,421.95,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,outpatient,,,435.00000,174.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,421.95,,,,,,,113.10,421.95,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,inpatient,,,270.00000,108.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,261.90,,,,,,,243.00,261.90,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,outpatient,,,270.00000,108.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,261.90,,,,,,,70.20,261.90,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,inpatient,,,504.00000,201.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,488.88,,,,,,,453.60,488.88,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,outpatient,,,504.00000,201.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,488.88,,,,,,,131.04,488.88,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,inpatient,,,98.00000,39.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,88.20,95.06,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,outpatient,,,98.00000,39.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,25.48,95.06,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,inpatient,,,608.00000,243.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,589.76,,,,,,,547.20,589.76,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,outpatient,,,608.00000,243.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,589.76,,,,,,,158.08,589.76,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,inpatient,,,114.00000,45.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,102.60,110.58,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,outpatient,,,114.00000,45.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,29.64,110.58,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,inpatient,,,187.00000,74.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,168.30,181.39,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,outpatient,,,187.00000,74.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,48.62,181.39,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,inpatient,,,214.00000,85.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,207.58,,,,,,,192.60,207.58,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,outpatient,,,214.00000,85.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,207.58,,,,,,,55.64,207.58,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,inpatient,,,863.00000,345.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,837.11,,,,,,,776.70,837.11,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,outpatient,,,863.00000,345.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,837.11,,,,,,,224.38,837.11,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,inpatient,,,453.00000,181.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,439.41,,,,,,,407.70,439.41,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,outpatient,,,453.00000,181.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,439.41,,,,,,,117.78,439.41,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,inpatient,,,144.00000,57.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,139.68,,,,,,,129.60,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,outpatient,,,144.00000,57.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,139.68,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,inpatient,,,107.00000,42.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,103.79,,,,,,,96.30,103.79,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,outpatient,,,107.00000,42.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,103.79,,,,,,,27.82,103.79,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,inpatient,,,403.00000,161.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,390.91,,,,,,,362.70,390.91,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,outpatient,,,403.00000,161.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,390.91,,,,,,,104.78,390.91,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,inpatient,,,144.00000,57.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,139.68,,,,,,,129.60,139.68,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,outpatient,,,144.00000,57.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,139.68,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,inpatient,,,370.00000,148.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,358.90,,,,,,,333.00,358.90,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,outpatient,,,370.00000,148.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,358.90,,,,,,,96.20,358.90,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,inpatient,,,334.00000,133.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,323.98,,,,,,,300.60,323.98,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,outpatient,,,334.00000,133.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,323.98,,,,,,,86.84,323.98,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,inpatient,,,1188.00000,475.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,1152.36,,,,,,,1069.20,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,outpatient,,,1188.00000,475.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,1152.36,,,,,,,308.88,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,inpatient,,,792.00000,316.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,768.24,,,,,,,712.80,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,768.24,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,inpatient,,,792.00000,316.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,768.24,,,,,,,712.80,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,768.24,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,inpatient,,,572.00000,228.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,554.84,,,,,,,514.80,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,outpatient,,,572.00000,228.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,554.84,,,,,,,148.72,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,inpatient,,,381.00000,152.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,369.57,,,,,,,342.90,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,369.57,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,inpatient,,,381.00000,152.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,369.57,,,,,,,342.90,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,369.57,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,inpatient,,,683.00000,273.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,662.51,,,,,,,614.70,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,outpatient,,,683.00000,273.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,662.51,,,,,,,177.58,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,inpatient,,,455.00000,182.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,441.35,,,,,,,409.50,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,441.35,,,,,,,118.30,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,inpatient,,,455.00000,182.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,441.35,,,,,,,409.50,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,441.35,,,,,,,118.30,441.35,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,inpatient,,,357.00000,142.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,346.29,,,,,,,321.30,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,outpatient,,,357.00000,142.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,346.29,,,,,,,92.82,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,inpatient,,,334.00000,133.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,323.98,,,,,,,300.60,323.98,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,outpatient,,,334.00000,133.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,323.98,,,,,,,86.84,323.98,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,inpatient,,,194.00000,77.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,188.18,,,,,,,174.60,188.18,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,outpatient,,,194.00000,77.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,188.18,,,,,,,50.44,188.18,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,inpatient,,,608.00000,243.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,589.76,,,,,,,547.20,589.76,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,outpatient,,,608.00000,243.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,589.76,,,,,,,158.08,589.76,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,inpatient,,,257.00000,102.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,249.29,,,,,,,231.30,249.29,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,outpatient,,,257.00000,102.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,249.29,,,,,,,66.82,249.29,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,inpatient,,,343.00000,137.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,332.71,,,,,,,308.70,332.71,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,outpatient,,,343.00000,137.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,332.71,,,,,,,89.18,332.71,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,inpatient,,,457.00000,182.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,443.29,,,,,,,411.30,443.29,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,outpatient,,,457.00000,182.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,443.29,,,,,,,118.82,443.29,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,inpatient,,,630.00000,252.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,611.10,,,,,,,567.00,611.10,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,outpatient,,,630.00000,252.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,611.10,,,,,,,163.80,611.10,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,inpatient,,,623.00000,249.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,604.31,,,,,,,560.70,604.31,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,outpatient,,,623.00000,249.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,604.31,,,,,,,161.98,604.31,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,inpatient,,,1457.00000,582.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1413.29,,,,,,,1311.30,1413.29,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,outpatient,,,1457.00000,582.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1413.29,,,,,,,378.82,1413.29,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,inpatient,,,890.00000,356.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,863.30,,,,,,,801.00,863.30,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,outpatient,,,890.00000,356.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,863.30,,,,,,,231.40,863.30,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,inpatient,,,532.00000,212.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,516.04,,,,,,,478.80,516.04,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,outpatient,,,532.00000,212.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,516.04,,,,,,,138.32,516.04,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,inpatient,,,492.00000,196.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,477.24,,,,,,,442.80,477.24,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,outpatient,,,492.00000,196.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,477.24,,,,,,,127.92,477.24,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,inpatient,,,550.00000,220.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,533.50,,,,,,,495.00,533.50,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,outpatient,,,550.00000,220.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,533.50,,,,,,,143.00,533.50,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,inpatient,,,305.00000,122.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,295.85,,,,,,,274.50,295.85,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,outpatient,,,305.00000,122.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,295.85,,,,,,,79.30,295.85,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,inpatient,,,220.00000,88.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,213.40,,,,,,,198.00,213.40,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,outpatient,,,220.00000,88.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,213.40,,,,,,,57.20,213.40,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,inpatient,,,780.00000,312.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,756.60,,,,,,,702.00,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,outpatient,,,780.00000,312.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,756.60,,,,,,,202.80,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,inpatient,,,1165.00000,466.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1130.05,,,,,,,1048.50,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,outpatient,,,1165.00000,466.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1130.05,,,,,,,302.90,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,inpatient,,,2350.00000,940.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2279.50,,,,,,,2115.00,2279.50,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,outpatient,,,2350.00000,940.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2279.50,,,,,,,611.00,2279.50,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,inpatient,,,896.00000,358.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,869.12,,,,,,,806.40,869.12,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,outpatient,,,896.00000,358.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,869.12,,,,,,,232.96,869.12,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,inpatient,,,385.00000,154.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,373.45,,,,,,,346.50,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,outpatient,,,385.00000,154.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,373.45,,,,,,,100.10,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,inpatient,,,470.00000,188.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,455.90,,,,,,,423.00,455.90,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,outpatient,,,470.00000,188.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,455.90,,,,,,,122.20,455.90,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,inpatient,,,150.00000,60.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,145.50,,,,,,,135.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,outpatient,,,150.00000,60.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,145.50,,,,,,,39.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,inpatient,,,100.00000,40.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97.00,,,,,,,90.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,outpatient,,,100.00000,40.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,97.00,,,,,,,26.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,inpatient,,,143.00000,57.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,138.71,,,,,,,128.70,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,outpatient,,,143.00000,57.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,138.71,,,,,,,37.18,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,inpatient,,,95.00000,38.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,92.15,,,,,,,85.50,92.15,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,outpatient,,,95.00000,38.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,92.15,,,,,,,24.70,92.15,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,inpatient,,,269.00000,107.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,260.93,,,,,,,242.10,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,outpatient,,,269.00000,107.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,260.93,,,,,,,69.94,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,inpatient,,,388.00000,155.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,376.36,,,,,,,349.20,376.36,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,outpatient,,,388.00000,155.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,376.36,,,,,,,100.88,376.36,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,inpatient,,,344.00000,137.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,333.68,,,,,,,309.60,333.68,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,outpatient,,,344.00000,137.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,333.68,,,,,,,89.44,333.68,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,inpatient,,,321.00000,128.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,311.37,,,,,,,288.90,311.37,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,outpatient,,,321.00000,128.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,311.37,,,,,,,83.46,311.37,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,inpatient,,,155.00000,62.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,150.35,,,,,,,139.50,150.35,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,outpatient,,,155.00000,62.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,150.35,,,,,,,40.30,150.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,inpatient,,,817.00000,326.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,792.49,,,,,,,735.30,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,outpatient,,,817.00000,326.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,792.49,,,,,,,212.42,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,inpatient,,,1255.00000,502.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1217.35,,,,,,,1129.50,1217.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,outpatient,,,1255.00000,502.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1217.35,,,,,,,326.30,1217.35,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,inpatient,,,391.00000,156.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,379.27,,,,,,,351.90,379.27,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,outpatient,,,391.00000,156.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,379.27,,,,,,,101.66,379.27,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,inpatient,,,671.00000,268.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,650.87,,,,,,,603.90,650.87,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,outpatient,,,671.00000,268.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,650.87,,,,,,,174.46,650.87,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,inpatient,,,456.00000,182.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,442.32,,,,,,,410.40,442.32,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,outpatient,,,456.00000,182.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,442.32,,,,,,,118.56,442.32,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,inpatient,,,112.00000,44.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,108.64,,,,,,,100.80,108.64,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,outpatient,,,112.00000,44.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,108.64,,,,,,,29.12,108.64,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,inpatient,,,84.00000,33.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,81.48,,,,,,,75.60,81.48,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,outpatient,,,84.00000,33.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,81.48,,,,,,,21.84,81.48,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,inpatient,,,216.00000,86.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,209.52,,,,,,,194.40,209.52,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,outpatient,,,216.00000,86.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,209.52,,,,,,,56.16,209.52,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,inpatient,,,2660.00000,1064.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2580.20,,,,,,,2394.00,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,outpatient,,,2660.00000,1064.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2580.20,,,,,,,691.60,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,inpatient,,,2960.00000,1184.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2871.20,,,,,,,2664.00,2871.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,outpatient,,,2960.00000,1184.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2871.20,,,,,,,769.60,2871.20,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,inpatient,,,3225.00000,1290.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3128.25,,,,,,,2902.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,outpatient,,,3225.00000,1290.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3128.25,,,,,,,838.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,inpatient,,,3395.00000,1358.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3293.15,,,,,,,3055.50,3293.15,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,outpatient,,,3395.00000,1358.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3293.15,,,,,,,882.70,3293.15,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,inpatient,,,490.00000,196.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,475.30,,,,,,,441.00,475.30,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,outpatient,,,490.00000,196.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,475.30,,,,,,,127.40,475.30,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,inpatient,,,520.00000,208.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,504.40,,,,,,,468.00,504.40,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,outpatient,,,520.00000,208.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,504.40,,,,,,,135.20,504.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,inpatient,,,720.00000,288.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,698.40,,,,,,,648.00,698.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,outpatient,,,720.00000,288.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,698.40,,,,,,,187.20,698.40,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,inpatient,,,215.00000,86.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,208.55,,,,,,,193.50,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,outpatient,,,215.00000,86.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,208.55,,,,,,,55.90,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,inpatient,,,240.00000,96.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,232.80,,,,,,,216.00,232.80,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,outpatient,,,240.00000,96.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,232.80,,,,,,,62.40,232.80,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,inpatient,,,1241.00000,496.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1203.77,,,,,,,1116.90,1203.77,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,outpatient,,,1241.00000,496.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1203.77,,,,,,,322.66,1203.77,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,inpatient,,,850.00000,340.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,765.00,824.50,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,outpatient,,,850.00000,340.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,824.50,,,,,,,221.00,824.50,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,inpatient,,,1085.00000,434.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1052.45,,,,,,,976.50,1052.45,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,outpatient,,,1085.00000,434.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1052.45,,,,,,,282.10,1052.45,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,inpatient,,,295.00000,118.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,286.15,,,,,,,265.50,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,286.15,,,,,,,76.70,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,inpatient,,,492.00000,196.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,477.24,,,,,,,442.80,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,outpatient,,,492.00000,196.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,477.24,,,,,,,127.92,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,inpatient,,,563.00000,225.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,546.11,,,,,,,506.70,546.11,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,outpatient,,,563.00000,225.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,546.11,,,,,,,146.38,546.11,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,inpatient,,,1612.00000,644.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1563.64,,,,,,,1450.80,1563.64,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,outpatient,,,1612.00000,644.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1563.64,,,,,,,419.12,1563.64,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,inpatient,,,1366.00000,546.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1325.02,,,,,,,1229.40,1325.02,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,outpatient,,,1366.00000,546.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1325.02,,,,,,,355.16,1325.02,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,inpatient,,,1911.00000,764.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1853.67,,,,,,,1719.90,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,outpatient,,,1911.00000,764.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1853.67,,,,,,,496.86,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,inpatient,,,956.00000,382.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,927.32,,,,,,,860.40,927.32,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,outpatient,,,956.00000,382.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,927.32,,,,,,,248.56,927.32,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,inpatient,,,189.00000,123.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,183.33,,,,,,,170.10,183.33,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,outpatient,,,189.00000,123.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,183.33,,,,,,,49.14,183.33,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,inpatient,,,352.00000,256.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,341.44,,,,,,,316.80,341.44,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,outpatient,,,352.00000,256.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,341.44,,,,,,,91.52,341.44,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,inpatient,,,625.00000,738.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,606.25,,,,,,,562.50,606.25,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,outpatient,,,625.00000,738.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,606.25,,,,,,,162.50,606.25,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,inpatient,,,1024.00000,2097.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,993.28,,,,,,,921.60,993.28,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1024.00000,2097.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,993.28,,,,,,,266.24,993.28,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,inpatient,,,1455.00000,2469.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1411.35,,,,,,,1309.50,1411.35,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,outpatient,,,1455.00000,2469.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1411.35,,,,,,,378.30,1411.35,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,inpatient,,,145.00000,75.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,140.65,,,,,,,130.50,140.65,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,140.65,,,,,,,37.70,140.65,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,inpatient,,,488.00000,254.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,473.36,,,,,,,439.20,473.36,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,473.36,,,,,,,126.88,473.36,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,112.52,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,112.52,,,,,,,30.16,112.52,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,72.90,78.57,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,21.06,78.57,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,39.77,,,,,,,36.90,39.77,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,39.77,,,,,,,10.66,39.77,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,inpatient,,,170.00000,73.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,164.90,,,,,,,153.00,164.90,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,outpatient,,,170.00000,73.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,164.90,,,,,,,44.20,164.90,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,2.70000,1.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2.62,,,,,,,2.43,2.62,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,2.70000,1.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2.62,,,,,,,0.70200,2.62,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,27.00000,11.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,26.19,,,,,,,24.30,26.19,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,27.00000,11.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,26.19,,,,,,,7.02,26.19,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,inpatient,,,20440.00000,8891.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19826.80,,,,,,,18396.00,19826.80,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,outpatient,,,20440.00000,8891.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,19826.80,,,,,,,5314.40,19826.80,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,inpatient,,,3322.00000,1445.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3222.34,,,,,,,2989.80,3222.34,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,3322.00000,1445.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3222.34,,,,,,,863.72,3222.34,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,inpatient,,,2492.00000,1084.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2417.24,,,,,,,2242.80,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,2492.00000,1084.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2417.24,,,,,,,647.92,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,inpatient,,,1814.00000,789.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1759.58,,,,,,,1632.60,1759.58,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1814.00000,789.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1759.58,,,,,,,471.64,1759.58,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,inpatient,,,2153.00000,936.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2088.41,,,,,,,1937.70,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,2153.00000,936.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2088.41,,,,,,,559.78,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,inpatient,,,1525.00000,663.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1479.25,,,,,,,1372.50,1479.25,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1525.00000,663.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1479.25,,,,,,,396.50,1479.25,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,inpatient,,,2716.00000,1181.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2634.52,,,,,,,2444.40,2634.52,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2716.00000,1181.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2634.52,,,,,,,706.16,2634.52,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,inpatient,,,2.70000,0.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2.62,,,,,,,2.43,2.62,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,outpatient,,,2.70000,0.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2.62,,,,,,,0.70200,2.62,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,inpatient,,,222.00000,32.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,215.34,,,,,,,199.80,215.34,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,outpatient,,,222.00000,32.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,215.34,,,,,,,57.72,215.34,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,inpatient,,,211.00000,113.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,204.67,,,,,,,189.90,204.67,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,outpatient,,,211.00000,113.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,204.67,,,,,,,54.86,204.67,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,inpatient,,,497.00000,266.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,482.09,,,,,,,447.30,482.09,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,outpatient,,,497.00000,266.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,482.09,,,,,,,129.22,482.09,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,inpatient,,,296.00000,158.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,287.12,,,,,,,266.40,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,outpatient,,,296.00000,158.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,287.12,,,,,,,76.96,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,inpatient,,,723.00000,387.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,701.31,,,,,,,650.70,701.31,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,outpatient,,,723.00000,387.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,701.31,,,,,,,187.98,701.31,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,inpatient,,,326.00000,174.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,316.22,,,,,,,293.40,316.22,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,outpatient,,,326.00000,174.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,316.22,,,,,,,84.76,316.22,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,inpatient,,,532.00000,285.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,516.04,,,,,,,478.80,516.04,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,outpatient,,,532.00000,285.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,516.04,,,,,,,138.32,516.04,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,inpatient,,,635.00000,340.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,615.95,,,,,,,571.50,615.95,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,outpatient,,,635.00000,340.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,615.95,,,,,,,165.10,615.95,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,inpatient,,,639.00000,342.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,619.83,,,,,,,575.10,619.83,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,outpatient,,,639.00000,342.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,619.83,,,,,,,166.14,619.83,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,inpatient,,,780.00000,418.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,756.60,,,,,,,702.00,756.60,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,outpatient,,,780.00000,418.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,756.60,,,,,,,202.80,756.60,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,inpatient,,,390.00000,209.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,378.30,,,,,,,351.00,378.30,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,outpatient,,,390.00000,209.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,378.30,,,,,,,101.40,378.30,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,inpatient,,,731.00000,391.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,709.07,,,,,,,657.90,709.07,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,outpatient,,,731.00000,391.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,709.07,,,,,,,190.06,709.07,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,inpatient,,,585.00000,313.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,567.45,,,,,,,526.50,567.45,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,outpatient,,,585.00000,313.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,567.45,,,,,,,152.10,567.45,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,inpatient,,,365.00000,195.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,354.05,,,,,,,328.50,354.05,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,outpatient,,,365.00000,195.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,354.05,,,,,,,94.90,354.05,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,inpatient,,,1086.00000,582.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1053.42,,,,,,,977.40,1053.42,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,outpatient,,,1086.00000,582.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1053.42,,,,,,,282.36,1053.42,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,inpatient,,,197.00000,105.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,191.09,,,,,,,177.30,191.09,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,outpatient,,,197.00000,105.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,191.09,,,,,,,51.22,191.09,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,inpatient,,,2774.00000,1486.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2690.78,,,,,,,2496.60,2690.78,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,outpatient,,,2774.00000,1486.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2690.78,,,,,,,721.24,2690.78,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,inpatient,,,1456.00000,780.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1412.32,,,,,,,1310.40,1412.32,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,outpatient,,,1456.00000,780.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1412.32,,,,,,,378.56,1412.32,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,inpatient,,,2647.00000,1418.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2567.59,,,,,,,2382.30,2567.59,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,outpatient,,,2647.00000,1418.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2567.59,,,,,,,688.22,2567.59,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,inpatient,,,1359.00000,728.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1318.23,,,,,,,1223.10,1318.23,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,outpatient,,,1359.00000,728.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1318.23,,,,,,,353.34,1318.23,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,inpatient,,,273.00000,146.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,264.81,,,,,,,245.70,264.81,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,outpatient,,,273.00000,146.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,264.81,,,,,,,70.98,264.81,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,inpatient,,,325.00000,174.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,315.25,,,,,,,292.50,315.25,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,outpatient,,,325.00000,174.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,315.25,,,,,,,84.50,315.25,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,inpatient,,,609.00000,326.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,590.73,,,,,,,548.10,590.73,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,590.73,,,,,,,158.34,590.73,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,inpatient,,,491.00000,263.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,476.27,,,,,,,441.90,476.27,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,outpatient,,,491.00000,263.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,476.27,,,,,,,127.66,476.27,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,inpatient,,,561.00000,300.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,544.17,,,,,,,504.90,544.17,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,outpatient,,,561.00000,300.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,544.17,,,,,,,145.86,544.17,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,inpatient,,,845.00000,452.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,819.65,,,,,,,760.50,819.65,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,outpatient,,,845.00000,452.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,819.65,,,,,,,219.70,819.65,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,inpatient,,,612.00000,328.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,593.64,,,,,,,550.80,593.64,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,outpatient,,,612.00000,328.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,593.64,,,,,,,159.12,593.64,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,inpatient,,,536.00000,287.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,519.92,,,,,,,482.40,519.92,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,outpatient,,,536.00000,287.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,519.92,,,,,,,139.36,519.92,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,inpatient,,,1225.00000,656.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1188.25,,,,,,,1102.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,outpatient,,,1225.00000,656.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1188.25,,,,,,,318.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,inpatient,,,816.00000,437.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,791.52,,,,,,,734.40,791.52,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,791.52,,,,,,,212.16,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,inpatient,,,816.00000,437.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,791.52,,,,,,,734.40,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,791.52,,,,,,,212.16,791.52,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,inpatient,,,250.00000,134.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,242.50,,,,,,,225.00,242.50,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,outpatient,,,250.00000,134.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,242.50,,,,,,,65.00,242.50,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,inpatient,,,302.00000,161.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,292.94,,,,,,,271.80,292.94,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,outpatient,,,302.00000,161.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,292.94,,,,,,,78.52,292.94,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,inpatient,,,354.00000,189.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,343.38,,,,,,,318.60,343.38,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,outpatient,,,354.00000,189.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,343.38,,,,,,,92.04,343.38,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,inpatient,,,409.00000,219.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,396.73,,,,,,,368.10,396.73,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,outpatient,,,409.00000,219.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,396.73,,,,,,,106.34,396.73,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,inpatient,,,593.00000,317.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,575.21,,,,,,,533.70,575.21,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,outpatient,,,593.00000,317.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,575.21,,,,,,,154.18,575.21,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,297.79,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,297.79,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,LT",297.79,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,LT",297.79,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,297.79,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,297.79,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,RT",297.79,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,RT",297.79,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,inpatient,,,330.00000,176.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,320.10,,,,,,,297.00,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,320.10,,,,,,,85.80,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,inpatient,,,330.00000,176.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,320.10,,,,,,,297.00,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,320.10,,,,,,,85.80,320.10,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,inpatient,,,195.00000,104.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,189.15,,,,,,,175.50,189.15,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,outpatient,,,195.00000,104.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,189.15,,,,,,,50.70,189.15,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,inpatient,,,578.00000,309.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,560.66,,,,,,,520.20,560.66,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,outpatient,,,578.00000,309.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,560.66,,,,,,,150.28,560.66,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,inpatient,,,384.00000,205.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,372.48,,,,,,,345.60,372.48,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,outpatient,,,384.00000,205.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,372.48,,,,,,,99.84,372.48,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,inpatient,,,303.00000,162.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,293.91,,,,,,,272.70,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,293.91,,,,,,,78.78,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,inpatient,,,303.00000,162.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,293.91,,,,,,,272.70,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,293.91,,,,,,,78.78,293.91,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,inpatient,,,445.00000,238.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,431.65,,,,,,,400.50,431.65,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,431.65,,,,,,,115.70,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,inpatient,,,445.00000,238.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,431.65,,,,,,,400.50,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,431.65,,,,,,,115.70,431.65,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,inpatient,,,937.00000,502.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,908.89,,,,,,,843.30,908.89,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,outpatient,,,937.00000,502.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,908.89,,,,,,,243.62,908.89,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,inpatient,,,615.00000,329.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,596.55,,,,,,,553.50,596.55,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,outpatient,,,615.00000,329.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,596.55,,,,,,,159.90,596.55,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,278.39,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,278.39,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,LT",278.39,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,LT",278.39,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,278.39,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,278.39,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,RT",278.39,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,RT",278.39,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,inpatient,,,323.00000,173.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,313.31,,,,,,,290.70,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,313.31,,,,,,,83.98,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,inpatient,,,323.00000,173.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,313.31,,,,,,,290.70,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,313.31,,,,,,,83.98,313.31,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,inpatient,,,694.00000,371.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,673.18,,,,,,,624.60,673.18,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,outpatient,,,694.00000,371.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,673.18,,,,,,,180.44,673.18,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,inpatient,,,276.00000,147.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,267.72,,,,,,,248.40,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,267.72,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,inpatient,,,276.00000,147.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,267.72,,,,,,,248.40,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,267.72,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,inpatient,,,254.00000,136.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,246.38,,,,,,,228.60,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,246.38,,,,,,,66.04,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,inpatient,,,254.00000,136.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,246.38,,,,,,,228.60,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,246.38,,,,,,,66.04,246.38,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,inpatient,,,275.00000,147.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,266.75,,,,,,,247.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,266.75,,,,,,,71.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,inpatient,,,275.00000,147.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,266.75,,,,,,,247.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,266.75,,,,,,,71.50,266.75,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,inpatient,,,173.00000,92.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,167.81,,,,,,,155.70,167.81,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,outpatient,,,173.00000,92.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,167.81,,,,,,,44.98,167.81,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,inpatient,,,483.00000,258.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,468.51,,,,,,,434.70,468.51,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,468.51,,,,,,,125.58,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,inpatient,,,483.00000,258.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,468.51,,,,,,,434.70,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,468.51,,,,,,,125.58,468.51,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,inpatient,,,191.00000,102.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,185.27,,,,,,,171.90,185.27,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,185.27,,,,,,,49.66,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,inpatient,,,191.00000,102.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,185.27,,,,,,,171.90,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,185.27,,,,,,,49.66,185.27,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,143.56,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,143.56,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,LT",143.56,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,LT",143.56,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,143.56,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,143.56,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,RT",143.56,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,RT",143.56,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,inpatient,,,481.00000,257.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,466.57,,,,,,,432.90,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,466.57,,,,,,,125.06,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,inpatient,,,481.00000,257.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,466.57,,,,,,,432.90,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,466.57,,,,,,,125.06,466.57,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,inpatient,,,215.00000,115.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,208.55,,,,,,,193.50,208.55,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,208.55,,,,,,,55.90,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,inpatient,,,215.00000,115.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,208.55,,,,,,,193.50,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,208.55,,,,,,,55.90,208.55,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,266.75,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,266.75,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,LT",266.75,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,LT",266.75,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,266.75,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,266.75,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,RT",266.75,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,RT",266.75,,,,,,,71.50,266.75,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,441.35,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,441.35,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,LT",441.35,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,LT",441.35,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,441.35,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,441.35,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,RT",441.35,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,RT",441.35,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,inpatient,,,503.00000,269.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,487.91,,,,,,,452.70,487.91,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,487.91,,,,,,,130.78,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,inpatient,,,503.00000,269.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,487.91,,,,,,,452.70,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,487.91,,,,,,,130.78,487.91,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,inpatient,,,209.00000,112.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,202.73,,,,,,,188.10,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,202.73,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,inpatient,,,209.00000,112.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,202.73,,,,,,,188.10,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,202.73,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,inpatient,,,566.00000,303.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,549.02,,,,,,,509.40,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,549.02,,,,,,,147.16,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,inpatient,,,566.00000,303.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,549.02,,,,,,,509.40,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,549.02,,,,,,,147.16,549.02,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,inpatient,,,598.00000,320.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,580.06,,,,,,,538.20,580.06,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,outpatient,,,598.00000,320.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,580.06,,,,,,,155.48,580.06,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,LT",441.35,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,LT",441.35,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,RT",441.35,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,RT",441.35,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,441.35,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,441.35,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,441.35,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,441.35,,,,,,,118.30,441.35,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,inpatient,,,1913.00000,1025.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1855.61,,,,,,,1721.70,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,outpatient,,,1913.00000,1025.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1855.61,,,,,,,497.38,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,inpatient,,,312.00000,167.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,302.64,,,,,,,280.80,302.64,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,outpatient,,,312.00000,167.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,302.64,,,,,,,81.12,302.64,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,inpatient,,,327.00000,175.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,317.19,,,,,,,294.30,317.19,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,outpatient,,,327.00000,175.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,317.19,,,,,,,85.02,317.19,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,inpatient,,,425.00000,227.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,412.25,,,,,,,382.50,412.25,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,outpatient,,,425.00000,227.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,412.25,,,,,,,110.50,412.25,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,inpatient,,,210.00000,112.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,203.70,,,,,,,189.00,203.70,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,outpatient,,,210.00000,112.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,203.70,,,,,,,54.60,203.70,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,inpatient,,,495.00000,265.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,480.15,,,,,,,445.50,480.15,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,outpatient,,,495.00000,265.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,480.15,,,,,,,128.70,480.15,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,inpatient,,,541.00000,289.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,524.77,,,,,,,486.90,524.77,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,outpatient,,,541.00000,289.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,524.77,,,,,,,140.66,524.77,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,inpatient,,,345.00000,184.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,334.65,,,,,,,310.50,334.65,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,334.65,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,inpatient,,,345.00000,184.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,334.65,,,,,,,310.50,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,334.65,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,inpatient,,,419.00000,224.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,406.43,,,,,,,377.10,406.43,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,406.43,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,inpatient,,,419.00000,224.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,406.43,,,,,,,377.10,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,406.43,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,inpatient,,,618.00000,331.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,599.46,,,,,,,556.20,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,599.46,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,inpatient,,,618.00000,331.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,599.46,,,,,,,556.20,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,599.46,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,inpatient,,,463.00000,248.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,449.11,,,,,,,416.70,449.11,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,outpatient,,,463.00000,248.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,449.11,,,,,,,120.38,449.11,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,inpatient,,,511.00000,273.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,495.67,,,,,,,459.90,495.67,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,outpatient,,,511.00000,273.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,495.67,,,,,,,132.86,495.67,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,inpatient,,,132.00000,70.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,128.04,,,,,,,118.80,128.04,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,outpatient,,,132.00000,70.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,128.04,,,,,,,34.32,128.04,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,inpatient,,,353.00000,189.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,342.41,,,,,,,317.70,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,342.41,,,,,,,91.78,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,inpatient,,,353.00000,189.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,342.41,,,,,,,317.70,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,342.41,,,,,,,91.78,342.41,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,inpatient,,,273.00000,146.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,264.81,,,,,,,245.70,264.81,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,outpatient,,,273.00000,146.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,264.81,,,,,,,70.98,264.81,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,inpatient,,,503.00000,269.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,487.91,,,,,,,452.70,487.91,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,outpatient,,,503.00000,269.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,487.91,,,,,,,130.78,487.91,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,inpatient,,,561.00000,300.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,544.17,,,,,,,504.90,544.17,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,outpatient,,,561.00000,300.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,544.17,,,,,,,145.86,544.17,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,inpatient,,,450.00000,241.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,436.50,,,,,,,405.00,436.50,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,436.50,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,inpatient,,,450.00000,241.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,436.50,,,,,,,405.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,436.50,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,inpatient,,,650.00000,348.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,630.50,,,,,,,585.00,630.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,outpatient,,,650.00000,348.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,630.50,,,,,,,169.00,630.50,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,inpatient,,,642.00000,344.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,622.74,,,,,,,577.80,622.74,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,outpatient,,,642.00000,344.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,622.74,,,,,,,166.92,622.74,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,inpatient,,,777.00000,416.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,753.69,,,,,,,699.30,753.69,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,outpatient,,,777.00000,416.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,753.69,,,,,,,202.02,753.69,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,inpatient,,,381.00000,204.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,369.57,,,,,,,342.90,369.57,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,outpatient,,,381.00000,204.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,369.57,,,,,,,99.06,369.57,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,inpatient,,,374.00000,200.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,362.78,,,,,,,336.60,362.78,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,362.78,,,,,,,97.24,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,inpatient,,,374.00000,200.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,362.78,,,,,,,336.60,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,362.78,,,,,,,97.24,362.78,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,inpatient,,,161.00000,86.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,156.17,,,,,,,144.90,156.17,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,156.17,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,inpatient,,,161.00000,86.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,156.17,,,,,,,144.90,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,156.17,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,inpatient,,,499.00000,267.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,484.03,,,,,,,449.10,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,484.03,,,,,,,129.74,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,inpatient,,,499.00000,267.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,484.03,,,,,,,449.10,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,484.03,,,,,,,129.74,484.03,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,inpatient,,,214.00000,114.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,207.58,,,,,,,192.60,207.58,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,outpatient,,,214.00000,114.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,207.58,,,,,,,55.64,207.58,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,inpatient,,,329.00000,176.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,319.13,,,,,,,296.10,319.13,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,outpatient,,,329.00000,176.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,319.13,,,,,,,85.54,319.13,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,inpatient,,,197.00000,105.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,191.09,,,,,,,177.30,191.09,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,outpatient,,,197.00000,105.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,191.09,,,,,,,51.22,191.09,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,inpatient,,,263.00000,140.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,255.11,,,,,,,236.70,255.11,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,outpatient,,,263.00000,140.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,255.11,,,,,,,68.38,255.11,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,inpatient,,,234.00000,125.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,226.98,,,,,,,210.60,226.98,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,outpatient,,,234.00000,125.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,226.98,,,,,,,60.84,226.98,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,inpatient,,,401.00000,214.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,388.97,,,,,,,360.90,388.97,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,outpatient,,,401.00000,214.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,388.97,,,,,,,104.26,388.97,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,inpatient,,,515.00000,276.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,499.55,,,,,,,463.50,499.55,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,outpatient,,,515.00000,276.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,499.55,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,inpatient,,,747.00000,400.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,724.59,,,,,,,672.30,724.59,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,outpatient,,,747.00000,400.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,724.59,,,,,,,194.22,724.59,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,inpatient,,,854.00000,457.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,828.38,,,,,,,768.60,828.38,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,outpatient,,,854.00000,457.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,828.38,,,,,,,222.04,828.38,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,inpatient,,,589.00000,315.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,571.33,,,,,,,530.10,571.33,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,outpatient,,,589.00000,315.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,571.33,,,,,,,153.14,571.33,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,inpatient,,,613.00000,328.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,594.61,,,,,,,551.70,594.61,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,outpatient,,,613.00000,328.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,594.61,,,,,,,159.38,594.61,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,inpatient,,,806.00000,432.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,781.82,,,,,,,725.40,781.82,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,outpatient,,,806.00000,432.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,781.82,,,,,,,209.56,781.82,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,inpatient,,,529.00000,283.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,513.13,,,,,,,476.10,513.13,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,outpatient,,,529.00000,283.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,513.13,,,,,,,137.54,513.13,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,inpatient,,,939.00000,503.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,910.83,,,,,,,845.10,910.83,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,outpatient,,,939.00000,503.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,910.83,,,,,,,244.14,910.83,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,inpatient,,,515.00000,276.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,499.55,,,,,,,463.50,499.55,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,outpatient,,,515.00000,276.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,499.55,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,inpatient,,,616.00000,330.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,597.52,,,,,,,554.40,597.52,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,outpatient,,,616.00000,330.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,597.52,,,,,,,160.16,597.52,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,inpatient,,,377.00000,202.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,365.69,,,,,,,339.30,365.69,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,outpatient,,,377.00000,202.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,365.69,,,,,,,98.02,365.69,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,inpatient,,,340.00000,182.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,329.80,,,,,,,306.00,329.80,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,outpatient,,,340.00000,182.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,329.80,,,,,,,88.40,329.80,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,inpatient,,,388.00000,207.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,376.36,,,,,,,349.20,376.36,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,outpatient,,,388.00000,207.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,376.36,,,,,,,100.88,376.36,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,inpatient,,,456.00000,244.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,442.32,,,,,,,410.40,442.32,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,outpatient,,,456.00000,244.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,442.32,,,,,,,118.56,442.32,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,inpatient,,,267.00000,143.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,258.99,,,,,,,240.30,258.99,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,outpatient,,,267.00000,143.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,258.99,,,,,,,69.42,258.99,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,296.82,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,296.82,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,LT",296.82,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,LT",296.82,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,296.82,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,296.82,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,RT",296.82,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,RT",296.82,,,,,,,79.56,296.82,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,inpatient,,,456.00000,244.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,442.32,,,,,,,410.40,442.32,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,outpatient,,,456.00000,244.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,442.32,,,,,,,118.56,442.32,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,inpatient,,,381.00000,204.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,369.57,,,,,,,342.90,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,outpatient,,,381.00000,204.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,369.57,,,,,,,99.06,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,inpatient,,,143.00000,76.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,138.71,,,,,,,128.70,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,138.71,,,,,,,37.18,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,inpatient,,,143.00000,76.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,138.71,,,,,,,128.70,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,138.71,,,,,,,37.18,138.71,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,inpatient,,,331.00000,177.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,321.07,,,,,,,297.90,321.07,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,321.07,,,,,,,86.06,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,inpatient,,,331.00000,177.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,321.07,,,,,,,297.90,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,321.07,,,,,,,86.06,321.07,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,inpatient,,,1113.00000,596.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1079.61,,,,,,,1001.70,1079.61,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1113.00000,596.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1079.61,,,,,,,289.38,1079.61,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,inpatient,,,1043.00000,559.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1011.71,,,,,,,938.70,1011.71,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,outpatient,,,1043.00000,559.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1011.71,,,,,,,271.18,1011.71,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,248.32,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,248.32,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,LT",248.32,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,LT",248.32,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,248.32,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,248.32,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,RT",248.32,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,"52,RT",248.32,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,inpatient,,,511.00000,273.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,495.67,,,,,,,459.90,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,495.67,,,,,,,132.86,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,inpatient,,,511.00000,273.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,495.67,,,,,,,459.90,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,495.67,,,,,,,132.86,495.67,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,inpatient,,,553.00000,314.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,536.41,,,,,,,497.70,536.41,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,536.41,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,inpatient,,,553.00000,314.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,536.41,,,,,,,497.70,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,536.41,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,inpatient,,,1076.00000,611.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1043.72,,,,,,,968.40,1043.72,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1043.72,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,inpatient,,,1076.00000,611.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1043.72,,,,,,,968.40,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1043.72,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,inpatient,,,865.00000,491.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,839.05,,,,,,,778.50,839.05,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,839.05,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,inpatient,,,865.00000,491.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,839.05,,,,,,,778.50,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,839.05,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,inpatient,,,734.00000,417.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,711.98,,,,,,,660.60,711.98,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,711.98,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,inpatient,,,734.00000,417.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,711.98,,,,,,,660.60,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,711.98,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,inpatient,,,730.00000,414.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,708.10,,,,,,,657.00,708.10,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,708.10,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,inpatient,,,730.00000,414.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,708.10,,,,,,,657.00,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,708.10,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,inpatient,,,260.00000,147.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,252.20,,,,,,,234.00,252.20,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,252.20,,,,,,,67.60,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,inpatient,,,260.00000,147.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,252.20,,,,,,,234.00,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,252.20,,,,,,,67.60,252.20,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,inpatient,,,428.00000,203.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,415.16,,,,,,,385.20,415.16,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,outpatient,,,428.00000,203.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,415.16,,,,,,,111.28,415.16,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,inpatient,,,492.00000,234.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,477.24,,,,,,,442.80,477.24,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,outpatient,,,492.00000,234.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,477.24,,,,,,,127.92,477.24,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,inpatient,,,607.00000,288.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,588.79,,,,,,,546.30,588.79,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,outpatient,,,607.00000,288.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,588.79,,,,,,,157.82,588.79,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,inpatient,,,649.00000,308.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,629.53,,,,,,,584.10,629.53,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,outpatient,,,649.00000,308.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,629.53,,,,,,,168.74,629.53,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,inpatient,,,377.00000,121.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,365.69,,,,,,,339.30,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,outpatient,,,377.00000,121.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,365.69,,,,,,,98.02,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,inpatient,,,251.00000,81.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,243.47,,,,,,,225.90,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,243.47,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,inpatient,,,251.00000,81.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,243.47,,,,,,,225.90,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,243.47,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,inpatient,,,1170.00000,377.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,1134.90,,,,,,,1053.00,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,outpatient,,,1170.00000,377.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,1134.90,,,,,,,304.20,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,inpatient,,,780.00000,251.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,756.60,,,,,,,702.00,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,756.60,,,,,,,202.80,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,inpatient,,,780.00000,251.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,756.60,,,,,,,702.00,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,756.60,,,,,,,202.80,756.60,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,inpatient,,,1389.00000,448.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1347.33,,,,,,,1250.10,1347.33,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,outpatient,,,1389.00000,448.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1347.33,,,,,,,361.14,1347.33,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,inpatient,,,345.00000,111.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,334.65,,,,,,,310.50,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,outpatient,,,345.00000,111.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,334.65,,,,,,,89.70,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,inpatient,,,230.00000,74.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,223.10,,,,,,,207.00,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,223.10,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,inpatient,,,230.00000,74.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,223.10,,,,,,,207.00,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,223.10,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,inpatient,,,2102.00000,678.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,2038.94,,,,,,,1891.80,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,outpatient,,,2102.00000,678.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,2038.94,,,,,,,546.52,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,inpatient,,,1401.00000,452.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1358.97,,,,,,,1260.90,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1358.97,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,inpatient,,,1401.00000,452.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1358.97,,,,,,,1260.90,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1358.97,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,inpatient,,,357.00000,115.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,346.29,,,,,,,321.30,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,outpatient,,,357.00000,115.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,346.29,,,,,,,92.82,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,inpatient,,,238.00000,76.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,230.86,,,,,,,214.20,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,230.86,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,inpatient,,,238.00000,76.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,230.86,,,,,,,214.20,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,230.86,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,inpatient,,,2082.00000,672.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,2019.54,,,,,,,1873.80,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,outpatient,,,2082.00000,672.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,2019.54,,,,,,,541.32,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,inpatient,,,1388.00000,448.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1346.36,,,,,,,1249.20,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1346.36,,,,,,,360.88,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,inpatient,,,1388.00000,448.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1346.36,,,,,,,1249.20,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1346.36,,,,,,,360.88,1346.36,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,inpatient,,,246.00000,79.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,238.62,,,,,,,221.40,238.62,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,outpatient,,,246.00000,79.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,238.62,,,,,,,63.96,238.62,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,inpatient,,,164.00000,52.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,159.08,,,,,,,147.60,159.08,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,159.08,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,inpatient,,,164.00000,52.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,159.08,,,,,,,147.60,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,159.08,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,inpatient,,,309.00000,99.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,299.73,,,,,,,278.10,299.73,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,outpatient,,,309.00000,99.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,299.73,,,,,,,80.34,299.73,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,inpatient,,,206.00000,66.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,199.82,,,,,,,185.40,199.82,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,199.82,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,inpatient,,,206.00000,66.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,199.82,,,,,,,185.40,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,199.82,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,inpatient,,,471.00000,152.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,456.87,,,,,,,423.90,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,outpatient,,,471.00000,152.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,456.87,,,,,,,122.46,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,inpatient,,,314.00000,101.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,304.58,,,,,,,282.60,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,304.58,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,inpatient,,,314.00000,101.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,304.58,,,,,,,282.60,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,304.58,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,inpatient,,,239.00000,77.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,231.83,,,,,,,215.10,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,outpatient,,,239.00000,77.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,231.83,,,,,,,62.14,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,inpatient,,,159.00000,51.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,154.23,,,,,,,143.10,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,154.23,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,inpatient,,,159.00000,51.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,154.23,,,,,,,143.10,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,154.23,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,inpatient,,,558.00000,180.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,541.26,,,,,,,502.20,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,outpatient,,,558.00000,180.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,541.26,,,,,,,145.08,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,inpatient,,,372.00000,120.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,360.84,,,,,,,334.80,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,360.84,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,inpatient,,,372.00000,120.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,360.84,,,,,,,334.80,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,360.84,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,inpatient,,,413.00000,133.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,400.61,,,,,,,371.70,400.61,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,outpatient,,,413.00000,133.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,400.61,,,,,,,107.38,400.61,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,inpatient,,,275.00000,88.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,266.75,,,,,,,247.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,266.75,,,,,,,71.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,inpatient,,,275.00000,88.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,266.75,,,,,,,247.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,266.75,,,,,,,71.50,266.75,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,inpatient,,,462.00000,149.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,448.14,,,,,,,415.80,448.14,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,outpatient,,,462.00000,149.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,448.14,,,,,,,120.12,448.14,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,inpatient,,,170.00000,54.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,164.90,,,,,,,153.00,164.90,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,outpatient,,,170.00000,54.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,164.90,,,,,,,44.20,164.90,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,inpatient,,,281.00000,90.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,272.57,,,,,,,252.90,272.57,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,outpatient,,,281.00000,90.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,272.57,,,,,,,73.06,272.57,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,inpatient,,,562.00000,181.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,545.14,,,,,,,505.80,545.14,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,outpatient,,,562.00000,181.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,545.14,,,,,,,146.12,545.14,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,inpatient,,,2076.00000,670.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,2013.72,,,,,,,1868.40,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,outpatient,,,2076.00000,670.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,2013.72,,,,,,,539.76,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1384.00000,447.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1342.48,,,,,,,1245.60,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1342.48,,,,,,,359.84,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1384.00000,447.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1342.48,,,,,,,1245.60,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1342.48,,,,,,,359.84,1342.48,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,inpatient,,,934.00000,301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,905.98,,,,,,,840.60,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,outpatient,,,934.00000,301.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,905.98,,,,,,,242.84,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,inpatient,,,842.00000,271.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,816.74,,,,,,,757.80,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,outpatient,,,842.00000,271.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,816.74,,,,,,,218.92,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,inpatient,,,846.00000,273.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,820.62,,,,,,,761.40,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,outpatient,,,846.00000,273.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,820.62,,,,,,,219.96,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,inpatient,,,971.00000,313.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,941.87,,,,,,,873.90,941.87,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,outpatient,,,971.00000,313.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,941.87,,,,,,,252.46,941.87,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,inpatient,,,762.00000,246.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,739.14,,,,,,,685.80,739.14,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,outpatient,,,762.00000,246.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,739.14,,,,,,,198.12,739.14,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,inpatient,,,758.00000,244.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,735.26,,,,,,,682.20,735.26,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,outpatient,,,758.00000,244.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,735.26,,,,,,,197.08,735.26,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,inpatient,,,161.00000,52.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,156.17,,,,,,,144.90,156.17,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,outpatient,,,161.00000,52.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,156.17,,,,,,,41.86,156.17,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,inpatient,,,234.00000,75.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,226.98,,,,,,,210.60,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,outpatient,,,234.00000,75.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,226.98,,,,,,,60.84,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,inpatient,,,156.00000,50.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,151.32,,,,,,,140.40,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,151.32,,,,,,,40.56,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,inpatient,,,156.00000,50.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,151.32,,,,,,,140.40,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,151.32,,,,,,,40.56,151.32,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1517.00000,489.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,1471.49,,,,,,,1365.30,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1517.00000,489.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,1471.49,,,,,,,394.42,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1011.00000,326.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,980.67,,,,,,,909.90,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,980.67,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1011.00000,326.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,980.67,,,,,,,909.90,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,980.67,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,inpatient,,,822.00000,265.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,797.34,,,,,,,739.80,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,outpatient,,,822.00000,265.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,797.34,,,,,,,213.72,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,inpatient,,,548.00000,177.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,531.56,,,,,,,493.20,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,531.56,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,inpatient,,,548.00000,177.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,531.56,,,,,,,493.20,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,531.56,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,inpatient,,,2613.00000,844.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2534.61,,,,,,,2351.70,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,outpatient,,,2613.00000,844.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2534.61,,,,,,,679.38,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,inpatient,,,903.00000,291.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,875.91,,,,,,,812.70,875.91,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,outpatient,,,903.00000,291.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,875.91,,,,,,,234.78,875.91,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,inpatient,,,1156.00000,373.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1121.32,,,,,,,1040.40,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,outpatient,,,1156.00000,373.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1121.32,,,,,,,300.56,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,inpatient,,,677.00000,218.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,656.69,,,,,,,609.30,656.69,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,outpatient,,,677.00000,218.67000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,656.69,,,,,,,176.02,656.69,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1928.00000,622.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,1870.16,,,,,,,1735.20,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1928.00000,622.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,1870.16,,,,,,,501.28,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1285.00000,415.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1246.45,,,,,,,1156.50,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1246.45,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1285.00000,415.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1246.45,,,,,,,1156.50,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1246.45,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,inpatient,,,812.00000,262.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,787.64,,,,,,,730.80,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,outpatient,,,812.00000,262.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,787.64,,,,,,,211.12,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,inpatient,,,541.00000,174.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,524.77,,,,,,,486.90,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,524.77,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,inpatient,,,541.00000,174.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,524.77,,,,,,,486.90,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,524.77,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,inpatient,,,825.00000,266.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,800.25,,,,,,,742.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,outpatient,,,825.00000,266.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,800.25,,,,,,,214.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,inpatient,,,550.00000,177.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,533.50,,,,,,,495.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,533.50,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,inpatient,,,550.00000,177.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,533.50,,,,,,,495.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,533.50,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,inpatient,,,3494.00000,1128.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,3389.18,,,,,,,3144.60,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,outpatient,,,3494.00000,1128.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,3389.18,,,,,,,908.44,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2329.00000,752.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2259.13,,,,,,,2096.10,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2259.13,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2329.00000,752.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2259.13,,,,,,,2096.10,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2259.13,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,inpatient,,,840.00000,271.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,814.80,,,,,,,756.00,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,outpatient,,,840.00000,271.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,814.80,,,,,,,218.40,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,inpatient,,,560.00000,180.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,543.20,,,,,,,504.00,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,543.20,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,inpatient,,,560.00000,180.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,543.20,,,,,,,504.00,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,543.20,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,inpatient,,,792.00000,255.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,768.24,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,outpatient,,,792.00000,255.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,768.24,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,inpatient,,,528.00000,170.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,512.16,,,,,,,475.20,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,512.16,,,,,,,137.28,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,inpatient,,,528.00000,170.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,512.16,,,,,,,475.20,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,512.16,,,,,,,137.28,512.16,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,inpatient,,,272.00000,87.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,263.84,,,,,,,244.80,263.84,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,outpatient,,,272.00000,87.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,263.84,,,,,,,70.72,263.84,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,inpatient,,,1268.00000,409.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1229.96,,,,,,,1141.20,1229.96,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,outpatient,,,1268.00000,409.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1229.96,,,,,,,329.68,1229.96,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,inpatient,,,896.00000,289.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,869.12,,,,,,,806.40,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,outpatient,,,896.00000,289.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,869.12,,,,,,,232.96,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,inpatient,,,884.00000,285.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,857.48,,,,,,,795.60,857.48,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,outpatient,,,884.00000,285.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,857.48,,,,,,,229.84,857.48,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,inpatient,,,609.00000,326.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,590.73,,,,,,,548.10,590.73,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,590.73,,,,,,,158.34,590.73,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,inpatient,,,966.00000,383.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,937.02,,,,,,,869.40,937.02,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,outpatient,,,966.00000,383.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,937.02,,,,,,,251.16,937.02,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,inpatient,,,872.00000,346.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,845.84,,,,,,,784.80,845.84,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,outpatient,,,872.00000,346.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,845.84,,,,,,,226.72,845.84,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,inpatient,,,492.00000,195.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,477.24,,,,,,,442.80,477.24,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,outpatient,,,492.00000,195.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,477.24,,,,,,,127.92,477.24,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,inpatient,,,331.00000,131.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,321.07,,,,,,,297.90,321.07,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,outpatient,,,331.00000,131.41000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,321.07,,,,,,,86.06,321.07,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,inpatient,,,5215.00000,2070.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5058.55,,,,,,,4693.50,5058.55,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,outpatient,,,5215.00000,2070.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5058.55,,,,,,,1355.90,5058.55,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,inpatient,,,5422.00000,2152.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5259.34,,,,,,,4879.80,5259.34,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,outpatient,,,5422.00000,2152.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5259.34,,,,,,,1409.72,5259.34,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,inpatient,,,1878.00000,788.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1821.66,,,,,,,1690.20,1821.66,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1878.00000,788.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1821.66,,,,,,,488.28,1821.66,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,inpatient,,,2253.00000,946.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2185.41,,,,,,,2027.70,2185.41,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,outpatient,,,2253.00000,946.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2185.41,,,,,,,585.78,2185.41,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,inpatient,,,1502.00000,630.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1456.94,,,,,,,1351.80,1456.94,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1502.00000,630.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1456.94,,,,,,,390.52,1456.94,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,inpatient,,,2024.00000,850.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1963.28,,,,,,,1821.60,1963.28,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,outpatient,,,2024.00000,850.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1963.28,,,,,,,526.24,1963.28,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,inpatient,,,2429.00000,1020.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2356.13,,,,,,,2186.10,2356.13,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,outpatient,,,2429.00000,1020.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2356.13,,,,,,,631.54,2356.13,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,inpatient,,,1619.00000,679.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1619.00000,679.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,inpatient,,,2425.00000,1018.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2352.25,,,,,,,2182.50,2352.25,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,outpatient,,,2425.00000,1018.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2352.25,,,,,,,630.50,2352.25,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,inpatient,,,2910.00000,1222.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2822.70,,,,,,,2619.00,2822.70,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2910.00000,1222.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2822.70,,,,,,,756.60,2822.70,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,inpatient,,,1940.00000,814.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1881.80,,,,,,,1746.00,1881.80,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1940.00000,814.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1881.80,,,,,,,504.40,1881.80,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,inpatient,,,2317.00000,973.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2247.49,,,,,,,2085.30,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2317.00000,973.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2247.49,,,,,,,602.42,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,inpatient,,,2780.00000,1167.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2696.60,,,,,,,2502.00,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2780.00000,1167.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2696.60,,,,,,,722.80,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,inpatient,,,1853.00000,778.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1797.41,,,,,,,1667.70,1797.41,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1853.00000,778.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1797.41,,,,,,,481.78,1797.41,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,inpatient,,,2366.00000,993.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2295.02,,,,,,,2129.40,2295.02,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2366.00000,993.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2295.02,,,,,,,615.16,2295.02,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,inpatient,,,3056.00000,1283.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2964.32,,,,,,,2750.40,2964.32,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,outpatient,,,3056.00000,1283.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2964.32,,,,,,,794.56,2964.32,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,inpatient,,,2829.00000,1386.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2744.13,,,,,,,2546.10,2744.13,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,outpatient,,,2829.00000,1386.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2744.13,,,,,,,735.54,2744.13,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,inpatient,,,3395.00000,1663.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3293.15,,,,,,,3055.50,3293.15,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,outpatient,,,3395.00000,1663.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3293.15,,,,,,,882.70,3293.15,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,inpatient,,,2263.00000,1108.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2195.11,,,,,,,2036.70,2195.11,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,outpatient,,,2263.00000,1108.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2195.11,,,,,,,588.38,2195.11,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,inpatient,,,4697.00000,2301.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4556.09,,,,,,,4227.30,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,outpatient,,,4697.00000,2301.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4556.09,,,,,,,1221.22,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,inpatient,,,5636.00000,2761.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5466.92,,,,,,,5072.40,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,outpatient,,,5636.00000,2761.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5466.92,,,,,,,1465.36,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,inpatient,,,3757.00000,1840.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3644.29,,,,,,,3381.30,3644.29,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,outpatient,,,3757.00000,1840.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3644.29,,,,,,,976.82,3644.29,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,inpatient,,,2619.00000,1283.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2540.43,,,,,,,2357.10,2540.43,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,outpatient,,,2619.00000,1283.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2540.43,,,,,,,680.94,2540.43,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,inpatient,,,3143.00000,1540.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3048.71,,,,,,,2828.70,3048.71,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,outpatient,,,3143.00000,1540.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3048.71,,,,,,,817.18,3048.71,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,inpatient,,,2095.00000,1026.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2032.15,,,,,,,1885.50,2032.15,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,outpatient,,,2095.00000,1026.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2032.15,,,,,,,544.70,2032.15,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,inpatient,,,278.00000,136.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,269.66,,,,,,,250.20,269.66,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,outpatient,,,278.00000,136.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,269.66,,,,,,,72.28,269.66,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,inpatient,,,2110.00000,1033.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2046.70,,,,,,,1899.00,2046.70,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2046.70,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,inpatient,,,2110.00000,1033.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2046.70,,,,,,,1899.00,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2046.70,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2532.00000,1240.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2456.04,,,,,,,2278.80,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2456.04,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2532.00000,1240.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2456.04,,,,,,,2278.80,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2456.04,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1688.00000,827.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1637.36,,,,,,,1519.20,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1637.36,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1688.00000,827.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1637.36,,,,,,,1519.20,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1637.36,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,inpatient,,,2024.00000,991.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1963.28,,,,,,,1821.60,1963.28,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1963.28,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,inpatient,,,2024.00000,991.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1963.28,,,,,,,1821.60,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1963.28,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2429.00000,1190.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2356.13,,,,,,,2186.10,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2356.13,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2429.00000,1190.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2356.13,,,,,,,2186.10,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2356.13,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1619.00000,793.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1619.00000,793.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1570.43,,,,,,,1457.10,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1570.43,,,,,,,420.94,1570.43,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,inpatient,,,1224.00000,599.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1187.28,,,,,,,1101.60,1187.28,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,outpatient,,,1224.00000,599.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1187.28,,,,,,,318.24,1187.28,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,inpatient,,,3020.00000,1479.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2929.40,,,,,,,2718.00,2929.40,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,outpatient,,,3020.00000,1479.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2929.40,,,,,,,785.20,2929.40,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,inpatient,,,3624.00000,1775.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3515.28,,,,,,,3261.60,3515.28,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,outpatient,,,3624.00000,1775.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3515.28,,,,,,,942.24,3515.28,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,inpatient,,,2416.00000,1183.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2343.52,,,,,,,2174.40,2343.52,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,outpatient,,,2416.00000,1183.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2343.52,,,,,,,628.16,2343.52,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,inpatient,,,2728.00000,1336.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2646.16,,,,,,,2455.20,2646.16,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,outpatient,,,2728.00000,1336.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2646.16,,,,,,,709.28,2646.16,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,inpatient,,,3273.00000,1603.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3174.81,,,,,,,2945.70,3174.81,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,outpatient,,,3273.00000,1603.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3174.81,,,,,,,850.98,3174.81,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,inpatient,,,2182.00000,1069.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2116.54,,,,,,,1963.80,2116.54,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,outpatient,,,2182.00000,1069.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2116.54,,,,,,,567.32,2116.54,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,inpatient,,,3133.00000,1535.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3039.01,,,,,,,2819.70,3039.01,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,outpatient,,,3133.00000,1535.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3039.01,,,,,,,814.58,3039.01,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,inpatient,,,3759.00000,1841.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3646.23,,,,,,,3383.10,3646.23,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,outpatient,,,3759.00000,1841.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3646.23,,,,,,,977.34,3646.23,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,inpatient,,,2506.00000,1227.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2430.82,,,,,,,2255.40,2430.82,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,outpatient,,,2506.00000,1227.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2430.82,,,,,,,651.56,2430.82,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,inpatient,,,2857.00000,1399.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2771.29,,,,,,,2571.30,2771.29,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,outpatient,,,2857.00000,1399.93000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2771.29,,,,,,,742.82,2771.29,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,inpatient,,,3428.00000,1679.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3325.16,,,,,,,3085.20,3325.16,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,outpatient,,,3428.00000,1679.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3325.16,,,,,,,891.28,3325.16,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,inpatient,,,2285.00000,1119.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2216.45,,,,,,,2056.50,2216.45,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,outpatient,,,2285.00000,1119.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2216.45,,,,,,,594.10,2216.45,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,inpatient,,,3565.00000,1746.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3458.05,,,,,,,3208.50,3458.05,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,outpatient,,,3565.00000,1746.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3458.05,,,,,,,926.90,3458.05,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,inpatient,,,5918.00000,2899.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5740.46,,,,,,,5326.20,5740.46,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,outpatient,,,5918.00000,2899.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5740.46,,,,,,,1538.68,5740.46,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,inpatient,,,3301.00000,1617.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3201.97,,,,,,,2970.90,3201.97,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,outpatient,,,3301.00000,1617.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3201.97,,,,,,,858.26,3201.97,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2659.00000,1302.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2579.23,,,,,,,2393.10,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2579.23,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2659.00000,1302.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2579.23,,,,,,,2393.10,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2579.23,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2551.00000,1249.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2474.47,,,,,,,2295.90,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2474.47,,,,,,,663.26,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2551.00000,1249.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2474.47,,,,,,,2295.90,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2474.47,,,,,,,663.26,2474.47,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,inpatient,,,3806.00000,1864.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3691.82,,,,,,,3425.40,3691.82,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3806.00000,1864.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3691.82,,,,,,,989.56,3691.82,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,inpatient,,,2149.00000,694.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2084.53,,,,,,,1934.10,2084.53,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,outpatient,,,2149.00000,694.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2084.53,,,,,,,558.74,2084.53,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,inpatient,,,1973.00000,637.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1913.81,,,,,,,1775.70,1913.81,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,outpatient,,,1973.00000,637.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1913.81,,,,,,,512.98,1913.81,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1784.00000,576.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,1730.48,,,,,,,1605.60,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1784.00000,576.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,1730.48,,,,,,,463.84,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1189.00000,384.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1153.33,,,,,,,1070.10,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1153.33,,,,,,,309.14,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1189.00000,384.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1153.33,,,,,,,1070.10,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1153.33,,,,,,,309.14,1153.33,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,inpatient,,,130.00000,69.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,126.10,,,,,,,117.00,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,outpatient,,,130.00000,69.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,126.10,,,,,,,33.80,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,inpatient,,,44.00000,23.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42.68,,,,,,,39.60,42.68,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,outpatient,,,44.00000,23.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,42.68,,,,,,,11.44,42.68,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,inpatient,,,456.00000,244.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,442.32,,,,,,,410.40,442.32,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,outpatient,,,456.00000,244.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,442.32,,,,,,,118.56,442.32,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,inpatient,,,108.00000,57.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,104.76,,,,,,,97.20,104.76,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,outpatient,,,108.00000,57.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,104.76,,,,,,,28.08,104.76,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,inpatient,,,306.00000,164.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,296.82,,,,,,,275.40,296.82,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,outpatient,,,306.00000,164.02000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,296.82,,,,,,,79.56,296.82,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,inpatient,,,257.00000,137.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,249.29,,,,,,,231.30,249.29,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,outpatient,,,257.00000,137.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,249.29,,,,,,,66.82,249.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4057.00000,2036.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3935.29,,,,,,,3651.30,3935.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3935.29,,,,,,,1054.82,3935.29,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4868.00000,2443.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4721.96,,,,,,,4381.20,4721.96,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4721.96,,,,,,,1265.68,4721.96,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,inpatient,,,3245.00000,1628.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3147.65,,,,,,,2920.50,3147.65,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3147.65,,,,,,,843.70,3147.65,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4057.00000,2036.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3935.29,,,,,,,3651.30,3935.29,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3935.29,,,,,,,1054.82,3935.29,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4868.00000,2443.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4721.96,,,,,,,4381.20,4721.96,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4721.96,,,,,,,1265.68,4721.96,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,inpatient,,,3245.00000,1628.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3147.65,,,,,,,2920.50,3147.65,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3147.65,,,,,,,843.70,3147.65,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,inpatient,,,1725.00000,865.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1673.25,,,,,,,1552.50,1673.25,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,outpatient,,,1725.00000,865.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1673.25,,,,,,,448.50,1673.25,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,inpatient,,,1743.00000,874.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1690.71,,,,,,,1568.70,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,outpatient,,,1743.00000,874.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1690.71,,,,,,,453.18,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,inpatient,,,1475.00000,740.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1430.75,,,,,,,1327.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1430.75,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,inpatient,,,1475.00000,740.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1430.75,,,,,,,1327.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1430.75,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,inpatient,,,1162.00000,583.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1127.14,,,,,,,1045.80,1127.14,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,outpatient,,,1162.00000,583.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1127.14,,,,,,,302.12,1127.14,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,inpatient,,,983.00000,493.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,953.51,,,,,,,884.70,953.51,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,953.51,,,,,,,255.58,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,inpatient,,,983.00000,493.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,953.51,,,,,,,884.70,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,953.51,,,,,,,255.58,953.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,inpatient,,,3183.00000,1597.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3087.51,,,,,,,2864.70,3087.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,outpatient,,,3183.00000,1597.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3087.51,,,,,,,827.58,3087.51,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,inpatient,,,3819.00000,1917.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3704.43,,,,,,,3437.10,3704.43,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,outpatient,,,3819.00000,1917.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3704.43,,,,,,,992.94,3704.43,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,inpatient,,,2546.00000,1278.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2469.62,,,,,,,2291.40,2469.62,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,outpatient,,,2546.00000,1278.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2469.62,,,,,,,661.96,2469.62,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,inpatient,,,3858.00000,1936.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,3742.26,,,,,,,3472.20,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,3742.26,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,inpatient,,,3858.00000,1936.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,3742.26,,,,,,,3472.20,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,3742.26,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,inpatient,,,4629.00000,2323.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,4490.13,,,,,,,4166.10,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,4490.13,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,inpatient,,,4629.00000,2323.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,4490.13,,,,,,,4166.10,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,4490.13,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,inpatient,,,3086.00000,1549.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2993.42,,,,,,,2777.40,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2993.42,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,inpatient,,,3086.00000,1549.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2993.42,,,,,,,2777.40,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2993.42,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,inpatient,,,2505.00000,1257.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2429.85,,,,,,,2254.50,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2429.85,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,inpatient,,,2505.00000,1257.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2429.85,,,,,,,2254.50,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2429.85,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,inpatient,,,3006.00000,1509.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2915.82,,,,,,,2705.40,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2915.82,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,inpatient,,,3006.00000,1509.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2915.82,,,,,,,2705.40,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2915.82,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,inpatient,,,2004.00000,1006.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1943.88,,,,,,,1803.60,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1943.88,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,inpatient,,,2004.00000,1006.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1943.88,,,,,,,1803.60,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1943.88,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,inpatient,,,3137.00000,1574.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,3042.89,,,,,,,2823.30,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,3042.89,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,inpatient,,,3137.00000,1574.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,3042.89,,,,,,,2823.30,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,3042.89,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,inpatient,,,3764.00000,1889.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,3651.08,,,,,,,3387.60,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,3651.08,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,inpatient,,,3764.00000,1889.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,3651.08,,,,,,,3387.60,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,3651.08,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,inpatient,,,2509.00000,1259.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2433.73,,,,,,,2258.10,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2433.73,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,inpatient,,,2509.00000,1259.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2433.73,,,,,,,2258.10,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2433.73,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,inpatient,,,3023.00000,1517.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2932.31,,,,,,,2720.70,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2932.31,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,inpatient,,,3023.00000,1517.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2932.31,,,,,,,2720.70,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2932.31,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,inpatient,,,3627.00000,1820.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,3518.19,,,,,,,3264.30,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,3518.19,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,inpatient,,,3627.00000,1820.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,3518.19,,,,,,,3264.30,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,3518.19,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,inpatient,,,2418.00000,1213.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2345.46,,,,,,,2176.20,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2345.46,,,,,,,628.68,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,inpatient,,,2418.00000,1213.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2345.46,,,,,,,2176.20,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2345.46,,,,,,,628.68,2345.46,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,inpatient,,,870.00000,436.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,843.90,,,,,,,783.00,843.90,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,outpatient,,,870.00000,436.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,843.90,,,,,,,226.20,843.90,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,inpatient,,,1353.00000,679.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1312.41,,,,,,,1217.70,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,outpatient,,,1353.00000,679.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1312.41,,,,,,,351.78,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,inpatient,,,902.00000,452.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,874.94,,,,,,,811.80,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,874.94,,,,,,,234.52,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,inpatient,,,902.00000,452.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,874.94,,,,,,,811.80,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,874.94,,,,,,,234.52,874.94,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,inpatient,,,3489.00000,1751.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3384.33,,,,,,,3140.10,3384.33,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3489.00000,1751.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3384.33,,,,,,,907.14,3384.33,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,inpatient,,,4187.00000,2101.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4061.39,,,,,,,3768.30,4061.39,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,outpatient,,,4187.00000,2101.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4061.39,,,,,,,1088.62,4061.39,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,inpatient,,,2791.00000,1401.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2707.27,,,,,,,2511.90,2707.27,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,outpatient,,,2791.00000,1401.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2707.27,,,,,,,725.66,2707.27,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,inpatient,,,492.00000,246.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,477.24,,,,,,,442.80,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,outpatient,,,492.00000,246.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,477.24,,,,,,,127.92,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,inpatient,,,331.00000,166.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,321.07,,,,,,,297.90,321.07,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,outpatient,,,331.00000,166.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,321.07,,,,,,,86.06,321.07,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,inpatient,,,4440.00000,2357.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4306.80,,,,,,,3996.00,4306.80,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,outpatient,,,4440.00000,2357.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4306.80,,,,,,,1154.40,4306.80,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,inpatient,,,5328.00000,2829.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5168.16,,,,,,,4795.20,5168.16,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,outpatient,,,5328.00000,2829.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5168.16,,,,,,,1385.28,5168.16,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,inpatient,,,3552.00000,1886.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3445.44,,,,,,,3196.80,3445.44,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,outpatient,,,3552.00000,1886.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3445.44,,,,,,,923.52,3445.44,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,inpatient,,,2528.00000,1342.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2452.16,,,,,,,2275.20,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,outpatient,,,2528.00000,1342.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2452.16,,,,,,,657.28,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,inpatient,,,3033.00000,1610.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2942.01,,,,,,,2729.70,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,outpatient,,,3033.00000,1610.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2942.01,,,,,,,788.58,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,inpatient,,,2022.00000,1073.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1961.34,,,,,,,1819.80,1961.34,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,outpatient,,,2022.00000,1073.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1961.34,,,,,,,525.72,1961.34,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,inpatient,,,3610.00000,1909.69000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3501.70,,,,,,,3249.00,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,outpatient,,,3610.00000,1909.69000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3501.70,,,,,,,938.60,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,inpatient,,,4332.00000,2291.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4202.04,,,,,,,3898.80,4202.04,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,outpatient,,,4332.00000,2291.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4202.04,,,,,,,1126.32,4202.04,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,inpatient,,,2888.00000,1527.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2801.36,,,,,,,2599.20,2801.36,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,outpatient,,,2888.00000,1527.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2801.36,,,,,,,750.88,2801.36,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,inpatient,,,4532.00000,2397.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4396.04,,,,,,,4078.80,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,outpatient,,,4532.00000,2397.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4396.04,,,,,,,1178.32,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,inpatient,,,5438.00000,2876.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5274.86,,,,,,,4894.20,5274.86,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,outpatient,,,5438.00000,2876.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5274.86,,,,,,,1413.88,5274.86,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,inpatient,,,3625.00000,1917.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3516.25,,,,,,,3262.50,3516.25,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,outpatient,,,3625.00000,1917.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3516.25,,,,,,,942.50,3516.25,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,inpatient,,,3639.00000,1925.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3529.83,,,,,,,3275.10,3529.83,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,outpatient,,,3639.00000,1925.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3529.83,,,,,,,946.14,3529.83,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,inpatient,,,4367.00000,2310.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4235.99,,,,,,,3930.30,4235.99,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,outpatient,,,4367.00000,2310.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4235.99,,,,,,,1135.42,4235.99,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,inpatient,,,2911.00000,1539.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2823.67,,,,,,,2619.90,2823.67,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,outpatient,,,2911.00000,1539.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2823.67,,,,,,,756.86,2823.67,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,inpatient,,,3494.00000,1719.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3389.18,,,,,,,3144.60,3389.18,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3494.00000,1719.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3389.18,,,,,,,908.44,3389.18,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,inpatient,,,4193.00000,2062.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4067.21,,,,,,,3773.70,4067.21,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,outpatient,,,4193.00000,2062.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4067.21,,,,,,,1090.18,4067.21,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,inpatient,,,2795.00000,1375.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2711.15,,,,,,,2515.50,2711.15,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,outpatient,,,2795.00000,1375.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2711.15,,,,,,,726.70,2711.15,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,inpatient,,,2717.00000,1336.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2635.49,,,,,,,2445.30,2635.49,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,outpatient,,,2717.00000,1336.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2635.49,,,,,,,706.42,2635.49,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,inpatient,,,3260.00000,1603.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3162.20,,,,,,,2934.00,3162.20,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,outpatient,,,3260.00000,1603.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3162.20,,,,,,,847.60,3162.20,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,inpatient,,,2173.00000,1069.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2107.81,,,,,,,1955.70,2107.81,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,outpatient,,,2173.00000,1069.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2107.81,,,,,,,564.98,2107.81,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4051.00000,2301.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,3929.47,,,,,,,3645.90,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,3929.47,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4051.00000,2301.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,3929.47,,,,,,,3645.90,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,3929.47,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4861.00000,2761.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,4715.17,,,,,,,4374.90,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,4715.17,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4861.00000,2761.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,4715.17,,,,,,,4374.90,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,4715.17,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3241.00000,1841.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,3143.77,,,,,,,2916.90,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,3143.77,,,,,,,842.66,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3241.00000,1841.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,3143.77,,,,,,,2916.90,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,3143.77,,,,,,,842.66,3143.77,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,inpatient,,,4260.00000,2420.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4132.20,,,,,,,3834.00,4132.20,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,outpatient,,,4260.00000,2420.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4132.20,,,,,,,1107.60,4132.20,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,inpatient,,,5112.00000,2904.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4958.64,,,,,,,4600.80,4958.64,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,outpatient,,,5112.00000,2904.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4958.64,,,,,,,1329.12,4958.64,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,inpatient,,,3408.00000,1936.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3305.76,,,,,,,3067.20,3305.76,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3408.00000,1936.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3305.76,,,,,,,886.08,3305.76,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,inpatient,,,3343.00000,1899.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3242.71,,,,,,,3008.70,3242.71,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3343.00000,1899.33000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3242.71,,,,,,,869.18,3242.71,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,inpatient,,,4010.00000,2278.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3889.70,,,,,,,3609.00,3889.70,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,outpatient,,,4010.00000,2278.28000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3889.70,,,,,,,1042.60,3889.70,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,inpatient,,,2674.00000,1519.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2593.78,,,,,,,2406.60,2593.78,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,outpatient,,,2674.00000,1519.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2593.78,,,,,,,695.24,2593.78,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3294.00000,1871.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,3195.18,,,,,,,2964.60,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,3195.18,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3294.00000,1871.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,3195.18,,,,,,,2964.60,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,3195.18,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3953.00000,2245.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,3834.41,,,,,,,3557.70,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,3834.41,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3953.00000,2245.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,3834.41,,,,,,,3557.70,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,3834.41,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,inpatient,,,2635.00000,1497.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2555.95,,,,,,,2371.50,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2555.95,,,,,,,685.10,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,inpatient,,,2635.00000,1497.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2555.95,,,,,,,2371.50,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2555.95,,,,,,,685.10,2555.95,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,inpatient,,,3664.00000,2081.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3554.08,,,,,,,3297.60,3554.08,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3664.00000,2081.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3554.08,,,,,,,952.64,3554.08,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,inpatient,,,4397.00000,2498.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,3957.30,4265.09,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,outpatient,,,4397.00000,2498.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4265.09,,,,,,,1143.22,4265.09,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,inpatient,,,2931.00000,1665.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2843.07,,,,,,,2637.90,2843.07,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,outpatient,,,2931.00000,1665.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2843.07,,,,,,,762.06,2843.07,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,inpatient,,,4759.00000,2703.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4616.23,,,,,,,4283.10,4616.23,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,outpatient,,,4759.00000,2703.83000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4616.23,,,,,,,1237.34,4616.23,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,inpatient,,,5710.00000,3244.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5538.70,,,,,,,5139.00,5538.70,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,outpatient,,,5710.00000,3244.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5538.70,,,,,,,1484.60,5538.70,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,inpatient,,,3807.00000,2162.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3692.79,,,,,,,3426.30,3692.79,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3807.00000,2162.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3692.79,,,,,,,989.82,3692.79,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,inpatient,,,2915.00000,1574.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2827.55,,,,,,,2623.50,2827.55,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2915.00000,1574.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2827.55,,,,,,,757.90,2827.55,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,inpatient,,,1918.00000,1035.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1860.46,,,,,,,1726.20,1860.46,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1918.00000,1035.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1860.46,,,,,,,498.68,1860.46,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,inpatient,,,2292.00000,1237.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2223.24,,,,,,,2062.80,2223.24,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2292.00000,1237.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2223.24,,,,,,,595.92,2223.24,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,inpatient,,,2984.00000,1611.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2894.48,,,,,,,2685.60,2894.48,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,outpatient,,,2984.00000,1611.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2894.48,,,,,,,775.84,2894.48,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,inpatient,,,769.00000,415.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,745.93,,,,,,,692.10,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,outpatient,,,769.00000,415.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,745.93,,,,,,,199.94,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,inpatient,,,1280.00000,691.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1241.60,,,,,,,1152.00,1241.60,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,outpatient,,,1280.00000,691.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1241.60,,,,,,,332.80,1241.60,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,inpatient,,,1878.00000,1014.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1821.66,,,,,,,1690.20,1821.66,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,outpatient,,,1878.00000,1014.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1821.66,,,,,,,488.28,1821.66,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,inpatient,,,2196.00000,1185.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2130.12,,,,,,,1976.40,2130.12,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,outpatient,,,2196.00000,1185.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2130.12,,,,,,,570.96,2130.12,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,inpatient,,,844.00000,455.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,818.68,,,,,,,759.60,818.68,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,outpatient,,,844.00000,455.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,818.68,,,,,,,219.44,818.68,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,inpatient,,,1305.00000,704.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1265.85,,,,,,,1174.50,1265.85,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,outpatient,,,1305.00000,704.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1265.85,,,,,,,339.30,1265.85,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,inpatient,,,576.00000,311.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,558.72,,,,,,,518.40,558.72,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,outpatient,,,576.00000,311.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,558.72,,,,,,,149.76,558.72,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,inpatient,,,809.00000,436.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,784.73,,,,,,,728.10,784.73,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,outpatient,,,809.00000,436.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,784.73,,,,,,,210.34,784.73,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,inpatient,,,2462.00000,1329.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2388.14,,,,,,,2215.80,2388.14,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,outpatient,,,2462.00000,1329.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2388.14,,,,,,,640.12,2388.14,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,inpatient,,,918.00000,495.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,890.46,,,,,,,826.20,890.46,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,outpatient,,,918.00000,495.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,890.46,,,,,,,238.68,890.46,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,inpatient,,,1102.00000,595.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1068.94,,,,,,,991.80,1068.94,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,outpatient,,,1102.00000,595.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1068.94,,,,,,,286.52,1068.94,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,inpatient,,,812.00000,438.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,787.64,,,,,,,730.80,787.64,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,outpatient,,,812.00000,438.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,787.64,,,,,,,211.12,787.64,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,inpatient,,,1407.00000,759.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1364.79,,,,,,,1266.30,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,outpatient,,,1407.00000,759.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1364.79,,,,,,,365.82,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,inpatient,,,1980.00000,1069.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1920.60,,,,,,,1782.00,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,outpatient,,,1980.00000,1069.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1920.60,,,,,,,514.80,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,inpatient,,,964.00000,520.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,935.08,,,,,,,867.60,935.08,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,outpatient,,,964.00000,520.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,935.08,,,,,,,250.64,935.08,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,inpatient,,,1040.00000,561.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1008.80,,,,,,,936.00,1008.80,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,outpatient,,,1040.00000,561.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1008.80,,,,,,,270.40,1008.80,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,inpatient,,,795.00000,429.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,771.15,,,,,,,715.50,771.15,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,outpatient,,,795.00000,429.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,771.15,,,,,,,206.70,771.15,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,inpatient,,,1124.00000,606.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1090.28,,,,,,,1011.60,1090.28,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,outpatient,,,1124.00000,606.96000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1090.28,,,,,,,292.24,1090.28,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,inpatient,,,736.00000,397.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,713.92,,,,,,,662.40,713.92,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,outpatient,,,736.00000,397.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,713.92,,,,,,,191.36,713.92,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,inpatient,,,700.00000,378.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,679.00,,,,,,,630.00,679.00,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,outpatient,,,700.00000,378.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,679.00,,,,,,,182.00,679.00,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,inpatient,,,821.00000,443.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,796.37,,,,,,,738.90,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,outpatient,,,821.00000,443.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,796.37,,,,,,,213.46,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,inpatient,,,846.00000,456.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,820.62,,,,,,,761.40,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,outpatient,,,846.00000,456.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,820.62,,,,,,,219.96,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,inpatient,,,958.00000,517.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,929.26,,,,,,,862.20,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,outpatient,,,958.00000,517.32000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,929.26,,,,,,,249.08,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,inpatient,,,1261.00000,680.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1223.17,,,,,,,1134.90,1223.17,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,outpatient,,,1261.00000,680.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1223.17,,,,,,,327.86,1223.17,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,inpatient,,,971.00000,524.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,941.87,,,,,,,873.90,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,outpatient,,,971.00000,524.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,941.87,,,,,,,252.46,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,inpatient,,,1837.00000,991.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1781.89,,,,,,,1653.30,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,outpatient,,,1837.00000,991.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1781.89,,,,,,,477.62,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,inpatient,,,1099.00000,593.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1066.03,,,,,,,989.10,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,outpatient,,,1099.00000,593.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1066.03,,,,,,,285.74,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,inpatient,,,2178.00000,1176.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2112.66,,,,,,,1960.20,2112.66,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,outpatient,,,2178.00000,1176.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2112.66,,,,,,,566.28,2112.66,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,inpatient,,,1226.00000,662.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1189.22,,,,,,,1103.40,1189.22,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,outpatient,,,1226.00000,662.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1189.22,,,,,,,318.76,1189.22,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,inpatient,,,1048.00000,565.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1016.56,,,,,,,943.20,1016.56,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,outpatient,,,1048.00000,565.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1016.56,,,,,,,272.48,1016.56,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,inpatient,,,970.00000,523.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,940.90,,,,,,,873.00,940.90,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,outpatient,,,970.00000,523.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,940.90,,,,,,,252.20,940.90,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,inpatient,,,1803.00000,973.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1748.91,,,,,,,1622.70,1748.91,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,outpatient,,,1803.00000,973.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1748.91,,,,,,,468.78,1748.91,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,inpatient,,,2504.00000,1352.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2428.88,,,,,,,2253.60,2428.88,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,outpatient,,,2504.00000,1352.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2428.88,,,,,,,651.04,2428.88,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,inpatient,,,2457.00000,1326.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2383.29,,,,,,,2211.30,2383.29,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2457.00000,1326.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2383.29,,,,,,,638.82,2383.29,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,inpatient,,,923.00000,498.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,895.31,,,,,,,830.70,895.31,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,outpatient,,,923.00000,498.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,895.31,,,,,,,239.98,895.31,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,inpatient,,,5478.00000,2958.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5313.66,,,,,,,4930.20,5313.66,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,outpatient,,,5478.00000,2958.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5313.66,,,,,,,1424.28,5313.66,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,inpatient,,,4551.00000,2457.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4414.47,,,,,,,4095.90,4414.47,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,outpatient,,,4551.00000,2457.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4414.47,,,,,,,1183.26,4414.47,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,inpatient,,,1360.00000,734.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1319.20,,,,,,,1224.00,1319.20,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,outpatient,,,1360.00000,734.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1319.20,,,,,,,353.60,1319.20,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,inpatient,,,1209.00000,652.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1172.73,,,,,,,1088.10,1172.73,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,outpatient,,,1209.00000,652.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1172.73,,,,,,,314.34,1172.73,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,inpatient,,,848.00000,457.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,822.56,,,,,,,763.20,822.56,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,outpatient,,,848.00000,457.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,822.56,,,,,,,220.48,822.56,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,inpatient,,,1071.00000,578.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1038.87,,,,,,,963.90,1038.87,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,outpatient,,,1071.00000,578.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1038.87,,,,,,,278.46,1038.87,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,inpatient,,,1792.00000,967.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1738.24,,,,,,,1612.80,1738.24,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,outpatient,,,1792.00000,967.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1738.24,,,,,,,465.92,1738.24,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,inpatient,,,35.00000,18.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33.95,,,,,,,31.50,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,outpatient,,,35.00000,18.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33.95,,,,,,,9.10,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,inpatient,,,285.00000,153.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,276.45,,,,,,,256.50,276.45,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,outpatient,,,285.00000,153.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,276.45,,,,,,,74.10,276.45,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,inpatient,,,1012.00000,546.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,981.64,,,,,,,910.80,981.64,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,outpatient,,,1012.00000,546.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,981.64,,,,,,,263.12,981.64,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,inpatient,,,492.00000,265.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,477.24,,,,,,,442.80,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,outpatient,,,492.00000,265.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,477.24,,,,,,,127.92,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,inpatient,,,739.00000,399.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,716.83,,,,,,,665.10,716.83,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,outpatient,,,739.00000,399.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,716.83,,,,,,,192.14,716.83,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,inpatient,,,515.00000,278.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,499.55,,,,,,,463.50,499.55,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,outpatient,,,515.00000,278.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,499.55,,,,,,,133.90,499.55,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,inpatient,,,1467.00000,792.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1422.99,,,,,,,1320.30,1422.99,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,outpatient,,,1467.00000,792.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1422.99,,,,,,,381.42,1422.99,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,inpatient,,,1683.00000,888.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1632.51,,,,,,,1514.70,1632.51,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,outpatient,,,1683.00000,888.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1632.51,,,,,,,437.58,1632.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,inpatient,,,426.30000,225.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,413.51,,,,,,,383.67,413.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,426.30000,225.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,413.51,,,,,,,110.84,413.51,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,inpatient,,,725.00000,382.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,703.25,,,,,,,652.50,703.25,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,725.00000,382.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,703.25,,,,,,,188.50,1855.42,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,inpatient,,,1852.00000,977.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1796.44,,,,,,,1666.80,1796.44,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,1852.00000,977.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1796.44,,,,,,,481.52,1868.26,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,110.00000,58.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,99.00,106.70,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,110.00000,58.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,106.70,,,,,,,28.60,106.70,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,inpatient,,,98.00000,51.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,88.20,95.06,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,98.00000,51.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,25.48,1662.92,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,inpatient,,,2018.00000,1065.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1957.46,,,,,,,1816.20,1957.46,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,2018.00000,1065.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1957.46,,,,,,,524.68,1957.46,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,inpatient,,,4325.00000,2283.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4195.25,,,,,,,3892.50,4195.25,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,4325.00000,2283.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4195.25,,,,,,,1124.50,4195.25,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,inpatient,,,172.00000,90.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,166.84,,,,,,,154.80,166.84,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,166.84,,,,,,,44.72,166.84,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,inpatient,,,942.00000,497.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,913.74,,,,,,,847.80,913.74,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,942.00000,497.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,913.74,,,,,,,244.92,913.74,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,inpatient,,,413.00000,218.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,400.61,,,,,,,371.70,400.61,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,413.00000,218.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,400.61,,,,,,,107.38,400.61,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,inpatient,,,257.00000,135.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,249.29,,,,,,,231.30,249.29,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,outpatient,,,257.00000,135.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,249.29,,,,,,,66.82,249.29,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,inpatient,,,116.00000,61.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,112.52,,,,,,,104.40,112.52,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,116.00000,61.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,112.52,,,,,,,30.16,112.52,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,inpatient,,,463.20000,244.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,449.30,,,,,,,416.88,449.30,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,463.20000,244.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,449.30,,,,,,,120.43,449.30,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,inpatient,,,804.00000,424.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,779.88,,,,,,,723.60,779.88,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,804.00000,424.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,779.88,,,,,,,209.04,779.88,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,inpatient,,,172.00000,90.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,166.84,,,,,,,154.80,166.84,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,172.00000,90.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,166.84,,,,,,,44.72,166.84,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,inpatient,,,354.30000,187.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,343.67,,,,,,,318.87,343.67,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,354.30000,187.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,343.67,,,,,,,92.12,343.67,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,inpatient,,,277.90000,146.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,269.56,,,,,,,250.11,269.56,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,277.90000,146.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,269.56,,,,,,,72.25,269.56,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,inpatient,,,200.00000,105.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,194.00,,,,,,,180.00,194.00,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,200.00000,105.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,194.00,,,,,,,52.00,194.00,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,inpatient,,,197.00000,63.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,191.09,,,,,,,177.30,191.09,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,outpatient,,,197.00000,63.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,191.09,,,,,,,51.22,191.09,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,inpatient,,,468.00000,151.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,453.96,,,,,,,421.20,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,outpatient,,,468.00000,151.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,453.96,,,,,,,121.68,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,inpatient,,,312.00000,100.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,302.64,,,,,,,280.80,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,302.64,,,,,,,81.12,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,inpatient,,,312.00000,100.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,302.64,,,,,,,280.80,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,302.64,,,,,,,81.12,302.64,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,439.41,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,439.41,,,,,,,117.78,439.41,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,inpatient,,,609.00000,196.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,590.73,,,,,,,548.10,590.73,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,590.73,,,,,,,158.34,590.73,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,inpatient,,,1248.00000,403.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,1210.56,,,,,,,1123.20,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1248.00000,403.10000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,1210.56,,,,,,,324.48,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,inpatient,,,832.00000,268.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,807.04,,,,,,,748.80,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,807.04,,,,,,,216.32,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,inpatient,,,832.00000,268.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,807.04,,,,,,,748.80,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,807.04,,,,,,,216.32,807.04,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,inpatient,,,4235.00000,1367.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,4107.95,,,,,,,3811.50,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,4107.95,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,inpatient,,,4235.00000,1367.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,4107.95,,,,,,,3811.50,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,4107.95,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,inpatient,,,2119.00000,684.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2055.43,,,,,,,1907.10,2055.43,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,outpatient,,,2119.00000,684.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2055.43,,,,,,,550.94,2055.43,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,inpatient,,,1943.00000,627.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1884.71,,,,,,,1748.70,1884.71,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1943.00000,627.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1884.71,,,,,,,505.18,1884.71,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,inpatient,,,1426.00000,460.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1383.22,,,,,,,1283.40,1383.22,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,outpatient,,,1426.00000,460.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1383.22,,,,,,,370.76,1383.22,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,inpatient,,,4202.00000,1357.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,4075.94,,,,,,,3781.80,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,outpatient,,,4202.00000,1357.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,4075.94,,,,,,,1092.52,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,inpatient,,,2801.00000,904.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2716.97,,,,,,,2520.90,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,2716.97,,,,,,,728.26,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,inpatient,,,2801.00000,904.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2716.97,,,,,,,2520.90,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,2716.97,,,,,,,728.26,2716.97,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,inpatient,,,832.00000,268.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,807.04,,,,,,,748.80,807.04,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,outpatient,,,832.00000,268.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,807.04,,,,,,,216.32,807.04,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,inpatient,,,1457.00000,470.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1413.29,,,,,,,1311.30,1413.29,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,outpatient,,,1457.00000,470.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1413.29,,,,,,,378.82,1413.29,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,inpatient,,,743.00000,239.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,720.71,,,,,,,668.70,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,720.71,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,inpatient,,,743.00000,239.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,720.71,,,,,,,668.70,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,720.71,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,inpatient,,,232.00000,74.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,225.04,,,,,,,208.80,225.04,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,outpatient,,,232.00000,74.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,225.04,,,,,,,60.32,225.04,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,inpatient,,,1364.00000,440.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,1323.08,,,,,,,1227.60,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,outpatient,,,1364.00000,440.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,1323.08,,,,,,,354.64,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,inpatient,,,909.00000,293.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,881.73,,,,,,,818.10,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,881.73,,,,,,,236.34,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,inpatient,,,909.00000,293.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,881.73,,,,,,,818.10,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,881.73,,,,,,,236.34,881.73,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,inpatient,,,510.00000,355.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,494.70,,,,,,,459.00,494.70,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,outpatient,,,510.00000,355.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,494.70,,,,,,,132.60,494.70,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,inpatient,,,1001.00000,698.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,970.97,,,,,,,900.90,970.97,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,outpatient,,,1001.00000,698.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,970.97,,,,,,,260.26,970.97,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,inpatient,,,887.00000,619.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,860.39,,,,,,,798.30,860.39,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,outpatient,,,887.00000,619.13000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,860.39,,,,,,,230.62,860.39,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,inpatient,,,1022.00000,713.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,991.34,,,,,,,919.80,991.34,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,outpatient,,,1022.00000,713.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,991.34,,,,,,,265.72,991.34,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,inpatient,,,681.00000,475.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,660.57,,,,,,,612.90,660.57,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,660.57,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,inpatient,,,681.00000,475.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,660.57,,,,,,,612.90,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,660.57,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,inpatient,,,945.00000,659.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,916.65,,,,,,,850.50,916.65,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,outpatient,,,945.00000,659.61000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,916.65,,,,,,,245.70,916.65,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,inpatient,,,630.00000,439.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,611.10,,,,,,,567.00,611.10,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,611.10,,,,,,,163.80,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,inpatient,,,630.00000,439.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,611.10,,,,,,,567.00,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,611.10,,,,,,,163.80,611.10,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,inpatient,,,577.00000,402.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,559.69,,,,,,,519.30,559.69,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,outpatient,,,577.00000,402.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,559.69,,,,,,,150.02,559.69,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,inpatient,,,433.00000,302.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,420.01,,,,,,,389.70,420.01,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,outpatient,,,433.00000,302.23000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,420.01,,,,,,,112.58,420.01,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,inpatient,,,331.00000,231.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,321.07,,,,,,,297.90,321.07,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,outpatient,,,331.00000,231.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,321.07,,,,,,,86.06,321.07,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,inpatient,,,662.00000,462.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,642.14,,,,,,,595.80,642.14,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,outpatient,,,662.00000,462.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,642.14,,,,,,,172.12,642.14,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,inpatient,,,752.00000,524.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,729.44,,,,,,,676.80,729.44,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,outpatient,,,752.00000,524.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,729.44,,,,,,,195.52,729.44,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,inpatient,,,182.00000,127.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,176.54,,,,,,,163.80,176.54,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,176.54,,,,,,,47.32,176.54,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,inpatient,,,420.00000,293.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,407.40,,,,,,,378.00,407.40,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,outpatient,,,420.00000,293.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,407.40,,,,,,,109.20,407.40,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,inpatient,,,253.00000,176.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,245.41,,,,,,,227.70,245.41,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,outpatient,,,253.00000,176.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,245.41,,,,,,,65.78,245.41,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,inpatient,,,168.00000,117.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,162.96,,,,,,,151.20,162.96,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,outpatient,,,168.00000,117.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,162.96,,,,,,,43.68,162.96,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,inpatient,,,695.00000,485.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,674.15,,,,,,,625.50,674.15,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,outpatient,,,695.00000,485.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,674.15,,,,,,,180.70,674.15,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,inpatient,,,474.00000,330.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,459.78,,,,,,,426.60,459.78,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,outpatient,,,474.00000,330.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,459.78,,,,,,,123.24,459.78,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,inpatient,,,930.00000,649.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,902.10,,,,,,,837.00,902.10,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,outpatient,,,930.00000,649.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,902.10,,,,,,,241.80,902.10,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,inpatient,,,786.00000,548.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,762.42,,,,,,,707.40,762.42,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,outpatient,,,786.00000,548.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,762.42,,,,,,,204.36,762.42,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,inpatient,,,620.00000,432.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,601.40,,,,,,,558.00,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,601.40,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,inpatient,,,620.00000,432.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,59,601.40,,,,,,,558.00,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,59,601.40,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,inpatient,,,435.00000,303.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,421.95,,,,,,,391.50,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,421.95,,,,,,,113.10,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,inpatient,,,435.00000,303.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,59,421.95,,,,,,,391.50,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,59,421.95,,,,,,,113.10,421.95,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,inpatient,,,492.00000,343.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,477.24,,,,,,,442.80,477.24,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,outpatient,,,492.00000,343.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,477.24,,,,,,,127.92,477.24,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,inpatient,,,331.00000,231.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,321.07,,,,,,,297.90,321.07,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,outpatient,,,331.00000,231.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,321.07,,,,,,,86.06,321.07,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,inpatient,,,875.00000,610.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,848.75,,,,,,,787.50,848.75,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,outpatient,,,875.00000,610.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,848.75,,,,,,,227.50,848.75,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,inpatient,,,688.00000,480.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,667.36,,,,,,,619.20,667.36,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,outpatient,,,688.00000,480.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,667.36,,,,,,,178.88,667.36,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,inpatient,,,465.00000,324.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,451.05,,,,,,,418.50,451.05,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,outpatient,,,465.00000,324.57000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,451.05,,,,,,,120.90,451.05,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,inpatient,,,846.00000,590.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,820.62,,,,,,,761.40,820.62,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,outpatient,,,846.00000,590.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,820.62,,,,,,,219.96,820.62,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,inpatient,,,482.00000,336.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,467.54,,,,,,,433.80,467.54,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,outpatient,,,482.00000,336.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,467.54,,,,,,,125.32,467.54,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,inpatient,,,926.00000,646.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,898.22,,,,,,,833.40,898.22,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,outpatient,,,926.00000,646.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,898.22,,,,,,,240.76,898.22,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,inpatient,,,292.00000,203.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,283.24,,,,,,,262.80,283.24,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,outpatient,,,292.00000,203.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,283.24,,,,,,,75.92,283.24,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,inpatient,,,827.00000,577.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,802.19,,,,,,,744.30,802.19,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,outpatient,,,827.00000,577.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,802.19,,,,,,,215.02,802.19,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,inpatient,,,253.00000,176.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,245.41,,,,,,,227.70,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,outpatient,,,253.00000,176.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,245.41,,,,,,,65.78,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,inpatient,,,901.00000,628.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,873.97,,,,,,,810.90,873.97,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,outpatient,,,901.00000,628.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,873.97,,,,,,,234.26,873.97,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,inpatient,,,460.00000,321.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,446.20,,,,,,,414.00,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,outpatient,,,460.00000,321.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,446.20,,,,,,,119.60,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,inpatient,,,1029.00000,718.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,998.13,,,,,,,926.10,998.13,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1029.00000,718.24000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,998.13,,,,,,,267.54,998.13,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,inpatient,,,959.00000,669.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,930.23,,,,,,,863.10,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,outpatient,,,959.00000,669.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,930.23,,,,,,,249.34,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,inpatient,,,558.00000,389.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,541.26,,,,,,,502.20,541.26,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,outpatient,,,558.00000,389.48000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,541.26,,,,,,,145.08,541.26,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,inpatient,,,705.00000,492.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,683.85,,,,,,,634.50,683.85,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,outpatient,,,705.00000,492.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,683.85,,,,,,,183.30,683.85,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,inpatient,,,249.00000,173.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,241.53,,,,,,,224.10,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,outpatient,,,249.00000,173.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,241.53,,,,,,,64.74,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,inpatient,,,427.00000,298.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,414.19,,,,,,,384.30,414.19,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,outpatient,,,427.00000,298.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,414.19,,,,,,,111.02,414.19,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,inpatient,,,737.00000,514.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,714.89,,,,,,,663.30,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,714.89,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,inpatient,,,737.00000,514.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,59,714.89,,,,,,,663.30,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,59,714.89,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,inpatient,,,809.00000,564.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,784.73,,,,,,,728.10,784.73,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,outpatient,,,809.00000,564.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,784.73,,,,,,,210.34,784.73,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,inpatient,,,525.00000,366.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,509.25,,,,,,,472.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,outpatient,,,525.00000,366.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,509.25,,,,,,,136.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,inpatient,,,319.00000,222.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,309.43,,,,,,,287.10,309.43,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,outpatient,,,319.00000,222.66000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,309.43,,,,,,,82.94,309.43,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,inpatient,,,1437.00000,678.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1393.89,,,,,,,1293.30,1393.89,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1437.00000,678.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1393.89,,,,,,,373.62,1393.89,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,inpatient,,,2143.00000,1011.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2078.71,,,,,,,1928.70,2078.71,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2143.00000,1011.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2078.71,,,,,,,557.18,2078.71,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,inpatient,,,755.00000,356.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,732.35,,,,,,,679.50,732.35,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,outpatient,,,755.00000,356.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,732.35,,,,,,,196.30,732.35,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,inpatient,,,979.00000,462.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,949.63,,,,,,,881.10,949.63,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,outpatient,,,979.00000,462.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,949.63,,,,,,,254.54,949.63,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,inpatient,,,436.00000,205.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,422.92,,,,,,,392.40,422.92,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,outpatient,,,436.00000,205.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,422.92,,,,,,,113.36,422.92,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,inpatient,,,220.00000,103.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,213.40,,,,,,,198.00,213.40,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,outpatient,,,220.00000,103.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,213.40,,,,,,,57.20,213.40,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,inpatient,,,344.00000,162.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,333.68,,,,,,,309.60,333.68,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,outpatient,,,344.00000,162.37000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,333.68,,,,,,,89.44,333.68,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,inpatient,,,818.00000,393.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,793.46,,,,,,,736.20,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,outpatient,,,818.00000,393.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,793.46,,,,,,,212.68,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,inpatient,,,545.00000,262.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,52,528.65,,,,,,,490.50,528.65,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,outpatient,,,545.00000,262.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,52,528.65,,,,,,,141.70,528.65,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,inpatient,,,1347.00000,647.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1306.59,,,,,,,1212.30,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,outpatient,,,1347.00000,647.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1306.59,,,,,,,350.22,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,inpatient,,,898.00000,431.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,52,871.06,,,,,,,808.20,871.06,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,outpatient,,,898.00000,431.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,52,871.06,,,,,,,233.48,871.06,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,inpatient,,,469.00000,225.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,454.93,,,,,,,422.10,454.93,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,outpatient,,,469.00000,225.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,454.93,,,,,,,121.94,454.93,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,inpatient,,,1762.00000,847.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1709.14,,,,,,,1585.80,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,outpatient,,,1762.00000,847.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1709.14,,,,,,,458.12,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,inpatient,,,627.00000,301.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,608.19,,,,,,,564.30,608.19,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,outpatient,,,627.00000,301.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,608.19,,,,,,,163.02,608.19,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,inpatient,,,590.00000,283.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,572.30,,,,,,,531.00,572.30,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,outpatient,,,590.00000,283.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,572.30,,,,,,,153.40,572.30,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,inpatient,,,1550.00000,745.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1503.50,,,,,,,1395.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,outpatient,,,1550.00000,745.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1503.50,,,,,,,403.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,inpatient,,,990.00000,476.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,960.30,,,,,,,891.00,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,960.30,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,inpatient,,,990.00000,476.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,960.30,,,,,,,891.00,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,960.30,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,inpatient,,,1402.00000,674.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1359.94,,,,,,,1261.80,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,outpatient,,,1402.00000,674.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1359.94,,,,,,,364.52,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,inpatient,,,980.00000,471.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,950.60,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,950.60,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,inpatient,,,980.00000,471.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,950.60,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,950.60,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,inpatient,,,1661.00000,798.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1611.17,,,,,,,1494.90,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,outpatient,,,1661.00000,798.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1611.17,,,,,,,431.86,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,inpatient,,,980.00000,471.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,950.60,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,outpatient,,,980.00000,471.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,950.60,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,inpatient,,,1740.00000,836.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1687.80,,,,,,,1566.00,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1740.00000,836.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1687.80,,,,,,,452.40,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,inpatient,,,1168.00000,561.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1132.96,,,,,,,1051.20,1132.96,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1168.00000,561.81000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1132.96,,,,,,,303.68,1132.96,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,inpatient,,,433.00000,232.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,420.01,,,,,,,389.70,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,outpatient,,,433.00000,232.09000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,420.01,,,,,,,112.58,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,inpatient,,,388.00000,207.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,376.36,,,,,,,349.20,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,376.36,,,,,,,100.88,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,inpatient,,,388.00000,207.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,376.36,,,,,,,349.20,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,376.36,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,inpatient,,,388.00000,207.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,376.36,,,,,,,349.20,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,outpatient,,,388.00000,207.97000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,376.36,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,inpatient,,,604.00000,323.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,585.88,,,,,,,543.60,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,outpatient,,,604.00000,323.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,585.88,,,,,,,157.04,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,inpatient,,,667.00000,357.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,646.99,,,,,,,600.30,646.99,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,outpatient,,,667.00000,357.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,646.99,,,,,,,173.42,646.99,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,inpatient,,,176.00000,94.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,170.72,,,,,,,158.40,170.72,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,outpatient,,,176.00000,94.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,170.72,,,,,,,45.76,170.72,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,inpatient,,,92.00000,29.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,89.24,,,,,,,82.80,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,89.24,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,inpatient,,,92.00000,29.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,89.24,,,,,,,82.80,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,89.24,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,inpatient,,,366.00000,118.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,355.02,,,,,,,329.40,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,355.02,,,,,,,95.16,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,inpatient,,,366.00000,118.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,355.02,,,,,,,329.40,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,355.02,,,,,,,95.16,355.02,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,inpatient,,,1117.00000,360.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1083.49,,,,,,,1005.30,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1083.49,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,inpatient,,,1117.00000,360.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1083.49,,,,,,,1005.30,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1083.49,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,inpatient,,,559.00000,180.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,542.23,,,,,,,503.10,542.23,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,outpatient,,,559.00000,180.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,542.23,,,,,,,145.34,542.23,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,inpatient,,,252.00000,81.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,244.44,,,,,,,226.80,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,outpatient,,,252.00000,81.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,50,244.44,,,,,,,65.52,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,inpatient,,,168.00000,54.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,162.96,,,,,,,151.20,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,162.96,,,,,,,43.68,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,inpatient,,,168.00000,54.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,162.96,,,,,,,151.20,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,162.96,,,,,,,43.68,162.96,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,inpatient,,,1148.00000,370.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1113.56,,,,,,,1033.20,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,1113.56,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,inpatient,,,1148.00000,370.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1113.56,,,,,,,1033.20,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,1113.56,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,inpatient,,,379.00000,122.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,367.63,,,,,,,341.10,367.63,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,outpatient,,,379.00000,122.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,367.63,,,,,,,98.54,367.63,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,inpatient,,,1015.00000,327.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,984.55,,,,,,,913.50,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,outpatient,,,1015.00000,327.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,984.55,,,,,,,263.90,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,inpatient,,,591.00000,190.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,573.27,,,,,,,531.90,573.27,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,outpatient,,,591.00000,190.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,573.27,,,,,,,153.66,573.27,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,inpatient,,,271.00000,169.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,262.87,,,,,,,243.90,262.87,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,outpatient,,,271.00000,169.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,262.87,,,,,,,70.46,262.87,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,inpatient,,,211.00000,132.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,204.67,,,,,,,189.90,204.67,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,LT,204.67,,,,,,,54.86,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,inpatient,,,211.00000,132.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,204.67,,,,,,,189.90,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,RT,204.67,,,,,,,54.86,204.67,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,59.00000,36.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,53.10,57.23,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,59.00000,36.99000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,57.23,,,,,,,15.34,57.23,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,inpatient,,,336.00000,219.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,325.92,,,,,,,302.40,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,outpatient,,,336.00000,219.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,325.92,,,,,,,87.36,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,inpatient,,,224.00000,146.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,52,217.28,,,,,,,201.60,217.28,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,outpatient,,,224.00000,146.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,52,217.28,,,,,,,58.24,217.28,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,inpatient,,,63.00000,41.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,56.70,61.11,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,outpatient,,,63.00000,41.20000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,61.11,,,,,,,16.38,61.11,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,488.88,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,488.88,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,589.76,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,589.76,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,207.58,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,207.58,,,,,,,55.64,207.58,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,inpatient,,,609.00000,196.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,590.73,,,,,,,548.10,590.73,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,590.73,,,,,,,158.34,590.73,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,inpatient,,,863.00000,278.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,837.11,,,,,,,776.70,837.11,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,837.11,,,,,,,224.38,837.11,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,inpatient,,,900.00000,605.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,873.00,,,,,,,810.00,873.00,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,outpatient,,,900.00000,605.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,873.00,,,,,,,234.00,873.00,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,inpatient,,,1940.00000,1102.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1881.80,,,,,,,1746.00,1881.80,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,outpatient,,,1940.00000,1102.21000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1881.80,,,,,,,504.40,1881.80,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,inpatient,,,422.00000,239.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,409.34,,,,,,,379.80,409.34,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,outpatient,,,422.00000,239.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,409.34,,,,,,,109.72,409.34,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,inpatient,,,1430.00000,812.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1387.10,,,,,,,1287.00,1387.10,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,outpatient,,,1430.00000,812.45000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1387.10,,,,,,,371.80,1387.10,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,inpatient,,,745.00000,423.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,722.65,,,,,,,670.50,722.65,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,outpatient,,,745.00000,423.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,722.65,,,,,,,193.70,722.65,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,inpatient,,,2655.00000,2487.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2575.35,,,,,,,2389.50,2575.35,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,outpatient,,,2655.00000,2487.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2575.35,,,,,,,690.30,2575.35,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,inpatient,,,3990.00000,3738.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3870.30,,,,,,,3591.00,3870.30,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,outpatient,,,3990.00000,3738.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3870.30,,,,,,,1037.40,3870.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,inpatient,,,290.00000,271.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,281.30,,,,,,,261.00,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,outpatient,,,290.00000,271.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,281.30,,,,,,,75.40,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,inpatient,,,735.00000,688.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,712.95,,,,,,,661.50,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,outpatient,,,735.00000,688.70000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,712.95,,,,,,,191.10,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,inpatient,,,1475.00000,1382.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1430.75,,,,,,,1327.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1430.75,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,inpatient,,,2275.00000,2131.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2206.75,,,,,,,2047.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,outpatient,,,2275.00000,2131.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2206.75,,,,,,,591.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,inpatient,,,3205.00000,3003.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3108.85,,,,,,,2884.50,3108.85,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,outpatient,,,3205.00000,3003.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3108.85,,,,,,,833.30,3108.85,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,inpatient,,,770.00000,721.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,746.90,,,,,,,693.00,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,outpatient,,,770.00000,721.49000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,746.90,,,,,,,200.20,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,inpatient,,,1475.00000,1382.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1430.75,,,,,,,1327.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,outpatient,,,1475.00000,1382.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1430.75,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,inpatient,,,2210.00000,2070.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2143.70,,,,,,,1989.00,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,outpatient,,,2210.00000,2070.77000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2143.70,,,,,,,574.60,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,inpatient,,,2660.00000,2492.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2580.20,,,,,,,2394.00,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,outpatient,,,2660.00000,2492.42000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,2580.20,,,,,,,691.60,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,inpatient,,,3560.00000,3335.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3453.20,,,,,,,3204.00,3453.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,outpatient,,,3560.00000,3335.72000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3453.20,,,,,,,925.60,3453.20,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,inpatient,,,5730.00000,3255.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5558.10,,,,,,,5157.00,5558.10,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,outpatient,,,5730.00000,3255.50000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5558.10,,,,,,,1489.80,5558.10,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,inpatient,,,3875.00000,2201.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3758.75,,,,,,,3487.50,3758.75,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,outpatient,,,3875.00000,2201.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3758.75,,,,,,,1007.50,3758.75,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,inpatient,,,519.00000,564.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,503.43,,,,,,,467.10,503.43,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,outpatient,,,519.00000,564.15000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,503.43,,,,,,,134.94,503.43,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,inpatient,,,536.00000,582.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,519.92,,,,,,,482.40,519.92,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,outpatient,,,536.00000,582.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,519.92,,,,,,,139.36,519.92,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,439.41,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,439.41,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,139.68,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,139.68,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,103.79,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,103.79,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,139.68,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,139.68,,,,,,,37.44,139.68,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,488.88,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,488.88,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,95.06,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,589.76,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,589.76,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,110.58,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,181.39,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,207.58,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,207.58,,,,,,,55.64,207.58,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,inpatient,,,175.00000,63.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,169.75,,,,,,,157.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,outpatient,,,175.00000,63.18000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,169.75,,,,,,,45.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,inpatient,,,304.00000,109.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,294.88,,,,,,,273.60,294.88,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,outpatient,,,304.00000,109.74000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,294.88,,,,,,,79.04,294.88,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,275.48,,,,,,,255.60,275.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,275.48,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,444.26,,,,,,,412.20,444.26,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,444.26,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,inpatient,,,438.00000,158.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,424.86,,,,,,,394.20,424.86,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,outpatient,,,438.00000,158.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,424.86,,,,,,,113.88,424.86,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,541.26,,,,,,,502.20,541.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,541.26,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,467.54,,,,,,,433.80,467.54,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,467.54,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,229.89,,,,,,,213.30,229.89,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,229.89,,,,,,,61.62,229.89,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,488.88,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,488.88,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,488.88,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,488.88,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,488.88,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,488.88,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,488.88,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,488.88,,,,,,,131.04,488.88,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,816.74,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,816.74,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1021.41,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1021.41,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1225.11,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1225.11,,,,,,,328.38,1225.11,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,inpatient,,,182.00000,127.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,176.54,,,,,,,163.80,176.54,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,176.54,,,,,,,47.32,176.54,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,inpatient,,,210.00000,119.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,203.70,,,,,,,189.00,203.70,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,203.70,,,,,,,54.60,203.70,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,inpatient,,,140.00000,79.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,135.80,,,,,,,126.00,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,outpatient,,,140.00000,79.54000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,135.80,,,,,,,36.40,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,inpatient,,,190.00000,107.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,184.30,,,,,,,171.00,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,outpatient,,,190.00000,107.95000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,184.30,,,,,,,49.40,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,inpatient,,,240.00000,136.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,232.80,,,,,,,216.00,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,outpatient,,,240.00000,136.36000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,232.80,,,,,,,62.40,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,inpatient,,,290.00000,164.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,281.30,,,,,,,261.00,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,outpatient,,,290.00000,164.76000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,281.30,,,,,,,75.40,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,inpatient,,,340.00000,193.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,329.80,,,,,,,306.00,329.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,outpatient,,,340.00000,193.17000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,329.80,,,,,,,88.40,329.80,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,inpatient,,,150.00000,85.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,145.50,,,,,,,135.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,outpatient,,,150.00000,85.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,145.50,,,,,,,39.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,inpatient,,,200.00000,113.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,194.00,,,,,,,180.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,outpatient,,,200.00000,113.63000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,194.00,,,,,,,52.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,inpatient,,,270.00000,153.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,261.90,,,,,,,243.00,261.90,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,outpatient,,,270.00000,153.40000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,261.90,,,,,,,70.20,261.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,inpatient,,,370.00000,210.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,358.90,,,,,,,333.00,358.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,outpatient,,,370.00000,210.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,358.90,,,,,,,96.20,358.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,inpatient,,,470.00000,267.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,455.90,,,,,,,423.00,455.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,outpatient,,,470.00000,267.03000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,455.90,,,,,,,122.20,455.90,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,inpatient,,,248.00000,96.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,240.56,,,,,,,223.20,240.56,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,outpatient,,,248.00000,96.22000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,240.56,,,,,,,64.48,240.56,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,inpatient,,,245.00000,95.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,237.65,,,,,,,220.50,237.65,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,outpatient,,,245.00000,95.06000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,237.65,,,,,,,63.70,237.65,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,inpatient,,,497.00000,192.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,482.09,,,,,,,447.30,482.09,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,outpatient,,,497.00000,192.84000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,482.09,,,,,,,129.22,482.09,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,inpatient,,,357.00000,138.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,346.29,,,,,,,321.30,346.29,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,outpatient,,,357.00000,138.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,346.29,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,inpatient,,,334.00000,129.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,323.98,,,,,,,300.60,323.98,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,outpatient,,,334.00000,129.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,323.98,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,inpatient,,,194.00000,75.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,188.18,,,,,,,174.60,188.18,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,outpatient,,,194.00000,75.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,188.18,,,,,,,50.44,188.18,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,inpatient,,,1035.00000,401.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1003.95,,,,,,,931.50,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,outpatient,,,1035.00000,401.58000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1003.95,,,,,,,269.10,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,inpatient,,,1137.00000,441.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1102.89,,,,,,,1023.30,1102.89,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,outpatient,,,1137.00000,441.16000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,1102.89,,,,,,,295.62,1102.89,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,inpatient,,,963.00000,373.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,934.11,,,,,,,866.70,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,outpatient,,,963.00000,373.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,934.11,,,,,,,250.38,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,inpatient,,,990.00000,384.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,960.30,,,,,,,891.00,960.30,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,outpatient,,,990.00000,384.12000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,960.30,,,,,,,257.40,960.30,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,inpatient,,,112.00000,43.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,108.64,,,,,,,100.80,108.64,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,outpatient,,,112.00000,43.46000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,108.64,,,,,,,29.12,108.64,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,inpatient,,,84.00000,32.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,81.48,,,,,,,75.60,81.48,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,outpatient,,,84.00000,32.59000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,81.48,,,,,,,21.84,81.48,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,inpatient,,,176.00000,68.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,170.72,,,,,,,158.40,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,outpatient,,,176.00000,68.29000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,170.72,,,,,,,45.76,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,inpatient,,,283.00000,109.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,274.51,,,,,,,254.70,274.51,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,outpatient,,,283.00000,109.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,274.51,,,,,,,73.58,274.51,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,72.90,78.57,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,78.57,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,39.77,,,,,,,36.90,39.77,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,39.77,,,,,,,10.66,39.77,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,inpatient,,,35.00000,19.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33.95,,,,,,,31.50,33.95,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,35.00000,19.89000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,33.95,,,,,,,9.10,33.95,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,inpatient,,,191.00000,89.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,185.27,,,,,,,171.90,185.27,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,outpatient,,,191.00000,89.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,185.27,,,,,,,49.66,185.27,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,439.41,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,439.41,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,139.68,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,139.68,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,103.79,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,103.79,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,139.68,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,139.68,,,,,,,37.44,139.68,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,inpatient,,,281.00000,131.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,272.57,,,,,,,252.90,272.57,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,outpatient,,,281.00000,131.51000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,272.57,,,,,,,73.06,272.57,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,inpatient,,,192.00000,89.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,186.24,,,,,,,172.80,186.24,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,outpatient,,,192.00000,89.86000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,186.24,,,,,,,49.92,186.24,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,inpatient,,,365.00000,170.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,354.05,,,,,,,328.50,354.05,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,outpatient,,,365.00000,170.82000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,354.05,,,,,,,94.90,354.05,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,inpatient,,,8391.00000,5856.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8139.27,,,,,,,7551.90,8139.27,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,outpatient,,,8391.00000,5856.92000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8139.27,,,,,,,2181.66,8139.27,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,inpatient,,,6917.00000,4828.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,52,6709.49,,,,,,,6225.30,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,52,6709.49,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,inpatient,,,6000.00000,4188.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5820.00,,,,,,,5400.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5820.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,inpatient,,,6917.00000,4828.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6709.49,,,,,,,6225.30,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6709.49,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,inpatient,,,6000.00000,4188.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,52,5820.00,,,,,,,5400.00,5820.00,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,52,5820.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,inpatient,,,8855.00000,9625.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8589.35,,,,,,,7969.50,8589.35,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,outpatient,,,8855.00000,9625.38000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,8589.35,,,,,,,2302.30,8589.35,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,inpatient,,,844.00000,917.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,818.68,,,,,,,759.60,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,818.68,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,inpatient,,,844.00000,917.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,52,818.68,,,,,,,759.60,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,52,818.68,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,inpatient,,,785.00000,853.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,761.45,,,,,,,706.50,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,761.45,,,,,,,204.10,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,inpatient,,,785.00000,853.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,52,761.45,,,,,,,706.50,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,52,761.45,,,,,,,204.10,761.45,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4709.00000,5118.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4567.73,,,,,,,4238.10,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,4567.73,,,,,,,1224.34,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4709.00000,5118.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,52,4567.73,,,,,,,4238.10,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,52,4567.73,,,,,,,1224.34,4567.73,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,inpatient,,,345.00000,128.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,334.65,,,,,,,310.50,334.65,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,outpatient,,,345.00000,128.34000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,334.65,,,,,,,89.70,334.65,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,inpatient,,,120.00000,99.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,116.40,,,,,,,108.00,116.40,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,outpatient,,,120.00000,99.60000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,116.40,,,,,,,31.20,116.40,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,inpatient,,,106.00000,87.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,95.40,102.82,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,outpatient,,,106.00000,87.98000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,102.82,,,,,,,27.56,102.82,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,inpatient,,,32.00000,26.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31.04,,,,,,,28.80,31.04,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,outpatient,,,32.00000,26.56000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,31.04,,,,,,,8.32,31.04,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,inpatient,,,60.00000,49.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,54.00,58.20,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,outpatient,,,60.00000,49.80000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,58.20,,,,,,,15.60,58.20,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,inpatient,,,57.00000,47.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,51.30,55.29,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,outpatient,,,57.00000,47.31000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,55.29,,,,,,,14.82,55.29,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,inpatient,1.0,ME,7.40000,0.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7.18,,,,,,,6.66,7.18,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,outpatient,1.0,ME,7.40000,0.65000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,7.18,,,,,,,1.92,7.18,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,inpatient,1.0,EA,6.60000,1.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,6.40,,,,,,,5.94,6.40,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,outpatient,1.0,EA,6.60000,1.43000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,6.40,,,,,,,1.72,6.40,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,inpatient,1.0,EA,2.95000,0.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,2.86,,,,,,,2.65,2.86,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,outpatient,1.0,EA,2.95000,0.64000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,2.86,,,,,,,0.76700,2.86,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,inpatient,1.0,EA,56.08000,12.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,54.40,,,,,,,50.47,54.40,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,56.08000,12.11000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,54.40,,,,,,,14.58,54.40,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,inpatient,1.0,UN,82.10000,28.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,79.64,,,,,,,73.89,79.64,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,outpatient,1.0,UN,82.10000,28.90000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,79.64,,,,,,,15.48,79.64,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.04000,,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,0.03880,,,,,,,0.03600,0.03880,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.04000,,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,0.03880,,,,,,,0.01040,0.03880,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.05000,,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,0.04850,,,,,,,0.04500,0.04850,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.05000,,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,0.04850,,,,,,,0.01300,0.04850,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,inpatient,1.0,ME,6.20000,0.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6.01,,,,,,,5.58,6.01,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,outpatient,1.0,ME,6.20000,0.55000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,6.01,,,,,,,1.61,6.01,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.12000,0.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,0.11640,,,,,,,0.10800,0.11640,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.12000,0.01000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,0.11640,,,,,,,0.03120,0.11640,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,inpatient,2.0,ML,5.80000,1.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5.63,,,,,,,5.22,5.63,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,outpatient,2.0,ML,5.80000,1.25000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,5.63,,,,,,,1.51,5.63,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,inpatient,1.0,ME,3.10000,0.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3.01,,,,,,,2.79,3.01,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,outpatient,1.0,ME,3.10000,0.27000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,3.01,,,,,,,0.80600,3.01,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,inpatient,1.0,EA,44.40000,3.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,43.07,,,,,,,39.96,43.07,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,outpatient,1.0,EA,44.40000,3.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,43.07,,,,,,,11.54,43.07,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,inpatient,1.0,EA,8.26000,0.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,8.01,,,,,,,7.43,8.01,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,8.26000,0.73000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,8.01,,,,,,,2.15,8.01,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,2.19000,0.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,2.12,,,,,,,1.97,2.12,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,2.19000,0.19000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,2.12,,,,,,,0.56940,2.12,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,inpatient,1.0,EA,28.60000,2.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,27.74,,,,,,,25.74,27.74,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,outpatient,1.0,EA,28.60000,2.52000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,,27.74,,,,,,,7.44,27.74,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,inpatient,1.0,EA,2.58000,0.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,2.50,,,,,,,2.32,2.50,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,outpatient,1.0,EA,2.58000,0.91000,Prominence HealthFirst (fka NV Preferred Healthcare Providers),Commercial,UD,2.50,,,,,,,0.67080,2.50,percent of total billed charges,
R&B OBSTETRICS PVT,3012,CDM,112,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,SilverSummit Healthplan,Commercial Exchange,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,23010,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,SilverSummit Healthplan,Commercial Exchange,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ICU,33019,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,SilverSummit Healthplan,Commercial Exchange,,7884.90,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,13011,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,SilverSummit Healthplan,Commercial Exchange,,5256.90,,,,,,,2512.00,5665.77,percent of total billed charges,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,244.00000,77.10000,SilverSummit Healthplan,Commercial Exchange,,219.60,,,,,,,219.60,236.68,percent of total billed charges,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,244.00000,77.10000,SilverSummit Healthplan,Commercial Exchange,,219.60,,,,,,,63.44,236.68,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,24075,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,SilverSummit Healthplan,Commercial Exchange,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B OBSTETRICS SEMI-PVT,44073,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,SilverSummit Healthplan,Commercial Exchange,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B NURSERY LEVEL 1,55160,CDM,171,RC,,,,,facility,inpatient,,,3477.00000,1975.46000,SilverSummit Healthplan,Commercial Exchange,,3129.30,,,,,,,2512.00,3372.69,percent of total billed charges,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,inpatient,,,16.00000,7.71000,SilverSummit Healthplan,Commercial Exchange,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,outpatient,,,16.00000,7.71000,SilverSummit Healthplan,Commercial Exchange,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,inpatient,,,210.00000,119.31000,SilverSummit Healthplan,Commercial Exchange,,189.00,,,,,,,189.00,203.70,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,SilverSummit Healthplan,Commercial Exchange,,189.00,,,,,,,54.60,203.70,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,inpatient,,,380.00000,215.90000,SilverSummit Healthplan,Commercial Exchange,,342.00,,,,,,,342.00,368.60,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,outpatient,,,380.00000,215.90000,SilverSummit Healthplan,Commercial Exchange,,342.00,,,,,,,98.80,368.60,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,SilverSummit Healthplan,Commercial Exchange,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,SilverSummit Healthplan,Commercial Exchange,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22012,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,SilverSummit Healthplan,Commercial Exchange,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ADMIN DAY SKILLED,82016,CDM,160,RC,,,,,facility,inpatient,,,1923.00000,1092.55000,SilverSummit Healthplan,Commercial Exchange,,1730.70,,,,,,,1730.70,3111.10,percent of total billed charges,
R&B SWING BED SKILLED,62018,CDM,160,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,SilverSummit Healthplan,Commercial Exchange,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ADMIN DAY INTERMEDIATE,72017,CDM,169,RC,,,,,facility,inpatient,,,1176.00000,668.14000,SilverSummit Healthplan,Commercial Exchange,,1058.40,,,,,,,1058.40,3111.10,percent of total billed charges,
R&B ICU,32011,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,SilverSummit Healthplan,Commercial Exchange,,7884.90,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,12013,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,SilverSummit Healthplan,Commercial Exchange,,5256.90,,,,,,,2512.00,5665.77,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,SilverSummit Healthplan,Commercial Exchange,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,SilverSummit Healthplan,Commercial Exchange,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,SilverSummit Healthplan,Commercial Exchange,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,SilverSummit Healthplan,Commercial Exchange,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,SilverSummit Healthplan,Commercial Exchange,,547.20,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,SilverSummit Healthplan,Commercial Exchange,,547.20,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,SilverSummit Healthplan,Commercial Exchange,,192.60,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,SilverSummit Healthplan,Commercial Exchange,,192.60,,,,,,,55.64,207.58,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,84.00000,63.59000,SilverSummit Healthplan,Commercial Exchange,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,SilverSummit Healthplan,Commercial Exchange,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,SilverSummit Healthplan,Commercial Exchange,,255.60,,,,,,,255.60,275.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,SilverSummit Healthplan,Commercial Exchange,,255.60,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,SilverSummit Healthplan,Commercial Exchange,,412.20,,,,,,,412.20,444.26,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,SilverSummit Healthplan,Commercial Exchange,,412.20,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,SilverSummit Healthplan,Commercial Exchange,,502.20,,,,,,,502.20,541.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,SilverSummit Healthplan,Commercial Exchange,,502.20,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,SilverSummit Healthplan,Commercial Exchange,,433.80,,,,,,,433.80,467.54,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,SilverSummit Healthplan,Commercial Exchange,,433.80,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,SilverSummit Healthplan,Commercial Exchange,,213.30,,,,,,,213.30,229.89,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,SilverSummit Healthplan,Commercial Exchange,,213.30,,,,,,,61.62,229.89,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,inpatient,,,2041.00000,659.24000,SilverSummit Healthplan,Commercial Exchange,,1836.90,,,,,,,1836.90,1979.77,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,outpatient,,,2041.00000,659.24000,SilverSummit Healthplan,Commercial Exchange,,1836.90,,,,,,,530.66,1979.77,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,inpatient,,,259.00000,83.66000,SilverSummit Healthplan,Commercial Exchange,,233.10,,,,,,,233.10,251.23,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,outpatient,,,259.00000,83.66000,SilverSummit Healthplan,Commercial Exchange,,233.10,,,,,,,67.34,251.23,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,inpatient,,,672.00000,217.06000,SilverSummit Healthplan,Commercial Exchange,,604.80,,,,,,,604.80,651.84,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,outpatient,,,672.00000,217.06000,SilverSummit Healthplan,Commercial Exchange,,604.80,,,,,,,174.72,651.84,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,inpatient,,,530.00000,171.19000,SilverSummit Healthplan,Commercial Exchange,,477.00,,,,,,,477.00,514.10,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,outpatient,,,530.00000,171.19000,SilverSummit Healthplan,Commercial Exchange,,477.00,,,,,,,137.80,514.10,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,inpatient,,,580.00000,187.34000,SilverSummit Healthplan,Commercial Exchange,,522.00,,,,,,,522.00,562.60,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,outpatient,,,580.00000,187.34000,SilverSummit Healthplan,Commercial Exchange,,522.00,,,,,,,150.80,562.60,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,inpatient,,,435.00000,140.50000,SilverSummit Healthplan,Commercial Exchange,,391.50,,,,,,,391.50,421.95,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,outpatient,,,435.00000,140.50000,SilverSummit Healthplan,Commercial Exchange,,391.50,,,,,,,113.10,421.95,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,inpatient,,,863.00000,278.75000,SilverSummit Healthplan,Commercial Exchange,,776.70,,,,,,,776.70,837.11,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,SilverSummit Healthplan,Commercial Exchange,,776.70,,,,,,,224.38,837.11,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,inpatient,,,334.00000,107.88000,SilverSummit Healthplan,Commercial Exchange,,300.60,,,,,,,300.60,323.98,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,outpatient,,,334.00000,107.88000,SilverSummit Healthplan,Commercial Exchange,,300.60,,,,,,,86.84,323.98,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,inpatient,,,1188.00000,383.72000,SilverSummit Healthplan,Commercial Exchange,50,1069.20,,,,,,,1069.20,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,outpatient,,,1188.00000,383.72000,SilverSummit Healthplan,Commercial Exchange,50,1069.20,,,,,,,308.88,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,inpatient,,,792.00000,255.82000,SilverSummit Healthplan,Commercial Exchange,LT,712.80,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,SilverSummit Healthplan,Commercial Exchange,LT,712.80,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,inpatient,,,792.00000,255.82000,SilverSummit Healthplan,Commercial Exchange,RT,712.80,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,SilverSummit Healthplan,Commercial Exchange,RT,712.80,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,inpatient,,,572.00000,184.76000,SilverSummit Healthplan,Commercial Exchange,50,514.80,,,,,,,514.80,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,outpatient,,,572.00000,184.76000,SilverSummit Healthplan,Commercial Exchange,50,514.80,,,,,,,148.72,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,inpatient,,,381.00000,123.06000,SilverSummit Healthplan,Commercial Exchange,LT,342.90,,,,,,,342.90,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,SilverSummit Healthplan,Commercial Exchange,LT,342.90,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,inpatient,,,381.00000,123.06000,SilverSummit Healthplan,Commercial Exchange,RT,342.90,,,,,,,342.90,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,SilverSummit Healthplan,Commercial Exchange,RT,342.90,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,inpatient,,,455.00000,146.96000,SilverSummit Healthplan,Commercial Exchange,,409.50,,,,,,,409.50,441.35,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,outpatient,,,455.00000,146.96000,SilverSummit Healthplan,Commercial Exchange,,409.50,,,,,,,118.30,441.35,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,inpatient,,,403.00000,130.17000,SilverSummit Healthplan,Commercial Exchange,,362.70,,,,,,,362.70,390.91,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,outpatient,,,403.00000,130.17000,SilverSummit Healthplan,Commercial Exchange,,362.70,,,,,,,104.78,390.91,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,inpatient,,,370.00000,119.51000,SilverSummit Healthplan,Commercial Exchange,,333.00,,,,,,,333.00,358.90,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,outpatient,,,370.00000,119.51000,SilverSummit Healthplan,Commercial Exchange,,333.00,,,,,,,96.20,358.90,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,inpatient,,,357.00000,115.31000,SilverSummit Healthplan,Commercial Exchange,,321.30,,,,,,,321.30,346.29,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,outpatient,,,357.00000,115.31000,SilverSummit Healthplan,Commercial Exchange,,321.30,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,inpatient,,,334.00000,107.88000,SilverSummit Healthplan,Commercial Exchange,,300.60,,,,,,,300.60,323.98,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,outpatient,,,334.00000,107.88000,SilverSummit Healthplan,Commercial Exchange,,300.60,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,inpatient,,,194.00000,62.66000,SilverSummit Healthplan,Commercial Exchange,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,outpatient,,,194.00000,62.66000,SilverSummit Healthplan,Commercial Exchange,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,inpatient,,,457.00000,147.61000,SilverSummit Healthplan,Commercial Exchange,,411.30,,,,,,,411.30,443.29,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,outpatient,,,457.00000,147.61000,SilverSummit Healthplan,Commercial Exchange,,411.30,,,,,,,118.82,443.29,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,inpatient,,,492.00000,158.92000,SilverSummit Healthplan,Commercial Exchange,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,outpatient,,,492.00000,158.92000,SilverSummit Healthplan,Commercial Exchange,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,inpatient,,,780.00000,251.94000,SilverSummit Healthplan,Commercial Exchange,,702.00,,,,,,,702.00,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,outpatient,,,780.00000,251.94000,SilverSummit Healthplan,Commercial Exchange,,702.00,,,,,,,202.80,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,inpatient,,,1165.00000,376.30000,SilverSummit Healthplan,Commercial Exchange,,1048.50,,,,,,,1048.50,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,outpatient,,,1165.00000,376.30000,SilverSummit Healthplan,Commercial Exchange,,1048.50,,,,,,,302.90,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,inpatient,,,2350.00000,759.05000,SilverSummit Healthplan,Commercial Exchange,,2115.00,,,,,,,2115.00,2279.50,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,outpatient,,,2350.00000,759.05000,SilverSummit Healthplan,Commercial Exchange,,2115.00,,,,,,,611.00,2279.50,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,inpatient,,,896.00000,289.41000,SilverSummit Healthplan,Commercial Exchange,,806.40,,,,,,,806.40,869.12,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,outpatient,,,896.00000,289.41000,SilverSummit Healthplan,Commercial Exchange,,806.40,,,,,,,232.96,869.12,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,inpatient,,,490.00000,158.27000,SilverSummit Healthplan,Commercial Exchange,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,outpatient,,,490.00000,158.27000,SilverSummit Healthplan,Commercial Exchange,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,inpatient,,,520.00000,167.96000,SilverSummit Healthplan,Commercial Exchange,,468.00,,,,,,,468.00,504.40,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,outpatient,,,520.00000,167.96000,SilverSummit Healthplan,Commercial Exchange,,468.00,,,,,,,135.20,504.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,inpatient,,,720.00000,232.56000,SilverSummit Healthplan,Commercial Exchange,,648.00,,,,,,,648.00,698.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,outpatient,,,720.00000,232.56000,SilverSummit Healthplan,Commercial Exchange,,648.00,,,,,,,187.20,698.40,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,inpatient,,,215.00000,69.45000,SilverSummit Healthplan,Commercial Exchange,,193.50,,,,,,,193.50,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,outpatient,,,215.00000,69.45000,SilverSummit Healthplan,Commercial Exchange,,193.50,,,,,,,55.90,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,inpatient,,,240.00000,77.52000,SilverSummit Healthplan,Commercial Exchange,,216.00,,,,,,,216.00,232.80,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,outpatient,,,240.00000,77.52000,SilverSummit Healthplan,Commercial Exchange,,216.00,,,,,,,62.40,232.80,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,inpatient,,,1241.00000,400.84000,SilverSummit Healthplan,Commercial Exchange,,1116.90,,,,,,,1116.90,1203.77,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,outpatient,,,1241.00000,400.84000,SilverSummit Healthplan,Commercial Exchange,,1116.90,,,,,,,322.66,1203.77,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,SilverSummit Healthplan,Commercial Exchange,,757.80,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,SilverSummit Healthplan,Commercial Exchange,,757.80,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,SilverSummit Healthplan,Commercial Exchange,,947.70,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,SilverSummit Healthplan,Commercial Exchange,,947.70,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,SilverSummit Healthplan,Commercial Exchange,,1136.70,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,SilverSummit Healthplan,Commercial Exchange,,1136.70,,,,,,,328.38,1225.11,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,inpatient,,,668.00000,559.78000,SilverSummit Healthplan,Commercial Exchange,,601.20,,,,,,,601.20,647.96,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,outpatient,,,668.00000,559.78000,SilverSummit Healthplan,Commercial Exchange,,601.20,,,,,,,173.68,647.96,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,SilverSummit Healthplan,Commercial Exchange,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,SilverSummit Healthplan,Commercial Exchange,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,SilverSummit Healthplan,Commercial Exchange,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,SilverSummit Healthplan,Commercial Exchange,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,SilverSummit Healthplan,Commercial Exchange,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,SilverSummit Healthplan,Commercial Exchange,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,SilverSummit Healthplan,Commercial Exchange,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,SilverSummit Healthplan,Commercial Exchange,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,SilverSummit Healthplan,Commercial Exchange,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,SilverSummit Healthplan,Commercial Exchange,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,SilverSummit Healthplan,Commercial Exchange,,3.06,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,SilverSummit Healthplan,Commercial Exchange,,3.06,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,SilverSummit Healthplan,Commercial Exchange,,3.06,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,SilverSummit Healthplan,Commercial Exchange,,3.06,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,SilverSummit Healthplan,Commercial Exchange,,3.06,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,SilverSummit Healthplan,Commercial Exchange,,3.06,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,4.90000,2.78000,SilverSummit Healthplan,Commercial Exchange,,4.41,,,,,,,4.41,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,SilverSummit Healthplan,Commercial Exchange,,4.41,,,,,,,1.27,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,7.90000,4.49000,SilverSummit Healthplan,Commercial Exchange,,7.11,,,,,,,7.11,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,7.90000,4.49000,SilverSummit Healthplan,Commercial Exchange,,7.11,,,,,,,2.05,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,4.90000,2.78000,SilverSummit Healthplan,Commercial Exchange,,4.41,,,,,,,4.41,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,SilverSummit Healthplan,Commercial Exchange,,4.41,,,,,,,1.27,4.75,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,inpatient,,,81.00000,44.14000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,81.00000,44.14000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,81.00000,44.14000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,81.00000,44.14000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,inpatient,,,81.00000,44.14000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,81.00000,44.14000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,inpatient,,,3141500.00000,1784843.22000,SilverSummit Healthplan,Commercial Exchange,,2827350.00,,,,,,,2827350.00,3047255.00,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,outpatient,,,3141500.00000,1784843.22000,SilverSummit Healthplan,Commercial Exchange,,2827350.00,,,,,,,816790.00,3047255.00,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.22000,0.12000,SilverSummit Healthplan,Commercial Exchange,UD,0.19800,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.22000,0.12000,SilverSummit Healthplan,Commercial Exchange,UD,0.19800,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.52000,0.30000,SilverSummit Healthplan,Commercial Exchange,UD,0.46800,,,,,,,0.46800,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.52000,0.30000,SilverSummit Healthplan,Commercial Exchange,UD,0.46800,,,,,,,0.13520,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.56000,0.32000,SilverSummit Healthplan,Commercial Exchange,UD,0.50400,,,,,,,0.50400,0.54320,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.56000,0.32000,SilverSummit Healthplan,Commercial Exchange,UD,0.50400,,,,,,,0.14560,0.54320,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.22000,0.12000,SilverSummit Healthplan,Commercial Exchange,UD,0.19800,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,SilverSummit Healthplan,Commercial Exchange,UD,0.19800,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.85000,0.48000,SilverSummit Healthplan,Commercial Exchange,UD,0.76500,,,,,,,0.76500,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.85000,0.48000,SilverSummit Healthplan,Commercial Exchange,UD,0.76500,,,,,,,0.22100,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.22000,0.12000,SilverSummit Healthplan,Commercial Exchange,UD,0.19800,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,SilverSummit Healthplan,Commercial Exchange,UD,0.19800,,,,,,,0.05720,0.21340,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,inpatient,,,102.00000,65.18000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,outpatient,,,102.00000,65.18000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,inpatient,,,190.00000,121.41000,SilverSummit Healthplan,Commercial Exchange,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,outpatient,,,190.00000,121.41000,SilverSummit Healthplan,Commercial Exchange,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,inpatient,,,359.00000,229.40000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,inpatient,,,535.00000,341.86000,SilverSummit Healthplan,Commercial Exchange,,481.50,,,,,,,481.50,518.95,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,SilverSummit Healthplan,Commercial Exchange,,481.50,,,,,,,139.10,518.95,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,inpatient,,,766.00000,489.47000,SilverSummit Healthplan,Commercial Exchange,,689.40,,,,,,,689.40,743.02,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,outpatient,,,766.00000,489.47000,SilverSummit Healthplan,Commercial Exchange,,689.40,,,,,,,199.16,743.02,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,inpatient,,,159.00000,101.60000,SilverSummit Healthplan,Commercial Exchange,,143.10,,,,,,,143.10,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,outpatient,,,159.00000,101.60000,SilverSummit Healthplan,Commercial Exchange,,143.10,,,,,,,41.34,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,inpatient,,,447.00000,285.63000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,outpatient,,,447.00000,285.63000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,inpatient,,,1413.00000,902.91000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,outpatient,,,1413.00000,902.91000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,inpatient,,,3853.00000,2462.07000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,outpatient,,,3853.00000,2462.07000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,inpatient,,,313.00000,200.01000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,outpatient,,,313.00000,200.01000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,inpatient,,,1132.00000,723.35000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,outpatient,,,1132.00000,723.35000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,inpatient,,,2695.00000,1722.10000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,outpatient,,,2695.00000,1722.10000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,inpatient,,,1619.00000,1034.54000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,outpatient,,,1619.00000,1034.54000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,inpatient,,,535.00000,341.86000,SilverSummit Healthplan,Commercial Exchange,,481.50,,,,,,,481.50,518.95,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,SilverSummit Healthplan,Commercial Exchange,,481.50,,,,,,,139.10,518.95,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,inpatient,,,850.00000,543.15000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,outpatient,,,850.00000,543.15000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,inpatient,,,32.00000,20.45000,SilverSummit Healthplan,Commercial Exchange,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,outpatient,,,32.00000,20.45000,SilverSummit Healthplan,Commercial Exchange,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,inpatient,,,134.00000,85.63000,SilverSummit Healthplan,Commercial Exchange,,120.60,,,,,,,120.60,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,outpatient,,,134.00000,85.63000,SilverSummit Healthplan,Commercial Exchange,,120.60,,,,,,,34.84,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,inpatient,,,359.00000,229.40000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,inpatient,,,709.00000,453.05000,SilverSummit Healthplan,Commercial Exchange,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,outpatient,,,709.00000,453.05000,SilverSummit Healthplan,Commercial Exchange,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,inpatient,,,4880.00000,2357.04000,SilverSummit Healthplan,Commercial Exchange,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,outpatient,,,4880.00000,2357.04000,SilverSummit Healthplan,Commercial Exchange,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,inpatient,,,6024.00000,2909.59000,SilverSummit Healthplan,Commercial Exchange,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,outpatient,,,6024.00000,2909.59000,SilverSummit Healthplan,Commercial Exchange,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,inpatient,,,7413.00000,3580.48000,SilverSummit Healthplan,Commercial Exchange,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,outpatient,,,7413.00000,3580.48000,SilverSummit Healthplan,Commercial Exchange,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,inpatient,,,7181.00000,3468.42000,SilverSummit Healthplan,Commercial Exchange,,6462.90,,,,,,,6462.90,6965.57,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,SilverSummit Healthplan,Commercial Exchange,,6462.90,,,,,,,1867.06,6965.57,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,inpatient,,,10654.00000,5145.88000,SilverSummit Healthplan,Commercial Exchange,,9588.60,,,,,,,9588.60,10334.38,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,outpatient,,,10654.00000,5145.88000,SilverSummit Healthplan,Commercial Exchange,,9588.60,,,,,,,2770.04,10334.38,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,6487.00000,3133.22000,SilverSummit Healthplan,Commercial Exchange,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,SilverSummit Healthplan,Commercial Exchange,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,7413.00000,3580.48000,SilverSummit Healthplan,Commercial Exchange,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,SilverSummit Healthplan,Commercial Exchange,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,11575.00000,5590.72000,SilverSummit Healthplan,Commercial Exchange,,10417.50,,,,,,,10417.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,11575.00000,5590.72000,SilverSummit Healthplan,Commercial Exchange,,10417.50,,,,,,,3009.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,13432.00000,6487.66000,SilverSummit Healthplan,Commercial Exchange,,12088.80,,,,,,,12088.80,13029.04,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,13432.00000,6487.66000,SilverSummit Healthplan,Commercial Exchange,,12088.80,,,,,,,3492.32,13029.04,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,21904.00000,10579.63000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,21904.00000,10579.63000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,4397.00000,2123.75000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,7413.00000,3580.48000,SilverSummit Healthplan,Commercial Exchange,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,SilverSummit Healthplan,Commercial Exchange,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,12969.00000,6264.03000,SilverSummit Healthplan,Commercial Exchange,,11672.10,,,,,,,11672.10,12579.93,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,12969.00000,6264.03000,SilverSummit Healthplan,Commercial Exchange,,11672.10,,,,,,,3371.94,12579.93,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,SilverSummit Healthplan,Commercial Exchange,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,SilverSummit Healthplan,Commercial Exchange,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,SilverSummit Healthplan,Commercial Exchange,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,SilverSummit Healthplan,Commercial Exchange,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,inpatient,,,134.00000,64.72000,SilverSummit Healthplan,Commercial Exchange,,120.60,,,,,,,120.60,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,SilverSummit Healthplan,Commercial Exchange,,120.60,,,,,,,34.84,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,inpatient,,,251.00000,121.23000,SilverSummit Healthplan,Commercial Exchange,,225.90,,,,,,,225.90,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,outpatient,,,251.00000,121.23000,SilverSummit Healthplan,Commercial Exchange,,225.90,,,,,,,65.26,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,447.00000,215.90000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,447.00000,215.90000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,2827.00000,1365.44000,SilverSummit Healthplan,Commercial Exchange,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,SilverSummit Healthplan,Commercial Exchange,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,2690.00000,1299.27000,SilverSummit Healthplan,Commercial Exchange,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,SilverSummit Healthplan,Commercial Exchange,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,6487.00000,3133.22000,SilverSummit Healthplan,Commercial Exchange,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,SilverSummit Healthplan,Commercial Exchange,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,2426.00000,1171.76000,SilverSummit Healthplan,Commercial Exchange,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,2426.00000,1171.76000,SilverSummit Healthplan,Commercial Exchange,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,15334.00000,7406.32000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,15334.00000,7406.32000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,SilverSummit Healthplan,Commercial Exchange,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,SilverSummit Healthplan,Commercial Exchange,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,251.00000,121.23000,SilverSummit Healthplan,Commercial Exchange,,225.90,,,,,,,225.90,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,251.00000,121.23000,SilverSummit Healthplan,Commercial Exchange,,225.90,,,,,,,65.26,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,2827.00000,1365.44000,SilverSummit Healthplan,Commercial Exchange,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,SilverSummit Healthplan,Commercial Exchange,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,SilverSummit Healthplan,Commercial Exchange,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,SilverSummit Healthplan,Commercial Exchange,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,inpatient,,,15334.00000,7406.32000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,inpatient,,,1485.00000,717.26000,SilverSummit Healthplan,Commercial Exchange,,1336.50,,,,,,,1336.50,1440.45,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,outpatient,,,1485.00000,717.26000,SilverSummit Healthplan,Commercial Exchange,,1336.50,,,,,,,386.10,1440.45,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,inpatient,,,2028.00000,979.52000,SilverSummit Healthplan,Commercial Exchange,,1825.20,,,,,,,1825.20,1967.16,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,outpatient,,,2028.00000,979.52000,SilverSummit Healthplan,Commercial Exchange,,1825.20,,,,,,,527.28,1967.16,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,4397.00000,2123.75000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,8107.00000,3915.68000,SilverSummit Healthplan,Commercial Exchange,,7296.30,,,,,,,7296.30,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,8107.00000,3915.68000,SilverSummit Healthplan,Commercial Exchange,,7296.30,,,,,,,2107.82,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,10422.00000,5033.83000,SilverSummit Healthplan,Commercial Exchange,,9379.80,,,,,,,9379.80,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,10422.00000,5033.83000,SilverSummit Healthplan,Commercial Exchange,,9379.80,,,,,,,2709.72,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,12737.00000,6151.97000,SilverSummit Healthplan,Commercial Exchange,,11463.30,,,,,,,11463.30,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,12737.00000,6151.97000,SilverSummit Healthplan,Commercial Exchange,,11463.30,,,,,,,3311.62,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,14239.00000,6877.44000,SilverSummit Healthplan,Commercial Exchange,,12815.10,,,,,,,12815.10,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,14239.00000,6877.44000,SilverSummit Healthplan,Commercial Exchange,,12815.10,,,,,,,3702.14,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,16429.00000,7935.21000,SilverSummit Healthplan,Commercial Exchange,,14786.10,,,,,,,14786.10,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,16429.00000,7935.21000,SilverSummit Healthplan,Commercial Exchange,,14786.10,,,,,,,4271.54,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,18619.00000,8992.98000,SilverSummit Healthplan,Commercial Exchange,,16757.10,,,,,,,16757.10,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,18619.00000,8992.98000,SilverSummit Healthplan,Commercial Exchange,,16757.10,,,,,,,4840.94,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,20809.00000,10050.75000,SilverSummit Healthplan,Commercial Exchange,,18728.10,,,,,,,18728.10,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,20809.00000,10050.75000,SilverSummit Healthplan,Commercial Exchange,,18728.10,,,,,,,5410.34,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,22999.00000,11108.52000,SilverSummit Healthplan,Commercial Exchange,,20699.10,,,,,,,20699.10,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,22999.00000,11108.52000,SilverSummit Healthplan,Commercial Exchange,,20699.10,,,,,,,5979.74,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,25189.00000,12166.29000,SilverSummit Healthplan,Commercial Exchange,,22670.10,,,,,,,22670.10,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,25189.00000,12166.29000,SilverSummit Healthplan,Commercial Exchange,,22670.10,,,,,,,6549.14,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,27379.00000,13224.06000,SilverSummit Healthplan,Commercial Exchange,,24641.10,,,,,,,24641.10,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,27379.00000,13224.06000,SilverSummit Healthplan,Commercial Exchange,,24641.10,,,,,,,7118.54,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,29569.00000,14281.83000,SilverSummit Healthplan,Commercial Exchange,,26612.10,,,,,,,26612.10,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,29569.00000,14281.83000,SilverSummit Healthplan,Commercial Exchange,,26612.10,,,,,,,7687.94,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,31759.00000,15339.60000,SilverSummit Healthplan,Commercial Exchange,,28583.10,,,,,,,28583.10,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,31759.00000,15339.60000,SilverSummit Healthplan,Commercial Exchange,,28583.10,,,,,,,8257.34,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,36139.00000,17455.14000,SilverSummit Healthplan,Commercial Exchange,,32525.10,,,,,,,32525.10,35054.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,36139.00000,17455.14000,SilverSummit Healthplan,Commercial Exchange,,32525.10,,,,,,,9396.14,35054.83,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,SilverSummit Healthplan,Commercial Exchange,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,SilverSummit Healthplan,Commercial Exchange,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,SilverSummit Healthplan,Commercial Exchange,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,SilverSummit Healthplan,Commercial Exchange,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,inpatient,,,134.00000,64.72000,SilverSummit Healthplan,Commercial Exchange,,120.60,,,,,,,120.60,129.98,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,SilverSummit Healthplan,Commercial Exchange,,120.60,,,,,,,34.84,129.98,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,SilverSummit Healthplan,Commercial Exchange,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,SilverSummit Healthplan,Commercial Exchange,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,inpatient,,,476.00000,229.91000,SilverSummit Healthplan,Commercial Exchange,,428.40,,,,,,,428.40,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,outpatient,,,476.00000,229.91000,SilverSummit Healthplan,Commercial Exchange,,428.40,,,,,,,123.76,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,SilverSummit Healthplan,Commercial Exchange,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,SilverSummit Healthplan,Commercial Exchange,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,inpatient,,,12506.00000,6040.40000,SilverSummit Healthplan,Commercial Exchange,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,outpatient,,,12506.00000,6040.40000,SilverSummit Healthplan,Commercial Exchange,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,inpatient,,,2404.80000,1161.52000,SilverSummit Healthplan,Commercial Exchange,,2164.32,,,,,,,2164.32,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,outpatient,,,2404.80000,1161.52000,SilverSummit Healthplan,Commercial Exchange,,2164.32,,,,,,,625.25,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,inpatient,,,969.00000,468.03000,SilverSummit Healthplan,Commercial Exchange,,872.10,,,,,,,872.10,939.93,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,outpatient,,,969.00000,468.03000,SilverSummit Healthplan,Commercial Exchange,,872.10,,,,,,,251.94,939.93,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,inpatient,,,2256.90000,1090.08000,SilverSummit Healthplan,Commercial Exchange,,2031.21,,,,,,,2031.21,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,outpatient,,,2256.90000,1090.08000,SilverSummit Healthplan,Commercial Exchange,,2031.21,,,,,,,586.79,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,inpatient,,,644.30000,311.20000,SilverSummit Healthplan,Commercial Exchange,,579.87,,,,,,,579.87,624.97,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,outpatient,,,644.30000,311.20000,SilverSummit Healthplan,Commercial Exchange,,579.87,,,,,,,167.52,624.97,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,SilverSummit Healthplan,Commercial Exchange,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,SilverSummit Healthplan,Commercial Exchange,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,inpatient,,,26284.00000,12695.17000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,inpatient,,,30664.00000,14810.71000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,inpatient,,,35044.00000,16926.25000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,inpatient,,,43804.00000,21157.33000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,outpatient,,,43804.00000,21157.33000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,inpatient,,,52564.00000,25388.41000,SilverSummit Healthplan,Commercial Exchange,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,outpatient,,,52564.00000,25388.41000,SilverSummit Healthplan,Commercial Exchange,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,inpatient,,,61324.00000,29619.49000,SilverSummit Healthplan,Commercial Exchange,,55191.60,,,,,,,55191.60,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,outpatient,,,61324.00000,29619.49000,SilverSummit Healthplan,Commercial Exchange,,55191.60,,,,,,,15944.24,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,inpatient,,,70084.00000,33850.57000,SilverSummit Healthplan,Commercial Exchange,,63075.60,,,,,,,63075.60,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,outpatient,,,70084.00000,33850.57000,SilverSummit Healthplan,Commercial Exchange,,63075.60,,,,,,,18221.84,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,inpatient,,,78844.00000,38081.65000,SilverSummit Healthplan,Commercial Exchange,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,outpatient,,,78844.00000,38081.65000,SilverSummit Healthplan,Commercial Exchange,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,inpatient,,,87604.00000,42312.73000,SilverSummit Healthplan,Commercial Exchange,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,outpatient,,,87604.00000,42312.73000,SilverSummit Healthplan,Commercial Exchange,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,inpatient,,,96364.00000,46543.81000,SilverSummit Healthplan,Commercial Exchange,,86727.60,,,,,,,86727.60,93473.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,outpatient,,,96364.00000,46543.81000,SilverSummit Healthplan,Commercial Exchange,,86727.60,,,,,,,25054.64,93473.08,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,inpatient,,,26284.00000,12695.17000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,inpatient,,,30664.00000,14810.71000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,inpatient,,,35044.00000,16926.25000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,inpatient,,,39424.00000,19041.79000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,outpatient,,,39424.00000,19041.79000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,SilverSummit Healthplan,Commercial Exchange,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,SilverSummit Healthplan,Commercial Exchange,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,SilverSummit Healthplan,Commercial Exchange,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,SilverSummit Healthplan,Commercial Exchange,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,inpatient,,,15334.00000,7406.32000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,2023.00000,977.11000,SilverSummit Healthplan,Commercial Exchange,,1820.70,,,,,,,1820.70,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2023.00000,977.11000,SilverSummit Healthplan,Commercial Exchange,,1820.70,,,,,,,525.98,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,inpatient,,,7876.00000,3804.11000,SilverSummit Healthplan,Commercial Exchange,,7088.40,,,,,,,7088.40,7639.72,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,SilverSummit Healthplan,Commercial Exchange,,7088.40,,,,,,,2047.76,7639.72,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,inpatient,,,10191.00000,4922.25000,SilverSummit Healthplan,Commercial Exchange,,9171.90,,,,,,,9171.90,9885.27,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,outpatient,,,10191.00000,4922.25000,SilverSummit Healthplan,Commercial Exchange,,9171.90,,,,,,,2649.66,9885.27,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,96.00000,46.37000,SilverSummit Healthplan,Commercial Exchange,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,96.00000,46.37000,SilverSummit Healthplan,Commercial Exchange,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,7876.00000,3804.11000,SilverSummit Healthplan,Commercial Exchange,,7088.40,,,,,,,7088.40,7639.72,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,7876.00000,3804.11000,SilverSummit Healthplan,Commercial Exchange,,7088.40,,,,,,,2047.76,7639.72,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,SilverSummit Healthplan,Commercial Exchange,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,SilverSummit Healthplan,Commercial Exchange,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,inpatient,,,5373.00000,2595.16000,SilverSummit Healthplan,Commercial Exchange,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,outpatient,,,5373.00000,2595.16000,SilverSummit Healthplan,Commercial Exchange,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,inpatient,,,6487.00000,3133.22000,SilverSummit Healthplan,Commercial Exchange,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,outpatient,,,6487.00000,3133.22000,SilverSummit Healthplan,Commercial Exchange,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,inpatient,,,7876.00000,3804.11000,SilverSummit Healthplan,Commercial Exchange,,7088.40,,,,,,,7088.40,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,SilverSummit Healthplan,Commercial Exchange,,7088.40,,,,,,,2047.76,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,inpatient,,,1126.00000,543.86000,SilverSummit Healthplan,Commercial Exchange,,1013.40,,,,,,,1013.40,1092.22,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,outpatient,,,1126.00000,543.86000,SilverSummit Healthplan,Commercial Exchange,,1013.40,,,,,,,292.76,1092.22,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,2690.00000,1299.27000,SilverSummit Healthplan,Commercial Exchange,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,SilverSummit Healthplan,Commercial Exchange,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,4880.00000,2357.04000,SilverSummit Healthplan,Commercial Exchange,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,4880.00000,2357.04000,SilverSummit Healthplan,Commercial Exchange,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,9260.00000,4472.58000,SilverSummit Healthplan,Commercial Exchange,,8334.00,,,,,,,8334.00,8982.20,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,9260.00000,4472.58000,SilverSummit Healthplan,Commercial Exchange,,8334.00,,,,,,,2407.60,8982.20,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,inpatient,,,588.00000,284.00000,SilverSummit Healthplan,Commercial Exchange,,529.20,,,,,,,529.20,570.36,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,588.00000,284.00000,SilverSummit Healthplan,Commercial Exchange,,529.20,,,,,,,152.88,570.36,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,SilverSummit Healthplan,Commercial Exchange,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,SilverSummit Healthplan,Commercial Exchange,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,SilverSummit Healthplan,Commercial Exchange,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,SilverSummit Healthplan,Commercial Exchange,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,SilverSummit Healthplan,Commercial Exchange,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,SilverSummit Healthplan,Commercial Exchange,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,SilverSummit Healthplan,Commercial Exchange,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,SilverSummit Healthplan,Commercial Exchange,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,SilverSummit Healthplan,Commercial Exchange,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,SilverSummit Healthplan,Commercial Exchange,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,inpatient,,,159.00000,76.80000,SilverSummit Healthplan,Commercial Exchange,,143.10,,,,,,,143.10,154.23,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,outpatient,,,159.00000,76.80000,SilverSummit Healthplan,Commercial Exchange,,143.10,,,,,,,41.34,154.23,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,inpatient,,,588.00000,284.00000,SilverSummit Healthplan,Commercial Exchange,,529.20,,,,,,,529.20,570.36,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,outpatient,,,588.00000,284.00000,SilverSummit Healthplan,Commercial Exchange,,529.20,,,,,,,152.88,570.36,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,SilverSummit Healthplan,Commercial Exchange,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,SilverSummit Healthplan,Commercial Exchange,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,inpatient,,,8107.00000,3915.68000,SilverSummit Healthplan,Commercial Exchange,,7296.30,,,,,,,7296.30,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,outpatient,,,8107.00000,3915.68000,SilverSummit Healthplan,Commercial Exchange,,7296.30,,,,,,,2107.82,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,inpatient,,,10422.00000,5033.83000,SilverSummit Healthplan,Commercial Exchange,,9379.80,,,,,,,9379.80,10109.34,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,outpatient,,,10422.00000,5033.83000,SilverSummit Healthplan,Commercial Exchange,,9379.80,,,,,,,2709.72,10109.34,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,inpatient,,,221.00000,106.74000,SilverSummit Healthplan,Commercial Exchange,,198.90,,,,,,,198.90,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,outpatient,,,221.00000,106.74000,SilverSummit Healthplan,Commercial Exchange,,198.90,,,,,,,57.46,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,SilverSummit Healthplan,Commercial Exchange,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,SilverSummit Healthplan,Commercial Exchange,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,SilverSummit Healthplan,Commercial Exchange,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,SilverSummit Healthplan,Commercial Exchange,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,inpatient,,,4153.00000,2005.90000,SilverSummit Healthplan,Commercial Exchange,,3737.70,,,,,,,3737.70,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,outpatient,,,4153.00000,2005.90000,SilverSummit Healthplan,Commercial Exchange,,3737.70,,,,,,,1079.78,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,inpatient,,,5129.00000,2477.31000,SilverSummit Healthplan,Commercial Exchange,,4616.10,,,,,,,4616.10,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,outpatient,,,5129.00000,2477.31000,SilverSummit Healthplan,Commercial Exchange,,4616.10,,,,,,,1333.54,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,inpatient,,,7181.00000,3468.42000,SilverSummit Healthplan,Commercial Exchange,,6462.90,,,,,,,6462.90,6965.57,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,SilverSummit Healthplan,Commercial Exchange,,6462.90,,,,,,,1867.06,6965.57,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,inpatient,,,52.50000,25.36000,SilverSummit Healthplan,Commercial Exchange,,47.25,,,,,,,47.25,50.92,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,outpatient,,,52.50000,25.36000,SilverSummit Healthplan,Commercial Exchange,,47.25,,,,,,,13.65,50.92,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,inpatient,,,50.40000,24.34000,SilverSummit Healthplan,Commercial Exchange,,45.36,,,,,,,45.36,48.89,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,outpatient,,,50.40000,24.34000,SilverSummit Healthplan,Commercial Exchange,,45.36,,,,,,,13.10,48.89,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,SilverSummit Healthplan,Commercial Exchange,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,SilverSummit Healthplan,Commercial Exchange,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,SilverSummit Healthplan,Commercial Exchange,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,SilverSummit Healthplan,Commercial Exchange,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,SilverSummit Healthplan,Commercial Exchange,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,SilverSummit Healthplan,Commercial Exchange,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,inpatient,,,709.00000,342.45000,SilverSummit Healthplan,Commercial Exchange,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,outpatient,,,709.00000,342.45000,SilverSummit Healthplan,Commercial Exchange,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,SilverSummit Healthplan,Commercial Exchange,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,SilverSummit Healthplan,Commercial Exchange,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,109504.00000,62214.70000,SilverSummit Healthplan,Commercial Exchange,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,SilverSummit Healthplan,Commercial Exchange,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,131404.00000,74657.18000,SilverSummit Healthplan,Commercial Exchange,,118263.60,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,131404.00000,74657.18000,SilverSummit Healthplan,Commercial Exchange,,118263.60,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,43800.00000,24884.97000,SilverSummit Healthplan,Commercial Exchange,,39420.00,,,,,,,39420.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,43800.00000,24884.97000,SilverSummit Healthplan,Commercial Exchange,,39420.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,SilverSummit Healthplan,Commercial Exchange,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,SilverSummit Healthplan,Commercial Exchange,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,19714.00000,11200.51000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,24090.00000,13686.73000,SilverSummit Healthplan,Commercial Exchange,,21681.00,,,,,,,21681.00,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,24090.00000,13686.73000,SilverSummit Healthplan,Commercial Exchange,,21681.00,,,,,,,6263.40,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,28474.00000,16177.50000,SilverSummit Healthplan,Commercial Exchange,,25626.60,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,SilverSummit Healthplan,Commercial Exchange,,25626.60,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,17520.00000,9953.99000,SilverSummit Healthplan,Commercial Exchange,,15768.00,,,,,,,15768.00,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,SilverSummit Healthplan,Commercial Exchange,,15768.00,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,21904.00000,12444.76000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,26284.00000,14933.25000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,43804.00000,24887.24000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,SilverSummit Healthplan,Commercial Exchange,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,SilverSummit Healthplan,Commercial Exchange,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,109504.00000,62214.70000,SilverSummit Healthplan,Commercial Exchange,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,SilverSummit Healthplan,Commercial Exchange,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,6105.00000,3468.56000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,6105.00000,3468.56000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,13895.00000,7894.44000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,13895.00000,7894.44000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,21900.00000,12442.48000,SilverSummit Healthplan,Commercial Exchange,,19710.00,,,,,,,19710.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,21900.00000,12442.48000,SilverSummit Healthplan,Commercial Exchange,,19710.00,,,,,,,5694.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,35040.00000,19907.98000,SilverSummit Healthplan,Commercial Exchange,,31536.00,,,,,,,31536.00,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,35040.00000,19907.98000,SilverSummit Healthplan,Commercial Exchange,,31536.00,,,,,,,9110.40,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,43804.00000,24887.24000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,19714.00000,11200.51000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,22776.00000,12940.18000,SilverSummit Healthplan,Commercial Exchange,,20498.40,,,,,,,20498.40,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,22776.00000,12940.18000,SilverSummit Healthplan,Commercial Exchange,,20498.40,,,,,,,5921.76,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,28474.00000,16177.50000,SilverSummit Healthplan,Commercial Exchange,,25626.60,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,SilverSummit Healthplan,Commercial Exchange,,25626.60,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,17520.00000,9953.99000,SilverSummit Healthplan,Commercial Exchange,,15768.00,,,,,,,15768.00,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,SilverSummit Healthplan,Commercial Exchange,,15768.00,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,21904.00000,12444.76000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,26284.00000,14933.25000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,30664.00000,17421.75000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,30664.00000,17421.75000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,35044.00000,19910.25000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,35044.00000,19910.25000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,594.00000,238.19000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,594.00000,238.19000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,2157.00000,864.96000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,594.00000,238.19000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,594.00000,238.19000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,2157.00000,864.96000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,2695.00000,1080.70000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2695.00000,1080.70000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,3853.00000,1545.05000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,3853.00000,1545.05000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,inpatient,,,1413.00000,566.61000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,outpatient,,,1413.00000,566.61000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,inpatient,,,594.00000,238.19000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,594.00000,238.19000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,3229.80000,1857.14000,SilverSummit Healthplan,Commercial Exchange,,2906.82,,,,,,,2906.82,3132.91,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,3229.80000,1857.14000,SilverSummit Healthplan,Commercial Exchange,,2906.82,,,,,,,839.75,3132.91,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,854.40000,491.28000,SilverSummit Healthplan,Commercial Exchange,,768.96,,,,,,,768.96,828.77,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,854.40000,491.28000,SilverSummit Healthplan,Commercial Exchange,,768.96,,,,,,,222.14,828.77,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1200.50000,690.29000,SilverSummit Healthplan,Commercial Exchange,,1080.45,,,,,,,1080.45,1164.48,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1200.50000,690.29000,SilverSummit Healthplan,Commercial Exchange,,1080.45,,,,,,,312.13,1164.48,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1011.00000,581.32000,SilverSummit Healthplan,Commercial Exchange,,909.90,,,,,,,909.90,980.67,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1011.00000,581.32000,SilverSummit Healthplan,Commercial Exchange,,909.90,,,,,,,262.86,980.67,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1823.80000,1048.68000,SilverSummit Healthplan,Commercial Exchange,,1641.42,,,,,,,1641.42,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1823.80000,1048.68000,SilverSummit Healthplan,Commercial Exchange,,1641.42,,,,,,,474.19,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2028.50000,1166.39000,SilverSummit Healthplan,Commercial Exchange,,1825.65,,,,,,,1825.65,1967.64,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2028.50000,1166.39000,SilverSummit Healthplan,Commercial Exchange,,1825.65,,,,,,,527.41,1967.64,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,841.00000,483.58000,SilverSummit Healthplan,Commercial Exchange,,756.90,,,,,,,756.90,815.77,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,841.00000,483.58000,SilverSummit Healthplan,Commercial Exchange,,756.90,,,,,,,218.66,815.77,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1366.20000,785.56000,SilverSummit Healthplan,Commercial Exchange,,1229.58,,,,,,,1229.58,1325.21,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1366.20000,785.56000,SilverSummit Healthplan,Commercial Exchange,,1229.58,,,,,,,355.21,1325.21,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1384.00000,795.80000,SilverSummit Healthplan,Commercial Exchange,,1245.60,,,,,,,1245.60,1342.48,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1384.00000,795.80000,SilverSummit Healthplan,Commercial Exchange,,1245.60,,,,,,,359.84,1342.48,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2458.70000,1413.75000,SilverSummit Healthplan,Commercial Exchange,,2212.83,,,,,,,2212.83,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2458.70000,1413.75000,SilverSummit Healthplan,Commercial Exchange,,2212.83,,,,,,,639.26,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2393.50000,1376.26000,SilverSummit Healthplan,Commercial Exchange,,2154.15,,,,,,,2154.15,2321.70,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2393.50000,1376.26000,SilverSummit Healthplan,Commercial Exchange,,2154.15,,,,,,,622.31,2321.70,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1369.50000,787.46000,SilverSummit Healthplan,Commercial Exchange,,1232.55,,,,,,,1232.55,1328.41,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1369.50000,787.46000,SilverSummit Healthplan,Commercial Exchange,,1232.55,,,,,,,356.07,1328.41,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2697.40000,1551.00000,SilverSummit Healthplan,Commercial Exchange,,2427.66,,,,,,,2427.66,2616.48,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2697.40000,1551.00000,SilverSummit Healthplan,Commercial Exchange,,2427.66,,,,,,,701.32,2616.48,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4621.80000,2657.54000,SilverSummit Healthplan,Commercial Exchange,,4159.62,,,,,,,4159.62,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4621.80000,2657.54000,SilverSummit Healthplan,Commercial Exchange,,4159.62,,,,,,,1201.67,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2592.50000,1490.69000,SilverSummit Healthplan,Commercial Exchange,,2333.25,,,,,,,2333.25,2514.72,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2592.50000,1490.69000,SilverSummit Healthplan,Commercial Exchange,,2333.25,,,,,,,674.05,2514.72,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,SilverSummit Healthplan,Commercial Exchange,,7505.10,,,,,,,7505.10,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,SilverSummit Healthplan,Commercial Exchange,,7505.10,,,,,,,2168.14,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,8107.00000,4661.52000,SilverSummit Healthplan,Commercial Exchange,,7296.30,,,,,,,7296.30,7863.79,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,SilverSummit Healthplan,Commercial Exchange,,7296.30,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,SilverSummit Healthplan,Commercial Exchange,,1013.40,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,SilverSummit Healthplan,Commercial Exchange,,1013.40,,,,,,,292.76,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,SilverSummit Healthplan,Commercial Exchange,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,SilverSummit Healthplan,Commercial Exchange,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,inpatient,,,20152.00000,11587.40000,SilverSummit Healthplan,Commercial Exchange,,18136.80,,,,,,,18136.80,19547.44,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,outpatient,,,20152.00000,11587.40000,SilverSummit Healthplan,Commercial Exchange,,18136.80,,,,,,,5239.52,19547.44,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,166.00000,95.45000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,166.00000,95.45000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,447.00000,257.02000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,447.00000,257.02000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,709.00000,407.67000,SilverSummit Healthplan,Commercial Exchange,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,709.00000,407.67000,SilverSummit Healthplan,Commercial Exchange,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,1272.00000,731.40000,SilverSummit Healthplan,Commercial Exchange,,1144.80,,,,,,,1144.80,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,1272.00000,731.40000,SilverSummit Healthplan,Commercial Exchange,,1144.80,,,,,,,330.72,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,SilverSummit Healthplan,Commercial Exchange,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,SilverSummit Healthplan,Commercial Exchange,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,3078.00000,1769.85000,SilverSummit Healthplan,Commercial Exchange,,2770.20,,,,,,,2770.20,2985.66,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,3078.00000,1769.85000,SilverSummit Healthplan,Commercial Exchange,,2770.20,,,,,,,800.28,2985.66,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,70.00000,40.25000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,70.00000,40.25000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,102.00000,58.65000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,102.00000,58.65000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,166.00000,95.45000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,221.00000,127.07000,SilverSummit Healthplan,Commercial Exchange,,198.90,,,,,,,198.90,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,221.00000,127.07000,SilverSummit Healthplan,Commercial Exchange,,198.90,,,,,,,57.46,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,447.00000,257.02000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,709.00000,407.67000,SilverSummit Healthplan,Commercial Exchange,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,SilverSummit Healthplan,Commercial Exchange,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,SilverSummit Healthplan,Commercial Exchange,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,SilverSummit Healthplan,Commercial Exchange,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35482.00000,20402.15000,SilverSummit Healthplan,Commercial Exchange,,31933.80,,,,,,,31933.80,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35482.00000,20402.15000,SilverSummit Healthplan,Commercial Exchange,,31933.80,,,,,,,9225.32,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39862.00000,22920.65000,SilverSummit Healthplan,Commercial Exchange,,35875.80,,,,,,,35875.80,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39862.00000,22920.65000,SilverSummit Healthplan,Commercial Exchange,,35875.80,,,,,,,10364.12,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,44242.00000,25439.15000,SilverSummit Healthplan,Commercial Exchange,,39817.80,,,,,,,39817.80,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,44242.00000,25439.15000,SilverSummit Healthplan,Commercial Exchange,,39817.80,,,,,,,11502.92,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,48622.00000,27957.65000,SilverSummit Healthplan,Commercial Exchange,,43759.80,,,,,,,43759.80,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,48622.00000,27957.65000,SilverSummit Healthplan,Commercial Exchange,,43759.80,,,,,,,12641.72,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,53002.00000,30476.15000,SilverSummit Healthplan,Commercial Exchange,,47701.80,,,,,,,47701.80,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,53002.00000,30476.15000,SilverSummit Healthplan,Commercial Exchange,,47701.80,,,,,,,13780.52,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,SilverSummit Healthplan,Commercial Exchange,,55191.60,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,SilverSummit Healthplan,Commercial Exchange,,55191.60,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,SilverSummit Healthplan,Commercial Exchange,,63075.60,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,SilverSummit Healthplan,Commercial Exchange,,63075.60,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,SilverSummit Healthplan,Commercial Exchange,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,SilverSummit Healthplan,Commercial Exchange,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,SilverSummit Healthplan,Commercial Exchange,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,SilverSummit Healthplan,Commercial Exchange,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,SilverSummit Healthplan,Commercial Exchange,,86727.60,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,SilverSummit Healthplan,Commercial Exchange,,86727.60,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,844.00000,485.30000,SilverSummit Healthplan,Commercial Exchange,,759.60,,,,,,,759.60,818.68,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,844.00000,485.30000,SilverSummit Healthplan,Commercial Exchange,,759.60,,,,,,,219.44,818.68,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,11575.00000,6655.62000,SilverSummit Healthplan,Commercial Exchange,,10417.50,,,,,,,10417.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,11575.00000,6655.62000,SilverSummit Healthplan,Commercial Exchange,,10417.50,,,,,,,3009.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,14892.00000,8562.90000,SilverSummit Healthplan,Commercial Exchange,,13402.80,,,,,,,13402.80,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14892.00000,8562.90000,SilverSummit Healthplan,Commercial Exchange,,13402.80,,,,,,,3871.92,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,24970.00000,14357.75000,SilverSummit Healthplan,Commercial Exchange,,22473.00,,,,,,,22473.00,24220.90,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,24970.00000,14357.75000,SilverSummit Healthplan,Commercial Exchange,,22473.00,,,,,,,6492.20,24220.90,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,166.00000,95.45000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,166.00000,95.45000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,447.00000,257.02000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,447.00000,257.02000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,SilverSummit Healthplan,Commercial Exchange,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,SilverSummit Healthplan,Commercial Exchange,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,4153.00000,2387.98000,SilverSummit Healthplan,Commercial Exchange,,3737.70,,,,,,,3737.70,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,SilverSummit Healthplan,Commercial Exchange,,3737.70,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,4641.00000,2668.58000,SilverSummit Healthplan,Commercial Exchange,,4176.90,,,,,,,4176.90,4501.77,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4641.00000,2668.58000,SilverSummit Healthplan,Commercial Exchange,,4176.90,,,,,,,1206.66,4501.77,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,SilverSummit Healthplan,Commercial Exchange,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,SilverSummit Healthplan,Commercial Exchange,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,SilverSummit Healthplan,Commercial Exchange,,86727.60,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,SilverSummit Healthplan,Commercial Exchange,,86727.60,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,SilverSummit Healthplan,Commercial Exchange,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,SilverSummit Healthplan,Commercial Exchange,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,131404.00000,75557.30000,SilverSummit Healthplan,Commercial Exchange,,118263.60,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,SilverSummit Healthplan,Commercial Exchange,,118263.60,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,153304.00000,88149.80000,SilverSummit Healthplan,Commercial Exchange,,137973.60,,,,,,,137973.60,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,153304.00000,88149.80000,SilverSummit Healthplan,Commercial Exchange,,137973.60,,,,,,,39859.04,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,175204.00000,100742.30000,SilverSummit Healthplan,Commercial Exchange,,157683.60,,,,,,,157683.60,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,175204.00000,100742.30000,SilverSummit Healthplan,Commercial Exchange,,157683.60,,,,,,,45553.04,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,197104.00000,113334.80000,SilverSummit Healthplan,Commercial Exchange,,177393.60,,,,,,,177393.60,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,197104.00000,113334.80000,SilverSummit Healthplan,Commercial Exchange,,177393.60,,,,,,,51247.04,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,219004.00000,125927.30000,SilverSummit Healthplan,Commercial Exchange,,197103.60,,,,,,,197103.60,212433.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,219004.00000,125927.30000,SilverSummit Healthplan,Commercial Exchange,,197103.60,,,,,,,56941.04,212433.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,SilverSummit Healthplan,Commercial Exchange,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,SilverSummit Healthplan,Commercial Exchange,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Commercial Exchange,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Commercial Exchange,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,SilverSummit Healthplan,Commercial Exchange,,51249.60,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,SilverSummit Healthplan,Commercial Exchange,,51249.60,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,SilverSummit Healthplan,Commercial Exchange,,55191.60,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,SilverSummit Healthplan,Commercial Exchange,,55191.60,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Commercial Exchange,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Commercial Exchange,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,SilverSummit Healthplan,Commercial Exchange,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,SilverSummit Healthplan,Commercial Exchange,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,SilverSummit Healthplan,Commercial Exchange,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,SilverSummit Healthplan,Commercial Exchange,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,SilverSummit Healthplan,Commercial Exchange,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,SilverSummit Healthplan,Commercial Exchange,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,SilverSummit Healthplan,Commercial Exchange,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,SilverSummit Healthplan,Commercial Exchange,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Commercial Exchange,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Commercial Exchange,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,SilverSummit Healthplan,Commercial Exchange,,51249.60,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,SilverSummit Healthplan,Commercial Exchange,,51249.60,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,SilverSummit Healthplan,Commercial Exchange,,55191.60,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,SilverSummit Healthplan,Commercial Exchange,,55191.60,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,SilverSummit Healthplan,Commercial Exchange,,63075.60,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,SilverSummit Healthplan,Commercial Exchange,,63075.60,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,SilverSummit Healthplan,Commercial Exchange,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,SilverSummit Healthplan,Commercial Exchange,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,SilverSummit Healthplan,Commercial Exchange,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,SilverSummit Healthplan,Commercial Exchange,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,SilverSummit Healthplan,Commercial Exchange,,86727.60,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,SilverSummit Healthplan,Commercial Exchange,,86727.60,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,SilverSummit Healthplan,Commercial Exchange,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,SilverSummit Healthplan,Commercial Exchange,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,122644.00000,70520.30000,SilverSummit Healthplan,Commercial Exchange,,110379.60,,,,,,,110379.60,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,SilverSummit Healthplan,Commercial Exchange,,110379.60,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,135784.00000,78075.80000,SilverSummit Healthplan,Commercial Exchange,,122205.60,,,,,,,122205.60,131710.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,135784.00000,78075.80000,SilverSummit Healthplan,Commercial Exchange,,122205.60,,,,,,,35303.84,131710.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,SilverSummit Healthplan,Commercial Exchange,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,SilverSummit Healthplan,Commercial Exchange,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,55630.00000,31987.25000,SilverSummit Healthplan,Commercial Exchange,,50067.00,,,,,,,50067.00,53961.10,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,55630.00000,31987.25000,SilverSummit Healthplan,Commercial Exchange,,50067.00,,,,,,,14463.80,53961.10,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,SilverSummit Healthplan,Commercial Exchange,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,SilverSummit Healthplan,Commercial Exchange,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,14020.00000,8061.50000,SilverSummit Healthplan,Commercial Exchange,,12618.00,,,,,,,12618.00,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,SilverSummit Healthplan,Commercial Exchange,,12618.00,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,17962.00000,10328.15000,SilverSummit Healthplan,Commercial Exchange,,16165.80,,,,,,,16165.80,17423.14,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,17962.00000,10328.15000,SilverSummit Healthplan,Commercial Exchange,,16165.80,,,,,,,4670.12,17423.14,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,2421.00000,1392.07000,SilverSummit Healthplan,Commercial Exchange,,2178.90,,,,,,,2178.90,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,2421.00000,1392.07000,SilverSummit Healthplan,Commercial Exchange,,2178.90,,,,,,,629.46,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,SilverSummit Healthplan,Commercial Exchange,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,SilverSummit Healthplan,Commercial Exchange,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,SilverSummit Healthplan,Commercial Exchange,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,SilverSummit Healthplan,Commercial Exchange,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,27160.00000,15617.00000,SilverSummit Healthplan,Commercial Exchange,,24444.00,,,,,,,24444.00,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,27160.00000,15617.00000,SilverSummit Healthplan,Commercial Exchange,,24444.00,,,,,,,7061.60,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,SilverSummit Healthplan,Commercial Exchange,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,SilverSummit Healthplan,Commercial Exchange,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Commercial Exchange,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Commercial Exchange,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,SilverSummit Healthplan,Commercial Exchange,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,SilverSummit Healthplan,Commercial Exchange,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,28470.00000,16370.25000,SilverSummit Healthplan,Commercial Exchange,,25623.00,,,,,,,25623.00,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,28470.00000,16370.25000,SilverSummit Healthplan,Commercial Exchange,,25623.00,,,,,,,7402.20,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,43800.00000,25185.00000,SilverSummit Healthplan,Commercial Exchange,,39420.00,,,,,,,39420.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,43800.00000,25185.00000,SilverSummit Healthplan,Commercial Exchange,,39420.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,SilverSummit Healthplan,Commercial Exchange,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,SilverSummit Healthplan,Commercial Exchange,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,SilverSummit Healthplan,Commercial Exchange,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,SilverSummit Healthplan,Commercial Exchange,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,SilverSummit Healthplan,Commercial Exchange,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,SilverSummit Healthplan,Commercial Exchange,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,SilverSummit Healthplan,Commercial Exchange,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,SilverSummit Healthplan,Commercial Exchange,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,54754.00000,31483.55000,SilverSummit Healthplan,Commercial Exchange,,49278.60,,,,,,,49278.60,53111.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,54754.00000,31483.55000,SilverSummit Healthplan,Commercial Exchange,,49278.60,,,,,,,14236.04,53111.38,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,SilverSummit Healthplan,Commercial Exchange,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,SilverSummit Healthplan,Commercial Exchange,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,61320.00000,35259.00000,SilverSummit Healthplan,Commercial Exchange,,55188.00,,,,,,,55188.00,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,61320.00000,35259.00000,SilverSummit Healthplan,Commercial Exchange,,55188.00,,,,,,,15943.20,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,70080.00000,40296.00000,SilverSummit Healthplan,Commercial Exchange,,63072.00,,,,,,,63072.00,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,70080.00000,40296.00000,SilverSummit Healthplan,Commercial Exchange,,63072.00,,,,,,,18220.80,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,78840.00000,45333.00000,SilverSummit Healthplan,Commercial Exchange,,70956.00,,,,,,,70956.00,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,78840.00000,45333.00000,SilverSummit Healthplan,Commercial Exchange,,70956.00,,,,,,,20498.40,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,SilverSummit Healthplan,Commercial Exchange,,86727.60,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,SilverSummit Healthplan,Commercial Exchange,,86727.60,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,SilverSummit Healthplan,Commercial Exchange,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,SilverSummit Healthplan,Commercial Exchange,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,122644.00000,70520.30000,SilverSummit Healthplan,Commercial Exchange,,110379.60,,,,,,,110379.60,118964.68,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,SilverSummit Healthplan,Commercial Exchange,,110379.60,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,SilverSummit Healthplan,Commercial Exchange,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,SilverSummit Healthplan,Commercial Exchange,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,SilverSummit Healthplan,Commercial Exchange,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,SilverSummit Healthplan,Commercial Exchange,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,166.00000,95.45000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,166.00000,95.45000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,1883.00000,1082.72000,SilverSummit Healthplan,Commercial Exchange,,1694.70,,,,,,,1694.70,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1883.00000,1082.72000,SilverSummit Healthplan,Commercial Exchange,,1694.70,,,,,,,489.58,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,SilverSummit Healthplan,Commercial Exchange,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,SilverSummit Healthplan,Commercial Exchange,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,7644.00000,4395.30000,SilverSummit Healthplan,Commercial Exchange,,6879.60,,,,,,,6879.60,7414.68,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,7644.00000,4395.30000,SilverSummit Healthplan,Commercial Exchange,,6879.60,,,,,,,1987.44,7414.68,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,SilverSummit Healthplan,Commercial Exchange,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,SilverSummit Healthplan,Commercial Exchange,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,inpatient,,,1614.00000,928.05000,SilverSummit Healthplan,Commercial Exchange,,1452.60,,,,,,,1452.60,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,SilverSummit Healthplan,Commercial Exchange,,1452.60,,,,,,,419.64,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,SilverSummit Healthplan,Commercial Exchange,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,SilverSummit Healthplan,Commercial Exchange,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,SilverSummit Healthplan,Commercial Exchange,,25626.60,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,SilverSummit Healthplan,Commercial Exchange,,25626.60,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,SilverSummit Healthplan,Commercial Exchange,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,SilverSummit Healthplan,Commercial Exchange,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,37234.00000,21409.55000,SilverSummit Healthplan,Commercial Exchange,,33510.60,,,,,,,33510.60,36116.98,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,37234.00000,21409.55000,SilverSummit Healthplan,Commercial Exchange,,33510.60,,,,,,,9680.84,36116.98,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Commercial Exchange,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Commercial Exchange,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,SilverSummit Healthplan,Commercial Exchange,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,SilverSummit Healthplan,Commercial Exchange,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,159.00000,91.42000,SilverSummit Healthplan,Commercial Exchange,,143.10,,,,,,,143.10,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,159.00000,91.42000,SilverSummit Healthplan,Commercial Exchange,,143.10,,,,,,,41.34,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,SilverSummit Healthplan,Commercial Exchange,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,SilverSummit Healthplan,Commercial Exchange,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2827.00000,1625.52000,SilverSummit Healthplan,Commercial Exchange,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,SilverSummit Healthplan,Commercial Exchange,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,SilverSummit Healthplan,Commercial Exchange,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,SilverSummit Healthplan,Commercial Exchange,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8107.00000,4661.52000,SilverSummit Healthplan,Commercial Exchange,,7296.30,,,,,,,7296.30,7863.79,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,SilverSummit Healthplan,Commercial Exchange,,7296.30,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,SilverSummit Healthplan,Commercial Exchange,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,SilverSummit Healthplan,Commercial Exchange,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,SilverSummit Healthplan,Commercial Exchange,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,SilverSummit Healthplan,Commercial Exchange,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,131404.00000,75557.30000,SilverSummit Healthplan,Commercial Exchange,,118263.60,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,SilverSummit Healthplan,Commercial Exchange,,118263.60,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,18400.00000,10580.00000,SilverSummit Healthplan,Commercial Exchange,,16560.00,,,,,,,16560.00,17848.00,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,18400.00000,10580.00000,SilverSummit Healthplan,Commercial Exchange,,16560.00,,,,,,,4784.00,17848.00,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,SilverSummit Healthplan,Commercial Exchange,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,SilverSummit Healthplan,Commercial Exchange,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,SilverSummit Healthplan,Commercial Exchange,,25626.60,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,SilverSummit Healthplan,Commercial Exchange,,25626.60,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,SilverSummit Healthplan,Commercial Exchange,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,SilverSummit Healthplan,Commercial Exchange,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1614.00000,928.05000,SilverSummit Healthplan,Commercial Exchange,,1452.60,,,,,,,1452.60,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,SilverSummit Healthplan,Commercial Exchange,,1452.60,,,,,,,419.64,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,SilverSummit Healthplan,Commercial Exchange,,51249.60,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,SilverSummit Healthplan,Commercial Exchange,,51249.60,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,5368.00000,3086.60000,SilverSummit Healthplan,Commercial Exchange,,4831.20,,,,,,,4831.20,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,5368.00000,3086.60000,SilverSummit Healthplan,Commercial Exchange,,4831.20,,,,,,,1395.68,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,14020.00000,8061.50000,SilverSummit Healthplan,Commercial Exchange,,12618.00,,,,,,,12618.00,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,SilverSummit Healthplan,Commercial Exchange,,12618.00,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,25408.00000,14609.60000,SilverSummit Healthplan,Commercial Exchange,,22867.20,,,,,,,22867.20,24645.76,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,25408.00000,14609.60000,SilverSummit Healthplan,Commercial Exchange,,22867.20,,,,,,,6606.08,24645.76,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,8112.00000,4664.40000,SilverSummit Healthplan,Commercial Exchange,,7300.80,,,,,,,7300.80,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,8112.00000,4664.40000,SilverSummit Healthplan,Commercial Exchange,,7300.80,,,,,,,2109.12,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,10431.00000,5997.82000,SilverSummit Healthplan,Commercial Exchange,,9387.90,,,,,,,9387.90,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,10431.00000,5997.82000,SilverSummit Healthplan,Commercial Exchange,,9387.90,,,,,,,2712.06,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,SilverSummit Healthplan,Commercial Exchange,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,SilverSummit Healthplan,Commercial Exchange,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,46870.00000,26950.25000,SilverSummit Healthplan,Commercial Exchange,,42183.00,,,,,,,42183.00,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,46870.00000,26950.25000,SilverSummit Healthplan,Commercial Exchange,,42183.00,,,,,,,12186.20,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,51250.00000,29468.75000,SilverSummit Healthplan,Commercial Exchange,,46125.00,,,,,,,46125.00,49712.50,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,51250.00000,29468.75000,SilverSummit Healthplan,Commercial Exchange,,46125.00,,,,,,,13325.00,49712.50,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Commercial Exchange,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Commercial Exchange,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,SilverSummit Healthplan,Commercial Exchange,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,SilverSummit Healthplan,Commercial Exchange,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,SilverSummit Healthplan,Commercial Exchange,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,SilverSummit Healthplan,Commercial Exchange,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,166.00000,95.45000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,166.00000,95.45000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,588.00000,338.10000,SilverSummit Healthplan,Commercial Exchange,,529.20,,,,,,,529.20,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,588.00000,338.10000,SilverSummit Healthplan,Commercial Exchange,,529.20,,,,,,,152.88,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,SilverSummit Healthplan,Commercial Exchange,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,SilverSummit Healthplan,Commercial Exchange,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Commercial Exchange,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Commercial Exchange,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,SilverSummit Healthplan,Commercial Exchange,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,SilverSummit Healthplan,Commercial Exchange,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,7876.00000,4528.70000,SilverSummit Healthplan,Commercial Exchange,,7088.40,,,,,,,7088.40,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7876.00000,4528.70000,SilverSummit Healthplan,Commercial Exchange,,7088.40,,,,,,,2047.76,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,SilverSummit Healthplan,Commercial Exchange,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,SilverSummit Healthplan,Commercial Exchange,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5856.00000,3367.20000,SilverSummit Healthplan,Commercial Exchange,,5270.40,,,,,,,5270.40,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5856.00000,3367.20000,SilverSummit Healthplan,Commercial Exchange,,5270.40,,,,,,,1522.56,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,SilverSummit Healthplan,Commercial Exchange,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,SilverSummit Healthplan,Commercial Exchange,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,SilverSummit Healthplan,Commercial Exchange,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,SilverSummit Healthplan,Commercial Exchange,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,SilverSummit Healthplan,Commercial Exchange,,7505.10,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,SilverSummit Healthplan,Commercial Exchange,,7505.10,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Commercial Exchange,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Commercial Exchange,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,SilverSummit Healthplan,Commercial Exchange,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,SilverSummit Healthplan,Commercial Exchange,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,SilverSummit Healthplan,Commercial Exchange,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,SilverSummit Healthplan,Commercial Exchange,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Commercial Exchange,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Commercial Exchange,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,SilverSummit Healthplan,Commercial Exchange,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,SilverSummit Healthplan,Commercial Exchange,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,SilverSummit Healthplan,Commercial Exchange,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,SilverSummit Healthplan,Commercial Exchange,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4392.00000,2525.40000,SilverSummit Healthplan,Commercial Exchange,,3952.80,,,,,,,3952.80,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4392.00000,2525.40000,SilverSummit Healthplan,Commercial Exchange,,3952.80,,,,,,,1141.92,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Commercial Exchange,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Commercial Exchange,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,SilverSummit Healthplan,Commercial Exchange,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,SilverSummit Healthplan,Commercial Exchange,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Commercial Exchange,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Commercial Exchange,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,SilverSummit Healthplan,Commercial Exchange,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,SilverSummit Healthplan,Commercial Exchange,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,SilverSummit Healthplan,Commercial Exchange,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,SilverSummit Healthplan,Commercial Exchange,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,SilverSummit Healthplan,Commercial Exchange,,1013.40,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,SilverSummit Healthplan,Commercial Exchange,,1013.40,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Commercial Exchange,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Commercial Exchange,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,SilverSummit Healthplan,Commercial Exchange,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,SilverSummit Healthplan,Commercial Exchange,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,SilverSummit Healthplan,Commercial Exchange,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,SilverSummit Healthplan,Commercial Exchange,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,SilverSummit Healthplan,Commercial Exchange,,12223.80,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,SilverSummit Healthplan,Commercial Exchange,,12223.80,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2152.00000,1237.40000,SilverSummit Healthplan,Commercial Exchange,,1936.80,,,,,,,1936.80,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2152.00000,1237.40000,SilverSummit Healthplan,Commercial Exchange,,1936.80,,,,,,,559.52,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,SilverSummit Healthplan,Commercial Exchange,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,SilverSummit Healthplan,Commercial Exchange,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,SilverSummit Healthplan,Commercial Exchange,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,SilverSummit Healthplan,Commercial Exchange,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,SilverSummit Healthplan,Commercial Exchange,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,SilverSummit Healthplan,Commercial Exchange,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Commercial Exchange,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Commercial Exchange,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,SilverSummit Healthplan,Commercial Exchange,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,SilverSummit Healthplan,Commercial Exchange,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,SilverSummit Healthplan,Commercial Exchange,,1013.40,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,SilverSummit Healthplan,Commercial Exchange,,1013.40,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Commercial Exchange,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Commercial Exchange,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,SilverSummit Healthplan,Commercial Exchange,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,SilverSummit Healthplan,Commercial Exchange,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,SilverSummit Healthplan,Commercial Exchange,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,SilverSummit Healthplan,Commercial Exchange,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,SilverSummit Healthplan,Commercial Exchange,,12223.80,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,SilverSummit Healthplan,Commercial Exchange,,12223.80,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Commercial Exchange,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Commercial Exchange,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8802.00000,5061.15000,SilverSummit Healthplan,Commercial Exchange,,7921.80,,,,,,,7921.80,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8802.00000,5061.15000,SilverSummit Healthplan,Commercial Exchange,,7921.80,,,,,,,2288.52,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,10654.00000,6126.05000,SilverSummit Healthplan,Commercial Exchange,,9588.60,,,,,,,9588.60,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10654.00000,6126.05000,SilverSummit Healthplan,Commercial Exchange,,9588.60,,,,,,,2770.04,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,SilverSummit Healthplan,Commercial Exchange,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,SilverSummit Healthplan,Commercial Exchange,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,SilverSummit Healthplan,Commercial Exchange,,12223.80,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,SilverSummit Healthplan,Commercial Exchange,,12223.80,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17086.00000,9824.45000,SilverSummit Healthplan,Commercial Exchange,,15377.40,,,,,,,15377.40,16573.42,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17086.00000,9824.45000,SilverSummit Healthplan,Commercial Exchange,,15377.40,,,,,,,4442.36,16573.42,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,SilverSummit Healthplan,Commercial Exchange,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,SilverSummit Healthplan,Commercial Exchange,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,SilverSummit Healthplan,Commercial Exchange,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,SilverSummit Healthplan,Commercial Exchange,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,SilverSummit Healthplan,Commercial Exchange,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,SilverSummit Healthplan,Commercial Exchange,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,SilverSummit Healthplan,Commercial Exchange,,7505.10,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,SilverSummit Healthplan,Commercial Exchange,,7505.10,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,SilverSummit Healthplan,Commercial Exchange,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,SilverSummit Healthplan,Commercial Exchange,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,SilverSummit Healthplan,Commercial Exchange,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,SilverSummit Healthplan,Commercial Exchange,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Commercial Exchange,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Commercial Exchange,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,SilverSummit Healthplan,Commercial Exchange,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,SilverSummit Healthplan,Commercial Exchange,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,SilverSummit Healthplan,Commercial Exchange,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,SilverSummit Healthplan,Commercial Exchange,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,SilverSummit Healthplan,Commercial Exchange,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,SilverSummit Healthplan,Commercial Exchange,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,SilverSummit Healthplan,Commercial Exchange,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,SilverSummit Healthplan,Commercial Exchange,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,SilverSummit Healthplan,Commercial Exchange,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2827.00000,1625.52000,SilverSummit Healthplan,Commercial Exchange,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,SilverSummit Healthplan,Commercial Exchange,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,SilverSummit Healthplan,Commercial Exchange,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,SilverSummit Healthplan,Commercial Exchange,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4153.00000,2387.98000,SilverSummit Healthplan,Commercial Exchange,,3737.70,,,,,,,3737.70,4028.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,SilverSummit Healthplan,Commercial Exchange,,3737.70,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,SilverSummit Healthplan,Commercial Exchange,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,SilverSummit Healthplan,Commercial Exchange,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,SilverSummit Healthplan,Commercial Exchange,,7505.10,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,SilverSummit Healthplan,Commercial Exchange,,7505.10,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9728.00000,5593.60000,SilverSummit Healthplan,Commercial Exchange,,8755.20,,,,,,,8755.20,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9728.00000,5593.60000,SilverSummit Healthplan,Commercial Exchange,,8755.20,,,,,,,2529.28,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11117.00000,6392.28000,SilverSummit Healthplan,Commercial Exchange,,10005.30,,,,,,,10005.30,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11117.00000,6392.28000,SilverSummit Healthplan,Commercial Exchange,,10005.30,,,,,,,2890.42,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,SilverSummit Healthplan,Commercial Exchange,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,SilverSummit Healthplan,Commercial Exchange,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Commercial Exchange,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Commercial Exchange,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,SilverSummit Healthplan,Commercial Exchange,,51249.60,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,SilverSummit Healthplan,Commercial Exchange,,51249.60,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,SilverSummit Healthplan,Commercial Exchange,,55191.60,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,SilverSummit Healthplan,Commercial Exchange,,55191.60,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,SilverSummit Healthplan,Commercial Exchange,,63075.60,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,SilverSummit Healthplan,Commercial Exchange,,63075.60,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,74464.00000,42816.80000,SilverSummit Healthplan,Commercial Exchange,,67017.60,,,,,,,67017.60,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,SilverSummit Healthplan,Commercial Exchange,,67017.60,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,SilverSummit Healthplan,Commercial Exchange,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,SilverSummit Healthplan,Commercial Exchange,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,83224.00000,47853.80000,SilverSummit Healthplan,Commercial Exchange,,74901.60,,,,,,,74901.60,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,SilverSummit Healthplan,Commercial Exchange,,74901.60,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,111694.00000,64224.05000,SilverSummit Healthplan,Commercial Exchange,,100524.60,,,,,,,100524.60,108343.18,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,111694.00000,64224.05000,SilverSummit Healthplan,Commercial Exchange,,100524.60,,,,,,,29040.44,108343.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,166.00000,95.45000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,447.00000,257.02000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,709.00000,407.67000,SilverSummit Healthplan,Commercial Exchange,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,SilverSummit Healthplan,Commercial Exchange,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,991.00000,569.82000,SilverSummit Healthplan,Commercial Exchange,,891.90,,,,,,,891.90,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,991.00000,569.82000,SilverSummit Healthplan,Commercial Exchange,,891.90,,,,,,,257.66,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1490.00000,856.75000,SilverSummit Healthplan,Commercial Exchange,,1341.00,,,,,,,1341.00,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1490.00000,856.75000,SilverSummit Healthplan,Commercial Exchange,,1341.00,,,,,,,387.40,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,SilverSummit Healthplan,Commercial Exchange,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,SilverSummit Healthplan,Commercial Exchange,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,SilverSummit Healthplan,Commercial Exchange,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,SilverSummit Healthplan,Commercial Exchange,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,SilverSummit Healthplan,Commercial Exchange,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,SilverSummit Healthplan,Commercial Exchange,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,SilverSummit Healthplan,Commercial Exchange,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,SilverSummit Healthplan,Commercial Exchange,,7505.10,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,SilverSummit Healthplan,Commercial Exchange,,7505.10,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Commercial Exchange,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Commercial Exchange,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,6945.00000,3993.37000,SilverSummit Healthplan,Commercial Exchange,,6250.50,,,,,,,6250.50,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,6945.00000,3993.37000,SilverSummit Healthplan,Commercial Exchange,,6250.50,,,,,,,1805.70,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,447.00000,257.02000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,447.00000,257.02000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,SilverSummit Healthplan,Commercial Exchange,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,SilverSummit Healthplan,Commercial Exchange,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Commercial Exchange,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Commercial Exchange,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,166.00000,95.45000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,166.00000,95.45000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Commercial Exchange,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,50374.00000,28965.05000,SilverSummit Healthplan,Commercial Exchange,,45336.60,,,,,,,45336.60,48862.78,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,50374.00000,28965.05000,SilverSummit Healthplan,Commercial Exchange,,45336.60,,,,,,,13097.24,48862.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Commercial Exchange,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,SilverSummit Healthplan,Commercial Exchange,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,SilverSummit Healthplan,Commercial Exchange,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,SilverSummit Healthplan,Commercial Exchange,,25626.60,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,SilverSummit Healthplan,Commercial Exchange,,25626.60,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Commercial Exchange,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Commercial Exchange,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Commercial Exchange,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Commercial Exchange,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,SilverSummit Healthplan,Commercial Exchange,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,SilverSummit Healthplan,Commercial Exchange,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Commercial Exchange,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Commercial Exchange,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,SilverSummit Healthplan,Commercial Exchange,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,SilverSummit Healthplan,Commercial Exchange,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Commercial Exchange,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Commercial Exchange,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,SilverSummit Healthplan,Commercial Exchange,,51249.60,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,SilverSummit Healthplan,Commercial Exchange,,51249.60,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Commercial Exchange,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,74464.00000,42816.80000,SilverSummit Healthplan,Commercial Exchange,,67017.60,,,,,,,67017.60,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,SilverSummit Healthplan,Commercial Exchange,,67017.60,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,83224.00000,47853.80000,SilverSummit Healthplan,Commercial Exchange,,74901.60,,,,,,,74901.60,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,SilverSummit Healthplan,Commercial Exchange,,74901.60,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,91984.00000,52890.80000,SilverSummit Healthplan,Commercial Exchange,,82785.60,,,,,,,82785.60,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,91984.00000,52890.80000,SilverSummit Healthplan,Commercial Exchange,,82785.60,,,,,,,23915.84,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,100744.00000,57927.80000,SilverSummit Healthplan,Commercial Exchange,,90669.60,,,,,,,90669.60,97721.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,100744.00000,57927.80000,SilverSummit Healthplan,Commercial Exchange,,90669.60,,,,,,,26193.44,97721.68,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,166.00000,95.45000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,166.00000,95.45000,SilverSummit Healthplan,Commercial Exchange,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,447.00000,257.02000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,447.00000,257.02000,SilverSummit Healthplan,Commercial Exchange,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,709.00000,407.67000,SilverSummit Healthplan,Commercial Exchange,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,709.00000,407.67000,SilverSummit Healthplan,Commercial Exchange,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Commercial Exchange,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Commercial Exchange,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Commercial Exchange,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Commercial Exchange,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Commercial Exchange,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Commercial Exchange,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Commercial Exchange,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Commercial Exchange,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Commercial Exchange,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Commercial Exchange,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Commercial Exchange,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Commercial Exchange,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2180.20000,1253.61000,SilverSummit Healthplan,Commercial Exchange,,1962.18,,,,,,,1962.18,2114.79,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2180.20000,1253.61000,SilverSummit Healthplan,Commercial Exchange,,1962.18,,,,,,,566.85,2114.79,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1880.60000,1081.34000,SilverSummit Healthplan,Commercial Exchange,,1692.54,,,,,,,1692.54,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1880.60000,1081.34000,SilverSummit Healthplan,Commercial Exchange,,1692.54,,,,,,,488.96,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2908.70000,1672.50000,SilverSummit Healthplan,Commercial Exchange,,2617.83,,,,,,,2617.83,2821.44,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2908.70000,1672.50000,SilverSummit Healthplan,Commercial Exchange,,2617.83,,,,,,,756.26,2821.44,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,inpatient,,,34.00000,25.74000,SilverSummit Healthplan,Commercial Exchange,,30.60,,,,,,,30.60,32.98,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,outpatient,,,34.00000,25.74000,SilverSummit Healthplan,Commercial Exchange,,30.60,,,,,,,8.84,32.98,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,inpatient,,,13.00000,9.84000,SilverSummit Healthplan,Commercial Exchange,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,outpatient,,,13.00000,9.84000,SilverSummit Healthplan,Commercial Exchange,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,SilverSummit Healthplan,Commercial Exchange,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,SilverSummit Healthplan,Commercial Exchange,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,SilverSummit Healthplan,Commercial Exchange,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,SilverSummit Healthplan,Commercial Exchange,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,SilverSummit Healthplan,Commercial Exchange,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,SilverSummit Healthplan,Commercial Exchange,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,SilverSummit Healthplan,Commercial Exchange,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,SilverSummit Healthplan,Commercial Exchange,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,SilverSummit Healthplan,Commercial Exchange,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,SilverSummit Healthplan,Commercial Exchange,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,SilverSummit Healthplan,Commercial Exchange,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,SilverSummit Healthplan,Commercial Exchange,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,inpatient,,,122.00000,92.35000,SilverSummit Healthplan,Commercial Exchange,,109.80,,,,,,,109.80,118.34,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,outpatient,,,122.00000,92.35000,SilverSummit Healthplan,Commercial Exchange,,109.80,,,,,,,31.72,118.34,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,inpatient,,,79.00000,59.80000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,inpatient,,,79.00000,59.80000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,inpatient,,,15.00000,11.36000,SilverSummit Healthplan,Commercial Exchange,,13.50,,,,,,,13.50,14.55,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,SilverSummit Healthplan,Commercial Exchange,,13.50,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,inpatient,,,15.00000,11.36000,SilverSummit Healthplan,Commercial Exchange,,13.50,,,,,,,13.50,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,SilverSummit Healthplan,Commercial Exchange,,13.50,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,inpatient,,,17.00000,12.87000,SilverSummit Healthplan,Commercial Exchange,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,SilverSummit Healthplan,Commercial Exchange,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,inpatient,,,17.00000,12.87000,SilverSummit Healthplan,Commercial Exchange,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,SilverSummit Healthplan,Commercial Exchange,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,inpatient,,,359.00000,271.76000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,outpatient,,,359.00000,271.76000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,inpatient,,,359.00000,271.76000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,outpatient,,,359.00000,271.76000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,inpatient,,,359.00000,271.76000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,outpatient,,,359.00000,271.76000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,inpatient,,,155.00000,117.34000,SilverSummit Healthplan,Commercial Exchange,,139.50,,,,,,,139.50,150.35,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,outpatient,,,155.00000,117.34000,SilverSummit Healthplan,Commercial Exchange,,139.50,,,,,,,40.30,150.35,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,inpatient,,,294.00000,222.56000,SilverSummit Healthplan,Commercial Exchange,,264.60,,,,,,,264.60,285.18,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,outpatient,,,294.00000,222.56000,SilverSummit Healthplan,Commercial Exchange,,264.60,,,,,,,76.44,285.18,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,inpatient,,,1511.00000,1143.83000,SilverSummit Healthplan,Commercial Exchange,,1359.90,,,,,,,1359.90,1465.67,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,outpatient,,,1511.00000,1143.83000,SilverSummit Healthplan,Commercial Exchange,,1359.90,,,,,,,392.86,1465.67,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,inpatient,,,751.00000,568.51000,SilverSummit Healthplan,Commercial Exchange,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,SilverSummit Healthplan,Commercial Exchange,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,inpatient,,,751.00000,568.51000,SilverSummit Healthplan,Commercial Exchange,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,SilverSummit Healthplan,Commercial Exchange,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,inpatient,,,150.00000,113.55000,SilverSummit Healthplan,Commercial Exchange,,135.00,,,,,,,135.00,145.50,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,outpatient,,,150.00000,113.55000,SilverSummit Healthplan,Commercial Exchange,,135.00,,,,,,,39.00,145.50,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,inpatient,,,110.00000,83.27000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,outpatient,,,110.00000,83.27000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,inpatient,,,158.00000,119.61000,SilverSummit Healthplan,Commercial Exchange,,142.20,,,,,,,142.20,153.26,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,outpatient,,,158.00000,119.61000,SilverSummit Healthplan,Commercial Exchange,,142.20,,,,,,,41.08,153.26,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,inpatient,,,153.00000,115.82000,SilverSummit Healthplan,Commercial Exchange,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,outpatient,,,153.00000,115.82000,SilverSummit Healthplan,Commercial Exchange,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,inpatient,,,157.00000,118.85000,SilverSummit Healthplan,Commercial Exchange,,141.30,,,,,,,141.30,152.29,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,outpatient,,,157.00000,118.85000,SilverSummit Healthplan,Commercial Exchange,,141.30,,,,,,,40.82,152.29,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,inpatient,,,26.00000,19.68000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,outpatient,,,26.00000,19.68000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,inpatient,,,37.00000,28.01000,SilverSummit Healthplan,Commercial Exchange,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,outpatient,,,37.00000,28.01000,SilverSummit Healthplan,Commercial Exchange,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,inpatient,,,268.00000,202.88000,SilverSummit Healthplan,Commercial Exchange,,241.20,,,,,,,241.20,259.96,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,outpatient,,,268.00000,202.88000,SilverSummit Healthplan,Commercial Exchange,,241.20,,,,,,,69.68,259.96,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,inpatient,,,91.00000,68.89000,SilverSummit Healthplan,Commercial Exchange,,81.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,outpatient,,,91.00000,68.89000,SilverSummit Healthplan,Commercial Exchange,,81.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,inpatient,,,200.00000,151.40000,SilverSummit Healthplan,Commercial Exchange,,180.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,outpatient,,,200.00000,151.40000,SilverSummit Healthplan,Commercial Exchange,,180.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,inpatient,,,152.00000,115.06000,SilverSummit Healthplan,Commercial Exchange,,136.80,,,,,,,136.80,147.44,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,outpatient,,,152.00000,115.06000,SilverSummit Healthplan,Commercial Exchange,,136.80,,,,,,,39.52,147.44,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,inpatient,,,359.00000,271.76000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,outpatient,,,359.00000,271.76000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,inpatient,,,69.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,outpatient,,,69.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,inpatient,,,75.00000,36.15000,SilverSummit Healthplan,Commercial Exchange,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,outpatient,,,75.00000,36.15000,SilverSummit Healthplan,Commercial Exchange,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,inpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,inpatient,,,45.00000,21.69000,SilverSummit Healthplan,Commercial Exchange,,40.50,,,,,,,40.50,43.65,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,outpatient,,,45.00000,21.69000,SilverSummit Healthplan,Commercial Exchange,,40.50,,,,,,,11.70,43.65,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,inpatient,,,68.00000,32.78000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,outpatient,,,68.00000,32.78000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,inpatient,,,61.00000,29.40000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,outpatient,,,61.00000,29.40000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,inpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,inpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,inpatient,,,64.00000,30.85000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,outpatient,,,64.00000,30.85000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,inpatient,,,195.00000,93.99000,SilverSummit Healthplan,Commercial Exchange,,175.50,,,,,,,175.50,189.15,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,outpatient,,,195.00000,93.99000,SilverSummit Healthplan,Commercial Exchange,,175.50,,,,,,,50.70,189.15,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,inpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,inpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,inpatient,,,14.00000,6.75000,SilverSummit Healthplan,Commercial Exchange,,12.60,,,,,,,12.60,13.58,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,outpatient,,,14.00000,6.75000,SilverSummit Healthplan,Commercial Exchange,,12.60,,,,,,,3.64,13.58,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,inpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,inpatient,,,53.00000,25.55000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,outpatient,,,53.00000,25.55000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,inpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,inpatient,,,82.00000,39.52000,SilverSummit Healthplan,Commercial Exchange,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,outpatient,,,82.00000,39.52000,SilverSummit Healthplan,Commercial Exchange,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,inpatient,,,141.00000,67.96000,SilverSummit Healthplan,Commercial Exchange,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,SilverSummit Healthplan,Commercial Exchange,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,inpatient,,,141.00000,67.96000,SilverSummit Healthplan,Commercial Exchange,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,SilverSummit Healthplan,Commercial Exchange,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,inpatient,,,91.00000,43.86000,SilverSummit Healthplan,Commercial Exchange,,81.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,outpatient,,,91.00000,43.86000,SilverSummit Healthplan,Commercial Exchange,,81.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,inpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,inpatient,,,69.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,outpatient,,,69.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,inpatient,,,205.00000,98.81000,SilverSummit Healthplan,Commercial Exchange,,184.50,,,,,,,184.50,198.85,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,outpatient,,,205.00000,98.81000,SilverSummit Healthplan,Commercial Exchange,,184.50,,,,,,,53.30,198.85,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,inpatient,,,50.00000,24.10000,SilverSummit Healthplan,Commercial Exchange,,45.00,,,,,,,45.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,outpatient,,,50.00000,24.10000,SilverSummit Healthplan,Commercial Exchange,,45.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,inpatient,,,406.00000,195.69000,SilverSummit Healthplan,Commercial Exchange,,365.40,,,,,,,365.40,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,outpatient,,,406.00000,195.69000,SilverSummit Healthplan,Commercial Exchange,,365.40,,,,,,,105.56,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,inpatient,,,101.00000,48.68000,SilverSummit Healthplan,Commercial Exchange,,90.90,,,,,,,90.90,97.97,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,outpatient,,,101.00000,48.68000,SilverSummit Healthplan,Commercial Exchange,,90.90,,,,,,,26.26,97.97,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,inpatient,,,375.00000,180.75000,SilverSummit Healthplan,Commercial Exchange,,337.50,,,,,,,337.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,outpatient,,,375.00000,180.75000,SilverSummit Healthplan,Commercial Exchange,,337.50,,,,,,,97.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,inpatient,,,362.00000,174.48000,SilverSummit Healthplan,Commercial Exchange,,325.80,,,,,,,325.80,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,outpatient,,,362.00000,174.48000,SilverSummit Healthplan,Commercial Exchange,,325.80,,,,,,,94.12,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,inpatient,,,325.00000,156.65000,SilverSummit Healthplan,Commercial Exchange,,292.50,,,,,,,292.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,outpatient,,,325.00000,156.65000,SilverSummit Healthplan,Commercial Exchange,,292.50,,,,,,,84.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,inpatient,,,121.00000,58.32000,SilverSummit Healthplan,Commercial Exchange,,108.90,,,,,,,108.90,117.37,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,outpatient,,,121.00000,58.32000,SilverSummit Healthplan,Commercial Exchange,,108.90,,,,,,,31.46,117.37,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,inpatient,,,115.00000,55.43000,SilverSummit Healthplan,Commercial Exchange,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,outpatient,,,115.00000,55.43000,SilverSummit Healthplan,Commercial Exchange,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,inpatient,,,300.00000,144.60000,SilverSummit Healthplan,Commercial Exchange,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,outpatient,,,300.00000,144.60000,SilverSummit Healthplan,Commercial Exchange,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,inpatient,,,51.00000,24.58000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,outpatient,,,51.00000,24.58000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,inpatient,,,51.00000,24.58000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,inpatient,,,51.00000,24.58000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,inpatient,,,194.00000,93.51000,SilverSummit Healthplan,Commercial Exchange,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,outpatient,,,194.00000,93.51000,SilverSummit Healthplan,Commercial Exchange,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,inpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,inpatient,,,68.00000,32.78000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,outpatient,,,68.00000,32.78000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,inpatient,,,329.00000,158.58000,SilverSummit Healthplan,Commercial Exchange,,296.10,,,,,,,296.10,319.13,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,outpatient,,,329.00000,158.58000,SilverSummit Healthplan,Commercial Exchange,,296.10,,,,,,,85.54,319.13,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,inpatient,,,24.00000,11.57000,SilverSummit Healthplan,Commercial Exchange,,21.60,,,,,,,21.60,23.28,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,outpatient,,,24.00000,11.57000,SilverSummit Healthplan,Commercial Exchange,,21.60,,,,,,,6.24,23.28,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,inpatient,,,30.00000,14.46000,SilverSummit Healthplan,Commercial Exchange,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,outpatient,,,30.00000,14.46000,SilverSummit Healthplan,Commercial Exchange,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,inpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,inpatient,,,53.00000,25.55000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,outpatient,,,53.00000,25.55000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,inpatient,,,270.00000,130.14000,SilverSummit Healthplan,Commercial Exchange,,243.00,,,,,,,243.00,261.90,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,outpatient,,,270.00000,130.14000,SilverSummit Healthplan,Commercial Exchange,,243.00,,,,,,,70.20,261.90,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,inpatient,,,123.00000,59.29000,SilverSummit Healthplan,Commercial Exchange,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,SilverSummit Healthplan,Commercial Exchange,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,inpatient,,,123.00000,59.29000,SilverSummit Healthplan,Commercial Exchange,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,SilverSummit Healthplan,Commercial Exchange,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,inpatient,,,37.00000,17.83000,SilverSummit Healthplan,Commercial Exchange,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,outpatient,,,37.00000,17.83000,SilverSummit Healthplan,Commercial Exchange,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,inpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,inpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,inpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,inpatient,,,41.00000,19.76000,SilverSummit Healthplan,Commercial Exchange,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,outpatient,,,41.00000,19.76000,SilverSummit Healthplan,Commercial Exchange,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,inpatient,,,72.00000,34.70000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,outpatient,,,72.00000,34.70000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,inpatient,,,77.00000,37.11000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,outpatient,,,77.00000,37.11000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,inpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,inpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,inpatient,,,90.00000,43.38000,SilverSummit Healthplan,Commercial Exchange,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,outpatient,,,90.00000,43.38000,SilverSummit Healthplan,Commercial Exchange,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,inpatient,,,44.00000,21.21000,SilverSummit Healthplan,Commercial Exchange,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,outpatient,,,44.00000,21.21000,SilverSummit Healthplan,Commercial Exchange,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,inpatient,,,115.00000,55.43000,SilverSummit Healthplan,Commercial Exchange,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,outpatient,,,115.00000,55.43000,SilverSummit Healthplan,Commercial Exchange,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,inpatient,,,20.00000,9.64000,SilverSummit Healthplan,Commercial Exchange,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,outpatient,,,20.00000,9.64000,SilverSummit Healthplan,Commercial Exchange,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,inpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,inpatient,,,341.00000,164.36000,SilverSummit Healthplan,Commercial Exchange,,306.90,,,,,,,306.90,330.77,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,outpatient,,,341.00000,164.36000,SilverSummit Healthplan,Commercial Exchange,,306.90,,,,,,,88.66,330.77,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,inpatient,,,54.00000,26.03000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,outpatient,,,54.00000,26.03000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,inpatient,,,53.00000,25.55000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,outpatient,,,53.00000,25.55000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,inpatient,,,88.00000,42.42000,SilverSummit Healthplan,Commercial Exchange,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,outpatient,,,88.00000,42.42000,SilverSummit Healthplan,Commercial Exchange,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,inpatient,,,89.00000,42.90000,SilverSummit Healthplan,Commercial Exchange,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,outpatient,,,89.00000,42.90000,SilverSummit Healthplan,Commercial Exchange,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,inpatient,,,61.00000,29.40000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,outpatient,,,61.00000,29.40000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,inpatient,,,77.00000,37.11000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,inpatient,,,77.00000,37.11000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,inpatient,,,64.00000,30.85000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,inpatient,,,64.00000,30.85000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,inpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,inpatient,,,95.00000,45.79000,SilverSummit Healthplan,Commercial Exchange,,85.50,,,,,,,85.50,92.15,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,outpatient,,,95.00000,45.79000,SilverSummit Healthplan,Commercial Exchange,,85.50,,,,,,,24.70,92.15,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,inpatient,,,132.00000,63.62000,SilverSummit Healthplan,Commercial Exchange,,118.80,,,,,,,118.80,128.04,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,outpatient,,,132.00000,63.62000,SilverSummit Healthplan,Commercial Exchange,,118.80,,,,,,,34.32,128.04,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,inpatient,,,83.00000,40.01000,SilverSummit Healthplan,Commercial Exchange,,74.70,,,,,,,74.70,80.51,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,outpatient,,,83.00000,40.01000,SilverSummit Healthplan,Commercial Exchange,,74.70,,,,,,,21.58,80.51,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,inpatient,,,387.00000,186.53000,SilverSummit Healthplan,Commercial Exchange,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,outpatient,,,387.00000,186.53000,SilverSummit Healthplan,Commercial Exchange,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,inpatient,,,387.00000,186.53000,SilverSummit Healthplan,Commercial Exchange,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,outpatient,,,387.00000,186.53000,SilverSummit Healthplan,Commercial Exchange,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,inpatient,,,31.00000,14.94000,SilverSummit Healthplan,Commercial Exchange,,27.90,,,,,,,27.90,30.07,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,outpatient,,,31.00000,14.94000,SilverSummit Healthplan,Commercial Exchange,,27.90,,,,,,,8.06,30.07,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,inpatient,,,36.00000,17.35000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,outpatient,,,36.00000,17.35000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,inpatient,,,160.00000,77.12000,SilverSummit Healthplan,Commercial Exchange,,144.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,outpatient,,,160.00000,77.12000,SilverSummit Healthplan,Commercial Exchange,,144.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,inpatient,,,112.00000,53.98000,SilverSummit Healthplan,Commercial Exchange,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,outpatient,,,112.00000,53.98000,SilverSummit Healthplan,Commercial Exchange,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,inpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,inpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,inpatient,,,14.00000,6.75000,SilverSummit Healthplan,Commercial Exchange,,12.60,,,,,,,12.60,13.58,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,outpatient,,,14.00000,6.75000,SilverSummit Healthplan,Commercial Exchange,,12.60,,,,,,,3.64,13.58,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,inpatient,,,16.00000,7.71000,SilverSummit Healthplan,Commercial Exchange,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,outpatient,,,16.00000,7.71000,SilverSummit Healthplan,Commercial Exchange,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,inpatient,,,71.00000,34.22000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,outpatient,,,71.00000,34.22000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,inpatient,,,116.00000,55.91000,SilverSummit Healthplan,Commercial Exchange,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,outpatient,,,116.00000,55.91000,SilverSummit Healthplan,Commercial Exchange,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,inpatient,,,81.00000,39.04000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,outpatient,,,81.00000,39.04000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,inpatient,,,97.00000,46.75000,SilverSummit Healthplan,Commercial Exchange,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,outpatient,,,97.00000,46.75000,SilverSummit Healthplan,Commercial Exchange,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,inpatient,,,77.00000,37.11000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,outpatient,,,77.00000,37.11000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,inpatient,,,35.00000,16.87000,SilverSummit Healthplan,Commercial Exchange,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,outpatient,,,35.00000,16.87000,SilverSummit Healthplan,Commercial Exchange,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,inpatient,,,65.00000,31.33000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,outpatient,,,65.00000,31.33000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,inpatient,,,74.00000,35.67000,SilverSummit Healthplan,Commercial Exchange,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,outpatient,,,74.00000,35.67000,SilverSummit Healthplan,Commercial Exchange,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,inpatient,,,250.00000,120.50000,SilverSummit Healthplan,Commercial Exchange,,225.00,,,,,,,225.00,242.50,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,outpatient,,,250.00000,120.50000,SilverSummit Healthplan,Commercial Exchange,,225.00,,,,,,,65.00,242.50,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,inpatient,,,90.00000,43.38000,SilverSummit Healthplan,Commercial Exchange,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,outpatient,,,90.00000,43.38000,SilverSummit Healthplan,Commercial Exchange,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,inpatient,,,90.00000,43.38000,SilverSummit Healthplan,Commercial Exchange,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,outpatient,,,90.00000,43.38000,SilverSummit Healthplan,Commercial Exchange,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,inpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,inpatient,,,36.00000,17.35000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,outpatient,,,36.00000,17.35000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,inpatient,,,78.00000,37.60000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,outpatient,,,78.00000,37.60000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,inpatient,,,115.00000,55.43000,SilverSummit Healthplan,Commercial Exchange,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,outpatient,,,115.00000,55.43000,SilverSummit Healthplan,Commercial Exchange,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,inpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,inpatient,,,76.00000,36.63000,SilverSummit Healthplan,Commercial Exchange,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,outpatient,,,76.00000,36.63000,SilverSummit Healthplan,Commercial Exchange,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,inpatient,,,53.00000,25.55000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,outpatient,,,53.00000,25.55000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,inpatient,,,70.00000,33.74000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,outpatient,,,70.00000,33.74000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,inpatient,,,169.00000,81.46000,SilverSummit Healthplan,Commercial Exchange,,152.10,,,,,,,152.10,163.93,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,outpatient,,,169.00000,81.46000,SilverSummit Healthplan,Commercial Exchange,,152.10,,,,,,,43.94,163.93,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,inpatient,,,28.00000,13.50000,SilverSummit Healthplan,Commercial Exchange,,25.20,,,,,,,25.20,27.16,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,outpatient,,,28.00000,13.50000,SilverSummit Healthplan,Commercial Exchange,,25.20,,,,,,,7.28,27.16,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,inpatient,,,51.00000,24.58000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,outpatient,,,51.00000,24.58000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,inpatient,,,15.00000,7.23000,SilverSummit Healthplan,Commercial Exchange,,13.50,,,,,,,13.50,14.55,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,outpatient,,,15.00000,7.23000,SilverSummit Healthplan,Commercial Exchange,,13.50,,,,,,,3.90,14.55,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,inpatient,,,18.00000,8.68000,SilverSummit Healthplan,Commercial Exchange,,16.20,,,,,,,16.20,17.46,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,outpatient,,,18.00000,8.68000,SilverSummit Healthplan,Commercial Exchange,,16.20,,,,,,,4.68,17.46,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,inpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,inpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,inpatient,,,61.00000,29.40000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,outpatient,,,61.00000,29.40000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,inpatient,,,550.00000,265.10000,SilverSummit Healthplan,Commercial Exchange,,495.00,,,,,,,495.00,533.50,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,outpatient,,,550.00000,265.10000,SilverSummit Healthplan,Commercial Exchange,,495.00,,,,,,,143.00,533.50,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,inpatient,,,73.00000,35.19000,SilverSummit Healthplan,Commercial Exchange,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,SilverSummit Healthplan,Commercial Exchange,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,inpatient,,,392.00000,188.94000,SilverSummit Healthplan,Commercial Exchange,,352.80,,,,,,,352.80,380.24,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,outpatient,,,392.00000,188.94000,SilverSummit Healthplan,Commercial Exchange,,352.80,,,,,,,101.92,380.24,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,inpatient,,,75.00000,36.15000,SilverSummit Healthplan,Commercial Exchange,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,outpatient,,,75.00000,36.15000,SilverSummit Healthplan,Commercial Exchange,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,inpatient,,,73.00000,35.19000,SilverSummit Healthplan,Commercial Exchange,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,SilverSummit Healthplan,Commercial Exchange,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,inpatient,,,100.00000,48.20000,SilverSummit Healthplan,Commercial Exchange,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,outpatient,,,100.00000,48.20000,SilverSummit Healthplan,Commercial Exchange,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,inpatient,,,153.00000,73.75000,SilverSummit Healthplan,Commercial Exchange,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,outpatient,,,153.00000,73.75000,SilverSummit Healthplan,Commercial Exchange,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,inpatient,,,909.00000,438.14000,SilverSummit Healthplan,Commercial Exchange,,818.10,,,,,,,818.10,881.73,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,outpatient,,,909.00000,438.14000,SilverSummit Healthplan,Commercial Exchange,,818.10,,,,,,,236.34,881.73,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,inpatient,,,266.00000,128.21000,SilverSummit Healthplan,Commercial Exchange,,239.40,,,,,,,239.40,258.02,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,outpatient,,,266.00000,128.21000,SilverSummit Healthplan,Commercial Exchange,,239.40,,,,,,,69.16,258.02,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,inpatient,,,275.00000,132.55000,SilverSummit Healthplan,Commercial Exchange,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,outpatient,,,275.00000,132.55000,SilverSummit Healthplan,Commercial Exchange,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,inpatient,,,61.00000,29.40000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,outpatient,,,61.00000,29.40000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,inpatient,,,84.00000,40.49000,SilverSummit Healthplan,Commercial Exchange,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,outpatient,,,84.00000,40.49000,SilverSummit Healthplan,Commercial Exchange,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,inpatient,,,174.00000,83.87000,SilverSummit Healthplan,Commercial Exchange,,156.60,,,,,,,156.60,168.78,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,outpatient,,,174.00000,83.87000,SilverSummit Healthplan,Commercial Exchange,,156.60,,,,,,,45.24,168.78,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,inpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,inpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,inpatient,,,68.00000,32.78000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,outpatient,,,68.00000,32.78000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,inpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,inpatient,,,211.00000,101.70000,SilverSummit Healthplan,Commercial Exchange,,189.90,,,,,,,189.90,204.67,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,outpatient,,,211.00000,101.70000,SilverSummit Healthplan,Commercial Exchange,,189.90,,,,,,,54.86,204.67,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,inpatient,,,65.00000,31.33000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,outpatient,,,65.00000,31.33000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,inpatient,,,83.00000,40.01000,SilverSummit Healthplan,Commercial Exchange,,74.70,,,,,,,74.70,80.51,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,outpatient,,,83.00000,40.01000,SilverSummit Healthplan,Commercial Exchange,,74.70,,,,,,,21.58,80.51,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,inpatient,,,54.00000,26.03000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,outpatient,,,54.00000,26.03000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,inpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,inpatient,,,323.00000,155.69000,SilverSummit Healthplan,Commercial Exchange,,290.70,,,,,,,290.70,313.31,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,outpatient,,,323.00000,155.69000,SilverSummit Healthplan,Commercial Exchange,,290.70,,,,,,,83.98,313.31,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,inpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,inpatient,,,35.00000,16.87000,SilverSummit Healthplan,Commercial Exchange,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,outpatient,,,35.00000,16.87000,SilverSummit Healthplan,Commercial Exchange,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,inpatient,,,20.00000,9.64000,SilverSummit Healthplan,Commercial Exchange,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,outpatient,,,20.00000,9.64000,SilverSummit Healthplan,Commercial Exchange,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,inpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,inpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,inpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,inpatient,,,34.00000,16.39000,SilverSummit Healthplan,Commercial Exchange,,30.60,,,,,,,30.60,32.98,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,outpatient,,,34.00000,16.39000,SilverSummit Healthplan,Commercial Exchange,,30.60,,,,,,,8.84,32.98,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,inpatient,,,29.00000,13.98000,SilverSummit Healthplan,Commercial Exchange,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,outpatient,,,29.00000,13.98000,SilverSummit Healthplan,Commercial Exchange,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,inpatient,,,80.00000,38.56000,SilverSummit Healthplan,Commercial Exchange,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,outpatient,,,80.00000,38.56000,SilverSummit Healthplan,Commercial Exchange,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,inpatient,,,73.00000,35.19000,SilverSummit Healthplan,Commercial Exchange,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,outpatient,,,73.00000,35.19000,SilverSummit Healthplan,Commercial Exchange,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,inpatient,,,16.00000,7.71000,SilverSummit Healthplan,Commercial Exchange,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,outpatient,,,16.00000,7.71000,SilverSummit Healthplan,Commercial Exchange,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,inpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,inpatient,,,113.00000,54.47000,SilverSummit Healthplan,Commercial Exchange,,101.70,,,,,,,101.70,109.61,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,outpatient,,,113.00000,54.47000,SilverSummit Healthplan,Commercial Exchange,,101.70,,,,,,,29.38,109.61,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,inpatient,,,68.00000,32.78000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,outpatient,,,68.00000,32.78000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,inpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,inpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,inpatient,,,78.00000,37.60000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,outpatient,,,78.00000,37.60000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,inpatient,,,54.00000,26.03000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,outpatient,,,54.00000,26.03000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,inpatient,,,76.00000,36.63000,SilverSummit Healthplan,Commercial Exchange,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,outpatient,,,76.00000,36.63000,SilverSummit Healthplan,Commercial Exchange,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,inpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,inpatient,,,88.00000,42.42000,SilverSummit Healthplan,Commercial Exchange,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,outpatient,,,88.00000,42.42000,SilverSummit Healthplan,Commercial Exchange,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,inpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,inpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,inpatient,,,53.00000,25.55000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,outpatient,,,53.00000,25.55000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,inpatient,,,88.00000,42.42000,SilverSummit Healthplan,Commercial Exchange,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,outpatient,,,88.00000,42.42000,SilverSummit Healthplan,Commercial Exchange,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,inpatient,,,105.00000,50.61000,SilverSummit Healthplan,Commercial Exchange,,94.50,,,,,,,94.50,101.85,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,outpatient,,,105.00000,50.61000,SilverSummit Healthplan,Commercial Exchange,,94.50,,,,,,,27.30,101.85,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,inpatient,,,73.00000,35.19000,SilverSummit Healthplan,Commercial Exchange,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,SilverSummit Healthplan,Commercial Exchange,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,inpatient,,,83.00000,40.01000,SilverSummit Healthplan,Commercial Exchange,,74.70,,,,,,,74.70,80.51,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,outpatient,,,83.00000,40.01000,SilverSummit Healthplan,Commercial Exchange,,74.70,,,,,,,21.58,80.51,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,inpatient,,,154.00000,74.23000,SilverSummit Healthplan,Commercial Exchange,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,SilverSummit Healthplan,Commercial Exchange,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,inpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,inpatient,,,97.00000,46.75000,SilverSummit Healthplan,Commercial Exchange,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,outpatient,,,97.00000,46.75000,SilverSummit Healthplan,Commercial Exchange,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,inpatient,,,154.00000,74.23000,SilverSummit Healthplan,Commercial Exchange,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,SilverSummit Healthplan,Commercial Exchange,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,inpatient,,,87.00000,41.93000,SilverSummit Healthplan,Commercial Exchange,,78.30,,,,,,,78.30,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,outpatient,,,87.00000,41.93000,SilverSummit Healthplan,Commercial Exchange,,78.30,,,,,,,22.62,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,inpatient,,,68.00000,32.78000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,outpatient,,,68.00000,32.78000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,inpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,inpatient,,,51.00000,24.58000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,outpatient,,,51.00000,24.58000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,inpatient,,,97.00000,46.75000,SilverSummit Healthplan,Commercial Exchange,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,outpatient,,,97.00000,46.75000,SilverSummit Healthplan,Commercial Exchange,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,inpatient,,,176.00000,84.83000,SilverSummit Healthplan,Commercial Exchange,,158.40,,,,,,,158.40,170.72,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,outpatient,,,176.00000,84.83000,SilverSummit Healthplan,Commercial Exchange,,158.40,,,,,,,45.76,170.72,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,inpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,inpatient,,,158.00000,76.16000,SilverSummit Healthplan,Commercial Exchange,,142.20,,,,,,,142.20,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,outpatient,,,158.00000,76.16000,SilverSummit Healthplan,Commercial Exchange,,142.20,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,inpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,inpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,inpatient,,,84.00000,40.49000,SilverSummit Healthplan,Commercial Exchange,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,outpatient,,,84.00000,40.49000,SilverSummit Healthplan,Commercial Exchange,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,inpatient,,,189.00000,91.10000,SilverSummit Healthplan,Commercial Exchange,,170.10,,,,,,,170.10,183.33,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,outpatient,,,189.00000,91.10000,SilverSummit Healthplan,Commercial Exchange,,170.10,,,,,,,49.14,183.33,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,inpatient,,,109.00000,52.54000,SilverSummit Healthplan,Commercial Exchange,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,outpatient,,,109.00000,52.54000,SilverSummit Healthplan,Commercial Exchange,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,inpatient,,,129.00000,62.18000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,outpatient,,,129.00000,62.18000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,inpatient,,,84.00000,40.49000,SilverSummit Healthplan,Commercial Exchange,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,outpatient,,,84.00000,40.49000,SilverSummit Healthplan,Commercial Exchange,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,inpatient,,,73.00000,35.19000,SilverSummit Healthplan,Commercial Exchange,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,SilverSummit Healthplan,Commercial Exchange,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,inpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,inpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,inpatient,,,149.00000,71.82000,SilverSummit Healthplan,Commercial Exchange,,134.10,,,,,,,134.10,144.53,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,outpatient,,,149.00000,71.82000,SilverSummit Healthplan,Commercial Exchange,,134.10,,,,,,,38.74,144.53,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,inpatient,,,130.00000,62.66000,SilverSummit Healthplan,Commercial Exchange,,117.00,,,,,,,117.00,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,outpatient,,,130.00000,62.66000,SilverSummit Healthplan,Commercial Exchange,,117.00,,,,,,,33.80,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,inpatient,,,110.00000,53.02000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,outpatient,,,110.00000,53.02000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,inpatient,,,158.00000,76.16000,SilverSummit Healthplan,Commercial Exchange,,142.20,,,,,,,142.20,153.26,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,outpatient,,,158.00000,76.16000,SilverSummit Healthplan,Commercial Exchange,,142.20,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,inpatient,,,117.00000,56.39000,SilverSummit Healthplan,Commercial Exchange,,105.30,,,,,,,105.30,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,outpatient,,,117.00000,56.39000,SilverSummit Healthplan,Commercial Exchange,,105.30,,,,,,,30.42,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,inpatient,,,61.00000,29.40000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,outpatient,,,61.00000,29.40000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,inpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,inpatient,,,145.00000,69.89000,SilverSummit Healthplan,Commercial Exchange,,130.50,,,,,,,130.50,140.65,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,outpatient,,,145.00000,69.89000,SilverSummit Healthplan,Commercial Exchange,,130.50,,,,,,,37.70,140.65,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,inpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,inpatient,,,165.00000,79.53000,SilverSummit Healthplan,Commercial Exchange,,148.50,,,,,,,148.50,160.05,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,outpatient,,,165.00000,79.53000,SilverSummit Healthplan,Commercial Exchange,,148.50,,,,,,,42.90,160.05,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,inpatient,,,70.00000,33.74000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,outpatient,,,70.00000,33.74000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,inpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,inpatient,,,154.00000,74.23000,SilverSummit Healthplan,Commercial Exchange,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,outpatient,,,154.00000,74.23000,SilverSummit Healthplan,Commercial Exchange,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,inpatient,,,104.00000,50.13000,SilverSummit Healthplan,Commercial Exchange,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,outpatient,,,104.00000,50.13000,SilverSummit Healthplan,Commercial Exchange,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,inpatient,,,70.00000,33.74000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,outpatient,,,70.00000,33.74000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,inpatient,,,104.00000,50.13000,SilverSummit Healthplan,Commercial Exchange,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,outpatient,,,104.00000,50.13000,SilverSummit Healthplan,Commercial Exchange,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,inpatient,,,70.00000,33.74000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,outpatient,,,70.00000,33.74000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,inpatient,,,123.00000,59.29000,SilverSummit Healthplan,Commercial Exchange,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,outpatient,,,123.00000,59.29000,SilverSummit Healthplan,Commercial Exchange,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,inpatient,,,95.00000,45.79000,SilverSummit Healthplan,Commercial Exchange,,85.50,,,,,,,85.50,92.15,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,outpatient,,,95.00000,45.79000,SilverSummit Healthplan,Commercial Exchange,,85.50,,,,,,,24.70,92.15,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,inpatient,,,160.00000,77.12000,SilverSummit Healthplan,Commercial Exchange,,144.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,outpatient,,,160.00000,77.12000,SilverSummit Healthplan,Commercial Exchange,,144.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,inpatient,,,147.00000,70.85000,SilverSummit Healthplan,Commercial Exchange,,132.30,,,,,,,132.30,142.59,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,outpatient,,,147.00000,70.85000,SilverSummit Healthplan,Commercial Exchange,,132.30,,,,,,,38.22,142.59,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,inpatient,,,178.00000,85.80000,SilverSummit Healthplan,Commercial Exchange,,160.20,,,,,,,160.20,172.66,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,outpatient,,,178.00000,85.80000,SilverSummit Healthplan,Commercial Exchange,,160.20,,,,,,,46.28,172.66,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,inpatient,,,160.00000,77.12000,SilverSummit Healthplan,Commercial Exchange,,144.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,outpatient,,,160.00000,77.12000,SilverSummit Healthplan,Commercial Exchange,,144.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,inpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,inpatient,,,70.00000,33.74000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,outpatient,,,70.00000,33.74000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,inpatient,,,449.00000,216.42000,SilverSummit Healthplan,Commercial Exchange,,404.10,,,,,,,404.10,435.53,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,outpatient,,,449.00000,216.42000,SilverSummit Healthplan,Commercial Exchange,,404.10,,,,,,,116.74,435.53,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,inpatient,,,104.00000,50.13000,SilverSummit Healthplan,Commercial Exchange,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,outpatient,,,104.00000,50.13000,SilverSummit Healthplan,Commercial Exchange,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,inpatient,,,185.00000,89.17000,SilverSummit Healthplan,Commercial Exchange,,166.50,,,,,,,166.50,179.45,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,SilverSummit Healthplan,Commercial Exchange,,166.50,,,,,,,48.10,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,inpatient,,,185.00000,89.17000,SilverSummit Healthplan,Commercial Exchange,,166.50,,,,,,,166.50,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,SilverSummit Healthplan,Commercial Exchange,,166.50,,,,,,,48.10,179.45,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,inpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,inpatient,,,84.00000,40.49000,SilverSummit Healthplan,Commercial Exchange,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,outpatient,,,84.00000,40.49000,SilverSummit Healthplan,Commercial Exchange,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,inpatient,,,84.00000,40.49000,SilverSummit Healthplan,Commercial Exchange,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,SilverSummit Healthplan,Commercial Exchange,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,inpatient,,,84.00000,40.49000,SilverSummit Healthplan,Commercial Exchange,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,SilverSummit Healthplan,Commercial Exchange,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,inpatient,,,73.00000,35.19000,SilverSummit Healthplan,Commercial Exchange,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,SilverSummit Healthplan,Commercial Exchange,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,inpatient,,,73.00000,35.19000,SilverSummit Healthplan,Commercial Exchange,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,SilverSummit Healthplan,Commercial Exchange,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,inpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,inpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,inpatient,,,98.00000,47.24000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,outpatient,,,98.00000,47.24000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,inpatient,,,75.00000,36.15000,SilverSummit Healthplan,Commercial Exchange,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,outpatient,,,75.00000,36.15000,SilverSummit Healthplan,Commercial Exchange,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,inpatient,,,107.00000,51.57000,SilverSummit Healthplan,Commercial Exchange,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,outpatient,,,107.00000,51.57000,SilverSummit Healthplan,Commercial Exchange,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,inpatient,,,81.00000,39.04000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,outpatient,,,81.00000,39.04000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,inpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,inpatient,,,68.00000,32.78000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,outpatient,,,68.00000,32.78000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,inpatient,,,51.00000,24.58000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,outpatient,,,51.00000,24.58000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,inpatient,,,74.00000,35.67000,SilverSummit Healthplan,Commercial Exchange,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,outpatient,,,74.00000,35.67000,SilverSummit Healthplan,Commercial Exchange,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,inpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,inpatient,,,194.00000,93.51000,SilverSummit Healthplan,Commercial Exchange,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,outpatient,,,194.00000,93.51000,SilverSummit Healthplan,Commercial Exchange,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,inpatient,,,111.00000,53.50000,SilverSummit Healthplan,Commercial Exchange,,99.90,,,,,,,99.90,107.67,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,outpatient,,,111.00000,53.50000,SilverSummit Healthplan,Commercial Exchange,,99.90,,,,,,,28.86,107.67,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,inpatient,,,77.00000,37.11000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,outpatient,,,77.00000,37.11000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,inpatient,,,237.00000,114.23000,SilverSummit Healthplan,Commercial Exchange,,213.30,,,,,,,213.30,229.89,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,SilverSummit Healthplan,Commercial Exchange,,213.30,,,,,,,61.62,229.89,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,inpatient,,,51.00000,24.58000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,outpatient,,,51.00000,24.58000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,inpatient,,,82.00000,39.52000,SilverSummit Healthplan,Commercial Exchange,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,SilverSummit Healthplan,Commercial Exchange,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,inpatient,,,82.00000,39.52000,SilverSummit Healthplan,Commercial Exchange,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,SilverSummit Healthplan,Commercial Exchange,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,inpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,inpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,inpatient,,,131.00000,63.14000,SilverSummit Healthplan,Commercial Exchange,,117.90,,,,,,,117.90,127.07,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,outpatient,,,131.00000,63.14000,SilverSummit Healthplan,Commercial Exchange,,117.90,,,,,,,34.06,127.07,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,inpatient,,,15.00000,7.23000,SilverSummit Healthplan,Commercial Exchange,,13.50,,,,,,,13.50,14.55,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,outpatient,,,15.00000,7.23000,SilverSummit Healthplan,Commercial Exchange,,13.50,,,,,,,3.90,14.55,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,inpatient,,,39.00000,18.80000,SilverSummit Healthplan,Commercial Exchange,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,outpatient,,,39.00000,18.80000,SilverSummit Healthplan,Commercial Exchange,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,inpatient,,,12.00000,5.78000,SilverSummit Healthplan,Commercial Exchange,,10.80,,,,,,,10.80,11.64,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,outpatient,,,12.00000,5.78000,SilverSummit Healthplan,Commercial Exchange,,10.80,,,,,,,3.12,11.64,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,inpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,inpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,inpatient,,,203.00000,97.85000,SilverSummit Healthplan,Commercial Exchange,,182.70,,,,,,,182.70,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,SilverSummit Healthplan,Commercial Exchange,,182.70,,,,,,,52.78,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,inpatient,,,203.00000,97.85000,SilverSummit Healthplan,Commercial Exchange,,182.70,,,,,,,182.70,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,SilverSummit Healthplan,Commercial Exchange,,182.70,,,,,,,52.78,196.91,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,inpatient,,,99.00000,47.72000,SilverSummit Healthplan,Commercial Exchange,,89.10,,,,,,,89.10,96.03,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,outpatient,,,99.00000,47.72000,SilverSummit Healthplan,Commercial Exchange,,89.10,,,,,,,25.74,96.03,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,inpatient,,,53.00000,25.55000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,outpatient,,,53.00000,25.55000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,inpatient,,,23.00000,11.09000,SilverSummit Healthplan,Commercial Exchange,,20.70,,,,,,,20.70,22.31,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,outpatient,,,23.00000,11.09000,SilverSummit Healthplan,Commercial Exchange,,20.70,,,,,,,5.98,22.31,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,inpatient,,,46.00000,22.17000,SilverSummit Healthplan,Commercial Exchange,,41.40,,,,,,,41.40,44.62,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,outpatient,,,46.00000,22.17000,SilverSummit Healthplan,Commercial Exchange,,41.40,,,,,,,11.96,44.62,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,inpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,inpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,inpatient,,,288.00000,138.82000,SilverSummit Healthplan,Commercial Exchange,,259.20,,,,,,,259.20,279.36,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,outpatient,,,288.00000,138.82000,SilverSummit Healthplan,Commercial Exchange,,259.20,,,,,,,74.88,279.36,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,inpatient,,,106.00000,51.09000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,outpatient,,,106.00000,51.09000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,inpatient,,,30.00000,14.46000,SilverSummit Healthplan,Commercial Exchange,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,outpatient,,,30.00000,14.46000,SilverSummit Healthplan,Commercial Exchange,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,inpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,inpatient,,,71.00000,34.22000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,outpatient,,,71.00000,34.22000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,inpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,inpatient,,,89.00000,42.90000,SilverSummit Healthplan,Commercial Exchange,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,outpatient,,,89.00000,42.90000,SilverSummit Healthplan,Commercial Exchange,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,inpatient,,,116.00000,55.91000,SilverSummit Healthplan,Commercial Exchange,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,outpatient,,,116.00000,55.91000,SilverSummit Healthplan,Commercial Exchange,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,inpatient,,,116.00000,55.91000,SilverSummit Healthplan,Commercial Exchange,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,SilverSummit Healthplan,Commercial Exchange,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,inpatient,,,116.00000,55.91000,SilverSummit Healthplan,Commercial Exchange,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,SilverSummit Healthplan,Commercial Exchange,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,inpatient,,,51.00000,24.58000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,outpatient,,,51.00000,24.58000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,inpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,inpatient,,,174.00000,83.87000,SilverSummit Healthplan,Commercial Exchange,,156.60,,,,,,,156.60,168.78,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,outpatient,,,174.00000,83.87000,SilverSummit Healthplan,Commercial Exchange,,156.60,,,,,,,45.24,168.78,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,inpatient,,,82.00000,39.52000,SilverSummit Healthplan,Commercial Exchange,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,outpatient,,,82.00000,39.52000,SilverSummit Healthplan,Commercial Exchange,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,inpatient,,,112.00000,53.98000,SilverSummit Healthplan,Commercial Exchange,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,outpatient,,,112.00000,53.98000,SilverSummit Healthplan,Commercial Exchange,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,inpatient,,,61.00000,29.40000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,outpatient,,,61.00000,29.40000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,inpatient,,,69.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,outpatient,,,69.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,inpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,inpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,inpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,inpatient,,,286.00000,137.85000,SilverSummit Healthplan,Commercial Exchange,,257.40,,,,,,,257.40,277.42,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,outpatient,,,286.00000,137.85000,SilverSummit Healthplan,Commercial Exchange,,257.40,,,,,,,74.36,277.42,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,inpatient,,,300.00000,144.60000,SilverSummit Healthplan,Commercial Exchange,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,outpatient,,,300.00000,144.60000,SilverSummit Healthplan,Commercial Exchange,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,inpatient,,,73.00000,35.19000,SilverSummit Healthplan,Commercial Exchange,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,outpatient,,,73.00000,35.19000,SilverSummit Healthplan,Commercial Exchange,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,inpatient,,,90.00000,43.38000,SilverSummit Healthplan,Commercial Exchange,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,outpatient,,,90.00000,43.38000,SilverSummit Healthplan,Commercial Exchange,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,inpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,inpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,inpatient,,,315.00000,151.83000,SilverSummit Healthplan,Commercial Exchange,,283.50,,,,,,,283.50,305.55,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,outpatient,,,315.00000,151.83000,SilverSummit Healthplan,Commercial Exchange,,283.50,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,inpatient,,,100.00000,48.20000,SilverSummit Healthplan,Commercial Exchange,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,outpatient,,,100.00000,48.20000,SilverSummit Healthplan,Commercial Exchange,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,inpatient,,,89.00000,42.90000,SilverSummit Healthplan,Commercial Exchange,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,outpatient,,,89.00000,42.90000,SilverSummit Healthplan,Commercial Exchange,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,inpatient,,,71.00000,34.22000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,outpatient,,,71.00000,34.22000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,inpatient,,,135.00000,65.07000,SilverSummit Healthplan,Commercial Exchange,,121.50,,,,,,,121.50,130.95,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,outpatient,,,135.00000,65.07000,SilverSummit Healthplan,Commercial Exchange,,121.50,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,inpatient,,,80.00000,38.56000,SilverSummit Healthplan,Commercial Exchange,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,outpatient,,,80.00000,38.56000,SilverSummit Healthplan,Commercial Exchange,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,inpatient,,,72.00000,34.70000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,inpatient,,,72.00000,34.70000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,inpatient,,,100.00000,48.20000,SilverSummit Healthplan,Commercial Exchange,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,outpatient,,,100.00000,48.20000,SilverSummit Healthplan,Commercial Exchange,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,inpatient,,,305.00000,147.01000,SilverSummit Healthplan,Commercial Exchange,,274.50,,,,,,,274.50,295.85,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,outpatient,,,305.00000,147.01000,SilverSummit Healthplan,Commercial Exchange,,274.50,,,,,,,79.30,295.85,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,inpatient,,,70.00000,33.74000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,outpatient,,,70.00000,33.74000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,inpatient,,,69.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,outpatient,,,69.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,inpatient,,,64.00000,30.85000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,outpatient,,,64.00000,30.85000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,inpatient,,,368.00000,177.38000,SilverSummit Healthplan,Commercial Exchange,,331.20,,,,,,,331.20,356.96,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,outpatient,,,368.00000,177.38000,SilverSummit Healthplan,Commercial Exchange,,331.20,,,,,,,95.68,356.96,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,inpatient,,,104.00000,50.13000,SilverSummit Healthplan,Commercial Exchange,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,outpatient,,,104.00000,50.13000,SilverSummit Healthplan,Commercial Exchange,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,inpatient,,,109.00000,52.54000,SilverSummit Healthplan,Commercial Exchange,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,outpatient,,,109.00000,52.54000,SilverSummit Healthplan,Commercial Exchange,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,inpatient,,,114.00000,54.95000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,outpatient,,,114.00000,54.95000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,inpatient,,,135.00000,65.07000,SilverSummit Healthplan,Commercial Exchange,,121.50,,,,,,,121.50,130.95,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,outpatient,,,135.00000,65.07000,SilverSummit Healthplan,Commercial Exchange,,121.50,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,inpatient,,,105.00000,50.61000,SilverSummit Healthplan,Commercial Exchange,,94.50,,,,,,,94.50,101.85,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,outpatient,,,105.00000,50.61000,SilverSummit Healthplan,Commercial Exchange,,94.50,,,,,,,27.30,101.85,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,inpatient,,,315.00000,151.83000,SilverSummit Healthplan,Commercial Exchange,,283.50,,,,,,,283.50,305.55,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,outpatient,,,315.00000,151.83000,SilverSummit Healthplan,Commercial Exchange,,283.50,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,inpatient,,,148.00000,71.34000,SilverSummit Healthplan,Commercial Exchange,,133.20,,,,,,,133.20,143.56,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,outpatient,,,148.00000,71.34000,SilverSummit Healthplan,Commercial Exchange,,133.20,,,,,,,38.48,143.56,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,inpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,inpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,inpatient,,,107.00000,51.57000,SilverSummit Healthplan,Commercial Exchange,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,outpatient,,,107.00000,51.57000,SilverSummit Healthplan,Commercial Exchange,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,inpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,inpatient,,,35.00000,16.87000,SilverSummit Healthplan,Commercial Exchange,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,outpatient,,,35.00000,16.87000,SilverSummit Healthplan,Commercial Exchange,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,inpatient,,,104.00000,50.13000,SilverSummit Healthplan,Commercial Exchange,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,outpatient,,,104.00000,50.13000,SilverSummit Healthplan,Commercial Exchange,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,inpatient,,,650.00000,313.30000,SilverSummit Healthplan,Commercial Exchange,,585.00,,,,,,,585.00,630.50,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,outpatient,,,650.00000,313.30000,SilverSummit Healthplan,Commercial Exchange,,585.00,,,,,,,169.00,630.50,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,inpatient,,,91.00000,43.86000,SilverSummit Healthplan,Commercial Exchange,,81.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,outpatient,,,91.00000,43.86000,SilverSummit Healthplan,Commercial Exchange,,81.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,inpatient,,,114.00000,54.95000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,outpatient,,,114.00000,54.95000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,inpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,inpatient,,,360.00000,173.52000,SilverSummit Healthplan,Commercial Exchange,,324.00,,,,,,,324.00,349.20,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,outpatient,,,360.00000,173.52000,SilverSummit Healthplan,Commercial Exchange,,324.00,,,,,,,93.60,349.20,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,inpatient,,,106.00000,51.09000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,outpatient,,,106.00000,51.09000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,inpatient,,,78.00000,37.60000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,outpatient,,,78.00000,37.60000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,inpatient,,,72.00000,34.70000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,outpatient,,,72.00000,34.70000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,inpatient,,,94.00000,45.31000,SilverSummit Healthplan,Commercial Exchange,,84.60,,,,,,,84.60,91.18,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,outpatient,,,94.00000,45.31000,SilverSummit Healthplan,Commercial Exchange,,84.60,,,,,,,24.44,91.18,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,inpatient,,,101.00000,48.68000,SilverSummit Healthplan,Commercial Exchange,,90.90,,,,,,,90.90,97.97,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,outpatient,,,101.00000,48.68000,SilverSummit Healthplan,Commercial Exchange,,90.90,,,,,,,26.26,97.97,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,inpatient,,,82.00000,39.52000,SilverSummit Healthplan,Commercial Exchange,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,outpatient,,,82.00000,39.52000,SilverSummit Healthplan,Commercial Exchange,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,inpatient,,,77.00000,37.11000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,outpatient,,,77.00000,37.11000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,inpatient,,,145.00000,69.89000,SilverSummit Healthplan,Commercial Exchange,,130.50,,,,,,,130.50,140.65,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,outpatient,,,145.00000,69.89000,SilverSummit Healthplan,Commercial Exchange,,130.50,,,,,,,37.70,140.65,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,inpatient,,,266.00000,128.21000,SilverSummit Healthplan,Commercial Exchange,,239.40,,,,,,,239.40,258.02,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,outpatient,,,266.00000,128.21000,SilverSummit Healthplan,Commercial Exchange,,239.40,,,,,,,69.16,258.02,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,inpatient,,,79.00000,38.08000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,outpatient,,,79.00000,38.08000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,inpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,inpatient,,,144.00000,69.41000,SilverSummit Healthplan,Commercial Exchange,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,outpatient,,,144.00000,69.41000,SilverSummit Healthplan,Commercial Exchange,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,inpatient,,,20.00000,9.64000,SilverSummit Healthplan,Commercial Exchange,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,outpatient,,,20.00000,9.64000,SilverSummit Healthplan,Commercial Exchange,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,inpatient,,,208.00000,100.26000,SilverSummit Healthplan,Commercial Exchange,,187.20,,,,,,,187.20,201.76,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,outpatient,,,208.00000,100.26000,SilverSummit Healthplan,Commercial Exchange,,187.20,,,,,,,54.08,201.76,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,inpatient,,,135.00000,65.07000,SilverSummit Healthplan,Commercial Exchange,,121.50,,,,,,,121.50,130.95,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,outpatient,,,135.00000,65.07000,SilverSummit Healthplan,Commercial Exchange,,121.50,,,,,,,35.10,130.95,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,inpatient,,,131.00000,63.14000,SilverSummit Healthplan,Commercial Exchange,,117.90,,,,,,,117.90,127.07,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,outpatient,,,131.00000,63.14000,SilverSummit Healthplan,Commercial Exchange,,117.90,,,,,,,34.06,127.07,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,inpatient,,,69.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,outpatient,,,69.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,inpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,inpatient,,,25.00000,12.05000,SilverSummit Healthplan,Commercial Exchange,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,outpatient,,,25.00000,12.05000,SilverSummit Healthplan,Commercial Exchange,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,inpatient,,,61.00000,29.40000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,outpatient,,,61.00000,29.40000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,inpatient,,,80.00000,38.56000,SilverSummit Healthplan,Commercial Exchange,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,outpatient,,,80.00000,38.56000,SilverSummit Healthplan,Commercial Exchange,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,inpatient,,,82.00000,39.52000,SilverSummit Healthplan,Commercial Exchange,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,outpatient,,,82.00000,39.52000,SilverSummit Healthplan,Commercial Exchange,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,inpatient,,,35.00000,16.87000,SilverSummit Healthplan,Commercial Exchange,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,outpatient,,,35.00000,16.87000,SilverSummit Healthplan,Commercial Exchange,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,inpatient,,,88.00000,42.42000,SilverSummit Healthplan,Commercial Exchange,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,outpatient,,,88.00000,42.42000,SilverSummit Healthplan,Commercial Exchange,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,inpatient,,,98.00000,47.24000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,outpatient,,,98.00000,47.24000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,inpatient,,,204.00000,98.33000,SilverSummit Healthplan,Commercial Exchange,,183.60,,,,,,,183.60,197.88,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,outpatient,,,204.00000,98.33000,SilverSummit Healthplan,Commercial Exchange,,183.60,,,,,,,53.04,197.88,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,inpatient,,,61.00000,29.40000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,outpatient,,,61.00000,29.40000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,inpatient,,,19.00000,9.16000,SilverSummit Healthplan,Commercial Exchange,,17.10,,,,,,,17.10,18.43,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,outpatient,,,19.00000,9.16000,SilverSummit Healthplan,Commercial Exchange,,17.10,,,,,,,4.94,18.43,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,inpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,inpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,inpatient,,,37.00000,17.83000,SilverSummit Healthplan,Commercial Exchange,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,outpatient,,,37.00000,17.83000,SilverSummit Healthplan,Commercial Exchange,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,inpatient,,,79.00000,38.08000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,outpatient,,,79.00000,38.08000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,inpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,inpatient,,,21.00000,10.12000,SilverSummit Healthplan,Commercial Exchange,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,outpatient,,,21.00000,10.12000,SilverSummit Healthplan,Commercial Exchange,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,inpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,inpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,inpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,inpatient,,,32.00000,15.42000,SilverSummit Healthplan,Commercial Exchange,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,outpatient,,,32.00000,15.42000,SilverSummit Healthplan,Commercial Exchange,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,inpatient,,,94.00000,45.31000,SilverSummit Healthplan,Commercial Exchange,,84.60,,,,,,,84.60,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,outpatient,,,94.00000,45.31000,SilverSummit Healthplan,Commercial Exchange,,84.60,,,,,,,24.44,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,inpatient,,,103.00000,49.65000,SilverSummit Healthplan,Commercial Exchange,,92.70,,,,,,,92.70,99.91,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,outpatient,,,103.00000,49.65000,SilverSummit Healthplan,Commercial Exchange,,92.70,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,inpatient,,,64.00000,30.85000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,outpatient,,,64.00000,30.85000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,inpatient,,,102.00000,49.16000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,outpatient,,,102.00000,49.16000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,inpatient,,,103.00000,49.65000,SilverSummit Healthplan,Commercial Exchange,,92.70,,,,,,,92.70,99.91,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,outpatient,,,103.00000,49.65000,SilverSummit Healthplan,Commercial Exchange,,92.70,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,inpatient,,,139.00000,67.00000,SilverSummit Healthplan,Commercial Exchange,,125.10,,,,,,,125.10,134.83,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,outpatient,,,139.00000,67.00000,SilverSummit Healthplan,Commercial Exchange,,125.10,,,,,,,36.14,134.83,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,inpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,inpatient,,,21.00000,10.12000,SilverSummit Healthplan,Commercial Exchange,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,SilverSummit Healthplan,Commercial Exchange,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,inpatient,,,88.00000,42.42000,SilverSummit Healthplan,Commercial Exchange,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,outpatient,,,88.00000,42.42000,SilverSummit Healthplan,Commercial Exchange,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,inpatient,,,21.00000,10.12000,SilverSummit Healthplan,Commercial Exchange,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,SilverSummit Healthplan,Commercial Exchange,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,inpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,inpatient,,,80.00000,38.56000,SilverSummit Healthplan,Commercial Exchange,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,outpatient,,,80.00000,38.56000,SilverSummit Healthplan,Commercial Exchange,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,inpatient,,,49.00000,23.62000,SilverSummit Healthplan,Commercial Exchange,,44.10,,,,,,,44.10,47.53,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,outpatient,,,49.00000,23.62000,SilverSummit Healthplan,Commercial Exchange,,44.10,,,,,,,12.74,47.53,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,inpatient,,,88.00000,42.42000,SilverSummit Healthplan,Commercial Exchange,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,outpatient,,,88.00000,42.42000,SilverSummit Healthplan,Commercial Exchange,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,inpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,inpatient,,,68.00000,32.78000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,outpatient,,,68.00000,32.78000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,inpatient,,,93.00000,44.83000,SilverSummit Healthplan,Commercial Exchange,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,outpatient,,,93.00000,44.83000,SilverSummit Healthplan,Commercial Exchange,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,inpatient,,,73.00000,35.19000,SilverSummit Healthplan,Commercial Exchange,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,outpatient,,,73.00000,35.19000,SilverSummit Healthplan,Commercial Exchange,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,inpatient,,,41.00000,19.76000,SilverSummit Healthplan,Commercial Exchange,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,outpatient,,,41.00000,19.76000,SilverSummit Healthplan,Commercial Exchange,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,inpatient,,,94.00000,45.31000,SilverSummit Healthplan,Commercial Exchange,,84.60,,,,,,,84.60,91.18,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,outpatient,,,94.00000,45.31000,SilverSummit Healthplan,Commercial Exchange,,84.60,,,,,,,24.44,91.18,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,inpatient,,,124.00000,59.77000,SilverSummit Healthplan,Commercial Exchange,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,outpatient,,,124.00000,59.77000,SilverSummit Healthplan,Commercial Exchange,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,inpatient,,,71.00000,34.22000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,outpatient,,,71.00000,34.22000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,inpatient,,,33.00000,15.91000,SilverSummit Healthplan,Commercial Exchange,,29.70,,,,,,,29.70,32.01,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,outpatient,,,33.00000,15.91000,SilverSummit Healthplan,Commercial Exchange,,29.70,,,,,,,8.58,32.01,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,inpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,inpatient,,,68.00000,32.78000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,outpatient,,,68.00000,32.78000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,inpatient,,,99.00000,47.72000,SilverSummit Healthplan,Commercial Exchange,,89.10,,,,,,,89.10,96.03,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,outpatient,,,99.00000,47.72000,SilverSummit Healthplan,Commercial Exchange,,89.10,,,,,,,25.74,96.03,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,inpatient,,,197.00000,94.95000,SilverSummit Healthplan,Commercial Exchange,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,outpatient,,,197.00000,94.95000,SilverSummit Healthplan,Commercial Exchange,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,inpatient,,,194.00000,93.51000,SilverSummit Healthplan,Commercial Exchange,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,outpatient,,,194.00000,93.51000,SilverSummit Healthplan,Commercial Exchange,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,inpatient,,,68.00000,32.78000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,outpatient,,,68.00000,32.78000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,inpatient,,,90.00000,43.38000,SilverSummit Healthplan,Commercial Exchange,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,outpatient,,,90.00000,43.38000,SilverSummit Healthplan,Commercial Exchange,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,inpatient,,,109.00000,52.54000,SilverSummit Healthplan,Commercial Exchange,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,outpatient,,,109.00000,52.54000,SilverSummit Healthplan,Commercial Exchange,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,inpatient,,,108.00000,52.06000,SilverSummit Healthplan,Commercial Exchange,,97.20,,,,,,,97.20,104.76,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,outpatient,,,108.00000,52.06000,SilverSummit Healthplan,Commercial Exchange,,97.20,,,,,,,28.08,104.76,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,inpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,inpatient,,,69.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,outpatient,,,69.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,inpatient,,,71.00000,34.22000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,outpatient,,,71.00000,34.22000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,inpatient,,,98.00000,47.24000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,outpatient,,,98.00000,47.24000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,inpatient,,,141.00000,67.96000,SilverSummit Healthplan,Commercial Exchange,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,outpatient,,,141.00000,67.96000,SilverSummit Healthplan,Commercial Exchange,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,inpatient,,,226.00000,108.93000,SilverSummit Healthplan,Commercial Exchange,,203.40,,,,,,,203.40,219.22,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,outpatient,,,226.00000,108.93000,SilverSummit Healthplan,Commercial Exchange,,203.40,,,,,,,58.76,219.22,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,inpatient,,,92.00000,44.34000,SilverSummit Healthplan,Commercial Exchange,,82.80,,,,,,,82.80,89.24,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,outpatient,,,92.00000,44.34000,SilverSummit Healthplan,Commercial Exchange,,82.80,,,,,,,23.92,89.24,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,inpatient,,,69.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,outpatient,,,69.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,inpatient,,,100.00000,48.20000,SilverSummit Healthplan,Commercial Exchange,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,outpatient,,,100.00000,48.20000,SilverSummit Healthplan,Commercial Exchange,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,inpatient,,,124.00000,59.77000,SilverSummit Healthplan,Commercial Exchange,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,outpatient,,,124.00000,59.77000,SilverSummit Healthplan,Commercial Exchange,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,inpatient,,,69.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,outpatient,,,69.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,SilverSummit Healthplan,Commercial Exchange,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,SilverSummit Healthplan,Commercial Exchange,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,SilverSummit Healthplan,Commercial Exchange,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,SilverSummit Healthplan,Commercial Exchange,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,SilverSummit Healthplan,Commercial Exchange,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,SilverSummit Healthplan,Commercial Exchange,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,inpatient,,,118.00000,56.88000,SilverSummit Healthplan,Commercial Exchange,,106.20,,,,,,,106.20,114.46,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,outpatient,,,118.00000,56.88000,SilverSummit Healthplan,Commercial Exchange,,106.20,,,,,,,30.68,114.46,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,inpatient,,,51.00000,24.58000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,outpatient,,,51.00000,24.58000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,inpatient,,,104.00000,50.13000,SilverSummit Healthplan,Commercial Exchange,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,outpatient,,,104.00000,50.13000,SilverSummit Healthplan,Commercial Exchange,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,inpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,inpatient,,,72.00000,34.70000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,outpatient,,,72.00000,34.70000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,inpatient,,,54.00000,26.03000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,outpatient,,,54.00000,26.03000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,inpatient,,,17.00000,8.19000,SilverSummit Healthplan,Commercial Exchange,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,outpatient,,,17.00000,8.19000,SilverSummit Healthplan,Commercial Exchange,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,inpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,inpatient,,,36.00000,17.35000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,outpatient,,,36.00000,17.35000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,inpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,inpatient,,,18.00000,8.68000,SilverSummit Healthplan,Commercial Exchange,,16.20,,,,,,,16.20,17.46,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,outpatient,,,18.00000,8.68000,SilverSummit Healthplan,Commercial Exchange,,16.20,,,,,,,4.68,17.46,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,inpatient,,,74.00000,35.67000,SilverSummit Healthplan,Commercial Exchange,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,outpatient,,,74.00000,35.67000,SilverSummit Healthplan,Commercial Exchange,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,inpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,inpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,inpatient,,,118.00000,56.88000,SilverSummit Healthplan,Commercial Exchange,,106.20,,,,,,,106.20,114.46,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,outpatient,,,118.00000,56.88000,SilverSummit Healthplan,Commercial Exchange,,106.20,,,,,,,30.68,114.46,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,inpatient,,,82.00000,39.52000,SilverSummit Healthplan,Commercial Exchange,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,outpatient,,,82.00000,39.52000,SilverSummit Healthplan,Commercial Exchange,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,inpatient,,,30.00000,14.46000,SilverSummit Healthplan,Commercial Exchange,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,outpatient,,,30.00000,14.46000,SilverSummit Healthplan,Commercial Exchange,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,inpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,inpatient,,,70.00000,33.74000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,outpatient,,,70.00000,33.74000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,inpatient,,,54.00000,26.03000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,outpatient,,,54.00000,26.03000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,inpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,inpatient,,,51.00000,24.58000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,outpatient,,,51.00000,24.58000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,inpatient,,,141.00000,67.96000,SilverSummit Healthplan,Commercial Exchange,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,outpatient,,,141.00000,67.96000,SilverSummit Healthplan,Commercial Exchange,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,inpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,inpatient,,,81.00000,39.04000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,outpatient,,,81.00000,39.04000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,inpatient,,,335.00000,161.47000,SilverSummit Healthplan,Commercial Exchange,,301.50,,,,,,,301.50,324.95,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,outpatient,,,335.00000,161.47000,SilverSummit Healthplan,Commercial Exchange,,301.50,,,,,,,87.10,324.95,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,inpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,inpatient,,,54.00000,26.03000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,inpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,inpatient,,,54.00000,26.03000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,inpatient,,,53.00000,25.55000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,outpatient,,,53.00000,25.55000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,inpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,inpatient,,,53.00000,25.55000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,outpatient,,,53.00000,25.55000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,inpatient,,,12.00000,5.78000,SilverSummit Healthplan,Commercial Exchange,,10.80,,,,,,,10.80,11.64,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,outpatient,,,12.00000,5.78000,SilverSummit Healthplan,Commercial Exchange,,10.80,,,,,,,3.12,11.64,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,inpatient,,,710.00000,342.22000,SilverSummit Healthplan,Commercial Exchange,,639.00,,,,,,,639.00,688.70,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,outpatient,,,710.00000,342.22000,SilverSummit Healthplan,Commercial Exchange,,639.00,,,,,,,184.60,688.70,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,inpatient,,,104.00000,50.13000,SilverSummit Healthplan,Commercial Exchange,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,outpatient,,,104.00000,50.13000,SilverSummit Healthplan,Commercial Exchange,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,inpatient,,,155.00000,74.71000,SilverSummit Healthplan,Commercial Exchange,,139.50,,,,,,,139.50,150.35,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,outpatient,,,155.00000,74.71000,SilverSummit Healthplan,Commercial Exchange,,139.50,,,,,,,40.30,150.35,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,inpatient,,,139.00000,67.00000,SilverSummit Healthplan,Commercial Exchange,,125.10,,,,,,,125.10,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,outpatient,,,139.00000,67.00000,SilverSummit Healthplan,Commercial Exchange,,125.10,,,,,,,36.14,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,inpatient,,,89.00000,42.90000,SilverSummit Healthplan,Commercial Exchange,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,outpatient,,,89.00000,42.90000,SilverSummit Healthplan,Commercial Exchange,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,inpatient,,,88.00000,42.42000,SilverSummit Healthplan,Commercial Exchange,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,outpatient,,,88.00000,42.42000,SilverSummit Healthplan,Commercial Exchange,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,inpatient,,,111.00000,53.50000,SilverSummit Healthplan,Commercial Exchange,,99.90,,,,,,,99.90,107.67,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,outpatient,,,111.00000,53.50000,SilverSummit Healthplan,Commercial Exchange,,99.90,,,,,,,28.86,107.67,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,inpatient,,,70.00000,33.74000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,outpatient,,,70.00000,33.74000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,inpatient,,,85.00000,40.97000,SilverSummit Healthplan,Commercial Exchange,,76.50,,,,,,,76.50,82.45,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,outpatient,,,85.00000,40.97000,SilverSummit Healthplan,Commercial Exchange,,76.50,,,,,,,22.10,82.45,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,inpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,inpatient,,,110.00000,53.02000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,outpatient,,,110.00000,53.02000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,inpatient,,,500.00000,241.00000,SilverSummit Healthplan,Commercial Exchange,,450.00,,,,,,,450.00,485.00,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,outpatient,,,500.00000,241.00000,SilverSummit Healthplan,Commercial Exchange,,450.00,,,,,,,130.00,485.00,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,inpatient,,,140.00000,67.48000,SilverSummit Healthplan,Commercial Exchange,,126.00,,,,,,,126.00,135.80,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,outpatient,,,140.00000,67.48000,SilverSummit Healthplan,Commercial Exchange,,126.00,,,,,,,36.40,135.80,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,inpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,inpatient,,,74.00000,35.67000,SilverSummit Healthplan,Commercial Exchange,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,outpatient,,,74.00000,35.67000,SilverSummit Healthplan,Commercial Exchange,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,inpatient,,,77.00000,37.11000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,outpatient,,,77.00000,37.11000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,inpatient,,,93.00000,44.83000,SilverSummit Healthplan,Commercial Exchange,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,outpatient,,,93.00000,44.83000,SilverSummit Healthplan,Commercial Exchange,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,inpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,inpatient,,,15.00000,7.23000,SilverSummit Healthplan,Commercial Exchange,,13.50,,,,,,,13.50,14.55,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,outpatient,,,15.00000,7.23000,SilverSummit Healthplan,Commercial Exchange,,13.50,,,,,,,3.90,14.55,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,inpatient,,,24.00000,11.57000,SilverSummit Healthplan,Commercial Exchange,,21.60,,,,,,,21.60,23.28,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,outpatient,,,24.00000,11.57000,SilverSummit Healthplan,Commercial Exchange,,21.60,,,,,,,6.24,23.28,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,inpatient,,,72.00000,34.70000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,outpatient,,,72.00000,34.70000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,inpatient,,,16.00000,7.71000,SilverSummit Healthplan,Commercial Exchange,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,SilverSummit Healthplan,Commercial Exchange,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,inpatient,,,16.00000,7.71000,SilverSummit Healthplan,Commercial Exchange,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,SilverSummit Healthplan,Commercial Exchange,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,inpatient,,,64.00000,30.85000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,outpatient,,,64.00000,30.85000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,inpatient,,,82.00000,39.52000,SilverSummit Healthplan,Commercial Exchange,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,outpatient,,,82.00000,39.52000,SilverSummit Healthplan,Commercial Exchange,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,inpatient,,,157.00000,75.67000,SilverSummit Healthplan,Commercial Exchange,,141.30,,,,,,,141.30,152.29,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,outpatient,,,157.00000,75.67000,SilverSummit Healthplan,Commercial Exchange,,141.30,,,,,,,40.82,152.29,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,inpatient,,,70.00000,33.74000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,outpatient,,,70.00000,33.74000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,inpatient,,,229.00000,110.38000,SilverSummit Healthplan,Commercial Exchange,,206.10,,,,,,,206.10,222.13,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,outpatient,,,229.00000,110.38000,SilverSummit Healthplan,Commercial Exchange,,206.10,,,,,,,59.54,222.13,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,inpatient,,,64.00000,30.85000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,outpatient,,,64.00000,30.85000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,inpatient,,,72.00000,34.70000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,outpatient,,,72.00000,34.70000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,inpatient,,,17.00000,8.19000,SilverSummit Healthplan,Commercial Exchange,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,outpatient,,,17.00000,8.19000,SilverSummit Healthplan,Commercial Exchange,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,inpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,inpatient,,,64.00000,30.85000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,outpatient,,,64.00000,30.85000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,inpatient,,,387.00000,186.53000,SilverSummit Healthplan,Commercial Exchange,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,outpatient,,,387.00000,186.53000,SilverSummit Healthplan,Commercial Exchange,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,inpatient,,,387.00000,186.53000,SilverSummit Healthplan,Commercial Exchange,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,SilverSummit Healthplan,Commercial Exchange,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,inpatient,,,387.00000,186.53000,SilverSummit Healthplan,Commercial Exchange,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,SilverSummit Healthplan,Commercial Exchange,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,inpatient,,,77.00000,37.11000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,outpatient,,,77.00000,37.11000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,inpatient,,,78.00000,37.60000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,inpatient,,,78.00000,37.60000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,inpatient,,,43.00000,20.73000,SilverSummit Healthplan,Commercial Exchange,,38.70,,,,,,,38.70,41.71,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,outpatient,,,43.00000,20.73000,SilverSummit Healthplan,Commercial Exchange,,38.70,,,,,,,11.18,41.71,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,inpatient,,,64.00000,30.85000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,outpatient,,,64.00000,30.85000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,inpatient,,,160.00000,77.12000,SilverSummit Healthplan,Commercial Exchange,,144.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,outpatient,,,160.00000,77.12000,SilverSummit Healthplan,Commercial Exchange,,144.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,inpatient,,,112.00000,53.98000,SilverSummit Healthplan,Commercial Exchange,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,outpatient,,,112.00000,53.98000,SilverSummit Healthplan,Commercial Exchange,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,inpatient,,,82.00000,39.52000,SilverSummit Healthplan,Commercial Exchange,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,outpatient,,,82.00000,39.52000,SilverSummit Healthplan,Commercial Exchange,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,inpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,inpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,inpatient,,,54.00000,26.03000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,outpatient,,,54.00000,26.03000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,inpatient,,,153.00000,73.75000,SilverSummit Healthplan,Commercial Exchange,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,outpatient,,,153.00000,73.75000,SilverSummit Healthplan,Commercial Exchange,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,inpatient,,,45.00000,21.69000,SilverSummit Healthplan,Commercial Exchange,,40.50,,,,,,,40.50,43.65,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,outpatient,,,45.00000,21.69000,SilverSummit Healthplan,Commercial Exchange,,40.50,,,,,,,11.70,43.65,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,inpatient,,,28.00000,13.50000,SilverSummit Healthplan,Commercial Exchange,,25.20,,,,,,,25.20,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,outpatient,,,28.00000,13.50000,SilverSummit Healthplan,Commercial Exchange,,25.20,,,,,,,7.28,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,inpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,SilverSummit Healthplan,Commercial Exchange,,44.10,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,SilverSummit Healthplan,Commercial Exchange,,44.10,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,SilverSummit Healthplan,Commercial Exchange,,44.10,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,SilverSummit Healthplan,Commercial Exchange,,44.10,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,SilverSummit Healthplan,Commercial Exchange,,44.10,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,SilverSummit Healthplan,Commercial Exchange,,44.10,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,inpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,inpatient,,,36.00000,17.35000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,outpatient,,,36.00000,17.35000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,inpatient,,,38.00000,18.32000,SilverSummit Healthplan,Commercial Exchange,,34.20,,,,,,,34.20,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,outpatient,,,38.00000,18.32000,SilverSummit Healthplan,Commercial Exchange,,34.20,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,inpatient,,,38.00000,18.32000,SilverSummit Healthplan,Commercial Exchange,,34.20,,,,,,,34.20,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,outpatient,,,38.00000,18.32000,SilverSummit Healthplan,Commercial Exchange,,34.20,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,inpatient,,,76.00000,36.63000,SilverSummit Healthplan,Commercial Exchange,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,outpatient,,,76.00000,36.63000,SilverSummit Healthplan,Commercial Exchange,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,inpatient,,,173.00000,83.39000,SilverSummit Healthplan,Commercial Exchange,,155.70,,,,,,,155.70,167.81,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,outpatient,,,173.00000,83.39000,SilverSummit Healthplan,Commercial Exchange,,155.70,,,,,,,44.98,167.81,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,inpatient,,,22.00000,10.60000,SilverSummit Healthplan,Commercial Exchange,,19.80,,,,,,,19.80,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,outpatient,,,22.00000,10.60000,SilverSummit Healthplan,Commercial Exchange,,19.80,,,,,,,5.72,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,inpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,inpatient,,,39.00000,18.80000,SilverSummit Healthplan,Commercial Exchange,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,outpatient,,,39.00000,18.80000,SilverSummit Healthplan,Commercial Exchange,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,inpatient,,,41.00000,19.76000,SilverSummit Healthplan,Commercial Exchange,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,outpatient,,,41.00000,19.76000,SilverSummit Healthplan,Commercial Exchange,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,inpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,inpatient,,,54.00000,26.03000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,outpatient,,,54.00000,26.03000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,inpatient,,,71.00000,34.22000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,outpatient,,,71.00000,34.22000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,inpatient,,,43.00000,20.73000,SilverSummit Healthplan,Commercial Exchange,,38.70,,,,,,,38.70,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,SilverSummit Healthplan,Commercial Exchange,,38.70,,,,,,,11.18,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,inpatient,,,43.00000,20.73000,SilverSummit Healthplan,Commercial Exchange,,38.70,,,,,,,38.70,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,SilverSummit Healthplan,Commercial Exchange,,38.70,,,,,,,11.18,41.71,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,inpatient,,,38.00000,18.32000,SilverSummit Healthplan,Commercial Exchange,,34.20,,,,,,,34.20,36.86,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,outpatient,,,38.00000,18.32000,SilverSummit Healthplan,Commercial Exchange,,34.20,,,,,,,9.88,36.86,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,inpatient,,,72.00000,34.70000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,outpatient,,,72.00000,34.70000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,inpatient,,,226.00000,108.93000,SilverSummit Healthplan,Commercial Exchange,,203.40,,,,,,,203.40,219.22,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,outpatient,,,226.00000,108.93000,SilverSummit Healthplan,Commercial Exchange,,203.40,,,,,,,58.76,219.22,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,SilverSummit Healthplan,Commercial Exchange,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,SilverSummit Healthplan,Commercial Exchange,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,SilverSummit Healthplan,Commercial Exchange,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,SilverSummit Healthplan,Commercial Exchange,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,SilverSummit Healthplan,Commercial Exchange,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,SilverSummit Healthplan,Commercial Exchange,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,inpatient,,,160.00000,77.12000,SilverSummit Healthplan,Commercial Exchange,,144.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,outpatient,,,160.00000,77.12000,SilverSummit Healthplan,Commercial Exchange,,144.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,inpatient,,,102.00000,49.16000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,outpatient,,,102.00000,49.16000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,inpatient,,,317.00000,152.79000,SilverSummit Healthplan,Commercial Exchange,,285.30,,,,,,,285.30,307.49,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,outpatient,,,317.00000,152.79000,SilverSummit Healthplan,Commercial Exchange,,285.30,,,,,,,82.42,307.49,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,inpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,inpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,inpatient,,,116.00000,55.91000,SilverSummit Healthplan,Commercial Exchange,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,outpatient,,,116.00000,55.91000,SilverSummit Healthplan,Commercial Exchange,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,inpatient,,,89.00000,42.90000,SilverSummit Healthplan,Commercial Exchange,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,SilverSummit Healthplan,Commercial Exchange,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,inpatient,,,89.00000,42.90000,SilverSummit Healthplan,Commercial Exchange,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,SilverSummit Healthplan,Commercial Exchange,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,inpatient,,,85.00000,40.97000,SilverSummit Healthplan,Commercial Exchange,,76.50,,,,,,,76.50,82.45,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,outpatient,,,85.00000,40.97000,SilverSummit Healthplan,Commercial Exchange,,76.50,,,,,,,22.10,82.45,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,inpatient,,,184.00000,88.69000,SilverSummit Healthplan,Commercial Exchange,,165.60,,,,,,,165.60,178.48,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,outpatient,,,184.00000,88.69000,SilverSummit Healthplan,Commercial Exchange,,165.60,,,,,,,47.84,178.48,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,inpatient,,,127.00000,61.21000,SilverSummit Healthplan,Commercial Exchange,,114.30,,,,,,,114.30,123.19,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,outpatient,,,127.00000,61.21000,SilverSummit Healthplan,Commercial Exchange,,114.30,,,,,,,33.02,123.19,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,inpatient,,,61.00000,29.40000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,outpatient,,,61.00000,29.40000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,inpatient,,,35.00000,16.87000,SilverSummit Healthplan,Commercial Exchange,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,outpatient,,,35.00000,16.87000,SilverSummit Healthplan,Commercial Exchange,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,inpatient,,,79.00000,38.08000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,outpatient,,,79.00000,38.08000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,inpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,inpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,inpatient,,,57.00000,32.83000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,outpatient,,,57.00000,32.83000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,SilverSummit Healthplan,Commercial Exchange,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,SilverSummit Healthplan,Commercial Exchange,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,inpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,inpatient,,,77.00000,44.35000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,outpatient,,,77.00000,44.35000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,inpatient,,,70.00000,40.32000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,outpatient,,,70.00000,40.32000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,inpatient,,,67.00000,38.59000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,outpatient,,,67.00000,38.59000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,inpatient,,,40.00000,23.04000,SilverSummit Healthplan,Commercial Exchange,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,outpatient,,,40.00000,23.04000,SilverSummit Healthplan,Commercial Exchange,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,inpatient,,,71.00000,40.90000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,outpatient,,,71.00000,40.90000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,inpatient,,,80.00000,46.08000,SilverSummit Healthplan,Commercial Exchange,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,outpatient,,,80.00000,46.08000,SilverSummit Healthplan,Commercial Exchange,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,inpatient,,,72.00000,41.47000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,outpatient,,,72.00000,41.47000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,inpatient,,,444.00000,255.74000,SilverSummit Healthplan,Commercial Exchange,,399.60,,,,,,,399.60,430.68,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,outpatient,,,444.00000,255.74000,SilverSummit Healthplan,Commercial Exchange,,399.60,,,,,,,115.44,430.68,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,inpatient,,,81.00000,46.66000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,outpatient,,,81.00000,46.66000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,inpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,inpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,inpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,inpatient,,,66.00000,38.02000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,outpatient,,,66.00000,38.02000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,inpatient,,,57.00000,32.83000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,outpatient,,,57.00000,32.83000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,inpatient,,,53.00000,30.53000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,outpatient,,,53.00000,30.53000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,inpatient,,,60.00000,34.56000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,outpatient,,,60.00000,34.56000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,inpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,inpatient,,,40.00000,23.04000,SilverSummit Healthplan,Commercial Exchange,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,outpatient,,,40.00000,23.04000,SilverSummit Healthplan,Commercial Exchange,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,inpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,inpatient,,,42.00000,24.19000,SilverSummit Healthplan,Commercial Exchange,,37.80,,,,,,,37.80,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,outpatient,,,42.00000,24.19000,SilverSummit Healthplan,Commercial Exchange,,37.80,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,inpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,inpatient,,,46.00000,26.50000,SilverSummit Healthplan,Commercial Exchange,,41.40,,,,,,,41.40,44.62,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,outpatient,,,46.00000,26.50000,SilverSummit Healthplan,Commercial Exchange,,41.40,,,,,,,11.96,44.62,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,inpatient,,,54.00000,31.10000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,outpatient,,,54.00000,31.10000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,inpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,inpatient,,,71.00000,40.90000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,outpatient,,,71.00000,40.90000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,inpatient,,,54.00000,31.10000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,outpatient,,,54.00000,31.10000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,inpatient,,,80.00000,46.08000,SilverSummit Healthplan,Commercial Exchange,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,outpatient,,,80.00000,46.08000,SilverSummit Healthplan,Commercial Exchange,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,inpatient,,,60.00000,34.56000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,outpatient,,,60.00000,34.56000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,inpatient,,,124.00000,71.42000,SilverSummit Healthplan,Commercial Exchange,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,SilverSummit Healthplan,Commercial Exchange,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,inpatient,,,130.00000,74.88000,SilverSummit Healthplan,Commercial Exchange,,117.00,,,,,,,117.00,126.10,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,outpatient,,,130.00000,74.88000,SilverSummit Healthplan,Commercial Exchange,,117.00,,,,,,,33.80,126.10,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,inpatient,,,123.00000,70.85000,SilverSummit Healthplan,Commercial Exchange,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,SilverSummit Healthplan,Commercial Exchange,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,inpatient,,,77.00000,44.35000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,outpatient,,,77.00000,44.35000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,inpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,inpatient,,,115.00000,66.24000,SilverSummit Healthplan,Commercial Exchange,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,outpatient,,,115.00000,66.24000,SilverSummit Healthplan,Commercial Exchange,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,inpatient,,,123.00000,70.85000,SilverSummit Healthplan,Commercial Exchange,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,SilverSummit Healthplan,Commercial Exchange,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,inpatient,,,161.00000,92.74000,SilverSummit Healthplan,Commercial Exchange,,144.90,,,,,,,144.90,156.17,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,outpatient,,,161.00000,92.74000,SilverSummit Healthplan,Commercial Exchange,,144.90,,,,,,,41.86,156.17,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,inpatient,,,124.00000,71.42000,SilverSummit Healthplan,Commercial Exchange,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,SilverSummit Healthplan,Commercial Exchange,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,inpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,inpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,inpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,inpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,inpatient,,,102.00000,58.75000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,outpatient,,,102.00000,58.75000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,inpatient,,,219.00000,126.14000,SilverSummit Healthplan,Commercial Exchange,,197.10,,,,,,,197.10,212.43,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,outpatient,,,219.00000,126.14000,SilverSummit Healthplan,Commercial Exchange,,197.10,,,,,,,56.94,212.43,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,inpatient,,,194.00000,111.74000,SilverSummit Healthplan,Commercial Exchange,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,SilverSummit Healthplan,Commercial Exchange,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,inpatient,,,103.00000,59.33000,SilverSummit Healthplan,Commercial Exchange,,92.70,,,,,,,92.70,99.91,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,outpatient,,,103.00000,59.33000,SilverSummit Healthplan,Commercial Exchange,,92.70,,,,,,,26.78,99.91,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,inpatient,,,60.00000,34.56000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,outpatient,,,60.00000,34.56000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,inpatient,,,837.00000,482.11000,SilverSummit Healthplan,Commercial Exchange,,753.30,,,,,,,753.30,811.89,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,outpatient,,,837.00000,482.11000,SilverSummit Healthplan,Commercial Exchange,,753.30,,,,,,,217.62,811.89,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,inpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,inpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,inpatient,,,194.00000,111.74000,SilverSummit Healthplan,Commercial Exchange,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,SilverSummit Healthplan,Commercial Exchange,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,inpatient,,,78.00000,44.93000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,outpatient,,,78.00000,44.93000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,inpatient,,,285.00000,164.16000,SilverSummit Healthplan,Commercial Exchange,,256.50,,,,,,,256.50,276.45,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,outpatient,,,285.00000,164.16000,SilverSummit Healthplan,Commercial Exchange,,256.50,,,,,,,74.10,276.45,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,inpatient,,,190.00000,109.44000,SilverSummit Healthplan,Commercial Exchange,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,outpatient,,,190.00000,109.44000,SilverSummit Healthplan,Commercial Exchange,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,inpatient,,,100.00000,57.60000,SilverSummit Healthplan,Commercial Exchange,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,outpatient,,,100.00000,57.60000,SilverSummit Healthplan,Commercial Exchange,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,inpatient,,,40.00000,23.04000,SilverSummit Healthplan,Commercial Exchange,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,SilverSummit Healthplan,Commercial Exchange,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,inpatient,,,67.00000,38.59000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,outpatient,,,67.00000,38.59000,SilverSummit Healthplan,Commercial Exchange,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,inpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,inpatient,,,78.00000,44.93000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,outpatient,,,78.00000,44.93000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,inpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,inpatient,,,57.00000,32.83000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,outpatient,,,57.00000,32.83000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,inpatient,,,72.00000,41.47000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,outpatient,,,72.00000,41.47000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,inpatient,,,59.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,outpatient,,,59.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,inpatient,,,72.00000,41.47000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,outpatient,,,72.00000,41.47000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,inpatient,,,239.00000,137.66000,SilverSummit Healthplan,Commercial Exchange,,215.10,,,,,,,215.10,231.83,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,outpatient,,,239.00000,137.66000,SilverSummit Healthplan,Commercial Exchange,,215.10,,,,,,,62.14,231.83,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,inpatient,,,85.00000,48.96000,SilverSummit Healthplan,Commercial Exchange,,76.50,,,,,,,76.50,82.45,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,outpatient,,,85.00000,48.96000,SilverSummit Healthplan,Commercial Exchange,,76.50,,,,,,,22.10,82.45,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,inpatient,,,44.00000,25.34000,SilverSummit Healthplan,Commercial Exchange,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,outpatient,,,44.00000,25.34000,SilverSummit Healthplan,Commercial Exchange,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,inpatient,,,40.00000,23.04000,SilverSummit Healthplan,Commercial Exchange,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,outpatient,,,40.00000,23.04000,SilverSummit Healthplan,Commercial Exchange,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,inpatient,,,53.00000,30.53000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,outpatient,,,53.00000,30.53000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,inpatient,,,59.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,inpatient,,,59.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,inpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,inpatient,,,68.00000,39.17000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,outpatient,,,68.00000,39.17000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,inpatient,,,76.00000,43.78000,SilverSummit Healthplan,Commercial Exchange,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,outpatient,,,76.00000,43.78000,SilverSummit Healthplan,Commercial Exchange,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,inpatient,,,42.00000,24.19000,SilverSummit Healthplan,Commercial Exchange,,37.80,,,,,,,37.80,40.74,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,outpatient,,,42.00000,24.19000,SilverSummit Healthplan,Commercial Exchange,,37.80,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,inpatient,,,87.00000,50.11000,SilverSummit Healthplan,Commercial Exchange,,78.30,,,,,,,78.30,84.39,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,outpatient,,,87.00000,50.11000,SilverSummit Healthplan,Commercial Exchange,,78.30,,,,,,,22.62,84.39,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,inpatient,,,503.00000,289.73000,SilverSummit Healthplan,Commercial Exchange,,452.70,,,,,,,452.70,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,outpatient,,,503.00000,289.73000,SilverSummit Healthplan,Commercial Exchange,,452.70,,,,,,,130.78,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,inpatient,,,472.00000,271.87000,SilverSummit Healthplan,Commercial Exchange,,424.80,,,,,,,424.80,457.84,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,outpatient,,,472.00000,271.87000,SilverSummit Healthplan,Commercial Exchange,,424.80,,,,,,,122.72,457.84,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,inpatient,,,28.00000,16.13000,SilverSummit Healthplan,Commercial Exchange,,25.20,,,,,,,25.20,27.16,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,outpatient,,,28.00000,16.13000,SilverSummit Healthplan,Commercial Exchange,,25.20,,,,,,,7.28,27.16,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,inpatient,,,236.00000,135.94000,SilverSummit Healthplan,Commercial Exchange,,212.40,,,,,,,212.40,228.92,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,outpatient,,,236.00000,135.94000,SilverSummit Healthplan,Commercial Exchange,,212.40,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,inpatient,,,54.00000,31.10000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,outpatient,,,54.00000,31.10000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,inpatient,,,238.00000,137.09000,SilverSummit Healthplan,Commercial Exchange,,214.20,,,,,,,214.20,230.86,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,outpatient,,,238.00000,137.09000,SilverSummit Healthplan,Commercial Exchange,,214.20,,,,,,,61.88,230.86,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,inpatient,,,236.00000,135.94000,SilverSummit Healthplan,Commercial Exchange,,212.40,,,,,,,212.40,228.92,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,outpatient,,,236.00000,135.94000,SilverSummit Healthplan,Commercial Exchange,,212.40,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,inpatient,,,145.00000,83.52000,SilverSummit Healthplan,Commercial Exchange,,130.50,,,,,,,130.50,140.65,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,outpatient,,,145.00000,83.52000,SilverSummit Healthplan,Commercial Exchange,,130.50,,,,,,,37.70,140.65,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,inpatient,,,68.00000,39.17000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,inpatient,,,68.00000,39.17000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,inpatient,,,66.00000,38.02000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,outpatient,,,66.00000,38.02000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,inpatient,,,59.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,outpatient,,,59.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,inpatient,,,158.00000,91.01000,SilverSummit Healthplan,Commercial Exchange,,142.20,,,,,,,142.20,153.26,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,outpatient,,,158.00000,91.01000,SilverSummit Healthplan,Commercial Exchange,,142.20,,,,,,,41.08,153.26,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,inpatient,,,71.00000,40.90000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,outpatient,,,71.00000,40.90000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,inpatient,,,144.00000,82.94000,SilverSummit Healthplan,Commercial Exchange,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,outpatient,,,144.00000,82.94000,SilverSummit Healthplan,Commercial Exchange,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,inpatient,,,1448.00000,834.05000,SilverSummit Healthplan,Commercial Exchange,,1303.20,,,,,,,1303.20,1404.56,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,outpatient,,,1448.00000,834.05000,SilverSummit Healthplan,Commercial Exchange,,1303.20,,,,,,,376.48,1404.56,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,inpatient,,,72.00000,41.47000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,outpatient,,,72.00000,41.47000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,inpatient,,,102.00000,58.75000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,outpatient,,,102.00000,58.75000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,inpatient,,,154.00000,88.70000,SilverSummit Healthplan,Commercial Exchange,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,outpatient,,,154.00000,88.70000,SilverSummit Healthplan,Commercial Exchange,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,SilverSummit Healthplan,Commercial Exchange,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,SilverSummit Healthplan,Commercial Exchange,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,inpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,inpatient,,,66.00000,38.02000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,outpatient,,,66.00000,38.02000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,SilverSummit Healthplan,Commercial Exchange,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,SilverSummit Healthplan,Commercial Exchange,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,inpatient,,,44.00000,25.34000,SilverSummit Healthplan,Commercial Exchange,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,outpatient,,,44.00000,25.34000,SilverSummit Healthplan,Commercial Exchange,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,inpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,inpatient,,,150.00000,86.40000,SilverSummit Healthplan,Commercial Exchange,,135.00,,,,,,,135.00,145.50,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,outpatient,,,150.00000,86.40000,SilverSummit Healthplan,Commercial Exchange,,135.00,,,,,,,39.00,145.50,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,inpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,inpatient,,,56.00000,32.26000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,outpatient,,,56.00000,32.26000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,inpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,inpatient,,,66.00000,38.02000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,outpatient,,,66.00000,38.02000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,inpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,inpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,inpatient,,,60.00000,34.56000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,outpatient,,,60.00000,34.56000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,inpatient,,,58.00000,33.41000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,outpatient,,,58.00000,33.41000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,inpatient,,,71.00000,40.90000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,outpatient,,,71.00000,40.90000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,inpatient,,,72.00000,41.47000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,outpatient,,,72.00000,41.47000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,inpatient,,,56.00000,32.26000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,inpatient,,,56.00000,32.26000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,inpatient,,,60.00000,34.56000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,outpatient,,,60.00000,34.56000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,inpatient,,,56.00000,32.26000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,outpatient,,,56.00000,32.26000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,inpatient,,,39.00000,22.46000,SilverSummit Healthplan,Commercial Exchange,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,outpatient,,,39.00000,22.46000,SilverSummit Healthplan,Commercial Exchange,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,SilverSummit Healthplan,Commercial Exchange,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,SilverSummit Healthplan,Commercial Exchange,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,inpatient,,,73.00000,42.05000,SilverSummit Healthplan,Commercial Exchange,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,outpatient,,,73.00000,42.05000,SilverSummit Healthplan,Commercial Exchange,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,inpatient,,,127.00000,73.15000,SilverSummit Healthplan,Commercial Exchange,,114.30,,,,,,,114.30,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,SilverSummit Healthplan,Commercial Exchange,,114.30,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,inpatient,,,127.00000,73.15000,SilverSummit Healthplan,Commercial Exchange,,114.30,,,,,,,114.30,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,SilverSummit Healthplan,Commercial Exchange,,114.30,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,inpatient,,,372.00000,214.27000,SilverSummit Healthplan,Commercial Exchange,,334.80,,,,,,,334.80,360.84,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,outpatient,,,372.00000,214.27000,SilverSummit Healthplan,Commercial Exchange,,334.80,,,,,,,96.72,360.84,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,inpatient,,,69.00000,39.74000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,outpatient,,,69.00000,39.74000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,SilverSummit Healthplan,Commercial Exchange,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,SilverSummit Healthplan,Commercial Exchange,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,SilverSummit Healthplan,Commercial Exchange,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,SilverSummit Healthplan,Commercial Exchange,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,inpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,inpatient,,,57.00000,32.83000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,outpatient,,,57.00000,32.83000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,inpatient,,,96.00000,55.30000,SilverSummit Healthplan,Commercial Exchange,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,outpatient,,,96.00000,55.30000,SilverSummit Healthplan,Commercial Exchange,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,inpatient,,,44.00000,25.34000,SilverSummit Healthplan,Commercial Exchange,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,outpatient,,,44.00000,25.34000,SilverSummit Healthplan,Commercial Exchange,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,inpatient,,,60.00000,34.56000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,outpatient,,,60.00000,34.56000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,inpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,inpatient,,,60.00000,34.56000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,outpatient,,,60.00000,34.56000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,inpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,inpatient,,,74.00000,42.62000,SilverSummit Healthplan,Commercial Exchange,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,outpatient,,,74.00000,42.62000,SilverSummit Healthplan,Commercial Exchange,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,inpatient,,,69.00000,39.74000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,outpatient,,,69.00000,39.74000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,SilverSummit Healthplan,Commercial Exchange,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,SilverSummit Healthplan,Commercial Exchange,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,inpatient,,,53.00000,30.53000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,outpatient,,,53.00000,30.53000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,SilverSummit Healthplan,Commercial Exchange,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,SilverSummit Healthplan,Commercial Exchange,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,SilverSummit Healthplan,Commercial Exchange,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,SilverSummit Healthplan,Commercial Exchange,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,inpatient,,,70.00000,40.32000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,outpatient,,,70.00000,40.32000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,inpatient,,,71.00000,40.90000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,outpatient,,,71.00000,40.90000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,inpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,inpatient,,,325.00000,187.20000,SilverSummit Healthplan,Commercial Exchange,,292.50,,,,,,,292.50,315.25,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,outpatient,,,325.00000,187.20000,SilverSummit Healthplan,Commercial Exchange,,292.50,,,,,,,84.50,315.25,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,inpatient,,,72.00000,41.47000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,outpatient,,,72.00000,41.47000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,inpatient,,,72.00000,41.47000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,outpatient,,,72.00000,41.47000,SilverSummit Healthplan,Commercial Exchange,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,inpatient,,,76.00000,43.78000,SilverSummit Healthplan,Commercial Exchange,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,outpatient,,,76.00000,43.78000,SilverSummit Healthplan,Commercial Exchange,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,inpatient,,,240.00000,138.24000,SilverSummit Healthplan,Commercial Exchange,,216.00,,,,,,,216.00,232.80,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,outpatient,,,240.00000,138.24000,SilverSummit Healthplan,Commercial Exchange,,216.00,,,,,,,62.40,232.80,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,inpatient,,,93.00000,53.57000,SilverSummit Healthplan,Commercial Exchange,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,outpatient,,,93.00000,53.57000,SilverSummit Healthplan,Commercial Exchange,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,inpatient,,,59.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,outpatient,,,59.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,inpatient,,,81.00000,46.66000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,outpatient,,,81.00000,46.66000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,inpatient,,,58.00000,33.41000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,outpatient,,,58.00000,33.41000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,inpatient,,,21.00000,12.10000,SilverSummit Healthplan,Commercial Exchange,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,outpatient,,,21.00000,12.10000,SilverSummit Healthplan,Commercial Exchange,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,inpatient,,,56.00000,32.26000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,outpatient,,,56.00000,32.26000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,inpatient,,,64.00000,36.86000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,outpatient,,,64.00000,36.86000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,inpatient,,,80.00000,46.08000,SilverSummit Healthplan,Commercial Exchange,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,outpatient,,,80.00000,46.08000,SilverSummit Healthplan,Commercial Exchange,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,inpatient,,,109.00000,62.78000,SilverSummit Healthplan,Commercial Exchange,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,outpatient,,,109.00000,62.78000,SilverSummit Healthplan,Commercial Exchange,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,inpatient,,,59.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,outpatient,,,59.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,inpatient,,,115.00000,66.24000,SilverSummit Healthplan,Commercial Exchange,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,outpatient,,,115.00000,66.24000,SilverSummit Healthplan,Commercial Exchange,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,inpatient,,,57.00000,32.83000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,outpatient,,,57.00000,32.83000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,inpatient,,,118.00000,67.97000,SilverSummit Healthplan,Commercial Exchange,,106.20,,,,,,,106.20,114.46,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,outpatient,,,118.00000,67.97000,SilverSummit Healthplan,Commercial Exchange,,106.20,,,,,,,30.68,114.46,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,inpatient,,,268.00000,154.37000,SilverSummit Healthplan,Commercial Exchange,,241.20,,,,,,,241.20,259.96,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,outpatient,,,268.00000,154.37000,SilverSummit Healthplan,Commercial Exchange,,241.20,,,,,,,69.68,259.96,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,inpatient,,,114.00000,65.66000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,inpatient,,,114.00000,65.66000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,inpatient,,,78.00000,44.93000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,outpatient,,,78.00000,44.93000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,inpatient,,,91.00000,52.42000,SilverSummit Healthplan,Commercial Exchange,,81.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,outpatient,,,91.00000,52.42000,SilverSummit Healthplan,Commercial Exchange,,81.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,inpatient,,,66.00000,38.02000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,inpatient,,,66.00000,38.02000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,inpatient,,,300.00000,172.80000,SilverSummit Healthplan,Commercial Exchange,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,outpatient,,,300.00000,172.80000,SilverSummit Healthplan,Commercial Exchange,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,inpatient,,,185.00000,106.56000,SilverSummit Healthplan,Commercial Exchange,,166.50,,,,,,,166.50,179.45,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,outpatient,,,185.00000,106.56000,SilverSummit Healthplan,Commercial Exchange,,166.50,,,,,,,48.10,179.45,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,inpatient,,,76.00000,43.78000,SilverSummit Healthplan,Commercial Exchange,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,outpatient,,,76.00000,43.78000,SilverSummit Healthplan,Commercial Exchange,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,inpatient,,,53.00000,30.53000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,outpatient,,,53.00000,30.53000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,inpatient,,,77.00000,44.35000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,outpatient,,,77.00000,44.35000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,inpatient,,,222.00000,127.87000,SilverSummit Healthplan,Commercial Exchange,,199.80,,,,,,,199.80,215.34,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,outpatient,,,222.00000,127.87000,SilverSummit Healthplan,Commercial Exchange,,199.80,,,,,,,57.72,215.34,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,inpatient,,,292.00000,168.19000,SilverSummit Healthplan,Commercial Exchange,,262.80,,,,,,,262.80,283.24,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,outpatient,,,292.00000,168.19000,SilverSummit Healthplan,Commercial Exchange,,262.80,,,,,,,75.92,283.24,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,inpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,inpatient,,,125.00000,72.00000,SilverSummit Healthplan,Commercial Exchange,,112.50,,,,,,,112.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,SilverSummit Healthplan,Commercial Exchange,,112.50,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,inpatient,,,125.00000,72.00000,SilverSummit Healthplan,Commercial Exchange,,112.50,,,,,,,112.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,SilverSummit Healthplan,Commercial Exchange,,112.50,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,inpatient,,,359.00000,206.78000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,outpatient,,,359.00000,206.78000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,inpatient,,,111.00000,63.94000,SilverSummit Healthplan,Commercial Exchange,,99.90,,,,,,,99.90,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,outpatient,,,111.00000,63.94000,SilverSummit Healthplan,Commercial Exchange,,99.90,,,,,,,28.86,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,inpatient,,,141.00000,81.22000,SilverSummit Healthplan,Commercial Exchange,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,SilverSummit Healthplan,Commercial Exchange,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,inpatient,,,141.00000,81.22000,SilverSummit Healthplan,Commercial Exchange,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,SilverSummit Healthplan,Commercial Exchange,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,inpatient,,,114.00000,65.66000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,inpatient,,,114.00000,65.66000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,inpatient,,,114.00000,65.66000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,inpatient,,,114.00000,65.66000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,inpatient,,,78.00000,44.93000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,outpatient,,,78.00000,44.93000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,inpatient,,,359.00000,206.78000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,inpatient,,,359.00000,206.78000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,inpatient,,,70.00000,40.32000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,outpatient,,,70.00000,40.32000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,inpatient,,,18.00000,10.37000,SilverSummit Healthplan,Commercial Exchange,,16.20,,,,,,,16.20,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,outpatient,,,18.00000,10.37000,SilverSummit Healthplan,Commercial Exchange,,16.20,,,,,,,4.68,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,inpatient,,,408.00000,235.01000,SilverSummit Healthplan,Commercial Exchange,,367.20,,,,,,,367.20,395.76,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,outpatient,,,408.00000,235.01000,SilverSummit Healthplan,Commercial Exchange,,367.20,,,,,,,106.08,395.76,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,inpatient,,,102.00000,58.75000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,outpatient,,,102.00000,58.75000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,inpatient,,,330.00000,190.08000,SilverSummit Healthplan,Commercial Exchange,,297.00,,,,,,,297.00,320.10,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,outpatient,,,330.00000,190.08000,SilverSummit Healthplan,Commercial Exchange,,297.00,,,,,,,85.80,320.10,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,inpatient,,,56.00000,32.26000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,outpatient,,,56.00000,32.26000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,inpatient,,,136.00000,78.34000,SilverSummit Healthplan,Commercial Exchange,,122.40,,,,,,,122.40,131.92,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,outpatient,,,136.00000,78.34000,SilverSummit Healthplan,Commercial Exchange,,122.40,,,,,,,35.36,131.92,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,inpatient,,,83.00000,47.81000,SilverSummit Healthplan,Commercial Exchange,,74.70,,,,,,,74.70,80.51,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,outpatient,,,83.00000,47.81000,SilverSummit Healthplan,Commercial Exchange,,74.70,,,,,,,21.58,80.51,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,inpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,inpatient,,,142.00000,81.79000,SilverSummit Healthplan,Commercial Exchange,,127.80,,,,,,,127.80,137.74,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,outpatient,,,142.00000,81.79000,SilverSummit Healthplan,Commercial Exchange,,127.80,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,inpatient,,,51.00000,29.38000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,outpatient,,,51.00000,29.38000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,inpatient,,,70.00000,40.32000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,outpatient,,,70.00000,40.32000,SilverSummit Healthplan,Commercial Exchange,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,inpatient,,,99.00000,57.02000,SilverSummit Healthplan,Commercial Exchange,,89.10,,,,,,,89.10,96.03,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,outpatient,,,99.00000,57.02000,SilverSummit Healthplan,Commercial Exchange,,89.10,,,,,,,25.74,96.03,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,inpatient,,,78.00000,44.93000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,outpatient,,,78.00000,44.93000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,inpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,inpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,inpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,inpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,inpatient,,,75.00000,43.20000,SilverSummit Healthplan,Commercial Exchange,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,outpatient,,,75.00000,43.20000,SilverSummit Healthplan,Commercial Exchange,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,inpatient,,,37.00000,21.31000,SilverSummit Healthplan,Commercial Exchange,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,SilverSummit Healthplan,Commercial Exchange,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,inpatient,,,37.00000,21.31000,SilverSummit Healthplan,Commercial Exchange,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,SilverSummit Healthplan,Commercial Exchange,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,inpatient,,,59.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,outpatient,,,59.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,inpatient,,,35.00000,20.16000,SilverSummit Healthplan,Commercial Exchange,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,outpatient,,,35.00000,20.16000,SilverSummit Healthplan,Commercial Exchange,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,inpatient,,,59.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,outpatient,,,59.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,inpatient,,,56.00000,32.26000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,outpatient,,,56.00000,32.26000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,inpatient,,,74.00000,42.62000,SilverSummit Healthplan,Commercial Exchange,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,outpatient,,,74.00000,42.62000,SilverSummit Healthplan,Commercial Exchange,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,inpatient,,,90.00000,51.84000,SilverSummit Healthplan,Commercial Exchange,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,outpatient,,,90.00000,51.84000,SilverSummit Healthplan,Commercial Exchange,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,inpatient,,,68.00000,39.17000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,inpatient,,,142.00000,81.79000,SilverSummit Healthplan,Commercial Exchange,,127.80,,,,,,,127.80,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,outpatient,,,142.00000,81.79000,SilverSummit Healthplan,Commercial Exchange,,127.80,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,inpatient,,,68.00000,39.17000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,inpatient,,,74.00000,42.62000,SilverSummit Healthplan,Commercial Exchange,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,outpatient,,,74.00000,42.62000,SilverSummit Healthplan,Commercial Exchange,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,inpatient,,,89.00000,51.26000,SilverSummit Healthplan,Commercial Exchange,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,SilverSummit Healthplan,Commercial Exchange,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,inpatient,,,89.00000,51.26000,SilverSummit Healthplan,Commercial Exchange,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,SilverSummit Healthplan,Commercial Exchange,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,inpatient,,,57.00000,32.83000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,outpatient,,,57.00000,32.83000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,inpatient,,,77.00000,44.35000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,outpatient,,,77.00000,44.35000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,inpatient,,,64.00000,36.86000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,outpatient,,,64.00000,36.86000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,inpatient,,,69.00000,39.74000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,outpatient,,,69.00000,39.74000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,inpatient,,,1178.00000,678.53000,SilverSummit Healthplan,Commercial Exchange,,1060.20,,,,,,,1060.20,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,outpatient,,,1178.00000,678.53000,SilverSummit Healthplan,Commercial Exchange,,1060.20,,,,,,,306.28,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,inpatient,,,127.00000,73.15000,SilverSummit Healthplan,Commercial Exchange,,114.30,,,,,,,114.30,123.19,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,outpatient,,,127.00000,73.15000,SilverSummit Healthplan,Commercial Exchange,,114.30,,,,,,,33.02,123.19,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,inpatient,,,277.00000,159.55000,SilverSummit Healthplan,Commercial Exchange,,249.30,,,,,,,249.30,268.69,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,outpatient,,,277.00000,159.55000,SilverSummit Healthplan,Commercial Exchange,,249.30,,,,,,,72.02,268.69,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,inpatient,,,940.00000,541.44000,SilverSummit Healthplan,Commercial Exchange,,846.00,,,,,,,846.00,911.80,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,outpatient,,,940.00000,541.44000,SilverSummit Healthplan,Commercial Exchange,,846.00,,,,,,,244.40,911.80,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,inpatient,,,97.00000,55.87000,SilverSummit Healthplan,Commercial Exchange,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,outpatient,,,97.00000,55.87000,SilverSummit Healthplan,Commercial Exchange,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,inpatient,,,16.00000,9.22000,SilverSummit Healthplan,Commercial Exchange,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,outpatient,,,16.00000,9.22000,SilverSummit Healthplan,Commercial Exchange,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,inpatient,,,57.00000,32.83000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,outpatient,,,57.00000,32.83000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,inpatient,,,131.00000,75.46000,SilverSummit Healthplan,Commercial Exchange,,117.90,,,,,,,117.90,127.07,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,outpatient,,,131.00000,75.46000,SilverSummit Healthplan,Commercial Exchange,,117.90,,,,,,,34.06,127.07,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,inpatient,,,2160.00000,1244.16000,SilverSummit Healthplan,Commercial Exchange,,1944.00,,,,,,,1944.00,2095.20,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,outpatient,,,2160.00000,1244.16000,SilverSummit Healthplan,Commercial Exchange,,1944.00,,,,,,,561.60,2095.20,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,inpatient,,,37.00000,21.31000,SilverSummit Healthplan,Commercial Exchange,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,outpatient,,,37.00000,21.31000,SilverSummit Healthplan,Commercial Exchange,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,inpatient,,,74.00000,42.62000,SilverSummit Healthplan,Commercial Exchange,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,SilverSummit Healthplan,Commercial Exchange,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,inpatient,,,54.00000,31.10000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,outpatient,,,54.00000,31.10000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,inpatient,,,76.00000,43.78000,SilverSummit Healthplan,Commercial Exchange,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,outpatient,,,76.00000,43.78000,SilverSummit Healthplan,Commercial Exchange,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,inpatient,,,606.00000,349.06000,SilverSummit Healthplan,Commercial Exchange,,545.40,,,,,,,545.40,587.82,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,outpatient,,,606.00000,349.06000,SilverSummit Healthplan,Commercial Exchange,,545.40,,,,,,,157.56,587.82,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,inpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,inpatient,,,300.00000,172.80000,SilverSummit Healthplan,Commercial Exchange,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,outpatient,,,300.00000,172.80000,SilverSummit Healthplan,Commercial Exchange,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,inpatient,,,59.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,outpatient,,,59.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,inpatient,,,98.00000,56.45000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,outpatient,,,98.00000,56.45000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,inpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,inpatient,,,128.00000,73.73000,SilverSummit Healthplan,Commercial Exchange,,115.20,,,,,,,115.20,124.16,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,outpatient,,,128.00000,73.73000,SilverSummit Healthplan,Commercial Exchange,,115.20,,,,,,,33.28,124.16,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,inpatient,,,16.00000,9.22000,SilverSummit Healthplan,Commercial Exchange,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,outpatient,,,16.00000,9.22000,SilverSummit Healthplan,Commercial Exchange,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,inpatient,,,565.00000,325.44000,SilverSummit Healthplan,Commercial Exchange,,508.50,,,,,,,508.50,548.05,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,outpatient,,,565.00000,325.44000,SilverSummit Healthplan,Commercial Exchange,,508.50,,,,,,,146.90,548.05,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,inpatient,,,850.00000,489.60000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,outpatient,,,850.00000,489.60000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,inpatient,,,77.00000,44.35000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,outpatient,,,77.00000,44.35000,SilverSummit Healthplan,Commercial Exchange,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,inpatient,,,86.00000,49.54000,SilverSummit Healthplan,Commercial Exchange,,77.40,,,,,,,77.40,83.42,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,outpatient,,,86.00000,49.54000,SilverSummit Healthplan,Commercial Exchange,,77.40,,,,,,,22.36,83.42,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,inpatient,,,837.00000,482.11000,SilverSummit Healthplan,Commercial Exchange,,753.30,,,,,,,753.30,811.89,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,outpatient,,,837.00000,482.11000,SilverSummit Healthplan,Commercial Exchange,,753.30,,,,,,,217.62,811.89,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,inpatient,,,60.00000,34.56000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,outpatient,,,60.00000,34.56000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,inpatient,,,56.00000,32.26000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,outpatient,,,56.00000,32.26000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,inpatient,,,56.00000,32.26000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,outpatient,,,56.00000,32.26000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,inpatient,,,74.00000,42.62000,SilverSummit Healthplan,Commercial Exchange,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,SilverSummit Healthplan,Commercial Exchange,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,inpatient,,,167.00000,96.19000,SilverSummit Healthplan,Commercial Exchange,,150.30,,,,,,,150.30,161.99,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,outpatient,,,167.00000,96.19000,SilverSummit Healthplan,Commercial Exchange,,150.30,,,,,,,43.42,161.99,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,inpatient,,,200.00000,115.20000,SilverSummit Healthplan,Commercial Exchange,,180.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,outpatient,,,200.00000,115.20000,SilverSummit Healthplan,Commercial Exchange,,180.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,inpatient,,,93.00000,53.57000,SilverSummit Healthplan,Commercial Exchange,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,outpatient,,,93.00000,53.57000,SilverSummit Healthplan,Commercial Exchange,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,inpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Commercial Exchange,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,inpatient,,,190.00000,109.44000,SilverSummit Healthplan,Commercial Exchange,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,outpatient,,,190.00000,109.44000,SilverSummit Healthplan,Commercial Exchange,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,inpatient,,,64.00000,36.86000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,outpatient,,,64.00000,36.86000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,inpatient,,,525.00000,302.40000,SilverSummit Healthplan,Commercial Exchange,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,outpatient,,,525.00000,302.40000,SilverSummit Healthplan,Commercial Exchange,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,inpatient,,,54.00000,31.10000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,outpatient,,,54.00000,31.10000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,inpatient,,,53.00000,30.53000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,outpatient,,,53.00000,30.53000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,inpatient,,,40.00000,23.04000,SilverSummit Healthplan,Commercial Exchange,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,SilverSummit Healthplan,Commercial Exchange,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,inpatient,,,453.00000,260.93000,SilverSummit Healthplan,Commercial Exchange,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,outpatient,,,453.00000,260.93000,SilverSummit Healthplan,Commercial Exchange,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,inpatient,,,25.00000,14.40000,SilverSummit Healthplan,Commercial Exchange,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,outpatient,,,25.00000,14.40000,SilverSummit Healthplan,Commercial Exchange,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,inpatient,,,56.00000,32.26000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,outpatient,,,56.00000,32.26000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,inpatient,,,59.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,outpatient,,,59.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,inpatient,,,53.00000,30.53000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,outpatient,,,53.00000,30.53000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,inpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,inpatient,,,350.00000,201.60000,SilverSummit Healthplan,Commercial Exchange,,315.00,,,,,,,315.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,outpatient,,,350.00000,201.60000,SilverSummit Healthplan,Commercial Exchange,,315.00,,,,,,,91.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,inpatient,,,225.00000,129.60000,SilverSummit Healthplan,Commercial Exchange,,202.50,,,,,,,202.50,218.25,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,outpatient,,,225.00000,129.60000,SilverSummit Healthplan,Commercial Exchange,,202.50,,,,,,,58.50,218.25,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,inpatient,,,52.00000,29.95000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,outpatient,,,52.00000,29.95000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,inpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,inpatient,,,134.00000,77.18000,SilverSummit Healthplan,Commercial Exchange,,120.60,,,,,,,120.60,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,outpatient,,,134.00000,77.18000,SilverSummit Healthplan,Commercial Exchange,,120.60,,,,,,,34.84,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,inpatient,,,52.00000,29.95000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,outpatient,,,52.00000,29.95000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,inpatient,,,186.00000,107.14000,SilverSummit Healthplan,Commercial Exchange,,167.40,,,,,,,167.40,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,outpatient,,,186.00000,107.14000,SilverSummit Healthplan,Commercial Exchange,,167.40,,,,,,,48.36,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,inpatient,,,300.00000,172.80000,SilverSummit Healthplan,Commercial Exchange,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,SilverSummit Healthplan,Commercial Exchange,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,inpatient,,,300.00000,172.80000,SilverSummit Healthplan,Commercial Exchange,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,SilverSummit Healthplan,Commercial Exchange,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,inpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,inpatient,,,205.00000,118.08000,SilverSummit Healthplan,Commercial Exchange,,184.50,,,,,,,184.50,198.85,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,outpatient,,,205.00000,118.08000,SilverSummit Healthplan,Commercial Exchange,,184.50,,,,,,,53.30,198.85,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,inpatient,,,75.00000,36.15000,SilverSummit Healthplan,Commercial Exchange,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,outpatient,,,75.00000,36.15000,SilverSummit Healthplan,Commercial Exchange,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,inpatient,,,65.00000,31.33000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,outpatient,,,65.00000,31.33000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,inpatient,,,92.00000,44.34000,SilverSummit Healthplan,Commercial Exchange,,82.80,,,,,,,82.80,89.24,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,outpatient,,,92.00000,44.34000,SilverSummit Healthplan,Commercial Exchange,,82.80,,,,,,,23.92,89.24,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,inpatient,,,24.00000,11.57000,SilverSummit Healthplan,Commercial Exchange,,21.60,,,,,,,21.60,23.28,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,SilverSummit Healthplan,Commercial Exchange,,21.60,,,,,,,6.24,23.28,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,inpatient,,,20.00000,9.64000,SilverSummit Healthplan,Commercial Exchange,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,outpatient,,,20.00000,9.64000,SilverSummit Healthplan,Commercial Exchange,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,inpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,inpatient,,,42.00000,20.24000,SilverSummit Healthplan,Commercial Exchange,,37.80,,,,,,,37.80,40.74,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,outpatient,,,42.00000,20.24000,SilverSummit Healthplan,Commercial Exchange,,37.80,,,,,,,10.92,40.74,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,inpatient,,,69.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,outpatient,,,69.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,inpatient,,,65.00000,31.33000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,outpatient,,,65.00000,31.33000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,inpatient,,,76.00000,36.63000,SilverSummit Healthplan,Commercial Exchange,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,outpatient,,,76.00000,36.63000,SilverSummit Healthplan,Commercial Exchange,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,inpatient,,,89.00000,42.90000,SilverSummit Healthplan,Commercial Exchange,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,outpatient,,,89.00000,42.90000,SilverSummit Healthplan,Commercial Exchange,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,inpatient,,,76.00000,36.63000,SilverSummit Healthplan,Commercial Exchange,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,outpatient,,,76.00000,36.63000,SilverSummit Healthplan,Commercial Exchange,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,inpatient,,,28.00000,13.50000,SilverSummit Healthplan,Commercial Exchange,,25.20,,,,,,,25.20,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,outpatient,,,28.00000,13.50000,SilverSummit Healthplan,Commercial Exchange,,25.20,,,,,,,7.28,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,inpatient,,,98.00000,47.24000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,outpatient,,,98.00000,47.24000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,inpatient,,,64.00000,30.85000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,outpatient,,,64.00000,30.85000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,inpatient,,,75.00000,36.15000,SilverSummit Healthplan,Commercial Exchange,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,outpatient,,,75.00000,36.15000,SilverSummit Healthplan,Commercial Exchange,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,inpatient,,,76.00000,36.63000,SilverSummit Healthplan,Commercial Exchange,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,outpatient,,,76.00000,36.63000,SilverSummit Healthplan,Commercial Exchange,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,inpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,inpatient,,,114.00000,54.95000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,outpatient,,,114.00000,54.95000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,inpatient,,,74.00000,35.67000,SilverSummit Healthplan,Commercial Exchange,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,outpatient,,,74.00000,35.67000,SilverSummit Healthplan,Commercial Exchange,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,inpatient,,,69.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,outpatient,,,69.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,inpatient,,,74.00000,35.67000,SilverSummit Healthplan,Commercial Exchange,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,outpatient,,,74.00000,35.67000,SilverSummit Healthplan,Commercial Exchange,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,inpatient,,,87.00000,41.93000,SilverSummit Healthplan,Commercial Exchange,,78.30,,,,,,,78.30,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,outpatient,,,87.00000,41.93000,SilverSummit Healthplan,Commercial Exchange,,78.30,,,,,,,22.62,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,inpatient,,,79.00000,38.08000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,outpatient,,,79.00000,38.08000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,inpatient,,,75.00000,36.15000,SilverSummit Healthplan,Commercial Exchange,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,outpatient,,,75.00000,36.15000,SilverSummit Healthplan,Commercial Exchange,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,inpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,inpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,inpatient,,,64.00000,30.85000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,outpatient,,,64.00000,30.85000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,inpatient,,,164.00000,79.05000,SilverSummit Healthplan,Commercial Exchange,,147.60,,,,,,,147.60,159.08,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,outpatient,,,164.00000,79.05000,SilverSummit Healthplan,Commercial Exchange,,147.60,,,,,,,42.64,159.08,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,inpatient,,,54.00000,26.03000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,outpatient,,,54.00000,26.03000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,inpatient,,,8.00000,3.86000,SilverSummit Healthplan,Commercial Exchange,,7.20,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,outpatient,,,8.00000,3.86000,SilverSummit Healthplan,Commercial Exchange,,7.20,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,inpatient,,,69.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,outpatient,,,69.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,inpatient,,,8.00000,3.86000,SilverSummit Healthplan,Commercial Exchange,,7.20,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,outpatient,,,8.00000,3.86000,SilverSummit Healthplan,Commercial Exchange,,7.20,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,inpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,inpatient,,,8.00000,3.86000,SilverSummit Healthplan,Commercial Exchange,,7.20,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,outpatient,,,8.00000,3.86000,SilverSummit Healthplan,Commercial Exchange,,7.20,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,inpatient,,,14.00000,6.75000,SilverSummit Healthplan,Commercial Exchange,,12.60,,,,,,,12.60,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,outpatient,,,14.00000,6.75000,SilverSummit Healthplan,Commercial Exchange,,12.60,,,,,,,3.64,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,inpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,inpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,inpatient,,,112.00000,53.98000,SilverSummit Healthplan,Commercial Exchange,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,outpatient,,,112.00000,53.98000,SilverSummit Healthplan,Commercial Exchange,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,inpatient,,,13.00000,6.27000,SilverSummit Healthplan,Commercial Exchange,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,outpatient,,,13.00000,6.27000,SilverSummit Healthplan,Commercial Exchange,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,inpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,inpatient,,,31.00000,14.94000,SilverSummit Healthplan,Commercial Exchange,,27.90,,,,,,,27.90,30.07,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,outpatient,,,31.00000,14.94000,SilverSummit Healthplan,Commercial Exchange,,27.90,,,,,,,8.06,30.07,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,inpatient,,,92.00000,44.34000,SilverSummit Healthplan,Commercial Exchange,,82.80,,,,,,,82.80,89.24,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,outpatient,,,92.00000,44.34000,SilverSummit Healthplan,Commercial Exchange,,82.80,,,,,,,23.92,89.24,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,inpatient,,,80.00000,38.56000,SilverSummit Healthplan,Commercial Exchange,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,outpatient,,,80.00000,38.56000,SilverSummit Healthplan,Commercial Exchange,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,inpatient,,,30.00000,14.46000,SilverSummit Healthplan,Commercial Exchange,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,SilverSummit Healthplan,Commercial Exchange,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,inpatient,,,30.00000,14.46000,SilverSummit Healthplan,Commercial Exchange,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,SilverSummit Healthplan,Commercial Exchange,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,inpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,inpatient,,,24.00000,11.57000,SilverSummit Healthplan,Commercial Exchange,,21.60,,,,,,,21.60,23.28,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,SilverSummit Healthplan,Commercial Exchange,,21.60,,,,,,,6.24,23.28,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,inpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,inpatient,,,29.00000,13.98000,SilverSummit Healthplan,Commercial Exchange,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,outpatient,,,29.00000,13.98000,SilverSummit Healthplan,Commercial Exchange,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,inpatient,,,97.00000,46.75000,SilverSummit Healthplan,Commercial Exchange,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,outpatient,,,97.00000,46.75000,SilverSummit Healthplan,Commercial Exchange,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,inpatient,,,225.00000,108.45000,SilverSummit Healthplan,Commercial Exchange,,202.50,,,,,,,202.50,218.25,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,outpatient,,,225.00000,108.45000,SilverSummit Healthplan,Commercial Exchange,,202.50,,,,,,,58.50,218.25,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,inpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,inpatient,,,71.00000,34.22000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,outpatient,,,71.00000,34.22000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,inpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,inpatient,,,71.00000,34.22000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,outpatient,,,71.00000,34.22000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,inpatient,,,108.00000,52.06000,SilverSummit Healthplan,Commercial Exchange,,97.20,,,,,,,97.20,104.76,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,outpatient,,,108.00000,52.06000,SilverSummit Healthplan,Commercial Exchange,,97.20,,,,,,,28.08,104.76,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,inpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,inpatient,,,51.00000,24.58000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,outpatient,,,51.00000,24.58000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,inpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,inpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,inpatient,,,19.00000,9.16000,SilverSummit Healthplan,Commercial Exchange,,17.10,,,,,,,17.10,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,outpatient,,,19.00000,9.16000,SilverSummit Healthplan,Commercial Exchange,,17.10,,,,,,,4.94,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,inpatient,,,54.00000,26.03000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,outpatient,,,54.00000,26.03000,SilverSummit Healthplan,Commercial Exchange,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,inpatient,,,103.00000,49.65000,SilverSummit Healthplan,Commercial Exchange,,92.70,,,,,,,92.70,99.91,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,outpatient,,,103.00000,49.65000,SilverSummit Healthplan,Commercial Exchange,,92.70,,,,,,,26.78,99.91,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,inpatient,,,9.00000,4.34000,SilverSummit Healthplan,Commercial Exchange,,8.10,,,,,,,8.10,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,outpatient,,,9.00000,4.34000,SilverSummit Healthplan,Commercial Exchange,,8.10,,,,,,,2.34,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,inpatient,,,13.00000,6.27000,SilverSummit Healthplan,Commercial Exchange,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,outpatient,,,13.00000,6.27000,SilverSummit Healthplan,Commercial Exchange,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,inpatient,,,80.00000,38.56000,SilverSummit Healthplan,Commercial Exchange,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,outpatient,,,80.00000,38.56000,SilverSummit Healthplan,Commercial Exchange,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,inpatient,,,47.00000,22.65000,SilverSummit Healthplan,Commercial Exchange,,42.30,,,,,,,42.30,45.59,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,outpatient,,,47.00000,22.65000,SilverSummit Healthplan,Commercial Exchange,,42.30,,,,,,,12.22,45.59,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,inpatient,,,91.00000,43.86000,SilverSummit Healthplan,Commercial Exchange,,81.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,outpatient,,,91.00000,43.86000,SilverSummit Healthplan,Commercial Exchange,,81.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,inpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,inpatient,,,18.00000,8.68000,SilverSummit Healthplan,Commercial Exchange,,16.20,,,,,,,16.20,17.46,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,outpatient,,,18.00000,8.68000,SilverSummit Healthplan,Commercial Exchange,,16.20,,,,,,,4.68,17.46,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,inpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,inpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,inpatient,,,21.00000,11.15000,SilverSummit Healthplan,Commercial Exchange,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,SilverSummit Healthplan,Commercial Exchange,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,inpatient,,,71.00000,37.70000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,outpatient,,,71.00000,37.70000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,inpatient,,,21.00000,11.15000,SilverSummit Healthplan,Commercial Exchange,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,SilverSummit Healthplan,Commercial Exchange,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,inpatient,,,128.00000,67.97000,SilverSummit Healthplan,Commercial Exchange,,115.20,,,,,,,115.20,124.16,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,outpatient,,,128.00000,67.97000,SilverSummit Healthplan,Commercial Exchange,,115.20,,,,,,,33.28,124.16,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,inpatient,,,65.00000,34.52000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,outpatient,,,65.00000,34.52000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,inpatient,,,31.00000,16.46000,SilverSummit Healthplan,Commercial Exchange,,27.90,,,,,,,27.90,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,outpatient,,,31.00000,16.46000,SilverSummit Healthplan,Commercial Exchange,,27.90,,,,,,,8.06,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,inpatient,,,61.00000,32.39000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,outpatient,,,61.00000,32.39000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,inpatient,,,25.00000,13.28000,SilverSummit Healthplan,Commercial Exchange,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,SilverSummit Healthplan,Commercial Exchange,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,inpatient,,,25.00000,13.28000,SilverSummit Healthplan,Commercial Exchange,91,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,SilverSummit Healthplan,Commercial Exchange,91,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,inpatient,,,103.00000,54.69000,SilverSummit Healthplan,Commercial Exchange,,92.70,,,,,,,92.70,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,outpatient,,,103.00000,54.69000,SilverSummit Healthplan,Commercial Exchange,,92.70,,,,,,,26.78,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,inpatient,,,96.00000,50.98000,SilverSummit Healthplan,Commercial Exchange,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,outpatient,,,96.00000,50.98000,SilverSummit Healthplan,Commercial Exchange,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,inpatient,,,75.00000,39.83000,SilverSummit Healthplan,Commercial Exchange,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,outpatient,,,75.00000,39.83000,SilverSummit Healthplan,Commercial Exchange,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,inpatient,,,68.00000,36.11000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,outpatient,,,68.00000,36.11000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,inpatient,,,61.00000,32.39000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,outpatient,,,61.00000,32.39000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,inpatient,,,29.00000,15.40000,SilverSummit Healthplan,Commercial Exchange,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,outpatient,,,29.00000,15.40000,SilverSummit Healthplan,Commercial Exchange,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,SilverSummit Healthplan,Commercial Exchange,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,SilverSummit Healthplan,Commercial Exchange,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,SilverSummit Healthplan,Commercial Exchange,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,SilverSummit Healthplan,Commercial Exchange,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,inpatient,,,63.00000,33.45000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,outpatient,,,63.00000,33.45000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,inpatient,,,79.00000,41.95000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,outpatient,,,79.00000,41.95000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,inpatient,,,63.00000,33.45000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,outpatient,,,63.00000,33.45000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,SilverSummit Healthplan,Commercial Exchange,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,SilverSummit Healthplan,Commercial Exchange,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,inpatient,,,112.00000,59.47000,SilverSummit Healthplan,Commercial Exchange,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,outpatient,,,112.00000,59.47000,SilverSummit Healthplan,Commercial Exchange,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,inpatient,,,25.00000,13.28000,SilverSummit Healthplan,Commercial Exchange,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,outpatient,,,25.00000,13.28000,SilverSummit Healthplan,Commercial Exchange,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,inpatient,,,118.00000,62.66000,SilverSummit Healthplan,Commercial Exchange,,106.20,,,,,,,106.20,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,outpatient,,,118.00000,62.66000,SilverSummit Healthplan,Commercial Exchange,,106.20,,,,,,,30.68,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,inpatient,,,29.00000,15.40000,SilverSummit Healthplan,Commercial Exchange,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,outpatient,,,29.00000,15.40000,SilverSummit Healthplan,Commercial Exchange,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,inpatient,,,25.00000,13.28000,SilverSummit Healthplan,Commercial Exchange,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,outpatient,,,25.00000,13.28000,SilverSummit Healthplan,Commercial Exchange,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,inpatient,,,25.00000,13.28000,SilverSummit Healthplan,Commercial Exchange,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,outpatient,,,25.00000,13.28000,SilverSummit Healthplan,Commercial Exchange,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,inpatient,,,71.00000,37.70000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,outpatient,,,71.00000,37.70000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,inpatient,,,59.00000,31.33000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,outpatient,,,59.00000,31.33000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,inpatient,,,62.00000,32.92000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,outpatient,,,62.00000,32.92000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,inpatient,,,138.00000,73.28000,SilverSummit Healthplan,Commercial Exchange,,124.20,,,,,,,124.20,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,outpatient,,,138.00000,73.28000,SilverSummit Healthplan,Commercial Exchange,,124.20,,,,,,,35.88,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,inpatient,,,62.00000,32.92000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,outpatient,,,62.00000,32.92000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,inpatient,,,78.00000,41.42000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,outpatient,,,78.00000,41.42000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,inpatient,,,69.00000,36.64000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,outpatient,,,69.00000,36.64000,SilverSummit Healthplan,Commercial Exchange,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,inpatient,,,88.00000,46.73000,SilverSummit Healthplan,Commercial Exchange,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,outpatient,,,88.00000,46.73000,SilverSummit Healthplan,Commercial Exchange,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,inpatient,,,60.00000,31.86000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,outpatient,,,60.00000,31.86000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,inpatient,,,64.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,outpatient,,,64.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,inpatient,,,63.00000,33.45000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,outpatient,,,63.00000,33.45000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,inpatient,,,137.00000,72.75000,SilverSummit Healthplan,Commercial Exchange,,123.30,,,,,,,123.30,132.89,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,outpatient,,,137.00000,72.75000,SilverSummit Healthplan,Commercial Exchange,,123.30,,,,,,,35.62,132.89,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,inpatient,,,347.00000,184.26000,SilverSummit Healthplan,Commercial Exchange,,312.30,,,,,,,312.30,336.59,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,outpatient,,,347.00000,184.26000,SilverSummit Healthplan,Commercial Exchange,,312.30,,,,,,,90.22,336.59,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,inpatient,,,57.00000,30.27000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,outpatient,,,57.00000,30.27000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,inpatient,,,56.00000,29.74000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,outpatient,,,56.00000,29.74000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,inpatient,,,16.00000,8.50000,SilverSummit Healthplan,Commercial Exchange,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,outpatient,,,16.00000,8.50000,SilverSummit Healthplan,Commercial Exchange,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,inpatient,,,85.00000,45.14000,SilverSummit Healthplan,Commercial Exchange,,76.50,,,,,,,76.50,82.45,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,outpatient,,,85.00000,45.14000,SilverSummit Healthplan,Commercial Exchange,,76.50,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,inpatient,,,34.00000,18.05000,SilverSummit Healthplan,Commercial Exchange,,30.60,,,,,,,30.60,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,outpatient,,,34.00000,18.05000,SilverSummit Healthplan,Commercial Exchange,,30.60,,,,,,,8.84,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,inpatient,,,231.00000,122.66000,SilverSummit Healthplan,Commercial Exchange,,207.90,,,,,,,207.90,224.07,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,outpatient,,,231.00000,122.66000,SilverSummit Healthplan,Commercial Exchange,,207.90,,,,,,,60.06,224.07,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,inpatient,,,36.00000,19.12000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,outpatient,,,36.00000,19.12000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,inpatient,,,61.00000,32.39000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,outpatient,,,61.00000,32.39000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,inpatient,,,111.00000,58.94000,SilverSummit Healthplan,Commercial Exchange,,99.90,,,,,,,99.90,107.67,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,outpatient,,,111.00000,58.94000,SilverSummit Healthplan,Commercial Exchange,,99.90,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,inpatient,,,61.00000,32.39000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,outpatient,,,61.00000,32.39000,SilverSummit Healthplan,Commercial Exchange,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,inpatient,,,60.00000,31.86000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,outpatient,,,60.00000,31.86000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,inpatient,,,60.00000,31.86000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,outpatient,,,60.00000,31.86000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,inpatient,,,60.00000,31.86000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,outpatient,,,60.00000,31.86000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,inpatient,,,60.00000,31.86000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,outpatient,,,60.00000,31.86000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,inpatient,,,60.00000,31.86000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,outpatient,,,60.00000,31.86000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,inpatient,,,36.00000,19.12000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,outpatient,,,36.00000,19.12000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,inpatient,,,76.00000,40.36000,SilverSummit Healthplan,Commercial Exchange,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,outpatient,,,76.00000,40.36000,SilverSummit Healthplan,Commercial Exchange,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,inpatient,,,60.00000,31.86000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,outpatient,,,60.00000,31.86000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,inpatient,,,60.00000,31.86000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,outpatient,,,60.00000,31.86000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,inpatient,,,152.00000,80.71000,SilverSummit Healthplan,Commercial Exchange,,136.80,,,,,,,136.80,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,outpatient,,,152.00000,80.71000,SilverSummit Healthplan,Commercial Exchange,,136.80,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,inpatient,,,78.00000,41.42000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,outpatient,,,78.00000,41.42000,SilverSummit Healthplan,Commercial Exchange,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,inpatient,,,42.00000,22.30000,SilverSummit Healthplan,Commercial Exchange,,37.80,,,,,,,37.80,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,outpatient,,,42.00000,22.30000,SilverSummit Healthplan,Commercial Exchange,,37.80,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,inpatient,,,73.00000,38.76000,SilverSummit Healthplan,Commercial Exchange,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,outpatient,,,73.00000,38.76000,SilverSummit Healthplan,Commercial Exchange,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,inpatient,,,97.00000,51.51000,SilverSummit Healthplan,Commercial Exchange,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,outpatient,,,97.00000,51.51000,SilverSummit Healthplan,Commercial Exchange,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,inpatient,,,157.00000,83.37000,SilverSummit Healthplan,Commercial Exchange,,141.30,,,,,,,141.30,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,outpatient,,,157.00000,83.37000,SilverSummit Healthplan,Commercial Exchange,,141.30,,,,,,,40.82,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,inpatient,,,36.00000,19.12000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,outpatient,,,36.00000,19.12000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,inpatient,,,66.00000,35.05000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,outpatient,,,66.00000,35.05000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,inpatient,,,58.00000,30.80000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,outpatient,,,58.00000,30.80000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,inpatient,,,85.00000,45.14000,SilverSummit Healthplan,Commercial Exchange,,76.50,,,,,,,76.50,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,outpatient,,,85.00000,45.14000,SilverSummit Healthplan,Commercial Exchange,,76.50,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,inpatient,,,59.00000,31.33000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,outpatient,,,59.00000,31.33000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,inpatient,,,175.00000,92.93000,SilverSummit Healthplan,Commercial Exchange,,157.50,,,,,,,157.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,outpatient,,,175.00000,92.93000,SilverSummit Healthplan,Commercial Exchange,,157.50,,,,,,,45.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,inpatient,,,152.00000,80.71000,SilverSummit Healthplan,Commercial Exchange,,136.80,,,,,,,136.80,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,outpatient,,,152.00000,80.71000,SilverSummit Healthplan,Commercial Exchange,,136.80,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,inpatient,,,43.00000,22.83000,SilverSummit Healthplan,Commercial Exchange,,38.70,,,,,,,38.70,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,outpatient,,,43.00000,22.83000,SilverSummit Healthplan,Commercial Exchange,,38.70,,,,,,,11.18,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,inpatient,,,66.00000,35.05000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,outpatient,,,66.00000,35.05000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,inpatient,,,36.00000,19.12000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,outpatient,,,36.00000,19.12000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,inpatient,,,36.00000,19.12000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,outpatient,,,36.00000,19.12000,SilverSummit Healthplan,Commercial Exchange,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,inpatient,,,42.00000,22.30000,SilverSummit Healthplan,Commercial Exchange,,37.80,,,,,,,37.80,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,outpatient,,,42.00000,22.30000,SilverSummit Healthplan,Commercial Exchange,,37.80,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,inpatient,,,147.00000,78.06000,SilverSummit Healthplan,Commercial Exchange,,132.30,,,,,,,132.30,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,outpatient,,,147.00000,78.06000,SilverSummit Healthplan,Commercial Exchange,,132.30,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,inpatient,,,64.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,outpatient,,,64.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,inpatient,,,60.00000,31.86000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,outpatient,,,60.00000,31.86000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,inpatient,,,75.00000,39.83000,SilverSummit Healthplan,Commercial Exchange,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,outpatient,,,75.00000,39.83000,SilverSummit Healthplan,Commercial Exchange,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,inpatient,,,44.00000,23.36000,SilverSummit Healthplan,Commercial Exchange,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,outpatient,,,44.00000,23.36000,SilverSummit Healthplan,Commercial Exchange,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,inpatient,,,87.00000,46.20000,SilverSummit Healthplan,Commercial Exchange,,78.30,,,,,,,78.30,84.39,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,outpatient,,,87.00000,46.20000,SilverSummit Healthplan,Commercial Exchange,,78.30,,,,,,,22.62,84.39,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,inpatient,,,65.00000,34.52000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,outpatient,,,65.00000,34.52000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,inpatient,,,75.00000,39.83000,SilverSummit Healthplan,Commercial Exchange,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,outpatient,,,75.00000,39.83000,SilverSummit Healthplan,Commercial Exchange,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,inpatient,,,50.00000,26.55000,SilverSummit Healthplan,Commercial Exchange,,45.00,,,,,,,45.00,48.50,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,outpatient,,,50.00000,26.55000,SilverSummit Healthplan,Commercial Exchange,,45.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,inpatient,,,40.00000,21.24000,SilverSummit Healthplan,Commercial Exchange,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,outpatient,,,40.00000,21.24000,SilverSummit Healthplan,Commercial Exchange,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,inpatient,,,50.00000,26.55000,SilverSummit Healthplan,Commercial Exchange,,45.00,,,,,,,45.00,48.50,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,outpatient,,,50.00000,26.55000,SilverSummit Healthplan,Commercial Exchange,,45.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,inpatient,,,115.00000,61.07000,SilverSummit Healthplan,Commercial Exchange,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,outpatient,,,115.00000,61.07000,SilverSummit Healthplan,Commercial Exchange,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,inpatient,,,1309.00000,695.08000,SilverSummit Healthplan,Commercial Exchange,,1178.10,,,,,,,1178.10,1269.73,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1309.00000,695.08000,SilverSummit Healthplan,Commercial Exchange,,1178.10,,,,,,,340.34,1269.73,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,inpatient,,,328.00000,174.17000,SilverSummit Healthplan,Commercial Exchange,,295.20,,,,,,,295.20,318.16,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,outpatient,,,328.00000,174.17000,SilverSummit Healthplan,Commercial Exchange,,295.20,,,,,,,85.28,318.16,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,inpatient,,,115.00000,61.07000,SilverSummit Healthplan,Commercial Exchange,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,outpatient,,,115.00000,61.07000,SilverSummit Healthplan,Commercial Exchange,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,inpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,inpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,inpatient,,,1251.00000,664.28000,SilverSummit Healthplan,Commercial Exchange,,1125.90,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,outpatient,,,1251.00000,664.28000,SilverSummit Healthplan,Commercial Exchange,,1125.90,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,inpatient,,,154.00000,81.77000,SilverSummit Healthplan,Commercial Exchange,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,SilverSummit Healthplan,Commercial Exchange,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,inpatient,,,154.00000,81.77000,SilverSummit Healthplan,Commercial Exchange,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,SilverSummit Healthplan,Commercial Exchange,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,inpatient,,,96.00000,50.98000,SilverSummit Healthplan,Commercial Exchange,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,outpatient,,,96.00000,50.98000,SilverSummit Healthplan,Commercial Exchange,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,inpatient,,,211.00000,112.04000,SilverSummit Healthplan,Commercial Exchange,,189.90,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,outpatient,,,211.00000,112.04000,SilverSummit Healthplan,Commercial Exchange,,189.90,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,inpatient,,,290.00000,153.99000,SilverSummit Healthplan,Commercial Exchange,,261.00,,,,,,,261.00,281.30,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,outpatient,,,290.00000,153.99000,SilverSummit Healthplan,Commercial Exchange,,261.00,,,,,,,75.40,281.30,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,inpatient,,,411.00000,218.24000,SilverSummit Healthplan,Commercial Exchange,,369.90,,,,,,,369.90,398.67,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,outpatient,,,411.00000,218.24000,SilverSummit Healthplan,Commercial Exchange,,369.90,,,,,,,106.86,398.67,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,inpatient,,,139.00000,73.81000,SilverSummit Healthplan,Commercial Exchange,,125.10,,,,,,,125.10,134.83,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,outpatient,,,139.00000,73.81000,SilverSummit Healthplan,Commercial Exchange,,125.10,,,,,,,36.14,134.83,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,inpatient,,,288.00000,152.93000,SilverSummit Healthplan,Commercial Exchange,,259.20,,,,,,,259.20,279.36,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,outpatient,,,288.00000,152.93000,SilverSummit Healthplan,Commercial Exchange,,259.20,,,,,,,74.88,279.36,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,inpatient,,,1372.00000,728.53000,SilverSummit Healthplan,Commercial Exchange,,1234.80,,,,,,,1234.80,1330.84,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1372.00000,728.53000,SilverSummit Healthplan,Commercial Exchange,,1234.80,,,,,,,356.72,1330.84,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,inpatient,,,1251.00000,664.28000,SilverSummit Healthplan,Commercial Exchange,,1125.90,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,outpatient,,,1251.00000,664.28000,SilverSummit Healthplan,Commercial Exchange,,1125.90,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,inpatient,,,135.00000,71.68000,SilverSummit Healthplan,Commercial Exchange,,121.50,,,,,,,121.50,130.95,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,outpatient,,,135.00000,71.68000,SilverSummit Healthplan,Commercial Exchange,,121.50,,,,,,,35.10,130.95,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,inpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,inpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,inpatient,,,147.00000,78.06000,SilverSummit Healthplan,Commercial Exchange,,132.30,,,,,,,132.30,142.59,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,outpatient,,,147.00000,78.06000,SilverSummit Healthplan,Commercial Exchange,,132.30,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,inpatient,,,126.00000,66.91000,SilverSummit Healthplan,Commercial Exchange,,113.40,,,,,,,113.40,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,outpatient,,,126.00000,66.91000,SilverSummit Healthplan,Commercial Exchange,,113.40,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,inpatient,,,120.00000,63.72000,SilverSummit Healthplan,Commercial Exchange,,108.00,,,,,,,108.00,116.40,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,outpatient,,,120.00000,63.72000,SilverSummit Healthplan,Commercial Exchange,,108.00,,,,,,,31.20,116.40,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,inpatient,,,124.00000,65.84000,SilverSummit Healthplan,Commercial Exchange,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,outpatient,,,124.00000,65.84000,SilverSummit Healthplan,Commercial Exchange,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,inpatient,,,108.00000,57.35000,SilverSummit Healthplan,Commercial Exchange,,97.20,,,,,,,97.20,104.76,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,outpatient,,,108.00000,57.35000,SilverSummit Healthplan,Commercial Exchange,,97.20,,,,,,,28.08,104.76,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,inpatient,,,256.00000,135.94000,SilverSummit Healthplan,Commercial Exchange,,230.40,,,,,,,230.40,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,SilverSummit Healthplan,Commercial Exchange,,230.40,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,inpatient,,,256.00000,135.94000,SilverSummit Healthplan,Commercial Exchange,,230.40,,,,,,,230.40,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,SilverSummit Healthplan,Commercial Exchange,,230.40,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,inpatient,,,122.00000,64.78000,SilverSummit Healthplan,Commercial Exchange,,109.80,,,,,,,109.80,118.34,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,outpatient,,,122.00000,64.78000,SilverSummit Healthplan,Commercial Exchange,,109.80,,,,,,,31.72,118.34,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,inpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,inpatient,,,123.00000,65.31000,SilverSummit Healthplan,Commercial Exchange,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,outpatient,,,123.00000,65.31000,SilverSummit Healthplan,Commercial Exchange,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,inpatient,,,518.00000,275.06000,SilverSummit Healthplan,Commercial Exchange,,466.20,,,,,,,466.20,502.46,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,outpatient,,,518.00000,275.06000,SilverSummit Healthplan,Commercial Exchange,,466.20,,,,,,,134.68,502.46,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,inpatient,,,275.00000,146.02000,SilverSummit Healthplan,Commercial Exchange,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,outpatient,,,275.00000,146.02000,SilverSummit Healthplan,Commercial Exchange,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,inpatient,,,270.00000,143.37000,SilverSummit Healthplan,Commercial Exchange,,243.00,,,,,,,243.00,261.90,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,outpatient,,,270.00000,143.37000,SilverSummit Healthplan,Commercial Exchange,,243.00,,,,,,,70.20,261.90,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,inpatient,,,450.00000,238.95000,SilverSummit Healthplan,Commercial Exchange,,405.00,,,,,,,405.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,outpatient,,,450.00000,238.95000,SilverSummit Healthplan,Commercial Exchange,,405.00,,,,,,,117.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,inpatient,,,126.00000,66.91000,SilverSummit Healthplan,Commercial Exchange,,113.40,,,,,,,113.40,122.22,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,outpatient,,,126.00000,66.91000,SilverSummit Healthplan,Commercial Exchange,,113.40,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,inpatient,,,362.00000,192.22000,SilverSummit Healthplan,Commercial Exchange,,325.80,,,,,,,325.80,351.14,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,outpatient,,,362.00000,192.22000,SilverSummit Healthplan,Commercial Exchange,,325.80,,,,,,,94.12,351.14,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,inpatient,,,109.00000,57.88000,SilverSummit Healthplan,Commercial Exchange,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,SilverSummit Healthplan,Commercial Exchange,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,inpatient,,,638.00000,338.78000,SilverSummit Healthplan,Commercial Exchange,,574.20,,,,,,,574.20,618.86,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,outpatient,,,638.00000,338.78000,SilverSummit Healthplan,Commercial Exchange,,574.20,,,,,,,165.88,618.86,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,inpatient,,,211.00000,112.04000,SilverSummit Healthplan,Commercial Exchange,,189.90,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,outpatient,,,211.00000,112.04000,SilverSummit Healthplan,Commercial Exchange,,189.90,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,inpatient,,,154.00000,81.77000,SilverSummit Healthplan,Commercial Exchange,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,outpatient,,,154.00000,81.77000,SilverSummit Healthplan,Commercial Exchange,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,inpatient,,,141.00000,74.87000,SilverSummit Healthplan,Commercial Exchange,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,outpatient,,,141.00000,74.87000,SilverSummit Healthplan,Commercial Exchange,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,inpatient,,,2040.00000,1083.24000,SilverSummit Healthplan,Commercial Exchange,,1836.00,,,,,,,1836.00,1978.80,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,outpatient,,,2040.00000,1083.24000,SilverSummit Healthplan,Commercial Exchange,,1836.00,,,,,,,530.40,1978.80,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,inpatient,,,421.00000,223.55000,SilverSummit Healthplan,Commercial Exchange,,378.90,,,,,,,378.90,408.37,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,outpatient,,,421.00000,223.55000,SilverSummit Healthplan,Commercial Exchange,,378.90,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,inpatient,,,275.00000,146.02000,SilverSummit Healthplan,Commercial Exchange,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,outpatient,,,275.00000,146.02000,SilverSummit Healthplan,Commercial Exchange,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,inpatient,,,1251.00000,664.28000,SilverSummit Healthplan,Commercial Exchange,,1125.90,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,outpatient,,,1251.00000,664.28000,SilverSummit Healthplan,Commercial Exchange,,1125.90,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,inpatient,,,428.00000,227.27000,SilverSummit Healthplan,Commercial Exchange,,385.20,,,,,,,385.20,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,SilverSummit Healthplan,Commercial Exchange,,385.20,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,inpatient,,,428.00000,227.27000,SilverSummit Healthplan,Commercial Exchange,,385.20,,,,,,,385.20,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,SilverSummit Healthplan,Commercial Exchange,,385.20,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,inpatient,,,655.00000,347.80000,SilverSummit Healthplan,Commercial Exchange,,589.50,,,,,,,589.50,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,SilverSummit Healthplan,Commercial Exchange,,589.50,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,inpatient,,,655.00000,347.80000,SilverSummit Healthplan,Commercial Exchange,,589.50,,,,,,,589.50,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,SilverSummit Healthplan,Commercial Exchange,,589.50,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,inpatient,,,211.00000,112.04000,SilverSummit Healthplan,Commercial Exchange,,189.90,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,outpatient,,,211.00000,112.04000,SilverSummit Healthplan,Commercial Exchange,,189.90,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,inpatient,,,112.00000,59.47000,SilverSummit Healthplan,Commercial Exchange,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,SilverSummit Healthplan,Commercial Exchange,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,inpatient,,,112.00000,59.47000,SilverSummit Healthplan,Commercial Exchange,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,SilverSummit Healthplan,Commercial Exchange,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,inpatient,,,130.00000,69.03000,SilverSummit Healthplan,Commercial Exchange,,117.00,,,,,,,117.00,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,outpatient,,,130.00000,69.03000,SilverSummit Healthplan,Commercial Exchange,,117.00,,,,,,,33.80,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,inpatient,,,421.00000,223.55000,SilverSummit Healthplan,Commercial Exchange,,378.90,,,,,,,378.90,408.37,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,outpatient,,,421.00000,223.55000,SilverSummit Healthplan,Commercial Exchange,,378.90,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,inpatient,,,111.00000,58.94000,SilverSummit Healthplan,Commercial Exchange,,99.90,,,,,,,99.90,107.67,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,outpatient,,,111.00000,58.94000,SilverSummit Healthplan,Commercial Exchange,,99.90,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,inpatient,,,200.00000,106.20000,SilverSummit Healthplan,Commercial Exchange,,180.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,outpatient,,,200.00000,106.20000,SilverSummit Healthplan,Commercial Exchange,,180.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Commercial Exchange,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,inpatient,,,13.00000,6.90000,SilverSummit Healthplan,Commercial Exchange,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,outpatient,,,13.00000,6.90000,SilverSummit Healthplan,Commercial Exchange,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,inpatient,,,58.00000,30.80000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,outpatient,,,58.00000,30.80000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,inpatient,,,13.00000,6.90000,SilverSummit Healthplan,Commercial Exchange,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,outpatient,,,13.00000,6.90000,SilverSummit Healthplan,Commercial Exchange,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,inpatient,,,773.00000,410.46000,SilverSummit Healthplan,Commercial Exchange,,695.70,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,outpatient,,,773.00000,410.46000,SilverSummit Healthplan,Commercial Exchange,,695.70,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,inpatient,,,773.00000,410.46000,SilverSummit Healthplan,Commercial Exchange,,695.70,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,outpatient,,,773.00000,410.46000,SilverSummit Healthplan,Commercial Exchange,,695.70,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,inpatient,,,773.00000,410.46000,SilverSummit Healthplan,Commercial Exchange,,695.70,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,outpatient,,,773.00000,410.46000,SilverSummit Healthplan,Commercial Exchange,,695.70,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,inpatient,,,773.00000,410.46000,SilverSummit Healthplan,Commercial Exchange,,695.70,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,outpatient,,,773.00000,410.46000,SilverSummit Healthplan,Commercial Exchange,,695.70,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,inpatient,,,387.00000,205.50000,SilverSummit Healthplan,Commercial Exchange,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,outpatient,,,387.00000,205.50000,SilverSummit Healthplan,Commercial Exchange,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,inpatient,,,52.00000,27.61000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,outpatient,,,52.00000,27.61000,SilverSummit Healthplan,Commercial Exchange,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,inpatient,,,102.00000,54.16000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,inpatient,,,102.00000,54.16000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,SilverSummit Healthplan,Commercial Exchange,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,inpatient,,,79.00000,41.95000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,outpatient,,,79.00000,41.95000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,inpatient,,,65.00000,34.52000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,outpatient,,,65.00000,34.52000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,inpatient,,,100.00000,53.10000,SilverSummit Healthplan,Commercial Exchange,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,outpatient,,,100.00000,53.10000,SilverSummit Healthplan,Commercial Exchange,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,inpatient,,,64.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,outpatient,,,64.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,inpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,inpatient,,,109.00000,57.88000,SilverSummit Healthplan,Commercial Exchange,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,SilverSummit Healthplan,Commercial Exchange,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,inpatient,,,58.00000,30.80000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,outpatient,,,58.00000,30.80000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,SilverSummit Healthplan,Commercial Exchange,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,SilverSummit Healthplan,Commercial Exchange,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,inpatient,,,66.00000,35.05000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,outpatient,,,66.00000,35.05000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,SilverSummit Healthplan,Commercial Exchange,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,SilverSummit Healthplan,Commercial Exchange,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,SilverSummit Healthplan,Commercial Exchange,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,SilverSummit Healthplan,Commercial Exchange,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,SilverSummit Healthplan,Commercial Exchange,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,SilverSummit Healthplan,Commercial Exchange,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,inpatient,,,13.00000,6.90000,SilverSummit Healthplan,Commercial Exchange,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,outpatient,,,13.00000,6.90000,SilverSummit Healthplan,Commercial Exchange,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,inpatient,,,53.00000,28.14000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,outpatient,,,53.00000,28.14000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,inpatient,,,18.00000,9.56000,SilverSummit Healthplan,Commercial Exchange,,16.20,,,,,,,16.20,17.46,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,outpatient,,,18.00000,9.56000,SilverSummit Healthplan,Commercial Exchange,,16.20,,,,,,,4.68,17.46,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,inpatient,,,17.00000,9.03000,SilverSummit Healthplan,Commercial Exchange,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,outpatient,,,17.00000,9.03000,SilverSummit Healthplan,Commercial Exchange,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,inpatient,,,71.00000,37.70000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,outpatient,,,71.00000,37.70000,SilverSummit Healthplan,Commercial Exchange,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,inpatient,,,57.00000,30.27000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,outpatient,,,57.00000,30.27000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,inpatient,,,68.00000,36.11000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,outpatient,,,68.00000,36.11000,SilverSummit Healthplan,Commercial Exchange,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,inpatient,,,58.00000,30.80000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,outpatient,,,58.00000,30.80000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,inpatient,,,27.00000,14.34000,SilverSummit Healthplan,Commercial Exchange,,24.30,,,,,,,24.30,26.19,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,outpatient,,,27.00000,14.34000,SilverSummit Healthplan,Commercial Exchange,,24.30,,,,,,,7.02,26.19,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,inpatient,,,56.00000,29.74000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,outpatient,,,56.00000,29.74000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,inpatient,,,56.00000,29.74000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,outpatient,,,56.00000,29.74000,SilverSummit Healthplan,Commercial Exchange,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,inpatient,,,58.00000,30.80000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,outpatient,,,58.00000,30.80000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,inpatient,,,115.00000,61.07000,SilverSummit Healthplan,Commercial Exchange,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,outpatient,,,115.00000,61.07000,SilverSummit Healthplan,Commercial Exchange,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,inpatient,,,23.00000,12.21000,SilverSummit Healthplan,Commercial Exchange,,20.70,,,,,,,20.70,22.31,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,outpatient,,,23.00000,12.21000,SilverSummit Healthplan,Commercial Exchange,,20.70,,,,,,,5.98,22.31,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,inpatient,,,255.00000,135.40000,SilverSummit Healthplan,Commercial Exchange,,229.50,,,,,,,229.50,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,outpatient,,,255.00000,135.40000,SilverSummit Healthplan,Commercial Exchange,,229.50,,,,,,,66.30,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,inpatient,,,66.00000,35.05000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,outpatient,,,66.00000,35.05000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,inpatient,,,26.00000,13.81000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,outpatient,,,26.00000,13.81000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,inpatient,,,64.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,outpatient,,,64.00000,33.98000,SilverSummit Healthplan,Commercial Exchange,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,inpatient,,,215.00000,114.16000,SilverSummit Healthplan,Commercial Exchange,,193.50,,,,,,,193.50,208.55,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,outpatient,,,215.00000,114.16000,SilverSummit Healthplan,Commercial Exchange,,193.50,,,,,,,55.90,208.55,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,inpatient,,,79.00000,41.95000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,outpatient,,,79.00000,41.95000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,inpatient,,,11.00000,5.29000,SilverSummit Healthplan,Commercial Exchange,,9.90,,,,,,,9.90,10.67,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,outpatient,,,11.00000,5.29000,SilverSummit Healthplan,Commercial Exchange,,9.90,,,,,,,2.86,10.67,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,inpatient,,,58.00000,27.90000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,outpatient,,,58.00000,27.90000,SilverSummit Healthplan,Commercial Exchange,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,inpatient,,,10.00000,4.81000,SilverSummit Healthplan,Commercial Exchange,,9.00,,,,,,,9.00,9.70,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,outpatient,,,10.00000,4.81000,SilverSummit Healthplan,Commercial Exchange,,9.00,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,inpatient,,,7.00000,3.37000,SilverSummit Healthplan,Commercial Exchange,,6.30,,,,,,,6.30,6.79,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,outpatient,,,7.00000,3.37000,SilverSummit Healthplan,Commercial Exchange,,6.30,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,inpatient,,,53.00000,25.49000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,outpatient,,,53.00000,25.49000,SilverSummit Healthplan,Commercial Exchange,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,inpatient,,,10.00000,4.81000,SilverSummit Healthplan,Commercial Exchange,,9.00,,,,,,,9.00,9.70,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,outpatient,,,10.00000,4.81000,SilverSummit Healthplan,Commercial Exchange,,9.00,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,inpatient,,,11.00000,5.29000,SilverSummit Healthplan,Commercial Exchange,,9.90,,,,,,,9.90,10.67,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,SilverSummit Healthplan,Commercial Exchange,,9.90,,,,,,,2.86,10.67,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,inpatient,,,7.00000,3.37000,SilverSummit Healthplan,Commercial Exchange,,6.30,,,,,,,6.30,6.79,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,outpatient,,,7.00000,3.37000,SilverSummit Healthplan,Commercial Exchange,,6.30,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,inpatient,,,11.00000,5.29000,SilverSummit Healthplan,Commercial Exchange,,9.90,,,,,,,9.90,10.67,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,SilverSummit Healthplan,Commercial Exchange,,9.90,,,,,,,2.86,10.67,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,inpatient,,,597.00000,290.14000,SilverSummit Healthplan,Commercial Exchange,,537.30,,,,,,,537.30,579.09,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,outpatient,,,597.00000,290.14000,SilverSummit Healthplan,Commercial Exchange,,537.30,,,,,,,155.22,579.09,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,inpatient,,,6379.00000,3100.19000,SilverSummit Healthplan,Commercial Exchange,,5741.10,,,,,,,5741.10,6187.63,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,outpatient,,,6379.00000,3100.19000,SilverSummit Healthplan,Commercial Exchange,,5741.10,,,,,,,1658.54,6187.63,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,inpatient,,,471.00000,228.91000,SilverSummit Healthplan,Commercial Exchange,,423.90,,,,,,,423.90,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,outpatient,,,471.00000,228.91000,SilverSummit Healthplan,Commercial Exchange,,423.90,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,inpatient,,,471.00000,228.91000,SilverSummit Healthplan,Commercial Exchange,,423.90,,,,,,,423.90,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,outpatient,,,471.00000,228.91000,SilverSummit Healthplan,Commercial Exchange,,423.90,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,inpatient,,,1251.00000,607.99000,SilverSummit Healthplan,Commercial Exchange,,1125.90,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,outpatient,,,1251.00000,607.99000,SilverSummit Healthplan,Commercial Exchange,,1125.90,,,,,,,325.26,1213.47,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,inpatient,,,260.00000,126.36000,SilverSummit Healthplan,Commercial Exchange,,234.00,,,,,,,234.00,252.20,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,outpatient,,,260.00000,126.36000,SilverSummit Healthplan,Commercial Exchange,,234.00,,,,,,,67.60,252.20,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,inpatient,,,785.00000,381.51000,SilverSummit Healthplan,Commercial Exchange,,706.50,,,,,,,706.50,761.45,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,outpatient,,,785.00000,381.51000,SilverSummit Healthplan,Commercial Exchange,,706.50,,,,,,,204.10,761.45,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,inpatient,,,529.00000,257.09000,SilverSummit Healthplan,Commercial Exchange,,476.10,,,,,,,476.10,513.13,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,outpatient,,,529.00000,257.09000,SilverSummit Healthplan,Commercial Exchange,,476.10,,,,,,,137.54,513.13,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,inpatient,,,1623.00000,788.78000,SilverSummit Healthplan,Commercial Exchange,,1460.70,,,,,,,1460.70,1574.31,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,outpatient,,,1623.00000,788.78000,SilverSummit Healthplan,Commercial Exchange,,1460.70,,,,,,,421.98,1574.31,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,inpatient,,,10800.00000,5248.80000,SilverSummit Healthplan,Commercial Exchange,,9720.00,,,,,,,9720.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,outpatient,,,10800.00000,5248.80000,SilverSummit Healthplan,Commercial Exchange,,9720.00,,,,,,,2808.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,inpatient,,,25365.00000,12327.39000,SilverSummit Healthplan,Commercial Exchange,,22828.50,,,,,,,22828.50,24604.05,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,outpatient,,,25365.00000,12327.39000,SilverSummit Healthplan,Commercial Exchange,,22828.50,,,,,,,6594.90,24604.05,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,inpatient,,,101.00000,21.82000,SilverSummit Healthplan,Commercial Exchange,,90.90,,,,,,,90.90,97.97,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,outpatient,,,101.00000,21.82000,SilverSummit Healthplan,Commercial Exchange,,90.90,,,,,,,26.26,97.97,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,inpatient,,,81.00000,17.50000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,outpatient,,,81.00000,17.50000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,inpatient,,,104.00000,22.46000,SilverSummit Healthplan,Commercial Exchange,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,outpatient,,,104.00000,22.46000,SilverSummit Healthplan,Commercial Exchange,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,inpatient,,,377.00000,81.43000,SilverSummit Healthplan,Commercial Exchange,,339.30,,,,,,,339.30,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,outpatient,,,377.00000,81.43000,SilverSummit Healthplan,Commercial Exchange,,339.30,,,,,,,98.02,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,inpatient,,,532.00000,114.91000,SilverSummit Healthplan,Commercial Exchange,,478.80,,,,,,,478.80,516.04,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,outpatient,,,532.00000,114.91000,SilverSummit Healthplan,Commercial Exchange,,478.80,,,,,,,138.32,516.04,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,inpatient,,,521.00000,112.54000,SilverSummit Healthplan,Commercial Exchange,,468.90,,,,,,,468.90,505.37,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,outpatient,,,521.00000,112.54000,SilverSummit Healthplan,Commercial Exchange,,468.90,,,,,,,135.46,505.37,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,inpatient,,,451.00000,97.42000,SilverSummit Healthplan,Commercial Exchange,,405.90,,,,,,,405.90,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,outpatient,,,451.00000,97.42000,SilverSummit Healthplan,Commercial Exchange,,405.90,,,,,,,117.26,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,inpatient,,,1148.00000,247.97000,SilverSummit Healthplan,Commercial Exchange,,1033.20,,,,,,,1033.20,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,outpatient,,,1148.00000,247.97000,SilverSummit Healthplan,Commercial Exchange,,1033.20,,,,,,,298.48,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,inpatient,,,350.00000,75.60000,SilverSummit Healthplan,Commercial Exchange,,315.00,,,,,,,315.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,outpatient,,,350.00000,75.60000,SilverSummit Healthplan,Commercial Exchange,,315.00,,,,,,,91.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,inpatient,,,423.00000,91.37000,SilverSummit Healthplan,Commercial Exchange,,380.70,,,,,,,380.70,410.31,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,outpatient,,,423.00000,91.37000,SilverSummit Healthplan,Commercial Exchange,,380.70,,,,,,,109.98,410.31,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,inpatient,,,751.00000,162.22000,SilverSummit Healthplan,Commercial Exchange,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,SilverSummit Healthplan,Commercial Exchange,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,inpatient,,,751.00000,162.22000,SilverSummit Healthplan,Commercial Exchange,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,SilverSummit Healthplan,Commercial Exchange,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,inpatient,,,119.00000,25.70000,SilverSummit Healthplan,Commercial Exchange,,107.10,,,,,,,107.10,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,outpatient,,,119.00000,25.70000,SilverSummit Healthplan,Commercial Exchange,,107.10,,,,,,,30.94,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,inpatient,,,126.00000,27.22000,SilverSummit Healthplan,Commercial Exchange,,113.40,,,,,,,113.40,122.22,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,outpatient,,,126.00000,27.22000,SilverSummit Healthplan,Commercial Exchange,,113.40,,,,,,,32.76,122.22,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,inpatient,,,110.00000,23.76000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,inpatient,,,110.00000,23.76000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,inpatient,,,79.00000,17.06000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,outpatient,,,79.00000,17.06000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,inpatient,,,110.00000,23.76000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,inpatient,,,110.00000,23.76000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,inpatient,,,79.00000,17.06000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,outpatient,,,79.00000,17.06000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,inpatient,,,335.00000,72.36000,SilverSummit Healthplan,Commercial Exchange,,301.50,,,,,,,301.50,324.95,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,outpatient,,,335.00000,72.36000,SilverSummit Healthplan,Commercial Exchange,,301.50,,,,,,,87.10,324.95,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,inpatient,,,154.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,inpatient,,,154.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,SilverSummit Healthplan,Commercial Exchange,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,inpatient,,,128.00000,27.65000,SilverSummit Healthplan,Commercial Exchange,,115.20,,,,,,,115.20,124.16,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,outpatient,,,128.00000,27.65000,SilverSummit Healthplan,Commercial Exchange,,115.20,,,,,,,33.28,124.16,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,inpatient,,,65.00000,14.04000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,outpatient,,,65.00000,14.04000,SilverSummit Healthplan,Commercial Exchange,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,inpatient,,,272.00000,58.75000,SilverSummit Healthplan,Commercial Exchange,,244.80,,,,,,,244.80,263.84,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,outpatient,,,272.00000,58.75000,SilverSummit Healthplan,Commercial Exchange,,244.80,,,,,,,70.72,263.84,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,inpatient,,,26.00000,11.44000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,outpatient,,,26.00000,11.44000,SilverSummit Healthplan,Commercial Exchange,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,inpatient,,,359.00000,157.96000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,outpatient,,,359.00000,157.96000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,inpatient,,,189.00000,83.16000,SilverSummit Healthplan,Commercial Exchange,,170.10,,,,,,,170.10,183.33,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,outpatient,,,189.00000,83.16000,SilverSummit Healthplan,Commercial Exchange,,170.10,,,,,,,49.14,183.33,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,inpatient,,,359.00000,157.96000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,outpatient,,,359.00000,157.96000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,inpatient,,,137.00000,60.28000,SilverSummit Healthplan,Commercial Exchange,,123.30,,,,,,,123.30,132.89,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,outpatient,,,137.00000,60.28000,SilverSummit Healthplan,Commercial Exchange,,123.30,,,,,,,35.62,132.89,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,inpatient,,,1665.00000,732.60000,SilverSummit Healthplan,Commercial Exchange,,1498.50,,,,,,,1498.50,1615.05,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,outpatient,,,1665.00000,732.60000,SilverSummit Healthplan,Commercial Exchange,,1498.50,,,,,,,432.90,1615.05,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,inpatient,,,751.00000,330.44000,SilverSummit Healthplan,Commercial Exchange,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,outpatient,,,751.00000,330.44000,SilverSummit Healthplan,Commercial Exchange,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,inpatient,,,374.00000,164.56000,SilverSummit Healthplan,Commercial Exchange,,336.60,,,,,,,336.60,362.78,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,outpatient,,,374.00000,164.56000,SilverSummit Healthplan,Commercial Exchange,,336.60,,,,,,,97.24,362.78,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,inpatient,,,553.00000,243.32000,SilverSummit Healthplan,Commercial Exchange,,497.70,,,,,,,497.70,536.41,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,outpatient,,,553.00000,243.32000,SilverSummit Healthplan,Commercial Exchange,,497.70,,,,,,,143.78,536.41,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,inpatient,,,359.00000,157.96000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,outpatient,,,359.00000,157.96000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,inpatient,,,62.00000,27.28000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,outpatient,,,62.00000,27.28000,SilverSummit Healthplan,Commercial Exchange,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,inpatient,,,79.00000,34.76000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,outpatient,,,79.00000,34.76000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,inpatient,,,110.00000,48.40000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,outpatient,,,110.00000,48.40000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,inpatient,,,110.00000,48.40000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,outpatient,,,110.00000,48.40000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,inpatient,,,751.00000,330.44000,SilverSummit Healthplan,Commercial Exchange,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,outpatient,,,751.00000,330.44000,SilverSummit Healthplan,Commercial Exchange,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,inpatient,,,1665.00000,732.60000,SilverSummit Healthplan,Commercial Exchange,,1498.50,,,,,,,1498.50,1615.05,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,outpatient,,,1665.00000,732.60000,SilverSummit Healthplan,Commercial Exchange,,1498.50,,,,,,,432.90,1615.05,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,inpatient,,,110.00000,48.40000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,outpatient,,,110.00000,48.40000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,inpatient,,,281.00000,123.64000,SilverSummit Healthplan,Commercial Exchange,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,SilverSummit Healthplan,Commercial Exchange,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,inpatient,,,281.00000,123.64000,SilverSummit Healthplan,Commercial Exchange,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,SilverSummit Healthplan,Commercial Exchange,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,inpatient,,,451.00000,341.41000,SilverSummit Healthplan,Commercial Exchange,,405.90,,,,,,,405.90,437.47,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,outpatient,,,451.00000,341.41000,SilverSummit Healthplan,Commercial Exchange,,405.90,,,,,,,117.26,437.47,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,inpatient,,,300.00000,145.80000,SilverSummit Healthplan,Commercial Exchange,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,outpatient,,,300.00000,145.80000,SilverSummit Healthplan,Commercial Exchange,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,inpatient,,,2278.00000,1107.11000,SilverSummit Healthplan,Commercial Exchange,,2050.20,,,,,,,2050.20,2209.66,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,outpatient,,,2278.00000,1107.11000,SilverSummit Healthplan,Commercial Exchange,,2050.20,,,,,,,592.28,2209.66,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,inpatient,,,3912.00000,1901.23000,SilverSummit Healthplan,Commercial Exchange,,3520.80,,,,,,,3520.80,3794.64,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,outpatient,,,3912.00000,1901.23000,SilverSummit Healthplan,Commercial Exchange,,3520.80,,,,,,,1017.12,3794.64,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,inpatient,,,900.00000,437.40000,SilverSummit Healthplan,Commercial Exchange,,810.00,,,,,,,810.00,873.00,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,outpatient,,,900.00000,437.40000,SilverSummit Healthplan,Commercial Exchange,,810.00,,,,,,,234.00,873.00,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,inpatient,,,365.00000,177.39000,SilverSummit Healthplan,Commercial Exchange,,328.50,,,,,,,328.50,354.05,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,outpatient,,,365.00000,177.39000,SilverSummit Healthplan,Commercial Exchange,,328.50,,,,,,,94.90,354.05,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,inpatient,,,989.00000,480.65000,SilverSummit Healthplan,Commercial Exchange,,890.10,,,,,,,890.10,959.33,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,outpatient,,,989.00000,480.65000,SilverSummit Healthplan,Commercial Exchange,,890.10,,,,,,,257.14,959.33,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,SilverSummit Healthplan,Commercial Exchange,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,SilverSummit Healthplan,Commercial Exchange,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,inpatient,,,435.00000,211.41000,SilverSummit Healthplan,Commercial Exchange,,391.50,,,,,,,391.50,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,SilverSummit Healthplan,Commercial Exchange,,391.50,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,inpatient,,,435.00000,211.41000,SilverSummit Healthplan,Commercial Exchange,,391.50,,,,,,,391.50,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,SilverSummit Healthplan,Commercial Exchange,,391.50,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,inpatient,,,644.00000,312.98000,SilverSummit Healthplan,Commercial Exchange,,579.60,,,,,,,579.60,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,outpatient,,,644.00000,312.98000,SilverSummit Healthplan,Commercial Exchange,,579.60,,,,,,,167.44,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,SilverSummit Healthplan,Commercial Exchange,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,SilverSummit Healthplan,Commercial Exchange,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,SilverSummit Healthplan,Commercial Exchange,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,SilverSummit Healthplan,Commercial Exchange,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,inpatient,,,527.00000,256.12000,SilverSummit Healthplan,Commercial Exchange,,474.30,,,,,,,474.30,511.19,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,outpatient,,,527.00000,256.12000,SilverSummit Healthplan,Commercial Exchange,,474.30,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,inpatient,,,1404.00000,682.34000,SilverSummit Healthplan,Commercial Exchange,,1263.60,,,,,,,1263.60,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,outpatient,,,1404.00000,682.34000,SilverSummit Healthplan,Commercial Exchange,,1263.60,,,,,,,365.04,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,inpatient,,,5475.00000,2660.85000,SilverSummit Healthplan,Commercial Exchange,,4927.50,,,,,,,4927.50,5310.75,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,outpatient,,,5475.00000,2660.85000,SilverSummit Healthplan,Commercial Exchange,,4927.50,,,,,,,1423.50,5310.75,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,inpatient,,,726.00000,352.84000,SilverSummit Healthplan,Commercial Exchange,,653.40,,,,,,,653.40,704.22,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,outpatient,,,726.00000,352.84000,SilverSummit Healthplan,Commercial Exchange,,653.40,,,,,,,188.76,704.22,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,inpatient,,,507.00000,246.40000,SilverSummit Healthplan,Commercial Exchange,,456.30,,,,,,,456.30,491.79,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,outpatient,,,507.00000,246.40000,SilverSummit Healthplan,Commercial Exchange,,456.30,,,,,,,131.82,491.79,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,inpatient,,,1670.00000,811.62000,SilverSummit Healthplan,Commercial Exchange,,1503.00,,,,,,,1503.00,1619.90,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,outpatient,,,1670.00000,811.62000,SilverSummit Healthplan,Commercial Exchange,,1503.00,,,,,,,434.20,1619.90,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,inpatient,,,1139.00000,553.55000,SilverSummit Healthplan,Commercial Exchange,,1025.10,,,,,,,1025.10,1104.83,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,outpatient,,,1139.00000,553.55000,SilverSummit Healthplan,Commercial Exchange,,1025.10,,,,,,,296.14,1104.83,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,inpatient,,,875.00000,425.25000,SilverSummit Healthplan,Commercial Exchange,,787.50,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,outpatient,,,875.00000,425.25000,SilverSummit Healthplan,Commercial Exchange,,787.50,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,inpatient,,,525.00000,255.15000,SilverSummit Healthplan,Commercial Exchange,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,outpatient,,,525.00000,255.15000,SilverSummit Healthplan,Commercial Exchange,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,inpatient,,,1353.00000,657.56000,SilverSummit Healthplan,Commercial Exchange,,1217.70,,,,,,,1217.70,1312.41,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,outpatient,,,1353.00000,657.56000,SilverSummit Healthplan,Commercial Exchange,,1217.70,,,,,,,351.78,1312.41,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,inpatient,,,525.00000,255.15000,SilverSummit Healthplan,Commercial Exchange,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,outpatient,,,525.00000,255.15000,SilverSummit Healthplan,Commercial Exchange,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,inpatient,,,525.00000,255.15000,SilverSummit Healthplan,Commercial Exchange,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,outpatient,,,525.00000,255.15000,SilverSummit Healthplan,Commercial Exchange,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,inpatient,,,825.00000,400.95000,SilverSummit Healthplan,Commercial Exchange,,742.50,,,,,,,742.50,800.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,outpatient,,,825.00000,400.95000,SilverSummit Healthplan,Commercial Exchange,,742.50,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,inpatient,,,525.00000,255.15000,SilverSummit Healthplan,Commercial Exchange,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,SilverSummit Healthplan,Commercial Exchange,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,inpatient,,,525.00000,255.15000,SilverSummit Healthplan,Commercial Exchange,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,SilverSummit Healthplan,Commercial Exchange,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,inpatient,,,974.00000,473.36000,SilverSummit Healthplan,Commercial Exchange,,876.60,,,,,,,876.60,944.78,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,outpatient,,,974.00000,473.36000,SilverSummit Healthplan,Commercial Exchange,,876.60,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,inpatient,,,198.00000,96.23000,SilverSummit Healthplan,Commercial Exchange,,178.20,,,,,,,178.20,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,SilverSummit Healthplan,Commercial Exchange,,178.20,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,inpatient,,,198.00000,96.23000,SilverSummit Healthplan,Commercial Exchange,,178.20,,,,,,,178.20,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,SilverSummit Healthplan,Commercial Exchange,,178.20,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,inpatient,,,221.00000,107.41000,SilverSummit Healthplan,Commercial Exchange,,198.90,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,SilverSummit Healthplan,Commercial Exchange,,198.90,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,inpatient,,,221.00000,107.41000,SilverSummit Healthplan,Commercial Exchange,,198.90,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,SilverSummit Healthplan,Commercial Exchange,,198.90,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,inpatient,,,497.00000,241.54000,SilverSummit Healthplan,Commercial Exchange,,447.30,,,,,,,447.30,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,outpatient,,,497.00000,241.54000,SilverSummit Healthplan,Commercial Exchange,,447.30,,,,,,,129.22,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,inpatient,,,2340.00000,1137.24000,SilverSummit Healthplan,Commercial Exchange,,2106.00,,,,,,,2106.00,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,outpatient,,,2340.00000,1137.24000,SilverSummit Healthplan,Commercial Exchange,,2106.00,,,,,,,608.40,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,inpatient,,,249.00000,121.01000,SilverSummit Healthplan,Commercial Exchange,,224.10,,,,,,,224.10,241.53,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,outpatient,,,249.00000,121.01000,SilverSummit Healthplan,Commercial Exchange,,224.10,,,,,,,64.74,241.53,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,inpatient,,,135.00000,65.61000,SilverSummit Healthplan,Commercial Exchange,,121.50,,,,,,,121.50,130.95,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,outpatient,,,135.00000,65.61000,SilverSummit Healthplan,Commercial Exchange,,121.50,,,,,,,35.10,130.95,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,inpatient,,,172.00000,83.59000,SilverSummit Healthplan,Commercial Exchange,,154.80,,,,,,,154.80,166.84,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,outpatient,,,172.00000,83.59000,SilverSummit Healthplan,Commercial Exchange,,154.80,,,,,,,44.72,166.84,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,inpatient,,,307.00000,149.20000,SilverSummit Healthplan,Commercial Exchange,,276.30,,,,,,,276.30,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,outpatient,,,307.00000,149.20000,SilverSummit Healthplan,Commercial Exchange,,276.30,,,,,,,79.82,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,inpatient,,,1800.00000,874.80000,SilverSummit Healthplan,Commercial Exchange,,1620.00,,,,,,,1620.00,1746.00,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,outpatient,,,1800.00000,874.80000,SilverSummit Healthplan,Commercial Exchange,,1620.00,,,,,,,468.00,1746.00,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,inpatient,,,974.00000,473.36000,SilverSummit Healthplan,Commercial Exchange,,876.60,,,,,,,876.60,944.78,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,outpatient,,,974.00000,473.36000,SilverSummit Healthplan,Commercial Exchange,,876.60,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,inpatient,,,197.00000,95.74000,SilverSummit Healthplan,Commercial Exchange,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,SilverSummit Healthplan,Commercial Exchange,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,inpatient,,,197.00000,95.74000,SilverSummit Healthplan,Commercial Exchange,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,SilverSummit Healthplan,Commercial Exchange,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,inpatient,,,411.00000,199.75000,SilverSummit Healthplan,Commercial Exchange,,369.90,,,,,,,369.90,398.67,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,outpatient,,,411.00000,199.75000,SilverSummit Healthplan,Commercial Exchange,,369.90,,,,,,,106.86,398.67,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,inpatient,,,221.00000,107.41000,SilverSummit Healthplan,Commercial Exchange,,198.90,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,outpatient,,,221.00000,107.41000,SilverSummit Healthplan,Commercial Exchange,,198.90,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,inpatient,,,884.00000,429.62000,SilverSummit Healthplan,Commercial Exchange,,795.60,,,,,,,795.60,857.48,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,outpatient,,,884.00000,429.62000,SilverSummit Healthplan,Commercial Exchange,,795.60,,,,,,,229.84,857.48,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,inpatient,,,594.00000,288.68000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,outpatient,,,594.00000,288.68000,SilverSummit Healthplan,Commercial Exchange,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,inpatient,,,519.00000,252.23000,SilverSummit Healthplan,Commercial Exchange,,467.10,,,,,,,467.10,503.43,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,outpatient,,,519.00000,252.23000,SilverSummit Healthplan,Commercial Exchange,,467.10,,,,,,,134.94,503.43,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,inpatient,,,1046.00000,508.36000,SilverSummit Healthplan,Commercial Exchange,,941.40,,,,,,,941.40,1014.62,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,outpatient,,,1046.00000,508.36000,SilverSummit Healthplan,Commercial Exchange,,941.40,,,,,,,271.96,1014.62,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,inpatient,,,556.00000,270.22000,SilverSummit Healthplan,Commercial Exchange,,500.40,,,,,,,500.40,539.32,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,outpatient,,,556.00000,270.22000,SilverSummit Healthplan,Commercial Exchange,,500.40,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,inpatient,,,275.00000,133.65000,SilverSummit Healthplan,Commercial Exchange,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,outpatient,,,275.00000,133.65000,SilverSummit Healthplan,Commercial Exchange,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,inpatient,,,580.00000,281.88000,SilverSummit Healthplan,Commercial Exchange,,522.00,,,,,,,522.00,562.60,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,outpatient,,,580.00000,281.88000,SilverSummit Healthplan,Commercial Exchange,,522.00,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,inpatient,,,580.00000,281.88000,SilverSummit Healthplan,Commercial Exchange,,522.00,,,,,,,522.00,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,outpatient,,,580.00000,281.88000,SilverSummit Healthplan,Commercial Exchange,,522.00,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,inpatient,,,3480.00000,1691.28000,SilverSummit Healthplan,Commercial Exchange,,3132.00,,,,,,,3132.00,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,SilverSummit Healthplan,Commercial Exchange,,3132.00,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,inpatient,,,3480.00000,1691.28000,SilverSummit Healthplan,Commercial Exchange,,3132.00,,,,,,,3132.00,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,SilverSummit Healthplan,Commercial Exchange,,3132.00,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,inpatient,,,700.00000,340.20000,SilverSummit Healthplan,Commercial Exchange,,630.00,,,,,,,630.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,outpatient,,,700.00000,340.20000,SilverSummit Healthplan,Commercial Exchange,,630.00,,,,,,,182.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,inpatient,,,1427.00000,693.52000,SilverSummit Healthplan,Commercial Exchange,,1284.30,,,,,,,1284.30,1384.19,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,outpatient,,,1427.00000,693.52000,SilverSummit Healthplan,Commercial Exchange,,1284.30,,,,,,,371.02,1384.19,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,inpatient,,,614.00000,298.40000,SilverSummit Healthplan,Commercial Exchange,,552.60,,,,,,,552.60,595.58,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,outpatient,,,614.00000,298.40000,SilverSummit Healthplan,Commercial Exchange,,552.60,,,,,,,159.64,595.58,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,inpatient,,,2027.00000,985.12000,SilverSummit Healthplan,Commercial Exchange,,1824.30,,,,,,,1824.30,1966.19,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,outpatient,,,2027.00000,985.12000,SilverSummit Healthplan,Commercial Exchange,,1824.30,,,,,,,527.02,1966.19,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,inpatient,,,556.00000,270.22000,SilverSummit Healthplan,Commercial Exchange,,500.40,,,,,,,500.40,539.32,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,outpatient,,,556.00000,270.22000,SilverSummit Healthplan,Commercial Exchange,,500.40,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,inpatient,,,1146.00000,556.96000,SilverSummit Healthplan,Commercial Exchange,,1031.40,,,,,,,1031.40,1111.62,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,outpatient,,,1146.00000,556.96000,SilverSummit Healthplan,Commercial Exchange,,1031.40,,,,,,,297.96,1111.62,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,inpatient,,,197.00000,95.74000,SilverSummit Healthplan,Commercial Exchange,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,SilverSummit Healthplan,Commercial Exchange,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,inpatient,,,197.00000,95.74000,SilverSummit Healthplan,Commercial Exchange,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,SilverSummit Healthplan,Commercial Exchange,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,inpatient,,,527.00000,256.12000,SilverSummit Healthplan,Commercial Exchange,,474.30,,,,,,,474.30,511.19,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,outpatient,,,527.00000,256.12000,SilverSummit Healthplan,Commercial Exchange,,474.30,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,inpatient,,,740.00000,359.64000,SilverSummit Healthplan,Commercial Exchange,,666.00,,,,,,,666.00,717.80,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,outpatient,,,740.00000,359.64000,SilverSummit Healthplan,Commercial Exchange,,666.00,,,,,,,192.40,717.80,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,inpatient,,,875.00000,425.25000,SilverSummit Healthplan,Commercial Exchange,,787.50,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,SilverSummit Healthplan,Commercial Exchange,,787.50,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,inpatient,,,875.00000,425.25000,SilverSummit Healthplan,Commercial Exchange,,787.50,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,SilverSummit Healthplan,Commercial Exchange,,787.50,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,inpatient,,,1399.00000,679.91000,SilverSummit Healthplan,Commercial Exchange,,1259.10,,,,,,,1259.10,1357.03,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,outpatient,,,1399.00000,679.91000,SilverSummit Healthplan,Commercial Exchange,,1259.10,,,,,,,363.74,1357.03,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,inpatient,,,51.00000,24.79000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,outpatient,,,51.00000,24.79000,SilverSummit Healthplan,Commercial Exchange,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,inpatient,,,825.00000,400.95000,SilverSummit Healthplan,Commercial Exchange,,742.50,,,,,,,742.50,800.25,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,outpatient,,,825.00000,400.95000,SilverSummit Healthplan,Commercial Exchange,,742.50,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,inpatient,,,576.00000,279.94000,SilverSummit Healthplan,Commercial Exchange,,518.40,,,,,,,518.40,558.72,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,outpatient,,,576.00000,279.94000,SilverSummit Healthplan,Commercial Exchange,,518.40,,,,,,,149.76,558.72,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,inpatient,,,224.00000,108.86000,SilverSummit Healthplan,Commercial Exchange,,201.60,,,,,,,201.60,217.28,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,outpatient,,,224.00000,108.86000,SilverSummit Healthplan,Commercial Exchange,,201.60,,,,,,,58.24,217.28,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,inpatient,,,346.00000,168.16000,SilverSummit Healthplan,Commercial Exchange,,311.40,,,,,,,311.40,335.62,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,outpatient,,,346.00000,168.16000,SilverSummit Healthplan,Commercial Exchange,,311.40,,,,,,,89.96,335.62,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,inpatient,,,525.00000,255.15000,SilverSummit Healthplan,Commercial Exchange,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,outpatient,,,525.00000,255.15000,SilverSummit Healthplan,Commercial Exchange,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,inpatient,,,525.00000,255.15000,SilverSummit Healthplan,Commercial Exchange,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,outpatient,,,525.00000,255.15000,SilverSummit Healthplan,Commercial Exchange,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,inpatient,,,525.00000,255.15000,SilverSummit Healthplan,Commercial Exchange,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,SilverSummit Healthplan,Commercial Exchange,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,inpatient,,,525.00000,255.15000,SilverSummit Healthplan,Commercial Exchange,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,SilverSummit Healthplan,Commercial Exchange,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,inpatient,,,627.00000,304.72000,SilverSummit Healthplan,Commercial Exchange,,564.30,,,,,,,564.30,608.19,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,outpatient,,,627.00000,304.72000,SilverSummit Healthplan,Commercial Exchange,,564.30,,,,,,,163.02,608.19,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,inpatient,,,605.00000,294.03000,SilverSummit Healthplan,Commercial Exchange,,544.50,,,,,,,544.50,586.85,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,outpatient,,,605.00000,294.03000,SilverSummit Healthplan,Commercial Exchange,,544.50,,,,,,,157.30,586.85,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,inpatient,,,510.00000,247.86000,SilverSummit Healthplan,Commercial Exchange,,459.00,,,,,,,459.00,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,outpatient,,,510.00000,247.86000,SilverSummit Healthplan,Commercial Exchange,,459.00,,,,,,,132.60,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,inpatient,,,223.00000,108.38000,SilverSummit Healthplan,Commercial Exchange,,200.70,,,,,,,200.70,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,outpatient,,,223.00000,108.38000,SilverSummit Healthplan,Commercial Exchange,,200.70,,,,,,,57.98,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,inpatient,,,1211.00000,588.55000,SilverSummit Healthplan,Commercial Exchange,,1089.90,,,,,,,1089.90,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,outpatient,,,1211.00000,588.55000,SilverSummit Healthplan,Commercial Exchange,,1089.90,,,,,,,314.86,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,inpatient,,,383.00000,186.14000,SilverSummit Healthplan,Commercial Exchange,,344.70,,,,,,,344.70,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,outpatient,,,383.00000,186.14000,SilverSummit Healthplan,Commercial Exchange,,344.70,,,,,,,99.58,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,inpatient,,,1214.00000,590.00000,SilverSummit Healthplan,Commercial Exchange,,1092.60,,,,,,,1092.60,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,outpatient,,,1214.00000,590.00000,SilverSummit Healthplan,Commercial Exchange,,1092.60,,,,,,,315.64,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,inpatient,,,328.00000,159.41000,SilverSummit Healthplan,Commercial Exchange,,295.20,,,,,,,295.20,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,outpatient,,,328.00000,159.41000,SilverSummit Healthplan,Commercial Exchange,,295.20,,,,,,,85.28,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,inpatient,,,372.00000,180.79000,SilverSummit Healthplan,Commercial Exchange,,334.80,,,,,,,334.80,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,outpatient,,,372.00000,180.79000,SilverSummit Healthplan,Commercial Exchange,,334.80,,,,,,,96.72,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,inpatient,,,285.00000,138.51000,SilverSummit Healthplan,Commercial Exchange,,256.50,,,,,,,256.50,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,outpatient,,,285.00000,138.51000,SilverSummit Healthplan,Commercial Exchange,,256.50,,,,,,,74.10,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,inpatient,,,367.00000,178.36000,SilverSummit Healthplan,Commercial Exchange,,330.30,,,,,,,330.30,355.99,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,outpatient,,,367.00000,178.36000,SilverSummit Healthplan,Commercial Exchange,,330.30,,,,,,,95.42,355.99,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,inpatient,,,702.00000,341.17000,SilverSummit Healthplan,Commercial Exchange,,631.80,,,,,,,631.80,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,SilverSummit Healthplan,Commercial Exchange,,631.80,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,inpatient,,,702.00000,341.17000,SilverSummit Healthplan,Commercial Exchange,,631.80,,,,,,,631.80,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,SilverSummit Healthplan,Commercial Exchange,,631.80,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,inpatient,,,265.00000,128.79000,SilverSummit Healthplan,Commercial Exchange,,238.50,,,,,,,238.50,257.05,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,outpatient,,,265.00000,128.79000,SilverSummit Healthplan,Commercial Exchange,,238.50,,,,,,,68.90,257.05,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,inpatient,,,2279.00000,1107.59000,SilverSummit Healthplan,Commercial Exchange,,2051.10,,,,,,,2051.10,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2279.00000,1107.59000,SilverSummit Healthplan,Commercial Exchange,,2051.10,,,,,,,592.54,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,inpatient,,,2395.00000,1163.97000,SilverSummit Healthplan,Commercial Exchange,,2155.50,,,,,,,2155.50,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2395.00000,1163.97000,SilverSummit Healthplan,Commercial Exchange,,2155.50,,,,,,,622.70,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,inpatient,,,8759.00000,4256.87000,SilverSummit Healthplan,Commercial Exchange,,7883.10,,,,,,,7883.10,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,SilverSummit Healthplan,Commercial Exchange,,7883.10,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,inpatient,,,8759.00000,4256.87000,SilverSummit Healthplan,Commercial Exchange,,7883.10,,,,,,,7883.10,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,SilverSummit Healthplan,Commercial Exchange,,7883.10,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,inpatient,,,2752.00000,1337.47000,SilverSummit Healthplan,Commercial Exchange,,2476.80,,,,,,,2476.80,2669.44,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,outpatient,,,2752.00000,1337.47000,SilverSummit Healthplan,Commercial Exchange,,2476.80,,,,,,,715.52,2669.44,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,inpatient,,,217.00000,105.46000,SilverSummit Healthplan,Commercial Exchange,,195.30,,,,,,,195.30,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,SilverSummit Healthplan,Commercial Exchange,,195.30,,,,,,,56.42,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,inpatient,,,217.00000,105.46000,SilverSummit Healthplan,Commercial Exchange,,195.30,,,,,,,195.30,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,SilverSummit Healthplan,Commercial Exchange,,195.30,,,,,,,56.42,210.49,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,inpatient,,,292.00000,141.91000,SilverSummit Healthplan,Commercial Exchange,,262.80,,,,,,,262.80,283.24,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,outpatient,,,292.00000,141.91000,SilverSummit Healthplan,Commercial Exchange,,262.80,,,,,,,75.92,283.24,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,SilverSummit Healthplan,Commercial Exchange,,369.90,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,SilverSummit Healthplan,Commercial Exchange,,369.90,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,SilverSummit Healthplan,Commercial Exchange,,369.90,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,SilverSummit Healthplan,Commercial Exchange,,369.90,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,SilverSummit Healthplan,Commercial Exchange,,369.90,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,SilverSummit Healthplan,Commercial Exchange,,369.90,,,,,,,106.86,398.67,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,inpatient,,,2275.00000,1105.65000,SilverSummit Healthplan,Commercial Exchange,,2047.50,,,,,,,2047.50,2206.75,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,outpatient,,,2275.00000,1105.65000,SilverSummit Healthplan,Commercial Exchange,,2047.50,,,,,,,591.50,2206.75,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,inpatient,,,192.00000,93.31000,SilverSummit Healthplan,Commercial Exchange,,172.80,,,,,,,172.80,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,outpatient,,,192.00000,93.31000,SilverSummit Healthplan,Commercial Exchange,,172.80,,,,,,,49.92,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,inpatient,,,451.00000,219.19000,SilverSummit Healthplan,Commercial Exchange,,405.90,,,,,,,405.90,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,outpatient,,,451.00000,219.19000,SilverSummit Healthplan,Commercial Exchange,,405.90,,,,,,,117.26,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,inpatient,,,617.00000,299.86000,SilverSummit Healthplan,Commercial Exchange,,555.30,,,,,,,555.30,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,outpatient,,,617.00000,299.86000,SilverSummit Healthplan,Commercial Exchange,,555.30,,,,,,,160.42,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,inpatient,,,825.00000,400.95000,SilverSummit Healthplan,Commercial Exchange,,742.50,,,,,,,742.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,outpatient,,,825.00000,400.95000,SilverSummit Healthplan,Commercial Exchange,,742.50,,,,,,,214.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,inpatient,,,905.00000,439.83000,SilverSummit Healthplan,Commercial Exchange,,814.50,,,,,,,814.50,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,outpatient,,,905.00000,439.83000,SilverSummit Healthplan,Commercial Exchange,,814.50,,,,,,,235.30,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,inpatient,,,849.00000,412.61000,SilverSummit Healthplan,Commercial Exchange,,764.10,,,,,,,764.10,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,outpatient,,,849.00000,412.61000,SilverSummit Healthplan,Commercial Exchange,,764.10,,,,,,,220.74,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,inpatient,,,2539.00000,1233.95000,SilverSummit Healthplan,Commercial Exchange,,2285.10,,,,,,,2285.10,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,outpatient,,,2539.00000,1233.95000,SilverSummit Healthplan,Commercial Exchange,,2285.10,,,,,,,660.14,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,inpatient,,,6000.00000,2916.00000,SilverSummit Healthplan,Commercial Exchange,,5400.00,,,,,,,5400.00,5820.00,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,outpatient,,,6000.00000,2916.00000,SilverSummit Healthplan,Commercial Exchange,,5400.00,,,,,,,1560.00,5820.00,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,inpatient,,,8260.00000,4014.36000,SilverSummit Healthplan,Commercial Exchange,,7434.00,,,,,,,7434.00,8012.20,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,outpatient,,,8260.00000,4014.36000,SilverSummit Healthplan,Commercial Exchange,,7434.00,,,,,,,2147.60,8012.20,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,inpatient,,,202.00000,88.88000,SilverSummit Healthplan,Commercial Exchange,,181.80,,,,,,,181.80,195.94,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,outpatient,,,202.00000,88.88000,SilverSummit Healthplan,Commercial Exchange,,181.80,,,,,,,52.52,195.94,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,inpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Commercial Exchange,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,inpatient,,,295.00000,142.19000,SilverSummit Healthplan,Commercial Exchange,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,outpatient,,,295.00000,142.19000,SilverSummit Healthplan,Commercial Exchange,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,89.00000,26.79000,SilverSummit Healthplan,Commercial Exchange,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,89.00000,26.79000,SilverSummit Healthplan,Commercial Exchange,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,inpatient,,,93.00000,27.99000,SilverSummit Healthplan,Commercial Exchange,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,outpatient,,,93.00000,27.99000,SilverSummit Healthplan,Commercial Exchange,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,93.00000,27.99000,SilverSummit Healthplan,Commercial Exchange,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,93.00000,27.99000,SilverSummit Healthplan,Commercial Exchange,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,SilverSummit Healthplan,Commercial Exchange,,1687.50,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,SilverSummit Healthplan,Commercial Exchange,,1687.50,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,SilverSummit Healthplan,Commercial Exchange,,1687.50,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,SilverSummit Healthplan,Commercial Exchange,,1687.50,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1752.00000,527.35000,SilverSummit Healthplan,Commercial Exchange,,1576.80,,,,,,,1576.80,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,SilverSummit Healthplan,Commercial Exchange,,1576.80,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1752.00000,527.35000,SilverSummit Healthplan,Commercial Exchange,,1576.80,,,,,,,1576.80,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,SilverSummit Healthplan,Commercial Exchange,,1576.80,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,731.00000,220.03000,SilverSummit Healthplan,Commercial Exchange,,657.90,,,,,,,657.90,709.07,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,731.00000,220.03000,SilverSummit Healthplan,Commercial Exchange,,657.90,,,,,,,190.06,709.07,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,787.00000,236.89000,SilverSummit Healthplan,Commercial Exchange,,708.30,,,,,,,708.30,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,787.00000,236.89000,SilverSummit Healthplan,Commercial Exchange,,708.30,,,,,,,204.62,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,2042.00000,614.64000,SilverSummit Healthplan,Commercial Exchange,,1837.80,,,,,,,1837.80,1980.74,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,2042.00000,614.64000,SilverSummit Healthplan,Commercial Exchange,,1837.80,,,,,,,530.92,1980.74,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,SilverSummit Healthplan,Commercial Exchange,,1687.50,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,SilverSummit Healthplan,Commercial Exchange,,1687.50,,,,,,,487.50,1818.75,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,714.00000,214.91000,SilverSummit Healthplan,Commercial Exchange,,642.60,,,,,,,642.60,692.58,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,714.00000,214.91000,SilverSummit Healthplan,Commercial Exchange,,642.60,,,,,,,185.64,692.58,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,294.00000,88.49000,SilverSummit Healthplan,Commercial Exchange,,264.60,,,,,,,264.60,285.18,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,294.00000,88.49000,SilverSummit Healthplan,Commercial Exchange,,264.60,,,,,,,76.44,285.18,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,inpatient,,,350.00000,105.35000,SilverSummit Healthplan,Commercial Exchange,,315.00,,,,,,,315.00,339.50,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,350.00000,105.35000,SilverSummit Healthplan,Commercial Exchange,,315.00,,,,,,,91.00,339.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,inpatient,,,1350.00000,780.30000,SilverSummit Healthplan,Commercial Exchange,,1215.00,,,,,,,1215.00,1309.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,outpatient,,,1350.00000,780.30000,SilverSummit Healthplan,Commercial Exchange,,1215.00,,,,,,,351.00,1309.50,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,inpatient,,,3680.00000,2127.04000,SilverSummit Healthplan,Commercial Exchange,,3312.00,,,,,,,3312.00,3569.60,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,outpatient,,,3680.00000,2127.04000,SilverSummit Healthplan,Commercial Exchange,,3312.00,,,,,,,956.80,3569.60,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,inpatient,,,1600.00000,924.80000,SilverSummit Healthplan,Commercial Exchange,,1440.00,,,,,,,1440.00,1552.00,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,outpatient,,,1600.00000,924.80000,SilverSummit Healthplan,Commercial Exchange,,1440.00,,,,,,,416.00,1552.00,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,inpatient,,,4680.00000,2705.04000,SilverSummit Healthplan,Commercial Exchange,,4212.00,,,,,,,4212.00,4539.60,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,outpatient,,,4680.00000,2705.04000,SilverSummit Healthplan,Commercial Exchange,,4212.00,,,,,,,1216.80,4539.60,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,inpatient,,,2100.00000,1213.80000,SilverSummit Healthplan,Commercial Exchange,,1890.00,,,,,,,1890.00,2037.00,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,outpatient,,,2100.00000,1213.80000,SilverSummit Healthplan,Commercial Exchange,,1890.00,,,,,,,546.00,2037.00,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,inpatient,,,5680.00000,3283.04000,SilverSummit Healthplan,Commercial Exchange,,5112.00,,,,,,,5112.00,5509.60,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,outpatient,,,5680.00000,3283.04000,SilverSummit Healthplan,Commercial Exchange,,5112.00,,,,,,,1476.80,5509.60,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,inpatient,,,2420.00000,1398.76000,SilverSummit Healthplan,Commercial Exchange,,2178.00,,,,,,,2178.00,2347.40,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,outpatient,,,2420.00000,1398.76000,SilverSummit Healthplan,Commercial Exchange,,2178.00,,,,,,,629.20,2347.40,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,inpatient,,,6415.00000,3707.87000,SilverSummit Healthplan,Commercial Exchange,,5773.50,,,,,,,5773.50,6222.55,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,outpatient,,,6415.00000,3707.87000,SilverSummit Healthplan,Commercial Exchange,,5773.50,,,,,,,1667.90,6222.55,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,inpatient,,,2920.00000,1687.76000,SilverSummit Healthplan,Commercial Exchange,,2628.00,,,,,,,2628.00,2832.40,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,outpatient,,,2920.00000,1687.76000,SilverSummit Healthplan,Commercial Exchange,,2628.00,,,,,,,759.20,2832.40,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,inpatient,,,8915.00000,5152.87000,SilverSummit Healthplan,Commercial Exchange,,8023.50,,,,,,,8023.50,8647.55,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,outpatient,,,8915.00000,5152.87000,SilverSummit Healthplan,Commercial Exchange,,8023.50,,,,,,,2317.90,8647.55,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,inpatient,,,3420.00000,1976.76000,SilverSummit Healthplan,Commercial Exchange,,3078.00,,,,,,,3078.00,3317.40,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,outpatient,,,3420.00000,1976.76000,SilverSummit Healthplan,Commercial Exchange,,3078.00,,,,,,,889.20,3317.40,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,inpatient,,,11415.00000,6597.87000,SilverSummit Healthplan,Commercial Exchange,,10273.50,,,,,,,10273.50,11072.55,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,outpatient,,,11415.00000,6597.87000,SilverSummit Healthplan,Commercial Exchange,,10273.50,,,,,,,2967.90,11072.55,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,inpatient,,,142.00000,154.35000,SilverSummit Healthplan,Commercial Exchange,,127.80,,,,,,,127.80,137.74,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,outpatient,,,142.00000,154.35000,SilverSummit Healthplan,Commercial Exchange,,127.80,,,,,,,36.92,137.74,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,inpatient,,,340.00000,228.82000,SilverSummit Healthplan,Commercial Exchange,,306.00,,,,,,,306.00,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,SilverSummit Healthplan,Commercial Exchange,,306.00,,,,,,,88.40,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,inpatient,,,670.00000,450.91000,SilverSummit Healthplan,Commercial Exchange,,603.00,,,,,,,603.00,649.90,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,SilverSummit Healthplan,Commercial Exchange,,603.00,,,,,,,174.20,649.90,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,inpatient,,,390.00000,262.47000,SilverSummit Healthplan,Commercial Exchange,,351.00,,,,,,,351.00,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,outpatient,,,390.00000,262.47000,SilverSummit Healthplan,Commercial Exchange,,351.00,,,,,,,101.40,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,inpatient,,,1170.00000,787.41000,SilverSummit Healthplan,Commercial Exchange,,1053.00,,,,,,,1053.00,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,outpatient,,,1170.00000,787.41000,SilverSummit Healthplan,Commercial Exchange,,1053.00,,,,,,,304.20,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,inpatient,,,440.00000,296.12000,SilverSummit Healthplan,Commercial Exchange,,396.00,,,,,,,396.00,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,outpatient,,,440.00000,296.12000,SilverSummit Healthplan,Commercial Exchange,,396.00,,,,,,,114.40,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,inpatient,,,1670.00000,1123.91000,SilverSummit Healthplan,Commercial Exchange,,1503.00,,,,,,,1503.00,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,outpatient,,,1670.00000,1123.91000,SilverSummit Healthplan,Commercial Exchange,,1503.00,,,,,,,434.20,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,inpatient,,,640.00000,430.72000,SilverSummit Healthplan,Commercial Exchange,,576.00,,,,,,,576.00,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,outpatient,,,640.00000,430.72000,SilverSummit Healthplan,Commercial Exchange,,576.00,,,,,,,166.40,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,inpatient,,,2170.00000,1460.41000,SilverSummit Healthplan,Commercial Exchange,,1953.00,,,,,,,1953.00,2104.90,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,outpatient,,,2170.00000,1460.41000,SilverSummit Healthplan,Commercial Exchange,,1953.00,,,,,,,564.20,2104.90,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,inpatient,,,17.00000,10.96000,SilverSummit Healthplan,Commercial Exchange,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,outpatient,,,17.00000,10.96000,SilverSummit Healthplan,Commercial Exchange,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,inpatient,,,535.00000,345.08000,SilverSummit Healthplan,Commercial Exchange,,481.50,,,,,,,481.50,518.95,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,outpatient,,,535.00000,345.08000,SilverSummit Healthplan,Commercial Exchange,,481.50,,,,,,,139.10,518.95,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,inpatient,,,23.00000,14.84000,SilverSummit Healthplan,Commercial Exchange,,20.70,,,,,,,20.70,22.31,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,outpatient,,,23.00000,14.84000,SilverSummit Healthplan,Commercial Exchange,,20.70,,,,,,,5.98,22.31,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,inpatient,,,635.00000,409.58000,SilverSummit Healthplan,Commercial Exchange,,571.50,,,,,,,571.50,615.95,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,outpatient,,,635.00000,409.58000,SilverSummit Healthplan,Commercial Exchange,,571.50,,,,,,,165.10,615.95,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,inpatient,,,30.00000,19.35000,SilverSummit Healthplan,Commercial Exchange,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,outpatient,,,30.00000,19.35000,SilverSummit Healthplan,Commercial Exchange,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,inpatient,,,735.00000,474.08000,SilverSummit Healthplan,Commercial Exchange,,661.50,,,,,,,661.50,712.95,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,outpatient,,,735.00000,474.08000,SilverSummit Healthplan,Commercial Exchange,,661.50,,,,,,,191.10,712.95,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,inpatient,,,33.00000,21.28000,SilverSummit Healthplan,Commercial Exchange,,29.70,,,,,,,29.70,32.01,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,outpatient,,,33.00000,21.28000,SilverSummit Healthplan,Commercial Exchange,,29.70,,,,,,,8.58,32.01,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,inpatient,,,835.00000,538.58000,SilverSummit Healthplan,Commercial Exchange,,751.50,,,,,,,751.50,809.95,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,outpatient,,,835.00000,538.58000,SilverSummit Healthplan,Commercial Exchange,,751.50,,,,,,,217.10,809.95,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,inpatient,,,140.00000,80.92000,SilverSummit Healthplan,Commercial Exchange,,126.00,,,,,,,126.00,135.80,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,outpatient,,,140.00000,80.92000,SilverSummit Healthplan,Commercial Exchange,,126.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,inpatient,,,275.00000,158.95000,SilverSummit Healthplan,Commercial Exchange,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,outpatient,,,275.00000,158.95000,SilverSummit Healthplan,Commercial Exchange,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,inpatient,,,295.00000,170.51000,SilverSummit Healthplan,Commercial Exchange,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,outpatient,,,295.00000,170.51000,SilverSummit Healthplan,Commercial Exchange,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,inpatient,,,590.00000,341.02000,SilverSummit Healthplan,Commercial Exchange,,531.00,,,,,,,531.00,572.30,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,outpatient,,,590.00000,341.02000,SilverSummit Healthplan,Commercial Exchange,,531.00,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,inpatient,,,690.00000,398.82000,SilverSummit Healthplan,Commercial Exchange,,621.00,,,,,,,621.00,669.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,outpatient,,,690.00000,398.82000,SilverSummit Healthplan,Commercial Exchange,,621.00,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,inpatient,,,1375.00000,794.75000,SilverSummit Healthplan,Commercial Exchange,,1237.50,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,outpatient,,,1375.00000,794.75000,SilverSummit Healthplan,Commercial Exchange,,1237.50,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,inpatient,,,950.00000,549.10000,SilverSummit Healthplan,Commercial Exchange,,855.00,,,,,,,855.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,outpatient,,,950.00000,549.10000,SilverSummit Healthplan,Commercial Exchange,,855.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,inpatient,,,1900.00000,1098.20000,SilverSummit Healthplan,Commercial Exchange,,1710.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,outpatient,,,1900.00000,1098.20000,SilverSummit Healthplan,Commercial Exchange,,1710.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,inpatient,,,140.00000,45.22000,SilverSummit Healthplan,Commercial Exchange,,126.00,,,,,,,126.00,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,outpatient,,,140.00000,45.22000,SilverSummit Healthplan,Commercial Exchange,,126.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,inpatient,,,275.00000,88.82000,SilverSummit Healthplan,Commercial Exchange,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,outpatient,,,275.00000,88.82000,SilverSummit Healthplan,Commercial Exchange,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,inpatient,,,295.00000,95.28000,SilverSummit Healthplan,Commercial Exchange,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,outpatient,,,295.00000,95.28000,SilverSummit Healthplan,Commercial Exchange,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,inpatient,,,590.00000,190.57000,SilverSummit Healthplan,Commercial Exchange,,531.00,,,,,,,531.00,572.30,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,outpatient,,,590.00000,190.57000,SilverSummit Healthplan,Commercial Exchange,,531.00,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,inpatient,,,690.00000,222.87000,SilverSummit Healthplan,Commercial Exchange,,621.00,,,,,,,621.00,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,outpatient,,,690.00000,222.87000,SilverSummit Healthplan,Commercial Exchange,,621.00,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,inpatient,,,1375.00000,444.12000,SilverSummit Healthplan,Commercial Exchange,,1237.50,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,outpatient,,,1375.00000,444.12000,SilverSummit Healthplan,Commercial Exchange,,1237.50,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,inpatient,,,950.00000,306.85000,SilverSummit Healthplan,Commercial Exchange,,855.00,,,,,,,855.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,outpatient,,,950.00000,306.85000,SilverSummit Healthplan,Commercial Exchange,,855.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,inpatient,,,1900.00000,613.70000,SilverSummit Healthplan,Commercial Exchange,,1710.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,outpatient,,,1900.00000,613.70000,SilverSummit Healthplan,Commercial Exchange,,1710.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,inpatient,,,340.00000,228.82000,SilverSummit Healthplan,Commercial Exchange,,306.00,,,,,,,306.00,329.80,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,SilverSummit Healthplan,Commercial Exchange,,306.00,,,,,,,88.40,329.80,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,inpatient,,,670.00000,450.91000,SilverSummit Healthplan,Commercial Exchange,,603.00,,,,,,,603.00,649.90,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,SilverSummit Healthplan,Commercial Exchange,,603.00,,,,,,,174.20,649.90,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,SilverSummit Healthplan,Commercial Exchange,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,SilverSummit Healthplan,Commercial Exchange,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,inpatient,,,490.00000,329.77000,SilverSummit Healthplan,Commercial Exchange,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,SilverSummit Healthplan,Commercial Exchange,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,SilverSummit Healthplan,Commercial Exchange,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,SilverSummit Healthplan,Commercial Exchange,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,inpatient,,,245.00000,164.89000,SilverSummit Healthplan,Commercial Exchange,,220.50,,,,,,,220.50,237.65,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,SilverSummit Healthplan,Commercial Exchange,,220.50,,,,,,,63.70,237.65,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,SilverSummit Healthplan,Commercial Exchange,,757.80,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,SilverSummit Healthplan,Commercial Exchange,,757.80,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,SilverSummit Healthplan,Commercial Exchange,,947.70,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,SilverSummit Healthplan,Commercial Exchange,,947.70,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,SilverSummit Healthplan,Commercial Exchange,,1136.70,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,SilverSummit Healthplan,Commercial Exchange,,1136.70,,,,,,,328.38,1225.11,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,inpatient,,,1178.00000,669.28000,SilverSummit Healthplan,Commercial Exchange,,1060.20,,,,,,,1060.20,1142.66,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1178.00000,669.28000,SilverSummit Healthplan,Commercial Exchange,,1060.20,,,,,,,306.28,1142.66,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,inpatient,,,140.00000,102.34000,SilverSummit Healthplan,Commercial Exchange,,126.00,,,,,,,126.00,135.80,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,outpatient,,,140.00000,102.34000,SilverSummit Healthplan,Commercial Exchange,,126.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,inpatient,,,275.00000,201.02000,SilverSummit Healthplan,Commercial Exchange,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,outpatient,,,275.00000,201.02000,SilverSummit Healthplan,Commercial Exchange,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,inpatient,,,295.00000,215.64000,SilverSummit Healthplan,Commercial Exchange,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,outpatient,,,295.00000,215.64000,SilverSummit Healthplan,Commercial Exchange,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,inpatient,,,590.00000,431.29000,SilverSummit Healthplan,Commercial Exchange,,531.00,,,,,,,531.00,572.30,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,outpatient,,,590.00000,431.29000,SilverSummit Healthplan,Commercial Exchange,,531.00,,,,,,,153.40,572.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,inpatient,,,690.00000,504.39000,SilverSummit Healthplan,Commercial Exchange,,621.00,,,,,,,621.00,669.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,outpatient,,,690.00000,504.39000,SilverSummit Healthplan,Commercial Exchange,,621.00,,,,,,,179.40,669.30,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,inpatient,,,1375.00000,1005.12000,SilverSummit Healthplan,Commercial Exchange,,1237.50,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,outpatient,,,1375.00000,1005.12000,SilverSummit Healthplan,Commercial Exchange,,1237.50,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,inpatient,,,950.00000,694.45000,SilverSummit Healthplan,Commercial Exchange,,855.00,,,,,,,855.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,outpatient,,,950.00000,694.45000,SilverSummit Healthplan,Commercial Exchange,,855.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,inpatient,,,1900.00000,1388.90000,SilverSummit Healthplan,Commercial Exchange,,1710.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,outpatient,,,1900.00000,1388.90000,SilverSummit Healthplan,Commercial Exchange,,1710.00,,,,,,,494.00,1843.00,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,inpatient,,,584.00000,426.90000,SilverSummit Healthplan,Commercial Exchange,,525.60,,,,,,,525.60,566.48,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,outpatient,,,584.00000,426.90000,SilverSummit Healthplan,Commercial Exchange,,525.60,,,,,,,151.84,566.48,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,inpatient,,,1391.00000,1016.82000,SilverSummit Healthplan,Commercial Exchange,,1251.90,,,,,,,1251.90,1349.27,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,outpatient,,,1391.00000,1016.82000,SilverSummit Healthplan,Commercial Exchange,,1251.90,,,,,,,361.66,1349.27,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,inpatient,,,359.00000,271.76000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,outpatient,,,359.00000,271.76000,SilverSummit Healthplan,Commercial Exchange,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,inpatient,,,95.00000,71.92000,SilverSummit Healthplan,Commercial Exchange,,85.50,,,,,,,85.50,92.15,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,outpatient,,,95.00000,71.92000,SilverSummit Healthplan,Commercial Exchange,,85.50,,,,,,,24.70,92.15,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,inpatient,,,37.00000,17.83000,SilverSummit Healthplan,Commercial Exchange,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,outpatient,,,37.00000,17.83000,SilverSummit Healthplan,Commercial Exchange,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,SilverSummit Healthplan,Commercial Exchange,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,inpatient,,,237.00000,114.23000,SilverSummit Healthplan,Commercial Exchange,,213.30,,,,,,,213.30,229.89,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,SilverSummit Healthplan,Commercial Exchange,,213.30,,,,,,,61.62,229.89,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,inpatient,,,33.00000,15.91000,SilverSummit Healthplan,Commercial Exchange,,29.70,,,,,,,29.70,32.01,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,outpatient,,,33.00000,15.91000,SilverSummit Healthplan,Commercial Exchange,,29.70,,,,,,,8.58,32.01,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,inpatient,,,25.00000,12.05000,SilverSummit Healthplan,Commercial Exchange,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,outpatient,,,25.00000,12.05000,SilverSummit Healthplan,Commercial Exchange,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,inpatient,,,497.00000,160.53000,SilverSummit Healthplan,Commercial Exchange,,447.30,,,,,,,447.30,482.09,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,outpatient,,,497.00000,160.53000,SilverSummit Healthplan,Commercial Exchange,,447.30,,,,,,,129.22,482.09,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,SilverSummit Healthplan,Commercial Exchange,,793.80,,,,,,,793.80,855.54,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,SilverSummit Healthplan,Commercial Exchange,,793.80,,,,,,,229.32,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,SilverSummit Healthplan,Commercial Exchange,,793.80,,,,,,,793.80,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,SilverSummit Healthplan,Commercial Exchange,,793.80,,,,,,,229.32,855.54,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,inpatient,,,98.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,inpatient,,,96.00000,36.67000,SilverSummit Healthplan,Commercial Exchange,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,SilverSummit Healthplan,Commercial Exchange,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,SilverSummit Healthplan,Commercial Exchange,,793.80,,,,,,,793.80,855.54,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,SilverSummit Healthplan,Commercial Exchange,,793.80,,,,,,,229.32,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,SilverSummit Healthplan,Commercial Exchange,,793.80,,,,,,,793.80,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,SilverSummit Healthplan,Commercial Exchange,,793.80,,,,,,,229.32,855.54,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,inpatient,,,763.00000,291.47000,SilverSummit Healthplan,Commercial Exchange,,686.70,,,,,,,686.70,740.11,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,outpatient,,,763.00000,291.47000,SilverSummit Healthplan,Commercial Exchange,,686.70,,,,,,,198.38,740.11,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,inpatient,,,199.00000,76.02000,SilverSummit Healthplan,Commercial Exchange,,179.10,,,,,,,179.10,193.03,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,outpatient,,,199.00000,76.02000,SilverSummit Healthplan,Commercial Exchange,,179.10,,,,,,,51.74,193.03,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,inpatient,,,98.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,inpatient,,,96.00000,36.67000,SilverSummit Healthplan,Commercial Exchange,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,SilverSummit Healthplan,Commercial Exchange,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,inpatient,,,1265.00000,483.23000,SilverSummit Healthplan,Commercial Exchange,,1138.50,,,,,,,1138.50,1227.05,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,outpatient,,,1265.00000,483.23000,SilverSummit Healthplan,Commercial Exchange,,1138.50,,,,,,,328.90,1227.05,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,inpatient,,,924.00000,352.97000,SilverSummit Healthplan,Commercial Exchange,,831.60,,,,,,,831.60,896.28,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,outpatient,,,924.00000,352.97000,SilverSummit Healthplan,Commercial Exchange,,831.60,,,,,,,240.24,896.28,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,inpatient,,,580.00000,215.76000,SilverSummit Healthplan,Commercial Exchange,,522.00,,,,,,,522.00,562.60,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,outpatient,,,580.00000,215.76000,SilverSummit Healthplan,Commercial Exchange,,522.00,,,,,,,150.80,562.60,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,inpatient,,,110.00000,40.92000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,outpatient,,,110.00000,40.92000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,inpatient,,,373.00000,138.76000,SilverSummit Healthplan,Commercial Exchange,,335.70,,,,,,,335.70,361.81,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,outpatient,,,373.00000,138.76000,SilverSummit Healthplan,Commercial Exchange,,335.70,,,,,,,96.98,361.81,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,inpatient,,,337.00000,125.36000,SilverSummit Healthplan,Commercial Exchange,,303.30,,,,,,,303.30,326.89,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,outpatient,,,337.00000,125.36000,SilverSummit Healthplan,Commercial Exchange,,303.30,,,,,,,87.62,326.89,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,inpatient,,,784.00000,291.65000,SilverSummit Healthplan,Commercial Exchange,,705.60,,,,,,,705.60,760.48,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,outpatient,,,784.00000,291.65000,SilverSummit Healthplan,Commercial Exchange,,705.60,,,,,,,203.84,760.48,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,inpatient,,,341.00000,126.85000,SilverSummit Healthplan,Commercial Exchange,,306.90,,,,,,,306.90,330.77,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,outpatient,,,341.00000,126.85000,SilverSummit Healthplan,Commercial Exchange,,306.90,,,,,,,88.66,330.77,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,inpatient,,,252.00000,93.74000,SilverSummit Healthplan,Commercial Exchange,,226.80,,,,,,,226.80,244.44,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,outpatient,,,252.00000,93.74000,SilverSummit Healthplan,Commercial Exchange,,226.80,,,,,,,65.52,244.44,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,inpatient,,,282.00000,104.90000,SilverSummit Healthplan,Commercial Exchange,,253.80,,,,,,,253.80,273.54,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,outpatient,,,282.00000,104.90000,SilverSummit Healthplan,Commercial Exchange,,253.80,,,,,,,73.32,273.54,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,inpatient,,,404.00000,150.29000,SilverSummit Healthplan,Commercial Exchange,,363.60,,,,,,,363.60,391.88,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,outpatient,,,404.00000,150.29000,SilverSummit Healthplan,Commercial Exchange,,363.60,,,,,,,105.04,391.88,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,inpatient,,,306.00000,173.85000,SilverSummit Healthplan,Commercial Exchange,,275.40,,,,,,,275.40,296.82,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,outpatient,,,306.00000,173.85000,SilverSummit Healthplan,Commercial Exchange,,275.40,,,,,,,79.56,296.82,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,inpatient,,,158.00000,89.77000,SilverSummit Healthplan,Commercial Exchange,,142.20,,,,,,,142.20,153.26,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,outpatient,,,158.00000,89.77000,SilverSummit Healthplan,Commercial Exchange,,142.20,,,,,,,41.08,153.26,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,inpatient,,,147.00000,89.38000,SilverSummit Healthplan,Commercial Exchange,GP,132.30,,,,,,,132.30,142.59,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,SilverSummit Healthplan,Commercial Exchange,GP,132.30,,,,,,,38.22,142.59,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,inpatient,,,270.00000,164.16000,SilverSummit Healthplan,Commercial Exchange,GP,243.00,,,,,,,243.00,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,SilverSummit Healthplan,Commercial Exchange,GP,243.00,,,,,,,70.20,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,inpatient,,,84.00000,51.07000,SilverSummit Healthplan,Commercial Exchange,GP,75.60,,,,,,,75.60,81.48,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,SilverSummit Healthplan,Commercial Exchange,GP,75.60,,,,,,,21.84,81.48,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,inpatient,,,86.00000,52.29000,SilverSummit Healthplan,Commercial Exchange,GP,77.40,,,,,,,77.40,83.42,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,SilverSummit Healthplan,Commercial Exchange,GP,77.40,,,,,,,22.36,83.42,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,inpatient,,,82.00000,49.86000,SilverSummit Healthplan,Commercial Exchange,GP,73.80,,,,,,,73.80,79.54,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,SilverSummit Healthplan,Commercial Exchange,GP,73.80,,,,,,,21.32,79.54,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,inpatient,,,85.00000,51.68000,SilverSummit Healthplan,Commercial Exchange,GP,76.50,,,,,,,76.50,82.45,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,SilverSummit Healthplan,Commercial Exchange,GP,76.50,,,,,,,22.10,82.45,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,inpatient,,,43.00000,26.14000,SilverSummit Healthplan,Commercial Exchange,GP,38.70,,,,,,,38.70,41.71,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,SilverSummit Healthplan,Commercial Exchange,GP,38.70,,,,,,,11.18,41.71,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,inpatient,,,41.00000,24.93000,SilverSummit Healthplan,Commercial Exchange,GP,36.90,,,,,,,36.90,39.77,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,SilverSummit Healthplan,Commercial Exchange,GP,36.90,,,,,,,10.66,39.77,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,inpatient,,,79.00000,48.03000,SilverSummit Healthplan,Commercial Exchange,GP,71.10,,,,,,,71.10,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,SilverSummit Healthplan,Commercial Exchange,GP,71.10,,,,,,,20.54,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,SilverSummit Healthplan,Commercial Exchange,GP,66.60,,,,,,,66.60,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,SilverSummit Healthplan,Commercial Exchange,GP,66.60,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,SilverSummit Healthplan,Commercial Exchange,GP,66.60,,,,,,,66.60,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,SilverSummit Healthplan,Commercial Exchange,GP,66.60,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,inpatient,,,34.00000,20.67000,SilverSummit Healthplan,Commercial Exchange,GP,30.60,,,,,,,30.60,32.98,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,SilverSummit Healthplan,Commercial Exchange,GP,30.60,,,,,,,8.84,32.98,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,inpatient,,,65.00000,39.52000,SilverSummit Healthplan,Commercial Exchange,GP,58.50,,,,,,,58.50,63.05,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,SilverSummit Healthplan,Commercial Exchange,GP,58.50,,,,,,,16.90,63.05,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,inpatient,,,113.00000,68.70000,SilverSummit Healthplan,Commercial Exchange,,101.70,,,,,,,101.70,109.61,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,outpatient,,,113.00000,68.70000,SilverSummit Healthplan,Commercial Exchange,,101.70,,,,,,,29.38,109.61,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,inpatient,,,80.00000,48.64000,SilverSummit Healthplan,Commercial Exchange,GP,72.00,,,,,,,72.00,77.60,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,SilverSummit Healthplan,Commercial Exchange,GP,72.00,,,,,,,20.80,77.60,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,inpatient,,,84.00000,51.07000,SilverSummit Healthplan,Commercial Exchange,GP,75.60,,,,,,,75.60,81.48,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,SilverSummit Healthplan,Commercial Exchange,GP,75.60,,,,,,,21.84,81.48,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,inpatient,,,73.00000,44.38000,SilverSummit Healthplan,Commercial Exchange,GP,65.70,,,,,,,65.70,70.81,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,SilverSummit Healthplan,Commercial Exchange,GP,65.70,,,,,,,18.98,70.81,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,inpatient,,,100.00000,60.80000,SilverSummit Healthplan,Commercial Exchange,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,outpatient,,,100.00000,60.80000,SilverSummit Healthplan,Commercial Exchange,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,inpatient,,,167.00000,101.54000,SilverSummit Healthplan,Commercial Exchange,GP,150.30,,,,,,,150.30,161.99,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,outpatient,,,167.00000,101.54000,SilverSummit Healthplan,Commercial Exchange,GP,150.30,,,,,,,43.42,161.99,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,inpatient,,,413.00000,251.10000,SilverSummit Healthplan,Commercial Exchange,"50,GP",371.70,,,,,,,371.70,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,SilverSummit Healthplan,Commercial Exchange,"50,GP",371.70,,,,,,,107.38,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,SilverSummit Healthplan,Commercial Exchange,"LT,GP",247.50,,,,,,,247.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,SilverSummit Healthplan,Commercial Exchange,"LT,GP",247.50,,,,,,,71.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,SilverSummit Healthplan,Commercial Exchange,"RT,GP",247.50,,,,,,,247.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,SilverSummit Healthplan,Commercial Exchange,"RT,GP",247.50,,,,,,,71.50,266.75,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,inpatient,,,95.00000,57.76000,SilverSummit Healthplan,Commercial Exchange,GP,85.50,,,,,,,85.50,92.15,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,SilverSummit Healthplan,Commercial Exchange,GP,85.50,,,,,,,24.70,92.15,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,inpatient,,,146.00000,88.77000,SilverSummit Healthplan,Commercial Exchange,GP,131.40,,,,,,,131.40,141.62,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,SilverSummit Healthplan,Commercial Exchange,GP,131.40,,,,,,,37.96,141.62,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,inpatient,,,139.00000,84.51000,SilverSummit Healthplan,Commercial Exchange,GP,125.10,,,,,,,125.10,134.83,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,SilverSummit Healthplan,Commercial Exchange,GP,125.10,,,,,,,36.14,134.83,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,inpatient,,,75.00000,45.60000,SilverSummit Healthplan,Commercial Exchange,GP,67.50,,,,,,,67.50,72.75,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,SilverSummit Healthplan,Commercial Exchange,GP,67.50,,,,,,,19.50,72.75,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,inpatient,,,154.00000,93.63000,SilverSummit Healthplan,Commercial Exchange,GP,138.60,,,,,,,138.60,149.38,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,SilverSummit Healthplan,Commercial Exchange,GP,138.60,,,,,,,40.04,149.38,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,inpatient,,,73.00000,44.38000,SilverSummit Healthplan,Commercial Exchange,GP,65.70,,,,,,,65.70,70.81,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,SilverSummit Healthplan,Commercial Exchange,GP,65.70,,,,,,,18.98,70.81,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,inpatient,,,160.00000,97.28000,SilverSummit Healthplan,Commercial Exchange,GP,144.00,,,,,,,144.00,155.20,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,SilverSummit Healthplan,Commercial Exchange,GP,144.00,,,,,,,41.60,155.20,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,inpatient,,,325.00000,197.60000,SilverSummit Healthplan,Commercial Exchange,GP,292.50,,,,,,,292.50,315.25,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,SilverSummit Healthplan,Commercial Exchange,GP,292.50,,,,,,,84.50,315.25,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,inpatient,,,98.00000,59.58000,SilverSummit Healthplan,Commercial Exchange,GP,88.20,,,,,,,88.20,95.06,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,outpatient,,,98.00000,59.58000,SilverSummit Healthplan,Commercial Exchange,GP,88.20,,,,,,,25.48,95.06,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,inpatient,,,303.00000,184.22000,SilverSummit Healthplan,Commercial Exchange,GP,272.70,,,,,,,272.70,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,outpatient,,,303.00000,184.22000,SilverSummit Healthplan,Commercial Exchange,GP,272.70,,,,,,,78.78,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,inpatient,,,115.00000,69.92000,SilverSummit Healthplan,Commercial Exchange,GP,103.50,,,,,,,103.50,111.55,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,outpatient,,,115.00000,69.92000,SilverSummit Healthplan,Commercial Exchange,GP,103.50,,,,,,,29.90,111.55,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,inpatient,,,74.00000,44.99000,SilverSummit Healthplan,Commercial Exchange,GP,66.60,,,,,,,66.60,71.78,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,SilverSummit Healthplan,Commercial Exchange,GP,66.60,,,,,,,19.24,71.78,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,inpatient,,,79.00000,48.03000,SilverSummit Healthplan,Commercial Exchange,GP,71.10,,,,,,,71.10,76.63,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,SilverSummit Healthplan,Commercial Exchange,GP,71.10,,,,,,,20.54,76.63,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,inpatient,,,72.00000,43.78000,SilverSummit Healthplan,Commercial Exchange,GP,64.80,,,,,,,64.80,69.84,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,SilverSummit Healthplan,Commercial Exchange,GP,64.80,,,,,,,18.72,69.84,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,inpatient,,,147.00000,89.38000,SilverSummit Healthplan,Commercial Exchange,GP,132.30,,,,,,,132.30,142.59,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,SilverSummit Healthplan,Commercial Exchange,GP,132.30,,,,,,,38.22,142.59,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,inpatient,,,270.00000,164.16000,SilverSummit Healthplan,Commercial Exchange,GP,243.00,,,,,,,243.00,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,SilverSummit Healthplan,Commercial Exchange,GP,243.00,,,,,,,70.20,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,inpatient,,,84.00000,51.07000,SilverSummit Healthplan,Commercial Exchange,GP,75.60,,,,,,,75.60,81.48,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,SilverSummit Healthplan,Commercial Exchange,GP,75.60,,,,,,,21.84,81.48,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,inpatient,,,86.00000,52.29000,SilverSummit Healthplan,Commercial Exchange,GP,77.40,,,,,,,77.40,83.42,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,SilverSummit Healthplan,Commercial Exchange,GP,77.40,,,,,,,22.36,83.42,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,inpatient,,,82.00000,49.86000,SilverSummit Healthplan,Commercial Exchange,GP,73.80,,,,,,,73.80,79.54,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,SilverSummit Healthplan,Commercial Exchange,GP,73.80,,,,,,,21.32,79.54,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,inpatient,,,85.00000,51.68000,SilverSummit Healthplan,Commercial Exchange,GP,76.50,,,,,,,76.50,82.45,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,SilverSummit Healthplan,Commercial Exchange,GP,76.50,,,,,,,22.10,82.45,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,inpatient,,,43.00000,26.14000,SilverSummit Healthplan,Commercial Exchange,GP,38.70,,,,,,,38.70,41.71,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,SilverSummit Healthplan,Commercial Exchange,GP,38.70,,,,,,,11.18,41.71,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,inpatient,,,41.00000,24.93000,SilverSummit Healthplan,Commercial Exchange,GP,36.90,,,,,,,36.90,39.77,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,SilverSummit Healthplan,Commercial Exchange,GP,36.90,,,,,,,10.66,39.77,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,inpatient,,,79.00000,48.03000,SilverSummit Healthplan,Commercial Exchange,GP,71.10,,,,,,,71.10,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,SilverSummit Healthplan,Commercial Exchange,GP,71.10,,,,,,,20.54,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,SilverSummit Healthplan,Commercial Exchange,"CQ,GP",66.60,,,,,,,66.60,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,SilverSummit Healthplan,Commercial Exchange,"CQ,GP",66.60,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,SilverSummit Healthplan,Commercial Exchange,"CQ,GP",66.60,,,,,,,66.60,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,SilverSummit Healthplan,Commercial Exchange,"CQ,GP",66.60,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,inpatient,,,34.00000,20.67000,SilverSummit Healthplan,Commercial Exchange,GP,30.60,,,,,,,30.60,32.98,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,SilverSummit Healthplan,Commercial Exchange,GP,30.60,,,,,,,8.84,32.98,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,inpatient,,,65.00000,39.52000,SilverSummit Healthplan,Commercial Exchange,GP,58.50,,,,,,,58.50,63.05,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,SilverSummit Healthplan,Commercial Exchange,GP,58.50,,,,,,,16.90,63.05,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,inpatient,,,80.00000,48.64000,SilverSummit Healthplan,Commercial Exchange,GP,72.00,,,,,,,72.00,77.60,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,SilverSummit Healthplan,Commercial Exchange,GP,72.00,,,,,,,20.80,77.60,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,inpatient,,,84.00000,51.07000,SilverSummit Healthplan,Commercial Exchange,GP,75.60,,,,,,,75.60,81.48,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,SilverSummit Healthplan,Commercial Exchange,GP,75.60,,,,,,,21.84,81.48,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,inpatient,,,73.00000,44.38000,SilverSummit Healthplan,Commercial Exchange,GP,65.70,,,,,,,65.70,70.81,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,SilverSummit Healthplan,Commercial Exchange,GP,65.70,,,,,,,18.98,70.81,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,inpatient,,,413.00000,251.10000,SilverSummit Healthplan,Commercial Exchange,"GP,50",371.70,,,,,,,371.70,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,SilverSummit Healthplan,Commercial Exchange,"GP,50",371.70,,,,,,,107.38,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,SilverSummit Healthplan,Commercial Exchange,"GP,LT",247.50,,,,,,,247.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,SilverSummit Healthplan,Commercial Exchange,"GP,LT",247.50,,,,,,,71.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,SilverSummit Healthplan,Commercial Exchange,"GP,RT",247.50,,,,,,,247.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,SilverSummit Healthplan,Commercial Exchange,"GP,RT",247.50,,,,,,,71.50,266.75,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,inpatient,,,95.00000,57.76000,SilverSummit Healthplan,Commercial Exchange,GP,85.50,,,,,,,85.50,92.15,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,SilverSummit Healthplan,Commercial Exchange,GP,85.50,,,,,,,24.70,92.15,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,inpatient,,,146.00000,88.77000,SilverSummit Healthplan,Commercial Exchange,GP,131.40,,,,,,,131.40,141.62,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,SilverSummit Healthplan,Commercial Exchange,GP,131.40,,,,,,,37.96,141.62,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,inpatient,,,139.00000,84.51000,SilverSummit Healthplan,Commercial Exchange,GP,125.10,,,,,,,125.10,134.83,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,SilverSummit Healthplan,Commercial Exchange,GP,125.10,,,,,,,36.14,134.83,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,inpatient,,,75.00000,45.60000,SilverSummit Healthplan,Commercial Exchange,GP,67.50,,,,,,,67.50,72.75,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,SilverSummit Healthplan,Commercial Exchange,GP,67.50,,,,,,,19.50,72.75,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,inpatient,,,154.00000,93.63000,SilverSummit Healthplan,Commercial Exchange,GP,138.60,,,,,,,138.60,149.38,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,SilverSummit Healthplan,Commercial Exchange,GP,138.60,,,,,,,40.04,149.38,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,inpatient,,,73.00000,44.38000,SilverSummit Healthplan,Commercial Exchange,GP,65.70,,,,,,,65.70,70.81,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,SilverSummit Healthplan,Commercial Exchange,GP,65.70,,,,,,,18.98,70.81,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,inpatient,,,160.00000,97.28000,SilverSummit Healthplan,Commercial Exchange,GP,144.00,,,,,,,144.00,155.20,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,SilverSummit Healthplan,Commercial Exchange,GP,144.00,,,,,,,41.60,155.20,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,inpatient,,,325.00000,197.60000,SilverSummit Healthplan,Commercial Exchange,GP,292.50,,,,,,,292.50,315.25,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,SilverSummit Healthplan,Commercial Exchange,GP,292.50,,,,,,,84.50,315.25,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,inpatient,,,74.00000,44.99000,SilverSummit Healthplan,Commercial Exchange,GP,66.60,,,,,,,66.60,71.78,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,SilverSummit Healthplan,Commercial Exchange,GP,66.60,,,,,,,19.24,71.78,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,inpatient,,,79.00000,48.03000,SilverSummit Healthplan,Commercial Exchange,GP,71.10,,,,,,,71.10,76.63,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,SilverSummit Healthplan,Commercial Exchange,GP,71.10,,,,,,,20.54,76.63,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,inpatient,,,72.00000,43.78000,SilverSummit Healthplan,Commercial Exchange,GP,64.80,,,,,,,64.80,69.84,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,SilverSummit Healthplan,Commercial Exchange,GP,64.80,,,,,,,18.72,69.84,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,inpatient,,,445.00000,262.55000,SilverSummit Healthplan,Commercial Exchange,GP,400.50,,,,,,,400.50,431.65,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,outpatient,,,445.00000,262.55000,SilverSummit Healthplan,Commercial Exchange,GP,400.50,,,,,,,115.70,431.65,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,inpatient,,,310.00000,182.90000,SilverSummit Healthplan,Commercial Exchange,GP,279.00,,,,,,,279.00,300.70,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,outpatient,,,310.00000,182.90000,SilverSummit Healthplan,Commercial Exchange,GP,279.00,,,,,,,80.60,300.70,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,inpatient,,,393.00000,231.87000,SilverSummit Healthplan,Commercial Exchange,GP,353.70,,,,,,,353.70,381.21,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,outpatient,,,393.00000,231.87000,SilverSummit Healthplan,Commercial Exchange,GP,353.70,,,,,,,102.18,381.21,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,inpatient,,,310.00000,182.90000,SilverSummit Healthplan,Commercial Exchange,GP,279.00,,,,,,,279.00,300.70,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,outpatient,,,310.00000,182.90000,SilverSummit Healthplan,Commercial Exchange,GP,279.00,,,,,,,80.60,300.70,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,inpatient,,,80.00000,30.96000,SilverSummit Healthplan,Commercial Exchange,GO,72.00,,,,,,,72.00,77.60,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,SilverSummit Healthplan,Commercial Exchange,GO,72.00,,,,,,,20.80,77.60,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,inpatient,,,84.00000,32.51000,SilverSummit Healthplan,Commercial Exchange,GO,75.60,,,,,,,75.60,81.48,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,SilverSummit Healthplan,Commercial Exchange,GO,75.60,,,,,,,21.84,81.48,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,inpatient,,,126.00000,48.76000,SilverSummit Healthplan,Commercial Exchange,GO,113.40,,,,,,,113.40,122.22,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,SilverSummit Healthplan,Commercial Exchange,GO,113.40,,,,,,,32.76,122.22,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,inpatient,,,66.00000,25.54000,SilverSummit Healthplan,Commercial Exchange,GO,59.40,,,,,,,59.40,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,SilverSummit Healthplan,Commercial Exchange,GO,59.40,,,,,,,17.16,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,inpatient,,,62.00000,23.99000,SilverSummit Healthplan,Commercial Exchange,GO,55.80,,,,,,,55.80,60.14,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,SilverSummit Healthplan,Commercial Exchange,GO,55.80,,,,,,,16.12,60.14,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,inpatient,,,90.00000,34.83000,SilverSummit Healthplan,Commercial Exchange,GO,81.00,,,,,,,81.00,87.30,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,SilverSummit Healthplan,Commercial Exchange,GO,81.00,,,,,,,23.40,87.30,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,inpatient,,,95.00000,36.76000,SilverSummit Healthplan,Commercial Exchange,GO,85.50,,,,,,,85.50,92.15,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,SilverSummit Healthplan,Commercial Exchange,GO,85.50,,,,,,,24.70,92.15,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,inpatient,,,146.00000,56.50000,SilverSummit Healthplan,Commercial Exchange,GO,131.40,,,,,,,131.40,141.62,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,SilverSummit Healthplan,Commercial Exchange,GO,131.40,,,,,,,37.96,141.62,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,inpatient,,,139.00000,53.79000,SilverSummit Healthplan,Commercial Exchange,GO,125.10,,,,,,,125.10,134.83,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,SilverSummit Healthplan,Commercial Exchange,GO,125.10,,,,,,,36.14,134.83,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,inpatient,,,75.00000,29.02000,SilverSummit Healthplan,Commercial Exchange,GO,67.50,,,,,,,67.50,72.75,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,SilverSummit Healthplan,Commercial Exchange,GO,67.50,,,,,,,19.50,72.75,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,inpatient,,,154.00000,59.60000,SilverSummit Healthplan,Commercial Exchange,GO,138.60,,,,,,,138.60,149.38,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,SilverSummit Healthplan,Commercial Exchange,GO,138.60,,,,,,,40.04,149.38,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,inpatient,,,73.00000,28.25000,SilverSummit Healthplan,Commercial Exchange,GO,65.70,,,,,,,65.70,70.81,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,SilverSummit Healthplan,Commercial Exchange,GO,65.70,,,,,,,18.98,70.81,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,inpatient,,,160.00000,61.92000,SilverSummit Healthplan,Commercial Exchange,GO,144.00,,,,,,,144.00,155.20,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,SilverSummit Healthplan,Commercial Exchange,GO,144.00,,,,,,,41.60,155.20,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,inpatient,,,98.00000,37.93000,SilverSummit Healthplan,Commercial Exchange,GO,88.20,,,,,,,88.20,95.06,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,outpatient,,,98.00000,37.93000,SilverSummit Healthplan,Commercial Exchange,GO,88.20,,,,,,,25.48,95.06,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,inpatient,,,303.00000,117.26000,SilverSummit Healthplan,Commercial Exchange,GO,272.70,,,,,,,272.70,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,outpatient,,,303.00000,117.26000,SilverSummit Healthplan,Commercial Exchange,GO,272.70,,,,,,,78.78,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,inpatient,,,115.00000,44.50000,SilverSummit Healthplan,Commercial Exchange,GO,103.50,,,,,,,103.50,111.55,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,outpatient,,,115.00000,44.50000,SilverSummit Healthplan,Commercial Exchange,GO,103.50,,,,,,,29.90,111.55,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,inpatient,,,74.00000,28.64000,SilverSummit Healthplan,Commercial Exchange,GO,66.60,,,,,,,66.60,71.78,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,SilverSummit Healthplan,Commercial Exchange,GO,66.60,,,,,,,19.24,71.78,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,inpatient,,,72.00000,27.86000,SilverSummit Healthplan,Commercial Exchange,GO,64.80,,,,,,,64.80,69.84,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,SilverSummit Healthplan,Commercial Exchange,GO,64.80,,,,,,,18.72,69.84,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,inpatient,,,80.00000,30.96000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",72.00,,,,,,,72.00,77.60,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",72.00,,,,,,,20.80,77.60,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,inpatient,,,84.00000,32.51000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",75.60,,,,,,,75.60,81.48,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",75.60,,,,,,,21.84,81.48,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,inpatient,,,126.00000,48.76000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",113.40,,,,,,,113.40,122.22,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",113.40,,,,,,,32.76,122.22,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,inpatient,,,62.00000,23.99000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",55.80,,,,,,,55.80,60.14,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",55.80,,,,,,,16.12,60.14,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,inpatient,,,66.00000,25.54000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",59.40,,,,,,,59.40,64.02,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",59.40,,,,,,,17.16,64.02,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,inpatient,,,90.00000,34.83000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",81.00,,,,,,,81.00,87.30,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",81.00,,,,,,,23.40,87.30,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,inpatient,,,95.00000,36.76000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",85.50,,,,,,,85.50,92.15,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",85.50,,,,,,,24.70,92.15,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,inpatient,,,146.00000,56.50000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",131.40,,,,,,,131.40,141.62,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",131.40,,,,,,,37.96,141.62,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,inpatient,,,139.00000,53.79000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",125.10,,,,,,,125.10,134.83,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",125.10,,,,,,,36.14,134.83,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,inpatient,,,75.00000,29.02000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",67.50,,,,,,,67.50,72.75,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",67.50,,,,,,,19.50,72.75,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,inpatient,,,154.00000,59.60000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",138.60,,,,,,,138.60,149.38,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",138.60,,,,,,,40.04,149.38,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,inpatient,,,73.00000,28.25000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",65.70,,,,,,,65.70,70.81,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",65.70,,,,,,,18.98,70.81,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,inpatient,,,160.00000,61.92000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",144.00,,,,,,,144.00,155.20,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",144.00,,,,,,,41.60,155.20,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,inpatient,,,74.00000,28.64000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",66.60,,,,,,,66.60,71.78,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",66.60,,,,,,,19.24,71.78,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,inpatient,,,72.00000,27.86000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",64.80,,,,,,,64.80,69.84,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",64.80,,,,,,,18.72,69.84,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,inpatient,,,47.00000,26.70000,SilverSummit Healthplan,Commercial Exchange,GO,42.30,,,,,,,42.30,45.59,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,SilverSummit Healthplan,Commercial Exchange,GO,42.30,,,,,,,12.22,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,inpatient,,,47.00000,26.70000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",42.30,,,,,,,42.30,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,SilverSummit Healthplan,Commercial Exchange,"CO,GO",42.30,,,,,,,12.22,45.59,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,inpatient,,,250.00000,142.04000,SilverSummit Healthplan,Commercial Exchange,GO,225.00,,,,,,,225.00,242.50,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,outpatient,,,250.00000,142.04000,SilverSummit Healthplan,Commercial Exchange,GO,225.00,,,,,,,65.00,242.50,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,inpatient,,,175.00000,99.43000,SilverSummit Healthplan,Commercial Exchange,GO,157.50,,,,,,,157.50,169.75,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,outpatient,,,175.00000,99.43000,SilverSummit Healthplan,Commercial Exchange,GO,157.50,,,,,,,45.50,169.75,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,inpatient,,,233.00000,132.38000,SilverSummit Healthplan,Commercial Exchange,GO,209.70,,,,,,,209.70,226.01,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,outpatient,,,233.00000,132.38000,SilverSummit Healthplan,Commercial Exchange,GO,209.70,,,,,,,60.58,226.01,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,inpatient,,,175.00000,99.43000,SilverSummit Healthplan,Commercial Exchange,GO,157.50,,,,,,,157.50,169.75,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,outpatient,,,175.00000,99.43000,SilverSummit Healthplan,Commercial Exchange,GO,157.50,,,,,,,45.50,169.75,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,inpatient,,,291.00000,93.99000,SilverSummit Healthplan,Commercial Exchange,,261.90,,,,,,,261.90,282.27,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,outpatient,,,291.00000,93.99000,SilverSummit Healthplan,Commercial Exchange,,261.90,,,,,,,75.66,282.27,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,inpatient,,,273.00000,155.10000,SilverSummit Healthplan,Commercial Exchange,GN,245.70,,,,,,,245.70,264.81,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,outpatient,,,273.00000,155.10000,SilverSummit Healthplan,Commercial Exchange,GN,245.70,,,,,,,70.98,264.81,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,inpatient,,,279.00000,158.51000,SilverSummit Healthplan,Commercial Exchange,GN,251.10,,,,,,,251.10,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,outpatient,,,279.00000,158.51000,SilverSummit Healthplan,Commercial Exchange,GN,251.10,,,,,,,72.54,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,inpatient,,,426.00000,242.03000,SilverSummit Healthplan,Commercial Exchange,GN,383.40,,,,,,,383.40,413.22,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,outpatient,,,426.00000,242.03000,SilverSummit Healthplan,Commercial Exchange,GN,383.40,,,,,,,110.76,413.22,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,inpatient,,,242.00000,137.49000,SilverSummit Healthplan,Commercial Exchange,GN,217.80,,,,,,,217.80,234.74,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,outpatient,,,242.00000,137.49000,SilverSummit Healthplan,Commercial Exchange,GN,217.80,,,,,,,62.92,234.74,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,inpatient,,,128.00000,72.72000,SilverSummit Healthplan,Commercial Exchange,,115.20,,,,,,,115.20,124.16,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,outpatient,,,128.00000,72.72000,SilverSummit Healthplan,Commercial Exchange,,115.20,,,,,,,33.28,124.16,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,inpatient,,,66.00000,37.50000,SilverSummit Healthplan,Commercial Exchange,GN,59.40,,,,,,,59.40,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,outpatient,,,66.00000,37.50000,SilverSummit Healthplan,Commercial Exchange,GN,59.40,,,,,,,17.16,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,inpatient,,,62.00000,35.23000,SilverSummit Healthplan,Commercial Exchange,GN,55.80,,,,,,,55.80,60.14,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,outpatient,,,62.00000,35.23000,SilverSummit Healthplan,Commercial Exchange,GN,55.80,,,,,,,16.12,60.14,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,inpatient,,,269.00000,152.83000,SilverSummit Healthplan,Commercial Exchange,GN,242.10,,,,,,,242.10,260.93,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,outpatient,,,269.00000,152.83000,SilverSummit Healthplan,Commercial Exchange,GN,242.10,,,,,,,69.94,260.93,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,inpatient,,,153.00000,86.93000,SilverSummit Healthplan,Commercial Exchange,GN,137.70,,,,,,,137.70,148.41,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,outpatient,,,153.00000,86.93000,SilverSummit Healthplan,Commercial Exchange,GN,137.70,,,,,,,39.78,148.41,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,inpatient,,,98.00000,55.68000,SilverSummit Healthplan,Commercial Exchange,GN,88.20,,,,,,,88.20,95.06,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,outpatient,,,98.00000,55.68000,SilverSummit Healthplan,Commercial Exchange,GN,88.20,,,,,,,25.48,95.06,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,inpatient,,,303.00000,172.15000,SilverSummit Healthplan,Commercial Exchange,GN,272.70,,,,,,,272.70,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,outpatient,,,303.00000,172.15000,SilverSummit Healthplan,Commercial Exchange,GN,272.70,,,,,,,78.78,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,inpatient,,,115.00000,65.34000,SilverSummit Healthplan,Commercial Exchange,GN,103.50,,,,,,,103.50,111.55,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,outpatient,,,115.00000,65.34000,SilverSummit Healthplan,Commercial Exchange,GN,103.50,,,,,,,29.90,111.55,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,inpatient,,,210.00000,119.31000,SilverSummit Healthplan,Commercial Exchange,GN,189.00,,,,,,,189.00,203.70,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,outpatient,,,210.00000,119.31000,SilverSummit Healthplan,Commercial Exchange,GN,189.00,,,,,,,54.60,203.70,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,inpatient,,,250.00000,142.04000,SilverSummit Healthplan,Commercial Exchange,GN,225.00,,,,,,,225.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,outpatient,,,250.00000,142.04000,SilverSummit Healthplan,Commercial Exchange,GN,225.00,,,,,,,65.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,inpatient,,,78.00000,44.32000,SilverSummit Healthplan,Commercial Exchange,GN,70.20,,,,,,,70.20,75.66,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,outpatient,,,78.00000,44.32000,SilverSummit Healthplan,Commercial Exchange,GN,70.20,,,,,,,20.28,75.66,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,inpatient,,,322.00000,182.94000,SilverSummit Healthplan,Commercial Exchange,GN,289.80,,,,,,,289.80,312.34,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,outpatient,,,322.00000,182.94000,SilverSummit Healthplan,Commercial Exchange,GN,289.80,,,,,,,83.72,312.34,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,inpatient,,,309.00000,175.56000,SilverSummit Healthplan,Commercial Exchange,GN,278.10,,,,,,,278.10,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,outpatient,,,309.00000,175.56000,SilverSummit Healthplan,Commercial Exchange,GN,278.10,,,,,,,80.34,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,inpatient,,,245.00000,139.20000,SilverSummit Healthplan,Commercial Exchange,GN,220.50,,,,,,,220.50,237.65,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,outpatient,,,245.00000,139.20000,SilverSummit Healthplan,Commercial Exchange,GN,220.50,,,,,,,63.70,237.65,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,inpatient,,,313.00000,116.44000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,outpatient,,,313.00000,116.44000,SilverSummit Healthplan,Commercial Exchange,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,inpatient,,,1250.00000,632.50000,SilverSummit Healthplan,Commercial Exchange,,1125.00,,,,,,,1125.00,1212.50,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,outpatient,,,1250.00000,632.50000,SilverSummit Healthplan,Commercial Exchange,,1125.00,,,,,,,325.00,1212.50,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,inpatient,,,145.00000,75.54000,SilverSummit Healthplan,Commercial Exchange,,130.50,,,,,,,130.50,140.65,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,SilverSummit Healthplan,Commercial Exchange,,130.50,,,,,,,37.70,140.65,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,inpatient,,,488.00000,254.25000,SilverSummit Healthplan,Commercial Exchange,,439.20,,,,,,,439.20,473.36,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,SilverSummit Healthplan,Commercial Exchange,,439.20,,,,,,,126.88,473.36,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,inpatient,,,684.00000,337.90000,SilverSummit Healthplan,Commercial Exchange,,615.60,,,,,,,615.60,663.48,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,outpatient,,,684.00000,337.90000,SilverSummit Healthplan,Commercial Exchange,,615.60,,,,,,,177.84,663.48,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,inpatient,,,206.00000,101.76000,SilverSummit Healthplan,Commercial Exchange,,185.40,,,,,,,185.40,199.82,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,outpatient,,,206.00000,101.76000,SilverSummit Healthplan,Commercial Exchange,,185.40,,,,,,,53.56,199.82,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,inpatient,,,195.00000,96.33000,SilverSummit Healthplan,Commercial Exchange,,175.50,,,,,,,175.50,189.15,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,outpatient,,,195.00000,96.33000,SilverSummit Healthplan,Commercial Exchange,,175.50,,,,,,,50.70,189.15,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,inpatient,,,375.00000,185.25000,SilverSummit Healthplan,Commercial Exchange,,337.50,,,,,,,337.50,363.75,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,outpatient,,,375.00000,185.25000,SilverSummit Healthplan,Commercial Exchange,,337.50,,,,,,,97.50,363.75,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,inpatient,,,429.00000,211.93000,SilverSummit Healthplan,Commercial Exchange,,386.10,,,,,,,386.10,416.13,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,outpatient,,,429.00000,211.93000,SilverSummit Healthplan,Commercial Exchange,,386.10,,,,,,,111.54,416.13,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22475,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,SilverSummit Healthplan,Commercial Exchange,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B OBSTETRICS SEMI-PVT,42473,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,SilverSummit Healthplan,Commercial Exchange,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ICU,32474,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,SilverSummit Healthplan,Commercial Exchange,,7884.90,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,12476,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,SilverSummit Healthplan,Commercial Exchange,,5256.90,,,,,,,2512.00,5665.77,percent of total billed charges,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,84.00000,63.59000,SilverSummit Healthplan,Commercial Exchange,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,SilverSummit Healthplan,Commercial Exchange,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,SilverSummit Healthplan,Commercial Exchange,,255.60,,,,,,,255.60,275.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,SilverSummit Healthplan,Commercial Exchange,,255.60,,,,,,,73.84,275.48,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,SilverSummit Healthplan,Commercial Exchange,,412.20,,,,,,,412.20,444.26,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,SilverSummit Healthplan,Commercial Exchange,,412.20,,,,,,,119.08,444.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,SilverSummit Healthplan,Commercial Exchange,,502.20,,,,,,,502.20,541.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,SilverSummit Healthplan,Commercial Exchange,,502.20,,,,,,,145.08,541.26,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,SilverSummit Healthplan,Commercial Exchange,,433.80,,,,,,,433.80,467.54,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,SilverSummit Healthplan,Commercial Exchange,,433.80,,,,,,,125.32,467.54,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,SilverSummit Healthplan,Commercial Exchange,,213.30,,,,,,,213.30,229.89,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,SilverSummit Healthplan,Commercial Exchange,,213.30,,,,,,,61.62,229.89,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,inpatient,,,490.00000,329.77000,SilverSummit Healthplan,Commercial Exchange,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,outpatient,,,490.00000,329.77000,SilverSummit Healthplan,Commercial Exchange,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,inpatient,,,490.00000,329.77000,SilverSummit Healthplan,Commercial Exchange,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,outpatient,,,490.00000,329.77000,SilverSummit Healthplan,Commercial Exchange,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,inpatient,,,245.00000,164.89000,SilverSummit Healthplan,Commercial Exchange,,220.50,,,,,,,220.50,237.65,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,outpatient,,,245.00000,164.89000,SilverSummit Healthplan,Commercial Exchange,,220.50,,,,,,,63.70,237.65,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,inpatient,,,490.00000,329.77000,SilverSummit Healthplan,Commercial Exchange,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,SilverSummit Healthplan,Commercial Exchange,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,SilverSummit Healthplan,Commercial Exchange,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,SilverSummit Healthplan,Commercial Exchange,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,inpatient,,,245.00000,164.89000,SilverSummit Healthplan,Commercial Exchange,,220.50,,,,,,,220.50,237.65,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,SilverSummit Healthplan,Commercial Exchange,,220.50,,,,,,,63.70,237.65,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,SilverSummit Healthplan,Commercial Exchange,,757.80,,,,,,,757.80,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,SilverSummit Healthplan,Commercial Exchange,,757.80,,,,,,,218.92,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,SilverSummit Healthplan,Commercial Exchange,,947.70,,,,,,,947.70,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,SilverSummit Healthplan,Commercial Exchange,,947.70,,,,,,,273.78,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,SilverSummit Healthplan,Commercial Exchange,,1136.70,,,,,,,1136.70,1225.11,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,SilverSummit Healthplan,Commercial Exchange,,1136.70,,,,,,,328.38,1225.11,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,inpatient,,,2466.00000,986.40000,SilverSummit Healthplan,Commercial Exchange,,2219.40,,,,,,,2219.40,2392.02,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,outpatient,,,2466.00000,986.40000,SilverSummit Healthplan,Commercial Exchange,,2219.40,,,,,,,641.16,2392.02,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,inpatient,,,260.00000,104.00000,SilverSummit Healthplan,Commercial Exchange,,234.00,,,,,,,234.00,252.20,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,outpatient,,,260.00000,104.00000,SilverSummit Healthplan,Commercial Exchange,,234.00,,,,,,,67.60,252.20,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,inpatient,,,2041.00000,816.40000,SilverSummit Healthplan,Commercial Exchange,,1836.90,,,,,,,1836.90,1979.77,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,outpatient,,,2041.00000,816.40000,SilverSummit Healthplan,Commercial Exchange,,1836.90,,,,,,,530.66,1979.77,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,inpatient,,,375.00000,150.00000,SilverSummit Healthplan,Commercial Exchange,,337.50,,,,,,,337.50,363.75,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,outpatient,,,375.00000,150.00000,SilverSummit Healthplan,Commercial Exchange,,337.50,,,,,,,97.50,363.75,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,inpatient,,,1178.00000,471.20000,SilverSummit Healthplan,Commercial Exchange,,1060.20,,,,,,,1060.20,1142.66,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,outpatient,,,1178.00000,471.20000,SilverSummit Healthplan,Commercial Exchange,,1060.20,,,,,,,306.28,1142.66,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,inpatient,,,245.00000,98.00000,SilverSummit Healthplan,Commercial Exchange,,220.50,,,,,,,220.50,237.65,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,outpatient,,,245.00000,98.00000,SilverSummit Healthplan,Commercial Exchange,,220.50,,,,,,,63.70,237.65,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,inpatient,,,280.00000,112.00000,SilverSummit Healthplan,Commercial Exchange,,252.00,,,,,,,252.00,271.60,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,outpatient,,,280.00000,112.00000,SilverSummit Healthplan,Commercial Exchange,,252.00,,,,,,,72.80,271.60,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,inpatient,,,336.00000,134.40000,SilverSummit Healthplan,Commercial Exchange,,302.40,,,,,,,302.40,325.92,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,outpatient,,,336.00000,134.40000,SilverSummit Healthplan,Commercial Exchange,,302.40,,,,,,,87.36,325.92,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,inpatient,,,380.00000,152.00000,SilverSummit Healthplan,Commercial Exchange,,342.00,,,,,,,342.00,368.60,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,outpatient,,,380.00000,152.00000,SilverSummit Healthplan,Commercial Exchange,,342.00,,,,,,,98.80,368.60,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,inpatient,,,530.00000,212.00000,SilverSummit Healthplan,Commercial Exchange,,477.00,,,,,,,477.00,514.10,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,SilverSummit Healthplan,Commercial Exchange,,477.00,,,,,,,137.80,514.10,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,inpatient,,,264.00000,105.60000,SilverSummit Healthplan,Commercial Exchange,,237.60,,,,,,,237.60,256.08,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,outpatient,,,264.00000,105.60000,SilverSummit Healthplan,Commercial Exchange,,237.60,,,,,,,68.64,256.08,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,inpatient,,,763.00000,305.20000,SilverSummit Healthplan,Commercial Exchange,,686.70,,,,,,,686.70,740.11,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,outpatient,,,763.00000,305.20000,SilverSummit Healthplan,Commercial Exchange,,686.70,,,,,,,198.38,740.11,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,inpatient,,,672.00000,268.80000,SilverSummit Healthplan,Commercial Exchange,,604.80,,,,,,,604.80,651.84,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,outpatient,,,672.00000,268.80000,SilverSummit Healthplan,Commercial Exchange,,604.80,,,,,,,174.72,651.84,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,inpatient,,,1940.00000,776.00000,SilverSummit Healthplan,Commercial Exchange,,1746.00,,,,,,,1746.00,1881.80,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,outpatient,,,1940.00000,776.00000,SilverSummit Healthplan,Commercial Exchange,,1746.00,,,,,,,504.40,1881.80,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,inpatient,,,3875.00000,1550.00000,SilverSummit Healthplan,Commercial Exchange,,3487.50,,,,,,,3487.50,3758.75,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,outpatient,,,3875.00000,1550.00000,SilverSummit Healthplan,Commercial Exchange,,3487.50,,,,,,,1007.50,3758.75,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,inpatient,,,505.00000,202.00000,SilverSummit Healthplan,Commercial Exchange,,454.50,,,,,,,454.50,489.85,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,outpatient,,,505.00000,202.00000,SilverSummit Healthplan,Commercial Exchange,,454.50,,,,,,,131.30,489.85,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,inpatient,,,295.00000,118.00000,SilverSummit Healthplan,Commercial Exchange,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,SilverSummit Healthplan,Commercial Exchange,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,inpatient,,,585.00000,234.00000,SilverSummit Healthplan,Commercial Exchange,,526.50,,,,,,,526.50,567.45,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,outpatient,,,585.00000,234.00000,SilverSummit Healthplan,Commercial Exchange,,526.50,,,,,,,152.10,567.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,inpatient,,,285.00000,114.00000,SilverSummit Healthplan,Commercial Exchange,,256.50,,,,,,,256.50,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,outpatient,,,285.00000,114.00000,SilverSummit Healthplan,Commercial Exchange,,256.50,,,,,,,74.10,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,inpatient,,,575.00000,230.00000,SilverSummit Healthplan,Commercial Exchange,,517.50,,,,,,,517.50,557.75,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,outpatient,,,575.00000,230.00000,SilverSummit Healthplan,Commercial Exchange,,517.50,,,,,,,149.50,557.75,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,inpatient,,,697.00000,278.80000,SilverSummit Healthplan,Commercial Exchange,,627.30,,,,,,,627.30,676.09,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,outpatient,,,697.00000,278.80000,SilverSummit Healthplan,Commercial Exchange,,627.30,,,,,,,181.22,676.09,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,inpatient,,,530.00000,212.00000,SilverSummit Healthplan,Commercial Exchange,,477.00,,,,,,,477.00,514.10,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,SilverSummit Healthplan,Commercial Exchange,,477.00,,,,,,,137.80,514.10,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,inpatient,,,580.00000,232.00000,SilverSummit Healthplan,Commercial Exchange,,522.00,,,,,,,522.00,562.60,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,outpatient,,,580.00000,232.00000,SilverSummit Healthplan,Commercial Exchange,,522.00,,,,,,,150.80,562.60,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,inpatient,,,435.00000,174.00000,SilverSummit Healthplan,Commercial Exchange,,391.50,,,,,,,391.50,421.95,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,outpatient,,,435.00000,174.00000,SilverSummit Healthplan,Commercial Exchange,,391.50,,,,,,,113.10,421.95,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,inpatient,,,270.00000,108.00000,SilverSummit Healthplan,Commercial Exchange,,243.00,,,,,,,243.00,261.90,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,outpatient,,,270.00000,108.00000,SilverSummit Healthplan,Commercial Exchange,,243.00,,,,,,,70.20,261.90,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,inpatient,,,504.00000,201.60000,SilverSummit Healthplan,Commercial Exchange,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,outpatient,,,504.00000,201.60000,SilverSummit Healthplan,Commercial Exchange,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,inpatient,,,98.00000,39.20000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,outpatient,,,98.00000,39.20000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,inpatient,,,608.00000,243.20000,SilverSummit Healthplan,Commercial Exchange,,547.20,,,,,,,547.20,589.76,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,outpatient,,,608.00000,243.20000,SilverSummit Healthplan,Commercial Exchange,,547.20,,,,,,,158.08,589.76,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,inpatient,,,114.00000,45.60000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,outpatient,,,114.00000,45.60000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,inpatient,,,187.00000,74.80000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,outpatient,,,187.00000,74.80000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,inpatient,,,214.00000,85.60000,SilverSummit Healthplan,Commercial Exchange,,192.60,,,,,,,192.60,207.58,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,outpatient,,,214.00000,85.60000,SilverSummit Healthplan,Commercial Exchange,,192.60,,,,,,,55.64,207.58,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,inpatient,,,863.00000,345.20000,SilverSummit Healthplan,Commercial Exchange,,776.70,,,,,,,776.70,837.11,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,outpatient,,,863.00000,345.20000,SilverSummit Healthplan,Commercial Exchange,,776.70,,,,,,,224.38,837.11,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,inpatient,,,453.00000,181.20000,SilverSummit Healthplan,Commercial Exchange,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,outpatient,,,453.00000,181.20000,SilverSummit Healthplan,Commercial Exchange,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,inpatient,,,144.00000,57.60000,SilverSummit Healthplan,Commercial Exchange,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,outpatient,,,144.00000,57.60000,SilverSummit Healthplan,Commercial Exchange,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,inpatient,,,107.00000,42.80000,SilverSummit Healthplan,Commercial Exchange,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,outpatient,,,107.00000,42.80000,SilverSummit Healthplan,Commercial Exchange,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,inpatient,,,403.00000,161.20000,SilverSummit Healthplan,Commercial Exchange,,362.70,,,,,,,362.70,390.91,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,outpatient,,,403.00000,161.20000,SilverSummit Healthplan,Commercial Exchange,,362.70,,,,,,,104.78,390.91,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,inpatient,,,144.00000,57.60000,SilverSummit Healthplan,Commercial Exchange,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,outpatient,,,144.00000,57.60000,SilverSummit Healthplan,Commercial Exchange,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,inpatient,,,370.00000,148.00000,SilverSummit Healthplan,Commercial Exchange,,333.00,,,,,,,333.00,358.90,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,outpatient,,,370.00000,148.00000,SilverSummit Healthplan,Commercial Exchange,,333.00,,,,,,,96.20,358.90,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,inpatient,,,334.00000,133.60000,SilverSummit Healthplan,Commercial Exchange,,300.60,,,,,,,300.60,323.98,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,outpatient,,,334.00000,133.60000,SilverSummit Healthplan,Commercial Exchange,,300.60,,,,,,,86.84,323.98,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,inpatient,,,1188.00000,475.20000,SilverSummit Healthplan,Commercial Exchange,50,1069.20,,,,,,,1069.20,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,outpatient,,,1188.00000,475.20000,SilverSummit Healthplan,Commercial Exchange,50,1069.20,,,,,,,308.88,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,inpatient,,,792.00000,316.80000,SilverSummit Healthplan,Commercial Exchange,LT,712.80,,,,,,,712.80,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,SilverSummit Healthplan,Commercial Exchange,LT,712.80,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,inpatient,,,792.00000,316.80000,SilverSummit Healthplan,Commercial Exchange,RT,712.80,,,,,,,712.80,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,SilverSummit Healthplan,Commercial Exchange,RT,712.80,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,inpatient,,,572.00000,228.80000,SilverSummit Healthplan,Commercial Exchange,50,514.80,,,,,,,514.80,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,outpatient,,,572.00000,228.80000,SilverSummit Healthplan,Commercial Exchange,50,514.80,,,,,,,148.72,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,inpatient,,,381.00000,152.40000,SilverSummit Healthplan,Commercial Exchange,LT,342.90,,,,,,,342.90,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,SilverSummit Healthplan,Commercial Exchange,LT,342.90,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,inpatient,,,381.00000,152.40000,SilverSummit Healthplan,Commercial Exchange,RT,342.90,,,,,,,342.90,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,SilverSummit Healthplan,Commercial Exchange,RT,342.90,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,inpatient,,,683.00000,273.20000,SilverSummit Healthplan,Commercial Exchange,50,614.70,,,,,,,614.70,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,outpatient,,,683.00000,273.20000,SilverSummit Healthplan,Commercial Exchange,50,614.70,,,,,,,177.58,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,inpatient,,,455.00000,182.00000,SilverSummit Healthplan,Commercial Exchange,LT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,SilverSummit Healthplan,Commercial Exchange,LT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,inpatient,,,455.00000,182.00000,SilverSummit Healthplan,Commercial Exchange,RT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,SilverSummit Healthplan,Commercial Exchange,RT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,inpatient,,,357.00000,142.80000,SilverSummit Healthplan,Commercial Exchange,,321.30,,,,,,,321.30,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,outpatient,,,357.00000,142.80000,SilverSummit Healthplan,Commercial Exchange,,321.30,,,,,,,92.82,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,inpatient,,,334.00000,133.60000,SilverSummit Healthplan,Commercial Exchange,,300.60,,,,,,,300.60,323.98,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,outpatient,,,334.00000,133.60000,SilverSummit Healthplan,Commercial Exchange,,300.60,,,,,,,86.84,323.98,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,inpatient,,,194.00000,77.60000,SilverSummit Healthplan,Commercial Exchange,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,outpatient,,,194.00000,77.60000,SilverSummit Healthplan,Commercial Exchange,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,inpatient,,,608.00000,243.20000,SilverSummit Healthplan,Commercial Exchange,,547.20,,,,,,,547.20,589.76,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,outpatient,,,608.00000,243.20000,SilverSummit Healthplan,Commercial Exchange,,547.20,,,,,,,158.08,589.76,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,inpatient,,,257.00000,102.80000,SilverSummit Healthplan,Commercial Exchange,,231.30,,,,,,,231.30,249.29,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,outpatient,,,257.00000,102.80000,SilverSummit Healthplan,Commercial Exchange,,231.30,,,,,,,66.82,249.29,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,inpatient,,,343.00000,137.20000,SilverSummit Healthplan,Commercial Exchange,,308.70,,,,,,,308.70,332.71,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,outpatient,,,343.00000,137.20000,SilverSummit Healthplan,Commercial Exchange,,308.70,,,,,,,89.18,332.71,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,inpatient,,,457.00000,182.80000,SilverSummit Healthplan,Commercial Exchange,,411.30,,,,,,,411.30,443.29,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,outpatient,,,457.00000,182.80000,SilverSummit Healthplan,Commercial Exchange,,411.30,,,,,,,118.82,443.29,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,inpatient,,,630.00000,252.00000,SilverSummit Healthplan,Commercial Exchange,,567.00,,,,,,,567.00,611.10,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,outpatient,,,630.00000,252.00000,SilverSummit Healthplan,Commercial Exchange,,567.00,,,,,,,163.80,611.10,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,inpatient,,,623.00000,249.20000,SilverSummit Healthplan,Commercial Exchange,,560.70,,,,,,,560.70,604.31,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,outpatient,,,623.00000,249.20000,SilverSummit Healthplan,Commercial Exchange,,560.70,,,,,,,161.98,604.31,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,inpatient,,,1457.00000,582.80000,SilverSummit Healthplan,Commercial Exchange,,1311.30,,,,,,,1311.30,1413.29,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,outpatient,,,1457.00000,582.80000,SilverSummit Healthplan,Commercial Exchange,,1311.30,,,,,,,378.82,1413.29,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,inpatient,,,890.00000,356.00000,SilverSummit Healthplan,Commercial Exchange,,801.00,,,,,,,801.00,863.30,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,outpatient,,,890.00000,356.00000,SilverSummit Healthplan,Commercial Exchange,,801.00,,,,,,,231.40,863.30,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,inpatient,,,532.00000,212.80000,SilverSummit Healthplan,Commercial Exchange,,478.80,,,,,,,478.80,516.04,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,outpatient,,,532.00000,212.80000,SilverSummit Healthplan,Commercial Exchange,,478.80,,,,,,,138.32,516.04,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,inpatient,,,492.00000,196.80000,SilverSummit Healthplan,Commercial Exchange,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,outpatient,,,492.00000,196.80000,SilverSummit Healthplan,Commercial Exchange,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,inpatient,,,550.00000,220.00000,SilverSummit Healthplan,Commercial Exchange,,495.00,,,,,,,495.00,533.50,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,outpatient,,,550.00000,220.00000,SilverSummit Healthplan,Commercial Exchange,,495.00,,,,,,,143.00,533.50,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,inpatient,,,305.00000,122.00000,SilverSummit Healthplan,Commercial Exchange,,274.50,,,,,,,274.50,295.85,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,outpatient,,,305.00000,122.00000,SilverSummit Healthplan,Commercial Exchange,,274.50,,,,,,,79.30,295.85,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,inpatient,,,220.00000,88.00000,SilverSummit Healthplan,Commercial Exchange,,198.00,,,,,,,198.00,213.40,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,outpatient,,,220.00000,88.00000,SilverSummit Healthplan,Commercial Exchange,,198.00,,,,,,,57.20,213.40,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,inpatient,,,780.00000,312.00000,SilverSummit Healthplan,Commercial Exchange,,702.00,,,,,,,702.00,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,outpatient,,,780.00000,312.00000,SilverSummit Healthplan,Commercial Exchange,,702.00,,,,,,,202.80,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,inpatient,,,1165.00000,466.00000,SilverSummit Healthplan,Commercial Exchange,,1048.50,,,,,,,1048.50,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,outpatient,,,1165.00000,466.00000,SilverSummit Healthplan,Commercial Exchange,,1048.50,,,,,,,302.90,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,inpatient,,,2350.00000,940.00000,SilverSummit Healthplan,Commercial Exchange,,2115.00,,,,,,,2115.00,2279.50,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,outpatient,,,2350.00000,940.00000,SilverSummit Healthplan,Commercial Exchange,,2115.00,,,,,,,611.00,2279.50,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,inpatient,,,896.00000,358.40000,SilverSummit Healthplan,Commercial Exchange,,806.40,,,,,,,806.40,869.12,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,outpatient,,,896.00000,358.40000,SilverSummit Healthplan,Commercial Exchange,,806.40,,,,,,,232.96,869.12,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,inpatient,,,385.00000,154.00000,SilverSummit Healthplan,Commercial Exchange,,346.50,,,,,,,346.50,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,outpatient,,,385.00000,154.00000,SilverSummit Healthplan,Commercial Exchange,,346.50,,,,,,,100.10,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,inpatient,,,470.00000,188.00000,SilverSummit Healthplan,Commercial Exchange,,423.00,,,,,,,423.00,455.90,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,outpatient,,,470.00000,188.00000,SilverSummit Healthplan,Commercial Exchange,,423.00,,,,,,,122.20,455.90,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,inpatient,,,150.00000,60.00000,SilverSummit Healthplan,Commercial Exchange,,135.00,,,,,,,135.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,outpatient,,,150.00000,60.00000,SilverSummit Healthplan,Commercial Exchange,,135.00,,,,,,,39.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,inpatient,,,100.00000,40.00000,SilverSummit Healthplan,Commercial Exchange,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,outpatient,,,100.00000,40.00000,SilverSummit Healthplan,Commercial Exchange,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,inpatient,,,143.00000,57.20000,SilverSummit Healthplan,Commercial Exchange,,128.70,,,,,,,128.70,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,outpatient,,,143.00000,57.20000,SilverSummit Healthplan,Commercial Exchange,,128.70,,,,,,,37.18,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,inpatient,,,95.00000,38.00000,SilverSummit Healthplan,Commercial Exchange,,85.50,,,,,,,85.50,92.15,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,outpatient,,,95.00000,38.00000,SilverSummit Healthplan,Commercial Exchange,,85.50,,,,,,,24.70,92.15,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,inpatient,,,269.00000,107.60000,SilverSummit Healthplan,Commercial Exchange,,242.10,,,,,,,242.10,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,outpatient,,,269.00000,107.60000,SilverSummit Healthplan,Commercial Exchange,,242.10,,,,,,,69.94,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,inpatient,,,388.00000,155.20000,SilverSummit Healthplan,Commercial Exchange,,349.20,,,,,,,349.20,376.36,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,outpatient,,,388.00000,155.20000,SilverSummit Healthplan,Commercial Exchange,,349.20,,,,,,,100.88,376.36,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,inpatient,,,344.00000,137.60000,SilverSummit Healthplan,Commercial Exchange,,309.60,,,,,,,309.60,333.68,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,outpatient,,,344.00000,137.60000,SilverSummit Healthplan,Commercial Exchange,,309.60,,,,,,,89.44,333.68,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,inpatient,,,321.00000,128.40000,SilverSummit Healthplan,Commercial Exchange,,288.90,,,,,,,288.90,311.37,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,outpatient,,,321.00000,128.40000,SilverSummit Healthplan,Commercial Exchange,,288.90,,,,,,,83.46,311.37,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,inpatient,,,155.00000,62.00000,SilverSummit Healthplan,Commercial Exchange,,139.50,,,,,,,139.50,150.35,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,outpatient,,,155.00000,62.00000,SilverSummit Healthplan,Commercial Exchange,,139.50,,,,,,,40.30,150.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,inpatient,,,817.00000,326.80000,SilverSummit Healthplan,Commercial Exchange,,735.30,,,,,,,735.30,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,outpatient,,,817.00000,326.80000,SilverSummit Healthplan,Commercial Exchange,,735.30,,,,,,,212.42,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,inpatient,,,1255.00000,502.00000,SilverSummit Healthplan,Commercial Exchange,,1129.50,,,,,,,1129.50,1217.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,outpatient,,,1255.00000,502.00000,SilverSummit Healthplan,Commercial Exchange,,1129.50,,,,,,,326.30,1217.35,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,inpatient,,,391.00000,156.40000,SilverSummit Healthplan,Commercial Exchange,,351.90,,,,,,,351.90,379.27,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,outpatient,,,391.00000,156.40000,SilverSummit Healthplan,Commercial Exchange,,351.90,,,,,,,101.66,379.27,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,inpatient,,,671.00000,268.40000,SilverSummit Healthplan,Commercial Exchange,,603.90,,,,,,,603.90,650.87,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,outpatient,,,671.00000,268.40000,SilverSummit Healthplan,Commercial Exchange,,603.90,,,,,,,174.46,650.87,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,inpatient,,,456.00000,182.40000,SilverSummit Healthplan,Commercial Exchange,,410.40,,,,,,,410.40,442.32,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,outpatient,,,456.00000,182.40000,SilverSummit Healthplan,Commercial Exchange,,410.40,,,,,,,118.56,442.32,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,inpatient,,,112.00000,44.80000,SilverSummit Healthplan,Commercial Exchange,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,outpatient,,,112.00000,44.80000,SilverSummit Healthplan,Commercial Exchange,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,inpatient,,,84.00000,33.60000,SilverSummit Healthplan,Commercial Exchange,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,outpatient,,,84.00000,33.60000,SilverSummit Healthplan,Commercial Exchange,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,inpatient,,,216.00000,86.40000,SilverSummit Healthplan,Commercial Exchange,,194.40,,,,,,,194.40,209.52,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,outpatient,,,216.00000,86.40000,SilverSummit Healthplan,Commercial Exchange,,194.40,,,,,,,56.16,209.52,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,inpatient,,,2660.00000,1064.00000,SilverSummit Healthplan,Commercial Exchange,,2394.00,,,,,,,2394.00,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,outpatient,,,2660.00000,1064.00000,SilverSummit Healthplan,Commercial Exchange,,2394.00,,,,,,,691.60,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,inpatient,,,2960.00000,1184.00000,SilverSummit Healthplan,Commercial Exchange,,2664.00,,,,,,,2664.00,2871.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,outpatient,,,2960.00000,1184.00000,SilverSummit Healthplan,Commercial Exchange,,2664.00,,,,,,,769.60,2871.20,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,inpatient,,,3225.00000,1290.00000,SilverSummit Healthplan,Commercial Exchange,,2902.50,,,,,,,2902.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,outpatient,,,3225.00000,1290.00000,SilverSummit Healthplan,Commercial Exchange,,2902.50,,,,,,,838.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,inpatient,,,3395.00000,1358.00000,SilverSummit Healthplan,Commercial Exchange,,3055.50,,,,,,,3055.50,3293.15,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,outpatient,,,3395.00000,1358.00000,SilverSummit Healthplan,Commercial Exchange,,3055.50,,,,,,,882.70,3293.15,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,inpatient,,,490.00000,196.00000,SilverSummit Healthplan,Commercial Exchange,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,outpatient,,,490.00000,196.00000,SilverSummit Healthplan,Commercial Exchange,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,inpatient,,,520.00000,208.00000,SilverSummit Healthplan,Commercial Exchange,,468.00,,,,,,,468.00,504.40,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,outpatient,,,520.00000,208.00000,SilverSummit Healthplan,Commercial Exchange,,468.00,,,,,,,135.20,504.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,inpatient,,,720.00000,288.00000,SilverSummit Healthplan,Commercial Exchange,,648.00,,,,,,,648.00,698.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,outpatient,,,720.00000,288.00000,SilverSummit Healthplan,Commercial Exchange,,648.00,,,,,,,187.20,698.40,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,inpatient,,,215.00000,86.00000,SilverSummit Healthplan,Commercial Exchange,,193.50,,,,,,,193.50,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,outpatient,,,215.00000,86.00000,SilverSummit Healthplan,Commercial Exchange,,193.50,,,,,,,55.90,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,inpatient,,,240.00000,96.00000,SilverSummit Healthplan,Commercial Exchange,,216.00,,,,,,,216.00,232.80,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,outpatient,,,240.00000,96.00000,SilverSummit Healthplan,Commercial Exchange,,216.00,,,,,,,62.40,232.80,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,inpatient,,,1241.00000,496.40000,SilverSummit Healthplan,Commercial Exchange,,1116.90,,,,,,,1116.90,1203.77,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,outpatient,,,1241.00000,496.40000,SilverSummit Healthplan,Commercial Exchange,,1116.90,,,,,,,322.66,1203.77,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,inpatient,,,850.00000,340.00000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,outpatient,,,850.00000,340.00000,SilverSummit Healthplan,Commercial Exchange,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,inpatient,,,1085.00000,434.00000,SilverSummit Healthplan,Commercial Exchange,,976.50,,,,,,,976.50,1052.45,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,outpatient,,,1085.00000,434.00000,SilverSummit Healthplan,Commercial Exchange,,976.50,,,,,,,282.10,1052.45,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,inpatient,,,295.00000,118.00000,SilverSummit Healthplan,Commercial Exchange,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,SilverSummit Healthplan,Commercial Exchange,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,inpatient,,,492.00000,196.80000,SilverSummit Healthplan,Commercial Exchange,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,outpatient,,,492.00000,196.80000,SilverSummit Healthplan,Commercial Exchange,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,inpatient,,,563.00000,225.20000,SilverSummit Healthplan,Commercial Exchange,,506.70,,,,,,,506.70,546.11,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,outpatient,,,563.00000,225.20000,SilverSummit Healthplan,Commercial Exchange,,506.70,,,,,,,146.38,546.11,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,inpatient,,,1612.00000,644.80000,SilverSummit Healthplan,Commercial Exchange,,1450.80,,,,,,,1450.80,1563.64,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,outpatient,,,1612.00000,644.80000,SilverSummit Healthplan,Commercial Exchange,,1450.80,,,,,,,419.12,1563.64,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,inpatient,,,1366.00000,546.40000,SilverSummit Healthplan,Commercial Exchange,,1229.40,,,,,,,1229.40,1325.02,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,outpatient,,,1366.00000,546.40000,SilverSummit Healthplan,Commercial Exchange,,1229.40,,,,,,,355.16,1325.02,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,inpatient,,,1911.00000,764.40000,SilverSummit Healthplan,Commercial Exchange,,1719.90,,,,,,,1719.90,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,outpatient,,,1911.00000,764.40000,SilverSummit Healthplan,Commercial Exchange,,1719.90,,,,,,,496.86,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,inpatient,,,956.00000,382.40000,SilverSummit Healthplan,Commercial Exchange,,860.40,,,,,,,860.40,927.32,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,outpatient,,,956.00000,382.40000,SilverSummit Healthplan,Commercial Exchange,,860.40,,,,,,,248.56,927.32,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,inpatient,,,189.00000,123.20000,SilverSummit Healthplan,Commercial Exchange,,170.10,,,,,,,170.10,183.33,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,outpatient,,,189.00000,123.20000,SilverSummit Healthplan,Commercial Exchange,,170.10,,,,,,,49.14,183.33,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,inpatient,,,352.00000,256.87000,SilverSummit Healthplan,Commercial Exchange,,316.80,,,,,,,316.80,341.44,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,outpatient,,,352.00000,256.87000,SilverSummit Healthplan,Commercial Exchange,,316.80,,,,,,,91.52,341.44,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,inpatient,,,625.00000,738.40000,SilverSummit Healthplan,Commercial Exchange,,562.50,,,,,,,562.50,606.25,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,outpatient,,,625.00000,738.40000,SilverSummit Healthplan,Commercial Exchange,,562.50,,,,,,,162.50,606.25,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,inpatient,,,1024.00000,2097.47000,SilverSummit Healthplan,Commercial Exchange,,921.60,,,,,,,921.60,993.28,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1024.00000,2097.47000,SilverSummit Healthplan,Commercial Exchange,,921.60,,,,,,,266.24,993.28,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,inpatient,,,1455.00000,2469.72000,SilverSummit Healthplan,Commercial Exchange,,1309.50,,,,,,,1309.50,1411.35,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,outpatient,,,1455.00000,2469.72000,SilverSummit Healthplan,Commercial Exchange,,1309.50,,,,,,,378.30,1411.35,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,inpatient,,,145.00000,75.54000,SilverSummit Healthplan,Commercial Exchange,,130.50,,,,,,,130.50,140.65,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,SilverSummit Healthplan,Commercial Exchange,,130.50,,,,,,,37.70,140.65,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,inpatient,,,488.00000,254.25000,SilverSummit Healthplan,Commercial Exchange,,439.20,,,,,,,439.20,473.36,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,SilverSummit Healthplan,Commercial Exchange,,439.20,,,,,,,126.88,473.36,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,SilverSummit Healthplan,Commercial Exchange,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,SilverSummit Healthplan,Commercial Exchange,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,SilverSummit Healthplan,Commercial Exchange,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,SilverSummit Healthplan,Commercial Exchange,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,inpatient,,,170.00000,73.95000,SilverSummit Healthplan,Commercial Exchange,,153.00,,,,,,,153.00,164.90,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,outpatient,,,170.00000,73.95000,SilverSummit Healthplan,Commercial Exchange,,153.00,,,,,,,44.20,164.90,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,2.70000,1.17000,SilverSummit Healthplan,Commercial Exchange,,2.43,,,,,,,2.43,2.62,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,2.70000,1.17000,SilverSummit Healthplan,Commercial Exchange,,2.43,,,,,,,0.70200,2.62,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,27.00000,11.74000,SilverSummit Healthplan,Commercial Exchange,,24.30,,,,,,,24.30,26.19,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,27.00000,11.74000,SilverSummit Healthplan,Commercial Exchange,,24.30,,,,,,,7.02,26.19,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,inpatient,,,20440.00000,8891.40000,SilverSummit Healthplan,Commercial Exchange,,18396.00,,,,,,,18396.00,19826.80,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,outpatient,,,20440.00000,8891.40000,SilverSummit Healthplan,Commercial Exchange,,18396.00,,,,,,,5314.40,19826.80,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,inpatient,,,3322.00000,1445.07000,SilverSummit Healthplan,Commercial Exchange,,2989.80,,,,,,,2989.80,3222.34,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,3322.00000,1445.07000,SilverSummit Healthplan,Commercial Exchange,,2989.80,,,,,,,863.72,3222.34,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,inpatient,,,2492.00000,1084.02000,SilverSummit Healthplan,Commercial Exchange,,2242.80,,,,,,,2242.80,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,2492.00000,1084.02000,SilverSummit Healthplan,Commercial Exchange,,2242.80,,,,,,,647.92,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,inpatient,,,1814.00000,789.09000,SilverSummit Healthplan,Commercial Exchange,,1632.60,,,,,,,1632.60,1759.58,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1814.00000,789.09000,SilverSummit Healthplan,Commercial Exchange,,1632.60,,,,,,,471.64,1759.58,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,inpatient,,,2153.00000,936.56000,SilverSummit Healthplan,Commercial Exchange,,1937.70,,,,,,,1937.70,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,2153.00000,936.56000,SilverSummit Healthplan,Commercial Exchange,,1937.70,,,,,,,559.78,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,inpatient,,,1525.00000,663.38000,SilverSummit Healthplan,Commercial Exchange,,1372.50,,,,,,,1372.50,1479.25,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1525.00000,663.38000,SilverSummit Healthplan,Commercial Exchange,,1372.50,,,,,,,396.50,1479.25,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,inpatient,,,2716.00000,1181.46000,SilverSummit Healthplan,Commercial Exchange,,2444.40,,,,,,,2444.40,2634.52,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2716.00000,1181.46000,SilverSummit Healthplan,Commercial Exchange,,2444.40,,,,,,,706.16,2634.52,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,inpatient,,,2.70000,0.39000,SilverSummit Healthplan,Commercial Exchange,,2.43,,,,,,,2.43,2.62,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,outpatient,,,2.70000,0.39000,SilverSummit Healthplan,Commercial Exchange,,2.43,,,,,,,0.70200,2.62,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,inpatient,,,222.00000,32.41000,SilverSummit Healthplan,Commercial Exchange,,199.80,,,,,,,199.80,215.34,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,outpatient,,,222.00000,32.41000,SilverSummit Healthplan,Commercial Exchange,,199.80,,,,,,,57.72,215.34,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,inpatient,,,211.00000,113.10000,SilverSummit Healthplan,Commercial Exchange,,189.90,,,,,,,189.90,204.67,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,outpatient,,,211.00000,113.10000,SilverSummit Healthplan,Commercial Exchange,,189.90,,,,,,,54.86,204.67,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,inpatient,,,497.00000,266.39000,SilverSummit Healthplan,Commercial Exchange,,447.30,,,,,,,447.30,482.09,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,outpatient,,,497.00000,266.39000,SilverSummit Healthplan,Commercial Exchange,,447.30,,,,,,,129.22,482.09,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,inpatient,,,296.00000,158.66000,SilverSummit Healthplan,Commercial Exchange,,266.40,,,,,,,266.40,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,outpatient,,,296.00000,158.66000,SilverSummit Healthplan,Commercial Exchange,,266.40,,,,,,,76.96,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,inpatient,,,723.00000,387.53000,SilverSummit Healthplan,Commercial Exchange,,650.70,,,,,,,650.70,701.31,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,outpatient,,,723.00000,387.53000,SilverSummit Healthplan,Commercial Exchange,,650.70,,,,,,,187.98,701.31,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,inpatient,,,326.00000,174.74000,SilverSummit Healthplan,Commercial Exchange,,293.40,,,,,,,293.40,316.22,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,outpatient,,,326.00000,174.74000,SilverSummit Healthplan,Commercial Exchange,,293.40,,,,,,,84.76,316.22,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,inpatient,,,532.00000,285.15000,SilverSummit Healthplan,Commercial Exchange,,478.80,,,,,,,478.80,516.04,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,outpatient,,,532.00000,285.15000,SilverSummit Healthplan,Commercial Exchange,,478.80,,,,,,,138.32,516.04,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,inpatient,,,635.00000,340.36000,SilverSummit Healthplan,Commercial Exchange,,571.50,,,,,,,571.50,615.95,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,outpatient,,,635.00000,340.36000,SilverSummit Healthplan,Commercial Exchange,,571.50,,,,,,,165.10,615.95,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,inpatient,,,639.00000,342.50000,SilverSummit Healthplan,Commercial Exchange,,575.10,,,,,,,575.10,619.83,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,outpatient,,,639.00000,342.50000,SilverSummit Healthplan,Commercial Exchange,,575.10,,,,,,,166.14,619.83,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,inpatient,,,780.00000,418.08000,SilverSummit Healthplan,Commercial Exchange,,702.00,,,,,,,702.00,756.60,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,outpatient,,,780.00000,418.08000,SilverSummit Healthplan,Commercial Exchange,,702.00,,,,,,,202.80,756.60,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,inpatient,,,390.00000,209.04000,SilverSummit Healthplan,Commercial Exchange,,351.00,,,,,,,351.00,378.30,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,outpatient,,,390.00000,209.04000,SilverSummit Healthplan,Commercial Exchange,,351.00,,,,,,,101.40,378.30,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,inpatient,,,731.00000,391.82000,SilverSummit Healthplan,Commercial Exchange,,657.90,,,,,,,657.90,709.07,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,outpatient,,,731.00000,391.82000,SilverSummit Healthplan,Commercial Exchange,,657.90,,,,,,,190.06,709.07,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,inpatient,,,585.00000,313.56000,SilverSummit Healthplan,Commercial Exchange,,526.50,,,,,,,526.50,567.45,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,outpatient,,,585.00000,313.56000,SilverSummit Healthplan,Commercial Exchange,,526.50,,,,,,,152.10,567.45,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,inpatient,,,365.00000,195.64000,SilverSummit Healthplan,Commercial Exchange,,328.50,,,,,,,328.50,354.05,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,outpatient,,,365.00000,195.64000,SilverSummit Healthplan,Commercial Exchange,,328.50,,,,,,,94.90,354.05,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,inpatient,,,1086.00000,582.10000,SilverSummit Healthplan,Commercial Exchange,,977.40,,,,,,,977.40,1053.42,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,outpatient,,,1086.00000,582.10000,SilverSummit Healthplan,Commercial Exchange,,977.40,,,,,,,282.36,1053.42,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,inpatient,,,197.00000,105.59000,SilverSummit Healthplan,Commercial Exchange,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,outpatient,,,197.00000,105.59000,SilverSummit Healthplan,Commercial Exchange,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,inpatient,,,2774.00000,1486.86000,SilverSummit Healthplan,Commercial Exchange,,2496.60,,,,,,,2496.60,2690.78,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,outpatient,,,2774.00000,1486.86000,SilverSummit Healthplan,Commercial Exchange,,2496.60,,,,,,,721.24,2690.78,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,inpatient,,,1456.00000,780.42000,SilverSummit Healthplan,Commercial Exchange,,1310.40,,,,,,,1310.40,1412.32,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,outpatient,,,1456.00000,780.42000,SilverSummit Healthplan,Commercial Exchange,,1310.40,,,,,,,378.56,1412.32,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,inpatient,,,2647.00000,1418.79000,SilverSummit Healthplan,Commercial Exchange,,2382.30,,,,,,,2382.30,2567.59,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,outpatient,,,2647.00000,1418.79000,SilverSummit Healthplan,Commercial Exchange,,2382.30,,,,,,,688.22,2567.59,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,inpatient,,,1359.00000,728.42000,SilverSummit Healthplan,Commercial Exchange,,1223.10,,,,,,,1223.10,1318.23,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,outpatient,,,1359.00000,728.42000,SilverSummit Healthplan,Commercial Exchange,,1223.10,,,,,,,353.34,1318.23,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,inpatient,,,273.00000,146.33000,SilverSummit Healthplan,Commercial Exchange,,245.70,,,,,,,245.70,264.81,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,outpatient,,,273.00000,146.33000,SilverSummit Healthplan,Commercial Exchange,,245.70,,,,,,,70.98,264.81,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,inpatient,,,325.00000,174.20000,SilverSummit Healthplan,Commercial Exchange,,292.50,,,,,,,292.50,315.25,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,outpatient,,,325.00000,174.20000,SilverSummit Healthplan,Commercial Exchange,,292.50,,,,,,,84.50,315.25,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,inpatient,,,609.00000,326.42000,SilverSummit Healthplan,Commercial Exchange,,548.10,,,,,,,548.10,590.73,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,SilverSummit Healthplan,Commercial Exchange,,548.10,,,,,,,158.34,590.73,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,inpatient,,,491.00000,263.18000,SilverSummit Healthplan,Commercial Exchange,,441.90,,,,,,,441.90,476.27,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,outpatient,,,491.00000,263.18000,SilverSummit Healthplan,Commercial Exchange,,441.90,,,,,,,127.66,476.27,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,inpatient,,,561.00000,300.70000,SilverSummit Healthplan,Commercial Exchange,,504.90,,,,,,,504.90,544.17,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,outpatient,,,561.00000,300.70000,SilverSummit Healthplan,Commercial Exchange,,504.90,,,,,,,145.86,544.17,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,inpatient,,,845.00000,452.92000,SilverSummit Healthplan,Commercial Exchange,,760.50,,,,,,,760.50,819.65,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,outpatient,,,845.00000,452.92000,SilverSummit Healthplan,Commercial Exchange,,760.50,,,,,,,219.70,819.65,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,inpatient,,,612.00000,328.03000,SilverSummit Healthplan,Commercial Exchange,,550.80,,,,,,,550.80,593.64,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,outpatient,,,612.00000,328.03000,SilverSummit Healthplan,Commercial Exchange,,550.80,,,,,,,159.12,593.64,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,inpatient,,,536.00000,287.30000,SilverSummit Healthplan,Commercial Exchange,,482.40,,,,,,,482.40,519.92,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,outpatient,,,536.00000,287.30000,SilverSummit Healthplan,Commercial Exchange,,482.40,,,,,,,139.36,519.92,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,inpatient,,,1225.00000,656.60000,SilverSummit Healthplan,Commercial Exchange,,1102.50,,,,,,,1102.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,outpatient,,,1225.00000,656.60000,SilverSummit Healthplan,Commercial Exchange,,1102.50,,,,,,,318.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,inpatient,,,816.00000,437.38000,SilverSummit Healthplan,Commercial Exchange,LT,734.40,,,,,,,734.40,791.52,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,SilverSummit Healthplan,Commercial Exchange,LT,734.40,,,,,,,212.16,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,inpatient,,,816.00000,437.38000,SilverSummit Healthplan,Commercial Exchange,RT,734.40,,,,,,,734.40,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,SilverSummit Healthplan,Commercial Exchange,RT,734.40,,,,,,,212.16,791.52,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,inpatient,,,250.00000,134.00000,SilverSummit Healthplan,Commercial Exchange,,225.00,,,,,,,225.00,242.50,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,outpatient,,,250.00000,134.00000,SilverSummit Healthplan,Commercial Exchange,,225.00,,,,,,,65.00,242.50,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,inpatient,,,302.00000,161.87000,SilverSummit Healthplan,Commercial Exchange,,271.80,,,,,,,271.80,292.94,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,outpatient,,,302.00000,161.87000,SilverSummit Healthplan,Commercial Exchange,,271.80,,,,,,,78.52,292.94,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,inpatient,,,354.00000,189.74000,SilverSummit Healthplan,Commercial Exchange,,318.60,,,,,,,318.60,343.38,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,outpatient,,,354.00000,189.74000,SilverSummit Healthplan,Commercial Exchange,,318.60,,,,,,,92.04,343.38,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,inpatient,,,409.00000,219.22000,SilverSummit Healthplan,Commercial Exchange,,368.10,,,,,,,368.10,396.73,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,outpatient,,,409.00000,219.22000,SilverSummit Healthplan,Commercial Exchange,,368.10,,,,,,,106.34,396.73,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,inpatient,,,593.00000,317.85000,SilverSummit Healthplan,Commercial Exchange,,533.70,,,,,,,533.70,575.21,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,outpatient,,,593.00000,317.85000,SilverSummit Healthplan,Commercial Exchange,,533.70,,,,,,,154.18,575.21,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,SilverSummit Healthplan,Commercial Exchange,LT,276.30,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,SilverSummit Healthplan,Commercial Exchange,LT,276.30,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,SilverSummit Healthplan,Commercial Exchange,"52,LT",276.30,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,SilverSummit Healthplan,Commercial Exchange,"52,LT",276.30,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,SilverSummit Healthplan,Commercial Exchange,RT,276.30,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,SilverSummit Healthplan,Commercial Exchange,RT,276.30,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,SilverSummit Healthplan,Commercial Exchange,"52,RT",276.30,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,SilverSummit Healthplan,Commercial Exchange,"52,RT",276.30,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,inpatient,,,330.00000,176.88000,SilverSummit Healthplan,Commercial Exchange,LT,297.00,,,,,,,297.00,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,SilverSummit Healthplan,Commercial Exchange,LT,297.00,,,,,,,85.80,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,inpatient,,,330.00000,176.88000,SilverSummit Healthplan,Commercial Exchange,RT,297.00,,,,,,,297.00,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,SilverSummit Healthplan,Commercial Exchange,RT,297.00,,,,,,,85.80,320.10,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,inpatient,,,195.00000,104.52000,SilverSummit Healthplan,Commercial Exchange,,175.50,,,,,,,175.50,189.15,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,outpatient,,,195.00000,104.52000,SilverSummit Healthplan,Commercial Exchange,,175.50,,,,,,,50.70,189.15,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,inpatient,,,578.00000,309.81000,SilverSummit Healthplan,Commercial Exchange,,520.20,,,,,,,520.20,560.66,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,outpatient,,,578.00000,309.81000,SilverSummit Healthplan,Commercial Exchange,,520.20,,,,,,,150.28,560.66,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,inpatient,,,384.00000,205.82000,SilverSummit Healthplan,Commercial Exchange,,345.60,,,,,,,345.60,372.48,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,outpatient,,,384.00000,205.82000,SilverSummit Healthplan,Commercial Exchange,,345.60,,,,,,,99.84,372.48,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,inpatient,,,303.00000,162.41000,SilverSummit Healthplan,Commercial Exchange,LT,272.70,,,,,,,272.70,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,SilverSummit Healthplan,Commercial Exchange,LT,272.70,,,,,,,78.78,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,inpatient,,,303.00000,162.41000,SilverSummit Healthplan,Commercial Exchange,RT,272.70,,,,,,,272.70,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,SilverSummit Healthplan,Commercial Exchange,RT,272.70,,,,,,,78.78,293.91,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,inpatient,,,445.00000,238.52000,SilverSummit Healthplan,Commercial Exchange,LT,400.50,,,,,,,400.50,431.65,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,SilverSummit Healthplan,Commercial Exchange,LT,400.50,,,,,,,115.70,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,inpatient,,,445.00000,238.52000,SilverSummit Healthplan,Commercial Exchange,RT,400.50,,,,,,,400.50,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,SilverSummit Healthplan,Commercial Exchange,RT,400.50,,,,,,,115.70,431.65,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,inpatient,,,937.00000,502.23000,SilverSummit Healthplan,Commercial Exchange,,843.30,,,,,,,843.30,908.89,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,outpatient,,,937.00000,502.23000,SilverSummit Healthplan,Commercial Exchange,,843.30,,,,,,,243.62,908.89,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,inpatient,,,615.00000,329.64000,SilverSummit Healthplan,Commercial Exchange,,553.50,,,,,,,553.50,596.55,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,outpatient,,,615.00000,329.64000,SilverSummit Healthplan,Commercial Exchange,,553.50,,,,,,,159.90,596.55,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,SilverSummit Healthplan,Commercial Exchange,LT,258.30,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,SilverSummit Healthplan,Commercial Exchange,LT,258.30,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,SilverSummit Healthplan,Commercial Exchange,"52,LT",258.30,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,SilverSummit Healthplan,Commercial Exchange,"52,LT",258.30,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,SilverSummit Healthplan,Commercial Exchange,RT,258.30,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,SilverSummit Healthplan,Commercial Exchange,RT,258.30,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,SilverSummit Healthplan,Commercial Exchange,"52,RT",258.30,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,SilverSummit Healthplan,Commercial Exchange,"52,RT",258.30,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,inpatient,,,323.00000,173.13000,SilverSummit Healthplan,Commercial Exchange,LT,290.70,,,,,,,290.70,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,SilverSummit Healthplan,Commercial Exchange,LT,290.70,,,,,,,83.98,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,inpatient,,,323.00000,173.13000,SilverSummit Healthplan,Commercial Exchange,RT,290.70,,,,,,,290.70,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,SilverSummit Healthplan,Commercial Exchange,RT,290.70,,,,,,,83.98,313.31,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,inpatient,,,694.00000,371.98000,SilverSummit Healthplan,Commercial Exchange,,624.60,,,,,,,624.60,673.18,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,outpatient,,,694.00000,371.98000,SilverSummit Healthplan,Commercial Exchange,,624.60,,,,,,,180.44,673.18,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,inpatient,,,276.00000,147.94000,SilverSummit Healthplan,Commercial Exchange,LT,248.40,,,,,,,248.40,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,SilverSummit Healthplan,Commercial Exchange,LT,248.40,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,inpatient,,,276.00000,147.94000,SilverSummit Healthplan,Commercial Exchange,RT,248.40,,,,,,,248.40,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,SilverSummit Healthplan,Commercial Exchange,RT,248.40,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,inpatient,,,254.00000,136.14000,SilverSummit Healthplan,Commercial Exchange,LT,228.60,,,,,,,228.60,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,SilverSummit Healthplan,Commercial Exchange,LT,228.60,,,,,,,66.04,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,inpatient,,,254.00000,136.14000,SilverSummit Healthplan,Commercial Exchange,RT,228.60,,,,,,,228.60,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,SilverSummit Healthplan,Commercial Exchange,RT,228.60,,,,,,,66.04,246.38,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,inpatient,,,275.00000,147.40000,SilverSummit Healthplan,Commercial Exchange,LT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,SilverSummit Healthplan,Commercial Exchange,LT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,inpatient,,,275.00000,147.40000,SilverSummit Healthplan,Commercial Exchange,RT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,SilverSummit Healthplan,Commercial Exchange,RT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,inpatient,,,173.00000,92.73000,SilverSummit Healthplan,Commercial Exchange,,155.70,,,,,,,155.70,167.81,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,outpatient,,,173.00000,92.73000,SilverSummit Healthplan,Commercial Exchange,,155.70,,,,,,,44.98,167.81,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,inpatient,,,483.00000,258.89000,SilverSummit Healthplan,Commercial Exchange,LT,434.70,,,,,,,434.70,468.51,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,SilverSummit Healthplan,Commercial Exchange,LT,434.70,,,,,,,125.58,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,inpatient,,,483.00000,258.89000,SilverSummit Healthplan,Commercial Exchange,RT,434.70,,,,,,,434.70,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,SilverSummit Healthplan,Commercial Exchange,RT,434.70,,,,,,,125.58,468.51,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,inpatient,,,191.00000,102.38000,SilverSummit Healthplan,Commercial Exchange,LT,171.90,,,,,,,171.90,185.27,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,SilverSummit Healthplan,Commercial Exchange,LT,171.90,,,,,,,49.66,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,inpatient,,,191.00000,102.38000,SilverSummit Healthplan,Commercial Exchange,RT,171.90,,,,,,,171.90,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,SilverSummit Healthplan,Commercial Exchange,RT,171.90,,,,,,,49.66,185.27,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,SilverSummit Healthplan,Commercial Exchange,LT,133.20,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,SilverSummit Healthplan,Commercial Exchange,LT,133.20,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,SilverSummit Healthplan,Commercial Exchange,"52,LT",133.20,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,SilverSummit Healthplan,Commercial Exchange,"52,LT",133.20,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,SilverSummit Healthplan,Commercial Exchange,RT,133.20,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,SilverSummit Healthplan,Commercial Exchange,RT,133.20,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,SilverSummit Healthplan,Commercial Exchange,"52,RT",133.20,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,SilverSummit Healthplan,Commercial Exchange,"52,RT",133.20,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,inpatient,,,481.00000,257.82000,SilverSummit Healthplan,Commercial Exchange,LT,432.90,,,,,,,432.90,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,SilverSummit Healthplan,Commercial Exchange,LT,432.90,,,,,,,125.06,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,inpatient,,,481.00000,257.82000,SilverSummit Healthplan,Commercial Exchange,RT,432.90,,,,,,,432.90,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,SilverSummit Healthplan,Commercial Exchange,RT,432.90,,,,,,,125.06,466.57,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,inpatient,,,215.00000,115.24000,SilverSummit Healthplan,Commercial Exchange,LT,193.50,,,,,,,193.50,208.55,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,SilverSummit Healthplan,Commercial Exchange,LT,193.50,,,,,,,55.90,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,inpatient,,,215.00000,115.24000,SilverSummit Healthplan,Commercial Exchange,RT,193.50,,,,,,,193.50,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,SilverSummit Healthplan,Commercial Exchange,RT,193.50,,,,,,,55.90,208.55,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,SilverSummit Healthplan,Commercial Exchange,LT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,SilverSummit Healthplan,Commercial Exchange,LT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,SilverSummit Healthplan,Commercial Exchange,"52,LT",247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,SilverSummit Healthplan,Commercial Exchange,"52,LT",247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,SilverSummit Healthplan,Commercial Exchange,RT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,SilverSummit Healthplan,Commercial Exchange,RT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,SilverSummit Healthplan,Commercial Exchange,"52,RT",247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,SilverSummit Healthplan,Commercial Exchange,"52,RT",247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,SilverSummit Healthplan,Commercial Exchange,LT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,SilverSummit Healthplan,Commercial Exchange,LT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,SilverSummit Healthplan,Commercial Exchange,"52,LT",409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,SilverSummit Healthplan,Commercial Exchange,"52,LT",409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,SilverSummit Healthplan,Commercial Exchange,RT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,SilverSummit Healthplan,Commercial Exchange,RT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,SilverSummit Healthplan,Commercial Exchange,"52,RT",409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,SilverSummit Healthplan,Commercial Exchange,"52,RT",409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,inpatient,,,503.00000,269.61000,SilverSummit Healthplan,Commercial Exchange,LT,452.70,,,,,,,452.70,487.91,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,SilverSummit Healthplan,Commercial Exchange,LT,452.70,,,,,,,130.78,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,inpatient,,,503.00000,269.61000,SilverSummit Healthplan,Commercial Exchange,RT,452.70,,,,,,,452.70,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,SilverSummit Healthplan,Commercial Exchange,RT,452.70,,,,,,,130.78,487.91,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,inpatient,,,209.00000,112.02000,SilverSummit Healthplan,Commercial Exchange,LT,188.10,,,,,,,188.10,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,SilverSummit Healthplan,Commercial Exchange,LT,188.10,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,inpatient,,,209.00000,112.02000,SilverSummit Healthplan,Commercial Exchange,RT,188.10,,,,,,,188.10,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,SilverSummit Healthplan,Commercial Exchange,RT,188.10,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,inpatient,,,566.00000,303.38000,SilverSummit Healthplan,Commercial Exchange,LT,509.40,,,,,,,509.40,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,SilverSummit Healthplan,Commercial Exchange,LT,509.40,,,,,,,147.16,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,inpatient,,,566.00000,303.38000,SilverSummit Healthplan,Commercial Exchange,RT,509.40,,,,,,,509.40,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,SilverSummit Healthplan,Commercial Exchange,RT,509.40,,,,,,,147.16,549.02,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,inpatient,,,598.00000,320.53000,SilverSummit Healthplan,Commercial Exchange,,538.20,,,,,,,538.20,580.06,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,outpatient,,,598.00000,320.53000,SilverSummit Healthplan,Commercial Exchange,,538.20,,,,,,,155.48,580.06,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,SilverSummit Healthplan,Commercial Exchange,"52,LT",409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,SilverSummit Healthplan,Commercial Exchange,"52,LT",409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,SilverSummit Healthplan,Commercial Exchange,"52,RT",409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,SilverSummit Healthplan,Commercial Exchange,"52,RT",409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,SilverSummit Healthplan,Commercial Exchange,LT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,SilverSummit Healthplan,Commercial Exchange,LT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,SilverSummit Healthplan,Commercial Exchange,RT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,SilverSummit Healthplan,Commercial Exchange,RT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,inpatient,,,1913.00000,1025.37000,SilverSummit Healthplan,Commercial Exchange,,1721.70,,,,,,,1721.70,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,outpatient,,,1913.00000,1025.37000,SilverSummit Healthplan,Commercial Exchange,,1721.70,,,,,,,497.38,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,inpatient,,,312.00000,167.23000,SilverSummit Healthplan,Commercial Exchange,,280.80,,,,,,,280.80,302.64,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,outpatient,,,312.00000,167.23000,SilverSummit Healthplan,Commercial Exchange,,280.80,,,,,,,81.12,302.64,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,inpatient,,,327.00000,175.27000,SilverSummit Healthplan,Commercial Exchange,,294.30,,,,,,,294.30,317.19,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,outpatient,,,327.00000,175.27000,SilverSummit Healthplan,Commercial Exchange,,294.30,,,,,,,85.02,317.19,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,inpatient,,,425.00000,227.80000,SilverSummit Healthplan,Commercial Exchange,,382.50,,,,,,,382.50,412.25,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,outpatient,,,425.00000,227.80000,SilverSummit Healthplan,Commercial Exchange,,382.50,,,,,,,110.50,412.25,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,inpatient,,,210.00000,112.56000,SilverSummit Healthplan,Commercial Exchange,,189.00,,,,,,,189.00,203.70,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,outpatient,,,210.00000,112.56000,SilverSummit Healthplan,Commercial Exchange,,189.00,,,,,,,54.60,203.70,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,inpatient,,,495.00000,265.32000,SilverSummit Healthplan,Commercial Exchange,,445.50,,,,,,,445.50,480.15,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,outpatient,,,495.00000,265.32000,SilverSummit Healthplan,Commercial Exchange,,445.50,,,,,,,128.70,480.15,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,inpatient,,,541.00000,289.98000,SilverSummit Healthplan,Commercial Exchange,,486.90,,,,,,,486.90,524.77,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,outpatient,,,541.00000,289.98000,SilverSummit Healthplan,Commercial Exchange,,486.90,,,,,,,140.66,524.77,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,inpatient,,,345.00000,184.92000,SilverSummit Healthplan,Commercial Exchange,LT,310.50,,,,,,,310.50,334.65,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,SilverSummit Healthplan,Commercial Exchange,LT,310.50,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,inpatient,,,345.00000,184.92000,SilverSummit Healthplan,Commercial Exchange,RT,310.50,,,,,,,310.50,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,SilverSummit Healthplan,Commercial Exchange,RT,310.50,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,inpatient,,,419.00000,224.58000,SilverSummit Healthplan,Commercial Exchange,LT,377.10,,,,,,,377.10,406.43,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,SilverSummit Healthplan,Commercial Exchange,LT,377.10,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,inpatient,,,419.00000,224.58000,SilverSummit Healthplan,Commercial Exchange,RT,377.10,,,,,,,377.10,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,SilverSummit Healthplan,Commercial Exchange,RT,377.10,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,inpatient,,,618.00000,331.25000,SilverSummit Healthplan,Commercial Exchange,LT,556.20,,,,,,,556.20,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,SilverSummit Healthplan,Commercial Exchange,LT,556.20,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,inpatient,,,618.00000,331.25000,SilverSummit Healthplan,Commercial Exchange,RT,556.20,,,,,,,556.20,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,SilverSummit Healthplan,Commercial Exchange,RT,556.20,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,inpatient,,,463.00000,248.17000,SilverSummit Healthplan,Commercial Exchange,,416.70,,,,,,,416.70,449.11,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,outpatient,,,463.00000,248.17000,SilverSummit Healthplan,Commercial Exchange,,416.70,,,,,,,120.38,449.11,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,inpatient,,,511.00000,273.90000,SilverSummit Healthplan,Commercial Exchange,,459.90,,,,,,,459.90,495.67,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,outpatient,,,511.00000,273.90000,SilverSummit Healthplan,Commercial Exchange,,459.90,,,,,,,132.86,495.67,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,inpatient,,,132.00000,70.75000,SilverSummit Healthplan,Commercial Exchange,,118.80,,,,,,,118.80,128.04,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,outpatient,,,132.00000,70.75000,SilverSummit Healthplan,Commercial Exchange,,118.80,,,,,,,34.32,128.04,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,inpatient,,,353.00000,189.21000,SilverSummit Healthplan,Commercial Exchange,LT,317.70,,,,,,,317.70,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,SilverSummit Healthplan,Commercial Exchange,LT,317.70,,,,,,,91.78,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,inpatient,,,353.00000,189.21000,SilverSummit Healthplan,Commercial Exchange,RT,317.70,,,,,,,317.70,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,SilverSummit Healthplan,Commercial Exchange,RT,317.70,,,,,,,91.78,342.41,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,inpatient,,,273.00000,146.33000,SilverSummit Healthplan,Commercial Exchange,,245.70,,,,,,,245.70,264.81,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,outpatient,,,273.00000,146.33000,SilverSummit Healthplan,Commercial Exchange,,245.70,,,,,,,70.98,264.81,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,inpatient,,,503.00000,269.61000,SilverSummit Healthplan,Commercial Exchange,,452.70,,,,,,,452.70,487.91,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,outpatient,,,503.00000,269.61000,SilverSummit Healthplan,Commercial Exchange,,452.70,,,,,,,130.78,487.91,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,inpatient,,,561.00000,300.70000,SilverSummit Healthplan,Commercial Exchange,,504.90,,,,,,,504.90,544.17,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,outpatient,,,561.00000,300.70000,SilverSummit Healthplan,Commercial Exchange,,504.90,,,,,,,145.86,544.17,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,inpatient,,,450.00000,241.20000,SilverSummit Healthplan,Commercial Exchange,LT,405.00,,,,,,,405.00,436.50,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,SilverSummit Healthplan,Commercial Exchange,LT,405.00,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,inpatient,,,450.00000,241.20000,SilverSummit Healthplan,Commercial Exchange,RT,405.00,,,,,,,405.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,SilverSummit Healthplan,Commercial Exchange,RT,405.00,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,inpatient,,,650.00000,348.40000,SilverSummit Healthplan,Commercial Exchange,,585.00,,,,,,,585.00,630.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,outpatient,,,650.00000,348.40000,SilverSummit Healthplan,Commercial Exchange,,585.00,,,,,,,169.00,630.50,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,inpatient,,,642.00000,344.11000,SilverSummit Healthplan,Commercial Exchange,,577.80,,,,,,,577.80,622.74,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,outpatient,,,642.00000,344.11000,SilverSummit Healthplan,Commercial Exchange,,577.80,,,,,,,166.92,622.74,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,inpatient,,,777.00000,416.47000,SilverSummit Healthplan,Commercial Exchange,,699.30,,,,,,,699.30,753.69,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,outpatient,,,777.00000,416.47000,SilverSummit Healthplan,Commercial Exchange,,699.30,,,,,,,202.02,753.69,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,inpatient,,,381.00000,204.22000,SilverSummit Healthplan,Commercial Exchange,,342.90,,,,,,,342.90,369.57,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,outpatient,,,381.00000,204.22000,SilverSummit Healthplan,Commercial Exchange,,342.90,,,,,,,99.06,369.57,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,inpatient,,,374.00000,200.46000,SilverSummit Healthplan,Commercial Exchange,LT,336.60,,,,,,,336.60,362.78,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,SilverSummit Healthplan,Commercial Exchange,LT,336.60,,,,,,,97.24,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,inpatient,,,374.00000,200.46000,SilverSummit Healthplan,Commercial Exchange,RT,336.60,,,,,,,336.60,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,SilverSummit Healthplan,Commercial Exchange,RT,336.60,,,,,,,97.24,362.78,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,inpatient,,,161.00000,86.30000,SilverSummit Healthplan,Commercial Exchange,LT,144.90,,,,,,,144.90,156.17,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,SilverSummit Healthplan,Commercial Exchange,LT,144.90,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,inpatient,,,161.00000,86.30000,SilverSummit Healthplan,Commercial Exchange,RT,144.90,,,,,,,144.90,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,SilverSummit Healthplan,Commercial Exchange,RT,144.90,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,inpatient,,,499.00000,267.46000,SilverSummit Healthplan,Commercial Exchange,LT,449.10,,,,,,,449.10,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,SilverSummit Healthplan,Commercial Exchange,LT,449.10,,,,,,,129.74,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,inpatient,,,499.00000,267.46000,SilverSummit Healthplan,Commercial Exchange,RT,449.10,,,,,,,449.10,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,SilverSummit Healthplan,Commercial Exchange,RT,449.10,,,,,,,129.74,484.03,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,inpatient,,,214.00000,114.70000,SilverSummit Healthplan,Commercial Exchange,,192.60,,,,,,,192.60,207.58,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,outpatient,,,214.00000,114.70000,SilverSummit Healthplan,Commercial Exchange,,192.60,,,,,,,55.64,207.58,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,inpatient,,,329.00000,176.34000,SilverSummit Healthplan,Commercial Exchange,,296.10,,,,,,,296.10,319.13,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,outpatient,,,329.00000,176.34000,SilverSummit Healthplan,Commercial Exchange,,296.10,,,,,,,85.54,319.13,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,inpatient,,,197.00000,105.59000,SilverSummit Healthplan,Commercial Exchange,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,outpatient,,,197.00000,105.59000,SilverSummit Healthplan,Commercial Exchange,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,inpatient,,,263.00000,140.97000,SilverSummit Healthplan,Commercial Exchange,,236.70,,,,,,,236.70,255.11,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,outpatient,,,263.00000,140.97000,SilverSummit Healthplan,Commercial Exchange,,236.70,,,,,,,68.38,255.11,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,inpatient,,,234.00000,125.42000,SilverSummit Healthplan,Commercial Exchange,,210.60,,,,,,,210.60,226.98,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,outpatient,,,234.00000,125.42000,SilverSummit Healthplan,Commercial Exchange,,210.60,,,,,,,60.84,226.98,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,inpatient,,,401.00000,214.94000,SilverSummit Healthplan,Commercial Exchange,,360.90,,,,,,,360.90,388.97,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,outpatient,,,401.00000,214.94000,SilverSummit Healthplan,Commercial Exchange,,360.90,,,,,,,104.26,388.97,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,inpatient,,,515.00000,276.04000,SilverSummit Healthplan,Commercial Exchange,,463.50,,,,,,,463.50,499.55,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,outpatient,,,515.00000,276.04000,SilverSummit Healthplan,Commercial Exchange,,463.50,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,inpatient,,,747.00000,400.39000,SilverSummit Healthplan,Commercial Exchange,,672.30,,,,,,,672.30,724.59,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,outpatient,,,747.00000,400.39000,SilverSummit Healthplan,Commercial Exchange,,672.30,,,,,,,194.22,724.59,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,inpatient,,,854.00000,457.74000,SilverSummit Healthplan,Commercial Exchange,,768.60,,,,,,,768.60,828.38,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,outpatient,,,854.00000,457.74000,SilverSummit Healthplan,Commercial Exchange,,768.60,,,,,,,222.04,828.38,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,inpatient,,,589.00000,315.70000,SilverSummit Healthplan,Commercial Exchange,,530.10,,,,,,,530.10,571.33,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,outpatient,,,589.00000,315.70000,SilverSummit Healthplan,Commercial Exchange,,530.10,,,,,,,153.14,571.33,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,inpatient,,,613.00000,328.57000,SilverSummit Healthplan,Commercial Exchange,,551.70,,,,,,,551.70,594.61,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,outpatient,,,613.00000,328.57000,SilverSummit Healthplan,Commercial Exchange,,551.70,,,,,,,159.38,594.61,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,inpatient,,,806.00000,432.02000,SilverSummit Healthplan,Commercial Exchange,,725.40,,,,,,,725.40,781.82,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,outpatient,,,806.00000,432.02000,SilverSummit Healthplan,Commercial Exchange,,725.40,,,,,,,209.56,781.82,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,inpatient,,,529.00000,283.54000,SilverSummit Healthplan,Commercial Exchange,,476.10,,,,,,,476.10,513.13,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,outpatient,,,529.00000,283.54000,SilverSummit Healthplan,Commercial Exchange,,476.10,,,,,,,137.54,513.13,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,inpatient,,,939.00000,503.30000,SilverSummit Healthplan,Commercial Exchange,,845.10,,,,,,,845.10,910.83,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,outpatient,,,939.00000,503.30000,SilverSummit Healthplan,Commercial Exchange,,845.10,,,,,,,244.14,910.83,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,inpatient,,,515.00000,276.04000,SilverSummit Healthplan,Commercial Exchange,,463.50,,,,,,,463.50,499.55,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,outpatient,,,515.00000,276.04000,SilverSummit Healthplan,Commercial Exchange,,463.50,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,inpatient,,,616.00000,330.18000,SilverSummit Healthplan,Commercial Exchange,,554.40,,,,,,,554.40,597.52,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,outpatient,,,616.00000,330.18000,SilverSummit Healthplan,Commercial Exchange,,554.40,,,,,,,160.16,597.52,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,inpatient,,,377.00000,202.07000,SilverSummit Healthplan,Commercial Exchange,,339.30,,,,,,,339.30,365.69,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,outpatient,,,377.00000,202.07000,SilverSummit Healthplan,Commercial Exchange,,339.30,,,,,,,98.02,365.69,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,inpatient,,,340.00000,182.24000,SilverSummit Healthplan,Commercial Exchange,,306.00,,,,,,,306.00,329.80,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,outpatient,,,340.00000,182.24000,SilverSummit Healthplan,Commercial Exchange,,306.00,,,,,,,88.40,329.80,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,inpatient,,,388.00000,207.97000,SilverSummit Healthplan,Commercial Exchange,,349.20,,,,,,,349.20,376.36,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,outpatient,,,388.00000,207.97000,SilverSummit Healthplan,Commercial Exchange,,349.20,,,,,,,100.88,376.36,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,inpatient,,,456.00000,244.42000,SilverSummit Healthplan,Commercial Exchange,,410.40,,,,,,,410.40,442.32,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,outpatient,,,456.00000,244.42000,SilverSummit Healthplan,Commercial Exchange,,410.40,,,,,,,118.56,442.32,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,inpatient,,,267.00000,143.11000,SilverSummit Healthplan,Commercial Exchange,,240.30,,,,,,,240.30,258.99,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,outpatient,,,267.00000,143.11000,SilverSummit Healthplan,Commercial Exchange,,240.30,,,,,,,69.42,258.99,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,SilverSummit Healthplan,Commercial Exchange,LT,275.40,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,SilverSummit Healthplan,Commercial Exchange,LT,275.40,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,SilverSummit Healthplan,Commercial Exchange,"52,LT",275.40,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,SilverSummit Healthplan,Commercial Exchange,"52,LT",275.40,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,SilverSummit Healthplan,Commercial Exchange,RT,275.40,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,SilverSummit Healthplan,Commercial Exchange,RT,275.40,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,SilverSummit Healthplan,Commercial Exchange,"52,RT",275.40,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,SilverSummit Healthplan,Commercial Exchange,"52,RT",275.40,,,,,,,79.56,296.82,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,inpatient,,,456.00000,244.42000,SilverSummit Healthplan,Commercial Exchange,,410.40,,,,,,,410.40,442.32,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,outpatient,,,456.00000,244.42000,SilverSummit Healthplan,Commercial Exchange,,410.40,,,,,,,118.56,442.32,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,inpatient,,,381.00000,204.22000,SilverSummit Healthplan,Commercial Exchange,,342.90,,,,,,,342.90,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,outpatient,,,381.00000,204.22000,SilverSummit Healthplan,Commercial Exchange,,342.90,,,,,,,99.06,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,inpatient,,,143.00000,76.65000,SilverSummit Healthplan,Commercial Exchange,LT,128.70,,,,,,,128.70,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,SilverSummit Healthplan,Commercial Exchange,LT,128.70,,,,,,,37.18,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,inpatient,,,143.00000,76.65000,SilverSummit Healthplan,Commercial Exchange,RT,128.70,,,,,,,128.70,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,SilverSummit Healthplan,Commercial Exchange,RT,128.70,,,,,,,37.18,138.71,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,inpatient,,,331.00000,177.42000,SilverSummit Healthplan,Commercial Exchange,LT,297.90,,,,,,,297.90,321.07,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,SilverSummit Healthplan,Commercial Exchange,LT,297.90,,,,,,,86.06,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,inpatient,,,331.00000,177.42000,SilverSummit Healthplan,Commercial Exchange,RT,297.90,,,,,,,297.90,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,SilverSummit Healthplan,Commercial Exchange,RT,297.90,,,,,,,86.06,321.07,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,inpatient,,,1113.00000,596.57000,SilverSummit Healthplan,Commercial Exchange,,1001.70,,,,,,,1001.70,1079.61,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1113.00000,596.57000,SilverSummit Healthplan,Commercial Exchange,,1001.70,,,,,,,289.38,1079.61,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,inpatient,,,1043.00000,559.05000,SilverSummit Healthplan,Commercial Exchange,,938.70,,,,,,,938.70,1011.71,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,outpatient,,,1043.00000,559.05000,SilverSummit Healthplan,Commercial Exchange,,938.70,,,,,,,271.18,1011.71,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,SilverSummit Healthplan,Commercial Exchange,LT,230.40,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,SilverSummit Healthplan,Commercial Exchange,LT,230.40,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,SilverSummit Healthplan,Commercial Exchange,"52,LT",230.40,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,SilverSummit Healthplan,Commercial Exchange,"52,LT",230.40,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,SilverSummit Healthplan,Commercial Exchange,RT,230.40,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,SilverSummit Healthplan,Commercial Exchange,RT,230.40,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,SilverSummit Healthplan,Commercial Exchange,"52,RT",230.40,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,SilverSummit Healthplan,Commercial Exchange,"52,RT",230.40,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,inpatient,,,511.00000,273.90000,SilverSummit Healthplan,Commercial Exchange,LT,459.90,,,,,,,459.90,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,SilverSummit Healthplan,Commercial Exchange,LT,459.90,,,,,,,132.86,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,inpatient,,,511.00000,273.90000,SilverSummit Healthplan,Commercial Exchange,RT,459.90,,,,,,,459.90,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,SilverSummit Healthplan,Commercial Exchange,RT,459.90,,,,,,,132.86,495.67,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,inpatient,,,553.00000,314.19000,SilverSummit Healthplan,Commercial Exchange,LT,497.70,,,,,,,497.70,536.41,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,SilverSummit Healthplan,Commercial Exchange,LT,497.70,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,inpatient,,,553.00000,314.19000,SilverSummit Healthplan,Commercial Exchange,RT,497.70,,,,,,,497.70,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,SilverSummit Healthplan,Commercial Exchange,RT,497.70,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,inpatient,,,1076.00000,611.33000,SilverSummit Healthplan,Commercial Exchange,LT,968.40,,,,,,,968.40,1043.72,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,SilverSummit Healthplan,Commercial Exchange,LT,968.40,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,inpatient,,,1076.00000,611.33000,SilverSummit Healthplan,Commercial Exchange,RT,968.40,,,,,,,968.40,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,SilverSummit Healthplan,Commercial Exchange,RT,968.40,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,inpatient,,,865.00000,491.45000,SilverSummit Healthplan,Commercial Exchange,LT,778.50,,,,,,,778.50,839.05,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,SilverSummit Healthplan,Commercial Exchange,LT,778.50,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,inpatient,,,865.00000,491.45000,SilverSummit Healthplan,Commercial Exchange,RT,778.50,,,,,,,778.50,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,SilverSummit Healthplan,Commercial Exchange,RT,778.50,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,inpatient,,,734.00000,417.02000,SilverSummit Healthplan,Commercial Exchange,LT,660.60,,,,,,,660.60,711.98,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,SilverSummit Healthplan,Commercial Exchange,LT,660.60,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,inpatient,,,734.00000,417.02000,SilverSummit Healthplan,Commercial Exchange,RT,660.60,,,,,,,660.60,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,SilverSummit Healthplan,Commercial Exchange,RT,660.60,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,inpatient,,,730.00000,414.75000,SilverSummit Healthplan,Commercial Exchange,LT,657.00,,,,,,,657.00,708.10,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,SilverSummit Healthplan,Commercial Exchange,LT,657.00,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,inpatient,,,730.00000,414.75000,SilverSummit Healthplan,Commercial Exchange,RT,657.00,,,,,,,657.00,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,SilverSummit Healthplan,Commercial Exchange,RT,657.00,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,inpatient,,,260.00000,147.72000,SilverSummit Healthplan,Commercial Exchange,LT,234.00,,,,,,,234.00,252.20,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,SilverSummit Healthplan,Commercial Exchange,LT,234.00,,,,,,,67.60,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,inpatient,,,260.00000,147.72000,SilverSummit Healthplan,Commercial Exchange,RT,234.00,,,,,,,234.00,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,SilverSummit Healthplan,Commercial Exchange,RT,234.00,,,,,,,67.60,252.20,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,inpatient,,,428.00000,203.73000,SilverSummit Healthplan,Commercial Exchange,,385.20,,,,,,,385.20,415.16,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,outpatient,,,428.00000,203.73000,SilverSummit Healthplan,Commercial Exchange,,385.20,,,,,,,111.28,415.16,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,inpatient,,,492.00000,234.19000,SilverSummit Healthplan,Commercial Exchange,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,outpatient,,,492.00000,234.19000,SilverSummit Healthplan,Commercial Exchange,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,inpatient,,,607.00000,288.93000,SilverSummit Healthplan,Commercial Exchange,,546.30,,,,,,,546.30,588.79,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,outpatient,,,607.00000,288.93000,SilverSummit Healthplan,Commercial Exchange,,546.30,,,,,,,157.82,588.79,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,inpatient,,,649.00000,308.92000,SilverSummit Healthplan,Commercial Exchange,,584.10,,,,,,,584.10,629.53,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,outpatient,,,649.00000,308.92000,SilverSummit Healthplan,Commercial Exchange,,584.10,,,,,,,168.74,629.53,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,inpatient,,,377.00000,121.77000,SilverSummit Healthplan,Commercial Exchange,50,339.30,,,,,,,339.30,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,outpatient,,,377.00000,121.77000,SilverSummit Healthplan,Commercial Exchange,50,339.30,,,,,,,98.02,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,inpatient,,,251.00000,81.07000,SilverSummit Healthplan,Commercial Exchange,LT,225.90,,,,,,,225.90,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,SilverSummit Healthplan,Commercial Exchange,LT,225.90,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,inpatient,,,251.00000,81.07000,SilverSummit Healthplan,Commercial Exchange,RT,225.90,,,,,,,225.90,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,SilverSummit Healthplan,Commercial Exchange,RT,225.90,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,inpatient,,,1170.00000,377.91000,SilverSummit Healthplan,Commercial Exchange,50,1053.00,,,,,,,1053.00,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,outpatient,,,1170.00000,377.91000,SilverSummit Healthplan,Commercial Exchange,50,1053.00,,,,,,,304.20,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,inpatient,,,780.00000,251.94000,SilverSummit Healthplan,Commercial Exchange,LT,702.00,,,,,,,702.00,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,SilverSummit Healthplan,Commercial Exchange,LT,702.00,,,,,,,202.80,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,inpatient,,,780.00000,251.94000,SilverSummit Healthplan,Commercial Exchange,RT,702.00,,,,,,,702.00,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,SilverSummit Healthplan,Commercial Exchange,RT,702.00,,,,,,,202.80,756.60,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,inpatient,,,1389.00000,448.65000,SilverSummit Healthplan,Commercial Exchange,,1250.10,,,,,,,1250.10,1347.33,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,outpatient,,,1389.00000,448.65000,SilverSummit Healthplan,Commercial Exchange,,1250.10,,,,,,,361.14,1347.33,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,inpatient,,,345.00000,111.44000,SilverSummit Healthplan,Commercial Exchange,50,310.50,,,,,,,310.50,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,outpatient,,,345.00000,111.44000,SilverSummit Healthplan,Commercial Exchange,50,310.50,,,,,,,89.70,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,inpatient,,,230.00000,74.29000,SilverSummit Healthplan,Commercial Exchange,LT,207.00,,,,,,,207.00,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,SilverSummit Healthplan,Commercial Exchange,LT,207.00,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,inpatient,,,230.00000,74.29000,SilverSummit Healthplan,Commercial Exchange,RT,207.00,,,,,,,207.00,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,SilverSummit Healthplan,Commercial Exchange,RT,207.00,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,inpatient,,,2102.00000,678.95000,SilverSummit Healthplan,Commercial Exchange,50,1891.80,,,,,,,1891.80,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,outpatient,,,2102.00000,678.95000,SilverSummit Healthplan,Commercial Exchange,50,1891.80,,,,,,,546.52,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,inpatient,,,1401.00000,452.52000,SilverSummit Healthplan,Commercial Exchange,LT,1260.90,,,,,,,1260.90,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,SilverSummit Healthplan,Commercial Exchange,LT,1260.90,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,inpatient,,,1401.00000,452.52000,SilverSummit Healthplan,Commercial Exchange,RT,1260.90,,,,,,,1260.90,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,SilverSummit Healthplan,Commercial Exchange,RT,1260.90,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,inpatient,,,357.00000,115.31000,SilverSummit Healthplan,Commercial Exchange,50,321.30,,,,,,,321.30,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,outpatient,,,357.00000,115.31000,SilverSummit Healthplan,Commercial Exchange,50,321.30,,,,,,,92.82,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,inpatient,,,238.00000,76.87000,SilverSummit Healthplan,Commercial Exchange,LT,214.20,,,,,,,214.20,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,SilverSummit Healthplan,Commercial Exchange,LT,214.20,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,inpatient,,,238.00000,76.87000,SilverSummit Healthplan,Commercial Exchange,RT,214.20,,,,,,,214.20,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,SilverSummit Healthplan,Commercial Exchange,RT,214.20,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,inpatient,,,2082.00000,672.49000,SilverSummit Healthplan,Commercial Exchange,50,1873.80,,,,,,,1873.80,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,outpatient,,,2082.00000,672.49000,SilverSummit Healthplan,Commercial Exchange,50,1873.80,,,,,,,541.32,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,inpatient,,,1388.00000,448.32000,SilverSummit Healthplan,Commercial Exchange,LT,1249.20,,,,,,,1249.20,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,SilverSummit Healthplan,Commercial Exchange,LT,1249.20,,,,,,,360.88,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,inpatient,,,1388.00000,448.32000,SilverSummit Healthplan,Commercial Exchange,RT,1249.20,,,,,,,1249.20,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,SilverSummit Healthplan,Commercial Exchange,RT,1249.20,,,,,,,360.88,1346.36,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,inpatient,,,246.00000,79.46000,SilverSummit Healthplan,Commercial Exchange,50,221.40,,,,,,,221.40,238.62,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,outpatient,,,246.00000,79.46000,SilverSummit Healthplan,Commercial Exchange,50,221.40,,,,,,,63.96,238.62,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,inpatient,,,164.00000,52.97000,SilverSummit Healthplan,Commercial Exchange,LT,147.60,,,,,,,147.60,159.08,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,SilverSummit Healthplan,Commercial Exchange,LT,147.60,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,inpatient,,,164.00000,52.97000,SilverSummit Healthplan,Commercial Exchange,RT,147.60,,,,,,,147.60,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,SilverSummit Healthplan,Commercial Exchange,RT,147.60,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,inpatient,,,309.00000,99.81000,SilverSummit Healthplan,Commercial Exchange,50,278.10,,,,,,,278.10,299.73,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,outpatient,,,309.00000,99.81000,SilverSummit Healthplan,Commercial Exchange,50,278.10,,,,,,,80.34,299.73,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,inpatient,,,206.00000,66.54000,SilverSummit Healthplan,Commercial Exchange,LT,185.40,,,,,,,185.40,199.82,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,SilverSummit Healthplan,Commercial Exchange,LT,185.40,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,inpatient,,,206.00000,66.54000,SilverSummit Healthplan,Commercial Exchange,RT,185.40,,,,,,,185.40,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,SilverSummit Healthplan,Commercial Exchange,RT,185.40,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,inpatient,,,471.00000,152.13000,SilverSummit Healthplan,Commercial Exchange,50,423.90,,,,,,,423.90,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,outpatient,,,471.00000,152.13000,SilverSummit Healthplan,Commercial Exchange,50,423.90,,,,,,,122.46,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,inpatient,,,314.00000,101.42000,SilverSummit Healthplan,Commercial Exchange,LT,282.60,,,,,,,282.60,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,SilverSummit Healthplan,Commercial Exchange,LT,282.60,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,inpatient,,,314.00000,101.42000,SilverSummit Healthplan,Commercial Exchange,RT,282.60,,,,,,,282.60,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,SilverSummit Healthplan,Commercial Exchange,RT,282.60,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,inpatient,,,239.00000,77.20000,SilverSummit Healthplan,Commercial Exchange,50,215.10,,,,,,,215.10,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,outpatient,,,239.00000,77.20000,SilverSummit Healthplan,Commercial Exchange,50,215.10,,,,,,,62.14,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,inpatient,,,159.00000,51.36000,SilverSummit Healthplan,Commercial Exchange,LT,143.10,,,,,,,143.10,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,SilverSummit Healthplan,Commercial Exchange,LT,143.10,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,inpatient,,,159.00000,51.36000,SilverSummit Healthplan,Commercial Exchange,RT,143.10,,,,,,,143.10,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,SilverSummit Healthplan,Commercial Exchange,RT,143.10,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,inpatient,,,558.00000,180.23000,SilverSummit Healthplan,Commercial Exchange,50,502.20,,,,,,,502.20,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,outpatient,,,558.00000,180.23000,SilverSummit Healthplan,Commercial Exchange,50,502.20,,,,,,,145.08,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,inpatient,,,372.00000,120.16000,SilverSummit Healthplan,Commercial Exchange,LT,334.80,,,,,,,334.80,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,SilverSummit Healthplan,Commercial Exchange,LT,334.80,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,inpatient,,,372.00000,120.16000,SilverSummit Healthplan,Commercial Exchange,RT,334.80,,,,,,,334.80,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,SilverSummit Healthplan,Commercial Exchange,RT,334.80,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,inpatient,,,413.00000,133.40000,SilverSummit Healthplan,Commercial Exchange,50,371.70,,,,,,,371.70,400.61,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,outpatient,,,413.00000,133.40000,SilverSummit Healthplan,Commercial Exchange,50,371.70,,,,,,,107.38,400.61,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,inpatient,,,275.00000,88.82000,SilverSummit Healthplan,Commercial Exchange,LT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,SilverSummit Healthplan,Commercial Exchange,LT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,inpatient,,,275.00000,88.82000,SilverSummit Healthplan,Commercial Exchange,RT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,SilverSummit Healthplan,Commercial Exchange,RT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,inpatient,,,462.00000,149.23000,SilverSummit Healthplan,Commercial Exchange,,415.80,,,,,,,415.80,448.14,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,outpatient,,,462.00000,149.23000,SilverSummit Healthplan,Commercial Exchange,,415.80,,,,,,,120.12,448.14,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,inpatient,,,170.00000,54.91000,SilverSummit Healthplan,Commercial Exchange,,153.00,,,,,,,153.00,164.90,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,outpatient,,,170.00000,54.91000,SilverSummit Healthplan,Commercial Exchange,,153.00,,,,,,,44.20,164.90,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,inpatient,,,281.00000,90.76000,SilverSummit Healthplan,Commercial Exchange,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,outpatient,,,281.00000,90.76000,SilverSummit Healthplan,Commercial Exchange,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,inpatient,,,562.00000,181.53000,SilverSummit Healthplan,Commercial Exchange,,505.80,,,,,,,505.80,545.14,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,outpatient,,,562.00000,181.53000,SilverSummit Healthplan,Commercial Exchange,,505.80,,,,,,,146.12,545.14,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,inpatient,,,2076.00000,670.55000,SilverSummit Healthplan,Commercial Exchange,50,1868.40,,,,,,,1868.40,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,outpatient,,,2076.00000,670.55000,SilverSummit Healthplan,Commercial Exchange,50,1868.40,,,,,,,539.76,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1384.00000,447.03000,SilverSummit Healthplan,Commercial Exchange,LT,1245.60,,,,,,,1245.60,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,SilverSummit Healthplan,Commercial Exchange,LT,1245.60,,,,,,,359.84,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1384.00000,447.03000,SilverSummit Healthplan,Commercial Exchange,RT,1245.60,,,,,,,1245.60,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,SilverSummit Healthplan,Commercial Exchange,RT,1245.60,,,,,,,359.84,1342.48,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,inpatient,,,934.00000,301.68000,SilverSummit Healthplan,Commercial Exchange,,840.60,,,,,,,840.60,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,outpatient,,,934.00000,301.68000,SilverSummit Healthplan,Commercial Exchange,,840.60,,,,,,,242.84,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,inpatient,,,842.00000,271.97000,SilverSummit Healthplan,Commercial Exchange,,757.80,,,,,,,757.80,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,outpatient,,,842.00000,271.97000,SilverSummit Healthplan,Commercial Exchange,,757.80,,,,,,,218.92,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,inpatient,,,846.00000,273.26000,SilverSummit Healthplan,Commercial Exchange,,761.40,,,,,,,761.40,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,outpatient,,,846.00000,273.26000,SilverSummit Healthplan,Commercial Exchange,,761.40,,,,,,,219.96,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,inpatient,,,971.00000,313.63000,SilverSummit Healthplan,Commercial Exchange,,873.90,,,,,,,873.90,941.87,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,outpatient,,,971.00000,313.63000,SilverSummit Healthplan,Commercial Exchange,,873.90,,,,,,,252.46,941.87,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,inpatient,,,762.00000,246.13000,SilverSummit Healthplan,Commercial Exchange,,685.80,,,,,,,685.80,739.14,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,outpatient,,,762.00000,246.13000,SilverSummit Healthplan,Commercial Exchange,,685.80,,,,,,,198.12,739.14,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,inpatient,,,758.00000,244.83000,SilverSummit Healthplan,Commercial Exchange,,682.20,,,,,,,682.20,735.26,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,outpatient,,,758.00000,244.83000,SilverSummit Healthplan,Commercial Exchange,,682.20,,,,,,,197.08,735.26,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,inpatient,,,161.00000,52.00000,SilverSummit Healthplan,Commercial Exchange,,144.90,,,,,,,144.90,156.17,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,outpatient,,,161.00000,52.00000,SilverSummit Healthplan,Commercial Exchange,,144.90,,,,,,,41.86,156.17,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,inpatient,,,234.00000,75.58000,SilverSummit Healthplan,Commercial Exchange,50,210.60,,,,,,,210.60,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,outpatient,,,234.00000,75.58000,SilverSummit Healthplan,Commercial Exchange,50,210.60,,,,,,,60.84,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,inpatient,,,156.00000,50.39000,SilverSummit Healthplan,Commercial Exchange,LT,140.40,,,,,,,140.40,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,SilverSummit Healthplan,Commercial Exchange,LT,140.40,,,,,,,40.56,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,inpatient,,,156.00000,50.39000,SilverSummit Healthplan,Commercial Exchange,RT,140.40,,,,,,,140.40,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,SilverSummit Healthplan,Commercial Exchange,RT,140.40,,,,,,,40.56,151.32,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1517.00000,489.99000,SilverSummit Healthplan,Commercial Exchange,50,1365.30,,,,,,,1365.30,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1517.00000,489.99000,SilverSummit Healthplan,Commercial Exchange,50,1365.30,,,,,,,394.42,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1011.00000,326.55000,SilverSummit Healthplan,Commercial Exchange,LT,909.90,,,,,,,909.90,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,SilverSummit Healthplan,Commercial Exchange,LT,909.90,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1011.00000,326.55000,SilverSummit Healthplan,Commercial Exchange,RT,909.90,,,,,,,909.90,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,SilverSummit Healthplan,Commercial Exchange,RT,909.90,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,inpatient,,,822.00000,265.51000,SilverSummit Healthplan,Commercial Exchange,50,739.80,,,,,,,739.80,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,outpatient,,,822.00000,265.51000,SilverSummit Healthplan,Commercial Exchange,50,739.80,,,,,,,213.72,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,inpatient,,,548.00000,177.00000,SilverSummit Healthplan,Commercial Exchange,LT,493.20,,,,,,,493.20,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,SilverSummit Healthplan,Commercial Exchange,LT,493.20,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,inpatient,,,548.00000,177.00000,SilverSummit Healthplan,Commercial Exchange,RT,493.20,,,,,,,493.20,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,SilverSummit Healthplan,Commercial Exchange,RT,493.20,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,inpatient,,,2613.00000,844.00000,SilverSummit Healthplan,Commercial Exchange,,2351.70,,,,,,,2351.70,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,outpatient,,,2613.00000,844.00000,SilverSummit Healthplan,Commercial Exchange,,2351.70,,,,,,,679.38,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,inpatient,,,903.00000,291.67000,SilverSummit Healthplan,Commercial Exchange,,812.70,,,,,,,812.70,875.91,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,outpatient,,,903.00000,291.67000,SilverSummit Healthplan,Commercial Exchange,,812.70,,,,,,,234.78,875.91,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,inpatient,,,1156.00000,373.39000,SilverSummit Healthplan,Commercial Exchange,,1040.40,,,,,,,1040.40,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,outpatient,,,1156.00000,373.39000,SilverSummit Healthplan,Commercial Exchange,,1040.40,,,,,,,300.56,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,inpatient,,,677.00000,218.67000,SilverSummit Healthplan,Commercial Exchange,,609.30,,,,,,,609.30,656.69,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,outpatient,,,677.00000,218.67000,SilverSummit Healthplan,Commercial Exchange,,609.30,,,,,,,176.02,656.69,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1928.00000,622.74000,SilverSummit Healthplan,Commercial Exchange,50,1735.20,,,,,,,1735.20,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1928.00000,622.74000,SilverSummit Healthplan,Commercial Exchange,50,1735.20,,,,,,,501.28,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1285.00000,415.06000,SilverSummit Healthplan,Commercial Exchange,LT,1156.50,,,,,,,1156.50,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,SilverSummit Healthplan,Commercial Exchange,LT,1156.50,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1285.00000,415.06000,SilverSummit Healthplan,Commercial Exchange,RT,1156.50,,,,,,,1156.50,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,SilverSummit Healthplan,Commercial Exchange,RT,1156.50,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,inpatient,,,812.00000,262.28000,SilverSummit Healthplan,Commercial Exchange,50,730.80,,,,,,,730.80,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,outpatient,,,812.00000,262.28000,SilverSummit Healthplan,Commercial Exchange,50,730.80,,,,,,,211.12,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,inpatient,,,541.00000,174.74000,SilverSummit Healthplan,Commercial Exchange,LT,486.90,,,,,,,486.90,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,SilverSummit Healthplan,Commercial Exchange,LT,486.90,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,inpatient,,,541.00000,174.74000,SilverSummit Healthplan,Commercial Exchange,RT,486.90,,,,,,,486.90,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,SilverSummit Healthplan,Commercial Exchange,RT,486.90,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,inpatient,,,825.00000,266.48000,SilverSummit Healthplan,Commercial Exchange,50,742.50,,,,,,,742.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,outpatient,,,825.00000,266.48000,SilverSummit Healthplan,Commercial Exchange,50,742.50,,,,,,,214.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,inpatient,,,550.00000,177.65000,SilverSummit Healthplan,Commercial Exchange,LT,495.00,,,,,,,495.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,SilverSummit Healthplan,Commercial Exchange,LT,495.00,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,inpatient,,,550.00000,177.65000,SilverSummit Healthplan,Commercial Exchange,RT,495.00,,,,,,,495.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,SilverSummit Healthplan,Commercial Exchange,RT,495.00,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,inpatient,,,3494.00000,1128.56000,SilverSummit Healthplan,Commercial Exchange,50,3144.60,,,,,,,3144.60,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,outpatient,,,3494.00000,1128.56000,SilverSummit Healthplan,Commercial Exchange,50,3144.60,,,,,,,908.44,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2329.00000,752.27000,SilverSummit Healthplan,Commercial Exchange,LT,2096.10,,,,,,,2096.10,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,SilverSummit Healthplan,Commercial Exchange,LT,2096.10,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2329.00000,752.27000,SilverSummit Healthplan,Commercial Exchange,RT,2096.10,,,,,,,2096.10,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,SilverSummit Healthplan,Commercial Exchange,RT,2096.10,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,inpatient,,,840.00000,271.32000,SilverSummit Healthplan,Commercial Exchange,50,756.00,,,,,,,756.00,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,outpatient,,,840.00000,271.32000,SilverSummit Healthplan,Commercial Exchange,50,756.00,,,,,,,218.40,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,inpatient,,,560.00000,180.88000,SilverSummit Healthplan,Commercial Exchange,LT,504.00,,,,,,,504.00,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,SilverSummit Healthplan,Commercial Exchange,LT,504.00,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,inpatient,,,560.00000,180.88000,SilverSummit Healthplan,Commercial Exchange,RT,504.00,,,,,,,504.00,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,SilverSummit Healthplan,Commercial Exchange,RT,504.00,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,inpatient,,,792.00000,255.82000,SilverSummit Healthplan,Commercial Exchange,50,712.80,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,outpatient,,,792.00000,255.82000,SilverSummit Healthplan,Commercial Exchange,50,712.80,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,inpatient,,,528.00000,170.54000,SilverSummit Healthplan,Commercial Exchange,LT,475.20,,,,,,,475.20,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,SilverSummit Healthplan,Commercial Exchange,LT,475.20,,,,,,,137.28,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,inpatient,,,528.00000,170.54000,SilverSummit Healthplan,Commercial Exchange,RT,475.20,,,,,,,475.20,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,SilverSummit Healthplan,Commercial Exchange,RT,475.20,,,,,,,137.28,512.16,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,inpatient,,,272.00000,87.86000,SilverSummit Healthplan,Commercial Exchange,,244.80,,,,,,,244.80,263.84,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,outpatient,,,272.00000,87.86000,SilverSummit Healthplan,Commercial Exchange,,244.80,,,,,,,70.72,263.84,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,inpatient,,,1268.00000,409.56000,SilverSummit Healthplan,Commercial Exchange,,1141.20,,,,,,,1141.20,1229.96,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,outpatient,,,1268.00000,409.56000,SilverSummit Healthplan,Commercial Exchange,,1141.20,,,,,,,329.68,1229.96,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,inpatient,,,896.00000,289.41000,SilverSummit Healthplan,Commercial Exchange,,806.40,,,,,,,806.40,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,outpatient,,,896.00000,289.41000,SilverSummit Healthplan,Commercial Exchange,,806.40,,,,,,,232.96,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,inpatient,,,884.00000,285.53000,SilverSummit Healthplan,Commercial Exchange,,795.60,,,,,,,795.60,857.48,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,outpatient,,,884.00000,285.53000,SilverSummit Healthplan,Commercial Exchange,,795.60,,,,,,,229.84,857.48,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,inpatient,,,609.00000,326.42000,SilverSummit Healthplan,Commercial Exchange,,548.10,,,,,,,548.10,590.73,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,SilverSummit Healthplan,Commercial Exchange,,548.10,,,,,,,158.34,590.73,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,inpatient,,,966.00000,383.50000,SilverSummit Healthplan,Commercial Exchange,,869.40,,,,,,,869.40,937.02,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,outpatient,,,966.00000,383.50000,SilverSummit Healthplan,Commercial Exchange,,869.40,,,,,,,251.16,937.02,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,inpatient,,,872.00000,346.18000,SilverSummit Healthplan,Commercial Exchange,,784.80,,,,,,,784.80,845.84,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,outpatient,,,872.00000,346.18000,SilverSummit Healthplan,Commercial Exchange,,784.80,,,,,,,226.72,845.84,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,inpatient,,,492.00000,195.32000,SilverSummit Healthplan,Commercial Exchange,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,outpatient,,,492.00000,195.32000,SilverSummit Healthplan,Commercial Exchange,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,inpatient,,,331.00000,131.41000,SilverSummit Healthplan,Commercial Exchange,,297.90,,,,,,,297.90,321.07,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,outpatient,,,331.00000,131.41000,SilverSummit Healthplan,Commercial Exchange,,297.90,,,,,,,86.06,321.07,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,inpatient,,,5215.00000,2070.36000,SilverSummit Healthplan,Commercial Exchange,,4693.50,,,,,,,4693.50,5058.55,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,outpatient,,,5215.00000,2070.36000,SilverSummit Healthplan,Commercial Exchange,,4693.50,,,,,,,1355.90,5058.55,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,inpatient,,,5422.00000,2152.53000,SilverSummit Healthplan,Commercial Exchange,,4879.80,,,,,,,4879.80,5259.34,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,outpatient,,,5422.00000,2152.53000,SilverSummit Healthplan,Commercial Exchange,,4879.80,,,,,,,1409.72,5259.34,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,inpatient,,,1878.00000,788.76000,SilverSummit Healthplan,Commercial Exchange,,1690.20,,,,,,,1690.20,1821.66,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1878.00000,788.76000,SilverSummit Healthplan,Commercial Exchange,,1690.20,,,,,,,488.28,1821.66,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,inpatient,,,2253.00000,946.26000,SilverSummit Healthplan,Commercial Exchange,,2027.70,,,,,,,2027.70,2185.41,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,outpatient,,,2253.00000,946.26000,SilverSummit Healthplan,Commercial Exchange,,2027.70,,,,,,,585.78,2185.41,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,inpatient,,,1502.00000,630.84000,SilverSummit Healthplan,Commercial Exchange,,1351.80,,,,,,,1351.80,1456.94,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1502.00000,630.84000,SilverSummit Healthplan,Commercial Exchange,,1351.80,,,,,,,390.52,1456.94,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,inpatient,,,2024.00000,850.08000,SilverSummit Healthplan,Commercial Exchange,,1821.60,,,,,,,1821.60,1963.28,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,outpatient,,,2024.00000,850.08000,SilverSummit Healthplan,Commercial Exchange,,1821.60,,,,,,,526.24,1963.28,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,inpatient,,,2429.00000,1020.18000,SilverSummit Healthplan,Commercial Exchange,,2186.10,,,,,,,2186.10,2356.13,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,outpatient,,,2429.00000,1020.18000,SilverSummit Healthplan,Commercial Exchange,,2186.10,,,,,,,631.54,2356.13,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,inpatient,,,1619.00000,679.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1619.00000,679.98000,SilverSummit Healthplan,Commercial Exchange,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,inpatient,,,2425.00000,1018.50000,SilverSummit Healthplan,Commercial Exchange,,2182.50,,,,,,,2182.50,2352.25,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,outpatient,,,2425.00000,1018.50000,SilverSummit Healthplan,Commercial Exchange,,2182.50,,,,,,,630.50,2352.25,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,inpatient,,,2910.00000,1222.20000,SilverSummit Healthplan,Commercial Exchange,,2619.00,,,,,,,2619.00,2822.70,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2910.00000,1222.20000,SilverSummit Healthplan,Commercial Exchange,,2619.00,,,,,,,756.60,2822.70,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,inpatient,,,1940.00000,814.80000,SilverSummit Healthplan,Commercial Exchange,,1746.00,,,,,,,1746.00,1881.80,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1940.00000,814.80000,SilverSummit Healthplan,Commercial Exchange,,1746.00,,,,,,,504.40,1881.80,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,inpatient,,,2317.00000,973.14000,SilverSummit Healthplan,Commercial Exchange,,2085.30,,,,,,,2085.30,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2317.00000,973.14000,SilverSummit Healthplan,Commercial Exchange,,2085.30,,,,,,,602.42,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,inpatient,,,2780.00000,1167.60000,SilverSummit Healthplan,Commercial Exchange,,2502.00,,,,,,,2502.00,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2780.00000,1167.60000,SilverSummit Healthplan,Commercial Exchange,,2502.00,,,,,,,722.80,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,inpatient,,,1853.00000,778.26000,SilverSummit Healthplan,Commercial Exchange,,1667.70,,,,,,,1667.70,1797.41,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1853.00000,778.26000,SilverSummit Healthplan,Commercial Exchange,,1667.70,,,,,,,481.78,1797.41,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,inpatient,,,2366.00000,993.72000,SilverSummit Healthplan,Commercial Exchange,,2129.40,,,,,,,2129.40,2295.02,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2366.00000,993.72000,SilverSummit Healthplan,Commercial Exchange,,2129.40,,,,,,,615.16,2295.02,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,inpatient,,,3056.00000,1283.52000,SilverSummit Healthplan,Commercial Exchange,,2750.40,,,,,,,2750.40,2964.32,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,outpatient,,,3056.00000,1283.52000,SilverSummit Healthplan,Commercial Exchange,,2750.40,,,,,,,794.56,2964.32,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,inpatient,,,2829.00000,1386.21000,SilverSummit Healthplan,Commercial Exchange,,2546.10,,,,,,,2546.10,2744.13,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,outpatient,,,2829.00000,1386.21000,SilverSummit Healthplan,Commercial Exchange,,2546.10,,,,,,,735.54,2744.13,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,inpatient,,,3395.00000,1663.55000,SilverSummit Healthplan,Commercial Exchange,,3055.50,,,,,,,3055.50,3293.15,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,outpatient,,,3395.00000,1663.55000,SilverSummit Healthplan,Commercial Exchange,,3055.50,,,,,,,882.70,3293.15,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,inpatient,,,2263.00000,1108.87000,SilverSummit Healthplan,Commercial Exchange,,2036.70,,,,,,,2036.70,2195.11,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,outpatient,,,2263.00000,1108.87000,SilverSummit Healthplan,Commercial Exchange,,2036.70,,,,,,,588.38,2195.11,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,inpatient,,,4697.00000,2301.53000,SilverSummit Healthplan,Commercial Exchange,,4227.30,,,,,,,4227.30,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,outpatient,,,4697.00000,2301.53000,SilverSummit Healthplan,Commercial Exchange,,4227.30,,,,,,,1221.22,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,inpatient,,,5636.00000,2761.64000,SilverSummit Healthplan,Commercial Exchange,,5072.40,,,,,,,5072.40,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,outpatient,,,5636.00000,2761.64000,SilverSummit Healthplan,Commercial Exchange,,5072.40,,,,,,,1465.36,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,inpatient,,,3757.00000,1840.93000,SilverSummit Healthplan,Commercial Exchange,,3381.30,,,,,,,3381.30,3644.29,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,outpatient,,,3757.00000,1840.93000,SilverSummit Healthplan,Commercial Exchange,,3381.30,,,,,,,976.82,3644.29,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,inpatient,,,2619.00000,1283.31000,SilverSummit Healthplan,Commercial Exchange,,2357.10,,,,,,,2357.10,2540.43,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,outpatient,,,2619.00000,1283.31000,SilverSummit Healthplan,Commercial Exchange,,2357.10,,,,,,,680.94,2540.43,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,inpatient,,,3143.00000,1540.07000,SilverSummit Healthplan,Commercial Exchange,,2828.70,,,,,,,2828.70,3048.71,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,outpatient,,,3143.00000,1540.07000,SilverSummit Healthplan,Commercial Exchange,,2828.70,,,,,,,817.18,3048.71,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,inpatient,,,2095.00000,1026.55000,SilverSummit Healthplan,Commercial Exchange,,1885.50,,,,,,,1885.50,2032.15,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,outpatient,,,2095.00000,1026.55000,SilverSummit Healthplan,Commercial Exchange,,1885.50,,,,,,,544.70,2032.15,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,inpatient,,,278.00000,136.22000,SilverSummit Healthplan,Commercial Exchange,,250.20,,,,,,,250.20,269.66,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,outpatient,,,278.00000,136.22000,SilverSummit Healthplan,Commercial Exchange,,250.20,,,,,,,72.28,269.66,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,inpatient,,,2110.00000,1033.90000,SilverSummit Healthplan,Commercial Exchange,LT,1899.00,,,,,,,1899.00,2046.70,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,SilverSummit Healthplan,Commercial Exchange,LT,1899.00,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,inpatient,,,2110.00000,1033.90000,SilverSummit Healthplan,Commercial Exchange,RT,1899.00,,,,,,,1899.00,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,SilverSummit Healthplan,Commercial Exchange,RT,1899.00,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2532.00000,1240.68000,SilverSummit Healthplan,Commercial Exchange,LT,2278.80,,,,,,,2278.80,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,SilverSummit Healthplan,Commercial Exchange,LT,2278.80,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2532.00000,1240.68000,SilverSummit Healthplan,Commercial Exchange,RT,2278.80,,,,,,,2278.80,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,SilverSummit Healthplan,Commercial Exchange,RT,2278.80,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1688.00000,827.12000,SilverSummit Healthplan,Commercial Exchange,LT,1519.20,,,,,,,1519.20,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,SilverSummit Healthplan,Commercial Exchange,LT,1519.20,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1688.00000,827.12000,SilverSummit Healthplan,Commercial Exchange,RT,1519.20,,,,,,,1519.20,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,SilverSummit Healthplan,Commercial Exchange,RT,1519.20,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,inpatient,,,2024.00000,991.76000,SilverSummit Healthplan,Commercial Exchange,LT,1821.60,,,,,,,1821.60,1963.28,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,SilverSummit Healthplan,Commercial Exchange,LT,1821.60,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,inpatient,,,2024.00000,991.76000,SilverSummit Healthplan,Commercial Exchange,RT,1821.60,,,,,,,1821.60,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,SilverSummit Healthplan,Commercial Exchange,RT,1821.60,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2429.00000,1190.21000,SilverSummit Healthplan,Commercial Exchange,LT,2186.10,,,,,,,2186.10,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,SilverSummit Healthplan,Commercial Exchange,LT,2186.10,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2429.00000,1190.21000,SilverSummit Healthplan,Commercial Exchange,RT,2186.10,,,,,,,2186.10,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,SilverSummit Healthplan,Commercial Exchange,RT,2186.10,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1619.00000,793.31000,SilverSummit Healthplan,Commercial Exchange,LT,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,SilverSummit Healthplan,Commercial Exchange,LT,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1619.00000,793.31000,SilverSummit Healthplan,Commercial Exchange,RT,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,SilverSummit Healthplan,Commercial Exchange,RT,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,inpatient,,,1224.00000,599.76000,SilverSummit Healthplan,Commercial Exchange,,1101.60,,,,,,,1101.60,1187.28,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,outpatient,,,1224.00000,599.76000,SilverSummit Healthplan,Commercial Exchange,,1101.60,,,,,,,318.24,1187.28,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,inpatient,,,3020.00000,1479.80000,SilverSummit Healthplan,Commercial Exchange,,2718.00,,,,,,,2718.00,2929.40,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,outpatient,,,3020.00000,1479.80000,SilverSummit Healthplan,Commercial Exchange,,2718.00,,,,,,,785.20,2929.40,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,inpatient,,,3624.00000,1775.76000,SilverSummit Healthplan,Commercial Exchange,,3261.60,,,,,,,3261.60,3515.28,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,outpatient,,,3624.00000,1775.76000,SilverSummit Healthplan,Commercial Exchange,,3261.60,,,,,,,942.24,3515.28,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,inpatient,,,2416.00000,1183.84000,SilverSummit Healthplan,Commercial Exchange,,2174.40,,,,,,,2174.40,2343.52,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,outpatient,,,2416.00000,1183.84000,SilverSummit Healthplan,Commercial Exchange,,2174.40,,,,,,,628.16,2343.52,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,inpatient,,,2728.00000,1336.72000,SilverSummit Healthplan,Commercial Exchange,,2455.20,,,,,,,2455.20,2646.16,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,outpatient,,,2728.00000,1336.72000,SilverSummit Healthplan,Commercial Exchange,,2455.20,,,,,,,709.28,2646.16,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,inpatient,,,3273.00000,1603.77000,SilverSummit Healthplan,Commercial Exchange,,2945.70,,,,,,,2945.70,3174.81,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,outpatient,,,3273.00000,1603.77000,SilverSummit Healthplan,Commercial Exchange,,2945.70,,,,,,,850.98,3174.81,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,inpatient,,,2182.00000,1069.18000,SilverSummit Healthplan,Commercial Exchange,,1963.80,,,,,,,1963.80,2116.54,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,outpatient,,,2182.00000,1069.18000,SilverSummit Healthplan,Commercial Exchange,,1963.80,,,,,,,567.32,2116.54,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,inpatient,,,3133.00000,1535.17000,SilverSummit Healthplan,Commercial Exchange,,2819.70,,,,,,,2819.70,3039.01,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,outpatient,,,3133.00000,1535.17000,SilverSummit Healthplan,Commercial Exchange,,2819.70,,,,,,,814.58,3039.01,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,inpatient,,,3759.00000,1841.91000,SilverSummit Healthplan,Commercial Exchange,,3383.10,,,,,,,3383.10,3646.23,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,outpatient,,,3759.00000,1841.91000,SilverSummit Healthplan,Commercial Exchange,,3383.10,,,,,,,977.34,3646.23,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,inpatient,,,2506.00000,1227.94000,SilverSummit Healthplan,Commercial Exchange,,2255.40,,,,,,,2255.40,2430.82,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,outpatient,,,2506.00000,1227.94000,SilverSummit Healthplan,Commercial Exchange,,2255.40,,,,,,,651.56,2430.82,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,inpatient,,,2857.00000,1399.93000,SilverSummit Healthplan,Commercial Exchange,,2571.30,,,,,,,2571.30,2771.29,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,outpatient,,,2857.00000,1399.93000,SilverSummit Healthplan,Commercial Exchange,,2571.30,,,,,,,742.82,2771.29,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,inpatient,,,3428.00000,1679.72000,SilverSummit Healthplan,Commercial Exchange,,3085.20,,,,,,,3085.20,3325.16,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,outpatient,,,3428.00000,1679.72000,SilverSummit Healthplan,Commercial Exchange,,3085.20,,,,,,,891.28,3325.16,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,inpatient,,,2285.00000,1119.65000,SilverSummit Healthplan,Commercial Exchange,,2056.50,,,,,,,2056.50,2216.45,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,outpatient,,,2285.00000,1119.65000,SilverSummit Healthplan,Commercial Exchange,,2056.50,,,,,,,594.10,2216.45,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,inpatient,,,3565.00000,1746.85000,SilverSummit Healthplan,Commercial Exchange,,3208.50,,,,,,,3208.50,3458.05,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,outpatient,,,3565.00000,1746.85000,SilverSummit Healthplan,Commercial Exchange,,3208.50,,,,,,,926.90,3458.05,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,inpatient,,,5918.00000,2899.82000,SilverSummit Healthplan,Commercial Exchange,,5326.20,,,,,,,5326.20,5740.46,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,outpatient,,,5918.00000,2899.82000,SilverSummit Healthplan,Commercial Exchange,,5326.20,,,,,,,1538.68,5740.46,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,inpatient,,,3301.00000,1617.49000,SilverSummit Healthplan,Commercial Exchange,,2970.90,,,,,,,2970.90,3201.97,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,outpatient,,,3301.00000,1617.49000,SilverSummit Healthplan,Commercial Exchange,,2970.90,,,,,,,858.26,3201.97,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2659.00000,1302.91000,SilverSummit Healthplan,Commercial Exchange,LT,2393.10,,,,,,,2393.10,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,SilverSummit Healthplan,Commercial Exchange,LT,2393.10,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2659.00000,1302.91000,SilverSummit Healthplan,Commercial Exchange,RT,2393.10,,,,,,,2393.10,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,SilverSummit Healthplan,Commercial Exchange,RT,2393.10,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2551.00000,1249.99000,SilverSummit Healthplan,Commercial Exchange,LT,2295.90,,,,,,,2295.90,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,SilverSummit Healthplan,Commercial Exchange,LT,2295.90,,,,,,,663.26,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2551.00000,1249.99000,SilverSummit Healthplan,Commercial Exchange,RT,2295.90,,,,,,,2295.90,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,SilverSummit Healthplan,Commercial Exchange,RT,2295.90,,,,,,,663.26,2474.47,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,inpatient,,,3806.00000,1864.94000,SilverSummit Healthplan,Commercial Exchange,,3425.40,,,,,,,3425.40,3691.82,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3806.00000,1864.94000,SilverSummit Healthplan,Commercial Exchange,,3425.40,,,,,,,989.56,3691.82,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,inpatient,,,2149.00000,694.13000,SilverSummit Healthplan,Commercial Exchange,,1934.10,,,,,,,1934.10,2084.53,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,outpatient,,,2149.00000,694.13000,SilverSummit Healthplan,Commercial Exchange,,1934.10,,,,,,,558.74,2084.53,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,inpatient,,,1973.00000,637.28000,SilverSummit Healthplan,Commercial Exchange,,1775.70,,,,,,,1775.70,1913.81,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,outpatient,,,1973.00000,637.28000,SilverSummit Healthplan,Commercial Exchange,,1775.70,,,,,,,512.98,1913.81,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1784.00000,576.23000,SilverSummit Healthplan,Commercial Exchange,50,1605.60,,,,,,,1605.60,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1784.00000,576.23000,SilverSummit Healthplan,Commercial Exchange,50,1605.60,,,,,,,463.84,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1189.00000,384.05000,SilverSummit Healthplan,Commercial Exchange,LT,1070.10,,,,,,,1070.10,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,SilverSummit Healthplan,Commercial Exchange,LT,1070.10,,,,,,,309.14,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1189.00000,384.05000,SilverSummit Healthplan,Commercial Exchange,RT,1070.10,,,,,,,1070.10,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,SilverSummit Healthplan,Commercial Exchange,RT,1070.10,,,,,,,309.14,1153.33,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,inpatient,,,130.00000,69.68000,SilverSummit Healthplan,Commercial Exchange,,117.00,,,,,,,117.00,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,outpatient,,,130.00000,69.68000,SilverSummit Healthplan,Commercial Exchange,,117.00,,,,,,,33.80,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,inpatient,,,44.00000,23.58000,SilverSummit Healthplan,Commercial Exchange,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,outpatient,,,44.00000,23.58000,SilverSummit Healthplan,Commercial Exchange,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,inpatient,,,456.00000,244.42000,SilverSummit Healthplan,Commercial Exchange,,410.40,,,,,,,410.40,442.32,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,outpatient,,,456.00000,244.42000,SilverSummit Healthplan,Commercial Exchange,,410.40,,,,,,,118.56,442.32,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,inpatient,,,108.00000,57.89000,SilverSummit Healthplan,Commercial Exchange,,97.20,,,,,,,97.20,104.76,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,outpatient,,,108.00000,57.89000,SilverSummit Healthplan,Commercial Exchange,,97.20,,,,,,,28.08,104.76,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,inpatient,,,306.00000,164.02000,SilverSummit Healthplan,Commercial Exchange,,275.40,,,,,,,275.40,296.82,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,outpatient,,,306.00000,164.02000,SilverSummit Healthplan,Commercial Exchange,,275.40,,,,,,,79.56,296.82,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,inpatient,,,257.00000,137.75000,SilverSummit Healthplan,Commercial Exchange,,231.30,,,,,,,231.30,249.29,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,outpatient,,,257.00000,137.75000,SilverSummit Healthplan,Commercial Exchange,,231.30,,,,,,,66.82,249.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4057.00000,2036.61000,SilverSummit Healthplan,Commercial Exchange,,3651.30,,,,,,,3651.30,3935.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,SilverSummit Healthplan,Commercial Exchange,,3651.30,,,,,,,1054.82,3935.29,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4868.00000,2443.74000,SilverSummit Healthplan,Commercial Exchange,,4381.20,,,,,,,4381.20,4721.96,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,SilverSummit Healthplan,Commercial Exchange,,4381.20,,,,,,,1265.68,4721.96,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,inpatient,,,3245.00000,1628.99000,SilverSummit Healthplan,Commercial Exchange,,2920.50,,,,,,,2920.50,3147.65,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,SilverSummit Healthplan,Commercial Exchange,,2920.50,,,,,,,843.70,3147.65,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4057.00000,2036.61000,SilverSummit Healthplan,Commercial Exchange,,3651.30,,,,,,,3651.30,3935.29,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,SilverSummit Healthplan,Commercial Exchange,,3651.30,,,,,,,1054.82,3935.29,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4868.00000,2443.74000,SilverSummit Healthplan,Commercial Exchange,,4381.20,,,,,,,4381.20,4721.96,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,SilverSummit Healthplan,Commercial Exchange,,4381.20,,,,,,,1265.68,4721.96,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,inpatient,,,3245.00000,1628.99000,SilverSummit Healthplan,Commercial Exchange,,2920.50,,,,,,,2920.50,3147.65,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,SilverSummit Healthplan,Commercial Exchange,,2920.50,,,,,,,843.70,3147.65,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,inpatient,,,1725.00000,865.95000,SilverSummit Healthplan,Commercial Exchange,,1552.50,,,,,,,1552.50,1673.25,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,outpatient,,,1725.00000,865.95000,SilverSummit Healthplan,Commercial Exchange,,1552.50,,,,,,,448.50,1673.25,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,inpatient,,,1743.00000,874.99000,SilverSummit Healthplan,Commercial Exchange,,1568.70,,,,,,,1568.70,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,outpatient,,,1743.00000,874.99000,SilverSummit Healthplan,Commercial Exchange,,1568.70,,,,,,,453.18,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,inpatient,,,1475.00000,740.45000,SilverSummit Healthplan,Commercial Exchange,LT,1327.50,,,,,,,1327.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,SilverSummit Healthplan,Commercial Exchange,LT,1327.50,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,inpatient,,,1475.00000,740.45000,SilverSummit Healthplan,Commercial Exchange,RT,1327.50,,,,,,,1327.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,SilverSummit Healthplan,Commercial Exchange,RT,1327.50,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,inpatient,,,1162.00000,583.32000,SilverSummit Healthplan,Commercial Exchange,,1045.80,,,,,,,1045.80,1127.14,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,outpatient,,,1162.00000,583.32000,SilverSummit Healthplan,Commercial Exchange,,1045.80,,,,,,,302.12,1127.14,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,inpatient,,,983.00000,493.47000,SilverSummit Healthplan,Commercial Exchange,LT,884.70,,,,,,,884.70,953.51,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,SilverSummit Healthplan,Commercial Exchange,LT,884.70,,,,,,,255.58,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,inpatient,,,983.00000,493.47000,SilverSummit Healthplan,Commercial Exchange,RT,884.70,,,,,,,884.70,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,SilverSummit Healthplan,Commercial Exchange,RT,884.70,,,,,,,255.58,953.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,inpatient,,,3183.00000,1597.87000,SilverSummit Healthplan,Commercial Exchange,,2864.70,,,,,,,2864.70,3087.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,outpatient,,,3183.00000,1597.87000,SilverSummit Healthplan,Commercial Exchange,,2864.70,,,,,,,827.58,3087.51,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,inpatient,,,3819.00000,1917.14000,SilverSummit Healthplan,Commercial Exchange,,3437.10,,,,,,,3437.10,3704.43,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,outpatient,,,3819.00000,1917.14000,SilverSummit Healthplan,Commercial Exchange,,3437.10,,,,,,,992.94,3704.43,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,inpatient,,,2546.00000,1278.09000,SilverSummit Healthplan,Commercial Exchange,,2291.40,,,,,,,2291.40,2469.62,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,outpatient,,,2546.00000,1278.09000,SilverSummit Healthplan,Commercial Exchange,,2291.40,,,,,,,661.96,2469.62,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,inpatient,,,3858.00000,1936.72000,SilverSummit Healthplan,Commercial Exchange,LT,3472.20,,,,,,,3472.20,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,SilverSummit Healthplan,Commercial Exchange,LT,3472.20,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,inpatient,,,3858.00000,1936.72000,SilverSummit Healthplan,Commercial Exchange,RT,3472.20,,,,,,,3472.20,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,SilverSummit Healthplan,Commercial Exchange,RT,3472.20,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,inpatient,,,4629.00000,2323.76000,SilverSummit Healthplan,Commercial Exchange,LT,4166.10,,,,,,,4166.10,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,SilverSummit Healthplan,Commercial Exchange,LT,4166.10,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,inpatient,,,4629.00000,2323.76000,SilverSummit Healthplan,Commercial Exchange,RT,4166.10,,,,,,,4166.10,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,SilverSummit Healthplan,Commercial Exchange,RT,4166.10,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,inpatient,,,3086.00000,1549.17000,SilverSummit Healthplan,Commercial Exchange,LT,2777.40,,,,,,,2777.40,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,SilverSummit Healthplan,Commercial Exchange,LT,2777.40,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,inpatient,,,3086.00000,1549.17000,SilverSummit Healthplan,Commercial Exchange,RT,2777.40,,,,,,,2777.40,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,SilverSummit Healthplan,Commercial Exchange,RT,2777.40,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,inpatient,,,2505.00000,1257.51000,SilverSummit Healthplan,Commercial Exchange,LT,2254.50,,,,,,,2254.50,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,SilverSummit Healthplan,Commercial Exchange,LT,2254.50,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,inpatient,,,2505.00000,1257.51000,SilverSummit Healthplan,Commercial Exchange,RT,2254.50,,,,,,,2254.50,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,SilverSummit Healthplan,Commercial Exchange,RT,2254.50,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,inpatient,,,3006.00000,1509.01000,SilverSummit Healthplan,Commercial Exchange,LT,2705.40,,,,,,,2705.40,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,SilverSummit Healthplan,Commercial Exchange,LT,2705.40,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,inpatient,,,3006.00000,1509.01000,SilverSummit Healthplan,Commercial Exchange,RT,2705.40,,,,,,,2705.40,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,SilverSummit Healthplan,Commercial Exchange,RT,2705.40,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,inpatient,,,2004.00000,1006.01000,SilverSummit Healthplan,Commercial Exchange,LT,1803.60,,,,,,,1803.60,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,SilverSummit Healthplan,Commercial Exchange,LT,1803.60,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,inpatient,,,2004.00000,1006.01000,SilverSummit Healthplan,Commercial Exchange,RT,1803.60,,,,,,,1803.60,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,SilverSummit Healthplan,Commercial Exchange,RT,1803.60,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,inpatient,,,3137.00000,1574.77000,SilverSummit Healthplan,Commercial Exchange,LT,2823.30,,,,,,,2823.30,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,SilverSummit Healthplan,Commercial Exchange,LT,2823.30,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,inpatient,,,3137.00000,1574.77000,SilverSummit Healthplan,Commercial Exchange,RT,2823.30,,,,,,,2823.30,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,SilverSummit Healthplan,Commercial Exchange,RT,2823.30,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,inpatient,,,3764.00000,1889.53000,SilverSummit Healthplan,Commercial Exchange,LT,3387.60,,,,,,,3387.60,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,SilverSummit Healthplan,Commercial Exchange,LT,3387.60,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,inpatient,,,3764.00000,1889.53000,SilverSummit Healthplan,Commercial Exchange,RT,3387.60,,,,,,,3387.60,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,SilverSummit Healthplan,Commercial Exchange,RT,3387.60,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,inpatient,,,2509.00000,1259.52000,SilverSummit Healthplan,Commercial Exchange,LT,2258.10,,,,,,,2258.10,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,SilverSummit Healthplan,Commercial Exchange,LT,2258.10,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,inpatient,,,2509.00000,1259.52000,SilverSummit Healthplan,Commercial Exchange,RT,2258.10,,,,,,,2258.10,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,SilverSummit Healthplan,Commercial Exchange,RT,2258.10,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,inpatient,,,3023.00000,1517.55000,SilverSummit Healthplan,Commercial Exchange,LT,2720.70,,,,,,,2720.70,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,SilverSummit Healthplan,Commercial Exchange,LT,2720.70,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,inpatient,,,3023.00000,1517.55000,SilverSummit Healthplan,Commercial Exchange,RT,2720.70,,,,,,,2720.70,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,SilverSummit Healthplan,Commercial Exchange,RT,2720.70,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,inpatient,,,3627.00000,1820.75000,SilverSummit Healthplan,Commercial Exchange,LT,3264.30,,,,,,,3264.30,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,SilverSummit Healthplan,Commercial Exchange,LT,3264.30,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,inpatient,,,3627.00000,1820.75000,SilverSummit Healthplan,Commercial Exchange,RT,3264.30,,,,,,,3264.30,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,SilverSummit Healthplan,Commercial Exchange,RT,3264.30,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,inpatient,,,2418.00000,1213.84000,SilverSummit Healthplan,Commercial Exchange,LT,2176.20,,,,,,,2176.20,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,SilverSummit Healthplan,Commercial Exchange,LT,2176.20,,,,,,,628.68,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,inpatient,,,2418.00000,1213.84000,SilverSummit Healthplan,Commercial Exchange,RT,2176.20,,,,,,,2176.20,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,SilverSummit Healthplan,Commercial Exchange,RT,2176.20,,,,,,,628.68,2345.46,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,inpatient,,,870.00000,436.74000,SilverSummit Healthplan,Commercial Exchange,,783.00,,,,,,,783.00,843.90,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,outpatient,,,870.00000,436.74000,SilverSummit Healthplan,Commercial Exchange,,783.00,,,,,,,226.20,843.90,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,inpatient,,,1353.00000,679.21000,SilverSummit Healthplan,Commercial Exchange,,1217.70,,,,,,,1217.70,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,outpatient,,,1353.00000,679.21000,SilverSummit Healthplan,Commercial Exchange,,1217.70,,,,,,,351.78,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,inpatient,,,902.00000,452.80000,SilverSummit Healthplan,Commercial Exchange,LT,811.80,,,,,,,811.80,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,SilverSummit Healthplan,Commercial Exchange,LT,811.80,,,,,,,234.52,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,inpatient,,,902.00000,452.80000,SilverSummit Healthplan,Commercial Exchange,RT,811.80,,,,,,,811.80,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,SilverSummit Healthplan,Commercial Exchange,RT,811.80,,,,,,,234.52,874.94,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,inpatient,,,3489.00000,1751.48000,SilverSummit Healthplan,Commercial Exchange,,3140.10,,,,,,,3140.10,3384.33,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3489.00000,1751.48000,SilverSummit Healthplan,Commercial Exchange,,3140.10,,,,,,,907.14,3384.33,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,inpatient,,,4187.00000,2101.87000,SilverSummit Healthplan,Commercial Exchange,,3768.30,,,,,,,3768.30,4061.39,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,outpatient,,,4187.00000,2101.87000,SilverSummit Healthplan,Commercial Exchange,,3768.30,,,,,,,1088.62,4061.39,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,inpatient,,,2791.00000,1401.08000,SilverSummit Healthplan,Commercial Exchange,,2511.90,,,,,,,2511.90,2707.27,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,outpatient,,,2791.00000,1401.08000,SilverSummit Healthplan,Commercial Exchange,,2511.90,,,,,,,725.66,2707.27,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,inpatient,,,492.00000,246.98000,SilverSummit Healthplan,Commercial Exchange,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,outpatient,,,492.00000,246.98000,SilverSummit Healthplan,Commercial Exchange,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,inpatient,,,331.00000,166.16000,SilverSummit Healthplan,Commercial Exchange,,297.90,,,,,,,297.90,321.07,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,outpatient,,,331.00000,166.16000,SilverSummit Healthplan,Commercial Exchange,,297.90,,,,,,,86.06,321.07,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,inpatient,,,4440.00000,2357.64000,SilverSummit Healthplan,Commercial Exchange,,3996.00,,,,,,,3996.00,4306.80,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,outpatient,,,4440.00000,2357.64000,SilverSummit Healthplan,Commercial Exchange,,3996.00,,,,,,,1154.40,4306.80,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,inpatient,,,5328.00000,2829.17000,SilverSummit Healthplan,Commercial Exchange,,4795.20,,,,,,,4795.20,5168.16,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,outpatient,,,5328.00000,2829.17000,SilverSummit Healthplan,Commercial Exchange,,4795.20,,,,,,,1385.28,5168.16,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,inpatient,,,3552.00000,1886.11000,SilverSummit Healthplan,Commercial Exchange,,3196.80,,,,,,,3196.80,3445.44,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,outpatient,,,3552.00000,1886.11000,SilverSummit Healthplan,Commercial Exchange,,3196.80,,,,,,,923.52,3445.44,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,inpatient,,,2528.00000,1342.37000,SilverSummit Healthplan,Commercial Exchange,,2275.20,,,,,,,2275.20,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,outpatient,,,2528.00000,1342.37000,SilverSummit Healthplan,Commercial Exchange,,2275.20,,,,,,,657.28,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,inpatient,,,3033.00000,1610.52000,SilverSummit Healthplan,Commercial Exchange,,2729.70,,,,,,,2729.70,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,outpatient,,,3033.00000,1610.52000,SilverSummit Healthplan,Commercial Exchange,,2729.70,,,,,,,788.58,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,inpatient,,,2022.00000,1073.68000,SilverSummit Healthplan,Commercial Exchange,,1819.80,,,,,,,1819.80,1961.34,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,outpatient,,,2022.00000,1073.68000,SilverSummit Healthplan,Commercial Exchange,,1819.80,,,,,,,525.72,1961.34,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,inpatient,,,3610.00000,1909.69000,SilverSummit Healthplan,Commercial Exchange,,3249.00,,,,,,,3249.00,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,outpatient,,,3610.00000,1909.69000,SilverSummit Healthplan,Commercial Exchange,,3249.00,,,,,,,938.60,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,inpatient,,,4332.00000,2291.63000,SilverSummit Healthplan,Commercial Exchange,,3898.80,,,,,,,3898.80,4202.04,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,outpatient,,,4332.00000,2291.63000,SilverSummit Healthplan,Commercial Exchange,,3898.80,,,,,,,1126.32,4202.04,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,inpatient,,,2888.00000,1527.75000,SilverSummit Healthplan,Commercial Exchange,,2599.20,,,,,,,2599.20,2801.36,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,outpatient,,,2888.00000,1527.75000,SilverSummit Healthplan,Commercial Exchange,,2599.20,,,,,,,750.88,2801.36,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,inpatient,,,4532.00000,2397.43000,SilverSummit Healthplan,Commercial Exchange,,4078.80,,,,,,,4078.80,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,outpatient,,,4532.00000,2397.43000,SilverSummit Healthplan,Commercial Exchange,,4078.80,,,,,,,1178.32,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,inpatient,,,5438.00000,2876.70000,SilverSummit Healthplan,Commercial Exchange,,4894.20,,,,,,,4894.20,5274.86,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,outpatient,,,5438.00000,2876.70000,SilverSummit Healthplan,Commercial Exchange,,4894.20,,,,,,,1413.88,5274.86,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,inpatient,,,3625.00000,1917.62000,SilverSummit Healthplan,Commercial Exchange,,3262.50,,,,,,,3262.50,3516.25,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,outpatient,,,3625.00000,1917.62000,SilverSummit Healthplan,Commercial Exchange,,3262.50,,,,,,,942.50,3516.25,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,inpatient,,,3639.00000,1925.03000,SilverSummit Healthplan,Commercial Exchange,,3275.10,,,,,,,3275.10,3529.83,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,outpatient,,,3639.00000,1925.03000,SilverSummit Healthplan,Commercial Exchange,,3275.10,,,,,,,946.14,3529.83,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,inpatient,,,4367.00000,2310.14000,SilverSummit Healthplan,Commercial Exchange,,3930.30,,,,,,,3930.30,4235.99,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,outpatient,,,4367.00000,2310.14000,SilverSummit Healthplan,Commercial Exchange,,3930.30,,,,,,,1135.42,4235.99,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,inpatient,,,2911.00000,1539.92000,SilverSummit Healthplan,Commercial Exchange,,2619.90,,,,,,,2619.90,2823.67,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,outpatient,,,2911.00000,1539.92000,SilverSummit Healthplan,Commercial Exchange,,2619.90,,,,,,,756.86,2823.67,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,inpatient,,,3494.00000,1719.05000,SilverSummit Healthplan,Commercial Exchange,,3144.60,,,,,,,3144.60,3389.18,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3494.00000,1719.05000,SilverSummit Healthplan,Commercial Exchange,,3144.60,,,,,,,908.44,3389.18,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,inpatient,,,4193.00000,2062.96000,SilverSummit Healthplan,Commercial Exchange,,3773.70,,,,,,,3773.70,4067.21,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,outpatient,,,4193.00000,2062.96000,SilverSummit Healthplan,Commercial Exchange,,3773.70,,,,,,,1090.18,4067.21,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,inpatient,,,2795.00000,1375.14000,SilverSummit Healthplan,Commercial Exchange,,2515.50,,,,,,,2515.50,2711.15,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,outpatient,,,2795.00000,1375.14000,SilverSummit Healthplan,Commercial Exchange,,2515.50,,,,,,,726.70,2711.15,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,inpatient,,,2717.00000,1336.76000,SilverSummit Healthplan,Commercial Exchange,,2445.30,,,,,,,2445.30,2635.49,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,outpatient,,,2717.00000,1336.76000,SilverSummit Healthplan,Commercial Exchange,,2445.30,,,,,,,706.42,2635.49,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,inpatient,,,3260.00000,1603.92000,SilverSummit Healthplan,Commercial Exchange,,2934.00,,,,,,,2934.00,3162.20,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,outpatient,,,3260.00000,1603.92000,SilverSummit Healthplan,Commercial Exchange,,2934.00,,,,,,,847.60,3162.20,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,inpatient,,,2173.00000,1069.12000,SilverSummit Healthplan,Commercial Exchange,,1955.70,,,,,,,1955.70,2107.81,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,outpatient,,,2173.00000,1069.12000,SilverSummit Healthplan,Commercial Exchange,,1955.70,,,,,,,564.98,2107.81,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4051.00000,2301.58000,SilverSummit Healthplan,Commercial Exchange,LT,3645.90,,,,,,,3645.90,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,SilverSummit Healthplan,Commercial Exchange,LT,3645.90,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4051.00000,2301.58000,SilverSummit Healthplan,Commercial Exchange,RT,3645.90,,,,,,,3645.90,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,SilverSummit Healthplan,Commercial Exchange,RT,3645.90,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4861.00000,2761.78000,SilverSummit Healthplan,Commercial Exchange,LT,4374.90,,,,,,,4374.90,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,SilverSummit Healthplan,Commercial Exchange,LT,4374.90,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4861.00000,2761.78000,SilverSummit Healthplan,Commercial Exchange,RT,4374.90,,,,,,,4374.90,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,SilverSummit Healthplan,Commercial Exchange,RT,4374.90,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3241.00000,1841.37000,SilverSummit Healthplan,Commercial Exchange,LT,2916.90,,,,,,,2916.90,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,SilverSummit Healthplan,Commercial Exchange,LT,2916.90,,,,,,,842.66,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3241.00000,1841.37000,SilverSummit Healthplan,Commercial Exchange,RT,2916.90,,,,,,,2916.90,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,SilverSummit Healthplan,Commercial Exchange,RT,2916.90,,,,,,,842.66,3143.77,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,inpatient,,,4260.00000,2420.32000,SilverSummit Healthplan,Commercial Exchange,,3834.00,,,,,,,3834.00,4132.20,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,outpatient,,,4260.00000,2420.32000,SilverSummit Healthplan,Commercial Exchange,,3834.00,,,,,,,1107.60,4132.20,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,inpatient,,,5112.00000,2904.38000,SilverSummit Healthplan,Commercial Exchange,,4600.80,,,,,,,4600.80,4958.64,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,outpatient,,,5112.00000,2904.38000,SilverSummit Healthplan,Commercial Exchange,,4600.80,,,,,,,1329.12,4958.64,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,inpatient,,,3408.00000,1936.26000,SilverSummit Healthplan,Commercial Exchange,,3067.20,,,,,,,3067.20,3305.76,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3408.00000,1936.26000,SilverSummit Healthplan,Commercial Exchange,,3067.20,,,,,,,886.08,3305.76,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,inpatient,,,3343.00000,1899.33000,SilverSummit Healthplan,Commercial Exchange,,3008.70,,,,,,,3008.70,3242.71,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3343.00000,1899.33000,SilverSummit Healthplan,Commercial Exchange,,3008.70,,,,,,,869.18,3242.71,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,inpatient,,,4010.00000,2278.28000,SilverSummit Healthplan,Commercial Exchange,,3609.00,,,,,,,3609.00,3889.70,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,outpatient,,,4010.00000,2278.28000,SilverSummit Healthplan,Commercial Exchange,,3609.00,,,,,,,1042.60,3889.70,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,inpatient,,,2674.00000,1519.23000,SilverSummit Healthplan,Commercial Exchange,,2406.60,,,,,,,2406.60,2593.78,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,outpatient,,,2674.00000,1519.23000,SilverSummit Healthplan,Commercial Exchange,,2406.60,,,,,,,695.24,2593.78,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3294.00000,1871.49000,SilverSummit Healthplan,Commercial Exchange,LT,2964.60,,,,,,,2964.60,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,SilverSummit Healthplan,Commercial Exchange,LT,2964.60,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3294.00000,1871.49000,SilverSummit Healthplan,Commercial Exchange,RT,2964.60,,,,,,,2964.60,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,SilverSummit Healthplan,Commercial Exchange,RT,2964.60,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3953.00000,2245.90000,SilverSummit Healthplan,Commercial Exchange,LT,3557.70,,,,,,,3557.70,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,SilverSummit Healthplan,Commercial Exchange,LT,3557.70,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3953.00000,2245.90000,SilverSummit Healthplan,Commercial Exchange,RT,3557.70,,,,,,,3557.70,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,SilverSummit Healthplan,Commercial Exchange,RT,3557.70,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,inpatient,,,2635.00000,1497.08000,SilverSummit Healthplan,Commercial Exchange,LT,2371.50,,,,,,,2371.50,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,SilverSummit Healthplan,Commercial Exchange,LT,2371.50,,,,,,,685.10,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,inpatient,,,2635.00000,1497.08000,SilverSummit Healthplan,Commercial Exchange,RT,2371.50,,,,,,,2371.50,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,SilverSummit Healthplan,Commercial Exchange,RT,2371.50,,,,,,,685.10,2555.95,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,inpatient,,,3664.00000,2081.70000,SilverSummit Healthplan,Commercial Exchange,,3297.60,,,,,,,3297.60,3554.08,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3664.00000,2081.70000,SilverSummit Healthplan,Commercial Exchange,,3297.60,,,,,,,952.64,3554.08,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,inpatient,,,4397.00000,2498.16000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,outpatient,,,4397.00000,2498.16000,SilverSummit Healthplan,Commercial Exchange,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,inpatient,,,2931.00000,1665.25000,SilverSummit Healthplan,Commercial Exchange,,2637.90,,,,,,,2637.90,2843.07,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,outpatient,,,2931.00000,1665.25000,SilverSummit Healthplan,Commercial Exchange,,2637.90,,,,,,,762.06,2843.07,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,inpatient,,,4759.00000,2703.83000,SilverSummit Healthplan,Commercial Exchange,,4283.10,,,,,,,4283.10,4616.23,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,outpatient,,,4759.00000,2703.83000,SilverSummit Healthplan,Commercial Exchange,,4283.10,,,,,,,1237.34,4616.23,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,inpatient,,,5710.00000,3244.14000,SilverSummit Healthplan,Commercial Exchange,,5139.00,,,,,,,5139.00,5538.70,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,outpatient,,,5710.00000,3244.14000,SilverSummit Healthplan,Commercial Exchange,,5139.00,,,,,,,1484.60,5538.70,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,inpatient,,,3807.00000,2162.95000,SilverSummit Healthplan,Commercial Exchange,,3426.30,,,,,,,3426.30,3692.79,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3807.00000,2162.95000,SilverSummit Healthplan,Commercial Exchange,,3426.30,,,,,,,989.82,3692.79,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,inpatient,,,2915.00000,1574.10000,SilverSummit Healthplan,Commercial Exchange,,2623.50,,,,,,,2623.50,2827.55,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2915.00000,1574.10000,SilverSummit Healthplan,Commercial Exchange,,2623.50,,,,,,,757.90,2827.55,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,inpatient,,,1918.00000,1035.72000,SilverSummit Healthplan,Commercial Exchange,,1726.20,,,,,,,1726.20,1860.46,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1918.00000,1035.72000,SilverSummit Healthplan,Commercial Exchange,,1726.20,,,,,,,498.68,1860.46,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,inpatient,,,2292.00000,1237.68000,SilverSummit Healthplan,Commercial Exchange,,2062.80,,,,,,,2062.80,2223.24,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2292.00000,1237.68000,SilverSummit Healthplan,Commercial Exchange,,2062.80,,,,,,,595.92,2223.24,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,inpatient,,,2984.00000,1611.36000,SilverSummit Healthplan,Commercial Exchange,,2685.60,,,,,,,2685.60,2894.48,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,outpatient,,,2984.00000,1611.36000,SilverSummit Healthplan,Commercial Exchange,,2685.60,,,,,,,775.84,2894.48,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,inpatient,,,769.00000,415.26000,SilverSummit Healthplan,Commercial Exchange,,692.10,,,,,,,692.10,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,outpatient,,,769.00000,415.26000,SilverSummit Healthplan,Commercial Exchange,,692.10,,,,,,,199.94,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,inpatient,,,1280.00000,691.20000,SilverSummit Healthplan,Commercial Exchange,,1152.00,,,,,,,1152.00,1241.60,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,outpatient,,,1280.00000,691.20000,SilverSummit Healthplan,Commercial Exchange,,1152.00,,,,,,,332.80,1241.60,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,inpatient,,,1878.00000,1014.12000,SilverSummit Healthplan,Commercial Exchange,,1690.20,,,,,,,1690.20,1821.66,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,outpatient,,,1878.00000,1014.12000,SilverSummit Healthplan,Commercial Exchange,,1690.20,,,,,,,488.28,1821.66,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,inpatient,,,2196.00000,1185.84000,SilverSummit Healthplan,Commercial Exchange,,1976.40,,,,,,,1976.40,2130.12,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,outpatient,,,2196.00000,1185.84000,SilverSummit Healthplan,Commercial Exchange,,1976.40,,,,,,,570.96,2130.12,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,inpatient,,,844.00000,455.76000,SilverSummit Healthplan,Commercial Exchange,,759.60,,,,,,,759.60,818.68,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,outpatient,,,844.00000,455.76000,SilverSummit Healthplan,Commercial Exchange,,759.60,,,,,,,219.44,818.68,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,inpatient,,,1305.00000,704.70000,SilverSummit Healthplan,Commercial Exchange,,1174.50,,,,,,,1174.50,1265.85,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,outpatient,,,1305.00000,704.70000,SilverSummit Healthplan,Commercial Exchange,,1174.50,,,,,,,339.30,1265.85,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,inpatient,,,576.00000,311.04000,SilverSummit Healthplan,Commercial Exchange,,518.40,,,,,,,518.40,558.72,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,outpatient,,,576.00000,311.04000,SilverSummit Healthplan,Commercial Exchange,,518.40,,,,,,,149.76,558.72,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,inpatient,,,809.00000,436.86000,SilverSummit Healthplan,Commercial Exchange,,728.10,,,,,,,728.10,784.73,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,outpatient,,,809.00000,436.86000,SilverSummit Healthplan,Commercial Exchange,,728.10,,,,,,,210.34,784.73,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,inpatient,,,2462.00000,1329.48000,SilverSummit Healthplan,Commercial Exchange,,2215.80,,,,,,,2215.80,2388.14,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,outpatient,,,2462.00000,1329.48000,SilverSummit Healthplan,Commercial Exchange,,2215.80,,,,,,,640.12,2388.14,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,inpatient,,,918.00000,495.72000,SilverSummit Healthplan,Commercial Exchange,,826.20,,,,,,,826.20,890.46,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,outpatient,,,918.00000,495.72000,SilverSummit Healthplan,Commercial Exchange,,826.20,,,,,,,238.68,890.46,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,inpatient,,,1102.00000,595.08000,SilverSummit Healthplan,Commercial Exchange,,991.80,,,,,,,991.80,1068.94,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,outpatient,,,1102.00000,595.08000,SilverSummit Healthplan,Commercial Exchange,,991.80,,,,,,,286.52,1068.94,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,inpatient,,,812.00000,438.48000,SilverSummit Healthplan,Commercial Exchange,,730.80,,,,,,,730.80,787.64,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,outpatient,,,812.00000,438.48000,SilverSummit Healthplan,Commercial Exchange,,730.80,,,,,,,211.12,787.64,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,inpatient,,,1407.00000,759.78000,SilverSummit Healthplan,Commercial Exchange,,1266.30,,,,,,,1266.30,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,outpatient,,,1407.00000,759.78000,SilverSummit Healthplan,Commercial Exchange,,1266.30,,,,,,,365.82,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,inpatient,,,1980.00000,1069.20000,SilverSummit Healthplan,Commercial Exchange,,1782.00,,,,,,,1782.00,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,outpatient,,,1980.00000,1069.20000,SilverSummit Healthplan,Commercial Exchange,,1782.00,,,,,,,514.80,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,inpatient,,,964.00000,520.56000,SilverSummit Healthplan,Commercial Exchange,,867.60,,,,,,,867.60,935.08,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,outpatient,,,964.00000,520.56000,SilverSummit Healthplan,Commercial Exchange,,867.60,,,,,,,250.64,935.08,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,inpatient,,,1040.00000,561.60000,SilverSummit Healthplan,Commercial Exchange,,936.00,,,,,,,936.00,1008.80,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,outpatient,,,1040.00000,561.60000,SilverSummit Healthplan,Commercial Exchange,,936.00,,,,,,,270.40,1008.80,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,inpatient,,,795.00000,429.30000,SilverSummit Healthplan,Commercial Exchange,,715.50,,,,,,,715.50,771.15,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,outpatient,,,795.00000,429.30000,SilverSummit Healthplan,Commercial Exchange,,715.50,,,,,,,206.70,771.15,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,inpatient,,,1124.00000,606.96000,SilverSummit Healthplan,Commercial Exchange,,1011.60,,,,,,,1011.60,1090.28,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,outpatient,,,1124.00000,606.96000,SilverSummit Healthplan,Commercial Exchange,,1011.60,,,,,,,292.24,1090.28,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,inpatient,,,736.00000,397.44000,SilverSummit Healthplan,Commercial Exchange,,662.40,,,,,,,662.40,713.92,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,outpatient,,,736.00000,397.44000,SilverSummit Healthplan,Commercial Exchange,,662.40,,,,,,,191.36,713.92,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,inpatient,,,700.00000,378.00000,SilverSummit Healthplan,Commercial Exchange,,630.00,,,,,,,630.00,679.00,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,outpatient,,,700.00000,378.00000,SilverSummit Healthplan,Commercial Exchange,,630.00,,,,,,,182.00,679.00,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,inpatient,,,821.00000,443.34000,SilverSummit Healthplan,Commercial Exchange,,738.90,,,,,,,738.90,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,outpatient,,,821.00000,443.34000,SilverSummit Healthplan,Commercial Exchange,,738.90,,,,,,,213.46,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,inpatient,,,846.00000,456.84000,SilverSummit Healthplan,Commercial Exchange,,761.40,,,,,,,761.40,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,outpatient,,,846.00000,456.84000,SilverSummit Healthplan,Commercial Exchange,,761.40,,,,,,,219.96,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,inpatient,,,958.00000,517.32000,SilverSummit Healthplan,Commercial Exchange,,862.20,,,,,,,862.20,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,outpatient,,,958.00000,517.32000,SilverSummit Healthplan,Commercial Exchange,,862.20,,,,,,,249.08,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,inpatient,,,1261.00000,680.94000,SilverSummit Healthplan,Commercial Exchange,,1134.90,,,,,,,1134.90,1223.17,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,outpatient,,,1261.00000,680.94000,SilverSummit Healthplan,Commercial Exchange,,1134.90,,,,,,,327.86,1223.17,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,inpatient,,,971.00000,524.34000,SilverSummit Healthplan,Commercial Exchange,,873.90,,,,,,,873.90,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,outpatient,,,971.00000,524.34000,SilverSummit Healthplan,Commercial Exchange,,873.90,,,,,,,252.46,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,inpatient,,,1837.00000,991.98000,SilverSummit Healthplan,Commercial Exchange,,1653.30,,,,,,,1653.30,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,outpatient,,,1837.00000,991.98000,SilverSummit Healthplan,Commercial Exchange,,1653.30,,,,,,,477.62,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,inpatient,,,1099.00000,593.46000,SilverSummit Healthplan,Commercial Exchange,,989.10,,,,,,,989.10,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,outpatient,,,1099.00000,593.46000,SilverSummit Healthplan,Commercial Exchange,,989.10,,,,,,,285.74,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,inpatient,,,2178.00000,1176.12000,SilverSummit Healthplan,Commercial Exchange,,1960.20,,,,,,,1960.20,2112.66,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,outpatient,,,2178.00000,1176.12000,SilverSummit Healthplan,Commercial Exchange,,1960.20,,,,,,,566.28,2112.66,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,inpatient,,,1226.00000,662.04000,SilverSummit Healthplan,Commercial Exchange,,1103.40,,,,,,,1103.40,1189.22,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,outpatient,,,1226.00000,662.04000,SilverSummit Healthplan,Commercial Exchange,,1103.40,,,,,,,318.76,1189.22,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,inpatient,,,1048.00000,565.92000,SilverSummit Healthplan,Commercial Exchange,,943.20,,,,,,,943.20,1016.56,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,outpatient,,,1048.00000,565.92000,SilverSummit Healthplan,Commercial Exchange,,943.20,,,,,,,272.48,1016.56,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,inpatient,,,970.00000,523.80000,SilverSummit Healthplan,Commercial Exchange,,873.00,,,,,,,873.00,940.90,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,outpatient,,,970.00000,523.80000,SilverSummit Healthplan,Commercial Exchange,,873.00,,,,,,,252.20,940.90,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,inpatient,,,1803.00000,973.62000,SilverSummit Healthplan,Commercial Exchange,,1622.70,,,,,,,1622.70,1748.91,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,outpatient,,,1803.00000,973.62000,SilverSummit Healthplan,Commercial Exchange,,1622.70,,,,,,,468.78,1748.91,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,inpatient,,,2504.00000,1352.16000,SilverSummit Healthplan,Commercial Exchange,,2253.60,,,,,,,2253.60,2428.88,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,outpatient,,,2504.00000,1352.16000,SilverSummit Healthplan,Commercial Exchange,,2253.60,,,,,,,651.04,2428.88,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,inpatient,,,2457.00000,1326.78000,SilverSummit Healthplan,Commercial Exchange,,2211.30,,,,,,,2211.30,2383.29,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2457.00000,1326.78000,SilverSummit Healthplan,Commercial Exchange,,2211.30,,,,,,,638.82,2383.29,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,inpatient,,,923.00000,498.42000,SilverSummit Healthplan,Commercial Exchange,,830.70,,,,,,,830.70,895.31,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,outpatient,,,923.00000,498.42000,SilverSummit Healthplan,Commercial Exchange,,830.70,,,,,,,239.98,895.31,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,inpatient,,,5478.00000,2958.12000,SilverSummit Healthplan,Commercial Exchange,,4930.20,,,,,,,4930.20,5313.66,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,outpatient,,,5478.00000,2958.12000,SilverSummit Healthplan,Commercial Exchange,,4930.20,,,,,,,1424.28,5313.66,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,inpatient,,,4551.00000,2457.54000,SilverSummit Healthplan,Commercial Exchange,,4095.90,,,,,,,4095.90,4414.47,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,outpatient,,,4551.00000,2457.54000,SilverSummit Healthplan,Commercial Exchange,,4095.90,,,,,,,1183.26,4414.47,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,inpatient,,,1360.00000,734.40000,SilverSummit Healthplan,Commercial Exchange,,1224.00,,,,,,,1224.00,1319.20,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,outpatient,,,1360.00000,734.40000,SilverSummit Healthplan,Commercial Exchange,,1224.00,,,,,,,353.60,1319.20,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,inpatient,,,1209.00000,652.86000,SilverSummit Healthplan,Commercial Exchange,,1088.10,,,,,,,1088.10,1172.73,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,outpatient,,,1209.00000,652.86000,SilverSummit Healthplan,Commercial Exchange,,1088.10,,,,,,,314.34,1172.73,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,inpatient,,,848.00000,457.92000,SilverSummit Healthplan,Commercial Exchange,,763.20,,,,,,,763.20,822.56,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,outpatient,,,848.00000,457.92000,SilverSummit Healthplan,Commercial Exchange,,763.20,,,,,,,220.48,822.56,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,inpatient,,,1071.00000,578.34000,SilverSummit Healthplan,Commercial Exchange,,963.90,,,,,,,963.90,1038.87,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,outpatient,,,1071.00000,578.34000,SilverSummit Healthplan,Commercial Exchange,,963.90,,,,,,,278.46,1038.87,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,inpatient,,,1792.00000,967.68000,SilverSummit Healthplan,Commercial Exchange,,1612.80,,,,,,,1612.80,1738.24,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,outpatient,,,1792.00000,967.68000,SilverSummit Healthplan,Commercial Exchange,,1612.80,,,,,,,465.92,1738.24,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,inpatient,,,35.00000,18.90000,SilverSummit Healthplan,Commercial Exchange,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,outpatient,,,35.00000,18.90000,SilverSummit Healthplan,Commercial Exchange,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,inpatient,,,285.00000,153.90000,SilverSummit Healthplan,Commercial Exchange,,256.50,,,,,,,256.50,276.45,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,outpatient,,,285.00000,153.90000,SilverSummit Healthplan,Commercial Exchange,,256.50,,,,,,,74.10,276.45,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,inpatient,,,1012.00000,546.48000,SilverSummit Healthplan,Commercial Exchange,,910.80,,,,,,,910.80,981.64,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,outpatient,,,1012.00000,546.48000,SilverSummit Healthplan,Commercial Exchange,,910.80,,,,,,,263.12,981.64,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,inpatient,,,492.00000,265.68000,SilverSummit Healthplan,Commercial Exchange,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,outpatient,,,492.00000,265.68000,SilverSummit Healthplan,Commercial Exchange,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,inpatient,,,739.00000,399.06000,SilverSummit Healthplan,Commercial Exchange,,665.10,,,,,,,665.10,716.83,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,outpatient,,,739.00000,399.06000,SilverSummit Healthplan,Commercial Exchange,,665.10,,,,,,,192.14,716.83,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,inpatient,,,515.00000,278.10000,SilverSummit Healthplan,Commercial Exchange,,463.50,,,,,,,463.50,499.55,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,outpatient,,,515.00000,278.10000,SilverSummit Healthplan,Commercial Exchange,,463.50,,,,,,,133.90,499.55,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,inpatient,,,1467.00000,792.18000,SilverSummit Healthplan,Commercial Exchange,,1320.30,,,,,,,1320.30,1422.99,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,outpatient,,,1467.00000,792.18000,SilverSummit Healthplan,Commercial Exchange,,1320.30,,,,,,,381.42,1422.99,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,inpatient,,,1683.00000,888.62000,SilverSummit Healthplan,Commercial Exchange,,1514.70,,,,,,,1514.70,1632.51,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,outpatient,,,1683.00000,888.62000,SilverSummit Healthplan,Commercial Exchange,,1514.70,,,,,,,437.58,1632.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,inpatient,,,426.30000,225.09000,SilverSummit Healthplan,Commercial Exchange,,383.67,,,,,,,383.67,413.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,426.30000,225.09000,SilverSummit Healthplan,Commercial Exchange,,383.67,,,,,,,110.84,413.51,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,inpatient,,,725.00000,382.80000,SilverSummit Healthplan,Commercial Exchange,,652.50,,,,,,,652.50,703.25,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,725.00000,382.80000,SilverSummit Healthplan,Commercial Exchange,,652.50,,,,,,,188.50,1855.42,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,inpatient,,,1852.00000,977.86000,SilverSummit Healthplan,Commercial Exchange,,1666.80,,,,,,,1666.80,1796.44,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,1852.00000,977.86000,SilverSummit Healthplan,Commercial Exchange,,1666.80,,,,,,,481.52,1868.26,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,110.00000,58.08000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,110.00000,58.08000,SilverSummit Healthplan,Commercial Exchange,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,inpatient,,,98.00000,51.74000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,98.00000,51.74000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,25.48,1662.92,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,inpatient,,,2018.00000,1065.50000,SilverSummit Healthplan,Commercial Exchange,,1816.20,,,,,,,1816.20,1957.46,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,2018.00000,1065.50000,SilverSummit Healthplan,Commercial Exchange,,1816.20,,,,,,,524.68,1957.46,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,inpatient,,,4325.00000,2283.60000,SilverSummit Healthplan,Commercial Exchange,,3892.50,,,,,,,3892.50,4195.25,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,4325.00000,2283.60000,SilverSummit Healthplan,Commercial Exchange,,3892.50,,,,,,,1124.50,4195.25,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,inpatient,,,172.00000,90.82000,SilverSummit Healthplan,Commercial Exchange,,154.80,,,,,,,154.80,166.84,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,172.00000,90.82000,SilverSummit Healthplan,Commercial Exchange,,154.80,,,,,,,44.72,166.84,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,inpatient,,,942.00000,497.38000,SilverSummit Healthplan,Commercial Exchange,,847.80,,,,,,,847.80,913.74,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,942.00000,497.38000,SilverSummit Healthplan,Commercial Exchange,,847.80,,,,,,,244.92,913.74,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,inpatient,,,413.00000,218.06000,SilverSummit Healthplan,Commercial Exchange,,371.70,,,,,,,371.70,400.61,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,413.00000,218.06000,SilverSummit Healthplan,Commercial Exchange,,371.70,,,,,,,107.38,400.61,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,inpatient,,,257.00000,135.70000,SilverSummit Healthplan,Commercial Exchange,,231.30,,,,,,,231.30,249.29,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,outpatient,,,257.00000,135.70000,SilverSummit Healthplan,Commercial Exchange,,231.30,,,,,,,66.82,249.29,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,inpatient,,,116.00000,61.25000,SilverSummit Healthplan,Commercial Exchange,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,116.00000,61.25000,SilverSummit Healthplan,Commercial Exchange,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,inpatient,,,463.20000,244.57000,SilverSummit Healthplan,Commercial Exchange,,416.88,,,,,,,416.88,449.30,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,463.20000,244.57000,SilverSummit Healthplan,Commercial Exchange,,416.88,,,,,,,120.43,449.30,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,inpatient,,,804.00000,424.51000,SilverSummit Healthplan,Commercial Exchange,,723.60,,,,,,,723.60,779.88,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,804.00000,424.51000,SilverSummit Healthplan,Commercial Exchange,,723.60,,,,,,,209.04,779.88,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,inpatient,,,172.00000,90.82000,SilverSummit Healthplan,Commercial Exchange,,154.80,,,,,,,154.80,166.84,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,172.00000,90.82000,SilverSummit Healthplan,Commercial Exchange,,154.80,,,,,,,44.72,166.84,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,inpatient,,,354.30000,187.07000,SilverSummit Healthplan,Commercial Exchange,,318.87,,,,,,,318.87,343.67,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,354.30000,187.07000,SilverSummit Healthplan,Commercial Exchange,,318.87,,,,,,,92.12,343.67,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,inpatient,,,277.90000,146.73000,SilverSummit Healthplan,Commercial Exchange,,250.11,,,,,,,250.11,269.56,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,277.90000,146.73000,SilverSummit Healthplan,Commercial Exchange,,250.11,,,,,,,72.25,269.56,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,inpatient,,,200.00000,105.60000,SilverSummit Healthplan,Commercial Exchange,,180.00,,,,,,,180.00,194.00,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,200.00000,105.60000,SilverSummit Healthplan,Commercial Exchange,,180.00,,,,,,,52.00,194.00,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,inpatient,,,197.00000,63.63000,SilverSummit Healthplan,Commercial Exchange,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,outpatient,,,197.00000,63.63000,SilverSummit Healthplan,Commercial Exchange,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,inpatient,,,468.00000,151.16000,SilverSummit Healthplan,Commercial Exchange,50,421.20,,,,,,,421.20,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,outpatient,,,468.00000,151.16000,SilverSummit Healthplan,Commercial Exchange,50,421.20,,,,,,,121.68,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,inpatient,,,312.00000,100.78000,SilverSummit Healthplan,Commercial Exchange,LT,280.80,,,,,,,280.80,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,SilverSummit Healthplan,Commercial Exchange,LT,280.80,,,,,,,81.12,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,inpatient,,,312.00000,100.78000,SilverSummit Healthplan,Commercial Exchange,RT,280.80,,,,,,,280.80,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,SilverSummit Healthplan,Commercial Exchange,RT,280.80,,,,,,,81.12,302.64,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,SilverSummit Healthplan,Commercial Exchange,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,SilverSummit Healthplan,Commercial Exchange,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,inpatient,,,609.00000,196.71000,SilverSummit Healthplan,Commercial Exchange,,548.10,,,,,,,548.10,590.73,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,SilverSummit Healthplan,Commercial Exchange,,548.10,,,,,,,158.34,590.73,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,inpatient,,,1248.00000,403.10000,SilverSummit Healthplan,Commercial Exchange,50,1123.20,,,,,,,1123.20,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1248.00000,403.10000,SilverSummit Healthplan,Commercial Exchange,50,1123.20,,,,,,,324.48,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,inpatient,,,832.00000,268.74000,SilverSummit Healthplan,Commercial Exchange,LT,748.80,,,,,,,748.80,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,SilverSummit Healthplan,Commercial Exchange,LT,748.80,,,,,,,216.32,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,inpatient,,,832.00000,268.74000,SilverSummit Healthplan,Commercial Exchange,RT,748.80,,,,,,,748.80,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,SilverSummit Healthplan,Commercial Exchange,RT,748.80,,,,,,,216.32,807.04,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,inpatient,,,4235.00000,1367.90000,SilverSummit Healthplan,Commercial Exchange,LT,3811.50,,,,,,,3811.50,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,SilverSummit Healthplan,Commercial Exchange,LT,3811.50,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,inpatient,,,4235.00000,1367.90000,SilverSummit Healthplan,Commercial Exchange,RT,3811.50,,,,,,,3811.50,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,SilverSummit Healthplan,Commercial Exchange,RT,3811.50,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,inpatient,,,2119.00000,684.44000,SilverSummit Healthplan,Commercial Exchange,,1907.10,,,,,,,1907.10,2055.43,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,outpatient,,,2119.00000,684.44000,SilverSummit Healthplan,Commercial Exchange,,1907.10,,,,,,,550.94,2055.43,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,inpatient,,,1943.00000,627.59000,SilverSummit Healthplan,Commercial Exchange,,1748.70,,,,,,,1748.70,1884.71,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1943.00000,627.59000,SilverSummit Healthplan,Commercial Exchange,,1748.70,,,,,,,505.18,1884.71,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,inpatient,,,1426.00000,460.60000,SilverSummit Healthplan,Commercial Exchange,,1283.40,,,,,,,1283.40,1383.22,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,outpatient,,,1426.00000,460.60000,SilverSummit Healthplan,Commercial Exchange,,1283.40,,,,,,,370.76,1383.22,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,inpatient,,,4202.00000,1357.25000,SilverSummit Healthplan,Commercial Exchange,50,3781.80,,,,,,,3781.80,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,outpatient,,,4202.00000,1357.25000,SilverSummit Healthplan,Commercial Exchange,50,3781.80,,,,,,,1092.52,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,inpatient,,,2801.00000,904.72000,SilverSummit Healthplan,Commercial Exchange,LT,2520.90,,,,,,,2520.90,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,SilverSummit Healthplan,Commercial Exchange,LT,2520.90,,,,,,,728.26,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,inpatient,,,2801.00000,904.72000,SilverSummit Healthplan,Commercial Exchange,RT,2520.90,,,,,,,2520.90,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,SilverSummit Healthplan,Commercial Exchange,RT,2520.90,,,,,,,728.26,2716.97,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,inpatient,,,832.00000,268.74000,SilverSummit Healthplan,Commercial Exchange,,748.80,,,,,,,748.80,807.04,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,outpatient,,,832.00000,268.74000,SilverSummit Healthplan,Commercial Exchange,,748.80,,,,,,,216.32,807.04,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,inpatient,,,1457.00000,470.61000,SilverSummit Healthplan,Commercial Exchange,,1311.30,,,,,,,1311.30,1413.29,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,outpatient,,,1457.00000,470.61000,SilverSummit Healthplan,Commercial Exchange,,1311.30,,,,,,,378.82,1413.29,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,inpatient,,,743.00000,239.99000,SilverSummit Healthplan,Commercial Exchange,LT,668.70,,,,,,,668.70,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,SilverSummit Healthplan,Commercial Exchange,LT,668.70,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,inpatient,,,743.00000,239.99000,SilverSummit Healthplan,Commercial Exchange,RT,668.70,,,,,,,668.70,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,SilverSummit Healthplan,Commercial Exchange,RT,668.70,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,inpatient,,,232.00000,74.94000,SilverSummit Healthplan,Commercial Exchange,,208.80,,,,,,,208.80,225.04,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,outpatient,,,232.00000,74.94000,SilverSummit Healthplan,Commercial Exchange,,208.80,,,,,,,60.32,225.04,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,inpatient,,,1364.00000,440.57000,SilverSummit Healthplan,Commercial Exchange,50,1227.60,,,,,,,1227.60,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,outpatient,,,1364.00000,440.57000,SilverSummit Healthplan,Commercial Exchange,50,1227.60,,,,,,,354.64,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,inpatient,,,909.00000,293.61000,SilverSummit Healthplan,Commercial Exchange,LT,818.10,,,,,,,818.10,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,SilverSummit Healthplan,Commercial Exchange,LT,818.10,,,,,,,236.34,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,inpatient,,,909.00000,293.61000,SilverSummit Healthplan,Commercial Exchange,RT,818.10,,,,,,,818.10,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,SilverSummit Healthplan,Commercial Exchange,RT,818.10,,,,,,,236.34,881.73,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,inpatient,,,510.00000,355.98000,SilverSummit Healthplan,Commercial Exchange,,459.00,,,,,,,459.00,494.70,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,outpatient,,,510.00000,355.98000,SilverSummit Healthplan,Commercial Exchange,,459.00,,,,,,,132.60,494.70,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,inpatient,,,1001.00000,698.70000,SilverSummit Healthplan,Commercial Exchange,,900.90,,,,,,,900.90,970.97,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,outpatient,,,1001.00000,698.70000,SilverSummit Healthplan,Commercial Exchange,,900.90,,,,,,,260.26,970.97,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,inpatient,,,887.00000,619.13000,SilverSummit Healthplan,Commercial Exchange,,798.30,,,,,,,798.30,860.39,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,outpatient,,,887.00000,619.13000,SilverSummit Healthplan,Commercial Exchange,,798.30,,,,,,,230.62,860.39,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,inpatient,,,1022.00000,713.36000,SilverSummit Healthplan,Commercial Exchange,50,919.80,,,,,,,919.80,991.34,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,outpatient,,,1022.00000,713.36000,SilverSummit Healthplan,Commercial Exchange,50,919.80,,,,,,,265.72,991.34,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,inpatient,,,681.00000,475.34000,SilverSummit Healthplan,Commercial Exchange,LT,612.90,,,,,,,612.90,660.57,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,SilverSummit Healthplan,Commercial Exchange,LT,612.90,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,inpatient,,,681.00000,475.34000,SilverSummit Healthplan,Commercial Exchange,RT,612.90,,,,,,,612.90,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,SilverSummit Healthplan,Commercial Exchange,RT,612.90,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,inpatient,,,945.00000,659.61000,SilverSummit Healthplan,Commercial Exchange,50,850.50,,,,,,,850.50,916.65,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,outpatient,,,945.00000,659.61000,SilverSummit Healthplan,Commercial Exchange,50,850.50,,,,,,,245.70,916.65,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,inpatient,,,630.00000,439.74000,SilverSummit Healthplan,Commercial Exchange,LT,567.00,,,,,,,567.00,611.10,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,SilverSummit Healthplan,Commercial Exchange,LT,567.00,,,,,,,163.80,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,inpatient,,,630.00000,439.74000,SilverSummit Healthplan,Commercial Exchange,RT,567.00,,,,,,,567.00,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,SilverSummit Healthplan,Commercial Exchange,RT,567.00,,,,,,,163.80,611.10,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,inpatient,,,577.00000,402.75000,SilverSummit Healthplan,Commercial Exchange,,519.30,,,,,,,519.30,559.69,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,outpatient,,,577.00000,402.75000,SilverSummit Healthplan,Commercial Exchange,,519.30,,,,,,,150.02,559.69,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,inpatient,,,433.00000,302.23000,SilverSummit Healthplan,Commercial Exchange,,389.70,,,,,,,389.70,420.01,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,outpatient,,,433.00000,302.23000,SilverSummit Healthplan,Commercial Exchange,,389.70,,,,,,,112.58,420.01,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,inpatient,,,331.00000,231.04000,SilverSummit Healthplan,Commercial Exchange,,297.90,,,,,,,297.90,321.07,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,outpatient,,,331.00000,231.04000,SilverSummit Healthplan,Commercial Exchange,,297.90,,,,,,,86.06,321.07,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,inpatient,,,662.00000,462.08000,SilverSummit Healthplan,Commercial Exchange,,595.80,,,,,,,595.80,642.14,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,outpatient,,,662.00000,462.08000,SilverSummit Healthplan,Commercial Exchange,,595.80,,,,,,,172.12,642.14,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,inpatient,,,752.00000,524.90000,SilverSummit Healthplan,Commercial Exchange,,676.80,,,,,,,676.80,729.44,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,outpatient,,,752.00000,524.90000,SilverSummit Healthplan,Commercial Exchange,,676.80,,,,,,,195.52,729.44,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,inpatient,,,182.00000,127.04000,SilverSummit Healthplan,Commercial Exchange,,163.80,,,,,,,163.80,176.54,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,SilverSummit Healthplan,Commercial Exchange,,163.80,,,,,,,47.32,176.54,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,inpatient,,,420.00000,293.16000,SilverSummit Healthplan,Commercial Exchange,,378.00,,,,,,,378.00,407.40,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,outpatient,,,420.00000,293.16000,SilverSummit Healthplan,Commercial Exchange,,378.00,,,,,,,109.20,407.40,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,inpatient,,,253.00000,176.59000,SilverSummit Healthplan,Commercial Exchange,,227.70,,,,,,,227.70,245.41,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,outpatient,,,253.00000,176.59000,SilverSummit Healthplan,Commercial Exchange,,227.70,,,,,,,65.78,245.41,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,inpatient,,,168.00000,117.26000,SilverSummit Healthplan,Commercial Exchange,,151.20,,,,,,,151.20,162.96,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,outpatient,,,168.00000,117.26000,SilverSummit Healthplan,Commercial Exchange,,151.20,,,,,,,43.68,162.96,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,inpatient,,,695.00000,485.11000,SilverSummit Healthplan,Commercial Exchange,,625.50,,,,,,,625.50,674.15,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,outpatient,,,695.00000,485.11000,SilverSummit Healthplan,Commercial Exchange,,625.50,,,,,,,180.70,674.15,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,inpatient,,,474.00000,330.85000,SilverSummit Healthplan,Commercial Exchange,,426.60,,,,,,,426.60,459.78,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,outpatient,,,474.00000,330.85000,SilverSummit Healthplan,Commercial Exchange,,426.60,,,,,,,123.24,459.78,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,inpatient,,,930.00000,649.14000,SilverSummit Healthplan,Commercial Exchange,,837.00,,,,,,,837.00,902.10,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,outpatient,,,930.00000,649.14000,SilverSummit Healthplan,Commercial Exchange,,837.00,,,,,,,241.80,902.10,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,inpatient,,,786.00000,548.63000,SilverSummit Healthplan,Commercial Exchange,,707.40,,,,,,,707.40,762.42,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,outpatient,,,786.00000,548.63000,SilverSummit Healthplan,Commercial Exchange,,707.40,,,,,,,204.36,762.42,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,inpatient,,,620.00000,432.76000,SilverSummit Healthplan,Commercial Exchange,,558.00,,,,,,,558.00,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,SilverSummit Healthplan,Commercial Exchange,,558.00,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,inpatient,,,620.00000,432.76000,SilverSummit Healthplan,Commercial Exchange,59,558.00,,,,,,,558.00,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,SilverSummit Healthplan,Commercial Exchange,59,558.00,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,inpatient,,,435.00000,303.63000,SilverSummit Healthplan,Commercial Exchange,,391.50,,,,,,,391.50,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,SilverSummit Healthplan,Commercial Exchange,,391.50,,,,,,,113.10,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,inpatient,,,435.00000,303.63000,SilverSummit Healthplan,Commercial Exchange,59,391.50,,,,,,,391.50,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,SilverSummit Healthplan,Commercial Exchange,59,391.50,,,,,,,113.10,421.95,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,inpatient,,,492.00000,343.42000,SilverSummit Healthplan,Commercial Exchange,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,outpatient,,,492.00000,343.42000,SilverSummit Healthplan,Commercial Exchange,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,inpatient,,,331.00000,231.04000,SilverSummit Healthplan,Commercial Exchange,,297.90,,,,,,,297.90,321.07,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,outpatient,,,331.00000,231.04000,SilverSummit Healthplan,Commercial Exchange,,297.90,,,,,,,86.06,321.07,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,inpatient,,,875.00000,610.75000,SilverSummit Healthplan,Commercial Exchange,,787.50,,,,,,,787.50,848.75,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,outpatient,,,875.00000,610.75000,SilverSummit Healthplan,Commercial Exchange,,787.50,,,,,,,227.50,848.75,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,inpatient,,,688.00000,480.22000,SilverSummit Healthplan,Commercial Exchange,,619.20,,,,,,,619.20,667.36,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,outpatient,,,688.00000,480.22000,SilverSummit Healthplan,Commercial Exchange,,619.20,,,,,,,178.88,667.36,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,inpatient,,,465.00000,324.57000,SilverSummit Healthplan,Commercial Exchange,,418.50,,,,,,,418.50,451.05,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,outpatient,,,465.00000,324.57000,SilverSummit Healthplan,Commercial Exchange,,418.50,,,,,,,120.90,451.05,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,inpatient,,,846.00000,590.51000,SilverSummit Healthplan,Commercial Exchange,,761.40,,,,,,,761.40,820.62,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,outpatient,,,846.00000,590.51000,SilverSummit Healthplan,Commercial Exchange,,761.40,,,,,,,219.96,820.62,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,inpatient,,,482.00000,336.44000,SilverSummit Healthplan,Commercial Exchange,,433.80,,,,,,,433.80,467.54,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,outpatient,,,482.00000,336.44000,SilverSummit Healthplan,Commercial Exchange,,433.80,,,,,,,125.32,467.54,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,inpatient,,,926.00000,646.35000,SilverSummit Healthplan,Commercial Exchange,,833.40,,,,,,,833.40,898.22,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,outpatient,,,926.00000,646.35000,SilverSummit Healthplan,Commercial Exchange,,833.40,,,,,,,240.76,898.22,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,inpatient,,,292.00000,203.82000,SilverSummit Healthplan,Commercial Exchange,,262.80,,,,,,,262.80,283.24,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,outpatient,,,292.00000,203.82000,SilverSummit Healthplan,Commercial Exchange,,262.80,,,,,,,75.92,283.24,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,inpatient,,,827.00000,577.25000,SilverSummit Healthplan,Commercial Exchange,,744.30,,,,,,,744.30,802.19,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,outpatient,,,827.00000,577.25000,SilverSummit Healthplan,Commercial Exchange,,744.30,,,,,,,215.02,802.19,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,inpatient,,,253.00000,176.59000,SilverSummit Healthplan,Commercial Exchange,,227.70,,,,,,,227.70,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,outpatient,,,253.00000,176.59000,SilverSummit Healthplan,Commercial Exchange,,227.70,,,,,,,65.78,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,inpatient,,,901.00000,628.90000,SilverSummit Healthplan,Commercial Exchange,,810.90,,,,,,,810.90,873.97,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,outpatient,,,901.00000,628.90000,SilverSummit Healthplan,Commercial Exchange,,810.90,,,,,,,234.26,873.97,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,inpatient,,,460.00000,321.08000,SilverSummit Healthplan,Commercial Exchange,,414.00,,,,,,,414.00,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,outpatient,,,460.00000,321.08000,SilverSummit Healthplan,Commercial Exchange,,414.00,,,,,,,119.60,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,inpatient,,,1029.00000,718.24000,SilverSummit Healthplan,Commercial Exchange,,926.10,,,,,,,926.10,998.13,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1029.00000,718.24000,SilverSummit Healthplan,Commercial Exchange,,926.10,,,,,,,267.54,998.13,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,inpatient,,,959.00000,669.38000,SilverSummit Healthplan,Commercial Exchange,,863.10,,,,,,,863.10,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,outpatient,,,959.00000,669.38000,SilverSummit Healthplan,Commercial Exchange,,863.10,,,,,,,249.34,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,inpatient,,,558.00000,389.48000,SilverSummit Healthplan,Commercial Exchange,,502.20,,,,,,,502.20,541.26,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,outpatient,,,558.00000,389.48000,SilverSummit Healthplan,Commercial Exchange,,502.20,,,,,,,145.08,541.26,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,inpatient,,,705.00000,492.09000,SilverSummit Healthplan,Commercial Exchange,,634.50,,,,,,,634.50,683.85,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,outpatient,,,705.00000,492.09000,SilverSummit Healthplan,Commercial Exchange,,634.50,,,,,,,183.30,683.85,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,inpatient,,,249.00000,173.80000,SilverSummit Healthplan,Commercial Exchange,,224.10,,,,,,,224.10,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,outpatient,,,249.00000,173.80000,SilverSummit Healthplan,Commercial Exchange,,224.10,,,,,,,64.74,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,inpatient,,,427.00000,298.05000,SilverSummit Healthplan,Commercial Exchange,,384.30,,,,,,,384.30,414.19,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,outpatient,,,427.00000,298.05000,SilverSummit Healthplan,Commercial Exchange,,384.30,,,,,,,111.02,414.19,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,inpatient,,,737.00000,514.43000,SilverSummit Healthplan,Commercial Exchange,,663.30,,,,,,,663.30,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,SilverSummit Healthplan,Commercial Exchange,,663.30,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,inpatient,,,737.00000,514.43000,SilverSummit Healthplan,Commercial Exchange,59,663.30,,,,,,,663.30,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,SilverSummit Healthplan,Commercial Exchange,59,663.30,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,inpatient,,,809.00000,564.68000,SilverSummit Healthplan,Commercial Exchange,,728.10,,,,,,,728.10,784.73,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,outpatient,,,809.00000,564.68000,SilverSummit Healthplan,Commercial Exchange,,728.10,,,,,,,210.34,784.73,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,inpatient,,,525.00000,366.45000,SilverSummit Healthplan,Commercial Exchange,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,outpatient,,,525.00000,366.45000,SilverSummit Healthplan,Commercial Exchange,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,inpatient,,,319.00000,222.66000,SilverSummit Healthplan,Commercial Exchange,,287.10,,,,,,,287.10,309.43,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,outpatient,,,319.00000,222.66000,SilverSummit Healthplan,Commercial Exchange,,287.10,,,,,,,82.94,309.43,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,inpatient,,,1437.00000,678.26000,SilverSummit Healthplan,Commercial Exchange,,1293.30,,,,,,,1293.30,1393.89,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1437.00000,678.26000,SilverSummit Healthplan,Commercial Exchange,,1293.30,,,,,,,373.62,1393.89,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,inpatient,,,2143.00000,1011.50000,SilverSummit Healthplan,Commercial Exchange,,1928.70,,,,,,,1928.70,2078.71,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2143.00000,1011.50000,SilverSummit Healthplan,Commercial Exchange,,1928.70,,,,,,,557.18,2078.71,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,inpatient,,,755.00000,356.36000,SilverSummit Healthplan,Commercial Exchange,,679.50,,,,,,,679.50,732.35,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,outpatient,,,755.00000,356.36000,SilverSummit Healthplan,Commercial Exchange,,679.50,,,,,,,196.30,732.35,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,inpatient,,,979.00000,462.09000,SilverSummit Healthplan,Commercial Exchange,,881.10,,,,,,,881.10,949.63,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,outpatient,,,979.00000,462.09000,SilverSummit Healthplan,Commercial Exchange,,881.10,,,,,,,254.54,949.63,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,inpatient,,,436.00000,205.79000,SilverSummit Healthplan,Commercial Exchange,,392.40,,,,,,,392.40,422.92,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,outpatient,,,436.00000,205.79000,SilverSummit Healthplan,Commercial Exchange,,392.40,,,,,,,113.36,422.92,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,inpatient,,,220.00000,103.84000,SilverSummit Healthplan,Commercial Exchange,,198.00,,,,,,,198.00,213.40,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,outpatient,,,220.00000,103.84000,SilverSummit Healthplan,Commercial Exchange,,198.00,,,,,,,57.20,213.40,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,inpatient,,,344.00000,162.37000,SilverSummit Healthplan,Commercial Exchange,,309.60,,,,,,,309.60,333.68,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,outpatient,,,344.00000,162.37000,SilverSummit Healthplan,Commercial Exchange,,309.60,,,,,,,89.44,333.68,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,inpatient,,,818.00000,393.46000,SilverSummit Healthplan,Commercial Exchange,,736.20,,,,,,,736.20,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,outpatient,,,818.00000,393.46000,SilverSummit Healthplan,Commercial Exchange,,736.20,,,,,,,212.68,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,inpatient,,,545.00000,262.14000,SilverSummit Healthplan,Commercial Exchange,52,490.50,,,,,,,490.50,528.65,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,outpatient,,,545.00000,262.14000,SilverSummit Healthplan,Commercial Exchange,52,490.50,,,,,,,141.70,528.65,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,inpatient,,,1347.00000,647.91000,SilverSummit Healthplan,Commercial Exchange,,1212.30,,,,,,,1212.30,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,outpatient,,,1347.00000,647.91000,SilverSummit Healthplan,Commercial Exchange,,1212.30,,,,,,,350.22,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,inpatient,,,898.00000,431.94000,SilverSummit Healthplan,Commercial Exchange,52,808.20,,,,,,,808.20,871.06,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,outpatient,,,898.00000,431.94000,SilverSummit Healthplan,Commercial Exchange,52,808.20,,,,,,,233.48,871.06,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,inpatient,,,469.00000,225.59000,SilverSummit Healthplan,Commercial Exchange,,422.10,,,,,,,422.10,454.93,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,outpatient,,,469.00000,225.59000,SilverSummit Healthplan,Commercial Exchange,,422.10,,,,,,,121.94,454.93,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,inpatient,,,1762.00000,847.52000,SilverSummit Healthplan,Commercial Exchange,,1585.80,,,,,,,1585.80,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,outpatient,,,1762.00000,847.52000,SilverSummit Healthplan,Commercial Exchange,,1585.80,,,,,,,458.12,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,inpatient,,,627.00000,301.59000,SilverSummit Healthplan,Commercial Exchange,,564.30,,,,,,,564.30,608.19,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,outpatient,,,627.00000,301.59000,SilverSummit Healthplan,Commercial Exchange,,564.30,,,,,,,163.02,608.19,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,inpatient,,,590.00000,283.79000,SilverSummit Healthplan,Commercial Exchange,,531.00,,,,,,,531.00,572.30,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,outpatient,,,590.00000,283.79000,SilverSummit Healthplan,Commercial Exchange,,531.00,,,,,,,153.40,572.30,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,inpatient,,,1550.00000,745.55000,SilverSummit Healthplan,Commercial Exchange,,1395.00,,,,,,,1395.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,outpatient,,,1550.00000,745.55000,SilverSummit Healthplan,Commercial Exchange,,1395.00,,,,,,,403.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,inpatient,,,990.00000,476.19000,SilverSummit Healthplan,Commercial Exchange,LT,891.00,,,,,,,891.00,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,SilverSummit Healthplan,Commercial Exchange,LT,891.00,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,inpatient,,,990.00000,476.19000,SilverSummit Healthplan,Commercial Exchange,RT,891.00,,,,,,,891.00,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,SilverSummit Healthplan,Commercial Exchange,RT,891.00,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,inpatient,,,1402.00000,674.36000,SilverSummit Healthplan,Commercial Exchange,,1261.80,,,,,,,1261.80,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,outpatient,,,1402.00000,674.36000,SilverSummit Healthplan,Commercial Exchange,,1261.80,,,,,,,364.52,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,inpatient,,,980.00000,471.38000,SilverSummit Healthplan,Commercial Exchange,LT,882.00,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,SilverSummit Healthplan,Commercial Exchange,LT,882.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,inpatient,,,980.00000,471.38000,SilverSummit Healthplan,Commercial Exchange,RT,882.00,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,SilverSummit Healthplan,Commercial Exchange,RT,882.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,inpatient,,,1661.00000,798.94000,SilverSummit Healthplan,Commercial Exchange,,1494.90,,,,,,,1494.90,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,outpatient,,,1661.00000,798.94000,SilverSummit Healthplan,Commercial Exchange,,1494.90,,,,,,,431.86,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,inpatient,,,980.00000,471.38000,SilverSummit Healthplan,Commercial Exchange,,882.00,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,outpatient,,,980.00000,471.38000,SilverSummit Healthplan,Commercial Exchange,,882.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,inpatient,,,1740.00000,836.94000,SilverSummit Healthplan,Commercial Exchange,,1566.00,,,,,,,1566.00,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1740.00000,836.94000,SilverSummit Healthplan,Commercial Exchange,,1566.00,,,,,,,452.40,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,inpatient,,,1168.00000,561.81000,SilverSummit Healthplan,Commercial Exchange,,1051.20,,,,,,,1051.20,1132.96,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1168.00000,561.81000,SilverSummit Healthplan,Commercial Exchange,,1051.20,,,,,,,303.68,1132.96,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,inpatient,,,433.00000,232.09000,SilverSummit Healthplan,Commercial Exchange,,389.70,,,,,,,389.70,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,outpatient,,,433.00000,232.09000,SilverSummit Healthplan,Commercial Exchange,,389.70,,,,,,,112.58,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,inpatient,,,388.00000,207.97000,SilverSummit Healthplan,Commercial Exchange,LT,349.20,,,,,,,349.20,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,SilverSummit Healthplan,Commercial Exchange,LT,349.20,,,,,,,100.88,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,inpatient,,,388.00000,207.97000,SilverSummit Healthplan,Commercial Exchange,RT,349.20,,,,,,,349.20,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,SilverSummit Healthplan,Commercial Exchange,RT,349.20,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,inpatient,,,388.00000,207.97000,SilverSummit Healthplan,Commercial Exchange,,349.20,,,,,,,349.20,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,outpatient,,,388.00000,207.97000,SilverSummit Healthplan,Commercial Exchange,,349.20,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,inpatient,,,604.00000,323.74000,SilverSummit Healthplan,Commercial Exchange,,543.60,,,,,,,543.60,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,outpatient,,,604.00000,323.74000,SilverSummit Healthplan,Commercial Exchange,,543.60,,,,,,,157.04,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,inpatient,,,667.00000,357.51000,SilverSummit Healthplan,Commercial Exchange,,600.30,,,,,,,600.30,646.99,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,outpatient,,,667.00000,357.51000,SilverSummit Healthplan,Commercial Exchange,,600.30,,,,,,,173.42,646.99,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,inpatient,,,176.00000,94.34000,SilverSummit Healthplan,Commercial Exchange,,158.40,,,,,,,158.40,170.72,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,outpatient,,,176.00000,94.34000,SilverSummit Healthplan,Commercial Exchange,,158.40,,,,,,,45.76,170.72,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,inpatient,,,92.00000,29.72000,SilverSummit Healthplan,Commercial Exchange,LT,82.80,,,,,,,82.80,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,SilverSummit Healthplan,Commercial Exchange,LT,82.80,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,inpatient,,,92.00000,29.72000,SilverSummit Healthplan,Commercial Exchange,RT,82.80,,,,,,,82.80,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,SilverSummit Healthplan,Commercial Exchange,RT,82.80,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,inpatient,,,366.00000,118.22000,SilverSummit Healthplan,Commercial Exchange,LT,329.40,,,,,,,329.40,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,SilverSummit Healthplan,Commercial Exchange,LT,329.40,,,,,,,95.16,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,inpatient,,,366.00000,118.22000,SilverSummit Healthplan,Commercial Exchange,RT,329.40,,,,,,,329.40,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,SilverSummit Healthplan,Commercial Exchange,RT,329.40,,,,,,,95.16,355.02,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,inpatient,,,1117.00000,360.79000,SilverSummit Healthplan,Commercial Exchange,LT,1005.30,,,,,,,1005.30,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,SilverSummit Healthplan,Commercial Exchange,LT,1005.30,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,inpatient,,,1117.00000,360.79000,SilverSummit Healthplan,Commercial Exchange,RT,1005.30,,,,,,,1005.30,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,SilverSummit Healthplan,Commercial Exchange,RT,1005.30,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,inpatient,,,559.00000,180.56000,SilverSummit Healthplan,Commercial Exchange,,503.10,,,,,,,503.10,542.23,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,outpatient,,,559.00000,180.56000,SilverSummit Healthplan,Commercial Exchange,,503.10,,,,,,,145.34,542.23,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,inpatient,,,252.00000,81.40000,SilverSummit Healthplan,Commercial Exchange,50,226.80,,,,,,,226.80,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,outpatient,,,252.00000,81.40000,SilverSummit Healthplan,Commercial Exchange,50,226.80,,,,,,,65.52,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,inpatient,,,168.00000,54.26000,SilverSummit Healthplan,Commercial Exchange,LT,151.20,,,,,,,151.20,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,SilverSummit Healthplan,Commercial Exchange,LT,151.20,,,,,,,43.68,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,inpatient,,,168.00000,54.26000,SilverSummit Healthplan,Commercial Exchange,RT,151.20,,,,,,,151.20,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,SilverSummit Healthplan,Commercial Exchange,RT,151.20,,,,,,,43.68,162.96,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,inpatient,,,1148.00000,370.80000,SilverSummit Healthplan,Commercial Exchange,LT,1033.20,,,,,,,1033.20,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,SilverSummit Healthplan,Commercial Exchange,LT,1033.20,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,inpatient,,,1148.00000,370.80000,SilverSummit Healthplan,Commercial Exchange,RT,1033.20,,,,,,,1033.20,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,SilverSummit Healthplan,Commercial Exchange,RT,1033.20,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,inpatient,,,379.00000,122.42000,SilverSummit Healthplan,Commercial Exchange,,341.10,,,,,,,341.10,367.63,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,outpatient,,,379.00000,122.42000,SilverSummit Healthplan,Commercial Exchange,,341.10,,,,,,,98.54,367.63,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,inpatient,,,1015.00000,327.84000,SilverSummit Healthplan,Commercial Exchange,,913.50,,,,,,,913.50,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,outpatient,,,1015.00000,327.84000,SilverSummit Healthplan,Commercial Exchange,,913.50,,,,,,,263.90,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,inpatient,,,591.00000,190.89000,SilverSummit Healthplan,Commercial Exchange,,531.90,,,,,,,531.90,573.27,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,outpatient,,,591.00000,190.89000,SilverSummit Healthplan,Commercial Exchange,,531.90,,,,,,,153.66,573.27,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,inpatient,,,271.00000,169.92000,SilverSummit Healthplan,Commercial Exchange,,243.90,,,,,,,243.90,262.87,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,outpatient,,,271.00000,169.92000,SilverSummit Healthplan,Commercial Exchange,,243.90,,,,,,,70.46,262.87,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,inpatient,,,211.00000,132.30000,SilverSummit Healthplan,Commercial Exchange,LT,189.90,,,,,,,189.90,204.67,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,SilverSummit Healthplan,Commercial Exchange,LT,189.90,,,,,,,54.86,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,inpatient,,,211.00000,132.30000,SilverSummit Healthplan,Commercial Exchange,RT,189.90,,,,,,,189.90,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,SilverSummit Healthplan,Commercial Exchange,RT,189.90,,,,,,,54.86,204.67,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,59.00000,36.99000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,59.00000,36.99000,SilverSummit Healthplan,Commercial Exchange,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,inpatient,,,336.00000,219.74000,SilverSummit Healthplan,Commercial Exchange,,302.40,,,,,,,302.40,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,outpatient,,,336.00000,219.74000,SilverSummit Healthplan,Commercial Exchange,,302.40,,,,,,,87.36,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,inpatient,,,224.00000,146.50000,SilverSummit Healthplan,Commercial Exchange,52,201.60,,,,,,,201.60,217.28,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,outpatient,,,224.00000,146.50000,SilverSummit Healthplan,Commercial Exchange,52,201.60,,,,,,,58.24,217.28,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,inpatient,,,63.00000,41.20000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,outpatient,,,63.00000,41.20000,SilverSummit Healthplan,Commercial Exchange,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,SilverSummit Healthplan,Commercial Exchange,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,SilverSummit Healthplan,Commercial Exchange,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,SilverSummit Healthplan,Commercial Exchange,,547.20,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,SilverSummit Healthplan,Commercial Exchange,,547.20,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,SilverSummit Healthplan,Commercial Exchange,,192.60,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,SilverSummit Healthplan,Commercial Exchange,,192.60,,,,,,,55.64,207.58,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,inpatient,,,609.00000,196.71000,SilverSummit Healthplan,Commercial Exchange,,548.10,,,,,,,548.10,590.73,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,SilverSummit Healthplan,Commercial Exchange,,548.10,,,,,,,158.34,590.73,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,inpatient,,,863.00000,278.75000,SilverSummit Healthplan,Commercial Exchange,,776.70,,,,,,,776.70,837.11,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,SilverSummit Healthplan,Commercial Exchange,,776.70,,,,,,,224.38,837.11,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,inpatient,,,900.00000,605.70000,SilverSummit Healthplan,Commercial Exchange,,810.00,,,,,,,810.00,873.00,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,outpatient,,,900.00000,605.70000,SilverSummit Healthplan,Commercial Exchange,,810.00,,,,,,,234.00,873.00,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,inpatient,,,1940.00000,1102.21000,SilverSummit Healthplan,Commercial Exchange,,1746.00,,,,,,,1746.00,1881.80,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,outpatient,,,1940.00000,1102.21000,SilverSummit Healthplan,Commercial Exchange,,1746.00,,,,,,,504.40,1881.80,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,inpatient,,,422.00000,239.76000,SilverSummit Healthplan,Commercial Exchange,,379.80,,,,,,,379.80,409.34,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,outpatient,,,422.00000,239.76000,SilverSummit Healthplan,Commercial Exchange,,379.80,,,,,,,109.72,409.34,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,inpatient,,,1430.00000,812.45000,SilverSummit Healthplan,Commercial Exchange,,1287.00,,,,,,,1287.00,1387.10,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,outpatient,,,1430.00000,812.45000,SilverSummit Healthplan,Commercial Exchange,,1287.00,,,,,,,371.80,1387.10,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,inpatient,,,745.00000,423.27000,SilverSummit Healthplan,Commercial Exchange,,670.50,,,,,,,670.50,722.65,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,outpatient,,,745.00000,423.27000,SilverSummit Healthplan,Commercial Exchange,,670.50,,,,,,,193.70,722.65,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,inpatient,,,2655.00000,2487.74000,SilverSummit Healthplan,Commercial Exchange,,2389.50,,,,,,,2389.50,2575.35,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,outpatient,,,2655.00000,2487.74000,SilverSummit Healthplan,Commercial Exchange,,2389.50,,,,,,,690.30,2575.35,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,inpatient,,,3990.00000,3738.63000,SilverSummit Healthplan,Commercial Exchange,,3591.00,,,,,,,3591.00,3870.30,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,outpatient,,,3990.00000,3738.63000,SilverSummit Healthplan,Commercial Exchange,,3591.00,,,,,,,1037.40,3870.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,inpatient,,,290.00000,271.73000,SilverSummit Healthplan,Commercial Exchange,,261.00,,,,,,,261.00,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,outpatient,,,290.00000,271.73000,SilverSummit Healthplan,Commercial Exchange,,261.00,,,,,,,75.40,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,inpatient,,,735.00000,688.70000,SilverSummit Healthplan,Commercial Exchange,,661.50,,,,,,,661.50,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,outpatient,,,735.00000,688.70000,SilverSummit Healthplan,Commercial Exchange,,661.50,,,,,,,191.10,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,inpatient,,,1475.00000,1382.08000,SilverSummit Healthplan,Commercial Exchange,,1327.50,,,,,,,1327.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,outpatient,,,1475.00000,1382.08000,SilverSummit Healthplan,Commercial Exchange,,1327.50,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,inpatient,,,2275.00000,2131.68000,SilverSummit Healthplan,Commercial Exchange,,2047.50,,,,,,,2047.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,outpatient,,,2275.00000,2131.68000,SilverSummit Healthplan,Commercial Exchange,,2047.50,,,,,,,591.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,inpatient,,,3205.00000,3003.08000,SilverSummit Healthplan,Commercial Exchange,,2884.50,,,,,,,2884.50,3108.85,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,outpatient,,,3205.00000,3003.08000,SilverSummit Healthplan,Commercial Exchange,,2884.50,,,,,,,833.30,3108.85,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,inpatient,,,770.00000,721.49000,SilverSummit Healthplan,Commercial Exchange,,693.00,,,,,,,693.00,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,outpatient,,,770.00000,721.49000,SilverSummit Healthplan,Commercial Exchange,,693.00,,,,,,,200.20,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,inpatient,,,1475.00000,1382.08000,SilverSummit Healthplan,Commercial Exchange,,1327.50,,,,,,,1327.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,outpatient,,,1475.00000,1382.08000,SilverSummit Healthplan,Commercial Exchange,,1327.50,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,inpatient,,,2210.00000,2070.77000,SilverSummit Healthplan,Commercial Exchange,,1989.00,,,,,,,1989.00,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,outpatient,,,2210.00000,2070.77000,SilverSummit Healthplan,Commercial Exchange,,1989.00,,,,,,,574.60,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,inpatient,,,2660.00000,2492.42000,SilverSummit Healthplan,Commercial Exchange,,2394.00,,,,,,,2394.00,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,outpatient,,,2660.00000,2492.42000,SilverSummit Healthplan,Commercial Exchange,,2394.00,,,,,,,691.60,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,inpatient,,,3560.00000,3335.72000,SilverSummit Healthplan,Commercial Exchange,,3204.00,,,,,,,3204.00,3453.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,outpatient,,,3560.00000,3335.72000,SilverSummit Healthplan,Commercial Exchange,,3204.00,,,,,,,925.60,3453.20,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,inpatient,,,5730.00000,3255.50000,SilverSummit Healthplan,Commercial Exchange,,5157.00,,,,,,,5157.00,5558.10,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,outpatient,,,5730.00000,3255.50000,SilverSummit Healthplan,Commercial Exchange,,5157.00,,,,,,,1489.80,5558.10,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,inpatient,,,3875.00000,2201.58000,SilverSummit Healthplan,Commercial Exchange,,3487.50,,,,,,,3487.50,3758.75,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,outpatient,,,3875.00000,2201.58000,SilverSummit Healthplan,Commercial Exchange,,3487.50,,,,,,,1007.50,3758.75,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,inpatient,,,519.00000,564.15000,SilverSummit Healthplan,Commercial Exchange,,467.10,,,,,,,467.10,503.43,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,outpatient,,,519.00000,564.15000,SilverSummit Healthplan,Commercial Exchange,,467.10,,,,,,,134.94,503.43,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,inpatient,,,536.00000,582.63000,SilverSummit Healthplan,Commercial Exchange,,482.40,,,,,,,482.40,519.92,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,outpatient,,,536.00000,582.63000,SilverSummit Healthplan,Commercial Exchange,,482.40,,,,,,,139.36,519.92,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,SilverSummit Healthplan,Commercial Exchange,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,SilverSummit Healthplan,Commercial Exchange,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,SilverSummit Healthplan,Commercial Exchange,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,SilverSummit Healthplan,Commercial Exchange,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,SilverSummit Healthplan,Commercial Exchange,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,SilverSummit Healthplan,Commercial Exchange,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,SilverSummit Healthplan,Commercial Exchange,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,SilverSummit Healthplan,Commercial Exchange,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,SilverSummit Healthplan,Commercial Exchange,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,SilverSummit Healthplan,Commercial Exchange,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,SilverSummit Healthplan,Commercial Exchange,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,SilverSummit Healthplan,Commercial Exchange,,547.20,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,SilverSummit Healthplan,Commercial Exchange,,547.20,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,SilverSummit Healthplan,Commercial Exchange,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,SilverSummit Healthplan,Commercial Exchange,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,SilverSummit Healthplan,Commercial Exchange,,192.60,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,SilverSummit Healthplan,Commercial Exchange,,192.60,,,,,,,55.64,207.58,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,inpatient,,,175.00000,63.18000,SilverSummit Healthplan,Commercial Exchange,,157.50,,,,,,,157.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,outpatient,,,175.00000,63.18000,SilverSummit Healthplan,Commercial Exchange,,157.50,,,,,,,45.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,inpatient,,,304.00000,109.74000,SilverSummit Healthplan,Commercial Exchange,,273.60,,,,,,,273.60,294.88,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,outpatient,,,304.00000,109.74000,SilverSummit Healthplan,Commercial Exchange,,273.60,,,,,,,79.04,294.88,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,SilverSummit Healthplan,Commercial Exchange,,255.60,,,,,,,255.60,275.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,SilverSummit Healthplan,Commercial Exchange,,255.60,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,SilverSummit Healthplan,Commercial Exchange,,412.20,,,,,,,412.20,444.26,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,SilverSummit Healthplan,Commercial Exchange,,412.20,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,inpatient,,,438.00000,158.12000,SilverSummit Healthplan,Commercial Exchange,,394.20,,,,,,,394.20,424.86,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,outpatient,,,438.00000,158.12000,SilverSummit Healthplan,Commercial Exchange,,394.20,,,,,,,113.88,424.86,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,SilverSummit Healthplan,Commercial Exchange,,502.20,,,,,,,502.20,541.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,SilverSummit Healthplan,Commercial Exchange,,502.20,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,SilverSummit Healthplan,Commercial Exchange,,433.80,,,,,,,433.80,467.54,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,SilverSummit Healthplan,Commercial Exchange,,433.80,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,SilverSummit Healthplan,Commercial Exchange,,213.30,,,,,,,213.30,229.89,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,SilverSummit Healthplan,Commercial Exchange,,213.30,,,,,,,61.62,229.89,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,SilverSummit Healthplan,Commercial Exchange,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,SilverSummit Healthplan,Commercial Exchange,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,SilverSummit Healthplan,Commercial Exchange,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,SilverSummit Healthplan,Commercial Exchange,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,SilverSummit Healthplan,Commercial Exchange,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,SilverSummit Healthplan,Commercial Exchange,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,SilverSummit Healthplan,Commercial Exchange,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,SilverSummit Healthplan,Commercial Exchange,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,SilverSummit Healthplan,Commercial Exchange,,757.80,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,SilverSummit Healthplan,Commercial Exchange,,757.80,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,SilverSummit Healthplan,Commercial Exchange,,947.70,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,SilverSummit Healthplan,Commercial Exchange,,947.70,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,SilverSummit Healthplan,Commercial Exchange,,1136.70,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,SilverSummit Healthplan,Commercial Exchange,,1136.70,,,,,,,328.38,1225.11,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,inpatient,,,182.00000,127.04000,SilverSummit Healthplan,Commercial Exchange,,163.80,,,,,,,163.80,176.54,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,SilverSummit Healthplan,Commercial Exchange,,163.80,,,,,,,47.32,176.54,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,inpatient,,,210.00000,119.31000,SilverSummit Healthplan,Commercial Exchange,,189.00,,,,,,,189.00,203.70,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,SilverSummit Healthplan,Commercial Exchange,,189.00,,,,,,,54.60,203.70,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,inpatient,,,140.00000,79.54000,SilverSummit Healthplan,Commercial Exchange,,126.00,,,,,,,126.00,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,outpatient,,,140.00000,79.54000,SilverSummit Healthplan,Commercial Exchange,,126.00,,,,,,,36.40,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,inpatient,,,190.00000,107.95000,SilverSummit Healthplan,Commercial Exchange,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,outpatient,,,190.00000,107.95000,SilverSummit Healthplan,Commercial Exchange,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,inpatient,,,240.00000,136.36000,SilverSummit Healthplan,Commercial Exchange,,216.00,,,,,,,216.00,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,outpatient,,,240.00000,136.36000,SilverSummit Healthplan,Commercial Exchange,,216.00,,,,,,,62.40,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,inpatient,,,290.00000,164.76000,SilverSummit Healthplan,Commercial Exchange,,261.00,,,,,,,261.00,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,outpatient,,,290.00000,164.76000,SilverSummit Healthplan,Commercial Exchange,,261.00,,,,,,,75.40,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,inpatient,,,340.00000,193.17000,SilverSummit Healthplan,Commercial Exchange,,306.00,,,,,,,306.00,329.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,outpatient,,,340.00000,193.17000,SilverSummit Healthplan,Commercial Exchange,,306.00,,,,,,,88.40,329.80,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,inpatient,,,150.00000,85.22000,SilverSummit Healthplan,Commercial Exchange,,135.00,,,,,,,135.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,outpatient,,,150.00000,85.22000,SilverSummit Healthplan,Commercial Exchange,,135.00,,,,,,,39.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,inpatient,,,200.00000,113.63000,SilverSummit Healthplan,Commercial Exchange,,180.00,,,,,,,180.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,outpatient,,,200.00000,113.63000,SilverSummit Healthplan,Commercial Exchange,,180.00,,,,,,,52.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,inpatient,,,270.00000,153.40000,SilverSummit Healthplan,Commercial Exchange,,243.00,,,,,,,243.00,261.90,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,outpatient,,,270.00000,153.40000,SilverSummit Healthplan,Commercial Exchange,,243.00,,,,,,,70.20,261.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,inpatient,,,370.00000,210.22000,SilverSummit Healthplan,Commercial Exchange,,333.00,,,,,,,333.00,358.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,outpatient,,,370.00000,210.22000,SilverSummit Healthplan,Commercial Exchange,,333.00,,,,,,,96.20,358.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,inpatient,,,470.00000,267.03000,SilverSummit Healthplan,Commercial Exchange,,423.00,,,,,,,423.00,455.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,outpatient,,,470.00000,267.03000,SilverSummit Healthplan,Commercial Exchange,,423.00,,,,,,,122.20,455.90,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,inpatient,,,248.00000,96.22000,SilverSummit Healthplan,Commercial Exchange,,223.20,,,,,,,223.20,240.56,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,outpatient,,,248.00000,96.22000,SilverSummit Healthplan,Commercial Exchange,,223.20,,,,,,,64.48,240.56,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,inpatient,,,245.00000,95.06000,SilverSummit Healthplan,Commercial Exchange,,220.50,,,,,,,220.50,237.65,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,outpatient,,,245.00000,95.06000,SilverSummit Healthplan,Commercial Exchange,,220.50,,,,,,,63.70,237.65,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,inpatient,,,497.00000,192.84000,SilverSummit Healthplan,Commercial Exchange,,447.30,,,,,,,447.30,482.09,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,outpatient,,,497.00000,192.84000,SilverSummit Healthplan,Commercial Exchange,,447.30,,,,,,,129.22,482.09,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,inpatient,,,357.00000,138.52000,SilverSummit Healthplan,Commercial Exchange,,321.30,,,,,,,321.30,346.29,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,outpatient,,,357.00000,138.52000,SilverSummit Healthplan,Commercial Exchange,,321.30,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,inpatient,,,334.00000,129.59000,SilverSummit Healthplan,Commercial Exchange,,300.60,,,,,,,300.60,323.98,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,outpatient,,,334.00000,129.59000,SilverSummit Healthplan,Commercial Exchange,,300.60,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,inpatient,,,194.00000,75.27000,SilverSummit Healthplan,Commercial Exchange,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,outpatient,,,194.00000,75.27000,SilverSummit Healthplan,Commercial Exchange,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,inpatient,,,1035.00000,401.58000,SilverSummit Healthplan,Commercial Exchange,,931.50,,,,,,,931.50,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,outpatient,,,1035.00000,401.58000,SilverSummit Healthplan,Commercial Exchange,,931.50,,,,,,,269.10,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,inpatient,,,1137.00000,441.16000,SilverSummit Healthplan,Commercial Exchange,,1023.30,,,,,,,1023.30,1102.89,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,outpatient,,,1137.00000,441.16000,SilverSummit Healthplan,Commercial Exchange,,1023.30,,,,,,,295.62,1102.89,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,inpatient,,,963.00000,373.64000,SilverSummit Healthplan,Commercial Exchange,,866.70,,,,,,,866.70,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,outpatient,,,963.00000,373.64000,SilverSummit Healthplan,Commercial Exchange,,866.70,,,,,,,250.38,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,inpatient,,,990.00000,384.12000,SilverSummit Healthplan,Commercial Exchange,,891.00,,,,,,,891.00,960.30,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,outpatient,,,990.00000,384.12000,SilverSummit Healthplan,Commercial Exchange,,891.00,,,,,,,257.40,960.30,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,inpatient,,,112.00000,43.46000,SilverSummit Healthplan,Commercial Exchange,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,outpatient,,,112.00000,43.46000,SilverSummit Healthplan,Commercial Exchange,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,inpatient,,,84.00000,32.59000,SilverSummit Healthplan,Commercial Exchange,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,outpatient,,,84.00000,32.59000,SilverSummit Healthplan,Commercial Exchange,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,inpatient,,,176.00000,68.29000,SilverSummit Healthplan,Commercial Exchange,,158.40,,,,,,,158.40,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,outpatient,,,176.00000,68.29000,SilverSummit Healthplan,Commercial Exchange,,158.40,,,,,,,45.76,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,inpatient,,,283.00000,109.80000,SilverSummit Healthplan,Commercial Exchange,,254.70,,,,,,,254.70,274.51,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,outpatient,,,283.00000,109.80000,SilverSummit Healthplan,Commercial Exchange,,254.70,,,,,,,73.58,274.51,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,SilverSummit Healthplan,Commercial Exchange,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,SilverSummit Healthplan,Commercial Exchange,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,SilverSummit Healthplan,Commercial Exchange,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,inpatient,,,35.00000,19.89000,SilverSummit Healthplan,Commercial Exchange,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,35.00000,19.89000,SilverSummit Healthplan,Commercial Exchange,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,inpatient,,,191.00000,89.39000,SilverSummit Healthplan,Commercial Exchange,,171.90,,,,,,,171.90,185.27,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,outpatient,,,191.00000,89.39000,SilverSummit Healthplan,Commercial Exchange,,171.90,,,,,,,49.66,185.27,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,SilverSummit Healthplan,Commercial Exchange,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,SilverSummit Healthplan,Commercial Exchange,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,SilverSummit Healthplan,Commercial Exchange,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,SilverSummit Healthplan,Commercial Exchange,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,SilverSummit Healthplan,Commercial Exchange,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,SilverSummit Healthplan,Commercial Exchange,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,SilverSummit Healthplan,Commercial Exchange,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,SilverSummit Healthplan,Commercial Exchange,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,inpatient,,,281.00000,131.51000,SilverSummit Healthplan,Commercial Exchange,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,outpatient,,,281.00000,131.51000,SilverSummit Healthplan,Commercial Exchange,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,inpatient,,,192.00000,89.86000,SilverSummit Healthplan,Commercial Exchange,,172.80,,,,,,,172.80,186.24,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,outpatient,,,192.00000,89.86000,SilverSummit Healthplan,Commercial Exchange,,172.80,,,,,,,49.92,186.24,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,inpatient,,,365.00000,170.82000,SilverSummit Healthplan,Commercial Exchange,,328.50,,,,,,,328.50,354.05,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,outpatient,,,365.00000,170.82000,SilverSummit Healthplan,Commercial Exchange,,328.50,,,,,,,94.90,354.05,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,inpatient,,,8391.00000,5856.92000,SilverSummit Healthplan,Commercial Exchange,,7551.90,,,,,,,7551.90,8139.27,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,outpatient,,,8391.00000,5856.92000,SilverSummit Healthplan,Commercial Exchange,,7551.90,,,,,,,2181.66,8139.27,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,inpatient,,,6917.00000,4828.07000,SilverSummit Healthplan,Commercial Exchange,52,6225.30,,,,,,,6225.30,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,SilverSummit Healthplan,Commercial Exchange,52,6225.30,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,inpatient,,,6000.00000,4188.00000,SilverSummit Healthplan,Commercial Exchange,,5400.00,,,,,,,5400.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,SilverSummit Healthplan,Commercial Exchange,,5400.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,inpatient,,,6917.00000,4828.07000,SilverSummit Healthplan,Commercial Exchange,,6225.30,,,,,,,6225.30,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,SilverSummit Healthplan,Commercial Exchange,,6225.30,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,inpatient,,,6000.00000,4188.00000,SilverSummit Healthplan,Commercial Exchange,52,5400.00,,,,,,,5400.00,5820.00,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,SilverSummit Healthplan,Commercial Exchange,52,5400.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,inpatient,,,8855.00000,9625.38000,SilverSummit Healthplan,Commercial Exchange,,7969.50,,,,,,,7969.50,8589.35,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,outpatient,,,8855.00000,9625.38000,SilverSummit Healthplan,Commercial Exchange,,7969.50,,,,,,,2302.30,8589.35,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,inpatient,,,844.00000,917.43000,SilverSummit Healthplan,Commercial Exchange,,759.60,,,,,,,759.60,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,SilverSummit Healthplan,Commercial Exchange,,759.60,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,inpatient,,,844.00000,917.43000,SilverSummit Healthplan,Commercial Exchange,52,759.60,,,,,,,759.60,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,SilverSummit Healthplan,Commercial Exchange,52,759.60,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,inpatient,,,785.00000,853.30000,SilverSummit Healthplan,Commercial Exchange,,706.50,,,,,,,706.50,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,SilverSummit Healthplan,Commercial Exchange,,706.50,,,,,,,204.10,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,inpatient,,,785.00000,853.30000,SilverSummit Healthplan,Commercial Exchange,52,706.50,,,,,,,706.50,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,SilverSummit Healthplan,Commercial Exchange,52,706.50,,,,,,,204.10,761.45,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4709.00000,5118.68000,SilverSummit Healthplan,Commercial Exchange,,4238.10,,,,,,,4238.10,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,SilverSummit Healthplan,Commercial Exchange,,4238.10,,,,,,,1224.34,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4709.00000,5118.68000,SilverSummit Healthplan,Commercial Exchange,52,4238.10,,,,,,,4238.10,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,SilverSummit Healthplan,Commercial Exchange,52,4238.10,,,,,,,1224.34,4567.73,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,inpatient,,,345.00000,128.34000,SilverSummit Healthplan,Commercial Exchange,,310.50,,,,,,,310.50,334.65,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,outpatient,,,345.00000,128.34000,SilverSummit Healthplan,Commercial Exchange,,310.50,,,,,,,89.70,334.65,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,inpatient,,,120.00000,99.60000,SilverSummit Healthplan,Commercial Exchange,,108.00,,,,,,,108.00,116.40,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,outpatient,,,120.00000,99.60000,SilverSummit Healthplan,Commercial Exchange,,108.00,,,,,,,31.20,116.40,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,inpatient,,,106.00000,87.98000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,outpatient,,,106.00000,87.98000,SilverSummit Healthplan,Commercial Exchange,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,inpatient,,,32.00000,26.56000,SilverSummit Healthplan,Commercial Exchange,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,outpatient,,,32.00000,26.56000,SilverSummit Healthplan,Commercial Exchange,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,inpatient,,,60.00000,49.80000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,outpatient,,,60.00000,49.80000,SilverSummit Healthplan,Commercial Exchange,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,inpatient,,,57.00000,47.31000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,outpatient,,,57.00000,47.31000,SilverSummit Healthplan,Commercial Exchange,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,inpatient,1.0,ME,7.40000,0.65000,SilverSummit Healthplan,Commercial Exchange,,6.66,,,,,,,6.66,7.18,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,outpatient,1.0,ME,7.40000,0.65000,SilverSummit Healthplan,Commercial Exchange,,6.66,,,,,,,1.92,7.18,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,inpatient,1.0,EA,6.60000,1.43000,SilverSummit Healthplan,Commercial Exchange,UD,5.94,,,,,,,5.94,6.40,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,outpatient,1.0,EA,6.60000,1.43000,SilverSummit Healthplan,Commercial Exchange,UD,5.94,,,,,,,1.72,6.40,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,inpatient,1.0,EA,2.95000,0.64000,SilverSummit Healthplan,Commercial Exchange,UD,2.65,,,,,,,2.65,2.86,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,outpatient,1.0,EA,2.95000,0.64000,SilverSummit Healthplan,Commercial Exchange,UD,2.65,,,,,,,0.76700,2.86,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,inpatient,1.0,EA,56.08000,12.11000,SilverSummit Healthplan,Commercial Exchange,UD,50.47,,,,,,,50.47,54.40,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,56.08000,12.11000,SilverSummit Healthplan,Commercial Exchange,UD,50.47,,,,,,,14.58,54.40,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,inpatient,1.0,UN,82.10000,28.90000,SilverSummit Healthplan,Commercial Exchange,,73.89,,,,,,,73.89,79.64,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,outpatient,1.0,UN,82.10000,28.90000,SilverSummit Healthplan,Commercial Exchange,,73.89,,,,,,,15.48,79.64,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.04000,,SilverSummit Healthplan,Commercial Exchange,UD,0.03600,,,,,,,0.03600,0.03880,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.04000,,SilverSummit Healthplan,Commercial Exchange,UD,0.03600,,,,,,,0.01040,0.03880,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.05000,,SilverSummit Healthplan,Commercial Exchange,UD,0.04500,,,,,,,0.04500,0.04850,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.05000,,SilverSummit Healthplan,Commercial Exchange,UD,0.04500,,,,,,,0.01300,0.04850,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,inpatient,1.0,ME,6.20000,0.55000,SilverSummit Healthplan,Commercial Exchange,,5.58,,,,,,,5.58,6.01,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,outpatient,1.0,ME,6.20000,0.55000,SilverSummit Healthplan,Commercial Exchange,,5.58,,,,,,,1.61,6.01,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.12000,0.01000,SilverSummit Healthplan,Commercial Exchange,UD,0.10800,,,,,,,0.10800,0.11640,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.12000,0.01000,SilverSummit Healthplan,Commercial Exchange,UD,0.10800,,,,,,,0.03120,0.11640,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,inpatient,2.0,ML,5.80000,1.25000,SilverSummit Healthplan,Commercial Exchange,,5.22,,,,,,,5.22,5.63,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,outpatient,2.0,ML,5.80000,1.25000,SilverSummit Healthplan,Commercial Exchange,,5.22,,,,,,,1.51,5.63,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,inpatient,1.0,ME,3.10000,0.27000,SilverSummit Healthplan,Commercial Exchange,,2.79,,,,,,,2.79,3.01,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,outpatient,1.0,ME,3.10000,0.27000,SilverSummit Healthplan,Commercial Exchange,,2.79,,,,,,,0.80600,3.01,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,inpatient,1.0,EA,44.40000,3.91000,SilverSummit Healthplan,Commercial Exchange,,39.96,,,,,,,39.96,43.07,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,outpatient,1.0,EA,44.40000,3.91000,SilverSummit Healthplan,Commercial Exchange,,39.96,,,,,,,11.54,43.07,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,inpatient,1.0,EA,8.26000,0.73000,SilverSummit Healthplan,Commercial Exchange,UD,7.43,,,,,,,7.43,8.01,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,8.26000,0.73000,SilverSummit Healthplan,Commercial Exchange,UD,7.43,,,,,,,2.15,8.01,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,2.19000,0.19000,SilverSummit Healthplan,Commercial Exchange,UD,1.97,,,,,,,1.97,2.12,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,2.19000,0.19000,SilverSummit Healthplan,Commercial Exchange,UD,1.97,,,,,,,0.56940,2.12,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,inpatient,1.0,EA,28.60000,2.52000,SilverSummit Healthplan,Commercial Exchange,,25.74,,,,,,,25.74,27.74,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,outpatient,1.0,EA,28.60000,2.52000,SilverSummit Healthplan,Commercial Exchange,,25.74,,,,,,,7.44,27.74,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,inpatient,1.0,EA,2.58000,0.91000,SilverSummit Healthplan,Commercial Exchange,UD,2.32,,,,,,,2.32,2.50,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,outpatient,1.0,EA,2.58000,0.91000,SilverSummit Healthplan,Commercial Exchange,UD,2.32,,,,,,,0.67080,2.50,percent of total billed charges,
R&B OBSTETRICS PVT,3012,CDM,112,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,SilverSummit Healthplan,Medicare Advantage,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B MEDICAL/SURGICAL SEMI-PVT,23010,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,SilverSummit Healthplan,Medicare Advantage,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B ICU,33019,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,SilverSummit Healthplan,Medicare Advantage,,2935.00,,,,,,,2512.00,8498.17,per diem,
R&B ICU INTERMEDIATE,13011,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,SilverSummit Healthplan,Medicare Advantage,,2935.00,,,,,,,2512.00,5665.77,per diem,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,244.00000,77.10000,SilverSummit Healthplan,Medicare Advantage,,85.40,,,,,,,63.44,236.68,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,24075,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,SilverSummit Healthplan,Medicare Advantage,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B OBSTETRICS SEMI-PVT,44073,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,SilverSummit Healthplan,Medicare Advantage,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B NURSERY LEVEL 1,55160,CDM,171,RC,,,,,facility,inpatient,,,3477.00000,1975.46000,SilverSummit Healthplan,Medicare Advantage,,2935.00,,,,,,,2512.00,3372.69,per diem,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,outpatient,,,16.00000,7.71000,SilverSummit Healthplan,Medicare Advantage,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,SilverSummit Healthplan,Medicare Advantage,,73.50,,,,,,,54.60,203.70,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,outpatient,,,380.00000,215.90000,SilverSummit Healthplan,Medicare Advantage,,133.00,,,,,,,98.80,368.60,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,SilverSummit Healthplan,Medicare Advantage,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22012,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,SilverSummit Healthplan,Medicare Advantage,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B ADMIN DAY SKILLED,82016,CDM,160,RC,,,,,facility,inpatient,,,1923.00000,1092.55000,SilverSummit Healthplan,Medicare Advantage,,2935.00,,,,,,,1730.70,3111.10,per diem,
R&B SWING BED SKILLED,62018,CDM,160,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,SilverSummit Healthplan,Medicare Advantage,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B ADMIN DAY INTERMEDIATE,72017,CDM,169,RC,,,,,facility,inpatient,,,1176.00000,668.14000,SilverSummit Healthplan,Medicare Advantage,,2935.00,,,,,,,1058.40,3111.10,per diem,
R&B ICU,32011,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,SilverSummit Healthplan,Medicare Advantage,,2935.00,,,,,,,2512.00,8498.17,per diem,
R&B ICU INTERMEDIATE,12013,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,SilverSummit Healthplan,Medicare Advantage,,2935.00,,,,,,,2512.00,5665.77,per diem,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,SilverSummit Healthplan,Medicare Advantage,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,SilverSummit Healthplan,Medicare Advantage,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,SilverSummit Healthplan,Medicare Advantage,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,SilverSummit Healthplan,Medicare Advantage,,212.80,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,SilverSummit Healthplan,Medicare Advantage,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,SilverSummit Healthplan,Medicare Advantage,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,SilverSummit Healthplan,Medicare Advantage,,74.90,,,,,,,55.64,207.58,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,SilverSummit Healthplan,Medicare Advantage,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,SilverSummit Healthplan,Medicare Advantage,,99.40,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,SilverSummit Healthplan,Medicare Advantage,,160.30,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,SilverSummit Healthplan,Medicare Advantage,,195.30,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,SilverSummit Healthplan,Medicare Advantage,,168.70,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,SilverSummit Healthplan,Medicare Advantage,,82.95,,,,,,,61.62,229.89,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,outpatient,,,2041.00000,659.24000,SilverSummit Healthplan,Medicare Advantage,,714.35,,,,,,,530.66,1979.77,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,outpatient,,,259.00000,83.66000,SilverSummit Healthplan,Medicare Advantage,,90.65,,,,,,,67.34,251.23,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,outpatient,,,672.00000,217.06000,SilverSummit Healthplan,Medicare Advantage,,235.20,,,,,,,174.72,651.84,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,outpatient,,,530.00000,171.19000,SilverSummit Healthplan,Medicare Advantage,,185.50,,,,,,,137.80,514.10,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,outpatient,,,580.00000,187.34000,SilverSummit Healthplan,Medicare Advantage,,203.00,,,,,,,150.80,562.60,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,outpatient,,,435.00000,140.50000,SilverSummit Healthplan,Medicare Advantage,,152.25,,,,,,,113.10,421.95,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,SilverSummit Healthplan,Medicare Advantage,,302.05,,,,,,,224.38,837.11,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,outpatient,,,334.00000,107.88000,SilverSummit Healthplan,Medicare Advantage,,116.90,,,,,,,86.84,323.98,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,outpatient,,,1188.00000,383.72000,SilverSummit Healthplan,Medicare Advantage,50,415.80,,,,,,,308.88,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,SilverSummit Healthplan,Medicare Advantage,LT,277.20,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,SilverSummit Healthplan,Medicare Advantage,RT,277.20,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,outpatient,,,572.00000,184.76000,SilverSummit Healthplan,Medicare Advantage,50,200.20,,,,,,,148.72,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,SilverSummit Healthplan,Medicare Advantage,LT,133.35,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,SilverSummit Healthplan,Medicare Advantage,RT,133.35,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,outpatient,,,455.00000,146.96000,SilverSummit Healthplan,Medicare Advantage,,159.25,,,,,,,118.30,441.35,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,outpatient,,,403.00000,130.17000,SilverSummit Healthplan,Medicare Advantage,,141.05,,,,,,,104.78,390.91,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,outpatient,,,370.00000,119.51000,SilverSummit Healthplan,Medicare Advantage,,129.50,,,,,,,96.20,358.90,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,outpatient,,,357.00000,115.31000,SilverSummit Healthplan,Medicare Advantage,,124.95,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,outpatient,,,334.00000,107.88000,SilverSummit Healthplan,Medicare Advantage,,116.90,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,outpatient,,,194.00000,62.66000,SilverSummit Healthplan,Medicare Advantage,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,outpatient,,,457.00000,147.61000,SilverSummit Healthplan,Medicare Advantage,,159.95,,,,,,,118.82,443.29,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,outpatient,,,492.00000,158.92000,SilverSummit Healthplan,Medicare Advantage,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,outpatient,,,780.00000,251.94000,SilverSummit Healthplan,Medicare Advantage,,273.00,,,,,,,202.80,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,outpatient,,,1165.00000,376.30000,SilverSummit Healthplan,Medicare Advantage,,407.75,,,,,,,302.90,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,outpatient,,,2350.00000,759.05000,SilverSummit Healthplan,Medicare Advantage,,822.50,,,,,,,611.00,2279.50,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,outpatient,,,896.00000,289.41000,SilverSummit Healthplan,Medicare Advantage,,313.60,,,,,,,232.96,869.12,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,outpatient,,,490.00000,158.27000,SilverSummit Healthplan,Medicare Advantage,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,outpatient,,,520.00000,167.96000,SilverSummit Healthplan,Medicare Advantage,,182.00,,,,,,,135.20,504.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,outpatient,,,720.00000,232.56000,SilverSummit Healthplan,Medicare Advantage,,252.00,,,,,,,187.20,698.40,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,outpatient,,,215.00000,69.45000,SilverSummit Healthplan,Medicare Advantage,,75.25,,,,,,,55.90,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,outpatient,,,240.00000,77.52000,SilverSummit Healthplan,Medicare Advantage,,84.00,,,,,,,62.40,232.80,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,outpatient,,,1241.00000,400.84000,SilverSummit Healthplan,Medicare Advantage,,434.35,,,,,,,322.66,1203.77,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,SilverSummit Healthplan,Medicare Advantage,,294.70,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,SilverSummit Healthplan,Medicare Advantage,,368.55,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,SilverSummit Healthplan,Medicare Advantage,,442.05,,,,,,,328.38,1225.11,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,outpatient,,,668.00000,559.78000,SilverSummit Healthplan,Medicare Advantage,,233.80,,,,,,,173.68,647.96,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,SilverSummit Healthplan,Medicare Advantage,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,SilverSummit Healthplan,Medicare Advantage,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,SilverSummit Healthplan,Medicare Advantage,,158.55,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,SilverSummit Healthplan,Medicare Advantage,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,SilverSummit Healthplan,Medicare Advantage,,37.45,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,SilverSummit Healthplan,Medicare Advantage,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,SilverSummit Healthplan,Medicare Advantage,,1.19,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,SilverSummit Healthplan,Medicare Advantage,,1.19,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,SilverSummit Healthplan,Medicare Advantage,,1.19,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,SilverSummit Healthplan,Medicare Advantage,,1.72,,,,,,,1.27,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,7.90000,4.49000,SilverSummit Healthplan,Medicare Advantage,,2.77,,,,,,,2.05,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,SilverSummit Healthplan,Medicare Advantage,,1.72,,,,,,,1.27,4.75,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,81.00000,44.14000,SilverSummit Healthplan,Medicare Advantage,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,81.00000,44.14000,SilverSummit Healthplan,Medicare Advantage,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,81.00000,44.14000,SilverSummit Healthplan,Medicare Advantage,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,outpatient,,,3141500.00000,1784843.22000,SilverSummit Healthplan,Medicare Advantage,,1099525.00,,,,,,,816790.00,3047255.00,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.22000,0.12000,SilverSummit Healthplan,Medicare Advantage,UD,0.07700,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.52000,0.30000,SilverSummit Healthplan,Medicare Advantage,UD,0.18200,,,,,,,0.13520,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.56000,0.32000,SilverSummit Healthplan,Medicare Advantage,UD,0.19600,,,,,,,0.14560,0.54320,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,SilverSummit Healthplan,Medicare Advantage,UD,0.07700,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.85000,0.48000,SilverSummit Healthplan,Medicare Advantage,UD,0.29750,,,,,,,0.22100,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,SilverSummit Healthplan,Medicare Advantage,UD,0.07700,,,,,,,0.05720,0.21340,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,outpatient,,,102.00000,65.18000,SilverSummit Healthplan,Medicare Advantage,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,outpatient,,,190.00000,121.41000,SilverSummit Healthplan,Medicare Advantage,,66.50,,,,,,,49.40,184.30,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,SilverSummit Healthplan,Medicare Advantage,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,SilverSummit Healthplan,Medicare Advantage,,187.25,,,,,,,139.10,518.95,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,outpatient,,,766.00000,489.47000,SilverSummit Healthplan,Medicare Advantage,,268.10,,,,,,,199.16,743.02,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,outpatient,,,159.00000,101.60000,SilverSummit Healthplan,Medicare Advantage,,55.65,,,,,,,41.34,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,outpatient,,,447.00000,285.63000,SilverSummit Healthplan,Medicare Advantage,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,outpatient,,,1413.00000,902.91000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,outpatient,,,3853.00000,2462.07000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,outpatient,,,313.00000,200.01000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,outpatient,,,1132.00000,723.35000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,outpatient,,,2695.00000,1722.10000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,outpatient,,,1619.00000,1034.54000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,SilverSummit Healthplan,Medicare Advantage,,187.25,,,,,,,139.10,518.95,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,outpatient,,,850.00000,543.15000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,outpatient,,,32.00000,20.45000,SilverSummit Healthplan,Medicare Advantage,,11.20,,,,,,,8.32,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,outpatient,,,134.00000,85.63000,SilverSummit Healthplan,Medicare Advantage,,46.90,,,,,,,34.84,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,SilverSummit Healthplan,Medicare Advantage,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,outpatient,,,709.00000,453.05000,SilverSummit Healthplan,Medicare Advantage,,248.15,,,,,,,184.34,687.73,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,outpatient,,,4880.00000,2357.04000,SilverSummit Healthplan,Medicare Advantage,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,outpatient,,,6024.00000,2909.59000,SilverSummit Healthplan,Medicare Advantage,,2108.40,,,,,,,1566.24,5843.28,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,SilverSummit Healthplan,Medicare Advantage,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,SilverSummit Healthplan,Medicare Advantage,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Medicare Advantage,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,outpatient,,,7413.00000,3580.48000,SilverSummit Healthplan,Medicare Advantage,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,SilverSummit Healthplan,Medicare Advantage,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,SilverSummit Healthplan,Medicare Advantage,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,SilverSummit Healthplan,Medicare Advantage,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,SilverSummit Healthplan,Medicare Advantage,,2513.35,,,,,,,1867.06,6965.57,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,outpatient,,,10654.00000,5145.88000,SilverSummit Healthplan,Medicare Advantage,,3728.90,,,,,,,2770.04,10334.38,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Medicare Advantage,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,SilverSummit Healthplan,Medicare Advantage,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,SilverSummit Healthplan,Medicare Advantage,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,11575.00000,5590.72000,SilverSummit Healthplan,Medicare Advantage,,4051.25,,,,,,,3009.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,13432.00000,6487.66000,SilverSummit Healthplan,Medicare Advantage,,4701.20,,,,,,,3492.32,13029.04,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,21904.00000,10579.63000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Medicare Advantage,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,SilverSummit Healthplan,Medicare Advantage,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Medicare Advantage,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,SilverSummit Healthplan,Medicare Advantage,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,12969.00000,6264.03000,SilverSummit Healthplan,Medicare Advantage,,4539.15,,,,,,,3371.94,12579.93,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Medicare Advantage,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,SilverSummit Healthplan,Medicare Advantage,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,SilverSummit Healthplan,Medicare Advantage,,989.45,,,,,,,735.02,2742.19,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,SilverSummit Healthplan,Medicare Advantage,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,SilverSummit Healthplan,Medicare Advantage,,46.90,,,,,,,34.84,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,outpatient,,,251.00000,121.23000,SilverSummit Healthplan,Medicare Advantage,,87.85,,,,,,,65.26,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Medicare Advantage,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Medicare Advantage,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Medicare Advantage,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,447.00000,215.90000,SilverSummit Healthplan,Medicare Advantage,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,SilverSummit Healthplan,Medicare Advantage,,989.45,,,,,,,735.02,2742.19,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,SilverSummit Healthplan,Medicare Advantage,,941.50,,,,,,,699.40,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,SilverSummit Healthplan,Medicare Advantage,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,2426.00000,1171.76000,SilverSummit Healthplan,Medicare Advantage,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,15334.00000,7406.32000,SilverSummit Healthplan,Medicare Advantage,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Medicare Advantage,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,SilverSummit Healthplan,Medicare Advantage,,989.45,,,,,,,735.02,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,251.00000,121.23000,SilverSummit Healthplan,Medicare Advantage,,87.85,,,,,,,65.26,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Medicare Advantage,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,SilverSummit Healthplan,Medicare Advantage,,989.45,,,,,,,735.02,2742.19,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,SilverSummit Healthplan,Medicare Advantage,,11.20,,,,,,,8.32,31.04,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Medicare Advantage,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,SilverSummit Healthplan,Medicare Advantage,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,outpatient,,,1485.00000,717.26000,SilverSummit Healthplan,Medicare Advantage,,519.75,,,,,,,386.10,1440.45,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,outpatient,,,2028.00000,979.52000,SilverSummit Healthplan,Medicare Advantage,,709.80,,,,,,,527.28,1967.16,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,SilverSummit Healthplan,Medicare Advantage,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,8107.00000,3915.68000,SilverSummit Healthplan,Medicare Advantage,,2837.45,,,,,,,2107.82,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,10422.00000,5033.83000,SilverSummit Healthplan,Medicare Advantage,,3647.70,,,,,,,2709.72,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,12737.00000,6151.97000,SilverSummit Healthplan,Medicare Advantage,,4457.95,,,,,,,3311.62,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,14239.00000,6877.44000,SilverSummit Healthplan,Medicare Advantage,,4983.65,,,,,,,3702.14,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,16429.00000,7935.21000,SilverSummit Healthplan,Medicare Advantage,,5750.15,,,,,,,4271.54,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,18619.00000,8992.98000,SilverSummit Healthplan,Medicare Advantage,,6516.65,,,,,,,4840.94,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,20809.00000,10050.75000,SilverSummit Healthplan,Medicare Advantage,,7283.15,,,,,,,5410.34,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,22999.00000,11108.52000,SilverSummit Healthplan,Medicare Advantage,,8049.65,,,,,,,5979.74,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,25189.00000,12166.29000,SilverSummit Healthplan,Medicare Advantage,,8816.15,,,,,,,6549.14,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,27379.00000,13224.06000,SilverSummit Healthplan,Medicare Advantage,,9582.65,,,,,,,7118.54,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,29569.00000,14281.83000,SilverSummit Healthplan,Medicare Advantage,,10349.15,,,,,,,7687.94,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,31759.00000,15339.60000,SilverSummit Healthplan,Medicare Advantage,,11115.65,,,,,,,8257.34,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,36139.00000,17455.14000,SilverSummit Healthplan,Medicare Advantage,,12648.65,,,,,,,9396.14,35054.83,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Medicare Advantage,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,SilverSummit Healthplan,Medicare Advantage,,1169.00,,,,,,,868.40,3239.80,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Medicare Advantage,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,SilverSummit Healthplan,Medicare Advantage,,11.20,,,,,,,8.32,31.04,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,SilverSummit Healthplan,Medicare Advantage,,46.90,,,,,,,34.84,129.98,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,SilverSummit Healthplan,Medicare Advantage,,66.50,,,,,,,49.40,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,outpatient,,,476.00000,229.91000,SilverSummit Healthplan,Medicare Advantage,,166.60,,,,,,,123.76,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,SilverSummit Healthplan,Medicare Advantage,,11.20,,,,,,,8.32,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,SilverSummit Healthplan,Medicare Advantage,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Medicare Advantage,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Medicare Advantage,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,outpatient,,,12506.00000,6040.40000,SilverSummit Healthplan,Medicare Advantage,,4377.10,,,,,,,3251.56,12130.82,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,outpatient,,,2404.80000,1161.52000,SilverSummit Healthplan,Medicare Advantage,,841.68,,,,,,,625.25,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,outpatient,,,969.00000,468.03000,SilverSummit Healthplan,Medicare Advantage,,339.15,,,,,,,251.94,939.93,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,outpatient,,,2256.90000,1090.08000,SilverSummit Healthplan,Medicare Advantage,,789.91,,,,,,,586.79,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,outpatient,,,644.30000,311.20000,SilverSummit Healthplan,Medicare Advantage,,225.50,,,,,,,167.52,624.97,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,SilverSummit Healthplan,Medicare Advantage,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,SilverSummit Healthplan,Medicare Advantage,,66.50,,,,,,,49.40,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,SilverSummit Healthplan,Medicare Advantage,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,outpatient,,,43804.00000,21157.33000,SilverSummit Healthplan,Medicare Advantage,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,outpatient,,,52564.00000,25388.41000,SilverSummit Healthplan,Medicare Advantage,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,outpatient,,,61324.00000,29619.49000,SilverSummit Healthplan,Medicare Advantage,,21463.40,,,,,,,15944.24,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,outpatient,,,70084.00000,33850.57000,SilverSummit Healthplan,Medicare Advantage,,24529.40,,,,,,,18221.84,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,outpatient,,,78844.00000,38081.65000,SilverSummit Healthplan,Medicare Advantage,,27595.40,,,,,,,20499.44,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,outpatient,,,87604.00000,42312.73000,SilverSummit Healthplan,Medicare Advantage,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,outpatient,,,96364.00000,46543.81000,SilverSummit Healthplan,Medicare Advantage,,33727.40,,,,,,,25054.64,93473.08,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,SilverSummit Healthplan,Medicare Advantage,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,outpatient,,,39424.00000,19041.79000,SilverSummit Healthplan,Medicare Advantage,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,SilverSummit Healthplan,Medicare Advantage,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,SilverSummit Healthplan,Medicare Advantage,,66.50,,,,,,,49.40,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Medicare Advantage,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,SilverSummit Healthplan,Medicare Advantage,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Medicare Advantage,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2023.00000,977.11000,SilverSummit Healthplan,Medicare Advantage,,708.05,,,,,,,525.98,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Medicare Advantage,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Medicare Advantage,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Medicare Advantage,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,SilverSummit Healthplan,Medicare Advantage,,2756.60,,,,,,,2047.76,7639.72,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,outpatient,,,10191.00000,4922.25000,SilverSummit Healthplan,Medicare Advantage,,3566.85,,,,,,,2649.66,9885.27,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,96.00000,46.37000,SilverSummit Healthplan,Medicare Advantage,,33.60,,,,,,,24.96,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Medicare Advantage,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,7876.00000,3804.11000,SilverSummit Healthplan,Medicare Advantage,,2756.60,,,,,,,2047.76,7639.72,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,SilverSummit Healthplan,Medicare Advantage,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,outpatient,,,5373.00000,2595.16000,SilverSummit Healthplan,Medicare Advantage,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,outpatient,,,6487.00000,3133.22000,SilverSummit Healthplan,Medicare Advantage,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,SilverSummit Healthplan,Medicare Advantage,,2756.60,,,,,,,2047.76,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,SilverSummit Healthplan,Medicare Advantage,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Medicare Advantage,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,outpatient,,,1126.00000,543.86000,SilverSummit Healthplan,Medicare Advantage,,394.10,,,,,,,292.76,1092.22,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,SilverSummit Healthplan,Medicare Advantage,,941.50,,,,,,,699.40,2609.30,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,4880.00000,2357.04000,SilverSummit Healthplan,Medicare Advantage,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,9260.00000,4472.58000,SilverSummit Healthplan,Medicare Advantage,,3241.00,,,,,,,2407.60,8982.20,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Medicare Advantage,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,588.00000,284.00000,SilverSummit Healthplan,Medicare Advantage,,205.80,,,,,,,152.88,570.36,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Medicare Advantage,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,SilverSummit Healthplan,Medicare Advantage,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,SilverSummit Healthplan,Medicare Advantage,,989.45,,,,,,,735.02,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,SilverSummit Healthplan,Medicare Advantage,,1169.00,,,,,,,868.40,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,SilverSummit Healthplan,Medicare Advantage,,1169.00,,,,,,,868.40,3239.80,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,SilverSummit Healthplan,Medicare Advantage,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,SilverSummit Healthplan,Medicare Advantage,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Medicare Advantage,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,outpatient,,,159.00000,76.80000,SilverSummit Healthplan,Medicare Advantage,,55.65,,,,,,,41.34,154.23,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,outpatient,,,588.00000,284.00000,SilverSummit Healthplan,Medicare Advantage,,205.80,,,,,,,152.88,570.36,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,SilverSummit Healthplan,Medicare Advantage,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,SilverSummit Healthplan,Medicare Advantage,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,outpatient,,,8107.00000,3915.68000,SilverSummit Healthplan,Medicare Advantage,,2837.45,,,,,,,2107.82,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,outpatient,,,10422.00000,5033.83000,SilverSummit Healthplan,Medicare Advantage,,3647.70,,,,,,,2709.72,10109.34,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,SilverSummit Healthplan,Medicare Advantage,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,SilverSummit Healthplan,Medicare Advantage,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,SilverSummit Healthplan,Medicare Advantage,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,outpatient,,,221.00000,106.74000,SilverSummit Healthplan,Medicare Advantage,,77.35,,,,,,,57.46,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,SilverSummit Healthplan,Medicare Advantage,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,SilverSummit Healthplan,Medicare Advantage,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,SilverSummit Healthplan,Medicare Advantage,,1169.00,,,,,,,868.40,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,outpatient,,,4153.00000,2005.90000,SilverSummit Healthplan,Medicare Advantage,,1453.55,,,,,,,1079.78,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,outpatient,,,5129.00000,2477.31000,SilverSummit Healthplan,Medicare Advantage,,1795.15,,,,,,,1333.54,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,SilverSummit Healthplan,Medicare Advantage,,2513.35,,,,,,,1867.06,6965.57,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,outpatient,,,52.50000,25.36000,SilverSummit Healthplan,Medicare Advantage,,18.38,,,,,,,13.65,50.92,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,outpatient,,,50.40000,24.34000,SilverSummit Healthplan,Medicare Advantage,,17.64,,,,,,,13.10,48.89,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,SilverSummit Healthplan,Medicare Advantage,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,SilverSummit Healthplan,Medicare Advantage,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,SilverSummit Healthplan,Medicare Advantage,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,SilverSummit Healthplan,Medicare Advantage,,11.20,,,,,,,8.32,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,SilverSummit Healthplan,Medicare Advantage,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,outpatient,,,709.00000,342.45000,SilverSummit Healthplan,Medicare Advantage,,248.15,,,,,,,184.34,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,166.00000,80.18000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,SilverSummit Healthplan,Medicare Advantage,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,SilverSummit Healthplan,Medicare Advantage,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,SilverSummit Healthplan,Medicare Advantage,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,131404.00000,74657.18000,SilverSummit Healthplan,Medicare Advantage,,45991.40,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,43800.00000,24884.97000,SilverSummit Healthplan,Medicare Advantage,,15330.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,SilverSummit Healthplan,Medicare Advantage,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,SilverSummit Healthplan,Medicare Advantage,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,SilverSummit Healthplan,Medicare Advantage,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,24090.00000,13686.73000,SilverSummit Healthplan,Medicare Advantage,,8431.50,,,,,,,6263.40,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,SilverSummit Healthplan,Medicare Advantage,,9965.90,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,SilverSummit Healthplan,Medicare Advantage,,6132.00,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,SilverSummit Healthplan,Medicare Advantage,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,SilverSummit Healthplan,Medicare Advantage,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,SilverSummit Healthplan,Medicare Advantage,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,SilverSummit Healthplan,Medicare Advantage,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,6105.00000,3468.56000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,13895.00000,7894.44000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,21900.00000,12442.48000,SilverSummit Healthplan,Medicare Advantage,,7665.00,,,,,,,5694.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,35040.00000,19907.98000,SilverSummit Healthplan,Medicare Advantage,,12264.00,,,,,,,9110.40,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,SilverSummit Healthplan,Medicare Advantage,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,SilverSummit Healthplan,Medicare Advantage,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,22776.00000,12940.18000,SilverSummit Healthplan,Medicare Advantage,,7971.60,,,,,,,5921.76,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,SilverSummit Healthplan,Medicare Advantage,,9965.90,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,SilverSummit Healthplan,Medicare Advantage,,6132.00,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,30664.00000,17421.75000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,35044.00000,19910.25000,SilverSummit Healthplan,Medicare Advantage,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,594.00000,238.19000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,594.00000,238.19000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2695.00000,1080.70000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,3853.00000,1545.05000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,outpatient,,,1413.00000,566.61000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,594.00000,238.19000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,3229.80000,1857.14000,SilverSummit Healthplan,Medicare Advantage,,1130.43,,,,,,,839.75,3132.91,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,854.40000,491.28000,SilverSummit Healthplan,Medicare Advantage,,299.04,,,,,,,222.14,828.77,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1200.50000,690.29000,SilverSummit Healthplan,Medicare Advantage,,420.18,,,,,,,312.13,1164.48,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1011.00000,581.32000,SilverSummit Healthplan,Medicare Advantage,,353.85,,,,,,,262.86,980.67,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1823.80000,1048.68000,SilverSummit Healthplan,Medicare Advantage,,638.33,,,,,,,474.19,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2028.50000,1166.39000,SilverSummit Healthplan,Medicare Advantage,,709.98,,,,,,,527.41,1967.64,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,841.00000,483.58000,SilverSummit Healthplan,Medicare Advantage,,294.35,,,,,,,218.66,815.77,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1366.20000,785.56000,SilverSummit Healthplan,Medicare Advantage,,478.17,,,,,,,355.21,1325.21,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1384.00000,795.80000,SilverSummit Healthplan,Medicare Advantage,,484.40,,,,,,,359.84,1342.48,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2458.70000,1413.75000,SilverSummit Healthplan,Medicare Advantage,,860.54,,,,,,,639.26,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2393.50000,1376.26000,SilverSummit Healthplan,Medicare Advantage,,837.73,,,,,,,622.31,2321.70,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1369.50000,787.46000,SilverSummit Healthplan,Medicare Advantage,,479.32,,,,,,,356.07,1328.41,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2697.40000,1551.00000,SilverSummit Healthplan,Medicare Advantage,,944.09,,,,,,,701.32,2616.48,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4621.80000,2657.54000,SilverSummit Healthplan,Medicare Advantage,,1617.63,,,,,,,1201.67,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2592.50000,1490.69000,SilverSummit Healthplan,Medicare Advantage,,907.38,,,,,,,674.05,2514.72,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,SilverSummit Healthplan,Medicare Advantage,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,SilverSummit Healthplan,Medicare Advantage,,2918.65,,,,,,,2168.14,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,SilverSummit Healthplan,Medicare Advantage,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,SilverSummit Healthplan,Medicare Advantage,,2837.45,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,SilverSummit Healthplan,Medicare Advantage,,394.10,,,,,,,292.76,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Medicare Advantage,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,SilverSummit Healthplan,Medicare Advantage,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,outpatient,,,20152.00000,11587.40000,SilverSummit Healthplan,Medicare Advantage,,7053.20,,,,,,,5239.52,19547.44,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,166.00000,95.45000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,447.00000,257.02000,SilverSummit Healthplan,Medicare Advantage,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,709.00000,407.67000,SilverSummit Healthplan,Medicare Advantage,,248.15,,,,,,,184.34,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,1272.00000,731.40000,SilverSummit Healthplan,Medicare Advantage,,445.20,,,,,,,330.72,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,SilverSummit Healthplan,Medicare Advantage,,941.50,,,,,,,699.40,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,3078.00000,1769.85000,SilverSummit Healthplan,Medicare Advantage,,1077.30,,,,,,,800.28,2985.66,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,70.00000,40.25000,SilverSummit Healthplan,Medicare Advantage,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,102.00000,58.65000,SilverSummit Healthplan,Medicare Advantage,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,221.00000,127.07000,SilverSummit Healthplan,Medicare Advantage,,77.35,,,,,,,57.46,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,SilverSummit Healthplan,Medicare Advantage,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,SilverSummit Healthplan,Medicare Advantage,,248.15,,,,,,,184.34,687.73,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,SilverSummit Healthplan,Medicare Advantage,,4377.10,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35482.00000,20402.15000,SilverSummit Healthplan,Medicare Advantage,,12418.70,,,,,,,9225.32,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39862.00000,22920.65000,SilverSummit Healthplan,Medicare Advantage,,13951.70,,,,,,,10364.12,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,44242.00000,25439.15000,SilverSummit Healthplan,Medicare Advantage,,15484.70,,,,,,,11502.92,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,48622.00000,27957.65000,SilverSummit Healthplan,Medicare Advantage,,17017.70,,,,,,,12641.72,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,53002.00000,30476.15000,SilverSummit Healthplan,Medicare Advantage,,18550.70,,,,,,,13780.52,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,SilverSummit Healthplan,Medicare Advantage,,21463.40,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,SilverSummit Healthplan,Medicare Advantage,,24529.40,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,SilverSummit Healthplan,Medicare Advantage,,27595.40,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,SilverSummit Healthplan,Medicare Advantage,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,SilverSummit Healthplan,Medicare Advantage,,33727.40,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,844.00000,485.30000,SilverSummit Healthplan,Medicare Advantage,,295.40,,,,,,,219.44,818.68,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,11575.00000,6655.62000,SilverSummit Healthplan,Medicare Advantage,,4051.25,,,,,,,3009.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14892.00000,8562.90000,SilverSummit Healthplan,Medicare Advantage,,5212.20,,,,,,,3871.92,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,24970.00000,14357.75000,SilverSummit Healthplan,Medicare Advantage,,8739.50,,,,,,,6492.20,24220.90,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,SilverSummit Healthplan,Medicare Advantage,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,166.00000,95.45000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,447.00000,257.02000,SilverSummit Healthplan,Medicare Advantage,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,SilverSummit Healthplan,Medicare Advantage,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,SilverSummit Healthplan,Medicare Advantage,,1169.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,SilverSummit Healthplan,Medicare Advantage,,1453.55,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4641.00000,2668.58000,SilverSummit Healthplan,Medicare Advantage,,1624.35,,,,,,,1206.66,4501.77,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,SilverSummit Healthplan,Medicare Advantage,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Medicare Advantage,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,SilverSummit Healthplan,Medicare Advantage,,33727.40,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,SilverSummit Healthplan,Medicare Advantage,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,SilverSummit Healthplan,Medicare Advantage,,45991.40,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,153304.00000,88149.80000,SilverSummit Healthplan,Medicare Advantage,,53656.40,,,,,,,39859.04,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,175204.00000,100742.30000,SilverSummit Healthplan,Medicare Advantage,,61321.40,,,,,,,45553.04,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,197104.00000,113334.80000,SilverSummit Healthplan,Medicare Advantage,,68986.40,,,,,,,51247.04,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,219004.00000,125927.30000,SilverSummit Healthplan,Medicare Advantage,,76651.40,,,,,,,56941.04,212433.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Medicare Advantage,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Medicare Advantage,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Medicare Advantage,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Medicare Advantage,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,SilverSummit Healthplan,Medicare Advantage,,16864.40,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Medicare Advantage,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,SilverSummit Healthplan,Medicare Advantage,,19930.40,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,SilverSummit Healthplan,Medicare Advantage,,21463.40,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Medicare Advantage,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Medicare Advantage,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Medicare Advantage,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Medicare Advantage,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Medicare Advantage,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,SilverSummit Healthplan,Medicare Advantage,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,SilverSummit Healthplan,Medicare Advantage,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,SilverSummit Healthplan,Medicare Advantage,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Medicare Advantage,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Medicare Advantage,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Medicare Advantage,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,SilverSummit Healthplan,Medicare Advantage,,16864.40,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Medicare Advantage,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,SilverSummit Healthplan,Medicare Advantage,,19930.40,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,SilverSummit Healthplan,Medicare Advantage,,21463.40,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,SilverSummit Healthplan,Medicare Advantage,,24529.40,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,SilverSummit Healthplan,Medicare Advantage,,27595.40,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,SilverSummit Healthplan,Medicare Advantage,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,SilverSummit Healthplan,Medicare Advantage,,33727.40,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,SilverSummit Healthplan,Medicare Advantage,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,SilverSummit Healthplan,Medicare Advantage,,42925.40,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,135784.00000,78075.80000,SilverSummit Healthplan,Medicare Advantage,,47524.40,,,,,,,35303.84,131710.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Medicare Advantage,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Medicare Advantage,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Medicare Advantage,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,SilverSummit Healthplan,Medicare Advantage,,16864.40,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,55630.00000,31987.25000,SilverSummit Healthplan,Medicare Advantage,,19470.50,,,,,,,14463.80,53961.10,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,SilverSummit Healthplan,Medicare Advantage,,941.50,,,,,,,699.40,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,SilverSummit Healthplan,Medicare Advantage,,4907.00,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,17962.00000,10328.15000,SilverSummit Healthplan,Medicare Advantage,,6286.70,,,,,,,4670.12,17423.14,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,2421.00000,1392.07000,SilverSummit Healthplan,Medicare Advantage,,847.35,,,,,,,629.46,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Medicare Advantage,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,SilverSummit Healthplan,Medicare Advantage,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,SilverSummit Healthplan,Medicare Advantage,,941.50,,,,,,,699.40,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,27160.00000,15617.00000,SilverSummit Healthplan,Medicare Advantage,,9506.00,,,,,,,7061.60,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,SilverSummit Healthplan,Medicare Advantage,,11498.90,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Medicare Advantage,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Medicare Advantage,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Medicare Advantage,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,SilverSummit Healthplan,Medicare Advantage,,27595.40,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,28470.00000,16370.25000,SilverSummit Healthplan,Medicare Advantage,,9964.50,,,,,,,7402.20,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,43800.00000,25185.00000,SilverSummit Healthplan,Medicare Advantage,,15330.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Medicare Advantage,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,SilverSummit Healthplan,Medicare Advantage,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,SilverSummit Healthplan,Medicare Advantage,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,SilverSummit Healthplan,Medicare Advantage,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,SilverSummit Healthplan,Medicare Advantage,,11498.90,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Medicare Advantage,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,54754.00000,31483.55000,SilverSummit Healthplan,Medicare Advantage,,19163.90,,,,,,,14236.04,53111.38,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,SilverSummit Healthplan,Medicare Advantage,,941.50,,,,,,,699.40,2609.30,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,61320.00000,35259.00000,SilverSummit Healthplan,Medicare Advantage,,21462.00,,,,,,,15943.20,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,70080.00000,40296.00000,SilverSummit Healthplan,Medicare Advantage,,24528.00,,,,,,,18220.80,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,78840.00000,45333.00000,SilverSummit Healthplan,Medicare Advantage,,27594.00,,,,,,,20498.40,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,SilverSummit Healthplan,Medicare Advantage,,33727.40,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,SilverSummit Healthplan,Medicare Advantage,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,SilverSummit Healthplan,Medicare Advantage,,42925.40,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Medicare Advantage,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Medicare Advantage,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,SilverSummit Healthplan,Medicare Advantage,,8432.90,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,SilverSummit Healthplan,Medicare Advantage,,11498.90,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Medicare Advantage,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Medicare Advantage,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,166.00000,95.45000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1883.00000,1082.72000,SilverSummit Healthplan,Medicare Advantage,,659.05,,,,,,,489.58,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,SilverSummit Healthplan,Medicare Advantage,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,7644.00000,4395.30000,SilverSummit Healthplan,Medicare Advantage,,2675.40,,,,,,,1987.44,7414.68,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,SilverSummit Healthplan,Medicare Advantage,,941.50,,,,,,,699.40,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Medicare Advantage,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Medicare Advantage,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,SilverSummit Healthplan,Medicare Advantage,,564.90,,,,,,,419.64,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Medicare Advantage,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Medicare Advantage,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,SilverSummit Healthplan,Medicare Advantage,,8432.90,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,SilverSummit Healthplan,Medicare Advantage,,9965.90,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,SilverSummit Healthplan,Medicare Advantage,,11498.90,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,37234.00000,21409.55000,SilverSummit Healthplan,Medicare Advantage,,13031.90,,,,,,,9680.84,36116.98,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Medicare Advantage,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Medicare Advantage,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Medicare Advantage,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Medicare Advantage,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Medicare Advantage,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Medicare Advantage,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,SilverSummit Healthplan,Medicare Advantage,,27595.40,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,159.00000,91.42000,SilverSummit Healthplan,Medicare Advantage,,55.65,,,,,,,41.34,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,SilverSummit Healthplan,Medicare Advantage,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,SilverSummit Healthplan,Medicare Advantage,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,SilverSummit Healthplan,Medicare Advantage,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,SilverSummit Healthplan,Medicare Advantage,,989.45,,,,,,,735.02,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,SilverSummit Healthplan,Medicare Advantage,,1169.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,SilverSummit Healthplan,Medicare Advantage,,2837.45,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Medicare Advantage,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,SilverSummit Healthplan,Medicare Advantage,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,SilverSummit Healthplan,Medicare Advantage,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,SilverSummit Healthplan,Medicare Advantage,,45991.40,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Medicare Advantage,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,18400.00000,10580.00000,SilverSummit Healthplan,Medicare Advantage,,6440.00,,,,,,,4784.00,17848.00,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,SilverSummit Healthplan,Medicare Advantage,,8432.90,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,SilverSummit Healthplan,Medicare Advantage,,9965.90,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,SilverSummit Healthplan,Medicare Advantage,,11498.90,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Medicare Advantage,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Medicare Advantage,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Medicare Advantage,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Medicare Advantage,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,SilverSummit Healthplan,Medicare Advantage,,564.90,,,,,,,419.64,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Medicare Advantage,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,SilverSummit Healthplan,Medicare Advantage,,19930.40,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Medicare Advantage,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,5368.00000,3086.60000,SilverSummit Healthplan,Medicare Advantage,,1878.80,,,,,,,1395.68,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Medicare Advantage,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Medicare Advantage,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,SilverSummit Healthplan,Medicare Advantage,,4907.00,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Medicare Advantage,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,25408.00000,14609.60000,SilverSummit Healthplan,Medicare Advantage,,8892.80,,,,,,,6606.08,24645.76,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Medicare Advantage,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Medicare Advantage,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,8112.00000,4664.40000,SilverSummit Healthplan,Medicare Advantage,,2839.20,,,,,,,2109.12,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,10431.00000,5997.82000,SilverSummit Healthplan,Medicare Advantage,,3650.85,,,,,,,2712.06,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Medicare Advantage,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,SilverSummit Healthplan,Medicare Advantage,,11498.90,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Medicare Advantage,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,46870.00000,26950.25000,SilverSummit Healthplan,Medicare Advantage,,16404.50,,,,,,,12186.20,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,51250.00000,29468.75000,SilverSummit Healthplan,Medicare Advantage,,17937.50,,,,,,,13325.00,49712.50,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Medicare Advantage,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Medicare Advantage,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Medicare Advantage,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,SilverSummit Healthplan,Medicare Advantage,,27595.40,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,SilverSummit Healthplan,Medicare Advantage,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,166.00000,95.45000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,588.00000,338.10000,SilverSummit Healthplan,Medicare Advantage,,205.80,,,,,,,152.88,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Medicare Advantage,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,SilverSummit Healthplan,Medicare Advantage,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Medicare Advantage,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,SilverSummit Healthplan,Medicare Advantage,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7876.00000,4528.70000,SilverSummit Healthplan,Medicare Advantage,,2756.60,,,,,,,2047.76,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Medicare Advantage,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Medicare Advantage,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,SilverSummit Healthplan,Medicare Advantage,,8432.90,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5856.00000,3367.20000,SilverSummit Healthplan,Medicare Advantage,,2049.60,,,,,,,1522.56,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,SilverSummit Healthplan,Medicare Advantage,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,SilverSummit Healthplan,Medicare Advantage,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,SilverSummit Healthplan,Medicare Advantage,,2918.65,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Medicare Advantage,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Medicare Advantage,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,SilverSummit Healthplan,Medicare Advantage,,2108.40,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,SilverSummit Healthplan,Medicare Advantage,,4377.10,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Medicare Advantage,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Medicare Advantage,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,SilverSummit Healthplan,Medicare Advantage,,2108.40,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,SilverSummit Healthplan,Medicare Advantage,,4377.10,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4392.00000,2525.40000,SilverSummit Healthplan,Medicare Advantage,,1537.20,,,,,,,1141.92,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Medicare Advantage,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,SilverSummit Healthplan,Medicare Advantage,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Medicare Advantage,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Medicare Advantage,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,SilverSummit Healthplan,Medicare Advantage,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,SilverSummit Healthplan,Medicare Advantage,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,SilverSummit Healthplan,Medicare Advantage,,394.10,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Medicare Advantage,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Medicare Advantage,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,SilverSummit Healthplan,Medicare Advantage,,2108.40,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,SilverSummit Healthplan,Medicare Advantage,,4377.10,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,SilverSummit Healthplan,Medicare Advantage,,4753.70,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Medicare Advantage,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Medicare Advantage,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2152.00000,1237.40000,SilverSummit Healthplan,Medicare Advantage,,753.20,,,,,,,559.52,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,SilverSummit Healthplan,Medicare Advantage,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,SilverSummit Healthplan,Medicare Advantage,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,SilverSummit Healthplan,Medicare Advantage,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,SilverSummit Healthplan,Medicare Advantage,,2108.40,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Medicare Advantage,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Medicare Advantage,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Medicare Advantage,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,SilverSummit Healthplan,Medicare Advantage,,2108.40,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,SilverSummit Healthplan,Medicare Advantage,,394.10,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Medicare Advantage,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Medicare Advantage,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,SilverSummit Healthplan,Medicare Advantage,,2108.40,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,SilverSummit Healthplan,Medicare Advantage,,4377.10,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,SilverSummit Healthplan,Medicare Advantage,,4753.70,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Medicare Advantage,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Medicare Advantage,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Medicare Advantage,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8802.00000,5061.15000,SilverSummit Healthplan,Medicare Advantage,,3080.70,,,,,,,2288.52,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10654.00000,6126.05000,SilverSummit Healthplan,Medicare Advantage,,3728.90,,,,,,,2770.04,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,SilverSummit Healthplan,Medicare Advantage,,4377.10,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,SilverSummit Healthplan,Medicare Advantage,,4753.70,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Medicare Advantage,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17086.00000,9824.45000,SilverSummit Healthplan,Medicare Advantage,,5980.10,,,,,,,4442.36,16573.42,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,SilverSummit Healthplan,Medicare Advantage,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,SilverSummit Healthplan,Medicare Advantage,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,SilverSummit Healthplan,Medicare Advantage,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,SilverSummit Healthplan,Medicare Advantage,,2918.65,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,SilverSummit Healthplan,Medicare Advantage,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,SilverSummit Healthplan,Medicare Advantage,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,SilverSummit Healthplan,Medicare Advantage,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,SilverSummit Healthplan,Medicare Advantage,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,SilverSummit Healthplan,Medicare Advantage,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Medicare Advantage,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Medicare Advantage,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,SilverSummit Healthplan,Medicare Advantage,,8432.90,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,SilverSummit Healthplan,Medicare Advantage,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,SilverSummit Healthplan,Medicare Advantage,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,SilverSummit Healthplan,Medicare Advantage,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,SilverSummit Healthplan,Medicare Advantage,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,SilverSummit Healthplan,Medicare Advantage,,989.45,,,,,,,735.02,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,SilverSummit Healthplan,Medicare Advantage,,1169.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,SilverSummit Healthplan,Medicare Advantage,,1453.55,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,SilverSummit Healthplan,Medicare Advantage,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,SilverSummit Healthplan,Medicare Advantage,,2918.65,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9728.00000,5593.60000,SilverSummit Healthplan,Medicare Advantage,,3404.80,,,,,,,2529.28,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11117.00000,6392.28000,SilverSummit Healthplan,Medicare Advantage,,3890.95,,,,,,,2890.42,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Medicare Advantage,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Medicare Advantage,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Medicare Advantage,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,SilverSummit Healthplan,Medicare Advantage,,16864.40,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Medicare Advantage,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,SilverSummit Healthplan,Medicare Advantage,,19930.40,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,SilverSummit Healthplan,Medicare Advantage,,21463.40,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Medicare Advantage,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,SilverSummit Healthplan,Medicare Advantage,,24529.40,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,SilverSummit Healthplan,Medicare Advantage,,26062.40,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,SilverSummit Healthplan,Medicare Advantage,,27595.40,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,SilverSummit Healthplan,Medicare Advantage,,29128.40,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,111694.00000,64224.05000,SilverSummit Healthplan,Medicare Advantage,,39092.90,,,,,,,29040.44,108343.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,SilverSummit Healthplan,Medicare Advantage,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,SilverSummit Healthplan,Medicare Advantage,,248.15,,,,,,,184.34,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,991.00000,569.82000,SilverSummit Healthplan,Medicare Advantage,,346.85,,,,,,,257.66,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1490.00000,856.75000,SilverSummit Healthplan,Medicare Advantage,,521.50,,,,,,,387.40,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,SilverSummit Healthplan,Medicare Advantage,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,SilverSummit Healthplan,Medicare Advantage,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,SilverSummit Healthplan,Medicare Advantage,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,SilverSummit Healthplan,Medicare Advantage,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,SilverSummit Healthplan,Medicare Advantage,,2918.65,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Medicare Advantage,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Medicare Advantage,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Medicare Advantage,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Medicare Advantage,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,SilverSummit Healthplan,Medicare Advantage,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,SilverSummit Healthplan,Medicare Advantage,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,6945.00000,3993.37000,SilverSummit Healthplan,Medicare Advantage,,2430.75,,,,,,,1805.70,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Medicare Advantage,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,447.00000,257.02000,SilverSummit Healthplan,Medicare Advantage,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Medicare Advantage,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,SilverSummit Healthplan,Medicare Advantage,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,SilverSummit Healthplan,Medicare Advantage,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,166.00000,95.45000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,SilverSummit Healthplan,Medicare Advantage,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Medicare Advantage,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Medicare Advantage,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Medicare Advantage,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,50374.00000,28965.05000,SilverSummit Healthplan,Medicare Advantage,,17630.90,,,,,,,13097.24,48862.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,SilverSummit Healthplan,Medicare Advantage,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,SilverSummit Healthplan,Medicare Advantage,,8432.90,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,SilverSummit Healthplan,Medicare Advantage,,9965.90,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,SilverSummit Healthplan,Medicare Advantage,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,SilverSummit Healthplan,Medicare Advantage,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,SilverSummit Healthplan,Medicare Advantage,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,SilverSummit Healthplan,Medicare Advantage,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Medicare Advantage,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Medicare Advantage,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Medicare Advantage,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,SilverSummit Healthplan,Medicare Advantage,,16864.40,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,850.00000,488.75000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,SilverSummit Healthplan,Medicare Advantage,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,SilverSummit Healthplan,Medicare Advantage,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Medicare Advantage,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Medicare Advantage,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,SilverSummit Healthplan,Medicare Advantage,,16864.40,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Medicare Advantage,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,SilverSummit Healthplan,Medicare Advantage,,19930.40,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,SilverSummit Healthplan,Medicare Advantage,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,SilverSummit Healthplan,Medicare Advantage,,26062.40,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,SilverSummit Healthplan,Medicare Advantage,,29128.40,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,91984.00000,52890.80000,SilverSummit Healthplan,Medicare Advantage,,32194.40,,,,,,,23915.84,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,100744.00000,57927.80000,SilverSummit Healthplan,Medicare Advantage,,35260.40,,,,,,,26193.44,97721.68,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,166.00000,95.45000,SilverSummit Healthplan,Medicare Advantage,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,447.00000,257.02000,SilverSummit Healthplan,Medicare Advantage,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,709.00000,407.67000,SilverSummit Healthplan,Medicare Advantage,,248.15,,,,,,,184.34,687.73,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,SilverSummit Healthplan,Medicare Advantage,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,SilverSummit Healthplan,Medicare Advantage,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,SilverSummit Healthplan,Medicare Advantage,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,SilverSummit Healthplan,Medicare Advantage,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,SilverSummit Healthplan,Medicare Advantage,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,SilverSummit Healthplan,Medicare Advantage,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,SilverSummit Healthplan,Medicare Advantage,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,SilverSummit Healthplan,Medicare Advantage,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,SilverSummit Healthplan,Medicare Advantage,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,SilverSummit Healthplan,Medicare Advantage,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,SilverSummit Healthplan,Medicare Advantage,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2180.20000,1253.61000,SilverSummit Healthplan,Medicare Advantage,,763.07,,,,,,,566.85,2114.79,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1880.60000,1081.34000,SilverSummit Healthplan,Medicare Advantage,,658.21,,,,,,,488.96,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2908.70000,1672.50000,SilverSummit Healthplan,Medicare Advantage,,1018.04,,,,,,,756.26,2821.44,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,outpatient,,,34.00000,25.74000,SilverSummit Healthplan,Medicare Advantage,,11.90,,,,,,,8.84,32.98,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,outpatient,,,13.00000,9.84000,SilverSummit Healthplan,Medicare Advantage,,4.55,,,,,,,3.38,12.61,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,SilverSummit Healthplan,Medicare Advantage,,98.35,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,SilverSummit Healthplan,Medicare Advantage,,98.35,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,SilverSummit Healthplan,Medicare Advantage,,98.35,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,SilverSummit Healthplan,Medicare Advantage,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,SilverSummit Healthplan,Medicare Advantage,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,SilverSummit Healthplan,Medicare Advantage,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,outpatient,,,122.00000,92.35000,SilverSummit Healthplan,Medicare Advantage,,42.70,,,,,,,31.72,118.34,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,SilverSummit Healthplan,Medicare Advantage,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,SilverSummit Healthplan,Medicare Advantage,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,SilverSummit Healthplan,Medicare Advantage,,5.25,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,SilverSummit Healthplan,Medicare Advantage,,5.25,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,SilverSummit Healthplan,Medicare Advantage,,5.95,,,,,,,4.42,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,SilverSummit Healthplan,Medicare Advantage,,5.95,,,,,,,4.42,16.49,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,outpatient,,,359.00000,271.76000,SilverSummit Healthplan,Medicare Advantage,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,outpatient,,,359.00000,271.76000,SilverSummit Healthplan,Medicare Advantage,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,outpatient,,,359.00000,271.76000,SilverSummit Healthplan,Medicare Advantage,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,outpatient,,,155.00000,117.34000,SilverSummit Healthplan,Medicare Advantage,,54.25,,,,,,,40.30,150.35,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,outpatient,,,294.00000,222.56000,SilverSummit Healthplan,Medicare Advantage,,102.90,,,,,,,76.44,285.18,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,outpatient,,,1511.00000,1143.83000,SilverSummit Healthplan,Medicare Advantage,,528.85,,,,,,,392.86,1465.67,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,SilverSummit Healthplan,Medicare Advantage,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,SilverSummit Healthplan,Medicare Advantage,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,outpatient,,,150.00000,113.55000,SilverSummit Healthplan,Medicare Advantage,,52.50,,,,,,,39.00,145.50,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,outpatient,,,110.00000,83.27000,SilverSummit Healthplan,Medicare Advantage,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,outpatient,,,158.00000,119.61000,SilverSummit Healthplan,Medicare Advantage,,55.30,,,,,,,41.08,153.26,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,outpatient,,,153.00000,115.82000,SilverSummit Healthplan,Medicare Advantage,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,outpatient,,,157.00000,118.85000,SilverSummit Healthplan,Medicare Advantage,,54.95,,,,,,,40.82,152.29,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,outpatient,,,26.00000,19.68000,SilverSummit Healthplan,Medicare Advantage,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,outpatient,,,37.00000,28.01000,SilverSummit Healthplan,Medicare Advantage,,12.95,,,,,,,9.62,35.89,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,outpatient,,,268.00000,202.88000,SilverSummit Healthplan,Medicare Advantage,,93.80,,,,,,,69.68,259.96,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,outpatient,,,91.00000,68.89000,SilverSummit Healthplan,Medicare Advantage,,31.85,,,,,,,23.66,88.27,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,outpatient,,,200.00000,151.40000,SilverSummit Healthplan,Medicare Advantage,,70.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,outpatient,,,152.00000,115.06000,SilverSummit Healthplan,Medicare Advantage,,53.20,,,,,,,39.52,147.44,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,outpatient,,,359.00000,271.76000,SilverSummit Healthplan,Medicare Advantage,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,outpatient,,,69.00000,33.26000,SilverSummit Healthplan,Medicare Advantage,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,outpatient,,,75.00000,36.15000,SilverSummit Healthplan,Medicare Advantage,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,outpatient,,,45.00000,21.69000,SilverSummit Healthplan,Medicare Advantage,,15.75,,,,,,,11.70,43.65,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,outpatient,,,68.00000,32.78000,SilverSummit Healthplan,Medicare Advantage,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,outpatient,,,61.00000,29.40000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,outpatient,,,64.00000,30.85000,SilverSummit Healthplan,Medicare Advantage,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,outpatient,,,195.00000,93.99000,SilverSummit Healthplan,Medicare Advantage,,68.25,,,,,,,50.70,189.15,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,outpatient,,,14.00000,6.75000,SilverSummit Healthplan,Medicare Advantage,,4.90,,,,,,,3.64,13.58,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,outpatient,,,53.00000,25.55000,SilverSummit Healthplan,Medicare Advantage,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,outpatient,,,82.00000,39.52000,SilverSummit Healthplan,Medicare Advantage,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,SilverSummit Healthplan,Medicare Advantage,,49.35,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,SilverSummit Healthplan,Medicare Advantage,,49.35,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,outpatient,,,91.00000,43.86000,SilverSummit Healthplan,Medicare Advantage,,31.85,,,,,,,23.66,88.27,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,outpatient,,,69.00000,33.26000,SilverSummit Healthplan,Medicare Advantage,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,outpatient,,,205.00000,98.81000,SilverSummit Healthplan,Medicare Advantage,,71.75,,,,,,,53.30,198.85,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,outpatient,,,50.00000,24.10000,SilverSummit Healthplan,Medicare Advantage,,17.50,,,,,,,13.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,outpatient,,,406.00000,195.69000,SilverSummit Healthplan,Medicare Advantage,,142.10,,,,,,,105.56,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,outpatient,,,101.00000,48.68000,SilverSummit Healthplan,Medicare Advantage,,35.35,,,,,,,26.26,97.97,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,outpatient,,,375.00000,180.75000,SilverSummit Healthplan,Medicare Advantage,,131.25,,,,,,,97.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,outpatient,,,362.00000,174.48000,SilverSummit Healthplan,Medicare Advantage,,126.70,,,,,,,94.12,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,outpatient,,,325.00000,156.65000,SilverSummit Healthplan,Medicare Advantage,,113.75,,,,,,,84.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,outpatient,,,121.00000,58.32000,SilverSummit Healthplan,Medicare Advantage,,42.35,,,,,,,31.46,117.37,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,outpatient,,,115.00000,55.43000,SilverSummit Healthplan,Medicare Advantage,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,outpatient,,,300.00000,144.60000,SilverSummit Healthplan,Medicare Advantage,,105.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,outpatient,,,51.00000,24.58000,SilverSummit Healthplan,Medicare Advantage,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,SilverSummit Healthplan,Medicare Advantage,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,SilverSummit Healthplan,Medicare Advantage,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,outpatient,,,194.00000,93.51000,SilverSummit Healthplan,Medicare Advantage,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,outpatient,,,68.00000,32.78000,SilverSummit Healthplan,Medicare Advantage,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,outpatient,,,329.00000,158.58000,SilverSummit Healthplan,Medicare Advantage,,115.15,,,,,,,85.54,319.13,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,outpatient,,,24.00000,11.57000,SilverSummit Healthplan,Medicare Advantage,,8.40,,,,,,,6.24,23.28,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,outpatient,,,30.00000,14.46000,SilverSummit Healthplan,Medicare Advantage,,10.50,,,,,,,7.80,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,outpatient,,,53.00000,25.55000,SilverSummit Healthplan,Medicare Advantage,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,outpatient,,,270.00000,130.14000,SilverSummit Healthplan,Medicare Advantage,,94.50,,,,,,,70.20,261.90,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,SilverSummit Healthplan,Medicare Advantage,,43.05,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,SilverSummit Healthplan,Medicare Advantage,,43.05,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,outpatient,,,37.00000,17.83000,SilverSummit Healthplan,Medicare Advantage,,12.95,,,,,,,9.62,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,outpatient,,,41.00000,19.76000,SilverSummit Healthplan,Medicare Advantage,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,outpatient,,,72.00000,34.70000,SilverSummit Healthplan,Medicare Advantage,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,outpatient,,,77.00000,37.11000,SilverSummit Healthplan,Medicare Advantage,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,outpatient,,,90.00000,43.38000,SilverSummit Healthplan,Medicare Advantage,,31.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,outpatient,,,44.00000,21.21000,SilverSummit Healthplan,Medicare Advantage,,15.40,,,,,,,11.44,42.68,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,outpatient,,,115.00000,55.43000,SilverSummit Healthplan,Medicare Advantage,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,outpatient,,,20.00000,9.64000,SilverSummit Healthplan,Medicare Advantage,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Medicare Advantage,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,outpatient,,,341.00000,164.36000,SilverSummit Healthplan,Medicare Advantage,,119.35,,,,,,,88.66,330.77,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,outpatient,,,54.00000,26.03000,SilverSummit Healthplan,Medicare Advantage,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,outpatient,,,53.00000,25.55000,SilverSummit Healthplan,Medicare Advantage,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,outpatient,,,88.00000,42.42000,SilverSummit Healthplan,Medicare Advantage,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,outpatient,,,89.00000,42.90000,SilverSummit Healthplan,Medicare Advantage,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,outpatient,,,61.00000,29.40000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,SilverSummit Healthplan,Medicare Advantage,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,SilverSummit Healthplan,Medicare Advantage,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,SilverSummit Healthplan,Medicare Advantage,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,SilverSummit Healthplan,Medicare Advantage,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,outpatient,,,95.00000,45.79000,SilverSummit Healthplan,Medicare Advantage,,33.25,,,,,,,24.70,92.15,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,outpatient,,,132.00000,63.62000,SilverSummit Healthplan,Medicare Advantage,,46.20,,,,,,,34.32,128.04,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,outpatient,,,83.00000,40.01000,SilverSummit Healthplan,Medicare Advantage,,29.05,,,,,,,21.58,80.51,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,outpatient,,,387.00000,186.53000,SilverSummit Healthplan,Medicare Advantage,,135.45,,,,,,,100.62,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,outpatient,,,387.00000,186.53000,SilverSummit Healthplan,Medicare Advantage,,135.45,,,,,,,100.62,375.39,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,outpatient,,,31.00000,14.94000,SilverSummit Healthplan,Medicare Advantage,,10.85,,,,,,,8.06,30.07,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,outpatient,,,36.00000,17.35000,SilverSummit Healthplan,Medicare Advantage,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,outpatient,,,160.00000,77.12000,SilverSummit Healthplan,Medicare Advantage,,56.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,outpatient,,,112.00000,53.98000,SilverSummit Healthplan,Medicare Advantage,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,outpatient,,,14.00000,6.75000,SilverSummit Healthplan,Medicare Advantage,,4.90,,,,,,,3.64,13.58,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,outpatient,,,16.00000,7.71000,SilverSummit Healthplan,Medicare Advantage,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,outpatient,,,71.00000,34.22000,SilverSummit Healthplan,Medicare Advantage,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,outpatient,,,116.00000,55.91000,SilverSummit Healthplan,Medicare Advantage,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,outpatient,,,81.00000,39.04000,SilverSummit Healthplan,Medicare Advantage,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,outpatient,,,97.00000,46.75000,SilverSummit Healthplan,Medicare Advantage,,33.95,,,,,,,25.22,94.09,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,outpatient,,,77.00000,37.11000,SilverSummit Healthplan,Medicare Advantage,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,outpatient,,,35.00000,16.87000,SilverSummit Healthplan,Medicare Advantage,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,outpatient,,,65.00000,31.33000,SilverSummit Healthplan,Medicare Advantage,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,outpatient,,,74.00000,35.67000,SilverSummit Healthplan,Medicare Advantage,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,outpatient,,,250.00000,120.50000,SilverSummit Healthplan,Medicare Advantage,,87.50,,,,,,,65.00,242.50,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,outpatient,,,90.00000,43.38000,SilverSummit Healthplan,Medicare Advantage,,31.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,outpatient,,,90.00000,43.38000,SilverSummit Healthplan,Medicare Advantage,,31.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Medicare Advantage,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,outpatient,,,36.00000,17.35000,SilverSummit Healthplan,Medicare Advantage,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,outpatient,,,78.00000,37.60000,SilverSummit Healthplan,Medicare Advantage,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,outpatient,,,115.00000,55.43000,SilverSummit Healthplan,Medicare Advantage,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Medicare Advantage,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,outpatient,,,76.00000,36.63000,SilverSummit Healthplan,Medicare Advantage,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,outpatient,,,53.00000,25.55000,SilverSummit Healthplan,Medicare Advantage,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,outpatient,,,70.00000,33.74000,SilverSummit Healthplan,Medicare Advantage,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,outpatient,,,169.00000,81.46000,SilverSummit Healthplan,Medicare Advantage,,59.15,,,,,,,43.94,163.93,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,outpatient,,,28.00000,13.50000,SilverSummit Healthplan,Medicare Advantage,,9.80,,,,,,,7.28,27.16,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,outpatient,,,51.00000,24.58000,SilverSummit Healthplan,Medicare Advantage,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,outpatient,,,15.00000,7.23000,SilverSummit Healthplan,Medicare Advantage,,5.25,,,,,,,3.90,14.55,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,outpatient,,,18.00000,8.68000,SilverSummit Healthplan,Medicare Advantage,,6.30,,,,,,,4.68,17.46,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,outpatient,,,61.00000,29.40000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,outpatient,,,550.00000,265.10000,SilverSummit Healthplan,Medicare Advantage,,192.50,,,,,,,143.00,533.50,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,SilverSummit Healthplan,Medicare Advantage,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,outpatient,,,392.00000,188.94000,SilverSummit Healthplan,Medicare Advantage,,137.20,,,,,,,101.92,380.24,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,outpatient,,,75.00000,36.15000,SilverSummit Healthplan,Medicare Advantage,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,SilverSummit Healthplan,Medicare Advantage,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,outpatient,,,100.00000,48.20000,SilverSummit Healthplan,Medicare Advantage,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,outpatient,,,153.00000,73.75000,SilverSummit Healthplan,Medicare Advantage,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,outpatient,,,909.00000,438.14000,SilverSummit Healthplan,Medicare Advantage,,318.15,,,,,,,236.34,881.73,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,outpatient,,,266.00000,128.21000,SilverSummit Healthplan,Medicare Advantage,,93.10,,,,,,,69.16,258.02,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,outpatient,,,275.00000,132.55000,SilverSummit Healthplan,Medicare Advantage,,96.25,,,,,,,71.50,266.75,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,outpatient,,,61.00000,29.40000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,outpatient,,,84.00000,40.49000,SilverSummit Healthplan,Medicare Advantage,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,outpatient,,,174.00000,83.87000,SilverSummit Healthplan,Medicare Advantage,,60.90,,,,,,,45.24,168.78,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Medicare Advantage,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,outpatient,,,68.00000,32.78000,SilverSummit Healthplan,Medicare Advantage,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,outpatient,,,211.00000,101.70000,SilverSummit Healthplan,Medicare Advantage,,73.85,,,,,,,54.86,204.67,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,outpatient,,,65.00000,31.33000,SilverSummit Healthplan,Medicare Advantage,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,outpatient,,,83.00000,40.01000,SilverSummit Healthplan,Medicare Advantage,,29.05,,,,,,,21.58,80.51,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,outpatient,,,54.00000,26.03000,SilverSummit Healthplan,Medicare Advantage,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,outpatient,,,323.00000,155.69000,SilverSummit Healthplan,Medicare Advantage,,113.05,,,,,,,83.98,313.31,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,outpatient,,,35.00000,16.87000,SilverSummit Healthplan,Medicare Advantage,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,outpatient,,,20.00000,9.64000,SilverSummit Healthplan,Medicare Advantage,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,outpatient,,,34.00000,16.39000,SilverSummit Healthplan,Medicare Advantage,,11.90,,,,,,,8.84,32.98,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,outpatient,,,29.00000,13.98000,SilverSummit Healthplan,Medicare Advantage,,10.15,,,,,,,7.54,28.13,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,outpatient,,,80.00000,38.56000,SilverSummit Healthplan,Medicare Advantage,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,outpatient,,,73.00000,35.19000,SilverSummit Healthplan,Medicare Advantage,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,outpatient,,,16.00000,7.71000,SilverSummit Healthplan,Medicare Advantage,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Medicare Advantage,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,outpatient,,,113.00000,54.47000,SilverSummit Healthplan,Medicare Advantage,,39.55,,,,,,,29.38,109.61,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,outpatient,,,68.00000,32.78000,SilverSummit Healthplan,Medicare Advantage,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,outpatient,,,78.00000,37.60000,SilverSummit Healthplan,Medicare Advantage,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,outpatient,,,54.00000,26.03000,SilverSummit Healthplan,Medicare Advantage,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,outpatient,,,76.00000,36.63000,SilverSummit Healthplan,Medicare Advantage,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Medicare Advantage,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,outpatient,,,88.00000,42.42000,SilverSummit Healthplan,Medicare Advantage,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Medicare Advantage,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,outpatient,,,53.00000,25.55000,SilverSummit Healthplan,Medicare Advantage,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,outpatient,,,88.00000,42.42000,SilverSummit Healthplan,Medicare Advantage,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,outpatient,,,105.00000,50.61000,SilverSummit Healthplan,Medicare Advantage,,36.75,,,,,,,27.30,101.85,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,SilverSummit Healthplan,Medicare Advantage,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,outpatient,,,83.00000,40.01000,SilverSummit Healthplan,Medicare Advantage,,29.05,,,,,,,21.58,80.51,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,SilverSummit Healthplan,Medicare Advantage,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,outpatient,,,97.00000,46.75000,SilverSummit Healthplan,Medicare Advantage,,33.95,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,SilverSummit Healthplan,Medicare Advantage,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,outpatient,,,87.00000,41.93000,SilverSummit Healthplan,Medicare Advantage,,30.45,,,,,,,22.62,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,outpatient,,,68.00000,32.78000,SilverSummit Healthplan,Medicare Advantage,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Medicare Advantage,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,outpatient,,,51.00000,24.58000,SilverSummit Healthplan,Medicare Advantage,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,outpatient,,,97.00000,46.75000,SilverSummit Healthplan,Medicare Advantage,,33.95,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,outpatient,,,176.00000,84.83000,SilverSummit Healthplan,Medicare Advantage,,61.60,,,,,,,45.76,170.72,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,outpatient,,,158.00000,76.16000,SilverSummit Healthplan,Medicare Advantage,,55.30,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Medicare Advantage,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Medicare Advantage,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,outpatient,,,84.00000,40.49000,SilverSummit Healthplan,Medicare Advantage,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,outpatient,,,189.00000,91.10000,SilverSummit Healthplan,Medicare Advantage,,66.15,,,,,,,49.14,183.33,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,outpatient,,,109.00000,52.54000,SilverSummit Healthplan,Medicare Advantage,,38.15,,,,,,,28.34,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,outpatient,,,129.00000,62.18000,SilverSummit Healthplan,Medicare Advantage,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,outpatient,,,84.00000,40.49000,SilverSummit Healthplan,Medicare Advantage,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,SilverSummit Healthplan,Medicare Advantage,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Medicare Advantage,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Medicare Advantage,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,outpatient,,,149.00000,71.82000,SilverSummit Healthplan,Medicare Advantage,,52.15,,,,,,,38.74,144.53,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,outpatient,,,130.00000,62.66000,SilverSummit Healthplan,Medicare Advantage,,45.50,,,,,,,33.80,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,outpatient,,,110.00000,53.02000,SilverSummit Healthplan,Medicare Advantage,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,outpatient,,,158.00000,76.16000,SilverSummit Healthplan,Medicare Advantage,,55.30,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,outpatient,,,117.00000,56.39000,SilverSummit Healthplan,Medicare Advantage,,40.95,,,,,,,30.42,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,outpatient,,,61.00000,29.40000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Medicare Advantage,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,SilverSummit Healthplan,Medicare Advantage,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,outpatient,,,145.00000,69.89000,SilverSummit Healthplan,Medicare Advantage,,50.75,,,,,,,37.70,140.65,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Medicare Advantage,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,outpatient,,,165.00000,79.53000,SilverSummit Healthplan,Medicare Advantage,,57.75,,,,,,,42.90,160.05,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,outpatient,,,70.00000,33.74000,SilverSummit Healthplan,Medicare Advantage,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Medicare Advantage,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,SilverSummit Healthplan,Medicare Advantage,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,outpatient,,,154.00000,74.23000,SilverSummit Healthplan,Medicare Advantage,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,outpatient,,,104.00000,50.13000,SilverSummit Healthplan,Medicare Advantage,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,outpatient,,,70.00000,33.74000,SilverSummit Healthplan,Medicare Advantage,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,outpatient,,,104.00000,50.13000,SilverSummit Healthplan,Medicare Advantage,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,outpatient,,,70.00000,33.74000,SilverSummit Healthplan,Medicare Advantage,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,outpatient,,,123.00000,59.29000,SilverSummit Healthplan,Medicare Advantage,,43.05,,,,,,,31.98,119.31,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,outpatient,,,95.00000,45.79000,SilverSummit Healthplan,Medicare Advantage,,33.25,,,,,,,24.70,92.15,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,outpatient,,,160.00000,77.12000,SilverSummit Healthplan,Medicare Advantage,,56.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,outpatient,,,147.00000,70.85000,SilverSummit Healthplan,Medicare Advantage,,51.45,,,,,,,38.22,142.59,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,outpatient,,,178.00000,85.80000,SilverSummit Healthplan,Medicare Advantage,,62.30,,,,,,,46.28,172.66,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,outpatient,,,160.00000,77.12000,SilverSummit Healthplan,Medicare Advantage,,56.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,SilverSummit Healthplan,Medicare Advantage,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Medicare Advantage,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,outpatient,,,70.00000,33.74000,SilverSummit Healthplan,Medicare Advantage,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,SilverSummit Healthplan,Medicare Advantage,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,SilverSummit Healthplan,Medicare Advantage,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,SilverSummit Healthplan,Medicare Advantage,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,SilverSummit Healthplan,Medicare Advantage,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,SilverSummit Healthplan,Medicare Advantage,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,SilverSummit Healthplan,Medicare Advantage,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,SilverSummit Healthplan,Medicare Advantage,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,SilverSummit Healthplan,Medicare Advantage,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,outpatient,,,449.00000,216.42000,SilverSummit Healthplan,Medicare Advantage,,157.15,,,,,,,116.74,435.53,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,outpatient,,,104.00000,50.13000,SilverSummit Healthplan,Medicare Advantage,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,SilverSummit Healthplan,Medicare Advantage,,64.75,,,,,,,48.10,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,SilverSummit Healthplan,Medicare Advantage,,64.75,,,,,,,48.10,179.45,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,outpatient,,,84.00000,40.49000,SilverSummit Healthplan,Medicare Advantage,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,SilverSummit Healthplan,Medicare Advantage,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,SilverSummit Healthplan,Medicare Advantage,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,SilverSummit Healthplan,Medicare Advantage,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,SilverSummit Healthplan,Medicare Advantage,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,outpatient,,,98.00000,47.24000,SilverSummit Healthplan,Medicare Advantage,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,outpatient,,,75.00000,36.15000,SilverSummit Healthplan,Medicare Advantage,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,outpatient,,,107.00000,51.57000,SilverSummit Healthplan,Medicare Advantage,,37.45,,,,,,,27.82,103.79,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,outpatient,,,81.00000,39.04000,SilverSummit Healthplan,Medicare Advantage,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,outpatient,,,68.00000,32.78000,SilverSummit Healthplan,Medicare Advantage,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,outpatient,,,51.00000,24.58000,SilverSummit Healthplan,Medicare Advantage,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,outpatient,,,74.00000,35.67000,SilverSummit Healthplan,Medicare Advantage,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,outpatient,,,194.00000,93.51000,SilverSummit Healthplan,Medicare Advantage,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,outpatient,,,111.00000,53.50000,SilverSummit Healthplan,Medicare Advantage,,38.85,,,,,,,28.86,107.67,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,outpatient,,,77.00000,37.11000,SilverSummit Healthplan,Medicare Advantage,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,SilverSummit Healthplan,Medicare Advantage,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,SilverSummit Healthplan,Medicare Advantage,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,SilverSummit Healthplan,Medicare Advantage,,82.95,,,,,,,61.62,229.89,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,outpatient,,,51.00000,24.58000,SilverSummit Healthplan,Medicare Advantage,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,SilverSummit Healthplan,Medicare Advantage,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,SilverSummit Healthplan,Medicare Advantage,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Medicare Advantage,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,outpatient,,,131.00000,63.14000,SilverSummit Healthplan,Medicare Advantage,,45.85,,,,,,,34.06,127.07,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,outpatient,,,15.00000,7.23000,SilverSummit Healthplan,Medicare Advantage,,5.25,,,,,,,3.90,14.55,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,outpatient,,,39.00000,18.80000,SilverSummit Healthplan,Medicare Advantage,,13.65,,,,,,,10.14,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,outpatient,,,12.00000,5.78000,SilverSummit Healthplan,Medicare Advantage,,4.20,,,,,,,3.12,11.64,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,SilverSummit Healthplan,Medicare Advantage,,71.05,,,,,,,52.78,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,SilverSummit Healthplan,Medicare Advantage,,71.05,,,,,,,52.78,196.91,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,outpatient,,,99.00000,47.72000,SilverSummit Healthplan,Medicare Advantage,,34.65,,,,,,,25.74,96.03,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,outpatient,,,53.00000,25.55000,SilverSummit Healthplan,Medicare Advantage,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,outpatient,,,23.00000,11.09000,SilverSummit Healthplan,Medicare Advantage,,8.05,,,,,,,5.98,22.31,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,outpatient,,,46.00000,22.17000,SilverSummit Healthplan,Medicare Advantage,,16.10,,,,,,,11.96,44.62,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Medicare Advantage,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,outpatient,,,288.00000,138.82000,SilverSummit Healthplan,Medicare Advantage,,100.80,,,,,,,74.88,279.36,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,outpatient,,,106.00000,51.09000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,outpatient,,,30.00000,14.46000,SilverSummit Healthplan,Medicare Advantage,,10.50,,,,,,,7.80,29.10,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,outpatient,,,71.00000,34.22000,SilverSummit Healthplan,Medicare Advantage,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Medicare Advantage,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,outpatient,,,89.00000,42.90000,SilverSummit Healthplan,Medicare Advantage,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,outpatient,,,116.00000,55.91000,SilverSummit Healthplan,Medicare Advantage,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,SilverSummit Healthplan,Medicare Advantage,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,SilverSummit Healthplan,Medicare Advantage,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,outpatient,,,51.00000,24.58000,SilverSummit Healthplan,Medicare Advantage,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,outpatient,,,174.00000,83.87000,SilverSummit Healthplan,Medicare Advantage,,60.90,,,,,,,45.24,168.78,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,outpatient,,,82.00000,39.52000,SilverSummit Healthplan,Medicare Advantage,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,outpatient,,,112.00000,53.98000,SilverSummit Healthplan,Medicare Advantage,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,outpatient,,,61.00000,29.40000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,outpatient,,,69.00000,33.26000,SilverSummit Healthplan,Medicare Advantage,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Medicare Advantage,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,outpatient,,,286.00000,137.85000,SilverSummit Healthplan,Medicare Advantage,,100.10,,,,,,,74.36,277.42,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,outpatient,,,300.00000,144.60000,SilverSummit Healthplan,Medicare Advantage,,105.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,outpatient,,,73.00000,35.19000,SilverSummit Healthplan,Medicare Advantage,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,outpatient,,,90.00000,43.38000,SilverSummit Healthplan,Medicare Advantage,,31.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Medicare Advantage,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,outpatient,,,315.00000,151.83000,SilverSummit Healthplan,Medicare Advantage,,110.25,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,outpatient,,,100.00000,48.20000,SilverSummit Healthplan,Medicare Advantage,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,outpatient,,,89.00000,42.90000,SilverSummit Healthplan,Medicare Advantage,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,outpatient,,,71.00000,34.22000,SilverSummit Healthplan,Medicare Advantage,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,outpatient,,,135.00000,65.07000,SilverSummit Healthplan,Medicare Advantage,,47.25,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,outpatient,,,80.00000,38.56000,SilverSummit Healthplan,Medicare Advantage,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,SilverSummit Healthplan,Medicare Advantage,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,SilverSummit Healthplan,Medicare Advantage,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,outpatient,,,100.00000,48.20000,SilverSummit Healthplan,Medicare Advantage,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,outpatient,,,305.00000,147.01000,SilverSummit Healthplan,Medicare Advantage,,106.75,,,,,,,79.30,295.85,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,outpatient,,,70.00000,33.74000,SilverSummit Healthplan,Medicare Advantage,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,outpatient,,,69.00000,33.26000,SilverSummit Healthplan,Medicare Advantage,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,outpatient,,,64.00000,30.85000,SilverSummit Healthplan,Medicare Advantage,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,outpatient,,,368.00000,177.38000,SilverSummit Healthplan,Medicare Advantage,,128.80,,,,,,,95.68,356.96,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,outpatient,,,104.00000,50.13000,SilverSummit Healthplan,Medicare Advantage,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,outpatient,,,109.00000,52.54000,SilverSummit Healthplan,Medicare Advantage,,38.15,,,,,,,28.34,105.73,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,outpatient,,,114.00000,54.95000,SilverSummit Healthplan,Medicare Advantage,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,outpatient,,,135.00000,65.07000,SilverSummit Healthplan,Medicare Advantage,,47.25,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,outpatient,,,105.00000,50.61000,SilverSummit Healthplan,Medicare Advantage,,36.75,,,,,,,27.30,101.85,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,outpatient,,,315.00000,151.83000,SilverSummit Healthplan,Medicare Advantage,,110.25,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,outpatient,,,148.00000,71.34000,SilverSummit Healthplan,Medicare Advantage,,51.80,,,,,,,38.48,143.56,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Medicare Advantage,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,outpatient,,,107.00000,51.57000,SilverSummit Healthplan,Medicare Advantage,,37.45,,,,,,,27.82,103.79,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,outpatient,,,35.00000,16.87000,SilverSummit Healthplan,Medicare Advantage,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,outpatient,,,104.00000,50.13000,SilverSummit Healthplan,Medicare Advantage,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,outpatient,,,650.00000,313.30000,SilverSummit Healthplan,Medicare Advantage,,227.50,,,,,,,169.00,630.50,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,outpatient,,,91.00000,43.86000,SilverSummit Healthplan,Medicare Advantage,,31.85,,,,,,,23.66,88.27,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,outpatient,,,114.00000,54.95000,SilverSummit Healthplan,Medicare Advantage,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Medicare Advantage,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,outpatient,,,360.00000,173.52000,SilverSummit Healthplan,Medicare Advantage,,126.00,,,,,,,93.60,349.20,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,outpatient,,,106.00000,51.09000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,outpatient,,,78.00000,37.60000,SilverSummit Healthplan,Medicare Advantage,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,outpatient,,,72.00000,34.70000,SilverSummit Healthplan,Medicare Advantage,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,outpatient,,,94.00000,45.31000,SilverSummit Healthplan,Medicare Advantage,,32.90,,,,,,,24.44,91.18,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,outpatient,,,101.00000,48.68000,SilverSummit Healthplan,Medicare Advantage,,35.35,,,,,,,26.26,97.97,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,outpatient,,,82.00000,39.52000,SilverSummit Healthplan,Medicare Advantage,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,outpatient,,,77.00000,37.11000,SilverSummit Healthplan,Medicare Advantage,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,outpatient,,,145.00000,69.89000,SilverSummit Healthplan,Medicare Advantage,,50.75,,,,,,,37.70,140.65,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,outpatient,,,266.00000,128.21000,SilverSummit Healthplan,Medicare Advantage,,93.10,,,,,,,69.16,258.02,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,outpatient,,,79.00000,38.08000,SilverSummit Healthplan,Medicare Advantage,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,outpatient,,,144.00000,69.41000,SilverSummit Healthplan,Medicare Advantage,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,outpatient,,,20.00000,9.64000,SilverSummit Healthplan,Medicare Advantage,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,outpatient,,,208.00000,100.26000,SilverSummit Healthplan,Medicare Advantage,,72.80,,,,,,,54.08,201.76,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,outpatient,,,135.00000,65.07000,SilverSummit Healthplan,Medicare Advantage,,47.25,,,,,,,35.10,130.95,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,outpatient,,,131.00000,63.14000,SilverSummit Healthplan,Medicare Advantage,,45.85,,,,,,,34.06,127.07,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,outpatient,,,69.00000,33.26000,SilverSummit Healthplan,Medicare Advantage,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,outpatient,,,25.00000,12.05000,SilverSummit Healthplan,Medicare Advantage,,8.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,outpatient,,,61.00000,29.40000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,outpatient,,,80.00000,38.56000,SilverSummit Healthplan,Medicare Advantage,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,outpatient,,,82.00000,39.52000,SilverSummit Healthplan,Medicare Advantage,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,outpatient,,,35.00000,16.87000,SilverSummit Healthplan,Medicare Advantage,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,outpatient,,,88.00000,42.42000,SilverSummit Healthplan,Medicare Advantage,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,outpatient,,,98.00000,47.24000,SilverSummit Healthplan,Medicare Advantage,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,outpatient,,,204.00000,98.33000,SilverSummit Healthplan,Medicare Advantage,,71.40,,,,,,,53.04,197.88,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,outpatient,,,61.00000,29.40000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,outpatient,,,19.00000,9.16000,SilverSummit Healthplan,Medicare Advantage,,6.65,,,,,,,4.94,18.43,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,outpatient,,,37.00000,17.83000,SilverSummit Healthplan,Medicare Advantage,,12.95,,,,,,,9.62,35.89,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,outpatient,,,79.00000,38.08000,SilverSummit Healthplan,Medicare Advantage,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,outpatient,,,21.00000,10.12000,SilverSummit Healthplan,Medicare Advantage,,7.35,,,,,,,5.46,20.37,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Medicare Advantage,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,outpatient,,,32.00000,15.42000,SilverSummit Healthplan,Medicare Advantage,,11.20,,,,,,,8.32,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,outpatient,,,94.00000,45.31000,SilverSummit Healthplan,Medicare Advantage,,32.90,,,,,,,24.44,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,outpatient,,,103.00000,49.65000,SilverSummit Healthplan,Medicare Advantage,,36.05,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,outpatient,,,64.00000,30.85000,SilverSummit Healthplan,Medicare Advantage,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,outpatient,,,102.00000,49.16000,SilverSummit Healthplan,Medicare Advantage,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,outpatient,,,103.00000,49.65000,SilverSummit Healthplan,Medicare Advantage,,36.05,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,outpatient,,,139.00000,67.00000,SilverSummit Healthplan,Medicare Advantage,,48.65,,,,,,,36.14,134.83,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Medicare Advantage,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,SilverSummit Healthplan,Medicare Advantage,,7.35,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,outpatient,,,88.00000,42.42000,SilverSummit Healthplan,Medicare Advantage,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,SilverSummit Healthplan,Medicare Advantage,,7.35,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Medicare Advantage,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,outpatient,,,80.00000,38.56000,SilverSummit Healthplan,Medicare Advantage,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,outpatient,,,49.00000,23.62000,SilverSummit Healthplan,Medicare Advantage,,17.15,,,,,,,12.74,47.53,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,outpatient,,,88.00000,42.42000,SilverSummit Healthplan,Medicare Advantage,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,outpatient,,,68.00000,32.78000,SilverSummit Healthplan,Medicare Advantage,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,outpatient,,,93.00000,44.83000,SilverSummit Healthplan,Medicare Advantage,,32.55,,,,,,,24.18,90.21,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,outpatient,,,73.00000,35.19000,SilverSummit Healthplan,Medicare Advantage,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,outpatient,,,41.00000,19.76000,SilverSummit Healthplan,Medicare Advantage,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,outpatient,,,94.00000,45.31000,SilverSummit Healthplan,Medicare Advantage,,32.90,,,,,,,24.44,91.18,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,outpatient,,,124.00000,59.77000,SilverSummit Healthplan,Medicare Advantage,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,outpatient,,,71.00000,34.22000,SilverSummit Healthplan,Medicare Advantage,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,outpatient,,,33.00000,15.91000,SilverSummit Healthplan,Medicare Advantage,,11.55,,,,,,,8.58,32.01,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Medicare Advantage,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,outpatient,,,68.00000,32.78000,SilverSummit Healthplan,Medicare Advantage,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,outpatient,,,99.00000,47.72000,SilverSummit Healthplan,Medicare Advantage,,34.65,,,,,,,25.74,96.03,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,outpatient,,,197.00000,94.95000,SilverSummit Healthplan,Medicare Advantage,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,outpatient,,,194.00000,93.51000,SilverSummit Healthplan,Medicare Advantage,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,outpatient,,,68.00000,32.78000,SilverSummit Healthplan,Medicare Advantage,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,outpatient,,,90.00000,43.38000,SilverSummit Healthplan,Medicare Advantage,,31.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,outpatient,,,109.00000,52.54000,SilverSummit Healthplan,Medicare Advantage,,38.15,,,,,,,28.34,105.73,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,outpatient,,,108.00000,52.06000,SilverSummit Healthplan,Medicare Advantage,,37.80,,,,,,,28.08,104.76,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,outpatient,,,67.00000,32.29000,SilverSummit Healthplan,Medicare Advantage,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,outpatient,,,69.00000,33.26000,SilverSummit Healthplan,Medicare Advantage,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,outpatient,,,71.00000,34.22000,SilverSummit Healthplan,Medicare Advantage,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,outpatient,,,98.00000,47.24000,SilverSummit Healthplan,Medicare Advantage,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,outpatient,,,141.00000,67.96000,SilverSummit Healthplan,Medicare Advantage,,49.35,,,,,,,36.66,136.77,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,outpatient,,,226.00000,108.93000,SilverSummit Healthplan,Medicare Advantage,,79.10,,,,,,,58.76,219.22,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,outpatient,,,92.00000,44.34000,SilverSummit Healthplan,Medicare Advantage,,32.20,,,,,,,23.92,89.24,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,outpatient,,,69.00000,33.26000,SilverSummit Healthplan,Medicare Advantage,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,outpatient,,,100.00000,48.20000,SilverSummit Healthplan,Medicare Advantage,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,outpatient,,,124.00000,59.77000,SilverSummit Healthplan,Medicare Advantage,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,outpatient,,,69.00000,33.26000,SilverSummit Healthplan,Medicare Advantage,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,SilverSummit Healthplan,Medicare Advantage,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,SilverSummit Healthplan,Medicare Advantage,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,SilverSummit Healthplan,Medicare Advantage,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,outpatient,,,118.00000,56.88000,SilverSummit Healthplan,Medicare Advantage,,41.30,,,,,,,30.68,114.46,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,outpatient,,,51.00000,24.58000,SilverSummit Healthplan,Medicare Advantage,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,outpatient,,,104.00000,50.13000,SilverSummit Healthplan,Medicare Advantage,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,outpatient,,,72.00000,34.70000,SilverSummit Healthplan,Medicare Advantage,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,outpatient,,,54.00000,26.03000,SilverSummit Healthplan,Medicare Advantage,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,outpatient,,,17.00000,8.19000,SilverSummit Healthplan,Medicare Advantage,,5.95,,,,,,,4.42,16.49,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,outpatient,,,36.00000,17.35000,SilverSummit Healthplan,Medicare Advantage,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Medicare Advantage,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,outpatient,,,18.00000,8.68000,SilverSummit Healthplan,Medicare Advantage,,6.30,,,,,,,4.68,17.46,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,outpatient,,,74.00000,35.67000,SilverSummit Healthplan,Medicare Advantage,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,outpatient,,,118.00000,56.88000,SilverSummit Healthplan,Medicare Advantage,,41.30,,,,,,,30.68,114.46,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,outpatient,,,82.00000,39.52000,SilverSummit Healthplan,Medicare Advantage,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,outpatient,,,30.00000,14.46000,SilverSummit Healthplan,Medicare Advantage,,10.50,,,,,,,7.80,29.10,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,outpatient,,,70.00000,33.74000,SilverSummit Healthplan,Medicare Advantage,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,outpatient,,,54.00000,26.03000,SilverSummit Healthplan,Medicare Advantage,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,outpatient,,,51.00000,24.58000,SilverSummit Healthplan,Medicare Advantage,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,outpatient,,,141.00000,67.96000,SilverSummit Healthplan,Medicare Advantage,,49.35,,,,,,,36.66,136.77,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,outpatient,,,81.00000,39.04000,SilverSummit Healthplan,Medicare Advantage,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,outpatient,,,335.00000,161.47000,SilverSummit Healthplan,Medicare Advantage,,117.25,,,,,,,87.10,324.95,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,outpatient,,,52.00000,25.06000,SilverSummit Healthplan,Medicare Advantage,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,SilverSummit Healthplan,Medicare Advantage,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,SilverSummit Healthplan,Medicare Advantage,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,outpatient,,,53.00000,25.55000,SilverSummit Healthplan,Medicare Advantage,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,outpatient,,,53.00000,25.55000,SilverSummit Healthplan,Medicare Advantage,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,outpatient,,,12.00000,5.78000,SilverSummit Healthplan,Medicare Advantage,,4.20,,,,,,,3.12,11.64,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,outpatient,,,710.00000,342.22000,SilverSummit Healthplan,Medicare Advantage,,248.50,,,,,,,184.60,688.70,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,outpatient,,,104.00000,50.13000,SilverSummit Healthplan,Medicare Advantage,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,outpatient,,,155.00000,74.71000,SilverSummit Healthplan,Medicare Advantage,,54.25,,,,,,,40.30,150.35,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,outpatient,,,139.00000,67.00000,SilverSummit Healthplan,Medicare Advantage,,48.65,,,,,,,36.14,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,outpatient,,,89.00000,42.90000,SilverSummit Healthplan,Medicare Advantage,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,outpatient,,,88.00000,42.42000,SilverSummit Healthplan,Medicare Advantage,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,outpatient,,,111.00000,53.50000,SilverSummit Healthplan,Medicare Advantage,,38.85,,,,,,,28.86,107.67,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,outpatient,,,70.00000,33.74000,SilverSummit Healthplan,Medicare Advantage,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,outpatient,,,85.00000,40.97000,SilverSummit Healthplan,Medicare Advantage,,29.75,,,,,,,22.10,82.45,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,outpatient,,,110.00000,53.02000,SilverSummit Healthplan,Medicare Advantage,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,outpatient,,,500.00000,241.00000,SilverSummit Healthplan,Medicare Advantage,,175.00,,,,,,,130.00,485.00,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,outpatient,,,140.00000,67.48000,SilverSummit Healthplan,Medicare Advantage,,49.00,,,,,,,36.40,135.80,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,outpatient,,,74.00000,35.67000,SilverSummit Healthplan,Medicare Advantage,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,outpatient,,,77.00000,37.11000,SilverSummit Healthplan,Medicare Advantage,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,outpatient,,,93.00000,44.83000,SilverSummit Healthplan,Medicare Advantage,,32.55,,,,,,,24.18,90.21,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,outpatient,,,15.00000,7.23000,SilverSummit Healthplan,Medicare Advantage,,5.25,,,,,,,3.90,14.55,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,outpatient,,,24.00000,11.57000,SilverSummit Healthplan,Medicare Advantage,,8.40,,,,,,,6.24,23.28,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,outpatient,,,72.00000,34.70000,SilverSummit Healthplan,Medicare Advantage,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,SilverSummit Healthplan,Medicare Advantage,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,SilverSummit Healthplan,Medicare Advantage,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,outpatient,,,64.00000,30.85000,SilverSummit Healthplan,Medicare Advantage,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,outpatient,,,82.00000,39.52000,SilverSummit Healthplan,Medicare Advantage,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,outpatient,,,157.00000,75.67000,SilverSummit Healthplan,Medicare Advantage,,54.95,,,,,,,40.82,152.29,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,outpatient,,,70.00000,33.74000,SilverSummit Healthplan,Medicare Advantage,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,outpatient,,,229.00000,110.38000,SilverSummit Healthplan,Medicare Advantage,,80.15,,,,,,,59.54,222.13,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,outpatient,,,64.00000,30.85000,SilverSummit Healthplan,Medicare Advantage,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,outpatient,,,72.00000,34.70000,SilverSummit Healthplan,Medicare Advantage,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,outpatient,,,17.00000,8.19000,SilverSummit Healthplan,Medicare Advantage,,5.95,,,,,,,4.42,16.49,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,outpatient,,,64.00000,30.85000,SilverSummit Healthplan,Medicare Advantage,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,outpatient,,,387.00000,186.53000,SilverSummit Healthplan,Medicare Advantage,,135.45,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,SilverSummit Healthplan,Medicare Advantage,,135.45,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,SilverSummit Healthplan,Medicare Advantage,,135.45,,,,,,,100.62,375.39,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,outpatient,,,77.00000,37.11000,SilverSummit Healthplan,Medicare Advantage,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,SilverSummit Healthplan,Medicare Advantage,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,SilverSummit Healthplan,Medicare Advantage,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,outpatient,,,43.00000,20.73000,SilverSummit Healthplan,Medicare Advantage,,15.05,,,,,,,11.18,41.71,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,outpatient,,,64.00000,30.85000,SilverSummit Healthplan,Medicare Advantage,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,outpatient,,,160.00000,77.12000,SilverSummit Healthplan,Medicare Advantage,,56.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,outpatient,,,112.00000,53.98000,SilverSummit Healthplan,Medicare Advantage,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,outpatient,,,82.00000,39.52000,SilverSummit Healthplan,Medicare Advantage,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,outpatient,,,55.00000,26.51000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,outpatient,,,54.00000,26.03000,SilverSummit Healthplan,Medicare Advantage,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,outpatient,,,153.00000,73.75000,SilverSummit Healthplan,Medicare Advantage,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,outpatient,,,45.00000,21.69000,SilverSummit Healthplan,Medicare Advantage,,15.75,,,,,,,11.70,43.65,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,outpatient,,,28.00000,13.50000,SilverSummit Healthplan,Medicare Advantage,,9.80,,,,,,,7.28,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,SilverSummit Healthplan,Medicare Advantage,,17.15,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,SilverSummit Healthplan,Medicare Advantage,,17.15,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,SilverSummit Healthplan,Medicare Advantage,,17.15,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,outpatient,,,36.00000,17.35000,SilverSummit Healthplan,Medicare Advantage,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,outpatient,,,38.00000,18.32000,SilverSummit Healthplan,Medicare Advantage,,13.30,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,outpatient,,,38.00000,18.32000,SilverSummit Healthplan,Medicare Advantage,,13.30,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,outpatient,,,76.00000,36.63000,SilverSummit Healthplan,Medicare Advantage,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,outpatient,,,173.00000,83.39000,SilverSummit Healthplan,Medicare Advantage,,60.55,,,,,,,44.98,167.81,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,outpatient,,,22.00000,10.60000,SilverSummit Healthplan,Medicare Advantage,,7.70,,,,,,,5.72,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,outpatient,,,39.00000,18.80000,SilverSummit Healthplan,Medicare Advantage,,13.65,,,,,,,10.14,37.83,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,outpatient,,,41.00000,19.76000,SilverSummit Healthplan,Medicare Advantage,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,outpatient,,,54.00000,26.03000,SilverSummit Healthplan,Medicare Advantage,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,outpatient,,,71.00000,34.22000,SilverSummit Healthplan,Medicare Advantage,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,SilverSummit Healthplan,Medicare Advantage,,15.05,,,,,,,11.18,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,SilverSummit Healthplan,Medicare Advantage,,15.05,,,,,,,11.18,41.71,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,outpatient,,,38.00000,18.32000,SilverSummit Healthplan,Medicare Advantage,,13.30,,,,,,,9.88,36.86,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,outpatient,,,72.00000,34.70000,SilverSummit Healthplan,Medicare Advantage,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,outpatient,,,226.00000,108.93000,SilverSummit Healthplan,Medicare Advantage,,79.10,,,,,,,58.76,219.22,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,SilverSummit Healthplan,Medicare Advantage,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,SilverSummit Healthplan,Medicare Advantage,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,SilverSummit Healthplan,Medicare Advantage,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,outpatient,,,160.00000,77.12000,SilverSummit Healthplan,Medicare Advantage,,56.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,outpatient,,,102.00000,49.16000,SilverSummit Healthplan,Medicare Advantage,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,outpatient,,,317.00000,152.79000,SilverSummit Healthplan,Medicare Advantage,,110.95,,,,,,,82.42,307.49,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,outpatient,,,116.00000,55.91000,SilverSummit Healthplan,Medicare Advantage,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,SilverSummit Healthplan,Medicare Advantage,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,SilverSummit Healthplan,Medicare Advantage,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,outpatient,,,85.00000,40.97000,SilverSummit Healthplan,Medicare Advantage,,29.75,,,,,,,22.10,82.45,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,outpatient,,,184.00000,88.69000,SilverSummit Healthplan,Medicare Advantage,,64.40,,,,,,,47.84,178.48,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,outpatient,,,127.00000,61.21000,SilverSummit Healthplan,Medicare Advantage,,44.45,,,,,,,33.02,123.19,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,outpatient,,,61.00000,29.40000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,outpatient,,,35.00000,16.87000,SilverSummit Healthplan,Medicare Advantage,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,outpatient,,,79.00000,38.08000,SilverSummit Healthplan,Medicare Advantage,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Medicare Advantage,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,outpatient,,,57.00000,32.83000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,SilverSummit Healthplan,Medicare Advantage,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,outpatient,,,77.00000,44.35000,SilverSummit Healthplan,Medicare Advantage,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,outpatient,,,70.00000,40.32000,SilverSummit Healthplan,Medicare Advantage,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,outpatient,,,67.00000,38.59000,SilverSummit Healthplan,Medicare Advantage,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,outpatient,,,40.00000,23.04000,SilverSummit Healthplan,Medicare Advantage,,14.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,outpatient,,,71.00000,40.90000,SilverSummit Healthplan,Medicare Advantage,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,outpatient,,,80.00000,46.08000,SilverSummit Healthplan,Medicare Advantage,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,outpatient,,,72.00000,41.47000,SilverSummit Healthplan,Medicare Advantage,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,outpatient,,,444.00000,255.74000,SilverSummit Healthplan,Medicare Advantage,,155.40,,,,,,,115.44,430.68,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,outpatient,,,81.00000,46.66000,SilverSummit Healthplan,Medicare Advantage,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,outpatient,,,66.00000,38.02000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,outpatient,,,57.00000,32.83000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,outpatient,,,53.00000,30.53000,SilverSummit Healthplan,Medicare Advantage,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Medicare Advantage,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Medicare Advantage,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,outpatient,,,60.00000,34.56000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,outpatient,,,40.00000,23.04000,SilverSummit Healthplan,Medicare Advantage,,14.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,outpatient,,,42.00000,24.19000,SilverSummit Healthplan,Medicare Advantage,,14.70,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,outpatient,,,46.00000,26.50000,SilverSummit Healthplan,Medicare Advantage,,16.10,,,,,,,11.96,44.62,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,outpatient,,,54.00000,31.10000,SilverSummit Healthplan,Medicare Advantage,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,outpatient,,,71.00000,40.90000,SilverSummit Healthplan,Medicare Advantage,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,outpatient,,,54.00000,31.10000,SilverSummit Healthplan,Medicare Advantage,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,outpatient,,,80.00000,46.08000,SilverSummit Healthplan,Medicare Advantage,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,outpatient,,,60.00000,34.56000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,SilverSummit Healthplan,Medicare Advantage,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,outpatient,,,130.00000,74.88000,SilverSummit Healthplan,Medicare Advantage,,45.50,,,,,,,33.80,126.10,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,SilverSummit Healthplan,Medicare Advantage,,43.05,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,outpatient,,,77.00000,44.35000,SilverSummit Healthplan,Medicare Advantage,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Medicare Advantage,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,outpatient,,,115.00000,66.24000,SilverSummit Healthplan,Medicare Advantage,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,SilverSummit Healthplan,Medicare Advantage,,43.05,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,outpatient,,,161.00000,92.74000,SilverSummit Healthplan,Medicare Advantage,,56.35,,,,,,,41.86,156.17,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,SilverSummit Healthplan,Medicare Advantage,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Medicare Advantage,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Medicare Advantage,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Medicare Advantage,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Medicare Advantage,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,outpatient,,,102.00000,58.75000,SilverSummit Healthplan,Medicare Advantage,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,outpatient,,,219.00000,126.14000,SilverSummit Healthplan,Medicare Advantage,,76.65,,,,,,,56.94,212.43,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,SilverSummit Healthplan,Medicare Advantage,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,outpatient,,,103.00000,59.33000,SilverSummit Healthplan,Medicare Advantage,,36.05,,,,,,,26.78,99.91,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,outpatient,,,60.00000,34.56000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,outpatient,,,837.00000,482.11000,SilverSummit Healthplan,Medicare Advantage,,292.95,,,,,,,217.62,811.89,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Medicare Advantage,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Medicare Advantage,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,SilverSummit Healthplan,Medicare Advantage,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,outpatient,,,78.00000,44.93000,SilverSummit Healthplan,Medicare Advantage,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,outpatient,,,285.00000,164.16000,SilverSummit Healthplan,Medicare Advantage,,99.75,,,,,,,74.10,276.45,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,outpatient,,,190.00000,109.44000,SilverSummit Healthplan,Medicare Advantage,,66.50,,,,,,,49.40,184.30,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,outpatient,,,100.00000,57.60000,SilverSummit Healthplan,Medicare Advantage,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,SilverSummit Healthplan,Medicare Advantage,,14.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,outpatient,,,67.00000,38.59000,SilverSummit Healthplan,Medicare Advantage,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,outpatient,,,78.00000,44.93000,SilverSummit Healthplan,Medicare Advantage,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Medicare Advantage,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Medicare Advantage,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,outpatient,,,57.00000,32.83000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,outpatient,,,72.00000,41.47000,SilverSummit Healthplan,Medicare Advantage,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,outpatient,,,59.00000,33.98000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,outpatient,,,72.00000,41.47000,SilverSummit Healthplan,Medicare Advantage,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,outpatient,,,239.00000,137.66000,SilverSummit Healthplan,Medicare Advantage,,83.65,,,,,,,62.14,231.83,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,outpatient,,,85.00000,48.96000,SilverSummit Healthplan,Medicare Advantage,,29.75,,,,,,,22.10,82.45,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,outpatient,,,44.00000,25.34000,SilverSummit Healthplan,Medicare Advantage,,15.40,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,outpatient,,,40.00000,23.04000,SilverSummit Healthplan,Medicare Advantage,,14.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,outpatient,,,53.00000,30.53000,SilverSummit Healthplan,Medicare Advantage,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,outpatient,,,68.00000,39.17000,SilverSummit Healthplan,Medicare Advantage,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,outpatient,,,76.00000,43.78000,SilverSummit Healthplan,Medicare Advantage,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,outpatient,,,42.00000,24.19000,SilverSummit Healthplan,Medicare Advantage,,14.70,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,outpatient,,,87.00000,50.11000,SilverSummit Healthplan,Medicare Advantage,,30.45,,,,,,,22.62,84.39,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,outpatient,,,503.00000,289.73000,SilverSummit Healthplan,Medicare Advantage,,176.05,,,,,,,130.78,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,outpatient,,,472.00000,271.87000,SilverSummit Healthplan,Medicare Advantage,,165.20,,,,,,,122.72,457.84,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,outpatient,,,28.00000,16.13000,SilverSummit Healthplan,Medicare Advantage,,9.80,,,,,,,7.28,27.16,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,outpatient,,,236.00000,135.94000,SilverSummit Healthplan,Medicare Advantage,,82.60,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,outpatient,,,54.00000,31.10000,SilverSummit Healthplan,Medicare Advantage,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,outpatient,,,238.00000,137.09000,SilverSummit Healthplan,Medicare Advantage,,83.30,,,,,,,61.88,230.86,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,outpatient,,,236.00000,135.94000,SilverSummit Healthplan,Medicare Advantage,,82.60,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,outpatient,,,145.00000,83.52000,SilverSummit Healthplan,Medicare Advantage,,50.75,,,,,,,37.70,140.65,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,SilverSummit Healthplan,Medicare Advantage,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,SilverSummit Healthplan,Medicare Advantage,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,outpatient,,,66.00000,38.02000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,outpatient,,,59.00000,33.98000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,outpatient,,,158.00000,91.01000,SilverSummit Healthplan,Medicare Advantage,,55.30,,,,,,,41.08,153.26,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,outpatient,,,71.00000,40.90000,SilverSummit Healthplan,Medicare Advantage,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,outpatient,,,144.00000,82.94000,SilverSummit Healthplan,Medicare Advantage,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,outpatient,,,1448.00000,834.05000,SilverSummit Healthplan,Medicare Advantage,,506.80,,,,,,,376.48,1404.56,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,outpatient,,,72.00000,41.47000,SilverSummit Healthplan,Medicare Advantage,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,outpatient,,,102.00000,58.75000,SilverSummit Healthplan,Medicare Advantage,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,outpatient,,,154.00000,88.70000,SilverSummit Healthplan,Medicare Advantage,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,SilverSummit Healthplan,Medicare Advantage,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,outpatient,,,66.00000,38.02000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,SilverSummit Healthplan,Medicare Advantage,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,outpatient,,,44.00000,25.34000,SilverSummit Healthplan,Medicare Advantage,,15.40,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,outpatient,,,150.00000,86.40000,SilverSummit Healthplan,Medicare Advantage,,52.50,,,,,,,39.00,145.50,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,outpatient,,,56.00000,32.26000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,outpatient,,,66.00000,38.02000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,outpatient,,,60.00000,34.56000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,outpatient,,,58.00000,33.41000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,outpatient,,,71.00000,40.90000,SilverSummit Healthplan,Medicare Advantage,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,outpatient,,,72.00000,41.47000,SilverSummit Healthplan,Medicare Advantage,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,outpatient,,,60.00000,34.56000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,outpatient,,,56.00000,32.26000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,outpatient,,,39.00000,22.46000,SilverSummit Healthplan,Medicare Advantage,,13.65,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,SilverSummit Healthplan,Medicare Advantage,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,outpatient,,,73.00000,42.05000,SilverSummit Healthplan,Medicare Advantage,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,SilverSummit Healthplan,Medicare Advantage,,44.45,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,SilverSummit Healthplan,Medicare Advantage,,44.45,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Medicare Advantage,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,outpatient,,,372.00000,214.27000,SilverSummit Healthplan,Medicare Advantage,,130.20,,,,,,,96.72,360.84,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,outpatient,,,69.00000,39.74000,SilverSummit Healthplan,Medicare Advantage,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,SilverSummit Healthplan,Medicare Advantage,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,SilverSummit Healthplan,Medicare Advantage,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,outpatient,,,57.00000,32.83000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,outpatient,,,96.00000,55.30000,SilverSummit Healthplan,Medicare Advantage,,33.60,,,,,,,24.96,93.12,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,outpatient,,,44.00000,25.34000,SilverSummit Healthplan,Medicare Advantage,,15.40,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,outpatient,,,60.00000,34.56000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,outpatient,,,60.00000,34.56000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,outpatient,,,74.00000,42.62000,SilverSummit Healthplan,Medicare Advantage,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,outpatient,,,69.00000,39.74000,SilverSummit Healthplan,Medicare Advantage,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,SilverSummit Healthplan,Medicare Advantage,,13.65,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,outpatient,,,53.00000,30.53000,SilverSummit Healthplan,Medicare Advantage,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,SilverSummit Healthplan,Medicare Advantage,,13.65,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,SilverSummit Healthplan,Medicare Advantage,,13.65,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,outpatient,,,70.00000,40.32000,SilverSummit Healthplan,Medicare Advantage,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,outpatient,,,71.00000,40.90000,SilverSummit Healthplan,Medicare Advantage,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,outpatient,,,65.00000,37.44000,SilverSummit Healthplan,Medicare Advantage,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,outpatient,,,325.00000,187.20000,SilverSummit Healthplan,Medicare Advantage,,113.75,,,,,,,84.50,315.25,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,outpatient,,,72.00000,41.47000,SilverSummit Healthplan,Medicare Advantage,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,outpatient,,,72.00000,41.47000,SilverSummit Healthplan,Medicare Advantage,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,outpatient,,,76.00000,43.78000,SilverSummit Healthplan,Medicare Advantage,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,outpatient,,,240.00000,138.24000,SilverSummit Healthplan,Medicare Advantage,,84.00,,,,,,,62.40,232.80,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,outpatient,,,93.00000,53.57000,SilverSummit Healthplan,Medicare Advantage,,32.55,,,,,,,24.18,90.21,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,outpatient,,,59.00000,33.98000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,outpatient,,,81.00000,46.66000,SilverSummit Healthplan,Medicare Advantage,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,outpatient,,,58.00000,33.41000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,outpatient,,,21.00000,12.10000,SilverSummit Healthplan,Medicare Advantage,,7.35,,,,,,,5.46,20.37,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,outpatient,,,56.00000,32.26000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,outpatient,,,64.00000,36.86000,SilverSummit Healthplan,Medicare Advantage,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,outpatient,,,80.00000,46.08000,SilverSummit Healthplan,Medicare Advantage,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,outpatient,,,109.00000,62.78000,SilverSummit Healthplan,Medicare Advantage,,38.15,,,,,,,28.34,105.73,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,outpatient,,,59.00000,33.98000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,outpatient,,,115.00000,66.24000,SilverSummit Healthplan,Medicare Advantage,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,outpatient,,,57.00000,32.83000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,outpatient,,,118.00000,67.97000,SilverSummit Healthplan,Medicare Advantage,,41.30,,,,,,,30.68,114.46,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,outpatient,,,268.00000,154.37000,SilverSummit Healthplan,Medicare Advantage,,93.80,,,,,,,69.68,259.96,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,SilverSummit Healthplan,Medicare Advantage,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,SilverSummit Healthplan,Medicare Advantage,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,outpatient,,,78.00000,44.93000,SilverSummit Healthplan,Medicare Advantage,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,outpatient,,,91.00000,52.42000,SilverSummit Healthplan,Medicare Advantage,,31.85,,,,,,,23.66,88.27,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,outpatient,,,300.00000,172.80000,SilverSummit Healthplan,Medicare Advantage,,105.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,outpatient,,,185.00000,106.56000,SilverSummit Healthplan,Medicare Advantage,,64.75,,,,,,,48.10,179.45,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,SilverSummit Healthplan,Medicare Advantage,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,outpatient,,,76.00000,43.78000,SilverSummit Healthplan,Medicare Advantage,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,SilverSummit Healthplan,Medicare Advantage,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,SilverSummit Healthplan,Medicare Advantage,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,outpatient,,,53.00000,30.53000,SilverSummit Healthplan,Medicare Advantage,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,outpatient,,,77.00000,44.35000,SilverSummit Healthplan,Medicare Advantage,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,SilverSummit Healthplan,Medicare Advantage,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,outpatient,,,222.00000,127.87000,SilverSummit Healthplan,Medicare Advantage,,77.70,,,,,,,57.72,215.34,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,outpatient,,,292.00000,168.19000,SilverSummit Healthplan,Medicare Advantage,,102.20,,,,,,,75.92,283.24,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,SilverSummit Healthplan,Medicare Advantage,,43.75,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,SilverSummit Healthplan,Medicare Advantage,,43.75,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,outpatient,,,359.00000,206.78000,SilverSummit Healthplan,Medicare Advantage,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,outpatient,,,111.00000,63.94000,SilverSummit Healthplan,Medicare Advantage,,38.85,,,,,,,28.86,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,SilverSummit Healthplan,Medicare Advantage,,49.35,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,SilverSummit Healthplan,Medicare Advantage,,49.35,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,SilverSummit Healthplan,Medicare Advantage,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,SilverSummit Healthplan,Medicare Advantage,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,SilverSummit Healthplan,Medicare Advantage,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,SilverSummit Healthplan,Medicare Advantage,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,outpatient,,,78.00000,44.93000,SilverSummit Healthplan,Medicare Advantage,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,SilverSummit Healthplan,Medicare Advantage,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,SilverSummit Healthplan,Medicare Advantage,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,outpatient,,,70.00000,40.32000,SilverSummit Healthplan,Medicare Advantage,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,outpatient,,,18.00000,10.37000,SilverSummit Healthplan,Medicare Advantage,,6.30,,,,,,,4.68,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,outpatient,,,408.00000,235.01000,SilverSummit Healthplan,Medicare Advantage,,142.80,,,,,,,106.08,395.76,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,outpatient,,,102.00000,58.75000,SilverSummit Healthplan,Medicare Advantage,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,outpatient,,,330.00000,190.08000,SilverSummit Healthplan,Medicare Advantage,,115.50,,,,,,,85.80,320.10,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,outpatient,,,56.00000,32.26000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,outpatient,,,136.00000,78.34000,SilverSummit Healthplan,Medicare Advantage,,47.60,,,,,,,35.36,131.92,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,outpatient,,,83.00000,47.81000,SilverSummit Healthplan,Medicare Advantage,,29.05,,,,,,,21.58,80.51,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,outpatient,,,142.00000,81.79000,SilverSummit Healthplan,Medicare Advantage,,49.70,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,outpatient,,,51.00000,29.38000,SilverSummit Healthplan,Medicare Advantage,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,outpatient,,,70.00000,40.32000,SilverSummit Healthplan,Medicare Advantage,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,outpatient,,,99.00000,57.02000,SilverSummit Healthplan,Medicare Advantage,,34.65,,,,,,,25.74,96.03,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,outpatient,,,78.00000,44.93000,SilverSummit Healthplan,Medicare Advantage,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,outpatient,,,75.00000,43.20000,SilverSummit Healthplan,Medicare Advantage,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,SilverSummit Healthplan,Medicare Advantage,,12.95,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,SilverSummit Healthplan,Medicare Advantage,,12.95,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,outpatient,,,59.00000,33.98000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,outpatient,,,35.00000,20.16000,SilverSummit Healthplan,Medicare Advantage,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,outpatient,,,59.00000,33.98000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,outpatient,,,56.00000,32.26000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,outpatient,,,74.00000,42.62000,SilverSummit Healthplan,Medicare Advantage,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,outpatient,,,90.00000,51.84000,SilverSummit Healthplan,Medicare Advantage,,31.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,SilverSummit Healthplan,Medicare Advantage,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,outpatient,,,142.00000,81.79000,SilverSummit Healthplan,Medicare Advantage,,49.70,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,SilverSummit Healthplan,Medicare Advantage,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,outpatient,,,74.00000,42.62000,SilverSummit Healthplan,Medicare Advantage,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,SilverSummit Healthplan,Medicare Advantage,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,SilverSummit Healthplan,Medicare Advantage,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,outpatient,,,57.00000,32.83000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,outpatient,,,77.00000,44.35000,SilverSummit Healthplan,Medicare Advantage,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,outpatient,,,64.00000,36.86000,SilverSummit Healthplan,Medicare Advantage,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,outpatient,,,69.00000,39.74000,SilverSummit Healthplan,Medicare Advantage,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,outpatient,,,1178.00000,678.53000,SilverSummit Healthplan,Medicare Advantage,,412.30,,,,,,,306.28,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,outpatient,,,127.00000,73.15000,SilverSummit Healthplan,Medicare Advantage,,44.45,,,,,,,33.02,123.19,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,outpatient,,,277.00000,159.55000,SilverSummit Healthplan,Medicare Advantage,,96.95,,,,,,,72.02,268.69,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,outpatient,,,940.00000,541.44000,SilverSummit Healthplan,Medicare Advantage,,329.00,,,,,,,244.40,911.80,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,outpatient,,,97.00000,55.87000,SilverSummit Healthplan,Medicare Advantage,,33.95,,,,,,,25.22,94.09,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,outpatient,,,16.00000,9.22000,SilverSummit Healthplan,Medicare Advantage,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,outpatient,,,57.00000,32.83000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,outpatient,,,131.00000,75.46000,SilverSummit Healthplan,Medicare Advantage,,45.85,,,,,,,34.06,127.07,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,outpatient,,,2160.00000,1244.16000,SilverSummit Healthplan,Medicare Advantage,,756.00,,,,,,,561.60,2095.20,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,outpatient,,,37.00000,21.31000,SilverSummit Healthplan,Medicare Advantage,,12.95,,,,,,,9.62,35.89,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,SilverSummit Healthplan,Medicare Advantage,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,outpatient,,,54.00000,31.10000,SilverSummit Healthplan,Medicare Advantage,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,outpatient,,,76.00000,43.78000,SilverSummit Healthplan,Medicare Advantage,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,outpatient,,,606.00000,349.06000,SilverSummit Healthplan,Medicare Advantage,,212.10,,,,,,,157.56,587.82,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,outpatient,,,300.00000,172.80000,SilverSummit Healthplan,Medicare Advantage,,105.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,outpatient,,,59.00000,33.98000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,outpatient,,,98.00000,56.45000,SilverSummit Healthplan,Medicare Advantage,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,outpatient,,,61.00000,35.14000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,outpatient,,,128.00000,73.73000,SilverSummit Healthplan,Medicare Advantage,,44.80,,,,,,,33.28,124.16,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,SilverSummit Healthplan,Medicare Advantage,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,outpatient,,,16.00000,9.22000,SilverSummit Healthplan,Medicare Advantage,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,outpatient,,,565.00000,325.44000,SilverSummit Healthplan,Medicare Advantage,,197.75,,,,,,,146.90,548.05,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,outpatient,,,850.00000,489.60000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,outpatient,,,77.00000,44.35000,SilverSummit Healthplan,Medicare Advantage,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,outpatient,,,86.00000,49.54000,SilverSummit Healthplan,Medicare Advantage,,30.10,,,,,,,22.36,83.42,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,outpatient,,,837.00000,482.11000,SilverSummit Healthplan,Medicare Advantage,,292.95,,,,,,,217.62,811.89,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,outpatient,,,60.00000,34.56000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,outpatient,,,56.00000,32.26000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,outpatient,,,56.00000,32.26000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,SilverSummit Healthplan,Medicare Advantage,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,SilverSummit Healthplan,Medicare Advantage,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,SilverSummit Healthplan,Medicare Advantage,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,outpatient,,,167.00000,96.19000,SilverSummit Healthplan,Medicare Advantage,,58.45,,,,,,,43.42,161.99,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,outpatient,,,200.00000,115.20000,SilverSummit Healthplan,Medicare Advantage,,70.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,outpatient,,,93.00000,53.57000,SilverSummit Healthplan,Medicare Advantage,,32.55,,,,,,,24.18,90.21,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,SilverSummit Healthplan,Medicare Advantage,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,outpatient,,,190.00000,109.44000,SilverSummit Healthplan,Medicare Advantage,,66.50,,,,,,,49.40,184.30,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,outpatient,,,64.00000,36.86000,SilverSummit Healthplan,Medicare Advantage,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,outpatient,,,525.00000,302.40000,SilverSummit Healthplan,Medicare Advantage,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,outpatient,,,54.00000,31.10000,SilverSummit Healthplan,Medicare Advantage,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,SilverSummit Healthplan,Medicare Advantage,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,outpatient,,,53.00000,30.53000,SilverSummit Healthplan,Medicare Advantage,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,SilverSummit Healthplan,Medicare Advantage,,14.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,outpatient,,,453.00000,260.93000,SilverSummit Healthplan,Medicare Advantage,,158.55,,,,,,,117.78,439.41,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,outpatient,,,25.00000,14.40000,SilverSummit Healthplan,Medicare Advantage,,8.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,outpatient,,,56.00000,32.26000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,outpatient,,,59.00000,33.98000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,outpatient,,,53.00000,30.53000,SilverSummit Healthplan,Medicare Advantage,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,outpatient,,,350.00000,201.60000,SilverSummit Healthplan,Medicare Advantage,,122.50,,,,,,,91.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,outpatient,,,225.00000,129.60000,SilverSummit Healthplan,Medicare Advantage,,78.75,,,,,,,58.50,218.25,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,outpatient,,,52.00000,29.95000,SilverSummit Healthplan,Medicare Advantage,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,outpatient,,,134.00000,77.18000,SilverSummit Healthplan,Medicare Advantage,,46.90,,,,,,,34.84,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,outpatient,,,52.00000,29.95000,SilverSummit Healthplan,Medicare Advantage,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,outpatient,,,186.00000,107.14000,SilverSummit Healthplan,Medicare Advantage,,65.10,,,,,,,48.36,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,SilverSummit Healthplan,Medicare Advantage,,105.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,SilverSummit Healthplan,Medicare Advantage,,105.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,outpatient,,,62.00000,35.71000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,outpatient,,,205.00000,118.08000,SilverSummit Healthplan,Medicare Advantage,,71.75,,,,,,,53.30,198.85,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,outpatient,,,75.00000,36.15000,SilverSummit Healthplan,Medicare Advantage,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,outpatient,,,65.00000,31.33000,SilverSummit Healthplan,Medicare Advantage,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,outpatient,,,92.00000,44.34000,SilverSummit Healthplan,Medicare Advantage,,32.20,,,,,,,23.92,89.24,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,SilverSummit Healthplan,Medicare Advantage,,8.40,,,,,,,6.24,23.28,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,outpatient,,,20.00000,9.64000,SilverSummit Healthplan,Medicare Advantage,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,outpatient,,,42.00000,20.24000,SilverSummit Healthplan,Medicare Advantage,,14.70,,,,,,,10.92,40.74,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,outpatient,,,69.00000,33.26000,SilverSummit Healthplan,Medicare Advantage,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,outpatient,,,65.00000,31.33000,SilverSummit Healthplan,Medicare Advantage,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,outpatient,,,76.00000,36.63000,SilverSummit Healthplan,Medicare Advantage,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,outpatient,,,89.00000,42.90000,SilverSummit Healthplan,Medicare Advantage,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,outpatient,,,76.00000,36.63000,SilverSummit Healthplan,Medicare Advantage,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,outpatient,,,28.00000,13.50000,SilverSummit Healthplan,Medicare Advantage,,9.80,,,,,,,7.28,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,outpatient,,,98.00000,47.24000,SilverSummit Healthplan,Medicare Advantage,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,outpatient,,,64.00000,30.85000,SilverSummit Healthplan,Medicare Advantage,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,outpatient,,,75.00000,36.15000,SilverSummit Healthplan,Medicare Advantage,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,outpatient,,,76.00000,36.63000,SilverSummit Healthplan,Medicare Advantage,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,outpatient,,,114.00000,54.95000,SilverSummit Healthplan,Medicare Advantage,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,outpatient,,,74.00000,35.67000,SilverSummit Healthplan,Medicare Advantage,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,outpatient,,,69.00000,33.26000,SilverSummit Healthplan,Medicare Advantage,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,outpatient,,,74.00000,35.67000,SilverSummit Healthplan,Medicare Advantage,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,outpatient,,,87.00000,41.93000,SilverSummit Healthplan,Medicare Advantage,,30.45,,,,,,,22.62,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,outpatient,,,79.00000,38.08000,SilverSummit Healthplan,Medicare Advantage,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,outpatient,,,75.00000,36.15000,SilverSummit Healthplan,Medicare Advantage,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,outpatient,,,64.00000,30.85000,SilverSummit Healthplan,Medicare Advantage,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,outpatient,,,164.00000,79.05000,SilverSummit Healthplan,Medicare Advantage,,57.40,,,,,,,42.64,159.08,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,outpatient,,,54.00000,26.03000,SilverSummit Healthplan,Medicare Advantage,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,outpatient,,,8.00000,3.86000,SilverSummit Healthplan,Medicare Advantage,,2.80,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,outpatient,,,69.00000,33.26000,SilverSummit Healthplan,Medicare Advantage,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,outpatient,,,8.00000,3.86000,SilverSummit Healthplan,Medicare Advantage,,2.80,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,outpatient,,,8.00000,3.86000,SilverSummit Healthplan,Medicare Advantage,,2.80,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,outpatient,,,14.00000,6.75000,SilverSummit Healthplan,Medicare Advantage,,4.90,,,,,,,3.64,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,outpatient,,,62.00000,29.88000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,outpatient,,,112.00000,53.98000,SilverSummit Healthplan,Medicare Advantage,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,outpatient,,,13.00000,6.27000,SilverSummit Healthplan,Medicare Advantage,,4.55,,,,,,,3.38,12.61,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,outpatient,,,31.00000,14.94000,SilverSummit Healthplan,Medicare Advantage,,10.85,,,,,,,8.06,30.07,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,outpatient,,,92.00000,44.34000,SilverSummit Healthplan,Medicare Advantage,,32.20,,,,,,,23.92,89.24,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,outpatient,,,80.00000,38.56000,SilverSummit Healthplan,Medicare Advantage,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,SilverSummit Healthplan,Medicare Advantage,,10.50,,,,,,,7.80,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,SilverSummit Healthplan,Medicare Advantage,,10.50,,,,,,,7.80,29.10,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,SilverSummit Healthplan,Medicare Advantage,,8.40,,,,,,,6.24,23.28,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,outpatient,,,59.00000,28.44000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,outpatient,,,29.00000,13.98000,SilverSummit Healthplan,Medicare Advantage,,10.15,,,,,,,7.54,28.13,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,outpatient,,,97.00000,46.75000,SilverSummit Healthplan,Medicare Advantage,,33.95,,,,,,,25.22,94.09,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,outpatient,,,225.00000,108.45000,SilverSummit Healthplan,Medicare Advantage,,78.75,,,,,,,58.50,218.25,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,outpatient,,,71.00000,34.22000,SilverSummit Healthplan,Medicare Advantage,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,outpatient,,,71.00000,34.22000,SilverSummit Healthplan,Medicare Advantage,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,outpatient,,,108.00000,52.06000,SilverSummit Healthplan,Medicare Advantage,,37.80,,,,,,,28.08,104.76,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,outpatient,,,51.00000,24.58000,SilverSummit Healthplan,Medicare Advantage,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,outpatient,,,63.00000,30.37000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,outpatient,,,58.00000,27.96000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,outpatient,,,19.00000,9.16000,SilverSummit Healthplan,Medicare Advantage,,6.65,,,,,,,4.94,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,outpatient,,,54.00000,26.03000,SilverSummit Healthplan,Medicare Advantage,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,outpatient,,,103.00000,49.65000,SilverSummit Healthplan,Medicare Advantage,,36.05,,,,,,,26.78,99.91,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,outpatient,,,9.00000,4.34000,SilverSummit Healthplan,Medicare Advantage,,3.15,,,,,,,2.34,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,outpatient,,,13.00000,6.27000,SilverSummit Healthplan,Medicare Advantage,,4.55,,,,,,,3.38,12.61,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,outpatient,,,80.00000,38.56000,SilverSummit Healthplan,Medicare Advantage,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,outpatient,,,47.00000,22.65000,SilverSummit Healthplan,Medicare Advantage,,16.45,,,,,,,12.22,45.59,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,outpatient,,,91.00000,43.86000,SilverSummit Healthplan,Medicare Advantage,,31.85,,,,,,,23.66,88.27,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,outpatient,,,56.00000,26.99000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,outpatient,,,18.00000,8.68000,SilverSummit Healthplan,Medicare Advantage,,6.30,,,,,,,4.68,17.46,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,outpatient,,,60.00000,28.92000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,outpatient,,,57.00000,27.47000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,SilverSummit Healthplan,Medicare Advantage,,7.35,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,outpatient,,,71.00000,37.70000,SilverSummit Healthplan,Medicare Advantage,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,SilverSummit Healthplan,Medicare Advantage,,7.35,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,outpatient,,,128.00000,67.97000,SilverSummit Healthplan,Medicare Advantage,,44.80,,,,,,,33.28,124.16,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,outpatient,,,65.00000,34.52000,SilverSummit Healthplan,Medicare Advantage,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,SilverSummit Healthplan,Medicare Advantage,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,outpatient,,,31.00000,16.46000,SilverSummit Healthplan,Medicare Advantage,,10.85,,,,,,,8.06,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,SilverSummit Healthplan,Medicare Advantage,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,SilverSummit Healthplan,Medicare Advantage,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,SilverSummit Healthplan,Medicare Advantage,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,outpatient,,,61.00000,32.39000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,SilverSummit Healthplan,Medicare Advantage,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,SilverSummit Healthplan,Medicare Advantage,,8.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,SilverSummit Healthplan,Medicare Advantage,91,8.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,outpatient,,,103.00000,54.69000,SilverSummit Healthplan,Medicare Advantage,,36.05,,,,,,,26.78,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,outpatient,,,96.00000,50.98000,SilverSummit Healthplan,Medicare Advantage,,33.60,,,,,,,24.96,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,outpatient,,,75.00000,39.83000,SilverSummit Healthplan,Medicare Advantage,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,outpatient,,,68.00000,36.11000,SilverSummit Healthplan,Medicare Advantage,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,outpatient,,,61.00000,32.39000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,SilverSummit Healthplan,Medicare Advantage,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,SilverSummit Healthplan,Medicare Advantage,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,outpatient,,,29.00000,15.40000,SilverSummit Healthplan,Medicare Advantage,,10.15,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,SilverSummit Healthplan,Medicare Advantage,,10.15,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,SilverSummit Healthplan,Medicare Advantage,,10.15,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,outpatient,,,63.00000,33.45000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,outpatient,,,79.00000,41.95000,SilverSummit Healthplan,Medicare Advantage,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,outpatient,,,63.00000,33.45000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,SilverSummit Healthplan,Medicare Advantage,,10.15,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,outpatient,,,112.00000,59.47000,SilverSummit Healthplan,Medicare Advantage,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,SilverSummit Healthplan,Medicare Advantage,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,outpatient,,,25.00000,13.28000,SilverSummit Healthplan,Medicare Advantage,,8.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,outpatient,,,118.00000,62.66000,SilverSummit Healthplan,Medicare Advantage,,41.30,,,,,,,30.68,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,outpatient,,,29.00000,15.40000,SilverSummit Healthplan,Medicare Advantage,,10.15,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,outpatient,,,25.00000,13.28000,SilverSummit Healthplan,Medicare Advantage,,8.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,SilverSummit Healthplan,Medicare Advantage,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,outpatient,,,25.00000,13.28000,SilverSummit Healthplan,Medicare Advantage,,8.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,outpatient,,,71.00000,37.70000,SilverSummit Healthplan,Medicare Advantage,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,outpatient,,,59.00000,31.33000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,outpatient,,,62.00000,32.92000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,outpatient,,,138.00000,73.28000,SilverSummit Healthplan,Medicare Advantage,,48.30,,,,,,,35.88,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,outpatient,,,62.00000,32.92000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,outpatient,,,78.00000,41.42000,SilverSummit Healthplan,Medicare Advantage,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,outpatient,,,69.00000,36.64000,SilverSummit Healthplan,Medicare Advantage,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,outpatient,,,88.00000,46.73000,SilverSummit Healthplan,Medicare Advantage,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,outpatient,,,60.00000,31.86000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,outpatient,,,64.00000,33.98000,SilverSummit Healthplan,Medicare Advantage,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,outpatient,,,63.00000,33.45000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,outpatient,,,137.00000,72.75000,SilverSummit Healthplan,Medicare Advantage,,47.95,,,,,,,35.62,132.89,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,outpatient,,,347.00000,184.26000,SilverSummit Healthplan,Medicare Advantage,,121.45,,,,,,,90.22,336.59,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,outpatient,,,57.00000,30.27000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,outpatient,,,56.00000,29.74000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,outpatient,,,16.00000,8.50000,SilverSummit Healthplan,Medicare Advantage,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,outpatient,,,85.00000,45.14000,SilverSummit Healthplan,Medicare Advantage,,29.75,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,outpatient,,,34.00000,18.05000,SilverSummit Healthplan,Medicare Advantage,,11.90,,,,,,,8.84,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,outpatient,,,231.00000,122.66000,SilverSummit Healthplan,Medicare Advantage,,80.85,,,,,,,60.06,224.07,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,outpatient,,,36.00000,19.12000,SilverSummit Healthplan,Medicare Advantage,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,outpatient,,,61.00000,32.39000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,outpatient,,,111.00000,58.94000,SilverSummit Healthplan,Medicare Advantage,,38.85,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,outpatient,,,61.00000,32.39000,SilverSummit Healthplan,Medicare Advantage,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,outpatient,,,60.00000,31.86000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,outpatient,,,60.00000,31.86000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,outpatient,,,60.00000,31.86000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,outpatient,,,60.00000,31.86000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,outpatient,,,60.00000,31.86000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,outpatient,,,36.00000,19.12000,SilverSummit Healthplan,Medicare Advantage,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,outpatient,,,76.00000,40.36000,SilverSummit Healthplan,Medicare Advantage,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,outpatient,,,60.00000,31.86000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,outpatient,,,60.00000,31.86000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,outpatient,,,152.00000,80.71000,SilverSummit Healthplan,Medicare Advantage,,53.20,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,outpatient,,,78.00000,41.42000,SilverSummit Healthplan,Medicare Advantage,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,outpatient,,,42.00000,22.30000,SilverSummit Healthplan,Medicare Advantage,,14.70,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,outpatient,,,73.00000,38.76000,SilverSummit Healthplan,Medicare Advantage,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,outpatient,,,97.00000,51.51000,SilverSummit Healthplan,Medicare Advantage,,33.95,,,,,,,25.22,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,outpatient,,,157.00000,83.37000,SilverSummit Healthplan,Medicare Advantage,,54.95,,,,,,,40.82,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,outpatient,,,36.00000,19.12000,SilverSummit Healthplan,Medicare Advantage,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,outpatient,,,66.00000,35.05000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,outpatient,,,58.00000,30.80000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,outpatient,,,85.00000,45.14000,SilverSummit Healthplan,Medicare Advantage,,29.75,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,outpatient,,,59.00000,31.33000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,outpatient,,,175.00000,92.93000,SilverSummit Healthplan,Medicare Advantage,,61.25,,,,,,,45.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,outpatient,,,152.00000,80.71000,SilverSummit Healthplan,Medicare Advantage,,53.20,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,outpatient,,,43.00000,22.83000,SilverSummit Healthplan,Medicare Advantage,,15.05,,,,,,,11.18,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,outpatient,,,66.00000,35.05000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,outpatient,,,36.00000,19.12000,SilverSummit Healthplan,Medicare Advantage,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,outpatient,,,36.00000,19.12000,SilverSummit Healthplan,Medicare Advantage,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,outpatient,,,42.00000,22.30000,SilverSummit Healthplan,Medicare Advantage,,14.70,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,outpatient,,,147.00000,78.06000,SilverSummit Healthplan,Medicare Advantage,,51.45,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,outpatient,,,64.00000,33.98000,SilverSummit Healthplan,Medicare Advantage,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,outpatient,,,60.00000,31.86000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,outpatient,,,75.00000,39.83000,SilverSummit Healthplan,Medicare Advantage,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,outpatient,,,44.00000,23.36000,SilverSummit Healthplan,Medicare Advantage,,15.40,,,,,,,11.44,42.68,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,outpatient,,,87.00000,46.20000,SilverSummit Healthplan,Medicare Advantage,,30.45,,,,,,,22.62,84.39,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,outpatient,,,65.00000,34.52000,SilverSummit Healthplan,Medicare Advantage,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,outpatient,,,75.00000,39.83000,SilverSummit Healthplan,Medicare Advantage,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,outpatient,,,50.00000,26.55000,SilverSummit Healthplan,Medicare Advantage,,17.50,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,outpatient,,,40.00000,21.24000,SilverSummit Healthplan,Medicare Advantage,,14.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,outpatient,,,50.00000,26.55000,SilverSummit Healthplan,Medicare Advantage,,17.50,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Medicare Advantage,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,outpatient,,,115.00000,61.07000,SilverSummit Healthplan,Medicare Advantage,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1309.00000,695.08000,SilverSummit Healthplan,Medicare Advantage,,458.15,,,,,,,340.34,1269.73,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Medicare Advantage,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Medicare Advantage,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,outpatient,,,328.00000,174.17000,SilverSummit Healthplan,Medicare Advantage,,114.80,,,,,,,85.28,318.16,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,outpatient,,,115.00000,61.07000,SilverSummit Healthplan,Medicare Advantage,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Medicare Advantage,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Medicare Advantage,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,outpatient,,,1251.00000,664.28000,SilverSummit Healthplan,Medicare Advantage,,437.85,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,SilverSummit Healthplan,Medicare Advantage,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,SilverSummit Healthplan,Medicare Advantage,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,outpatient,,,96.00000,50.98000,SilverSummit Healthplan,Medicare Advantage,,33.60,,,,,,,24.96,93.12,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,outpatient,,,211.00000,112.04000,SilverSummit Healthplan,Medicare Advantage,,73.85,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,outpatient,,,290.00000,153.99000,SilverSummit Healthplan,Medicare Advantage,,101.50,,,,,,,75.40,281.30,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Medicare Advantage,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Medicare Advantage,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,outpatient,,,411.00000,218.24000,SilverSummit Healthplan,Medicare Advantage,,143.85,,,,,,,106.86,398.67,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,outpatient,,,139.00000,73.81000,SilverSummit Healthplan,Medicare Advantage,,48.65,,,,,,,36.14,134.83,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,outpatient,,,288.00000,152.93000,SilverSummit Healthplan,Medicare Advantage,,100.80,,,,,,,74.88,279.36,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1372.00000,728.53000,SilverSummit Healthplan,Medicare Advantage,,480.20,,,,,,,356.72,1330.84,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,outpatient,,,1251.00000,664.28000,SilverSummit Healthplan,Medicare Advantage,,437.85,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,outpatient,,,135.00000,71.68000,SilverSummit Healthplan,Medicare Advantage,,47.25,,,,,,,35.10,130.95,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Medicare Advantage,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Medicare Advantage,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,outpatient,,,147.00000,78.06000,SilverSummit Healthplan,Medicare Advantage,,51.45,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,outpatient,,,126.00000,66.91000,SilverSummit Healthplan,Medicare Advantage,,44.10,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,outpatient,,,120.00000,63.72000,SilverSummit Healthplan,Medicare Advantage,,42.00,,,,,,,31.20,116.40,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Medicare Advantage,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,outpatient,,,124.00000,65.84000,SilverSummit Healthplan,Medicare Advantage,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,outpatient,,,108.00000,57.35000,SilverSummit Healthplan,Medicare Advantage,,37.80,,,,,,,28.08,104.76,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,SilverSummit Healthplan,Medicare Advantage,,89.60,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,SilverSummit Healthplan,Medicare Advantage,,89.60,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,outpatient,,,122.00000,64.78000,SilverSummit Healthplan,Medicare Advantage,,42.70,,,,,,,31.72,118.34,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Medicare Advantage,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,outpatient,,,123.00000,65.31000,SilverSummit Healthplan,Medicare Advantage,,43.05,,,,,,,31.98,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Medicare Advantage,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,outpatient,,,518.00000,275.06000,SilverSummit Healthplan,Medicare Advantage,,181.30,,,,,,,134.68,502.46,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,outpatient,,,275.00000,146.02000,SilverSummit Healthplan,Medicare Advantage,,96.25,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,outpatient,,,270.00000,143.37000,SilverSummit Healthplan,Medicare Advantage,,94.50,,,,,,,70.20,261.90,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,outpatient,,,450.00000,238.95000,SilverSummit Healthplan,Medicare Advantage,,157.50,,,,,,,117.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,outpatient,,,126.00000,66.91000,SilverSummit Healthplan,Medicare Advantage,,44.10,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,outpatient,,,362.00000,192.22000,SilverSummit Healthplan,Medicare Advantage,,126.70,,,,,,,94.12,351.14,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,SilverSummit Healthplan,Medicare Advantage,,38.15,,,,,,,28.34,105.73,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,outpatient,,,638.00000,338.78000,SilverSummit Healthplan,Medicare Advantage,,223.30,,,,,,,165.88,618.86,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,outpatient,,,211.00000,112.04000,SilverSummit Healthplan,Medicare Advantage,,73.85,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,outpatient,,,154.00000,81.77000,SilverSummit Healthplan,Medicare Advantage,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,outpatient,,,141.00000,74.87000,SilverSummit Healthplan,Medicare Advantage,,49.35,,,,,,,36.66,136.77,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,outpatient,,,2040.00000,1083.24000,SilverSummit Healthplan,Medicare Advantage,,714.00,,,,,,,530.40,1978.80,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,outpatient,,,421.00000,223.55000,SilverSummit Healthplan,Medicare Advantage,,147.35,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,outpatient,,,275.00000,146.02000,SilverSummit Healthplan,Medicare Advantage,,96.25,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,outpatient,,,1251.00000,664.28000,SilverSummit Healthplan,Medicare Advantage,,437.85,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,SilverSummit Healthplan,Medicare Advantage,,149.80,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,SilverSummit Healthplan,Medicare Advantage,,149.80,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,SilverSummit Healthplan,Medicare Advantage,,229.25,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,SilverSummit Healthplan,Medicare Advantage,,229.25,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,outpatient,,,211.00000,112.04000,SilverSummit Healthplan,Medicare Advantage,,73.85,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,SilverSummit Healthplan,Medicare Advantage,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,SilverSummit Healthplan,Medicare Advantage,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,outpatient,,,130.00000,69.03000,SilverSummit Healthplan,Medicare Advantage,,45.50,,,,,,,33.80,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,outpatient,,,421.00000,223.55000,SilverSummit Healthplan,Medicare Advantage,,147.35,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,outpatient,,,111.00000,58.94000,SilverSummit Healthplan,Medicare Advantage,,38.85,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,outpatient,,,200.00000,106.20000,SilverSummit Healthplan,Medicare Advantage,,70.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,SilverSummit Healthplan,Medicare Advantage,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,outpatient,,,13.00000,6.90000,SilverSummit Healthplan,Medicare Advantage,,4.55,,,,,,,3.38,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,outpatient,,,58.00000,30.80000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,outpatient,,,13.00000,6.90000,SilverSummit Healthplan,Medicare Advantage,,4.55,,,,,,,3.38,12.61,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,outpatient,,,773.00000,410.46000,SilverSummit Healthplan,Medicare Advantage,,270.55,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,outpatient,,,773.00000,410.46000,SilverSummit Healthplan,Medicare Advantage,,270.55,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,outpatient,,,773.00000,410.46000,SilverSummit Healthplan,Medicare Advantage,,270.55,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,outpatient,,,773.00000,410.46000,SilverSummit Healthplan,Medicare Advantage,,270.55,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,outpatient,,,387.00000,205.50000,SilverSummit Healthplan,Medicare Advantage,,135.45,,,,,,,100.62,375.39,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,outpatient,,,52.00000,27.61000,SilverSummit Healthplan,Medicare Advantage,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,SilverSummit Healthplan,Medicare Advantage,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,SilverSummit Healthplan,Medicare Advantage,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,outpatient,,,79.00000,41.95000,SilverSummit Healthplan,Medicare Advantage,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,outpatient,,,65.00000,34.52000,SilverSummit Healthplan,Medicare Advantage,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,outpatient,,,100.00000,53.10000,SilverSummit Healthplan,Medicare Advantage,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,outpatient,,,64.00000,33.98000,SilverSummit Healthplan,Medicare Advantage,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,outpatient,,,106.00000,56.29000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,SilverSummit Healthplan,Medicare Advantage,,38.15,,,,,,,28.34,105.73,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,outpatient,,,58.00000,30.80000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,SilverSummit Healthplan,Medicare Advantage,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,outpatient,,,66.00000,35.05000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,SilverSummit Healthplan,Medicare Advantage,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,SilverSummit Healthplan,Medicare Advantage,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,SilverSummit Healthplan,Medicare Advantage,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,outpatient,,,13.00000,6.90000,SilverSummit Healthplan,Medicare Advantage,,4.55,,,,,,,3.38,12.61,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,outpatient,,,53.00000,28.14000,SilverSummit Healthplan,Medicare Advantage,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,outpatient,,,18.00000,9.56000,SilverSummit Healthplan,Medicare Advantage,,6.30,,,,,,,4.68,17.46,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,outpatient,,,17.00000,9.03000,SilverSummit Healthplan,Medicare Advantage,,5.95,,,,,,,4.42,16.49,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,outpatient,,,71.00000,37.70000,SilverSummit Healthplan,Medicare Advantage,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,outpatient,,,57.00000,30.27000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,outpatient,,,68.00000,36.11000,SilverSummit Healthplan,Medicare Advantage,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,outpatient,,,58.00000,30.80000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,outpatient,,,27.00000,14.34000,SilverSummit Healthplan,Medicare Advantage,,9.45,,,,,,,7.02,26.19,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,outpatient,,,56.00000,29.74000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,outpatient,,,56.00000,29.74000,SilverSummit Healthplan,Medicare Advantage,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,outpatient,,,58.00000,30.80000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,outpatient,,,115.00000,61.07000,SilverSummit Healthplan,Medicare Advantage,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,outpatient,,,23.00000,12.21000,SilverSummit Healthplan,Medicare Advantage,,8.05,,,,,,,5.98,22.31,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,outpatient,,,255.00000,135.40000,SilverSummit Healthplan,Medicare Advantage,,89.25,,,,,,,66.30,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,outpatient,,,66.00000,35.05000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,outpatient,,,26.00000,13.81000,SilverSummit Healthplan,Medicare Advantage,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,outpatient,,,64.00000,33.98000,SilverSummit Healthplan,Medicare Advantage,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,outpatient,,,215.00000,114.16000,SilverSummit Healthplan,Medicare Advantage,,75.25,,,,,,,55.90,208.55,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,outpatient,,,79.00000,41.95000,SilverSummit Healthplan,Medicare Advantage,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,outpatient,,,11.00000,5.29000,SilverSummit Healthplan,Medicare Advantage,,3.85,,,,,,,2.86,10.67,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,outpatient,,,58.00000,27.90000,SilverSummit Healthplan,Medicare Advantage,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,outpatient,,,10.00000,4.81000,SilverSummit Healthplan,Medicare Advantage,,3.50,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,outpatient,,,7.00000,3.37000,SilverSummit Healthplan,Medicare Advantage,,2.45,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,outpatient,,,53.00000,25.49000,SilverSummit Healthplan,Medicare Advantage,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,outpatient,,,10.00000,4.81000,SilverSummit Healthplan,Medicare Advantage,,3.50,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,SilverSummit Healthplan,Medicare Advantage,,3.85,,,,,,,2.86,10.67,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,outpatient,,,7.00000,3.37000,SilverSummit Healthplan,Medicare Advantage,,2.45,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,SilverSummit Healthplan,Medicare Advantage,,3.85,,,,,,,2.86,10.67,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,outpatient,,,597.00000,290.14000,SilverSummit Healthplan,Medicare Advantage,,208.95,,,,,,,155.22,579.09,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,outpatient,,,6379.00000,3100.19000,SilverSummit Healthplan,Medicare Advantage,,2232.65,,,,,,,1658.54,6187.63,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,outpatient,,,471.00000,228.91000,SilverSummit Healthplan,Medicare Advantage,,164.85,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,outpatient,,,471.00000,228.91000,SilverSummit Healthplan,Medicare Advantage,,164.85,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,outpatient,,,1251.00000,607.99000,SilverSummit Healthplan,Medicare Advantage,,437.85,,,,,,,325.26,1213.47,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,outpatient,,,260.00000,126.36000,SilverSummit Healthplan,Medicare Advantage,,91.00,,,,,,,67.60,252.20,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,outpatient,,,785.00000,381.51000,SilverSummit Healthplan,Medicare Advantage,,274.75,,,,,,,204.10,761.45,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,outpatient,,,529.00000,257.09000,SilverSummit Healthplan,Medicare Advantage,,185.15,,,,,,,137.54,513.13,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,outpatient,,,1623.00000,788.78000,SilverSummit Healthplan,Medicare Advantage,,568.05,,,,,,,421.98,1574.31,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,outpatient,,,10800.00000,5248.80000,SilverSummit Healthplan,Medicare Advantage,,3780.00,,,,,,,2808.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,outpatient,,,25365.00000,12327.39000,SilverSummit Healthplan,Medicare Advantage,,8877.75,,,,,,,6594.90,24604.05,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,outpatient,,,101.00000,21.82000,SilverSummit Healthplan,Medicare Advantage,,35.35,,,,,,,26.26,97.97,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,outpatient,,,81.00000,17.50000,SilverSummit Healthplan,Medicare Advantage,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,outpatient,,,104.00000,22.46000,SilverSummit Healthplan,Medicare Advantage,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,outpatient,,,377.00000,81.43000,SilverSummit Healthplan,Medicare Advantage,,131.95,,,,,,,98.02,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,outpatient,,,532.00000,114.91000,SilverSummit Healthplan,Medicare Advantage,,186.20,,,,,,,138.32,516.04,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,outpatient,,,521.00000,112.54000,SilverSummit Healthplan,Medicare Advantage,,182.35,,,,,,,135.46,505.37,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,outpatient,,,451.00000,97.42000,SilverSummit Healthplan,Medicare Advantage,,157.85,,,,,,,117.26,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,outpatient,,,1148.00000,247.97000,SilverSummit Healthplan,Medicare Advantage,,401.80,,,,,,,298.48,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,outpatient,,,350.00000,75.60000,SilverSummit Healthplan,Medicare Advantage,,122.50,,,,,,,91.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,outpatient,,,423.00000,91.37000,SilverSummit Healthplan,Medicare Advantage,,148.05,,,,,,,109.98,410.31,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,SilverSummit Healthplan,Medicare Advantage,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,SilverSummit Healthplan,Medicare Advantage,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,outpatient,,,119.00000,25.70000,SilverSummit Healthplan,Medicare Advantage,,41.65,,,,,,,30.94,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,outpatient,,,126.00000,27.22000,SilverSummit Healthplan,Medicare Advantage,,44.10,,,,,,,32.76,122.22,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,SilverSummit Healthplan,Medicare Advantage,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,SilverSummit Healthplan,Medicare Advantage,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,outpatient,,,79.00000,17.06000,SilverSummit Healthplan,Medicare Advantage,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,SilverSummit Healthplan,Medicare Advantage,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,SilverSummit Healthplan,Medicare Advantage,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,outpatient,,,79.00000,17.06000,SilverSummit Healthplan,Medicare Advantage,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,outpatient,,,335.00000,72.36000,SilverSummit Healthplan,Medicare Advantage,,117.25,,,,,,,87.10,324.95,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,SilverSummit Healthplan,Medicare Advantage,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,SilverSummit Healthplan,Medicare Advantage,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,outpatient,,,128.00000,27.65000,SilverSummit Healthplan,Medicare Advantage,,44.80,,,,,,,33.28,124.16,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,outpatient,,,65.00000,14.04000,SilverSummit Healthplan,Medicare Advantage,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,outpatient,,,272.00000,58.75000,SilverSummit Healthplan,Medicare Advantage,,95.20,,,,,,,70.72,263.84,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,outpatient,,,26.00000,11.44000,SilverSummit Healthplan,Medicare Advantage,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,outpatient,,,359.00000,157.96000,SilverSummit Healthplan,Medicare Advantage,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,outpatient,,,189.00000,83.16000,SilverSummit Healthplan,Medicare Advantage,,66.15,,,,,,,49.14,183.33,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,outpatient,,,359.00000,157.96000,SilverSummit Healthplan,Medicare Advantage,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,outpatient,,,137.00000,60.28000,SilverSummit Healthplan,Medicare Advantage,,47.95,,,,,,,35.62,132.89,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,outpatient,,,1665.00000,732.60000,SilverSummit Healthplan,Medicare Advantage,,582.75,,,,,,,432.90,1615.05,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,outpatient,,,751.00000,330.44000,SilverSummit Healthplan,Medicare Advantage,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,outpatient,,,374.00000,164.56000,SilverSummit Healthplan,Medicare Advantage,,130.90,,,,,,,97.24,362.78,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,outpatient,,,553.00000,243.32000,SilverSummit Healthplan,Medicare Advantage,,193.55,,,,,,,143.78,536.41,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,outpatient,,,359.00000,157.96000,SilverSummit Healthplan,Medicare Advantage,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,outpatient,,,62.00000,27.28000,SilverSummit Healthplan,Medicare Advantage,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,outpatient,,,79.00000,34.76000,SilverSummit Healthplan,Medicare Advantage,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,outpatient,,,110.00000,48.40000,SilverSummit Healthplan,Medicare Advantage,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,outpatient,,,110.00000,48.40000,SilverSummit Healthplan,Medicare Advantage,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,outpatient,,,751.00000,330.44000,SilverSummit Healthplan,Medicare Advantage,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,outpatient,,,1665.00000,732.60000,SilverSummit Healthplan,Medicare Advantage,,582.75,,,,,,,432.90,1615.05,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,outpatient,,,110.00000,48.40000,SilverSummit Healthplan,Medicare Advantage,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,SilverSummit Healthplan,Medicare Advantage,,98.35,,,,,,,73.06,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,SilverSummit Healthplan,Medicare Advantage,,98.35,,,,,,,73.06,272.57,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,outpatient,,,451.00000,341.41000,SilverSummit Healthplan,Medicare Advantage,,157.85,,,,,,,117.26,437.47,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,outpatient,,,300.00000,145.80000,SilverSummit Healthplan,Medicare Advantage,,105.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,outpatient,,,2278.00000,1107.11000,SilverSummit Healthplan,Medicare Advantage,,797.30,,,,,,,592.28,2209.66,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,outpatient,,,3912.00000,1901.23000,SilverSummit Healthplan,Medicare Advantage,,1369.20,,,,,,,1017.12,3794.64,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,outpatient,,,900.00000,437.40000,SilverSummit Healthplan,Medicare Advantage,,315.00,,,,,,,234.00,873.00,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,outpatient,,,365.00000,177.39000,SilverSummit Healthplan,Medicare Advantage,,127.75,,,,,,,94.90,354.05,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,outpatient,,,989.00000,480.65000,SilverSummit Healthplan,Medicare Advantage,,346.15,,,,,,,257.14,959.33,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,SilverSummit Healthplan,Medicare Advantage,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,SilverSummit Healthplan,Medicare Advantage,,152.25,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,SilverSummit Healthplan,Medicare Advantage,,152.25,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,outpatient,,,644.00000,312.98000,SilverSummit Healthplan,Medicare Advantage,,225.40,,,,,,,167.44,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,SilverSummit Healthplan,Medicare Advantage,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,SilverSummit Healthplan,Medicare Advantage,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,outpatient,,,527.00000,256.12000,SilverSummit Healthplan,Medicare Advantage,,184.45,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,outpatient,,,1404.00000,682.34000,SilverSummit Healthplan,Medicare Advantage,,491.40,,,,,,,365.04,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,outpatient,,,5475.00000,2660.85000,SilverSummit Healthplan,Medicare Advantage,,1916.25,,,,,,,1423.50,5310.75,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,outpatient,,,726.00000,352.84000,SilverSummit Healthplan,Medicare Advantage,,254.10,,,,,,,188.76,704.22,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,outpatient,,,507.00000,246.40000,SilverSummit Healthplan,Medicare Advantage,,177.45,,,,,,,131.82,491.79,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,outpatient,,,1670.00000,811.62000,SilverSummit Healthplan,Medicare Advantage,,584.50,,,,,,,434.20,1619.90,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,outpatient,,,1139.00000,553.55000,SilverSummit Healthplan,Medicare Advantage,,398.65,,,,,,,296.14,1104.83,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,outpatient,,,875.00000,425.25000,SilverSummit Healthplan,Medicare Advantage,,306.25,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,outpatient,,,525.00000,255.15000,SilverSummit Healthplan,Medicare Advantage,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,outpatient,,,1353.00000,657.56000,SilverSummit Healthplan,Medicare Advantage,,473.55,,,,,,,351.78,1312.41,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,outpatient,,,525.00000,255.15000,SilverSummit Healthplan,Medicare Advantage,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,outpatient,,,525.00000,255.15000,SilverSummit Healthplan,Medicare Advantage,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,outpatient,,,825.00000,400.95000,SilverSummit Healthplan,Medicare Advantage,,288.75,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,SilverSummit Healthplan,Medicare Advantage,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,SilverSummit Healthplan,Medicare Advantage,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,outpatient,,,974.00000,473.36000,SilverSummit Healthplan,Medicare Advantage,,340.90,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,SilverSummit Healthplan,Medicare Advantage,,69.30,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,SilverSummit Healthplan,Medicare Advantage,,69.30,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,SilverSummit Healthplan,Medicare Advantage,,77.35,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,SilverSummit Healthplan,Medicare Advantage,,77.35,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,outpatient,,,497.00000,241.54000,SilverSummit Healthplan,Medicare Advantage,,173.95,,,,,,,129.22,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,outpatient,,,2340.00000,1137.24000,SilverSummit Healthplan,Medicare Advantage,,819.00,,,,,,,608.40,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,outpatient,,,249.00000,121.01000,SilverSummit Healthplan,Medicare Advantage,,87.15,,,,,,,64.74,241.53,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,outpatient,,,135.00000,65.61000,SilverSummit Healthplan,Medicare Advantage,,47.25,,,,,,,35.10,130.95,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,outpatient,,,172.00000,83.59000,SilverSummit Healthplan,Medicare Advantage,,60.20,,,,,,,44.72,166.84,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,outpatient,,,307.00000,149.20000,SilverSummit Healthplan,Medicare Advantage,,107.45,,,,,,,79.82,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,outpatient,,,1800.00000,874.80000,SilverSummit Healthplan,Medicare Advantage,,630.00,,,,,,,468.00,1746.00,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,outpatient,,,974.00000,473.36000,SilverSummit Healthplan,Medicare Advantage,,340.90,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,SilverSummit Healthplan,Medicare Advantage,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,SilverSummit Healthplan,Medicare Advantage,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,outpatient,,,411.00000,199.75000,SilverSummit Healthplan,Medicare Advantage,,143.85,,,,,,,106.86,398.67,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,outpatient,,,221.00000,107.41000,SilverSummit Healthplan,Medicare Advantage,,77.35,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,outpatient,,,884.00000,429.62000,SilverSummit Healthplan,Medicare Advantage,,309.40,,,,,,,229.84,857.48,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,outpatient,,,594.00000,288.68000,SilverSummit Healthplan,Medicare Advantage,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,outpatient,,,519.00000,252.23000,SilverSummit Healthplan,Medicare Advantage,,181.65,,,,,,,134.94,503.43,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,outpatient,,,1046.00000,508.36000,SilverSummit Healthplan,Medicare Advantage,,366.10,,,,,,,271.96,1014.62,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,outpatient,,,556.00000,270.22000,SilverSummit Healthplan,Medicare Advantage,,194.60,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,outpatient,,,275.00000,133.65000,SilverSummit Healthplan,Medicare Advantage,,96.25,,,,,,,71.50,266.75,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,outpatient,,,580.00000,281.88000,SilverSummit Healthplan,Medicare Advantage,,203.00,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,outpatient,,,580.00000,281.88000,SilverSummit Healthplan,Medicare Advantage,,203.00,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,SilverSummit Healthplan,Medicare Advantage,,1218.00,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,SilverSummit Healthplan,Medicare Advantage,,1218.00,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,outpatient,,,700.00000,340.20000,SilverSummit Healthplan,Medicare Advantage,,245.00,,,,,,,182.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,outpatient,,,1427.00000,693.52000,SilverSummit Healthplan,Medicare Advantage,,499.45,,,,,,,371.02,1384.19,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,outpatient,,,614.00000,298.40000,SilverSummit Healthplan,Medicare Advantage,,214.90,,,,,,,159.64,595.58,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,outpatient,,,2027.00000,985.12000,SilverSummit Healthplan,Medicare Advantage,,709.45,,,,,,,527.02,1966.19,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,outpatient,,,556.00000,270.22000,SilverSummit Healthplan,Medicare Advantage,,194.60,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,outpatient,,,1146.00000,556.96000,SilverSummit Healthplan,Medicare Advantage,,401.10,,,,,,,297.96,1111.62,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,SilverSummit Healthplan,Medicare Advantage,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,SilverSummit Healthplan,Medicare Advantage,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,outpatient,,,527.00000,256.12000,SilverSummit Healthplan,Medicare Advantage,,184.45,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,outpatient,,,740.00000,359.64000,SilverSummit Healthplan,Medicare Advantage,,259.00,,,,,,,192.40,717.80,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,SilverSummit Healthplan,Medicare Advantage,,306.25,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,SilverSummit Healthplan,Medicare Advantage,,306.25,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,outpatient,,,1399.00000,679.91000,SilverSummit Healthplan,Medicare Advantage,,489.65,,,,,,,363.74,1357.03,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,outpatient,,,51.00000,24.79000,SilverSummit Healthplan,Medicare Advantage,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,outpatient,,,825.00000,400.95000,SilverSummit Healthplan,Medicare Advantage,,288.75,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,outpatient,,,576.00000,279.94000,SilverSummit Healthplan,Medicare Advantage,,201.60,,,,,,,149.76,558.72,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,outpatient,,,224.00000,108.86000,SilverSummit Healthplan,Medicare Advantage,,78.40,,,,,,,58.24,217.28,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,outpatient,,,346.00000,168.16000,SilverSummit Healthplan,Medicare Advantage,,121.10,,,,,,,89.96,335.62,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,outpatient,,,525.00000,255.15000,SilverSummit Healthplan,Medicare Advantage,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,outpatient,,,525.00000,255.15000,SilverSummit Healthplan,Medicare Advantage,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,SilverSummit Healthplan,Medicare Advantage,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,SilverSummit Healthplan,Medicare Advantage,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,outpatient,,,627.00000,304.72000,SilverSummit Healthplan,Medicare Advantage,,219.45,,,,,,,163.02,608.19,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,outpatient,,,605.00000,294.03000,SilverSummit Healthplan,Medicare Advantage,,211.75,,,,,,,157.30,586.85,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,outpatient,,,510.00000,247.86000,SilverSummit Healthplan,Medicare Advantage,,178.50,,,,,,,132.60,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,outpatient,,,223.00000,108.38000,SilverSummit Healthplan,Medicare Advantage,,78.05,,,,,,,57.98,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,outpatient,,,1211.00000,588.55000,SilverSummit Healthplan,Medicare Advantage,,423.85,,,,,,,314.86,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,outpatient,,,383.00000,186.14000,SilverSummit Healthplan,Medicare Advantage,,134.05,,,,,,,99.58,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,outpatient,,,1214.00000,590.00000,SilverSummit Healthplan,Medicare Advantage,,424.90,,,,,,,315.64,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,outpatient,,,328.00000,159.41000,SilverSummit Healthplan,Medicare Advantage,,114.80,,,,,,,85.28,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,outpatient,,,372.00000,180.79000,SilverSummit Healthplan,Medicare Advantage,,130.20,,,,,,,96.72,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,outpatient,,,285.00000,138.51000,SilverSummit Healthplan,Medicare Advantage,,99.75,,,,,,,74.10,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,outpatient,,,367.00000,178.36000,SilverSummit Healthplan,Medicare Advantage,,128.45,,,,,,,95.42,355.99,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,SilverSummit Healthplan,Medicare Advantage,,245.70,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,SilverSummit Healthplan,Medicare Advantage,,245.70,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,outpatient,,,265.00000,128.79000,SilverSummit Healthplan,Medicare Advantage,,92.75,,,,,,,68.90,257.05,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2279.00000,1107.59000,SilverSummit Healthplan,Medicare Advantage,,797.65,,,,,,,592.54,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2395.00000,1163.97000,SilverSummit Healthplan,Medicare Advantage,,838.25,,,,,,,622.70,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,SilverSummit Healthplan,Medicare Advantage,,3065.65,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,SilverSummit Healthplan,Medicare Advantage,,3065.65,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,outpatient,,,2752.00000,1337.47000,SilverSummit Healthplan,Medicare Advantage,,963.20,,,,,,,715.52,2669.44,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,SilverSummit Healthplan,Medicare Advantage,,75.95,,,,,,,56.42,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,SilverSummit Healthplan,Medicare Advantage,,75.95,,,,,,,56.42,210.49,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,outpatient,,,292.00000,141.91000,SilverSummit Healthplan,Medicare Advantage,,102.20,,,,,,,75.92,283.24,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,SilverSummit Healthplan,Medicare Advantage,,143.85,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,SilverSummit Healthplan,Medicare Advantage,,143.85,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,SilverSummit Healthplan,Medicare Advantage,,143.85,,,,,,,106.86,398.67,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,outpatient,,,2275.00000,1105.65000,SilverSummit Healthplan,Medicare Advantage,,796.25,,,,,,,591.50,2206.75,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,outpatient,,,192.00000,93.31000,SilverSummit Healthplan,Medicare Advantage,,67.20,,,,,,,49.92,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,outpatient,,,451.00000,219.19000,SilverSummit Healthplan,Medicare Advantage,,157.85,,,,,,,117.26,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,outpatient,,,617.00000,299.86000,SilverSummit Healthplan,Medicare Advantage,,215.95,,,,,,,160.42,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,outpatient,,,825.00000,400.95000,SilverSummit Healthplan,Medicare Advantage,,288.75,,,,,,,214.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,outpatient,,,905.00000,439.83000,SilverSummit Healthplan,Medicare Advantage,,316.75,,,,,,,235.30,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,outpatient,,,849.00000,412.61000,SilverSummit Healthplan,Medicare Advantage,,297.15,,,,,,,220.74,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,outpatient,,,2539.00000,1233.95000,SilverSummit Healthplan,Medicare Advantage,,888.65,,,,,,,660.14,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,outpatient,,,6000.00000,2916.00000,SilverSummit Healthplan,Medicare Advantage,,2100.00,,,,,,,1560.00,5820.00,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,outpatient,,,8260.00000,4014.36000,SilverSummit Healthplan,Medicare Advantage,,2891.00,,,,,,,2147.60,8012.20,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,outpatient,,,202.00000,88.88000,SilverSummit Healthplan,Medicare Advantage,,70.70,,,,,,,52.52,195.94,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,outpatient,,,66.00000,31.81000,SilverSummit Healthplan,Medicare Advantage,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,outpatient,,,295.00000,142.19000,SilverSummit Healthplan,Medicare Advantage,,103.25,,,,,,,76.70,286.15,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,89.00000,26.79000,SilverSummit Healthplan,Medicare Advantage,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,outpatient,,,93.00000,27.99000,SilverSummit Healthplan,Medicare Advantage,,32.55,,,,,,,24.18,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,93.00000,27.99000,SilverSummit Healthplan,Medicare Advantage,,32.55,,,,,,,24.18,90.21,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,SilverSummit Healthplan,Medicare Advantage,,656.25,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,SilverSummit Healthplan,Medicare Advantage,,656.25,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,SilverSummit Healthplan,Medicare Advantage,,613.20,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,SilverSummit Healthplan,Medicare Advantage,,613.20,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,731.00000,220.03000,SilverSummit Healthplan,Medicare Advantage,,255.85,,,,,,,190.06,709.07,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,787.00000,236.89000,SilverSummit Healthplan,Medicare Advantage,,275.45,,,,,,,204.62,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,2042.00000,614.64000,SilverSummit Healthplan,Medicare Advantage,,714.70,,,,,,,530.92,1980.74,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,SilverSummit Healthplan,Medicare Advantage,,656.25,,,,,,,487.50,1818.75,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,714.00000,214.91000,SilverSummit Healthplan,Medicare Advantage,,249.90,,,,,,,185.64,692.58,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,294.00000,88.49000,SilverSummit Healthplan,Medicare Advantage,,102.90,,,,,,,76.44,285.18,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,350.00000,105.35000,SilverSummit Healthplan,Medicare Advantage,,122.50,,,,,,,91.00,339.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,outpatient,,,1350.00000,780.30000,SilverSummit Healthplan,Medicare Advantage,,472.50,,,,,,,351.00,1309.50,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,outpatient,,,3680.00000,2127.04000,SilverSummit Healthplan,Medicare Advantage,,1288.00,,,,,,,956.80,3569.60,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,outpatient,,,1600.00000,924.80000,SilverSummit Healthplan,Medicare Advantage,,560.00,,,,,,,416.00,1552.00,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,outpatient,,,4680.00000,2705.04000,SilverSummit Healthplan,Medicare Advantage,,1638.00,,,,,,,1216.80,4539.60,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,outpatient,,,2100.00000,1213.80000,SilverSummit Healthplan,Medicare Advantage,,735.00,,,,,,,546.00,2037.00,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,outpatient,,,5680.00000,3283.04000,SilverSummit Healthplan,Medicare Advantage,,1988.00,,,,,,,1476.80,5509.60,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,outpatient,,,2420.00000,1398.76000,SilverSummit Healthplan,Medicare Advantage,,847.00,,,,,,,629.20,2347.40,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,outpatient,,,6415.00000,3707.87000,SilverSummit Healthplan,Medicare Advantage,,2245.25,,,,,,,1667.90,6222.55,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,outpatient,,,2920.00000,1687.76000,SilverSummit Healthplan,Medicare Advantage,,1022.00,,,,,,,759.20,2832.40,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,outpatient,,,8915.00000,5152.87000,SilverSummit Healthplan,Medicare Advantage,,3120.25,,,,,,,2317.90,8647.55,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,outpatient,,,3420.00000,1976.76000,SilverSummit Healthplan,Medicare Advantage,,1197.00,,,,,,,889.20,3317.40,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,outpatient,,,11415.00000,6597.87000,SilverSummit Healthplan,Medicare Advantage,,3995.25,,,,,,,2967.90,11072.55,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,outpatient,,,142.00000,154.35000,SilverSummit Healthplan,Medicare Advantage,,49.70,,,,,,,36.92,137.74,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,SilverSummit Healthplan,Medicare Advantage,,119.00,,,,,,,88.40,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,SilverSummit Healthplan,Medicare Advantage,,234.50,,,,,,,174.20,649.90,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,outpatient,,,390.00000,262.47000,SilverSummit Healthplan,Medicare Advantage,,136.50,,,,,,,101.40,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,outpatient,,,1170.00000,787.41000,SilverSummit Healthplan,Medicare Advantage,,409.50,,,,,,,304.20,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,outpatient,,,440.00000,296.12000,SilverSummit Healthplan,Medicare Advantage,,154.00,,,,,,,114.40,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,outpatient,,,1670.00000,1123.91000,SilverSummit Healthplan,Medicare Advantage,,584.50,,,,,,,434.20,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,outpatient,,,640.00000,430.72000,SilverSummit Healthplan,Medicare Advantage,,224.00,,,,,,,166.40,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,outpatient,,,2170.00000,1460.41000,SilverSummit Healthplan,Medicare Advantage,,759.50,,,,,,,564.20,2104.90,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,outpatient,,,17.00000,10.96000,SilverSummit Healthplan,Medicare Advantage,,5.95,,,,,,,4.42,16.49,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,outpatient,,,535.00000,345.08000,SilverSummit Healthplan,Medicare Advantage,,187.25,,,,,,,139.10,518.95,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,outpatient,,,23.00000,14.84000,SilverSummit Healthplan,Medicare Advantage,,8.05,,,,,,,5.98,22.31,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,outpatient,,,635.00000,409.58000,SilverSummit Healthplan,Medicare Advantage,,222.25,,,,,,,165.10,615.95,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,outpatient,,,30.00000,19.35000,SilverSummit Healthplan,Medicare Advantage,,10.50,,,,,,,7.80,29.10,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,outpatient,,,735.00000,474.08000,SilverSummit Healthplan,Medicare Advantage,,257.25,,,,,,,191.10,712.95,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,outpatient,,,33.00000,21.28000,SilverSummit Healthplan,Medicare Advantage,,11.55,,,,,,,8.58,32.01,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,outpatient,,,835.00000,538.58000,SilverSummit Healthplan,Medicare Advantage,,292.25,,,,,,,217.10,809.95,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,outpatient,,,140.00000,80.92000,SilverSummit Healthplan,Medicare Advantage,,49.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,outpatient,,,275.00000,158.95000,SilverSummit Healthplan,Medicare Advantage,,96.25,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,outpatient,,,295.00000,170.51000,SilverSummit Healthplan,Medicare Advantage,,103.25,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,outpatient,,,590.00000,341.02000,SilverSummit Healthplan,Medicare Advantage,,206.50,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,outpatient,,,690.00000,398.82000,SilverSummit Healthplan,Medicare Advantage,,241.50,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,outpatient,,,1375.00000,794.75000,SilverSummit Healthplan,Medicare Advantage,,481.25,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,outpatient,,,950.00000,549.10000,SilverSummit Healthplan,Medicare Advantage,,332.50,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,outpatient,,,1900.00000,1098.20000,SilverSummit Healthplan,Medicare Advantage,,665.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,outpatient,,,140.00000,45.22000,SilverSummit Healthplan,Medicare Advantage,,49.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,outpatient,,,275.00000,88.82000,SilverSummit Healthplan,Medicare Advantage,,96.25,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,outpatient,,,295.00000,95.28000,SilverSummit Healthplan,Medicare Advantage,,103.25,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,outpatient,,,590.00000,190.57000,SilverSummit Healthplan,Medicare Advantage,,206.50,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,outpatient,,,690.00000,222.87000,SilverSummit Healthplan,Medicare Advantage,,241.50,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,outpatient,,,1375.00000,444.12000,SilverSummit Healthplan,Medicare Advantage,,481.25,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,outpatient,,,950.00000,306.85000,SilverSummit Healthplan,Medicare Advantage,,332.50,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,outpatient,,,1900.00000,613.70000,SilverSummit Healthplan,Medicare Advantage,,665.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,SilverSummit Healthplan,Medicare Advantage,,119.00,,,,,,,88.40,329.80,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,SilverSummit Healthplan,Medicare Advantage,,234.50,,,,,,,174.20,649.90,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,SilverSummit Healthplan,Medicare Advantage,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,SilverSummit Healthplan,Medicare Advantage,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,SilverSummit Healthplan,Medicare Advantage,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,SilverSummit Healthplan,Medicare Advantage,,85.75,,,,,,,63.70,237.65,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,SilverSummit Healthplan,Medicare Advantage,,294.70,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,SilverSummit Healthplan,Medicare Advantage,,368.55,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,SilverSummit Healthplan,Medicare Advantage,,442.05,,,,,,,328.38,1225.11,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1178.00000,669.28000,SilverSummit Healthplan,Medicare Advantage,,412.30,,,,,,,306.28,1142.66,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,outpatient,,,140.00000,102.34000,SilverSummit Healthplan,Medicare Advantage,,49.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,outpatient,,,275.00000,201.02000,SilverSummit Healthplan,Medicare Advantage,,96.25,,,,,,,71.50,266.75,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,outpatient,,,295.00000,215.64000,SilverSummit Healthplan,Medicare Advantage,,103.25,,,,,,,76.70,286.15,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,outpatient,,,590.00000,431.29000,SilverSummit Healthplan,Medicare Advantage,,206.50,,,,,,,153.40,572.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,outpatient,,,690.00000,504.39000,SilverSummit Healthplan,Medicare Advantage,,241.50,,,,,,,179.40,669.30,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,outpatient,,,1375.00000,1005.12000,SilverSummit Healthplan,Medicare Advantage,,481.25,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,outpatient,,,950.00000,694.45000,SilverSummit Healthplan,Medicare Advantage,,332.50,,,,,,,247.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,outpatient,,,1900.00000,1388.90000,SilverSummit Healthplan,Medicare Advantage,,665.00,,,,,,,494.00,1843.00,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,outpatient,,,584.00000,426.90000,SilverSummit Healthplan,Medicare Advantage,,204.40,,,,,,,151.84,566.48,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,outpatient,,,1391.00000,1016.82000,SilverSummit Healthplan,Medicare Advantage,,486.85,,,,,,,361.66,1349.27,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,outpatient,,,359.00000,271.76000,SilverSummit Healthplan,Medicare Advantage,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,outpatient,,,95.00000,71.92000,SilverSummit Healthplan,Medicare Advantage,,33.25,,,,,,,24.70,92.15,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,outpatient,,,37.00000,17.83000,SilverSummit Healthplan,Medicare Advantage,,12.95,,,,,,,9.62,35.89,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,SilverSummit Healthplan,Medicare Advantage,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,SilverSummit Healthplan,Medicare Advantage,,82.95,,,,,,,61.62,229.89,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,outpatient,,,33.00000,15.91000,SilverSummit Healthplan,Medicare Advantage,,11.55,,,,,,,8.58,32.01,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,outpatient,,,25.00000,12.05000,SilverSummit Healthplan,Medicare Advantage,,8.75,,,,,,,6.50,24.25,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,outpatient,,,497.00000,160.53000,SilverSummit Healthplan,Medicare Advantage,,173.95,,,,,,,129.22,482.09,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,SilverSummit Healthplan,Medicare Advantage,,308.70,,,,,,,229.32,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,SilverSummit Healthplan,Medicare Advantage,,308.70,,,,,,,229.32,855.54,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,SilverSummit Healthplan,Medicare Advantage,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,SilverSummit Healthplan,Medicare Advantage,,33.60,,,,,,,24.96,93.12,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,SilverSummit Healthplan,Medicare Advantage,,308.70,,,,,,,229.32,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,SilverSummit Healthplan,Medicare Advantage,,308.70,,,,,,,229.32,855.54,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,outpatient,,,763.00000,291.47000,SilverSummit Healthplan,Medicare Advantage,,267.05,,,,,,,198.38,740.11,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,outpatient,,,199.00000,76.02000,SilverSummit Healthplan,Medicare Advantage,,69.65,,,,,,,51.74,193.03,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,SilverSummit Healthplan,Medicare Advantage,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,SilverSummit Healthplan,Medicare Advantage,,33.60,,,,,,,24.96,93.12,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,outpatient,,,1265.00000,483.23000,SilverSummit Healthplan,Medicare Advantage,,442.75,,,,,,,328.90,1227.05,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,outpatient,,,924.00000,352.97000,SilverSummit Healthplan,Medicare Advantage,,323.40,,,,,,,240.24,896.28,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,outpatient,,,580.00000,215.76000,SilverSummit Healthplan,Medicare Advantage,,203.00,,,,,,,150.80,562.60,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,outpatient,,,110.00000,40.92000,SilverSummit Healthplan,Medicare Advantage,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,outpatient,,,373.00000,138.76000,SilverSummit Healthplan,Medicare Advantage,,130.55,,,,,,,96.98,361.81,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,outpatient,,,337.00000,125.36000,SilverSummit Healthplan,Medicare Advantage,,117.95,,,,,,,87.62,326.89,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,outpatient,,,784.00000,291.65000,SilverSummit Healthplan,Medicare Advantage,,274.40,,,,,,,203.84,760.48,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,outpatient,,,341.00000,126.85000,SilverSummit Healthplan,Medicare Advantage,,119.35,,,,,,,88.66,330.77,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,outpatient,,,252.00000,93.74000,SilverSummit Healthplan,Medicare Advantage,,88.20,,,,,,,65.52,244.44,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,outpatient,,,282.00000,104.90000,SilverSummit Healthplan,Medicare Advantage,,98.70,,,,,,,73.32,273.54,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,outpatient,,,404.00000,150.29000,SilverSummit Healthplan,Medicare Advantage,,141.40,,,,,,,105.04,391.88,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,outpatient,,,306.00000,173.85000,SilverSummit Healthplan,Medicare Advantage,,107.10,,,,,,,79.56,296.82,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,outpatient,,,158.00000,89.77000,SilverSummit Healthplan,Medicare Advantage,,55.30,,,,,,,41.08,153.26,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,SilverSummit Healthplan,Medicare Advantage,GP,51.45,,,,,,,38.22,142.59,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,SilverSummit Healthplan,Medicare Advantage,GP,94.50,,,,,,,70.20,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,SilverSummit Healthplan,Medicare Advantage,GP,29.40,,,,,,,21.84,81.48,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,SilverSummit Healthplan,Medicare Advantage,GP,30.10,,,,,,,22.36,83.42,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,SilverSummit Healthplan,Medicare Advantage,GP,28.70,,,,,,,21.32,79.54,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,SilverSummit Healthplan,Medicare Advantage,GP,29.75,,,,,,,22.10,82.45,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,SilverSummit Healthplan,Medicare Advantage,GP,15.05,,,,,,,11.18,41.71,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,SilverSummit Healthplan,Medicare Advantage,GP,14.35,,,,,,,10.66,39.77,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,SilverSummit Healthplan,Medicare Advantage,GP,27.65,,,,,,,20.54,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,SilverSummit Healthplan,Medicare Advantage,GP,25.90,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,SilverSummit Healthplan,Medicare Advantage,GP,25.90,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,SilverSummit Healthplan,Medicare Advantage,GP,11.90,,,,,,,8.84,32.98,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,SilverSummit Healthplan,Medicare Advantage,GP,22.75,,,,,,,16.90,63.05,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,outpatient,,,113.00000,68.70000,SilverSummit Healthplan,Medicare Advantage,,39.55,,,,,,,29.38,109.61,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,SilverSummit Healthplan,Medicare Advantage,GP,28.00,,,,,,,20.80,77.60,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,SilverSummit Healthplan,Medicare Advantage,GP,29.40,,,,,,,21.84,81.48,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,SilverSummit Healthplan,Medicare Advantage,GP,25.55,,,,,,,18.98,70.81,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,outpatient,,,100.00000,60.80000,SilverSummit Healthplan,Medicare Advantage,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,outpatient,,,167.00000,101.54000,SilverSummit Healthplan,Medicare Advantage,GP,58.45,,,,,,,43.42,161.99,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,SilverSummit Healthplan,Medicare Advantage,"50,GP",144.55,,,,,,,107.38,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,SilverSummit Healthplan,Medicare Advantage,"LT,GP",96.25,,,,,,,71.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,SilverSummit Healthplan,Medicare Advantage,"RT,GP",96.25,,,,,,,71.50,266.75,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,SilverSummit Healthplan,Medicare Advantage,GP,33.25,,,,,,,24.70,92.15,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,SilverSummit Healthplan,Medicare Advantage,GP,51.10,,,,,,,37.96,141.62,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,SilverSummit Healthplan,Medicare Advantage,GP,48.65,,,,,,,36.14,134.83,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,SilverSummit Healthplan,Medicare Advantage,GP,26.25,,,,,,,19.50,72.75,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,SilverSummit Healthplan,Medicare Advantage,GP,53.90,,,,,,,40.04,149.38,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,SilverSummit Healthplan,Medicare Advantage,GP,25.55,,,,,,,18.98,70.81,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,SilverSummit Healthplan,Medicare Advantage,GP,56.00,,,,,,,41.60,155.20,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,SilverSummit Healthplan,Medicare Advantage,GP,113.75,,,,,,,84.50,315.25,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,outpatient,,,98.00000,59.58000,SilverSummit Healthplan,Medicare Advantage,GP,34.30,,,,,,,25.48,95.06,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,outpatient,,,303.00000,184.22000,SilverSummit Healthplan,Medicare Advantage,GP,106.05,,,,,,,78.78,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,outpatient,,,115.00000,69.92000,SilverSummit Healthplan,Medicare Advantage,GP,40.25,,,,,,,29.90,111.55,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,SilverSummit Healthplan,Medicare Advantage,GP,25.90,,,,,,,19.24,71.78,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,SilverSummit Healthplan,Medicare Advantage,GP,27.65,,,,,,,20.54,76.63,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,SilverSummit Healthplan,Medicare Advantage,GP,25.20,,,,,,,18.72,69.84,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,SilverSummit Healthplan,Medicare Advantage,GP,51.45,,,,,,,38.22,142.59,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,SilverSummit Healthplan,Medicare Advantage,GP,94.50,,,,,,,70.20,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,SilverSummit Healthplan,Medicare Advantage,GP,29.40,,,,,,,21.84,81.48,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,SilverSummit Healthplan,Medicare Advantage,GP,30.10,,,,,,,22.36,83.42,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,SilverSummit Healthplan,Medicare Advantage,GP,28.70,,,,,,,21.32,79.54,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,SilverSummit Healthplan,Medicare Advantage,GP,29.75,,,,,,,22.10,82.45,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,SilverSummit Healthplan,Medicare Advantage,GP,15.05,,,,,,,11.18,41.71,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,SilverSummit Healthplan,Medicare Advantage,GP,14.35,,,,,,,10.66,39.77,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,SilverSummit Healthplan,Medicare Advantage,GP,27.65,,,,,,,20.54,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,SilverSummit Healthplan,Medicare Advantage,"CQ,GP",25.90,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,SilverSummit Healthplan,Medicare Advantage,"CQ,GP",25.90,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,SilverSummit Healthplan,Medicare Advantage,GP,11.90,,,,,,,8.84,32.98,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,SilverSummit Healthplan,Medicare Advantage,GP,22.75,,,,,,,16.90,63.05,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,SilverSummit Healthplan,Medicare Advantage,GP,28.00,,,,,,,20.80,77.60,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,SilverSummit Healthplan,Medicare Advantage,GP,29.40,,,,,,,21.84,81.48,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,SilverSummit Healthplan,Medicare Advantage,GP,25.55,,,,,,,18.98,70.81,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,SilverSummit Healthplan,Medicare Advantage,"GP,50",144.55,,,,,,,107.38,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,SilverSummit Healthplan,Medicare Advantage,"GP,LT",96.25,,,,,,,71.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,SilverSummit Healthplan,Medicare Advantage,"GP,RT",96.25,,,,,,,71.50,266.75,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,SilverSummit Healthplan,Medicare Advantage,GP,33.25,,,,,,,24.70,92.15,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,SilverSummit Healthplan,Medicare Advantage,GP,51.10,,,,,,,37.96,141.62,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,SilverSummit Healthplan,Medicare Advantage,GP,48.65,,,,,,,36.14,134.83,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,SilverSummit Healthplan,Medicare Advantage,GP,26.25,,,,,,,19.50,72.75,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,SilverSummit Healthplan,Medicare Advantage,GP,53.90,,,,,,,40.04,149.38,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,SilverSummit Healthplan,Medicare Advantage,GP,25.55,,,,,,,18.98,70.81,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,SilverSummit Healthplan,Medicare Advantage,GP,56.00,,,,,,,41.60,155.20,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,SilverSummit Healthplan,Medicare Advantage,GP,113.75,,,,,,,84.50,315.25,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,SilverSummit Healthplan,Medicare Advantage,GP,25.90,,,,,,,19.24,71.78,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,SilverSummit Healthplan,Medicare Advantage,GP,27.65,,,,,,,20.54,76.63,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,SilverSummit Healthplan,Medicare Advantage,GP,25.20,,,,,,,18.72,69.84,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,outpatient,,,445.00000,262.55000,SilverSummit Healthplan,Medicare Advantage,GP,155.75,,,,,,,115.70,431.65,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,outpatient,,,310.00000,182.90000,SilverSummit Healthplan,Medicare Advantage,GP,108.50,,,,,,,80.60,300.70,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,outpatient,,,393.00000,231.87000,SilverSummit Healthplan,Medicare Advantage,GP,137.55,,,,,,,102.18,381.21,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,outpatient,,,310.00000,182.90000,SilverSummit Healthplan,Medicare Advantage,GP,108.50,,,,,,,80.60,300.70,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,SilverSummit Healthplan,Medicare Advantage,GO,28.00,,,,,,,20.80,77.60,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,SilverSummit Healthplan,Medicare Advantage,GO,29.40,,,,,,,21.84,81.48,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,SilverSummit Healthplan,Medicare Advantage,GO,44.10,,,,,,,32.76,122.22,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,SilverSummit Healthplan,Medicare Advantage,GO,23.10,,,,,,,17.16,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,SilverSummit Healthplan,Medicare Advantage,GO,21.70,,,,,,,16.12,60.14,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,SilverSummit Healthplan,Medicare Advantage,GO,31.50,,,,,,,23.40,87.30,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,SilverSummit Healthplan,Medicare Advantage,GO,33.25,,,,,,,24.70,92.15,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,SilverSummit Healthplan,Medicare Advantage,GO,51.10,,,,,,,37.96,141.62,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,SilverSummit Healthplan,Medicare Advantage,GO,48.65,,,,,,,36.14,134.83,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,SilverSummit Healthplan,Medicare Advantage,GO,26.25,,,,,,,19.50,72.75,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,SilverSummit Healthplan,Medicare Advantage,GO,53.90,,,,,,,40.04,149.38,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,SilverSummit Healthplan,Medicare Advantage,GO,25.55,,,,,,,18.98,70.81,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,SilverSummit Healthplan,Medicare Advantage,GO,56.00,,,,,,,41.60,155.20,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,outpatient,,,98.00000,37.93000,SilverSummit Healthplan,Medicare Advantage,GO,34.30,,,,,,,25.48,95.06,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,outpatient,,,303.00000,117.26000,SilverSummit Healthplan,Medicare Advantage,GO,106.05,,,,,,,78.78,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,outpatient,,,115.00000,44.50000,SilverSummit Healthplan,Medicare Advantage,GO,40.25,,,,,,,29.90,111.55,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,SilverSummit Healthplan,Medicare Advantage,GO,25.90,,,,,,,19.24,71.78,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,SilverSummit Healthplan,Medicare Advantage,GO,25.20,,,,,,,18.72,69.84,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,SilverSummit Healthplan,Medicare Advantage,"CO,GO",28.00,,,,,,,20.80,77.60,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,SilverSummit Healthplan,Medicare Advantage,"CO,GO",29.40,,,,,,,21.84,81.48,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,SilverSummit Healthplan,Medicare Advantage,"CO,GO",44.10,,,,,,,32.76,122.22,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,SilverSummit Healthplan,Medicare Advantage,"CO,GO",21.70,,,,,,,16.12,60.14,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,SilverSummit Healthplan,Medicare Advantage,"CO,GO",23.10,,,,,,,17.16,64.02,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,SilverSummit Healthplan,Medicare Advantage,"CO,GO",31.50,,,,,,,23.40,87.30,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,SilverSummit Healthplan,Medicare Advantage,"CO,GO",33.25,,,,,,,24.70,92.15,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,SilverSummit Healthplan,Medicare Advantage,"CO,GO",51.10,,,,,,,37.96,141.62,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,SilverSummit Healthplan,Medicare Advantage,"CO,GO",48.65,,,,,,,36.14,134.83,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,SilverSummit Healthplan,Medicare Advantage,"CO,GO",26.25,,,,,,,19.50,72.75,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,SilverSummit Healthplan,Medicare Advantage,"CO,GO",53.90,,,,,,,40.04,149.38,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,SilverSummit Healthplan,Medicare Advantage,"CO,GO",25.55,,,,,,,18.98,70.81,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,SilverSummit Healthplan,Medicare Advantage,"CO,GO",56.00,,,,,,,41.60,155.20,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,SilverSummit Healthplan,Medicare Advantage,"CO,GO",25.90,,,,,,,19.24,71.78,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,SilverSummit Healthplan,Medicare Advantage,"CO,GO",25.20,,,,,,,18.72,69.84,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,SilverSummit Healthplan,Medicare Advantage,GO,16.45,,,,,,,12.22,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,SilverSummit Healthplan,Medicare Advantage,"CO,GO",16.45,,,,,,,12.22,45.59,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,outpatient,,,250.00000,142.04000,SilverSummit Healthplan,Medicare Advantage,GO,87.50,,,,,,,65.00,242.50,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,outpatient,,,175.00000,99.43000,SilverSummit Healthplan,Medicare Advantage,GO,61.25,,,,,,,45.50,169.75,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,outpatient,,,233.00000,132.38000,SilverSummit Healthplan,Medicare Advantage,GO,81.55,,,,,,,60.58,226.01,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,outpatient,,,175.00000,99.43000,SilverSummit Healthplan,Medicare Advantage,GO,61.25,,,,,,,45.50,169.75,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,outpatient,,,291.00000,93.99000,SilverSummit Healthplan,Medicare Advantage,,101.85,,,,,,,75.66,282.27,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,outpatient,,,273.00000,155.10000,SilverSummit Healthplan,Medicare Advantage,GN,95.55,,,,,,,70.98,264.81,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,outpatient,,,279.00000,158.51000,SilverSummit Healthplan,Medicare Advantage,GN,97.65,,,,,,,72.54,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,outpatient,,,426.00000,242.03000,SilverSummit Healthplan,Medicare Advantage,GN,149.10,,,,,,,110.76,413.22,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,outpatient,,,242.00000,137.49000,SilverSummit Healthplan,Medicare Advantage,GN,84.70,,,,,,,62.92,234.74,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,outpatient,,,128.00000,72.72000,SilverSummit Healthplan,Medicare Advantage,,44.80,,,,,,,33.28,124.16,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,outpatient,,,66.00000,37.50000,SilverSummit Healthplan,Medicare Advantage,GN,23.10,,,,,,,17.16,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,outpatient,,,62.00000,35.23000,SilverSummit Healthplan,Medicare Advantage,GN,21.70,,,,,,,16.12,60.14,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,outpatient,,,269.00000,152.83000,SilverSummit Healthplan,Medicare Advantage,GN,94.15,,,,,,,69.94,260.93,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,outpatient,,,153.00000,86.93000,SilverSummit Healthplan,Medicare Advantage,GN,53.55,,,,,,,39.78,148.41,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,outpatient,,,98.00000,55.68000,SilverSummit Healthplan,Medicare Advantage,GN,34.30,,,,,,,25.48,95.06,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,outpatient,,,303.00000,172.15000,SilverSummit Healthplan,Medicare Advantage,GN,106.05,,,,,,,78.78,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,outpatient,,,115.00000,65.34000,SilverSummit Healthplan,Medicare Advantage,GN,40.25,,,,,,,29.90,111.55,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,outpatient,,,210.00000,119.31000,SilverSummit Healthplan,Medicare Advantage,GN,73.50,,,,,,,54.60,203.70,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,outpatient,,,250.00000,142.04000,SilverSummit Healthplan,Medicare Advantage,GN,87.50,,,,,,,65.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,outpatient,,,78.00000,44.32000,SilverSummit Healthplan,Medicare Advantage,GN,27.30,,,,,,,20.28,75.66,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,outpatient,,,322.00000,182.94000,SilverSummit Healthplan,Medicare Advantage,GN,112.70,,,,,,,83.72,312.34,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,outpatient,,,309.00000,175.56000,SilverSummit Healthplan,Medicare Advantage,GN,108.15,,,,,,,80.34,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,outpatient,,,245.00000,139.20000,SilverSummit Healthplan,Medicare Advantage,GN,85.75,,,,,,,63.70,237.65,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,outpatient,,,313.00000,116.44000,SilverSummit Healthplan,Medicare Advantage,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,outpatient,,,1250.00000,632.50000,SilverSummit Healthplan,Medicare Advantage,,437.50,,,,,,,325.00,1212.50,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,SilverSummit Healthplan,Medicare Advantage,,50.75,,,,,,,37.70,140.65,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,SilverSummit Healthplan,Medicare Advantage,,170.80,,,,,,,126.88,473.36,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,outpatient,,,684.00000,337.90000,SilverSummit Healthplan,Medicare Advantage,,239.40,,,,,,,177.84,663.48,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,outpatient,,,206.00000,101.76000,SilverSummit Healthplan,Medicare Advantage,,72.10,,,,,,,53.56,199.82,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,outpatient,,,195.00000,96.33000,SilverSummit Healthplan,Medicare Advantage,,68.25,,,,,,,50.70,189.15,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,outpatient,,,375.00000,185.25000,SilverSummit Healthplan,Medicare Advantage,,131.25,,,,,,,97.50,363.75,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,outpatient,,,429.00000,211.93000,SilverSummit Healthplan,Medicare Advantage,,150.15,,,,,,,111.54,416.13,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22475,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,SilverSummit Healthplan,Medicare Advantage,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B OBSTETRICS SEMI-PVT,42473,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,SilverSummit Healthplan,Medicare Advantage,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B ICU,32474,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,SilverSummit Healthplan,Medicare Advantage,,2935.00,,,,,,,2512.00,8498.17,per diem,
R&B ICU INTERMEDIATE,12476,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,SilverSummit Healthplan,Medicare Advantage,,2935.00,,,,,,,2512.00,5665.77,per diem,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,SilverSummit Healthplan,Medicare Advantage,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,SilverSummit Healthplan,Medicare Advantage,,99.40,,,,,,,73.84,275.48,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,SilverSummit Healthplan,Medicare Advantage,,160.30,,,,,,,119.08,444.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,SilverSummit Healthplan,Medicare Advantage,,195.30,,,,,,,145.08,541.26,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,SilverSummit Healthplan,Medicare Advantage,,168.70,,,,,,,125.32,467.54,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,SilverSummit Healthplan,Medicare Advantage,,82.95,,,,,,,61.62,229.89,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,outpatient,,,490.00000,329.77000,SilverSummit Healthplan,Medicare Advantage,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,outpatient,,,490.00000,329.77000,SilverSummit Healthplan,Medicare Advantage,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,outpatient,,,245.00000,164.89000,SilverSummit Healthplan,Medicare Advantage,,85.75,,,,,,,63.70,237.65,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,SilverSummit Healthplan,Medicare Advantage,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,SilverSummit Healthplan,Medicare Advantage,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,SilverSummit Healthplan,Medicare Advantage,,85.75,,,,,,,63.70,237.65,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,SilverSummit Healthplan,Medicare Advantage,,294.70,,,,,,,218.92,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,SilverSummit Healthplan,Medicare Advantage,,368.55,,,,,,,273.78,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,SilverSummit Healthplan,Medicare Advantage,,442.05,,,,,,,328.38,1225.11,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,outpatient,,,2466.00000,986.40000,SilverSummit Healthplan,Medicare Advantage,,863.10,,,,,,,641.16,2392.02,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,outpatient,,,260.00000,104.00000,SilverSummit Healthplan,Medicare Advantage,,91.00,,,,,,,67.60,252.20,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,outpatient,,,2041.00000,816.40000,SilverSummit Healthplan,Medicare Advantage,,714.35,,,,,,,530.66,1979.77,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,outpatient,,,375.00000,150.00000,SilverSummit Healthplan,Medicare Advantage,,131.25,,,,,,,97.50,363.75,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,outpatient,,,1178.00000,471.20000,SilverSummit Healthplan,Medicare Advantage,,412.30,,,,,,,306.28,1142.66,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,outpatient,,,245.00000,98.00000,SilverSummit Healthplan,Medicare Advantage,,85.75,,,,,,,63.70,237.65,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,outpatient,,,280.00000,112.00000,SilverSummit Healthplan,Medicare Advantage,,98.00,,,,,,,72.80,271.60,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,outpatient,,,336.00000,134.40000,SilverSummit Healthplan,Medicare Advantage,,117.60,,,,,,,87.36,325.92,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,outpatient,,,380.00000,152.00000,SilverSummit Healthplan,Medicare Advantage,,133.00,,,,,,,98.80,368.60,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,SilverSummit Healthplan,Medicare Advantage,,185.50,,,,,,,137.80,514.10,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,outpatient,,,264.00000,105.60000,SilverSummit Healthplan,Medicare Advantage,,92.40,,,,,,,68.64,256.08,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,outpatient,,,763.00000,305.20000,SilverSummit Healthplan,Medicare Advantage,,267.05,,,,,,,198.38,740.11,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,outpatient,,,672.00000,268.80000,SilverSummit Healthplan,Medicare Advantage,,235.20,,,,,,,174.72,651.84,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,outpatient,,,1940.00000,776.00000,SilverSummit Healthplan,Medicare Advantage,,679.00,,,,,,,504.40,1881.80,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,outpatient,,,3875.00000,1550.00000,SilverSummit Healthplan,Medicare Advantage,,1356.25,,,,,,,1007.50,3758.75,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,outpatient,,,505.00000,202.00000,SilverSummit Healthplan,Medicare Advantage,,176.75,,,,,,,131.30,489.85,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,SilverSummit Healthplan,Medicare Advantage,,103.25,,,,,,,76.70,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,outpatient,,,585.00000,234.00000,SilverSummit Healthplan,Medicare Advantage,,204.75,,,,,,,152.10,567.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,outpatient,,,285.00000,114.00000,SilverSummit Healthplan,Medicare Advantage,,99.75,,,,,,,74.10,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,outpatient,,,575.00000,230.00000,SilverSummit Healthplan,Medicare Advantage,,201.25,,,,,,,149.50,557.75,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,outpatient,,,697.00000,278.80000,SilverSummit Healthplan,Medicare Advantage,,243.95,,,,,,,181.22,676.09,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,SilverSummit Healthplan,Medicare Advantage,,185.50,,,,,,,137.80,514.10,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,outpatient,,,580.00000,232.00000,SilverSummit Healthplan,Medicare Advantage,,203.00,,,,,,,150.80,562.60,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,outpatient,,,435.00000,174.00000,SilverSummit Healthplan,Medicare Advantage,,152.25,,,,,,,113.10,421.95,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,outpatient,,,270.00000,108.00000,SilverSummit Healthplan,Medicare Advantage,,94.50,,,,,,,70.20,261.90,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,outpatient,,,504.00000,201.60000,SilverSummit Healthplan,Medicare Advantage,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,outpatient,,,98.00000,39.20000,SilverSummit Healthplan,Medicare Advantage,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,outpatient,,,608.00000,243.20000,SilverSummit Healthplan,Medicare Advantage,,212.80,,,,,,,158.08,589.76,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,outpatient,,,114.00000,45.60000,SilverSummit Healthplan,Medicare Advantage,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,outpatient,,,187.00000,74.80000,SilverSummit Healthplan,Medicare Advantage,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,outpatient,,,214.00000,85.60000,SilverSummit Healthplan,Medicare Advantage,,74.90,,,,,,,55.64,207.58,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,outpatient,,,863.00000,345.20000,SilverSummit Healthplan,Medicare Advantage,,302.05,,,,,,,224.38,837.11,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,outpatient,,,453.00000,181.20000,SilverSummit Healthplan,Medicare Advantage,,158.55,,,,,,,117.78,439.41,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,outpatient,,,144.00000,57.60000,SilverSummit Healthplan,Medicare Advantage,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,outpatient,,,107.00000,42.80000,SilverSummit Healthplan,Medicare Advantage,,37.45,,,,,,,27.82,103.79,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,outpatient,,,403.00000,161.20000,SilverSummit Healthplan,Medicare Advantage,,141.05,,,,,,,104.78,390.91,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,outpatient,,,144.00000,57.60000,SilverSummit Healthplan,Medicare Advantage,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,outpatient,,,370.00000,148.00000,SilverSummit Healthplan,Medicare Advantage,,129.50,,,,,,,96.20,358.90,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,outpatient,,,334.00000,133.60000,SilverSummit Healthplan,Medicare Advantage,,116.90,,,,,,,86.84,323.98,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,outpatient,,,1188.00000,475.20000,SilverSummit Healthplan,Medicare Advantage,50,415.80,,,,,,,308.88,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,SilverSummit Healthplan,Medicare Advantage,LT,277.20,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,SilverSummit Healthplan,Medicare Advantage,RT,277.20,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,outpatient,,,572.00000,228.80000,SilverSummit Healthplan,Medicare Advantage,50,200.20,,,,,,,148.72,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,SilverSummit Healthplan,Medicare Advantage,LT,133.35,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,SilverSummit Healthplan,Medicare Advantage,RT,133.35,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,outpatient,,,683.00000,273.20000,SilverSummit Healthplan,Medicare Advantage,50,239.05,,,,,,,177.58,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,SilverSummit Healthplan,Medicare Advantage,LT,159.25,,,,,,,118.30,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,SilverSummit Healthplan,Medicare Advantage,RT,159.25,,,,,,,118.30,441.35,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,outpatient,,,357.00000,142.80000,SilverSummit Healthplan,Medicare Advantage,,124.95,,,,,,,92.82,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,outpatient,,,334.00000,133.60000,SilverSummit Healthplan,Medicare Advantage,,116.90,,,,,,,86.84,323.98,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,outpatient,,,194.00000,77.60000,SilverSummit Healthplan,Medicare Advantage,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,outpatient,,,608.00000,243.20000,SilverSummit Healthplan,Medicare Advantage,,212.80,,,,,,,158.08,589.76,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,outpatient,,,257.00000,102.80000,SilverSummit Healthplan,Medicare Advantage,,89.95,,,,,,,66.82,249.29,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,outpatient,,,343.00000,137.20000,SilverSummit Healthplan,Medicare Advantage,,120.05,,,,,,,89.18,332.71,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,outpatient,,,457.00000,182.80000,SilverSummit Healthplan,Medicare Advantage,,159.95,,,,,,,118.82,443.29,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,outpatient,,,630.00000,252.00000,SilverSummit Healthplan,Medicare Advantage,,220.50,,,,,,,163.80,611.10,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,outpatient,,,623.00000,249.20000,SilverSummit Healthplan,Medicare Advantage,,218.05,,,,,,,161.98,604.31,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,outpatient,,,1457.00000,582.80000,SilverSummit Healthplan,Medicare Advantage,,509.95,,,,,,,378.82,1413.29,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,outpatient,,,890.00000,356.00000,SilverSummit Healthplan,Medicare Advantage,,311.50,,,,,,,231.40,863.30,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,outpatient,,,532.00000,212.80000,SilverSummit Healthplan,Medicare Advantage,,186.20,,,,,,,138.32,516.04,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,outpatient,,,492.00000,196.80000,SilverSummit Healthplan,Medicare Advantage,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,outpatient,,,550.00000,220.00000,SilverSummit Healthplan,Medicare Advantage,,192.50,,,,,,,143.00,533.50,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,outpatient,,,305.00000,122.00000,SilverSummit Healthplan,Medicare Advantage,,106.75,,,,,,,79.30,295.85,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,outpatient,,,220.00000,88.00000,SilverSummit Healthplan,Medicare Advantage,,77.00,,,,,,,57.20,213.40,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,outpatient,,,780.00000,312.00000,SilverSummit Healthplan,Medicare Advantage,,273.00,,,,,,,202.80,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,outpatient,,,1165.00000,466.00000,SilverSummit Healthplan,Medicare Advantage,,407.75,,,,,,,302.90,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,outpatient,,,2350.00000,940.00000,SilverSummit Healthplan,Medicare Advantage,,822.50,,,,,,,611.00,2279.50,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,outpatient,,,896.00000,358.40000,SilverSummit Healthplan,Medicare Advantage,,313.60,,,,,,,232.96,869.12,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,outpatient,,,385.00000,154.00000,SilverSummit Healthplan,Medicare Advantage,,134.75,,,,,,,100.10,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,outpatient,,,470.00000,188.00000,SilverSummit Healthplan,Medicare Advantage,,164.50,,,,,,,122.20,455.90,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,outpatient,,,150.00000,60.00000,SilverSummit Healthplan,Medicare Advantage,,52.50,,,,,,,39.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,outpatient,,,100.00000,40.00000,SilverSummit Healthplan,Medicare Advantage,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,outpatient,,,143.00000,57.20000,SilverSummit Healthplan,Medicare Advantage,,50.05,,,,,,,37.18,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,outpatient,,,95.00000,38.00000,SilverSummit Healthplan,Medicare Advantage,,33.25,,,,,,,24.70,92.15,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,outpatient,,,269.00000,107.60000,SilverSummit Healthplan,Medicare Advantage,,94.15,,,,,,,69.94,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,outpatient,,,388.00000,155.20000,SilverSummit Healthplan,Medicare Advantage,,135.80,,,,,,,100.88,376.36,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,outpatient,,,344.00000,137.60000,SilverSummit Healthplan,Medicare Advantage,,120.40,,,,,,,89.44,333.68,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,outpatient,,,321.00000,128.40000,SilverSummit Healthplan,Medicare Advantage,,112.35,,,,,,,83.46,311.37,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,outpatient,,,155.00000,62.00000,SilverSummit Healthplan,Medicare Advantage,,54.25,,,,,,,40.30,150.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,outpatient,,,817.00000,326.80000,SilverSummit Healthplan,Medicare Advantage,,285.95,,,,,,,212.42,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,outpatient,,,1255.00000,502.00000,SilverSummit Healthplan,Medicare Advantage,,439.25,,,,,,,326.30,1217.35,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,outpatient,,,391.00000,156.40000,SilverSummit Healthplan,Medicare Advantage,,136.85,,,,,,,101.66,379.27,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,outpatient,,,671.00000,268.40000,SilverSummit Healthplan,Medicare Advantage,,234.85,,,,,,,174.46,650.87,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,outpatient,,,456.00000,182.40000,SilverSummit Healthplan,Medicare Advantage,,159.60,,,,,,,118.56,442.32,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,outpatient,,,112.00000,44.80000,SilverSummit Healthplan,Medicare Advantage,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,outpatient,,,84.00000,33.60000,SilverSummit Healthplan,Medicare Advantage,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,outpatient,,,216.00000,86.40000,SilverSummit Healthplan,Medicare Advantage,,75.60,,,,,,,56.16,209.52,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,outpatient,,,2660.00000,1064.00000,SilverSummit Healthplan,Medicare Advantage,,931.00,,,,,,,691.60,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,outpatient,,,2960.00000,1184.00000,SilverSummit Healthplan,Medicare Advantage,,1036.00,,,,,,,769.60,2871.20,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,outpatient,,,3225.00000,1290.00000,SilverSummit Healthplan,Medicare Advantage,,1128.75,,,,,,,838.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,outpatient,,,3395.00000,1358.00000,SilverSummit Healthplan,Medicare Advantage,,1188.25,,,,,,,882.70,3293.15,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,outpatient,,,490.00000,196.00000,SilverSummit Healthplan,Medicare Advantage,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,outpatient,,,520.00000,208.00000,SilverSummit Healthplan,Medicare Advantage,,182.00,,,,,,,135.20,504.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,outpatient,,,720.00000,288.00000,SilverSummit Healthplan,Medicare Advantage,,252.00,,,,,,,187.20,698.40,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,outpatient,,,215.00000,86.00000,SilverSummit Healthplan,Medicare Advantage,,75.25,,,,,,,55.90,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,outpatient,,,240.00000,96.00000,SilverSummit Healthplan,Medicare Advantage,,84.00,,,,,,,62.40,232.80,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,outpatient,,,1241.00000,496.40000,SilverSummit Healthplan,Medicare Advantage,,434.35,,,,,,,322.66,1203.77,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,outpatient,,,850.00000,340.00000,SilverSummit Healthplan,Medicare Advantage,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,outpatient,,,1085.00000,434.00000,SilverSummit Healthplan,Medicare Advantage,,379.75,,,,,,,282.10,1052.45,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,SilverSummit Healthplan,Medicare Advantage,,103.25,,,,,,,76.70,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,outpatient,,,492.00000,196.80000,SilverSummit Healthplan,Medicare Advantage,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,outpatient,,,563.00000,225.20000,SilverSummit Healthplan,Medicare Advantage,,197.05,,,,,,,146.38,546.11,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,outpatient,,,1612.00000,644.80000,SilverSummit Healthplan,Medicare Advantage,,564.20,,,,,,,419.12,1563.64,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,outpatient,,,1366.00000,546.40000,SilverSummit Healthplan,Medicare Advantage,,478.10,,,,,,,355.16,1325.02,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,outpatient,,,1911.00000,764.40000,SilverSummit Healthplan,Medicare Advantage,,668.85,,,,,,,496.86,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,outpatient,,,956.00000,382.40000,SilverSummit Healthplan,Medicare Advantage,,334.60,,,,,,,248.56,927.32,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,outpatient,,,189.00000,123.20000,SilverSummit Healthplan,Medicare Advantage,,66.15,,,,,,,49.14,183.33,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,outpatient,,,352.00000,256.87000,SilverSummit Healthplan,Medicare Advantage,,123.20,,,,,,,91.52,341.44,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,outpatient,,,625.00000,738.40000,SilverSummit Healthplan,Medicare Advantage,,218.75,,,,,,,162.50,606.25,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1024.00000,2097.47000,SilverSummit Healthplan,Medicare Advantage,,358.40,,,,,,,266.24,993.28,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,outpatient,,,1455.00000,2469.72000,SilverSummit Healthplan,Medicare Advantage,,509.25,,,,,,,378.30,1411.35,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,SilverSummit Healthplan,Medicare Advantage,,50.75,,,,,,,37.70,140.65,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,SilverSummit Healthplan,Medicare Advantage,,170.80,,,,,,,126.88,473.36,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,SilverSummit Healthplan,Medicare Advantage,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,SilverSummit Healthplan,Medicare Advantage,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,SilverSummit Healthplan,Medicare Advantage,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,outpatient,,,170.00000,73.95000,SilverSummit Healthplan,Medicare Advantage,,59.50,,,,,,,44.20,164.90,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,2.70000,1.17000,SilverSummit Healthplan,Medicare Advantage,,0.94500,,,,,,,0.70200,2.62,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,27.00000,11.74000,SilverSummit Healthplan,Medicare Advantage,,9.45,,,,,,,7.02,26.19,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,outpatient,,,20440.00000,8891.40000,SilverSummit Healthplan,Medicare Advantage,,7154.00,,,,,,,5314.40,19826.80,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,3322.00000,1445.07000,SilverSummit Healthplan,Medicare Advantage,,1162.70,,,,,,,863.72,3222.34,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,2492.00000,1084.02000,SilverSummit Healthplan,Medicare Advantage,,872.20,,,,,,,647.92,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1814.00000,789.09000,SilverSummit Healthplan,Medicare Advantage,,634.90,,,,,,,471.64,1759.58,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,2153.00000,936.56000,SilverSummit Healthplan,Medicare Advantage,,753.55,,,,,,,559.78,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1525.00000,663.38000,SilverSummit Healthplan,Medicare Advantage,,533.75,,,,,,,396.50,1479.25,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2716.00000,1181.46000,SilverSummit Healthplan,Medicare Advantage,,950.60,,,,,,,706.16,2634.52,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,outpatient,,,2.70000,0.39000,SilverSummit Healthplan,Medicare Advantage,,0.94500,,,,,,,0.70200,2.62,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,outpatient,,,222.00000,32.41000,SilverSummit Healthplan,Medicare Advantage,,77.70,,,,,,,57.72,215.34,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,outpatient,,,211.00000,113.10000,SilverSummit Healthplan,Medicare Advantage,,73.85,,,,,,,54.86,204.67,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,outpatient,,,497.00000,266.39000,SilverSummit Healthplan,Medicare Advantage,,173.95,,,,,,,129.22,482.09,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,outpatient,,,296.00000,158.66000,SilverSummit Healthplan,Medicare Advantage,,103.60,,,,,,,76.96,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,outpatient,,,723.00000,387.53000,SilverSummit Healthplan,Medicare Advantage,,253.05,,,,,,,187.98,701.31,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,outpatient,,,326.00000,174.74000,SilverSummit Healthplan,Medicare Advantage,,114.10,,,,,,,84.76,316.22,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,outpatient,,,532.00000,285.15000,SilverSummit Healthplan,Medicare Advantage,,186.20,,,,,,,138.32,516.04,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,outpatient,,,635.00000,340.36000,SilverSummit Healthplan,Medicare Advantage,,222.25,,,,,,,165.10,615.95,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,outpatient,,,639.00000,342.50000,SilverSummit Healthplan,Medicare Advantage,,223.65,,,,,,,166.14,619.83,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,outpatient,,,780.00000,418.08000,SilverSummit Healthplan,Medicare Advantage,,273.00,,,,,,,202.80,756.60,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,outpatient,,,390.00000,209.04000,SilverSummit Healthplan,Medicare Advantage,,136.50,,,,,,,101.40,378.30,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,outpatient,,,731.00000,391.82000,SilverSummit Healthplan,Medicare Advantage,,255.85,,,,,,,190.06,709.07,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,outpatient,,,585.00000,313.56000,SilverSummit Healthplan,Medicare Advantage,,204.75,,,,,,,152.10,567.45,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,outpatient,,,365.00000,195.64000,SilverSummit Healthplan,Medicare Advantage,,127.75,,,,,,,94.90,354.05,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,outpatient,,,1086.00000,582.10000,SilverSummit Healthplan,Medicare Advantage,,380.10,,,,,,,282.36,1053.42,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,outpatient,,,197.00000,105.59000,SilverSummit Healthplan,Medicare Advantage,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,outpatient,,,2774.00000,1486.86000,SilverSummit Healthplan,Medicare Advantage,,970.90,,,,,,,721.24,2690.78,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,outpatient,,,1456.00000,780.42000,SilverSummit Healthplan,Medicare Advantage,,509.60,,,,,,,378.56,1412.32,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,outpatient,,,2647.00000,1418.79000,SilverSummit Healthplan,Medicare Advantage,,926.45,,,,,,,688.22,2567.59,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,outpatient,,,1359.00000,728.42000,SilverSummit Healthplan,Medicare Advantage,,475.65,,,,,,,353.34,1318.23,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,outpatient,,,273.00000,146.33000,SilverSummit Healthplan,Medicare Advantage,,95.55,,,,,,,70.98,264.81,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,outpatient,,,325.00000,174.20000,SilverSummit Healthplan,Medicare Advantage,,113.75,,,,,,,84.50,315.25,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,SilverSummit Healthplan,Medicare Advantage,,213.15,,,,,,,158.34,590.73,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,outpatient,,,491.00000,263.18000,SilverSummit Healthplan,Medicare Advantage,,171.85,,,,,,,127.66,476.27,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,outpatient,,,561.00000,300.70000,SilverSummit Healthplan,Medicare Advantage,,196.35,,,,,,,145.86,544.17,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,outpatient,,,845.00000,452.92000,SilverSummit Healthplan,Medicare Advantage,,295.75,,,,,,,219.70,819.65,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,outpatient,,,612.00000,328.03000,SilverSummit Healthplan,Medicare Advantage,,214.20,,,,,,,159.12,593.64,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,outpatient,,,536.00000,287.30000,SilverSummit Healthplan,Medicare Advantage,,187.60,,,,,,,139.36,519.92,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,outpatient,,,1225.00000,656.60000,SilverSummit Healthplan,Medicare Advantage,,428.75,,,,,,,318.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,SilverSummit Healthplan,Medicare Advantage,LT,285.60,,,,,,,212.16,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,SilverSummit Healthplan,Medicare Advantage,RT,285.60,,,,,,,212.16,791.52,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,outpatient,,,250.00000,134.00000,SilverSummit Healthplan,Medicare Advantage,,87.50,,,,,,,65.00,242.50,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,outpatient,,,302.00000,161.87000,SilverSummit Healthplan,Medicare Advantage,,105.70,,,,,,,78.52,292.94,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,outpatient,,,354.00000,189.74000,SilverSummit Healthplan,Medicare Advantage,,123.90,,,,,,,92.04,343.38,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,outpatient,,,409.00000,219.22000,SilverSummit Healthplan,Medicare Advantage,,143.15,,,,,,,106.34,396.73,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,outpatient,,,593.00000,317.85000,SilverSummit Healthplan,Medicare Advantage,,207.55,,,,,,,154.18,575.21,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,SilverSummit Healthplan,Medicare Advantage,LT,107.45,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,SilverSummit Healthplan,Medicare Advantage,"52,LT",107.45,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,SilverSummit Healthplan,Medicare Advantage,RT,107.45,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,SilverSummit Healthplan,Medicare Advantage,"52,RT",107.45,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,SilverSummit Healthplan,Medicare Advantage,LT,115.50,,,,,,,85.80,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,SilverSummit Healthplan,Medicare Advantage,RT,115.50,,,,,,,85.80,320.10,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,outpatient,,,195.00000,104.52000,SilverSummit Healthplan,Medicare Advantage,,68.25,,,,,,,50.70,189.15,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,outpatient,,,578.00000,309.81000,SilverSummit Healthplan,Medicare Advantage,,202.30,,,,,,,150.28,560.66,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,outpatient,,,384.00000,205.82000,SilverSummit Healthplan,Medicare Advantage,,134.40,,,,,,,99.84,372.48,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,SilverSummit Healthplan,Medicare Advantage,LT,106.05,,,,,,,78.78,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,SilverSummit Healthplan,Medicare Advantage,RT,106.05,,,,,,,78.78,293.91,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,SilverSummit Healthplan,Medicare Advantage,LT,155.75,,,,,,,115.70,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,SilverSummit Healthplan,Medicare Advantage,RT,155.75,,,,,,,115.70,431.65,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,outpatient,,,937.00000,502.23000,SilverSummit Healthplan,Medicare Advantage,,327.95,,,,,,,243.62,908.89,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,outpatient,,,615.00000,329.64000,SilverSummit Healthplan,Medicare Advantage,,215.25,,,,,,,159.90,596.55,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,SilverSummit Healthplan,Medicare Advantage,LT,100.45,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,SilverSummit Healthplan,Medicare Advantage,"52,LT",100.45,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,SilverSummit Healthplan,Medicare Advantage,RT,100.45,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,SilverSummit Healthplan,Medicare Advantage,"52,RT",100.45,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,SilverSummit Healthplan,Medicare Advantage,LT,113.05,,,,,,,83.98,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,SilverSummit Healthplan,Medicare Advantage,RT,113.05,,,,,,,83.98,313.31,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,outpatient,,,694.00000,371.98000,SilverSummit Healthplan,Medicare Advantage,,242.90,,,,,,,180.44,673.18,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,SilverSummit Healthplan,Medicare Advantage,LT,96.60,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,SilverSummit Healthplan,Medicare Advantage,RT,96.60,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,SilverSummit Healthplan,Medicare Advantage,LT,88.90,,,,,,,66.04,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,SilverSummit Healthplan,Medicare Advantage,RT,88.90,,,,,,,66.04,246.38,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,SilverSummit Healthplan,Medicare Advantage,LT,96.25,,,,,,,71.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,SilverSummit Healthplan,Medicare Advantage,RT,96.25,,,,,,,71.50,266.75,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,outpatient,,,173.00000,92.73000,SilverSummit Healthplan,Medicare Advantage,,60.55,,,,,,,44.98,167.81,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,SilverSummit Healthplan,Medicare Advantage,LT,169.05,,,,,,,125.58,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,SilverSummit Healthplan,Medicare Advantage,RT,169.05,,,,,,,125.58,468.51,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,SilverSummit Healthplan,Medicare Advantage,LT,66.85,,,,,,,49.66,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,SilverSummit Healthplan,Medicare Advantage,RT,66.85,,,,,,,49.66,185.27,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,SilverSummit Healthplan,Medicare Advantage,LT,51.80,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,SilverSummit Healthplan,Medicare Advantage,"52,LT",51.80,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,SilverSummit Healthplan,Medicare Advantage,RT,51.80,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,SilverSummit Healthplan,Medicare Advantage,"52,RT",51.80,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,SilverSummit Healthplan,Medicare Advantage,LT,168.35,,,,,,,125.06,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,SilverSummit Healthplan,Medicare Advantage,RT,168.35,,,,,,,125.06,466.57,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,SilverSummit Healthplan,Medicare Advantage,LT,75.25,,,,,,,55.90,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,SilverSummit Healthplan,Medicare Advantage,RT,75.25,,,,,,,55.90,208.55,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,SilverSummit Healthplan,Medicare Advantage,LT,96.25,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,SilverSummit Healthplan,Medicare Advantage,"52,LT",96.25,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,SilverSummit Healthplan,Medicare Advantage,RT,96.25,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,SilverSummit Healthplan,Medicare Advantage,"52,RT",96.25,,,,,,,71.50,266.75,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,SilverSummit Healthplan,Medicare Advantage,LT,159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,SilverSummit Healthplan,Medicare Advantage,"52,LT",159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,SilverSummit Healthplan,Medicare Advantage,RT,159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,SilverSummit Healthplan,Medicare Advantage,"52,RT",159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,SilverSummit Healthplan,Medicare Advantage,LT,176.05,,,,,,,130.78,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,SilverSummit Healthplan,Medicare Advantage,RT,176.05,,,,,,,130.78,487.91,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,SilverSummit Healthplan,Medicare Advantage,LT,73.15,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,SilverSummit Healthplan,Medicare Advantage,RT,73.15,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,SilverSummit Healthplan,Medicare Advantage,LT,198.10,,,,,,,147.16,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,SilverSummit Healthplan,Medicare Advantage,RT,198.10,,,,,,,147.16,549.02,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,outpatient,,,598.00000,320.53000,SilverSummit Healthplan,Medicare Advantage,,209.30,,,,,,,155.48,580.06,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,SilverSummit Healthplan,Medicare Advantage,"52,LT",159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,SilverSummit Healthplan,Medicare Advantage,"52,RT",159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,SilverSummit Healthplan,Medicare Advantage,LT,159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,SilverSummit Healthplan,Medicare Advantage,RT,159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,outpatient,,,1913.00000,1025.37000,SilverSummit Healthplan,Medicare Advantage,,669.55,,,,,,,497.38,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,outpatient,,,312.00000,167.23000,SilverSummit Healthplan,Medicare Advantage,,109.20,,,,,,,81.12,302.64,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,outpatient,,,327.00000,175.27000,SilverSummit Healthplan,Medicare Advantage,,114.45,,,,,,,85.02,317.19,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,outpatient,,,425.00000,227.80000,SilverSummit Healthplan,Medicare Advantage,,148.75,,,,,,,110.50,412.25,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,outpatient,,,210.00000,112.56000,SilverSummit Healthplan,Medicare Advantage,,73.50,,,,,,,54.60,203.70,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,outpatient,,,495.00000,265.32000,SilverSummit Healthplan,Medicare Advantage,,173.25,,,,,,,128.70,480.15,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,outpatient,,,541.00000,289.98000,SilverSummit Healthplan,Medicare Advantage,,189.35,,,,,,,140.66,524.77,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,SilverSummit Healthplan,Medicare Advantage,LT,120.75,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,SilverSummit Healthplan,Medicare Advantage,RT,120.75,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,SilverSummit Healthplan,Medicare Advantage,LT,146.65,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,SilverSummit Healthplan,Medicare Advantage,RT,146.65,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,SilverSummit Healthplan,Medicare Advantage,LT,216.30,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,SilverSummit Healthplan,Medicare Advantage,RT,216.30,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,outpatient,,,463.00000,248.17000,SilverSummit Healthplan,Medicare Advantage,,162.05,,,,,,,120.38,449.11,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,outpatient,,,511.00000,273.90000,SilverSummit Healthplan,Medicare Advantage,,178.85,,,,,,,132.86,495.67,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,outpatient,,,132.00000,70.75000,SilverSummit Healthplan,Medicare Advantage,,46.20,,,,,,,34.32,128.04,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,SilverSummit Healthplan,Medicare Advantage,LT,123.55,,,,,,,91.78,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,SilverSummit Healthplan,Medicare Advantage,RT,123.55,,,,,,,91.78,342.41,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,outpatient,,,273.00000,146.33000,SilverSummit Healthplan,Medicare Advantage,,95.55,,,,,,,70.98,264.81,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,outpatient,,,503.00000,269.61000,SilverSummit Healthplan,Medicare Advantage,,176.05,,,,,,,130.78,487.91,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,outpatient,,,561.00000,300.70000,SilverSummit Healthplan,Medicare Advantage,,196.35,,,,,,,145.86,544.17,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,SilverSummit Healthplan,Medicare Advantage,LT,157.50,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,SilverSummit Healthplan,Medicare Advantage,RT,157.50,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,outpatient,,,650.00000,348.40000,SilverSummit Healthplan,Medicare Advantage,,227.50,,,,,,,169.00,630.50,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,outpatient,,,642.00000,344.11000,SilverSummit Healthplan,Medicare Advantage,,224.70,,,,,,,166.92,622.74,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,outpatient,,,777.00000,416.47000,SilverSummit Healthplan,Medicare Advantage,,271.95,,,,,,,202.02,753.69,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,outpatient,,,381.00000,204.22000,SilverSummit Healthplan,Medicare Advantage,,133.35,,,,,,,99.06,369.57,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,SilverSummit Healthplan,Medicare Advantage,LT,130.90,,,,,,,97.24,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,SilverSummit Healthplan,Medicare Advantage,RT,130.90,,,,,,,97.24,362.78,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,SilverSummit Healthplan,Medicare Advantage,LT,56.35,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,SilverSummit Healthplan,Medicare Advantage,RT,56.35,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,SilverSummit Healthplan,Medicare Advantage,LT,174.65,,,,,,,129.74,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,SilverSummit Healthplan,Medicare Advantage,RT,174.65,,,,,,,129.74,484.03,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,outpatient,,,214.00000,114.70000,SilverSummit Healthplan,Medicare Advantage,,74.90,,,,,,,55.64,207.58,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,outpatient,,,329.00000,176.34000,SilverSummit Healthplan,Medicare Advantage,,115.15,,,,,,,85.54,319.13,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,outpatient,,,197.00000,105.59000,SilverSummit Healthplan,Medicare Advantage,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,outpatient,,,263.00000,140.97000,SilverSummit Healthplan,Medicare Advantage,,92.05,,,,,,,68.38,255.11,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,outpatient,,,234.00000,125.42000,SilverSummit Healthplan,Medicare Advantage,,81.90,,,,,,,60.84,226.98,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,outpatient,,,401.00000,214.94000,SilverSummit Healthplan,Medicare Advantage,,140.35,,,,,,,104.26,388.97,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,outpatient,,,515.00000,276.04000,SilverSummit Healthplan,Medicare Advantage,,180.25,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,outpatient,,,747.00000,400.39000,SilverSummit Healthplan,Medicare Advantage,,261.45,,,,,,,194.22,724.59,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,outpatient,,,854.00000,457.74000,SilverSummit Healthplan,Medicare Advantage,,298.90,,,,,,,222.04,828.38,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,outpatient,,,589.00000,315.70000,SilverSummit Healthplan,Medicare Advantage,,206.15,,,,,,,153.14,571.33,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,outpatient,,,613.00000,328.57000,SilverSummit Healthplan,Medicare Advantage,,214.55,,,,,,,159.38,594.61,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,outpatient,,,806.00000,432.02000,SilverSummit Healthplan,Medicare Advantage,,282.10,,,,,,,209.56,781.82,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,outpatient,,,529.00000,283.54000,SilverSummit Healthplan,Medicare Advantage,,185.15,,,,,,,137.54,513.13,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,outpatient,,,939.00000,503.30000,SilverSummit Healthplan,Medicare Advantage,,328.65,,,,,,,244.14,910.83,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,outpatient,,,515.00000,276.04000,SilverSummit Healthplan,Medicare Advantage,,180.25,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,outpatient,,,616.00000,330.18000,SilverSummit Healthplan,Medicare Advantage,,215.60,,,,,,,160.16,597.52,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,outpatient,,,377.00000,202.07000,SilverSummit Healthplan,Medicare Advantage,,131.95,,,,,,,98.02,365.69,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,outpatient,,,340.00000,182.24000,SilverSummit Healthplan,Medicare Advantage,,119.00,,,,,,,88.40,329.80,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,outpatient,,,388.00000,207.97000,SilverSummit Healthplan,Medicare Advantage,,135.80,,,,,,,100.88,376.36,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,outpatient,,,456.00000,244.42000,SilverSummit Healthplan,Medicare Advantage,,159.60,,,,,,,118.56,442.32,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,outpatient,,,267.00000,143.11000,SilverSummit Healthplan,Medicare Advantage,,93.45,,,,,,,69.42,258.99,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,SilverSummit Healthplan,Medicare Advantage,LT,107.10,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,SilverSummit Healthplan,Medicare Advantage,"52,LT",107.10,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,SilverSummit Healthplan,Medicare Advantage,RT,107.10,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,SilverSummit Healthplan,Medicare Advantage,"52,RT",107.10,,,,,,,79.56,296.82,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,outpatient,,,456.00000,244.42000,SilverSummit Healthplan,Medicare Advantage,,159.60,,,,,,,118.56,442.32,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,outpatient,,,381.00000,204.22000,SilverSummit Healthplan,Medicare Advantage,,133.35,,,,,,,99.06,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,SilverSummit Healthplan,Medicare Advantage,LT,50.05,,,,,,,37.18,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,SilverSummit Healthplan,Medicare Advantage,RT,50.05,,,,,,,37.18,138.71,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,SilverSummit Healthplan,Medicare Advantage,LT,115.85,,,,,,,86.06,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,SilverSummit Healthplan,Medicare Advantage,RT,115.85,,,,,,,86.06,321.07,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1113.00000,596.57000,SilverSummit Healthplan,Medicare Advantage,,389.55,,,,,,,289.38,1079.61,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,outpatient,,,1043.00000,559.05000,SilverSummit Healthplan,Medicare Advantage,,365.05,,,,,,,271.18,1011.71,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,SilverSummit Healthplan,Medicare Advantage,LT,89.60,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,SilverSummit Healthplan,Medicare Advantage,"52,LT",89.60,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,SilverSummit Healthplan,Medicare Advantage,RT,89.60,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,SilverSummit Healthplan,Medicare Advantage,"52,RT",89.60,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,SilverSummit Healthplan,Medicare Advantage,LT,178.85,,,,,,,132.86,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,SilverSummit Healthplan,Medicare Advantage,RT,178.85,,,,,,,132.86,495.67,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,SilverSummit Healthplan,Medicare Advantage,LT,193.55,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,SilverSummit Healthplan,Medicare Advantage,RT,193.55,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,SilverSummit Healthplan,Medicare Advantage,LT,376.60,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,SilverSummit Healthplan,Medicare Advantage,RT,376.60,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,SilverSummit Healthplan,Medicare Advantage,LT,302.75,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,SilverSummit Healthplan,Medicare Advantage,RT,302.75,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,SilverSummit Healthplan,Medicare Advantage,LT,256.90,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,SilverSummit Healthplan,Medicare Advantage,RT,256.90,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,SilverSummit Healthplan,Medicare Advantage,LT,255.50,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,SilverSummit Healthplan,Medicare Advantage,RT,255.50,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,SilverSummit Healthplan,Medicare Advantage,LT,91.00,,,,,,,67.60,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,SilverSummit Healthplan,Medicare Advantage,RT,91.00,,,,,,,67.60,252.20,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,outpatient,,,428.00000,203.73000,SilverSummit Healthplan,Medicare Advantage,,149.80,,,,,,,111.28,415.16,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,outpatient,,,492.00000,234.19000,SilverSummit Healthplan,Medicare Advantage,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,outpatient,,,607.00000,288.93000,SilverSummit Healthplan,Medicare Advantage,,212.45,,,,,,,157.82,588.79,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,outpatient,,,649.00000,308.92000,SilverSummit Healthplan,Medicare Advantage,,227.15,,,,,,,168.74,629.53,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,outpatient,,,377.00000,121.77000,SilverSummit Healthplan,Medicare Advantage,50,131.95,,,,,,,98.02,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,SilverSummit Healthplan,Medicare Advantage,LT,87.85,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,SilverSummit Healthplan,Medicare Advantage,RT,87.85,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,outpatient,,,1170.00000,377.91000,SilverSummit Healthplan,Medicare Advantage,50,409.50,,,,,,,304.20,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,SilverSummit Healthplan,Medicare Advantage,LT,273.00,,,,,,,202.80,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,SilverSummit Healthplan,Medicare Advantage,RT,273.00,,,,,,,202.80,756.60,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,outpatient,,,1389.00000,448.65000,SilverSummit Healthplan,Medicare Advantage,,486.15,,,,,,,361.14,1347.33,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,outpatient,,,345.00000,111.44000,SilverSummit Healthplan,Medicare Advantage,50,120.75,,,,,,,89.70,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,SilverSummit Healthplan,Medicare Advantage,LT,80.50,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,SilverSummit Healthplan,Medicare Advantage,RT,80.50,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,outpatient,,,2102.00000,678.95000,SilverSummit Healthplan,Medicare Advantage,50,735.70,,,,,,,546.52,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,SilverSummit Healthplan,Medicare Advantage,LT,490.35,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,SilverSummit Healthplan,Medicare Advantage,RT,490.35,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,outpatient,,,357.00000,115.31000,SilverSummit Healthplan,Medicare Advantage,50,124.95,,,,,,,92.82,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,SilverSummit Healthplan,Medicare Advantage,LT,83.30,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,SilverSummit Healthplan,Medicare Advantage,RT,83.30,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,outpatient,,,2082.00000,672.49000,SilverSummit Healthplan,Medicare Advantage,50,728.70,,,,,,,541.32,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,SilverSummit Healthplan,Medicare Advantage,LT,485.80,,,,,,,360.88,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,SilverSummit Healthplan,Medicare Advantage,RT,485.80,,,,,,,360.88,1346.36,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,outpatient,,,246.00000,79.46000,SilverSummit Healthplan,Medicare Advantage,50,86.10,,,,,,,63.96,238.62,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,SilverSummit Healthplan,Medicare Advantage,LT,57.40,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,SilverSummit Healthplan,Medicare Advantage,RT,57.40,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,outpatient,,,309.00000,99.81000,SilverSummit Healthplan,Medicare Advantage,50,108.15,,,,,,,80.34,299.73,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,SilverSummit Healthplan,Medicare Advantage,LT,72.10,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,SilverSummit Healthplan,Medicare Advantage,RT,72.10,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,outpatient,,,471.00000,152.13000,SilverSummit Healthplan,Medicare Advantage,50,164.85,,,,,,,122.46,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,SilverSummit Healthplan,Medicare Advantage,LT,109.90,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,SilverSummit Healthplan,Medicare Advantage,RT,109.90,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,outpatient,,,239.00000,77.20000,SilverSummit Healthplan,Medicare Advantage,50,83.65,,,,,,,62.14,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,SilverSummit Healthplan,Medicare Advantage,LT,55.65,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,SilverSummit Healthplan,Medicare Advantage,RT,55.65,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,outpatient,,,558.00000,180.23000,SilverSummit Healthplan,Medicare Advantage,50,195.30,,,,,,,145.08,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,SilverSummit Healthplan,Medicare Advantage,LT,130.20,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,SilverSummit Healthplan,Medicare Advantage,RT,130.20,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,outpatient,,,413.00000,133.40000,SilverSummit Healthplan,Medicare Advantage,50,144.55,,,,,,,107.38,400.61,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,SilverSummit Healthplan,Medicare Advantage,LT,96.25,,,,,,,71.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,SilverSummit Healthplan,Medicare Advantage,RT,96.25,,,,,,,71.50,266.75,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,outpatient,,,462.00000,149.23000,SilverSummit Healthplan,Medicare Advantage,,161.70,,,,,,,120.12,448.14,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,outpatient,,,170.00000,54.91000,SilverSummit Healthplan,Medicare Advantage,,59.50,,,,,,,44.20,164.90,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,outpatient,,,281.00000,90.76000,SilverSummit Healthplan,Medicare Advantage,,98.35,,,,,,,73.06,272.57,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,outpatient,,,562.00000,181.53000,SilverSummit Healthplan,Medicare Advantage,,196.70,,,,,,,146.12,545.14,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,outpatient,,,2076.00000,670.55000,SilverSummit Healthplan,Medicare Advantage,50,726.60,,,,,,,539.76,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,SilverSummit Healthplan,Medicare Advantage,LT,484.40,,,,,,,359.84,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,SilverSummit Healthplan,Medicare Advantage,RT,484.40,,,,,,,359.84,1342.48,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,outpatient,,,934.00000,301.68000,SilverSummit Healthplan,Medicare Advantage,,326.90,,,,,,,242.84,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,outpatient,,,842.00000,271.97000,SilverSummit Healthplan,Medicare Advantage,,294.70,,,,,,,218.92,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,outpatient,,,846.00000,273.26000,SilverSummit Healthplan,Medicare Advantage,,296.10,,,,,,,219.96,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,outpatient,,,971.00000,313.63000,SilverSummit Healthplan,Medicare Advantage,,339.85,,,,,,,252.46,941.87,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,outpatient,,,762.00000,246.13000,SilverSummit Healthplan,Medicare Advantage,,266.70,,,,,,,198.12,739.14,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,outpatient,,,758.00000,244.83000,SilverSummit Healthplan,Medicare Advantage,,265.30,,,,,,,197.08,735.26,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,outpatient,,,161.00000,52.00000,SilverSummit Healthplan,Medicare Advantage,,56.35,,,,,,,41.86,156.17,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,outpatient,,,234.00000,75.58000,SilverSummit Healthplan,Medicare Advantage,50,81.90,,,,,,,60.84,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,SilverSummit Healthplan,Medicare Advantage,LT,54.60,,,,,,,40.56,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,SilverSummit Healthplan,Medicare Advantage,RT,54.60,,,,,,,40.56,151.32,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1517.00000,489.99000,SilverSummit Healthplan,Medicare Advantage,50,530.95,,,,,,,394.42,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,SilverSummit Healthplan,Medicare Advantage,LT,353.85,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,SilverSummit Healthplan,Medicare Advantage,RT,353.85,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,outpatient,,,822.00000,265.51000,SilverSummit Healthplan,Medicare Advantage,50,287.70,,,,,,,213.72,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,SilverSummit Healthplan,Medicare Advantage,LT,191.80,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,SilverSummit Healthplan,Medicare Advantage,RT,191.80,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,outpatient,,,2613.00000,844.00000,SilverSummit Healthplan,Medicare Advantage,,914.55,,,,,,,679.38,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,outpatient,,,903.00000,291.67000,SilverSummit Healthplan,Medicare Advantage,,316.05,,,,,,,234.78,875.91,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,outpatient,,,1156.00000,373.39000,SilverSummit Healthplan,Medicare Advantage,,404.60,,,,,,,300.56,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,outpatient,,,677.00000,218.67000,SilverSummit Healthplan,Medicare Advantage,,236.95,,,,,,,176.02,656.69,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1928.00000,622.74000,SilverSummit Healthplan,Medicare Advantage,50,674.80,,,,,,,501.28,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,SilverSummit Healthplan,Medicare Advantage,LT,449.75,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,SilverSummit Healthplan,Medicare Advantage,RT,449.75,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,outpatient,,,812.00000,262.28000,SilverSummit Healthplan,Medicare Advantage,50,284.20,,,,,,,211.12,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,SilverSummit Healthplan,Medicare Advantage,LT,189.35,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,SilverSummit Healthplan,Medicare Advantage,RT,189.35,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,outpatient,,,825.00000,266.48000,SilverSummit Healthplan,Medicare Advantage,50,288.75,,,,,,,214.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,SilverSummit Healthplan,Medicare Advantage,LT,192.50,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,SilverSummit Healthplan,Medicare Advantage,RT,192.50,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,outpatient,,,3494.00000,1128.56000,SilverSummit Healthplan,Medicare Advantage,50,1222.90,,,,,,,908.44,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,SilverSummit Healthplan,Medicare Advantage,LT,815.15,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,SilverSummit Healthplan,Medicare Advantage,RT,815.15,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,outpatient,,,840.00000,271.32000,SilverSummit Healthplan,Medicare Advantage,50,294.00,,,,,,,218.40,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,SilverSummit Healthplan,Medicare Advantage,LT,196.00,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,SilverSummit Healthplan,Medicare Advantage,RT,196.00,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,outpatient,,,792.00000,255.82000,SilverSummit Healthplan,Medicare Advantage,50,277.20,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,SilverSummit Healthplan,Medicare Advantage,LT,184.80,,,,,,,137.28,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,SilverSummit Healthplan,Medicare Advantage,RT,184.80,,,,,,,137.28,512.16,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,outpatient,,,272.00000,87.86000,SilverSummit Healthplan,Medicare Advantage,,95.20,,,,,,,70.72,263.84,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,outpatient,,,1268.00000,409.56000,SilverSummit Healthplan,Medicare Advantage,,443.80,,,,,,,329.68,1229.96,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,outpatient,,,896.00000,289.41000,SilverSummit Healthplan,Medicare Advantage,,313.60,,,,,,,232.96,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,outpatient,,,884.00000,285.53000,SilverSummit Healthplan,Medicare Advantage,,309.40,,,,,,,229.84,857.48,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,SilverSummit Healthplan,Medicare Advantage,,213.15,,,,,,,158.34,590.73,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,outpatient,,,966.00000,383.50000,SilverSummit Healthplan,Medicare Advantage,,338.10,,,,,,,251.16,937.02,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,outpatient,,,872.00000,346.18000,SilverSummit Healthplan,Medicare Advantage,,305.20,,,,,,,226.72,845.84,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,outpatient,,,492.00000,195.32000,SilverSummit Healthplan,Medicare Advantage,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,outpatient,,,331.00000,131.41000,SilverSummit Healthplan,Medicare Advantage,,115.85,,,,,,,86.06,321.07,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,outpatient,,,5215.00000,2070.36000,SilverSummit Healthplan,Medicare Advantage,,1825.25,,,,,,,1355.90,5058.55,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,outpatient,,,5422.00000,2152.53000,SilverSummit Healthplan,Medicare Advantage,,1897.70,,,,,,,1409.72,5259.34,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1878.00000,788.76000,SilverSummit Healthplan,Medicare Advantage,,657.30,,,,,,,488.28,1821.66,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,outpatient,,,2253.00000,946.26000,SilverSummit Healthplan,Medicare Advantage,,788.55,,,,,,,585.78,2185.41,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1502.00000,630.84000,SilverSummit Healthplan,Medicare Advantage,,525.70,,,,,,,390.52,1456.94,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,outpatient,,,2024.00000,850.08000,SilverSummit Healthplan,Medicare Advantage,,708.40,,,,,,,526.24,1963.28,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,outpatient,,,2429.00000,1020.18000,SilverSummit Healthplan,Medicare Advantage,,850.15,,,,,,,631.54,2356.13,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1619.00000,679.98000,SilverSummit Healthplan,Medicare Advantage,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,outpatient,,,2425.00000,1018.50000,SilverSummit Healthplan,Medicare Advantage,,848.75,,,,,,,630.50,2352.25,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2910.00000,1222.20000,SilverSummit Healthplan,Medicare Advantage,,1018.50,,,,,,,756.60,2822.70,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1940.00000,814.80000,SilverSummit Healthplan,Medicare Advantage,,679.00,,,,,,,504.40,1881.80,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2317.00000,973.14000,SilverSummit Healthplan,Medicare Advantage,,810.95,,,,,,,602.42,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2780.00000,1167.60000,SilverSummit Healthplan,Medicare Advantage,,973.00,,,,,,,722.80,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1853.00000,778.26000,SilverSummit Healthplan,Medicare Advantage,,648.55,,,,,,,481.78,1797.41,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2366.00000,993.72000,SilverSummit Healthplan,Medicare Advantage,,828.10,,,,,,,615.16,2295.02,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,outpatient,,,3056.00000,1283.52000,SilverSummit Healthplan,Medicare Advantage,,1069.60,,,,,,,794.56,2964.32,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,outpatient,,,2829.00000,1386.21000,SilverSummit Healthplan,Medicare Advantage,,990.15,,,,,,,735.54,2744.13,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,outpatient,,,3395.00000,1663.55000,SilverSummit Healthplan,Medicare Advantage,,1188.25,,,,,,,882.70,3293.15,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,outpatient,,,2263.00000,1108.87000,SilverSummit Healthplan,Medicare Advantage,,792.05,,,,,,,588.38,2195.11,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,outpatient,,,4697.00000,2301.53000,SilverSummit Healthplan,Medicare Advantage,,1643.95,,,,,,,1221.22,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,outpatient,,,5636.00000,2761.64000,SilverSummit Healthplan,Medicare Advantage,,1972.60,,,,,,,1465.36,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,outpatient,,,3757.00000,1840.93000,SilverSummit Healthplan,Medicare Advantage,,1314.95,,,,,,,976.82,3644.29,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,outpatient,,,2619.00000,1283.31000,SilverSummit Healthplan,Medicare Advantage,,916.65,,,,,,,680.94,2540.43,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,outpatient,,,3143.00000,1540.07000,SilverSummit Healthplan,Medicare Advantage,,1100.05,,,,,,,817.18,3048.71,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,outpatient,,,2095.00000,1026.55000,SilverSummit Healthplan,Medicare Advantage,,733.25,,,,,,,544.70,2032.15,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,outpatient,,,278.00000,136.22000,SilverSummit Healthplan,Medicare Advantage,,97.30,,,,,,,72.28,269.66,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,SilverSummit Healthplan,Medicare Advantage,LT,738.50,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,SilverSummit Healthplan,Medicare Advantage,RT,738.50,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,SilverSummit Healthplan,Medicare Advantage,LT,886.20,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,SilverSummit Healthplan,Medicare Advantage,RT,886.20,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,SilverSummit Healthplan,Medicare Advantage,LT,590.80,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,SilverSummit Healthplan,Medicare Advantage,RT,590.80,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,SilverSummit Healthplan,Medicare Advantage,LT,708.40,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,SilverSummit Healthplan,Medicare Advantage,RT,708.40,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,SilverSummit Healthplan,Medicare Advantage,LT,850.15,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,SilverSummit Healthplan,Medicare Advantage,RT,850.15,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,SilverSummit Healthplan,Medicare Advantage,LT,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,SilverSummit Healthplan,Medicare Advantage,RT,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,outpatient,,,1224.00000,599.76000,SilverSummit Healthplan,Medicare Advantage,,428.40,,,,,,,318.24,1187.28,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,outpatient,,,3020.00000,1479.80000,SilverSummit Healthplan,Medicare Advantage,,1057.00,,,,,,,785.20,2929.40,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,outpatient,,,3624.00000,1775.76000,SilverSummit Healthplan,Medicare Advantage,,1268.40,,,,,,,942.24,3515.28,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,outpatient,,,2416.00000,1183.84000,SilverSummit Healthplan,Medicare Advantage,,845.60,,,,,,,628.16,2343.52,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,outpatient,,,2728.00000,1336.72000,SilverSummit Healthplan,Medicare Advantage,,954.80,,,,,,,709.28,2646.16,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,outpatient,,,3273.00000,1603.77000,SilverSummit Healthplan,Medicare Advantage,,1145.55,,,,,,,850.98,3174.81,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,outpatient,,,2182.00000,1069.18000,SilverSummit Healthplan,Medicare Advantage,,763.70,,,,,,,567.32,2116.54,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,outpatient,,,3133.00000,1535.17000,SilverSummit Healthplan,Medicare Advantage,,1096.55,,,,,,,814.58,3039.01,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,outpatient,,,3759.00000,1841.91000,SilverSummit Healthplan,Medicare Advantage,,1315.65,,,,,,,977.34,3646.23,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,outpatient,,,2506.00000,1227.94000,SilverSummit Healthplan,Medicare Advantage,,877.10,,,,,,,651.56,2430.82,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,outpatient,,,2857.00000,1399.93000,SilverSummit Healthplan,Medicare Advantage,,999.95,,,,,,,742.82,2771.29,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,outpatient,,,3428.00000,1679.72000,SilverSummit Healthplan,Medicare Advantage,,1199.80,,,,,,,891.28,3325.16,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,outpatient,,,2285.00000,1119.65000,SilverSummit Healthplan,Medicare Advantage,,799.75,,,,,,,594.10,2216.45,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,outpatient,,,3565.00000,1746.85000,SilverSummit Healthplan,Medicare Advantage,,1247.75,,,,,,,926.90,3458.05,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,outpatient,,,5918.00000,2899.82000,SilverSummit Healthplan,Medicare Advantage,,2071.30,,,,,,,1538.68,5740.46,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,outpatient,,,3301.00000,1617.49000,SilverSummit Healthplan,Medicare Advantage,,1155.35,,,,,,,858.26,3201.97,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,SilverSummit Healthplan,Medicare Advantage,LT,930.65,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,SilverSummit Healthplan,Medicare Advantage,RT,930.65,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,SilverSummit Healthplan,Medicare Advantage,LT,892.85,,,,,,,663.26,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,SilverSummit Healthplan,Medicare Advantage,RT,892.85,,,,,,,663.26,2474.47,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3806.00000,1864.94000,SilverSummit Healthplan,Medicare Advantage,,1332.10,,,,,,,989.56,3691.82,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,outpatient,,,2149.00000,694.13000,SilverSummit Healthplan,Medicare Advantage,,752.15,,,,,,,558.74,2084.53,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,outpatient,,,1973.00000,637.28000,SilverSummit Healthplan,Medicare Advantage,,690.55,,,,,,,512.98,1913.81,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1784.00000,576.23000,SilverSummit Healthplan,Medicare Advantage,50,624.40,,,,,,,463.84,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,SilverSummit Healthplan,Medicare Advantage,LT,416.15,,,,,,,309.14,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,SilverSummit Healthplan,Medicare Advantage,RT,416.15,,,,,,,309.14,1153.33,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,outpatient,,,130.00000,69.68000,SilverSummit Healthplan,Medicare Advantage,,45.50,,,,,,,33.80,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,outpatient,,,44.00000,23.58000,SilverSummit Healthplan,Medicare Advantage,,15.40,,,,,,,11.44,42.68,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,outpatient,,,456.00000,244.42000,SilverSummit Healthplan,Medicare Advantage,,159.60,,,,,,,118.56,442.32,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,outpatient,,,108.00000,57.89000,SilverSummit Healthplan,Medicare Advantage,,37.80,,,,,,,28.08,104.76,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,outpatient,,,306.00000,164.02000,SilverSummit Healthplan,Medicare Advantage,,107.10,,,,,,,79.56,296.82,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,outpatient,,,257.00000,137.75000,SilverSummit Healthplan,Medicare Advantage,,89.95,,,,,,,66.82,249.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,SilverSummit Healthplan,Medicare Advantage,,1419.95,,,,,,,1054.82,3935.29,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,SilverSummit Healthplan,Medicare Advantage,,1703.80,,,,,,,1265.68,4721.96,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,SilverSummit Healthplan,Medicare Advantage,,1135.75,,,,,,,843.70,3147.65,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,SilverSummit Healthplan,Medicare Advantage,,1419.95,,,,,,,1054.82,3935.29,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,SilverSummit Healthplan,Medicare Advantage,,1703.80,,,,,,,1265.68,4721.96,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,SilverSummit Healthplan,Medicare Advantage,,1135.75,,,,,,,843.70,3147.65,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,outpatient,,,1725.00000,865.95000,SilverSummit Healthplan,Medicare Advantage,,603.75,,,,,,,448.50,1673.25,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,outpatient,,,1743.00000,874.99000,SilverSummit Healthplan,Medicare Advantage,,610.05,,,,,,,453.18,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,SilverSummit Healthplan,Medicare Advantage,LT,516.25,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,SilverSummit Healthplan,Medicare Advantage,RT,516.25,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,outpatient,,,1162.00000,583.32000,SilverSummit Healthplan,Medicare Advantage,,406.70,,,,,,,302.12,1127.14,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,SilverSummit Healthplan,Medicare Advantage,LT,344.05,,,,,,,255.58,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,SilverSummit Healthplan,Medicare Advantage,RT,344.05,,,,,,,255.58,953.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,outpatient,,,3183.00000,1597.87000,SilverSummit Healthplan,Medicare Advantage,,1114.05,,,,,,,827.58,3087.51,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,outpatient,,,3819.00000,1917.14000,SilverSummit Healthplan,Medicare Advantage,,1336.65,,,,,,,992.94,3704.43,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,outpatient,,,2546.00000,1278.09000,SilverSummit Healthplan,Medicare Advantage,,891.10,,,,,,,661.96,2469.62,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,SilverSummit Healthplan,Medicare Advantage,LT,1350.30,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,SilverSummit Healthplan,Medicare Advantage,RT,1350.30,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,SilverSummit Healthplan,Medicare Advantage,LT,1620.15,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,SilverSummit Healthplan,Medicare Advantage,RT,1620.15,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,SilverSummit Healthplan,Medicare Advantage,LT,1080.10,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,SilverSummit Healthplan,Medicare Advantage,RT,1080.10,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,SilverSummit Healthplan,Medicare Advantage,LT,876.75,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,SilverSummit Healthplan,Medicare Advantage,RT,876.75,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,SilverSummit Healthplan,Medicare Advantage,LT,1052.10,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,SilverSummit Healthplan,Medicare Advantage,RT,1052.10,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,SilverSummit Healthplan,Medicare Advantage,LT,701.40,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,SilverSummit Healthplan,Medicare Advantage,RT,701.40,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,SilverSummit Healthplan,Medicare Advantage,LT,1097.95,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,SilverSummit Healthplan,Medicare Advantage,RT,1097.95,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,SilverSummit Healthplan,Medicare Advantage,LT,1317.40,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,SilverSummit Healthplan,Medicare Advantage,RT,1317.40,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,SilverSummit Healthplan,Medicare Advantage,LT,878.15,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,SilverSummit Healthplan,Medicare Advantage,RT,878.15,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,SilverSummit Healthplan,Medicare Advantage,LT,1058.05,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,SilverSummit Healthplan,Medicare Advantage,RT,1058.05,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,SilverSummit Healthplan,Medicare Advantage,LT,1269.45,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,SilverSummit Healthplan,Medicare Advantage,RT,1269.45,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,SilverSummit Healthplan,Medicare Advantage,LT,846.30,,,,,,,628.68,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,SilverSummit Healthplan,Medicare Advantage,RT,846.30,,,,,,,628.68,2345.46,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,outpatient,,,870.00000,436.74000,SilverSummit Healthplan,Medicare Advantage,,304.50,,,,,,,226.20,843.90,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,outpatient,,,1353.00000,679.21000,SilverSummit Healthplan,Medicare Advantage,,473.55,,,,,,,351.78,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,SilverSummit Healthplan,Medicare Advantage,LT,315.70,,,,,,,234.52,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,SilverSummit Healthplan,Medicare Advantage,RT,315.70,,,,,,,234.52,874.94,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3489.00000,1751.48000,SilverSummit Healthplan,Medicare Advantage,,1221.15,,,,,,,907.14,3384.33,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,outpatient,,,4187.00000,2101.87000,SilverSummit Healthplan,Medicare Advantage,,1465.45,,,,,,,1088.62,4061.39,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,outpatient,,,2791.00000,1401.08000,SilverSummit Healthplan,Medicare Advantage,,976.85,,,,,,,725.66,2707.27,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,outpatient,,,492.00000,246.98000,SilverSummit Healthplan,Medicare Advantage,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,outpatient,,,331.00000,166.16000,SilverSummit Healthplan,Medicare Advantage,,115.85,,,,,,,86.06,321.07,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,outpatient,,,4440.00000,2357.64000,SilverSummit Healthplan,Medicare Advantage,,1554.00,,,,,,,1154.40,4306.80,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,outpatient,,,5328.00000,2829.17000,SilverSummit Healthplan,Medicare Advantage,,1864.80,,,,,,,1385.28,5168.16,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,outpatient,,,3552.00000,1886.11000,SilverSummit Healthplan,Medicare Advantage,,1243.20,,,,,,,923.52,3445.44,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,outpatient,,,2528.00000,1342.37000,SilverSummit Healthplan,Medicare Advantage,,884.80,,,,,,,657.28,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,outpatient,,,3033.00000,1610.52000,SilverSummit Healthplan,Medicare Advantage,,1061.55,,,,,,,788.58,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,outpatient,,,2022.00000,1073.68000,SilverSummit Healthplan,Medicare Advantage,,707.70,,,,,,,525.72,1961.34,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,outpatient,,,3610.00000,1909.69000,SilverSummit Healthplan,Medicare Advantage,,1263.50,,,,,,,938.60,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,outpatient,,,4332.00000,2291.63000,SilverSummit Healthplan,Medicare Advantage,,1516.20,,,,,,,1126.32,4202.04,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,outpatient,,,2888.00000,1527.75000,SilverSummit Healthplan,Medicare Advantage,,1010.80,,,,,,,750.88,2801.36,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,outpatient,,,4532.00000,2397.43000,SilverSummit Healthplan,Medicare Advantage,,1586.20,,,,,,,1178.32,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,outpatient,,,5438.00000,2876.70000,SilverSummit Healthplan,Medicare Advantage,,1903.30,,,,,,,1413.88,5274.86,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,outpatient,,,3625.00000,1917.62000,SilverSummit Healthplan,Medicare Advantage,,1268.75,,,,,,,942.50,3516.25,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,outpatient,,,3639.00000,1925.03000,SilverSummit Healthplan,Medicare Advantage,,1273.65,,,,,,,946.14,3529.83,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,outpatient,,,4367.00000,2310.14000,SilverSummit Healthplan,Medicare Advantage,,1528.45,,,,,,,1135.42,4235.99,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,outpatient,,,2911.00000,1539.92000,SilverSummit Healthplan,Medicare Advantage,,1018.85,,,,,,,756.86,2823.67,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3494.00000,1719.05000,SilverSummit Healthplan,Medicare Advantage,,1222.90,,,,,,,908.44,3389.18,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,outpatient,,,4193.00000,2062.96000,SilverSummit Healthplan,Medicare Advantage,,1467.55,,,,,,,1090.18,4067.21,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,outpatient,,,2795.00000,1375.14000,SilverSummit Healthplan,Medicare Advantage,,978.25,,,,,,,726.70,2711.15,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,outpatient,,,2717.00000,1336.76000,SilverSummit Healthplan,Medicare Advantage,,950.95,,,,,,,706.42,2635.49,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,outpatient,,,3260.00000,1603.92000,SilverSummit Healthplan,Medicare Advantage,,1141.00,,,,,,,847.60,3162.20,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,outpatient,,,2173.00000,1069.12000,SilverSummit Healthplan,Medicare Advantage,,760.55,,,,,,,564.98,2107.81,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,SilverSummit Healthplan,Medicare Advantage,LT,1417.85,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,SilverSummit Healthplan,Medicare Advantage,RT,1417.85,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,SilverSummit Healthplan,Medicare Advantage,LT,1701.35,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,SilverSummit Healthplan,Medicare Advantage,RT,1701.35,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,SilverSummit Healthplan,Medicare Advantage,LT,1134.35,,,,,,,842.66,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,SilverSummit Healthplan,Medicare Advantage,RT,1134.35,,,,,,,842.66,3143.77,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,outpatient,,,4260.00000,2420.32000,SilverSummit Healthplan,Medicare Advantage,,1491.00,,,,,,,1107.60,4132.20,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,outpatient,,,5112.00000,2904.38000,SilverSummit Healthplan,Medicare Advantage,,1789.20,,,,,,,1329.12,4958.64,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3408.00000,1936.26000,SilverSummit Healthplan,Medicare Advantage,,1192.80,,,,,,,886.08,3305.76,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3343.00000,1899.33000,SilverSummit Healthplan,Medicare Advantage,,1170.05,,,,,,,869.18,3242.71,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,outpatient,,,4010.00000,2278.28000,SilverSummit Healthplan,Medicare Advantage,,1403.50,,,,,,,1042.60,3889.70,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,outpatient,,,2674.00000,1519.23000,SilverSummit Healthplan,Medicare Advantage,,935.90,,,,,,,695.24,2593.78,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,SilverSummit Healthplan,Medicare Advantage,LT,1152.90,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,SilverSummit Healthplan,Medicare Advantage,RT,1152.90,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,SilverSummit Healthplan,Medicare Advantage,LT,1383.55,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,SilverSummit Healthplan,Medicare Advantage,RT,1383.55,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,SilverSummit Healthplan,Medicare Advantage,LT,922.25,,,,,,,685.10,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,SilverSummit Healthplan,Medicare Advantage,RT,922.25,,,,,,,685.10,2555.95,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3664.00000,2081.70000,SilverSummit Healthplan,Medicare Advantage,,1282.40,,,,,,,952.64,3554.08,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,outpatient,,,4397.00000,2498.16000,SilverSummit Healthplan,Medicare Advantage,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,outpatient,,,2931.00000,1665.25000,SilverSummit Healthplan,Medicare Advantage,,1025.85,,,,,,,762.06,2843.07,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,outpatient,,,4759.00000,2703.83000,SilverSummit Healthplan,Medicare Advantage,,1665.65,,,,,,,1237.34,4616.23,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,outpatient,,,5710.00000,3244.14000,SilverSummit Healthplan,Medicare Advantage,,1998.50,,,,,,,1484.60,5538.70,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3807.00000,2162.95000,SilverSummit Healthplan,Medicare Advantage,,1332.45,,,,,,,989.82,3692.79,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2915.00000,1574.10000,SilverSummit Healthplan,Medicare Advantage,,1020.25,,,,,,,757.90,2827.55,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1918.00000,1035.72000,SilverSummit Healthplan,Medicare Advantage,,671.30,,,,,,,498.68,1860.46,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2292.00000,1237.68000,SilverSummit Healthplan,Medicare Advantage,,802.20,,,,,,,595.92,2223.24,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,outpatient,,,2984.00000,1611.36000,SilverSummit Healthplan,Medicare Advantage,,1044.40,,,,,,,775.84,2894.48,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,outpatient,,,769.00000,415.26000,SilverSummit Healthplan,Medicare Advantage,,269.15,,,,,,,199.94,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,outpatient,,,1280.00000,691.20000,SilverSummit Healthplan,Medicare Advantage,,448.00,,,,,,,332.80,1241.60,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,outpatient,,,1878.00000,1014.12000,SilverSummit Healthplan,Medicare Advantage,,657.30,,,,,,,488.28,1821.66,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,outpatient,,,2196.00000,1185.84000,SilverSummit Healthplan,Medicare Advantage,,768.60,,,,,,,570.96,2130.12,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,outpatient,,,844.00000,455.76000,SilverSummit Healthplan,Medicare Advantage,,295.40,,,,,,,219.44,818.68,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,outpatient,,,1305.00000,704.70000,SilverSummit Healthplan,Medicare Advantage,,456.75,,,,,,,339.30,1265.85,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,outpatient,,,576.00000,311.04000,SilverSummit Healthplan,Medicare Advantage,,201.60,,,,,,,149.76,558.72,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,outpatient,,,809.00000,436.86000,SilverSummit Healthplan,Medicare Advantage,,283.15,,,,,,,210.34,784.73,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,outpatient,,,2462.00000,1329.48000,SilverSummit Healthplan,Medicare Advantage,,861.70,,,,,,,640.12,2388.14,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,outpatient,,,918.00000,495.72000,SilverSummit Healthplan,Medicare Advantage,,321.30,,,,,,,238.68,890.46,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,outpatient,,,1102.00000,595.08000,SilverSummit Healthplan,Medicare Advantage,,385.70,,,,,,,286.52,1068.94,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,outpatient,,,812.00000,438.48000,SilverSummit Healthplan,Medicare Advantage,,284.20,,,,,,,211.12,787.64,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,outpatient,,,1407.00000,759.78000,SilverSummit Healthplan,Medicare Advantage,,492.45,,,,,,,365.82,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,outpatient,,,1980.00000,1069.20000,SilverSummit Healthplan,Medicare Advantage,,693.00,,,,,,,514.80,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,outpatient,,,964.00000,520.56000,SilverSummit Healthplan,Medicare Advantage,,337.40,,,,,,,250.64,935.08,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,outpatient,,,1040.00000,561.60000,SilverSummit Healthplan,Medicare Advantage,,364.00,,,,,,,270.40,1008.80,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,outpatient,,,795.00000,429.30000,SilverSummit Healthplan,Medicare Advantage,,278.25,,,,,,,206.70,771.15,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,outpatient,,,1124.00000,606.96000,SilverSummit Healthplan,Medicare Advantage,,393.40,,,,,,,292.24,1090.28,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,outpatient,,,736.00000,397.44000,SilverSummit Healthplan,Medicare Advantage,,257.60,,,,,,,191.36,713.92,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,outpatient,,,700.00000,378.00000,SilverSummit Healthplan,Medicare Advantage,,245.00,,,,,,,182.00,679.00,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,outpatient,,,821.00000,443.34000,SilverSummit Healthplan,Medicare Advantage,,287.35,,,,,,,213.46,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,outpatient,,,846.00000,456.84000,SilverSummit Healthplan,Medicare Advantage,,296.10,,,,,,,219.96,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,outpatient,,,958.00000,517.32000,SilverSummit Healthplan,Medicare Advantage,,335.30,,,,,,,249.08,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,outpatient,,,1261.00000,680.94000,SilverSummit Healthplan,Medicare Advantage,,441.35,,,,,,,327.86,1223.17,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,outpatient,,,971.00000,524.34000,SilverSummit Healthplan,Medicare Advantage,,339.85,,,,,,,252.46,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,outpatient,,,1837.00000,991.98000,SilverSummit Healthplan,Medicare Advantage,,642.95,,,,,,,477.62,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,outpatient,,,1099.00000,593.46000,SilverSummit Healthplan,Medicare Advantage,,384.65,,,,,,,285.74,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,outpatient,,,2178.00000,1176.12000,SilverSummit Healthplan,Medicare Advantage,,762.30,,,,,,,566.28,2112.66,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,outpatient,,,1226.00000,662.04000,SilverSummit Healthplan,Medicare Advantage,,429.10,,,,,,,318.76,1189.22,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,outpatient,,,1048.00000,565.92000,SilverSummit Healthplan,Medicare Advantage,,366.80,,,,,,,272.48,1016.56,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,outpatient,,,970.00000,523.80000,SilverSummit Healthplan,Medicare Advantage,,339.50,,,,,,,252.20,940.90,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,outpatient,,,1803.00000,973.62000,SilverSummit Healthplan,Medicare Advantage,,631.05,,,,,,,468.78,1748.91,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,outpatient,,,2504.00000,1352.16000,SilverSummit Healthplan,Medicare Advantage,,876.40,,,,,,,651.04,2428.88,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2457.00000,1326.78000,SilverSummit Healthplan,Medicare Advantage,,859.95,,,,,,,638.82,2383.29,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,outpatient,,,923.00000,498.42000,SilverSummit Healthplan,Medicare Advantage,,323.05,,,,,,,239.98,895.31,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,outpatient,,,5478.00000,2958.12000,SilverSummit Healthplan,Medicare Advantage,,1917.30,,,,,,,1424.28,5313.66,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,outpatient,,,4551.00000,2457.54000,SilverSummit Healthplan,Medicare Advantage,,1592.85,,,,,,,1183.26,4414.47,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,outpatient,,,1360.00000,734.40000,SilverSummit Healthplan,Medicare Advantage,,476.00,,,,,,,353.60,1319.20,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,outpatient,,,1209.00000,652.86000,SilverSummit Healthplan,Medicare Advantage,,423.15,,,,,,,314.34,1172.73,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,outpatient,,,848.00000,457.92000,SilverSummit Healthplan,Medicare Advantage,,296.80,,,,,,,220.48,822.56,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,outpatient,,,1071.00000,578.34000,SilverSummit Healthplan,Medicare Advantage,,374.85,,,,,,,278.46,1038.87,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,outpatient,,,1792.00000,967.68000,SilverSummit Healthplan,Medicare Advantage,,627.20,,,,,,,465.92,1738.24,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,outpatient,,,35.00000,18.90000,SilverSummit Healthplan,Medicare Advantage,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,outpatient,,,285.00000,153.90000,SilverSummit Healthplan,Medicare Advantage,,99.75,,,,,,,74.10,276.45,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,outpatient,,,1012.00000,546.48000,SilverSummit Healthplan,Medicare Advantage,,354.20,,,,,,,263.12,981.64,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,outpatient,,,492.00000,265.68000,SilverSummit Healthplan,Medicare Advantage,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,outpatient,,,739.00000,399.06000,SilverSummit Healthplan,Medicare Advantage,,258.65,,,,,,,192.14,716.83,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,outpatient,,,515.00000,278.10000,SilverSummit Healthplan,Medicare Advantage,,180.25,,,,,,,133.90,499.55,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,outpatient,,,1467.00000,792.18000,SilverSummit Healthplan,Medicare Advantage,,513.45,,,,,,,381.42,1422.99,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,outpatient,,,1683.00000,888.62000,SilverSummit Healthplan,Medicare Advantage,,589.05,,,,,,,437.58,1632.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,426.30000,225.09000,SilverSummit Healthplan,Medicare Advantage,,149.21,,,,,,,110.84,413.51,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,725.00000,382.80000,SilverSummit Healthplan,Medicare Advantage,,253.75,,,,,,,188.50,1855.42,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,1852.00000,977.86000,SilverSummit Healthplan,Medicare Advantage,,648.20,,,,,,,481.52,1868.26,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,110.00000,58.08000,SilverSummit Healthplan,Medicare Advantage,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,98.00000,51.74000,SilverSummit Healthplan,Medicare Advantage,,34.30,,,,,,,25.48,1662.92,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,2018.00000,1065.50000,SilverSummit Healthplan,Medicare Advantage,,706.30,,,,,,,524.68,1957.46,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,4325.00000,2283.60000,SilverSummit Healthplan,Medicare Advantage,,1513.75,,,,,,,1124.50,4195.25,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,172.00000,90.82000,SilverSummit Healthplan,Medicare Advantage,,60.20,,,,,,,44.72,166.84,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,942.00000,497.38000,SilverSummit Healthplan,Medicare Advantage,,329.70,,,,,,,244.92,913.74,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,413.00000,218.06000,SilverSummit Healthplan,Medicare Advantage,,144.55,,,,,,,107.38,400.61,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,outpatient,,,257.00000,135.70000,SilverSummit Healthplan,Medicare Advantage,,89.95,,,,,,,66.82,249.29,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,116.00000,61.25000,SilverSummit Healthplan,Medicare Advantage,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,463.20000,244.57000,SilverSummit Healthplan,Medicare Advantage,,162.12,,,,,,,120.43,449.30,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,804.00000,424.51000,SilverSummit Healthplan,Medicare Advantage,,281.40,,,,,,,209.04,779.88,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,172.00000,90.82000,SilverSummit Healthplan,Medicare Advantage,,60.20,,,,,,,44.72,166.84,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,354.30000,187.07000,SilverSummit Healthplan,Medicare Advantage,,124.00,,,,,,,92.12,343.67,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,277.90000,146.73000,SilverSummit Healthplan,Medicare Advantage,,97.27,,,,,,,72.25,269.56,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,200.00000,105.60000,SilverSummit Healthplan,Medicare Advantage,,70.00,,,,,,,52.00,194.00,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,outpatient,,,197.00000,63.63000,SilverSummit Healthplan,Medicare Advantage,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,outpatient,,,468.00000,151.16000,SilverSummit Healthplan,Medicare Advantage,50,163.80,,,,,,,121.68,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,SilverSummit Healthplan,Medicare Advantage,LT,109.20,,,,,,,81.12,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,SilverSummit Healthplan,Medicare Advantage,RT,109.20,,,,,,,81.12,302.64,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,SilverSummit Healthplan,Medicare Advantage,,158.55,,,,,,,117.78,439.41,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,SilverSummit Healthplan,Medicare Advantage,,213.15,,,,,,,158.34,590.73,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1248.00000,403.10000,SilverSummit Healthplan,Medicare Advantage,50,436.80,,,,,,,324.48,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,SilverSummit Healthplan,Medicare Advantage,LT,291.20,,,,,,,216.32,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,SilverSummit Healthplan,Medicare Advantage,RT,291.20,,,,,,,216.32,807.04,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,SilverSummit Healthplan,Medicare Advantage,LT,1482.25,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,SilverSummit Healthplan,Medicare Advantage,RT,1482.25,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,outpatient,,,2119.00000,684.44000,SilverSummit Healthplan,Medicare Advantage,,741.65,,,,,,,550.94,2055.43,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1943.00000,627.59000,SilverSummit Healthplan,Medicare Advantage,,680.05,,,,,,,505.18,1884.71,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,outpatient,,,1426.00000,460.60000,SilverSummit Healthplan,Medicare Advantage,,499.10,,,,,,,370.76,1383.22,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,outpatient,,,4202.00000,1357.25000,SilverSummit Healthplan,Medicare Advantage,50,1470.70,,,,,,,1092.52,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,SilverSummit Healthplan,Medicare Advantage,LT,980.35,,,,,,,728.26,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,SilverSummit Healthplan,Medicare Advantage,RT,980.35,,,,,,,728.26,2716.97,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,outpatient,,,832.00000,268.74000,SilverSummit Healthplan,Medicare Advantage,,291.20,,,,,,,216.32,807.04,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,outpatient,,,1457.00000,470.61000,SilverSummit Healthplan,Medicare Advantage,,509.95,,,,,,,378.82,1413.29,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,SilverSummit Healthplan,Medicare Advantage,LT,260.05,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,SilverSummit Healthplan,Medicare Advantage,RT,260.05,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,outpatient,,,232.00000,74.94000,SilverSummit Healthplan,Medicare Advantage,,81.20,,,,,,,60.32,225.04,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,outpatient,,,1364.00000,440.57000,SilverSummit Healthplan,Medicare Advantage,50,477.40,,,,,,,354.64,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,SilverSummit Healthplan,Medicare Advantage,LT,318.15,,,,,,,236.34,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,SilverSummit Healthplan,Medicare Advantage,RT,318.15,,,,,,,236.34,881.73,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,outpatient,,,510.00000,355.98000,SilverSummit Healthplan,Medicare Advantage,,178.50,,,,,,,132.60,494.70,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,outpatient,,,1001.00000,698.70000,SilverSummit Healthplan,Medicare Advantage,,350.35,,,,,,,260.26,970.97,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,outpatient,,,887.00000,619.13000,SilverSummit Healthplan,Medicare Advantage,,310.45,,,,,,,230.62,860.39,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,outpatient,,,1022.00000,713.36000,SilverSummit Healthplan,Medicare Advantage,50,357.70,,,,,,,265.72,991.34,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,SilverSummit Healthplan,Medicare Advantage,LT,238.35,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,SilverSummit Healthplan,Medicare Advantage,RT,238.35,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,outpatient,,,945.00000,659.61000,SilverSummit Healthplan,Medicare Advantage,50,330.75,,,,,,,245.70,916.65,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,SilverSummit Healthplan,Medicare Advantage,LT,220.50,,,,,,,163.80,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,SilverSummit Healthplan,Medicare Advantage,RT,220.50,,,,,,,163.80,611.10,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,outpatient,,,577.00000,402.75000,SilverSummit Healthplan,Medicare Advantage,,201.95,,,,,,,150.02,559.69,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,outpatient,,,433.00000,302.23000,SilverSummit Healthplan,Medicare Advantage,,151.55,,,,,,,112.58,420.01,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,outpatient,,,331.00000,231.04000,SilverSummit Healthplan,Medicare Advantage,,115.85,,,,,,,86.06,321.07,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,outpatient,,,662.00000,462.08000,SilverSummit Healthplan,Medicare Advantage,,231.70,,,,,,,172.12,642.14,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,outpatient,,,752.00000,524.90000,SilverSummit Healthplan,Medicare Advantage,,263.20,,,,,,,195.52,729.44,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,SilverSummit Healthplan,Medicare Advantage,,63.70,,,,,,,47.32,176.54,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,outpatient,,,420.00000,293.16000,SilverSummit Healthplan,Medicare Advantage,,147.00,,,,,,,109.20,407.40,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,outpatient,,,253.00000,176.59000,SilverSummit Healthplan,Medicare Advantage,,88.55,,,,,,,65.78,245.41,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,outpatient,,,168.00000,117.26000,SilverSummit Healthplan,Medicare Advantage,,58.80,,,,,,,43.68,162.96,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,outpatient,,,695.00000,485.11000,SilverSummit Healthplan,Medicare Advantage,,243.25,,,,,,,180.70,674.15,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,outpatient,,,474.00000,330.85000,SilverSummit Healthplan,Medicare Advantage,,165.90,,,,,,,123.24,459.78,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,outpatient,,,930.00000,649.14000,SilverSummit Healthplan,Medicare Advantage,,325.50,,,,,,,241.80,902.10,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,outpatient,,,786.00000,548.63000,SilverSummit Healthplan,Medicare Advantage,,275.10,,,,,,,204.36,762.42,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,SilverSummit Healthplan,Medicare Advantage,,217.00,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,SilverSummit Healthplan,Medicare Advantage,59,217.00,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,SilverSummit Healthplan,Medicare Advantage,,152.25,,,,,,,113.10,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,SilverSummit Healthplan,Medicare Advantage,59,152.25,,,,,,,113.10,421.95,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,outpatient,,,492.00000,343.42000,SilverSummit Healthplan,Medicare Advantage,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,outpatient,,,331.00000,231.04000,SilverSummit Healthplan,Medicare Advantage,,115.85,,,,,,,86.06,321.07,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,outpatient,,,875.00000,610.75000,SilverSummit Healthplan,Medicare Advantage,,306.25,,,,,,,227.50,848.75,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,outpatient,,,688.00000,480.22000,SilverSummit Healthplan,Medicare Advantage,,240.80,,,,,,,178.88,667.36,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,outpatient,,,465.00000,324.57000,SilverSummit Healthplan,Medicare Advantage,,162.75,,,,,,,120.90,451.05,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,outpatient,,,846.00000,590.51000,SilverSummit Healthplan,Medicare Advantage,,296.10,,,,,,,219.96,820.62,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,outpatient,,,482.00000,336.44000,SilverSummit Healthplan,Medicare Advantage,,168.70,,,,,,,125.32,467.54,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,outpatient,,,926.00000,646.35000,SilverSummit Healthplan,Medicare Advantage,,324.10,,,,,,,240.76,898.22,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,outpatient,,,292.00000,203.82000,SilverSummit Healthplan,Medicare Advantage,,102.20,,,,,,,75.92,283.24,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,outpatient,,,827.00000,577.25000,SilverSummit Healthplan,Medicare Advantage,,289.45,,,,,,,215.02,802.19,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,outpatient,,,253.00000,176.59000,SilverSummit Healthplan,Medicare Advantage,,88.55,,,,,,,65.78,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,outpatient,,,901.00000,628.90000,SilverSummit Healthplan,Medicare Advantage,,315.35,,,,,,,234.26,873.97,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,outpatient,,,460.00000,321.08000,SilverSummit Healthplan,Medicare Advantage,,161.00,,,,,,,119.60,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1029.00000,718.24000,SilverSummit Healthplan,Medicare Advantage,,360.15,,,,,,,267.54,998.13,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,outpatient,,,959.00000,669.38000,SilverSummit Healthplan,Medicare Advantage,,335.65,,,,,,,249.34,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,outpatient,,,558.00000,389.48000,SilverSummit Healthplan,Medicare Advantage,,195.30,,,,,,,145.08,541.26,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,outpatient,,,705.00000,492.09000,SilverSummit Healthplan,Medicare Advantage,,246.75,,,,,,,183.30,683.85,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,outpatient,,,249.00000,173.80000,SilverSummit Healthplan,Medicare Advantage,,87.15,,,,,,,64.74,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,outpatient,,,427.00000,298.05000,SilverSummit Healthplan,Medicare Advantage,,149.45,,,,,,,111.02,414.19,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,SilverSummit Healthplan,Medicare Advantage,,257.95,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,SilverSummit Healthplan,Medicare Advantage,59,257.95,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,outpatient,,,809.00000,564.68000,SilverSummit Healthplan,Medicare Advantage,,283.15,,,,,,,210.34,784.73,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,outpatient,,,525.00000,366.45000,SilverSummit Healthplan,Medicare Advantage,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,outpatient,,,319.00000,222.66000,SilverSummit Healthplan,Medicare Advantage,,111.65,,,,,,,82.94,309.43,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1437.00000,678.26000,SilverSummit Healthplan,Medicare Advantage,,502.95,,,,,,,373.62,1393.89,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2143.00000,1011.50000,SilverSummit Healthplan,Medicare Advantage,,750.05,,,,,,,557.18,2078.71,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,outpatient,,,755.00000,356.36000,SilverSummit Healthplan,Medicare Advantage,,264.25,,,,,,,196.30,732.35,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,outpatient,,,979.00000,462.09000,SilverSummit Healthplan,Medicare Advantage,,342.65,,,,,,,254.54,949.63,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,outpatient,,,436.00000,205.79000,SilverSummit Healthplan,Medicare Advantage,,152.60,,,,,,,113.36,422.92,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,outpatient,,,220.00000,103.84000,SilverSummit Healthplan,Medicare Advantage,,77.00,,,,,,,57.20,213.40,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,outpatient,,,344.00000,162.37000,SilverSummit Healthplan,Medicare Advantage,,120.40,,,,,,,89.44,333.68,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,outpatient,,,818.00000,393.46000,SilverSummit Healthplan,Medicare Advantage,,286.30,,,,,,,212.68,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,outpatient,,,545.00000,262.14000,SilverSummit Healthplan,Medicare Advantage,52,190.75,,,,,,,141.70,528.65,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,outpatient,,,1347.00000,647.91000,SilverSummit Healthplan,Medicare Advantage,,471.45,,,,,,,350.22,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,outpatient,,,898.00000,431.94000,SilverSummit Healthplan,Medicare Advantage,52,314.30,,,,,,,233.48,871.06,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,outpatient,,,469.00000,225.59000,SilverSummit Healthplan,Medicare Advantage,,164.15,,,,,,,121.94,454.93,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,outpatient,,,1762.00000,847.52000,SilverSummit Healthplan,Medicare Advantage,,616.70,,,,,,,458.12,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,outpatient,,,627.00000,301.59000,SilverSummit Healthplan,Medicare Advantage,,219.45,,,,,,,163.02,608.19,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,outpatient,,,590.00000,283.79000,SilverSummit Healthplan,Medicare Advantage,,206.50,,,,,,,153.40,572.30,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,outpatient,,,1550.00000,745.55000,SilverSummit Healthplan,Medicare Advantage,,542.50,,,,,,,403.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,SilverSummit Healthplan,Medicare Advantage,LT,346.50,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,SilverSummit Healthplan,Medicare Advantage,RT,346.50,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,outpatient,,,1402.00000,674.36000,SilverSummit Healthplan,Medicare Advantage,,490.70,,,,,,,364.52,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,SilverSummit Healthplan,Medicare Advantage,LT,343.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,SilverSummit Healthplan,Medicare Advantage,RT,343.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,outpatient,,,1661.00000,798.94000,SilverSummit Healthplan,Medicare Advantage,,581.35,,,,,,,431.86,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,outpatient,,,980.00000,471.38000,SilverSummit Healthplan,Medicare Advantage,,343.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1740.00000,836.94000,SilverSummit Healthplan,Medicare Advantage,,609.00,,,,,,,452.40,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1168.00000,561.81000,SilverSummit Healthplan,Medicare Advantage,,408.80,,,,,,,303.68,1132.96,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,outpatient,,,433.00000,232.09000,SilverSummit Healthplan,Medicare Advantage,,151.55,,,,,,,112.58,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,SilverSummit Healthplan,Medicare Advantage,LT,135.80,,,,,,,100.88,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,SilverSummit Healthplan,Medicare Advantage,RT,135.80,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,outpatient,,,388.00000,207.97000,SilverSummit Healthplan,Medicare Advantage,,135.80,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,outpatient,,,604.00000,323.74000,SilverSummit Healthplan,Medicare Advantage,,211.40,,,,,,,157.04,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,outpatient,,,667.00000,357.51000,SilverSummit Healthplan,Medicare Advantage,,233.45,,,,,,,173.42,646.99,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,outpatient,,,176.00000,94.34000,SilverSummit Healthplan,Medicare Advantage,,61.60,,,,,,,45.76,170.72,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,SilverSummit Healthplan,Medicare Advantage,LT,32.20,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,SilverSummit Healthplan,Medicare Advantage,RT,32.20,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,SilverSummit Healthplan,Medicare Advantage,LT,128.10,,,,,,,95.16,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,SilverSummit Healthplan,Medicare Advantage,RT,128.10,,,,,,,95.16,355.02,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,SilverSummit Healthplan,Medicare Advantage,LT,390.95,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,SilverSummit Healthplan,Medicare Advantage,RT,390.95,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,outpatient,,,559.00000,180.56000,SilverSummit Healthplan,Medicare Advantage,,195.65,,,,,,,145.34,542.23,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,outpatient,,,252.00000,81.40000,SilverSummit Healthplan,Medicare Advantage,50,88.20,,,,,,,65.52,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,SilverSummit Healthplan,Medicare Advantage,LT,58.80,,,,,,,43.68,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,SilverSummit Healthplan,Medicare Advantage,RT,58.80,,,,,,,43.68,162.96,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,SilverSummit Healthplan,Medicare Advantage,LT,401.80,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,SilverSummit Healthplan,Medicare Advantage,RT,401.80,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,outpatient,,,379.00000,122.42000,SilverSummit Healthplan,Medicare Advantage,,132.65,,,,,,,98.54,367.63,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,outpatient,,,1015.00000,327.84000,SilverSummit Healthplan,Medicare Advantage,,355.25,,,,,,,263.90,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,outpatient,,,591.00000,190.89000,SilverSummit Healthplan,Medicare Advantage,,206.85,,,,,,,153.66,573.27,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,outpatient,,,271.00000,169.92000,SilverSummit Healthplan,Medicare Advantage,,94.85,,,,,,,70.46,262.87,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,SilverSummit Healthplan,Medicare Advantage,LT,73.85,,,,,,,54.86,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,SilverSummit Healthplan,Medicare Advantage,RT,73.85,,,,,,,54.86,204.67,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,59.00000,36.99000,SilverSummit Healthplan,Medicare Advantage,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,outpatient,,,336.00000,219.74000,SilverSummit Healthplan,Medicare Advantage,,117.60,,,,,,,87.36,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,outpatient,,,224.00000,146.50000,SilverSummit Healthplan,Medicare Advantage,52,78.40,,,,,,,58.24,217.28,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,outpatient,,,63.00000,41.20000,SilverSummit Healthplan,Medicare Advantage,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,SilverSummit Healthplan,Medicare Advantage,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,SilverSummit Healthplan,Medicare Advantage,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,SilverSummit Healthplan,Medicare Advantage,,212.80,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,SilverSummit Healthplan,Medicare Advantage,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,SilverSummit Healthplan,Medicare Advantage,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,SilverSummit Healthplan,Medicare Advantage,,74.90,,,,,,,55.64,207.58,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,SilverSummit Healthplan,Medicare Advantage,,213.15,,,,,,,158.34,590.73,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,SilverSummit Healthplan,Medicare Advantage,,302.05,,,,,,,224.38,837.11,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,outpatient,,,900.00000,605.70000,SilverSummit Healthplan,Medicare Advantage,,315.00,,,,,,,234.00,873.00,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,outpatient,,,1940.00000,1102.21000,SilverSummit Healthplan,Medicare Advantage,,679.00,,,,,,,504.40,1881.80,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,outpatient,,,422.00000,239.76000,SilverSummit Healthplan,Medicare Advantage,,147.70,,,,,,,109.72,409.34,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,outpatient,,,1430.00000,812.45000,SilverSummit Healthplan,Medicare Advantage,,500.50,,,,,,,371.80,1387.10,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,outpatient,,,745.00000,423.27000,SilverSummit Healthplan,Medicare Advantage,,260.75,,,,,,,193.70,722.65,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,outpatient,,,2655.00000,2487.74000,SilverSummit Healthplan,Medicare Advantage,,929.25,,,,,,,690.30,2575.35,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,outpatient,,,3990.00000,3738.63000,SilverSummit Healthplan,Medicare Advantage,,1396.50,,,,,,,1037.40,3870.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,outpatient,,,290.00000,271.73000,SilverSummit Healthplan,Medicare Advantage,,101.50,,,,,,,75.40,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,outpatient,,,735.00000,688.70000,SilverSummit Healthplan,Medicare Advantage,,257.25,,,,,,,191.10,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,outpatient,,,1475.00000,1382.08000,SilverSummit Healthplan,Medicare Advantage,,516.25,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,outpatient,,,2275.00000,2131.68000,SilverSummit Healthplan,Medicare Advantage,,796.25,,,,,,,591.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,outpatient,,,3205.00000,3003.08000,SilverSummit Healthplan,Medicare Advantage,,1121.75,,,,,,,833.30,3108.85,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,outpatient,,,770.00000,721.49000,SilverSummit Healthplan,Medicare Advantage,,269.50,,,,,,,200.20,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,outpatient,,,1475.00000,1382.08000,SilverSummit Healthplan,Medicare Advantage,,516.25,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,outpatient,,,2210.00000,2070.77000,SilverSummit Healthplan,Medicare Advantage,,773.50,,,,,,,574.60,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,outpatient,,,2660.00000,2492.42000,SilverSummit Healthplan,Medicare Advantage,,931.00,,,,,,,691.60,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,outpatient,,,3560.00000,3335.72000,SilverSummit Healthplan,Medicare Advantage,,1246.00,,,,,,,925.60,3453.20,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,outpatient,,,5730.00000,3255.50000,SilverSummit Healthplan,Medicare Advantage,,2005.50,,,,,,,1489.80,5558.10,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,outpatient,,,3875.00000,2201.58000,SilverSummit Healthplan,Medicare Advantage,,1356.25,,,,,,,1007.50,3758.75,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,outpatient,,,519.00000,564.15000,SilverSummit Healthplan,Medicare Advantage,,181.65,,,,,,,134.94,503.43,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,outpatient,,,536.00000,582.63000,SilverSummit Healthplan,Medicare Advantage,,187.60,,,,,,,139.36,519.92,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,SilverSummit Healthplan,Medicare Advantage,,158.55,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,SilverSummit Healthplan,Medicare Advantage,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,SilverSummit Healthplan,Medicare Advantage,,37.45,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,SilverSummit Healthplan,Medicare Advantage,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,SilverSummit Healthplan,Medicare Advantage,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,SilverSummit Healthplan,Medicare Advantage,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,SilverSummit Healthplan,Medicare Advantage,,212.80,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,SilverSummit Healthplan,Medicare Advantage,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,SilverSummit Healthplan,Medicare Advantage,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,SilverSummit Healthplan,Medicare Advantage,,74.90,,,,,,,55.64,207.58,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,outpatient,,,175.00000,63.18000,SilverSummit Healthplan,Medicare Advantage,,61.25,,,,,,,45.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,outpatient,,,304.00000,109.74000,SilverSummit Healthplan,Medicare Advantage,,106.40,,,,,,,79.04,294.88,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,SilverSummit Healthplan,Medicare Advantage,,99.40,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,SilverSummit Healthplan,Medicare Advantage,,160.30,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,outpatient,,,438.00000,158.12000,SilverSummit Healthplan,Medicare Advantage,,153.30,,,,,,,113.88,424.86,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,SilverSummit Healthplan,Medicare Advantage,,195.30,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,SilverSummit Healthplan,Medicare Advantage,,168.70,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,SilverSummit Healthplan,Medicare Advantage,,82.95,,,,,,,61.62,229.89,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,SilverSummit Healthplan,Medicare Advantage,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,SilverSummit Healthplan,Medicare Advantage,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,SilverSummit Healthplan,Medicare Advantage,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,SilverSummit Healthplan,Medicare Advantage,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,SilverSummit Healthplan,Medicare Advantage,,294.70,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,SilverSummit Healthplan,Medicare Advantage,,368.55,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,SilverSummit Healthplan,Medicare Advantage,,442.05,,,,,,,328.38,1225.11,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,SilverSummit Healthplan,Medicare Advantage,,63.70,,,,,,,47.32,176.54,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,SilverSummit Healthplan,Medicare Advantage,,73.50,,,,,,,54.60,203.70,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,outpatient,,,140.00000,79.54000,SilverSummit Healthplan,Medicare Advantage,,49.00,,,,,,,36.40,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,outpatient,,,190.00000,107.95000,SilverSummit Healthplan,Medicare Advantage,,66.50,,,,,,,49.40,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,outpatient,,,240.00000,136.36000,SilverSummit Healthplan,Medicare Advantage,,84.00,,,,,,,62.40,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,outpatient,,,290.00000,164.76000,SilverSummit Healthplan,Medicare Advantage,,101.50,,,,,,,75.40,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,outpatient,,,340.00000,193.17000,SilverSummit Healthplan,Medicare Advantage,,119.00,,,,,,,88.40,329.80,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,outpatient,,,150.00000,85.22000,SilverSummit Healthplan,Medicare Advantage,,52.50,,,,,,,39.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,outpatient,,,200.00000,113.63000,SilverSummit Healthplan,Medicare Advantage,,70.00,,,,,,,52.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,outpatient,,,270.00000,153.40000,SilverSummit Healthplan,Medicare Advantage,,94.50,,,,,,,70.20,261.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,outpatient,,,370.00000,210.22000,SilverSummit Healthplan,Medicare Advantage,,129.50,,,,,,,96.20,358.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,outpatient,,,470.00000,267.03000,SilverSummit Healthplan,Medicare Advantage,,164.50,,,,,,,122.20,455.90,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,outpatient,,,248.00000,96.22000,SilverSummit Healthplan,Medicare Advantage,,86.80,,,,,,,64.48,240.56,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,outpatient,,,245.00000,95.06000,SilverSummit Healthplan,Medicare Advantage,,85.75,,,,,,,63.70,237.65,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,outpatient,,,497.00000,192.84000,SilverSummit Healthplan,Medicare Advantage,,173.95,,,,,,,129.22,482.09,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,outpatient,,,357.00000,138.52000,SilverSummit Healthplan,Medicare Advantage,,124.95,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,outpatient,,,334.00000,129.59000,SilverSummit Healthplan,Medicare Advantage,,116.90,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,outpatient,,,194.00000,75.27000,SilverSummit Healthplan,Medicare Advantage,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,outpatient,,,1035.00000,401.58000,SilverSummit Healthplan,Medicare Advantage,,362.25,,,,,,,269.10,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,outpatient,,,1137.00000,441.16000,SilverSummit Healthplan,Medicare Advantage,,397.95,,,,,,,295.62,1102.89,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,outpatient,,,963.00000,373.64000,SilverSummit Healthplan,Medicare Advantage,,337.05,,,,,,,250.38,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,outpatient,,,990.00000,384.12000,SilverSummit Healthplan,Medicare Advantage,,346.50,,,,,,,257.40,960.30,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,outpatient,,,112.00000,43.46000,SilverSummit Healthplan,Medicare Advantage,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,outpatient,,,84.00000,32.59000,SilverSummit Healthplan,Medicare Advantage,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,outpatient,,,176.00000,68.29000,SilverSummit Healthplan,Medicare Advantage,,61.60,,,,,,,45.76,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,outpatient,,,283.00000,109.80000,SilverSummit Healthplan,Medicare Advantage,,99.05,,,,,,,73.58,274.51,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,SilverSummit Healthplan,Medicare Advantage,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,SilverSummit Healthplan,Medicare Advantage,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,35.00000,19.89000,SilverSummit Healthplan,Medicare Advantage,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,outpatient,,,191.00000,89.39000,SilverSummit Healthplan,Medicare Advantage,,66.85,,,,,,,49.66,185.27,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,SilverSummit Healthplan,Medicare Advantage,,158.55,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,SilverSummit Healthplan,Medicare Advantage,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,SilverSummit Healthplan,Medicare Advantage,,37.45,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,SilverSummit Healthplan,Medicare Advantage,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,outpatient,,,281.00000,131.51000,SilverSummit Healthplan,Medicare Advantage,,98.35,,,,,,,73.06,272.57,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,outpatient,,,192.00000,89.86000,SilverSummit Healthplan,Medicare Advantage,,67.20,,,,,,,49.92,186.24,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,outpatient,,,365.00000,170.82000,SilverSummit Healthplan,Medicare Advantage,,127.75,,,,,,,94.90,354.05,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,outpatient,,,8391.00000,5856.92000,SilverSummit Healthplan,Medicare Advantage,,2936.85,,,,,,,2181.66,8139.27,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,SilverSummit Healthplan,Medicare Advantage,52,2420.95,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,SilverSummit Healthplan,Medicare Advantage,,2100.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,SilverSummit Healthplan,Medicare Advantage,,2420.95,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,SilverSummit Healthplan,Medicare Advantage,52,2100.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,outpatient,,,8855.00000,9625.38000,SilverSummit Healthplan,Medicare Advantage,,3099.25,,,,,,,2302.30,8589.35,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,SilverSummit Healthplan,Medicare Advantage,,295.40,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,SilverSummit Healthplan,Medicare Advantage,52,295.40,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,SilverSummit Healthplan,Medicare Advantage,,274.75,,,,,,,204.10,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,SilverSummit Healthplan,Medicare Advantage,52,274.75,,,,,,,204.10,761.45,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,SilverSummit Healthplan,Medicare Advantage,,1648.15,,,,,,,1224.34,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,SilverSummit Healthplan,Medicare Advantage,52,1648.15,,,,,,,1224.34,4567.73,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,outpatient,,,345.00000,128.34000,SilverSummit Healthplan,Medicare Advantage,,120.75,,,,,,,89.70,334.65,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,outpatient,,,120.00000,99.60000,SilverSummit Healthplan,Medicare Advantage,,42.00,,,,,,,31.20,116.40,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,outpatient,,,106.00000,87.98000,SilverSummit Healthplan,Medicare Advantage,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,outpatient,,,32.00000,26.56000,SilverSummit Healthplan,Medicare Advantage,,11.20,,,,,,,8.32,31.04,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,outpatient,,,60.00000,49.80000,SilverSummit Healthplan,Medicare Advantage,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,outpatient,,,57.00000,47.31000,SilverSummit Healthplan,Medicare Advantage,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,outpatient,1.0,ME,7.40000,0.65000,SilverSummit Healthplan,Medicare Advantage,,2.59,,,,,,,1.92,7.18,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,outpatient,1.0,EA,6.60000,1.43000,SilverSummit Healthplan,Medicare Advantage,UD,2.31,,,,,,,1.72,6.40,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,outpatient,1.0,EA,2.95000,0.64000,SilverSummit Healthplan,Medicare Advantage,UD,1.03,,,,,,,0.76700,2.86,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,56.08000,12.11000,SilverSummit Healthplan,Medicare Advantage,UD,19.63,,,,,,,14.58,54.40,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,outpatient,1.0,UN,82.10000,28.90000,SilverSummit Healthplan,Medicare Advantage,,28.73,,,,,,,15.48,79.64,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.04000,,SilverSummit Healthplan,Medicare Advantage,UD,0.01400,,,,,,,0.01040,0.03880,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.05000,,SilverSummit Healthplan,Medicare Advantage,UD,0.01750,,,,,,,0.01300,0.04850,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,outpatient,1.0,ME,6.20000,0.55000,SilverSummit Healthplan,Medicare Advantage,,2.17,,,,,,,1.61,6.01,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.12000,0.01000,SilverSummit Healthplan,Medicare Advantage,UD,0.04200,,,,,,,0.03120,0.11640,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,outpatient,2.0,ML,5.80000,1.25000,SilverSummit Healthplan,Medicare Advantage,,2.03,,,,,,,1.51,5.63,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,outpatient,1.0,ME,3.10000,0.27000,SilverSummit Healthplan,Medicare Advantage,,1.08,,,,,,,0.80600,3.01,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,outpatient,1.0,EA,44.40000,3.91000,SilverSummit Healthplan,Medicare Advantage,,15.54,,,,,,,11.54,43.07,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,8.26000,0.73000,SilverSummit Healthplan,Medicare Advantage,UD,2.89,,,,,,,2.15,8.01,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,2.19000,0.19000,SilverSummit Healthplan,Medicare Advantage,UD,0.76650,,,,,,,0.56940,2.12,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,outpatient,1.0,EA,28.60000,2.52000,SilverSummit Healthplan,Medicare Advantage,,10.01,,,,,,,7.44,27.74,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,outpatient,1.0,EA,2.58000,0.91000,SilverSummit Healthplan,Medicare Advantage,UD,0.90300,,,,,,,0.67080,2.50,percent of total billed charges,
R&B OBSTETRICS PVT,3012,CDM,112,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B MEDICAL/SURGICAL SEMI-PVT,23010,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B ICU,33019,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2935.00,,,,,,,2512.00,8498.17,per diem,
R&B ICU INTERMEDIATE,13011,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2935.00,,,,,,,2512.00,5665.77,per diem,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,244.00000,77.10000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,85.40,,,,,,,63.44,236.68,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,24075,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B OBSTETRICS SEMI-PVT,44073,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B NURSERY LEVEL 1,55160,CDM,171,RC,,,,,facility,inpatient,,,3477.00000,1975.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2935.00,,,,,,,2512.00,3372.69,per diem,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,outpatient,,,16.00000,7.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,73.50,,,,,,,54.60,203.70,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,outpatient,,,380.00000,215.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,133.00,,,,,,,98.80,368.60,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22012,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B ADMIN DAY SKILLED,82016,CDM,160,RC,,,,,facility,inpatient,,,1923.00000,1092.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2935.00,,,,,,,1730.70,3111.10,per diem,
R&B SWING BED SKILLED,62018,CDM,160,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B ADMIN DAY INTERMEDIATE,72017,CDM,169,RC,,,,,facility,inpatient,,,1176.00000,668.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2935.00,,,,,,,1058.40,3111.10,per diem,
R&B ICU,32011,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2935.00,,,,,,,2512.00,8498.17,per diem,
R&B ICU INTERMEDIATE,12013,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2935.00,,,,,,,2512.00,5665.77,per diem,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,212.80,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,74.90,,,,,,,55.64,207.58,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,99.40,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,160.30,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,195.30,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,168.70,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,82.95,,,,,,,61.62,229.89,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,outpatient,,,2041.00000,659.24000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,714.35,,,,,,,530.66,1979.77,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,outpatient,,,259.00000,83.66000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,90.65,,,,,,,67.34,251.23,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,outpatient,,,672.00000,217.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,235.20,,,,,,,174.72,651.84,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,outpatient,,,530.00000,171.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,185.50,,,,,,,137.80,514.10,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,outpatient,,,580.00000,187.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,203.00,,,,,,,150.80,562.60,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,outpatient,,,435.00000,140.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,152.25,,,,,,,113.10,421.95,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,302.05,,,,,,,224.38,837.11,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,outpatient,,,334.00000,107.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,116.90,,,,,,,86.84,323.98,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,outpatient,,,1188.00000,383.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,415.80,,,,,,,308.88,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,277.20,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,277.20,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,outpatient,,,572.00000,184.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,200.20,,,,,,,148.72,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,133.35,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,133.35,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,outpatient,,,455.00000,146.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,159.25,,,,,,,118.30,441.35,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,outpatient,,,403.00000,130.17000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,141.05,,,,,,,104.78,390.91,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,outpatient,,,370.00000,119.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,129.50,,,,,,,96.20,358.90,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,outpatient,,,357.00000,115.31000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,124.95,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,outpatient,,,334.00000,107.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,116.90,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,outpatient,,,194.00000,62.66000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,outpatient,,,457.00000,147.61000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,159.95,,,,,,,118.82,443.29,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,outpatient,,,492.00000,158.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,outpatient,,,780.00000,251.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,273.00,,,,,,,202.80,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,outpatient,,,1165.00000,376.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,407.75,,,,,,,302.90,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,outpatient,,,2350.00000,759.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,822.50,,,,,,,611.00,2279.50,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,outpatient,,,896.00000,289.41000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,313.60,,,,,,,232.96,869.12,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,outpatient,,,490.00000,158.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,outpatient,,,520.00000,167.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,182.00,,,,,,,135.20,504.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,outpatient,,,720.00000,232.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,252.00,,,,,,,187.20,698.40,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,outpatient,,,215.00000,69.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,75.25,,,,,,,55.90,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,outpatient,,,240.00000,77.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,84.00,,,,,,,62.40,232.80,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,outpatient,,,1241.00000,400.84000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,434.35,,,,,,,322.66,1203.77,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,294.70,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,368.55,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,442.05,,,,,,,328.38,1225.11,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,outpatient,,,668.00000,559.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,233.80,,,,,,,173.68,647.96,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,158.55,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.45,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1.19,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1.19,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1.19,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1.72,,,,,,,1.27,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,7.90000,4.49000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2.77,,,,,,,2.05,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1.72,,,,,,,1.27,4.75,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,81.00000,44.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,81.00000,44.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,81.00000,44.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,outpatient,,,3141500.00000,1784843.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1099525.00,,,,,,,816790.00,3047255.00,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.22000,0.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,UD,0.07700,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.52000,0.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,UD,0.18200,,,,,,,0.13520,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.56000,0.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,UD,0.19600,,,,,,,0.14560,0.54320,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,UD,0.07700,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.85000,0.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,UD,0.29750,,,,,,,0.22100,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,UD,0.07700,,,,,,,0.05720,0.21340,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,outpatient,,,102.00000,65.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,outpatient,,,190.00000,121.41000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,66.50,,,,,,,49.40,184.30,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,187.25,,,,,,,139.10,518.95,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,outpatient,,,766.00000,489.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,268.10,,,,,,,199.16,743.02,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,outpatient,,,159.00000,101.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,55.65,,,,,,,41.34,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,outpatient,,,447.00000,285.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,outpatient,,,1413.00000,902.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,outpatient,,,3853.00000,2462.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,outpatient,,,313.00000,200.01000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,outpatient,,,1132.00000,723.35000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,outpatient,,,2695.00000,1722.10000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,outpatient,,,1619.00000,1034.54000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,187.25,,,,,,,139.10,518.95,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,outpatient,,,850.00000,543.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,outpatient,,,32.00000,20.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,11.20,,,,,,,8.32,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,outpatient,,,134.00000,85.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,46.90,,,,,,,34.84,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,outpatient,,,709.00000,453.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,248.15,,,,,,,184.34,687.73,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,outpatient,,,4880.00000,2357.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,outpatient,,,6024.00000,2909.59000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2108.40,,,,,,,1566.24,5843.28,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,outpatient,,,7413.00000,3580.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2513.35,,,,,,,1867.06,6965.57,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,outpatient,,,10654.00000,5145.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3728.90,,,,,,,2770.04,10334.38,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,11575.00000,5590.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4051.25,,,,,,,3009.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,13432.00000,6487.66000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4701.20,,,,,,,3492.32,13029.04,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,21904.00000,10579.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,12969.00000,6264.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4539.15,,,,,,,3371.94,12579.93,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,989.45,,,,,,,735.02,2742.19,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,46.90,,,,,,,34.84,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,outpatient,,,251.00000,121.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,87.85,,,,,,,65.26,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,447.00000,215.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,989.45,,,,,,,735.02,2742.19,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,941.50,,,,,,,699.40,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,2426.00000,1171.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,15334.00000,7406.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,989.45,,,,,,,735.02,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,251.00000,121.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,87.85,,,,,,,65.26,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,989.45,,,,,,,735.02,2742.19,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,11.20,,,,,,,8.32,31.04,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,outpatient,,,1485.00000,717.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,519.75,,,,,,,386.10,1440.45,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,outpatient,,,2028.00000,979.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,709.80,,,,,,,527.28,1967.16,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,8107.00000,3915.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2837.45,,,,,,,2107.82,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,10422.00000,5033.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3647.70,,,,,,,2709.72,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,12737.00000,6151.97000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4457.95,,,,,,,3311.62,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,14239.00000,6877.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4983.65,,,,,,,3702.14,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,16429.00000,7935.21000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5750.15,,,,,,,4271.54,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,18619.00000,8992.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6516.65,,,,,,,4840.94,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,20809.00000,10050.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7283.15,,,,,,,5410.34,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,22999.00000,11108.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8049.65,,,,,,,5979.74,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,25189.00000,12166.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8816.15,,,,,,,6549.14,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,27379.00000,13224.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9582.65,,,,,,,7118.54,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,29569.00000,14281.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10349.15,,,,,,,7687.94,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,31759.00000,15339.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,11115.65,,,,,,,8257.34,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,36139.00000,17455.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12648.65,,,,,,,9396.14,35054.83,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1169.00,,,,,,,868.40,3239.80,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,11.20,,,,,,,8.32,31.04,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,46.90,,,,,,,34.84,129.98,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,66.50,,,,,,,49.40,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,outpatient,,,476.00000,229.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,166.60,,,,,,,123.76,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,11.20,,,,,,,8.32,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,outpatient,,,12506.00000,6040.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4377.10,,,,,,,3251.56,12130.82,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,outpatient,,,2404.80000,1161.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,841.68,,,,,,,625.25,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,outpatient,,,969.00000,468.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,339.15,,,,,,,251.94,939.93,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,outpatient,,,2256.90000,1090.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,789.91,,,,,,,586.79,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,outpatient,,,644.30000,311.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,225.50,,,,,,,167.52,624.97,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,66.50,,,,,,,49.40,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,outpatient,,,43804.00000,21157.33000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,outpatient,,,52564.00000,25388.41000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,outpatient,,,61324.00000,29619.49000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21463.40,,,,,,,15944.24,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,outpatient,,,70084.00000,33850.57000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24529.40,,,,,,,18221.84,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,outpatient,,,78844.00000,38081.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27595.40,,,,,,,20499.44,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,outpatient,,,87604.00000,42312.73000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,outpatient,,,96364.00000,46543.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,33727.40,,,,,,,25054.64,93473.08,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,outpatient,,,39424.00000,19041.79000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,66.50,,,,,,,49.40,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2023.00000,977.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,708.05,,,,,,,525.98,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2756.60,,,,,,,2047.76,7639.72,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,outpatient,,,10191.00000,4922.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3566.85,,,,,,,2649.66,9885.27,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,96.00000,46.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,33.60,,,,,,,24.96,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,7876.00000,3804.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2756.60,,,,,,,2047.76,7639.72,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,outpatient,,,5373.00000,2595.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,outpatient,,,6487.00000,3133.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2756.60,,,,,,,2047.76,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,outpatient,,,1126.00000,543.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,394.10,,,,,,,292.76,1092.22,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,941.50,,,,,,,699.40,2609.30,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,4880.00000,2357.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,9260.00000,4472.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3241.00,,,,,,,2407.60,8982.20,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,588.00000,284.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,205.80,,,,,,,152.88,570.36,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,989.45,,,,,,,735.02,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1169.00,,,,,,,868.40,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1169.00,,,,,,,868.40,3239.80,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,outpatient,,,159.00000,76.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,55.65,,,,,,,41.34,154.23,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,outpatient,,,588.00000,284.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,205.80,,,,,,,152.88,570.36,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,outpatient,,,8107.00000,3915.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2837.45,,,,,,,2107.82,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,outpatient,,,10422.00000,5033.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3647.70,,,,,,,2709.72,10109.34,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,outpatient,,,221.00000,106.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,77.35,,,,,,,57.46,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1169.00,,,,,,,868.40,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,outpatient,,,4153.00000,2005.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1453.55,,,,,,,1079.78,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,outpatient,,,5129.00000,2477.31000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1795.15,,,,,,,1333.54,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2513.35,,,,,,,1867.06,6965.57,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,outpatient,,,52.50000,25.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.38,,,,,,,13.65,50.92,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,outpatient,,,50.40000,24.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17.64,,,,,,,13.10,48.89,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,11.20,,,,,,,8.32,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,outpatient,,,709.00000,342.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,248.15,,,,,,,184.34,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,166.00000,80.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,131404.00000,74657.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45991.40,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,43800.00000,24884.97000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15330.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,24090.00000,13686.73000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8431.50,,,,,,,6263.40,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9965.90,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6132.00,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,6105.00000,3468.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,13895.00000,7894.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,21900.00000,12442.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7665.00,,,,,,,5694.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,35040.00000,19907.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12264.00,,,,,,,9110.40,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,22776.00000,12940.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7971.60,,,,,,,5921.76,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9965.90,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6132.00,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,30664.00000,17421.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,35044.00000,19910.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,594.00000,238.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,594.00000,238.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2695.00000,1080.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,3853.00000,1545.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,outpatient,,,1413.00000,566.61000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,594.00000,238.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,3229.80000,1857.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1130.43,,,,,,,839.75,3132.91,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,854.40000,491.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,299.04,,,,,,,222.14,828.77,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1200.50000,690.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,420.18,,,,,,,312.13,1164.48,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1011.00000,581.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,353.85,,,,,,,262.86,980.67,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1823.80000,1048.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,638.33,,,,,,,474.19,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2028.50000,1166.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,709.98,,,,,,,527.41,1967.64,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,841.00000,483.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,294.35,,,,,,,218.66,815.77,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1366.20000,785.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,478.17,,,,,,,355.21,1325.21,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1384.00000,795.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,484.40,,,,,,,359.84,1342.48,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2458.70000,1413.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,860.54,,,,,,,639.26,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2393.50000,1376.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,837.73,,,,,,,622.31,2321.70,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1369.50000,787.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,479.32,,,,,,,356.07,1328.41,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2697.40000,1551.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,944.09,,,,,,,701.32,2616.48,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4621.80000,2657.54000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1617.63,,,,,,,1201.67,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2592.50000,1490.69000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,907.38,,,,,,,674.05,2514.72,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2918.65,,,,,,,2168.14,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2837.45,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,488.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,394.10,,,,,,,292.76,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,outpatient,,,20152.00000,11587.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7053.20,,,,,,,5239.52,19547.44,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,166.00000,95.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,447.00000,257.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,709.00000,407.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,248.15,,,,,,,184.34,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,1272.00000,731.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,445.20,,,,,,,330.72,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,941.50,,,,,,,699.40,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,3078.00000,1769.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1077.30,,,,,,,800.28,2985.66,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,70.00000,40.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,102.00000,58.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,221.00000,127.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,77.35,,,,,,,57.46,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,248.15,,,,,,,184.34,687.73,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4377.10,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35482.00000,20402.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12418.70,,,,,,,9225.32,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39862.00000,22920.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13951.70,,,,,,,10364.12,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,44242.00000,25439.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15484.70,,,,,,,11502.92,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,48622.00000,27957.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17017.70,,,,,,,12641.72,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,53002.00000,30476.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18550.70,,,,,,,13780.52,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21463.40,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24529.40,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27595.40,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,33727.40,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,844.00000,485.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,295.40,,,,,,,219.44,818.68,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,11575.00000,6655.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4051.25,,,,,,,3009.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14892.00000,8562.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5212.20,,,,,,,3871.92,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,24970.00000,14357.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8739.50,,,,,,,6492.20,24220.90,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,313.00000,179.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,166.00000,95.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,447.00000,257.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,850.00000,488.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1169.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1453.55,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4641.00000,2668.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1624.35,,,,,,,1206.66,4501.77,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,313.00000,179.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,33727.40,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45991.40,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,153304.00000,88149.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,53656.40,,,,,,,39859.04,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,175204.00000,100742.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,61321.40,,,,,,,45553.04,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,197104.00000,113334.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,68986.40,,,,,,,51247.04,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,219004.00000,125927.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,76651.40,,,,,,,56941.04,212433.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,16864.40,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19930.40,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21463.40,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,16864.40,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19930.40,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21463.40,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24529.40,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27595.40,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,33727.40,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,42925.40,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,135784.00000,78075.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,47524.40,,,,,,,35303.84,131710.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,16864.40,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,55630.00000,31987.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19470.50,,,,,,,14463.80,53961.10,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,941.50,,,,,,,699.40,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4907.00,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,17962.00000,10328.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6286.70,,,,,,,4670.12,17423.14,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,2421.00000,1392.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,847.35,,,,,,,629.46,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,941.50,,,,,,,699.40,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,27160.00000,15617.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9506.00,,,,,,,7061.60,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,11498.90,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27595.40,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,28470.00000,16370.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9964.50,,,,,,,7402.20,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,43800.00000,25185.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15330.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,11498.90,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,54754.00000,31483.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19163.90,,,,,,,14236.04,53111.38,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,941.50,,,,,,,699.40,2609.30,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,61320.00000,35259.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21462.00,,,,,,,15943.20,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,70080.00000,40296.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24528.00,,,,,,,18220.80,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,78840.00000,45333.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27594.00,,,,,,,20498.40,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,33727.40,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,42925.40,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8432.90,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,11498.90,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,166.00000,95.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,313.00000,179.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1883.00000,1082.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,659.05,,,,,,,489.58,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,7644.00000,4395.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2675.40,,,,,,,1987.44,7414.68,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,941.50,,,,,,,699.40,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,313.00000,179.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,564.90,,,,,,,419.64,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,313.00000,179.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8432.90,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9965.90,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,11498.90,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,37234.00000,21409.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13031.90,,,,,,,9680.84,36116.98,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27595.40,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,159.00000,91.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,55.65,,,,,,,41.34,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,850.00000,488.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,989.45,,,,,,,735.02,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1169.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2837.45,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38326.40,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45991.40,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,18400.00000,10580.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6440.00,,,,,,,4784.00,17848.00,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8432.90,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9965.90,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,11498.90,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,564.90,,,,,,,419.64,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19930.40,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,5368.00000,3086.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1878.80,,,,,,,1395.68,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4907.00,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,25408.00000,14609.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8892.80,,,,,,,6606.08,24645.76,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,8112.00000,4664.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2839.20,,,,,,,2109.12,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,10431.00000,5997.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3650.85,,,,,,,2712.06,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,11498.90,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,46870.00000,26950.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,16404.50,,,,,,,12186.20,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,51250.00000,29468.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17937.50,,,,,,,13325.00,49712.50,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27595.40,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30661.40,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,166.00000,95.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,588.00000,338.10000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,205.80,,,,,,,152.88,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7876.00000,4528.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2756.60,,,,,,,2047.76,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8432.90,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5856.00000,3367.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2049.60,,,,,,,1522.56,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2918.65,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2108.40,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4377.10,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2108.40,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4377.10,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4392.00000,2525.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1537.20,,,,,,,1141.92,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,394.10,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2108.40,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4377.10,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4753.70,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2152.00000,1237.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,753.20,,,,,,,559.52,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2108.40,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2108.40,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,394.10,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2108.40,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4377.10,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4753.70,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8802.00000,5061.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3080.70,,,,,,,2288.52,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10654.00000,6126.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3728.90,,,,,,,2770.04,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4377.10,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4753.70,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17086.00000,9824.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5980.10,,,,,,,4442.36,16573.42,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2918.65,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1708.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1258.60,,,,,,,934.96,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2136.75,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8432.90,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,850.00000,488.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,660.80,,,,,,,490.88,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,849.10,,,,,,,630.76,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,989.45,,,,,,,735.02,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1169.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1453.55,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2918.65,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9728.00000,5593.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3404.80,,,,,,,2529.28,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11117.00000,6392.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3890.95,,,,,,,2890.42,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,16864.40,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19930.40,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21463.40,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24529.40,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26062.40,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27595.40,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,29128.40,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,111694.00000,64224.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39092.90,,,,,,,29040.44,108343.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,248.15,,,,,,,184.34,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,991.00000,569.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,346.85,,,,,,,257.66,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1490.00000,856.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,521.50,,,,,,,387.40,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2051.35,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2270.45,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2594.55,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2918.65,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,494.55,,,,,,,367.38,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1348.55,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,6945.00000,3993.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2430.75,,,,,,,1805.70,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,447.00000,257.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,850.00000,488.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,850.00000,488.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1368.15,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1880.55,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,166.00000,95.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,850.00000,488.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,396.20,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,50374.00000,28965.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17630.90,,,,,,,13097.24,48862.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6899.90,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8432.90,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9965.90,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,943.25,,,,,,,700.70,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2432.50,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4053.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5366.90,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,16864.40,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,850.00000,488.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,754.95,,,,,,,560.82,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1079.05,,,,,,,801.58,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,16864.40,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19930.40,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22996.40,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26062.40,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,29128.40,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,91984.00000,52890.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,32194.40,,,,,,,23915.84,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,100744.00000,57927.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35260.40,,,,,,,26193.44,97721.68,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,166.00000,95.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.10,,,,,,,43.16,161.02,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,447.00000,257.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,156.45,,,,,,,116.22,433.59,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,709.00000,407.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,248.15,,,,,,,184.34,687.73,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6133.40,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7666.40,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9199.40,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10732.40,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12265.40,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13798.40,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15331.40,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18397.40,,,,,,,13666.64,50987.08,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1709.75,,,,,,,1270.10,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3242.75,,,,,,,2408.90,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4863.25,,,,,,,3612.70,13478.15,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2180.20000,1253.61000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,763.07,,,,,,,566.85,2114.79,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1880.60000,1081.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,658.21,,,,,,,488.96,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2908.70000,1672.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1018.04,,,,,,,756.26,2821.44,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,outpatient,,,34.00000,25.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,11.90,,,,,,,8.84,32.98,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,outpatient,,,13.00000,9.84000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4.55,,,,,,,3.38,12.61,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,98.35,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,98.35,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,98.35,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,outpatient,,,122.00000,92.35000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,42.70,,,,,,,31.72,118.34,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5.25,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5.25,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5.95,,,,,,,4.42,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5.95,,,,,,,4.42,16.49,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,outpatient,,,359.00000,271.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,outpatient,,,359.00000,271.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,outpatient,,,359.00000,271.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,outpatient,,,155.00000,117.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,54.25,,,,,,,40.30,150.35,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,outpatient,,,294.00000,222.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,102.90,,,,,,,76.44,285.18,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,outpatient,,,1511.00000,1143.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,528.85,,,,,,,392.86,1465.67,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,outpatient,,,150.00000,113.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,52.50,,,,,,,39.00,145.50,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,outpatient,,,110.00000,83.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,outpatient,,,158.00000,119.61000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,55.30,,,,,,,41.08,153.26,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,outpatient,,,153.00000,115.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,outpatient,,,157.00000,118.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,54.95,,,,,,,40.82,152.29,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,outpatient,,,26.00000,19.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,outpatient,,,37.00000,28.01000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.95,,,,,,,9.62,35.89,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,outpatient,,,268.00000,202.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,93.80,,,,,,,69.68,259.96,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,outpatient,,,91.00000,68.89000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,31.85,,,,,,,23.66,88.27,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,outpatient,,,200.00000,151.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,70.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,outpatient,,,152.00000,115.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,53.20,,,,,,,39.52,147.44,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,outpatient,,,359.00000,271.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,outpatient,,,69.00000,33.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,outpatient,,,75.00000,36.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,outpatient,,,55.00000,26.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,outpatient,,,45.00000,21.69000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15.75,,,,,,,11.70,43.65,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,outpatient,,,68.00000,32.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,outpatient,,,61.00000,29.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,outpatient,,,64.00000,30.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,outpatient,,,195.00000,93.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,68.25,,,,,,,50.70,189.15,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,outpatient,,,60.00000,28.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,outpatient,,,63.00000,30.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,outpatient,,,14.00000,6.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4.90,,,,,,,3.64,13.58,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,outpatient,,,66.00000,31.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,outpatient,,,53.00000,25.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,outpatient,,,66.00000,31.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,outpatient,,,82.00000,39.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,49.35,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,49.35,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,outpatient,,,91.00000,43.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,31.85,,,,,,,23.66,88.27,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,outpatient,,,63.00000,30.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,outpatient,,,69.00000,33.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,outpatient,,,205.00000,98.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,71.75,,,,,,,53.30,198.85,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,outpatient,,,50.00000,24.10000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17.50,,,,,,,13.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,outpatient,,,406.00000,195.69000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,142.10,,,,,,,105.56,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,outpatient,,,101.00000,48.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.35,,,,,,,26.26,97.97,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,outpatient,,,375.00000,180.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,131.25,,,,,,,97.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,outpatient,,,362.00000,174.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,126.70,,,,,,,94.12,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,outpatient,,,325.00000,156.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,113.75,,,,,,,84.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,outpatient,,,121.00000,58.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,42.35,,,,,,,31.46,117.37,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,outpatient,,,115.00000,55.43000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,outpatient,,,300.00000,144.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,105.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,outpatient,,,51.00000,24.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,outpatient,,,194.00000,93.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,outpatient,,,57.00000,27.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,outpatient,,,68.00000,32.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,outpatient,,,329.00000,158.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,115.15,,,,,,,85.54,319.13,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,outpatient,,,24.00000,11.57000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8.40,,,,,,,6.24,23.28,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,outpatient,,,30.00000,14.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10.50,,,,,,,7.80,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,outpatient,,,63.00000,30.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,outpatient,,,53.00000,25.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,outpatient,,,270.00000,130.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,94.50,,,,,,,70.20,261.90,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,43.05,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,43.05,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,outpatient,,,37.00000,17.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.95,,,,,,,9.62,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,outpatient,,,57.00000,27.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,outpatient,,,57.00000,27.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,outpatient,,,63.00000,30.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,outpatient,,,41.00000,19.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,outpatient,,,72.00000,34.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,outpatient,,,77.00000,37.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,outpatient,,,90.00000,43.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,31.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,outpatient,,,44.00000,21.21000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15.40,,,,,,,11.44,42.68,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,outpatient,,,115.00000,55.43000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,outpatient,,,20.00000,9.64000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,outpatient,,,52.00000,25.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,outpatient,,,341.00000,164.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,119.35,,,,,,,88.66,330.77,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,outpatient,,,54.00000,26.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,outpatient,,,53.00000,25.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,outpatient,,,88.00000,42.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,outpatient,,,89.00000,42.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,outpatient,,,61.00000,29.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,outpatient,,,63.00000,30.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,outpatient,,,95.00000,45.79000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,33.25,,,,,,,24.70,92.15,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,outpatient,,,132.00000,63.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,46.20,,,,,,,34.32,128.04,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,outpatient,,,83.00000,40.01000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,29.05,,,,,,,21.58,80.51,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,outpatient,,,387.00000,186.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,135.45,,,,,,,100.62,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,outpatient,,,387.00000,186.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,135.45,,,,,,,100.62,375.39,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,outpatient,,,31.00000,14.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10.85,,,,,,,8.06,30.07,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,outpatient,,,36.00000,17.35000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,outpatient,,,160.00000,77.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,56.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,outpatient,,,112.00000,53.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,outpatient,,,14.00000,6.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4.90,,,,,,,3.64,13.58,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,outpatient,,,16.00000,7.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,outpatient,,,71.00000,34.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,outpatient,,,116.00000,55.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,outpatient,,,81.00000,39.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,outpatient,,,97.00000,46.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,33.95,,,,,,,25.22,94.09,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,outpatient,,,77.00000,37.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,outpatient,,,35.00000,16.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,outpatient,,,65.00000,31.33000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,outpatient,,,74.00000,35.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,outpatient,,,250.00000,120.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,87.50,,,,,,,65.00,242.50,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,outpatient,,,90.00000,43.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,31.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,outpatient,,,90.00000,43.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,31.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,outpatient,,,52.00000,25.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,outpatient,,,36.00000,17.35000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,outpatient,,,78.00000,37.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,outpatient,,,115.00000,55.43000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,outpatient,,,67.00000,32.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,outpatient,,,76.00000,36.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,outpatient,,,53.00000,25.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,outpatient,,,70.00000,33.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,outpatient,,,169.00000,81.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,59.15,,,,,,,43.94,163.93,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,outpatient,,,28.00000,13.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9.80,,,,,,,7.28,27.16,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,outpatient,,,51.00000,24.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,outpatient,,,15.00000,7.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5.25,,,,,,,3.90,14.55,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,outpatient,,,18.00000,8.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6.30,,,,,,,4.68,17.46,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,outpatient,,,55.00000,26.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,outpatient,,,55.00000,26.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,outpatient,,,61.00000,29.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,outpatient,,,550.00000,265.10000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,192.50,,,,,,,143.00,533.50,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,outpatient,,,392.00000,188.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,137.20,,,,,,,101.92,380.24,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,outpatient,,,75.00000,36.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,outpatient,,,100.00000,48.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,outpatient,,,153.00000,73.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,outpatient,,,909.00000,438.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,318.15,,,,,,,236.34,881.73,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,outpatient,,,266.00000,128.21000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,93.10,,,,,,,69.16,258.02,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,outpatient,,,275.00000,132.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,96.25,,,,,,,71.50,266.75,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,outpatient,,,61.00000,29.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,outpatient,,,84.00000,40.49000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,outpatient,,,174.00000,83.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,60.90,,,,,,,45.24,168.78,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,outpatient,,,62.00000,29.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,outpatient,,,67.00000,32.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,outpatient,,,68.00000,32.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,outpatient,,,63.00000,30.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,outpatient,,,211.00000,101.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,73.85,,,,,,,54.86,204.67,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,outpatient,,,65.00000,31.33000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,outpatient,,,83.00000,40.01000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,29.05,,,,,,,21.58,80.51,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,outpatient,,,54.00000,26.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,outpatient,,,55.00000,26.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,outpatient,,,323.00000,155.69000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,113.05,,,,,,,83.98,313.31,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,outpatient,,,63.00000,30.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,outpatient,,,35.00000,16.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,outpatient,,,20.00000,9.64000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,outpatient,,,55.00000,26.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,outpatient,,,34.00000,16.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,11.90,,,,,,,8.84,32.98,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,outpatient,,,29.00000,13.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10.15,,,,,,,7.54,28.13,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,outpatient,,,80.00000,38.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,outpatient,,,73.00000,35.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,outpatient,,,16.00000,7.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,outpatient,,,52.00000,25.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,outpatient,,,113.00000,54.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.55,,,,,,,29.38,109.61,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,outpatient,,,68.00000,32.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,outpatient,,,78.00000,37.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,outpatient,,,54.00000,26.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,outpatient,,,76.00000,36.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,outpatient,,,67.00000,32.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,outpatient,,,88.00000,42.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,outpatient,,,60.00000,28.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,outpatient,,,67.00000,32.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,outpatient,,,53.00000,25.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,outpatient,,,88.00000,42.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,outpatient,,,105.00000,50.61000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,36.75,,,,,,,27.30,101.85,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,outpatient,,,83.00000,40.01000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,29.05,,,,,,,21.58,80.51,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,outpatient,,,57.00000,27.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,outpatient,,,97.00000,46.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,33.95,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,outpatient,,,87.00000,41.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30.45,,,,,,,22.62,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,outpatient,,,68.00000,32.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,outpatient,,,52.00000,25.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,outpatient,,,51.00000,24.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,outpatient,,,97.00000,46.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,33.95,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,outpatient,,,176.00000,84.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,61.60,,,,,,,45.76,170.72,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,outpatient,,,57.00000,27.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,outpatient,,,158.00000,76.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,55.30,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,outpatient,,,67.00000,32.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,outpatient,,,67.00000,32.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,outpatient,,,84.00000,40.49000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,outpatient,,,189.00000,91.10000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,66.15,,,,,,,49.14,183.33,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,outpatient,,,109.00000,52.54000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.15,,,,,,,28.34,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,outpatient,,,129.00000,62.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,outpatient,,,84.00000,40.49000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,outpatient,,,67.00000,32.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,outpatient,,,67.00000,32.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,outpatient,,,149.00000,71.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,52.15,,,,,,,38.74,144.53,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,outpatient,,,130.00000,62.66000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45.50,,,,,,,33.80,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,outpatient,,,110.00000,53.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,outpatient,,,158.00000,76.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,55.30,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,outpatient,,,117.00000,56.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,40.95,,,,,,,30.42,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,outpatient,,,61.00000,29.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,outpatient,,,67.00000,32.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,outpatient,,,145.00000,69.89000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,50.75,,,,,,,37.70,140.65,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,outpatient,,,67.00000,32.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,outpatient,,,165.00000,79.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,57.75,,,,,,,42.90,160.05,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,outpatient,,,70.00000,33.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,outpatient,,,67.00000,32.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,outpatient,,,154.00000,74.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,outpatient,,,104.00000,50.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,outpatient,,,70.00000,33.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,outpatient,,,104.00000,50.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,outpatient,,,70.00000,33.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,outpatient,,,123.00000,59.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,43.05,,,,,,,31.98,119.31,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,outpatient,,,95.00000,45.79000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,33.25,,,,,,,24.70,92.15,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,outpatient,,,160.00000,77.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,56.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,outpatient,,,147.00000,70.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,51.45,,,,,,,38.22,142.59,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,outpatient,,,178.00000,85.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,62.30,,,,,,,46.28,172.66,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,outpatient,,,160.00000,77.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,56.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,outpatient,,,67.00000,32.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,outpatient,,,70.00000,33.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,outpatient,,,449.00000,216.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,157.15,,,,,,,116.74,435.53,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,outpatient,,,104.00000,50.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,64.75,,,,,,,48.10,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,64.75,,,,,,,48.10,179.45,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,outpatient,,,57.00000,27.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,outpatient,,,84.00000,40.49000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,outpatient,,,98.00000,47.24000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,outpatient,,,75.00000,36.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,outpatient,,,107.00000,51.57000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.45,,,,,,,27.82,103.79,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,outpatient,,,81.00000,39.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,outpatient,,,60.00000,28.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,outpatient,,,68.00000,32.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,outpatient,,,51.00000,24.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,outpatient,,,74.00000,35.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,outpatient,,,60.00000,28.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,outpatient,,,194.00000,93.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,outpatient,,,111.00000,53.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.85,,,,,,,28.86,107.67,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,outpatient,,,77.00000,37.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,82.95,,,,,,,61.62,229.89,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,outpatient,,,51.00000,24.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,outpatient,,,67.00000,32.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,outpatient,,,131.00000,63.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45.85,,,,,,,34.06,127.07,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,outpatient,,,15.00000,7.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5.25,,,,,,,3.90,14.55,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,outpatient,,,39.00000,18.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13.65,,,,,,,10.14,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,outpatient,,,12.00000,5.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4.20,,,,,,,3.12,11.64,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,outpatient,,,57.00000,27.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,71.05,,,,,,,52.78,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,71.05,,,,,,,52.78,196.91,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,outpatient,,,99.00000,47.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,34.65,,,,,,,25.74,96.03,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,outpatient,,,53.00000,25.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,outpatient,,,23.00000,11.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8.05,,,,,,,5.98,22.31,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,outpatient,,,46.00000,22.17000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,16.10,,,,,,,11.96,44.62,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,outpatient,,,67.00000,32.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,outpatient,,,57.00000,27.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,outpatient,,,288.00000,138.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,100.80,,,,,,,74.88,279.36,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,outpatient,,,106.00000,51.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,outpatient,,,30.00000,14.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10.50,,,,,,,7.80,29.10,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,outpatient,,,55.00000,26.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,outpatient,,,71.00000,34.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,outpatient,,,67.00000,32.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,outpatient,,,89.00000,42.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,outpatient,,,116.00000,55.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,outpatient,,,51.00000,24.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,outpatient,,,66.00000,31.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,outpatient,,,174.00000,83.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,60.90,,,,,,,45.24,168.78,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,outpatient,,,82.00000,39.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,outpatient,,,112.00000,53.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,outpatient,,,61.00000,29.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,outpatient,,,69.00000,33.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,outpatient,,,52.00000,25.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,outpatient,,,286.00000,137.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,100.10,,,,,,,74.36,277.42,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,outpatient,,,300.00000,144.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,105.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,outpatient,,,73.00000,35.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,outpatient,,,90.00000,43.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,31.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,outpatient,,,60.00000,28.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,outpatient,,,315.00000,151.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,110.25,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,outpatient,,,100.00000,48.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,outpatient,,,89.00000,42.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,outpatient,,,71.00000,34.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,outpatient,,,135.00000,65.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,47.25,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,outpatient,,,80.00000,38.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,outpatient,,,100.00000,48.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,outpatient,,,305.00000,147.01000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,106.75,,,,,,,79.30,295.85,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,outpatient,,,70.00000,33.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,outpatient,,,69.00000,33.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,outpatient,,,64.00000,30.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,outpatient,,,368.00000,177.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,128.80,,,,,,,95.68,356.96,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,outpatient,,,104.00000,50.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,outpatient,,,109.00000,52.54000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.15,,,,,,,28.34,105.73,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,outpatient,,,114.00000,54.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,outpatient,,,135.00000,65.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,47.25,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,outpatient,,,105.00000,50.61000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,36.75,,,,,,,27.30,101.85,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,outpatient,,,315.00000,151.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,110.25,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,outpatient,,,148.00000,71.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,51.80,,,,,,,38.48,143.56,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,outpatient,,,62.00000,29.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,outpatient,,,67.00000,32.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,outpatient,,,107.00000,51.57000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.45,,,,,,,27.82,103.79,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,outpatient,,,57.00000,27.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,outpatient,,,35.00000,16.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,outpatient,,,104.00000,50.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,outpatient,,,650.00000,313.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,227.50,,,,,,,169.00,630.50,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,outpatient,,,91.00000,43.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,31.85,,,,,,,23.66,88.27,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,outpatient,,,114.00000,54.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,outpatient,,,360.00000,173.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,126.00,,,,,,,93.60,349.20,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,outpatient,,,106.00000,51.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,outpatient,,,78.00000,37.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,outpatient,,,72.00000,34.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,outpatient,,,94.00000,45.31000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,32.90,,,,,,,24.44,91.18,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,outpatient,,,101.00000,48.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.35,,,,,,,26.26,97.97,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,outpatient,,,82.00000,39.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,outpatient,,,77.00000,37.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,outpatient,,,145.00000,69.89000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,50.75,,,,,,,37.70,140.65,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,outpatient,,,266.00000,128.21000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,93.10,,,,,,,69.16,258.02,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,outpatient,,,79.00000,38.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,outpatient,,,57.00000,27.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,outpatient,,,144.00000,69.41000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,outpatient,,,20.00000,9.64000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,outpatient,,,208.00000,100.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,72.80,,,,,,,54.08,201.76,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,outpatient,,,135.00000,65.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,47.25,,,,,,,35.10,130.95,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,outpatient,,,131.00000,63.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45.85,,,,,,,34.06,127.07,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,outpatient,,,69.00000,33.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,outpatient,,,55.00000,26.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,outpatient,,,25.00000,12.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,outpatient,,,61.00000,29.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,outpatient,,,80.00000,38.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,outpatient,,,82.00000,39.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,outpatient,,,35.00000,16.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,outpatient,,,88.00000,42.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,outpatient,,,98.00000,47.24000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,outpatient,,,204.00000,98.33000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,71.40,,,,,,,53.04,197.88,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,outpatient,,,61.00000,29.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,outpatient,,,19.00000,9.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6.65,,,,,,,4.94,18.43,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,outpatient,,,57.00000,27.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,outpatient,,,55.00000,26.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,outpatient,,,37.00000,17.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.95,,,,,,,9.62,35.89,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,outpatient,,,79.00000,38.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,outpatient,,,63.00000,30.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,outpatient,,,21.00000,10.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7.35,,,,,,,5.46,20.37,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,outpatient,,,52.00000,25.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,outpatient,,,57.00000,27.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,outpatient,,,60.00000,28.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,outpatient,,,32.00000,15.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,11.20,,,,,,,8.32,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,outpatient,,,94.00000,45.31000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,32.90,,,,,,,24.44,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,outpatient,,,103.00000,49.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,36.05,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,outpatient,,,64.00000,30.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,outpatient,,,102.00000,49.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,outpatient,,,103.00000,49.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,36.05,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,outpatient,,,139.00000,67.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,48.65,,,,,,,36.14,134.83,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,outpatient,,,52.00000,25.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7.35,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,outpatient,,,88.00000,42.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7.35,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,outpatient,,,52.00000,25.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,outpatient,,,80.00000,38.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,outpatient,,,49.00000,23.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17.15,,,,,,,12.74,47.53,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,outpatient,,,88.00000,42.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,outpatient,,,66.00000,31.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,outpatient,,,68.00000,32.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,outpatient,,,93.00000,44.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,32.55,,,,,,,24.18,90.21,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,outpatient,,,73.00000,35.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,outpatient,,,41.00000,19.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,outpatient,,,94.00000,45.31000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,32.90,,,,,,,24.44,91.18,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,outpatient,,,124.00000,59.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,outpatient,,,71.00000,34.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,outpatient,,,33.00000,15.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,11.55,,,,,,,8.58,32.01,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,outpatient,,,52.00000,25.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,outpatient,,,68.00000,32.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,outpatient,,,99.00000,47.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,34.65,,,,,,,25.74,96.03,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,outpatient,,,197.00000,94.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,outpatient,,,194.00000,93.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,outpatient,,,68.00000,32.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,outpatient,,,90.00000,43.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,31.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,outpatient,,,109.00000,52.54000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.15,,,,,,,28.34,105.73,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,outpatient,,,108.00000,52.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.80,,,,,,,28.08,104.76,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,outpatient,,,67.00000,32.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,outpatient,,,69.00000,33.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,outpatient,,,71.00000,34.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,outpatient,,,98.00000,47.24000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,outpatient,,,141.00000,67.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,49.35,,,,,,,36.66,136.77,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,outpatient,,,226.00000,108.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,79.10,,,,,,,58.76,219.22,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,outpatient,,,92.00000,44.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,32.20,,,,,,,23.92,89.24,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,outpatient,,,69.00000,33.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,outpatient,,,100.00000,48.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,outpatient,,,124.00000,59.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,outpatient,,,69.00000,33.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,outpatient,,,118.00000,56.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,41.30,,,,,,,30.68,114.46,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,outpatient,,,51.00000,24.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,outpatient,,,104.00000,50.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,outpatient,,,66.00000,31.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,outpatient,,,72.00000,34.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,outpatient,,,54.00000,26.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,outpatient,,,17.00000,8.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5.95,,,,,,,4.42,16.49,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,outpatient,,,63.00000,30.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,outpatient,,,36.00000,17.35000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,outpatient,,,52.00000,25.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,outpatient,,,18.00000,8.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6.30,,,,,,,4.68,17.46,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,outpatient,,,74.00000,35.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,outpatient,,,62.00000,29.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,outpatient,,,62.00000,29.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,outpatient,,,118.00000,56.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,41.30,,,,,,,30.68,114.46,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,outpatient,,,82.00000,39.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,outpatient,,,30.00000,14.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10.50,,,,,,,7.80,29.10,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,outpatient,,,55.00000,26.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,outpatient,,,70.00000,33.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,outpatient,,,54.00000,26.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,outpatient,,,63.00000,30.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,outpatient,,,51.00000,24.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,outpatient,,,141.00000,67.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,49.35,,,,,,,36.66,136.77,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,outpatient,,,63.00000,30.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,outpatient,,,81.00000,39.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,outpatient,,,335.00000,161.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,117.25,,,,,,,87.10,324.95,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,outpatient,,,52.00000,25.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,outpatient,,,57.00000,27.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,outpatient,,,53.00000,25.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,outpatient,,,63.00000,30.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,outpatient,,,53.00000,25.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,outpatient,,,12.00000,5.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4.20,,,,,,,3.12,11.64,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,outpatient,,,710.00000,342.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,248.50,,,,,,,184.60,688.70,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,outpatient,,,104.00000,50.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,outpatient,,,155.00000,74.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,54.25,,,,,,,40.30,150.35,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,outpatient,,,139.00000,67.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,48.65,,,,,,,36.14,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,outpatient,,,89.00000,42.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,outpatient,,,88.00000,42.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,outpatient,,,111.00000,53.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.85,,,,,,,28.86,107.67,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,outpatient,,,70.00000,33.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,outpatient,,,85.00000,40.97000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,29.75,,,,,,,22.10,82.45,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,outpatient,,,60.00000,28.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,outpatient,,,110.00000,53.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,outpatient,,,500.00000,241.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,175.00,,,,,,,130.00,485.00,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,outpatient,,,140.00000,67.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,49.00,,,,,,,36.40,135.80,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,outpatient,,,66.00000,31.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,outpatient,,,74.00000,35.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,outpatient,,,77.00000,37.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,outpatient,,,93.00000,44.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,32.55,,,,,,,24.18,90.21,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,outpatient,,,57.00000,27.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,outpatient,,,15.00000,7.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5.25,,,,,,,3.90,14.55,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,outpatient,,,24.00000,11.57000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8.40,,,,,,,6.24,23.28,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,outpatient,,,72.00000,34.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,outpatient,,,64.00000,30.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,outpatient,,,82.00000,39.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,outpatient,,,157.00000,75.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,54.95,,,,,,,40.82,152.29,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,outpatient,,,70.00000,33.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,outpatient,,,229.00000,110.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,80.15,,,,,,,59.54,222.13,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,outpatient,,,64.00000,30.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,outpatient,,,72.00000,34.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,outpatient,,,17.00000,8.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5.95,,,,,,,4.42,16.49,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,outpatient,,,57.00000,27.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,outpatient,,,64.00000,30.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,outpatient,,,387.00000,186.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,135.45,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,135.45,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,135.45,,,,,,,100.62,375.39,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,outpatient,,,77.00000,37.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,outpatient,,,43.00000,20.73000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15.05,,,,,,,11.18,41.71,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,outpatient,,,64.00000,30.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,outpatient,,,160.00000,77.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,56.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,outpatient,,,112.00000,53.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,outpatient,,,82.00000,39.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.70,,,,,,,21.32,79.54,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,outpatient,,,57.00000,27.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,outpatient,,,55.00000,26.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,outpatient,,,54.00000,26.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,outpatient,,,153.00000,73.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,outpatient,,,45.00000,21.69000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15.75,,,,,,,11.70,43.65,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,outpatient,,,28.00000,13.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9.80,,,,,,,7.28,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,outpatient,,,66.00000,31.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17.15,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17.15,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17.15,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,outpatient,,,62.00000,29.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,outpatient,,,36.00000,17.35000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,outpatient,,,38.00000,18.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13.30,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,outpatient,,,38.00000,18.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13.30,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,outpatient,,,76.00000,36.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,outpatient,,,173.00000,83.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,60.55,,,,,,,44.98,167.81,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,outpatient,,,22.00000,10.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7.70,,,,,,,5.72,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,outpatient,,,62.00000,29.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,outpatient,,,39.00000,18.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13.65,,,,,,,10.14,37.83,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,outpatient,,,41.00000,19.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,outpatient,,,57.00000,27.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,outpatient,,,54.00000,26.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,outpatient,,,71.00000,34.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15.05,,,,,,,11.18,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15.05,,,,,,,11.18,41.71,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,outpatient,,,38.00000,18.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13.30,,,,,,,9.88,36.86,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,outpatient,,,72.00000,34.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,outpatient,,,226.00000,108.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,79.10,,,,,,,58.76,219.22,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,outpatient,,,160.00000,77.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,56.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,outpatient,,,102.00000,49.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,outpatient,,,317.00000,152.79000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,110.95,,,,,,,82.42,307.49,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,outpatient,,,62.00000,29.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,outpatient,,,66.00000,31.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,outpatient,,,116.00000,55.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,outpatient,,,85.00000,40.97000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,29.75,,,,,,,22.10,82.45,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,outpatient,,,184.00000,88.69000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,64.40,,,,,,,47.84,178.48,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,outpatient,,,127.00000,61.21000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,44.45,,,,,,,33.02,123.19,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,outpatient,,,61.00000,29.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,outpatient,,,35.00000,16.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,outpatient,,,79.00000,38.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,outpatient,,,61.00000,35.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,outpatient,,,65.00000,37.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,outpatient,,,57.00000,32.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,outpatient,,,62.00000,35.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,outpatient,,,77.00000,44.35000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,outpatient,,,70.00000,40.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,outpatient,,,67.00000,38.59000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,outpatient,,,40.00000,23.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,14.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,outpatient,,,71.00000,40.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,outpatient,,,80.00000,46.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,outpatient,,,72.00000,41.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,outpatient,,,444.00000,255.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,155.40,,,,,,,115.44,430.68,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,outpatient,,,81.00000,46.66000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,outpatient,,,62.00000,35.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,outpatient,,,66.00000,38.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,outpatient,,,57.00000,32.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,outpatient,,,53.00000,30.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,outpatient,,,60.00000,34.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,outpatient,,,61.00000,35.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,outpatient,,,40.00000,23.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,14.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,outpatient,,,63.00000,36.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,outpatient,,,42.00000,24.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,14.70,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,outpatient,,,62.00000,35.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,outpatient,,,46.00000,26.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,16.10,,,,,,,11.96,44.62,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,outpatient,,,54.00000,31.10000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,outpatient,,,62.00000,35.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,outpatient,,,71.00000,40.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,outpatient,,,54.00000,31.10000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,outpatient,,,80.00000,46.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,outpatient,,,60.00000,34.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,outpatient,,,130.00000,74.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45.50,,,,,,,33.80,126.10,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,43.05,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,outpatient,,,77.00000,44.35000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,outpatient,,,65.00000,37.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,outpatient,,,115.00000,66.24000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,43.05,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,outpatient,,,161.00000,92.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,56.35,,,,,,,41.86,156.17,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,outpatient,,,65.00000,37.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,outpatient,,,65.00000,37.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,outpatient,,,65.00000,37.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,outpatient,,,65.00000,37.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,outpatient,,,102.00000,58.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,outpatient,,,219.00000,126.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,76.65,,,,,,,56.94,212.43,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,outpatient,,,103.00000,59.33000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,36.05,,,,,,,26.78,99.91,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,outpatient,,,60.00000,34.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,outpatient,,,837.00000,482.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,292.95,,,,,,,217.62,811.89,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,outpatient,,,78.00000,44.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,outpatient,,,285.00000,164.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,99.75,,,,,,,74.10,276.45,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,outpatient,,,190.00000,109.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,66.50,,,,,,,49.40,184.30,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,outpatient,,,100.00000,57.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,14.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,outpatient,,,67.00000,38.59000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.45,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,outpatient,,,62.00000,35.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,outpatient,,,78.00000,44.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,outpatient,,,65.00000,37.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,outpatient,,,57.00000,32.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,outpatient,,,72.00000,41.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,outpatient,,,59.00000,33.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,outpatient,,,72.00000,41.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,outpatient,,,239.00000,137.66000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,83.65,,,,,,,62.14,231.83,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,outpatient,,,85.00000,48.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,29.75,,,,,,,22.10,82.45,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,outpatient,,,44.00000,25.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15.40,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,outpatient,,,40.00000,23.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,14.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,outpatient,,,53.00000,30.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,outpatient,,,63.00000,36.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,outpatient,,,68.00000,39.17000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,outpatient,,,76.00000,43.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,outpatient,,,42.00000,24.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,14.70,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,outpatient,,,87.00000,50.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30.45,,,,,,,22.62,84.39,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,outpatient,,,503.00000,289.73000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,176.05,,,,,,,130.78,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,outpatient,,,472.00000,271.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,165.20,,,,,,,122.72,457.84,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,outpatient,,,28.00000,16.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9.80,,,,,,,7.28,27.16,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,outpatient,,,236.00000,135.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,82.60,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,outpatient,,,54.00000,31.10000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,outpatient,,,238.00000,137.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,83.30,,,,,,,61.88,230.86,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,outpatient,,,236.00000,135.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,82.60,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,outpatient,,,145.00000,83.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,50.75,,,,,,,37.70,140.65,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,outpatient,,,66.00000,38.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,outpatient,,,59.00000,33.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,outpatient,,,158.00000,91.01000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,55.30,,,,,,,41.08,153.26,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,outpatient,,,71.00000,40.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,outpatient,,,144.00000,82.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,outpatient,,,1448.00000,834.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,506.80,,,,,,,376.48,1404.56,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,outpatient,,,72.00000,41.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,outpatient,,,102.00000,58.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,outpatient,,,154.00000,88.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,outpatient,,,61.00000,35.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,outpatient,,,66.00000,38.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,outpatient,,,44.00000,25.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15.40,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,outpatient,,,63.00000,36.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,outpatient,,,150.00000,86.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,52.50,,,,,,,39.00,145.50,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,outpatient,,,61.00000,35.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,outpatient,,,56.00000,32.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,outpatient,,,62.00000,35.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,outpatient,,,66.00000,38.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,outpatient,,,60.00000,34.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,outpatient,,,58.00000,33.41000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,outpatient,,,71.00000,40.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,outpatient,,,72.00000,41.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,outpatient,,,60.00000,34.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,outpatient,,,56.00000,32.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,outpatient,,,39.00000,22.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13.65,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,outpatient,,,73.00000,42.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,44.45,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,44.45,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,outpatient,,,372.00000,214.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,130.20,,,,,,,96.72,360.84,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,outpatient,,,69.00000,39.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,53.55,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,outpatient,,,63.00000,36.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,outpatient,,,57.00000,32.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,outpatient,,,96.00000,55.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,33.60,,,,,,,24.96,93.12,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,outpatient,,,44.00000,25.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15.40,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,outpatient,,,60.00000,34.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,outpatient,,,63.00000,36.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,outpatient,,,60.00000,34.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,outpatient,,,63.00000,36.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,outpatient,,,74.00000,42.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,outpatient,,,69.00000,39.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13.65,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,outpatient,,,53.00000,30.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13.65,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,13.65,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,outpatient,,,70.00000,40.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,outpatient,,,71.00000,40.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,outpatient,,,65.00000,37.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,outpatient,,,325.00000,187.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,113.75,,,,,,,84.50,315.25,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,outpatient,,,72.00000,41.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,outpatient,,,72.00000,41.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.20,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,outpatient,,,76.00000,43.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,outpatient,,,240.00000,138.24000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,84.00,,,,,,,62.40,232.80,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,outpatient,,,93.00000,53.57000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,32.55,,,,,,,24.18,90.21,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,outpatient,,,59.00000,33.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,outpatient,,,81.00000,46.66000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,outpatient,,,58.00000,33.41000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,outpatient,,,21.00000,12.10000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7.35,,,,,,,5.46,20.37,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,outpatient,,,56.00000,32.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,outpatient,,,64.00000,36.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,outpatient,,,80.00000,46.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,outpatient,,,109.00000,62.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.15,,,,,,,28.34,105.73,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,outpatient,,,59.00000,33.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,outpatient,,,115.00000,66.24000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,outpatient,,,57.00000,32.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,outpatient,,,118.00000,67.97000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,41.30,,,,,,,30.68,114.46,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,outpatient,,,268.00000,154.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,93.80,,,,,,,69.68,259.96,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,outpatient,,,78.00000,44.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,outpatient,,,91.00000,52.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,31.85,,,,,,,23.66,88.27,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,outpatient,,,300.00000,172.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,105.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,outpatient,,,185.00000,106.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,64.75,,,,,,,48.10,179.45,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,outpatient,,,76.00000,43.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,outpatient,,,53.00000,30.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,outpatient,,,77.00000,44.35000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,outpatient,,,222.00000,127.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,77.70,,,,,,,57.72,215.34,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,outpatient,,,292.00000,168.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,102.20,,,,,,,75.92,283.24,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,outpatient,,,61.00000,35.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,43.75,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,43.75,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,outpatient,,,359.00000,206.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,outpatient,,,111.00000,63.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.85,,,,,,,28.86,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,49.35,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,49.35,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,outpatient,,,78.00000,44.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,outpatient,,,70.00000,40.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,outpatient,,,18.00000,10.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6.30,,,,,,,4.68,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,outpatient,,,408.00000,235.01000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,142.80,,,,,,,106.08,395.76,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,outpatient,,,102.00000,58.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,outpatient,,,330.00000,190.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,115.50,,,,,,,85.80,320.10,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,outpatient,,,56.00000,32.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,outpatient,,,136.00000,78.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,47.60,,,,,,,35.36,131.92,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,outpatient,,,83.00000,47.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,29.05,,,,,,,21.58,80.51,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,outpatient,,,63.00000,36.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,outpatient,,,142.00000,81.79000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,49.70,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,outpatient,,,51.00000,29.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,outpatient,,,70.00000,40.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.50,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,outpatient,,,99.00000,57.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,34.65,,,,,,,25.74,96.03,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,outpatient,,,78.00000,44.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,outpatient,,,63.00000,36.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,outpatient,,,63.00000,36.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,outpatient,,,75.00000,43.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.95,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.95,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,outpatient,,,59.00000,33.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,outpatient,,,35.00000,20.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,outpatient,,,59.00000,33.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,outpatient,,,56.00000,32.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,outpatient,,,74.00000,42.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,outpatient,,,90.00000,51.84000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,31.50,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,outpatient,,,142.00000,81.79000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,49.70,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,outpatient,,,74.00000,42.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,outpatient,,,57.00000,32.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,outpatient,,,77.00000,44.35000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,outpatient,,,64.00000,36.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,outpatient,,,69.00000,39.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,outpatient,,,1178.00000,678.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,412.30,,,,,,,306.28,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,outpatient,,,127.00000,73.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,44.45,,,,,,,33.02,123.19,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,outpatient,,,277.00000,159.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,96.95,,,,,,,72.02,268.69,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,outpatient,,,940.00000,541.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,329.00,,,,,,,244.40,911.80,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,outpatient,,,97.00000,55.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,33.95,,,,,,,25.22,94.09,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,outpatient,,,16.00000,9.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,outpatient,,,57.00000,32.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,outpatient,,,131.00000,75.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45.85,,,,,,,34.06,127.07,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,outpatient,,,2160.00000,1244.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,756.00,,,,,,,561.60,2095.20,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,outpatient,,,37.00000,21.31000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.95,,,,,,,9.62,35.89,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,outpatient,,,54.00000,31.10000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,outpatient,,,76.00000,43.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,outpatient,,,606.00000,349.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,212.10,,,,,,,157.56,587.82,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,outpatient,,,62.00000,35.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,outpatient,,,300.00000,172.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,105.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,outpatient,,,59.00000,33.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,outpatient,,,98.00000,56.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,outpatient,,,61.00000,35.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,outpatient,,,128.00000,73.73000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,44.80,,,,,,,33.28,124.16,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,outpatient,,,16.00000,9.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,outpatient,,,565.00000,325.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,197.75,,,,,,,146.90,548.05,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,outpatient,,,850.00000,489.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,outpatient,,,77.00000,44.35000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.95,,,,,,,20.02,74.69,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,outpatient,,,86.00000,49.54000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30.10,,,,,,,22.36,83.42,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,outpatient,,,837.00000,482.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,292.95,,,,,,,217.62,811.89,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,outpatient,,,60.00000,34.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,outpatient,,,56.00000,32.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,outpatient,,,56.00000,32.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,outpatient,,,167.00000,96.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.45,,,,,,,43.42,161.99,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,outpatient,,,200.00000,115.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,70.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,outpatient,,,93.00000,53.57000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,32.55,,,,,,,24.18,90.21,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.25,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,outpatient,,,190.00000,109.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,66.50,,,,,,,49.40,184.30,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,outpatient,,,64.00000,36.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,outpatient,,,525.00000,302.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,outpatient,,,54.00000,31.10000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,outpatient,,,53.00000,30.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,14.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,outpatient,,,453.00000,260.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,158.55,,,,,,,117.78,439.41,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,outpatient,,,25.00000,14.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,outpatient,,,56.00000,32.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,outpatient,,,59.00000,33.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,outpatient,,,53.00000,30.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,outpatient,,,62.00000,35.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,outpatient,,,350.00000,201.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,122.50,,,,,,,91.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,outpatient,,,225.00000,129.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,78.75,,,,,,,58.50,218.25,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,outpatient,,,52.00000,29.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,outpatient,,,62.00000,35.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,outpatient,,,134.00000,77.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,46.90,,,,,,,34.84,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,outpatient,,,52.00000,29.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,outpatient,,,186.00000,107.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,65.10,,,,,,,48.36,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,105.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,105.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,outpatient,,,62.00000,35.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,outpatient,,,205.00000,118.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,71.75,,,,,,,53.30,198.85,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,outpatient,,,75.00000,36.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,outpatient,,,65.00000,31.33000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,outpatient,,,92.00000,44.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,32.20,,,,,,,23.92,89.24,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8.40,,,,,,,6.24,23.28,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,outpatient,,,20.00000,9.64000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,outpatient,,,63.00000,30.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,outpatient,,,42.00000,20.24000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,14.70,,,,,,,10.92,40.74,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,outpatient,,,69.00000,33.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,outpatient,,,65.00000,31.33000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,outpatient,,,76.00000,36.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,outpatient,,,89.00000,42.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,outpatient,,,76.00000,36.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,outpatient,,,28.00000,13.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9.80,,,,,,,7.28,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,outpatient,,,98.00000,47.24000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,outpatient,,,64.00000,30.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,outpatient,,,75.00000,36.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,outpatient,,,76.00000,36.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,outpatient,,,66.00000,31.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,outpatient,,,114.00000,54.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,outpatient,,,74.00000,35.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,outpatient,,,69.00000,33.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,outpatient,,,74.00000,35.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.90,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,outpatient,,,87.00000,41.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30.45,,,,,,,22.62,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,outpatient,,,79.00000,38.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,outpatient,,,75.00000,36.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,outpatient,,,66.00000,31.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,outpatient,,,60.00000,28.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,outpatient,,,64.00000,30.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,outpatient,,,164.00000,79.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,57.40,,,,,,,42.64,159.08,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,outpatient,,,54.00000,26.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,outpatient,,,8.00000,3.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2.80,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,outpatient,,,69.00000,33.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,outpatient,,,8.00000,3.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2.80,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,outpatient,,,60.00000,28.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,outpatient,,,8.00000,3.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2.80,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,outpatient,,,14.00000,6.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4.90,,,,,,,3.64,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,outpatient,,,62.00000,29.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,outpatient,,,63.00000,30.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,outpatient,,,112.00000,53.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,outpatient,,,13.00000,6.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4.55,,,,,,,3.38,12.61,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,outpatient,,,57.00000,27.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,outpatient,,,31.00000,14.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10.85,,,,,,,8.06,30.07,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,outpatient,,,92.00000,44.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,32.20,,,,,,,23.92,89.24,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,outpatient,,,80.00000,38.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10.50,,,,,,,7.80,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10.50,,,,,,,7.80,29.10,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,outpatient,,,57.00000,27.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8.40,,,,,,,6.24,23.28,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,outpatient,,,59.00000,28.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,outpatient,,,29.00000,13.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10.15,,,,,,,7.54,28.13,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,outpatient,,,97.00000,46.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,33.95,,,,,,,25.22,94.09,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,outpatient,,,225.00000,108.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,78.75,,,,,,,58.50,218.25,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,outpatient,,,57.00000,27.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,outpatient,,,71.00000,34.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,outpatient,,,57.00000,27.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,outpatient,,,71.00000,34.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,outpatient,,,108.00000,52.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.80,,,,,,,28.08,104.76,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,outpatient,,,66.00000,31.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,outpatient,,,51.00000,24.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,outpatient,,,63.00000,30.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,outpatient,,,58.00000,27.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,outpatient,,,19.00000,9.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6.65,,,,,,,4.94,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,outpatient,,,54.00000,26.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.90,,,,,,,14.04,52.38,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,outpatient,,,103.00000,49.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,36.05,,,,,,,26.78,99.91,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,outpatient,,,9.00000,4.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3.15,,,,,,,2.34,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,outpatient,,,13.00000,6.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4.55,,,,,,,3.38,12.61,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,outpatient,,,80.00000,38.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,outpatient,,,47.00000,22.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,16.45,,,,,,,12.22,45.59,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,outpatient,,,91.00000,43.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,31.85,,,,,,,23.66,88.27,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,outpatient,,,56.00000,26.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,outpatient,,,18.00000,8.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6.30,,,,,,,4.68,17.46,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,outpatient,,,60.00000,28.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,outpatient,,,57.00000,27.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7.35,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,outpatient,,,71.00000,37.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7.35,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,outpatient,,,128.00000,67.97000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,44.80,,,,,,,33.28,124.16,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,outpatient,,,65.00000,34.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,outpatient,,,31.00000,16.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10.85,,,,,,,8.06,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,outpatient,,,61.00000,32.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,91,8.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,outpatient,,,103.00000,54.69000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,36.05,,,,,,,26.78,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,outpatient,,,96.00000,50.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,33.60,,,,,,,24.96,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,outpatient,,,75.00000,39.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,outpatient,,,68.00000,36.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,outpatient,,,61.00000,32.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,outpatient,,,29.00000,15.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10.15,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10.15,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10.15,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,outpatient,,,63.00000,33.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,outpatient,,,79.00000,41.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,outpatient,,,63.00000,33.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10.15,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,outpatient,,,112.00000,59.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,outpatient,,,25.00000,13.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,outpatient,,,118.00000,62.66000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,41.30,,,,,,,30.68,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,outpatient,,,29.00000,15.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10.15,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,outpatient,,,25.00000,13.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,outpatient,,,25.00000,13.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8.75,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,outpatient,,,71.00000,37.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,outpatient,,,59.00000,31.33000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,outpatient,,,62.00000,32.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,outpatient,,,138.00000,73.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,48.30,,,,,,,35.88,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,outpatient,,,62.00000,32.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,outpatient,,,78.00000,41.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,outpatient,,,69.00000,36.64000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.15,,,,,,,17.94,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,outpatient,,,88.00000,46.73000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30.80,,,,,,,22.88,85.36,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,outpatient,,,60.00000,31.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,outpatient,,,64.00000,33.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,outpatient,,,63.00000,33.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,outpatient,,,137.00000,72.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,47.95,,,,,,,35.62,132.89,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,outpatient,,,347.00000,184.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,121.45,,,,,,,90.22,336.59,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,outpatient,,,57.00000,30.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,outpatient,,,56.00000,29.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,outpatient,,,16.00000,8.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5.60,,,,,,,4.16,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,outpatient,,,85.00000,45.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,29.75,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,outpatient,,,34.00000,18.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,11.90,,,,,,,8.84,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,outpatient,,,231.00000,122.66000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,80.85,,,,,,,60.06,224.07,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,outpatient,,,36.00000,19.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,outpatient,,,61.00000,32.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,outpatient,,,111.00000,58.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.85,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,outpatient,,,61.00000,32.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.35,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,outpatient,,,60.00000,31.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,outpatient,,,60.00000,31.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,outpatient,,,60.00000,31.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,outpatient,,,60.00000,31.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,outpatient,,,60.00000,31.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,outpatient,,,36.00000,19.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,outpatient,,,76.00000,40.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.60,,,,,,,19.76,73.72,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,outpatient,,,60.00000,31.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,outpatient,,,60.00000,31.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,outpatient,,,152.00000,80.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,53.20,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,outpatient,,,78.00000,41.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.30,,,,,,,20.28,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,outpatient,,,42.00000,22.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,14.70,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,outpatient,,,73.00000,38.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,25.55,,,,,,,18.98,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,outpatient,,,97.00000,51.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,33.95,,,,,,,25.22,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,outpatient,,,157.00000,83.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,54.95,,,,,,,40.82,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,outpatient,,,36.00000,19.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,outpatient,,,66.00000,35.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,outpatient,,,58.00000,30.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,outpatient,,,85.00000,45.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,29.75,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,outpatient,,,59.00000,31.33000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,outpatient,,,175.00000,92.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,61.25,,,,,,,45.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,outpatient,,,152.00000,80.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,53.20,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,outpatient,,,43.00000,22.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15.05,,,,,,,11.18,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,outpatient,,,66.00000,35.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,outpatient,,,36.00000,19.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,outpatient,,,36.00000,19.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.60,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,outpatient,,,42.00000,22.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,14.70,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,outpatient,,,147.00000,78.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,51.45,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,outpatient,,,64.00000,33.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,outpatient,,,60.00000,31.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,outpatient,,,75.00000,39.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,outpatient,,,44.00000,23.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15.40,,,,,,,11.44,42.68,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,outpatient,,,87.00000,46.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,30.45,,,,,,,22.62,84.39,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,outpatient,,,65.00000,34.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,outpatient,,,75.00000,39.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,26.25,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,outpatient,,,50.00000,26.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17.50,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,outpatient,,,40.00000,21.24000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,14.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,outpatient,,,50.00000,26.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17.50,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,outpatient,,,115.00000,61.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1309.00000,695.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,458.15,,,,,,,340.34,1269.73,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,outpatient,,,328.00000,174.17000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,114.80,,,,,,,85.28,318.16,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,outpatient,,,115.00000,61.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,outpatient,,,1251.00000,664.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,437.85,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,outpatient,,,96.00000,50.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,33.60,,,,,,,24.96,93.12,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,outpatient,,,211.00000,112.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,73.85,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,outpatient,,,290.00000,153.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,101.50,,,,,,,75.40,281.30,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,outpatient,,,411.00000,218.24000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,143.85,,,,,,,106.86,398.67,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,outpatient,,,139.00000,73.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,48.65,,,,,,,36.14,134.83,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,outpatient,,,288.00000,152.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,100.80,,,,,,,74.88,279.36,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1372.00000,728.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,480.20,,,,,,,356.72,1330.84,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,outpatient,,,1251.00000,664.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,437.85,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,outpatient,,,135.00000,71.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,47.25,,,,,,,35.10,130.95,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,outpatient,,,129.00000,68.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,outpatient,,,129.00000,68.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,outpatient,,,147.00000,78.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,51.45,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,outpatient,,,126.00000,66.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,44.10,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,outpatient,,,120.00000,63.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,42.00,,,,,,,31.20,116.40,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,outpatient,,,124.00000,65.84000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,43.40,,,,,,,32.24,120.28,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,outpatient,,,108.00000,57.35000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.80,,,,,,,28.08,104.76,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,89.60,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,89.60,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,outpatient,,,122.00000,64.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,42.70,,,,,,,31.72,118.34,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,outpatient,,,129.00000,68.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,outpatient,,,123.00000,65.31000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,43.05,,,,,,,31.98,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,outpatient,,,518.00000,275.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,181.30,,,,,,,134.68,502.46,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,outpatient,,,275.00000,146.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,96.25,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,outpatient,,,270.00000,143.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,94.50,,,,,,,70.20,261.90,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,outpatient,,,450.00000,238.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,157.50,,,,,,,117.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,outpatient,,,126.00000,66.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,44.10,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,outpatient,,,362.00000,192.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,126.70,,,,,,,94.12,351.14,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.15,,,,,,,28.34,105.73,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,outpatient,,,638.00000,338.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,223.30,,,,,,,165.88,618.86,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,outpatient,,,211.00000,112.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,73.85,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,outpatient,,,154.00000,81.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,outpatient,,,141.00000,74.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,49.35,,,,,,,36.66,136.77,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,outpatient,,,2040.00000,1083.24000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,714.00,,,,,,,530.40,1978.80,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,outpatient,,,421.00000,223.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,147.35,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,outpatient,,,275.00000,146.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,96.25,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,outpatient,,,1251.00000,664.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,437.85,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,149.80,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,149.80,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,229.25,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,229.25,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,outpatient,,,211.00000,112.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,73.85,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,outpatient,,,130.00000,69.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45.50,,,,,,,33.80,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,outpatient,,,421.00000,223.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,147.35,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,outpatient,,,111.00000,58.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.85,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,outpatient,,,200.00000,106.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,70.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45.15,,,,,,,33.54,125.13,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,outpatient,,,13.00000,6.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4.55,,,,,,,3.38,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,outpatient,,,58.00000,30.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,outpatient,,,13.00000,6.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4.55,,,,,,,3.38,12.61,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,outpatient,,,773.00000,410.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,270.55,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,outpatient,,,773.00000,410.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,270.55,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,outpatient,,,773.00000,410.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,270.55,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,outpatient,,,773.00000,410.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,270.55,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,outpatient,,,387.00000,205.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,135.45,,,,,,,100.62,375.39,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,outpatient,,,52.00000,27.61000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.20,,,,,,,13.52,50.44,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.70,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,outpatient,,,79.00000,41.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,outpatient,,,65.00000,34.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,outpatient,,,100.00000,53.10000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,outpatient,,,64.00000,33.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,outpatient,,,106.00000,56.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.15,,,,,,,28.34,105.73,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,outpatient,,,58.00000,30.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,outpatient,,,66.00000,35.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,outpatient,,,13.00000,6.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,4.55,,,,,,,3.38,12.61,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,outpatient,,,53.00000,28.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,outpatient,,,18.00000,9.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,6.30,,,,,,,4.68,17.46,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,outpatient,,,17.00000,9.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5.95,,,,,,,4.42,16.49,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,outpatient,,,71.00000,37.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,24.85,,,,,,,18.46,68.87,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,outpatient,,,57.00000,30.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,outpatient,,,68.00000,36.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.80,,,,,,,17.68,65.96,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,outpatient,,,58.00000,30.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,outpatient,,,27.00000,14.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9.45,,,,,,,7.02,26.19,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,outpatient,,,56.00000,29.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,outpatient,,,56.00000,29.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.60,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,outpatient,,,58.00000,30.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,outpatient,,,115.00000,61.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,40.25,,,,,,,29.90,111.55,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,outpatient,,,23.00000,12.21000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8.05,,,,,,,5.98,22.31,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,outpatient,,,255.00000,135.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,89.25,,,,,,,66.30,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,outpatient,,,66.00000,35.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,outpatient,,,26.00000,13.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,outpatient,,,64.00000,33.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.40,,,,,,,16.64,62.08,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,outpatient,,,215.00000,114.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,75.25,,,,,,,55.90,208.55,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,outpatient,,,79.00000,41.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,outpatient,,,11.00000,5.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3.85,,,,,,,2.86,10.67,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,outpatient,,,58.00000,27.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.30,,,,,,,15.08,56.26,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,outpatient,,,10.00000,4.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3.50,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,outpatient,,,7.00000,3.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2.45,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,outpatient,,,53.00000,25.49000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,18.55,,,,,,,13.78,51.41,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,outpatient,,,10.00000,4.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3.50,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3.85,,,,,,,2.86,10.67,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,outpatient,,,7.00000,3.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2.45,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3.85,,,,,,,2.86,10.67,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,outpatient,,,597.00000,290.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,208.95,,,,,,,155.22,579.09,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,outpatient,,,6379.00000,3100.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2232.65,,,,,,,1658.54,6187.63,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,outpatient,,,471.00000,228.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,164.85,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,outpatient,,,471.00000,228.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,164.85,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,outpatient,,,1251.00000,607.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,437.85,,,,,,,325.26,1213.47,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,outpatient,,,260.00000,126.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,91.00,,,,,,,67.60,252.20,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,outpatient,,,785.00000,381.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,274.75,,,,,,,204.10,761.45,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,outpatient,,,529.00000,257.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,185.15,,,,,,,137.54,513.13,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,outpatient,,,1623.00000,788.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,568.05,,,,,,,421.98,1574.31,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,outpatient,,,10800.00000,5248.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3780.00,,,,,,,2808.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,outpatient,,,25365.00000,12327.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8877.75,,,,,,,6594.90,24604.05,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,outpatient,,,101.00000,21.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.35,,,,,,,26.26,97.97,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,outpatient,,,81.00000,17.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,outpatient,,,104.00000,22.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,36.40,,,,,,,27.04,100.88,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,outpatient,,,377.00000,81.43000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,131.95,,,,,,,98.02,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,outpatient,,,532.00000,114.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,186.20,,,,,,,138.32,516.04,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,outpatient,,,521.00000,112.54000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,182.35,,,,,,,135.46,505.37,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,outpatient,,,451.00000,97.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,157.85,,,,,,,117.26,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,outpatient,,,1148.00000,247.97000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,401.80,,,,,,,298.48,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,outpatient,,,350.00000,75.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,122.50,,,,,,,91.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,outpatient,,,423.00000,91.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,148.05,,,,,,,109.98,410.31,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,outpatient,,,119.00000,25.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,41.65,,,,,,,30.94,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,outpatient,,,126.00000,27.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,44.10,,,,,,,32.76,122.22,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,outpatient,,,79.00000,17.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,outpatient,,,79.00000,17.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,outpatient,,,335.00000,72.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,117.25,,,,,,,87.10,324.95,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,53.90,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,outpatient,,,128.00000,27.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,44.80,,,,,,,33.28,124.16,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,outpatient,,,65.00000,14.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.75,,,,,,,16.90,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,outpatient,,,272.00000,58.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,95.20,,,,,,,70.72,263.84,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,outpatient,,,26.00000,11.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9.10,,,,,,,6.76,25.22,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,outpatient,,,359.00000,157.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,outpatient,,,189.00000,83.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,66.15,,,,,,,49.14,183.33,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,outpatient,,,359.00000,157.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,outpatient,,,137.00000,60.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,47.95,,,,,,,35.62,132.89,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,outpatient,,,1665.00000,732.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,582.75,,,,,,,432.90,1615.05,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,outpatient,,,751.00000,330.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,outpatient,,,374.00000,164.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,130.90,,,,,,,97.24,362.78,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,outpatient,,,553.00000,243.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,193.55,,,,,,,143.78,536.41,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,outpatient,,,359.00000,157.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,outpatient,,,62.00000,27.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.70,,,,,,,16.12,60.14,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,outpatient,,,79.00000,34.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,outpatient,,,110.00000,48.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,outpatient,,,110.00000,48.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,outpatient,,,751.00000,330.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,262.85,,,,,,,195.26,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,outpatient,,,1665.00000,732.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,582.75,,,,,,,432.90,1615.05,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,outpatient,,,110.00000,48.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,98.35,,,,,,,73.06,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,98.35,,,,,,,73.06,272.57,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,outpatient,,,451.00000,341.41000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,157.85,,,,,,,117.26,437.47,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,outpatient,,,300.00000,145.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,105.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,outpatient,,,2278.00000,1107.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,797.30,,,,,,,592.28,2209.66,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,outpatient,,,3912.00000,1901.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1369.20,,,,,,,1017.12,3794.64,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,outpatient,,,900.00000,437.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,315.00,,,,,,,234.00,873.00,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,outpatient,,,365.00000,177.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,127.75,,,,,,,94.90,354.05,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,outpatient,,,989.00000,480.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,346.15,,,,,,,257.14,959.33,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,152.25,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,152.25,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,outpatient,,,644.00000,312.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,225.40,,,,,,,167.44,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,outpatient,,,527.00000,256.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,184.45,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,outpatient,,,1404.00000,682.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,491.40,,,,,,,365.04,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,outpatient,,,5475.00000,2660.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1916.25,,,,,,,1423.50,5310.75,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,outpatient,,,726.00000,352.84000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,254.10,,,,,,,188.76,704.22,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,outpatient,,,507.00000,246.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,177.45,,,,,,,131.82,491.79,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,outpatient,,,1670.00000,811.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,584.50,,,,,,,434.20,1619.90,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,outpatient,,,1139.00000,553.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,398.65,,,,,,,296.14,1104.83,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,outpatient,,,875.00000,425.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,306.25,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,outpatient,,,525.00000,255.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,outpatient,,,1353.00000,657.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,473.55,,,,,,,351.78,1312.41,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,outpatient,,,525.00000,255.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,outpatient,,,525.00000,255.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,outpatient,,,825.00000,400.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,288.75,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,outpatient,,,974.00000,473.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,340.90,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,69.30,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,69.30,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,77.35,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,77.35,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,outpatient,,,497.00000,241.54000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,173.95,,,,,,,129.22,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,outpatient,,,2340.00000,1137.24000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,819.00,,,,,,,608.40,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,outpatient,,,249.00000,121.01000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,87.15,,,,,,,64.74,241.53,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,outpatient,,,135.00000,65.61000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,47.25,,,,,,,35.10,130.95,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,outpatient,,,172.00000,83.59000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,60.20,,,,,,,44.72,166.84,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,outpatient,,,307.00000,149.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,107.45,,,,,,,79.82,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,outpatient,,,1800.00000,874.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,630.00,,,,,,,468.00,1746.00,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,outpatient,,,974.00000,473.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,340.90,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,outpatient,,,411.00000,199.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,143.85,,,,,,,106.86,398.67,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,outpatient,,,221.00000,107.41000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,77.35,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,outpatient,,,884.00000,429.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,309.40,,,,,,,229.84,857.48,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,outpatient,,,594.00000,288.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.90,,,,,,,154.44,576.18,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,outpatient,,,519.00000,252.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,181.65,,,,,,,134.94,503.43,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,outpatient,,,1046.00000,508.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,366.10,,,,,,,271.96,1014.62,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,outpatient,,,556.00000,270.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,194.60,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,outpatient,,,275.00000,133.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,96.25,,,,,,,71.50,266.75,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,outpatient,,,580.00000,281.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,203.00,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,outpatient,,,580.00000,281.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,203.00,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1218.00,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1218.00,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,outpatient,,,700.00000,340.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,245.00,,,,,,,182.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,outpatient,,,1427.00000,693.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,499.45,,,,,,,371.02,1384.19,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,outpatient,,,614.00000,298.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,214.90,,,,,,,159.64,595.58,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,outpatient,,,2027.00000,985.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,709.45,,,,,,,527.02,1966.19,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,outpatient,,,556.00000,270.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,194.60,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,outpatient,,,1146.00000,556.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,401.10,,,,,,,297.96,1111.62,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,outpatient,,,527.00000,256.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,184.45,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,outpatient,,,740.00000,359.64000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,259.00,,,,,,,192.40,717.80,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,306.25,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,306.25,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,outpatient,,,1399.00000,679.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,489.65,,,,,,,363.74,1357.03,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,outpatient,,,51.00000,24.79000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,17.85,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,outpatient,,,825.00000,400.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,288.75,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,outpatient,,,576.00000,279.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,201.60,,,,,,,149.76,558.72,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,outpatient,,,224.00000,108.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,78.40,,,,,,,58.24,217.28,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,outpatient,,,346.00000,168.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,121.10,,,,,,,89.96,335.62,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,outpatient,,,525.00000,255.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,outpatient,,,525.00000,255.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,outpatient,,,627.00000,304.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,219.45,,,,,,,163.02,608.19,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,outpatient,,,605.00000,294.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,211.75,,,,,,,157.30,586.85,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,outpatient,,,510.00000,247.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,178.50,,,,,,,132.60,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,outpatient,,,223.00000,108.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,78.05,,,,,,,57.98,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,outpatient,,,1211.00000,588.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,423.85,,,,,,,314.86,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,outpatient,,,383.00000,186.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,134.05,,,,,,,99.58,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,outpatient,,,1214.00000,590.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,424.90,,,,,,,315.64,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,outpatient,,,328.00000,159.41000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,114.80,,,,,,,85.28,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,outpatient,,,372.00000,180.79000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,130.20,,,,,,,96.72,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,outpatient,,,285.00000,138.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,99.75,,,,,,,74.10,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,outpatient,,,367.00000,178.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,128.45,,,,,,,95.42,355.99,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,245.70,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,245.70,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,outpatient,,,265.00000,128.79000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,92.75,,,,,,,68.90,257.05,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2279.00000,1107.59000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,797.65,,,,,,,592.54,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2395.00000,1163.97000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,838.25,,,,,,,622.70,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3065.65,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3065.65,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,outpatient,,,2752.00000,1337.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,963.20,,,,,,,715.52,2669.44,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,75.95,,,,,,,56.42,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,75.95,,,,,,,56.42,210.49,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,outpatient,,,292.00000,141.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,102.20,,,,,,,75.92,283.24,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,143.85,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,143.85,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,143.85,,,,,,,106.86,398.67,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,outpatient,,,2275.00000,1105.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,796.25,,,,,,,591.50,2206.75,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,outpatient,,,192.00000,93.31000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,67.20,,,,,,,49.92,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,outpatient,,,451.00000,219.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,157.85,,,,,,,117.26,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,outpatient,,,617.00000,299.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,215.95,,,,,,,160.42,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,outpatient,,,825.00000,400.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,288.75,,,,,,,214.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,outpatient,,,905.00000,439.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,316.75,,,,,,,235.30,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,outpatient,,,849.00000,412.61000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.15,,,,,,,220.74,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,outpatient,,,2539.00000,1233.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,888.65,,,,,,,660.14,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,outpatient,,,6000.00000,2916.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2100.00,,,,,,,1560.00,5820.00,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,outpatient,,,8260.00000,4014.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2891.00,,,,,,,2147.60,8012.20,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,outpatient,,,202.00000,88.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,70.70,,,,,,,52.52,195.94,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,outpatient,,,66.00000,31.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,23.10,,,,,,,17.16,64.02,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,outpatient,,,295.00000,142.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,103.25,,,,,,,76.70,286.15,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,89.00000,26.79000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,31.15,,,,,,,23.14,86.33,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,outpatient,,,93.00000,27.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,32.55,,,,,,,24.18,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,93.00000,27.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,32.55,,,,,,,24.18,90.21,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,656.25,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,656.25,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,613.20,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,613.20,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,731.00000,220.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,255.85,,,,,,,190.06,709.07,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,787.00000,236.89000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,275.45,,,,,,,204.62,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,2042.00000,614.64000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,714.70,,,,,,,530.92,1980.74,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,656.25,,,,,,,487.50,1818.75,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,714.00000,214.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,249.90,,,,,,,185.64,692.58,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,294.00000,88.49000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,102.90,,,,,,,76.44,285.18,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,350.00000,105.35000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,122.50,,,,,,,91.00,339.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,outpatient,,,1350.00000,780.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,472.50,,,,,,,351.00,1309.50,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,outpatient,,,3680.00000,2127.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1288.00,,,,,,,956.80,3569.60,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,outpatient,,,1600.00000,924.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,560.00,,,,,,,416.00,1552.00,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,outpatient,,,4680.00000,2705.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1638.00,,,,,,,1216.80,4539.60,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,outpatient,,,2100.00000,1213.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,735.00,,,,,,,546.00,2037.00,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,outpatient,,,5680.00000,3283.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1988.00,,,,,,,1476.80,5509.60,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,outpatient,,,2420.00000,1398.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,847.00,,,,,,,629.20,2347.40,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,outpatient,,,6415.00000,3707.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2245.25,,,,,,,1667.90,6222.55,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,outpatient,,,2920.00000,1687.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1022.00,,,,,,,759.20,2832.40,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,outpatient,,,8915.00000,5152.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3120.25,,,,,,,2317.90,8647.55,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,outpatient,,,3420.00000,1976.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1197.00,,,,,,,889.20,3317.40,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,outpatient,,,11415.00000,6597.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3995.25,,,,,,,2967.90,11072.55,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,outpatient,,,142.00000,154.35000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,49.70,,,,,,,36.92,137.74,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,119.00,,,,,,,88.40,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,234.50,,,,,,,174.20,649.90,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,outpatient,,,390.00000,262.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,136.50,,,,,,,101.40,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,outpatient,,,1170.00000,787.41000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,409.50,,,,,,,304.20,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,outpatient,,,440.00000,296.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,154.00,,,,,,,114.40,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,outpatient,,,1670.00000,1123.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,584.50,,,,,,,434.20,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,outpatient,,,640.00000,430.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,224.00,,,,,,,166.40,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,outpatient,,,2170.00000,1460.41000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,759.50,,,,,,,564.20,2104.90,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,outpatient,,,17.00000,10.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,5.95,,,,,,,4.42,16.49,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,outpatient,,,535.00000,345.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,187.25,,,,,,,139.10,518.95,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,outpatient,,,23.00000,14.84000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8.05,,,,,,,5.98,22.31,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,outpatient,,,635.00000,409.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,222.25,,,,,,,165.10,615.95,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,outpatient,,,30.00000,19.35000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10.50,,,,,,,7.80,29.10,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,outpatient,,,735.00000,474.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,257.25,,,,,,,191.10,712.95,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,outpatient,,,33.00000,21.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,11.55,,,,,,,8.58,32.01,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,outpatient,,,835.00000,538.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,292.25,,,,,,,217.10,809.95,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,outpatient,,,140.00000,80.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,49.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,outpatient,,,275.00000,158.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,96.25,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,outpatient,,,295.00000,170.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,103.25,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,outpatient,,,590.00000,341.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,206.50,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,outpatient,,,690.00000,398.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,241.50,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,outpatient,,,1375.00000,794.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,481.25,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,outpatient,,,950.00000,549.10000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,332.50,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,outpatient,,,1900.00000,1098.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,665.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,outpatient,,,140.00000,45.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,49.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,outpatient,,,275.00000,88.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,96.25,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,outpatient,,,295.00000,95.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,103.25,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,outpatient,,,590.00000,190.57000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,206.50,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,outpatient,,,690.00000,222.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,241.50,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,outpatient,,,1375.00000,444.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,481.25,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,outpatient,,,950.00000,306.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,332.50,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,outpatient,,,1900.00000,613.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,665.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,119.00,,,,,,,88.40,329.80,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,234.50,,,,,,,174.20,649.90,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,85.75,,,,,,,63.70,237.65,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,294.70,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,368.55,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,442.05,,,,,,,328.38,1225.11,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1178.00000,669.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,412.30,,,,,,,306.28,1142.66,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,outpatient,,,140.00000,102.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,49.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,outpatient,,,275.00000,201.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,96.25,,,,,,,71.50,266.75,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,outpatient,,,295.00000,215.64000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,103.25,,,,,,,76.70,286.15,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,outpatient,,,590.00000,431.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,206.50,,,,,,,153.40,572.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,outpatient,,,690.00000,504.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,241.50,,,,,,,179.40,669.30,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,outpatient,,,1375.00000,1005.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,481.25,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,outpatient,,,950.00000,694.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,332.50,,,,,,,247.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,outpatient,,,1900.00000,1388.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,665.00,,,,,,,494.00,1843.00,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,outpatient,,,584.00000,426.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,204.40,,,,,,,151.84,566.48,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,outpatient,,,1391.00000,1016.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,486.85,,,,,,,361.66,1349.27,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,outpatient,,,359.00000,271.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,125.65,,,,,,,93.34,348.23,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,outpatient,,,95.00000,71.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,33.25,,,,,,,24.70,92.15,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,outpatient,,,37.00000,17.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.95,,,,,,,9.62,35.89,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,27.65,,,,,,,20.54,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,82.95,,,,,,,61.62,229.89,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,outpatient,,,33.00000,15.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,11.55,,,,,,,8.58,32.01,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,outpatient,,,25.00000,12.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,8.75,,,,,,,6.50,24.25,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,outpatient,,,497.00000,160.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,173.95,,,,,,,129.22,482.09,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,308.70,,,,,,,229.32,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,308.70,,,,,,,229.32,855.54,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,33.60,,,,,,,24.96,93.12,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,308.70,,,,,,,229.32,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,308.70,,,,,,,229.32,855.54,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,outpatient,,,763.00000,291.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,267.05,,,,,,,198.38,740.11,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,outpatient,,,199.00000,76.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,69.65,,,,,,,51.74,193.03,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,33.60,,,,,,,24.96,93.12,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,outpatient,,,1265.00000,483.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,442.75,,,,,,,328.90,1227.05,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,outpatient,,,924.00000,352.97000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,323.40,,,,,,,240.24,896.28,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,outpatient,,,580.00000,215.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,203.00,,,,,,,150.80,562.60,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,outpatient,,,110.00000,40.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,outpatient,,,373.00000,138.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,130.55,,,,,,,96.98,361.81,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,outpatient,,,337.00000,125.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,117.95,,,,,,,87.62,326.89,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,outpatient,,,784.00000,291.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,274.40,,,,,,,203.84,760.48,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,outpatient,,,341.00000,126.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,119.35,,,,,,,88.66,330.77,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,outpatient,,,252.00000,93.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,88.20,,,,,,,65.52,244.44,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,outpatient,,,282.00000,104.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,98.70,,,,,,,73.32,273.54,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,outpatient,,,404.00000,150.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,141.40,,,,,,,105.04,391.88,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,outpatient,,,306.00000,173.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,107.10,,,,,,,79.56,296.82,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,outpatient,,,158.00000,89.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,55.30,,,,,,,41.08,153.26,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,51.45,,,,,,,38.22,142.59,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,94.50,,,,,,,70.20,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,29.40,,,,,,,21.84,81.48,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,30.10,,,,,,,22.36,83.42,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,28.70,,,,,,,21.32,79.54,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,29.75,,,,,,,22.10,82.45,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,15.05,,,,,,,11.18,41.71,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,14.35,,,,,,,10.66,39.77,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,27.65,,,,,,,20.54,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,25.90,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,25.90,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,11.90,,,,,,,8.84,32.98,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,22.75,,,,,,,16.90,63.05,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,outpatient,,,113.00000,68.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.55,,,,,,,29.38,109.61,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,28.00,,,,,,,20.80,77.60,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,29.40,,,,,,,21.84,81.48,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,25.55,,,,,,,18.98,70.81,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,outpatient,,,100.00000,60.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,outpatient,,,167.00000,101.54000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,58.45,,,,,,,43.42,161.99,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"50,GP",144.55,,,,,,,107.38,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"LT,GP",96.25,,,,,,,71.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"RT,GP",96.25,,,,,,,71.50,266.75,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,33.25,,,,,,,24.70,92.15,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,51.10,,,,,,,37.96,141.62,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,48.65,,,,,,,36.14,134.83,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,26.25,,,,,,,19.50,72.75,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,53.90,,,,,,,40.04,149.38,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,25.55,,,,,,,18.98,70.81,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,56.00,,,,,,,41.60,155.20,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,113.75,,,,,,,84.50,315.25,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,outpatient,,,98.00000,59.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,34.30,,,,,,,25.48,95.06,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,outpatient,,,303.00000,184.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,106.05,,,,,,,78.78,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,outpatient,,,115.00000,69.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,40.25,,,,,,,29.90,111.55,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,25.90,,,,,,,19.24,71.78,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,27.65,,,,,,,20.54,76.63,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,25.20,,,,,,,18.72,69.84,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,51.45,,,,,,,38.22,142.59,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,94.50,,,,,,,70.20,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,29.40,,,,,,,21.84,81.48,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,30.10,,,,,,,22.36,83.42,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,28.70,,,,,,,21.32,79.54,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,29.75,,,,,,,22.10,82.45,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,15.05,,,,,,,11.18,41.71,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,14.35,,,,,,,10.66,39.77,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,27.65,,,,,,,20.54,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"CQ,GP",25.90,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"CQ,GP",25.90,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,11.90,,,,,,,8.84,32.98,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,22.75,,,,,,,16.90,63.05,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,28.00,,,,,,,20.80,77.60,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,29.40,,,,,,,21.84,81.48,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,25.55,,,,,,,18.98,70.81,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"GP,50",144.55,,,,,,,107.38,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"GP,LT",96.25,,,,,,,71.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"GP,RT",96.25,,,,,,,71.50,266.75,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,33.25,,,,,,,24.70,92.15,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,51.10,,,,,,,37.96,141.62,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,48.65,,,,,,,36.14,134.83,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,26.25,,,,,,,19.50,72.75,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,53.90,,,,,,,40.04,149.38,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,25.55,,,,,,,18.98,70.81,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,56.00,,,,,,,41.60,155.20,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,113.75,,,,,,,84.50,315.25,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,25.90,,,,,,,19.24,71.78,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,27.65,,,,,,,20.54,76.63,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,25.20,,,,,,,18.72,69.84,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,outpatient,,,445.00000,262.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,155.75,,,,,,,115.70,431.65,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,outpatient,,,310.00000,182.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,108.50,,,,,,,80.60,300.70,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,outpatient,,,393.00000,231.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,137.55,,,,,,,102.18,381.21,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,outpatient,,,310.00000,182.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GP,108.50,,,,,,,80.60,300.70,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,28.00,,,,,,,20.80,77.60,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,29.40,,,,,,,21.84,81.48,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,44.10,,,,,,,32.76,122.22,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,23.10,,,,,,,17.16,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,21.70,,,,,,,16.12,60.14,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,31.50,,,,,,,23.40,87.30,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,33.25,,,,,,,24.70,92.15,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,51.10,,,,,,,37.96,141.62,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,48.65,,,,,,,36.14,134.83,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,26.25,,,,,,,19.50,72.75,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,53.90,,,,,,,40.04,149.38,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,25.55,,,,,,,18.98,70.81,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,56.00,,,,,,,41.60,155.20,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,outpatient,,,98.00000,37.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,34.30,,,,,,,25.48,95.06,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,outpatient,,,303.00000,117.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,106.05,,,,,,,78.78,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,outpatient,,,115.00000,44.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,40.25,,,,,,,29.90,111.55,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,25.90,,,,,,,19.24,71.78,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,25.20,,,,,,,18.72,69.84,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"CO,GO",28.00,,,,,,,20.80,77.60,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"CO,GO",29.40,,,,,,,21.84,81.48,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"CO,GO",44.10,,,,,,,32.76,122.22,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"CO,GO",21.70,,,,,,,16.12,60.14,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"CO,GO",23.10,,,,,,,17.16,64.02,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"CO,GO",31.50,,,,,,,23.40,87.30,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"CO,GO",33.25,,,,,,,24.70,92.15,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"CO,GO",51.10,,,,,,,37.96,141.62,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"CO,GO",48.65,,,,,,,36.14,134.83,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"CO,GO",26.25,,,,,,,19.50,72.75,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"CO,GO",53.90,,,,,,,40.04,149.38,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"CO,GO",25.55,,,,,,,18.98,70.81,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"CO,GO",56.00,,,,,,,41.60,155.20,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"CO,GO",25.90,,,,,,,19.24,71.78,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"CO,GO",25.20,,,,,,,18.72,69.84,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,16.45,,,,,,,12.22,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"CO,GO",16.45,,,,,,,12.22,45.59,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,outpatient,,,250.00000,142.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,87.50,,,,,,,65.00,242.50,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,outpatient,,,175.00000,99.43000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,61.25,,,,,,,45.50,169.75,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,outpatient,,,233.00000,132.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,81.55,,,,,,,60.58,226.01,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,outpatient,,,175.00000,99.43000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GO,61.25,,,,,,,45.50,169.75,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,outpatient,,,291.00000,93.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,101.85,,,,,,,75.66,282.27,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,outpatient,,,273.00000,155.10000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GN,95.55,,,,,,,70.98,264.81,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,outpatient,,,279.00000,158.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GN,97.65,,,,,,,72.54,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,outpatient,,,426.00000,242.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GN,149.10,,,,,,,110.76,413.22,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,outpatient,,,242.00000,137.49000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GN,84.70,,,,,,,62.92,234.74,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,outpatient,,,128.00000,72.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,44.80,,,,,,,33.28,124.16,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,outpatient,,,66.00000,37.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GN,23.10,,,,,,,17.16,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,outpatient,,,62.00000,35.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GN,21.70,,,,,,,16.12,60.14,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,outpatient,,,269.00000,152.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GN,94.15,,,,,,,69.94,260.93,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,outpatient,,,153.00000,86.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GN,53.55,,,,,,,39.78,148.41,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,outpatient,,,98.00000,55.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GN,34.30,,,,,,,25.48,95.06,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,outpatient,,,303.00000,172.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GN,106.05,,,,,,,78.78,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,outpatient,,,115.00000,65.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GN,40.25,,,,,,,29.90,111.55,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,outpatient,,,210.00000,119.31000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GN,73.50,,,,,,,54.60,203.70,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,outpatient,,,250.00000,142.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GN,87.50,,,,,,,65.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,outpatient,,,78.00000,44.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GN,27.30,,,,,,,20.28,75.66,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,outpatient,,,322.00000,182.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GN,112.70,,,,,,,83.72,312.34,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,outpatient,,,309.00000,175.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GN,108.15,,,,,,,80.34,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,outpatient,,,245.00000,139.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,GN,85.75,,,,,,,63.70,237.65,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,outpatient,,,313.00000,116.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.55,,,,,,,81.38,303.61,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,outpatient,,,1250.00000,632.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,437.50,,,,,,,325.00,1212.50,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,50.75,,,,,,,37.70,140.65,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,170.80,,,,,,,126.88,473.36,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,outpatient,,,684.00000,337.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,239.40,,,,,,,177.84,663.48,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,outpatient,,,206.00000,101.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,72.10,,,,,,,53.56,199.82,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,outpatient,,,195.00000,96.33000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,68.25,,,,,,,50.70,189.15,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,outpatient,,,375.00000,185.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,131.25,,,,,,,97.50,363.75,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,outpatient,,,429.00000,211.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,150.15,,,,,,,111.54,416.13,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22475,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B OBSTETRICS SEMI-PVT,42473,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2935.00,,,,,,,2502.90,3111.10,per diem,
R&B ICU,32474,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2935.00,,,,,,,2512.00,8498.17,per diem,
R&B ICU INTERMEDIATE,12476,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2935.00,,,,,,,2512.00,5665.77,per diem,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,99.40,,,,,,,73.84,275.48,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,160.30,,,,,,,119.08,444.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,195.30,,,,,,,145.08,541.26,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,168.70,,,,,,,125.32,467.54,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,82.95,,,,,,,61.62,229.89,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,outpatient,,,490.00000,329.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,outpatient,,,490.00000,329.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,outpatient,,,245.00000,164.89000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,85.75,,,,,,,63.70,237.65,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,85.75,,,,,,,63.70,237.65,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,294.70,,,,,,,218.92,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,368.55,,,,,,,273.78,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,442.05,,,,,,,328.38,1225.11,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,outpatient,,,2466.00000,986.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,863.10,,,,,,,641.16,2392.02,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,outpatient,,,260.00000,104.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,91.00,,,,,,,67.60,252.20,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,outpatient,,,2041.00000,816.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,714.35,,,,,,,530.66,1979.77,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,outpatient,,,375.00000,150.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,131.25,,,,,,,97.50,363.75,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,outpatient,,,1178.00000,471.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,412.30,,,,,,,306.28,1142.66,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,outpatient,,,245.00000,98.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,85.75,,,,,,,63.70,237.65,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,outpatient,,,280.00000,112.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,98.00,,,,,,,72.80,271.60,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,outpatient,,,336.00000,134.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,117.60,,,,,,,87.36,325.92,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,outpatient,,,380.00000,152.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,133.00,,,,,,,98.80,368.60,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,185.50,,,,,,,137.80,514.10,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,outpatient,,,264.00000,105.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,92.40,,,,,,,68.64,256.08,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,outpatient,,,763.00000,305.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,267.05,,,,,,,198.38,740.11,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,outpatient,,,672.00000,268.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,235.20,,,,,,,174.72,651.84,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,outpatient,,,1940.00000,776.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,679.00,,,,,,,504.40,1881.80,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,outpatient,,,3875.00000,1550.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1356.25,,,,,,,1007.50,3758.75,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,outpatient,,,505.00000,202.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,176.75,,,,,,,131.30,489.85,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,103.25,,,,,,,76.70,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,outpatient,,,585.00000,234.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,204.75,,,,,,,152.10,567.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,outpatient,,,285.00000,114.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,99.75,,,,,,,74.10,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,outpatient,,,575.00000,230.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,201.25,,,,,,,149.50,557.75,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,outpatient,,,697.00000,278.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,243.95,,,,,,,181.22,676.09,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,185.50,,,,,,,137.80,514.10,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,outpatient,,,580.00000,232.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,203.00,,,,,,,150.80,562.60,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,outpatient,,,435.00000,174.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,152.25,,,,,,,113.10,421.95,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,outpatient,,,270.00000,108.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,94.50,,,,,,,70.20,261.90,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,outpatient,,,504.00000,201.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,outpatient,,,98.00000,39.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,outpatient,,,608.00000,243.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,212.80,,,,,,,158.08,589.76,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,outpatient,,,114.00000,45.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,outpatient,,,187.00000,74.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,outpatient,,,214.00000,85.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,74.90,,,,,,,55.64,207.58,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,outpatient,,,863.00000,345.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,302.05,,,,,,,224.38,837.11,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,outpatient,,,453.00000,181.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,158.55,,,,,,,117.78,439.41,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,outpatient,,,144.00000,57.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,outpatient,,,107.00000,42.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.45,,,,,,,27.82,103.79,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,outpatient,,,403.00000,161.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,141.05,,,,,,,104.78,390.91,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,outpatient,,,144.00000,57.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,outpatient,,,370.00000,148.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,129.50,,,,,,,96.20,358.90,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,outpatient,,,334.00000,133.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,116.90,,,,,,,86.84,323.98,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,outpatient,,,1188.00000,475.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,415.80,,,,,,,308.88,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,277.20,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,277.20,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,outpatient,,,572.00000,228.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,200.20,,,,,,,148.72,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,133.35,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,133.35,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,outpatient,,,683.00000,273.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,239.05,,,,,,,177.58,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,159.25,,,,,,,118.30,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,159.25,,,,,,,118.30,441.35,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,outpatient,,,357.00000,142.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,124.95,,,,,,,92.82,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,outpatient,,,334.00000,133.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,116.90,,,,,,,86.84,323.98,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,outpatient,,,194.00000,77.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,outpatient,,,608.00000,243.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,212.80,,,,,,,158.08,589.76,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,outpatient,,,257.00000,102.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,89.95,,,,,,,66.82,249.29,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,outpatient,,,343.00000,137.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,120.05,,,,,,,89.18,332.71,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,outpatient,,,457.00000,182.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,159.95,,,,,,,118.82,443.29,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,outpatient,,,630.00000,252.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,220.50,,,,,,,163.80,611.10,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,outpatient,,,623.00000,249.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,218.05,,,,,,,161.98,604.31,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,outpatient,,,1457.00000,582.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,509.95,,,,,,,378.82,1413.29,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,outpatient,,,890.00000,356.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,311.50,,,,,,,231.40,863.30,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,outpatient,,,532.00000,212.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,186.20,,,,,,,138.32,516.04,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,outpatient,,,492.00000,196.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,outpatient,,,550.00000,220.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,192.50,,,,,,,143.00,533.50,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,outpatient,,,305.00000,122.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,106.75,,,,,,,79.30,295.85,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,outpatient,,,220.00000,88.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,77.00,,,,,,,57.20,213.40,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,outpatient,,,780.00000,312.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,273.00,,,,,,,202.80,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,outpatient,,,1165.00000,466.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,407.75,,,,,,,302.90,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,outpatient,,,2350.00000,940.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,822.50,,,,,,,611.00,2279.50,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,outpatient,,,896.00000,358.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,313.60,,,,,,,232.96,869.12,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,outpatient,,,385.00000,154.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,134.75,,,,,,,100.10,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,outpatient,,,470.00000,188.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,164.50,,,,,,,122.20,455.90,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,outpatient,,,150.00000,60.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,52.50,,,,,,,39.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,outpatient,,,100.00000,40.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,35.00,,,,,,,26.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,outpatient,,,143.00000,57.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,50.05,,,,,,,37.18,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,outpatient,,,95.00000,38.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,33.25,,,,,,,24.70,92.15,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,outpatient,,,269.00000,107.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,94.15,,,,,,,69.94,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,outpatient,,,388.00000,155.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,135.80,,,,,,,100.88,376.36,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,outpatient,,,344.00000,137.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,120.40,,,,,,,89.44,333.68,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,outpatient,,,321.00000,128.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,112.35,,,,,,,83.46,311.37,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,outpatient,,,155.00000,62.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,54.25,,,,,,,40.30,150.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,outpatient,,,817.00000,326.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,285.95,,,,,,,212.42,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,outpatient,,,1255.00000,502.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,439.25,,,,,,,326.30,1217.35,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,outpatient,,,391.00000,156.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,136.85,,,,,,,101.66,379.27,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,outpatient,,,671.00000,268.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,234.85,,,,,,,174.46,650.87,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,outpatient,,,456.00000,182.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,159.60,,,,,,,118.56,442.32,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,outpatient,,,112.00000,44.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,outpatient,,,84.00000,33.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,outpatient,,,216.00000,86.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,75.60,,,,,,,56.16,209.52,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,outpatient,,,2660.00000,1064.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,931.00,,,,,,,691.60,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,outpatient,,,2960.00000,1184.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1036.00,,,,,,,769.60,2871.20,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,outpatient,,,3225.00000,1290.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1128.75,,,,,,,838.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,outpatient,,,3395.00000,1358.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1188.25,,,,,,,882.70,3293.15,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,outpatient,,,490.00000,196.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,171.50,,,,,,,127.40,475.30,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,outpatient,,,520.00000,208.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,182.00,,,,,,,135.20,504.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,outpatient,,,720.00000,288.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,252.00,,,,,,,187.20,698.40,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,outpatient,,,215.00000,86.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,75.25,,,,,,,55.90,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,outpatient,,,240.00000,96.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,84.00,,,,,,,62.40,232.80,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,outpatient,,,1241.00000,496.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,434.35,,,,,,,322.66,1203.77,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,outpatient,,,850.00000,340.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,297.50,,,,,,,221.00,824.50,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,outpatient,,,1085.00000,434.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,379.75,,,,,,,282.10,1052.45,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,103.25,,,,,,,76.70,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,outpatient,,,492.00000,196.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,outpatient,,,563.00000,225.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,197.05,,,,,,,146.38,546.11,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,outpatient,,,1612.00000,644.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,564.20,,,,,,,419.12,1563.64,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,outpatient,,,1366.00000,546.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,478.10,,,,,,,355.16,1325.02,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,outpatient,,,1911.00000,764.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,668.85,,,,,,,496.86,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,outpatient,,,956.00000,382.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,334.60,,,,,,,248.56,927.32,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,outpatient,,,189.00000,123.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,66.15,,,,,,,49.14,183.33,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,outpatient,,,352.00000,256.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,123.20,,,,,,,91.52,341.44,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,outpatient,,,625.00000,738.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,218.75,,,,,,,162.50,606.25,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1024.00000,2097.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,358.40,,,,,,,266.24,993.28,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,outpatient,,,1455.00000,2469.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,509.25,,,,,,,378.30,1411.35,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,50.75,,,,,,,37.70,140.65,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,170.80,,,,,,,126.88,473.36,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,outpatient,,,170.00000,73.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,59.50,,,,,,,44.20,164.90,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,2.70000,1.17000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,0.94500,,,,,,,0.70200,2.62,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,27.00000,11.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,9.45,,,,,,,7.02,26.19,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,outpatient,,,20440.00000,8891.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,7154.00,,,,,,,5314.40,19826.80,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,3322.00000,1445.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1162.70,,,,,,,863.72,3222.34,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,2492.00000,1084.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,872.20,,,,,,,647.92,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1814.00000,789.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,634.90,,,,,,,471.64,1759.58,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,2153.00000,936.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,753.55,,,,,,,559.78,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1525.00000,663.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,533.75,,,,,,,396.50,1479.25,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2716.00000,1181.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,950.60,,,,,,,706.16,2634.52,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,outpatient,,,2.70000,0.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,0.94500,,,,,,,0.70200,2.62,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,outpatient,,,222.00000,32.41000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,77.70,,,,,,,57.72,215.34,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,outpatient,,,211.00000,113.10000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,73.85,,,,,,,54.86,204.67,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,outpatient,,,497.00000,266.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,173.95,,,,,,,129.22,482.09,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,outpatient,,,296.00000,158.66000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,103.60,,,,,,,76.96,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,outpatient,,,723.00000,387.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,253.05,,,,,,,187.98,701.31,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,outpatient,,,326.00000,174.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,114.10,,,,,,,84.76,316.22,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,outpatient,,,532.00000,285.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,186.20,,,,,,,138.32,516.04,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,outpatient,,,635.00000,340.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,222.25,,,,,,,165.10,615.95,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,outpatient,,,639.00000,342.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,223.65,,,,,,,166.14,619.83,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,outpatient,,,780.00000,418.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,273.00,,,,,,,202.80,756.60,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,outpatient,,,390.00000,209.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,136.50,,,,,,,101.40,378.30,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,outpatient,,,731.00000,391.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,255.85,,,,,,,190.06,709.07,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,outpatient,,,585.00000,313.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,204.75,,,,,,,152.10,567.45,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,outpatient,,,365.00000,195.64000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,127.75,,,,,,,94.90,354.05,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,outpatient,,,1086.00000,582.10000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,380.10,,,,,,,282.36,1053.42,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,outpatient,,,197.00000,105.59000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,outpatient,,,2774.00000,1486.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,970.90,,,,,,,721.24,2690.78,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,outpatient,,,1456.00000,780.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,509.60,,,,,,,378.56,1412.32,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,outpatient,,,2647.00000,1418.79000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,926.45,,,,,,,688.22,2567.59,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,outpatient,,,1359.00000,728.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,475.65,,,,,,,353.34,1318.23,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,outpatient,,,273.00000,146.33000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,95.55,,,,,,,70.98,264.81,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,outpatient,,,325.00000,174.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,113.75,,,,,,,84.50,315.25,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,213.15,,,,,,,158.34,590.73,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,outpatient,,,491.00000,263.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,171.85,,,,,,,127.66,476.27,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,outpatient,,,561.00000,300.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,196.35,,,,,,,145.86,544.17,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,outpatient,,,845.00000,452.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,295.75,,,,,,,219.70,819.65,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,outpatient,,,612.00000,328.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,214.20,,,,,,,159.12,593.64,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,outpatient,,,536.00000,287.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,187.60,,,,,,,139.36,519.92,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,outpatient,,,1225.00000,656.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,428.75,,,,,,,318.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,285.60,,,,,,,212.16,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,285.60,,,,,,,212.16,791.52,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,outpatient,,,250.00000,134.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,87.50,,,,,,,65.00,242.50,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,outpatient,,,302.00000,161.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,105.70,,,,,,,78.52,292.94,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,outpatient,,,354.00000,189.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,123.90,,,,,,,92.04,343.38,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,outpatient,,,409.00000,219.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,143.15,,,,,,,106.34,396.73,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,outpatient,,,593.00000,317.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,207.55,,,,,,,154.18,575.21,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,107.45,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"52,LT",107.45,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,107.45,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"52,RT",107.45,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,115.50,,,,,,,85.80,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,115.50,,,,,,,85.80,320.10,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,outpatient,,,195.00000,104.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,68.25,,,,,,,50.70,189.15,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,outpatient,,,578.00000,309.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,202.30,,,,,,,150.28,560.66,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,outpatient,,,384.00000,205.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,134.40,,,,,,,99.84,372.48,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,106.05,,,,,,,78.78,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,106.05,,,,,,,78.78,293.91,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,155.75,,,,,,,115.70,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,155.75,,,,,,,115.70,431.65,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,outpatient,,,937.00000,502.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,327.95,,,,,,,243.62,908.89,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,outpatient,,,615.00000,329.64000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,215.25,,,,,,,159.90,596.55,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,100.45,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"52,LT",100.45,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,100.45,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"52,RT",100.45,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,113.05,,,,,,,83.98,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,113.05,,,,,,,83.98,313.31,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,outpatient,,,694.00000,371.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,242.90,,,,,,,180.44,673.18,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,96.60,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,96.60,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,88.90,,,,,,,66.04,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,88.90,,,,,,,66.04,246.38,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,96.25,,,,,,,71.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,96.25,,,,,,,71.50,266.75,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,outpatient,,,173.00000,92.73000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,60.55,,,,,,,44.98,167.81,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,169.05,,,,,,,125.58,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,169.05,,,,,,,125.58,468.51,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,66.85,,,,,,,49.66,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,66.85,,,,,,,49.66,185.27,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,51.80,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"52,LT",51.80,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,51.80,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"52,RT",51.80,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,168.35,,,,,,,125.06,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,168.35,,,,,,,125.06,466.57,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,75.25,,,,,,,55.90,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,75.25,,,,,,,55.90,208.55,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,96.25,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"52,LT",96.25,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,96.25,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"52,RT",96.25,,,,,,,71.50,266.75,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"52,LT",159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"52,RT",159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,176.05,,,,,,,130.78,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,176.05,,,,,,,130.78,487.91,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,73.15,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,73.15,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,198.10,,,,,,,147.16,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,198.10,,,,,,,147.16,549.02,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,outpatient,,,598.00000,320.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,209.30,,,,,,,155.48,580.06,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"52,LT",159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"52,RT",159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,159.25,,,,,,,118.30,441.35,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,outpatient,,,1913.00000,1025.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,669.55,,,,,,,497.38,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,outpatient,,,312.00000,167.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,109.20,,,,,,,81.12,302.64,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,outpatient,,,327.00000,175.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,114.45,,,,,,,85.02,317.19,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,outpatient,,,425.00000,227.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,148.75,,,,,,,110.50,412.25,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,outpatient,,,210.00000,112.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,73.50,,,,,,,54.60,203.70,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,outpatient,,,495.00000,265.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,173.25,,,,,,,128.70,480.15,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,outpatient,,,541.00000,289.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,189.35,,,,,,,140.66,524.77,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,120.75,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,120.75,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,146.65,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,146.65,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,216.30,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,216.30,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,outpatient,,,463.00000,248.17000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,162.05,,,,,,,120.38,449.11,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,outpatient,,,511.00000,273.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,178.85,,,,,,,132.86,495.67,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,outpatient,,,132.00000,70.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,46.20,,,,,,,34.32,128.04,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,123.55,,,,,,,91.78,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,123.55,,,,,,,91.78,342.41,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,outpatient,,,273.00000,146.33000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,95.55,,,,,,,70.98,264.81,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,outpatient,,,503.00000,269.61000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,176.05,,,,,,,130.78,487.91,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,outpatient,,,561.00000,300.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,196.35,,,,,,,145.86,544.17,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,157.50,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,157.50,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,outpatient,,,650.00000,348.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,227.50,,,,,,,169.00,630.50,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,outpatient,,,642.00000,344.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,224.70,,,,,,,166.92,622.74,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,outpatient,,,777.00000,416.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,271.95,,,,,,,202.02,753.69,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,outpatient,,,381.00000,204.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,133.35,,,,,,,99.06,369.57,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,130.90,,,,,,,97.24,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,130.90,,,,,,,97.24,362.78,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,56.35,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,56.35,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,174.65,,,,,,,129.74,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,174.65,,,,,,,129.74,484.03,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,outpatient,,,214.00000,114.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,74.90,,,,,,,55.64,207.58,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,outpatient,,,329.00000,176.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,115.15,,,,,,,85.54,319.13,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,outpatient,,,197.00000,105.59000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,outpatient,,,263.00000,140.97000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,92.05,,,,,,,68.38,255.11,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,outpatient,,,234.00000,125.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,81.90,,,,,,,60.84,226.98,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,outpatient,,,401.00000,214.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,140.35,,,,,,,104.26,388.97,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,outpatient,,,515.00000,276.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,180.25,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,outpatient,,,747.00000,400.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,261.45,,,,,,,194.22,724.59,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,outpatient,,,854.00000,457.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,298.90,,,,,,,222.04,828.38,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,outpatient,,,589.00000,315.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,206.15,,,,,,,153.14,571.33,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,outpatient,,,613.00000,328.57000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,214.55,,,,,,,159.38,594.61,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,outpatient,,,806.00000,432.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,282.10,,,,,,,209.56,781.82,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,outpatient,,,529.00000,283.54000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,185.15,,,,,,,137.54,513.13,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,outpatient,,,939.00000,503.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,328.65,,,,,,,244.14,910.83,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,outpatient,,,515.00000,276.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,180.25,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,outpatient,,,616.00000,330.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,215.60,,,,,,,160.16,597.52,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,outpatient,,,377.00000,202.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,131.95,,,,,,,98.02,365.69,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,outpatient,,,340.00000,182.24000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,119.00,,,,,,,88.40,329.80,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,outpatient,,,388.00000,207.97000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,135.80,,,,,,,100.88,376.36,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,outpatient,,,456.00000,244.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,159.60,,,,,,,118.56,442.32,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,outpatient,,,267.00000,143.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,93.45,,,,,,,69.42,258.99,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,107.10,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"52,LT",107.10,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,107.10,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"52,RT",107.10,,,,,,,79.56,296.82,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,outpatient,,,456.00000,244.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,159.60,,,,,,,118.56,442.32,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,outpatient,,,381.00000,204.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,133.35,,,,,,,99.06,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,50.05,,,,,,,37.18,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,50.05,,,,,,,37.18,138.71,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,115.85,,,,,,,86.06,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,115.85,,,,,,,86.06,321.07,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1113.00000,596.57000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,389.55,,,,,,,289.38,1079.61,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,outpatient,,,1043.00000,559.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,365.05,,,,,,,271.18,1011.71,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,89.60,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"52,LT",89.60,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,89.60,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,"52,RT",89.60,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,178.85,,,,,,,132.86,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,178.85,,,,,,,132.86,495.67,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,193.55,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,193.55,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,376.60,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,376.60,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,302.75,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,302.75,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,256.90,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,256.90,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,255.50,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,255.50,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,91.00,,,,,,,67.60,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,91.00,,,,,,,67.60,252.20,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,outpatient,,,428.00000,203.73000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,149.80,,,,,,,111.28,415.16,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,outpatient,,,492.00000,234.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,outpatient,,,607.00000,288.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,212.45,,,,,,,157.82,588.79,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,outpatient,,,649.00000,308.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,227.15,,,,,,,168.74,629.53,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,outpatient,,,377.00000,121.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,131.95,,,,,,,98.02,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,87.85,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,87.85,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,outpatient,,,1170.00000,377.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,409.50,,,,,,,304.20,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,273.00,,,,,,,202.80,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,273.00,,,,,,,202.80,756.60,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,outpatient,,,1389.00000,448.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,486.15,,,,,,,361.14,1347.33,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,outpatient,,,345.00000,111.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,120.75,,,,,,,89.70,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,80.50,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,80.50,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,outpatient,,,2102.00000,678.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,735.70,,,,,,,546.52,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,490.35,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,490.35,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,outpatient,,,357.00000,115.31000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,124.95,,,,,,,92.82,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,83.30,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,83.30,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,outpatient,,,2082.00000,672.49000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,728.70,,,,,,,541.32,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,485.80,,,,,,,360.88,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,485.80,,,,,,,360.88,1346.36,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,outpatient,,,246.00000,79.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,86.10,,,,,,,63.96,238.62,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,57.40,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,57.40,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,outpatient,,,309.00000,99.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,108.15,,,,,,,80.34,299.73,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,72.10,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,72.10,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,outpatient,,,471.00000,152.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,164.85,,,,,,,122.46,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,109.90,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,109.90,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,outpatient,,,239.00000,77.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,83.65,,,,,,,62.14,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,55.65,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,55.65,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,outpatient,,,558.00000,180.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,195.30,,,,,,,145.08,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,130.20,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,130.20,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,outpatient,,,413.00000,133.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,144.55,,,,,,,107.38,400.61,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,96.25,,,,,,,71.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,96.25,,,,,,,71.50,266.75,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,outpatient,,,462.00000,149.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,161.70,,,,,,,120.12,448.14,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,outpatient,,,170.00000,54.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,59.50,,,,,,,44.20,164.90,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,outpatient,,,281.00000,90.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,98.35,,,,,,,73.06,272.57,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,outpatient,,,562.00000,181.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,196.70,,,,,,,146.12,545.14,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,outpatient,,,2076.00000,670.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,726.60,,,,,,,539.76,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,484.40,,,,,,,359.84,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,484.40,,,,,,,359.84,1342.48,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,outpatient,,,934.00000,301.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,326.90,,,,,,,242.84,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,outpatient,,,842.00000,271.97000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,294.70,,,,,,,218.92,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,outpatient,,,846.00000,273.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,296.10,,,,,,,219.96,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,outpatient,,,971.00000,313.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,339.85,,,,,,,252.46,941.87,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,outpatient,,,762.00000,246.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,266.70,,,,,,,198.12,739.14,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,outpatient,,,758.00000,244.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,265.30,,,,,,,197.08,735.26,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,outpatient,,,161.00000,52.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,56.35,,,,,,,41.86,156.17,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,outpatient,,,234.00000,75.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,81.90,,,,,,,60.84,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,54.60,,,,,,,40.56,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,54.60,,,,,,,40.56,151.32,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1517.00000,489.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,530.95,,,,,,,394.42,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,353.85,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,353.85,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,outpatient,,,822.00000,265.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,287.70,,,,,,,213.72,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,191.80,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,191.80,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,outpatient,,,2613.00000,844.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,914.55,,,,,,,679.38,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,outpatient,,,903.00000,291.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,316.05,,,,,,,234.78,875.91,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,outpatient,,,1156.00000,373.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,404.60,,,,,,,300.56,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,outpatient,,,677.00000,218.67000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,236.95,,,,,,,176.02,656.69,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1928.00000,622.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,674.80,,,,,,,501.28,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,449.75,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,449.75,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,outpatient,,,812.00000,262.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,284.20,,,,,,,211.12,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,189.35,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,189.35,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,outpatient,,,825.00000,266.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,288.75,,,,,,,214.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,192.50,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,192.50,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,outpatient,,,3494.00000,1128.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,1222.90,,,,,,,908.44,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,815.15,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,815.15,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,outpatient,,,840.00000,271.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,294.00,,,,,,,218.40,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,196.00,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,196.00,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,outpatient,,,792.00000,255.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,277.20,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,184.80,,,,,,,137.28,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,184.80,,,,,,,137.28,512.16,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,outpatient,,,272.00000,87.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,95.20,,,,,,,70.72,263.84,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,outpatient,,,1268.00000,409.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,443.80,,,,,,,329.68,1229.96,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,outpatient,,,896.00000,289.41000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,313.60,,,,,,,232.96,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,outpatient,,,884.00000,285.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,309.40,,,,,,,229.84,857.48,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,213.15,,,,,,,158.34,590.73,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,outpatient,,,966.00000,383.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,338.10,,,,,,,251.16,937.02,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,outpatient,,,872.00000,346.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,305.20,,,,,,,226.72,845.84,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,outpatient,,,492.00000,195.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,outpatient,,,331.00000,131.41000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,115.85,,,,,,,86.06,321.07,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,outpatient,,,5215.00000,2070.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1825.25,,,,,,,1355.90,5058.55,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,outpatient,,,5422.00000,2152.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1897.70,,,,,,,1409.72,5259.34,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1878.00000,788.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,657.30,,,,,,,488.28,1821.66,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,outpatient,,,2253.00000,946.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,788.55,,,,,,,585.78,2185.41,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1502.00000,630.84000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,525.70,,,,,,,390.52,1456.94,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,outpatient,,,2024.00000,850.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,708.40,,,,,,,526.24,1963.28,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,outpatient,,,2429.00000,1020.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,850.15,,,,,,,631.54,2356.13,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1619.00000,679.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,outpatient,,,2425.00000,1018.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,848.75,,,,,,,630.50,2352.25,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2910.00000,1222.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1018.50,,,,,,,756.60,2822.70,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1940.00000,814.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,679.00,,,,,,,504.40,1881.80,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2317.00000,973.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,810.95,,,,,,,602.42,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2780.00000,1167.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,973.00,,,,,,,722.80,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1853.00000,778.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,648.55,,,,,,,481.78,1797.41,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2366.00000,993.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,828.10,,,,,,,615.16,2295.02,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,outpatient,,,3056.00000,1283.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1069.60,,,,,,,794.56,2964.32,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,outpatient,,,2829.00000,1386.21000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,990.15,,,,,,,735.54,2744.13,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,outpatient,,,3395.00000,1663.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1188.25,,,,,,,882.70,3293.15,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,outpatient,,,2263.00000,1108.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,792.05,,,,,,,588.38,2195.11,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,outpatient,,,4697.00000,2301.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1643.95,,,,,,,1221.22,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,outpatient,,,5636.00000,2761.64000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1972.60,,,,,,,1465.36,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,outpatient,,,3757.00000,1840.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1314.95,,,,,,,976.82,3644.29,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,outpatient,,,2619.00000,1283.31000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,916.65,,,,,,,680.94,2540.43,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,outpatient,,,3143.00000,1540.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1100.05,,,,,,,817.18,3048.71,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,outpatient,,,2095.00000,1026.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,733.25,,,,,,,544.70,2032.15,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,outpatient,,,278.00000,136.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,97.30,,,,,,,72.28,269.66,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,738.50,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,738.50,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,886.20,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,886.20,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,590.80,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,590.80,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,708.40,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,708.40,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,850.15,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,850.15,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,566.65,,,,,,,420.94,1570.43,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,outpatient,,,1224.00000,599.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,428.40,,,,,,,318.24,1187.28,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,outpatient,,,3020.00000,1479.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1057.00,,,,,,,785.20,2929.40,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,outpatient,,,3624.00000,1775.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1268.40,,,,,,,942.24,3515.28,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,outpatient,,,2416.00000,1183.84000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,845.60,,,,,,,628.16,2343.52,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,outpatient,,,2728.00000,1336.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,954.80,,,,,,,709.28,2646.16,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,outpatient,,,3273.00000,1603.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1145.55,,,,,,,850.98,3174.81,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,outpatient,,,2182.00000,1069.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,763.70,,,,,,,567.32,2116.54,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,outpatient,,,3133.00000,1535.17000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1096.55,,,,,,,814.58,3039.01,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,outpatient,,,3759.00000,1841.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1315.65,,,,,,,977.34,3646.23,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,outpatient,,,2506.00000,1227.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,877.10,,,,,,,651.56,2430.82,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,outpatient,,,2857.00000,1399.93000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,999.95,,,,,,,742.82,2771.29,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,outpatient,,,3428.00000,1679.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1199.80,,,,,,,891.28,3325.16,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,outpatient,,,2285.00000,1119.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,799.75,,,,,,,594.10,2216.45,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,outpatient,,,3565.00000,1746.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1247.75,,,,,,,926.90,3458.05,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,outpatient,,,5918.00000,2899.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2071.30,,,,,,,1538.68,5740.46,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,outpatient,,,3301.00000,1617.49000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1155.35,,,,,,,858.26,3201.97,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,930.65,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,930.65,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,892.85,,,,,,,663.26,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,892.85,,,,,,,663.26,2474.47,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3806.00000,1864.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1332.10,,,,,,,989.56,3691.82,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,outpatient,,,2149.00000,694.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,752.15,,,,,,,558.74,2084.53,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,outpatient,,,1973.00000,637.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,690.55,,,,,,,512.98,1913.81,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1784.00000,576.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,624.40,,,,,,,463.84,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,416.15,,,,,,,309.14,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,416.15,,,,,,,309.14,1153.33,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,outpatient,,,130.00000,69.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,45.50,,,,,,,33.80,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,outpatient,,,44.00000,23.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15.40,,,,,,,11.44,42.68,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,outpatient,,,456.00000,244.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,159.60,,,,,,,118.56,442.32,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,outpatient,,,108.00000,57.89000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.80,,,,,,,28.08,104.76,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,outpatient,,,306.00000,164.02000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,107.10,,,,,,,79.56,296.82,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,outpatient,,,257.00000,137.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,89.95,,,,,,,66.82,249.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1419.95,,,,,,,1054.82,3935.29,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1703.80,,,,,,,1265.68,4721.96,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1135.75,,,,,,,843.70,3147.65,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1419.95,,,,,,,1054.82,3935.29,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1703.80,,,,,,,1265.68,4721.96,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1135.75,,,,,,,843.70,3147.65,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,outpatient,,,1725.00000,865.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,603.75,,,,,,,448.50,1673.25,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,outpatient,,,1743.00000,874.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,610.05,,,,,,,453.18,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,516.25,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,516.25,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,outpatient,,,1162.00000,583.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,406.70,,,,,,,302.12,1127.14,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,344.05,,,,,,,255.58,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,344.05,,,,,,,255.58,953.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,outpatient,,,3183.00000,1597.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1114.05,,,,,,,827.58,3087.51,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,outpatient,,,3819.00000,1917.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1336.65,,,,,,,992.94,3704.43,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,outpatient,,,2546.00000,1278.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,891.10,,,,,,,661.96,2469.62,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,1350.30,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,1350.30,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,1620.15,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,1620.15,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,1080.10,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,1080.10,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,876.75,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,876.75,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,1052.10,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,1052.10,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,701.40,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,701.40,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,1097.95,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,1097.95,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,1317.40,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,1317.40,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,878.15,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,878.15,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,1058.05,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,1058.05,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,1269.45,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,1269.45,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,846.30,,,,,,,628.68,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,846.30,,,,,,,628.68,2345.46,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,outpatient,,,870.00000,436.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,304.50,,,,,,,226.20,843.90,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,outpatient,,,1353.00000,679.21000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,473.55,,,,,,,351.78,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,315.70,,,,,,,234.52,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,315.70,,,,,,,234.52,874.94,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3489.00000,1751.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1221.15,,,,,,,907.14,3384.33,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,outpatient,,,4187.00000,2101.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1465.45,,,,,,,1088.62,4061.39,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,outpatient,,,2791.00000,1401.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,976.85,,,,,,,725.66,2707.27,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,outpatient,,,492.00000,246.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,outpatient,,,331.00000,166.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,115.85,,,,,,,86.06,321.07,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,outpatient,,,4440.00000,2357.64000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1554.00,,,,,,,1154.40,4306.80,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,outpatient,,,5328.00000,2829.17000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1864.80,,,,,,,1385.28,5168.16,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,outpatient,,,3552.00000,1886.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1243.20,,,,,,,923.52,3445.44,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,outpatient,,,2528.00000,1342.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,884.80,,,,,,,657.28,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,outpatient,,,3033.00000,1610.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1061.55,,,,,,,788.58,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,outpatient,,,2022.00000,1073.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,707.70,,,,,,,525.72,1961.34,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,outpatient,,,3610.00000,1909.69000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1263.50,,,,,,,938.60,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,outpatient,,,4332.00000,2291.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1516.20,,,,,,,1126.32,4202.04,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,outpatient,,,2888.00000,1527.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1010.80,,,,,,,750.88,2801.36,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,outpatient,,,4532.00000,2397.43000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1586.20,,,,,,,1178.32,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,outpatient,,,5438.00000,2876.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1903.30,,,,,,,1413.88,5274.86,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,outpatient,,,3625.00000,1917.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1268.75,,,,,,,942.50,3516.25,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,outpatient,,,3639.00000,1925.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1273.65,,,,,,,946.14,3529.83,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,outpatient,,,4367.00000,2310.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1528.45,,,,,,,1135.42,4235.99,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,outpatient,,,2911.00000,1539.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1018.85,,,,,,,756.86,2823.67,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3494.00000,1719.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1222.90,,,,,,,908.44,3389.18,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,outpatient,,,4193.00000,2062.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1467.55,,,,,,,1090.18,4067.21,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,outpatient,,,2795.00000,1375.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,978.25,,,,,,,726.70,2711.15,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,outpatient,,,2717.00000,1336.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,950.95,,,,,,,706.42,2635.49,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,outpatient,,,3260.00000,1603.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1141.00,,,,,,,847.60,3162.20,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,outpatient,,,2173.00000,1069.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,760.55,,,,,,,564.98,2107.81,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,1417.85,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,1417.85,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,1701.35,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,1701.35,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,1134.35,,,,,,,842.66,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,1134.35,,,,,,,842.66,3143.77,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,outpatient,,,4260.00000,2420.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1491.00,,,,,,,1107.60,4132.20,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,outpatient,,,5112.00000,2904.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1789.20,,,,,,,1329.12,4958.64,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3408.00000,1936.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1192.80,,,,,,,886.08,3305.76,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3343.00000,1899.33000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1170.05,,,,,,,869.18,3242.71,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,outpatient,,,4010.00000,2278.28000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1403.50,,,,,,,1042.60,3889.70,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,outpatient,,,2674.00000,1519.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,935.90,,,,,,,695.24,2593.78,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,1152.90,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,1152.90,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,1383.55,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,1383.55,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,922.25,,,,,,,685.10,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,922.25,,,,,,,685.10,2555.95,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3664.00000,2081.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1282.40,,,,,,,952.64,3554.08,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,outpatient,,,4397.00000,2498.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1538.95,,,,,,,1143.22,4265.09,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,outpatient,,,2931.00000,1665.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1025.85,,,,,,,762.06,2843.07,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,outpatient,,,4759.00000,2703.83000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1665.65,,,,,,,1237.34,4616.23,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,outpatient,,,5710.00000,3244.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1998.50,,,,,,,1484.60,5538.70,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3807.00000,2162.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1332.45,,,,,,,989.82,3692.79,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2915.00000,1574.10000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1020.25,,,,,,,757.90,2827.55,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1918.00000,1035.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,671.30,,,,,,,498.68,1860.46,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2292.00000,1237.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,802.20,,,,,,,595.92,2223.24,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,outpatient,,,2984.00000,1611.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1044.40,,,,,,,775.84,2894.48,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,outpatient,,,769.00000,415.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,269.15,,,,,,,199.94,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,outpatient,,,1280.00000,691.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,448.00,,,,,,,332.80,1241.60,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,outpatient,,,1878.00000,1014.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,657.30,,,,,,,488.28,1821.66,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,outpatient,,,2196.00000,1185.84000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,768.60,,,,,,,570.96,2130.12,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,outpatient,,,844.00000,455.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,295.40,,,,,,,219.44,818.68,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,outpatient,,,1305.00000,704.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,456.75,,,,,,,339.30,1265.85,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,outpatient,,,576.00000,311.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,201.60,,,,,,,149.76,558.72,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,outpatient,,,809.00000,436.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,283.15,,,,,,,210.34,784.73,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,outpatient,,,2462.00000,1329.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,861.70,,,,,,,640.12,2388.14,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,outpatient,,,918.00000,495.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,321.30,,,,,,,238.68,890.46,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,outpatient,,,1102.00000,595.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,385.70,,,,,,,286.52,1068.94,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,outpatient,,,812.00000,438.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,284.20,,,,,,,211.12,787.64,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,outpatient,,,1407.00000,759.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,492.45,,,,,,,365.82,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,outpatient,,,1980.00000,1069.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,693.00,,,,,,,514.80,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,outpatient,,,964.00000,520.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,337.40,,,,,,,250.64,935.08,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,outpatient,,,1040.00000,561.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,364.00,,,,,,,270.40,1008.80,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,outpatient,,,795.00000,429.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,278.25,,,,,,,206.70,771.15,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,outpatient,,,1124.00000,606.96000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,393.40,,,,,,,292.24,1090.28,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,outpatient,,,736.00000,397.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,257.60,,,,,,,191.36,713.92,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,outpatient,,,700.00000,378.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,245.00,,,,,,,182.00,679.00,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,outpatient,,,821.00000,443.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,287.35,,,,,,,213.46,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,outpatient,,,846.00000,456.84000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,296.10,,,,,,,219.96,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,outpatient,,,958.00000,517.32000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,335.30,,,,,,,249.08,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,outpatient,,,1261.00000,680.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,441.35,,,,,,,327.86,1223.17,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,outpatient,,,971.00000,524.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,339.85,,,,,,,252.46,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,outpatient,,,1837.00000,991.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,642.95,,,,,,,477.62,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,outpatient,,,1099.00000,593.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,384.65,,,,,,,285.74,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,outpatient,,,2178.00000,1176.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,762.30,,,,,,,566.28,2112.66,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,outpatient,,,1226.00000,662.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,429.10,,,,,,,318.76,1189.22,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,outpatient,,,1048.00000,565.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,366.80,,,,,,,272.48,1016.56,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,outpatient,,,970.00000,523.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,339.50,,,,,,,252.20,940.90,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,outpatient,,,1803.00000,973.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,631.05,,,,,,,468.78,1748.91,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,outpatient,,,2504.00000,1352.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,876.40,,,,,,,651.04,2428.88,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2457.00000,1326.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,859.95,,,,,,,638.82,2383.29,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,outpatient,,,923.00000,498.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,323.05,,,,,,,239.98,895.31,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,outpatient,,,5478.00000,2958.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1917.30,,,,,,,1424.28,5313.66,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,outpatient,,,4551.00000,2457.54000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1592.85,,,,,,,1183.26,4414.47,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,outpatient,,,1360.00000,734.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,476.00,,,,,,,353.60,1319.20,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,outpatient,,,1209.00000,652.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,423.15,,,,,,,314.34,1172.73,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,outpatient,,,848.00000,457.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,296.80,,,,,,,220.48,822.56,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,outpatient,,,1071.00000,578.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,374.85,,,,,,,278.46,1038.87,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,outpatient,,,1792.00000,967.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,627.20,,,,,,,465.92,1738.24,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,outpatient,,,35.00000,18.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,outpatient,,,285.00000,153.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,99.75,,,,,,,74.10,276.45,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,outpatient,,,1012.00000,546.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,354.20,,,,,,,263.12,981.64,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,outpatient,,,492.00000,265.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,outpatient,,,739.00000,399.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,258.65,,,,,,,192.14,716.83,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,outpatient,,,515.00000,278.10000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,180.25,,,,,,,133.90,499.55,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,outpatient,,,1467.00000,792.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,513.45,,,,,,,381.42,1422.99,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,outpatient,,,1683.00000,888.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,589.05,,,,,,,437.58,1632.51,percent of total billed charges,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,outpatient,,,426.30000,225.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,149.21,,,,,,,110.84,413.51,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,725.00000,382.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,253.75,,,,,,,188.50,1855.42,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,1852.00000,977.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,648.20,,,,,,,481.52,1868.26,percent of total billed charges,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,outpatient,,,110.00000,58.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,38.50,,,,,,,28.60,106.70,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,98.00000,51.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,34.30,,,,,,,25.48,1662.92,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,2018.00000,1065.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,706.30,,,,,,,524.68,1957.46,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,4325.00000,2283.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1513.75,,,,,,,1124.50,4195.25,percent of total billed charges,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,outpatient,,,172.00000,90.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,60.20,,,,,,,44.72,166.84,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,outpatient,,,942.00000,497.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,329.70,,,,,,,244.92,913.74,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,outpatient,,,413.00000,218.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,144.55,,,,,,,107.38,400.61,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,outpatient,,,257.00000,135.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,89.95,,,,,,,66.82,249.29,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,outpatient,,,116.00000,61.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,40.60,,,,,,,30.16,112.52,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,outpatient,,,463.20000,244.57000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,162.12,,,,,,,120.43,449.30,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,outpatient,,,804.00000,424.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,281.40,,,,,,,209.04,779.88,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,outpatient,,,172.00000,90.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,60.20,,,,,,,44.72,166.84,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,outpatient,,,354.30000,187.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,124.00,,,,,,,92.12,343.67,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,outpatient,,,277.90000,146.73000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,97.27,,,,,,,72.25,269.56,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,outpatient,,,200.00000,105.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,70.00,,,,,,,52.00,194.00,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,outpatient,,,197.00000,63.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,68.95,,,,,,,51.22,191.09,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,outpatient,,,468.00000,151.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,163.80,,,,,,,121.68,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,109.20,,,,,,,81.12,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,109.20,,,,,,,81.12,302.64,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,158.55,,,,,,,117.78,439.41,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,213.15,,,,,,,158.34,590.73,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1248.00000,403.10000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,436.80,,,,,,,324.48,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,291.20,,,,,,,216.32,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,291.20,,,,,,,216.32,807.04,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,1482.25,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,1482.25,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,outpatient,,,2119.00000,684.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,741.65,,,,,,,550.94,2055.43,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1943.00000,627.59000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,680.05,,,,,,,505.18,1884.71,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,outpatient,,,1426.00000,460.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,499.10,,,,,,,370.76,1383.22,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,outpatient,,,4202.00000,1357.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,1470.70,,,,,,,1092.52,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,980.35,,,,,,,728.26,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,980.35,,,,,,,728.26,2716.97,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,outpatient,,,832.00000,268.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,291.20,,,,,,,216.32,807.04,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,outpatient,,,1457.00000,470.61000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,509.95,,,,,,,378.82,1413.29,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,260.05,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,260.05,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,outpatient,,,232.00000,74.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,81.20,,,,,,,60.32,225.04,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,outpatient,,,1364.00000,440.57000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,477.40,,,,,,,354.64,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,318.15,,,,,,,236.34,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,318.15,,,,,,,236.34,881.73,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,outpatient,,,510.00000,355.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,178.50,,,,,,,132.60,494.70,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,outpatient,,,1001.00000,698.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,350.35,,,,,,,260.26,970.97,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,outpatient,,,887.00000,619.13000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,310.45,,,,,,,230.62,860.39,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,outpatient,,,1022.00000,713.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,357.70,,,,,,,265.72,991.34,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,238.35,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,238.35,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,outpatient,,,945.00000,659.61000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,330.75,,,,,,,245.70,916.65,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,220.50,,,,,,,163.80,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,220.50,,,,,,,163.80,611.10,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,outpatient,,,577.00000,402.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,201.95,,,,,,,150.02,559.69,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,outpatient,,,433.00000,302.23000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,151.55,,,,,,,112.58,420.01,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,outpatient,,,331.00000,231.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,115.85,,,,,,,86.06,321.07,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,outpatient,,,662.00000,462.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,231.70,,,,,,,172.12,642.14,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,outpatient,,,752.00000,524.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,263.20,,,,,,,195.52,729.44,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,63.70,,,,,,,47.32,176.54,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,outpatient,,,420.00000,293.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,147.00,,,,,,,109.20,407.40,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,outpatient,,,253.00000,176.59000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,88.55,,,,,,,65.78,245.41,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,outpatient,,,168.00000,117.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,58.80,,,,,,,43.68,162.96,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,outpatient,,,695.00000,485.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,243.25,,,,,,,180.70,674.15,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,outpatient,,,474.00000,330.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,165.90,,,,,,,123.24,459.78,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,outpatient,,,930.00000,649.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,325.50,,,,,,,241.80,902.10,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,outpatient,,,786.00000,548.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,275.10,,,,,,,204.36,762.42,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,217.00,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,59,217.00,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,152.25,,,,,,,113.10,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,59,152.25,,,,,,,113.10,421.95,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,outpatient,,,492.00000,343.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,172.20,,,,,,,127.92,477.24,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,outpatient,,,331.00000,231.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,115.85,,,,,,,86.06,321.07,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,outpatient,,,875.00000,610.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,306.25,,,,,,,227.50,848.75,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,outpatient,,,688.00000,480.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,240.80,,,,,,,178.88,667.36,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,outpatient,,,465.00000,324.57000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,162.75,,,,,,,120.90,451.05,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,outpatient,,,846.00000,590.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,296.10,,,,,,,219.96,820.62,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,outpatient,,,482.00000,336.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,168.70,,,,,,,125.32,467.54,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,outpatient,,,926.00000,646.35000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,324.10,,,,,,,240.76,898.22,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,outpatient,,,292.00000,203.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,102.20,,,,,,,75.92,283.24,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,outpatient,,,827.00000,577.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,289.45,,,,,,,215.02,802.19,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,outpatient,,,253.00000,176.59000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,88.55,,,,,,,65.78,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,outpatient,,,901.00000,628.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,315.35,,,,,,,234.26,873.97,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,outpatient,,,460.00000,321.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,161.00,,,,,,,119.60,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1029.00000,718.24000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,360.15,,,,,,,267.54,998.13,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,outpatient,,,959.00000,669.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,335.65,,,,,,,249.34,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,outpatient,,,558.00000,389.48000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,195.30,,,,,,,145.08,541.26,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,outpatient,,,705.00000,492.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,246.75,,,,,,,183.30,683.85,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,outpatient,,,249.00000,173.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,87.15,,,,,,,64.74,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,outpatient,,,427.00000,298.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,149.45,,,,,,,111.02,414.19,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,257.95,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,59,257.95,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,outpatient,,,809.00000,564.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,283.15,,,,,,,210.34,784.73,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,outpatient,,,525.00000,366.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,183.75,,,,,,,136.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,outpatient,,,319.00000,222.66000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,111.65,,,,,,,82.94,309.43,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1437.00000,678.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,502.95,,,,,,,373.62,1393.89,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2143.00000,1011.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,750.05,,,,,,,557.18,2078.71,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,outpatient,,,755.00000,356.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,264.25,,,,,,,196.30,732.35,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,outpatient,,,979.00000,462.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,342.65,,,,,,,254.54,949.63,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,outpatient,,,436.00000,205.79000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,152.60,,,,,,,113.36,422.92,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,outpatient,,,220.00000,103.84000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,77.00,,,,,,,57.20,213.40,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,outpatient,,,344.00000,162.37000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,120.40,,,,,,,89.44,333.68,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,outpatient,,,818.00000,393.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,286.30,,,,,,,212.68,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,outpatient,,,545.00000,262.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,52,190.75,,,,,,,141.70,528.65,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,outpatient,,,1347.00000,647.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,471.45,,,,,,,350.22,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,outpatient,,,898.00000,431.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,52,314.30,,,,,,,233.48,871.06,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,outpatient,,,469.00000,225.59000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,164.15,,,,,,,121.94,454.93,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,outpatient,,,1762.00000,847.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,616.70,,,,,,,458.12,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,outpatient,,,627.00000,301.59000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,219.45,,,,,,,163.02,608.19,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,outpatient,,,590.00000,283.79000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,206.50,,,,,,,153.40,572.30,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,outpatient,,,1550.00000,745.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,542.50,,,,,,,403.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,346.50,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,346.50,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,outpatient,,,1402.00000,674.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,490.70,,,,,,,364.52,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,343.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,343.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,outpatient,,,1661.00000,798.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,581.35,,,,,,,431.86,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,outpatient,,,980.00000,471.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,343.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1740.00000,836.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,609.00,,,,,,,452.40,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1168.00000,561.81000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,408.80,,,,,,,303.68,1132.96,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,outpatient,,,433.00000,232.09000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,151.55,,,,,,,112.58,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,135.80,,,,,,,100.88,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,135.80,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,outpatient,,,388.00000,207.97000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,135.80,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,outpatient,,,604.00000,323.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,211.40,,,,,,,157.04,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,outpatient,,,667.00000,357.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,233.45,,,,,,,173.42,646.99,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,outpatient,,,176.00000,94.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,61.60,,,,,,,45.76,170.72,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,32.20,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,32.20,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,128.10,,,,,,,95.16,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,128.10,,,,,,,95.16,355.02,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,390.95,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,390.95,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,outpatient,,,559.00000,180.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,195.65,,,,,,,145.34,542.23,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,outpatient,,,252.00000,81.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,50,88.20,,,,,,,65.52,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,58.80,,,,,,,43.68,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,58.80,,,,,,,43.68,162.96,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,401.80,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,401.80,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,outpatient,,,379.00000,122.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,132.65,,,,,,,98.54,367.63,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,outpatient,,,1015.00000,327.84000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,355.25,,,,,,,263.90,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,outpatient,,,591.00000,190.89000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,206.85,,,,,,,153.66,573.27,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,outpatient,,,271.00000,169.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,94.85,,,,,,,70.46,262.87,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,LT,73.85,,,,,,,54.86,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,RT,73.85,,,,,,,54.86,204.67,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,59.00000,36.99000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,20.65,,,,,,,15.34,57.23,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,outpatient,,,336.00000,219.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,117.60,,,,,,,87.36,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,outpatient,,,224.00000,146.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,52,78.40,,,,,,,58.24,217.28,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,outpatient,,,63.00000,41.20000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,22.05,,,,,,,16.38,61.11,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,212.80,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,74.90,,,,,,,55.64,207.58,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,213.15,,,,,,,158.34,590.73,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,302.05,,,,,,,224.38,837.11,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,outpatient,,,900.00000,605.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,315.00,,,,,,,234.00,873.00,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,outpatient,,,1940.00000,1102.21000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,679.00,,,,,,,504.40,1881.80,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,outpatient,,,422.00000,239.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,147.70,,,,,,,109.72,409.34,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,outpatient,,,1430.00000,812.45000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,500.50,,,,,,,371.80,1387.10,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,outpatient,,,745.00000,423.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,260.75,,,,,,,193.70,722.65,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,outpatient,,,2655.00000,2487.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,929.25,,,,,,,690.30,2575.35,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,outpatient,,,3990.00000,3738.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1396.50,,,,,,,1037.40,3870.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,outpatient,,,290.00000,271.73000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,101.50,,,,,,,75.40,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,outpatient,,,735.00000,688.70000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,257.25,,,,,,,191.10,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,outpatient,,,1475.00000,1382.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,516.25,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,outpatient,,,2275.00000,2131.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,796.25,,,,,,,591.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,outpatient,,,3205.00000,3003.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1121.75,,,,,,,833.30,3108.85,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,outpatient,,,770.00000,721.49000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,269.50,,,,,,,200.20,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,outpatient,,,1475.00000,1382.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,516.25,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,outpatient,,,2210.00000,2070.77000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,773.50,,,,,,,574.60,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,outpatient,,,2660.00000,2492.42000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,931.00,,,,,,,691.60,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,outpatient,,,3560.00000,3335.72000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1246.00,,,,,,,925.60,3453.20,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,outpatient,,,5730.00000,3255.50000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2005.50,,,,,,,1489.80,5558.10,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,outpatient,,,3875.00000,2201.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1356.25,,,,,,,1007.50,3758.75,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,outpatient,,,519.00000,564.15000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,181.65,,,,,,,134.94,503.43,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,outpatient,,,536.00000,582.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,187.60,,,,,,,139.36,519.92,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,158.55,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.45,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,34.30,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,212.80,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.90,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,65.45,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,74.90,,,,,,,55.64,207.58,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,outpatient,,,175.00000,63.18000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,61.25,,,,,,,45.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,outpatient,,,304.00000,109.74000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,106.40,,,,,,,79.04,294.88,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,99.40,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,160.30,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,outpatient,,,438.00000,158.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,153.30,,,,,,,113.88,424.86,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,195.30,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,168.70,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,82.95,,,,,,,61.62,229.89,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,176.40,,,,,,,131.04,488.88,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,294.70,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,368.55,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,442.05,,,,,,,328.38,1225.11,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,63.70,,,,,,,47.32,176.54,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,73.50,,,,,,,54.60,203.70,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,outpatient,,,140.00000,79.54000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,49.00,,,,,,,36.40,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,outpatient,,,190.00000,107.95000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,66.50,,,,,,,49.40,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,outpatient,,,240.00000,136.36000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,84.00,,,,,,,62.40,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,outpatient,,,290.00000,164.76000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,101.50,,,,,,,75.40,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,outpatient,,,340.00000,193.17000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,119.00,,,,,,,88.40,329.80,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,outpatient,,,150.00000,85.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,52.50,,,,,,,39.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,outpatient,,,200.00000,113.63000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,70.00,,,,,,,52.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,outpatient,,,270.00000,153.40000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,94.50,,,,,,,70.20,261.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,outpatient,,,370.00000,210.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,129.50,,,,,,,96.20,358.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,outpatient,,,470.00000,267.03000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,164.50,,,,,,,122.20,455.90,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,outpatient,,,248.00000,96.22000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,86.80,,,,,,,64.48,240.56,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,outpatient,,,245.00000,95.06000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,85.75,,,,,,,63.70,237.65,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,outpatient,,,497.00000,192.84000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,173.95,,,,,,,129.22,482.09,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,outpatient,,,357.00000,138.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,124.95,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,outpatient,,,334.00000,129.59000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,116.90,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,outpatient,,,194.00000,75.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,67.90,,,,,,,50.44,188.18,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,outpatient,,,1035.00000,401.58000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,362.25,,,,,,,269.10,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,outpatient,,,1137.00000,441.16000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,397.95,,,,,,,295.62,1102.89,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,outpatient,,,963.00000,373.64000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,337.05,,,,,,,250.38,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,outpatient,,,990.00000,384.12000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,346.50,,,,,,,257.40,960.30,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,outpatient,,,112.00000,43.46000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,39.20,,,,,,,29.12,108.64,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,outpatient,,,84.00000,32.59000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,29.40,,,,,,,21.84,81.48,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,outpatient,,,176.00000,68.29000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,61.60,,,,,,,45.76,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,outpatient,,,283.00000,109.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,99.05,,,,,,,73.58,274.51,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.35,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,14.35,,,,,,,10.66,39.77,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,35.00000,19.89000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,12.25,,,,,,,9.10,33.95,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,outpatient,,,191.00000,89.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,66.85,,,,,,,49.66,185.27,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,158.55,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.45,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,50.40,,,,,,,37.44,139.68,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,outpatient,,,281.00000,131.51000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,98.35,,,,,,,73.06,272.57,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,outpatient,,,192.00000,89.86000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,67.20,,,,,,,49.92,186.24,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,outpatient,,,365.00000,170.82000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,127.75,,,,,,,94.90,354.05,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,outpatient,,,8391.00000,5856.92000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2936.85,,,,,,,2181.66,8139.27,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,52,2420.95,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2100.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2420.95,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,52,2100.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,outpatient,,,8855.00000,9625.38000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,3099.25,,,,,,,2302.30,8589.35,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,295.40,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,52,295.40,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,274.75,,,,,,,204.10,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,52,274.75,,,,,,,204.10,761.45,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1648.15,,,,,,,1224.34,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,52,1648.15,,,,,,,1224.34,4567.73,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,outpatient,,,345.00000,128.34000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,120.75,,,,,,,89.70,334.65,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,outpatient,,,120.00000,99.60000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,42.00,,,,,,,31.20,116.40,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,outpatient,,,106.00000,87.98000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,37.10,,,,,,,27.56,102.82,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,outpatient,,,32.00000,26.56000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,11.20,,,,,,,8.32,31.04,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,outpatient,,,60.00000,49.80000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,21.00,,,,,,,15.60,58.20,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,outpatient,,,57.00000,47.31000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,19.95,,,,,,,14.82,55.29,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,outpatient,1.0,ME,7.40000,0.65000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2.59,,,,,,,1.92,7.18,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,outpatient,1.0,EA,6.60000,1.43000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,UD,2.31,,,,,,,1.72,6.40,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,outpatient,1.0,EA,2.95000,0.64000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,UD,1.03,,,,,,,0.76700,2.86,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,56.08000,12.11000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,UD,19.63,,,,,,,14.58,54.40,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,outpatient,1.0,UN,82.10000,28.90000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,28.73,,,,,,,15.48,79.64,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.04000,,TriWest Healthcare Alliance Corp - VA CCN,Tricare,UD,0.01400,,,,,,,0.01040,0.03880,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.05000,,TriWest Healthcare Alliance Corp - VA CCN,Tricare,UD,0.01750,,,,,,,0.01300,0.04850,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,outpatient,1.0,ME,6.20000,0.55000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2.17,,,,,,,1.61,6.01,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.12000,0.01000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,UD,0.04200,,,,,,,0.03120,0.11640,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,outpatient,2.0,ML,5.80000,1.25000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,2.03,,,,,,,1.51,5.63,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,outpatient,1.0,ME,3.10000,0.27000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,1.08,,,,,,,0.80600,3.01,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,outpatient,1.0,EA,44.40000,3.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,15.54,,,,,,,11.54,43.07,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,8.26000,0.73000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,UD,2.89,,,,,,,2.15,8.01,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,2.19000,0.19000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,UD,0.76650,,,,,,,0.56940,2.12,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,outpatient,1.0,EA,28.60000,2.52000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,,10.01,,,,,,,7.44,27.74,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,outpatient,1.0,EA,2.58000,0.91000,TriWest Healthcare Alliance Corp - VA CCN,Tricare,UD,0.90300,,,,,,,0.67080,2.50,percent of total billed charges,
R&B OBSTETRICS PVT,3012,CDM,112,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,United Healthcare,Commercial,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,23010,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,United Healthcare,Commercial,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ICU,33019,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,United Healthcare,Commercial,,7884.90,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,13011,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,United Healthcare,Commercial,,5256.90,,,,,,,2512.00,5665.77,percent of total billed charges,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,244.00000,77.10000,United Healthcare,Commercial,,219.60,,,,,,,219.60,236.68,percent of total billed charges,
OBSRV ICU PER HOUR,7622244,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,244.00000,77.10000,United Healthcare,Commercial,,219.60,,,,,,,63.44,236.68,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,24075,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,United Healthcare,Commercial,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B OBSTETRICS SEMI-PVT,44073,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,United Healthcare,Commercial,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B NURSERY LEVEL 1,55160,CDM,171,RC,,,,,facility,inpatient,,,3477.00000,1975.46000,United Healthcare,Commercial,,3129.30,,,,,,,2512.00,3372.69,percent of total billed charges,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,inpatient,,,16.00000,7.71000,United Healthcare,Commercial,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
POC BILIRUBIN TOTAL TRANSQ,3105566,CDM,301,RC,88720,CPT,,,facility,outpatient,,,16.00000,7.71000,United Healthcare,Commercial,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,inpatient,,,210.00000,119.31000,United Healthcare,Commercial,,189.00,,,,,,,189.00,203.70,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701306,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,United Healthcare,Commercial,,189.00,,,,,,,54.60,203.70,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,inpatient,,,380.00000,215.90000,United Healthcare,Commercial,,342.00,,,,,,,342.00,368.60,percent of total billed charges,
CIRCUMCISION W BLOCK REGIONAL,7201676,CDM,723,RC,54150,CPT,,,facility,outpatient,,,380.00000,215.90000,United Healthcare,Commercial,,342.00,,,,,,,98.80,368.60,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,United Healthcare,Commercial,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV OB PER HOUR,7621147,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,United Healthcare,Commercial,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22012,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,United Healthcare,Commercial,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ADMIN DAY SKILLED,82016,CDM,160,RC,,,,,facility,inpatient,,,1923.00000,1092.55000,United Healthcare,Commercial,,1730.70,,,,,,,1730.70,3111.10,percent of total billed charges,
R&B SWING BED SKILLED,62018,CDM,160,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,United Healthcare,Commercial,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ADMIN DAY INTERMEDIATE,72017,CDM,169,RC,,,,,facility,inpatient,,,1176.00000,668.14000,United Healthcare,Commercial,,1058.40,,,,,,,1058.40,3111.10,percent of total billed charges,
R&B ICU,32011,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,United Healthcare,Commercial,,7884.90,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,12013,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,United Healthcare,Commercial,,5256.90,,,,,,,2512.00,5665.77,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,United Healthcare,Commercial,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620529,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,United Healthcare,Commercial,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,United Healthcare,Commercial,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7690126,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,United Healthcare,Commercial,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,United Healthcare,Commercial,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,7690134,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,United Healthcare,Commercial,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,United Healthcare,Commercial,,547.20,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,7690050,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,United Healthcare,Commercial,,547.20,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,United Healthcare,Commercial,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,7690068,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,United Healthcare,Commercial,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,United Healthcare,Commercial,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,7690076,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,United Healthcare,Commercial,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,United Healthcare,Commercial,,192.60,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7690084,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,United Healthcare,Commercial,,192.60,,,,,,,55.64,207.58,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,84.00000,63.59000,United Healthcare,Commercial,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
CATH COLLECT SPEC URINE,7690183,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,United Healthcare,Commercial,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,United Healthcare,Commercial,,255.60,,,,,,,255.60,275.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,7690043,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,United Healthcare,Commercial,,255.60,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,United Healthcare,Commercial,,412.20,,,,,,,412.20,444.26,percent of total billed charges,
CHEMO IVP DRUG INITIAL,7690035,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,United Healthcare,Commercial,,412.20,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,United Healthcare,Commercial,,502.20,,,,,,,502.20,541.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,7690258,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,United Healthcare,Commercial,,502.20,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,United Healthcare,Commercial,,433.80,,,,,,,433.80,467.54,percent of total billed charges,
CHEMO INF IV 1ST HR,7690001,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,United Healthcare,Commercial,,433.80,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
CHEMO INF IV ADDL HR,7690019,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,United Healthcare,Commercial,,213.30,,,,,,,213.30,229.89,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,7690027,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,United Healthcare,Commercial,,213.30,,,,,,,61.62,229.89,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,inpatient,,,2041.00000,659.24000,United Healthcare,Commercial,,1836.90,,,,,,,1836.90,1979.77,percent of total billed charges,
ASP BLADDER CATH SUPRAPUB,7690142,CDM,361,RC,,,,,facility,outpatient,,,2041.00000,659.24000,United Healthcare,Commercial,,1836.90,,,,,,,530.66,1979.77,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,inpatient,,,259.00000,83.66000,United Healthcare,Commercial,,233.10,,,,,,,233.10,251.23,percent of total billed charges,
CHG TUBE CYSTO SIMPLE,7690621,CDM,361,RC,51705,CPT,,,facility,outpatient,,,259.00000,83.66000,United Healthcare,Commercial,,233.10,,,,,,,67.34,251.23,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,inpatient,,,672.00000,217.06000,United Healthcare,Commercial,,604.80,,,,,,,604.80,651.84,percent of total billed charges,
DEBRIDE TISSUE SKIN/SUBQ,7690647,CDM,361,RC,,,,,facility,outpatient,,,672.00000,217.06000,United Healthcare,Commercial,,604.80,,,,,,,174.72,651.84,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,inpatient,,,530.00000,171.19000,United Healthcare,Commercial,,477.00,,,,,,,477.00,514.10,percent of total billed charges,
I&D LVL 02 INTRM,7690472,CDM,361,RC,,,,,facility,outpatient,,,530.00000,171.19000,United Healthcare,Commercial,,477.00,,,,,,,137.80,514.10,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,inpatient,,,580.00000,187.34000,United Healthcare,Commercial,,522.00,,,,,,,522.00,562.60,percent of total billed charges,
I&D LVL 03 COMPLEX,7690480,CDM,361,RC,,,,,facility,outpatient,,,580.00000,187.34000,United Healthcare,Commercial,,522.00,,,,,,,150.80,562.60,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,inpatient,,,435.00000,140.50000,United Healthcare,Commercial,,391.50,,,,,,,391.50,421.95,percent of total billed charges,
I&D/ASP PUNCT LVL 01 SIMPLE,7690464,CDM,361,RC,,,,,facility,outpatient,,,435.00000,140.50000,United Healthcare,Commercial,,391.50,,,,,,,113.10,421.95,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,inpatient,,,863.00000,278.75000,United Healthcare,Commercial,,776.70,,,,,,,776.70,837.11,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7690217,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,United Healthcare,Commercial,,776.70,,,,,,,224.38,837.11,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,inpatient,,,334.00000,107.88000,United Healthcare,Commercial,,300.60,,,,,,,300.60,323.98,percent of total billed charges,
INJ/S ANES NRV BLOCK OTHER,7690274,CDM,361,RC,,,,,facility,outpatient,,,334.00000,107.88000,United Healthcare,Commercial,,300.60,,,,,,,86.84,323.98,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,inpatient,,,1188.00000,383.72000,United Healthcare,Commercial,50,1069.20,,,,,,,1069.20,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD BI,7623101,CDM,361,RC,64421,CPT,,,facility,outpatient,,,1188.00000,383.72000,United Healthcare,Commercial,50,1069.20,,,,,,,308.88,1152.36,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,inpatient,,,792.00000,255.82000,United Healthcare,Commercial,LT,712.80,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD LT,7623127,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,United Healthcare,Commercial,LT,712.80,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,inpatient,,,792.00000,255.82000,United Healthcare,Commercial,RT,712.80,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL ADD RT,7623119,CDM,361,RC,64421,CPT,,,facility,outpatient,,,792.00000,255.82000,United Healthcare,Commercial,RT,712.80,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,inpatient,,,572.00000,184.76000,United Healthcare,Commercial,50,514.80,,,,,,,514.80,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL BI,7623077,CDM,361,RC,64420,CPT,,,facility,outpatient,,,572.00000,184.76000,United Healthcare,Commercial,50,514.80,,,,,,,148.72,554.84,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,inpatient,,,381.00000,123.06000,United Healthcare,Commercial,LT,342.90,,,,,,,342.90,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL LT,7623093,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,United Healthcare,Commercial,LT,342.90,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,inpatient,,,381.00000,123.06000,United Healthcare,Commercial,RT,342.90,,,,,,,342.90,369.57,percent of total billed charges,
INJ/S ANES NRV INTRCST LVL SGL RT,7623085,CDM,361,RC,64420,CPT,,,facility,outpatient,,,381.00000,123.06000,United Healthcare,Commercial,RT,342.90,,,,,,,99.06,369.57,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,inpatient,,,455.00000,146.96000,United Healthcare,Commercial,,409.50,,,,,,,409.50,441.35,percent of total billed charges,
INJ/S ANES NRV TRIGEMINAL BR EA,7690555,CDM,361,RC,64400,CPT,,,facility,outpatient,,,455.00000,146.96000,United Healthcare,Commercial,,409.50,,,,,,,118.30,441.35,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,inpatient,,,403.00000,130.17000,United Healthcare,Commercial,,362.70,,,,,,,362.70,390.91,percent of total billed charges,
INJ/S SHTH TNDN SGL/LIG/AP,7690290,CDM,361,RC,,,,,facility,outpatient,,,403.00000,130.17000,United Healthcare,Commercial,,362.70,,,,,,,104.78,390.91,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,inpatient,,,370.00000,119.51000,United Healthcare,Commercial,,333.00,,,,,,,333.00,358.90,percent of total billed charges,
INJ/S TRIGGER PT/S MUSC/S,7690308,CDM,361,RC,,,,,facility,outpatient,,,370.00000,119.51000,United Healthcare,Commercial,,333.00,,,,,,,96.20,358.90,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,inpatient,,,357.00000,115.31000,United Healthcare,Commercial,,321.30,,,,,,,321.30,346.29,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7690167,CDM,361,RC,51703,CPT,,,facility,outpatient,,,357.00000,115.31000,United Healthcare,Commercial,,321.30,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,inpatient,,,334.00000,107.88000,United Healthcare,Commercial,,300.60,,,,,,,300.60,323.98,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7690159,CDM,361,RC,51702,CPT,,,facility,outpatient,,,334.00000,107.88000,United Healthcare,Commercial,,300.60,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,inpatient,,,194.00000,62.66000,United Healthcare,Commercial,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
INS CATH BLADDER NONINDWL,7690175,CDM,361,RC,51701,CPT,,,facility,outpatient,,,194.00000,62.66000,United Healthcare,Commercial,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,inpatient,,,457.00000,147.61000,United Healthcare,Commercial,,411.30,,,,,,,411.30,443.29,percent of total billed charges,
LAVAGE PERITONEAL/PARACENTESIS,7690340,CDM,361,RC,,,,,facility,outpatient,,,457.00000,147.61000,United Healthcare,Commercial,,411.30,,,,,,,118.82,443.29,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,inpatient,,,492.00000,158.92000,United Healthcare,Commercial,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
PROCEDURE IRRG BLADDER,7690316,CDM,361,RC,51700,CPT,,,facility,outpatient,,,492.00000,158.92000,United Healthcare,Commercial,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,inpatient,,,780.00000,251.94000,United Healthcare,Commercial,,702.00,,,,,,,702.00,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 01 SMPL,7690423,CDM,361,RC,,,,,facility,outpatient,,,780.00000,251.94000,United Healthcare,Commercial,,702.00,,,,,,,202.80,756.60,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,inpatient,,,1165.00000,376.30000,United Healthcare,Commercial,,1048.50,,,,,,,1048.50,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 02 INTRM,7690431,CDM,361,RC,,,,,facility,outpatient,,,1165.00000,376.30000,United Healthcare,Commercial,,1048.50,,,,,,,302.90,1130.05,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,inpatient,,,2350.00000,759.05000,United Healthcare,Commercial,,2115.00,,,,,,,2115.00,2279.50,percent of total billed charges,
PROCEDURE UNLIST LVL 03 CMPLX,7690449,CDM,361,RC,,,,,facility,outpatient,,,2350.00000,759.05000,United Healthcare,Commercial,,2115.00,,,,,,,611.00,2279.50,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,inpatient,,,896.00000,289.41000,United Healthcare,Commercial,,806.40,,,,,,,806.40,869.12,percent of total billed charges,
PUNCT LUMBAR,7690324,CDM,361,RC,,,,,facility,outpatient,,,896.00000,289.41000,United Healthcare,Commercial,,806.40,,,,,,,232.96,869.12,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,inpatient,,,490.00000,158.27000,United Healthcare,Commercial,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
RPR WOUND LVL 01 SIMPLE,7690654,CDM,361,RC,,,,,facility,outpatient,,,490.00000,158.27000,United Healthcare,Commercial,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,inpatient,,,520.00000,167.96000,United Healthcare,Commercial,,468.00,,,,,,,468.00,504.40,percent of total billed charges,
RPR WOUND LVL 02 INTERMEDIATE,7690662,CDM,361,RC,,,,,facility,outpatient,,,520.00000,167.96000,United Healthcare,Commercial,,468.00,,,,,,,135.20,504.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,inpatient,,,720.00000,232.56000,United Healthcare,Commercial,,648.00,,,,,,,648.00,698.40,percent of total billed charges,
RPR WOUND LVL 03 COMPLEX,7690670,CDM,361,RC,,,,,facility,outpatient,,,720.00000,232.56000,United Healthcare,Commercial,,648.00,,,,,,,187.20,698.40,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,inpatient,,,215.00000,69.45000,United Healthcare,Commercial,,193.50,,,,,,,193.50,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY LOWER,7690357,CDM,361,RC,,,,,facility,outpatient,,,215.00000,69.45000,United Healthcare,Commercial,,193.50,,,,,,,55.90,208.55,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,inpatient,,,240.00000,77.52000,United Healthcare,Commercial,,216.00,,,,,,,216.00,232.80,percent of total billed charges,
SPLINT/STRAP EXTREMITY UPPER,7690365,CDM,361,RC,,,,,facility,outpatient,,,240.00000,77.52000,United Healthcare,Commercial,,216.00,,,,,,,62.40,232.80,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,inpatient,,,1241.00000,400.84000,United Healthcare,Commercial,,1116.90,,,,,,,1116.90,1203.77,percent of total billed charges,
THORACENT/TUBE CHEST/DRN PLEURAL,7690373,CDM,361,RC,,,,,facility,outpatient,,,1241.00000,400.84000,United Healthcare,Commercial,,1116.90,,,,,,,322.66,1203.77,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,United Healthcare,Commercial,,757.80,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7690381,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,United Healthcare,Commercial,,757.80,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,United Healthcare,Commercial,,947.70,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7690399,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,United Healthcare,Commercial,,947.70,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,United Healthcare,Commercial,,1136.70,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7690407,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,United Healthcare,Commercial,,1136.70,,,,,,,328.38,1225.11,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,inpatient,,,668.00000,559.78000,United Healthcare,Commercial,,601.20,,,,,,,601.20,647.96,percent of total billed charges,
ADMISSION DIRECT OBSERVATION HOSP,7690415,CDM,760,RC,G0379,HCPCS,,,facility,outpatient,,,668.00000,559.78000,United Healthcare,Commercial,,601.20,,,,,,,173.68,647.96,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,United Healthcare,Commercial,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7690225,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,United Healthcare,Commercial,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,United Healthcare,Commercial,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7690233,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,United Healthcare,Commercial,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,United Healthcare,Commercial,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,7690092,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,United Healthcare,Commercial,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,United Healthcare,Commercial,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7690118,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,United Healthcare,Commercial,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,United Healthcare,Commercial,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7690100,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,United Healthcare,Commercial,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,United Healthcare,Commercial,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,7690282,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,United Healthcare,Commercial,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,United Healthcare,Commercial,,3.06,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,6872626,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,United Healthcare,Commercial,,3.06,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,United Healthcare,Commercial,,3.06,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,6872634,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,United Healthcare,Commercial,,3.06,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,3.40000,1.93000,United Healthcare,Commercial,,3.06,,,,,,,3.06,3.30,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,6872642,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,3.40000,1.93000,United Healthcare,Commercial,,3.06,,,,,,,0.88400,3.30,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,4.90000,2.78000,United Healthcare,Commercial,,4.41,,,,,,,4.41,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,6869291,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,United Healthcare,Commercial,,4.41,,,,,,,1.27,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,7.90000,4.49000,United Healthcare,Commercial,,7.11,,,,,,,7.11,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,6869317,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,7.90000,4.49000,United Healthcare,Commercial,,7.11,,,,,,,2.05,7.66,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,4.90000,2.78000,United Healthcare,Commercial,,4.41,,,,,,,4.41,4.75,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,6869325,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,4.90000,2.78000,United Healthcare,Commercial,,4.41,,,,,,,1.27,4.75,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,inpatient,,,81.00000,44.14000,United Healthcare,Commercial,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE HEPATITIS B,6824478,CDM,771,RC,G0010,HCPCS,,,facility,outpatient,,,81.00000,44.14000,United Healthcare,Commercial,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,inpatient,,,81.00000,44.14000,United Healthcare,Commercial,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE INFLUENZA,6824379,CDM,771,RC,G0008,HCPCS,,,facility,outpatient,,,81.00000,44.14000,United Healthcare,Commercial,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,inpatient,,,81.00000,44.14000,United Healthcare,Commercial,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
ADMIN FEE PNEUMOCOCCAL,6824361,CDM,771,RC,G0009,HCPCS,,,facility,outpatient,,,81.00000,44.14000,United Healthcare,Commercial,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LIFILEUCEL TIL/DOSE 7.5B-72B SNIJ,6883060,CDM,891,RC,J9999,HCPCS,,,facility,inpatient,,,3141500.00000,1784843.22000,United Healthcare,Commercial,,2827350.00,,,,,,,2827350.00,3047255.00,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.22000,0.12000,United Healthcare,Commercial,UD,0.19800,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 2KU SNIJ,8483315,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.22000,0.12000,United Healthcare,Commercial,UD,0.19800,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.52000,0.30000,United Healthcare,Commercial,UD,0.46800,,,,,,,0.46800,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 3KU SNIJ,8483323,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.52000,0.30000,United Healthcare,Commercial,UD,0.46800,,,,,,,0.13520,0.50440,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,inpatient,,,0.56000,0.32000,United Healthcare,Commercial,UD,0.50400,,,,,,,0.50400,0.54320,percent of total billed charges,
EPO ALFA EPBX ESRD/100U 4KU SNIJ,8483331,CDM,634,RC,Q5105,HCPCS,,,facility,outpatient,,,0.56000,0.32000,United Healthcare,Commercial,UD,0.50400,,,,,,,0.14560,0.54320,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.22000,0.12000,United Healthcare,Commercial,UD,0.19800,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 2KU SNIJ,8480139,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,United Healthcare,Commercial,UD,0.19800,,,,,,,0.05720,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.85000,0.48000,United Healthcare,Commercial,UD,0.76500,,,,,,,0.76500,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 3KU SNIJ,8480154,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.85000,0.48000,United Healthcare,Commercial,UD,0.76500,,,,,,,0.22100,0.82450,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,inpatient,,,0.22000,0.12000,United Healthcare,Commercial,UD,0.19800,,,,,,,0.19800,0.21340,percent of total billed charges,
EPO ALFA ESRD/100U 4KU SNIJ,8480162,CDM,634,RC,Q4081,HCPCS,,,facility,outpatient,,,0.22000,0.12000,United Healthcare,Commercial,UD,0.19800,,,,,,,0.05720,0.21340,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,inpatient,,,102.00000,65.18000,United Healthcare,Commercial,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
BAG DRAINAGE LVL 01,2777464,CDM,271,RC,,,,,facility,outpatient,,,102.00000,65.18000,United Healthcare,Commercial,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,inpatient,,,190.00000,121.41000,United Healthcare,Commercial,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
BAG DRAINAGE LVL 02,2777407,CDM,271,RC,,,,,facility,outpatient,,,190.00000,121.41000,United Healthcare,Commercial,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,inpatient,,,359.00000,229.40000,United Healthcare,Commercial,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
BAG DRAINAGE LVL 03,2777415,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,United Healthcare,Commercial,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,inpatient,,,535.00000,341.86000,United Healthcare,Commercial,,481.50,,,,,,,481.50,518.95,percent of total billed charges,
BAG DRAINAGE LVL 04,6278766,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,United Healthcare,Commercial,,481.50,,,,,,,139.10,518.95,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,inpatient,,,766.00000,489.47000,United Healthcare,Commercial,,689.40,,,,,,,689.40,743.02,percent of total billed charges,
BAG DRAINAGE LVL 05,6278774,CDM,271,RC,,,,,facility,outpatient,,,766.00000,489.47000,United Healthcare,Commercial,,689.40,,,,,,,199.16,743.02,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,inpatient,,,159.00000,101.60000,United Healthcare,Commercial,,143.10,,,,,,,143.10,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 01,6280291,CDM,271,RC,,,,,facility,outpatient,,,159.00000,101.60000,United Healthcare,Commercial,,143.10,,,,,,,41.34,154.23,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,inpatient,,,447.00000,285.63000,United Healthcare,Commercial,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
BRA SURG POSTOP LVL 02,2770469,CDM,271,RC,,,,,facility,outpatient,,,447.00000,285.63000,United Healthcare,Commercial,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 01,2770329,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 02,2778009,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,inpatient,,,1413.00000,902.91000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 03,6276257,CDM,271,RC,,,,,facility,outpatient,,,1413.00000,902.91000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,inpatient,,,3853.00000,2462.07000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
HYPO-HYPER THERMAL LVL 04,6279343,CDM,271,RC,,,,,facility,outpatient,,,3853.00000,2462.07000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMMOBILIZER LVL 01,2772408,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,inpatient,,,313.00000,200.01000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMMOBILIZER LVL 02,2772416,CDM,271,RC,,,,,facility,outpatient,,,313.00000,200.01000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMMOBILIZER LVL 03,2772424,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,inpatient,,,1132.00000,723.35000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMMOBILIZER LVL 04,2772432,CDM,271,RC,,,,,facility,outpatient,,,1132.00000,723.35000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,inpatient,,,2695.00000,1722.10000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
PATCH EP REFSTAR LVL 03,6276711,CDM,271,RC,,,,,facility,outpatient,,,2695.00000,1722.10000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,inpatient,,,1619.00000,1034.54000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
SENSOR CEREBRAL OXIMETER LVL 02,6280317,CDM,271,RC,,,,,facility,outpatient,,,1619.00000,1034.54000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,inpatient,,,166.00000,106.07000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
SLEEVE SCD LVL 01,2776250,CDM,271,RC,,,,,facility,outpatient,,,166.00000,106.07000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,inpatient,,,535.00000,341.86000,United Healthcare,Commercial,,481.50,,,,,,,481.50,518.95,percent of total billed charges,
SLEEVE SCD LVL 02,2776268,CDM,271,RC,,,,,facility,outpatient,,,535.00000,341.86000,United Healthcare,Commercial,,481.50,,,,,,,139.10,518.95,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,inpatient,,,850.00000,543.15000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
SLEEVE SCD LVL 03,2776276,CDM,271,RC,,,,,facility,outpatient,,,850.00000,543.15000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,inpatient,,,32.00000,20.45000,United Healthcare,Commercial,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 01,6275101,CDM,271,RC,,,,,facility,outpatient,,,32.00000,20.45000,United Healthcare,Commercial,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,inpatient,,,134.00000,85.63000,United Healthcare,Commercial,,120.60,,,,,,,120.60,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 02,2773570,CDM,271,RC,,,,,facility,outpatient,,,134.00000,85.63000,United Healthcare,Commercial,,120.60,,,,,,,34.84,129.98,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,inpatient,,,359.00000,229.40000,United Healthcare,Commercial,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 03,2773588,CDM,271,RC,,,,,facility,outpatient,,,359.00000,229.40000,United Healthcare,Commercial,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,inpatient,,,709.00000,453.05000,United Healthcare,Commercial,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
SUPPLY OSTOMY LVL 04,2773596,CDM,271,RC,,,,,facility,outpatient,,,709.00000,453.05000,United Healthcare,Commercial,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,inpatient,,,594.00000,379.57000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
VEST AIRWAY DISPOSABLE LVL 01,6275275,CDM,271,RC,,,,,facility,outpatient,,,594.00000,379.57000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
ADHESIVE LVL 01,6289615,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
ADHESIVE LVL 02,6289623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
ADHESIVE LVL 03,6289631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
ADHESIVE LVL 04,6289649,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
ADHESIVE LVL 05,6289656,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
ADHESIVE LVL 06,6289664,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
ADHESIVE LVL 07,6289672,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
ADHESIVE LVL 08,6289680,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 01,6312540,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 02,6312557,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 03,6312565,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
ADHSN BARRIER IMP <30DAYS LVL 04,6312573,CDM,272,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
BIT LVL 01,2777449,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
BIT LVL 02,2777456,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
BIT LVL 03,2770170,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
BIT LVL 04,2777266,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
BIT LVL 05,2777274,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
BIT LVL 06,2777282,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
BIT LVL 07,6271142,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,inpatient,,,4880.00000,2357.04000,United Healthcare,Commercial,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
BIT LVL 08,6271159,CDM,272,RC,,,,,facility,outpatient,,,4880.00000,2357.04000,United Healthcare,Commercial,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,inpatient,,,6024.00000,2909.59000,United Healthcare,Commercial,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
BIT LVL 09,6276034,CDM,272,RC,,,,,facility,outpatient,,,6024.00000,2909.59000,United Healthcare,Commercial,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
BLADE LVL 01,2777290,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
BLADE LVL 02,2777308,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,United Healthcare,Commercial,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
BLADE LVL 03,2777316,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,United Healthcare,Commercial,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
BLADE LVL 04,2777324,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
BLADE LVL 05,2777340,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
BLADE LVL 06,2777357,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
BLADE LVL 07,2770287,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
BLADE LVL 08,2777365,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,United Healthcare,Commercial,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
BLADE LVL 09,2777332,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,United Healthcare,Commercial,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
BLADE LVL 10,2777373,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,inpatient,,,7413.00000,3580.48000,United Healthcare,Commercial,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
BLADE LVL 11,2777944,CDM,272,RC,,,,,facility,outpatient,,,7413.00000,3580.48000,United Healthcare,Commercial,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
BLADE LVL 12,2777969,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
BOWL CELL SAVER LVL 01,2770451,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
BRUSH LVL 01,2770485,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,United Healthcare,Commercial,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
BRUSH LVL 02,2770477,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,United Healthcare,Commercial,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
BRUSH LVL 03,2778918,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
BRUSH LVL 04,6283949,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
BURR LVL 01,2770519,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
BURR LVL 02,2770527,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,United Healthcare,Commercial,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
BURR LVL 03,2770535,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,United Healthcare,Commercial,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
BURR LVL 04,2770543,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
BURR LVL 05,2770550,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
BURR LVL 06,2770568,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
BURR LVL 07,2778926,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
BUTTON SEPTAL LVL 01,2770576,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CANNULA LVL 01,2770634,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CANNULA LVL 02,2770642,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CANNULA LVL 03,2770659,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CANNULA LVL 04,2770667,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CANNULA LVL 05,2770683,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CANNULA LVL 06,6271217,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
CANNULA LVL 07,6271225,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,United Healthcare,Commercial,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
CANNULA LVL 08,6271233,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,United Healthcare,Commercial,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
CANNULA LVL 09,6275135,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,inpatient,,,7181.00000,3468.42000,United Healthcare,Commercial,,6462.90,,,,,,,6462.90,6965.57,percent of total billed charges,
CANNULA LVL 10,6278444,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,United Healthcare,Commercial,,6462.90,,,,,,,1867.06,6965.57,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,inpatient,,,10654.00000,5145.88000,United Healthcare,Commercial,,9588.60,,,,,,,9588.60,10334.38,percent of total billed charges,
CANNULA LVL 11,6278451,CDM,272,RC,,,,,facility,outpatient,,,10654.00000,5145.88000,United Healthcare,Commercial,,9588.60,,,,,,,2770.04,10334.38,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 05,2770741,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,6487.00000,3133.22000,United Healthcare,Commercial,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 06,6275762,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,United Healthcare,Commercial,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,7413.00000,3580.48000,United Healthcare,Commercial,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 07,6275770,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,United Healthcare,Commercial,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 08,6279202,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,11575.00000,5590.72000,United Healthcare,Commercial,,10417.50,,,,,,,10417.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 09,6279210,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,11575.00000,5590.72000,United Healthcare,Commercial,,10417.50,,,,,,,3009.50,11227.75,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,inpatient,,,13432.00000,6487.66000,United Healthcare,Commercial,,12088.80,,,,,,,12088.80,13029.04,percent of total billed charges,
CATH ABL COOL-TIP LVL 10,6279228,CDM,272,RC,C2630,HCPCS,,,facility,outpatient,,,13432.00000,6487.66000,United Healthcare,Commercial,,12088.80,,,,,,,3492.32,13029.04,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 01,2770758,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 02,2779056,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 03,2779064,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 04,2779072,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 05,2779080,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,inpatient,,,21904.00000,10579.63000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
CATH ABL EP 3D/VECTOR LVL 06,2779098,CDM,272,RC,C1732,HCPCS,,,facility,outpatient,,,21904.00000,10579.63000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 01,2770766,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 02,2771350,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 03,2771368,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 04,2771376,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ABL EP NON 3D/VECTOR LVL 05,6278717,CDM,272,RC,C1733,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 01,6275911,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ABL NONCARDIAC LVL 02,6275929,CDM,272,RC,C1888,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 01,2770774,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 02,2771384,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 03,6274468,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ANGIO TRANSL LASER LVL 04,6275325,CDM,272,RC,C1885,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 01,2770782,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 02,2771673,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 03,2771681,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 04,2771699,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 05,2771707,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,4397.00000,2123.75000,United Healthcare,Commercial,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 06,2771723,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,United Healthcare,Commercial,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 07,2771731,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,7413.00000,3580.48000,United Healthcare,Commercial,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 08,2771749,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,7413.00000,3580.48000,United Healthcare,Commercial,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 09,2771756,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,inpatient,,,12969.00000,6264.03000,United Healthcare,Commercial,,11672.10,,,,,,,11672.10,12579.93,percent of total billed charges,
CATH ANGIO TRANSL NONLASER LVL 10,6271241,CDM,272,RC,C1725,HCPCS,,,facility,outpatient,,,12969.00000,6264.03000,United Healthcare,Commercial,,11672.10,,,,,,,3371.94,12579.93,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 01,2770790,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 02,2779106,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL DIRECT LVL 03,6276083,CDM,272,RC,C1714,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 01,2770808,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 02,2779114,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH ATHERECT TRANSL ROTAT LVL 03,6274518,CDM,272,RC,C1724,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 01,2770824,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 02,2779189,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 03,2779197,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 04,2779205,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH BALLOON DILAT NONVASC LVL 05,2779213,CDM,272,RC,C1726,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CATH BALLOON LVL 01,2770816,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH BALLOON LVL 02,2779122,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH BALLOON LVL 03,2779130,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH BALLOON LVL 04,2779148,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH BALLOON LVL 05,2779155,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON LVL 06,2779163,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON LVL 07,2779171,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 08,6272405,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH BALLOON LVL 09,6272413,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH BALLOON LVL 10,6272421,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH BALLOON LVL 11,6272439,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 01,2771020,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 02,2771624,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 03,2771970,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH BALLOON PACING LVL 04,2771988,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 01,2770865,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 02,2779247,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 03,2779254,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 04,2779262,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,United Healthcare,Commercial,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 05,2783801,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,United Healthcare,Commercial,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,United Healthcare,Commercial,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH CHOLANGIOGRAM LVL 06,2783819,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,United Healthcare,Commercial,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,United Healthcare,Commercial,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 01,2770857,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,United Healthcare,Commercial,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,inpatient,,,134.00000,64.72000,United Healthcare,Commercial,,120.60,,,,,,,120.60,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 02,2779270,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,United Healthcare,Commercial,,120.60,,,,,,,34.84,129.98,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,inpatient,,,251.00000,121.23000,United Healthcare,Commercial,,225.90,,,,,,,225.90,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 03,2779288,CDM,272,RC,,,,,facility,outpatient,,,251.00000,121.23000,United Healthcare,Commercial,,225.90,,,,,,,65.26,243.47,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 04,2779296,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 05,2779304,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 06,2779312,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 07,2779320,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 08,2779338,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 09,2779346,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH DIAGNOSTIC LVL 10,6274682,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 01,6312607,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 02,6312615,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 03,6312623,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH DRAINAGE IMP <30DAYS LVL 04,6312631,CDM,272,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH ENDOBRONCHIAL LVL 01,2770899,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 01,2770873,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 02,2779353,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 03,2779361,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 04,2779379,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 05,2779387,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 06,2779395,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 07,6271258,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH EP NON 3D 1-19 LVL 08,6271266,CDM,272,RC,C1730,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 01,2770881,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 02,2771715,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 03,6274039,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 04,6274047,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,inpatient,,,17524.00000,8464.09000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
CATH EP NON 3D 20+ LVL 05,6274054,CDM,272,RC,C1731,HCPCS,,,facility,outpatient,,,17524.00000,8464.09000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH ERCP LVL 01,2778017,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH FEEDING LVL 01,2770907,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH FEEDING LVL 02,2771764,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CATH GUIDE LVL 01,2770915,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH GUIDE LVL 02,2779403,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,447.00000,215.90000,United Healthcare,Commercial,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
CATH GUIDE LVL 03,2779411,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,447.00000,215.90000,United Healthcare,Commercial,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH GUIDE LVL 04,2779429,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH GUIDE LVL 05,2779437,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH GUIDE LVL 06,2779445,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,2827.00000,1365.44000,United Healthcare,Commercial,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH GUIDE LVL 07,2779452,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,United Healthcare,Commercial,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH GUIDE LVL 08,6271274,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH GUIDE LVL 09,6271282,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
CATH GUIDE LVL 10,6278188,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH GUIDE LVL 11,6278196,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH GUIDE LVL 12,6278204,CDM,272,RC,C1887,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 01,2770923,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 02,2779460,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 03,2779478,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH HEM/PER SHORT TERM LVL 04,2779486,CDM,272,RC,C1752,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH HYDROPHYLIC LVL 01,2770949,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 01,2770956,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 02,2771772,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 03,2771780,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 04,2771798,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 05,2771806,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 06,2771814,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 07,2771822,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 08,2771830,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INF NON HEMODIALYSIS LVL 09,2771848,CDM,272,RC,C1751,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,2690.00000,1299.27000,United Healthcare,Commercial,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 01,6276661,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,United Healthcare,Commercial,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 02,2770964,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,6487.00000,3133.22000,United Healthcare,Commercial,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 03,6275531,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,6487.00000,3133.22000,United Healthcare,Commercial,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 04,6276927,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 05,6276935,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH INTRACARDIAC ECHO LVL 06,6278246,CDM,272,RC,C1759,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 01,6288468,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 02,6288476,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 03,6288484,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 04,2770980,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 05,6275028,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH INTRASPINAL LVL 06,6275036,CDM,272,RC,C1755,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 01,2777639,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 02,2771855,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 03,2771871,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 04,2771889,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INTRAUTERN/HYST LVL 05,2771897,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 01,2770998,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,2426.00000,1171.76000,United Healthcare,Commercial,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 02,2771905,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,2426.00000,1171.76000,United Healthcare,Commercial,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 03,2771863,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 04,6275085,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 05,6278113,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 06,6278121,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 07,6278139,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 08,6279665,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,inpatient,,,15334.00000,7406.32000,United Healthcare,Commercial,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
CATH INTRAVASCULAR US LVL 09,6279673,CDM,272,RC,C1753,HCPCS,,,facility,outpatient,,,15334.00000,7406.32000,United Healthcare,Commercial,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH OCCLUSION LVL 01,2771012,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 02,2771921,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 03,2771939,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 04,2771947,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 05,2771954,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
CATH OCCLUSION LVL 06,2771962,CDM,272,RC,C2628,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 01,2771046,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 02,2771996,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,United Healthcare,Commercial,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 03,2772010,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,United Healthcare,Commercial,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
CATH SPINAL/NEURO LVL 04,2772028,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,251.00000,121.23000,United Healthcare,Commercial,,225.90,,,,,,,225.90,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 01,2771053,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,251.00000,121.23000,United Healthcare,Commercial,,225.90,,,,,,,65.26,243.47,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 02,2776854,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 03,2776862,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH SUPRAPUBIC/CYSTOSCOPIC LVL 04,2776870,CDM,272,RC,C2627,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 01,2771061,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 02,2775583,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 03,2775591,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 04,2775609,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 05,2775526,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 06,2775534,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 07,2775542,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CATH THROMBECTOMY/EMBOLECTMY LVL 08,6276638,CDM,272,RC,C1757,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH URETERAL LVL 01,2771079,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH URETERAL LVL 02,2775559,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH URETERAL LVL 03,2775567,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,inpatient,,,2827.00000,1365.44000,United Healthcare,Commercial,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
CATH URETERAL LVL 04,2775575,CDM,272,RC,C1758,HCPCS,,,facility,outpatient,,,2827.00000,1365.44000,United Healthcare,Commercial,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,United Healthcare,Commercial,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
CATH URETHRAL LVL 01,6284996,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,United Healthcare,Commercial,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CATH URETHRAL LVL 02,2771087,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH URETHRAL LVL 03,2775070,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH URETHRAL LVL 04,2775088,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 05,2775096,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CATH URETHRAL LVL 06,2775054,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CATH URETHRAL LVL 07,6289979,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 01,2773679,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 02,2779890,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 03,6280283,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 04,6281646,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
CATH/WIRE/SUTURE PASSER LVL 05,6281653,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 01,2771202,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 02,2778025,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 03,2778512,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 04,6271332,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 05,6271340,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 06,6271357,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 07,6273494,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,inpatient,,,15334.00000,7406.32000,United Healthcare,Commercial,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
CEMENT ACCESSORIES LVL 08,6273502,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,United Healthcare,Commercial,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CLIP APPLIER LVL 01,2770055,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
CLIP APPLIER LVL 02,2770063,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
CLIP APPLIER LVL 03,2777399,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
CLIP APPLIER LVL 04,6273585,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
CLIP LVL 01,2771277,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
CLIP LVL 02,2778041,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
CLIP LVL 03,6271365,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
CLIP LVL 04,6274013,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,inpatient,,,1485.00000,717.26000,United Healthcare,Commercial,,1336.50,,,,,,,1336.50,1440.45,percent of total billed charges,
CLIP LVL 05,6280341,CDM,272,RC,,,,,facility,outpatient,,,1485.00000,717.26000,United Healthcare,Commercial,,1336.50,,,,,,,386.10,1440.45,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,inpatient,,,2028.00000,979.52000,United Healthcare,Commercial,,1825.20,,,,,,,1825.20,1967.16,percent of total billed charges,
CLIP LVL 06,6280358,CDM,272,RC,,,,,facility,outpatient,,,2028.00000,979.52000,United Healthcare,Commercial,,1825.20,,,,,,,527.28,1967.16,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 01,2771327,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
COIL IMAGING MAGNETIC RESON LVL 02,2778967,CDM,272,RC,C1770,HCPCS,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE ABLATION LVL 01,6288690,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 02,6281380,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 03,6281398,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 04,6281406,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 05,6281414,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 06,6281422,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 07,6281430,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
DEVICE ABLATION LVL 08,6281448,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 01,6280838,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 02,6280846,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 03,6280853,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 04,6280861,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 05,6280879,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 06,6280887,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 07,6280895,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 08,6280903,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 09,6280911,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 10,6280929,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
DEVICE CLOSURE TISSUE LVL 11,6280937,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 01,6281208,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 02,6281216,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 03,6281224,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 04,6281232,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 05,6281240,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 06,6281257,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 07,6281265,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
DEVICE FIXATION DISP LVL 08,6281323,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 01,6281117,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 02,6281125,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 03,6281133,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 04,6281141,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 05,6281158,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 06,6281166,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE INFLATION DISP LVL 07,6281174,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 01,2775781,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 02,6274401,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 03,6274419,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,4397.00000,2123.75000,United Healthcare,Commercial,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 04,6278683,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,4397.00000,2123.75000,United Healthcare,Commercial,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 05,6281489,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,8107.00000,3915.68000,United Healthcare,Commercial,,7296.30,,,,,,,7296.30,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 06,6281497,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,8107.00000,3915.68000,United Healthcare,Commercial,,7296.30,,,,,,,2107.82,7863.79,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,10422.00000,5033.83000,United Healthcare,Commercial,,9379.80,,,,,,,9379.80,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 07,6281505,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,10422.00000,5033.83000,United Healthcare,Commercial,,9379.80,,,,,,,2709.72,10109.34,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,12737.00000,6151.97000,United Healthcare,Commercial,,11463.30,,,,,,,11463.30,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 08,6281513,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,12737.00000,6151.97000,United Healthcare,Commercial,,11463.30,,,,,,,3311.62,12354.89,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,14239.00000,6877.44000,United Healthcare,Commercial,,12815.10,,,,,,,12815.10,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 09,6281521,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,14239.00000,6877.44000,United Healthcare,Commercial,,12815.10,,,,,,,3702.14,13811.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,16429.00000,7935.21000,United Healthcare,Commercial,,14786.10,,,,,,,14786.10,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 10,6281539,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,16429.00000,7935.21000,United Healthcare,Commercial,,14786.10,,,,,,,4271.54,15936.13,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,18619.00000,8992.98000,United Healthcare,Commercial,,16757.10,,,,,,,16757.10,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 11,6281547,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,18619.00000,8992.98000,United Healthcare,Commercial,,16757.10,,,,,,,4840.94,18060.43,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,20809.00000,10050.75000,United Healthcare,Commercial,,18728.10,,,,,,,18728.10,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 12,6281554,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,20809.00000,10050.75000,United Healthcare,Commercial,,18728.10,,,,,,,5410.34,20184.73,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,22999.00000,11108.52000,United Healthcare,Commercial,,20699.10,,,,,,,20699.10,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 13,6281562,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,22999.00000,11108.52000,United Healthcare,Commercial,,20699.10,,,,,,,5979.74,22309.03,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,25189.00000,12166.29000,United Healthcare,Commercial,,22670.10,,,,,,,22670.10,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 14,6281570,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,25189.00000,12166.29000,United Healthcare,Commercial,,22670.10,,,,,,,6549.14,24433.33,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,27379.00000,13224.06000,United Healthcare,Commercial,,24641.10,,,,,,,24641.10,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 15,6281588,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,27379.00000,13224.06000,United Healthcare,Commercial,,24641.10,,,,,,,7118.54,26557.63,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,29569.00000,14281.83000,United Healthcare,Commercial,,26612.10,,,,,,,26612.10,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 16,6281596,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,29569.00000,14281.83000,United Healthcare,Commercial,,26612.10,,,,,,,7687.94,28681.93,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,31759.00000,15339.60000,United Healthcare,Commercial,,28583.10,,,,,,,28583.10,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 17,6281604,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,31759.00000,15339.60000,United Healthcare,Commercial,,28583.10,,,,,,,8257.34,30806.23,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,inpatient,,,36139.00000,17455.14000,United Healthcare,Commercial,,32525.10,,,,,,,32525.10,35054.83,percent of total billed charges,
DEVICE INSERT RETRV LVL 18,6286678,CDM,272,RC,C1773,HCPCS,,,facility,outpatient,,,36139.00000,17455.14000,United Healthcare,Commercial,,32525.10,,,,,,,9396.14,35054.83,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 01,6313001,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 02,6313019,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 03,6313027,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 04,6313035,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 05,6313043,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 06,6313050,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 07,6313068,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 08,6313076,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
DEVICE SYS HEM CNTRL UTR VAC LVL 09,6313084,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 01,2771418,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 02,2779007,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 03,2779015,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 04,2779023,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
DIALYSIS ACCESSORIES LVL 05,6274575,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
DILATOR LVL 01,2771426,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DILATOR LVL 02,2771434,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
DILATOR LVL 03,2771442,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
DILATOR LVL 04,2771459,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DILATOR LVL 05,2771467,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,United Healthcare,Commercial,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
DILATOR LVL 06,6275226,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,United Healthcare,Commercial,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
DILATOR LVL 07,6277008,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,United Healthcare,Commercial,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
DRAIN LVL 01,6285001,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,United Healthcare,Commercial,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,inpatient,,,134.00000,64.72000,United Healthcare,Commercial,,120.60,,,,,,,120.60,129.98,percent of total billed charges,
DRAIN LVL 02,2771475,CDM,272,RC,,,,,facility,outpatient,,,134.00000,64.72000,United Healthcare,Commercial,,120.60,,,,,,,34.84,129.98,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DRAIN LVL 03,2771483,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DRAIN LVL 04,2771491,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DRAIN LVL 05,2771509,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 01,2771533,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 02,2778132,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 03,2778140,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 04,2779031,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DRAIN REINFUSION LVL 05,2779049,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,United Healthcare,Commercial,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 01,2771558,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,United Healthcare,Commercial,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,inpatient,,,476.00000,229.91000,United Healthcare,Commercial,,428.40,,,,,,,428.40,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 02,2778157,CDM,272,RC,,,,,facility,outpatient,,,476.00000,229.91000,United Healthcare,Commercial,,428.40,,,,,,,123.76,461.72,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 03,2778165,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
DRAIN W ACCESSORIES LVL 04,2778173,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,United Healthcare,Commercial,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 01,6284863,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,United Healthcare,Commercial,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 02,2771566,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 03,2771574,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 04,2771582,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 05,2771590,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 06,2771608,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 07,2779569,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 08,6277917,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 09,6279699,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
DRESSING SPECIALTY LVL 10,6279707,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 01,2771095,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 02,2771103,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,United Healthcare,Commercial,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 03,2771111,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,United Healthcare,Commercial,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 04,2771129,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 05,2771145,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 06,2771152,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 07,2771160,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 08,2771178,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 09,6271324,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 10,6271290,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 11,6271308,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,inpatient,,,12506.00000,6040.40000,United Healthcare,Commercial,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
ELECTRODE ELECTROSURGICAL LVL 12,6271316,CDM,272,RC,,,,,facility,outpatient,,,12506.00000,6040.40000,United Healthcare,Commercial,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
ERASER OPHTHALMIC LVL 01,2773539,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,inpatient,,,2404.80000,1161.52000,United Healthcare,Commercial,,2164.32,,,,,,,2164.32,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 10ML,6307953,CDM,272,RC,,,,,facility,outpatient,,,2404.80000,1161.52000,United Healthcare,Commercial,,2164.32,,,,,,,625.25,2332.66,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,inpatient,,,969.00000,468.03000,United Healthcare,Commercial,,872.10,,,,,,,872.10,939.93,percent of total billed charges,
FBR SLNT TISSEEL W DPLJECT SYS 4ML,6307979,CDM,272,RC,,,,,facility,outpatient,,,969.00000,468.03000,United Healthcare,Commercial,,872.10,,,,,,,251.94,939.93,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,inpatient,,,2256.90000,1090.08000,United Healthcare,Commercial,,2031.21,,,,,,,2031.21,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 10ML SYR,6307987,CDM,272,RC,,,,,facility,outpatient,,,2256.90000,1090.08000,United Healthcare,Commercial,,2031.21,,,,,,,586.79,2189.19,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,inpatient,,,644.30000,311.20000,United Healthcare,Commercial,,579.87,,,,,,,579.87,624.97,percent of total billed charges,
FBR SLNT TISSEEL W PRIMA 4ML SYR,6307995,CDM,272,RC,,,,,facility,outpatient,,,644.30000,311.20000,United Healthcare,Commercial,,579.87,,,,,,,167.52,624.97,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,United Healthcare,Commercial,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 01,2793552,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,United Healthcare,Commercial,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,United Healthcare,Commercial,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 02,2793560,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,United Healthcare,Commercial,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 03,2793578,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 04,2793586,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 05,2793594,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 06,2793602,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 07,2793610,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 08,2793628,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 09,2793636,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 10,2793644,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 11,2793651,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 12,2793669,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 13,2793677,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 14,2793685,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,inpatient,,,26284.00000,12695.17000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 15,2793693,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,inpatient,,,30664.00000,14810.71000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 16,2793701,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,inpatient,,,35044.00000,16926.25000,United Healthcare,Commercial,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 17,2793719,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,United Healthcare,Commercial,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,inpatient,,,43804.00000,21157.33000,United Healthcare,Commercial,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 18,2793727,CDM,272,RC,,,,,facility,outpatient,,,43804.00000,21157.33000,United Healthcare,Commercial,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,inpatient,,,52564.00000,25388.41000,United Healthcare,Commercial,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 19,2793735,CDM,272,RC,,,,,facility,outpatient,,,52564.00000,25388.41000,United Healthcare,Commercial,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,inpatient,,,61324.00000,29619.49000,United Healthcare,Commercial,,55191.60,,,,,,,55191.60,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 20,2793743,CDM,272,RC,,,,,facility,outpatient,,,61324.00000,29619.49000,United Healthcare,Commercial,,55191.60,,,,,,,15944.24,59484.28,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,inpatient,,,70084.00000,33850.57000,United Healthcare,Commercial,,63075.60,,,,,,,63075.60,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 21,2793750,CDM,272,RC,,,,,facility,outpatient,,,70084.00000,33850.57000,United Healthcare,Commercial,,63075.60,,,,,,,18221.84,67981.48,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,inpatient,,,78844.00000,38081.65000,United Healthcare,Commercial,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 22,2793768,CDM,272,RC,,,,,facility,outpatient,,,78844.00000,38081.65000,United Healthcare,Commercial,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,inpatient,,,87604.00000,42312.73000,United Healthcare,Commercial,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 23,2793776,CDM,272,RC,,,,,facility,outpatient,,,87604.00000,42312.73000,United Healthcare,Commercial,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,inpatient,,,96364.00000,46543.81000,United Healthcare,Commercial,,86727.60,,,,,,,86727.60,93473.08,percent of total billed charges,
FIX EXTRNL LW/UP/PELVIC LVL 24,2793784,CDM,272,RC,,,,,facility,outpatient,,,96364.00000,46543.81000,United Healthcare,Commercial,,86727.60,,,,,,,25054.64,93473.08,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
HANDPIECE LVL 01,2772309,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
HANDPIECE LVL 02,2772317,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
HANDPIECE LVL 03,2772325,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
HANDPIECE LVL 04,2779585,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
HANDPIECE LVL 05,2779593,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
HANDPIECE LVL 06,2779601,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
HANDPIECE LVL 07,6276802,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
HANDPIECE LVL 08,6276810,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,inpatient,,,26284.00000,12695.17000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
HANDPIECE LVL 09,6276828,CDM,272,RC,,,,,facility,outpatient,,,26284.00000,12695.17000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,inpatient,,,30664.00000,14810.71000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
HANDPIECE LVL 10,6276836,CDM,272,RC,,,,,facility,outpatient,,,30664.00000,14810.71000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,inpatient,,,35044.00000,16926.25000,United Healthcare,Commercial,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
HANDPIECE LVL 11,6276844,CDM,272,RC,,,,,facility,outpatient,,,35044.00000,16926.25000,United Healthcare,Commercial,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,inpatient,,,39424.00000,19041.79000,United Healthcare,Commercial,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
HANDPIECE LVL 12,6276851,CDM,272,RC,,,,,facility,outpatient,,,39424.00000,19041.79000,United Healthcare,Commercial,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
HARVESTER LVL 01,2772333,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
HARVESTER LVL 02,2779619,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
HARVESTER LVL 03,2779627,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 01,2772341,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 02,2772358,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 03,2772366,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 04,2778645,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
HEMOSTATIC AGENT LVL 05,6275853,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
INSERTER LVL 01,2772465,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INSERTER LVL 02,2772473,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INSERTER LVL 03,2772481,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
INSERTS LVL 01,2777662,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INSERTS LVL 02,2778330,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INSERTS LVL 03,6279624,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
INSERTS LVL 04,6279632,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 01,2772556,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 02,2772515,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 03,2772523,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 04,2772531,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 05,2772549,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,United Healthcare,Commercial,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 06,2778355,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,United Healthcare,Commercial,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 07,2778363,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
INSTRUMENT DISP MULTIPLE LVL 08,2778660,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,inpatient,,,190.00000,91.77000,United Healthcare,Commercial,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 01,2772564,CDM,272,RC,,,,,facility,outpatient,,,190.00000,91.77000,United Healthcare,Commercial,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 02,2772572,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 03,2772580,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 04,2772598,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 05,2772606,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 06,2778348,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 07,6271449,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 08,6272462,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 09,6272470,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 10,6272686,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 11,6272694,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 12,6272702,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,inpatient,,,15334.00000,7406.32000,United Healthcare,Commercial,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 13,6280200,CDM,272,RC,,,,,facility,outpatient,,,15334.00000,7406.32000,United Healthcare,Commercial,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
INSTRUMENT DISP SINGLE LVL 14,6295919,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 01,2772770,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 02,6275259,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 03,6277933,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 04,6277941,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,inpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
INTRO EP FIX CRV NONPEEL LVL 05,6277958,CDM,272,RC,C1893,HCPCS,,,facility,outpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 01,2772788,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 02,6273205,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 03,6273908,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,2023.00000,977.11000,United Healthcare,Commercial,,1820.70,,,,,,,1820.70,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 04,6273916,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2023.00000,977.11000,United Healthcare,Commercial,,1820.70,,,,,,,525.98,1962.31,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 05,6275820,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO EP FIX CRV PEEL LVL 06,6278915,CDM,272,RC,C1892,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INTRO EP LASER LVL 01,6273213,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INTRO EP LASER LVL 02,6273221,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO EP LASER LVL 03,6276398,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
INTRO EP LASER LVL 04,6276406,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
INTRO EP LASER LVL 05,6276414,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
INTRO EP LASER LVL 06,6276422,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
INTRO EP LASER LVL 07,6276430,CDM,272,RC,C2629,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 01,6301337,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 02,6301345,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 03,2772846,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,6105.00000,2948.71000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 04,6289227,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,6105.00000,2948.71000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
INTRO EP STEER NONPEEL LVL 05,6292106,CDM,272,RC,C1766,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
INTRO LVL 01,2772804,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INTRO LVL 02,2772812,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INTRO LVL 03,2772820,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
INTRO LVL 04,2778678,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
INTRO LVL 05,2778686,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO LVL 06,6271456,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
INTRO LVL 07,6271464,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,inpatient,,,7876.00000,3804.11000,United Healthcare,Commercial,,7088.40,,,,,,,7088.40,7639.72,percent of total billed charges,
INTRO LVL 08,6276646,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,United Healthcare,Commercial,,7088.40,,,,,,,2047.76,7639.72,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,inpatient,,,10191.00000,4922.25000,United Healthcare,Commercial,,9171.90,,,,,,,9171.90,9885.27,percent of total billed charges,
INTRO LVL 09,6276653,CDM,272,RC,,,,,facility,outpatient,,,10191.00000,4922.25000,United Healthcare,Commercial,,9171.90,,,,,,,2649.66,9885.27,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,96.00000,46.37000,United Healthcare,Commercial,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 01,6276893,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,96.00000,46.37000,United Healthcare,Commercial,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 02,6271472,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 03,6271480,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 04,6271498,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 05,6271506,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 06,6271514,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 07,6271522,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,inpatient,,,7876.00000,3804.11000,United Healthcare,Commercial,,7088.40,,,,,,,7088.40,7639.72,percent of total billed charges,
INTRO NON GD/EP/LASER LVL 08,6271530,CDM,272,RC,C1894,HCPCS,,,facility,outpatient,,,7876.00000,3804.11000,United Healthcare,Commercial,,7088.40,,,,,,,2047.76,7639.72,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 01,2772879,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 02,2772887,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 03,2772895,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 04,2778371,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IRRIGATOR/ACCESSORY LVL 05,2778389,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 01,2777670,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 02,2778397,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 03,2778405,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 04,2778413,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,United Healthcare,Commercial,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 05,2778421,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,United Healthcare,Commercial,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,inpatient,,,5373.00000,2595.16000,United Healthcare,Commercial,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 06,2778439,CDM,272,RC,,,,,facility,outpatient,,,5373.00000,2595.16000,United Healthcare,Commercial,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,inpatient,,,6487.00000,3133.22000,United Healthcare,Commercial,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 07,6275408,CDM,272,RC,,,,,facility,outpatient,,,6487.00000,3133.22000,United Healthcare,Commercial,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,inpatient,,,7876.00000,3804.11000,United Healthcare,Commercial,,7088.40,,,,,,,7088.40,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE CARDIAC LVL 08,6275416,CDM,272,RC,,,,,facility,outpatient,,,7876.00000,3804.11000,United Healthcare,Commercial,,7088.40,,,,,,,2047.76,7639.72,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 01,2777696,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 02,2779692,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 03,2779700,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 04,2779718,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE GI LVL 05,2779726,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 01,2777688,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 02,2779734,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 03,2779742,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 04,2779759,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 05,2779767,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 06,2779775,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE ORTH LVL 07,6273668,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 01,2777654,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 02,2778702,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 03,2778710,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 04,2778728,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 05,2778736,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 06,2778744,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 07,2778751,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 08,2778769,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 09,2778777,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 10,6271548,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 11,6271555,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,inpatient,,,11580.00000,5593.14000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 12,6271563,CDM,272,RC,,,,,facility,outpatient,,,11580.00000,5593.14000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 13,6271571,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 14,6273676,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
KIT/SET NON ROUTINE SURG LVL 15,6273684,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
KNOT PUSHER LVL 01,2772903,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
KNOT PUSHER LVL 02,2778447,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
KNOT PUSHER LVL 03,2778454,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
LASER FIBER LVL 01,2772911,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
LASER FIBER LVL 02,2772929,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
LASER FIBER LVL 03,2772937,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
LASER FIBER LVL 04,2772945,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
LASER FIBER LVL 05,2772952,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,inpatient,,,4397.00000,2123.75000,United Healthcare,Commercial,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
LASER FIBER LVL 06,2775120,CDM,272,RC,,,,,facility,outpatient,,,4397.00000,2123.75000,United Healthcare,Commercial,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
LASER FIBER LVL 07,6277578,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
LASER PROBE LVL 01,2772960,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
LASER PROBE LVL 02,2772978,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
LASER PROBE LVL 03,2772986,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
LASER PROBE LVL 04,2772994,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
LASER PROBE LVL 05,2773000,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
MAMMOTOME LVL 01,2773141,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
MAMMOTOME LVL 02,2779783,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,inpatient,,,1126.00000,543.86000,United Healthcare,Commercial,,1013.40,,,,,,,1013.40,1092.22,percent of total billed charges,
MAMMOTOME LVL 03,2779791,CDM,272,RC,,,,,facility,outpatient,,,1126.00000,543.86000,United Healthcare,Commercial,,1013.40,,,,,,,292.76,1092.22,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
MAMMOTOME LVL 04,2779809,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
MANIPULATOR LVL 01,6271589,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
MANIPULATOR LVL 02,6271597,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
MANIPULATOR LVL 03,6280796,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 01,2777381,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 02,2777886,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 03,2777894,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
MASK AIRWAY LARYNGEAL LVL 04,2777951,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,2690.00000,1299.27000,United Healthcare,Commercial,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
MORCELLATOR LVL 01,6276604,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,2690.00000,1299.27000,United Healthcare,Commercial,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,4880.00000,2357.04000,United Healthcare,Commercial,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
MORCELLATOR LVL 02,6276612,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,4880.00000,2357.04000,United Healthcare,Commercial,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,9260.00000,4472.58000,United Healthcare,Commercial,,8334.00,,,,,,,8334.00,8982.20,percent of total billed charges,
MORCELLATOR LVL 03,6276620,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,9260.00000,4472.58000,United Healthcare,Commercial,,8334.00,,,,,,,2407.60,8982.20,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
MORCELLATOR LVL 04,2773315,CDM,272,RC,C1782,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 01,2773331,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 02,2773349,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 03,2773356,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 04,2778488,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 05,2778496,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
NEEDLE BIOPSY LVL 06,2778504,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 01,2773364,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,inpatient,,,588.00000,284.00000,United Healthcare,Commercial,,529.20,,,,,,,529.20,570.36,percent of total billed charges,
NEEDLE BRACHYTHERAPY LVL 02,6280366,CDM,272,RC,C1715,HCPCS,,,facility,outpatient,,,588.00000,284.00000,United Healthcare,Commercial,,529.20,,,,,,,152.88,570.36,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 01,2773380,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE INSUFFLATION LVL 02,2773398,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 01,2773406,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 02,2773414,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 03,2773422,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 04,2773430,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 05,2773448,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 06,6271639,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,United Healthcare,Commercial,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 07,6271647,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,United Healthcare,Commercial,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,inpatient,,,2827.00000,1365.44000,United Healthcare,Commercial,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 08,6277545,CDM,272,RC,,,,,facility,outpatient,,,2827.00000,1365.44000,United Healthcare,Commercial,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,United Healthcare,Commercial,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 09,6277552,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,United Healthcare,Commercial,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
NEEDLE SPECIALTY LVL 10,6277560,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 01,2773505,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
OBTURATOR DISPOSABLE LVL 02,2778561,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
OCCLUDER LVL 01,2773513,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
OCCLUDER LVL 02,2773521,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
OCCLUDER LVL 03,2778579,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,inpatient,,,21904.00000,10579.63000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
OCCLUDER LVL 04,2778587,CDM,272,RC,,,,,facility,outpatient,,,21904.00000,10579.63000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
PACER ACCESSORY LVL 01,2773604,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
PACER ACCESSORY LVL 02,6272256,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 01,6272926,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 02,6272934,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 03,6272942,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 04,6275291,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 05,6275309,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,United Healthcare,Commercial,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
PAIN MGMT ACCESSORY LVL 06,6279046,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,United Healthcare,Commercial,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
PIN GUIDE LVL 01,2772242,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
PIN GUIDE LVL 02,2772259,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
PIN GUIDE LVL 03,2772267,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
PIN GUIDE LVL 04,6276315,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
POUCH LVL 01,6271787,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,United Healthcare,Commercial,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
POUCH LVL 02,6271795,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,United Healthcare,Commercial,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
POUCH LVL 03,6271803,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
POUCH LVL 04,6288948,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
PROBE LVL 01,2773893,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
PROBE LVL 02,2773901,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
PROBE LVL 03,2773919,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
PROBE LVL 04,2779940,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
PROBE LVL 05,2779957,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,United Healthcare,Commercial,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
PROBE LVL 06,2779965,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,United Healthcare,Commercial,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
PROBE LVL 07,2779973,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
PROBE LVL 08,6271829,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
PROBE LVL 09,6271837,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
PROBE LVL 10,6271811,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
PROBE LVL 11,6272645,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
PUNCH LVL 01,2775674,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
PUNCH LVL 02,2771517,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
PUNCH LVL 03,6272629,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
PUNCH LVL 04,6272637,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,inpatient,,,159.00000,76.80000,United Healthcare,Commercial,,143.10,,,,,,,143.10,154.23,percent of total billed charges,
REAMER LVL 01,6279178,CDM,272,RC,,,,,facility,outpatient,,,159.00000,76.80000,United Healthcare,Commercial,,143.10,,,,,,,41.34,154.23,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,inpatient,,,588.00000,284.00000,United Healthcare,Commercial,,529.20,,,,,,,529.20,570.36,percent of total billed charges,
REAMER LVL 02,6279111,CDM,272,RC,,,,,facility,outpatient,,,588.00000,284.00000,United Healthcare,Commercial,,529.20,,,,,,,152.88,570.36,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
REAMER LVL 03,2775682,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
REAMER LVL 04,6271852,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
REAMER LVL 05,6271860,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
REAMER LVL 06,6274690,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 01,2777647,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
RESERVOIR NEURO LVL 02,2771525,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 01,2775732,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 02,2774982,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 03,2774867,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 04,2774990,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,inpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
RESERVOIR OTHER LVL 05,2775005,CDM,272,RC,,,,,facility,outpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 01,2775740,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
RESERVOIR THORACIC LVL 02,2772440,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
RESERVOIR THORACIC REINFUSN LVL 01,2775757,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 01,2775799,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 02,2773778,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 03,2773927,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 04,2773984,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 05,2774008,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
RETRIEVER BASKET LVL 06,6279160,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 01,2775807,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 02,2774016,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 03,6276356,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,inpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 04,6276364,CDM,272,RC,,,,,facility,outpatient,,,3083.00000,1489.09000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
RETRIEVER SUTURE LVL 05,6276372,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 01,2775815,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
RETRIEVER VASCULAR LVL 02,2775823,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 01,6289961,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,United Healthcare,Commercial,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 02,2775930,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,United Healthcare,Commercial,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 03,6289540,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,inpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
SCALPEL HARMONIC LVL 04,6290308,CDM,272,RC,,,,,facility,outpatient,,,3853.00000,1861.00000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
SEAL PROXIMAL SYS LVL 01,2776136,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
SENSOR ENDOSURE AAA LVL 01,6277875,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
SNARE LVL 01,2776300,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
SNARE LVL 02,2776318,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,inpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
SNARE LVL 03,2776326,CDM,272,RC,,,,,facility,outpatient,,,2157.00000,1041.83000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
SNARE LVL 04,2774305,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
STAPLE RELOAD LVL 01,2776375,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,United Healthcare,Commercial,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
STAPLE RELOAD LVL 02,2776383,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,United Healthcare,Commercial,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 03,2776391,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 04,2774693,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 05,2774701,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 06,2775328,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 07,6278584,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,inpatient,,,8107.00000,3915.68000,United Healthcare,Commercial,,7296.30,,,,,,,7296.30,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 08,6278600,CDM,272,RC,,,,,facility,outpatient,,,8107.00000,3915.68000,United Healthcare,Commercial,,7296.30,,,,,,,2107.82,7863.79,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,inpatient,,,10422.00000,5033.83000,United Healthcare,Commercial,,9379.80,,,,,,,9379.80,10109.34,percent of total billed charges,
STAPLE RELOAD LVL 09,6280051,CDM,272,RC,,,,,facility,outpatient,,,10422.00000,5033.83000,United Healthcare,Commercial,,9379.80,,,,,,,2709.72,10109.34,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
STAPLER LVL 01,2776409,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
STAPLER LVL 02,2776417,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
STAPLER LVL 03,2776425,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
STAPLER LVL 04,2776433,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
STAPLER LVL 05,2776441,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
STAPLER LVL 06,2775351,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,inpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
STAPLER LVL 07,6271985,CDM,272,RC,,,,,facility,outpatient,,,5861.00000,2830.86000,United Healthcare,Commercial,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
STYLET LVL 01,2776623,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
STYLET LVL 02,2776631,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
STYLET LVL 03,2776649,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,inpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
STYLET LVL 04,6275895,CDM,272,RC,,,,,facility,outpatient,,,1888.00000,911.90000,United Healthcare,Commercial,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
SUPPLY NEURO LVL 01,2773455,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
SUPPLY NEURO LVL 02,2773463,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 03,2773471,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 04,2778520,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 05,2778876,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 06,2778884,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 07,2778892,CDM,272,RC,,,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 08,2778900,CDM,272,RC,,,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,inpatient,,,17524.00000,8464.09000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
SUPPLY NEURO LVL 09,6278741,CDM,272,RC,,,,,facility,outpatient,,,17524.00000,8464.09000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,United Healthcare,Commercial,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 01,2773687,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,United Healthcare,Commercial,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,inpatient,,,221.00000,106.74000,United Healthcare,Commercial,,198.90,,,,,,,198.90,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 02,2773695,CDM,272,RC,,,,,facility,outpatient,,,221.00000,106.74000,United Healthcare,Commercial,,198.90,,,,,,,57.46,214.37,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,United Healthcare,Commercial,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 03,2773703,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,United Healthcare,Commercial,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 04,2773711,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 05,2773729,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,United Healthcare,Commercial,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 06,2779833,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,United Healthcare,Commercial,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,inpatient,,,3340.00000,1613.22000,United Healthcare,Commercial,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 07,2779841,CDM,272,RC,,,,,facility,outpatient,,,3340.00000,1613.22000,United Healthcare,Commercial,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,inpatient,,,4153.00000,2005.90000,United Healthcare,Commercial,,3737.70,,,,,,,3737.70,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 08,2779858,CDM,272,RC,,,,,facility,outpatient,,,4153.00000,2005.90000,United Healthcare,Commercial,,3737.70,,,,,,,1079.78,4028.41,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,inpatient,,,5129.00000,2477.31000,United Healthcare,Commercial,,4616.10,,,,,,,4616.10,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 09,6271696,CDM,272,RC,,,,,facility,outpatient,,,5129.00000,2477.31000,United Healthcare,Commercial,,4616.10,,,,,,,1333.54,4975.13,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,inpatient,,,6105.00000,2948.71000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 10,6271688,CDM,272,RC,,,,,facility,outpatient,,,6105.00000,2948.71000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,inpatient,,,7181.00000,3468.42000,United Healthcare,Commercial,,6462.90,,,,,,,6462.90,6965.57,percent of total billed charges,
SUPPLY PERFUSION/ECMO LVL 11,6276885,CDM,272,RC,,,,,facility,outpatient,,,7181.00000,3468.42000,United Healthcare,Commercial,,6462.90,,,,,,,1867.06,6965.57,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,inpatient,,,52.50000,25.36000,United Healthcare,Commercial,,47.25,,,,,,,47.25,50.92,percent of total billed charges,
TACHOSIL 4.8X4.8CM PATCH,6318034,CDM,272,RC,,,,,facility,outpatient,,,52.50000,25.36000,United Healthcare,Commercial,,47.25,,,,,,,13.65,50.92,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,inpatient,,,50.40000,24.34000,United Healthcare,Commercial,,45.36,,,,,,,45.36,48.89,percent of total billed charges,
TACHOSIL 9.5X4.8CM PATCH,6318026,CDM,272,RC,,,,,facility,outpatient,,,50.40000,24.34000,United Healthcare,Commercial,,45.36,,,,,,,13.10,48.89,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
TAPE MARKING RADIOPAQUE LVL 01,6274393,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TAPS LVL 01,2777738,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
TAPS LVL 02,2772861,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
TAPS LVL 03,2772853,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
TAPS LVL 04,6280416,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
THERAPY COLD LVL 02,2771335,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
THERAPY COLD LVL 03,2778975,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,inpatient,,,2426.00000,1171.76000,United Healthcare,Commercial,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
THERAPY COLD LVL 04,6280424,CDM,272,RC,,,,,facility,outpatient,,,2426.00000,1171.76000,United Healthcare,Commercial,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,inpatient,,,3909.00000,1888.05000,United Healthcare,Commercial,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
THERAPY COLD LVL 05,6280432,CDM,272,RC,,,,,facility,outpatient,,,3909.00000,1888.05000,United Healthcare,Commercial,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
THERAPY COLD LVL 06,6283881,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TIPS LVL 01,2776763,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TIPS LVL 02,2776771,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
TIPS LVL 03,2776789,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
TIPS LVL 04,2778462,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TRANSDUCER LVL 01,2776979,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
TRANSDUCER LVL 02,2774461,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
TRANSDUCER LVL 03,2774479,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TREPHINE LVL 01,2776987,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
TREPHINE LVL 02,2776995,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TROCAR LVL 01,2777001,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TROCAR LVL 02,2777019,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
TROCAR LVL 03,2777027,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
TROCAR LVL 04,2777035,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
TROCAR LVL 05,2777043,CDM,272,RC,,,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,inpatient,,,102.00000,49.27000,United Healthcare,Commercial,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
TUBE CHEST LVL 01,2777050,CDM,272,RC,,,,,facility,outpatient,,,102.00000,49.27000,United Healthcare,Commercial,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TUBE CHEST LVL 02,2774487,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TUBE CHEST LVL 03,2774495,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
TUBE CHEST LVL 04,2774412,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TUBE ENDOBRONCHIAL LVL 01,2777076,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,inpatient,,,32.00000,15.46000,United Healthcare,Commercial,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 01,2777084,CDM,272,RC,,,,,facility,outpatient,,,32.00000,15.46000,United Healthcare,Commercial,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 02,2777100,CDM,272,RC,,,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 03,2777092,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,inpatient,,,447.00000,215.90000,United Healthcare,Commercial,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 04,2777118,CDM,272,RC,,,,,facility,outpatient,,,447.00000,215.90000,United Healthcare,Commercial,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 05,2777134,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,inpatient,,,709.00000,342.45000,United Healthcare,Commercial,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 06,2777142,CDM,272,RC,,,,,facility,outpatient,,,709.00000,342.45000,United Healthcare,Commercial,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 07,2777159,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 08,2777167,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,inpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 09,2777126,CDM,272,RC,,,,,facility,outpatient,,,1619.00000,781.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 10,2777175,CDM,272,RC,,,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,inpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
TUBE SPECIALTY LVL 11,2774420,CDM,272,RC,,,,,facility,outpatient,,,3596.00000,1736.87000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
WIRE GUIDE LVL 01,2772275,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,166.00000,80.18000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
WIRE GUIDE LVL 02,2772283,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
WIRE GUIDE LVL 03,2772291,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 04,2778280,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
WIRE GUIDE LVL 05,2778298,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
WIRE GUIDE LVL 06,2778306,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,2695.00000,1301.68000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
WIRE GUIDE LVL 07,2778629,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,4885.00000,2359.46000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 08,2778637,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,6950.00000,3356.85000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
WIRE GUIDE LVL 09,6271415,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,9265.00000,4475.00000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,11580.00000,5593.14000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
WIRE GUIDE LVL 10,6280986,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,11580.00000,5593.14000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,inpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
WIRE GUIDE LVL 11,6280994,CDM,272,RC,C1769,HCPCS,,,facility,outpatient,,,13895.00000,6711.28000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,inpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 01,6272231,CDM,272,RC,,,,,facility,outpatient,,,313.00000,151.18000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,inpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 02,6272249,CDM,272,RC,,,,,facility,outpatient,,,594.00000,286.90000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,inpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 03,6280762,CDM,272,RC,,,,,facility,outpatient,,,850.00000,410.55000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,inpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 04,6280770,CDM,272,RC,,,,,facility,outpatient,,,1132.00000,546.76000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,inpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
WIRE PACING TEMP LVL 05,6280788,CDM,272,RC,,,,,facility,outpatient,,,1413.00000,682.48000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,United Healthcare,Commercial,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 02,2772382,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,United Healthcare,Commercial,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,United Healthcare,Commercial,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 03,2778314,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,United Healthcare,Commercial,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,109504.00000,62214.70000,United Healthcare,Commercial,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 04,6271423,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,United Healthcare,Commercial,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,inpatient,,,131404.00000,74657.18000,United Healthcare,Commercial,,118263.60,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP ICD CHAMBER DUAL LVL 05,6271431,CDM,275,RC,C1721,HCPCS,,,facility,outpatient,,,131404.00000,74657.18000,United Healthcare,Commercial,,118263.60,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,43800.00000,24884.97000,United Healthcare,Commercial,,39420.00,,,,,,,39420.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 01,6279194,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,43800.00000,24884.97000,United Healthcare,Commercial,,39420.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,United Healthcare,Commercial,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 02,2772390,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,United Healthcare,Commercial,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,United Healthcare,Commercial,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP ICD CHAMBER SGL LVL 03,2778322,CDM,275,RC,C1722,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,United Healthcare,Commercial,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,19714.00000,11200.51000,United Healthcare,Commercial,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 01,6278360,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,United Healthcare,Commercial,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,24090.00000,13686.73000,United Healthcare,Commercial,,21681.00,,,,,,,21681.00,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 02,6278378,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,24090.00000,13686.73000,United Healthcare,Commercial,,21681.00,,,,,,,6263.40,23367.30,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,inpatient,,,28474.00000,16177.50000,United Healthcare,Commercial,,25626.60,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PCMKR DUAL NON RR LVL 03,2773620,CDM,275,RC,C2619,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,United Healthcare,Commercial,,25626.60,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,17520.00000,9953.99000,United Healthcare,Commercial,,15768.00,,,,,,,15768.00,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 01,6277982,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,United Healthcare,Commercial,,15768.00,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,21904.00000,12444.76000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 02,2773638,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,26284.00000,14933.25000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 03,2779817,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,43804.00000,24887.24000,United Healthcare,Commercial,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 04,2779825,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,United Healthcare,Commercial,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,65704.00000,37329.73000,United Healthcare,Commercial,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 05,6274260,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,65704.00000,37329.73000,United Healthcare,Commercial,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,87604.00000,49772.21000,United Healthcare,Commercial,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 06,6274278,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,87604.00000,49772.21000,United Healthcare,Commercial,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,inpatient,,,109504.00000,62214.70000,United Healthcare,Commercial,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP PCMKR DUAL RR LVL 07,6274286,CDM,275,RC,C1785,HCPCS,,,facility,outpatient,,,109504.00000,62214.70000,United Healthcare,Commercial,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,6105.00000,3468.56000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 01,6298954,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,6105.00000,3468.56000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,13895.00000,7894.44000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 02,6298962,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,13895.00000,7894.44000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,21900.00000,12442.48000,United Healthcare,Commercial,,19710.00,,,,,,,19710.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 03,6298970,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,21900.00000,12442.48000,United Healthcare,Commercial,,19710.00,,,,,,,5694.00,21243.00,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,35040.00000,19907.98000,United Healthcare,Commercial,,31536.00,,,,,,,31536.00,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 04,6274435,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,35040.00000,19907.98000,United Healthcare,Commercial,,31536.00,,,,,,,9110.40,33988.80,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,inpatient,,,43804.00000,24887.24000,United Healthcare,Commercial,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PCMKR NONSGL OR DUAL LVL 05,2773646,CDM,275,RC,C2621,HCPCS,,,facility,outpatient,,,43804.00000,24887.24000,United Healthcare,Commercial,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,19714.00000,11200.51000,United Healthcare,Commercial,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 02,6278386,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,19714.00000,11200.51000,United Healthcare,Commercial,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,22776.00000,12940.18000,United Healthcare,Commercial,,20498.40,,,,,,,20498.40,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 03,6278394,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,22776.00000,12940.18000,United Healthcare,Commercial,,20498.40,,,,,,,5921.76,22092.72,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,inpatient,,,28474.00000,16177.50000,United Healthcare,Commercial,,25626.60,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PCMKR SGL NON RR LVL 04,2773653,CDM,275,RC,C2620,HCPCS,,,facility,outpatient,,,28474.00000,16177.50000,United Healthcare,Commercial,,25626.60,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,17520.00000,9953.99000,United Healthcare,Commercial,,15768.00,,,,,,,15768.00,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 02,6276943,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,17520.00000,9953.99000,United Healthcare,Commercial,,15768.00,,,,,,,4555.20,16994.40,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,21904.00000,12444.76000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 03,2773661,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,21904.00000,12444.76000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,26284.00000,14933.25000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 04,2779882,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,26284.00000,14933.25000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,30664.00000,17421.75000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 05,6271662,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,30664.00000,17421.75000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,inpatient,,,35044.00000,19910.25000,United Healthcare,Commercial,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PCMKR SGL RR LVL 06,6271670,CDM,275,RC,C1786,HCPCS,,,facility,outpatient,,,35044.00000,19910.25000,United Healthcare,Commercial,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,594.00000,238.19000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 01,6278881,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,594.00000,238.19000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 02,6278899,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,inpatient,,,2157.00000,864.96000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM ANT LVL 03,6278907,CDM,276,RC,V2630,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,594.00000,238.19000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 01,6278857,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,594.00000,238.19000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 02,6278865,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,2157.00000,864.96000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 03,6278873,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2157.00000,864.96000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,2695.00000,1080.70000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 04,6288633,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,2695.00000,1080.70000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,inpatient,,,3853.00000,1545.05000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
LENS INTRAOCULAR CHAM POST LVL 05,6297758,CDM,276,RC,V2632,HCPCS,,,facility,outpatient,,,3853.00000,1545.05000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,inpatient,,,1413.00000,566.61000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
LENS INTRAOCULAR NEW TECH LVL 01,6292395,CDM,276,RC,C1780,HCPCS,,,facility,outpatient,,,1413.00000,566.61000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,inpatient,,,594.00000,238.19000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 01,6297576,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,594.00000,238.19000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,inpatient,,,1132.00000,453.93000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
LENS INTRAOCULAR PRESBYOPIA LVL 02,6297584,CDM,276,RC,V2788,HCPCS,,,facility,outpatient,,,1132.00000,453.93000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,3229.80000,1857.14000,United Healthcare,Commercial,,2906.82,,,,,,,2906.82,3132.91,percent of total billed charges,
DURAGEN CL 10X12.5/SH,6317010,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,3229.80000,1857.14000,United Healthcare,Commercial,,2906.82,,,,,,,839.75,3132.91,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,854.40000,491.28000,United Healthcare,Commercial,,768.96,,,,,,,768.96,828.77,percent of total billed charges,
DURAGEN CL 2.5X2.5/SH 5/PKG,6317028,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,854.40000,491.28000,United Healthcare,Commercial,,768.96,,,,,,,222.14,828.77,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1200.50000,690.29000,United Healthcare,Commercial,,1080.45,,,,,,,1080.45,1164.48,percent of total billed charges,
DURAGEN CL 2.5X7.5/SH,6317036,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1200.50000,690.29000,United Healthcare,Commercial,,1080.45,,,,,,,312.13,1164.48,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1011.00000,581.32000,United Healthcare,Commercial,,909.90,,,,,,,909.90,980.67,percent of total billed charges,
DURAGEN CL 5X5/SH,6317051,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1011.00000,581.32000,United Healthcare,Commercial,,909.90,,,,,,,262.86,980.67,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1823.80000,1048.68000,United Healthcare,Commercial,,1641.42,,,,,,,1641.42,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH,6317077,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1823.80000,1048.68000,United Healthcare,Commercial,,1641.42,,,,,,,474.19,1769.09,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2028.50000,1166.39000,United Healthcare,Commercial,,1825.65,,,,,,,1825.65,1967.64,percent of total billed charges,
DURAGEN CL 7.5X7.5/SH 5/PKG,6317085,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2028.50000,1166.39000,United Healthcare,Commercial,,1825.65,,,,,,,527.41,1967.64,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,841.00000,483.58000,United Healthcare,Commercial,,756.90,,,,,,,756.90,815.77,percent of total billed charges,
DURAGEN PL 2.5X2.5/SH,6316434,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,841.00000,483.58000,United Healthcare,Commercial,,756.90,,,,,,,218.66,815.77,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1366.20000,785.56000,United Healthcare,Commercial,,1229.58,,,,,,,1229.58,1325.21,percent of total billed charges,
DURAGEN PL 2.5X7.5/SH,6316772,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1366.20000,785.56000,United Healthcare,Commercial,,1229.58,,,,,,,355.21,1325.21,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1384.00000,795.80000,United Healthcare,Commercial,,1245.60,,,,,,,1245.60,1342.48,percent of total billed charges,
DURAGEN PL 5X5/SH,6316780,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1384.00000,795.80000,United Healthcare,Commercial,,1245.60,,,,,,,359.84,1342.48,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2458.70000,1413.75000,United Healthcare,Commercial,,2212.83,,,,,,,2212.83,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH,6316798,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2458.70000,1413.75000,United Healthcare,Commercial,,2212.83,,,,,,,639.26,2384.94,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2393.50000,1376.26000,United Healthcare,Commercial,,2154.15,,,,,,,2154.15,2321.70,percent of total billed charges,
DURAGEN PL 7.5X7.5/SH 5/PKG,6316806,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2393.50000,1376.26000,United Healthcare,Commercial,,2154.15,,,,,,,622.31,2321.70,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,1369.50000,787.46000,United Healthcare,Commercial,,1232.55,,,,,,,1232.55,1328.41,percent of total billed charges,
DURAGEN SU 2.5X7.5/SH,6316814,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,1369.50000,787.46000,United Healthcare,Commercial,,1232.55,,,,,,,356.07,1328.41,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,inpatient,,,2697.40000,1551.00000,United Healthcare,Commercial,,2427.66,,,,,,,2427.66,2616.48,percent of total billed charges,
DURAGEN SU 7.5X7.5/SH,6316822,CDM,278,RC,Q4432,HCPCS,,,facility,outpatient,,,2697.40000,1551.00000,United Healthcare,Commercial,,2427.66,,,,,,,701.32,2616.48,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4621.80000,2657.54000,United Healthcare,Commercial,,4159.62,,,,,,,4159.62,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY,6307425,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4621.80000,2657.54000,United Healthcare,Commercial,,4159.62,,,,,,,1201.67,4483.15,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2592.50000,1490.69000,United Healthcare,Commercial,,2333.25,,,,,,,2333.25,2514.72,percent of total billed charges,
DURAL SLNT ADHERUS AUTOSPRAY ET,6307433,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2592.50000,1490.69000,United Healthcare,Commercial,,2333.25,,,,,,,674.05,2514.72,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,United Healthcare,Commercial,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 01,6281372,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,United Healthcare,Commercial,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 02,6271373,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,United Healthcare,Commercial,,7505.10,,,,,,,7505.10,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 03,6275903,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,United Healthcare,Commercial,,7505.10,,,,,,,2168.14,8088.83,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
EMBOLIZATION SYS PROTECT LVL 04,6280408,CDM,278,RC,C1884,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 01,2771400,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 02,2778983,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 03,2778991,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 04,6273171,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,United Healthcare,Commercial,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 05,6273189,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,United Healthcare,Commercial,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,inpatient,,,8107.00000,4661.52000,United Healthcare,Commercial,,7296.30,,,,,,,7296.30,7863.79,percent of total billed charges,
IMP ACCESS SYSTEM DIALYS LVL 06,6273197,CDM,278,RC,C1881,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,United Healthcare,Commercial,,7296.30,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 01,6312359,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 02,6312367,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 03,6312375,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ADHSN BARRIER 30+ DAYS LVL 04,6312383,CDM,278,RC,C1765,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,United Healthcare,Commercial,,1013.40,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 01,6280523,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,United Healthcare,Commercial,,1013.40,,,,,,,292.76,1092.22,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,United Healthcare,Commercial,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 02,2770006,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,United Healthcare,Commercial,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,United Healthcare,Commercial,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP ADPT/EXT LD PACING/NEURO LVL 03,6278972,CDM,278,RC,C1883,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,United Healthcare,Commercial,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,inpatient,,,20152.00000,11587.40000,United Healthcare,Commercial,,18136.80,,,,,,,18136.80,19547.44,percent of total billed charges,
IMP AGENT COLLAGN BULK 2.5ML LVL 06,2770493,CDM,278,RC,L8603,HCPCS,,,facility,outpatient,,,20152.00000,11587.40000,United Healthcare,Commercial,,18136.80,,,,,,,5239.52,19547.44,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,166.00000,95.45000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 01,2770501,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,166.00000,95.45000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,447.00000,257.02000,United Healthcare,Commercial,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 02,6276455,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,447.00000,257.02000,United Healthcare,Commercial,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,709.00000,407.67000,United Healthcare,Commercial,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 03,6276463,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,709.00000,407.67000,United Healthcare,Commercial,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,1272.00000,731.40000,United Healthcare,Commercial,,1144.80,,,,,,,1144.80,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 04,6276471,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,1272.00000,731.40000,United Healthcare,Commercial,,1144.80,,,,,,,330.72,1233.84,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,United Healthcare,Commercial,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 05,6276729,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,United Healthcare,Commercial,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,inpatient,,,3078.00000,1769.85000,United Healthcare,Commercial,,2770.20,,,,,,,2770.20,2985.66,percent of total billed charges,
IMP AGENT SYNTHETIC BULK 1ML LVL 06,6276737,CDM,278,RC,L8606,HCPCS,,,facility,outpatient,,,3078.00000,1769.85000,United Healthcare,Commercial,,2770.20,,,,,,,800.28,2985.66,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,70.00000,40.25000,United Healthcare,Commercial,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 01,6306948,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,70.00000,40.25000,United Healthcare,Commercial,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,102.00000,58.65000,United Healthcare,Commercial,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 02,6306955,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,102.00000,58.65000,United Healthcare,Commercial,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,166.00000,95.45000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 03,6306963,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,221.00000,127.07000,United Healthcare,Commercial,,198.90,,,,,,,198.90,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 04,6306971,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,221.00000,127.07000,United Healthcare,Commercial,,198.90,,,,,,,57.46,214.37,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 05,6306989,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,447.00000,257.02000,United Healthcare,Commercial,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 06,6306997,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,United Healthcare,Commercial,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 07,6307003,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 08,6307011,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 09,6307029,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 10,6307037,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 11,6307045,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 12,6307052,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 13,6307060,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 14,6307078,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 15,6307086,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 16,6307094,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 17,6307102,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 18,6307110,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 19,6307128,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 20,6307136,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP ANCHOR/SCREW/WASHER/NUT LVL 21,6307144,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BLADE LVL 01,6295281,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP BLADE LVL 02,6295299,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP BLADE LVL 03,6295307,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,709.00000,407.67000,United Healthcare,Commercial,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
IMP BOLT LVL 01,2770337,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,United Healthcare,Commercial,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BOLT LVL 02,2770345,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP BOLT LVL 03,6271167,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP BOLT LVL 04,6271175,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP BOLT LVL 05,6271183,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP BOLT LVL 06,6276232,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP BOLT LVL 07,6280325,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,United Healthcare,Commercial,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP BOLT LVL 08,6280333,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,United Healthcare,Commercial,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 01,2770352,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 02,2770360,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 03,2770378,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 04,2770386,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 05,2770402,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 06,2770410,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 07,2770428,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 08,2770436,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 09,2770394,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 10,2770444,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 11,6271191,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 12,6275184,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35482.00000,20402.15000,United Healthcare,Commercial,,31933.80,,,,,,,31933.80,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 13,6275192,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35482.00000,20402.15000,United Healthcare,Commercial,,31933.80,,,,,,,9225.32,34417.54,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39862.00000,22920.65000,United Healthcare,Commercial,,35875.80,,,,,,,35875.80,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 14,6277131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39862.00000,22920.65000,United Healthcare,Commercial,,35875.80,,,,,,,10364.12,38666.14,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,44242.00000,25439.15000,United Healthcare,Commercial,,39817.80,,,,,,,39817.80,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 15,6277149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,44242.00000,25439.15000,United Healthcare,Commercial,,39817.80,,,,,,,11502.92,42914.74,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,48622.00000,27957.65000,United Healthcare,Commercial,,43759.80,,,,,,,43759.80,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 16,6277156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,48622.00000,27957.65000,United Healthcare,Commercial,,43759.80,,,,,,,12641.72,47163.34,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,53002.00000,30476.15000,United Healthcare,Commercial,,47701.80,,,,,,,47701.80,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 17,6277164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,53002.00000,30476.15000,United Healthcare,Commercial,,47701.80,,,,,,,13780.52,51411.94,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,United Healthcare,Commercial,,55191.60,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 18,6279392,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,United Healthcare,Commercial,,55191.60,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,United Healthcare,Commercial,,63075.60,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 19,6279400,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,United Healthcare,Commercial,,63075.60,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,United Healthcare,Commercial,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 20,6279418,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,United Healthcare,Commercial,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,United Healthcare,Commercial,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 21,6279426,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,United Healthcare,Commercial,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,United Healthcare,Commercial,,86727.60,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP BONE HUMAN/SYNTHETIC LVL 22,6279491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,United Healthcare,Commercial,,86727.60,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP CABLE LVL 01,2770584,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,844.00000,485.30000,United Healthcare,Commercial,,759.60,,,,,,,759.60,818.68,percent of total billed charges,
IMP CABLE LVL 02,2770592,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,844.00000,485.30000,United Healthcare,Commercial,,759.60,,,,,,,219.44,818.68,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CABLE LVL 03,2770600,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP CABLE LVL 04,2770618,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CABLE LVL 05,2770626,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CABLE LVL 06,2778934,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CABLE LVL 07,6278337,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CABLE LVL 08,6278345,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP CABLE LVL 09,6278352,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 01,6298939,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,11575.00000,6655.62000,United Healthcare,Commercial,,10417.50,,,,,,,10417.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 02,6298947,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,11575.00000,6655.62000,United Healthcare,Commercial,,10417.50,,,,,,,3009.50,11227.75,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,14892.00000,8562.90000,United Healthcare,Commercial,,13402.80,,,,,,,13402.80,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 03,6278410,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,14892.00000,8562.90000,United Healthcare,Commercial,,13402.80,,,,,,,3871.92,14445.24,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,inpatient,,,24970.00000,14357.75000,United Healthcare,Commercial,,22473.00,,,,,,,22473.00,24220.90,percent of total billed charges,
IMP CARDIAC EVENT REC LVL 04,2775724,CDM,278,RC,C1764,HCPCS,,,facility,outpatient,,,24970.00000,14357.75000,United Healthcare,Commercial,,22473.00,,,,,,,6492.20,24220.90,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 01,6292502,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 02,6292510,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 03,6292528,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 04,6292536,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 05,6292544,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP CATH BRACHY SEED ADM LVL 06,2779239,CDM,278,RC,C1728,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 01,6312417,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,United Healthcare,Commercial,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 02,6312425,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,United Healthcare,Commercial,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 03,6312433,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CATH DRAINAGE 30+ DAYS LVL 04,6312441,CDM,278,RC,C1729,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 01,2770931,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 02,2779494,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 03,2779502,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 04,2779510,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 05,2779528,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 06,2779536,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 07,2779544,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CATH HEM/PER LONG TERM LVL 08,2779551,CDM,278,RC,C1750,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,166.00000,95.45000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 01,2773885,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,166.00000,95.45000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,447.00000,257.02000,United Healthcare,Commercial,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 02,2779866,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,447.00000,257.02000,United Healthcare,Commercial,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 03,2779874,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 04,2779908,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,United Healthcare,Commercial,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 05,2779916,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,United Healthcare,Commercial,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 06,2779924,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,United Healthcare,Commercial,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 07,2779932,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,United Healthcare,Commercial,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,4153.00000,2387.98000,United Healthcare,Commercial,,3737.70,,,,,,,3737.70,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 08,6281299,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,United Healthcare,Commercial,,3737.70,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,inpatient,,,4641.00000,2668.58000,United Healthcare,Commercial,,4176.90,,,,,,,4176.90,4501.77,percent of total billed charges,
IMP CATH PORT INDWELLING LVL 09,6281307,CDM,278,RC,C1788,HCPCS,,,facility,outpatient,,,4641.00000,2668.58000,United Healthcare,Commercial,,4176.90,,,,,,,1206.66,4501.77,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 01,2771210,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 02,2775153,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 03,6272389,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 04,6272397,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 05,6279830,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,United Healthcare,Commercial,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP CEMENT ACCESSORY LVL 06,6279848,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,United Healthcare,Commercial,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP CEMENT LVL 01,2771194,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP CEMENT LVL 02,2771228,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CEMENT LVL 03,2771236,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CEMENT LVL 04,2778538,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 05,2778546,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CEMENT LVL 06,6277057,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP CEMENT LVL 07,6277065,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP CEMENT LVL 08,6278519,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 01,2771285,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CLIP ANEURYSM LVL 02,6273692,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 01,2771319,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 02,2778058,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 03,2778066,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 04,2778074,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 05,2778082,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 06,2778090,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 07,2778108,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 08,2778116,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 09,2778124,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP COIL EMBOLIZATION LVL 10,2778959,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 01,6272512,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 02,6272520,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 03,6272538,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 04,6272546,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 05,6272553,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 06,6272561,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP CONNECTOR SPINAL LVL 07,6272579,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP COVER BURR HOLE LVL 02,2771343,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 01,2771301,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 02,2778611,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 03,2778694,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 04,2778652,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 05,2778785,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 06,2778942,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 07,6274369,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 08,6276968,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 09,6276976,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 10,6276984,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV CLOSURE VASCULAR LVL 11,6276992,CDM,278,RC,C1760,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,United Healthcare,Commercial,,86727.60,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 04,6275374,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,United Healthcare,Commercial,,86727.60,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,United Healthcare,Commercial,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 05,2774172,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,United Healthcare,Commercial,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,131404.00000,75557.30000,United Healthcare,Commercial,,118263.60,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 06,6278634,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,United Healthcare,Commercial,,118263.60,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,153304.00000,88149.80000,United Healthcare,Commercial,,137973.60,,,,,,,137973.60,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 07,6278642,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,153304.00000,88149.80000,United Healthcare,Commercial,,137973.60,,,,,,,39859.04,148704.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,175204.00000,100742.30000,United Healthcare,Commercial,,157683.60,,,,,,,157683.60,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 08,6278659,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,175204.00000,100742.30000,United Healthcare,Commercial,,157683.60,,,,,,,45553.04,169947.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,197104.00000,113334.80000,United Healthcare,Commercial,,177393.60,,,,,,,177393.60,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 09,6278667,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,197104.00000,113334.80000,United Healthcare,Commercial,,177393.60,,,,,,,51247.04,191190.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,inpatient,,,219004.00000,125927.30000,United Healthcare,Commercial,,197103.60,,,,,,,197103.60,212433.88,percent of total billed charges,
IMP DEV COCHLEAR INT&EXT CMP LVL 10,6278675,CDM,278,RC,L8614,HCPCS,,,facility,outpatient,,,219004.00000,125927.30000,United Healthcare,Commercial,,197103.60,,,,,,,56941.04,212433.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 01,6279269,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 02,6279277,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 03,6279285,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 04,6279293,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 05,6279301,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 06,6279319,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 07,6279327,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV INTERSPINOUS LVL 08,6279335,CDM,278,RC,C1821,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 01,2774180,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 02,2774198,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 03,2774206,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 04,2774214,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 05,2774230,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 06,6272710,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 07,6272728,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 08,6272736,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 09,6272744,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 10,6272751,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,United Healthcare,Commercial,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 11,6272769,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,United Healthcare,Commercial,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,United Healthcare,Commercial,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 12,6272777,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,United Healthcare,Commercial,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,United Healthcare,Commercial,,51249.60,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 13,6272785,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,United Healthcare,Commercial,,51249.60,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,United Healthcare,Commercial,,55191.60,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 14,6272793,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,United Healthcare,Commercial,,55191.60,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,United Healthcare,Commercial,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP DEV JT ELBOW TOTAL LVL 15,6272801,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,United Healthcare,Commercial,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 01,2774362,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 02,2774370,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 03,2774503,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 04,2774388,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT FINGER LVL 05,2774404,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 01,2774511,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 02,2774529,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 03,2774537,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 04,2774545,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 05,2774560,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 06,2774578,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 07,2774586,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 08,2774594,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 09,2774552,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 10,2774602,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 11,2774610,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 12,2774628,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 13,2774636,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,United Healthcare,Commercial,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 14,2774644,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,United Healthcare,Commercial,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,United Healthcare,Commercial,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 15,2774669,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,United Healthcare,Commercial,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,United Healthcare,Commercial,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 16,2774677,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,United Healthcare,Commercial,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,United Healthcare,Commercial,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV JT HIP TOTAL LVL 17,6277016,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,United Healthcare,Commercial,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 01,6275937,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 02,6275945,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,United Healthcare,Commercial,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 03,6275952,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,United Healthcare,Commercial,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 04,2774727,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 05,2774735,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 06,2774743,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 07,2774750,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 08,2774776,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 09,2774784,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 10,2774792,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 11,2774800,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 12,2774768,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,United Healthcare,Commercial,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 13,2774818,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,United Healthcare,Commercial,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,United Healthcare,Commercial,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 14,2774826,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,United Healthcare,Commercial,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,United Healthcare,Commercial,,51249.60,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 15,2774719,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,United Healthcare,Commercial,,51249.60,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,United Healthcare,Commercial,,55191.60,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 16,2774834,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,United Healthcare,Commercial,,55191.60,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,United Healthcare,Commercial,,63075.60,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 17,2774842,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,United Healthcare,Commercial,,63075.60,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,United Healthcare,Commercial,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 18,2774859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,United Healthcare,Commercial,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,United Healthcare,Commercial,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 19,2771616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,United Healthcare,Commercial,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,United Healthcare,Commercial,,86727.60,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 20,6271845,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,United Healthcare,Commercial,,86727.60,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,United Healthcare,Commercial,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 21,6273627,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,United Healthcare,Commercial,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,122644.00000,70520.30000,United Healthcare,Commercial,,110379.60,,,,,,,110379.60,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 22,6273635,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,United Healthcare,Commercial,,110379.60,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,135784.00000,78075.80000,United Healthcare,Commercial,,122205.60,,,,,,,122205.60,131710.48,percent of total billed charges,
IMP DEV JT KNEE TOTAL LVL 23,6273643,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,135784.00000,78075.80000,United Healthcare,Commercial,,122205.60,,,,,,,35303.84,131710.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 01,6288088,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 02,6288096,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 03,6288104,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 04,6288112,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 05,2775286,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 06,2775294,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 07,2775302,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 08,2775310,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 09,2775336,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 10,2775344,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 11,6273924,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 12,6273932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 13,6276273,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 14,6276281,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,United Healthcare,Commercial,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 15,6276299,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,United Healthcare,Commercial,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,55630.00000,31987.25000,United Healthcare,Commercial,,50067.00,,,,,,,50067.00,53961.10,percent of total billed charges,
IMP DEV JT SHDR TOTAL LVL 16,6278709,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,55630.00000,31987.25000,United Healthcare,Commercial,,50067.00,,,,,,,14463.80,53961.10,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 01,2775468,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 02,2775476,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 03,2775484,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 04,2775492,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP DEV JT TOE LVL 05,2775518,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,United Healthcare,Commercial,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 01,6275580,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,United Healthcare,Commercial,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 02,2772499,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 03,6273247,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 04,6273254,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 05,6276513,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,14020.00000,8061.50000,United Healthcare,Commercial,,12618.00,,,,,,,12618.00,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 06,6278014,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,United Healthcare,Commercial,,12618.00,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,inpatient,,,17962.00000,10328.15000,United Healthcare,Commercial,,16165.80,,,,,,,16165.80,17423.14,percent of total billed charges,
IMP DEV URINARY W SLING LVL 07,6279640,CDM,278,RC,C1771,HCPCS,,,facility,outpatient,,,17962.00000,10328.15000,United Healthcare,Commercial,,16165.80,,,,,,,4670.12,17423.14,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,2421.00000,1392.07000,United Healthcare,Commercial,,2178.90,,,,,,,2178.90,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 01,6276042,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,2421.00000,1392.07000,United Healthcare,Commercial,,2178.90,,,,,,,629.46,2348.37,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 02,2772507,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 03,6275044,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 04,6275051,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP DEV URINARY WO SLNG LVL 05,6276521,CDM,278,RC,C2631,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 01,2772002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 02,6276117,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 03,6276125,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 04,6276133,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 05,6276141,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 06,6276158,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 07,6276166,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 08,6276174,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP EMBOLIZATION AGENT LVL 09,6276182,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 01,2776334,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 02,2774313,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 03,2774321,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EMBOLIZATION SPHERE LVL 04,2774651,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,United Healthcare,Commercial,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 01,2771632,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,United Healthcare,Commercial,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 02,2771640,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP EXPANDER TISSUE LVL 03,2771657,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,United Healthcare,Commercial,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 02,6274526,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,United Healthcare,Commercial,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 03,2772119,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 04,2778181,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP FILTER VENA CAVA LVL 05,2778199,CDM,278,RC,C1880,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP FIX SPINE LVL 01,2772622,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 02,2772630,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 03,2772648,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 04,2772655,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 05,2772671,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 06,2772689,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 07,2772697,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 08,2772705,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,27160.00000,15617.00000,United Healthcare,Commercial,,24444.00,,,,,,,24444.00,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 09,6274021,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,27160.00000,15617.00000,United Healthcare,Commercial,,24444.00,,,,,,,7061.60,26345.20,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,United Healthcare,Commercial,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 10,6275317,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,United Healthcare,Commercial,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 11,6279152,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,United Healthcare,Commercial,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 12,6279459,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,United Healthcare,Commercial,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,United Healthcare,Commercial,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 13,6279467,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,United Healthcare,Commercial,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,United Healthcare,Commercial,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP FIX SPINE LVL 14,6279483,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,United Healthcare,Commercial,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,28470.00000,16370.25000,United Healthcare,Commercial,,25623.00,,,,,,,25623.00,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 01,6282289,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,28470.00000,16370.25000,United Healthcare,Commercial,,25623.00,,,,,,,7402.20,27615.90,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,43800.00000,25185.00000,United Healthcare,Commercial,,39420.00,,,,,,,39420.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 02,6271381,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,43800.00000,25185.00000,United Healthcare,Commercial,,39420.00,,,,,,,11388.00,42486.00,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,United Healthcare,Commercial,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 03,6271399,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,United Healthcare,Commercial,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,United Healthcare,Commercial,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 04,6271407,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,United Healthcare,Commercial,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,United Healthcare,Commercial,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP GENERATOR NEUROSTIM LVL 05,6279509,CDM,278,RC,C1767,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,United Healthcare,Commercial,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 01,2772143,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 02,2772150,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 03,2772168,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 04,2772176,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 05,2772192,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 06,2772200,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,United Healthcare,Commercial,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 07,2772218,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,United Healthcare,Commercial,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 08,2772226,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 09,2772184,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 10,2772234,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 11,2778249,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 12,2778256,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,United Healthcare,Commercial,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 13,2778264,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,United Healthcare,Commercial,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 14,2778272,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,inpatient,,,54754.00000,31483.55000,United Healthcare,Commercial,,49278.60,,,,,,,49278.60,53111.38,percent of total billed charges,
IMP GRAFT VASCULAR LVL 15,2779577,CDM,278,RC,C1768,HCPCS,,,facility,outpatient,,,54754.00000,31483.55000,United Healthcare,Commercial,,49278.60,,,,,,,14236.04,53111.38,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,United Healthcare,Commercial,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP HOOK LVL 01,6280945,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,United Healthcare,Commercial,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP HOOK LVL 02,6280952,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP HOOK LVL 03,6280960,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP HOOK LVL 04,6280978,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,61320.00000,35259.00000,United Healthcare,Commercial,,55188.00,,,,,,,55188.00,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 01,6292460,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,61320.00000,35259.00000,United Healthcare,Commercial,,55188.00,,,,,,,15943.20,59480.40,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,70080.00000,40296.00000,United Healthcare,Commercial,,63072.00,,,,,,,63072.00,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 02,6286538,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,70080.00000,40296.00000,United Healthcare,Commercial,,63072.00,,,,,,,18220.80,67977.60,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,78840.00000,45333.00000,United Healthcare,Commercial,,70956.00,,,,,,,70956.00,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 03,6278238,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,78840.00000,45333.00000,United Healthcare,Commercial,,70956.00,,,,,,,20498.40,76474.80,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,96364.00000,55409.30000,United Healthcare,Commercial,,86727.60,,,,,,,86727.60,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 04,2772374,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,96364.00000,55409.30000,United Healthcare,Commercial,,86727.60,,,,,,,25054.64,93473.08,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,United Healthcare,Commercial,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 05,6274351,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,United Healthcare,Commercial,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,inpatient,,,122644.00000,70520.30000,United Healthcare,Commercial,,110379.60,,,,,,,110379.60,118964.68,percent of total billed charges,
IMP ICD CHAMBER NON SGL/DUAL LVL 06,6275077,CDM,278,RC,C1882,HCPCS,,,facility,outpatient,,,122644.00000,70520.30000,United Healthcare,Commercial,,110379.60,,,,,,,31887.44,118964.68,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 01,2773018,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 02,6273825,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 03,6273833,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 04,6273841,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 05,6273858,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 06,6273866,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 07,6273874,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 08,6273882,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 09,6273890,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,United Healthcare,Commercial,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 10,6274427,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,United Healthcare,Commercial,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,United Healthcare,Commercial,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP LD ICD COIL DUAL LVL 11,6276687,CDM,278,RC,C1895,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,United Healthcare,Commercial,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 01,2773034,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 02,6273742,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 03,6273759,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 04,6273767,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 05,6273775,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 06,6273783,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 07,6273791,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 08,6273809,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD ICD COIL SGL LVL 09,6273817,CDM,278,RC,C1777,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 04,2773026,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD ICD NON SGL/DUAL LVL 05,6278949,CDM,278,RC,C1896,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 01,2773042,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 02,6273700,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 03,6273718,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 04,6273726,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 05,6276323,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 06,6276331,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD NEUROSTIM LVL 07,6279004,CDM,278,RC,C1778,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,166.00000,95.45000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 01,6301493,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,166.00000,95.45000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 02,6301501,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 03,6301519,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 04,6301527,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,1883.00000,1082.72000,United Healthcare,Commercial,,1694.70,,,,,,,1694.70,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 05,6301535,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,1883.00000,1082.72000,United Healthcare,Commercial,,1694.70,,,,,,,489.58,1826.51,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 06,2773059,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,United Healthcare,Commercial,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 07,6280655,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,United Healthcare,Commercial,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 08,6280812,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,inpatient,,,7644.00000,4395.30000,United Healthcare,Commercial,,6879.60,,,,,,,6879.60,7414.68,percent of total billed charges,
IMP LD NEUROSTIM TEST KIT LVL 09,6280820,CDM,278,RC,C1897,HCPCS,,,facility,outpatient,,,7644.00000,4395.30000,United Healthcare,Commercial,,6879.60,,,,,,,1987.44,7414.68,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 01,2773075,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 02,6273361,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 03,6274294,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 04,6274302,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 05,6274310,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 06,6274328,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 07,6274336,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD PCMKR NON VDD LVL 08,6274344,CDM,278,RC,C1898,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,2690.00000,1546.75000,United Healthcare,Commercial,,2421.00,,,,,,,2421.00,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 01,6276240,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,2690.00000,1546.75000,United Healthcare,Commercial,,2421.00,,,,,,,699.40,2609.30,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 02,2773083,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 03,6274617,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 04,6274625,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 05,6274633,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 06,6274641,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 07,6274658,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP LD PCMKR VDD LVL 08,6274666,CDM,278,RC,C1779,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 01,2773067,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 02,2778793,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 03,2778801,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 04,2778819,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 05,2778827,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 06,2778835,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 07,2778843,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 08,2778850,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD PCMKR/ICD COMBO LVL 09,2778868,CDM,278,RC,C1899,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 04,6274062,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 05,6274070,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 06,6274088,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 07,6274096,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 08,6274104,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP LD VENOUS COR LV LVL 09,6274112,CDM,278,RC,C1900,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 01,6298475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 02,6298483,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 03,6298491,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 04,6298509,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 05,6298517,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 06,6298525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP LIG/TNDN HUMAN/SYNTHETIC LVL 07,6298533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 01,2773158,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 02,2778470,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP MARKER TISSUE LVL 03,6277925,CDM,278,RC,A4648,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,inpatient,,,1614.00000,928.05000,United Healthcare,Commercial,,1452.60,,,,,,,1452.60,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 02,6280804,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,United Healthcare,Commercial,,1452.60,,,,,,,419.64,1565.58,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP MATERIAL CORD VOCAL LVL 03,6275879,CDM,278,RC,C1878,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 01,6277024,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP MEMBRANE AMNIO OCULAR LVL 02,6277032,CDM,278,RC,V2790,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP MESH LVL 01,2773166,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP MESH LVL 02,2773174,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP MESH LVL 03,2773182,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP MESH LVL 04,2773190,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP MESH LVL 05,2773216,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP MESH LVL 06,2773224,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP MESH LVL 07,2773232,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP MESH LVL 08,2773240,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP MESH LVL 09,2773208,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP MESH LVL 10,2773257,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP MESH LVL 11,6271605,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,United Healthcare,Commercial,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP MESH LVL 12,6271613,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,United Healthcare,Commercial,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,United Healthcare,Commercial,,25626.60,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP MESH LVL 13,6271621,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,United Healthcare,Commercial,,25626.60,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,United Healthcare,Commercial,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP MESH LVL 14,6272678,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,United Healthcare,Commercial,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,inpatient,,,37234.00000,21409.55000,United Healthcare,Commercial,,33510.60,,,,,,,33510.60,36116.98,percent of total billed charges,
IMP MESH LVL 15,6278758,CDM,278,RC,C1781,HCPCS,,,facility,outpatient,,,37234.00000,21409.55000,United Healthcare,Commercial,,33510.60,,,,,,,9680.84,36116.98,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP NEURO LVL 01,2772457,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP NEURO LVL 02,2779635,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP NEURO LVL 03,2779643,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP NEURO LVL 04,2779650,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP NEURO LVL 05,2779668,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP NEURO LVL 06,2779676,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP NEURO LVL 07,2779684,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,United Healthcare,Commercial,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP NEURO LVL 08,6280721,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,United Healthcare,Commercial,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP NEUROSTIM RECVR&/TRANS LVL 01,2775716,CDM,278,RC,C1816,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 02,6273288,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 03,6273296,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 04,6273304,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 05,6273312,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 06,6273320,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 07,6273338,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 08,6273346,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 09,6273353,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 10,6279376,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,United Healthcare,Commercial,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 11,6279434,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,United Healthcare,Commercial,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,United Healthcare,Commercial,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 12,6279442,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,United Healthcare,Commercial,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,United Healthcare,Commercial,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP ORTHOPEDIC CAGE LVL 13,6279475,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,United Healthcare,Commercial,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,159.00000,91.42000,United Healthcare,Commercial,,143.10,,,,,,,143.10,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 01,6279541,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,159.00000,91.42000,United Healthcare,Commercial,,143.10,,,,,,,41.34,154.23,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 02,6279558,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 03,6279566,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 04,6279574,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,United Healthcare,Commercial,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 05,6279582,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,United Healthcare,Commercial,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ORTHOTIC CAP END LVL 06,6279590,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 01,2773737,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 02,2773745,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 03,2773752,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 04,6271704,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 05,6271712,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 06,6271720,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,United Healthcare,Commercial,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 07,6271738,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,United Healthcare,Commercial,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,United Healthcare,Commercial,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 08,6278147,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,United Healthcare,Commercial,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2827.00000,1625.52000,United Healthcare,Commercial,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 09,6278154,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,United Healthcare,Commercial,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,United Healthcare,Commercial,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 10,6278162,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,United Healthcare,Commercial,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 11,6278170,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 12,6278329,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8107.00000,4661.52000,United Healthcare,Commercial,,7296.30,,,,,,,7296.30,7863.79,percent of total billed charges,
IMP PIN/WIRE LVL 13,6278931,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8107.00000,4661.52000,United Healthcare,Commercial,,7296.30,,,,,,,2107.82,7863.79,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,United Healthcare,Commercial,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 01,6277099,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,United Healthcare,Commercial,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,United Healthcare,Commercial,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 02,6277107,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,United Healthcare,Commercial,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,109504.00000,62964.80000,United Healthcare,Commercial,,98553.60,,,,,,,98553.60,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 03,6277115,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,109504.00000,62964.80000,United Healthcare,Commercial,,98553.60,,,,,,,28471.04,106218.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,131404.00000,75557.30000,United Healthcare,Commercial,,118263.60,,,,,,,118263.60,127461.88,percent of total billed charges,
IMP PLATE CUST LVL 04,6277123,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,131404.00000,75557.30000,United Healthcare,Commercial,,118263.60,,,,,,,34165.04,127461.88,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP PLATE LVL 01,2773786,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PLATE LVL 02,2773794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP PLATE LVL 03,2773802,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PLATE LVL 04,2773810,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PLATE LVL 05,2773836,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PLATE LVL 06,2773844,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP PLATE LVL 07,2773851,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PLATE LVL 08,2773869,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PLATE LVL 09,2773828,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PLATE LVL 10,2773877,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PLATE LVL 11,6271746,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PLATE LVL 12,6271753,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PLATE LVL 13,6271761,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP PLATE LVL 14,6271779,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,18400.00000,10580.00000,United Healthcare,Commercial,,16560.00,,,,,,,16560.00,17848.00,percent of total billed charges,
IMP PLATE LVL 15,6274377,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,18400.00000,10580.00000,United Healthcare,Commercial,,16560.00,,,,,,,4784.00,17848.00,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PLATE LVL 16,6274864,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,United Healthcare,Commercial,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP PLATE LVL 17,6274872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,United Healthcare,Commercial,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PLATE LVL 18,6279855,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,United Healthcare,Commercial,,25626.60,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP PLATE LVL 19,6279863,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,United Healthcare,Commercial,,25626.60,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PLATE LVL 20,6279871,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,United Healthcare,Commercial,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP PLATE LVL 21,6279889,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,United Healthcare,Commercial,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PLATE LVL 22,6279897,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 01,2773943,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 02,2773950,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 03,2773968,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 04,2773976,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 05,2773992,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 06,6272488,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 07,6272496,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 08,6272504,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 09,6275390,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PROSTH ANKLE LVL 10,6280044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 01,2774099,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 02,2774107,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 03,2774115,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH BREAST LVL 04,2775104,CDM,278,RC,C1789,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 01,2774339,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 02,2774347,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 03,2774354,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 04,2771186,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 05,6273940,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 06,6273957,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 07,6273965,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 08,6273973,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 09,6274476,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 10,6274484,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 11,6274492,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH ENT LVL 12,6274500,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 01,2774875,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 02,2774883,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 03,2774891,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 04,2774909,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 05,2774925,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 06,6275671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 07,6275689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 08,6275697,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH MAXILLOFACIAL LVL 09,6275705,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 01,2775161,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 02,2775179,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 03,2775187,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 04,2770733,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH OPHTHALMIC LVL 05,2770675,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1614.00000,928.05000,United Healthcare,Commercial,,1452.60,,,,,,,1452.60,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 01,6276190,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1614.00000,928.05000,United Healthcare,Commercial,,1452.60,,,,,,,419.64,1565.58,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 02,6275200,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 03,6275218,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 04,6276208,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH ORTHOPEDIC LVL 05,6279236,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 02,2775195,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 03,2775203,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 04,2775211,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 05,6273528,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 06,6280374,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,United Healthcare,Commercial,,51249.60,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 07,6280382,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,United Healthcare,Commercial,,51249.60,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,United Healthcare,Commercial,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PROSTH PENILE INFLT LVL 08,6280390,CDM,278,RC,C1813,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,United Healthcare,Commercial,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 01,2775229,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 02,2775237,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH PENILE NONINF LVL 03,2775245,CDM,278,RC,C2622,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 01,2775252,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 02,2775260,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PROSTH PLASTIC SURG LVL 03,2775278,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,5368.00000,3086.60000,United Healthcare,Commercial,,4831.20,,,,,,,4831.20,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 01,6278469,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,5368.00000,3086.60000,United Healthcare,Commercial,,4831.20,,,,,,,1395.68,5206.96,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 02,6274005,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 03,6280671,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR ANAL LVL 04,6280689,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 01,2775617,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,14020.00000,8061.50000,United Healthcare,Commercial,,12618.00,,,,,,,12618.00,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 02,6277669,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,14020.00000,8061.50000,United Healthcare,Commercial,,12618.00,,,,,,,3645.20,13599.40,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 03,6277842,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,inpatient,,,25408.00000,14609.60000,United Healthcare,Commercial,,22867.20,,,,,,,22867.20,24645.76,percent of total billed charges,
IMP PROSTH SPHINCTR URIN LVL 04,6277859,CDM,278,RC,C1815,HCPCS,,,facility,outpatient,,,25408.00000,14609.60000,United Healthcare,Commercial,,22867.20,,,,,,,6606.08,24645.76,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 01,2775435,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 02,2775443,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 03,2775450,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 04,6274781,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 05,6274799,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 06,6274807,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 07,6274815,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP PROSTH TESTICULAR LVL 08,6274823,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG PERM LVL 01,2775641,CDM,278,RC,C1891,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 01,2775658,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 02,2774933,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 03,2774941,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 04,2774958,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP PUMP INF NONPRG TMP LVL 05,2774917,CDM,278,RC,C2626,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 01,2775666,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,8112.00000,4664.40000,United Healthcare,Commercial,,7300.80,,,,,,,7300.80,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 02,6274708,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,8112.00000,4664.40000,United Healthcare,Commercial,,7300.80,,,,,,,2109.12,7868.64,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,10431.00000,5997.82000,United Healthcare,Commercial,,9387.90,,,,,,,9387.90,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 03,6274716,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,10431.00000,5997.82000,United Healthcare,Commercial,,9387.90,,,,,,,2712.06,10118.07,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 04,6274724,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 05,6274732,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 06,6274740,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,32854.00000,18891.05000,United Healthcare,Commercial,,29568.60,,,,,,,29568.60,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 07,6274757,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,32854.00000,18891.05000,United Healthcare,Commercial,,29568.60,,,,,,,8542.04,31868.38,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 08,6274765,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,46870.00000,26950.25000,United Healthcare,Commercial,,42183.00,,,,,,,42183.00,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 09,6274773,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,46870.00000,26950.25000,United Healthcare,Commercial,,42183.00,,,,,,,12186.20,45463.90,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,inpatient,,,51250.00000,29468.75000,United Healthcare,Commercial,,46125.00,,,,,,,46125.00,49712.50,percent of total billed charges,
IMP PUMP INF PRG LVL 10,6275861,CDM,278,RC,C1772,HCPCS,,,facility,outpatient,,,51250.00000,29468.75000,United Healthcare,Commercial,,46125.00,,,,,,,13325.00,49712.50,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 01,6310056,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 02,6310064,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,United Healthcare,Commercial,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 03,6310072,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,United Healthcare,Commercial,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,United Healthcare,Commercial,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 04,6310080,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,United Healthcare,Commercial,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,United Healthcare,Commercial,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 05,6282198,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,United Healthcare,Commercial,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,87604.00000,50372.30000,United Healthcare,Commercial,,78843.60,,,,,,,78843.60,84975.88,percent of total billed charges,
IMP PUMP VALVE BLOOD LVL 06,6275143,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,87604.00000,50372.30000,United Healthcare,Commercial,,78843.60,,,,,,,22777.04,84975.88,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 01,2774024,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 02,2774032,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RING CARDIAC LVL 03,6273734,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,166.00000,95.45000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 01,6283725,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,166.00000,95.45000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,588.00000,338.10000,United Healthcare,Commercial,,529.20,,,,,,,529.20,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 02,6283733,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,588.00000,338.10000,United Healthcare,Commercial,,529.20,,,,,,,152.88,570.36,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 03,2775831,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RING FALLOPE LVL 04,6301287,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RING LVL 01,2775849,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RING LVL 02,6271878,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,United Healthcare,Commercial,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RING LVL 03,6271886,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,United Healthcare,Commercial,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 01,2775872,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 02,2775880,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 03,2775898,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 04,2775906,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,United Healthcare,Commercial,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 05,2775914,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,United Healthcare,Commercial,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,United Healthcare,Commercial,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 06,2775922,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,United Healthcare,Commercial,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,United Healthcare,Commercial,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 07,2774040,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,United Healthcare,Commercial,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,7876.00000,4528.70000,United Healthcare,Commercial,,7088.40,,,,,,,7088.40,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 08,6271894,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7876.00000,4528.70000,United Healthcare,Commercial,,7088.40,,,,,,,2047.76,7639.72,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 09,6271902,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 10,6276794,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 11,6278253,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 12,6278261,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,United Healthcare,Commercial,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP ROD/NAIL LVL 13,6278279,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,United Healthcare,Commercial,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 01,6310981,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 02,6310999,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 03,6286918,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5856.00000,3367.20000,United Healthcare,Commercial,,5270.40,,,,,,,5270.40,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 04,6286926,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5856.00000,3367.20000,United Healthcare,Commercial,,5270.40,,,,,,,1522.56,5680.32,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,United Healthcare,Commercial,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 05,6286934,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,United Healthcare,Commercial,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,United Healthcare,Commercial,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 06,6286942,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,United Healthcare,Commercial,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,United Healthcare,Commercial,,7505.10,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 07,6286959,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,United Healthcare,Commercial,,7505.10,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 08,6286967,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 09,6287551,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW HEAD LVL 10,6288260,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 01,6287015,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 02,6287023,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP ELBOW STEM LVL 03,6287031,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 01,6285472,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 02,6285480,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 03,6285498,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 04,6285506,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP BR/AX/YK/BH LVL 05,6285514,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 05,6282990,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 06,6283006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 07,6283014,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP CUP LVL 08,6283022,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 01,6301071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 02,6287577,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 03,6282859,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 04,6282867,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,United Healthcare,Commercial,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 05,6282875,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,United Healthcare,Commercial,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,United Healthcare,Commercial,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 06,6282883,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,United Healthcare,Commercial,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,United Healthcare,Commercial,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 07,6283501,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,United Healthcare,Commercial,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 08,6283519,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,United Healthcare,Commercial,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP FEMORAL HD LVL 09,6283527,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,United Healthcare,Commercial,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 01,6285415,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 02,6284806,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 03,6284228,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 04,6284236,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,United Healthcare,Commercial,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 05,6284244,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,United Healthcare,Commercial,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,United Healthcare,Commercial,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 06,6284251,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,United Healthcare,Commercial,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,United Healthcare,Commercial,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 07,6284269,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,United Healthcare,Commercial,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 08,6284277,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,United Healthcare,Commercial,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP INSR/EX/RNG LVL 09,6284285,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,United Healthcare,Commercial,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 02,6288609,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4392.00000,2525.40000,United Healthcare,Commercial,,3952.80,,,,,,,3952.80,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 03,6287932,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4392.00000,2525.40000,United Healthcare,Commercial,,3952.80,,,,,,,1141.92,4260.24,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,United Healthcare,Commercial,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 04,6282966,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,United Healthcare,Commercial,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,United Healthcare,Commercial,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 05,6282974,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,United Healthcare,Commercial,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP LINER LVL 06,6282982,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,United Healthcare,Commercial,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 03,6282925,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,United Healthcare,Commercial,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,United Healthcare,Commercial,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 04,6282933,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,United Healthcare,Commercial,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,United Healthcare,Commercial,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 05,6282941,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,United Healthcare,Commercial,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP SHELL LVL 06,6282958,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 01,6287940,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,United Healthcare,Commercial,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 02,6287957,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,United Healthcare,Commercial,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 03,6282891,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 04,6282909,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP STEM LVL 05,6282917,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 02,6285423,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 03,6285431,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 04,6285449,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 05,6285456,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP RV/AD/RP HIP SYS MODULAR LVL 06,6285464,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 01,6285712,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 02,6285720,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 03,6285738,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 04,6285746,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 05,6285753,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN BR/AX/YK/BH LVL 06,6287569,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,United Healthcare,Commercial,,1013.40,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 01,6284830,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,United Healthcare,Commercial,,1013.40,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 02,6284483,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 03,6284491,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 04,6284509,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,United Healthcare,Commercial,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 05,6284517,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,United Healthcare,Commercial,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,United Healthcare,Commercial,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 06,6284525,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,United Healthcare,Commercial,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,United Healthcare,Commercial,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 07,6284533,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,United Healthcare,Commercial,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 08,6284541,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,United Healthcare,Commercial,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 09,6284558,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,United Healthcare,Commercial,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,United Healthcare,Commercial,,12223.80,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 10,6284566,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,United Healthcare,Commercial,,12223.80,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 11,6284574,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 12,6284582,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN DIS/POS AUG LVL 13,6284590,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 05,6285589,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 06,6285597,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP RV/AD/RP KN EX/CONNECT LVL 07,6285605,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 01,6283030,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 02,6283048,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 03,6283055,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP RV/AD/RP KN FEMORAL LVL 04,6283063,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 01,6288203,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 02,6288211,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2152.00000,1237.40000,United Healthcare,Commercial,,1936.80,,,,,,,1936.80,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 03,6288229,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2152.00000,1237.40000,United Healthcare,Commercial,,1936.80,,,,,,,559.52,2087.44,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,United Healthcare,Commercial,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 04,6283840,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,United Healthcare,Commercial,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 05,6283204,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 06,6283212,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN INSR/SLV/LN LVL 07,6283220,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 03,6283238,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,United Healthcare,Commercial,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 04,6283246,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,United Healthcare,Commercial,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 05,6283253,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,United Healthcare,Commercial,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 06,6283261,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,United Healthcare,Commercial,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,United Healthcare,Commercial,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN PATELLA LVL 07,6283279,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,United Healthcare,Commercial,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 01,6285522,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 02,6285530,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 03,6285548,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 04,6285555,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 05,6285563,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN ROTATING HNG LVL 06,6285571,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 02,6283162,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,United Healthcare,Commercial,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 03,6283170,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,United Healthcare,Commercial,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,United Healthcare,Commercial,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 04,6283188,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,United Healthcare,Commercial,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,United Healthcare,Commercial,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 05,6283196,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,United Healthcare,Commercial,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 06,6285399,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN STEM LVL 07,6285407,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1126.00000,647.45000,United Healthcare,Commercial,,1013.40,,,,,,,1013.40,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 01,6284848,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1126.00000,647.45000,United Healthcare,Commercial,,1013.40,,,,,,,292.76,1092.22,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 02,6284608,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 03,6284616,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 04,6284624,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,United Healthcare,Commercial,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 05,6284632,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,United Healthcare,Commercial,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,United Healthcare,Commercial,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 06,6284640,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,United Healthcare,Commercial,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6024.00000,3463.80000,United Healthcare,Commercial,,5421.60,,,,,,,5421.60,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 07,6284657,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6024.00000,3463.80000,United Healthcare,Commercial,,5421.60,,,,,,,1566.24,5843.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 08,6284665,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,United Healthcare,Commercial,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 09,6284673,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,United Healthcare,Commercial,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,United Healthcare,Commercial,,12223.80,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 10,6284681,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,United Healthcare,Commercial,,12223.80,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 11,6284699,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 12,6284707,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIB/FM TRIAL LVL 13,6284715,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 01,6283071,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,United Healthcare,Commercial,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 02,6283089,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,United Healthcare,Commercial,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 03,6283097,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8802.00000,5061.15000,United Healthcare,Commercial,,7921.80,,,,,,,7921.80,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 04,6283105,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8802.00000,5061.15000,United Healthcare,Commercial,,7921.80,,,,,,,2288.52,8537.94,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,10654.00000,6126.05000,United Healthcare,Commercial,,9588.60,,,,,,,9588.60,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 05,6283113,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,10654.00000,6126.05000,United Healthcare,Commercial,,9588.60,,,,,,,2770.04,10334.38,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,12506.00000,7190.95000,United Healthcare,Commercial,,11255.40,,,,,,,11255.40,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 06,6283121,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,12506.00000,7190.95000,United Healthcare,Commercial,,11255.40,,,,,,,3251.56,12130.82,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13582.00000,7809.65000,United Healthcare,Commercial,,12223.80,,,,,,,12223.80,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 07,6283139,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13582.00000,7809.65000,United Healthcare,Commercial,,12223.80,,,,,,,3531.32,13174.54,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 08,6283147,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17086.00000,9824.45000,United Healthcare,Commercial,,15377.40,,,,,,,15377.40,16573.42,percent of total billed charges,
IMP RV/AD/RP KN TIBIAL LVL 09,6283154,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17086.00000,9824.45000,United Healthcare,Commercial,,15377.40,,,,,,,4442.36,16573.42,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,United Healthcare,Commercial,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 01,6289953,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,United Healthcare,Commercial,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 02,6283345,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 03,6283352,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR GLEN CMP LVL 04,6283360,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,United Healthcare,Commercial,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 05,6283287,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,United Healthcare,Commercial,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,United Healthcare,Commercial,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 06,6283295,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,United Healthcare,Commercial,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,United Healthcare,Commercial,,7505.10,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR HEAD LVL 07,6283303,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,United Healthcare,Commercial,,7505.10,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 01,6287692,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,United Healthcare,Commercial,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 02,6285233,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,United Healthcare,Commercial,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 03,6283436,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 04,6283444,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR INSERT LVL 05,6283451,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 01,6283402,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 02,6283410,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR SHELL LVL 03,6283428,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,4880.00000,2806.00000,United Healthcare,Commercial,,4392.00,,,,,,,4392.00,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 01,6297006,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,4880.00000,2806.00000,United Healthcare,Commercial,,4392.00,,,,,,,1268.80,4733.60,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 02,6283311,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 03,6283329,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP RV/AD/RP SHDR STEM LVL 04,6283337,CDM,278,RC,C1776,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 01,2776144,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,3236.40,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 02,6309256,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,3596.00000,2067.70000,United Healthcare,Commercial,,3236.40,,,,,,,934.96,3488.12,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,4397.00000,2528.27000,United Healthcare,Commercial,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 03,6309264,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,4397.00000,2528.27000,United Healthcare,Commercial,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,inpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,5494.50,5921.85,percent of total billed charges,
IMP SEALANT PULMONARY LIQUID LVL 04,6309272,CDM,278,RC,C2615,HCPCS,,,facility,outpatient,,,6105.00000,3510.37000,United Healthcare,Commercial,,5494.50,,,,,,,1587.30,5921.85,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 01,2776151,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 02,6276497,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,United Healthcare,Commercial,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP SEPTAL DEFECT INTRACARD LVL 03,6276505,CDM,278,RC,C1817,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,United Healthcare,Commercial,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP SHUNT LVL 01,2776169,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP SHUNT LVL 02,2776177,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SHUNT LVL 03,2776185,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP SHUNT LVL 04,2776193,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SHUNT LVL 05,2776201,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,United Healthcare,Commercial,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP SHUNT LVL 06,2774248,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,United Healthcare,Commercial,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,United Healthcare,Commercial,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP SHUNT LVL 07,2774255,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,United Healthcare,Commercial,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP SHUNT LVL 08,2774263,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SHUNT LVL 09,2774271,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SHUNT LVL 10,6278220,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 01,6281026,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 02,6281034,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 03,6281042,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 04,6281059,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 05,6281067,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1888.00000,1085.60000,United Healthcare,Commercial,,1699.20,,,,,,,1699.20,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 06,6281075,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1888.00000,1085.60000,United Healthcare,Commercial,,1699.20,,,,,,,490.88,1831.36,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2426.00000,1394.95000,United Healthcare,Commercial,,2183.40,,,,,,,2183.40,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 07,6281083,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2426.00000,1394.95000,United Healthcare,Commercial,,2183.40,,,,,,,630.76,2353.22,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2827.00000,1625.52000,United Healthcare,Commercial,,2544.30,,,,,,,2544.30,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 08,6281091,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2827.00000,1625.52000,United Healthcare,Commercial,,2544.30,,,,,,,735.02,2742.19,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3340.00000,1920.50000,United Healthcare,Commercial,,3006.00,,,,,,,3006.00,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 09,6281109,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3340.00000,1920.50000,United Healthcare,Commercial,,3006.00,,,,,,,868.40,3239.80,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 10,6281273,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4153.00000,2387.98000,United Healthcare,Commercial,,3737.70,,,,,,,3737.70,4028.41,percent of total billed charges,
IMP SPINAL BAR/RG/CLR LVL 11,6281281,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4153.00000,2387.98000,United Healthcare,Commercial,,3737.70,,,,,,,1079.78,4028.41,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,United Healthcare,Commercial,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 03,6279715,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,United Healthcare,Commercial,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,United Healthcare,Commercial,,7505.10,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 04,6279723,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,United Healthcare,Commercial,,7505.10,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9728.00000,5593.60000,United Healthcare,Commercial,,8755.20,,,,,,,8755.20,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 05,6279731,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9728.00000,5593.60000,United Healthcare,Commercial,,8755.20,,,,,,,2529.28,9436.16,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,11117.00000,6392.28000,United Healthcare,Commercial,,10005.30,,,,,,,10005.30,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 06,6279749,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,11117.00000,6392.28000,United Healthcare,Commercial,,10005.30,,,,,,,2890.42,10783.49,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 07,6279756,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 08,6279764,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 09,6279772,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 10,6279780,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 11,6279798,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 12,6279806,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 13,6279814,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 14,6279996,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,United Healthcare,Commercial,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 15,6280002,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,United Healthcare,Commercial,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,United Healthcare,Commercial,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 16,6280010,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,United Healthcare,Commercial,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,United Healthcare,Commercial,,51249.60,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 17,6280028,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,United Healthcare,Commercial,,51249.60,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,61324.00000,35261.30000,United Healthcare,Commercial,,55191.60,,,,,,,55191.60,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 18,6280036,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,61324.00000,35261.30000,United Healthcare,Commercial,,55191.60,,,,,,,15944.24,59484.28,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,United Healthcare,Commercial,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 19,6280234,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,United Healthcare,Commercial,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,70084.00000,40298.30000,United Healthcare,Commercial,,63075.60,,,,,,,63075.60,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 20,6280242,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,70084.00000,40298.30000,United Healthcare,Commercial,,63075.60,,,,,,,18221.84,67981.48,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,74464.00000,42816.80000,United Healthcare,Commercial,,67017.60,,,,,,,67017.60,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 21,6280259,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,United Healthcare,Commercial,,67017.60,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,78844.00000,45335.30000,United Healthcare,Commercial,,70959.60,,,,,,,70959.60,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 22,6280267,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,78844.00000,45335.30000,United Healthcare,Commercial,,70959.60,,,,,,,20499.44,76478.68,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,83224.00000,47853.80000,United Healthcare,Commercial,,74901.60,,,,,,,74901.60,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 23,6280275,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,United Healthcare,Commercial,,74901.60,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,111694.00000,64224.05000,United Healthcare,Commercial,,100524.60,,,,,,,100524.60,108343.18,percent of total billed charges,
IMP SPINE FUSION LVL 24,6280309,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,111694.00000,64224.05000,United Healthcare,Commercial,,100524.60,,,,,,,29040.44,108343.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 01,6277172,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 02,6277180,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 03,6277198,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 04,6277206,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 05,6277214,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 06,6277222,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 07,6277230,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP SPINE KYPHX LVL 08,6277248,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,166.00000,95.45000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 01,2776342,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,166.00000,95.45000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,447.00000,257.02000,United Healthcare,Commercial,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 02,2776359,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,447.00000,257.02000,United Healthcare,Commercial,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,709.00000,407.67000,United Healthcare,Commercial,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 03,2776367,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,709.00000,407.67000,United Healthcare,Commercial,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,991.00000,569.82000,United Healthcare,Commercial,,891.90,,,,,,,891.90,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 04,2774685,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,991.00000,569.82000,United Healthcare,Commercial,,891.90,,,,,,,257.66,961.27,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,1490.00000,856.75000,United Healthcare,Commercial,,1341.00,,,,,,,1341.00,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 05,6271910,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,1490.00000,856.75000,United Healthcare,Commercial,,1341.00,,,,,,,387.40,1445.30,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 06,6271928,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 07,6271936,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,United Healthcare,Commercial,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 08,6271944,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,United Healthcare,Commercial,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 09,6271951,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,5861.00000,3370.08000,United Healthcare,Commercial,,5274.90,,,,,,,5274.90,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 10,6271969,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,5861.00000,3370.08000,United Healthcare,Commercial,,5274.90,,,,,,,1523.86,5685.17,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,6487.00000,3730.02000,United Healthcare,Commercial,,5838.30,,,,,,,5838.30,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 11,6271977,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,6487.00000,3730.02000,United Healthcare,Commercial,,5838.30,,,,,,,1686.62,6292.39,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,7413.00000,4262.47000,United Healthcare,Commercial,,6671.70,,,,,,,6671.70,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 12,6275622,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,7413.00000,4262.47000,United Healthcare,Commercial,,6671.70,,,,,,,1927.38,7190.61,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,inpatient,,,8339.00000,4794.92000,United Healthcare,Commercial,,7505.10,,,,,,,7505.10,8088.83,percent of total billed charges,
IMP STAPLE BONE LVL 13,6279384,CDM,278,RC,C1713,HCPCS,,,facility,outpatient,,,8339.00000,4794.92000,United Healthcare,Commercial,,7505.10,,,,,,,2168.14,8088.83,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 01,6280572,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,313.00000,179.98000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 02,6280580,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 03,6280598,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 04,6280606,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP STAPLE REINFORCEMENT LVL 05,6280614,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 01,2776458,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 02,2775369,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 03,2775377,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 04,2775385,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 05,2775393,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 06,2775401,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 07,2775419,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 08,2775427,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 09,2775690,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 10,6272587,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 11,6272595,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 12,6272603,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 13,6272611,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 14,6281000,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP STENT COAT W DEL LVL 15,6281018,CDM,278,RC,C1874,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,1271.70,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 01,6310890,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,1413.00000,812.47000,United Healthcare,Commercial,,1271.70,,,,,,,367.38,1370.61,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 02,6310908,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,3467.70,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 03,6310916,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,3853.00000,2215.48000,United Healthcare,Commercial,,3467.70,,,,,,,1001.78,3737.41,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 04,6310924,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,6945.00000,3993.37000,United Healthcare,Commercial,,6250.50,,,,,,,6250.50,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 05,6310932,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,6945.00000,3993.37000,United Healthcare,Commercial,,6250.50,,,,,,,1805.70,6736.65,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT COAT WO DEL LVL 06,2776466,CDM,278,RC,C1875,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 01,2776573,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 02,2775708,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 03,2775856,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 04,2775864,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 05,2776094,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 06,2776102,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 07,2776110,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 08,2776284,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 09,6272058,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 10,6272066,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 11,6272074,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NONCOAT W DEL LVL 12,6272082,CDM,278,RC,C1876,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,447.00000,257.02000,United Healthcare,Commercial,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 01,2776581,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,447.00000,257.02000,United Healthcare,Commercial,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 02,2776292,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 03,2776516,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 04,2776565,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 05,2776813,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 06,2776821,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 07,2774289,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 08,2774297,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 09,6272140,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 10,6272090,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 11,6272108,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 12,6272116,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 13,6272124,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NONCOAT WO DEL LVL 14,6272132,CDM,278,RC,C1877,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 01,2776599,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 02,6279608,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 03,6280739,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,3909.00000,2247.67000,United Healthcare,Commercial,,3518.10,,,,,,,3518.10,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 04,6280747,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,3909.00000,2247.67000,United Healthcare,Commercial,,3518.10,,,,,,,1016.34,3791.73,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,inpatient,,,5373.00000,3089.48000,United Healthcare,Commercial,,4835.70,,,,,,,4835.70,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP W DEL LVL 05,6280754,CDM,278,RC,C2625,HCPCS,,,facility,outpatient,,,5373.00000,3089.48000,United Healthcare,Commercial,,4835.70,,,,,,,1396.98,5211.81,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,166.00000,95.45000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 01,2776607,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,166.00000,95.45000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 02,2772663,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 03,2772713,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 04,2772721,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 05,2772739,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,1619.00000,930.92000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 06,6273379,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 07,6273387,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 08,6273395,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NONCOR TEMP WO DEL LVL 09,6273403,CDM,278,RC,C2617,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
IMP STENT NOS LVL 01,2776474,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,594.00000,341.55000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,1018.80,1098.04,percent of total billed charges,
IMP STENT NOS LVL 02,2776482,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,1132.00000,650.90000,United Healthcare,Commercial,,1018.80,,,,,,,294.32,1098.04,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP STENT NOS LVL 03,2776490,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP STENT NOS LVL 04,2776508,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 05,2776524,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP STENT NOS LVL 06,2776532,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP STENT NOS LVL 07,2776540,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP STENT NOS LVL 08,2776557,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP STENT NOS LVL 09,6272041,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP STENT NOS LVL 10,6271993,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP STENT NOS LVL 11,6272009,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP STENT NOS LVL 12,6272017,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP STENT NOS LVL 13,6272025,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP STENT NOS LVL 14,6272033,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP STENT NOS LVL 15,6278956,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,50374.00000,28965.05000,United Healthcare,Commercial,,45336.60,,,,,,,45336.60,48862.78,percent of total billed charges,
IMP STENT NOS LVL 16,6281349,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,50374.00000,28965.05000,United Healthcare,Commercial,,45336.60,,,,,,,13097.24,48862.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,17742.60,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 02,6293385,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,19714.00000,11335.55000,United Healthcare,Commercial,,17742.60,,,,,,,5125.64,19122.58,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,24094.00000,13854.05000,United Healthcare,Commercial,,21684.60,,,,,,,21684.60,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 03,6293393,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,24094.00000,13854.05000,United Healthcare,Commercial,,21684.60,,,,,,,6264.44,23371.18,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,28474.00000,16372.55000,United Healthcare,Commercial,,25626.60,,,,,,,25626.60,27619.78,percent of total billed charges,
IMP STIMULATOR BONE LVL 04,6293401,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,28474.00000,16372.55000,United Healthcare,Commercial,,25626.60,,,,,,,7403.24,27619.78,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,2425.50,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 01,2776797,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,2695.00000,1549.62000,United Healthcare,Commercial,,2425.50,,,,,,,700.70,2614.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 02,2776805,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,6255.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 03,6272165,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,6950.00000,3996.25000,United Healthcare,Commercial,,6255.00,,,,,,,1807.00,6741.50,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 04,6272173,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,10422.00,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 05,6272181,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,11580.00000,6658.50000,United Healthcare,Commercial,,10422.00,,,,,,,3010.80,11232.60,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 06,6272199,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,13800.60,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 07,6272207,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,15334.00000,8817.05000,United Healthcare,Commercial,,13800.60,,,,,,,3986.84,14873.98,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 08,6272215,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 09,6272819,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 10,6272827,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 11,6272835,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 12,6275986,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 13,6276216,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 14,6276224,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,United Healthcare,Commercial,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP TISSUE CONNECT HUMAN LVL 15,6281182,CDM,278,RC,C1762,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,United Healthcare,Commercial,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 01,2776888,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,850.00000,488.75000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,1941.30,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 02,2776896,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,2157.00000,1240.27000,United Healthcare,Commercial,,1941.30,,,,,,,560.82,2092.29,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,3083.00000,1772.72000,United Healthcare,Commercial,,2774.70,,,,,,,2774.70,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 03,2776904,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,3083.00000,1772.72000,United Healthcare,Commercial,,2774.70,,,,,,,801.58,2990.51,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 04,2776912,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 05,2774446,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 06,2774453,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 07,6276679,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 08,6277818,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 09,6280101,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 10,6280119,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,48184.00000,27705.80000,United Healthcare,Commercial,,43365.60,,,,,,,43365.60,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 11,6280440,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,48184.00000,27705.80000,United Healthcare,Commercial,,43365.60,,,,,,,12527.84,46738.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,United Healthcare,Commercial,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 12,6281778,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,United Healthcare,Commercial,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,56944.00000,32742.80000,United Healthcare,Commercial,,51249.60,,,,,,,51249.60,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 13,6281786,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,56944.00000,32742.80000,United Healthcare,Commercial,,51249.60,,,,,,,14805.44,55235.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,65704.00000,37779.80000,United Healthcare,Commercial,,59133.60,,,,,,,59133.60,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 14,6285654,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,65704.00000,37779.80000,United Healthcare,Commercial,,59133.60,,,,,,,17083.04,63732.88,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,74464.00000,42816.80000,United Healthcare,Commercial,,67017.60,,,,,,,67017.60,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 15,6285662,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,74464.00000,42816.80000,United Healthcare,Commercial,,67017.60,,,,,,,19360.64,72230.08,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,83224.00000,47853.80000,United Healthcare,Commercial,,74901.60,,,,,,,74901.60,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 16,6285670,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,83224.00000,47853.80000,United Healthcare,Commercial,,74901.60,,,,,,,21638.24,80727.28,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,91984.00000,52890.80000,United Healthcare,Commercial,,82785.60,,,,,,,82785.60,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 17,6287916,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,91984.00000,52890.80000,United Healthcare,Commercial,,82785.60,,,,,,,23915.84,89224.48,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,inpatient,,,100744.00000,57927.80000,United Healthcare,Commercial,,90669.60,,,,,,,90669.60,97721.68,percent of total billed charges,
IMP TISSUE CONNECT NONHUMAN LVL 18,6287924,CDM,278,RC,C1763,HCPCS,,,facility,outpatient,,,100744.00000,57927.80000,United Healthcare,Commercial,,90669.60,,,,,,,26193.44,97721.68,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,166.00000,95.45000,United Healthcare,Commercial,,149.40,,,,,,,149.40,161.02,percent of total billed charges,
IMP TUBE EAR LVL 01,2777068,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,166.00000,95.45000,United Healthcare,Commercial,,149.40,,,,,,,43.16,161.02,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,447.00000,257.02000,United Healthcare,Commercial,,402.30,,,,,,,402.30,433.59,percent of total billed charges,
IMP TUBE EAR LVL 02,6279525,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,447.00000,257.02000,United Healthcare,Commercial,,402.30,,,,,,,116.22,433.59,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,709.00000,407.67000,United Healthcare,Commercial,,638.10,,,,,,,638.10,687.73,percent of total billed charges,
IMP TUBE EAR LVL 03,6279533,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,709.00000,407.67000,United Healthcare,Commercial,,638.10,,,,,,,184.34,687.73,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
IMP VALVE LVL 01,2774123,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
IMP VALVE LVL 02,2774131,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
IMP VALVE LVL 03,2774149,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,15771.60,16998.28,percent of total billed charges,
IMP VALVE LVL 04,2774156,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,17524.00000,10076.30000,United Healthcare,Commercial,,15771.60,,,,,,,4556.24,16998.28,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,19713.60,21246.88,percent of total billed charges,
IMP VALVE LVL 05,2774164,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,21904.00000,12594.80000,United Healthcare,Commercial,,19713.60,,,,,,,5695.04,21246.88,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,23655.60,25495.48,percent of total billed charges,
IMP VALVE LVL 06,2779981,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,26284.00000,15113.30000,United Healthcare,Commercial,,23655.60,,,,,,,6833.84,25495.48,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,27597.60,29744.08,percent of total billed charges,
IMP VALVE LVL 07,2772044,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,30664.00000,17631.80000,United Healthcare,Commercial,,27597.60,,,,,,,7972.64,29744.08,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,31539.60,33992.68,percent of total billed charges,
IMP VALVE LVL 08,2770691,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,35044.00000,20150.30000,United Healthcare,Commercial,,31539.60,,,,,,,9111.44,33992.68,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,35481.60,38241.28,percent of total billed charges,
IMP VALVE LVL 09,2770709,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,39424.00000,22668.80000,United Healthcare,Commercial,,35481.60,,,,,,,10250.24,38241.28,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,39423.60,42489.88,percent of total billed charges,
IMP VALVE LVL 10,2770725,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,43804.00000,25187.30000,United Healthcare,Commercial,,39423.60,,,,,,,11389.04,42489.88,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,inpatient,,,52564.00000,30224.30000,United Healthcare,Commercial,,47307.60,,,,,,,47307.60,50987.08,percent of total billed charges,
IMP VALVE LVL 11,2771137,CDM,278,RC,L8699,HCPCS,,,facility,outpatient,,,52564.00000,30224.30000,United Healthcare,Commercial,,47307.60,,,,,,,13666.64,50987.08,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,4396.50,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 01,2773935,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,4885.00000,2808.88000,United Healthcare,Commercial,,4396.50,,,,,,,1270.10,4738.45,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,8338.50,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 02,2775112,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,9265.00000,5327.38000,United Healthcare,Commercial,,8338.50,,,,,,,2408.90,8987.05,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,inpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,12505.50,13478.15,percent of total billed charges,
PROGRAMMER PT NEUROSTIM LVL 03,6273510,CDM,278,RC,C1787,HCPCS,,,facility,outpatient,,,13895.00000,7989.62000,United Healthcare,Commercial,,12505.50,,,,,,,3612.70,13478.15,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2180.20000,1253.61000,United Healthcare,Commercial,,1962.18,,,,,,,1962.18,2114.79,percent of total billed charges,
SEALANT SYS DURASEAL 5ML,6307821,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2180.20000,1253.61000,United Healthcare,Commercial,,1962.18,,,,,,,566.85,2114.79,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,1880.60000,1081.34000,United Healthcare,Commercial,,1692.54,,,,,,,1692.54,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL ADH VASC 4ML,6307565,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,1880.60000,1081.34000,United Healthcare,Commercial,,1692.54,,,,,,,488.96,1824.18,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,inpatient,,,2908.70000,1672.50000,United Healthcare,Commercial,,2617.83,,,,,,,2617.83,2821.44,percent of total billed charges,
SURGICAL SLNT COSEAL PREMIX 8ML,6307581,CDM,278,RC,C1889,HCPCS,,,facility,outpatient,,,2908.70000,1672.50000,United Healthcare,Commercial,,2617.83,,,,,,,756.26,2821.44,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,inpatient,,,34.00000,25.74000,United Healthcare,Commercial,,30.60,,,,,,,30.60,32.98,percent of total billed charges,
COLLECT SPEC BLD VENIPNCTR LEGAL,3107539,CDM,300,RC,36415,CPT,,,facility,outpatient,,,34.00000,25.74000,United Healthcare,Commercial,,30.60,,,,,,,8.84,32.98,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,inpatient,,,13.00000,9.84000,United Healthcare,Commercial,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB ASSESSMENT LEUKOCYTE FECAL,3062080,CDM,300,RC,89055,CPT,,,facility,outpatient,,,13.00000,9.84000,United Healthcare,Commercial,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,United Healthcare,Commercial,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO,3077070,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,United Healthcare,Commercial,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,United Healthcare,Commercial,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO DISCREPANCY,3104429,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,United Healthcare,Commercial,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,inpatient,,,281.00000,212.72000,United Healthcare,Commercial,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
LAB BLOOD TYPE ABO NS,3104411,CDM,300,RC,86900,CPT,,,facility,outpatient,,,281.00000,212.72000,United Healthcare,Commercial,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,United Healthcare,Commercial,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA,3902319,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,United Healthcare,Commercial,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,United Healthcare,Commercial,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC EA NS,3902558,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,United Healthcare,Commercial,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,inpatient,,,751.00000,568.51000,United Healthcare,Commercial,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB BLOOD TYPE AG RBC PT EA,3104452,CDM,300,RC,86905,CPT,,,facility,outpatient,,,751.00000,568.51000,United Healthcare,Commercial,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,inpatient,,,122.00000,92.35000,United Healthcare,Commercial,,109.80,,,,,,,109.80,118.34,percent of total billed charges,
LAB BLOOD TYPE PHENOTYPING RH COMP,3104460,CDM,300,RC,86906,CPT,,,facility,outpatient,,,122.00000,92.35000,United Healthcare,Commercial,,109.80,,,,,,,31.72,118.34,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,inpatient,,,79.00000,59.80000,United Healthcare,Commercial,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD,3077088,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,United Healthcare,Commercial,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,inpatient,,,79.00000,59.80000,United Healthcare,Commercial,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB BLOOD TYPE RHD NS,3104437,CDM,300,RC,86901,CPT,,,facility,outpatient,,,79.00000,59.80000,United Healthcare,Commercial,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,inpatient,,,15.00000,11.36000,United Healthcare,Commercial,,13.50,,,,,,,13.50,14.55,percent of total billed charges,
LAB COUNT CELL CSF,3062031,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,United Healthcare,Commercial,,13.50,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,inpatient,,,15.00000,11.36000,United Healthcare,Commercial,,13.50,,,,,,,13.50,14.55,percent of total billed charges,
LAB COUNT CELL FLUID BODY,3062023,CDM,300,RC,89050,CPT,,,facility,outpatient,,,15.00000,11.36000,United Healthcare,Commercial,,13.50,,,,,,,3.90,14.55,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,inpatient,,,17.00000,12.87000,United Healthcare,Commercial,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF CSF,3062049,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,United Healthcare,Commercial,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,inpatient,,,17.00000,12.87000,United Healthcare,Commercial,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
LAB COUNT CELL W DIFF FLUID BODY,3062015,CDM,300,RC,89051,CPT,,,facility,outpatient,,,17.00000,12.87000,United Healthcare,Commercial,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,inpatient,,,359.00000,271.76000,United Healthcare,Commercial,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH ANTIGLOBULIN,3077567,CDM,300,RC,86922,CPT,,,facility,outpatient,,,359.00000,271.76000,United Healthcare,Commercial,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,inpatient,,,359.00000,271.76000,United Healthcare,Commercial,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH ELECTRONIC,3106168,CDM,300,RC,86923,CPT,,,facility,outpatient,,,359.00000,271.76000,United Healthcare,Commercial,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,inpatient,,,359.00000,271.76000,United Healthcare,Commercial,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB CROSSMATCH SPIN IMMEDIATE,3077575,CDM,300,RC,86920,CPT,,,facility,outpatient,,,359.00000,271.76000,United Healthcare,Commercial,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,inpatient,,,155.00000,117.34000,United Healthcare,Commercial,,139.50,,,,,,,139.50,150.35,percent of total billed charges,
LAB FIBERS MEAT FECES,3062106,CDM,300,RC,89160,CPT,,,facility,outpatient,,,155.00000,117.34000,United Healthcare,Commercial,,139.50,,,,,,,40.30,150.35,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,inpatient,,,294.00000,222.56000,United Healthcare,Commercial,,264.60,,,,,,,264.60,285.18,percent of total billed charges,
LAB ID CRYSTAL MICROSCOPY LIGHT,3062056,CDM,300,RC,89060,CPT,,,facility,outpatient,,,294.00000,222.56000,United Healthcare,Commercial,,264.60,,,,,,,76.44,285.18,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,inpatient,,,1511.00000,1143.83000,United Healthcare,Commercial,,1359.90,,,,,,,1359.90,1465.67,percent of total billed charges,
LAB LIVER DISEASE 10 ASSAYS,3121209,CDM,300,RC,0003M,CPT,,,facility,outpatient,,,1511.00000,1143.83000,United Healthcare,Commercial,,1359.90,,,,,,,392.86,1465.67,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,inpatient,,,751.00000,568.51000,United Healthcare,Commercial,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM,3902327,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,United Healthcare,Commercial,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,inpatient,,,751.00000,568.51000,United Healthcare,Commercial,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB PANEL AB RBC EA TECH SERUM NS,3104395,CDM,300,RC,86870,CPT,,,facility,outpatient,,,751.00000,568.51000,United Healthcare,Commercial,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,inpatient,,,150.00000,113.55000,United Healthcare,Commercial,,135.00,,,,,,,135.00,145.50,percent of total billed charges,
LAB PRETREAT RBC AB CHEMICAL NS,3104486,CDM,300,RC,86970,CPT,,,facility,outpatient,,,150.00000,113.55000,United Healthcare,Commercial,,135.00,,,,,,,39.00,145.50,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,inpatient,,,110.00000,83.27000,United Healthcare,Commercial,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA,3902335,CDM,300,RC,86850,CPT,,,facility,outpatient,,,110.00000,83.27000,United Healthcare,Commercial,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,inpatient,,,158.00000,119.61000,United Healthcare,Commercial,,142.20,,,,,,,142.20,153.26,percent of total billed charges,
LAB SCR AB RBC SERUM EA NS,3104361,CDM,300,RC,86850,CPT,,,facility,outpatient,,,158.00000,119.61000,United Healthcare,Commercial,,142.20,,,,,,,41.08,153.26,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,inpatient,,,153.00000,115.82000,United Healthcare,Commercial,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB SCR AG BLD TYPE SERUM PT U NS,3024270,CDM,300,RC,86904,CPT,,,facility,outpatient,,,153.00000,115.82000,United Healthcare,Commercial,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,inpatient,,,157.00000,118.85000,United Healthcare,Commercial,,141.30,,,,,,,141.30,152.29,percent of total billed charges,
LAB SCR METABOLIC NEWBORN,3105871,CDM,300,RC,S3620,HCPCS,,,facility,outpatient,,,157.00000,118.85000,United Healthcare,Commercial,,141.30,,,,,,,40.82,152.29,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,inpatient,,,26.00000,19.68000,United Healthcare,Commercial,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB SEMEN MOTILITY&CT WO HUHNER,3062130,CDM,300,RC,89310,CPT,,,facility,outpatient,,,26.00000,19.68000,United Healthcare,Commercial,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,inpatient,,,37.00000,28.01000,United Healthcare,Commercial,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB SEMEN SPERM PRESENCE MOTILITY,3108552,CDM,300,RC,89321,CPT,,,facility,outpatient,,,37.00000,28.01000,United Healthcare,Commercial,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,inpatient,,,268.00000,202.88000,United Healthcare,Commercial,,241.20,,,,,,,241.20,259.96,percent of total billed charges,
LAB SEPARATION RED CELL,3112950,CDM,300,RC,86999,CPT,,,facility,outpatient,,,268.00000,202.88000,United Healthcare,Commercial,,241.20,,,,,,,69.68,259.96,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,inpatient,,,91.00000,68.89000,United Healthcare,Commercial,,81.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA NS,3107679,CDM,300,RC,87205,CPT,,,facility,outpatient,,,91.00000,68.89000,United Healthcare,Commercial,,81.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,inpatient,,,200.00000,151.40000,United Healthcare,Commercial,,180.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA LSI NS,3123825,CDM,300,RC,87186,CPT,,,facility,outpatient,,,200.00000,151.40000,United Healthcare,Commercial,,180.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,inpatient,,,152.00000,115.06000,United Healthcare,Commercial,,136.80,,,,,,,136.80,147.44,percent of total billed charges,
LAB SUSCPT MIC PLATE EA NS,3107687,CDM,300,RC,87186,CPT,,,facility,outpatient,,,152.00000,115.06000,United Healthcare,Commercial,,136.80,,,,,,,39.52,147.44,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,inpatient,,,359.00000,271.76000,United Healthcare,Commercial,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB THAWING PLASMA FRESH FROZEN,3077849,CDM,300,RC,86927,CPT,,,facility,outpatient,,,359.00000,271.76000,United Healthcare,Commercial,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,inpatient,,,69.00000,33.26000,United Healthcare,Commercial,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB 17-HYDROXYPREGNENOLONE,3075439,CDM,301,RC,84143,CPT,,,facility,outpatient,,,69.00000,33.26000,United Healthcare,Commercial,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,inpatient,,,75.00000,36.15000,United Healthcare,Commercial,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB ACID AMINOLEVULINIC DELTA URINE,3062585,CDM,301,RC,82135,CPT,,,facility,outpatient,,,75.00000,36.15000,United Healthcare,Commercial,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB ACID ASCORBIC BLOOD,3076726,CDM,301,RC,82180,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,inpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID FOLIC RBC,3064888,CDM,301,RC,82747,CPT,,,facility,outpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,inpatient,,,45.00000,21.69000,United Healthcare,Commercial,,40.50,,,,,,,40.50,43.65,percent of total billed charges,
LAB ACID FOLIC SERUM,3064896,CDM,301,RC,82746,CPT,,,facility,outpatient,,,45.00000,21.69000,United Healthcare,Commercial,,40.50,,,,,,,11.70,43.65,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,inpatient,,,68.00000,32.78000,United Healthcare,Commercial,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB ACID HOMOVANILLIC,3073665,CDM,301,RC,83150,CPT,,,facility,outpatient,,,68.00000,32.78000,United Healthcare,Commercial,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,inpatient,,,61.00000,29.40000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB ACID HYDROXYINDOLACETIC 5-,3073681,CDM,301,RC,83497,CPT,,,facility,outpatient,,,61.00000,29.40000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,inpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC,3110608,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,inpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB ACID MYCOPHENOLIC NS,3108792,CDM,301,RC,80180,CPT,,,facility,outpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,inpatient,,,64.00000,30.85000,United Healthcare,Commercial,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE METHY QN NS,3074960,CDM,301,RC,83921,CPT,,,facility,outpatient,,,64.00000,30.85000,United Healthcare,Commercial,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,inpatient,,,195.00000,93.99000,United Healthcare,Commercial,,175.50,,,,,,,175.50,189.15,percent of total billed charges,
LAB ACID ORGANIC SINGLE QN,3074952,CDM,301,RC,83921,CPT,,,facility,outpatient,,,195.00000,93.99000,United Healthcare,Commercial,,175.50,,,,,,,50.70,189.15,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,inpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE PROSTATIC,3075249,CDM,301,RC,84066,CPT,,,facility,outpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,inpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB ACID PHOSPHATASE TOTAL NS,3029196,CDM,301,RC,84060,CPT,,,facility,outpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,inpatient,,,14.00000,6.75000,United Healthcare,Commercial,,12.60,,,,,,,12.60,13.58,percent of total billed charges,
LAB ACID URIC BLOOD,3076544,CDM,301,RC,84550,CPT,,,facility,outpatient,,,14.00000,6.75000,United Healthcare,Commercial,,12.60,,,,,,,3.64,13.58,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB ACID URIC FLUID BODY,3076551,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB ACID URIC OTHER SOURCE NS,3029204,CDM,301,RC,84560,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB ACID URIC URINE,3076577,CDM,301,RC,84560,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,inpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB ACID VALPROIC FREE,3116134,CDM,301,RC,80165,CPT,,,facility,outpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,inpatient,,,53.00000,25.55000,United Healthcare,Commercial,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL,3115698,CDM,301,RC,80164,CPT,,,facility,outpatient,,,53.00000,25.55000,United Healthcare,Commercial,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,inpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB ACID VALPROIC TOTAL NS,3116126,CDM,301,RC,80164,CPT,,,facility,outpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,inpatient,,,82.00000,39.52000,United Healthcare,Commercial,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB ACID VANILLYLMANDELIC URINE,3076643,CDM,301,RC,84585,CPT,,,facility,outpatient,,,82.00000,39.52000,United Healthcare,Commercial,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,inpatient,,,141.00000,67.96000,United Healthcare,Commercial,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN SPEC EA,3062551,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,United Healthcare,Commercial,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,inpatient,,,141.00000,67.96000,United Healthcare,Commercial,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB ACIDS AMINO 6+ QN URINE SPEC EA,3062569,CDM,301,RC,82139,CPT,,,facility,outpatient,,,141.00000,67.96000,United Healthcare,Commercial,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,inpatient,,,91.00000,43.86000,United Healthcare,Commercial,,81.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB ACIDS AMINO SGL QN SPEC EA,3062536,CDM,301,RC,82131,CPT,,,facility,outpatient,,,91.00000,43.86000,United Healthcare,Commercial,,81.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,inpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB ACIDS BILE TOTAL,3062932,CDM,301,RC,82239,CPT,,,facility,outpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,inpatient,,,69.00000,33.26000,United Healthcare,Commercial,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB ACIDS FATTY NONESTERIFIED,3064771,CDM,301,RC,82725,CPT,,,facility,outpatient,,,69.00000,33.26000,United Healthcare,Commercial,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,inpatient,,,205.00000,98.81000,United Healthcare,Commercial,,184.50,,,,,,,184.50,198.85,percent of total billed charges,
LAB ACIDS FATTY VERY LONG CHAIN,3105434,CDM,301,RC,82726,CPT,,,facility,outpatient,,,205.00000,98.81000,United Healthcare,Commercial,,184.50,,,,,,,53.30,198.85,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,inpatient,,,50.00000,24.10000,United Healthcare,Commercial,,45.00,,,,,,,45.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC EA QL,3074978,CDM,301,RC,83919,CPT,,,facility,outpatient,,,50.00000,24.10000,United Healthcare,Commercial,,45.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,inpatient,,,406.00000,195.69000,United Healthcare,Commercial,,365.40,,,,,,,365.40,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL EA QN,3074994,CDM,301,RC,83918,CPT,,,facility,outpatient,,,406.00000,195.69000,United Healthcare,Commercial,,365.40,,,,,,,105.56,393.82,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,inpatient,,,101.00000,48.68000,United Healthcare,Commercial,,90.90,,,,,,,90.90,97.97,percent of total billed charges,
LAB ACIDS ORGANIC TOTAL URINE EA QN,3075009,CDM,301,RC,83918,CPT,,,facility,outpatient,,,101.00000,48.68000,United Healthcare,Commercial,,90.90,,,,,,,26.26,97.97,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,inpatient,,,375.00000,180.75000,United Healthcare,Commercial,,337.50,,,,,,,337.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME ALPHA GALACTOS,3121035,CDM,301,RC,82657,CPT,,,facility,outpatient,,,375.00000,180.75000,United Healthcare,Commercial,,337.50,,,,,,,97.50,363.75,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,inpatient,,,362.00000,174.48000,United Healthcare,Commercial,,325.80,,,,,,,325.80,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME CHITOTRIOSIDASE,3125341,CDM,301,RC,82657,CPT,,,facility,outpatient,,,362.00000,174.48000,United Healthcare,Commercial,,325.80,,,,,,,94.12,351.14,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,inpatient,,,325.00000,156.65000,United Healthcare,Commercial,,292.50,,,,,,,292.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME L-ASPARAGNSE,3904513,CDM,301,RC,82657,CPT,,,facility,outpatient,,,325.00000,156.65000,United Healthcare,Commercial,,292.50,,,,,,,84.50,315.25,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,inpatient,,,121.00000,58.32000,United Healthcare,Commercial,,108.90,,,,,,,108.90,117.37,percent of total billed charges,
LAB ACTIVITY ENZYME NONRADIOACTIVE,3064532,CDM,301,RC,82657,CPT,,,facility,outpatient,,,121.00000,58.32000,United Healthcare,Commercial,,108.90,,,,,,,31.46,117.37,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,inpatient,,,115.00000,55.43000,United Healthcare,Commercial,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB ACYLCARNITINES QN EA,3105608,CDM,301,RC,82017,CPT,,,facility,outpatient,,,115.00000,55.43000,United Healthcare,Commercial,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,inpatient,,,300.00000,144.60000,United Healthcare,Commercial,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB ADALIMUMAB,3121456,CDM,301,RC,80145,CPT,,,facility,outpatient,,,300.00000,144.60000,United Healthcare,Commercial,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,inpatient,,,51.00000,24.58000,United Healthcare,Commercial,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP AMNIOTIC FLUID,3062411,CDM,301,RC,82106,CPT,,,facility,outpatient,,,51.00000,24.58000,United Healthcare,Commercial,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,inpatient,,,51.00000,24.58000,United Healthcare,Commercial,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP SERUM,3062429,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,United Healthcare,Commercial,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,inpatient,,,51.00000,24.58000,United Healthcare,Commercial,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB AFP SERUM MATERNAL,3071321,CDM,301,RC,82105,CPT,,,facility,outpatient,,,51.00000,24.58000,United Healthcare,Commercial,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,inpatient,,,194.00000,93.51000,United Healthcare,Commercial,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
LAB AFP-L3 ISOFORM FRAC&AFP TOTAL,3107356,CDM,301,RC,82107,CPT,,,facility,outpatient,,,194.00000,93.51000,United Healthcare,Commercial,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,inpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC,3063203,CDM,301,RC,82378,CPT,,,facility,outpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,inpatient,,,68.00000,32.78000,United Healthcare,Commercial,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC ARUP NS,3030491,CDM,301,RC,82378,CPT,,,facility,outpatient,,,68.00000,32.78000,United Healthcare,Commercial,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,inpatient,,,329.00000,158.58000,United Healthcare,Commercial,,296.10,,,,,,,296.10,319.13,percent of total billed charges,
LAB AG CARCINOEMBRYONIC MAYO NS,3030509,CDM,301,RC,82378,CPT,,,facility,outpatient,,,329.00000,158.58000,United Healthcare,Commercial,,296.10,,,,,,,85.54,319.13,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA,3119047,CDM,301,RC,82042,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,inpatient,,,24.00000,11.57000,United Healthcare,Commercial,,21.60,,,,,,,21.60,23.28,percent of total billed charges,
LAB ALBUMIN OTHER SOURCE QN EA NS,3119054,CDM,301,RC,82042,CPT,,,facility,outpatient,,,24.00000,11.57000,United Healthcare,Commercial,,21.60,,,,,,,6.24,23.28,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,inpatient,,,30.00000,14.46000,United Healthcare,Commercial,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL,3062346,CDM,301,RC,82040,CPT,,,facility,outpatient,,,30.00000,14.46000,United Healthcare,Commercial,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,inpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB ALBUMIN SRM/PLASMA/BLD WHL NS,3105509,CDM,301,RC,82040,CPT,,,facility,outpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,inpatient,,,53.00000,25.55000,United Healthcare,Commercial,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB ALDOLASE,3062387,CDM,301,RC,82085,CPT,,,facility,outpatient,,,53.00000,25.55000,United Healthcare,Commercial,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,inpatient,,,270.00000,130.14000,United Healthcare,Commercial,,243.00,,,,,,,243.00,261.90,percent of total billed charges,
LAB ALDOSTERONE,3060001,CDM,301,RC,82088,CPT,,,facility,outpatient,,,270.00000,130.14000,United Healthcare,Commercial,,243.00,,,,,,,70.20,261.90,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,inpatient,,,123.00000,59.29000,United Healthcare,Commercial,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB ALDOSTERONE NS,3062395,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,United Healthcare,Commercial,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,inpatient,,,123.00000,59.29000,United Healthcare,Commercial,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB ALDOSTERONE URINE,3062403,CDM,301,RC,82088,CPT,,,facility,outpatient,,,123.00000,59.29000,United Healthcare,Commercial,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,inpatient,,,37.00000,17.83000,United Healthcare,Commercial,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE,3075272,CDM,301,RC,84075,CPT,,,facility,outpatient,,,37.00000,17.83000,United Healthcare,Commercial,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,inpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE ISOENZYMES,3075264,CDM,301,RC,84080,CPT,,,facility,outpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,inpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB ALKALINE PHOSPHATASE NS,3095015,CDM,301,RC,84075,CPT,,,facility,outpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,inpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN PHENOTYPE,3062452,CDM,301,RC,82104,CPT,,,facility,outpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,inpatient,,,41.00000,19.76000,United Healthcare,Commercial,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL,3088861,CDM,301,RC,82103,CPT,,,facility,outpatient,,,41.00000,19.76000,United Healthcare,Commercial,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB ALPHA-1-ANTITRYPSIN TOTAL NS,3062445,CDM,301,RC,82103,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,inpatient,,,72.00000,34.70000,United Healthcare,Commercial,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB ALPHA2-MACROGLOBULIN QN,3110582,CDM,301,RC,83883,CPT,,,facility,outpatient,,,72.00000,34.70000,United Healthcare,Commercial,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,inpatient,,,77.00000,37.11000,United Healthcare,Commercial,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB ALUMINUM,3062478,CDM,301,RC,82108,CPT,,,facility,outpatient,,,77.00000,37.11000,United Healthcare,Commercial,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AMIKACIN PEAK,3105343,CDM,301,RC,80150,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,inpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AMIKACIN RANDOM,3105350,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,inpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AMIKACIN TROUGH,3105368,CDM,301,RC,80150,CPT,,,facility,outpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,inpatient,,,90.00000,43.38000,United Healthcare,Commercial,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB AMIODARONE,3062593,CDM,301,RC,80151,CPT,,,facility,outpatient,,,90.00000,43.38000,United Healthcare,Commercial,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,inpatient,,,44.00000,21.21000,United Healthcare,Commercial,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
LAB AMMONIA,3062619,CDM,301,RC,82140,CPT,,,facility,outpatient,,,44.00000,21.21000,United Healthcare,Commercial,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,inpatient,,,115.00000,55.43000,United Healthcare,Commercial,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB AMMONIA STONE RISK,3121050,CDM,301,RC,82140,CPT,,,facility,outpatient,,,115.00000,55.43000,United Healthcare,Commercial,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,inpatient,,,20.00000,9.64000,United Healthcare,Commercial,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB AMYLASE,3062650,CDM,301,RC,82150,CPT,,,facility,outpatient,,,20.00000,9.64000,United Healthcare,Commercial,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,inpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB AMYLASE FLUID BODY,3062668,CDM,301,RC,82150,CPT,,,facility,outpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,inpatient,,,341.00000,164.36000,United Healthcare,Commercial,,306.90,,,,,,,306.90,330.77,percent of total billed charges,
LAB AMYLASE FLUID CYST PANCREATIC,3065455,CDM,301,RC,82150,CPT,,,facility,outpatient,,,341.00000,164.36000,United Healthcare,Commercial,,306.90,,,,,,,88.66,330.77,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,inpatient,,,54.00000,26.03000,United Healthcare,Commercial,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB AMYLASE TOTAL,3062676,CDM,301,RC,82150,CPT,,,facility,outpatient,,,54.00000,26.03000,United Healthcare,Commercial,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,inpatient,,,53.00000,25.55000,United Healthcare,Commercial,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB AMYLASE URINE,3062684,CDM,301,RC,82150,CPT,,,facility,outpatient,,,53.00000,25.55000,United Healthcare,Commercial,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,inpatient,,,88.00000,42.42000,United Healthcare,Commercial,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB ANDROSTENEDIONE,3062718,CDM,301,RC,82157,CPT,,,facility,outpatient,,,88.00000,42.42000,United Healthcare,Commercial,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,inpatient,,,89.00000,42.90000,United Healthcare,Commercial,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB ANGIOTENSIN 2,3062742,CDM,301,RC,82163,CPT,,,facility,outpatient,,,89.00000,42.90000,United Healthcare,Commercial,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,inpatient,,,61.00000,29.40000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB ANGIOTENSIN I CONVERTING ENZYME,3062734,CDM,301,RC,82164,CPT,,,facility,outpatient,,,61.00000,29.40000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,inpatient,,,77.00000,37.11000,United Healthcare,Commercial,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA,3062767,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,United Healthcare,Commercial,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,inpatient,,,77.00000,37.11000,United Healthcare,Commercial,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN A1 EA NS,3119815,CDM,301,RC,82172,CPT,,,facility,outpatient,,,77.00000,37.11000,United Healthcare,Commercial,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,inpatient,,,64.00000,30.85000,United Healthcare,Commercial,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN B EA,3062775,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,United Healthcare,Commercial,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,inpatient,,,64.00000,30.85000,United Healthcare,Commercial,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB APOLIPOPROTEIN EA,3062759,CDM,301,RC,82172,CPT,,,facility,outpatient,,,64.00000,30.85000,United Healthcare,Commercial,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,inpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB ARSENIC BLOOD NS,3062783,CDM,301,RC,82175,CPT,,,facility,outpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,inpatient,,,95.00000,45.79000,United Healthcare,Commercial,,85.50,,,,,,,85.50,92.15,percent of total billed charges,
LAB ARSENIC NON BLOOD,3062791,CDM,301,RC,82175,CPT,,,facility,outpatient,,,95.00000,45.79000,United Healthcare,Commercial,,85.50,,,,,,,24.70,92.15,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,inpatient,,,132.00000,63.62000,United Healthcare,Commercial,,118.80,,,,,,,118.80,128.04,percent of total billed charges,
LAB BACLOFEN,3026184,CDM,301,RC,80299,CPT,,,facility,outpatient,,,132.00000,63.62000,United Healthcare,Commercial,,118.80,,,,,,,34.32,128.04,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,inpatient,,,83.00000,40.01000,United Healthcare,Commercial,,74.70,,,,,,,74.70,80.51,percent of total billed charges,
LAB BANDS OLIGOCLONAL CSF,3074937,CDM,301,RC,83916,CPT,,,facility,outpatient,,,83.00000,40.01000,United Healthcare,Commercial,,74.70,,,,,,,21.58,80.51,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,inpatient,,,387.00000,186.53000,United Healthcare,Commercial,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-40,3125044,CDM,301,RC,82233,CPT,,,facility,outpatient,,,387.00000,186.53000,United Healthcare,Commercial,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,inpatient,,,387.00000,186.53000,United Healthcare,Commercial,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB BETA AMYLOID 1-42,3124864,CDM,301,RC,82234,CPT,,,facility,outpatient,,,387.00000,186.53000,United Healthcare,Commercial,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,inpatient,,,31.00000,14.94000,United Healthcare,Commercial,,27.90,,,,,,,27.90,30.07,percent of total billed charges,
LAB BILIRUBIN DIRECT,3062957,CDM,301,RC,82248,CPT,,,facility,outpatient,,,31.00000,14.94000,United Healthcare,Commercial,,27.90,,,,,,,8.06,30.07,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,inpatient,,,36.00000,17.35000,United Healthcare,Commercial,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL,3062973,CDM,301,RC,82247,CPT,,,facility,outpatient,,,36.00000,17.35000,United Healthcare,Commercial,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB BILIRUBIN TOTAL NS,3119823,CDM,301,RC,82247,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,inpatient,,,160.00000,77.12000,United Healthcare,Commercial,,144.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB BIOTIN,3028065,CDM,301,RC,84591,CPT,,,facility,outpatient,,,160.00000,77.12000,United Healthcare,Commercial,,144.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,inpatient,,,112.00000,53.98000,United Healthcare,Commercial,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB BIOTINIDASE SPEC EA,3031754,CDM,301,RC,82261,CPT,,,facility,outpatient,,,112.00000,53.98000,United Healthcare,Commercial,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,inpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM NS,3029519,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,inpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES 1-3 IMM QL,3111911,CDM,301,RC,82274,CPT,,,facility,outpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,inpatient,,,14.00000,6.75000,United Healthcare,Commercial,,12.60,,,,,,,12.60,13.58,percent of total billed charges,
LAB BLOOD OCCULT FECES SINGLE QL,3074887,CDM,301,RC,82270,CPT,,,facility,outpatient,,,14.00000,6.75000,United Healthcare,Commercial,,12.60,,,,,,,3.64,13.58,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,inpatient,,,16.00000,7.71000,United Healthcare,Commercial,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB BLOOD OCCULT OTHER SOURCE QL,3074903,CDM,301,RC,82271,CPT,,,facility,outpatient,,,16.00000,7.71000,United Healthcare,Commercial,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,inpatient,,,71.00000,34.22000,United Healthcare,Commercial,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB CADMIUM,3063070,CDM,301,RC,82300,CPT,,,facility,outpatient,,,71.00000,34.22000,United Healthcare,Commercial,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,inpatient,,,116.00000,55.91000,United Healthcare,Commercial,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
LAB CAFFEINE,3063088,CDM,301,RC,80155,CPT,,,facility,outpatient,,,116.00000,55.91000,United Healthcare,Commercial,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,inpatient,,,81.00000,39.04000,United Healthcare,Commercial,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB CALCITONIN,3063096,CDM,301,RC,82308,CPT,,,facility,outpatient,,,81.00000,39.04000,United Healthcare,Commercial,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,inpatient,,,97.00000,46.75000,United Healthcare,Commercial,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB CALCIUM IONIZED,3063104,CDM,301,RC,82330,CPT,,,facility,outpatient,,,97.00000,46.75000,United Healthcare,Commercial,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,inpatient,,,77.00000,37.11000,United Healthcare,Commercial,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB CALCIUM STONE RISK,3121068,CDM,301,RC,82340,CPT,,,facility,outpatient,,,77.00000,37.11000,United Healthcare,Commercial,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,inpatient,,,35.00000,16.87000,United Healthcare,Commercial,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB CALCIUM TOTAL,3063112,CDM,301,RC,82310,CPT,,,facility,outpatient,,,35.00000,16.87000,United Healthcare,Commercial,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,inpatient,,,65.00000,31.33000,United Healthcare,Commercial,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB CALCIUM TOTAL NS,3103728,CDM,301,RC,82310,CPT,,,facility,outpatient,,,65.00000,31.33000,United Healthcare,Commercial,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CALCIUM TOTAL URINE,3063120,CDM,301,RC,82310,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CALCIUM URINE QN TIMED,3063138,CDM,301,RC,82340,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,inpatient,,,74.00000,35.67000,United Healthcare,Commercial,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB CALCULUS SPECTROSCOPY INFRARED,3063146,CDM,301,RC,82365,CPT,,,facility,outpatient,,,74.00000,35.67000,United Healthcare,Commercial,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,inpatient,,,250.00000,120.50000,United Healthcare,Commercial,,225.00,,,,,,,225.00,242.50,percent of total billed charges,
LAB CALPROTECTIN FECAL,3108651,CDM,301,RC,83993,CPT,,,facility,outpatient,,,250.00000,120.50000,United Healthcare,Commercial,,225.00,,,,,,,65.00,242.50,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE,3028701,CDM,301,RC,80161,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,inpatient,,,90.00000,43.38000,United Healthcare,Commercial,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB CARBAMAZEPINE -10 11-EPOXIDE NS,3028719,CDM,301,RC,80161,CPT,,,facility,outpatient,,,90.00000,43.38000,United Healthcare,Commercial,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,inpatient,,,90.00000,43.38000,United Healthcare,Commercial,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB CARBAMAZEPINE FREE,3103652,CDM,301,RC,80157,CPT,,,facility,outpatient,,,90.00000,43.38000,United Healthcare,Commercial,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,inpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB CARBAMAZEPINE TOTAL,3063179,CDM,301,RC,80156,CPT,,,facility,outpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,inpatient,,,36.00000,17.35000,United Healthcare,Commercial,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB CARBON DIOXIDE HCO3,3063187,CDM,301,RC,82374,CPT,,,facility,outpatient,,,36.00000,17.35000,United Healthcare,Commercial,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CARBOXYHEMOGLOBIN QN,3112331,CDM,301,RC,82375,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,inpatient,,,78.00000,37.60000,United Healthcare,Commercial,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN,3063237,CDM,301,RC,82379,CPT,,,facility,outpatient,,,78.00000,37.60000,United Healthcare,Commercial,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,inpatient,,,115.00000,55.43000,United Healthcare,Commercial,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB CARNITINE TOTAL&FREE QN URINE,3063229,CDM,301,RC,82379,CPT,,,facility,outpatient,,,115.00000,55.43000,United Healthcare,Commercial,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,inpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB CAROTENE,3063252,CDM,301,RC,82380,CPT,,,facility,outpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,inpatient,,,76.00000,36.63000,United Healthcare,Commercial,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB CATECHOLAMINES FRACTIONATED,3063278,CDM,301,RC,82384,CPT,,,facility,outpatient,,,76.00000,36.63000,United Healthcare,Commercial,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,inpatient,,,53.00000,25.55000,United Healthcare,Commercial,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB CERULOPLASMIN,3063302,CDM,301,RC,82390,CPT,,,facility,outpatient,,,53.00000,25.55000,United Healthcare,Commercial,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,inpatient,,,70.00000,33.74000,United Healthcare,Commercial,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB CHEMILUMINESCENT,3063328,CDM,301,RC,82397,CPT,,,facility,outpatient,,,70.00000,33.74000,United Healthcare,Commercial,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,inpatient,,,169.00000,81.46000,United Healthcare,Commercial,,152.10,,,,,,,152.10,163.93,percent of total billed charges,
LAB CHLORDIAZEPOXIDE,3123171,CDM,301,RC,80299,CPT,,,facility,outpatient,,,169.00000,81.46000,United Healthcare,Commercial,,152.10,,,,,,,43.94,163.93,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,inpatient,,,28.00000,13.50000,United Healthcare,Commercial,,25.20,,,,,,,25.20,27.16,percent of total billed charges,
LAB CHLORIDE BLOOD,3063351,CDM,301,RC,82435,CPT,,,facility,outpatient,,,28.00000,13.50000,United Healthcare,Commercial,,25.20,,,,,,,7.28,27.16,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,inpatient,,,51.00000,24.58000,United Healthcare,Commercial,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB CHLORIDE FLUID BODY,3063369,CDM,301,RC,82438,CPT,,,facility,outpatient,,,51.00000,24.58000,United Healthcare,Commercial,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,inpatient,,,15.00000,7.23000,United Healthcare,Commercial,,13.50,,,,,,,13.50,14.55,percent of total billed charges,
LAB CHLORIDE OTHER SOURCE,3063385,CDM,301,RC,82438,CPT,,,facility,outpatient,,,15.00000,7.23000,United Healthcare,Commercial,,13.50,,,,,,,3.90,14.55,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB CHLORIDE STOOL NS,3103736,CDM,301,RC,82438,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,inpatient,,,18.00000,8.68000,United Healthcare,Commercial,,16.20,,,,,,,16.20,17.46,percent of total billed charges,
LAB CHLORIDE URINE,3063401,CDM,301,RC,82436,CPT,,,facility,outpatient,,,18.00000,8.68000,United Healthcare,Commercial,,16.20,,,,,,,4.68,17.46,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,inpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB CHOLESTEROL FLUID BODY,3904422,CDM,301,RC,84999,CPT,,,facility,outpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,inpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL,3063419,CDM,301,RC,82465,CPT,,,facility,outpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CHOLESTEROL SRM/BLD WHL TTL NS,3103744,CDM,301,RC,82465,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB CHOLINESTERASE RBC,3063450,CDM,301,RC,82482,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,inpatient,,,61.00000,29.40000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB CHOLINESTERASE SERUM NS,3022373,CDM,301,RC,82480,CPT,,,facility,outpatient,,,61.00000,29.40000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,inpatient,,,550.00000,265.10000,United Healthcare,Commercial,,495.00,,,,,,,495.00,533.50,percent of total billed charges,
LAB CHROMAT MS APOE ISOFORM,3124476,CDM,301,RC,82542,CPT,,,facility,outpatient,,,550.00000,265.10000,United Healthcare,Commercial,,495.00,,,,,,,143.00,533.50,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,inpatient,,,73.00000,35.19000,United Healthcare,Commercial,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB CHROMAT MS IODINE QL/QN,3120300,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,United Healthcare,Commercial,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,inpatient,,,392.00000,188.94000,United Healthcare,Commercial,,352.80,,,,,,,352.80,380.24,percent of total billed charges,
LAB CHROMAT MS METHOXYTYRAMINE,3029253,CDM,301,RC,82542,CPT,,,facility,outpatient,,,392.00000,188.94000,United Healthcare,Commercial,,352.80,,,,,,,101.92,380.24,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,inpatient,,,75.00000,36.15000,United Healthcare,Commercial,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN,3903689,CDM,301,RC,82542,CPT,,,facility,outpatient,,,75.00000,36.15000,United Healthcare,Commercial,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,inpatient,,,73.00000,35.19000,United Healthcare,Commercial,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB CHROMAT MS NON-DRUG QL/QN NS,3116514,CDM,301,RC,82542,CPT,,,facility,outpatient,,,73.00000,35.19000,United Healthcare,Commercial,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,inpatient,,,100.00000,48.20000,United Healthcare,Commercial,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB CHROMAT MS OMEGA FATTY ACIDS,3122058,CDM,301,RC,82542,CPT,,,facility,outpatient,,,100.00000,48.20000,United Healthcare,Commercial,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,inpatient,,,153.00000,73.75000,United Healthcare,Commercial,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB CHROMAT MS ORGANIC ACIDS,3120854,CDM,301,RC,82542,CPT,,,facility,outpatient,,,153.00000,73.75000,United Healthcare,Commercial,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,inpatient,,,909.00000,438.14000,United Healthcare,Commercial,,818.10,,,,,,,818.10,881.73,percent of total billed charges,
LAB CHROMAT MS PROT AMYLOID QN,3903739,CDM,301,RC,82542,CPT,,,facility,outpatient,,,909.00000,438.14000,United Healthcare,Commercial,,818.10,,,,,,,236.34,881.73,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,inpatient,,,266.00000,128.21000,United Healthcare,Commercial,,239.40,,,,,,,239.40,258.02,percent of total billed charges,
LAB CHROMAT/MS METHYLTETRAHYDOFOLAT,3119146,CDM,301,RC,82542,CPT,,,facility,outpatient,,,266.00000,128.21000,United Healthcare,Commercial,,239.40,,,,,,,69.16,258.02,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,inpatient,,,275.00000,132.55000,United Healthcare,Commercial,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
LAB CHROMAT/MS NEOPTERIN,3119153,CDM,301,RC,82542,CPT,,,facility,outpatient,,,275.00000,132.55000,United Healthcare,Commercial,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,inpatient,,,61.00000,29.40000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB CHROMIUM,3110517,CDM,301,RC,82495,CPT,,,facility,outpatient,,,61.00000,29.40000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,inpatient,,,84.00000,40.49000,United Healthcare,Commercial,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB CITRATE,3063559,CDM,301,RC,82507,CPT,,,facility,outpatient,,,84.00000,40.49000,United Healthcare,Commercial,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,inpatient,,,174.00000,83.87000,United Healthcare,Commercial,,156.60,,,,,,,156.60,168.78,percent of total billed charges,
LAB CITRATE STONE RISK,3121076,CDM,301,RC,82507,CPT,,,facility,outpatient,,,174.00000,83.87000,United Healthcare,Commercial,,156.60,,,,,,,45.24,168.78,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,inpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB CLOMIPRAMINE,3116571,CDM,301,RC,80299,CPT,,,facility,outpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,inpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB CLONAZEPAM,3124567,CDM,301,RC,80299,CPT,,,facility,outpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,inpatient,,,68.00000,32.78000,United Healthcare,Commercial,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB CLOZAPINE/NORCLOZAPINE,3103637,CDM,301,RC,80159,CPT,,,facility,outpatient,,,68.00000,32.78000,United Healthcare,Commercial,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,inpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB COPPER SERUM,3028164,CDM,301,RC,82525,CPT,,,facility,outpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,inpatient,,,211.00000,101.70000,United Healthcare,Commercial,,189.90,,,,,,,189.90,204.67,percent of total billed charges,
LAB COPPER TISSUE NS,3063674,CDM,301,RC,82525,CPT,,,facility,outpatient,,,211.00000,101.70000,United Healthcare,Commercial,,189.90,,,,,,,54.86,204.67,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,inpatient,,,65.00000,31.33000,United Healthcare,Commercial,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB COPPER URINE,3063682,CDM,301,RC,82525,CPT,,,facility,outpatient,,,65.00000,31.33000,United Healthcare,Commercial,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,inpatient,,,83.00000,40.01000,United Healthcare,Commercial,,74.70,,,,,,,74.70,80.51,percent of total billed charges,
LAB CORTICOSTERONE,3063690,CDM,301,RC,82528,CPT,,,facility,outpatient,,,83.00000,40.01000,United Healthcare,Commercial,,74.70,,,,,,,21.58,80.51,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,inpatient,,,54.00000,26.03000,United Healthcare,Commercial,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB CORTISOL BINDING GLOBULIN,3107703,CDM,301,RC,84449,CPT,,,facility,outpatient,,,54.00000,26.03000,United Healthcare,Commercial,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,inpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB CORTISOL FREE,3063708,CDM,301,RC,82530,CPT,,,facility,outpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB CORTISOL TOTAL,3063716,CDM,301,RC,82533,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,inpatient,,,323.00000,155.69000,United Healthcare,Commercial,,290.70,,,,,,,290.70,313.31,percent of total billed charges,
LAB CORTISOL TOTAL NS,3063724,CDM,301,RC,82533,CPT,,,facility,outpatient,,,323.00000,155.69000,United Healthcare,Commercial,,290.70,,,,,,,83.98,313.31,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,inpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB C-PEPTIDE,3063732,CDM,301,RC,84681,CPT,,,facility,outpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB CREATINE KINASE ISOENZYMES,3063740,CDM,301,RC,82552,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,inpatient,,,35.00000,16.87000,United Healthcare,Commercial,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB CREATINE KINASE MB ONLY QN,3063765,CDM,301,RC,82553,CPT,,,facility,outpatient,,,35.00000,16.87000,United Healthcare,Commercial,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,inpatient,,,20.00000,9.64000,United Healthcare,Commercial,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL,3063823,CDM,301,RC,82550,CPT,,,facility,outpatient,,,20.00000,9.64000,United Healthcare,Commercial,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,inpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB CREATINE KINASE TOTAL NS,3103777,CDM,301,RC,82550,CPT,,,facility,outpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,inpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB CREATINE SERUM,3063773,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,inpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB CREATINE URINE,3063781,CDM,301,RC,82540,CPT,,,facility,outpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,inpatient,,,34.00000,16.39000,United Healthcare,Commercial,,30.60,,,,,,,30.60,32.98,percent of total billed charges,
LAB CREATININE BLOOD,3063799,CDM,301,RC,82565,CPT,,,facility,outpatient,,,34.00000,16.39000,United Healthcare,Commercial,,30.60,,,,,,,8.84,32.98,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,inpatient,,,29.00000,13.98000,United Healthcare,Commercial,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CREATININE CLEARANCE,3063815,CDM,301,RC,82575,CPT,,,facility,outpatient,,,29.00000,13.98000,United Healthcare,Commercial,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,inpatient,,,80.00000,38.56000,United Healthcare,Commercial,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB CREATININE OTHER SOURCE,3063831,CDM,301,RC,82570,CPT,,,facility,outpatient,,,80.00000,38.56000,United Healthcare,Commercial,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,inpatient,,,73.00000,35.19000,United Healthcare,Commercial,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB CREATININE STONE RISK,3121084,CDM,301,RC,82570,CPT,,,facility,outpatient,,,73.00000,35.19000,United Healthcare,Commercial,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,inpatient,,,16.00000,7.71000,United Healthcare,Commercial,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB CREATININE URINE,3063849,CDM,301,RC,82570,CPT,,,facility,outpatient,,,16.00000,7.71000,United Healthcare,Commercial,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,inpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB CREATININE URINE NS,3103785,CDM,301,RC,82570,CPT,,,facility,outpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,inpatient,,,113.00000,54.47000,United Healthcare,Commercial,,101.70,,,,,,,101.70,109.61,percent of total billed charges,
LAB CROSS LINKS DEOXYPYRIDINOLINE,3029162,CDM,301,RC,82523,CPT,,,facility,outpatient,,,113.00000,54.47000,United Healthcare,Commercial,,101.70,,,,,,,29.38,109.61,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,inpatient,,,68.00000,32.78000,United Healthcare,Commercial,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB CROSS LINKS N-TELOPEPTIDE,3105772,CDM,301,RC,82523,CPT,,,facility,outpatient,,,68.00000,32.78000,United Healthcare,Commercial,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,inpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN,3063864,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,inpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CRYOGLOBULIN QL/SEMI QN NS,3103793,CDM,301,RC,82595,CPT,,,facility,outpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,inpatient,,,78.00000,37.60000,United Healthcare,Commercial,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB CYANIDE,3063872,CDM,301,RC,82600,CPT,,,facility,outpatient,,,78.00000,37.60000,United Healthcare,Commercial,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,inpatient,,,54.00000,26.03000,United Healthcare,Commercial,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB CYANOCOBALAMIN,3076791,CDM,301,RC,82607,CPT,,,facility,outpatient,,,54.00000,26.03000,United Healthcare,Commercial,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB CYCLOSPORINE A,3063898,CDM,301,RC,80158,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CYSTATIN C,3109022,CDM,301,RC,82610,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,inpatient,,,76.00000,36.63000,United Healthcare,Commercial,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE,3063955,CDM,301,RC,82626,CPT,,,facility,outpatient,,,76.00000,36.63000,United Healthcare,Commercial,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,inpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DEHYDROEPIANDROSTERONE-SULFATE,3063963,CDM,301,RC,82627,CPT,,,facility,outpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DEHYDROGENASE G6PD QN NS,3109311,CDM,301,RC,82955,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,inpatient,,,88.00000,42.42000,United Healthcare,Commercial,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB DEOXYCORTISOL 11-,3063922,CDM,301,RC,82634,CPT,,,facility,outpatient,,,88.00000,42.42000,United Healthcare,Commercial,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,inpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DEXAMETHASONE,3114998,CDM,301,RC,80299,CPT,,,facility,outpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,inpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DIBUCAINE NUMBER NS,3022381,CDM,301,RC,82638,CPT,,,facility,outpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,inpatient,,,53.00000,25.55000,United Healthcare,Commercial,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB DIGOXIN TOTAL,3115672,CDM,301,RC,80162,CPT,,,facility,outpatient,,,53.00000,25.55000,United Healthcare,Commercial,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,inpatient,,,88.00000,42.42000,United Healthcare,Commercial,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB DIHYDROTESTOSTERONE,3120656,CDM,301,RC,82642,CPT,,,facility,outpatient,,,88.00000,42.42000,United Healthcare,Commercial,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,inpatient,,,105.00000,50.61000,United Healthcare,Commercial,,94.50,,,,,,,94.50,101.85,percent of total billed charges,
LAB DRG DF ALKALOIDS NICOTINE DAY,3117298,CDM,301,RC,80323,CPT,,,facility,outpatient,,,105.00000,50.61000,United Healthcare,Commercial,,94.50,,,,,,,27.30,101.85,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NON UR,3030400,CDM,301,RC,80324,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,inpatient,,,73.00000,35.19000,United Healthcare,Commercial,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH DAY 1-2 NS,3117108,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,United Healthcare,Commercial,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,inpatient,,,83.00000,40.01000,United Healthcare,Commercial,,74.70,,,,,,,74.70,80.51,percent of total billed charges,
LAB DRG DF AMPH/METH MCNIUM DAY 1-2,3120417,CDM,301,RC,80324,CPT,,,facility,outpatient,,,83.00000,40.01000,United Healthcare,Commercial,,74.70,,,,,,,21.58,80.51,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,inpatient,,,154.00000,74.23000,United Healthcare,Commercial,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF ANLG ACETAMINPHN DAY 1-2,3117041,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,United Healthcare,Commercial,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,inpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB DRG DF ANLG NON-OPIOID DAY 1-2,3117884,CDM,301,RC,80329,CPT,,,facility,outpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,inpatient,,,97.00000,46.75000,United Healthcare,Commercial,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB DRG DF ANLG OPIOID&OPIAT UR 5+,3032281,CDM,301,RC,80364,CPT,,,facility,outpatient,,,97.00000,46.75000,United Healthcare,Commercial,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,inpatient,,,154.00000,74.23000,United Healthcare,Commercial,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF ANLG SALICYLATE DAY 1-2,3117017,CDM,301,RC,80329,CPT,,,facility,outpatient,,,154.00000,74.23000,United Healthcare,Commercial,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CLOM DAY 1-2,3122827,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL AMIT DAY 1-2,3116670,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,inpatient,,,87.00000,41.93000,United Healthcare,Commercial,,78.30,,,,,,,78.30,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DAY 6+,3117926,CDM,301,RC,80337,CPT,,,facility,outpatient,,,87.00000,41.93000,United Healthcare,Commercial,,78.30,,,,,,,22.62,84.39,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DESI DAY 1-2NS,3116837,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL DOXE DAY 1-2,3116860,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,inpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL IMIPRM DAY 1-2,3116928,CDM,301,RC,80335,CPT,,,facility,outpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,inpatient,,,68.00000,32.78000,United Healthcare,Commercial,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB DRG DF ANTD CYCL NORT DAY 1-2,3116951,CDM,301,RC,80335,CPT,,,facility,outpatient,,,68.00000,32.78000,United Healthcare,Commercial,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,inpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB DRG DF ANTD NOT SRTNRG/CYCL DAY,3119252,CDM,301,RC,80338,CPT,,,facility,outpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,inpatient,,,51.00000,24.58000,United Healthcare,Commercial,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 1-2,3117900,CDM,301,RC,80332,CPT,,,facility,outpatient,,,51.00000,24.58000,United Healthcare,Commercial,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,inpatient,,,97.00000,46.75000,United Healthcare,Commercial,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB DRG DF ANTD SEROTONERG DAY 3-5,3117918,CDM,301,RC,80333,CPT,,,facility,outpatient,,,97.00000,46.75000,United Healthcare,Commercial,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,inpatient,,,176.00000,84.83000,United Healthcare,Commercial,,158.40,,,,,,,158.40,170.72,percent of total billed charges,
LAB DRG DF ANTIEPILEPTICS DAY 1-3,3117645,CDM,301,RC,80339,CPT,,,facility,outpatient,,,176.00000,84.83000,United Healthcare,Commercial,,158.40,,,,,,,45.76,170.72,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,inpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB DRG DF ANTPSY DAY 1-3,3118239,CDM,301,RC,80342,CPT,,,facility,outpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,inpatient,,,158.00000,76.16000,United Healthcare,Commercial,,142.20,,,,,,,142.20,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB DAY NS,3121571,CDM,301,RC,80345,CPT,,,facility,outpatient,,,158.00000,76.16000,United Healthcare,Commercial,,142.20,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BARB PHENOBARB NON URINE,3030418,CDM,301,RC,80345,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,inpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF BARB URINE DAY,3117181,CDM,301,RC,80345,CPT,,,facility,outpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,inpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF BENZ CLONAZEPM DAY 1-12,3116720,CDM,301,RC,80346,CPT,,,facility,outpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,inpatient,,,84.00000,40.49000,United Healthcare,Commercial,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12,3116704,CDM,301,RC,80346,CPT,,,facility,outpatient,,,84.00000,40.49000,United Healthcare,Commercial,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BENZ DAY 1-12 NON URINE,3030301,CDM,301,RC,80346,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,inpatient,,,189.00000,91.10000,United Healthcare,Commercial,,170.10,,,,,,,170.10,183.33,percent of total billed charges,
LAB DRG DF BRIVARACETAM DAY 1-3,3032232,CDM,301,RC,80375,CPT,,,facility,outpatient,,,189.00000,91.10000,United Healthcare,Commercial,,170.10,,,,,,,49.14,183.33,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NON UR,3030319,CDM,301,RC,80348,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,inpatient,,,109.00000,52.54000,United Healthcare,Commercial,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE DAY NS,3119260,CDM,301,RC,80348,CPT,,,facility,outpatient,,,109.00000,52.54000,United Healthcare,Commercial,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,inpatient,,,129.00000,62.18000,United Healthcare,Commercial,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DRG DF BUPRENORPHINE MECON DAY,3122322,CDM,301,RC,80348,CPT,,,facility,outpatient,,,129.00000,62.18000,United Healthcare,Commercial,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,inpatient,,,84.00000,40.49000,United Healthcare,Commercial,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY,3117538,CDM,301,RC,80349,CPT,,,facility,outpatient,,,84.00000,40.49000,United Healthcare,Commercial,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF CANNABINOIDS DAY NON UR,3030459,CDM,301,RC,80349,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,inpatient,,,73.00000,35.19000,United Healthcare,Commercial,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB DRG DF CNFRM AMPH DAY 1-2,3117405,CDM,301,RC,80324,CPT,,,facility,outpatient,,,73.00000,35.19000,United Healthcare,Commercial,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,inpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF CNFRM PHENCYCLDN/PCP DAY,3117462,CDM,301,RC,83992,CPT,,,facility,outpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,inpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY,3117199,CDM,301,RC,80353,CPT,,,facility,outpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF COCAINE DAY NON URINE,3030327,CDM,301,RC,80353,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,inpatient,,,149.00000,71.82000,United Healthcare,Commercial,,134.10,,,,,,,134.10,144.53,percent of total billed charges,
LAB DRG DF COCAINE MECONIUM,3120425,CDM,301,RC,80353,CPT,,,facility,outpatient,,,149.00000,71.82000,United Healthcare,Commercial,,134.10,,,,,,,38.74,144.53,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF CONF PROPOXYPHENE DAY NS,3121498,CDM,301,RC,80367,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,inpatient,,,130.00000,62.66000,United Healthcare,Commercial,,117.00,,,,,,,117.00,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK 1-2,3903978,CDM,301,RC,80321,CPT,,,facility,outpatient,,,130.00000,62.66000,United Healthcare,Commercial,,117.00,,,,,,,33.80,126.10,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,inpatient,,,110.00000,53.02000,United Healthcare,Commercial,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK TIS CORD 1-2,3028842,CDM,301,RC,80321,CPT,,,facility,outpatient,,,110.00000,53.02000,United Healthcare,Commercial,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,inpatient,,,158.00000,76.16000,United Healthcare,Commercial,,142.20,,,,,,,142.20,153.26,percent of total billed charges,
LAB DRG DF ETOH BIOMRK URINE 1-2,3118601,CDM,301,RC,80321,CPT,,,facility,outpatient,,,158.00000,76.16000,United Healthcare,Commercial,,142.20,,,,,,,41.08,153.26,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,inpatient,,,117.00000,56.39000,United Healthcare,Commercial,,105.30,,,,,,,105.30,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY,3117074,CDM,301,RC,80320,CPT,,,facility,outpatient,,,117.00000,56.39000,United Healthcare,Commercial,,105.30,,,,,,,30.42,113.49,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,inpatient,,,61.00000,29.40000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB DRG DF ETOH EXCEPT BR DAY NS,3117082,CDM,301,RC,80320,CPT,,,facility,outpatient,,,61.00000,29.40000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,inpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY,3117728,CDM,301,RC,80354,CPT,,,facility,outpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF FENTANYL DAY NON URINE,3030376,CDM,301,RC,80354,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,United Healthcare,Commercial,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF FUROSEMIDE DAY 1-3,3123478,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,United Healthcare,Commercial,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF GABAPENTN NON BLD DAY,3119286,CDM,301,RC,80355,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF HEROIN METABOLITE DAY,3118387,CDM,301,RC,80356,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF HYPNOTICS SED DAY,3119302,CDM,301,RC,80368,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,inpatient,,,145.00000,69.89000,United Healthcare,Commercial,,130.50,,,,,,,130.50,140.65,percent of total billed charges,
LAB DRG DF KETAMN&NORKETMN DAY,3119294,CDM,301,RC,80357,CPT,,,facility,outpatient,,,145.00000,69.89000,United Healthcare,Commercial,,130.50,,,,,,,37.70,140.65,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY,3117272,CDM,301,RC,80358,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NON URINE,3030434,CDM,301,RC,80358,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,inpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF METHADONE DAY NS,3117280,CDM,301,RC,80358,CPT,,,facility,outpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,inpatient,,,165.00000,79.53000,United Healthcare,Commercial,,148.50,,,,,,,148.50,160.05,percent of total billed charges,
LAB DRG DF METHADONE MECONIUM DAY,3120433,CDM,301,RC,80358,CPT,,,facility,outpatient,,,165.00000,79.53000,United Healthcare,Commercial,,148.50,,,,,,,42.90,160.05,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMP NON UR,3030384,CDM,301,RC,80359,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,inpatient,,,70.00000,33.74000,United Healthcare,Commercial,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF METHYLENEDIOXYAMPH NS,3117819,CDM,301,RC,80359,CPT,,,facility,outpatient,,,70.00000,33.74000,United Healthcare,Commercial,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,inpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF METHYLPHENIDATE DAY,3118619,CDM,301,RC,80360,CPT,,,facility,outpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,United Healthcare,Commercial,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF MITOTANE DAY 1-3,3123486,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,United Healthcare,Commercial,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,inpatient,,,154.00000,74.23000,United Healthcare,Commercial,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DRG DF MSCL RELAX DAY 1-2,3117256,CDM,301,RC,80369,CPT,,,facility,outpatient,,,154.00000,74.23000,United Healthcare,Commercial,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,inpatient,,,104.00000,50.13000,United Healthcare,Commercial,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+,3117306,CDM,301,RC,80361,CPT,,,facility,outpatient,,,104.00000,50.13000,United Healthcare,Commercial,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OPIATE DAY 1+ NON URINE,3030335,CDM,301,RC,80361,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,inpatient,,,70.00000,33.74000,United Healthcare,Commercial,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF OPIATE MECONIUM DAY 1+,3120441,CDM,301,RC,80361,CPT,,,facility,outpatient,,,70.00000,33.74000,United Healthcare,Commercial,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OPIOID DAY 1-2 TISSUE,3124047,CDM,301,RC,80362,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,inpatient,,,104.00000,50.13000,United Healthcare,Commercial,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY,3117314,CDM,301,RC,80365,CPT,,,facility,outpatient,,,104.00000,50.13000,United Healthcare,Commercial,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE DAY NON URINE,3030350,CDM,301,RC,80365,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,inpatient,,,70.00000,33.74000,United Healthcare,Commercial,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF OXYCODONE MECONIUM DAY,3120458,CDM,301,RC,80365,CPT,,,facility,outpatient,,,70.00000,33.74000,United Healthcare,Commercial,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLDN NON URINE,3030442,CDM,301,RC,83992,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,inpatient,,,123.00000,59.29000,United Healthcare,Commercial,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB DRG DF PHENCYCLIDINE,3032208,CDM,301,RC,83992,CPT,,,facility,outpatient,,,123.00000,59.29000,United Healthcare,Commercial,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,inpatient,,,95.00000,45.79000,United Healthcare,Commercial,,85.50,,,,,,,85.50,92.15,percent of total billed charges,
LAB DRG DF PREGABALIN,3119120,CDM,301,RC,80366,CPT,,,facility,outpatient,,,95.00000,45.79000,United Healthcare,Commercial,,85.50,,,,,,,24.70,92.15,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,inpatient,,,160.00000,77.12000,United Healthcare,Commercial,,144.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB DRG DF STIMULANTS SYN DAY,3119310,CDM,301,RC,80371,CPT,,,facility,outpatient,,,160.00000,77.12000,United Healthcare,Commercial,,144.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,inpatient,,,147.00000,70.85000,United Healthcare,Commercial,,132.30,,,,,,,132.30,142.59,percent of total billed charges,
LAB DRG DF SULFONAMIDES DAY 1-3,3029188,CDM,301,RC,80375,CPT,,,facility,outpatient,,,147.00000,70.85000,United Healthcare,Commercial,,132.30,,,,,,,38.22,142.59,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,inpatient,,,178.00000,85.80000,United Healthcare,Commercial,,160.20,,,,,,,160.20,172.66,percent of total billed charges,
LAB DRG DF SULFONYLUREAS DAY 7+,3117512,CDM,301,RC,80377,CPT,,,facility,outpatient,,,178.00000,85.80000,United Healthcare,Commercial,,160.20,,,,,,,46.28,172.66,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF TAPENTADOL DAY,3119328,CDM,301,RC,80372,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,inpatient,,,160.00000,77.12000,United Healthcare,Commercial,,144.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB DRG DF THIOPURINE DAY 1-3,3119674,CDM,301,RC,80375,CPT,,,facility,outpatient,,,160.00000,77.12000,United Healthcare,Commercial,,144.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,inpatient,,,187.00000,90.13000,United Healthcare,Commercial,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG DF TPMT ACTIVITY DAY 1-3,3123494,CDM,301,RC,80375,CPT,,,facility,outpatient,,,187.00000,90.13000,United Healthcare,Commercial,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,inpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL,3118767,CDM,301,RC,80373,CPT,,,facility,outpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB DRG DF TRAMADOL NON URINE,3030368,CDM,301,RC,80373,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,inpatient,,,70.00000,33.74000,United Healthcare,Commercial,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB DRG DF TRAZODONE DAY,3076361,CDM,301,RC,80338,CPT,,,facility,outpatient,,,70.00000,33.74000,United Healthcare,Commercial,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,United Healthcare,Commercial,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAY,3125911,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,United Healthcare,Commercial,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,United Healthcare,Commercial,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ CORD TIS DAYNS,3122330,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,United Healthcare,Commercial,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,United Healthcare,Commercial,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ MECON DAY NS,3122306,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,United Healthcare,Commercial,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,United Healthcare,Commercial,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY,3122256,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,United Healthcare,Commercial,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,United Healthcare,Commercial,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ SERUM DAY NS,3122280,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,United Healthcare,Commercial,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,United Healthcare,Commercial,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY,3122249,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,United Healthcare,Commercial,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,United Healthcare,Commercial,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE DAY NS,3122272,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,United Healthcare,Commercial,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,inpatient,,,187.00000,90.13000,United Healthcare,Commercial,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE ETOH DAY,3122264,CDM,301,RC,80307,CPT,,,facility,outpatient,,,187.00000,90.13000,United Healthcare,Commercial,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,inpatient,,,449.00000,216.42000,United Healthcare,Commercial,,404.10,,,,,,,404.10,435.53,percent of total billed charges,
LAB DRG SC INST ALYZ URINE PMGT DAY,3122298,CDM,301,RC,80307,CPT,,,facility,outpatient,,,449.00000,216.42000,United Healthcare,Commercial,,404.10,,,,,,,116.74,435.53,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,inpatient,,,104.00000,50.13000,United Healthcare,Commercial,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB ELASTASE PANCREATIC FECAL,3110764,CDM,301,RC,82656,CPT,,,facility,outpatient,,,104.00000,50.13000,United Healthcare,Commercial,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,inpatient,,,185.00000,89.17000,United Healthcare,Commercial,,166.50,,,,,,,166.50,179.45,percent of total billed charges,
LAB ELECTRO,3064516,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,United Healthcare,Commercial,,166.50,,,,,,,48.10,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,inpatient,,,185.00000,89.17000,United Healthcare,Commercial,,166.50,,,,,,,166.50,179.45,percent of total billed charges,
LAB ELECTRO NS,3113206,CDM,301,RC,82664,CPT,,,facility,outpatient,,,185.00000,89.17000,United Healthcare,Commercial,,166.50,,,,,,,48.10,179.45,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,inpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB ERYTHROPOIETIN,3064540,CDM,301,RC,82668,CPT,,,facility,outpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,inpatient,,,84.00000,40.49000,United Healthcare,Commercial,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL FREE MEASURE DIRECT,3029725,CDM,301,RC,82681,CPT,,,facility,outpatient,,,84.00000,40.49000,United Healthcare,Commercial,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,inpatient,,,84.00000,40.49000,United Healthcare,Commercial,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL,3028669,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,United Healthcare,Commercial,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,inpatient,,,84.00000,40.49000,United Healthcare,Commercial,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
LAB ESTRADIOL TOTAL NS,3028677,CDM,301,RC,82670,CPT,,,facility,outpatient,,,84.00000,40.49000,United Healthcare,Commercial,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,inpatient,,,73.00000,35.19000,United Healthcare,Commercial,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB ESTRIOL SERUM,3104643,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,United Healthcare,Commercial,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,inpatient,,,73.00000,35.19000,United Healthcare,Commercial,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB ESTRIOL SERUM NS,3064565,CDM,301,RC,82677,CPT,,,facility,outpatient,,,73.00000,35.19000,United Healthcare,Commercial,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,inpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL,3064581,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,inpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB ESTROGEN TOTAL NS,3109956,CDM,301,RC,82672,CPT,,,facility,outpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,inpatient,,,98.00000,47.24000,United Healthcare,Commercial,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
LAB ESTROGENS FRACTIONATED,3064599,CDM,301,RC,82671,CPT,,,facility,outpatient,,,98.00000,47.24000,United Healthcare,Commercial,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,inpatient,,,75.00000,36.15000,United Healthcare,Commercial,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB ESTRONE,3064607,CDM,301,RC,82679,CPT,,,facility,outpatient,,,75.00000,36.15000,United Healthcare,Commercial,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,inpatient,,,107.00000,51.57000,United Healthcare,Commercial,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
LAB ETHOSUXIMIDE,3064631,CDM,301,RC,80168,CPT,,,facility,outpatient,,,107.00000,51.57000,United Healthcare,Commercial,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,inpatient,,,81.00000,39.04000,United Healthcare,Commercial,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB ETHYLENE GLYCOL,3064649,CDM,301,RC,82693,CPT,,,facility,outpatient,,,81.00000,39.04000,United Healthcare,Commercial,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,inpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB EVEROLIMUS,3022472,CDM,301,RC,80169,CPT,,,facility,outpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,inpatient,,,68.00000,32.78000,United Healthcare,Commercial,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QL NS,3109485,CDM,301,RC,82705,CPT,,,facility,outpatient,,,68.00000,32.78000,United Healthcare,Commercial,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,inpatient,,,51.00000,24.58000,United Healthcare,Commercial,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB FAT/LIPIDS FECES QN,3064763,CDM,301,RC,82710,CPT,,,facility,outpatient,,,51.00000,24.58000,United Healthcare,Commercial,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,inpatient,,,74.00000,35.67000,United Healthcare,Commercial,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB FELBAMATE,3064789,CDM,301,RC,80167,CPT,,,facility,outpatient,,,74.00000,35.67000,United Healthcare,Commercial,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,inpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB FERRITIN,3064797,CDM,301,RC,82728,CPT,,,facility,outpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,inpatient,,,194.00000,93.51000,United Healthcare,Commercial,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
LAB FIBRONECTIN FETAL SEMI QL,3064805,CDM,301,RC,82731,CPT,,,facility,outpatient,,,194.00000,93.51000,United Healthcare,Commercial,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,inpatient,,,111.00000,53.50000,United Healthcare,Commercial,,99.90,,,,,,,99.90,107.67,percent of total billed charges,
LAB FLUCONAZOLE,3115003,CDM,301,RC,80299,CPT,,,facility,outpatient,,,111.00000,53.50000,United Healthcare,Commercial,,99.90,,,,,,,28.86,107.67,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,inpatient,,,77.00000,37.11000,United Healthcare,Commercial,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB GABAPENTIN SRM/PLASMA/BLD WHL,3064946,CDM,301,RC,80171,CPT,,,facility,outpatient,,,77.00000,37.11000,United Healthcare,Commercial,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,United Healthcare,Commercial,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO ARTERIAL,3063005,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,United Healthcare,Commercial,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,United Healthcare,Commercial,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO VENOUS,3063047,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,United Healthcare,Commercial,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,inpatient,,,237.00000,114.23000,United Healthcare,Commercial,,213.30,,,,,,,213.30,229.89,percent of total billed charges,
LAB GASES BLD ANY COMBO W SAT O2,3063021,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,United Healthcare,Commercial,,213.30,,,,,,,61.62,229.89,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB GASTRIN,3073004,CDM,301,RC,82941,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,inpatient,,,51.00000,24.58000,United Healthcare,Commercial,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB GENE B-CELL CLONALITY PCR,3124583,CDM,301,RC,84999,CPT,,,facility,outpatient,,,51.00000,24.58000,United Healthcare,Commercial,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,inpatient,,,82.00000,39.52000,United Healthcare,Commercial,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB GENTAMICIN PEAK,3073038,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,United Healthcare,Commercial,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,inpatient,,,82.00000,39.52000,United Healthcare,Commercial,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB GENTAMICIN TROUGH,3073053,CDM,301,RC,80170,CPT,,,facility,outpatient,,,82.00000,39.52000,United Healthcare,Commercial,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,inpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB GLUCAGON,3073079,CDM,301,RC,82943,CPT,,,facility,outpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,inpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB GLUCOSE CSF,3073152,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY,3073137,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,inpatient,,,131.00000,63.14000,United Healthcare,Commercial,,117.90,,,,,,,117.90,127.07,percent of total billed charges,
LAB GLUCOSE FLUID BODY NS,3118684,CDM,301,RC,82945,CPT,,,facility,outpatient,,,131.00000,63.14000,United Healthcare,Commercial,,117.90,,,,,,,34.06,127.07,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,inpatient,,,15.00000,7.23000,United Healthcare,Commercial,,13.50,,,,,,,13.50,14.55,percent of total billed charges,
LAB GLUCOSE POST DOSE,3073160,CDM,301,RC,82950,CPT,,,facility,outpatient,,,15.00000,7.23000,United Healthcare,Commercial,,13.50,,,,,,,3.90,14.55,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,inpatient,,,39.00000,18.80000,United Healthcare,Commercial,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC 1ST 3,3073186,CDM,301,RC,82951,CPT,,,facility,outpatient,,,39.00000,18.80000,United Healthcare,Commercial,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,inpatient,,,12.00000,5.78000,United Healthcare,Commercial,,10.80,,,,,,,10.80,11.64,percent of total billed charges,
LAB GLUCOSE TOLERANCE SPEC EA ADDL,3073194,CDM,301,RC,82952,CPT,,,facility,outpatient,,,12.00000,5.78000,United Healthcare,Commercial,,10.80,,,,,,,3.12,11.64,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,inpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB GLUCOSE URINE RANDOM,3073202,CDM,301,RC,82945,CPT,,,facility,outpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB GLUCOSE URINE TIMED,3073210,CDM,301,RC,82945,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM,3064904,CDM,301,RC,83001,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB GONADOTROPIN FSH SERUM NS,3071560,CDM,301,RC,83001,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB GONADOTROPIN LH,3074259,CDM,301,RC,83002,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,inpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB GONADOTROPIN LH NS,3109303,CDM,301,RC,83002,CPT,,,facility,outpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,inpatient,,,203.00000,97.85000,United Healthcare,Commercial,,182.70,,,,,,,182.70,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT,3073269,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,United Healthcare,Commercial,,182.70,,,,,,,52.78,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,inpatient,,,203.00000,97.85000,United Healthcare,Commercial,,182.70,,,,,,,182.70,196.91,percent of total billed charges,
LAB H PYLORI UREASE NONRADIOACT NS,3122652,CDM,301,RC,83013,CPT,,,facility,outpatient,,,203.00000,97.85000,United Healthcare,Commercial,,182.70,,,,,,,52.78,196.91,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,inpatient,,,99.00000,47.72000,United Healthcare,Commercial,,89.10,,,,,,,89.10,96.03,percent of total billed charges,
LAB HALOPERIDOL,3073277,CDM,301,RC,80173,CPT,,,facility,outpatient,,,99.00000,47.72000,United Healthcare,Commercial,,89.10,,,,,,,25.74,96.03,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,inpatient,,,53.00000,25.55000,United Healthcare,Commercial,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN,3073285,CDM,301,RC,83010,CPT,,,facility,outpatient,,,53.00000,25.55000,United Healthcare,Commercial,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB HAPTOGLOBIN QN NS,3119807,CDM,301,RC,83010,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,inpatient,,,23.00000,11.09000,United Healthcare,Commercial,,20.70,,,,,,,20.70,22.31,percent of total billed charges,
LAB HCG QL,3073293,CDM,301,RC,84703,CPT,,,facility,outpatient,,,23.00000,11.09000,United Healthcare,Commercial,,20.70,,,,,,,5.98,22.31,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,inpatient,,,46.00000,22.17000,United Healthcare,Commercial,,41.40,,,,,,,41.40,44.62,percent of total billed charges,
LAB HCG QN,3073301,CDM,301,RC,84702,CPT,,,facility,outpatient,,,46.00000,22.17000,United Healthcare,Commercial,,41.40,,,,,,,11.96,44.62,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,inpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB HCG QN NS,3107612,CDM,301,RC,84702,CPT,,,facility,outpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,inpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB HCG TUMOR MARKER QN,3073319,CDM,301,RC,84702,CPT,,,facility,outpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,inpatient,,,288.00000,138.82000,United Healthcare,Commercial,,259.20,,,,,,,259.20,279.36,percent of total billed charges,
LAB HEAVY METAL QN COBALT,3112786,CDM,301,RC,83018,CPT,,,facility,outpatient,,,288.00000,138.82000,United Healthcare,Commercial,,259.20,,,,,,,74.88,279.36,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,inpatient,,,106.00000,51.09000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB HEAVY METAL QN EA,3073400,CDM,301,RC,83018,CPT,,,facility,outpatient,,,106.00000,51.09000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,inpatient,,,30.00000,14.46000,United Healthcare,Commercial,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
LAB HEMOGLOBIN A1C,3073624,CDM,301,RC,83036,CPT,,,facility,outpatient,,,30.00000,14.46000,United Healthcare,Commercial,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,inpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN CHROMAT NS,3111176,CDM,301,RC,83021,CPT,,,facility,outpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,inpatient,,,71.00000,34.22000,United Healthcare,Commercial,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB HEMOGLOBIN FRCTN&QN ELECTRO NS,3105525,CDM,301,RC,83020,CPT,,,facility,outpatient,,,71.00000,34.22000,United Healthcare,Commercial,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB HEMOGLOBIN PLASMA,3073558,CDM,301,RC,83051,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,inpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB HEMOSIDERIN QL,3073574,CDM,301,RC,83070,CPT,,,facility,outpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,inpatient,,,89.00000,42.90000,United Healthcare,Commercial,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB HISTAMINE,3073632,CDM,301,RC,83088,CPT,,,facility,outpatient,,,89.00000,42.90000,United Healthcare,Commercial,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB HOMOCYSTEINE SERUM,3073657,CDM,301,RC,83090,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,inpatient,,,116.00000,55.91000,United Healthcare,Commercial,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ADRENOCORTICOTROPIC,3062338,CDM,301,RC,82024,CPT,,,facility,outpatient,,,116.00000,55.91000,United Healthcare,Commercial,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,inpatient,,,116.00000,55.91000,United Healthcare,Commercial,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN,3022720,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,United Healthcare,Commercial,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,inpatient,,,116.00000,55.91000,United Healthcare,Commercial,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
LAB HORMONE ANTIMULLERIAN NS,3030152,CDM,301,RC,82166,CPT,,,facility,outpatient,,,116.00000,55.91000,United Healthcare,Commercial,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,inpatient,,,51.00000,24.58000,United Healthcare,Commercial,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB HORMONE HUMAN GROWTH,3073251,CDM,301,RC,83003,CPT,,,facility,outpatient,,,51.00000,24.58000,United Healthcare,Commercial,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,inpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB HORMONE SEX BINDING GLOBULIN,3075900,CDM,301,RC,84270,CPT,,,facility,outpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,inpatient,,,174.00000,83.87000,United Healthcare,Commercial,,156.60,,,,,,,156.60,168.78,percent of total billed charges,
LAB HSP 70 WB W INTRP,3116381,CDM,301,RC,84181,CPT,,,facility,outpatient,,,174.00000,83.87000,United Healthcare,Commercial,,156.60,,,,,,,45.24,168.78,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,inpatient,,,82.00000,39.52000,United Healthcare,Commercial,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB HYDROXYPROGESTERONE 17-D NS,3073699,CDM,301,RC,83498,CPT,,,facility,outpatient,,,82.00000,39.52000,United Healthcare,Commercial,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,inpatient,,,112.00000,53.98000,United Healthcare,Commercial,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB HYDROXYPROLINE FREE,3073707,CDM,301,RC,83500,CPT,,,facility,outpatient,,,112.00000,53.98000,United Healthcare,Commercial,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,inpatient,,,61.00000,29.40000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN SERUM EA,3000007,CDM,301,RC,83521,CPT,,,facility,outpatient,,,61.00000,29.40000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,inpatient,,,69.00000,33.26000,United Healthcare,Commercial,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB IG FREE LIGHT CHAIN URINE EA,3000015,CDM,301,RC,83521,CPT,,,facility,outpatient,,,69.00000,33.26000,United Healthcare,Commercial,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,inpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM CSF EA,3103819,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,inpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA,3073749,CDM,301,RC,82784,CPT,,,facility,outpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IG IGA IGD IGG IGM SERUM EA NS,3103827,CDM,301,RC,82784,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB IG IGA SERUM NS,3079977,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,inpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IG IGD SERUM EA,3119526,CDM,301,RC,82784,CPT,,,facility,outpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB IG IGE,3064979,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB IG IGE NS,3109287,CDM,301,RC,82785,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB IG IGG SERUM EA,3119542,CDM,301,RC,82784,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IG SUBCLASSES EA,3073897,CDM,301,RC,82787,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,inpatient,,,286.00000,137.85000,United Healthcare,Commercial,,257.40,,,,,,,257.40,277.42,percent of total billed charges,
LAB IMM AB ADALIMUMAB ANTIDRUG,3065448,CDM,301,RC,83520,CPT,,,facility,outpatient,,,286.00000,137.85000,United Healthcare,Commercial,,257.40,,,,,,,74.36,277.42,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,inpatient,,,300.00000,144.60000,United Healthcare,Commercial,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB IMM AB ADAMTS 13,3122983,CDM,301,RC,83520,CPT,,,facility,outpatient,,,300.00000,144.60000,United Healthcare,Commercial,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,inpatient,,,73.00000,35.19000,United Healthcare,Commercial,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB IMM AB BP180 QN,3028768,CDM,301,RC,83520,CPT,,,facility,outpatient,,,73.00000,35.19000,United Healthcare,Commercial,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,inpatient,,,90.00000,43.38000,United Healthcare,Commercial,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB IMM AB BP230 QN,3123981,CDM,301,RC,83520,CPT,,,facility,outpatient,,,90.00000,43.38000,United Healthcare,Commercial,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,inpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB IMM AB GBM QN,3112695,CDM,301,RC,83520,CPT,,,facility,outpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,inpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB IMM AB GBM QN NS,3105392,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,inpatient,,,315.00000,151.83000,United Healthcare,Commercial,,283.50,,,,,,,283.50,305.55,percent of total billed charges,
LAB IMM AB HMGCR IGG,3121183,CDM,301,RC,83520,CPT,,,facility,outpatient,,,315.00000,151.83000,United Healthcare,Commercial,,283.50,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,inpatient,,,100.00000,48.20000,United Healthcare,Commercial,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB IMM AB LDL OXIDIZED,3029964,CDM,301,RC,83520,CPT,,,facility,outpatient,,,100.00000,48.20000,United Healthcare,Commercial,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,inpatient,,,89.00000,42.90000,United Healthcare,Commercial,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMM AB MUT CITRULLINAT VIMENTIN,3904281,CDM,301,RC,83520,CPT,,,facility,outpatient,,,89.00000,42.90000,United Healthcare,Commercial,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,inpatient,,,71.00000,34.22000,United Healthcare,Commercial,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB IMM AG ANTI-SOLUBLE LIVER QN,3105400,CDM,301,RC,83520,CPT,,,facility,outpatient,,,71.00000,34.22000,United Healthcare,Commercial,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,inpatient,,,135.00000,65.07000,United Healthcare,Commercial,,121.50,,,,,,,121.50,130.95,percent of total billed charges,
LAB IMM ANALYTE CYTOKINES QN,3123296,CDM,301,RC,83520,CPT,,,facility,outpatient,,,135.00000,65.07000,United Healthcare,Commercial,,121.50,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,inpatient,,,80.00000,38.56000,United Healthcare,Commercial,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB IMM ANALYTE OTHER QN,3073830,CDM,301,RC,83520,CPT,,,facility,outpatient,,,80.00000,38.56000,United Healthcare,Commercial,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,inpatient,,,72.00000,34.70000,United Healthcare,Commercial,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM ANALYTE PIGF,3125739,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,United Healthcare,Commercial,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,inpatient,,,72.00000,34.70000,United Healthcare,Commercial,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM ANALYTE SFIT-1,3125721,CDM,301,RC,83520,CPT,,,facility,outpatient,,,72.00000,34.70000,United Healthcare,Commercial,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,inpatient,,,100.00000,48.20000,United Healthcare,Commercial,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB IMM ELASTASE PANCREATIC QN,3028859,CDM,301,RC,82653,CPT,,,facility,outpatient,,,100.00000,48.20000,United Healthcare,Commercial,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,inpatient,,,305.00000,147.01000,United Healthcare,Commercial,,274.50,,,,,,,274.50,295.85,percent of total billed charges,
LAB IMM FIBRO GROWTH FACTOR,3120409,CDM,301,RC,83520,CPT,,,facility,outpatient,,,305.00000,147.01000,United Healthcare,Commercial,,274.50,,,,,,,79.30,295.85,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,inpatient,,,70.00000,33.74000,United Healthcare,Commercial,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB IMM GANGLIOSIDE GM TRIPLE QN,3103884,CDM,301,RC,83520,CPT,,,facility,outpatient,,,70.00000,33.74000,United Healthcare,Commercial,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,inpatient,,,69.00000,33.26000,United Healthcare,Commercial,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB IMM GLYCPROT MYELIN ASSC IGM,3103918,CDM,301,RC,83520,CPT,,,facility,outpatient,,,69.00000,33.26000,United Healthcare,Commercial,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,inpatient,,,64.00000,30.85000,United Healthcare,Commercial,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB IMM IGFBP 3 QN,3118379,CDM,301,RC,83520,CPT,,,facility,outpatient,,,64.00000,30.85000,United Healthcare,Commercial,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,inpatient,,,368.00000,177.38000,United Healthcare,Commercial,,331.20,,,,,,,331.20,356.96,percent of total billed charges,
LAB IMM IL-2 RECPT SOLUBLE QN,3108545,CDM,301,RC,83520,CPT,,,facility,outpatient,,,368.00000,177.38000,United Healthcare,Commercial,,331.20,,,,,,,95.68,356.96,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,inpatient,,,104.00000,50.13000,United Healthcare,Commercial,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB IMM INHIBIN B QN,3124286,CDM,301,RC,83520,CPT,,,facility,outpatient,,,104.00000,50.13000,United Healthcare,Commercial,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,inpatient,,,109.00000,52.54000,United Healthcare,Commercial,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB IMM INTERLEUKIN 6 QN,3117769,CDM,301,RC,83529,CPT,,,facility,outpatient,,,109.00000,52.54000,United Healthcare,Commercial,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,inpatient,,,114.00000,54.95000,United Healthcare,Commercial,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB IMM MS 21-HYDROXYLASE QL,3121589,CDM,301,RC,83516,CPT,,,facility,outpatient,,,114.00000,54.95000,United Healthcare,Commercial,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS ALPHA 2 MACROGLOBULIN,3903788,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,inpatient,,,135.00000,65.07000,United Healthcare,Commercial,,121.50,,,,,,,121.50,130.95,percent of total billed charges,
LAB IMM MS ANTI TH/TO AB,3125358,CDM,301,RC,83516,CPT,,,facility,outpatient,,,135.00000,65.07000,United Healthcare,Commercial,,121.50,,,,,,,35.10,130.95,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,inpatient,,,105.00000,50.61000,United Healthcare,Commercial,,94.50,,,,,,,94.50,101.85,percent of total billed charges,
LAB IMM MS CARBAMYLATED PROTEIN AB,3124138,CDM,301,RC,83516,CPT,,,facility,outpatient,,,105.00000,50.61000,United Healthcare,Commercial,,94.50,,,,,,,27.30,101.85,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,inpatient,,,315.00000,151.83000,United Healthcare,Commercial,,283.50,,,,,,,283.50,305.55,percent of total billed charges,
LAB IMM MS CYTOSOLC 5 NUCLEOTDAS 1A,3126109,CDM,301,RC,83516,CPT,,,facility,outpatient,,,315.00000,151.83000,United Healthcare,Commercial,,283.50,,,,,,,81.90,305.55,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,inpatient,,,148.00000,71.34000,United Healthcare,Commercial,,133.20,,,,,,,133.20,143.56,percent of total billed charges,
LAB IMM MS GP210 IGG,3122926,CDM,301,RC,83516,CPT,,,facility,outpatient,,,148.00000,71.34000,United Healthcare,Commercial,,133.20,,,,,,,38.48,143.56,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,inpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB IMM MS HISTONE QL,3111341,CDM,301,RC,83516,CPT,,,facility,outpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,inpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB IMM MS MYOSITIS,3117652,CDM,301,RC,83516,CPT,,,facility,outpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS PHOSPHAT/PROTHROMBIN NS,3030111,CDM,301,RC,83516,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,inpatient,,,107.00000,51.57000,United Healthcare,Commercial,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
LAB IMM MS POLYMERASE III AB,3123080,CDM,301,RC,83516,CPT,,,facility,outpatient,,,107.00000,51.57000,United Healthcare,Commercial,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,inpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB IMM MS QL/SEMI QN NS,3073764,CDM,301,RC,83516,CPT,,,facility,outpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,inpatient,,,35.00000,16.87000,United Healthcare,Commercial,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB IMM MS RIBO P PROTEIN QL,3110889,CDM,301,RC,83516,CPT,,,facility,outpatient,,,35.00000,16.87000,United Healthcare,Commercial,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,inpatient,,,104.00000,50.13000,United Healthcare,Commercial,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB IMM MS SP100 IGG,3122215,CDM,301,RC,83516,CPT,,,facility,outpatient,,,104.00000,50.13000,United Healthcare,Commercial,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,inpatient,,,650.00000,313.30000,United Healthcare,Commercial,,585.00,,,,,,,585.00,630.50,percent of total billed charges,
LAB IMM PHOS TAU/TTL TAU/BETA42,3118270,CDM,301,RC,83520,CPT,,,facility,outpatient,,,650.00000,313.30000,United Healthcare,Commercial,,585.00,,,,,,,169.00,630.50,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,inpatient,,,91.00000,43.86000,United Healthcare,Commercial,,81.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB IMM POLY PANCREATIC QN,3073848,CDM,301,RC,83520,CPT,,,facility,outpatient,,,91.00000,43.86000,United Healthcare,Commercial,,81.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,inpatient,,,114.00000,54.95000,United Healthcare,Commercial,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB IMM RBA AB 21 HYDROXYLASE QN,3119732,CDM,301,RC,83519,CPT,,,facility,outpatient,,,114.00000,54.95000,United Healthcare,Commercial,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,inpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB IMM RECEPTOR TSH QN,3111929,CDM,301,RC,83520,CPT,,,facility,outpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,inpatient,,,360.00000,173.52000,United Healthcare,Commercial,,324.00,,,,,,,324.00,349.20,percent of total billed charges,
LAB IMM RIA BETAPROTEIN,3028206,CDM,301,RC,83519,CPT,,,facility,outpatient,,,360.00000,173.52000,United Healthcare,Commercial,,324.00,,,,,,,93.60,349.20,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,inpatient,,,106.00000,51.09000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB IMM RIA PB3 IGF QN,3073855,CDM,301,RC,83519,CPT,,,facility,outpatient,,,106.00000,51.09000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,inpatient,,,78.00000,37.60000,United Healthcare,Commercial,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB IMM RIA POLY PANCREATIC QN,3111101,CDM,301,RC,83519,CPT,,,facility,outpatient,,,78.00000,37.60000,United Healthcare,Commercial,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,inpatient,,,72.00000,34.70000,United Healthcare,Commercial,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB IMM RIA PTH REL PROT QN,3107265,CDM,301,RC,83519,CPT,,,facility,outpatient,,,72.00000,34.70000,United Healthcare,Commercial,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,inpatient,,,94.00000,45.31000,United Healthcare,Commercial,,84.60,,,,,,,84.60,91.18,percent of total billed charges,
LAB IMM RIA QN,3073863,CDM,301,RC,83519,CPT,,,facility,outpatient,,,94.00000,45.31000,United Healthcare,Commercial,,84.60,,,,,,,24.44,91.18,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,inpatient,,,101.00000,48.68000,United Healthcare,Commercial,,90.90,,,,,,,90.90,97.97,percent of total billed charges,
LAB IMM RIA RECEPTOR TSH QN,3111283,CDM,301,RC,83519,CPT,,,facility,outpatient,,,101.00000,48.68000,United Healthcare,Commercial,,90.90,,,,,,,26.26,97.97,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,inpatient,,,82.00000,39.52000,United Healthcare,Commercial,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB IMM RIA TRYPSIN QN,3073871,CDM,301,RC,83519,CPT,,,facility,outpatient,,,82.00000,39.52000,United Healthcare,Commercial,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,inpatient,,,77.00000,37.11000,United Healthcare,Commercial,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB IMM TRYPTASE QN,3106689,CDM,301,RC,83520,CPT,,,facility,outpatient,,,77.00000,37.11000,United Healthcare,Commercial,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,inpatient,,,145.00000,69.89000,United Healthcare,Commercial,,130.50,,,,,,,130.50,140.65,percent of total billed charges,
LAB IMM VWF BINDING ASSAY,3123155,CDM,301,RC,83520,CPT,,,facility,outpatient,,,145.00000,69.89000,United Healthcare,Commercial,,130.50,,,,,,,37.70,140.65,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,inpatient,,,266.00000,128.21000,United Healthcare,Commercial,,239.40,,,,,,,239.40,258.02,percent of total billed charges,
LAB INFLIXIMAB,3120607,CDM,301,RC,80230,CPT,,,facility,outpatient,,,266.00000,128.21000,United Healthcare,Commercial,,239.40,,,,,,,69.16,258.02,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,inpatient,,,79.00000,38.08000,United Healthcare,Commercial,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB INSULIN FREE,3073905,CDM,301,RC,83527,CPT,,,facility,outpatient,,,79.00000,38.08000,United Healthcare,Commercial,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,inpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB INSULIN TOTAL,3073913,CDM,301,RC,83525,CPT,,,facility,outpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,inpatient,,,144.00000,69.41000,United Healthcare,Commercial,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
LAB INTERLEUKIN 2 RECEPTOR,3117710,CDM,301,RC,84238,CPT,,,facility,outpatient,,,144.00000,69.41000,United Healthcare,Commercial,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,inpatient,,,20.00000,9.64000,United Healthcare,Commercial,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB IRON,3073921,CDM,301,RC,83540,CPT,,,facility,outpatient,,,20.00000,9.64000,United Healthcare,Commercial,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,inpatient,,,208.00000,100.26000,United Healthcare,Commercial,,187.20,,,,,,,187.20,201.76,percent of total billed charges,
LAB IRON TISSUE LIVER,3107836,CDM,301,RC,83540,CPT,,,facility,outpatient,,,208.00000,100.26000,United Healthcare,Commercial,,187.20,,,,,,,54.08,201.76,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,inpatient,,,135.00000,65.07000,United Healthcare,Commercial,,121.50,,,,,,,121.50,130.95,percent of total billed charges,
LAB ISAVUCONAZOLE,3122785,CDM,301,RC,80299,CPT,,,facility,outpatient,,,135.00000,65.07000,United Healthcare,Commercial,,121.50,,,,,,,35.10,130.95,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,inpatient,,,131.00000,63.14000,United Healthcare,Commercial,,117.90,,,,,,,117.90,127.07,percent of total billed charges,
LAB ITRACONAZOLE,3028230,CDM,301,RC,80189,CPT,,,facility,outpatient,,,131.00000,63.14000,United Healthcare,Commercial,,117.90,,,,,,,34.06,127.07,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,inpatient,,,69.00000,33.26000,United Healthcare,Commercial,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT,3113750,CDM,301,RC,83883,CPT,,,facility,outpatient,,,69.00000,33.26000,United Healthcare,Commercial,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,inpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB KAPPA/LAMBDA LIGHT NS,3110996,CDM,301,RC,83883,CPT,,,facility,outpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,inpatient,,,25.00000,12.05000,United Healthcare,Commercial,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB KETONES ACETONE QN,3062288,CDM,301,RC,82010,CPT,,,facility,outpatient,,,25.00000,12.05000,United Healthcare,Commercial,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,inpatient,,,61.00000,29.40000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB KETONES NS,3115979,CDM,301,RC,82010,CPT,,,facility,outpatient,,,61.00000,29.40000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,inpatient,,,80.00000,38.56000,United Healthcare,Commercial,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB KETOSTEROIDS 17- TOTAL,3074010,CDM,301,RC,83586,CPT,,,facility,outpatient,,,80.00000,38.56000,United Healthcare,Commercial,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,inpatient,,,82.00000,39.52000,United Healthcare,Commercial,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB LACOSAMIDE,3121464,CDM,301,RC,80235,CPT,,,facility,outpatient,,,82.00000,39.52000,United Healthcare,Commercial,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,inpatient,,,35.00000,16.87000,United Healthcare,Commercial,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID,3074036,CDM,301,RC,83605,CPT,,,facility,outpatient,,,35.00000,16.87000,United Healthcare,Commercial,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,inpatient,,,88.00000,42.42000,United Healthcare,Commercial,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB LACTATE/LACTIC ACID CSF,3074044,CDM,301,RC,83605,CPT,,,facility,outpatient,,,88.00000,42.42000,United Healthcare,Commercial,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,inpatient,,,98.00000,47.24000,United Healthcare,Commercial,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QL NS,3108123,CDM,301,RC,83630,CPT,,,facility,outpatient,,,98.00000,47.24000,United Healthcare,Commercial,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,inpatient,,,204.00000,98.33000,United Healthcare,Commercial,,183.60,,,,,,,183.60,197.88,percent of total billed charges,
LAB LACTOFERRIN FECAL QN,3111713,CDM,301,RC,83631,CPT,,,facility,outpatient,,,204.00000,98.33000,United Healthcare,Commercial,,183.60,,,,,,,53.04,197.88,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,inpatient,,,61.00000,29.40000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB LAMOTRIGINE,3074077,CDM,301,RC,80175,CPT,,,facility,outpatient,,,61.00000,29.40000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,inpatient,,,19.00000,9.16000,United Healthcare,Commercial,,17.10,,,,,,,17.10,18.43,percent of total billed charges,
LAB LDH,3074085,CDM,301,RC,83615,CPT,,,facility,outpatient,,,19.00000,9.16000,United Healthcare,Commercial,,17.10,,,,,,,4.94,18.43,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB LDH CSF,3074101,CDM,301,RC,83615,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,inpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB LDH FLUID BODY,3074093,CDM,301,RC,83615,CPT,,,facility,outpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB LDH ISOENZYMES,3074119,CDM,301,RC,83625,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,inpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB LDH NS,3103942,CDM,301,RC,83615,CPT,,,facility,outpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB LEAD BLOOD,3074127,CDM,301,RC,83655,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,inpatient,,,37.00000,17.83000,United Healthcare,Commercial,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB LEAD BLOOD NS,3105855,CDM,301,RC,83655,CPT,,,facility,outpatient,,,37.00000,17.83000,United Healthcare,Commercial,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,inpatient,,,79.00000,38.08000,United Healthcare,Commercial,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB LEAD NON BLOOD,3074135,CDM,301,RC,83655,CPT,,,facility,outpatient,,,79.00000,38.08000,United Healthcare,Commercial,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,inpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB LEVETIRACETAM NS,3094646,CDM,301,RC,80177,CPT,,,facility,outpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,inpatient,,,21.00000,10.12000,United Healthcare,Commercial,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB LIPASE,3074176,CDM,301,RC,83690,CPT,,,facility,outpatient,,,21.00000,10.12000,United Healthcare,Commercial,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,inpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY,3074184,CDM,301,RC,83690,CPT,,,facility,outpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB LIPASE FLUID BODY NS,3103967,CDM,301,RC,83690,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,inpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB LIPOPROTEIN A,3074200,CDM,301,RC,83695,CPT,,,facility,outpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB LIPOPROTEIN A NS,3109766,CDM,301,RC,83695,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,inpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL HDL,3063427,CDM,301,RC,83718,CPT,,,facility,outpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,inpatient,,,32.00000,15.42000,United Healthcare,Commercial,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL,3107596,CDM,301,RC,83721,CPT,,,facility,outpatient,,,32.00000,15.42000,United Healthcare,Commercial,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,inpatient,,,94.00000,45.31000,United Healthcare,Commercial,,84.60,,,,,,,84.60,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL NS,3121027,CDM,301,RC,83721,CPT,,,facility,outpatient,,,94.00000,45.31000,United Healthcare,Commercial,,84.60,,,,,,,24.44,91.18,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,inpatient,,,103.00000,49.65000,United Healthcare,Commercial,,92.70,,,,,,,92.70,99.91,percent of total billed charges,
LAB LIPOPROTEIN CHOLESTEROL LDL SD,3121696,CDM,301,RC,83722,CPT,,,facility,outpatient,,,103.00000,49.65000,United Healthcare,Commercial,,92.70,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,inpatient,,,64.00000,30.85000,United Healthcare,Commercial,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB LIPOPROTEIN ELECTRO,3074218,CDM,301,RC,83700,CPT,,,facility,outpatient,,,64.00000,30.85000,United Healthcare,Commercial,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,inpatient,,,102.00000,49.16000,United Healthcare,Commercial,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB LIPOPROTEIN FRCTN HR,3074226,CDM,301,RC,83701,CPT,,,facility,outpatient,,,102.00000,49.16000,United Healthcare,Commercial,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,inpatient,,,103.00000,49.65000,United Healthcare,Commercial,,92.70,,,,,,,92.70,99.91,percent of total billed charges,
LAB LIPOPROTEIN PART NO/S&SBCLS QN,3108404,CDM,301,RC,83704,CPT,,,facility,outpatient,,,103.00000,49.65000,United Healthcare,Commercial,,92.70,,,,,,,26.78,99.91,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,inpatient,,,139.00000,67.00000,United Healthcare,Commercial,,125.10,,,,,,,125.10,134.83,percent of total billed charges,
LAB LIPOPROTEIN PHOSPHOLIPASE A2,3107364,CDM,301,RC,83698,CPT,,,facility,outpatient,,,139.00000,67.00000,United Healthcare,Commercial,,125.10,,,,,,,36.14,134.83,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,inpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB LITHIUM,3074234,CDM,301,RC,80178,CPT,,,facility,outpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,inpatient,,,21.00000,10.12000,United Healthcare,Commercial,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB MAGNESIUM,3074283,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,United Healthcare,Commercial,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,inpatient,,,88.00000,42.42000,United Healthcare,Commercial,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB MAGNESIUM NS,3121092,CDM,301,RC,83735,CPT,,,facility,outpatient,,,88.00000,42.42000,United Healthcare,Commercial,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,inpatient,,,21.00000,10.12000,United Healthcare,Commercial,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB MAGNESIUM STOOL,3074291,CDM,301,RC,83735,CPT,,,facility,outpatient,,,21.00000,10.12000,United Healthcare,Commercial,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,inpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB MAGNESIUM URINE,3074309,CDM,301,RC,83735,CPT,,,facility,outpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,inpatient,,,80.00000,38.56000,United Healthcare,Commercial,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB MANGANESE,3074325,CDM,301,RC,83785,CPT,,,facility,outpatient,,,80.00000,38.56000,United Healthcare,Commercial,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,inpatient,,,49.00000,23.62000,United Healthcare,Commercial,,44.10,,,,,,,44.10,47.53,percent of total billed charges,
LAB MERCURY BLOOD QN,3074390,CDM,301,RC,83825,CPT,,,facility,outpatient,,,49.00000,23.62000,United Healthcare,Commercial,,44.10,,,,,,,12.74,47.53,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,inpatient,,,88.00000,42.42000,United Healthcare,Commercial,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB MERCURY NON BLOOD QN,3074408,CDM,301,RC,83825,CPT,,,facility,outpatient,,,88.00000,42.42000,United Healthcare,Commercial,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,inpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB METANEPHRINES,3074416,CDM,301,RC,83835,CPT,,,facility,outpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN,3074515,CDM,301,RC,82043,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,inpatient,,,68.00000,32.78000,United Healthcare,Commercial,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB MICROALBUMIN URINE QN NS,3107620,CDM,301,RC,82043,CPT,,,facility,outpatient,,,68.00000,32.78000,United Healthcare,Commercial,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2,3062882,CDM,301,RC,82232,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,inpatient,,,93.00000,44.83000,United Healthcare,Commercial,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
LAB MICROGLOBULIN BETA-2 NS,3109915,CDM,301,RC,82232,CPT,,,facility,outpatient,,,93.00000,44.83000,United Healthcare,Commercial,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,inpatient,,,73.00000,35.19000,United Healthcare,Commercial,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB MS&MS TNDM NON-DRUG QL/QN,3116522,CDM,301,RC,83789,CPT,,,facility,outpatient,,,73.00000,35.19000,United Healthcare,Commercial,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB MYOGLOBIN,3074788,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB MYOGLOBIN URINE,3074796,CDM,301,RC,83874,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,inpatient,,,41.00000,19.76000,United Healthcare,Commercial,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB NEPHELOMETRY ANALYTE EA,3074820,CDM,301,RC,83883,CPT,,,facility,outpatient,,,41.00000,19.76000,United Healthcare,Commercial,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,inpatient,,,94.00000,45.31000,United Healthcare,Commercial,,84.60,,,,,,,84.60,91.18,percent of total billed charges,
LAB NIACIN,3106390,CDM,301,RC,84591,CPT,,,facility,outpatient,,,94.00000,45.31000,United Healthcare,Commercial,,84.60,,,,,,,24.44,91.18,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,inpatient,,,124.00000,59.77000,United Healthcare,Commercial,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB NICKEL,3111457,CDM,301,RC,83885,CPT,,,facility,outpatient,,,124.00000,59.77000,United Healthcare,Commercial,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,inpatient,,,71.00000,34.22000,United Healthcare,Commercial,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB NITROGEN UREA CLEARANCE,3076528,CDM,301,RC,84545,CPT,,,facility,outpatient,,,71.00000,34.22000,United Healthcare,Commercial,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,inpatient,,,33.00000,15.91000,United Healthcare,Commercial,,29.70,,,,,,,29.70,32.01,percent of total billed charges,
LAB NITROGEN UREA QN,3076510,CDM,301,RC,84520,CPT,,,facility,outpatient,,,33.00000,15.91000,United Healthcare,Commercial,,29.70,,,,,,,8.58,32.01,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,inpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB NITROGEN UREA URINE,3076536,CDM,301,RC,84540,CPT,,,facility,outpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,inpatient,,,68.00000,32.78000,United Healthcare,Commercial,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB NORTRIPTYLINE,3124252,CDM,301,RC,80299,CPT,,,facility,outpatient,,,68.00000,32.78000,United Healthcare,Commercial,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,inpatient,,,99.00000,47.72000,United Healthcare,Commercial,,89.10,,,,,,,89.10,96.03,percent of total billed charges,
LAB NUCLEOTIDASE 5-,3074861,CDM,301,RC,83915,CPT,,,facility,outpatient,,,99.00000,47.72000,United Healthcare,Commercial,,89.10,,,,,,,25.74,96.03,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,inpatient,,,197.00000,94.95000,United Healthcare,Commercial,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
LAB OLANZAPINE,3115151,CDM,301,RC,80299,CPT,,,facility,outpatient,,,197.00000,94.95000,United Healthcare,Commercial,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,inpatient,,,194.00000,93.51000,United Healthcare,Commercial,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
LAB ONCOPROTEIN DCP,3111473,CDM,301,RC,83951,CPT,,,facility,outpatient,,,194.00000,93.51000,United Healthcare,Commercial,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB OSMOLALITY BLOOD,3075017,CDM,301,RC,83930,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,inpatient,,,68.00000,32.78000,United Healthcare,Commercial,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB OSMOLALITY STOOL,3075033,CDM,301,RC,84999,CPT,,,facility,outpatient,,,68.00000,32.78000,United Healthcare,Commercial,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB OSMOLALITY URINE,3075041,CDM,301,RC,83935,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,inpatient,,,90.00000,43.38000,United Healthcare,Commercial,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB OSTEOCALCIN,3075058,CDM,301,RC,83937,CPT,,,facility,outpatient,,,90.00000,43.38000,United Healthcare,Commercial,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,inpatient,,,109.00000,52.54000,United Healthcare,Commercial,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB OXALATE,3075066,CDM,301,RC,83945,CPT,,,facility,outpatient,,,109.00000,52.54000,United Healthcare,Commercial,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,inpatient,,,108.00000,52.06000,United Healthcare,Commercial,,97.20,,,,,,,97.20,104.76,percent of total billed charges,
LAB OXALATE STONE RISK,3121100,CDM,301,RC,83945,CPT,,,facility,outpatient,,,108.00000,52.06000,United Healthcare,Commercial,,97.20,,,,,,,28.08,104.76,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,inpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB OXALATE URINE,3075074,CDM,301,RC,83945,CPT,,,facility,outpatient,,,67.00000,32.29000,United Healthcare,Commercial,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,inpatient,,,69.00000,33.26000,United Healthcare,Commercial,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB OXCARBAZEPINE,3028024,CDM,301,RC,80183,CPT,,,facility,outpatient,,,69.00000,33.26000,United Healthcare,Commercial,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,inpatient,,,71.00000,34.22000,United Healthcare,Commercial,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB PANEL ELECTROLYTE,3064482,CDM,301,RC,80051,CPT,,,facility,outpatient,,,71.00000,34.22000,United Healthcare,Commercial,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,inpatient,,,98.00000,47.24000,United Healthcare,Commercial,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
LAB PANEL FUNCTION HEPATIC,3073582,CDM,301,RC,80076,CPT,,,facility,outpatient,,,98.00000,47.24000,United Healthcare,Commercial,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,inpatient,,,141.00000,67.96000,United Healthcare,Commercial,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB PANEL FUNCTION RENAL,3075843,CDM,301,RC,80069,CPT,,,facility,outpatient,,,141.00000,67.96000,United Healthcare,Commercial,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,inpatient,,,226.00000,108.93000,United Healthcare,Commercial,,203.40,,,,,,,203.40,219.22,percent of total billed charges,
LAB PANEL HEPATITIS ACUTE,3062312,CDM,301,RC,80074,CPT,,,facility,outpatient,,,226.00000,108.93000,United Healthcare,Commercial,,203.40,,,,,,,58.76,219.22,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,inpatient,,,92.00000,44.34000,United Healthcare,Commercial,,82.80,,,,,,,82.80,89.24,percent of total billed charges,
LAB PANEL LIPID,3074192,CDM,301,RC,80061,CPT,,,facility,outpatient,,,92.00000,44.34000,United Healthcare,Commercial,,82.80,,,,,,,23.92,89.24,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,inpatient,,,69.00000,33.26000,United Healthcare,Commercial,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB PANEL LIPID NS,3119716,CDM,301,RC,80061,CPT,,,facility,outpatient,,,69.00000,33.26000,United Healthcare,Commercial,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,inpatient,,,100.00000,48.20000,United Healthcare,Commercial,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB PANEL METAB BASIC W CA TOTAL,3062866,CDM,301,RC,80048,CPT,,,facility,outpatient,,,100.00000,48.20000,United Healthcare,Commercial,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,inpatient,,,124.00000,59.77000,United Healthcare,Commercial,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB PANEL METAB COMP,3063641,CDM,301,RC,80053,CPT,,,facility,outpatient,,,124.00000,59.77000,United Healthcare,Commercial,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,inpatient,,,69.00000,33.26000,United Healthcare,Commercial,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB PANTOTHENIC ACID B5,3118957,CDM,301,RC,84591,CPT,,,facility,outpatient,,,69.00000,33.26000,United Healthcare,Commercial,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,United Healthcare,Commercial,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE,3075660,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,United Healthcare,Commercial,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,United Healthcare,Commercial,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE C-TERMINAL,3075678,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,United Healthcare,Commercial,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,inpatient,,,124.00000,59.77000,United Healthcare,Commercial,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB PARATHORMONE INTRAOP BASELINE 3,3079993,CDM,301,RC,83970,CPT,,,facility,outpatient,,,124.00000,59.77000,United Healthcare,Commercial,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,inpatient,,,118.00000,56.88000,United Healthcare,Commercial,,106.20,,,,,,,106.20,114.46,percent of total billed charges,
LAB PEPTIDE NATRIURETIC PB,3075454,CDM,301,RC,83880,CPT,,,facility,outpatient,,,118.00000,56.88000,United Healthcare,Commercial,,106.20,,,,,,,30.68,114.46,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,inpatient,,,51.00000,24.58000,United Healthcare,Commercial,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS,3075132,CDM,301,RC,83986,CPT,,,facility,outpatient,,,51.00000,24.58000,United Healthcare,Commercial,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,inpatient,,,104.00000,50.13000,United Healthcare,Commercial,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB PH FLUID BODY NOS NS,3112737,CDM,301,RC,83986,CPT,,,facility,outpatient,,,104.00000,50.13000,United Healthcare,Commercial,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,inpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB PH STONE RISK,3121118,CDM,301,RC,83986,CPT,,,facility,outpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,inpatient,,,72.00000,34.70000,United Healthcare,Commercial,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB PH STOOL NS,3116357,CDM,301,RC,83986,CPT,,,facility,outpatient,,,72.00000,34.70000,United Healthcare,Commercial,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,inpatient,,,54.00000,26.03000,United Healthcare,Commercial,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB PHENOBARBITAL,3075165,CDM,301,RC,80184,CPT,,,facility,outpatient,,,54.00000,26.03000,United Healthcare,Commercial,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB PHENOBARBITAL NS,3113032,CDM,301,RC,80184,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,inpatient,,,17.00000,8.19000,United Healthcare,Commercial,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
LAB PHENYLALANINE BLOOD,3075181,CDM,301,RC,84030,CPT,,,facility,outpatient,,,17.00000,8.19000,United Healthcare,Commercial,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,inpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB PHENYTOIN FREE,3075215,CDM,301,RC,80186,CPT,,,facility,outpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB PHENYTOIN TOTAL,3075223,CDM,301,RC,80185,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,inpatient,,,36.00000,17.35000,United Healthcare,Commercial,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC,3075298,CDM,301,RC,84100,CPT,,,facility,outpatient,,,36.00000,17.35000,United Healthcare,Commercial,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,inpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE,3075306,CDM,301,RC,84105,CPT,,,facility,outpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,inpatient,,,18.00000,8.68000,United Healthcare,Commercial,,16.20,,,,,,,16.20,17.46,percent of total billed charges,
LAB PHOSPHORUS INORGANIC URINE NS,3109709,CDM,301,RC,84105,CPT,,,facility,outpatient,,,18.00000,8.68000,United Healthcare,Commercial,,16.20,,,,,,,4.68,17.46,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,inpatient,,,74.00000,35.67000,United Healthcare,Commercial,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB PHOSPHORUS STONE RISK,3121126,CDM,301,RC,84105,CPT,,,facility,outpatient,,,74.00000,35.67000,United Healthcare,Commercial,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,inpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB PORPHOBILINOGEN URINE QN,3075322,CDM,301,RC,84110,CPT,,,facility,outpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,inpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB PORPHYRINS URINE QN&FRCTN,3075330,CDM,301,RC,84120,CPT,,,facility,outpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,inpatient,,,118.00000,56.88000,United Healthcare,Commercial,,106.20,,,,,,,106.20,114.46,percent of total billed charges,
LAB POSACONAZOLE,3115664,CDM,301,RC,80187,CPT,,,facility,outpatient,,,118.00000,56.88000,United Healthcare,Commercial,,106.20,,,,,,,30.68,114.46,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,inpatient,,,82.00000,39.52000,United Healthcare,Commercial,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB POTASS BLD WHL RBC,3080124,CDM,301,RC,84132,CPT,,,facility,outpatient,,,82.00000,39.52000,United Healthcare,Commercial,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB POTASS FLUID BODY,3075363,CDM,301,RC,84999,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB POTASS PLASMA,3080132,CDM,301,RC,84132,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,inpatient,,,30.00000,14.46000,United Healthcare,Commercial,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
LAB POTASS SRM/PLASMA/BLD WHL,3075355,CDM,301,RC,84132,CPT,,,facility,outpatient,,,30.00000,14.46000,United Healthcare,Commercial,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,inpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB POTASS URINE,3075389,CDM,301,RC,84133,CPT,,,facility,outpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,inpatient,,,70.00000,33.74000,United Healthcare,Commercial,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB POTASSIUM STONE RISK,3121134,CDM,301,RC,84133,CPT,,,facility,outpatient,,,70.00000,33.74000,United Healthcare,Commercial,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,inpatient,,,54.00000,26.03000,United Healthcare,Commercial,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB PREALBUMIN,3075397,CDM,301,RC,84134,CPT,,,facility,outpatient,,,54.00000,26.03000,United Healthcare,Commercial,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,inpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB PREGNENOLONE,3075421,CDM,301,RC,84140,CPT,,,facility,outpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB PRIMIDONE NS,3110053,CDM,301,RC,80188,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,inpatient,,,51.00000,24.58000,United Healthcare,Commercial,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB PROCAINAMIDE W NAPA,3075462,CDM,301,RC,80192,CPT,,,facility,outpatient,,,51.00000,24.58000,United Healthcare,Commercial,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,inpatient,,,141.00000,67.96000,United Healthcare,Commercial,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB PROCALCITONIN,3111630,CDM,301,RC,84145,CPT,,,facility,outpatient,,,141.00000,67.96000,United Healthcare,Commercial,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,inpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROGESTERONE,3075470,CDM,301,RC,84144,CPT,,,facility,outpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,inpatient,,,81.00000,39.04000,United Healthcare,Commercial,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB PROINSULIN,3075488,CDM,301,RC,84206,CPT,,,facility,outpatient,,,81.00000,39.04000,United Healthcare,Commercial,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB PROLACTIN,3075496,CDM,301,RC,84146,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,inpatient,,,335.00000,161.47000,United Healthcare,Commercial,,301.50,,,,,,,301.50,324.95,percent of total billed charges,
LAB PROSTAGLANDIN EA ARP,3126372,CDM,301,RC,84150,CPT,,,facility,outpatient,,,335.00000,161.47000,United Healthcare,Commercial,,301.50,,,,,,,87.10,324.95,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FLUID BODY,3075553,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,inpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB PROT FLUID BODY NS,3108057,CDM,301,RC,84157,CPT,,,facility,outpatient,,,52.00000,25.06000,United Healthcare,Commercial,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FLUID CEREBROSPINAL,3075561,CDM,301,RC,84157,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,inpatient,,,54.00000,26.03000,United Healthcare,Commercial,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN OTHER,3095114,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,United Healthcare,Commercial,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,inpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM,3064490,CDM,301,RC,84165,CPT,,,facility,outpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN SERUM NS,3029642,CDM,301,RC,84165,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,inpatient,,,54.00000,26.03000,United Healthcare,Commercial,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB PROT FRCTN ELECTRO&QN URINE,3088283,CDM,301,RC,84166,CPT,,,facility,outpatient,,,54.00000,26.03000,United Healthcare,Commercial,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,inpatient,,,53.00000,25.55000,United Healthcare,Commercial,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB PROT GLYCATED,3073236,CDM,301,RC,82985,CPT,,,facility,outpatient,,,53.00000,25.55000,United Healthcare,Commercial,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT GLYCATED NS,3109436,CDM,301,RC,82985,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,inpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROT MYELIN BASIC CSF,3074770,CDM,301,RC,83873,CPT,,,facility,outpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL,3075579,CDM,301,RC,84155,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,inpatient,,,53.00000,25.55000,United Healthcare,Commercial,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB PROT TTL SRM/PLASMA/BLD WHL NS,3107638,CDM,301,RC,84155,CPT,,,facility,outpatient,,,53.00000,25.55000,United Healthcare,Commercial,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PROT URINE,3075587,CDM,301,RC,84156,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB PROT URINE NS,3107646,CDM,301,RC,84156,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,inpatient,,,12.00000,5.78000,United Healthcare,Commercial,,10.80,,,,,,,10.80,11.64,percent of total billed charges,
LAB PROT URINE TIMED,3075595,CDM,301,RC,84156,CPT,,,facility,outpatient,,,12.00000,5.78000,United Healthcare,Commercial,,10.80,,,,,,,3.12,11.64,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,inpatient,,,710.00000,342.22000,United Healthcare,Commercial,,639.00,,,,,,,639.00,688.70,percent of total billed charges,
LAB PROT WB AB RYR W INTRP,3904562,CDM,301,RC,84181,CPT,,,facility,outpatient,,,710.00000,342.22000,United Healthcare,Commercial,,639.00,,,,,,,184.60,688.70,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,inpatient,,,104.00000,50.13000,United Healthcare,Commercial,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB PROT WB W INTRP,3076841,CDM,301,RC,84181,CPT,,,facility,outpatient,,,104.00000,50.13000,United Healthcare,Commercial,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,inpatient,,,155.00000,74.71000,United Healthcare,Commercial,,139.50,,,,,,,139.50,150.35,percent of total billed charges,
LAB PROT WB W INTRP ENCEPHALITIS,3122520,CDM,301,RC,84182,CPT,,,facility,outpatient,,,155.00000,74.71000,United Healthcare,Commercial,,139.50,,,,,,,40.30,150.35,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,inpatient,,,139.00000,67.00000,United Healthcare,Commercial,,125.10,,,,,,,125.10,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID BAND,3076833,CDM,301,RC,84182,CPT,,,facility,outpatient,,,139.00000,67.00000,United Healthcare,Commercial,,125.10,,,,,,,36.14,134.83,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,inpatient,,,89.00000,42.90000,United Healthcare,Commercial,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID CREUTZ-JAKOB,3113131,CDM,301,RC,84182,CPT,,,facility,outpatient,,,89.00000,42.90000,United Healthcare,Commercial,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,inpatient,,,88.00000,42.42000,United Healthcare,Commercial,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB PROT WB W INTRP ID MYOSITIS,3029873,CDM,301,RC,84182,CPT,,,facility,outpatient,,,88.00000,42.42000,United Healthcare,Commercial,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,inpatient,,,111.00000,53.50000,United Healthcare,Commercial,,99.90,,,,,,,99.90,107.67,percent of total billed charges,
LAB PROTOPORPHYRIN RBC QN,3075603,CDM,301,RC,84202,CPT,,,facility,outpatient,,,111.00000,53.50000,United Healthcare,Commercial,,99.90,,,,,,,28.86,107.67,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PSA FREE,3075645,CDM,301,RC,84154,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB PSA TOTAL,3075652,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,inpatient,,,70.00000,33.74000,United Healthcare,Commercial,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB PSA TOTAL NS,3107653,CDM,301,RC,84153,CPT,,,facility,outpatient,,,70.00000,33.74000,United Healthcare,Commercial,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,inpatient,,,85.00000,40.97000,United Healthcare,Commercial,,76.50,,,,,,,76.50,82.45,percent of total billed charges,
LAB PYRIDOXAL PHOSPHATE,3076718,CDM,301,RC,84207,CPT,,,facility,outpatient,,,85.00000,40.97000,United Healthcare,Commercial,,76.50,,,,,,,22.10,82.45,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,inpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB QUINIDINE,3075769,CDM,301,RC,80194,CPT,,,facility,outpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,inpatient,,,110.00000,53.02000,United Healthcare,Commercial,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB RECEPTOR ACETYLCHOLINE NON-ENDO,3075819,CDM,301,RC,84238,CPT,,,facility,outpatient,,,110.00000,53.02000,United Healthcare,Commercial,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,inpatient,,,500.00000,241.00000,United Healthcare,Commercial,,450.00,,,,,,,450.00,485.00,percent of total billed charges,
LAB RECEPTOR INTERLEUK 2 SOL N-END,3080074,CDM,301,RC,84238,CPT,,,facility,outpatient,,,500.00000,241.00000,United Healthcare,Commercial,,450.00,,,,,,,130.00,485.00,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,inpatient,,,140.00000,67.48000,United Healthcare,Commercial,,126.00,,,,,,,126.00,135.80,percent of total billed charges,
LAB RENIN,3075850,CDM,301,RC,84244,CPT,,,facility,outpatient,,,140.00000,67.48000,United Healthcare,Commercial,,126.00,,,,,,,36.40,135.80,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,inpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB RENIN NS,3106531,CDM,301,RC,84244,CPT,,,facility,outpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,inpatient,,,74.00000,35.67000,United Healthcare,Commercial,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB RIBOFLAVIN,3076700,CDM,301,RC,84252,CPT,,,facility,outpatient,,,74.00000,35.67000,United Healthcare,Commercial,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR PSA,3107745,CDM,301,RC,84153,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,inpatient,,,77.00000,37.11000,United Healthcare,Commercial,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB SELENIUM,3075884,CDM,301,RC,84255,CPT,,,facility,outpatient,,,77.00000,37.11000,United Healthcare,Commercial,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,inpatient,,,93.00000,44.83000,United Healthcare,Commercial,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
LAB SEROTONIN,3075892,CDM,301,RC,84260,CPT,,,facility,outpatient,,,93.00000,44.83000,United Healthcare,Commercial,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,inpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB SIROLIMUS,3104650,CDM,301,RC,80195,CPT,,,facility,outpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,inpatient,,,15.00000,7.23000,United Healthcare,Commercial,,13.50,,,,,,,13.50,14.55,percent of total billed charges,
LAB SODIUM OTHER SOURCE,3075991,CDM,301,RC,84302,CPT,,,facility,outpatient,,,15.00000,7.23000,United Healthcare,Commercial,,13.50,,,,,,,3.90,14.55,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,inpatient,,,24.00000,11.57000,United Healthcare,Commercial,,21.60,,,,,,,21.60,23.28,percent of total billed charges,
LAB SODIUM SRM/PLASMA/BLD WHL,3075934,CDM,301,RC,84295,CPT,,,facility,outpatient,,,24.00000,11.57000,United Healthcare,Commercial,,21.60,,,,,,,6.24,23.28,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,inpatient,,,72.00000,34.70000,United Healthcare,Commercial,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB SODIUM STONE RISK,3121142,CDM,301,RC,84300,CPT,,,facility,outpatient,,,72.00000,34.70000,United Healthcare,Commercial,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB SODIUM STOOL NS,3104122,CDM,301,RC,84302,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,inpatient,,,16.00000,7.71000,United Healthcare,Commercial,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB SODIUM URINE,3075975,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,United Healthcare,Commercial,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,inpatient,,,16.00000,7.71000,United Healthcare,Commercial,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB SODIUM URINE TIMED,3075983,CDM,301,RC,84300,CPT,,,facility,outpatient,,,16.00000,7.71000,United Healthcare,Commercial,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,inpatient,,,64.00000,30.85000,United Healthcare,Commercial,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB SOMATOMEDIN NS,3109428,CDM,301,RC,84305,CPT,,,facility,outpatient,,,64.00000,30.85000,United Healthcare,Commercial,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,inpatient,,,82.00000,39.52000,United Healthcare,Commercial,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB SOMATOSTATIN,3076015,CDM,301,RC,84307,CPT,,,facility,outpatient,,,82.00000,39.52000,United Healthcare,Commercial,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,inpatient,,,157.00000,75.67000,United Healthcare,Commercial,,141.30,,,,,,,141.30,152.29,percent of total billed charges,
LAB SPCTPHOT 1-3-BETA-D-GLUCAN,3113156,CDM,301,RC,84311,CPT,,,facility,outpatient,,,157.00000,75.67000,United Healthcare,Commercial,,141.30,,,,,,,40.82,152.29,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB SPCTPHOT ANALYTE NS,3076056,CDM,301,RC,84311,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,inpatient,,,70.00000,33.74000,United Healthcare,Commercial,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB SPCTPHOT PORPHYRINS SERUM,3104130,CDM,301,RC,84311,CPT,,,facility,outpatient,,,70.00000,33.74000,United Healthcare,Commercial,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,inpatient,,,229.00000,110.38000,United Healthcare,Commercial,,206.10,,,,,,,206.10,222.13,percent of total billed charges,
LAB SUGARS MULTIPLE QL EA,3076072,CDM,301,RC,84377,CPT,,,facility,outpatient,,,229.00000,110.38000,United Healthcare,Commercial,,206.10,,,,,,,59.54,222.13,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,inpatient,,,64.00000,30.85000,United Healthcare,Commercial,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB SUGARS SINGLE QL STOOL NS,3020120,CDM,301,RC,84376,CPT,,,facility,outpatient,,,64.00000,30.85000,United Healthcare,Commercial,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,inpatient,,,72.00000,34.70000,United Healthcare,Commercial,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB SULFATE STONE RISK,3121159,CDM,301,RC,84392,CPT,,,facility,outpatient,,,72.00000,34.70000,United Healthcare,Commercial,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,inpatient,,,17.00000,8.19000,United Healthcare,Commercial,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
LAB SULFATE URINE,3076080,CDM,301,RC,84392,CPT,,,facility,outpatient,,,17.00000,8.19000,United Healthcare,Commercial,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,inpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506,3076122,CDM,301,RC,80197,CPT,,,facility,outpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,inpatient,,,64.00000,30.85000,United Healthcare,Commercial,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB TACROLIMUS FK-506 NS,3103686,CDM,301,RC,80197,CPT,,,facility,outpatient,,,64.00000,30.85000,United Healthcare,Commercial,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,inpatient,,,387.00000,186.53000,United Healthcare,Commercial,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU TOTAL,3124872,CDM,301,RC,84394,CPT,,,facility,outpatient,,,387.00000,186.53000,United Healthcare,Commercial,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,inpatient,,,387.00000,186.53000,United Healthcare,Commercial,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU181 PHOSPHORYLATED EA,3125119,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,United Healthcare,Commercial,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,inpatient,,,387.00000,186.53000,United Healthcare,Commercial,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB TAU217 PHOSPHORYLATED EA,3125101,CDM,301,RC,84393,CPT,,,facility,outpatient,,,387.00000,186.53000,United Healthcare,Commercial,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,inpatient,,,77.00000,37.11000,United Healthcare,Commercial,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB TESTOSTERONE FREE,3076155,CDM,301,RC,84402,CPT,,,facility,outpatient,,,77.00000,37.11000,United Healthcare,Commercial,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,inpatient,,,78.00000,37.60000,United Healthcare,Commercial,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL,3076148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,United Healthcare,Commercial,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,inpatient,,,78.00000,37.60000,United Healthcare,Commercial,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB TESTOSTERONE TOTAL NS,3104148,CDM,301,RC,84403,CPT,,,facility,outpatient,,,78.00000,37.60000,United Healthcare,Commercial,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,inpatient,,,43.00000,20.73000,United Healthcare,Commercial,,38.70,,,,,,,38.70,41.71,percent of total billed charges,
LAB THEOPHYLLINE,3076189,CDM,301,RC,80198,CPT,,,facility,outpatient,,,43.00000,20.73000,United Healthcare,Commercial,,38.70,,,,,,,11.18,41.71,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,inpatient,,,64.00000,30.85000,United Healthcare,Commercial,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB THIAMINE,3076783,CDM,301,RC,84425,CPT,,,facility,outpatient,,,64.00000,30.85000,United Healthcare,Commercial,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,inpatient,,,160.00000,77.12000,United Healthcare,Commercial,,144.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB THIOPURINE,3028461,CDM,301,RC,80299,CPT,,,facility,outpatient,,,160.00000,77.12000,United Healthcare,Commercial,,144.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,inpatient,,,112.00000,53.98000,United Healthcare,Commercial,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB THIOPURINE S-METHYLTRANSFERASE,3123569,CDM,301,RC,84433,CPT,,,facility,outpatient,,,112.00000,53.98000,United Healthcare,Commercial,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB THYROGLOBULIN,3076221,CDM,301,RC,84432,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,inpatient,,,82.00000,39.52000,United Healthcare,Commercial,,73.80,,,,,,,73.80,79.54,percent of total billed charges,
LAB THYROGLOBULIN FNA,3119583,CDM,301,RC,84432,CPT,,,facility,outpatient,,,82.00000,39.52000,United Healthcare,Commercial,,73.80,,,,,,,21.32,79.54,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,inpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB THYROGLOBULIN NS,3109980,CDM,301,RC,84432,CPT,,,facility,outpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,inpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB THYROID CASCADING REFLEX,3119591,CDM,301,RC,84443,CPT,,,facility,outpatient,,,55.00000,26.51000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,inpatient,,,54.00000,26.03000,United Healthcare,Commercial,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB THYROID STIMULATING HORMONE,3076486,CDM,301,RC,84443,CPT,,,facility,outpatient,,,54.00000,26.03000,United Healthcare,Commercial,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,inpatient,,,153.00000,73.75000,United Healthcare,Commercial,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB THYROID STIMULATING IMMUN GLOB,3076247,CDM,301,RC,84445,CPT,,,facility,outpatient,,,153.00000,73.75000,United Healthcare,Commercial,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,inpatient,,,45.00000,21.69000,United Healthcare,Commercial,,40.50,,,,,,,40.50,43.65,percent of total billed charges,
LAB THYROXINE BINDING GLOBULIN,3076239,CDM,301,RC,84442,CPT,,,facility,outpatient,,,45.00000,21.69000,United Healthcare,Commercial,,40.50,,,,,,,11.70,43.65,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,inpatient,,,28.00000,13.50000,United Healthcare,Commercial,,25.20,,,,,,,25.20,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE,3076254,CDM,301,RC,84439,CPT,,,facility,outpatient,,,28.00000,13.50000,United Healthcare,Commercial,,25.20,,,,,,,7.28,27.16,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,inpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB THYROXINE T4 FREE NS,3104155,CDM,301,RC,84439,CPT,,,facility,outpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB THYROXINE T4 TOTAL,3076262,CDM,301,RC,84436,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,United Healthcare,Commercial,,44.10,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN PEAK,3076288,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,United Healthcare,Commercial,,44.10,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,United Healthcare,Commercial,,44.10,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN RANDOM,3076296,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,United Healthcare,Commercial,,44.10,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,inpatient,,,49.00000,23.62000,United Healthcare,Commercial,,44.10,,,,,,,44.10,47.53,percent of total billed charges,
LAB TOBRAMYCIN TROUGH,3076304,CDM,301,RC,80200,CPT,,,facility,outpatient,,,49.00000,23.62000,United Healthcare,Commercial,,44.10,,,,,,,12.74,47.53,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,inpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB TOCOPHEROL ALPHA,3076767,CDM,301,RC,84446,CPT,,,facility,outpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,inpatient,,,36.00000,17.35000,United Healthcare,Commercial,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB TOPIRAMATE,3076338,CDM,301,RC,80201,CPT,,,facility,outpatient,,,36.00000,17.35000,United Healthcare,Commercial,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,inpatient,,,38.00000,18.32000,United Healthcare,Commercial,,34.20,,,,,,,34.20,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE,3062460,CDM,301,RC,84460,CPT,,,facility,outpatient,,,38.00000,18.32000,United Healthcare,Commercial,,34.20,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ALANINE NS,3106911,CDM,301,RC,84460,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,inpatient,,,38.00000,18.32000,United Healthcare,Commercial,,34.20,,,,,,,34.20,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE,3062809,CDM,301,RC,84450,CPT,,,facility,outpatient,,,38.00000,18.32000,United Healthcare,Commercial,,34.20,,,,,,,9.88,36.86,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,inpatient,,,76.00000,36.63000,United Healthcare,Commercial,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB TRANSFERASE AMINO ASPARTATE NS,3106929,CDM,301,RC,84450,CPT,,,facility,outpatient,,,76.00000,36.63000,United Healthcare,Commercial,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,inpatient,,,173.00000,83.39000,United Healthcare,Commercial,,155.70,,,,,,,155.70,167.81,percent of total billed charges,
LAB TRANSFERASE GALACTOSE-1 QN,3103801,CDM,301,RC,82775,CPT,,,facility,outpatient,,,173.00000,83.39000,United Healthcare,Commercial,,155.70,,,,,,,44.98,167.81,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,inpatient,,,22.00000,10.60000,United Healthcare,Commercial,,19.80,,,,,,,19.80,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL,3073061,CDM,301,RC,82977,CPT,,,facility,outpatient,,,22.00000,10.60000,United Healthcare,Commercial,,19.80,,,,,,,5.72,21.34,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,inpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB TRANSFERASE GAMMA-GLUTAMYL NS,3112646,CDM,301,RC,82977,CPT,,,facility,outpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,inpatient,,,39.00000,18.80000,United Healthcare,Commercial,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB TRANSFERRIN,3076353,CDM,301,RC,84466,CPT,,,facility,outpatient,,,39.00000,18.80000,United Healthcare,Commercial,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,inpatient,,,41.00000,19.76000,United Healthcare,Commercial,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB TRIGLYCERIDES,3076395,CDM,301,RC,84478,CPT,,,facility,outpatient,,,41.00000,19.76000,United Healthcare,Commercial,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,inpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB TRIGLYCERIDES NS,3104163,CDM,301,RC,84478,CPT,,,facility,outpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,inpatient,,,54.00000,26.03000,United Healthcare,Commercial,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE,3076411,CDM,301,RC,84481,CPT,,,facility,outpatient,,,54.00000,26.03000,United Healthcare,Commercial,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,inpatient,,,71.00000,34.22000,United Healthcare,Commercial,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 FREE TR DIA,3079928,CDM,301,RC,84481,CPT,,,facility,outpatient,,,71.00000,34.22000,United Healthcare,Commercial,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 REVERSE,3076429,CDM,301,RC,84482,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,inpatient,,,43.00000,20.73000,United Healthcare,Commercial,,38.70,,,,,,,38.70,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL,3076437,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,United Healthcare,Commercial,,38.70,,,,,,,11.18,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,inpatient,,,43.00000,20.73000,United Healthcare,Commercial,,38.70,,,,,,,38.70,41.71,percent of total billed charges,
LAB TRIIODOTHYRONINE T3 TOTAL NS,3111168,CDM,301,RC,84480,CPT,,,facility,outpatient,,,43.00000,20.73000,United Healthcare,Commercial,,38.70,,,,,,,11.18,41.71,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,inpatient,,,38.00000,18.32000,United Healthcare,Commercial,,34.20,,,,,,,34.20,36.86,percent of total billed charges,
LAB TROPONIN QN,3076460,CDM,301,RC,84484,CPT,,,facility,outpatient,,,38.00000,18.32000,United Healthcare,Commercial,,34.20,,,,,,,9.88,36.86,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB UPTAKE HORMONE T3,3076114,CDM,301,RC,84479,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,inpatient,,,72.00000,34.70000,United Healthcare,Commercial,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB URIC ACID STONE RISK,3121167,CDM,301,RC,84560,CPT,,,facility,outpatient,,,72.00000,34.70000,United Healthcare,Commercial,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,inpatient,,,226.00000,108.93000,United Healthcare,Commercial,,203.40,,,,,,,203.40,219.22,percent of total billed charges,
LAB USTEKINUMAB,3119385,CDM,301,RC,80299,CPT,,,facility,outpatient,,,226.00000,108.93000,United Healthcare,Commercial,,203.40,,,,,,,58.76,219.22,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,United Healthcare,Commercial,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN PEAK,3076619,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,United Healthcare,Commercial,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,United Healthcare,Commercial,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN RANDOM,3076627,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,United Healthcare,Commercial,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,inpatient,,,41.00000,19.76000,United Healthcare,Commercial,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
LAB VANCOMYCIN TROUGH,3076635,CDM,301,RC,80202,CPT,,,facility,outpatient,,,41.00000,19.76000,United Healthcare,Commercial,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,inpatient,,,160.00000,77.12000,United Healthcare,Commercial,,144.00,,,,,,,144.00,155.20,percent of total billed charges,
LAB VASOACTIVE INTS PEPTIDE NS,3076650,CDM,301,RC,84586,CPT,,,facility,outpatient,,,160.00000,77.12000,United Healthcare,Commercial,,144.00,,,,,,,41.60,155.20,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,inpatient,,,102.00000,49.16000,United Healthcare,Commercial,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB VASOPRESSIN,3076668,CDM,301,RC,84588,CPT,,,facility,outpatient,,,102.00000,49.16000,United Healthcare,Commercial,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,inpatient,,,317.00000,152.79000,United Healthcare,Commercial,,285.30,,,,,,,285.30,307.49,percent of total billed charges,
LAB VEDOLIZUMAB,3119880,CDM,301,RC,80280,CPT,,,facility,outpatient,,,317.00000,152.79000,United Healthcare,Commercial,,285.30,,,,,,,82.42,307.49,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,inpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB VITAMIN A,3076775,CDM,301,RC,84590,CPT,,,facility,outpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,inpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB VITAMIN B-12 CAPACITY BNDG NS,3112232,CDM,301,RC,82608,CPT,,,facility,outpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,inpatient,,,116.00000,55.91000,United Healthcare,Commercial,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
LAB VITAMIN D 1 25 DIHYDROXY FRAC,3076734,CDM,301,RC,82652,CPT,,,facility,outpatient,,,116.00000,55.91000,United Healthcare,Commercial,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,inpatient,,,89.00000,42.90000,United Healthcare,Commercial,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC,3107026,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,United Healthcare,Commercial,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,inpatient,,,89.00000,42.90000,United Healthcare,Commercial,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB VITAMIN D 25 HYDROXY W FRAC NS,3076759,CDM,301,RC,82306,CPT,,,facility,outpatient,,,89.00000,42.90000,United Healthcare,Commercial,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,inpatient,,,85.00000,40.97000,United Healthcare,Commercial,,76.50,,,,,,,76.50,82.45,percent of total billed charges,
LAB VITAMIN K,3076809,CDM,301,RC,84597,CPT,,,facility,outpatient,,,85.00000,40.97000,United Healthcare,Commercial,,76.50,,,,,,,22.10,82.45,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,inpatient,,,184.00000,88.69000,United Healthcare,Commercial,,165.60,,,,,,,165.60,178.48,percent of total billed charges,
LAB VOLATILE NS,3121712,CDM,301,RC,84600,CPT,,,facility,outpatient,,,184.00000,88.69000,United Healthcare,Commercial,,165.60,,,,,,,47.84,178.48,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,inpatient,,,127.00000,61.21000,United Healthcare,Commercial,,114.30,,,,,,,114.30,123.19,percent of total billed charges,
LAB VORICONAZOLE,3108933,CDM,301,RC,80285,CPT,,,facility,outpatient,,,127.00000,61.21000,United Healthcare,Commercial,,114.30,,,,,,,33.02,123.19,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,inpatient,,,61.00000,29.40000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB ZINC,3028172,CDM,301,RC,84630,CPT,,,facility,outpatient,,,61.00000,29.40000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,inpatient,,,35.00000,16.87000,United Healthcare,Commercial,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB ZINC NS,3076874,CDM,301,RC,84630,CPT,,,facility,outpatient,,,35.00000,16.87000,United Healthcare,Commercial,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,inpatient,,,79.00000,38.08000,United Healthcare,Commercial,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB ZONISAMIDE,3112711,CDM,301,RC,80203,CPT,,,facility,outpatient,,,79.00000,38.08000,United Healthcare,Commercial,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,inpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB ADENOVIRUS,3076924,CDM,302,RC,86603,CPT,,,facility,outpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,inpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB AMOEBIC,3076965,CDM,302,RC,86753,CPT,,,facility,outpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,inpatient,,,57.00000,32.83000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB ANTIPHOSPHATIDYLSERINE,3079118,CDM,302,RC,86148,CPT,,,facility,outpatient,,,57.00000,32.83000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ASPERGILLUS,3077013,CDM,302,RC,86606,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,United Healthcare,Commercial,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB BACTERIUM NONSPECIFIED NS,3107133,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,United Healthcare,Commercial,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,inpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB BARTONELLA,3077039,CDM,302,RC,86611,CPT,,,facility,outpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,inpatient,,,77.00000,44.35000,United Healthcare,Commercial,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB AB BETA 2 GLYCOPROTEIN I,3077047,CDM,302,RC,86146,CPT,,,facility,outpatient,,,77.00000,44.35000,United Healthcare,Commercial,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,inpatient,,,70.00000,40.32000,United Healthcare,Commercial,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB AB BORDETELLA,3077104,CDM,302,RC,86615,CPT,,,facility,outpatient,,,70.00000,40.32000,United Healthcare,Commercial,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,inpatient,,,67.00000,38.59000,United Healthcare,Commercial,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB AB BRUCELLA,3077112,CDM,302,RC,86622,CPT,,,facility,outpatient,,,67.00000,38.59000,United Healthcare,Commercial,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,inpatient,,,40.00000,23.04000,United Healthcare,Commercial,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB CAMPYLOBACTER NS,3112059,CDM,302,RC,86625,CPT,,,facility,outpatient,,,40.00000,23.04000,United Healthcare,Commercial,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,inpatient,,,71.00000,40.90000,United Healthcare,Commercial,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB CANDIDA,3077138,CDM,302,RC,86628,CPT,,,facility,outpatient,,,71.00000,40.90000,United Healthcare,Commercial,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,inpatient,,,80.00000,46.08000,United Healthcare,Commercial,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB AB CARDIOLIPIN IG EA,3077146,CDM,302,RC,86147,CPT,,,facility,outpatient,,,80.00000,46.08000,United Healthcare,Commercial,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,inpatient,,,72.00000,41.47000,United Healthcare,Commercial,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB CHAGAS IGG,3029998,CDM,302,RC,86753,CPT,,,facility,outpatient,,,72.00000,41.47000,United Healthcare,Commercial,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,inpatient,,,444.00000,255.74000,United Healthcare,Commercial,,399.60,,,,,,,399.60,430.68,percent of total billed charges,
LAB AB CHANNEL CA VOLTAGE-GATED,3065018,CDM,302,RC,86596,CPT,,,facility,outpatient,,,444.00000,255.74000,United Healthcare,Commercial,,399.60,,,,,,,115.44,430.68,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,inpatient,,,81.00000,46.66000,United Healthcare,Commercial,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB AB CHLAMYDIA,3077153,CDM,302,RC,86631,CPT,,,facility,outpatient,,,81.00000,46.66000,United Healthcare,Commercial,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEU IGG IGA,3077179,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PNEUM IGM,3077187,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGG IGA,3077195,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA PSITTACI IGM,3077203,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,inpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGG IGA,3104353,CDM,302,RC,86631,CPT,,,facility,outpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,inpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CHLAMYDIA TRAC IGM,3077211,CDM,302,RC,86632,CPT,,,facility,outpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,inpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB CHORIOMENINGITIS LYMPHOCYTIC,3078839,CDM,302,RC,86727,CPT,,,facility,outpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES,3077252,CDM,302,RC,86635,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,inpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGG,3077260,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,inpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES IGM,3077278,CDM,302,RC,86635,CPT,,,facility,outpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,inpatient,,,66.00000,38.02000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB COCCIDIOIDES NS,3109378,CDM,302,RC,86635,CPT,,,facility,outpatient,,,66.00000,38.02000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,inpatient,,,57.00000,32.83000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB COXIELLA BRUNETII,3077526,CDM,302,RC,86638,CPT,,,facility,outpatient,,,57.00000,32.83000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,inpatient,,,53.00000,30.53000,United Healthcare,Commercial,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB COXSACKIE,3077534,CDM,302,RC,86658,CPT,,,facility,outpatient,,,53.00000,30.53000,United Healthcare,Commercial,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB CYSTICERCUS CSF,3123445,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB CYSTICERCUS SERUM,3123452,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,inpatient,,,60.00000,34.56000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS,3077229,CDM,302,RC,86644,CPT,,,facility,outpatient,,,60.00000,34.56000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,inpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB CYTOMEGALOVIRUS IGM,3077237,CDM,302,RC,86645,CPT,,,facility,outpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,inpatient,,,40.00000,23.04000,United Healthcare,Commercial,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB DEOXYRIBONUCLEASE,3077617,CDM,302,RC,86215,CPT,,,facility,outpatient,,,40.00000,23.04000,United Healthcare,Commercial,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,inpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB DIPTHERIA,3077625,CDM,302,RC,86648,CPT,,,facility,outpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,inpatient,,,42.00000,24.19000,United Healthcare,Commercial,,37.80,,,,,,,37.80,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE,3077633,CDM,302,RC,86225,CPT,,,facility,outpatient,,,42.00000,24.19000,United Healthcare,Commercial,,37.80,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,inpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB DNA STRANDED NATVE/DOUBLE NS,3109212,CDM,302,RC,86225,CPT,,,facility,outpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV EARLY AG,3077658,CDM,302,RC,86663,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,inpatient,,,46.00000,26.50000,United Healthcare,Commercial,,41.40,,,,,,,41.40,44.62,percent of total billed charges,
LAB AB EBV EBNA,3077666,CDM,302,RC,86664,CPT,,,facility,outpatient,,,46.00000,26.50000,United Healthcare,Commercial,,41.40,,,,,,,11.96,44.62,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,inpatient,,,54.00000,31.10000,United Healthcare,Commercial,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB EBV EBNA NS,3109626,CDM,302,RC,86664,CPT,,,facility,outpatient,,,54.00000,31.10000,United Healthcare,Commercial,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV VCA IGG,3077674,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,inpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB EBV VCA IGM,3077682,CDM,302,RC,86665,CPT,,,facility,outpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB EBV VCA IGM NS,3109642,CDM,302,RC,86665,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,inpatient,,,71.00000,40.90000,United Healthcare,Commercial,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB ECHINOCOCCUS,3029170,CDM,302,RC,86682,CPT,,,facility,outpatient,,,71.00000,40.90000,United Healthcare,Commercial,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,inpatient,,,54.00000,31.10000,United Healthcare,Commercial,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB ECHOVIRUS,3077708,CDM,302,RC,86658,CPT,,,facility,outpatient,,,54.00000,31.10000,United Healthcare,Commercial,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,inpatient,,,80.00000,46.08000,United Healthcare,Commercial,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB AB EHRLICHIA,3077716,CDM,302,RC,86666,CPT,,,facility,outpatient,,,80.00000,46.08000,United Healthcare,Commercial,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,inpatient,,,60.00000,34.56000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB ENA CENTROMERE B,3105616,CDM,302,RC,86235,CPT,,,facility,outpatient,,,60.00000,34.56000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,inpatient,,,124.00000,71.42000,United Healthcare,Commercial,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB AB ENA CHROMATIN,3110897,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,United Healthcare,Commercial,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,inpatient,,,130.00000,74.88000,United Healthcare,Commercial,,117.00,,,,,,,117.00,126.10,percent of total billed charges,
LAB AB ENA FIBRILLARIN,3029493,CDM,302,RC,86235,CPT,,,facility,outpatient,,,130.00000,74.88000,United Healthcare,Commercial,,117.00,,,,,,,33.80,126.10,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,inpatient,,,123.00000,70.85000,United Healthcare,Commercial,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB AB ENA JO1,3110871,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,United Healthcare,Commercial,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,inpatient,,,77.00000,44.35000,United Healthcare,Commercial,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB AB ENA MYOSITIS,3029865,CDM,302,RC,86235,CPT,,,facility,outpatient,,,77.00000,44.35000,United Healthcare,Commercial,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,inpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENA NS,3107141,CDM,302,RC,86235,CPT,,,facility,outpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,inpatient,,,115.00000,66.24000,United Healthcare,Commercial,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB AB ENA PM/SC1-100,3123072,CDM,302,RC,86235,CPT,,,facility,outpatient,,,115.00000,66.24000,United Healthcare,Commercial,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA RNP,3077732,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,inpatient,,,123.00000,70.85000,United Healthcare,Commercial,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA,3077757,CDM,302,RC,86235,CPT,,,facility,outpatient,,,123.00000,70.85000,United Healthcare,Commercial,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,inpatient,,,161.00000,92.74000,United Healthcare,Commercial,,144.90,,,,,,,144.90,156.17,percent of total billed charges,
LAB AB ENA SCLERODERMA PANEL,3904661,CDM,302,RC,86235,CPT,,,facility,outpatient,,,161.00000,92.74000,United Healthcare,Commercial,,144.90,,,,,,,41.86,156.17,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,inpatient,,,124.00000,71.42000,United Healthcare,Commercial,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB AB ENA SM/RNP,3110905,CDM,302,RC,86235,CPT,,,facility,outpatient,,,124.00000,71.42000,United Healthcare,Commercial,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SMITH,3077765,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SS-A/RO,3077773,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ENA SS-B/LA,3077781,CDM,302,RC,86235,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,inpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS CALIFORNIA,3077799,CDM,302,RC,86651,CPT,,,facility,outpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,inpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE EASTERN,3077807,CDM,302,RC,86652,CPT,,,facility,outpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,inpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS EQUINE WEST NS,3077823,CDM,302,RC,86654,CPT,,,facility,outpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,inpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB ENCEPHALITIS SAINT LOUIS NS,3077815,CDM,302,RC,86653,CPT,,,facility,outpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,inpatient,,,102.00000,58.75000,United Healthcare,Commercial,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB AB FILARIA IGG4,3904539,CDM,302,RC,86682,CPT,,,facility,outpatient,,,102.00000,58.75000,United Healthcare,Commercial,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,inpatient,,,219.00000,126.14000,United Healthcare,Commercial,,197.10,,,,,,,197.10,212.43,percent of total billed charges,
LAB AB FL TITER AQUAPORIN 4,3029360,CDM,302,RC,86256,CPT,,,facility,outpatient,,,219.00000,126.14000,United Healthcare,Commercial,,197.10,,,,,,,56.94,212.43,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,inpatient,,,194.00000,111.74000,United Healthcare,Commercial,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
LAB AB FL TITER ENCEPHALITIS,3122512,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,United Healthcare,Commercial,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,inpatient,,,103.00000,59.33000,United Healthcare,Commercial,,92.70,,,,,,,92.70,99.91,percent of total billed charges,
LAB AB FL TITER ENDOMYSIAL,3121258,CDM,302,RC,86256,CPT,,,facility,outpatient,,,103.00000,59.33000,United Healthcare,Commercial,,92.70,,,,,,,26.78,99.91,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FL TITER HU,3078011,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,inpatient,,,60.00000,34.56000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB FL TITER MITOCHONDRIA,3078029,CDM,302,RC,86256,CPT,,,facility,outpatient,,,60.00000,34.56000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,inpatient,,,837.00000,482.11000,United Healthcare,Commercial,,753.30,,,,,,,753.30,811.89,percent of total billed charges,
LAB AB FL TITER MOG,3079969,CDM,302,RC,86256,CPT,,,facility,outpatient,,,837.00000,482.11000,United Healthcare,Commercial,,753.30,,,,,,,217.62,811.89,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,inpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE SMOOTH,3078060,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,inpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB FL TITER MUSCLE STRIATED,3078078,CDM,302,RC,86256,CPT,,,facility,outpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,inpatient,,,194.00000,111.74000,United Healthcare,Commercial,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
LAB AB FL TITER NMDA,3029527,CDM,302,RC,86256,CPT,,,facility,outpatient,,,194.00000,111.74000,United Healthcare,Commercial,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,inpatient,,,78.00000,44.93000,United Healthcare,Commercial,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB AB FL TITER NS,3113495,CDM,302,RC,86256,CPT,,,facility,outpatient,,,78.00000,44.93000,United Healthcare,Commercial,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FL TITER PARIETAL,3078045,CDM,302,RC,86256,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,inpatient,,,285.00000,164.16000,United Healthcare,Commercial,,256.50,,,,,,,256.50,276.45,percent of total billed charges,
LAB AB FL TITER PHOSPHOLPS A2 RECPT,3029139,CDM,302,RC,86256,CPT,,,facility,outpatient,,,285.00000,164.16000,United Healthcare,Commercial,,256.50,,,,,,,74.10,276.45,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,inpatient,,,190.00000,109.44000,United Healthcare,Commercial,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
LAB AB FL TITER PURKINJE,3078052,CDM,302,RC,86256,CPT,,,facility,outpatient,,,190.00000,109.44000,United Healthcare,Commercial,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,inpatient,,,100.00000,57.60000,United Healthcare,Commercial,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB AB FRANCISELLA TULARENSIS,3078094,CDM,302,RC,86668,CPT,,,facility,outpatient,,,100.00000,57.60000,United Healthcare,Commercial,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,inpatient,,,40.00000,23.04000,United Healthcare,Commercial,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB FTA CONFIRM,3106648,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,United Healthcare,Commercial,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB FUNGUS NOT SPECIFIED,3078110,CDM,302,RC,86671,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,inpatient,,,67.00000,38.59000,United Healthcare,Commercial,,60.30,,,,,,,60.30,64.99,percent of total billed charges,
LAB AB GIARDIA LAMBLIA,3078128,CDM,302,RC,86674,CPT,,,facility,outpatient,,,67.00000,38.59000,United Healthcare,Commercial,,60.30,,,,,,,17.42,64.99,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,inpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB HAEMOPHILUS INFLUENZA IGG,3078169,CDM,302,RC,86684,CPT,,,facility,outpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,inpatient,,,78.00000,44.93000,United Healthcare,Commercial,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB AB HELICOBACTER PYLORI,3078136,CDM,302,RC,86677,CPT,,,facility,outpatient,,,78.00000,44.93000,United Healthcare,Commercial,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB HELMINTH NONSPECIFIED,3078144,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS A,3116530,CDM,302,RC,86708,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,inpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB HEPATITIS A IGM,3078185,CDM,302,RC,86709,CPT,,,facility,outpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,inpatient,,,57.00000,32.83000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB HEPATITIS A NS,3118833,CDM,302,RC,86708,CPT,,,facility,outpatient,,,57.00000,32.83000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,inpatient,,,72.00000,41.47000,United Healthcare,Commercial,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE IGM,3078201,CDM,302,RC,86705,CPT,,,facility,outpatient,,,72.00000,41.47000,United Healthcare,Commercial,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS B CORE TOTAL,3078219,CDM,302,RC,86704,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB HEPATITIS B SURFACE,3078227,CDM,302,RC,86706,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,inpatient,,,59.00000,33.98000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HEPATITIS BE,3078235,CDM,302,RC,86707,CPT,,,facility,outpatient,,,59.00000,33.98000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,inpatient,,,72.00000,41.47000,United Healthcare,Commercial,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB HEPATITIS C,3078243,CDM,302,RC,86803,CPT,,,facility,outpatient,,,72.00000,41.47000,United Healthcare,Commercial,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,inpatient,,,239.00000,137.66000,United Healthcare,Commercial,,215.10,,,,,,,215.10,231.83,percent of total billed charges,
LAB AB HEPATITIS C CONFIRMATORY,3078250,CDM,302,RC,86804,CPT,,,facility,outpatient,,,239.00000,137.66000,United Healthcare,Commercial,,215.10,,,,,,,62.14,231.83,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,inpatient,,,85.00000,48.96000,United Healthcare,Commercial,,76.50,,,,,,,76.50,82.45,percent of total billed charges,
LAB AB HEPATITIS DELTA AGENT,3078268,CDM,302,RC,86692,CPT,,,facility,outpatient,,,85.00000,48.96000,United Healthcare,Commercial,,76.50,,,,,,,22.10,82.45,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,inpatient,,,44.00000,25.34000,United Healthcare,Commercial,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX NONSPECIFIC,3078276,CDM,302,RC,86694,CPT,,,facility,outpatient,,,44.00000,25.34000,United Healthcare,Commercial,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,inpatient,,,40.00000,23.04000,United Healthcare,Commercial,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1,3078284,CDM,302,RC,86695,CPT,,,facility,outpatient,,,40.00000,23.04000,United Healthcare,Commercial,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,inpatient,,,53.00000,30.53000,United Healthcare,Commercial,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 1 NS,3109444,CDM,302,RC,86695,CPT,,,facility,outpatient,,,53.00000,30.53000,United Healthcare,Commercial,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,inpatient,,,59.00000,33.98000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2,3078292,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,inpatient,,,59.00000,33.98000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB HERPES SIMPLEX TYPE 2 NS,3110830,CDM,302,RC,86696,CPT,,,facility,outpatient,,,59.00000,33.98000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,inpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB HISTOPLASMA COMP FIXATION,3026051,CDM,302,RC,86698,CPT,,,facility,outpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,inpatient,,,68.00000,39.17000,United Healthcare,Commercial,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB HISTOPLASMA IMMUNODIFFUSION,3078326,CDM,302,RC,86698,CPT,,,facility,outpatient,,,68.00000,39.17000,United Healthcare,Commercial,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,inpatient,,,76.00000,43.78000,United Healthcare,Commercial,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB AB HIV-1,3078334,CDM,302,RC,86701,CPT,,,facility,outpatient,,,76.00000,43.78000,United Healthcare,Commercial,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,inpatient,,,42.00000,24.19000,United Healthcare,Commercial,,37.80,,,,,,,37.80,40.74,percent of total billed charges,
LAB AB HIV-1&HIV-2 RESULT SGL,3078342,CDM,302,RC,86703,CPT,,,facility,outpatient,,,42.00000,24.19000,United Healthcare,Commercial,,37.80,,,,,,,10.92,40.74,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,inpatient,,,87.00000,50.11000,United Healthcare,Commercial,,78.30,,,,,,,78.30,84.39,percent of total billed charges,
LAB AB HIV-2,3078359,CDM,302,RC,86702,CPT,,,facility,outpatient,,,87.00000,50.11000,United Healthcare,Commercial,,78.30,,,,,,,22.62,84.39,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,inpatient,,,503.00000,289.73000,United Healthcare,Commercial,,452.70,,,,,,,452.70,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM DONOR NS,3123247,CDM,302,RC,86689,CPT,,,facility,outpatient,,,503.00000,289.73000,United Healthcare,Commercial,,452.70,,,,,,,130.78,487.91,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,inpatient,,,472.00000,271.87000,United Healthcare,Commercial,,424.80,,,,,,,424.80,457.84,percent of total billed charges,
LAB AB HTLV/HIV CONFIRM SRM/PLASMA,3125309,CDM,302,RC,86689,CPT,,,facility,outpatient,,,472.00000,271.87000,United Healthcare,Commercial,,424.80,,,,,,,122.72,457.84,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,inpatient,,,28.00000,16.13000,United Healthcare,Commercial,,25.20,,,,,,,25.20,27.16,percent of total billed charges,
LAB AB HTLV-I,3078425,CDM,302,RC,86687,CPT,,,facility,outpatient,,,28.00000,16.13000,United Healthcare,Commercial,,25.20,,,,,,,7.28,27.16,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,inpatient,,,236.00000,135.94000,United Healthcare,Commercial,,212.40,,,,,,,212.40,228.92,percent of total billed charges,
LAB AB ID IG PLATELET ASSOCIATED,3111671,CDM,302,RC,86023,CPT,,,facility,outpatient,,,236.00000,135.94000,United Healthcare,Commercial,,212.40,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE,3078748,CDM,302,RC,86021,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,inpatient,,,54.00000,31.10000,United Healthcare,Commercial,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB AB ID LEUKOCYTE NS,3078755,CDM,302,RC,86021,CPT,,,facility,outpatient,,,54.00000,31.10000,United Healthcare,Commercial,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,inpatient,,,238.00000,137.09000,United Healthcare,Commercial,,214.20,,,,,,,214.20,230.86,percent of total billed charges,
LAB AB ID PLATELET BLOOD PRODUCT,3124930,CDM,302,RC,86022,CPT,,,facility,outpatient,,,238.00000,137.09000,United Healthcare,Commercial,,214.20,,,,,,,61.88,230.86,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,inpatient,,,236.00000,135.94000,United Healthcare,Commercial,,212.40,,,,,,,212.40,228.92,percent of total billed charges,
LAB AB ID PLATELET IGG FLOW CYTO,3904166,CDM,302,RC,86022,CPT,,,facility,outpatient,,,236.00000,135.94000,United Healthcare,Commercial,,212.40,,,,,,,61.36,228.92,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,inpatient,,,145.00000,83.52000,United Healthcare,Commercial,,130.50,,,,,,,130.50,140.65,percent of total billed charges,
LAB AB ID PLATELET PATIENT SERUM NS,3104239,CDM,302,RC,86022,CPT,,,facility,outpatient,,,145.00000,83.52000,United Healthcare,Commercial,,130.50,,,,,,,37.70,140.65,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,inpatient,,,68.00000,39.17000,United Healthcare,Commercial,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB INFLUENZA A,3078631,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,United Healthcare,Commercial,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,inpatient,,,68.00000,39.17000,United Healthcare,Commercial,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB AB INFLUENZA B,3078656,CDM,302,RC,86710,CPT,,,facility,outpatient,,,68.00000,39.17000,United Healthcare,Commercial,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,inpatient,,,66.00000,38.02000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB INSULIN,3078672,CDM,302,RC,86337,CPT,,,facility,outpatient,,,66.00000,38.02000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,inpatient,,,59.00000,33.98000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AB INTRINSIC FACTOR,3078680,CDM,302,RC,86340,CPT,,,facility,outpatient,,,59.00000,33.98000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,inpatient,,,158.00000,91.01000,United Healthcare,Commercial,,142.20,,,,,,,142.20,153.26,percent of total billed charges,
LAB AB ISLET ANTIGEN 2 AUTOAB,3904471,CDM,302,RC,86341,CPT,,,facility,outpatient,,,158.00000,91.01000,United Healthcare,Commercial,,142.20,,,,,,,41.08,153.26,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,inpatient,,,71.00000,40.90000,United Healthcare,Commercial,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB ISLET CELL NS,3078698,CDM,302,RC,86341,CPT,,,facility,outpatient,,,71.00000,40.90000,United Healthcare,Commercial,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,inpatient,,,144.00000,82.94000,United Healthcare,Commercial,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
LAB AB ISLET ENCEPHALITIS,3122496,CDM,302,RC,86341,CPT,,,facility,outpatient,,,144.00000,82.94000,United Healthcare,Commercial,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,inpatient,,,1448.00000,834.05000,United Healthcare,Commercial,,1303.20,,,,,,,1303.20,1404.56,percent of total billed charges,
LAB AB JOHN CUNNINGHAM VIRUS,3117785,CDM,302,RC,86711,CPT,,,facility,outpatient,,,1448.00000,834.05000,United Healthcare,Commercial,,1303.20,,,,,,,376.48,1404.56,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,inpatient,,,72.00000,41.47000,United Healthcare,Commercial,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB LEGIONELLA,3078714,CDM,302,RC,86713,CPT,,,facility,outpatient,,,72.00000,41.47000,United Healthcare,Commercial,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,inpatient,,,102.00000,58.75000,United Healthcare,Commercial,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA IGM DOT BLOT,3126331,CDM,302,RC,86720,CPT,,,facility,outpatient,,,102.00000,58.75000,United Healthcare,Commercial,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,inpatient,,,154.00000,88.70000,United Healthcare,Commercial,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB AB LEPTOSPIRA TITER,3112026,CDM,302,RC,86720,CPT,,,facility,outpatient,,,154.00000,88.70000,United Healthcare,Commercial,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,United Healthcare,Commercial,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB LISTERIA,3123437,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,United Healthcare,Commercial,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,inpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB LYME DISEASE CONFIRMATORY,3106036,CDM,302,RC,86617,CPT,,,facility,outpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,inpatient,,,66.00000,38.02000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB LYME DISEASE IGG IGM,3110921,CDM,302,RC,86618,CPT,,,facility,outpatient,,,66.00000,38.02000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,United Healthcare,Commercial,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB M FAENI,3123395,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,United Healthcare,Commercial,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,inpatient,,,44.00000,25.34000,United Healthcare,Commercial,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB MICROSOMAL EA,3078854,CDM,302,RC,86376,CPT,,,facility,outpatient,,,44.00000,25.34000,United Healthcare,Commercial,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,inpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB MICROSOMAL LIVER-KIDNEY EA,3078862,CDM,302,RC,86376,CPT,,,facility,outpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MICROSOMAL THYROID EA NS,3109840,CDM,302,RC,86376,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,inpatient,,,150.00000,86.40000,United Healthcare,Commercial,,135.00,,,,,,,135.00,145.50,percent of total billed charges,
LAB AB MITOCHONDRIA EA,3116464,CDM,302,RC,86381,CPT,,,facility,outpatient,,,150.00000,86.40000,United Healthcare,Commercial,,135.00,,,,,,,39.00,145.50,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,inpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB AB MUMPS,3078888,CDM,302,RC,86735,CPT,,,facility,outpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,inpatient,,,56.00000,32.26000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB MUMPS IGG,3078896,CDM,302,RC,86735,CPT,,,facility,outpatient,,,56.00000,32.26000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,inpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB MUMPS IGM,3078904,CDM,302,RC,86735,CPT,,,facility,outpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGG NS,3103595,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB AB MYCOPLASMA IGM,3078938,CDM,302,RC,86738,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,inpatient,,,66.00000,38.02000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB AB PARAINFLUENZA,3111093,CDM,302,RC,86790,CPT,,,facility,outpatient,,,66.00000,38.02000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,inpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGG,3079092,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,inpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB AB PARVOVIRUS B19 IGM,3079100,CDM,302,RC,86747,CPT,,,facility,outpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,inpatient,,,60.00000,34.56000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB PEPTIDE CYCLIC CITRUL,3106176,CDM,302,RC,86200,CPT,,,facility,outpatient,,,60.00000,34.56000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,inpatient,,,58.00000,33.41000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB AB PROTOZOA BABESIA,3108768,CDM,302,RC,86753,CPT,,,facility,outpatient,,,58.00000,33.41000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,inpatient,,,71.00000,40.90000,United Healthcare,Commercial,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB RICKETTSIA,3079225,CDM,302,RC,86757,CPT,,,facility,outpatient,,,71.00000,40.90000,United Healthcare,Commercial,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,inpatient,,,72.00000,41.47000,United Healthcare,Commercial,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB RSV,3079258,CDM,302,RC,86756,CPT,,,facility,outpatient,,,72.00000,41.47000,United Healthcare,Commercial,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,inpatient,,,56.00000,32.26000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBELLA IGG,3079274,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,inpatient,,,56.00000,32.26000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBELLA IGM NS,3079282,CDM,302,RC,86762,CPT,,,facility,outpatient,,,56.00000,32.26000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,inpatient,,,60.00000,34.56000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB RUBEOLA IGG,3079308,CDM,302,RC,86765,CPT,,,facility,outpatient,,,60.00000,34.56000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,inpatient,,,56.00000,32.26000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB AB RUBEOLA IGM,3079316,CDM,302,RC,86765,CPT,,,facility,outpatient,,,56.00000,32.26000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,inpatient,,,39.00000,22.46000,United Healthcare,Commercial,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB RUBEOLA TITER NS,3079324,CDM,302,RC,86765,CPT,,,facility,outpatient,,,39.00000,22.46000,United Healthcare,Commercial,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,United Healthcare,Commercial,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB S VIRIDIS,3123403,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,United Healthcare,Commercial,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,inpatient,,,73.00000,42.05000,United Healthcare,Commercial,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB AB SALMONELLA,3079340,CDM,302,RC,86768,CPT,,,facility,outpatient,,,73.00000,42.05000,United Healthcare,Commercial,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,inpatient,,,127.00000,73.15000,United Healthcare,Commercial,,114.30,,,,,,,114.30,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19,3121910,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,United Healthcare,Commercial,,114.30,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,inpatient,,,127.00000,73.15000,United Healthcare,Commercial,,114.30,,,,,,,114.30,123.19,percent of total billed charges,
LAB AB SARS-COV-2 COVID-19 NS,3121928,CDM,302,RC,86769,CPT,,,facility,outpatient,,,127.00000,73.15000,United Healthcare,Commercial,,114.30,,,,,,,33.02,123.19,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,inpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB SCHISTOSOMA SERUM,3123460,CDM,302,RC,86682,CPT,,,facility,outpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,inpatient,,,372.00000,214.27000,United Healthcare,Commercial,,334.80,,,,,,,334.80,360.84,percent of total billed charges,
LAB AB STREP PNEU SEROT IA,3124914,CDM,302,RC,86581,CPT,,,facility,outpatient,,,372.00000,214.27000,United Healthcare,Commercial,,334.80,,,,,,,96.72,360.84,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,inpatient,,,69.00000,39.74000,United Healthcare,Commercial,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB AB STRONGYLOIDES,3111119,CDM,302,RC,86682,CPT,,,facility,outpatient,,,69.00000,39.74000,United Healthcare,Commercial,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,United Healthcare,Commercial,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB T CANDIDUS,3123411,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,United Healthcare,Commercial,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,inpatient,,,153.00000,88.13000,United Healthcare,Commercial,,137.70,,,,,,,137.70,148.41,percent of total billed charges,
LAB AB T VULGARIS,3123429,CDM,302,RC,86609,CPT,,,facility,outpatient,,,153.00000,88.13000,United Healthcare,Commercial,,137.70,,,,,,,39.78,148.41,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,inpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TETANUS,3079431,CDM,302,RC,86774,CPT,,,facility,outpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,inpatient,,,57.00000,32.83000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN,3079449,CDM,302,RC,86800,CPT,,,facility,outpatient,,,57.00000,32.83000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,inpatient,,,96.00000,55.30000,United Healthcare,Commercial,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
LAB AB THYROGLOBULIN NS,3110137,CDM,302,RC,86800,CPT,,,facility,outpatient,,,96.00000,55.30000,United Healthcare,Commercial,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,inpatient,,,44.00000,25.34000,United Healthcare,Commercial,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
LAB AB TOXOPLASMA,3079456,CDM,302,RC,86777,CPT,,,facility,outpatient,,,44.00000,25.34000,United Healthcare,Commercial,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,inpatient,,,60.00000,34.56000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG,3111077,CDM,302,RC,86777,CPT,,,facility,outpatient,,,60.00000,34.56000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,inpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGG NS,3079464,CDM,302,RC,86777,CPT,,,facility,outpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,inpatient,,,60.00000,34.56000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM,3111069,CDM,302,RC,86778,CPT,,,facility,outpatient,,,60.00000,34.56000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,inpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB AB TOXOPLASMA IGM NS,3079472,CDM,302,RC,86778,CPT,,,facility,outpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,inpatient,,,74.00000,42.62000,United Healthcare,Commercial,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB AB TREPONEMA PALLIDUM CONF,3119666,CDM,302,RC,86780,CPT,,,facility,outpatient,,,74.00000,42.62000,United Healthcare,Commercial,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,inpatient,,,69.00000,39.74000,United Healthcare,Commercial,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB AB TRICHINELLA,3079498,CDM,302,RC,86784,CPT,,,facility,outpatient,,,69.00000,39.74000,United Healthcare,Commercial,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,United Healthcare,Commercial,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG,3079514,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,United Healthcare,Commercial,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,inpatient,,,53.00000,30.53000,United Healthcare,Commercial,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGG NS,3109667,CDM,302,RC,86787,CPT,,,facility,outpatient,,,53.00000,30.53000,United Healthcare,Commercial,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,United Healthcare,Commercial,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM,3079522,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,United Healthcare,Commercial,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,inpatient,,,39.00000,22.46000,United Healthcare,Commercial,,35.10,,,,,,,35.10,37.83,percent of total billed charges,
LAB AB VARICELLA-ZOSTER IGM NS,3109659,CDM,302,RC,86787,CPT,,,facility,outpatient,,,39.00000,22.46000,United Healthcare,Commercial,,35.10,,,,,,,10.14,37.83,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,inpatient,,,70.00000,40.32000,United Healthcare,Commercial,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB AB VIRUS DENGUE,3904117,CDM,302,RC,86790,CPT,,,facility,outpatient,,,70.00000,40.32000,United Healthcare,Commercial,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,inpatient,,,71.00000,40.90000,United Healthcare,Commercial,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB AB VIRUS HEPATITIS E IGG,3120391,CDM,302,RC,86790,CPT,,,facility,outpatient,,,71.00000,40.90000,United Healthcare,Commercial,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,inpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB AB VIRUS NONSPECIFIED,3079530,CDM,302,RC,86790,CPT,,,facility,outpatient,,,65.00000,37.44000,United Healthcare,Commercial,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,inpatient,,,325.00000,187.20000,United Healthcare,Commercial,,292.50,,,,,,,292.50,315.25,percent of total billed charges,
LAB AB VIRUS ZIKA IGM,3119393,CDM,302,RC,86794,CPT,,,facility,outpatient,,,325.00000,187.20000,United Healthcare,Commercial,,292.50,,,,,,,84.50,315.25,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,inpatient,,,72.00000,41.47000,United Healthcare,Commercial,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS IGM NS,3107489,CDM,302,RC,86788,CPT,,,facility,outpatient,,,72.00000,41.47000,United Healthcare,Commercial,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,inpatient,,,72.00000,41.47000,United Healthcare,Commercial,,64.80,,,,,,,64.80,69.84,percent of total billed charges,
LAB AB WEST NILE VIRUS NS,3107497,CDM,302,RC,86789,CPT,,,facility,outpatient,,,72.00000,41.47000,United Healthcare,Commercial,,64.80,,,,,,,18.72,69.84,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,inpatient,,,76.00000,43.78000,United Healthcare,Commercial,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB AB YERSINIA,3106994,CDM,302,RC,86793,CPT,,,facility,outpatient,,,76.00000,43.78000,United Healthcare,Commercial,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,inpatient,,,240.00000,138.24000,United Healthcare,Commercial,,216.00,,,,,,,216.00,232.80,percent of total billed charges,
LAB AB ZINC TRANSPORTER,3119849,CDM,302,RC,86341,CPT,,,facility,outpatient,,,240.00000,138.24000,United Healthcare,Commercial,,216.00,,,,,,,62.40,232.80,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,inpatient,,,93.00000,53.57000,United Healthcare,Commercial,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
LAB AG CELL MONONUC QN EA AG,3111655,CDM,302,RC,86356,CPT,,,facility,outpatient,,,93.00000,53.57000,United Healthcare,Commercial,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,inpatient,,,59.00000,33.98000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER,3079076,CDM,302,RC,86406,CPT,,,facility,outpatient,,,59.00000,33.98000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,inpatient,,,81.00000,46.66000,United Healthcare,Commercial,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB AGG PARTICLE TITER STREPTOZYME,3111416,CDM,302,RC,86406,CPT,,,facility,outpatient,,,81.00000,46.66000,United Healthcare,Commercial,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,inpatient,,,58.00000,33.41000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB AGGLUTININ COLD TITER,3077294,CDM,302,RC,86157,CPT,,,facility,outpatient,,,58.00000,33.41000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,inpatient,,,21.00000,12.10000,United Healthcare,Commercial,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB AGGLUTININS FEBRILE AG EA,3076940,CDM,302,RC,86000,CPT,,,facility,outpatient,,,21.00000,12.10000,United Healthcare,Commercial,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,inpatient,,,56.00000,32.26000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA,3119062,CDM,302,RC,86003,CPT,,,facility,outpatient,,,56.00000,32.26000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN CRUDE EA NS,3119070,CDM,302,RC,86003,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,inpatient,,,64.00000,36.86000,United Healthcare,Commercial,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA,3119377,CDM,302,RC,86008,CPT,,,facility,outpatient,,,64.00000,36.86000,United Healthcare,Commercial,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,inpatient,,,80.00000,46.08000,United Healthcare,Commercial,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB ALLG IGE QN/SEMI QN EA NS,3123148,CDM,302,RC,86008,CPT,,,facility,outpatient,,,80.00000,46.08000,United Healthcare,Commercial,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,inpatient,,,109.00000,62.78000,United Healthcare,Commercial,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB ALLG IGG QN/SEMI QN EA,3106440,CDM,302,RC,86001,CPT,,,facility,outpatient,,,109.00000,62.78000,United Healthcare,Commercial,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,inpatient,,,59.00000,33.98000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB ANA TITER,3076981,CDM,302,RC,86039,CPT,,,facility,outpatient,,,59.00000,33.98000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,inpatient,,,115.00000,66.24000,United Healthcare,Commercial,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB ANA TITER NS,3109352,CDM,302,RC,86039,CPT,,,facility,outpatient,,,115.00000,66.24000,United Healthcare,Commercial,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,inpatient,,,57.00000,32.83000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB ANTISTREPTOLYSIN O TITER,3077005,CDM,302,RC,86060,CPT,,,facility,outpatient,,,57.00000,32.83000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,inpatient,,,118.00000,67.97000,United Healthcare,Commercial,,106.20,,,,,,,106.20,114.46,percent of total billed charges,
LAB AQUAPORIN 4 AB FLOW CYTOMETRY,3122793,CDM,302,RC,86053,CPT,,,facility,outpatient,,,118.00000,67.97000,United Healthcare,Commercial,,106.20,,,,,,,30.68,114.46,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,inpatient,,,268.00000,154.37000,United Healthcare,Commercial,,241.20,,,,,,,241.20,259.96,percent of total billed charges,
LAB AQUAPORIN AB,3122777,CDM,302,RC,86051,CPT,,,facility,outpatient,,,268.00000,154.37000,United Healthcare,Commercial,,241.20,,,,,,,69.68,259.96,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,inpatient,,,114.00000,65.66000,United Healthcare,Commercial,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL,3095056,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,United Healthcare,Commercial,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,inpatient,,,114.00000,65.66000,United Healthcare,Commercial,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB B CELLS CD19 COUNT TOTAL NS,3115193,CDM,302,RC,86355,CPT,,,facility,outpatient,,,114.00000,65.66000,United Healthcare,Commercial,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,inpatient,,,78.00000,44.93000,United Healthcare,Commercial,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA B-27 AG SINGLE,3078375,CDM,302,RC,86812,CPT,,,facility,outpatient,,,78.00000,44.93000,United Healthcare,Commercial,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,inpatient,,,91.00000,52.42000,United Healthcare,Commercial,,81.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB BLOOD TYPE HLA DR/DQ AG SGL,3078417,CDM,302,RC,86816,CPT,,,facility,outpatient,,,91.00000,52.42000,United Healthcare,Commercial,,81.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,inpatient,,,66.00000,38.02000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC,3077468,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,inpatient,,,66.00000,38.02000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C1 ESTER,3077377,CDM,302,RC,86161,CPT,,,facility,outpatient,,,66.00000,38.02000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,inpatient,,,300.00000,172.80000,United Healthcare,Commercial,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC C3NEF,3123577,CDM,302,RC,86161,CPT,,,facility,outpatient,,,300.00000,172.80000,United Healthcare,Commercial,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,inpatient,,,185.00000,106.56000,United Healthcare,Commercial,,166.50,,,,,,,166.50,179.45,percent of total billed charges,
LAB COMPLEMENT ACT FUNC NS,3120714,CDM,302,RC,86161,CPT,,,facility,outpatient,,,185.00000,106.56000,United Healthcare,Commercial,,166.50,,,,,,,48.10,179.45,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,United Healthcare,Commercial,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1 ESTER NONFUNC,3077443,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,United Healthcare,Commercial,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,inpatient,,,76.00000,43.78000,United Healthcare,Commercial,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB COMPLEMENT AG C1Q COMP EA,3077385,CDM,302,RC,86160,CPT,,,facility,outpatient,,,76.00000,43.78000,United Healthcare,Commercial,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,United Healthcare,Commercial,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C2 COMP EA,3077393,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,United Healthcare,Commercial,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,United Healthcare,Commercial,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C3 COMP EA,3077401,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,United Healthcare,Commercial,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,inpatient,,,53.00000,30.53000,United Healthcare,Commercial,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB COMPLEMENT AG C4 COMP EA,3077419,CDM,302,RC,86160,CPT,,,facility,outpatient,,,53.00000,30.53000,United Healthcare,Commercial,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,inpatient,,,77.00000,44.35000,United Healthcare,Commercial,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB COMPLEMENT AG C5 COMP EA,3077427,CDM,302,RC,86160,CPT,,,facility,outpatient,,,77.00000,44.35000,United Healthcare,Commercial,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,inpatient,,,36.00000,20.74000,United Healthcare,Commercial,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB COMPLEMENT AG C6 COMP EA,3104262,CDM,302,RC,86160,CPT,,,facility,outpatient,,,36.00000,20.74000,United Healthcare,Commercial,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,inpatient,,,222.00000,127.87000,United Healthcare,Commercial,,199.80,,,,,,,199.80,215.34,percent of total billed charges,
LAB COMPLEMENT AG COMP EA NS,3117611,CDM,302,RC,86160,CPT,,,facility,outpatient,,,222.00000,127.87000,United Healthcare,Commercial,,199.80,,,,,,,57.72,215.34,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,inpatient,,,292.00000,168.19000,United Healthcare,Commercial,,262.80,,,,,,,262.80,283.24,percent of total billed charges,
LAB COMPLEMENT AG SC5B-9 COMP EA,3123320,CDM,302,RC,86160,CPT,,,facility,outpatient,,,292.00000,168.19000,United Healthcare,Commercial,,262.80,,,,,,,75.92,283.24,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,inpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB COMPLEMENT TOTAL HEMOLYTIC,3077484,CDM,302,RC,86162,CPT,,,facility,outpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,inpatient,,,125.00000,72.00000,United Healthcare,Commercial,,112.50,,,,,,,112.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA,3902038,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,United Healthcare,Commercial,,112.50,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,inpatient,,,125.00000,72.00000,United Healthcare,Commercial,,112.50,,,,,,,112.50,121.25,percent of total billed charges,
LAB COOMBS DIR ANTISERUM EA NS,3104403,CDM,302,RC,86880,CPT,,,facility,outpatient,,,125.00000,72.00000,United Healthcare,Commercial,,112.50,,,,,,,32.50,121.25,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,inpatient,,,359.00000,206.78000,United Healthcare,Commercial,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB COOMBS INDIRECT TITER AB EA NS,3077492,CDM,302,RC,86886,CPT,,,facility,outpatient,,,359.00000,206.78000,United Healthcare,Commercial,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,inpatient,,,111.00000,63.94000,United Healthcare,Commercial,,99.90,,,,,,,99.90,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4 ABSOLUTE,3095122,CDM,302,RC,86361,CPT,,,facility,outpatient,,,111.00000,63.94000,United Healthcare,Commercial,,99.90,,,,,,,28.86,107.67,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,inpatient,,,141.00000,81.22000,United Healthcare,Commercial,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO,3079407,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,United Healthcare,Commercial,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,inpatient,,,141.00000,81.22000,United Healthcare,Commercial,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB COUNT CELLS T CD4&CD8 RATIO NS,3113552,CDM,302,RC,86360,CPT,,,facility,outpatient,,,141.00000,81.22000,United Healthcare,Commercial,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,inpatient,,,114.00000,65.66000,United Healthcare,Commercial,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK,3095049,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,United Healthcare,Commercial,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,inpatient,,,114.00000,65.66000,United Healthcare,Commercial,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS CD56 NK NS,3112075,CDM,302,RC,86357,CPT,,,facility,outpatient,,,114.00000,65.66000,United Healthcare,Commercial,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,inpatient,,,114.00000,65.66000,United Healthcare,Commercial,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T,3079415,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,United Healthcare,Commercial,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,inpatient,,,114.00000,65.66000,United Healthcare,Commercial,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB COUNT TOTAL CELLS T NS,3113545,CDM,302,RC,86359,CPT,,,facility,outpatient,,,114.00000,65.66000,United Healthcare,Commercial,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,inpatient,,,78.00000,44.93000,United Healthcare,Commercial,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB DET AB BLASTOMYCES NS,3077054,CDM,302,RC,86612,CPT,,,facility,outpatient,,,78.00000,44.93000,United Healthcare,Commercial,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,inpatient,,,359.00000,206.78000,United Healthcare,Commercial,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA,3079183,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,United Healthcare,Commercial,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,inpatient,,,359.00000,206.78000,United Healthcare,Commercial,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB ELUTION AB RBC EA NS,3104379,CDM,302,RC,86860,CPT,,,facility,outpatient,,,359.00000,206.78000,United Healthcare,Commercial,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,inpatient,,,70.00000,40.32000,United Healthcare,Commercial,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QL,3079209,CDM,302,RC,86430,CPT,,,facility,outpatient,,,70.00000,40.32000,United Healthcare,Commercial,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,inpatient,,,18.00000,10.37000,United Healthcare,Commercial,,16.20,,,,,,,16.20,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN,3079217,CDM,302,RC,86431,CPT,,,facility,outpatient,,,18.00000,10.37000,United Healthcare,Commercial,,16.20,,,,,,,4.68,17.46,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB FACTOR RHEUMATOID QN NS,3109758,CDM,302,RC,86431,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,inpatient,,,408.00000,235.01000,United Healthcare,Commercial,,367.20,,,,,,,367.20,395.76,percent of total billed charges,
LAB FNCT CELL W STIM&DET BIOMARK,3111648,CDM,302,RC,86352,CPT,,,facility,outpatient,,,408.00000,235.01000,United Healthcare,Commercial,,367.20,,,,,,,106.08,395.76,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,inpatient,,,102.00000,58.75000,United Healthcare,Commercial,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB HANTAVIRUS,3119575,CDM,302,RC,86790,CPT,,,facility,outpatient,,,102.00000,58.75000,United Healthcare,Commercial,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,inpatient,,,330.00000,190.08000,United Healthcare,Commercial,,297.00,,,,,,,297.00,320.10,percent of total billed charges,
LAB HLA CLASS I&II AB QL NS,3121365,CDM,302,RC,86828,CPT,,,facility,outpatient,,,330.00000,190.08000,United Healthcare,Commercial,,297.00,,,,,,,85.80,320.10,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB IMDF,3078565,CDM,302,RC,86329,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,inpatient,,,56.00000,32.26000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB IMDF GEL AB/AG QL,3078573,CDM,302,RC,86331,CPT,,,facility,outpatient,,,56.00000,32.26000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,inpatient,,,136.00000,78.34000,United Healthcare,Commercial,,122.40,,,,,,,122.40,131.92,percent of total billed charges,
LAB IMM AB QL/SEMI QN SGL COVID-19,3028727,CDM,302,RC,86328,CPT,,,facility,outpatient,,,136.00000,78.34000,United Healthcare,Commercial,,122.40,,,,,,,35.36,131.92,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,inpatient,,,83.00000,47.81000,United Healthcare,Commercial,,74.70,,,,,,,74.70,80.51,percent of total billed charges,
LAB IMM AB QN CREUTZFELDT-JAKOB,3113149,CDM,302,RC,86317,CPT,,,facility,outpatient,,,83.00000,47.81000,United Healthcare,Commercial,,74.70,,,,,,,21.58,80.51,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,inpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AB QN HAEMOPHILUS INFLU B,3904430,CDM,302,RC,86317,CPT,,,facility,outpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,inpatient,,,142.00000,81.79000,United Healthcare,Commercial,,127.80,,,,,,,127.80,137.74,percent of total billed charges,
LAB IMM AB QN NS,3105467,CDM,302,RC,86317,CPT,,,facility,outpatient,,,142.00000,81.79000,United Healthcare,Commercial,,127.80,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,inpatient,,,51.00000,29.38000,United Healthcare,Commercial,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB IMM AB QN PNEUMOCOCCAL,3112182,CDM,302,RC,86317,CPT,,,facility,outpatient,,,51.00000,29.38000,United Healthcare,Commercial,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,inpatient,,,70.00000,40.32000,United Healthcare,Commercial,,63.00,,,,,,,63.00,67.90,percent of total billed charges,
LAB IMM ACHR BINDING QN,3103850,CDM,302,RC,86041,CPT,,,facility,outpatient,,,70.00000,40.32000,United Healthcare,Commercial,,63.00,,,,,,,18.20,67.90,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,inpatient,,,99.00000,57.02000,United Healthcare,Commercial,,89.10,,,,,,,89.10,96.03,percent of total billed charges,
LAB IMM ACHR BLOCKING QN,3108735,CDM,302,RC,86042,CPT,,,facility,outpatient,,,99.00000,57.02000,United Healthcare,Commercial,,89.10,,,,,,,25.74,96.03,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,inpatient,,,78.00000,44.93000,United Healthcare,Commercial,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB IMM ACHR MODULATING QN,3110590,CDM,302,RC,86043,CPT,,,facility,outpatient,,,78.00000,44.93000,United Healthcare,Commercial,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,inpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 125,3078508,CDM,302,RC,86304,CPT,,,facility,outpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,inpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 15-3,3078516,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,inpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 19-9,3078524,CDM,302,RC,86301,CPT,,,facility,outpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,inpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB IMM AG TUMOR CA 27-29,3078532,CDM,302,RC,86300,CPT,,,facility,outpatient,,,63.00000,36.29000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,inpatient,,,75.00000,43.20000,United Healthcare,Commercial,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB IMM AG TUMOR OTHER QN NS,3078540,CDM,302,RC,86316,CPT,,,facility,outpatient,,,75.00000,43.20000,United Healthcare,Commercial,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,inpatient,,,37.00000,21.31000,United Healthcare,Commercial,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGA QL,3073780,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,United Healthcare,Commercial,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,inpatient,,,37.00000,21.31000,United Healthcare,Commercial,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB IMM MS GLIADIN IGG QL,3073798,CDM,302,RC,86258,CPT,,,facility,outpatient,,,37.00000,21.31000,United Healthcare,Commercial,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,inpatient,,,59.00000,33.98000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS GLIADIN QL,3113479,CDM,302,RC,86258,CPT,,,facility,outpatient,,,59.00000,33.98000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,inpatient,,,35.00000,20.16000,United Healthcare,Commercial,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE NS,3072360,CDM,302,RC,86364,CPT,,,facility,outpatient,,,35.00000,20.16000,United Healthcare,Commercial,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,inpatient,,,59.00000,33.98000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB IMM MS TRANSGLUTAMINASE QL,3113487,CDM,302,RC,86364,CPT,,,facility,outpatient,,,59.00000,33.98000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,inpatient,,,56.00000,32.26000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB IMM MUSK QN,3110301,CDM,302,RC,86366,CPT,,,facility,outpatient,,,56.00000,32.26000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,inpatient,,,74.00000,42.62000,United Healthcare,Commercial,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB IMMUNE COMPLEX C1Q BINDING,3078466,CDM,302,RC,86332,CPT,,,facility,outpatient,,,74.00000,42.62000,United Healthcare,Commercial,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,inpatient,,,90.00000,51.84000,United Healthcare,Commercial,,81.00,,,,,,,81.00,87.30,percent of total billed charges,
LAB IMMUNOELECTROPHORESIS SERUM,3078599,CDM,302,RC,86320,CPT,,,facility,outpatient,,,90.00000,51.84000,United Healthcare,Commercial,,81.00,,,,,,,23.40,87.30,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,inpatient,,,68.00000,39.17000,United Healthcare,Commercial,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP CRYOGLOBULIN,3119534,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,United Healthcare,Commercial,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,inpatient,,,142.00000,81.79000,United Healthcare,Commercial,,127.80,,,,,,,127.80,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP IGD IGE,3029626,CDM,302,RC,86334,CPT,,,facility,outpatient,,,142.00000,81.79000,United Healthcare,Commercial,,127.80,,,,,,,36.92,137.74,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,inpatient,,,68.00000,39.17000,United Healthcare,Commercial,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM,3106721,CDM,302,RC,86334,CPT,,,facility,outpatient,,,68.00000,39.17000,United Healthcare,Commercial,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,inpatient,,,74.00000,42.62000,United Healthcare,Commercial,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP SERUM NS,3029709,CDM,302,RC,86334,CPT,,,facility,outpatient,,,74.00000,42.62000,United Healthcare,Commercial,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,inpatient,,,89.00000,51.26000,United Healthcare,Commercial,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP TRANSFRN BETA,3029923,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,United Healthcare,Commercial,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,inpatient,,,89.00000,51.26000,United Healthcare,Commercial,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB IMMUNOFIXATION EP URINE/CSF,3078615,CDM,302,RC,86335,CPT,,,facility,outpatient,,,89.00000,51.26000,United Healthcare,Commercial,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,inpatient,,,57.00000,32.83000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB INHIBIN A,3104619,CDM,302,RC,86336,CPT,,,facility,outpatient,,,57.00000,32.83000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,inpatient,,,77.00000,44.35000,United Healthcare,Commercial,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB INHIBIN A NS,3078664,CDM,302,RC,86336,CPT,,,facility,outpatient,,,77.00000,44.35000,United Healthcare,Commercial,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,inpatient,,,64.00000,36.86000,United Healthcare,Commercial,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB LEUKOCYTE HISTAMINE RELEASE,3020922,CDM,302,RC,86343,CPT,,,facility,outpatient,,,64.00000,36.86000,United Healthcare,Commercial,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,inpatient,,,69.00000,39.74000,United Healthcare,Commercial,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL,3078953,CDM,302,RC,86382,CPT,,,facility,outpatient,,,69.00000,39.74000,United Healthcare,Commercial,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,inpatient,,,1178.00000,678.53000,United Healthcare,Commercial,,1060.20,,,,,,,1060.20,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL IFNB-1,3080082,CDM,302,RC,86382,CPT,,,facility,outpatient,,,1178.00000,678.53000,United Healthcare,Commercial,,1060.20,,,,,,,306.28,1142.66,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,inpatient,,,127.00000,73.15000,United Healthcare,Commercial,,114.30,,,,,,,114.30,123.19,percent of total billed charges,
LAB NEUTRALIZATION VIRAL RABIES,3102852,CDM,302,RC,86382,CPT,,,facility,outpatient,,,127.00000,73.15000,United Healthcare,Commercial,,114.30,,,,,,,33.02,123.19,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,inpatient,,,277.00000,159.55000,United Healthcare,Commercial,,249.30,,,,,,,249.30,268.69,percent of total billed charges,
LAB PRETREAT SERUM ABSORP NS,3104494,CDM,302,RC,86978,CPT,,,facility,outpatient,,,277.00000,159.55000,United Healthcare,Commercial,,249.30,,,,,,,72.02,268.69,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,inpatient,,,940.00000,541.44000,United Healthcare,Commercial,,846.00,,,,,,,846.00,911.80,percent of total billed charges,
LAB PRETREAT SERUM INCUB W DRUGS,3113727,CDM,302,RC,86975,CPT,,,facility,outpatient,,,940.00000,541.44000,United Healthcare,Commercial,,846.00,,,,,,,244.40,911.80,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,inpatient,,,97.00000,55.87000,United Healthcare,Commercial,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB PROT 4 HUMAN EPIDIDYMIS,3112661,CDM,302,RC,86305,CPT,,,facility,outpatient,,,97.00000,55.87000,United Healthcare,Commercial,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,inpatient,,,16.00000,9.22000,United Healthcare,Commercial,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB PROT C-REACTIVE,3077559,CDM,302,RC,86140,CPT,,,facility,outpatient,,,16.00000,9.22000,United Healthcare,Commercial,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,inpatient,,,57.00000,32.83000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH,3077542,CDM,302,RC,86141,CPT,,,facility,outpatient,,,57.00000,32.83000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,inpatient,,,131.00000,75.46000,United Healthcare,Commercial,,117.90,,,,,,,117.90,127.07,percent of total billed charges,
LAB PROT C-REACTIVE SENS HIGH NS,3110152,CDM,302,RC,86141,CPT,,,facility,outpatient,,,131.00000,75.46000,United Healthcare,Commercial,,117.90,,,,,,,34.06,127.07,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,inpatient,,,2160.00000,1244.16000,United Healthcare,Commercial,,1944.00,,,,,,,1944.00,2095.20,percent of total billed charges,
LAB RBC DNA HEA 35 AG 11 BLD GRP NS,3124518,CDM,302,RC,0001U,CPT,,,facility,outpatient,,,2160.00000,1244.16000,United Healthcare,Commercial,,1944.00,,,,,,,561.60,2095.20,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,inpatient,,,37.00000,21.31000,United Healthcare,Commercial,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
LAB SCR AB ADRENAL FL,3077872,CDM,302,RC,86255,CPT,,,facility,outpatient,,,37.00000,21.31000,United Healthcare,Commercial,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,inpatient,,,74.00000,42.62000,United Healthcare,Commercial,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB SCR AB AGG PARTICLE EA,3089000,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,United Healthcare,Commercial,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,inpatient,,,54.00000,31.10000,United Healthcare,Commercial,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB SCR AB ANCA FL EA AB,3065000,CDM,302,RC,86036,CPT,,,facility,outpatient,,,54.00000,31.10000,United Healthcare,Commercial,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,inpatient,,,76.00000,43.78000,United Healthcare,Commercial,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB SCR AB ANTIMYOCARDIAL FL,3104304,CDM,302,RC,86255,CPT,,,facility,outpatient,,,76.00000,43.78000,United Healthcare,Commercial,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,inpatient,,,606.00000,349.06000,United Healthcare,Commercial,,545.40,,,,,,,545.40,587.82,percent of total billed charges,
LAB SCR AB CASPR2 FL,3119187,CDM,302,RC,86255,CPT,,,facility,outpatient,,,606.00000,349.06000,United Healthcare,Commercial,,545.40,,,,,,,157.56,587.82,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,inpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB SCR AB CHAGAS,3026077,CDM,302,RC,86753,CPT,,,facility,outpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,inpatient,,,300.00000,172.80000,United Healthcare,Commercial,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB SCR AB COPEPTIN FL,3120847,CDM,302,RC,86255,CPT,,,facility,outpatient,,,300.00000,172.80000,United Healthcare,Commercial,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,inpatient,,,59.00000,33.98000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB SCR AB CRYPTO AGG PARTICLE,3078995,CDM,302,RC,86403,CPT,,,facility,outpatient,,,59.00000,33.98000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,inpatient,,,98.00000,56.45000,United Healthcare,Commercial,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
LAB SCR AB ENCEPHALITIS FL,3121647,CDM,302,RC,86255,CPT,,,facility,outpatient,,,98.00000,56.45000,United Healthcare,Commercial,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,inpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB SCR AB ENDOMYSIAL FL,3077906,CDM,302,RC,86231,CPT,,,facility,outpatient,,,61.00000,35.14000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,inpatient,,,128.00000,73.73000,United Healthcare,Commercial,,115.20,,,,,,,115.20,124.16,percent of total billed charges,
LAB SCR AB FL,3078086,CDM,302,RC,86255,CPT,,,facility,outpatient,,,128.00000,73.73000,United Healthcare,Commercial,,115.20,,,,,,,33.28,124.16,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB SCR AB FL NS,3077856,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,United Healthcare,Commercial,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB H INFLUENZA AGG PARTICLE,3104338,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,United Healthcare,Commercial,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,inpatient,,,16.00000,9.22000,United Healthcare,Commercial,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB SCR AB HETEROPHILE,3078300,CDM,302,RC,86308,CPT,,,facility,outpatient,,,16.00000,9.22000,United Healthcare,Commercial,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,inpatient,,,565.00000,325.44000,United Healthcare,Commercial,,508.50,,,,,,,508.50,548.05,percent of total billed charges,
LAB SCR AB LG1 FL,3119179,CDM,302,RC,86255,CPT,,,facility,outpatient,,,565.00000,325.44000,United Healthcare,Commercial,,508.50,,,,,,,146.90,548.05,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,inpatient,,,850.00000,489.60000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
LAB SCR AB LRP4 AUTO FL,3080041,CDM,302,RC,86255,CPT,,,facility,outpatient,,,850.00000,489.60000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,inpatient,,,77.00000,44.35000,United Healthcare,Commercial,,69.30,,,,,,,69.30,74.69,percent of total billed charges,
LAB SCR AB MITOCHONDRIAL,3122744,CDM,302,RC,86381,CPT,,,facility,outpatient,,,77.00000,44.35000,United Healthcare,Commercial,,69.30,,,,,,,20.02,74.69,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,inpatient,,,86.00000,49.54000,United Healthcare,Commercial,,77.40,,,,,,,77.40,83.42,percent of total billed charges,
LAB SCR AB MOG FL,3079951,CDM,302,RC,86362,CPT,,,facility,outpatient,,,86.00000,49.54000,United Healthcare,Commercial,,77.40,,,,,,,22.36,83.42,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,inpatient,,,837.00000,482.11000,United Healthcare,Commercial,,753.30,,,,,,,753.30,811.89,percent of total billed charges,
LAB SCR AB MOG TITER,3124294,CDM,302,RC,86362,CPT,,,facility,outpatient,,,837.00000,482.11000,United Healthcare,Commercial,,753.30,,,,,,,217.62,811.89,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,inpatient,,,60.00000,34.56000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL,3077963,CDM,302,RC,86015,CPT,,,facility,outpatient,,,60.00000,34.56000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,inpatient,,,56.00000,32.26000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR AB MUSCLE SMOOTH FL NS,3110319,CDM,302,RC,86015,CPT,,,facility,outpatient,,,56.00000,32.26000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,inpatient,,,56.00000,32.26000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR AB MUSCLE STRIATED FL,3077971,CDM,302,RC,86255,CPT,,,facility,outpatient,,,56.00000,32.26000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,inpatient,,,74.00000,42.62000,United Healthcare,Commercial,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB SCR AB NEISS AGG PARTICLE,3079019,CDM,302,RC,86403,CPT,,,facility,outpatient,,,74.00000,42.62000,United Healthcare,Commercial,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,United Healthcare,Commercial,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP A AGG PARTICLE,3079027,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,United Healthcare,Commercial,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,United Healthcare,Commercial,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB NEISS GRP C AGG PARTICLE,3079043,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,United Healthcare,Commercial,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,inpatient,,,167.00000,96.19000,United Healthcare,Commercial,,150.30,,,,,,,150.30,161.99,percent of total billed charges,
LAB SCR AB NMDA RECEPTOR FL,3114824,CDM,302,RC,86255,CPT,,,facility,outpatient,,,167.00000,96.19000,United Healthcare,Commercial,,150.30,,,,,,,43.42,161.99,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,inpatient,,,200.00000,115.20000,United Healthcare,Commercial,,180.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC CSF FL,3120755,CDM,302,RC,86255,CPT,,,facility,outpatient,,,200.00000,115.20000,United Healthcare,Commercial,,180.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,inpatient,,,93.00000,53.57000,United Healthcare,Commercial,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
LAB SCR AB PARANEOPLASTIC FL,3116365,CDM,302,RC,86255,CPT,,,facility,outpatient,,,93.00000,53.57000,United Healthcare,Commercial,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,inpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,49.50,53.35,percent of total billed charges,
LAB SCR AB PARIETAL FL,3077948,CDM,302,RC,86255,CPT,,,facility,outpatient,,,55.00000,31.68000,United Healthcare,Commercial,,49.50,,,,,,,14.30,53.35,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,inpatient,,,190.00000,109.44000,United Healthcare,Commercial,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
LAB SCR AB PHOSPHOLIPAS A2 RECPT FL,3029121,CDM,302,RC,86255,CPT,,,facility,outpatient,,,190.00000,109.44000,United Healthcare,Commercial,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,inpatient,,,64.00000,36.86000,United Healthcare,Commercial,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB SCR AB PURKINJE FL,3111390,CDM,302,RC,86255,CPT,,,facility,outpatient,,,64.00000,36.86000,United Healthcare,Commercial,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,inpatient,,,525.00000,302.40000,United Healthcare,Commercial,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB SCR AB REFLEX ENCEPHALITIS FL,3122504,CDM,302,RC,86255,CPT,,,facility,outpatient,,,525.00000,302.40000,United Healthcare,Commercial,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,inpatient,,,54.00000,31.10000,United Healthcare,Commercial,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB SCR AB RETICULUM FL,3077955,CDM,302,RC,86255,CPT,,,facility,outpatient,,,54.00000,31.10000,United Healthcare,Commercial,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,inpatient,,,53.00000,30.53000,United Healthcare,Commercial,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB STREP PNEUMO AGGPARTICLE,3079050,CDM,302,RC,86403,CPT,,,facility,outpatient,,,53.00000,30.53000,United Healthcare,Commercial,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,inpatient,,,53.00000,30.53000,United Healthcare,Commercial,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS,3021243,CDM,302,RC,86780,CPT,,,facility,outpatient,,,53.00000,30.53000,United Healthcare,Commercial,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,inpatient,,,40.00000,23.04000,United Healthcare,Commercial,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB SCR AB SYPHILIS NS,3115011,CDM,302,RC,86780,CPT,,,facility,outpatient,,,40.00000,23.04000,United Healthcare,Commercial,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,inpatient,,,453.00000,260.93000,United Healthcare,Commercial,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
LAB SCR AB THSD7A W REFLEX FL,3903838,CDM,302,RC,86255,CPT,,,facility,outpatient,,,453.00000,260.93000,United Healthcare,Commercial,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,inpatient,,,25.00000,14.40000,United Healthcare,Commercial,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB SCR AGGLUTININ COLD,3077286,CDM,302,RC,86156,CPT,,,facility,outpatient,,,25.00000,14.40000,United Healthcare,Commercial,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,inpatient,,,56.00000,32.26000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI,3079175,CDM,302,RC,86005,CPT,,,facility,outpatient,,,56.00000,32.26000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,inpatient,,,59.00000,33.98000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB SCR ALLG IGE QL MULTI NS,3079944,CDM,302,RC,86005,CPT,,,facility,outpatient,,,59.00000,33.98000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,inpatient,,,53.00000,30.53000,United Healthcare,Commercial,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SCR ANA,3076973,CDM,302,RC,86038,CPT,,,facility,outpatient,,,53.00000,30.53000,United Healthcare,Commercial,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,inpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB SCR ANCA TITER AB EA,3124302,CDM,302,RC,86037,CPT,,,facility,outpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,inpatient,,,350.00000,201.60000,United Healthcare,Commercial,,315.00,,,,,,,315.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG CSF,3122751,CDM,302,RC,86052,CPT,,,facility,outpatient,,,350.00000,201.60000,United Healthcare,Commercial,,315.00,,,,,,,91.00,339.50,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,inpatient,,,225.00000,129.60000,United Healthcare,Commercial,,202.50,,,,,,,202.50,218.25,percent of total billed charges,
LAB SCR AQUAPORIN 4 AB IGG SERUM,3122769,CDM,302,RC,86052,CPT,,,facility,outpatient,,,225.00000,129.60000,United Healthcare,Commercial,,202.50,,,,,,,58.50,218.25,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,inpatient,,,52.00000,29.95000,United Healthcare,Commercial,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL,3079373,CDM,302,RC,86592,CPT,,,facility,outpatient,,,52.00000,29.95000,United Healthcare,Commercial,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,inpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL CSF,3079381,CDM,302,RC,86592,CPT,,,facility,outpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,inpatient,,,134.00000,77.18000,United Healthcare,Commercial,,120.60,,,,,,,120.60,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QL DNR TESTNG,3030715,CDM,302,RC,86592,CPT,,,facility,outpatient,,,134.00000,77.18000,United Healthcare,Commercial,,120.60,,,,,,,34.84,129.98,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,inpatient,,,52.00000,29.95000,United Healthcare,Commercial,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB SYPHILIS VDRL/RPR QN,3079399,CDM,302,RC,86593,CPT,,,facility,outpatient,,,52.00000,29.95000,United Healthcare,Commercial,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,inpatient,,,186.00000,107.14000,United Healthcare,Commercial,,167.40,,,,,,,167.40,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY GAMMA INTERFRN,3112224,CDM,302,RC,86480,CPT,,,facility,outpatient,,,186.00000,107.14000,United Healthcare,Commercial,,167.40,,,,,,,48.36,180.42,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,inpatient,,,300.00000,172.80000,United Healthcare,Commercial,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP,3113362,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,United Healthcare,Commercial,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,inpatient,,,300.00000,172.80000,United Healthcare,Commercial,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB TB MEAS IMMUNITY T-CELL SUSP NS,3123288,CDM,302,RC,86481,CPT,,,facility,outpatient,,,300.00000,172.80000,United Healthcare,Commercial,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,inpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB TEST SKIN TB INTRADERMAL,3107067,CDM,302,RC,86580,CPT,,,facility,outpatient,,,62.00000,35.71000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,inpatient,,,205.00000,118.08000,United Healthcare,Commercial,,184.50,,,,,,,184.50,198.85,percent of total billed charges,
LAB TRANSFORM LYMPHOCYTE MITOGEN,3078813,CDM,302,RC,86353,CPT,,,facility,outpatient,,,205.00000,118.08000,United Healthcare,Commercial,,184.50,,,,,,,53.30,198.85,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,inpatient,,,75.00000,36.15000,United Healthcare,Commercial,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB AGGREGATION PLT EA AGENT,3094182,CDM,305,RC,85576,CPT,,,facility,outpatient,,,75.00000,36.15000,United Healthcare,Commercial,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,inpatient,,,65.00000,31.33000,United Healthcare,Commercial,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB ASSAY HEPARIN,3086147,CDM,305,RC,85520,CPT,,,facility,outpatient,,,65.00000,31.33000,United Healthcare,Commercial,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,inpatient,,,92.00000,44.34000,United Healthcare,Commercial,,82.80,,,,,,,82.80,89.24,percent of total billed charges,
LAB ASSAY HEPARIN NS,3089018,CDM,305,RC,85520,CPT,,,facility,outpatient,,,92.00000,44.34000,United Healthcare,Commercial,,82.80,,,,,,,23.92,89.24,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,inpatient,,,24.00000,11.57000,United Healthcare,Commercial,,21.60,,,,,,,21.60,23.28,percent of total billed charges,
LAB CBC AUTO W AUTO DIFF,3079688,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,United Healthcare,Commercial,,21.60,,,,,,,6.24,23.28,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,inpatient,,,20.00000,9.64000,United Healthcare,Commercial,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB CBC AUTO WO DIFF,3079696,CDM,305,RC,85027,CPT,,,facility,outpatient,,,20.00000,9.64000,United Healthcare,Commercial,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,inpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CLOTTING ACT ANTITHROM 3,3079563,CDM,305,RC,85300,CPT,,,facility,outpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,inpatient,,,42.00000,20.24000,United Healthcare,Commercial,,37.80,,,,,,,37.80,40.74,percent of total billed charges,
LAB CLOTTING ACT PROTEIN C,3086261,CDM,305,RC,85303,CPT,,,facility,outpatient,,,42.00000,20.24000,United Healthcare,Commercial,,37.80,,,,,,,10.92,40.74,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,inpatient,,,69.00000,33.26000,United Healthcare,Commercial,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB CLOTTING AG ANTITHROMBIN 3 NS,3104213,CDM,305,RC,85301,CPT,,,facility,outpatient,,,69.00000,33.26000,United Healthcare,Commercial,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,inpatient,,,65.00000,31.33000,United Healthcare,Commercial,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB CLOTTING AG PROTEIN C,3086279,CDM,305,RC,85302,CPT,,,facility,outpatient,,,65.00000,31.33000,United Healthcare,Commercial,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,inpatient,,,76.00000,36.63000,United Healthcare,Commercial,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 10 STUART-PROWR,3079852,CDM,305,RC,85260,CPT,,,facility,outpatient,,,76.00000,36.63000,United Healthcare,Commercial,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,inpatient,,,89.00000,42.90000,United Healthcare,Commercial,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 11 PTA NS,3109600,CDM,305,RC,85270,CPT,,,facility,outpatient,,,89.00000,42.90000,United Healthcare,Commercial,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,inpatient,,,76.00000,36.63000,United Healthcare,Commercial,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 12 HAGEMAN,3079878,CDM,305,RC,85280,CPT,,,facility,outpatient,,,76.00000,36.63000,United Healthcare,Commercial,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,inpatient,,,28.00000,13.50000,United Healthcare,Commercial,,25.20,,,,,,,25.20,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 SCR SOL,3079894,CDM,305,RC,85291,CPT,,,facility,outpatient,,,28.00000,13.50000,United Healthcare,Commercial,,25.20,,,,,,,7.28,27.16,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,inpatient,,,98.00000,47.24000,United Healthcare,Commercial,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 13 STB FBR NS,3110038,CDM,305,RC,85290,CPT,,,facility,outpatient,,,98.00000,47.24000,United Healthcare,Commercial,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,inpatient,,,64.00000,30.85000,United Healthcare,Commercial,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 2 PROTHROM,3079720,CDM,305,RC,85210,CPT,,,facility,outpatient,,,64.00000,30.85000,United Healthcare,Commercial,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,inpatient,,,75.00000,36.15000,United Healthcare,Commercial,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 5 LABILE,3079795,CDM,305,RC,85220,CPT,,,facility,outpatient,,,75.00000,36.15000,United Healthcare,Commercial,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,inpatient,,,76.00000,36.63000,United Healthcare,Commercial,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 7,3079803,CDM,305,RC,85230,CPT,,,facility,outpatient,,,76.00000,36.63000,United Healthcare,Commercial,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,inpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG,3079746,CDM,305,RC,85240,CPT,,,facility,outpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,inpatient,,,114.00000,54.95000,United Healthcare,Commercial,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 1-STG NS,3109576,CDM,305,RC,85240,CPT,,,facility,outpatient,,,114.00000,54.95000,United Healthcare,Commercial,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,inpatient,,,74.00000,35.67000,United Healthcare,Commercial,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF AG,3079829,CDM,305,RC,85246,CPT,,,facility,outpatient,,,74.00000,35.67000,United Healthcare,Commercial,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,inpatient,,,69.00000,33.26000,United Healthcare,Commercial,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF MULTI,3079837,CDM,305,RC,85247,CPT,,,facility,outpatient,,,69.00000,33.26000,United Healthcare,Commercial,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,inpatient,,,74.00000,35.67000,United Healthcare,Commercial,,66.60,,,,,,,66.60,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST,3079845,CDM,305,RC,85245,CPT,,,facility,outpatient,,,74.00000,35.67000,United Healthcare,Commercial,,66.60,,,,,,,19.24,71.78,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,inpatient,,,87.00000,41.93000,United Healthcare,Commercial,,78.30,,,,,,,78.30,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 8 VWF RIST NS,3109675,CDM,305,RC,85245,CPT,,,facility,outpatient,,,87.00000,41.93000,United Healthcare,Commercial,,78.30,,,,,,,22.62,84.39,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,inpatient,,,79.00000,38.08000,United Healthcare,Commercial,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS,3079787,CDM,305,RC,85250,CPT,,,facility,outpatient,,,79.00000,38.08000,United Healthcare,Commercial,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,inpatient,,,75.00000,36.15000,United Healthcare,Commercial,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB CLOTTING FACTOR 9 PTC/XMAS NS,3109584,CDM,305,RC,85250,CPT,,,facility,outpatient,,,75.00000,36.15000,United Healthcare,Commercial,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,inpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE,3086287,CDM,305,RC,85306,CPT,,,facility,outpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,inpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S FREE NS,3108040,CDM,305,RC,85306,CPT,,,facility,outpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,inpatient,,,64.00000,30.85000,United Healthcare,Commercial,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL,3086295,CDM,305,RC,85305,CPT,,,facility,outpatient,,,64.00000,30.85000,United Healthcare,Commercial,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB CLOTTING PROTEIN S TOTAL NS,3108032,CDM,305,RC,85305,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,inpatient,,,164.00000,79.05000,United Healthcare,Commercial,,147.60,,,,,,,147.60,159.08,percent of total billed charges,
LAB COAGULATION&FIBRINOLYSIS,3110863,CDM,305,RC,85397,CPT,,,facility,outpatient,,,164.00000,79.05000,United Healthcare,Commercial,,147.60,,,,,,,42.64,159.08,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,inpatient,,,54.00000,26.03000,United Healthcare,Commercial,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB COUNT BLD DIFF MANUAL WBC,3079654,CDM,305,RC,85007,CPT,,,facility,outpatient,,,54.00000,26.03000,United Healthcare,Commercial,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,inpatient,,,8.00000,3.86000,United Healthcare,Commercial,,7.20,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT,3086097,CDM,305,RC,85014,CPT,,,facility,outpatient,,,8.00000,3.86000,United Healthcare,Commercial,,7.20,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,inpatient,,,69.00000,33.26000,United Healthcare,Commercial,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB COUNT BLD HEMATOCRIT NS,3114964,CDM,305,RC,85014,CPT,,,facility,outpatient,,,69.00000,33.26000,United Healthcare,Commercial,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,inpatient,,,8.00000,3.86000,United Healthcare,Commercial,,7.20,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN,3086121,CDM,305,RC,85018,CPT,,,facility,outpatient,,,8.00000,3.86000,United Healthcare,Commercial,,7.20,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,inpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB COUNT BLD HEMOGLOBIN NS,3114972,CDM,305,RC,85018,CPT,,,facility,outpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,inpatient,,,8.00000,3.86000,United Healthcare,Commercial,,7.20,,,,,,,7.20,7.76,percent of total billed charges,
LAB COUNT BLD LEUKO AUTO,3079589,CDM,305,RC,85048,CPT,,,facility,outpatient,,,8.00000,3.86000,United Healthcare,Commercial,,7.20,,,,,,,2.08,7.76,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,inpatient,,,14.00000,6.75000,United Healthcare,Commercial,,12.60,,,,,,,12.60,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED,3079605,CDM,305,RC,85049,CPT,,,facility,outpatient,,,14.00000,6.75000,United Healthcare,Commercial,,12.60,,,,,,,3.64,13.58,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB COUNT BLD PLATELET AUTOMATED NS,3123502,CDM,305,RC,85049,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,inpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO,3079613,CDM,305,RC,85041,CPT,,,facility,outpatient,,,62.00000,29.88000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,inpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB COUNT BLD RBC AUTO NS,3114956,CDM,305,RC,85041,CPT,,,facility,outpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,inpatient,,,112.00000,53.98000,United Healthcare,Commercial,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB COUNT BLD RETIC AUTO W PARAM,3107919,CDM,305,RC,85046,CPT,,,facility,outpatient,,,112.00000,53.98000,United Healthcare,Commercial,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,inpatient,,,13.00000,6.27000,United Healthcare,Commercial,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB COUNT BLD RETIC MANUAL,3079639,CDM,305,RC,85044,CPT,,,facility,outpatient,,,13.00000,6.27000,United Healthcare,Commercial,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,inpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB EOSINOPHILS URINE/OTHER,3904216,CDM,305,RC,85999,CPT,,,facility,outpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,inpatient,,,31.00000,14.94000,United Healthcare,Commercial,,27.90,,,,,,,27.90,30.07,percent of total billed charges,
LAB FDP D-DIMER QN,3086055,CDM,305,RC,85379,CPT,,,facility,outpatient,,,31.00000,14.94000,United Healthcare,Commercial,,27.90,,,,,,,8.06,30.07,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,inpatient,,,92.00000,44.34000,United Healthcare,Commercial,,82.80,,,,,,,82.80,89.24,percent of total billed charges,
LAB FDP D-DIMER QN NS,3113065,CDM,305,RC,85379,CPT,,,facility,outpatient,,,92.00000,44.34000,United Healthcare,Commercial,,82.80,,,,,,,23.92,89.24,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,inpatient,,,80.00000,38.56000,United Healthcare,Commercial,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB FDP FSP AGG SEMI QN NS,3116035,CDM,305,RC,85362,CPT,,,facility,outpatient,,,80.00000,38.56000,United Healthcare,Commercial,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,inpatient,,,30.00000,14.46000,United Healthcare,Commercial,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY,3086063,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,United Healthcare,Commercial,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,inpatient,,,30.00000,14.46000,United Healthcare,Commercial,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
LAB FIBRINOGEN ACTIVITY NS,3104221,CDM,305,RC,85384,CPT,,,facility,outpatient,,,30.00000,14.46000,United Healthcare,Commercial,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,inpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB FRAGILITY OSMOTIC RBC INCUB,3086196,CDM,305,RC,85557,CPT,,,facility,outpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,inpatient,,,24.00000,11.57000,United Healthcare,Commercial,,21.60,,,,,,,21.60,23.28,percent of total billed charges,
LAB HEMO PLT AUTO W AUTO SCAN,3086113,CDM,305,RC,85025,CPT,,,facility,outpatient,,,24.00000,11.57000,United Healthcare,Commercial,,21.60,,,,,,,6.24,23.28,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,inpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB HGB FETAL KLEIHAUER-BETKE,3086014,CDM,305,RC,85460,CPT,,,facility,outpatient,,,59.00000,28.44000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,inpatient,,,29.00000,13.98000,United Healthcare,Commercial,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB HGB FETAL ROSETTE,3086022,CDM,305,RC,85461,CPT,,,facility,outpatient,,,29.00000,13.98000,United Healthcare,Commercial,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,inpatient,,,97.00000,46.75000,United Healthcare,Commercial,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB INHIBITOR FACTOR 8,3079779,CDM,305,RC,85335,CPT,,,facility,outpatient,,,97.00000,46.75000,United Healthcare,Commercial,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,inpatient,,,225.00000,108.45000,United Healthcare,Commercial,,202.50,,,,,,,202.50,218.25,percent of total billed charges,
LAB INHIBITOR VWF PROTEASE,3107893,CDM,305,RC,85335,CPT,,,facility,outpatient,,,225.00000,108.45000,United Healthcare,Commercial,,202.50,,,,,,,58.50,218.25,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,inpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB MURAMIDASE,3086188,CDM,305,RC,85549,CPT,,,facility,outpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,inpatient,,,71.00000,34.22000,United Healthcare,Commercial,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB NEUTRAL PHOSPHO HEXAGONAL,3112570,CDM,305,RC,85598,CPT,,,facility,outpatient,,,71.00000,34.22000,United Healthcare,Commercial,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,inpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC,3086238,CDM,305,RC,85420,CPT,,,facility,outpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,inpatient,,,71.00000,34.22000,United Healthcare,Commercial,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB PLASMINOGEN NON-ANTIGENIC NS,3123254,CDM,305,RC,85420,CPT,,,facility,outpatient,,,71.00000,34.22000,United Healthcare,Commercial,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,inpatient,,,108.00000,52.06000,United Healthcare,Commercial,,97.20,,,,,,,97.20,104.76,percent of total billed charges,
LAB PLATELET RETICULATED,3113685,CDM,305,RC,85055,CPT,,,facility,outpatient,,,108.00000,52.06000,United Healthcare,Commercial,,97.20,,,,,,,28.08,104.76,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,inpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB PROT C ACT RESISTANCE,3079548,CDM,305,RC,85307,CPT,,,facility,outpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,inpatient,,,51.00000,24.58000,United Healthcare,Commercial,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME,3086303,CDM,305,RC,85610,CPT,,,facility,outpatient,,,51.00000,24.58000,United Healthcare,Commercial,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,inpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME NS,3071370,CDM,305,RC,85610,CPT,,,facility,outpatient,,,63.00000,30.37000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,inpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB PROTHROMBIN TIME SUB,3086311,CDM,305,RC,85611,CPT,,,facility,outpatient,,,58.00000,27.96000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,inpatient,,,19.00000,9.16000,United Healthcare,Commercial,,17.10,,,,,,,17.10,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL,3086428,CDM,305,RC,85730,CPT,,,facility,outpatient,,,19.00000,9.16000,United Healthcare,Commercial,,17.10,,,,,,,4.94,18.43,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,inpatient,,,54.00000,26.03000,United Healthcare,Commercial,,48.60,,,,,,,48.60,52.38,percent of total billed charges,
LAB PTT PLASMA/BLD WHL NS,3107661,CDM,305,RC,85730,CPT,,,facility,outpatient,,,54.00000,26.03000,United Healthcare,Commercial,,48.60,,,,,,,14.04,52.38,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,inpatient,,,103.00000,49.65000,United Healthcare,Commercial,,92.70,,,,,,,92.70,99.91,percent of total billed charges,
LAB PTT SUBSTITUTION FRAC PLASMA,3086329,CDM,305,RC,85732,CPT,,,facility,outpatient,,,103.00000,49.65000,United Healthcare,Commercial,,92.70,,,,,,,26.78,99.91,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,inpatient,,,9.00000,4.34000,United Healthcare,Commercial,,8.10,,,,,,,8.10,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC AUTO,3086360,CDM,305,RC,85652,CPT,,,facility,outpatient,,,9.00000,4.34000,United Healthcare,Commercial,,8.10,,,,,,,2.34,8.73,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,inpatient,,,13.00000,6.27000,United Healthcare,Commercial,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB RATE SEDIMENTATION RBC NONAUTO,3086378,CDM,305,RC,85651,CPT,,,facility,outpatient,,,13.00000,6.27000,United Healthcare,Commercial,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,inpatient,,,80.00000,38.56000,United Healthcare,Commercial,,72.00,,,,,,,72.00,77.60,percent of total billed charges,
LAB REPTILASE,3086337,CDM,305,RC,85635,CPT,,,facility,outpatient,,,80.00000,38.56000,United Healthcare,Commercial,,72.00,,,,,,,20.80,77.60,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,inpatient,,,47.00000,22.65000,United Healthcare,Commercial,,42.30,,,,,,,42.30,45.59,percent of total billed charges,
LAB SCR FIBRINOLYSINS/COAG NS,3113636,CDM,305,RC,85390,CPT,,,facility,outpatient,,,47.00000,22.65000,United Healthcare,Commercial,,42.30,,,,,,,12.22,45.59,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION,3105129,CDM,305,RC,85660,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,inpatient,,,91.00000,43.86000,United Healthcare,Commercial,,81.90,,,,,,,81.90,88.27,percent of total billed charges,
LAB SICKLING RBC REDUCTION NS,3109725,CDM,305,RC,85660,CPT,,,facility,outpatient,,,91.00000,43.86000,United Healthcare,Commercial,,81.90,,,,,,,23.66,88.27,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,inpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA,3086402,CDM,305,RC,85670,CPT,,,facility,outpatient,,,56.00000,26.99000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,inpatient,,,18.00000,8.68000,United Healthcare,Commercial,,16.20,,,,,,,16.20,17.46,percent of total billed charges,
LAB THROMBIN TIME PLASMA NS,3114840,CDM,305,RC,85670,CPT,,,facility,outpatient,,,18.00000,8.68000,United Healthcare,Commercial,,16.20,,,,,,,4.68,17.46,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,inpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB VENOM TIME RUSSELL VIPER DLT,3086345,CDM,305,RC,85613,CPT,,,facility,outpatient,,,60.00000,28.92000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,inpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB VISCOSITY,3086444,CDM,305,RC,85810,CPT,,,facility,outpatient,,,57.00000,27.47000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,inpatient,,,21.00000,11.15000,United Healthcare,Commercial,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA,3086535,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,United Healthcare,Commercial,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,inpatient,,,71.00000,37.70000,United Healthcare,Commercial,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB CONCENTRATION AFB IA NS,3111820,CDM,306,RC,87015,CPT,,,facility,outpatient,,,71.00000,37.70000,United Healthcare,Commercial,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,inpatient,,,21.00000,11.15000,United Healthcare,Commercial,,18.90,,,,,,,18.90,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA,3086543,CDM,306,RC,87015,CPT,,,facility,outpatient,,,21.00000,11.15000,United Healthcare,Commercial,,18.90,,,,,,,5.46,20.37,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,inpatient,,,128.00000,67.97000,United Healthcare,Commercial,,115.20,,,,,,,115.20,124.16,percent of total billed charges,
LAB CONCENTRATION ANY TYPE IA NS,3116423,CDM,306,RC,87015,CPT,,,facility,outpatient,,,128.00000,67.97000,United Healthcare,Commercial,,115.20,,,,,,,33.28,124.16,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,inpatient,,,65.00000,34.52000,United Healthcare,Commercial,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB CULT AFB ID ISOLATES NS,3111838,CDM,306,RC,87116,CPT,,,facility,outpatient,,,65.00000,34.52000,United Healthcare,Commercial,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,United Healthcare,Commercial,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BARTONELLA,3104536,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,United Healthcare,Commercial,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,inpatient,,,31.00000,16.46000,United Healthcare,Commercial,,27.90,,,,,,,27.90,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC BLOOD,3086618,CDM,306,RC,87040,CPT,,,facility,outpatient,,,31.00000,16.46000,United Healthcare,Commercial,,27.90,,,,,,,8.06,30.07,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,United Healthcare,Commercial,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CATHETER TIP,3086626,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,United Healthcare,Commercial,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,United Healthcare,Commercial,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC CSF,3086642,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,United Healthcare,Commercial,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,United Healthcare,Commercial,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EAR,3086667,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,United Healthcare,Commercial,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,inpatient,,,61.00000,32.39000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC EYE,3086683,CDM,306,RC,87070,CPT,,,facility,outpatient,,,61.00000,32.39000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,United Healthcare,Commercial,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC GENITAL,3086741,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,United Healthcare,Commercial,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,inpatient,,,25.00000,13.28000,United Healthcare,Commercial,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF,3086550,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,United Healthcare,Commercial,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,inpatient,,,25.00000,13.28000,United Healthcare,Commercial,91,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL,3106069,CDM,306,RC,87077,CPT,,,facility,outpatient,,,25.00000,13.28000,United Healthcare,Commercial,91,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,inpatient,,,103.00000,54.69000,United Healthcare,Commercial,,92.70,,,,,,,92.70,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF ADDL NS,3122421,CDM,306,RC,87077,CPT,,,facility,outpatient,,,103.00000,54.69000,United Healthcare,Commercial,,92.70,,,,,,,26.78,99.91,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,inpatient,,,96.00000,50.98000,United Healthcare,Commercial,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC ID DF NS,3122389,CDM,306,RC,87077,CPT,,,facility,outpatient,,,96.00000,50.98000,United Healthcare,Commercial,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,inpatient,,,75.00000,39.83000,United Healthcare,Commercial,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER,3086808,CDM,306,RC,87070,CPT,,,facility,outpatient,,,75.00000,39.83000,United Healthcare,Commercial,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,inpatient,,,68.00000,36.11000,United Healthcare,Commercial,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER NS,3106572,CDM,306,RC,87070,CPT,,,facility,outpatient,,,68.00000,36.11000,United Healthcare,Commercial,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,inpatient,,,61.00000,32.39000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC OTHER QN,3086568,CDM,306,RC,87071,CPT,,,facility,outpatient,,,61.00000,32.39000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,United Healthcare,Commercial,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP LOWER,3086758,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,United Healthcare,Commercial,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,United Healthcare,Commercial,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC RESP UPPER,3087053,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,United Healthcare,Commercial,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,inpatient,,,29.00000,15.40000,United Healthcare,Commercial,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL,3086964,CDM,306,RC,87045,CPT,,,facility,outpatient,,,29.00000,15.40000,United Healthcare,Commercial,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,United Healthcare,Commercial,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL CAMPY,3086931,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,United Healthcare,Commercial,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,United Healthcare,Commercial,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL E COLI,3086949,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,United Healthcare,Commercial,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,inpatient,,,63.00000,33.45000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL NS,3122413,CDM,306,RC,87045,CPT,,,facility,outpatient,,,63.00000,33.45000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,inpatient,,,79.00000,41.95000,United Healthcare,Commercial,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH,3086956,CDM,306,RC,87046,CPT,,,facility,outpatient,,,79.00000,41.95000,United Healthcare,Commercial,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,inpatient,,,63.00000,33.45000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL PATH NS,3113073,CDM,306,RC,87046,CPT,,,facility,outpatient,,,63.00000,33.45000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,inpatient,,,29.00000,15.40000,United Healthcare,Commercial,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC STOOL YERSNIA,3086980,CDM,306,RC,87046,CPT,,,facility,outpatient,,,29.00000,15.40000,United Healthcare,Commercial,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,inpatient,,,112.00000,59.47000,United Healthcare,Commercial,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC TISSUE,3086998,CDM,306,RC,87070,CPT,,,facility,outpatient,,,112.00000,59.47000,United Healthcare,Commercial,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,United Healthcare,Commercial,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT AEROBIC WOUND,3087129,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,United Healthcare,Commercial,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,inpatient,,,25.00000,13.28000,United Healthcare,Commercial,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF,3086600,CDM,306,RC,87076,CPT,,,facility,outpatient,,,25.00000,13.28000,United Healthcare,Commercial,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,inpatient,,,118.00000,62.66000,United Healthcare,Commercial,,106.20,,,,,,,106.20,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC ID DF NS,3121399,CDM,306,RC,87076,CPT,,,facility,outpatient,,,118.00000,62.66000,United Healthcare,Commercial,,106.20,,,,,,,30.68,114.46,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,inpatient,,,29.00000,15.40000,United Healthcare,Commercial,,26.10,,,,,,,26.10,28.13,percent of total billed charges,
LAB CULT BACT ANAEROBIC OTHER,3086592,CDM,306,RC,87075,CPT,,,facility,outpatient,,,29.00000,15.40000,United Healthcare,Commercial,,26.10,,,,,,,7.54,28.13,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,inpatient,,,25.00000,13.28000,United Healthcare,Commercial,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT COLONY COUNT URINE,3087079,CDM,306,RC,87086,CPT,,,facility,outpatient,,,25.00000,13.28000,United Healthcare,Commercial,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,inpatient,,,26.00000,13.81000,United Healthcare,Commercial,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB CULT BACT FLUID BODY STERILE,3086915,CDM,306,RC,87070,CPT,,,facility,outpatient,,,26.00000,13.81000,United Healthcare,Commercial,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,inpatient,,,25.00000,13.28000,United Healthcare,Commercial,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
LAB CULT BACT ID ISOLATE URINE,3087061,CDM,306,RC,87088,CPT,,,facility,outpatient,,,25.00000,13.28000,United Healthcare,Commercial,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,inpatient,,,71.00000,37.70000,United Healthcare,Commercial,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB CULT CHLAMYDIA,3086634,CDM,306,RC,87110,CPT,,,facility,outpatient,,,71.00000,37.70000,United Healthcare,Commercial,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,inpatient,,,59.00000,31.33000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB CULT FUNGI ID DERMATOPHYTE,3086709,CDM,306,RC,87101,CPT,,,facility,outpatient,,,59.00000,31.33000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,inpatient,,,62.00000,32.92000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD,3086717,CDM,306,RC,87107,CPT,,,facility,outpatient,,,62.00000,32.92000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,inpatient,,,138.00000,73.28000,United Healthcare,Commercial,,124.20,,,,,,,124.20,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF MOLD NS,3110731,CDM,306,RC,87107,CPT,,,facility,outpatient,,,138.00000,73.28000,United Healthcare,Commercial,,124.20,,,,,,,35.88,133.86,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,inpatient,,,62.00000,32.92000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB CULT FUNGI ID DF YEAST,3086725,CDM,306,RC,87106,CPT,,,facility,outpatient,,,62.00000,32.92000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,inpatient,,,78.00000,41.42000,United Healthcare,Commercial,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES,3086733,CDM,306,RC,87102,CPT,,,facility,outpatient,,,78.00000,41.42000,United Healthcare,Commercial,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,inpatient,,,69.00000,36.64000,United Healthcare,Commercial,,62.10,,,,,,,62.10,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES BLOOD,3086691,CDM,306,RC,87103,CPT,,,facility,outpatient,,,69.00000,36.64000,United Healthcare,Commercial,,62.10,,,,,,,17.94,66.93,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,inpatient,,,88.00000,46.73000,United Healthcare,Commercial,,79.20,,,,,,,79.20,85.36,percent of total billed charges,
LAB CULT FUNGI ID ISOLATES NS,3121779,CDM,306,RC,87102,CPT,,,facility,outpatient,,,88.00000,46.73000,United Healthcare,Commercial,,79.20,,,,,,,22.88,85.36,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,inpatient,,,60.00000,31.86000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB CULT FUNGI YEAST ID ISOLATES,3087137,CDM,306,RC,87102,CPT,,,facility,outpatient,,,60.00000,31.86000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,inpatient,,,64.00000,33.98000,United Healthcare,Commercial,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB CULT MYCOBACTERIAL ID DF,3086774,CDM,306,RC,87118,CPT,,,facility,outpatient,,,64.00000,33.98000,United Healthcare,Commercial,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,inpatient,,,63.00000,33.45000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
LAB CULT MYCOPLASMA/UREAPLASMA,3086766,CDM,306,RC,87109,CPT,,,facility,outpatient,,,63.00000,33.45000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,inpatient,,,137.00000,72.75000,United Healthcare,Commercial,,123.30,,,,,,,123.30,132.89,percent of total billed charges,
LAB CULT TYPING ID NUC ACID PRB AMP,3113081,CDM,306,RC,87150,CPT,,,facility,outpatient,,,137.00000,72.75000,United Healthcare,Commercial,,123.30,,,,,,,35.62,132.89,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,inpatient,,,347.00000,184.26000,United Healthcare,Commercial,,312.30,,,,,,,312.30,336.59,percent of total billed charges,
LAB CULT TYPING ID SEQ NUC ACID NS,3119930,CDM,306,RC,87153,CPT,,,facility,outpatient,,,347.00000,184.26000,United Healthcare,Commercial,,312.30,,,,,,,90.22,336.59,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,inpatient,,,57.00000,30.27000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA,3087020,CDM,306,RC,87140,CPT,,,facility,outpatient,,,57.00000,30.27000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,inpatient,,,56.00000,29.74000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB CULT TYPING IF ANTISERUM EA NS,3119799,CDM,306,RC,87140,CPT,,,facility,outpatient,,,56.00000,29.74000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,inpatient,,,16.00000,8.50000,United Healthcare,Commercial,,14.40,,,,,,,14.40,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL,3087046,CDM,306,RC,87147,CPT,,,facility,outpatient,,,16.00000,8.50000,United Healthcare,Commercial,,14.40,,,,,,,4.16,15.52,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,inpatient,,,85.00000,45.14000,United Healthcare,Commercial,,76.50,,,,,,,76.50,82.45,percent of total billed charges,
LAB CULT TYPING SEROLOGICAL NS,3122439,CDM,306,RC,87147,CPT,,,facility,outpatient,,,85.00000,45.14000,United Healthcare,Commercial,,76.50,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,inpatient,,,34.00000,18.05000,United Healthcare,Commercial,,30.60,,,,,,,30.60,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN,3087228,CDM,306,RC,87340,CPT,,,facility,outpatient,,,34.00000,18.05000,United Healthcare,Commercial,,30.60,,,,,,,8.84,32.98,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,inpatient,,,231.00000,122.66000,United Healthcare,Commercial,,207.90,,,,,,,207.90,224.07,percent of total billed charges,
LAB DET AG IA HBSAG QL/SEMI QN NS,3118502,CDM,306,RC,87340,CPT,,,facility,outpatient,,,231.00000,122.66000,United Healthcare,Commercial,,207.90,,,,,,,60.06,224.07,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,inpatient,,,36.00000,19.12000,United Healthcare,Commercial,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IF BORDETELLA,3087533,CDM,306,RC,87265,CPT,,,facility,outpatient,,,36.00000,19.12000,United Healthcare,Commercial,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,inpatient,,,61.00000,32.39000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM,3087566,CDM,306,RC,87272,CPT,,,facility,outpatient,,,61.00000,32.39000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,inpatient,,,111.00000,58.94000,United Healthcare,Commercial,,99.90,,,,,,,99.90,107.67,percent of total billed charges,
LAB DET AG IA IF CRYPTOSPORIDIUM NS,3121902,CDM,306,RC,87272,CPT,,,facility,outpatient,,,111.00000,58.94000,United Healthcare,Commercial,,99.90,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,inpatient,,,61.00000,32.39000,United Healthcare,Commercial,,54.90,,,,,,,54.90,59.17,percent of total billed charges,
LAB DET AG IA IF GIARDIA,3094034,CDM,306,RC,87269,CPT,,,facility,outpatient,,,61.00000,32.39000,United Healthcare,Commercial,,54.90,,,,,,,15.86,59.17,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,inpatient,,,60.00000,31.86000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 1,3087582,CDM,306,RC,87274,CPT,,,facility,outpatient,,,60.00000,31.86000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,inpatient,,,60.00000,31.86000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF HSV TYPE 2,3087590,CDM,306,RC,87273,CPT,,,facility,outpatient,,,60.00000,31.86000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,inpatient,,,60.00000,31.86000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA A VIRUS,3087608,CDM,306,RC,87276,CPT,,,facility,outpatient,,,60.00000,31.86000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,inpatient,,,60.00000,31.86000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF INFLUENZA B VIRUS,3087616,CDM,306,RC,87275,CPT,,,facility,outpatient,,,60.00000,31.86000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,inpatient,,,60.00000,31.86000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF PLYVLT ORG MULT,3087657,CDM,306,RC,87300,CPT,,,facility,outpatient,,,60.00000,31.86000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,inpatient,,,36.00000,19.12000,United Healthcare,Commercial,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS,3087640,CDM,306,RC,87281,CPT,,,facility,outpatient,,,36.00000,19.12000,United Healthcare,Commercial,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,inpatient,,,76.00000,40.36000,United Healthcare,Commercial,,68.40,,,,,,,68.40,73.72,percent of total billed charges,
LAB DET AG IA IF PNEUMOCYSTIS NS,3116431,CDM,306,RC,87281,CPT,,,facility,outpatient,,,76.00000,40.36000,United Healthcare,Commercial,,68.40,,,,,,,19.76,73.72,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,inpatient,,,60.00000,31.86000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF RSV,3087665,CDM,306,RC,87280,CPT,,,facility,outpatient,,,60.00000,31.86000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,inpatient,,,60.00000,31.86000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IF VARICELLA-ZOSTER,3087673,CDM,306,RC,87290,CPT,,,facility,outpatient,,,60.00000,31.86000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,inpatient,,,152.00000,80.71000,United Healthcare,Commercial,,136.80,,,,,,,136.80,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ ASPRGLS NS,3107505,CDM,306,RC,87305,CPT,,,facility,outpatient,,,152.00000,80.71000,United Healthcare,Commercial,,136.80,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,inpatient,,,78.00000,41.42000,United Healthcare,Commercial,,70.20,,,,,,,70.20,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CAMPY,3120888,CDM,306,RC,87449,CPT,,,facility,outpatient,,,78.00000,41.42000,United Healthcare,Commercial,,70.20,,,,,,,20.28,75.66,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,inpatient,,,42.00000,22.30000,United Healthcare,Commercial,,37.80,,,,,,,37.80,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ CRYPTOSPOR,3087194,CDM,306,RC,87328,CPT,,,facility,outpatient,,,42.00000,22.30000,United Healthcare,Commercial,,37.80,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,inpatient,,,73.00000,38.76000,United Healthcare,Commercial,,65.70,,,,,,,65.70,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ ENTAM HIST NS,3113255,CDM,306,RC,87337,CPT,,,facility,outpatient,,,73.00000,38.76000,United Healthcare,Commercial,,65.70,,,,,,,18.98,70.81,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,inpatient,,,97.00000,51.51000,United Healthcare,Commercial,,87.30,,,,,,,87.30,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL,3123817,CDM,306,RC,87449,CPT,,,facility,outpatient,,,97.00000,51.51000,United Healthcare,Commercial,,87.30,,,,,,,25.22,94.09,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,inpatient,,,157.00000,83.37000,United Healthcare,Commercial,,141.30,,,,,,,141.30,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ FUNGITELL NS,3119898,CDM,306,RC,87449,CPT,,,facility,outpatient,,,157.00000,83.37000,United Healthcare,Commercial,,141.30,,,,,,,40.82,152.29,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,inpatient,,,36.00000,19.12000,United Healthcare,Commercial,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA,3106622,CDM,306,RC,87329,CPT,,,facility,outpatient,,,36.00000,19.12000,United Healthcare,Commercial,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,inpatient,,,66.00000,35.05000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ GIARDIA NS,3094042,CDM,306,RC,87329,CPT,,,facility,outpatient,,,66.00000,35.05000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,inpatient,,,58.00000,30.80000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF,3105244,CDM,306,RC,87341,CPT,,,facility,outpatient,,,58.00000,30.80000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,inpatient,,,85.00000,45.14000,United Healthcare,Commercial,,76.50,,,,,,,76.50,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP B SURF NS,3102811,CDM,306,RC,87341,CPT,,,facility,outpatient,,,85.00000,45.14000,United Healthcare,Commercial,,76.50,,,,,,,22.10,82.45,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,inpatient,,,59.00000,31.33000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP BE,3087236,CDM,306,RC,87350,CPT,,,facility,outpatient,,,59.00000,31.33000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,inpatient,,,175.00000,92.93000,United Healthcare,Commercial,,157.50,,,,,,,157.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HEP DELTA AGT,3109501,CDM,306,RC,87380,CPT,,,facility,outpatient,,,175.00000,92.93000,United Healthcare,Commercial,,157.50,,,,,,,45.50,169.75,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,inpatient,,,152.00000,80.71000,United Healthcare,Commercial,,136.80,,,,,,,136.80,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ HISTOPLASMA,3087244,CDM,306,RC,87385,CPT,,,facility,outpatient,,,152.00000,80.71000,United Healthcare,Commercial,,136.80,,,,,,,39.52,147.44,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,inpatient,,,43.00000,22.83000,United Healthcare,Commercial,,38.70,,,,,,,38.70,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ INFLUENZA A/B,3107166,CDM,306,RC,87400,CPT,,,facility,outpatient,,,43.00000,22.83000,United Healthcare,Commercial,,38.70,,,,,,,11.18,41.71,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,inpatient,,,66.00000,35.05000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ LEGN URINE NS,3104551,CDM,306,RC,87449,CPT,,,facility,outpatient,,,66.00000,35.05000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,inpatient,,,36.00000,19.12000,United Healthcare,Commercial,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ QL,3087350,CDM,306,RC,87449,CPT,,,facility,outpatient,,,36.00000,19.12000,United Healthcare,Commercial,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,inpatient,,,36.00000,19.12000,United Healthcare,Commercial,,32.40,,,,,,,32.40,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ ROTAVIRUS,3087301,CDM,306,RC,87425,CPT,,,facility,outpatient,,,36.00000,19.12000,United Healthcare,Commercial,,32.40,,,,,,,9.36,34.92,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,inpatient,,,42.00000,22.30000,United Healthcare,Commercial,,37.80,,,,,,,37.80,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ RSV,3087319,CDM,306,RC,87420,CPT,,,facility,outpatient,,,42.00000,22.30000,United Healthcare,Commercial,,37.80,,,,,,,10.92,40.74,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,inpatient,,,147.00000,78.06000,United Healthcare,Commercial,,132.30,,,,,,,132.30,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ SEMI QN,3029733,CDM,306,RC,87449,CPT,,,facility,outpatient,,,147.00000,78.06000,United Healthcare,Commercial,,132.30,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,inpatient,,,64.00000,33.98000,United Healthcare,Commercial,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOX SHIGA,3087327,CDM,306,RC,87427,CPT,,,facility,outpatient,,,64.00000,33.98000,United Healthcare,Commercial,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,inpatient,,,60.00000,31.86000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
LAB DET AG IA IMM ENZ TOXIN C DIFF,3087160,CDM,306,RC,87324,CPT,,,facility,outpatient,,,60.00000,31.86000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,inpatient,,,75.00000,39.83000,United Healthcare,Commercial,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL,3087210,CDM,306,RC,87338,CPT,,,facility,outpatient,,,75.00000,39.83000,United Healthcare,Commercial,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,inpatient,,,44.00000,23.36000,United Healthcare,Commercial,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
LAB DET AG IA IMM H PYLORI STOOL NS,3110160,CDM,306,RC,87338,CPT,,,facility,outpatient,,,44.00000,23.36000,United Healthcare,Commercial,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,inpatient,,,87.00000,46.20000,United Healthcare,Commercial,,78.30,,,,,,,78.30,84.39,percent of total billed charges,
LAB DET AG IA IMM HIV1 W HIV 1&2,3116316,CDM,306,RC,87389,CPT,,,facility,outpatient,,,87.00000,46.20000,United Healthcare,Commercial,,78.30,,,,,,,22.62,84.39,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,inpatient,,,65.00000,34.52000,United Healthcare,Commercial,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL,3087681,CDM,306,RC,87899,CPT,,,facility,outpatient,,,65.00000,34.52000,United Healthcare,Commercial,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,inpatient,,,75.00000,39.83000,United Healthcare,Commercial,,67.50,,,,,,,67.50,72.75,percent of total billed charges,
LAB DET AG IA IMM OPTICAL NS,3121274,CDM,306,RC,87899,CPT,,,facility,outpatient,,,75.00000,39.83000,United Healthcare,Commercial,,67.50,,,,,,,19.50,72.75,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,inpatient,,,50.00000,26.55000,United Healthcare,Commercial,,45.00,,,,,,,45.00,48.50,percent of total billed charges,
LAB DET AG IA INFLUENZA IMM OPT,3087715,CDM,306,RC,87804,CPT,,,facility,outpatient,,,50.00000,26.55000,United Healthcare,Commercial,,45.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,inpatient,,,40.00000,21.24000,United Healthcare,Commercial,,36.00,,,,,,,36.00,38.80,percent of total billed charges,
LAB DET AG IA RSV IMM OPT,3104692,CDM,306,RC,87807,CPT,,,facility,outpatient,,,40.00000,21.24000,United Healthcare,Commercial,,36.00,,,,,,,10.40,38.80,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,inpatient,,,50.00000,26.55000,United Healthcare,Commercial,,45.00,,,,,,,45.00,48.50,percent of total billed charges,
LAB DET AG IA STREP GROUP A IMM OPT,3105681,CDM,306,RC,87880,CPT,,,facility,outpatient,,,50.00000,26.55000,United Healthcare,Commercial,,45.00,,,,,,,13.00,48.50,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA ADENOVIRUS PCR QN,3110798,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,inpatient,,,115.00000,61.07000,United Healthcare,Commercial,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB DET IA ASPERGILLUS PCR PRB AMP,3029402,CDM,306,RC,87798,CPT,,,facility,outpatient,,,115.00000,61.07000,United Healthcare,Commercial,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA B PERTUSSIS PCR PRB AMP,3115169,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,inpatient,,,1309.00000,695.08000,United Healthcare,Commercial,,1178.10,,,,,,,1178.10,1269.73,percent of total billed charges,
LAB DET IA BACTERIAL MULT PRB AMP,3124559,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1309.00000,695.08000,United Healthcare,Commercial,,1178.10,,,,,,,340.34,1269.73,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR PRB AMP,3111002,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN NS,3108925,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA BK VIRUS PCR QN URINE,3113115,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,inpatient,,,328.00000,174.17000,United Healthcare,Commercial,,295.20,,,,,,,295.20,318.16,percent of total billed charges,
LAB DET IA CHLAMYD PNEU PRB AMP NS,3112372,CDM,306,RC,87486,CPT,,,facility,outpatient,,,328.00000,174.17000,United Healthcare,Commercial,,295.20,,,,,,,85.28,318.16,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP,3086493,CDM,306,RC,87491,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,inpatient,,,115.00000,61.07000,United Healthcare,Commercial,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB DET IA CHLAMYD TRAC PRB AMP NS,3111028,CDM,306,RC,87491,CPT,,,facility,outpatient,,,115.00000,61.07000,United Healthcare,Commercial,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA CMV PRB AMP NS,3086519,CDM,306,RC,87496,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,inpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA CMV QN,3118791,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,inpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA CMV QN NS,3086527,CDM,306,RC,87497,CPT,,,facility,outpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,inpatient,,,1251.00000,664.28000,United Healthcare,Commercial,,1125.90,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA CNS PRB AMP 12-25 TGT,3118775,CDM,306,RC,87483,CPT,,,facility,outpatient,,,1251.00000,664.28000,United Healthcare,Commercial,,1125.90,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,inpatient,,,154.00000,81.77000,United Healthcare,Commercial,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP,3121829,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,United Healthcare,Commercial,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,inpatient,,,154.00000,81.77000,United Healthcare,Commercial,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA COV19 PRB AMP NS,3121811,CDM,306,RC,87635,CPT,,,facility,outpatient,,,154.00000,81.77000,United Healthcare,Commercial,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,inpatient,,,96.00000,50.98000,United Healthcare,Commercial,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
LAB DET IA COV19&FLU A&B PRB AMP,3028388,CDM,306,RC,87636,CPT,,,facility,outpatient,,,96.00000,50.98000,United Healthcare,Commercial,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,inpatient,,,211.00000,112.04000,United Healthcare,Commercial,,189.90,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA CT&NG PRB AMP MULTIPLEX,3126034,CDM,306,RC,87494,CPT,,,facility,outpatient,,,211.00000,112.04000,United Healthcare,Commercial,,189.90,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,inpatient,,,290.00000,153.99000,United Healthcare,Commercial,,261.00,,,,,,,261.00,281.30,percent of total billed charges,
LAB DET IA DENGUE TYPES 1-4 PRB AMP,3904109,CDM,306,RC,87798,CPT,,,facility,outpatient,,,290.00000,153.99000,United Healthcare,Commercial,,261.00,,,,,,,75.40,281.30,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA EBV PCR PRB AMP,3110822,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN,3107828,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA EBV PCR QN NS,3110772,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,inpatient,,,411.00000,218.24000,United Healthcare,Commercial,,369.90,,,,,,,369.90,398.67,percent of total billed charges,
LAB DET IA ENTEROBACTR MULT PRB AMP,3124542,CDM,306,RC,87801,CPT,,,facility,outpatient,,,411.00000,218.24000,United Healthcare,Commercial,,369.90,,,,,,,106.86,398.67,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,inpatient,,,139.00000,73.81000,United Healthcare,Commercial,,125.10,,,,,,,125.10,134.83,percent of total billed charges,
LAB DET IA ENTEROVRS PRB AMP NS,3023355,CDM,306,RC,87498,CPT,,,facility,outpatient,,,139.00000,73.81000,United Healthcare,Commercial,,125.10,,,,,,,36.14,134.83,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,inpatient,,,288.00000,152.93000,United Healthcare,Commercial,,259.20,,,,,,,259.20,279.36,percent of total billed charges,
LAB DET IA FLU REV T&PRB AMP 1-2,3024114,CDM,306,RC,87502,CPT,,,facility,outpatient,,,288.00000,152.93000,United Healthcare,Commercial,,259.20,,,,,,,74.88,279.36,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,inpatient,,,1372.00000,728.53000,United Healthcare,Commercial,,1234.80,,,,,,,1234.80,1330.84,percent of total billed charges,
LAB DET IA FUNGAL MULT PRB AMP,3030632,CDM,306,RC,87801,CPT,,,facility,outpatient,,,1372.00000,728.53000,United Healthcare,Commercial,,1234.80,,,,,,,356.72,1330.84,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP,3087368,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA GC PRB AMP NS,3111036,CDM,306,RC,87591,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,inpatient,,,1251.00000,664.28000,United Healthcare,Commercial,,1125.90,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA GI MULT PRB 12-25TGT NS,3117660,CDM,306,RC,87507,CPT,,,facility,outpatient,,,1251.00000,664.28000,United Healthcare,Commercial,,1125.90,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,inpatient,,,135.00000,71.68000,United Healthcare,Commercial,,121.50,,,,,,,121.50,130.95,percent of total billed charges,
LAB DET IA HEP B PRB AMP,3072196,CDM,306,RC,87516,CPT,,,facility,outpatient,,,135.00000,71.68000,United Healthcare,Commercial,,121.50,,,,,,,35.10,130.95,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,inpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HEP B QN,3112240,CDM,306,RC,87517,CPT,,,facility,outpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HEP C PRB AMP,3024387,CDM,306,RC,87521,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,inpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HEP C QN,3024395,CDM,306,RC,87522,CPT,,,facility,outpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,inpatient,,,147.00000,78.06000,United Healthcare,Commercial,,132.30,,,,,,,132.30,142.59,percent of total billed charges,
LAB DET IA HEP C QN NS,3024411,CDM,306,RC,87522,CPT,,,facility,outpatient,,,147.00000,78.06000,United Healthcare,Commercial,,132.30,,,,,,,38.22,142.59,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,inpatient,,,126.00000,66.91000,United Healthcare,Commercial,,113.40,,,,,,,113.40,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PCR QN,3108891,CDM,306,RC,87533,CPT,,,facility,outpatient,,,126.00000,66.91000,United Healthcare,Commercial,,113.40,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,inpatient,,,120.00000,63.72000,United Healthcare,Commercial,,108.00,,,,,,,108.00,116.40,percent of total billed charges,
LAB DET IA HERPES 6 PRB AMP,3087459,CDM,306,RC,87532,CPT,,,facility,outpatient,,,120.00000,63.72000,United Healthcare,Commercial,,108.00,,,,,,,31.20,116.40,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HHV NON 6 PCR QN,3110806,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,inpatient,,,124.00000,65.84000,United Healthcare,Commercial,,111.60,,,,,,,111.60,120.28,percent of total billed charges,
LAB DET IA HHV-8 PCR PRB AMP,3110814,CDM,306,RC,87798,CPT,,,facility,outpatient,,,124.00000,65.84000,United Healthcare,Commercial,,111.60,,,,,,,32.24,120.28,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,inpatient,,,108.00000,57.35000,United Healthcare,Commercial,,97.20,,,,,,,97.20,104.76,percent of total billed charges,
LAB DET IA HIV-1 PRB AMP NS,3023199,CDM,306,RC,87535,CPT,,,facility,outpatient,,,108.00000,57.35000,United Healthcare,Commercial,,97.20,,,,,,,28.08,104.76,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,inpatient,,,256.00000,135.94000,United Healthcare,Commercial,,230.40,,,,,,,230.40,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN,3024403,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,United Healthcare,Commercial,,230.40,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,inpatient,,,256.00000,135.94000,United Healthcare,Commercial,,230.40,,,,,,,230.40,248.32,percent of total billed charges,
LAB DET IA HIV-1 QN NS,3116332,CDM,306,RC,87536,CPT,,,facility,outpatient,,,256.00000,135.94000,United Healthcare,Commercial,,230.40,,,,,,,66.56,248.32,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,inpatient,,,122.00000,64.78000,United Healthcare,Commercial,,109.80,,,,,,,109.80,118.34,percent of total billed charges,
LAB DET IA HIV-2 REV T&PRB AMP,3027612,CDM,306,RC,87538,CPT,,,facility,outpatient,,,122.00000,64.78000,United Healthcare,Commercial,,109.80,,,,,,,31.72,118.34,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HPV TYPE RISK HIGH POOL,3124690,CDM,306,RC,87624,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP,3117868,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP NS,3087467,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA HSV PRB AMP PCR CSF,3023488,CDM,306,RC,87529,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,inpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA HSV QN,3104569,CDM,306,RC,87530,CPT,,,facility,outpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA IGM PRB AMP,3121225,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,inpatient,,,123.00000,65.31000,United Healthcare,Commercial,,110.70,,,,,,,110.70,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR PRB AMP,3108909,CDM,306,RC,87798,CPT,,,facility,outpatient,,,123.00000,65.31000,United Healthcare,Commercial,,110.70,,,,,,,31.98,119.31,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA JC VIRUS PCR QN,3108917,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PNEUM PRB AMP,3115649,CDM,306,RC,87541,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEGIONELL PRB AMP,3119773,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA LEPTOSPIRA PCR PRB AMP,3124021,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,inpatient,,,518.00000,275.06000,United Healthcare,Commercial,,466.20,,,,,,,466.20,502.46,percent of total billed charges,
LAB DET IA MALARIA PCR PRB AMP,3030830,CDM,306,RC,87798,CPT,,,facility,outpatient,,,518.00000,275.06000,United Healthcare,Commercial,,466.20,,,,,,,134.68,502.46,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MRSA PRB AMP NS,3107422,CDM,306,RC,87641,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,inpatient,,,275.00000,146.02000,United Healthcare,Commercial,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
LAB DET IA MUCORALES PCR PRB AMP,3028347,CDM,306,RC,87798,CPT,,,facility,outpatient,,,275.00000,146.02000,United Healthcare,Commercial,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,inpatient,,,270.00000,143.37000,United Healthcare,Commercial,,243.00,,,,,,,243.00,261.90,percent of total billed charges,
LAB DET IA MYCOBCT AV-INTRA PRB AMP,3111234,CDM,306,RC,87561,CPT,,,facility,outpatient,,,270.00000,143.37000,United Healthcare,Commercial,,243.00,,,,,,,70.20,261.90,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,inpatient,,,450.00000,238.95000,United Healthcare,Commercial,,405.00,,,,,,,405.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT PRB AMP,3118106,CDM,306,RC,87551,CPT,,,facility,outpatient,,,450.00000,238.95000,United Healthcare,Commercial,,405.00,,,,,,,117.00,436.50,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,inpatient,,,126.00000,66.91000,United Healthcare,Commercial,,113.40,,,,,,,113.40,122.22,percent of total billed charges,
LAB DET IA MYCOBCT TB PRB AMP NS,3087749,CDM,306,RC,87556,CPT,,,facility,outpatient,,,126.00000,66.91000,United Healthcare,Commercial,,113.40,,,,,,,32.76,122.22,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS GEN PRB AMP,3121621,CDM,306,RC,87563,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP,3027778,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA MYCOPLAS PNEU PRB AMP NS,3087806,CDM,306,RC,87581,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,inpatient,,,362.00000,192.22000,United Healthcare,Commercial,,325.80,,,,,,,325.80,351.14,percent of total billed charges,
LAB DET IA NORCARDIA PCR PRB AMP,3028354,CDM,306,RC,87798,CPT,,,facility,outpatient,,,362.00000,192.22000,United Healthcare,Commercial,,325.80,,,,,,,94.12,351.14,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,inpatient,,,109.00000,57.88000,United Healthcare,Commercial,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB DET IA NOROVIRUS PCR PRB AMP,3125176,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,United Healthcare,Commercial,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,inpatient,,,638.00000,338.78000,United Healthcare,Commercial,,574.20,,,,,,,574.20,618.86,percent of total billed charges,
LAB DET IA ORGANISMS FNGL MULT PRB,3030608,CDM,306,RC,87801,CPT,,,facility,outpatient,,,638.00000,338.78000,United Healthcare,Commercial,,574.20,,,,,,,165.88,618.86,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,inpatient,,,211.00000,112.04000,United Healthcare,Commercial,,189.90,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA ORGANISMS MULT PRB AMP,3087798,CDM,306,RC,87801,CPT,,,facility,outpatient,,,211.00000,112.04000,United Healthcare,Commercial,,189.90,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,inpatient,,,154.00000,81.77000,United Healthcare,Commercial,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB DET IA ORTHOPOXVIRUS PRB AMP,3123122,CDM,306,RC,87593,CPT,,,facility,outpatient,,,154.00000,81.77000,United Healthcare,Commercial,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR PRB AMP,3105475,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,inpatient,,,141.00000,74.87000,United Healthcare,Commercial,,126.90,,,,,,,126.90,136.77,percent of total billed charges,
LAB DET IA PARVOVIRUS PCR QN,3113420,CDM,306,RC,87799,CPT,,,facility,outpatient,,,141.00000,74.87000,United Healthcare,Commercial,,126.90,,,,,,,36.66,136.77,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,inpatient,,,2040.00000,1083.24000,United Healthcare,Commercial,,1836.00,,,,,,,1836.00,1978.80,percent of total billed charges,
LAB DET IA PATH JT&GENE RXRST 26+,3126117,CDM,306,RC,87627,CPT,,,facility,outpatient,,,2040.00000,1083.24000,United Healthcare,Commercial,,1836.00,,,,,,,530.40,1978.80,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,inpatient,,,421.00000,223.55000,United Healthcare,Commercial,,378.90,,,,,,,378.90,408.37,percent of total billed charges,
LAB DET IA PNEUM JIROVECII RFLX PRB,3030657,CDM,306,RC,87594,CPT,,,facility,outpatient,,,421.00000,223.55000,United Healthcare,Commercial,,378.90,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,inpatient,,,275.00000,146.02000,United Healthcare,Commercial,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
LAB DET IA PNEUMOCYSTIS PCR QN,3113230,CDM,306,RC,87799,CPT,,,facility,outpatient,,,275.00000,146.02000,United Healthcare,Commercial,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA PRB AMP NS,3104577,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,inpatient,,,1251.00000,664.28000,United Healthcare,Commercial,,1125.90,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 12-25 TGT NS,3024049,CDM,306,RC,87633,CPT,,,facility,outpatient,,,1251.00000,664.28000,United Healthcare,Commercial,,1125.90,,,,,,,325.26,1213.47,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,inpatient,,,428.00000,227.27000,United Healthcare,Commercial,,385.20,,,,,,,385.20,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT,3025889,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,United Healthcare,Commercial,,385.20,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,inpatient,,,428.00000,227.27000,United Healthcare,Commercial,,385.20,,,,,,,385.20,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 3-5 TGT NS,3027588,CDM,306,RC,87631,CPT,,,facility,outpatient,,,428.00000,227.27000,United Healthcare,Commercial,,385.20,,,,,,,111.28,415.16,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,inpatient,,,655.00000,347.80000,United Healthcare,Commercial,,589.50,,,,,,,589.50,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT,3025426,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,United Healthcare,Commercial,,589.50,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,inpatient,,,655.00000,347.80000,United Healthcare,Commercial,,589.50,,,,,,,589.50,635.35,percent of total billed charges,
LAB DET IA RESP MLTPLX 6-11 TGT NS,3030004,CDM,306,RC,87632,CPT,,,facility,outpatient,,,655.00000,347.80000,United Healthcare,Commercial,,589.50,,,,,,,170.30,635.35,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,inpatient,,,211.00000,112.04000,United Healthcare,Commercial,,189.90,,,,,,,189.90,204.67,percent of total billed charges,
LAB DET IA RSV PRB AMP,3903630,CDM,306,RC,87634,CPT,,,facility,outpatient,,,211.00000,112.04000,United Healthcare,Commercial,,189.90,,,,,,,54.86,204.67,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA RUBELLA PCR PRB AMP,3124492,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA STREP GROUP A PRB AMP,3094661,CDM,306,RC,87651,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA STREP GROUP B PRB AMP,3107430,CDM,306,RC,87653,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,inpatient,,,112.00000,59.47000,United Healthcare,Commercial,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP,3113461,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,United Healthcare,Commercial,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,inpatient,,,112.00000,59.47000,United Healthcare,Commercial,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
LAB DET IA TOXIN C DIFF PRB AMP NS,3111895,CDM,306,RC,87493,CPT,,,facility,outpatient,,,112.00000,59.47000,United Healthcare,Commercial,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,inpatient,,,130.00000,69.03000,United Healthcare,Commercial,,117.00,,,,,,,117.00,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA PCR QN,3113222,CDM,306,RC,87799,CPT,,,facility,outpatient,,,130.00000,69.03000,United Healthcare,Commercial,,117.00,,,,,,,33.80,126.10,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,inpatient,,,421.00000,223.55000,United Healthcare,Commercial,,378.90,,,,,,,378.90,408.37,percent of total billed charges,
LAB DET IA TOXOPLASMA RFLX PCR PRB,3030665,CDM,306,RC,87798,CPT,,,facility,outpatient,,,421.00000,223.55000,United Healthcare,Commercial,,378.90,,,,,,,109.46,408.37,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,inpatient,,,111.00000,58.94000,United Healthcare,Commercial,,99.90,,,,,,,99.90,107.67,percent of total billed charges,
LAB DET IA TRICHOMON VAG PRB AMP NS,3119211,CDM,306,RC,87661,CPT,,,facility,outpatient,,,111.00000,58.94000,United Healthcare,Commercial,,99.90,,,,,,,28.86,107.67,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA TRICHOMONAS VAG PRB AMP,3115060,CDM,306,RC,87661,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB DET IA VARICELLA-ZOSTER PRB AMP,3029295,CDM,306,RC,87798,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,inpatient,,,200.00000,106.20000,United Healthcare,Commercial,,180.00,,,,,,,180.00,194.00,percent of total billed charges,
LAB DET IA VIRUS ZIKA PRB AMP,3119682,CDM,306,RC,87662,CPT,,,facility,outpatient,,,200.00000,106.20000,United Healthcare,Commercial,,180.00,,,,,,,52.00,194.00,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,inpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,116.10,125.13,percent of total billed charges,
LAB DET IA VZV PCR QN,3111432,CDM,306,RC,87799,CPT,,,facility,outpatient,,,129.00000,68.50000,United Healthcare,Commercial,,116.10,,,,,,,33.54,125.13,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,inpatient,,,13.00000,6.90000,United Healthcare,Commercial,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC ARTHROPOD,3087764,CDM,306,RC,87168,CPT,,,facility,outpatient,,,13.00000,6.90000,United Healthcare,Commercial,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,inpatient,,,58.00000,30.80000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB EXAM MACROSCOPIC PARASITE,3087772,CDM,306,RC,87169,CPT,,,facility,outpatient,,,58.00000,30.80000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,inpatient,,,13.00000,6.90000,United Healthcare,Commercial,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB EXAM PINWORM,3087822,CDM,306,RC,87172,CPT,,,facility,outpatient,,,13.00000,6.90000,United Healthcare,Commercial,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,inpatient,,,773.00000,410.46000,United Healthcare,Commercial,,695.70,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA CYTOMEGALOVIRUS,3025087,CDM,306,RC,87910,CPT,,,facility,outpatient,,,773.00000,410.46000,United Healthcare,Commercial,,695.70,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,inpatient,,,773.00000,410.46000,United Healthcare,Commercial,,695.70,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS B,3024007,CDM,306,RC,87912,CPT,,,facility,outpatient,,,773.00000,410.46000,United Healthcare,Commercial,,695.70,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,inpatient,,,773.00000,410.46000,United Healthcare,Commercial,,695.70,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HEPATITIS C NS,3104585,CDM,306,RC,87902,CPT,,,facility,outpatient,,,773.00000,410.46000,United Healthcare,Commercial,,695.70,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,inpatient,,,773.00000,410.46000,United Healthcare,Commercial,,695.70,,,,,,,695.70,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 REV T NS,3072808,CDM,306,RC,87901,CPT,,,facility,outpatient,,,773.00000,410.46000,United Healthcare,Commercial,,695.70,,,,,,,200.98,749.81,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,inpatient,,,387.00000,205.50000,United Healthcare,Commercial,,348.30,,,,,,,348.30,375.39,percent of total billed charges,
LAB GENOTYPE IA HIV-1 TROPISM CORCP,3112703,CDM,306,RC,87906,CPT,,,facility,outpatient,,,387.00000,205.50000,United Healthcare,Commercial,,348.30,,,,,,,100.62,375.39,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,inpatient,,,52.00000,27.61000,United Healthcare,Commercial,,46.80,,,,,,,46.80,50.44,percent of total billed charges,
LAB HOMOGENIZATION TISSUE,3087491,CDM,306,RC,87176,CPT,,,facility,outpatient,,,52.00000,27.61000,United Healthcare,Commercial,,46.80,,,,,,,13.52,50.44,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,inpatient,,,102.00000,54.16000,United Healthcare,Commercial,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC,3087087,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,United Healthcare,Commercial,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,inpatient,,,102.00000,54.16000,United Healthcare,Commercial,,91.80,,,,,,,91.80,98.94,percent of total billed charges,
LAB ISO VIRUS ID ACT ENZYMATIC NS,3122397,CDM,306,RC,87255,CPT,,,facility,outpatient,,,102.00000,54.16000,United Healthcare,Commercial,,91.80,,,,,,,26.52,98.94,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,inpatient,,,79.00000,41.95000,United Healthcare,Commercial,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE,3087103,CDM,306,RC,87252,CPT,,,facility,outpatient,,,79.00000,41.95000,United Healthcare,Commercial,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,inpatient,,,65.00000,34.52000,United Healthcare,Commercial,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE ADDL,3087095,CDM,306,RC,87253,CPT,,,facility,outpatient,,,65.00000,34.52000,United Healthcare,Commercial,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,inpatient,,,100.00000,53.10000,United Healthcare,Commercial,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
LAB ISO VIRUS INOC TISSUE NS,3105533,CDM,306,RC,87252,CPT,,,facility,outpatient,,,100.00000,53.10000,United Healthcare,Commercial,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,inpatient,,,64.00000,33.98000,United Healthcare,Commercial,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF,3086659,CDM,306,RC,87254,CPT,,,facility,outpatient,,,64.00000,33.98000,United Healthcare,Commercial,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,inpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
LAB ISO VIRUS SHELL VIAL ID W IF NS,3104544,CDM,306,RC,87254,CPT,,,facility,outpatient,,,106.00000,56.29000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,inpatient,,,109.00000,57.88000,United Healthcare,Commercial,,98.10,,,,,,,98.10,105.73,percent of total billed charges,
LAB RNA NOROVIRUS AMP PROBE,3027018,CDM,306,RC,87798,CPT,,,facility,outpatient,,,109.00000,57.88000,United Healthcare,Commercial,,98.10,,,,,,,28.34,105.73,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,inpatient,,,58.00000,30.80000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB SCR CULT GONORRHEA,3086840,CDM,306,RC,87081,CPT,,,facility,outpatient,,,58.00000,30.80000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,United Healthcare,Commercial,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT H PYLORI SGL,3109097,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,United Healthcare,Commercial,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,inpatient,,,66.00000,35.05000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB SCR CULT ORGANISMS SGL NS,3029980,CDM,306,RC,87081,CPT,,,facility,outpatient,,,66.00000,35.05000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,United Healthcare,Commercial,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STAPH MRSA,3086873,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,United Healthcare,Commercial,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,United Healthcare,Commercial,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP A,3094125,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,United Healthcare,Commercial,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,inpatient,,,20.00000,10.62000,United Healthcare,Commercial,,18.00,,,,,,,18.00,19.40,percent of total billed charges,
LAB SCR CULT STREP GROUP B,3086881,CDM,306,RC,87081,CPT,,,facility,outpatient,,,20.00000,10.62000,United Healthcare,Commercial,,18.00,,,,,,,5.20,19.40,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,inpatient,,,13.00000,6.90000,United Healthcare,Commercial,,11.70,,,,,,,11.70,12.61,percent of total billed charges,
LAB SMEAR GRAM/GIEMSA,3087897,CDM,306,RC,87205,CPT,,,facility,outpatient,,,13.00000,6.90000,United Healthcare,Commercial,,11.70,,,,,,,3.38,12.61,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,inpatient,,,53.00000,28.14000,United Healthcare,Commercial,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB SMEAR IA WET MOUNT,3088036,CDM,306,RC,87210,CPT,,,facility,outpatient,,,53.00000,28.14000,United Healthcare,Commercial,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,inpatient,,,18.00000,9.56000,United Healthcare,Commercial,,16.20,,,,,,,16.20,17.46,percent of total billed charges,
LAB SMEAR INCL BODIES/PARASITE,3087830,CDM,306,RC,87207,CPT,,,facility,outpatient,,,18.00000,9.56000,United Healthcare,Commercial,,16.20,,,,,,,4.68,17.46,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,inpatient,,,17.00000,9.03000,United Healthcare,Commercial,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
LAB SMEAR STAIN ACID FAST AFB,3087848,CDM,306,RC,87206,CPT,,,facility,outpatient,,,17.00000,9.03000,United Healthcare,Commercial,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,inpatient,,,71.00000,37.70000,United Healthcare,Commercial,,63.90,,,,,,,63.90,68.87,percent of total billed charges,
LAB SMEAR STAIN CMPLX OVA&PARASITES,3094091,CDM,306,RC,87209,CPT,,,facility,outpatient,,,71.00000,37.70000,United Healthcare,Commercial,,63.90,,,,,,,18.46,68.87,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,inpatient,,,57.00000,30.27000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB,3087863,CDM,306,RC,87206,CPT,,,facility,outpatient,,,57.00000,30.27000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,inpatient,,,68.00000,36.11000,United Healthcare,Commercial,,61.20,,,,,,,61.20,65.96,percent of total billed charges,
LAB SMEAR STAIN FL AFB NS,3107877,CDM,306,RC,87206,CPT,,,facility,outpatient,,,68.00000,36.11000,United Healthcare,Commercial,,61.20,,,,,,,17.68,65.96,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,inpatient,,,58.00000,30.80000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB SMEAR STAIN FL FUNGI,3087889,CDM,306,RC,87206,CPT,,,facility,outpatient,,,58.00000,30.80000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,inpatient,,,27.00000,14.34000,United Healthcare,Commercial,,24.30,,,,,,,24.30,26.19,percent of total billed charges,
LAB SMEARS DIRECT OVA&PARASITES,3087913,CDM,306,RC,87177,CPT,,,facility,outpatient,,,27.00000,14.34000,United Healthcare,Commercial,,24.30,,,,,,,7.02,26.19,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,inpatient,,,56.00000,29.74000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SUSCPT CARBAPENEMASE DET ENZ,3125945,CDM,306,RC,87182,CPT,,,facility,outpatient,,,56.00000,29.74000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,inpatient,,,56.00000,29.74000,United Healthcare,Commercial,,50.40,,,,,,,50.40,54.32,percent of total billed charges,
LAB SUSCPT DETECTION ENZYME EA,3087954,CDM,306,RC,87185,CPT,,,facility,outpatient,,,56.00000,29.74000,United Healthcare,Commercial,,50.40,,,,,,,14.56,54.32,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,inpatient,,,58.00000,30.80000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH,3087970,CDM,306,RC,87188,CPT,,,facility,outpatient,,,58.00000,30.80000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,inpatient,,,115.00000,61.07000,United Healthcare,Commercial,,103.50,,,,,,,103.50,111.55,percent of total billed charges,
LAB SUSCPT DILUTION MACROBROTH NS,3110715,CDM,306,RC,87188,CPT,,,facility,outpatient,,,115.00000,61.07000,United Healthcare,Commercial,,103.50,,,,,,,29.90,111.55,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,inpatient,,,23.00000,12.21000,United Healthcare,Commercial,,20.70,,,,,,,20.70,22.31,percent of total billed charges,
LAB SUSCPT DISK KIRBY BAUER,3087947,CDM,306,RC,87184,CPT,,,facility,outpatient,,,23.00000,12.21000,United Healthcare,Commercial,,20.70,,,,,,,5.98,22.31,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,inpatient,,,255.00000,135.40000,United Healthcare,Commercial,,229.50,,,,,,,229.50,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA,3087962,CDM,306,RC,87181,CPT,,,facility,outpatient,,,255.00000,135.40000,United Healthcare,Commercial,,229.50,,,,,,,66.30,247.35,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,inpatient,,,66.00000,35.05000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
LAB SUSCPT ETEST AGENT EA NS,3020112,CDM,306,RC,87181,CPT,,,facility,outpatient,,,66.00000,35.05000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,inpatient,,,26.00000,13.81000,United Healthcare,Commercial,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB SUSCPT MIC PLATE EA,3087988,CDM,306,RC,87186,CPT,,,facility,outpatient,,,26.00000,13.81000,United Healthcare,Commercial,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,inpatient,,,64.00000,33.98000,United Healthcare,Commercial,,57.60,,,,,,,57.60,62.08,percent of total billed charges,
LAB TISSUE KOH SKIN/HAIR/NAIL FUNGI,3088002,CDM,306,RC,87220,CPT,,,facility,outpatient,,,64.00000,33.98000,United Healthcare,Commercial,,57.60,,,,,,,16.64,62.08,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,inpatient,,,215.00000,114.16000,United Healthcare,Commercial,,193.50,,,,,,,193.50,208.55,percent of total billed charges,
LAB TISSUE KOH SKN/HAR/NAL FUNGI NS,3123007,CDM,306,RC,87220,CPT,,,facility,outpatient,,,215.00000,114.16000,United Healthcare,Commercial,,193.50,,,,,,,55.90,208.55,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,inpatient,,,79.00000,41.95000,United Healthcare,Commercial,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB TOXIN CULT TISSUE C DIFF NS,3088010,CDM,306,RC,87230,CPT,,,facility,outpatient,,,79.00000,41.95000,United Healthcare,Commercial,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,inpatient,,,11.00000,5.29000,United Healthcare,Commercial,,9.90,,,,,,,9.90,10.67,percent of total billed charges,
LAB MEASUREMENT VOL COLL TIMED EA,3088200,CDM,307,RC,81050,CPT,,,facility,outpatient,,,11.00000,5.29000,United Healthcare,Commercial,,9.90,,,,,,,2.86,10.67,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,inpatient,,,58.00000,27.90000,United Healthcare,Commercial,,52.20,,,,,,,52.20,56.26,percent of total billed charges,
LAB PREGNANCY URINE,3088192,CDM,307,RC,81025,CPT,,,facility,outpatient,,,58.00000,27.90000,United Healthcare,Commercial,,52.20,,,,,,,15.08,56.26,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,inpatient,,,10.00000,4.81000,United Healthcare,Commercial,,9.00,,,,,,,9.00,9.70,percent of total billed charges,
LAB UA AUTO W MICRO,3088119,CDM,307,RC,81001,CPT,,,facility,outpatient,,,10.00000,4.81000,United Healthcare,Commercial,,9.00,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,inpatient,,,7.00000,3.37000,United Healthcare,Commercial,,6.30,,,,,,,6.30,6.79,percent of total billed charges,
LAB UA AUTO WO MICRO,3088127,CDM,307,RC,81003,CPT,,,facility,outpatient,,,7.00000,3.37000,United Healthcare,Commercial,,6.30,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,inpatient,,,53.00000,25.49000,United Healthcare,Commercial,,47.70,,,,,,,47.70,51.41,percent of total billed charges,
LAB UA GRAVITY SPCFC AUTO WO MICRO,3088101,CDM,307,RC,81003,CPT,,,facility,outpatient,,,53.00000,25.49000,United Healthcare,Commercial,,47.70,,,,,,,13.78,51.41,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,inpatient,,,10.00000,4.81000,United Healthcare,Commercial,,9.00,,,,,,,9.00,9.70,percent of total billed charges,
LAB UA MICROSCOPIC ONLY,3088135,CDM,307,RC,81015,CPT,,,facility,outpatient,,,10.00000,4.81000,United Healthcare,Commercial,,9.00,,,,,,,2.60,9.70,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,inpatient,,,11.00000,5.29000,United Healthcare,Commercial,,9.90,,,,,,,9.90,10.67,percent of total billed charges,
LAB UA NONAUTO WO MICRO,3088143,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,United Healthcare,Commercial,,9.90,,,,,,,2.86,10.67,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,inpatient,,,7.00000,3.37000,United Healthcare,Commercial,,6.30,,,,,,,6.30,6.79,percent of total billed charges,
LAB UA QL/SEMI QN,3088168,CDM,307,RC,81005,CPT,,,facility,outpatient,,,7.00000,3.37000,United Healthcare,Commercial,,6.30,,,,,,,1.82,6.79,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,inpatient,,,11.00000,5.29000,United Healthcare,Commercial,,9.90,,,,,,,9.90,10.67,percent of total billed charges,
LAB UA REDUCING SUBSTANCE,3088069,CDM,307,RC,81002,CPT,,,facility,outpatient,,,11.00000,5.29000,United Healthcare,Commercial,,9.90,,,,,,,2.86,10.67,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,inpatient,,,597.00000,290.14000,United Healthcare,Commercial,,537.30,,,,,,,537.30,579.09,percent of total billed charges,
LAB CHROMAT MS PFAS 9 CMPD SRM/PLSM,3125796,CDM,310,RC,0457U,CPT,,,facility,outpatient,,,597.00000,290.14000,United Healthcare,Commercial,,537.30,,,,,,,155.22,579.09,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,inpatient,,,6379.00000,3100.19000,United Healthcare,Commercial,,5741.10,,,,,,,5741.10,6187.63,percent of total billed charges,
LAB DIS INFCT DNA PLASMA NGS UNTGT,3029147,CDM,310,RC,0152U,CPT,,,facility,outpatient,,,6379.00000,3100.19000,United Healthcare,Commercial,,5741.10,,,,,,,1658.54,6187.63,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,inpatient,,,471.00000,228.91000,United Healthcare,Commercial,,423.90,,,,,,,423.90,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM- RXRST,3122728,CDM,310,RC,0142U,CPT,,,facility,outpatient,,,471.00000,228.91000,United Healthcare,Commercial,,423.90,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,inpatient,,,471.00000,228.91000,United Healthcare,Commercial,,423.90,,,,,,,423.90,456.87,percent of total billed charges,
LAB DIS INFCT ID BAC&FNG GRM+ RXRST,3122710,CDM,310,RC,0141U,CPT,,,facility,outpatient,,,471.00000,228.91000,United Healthcare,Commercial,,423.90,,,,,,,122.46,456.87,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,inpatient,,,1251.00000,607.99000,United Healthcare,Commercial,,1125.90,,,,,,,1125.90,1213.47,percent of total billed charges,
LAB DIS INFCT SARS-COV-2 TGT 21,3123874,CDM,310,RC,0225U,CPT,,,facility,outpatient,,,1251.00000,607.99000,United Healthcare,Commercial,,1125.90,,,,,,,325.26,1213.47,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,inpatient,,,260.00000,126.36000,United Healthcare,Commercial,,234.00,,,,,,,234.00,252.20,percent of total billed charges,
LAB FETAL CONGENITAL ABNORMALITIES,3023462,CDM,310,RC,81508,CPT,,,facility,outpatient,,,260.00000,126.36000,United Healthcare,Commercial,,234.00,,,,,,,67.60,252.20,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,inpatient,,,785.00000,381.51000,United Healthcare,Commercial,,706.50,,,,,,,706.50,761.45,percent of total billed charges,
LAB IMM NEURO AMYLD 1-42&1-40 CSF,3030285,CDM,310,RC,0358U,CPT,,,facility,outpatient,,,785.00000,381.51000,United Healthcare,Commercial,,706.50,,,,,,,204.10,761.45,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,inpatient,,,529.00000,257.09000,United Healthcare,Commercial,,476.10,,,,,,,476.10,513.13,percent of total billed charges,
LAB LIVER DIS ANYL 3BIOMARK ALG SRM,3124245,CDM,310,RC,81517,CPT,,,facility,outpatient,,,529.00000,257.09000,United Healthcare,Commercial,,476.10,,,,,,,137.54,513.13,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,inpatient,,,1623.00000,788.78000,United Healthcare,Commercial,,1460.70,,,,,,,1460.70,1574.31,percent of total billed charges,
LAB NEURO CSF PRION PROT QUAL,3120839,CDM,310,RC,0035U,CPT,,,facility,outpatient,,,1623.00000,788.78000,United Healthcare,Commercial,,1460.70,,,,,,,421.98,1574.31,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,inpatient,,,10800.00000,5248.80000,United Healthcare,Commercial,,9720.00,,,,,,,9720.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&MRNA 74,3125168,CDM,310,RC,0313U,CPT,,,facility,outpatient,,,10800.00000,5248.80000,United Healthcare,Commercial,,9720.00,,,,,,,2808.00,10476.00,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,inpatient,,,25365.00000,12327.39000,United Healthcare,Commercial,,22828.50,,,,,,,22828.50,24604.05,percent of total billed charges,
LAB ONC SEQ NEXT GEN DNA&RNA FFPE,3125010,CDM,310,RC,0211U,CPT,,,facility,outpatient,,,25365.00000,12327.39000,United Healthcare,Commercial,,22828.50,,,,,,,6594.90,24604.05,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,inpatient,,,101.00000,21.82000,United Healthcare,Commercial,,90.90,,,,,,,90.90,97.97,percent of total billed charges,
LAB CHROM KARYOTYPES ADDL EA,3103017,CDM,311,RC,88280,CPT,,,facility,outpatient,,,101.00000,21.82000,United Healthcare,Commercial,,90.90,,,,,,,26.26,97.97,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,inpatient,,,81.00000,17.50000,United Healthcare,Commercial,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
LAB CHROM STUDY CELLS COUNTED ADDL,3102993,CDM,311,RC,88285,CPT,,,facility,outpatient,,,81.00000,17.50000,United Healthcare,Commercial,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,inpatient,,,104.00000,22.46000,United Healthcare,Commercial,,93.60,,,,,,,93.60,100.88,percent of total billed charges,
LAB CHROM STUDY RES HIGH ADDL,3103009,CDM,311,RC,88289,CPT,,,facility,outpatient,,,104.00000,22.46000,United Healthcare,Commercial,,93.60,,,,,,,27.04,100.88,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,inpatient,,,377.00000,81.43000,United Healthcare,Commercial,,339.30,,,,,,,339.30,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY,3102902,CDM,311,RC,88262,CPT,,,facility,outpatient,,,377.00000,81.43000,United Healthcare,Commercial,,339.30,,,,,,,98.02,365.69,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,inpatient,,,532.00000,114.91000,United Healthcare,Commercial,,478.80,,,,,,,478.80,516.04,percent of total billed charges,
LAB CHROM W BND 15-20 CLL 2 KRTY NS,3102894,CDM,311,RC,88262,CPT,,,facility,outpatient,,,532.00000,114.91000,United Healthcare,Commercial,,478.80,,,,,,,138.32,516.04,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,inpatient,,,521.00000,112.54000,United Healthcare,Commercial,,468.90,,,,,,,468.90,505.37,percent of total billed charges,
LAB CHROM W BND AF 6-12 COL 1 K,3102928,CDM,311,RC,88269,CPT,,,facility,outpatient,,,521.00000,112.54000,United Healthcare,Commercial,,468.90,,,,,,,135.46,505.37,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,inpatient,,,451.00000,97.42000,United Healthcare,Commercial,,405.90,,,,,,,405.90,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO AF/CELL CV,3102985,CDM,311,RC,88235,CPT,,,facility,outpatient,,,451.00000,97.42000,United Healthcare,Commercial,,405.90,,,,,,,117.26,437.47,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,inpatient,,,1148.00000,247.97000,United Healthcare,Commercial,,1033.20,,,,,,,1033.20,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYT MYO,3126448,CDM,311,RC,88230,CPT,,,facility,outpatient,,,1148.00000,247.97000,United Healthcare,Commercial,,1033.20,,,,,,,298.48,1113.56,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,inpatient,,,350.00000,75.60000,United Healthcare,Commercial,,315.00,,,,,,,315.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO LYMPHOCYTE NS,3104593,CDM,311,RC,88230,CPT,,,facility,outpatient,,,350.00000,75.60000,United Healthcare,Commercial,,315.00,,,,,,,91.00,339.50,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,inpatient,,,423.00000,91.37000,United Healthcare,Commercial,,380.70,,,,,,,380.70,410.31,percent of total billed charges,
LAB CULT TISS NON-NEO SKIN/BX NS,3106051,CDM,311,RC,88233,CPT,,,facility,outpatient,,,423.00000,91.37000,United Healthcare,Commercial,,380.70,,,,,,,109.98,410.31,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,inpatient,,,751.00000,162.22000,United Healthcare,Commercial,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST,3095064,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,United Healthcare,Commercial,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,inpatient,,,751.00000,162.22000,United Healthcare,Commercial,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER 1ST NS,3108305,CDM,311,RC,88184,CPT,,,facility,outpatient,,,751.00000,162.22000,United Healthcare,Commercial,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,inpatient,,,119.00000,25.70000,United Healthcare,Commercial,,107.10,,,,,,,107.10,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL,3095130,CDM,311,RC,88185,CPT,,,facility,outpatient,,,119.00000,25.70000,United Healthcare,Commercial,,107.10,,,,,,,30.94,115.43,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,inpatient,,,126.00000,27.22000,United Healthcare,Commercial,,113.40,,,,,,,113.40,122.22,percent of total billed charges,
LAB CYTOM FLOW TECH MARKER ADDL NS,3108313,CDM,311,RC,88185,CPT,,,facility,outpatient,,,126.00000,27.22000,United Healthcare,Commercial,,113.40,,,,,,,32.76,122.22,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,inpatient,,,110.00000,23.76000,United Healthcare,Commercial,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN,3094976,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,United Healthcare,Commercial,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,inpatient,,,110.00000,23.76000,United Healthcare,Commercial,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOP SLD LIQ NONGYN SMT/QNI NS,3090016,CDM,311,RC,88112,CPT,,,facility,outpatient,,,110.00000,23.76000,United Healthcare,Commercial,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,inpatient,,,79.00000,17.06000,United Healthcare,Commercial,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB CYTOPATH CONCENTRATION,3103090,CDM,311,RC,88108,CPT,,,facility,outpatient,,,79.00000,17.06000,United Healthcare,Commercial,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,inpatient,,,110.00000,23.76000,United Healthcare,Commercial,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT,3103157,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,United Healthcare,Commercial,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,inpatient,,,110.00000,23.76000,United Healthcare,Commercial,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB CYTOPATH EVAL FNA INTRP&RPT NS,3124971,CDM,311,RC,88173,CPT,,,facility,outpatient,,,110.00000,23.76000,United Healthcare,Commercial,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,inpatient,,,79.00000,17.06000,United Healthcare,Commercial,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB CYTOPATH FLUIDS SMEARS,3103108,CDM,311,RC,88104,CPT,,,facility,outpatient,,,79.00000,17.06000,United Healthcare,Commercial,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,inpatient,,,335.00000,72.36000,United Healthcare,Commercial,,301.50,,,,,,,301.50,324.95,percent of total billed charges,
LAB MCG IN SITU CHROM 10-30 CELL,3102936,CDM,311,RC,88273,CPT,,,facility,outpatient,,,335.00000,72.36000,United Healthcare,Commercial,,301.50,,,,,,,87.10,324.95,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,inpatient,,,154.00000,33.26000,United Healthcare,Commercial,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL,3102977,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,United Healthcare,Commercial,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,inpatient,,,154.00000,33.26000,United Healthcare,Commercial,,138.60,,,,,,,138.60,149.38,percent of total billed charges,
LAB MCG IN SITU INT 100-300 CELL NS,3111812,CDM,311,RC,88275,CPT,,,facility,outpatient,,,154.00000,33.26000,United Healthcare,Commercial,,138.60,,,,,,,40.04,149.38,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,inpatient,,,128.00000,27.65000,United Healthcare,Commercial,,115.20,,,,,,,115.20,124.16,percent of total billed charges,
LAB MCG IN SITU INT 25-99 CELL NS,3022886,CDM,311,RC,88274,CPT,,,facility,outpatient,,,128.00000,27.65000,United Healthcare,Commercial,,115.20,,,,,,,33.28,124.16,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,inpatient,,,65.00000,14.04000,United Healthcare,Commercial,,58.50,,,,,,,58.50,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA,3103199,CDM,311,RC,88271,CPT,,,facility,outpatient,,,65.00000,14.04000,United Healthcare,Commercial,,58.50,,,,,,,16.90,63.05,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,inpatient,,,272.00000,58.75000,United Healthcare,Commercial,,244.80,,,,,,,244.80,263.84,percent of total billed charges,
LAB MCG PROBE DNA PROBE EA NS,3111804,CDM,311,RC,88271,CPT,,,facility,outpatient,,,272.00000,58.75000,United Healthcare,Commercial,,244.80,,,,,,,70.72,263.84,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,inpatient,,,26.00000,11.44000,United Healthcare,Commercial,,23.40,,,,,,,23.40,25.22,percent of total billed charges,
LAB DECALCIFICATION,3103371,CDM,312,RC,88311,CPT,,,facility,outpatient,,,26.00000,11.44000,United Healthcare,Commercial,,23.40,,,,,,,6.76,25.22,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,inpatient,,,359.00000,157.96000,United Healthcare,Commercial,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB IF AB STAIN INITIAL PER SPEC NS,3117702,CDM,312,RC,88346,CPT,,,facility,outpatient,,,359.00000,157.96000,United Healthcare,Commercial,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,inpatient,,,189.00000,83.16000,United Healthcare,Commercial,,170.10,,,,,,,170.10,183.33,percent of total billed charges,
LAB IF AB STAIN PER SPEC ADDL NS,3117694,CDM,312,RC,88350,CPT,,,facility,outpatient,,,189.00000,83.16000,United Healthcare,Commercial,,170.10,,,,,,,49.14,183.33,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,inpatient,,,359.00000,157.96000,United Healthcare,Commercial,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB 1ST PER SPEC NS,3115904,CDM,312,RC,88342,CPT,,,facility,outpatient,,,359.00000,157.96000,United Healthcare,Commercial,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,inpatient,,,137.00000,60.28000,United Healthcare,Commercial,,123.30,,,,,,,123.30,132.89,percent of total billed charges,
LAB IMHST/IMCYT AB PER SPEC NS ADDL,3115912,CDM,312,RC,88341,CPT,,,facility,outpatient,,,137.00000,60.28000,United Healthcare,Commercial,,123.30,,,,,,,35.62,132.89,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,inpatient,,,1665.00000,732.60000,United Healthcare,Commercial,,1498.50,,,,,,,1498.50,1615.05,percent of total billed charges,
LAB MICROSCOPY ELECTRON DIAG NS,3088978,CDM,312,RC,88348,CPT,,,facility,outpatient,,,1665.00000,732.60000,United Healthcare,Commercial,,1498.50,,,,,,,432.90,1615.05,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,inpatient,,,751.00000,330.44000,United Healthcare,Commercial,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB MORPHO HER2 COMP PER SPEC,3115755,CDM,312,RC,88361,CPT,,,facility,outpatient,,,751.00000,330.44000,United Healthcare,Commercial,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,inpatient,,,374.00000,164.56000,United Healthcare,Commercial,,336.60,,,,,,,336.60,362.78,percent of total billed charges,
LAB MORPHO HER2 MANUAL PER SPEC NS,3115748,CDM,312,RC,88360,CPT,,,facility,outpatient,,,374.00000,164.56000,United Healthcare,Commercial,,336.60,,,,,,,97.24,362.78,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,inpatient,,,553.00000,243.32000,United Healthcare,Commercial,,497.70,,,,,,,497.70,536.41,percent of total billed charges,
LAB MORPHO ISH COMP MULT SPEC NS,3116001,CDM,312,RC,88374,CPT,,,facility,outpatient,,,553.00000,243.32000,United Healthcare,Commercial,,497.70,,,,,,,143.78,536.41,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,inpatient,,,359.00000,157.96000,United Healthcare,Commercial,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
LAB MORPHO ISH MAN MULT PER SPEC NS,3116043,CDM,312,RC,88377,CPT,,,facility,outpatient,,,359.00000,157.96000,United Healthcare,Commercial,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,inpatient,,,62.00000,27.28000,United Healthcare,Commercial,,55.80,,,,,,,55.80,60.14,percent of total billed charges,
LAB PATH GROSS ONLY LVL 1,3103447,CDM,312,RC,88300,CPT,,,facility,outpatient,,,62.00000,27.28000,United Healthcare,Commercial,,55.80,,,,,,,16.12,60.14,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,inpatient,,,79.00000,34.76000,United Healthcare,Commercial,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 2,3103397,CDM,312,RC,88302,CPT,,,facility,outpatient,,,79.00000,34.76000,United Healthcare,Commercial,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,inpatient,,,110.00000,48.40000,United Healthcare,Commercial,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 3,3103405,CDM,312,RC,88304,CPT,,,facility,outpatient,,,110.00000,48.40000,United Healthcare,Commercial,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,inpatient,,,110.00000,48.40000,United Healthcare,Commercial,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 4 NS,3108271,CDM,312,RC,88305,CPT,,,facility,outpatient,,,110.00000,48.40000,United Healthcare,Commercial,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,inpatient,,,751.00000,330.44000,United Healthcare,Commercial,,675.90,,,,,,,675.90,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 5 NS,3108180,CDM,312,RC,88307,CPT,,,facility,outpatient,,,751.00000,330.44000,United Healthcare,Commercial,,675.90,,,,,,,195.26,728.47,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,inpatient,,,1665.00000,732.60000,United Healthcare,Commercial,,1498.50,,,,,,,1498.50,1615.05,percent of total billed charges,
LAB PATH GROSS&MICRO LVL 6,3103439,CDM,312,RC,88309,CPT,,,facility,outpatient,,,1665.00000,732.60000,United Healthcare,Commercial,,1498.50,,,,,,,432.90,1615.05,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,inpatient,,,110.00000,48.40000,United Healthcare,Commercial,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
LAB STAIN SPECIAL 1 NS,3108198,CDM,312,RC,88312,CPT,,,facility,outpatient,,,110.00000,48.40000,United Healthcare,Commercial,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,inpatient,,,281.00000,123.64000,United Healthcare,Commercial,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 NS,3088937,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,United Healthcare,Commercial,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,inpatient,,,281.00000,123.64000,United Healthcare,Commercial,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
LAB STAIN SPECIAL 2 PROT AMYLOID,3903713,CDM,312,RC,88313,CPT,,,facility,outpatient,,,281.00000,123.64000,United Healthcare,Commercial,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,inpatient,,,451.00000,341.41000,United Healthcare,Commercial,,405.90,,,,,,,405.90,437.47,percent of total billed charges,
LAB GENE MPL VAR COMMON,3030145,CDM,300,RC,81338,CPT,,,facility,outpatient,,,451.00000,341.41000,United Healthcare,Commercial,,405.90,,,,,,,117.26,437.47,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,inpatient,,,300.00000,145.80000,United Healthcare,Commercial,,270.00,,,,,,,270.00,291.00,percent of total billed charges,
LAB CSF3R MUTATION EXONS 14&17,3120763,CDM,310,RC,81479,CPT,,,facility,outpatient,,,300.00000,145.80000,United Healthcare,Commercial,,270.00,,,,,,,78.00,291.00,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,inpatient,,,2278.00000,1107.11000,United Healthcare,Commercial,,2050.20,,,,,,,2050.20,2209.66,percent of total billed charges,
LAB FETAL CHROMOSOMAL ANEUPLOIDY,3118031,CDM,310,RC,81420,CPT,,,facility,outpatient,,,2278.00000,1107.11000,United Healthcare,Commercial,,2050.20,,,,,,,592.28,2209.66,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,inpatient,,,3912.00000,1901.23000,United Healthcare,Commercial,,3520.80,,,,,,,3520.80,3794.64,percent of total billed charges,
LAB GENE 5+ COLON CA DIS HRDTRY,3124716,CDM,310,RC,81435,CPT,,,facility,outpatient,,,3912.00000,1901.23000,United Healthcare,Commercial,,3520.80,,,,,,,1017.12,3794.64,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,inpatient,,,900.00000,437.40000,United Healthcare,Commercial,,810.00,,,,,,,810.00,873.00,percent of total billed charges,
LAB GENE ABL1 VAR KD,3116597,CDM,310,RC,81170,CPT,,,facility,outpatient,,,900.00000,437.40000,United Healthcare,Commercial,,810.00,,,,,,,234.00,873.00,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,inpatient,,,365.00000,177.39000,United Healthcare,Commercial,,328.50,,,,,,,328.50,354.05,percent of total billed charges,
LAB GENE ANLYS MUT CALRETICULIN,3116472,CDM,310,RC,81219,CPT,,,facility,outpatient,,,365.00000,177.39000,United Healthcare,Commercial,,328.50,,,,,,,94.90,354.05,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,inpatient,,,989.00000,480.65000,United Healthcare,Commercial,,890.10,,,,,,,890.10,959.33,percent of total billed charges,
LAB GENE ANLYS MUT C-KIT,3026234,CDM,310,RC,81272,CPT,,,facility,outpatient,,,989.00000,480.65000,United Healthcare,Commercial,,890.10,,,,,,,257.14,959.33,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,United Healthcare,Commercial,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MAJOR,3113784,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,United Healthcare,Commercial,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,inpatient,,,435.00000,211.41000,United Healthcare,Commercial,,391.50,,,,,,,391.50,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN,3116399,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,United Healthcare,Commercial,,391.50,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,inpatient,,,435.00000,211.41000,United Healthcare,Commercial,,391.50,,,,,,,391.50,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT MIN NS,3113792,CDM,310,RC,81207,CPT,,,facility,outpatient,,,435.00000,211.41000,United Healthcare,Commercial,,391.50,,,,,,,113.10,421.95,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,inpatient,,,644.00000,312.98000,United Healthcare,Commercial,,579.60,,,,,,,579.60,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 BREAKPOINT OTHER,3113800,CDM,310,RC,81208,CPT,,,facility,outpatient,,,644.00000,312.98000,United Healthcare,Commercial,,579.60,,,,,,,167.44,624.68,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,United Healthcare,Commercial,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210,3116407,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,United Healthcare,Commercial,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,inpatient,,,492.00000,239.11000,United Healthcare,Commercial,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
LAB GENE BCR/ABL1 REFLEX P210 NS,3026663,CDM,310,RC,81206,CPT,,,facility,outpatient,,,492.00000,239.11000,United Healthcare,Commercial,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,inpatient,,,527.00000,256.12000,United Healthcare,Commercial,,474.30,,,,,,,474.30,511.19,percent of total billed charges,
LAB GENE BRAF VAR V600E NS,3113826,CDM,310,RC,81210,CPT,,,facility,outpatient,,,527.00000,256.12000,United Healthcare,Commercial,,474.30,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,inpatient,,,1404.00000,682.34000,United Healthcare,Commercial,,1263.60,,,,,,,1263.60,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 ANLY SEQ FULL,3120375,CDM,310,RC,81163,CPT,,,facility,outpatient,,,1404.00000,682.34000,United Healthcare,Commercial,,1263.60,,,,,,,365.04,1361.88,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,inpatient,,,5475.00000,2660.85000,United Healthcare,Commercial,,4927.50,,,,,,,4927.50,5310.75,percent of total billed charges,
LAB GENE BRCA1&2 SEQ&DUP/DEL FULL,3117744,CDM,310,RC,81162,CPT,,,facility,outpatient,,,5475.00000,2660.85000,United Healthcare,Commercial,,4927.50,,,,,,,1423.50,5310.75,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,inpatient,,,726.00000,352.84000,United Healthcare,Commercial,,653.40,,,,,,,653.40,704.22,percent of total billed charges,
LAB GENE CEBPA SEQ FULL,3116605,CDM,310,RC,81218,CPT,,,facility,outpatient,,,726.00000,352.84000,United Healthcare,Commercial,,653.40,,,,,,,188.76,704.22,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,inpatient,,,507.00000,246.40000,United Healthcare,Commercial,,456.30,,,,,,,456.30,491.79,percent of total billed charges,
LAB GENE CFTR INTRON 8 POLY-T,3113941,CDM,310,RC,81224,CPT,,,facility,outpatient,,,507.00000,246.40000,United Healthcare,Commercial,,456.30,,,,,,,131.82,491.79,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,inpatient,,,1670.00000,811.62000,United Healthcare,Commercial,,1503.00,,,,,,,1503.00,1619.90,percent of total billed charges,
LAB GENE CFTR VAR COMMON,3113909,CDM,310,RC,81220,CPT,,,facility,outpatient,,,1670.00000,811.62000,United Healthcare,Commercial,,1503.00,,,,,,,434.20,1619.90,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,inpatient,,,1139.00000,553.55000,United Healthcare,Commercial,,1025.10,,,,,,,1025.10,1104.83,percent of total billed charges,
LAB GENE CHIMERISM WO CELL SLCT NS,3114188,CDM,310,RC,81267,CPT,,,facility,outpatient,,,1139.00000,553.55000,United Healthcare,Commercial,,1025.10,,,,,,,296.14,1104.83,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,inpatient,,,875.00000,425.25000,United Healthcare,Commercial,,787.50,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE CYP2C19 VAR COMMON,3120896,CDM,310,RC,81225,CPT,,,facility,outpatient,,,875.00000,425.25000,United Healthcare,Commercial,,787.50,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,inpatient,,,525.00000,255.15000,United Healthcare,Commercial,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP2C9 VAR COMMON,3120912,CDM,310,RC,81227,CPT,,,facility,outpatient,,,525.00000,255.15000,United Healthcare,Commercial,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,inpatient,,,1353.00000,657.56000,United Healthcare,Commercial,,1217.70,,,,,,,1217.70,1312.41,percent of total billed charges,
LAB GENE CYP2D6 VAR COMMON,3120904,CDM,310,RC,81226,CPT,,,facility,outpatient,,,1353.00000,657.56000,United Healthcare,Commercial,,1217.70,,,,,,,351.78,1312.41,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,inpatient,,,525.00000,255.15000,United Healthcare,Commercial,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP3A4 VAR COMMON,3120920,CDM,310,RC,81230,CPT,,,facility,outpatient,,,525.00000,255.15000,United Healthcare,Commercial,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,inpatient,,,525.00000,255.15000,United Healthcare,Commercial,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE CYP3A5 VAR COMMON,3120938,CDM,310,RC,81231,CPT,,,facility,outpatient,,,525.00000,255.15000,United Healthcare,Commercial,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,inpatient,,,825.00000,400.95000,United Healthcare,Commercial,,742.50,,,,,,,742.50,800.25,percent of total billed charges,
LAB GENE DMPK DET ALLELES ABNRM MYO,3120490,CDM,310,RC,81234,CPT,,,facility,outpatient,,,825.00000,400.95000,United Healthcare,Commercial,,742.50,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,inpatient,,,525.00000,255.15000,United Healthcare,Commercial,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON,3120946,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,United Healthcare,Commercial,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,inpatient,,,525.00000,255.15000,United Healthcare,Commercial,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE DPYD VAR COMMON NS,3120326,CDM,310,RC,81232,CPT,,,facility,outpatient,,,525.00000,255.15000,United Healthcare,Commercial,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,inpatient,,,974.00000,473.36000,United Healthcare,Commercial,,876.60,,,,,,,876.60,944.78,percent of total billed charges,
LAB GENE EGFR VAR COMMON,3118320,CDM,310,RC,81235,CPT,,,facility,outpatient,,,974.00000,473.36000,United Healthcare,Commercial,,876.60,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,inpatient,,,198.00000,96.23000,United Healthcare,Commercial,,178.20,,,,,,,178.20,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A,3025111,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,United Healthcare,Commercial,,178.20,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,inpatient,,,198.00000,96.23000,United Healthcare,Commercial,,178.20,,,,,,,178.20,192.06,percent of total billed charges,
LAB GENE F2 VAR 20210G>A NS,3114006,CDM,310,RC,81240,CPT,,,facility,outpatient,,,198.00000,96.23000,United Healthcare,Commercial,,178.20,,,,,,,51.48,192.06,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,inpatient,,,221.00000,107.41000,United Healthcare,Commercial,,198.90,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN,3114014,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,United Healthcare,Commercial,,198.90,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,inpatient,,,221.00000,107.41000,United Healthcare,Commercial,,198.90,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE F5 VAR LEIDEN NS,3122108,CDM,310,RC,81241,CPT,,,facility,outpatient,,,221.00000,107.41000,United Healthcare,Commercial,,198.90,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,inpatient,,,497.00000,241.54000,United Healthcare,Commercial,,447.30,,,,,,,447.30,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD,3114055,CDM,310,RC,81245,CPT,,,facility,outpatient,,,497.00000,241.54000,United Healthcare,Commercial,,447.30,,,,,,,129.22,482.09,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,inpatient,,,2340.00000,1137.24000,United Healthcare,Commercial,,2106.00,,,,,,,2106.00,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR ITD QN,3121597,CDM,310,RC,0046U,CPT,,,facility,outpatient,,,2340.00000,1137.24000,United Healthcare,Commercial,,2106.00,,,,,,,608.40,2269.80,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,inpatient,,,249.00000,121.01000,United Healthcare,Commercial,,224.10,,,,,,,224.10,241.53,percent of total billed charges,
LAB GENE FLT3 VAR TKD,3116662,CDM,310,RC,81246,CPT,,,facility,outpatient,,,249.00000,121.01000,United Healthcare,Commercial,,224.10,,,,,,,64.74,241.53,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,inpatient,,,135.00000,65.61000,United Healthcare,Commercial,,121.50,,,,,,,121.50,130.95,percent of total billed charges,
LAB GENE FMR1 CHARACTER ALLELES,3114048,CDM,310,RC,81244,CPT,,,facility,outpatient,,,135.00000,65.61000,United Healthcare,Commercial,,121.50,,,,,,,35.10,130.95,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,inpatient,,,172.00000,83.59000,United Healthcare,Commercial,,154.80,,,,,,,154.80,166.84,percent of total billed charges,
LAB GENE FMR1 DET ALLELES ABNORMAL,3114030,CDM,310,RC,81243,CPT,,,facility,outpatient,,,172.00000,83.59000,United Healthcare,Commercial,,154.80,,,,,,,44.72,166.84,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,inpatient,,,307.00000,149.20000,United Healthcare,Commercial,,276.30,,,,,,,276.30,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 DEL/VAR COMMON,3114105,CDM,310,RC,81257,CPT,,,facility,outpatient,,,307.00000,149.20000,United Healthcare,Commercial,,276.30,,,,,,,79.82,297.79,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,inpatient,,,1800.00000,874.80000,United Healthcare,Commercial,,1620.00,,,,,,,1620.00,1746.00,percent of total billed charges,
LAB GENE HBA1/HBA2 SEQ FULL,3120318,CDM,310,RC,81259,CPT,,,facility,outpatient,,,1800.00000,874.80000,United Healthcare,Commercial,,1620.00,,,,,,,468.00,1746.00,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,inpatient,,,974.00000,473.36000,United Healthcare,Commercial,,876.60,,,,,,,876.60,944.78,percent of total billed charges,
LAB GENE HBB SEQ FULL,3120342,CDM,310,RC,81364,CPT,,,facility,outpatient,,,974.00000,473.36000,United Healthcare,Commercial,,876.60,,,,,,,253.24,944.78,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,inpatient,,,197.00000,95.74000,United Healthcare,Commercial,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON,3124625,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,United Healthcare,Commercial,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,inpatient,,,197.00000,95.74000,United Healthcare,Commercial,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE HFE VAR COMMON NS,3114097,CDM,310,RC,81256,CPT,,,facility,outpatient,,,197.00000,95.74000,United Healthcare,Commercial,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,inpatient,,,411.00000,199.75000,United Healthcare,Commercial,,369.90,,,,,,,369.90,398.67,percent of total billed charges,
LAB GENE HTT DET ALLELES ABNORMAL,3121480,CDM,310,RC,81271,CPT,,,facility,outpatient,,,411.00000,199.75000,United Healthcare,Commercial,,369.90,,,,,,,106.86,398.67,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,inpatient,,,221.00000,107.41000,United Healthcare,Commercial,,198.90,,,,,,,198.90,214.37,percent of total billed charges,
LAB GENE IFNL3,3120953,CDM,310,RC,81283,CPT,,,facility,outpatient,,,221.00000,107.41000,United Healthcare,Commercial,,198.90,,,,,,,57.46,214.37,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,inpatient,,,884.00000,429.62000,United Healthcare,Commercial,,795.60,,,,,,,795.60,857.48,percent of total billed charges,
LAB GENE IGH MUT VARIABLE REGION,3114147,CDM,310,RC,81263,CPT,,,facility,outpatient,,,884.00000,429.62000,United Healthcare,Commercial,,795.60,,,,,,,229.84,857.48,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,inpatient,,,594.00000,288.68000,United Healthcare,Commercial,,534.60,,,,,,,534.60,576.18,percent of total billed charges,
LAB GENE IGH REARRANGEMENT AMP,3114121,CDM,310,RC,81261,CPT,,,facility,outpatient,,,594.00000,288.68000,United Healthcare,Commercial,,534.60,,,,,,,154.44,576.18,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,inpatient,,,519.00000,252.23000,United Healthcare,Commercial,,467.10,,,,,,,467.10,503.43,percent of total billed charges,
LAB GENE IGK REARRANGEMENT CLONAL,3114154,CDM,310,RC,81264,CPT,,,facility,outpatient,,,519.00000,252.23000,United Healthcare,Commercial,,467.10,,,,,,,134.94,503.43,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,inpatient,,,1046.00000,508.36000,United Healthcare,Commercial,,941.40,,,,,,,941.40,1014.62,percent of total billed charges,
LAB GENE INSTABILITY MICROSATELLITE,3114360,CDM,310,RC,81301,CPT,,,facility,outpatient,,,1046.00000,508.36000,United Healthcare,Commercial,,941.40,,,,,,,271.96,1014.62,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,inpatient,,,556.00000,270.22000,United Healthcare,Commercial,,500.40,,,,,,,500.40,539.32,percent of total billed charges,
LAB GENE JAK2 EXON TGT SEQ 12,3122207,CDM,310,RC,81279,CPT,,,facility,outpatient,,,556.00000,270.22000,United Healthcare,Commercial,,500.40,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,inpatient,,,275.00000,133.65000,United Healthcare,Commercial,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
LAB GENE JAK2 VAR V617F NS,3114204,CDM,310,RC,81270,CPT,,,facility,outpatient,,,275.00000,133.65000,United Healthcare,Commercial,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,inpatient,,,580.00000,281.88000,United Healthcare,Commercial,,522.00,,,,,,,522.00,562.60,percent of total billed charges,
LAB GENE KRAS VAR ADDL NS,3116589,CDM,310,RC,81276,CPT,,,facility,outpatient,,,580.00000,281.88000,United Healthcare,Commercial,,522.00,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,inpatient,,,580.00000,281.88000,United Healthcare,Commercial,,522.00,,,,,,,522.00,562.60,percent of total billed charges,
LAB GENE KRAS VAR CODONS 12&13 NS,3114212,CDM,310,RC,81275,CPT,,,facility,outpatient,,,580.00000,281.88000,United Healthcare,Commercial,,522.00,,,,,,,150.80,562.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,inpatient,,,3480.00000,1691.28000,United Healthcare,Commercial,,3132.00,,,,,,,3132.00,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP BLD NS,3114931,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,United Healthcare,Commercial,,3132.00,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,inpatient,,,3480.00000,1691.28000,United Healthcare,Commercial,,3132.00,,,,,,,3132.00,3375.60,percent of total billed charges,
LAB GENE MA CYTO COPY NO&SNP POC,3114949,CDM,310,RC,81229,CPT,,,facility,outpatient,,,3480.00000,1691.28000,United Healthcare,Commercial,,3132.00,,,,,,,904.80,3375.60,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,inpatient,,,700.00000,340.20000,United Healthcare,Commercial,,630.00,,,,,,,630.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP,3114162,CDM,310,RC,81265,CPT,,,facility,outpatient,,,700.00000,340.20000,United Healthcare,Commercial,,630.00,,,,,,,182.00,679.00,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,inpatient,,,1427.00000,693.52000,United Healthcare,Commercial,,1284.30,,,,,,,1284.30,1384.19,percent of total billed charges,
LAB GENE MARKERS STR SPEC PT&CMP NS,3124781,CDM,310,RC,81265,CPT,,,facility,outpatient,,,1427.00000,693.52000,United Healthcare,Commercial,,1284.30,,,,,,,371.02,1384.19,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,inpatient,,,614.00000,298.40000,United Healthcare,Commercial,,552.60,,,,,,,552.60,595.58,percent of total billed charges,
LAB GENE MLH1 METHYLATION,3116506,CDM,310,RC,81288,CPT,,,facility,outpatient,,,614.00000,298.40000,United Healthcare,Commercial,,552.60,,,,,,,159.64,595.58,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,inpatient,,,2027.00000,985.12000,United Healthcare,Commercial,,1824.30,,,,,,,1824.30,1966.19,percent of total billed charges,
LAB GENE MLH1 SEQ FULL,3114279,CDM,310,RC,81292,CPT,,,facility,outpatient,,,2027.00000,985.12000,United Healthcare,Commercial,,1824.30,,,,,,,527.02,1966.19,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,inpatient,,,556.00000,270.22000,United Healthcare,Commercial,,500.40,,,,,,,500.40,539.32,percent of total billed charges,
LAB GENE MPL MUTATION EXON 10 ANLYS,3122199,CDM,310,RC,81339,CPT,,,facility,outpatient,,,556.00000,270.22000,United Healthcare,Commercial,,500.40,,,,,,,144.56,539.32,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,inpatient,,,1146.00000,556.96000,United Healthcare,Commercial,,1031.40,,,,,,,1031.40,1111.62,percent of total billed charges,
LAB GENE MSH2 SEQ FULL,3114303,CDM,310,RC,81295,CPT,,,facility,outpatient,,,1146.00000,556.96000,United Healthcare,Commercial,,1031.40,,,,,,,297.96,1111.62,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,inpatient,,,197.00000,95.74000,United Healthcare,Commercial,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON,3117686,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,United Healthcare,Commercial,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,inpatient,,,197.00000,95.74000,United Healthcare,Commercial,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
LAB GENE MTHFR VAR COMMON NS,3114261,CDM,310,RC,81291,CPT,,,facility,outpatient,,,197.00000,95.74000,United Healthcare,Commercial,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,inpatient,,,527.00000,256.12000,United Healthcare,Commercial,,474.30,,,,,,,474.30,511.19,percent of total billed charges,
LAB GENE MYD88 VAR L265P,3120664,CDM,310,RC,81305,CPT,,,facility,outpatient,,,527.00000,256.12000,United Healthcare,Commercial,,474.30,,,,,,,137.02,511.19,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,inpatient,,,740.00000,359.64000,United Healthcare,Commercial,,666.00,,,,,,,666.00,717.80,percent of total billed charges,
LAB GENE NPM1 VAR EXON 12,3114402,CDM,310,RC,81310,CPT,,,facility,outpatient,,,740.00000,359.64000,United Healthcare,Commercial,,666.00,,,,,,,192.40,717.80,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,inpatient,,,875.00000,425.25000,United Healthcare,Commercial,,787.50,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON,3120961,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,United Healthcare,Commercial,,787.50,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,inpatient,,,875.00000,425.25000,United Healthcare,Commercial,,787.50,,,,,,,787.50,848.75,percent of total billed charges,
LAB GENE NUDT15 VAR COMMON NS,3120516,CDM,310,RC,81306,CPT,,,facility,outpatient,,,875.00000,425.25000,United Healthcare,Commercial,,787.50,,,,,,,227.50,848.75,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,inpatient,,,1399.00000,679.91000,United Healthcare,Commercial,,1259.10,,,,,,,1259.10,1357.03,percent of total billed charges,
LAB GENE NUDT15&TPMT VAR COMMON,3028735,CDM,310,RC,0169U,CPT,,,facility,outpatient,,,1399.00000,679.91000,United Healthcare,Commercial,,1259.10,,,,,,,363.74,1357.03,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,inpatient,,,51.00000,24.79000,United Healthcare,Commercial,,45.90,,,,,,,45.90,49.47,percent of total billed charges,
LAB GENE PHARMOCOGENOMICS PANEL,3121019,CDM,310,RC,81479,CPT,,,facility,outpatient,,,51.00000,24.79000,United Healthcare,Commercial,,45.90,,,,,,,13.26,49.47,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,inpatient,,,825.00000,400.95000,United Healthcare,Commercial,,742.50,,,,,,,742.50,800.25,percent of total billed charges,
LAB GENE PIK3CA ANLYS SEQ TARGETED,3122173,CDM,310,RC,81309,CPT,,,facility,outpatient,,,825.00000,400.95000,United Healthcare,Commercial,,742.50,,,,,,,214.50,800.25,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,inpatient,,,576.00000,279.94000,United Healthcare,Commercial,,518.40,,,,,,,518.40,558.72,percent of total billed charges,
LAB GENE SEPT9 ANLYS METHYLATION,3124906,CDM,310,RC,81327,CPT,,,facility,outpatient,,,576.00000,279.94000,United Healthcare,Commercial,,518.40,,,,,,,149.76,558.72,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,inpatient,,,224.00000,108.86000,United Healthcare,Commercial,,201.60,,,,,,,201.60,217.28,percent of total billed charges,
LAB GENE SEQ RET DUP/DEL,3029394,CDM,310,RC,81479,CPT,,,facility,outpatient,,,224.00000,108.86000,United Healthcare,Commercial,,201.60,,,,,,,58.24,217.28,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,inpatient,,,346.00000,168.16000,United Healthcare,Commercial,,311.40,,,,,,,311.40,335.62,percent of total billed charges,
LAB GENE SERPINA1 VAR COMMON,3114485,CDM,310,RC,81332,CPT,,,facility,outpatient,,,346.00000,168.16000,United Healthcare,Commercial,,311.40,,,,,,,89.96,335.62,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,inpatient,,,525.00000,255.15000,United Healthcare,Commercial,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE SLCO1B1 VAR COMMON,3120979,CDM,310,RC,81328,CPT,,,facility,outpatient,,,525.00000,255.15000,United Healthcare,Commercial,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,inpatient,,,525.00000,255.15000,United Healthcare,Commercial,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE SMN1 ANALYSIS DOSAGE/DEL,3120524,CDM,310,RC,81329,CPT,,,facility,outpatient,,,525.00000,255.15000,United Healthcare,Commercial,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,inpatient,,,525.00000,255.15000,United Healthcare,Commercial,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE TPMT,3120987,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,United Healthcare,Commercial,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,inpatient,,,525.00000,255.15000,United Healthcare,Commercial,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
LAB GENE TPMT NS,3116142,CDM,310,RC,81335,CPT,,,facility,outpatient,,,525.00000,255.15000,United Healthcare,Commercial,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,inpatient,,,627.00000,304.72000,United Healthcare,Commercial,,564.30,,,,,,,564.30,608.19,percent of total billed charges,
LAB GENE TRB REARRANGEMENT AMP,3114493,CDM,310,RC,81340,CPT,,,facility,outpatient,,,627.00000,304.72000,United Healthcare,Commercial,,564.30,,,,,,,163.02,608.19,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,inpatient,,,605.00000,294.03000,United Healthcare,Commercial,,544.50,,,,,,,544.50,586.85,percent of total billed charges,
LAB GENE TRG REARRANGEMENT CLONAL,3114519,CDM,310,RC,81342,CPT,,,facility,outpatient,,,605.00000,294.03000,United Healthcare,Commercial,,544.50,,,,,,,157.30,586.85,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,inpatient,,,510.00000,247.86000,United Healthcare,Commercial,,459.00,,,,,,,459.00,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 HR ALLE 1/GRP,3114659,CDM,310,RC,81381,CPT,,,facility,outpatient,,,510.00000,247.86000,United Healthcare,Commercial,,459.00,,,,,,,132.60,494.70,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,inpatient,,,223.00000,108.38000,United Healthcare,Commercial,,200.70,,,,,,,200.70,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR AG 1 EA NS,3029949,CDM,310,RC,81374,CPT,,,facility,outpatient,,,223.00000,108.38000,United Healthcare,Commercial,,200.70,,,,,,,57.98,216.31,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,inpatient,,,1211.00000,588.55000,United Healthcare,Commercial,,1089.90,,,,,,,1089.90,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR CMP,3114568,CDM,310,RC,81372,CPT,,,facility,outpatient,,,1211.00000,588.55000,United Healthcare,Commercial,,1089.90,,,,,,,314.86,1174.67,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,inpatient,,,383.00000,186.14000,United Healthcare,Commercial,,344.70,,,,,,,344.70,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1 LR LOCUS NS,3121308,CDM,310,RC,81373,CPT,,,facility,outpatient,,,383.00000,186.14000,United Healthcare,Commercial,,344.70,,,,,,,99.58,371.51,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,inpatient,,,1214.00000,590.00000,United Healthcare,Commercial,,1092.60,,,,,,,1092.60,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 1&2 LR VERIF NS,3122165,CDM,310,RC,81371,CPT,,,facility,outpatient,,,1214.00000,590.00000,United Healthcare,Commercial,,1092.60,,,,,,,315.64,1177.58,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,inpatient,,,328.00000,159.41000,United Healthcare,Commercial,,295.20,,,,,,,295.20,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR ALLE 1/GRP,3114675,CDM,310,RC,81383,CPT,,,facility,outpatient,,,328.00000,159.41000,United Healthcare,Commercial,,295.20,,,,,,,85.28,318.16,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,inpatient,,,372.00000,180.79000,United Healthcare,Commercial,,334.80,,,,,,,334.80,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 HR LOCUS NS,3121563,CDM,310,RC,81382,CPT,,,facility,outpatient,,,372.00000,180.79000,United Healthcare,Commercial,,334.80,,,,,,,96.72,360.84,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,inpatient,,,285.00000,138.51000,United Healthcare,Commercial,,256.50,,,,,,,256.50,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR AG 1 EA,3114618,CDM,310,RC,81377,CPT,,,facility,outpatient,,,285.00000,138.51000,United Healthcare,Commercial,,256.50,,,,,,,74.10,276.45,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,inpatient,,,367.00000,178.36000,United Healthcare,Commercial,,330.30,,,,,,,330.30,355.99,percent of total billed charges,
LAB GENE TYPING HLA 2 LR LOCUS EA,3114600,CDM,310,RC,81376,CPT,,,facility,outpatient,,,367.00000,178.36000,United Healthcare,Commercial,,330.30,,,,,,,95.42,355.99,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,inpatient,,,702.00000,341.17000,United Healthcare,Commercial,,631.80,,,,,,,631.80,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON,3120995,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,United Healthcare,Commercial,,631.80,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,inpatient,,,702.00000,341.17000,United Healthcare,Commercial,,631.80,,,,,,,631.80,680.94,percent of total billed charges,
LAB GENE UGT1A1 VAR COMMON NS,3114527,CDM,310,RC,81350,CPT,,,facility,outpatient,,,702.00000,341.17000,United Healthcare,Commercial,,631.80,,,,,,,182.52,680.94,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,inpatient,,,265.00000,128.79000,United Healthcare,Commercial,,238.50,,,,,,,238.50,257.05,percent of total billed charges,
LAB GENE VKORC1 VAR COMMON,3121001,CDM,310,RC,81355,CPT,,,facility,outpatient,,,265.00000,128.79000,United Healthcare,Commercial,,238.50,,,,,,,68.90,257.05,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,inpatient,,,2279.00000,1107.59000,United Healthcare,Commercial,,2051.10,,,,,,,2051.10,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50,3119872,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2279.00000,1107.59000,United Healthcare,Commercial,,2051.10,,,,,,,592.54,2210.63,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,inpatient,,,2395.00000,1163.97000,United Healthcare,Commercial,,2155.50,,,,,,,2155.50,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ HL 5-50 NS,3118064,CDM,310,RC,81450,CPT,,,facility,outpatient,,,2395.00000,1163.97000,United Healthcare,Commercial,,2155.50,,,,,,,622.70,2323.15,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,inpatient,,,8759.00000,4256.87000,United Healthcare,Commercial,,7883.10,,,,,,,7883.10,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+,3119864,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,United Healthcare,Commercial,,7883.10,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,inpatient,,,8759.00000,4256.87000,United Healthcare,Commercial,,7883.10,,,,,,,7883.10,8496.23,percent of total billed charges,
LAB GENOMIC ANLY SEQ SO/HL 51+ NS,3117835,CDM,310,RC,81455,CPT,,,facility,outpatient,,,8759.00000,4256.87000,United Healthcare,Commercial,,7883.10,,,,,,,2277.34,8496.23,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,inpatient,,,2752.00000,1337.47000,United Healthcare,Commercial,,2476.80,,,,,,,2476.80,2669.44,percent of total billed charges,
LAB GSAP METAB RX >=6,3123767,CDM,310,RC,81418,CPT,,,facility,outpatient,,,2752.00000,1337.47000,United Healthcare,Commercial,,2476.80,,,,,,,715.52,2669.44,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,inpatient,,,217.00000,105.46000,United Healthcare,Commercial,,195.30,,,,,,,195.30,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS,3120573,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,United Healthcare,Commercial,,195.30,,,,,,,56.42,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,inpatient,,,217.00000,105.46000,United Healthcare,Commercial,,195.30,,,,,,,195.30,210.49,percent of total billed charges,
LAB HCV INFCT DIS CHRNC 6 ASSAYS NS,3124229,CDM,310,RC,81596,CPT,,,facility,outpatient,,,217.00000,105.46000,United Healthcare,Commercial,,195.30,,,,,,,56.42,210.49,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,inpatient,,,292.00000,141.91000,United Healthcare,Commercial,,262.80,,,,,,,262.80,283.24,percent of total billed charges,
LAB IBD SGI DIAGNOSTIC,3026689,CDM,310,RC,81479,CPT,,,facility,outpatient,,,292.00000,141.91000,United Healthcare,Commercial,,262.80,,,,,,,75.92,283.24,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,United Healthcare,Commercial,,369.90,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 CARDIO IQ APOE GENO,3030517,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,United Healthcare,Commercial,,369.90,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,United Healthcare,Commercial,,369.90,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 CBFB/MYH11 DET QN,3125051,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,United Healthcare,Commercial,,369.90,,,,,,,106.86,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,inpatient,,,411.00000,199.75000,United Healthcare,Commercial,,369.90,,,,,,,369.90,398.67,percent of total billed charges,
LAB MOPATH LVL2 EML4-ALK,3030533,CDM,310,RC,81401,CPT,,,facility,outpatient,,,411.00000,199.75000,United Healthcare,Commercial,,369.90,,,,,,,106.86,398.67,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,inpatient,,,2275.00000,1105.65000,United Healthcare,Commercial,,2047.50,,,,,,,2047.50,2206.75,percent of total billed charges,
LAB NPM1 GENE ANALYSIS QUAN,3121654,CDM,310,RC,0049U,CPT,,,facility,outpatient,,,2275.00000,1105.65000,United Healthcare,Commercial,,2047.50,,,,,,,591.50,2206.75,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,inpatient,,,192.00000,93.31000,United Healthcare,Commercial,,172.80,,,,,,,172.80,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 1,3114683,CDM,310,RC,81400,CPT,,,facility,outpatient,,,192.00000,93.31000,United Healthcare,Commercial,,172.80,,,,,,,49.92,186.24,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,inpatient,,,451.00000,219.19000,United Healthcare,Commercial,,405.90,,,,,,,405.90,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 3,3114709,CDM,310,RC,81402,CPT,,,facility,outpatient,,,451.00000,219.19000,United Healthcare,Commercial,,405.90,,,,,,,117.26,437.47,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,inpatient,,,617.00000,299.86000,United Healthcare,Commercial,,555.30,,,,,,,555.30,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 4 NS,3114717,CDM,310,RC,81403,CPT,,,facility,outpatient,,,617.00000,299.86000,United Healthcare,Commercial,,555.30,,,,,,,160.42,598.49,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,inpatient,,,825.00000,400.95000,United Healthcare,Commercial,,742.50,,,,,,,742.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 5,3114725,CDM,310,RC,81404,CPT,,,facility,outpatient,,,825.00000,400.95000,United Healthcare,Commercial,,742.50,,,,,,,214.50,800.25,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,inpatient,,,905.00000,439.83000,United Healthcare,Commercial,,814.50,,,,,,,814.50,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 6,3114733,CDM,310,RC,81405,CPT,,,facility,outpatient,,,905.00000,439.83000,United Healthcare,Commercial,,814.50,,,,,,,235.30,877.85,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,inpatient,,,849.00000,412.61000,United Healthcare,Commercial,,764.10,,,,,,,764.10,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 7,3114741,CDM,310,RC,81406,CPT,,,facility,outpatient,,,849.00000,412.61000,United Healthcare,Commercial,,764.10,,,,,,,220.74,823.53,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,inpatient,,,2539.00000,1233.95000,United Healthcare,Commercial,,2285.10,,,,,,,2285.10,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 8,3114758,CDM,310,RC,81407,CPT,,,facility,outpatient,,,2539.00000,1233.95000,United Healthcare,Commercial,,2285.10,,,,,,,660.14,2462.83,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,inpatient,,,6000.00000,2916.00000,United Healthcare,Commercial,,5400.00,,,,,,,5400.00,5820.00,percent of total billed charges,
LAB PROC PATHOLOGY MOLEC LEVEL 9,3114766,CDM,310,RC,81408,CPT,,,facility,outpatient,,,6000.00000,2916.00000,United Healthcare,Commercial,,5400.00,,,,,,,1560.00,5820.00,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,inpatient,,,8260.00000,4014.36000,United Healthcare,Commercial,,7434.00,,,,,,,7434.00,8012.20,percent of total billed charges,
LAB TRNSPL DNA DNR DRV CELL-FREE QN,3029451,CDM,310,RC,0118U,CPT,,,facility,outpatient,,,8260.00000,4014.36000,United Healthcare,Commercial,,7434.00,,,,,,,2147.60,8012.20,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,inpatient,,,202.00000,88.88000,United Healthcare,Commercial,,181.80,,,,,,,181.80,195.94,percent of total billed charges,
LAB MICRODISSECTION LASER PROT AMYL,3903721,CDM,312,RC,88380,CPT,,,facility,outpatient,,,202.00000,88.88000,United Healthcare,Commercial,,181.80,,,,,,,52.52,195.94,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,inpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,59.40,64.02,percent of total billed charges,
POC FERN,3123882,CDM,301,RC,Q0114,HCPCS,,,facility,outpatient,,,66.00000,31.81000,United Healthcare,Commercial,,59.40,,,,,,,17.16,64.02,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,inpatient,,,295.00000,142.19000,United Healthcare,Commercial,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
POC PAMG-1 CERVICOVAGINAL QL,3112679,CDM,301,RC,84112,CPT,,,facility,outpatient,,,295.00000,142.19000,United Healthcare,Commercial,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,inpatient,,,89.00000,26.79000,United Healthcare,Commercial,,80.10,,,,,,,80.10,86.33,percent of total billed charges,
CRYOPRECIPITATE EA UNIT,3902053,CDM,390,RC,P9012,HCPCS,,,facility,outpatient,,,89.00000,26.79000,United Healthcare,Commercial,,80.10,,,,,,,23.14,86.33,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,inpatient,,,93.00000,27.99000,United Healthcare,Commercial,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
FFP FRZ 8-24 HRS AFTER COLL EA UNIT,3902129,CDM,390,RC,P9059,HCPCS,,,facility,outpatient,,,93.00000,27.99000,United Healthcare,Commercial,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,inpatient,,,93.00000,27.99000,United Healthcare,Commercial,,83.70,,,,,,,83.70,90.21,percent of total billed charges,
FFP FRZ WITHIN 8 HRS COLL EA UNIT,3902087,CDM,390,RC,P9017,HCPCS,,,facility,outpatient,,,93.00000,27.99000,United Healthcare,Commercial,,83.70,,,,,,,24.18,90.21,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,United Healthcare,Commercial,,1687.50,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN PHER LOW YIELDEA,3904737,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,United Healthcare,Commercial,,1687.50,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,United Healthcare,Commercial,,1687.50,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC LOW YIELD EA,3904729,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,United Healthcare,Commercial,,1687.50,,,,,,,487.50,1818.75,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1752.00000,527.35000,United Healthcare,Commercial,,1576.80,,,,,,,1576.80,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC VOL RDC EA,3900040,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,United Healthcare,Commercial,,1576.80,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,inpatient,,,1752.00000,527.35000,United Healthcare,Commercial,,1576.80,,,,,,,1576.80,1699.44,percent of total billed charges,
PLATELETS PATHOGEN RDC WASHED EA,3903614,CDM,390,RC,P9073,HCPCS,,,facility,outpatient,,,1752.00000,527.35000,United Healthcare,Commercial,,1576.80,,,,,,,455.52,1699.44,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,731.00000,220.03000,United Healthcare,Commercial,,657.90,,,,,,,657.90,709.07,percent of total billed charges,
PLATELETS PHER LR EA UNIT,3902277,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,731.00000,220.03000,United Healthcare,Commercial,,657.90,,,,,,,190.06,709.07,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,787.00000,236.89000,United Healthcare,Commercial,,708.30,,,,,,,708.30,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD EA UNIT,3902285,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,787.00000,236.89000,United Healthcare,Commercial,,708.30,,,,,,,204.62,763.39,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,inpatient,,,2042.00000,614.64000,United Healthcare,Commercial,,1837.80,,,,,,,1837.80,1980.74,percent of total billed charges,
PLATELETS PHER LR IRRD LOW YIELD EA,3904745,CDM,390,RC,P9037,HCPCS,,,facility,outpatient,,,2042.00000,614.64000,United Healthcare,Commercial,,1837.80,,,,,,,530.92,1980.74,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,inpatient,,,1875.00000,564.38000,United Healthcare,Commercial,,1687.50,,,,,,,1687.50,1818.75,percent of total billed charges,
PLATELETS PHER LR LOW YIELD EA,3904760,CDM,390,RC,P9035,HCPCS,,,facility,outpatient,,,1875.00000,564.38000,United Healthcare,Commercial,,1687.50,,,,,,,487.50,1818.75,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,714.00000,214.91000,United Healthcare,Commercial,,642.60,,,,,,,642.60,692.58,percent of total billed charges,
RBC LR AUTO EA UNIT,3902384,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,714.00000,214.91000,United Healthcare,Commercial,,642.60,,,,,,,185.64,692.58,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,inpatient,,,294.00000,88.49000,United Healthcare,Commercial,,264.60,,,,,,,264.60,285.18,percent of total billed charges,
RBC LR EA UNIT,3902632,CDM,390,RC,P9016,HCPCS,,,facility,outpatient,,,294.00000,88.49000,United Healthcare,Commercial,,264.60,,,,,,,76.44,285.18,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,inpatient,,,350.00000,105.35000,United Healthcare,Commercial,,315.00,,,,,,,315.00,339.50,percent of total billed charges,
RBC LR IRRD EA UNIT,3902418,CDM,390,RC,P9040,HCPCS,,,facility,outpatient,,,350.00000,105.35000,United Healthcare,Commercial,,315.00,,,,,,,91.00,339.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,inpatient,,,1350.00000,780.30000,United Healthcare,Commercial,,1215.00,,,,,,,1215.00,1309.50,percent of total billed charges,
OR LEVEL 1 ADDL 15MIN,3602018,CDM,360,RC,,,,,facility,outpatient,,,1350.00000,780.30000,United Healthcare,Commercial,,1215.00,,,,,,,351.00,1309.50,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,inpatient,,,3680.00000,2127.04000,United Healthcare,Commercial,,3312.00,,,,,,,3312.00,3569.60,percent of total billed charges,
OR LEVEL 1 FIRST 30MIN,3602000,CDM,360,RC,,,,,facility,outpatient,,,3680.00000,2127.04000,United Healthcare,Commercial,,3312.00,,,,,,,956.80,3569.60,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,inpatient,,,1600.00000,924.80000,United Healthcare,Commercial,,1440.00,,,,,,,1440.00,1552.00,percent of total billed charges,
OR LEVEL 2 ADDL 15MIN,3602034,CDM,360,RC,,,,,facility,outpatient,,,1600.00000,924.80000,United Healthcare,Commercial,,1440.00,,,,,,,416.00,1552.00,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,inpatient,,,4680.00000,2705.04000,United Healthcare,Commercial,,4212.00,,,,,,,4212.00,4539.60,percent of total billed charges,
OR LEVEL 2 FIRST 30MIN,3602026,CDM,360,RC,,,,,facility,outpatient,,,4680.00000,2705.04000,United Healthcare,Commercial,,4212.00,,,,,,,1216.80,4539.60,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,inpatient,,,2100.00000,1213.80000,United Healthcare,Commercial,,1890.00,,,,,,,1890.00,2037.00,percent of total billed charges,
OR LEVEL 3 ADDL 15MIN,3602059,CDM,360,RC,,,,,facility,outpatient,,,2100.00000,1213.80000,United Healthcare,Commercial,,1890.00,,,,,,,546.00,2037.00,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,inpatient,,,5680.00000,3283.04000,United Healthcare,Commercial,,5112.00,,,,,,,5112.00,5509.60,percent of total billed charges,
OR LEVEL 3 FIRST 30MIN,3602042,CDM,360,RC,,,,,facility,outpatient,,,5680.00000,3283.04000,United Healthcare,Commercial,,5112.00,,,,,,,1476.80,5509.60,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,inpatient,,,2420.00000,1398.76000,United Healthcare,Commercial,,2178.00,,,,,,,2178.00,2347.40,percent of total billed charges,
OR LEVEL 4 ADDL 15MIN,3602075,CDM,360,RC,,,,,facility,outpatient,,,2420.00000,1398.76000,United Healthcare,Commercial,,2178.00,,,,,,,629.20,2347.40,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,inpatient,,,6415.00000,3707.87000,United Healthcare,Commercial,,5773.50,,,,,,,5773.50,6222.55,percent of total billed charges,
OR LEVEL 4 FIRST 30MIN,3602067,CDM,360,RC,,,,,facility,outpatient,,,6415.00000,3707.87000,United Healthcare,Commercial,,5773.50,,,,,,,1667.90,6222.55,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,inpatient,,,2920.00000,1687.76000,United Healthcare,Commercial,,2628.00,,,,,,,2628.00,2832.40,percent of total billed charges,
OR LEVEL 5 ADDL 15MIN,3602091,CDM,360,RC,,,,,facility,outpatient,,,2920.00000,1687.76000,United Healthcare,Commercial,,2628.00,,,,,,,759.20,2832.40,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,inpatient,,,8915.00000,5152.87000,United Healthcare,Commercial,,8023.50,,,,,,,8023.50,8647.55,percent of total billed charges,
OR LEVEL 5 FIRST 30MIN,3602083,CDM,360,RC,,,,,facility,outpatient,,,8915.00000,5152.87000,United Healthcare,Commercial,,8023.50,,,,,,,2317.90,8647.55,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,inpatient,,,3420.00000,1976.76000,United Healthcare,Commercial,,3078.00,,,,,,,3078.00,3317.40,percent of total billed charges,
OR LEVEL 6 ADDL 15MIN,3602117,CDM,360,RC,,,,,facility,outpatient,,,3420.00000,1976.76000,United Healthcare,Commercial,,3078.00,,,,,,,889.20,3317.40,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,inpatient,,,11415.00000,6597.87000,United Healthcare,Commercial,,10273.50,,,,,,,10273.50,11072.55,percent of total billed charges,
OR LEVEL 6 FIRST 30MIN,3602109,CDM,360,RC,,,,,facility,outpatient,,,11415.00000,6597.87000,United Healthcare,Commercial,,10273.50,,,,,,,2967.90,11072.55,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,inpatient,,,142.00000,154.35000,United Healthcare,Commercial,,127.80,,,,,,,127.80,137.74,percent of total billed charges,
MONITOR NEURO 1:1 IN OR 15MIN,3604659,CDM,920,RC,95940,CPT,,,facility,outpatient,,,142.00000,154.35000,United Healthcare,Commercial,,127.80,,,,,,,36.92,137.74,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,inpatient,,,340.00000,228.82000,United Healthcare,Commercial,,306.00,,,,,,,306.00,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 ADDL 15MIN,3705100,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,United Healthcare,Commercial,,306.00,,,,,,,88.40,329.80,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,inpatient,,,670.00000,450.91000,United Healthcare,Commercial,,603.00,,,,,,,603.00,649.90,percent of total billed charges,
ANESTHESIA LEVEL 1 FIRST 30MIN,3702107,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,United Healthcare,Commercial,,603.00,,,,,,,174.20,649.90,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,inpatient,,,390.00000,262.47000,United Healthcare,Commercial,,351.00,,,,,,,351.00,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 ADDL 15MIN,3705118,CDM,370,RC,,,,,facility,outpatient,,,390.00000,262.47000,United Healthcare,Commercial,,351.00,,,,,,,101.40,378.30,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,inpatient,,,1170.00000,787.41000,United Healthcare,Commercial,,1053.00,,,,,,,1053.00,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 2 FIRST 30MIN,3702115,CDM,370,RC,,,,,facility,outpatient,,,1170.00000,787.41000,United Healthcare,Commercial,,1053.00,,,,,,,304.20,1134.90,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,inpatient,,,440.00000,296.12000,United Healthcare,Commercial,,396.00,,,,,,,396.00,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 ADDL 15MIN,3705126,CDM,370,RC,,,,,facility,outpatient,,,440.00000,296.12000,United Healthcare,Commercial,,396.00,,,,,,,114.40,426.80,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,inpatient,,,1670.00000,1123.91000,United Healthcare,Commercial,,1503.00,,,,,,,1503.00,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 3 FIRST 30MIN,3702123,CDM,370,RC,,,,,facility,outpatient,,,1670.00000,1123.91000,United Healthcare,Commercial,,1503.00,,,,,,,434.20,1619.90,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,inpatient,,,640.00000,430.72000,United Healthcare,Commercial,,576.00,,,,,,,576.00,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 ADDL 15MIN,3705134,CDM,370,RC,,,,,facility,outpatient,,,640.00000,430.72000,United Healthcare,Commercial,,576.00,,,,,,,166.40,620.80,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,inpatient,,,2170.00000,1460.41000,United Healthcare,Commercial,,1953.00,,,,,,,1953.00,2104.90,percent of total billed charges,
ANESTHESIA LEVEL 4 FIRST 30MIN,3702131,CDM,370,RC,,,,,facility,outpatient,,,2170.00000,1460.41000,United Healthcare,Commercial,,1953.00,,,,,,,564.20,2104.90,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,inpatient,,,17.00000,10.96000,United Healthcare,Commercial,,15.30,,,,,,,15.30,16.49,percent of total billed charges,
RECOVERY LEVEL 1 ADDL 1MIN,7140825,CDM,710,RC,,,,,facility,outpatient,,,17.00000,10.96000,United Healthcare,Commercial,,15.30,,,,,,,4.42,16.49,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,inpatient,,,535.00000,345.08000,United Healthcare,Commercial,,481.50,,,,,,,481.50,518.95,percent of total billed charges,
RECOVERY LEVEL 1 FIRST 1MIN,7140817,CDM,710,RC,,,,,facility,outpatient,,,535.00000,345.08000,United Healthcare,Commercial,,481.50,,,,,,,139.10,518.95,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,inpatient,,,23.00000,14.84000,United Healthcare,Commercial,,20.70,,,,,,,20.70,22.31,percent of total billed charges,
RECOVERY LEVEL 2 ADDL 1MIN,7140841,CDM,710,RC,,,,,facility,outpatient,,,23.00000,14.84000,United Healthcare,Commercial,,20.70,,,,,,,5.98,22.31,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,inpatient,,,635.00000,409.58000,United Healthcare,Commercial,,571.50,,,,,,,571.50,615.95,percent of total billed charges,
RECOVERY LEVEL 2 FIRST 1MIN,7140833,CDM,710,RC,,,,,facility,outpatient,,,635.00000,409.58000,United Healthcare,Commercial,,571.50,,,,,,,165.10,615.95,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,inpatient,,,30.00000,19.35000,United Healthcare,Commercial,,27.00,,,,,,,27.00,29.10,percent of total billed charges,
RECOVERY LEVEL 3 ADDL 1MIN,7140866,CDM,710,RC,,,,,facility,outpatient,,,30.00000,19.35000,United Healthcare,Commercial,,27.00,,,,,,,7.80,29.10,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,inpatient,,,735.00000,474.08000,United Healthcare,Commercial,,661.50,,,,,,,661.50,712.95,percent of total billed charges,
RECOVERY LEVEL 3 FIRST 1MIN,7140858,CDM,710,RC,,,,,facility,outpatient,,,735.00000,474.08000,United Healthcare,Commercial,,661.50,,,,,,,191.10,712.95,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,inpatient,,,33.00000,21.28000,United Healthcare,Commercial,,29.70,,,,,,,29.70,32.01,percent of total billed charges,
RECOVERY LEVEL 4 ADDL 1MIN,7140882,CDM,710,RC,,,,,facility,outpatient,,,33.00000,21.28000,United Healthcare,Commercial,,29.70,,,,,,,8.58,32.01,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,inpatient,,,835.00000,538.58000,United Healthcare,Commercial,,751.50,,,,,,,751.50,809.95,percent of total billed charges,
RECOVERY LEVEL 4 FIRST 1MIN,7140874,CDM,710,RC,,,,,facility,outpatient,,,835.00000,538.58000,United Healthcare,Commercial,,751.50,,,,,,,217.10,809.95,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,inpatient,,,140.00000,80.92000,United Healthcare,Commercial,,126.00,,,,,,,126.00,135.80,percent of total billed charges,
ENDO OR LEVEL 1 ADDL 15MIN,7503097,CDM,360,RC,,,,,facility,outpatient,,,140.00000,80.92000,United Healthcare,Commercial,,126.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,inpatient,,,275.00000,158.95000,United Healthcare,Commercial,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
ENDO OR LEVEL 1 FIRST 15MIN,7503089,CDM,360,RC,,,,,facility,outpatient,,,275.00000,158.95000,United Healthcare,Commercial,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,inpatient,,,295.00000,170.51000,United Healthcare,Commercial,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
ENDO OR LEVEL 2 ADDL 15MIN,7503113,CDM,360,RC,,,,,facility,outpatient,,,295.00000,170.51000,United Healthcare,Commercial,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,inpatient,,,590.00000,341.02000,United Healthcare,Commercial,,531.00,,,,,,,531.00,572.30,percent of total billed charges,
ENDO OR LEVEL 2 FIRST 15MIN,7503105,CDM,360,RC,,,,,facility,outpatient,,,590.00000,341.02000,United Healthcare,Commercial,,531.00,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,inpatient,,,690.00000,398.82000,United Healthcare,Commercial,,621.00,,,,,,,621.00,669.30,percent of total billed charges,
ENDO OR LEVEL 3 ADDL 15MIN,7503139,CDM,360,RC,,,,,facility,outpatient,,,690.00000,398.82000,United Healthcare,Commercial,,621.00,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,inpatient,,,1375.00000,794.75000,United Healthcare,Commercial,,1237.50,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 3 FIRST 15MIN,7503121,CDM,360,RC,,,,,facility,outpatient,,,1375.00000,794.75000,United Healthcare,Commercial,,1237.50,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,inpatient,,,950.00000,549.10000,United Healthcare,Commercial,,855.00,,,,,,,855.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 ADDL 15MIN,7503154,CDM,360,RC,,,,,facility,outpatient,,,950.00000,549.10000,United Healthcare,Commercial,,855.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,inpatient,,,1900.00000,1098.20000,United Healthcare,Commercial,,1710.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO OR LEVEL 4 FIRST 15MIN,7503147,CDM,360,RC,,,,,facility,outpatient,,,1900.00000,1098.20000,United Healthcare,Commercial,,1710.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,inpatient,,,140.00000,45.22000,United Healthcare,Commercial,,126.00,,,,,,,126.00,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 ADDL 15MIN,7502958,CDM,361,RC,,,,,facility,outpatient,,,140.00000,45.22000,United Healthcare,Commercial,,126.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,inpatient,,,275.00000,88.82000,United Healthcare,Commercial,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 1 FIRST 15MIN,7502941,CDM,361,RC,,,,,facility,outpatient,,,275.00000,88.82000,United Healthcare,Commercial,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,inpatient,,,295.00000,95.28000,United Healthcare,Commercial,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 ADDL 15MIN,7502974,CDM,361,RC,,,,,facility,outpatient,,,295.00000,95.28000,United Healthcare,Commercial,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,inpatient,,,590.00000,190.57000,United Healthcare,Commercial,,531.00,,,,,,,531.00,572.30,percent of total billed charges,
ENDO OTHER LEVEL 2 FIRST 15MIN,7502966,CDM,361,RC,,,,,facility,outpatient,,,590.00000,190.57000,United Healthcare,Commercial,,531.00,,,,,,,153.40,572.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,inpatient,,,690.00000,222.87000,United Healthcare,Commercial,,621.00,,,,,,,621.00,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 ADDL 15MIN,7502990,CDM,361,RC,,,,,facility,outpatient,,,690.00000,222.87000,United Healthcare,Commercial,,621.00,,,,,,,179.40,669.30,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,inpatient,,,1375.00000,444.12000,United Healthcare,Commercial,,1237.50,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 3 FIRST 15MIN,7502982,CDM,361,RC,,,,,facility,outpatient,,,1375.00000,444.12000,United Healthcare,Commercial,,1237.50,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,inpatient,,,950.00000,306.85000,United Healthcare,Commercial,,855.00,,,,,,,855.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 ADDL 15MIN,7503014,CDM,361,RC,,,,,facility,outpatient,,,950.00000,306.85000,United Healthcare,Commercial,,855.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,inpatient,,,1900.00000,613.70000,United Healthcare,Commercial,,1710.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO OTHER LEVEL 4 FIRST 15MIN,7503006,CDM,361,RC,,,,,facility,outpatient,,,1900.00000,613.70000,United Healthcare,Commercial,,1710.00,,,,,,,494.00,1843.00,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,inpatient,,,340.00000,228.82000,United Healthcare,Commercial,,306.00,,,,,,,306.00,329.80,percent of total billed charges,
ENDO ANES MAC/GEN ADDL 15MIN,7503048,CDM,370,RC,,,,,facility,outpatient,,,340.00000,228.82000,United Healthcare,Commercial,,306.00,,,,,,,88.40,329.80,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,inpatient,,,670.00000,450.91000,United Healthcare,Commercial,,603.00,,,,,,,603.00,649.90,percent of total billed charges,
ENDO ANES MAC/GEN FIRST 15MIN,7503030,CDM,370,RC,,,,,facility,outpatient,,,670.00000,450.91000,United Healthcare,Commercial,,603.00,,,,,,,174.20,649.90,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,United Healthcare,Commercial,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD ENDO SAME 5+Y INIT 15MN,3701091,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,United Healthcare,Commercial,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,inpatient,,,490.00000,329.77000,United Healthcare,Commercial,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD SAME 0-4Y INIT 15MN,3701075,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,United Healthcare,Commercial,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,United Healthcare,Commercial,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
SED MOD SAME 5+Y INIT 15MN,3701083,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,United Healthcare,Commercial,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,inpatient,,,245.00000,164.89000,United Healthcare,Commercial,,220.50,,,,,,,220.50,237.65,percent of total billed charges,
SED MOD SAME ADDL 15MN,3701109,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,United Healthcare,Commercial,,220.50,,,,,,,63.70,237.65,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,United Healthcare,Commercial,,757.80,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,7503055,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,United Healthcare,Commercial,,757.80,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,United Healthcare,Commercial,,947.70,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,7503063,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,United Healthcare,Commercial,,947.70,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,United Healthcare,Commercial,,1136.70,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,7503071,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,United Healthcare,Commercial,,1136.70,,,,,,,328.38,1225.11,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,inpatient,,,1178.00000,669.28000,United Healthcare,Commercial,,1060.20,,,,,,,1060.20,1142.66,percent of total billed charges,
CARDIOVERSION ELECTIVE EXTERNAL,7501240,CDM,480,RC,92960,CPT,,,facility,outpatient,,,1178.00000,669.28000,United Healthcare,Commercial,,1060.20,,,,,,,306.28,1142.66,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,inpatient,,,140.00000,102.34000,United Healthcare,Commercial,,126.00,,,,,,,126.00,135.80,percent of total billed charges,
ENDO GI LEVEL 1 ADDL 15MIN,7502792,CDM,750,RC,,,,,facility,outpatient,,,140.00000,102.34000,United Healthcare,Commercial,,126.00,,,,,,,36.40,135.80,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,inpatient,,,275.00000,201.02000,United Healthcare,Commercial,,247.50,,,,,,,247.50,266.75,percent of total billed charges,
ENDO GI LEVEL 1 FIRST 15MIN,7502784,CDM,750,RC,,,,,facility,outpatient,,,275.00000,201.02000,United Healthcare,Commercial,,247.50,,,,,,,71.50,266.75,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,inpatient,,,295.00000,215.64000,United Healthcare,Commercial,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
ENDO GI LEVEL 2 ADDL 15MIN,7502818,CDM,750,RC,,,,,facility,outpatient,,,295.00000,215.64000,United Healthcare,Commercial,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,inpatient,,,590.00000,431.29000,United Healthcare,Commercial,,531.00,,,,,,,531.00,572.30,percent of total billed charges,
ENDO GI LEVEL 2 FIRST 15MIN,7502800,CDM,750,RC,,,,,facility,outpatient,,,590.00000,431.29000,United Healthcare,Commercial,,531.00,,,,,,,153.40,572.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,inpatient,,,690.00000,504.39000,United Healthcare,Commercial,,621.00,,,,,,,621.00,669.30,percent of total billed charges,
ENDO GI LEVEL 3 ADDL 15MIN,7502834,CDM,750,RC,,,,,facility,outpatient,,,690.00000,504.39000,United Healthcare,Commercial,,621.00,,,,,,,179.40,669.30,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,inpatient,,,1375.00000,1005.12000,United Healthcare,Commercial,,1237.50,,,,,,,1237.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 3 FIRST 15MIN,7502826,CDM,750,RC,,,,,facility,outpatient,,,1375.00000,1005.12000,United Healthcare,Commercial,,1237.50,,,,,,,357.50,1333.75,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,inpatient,,,950.00000,694.45000,United Healthcare,Commercial,,855.00,,,,,,,855.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 ADDL 15MIN,7502859,CDM,750,RC,,,,,facility,outpatient,,,950.00000,694.45000,United Healthcare,Commercial,,855.00,,,,,,,247.00,921.50,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,inpatient,,,1900.00000,1388.90000,United Healthcare,Commercial,,1710.00,,,,,,,1710.00,1843.00,percent of total billed charges,
ENDO GI LEVEL 4 FIRST 15MIN,7502842,CDM,750,RC,,,,,facility,outpatient,,,1900.00000,1388.90000,United Healthcare,Commercial,,1710.00,,,,,,,494.00,1843.00,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,inpatient,,,584.00000,426.90000,United Healthcare,Commercial,,525.60,,,,,,,525.60,566.48,percent of total billed charges,
INSTILL FECAL MICROB LGI EN RECT SP,7503360,CDM,750,RC,0780T,CPT,,,facility,outpatient,,,584.00000,426.90000,United Healthcare,Commercial,,525.60,,,,,,,151.84,566.48,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,inpatient,,,1391.00000,1016.82000,United Healthcare,Commercial,,1251.90,,,,,,,1251.90,1349.27,percent of total billed charges,
TEST ESOPHAGUS PH CAP,7501984,CDM,750,RC,91035,CPT,,,facility,outpatient,,,1391.00000,1016.82000,United Healthcare,Commercial,,1251.90,,,,,,,361.66,1349.27,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,inpatient,,,359.00000,271.76000,United Healthcare,Commercial,,323.10,,,,,,,323.10,348.23,percent of total billed charges,
POC COLLECT SPEC SPUTUM AEROSOL,3094059,CDM,300,RC,89220,CPT,,,facility,outpatient,,,359.00000,271.76000,United Healthcare,Commercial,,323.10,,,,,,,93.34,348.23,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,inpatient,,,95.00000,71.92000,United Healthcare,Commercial,,85.50,,,,,,,85.50,92.15,percent of total billed charges,
PUNCT ARTERIAL FOR DIAGNOSIS,4109823,CDM,300,RC,36600,CPT,,,facility,outpatient,,,95.00000,71.92000,United Healthcare,Commercial,,85.50,,,,,,,24.70,92.15,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,inpatient,,,37.00000,17.83000,United Healthcare,Commercial,,33.30,,,,,,,33.30,35.89,percent of total billed charges,
POC CARBOXYHEMOGLOBIN QN,3105194,CDM,301,RC,82375,CPT,,,facility,outpatient,,,37.00000,17.83000,United Healthcare,Commercial,,33.30,,,,,,,9.62,35.89,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,inpatient,,,79.00000,38.08000,United Healthcare,Commercial,,71.10,,,,,,,71.10,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO,3094638,CDM,301,RC,82803,CPT,,,facility,outpatient,,,79.00000,38.08000,United Healthcare,Commercial,,71.10,,,,,,,20.54,76.63,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,inpatient,,,237.00000,114.23000,United Healthcare,Commercial,,213.30,,,,,,,213.30,229.89,percent of total billed charges,
POC GASES BLD ANY COMBO W SAT O2,3105210,CDM,301,RC,82805,CPT,,,facility,outpatient,,,237.00000,114.23000,United Healthcare,Commercial,,213.30,,,,,,,61.62,229.89,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,inpatient,,,33.00000,15.91000,United Healthcare,Commercial,,29.70,,,,,,,29.70,32.01,percent of total billed charges,
POC GASES BLD PH ONLY,3105756,CDM,301,RC,82800,CPT,,,facility,outpatient,,,33.00000,15.91000,United Healthcare,Commercial,,29.70,,,,,,,8.58,32.01,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,inpatient,,,25.00000,12.05000,United Healthcare,Commercial,,22.50,,,,,,,22.50,24.25,percent of total billed charges,
POC HEMOGLOBIN METHEMOGLOBIN QN,3108628,CDM,301,RC,83050,CPT,,,facility,outpatient,,,25.00000,12.05000,United Healthcare,Commercial,,22.50,,,,,,,6.50,24.25,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,inpatient,,,497.00000,160.53000,United Healthcare,Commercial,,447.30,,,,,,,447.30,482.09,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,4110458,CDM,361,RC,36593,CPT,,,facility,outpatient,,,497.00000,160.53000,United Healthcare,Commercial,,447.30,,,,,,,129.22,482.09,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,United Healthcare,Commercial,,793.80,,,,,,,793.80,855.54,percent of total billed charges,
BIPAP INITIAL DAY,4109385,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,United Healthcare,Commercial,,793.80,,,,,,,229.32,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,United Healthcare,Commercial,,793.80,,,,,,,793.80,855.54,percent of total billed charges,
BIPAP SUBSQ DAY,4109393,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,United Healthcare,Commercial,,793.80,,,,,,,229.32,855.54,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,inpatient,,,98.00000,37.44000,United Healthcare,Commercial,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
CLEARANCE AIRWAY INITIAL,4109468,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,United Healthcare,Commercial,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,inpatient,,,96.00000,36.67000,United Healthcare,Commercial,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
CLEARANCE AIRWAY SUBSQ,4109476,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,United Healthcare,Commercial,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,United Healthcare,Commercial,,793.80,,,,,,,793.80,855.54,percent of total billed charges,
CPAP INITIAL DAY,4109435,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,United Healthcare,Commercial,,793.80,,,,,,,229.32,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,inpatient,,,882.00000,336.92000,United Healthcare,Commercial,,793.80,,,,,,,793.80,855.54,percent of total billed charges,
CPAP SUBSQ DAY,4109443,CDM,410,RC,94660,CPT,,,facility,outpatient,,,882.00000,336.92000,United Healthcare,Commercial,,793.80,,,,,,,229.32,855.54,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,inpatient,,,763.00000,291.47000,United Healthcare,Commercial,,686.70,,,,,,,686.70,740.11,percent of total billed charges,
CPR,4109245,CDM,410,RC,92950,CPT,,,facility,outpatient,,,763.00000,291.47000,United Healthcare,Commercial,,686.70,,,,,,,198.38,740.11,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,inpatient,,,199.00000,76.02000,United Healthcare,Commercial,,179.10,,,,,,,179.10,193.03,percent of total billed charges,
DEMO&/EVAL PT AEROSOL/NEB/MDI/IPPB,4109351,CDM,410,RC,94664,CPT,,,facility,outpatient,,,199.00000,76.02000,United Healthcare,Commercial,,179.10,,,,,,,51.74,193.03,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,inpatient,,,98.00000,37.44000,United Healthcare,Commercial,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST INITIAL,4109401,CDM,410,RC,94667,CPT,,,facility,outpatient,,,98.00000,37.44000,United Healthcare,Commercial,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,inpatient,,,96.00000,36.67000,United Healthcare,Commercial,,86.40,,,,,,,86.40,93.12,percent of total billed charges,
PHYSIOTHERAPY CHEST SUBSQ,4109419,CDM,410,RC,94668,CPT,,,facility,outpatient,,,96.00000,36.67000,United Healthcare,Commercial,,86.40,,,,,,,24.96,93.12,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,inpatient,,,1265.00000,483.23000,United Healthcare,Commercial,,1138.50,,,,,,,1138.50,1227.05,percent of total billed charges,
VENT INITIAL DAY,4109583,CDM,410,RC,94002,CPT,,,facility,outpatient,,,1265.00000,483.23000,United Healthcare,Commercial,,1138.50,,,,,,,328.90,1227.05,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,inpatient,,,924.00000,352.97000,United Healthcare,Commercial,,831.60,,,,,,,831.60,896.28,percent of total billed charges,
VENT SUBSQ DAY,4109591,CDM,410,RC,94003,CPT,,,facility,outpatient,,,924.00000,352.97000,United Healthcare,Commercial,,831.60,,,,,,,240.24,896.28,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,inpatient,,,580.00000,215.76000,United Healthcare,Commercial,,522.00,,,,,,,522.00,562.60,percent of total billed charges,
BRONCHDLTN PRE&POST SPIROMETRY W VC,4110094,CDM,460,RC,94060,CPT,,,facility,outpatient,,,580.00000,215.76000,United Healthcare,Commercial,,522.00,,,,,,,150.80,562.60,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,inpatient,,,110.00000,40.92000,United Healthcare,Commercial,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
CAPACITY BREATHING MAX VENT VOL MAX,4110169,CDM,460,RC,94200,CPT,,,facility,outpatient,,,110.00000,40.92000,United Healthcare,Commercial,,99.00,,,,,,,28.60,106.70,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,inpatient,,,373.00000,138.76000,United Healthcare,Commercial,,335.70,,,,,,,335.70,361.81,percent of total billed charges,
CAPACITY DIFFUSING,4110649,CDM,460,RC,94729,CPT,,,facility,outpatient,,,373.00000,138.76000,United Healthcare,Commercial,,335.70,,,,,,,96.98,361.81,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,inpatient,,,337.00000,125.36000,United Healthcare,Commercial,,303.30,,,,,,,303.30,326.89,percent of total billed charges,
DILUT GAS/WASHOUT VOLUMES LUNG,4110623,CDM,460,RC,94727,CPT,,,facility,outpatient,,,337.00000,125.36000,United Healthcare,Commercial,,303.30,,,,,,,87.62,326.89,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,inpatient,,,784.00000,291.65000,United Healthcare,Commercial,,705.60,,,,,,,705.60,760.48,percent of total billed charges,
EVAL BRONCHSPSM SPIRO W AGENTS,4110151,CDM,460,RC,94070,CPT,,,facility,outpatient,,,784.00000,291.65000,United Healthcare,Commercial,,705.60,,,,,,,203.84,760.48,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,inpatient,,,341.00000,126.85000,United Healthcare,Commercial,,306.90,,,,,,,306.90,330.77,percent of total billed charges,
LOOP VOLUME FLOW RESP,4110193,CDM,460,RC,94375,CPT,,,facility,outpatient,,,341.00000,126.85000,United Healthcare,Commercial,,306.90,,,,,,,88.66,330.77,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,inpatient,,,252.00000,93.74000,United Healthcare,Commercial,,226.80,,,,,,,226.80,244.44,percent of total billed charges,
PLETHYSMOGRAPHY VOLUMES LUNG,4110615,CDM,460,RC,94726,CPT,,,facility,outpatient,,,252.00000,93.74000,United Healthcare,Commercial,,226.80,,,,,,,65.52,244.44,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,inpatient,,,282.00000,104.90000,United Healthcare,Commercial,,253.80,,,,,,,253.80,273.54,percent of total billed charges,
RESIST AIRWAY OSCILLOMETRY,4110961,CDM,460,RC,94728,CPT,,,facility,outpatient,,,282.00000,104.90000,United Healthcare,Commercial,,253.80,,,,,,,73.32,273.54,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,inpatient,,,404.00000,150.29000,United Healthcare,Commercial,,363.60,,,,,,,363.60,391.88,percent of total billed charges,
SPIROMETRY W VITAL CAP W/WO VENT,4109963,CDM,460,RC,94010,CPT,,,facility,outpatient,,,404.00000,150.29000,United Healthcare,Commercial,,363.60,,,,,,,105.04,391.88,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,inpatient,,,306.00000,173.85000,United Healthcare,Commercial,,275.40,,,,,,,275.40,296.82,percent of total billed charges,
REHAB PULM OP W CONT OX SESSN,4601761,CDM,948,RC,94626,CPT,,,facility,outpatient,,,306.00000,173.85000,United Healthcare,Commercial,,275.40,,,,,,,79.56,296.82,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,inpatient,,,158.00000,89.77000,United Healthcare,Commercial,,142.20,,,,,,,142.20,153.26,percent of total billed charges,
REHAB PULM OP WO CONT OX SESSN,4601753,CDM,948,RC,94625,CPT,,,facility,outpatient,,,158.00000,89.77000,United Healthcare,Commercial,,142.20,,,,,,,41.08,153.26,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,inpatient,,,147.00000,89.38000,United Healthcare,Commercial,GP,132.30,,,,,,,132.30,142.59,percent of total billed charges,
PT DEBRIDE NONSELECT WO ANES SESSN,4209524,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,United Healthcare,Commercial,GP,132.30,,,,,,,38.22,142.59,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,inpatient,,,270.00000,164.16000,United Healthcare,Commercial,GP,243.00,,,,,,,243.00,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN 1ST 20CM,4211975,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,United Healthcare,Commercial,GP,243.00,,,,,,,70.20,261.90,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,inpatient,,,84.00000,51.07000,United Healthcare,Commercial,GP,75.60,,,,,,,75.60,81.48,percent of total billed charges,
PT DEBRIDE SLCT WND OPEN ADDL 20CM,4211983,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,United Healthcare,Commercial,GP,75.60,,,,,,,21.84,81.48,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,inpatient,,,86.00000,52.29000,United Healthcare,Commercial,GP,77.40,,,,,,,77.40,83.42,percent of total billed charges,
PT MANAGEMENT SELF-CARE/HOME 15MN,4209474,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,United Healthcare,Commercial,GP,77.40,,,,,,,22.36,83.42,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,inpatient,,,82.00000,49.86000,United Healthcare,Commercial,GP,73.80,,,,,,,73.80,79.54,percent of total billed charges,
PT MANAGEMENT WHEELCHAIR 15MN,4209490,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,United Healthcare,Commercial,GP,73.80,,,,,,,21.32,79.54,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,inpatient,,,85.00000,51.68000,United Healthcare,Commercial,GP,76.50,,,,,,,76.50,82.45,percent of total billed charges,
PT MEAS/TEST PERFORMANCE 15MIN,4209557,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,United Healthcare,Commercial,GP,76.50,,,,,,,22.10,82.45,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,inpatient,,,43.00000,26.14000,United Healthcare,Commercial,GP,38.70,,,,,,,38.70,41.71,percent of total billed charges,
PT MODALITY APPL BATH CNT 15MN,4209276,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,United Healthcare,Commercial,GP,38.70,,,,,,,11.18,41.71,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,inpatient,,,41.00000,24.93000,United Healthcare,Commercial,GP,36.90,,,,,,,36.90,39.77,percent of total billed charges,
PT MODALITY APPL BATH PARAFFIN,4209169,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,United Healthcare,Commercial,GP,36.90,,,,,,,10.66,39.77,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,inpatient,,,79.00000,48.03000,United Healthcare,Commercial,GP,71.10,,,,,,,71.10,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM MAN 15MN,4209250,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,United Healthcare,Commercial,GP,71.10,,,,,,,20.54,76.63,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,United Healthcare,Commercial,GP,66.60,,,,,,,66.60,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND OTH,4209128,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,United Healthcare,Commercial,GP,66.60,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,United Healthcare,Commercial,GP,66.60,,,,,,,66.60,71.78,percent of total billed charges,
PT MODALITY APPL E-STIM UNATND ULC,4209136,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,United Healthcare,Commercial,GP,66.60,,,,,,,19.24,71.78,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,inpatient,,,34.00000,20.67000,United Healthcare,Commercial,GP,30.60,,,,,,,30.60,32.98,percent of total billed charges,
PT MODALITY APPL HOT/COLD,4209094,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,United Healthcare,Commercial,GP,30.60,,,,,,,8.84,32.98,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,inpatient,,,65.00000,39.52000,United Healthcare,Commercial,GP,58.50,,,,,,,58.50,63.05,percent of total billed charges,
PT MODALITY APPL IONTOPHORES 15MN,4209268,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,United Healthcare,Commercial,GP,58.50,,,,,,,16.90,63.05,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,inpatient,,,113.00000,68.70000,United Healthcare,Commercial,,101.70,,,,,,,101.70,109.61,percent of total billed charges,
PT MODALITY APPL THPY LASER LOW LVL,4219853,CDM,420,RC,97037,CPT,,,facility,outpatient,,,113.00000,68.70000,United Healthcare,Commercial,,101.70,,,,,,,29.38,109.61,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,inpatient,,,80.00000,48.64000,United Healthcare,Commercial,GP,72.00,,,,,,,72.00,77.60,percent of total billed charges,
PT MODALITY APPL TRACTION MECHANIC,4209102,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,United Healthcare,Commercial,GP,72.00,,,,,,,20.80,77.60,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,inpatient,,,84.00000,51.07000,United Healthcare,Commercial,GP,75.60,,,,,,,75.60,81.48,percent of total billed charges,
PT MODALITY APPL ULTRASOUND 15MN,4209284,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,United Healthcare,Commercial,GP,75.60,,,,,,,21.84,81.48,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,inpatient,,,73.00000,44.38000,United Healthcare,Commercial,GP,65.70,,,,,,,65.70,70.81,percent of total billed charges,
PT MODALITY APPL WHIRLPOOL,4209185,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,United Healthcare,Commercial,GP,65.70,,,,,,,18.98,70.81,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,inpatient,,,100.00000,60.80000,United Healthcare,Commercial,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
PT MOTOR COG VRF TRAIN GAIT 15MN,4219895,CDM,420,RC,0791T,CPT,,,facility,outpatient,,,100.00000,60.80000,United Healthcare,Commercial,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,inpatient,,,167.00000,101.54000,United Healthcare,Commercial,GP,150.30,,,,,,,150.30,161.99,percent of total billed charges,
PT REPOSITIONING CANALITH PER DAY,4212056,CDM,420,RC,95992,CPT,,,facility,outpatient,,,167.00000,101.54000,United Healthcare,Commercial,GP,150.30,,,,,,,43.42,161.99,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,inpatient,,,413.00000,251.10000,United Healthcare,Commercial,"50,GP",371.70,,,,,,,371.70,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA BI,4201794,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,United Healthcare,Commercial,"50,GP",371.70,,,,,,,107.38,400.61,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,United Healthcare,Commercial,"LT,GP",247.50,,,,,,,247.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA LT,4201802,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,United Healthcare,Commercial,"LT,GP",247.50,,,,,,,71.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,United Healthcare,Commercial,"RT,GP",247.50,,,,,,,247.50,266.75,percent of total billed charges,
PT STRAPPING BOOT UNNA RT,4201810,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,United Healthcare,Commercial,"RT,GP",247.50,,,,,,,71.50,266.75,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,inpatient,,,95.00000,57.76000,United Healthcare,Commercial,GP,85.50,,,,,,,85.50,92.15,percent of total billed charges,
PT THER ACTIVITIES 15MN,4209433,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,United Healthcare,Commercial,GP,85.50,,,,,,,24.70,92.15,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,inpatient,,,146.00000,88.77000,United Healthcare,Commercial,GP,131.40,,,,,,,131.40,141.62,percent of total billed charges,
PT THER AQUATIC 15MN,4209342,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,United Healthcare,Commercial,GP,131.40,,,,,,,37.96,141.62,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,inpatient,,,139.00000,84.51000,United Healthcare,Commercial,GP,125.10,,,,,,,125.10,134.83,percent of total billed charges,
PT THER EXERCISE 15MN,4209318,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,United Healthcare,Commercial,GP,125.10,,,,,,,36.14,134.83,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,inpatient,,,75.00000,45.60000,United Healthcare,Commercial,GP,67.50,,,,,,,67.50,72.75,percent of total billed charges,
PT THER MASSAGE 15MN,4209375,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,United Healthcare,Commercial,GP,67.50,,,,,,,19.50,72.75,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,inpatient,,,154.00000,93.63000,United Healthcare,Commercial,GP,138.60,,,,,,,138.60,149.38,percent of total billed charges,
PT THER NEUROMUS REEDUCATE 15MN,4209334,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,United Healthcare,Commercial,GP,138.60,,,,,,,40.04,149.38,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,inpatient,,,73.00000,44.38000,United Healthcare,Commercial,GP,65.70,,,,,,,65.70,70.81,percent of total billed charges,
PT THER TRAIN GAIT 15MN,4209359,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,United Healthcare,Commercial,GP,65.70,,,,,,,18.98,70.81,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,inpatient,,,160.00000,97.28000,United Healthcare,Commercial,GP,144.00,,,,,,,144.00,155.20,percent of total billed charges,
PT THERAPY MANUAL 15MN,4209391,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,United Healthcare,Commercial,GP,144.00,,,,,,,41.60,155.20,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,inpatient,,,325.00000,197.60000,United Healthcare,Commercial,GP,292.50,,,,,,,292.50,315.25,percent of total billed charges,
PT THERAPY MIST,4209698,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,United Healthcare,Commercial,GP,292.50,,,,,,,84.50,315.25,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,inpatient,,,98.00000,59.58000,United Healthcare,Commercial,GP,88.20,,,,,,,88.20,95.06,percent of total billed charges,
PT TRAIN CAREGIVER GROUP,4219887,CDM,420,RC,97552,CPT,,,facility,outpatient,,,98.00000,59.58000,United Healthcare,Commercial,GP,88.20,,,,,,,25.48,95.06,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,inpatient,,,303.00000,184.22000,United Healthcare,Commercial,GP,272.70,,,,,,,272.70,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT 1ST 30MIN,4219861,CDM,420,RC,97550,CPT,,,facility,outpatient,,,303.00000,184.22000,United Healthcare,Commercial,GP,272.70,,,,,,,78.78,293.91,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,inpatient,,,115.00000,69.92000,United Healthcare,Commercial,GP,103.50,,,,,,,103.50,111.55,percent of total billed charges,
PT TRAIN CAREGIVER WO PT ADD 15MIN,4219879,CDM,420,RC,97551,CPT,,,facility,outpatient,,,115.00000,69.92000,United Healthcare,Commercial,GP,103.50,,,,,,,29.90,111.55,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,inpatient,,,74.00000,44.99000,United Healthcare,Commercial,GP,66.60,,,,,,,66.60,71.78,percent of total billed charges,
PT TRAIN ORTHO UE/LE INIT 15MN,4214144,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,United Healthcare,Commercial,GP,66.60,,,,,,,19.24,71.78,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,inpatient,,,79.00000,48.03000,United Healthcare,Commercial,GP,71.10,,,,,,,71.10,76.63,percent of total billed charges,
PT TRAIN ORTHO/PROS EXT SUBSQ 15MN,4214227,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,United Healthcare,Commercial,GP,71.10,,,,,,,20.54,76.63,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,inpatient,,,72.00000,43.78000,United Healthcare,Commercial,GP,64.80,,,,,,,64.80,69.84,percent of total billed charges,
PT TRAIN PROSTH UE&/LE INIT 15MN,4214177,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,United Healthcare,Commercial,GP,64.80,,,,,,,18.72,69.84,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,inpatient,,,147.00000,89.38000,United Healthcare,Commercial,GP,132.30,,,,,,,132.30,142.59,percent of total billed charges,
PTA DEBRIDE NONSELECT WO ANES SESSN,4214987,CDM,420,RC,97602,CPT,,,facility,outpatient,,,147.00000,89.38000,United Healthcare,Commercial,GP,132.30,,,,,,,38.22,142.59,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,inpatient,,,270.00000,164.16000,United Healthcare,Commercial,GP,243.00,,,,,,,243.00,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN 1ST 20CM,4214961,CDM,420,RC,97597,CPT,,,facility,outpatient,,,270.00000,164.16000,United Healthcare,Commercial,GP,243.00,,,,,,,70.20,261.90,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,inpatient,,,84.00000,51.07000,United Healthcare,Commercial,GP,75.60,,,,,,,75.60,81.48,percent of total billed charges,
PTA DEBRIDE SLCT WND OPEN ADDL 20CM,4214979,CDM,420,RC,97598,CPT,,,facility,outpatient,,,84.00000,51.07000,United Healthcare,Commercial,GP,75.60,,,,,,,21.84,81.48,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,inpatient,,,86.00000,52.29000,United Healthcare,Commercial,GP,77.40,,,,,,,77.40,83.42,percent of total billed charges,
PTA MANAGEMENT SELF-CARE/HOME 15MN,4214912,CDM,420,RC,97535,CPT,,,facility,outpatient,,,86.00000,52.29000,United Healthcare,Commercial,GP,77.40,,,,,,,22.36,83.42,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,inpatient,,,82.00000,49.86000,United Healthcare,Commercial,GP,73.80,,,,,,,73.80,79.54,percent of total billed charges,
PTA MANAGEMENT WHEELCHAIR 15MN,4214938,CDM,420,RC,97542,CPT,,,facility,outpatient,,,82.00000,49.86000,United Healthcare,Commercial,GP,73.80,,,,,,,21.32,79.54,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,inpatient,,,85.00000,51.68000,United Healthcare,Commercial,GP,76.50,,,,,,,76.50,82.45,percent of total billed charges,
PTA MEAS/TEST PERFORMANCE 15MIN,4215059,CDM,420,RC,97750,CPT,,,facility,outpatient,,,85.00000,51.68000,United Healthcare,Commercial,GP,76.50,,,,,,,22.10,82.45,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,inpatient,,,43.00000,26.14000,United Healthcare,Commercial,GP,38.70,,,,,,,38.70,41.71,percent of total billed charges,
PTA MODALITY APPL BATH CNT 15MN,4214805,CDM,420,RC,97034,CPT,,,facility,outpatient,,,43.00000,26.14000,United Healthcare,Commercial,GP,38.70,,,,,,,11.18,41.71,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,inpatient,,,41.00000,24.93000,United Healthcare,Commercial,GP,36.90,,,,,,,36.90,39.77,percent of total billed charges,
PTA MODALITY APPL BATH PARAFFIN,4214755,CDM,420,RC,97018,CPT,,,facility,outpatient,,,41.00000,24.93000,United Healthcare,Commercial,GP,36.90,,,,,,,10.66,39.77,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,inpatient,,,79.00000,48.03000,United Healthcare,Commercial,GP,71.10,,,,,,,71.10,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM MAN 15MN,4214789,CDM,420,RC,97032,CPT,,,facility,outpatient,,,79.00000,48.03000,United Healthcare,Commercial,GP,71.10,,,,,,,20.54,76.63,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,United Healthcare,Commercial,"CQ,GP",66.60,,,,,,,66.60,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND OTH,4219556,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,United Healthcare,Commercial,"CQ,GP",66.60,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,inpatient,,,74.00000,44.99000,United Healthcare,Commercial,"CQ,GP",66.60,,,,,,,66.60,71.78,percent of total billed charges,
PTA MODALITY APPL E-STIM UNATND ULC,4219564,CDM,420,RC,97014,CPT,,,facility,outpatient,,,74.00000,44.99000,United Healthcare,Commercial,"CQ,GP",66.60,,,,,,,19.24,71.78,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,inpatient,,,34.00000,20.67000,United Healthcare,Commercial,GP,30.60,,,,,,,30.60,32.98,percent of total billed charges,
PTA MODALITY APPL HOT/COLD,4214722,CDM,420,RC,97010,CPT,,,facility,outpatient,,,34.00000,20.67000,United Healthcare,Commercial,GP,30.60,,,,,,,8.84,32.98,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,inpatient,,,65.00000,39.52000,United Healthcare,Commercial,GP,58.50,,,,,,,58.50,63.05,percent of total billed charges,
PTA MODALITY APPL IONTOPHORES 15MN,4214797,CDM,420,RC,97033,CPT,,,facility,outpatient,,,65.00000,39.52000,United Healthcare,Commercial,GP,58.50,,,,,,,16.90,63.05,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,inpatient,,,80.00000,48.64000,United Healthcare,Commercial,GP,72.00,,,,,,,72.00,77.60,percent of total billed charges,
PTA MODALITY APPL TRACTION MECHANIC,4214730,CDM,420,RC,97012,CPT,,,facility,outpatient,,,80.00000,48.64000,United Healthcare,Commercial,GP,72.00,,,,,,,20.80,77.60,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,inpatient,,,84.00000,51.07000,United Healthcare,Commercial,GP,75.60,,,,,,,75.60,81.48,percent of total billed charges,
PTA MODALITY APPL ULTRASOUND 15MN,4214813,CDM,420,RC,97035,CPT,,,facility,outpatient,,,84.00000,51.07000,United Healthcare,Commercial,GP,75.60,,,,,,,21.84,81.48,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,inpatient,,,73.00000,44.38000,United Healthcare,Commercial,GP,65.70,,,,,,,65.70,70.81,percent of total billed charges,
PTA MODALITY APPL WHIRLPOOL,4214763,CDM,420,RC,97022,CPT,,,facility,outpatient,,,73.00000,44.38000,United Healthcare,Commercial,GP,65.70,,,,,,,18.98,70.81,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,inpatient,,,413.00000,251.10000,United Healthcare,Commercial,"GP,50",371.70,,,,,,,371.70,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA BI,4218731,CDM,420,RC,29580,CPT,,,facility,outpatient,,,413.00000,251.10000,United Healthcare,Commercial,"GP,50",371.70,,,,,,,107.38,400.61,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,United Healthcare,Commercial,"GP,LT",247.50,,,,,,,247.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA LT,4218749,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,United Healthcare,Commercial,"GP,LT",247.50,,,,,,,71.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,inpatient,,,275.00000,167.20000,United Healthcare,Commercial,"GP,RT",247.50,,,,,,,247.50,266.75,percent of total billed charges,
PTA STRAPPING BOOT UNNA RT,4218756,CDM,420,RC,29580,CPT,,,facility,outpatient,,,275.00000,167.20000,United Healthcare,Commercial,"GP,RT",247.50,,,,,,,71.50,266.75,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,inpatient,,,95.00000,57.76000,United Healthcare,Commercial,GP,85.50,,,,,,,85.50,92.15,percent of total billed charges,
PTA THER ACTIVITIES 15MN,4214896,CDM,420,RC,97530,CPT,,,facility,outpatient,,,95.00000,57.76000,United Healthcare,Commercial,GP,85.50,,,,,,,24.70,92.15,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,inpatient,,,146.00000,88.77000,United Healthcare,Commercial,GP,131.40,,,,,,,131.40,141.62,percent of total billed charges,
PTA THER AQUATIC 15MN,4214847,CDM,420,RC,97113,CPT,,,facility,outpatient,,,146.00000,88.77000,United Healthcare,Commercial,GP,131.40,,,,,,,37.96,141.62,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,inpatient,,,139.00000,84.51000,United Healthcare,Commercial,GP,125.10,,,,,,,125.10,134.83,percent of total billed charges,
PTA THER EXERCISE 15MN,4214821,CDM,420,RC,97110,CPT,,,facility,outpatient,,,139.00000,84.51000,United Healthcare,Commercial,GP,125.10,,,,,,,36.14,134.83,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,inpatient,,,75.00000,45.60000,United Healthcare,Commercial,GP,67.50,,,,,,,67.50,72.75,percent of total billed charges,
PTA THER MASSAGE 15MN,4214862,CDM,420,RC,97124,CPT,,,facility,outpatient,,,75.00000,45.60000,United Healthcare,Commercial,GP,67.50,,,,,,,19.50,72.75,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,inpatient,,,154.00000,93.63000,United Healthcare,Commercial,GP,138.60,,,,,,,138.60,149.38,percent of total billed charges,
PTA THER NEUROMUS REEDUCATE 15MN,4214839,CDM,420,RC,97112,CPT,,,facility,outpatient,,,154.00000,93.63000,United Healthcare,Commercial,GP,138.60,,,,,,,40.04,149.38,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,inpatient,,,73.00000,44.38000,United Healthcare,Commercial,GP,65.70,,,,,,,65.70,70.81,percent of total billed charges,
PTA THER TRAIN GAIT 15MN,4214854,CDM,420,RC,97116,CPT,,,facility,outpatient,,,73.00000,44.38000,United Healthcare,Commercial,GP,65.70,,,,,,,18.98,70.81,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,inpatient,,,160.00000,97.28000,United Healthcare,Commercial,GP,144.00,,,,,,,144.00,155.20,percent of total billed charges,
PTA THERAPY MANUAL 15MN,4214870,CDM,420,RC,97140,CPT,,,facility,outpatient,,,160.00000,97.28000,United Healthcare,Commercial,GP,144.00,,,,,,,41.60,155.20,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,inpatient,,,325.00000,197.60000,United Healthcare,Commercial,GP,292.50,,,,,,,292.50,315.25,percent of total billed charges,
PTA THERAPY MIST,4215034,CDM,420,RC,97610,CPT,,,facility,outpatient,,,325.00000,197.60000,United Healthcare,Commercial,GP,292.50,,,,,,,84.50,315.25,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,inpatient,,,74.00000,44.99000,United Healthcare,Commercial,GP,66.60,,,,,,,66.60,71.78,percent of total billed charges,
PTA TRAIN ORTHO UE/LE INIT 15MN,4215067,CDM,420,RC,97760,CPT,,,facility,outpatient,,,74.00000,44.99000,United Healthcare,Commercial,GP,66.60,,,,,,,19.24,71.78,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,inpatient,,,79.00000,48.03000,United Healthcare,Commercial,GP,71.10,,,,,,,71.10,76.63,percent of total billed charges,
PTA TRAIN ORTHO/PROS EXT SUBSQ 15MN,4215083,CDM,420,RC,97763,CPT,,,facility,outpatient,,,79.00000,48.03000,United Healthcare,Commercial,GP,71.10,,,,,,,20.54,76.63,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,inpatient,,,72.00000,43.78000,United Healthcare,Commercial,GP,64.80,,,,,,,64.80,69.84,percent of total billed charges,
PTA TRAIN PROSTH UE&/LE INIT 15MN,4215075,CDM,420,RC,97761,CPT,,,facility,outpatient,,,72.00000,43.78000,United Healthcare,Commercial,GP,64.80,,,,,,,18.72,69.84,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,inpatient,,,445.00000,262.55000,United Healthcare,Commercial,GP,400.50,,,,,,,400.50,431.65,percent of total billed charges,
PT EVAL THERAPY HIGH,4200614,CDM,424,RC,97163,CPT,,,facility,outpatient,,,445.00000,262.55000,United Healthcare,Commercial,GP,400.50,,,,,,,115.70,431.65,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,inpatient,,,310.00000,182.90000,United Healthcare,Commercial,GP,279.00,,,,,,,279.00,300.70,percent of total billed charges,
PT EVAL THERAPY LOW,4200515,CDM,424,RC,97161,CPT,,,facility,outpatient,,,310.00000,182.90000,United Healthcare,Commercial,GP,279.00,,,,,,,80.60,300.70,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,inpatient,,,393.00000,231.87000,United Healthcare,Commercial,GP,353.70,,,,,,,353.70,381.21,percent of total billed charges,
PT EVAL THERAPY MOD,4200564,CDM,424,RC,97162,CPT,,,facility,outpatient,,,393.00000,231.87000,United Healthcare,Commercial,GP,353.70,,,,,,,102.18,381.21,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,inpatient,,,310.00000,182.90000,United Healthcare,Commercial,GP,279.00,,,,,,,279.00,300.70,percent of total billed charges,
PT RE-EVAL THERAPY,4200663,CDM,424,RC,97164,CPT,,,facility,outpatient,,,310.00000,182.90000,United Healthcare,Commercial,GP,279.00,,,,,,,80.60,300.70,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,inpatient,,,80.00000,30.96000,United Healthcare,Commercial,GO,72.00,,,,,,,72.00,77.60,percent of total billed charges,
OT MODALITY APPL TRACTION MECHANIC,4307781,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,United Healthcare,Commercial,GO,72.00,,,,,,,20.80,77.60,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,inpatient,,,84.00000,32.51000,United Healthcare,Commercial,GO,75.60,,,,,,,75.60,81.48,percent of total billed charges,
OT MODALITY APPL ULTRASOUND 15MN,4307955,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,United Healthcare,Commercial,GO,75.60,,,,,,,21.84,81.48,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,inpatient,,,126.00000,48.76000,United Healthcare,Commercial,GO,113.40,,,,,,,113.40,122.22,percent of total billed charges,
OT REINTEGRATION COMM/WORK 15MN,4308136,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,United Healthcare,Commercial,GO,113.40,,,,,,,32.76,122.22,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,inpatient,,,66.00000,25.54000,United Healthcare,Commercial,GO,59.40,,,,,,,59.40,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE 15MN,4313326,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,United Healthcare,Commercial,GO,59.40,,,,,,,17.16,64.02,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,inpatient,,,62.00000,23.99000,United Healthcare,Commercial,GO,55.80,,,,,,,55.80,60.14,percent of total billed charges,
OT SKILLS DEVLPMT COGNITIVE AD 15MN,4313334,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,United Healthcare,Commercial,GO,55.80,,,,,,,16.12,60.14,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,inpatient,,,90.00000,34.83000,United Healthcare,Commercial,GO,81.00,,,,,,,81.00,87.30,percent of total billed charges,
OT TECHNIQUES SENSORY 15MN,4308110,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,United Healthcare,Commercial,GO,81.00,,,,,,,23.40,87.30,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,inpatient,,,95.00000,36.76000,United Healthcare,Commercial,GO,85.50,,,,,,,85.50,92.15,percent of total billed charges,
OT THER ACTIVITIES 15MN,4308086,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,United Healthcare,Commercial,GO,85.50,,,,,,,24.70,92.15,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,inpatient,,,146.00000,56.50000,United Healthcare,Commercial,GO,131.40,,,,,,,131.40,141.62,percent of total billed charges,
OT THER AQUATIC 15MN,4308003,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,United Healthcare,Commercial,GO,131.40,,,,,,,37.96,141.62,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,inpatient,,,139.00000,53.79000,United Healthcare,Commercial,GO,125.10,,,,,,,125.10,134.83,percent of total billed charges,
OT THER EXERCISE 15MN,4307989,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,United Healthcare,Commercial,GO,125.10,,,,,,,36.14,134.83,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,inpatient,,,75.00000,29.02000,United Healthcare,Commercial,GO,67.50,,,,,,,67.50,72.75,percent of total billed charges,
OT THER MASSAGE 15MN,4308029,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,United Healthcare,Commercial,GO,67.50,,,,,,,19.50,72.75,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,inpatient,,,154.00000,59.60000,United Healthcare,Commercial,GO,138.60,,,,,,,138.60,149.38,percent of total billed charges,
OT THER NEUROMUS REEDUCATE 15MN,4307997,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,United Healthcare,Commercial,GO,138.60,,,,,,,40.04,149.38,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,inpatient,,,73.00000,28.25000,United Healthcare,Commercial,GO,65.70,,,,,,,65.70,70.81,percent of total billed charges,
OT THER TRAIN GAIT 15MN,4308011,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,United Healthcare,Commercial,GO,65.70,,,,,,,18.98,70.81,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,inpatient,,,160.00000,61.92000,United Healthcare,Commercial,GO,144.00,,,,,,,144.00,155.20,percent of total billed charges,
OT THERAPY MANUAL 15MN,4308045,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,United Healthcare,Commercial,GO,144.00,,,,,,,41.60,155.20,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,inpatient,,,98.00000,37.93000,United Healthcare,Commercial,GO,88.20,,,,,,,88.20,95.06,percent of total billed charges,
OT TRAIN CAREGIVER GROUP,4318150,CDM,430,RC,97552,CPT,,,facility,outpatient,,,98.00000,37.93000,United Healthcare,Commercial,GO,88.20,,,,,,,25.48,95.06,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,inpatient,,,303.00000,117.26000,United Healthcare,Commercial,GO,272.70,,,,,,,272.70,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT 1ST 30MIN,4318135,CDM,430,RC,97550,CPT,,,facility,outpatient,,,303.00000,117.26000,United Healthcare,Commercial,GO,272.70,,,,,,,78.78,293.91,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,inpatient,,,115.00000,44.50000,United Healthcare,Commercial,GO,103.50,,,,,,,103.50,111.55,percent of total billed charges,
OT TRAIN CAREGIVER WO PT ADD 15MIN,4318143,CDM,430,RC,97551,CPT,,,facility,outpatient,,,115.00000,44.50000,United Healthcare,Commercial,GO,103.50,,,,,,,29.90,111.55,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,inpatient,,,74.00000,28.64000,United Healthcare,Commercial,GO,66.60,,,,,,,66.60,71.78,percent of total billed charges,
OT TRAIN ORTHO UE/LE INIT 15MN,4313011,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,United Healthcare,Commercial,GO,66.60,,,,,,,19.24,71.78,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,inpatient,,,72.00000,27.86000,United Healthcare,Commercial,GO,64.80,,,,,,,64.80,69.84,percent of total billed charges,
OT TRAIN PROSTH UE&/LE INIT 15MN,4313052,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,United Healthcare,Commercial,GO,64.80,,,,,,,18.72,69.84,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,inpatient,,,80.00000,30.96000,United Healthcare,Commercial,"CO,GO",72.00,,,,,,,72.00,77.60,percent of total billed charges,
OTA MODALITY APPL TRACTION MECHANIC,4313714,CDM,430,RC,97012,CPT,,,facility,outpatient,,,80.00000,30.96000,United Healthcare,Commercial,"CO,GO",72.00,,,,,,,20.80,77.60,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,inpatient,,,84.00000,32.51000,United Healthcare,Commercial,"CO,GO",75.60,,,,,,,75.60,81.48,percent of total billed charges,
OTA MODALITY APPL ULTRASOUND 15MN,4313797,CDM,430,RC,97035,CPT,,,facility,outpatient,,,84.00000,32.51000,United Healthcare,Commercial,"CO,GO",75.60,,,,,,,21.84,81.48,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,inpatient,,,126.00000,48.76000,United Healthcare,Commercial,"CO,GO",113.40,,,,,,,113.40,122.22,percent of total billed charges,
OTA REINTEGRATION COMM/WORK 15MN,4313912,CDM,430,RC,97537,CPT,,,facility,outpatient,,,126.00000,48.76000,United Healthcare,Commercial,"CO,GO",113.40,,,,,,,32.76,122.22,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,inpatient,,,62.00000,23.99000,United Healthcare,Commercial,"CO,GO",55.80,,,,,,,55.80,60.14,percent of total billed charges,
OTA SKILL DEVLPMT COGNITIVE AD 15MN,4315685,CDM,430,RC,97130,CPT,,,facility,outpatient,,,62.00000,23.99000,United Healthcare,Commercial,"CO,GO",55.80,,,,,,,16.12,60.14,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,inpatient,,,66.00000,25.54000,United Healthcare,Commercial,"CO,GO",59.40,,,,,,,59.40,64.02,percent of total billed charges,
OTA SKILLS DEVLPMT COGNITIVE 15MN,4315677,CDM,430,RC,97129,CPT,,,facility,outpatient,,,66.00000,25.54000,United Healthcare,Commercial,"CO,GO",59.40,,,,,,,17.16,64.02,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,inpatient,,,90.00000,34.83000,United Healthcare,Commercial,"CO,GO",81.00,,,,,,,81.00,87.30,percent of total billed charges,
OTA TECHNIQUES SENSORY 15MN,4313896,CDM,430,RC,97533,CPT,,,facility,outpatient,,,90.00000,34.83000,United Healthcare,Commercial,"CO,GO",81.00,,,,,,,23.40,87.30,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,inpatient,,,95.00000,36.76000,United Healthcare,Commercial,"CO,GO",85.50,,,,,,,85.50,92.15,percent of total billed charges,
OTA THER ACTIVITIES 15MN,4313888,CDM,430,RC,97530,CPT,,,facility,outpatient,,,95.00000,36.76000,United Healthcare,Commercial,"CO,GO",85.50,,,,,,,24.70,92.15,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,inpatient,,,146.00000,56.50000,United Healthcare,Commercial,"CO,GO",131.40,,,,,,,131.40,141.62,percent of total billed charges,
OTA THER AQUATIC 15MN,4313821,CDM,430,RC,97113,CPT,,,facility,outpatient,,,146.00000,56.50000,United Healthcare,Commercial,"CO,GO",131.40,,,,,,,37.96,141.62,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,inpatient,,,139.00000,53.79000,United Healthcare,Commercial,"CO,GO",125.10,,,,,,,125.10,134.83,percent of total billed charges,
OTA THER EXERCISE 15MN,4313805,CDM,430,RC,97110,CPT,,,facility,outpatient,,,139.00000,53.79000,United Healthcare,Commercial,"CO,GO",125.10,,,,,,,36.14,134.83,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,inpatient,,,75.00000,29.02000,United Healthcare,Commercial,"CO,GO",67.50,,,,,,,67.50,72.75,percent of total billed charges,
OTA THER MASSAGE 15MN,4313847,CDM,430,RC,97124,CPT,,,facility,outpatient,,,75.00000,29.02000,United Healthcare,Commercial,"CO,GO",67.50,,,,,,,19.50,72.75,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,inpatient,,,154.00000,59.60000,United Healthcare,Commercial,"CO,GO",138.60,,,,,,,138.60,149.38,percent of total billed charges,
OTA THER NEUROMUS REEDUCATE 15MN,4313813,CDM,430,RC,97112,CPT,,,facility,outpatient,,,154.00000,59.60000,United Healthcare,Commercial,"CO,GO",138.60,,,,,,,40.04,149.38,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,inpatient,,,73.00000,28.25000,United Healthcare,Commercial,"CO,GO",65.70,,,,,,,65.70,70.81,percent of total billed charges,
OTA THER TRAIN GAIT 15MN,4313839,CDM,430,RC,97116,CPT,,,facility,outpatient,,,73.00000,28.25000,United Healthcare,Commercial,"CO,GO",65.70,,,,,,,18.98,70.81,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,inpatient,,,160.00000,61.92000,United Healthcare,Commercial,"CO,GO",144.00,,,,,,,144.00,155.20,percent of total billed charges,
OTA THERAPY MANUAL 15MN,4313862,CDM,430,RC,97140,CPT,,,facility,outpatient,,,160.00000,61.92000,United Healthcare,Commercial,"CO,GO",144.00,,,,,,,41.60,155.20,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,inpatient,,,74.00000,28.64000,United Healthcare,Commercial,"CO,GO",66.60,,,,,,,66.60,71.78,percent of total billed charges,
OTA TRAIN ORTHO UE/LE INIT 15MN,4314035,CDM,430,RC,97760,CPT,,,facility,outpatient,,,74.00000,28.64000,United Healthcare,Commercial,"CO,GO",66.60,,,,,,,19.24,71.78,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,inpatient,,,72.00000,27.86000,United Healthcare,Commercial,"CO,GO",64.80,,,,,,,64.80,69.84,percent of total billed charges,
OTA TRAIN PROSTH UE&/LE INIT 15MN,4314043,CDM,430,RC,97761,CPT,,,facility,outpatient,,,72.00000,27.86000,United Healthcare,Commercial,"CO,GO",64.80,,,,,,,18.72,69.84,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,inpatient,,,47.00000,26.70000,United Healthcare,Commercial,GO,42.30,,,,,,,42.30,45.59,percent of total billed charges,
OT THER GROUP,4308052,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,United Healthcare,Commercial,GO,42.30,,,,,,,12.22,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,inpatient,,,47.00000,26.70000,United Healthcare,Commercial,"CO,GO",42.30,,,,,,,42.30,45.59,percent of total billed charges,
OTA THER GROUP,4313870,CDM,433,RC,97150,CPT,,,facility,outpatient,,,47.00000,26.70000,United Healthcare,Commercial,"CO,GO",42.30,,,,,,,12.22,45.59,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,inpatient,,,250.00000,142.04000,United Healthcare,Commercial,GO,225.00,,,,,,,225.00,242.50,percent of total billed charges,
OT EVAL THERAPY HIGH,4312443,CDM,434,RC,97167,CPT,,,facility,outpatient,,,250.00000,142.04000,United Healthcare,Commercial,GO,225.00,,,,,,,65.00,242.50,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,inpatient,,,175.00000,99.43000,United Healthcare,Commercial,GO,157.50,,,,,,,157.50,169.75,percent of total billed charges,
OT EVAL THERAPY LOW,4312401,CDM,434,RC,97165,CPT,,,facility,outpatient,,,175.00000,99.43000,United Healthcare,Commercial,GO,157.50,,,,,,,45.50,169.75,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,inpatient,,,233.00000,132.38000,United Healthcare,Commercial,GO,209.70,,,,,,,209.70,226.01,percent of total billed charges,
OT EVAL THERAPY MOD,4312427,CDM,434,RC,97166,CPT,,,facility,outpatient,,,233.00000,132.38000,United Healthcare,Commercial,GO,209.70,,,,,,,60.58,226.01,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,inpatient,,,175.00000,99.43000,United Healthcare,Commercial,GO,157.50,,,,,,,157.50,169.75,percent of total billed charges,
OT RE-EVAL THERAPY,4312468,CDM,434,RC,97168,CPT,,,facility,outpatient,,,175.00000,99.43000,United Healthcare,Commercial,GO,157.50,,,,,,,45.50,169.75,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,inpatient,,,291.00000,93.99000,United Healthcare,Commercial,,261.90,,,,,,,261.90,282.27,percent of total billed charges,
ST LARYNGOSCOPY DIAGNOSTIC FLEX,4403283,CDM,361,RC,31575,CPT,,,facility,outpatient,,,291.00000,93.99000,United Healthcare,Commercial,,261.90,,,,,,,75.66,282.27,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,inpatient,,,273.00000,155.10000,United Healthcare,Commercial,GN,245.70,,,,,,,245.70,264.81,percent of total billed charges,
ST ANALYSIS VOICE&RESON BEH&QUAL,4409165,CDM,440,RC,92524,CPT,,,facility,outpatient,,,273.00000,155.10000,United Healthcare,Commercial,GN,245.70,,,,,,,70.98,264.81,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,inpatient,,,279.00000,158.51000,United Healthcare,Commercial,GN,251.10,,,,,,,251.10,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP,4409140,CDM,440,RC,92522,CPT,,,facility,outpatient,,,279.00000,158.51000,United Healthcare,Commercial,GN,251.10,,,,,,,72.54,270.63,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,inpatient,,,426.00000,242.03000,United Healthcare,Commercial,GN,383.40,,,,,,,383.40,413.22,percent of total billed charges,
ST EVAL PROD SOUND SP W LANG&EXPRSN,4409157,CDM,440,RC,92523,CPT,,,facility,outpatient,,,426.00000,242.03000,United Healthcare,Commercial,GN,383.40,,,,,,,110.76,413.22,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,inpatient,,,242.00000,137.49000,United Healthcare,Commercial,GN,217.80,,,,,,,217.80,234.74,percent of total billed charges,
ST EVAL/EXAM APHASIA W RPT PER HR,4406062,CDM,440,RC,96105,CPT,,,facility,outpatient,,,242.00000,137.49000,United Healthcare,Commercial,GN,217.80,,,,,,,62.92,234.74,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,inpatient,,,128.00000,72.72000,United Healthcare,Commercial,,115.20,,,,,,,115.20,124.16,percent of total billed charges,
ST SCRN DVLPMNTL W S&D INST STD,4400057,CDM,440,RC,96110,CPT,,,facility,outpatient,,,128.00000,72.72000,United Healthcare,Commercial,,115.20,,,,,,,33.28,124.16,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,inpatient,,,66.00000,37.50000,United Healthcare,Commercial,GN,59.40,,,,,,,59.40,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE 15MN,4409645,CDM,440,RC,97129,CPT,,,facility,outpatient,,,66.00000,37.50000,United Healthcare,Commercial,GN,59.40,,,,,,,17.16,64.02,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,inpatient,,,62.00000,35.23000,United Healthcare,Commercial,GN,55.80,,,,,,,55.80,60.14,percent of total billed charges,
ST SKILLS DEVLPMT COGNITIVE AD 15MN,4409652,CDM,440,RC,97130,CPT,,,facility,outpatient,,,62.00000,35.23000,United Healthcare,Commercial,GN,55.80,,,,,,,16.12,60.14,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,inpatient,,,269.00000,152.83000,United Healthcare,Commercial,GN,242.10,,,,,,,242.10,260.93,percent of total billed charges,
ST TEST COGNITIVE HC PRO PER HR,4406278,CDM,440,RC,96125,CPT,,,facility,outpatient,,,269.00000,152.83000,United Healthcare,Commercial,GN,242.10,,,,,,,69.94,260.93,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,inpatient,,,153.00000,86.93000,United Healthcare,Commercial,GN,137.70,,,,,,,137.70,148.41,percent of total billed charges,
ST THER DEVICE NON SP W PRG,4405973,CDM,440,RC,92606,CPT,,,facility,outpatient,,,153.00000,86.93000,United Healthcare,Commercial,GN,137.70,,,,,,,39.78,148.41,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,inpatient,,,98.00000,55.68000,United Healthcare,Commercial,GN,88.20,,,,,,,88.20,95.06,percent of total billed charges,
ST TRAIN CAREGIVER GROUP,4409819,CDM,440,RC,97552,CPT,,,facility,outpatient,,,98.00000,55.68000,United Healthcare,Commercial,GN,88.20,,,,,,,25.48,95.06,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,inpatient,,,303.00000,172.15000,United Healthcare,Commercial,GN,272.70,,,,,,,272.70,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT 1ST 30MIN,4409793,CDM,440,RC,97550,CPT,,,facility,outpatient,,,303.00000,172.15000,United Healthcare,Commercial,GN,272.70,,,,,,,78.78,293.91,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,inpatient,,,115.00000,65.34000,United Healthcare,Commercial,GN,103.50,,,,,,,103.50,111.55,percent of total billed charges,
ST TRAIN CAREGIVER WO PT ADD 15MIN,4409801,CDM,440,RC,97551,CPT,,,facility,outpatient,,,115.00000,65.34000,United Healthcare,Commercial,GN,103.50,,,,,,,29.90,111.55,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,inpatient,,,210.00000,119.31000,United Healthcare,Commercial,GN,189.00,,,,,,,189.00,203.70,percent of total billed charges,
ST TX DYSFNCT SWALLOW FNCT FEED,4405940,CDM,440,RC,92526,CPT,,,facility,outpatient,,,210.00000,119.31000,United Healthcare,Commercial,GN,189.00,,,,,,,54.60,203.70,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,inpatient,,,250.00000,142.04000,United Healthcare,Commercial,GN,225.00,,,,,,,225.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM IND,4405924,CDM,440,RC,92507,CPT,,,facility,outpatient,,,250.00000,142.04000,United Healthcare,Commercial,GN,225.00,,,,,,,65.00,242.50,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,inpatient,,,78.00000,44.32000,United Healthcare,Commercial,GN,70.20,,,,,,,70.20,75.66,percent of total billed charges,
ST TX SPEECH/LANG/VOICE/COM GROUP,4405932,CDM,443,RC,92508,CPT,,,facility,outpatient,,,78.00000,44.32000,United Healthcare,Commercial,GN,70.20,,,,,,,20.28,75.66,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,inpatient,,,322.00000,182.94000,United Healthcare,Commercial,GN,289.80,,,,,,,289.80,312.34,percent of total billed charges,
ST EVAL DEVICE NON SP W PT 1ST HR,4405965,CDM,444,RC,92605,CPT,,,facility,outpatient,,,322.00000,182.94000,United Healthcare,Commercial,GN,289.80,,,,,,,83.72,312.34,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,inpatient,,,309.00000,175.56000,United Healthcare,Commercial,GN,278.10,,,,,,,278.10,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW FLUOROSCOPIC,4406021,CDM,444,RC,92611,CPT,,,facility,outpatient,,,309.00000,175.56000,United Healthcare,Commercial,GN,278.10,,,,,,,80.34,299.73,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,inpatient,,,245.00000,139.20000,United Healthcare,Commercial,GN,220.50,,,,,,,220.50,237.65,percent of total billed charges,
ST EVAL FNCT SWALLOW ORAL&PHARYNGEL,4406013,CDM,444,RC,92610,CPT,,,facility,outpatient,,,245.00000,139.20000,United Healthcare,Commercial,GN,220.50,,,,,,,63.70,237.65,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,inpatient,,,313.00000,116.44000,United Healthcare,Commercial,,281.70,,,,,,,281.70,303.61,percent of total billed charges,
TEST STRESS PULMONARY,4818589,CDM,460,RC,94618,CPT,,,facility,outpatient,,,313.00000,116.44000,United Healthcare,Commercial,,281.70,,,,,,,81.38,303.61,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,inpatient,,,1250.00000,632.50000,United Healthcare,Commercial,,1125.00,,,,,,,1125.00,1212.50,percent of total billed charges,
TEST CV STRESS TREAD/BIKE&/RX TRACE,4803359,CDM,482,RC,93017,CPT,,,facility,outpatient,,,1250.00000,632.50000,United Healthcare,Commercial,,1125.00,,,,,,,325.00,1212.50,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,inpatient,,,145.00000,75.54000,United Healthcare,Commercial,,130.50,,,,,,,130.50,140.65,percent of total billed charges,
EKG TRACING RHYTHM 1-3 LEADS,7301013,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,United Healthcare,Commercial,,130.50,,,,,,,37.70,140.65,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,inpatient,,,488.00000,254.25000,United Healthcare,Commercial,,439.20,,,,,,,439.20,473.36,percent of total billed charges,
EKG TRACING ROUTINE 12+ LEADS,7301021,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,United Healthcare,Commercial,,439.20,,,,,,,126.88,473.36,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,inpatient,,,684.00000,337.90000,United Healthcare,Commercial,,615.60,,,,,,,615.60,663.48,percent of total billed charges,
EKG ANALYSIS EXTERNAL 0-48HR,7301393,CDM,731,RC,93226,CPT,,,facility,outpatient,,,684.00000,337.90000,United Healthcare,Commercial,,615.60,,,,,,,177.84,663.48,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,inpatient,,,206.00000,101.76000,United Healthcare,Commercial,,185.40,,,,,,,185.40,199.82,percent of total billed charges,
EKG EXT REC >48HR<=7 DAYS REC,4819264,CDM,731,RC,93242,CPT,,,facility,outpatient,,,206.00000,101.76000,United Healthcare,Commercial,,185.40,,,,,,,53.56,199.82,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,inpatient,,,195.00000,96.33000,United Healthcare,Commercial,,175.50,,,,,,,175.50,189.15,percent of total billed charges,
EKG EXT REC >7 DAYS-15 DAYS REC,4819272,CDM,731,RC,93246,CPT,,,facility,outpatient,,,195.00000,96.33000,United Healthcare,Commercial,,175.50,,,,,,,50.70,189.15,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,inpatient,,,375.00000,185.25000,United Healthcare,Commercial,,337.50,,,,,,,337.50,363.75,percent of total billed charges,
EKG RECORD EVENT REMOTE 0-30DAY,7301401,CDM,731,RC,93270,CPT,,,facility,outpatient,,,375.00000,185.25000,United Healthcare,Commercial,,337.50,,,,,,,97.50,363.75,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,inpatient,,,429.00000,211.93000,United Healthcare,Commercial,,386.10,,,,,,,386.10,416.13,percent of total billed charges,
EKG RECORD EXTERNAL 0-48HR,7301385,CDM,731,RC,93225,CPT,,,facility,outpatient,,,429.00000,211.93000,United Healthcare,Commercial,,386.10,,,,,,,111.54,416.13,percent of total billed charges,
R&B MEDICAL/SURGICAL SEMI-PVT,22475,CDM,121,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,United Healthcare,Commercial,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B OBSTETRICS SEMI-PVT,42473,CDM,122,RC,,,,,facility,inpatient,,,2781.00000,1580.03000,United Healthcare,Commercial,,2502.90,,,,,,,2502.90,3111.10,percent of total billed charges,
R&B ICU,32474,CDM,200,RC,,,,,facility,inpatient,,,8761.00000,4977.56000,United Healthcare,Commercial,,7884.90,,,,,,,2512.00,8498.17,percent of total billed charges,
R&B ICU INTERMEDIATE,12476,CDM,206,RC,,,,,facility,inpatient,,,5841.00000,3318.56000,United Healthcare,Commercial,,5256.90,,,,,,,2512.00,5665.77,percent of total billed charges,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,inpatient,,,84.00000,63.59000,United Healthcare,Commercial,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
ED CATH COLLECT SPEC URINE,4506325,CDM,300,RC,P9612,HCPCS,,,facility,outpatient,,,84.00000,63.59000,United Healthcare,Commercial,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,United Healthcare,Commercial,,255.60,,,,,,,255.60,275.48,percent of total billed charges,
ED CHEMO IVP DRUG ADDL,4505749,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,United Healthcare,Commercial,,255.60,,,,,,,73.84,275.48,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,United Healthcare,Commercial,,412.20,,,,,,,412.20,444.26,percent of total billed charges,
ED CHEMO IVP DRUG INITIAL,4505731,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,United Healthcare,Commercial,,412.20,,,,,,,119.08,444.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,United Healthcare,Commercial,,502.20,,,,,,,502.20,541.26,percent of total billed charges,
ED CHEMO SUBQ/IM NONHORMONAL,4505681,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,United Healthcare,Commercial,,502.20,,,,,,,145.08,541.26,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,United Healthcare,Commercial,,433.80,,,,,,,433.80,467.54,percent of total billed charges,
ED CHEMO INF IV 1ST HR,4505723,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,United Healthcare,Commercial,,433.80,,,,,,,125.32,467.54,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
ED CHEMO INF IV ADDL HR,4505715,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,United Healthcare,Commercial,,213.30,,,,,,,213.30,229.89,percent of total billed charges,
ED CHEMO INF IV SEQ 1ST HR,4505756,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,United Healthcare,Commercial,,213.30,,,,,,,61.62,229.89,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,inpatient,,,490.00000,329.77000,United Healthcare,Commercial,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD DIFF 0-4Y INIT 15MN,4506838,CDM,370,RC,99155,CPT,,,facility,outpatient,,,490.00000,329.77000,United Healthcare,Commercial,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,inpatient,,,490.00000,329.77000,United Healthcare,Commercial,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD DIFF 5+Y INIT 15MN,4506846,CDM,370,RC,99156,CPT,,,facility,outpatient,,,490.00000,329.77000,United Healthcare,Commercial,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,inpatient,,,245.00000,164.89000,United Healthcare,Commercial,,220.50,,,,,,,220.50,237.65,percent of total billed charges,
ED SED MOD DIFF ADDL 15MN,4506853,CDM,370,RC,99157,CPT,,,facility,outpatient,,,245.00000,164.89000,United Healthcare,Commercial,,220.50,,,,,,,63.70,237.65,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,inpatient,,,490.00000,329.77000,United Healthcare,Commercial,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD SAME 0-4Y INIT 15MN,4506804,CDM,370,RC,99151,CPT,,,facility,outpatient,,,490.00000,329.77000,United Healthcare,Commercial,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,inpatient,,,490.00000,329.77000,United Healthcare,Commercial,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
ED SED MOD SAME 5+Y INIT 15MN,4506812,CDM,370,RC,99152,CPT,,,facility,outpatient,,,490.00000,329.77000,United Healthcare,Commercial,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,inpatient,,,245.00000,164.89000,United Healthcare,Commercial,,220.50,,,,,,,220.50,237.65,percent of total billed charges,
ED SED MOD SAME ADDL 15MN,4506820,CDM,370,RC,99153,CPT,,,facility,outpatient,,,245.00000,164.89000,United Healthcare,Commercial,,220.50,,,,,,,63.70,237.65,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,United Healthcare,Commercial,,757.80,,,,,,,757.80,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 1 UNIT,4506168,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,United Healthcare,Commercial,,757.80,,,,,,,218.92,816.74,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,United Healthcare,Commercial,,947.70,,,,,,,947.70,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 2 UNITS,4506176,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,United Healthcare,Commercial,,947.70,,,,,,,273.78,1021.41,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,United Healthcare,Commercial,,1136.70,,,,,,,1136.70,1225.11,percent of total billed charges,
ED TRANSFUSION BLOOD/COMP 3+ UNITS,4506184,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,United Healthcare,Commercial,,1136.70,,,,,,,328.38,1225.11,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,inpatient,,,2466.00000,986.40000,United Healthcare,Commercial,,2219.40,,,,,,,2219.40,2392.02,percent of total billed charges,
ED AMPUTATION DIGIT,4504502,CDM,450,RC,,,,,facility,outpatient,,,2466.00000,986.40000,United Healthcare,Commercial,,2219.40,,,,,,,641.16,2392.02,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,inpatient,,,260.00000,104.00000,United Healthcare,Commercial,,234.00,,,,,,,234.00,252.20,percent of total billed charges,
ED ANOSCOPY,4504510,CDM,450,RC,,,,,facility,outpatient,,,260.00000,104.00000,United Healthcare,Commercial,,234.00,,,,,,,67.60,252.20,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,inpatient,,,2041.00000,816.40000,United Healthcare,Commercial,,1836.90,,,,,,,1836.90,1979.77,percent of total billed charges,
ED ASP BLADDER CATH SUPRAPUB,4504585,CDM,450,RC,,,,,facility,outpatient,,,2041.00000,816.40000,United Healthcare,Commercial,,1836.90,,,,,,,530.66,1979.77,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,inpatient,,,375.00000,150.00000,United Healthcare,Commercial,,337.50,,,,,,,337.50,363.75,percent of total billed charges,
ED ASP/INJECT JOINT/BURSA,4504528,CDM,450,RC,,,,,facility,outpatient,,,375.00000,150.00000,United Healthcare,Commercial,,337.50,,,,,,,97.50,363.75,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,inpatient,,,1178.00000,471.20000,United Healthcare,Commercial,,1060.20,,,,,,,1060.20,1142.66,percent of total billed charges,
ED CARDIOVERSION ELECTIVE EXTERNAL,4504551,CDM,450,RC,92960,CPT,,,facility,outpatient,,,1178.00000,471.20000,United Healthcare,Commercial,,1060.20,,,,,,,306.28,1142.66,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,inpatient,,,245.00000,98.00000,United Healthcare,Commercial,,220.50,,,,,,,220.50,237.65,percent of total billed charges,
ED CASTING EXTREMITY LOWER,4504569,CDM,450,RC,,,,,facility,outpatient,,,245.00000,98.00000,United Healthcare,Commercial,,220.50,,,,,,,63.70,237.65,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,inpatient,,,280.00000,112.00000,United Healthcare,Commercial,,252.00,,,,,,,252.00,271.60,percent of total billed charges,
ED CASTING EXTREMITY UPPER,4504577,CDM,450,RC,,,,,facility,outpatient,,,280.00000,112.00000,United Healthcare,Commercial,,252.00,,,,,,,72.80,271.60,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,inpatient,,,336.00000,134.40000,United Healthcare,Commercial,,302.40,,,,,,,302.40,325.92,percent of total billed charges,
ED CATH/CANN ART SMP/MNTR/TRNS PERC,4507026,CDM,450,RC,36620,CPT,,,facility,outpatient,,,336.00000,134.40000,United Healthcare,Commercial,,302.40,,,,,,,87.36,325.92,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,inpatient,,,380.00000,152.00000,United Healthcare,Commercial,,342.00,,,,,,,342.00,368.60,percent of total billed charges,
ED CHG TUBE CYSTO,4504684,CDM,450,RC,,,,,facility,outpatient,,,380.00000,152.00000,United Healthcare,Commercial,,342.00,,,,,,,98.80,368.60,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,inpatient,,,530.00000,212.00000,United Healthcare,Commercial,,477.00,,,,,,,477.00,514.10,percent of total billed charges,
ED CHG TUBE GASTRO WO GD IMG/ENDO,4505889,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,United Healthcare,Commercial,,477.00,,,,,,,137.80,514.10,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,inpatient,,,264.00000,105.60000,United Healthcare,Commercial,,237.60,,,,,,,237.60,256.08,percent of total billed charges,
ED CLOSURE WOUND W TISSUE ADHESIVE,4505350,CDM,450,RC,,,,,facility,outpatient,,,264.00000,105.60000,United Healthcare,Commercial,,237.60,,,,,,,68.64,256.08,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,inpatient,,,763.00000,305.20000,United Healthcare,Commercial,,686.70,,,,,,,686.70,740.11,percent of total billed charges,
ED CPR,4504650,CDM,450,RC,92950,CPT,,,facility,outpatient,,,763.00000,305.20000,United Healthcare,Commercial,,686.70,,,,,,,198.38,740.11,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,inpatient,,,672.00000,268.80000,United Healthcare,Commercial,,604.80,,,,,,,604.80,651.84,percent of total billed charges,
ED DEBRIDE TISSUE SKIN/SUBQ,4504692,CDM,450,RC,,,,,facility,outpatient,,,672.00000,268.80000,United Healthcare,Commercial,,604.80,,,,,,,174.72,651.84,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,inpatient,,,1940.00000,776.00000,United Healthcare,Commercial,,1746.00,,,,,,,1746.00,1881.80,percent of total billed charges,
ED DELIVERY PLACENTA,4504700,CDM,450,RC,59414,CPT,,,facility,outpatient,,,1940.00000,776.00000,United Healthcare,Commercial,,1746.00,,,,,,,504.40,1881.80,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,inpatient,,,3875.00000,1550.00000,United Healthcare,Commercial,,3487.50,,,,,,,3487.50,3758.75,percent of total billed charges,
ED DELIVERY VAGINAL ONLY,4504718,CDM,450,RC,,,,,facility,outpatient,,,3875.00000,1550.00000,United Healthcare,Commercial,,3487.50,,,,,,,1007.50,3758.75,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,inpatient,,,505.00000,202.00000,United Healthcare,Commercial,,454.50,,,,,,,454.50,489.85,percent of total billed charges,
ED EXPLORATION WOUND/TRAUMA,4504742,CDM,450,RC,,,,,facility,outpatient,,,505.00000,202.00000,United Healthcare,Commercial,,454.50,,,,,,,131.30,489.85,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,inpatient,,,295.00000,118.00000,United Healthcare,Commercial,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 01 UNI,4506598,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,United Healthcare,Commercial,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,inpatient,,,585.00000,234.00000,United Healthcare,Commercial,,526.50,,,,,,,526.50,567.45,percent of total billed charges,
ED HEM NASAL CNTRL ANT LVL 02 BI,4506572,CDM,450,RC,,,,,facility,outpatient,,,585.00000,234.00000,United Healthcare,Commercial,,526.50,,,,,,,152.10,567.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,inpatient,,,285.00000,114.00000,United Healthcare,Commercial,,256.50,,,,,,,256.50,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 01 UNI,4506606,CDM,450,RC,,,,,facility,outpatient,,,285.00000,114.00000,United Healthcare,Commercial,,256.50,,,,,,,74.10,276.45,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,inpatient,,,575.00000,230.00000,United Healthcare,Commercial,,517.50,,,,,,,517.50,557.75,percent of total billed charges,
ED HEM NASAL CNTRL POST LVL 02 BI,4506580,CDM,450,RC,,,,,facility,outpatient,,,575.00000,230.00000,United Healthcare,Commercial,,517.50,,,,,,,149.50,557.75,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,inpatient,,,697.00000,278.80000,United Healthcare,Commercial,,627.30,,,,,,,627.30,676.09,percent of total billed charges,
ED I&D HEMATOMA/SEROMA/FLUID,4504775,CDM,450,RC,,,,,facility,outpatient,,,697.00000,278.80000,United Healthcare,Commercial,,627.30,,,,,,,181.22,676.09,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,inpatient,,,530.00000,212.00000,United Healthcare,Commercial,,477.00,,,,,,,477.00,514.10,percent of total billed charges,
ED I&D LVL 02 INTRM,4506200,CDM,450,RC,,,,,facility,outpatient,,,530.00000,212.00000,United Healthcare,Commercial,,477.00,,,,,,,137.80,514.10,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,inpatient,,,580.00000,232.00000,United Healthcare,Commercial,,522.00,,,,,,,522.00,562.60,percent of total billed charges,
ED I&D LVL 03 COMPLEX,4506218,CDM,450,RC,,,,,facility,outpatient,,,580.00000,232.00000,United Healthcare,Commercial,,522.00,,,,,,,150.80,562.60,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,inpatient,,,435.00000,174.00000,United Healthcare,Commercial,,391.50,,,,,,,391.50,421.95,percent of total billed charges,
ED I&D/ASP PUNCT LVL 01 SIMPLE,4506192,CDM,450,RC,,,,,facility,outpatient,,,435.00000,174.00000,United Healthcare,Commercial,,391.50,,,,,,,113.10,421.95,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,inpatient,,,270.00000,108.00000,United Healthcare,Commercial,,243.00,,,,,,,243.00,261.90,percent of total billed charges,
ED I&R FB SUBCUTANEOUS,4504783,CDM,450,RC,,,,,facility,outpatient,,,270.00000,108.00000,United Healthcare,Commercial,,243.00,,,,,,,70.20,261.90,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,inpatient,,,504.00000,201.60000,United Healthcare,Commercial,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
ED INF IV HYDRATION 31-60MIN,4505590,CDM,450,RC,96360,CPT,,,facility,outpatient,,,504.00000,201.60000,United Healthcare,Commercial,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,inpatient,,,98.00000,39.20000,United Healthcare,Commercial,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
ED INF IV HYDRATION ADDL HR,4505608,CDM,450,RC,96361,CPT,,,facility,outpatient,,,98.00000,39.20000,United Healthcare,Commercial,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,inpatient,,,608.00000,243.20000,United Healthcare,Commercial,,547.20,,,,,,,547.20,589.76,percent of total billed charges,
ED INF IV THRPY 1ST HR,4505616,CDM,450,RC,96365,CPT,,,facility,outpatient,,,608.00000,243.20000,United Healthcare,Commercial,,547.20,,,,,,,158.08,589.76,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,inpatient,,,114.00000,45.60000,United Healthcare,Commercial,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
ED INF IV THRPY ADDL HR,4505624,CDM,450,RC,96366,CPT,,,facility,outpatient,,,114.00000,45.60000,United Healthcare,Commercial,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,inpatient,,,187.00000,74.80000,United Healthcare,Commercial,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
ED INF IV THRPY CONCURRENT,4505640,CDM,450,RC,96368,CPT,,,facility,outpatient,,,187.00000,74.80000,United Healthcare,Commercial,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,inpatient,,,214.00000,85.60000,United Healthcare,Commercial,,192.60,,,,,,,192.60,207.58,percent of total billed charges,
ED INF IV THRPY SEQ DRUG NEW 1ST HR,4506408,CDM,450,RC,96367,CPT,,,facility,outpatient,,,214.00000,85.60000,United Healthcare,Commercial,,192.60,,,,,,,55.64,207.58,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,inpatient,,,863.00000,345.20000,United Healthcare,Commercial,,776.70,,,,,,,776.70,837.11,percent of total billed charges,
ED INJ EPID PATCH BLOOD/CLOT,4504734,CDM,450,RC,62273,CPT,,,facility,outpatient,,,863.00000,345.20000,United Healthcare,Commercial,,776.70,,,,,,,224.38,837.11,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,inpatient,,,453.00000,181.20000,United Healthcare,Commercial,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
ED INJ IVP DRUG INITIAL,4505657,CDM,450,RC,96374,CPT,,,facility,outpatient,,,453.00000,181.20000,United Healthcare,Commercial,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,inpatient,,,144.00000,57.60000,United Healthcare,Commercial,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL NEW,4505665,CDM,450,RC,96375,CPT,,,facility,outpatient,,,144.00000,57.60000,United Healthcare,Commercial,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,inpatient,,,107.00000,42.80000,United Healthcare,Commercial,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
ED INJ IVP SEQ DRUG ADDL SAME,4505871,CDM,450,RC,96376,CPT,,,facility,outpatient,,,107.00000,42.80000,United Healthcare,Commercial,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,inpatient,,,403.00000,161.20000,United Healthcare,Commercial,,362.70,,,,,,,362.70,390.91,percent of total billed charges,
ED INJ SHTH TNDN SGL/LIG/AP,4504841,CDM,450,RC,,,,,facility,outpatient,,,403.00000,161.20000,United Healthcare,Commercial,,362.70,,,,,,,104.78,390.91,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,inpatient,,,144.00000,57.60000,United Healthcare,Commercial,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
ED INJ SUBQ/IM,4504833,CDM,450,RC,96372,CPT,,,facility,outpatient,,,144.00000,57.60000,United Healthcare,Commercial,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,inpatient,,,370.00000,148.00000,United Healthcare,Commercial,,333.00,,,,,,,333.00,358.90,percent of total billed charges,
ED INJ TRIGGER PT/S MUSCLE,4504858,CDM,450,RC,,,,,facility,outpatient,,,370.00000,148.00000,United Healthcare,Commercial,,333.00,,,,,,,96.20,358.90,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,inpatient,,,334.00000,133.60000,United Healthcare,Commercial,,300.60,,,,,,,300.60,323.98,percent of total billed charges,
ED INJ/S ANES NRV BLOCK OTHER,4505954,CDM,450,RC,,,,,facility,outpatient,,,334.00000,133.60000,United Healthcare,Commercial,,300.60,,,,,,,86.84,323.98,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,inpatient,,,1188.00000,475.20000,United Healthcare,Commercial,50,1069.20,,,,,,,1069.20,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDBI,4507125,CDM,450,RC,64421,CPT,,,facility,outpatient,,,1188.00000,475.20000,United Healthcare,Commercial,50,1069.20,,,,,,,308.88,1152.36,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,inpatient,,,792.00000,316.80000,United Healthcare,Commercial,LT,712.80,,,,,,,712.80,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDLT,4507141,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,United Healthcare,Commercial,LT,712.80,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,inpatient,,,792.00000,316.80000,United Healthcare,Commercial,RT,712.80,,,,,,,712.80,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL ADDRT,4507133,CDM,450,RC,64421,CPT,,,facility,outpatient,,,792.00000,316.80000,United Healthcare,Commercial,RT,712.80,,,,,,,205.92,768.24,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,inpatient,,,572.00000,228.80000,United Healthcare,Commercial,50,514.80,,,,,,,514.80,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLBI,4507091,CDM,450,RC,64420,CPT,,,facility,outpatient,,,572.00000,228.80000,United Healthcare,Commercial,50,514.80,,,,,,,148.72,554.84,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,inpatient,,,381.00000,152.40000,United Healthcare,Commercial,LT,342.90,,,,,,,342.90,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLLT,4507117,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,United Healthcare,Commercial,LT,342.90,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,inpatient,,,381.00000,152.40000,United Healthcare,Commercial,RT,342.90,,,,,,,342.90,369.57,percent of total billed charges,
ED INJ/S ANES NRV INTRCST LVL SGLRT,4507109,CDM,450,RC,64420,CPT,,,facility,outpatient,,,381.00000,152.40000,United Healthcare,Commercial,RT,342.90,,,,,,,99.06,369.57,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,inpatient,,,683.00000,273.20000,United Healthcare,Commercial,50,614.70,,,,,,,614.70,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR BI,4506960,CDM,450,RC,64400,CPT,,,facility,outpatient,,,683.00000,273.20000,United Healthcare,Commercial,50,614.70,,,,,,,177.58,662.51,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,inpatient,,,455.00000,182.00000,United Healthcare,Commercial,LT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR LT,4506978,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,United Healthcare,Commercial,LT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,inpatient,,,455.00000,182.00000,United Healthcare,Commercial,RT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
ED INJ/S ANES NRV TRIGEMINAL BR RT,4506986,CDM,450,RC,64400,CPT,,,facility,outpatient,,,455.00000,182.00000,United Healthcare,Commercial,RT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,inpatient,,,357.00000,142.80000,United Healthcare,Commercial,,321.30,,,,,,,321.30,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL CMPLX,4504593,CDM,450,RC,,,,,facility,outpatient,,,357.00000,142.80000,United Healthcare,Commercial,,321.30,,,,,,,92.82,346.29,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,inpatient,,,334.00000,133.60000,United Healthcare,Commercial,,300.60,,,,,,,300.60,323.98,percent of total billed charges,
ED INS CATH BLADDER INDWL SMPL,4505491,CDM,450,RC,51702,CPT,,,facility,outpatient,,,334.00000,133.60000,United Healthcare,Commercial,,300.60,,,,,,,86.84,323.98,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,inpatient,,,194.00000,77.60000,United Healthcare,Commercial,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
ED INS CATH BLADDER NONINDWL,4506333,CDM,450,RC,51701,CPT,,,facility,outpatient,,,194.00000,77.60000,United Healthcare,Commercial,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,inpatient,,,608.00000,243.20000,United Healthcare,Commercial,,547.20,,,,,,,547.20,589.76,percent of total billed charges,
ED INTUBATION ENDOTRACHEAL,4504726,CDM,450,RC,,,,,facility,outpatient,,,608.00000,243.20000,United Healthcare,Commercial,,547.20,,,,,,,158.08,589.76,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,inpatient,,,257.00000,102.80000,United Healthcare,Commercial,,231.30,,,,,,,231.30,249.29,percent of total billed charges,
ED INTUBATION/ASPIRATION GASTRIC,4506317,CDM,450,RC,,,,,facility,outpatient,,,257.00000,102.80000,United Healthcare,Commercial,,231.30,,,,,,,66.82,249.29,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,inpatient,,,343.00000,137.20000,United Healthcare,Commercial,,308.70,,,,,,,308.70,332.71,percent of total billed charges,
ED LARYNGOSCOPY,4504890,CDM,450,RC,,,,,facility,outpatient,,,343.00000,137.20000,United Healthcare,Commercial,,308.70,,,,,,,89.18,332.71,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,inpatient,,,457.00000,182.80000,United Healthcare,Commercial,,411.30,,,,,,,411.30,443.29,percent of total billed charges,
ED LAVAGE PERITONEAL/PARACENTESIS,4505038,CDM,450,RC,,,,,facility,outpatient,,,457.00000,182.80000,United Healthcare,Commercial,,411.30,,,,,,,118.82,443.29,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,inpatient,,,630.00000,252.00000,United Healthcare,Commercial,,567.00,,,,,,,567.00,611.10,percent of total billed charges,
ED MONITOR PRESS SYND COMPART MUSC,4504973,CDM,450,RC,20950,CPT,,,facility,outpatient,,,630.00000,252.00000,United Healthcare,Commercial,,567.00,,,,,,,163.80,611.10,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,inpatient,,,623.00000,249.20000,United Healthcare,Commercial,,560.70,,,,,,,560.70,604.31,percent of total billed charges,
ED PACING TRANSCUTANEOUS TEMP,4505210,CDM,450,RC,92953,CPT,,,facility,outpatient,,,623.00000,249.20000,United Healthcare,Commercial,,560.70,,,,,,,161.98,604.31,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,inpatient,,,1457.00000,582.80000,United Healthcare,Commercial,,1311.30,,,,,,,1311.30,1413.29,percent of total billed charges,
ED PERICARDIOCENTESIS INCL IMG GD,4506929,CDM,450,RC,33016,CPT,,,facility,outpatient,,,1457.00000,582.80000,United Healthcare,Commercial,,1311.30,,,,,,,378.82,1413.29,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,inpatient,,,890.00000,356.00000,United Healthcare,Commercial,,801.00,,,,,,,801.00,863.30,percent of total billed charges,
ED PLC CATHETER CENTRAL VENOUS,4505046,CDM,450,RC,,,,,facility,outpatient,,,890.00000,356.00000,United Healthcare,Commercial,,801.00,,,,,,,231.40,863.30,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,inpatient,,,532.00000,212.80000,United Healthcare,Commercial,,478.80,,,,,,,478.80,516.04,percent of total billed charges,
ED PLC NEEDLE INF INTRAOSSEOUS,4504999,CDM,450,RC,36680,CPT,,,facility,outpatient,,,532.00000,212.80000,United Healthcare,Commercial,,478.80,,,,,,,138.32,516.04,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,inpatient,,,492.00000,196.80000,United Healthcare,Commercial,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
ED PROCEDURE IRRG BLADDER,4504866,CDM,450,RC,51700,CPT,,,facility,outpatient,,,492.00000,196.80000,United Healthcare,Commercial,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,inpatient,,,550.00000,220.00000,United Healthcare,Commercial,,495.00,,,,,,,495.00,533.50,percent of total billed charges,
ED PROCEDURE IRRG NOT BLADDER,4505913,CDM,450,RC,,,,,facility,outpatient,,,550.00000,220.00000,United Healthcare,Commercial,,495.00,,,,,,,143.00,533.50,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,inpatient,,,305.00000,122.00000,United Healthcare,Commercial,,274.50,,,,,,,274.50,295.85,percent of total billed charges,
ED PROCEDURE NAIL,4504981,CDM,450,RC,,,,,facility,outpatient,,,305.00000,122.00000,United Healthcare,Commercial,,274.50,,,,,,,79.30,295.85,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,inpatient,,,220.00000,88.00000,United Healthcare,Commercial,,198.00,,,,,,,198.00,213.40,percent of total billed charges,
ED PROCEDURE UNLIST ADD-ON,4506341,CDM,450,RC,,,,,facility,outpatient,,,220.00000,88.00000,United Healthcare,Commercial,,198.00,,,,,,,57.20,213.40,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,inpatient,,,780.00000,312.00000,United Healthcare,Commercial,,702.00,,,,,,,702.00,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 01 SMPL,4506135,CDM,450,RC,,,,,facility,outpatient,,,780.00000,312.00000,United Healthcare,Commercial,,702.00,,,,,,,202.80,756.60,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,inpatient,,,1165.00000,466.00000,United Healthcare,Commercial,,1048.50,,,,,,,1048.50,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 02 INTRM,4506143,CDM,450,RC,,,,,facility,outpatient,,,1165.00000,466.00000,United Healthcare,Commercial,,1048.50,,,,,,,302.90,1130.05,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,inpatient,,,2350.00000,940.00000,United Healthcare,Commercial,,2115.00,,,,,,,2115.00,2279.50,percent of total billed charges,
ED PROCEDURE UNLIST LVL 03 CMPLX,4506150,CDM,450,RC,,,,,facility,outpatient,,,2350.00000,940.00000,United Healthcare,Commercial,,2115.00,,,,,,,611.00,2279.50,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,inpatient,,,896.00000,358.40000,United Healthcare,Commercial,,806.40,,,,,,,806.40,869.12,percent of total billed charges,
ED PUNCT LUMBAR,4504965,CDM,450,RC,,,,,facility,outpatient,,,896.00000,358.40000,United Healthcare,Commercial,,806.40,,,,,,,232.96,869.12,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,inpatient,,,385.00000,154.00000,United Healthcare,Commercial,,346.50,,,,,,,346.50,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION DIGIT,4505061,CDM,450,RC,,,,,facility,outpatient,,,385.00000,154.00000,United Healthcare,Commercial,,346.50,,,,,,,100.10,373.45,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,inpatient,,,470.00000,188.00000,United Healthcare,Commercial,,423.00,,,,,,,423.00,455.90,percent of total billed charges,
ED REDUCTION FX/DISLOCATION OTHER,4505053,CDM,450,RC,,,,,facility,outpatient,,,470.00000,188.00000,United Healthcare,Commercial,,423.00,,,,,,,122.20,455.90,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,inpatient,,,150.00000,60.00000,United Healthcare,Commercial,,135.00,,,,,,,135.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST BI,4506705,CDM,450,RC,,,,,facility,outpatient,,,150.00000,60.00000,United Healthcare,Commercial,,135.00,,,,,,,39.00,145.50,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,inpatient,,,100.00000,40.00000,United Healthcare,Commercial,,90.00,,,,,,,90.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W INST UNI,4506697,CDM,450,RC,,,,,facility,outpatient,,,100.00000,40.00000,United Healthcare,Commercial,,90.00,,,,,,,26.00,97.00,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,inpatient,,,143.00000,57.20000,United Healthcare,Commercial,,128.70,,,,,,,128.70,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG BI,4506739,CDM,450,RC,,,,,facility,outpatient,,,143.00000,57.20000,United Healthcare,Commercial,,128.70,,,,,,,37.18,138.71,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,inpatient,,,95.00000,38.00000,United Healthcare,Commercial,,85.50,,,,,,,85.50,92.15,percent of total billed charges,
ED REM CERUMEN IMPACTED W IRRG UNI,4506721,CDM,450,RC,,,,,facility,outpatient,,,95.00000,38.00000,United Healthcare,Commercial,,85.50,,,,,,,24.70,92.15,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,inpatient,,,269.00000,107.60000,United Healthcare,Commercial,,242.10,,,,,,,242.10,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 01 SMPL,4506226,CDM,450,RC,,,,,facility,outpatient,,,269.00000,107.60000,United Healthcare,Commercial,,242.10,,,,,,,69.94,260.93,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,inpatient,,,388.00000,155.20000,United Healthcare,Commercial,,349.20,,,,,,,349.20,376.36,percent of total billed charges,
ED REM FB CANL AUD EXT LVL 02 CMPLX,4506234,CDM,450,RC,,,,,facility,outpatient,,,388.00000,155.20000,United Healthcare,Commercial,,349.20,,,,,,,100.88,376.36,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,inpatient,,,344.00000,137.60000,United Healthcare,Commercial,,309.60,,,,,,,309.60,333.68,percent of total billed charges,
ED REM FB EYE EMBEDDED,4505129,CDM,450,RC,,,,,facility,outpatient,,,344.00000,137.60000,United Healthcare,Commercial,,309.60,,,,,,,89.44,333.68,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,inpatient,,,321.00000,128.40000,United Healthcare,Commercial,,288.90,,,,,,,288.90,311.37,percent of total billed charges,
ED REM FB EYE RUSTRING (METAL),4505137,CDM,450,RC,,,,,facility,outpatient,,,321.00000,128.40000,United Healthcare,Commercial,,288.90,,,,,,,83.46,311.37,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,inpatient,,,155.00000,62.00000,United Healthcare,Commercial,,139.50,,,,,,,139.50,150.35,percent of total billed charges,
ED REM FB EYE SUPERFICIAL,4505145,CDM,450,RC,,,,,facility,outpatient,,,155.00000,62.00000,United Healthcare,Commercial,,139.50,,,,,,,40.30,150.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,inpatient,,,817.00000,326.80000,United Healthcare,Commercial,,735.30,,,,,,,735.30,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 01 SIMPLE,4506242,CDM,450,RC,,,,,facility,outpatient,,,817.00000,326.80000,United Healthcare,Commercial,,735.30,,,,,,,212.42,792.49,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,inpatient,,,1255.00000,502.00000,United Healthcare,Commercial,,1129.50,,,,,,,1129.50,1217.35,percent of total billed charges,
ED REM FB MUSCLE/TNDN LVL 02 CMPLX,4506259,CDM,450,RC,,,,,facility,outpatient,,,1255.00000,502.00000,United Healthcare,Commercial,,1129.50,,,,,,,326.30,1217.35,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,inpatient,,,391.00000,156.40000,United Healthcare,Commercial,,351.90,,,,,,,351.90,379.27,percent of total billed charges,
ED REM FB NASAL,4505103,CDM,450,RC,,,,,facility,outpatient,,,391.00000,156.40000,United Healthcare,Commercial,,351.90,,,,,,,101.66,379.27,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,inpatient,,,671.00000,268.40000,United Healthcare,Commercial,,603.90,,,,,,,603.90,650.87,percent of total billed charges,
ED REM FB PHARYNX,4505152,CDM,450,RC,,,,,facility,outpatient,,,671.00000,268.40000,United Healthcare,Commercial,,603.90,,,,,,,174.46,650.87,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,inpatient,,,456.00000,182.40000,United Healthcare,Commercial,,410.40,,,,,,,410.40,442.32,percent of total billed charges,
ED REM IUD,4505095,CDM,450,RC,58301,CPT,,,facility,outpatient,,,456.00000,182.40000,United Healthcare,Commercial,,410.40,,,,,,,118.56,442.32,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,inpatient,,,112.00000,44.80000,United Healthcare,Commercial,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
ED REM SUTURE&STAPLE NO ANESTH,4507042,CDM,450,RC,15854,CPT,,,facility,outpatient,,,112.00000,44.80000,United Healthcare,Commercial,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,inpatient,,,84.00000,33.60000,United Healthcare,Commercial,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
ED REM SUTURE/STAPLE NO ANESTH,4507034,CDM,450,RC,15853,CPT,,,facility,outpatient,,,84.00000,33.60000,United Healthcare,Commercial,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,inpatient,,,216.00000,86.40000,United Healthcare,Commercial,,194.40,,,,,,,194.40,209.52,percent of total billed charges,
ED REM/BIVALVE CAST,4505087,CDM,450,RC,,,,,facility,outpatient,,,216.00000,86.40000,United Healthcare,Commercial,,194.40,,,,,,,56.16,209.52,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,inpatient,,,2660.00000,1064.00000,United Healthcare,Commercial,,2394.00,,,,,,,2394.00,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 01 SIMPLE,4506267,CDM,450,RC,,,,,facility,outpatient,,,2660.00000,1064.00000,United Healthcare,Commercial,,2394.00,,,,,,,691.60,2580.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,inpatient,,,2960.00000,1184.00000,United Healthcare,Commercial,,2664.00,,,,,,,2664.00,2871.20,percent of total billed charges,
ED RPR TENDON FOOT LVL 02 CMPLX,4506275,CDM,450,RC,,,,,facility,outpatient,,,2960.00000,1184.00000,United Healthcare,Commercial,,2664.00,,,,,,,769.60,2871.20,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,inpatient,,,3225.00000,1290.00000,United Healthcare,Commercial,,2902.50,,,,,,,2902.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 01 SMPL,4506283,CDM,450,RC,,,,,facility,outpatient,,,3225.00000,1290.00000,United Healthcare,Commercial,,2902.50,,,,,,,838.50,3128.25,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,inpatient,,,3395.00000,1358.00000,United Healthcare,Commercial,,3055.50,,,,,,,3055.50,3293.15,percent of total billed charges,
ED RPR TENDON HAND/FNG LVL 02 CMPLX,4506291,CDM,450,RC,,,,,facility,outpatient,,,3395.00000,1358.00000,United Healthcare,Commercial,,3055.50,,,,,,,882.70,3293.15,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,inpatient,,,490.00000,196.00000,United Healthcare,Commercial,,441.00,,,,,,,441.00,475.30,percent of total billed charges,
ED RPR WOUND LVL 01 SIMPLE,4506457,CDM,450,RC,,,,,facility,outpatient,,,490.00000,196.00000,United Healthcare,Commercial,,441.00,,,,,,,127.40,475.30,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,inpatient,,,520.00000,208.00000,United Healthcare,Commercial,,468.00,,,,,,,468.00,504.40,percent of total billed charges,
ED RPR WOUND LVL 02 INTERMEDIATE,4506440,CDM,450,RC,,,,,facility,outpatient,,,520.00000,208.00000,United Healthcare,Commercial,,468.00,,,,,,,135.20,504.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,inpatient,,,720.00000,288.00000,United Healthcare,Commercial,,648.00,,,,,,,648.00,698.40,percent of total billed charges,
ED RPR WOUND LVL 03 COMPLEX,4505368,CDM,450,RC,,,,,facility,outpatient,,,720.00000,288.00000,United Healthcare,Commercial,,648.00,,,,,,,187.20,698.40,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,inpatient,,,215.00000,86.00000,United Healthcare,Commercial,,193.50,,,,,,,193.50,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY LOWER,4505194,CDM,450,RC,,,,,facility,outpatient,,,215.00000,86.00000,United Healthcare,Commercial,,193.50,,,,,,,55.90,208.55,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,inpatient,,,240.00000,96.00000,United Healthcare,Commercial,,216.00,,,,,,,216.00,232.80,percent of total billed charges,
ED SPLINT/STRAP EXTREMITY UPPER,4505202,CDM,450,RC,,,,,facility,outpatient,,,240.00000,96.00000,United Healthcare,Commercial,,216.00,,,,,,,62.40,232.80,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,inpatient,,,1241.00000,496.40000,United Healthcare,Commercial,,1116.90,,,,,,,1116.90,1203.77,percent of total billed charges,
ED THORACENT/TUBE CHEST/DRN PLEURAL,4505228,CDM,450,RC,,,,,facility,outpatient,,,1241.00000,496.40000,United Healthcare,Commercial,,1116.90,,,,,,,322.66,1203.77,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,inpatient,,,850.00000,340.00000,United Healthcare,Commercial,,765.00,,,,,,,765.00,824.50,percent of total billed charges,
ED THORACOTOMY MASSAGE CARDIAC,4505236,CDM,450,RC,,,,,facility,outpatient,,,850.00000,340.00000,United Healthcare,Commercial,,765.00,,,,,,,221.00,824.50,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,inpatient,,,1085.00000,434.00000,United Healthcare,Commercial,,976.50,,,,,,,976.50,1052.45,percent of total billed charges,
ED TRACH/CRICOTHYROID,4505244,CDM,450,RC,,,,,facility,outpatient,,,1085.00000,434.00000,United Healthcare,Commercial,,976.50,,,,,,,282.10,1052.45,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,inpatient,,,295.00000,118.00000,United Healthcare,Commercial,,265.50,,,,,,,265.50,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 01 SMALL,4504544,CDM,450,RC,,,,,facility,outpatient,,,295.00000,118.00000,United Healthcare,Commercial,,265.50,,,,,,,76.70,286.15,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,inpatient,,,492.00000,196.80000,United Healthcare,Commercial,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 02 MEDIUM,4506424,CDM,450,RC,,,,,facility,outpatient,,,492.00000,196.80000,United Healthcare,Commercial,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,inpatient,,,563.00000,225.20000,United Healthcare,Commercial,,506.70,,,,,,,506.70,546.11,percent of total billed charges,
ED TREATMENT BURN LVL 03 LARGE,4506432,CDM,450,RC,,,,,facility,outpatient,,,563.00000,225.20000,United Healthcare,Commercial,,506.70,,,,,,,146.38,546.11,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,inpatient,,,1612.00000,644.80000,United Healthcare,Commercial,,1450.80,,,,,,,1450.80,1563.64,percent of total billed charges,
ED TREATMENT INCOMPLETE ABORTION,4505335,CDM,450,RC,,,,,facility,outpatient,,,1612.00000,644.80000,United Healthcare,Commercial,,1450.80,,,,,,,419.12,1563.64,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,inpatient,,,1366.00000,546.40000,United Healthcare,Commercial,,1229.40,,,,,,,1229.40,1325.02,percent of total billed charges,
ED VENIPUNCTURE CUTDOWN,4505343,CDM,450,RC,,,,,facility,outpatient,,,1366.00000,546.40000,United Healthcare,Commercial,,1229.40,,,,,,,355.16,1325.02,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,inpatient,,,1911.00000,764.40000,United Healthcare,Commercial,,1719.90,,,,,,,1719.90,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE 1ST 30-74MIN,4504676,CDM,450,RC,99291,CPT,,,facility,outpatient,,,1911.00000,764.40000,United Healthcare,Commercial,,1719.90,,,,,,,496.86,1853.67,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,inpatient,,,956.00000,382.40000,United Healthcare,Commercial,,860.40,,,,,,,860.40,927.32,percent of total billed charges,
ED VISIT CRITICAL CARE ADDL 30MIN,4504668,CDM,450,RC,99292,CPT,,,facility,outpatient,,,956.00000,382.40000,United Healthcare,Commercial,,860.40,,,,,,,248.56,927.32,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,inpatient,,,189.00000,123.20000,United Healthcare,Commercial,,170.10,,,,,,,170.10,183.33,percent of total billed charges,
ED VISIT LEVEL 1,4504908,CDM,450,RC,99281,CPT,,,facility,outpatient,,,189.00000,123.20000,United Healthcare,Commercial,,170.10,,,,,,,49.14,183.33,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,inpatient,,,352.00000,256.87000,United Healthcare,Commercial,,316.80,,,,,,,316.80,341.44,percent of total billed charges,
ED VISIT LEVEL 2,4504916,CDM,450,RC,99282,CPT,,,facility,outpatient,,,352.00000,256.87000,United Healthcare,Commercial,,316.80,,,,,,,91.52,341.44,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,inpatient,,,625.00000,738.40000,United Healthcare,Commercial,,562.50,,,,,,,562.50,606.25,percent of total billed charges,
ED VISIT LEVEL 3,4504924,CDM,450,RC,99283,CPT,,,facility,outpatient,,,625.00000,738.40000,United Healthcare,Commercial,,562.50,,,,,,,162.50,606.25,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,inpatient,,,1024.00000,2097.47000,United Healthcare,Commercial,,921.60,,,,,,,921.60,993.28,percent of total billed charges,
ED VISIT LEVEL 4,4504932,CDM,450,RC,99284,CPT,,,facility,outpatient,,,1024.00000,2097.47000,United Healthcare,Commercial,,921.60,,,,,,,266.24,993.28,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,inpatient,,,1455.00000,2469.72000,United Healthcare,Commercial,,1309.50,,,,,,,1309.50,1411.35,percent of total billed charges,
ED VISIT LEVEL 5,4504940,CDM,450,RC,99285,CPT,,,facility,outpatient,,,1455.00000,2469.72000,United Healthcare,Commercial,,1309.50,,,,,,,378.30,1411.35,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,inpatient,,,145.00000,75.54000,United Healthcare,Commercial,,130.50,,,,,,,130.50,140.65,percent of total billed charges,
ED EKG TRACING RHYTHM 1-3 LEADS,4505400,CDM,730,RC,93041,CPT,,,facility,outpatient,,,145.00000,75.54000,United Healthcare,Commercial,,130.50,,,,,,,37.70,140.65,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,inpatient,,,488.00000,254.25000,United Healthcare,Commercial,,439.20,,,,,,,439.20,473.36,percent of total billed charges,
ED EKG TRACING ROUTINE 12+ LEADS,4505392,CDM,730,RC,93005,CPT,,,facility,outpatient,,,488.00000,254.25000,United Healthcare,Commercial,,439.20,,,,,,,126.88,473.36,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,inpatient,,,116.00000,36.66000,United Healthcare,Commercial,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
OBSRV MEDICAL/SURGICAL PER HOUR,7620594,CDM,762,RC,G0378,HCPCS,,,facility,outpatient,,,116.00000,36.66000,United Healthcare,Commercial,,104.40,,,,,,,30.16,112.52,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,United Healthcare,Commercial,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
ED IMMUNIZATION 1ST VACCINE,4504809,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,United Healthcare,Commercial,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,United Healthcare,Commercial,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
ED IMMUNIZATION ADDL VACCINE,4504817,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,United Healthcare,Commercial,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,inpatient,,,170.00000,73.95000,United Healthcare,Commercial,,153.00,,,,,,,153.00,164.90,percent of total billed charges,
MILEAGE AIR FIXED WING MILE 1.00,5405733,CDM,540,RC,A0435,HCPCS,,,facility,outpatient,,,170.00000,73.95000,United Healthcare,Commercial,,153.00,,,,,,,44.20,164.90,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,2.70000,1.17000,United Healthcare,Commercial,,2.43,,,,,,,2.43,2.62,percent of total billed charges,
MILEAGE GROUND MILE 0.10,5405626,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,2.70000,1.17000,United Healthcare,Commercial,,2.43,,,,,,,0.70200,2.62,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,inpatient,,,27.00000,11.74000,United Healthcare,Commercial,,24.30,,,,,,,24.30,26.19,percent of total billed charges,
MILEAGE GROUND MILE 1.00,5405576,CDM,540,RC,A0425,HCPCS,,,facility,outpatient,,,27.00000,11.74000,United Healthcare,Commercial,,24.30,,,,,,,7.02,26.19,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,inpatient,,,20440.00000,8891.40000,United Healthcare,Commercial,,18396.00,,,,,,,18396.00,19826.80,percent of total billed charges,
TRNSPRT AIR FIXED WING,5405725,CDM,540,RC,A0430,HCPCS,,,facility,outpatient,,,20440.00000,8891.40000,United Healthcare,Commercial,,18396.00,,,,,,,5314.40,19826.80,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,inpatient,,,3322.00000,1445.07000,United Healthcare,Commercial,,2989.80,,,,,,,2989.80,3222.34,percent of total billed charges,
TRNSPRT AMB ALS LEVEL 2,5405600,CDM,540,RC,A0433,HCPCS,,,facility,outpatient,,,3322.00000,1445.07000,United Healthcare,Commercial,,2989.80,,,,,,,863.72,3222.34,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,inpatient,,,2492.00000,1084.02000,United Healthcare,Commercial,,2242.80,,,,,,,2242.80,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB ALS LEVEL 1,5405543,CDM,540,RC,A0427,HCPCS,,,facility,outpatient,,,2492.00000,1084.02000,United Healthcare,Commercial,,2242.80,,,,,,,647.92,2417.24,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,inpatient,,,1814.00000,789.09000,United Healthcare,Commercial,,1632.60,,,,,,,1632.60,1759.58,percent of total billed charges,
TRNSPRT EMERG AMB BLS,5405550,CDM,540,RC,A0429,HCPCS,,,facility,outpatient,,,1814.00000,789.09000,United Healthcare,Commercial,,1632.60,,,,,,,471.64,1759.58,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,inpatient,,,2153.00000,936.56000,United Healthcare,Commercial,,1937.70,,,,,,,1937.70,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB ALS LEVEL 1,5405469,CDM,540,RC,A0426,HCPCS,,,facility,outpatient,,,2153.00000,936.56000,United Healthcare,Commercial,,1937.70,,,,,,,559.78,2088.41,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,inpatient,,,1525.00000,663.38000,United Healthcare,Commercial,,1372.50,,,,,,,1372.50,1479.25,percent of total billed charges,
TRNSPRT NONEMR AMB BLS,5405568,CDM,540,RC,A0428,HCPCS,,,facility,outpatient,,,1525.00000,663.38000,United Healthcare,Commercial,,1372.50,,,,,,,396.50,1479.25,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,inpatient,,,2716.00000,1181.46000,United Healthcare,Commercial,,2444.40,,,,,,,2444.40,2634.52,percent of total billed charges,
TRNSPRT SPECIALTY CARE,5405592,CDM,540,RC,A0434,HCPCS,,,facility,outpatient,,,2716.00000,1181.46000,United Healthcare,Commercial,,2444.40,,,,,,,706.16,2634.52,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,inpatient,,,2.70000,0.39000,United Healthcare,Commercial,,2.43,,,,,,,2.43,2.62,percent of total billed charges,
MILEAGE NONCOVERED MILE 0.10,5405642,CDM,549,RC,A0888,HCPCS,,,facility,outpatient,,,2.70000,0.39000,United Healthcare,Commercial,,2.43,,,,,,,0.70200,2.62,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,inpatient,,,222.00000,32.41000,United Healthcare,Commercial,,199.80,,,,,,,199.80,215.34,percent of total billed charges,
RESPONSE/TREATMENT AMB WO TRNSPRT,5405618,CDM,549,RC,A0998,HCPCS,,,facility,outpatient,,,222.00000,32.41000,United Healthcare,Commercial,,199.80,,,,,,,57.72,215.34,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,inpatient,,,211.00000,113.10000,United Healthcare,Commercial,,189.90,,,,,,,189.90,204.67,percent of total billed charges,
APPLY MANUAL STRESS JOINT UNI/BI,3223096,CDM,320,RC,77071,CPT,,,facility,outpatient,,,211.00000,113.10000,United Healthcare,Commercial,,189.90,,,,,,,54.86,204.67,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,inpatient,,,497.00000,266.39000,United Healthcare,Commercial,,447.30,,,,,,,447.30,482.09,percent of total billed charges,
CATH ENDO DUCT BILIARY&PANCREAS S&I,3221371,CDM,320,RC,74330,CPT,,,facility,outpatient,,,497.00000,266.39000,United Healthcare,Commercial,,447.30,,,,,,,129.22,482.09,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,inpatient,,,296.00000,158.66000,United Healthcare,Commercial,,266.40,,,,,,,266.40,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR ADD S&I,3220696,CDM,320,RC,74301,CPT,,,facility,outpatient,,,296.00000,158.66000,United Healthcare,Commercial,,266.40,,,,,,,76.96,287.12,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,inpatient,,,723.00000,387.53000,United Healthcare,Commercial,,650.70,,,,,,,650.70,701.31,percent of total billed charges,
CHOLANGIO&/PANCREATOGRAM OR S&I,3220704,CDM,320,RC,74300,CPT,,,facility,outpatient,,,723.00000,387.53000,United Healthcare,Commercial,,650.70,,,,,,,187.98,701.31,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,inpatient,,,326.00000,174.74000,United Healthcare,Commercial,,293.40,,,,,,,293.40,316.22,percent of total billed charges,
CHOLECYSTOGRAPHY CNT ORAL,3220738,CDM,320,RC,74290,CPT,,,facility,outpatient,,,326.00000,174.74000,United Healthcare,Commercial,,293.40,,,,,,,84.76,316.22,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,inpatient,,,532.00000,285.15000,United Healthcare,Commercial,,478.80,,,,,,,478.80,516.04,percent of total billed charges,
CYSTOGRAM 3+ VW S&I,3220951,CDM,320,RC,74430,CPT,,,facility,outpatient,,,532.00000,285.15000,United Healthcare,Commercial,,478.80,,,,,,,138.32,516.04,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,inpatient,,,635.00000,340.36000,United Healthcare,Commercial,,571.50,,,,,,,571.50,615.95,percent of total billed charges,
ENEMA THERAPEUTIC,3221330,CDM,320,RC,74283,CPT,,,facility,outpatient,,,635.00000,340.36000,United Healthcare,Commercial,,571.50,,,,,,,165.10,615.95,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,inpatient,,,639.00000,342.50000,United Healthcare,Commercial,,575.10,,,,,,,575.10,619.83,percent of total billed charges,
EVAL SPEECH COMPLEX CINE/VIDEO,3224730,CDM,320,RC,70371,CPT,,,facility,outpatient,,,639.00000,342.50000,United Healthcare,Commercial,,575.10,,,,,,,166.14,619.83,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,inpatient,,,780.00000,418.08000,United Healthcare,Commercial,,702.00,,,,,,,702.00,756.60,percent of total billed charges,
FLUORO 0-1HR TIME PHYS/QHCP,3221611,CDM,320,RC,76000,CPT,,,facility,outpatient,,,780.00000,418.08000,United Healthcare,Commercial,,702.00,,,,,,,202.80,756.60,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,inpatient,,,390.00000,209.04000,United Healthcare,Commercial,,351.00,,,,,,,351.00,378.30,percent of total billed charges,
FLUORO GD PLC/REPL/REM CVAD,3229028,CDM,320,RC,77001,CPT,,,facility,outpatient,,,390.00000,209.04000,United Healthcare,Commercial,,351.00,,,,,,,101.40,378.30,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,inpatient,,,731.00000,391.82000,United Healthcare,Commercial,,657.90,,,,,,,657.90,709.07,percent of total billed charges,
FLUORO GD PLCMT NEEDLE,3221603,CDM,320,RC,77002,CPT,,,facility,outpatient,,,731.00000,391.82000,United Healthcare,Commercial,,657.90,,,,,,,190.06,709.07,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,inpatient,,,585.00000,313.56000,United Healthcare,Commercial,,526.50,,,,,,,526.50,567.45,percent of total billed charges,
FLUORO GD&LOC NEEDLE SPINE,3221579,CDM,320,RC,77003,CPT,,,facility,outpatient,,,585.00000,313.56000,United Healthcare,Commercial,,526.50,,,,,,,152.10,567.45,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,inpatient,,,365.00000,195.64000,United Healthcare,Commercial,,328.50,,,,,,,328.50,354.05,percent of total billed charges,
FNCT SWALLOW W CINE/VIDEO STUDY CNT,3266038,CDM,320,RC,74230,CPT,,,facility,outpatient,,,365.00000,195.64000,United Healthcare,Commercial,,328.50,,,,,,,94.90,354.05,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,inpatient,,,1086.00000,582.10000,United Healthcare,Commercial,,977.40,,,,,,,977.40,1053.42,percent of total billed charges,
HYSTEROSALPINGOGRAM S&I,3221892,CDM,320,RC,74740,CPT,,,facility,outpatient,,,1086.00000,582.10000,United Healthcare,Commercial,,977.40,,,,,,,282.36,1053.42,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,inpatient,,,197.00000,105.59000,United Healthcare,Commercial,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
INTRO TUBE GI LONG W FLUORO S&I,3222841,CDM,320,RC,74340,CPT,,,facility,outpatient,,,197.00000,105.59000,United Healthcare,Commercial,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,inpatient,,,2774.00000,1486.86000,United Healthcare,Commercial,,2496.60,,,,,,,2496.60,2690.78,percent of total billed charges,
MYELOGRAPHY 2+ REGIONS S&I,3223419,CDM,320,RC,72270,CPT,,,facility,outpatient,,,2774.00000,1486.86000,United Healthcare,Commercial,,2496.60,,,,,,,721.24,2690.78,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,inpatient,,,1456.00000,780.42000,United Healthcare,Commercial,,1310.40,,,,,,,1310.40,1412.32,percent of total billed charges,
MYELOGRAPHY CERVICAL S&I,3223377,CDM,320,RC,72240,CPT,,,facility,outpatient,,,1456.00000,780.42000,United Healthcare,Commercial,,1310.40,,,,,,,378.56,1412.32,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,inpatient,,,2647.00000,1418.79000,United Healthcare,Commercial,,2382.30,,,,,,,2382.30,2567.59,percent of total billed charges,
MYELOGRAPHY LUMBOSACRAL S&I,3223385,CDM,320,RC,72265,CPT,,,facility,outpatient,,,2647.00000,1418.79000,United Healthcare,Commercial,,2382.30,,,,,,,688.22,2567.59,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,inpatient,,,1359.00000,728.42000,United Healthcare,Commercial,,1223.10,,,,,,,1223.10,1318.23,percent of total billed charges,
MYELOGRAPHY THORACIC S&I,3223401,CDM,320,RC,72255,CPT,,,facility,outpatient,,,1359.00000,728.42000,United Healthcare,Commercial,,1223.10,,,,,,,353.34,1318.23,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,inpatient,,,273.00000,146.33000,United Healthcare,Commercial,,245.70,,,,,,,245.70,264.81,percent of total billed charges,
SHUNTOGRAM NONVASCULAR S&I,3224623,CDM,320,RC,75809,CPT,,,facility,outpatient,,,273.00000,146.33000,United Healthcare,Commercial,,245.70,,,,,,,70.98,264.81,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,inpatient,,,325.00000,174.20000,United Healthcare,Commercial,,292.50,,,,,,,292.50,315.25,percent of total billed charges,
STUDIES AGE BONE,3220357,CDM,320,RC,77072,CPT,,,facility,outpatient,,,325.00000,174.20000,United Healthcare,Commercial,,292.50,,,,,,,84.50,315.25,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,inpatient,,,609.00000,326.42000,United Healthcare,Commercial,,548.10,,,,,,,548.10,590.73,percent of total billed charges,
STUDIES LENGTH BONE,3220365,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,United Healthcare,Commercial,,548.10,,,,,,,158.34,590.73,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,inpatient,,,491.00000,263.18000,United Healthcare,Commercial,,441.90,,,,,,,441.90,476.27,percent of total billed charges,
URETHROCYSTOGRAM RETROGRADE S&I,3225323,CDM,320,RC,74450,CPT,,,facility,outpatient,,,491.00000,263.18000,United Healthcare,Commercial,,441.90,,,,,,,127.66,476.27,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,inpatient,,,561.00000,300.70000,United Healthcare,Commercial,,504.90,,,,,,,504.90,544.17,percent of total billed charges,
URETHROCYSTOGRAM VOIDING S&I,3225331,CDM,320,RC,74455,CPT,,,facility,outpatient,,,561.00000,300.70000,United Healthcare,Commercial,,504.90,,,,,,,145.86,544.17,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,inpatient,,,845.00000,452.92000,United Healthcare,Commercial,,760.50,,,,,,,760.50,819.65,percent of total billed charges,
UROGRAPHY ANTEGRADE S&I,3225349,CDM,320,RC,74425,CPT,,,facility,outpatient,,,845.00000,452.92000,United Healthcare,Commercial,,760.50,,,,,,,219.70,819.65,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,inpatient,,,612.00000,328.03000,United Healthcare,Commercial,,550.80,,,,,,,550.80,593.64,percent of total billed charges,
UROGRAPHY IV W/WO KUB,3223047,CDM,320,RC,74400,CPT,,,facility,outpatient,,,612.00000,328.03000,United Healthcare,Commercial,,550.80,,,,,,,159.12,593.64,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,inpatient,,,536.00000,287.30000,United Healthcare,Commercial,,482.40,,,,,,,482.40,519.92,percent of total billed charges,
UROGRAPHY RETROGRADE W/WO KUB,3225364,CDM,320,RC,74420,CPT,,,facility,outpatient,,,536.00000,287.30000,United Healthcare,Commercial,,482.40,,,,,,,139.36,519.92,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,inpatient,,,1225.00000,656.60000,United Healthcare,Commercial,,1102.50,,,,,,,1102.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY BI S&I,3225448,CDM,320,RC,75822,CPT,,,facility,outpatient,,,1225.00000,656.60000,United Healthcare,Commercial,,1102.50,,,,,,,318.50,1188.25,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,inpatient,,,816.00000,437.38000,United Healthcare,Commercial,LT,734.40,,,,,,,734.40,791.52,percent of total billed charges,
VENOGRAM EXTREMITY LT S&I,3225422,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,United Healthcare,Commercial,LT,734.40,,,,,,,212.16,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,inpatient,,,816.00000,437.38000,United Healthcare,Commercial,RT,734.40,,,,,,,734.40,791.52,percent of total billed charges,
VENOGRAM EXTREMITY RT S&I,3225430,CDM,320,RC,75820,CPT,,,facility,outpatient,,,816.00000,437.38000,United Healthcare,Commercial,RT,734.40,,,,,,,212.16,791.52,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,inpatient,,,250.00000,134.00000,United Healthcare,Commercial,,225.00,,,,,,,225.00,242.50,percent of total billed charges,
XR ABDOMEN 1 VW,3245479,CDM,320,RC,74018,CPT,,,facility,outpatient,,,250.00000,134.00000,United Healthcare,Commercial,,225.00,,,,,,,65.00,242.50,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,inpatient,,,302.00000,161.87000,United Healthcare,Commercial,,271.80,,,,,,,271.80,292.94,percent of total billed charges,
XR ABDOMEN 2 VW,3245495,CDM,320,RC,74019,CPT,,,facility,outpatient,,,302.00000,161.87000,United Healthcare,Commercial,,271.80,,,,,,,78.52,292.94,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,inpatient,,,354.00000,189.74000,United Healthcare,Commercial,,318.60,,,,,,,318.60,343.38,percent of total billed charges,
XR ABDOMEN 3+ VW,3245511,CDM,320,RC,74021,CPT,,,facility,outpatient,,,354.00000,189.74000,United Healthcare,Commercial,,318.60,,,,,,,92.04,343.38,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,inpatient,,,409.00000,219.22000,United Healthcare,Commercial,,368.10,,,,,,,368.10,396.73,percent of total billed charges,
XR ABDOMEN CMP 2+VW W CHEST 1 VW,3220019,CDM,320,RC,74022,CPT,,,facility,outpatient,,,409.00000,219.22000,United Healthcare,Commercial,,368.10,,,,,,,106.34,396.73,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,inpatient,,,593.00000,317.85000,United Healthcare,Commercial,,533.70,,,,,,,533.70,575.21,percent of total billed charges,
XR ABSCESS/SINUS/FISTULA S&I,3220001,CDM,320,RC,76080,CPT,,,facility,outpatient,,,593.00000,317.85000,United Healthcare,Commercial,,533.70,,,,,,,154.18,575.21,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,United Healthcare,Commercial,LT,276.30,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW LT,3220126,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,United Healthcare,Commercial,LT,276.30,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,United Healthcare,Commercial,"52,LT",276.30,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW LT RDC,3265519,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,United Healthcare,Commercial,"52,LT",276.30,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,United Healthcare,Commercial,RT,276.30,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW RT,3220134,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,United Healthcare,Commercial,RT,276.30,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,inpatient,,,307.00000,164.55000,United Healthcare,Commercial,"52,RT",276.30,,,,,,,276.30,297.79,percent of total billed charges,
XR ANKLE 2 VW RT RDC,3265501,CDM,320,RC,73600,CPT,,,facility,outpatient,,,307.00000,164.55000,United Healthcare,Commercial,"52,RT",276.30,,,,,,,79.82,297.79,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,inpatient,,,330.00000,176.88000,United Healthcare,Commercial,LT,297.00,,,,,,,297.00,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW LT,3220092,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,United Healthcare,Commercial,LT,297.00,,,,,,,85.80,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,inpatient,,,330.00000,176.88000,United Healthcare,Commercial,RT,297.00,,,,,,,297.00,320.10,percent of total billed charges,
XR ANKLE CMP 3+ VW RT,3220100,CDM,320,RC,73610,CPT,,,facility,outpatient,,,330.00000,176.88000,United Healthcare,Commercial,RT,297.00,,,,,,,85.80,320.10,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,inpatient,,,195.00000,104.52000,United Healthcare,Commercial,,175.50,,,,,,,175.50,189.15,percent of total billed charges,
XR BONES FACIAL 0-2 VW,3221470,CDM,320,RC,70140,CPT,,,facility,outpatient,,,195.00000,104.52000,United Healthcare,Commercial,,175.50,,,,,,,50.70,189.15,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,inpatient,,,578.00000,309.81000,United Healthcare,Commercial,,520.20,,,,,,,520.20,560.66,percent of total billed charges,
XR BONES FACIAL CMP 3+ VW,3221488,CDM,320,RC,70150,CPT,,,facility,outpatient,,,578.00000,309.81000,United Healthcare,Commercial,,520.20,,,,,,,150.28,560.66,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,inpatient,,,384.00000,205.82000,United Healthcare,Commercial,,345.60,,,,,,,345.60,372.48,percent of total billed charges,
XR BONES NASAL CMP 3+ VW,3223427,CDM,320,RC,70160,CPT,,,facility,outpatient,,,384.00000,205.82000,United Healthcare,Commercial,,345.60,,,,,,,99.84,372.48,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,inpatient,,,303.00000,162.41000,United Healthcare,Commercial,LT,272.70,,,,,,,272.70,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW LT,3220555,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,United Healthcare,Commercial,LT,272.70,,,,,,,78.78,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,inpatient,,,303.00000,162.41000,United Healthcare,Commercial,RT,272.70,,,,,,,272.70,293.91,percent of total billed charges,
XR CALCANEUS 2+ VW RT,3220563,CDM,320,RC,73650,CPT,,,facility,outpatient,,,303.00000,162.41000,United Healthcare,Commercial,RT,272.70,,,,,,,78.78,293.91,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,inpatient,,,445.00000,238.52000,United Healthcare,Commercial,LT,400.50,,,,,,,400.50,431.65,percent of total billed charges,
XR CLAVICLE CMP LT,3220803,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,United Healthcare,Commercial,LT,400.50,,,,,,,115.70,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,inpatient,,,445.00000,238.52000,United Healthcare,Commercial,RT,400.50,,,,,,,400.50,431.65,percent of total billed charges,
XR CLAVICLE CMP RT,3220811,CDM,320,RC,73000,CPT,,,facility,outpatient,,,445.00000,238.52000,United Healthcare,Commercial,RT,400.50,,,,,,,115.70,431.65,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,inpatient,,,937.00000,502.23000,United Healthcare,Commercial,,843.30,,,,,,,843.30,908.89,percent of total billed charges,
XR COLON STUDY CNT DOUBLE,3266103,CDM,320,RC,74280,CPT,,,facility,outpatient,,,937.00000,502.23000,United Healthcare,Commercial,,843.30,,,,,,,243.62,908.89,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,inpatient,,,615.00000,329.64000,United Healthcare,Commercial,,553.50,,,,,,,553.50,596.55,percent of total billed charges,
XR COLON STUDY CNT SINGLE,3266095,CDM,320,RC,74270,CPT,,,facility,outpatient,,,615.00000,329.64000,United Healthcare,Commercial,,553.50,,,,,,,159.90,596.55,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,United Healthcare,Commercial,LT,258.30,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW LT,3221264,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,United Healthcare,Commercial,LT,258.30,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,United Healthcare,Commercial,"52,LT",258.30,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW LT RDC,3265360,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,United Healthcare,Commercial,"52,LT",258.30,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,United Healthcare,Commercial,RT,258.30,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW RT,3221272,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,United Healthcare,Commercial,RT,258.30,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,inpatient,,,287.00000,153.83000,United Healthcare,Commercial,"52,RT",258.30,,,,,,,258.30,278.39,percent of total billed charges,
XR ELBOW 2 VW RT RDC,3265352,CDM,320,RC,73070,CPT,,,facility,outpatient,,,287.00000,153.83000,United Healthcare,Commercial,"52,RT",258.30,,,,,,,74.62,278.39,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,inpatient,,,323.00000,173.13000,United Healthcare,Commercial,LT,290.70,,,,,,,290.70,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW LT,3221231,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,United Healthcare,Commercial,LT,290.70,,,,,,,83.98,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,inpatient,,,323.00000,173.13000,United Healthcare,Commercial,RT,290.70,,,,,,,290.70,313.31,percent of total billed charges,
XR ELBOW CMP 3+ VW RT,3221249,CDM,320,RC,73080,CPT,,,facility,outpatient,,,323.00000,173.13000,United Healthcare,Commercial,RT,290.70,,,,,,,83.98,313.31,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,inpatient,,,694.00000,371.98000,United Healthcare,Commercial,,624.60,,,,,,,624.60,673.18,percent of total billed charges,
XR ESOPHAGUS STUDY CNT SINGLE,3266020,CDM,320,RC,74220,CPT,,,facility,outpatient,,,694.00000,371.98000,United Healthcare,Commercial,,624.60,,,,,,,180.44,673.18,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,inpatient,,,276.00000,147.94000,United Healthcare,Commercial,LT,248.40,,,,,,,248.40,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW LT,3223229,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,United Healthcare,Commercial,LT,248.40,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,inpatient,,,276.00000,147.94000,United Healthcare,Commercial,RT,248.40,,,,,,,248.40,267.72,percent of total billed charges,
XR EXT LOWER INFANT 2+ VW RT,3223237,CDM,320,RC,73592,CPT,,,facility,outpatient,,,276.00000,147.94000,United Healthcare,Commercial,RT,248.40,,,,,,,71.76,267.72,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,inpatient,,,254.00000,136.14000,United Healthcare,Commercial,LT,228.60,,,,,,,228.60,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW LT,3225299,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,United Healthcare,Commercial,LT,228.60,,,,,,,66.04,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,inpatient,,,254.00000,136.14000,United Healthcare,Commercial,RT,228.60,,,,,,,228.60,246.38,percent of total billed charges,
XR EXT UPPER INFANT 2+ VW RT,3225307,CDM,320,RC,73092,CPT,,,facility,outpatient,,,254.00000,136.14000,United Healthcare,Commercial,RT,228.60,,,,,,,66.04,246.38,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,inpatient,,,275.00000,147.40000,United Healthcare,Commercial,LT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY LT,3242237,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,United Healthcare,Commercial,LT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,inpatient,,,275.00000,147.40000,United Healthcare,Commercial,RT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR EYE FOREIGN BODY RT,3242245,CDM,320,RC,70030,CPT,,,facility,outpatient,,,275.00000,147.40000,United Healthcare,Commercial,RT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,inpatient,,,173.00000,92.73000,United Healthcare,Commercial,,155.70,,,,,,,155.70,167.81,percent of total billed charges,
XR FB NOSE TO RECTUM CHILD 1 VW,3221496,CDM,320,RC,76010,CPT,,,facility,outpatient,,,173.00000,92.73000,United Healthcare,Commercial,,155.70,,,,,,,44.98,167.81,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,inpatient,,,483.00000,258.89000,United Healthcare,Commercial,LT,434.70,,,,,,,434.70,468.51,percent of total billed charges,
XR FEMUR 2+ VW LT,3204773,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,United Healthcare,Commercial,LT,434.70,,,,,,,125.58,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,inpatient,,,483.00000,258.89000,United Healthcare,Commercial,RT,434.70,,,,,,,434.70,468.51,percent of total billed charges,
XR FEMUR 2+ VW RT,3204765,CDM,320,RC,73552,CPT,,,facility,outpatient,,,483.00000,258.89000,United Healthcare,Commercial,RT,434.70,,,,,,,125.58,468.51,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,inpatient,,,191.00000,102.38000,United Healthcare,Commercial,LT,171.90,,,,,,,171.90,185.27,percent of total billed charges,
XR FINGER/S 2+ VW LT,3221538,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,United Healthcare,Commercial,LT,171.90,,,,,,,49.66,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,inpatient,,,191.00000,102.38000,United Healthcare,Commercial,RT,171.90,,,,,,,171.90,185.27,percent of total billed charges,
XR FINGER/S 2+ VW RT,3221546,CDM,320,RC,73140,CPT,,,facility,outpatient,,,191.00000,102.38000,United Healthcare,Commercial,RT,171.90,,,,,,,49.66,185.27,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,United Healthcare,Commercial,LT,133.20,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW LT,3221678,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,United Healthcare,Commercial,LT,133.20,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,United Healthcare,Commercial,"52,LT",133.20,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW LT RDC,3265543,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,United Healthcare,Commercial,"52,LT",133.20,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,United Healthcare,Commercial,RT,133.20,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW RT,3221686,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,United Healthcare,Commercial,RT,133.20,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,inpatient,,,148.00000,79.33000,United Healthcare,Commercial,"52,RT",133.20,,,,,,,133.20,143.56,percent of total billed charges,
XR FOOT 2 VW RT RDC,3265535,CDM,320,RC,73620,CPT,,,facility,outpatient,,,148.00000,79.33000,United Healthcare,Commercial,"52,RT",133.20,,,,,,,38.48,143.56,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,inpatient,,,481.00000,257.82000,United Healthcare,Commercial,LT,432.90,,,,,,,432.90,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW LT,3221645,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,United Healthcare,Commercial,LT,432.90,,,,,,,125.06,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,inpatient,,,481.00000,257.82000,United Healthcare,Commercial,RT,432.90,,,,,,,432.90,466.57,percent of total billed charges,
XR FOOT CMP 3+ VW RT,3221652,CDM,320,RC,73630,CPT,,,facility,outpatient,,,481.00000,257.82000,United Healthcare,Commercial,RT,432.90,,,,,,,125.06,466.57,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,inpatient,,,215.00000,115.24000,United Healthcare,Commercial,LT,193.50,,,,,,,193.50,208.55,percent of total billed charges,
XR FORAMINA OPTIC LT,3223534,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,United Healthcare,Commercial,LT,193.50,,,,,,,55.90,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,inpatient,,,215.00000,115.24000,United Healthcare,Commercial,RT,193.50,,,,,,,193.50,208.55,percent of total billed charges,
XR FORAMINA OPTIC RT,3223542,CDM,320,RC,70190,CPT,,,facility,outpatient,,,215.00000,115.24000,United Healthcare,Commercial,RT,193.50,,,,,,,55.90,208.55,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,United Healthcare,Commercial,LT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT,3221702,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,United Healthcare,Commercial,LT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,United Healthcare,Commercial,"52,LT",247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW LT RDC,3265394,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,United Healthcare,Commercial,"52,LT",247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,United Healthcare,Commercial,RT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT,3221710,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,United Healthcare,Commercial,RT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,inpatient,,,275.00000,147.40000,United Healthcare,Commercial,"52,RT",247.50,,,,,,,247.50,266.75,percent of total billed charges,
XR FOREARM 2 VW RT RDC,3265386,CDM,320,RC,73090,CPT,,,facility,outpatient,,,275.00000,147.40000,United Healthcare,Commercial,"52,RT",247.50,,,,,,,71.50,266.75,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,United Healthcare,Commercial,LT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW LT,3221777,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,United Healthcare,Commercial,LT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,United Healthcare,Commercial,"52,LT",409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW LT RDC,3265451,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,United Healthcare,Commercial,"52,LT",409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,United Healthcare,Commercial,RT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW RT,3221785,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,United Healthcare,Commercial,RT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,inpatient,,,455.00000,243.88000,United Healthcare,Commercial,"52,RT",409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HAND 2 VW RT RDC,3265444,CDM,320,RC,73120,CPT,,,facility,outpatient,,,455.00000,243.88000,United Healthcare,Commercial,"52,RT",409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,inpatient,,,503.00000,269.61000,United Healthcare,Commercial,LT,452.70,,,,,,,452.70,487.91,percent of total billed charges,
XR HAND 3+ VW LT,3221744,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,United Healthcare,Commercial,LT,452.70,,,,,,,130.78,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,inpatient,,,503.00000,269.61000,United Healthcare,Commercial,RT,452.70,,,,,,,452.70,487.91,percent of total billed charges,
XR HAND 3+ VW RT,3221751,CDM,320,RC,73130,CPT,,,facility,outpatient,,,503.00000,269.61000,United Healthcare,Commercial,RT,452.70,,,,,,,130.78,487.91,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,inpatient,,,209.00000,112.02000,United Healthcare,Commercial,LT,188.10,,,,,,,188.10,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW LT,3204625,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,United Healthcare,Commercial,LT,188.10,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,inpatient,,,209.00000,112.02000,United Healthcare,Commercial,RT,188.10,,,,,,,188.10,202.73,percent of total billed charges,
XR HIP W PELVIS 1 VW RT,3204617,CDM,320,RC,73501,CPT,,,facility,outpatient,,,209.00000,112.02000,United Healthcare,Commercial,RT,188.10,,,,,,,54.34,202.73,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,inpatient,,,566.00000,303.38000,United Healthcare,Commercial,LT,509.40,,,,,,,509.40,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW LT,3204658,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,United Healthcare,Commercial,LT,509.40,,,,,,,147.16,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,inpatient,,,566.00000,303.38000,United Healthcare,Commercial,RT,509.40,,,,,,,509.40,549.02,percent of total billed charges,
XR HIP W PELVIS 2-3 VW RT,3204641,CDM,320,RC,73502,CPT,,,facility,outpatient,,,566.00000,303.38000,United Healthcare,Commercial,RT,509.40,,,,,,,147.16,549.02,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,inpatient,,,598.00000,320.53000,United Healthcare,Commercial,,538.20,,,,,,,538.20,580.06,percent of total billed charges,
XR HIPS W PELVIS 3-4 VW BI,3204716,CDM,320,RC,73522,CPT,,,facility,outpatient,,,598.00000,320.53000,United Healthcare,Commercial,,538.20,,,,,,,155.48,580.06,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,United Healthcare,Commercial,"52,LT",409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2 VW LT RDC,3265345,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,United Healthcare,Commercial,"52,LT",409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,United Healthcare,Commercial,"52,RT",409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2 VW RT RDC,3265337,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,United Healthcare,Commercial,"52,RT",409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,United Healthcare,Commercial,LT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2+ VW LT,3221876,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,United Healthcare,Commercial,LT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,inpatient,,,455.00000,243.88000,United Healthcare,Commercial,RT,409.50,,,,,,,409.50,441.35,percent of total billed charges,
XR HUMERUS 2+ VW RT,3221884,CDM,320,RC,73060,CPT,,,facility,outpatient,,,455.00000,243.88000,United Healthcare,Commercial,RT,409.50,,,,,,,118.30,441.35,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,inpatient,,,1913.00000,1025.37000,United Healthcare,Commercial,,1721.70,,,,,,,1721.70,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT DOUBLE,3266087,CDM,320,RC,74251,CPT,,,facility,outpatient,,,1913.00000,1025.37000,United Healthcare,Commercial,,1721.70,,,,,,,497.38,1855.61,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,inpatient,,,312.00000,167.23000,United Healthcare,Commercial,,280.80,,,,,,,280.80,302.64,percent of total billed charges,
XR INTESTINE SM STUDY CNT SINGLE,3266079,CDM,320,RC,74250,CPT,,,facility,outpatient,,,312.00000,167.23000,United Healthcare,Commercial,,280.80,,,,,,,81.12,302.64,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,inpatient,,,327.00000,175.27000,United Healthcare,Commercial,,294.30,,,,,,,294.30,317.19,percent of total billed charges,
XR INTESTINE SM STUDY FOLLOW THRU,3266061,CDM,320,RC,74248,CPT,,,facility,outpatient,,,327.00000,175.27000,United Healthcare,Commercial,,294.30,,,,,,,85.02,317.19,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,inpatient,,,425.00000,227.80000,United Healthcare,Commercial,,382.50,,,,,,,382.50,412.25,percent of total billed charges,
XR JT/S STERNOCLAVICULAR 3+ VW,3224920,CDM,320,RC,71130,CPT,,,facility,outpatient,,,425.00000,227.80000,United Healthcare,Commercial,,382.50,,,,,,,110.50,412.25,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,inpatient,,,210.00000,112.56000,United Healthcare,Commercial,,189.00,,,,,,,189.00,203.70,percent of total billed charges,
XR JTS ACROMIOCLAVICULAR BI,3220050,CDM,320,RC,73050,CPT,,,facility,outpatient,,,210.00000,112.56000,United Healthcare,Commercial,,189.00,,,,,,,54.60,203.70,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,inpatient,,,495.00000,265.32000,United Healthcare,Commercial,,445.50,,,,,,,445.50,480.15,percent of total billed charges,
XR JTS SACROILIAC 1-2 VW,3224631,CDM,320,RC,72200,CPT,,,facility,outpatient,,,495.00000,265.32000,United Healthcare,Commercial,,445.50,,,,,,,128.70,480.15,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,inpatient,,,541.00000,289.98000,United Healthcare,Commercial,,486.90,,,,,,,486.90,524.77,percent of total billed charges,
XR JTS SACROILIAC 3+ VW,3224649,CDM,320,RC,72202,CPT,,,facility,outpatient,,,541.00000,289.98000,United Healthcare,Commercial,,486.90,,,,,,,140.66,524.77,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,inpatient,,,345.00000,184.92000,United Healthcare,Commercial,LT,310.50,,,,,,,310.50,334.65,percent of total billed charges,
XR KNEE 1-2 VW LT,3223153,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,United Healthcare,Commercial,LT,310.50,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,inpatient,,,345.00000,184.92000,United Healthcare,Commercial,RT,310.50,,,,,,,310.50,334.65,percent of total billed charges,
XR KNEE 1-2 VW RT,3223161,CDM,320,RC,73560,CPT,,,facility,outpatient,,,345.00000,184.92000,United Healthcare,Commercial,RT,310.50,,,,,,,89.70,334.65,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,inpatient,,,419.00000,224.58000,United Healthcare,Commercial,LT,377.10,,,,,,,377.10,406.43,percent of total billed charges,
XR KNEE 3 VW LT,3223187,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,United Healthcare,Commercial,LT,377.10,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,inpatient,,,419.00000,224.58000,United Healthcare,Commercial,RT,377.10,,,,,,,377.10,406.43,percent of total billed charges,
XR KNEE 3 VW RT,3223195,CDM,320,RC,73562,CPT,,,facility,outpatient,,,419.00000,224.58000,United Healthcare,Commercial,RT,377.10,,,,,,,108.94,406.43,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,inpatient,,,618.00000,331.25000,United Healthcare,Commercial,LT,556.20,,,,,,,556.20,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW LT,3223120,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,United Healthcare,Commercial,LT,556.20,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,inpatient,,,618.00000,331.25000,United Healthcare,Commercial,RT,556.20,,,,,,,556.20,599.46,percent of total billed charges,
XR KNEE CMP 4+ VW RT,3223138,CDM,320,RC,73564,CPT,,,facility,outpatient,,,618.00000,331.25000,United Healthcare,Commercial,RT,556.20,,,,,,,160.68,599.46,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,inpatient,,,463.00000,248.17000,United Healthcare,Commercial,,416.70,,,,,,,416.70,449.11,percent of total billed charges,
XR KNEES STANDING AP BI,3223203,CDM,320,RC,73565,CPT,,,facility,outpatient,,,463.00000,248.17000,United Healthcare,Commercial,,416.70,,,,,,,120.38,449.11,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,inpatient,,,511.00000,273.90000,United Healthcare,Commercial,,459.90,,,,,,,459.90,495.67,percent of total billed charges,
XR MANDIBLE CMP 4+ VW,3223336,CDM,320,RC,70110,CPT,,,facility,outpatient,,,511.00000,273.90000,United Healthcare,Commercial,,459.90,,,,,,,132.86,495.67,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,inpatient,,,132.00000,70.75000,United Healthcare,Commercial,,118.80,,,,,,,118.80,128.04,percent of total billed charges,
XR MANDIBLE PARTIAL 1-3 VW,3223344,CDM,320,RC,70100,CPT,,,facility,outpatient,,,132.00000,70.75000,United Healthcare,Commercial,,118.80,,,,,,,34.32,128.04,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,inpatient,,,353.00000,189.21000,United Healthcare,Commercial,LT,317.70,,,,,,,317.70,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE LT,3243979,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,United Healthcare,Commercial,LT,317.70,,,,,,,91.78,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,inpatient,,,353.00000,189.21000,United Healthcare,Commercial,RT,317.70,,,,,,,317.70,342.41,percent of total billed charges,
XR MASTOIDS CMP 3+ VW PER SIDE RT,3243987,CDM,320,RC,70130,CPT,,,facility,outpatient,,,353.00000,189.21000,United Healthcare,Commercial,RT,317.70,,,,,,,91.78,342.41,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,inpatient,,,273.00000,146.33000,United Healthcare,Commercial,,245.70,,,,,,,245.70,264.81,percent of total billed charges,
XR ORBITS CMP 4+ VW,3223567,CDM,320,RC,70200,CPT,,,facility,outpatient,,,273.00000,146.33000,United Healthcare,Commercial,,245.70,,,,,,,70.98,264.81,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,inpatient,,,503.00000,269.61000,United Healthcare,Commercial,,452.70,,,,,,,452.70,487.91,percent of total billed charges,
XR PELVIS 1-2 VW,3223609,CDM,320,RC,72170,CPT,,,facility,outpatient,,,503.00000,269.61000,United Healthcare,Commercial,,452.70,,,,,,,130.78,487.91,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,inpatient,,,561.00000,300.70000,United Healthcare,Commercial,,504.90,,,,,,,504.90,544.17,percent of total billed charges,
XR PELVIS CMP 3+ VW,3223591,CDM,320,RC,72190,CPT,,,facility,outpatient,,,561.00000,300.70000,United Healthcare,Commercial,,504.90,,,,,,,145.86,544.17,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,inpatient,,,450.00000,241.20000,United Healthcare,Commercial,LT,405.00,,,,,,,405.00,436.50,percent of total billed charges,
XR RIBS 2 VW LT,3224227,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,United Healthcare,Commercial,LT,405.00,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,inpatient,,,450.00000,241.20000,United Healthcare,Commercial,RT,405.00,,,,,,,405.00,436.50,percent of total billed charges,
XR RIBS 2 VW RT,3224235,CDM,320,RC,71100,CPT,,,facility,outpatient,,,450.00000,241.20000,United Healthcare,Commercial,RT,405.00,,,,,,,117.00,436.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,inpatient,,,650.00000,348.40000,United Healthcare,Commercial,,585.00,,,,,,,585.00,630.50,percent of total billed charges,
XR RIBS 3+ VW BI,3224243,CDM,320,RC,71110,CPT,,,facility,outpatient,,,650.00000,348.40000,United Healthcare,Commercial,,585.00,,,,,,,169.00,630.50,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,inpatient,,,642.00000,344.11000,United Healthcare,Commercial,,577.80,,,,,,,577.80,622.74,percent of total billed charges,
XR RIBS W CXR 3+ VW,3243326,CDM,320,RC,71101,CPT,,,facility,outpatient,,,642.00000,344.11000,United Healthcare,Commercial,,577.80,,,,,,,166.92,622.74,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,inpatient,,,777.00000,416.47000,United Healthcare,Commercial,,699.30,,,,,,,699.30,753.69,percent of total billed charges,
XR RIBS W CXR 4+ VW BI,3224276,CDM,320,RC,71111,CPT,,,facility,outpatient,,,777.00000,416.47000,United Healthcare,Commercial,,699.30,,,,,,,202.02,753.69,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,inpatient,,,381.00000,204.22000,United Healthcare,Commercial,,342.90,,,,,,,342.90,369.57,percent of total billed charges,
XR SACRUM&COCCYX 2+ VW,3224359,CDM,320,RC,72220,CPT,,,facility,outpatient,,,381.00000,204.22000,United Healthcare,Commercial,,342.90,,,,,,,99.06,369.57,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,inpatient,,,374.00000,200.46000,United Healthcare,Commercial,LT,336.60,,,,,,,336.60,362.78,percent of total billed charges,
XR SCAPULA CMP LT,3224383,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,United Healthcare,Commercial,LT,336.60,,,,,,,97.24,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,inpatient,,,374.00000,200.46000,United Healthcare,Commercial,RT,336.60,,,,,,,336.60,362.78,percent of total billed charges,
XR SCAPULA CMP RT,3224391,CDM,320,RC,73010,CPT,,,facility,outpatient,,,374.00000,200.46000,United Healthcare,Commercial,RT,336.60,,,,,,,97.24,362.78,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,inpatient,,,161.00000,86.30000,United Healthcare,Commercial,LT,144.90,,,,,,,144.90,156.17,percent of total billed charges,
XR SHOULDER 1 VW LT,3224599,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,United Healthcare,Commercial,LT,144.90,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,inpatient,,,161.00000,86.30000,United Healthcare,Commercial,RT,144.90,,,,,,,144.90,156.17,percent of total billed charges,
XR SHOULDER 1 VW RT,3224607,CDM,320,RC,73020,CPT,,,facility,outpatient,,,161.00000,86.30000,United Healthcare,Commercial,RT,144.90,,,,,,,41.86,156.17,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,inpatient,,,499.00000,267.46000,United Healthcare,Commercial,LT,449.10,,,,,,,449.10,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW LT,3224565,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,United Healthcare,Commercial,LT,449.10,,,,,,,129.74,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,inpatient,,,499.00000,267.46000,United Healthcare,Commercial,RT,449.10,,,,,,,449.10,484.03,percent of total billed charges,
XR SHOULDER CMP 2+ VW RT,3224573,CDM,320,RC,73030,CPT,,,facility,outpatient,,,499.00000,267.46000,United Healthcare,Commercial,RT,449.10,,,,,,,129.74,484.03,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,inpatient,,,214.00000,114.70000,United Healthcare,Commercial,,192.60,,,,,,,192.60,207.58,percent of total billed charges,
XR SINUSES PARANASAL 0-2 VW,3224672,CDM,320,RC,70210,CPT,,,facility,outpatient,,,214.00000,114.70000,United Healthcare,Commercial,,192.60,,,,,,,55.64,207.58,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,inpatient,,,329.00000,176.34000,United Healthcare,Commercial,,296.10,,,,,,,296.10,319.13,percent of total billed charges,
XR SINUSES PARANASAL CMP 3+ VW,3224680,CDM,320,RC,70220,CPT,,,facility,outpatient,,,329.00000,176.34000,United Healthcare,Commercial,,296.10,,,,,,,85.54,319.13,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,inpatient,,,197.00000,105.59000,United Healthcare,Commercial,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
XR SKULL 0-3 VW,3224698,CDM,320,RC,70250,CPT,,,facility,outpatient,,,197.00000,105.59000,United Healthcare,Commercial,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,inpatient,,,263.00000,140.97000,United Healthcare,Commercial,,236.70,,,,,,,236.70,255.11,percent of total billed charges,
XR SKULL CMP 4+ VW,3224706,CDM,320,RC,70260,CPT,,,facility,outpatient,,,263.00000,140.97000,United Healthcare,Commercial,,236.70,,,,,,,68.38,255.11,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,inpatient,,,234.00000,125.42000,United Healthcare,Commercial,,210.60,,,,,,,210.60,226.98,percent of total billed charges,
XR SPECIMEN SURGICAL,3241973,CDM,320,RC,76098,CPT,,,facility,outpatient,,,234.00000,125.42000,United Healthcare,Commercial,,210.60,,,,,,,60.84,226.98,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,inpatient,,,401.00000,214.94000,United Healthcare,Commercial,,360.90,,,,,,,360.90,388.97,percent of total billed charges,
XR SPINE 1 VW,3224748,CDM,320,RC,72020,CPT,,,facility,outpatient,,,401.00000,214.94000,United Healthcare,Commercial,,360.90,,,,,,,104.26,388.97,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,inpatient,,,515.00000,276.04000,United Healthcare,Commercial,,463.50,,,,,,,463.50,499.55,percent of total billed charges,
XR SPINE CERVICAL 2-3 VW,3224771,CDM,320,RC,72040,CPT,,,facility,outpatient,,,515.00000,276.04000,United Healthcare,Commercial,,463.50,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,inpatient,,,747.00000,400.39000,United Healthcare,Commercial,,672.30,,,,,,,672.30,724.59,percent of total billed charges,
XR SPINE CERVICAL 4-5 VW,3252293,CDM,320,RC,72050,CPT,,,facility,outpatient,,,747.00000,400.39000,United Healthcare,Commercial,,672.30,,,,,,,194.22,724.59,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,inpatient,,,854.00000,457.74000,United Healthcare,Commercial,,768.60,,,,,,,768.60,828.38,percent of total billed charges,
XR SPINE CERVICAL 6+ VW,3252301,CDM,320,RC,72052,CPT,,,facility,outpatient,,,854.00000,457.74000,United Healthcare,Commercial,,768.60,,,,,,,222.04,828.38,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,inpatient,,,589.00000,315.70000,United Healthcare,Commercial,,530.10,,,,,,,530.10,571.33,percent of total billed charges,
XR SPINE ENTIRE THOR&LUMB 2-3 VW,3204583,CDM,320,RC,72082,CPT,,,facility,outpatient,,,589.00000,315.70000,United Healthcare,Commercial,,530.10,,,,,,,153.14,571.33,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,inpatient,,,613.00000,328.57000,United Healthcare,Commercial,,551.70,,,,,,,551.70,594.61,percent of total billed charges,
XR SPINE LS 2-3 VW,3224805,CDM,320,RC,72100,CPT,,,facility,outpatient,,,613.00000,328.57000,United Healthcare,Commercial,,551.70,,,,,,,159.38,594.61,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,inpatient,,,806.00000,432.02000,United Healthcare,Commercial,,725.40,,,,,,,725.40,781.82,percent of total billed charges,
XR SPINE LS 4+ VW,3224797,CDM,320,RC,72110,CPT,,,facility,outpatient,,,806.00000,432.02000,United Healthcare,Commercial,,725.40,,,,,,,209.56,781.82,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,inpatient,,,529.00000,283.54000,United Healthcare,Commercial,,476.10,,,,,,,476.10,513.13,percent of total billed charges,
XR SPINE LS BEND 2-3 VW,3249315,CDM,320,RC,72120,CPT,,,facility,outpatient,,,529.00000,283.54000,United Healthcare,Commercial,,476.10,,,,,,,137.54,513.13,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,inpatient,,,939.00000,503.30000,United Healthcare,Commercial,,845.10,,,,,,,845.10,910.83,percent of total billed charges,
XR SPINE LS CMP W BEND 6+ VW,3249307,CDM,320,RC,72114,CPT,,,facility,outpatient,,,939.00000,503.30000,United Healthcare,Commercial,,845.10,,,,,,,244.14,910.83,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,inpatient,,,515.00000,276.04000,United Healthcare,Commercial,,463.50,,,,,,,463.50,499.55,percent of total billed charges,
XR SPINE THORACIC 2 VW,3224862,CDM,320,RC,72070,CPT,,,facility,outpatient,,,515.00000,276.04000,United Healthcare,Commercial,,463.50,,,,,,,133.90,499.55,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,inpatient,,,616.00000,330.18000,United Healthcare,Commercial,,554.40,,,,,,,554.40,597.52,percent of total billed charges,
XR SPINE THORACIC 3 VW,3224870,CDM,320,RC,72072,CPT,,,facility,outpatient,,,616.00000,330.18000,United Healthcare,Commercial,,554.40,,,,,,,160.16,597.52,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,inpatient,,,377.00000,202.07000,United Healthcare,Commercial,,339.30,,,,,,,339.30,365.69,percent of total billed charges,
XR SPINE THORACOLUMBAR => 2 VW,3224888,CDM,320,RC,72080,CPT,,,facility,outpatient,,,377.00000,202.07000,United Healthcare,Commercial,,339.30,,,,,,,98.02,365.69,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,inpatient,,,340.00000,182.24000,United Healthcare,Commercial,,306.00,,,,,,,306.00,329.80,percent of total billed charges,
XR STERNUM 2+ VW,3224938,CDM,320,RC,71120,CPT,,,facility,outpatient,,,340.00000,182.24000,United Healthcare,Commercial,,306.00,,,,,,,88.40,329.80,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,inpatient,,,388.00000,207.97000,United Healthcare,Commercial,,349.20,,,,,,,349.20,376.36,percent of total billed charges,
XR SURVEY OSSEOUS CMP,3220373,CDM,320,RC,77075,CPT,,,facility,outpatient,,,388.00000,207.97000,United Healthcare,Commercial,,349.20,,,,,,,100.88,376.36,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,inpatient,,,456.00000,244.42000,United Healthcare,Commercial,,410.40,,,,,,,410.40,442.32,percent of total billed charges,
XR SURVEY OSSEOUS INFANT,3220381,CDM,320,RC,77076,CPT,,,facility,outpatient,,,456.00000,244.42000,United Healthcare,Commercial,,410.40,,,,,,,118.56,442.32,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,inpatient,,,267.00000,143.11000,United Healthcare,Commercial,,240.30,,,,,,,240.30,258.99,percent of total billed charges,
XR SURVEY OSSEOUS LTD,3220399,CDM,320,RC,77074,CPT,,,facility,outpatient,,,267.00000,143.11000,United Healthcare,Commercial,,240.30,,,,,,,69.42,258.99,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,United Healthcare,Commercial,LT,275.40,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT,3225091,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,United Healthcare,Commercial,LT,275.40,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,United Healthcare,Commercial,"52,LT",275.40,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW LT RDC,3265485,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,United Healthcare,Commercial,"52,LT",275.40,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,United Healthcare,Commercial,RT,275.40,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT,3225109,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,United Healthcare,Commercial,RT,275.40,,,,,,,79.56,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,inpatient,,,306.00000,164.02000,United Healthcare,Commercial,"52,RT",275.40,,,,,,,275.40,296.82,percent of total billed charges,
XR TIBIA&FIBULA 2 VW RT RDC,3265477,CDM,320,RC,73590,CPT,,,facility,outpatient,,,306.00000,164.02000,United Healthcare,Commercial,"52,RT",275.40,,,,,,,79.56,296.82,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,inpatient,,,456.00000,244.42000,United Healthcare,Commercial,,410.40,,,,,,,410.40,442.32,percent of total billed charges,
XR TISSUE SOFT NECK,3223435,CDM,320,RC,70360,CPT,,,facility,outpatient,,,456.00000,244.42000,United Healthcare,Commercial,,410.40,,,,,,,118.56,442.32,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,inpatient,,,381.00000,204.22000,United Healthcare,Commercial,,342.90,,,,,,,342.90,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE BI,3225125,CDM,320,RC,70330,CPT,,,facility,outpatient,,,381.00000,204.22000,United Healthcare,Commercial,,342.90,,,,,,,99.06,369.57,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,inpatient,,,143.00000,76.65000,United Healthcare,Commercial,LT,128.70,,,,,,,128.70,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE LT,3225133,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,United Healthcare,Commercial,LT,128.70,,,,,,,37.18,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,inpatient,,,143.00000,76.65000,United Healthcare,Commercial,RT,128.70,,,,,,,128.70,138.71,percent of total billed charges,
XR TMJ MOUTH OPEN&CLOSE RT,3225141,CDM,320,RC,70328,CPT,,,facility,outpatient,,,143.00000,76.65000,United Healthcare,Commercial,RT,128.70,,,,,,,37.18,138.71,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,inpatient,,,331.00000,177.42000,United Healthcare,Commercial,LT,297.90,,,,,,,297.90,321.07,percent of total billed charges,
XR TOE/S 2+ VW LT,3226479,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,United Healthcare,Commercial,LT,297.90,,,,,,,86.06,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,inpatient,,,331.00000,177.42000,United Healthcare,Commercial,RT,297.90,,,,,,,297.90,321.07,percent of total billed charges,
XR TOE/S 2+ VW RT,3226487,CDM,320,RC,73660,CPT,,,facility,outpatient,,,331.00000,177.42000,United Healthcare,Commercial,RT,297.90,,,,,,,86.06,321.07,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,inpatient,,,1113.00000,596.57000,United Healthcare,Commercial,,1001.70,,,,,,,1001.70,1079.61,percent of total billed charges,
XR UGI STUDY CNT DOUBLE,3266053,CDM,320,RC,74246,CPT,,,facility,outpatient,,,1113.00000,596.57000,United Healthcare,Commercial,,1001.70,,,,,,,289.38,1079.61,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,inpatient,,,1043.00000,559.05000,United Healthcare,Commercial,,938.70,,,,,,,938.70,1011.71,percent of total billed charges,
XR UGI STUDY CNT SINGLE,3266046,CDM,320,RC,74240,CPT,,,facility,outpatient,,,1043.00000,559.05000,United Healthcare,Commercial,,938.70,,,,,,,271.18,1011.71,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,United Healthcare,Commercial,LT,230.40,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW LT,3225653,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,United Healthcare,Commercial,LT,230.40,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,United Healthcare,Commercial,"52,LT",230.40,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW LT RDC,3265428,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,United Healthcare,Commercial,"52,LT",230.40,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,United Healthcare,Commercial,RT,230.40,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW RT,3225661,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,United Healthcare,Commercial,RT,230.40,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,inpatient,,,256.00000,137.22000,United Healthcare,Commercial,"52,RT",230.40,,,,,,,230.40,248.32,percent of total billed charges,
XR WRIST 2 VW RT RDC,3265410,CDM,320,RC,73100,CPT,,,facility,outpatient,,,256.00000,137.22000,United Healthcare,Commercial,"52,RT",230.40,,,,,,,66.56,248.32,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,inpatient,,,511.00000,273.90000,United Healthcare,Commercial,LT,459.90,,,,,,,459.90,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW LT,3225620,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,United Healthcare,Commercial,LT,459.90,,,,,,,132.86,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,inpatient,,,511.00000,273.90000,United Healthcare,Commercial,RT,459.90,,,,,,,459.90,495.67,percent of total billed charges,
XR WRIST CMP 3+ VW RT,3225638,CDM,320,RC,73110,CPT,,,facility,outpatient,,,511.00000,273.90000,United Healthcare,Commercial,RT,459.90,,,,,,,132.86,495.67,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,inpatient,,,553.00000,314.19000,United Healthcare,Commercial,LT,497.70,,,,,,,497.70,536.41,percent of total billed charges,
XR ARTHRO ANKLE LT S&I,3225703,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,United Healthcare,Commercial,LT,497.70,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,inpatient,,,553.00000,314.19000,United Healthcare,Commercial,RT,497.70,,,,,,,497.70,536.41,percent of total billed charges,
XR ARTHRO ANKLE RT S&I,3225711,CDM,322,RC,73615,CPT,,,facility,outpatient,,,553.00000,314.19000,United Healthcare,Commercial,RT,497.70,,,,,,,143.78,536.41,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,inpatient,,,1076.00000,611.33000,United Healthcare,Commercial,LT,968.40,,,,,,,968.40,1043.72,percent of total billed charges,
XR ARTHRO ELBOW LT S&I,3225729,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,United Healthcare,Commercial,LT,968.40,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,inpatient,,,1076.00000,611.33000,United Healthcare,Commercial,RT,968.40,,,,,,,968.40,1043.72,percent of total billed charges,
XR ARTHRO ELBOW RT S&I,3225737,CDM,322,RC,73085,CPT,,,facility,outpatient,,,1076.00000,611.33000,United Healthcare,Commercial,RT,968.40,,,,,,,279.76,1043.72,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,inpatient,,,865.00000,491.45000,United Healthcare,Commercial,LT,778.50,,,,,,,778.50,839.05,percent of total billed charges,
XR ARTHRO HIP LT S&I,3225745,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,United Healthcare,Commercial,LT,778.50,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,inpatient,,,865.00000,491.45000,United Healthcare,Commercial,RT,778.50,,,,,,,778.50,839.05,percent of total billed charges,
XR ARTHRO HIP RT S&I,3225752,CDM,322,RC,73525,CPT,,,facility,outpatient,,,865.00000,491.45000,United Healthcare,Commercial,RT,778.50,,,,,,,224.90,839.05,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,inpatient,,,734.00000,417.02000,United Healthcare,Commercial,LT,660.60,,,,,,,660.60,711.98,percent of total billed charges,
XR ARTHRO KNEE LT S&I,3225760,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,United Healthcare,Commercial,LT,660.60,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,inpatient,,,734.00000,417.02000,United Healthcare,Commercial,RT,660.60,,,,,,,660.60,711.98,percent of total billed charges,
XR ARTHRO KNEE RT S&I,3225778,CDM,322,RC,73580,CPT,,,facility,outpatient,,,734.00000,417.02000,United Healthcare,Commercial,RT,660.60,,,,,,,190.84,711.98,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,inpatient,,,730.00000,414.75000,United Healthcare,Commercial,LT,657.00,,,,,,,657.00,708.10,percent of total billed charges,
XR ARTHRO SHOULDER LT S&I,3225687,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,United Healthcare,Commercial,LT,657.00,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,inpatient,,,730.00000,414.75000,United Healthcare,Commercial,RT,657.00,,,,,,,657.00,708.10,percent of total billed charges,
XR ARTHRO SHOULDER RT S&I,3225695,CDM,322,RC,73040,CPT,,,facility,outpatient,,,730.00000,414.75000,United Healthcare,Commercial,RT,657.00,,,,,,,189.80,708.10,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,inpatient,,,260.00000,147.72000,United Healthcare,Commercial,LT,234.00,,,,,,,234.00,252.20,percent of total billed charges,
XR ARTHRO WRIST LT S&I,3225802,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,United Healthcare,Commercial,LT,234.00,,,,,,,67.60,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,inpatient,,,260.00000,147.72000,United Healthcare,Commercial,RT,234.00,,,,,,,234.00,252.20,percent of total billed charges,
XR ARTHRO WRIST RT S&I,3225810,CDM,322,RC,73115,CPT,,,facility,outpatient,,,260.00000,147.72000,United Healthcare,Commercial,RT,234.00,,,,,,,67.60,252.20,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,inpatient,,,428.00000,203.73000,United Healthcare,Commercial,,385.20,,,,,,,385.20,415.16,percent of total billed charges,
XR CHEST 1 VW,3244993,CDM,324,RC,71045,CPT,,,facility,outpatient,,,428.00000,203.73000,United Healthcare,Commercial,,385.20,,,,,,,111.28,415.16,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,inpatient,,,492.00000,234.19000,United Healthcare,Commercial,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
XR CHEST 2 VW,3245016,CDM,324,RC,71046,CPT,,,facility,outpatient,,,492.00000,234.19000,United Healthcare,Commercial,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,inpatient,,,607.00000,288.93000,United Healthcare,Commercial,,546.30,,,,,,,546.30,588.79,percent of total billed charges,
XR CHEST 3 VW,3245032,CDM,324,RC,71047,CPT,,,facility,outpatient,,,607.00000,288.93000,United Healthcare,Commercial,,546.30,,,,,,,157.82,588.79,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,inpatient,,,649.00000,308.92000,United Healthcare,Commercial,,584.10,,,,,,,584.10,629.53,percent of total billed charges,
XR CHEST 4+ VW,3245057,CDM,324,RC,71048,CPT,,,facility,outpatient,,,649.00000,308.92000,United Healthcare,Commercial,,584.10,,,,,,,168.74,629.53,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,inpatient,,,377.00000,121.77000,United Healthcare,Commercial,50,339.30,,,,,,,339.30,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD BI,3254125,CDM,361,RC,20605,CPT,,,facility,outpatient,,,377.00000,121.77000,United Healthcare,Commercial,50,339.30,,,,,,,98.02,365.69,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,inpatient,,,251.00000,81.07000,United Healthcare,Commercial,LT,225.90,,,,,,,225.90,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD LT,3254158,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,United Healthcare,Commercial,LT,225.90,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,inpatient,,,251.00000,81.07000,United Healthcare,Commercial,RT,225.90,,,,,,,225.90,243.47,percent of total billed charges,
ASP&/INJ JT/BUR INTR WO US GD RT,3254117,CDM,361,RC,20605,CPT,,,facility,outpatient,,,251.00000,81.07000,United Healthcare,Commercial,RT,225.90,,,,,,,65.26,243.47,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,inpatient,,,1170.00000,377.91000,United Healthcare,Commercial,50,1053.00,,,,,,,1053.00,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD BI,3254182,CDM,361,RC,20610,CPT,,,facility,outpatient,,,1170.00000,377.91000,United Healthcare,Commercial,50,1053.00,,,,,,,304.20,1134.90,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,inpatient,,,780.00000,251.94000,United Healthcare,Commercial,LT,702.00,,,,,,,702.00,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD LT,3254190,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,United Healthcare,Commercial,LT,702.00,,,,,,,202.80,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,inpatient,,,780.00000,251.94000,United Healthcare,Commercial,RT,702.00,,,,,,,702.00,756.60,percent of total billed charges,
ASP&/INJ JT/BUR MAJ WO US GD RT,3254174,CDM,361,RC,20610,CPT,,,facility,outpatient,,,780.00000,251.94000,United Healthcare,Commercial,RT,702.00,,,,,,,202.80,756.60,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,inpatient,,,1389.00000,448.65000,United Healthcare,Commercial,,1250.10,,,,,,,1250.10,1347.33,percent of total billed charges,
BX LIVER NDL PERC,3228020,CDM,361,RC,47000,CPT,,,facility,outpatient,,,1389.00000,448.65000,United Healthcare,Commercial,,1250.10,,,,,,,361.14,1347.33,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,inpatient,,,345.00000,111.44000,United Healthcare,Commercial,50,310.50,,,,,,,310.50,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL BI,3249216,CDM,361,RC,64634,CPT,,,facility,outpatient,,,345.00000,111.44000,United Healthcare,Commercial,50,310.50,,,,,,,89.70,334.65,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,inpatient,,,230.00000,74.29000,United Healthcare,Commercial,LT,207.00,,,,,,,207.00,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL LT,3249224,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,United Healthcare,Commercial,LT,207.00,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,inpatient,,,230.00000,74.29000,United Healthcare,Commercial,RT,207.00,,,,,,,207.00,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD ADDL RT,3249232,CDM,361,RC,64634,CPT,,,facility,outpatient,,,230.00000,74.29000,United Healthcare,Commercial,RT,207.00,,,,,,,59.80,223.10,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,inpatient,,,2102.00000,678.95000,United Healthcare,Commercial,50,1891.80,,,,,,,1891.80,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL BI,3249182,CDM,361,RC,64633,CPT,,,facility,outpatient,,,2102.00000,678.95000,United Healthcare,Commercial,50,1891.80,,,,,,,546.52,2038.94,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,inpatient,,,1401.00000,452.52000,United Healthcare,Commercial,LT,1260.90,,,,,,,1260.90,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL LT,3249190,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,United Healthcare,Commercial,LT,1260.90,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,inpatient,,,1401.00000,452.52000,United Healthcare,Commercial,RT,1260.90,,,,,,,1260.90,1358.97,percent of total billed charges,
DST NRV CERV/THOR FL/CT GD SGL RT,3249208,CDM,361,RC,64633,CPT,,,facility,outpatient,,,1401.00000,452.52000,United Healthcare,Commercial,RT,1260.90,,,,,,,364.26,1358.97,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,inpatient,,,357.00000,115.31000,United Healthcare,Commercial,50,321.30,,,,,,,321.30,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL BI,3249273,CDM,361,RC,64636,CPT,,,facility,outpatient,,,357.00000,115.31000,United Healthcare,Commercial,50,321.30,,,,,,,92.82,346.29,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,inpatient,,,238.00000,76.87000,United Healthcare,Commercial,LT,214.20,,,,,,,214.20,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL LT,3249281,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,United Healthcare,Commercial,LT,214.20,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,inpatient,,,238.00000,76.87000,United Healthcare,Commercial,RT,214.20,,,,,,,214.20,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD ADDL RT,3249299,CDM,361,RC,64636,CPT,,,facility,outpatient,,,238.00000,76.87000,United Healthcare,Commercial,RT,214.20,,,,,,,61.88,230.86,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,inpatient,,,2082.00000,672.49000,United Healthcare,Commercial,50,1873.80,,,,,,,1873.80,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL BI,3249240,CDM,361,RC,64635,CPT,,,facility,outpatient,,,2082.00000,672.49000,United Healthcare,Commercial,50,1873.80,,,,,,,541.32,2019.54,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,inpatient,,,1388.00000,448.32000,United Healthcare,Commercial,LT,1249.20,,,,,,,1249.20,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL LT,3249257,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,United Healthcare,Commercial,LT,1249.20,,,,,,,360.88,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,inpatient,,,1388.00000,448.32000,United Healthcare,Commercial,RT,1249.20,,,,,,,1249.20,1346.36,percent of total billed charges,
DST NRV LUMB/SAC FL/CT GD SGL RT,3249265,CDM,361,RC,64635,CPT,,,facility,outpatient,,,1388.00000,448.32000,United Healthcare,Commercial,RT,1249.20,,,,,,,360.88,1346.36,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,inpatient,,,246.00000,79.46000,United Healthcare,Commercial,50,221.40,,,,,,,221.40,238.62,percent of total billed charges,
INJ ARTHRO ANKLE BI,3247087,CDM,361,RC,27648,CPT,,,facility,outpatient,,,246.00000,79.46000,United Healthcare,Commercial,50,221.40,,,,,,,63.96,238.62,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,inpatient,,,164.00000,52.97000,United Healthcare,Commercial,LT,147.60,,,,,,,147.60,159.08,percent of total billed charges,
INJ ARTHRO ANKLE LT,3222023,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,United Healthcare,Commercial,LT,147.60,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,inpatient,,,164.00000,52.97000,United Healthcare,Commercial,RT,147.60,,,,,,,147.60,159.08,percent of total billed charges,
INJ ARTHRO ANKLE RT,3222031,CDM,361,RC,27648,CPT,,,facility,outpatient,,,164.00000,52.97000,United Healthcare,Commercial,RT,147.60,,,,,,,42.64,159.08,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,inpatient,,,309.00000,99.81000,United Healthcare,Commercial,50,278.10,,,,,,,278.10,299.73,percent of total billed charges,
INJ ARTHRO ELBOW BI,3247103,CDM,361,RC,24220,CPT,,,facility,outpatient,,,309.00000,99.81000,United Healthcare,Commercial,50,278.10,,,,,,,80.34,299.73,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,inpatient,,,206.00000,66.54000,United Healthcare,Commercial,LT,185.40,,,,,,,185.40,199.82,percent of total billed charges,
INJ ARTHRO ELBOW LT,3222049,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,United Healthcare,Commercial,LT,185.40,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,inpatient,,,206.00000,66.54000,United Healthcare,Commercial,RT,185.40,,,,,,,185.40,199.82,percent of total billed charges,
INJ ARTHRO ELBOW RT,3222056,CDM,361,RC,24220,CPT,,,facility,outpatient,,,206.00000,66.54000,United Healthcare,Commercial,RT,185.40,,,,,,,53.56,199.82,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,inpatient,,,471.00000,152.13000,United Healthcare,Commercial,50,423.90,,,,,,,423.90,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES BI,3247129,CDM,361,RC,27093,CPT,,,facility,outpatient,,,471.00000,152.13000,United Healthcare,Commercial,50,423.90,,,,,,,122.46,456.87,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,inpatient,,,314.00000,101.42000,United Healthcare,Commercial,LT,282.60,,,,,,,282.60,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES LT,3222080,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,United Healthcare,Commercial,LT,282.60,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,inpatient,,,314.00000,101.42000,United Healthcare,Commercial,RT,282.60,,,,,,,282.60,304.58,percent of total billed charges,
INJ ARTHRO HIP WO ANES RT,3222098,CDM,361,RC,27093,CPT,,,facility,outpatient,,,314.00000,101.42000,United Healthcare,Commercial,RT,282.60,,,,,,,81.64,304.58,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,inpatient,,,239.00000,77.20000,United Healthcare,Commercial,50,215.10,,,,,,,215.10,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE BI,3245800,CDM,361,RC,27369,CPT,,,facility,outpatient,,,239.00000,77.20000,United Healthcare,Commercial,50,215.10,,,,,,,62.14,231.83,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,inpatient,,,159.00000,51.36000,United Healthcare,Commercial,LT,143.10,,,,,,,143.10,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE LT,3245818,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,United Healthcare,Commercial,LT,143.10,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,inpatient,,,159.00000,51.36000,United Healthcare,Commercial,RT,143.10,,,,,,,143.10,154.23,percent of total billed charges,
INJ ARTHRO KNEE CNT/CNT ENHANCE RT,3245826,CDM,361,RC,27369,CPT,,,facility,outpatient,,,159.00000,51.36000,United Healthcare,Commercial,RT,143.10,,,,,,,41.34,154.23,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,inpatient,,,558.00000,180.23000,United Healthcare,Commercial,50,502.20,,,,,,,502.20,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER BI,3242351,CDM,361,RC,23350,CPT,,,facility,outpatient,,,558.00000,180.23000,United Healthcare,Commercial,50,502.20,,,,,,,145.08,541.26,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,inpatient,,,372.00000,120.16000,United Healthcare,Commercial,LT,334.80,,,,,,,334.80,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER LT,3222122,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,United Healthcare,Commercial,LT,334.80,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,inpatient,,,372.00000,120.16000,United Healthcare,Commercial,RT,334.80,,,,,,,334.80,360.84,percent of total billed charges,
INJ ARTHRO SHOULDER RT,3222130,CDM,361,RC,23350,CPT,,,facility,outpatient,,,372.00000,120.16000,United Healthcare,Commercial,RT,334.80,,,,,,,96.72,360.84,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,inpatient,,,413.00000,133.40000,United Healthcare,Commercial,50,371.70,,,,,,,371.70,400.61,percent of total billed charges,
INJ ARTHRO WRIST BI,3247111,CDM,361,RC,25246,CPT,,,facility,outpatient,,,413.00000,133.40000,United Healthcare,Commercial,50,371.70,,,,,,,107.38,400.61,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,inpatient,,,275.00000,88.82000,United Healthcare,Commercial,LT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST LT,3222163,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,United Healthcare,Commercial,LT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,inpatient,,,275.00000,88.82000,United Healthcare,Commercial,RT,247.50,,,,,,,247.50,266.75,percent of total billed charges,
INJ ARTHRO WRIST RT,3222171,CDM,361,RC,25246,CPT,,,facility,outpatient,,,275.00000,88.82000,United Healthcare,Commercial,RT,247.50,,,,,,,71.50,266.75,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,inpatient,,,462.00000,149.23000,United Healthcare,Commercial,,415.80,,,,,,,415.80,448.14,percent of total billed charges,
INJ CHOLANGIOGRAM ACCESS EXIST S&I,3204633,CDM,361,RC,47531,CPT,,,facility,outpatient,,,462.00000,149.23000,United Healthcare,Commercial,,415.80,,,,,,,120.12,448.14,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,inpatient,,,170.00000,54.91000,United Healthcare,Commercial,,153.00,,,,,,,153.00,164.90,percent of total billed charges,
INJ CNT ABSC/CYST VIA PREV CATH/TB,3228087,CDM,361,RC,49424,CPT,,,facility,outpatient,,,170.00000,54.91000,United Healthcare,Commercial,,153.00,,,,,,,44.20,164.90,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,inpatient,,,281.00000,90.76000,United Healthcare,Commercial,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
INJ CNT TUBE G/COLON PERC S&I,3234994,CDM,361,RC,49465,CPT,,,facility,outpatient,,,281.00000,90.76000,United Healthcare,Commercial,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,inpatient,,,562.00000,181.53000,United Healthcare,Commercial,,505.80,,,,,,,505.80,545.14,percent of total billed charges,
INJ CYSTOGRAM,3228103,CDM,361,RC,51600,CPT,,,facility,outpatient,,,562.00000,181.53000,United Healthcare,Commercial,,505.80,,,,,,,146.12,545.14,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,inpatient,,,2076.00000,670.55000,United Healthcare,Commercial,50,1868.40,,,,,,,1868.40,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD BI,3249000,CDM,361,RC,27096,CPT,,,facility,outpatient,,,2076.00000,670.55000,United Healthcare,Commercial,50,1868.40,,,,,,,539.76,2013.72,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1384.00000,447.03000,United Healthcare,Commercial,LT,1245.60,,,,,,,1245.60,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD LT,3249018,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,United Healthcare,Commercial,LT,1245.60,,,,,,,359.84,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,inpatient,,,1384.00000,447.03000,United Healthcare,Commercial,RT,1245.60,,,,,,,1245.60,1342.48,percent of total billed charges,
INJ JT SI ANES/STRD FL/CT GD RT,3249026,CDM,361,RC,27096,CPT,,,facility,outpatient,,,1384.00000,447.03000,United Healthcare,Commercial,RT,1245.60,,,,,,,359.84,1342.48,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,inpatient,,,934.00000,301.68000,United Healthcare,Commercial,,840.60,,,,,,,840.60,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY 2+ S&I,3263464,CDM,361,RC,62305,CPT,,,facility,outpatient,,,934.00000,301.68000,United Healthcare,Commercial,,840.60,,,,,,,242.84,905.98,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,inpatient,,,842.00000,271.97000,United Healthcare,Commercial,,757.80,,,,,,,757.80,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY CERVICAL S&I,3263415,CDM,361,RC,62302,CPT,,,facility,outpatient,,,842.00000,271.97000,United Healthcare,Commercial,,757.80,,,,,,,218.92,816.74,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,inpatient,,,846.00000,273.26000,United Healthcare,Commercial,,761.40,,,,,,,761.40,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY LUMBOSACRAL S&I,3263456,CDM,361,RC,62304,CPT,,,facility,outpatient,,,846.00000,273.26000,United Healthcare,Commercial,,761.40,,,,,,,219.96,820.62,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,inpatient,,,971.00000,313.63000,United Healthcare,Commercial,,873.90,,,,,,,873.90,941.87,percent of total billed charges,
INJ LUMB MYELOGRPHY THORACIC S&I,3263431,CDM,361,RC,62303,CPT,,,facility,outpatient,,,971.00000,313.63000,United Healthcare,Commercial,,873.90,,,,,,,252.46,941.87,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,inpatient,,,762.00000,246.13000,United Healthcare,Commercial,,685.80,,,,,,,685.80,739.14,percent of total billed charges,
INJ MYELOGRAM&/CT LUMBAR,3254257,CDM,361,RC,62284,CPT,,,facility,outpatient,,,762.00000,246.13000,United Healthcare,Commercial,,685.80,,,,,,,198.12,739.14,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,inpatient,,,758.00000,244.83000,United Healthcare,Commercial,,682.20,,,,,,,682.20,735.26,percent of total billed charges,
INJ SIS/HYSTEROSALPINGOGRAPHY,3228145,CDM,361,RC,58340,CPT,,,facility,outpatient,,,758.00000,244.83000,United Healthcare,Commercial,,682.20,,,,,,,197.08,735.26,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,inpatient,,,161.00000,52.00000,United Healthcare,Commercial,,144.90,,,,,,,144.90,156.17,percent of total billed charges,
INJ TRACT SINOGRAM,3227907,CDM,361,RC,20501,CPT,,,facility,outpatient,,,161.00000,52.00000,United Healthcare,Commercial,,144.90,,,,,,,41.86,156.17,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,inpatient,,,234.00000,75.58000,United Healthcare,Commercial,50,210.60,,,,,,,210.60,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY BI,3222338,CDM,361,RC,36005,CPT,,,facility,outpatient,,,234.00000,75.58000,United Healthcare,Commercial,50,210.60,,,,,,,60.84,226.98,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,inpatient,,,156.00000,50.39000,United Healthcare,Commercial,LT,140.40,,,,,,,140.40,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY LT,3222346,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,United Healthcare,Commercial,LT,140.40,,,,,,,40.56,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,inpatient,,,156.00000,50.39000,United Healthcare,Commercial,RT,140.40,,,,,,,140.40,151.32,percent of total billed charges,
INJ VENOGRAPHY EXTREMITY RT,3222353,CDM,361,RC,36005,CPT,,,facility,outpatient,,,156.00000,50.39000,United Healthcare,Commercial,RT,140.40,,,,,,,40.56,151.32,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1517.00000,489.99000,United Healthcare,Commercial,50,1365.30,,,,,,,1365.30,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGBI,3266970,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1517.00000,489.99000,United Healthcare,Commercial,50,1365.30,,,,,,,394.42,1471.49,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1011.00000,326.55000,United Healthcare,Commercial,LT,909.90,,,,,,,909.90,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGLT,3266988,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,United Healthcare,Commercial,LT,909.90,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,inpatient,,,1011.00000,326.55000,United Healthcare,Commercial,RT,909.90,,,,,,,909.90,980.67,percent of total billed charges,
INJ/S ANES NRV GENICULAR INCL IMGRT,3266996,CDM,361,RC,64454,CPT,,,facility,outpatient,,,1011.00000,326.55000,United Healthcare,Commercial,RT,909.90,,,,,,,262.86,980.67,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,inpatient,,,822.00000,265.51000,United Healthcare,Commercial,50,739.80,,,,,,,739.80,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS BI,3266863,CDM,361,RC,64425,CPT,,,facility,outpatient,,,822.00000,265.51000,United Healthcare,Commercial,50,739.80,,,,,,,213.72,797.34,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,inpatient,,,548.00000,177.00000,United Healthcare,Commercial,LT,493.20,,,,,,,493.20,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS LT,3266848,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,United Healthcare,Commercial,LT,493.20,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,inpatient,,,548.00000,177.00000,United Healthcare,Commercial,RT,493.20,,,,,,,493.20,531.56,percent of total billed charges,
INJ/S ANES NRV ILIOING ILIOHYGAS RT,3266855,CDM,361,RC,64425,CPT,,,facility,outpatient,,,548.00000,177.00000,United Healthcare,Commercial,RT,493.20,,,,,,,142.48,531.56,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,inpatient,,,2613.00000,844.00000,United Healthcare,Commercial,,2351.70,,,,,,,2351.70,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T W IMG,3204831,CDM,361,RC,62321,CPT,,,facility,outpatient,,,2613.00000,844.00000,United Healthcare,Commercial,,2351.70,,,,,,,679.38,2534.61,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,inpatient,,,903.00000,291.67000,United Healthcare,Commercial,,812.70,,,,,,,812.70,875.91,percent of total billed charges,
INJ/S EPID/SUB C/T WO IMG,3204823,CDM,361,RC,62320,CPT,,,facility,outpatient,,,903.00000,291.67000,United Healthcare,Commercial,,812.70,,,,,,,234.78,875.91,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,inpatient,,,1156.00000,373.39000,United Healthcare,Commercial,,1040.40,,,,,,,1040.40,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S W IMG,3204856,CDM,361,RC,62323,CPT,,,facility,outpatient,,,1156.00000,373.39000,United Healthcare,Commercial,,1040.40,,,,,,,300.56,1121.32,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,inpatient,,,677.00000,218.67000,United Healthcare,Commercial,,609.30,,,,,,,609.30,656.69,percent of total billed charges,
INJ/S EPID/SUB L/S WO IMG,3204849,CDM,361,RC,62322,CPT,,,facility,outpatient,,,677.00000,218.67000,United Healthcare,Commercial,,609.30,,,,,,,176.02,656.69,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1928.00000,622.74000,United Healthcare,Commercial,50,1735.20,,,,,,,1735.20,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL BI,3241734,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1928.00000,622.74000,United Healthcare,Commercial,50,1735.20,,,,,,,501.28,1870.16,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1285.00000,415.06000,United Healthcare,Commercial,LT,1156.50,,,,,,,1156.50,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL LT,3241742,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,United Healthcare,Commercial,LT,1156.50,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,inpatient,,,1285.00000,415.06000,United Healthcare,Commercial,RT,1156.50,,,,,,,1156.50,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 1 LVL RT,3241759,CDM,361,RC,64490,CPT,,,facility,outpatient,,,1285.00000,415.06000,United Healthcare,Commercial,RT,1156.50,,,,,,,334.10,1246.45,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,inpatient,,,812.00000,262.28000,United Healthcare,Commercial,50,730.80,,,,,,,730.80,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL BI,3241767,CDM,361,RC,64491,CPT,,,facility,outpatient,,,812.00000,262.28000,United Healthcare,Commercial,50,730.80,,,,,,,211.12,787.64,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,inpatient,,,541.00000,174.74000,United Healthcare,Commercial,LT,486.90,,,,,,,486.90,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL LT,3241775,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,United Healthcare,Commercial,LT,486.90,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,inpatient,,,541.00000,174.74000,United Healthcare,Commercial,RT,486.90,,,,,,,486.90,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 2 LVL RT,3241783,CDM,361,RC,64491,CPT,,,facility,outpatient,,,541.00000,174.74000,United Healthcare,Commercial,RT,486.90,,,,,,,140.66,524.77,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,inpatient,,,825.00000,266.48000,United Healthcare,Commercial,50,742.50,,,,,,,742.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL BI,3241791,CDM,361,RC,64492,CPT,,,facility,outpatient,,,825.00000,266.48000,United Healthcare,Commercial,50,742.50,,,,,,,214.50,800.25,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,inpatient,,,550.00000,177.65000,United Healthcare,Commercial,LT,495.00,,,,,,,495.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL LT,3241809,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,United Healthcare,Commercial,LT,495.00,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,inpatient,,,550.00000,177.65000,United Healthcare,Commercial,RT,495.00,,,,,,,495.00,533.50,percent of total billed charges,
INJ/S JT FCT C/T IMG 3+ LVL RT,3241817,CDM,361,RC,64492,CPT,,,facility,outpatient,,,550.00000,177.65000,United Healthcare,Commercial,RT,495.00,,,,,,,143.00,533.50,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,inpatient,,,3494.00000,1128.56000,United Healthcare,Commercial,50,3144.60,,,,,,,3144.60,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL BI,3241825,CDM,361,RC,64493,CPT,,,facility,outpatient,,,3494.00000,1128.56000,United Healthcare,Commercial,50,3144.60,,,,,,,908.44,3389.18,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2329.00000,752.27000,United Healthcare,Commercial,LT,2096.10,,,,,,,2096.10,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL LT,3241833,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,United Healthcare,Commercial,LT,2096.10,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,inpatient,,,2329.00000,752.27000,United Healthcare,Commercial,RT,2096.10,,,,,,,2096.10,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 1 LVL RT,3241841,CDM,361,RC,64493,CPT,,,facility,outpatient,,,2329.00000,752.27000,United Healthcare,Commercial,RT,2096.10,,,,,,,605.54,2259.13,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,inpatient,,,840.00000,271.32000,United Healthcare,Commercial,50,756.00,,,,,,,756.00,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL BI,3241858,CDM,361,RC,64494,CPT,,,facility,outpatient,,,840.00000,271.32000,United Healthcare,Commercial,50,756.00,,,,,,,218.40,814.80,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,inpatient,,,560.00000,180.88000,United Healthcare,Commercial,LT,504.00,,,,,,,504.00,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL LT,3241866,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,United Healthcare,Commercial,LT,504.00,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,inpatient,,,560.00000,180.88000,United Healthcare,Commercial,RT,504.00,,,,,,,504.00,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 2 LVL RT,3241874,CDM,361,RC,64494,CPT,,,facility,outpatient,,,560.00000,180.88000,United Healthcare,Commercial,RT,504.00,,,,,,,145.60,543.20,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,inpatient,,,792.00000,255.82000,United Healthcare,Commercial,50,712.80,,,,,,,712.80,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL BI,3241882,CDM,361,RC,64495,CPT,,,facility,outpatient,,,792.00000,255.82000,United Healthcare,Commercial,50,712.80,,,,,,,205.92,768.24,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,inpatient,,,528.00000,170.54000,United Healthcare,Commercial,LT,475.20,,,,,,,475.20,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL LT,3241890,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,United Healthcare,Commercial,LT,475.20,,,,,,,137.28,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,inpatient,,,528.00000,170.54000,United Healthcare,Commercial,RT,475.20,,,,,,,475.20,512.16,percent of total billed charges,
INJ/S JT FCT L/S IMG 3+ LVL RT,3241908,CDM,361,RC,64495,CPT,,,facility,outpatient,,,528.00000,170.54000,United Healthcare,Commercial,RT,475.20,,,,,,,137.28,512.16,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,inpatient,,,272.00000,87.86000,United Healthcare,Commercial,,244.80,,,,,,,244.80,263.84,percent of total billed charges,
PLC G-TUBE NASO/ORO PHYS W FL GD,3223773,CDM,361,RC,43752,CPT,,,facility,outpatient,,,272.00000,87.86000,United Healthcare,Commercial,,244.80,,,,,,,70.72,263.84,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,inpatient,,,1268.00000,409.56000,United Healthcare,Commercial,,1141.20,,,,,,,1141.20,1229.96,percent of total billed charges,
PUNCT C1-C2 W INJ,3228160,CDM,361,RC,61055,CPT,,,facility,outpatient,,,1268.00000,409.56000,United Healthcare,Commercial,,1141.20,,,,,,,329.68,1229.96,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,inpatient,,,896.00000,289.41000,United Healthcare,Commercial,,806.40,,,,,,,806.40,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC,3228186,CDM,361,RC,62270,CPT,,,facility,outpatient,,,896.00000,289.41000,United Healthcare,Commercial,,806.40,,,,,,,232.96,869.12,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,inpatient,,,884.00000,285.53000,United Healthcare,Commercial,,795.60,,,,,,,795.60,857.48,percent of total billed charges,
PUNCT LUMBAR DIAGNOSTIC W FL/CT GD,3266319,CDM,361,RC,62328,CPT,,,facility,outpatient,,,884.00000,285.53000,United Healthcare,Commercial,,795.60,,,,,,,229.84,857.48,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,inpatient,,,609.00000,326.42000,United Healthcare,Commercial,,548.10,,,,,,,548.10,590.73,percent of total billed charges,
STUDIES LENGTH BONE,3525375,CDM,320,RC,77073,CPT,,,facility,outpatient,,,609.00000,326.42000,United Healthcare,Commercial,,548.10,,,,,,,158.34,590.73,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,inpatient,,,966.00000,383.50000,United Healthcare,Commercial,,869.40,,,,,,,869.40,937.02,percent of total billed charges,
CT GD PLCMT NEEDLE S&I,3522216,CDM,350,RC,77012,CPT,,,facility,outpatient,,,966.00000,383.50000,United Healthcare,Commercial,,869.40,,,,,,,251.16,937.02,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,inpatient,,,872.00000,346.18000,United Healthcare,Commercial,,784.80,,,,,,,784.80,845.84,percent of total billed charges,
CT LTD/FOLLOWUP,3522182,CDM,350,RC,76380,CPT,,,facility,outpatient,,,872.00000,346.18000,United Healthcare,Commercial,,784.80,,,,,,,226.72,845.84,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,inpatient,,,492.00000,195.32000,United Healthcare,Commercial,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
CT REND 3D W I&R W PP DIFF WRKST,3530086,CDM,350,RC,76377,CPT,,,facility,outpatient,,,492.00000,195.32000,United Healthcare,Commercial,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,inpatient,,,331.00000,131.41000,United Healthcare,Commercial,,297.90,,,,,,,297.90,321.07,percent of total billed charges,
CT REND 3D W I&R W PP SAME WRKST,3530078,CDM,350,RC,76376,CPT,,,facility,outpatient,,,331.00000,131.41000,United Healthcare,Commercial,,297.90,,,,,,,86.06,321.07,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,inpatient,,,5215.00000,2070.36000,United Healthcare,Commercial,,4693.50,,,,,,,4693.50,5058.55,percent of total billed charges,
CTA AORTA ABD RUNOFF W CNT,3522307,CDM,350,RC,75635,CPT,,,facility,outpatient,,,5215.00000,2070.36000,United Healthcare,Commercial,,4693.50,,,,,,,1355.90,5058.55,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,inpatient,,,5422.00000,2152.53000,United Healthcare,Commercial,,4879.80,,,,,,,4879.80,5259.34,percent of total billed charges,
CTA HEAD&NECK W&WO CNT&PP,3534328,CDM,350,RC,70471,CPT,,,facility,outpatient,,,5422.00000,2152.53000,United Healthcare,Commercial,,4879.80,,,,,,,1409.72,5259.34,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,inpatient,,,1878.00000,788.76000,United Healthcare,Commercial,,1690.20,,,,,,,1690.20,1821.66,percent of total billed charges,
CT HEAD W CNT,3522687,CDM,351,RC,70460,CPT,,,facility,outpatient,,,1878.00000,788.76000,United Healthcare,Commercial,,1690.20,,,,,,,488.28,1821.66,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,inpatient,,,2253.00000,946.26000,United Healthcare,Commercial,,2027.70,,,,,,,2027.70,2185.41,percent of total billed charges,
CT HEAD W&WO CNT,3522703,CDM,351,RC,70470,CPT,,,facility,outpatient,,,2253.00000,946.26000,United Healthcare,Commercial,,2027.70,,,,,,,585.78,2185.41,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,inpatient,,,1502.00000,630.84000,United Healthcare,Commercial,,1351.80,,,,,,,1351.80,1456.94,percent of total billed charges,
CT HEAD WO CNT,3522695,CDM,351,RC,70450,CPT,,,facility,outpatient,,,1502.00000,630.84000,United Healthcare,Commercial,,1351.80,,,,,,,390.52,1456.94,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,inpatient,,,2024.00000,850.08000,United Healthcare,Commercial,,1821.60,,,,,,,1821.60,1963.28,percent of total billed charges,
CT MAXFACIAL W CNT,3522729,CDM,351,RC,70487,CPT,,,facility,outpatient,,,2024.00000,850.08000,United Healthcare,Commercial,,1821.60,,,,,,,526.24,1963.28,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,inpatient,,,2429.00000,1020.18000,United Healthcare,Commercial,,2186.10,,,,,,,2186.10,2356.13,percent of total billed charges,
CT MAXFACIAL W&WO CNT,3522737,CDM,351,RC,70488,CPT,,,facility,outpatient,,,2429.00000,1020.18000,United Healthcare,Commercial,,2186.10,,,,,,,631.54,2356.13,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,inpatient,,,1619.00000,679.98000,United Healthcare,Commercial,,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CT MAXFACIAL WO CNT,3522711,CDM,351,RC,70486,CPT,,,facility,outpatient,,,1619.00000,679.98000,United Healthcare,Commercial,,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,inpatient,,,2425.00000,1018.50000,United Healthcare,Commercial,,2182.50,,,,,,,2182.50,2352.25,percent of total billed charges,
CT NECK ST W CNT,3522745,CDM,351,RC,70491,CPT,,,facility,outpatient,,,2425.00000,1018.50000,United Healthcare,Commercial,,2182.50,,,,,,,630.50,2352.25,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,inpatient,,,2910.00000,1222.20000,United Healthcare,Commercial,,2619.00,,,,,,,2619.00,2822.70,percent of total billed charges,
CT NECK ST W&WO CNT,3522760,CDM,351,RC,70492,CPT,,,facility,outpatient,,,2910.00000,1222.20000,United Healthcare,Commercial,,2619.00,,,,,,,756.60,2822.70,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,inpatient,,,1940.00000,814.80000,United Healthcare,Commercial,,1746.00,,,,,,,1746.00,1881.80,percent of total billed charges,
CT NECK ST WO CNT,3522752,CDM,351,RC,70490,CPT,,,facility,outpatient,,,1940.00000,814.80000,United Healthcare,Commercial,,1746.00,,,,,,,504.40,1881.80,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,inpatient,,,2317.00000,973.14000,United Healthcare,Commercial,,2085.30,,,,,,,2085.30,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W CNT,3522778,CDM,351,RC,70481,CPT,,,facility,outpatient,,,2317.00000,973.14000,United Healthcare,Commercial,,2085.30,,,,,,,602.42,2247.49,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,inpatient,,,2780.00000,1167.60000,United Healthcare,Commercial,,2502.00,,,,,,,2502.00,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC W&WO CNT,3522794,CDM,351,RC,70482,CPT,,,facility,outpatient,,,2780.00000,1167.60000,United Healthcare,Commercial,,2502.00,,,,,,,722.80,2696.60,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,inpatient,,,1853.00000,778.26000,United Healthcare,Commercial,,1667.70,,,,,,,1667.70,1797.41,percent of total billed charges,
CT ORB/PF/SEL/IAC WO CNT,3522786,CDM,351,RC,70480,CPT,,,facility,outpatient,,,1853.00000,778.26000,United Healthcare,Commercial,,1667.70,,,,,,,481.78,1797.41,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,inpatient,,,2366.00000,993.72000,United Healthcare,Commercial,,2129.40,,,,,,,2129.40,2295.02,percent of total billed charges,
CTA HEAD W CNT&PP,3522810,CDM,351,RC,70496,CPT,,,facility,outpatient,,,2366.00000,993.72000,United Healthcare,Commercial,,2129.40,,,,,,,615.16,2295.02,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,inpatient,,,3056.00000,1283.52000,United Healthcare,Commercial,,2750.40,,,,,,,2750.40,2964.32,percent of total billed charges,
CTA NECK W CNT&PP,3522836,CDM,351,RC,70498,CPT,,,facility,outpatient,,,3056.00000,1283.52000,United Healthcare,Commercial,,2750.40,,,,,,,794.56,2964.32,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,inpatient,,,2829.00000,1386.21000,United Healthcare,Commercial,,2546.10,,,,,,,2546.10,2744.13,percent of total billed charges,
CT ABDOMEN W CNT,3522844,CDM,352,RC,74160,CPT,,,facility,outpatient,,,2829.00000,1386.21000,United Healthcare,Commercial,,2546.10,,,,,,,735.54,2744.13,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,inpatient,,,3395.00000,1663.55000,United Healthcare,Commercial,,3055.50,,,,,,,3055.50,3293.15,percent of total billed charges,
CT ABDOMEN W&WO CNT,3522869,CDM,352,RC,74170,CPT,,,facility,outpatient,,,3395.00000,1663.55000,United Healthcare,Commercial,,3055.50,,,,,,,882.70,3293.15,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,inpatient,,,2263.00000,1108.87000,United Healthcare,Commercial,,2036.70,,,,,,,2036.70,2195.11,percent of total billed charges,
CT ABDOMEN WO CNT,3522851,CDM,352,RC,74150,CPT,,,facility,outpatient,,,2263.00000,1108.87000,United Healthcare,Commercial,,2036.70,,,,,,,588.38,2195.11,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,inpatient,,,4697.00000,2301.53000,United Healthcare,Commercial,,4227.30,,,,,,,4227.30,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W CNT,3528965,CDM,352,RC,74177,CPT,,,facility,outpatient,,,4697.00000,2301.53000,United Healthcare,Commercial,,4227.30,,,,,,,1221.22,4556.09,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,inpatient,,,5636.00000,2761.64000,United Healthcare,Commercial,,5072.40,,,,,,,5072.40,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS W&WO CNT,3528973,CDM,352,RC,74178,CPT,,,facility,outpatient,,,5636.00000,2761.64000,United Healthcare,Commercial,,5072.40,,,,,,,1465.36,5466.92,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,inpatient,,,3757.00000,1840.93000,United Healthcare,Commercial,,3381.30,,,,,,,3381.30,3644.29,percent of total billed charges,
CT ABDOMEN&PELVIS WO CNT,3528957,CDM,352,RC,74176,CPT,,,facility,outpatient,,,3757.00000,1840.93000,United Healthcare,Commercial,,3381.30,,,,,,,976.82,3644.29,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,inpatient,,,2619.00000,1283.31000,United Healthcare,Commercial,,2357.10,,,,,,,2357.10,2540.43,percent of total billed charges,
CT CHEST DX W CNT,3522893,CDM,352,RC,71260,CPT,,,facility,outpatient,,,2619.00000,1283.31000,United Healthcare,Commercial,,2357.10,,,,,,,680.94,2540.43,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,inpatient,,,3143.00000,1540.07000,United Healthcare,Commercial,,2828.70,,,,,,,2828.70,3048.71,percent of total billed charges,
CT CHEST DX W&WO CNT,3522919,CDM,352,RC,71270,CPT,,,facility,outpatient,,,3143.00000,1540.07000,United Healthcare,Commercial,,2828.70,,,,,,,817.18,3048.71,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,inpatient,,,2095.00000,1026.55000,United Healthcare,Commercial,,1885.50,,,,,,,1885.50,2032.15,percent of total billed charges,
CT CHEST DX WO CNT,3522901,CDM,352,RC,71250,CPT,,,facility,outpatient,,,2095.00000,1026.55000,United Healthcare,Commercial,,1885.50,,,,,,,544.70,2032.15,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,inpatient,,,278.00000,136.22000,United Healthcare,Commercial,,250.20,,,,,,,250.20,269.66,percent of total billed charges,
CT DENSITY BONE AXIAL 1+ SITE,3522877,CDM,352,RC,77078,CPT,,,facility,outpatient,,,278.00000,136.22000,United Healthcare,Commercial,,250.20,,,,,,,72.28,269.66,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,inpatient,,,2110.00000,1033.90000,United Healthcare,Commercial,LT,1899.00,,,,,,,1899.00,2046.70,percent of total billed charges,
CT EXT LOWER W CNT LT,3522950,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,United Healthcare,Commercial,LT,1899.00,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,inpatient,,,2110.00000,1033.90000,United Healthcare,Commercial,RT,1899.00,,,,,,,1899.00,2046.70,percent of total billed charges,
CT EXT LOWER W CNT RT,3522968,CDM,352,RC,73701,CPT,,,facility,outpatient,,,2110.00000,1033.90000,United Healthcare,Commercial,RT,1899.00,,,,,,,548.60,2046.70,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2532.00000,1240.68000,United Healthcare,Commercial,LT,2278.80,,,,,,,2278.80,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT LT,3523024,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,United Healthcare,Commercial,LT,2278.80,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,inpatient,,,2532.00000,1240.68000,United Healthcare,Commercial,RT,2278.80,,,,,,,2278.80,2456.04,percent of total billed charges,
CT EXT LOWER W&WO CNT RT,3523032,CDM,352,RC,73702,CPT,,,facility,outpatient,,,2532.00000,1240.68000,United Healthcare,Commercial,RT,2278.80,,,,,,,658.32,2456.04,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1688.00000,827.12000,United Healthcare,Commercial,LT,1519.20,,,,,,,1519.20,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT LT,3522976,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,United Healthcare,Commercial,LT,1519.20,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,inpatient,,,1688.00000,827.12000,United Healthcare,Commercial,RT,1519.20,,,,,,,1519.20,1637.36,percent of total billed charges,
CT EXT LOWER WO CNT RT,3522984,CDM,352,RC,73700,CPT,,,facility,outpatient,,,1688.00000,827.12000,United Healthcare,Commercial,RT,1519.20,,,,,,,438.88,1637.36,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,inpatient,,,2024.00000,991.76000,United Healthcare,Commercial,LT,1821.60,,,,,,,1821.60,1963.28,percent of total billed charges,
CT EXT UPPER W CNT LT,3523156,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,United Healthcare,Commercial,LT,1821.60,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,inpatient,,,2024.00000,991.76000,United Healthcare,Commercial,RT,1821.60,,,,,,,1821.60,1963.28,percent of total billed charges,
CT EXT UPPER W CNT RT,3523164,CDM,352,RC,73201,CPT,,,facility,outpatient,,,2024.00000,991.76000,United Healthcare,Commercial,RT,1821.60,,,,,,,526.24,1963.28,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2429.00000,1190.21000,United Healthcare,Commercial,LT,2186.10,,,,,,,2186.10,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT LT,3523206,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,United Healthcare,Commercial,LT,2186.10,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,inpatient,,,2429.00000,1190.21000,United Healthcare,Commercial,RT,2186.10,,,,,,,2186.10,2356.13,percent of total billed charges,
CT EXT UPPER W&WO CNT RT,3523214,CDM,352,RC,73202,CPT,,,facility,outpatient,,,2429.00000,1190.21000,United Healthcare,Commercial,RT,2186.10,,,,,,,631.54,2356.13,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1619.00000,793.31000,United Healthcare,Commercial,LT,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT LT,3523180,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,United Healthcare,Commercial,LT,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,inpatient,,,1619.00000,793.31000,United Healthcare,Commercial,RT,1457.10,,,,,,,1457.10,1570.43,percent of total billed charges,
CT EXT UPPER WO CNT RT,3523198,CDM,352,RC,73200,CPT,,,facility,outpatient,,,1619.00000,793.31000,United Healthcare,Commercial,RT,1457.10,,,,,,,420.94,1570.43,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,inpatient,,,1224.00000,599.76000,United Healthcare,Commercial,,1101.60,,,,,,,1101.60,1187.28,percent of total billed charges,
CT LOW DOSE SCRN CA LUNG WO CNT,3532397,CDM,352,RC,71271,CPT,,,facility,outpatient,,,1224.00000,599.76000,United Healthcare,Commercial,,1101.60,,,,,,,318.24,1187.28,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,inpatient,,,3020.00000,1479.80000,United Healthcare,Commercial,,2718.00,,,,,,,2718.00,2929.40,percent of total billed charges,
CT PELVIS W CNT,3523073,CDM,352,RC,72193,CPT,,,facility,outpatient,,,3020.00000,1479.80000,United Healthcare,Commercial,,2718.00,,,,,,,785.20,2929.40,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,inpatient,,,3624.00000,1775.76000,United Healthcare,Commercial,,3261.60,,,,,,,3261.60,3515.28,percent of total billed charges,
CT PELVIS W&WO CNT,3523099,CDM,352,RC,72194,CPT,,,facility,outpatient,,,3624.00000,1775.76000,United Healthcare,Commercial,,3261.60,,,,,,,942.24,3515.28,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,inpatient,,,2416.00000,1183.84000,United Healthcare,Commercial,,2174.40,,,,,,,2174.40,2343.52,percent of total billed charges,
CT PELVIS WO CNT,3523081,CDM,352,RC,72192,CPT,,,facility,outpatient,,,2416.00000,1183.84000,United Healthcare,Commercial,,2174.40,,,,,,,628.16,2343.52,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,inpatient,,,2728.00000,1336.72000,United Healthcare,Commercial,,2455.20,,,,,,,2455.20,2646.16,percent of total billed charges,
CT SPINE CERVICAL W CNT,3522927,CDM,352,RC,72126,CPT,,,facility,outpatient,,,2728.00000,1336.72000,United Healthcare,Commercial,,2455.20,,,,,,,709.28,2646.16,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,inpatient,,,3273.00000,1603.77000,United Healthcare,Commercial,,2945.70,,,,,,,2945.70,3174.81,percent of total billed charges,
CT SPINE CERVICAL W&WO CNT,3522943,CDM,352,RC,72127,CPT,,,facility,outpatient,,,3273.00000,1603.77000,United Healthcare,Commercial,,2945.70,,,,,,,850.98,3174.81,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,inpatient,,,2182.00000,1069.18000,United Healthcare,Commercial,,1963.80,,,,,,,1963.80,2116.54,percent of total billed charges,
CT SPINE CERVICAL WO CNT,3522935,CDM,352,RC,72125,CPT,,,facility,outpatient,,,2182.00000,1069.18000,United Healthcare,Commercial,,1963.80,,,,,,,567.32,2116.54,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,inpatient,,,3133.00000,1535.17000,United Healthcare,Commercial,,2819.70,,,,,,,2819.70,3039.01,percent of total billed charges,
CT SPINE LUMBAR W CNT,3523040,CDM,352,RC,72132,CPT,,,facility,outpatient,,,3133.00000,1535.17000,United Healthcare,Commercial,,2819.70,,,,,,,814.58,3039.01,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,inpatient,,,3759.00000,1841.91000,United Healthcare,Commercial,,3383.10,,,,,,,3383.10,3646.23,percent of total billed charges,
CT SPINE LUMBAR W&WO CNT,3523065,CDM,352,RC,72133,CPT,,,facility,outpatient,,,3759.00000,1841.91000,United Healthcare,Commercial,,3383.10,,,,,,,977.34,3646.23,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,inpatient,,,2506.00000,1227.94000,United Healthcare,Commercial,,2255.40,,,,,,,2255.40,2430.82,percent of total billed charges,
CT SPINE LUMBAR WO CNT,3523057,CDM,352,RC,72131,CPT,,,facility,outpatient,,,2506.00000,1227.94000,United Healthcare,Commercial,,2255.40,,,,,,,651.56,2430.82,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,inpatient,,,2857.00000,1399.93000,United Healthcare,Commercial,,2571.30,,,,,,,2571.30,2771.29,percent of total billed charges,
CT SPINE THORACIC W CNT,3523107,CDM,352,RC,72129,CPT,,,facility,outpatient,,,2857.00000,1399.93000,United Healthcare,Commercial,,2571.30,,,,,,,742.82,2771.29,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,inpatient,,,3428.00000,1679.72000,United Healthcare,Commercial,,3085.20,,,,,,,3085.20,3325.16,percent of total billed charges,
CT SPINE THORACIC W&WO CNT,3523123,CDM,352,RC,72130,CPT,,,facility,outpatient,,,3428.00000,1679.72000,United Healthcare,Commercial,,3085.20,,,,,,,891.28,3325.16,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,inpatient,,,2285.00000,1119.65000,United Healthcare,Commercial,,2056.50,,,,,,,2056.50,2216.45,percent of total billed charges,
CT SPINE THORACIC WO CNT,3523115,CDM,352,RC,72128,CPT,,,facility,outpatient,,,2285.00000,1119.65000,United Healthcare,Commercial,,2056.50,,,,,,,594.10,2216.45,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,inpatient,,,3565.00000,1746.85000,United Healthcare,Commercial,,3208.50,,,,,,,3208.50,3458.05,percent of total billed charges,
CTA ABDOMEN W CNT&PP,3523230,CDM,352,RC,74175,CPT,,,facility,outpatient,,,3565.00000,1746.85000,United Healthcare,Commercial,,3208.50,,,,,,,926.90,3458.05,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,inpatient,,,5918.00000,2899.82000,United Healthcare,Commercial,,5326.20,,,,,,,5326.20,5740.46,percent of total billed charges,
CTA ABDOMEN&PELVIS W CNT&PP,3529542,CDM,352,RC,74174,CPT,,,facility,outpatient,,,5918.00000,2899.82000,United Healthcare,Commercial,,5326.20,,,,,,,1538.68,5740.46,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,inpatient,,,3301.00000,1617.49000,United Healthcare,Commercial,,2970.90,,,,,,,2970.90,3201.97,percent of total billed charges,
CTA CHEST W CNT&PP,3523255,CDM,352,RC,71275,CPT,,,facility,outpatient,,,3301.00000,1617.49000,United Healthcare,Commercial,,2970.90,,,,,,,858.26,3201.97,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2659.00000,1302.91000,United Healthcare,Commercial,LT,2393.10,,,,,,,2393.10,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP LT,3523289,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,United Healthcare,Commercial,LT,2393.10,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,inpatient,,,2659.00000,1302.91000,United Healthcare,Commercial,RT,2393.10,,,,,,,2393.10,2579.23,percent of total billed charges,
CTA EXT LOWER W CNT&PP RT,3523297,CDM,352,RC,73706,CPT,,,facility,outpatient,,,2659.00000,1302.91000,United Healthcare,Commercial,RT,2393.10,,,,,,,691.34,2579.23,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2551.00000,1249.99000,United Healthcare,Commercial,LT,2295.90,,,,,,,2295.90,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP LT,3523321,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,United Healthcare,Commercial,LT,2295.90,,,,,,,663.26,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,inpatient,,,2551.00000,1249.99000,United Healthcare,Commercial,RT,2295.90,,,,,,,2295.90,2474.47,percent of total billed charges,
CTA EXT UPPER W CNT&PP RT,3523339,CDM,352,RC,73206,CPT,,,facility,outpatient,,,2551.00000,1249.99000,United Healthcare,Commercial,RT,2295.90,,,,,,,663.26,2474.47,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,inpatient,,,3806.00000,1864.94000,United Healthcare,Commercial,,3425.40,,,,,,,3425.40,3691.82,percent of total billed charges,
CTA PELVIS W CNT&PP,3523313,CDM,352,RC,72191,CPT,,,facility,outpatient,,,3806.00000,1864.94000,United Healthcare,Commercial,,3425.40,,,,,,,989.56,3691.82,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,inpatient,,,2149.00000,694.13000,United Healthcare,Commercial,,1934.10,,,,,,,1934.10,2084.53,percent of total billed charges,
BX NEEDLE CORE LUNG/MEDSTRNM PERC,3532322,CDM,361,RC,32408,CPT,,,facility,outpatient,,,2149.00000,694.13000,United Healthcare,Commercial,,1934.10,,,,,,,558.74,2084.53,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,inpatient,,,1973.00000,637.28000,United Healthcare,Commercial,,1775.70,,,,,,,1775.70,1913.81,percent of total billed charges,
DRN CATH FLUID PERI PERC IMG GD,3530581,CDM,361,RC,49406,CPT,,,facility,outpatient,,,1973.00000,637.28000,United Healthcare,Commercial,,1775.70,,,,,,,512.98,1913.81,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1784.00000,576.23000,United Healthcare,Commercial,50,1605.60,,,,,,,1605.60,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG BI,3530201,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1784.00000,576.23000,United Healthcare,Commercial,50,1605.60,,,,,,,463.84,1730.48,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1189.00000,384.05000,United Healthcare,Commercial,LT,1070.10,,,,,,,1070.10,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG LT,3530185,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,United Healthcare,Commercial,LT,1070.10,,,,,,,309.14,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,inpatient,,,1189.00000,384.05000,United Healthcare,Commercial,RT,1070.10,,,,,,,1070.10,1153.33,percent of total billed charges,
DRN PLEURA INS CATH INDWL W IMG RT,3530193,CDM,361,RC,32557,CPT,,,facility,outpatient,,,1189.00000,384.05000,United Healthcare,Commercial,RT,1070.10,,,,,,,309.14,1153.33,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,inpatient,,,130.00000,69.68000,United Healthcare,Commercial,,117.00,,,,,,,117.00,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN EA ADD 30MIN,6113690,CDM,320,RC,76015,CPT,,,facility,outpatient,,,130.00000,69.68000,United Healthcare,Commercial,,117.00,,,,,,,33.80,126.10,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,inpatient,,,44.00000,23.58000,United Healthcare,Commercial,,39.60,,,,,,,39.60,42.68,percent of total billed charges,
MR ASSESS IMP&/FB CLIN INIT 15MIN,6113682,CDM,320,RC,76014,CPT,,,facility,outpatient,,,44.00000,23.58000,United Healthcare,Commercial,,39.60,,,,,,,11.44,42.68,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,inpatient,,,456.00000,244.42000,United Healthcare,Commercial,,410.40,,,,,,,410.40,442.32,percent of total billed charges,
MR CUST EXAM MED PHYSICS SAFETY PLN,6113716,CDM,320,RC,76017,CPT,,,facility,outpatient,,,456.00000,244.42000,United Healthcare,Commercial,,410.40,,,,,,,118.56,442.32,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,inpatient,,,108.00000,57.89000,United Healthcare,Commercial,,97.20,,,,,,,97.20,104.76,percent of total billed charges,
MR DETERMIN SAFETY PHYS/QHCP,6113708,CDM,320,RC,76016,CPT,,,facility,outpatient,,,108.00000,57.89000,United Healthcare,Commercial,,97.20,,,,,,,28.08,104.76,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,inpatient,,,306.00000,164.02000,United Healthcare,Commercial,,275.40,,,,,,,275.40,296.82,percent of total billed charges,
MR POS IMP SAFETY&/IMMOB PHYS/QHCP,6113732,CDM,320,RC,76019,CPT,,,facility,outpatient,,,306.00000,164.02000,United Healthcare,Commercial,,275.40,,,,,,,79.56,296.82,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,inpatient,,,257.00000,137.75000,United Healthcare,Commercial,,231.30,,,,,,,231.30,249.29,percent of total billed charges,
MR PREP ELECT IMP SAFETY PHYS/QHCP,6113724,CDM,320,RC,76018,CPT,,,facility,outpatient,,,257.00000,137.75000,United Healthcare,Commercial,,231.30,,,,,,,66.82,249.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4057.00000,2036.61000,United Healthcare,Commercial,,3651.30,,,,,,,3651.30,3935.29,percent of total billed charges,
MRCP W CNT,6111835,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,United Healthcare,Commercial,,3651.30,,,,,,,1054.82,3935.29,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4868.00000,2443.74000,United Healthcare,Commercial,,4381.20,,,,,,,4381.20,4721.96,percent of total billed charges,
MRCP W&WO CNT,6111843,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,United Healthcare,Commercial,,4381.20,,,,,,,1265.68,4721.96,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,inpatient,,,3245.00000,1628.99000,United Healthcare,Commercial,,2920.50,,,,,,,2920.50,3147.65,percent of total billed charges,
MRCP WO CNT,6111827,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,United Healthcare,Commercial,,2920.50,,,,,,,843.70,3147.65,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,inpatient,,,4057.00000,2036.61000,United Healthcare,Commercial,,3651.30,,,,,,,3651.30,3935.29,percent of total billed charges,
MRI ABDOMEN W CNT,6104137,CDM,610,RC,74182,CPT,,,facility,outpatient,,,4057.00000,2036.61000,United Healthcare,Commercial,,3651.30,,,,,,,1054.82,3935.29,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,inpatient,,,4868.00000,2443.74000,United Healthcare,Commercial,,4381.20,,,,,,,4381.20,4721.96,percent of total billed charges,
MRI ABDOMEN W&WO CNT,6104152,CDM,610,RC,74183,CPT,,,facility,outpatient,,,4868.00000,2443.74000,United Healthcare,Commercial,,4381.20,,,,,,,1265.68,4721.96,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,inpatient,,,3245.00000,1628.99000,United Healthcare,Commercial,,2920.50,,,,,,,2920.50,3147.65,percent of total billed charges,
MRI ABDOMEN WO CNT,6104145,CDM,610,RC,74181,CPT,,,facility,outpatient,,,3245.00000,1628.99000,United Healthcare,Commercial,,2920.50,,,,,,,843.70,3147.65,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,inpatient,,,1725.00000,865.95000,United Healthcare,Commercial,,1552.50,,,,,,,1552.50,1673.25,percent of total billed charges,
MRI BONE MARROW,6104160,CDM,610,RC,77084,CPT,,,facility,outpatient,,,1725.00000,865.95000,United Healthcare,Commercial,,1552.50,,,,,,,448.50,1673.25,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,inpatient,,,1743.00000,874.99000,United Healthcare,Commercial,,1568.70,,,,,,,1568.70,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT BI,6105712,CDM,610,RC,77049,CPT,,,facility,outpatient,,,1743.00000,874.99000,United Healthcare,Commercial,,1568.70,,,,,,,453.18,1690.71,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,inpatient,,,1475.00000,740.45000,United Healthcare,Commercial,LT,1327.50,,,,,,,1327.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT LT,6105696,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,United Healthcare,Commercial,LT,1327.50,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,inpatient,,,1475.00000,740.45000,United Healthcare,Commercial,RT,1327.50,,,,,,,1327.50,1430.75,percent of total billed charges,
MRI BREAST W&WO CNT RT,6105704,CDM,610,RC,77048,CPT,,,facility,outpatient,,,1475.00000,740.45000,United Healthcare,Commercial,RT,1327.50,,,,,,,383.50,1430.75,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,inpatient,,,1162.00000,583.32000,United Healthcare,Commercial,,1045.80,,,,,,,1045.80,1127.14,percent of total billed charges,
MRI BREAST WO CNT BI,6105688,CDM,610,RC,77047,CPT,,,facility,outpatient,,,1162.00000,583.32000,United Healthcare,Commercial,,1045.80,,,,,,,302.12,1127.14,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,inpatient,,,983.00000,493.47000,United Healthcare,Commercial,LT,884.70,,,,,,,884.70,953.51,percent of total billed charges,
MRI BREAST WO CNT LT,6105662,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,United Healthcare,Commercial,LT,884.70,,,,,,,255.58,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,inpatient,,,983.00000,493.47000,United Healthcare,Commercial,RT,884.70,,,,,,,884.70,953.51,percent of total billed charges,
MRI BREAST WO CNT RT,6105670,CDM,610,RC,77046,CPT,,,facility,outpatient,,,983.00000,493.47000,United Healthcare,Commercial,RT,884.70,,,,,,,255.58,953.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,inpatient,,,3183.00000,1597.87000,United Healthcare,Commercial,,2864.70,,,,,,,2864.70,3087.51,percent of total billed charges,
MRI CHEST W CNT,6104319,CDM,610,RC,71551,CPT,,,facility,outpatient,,,3183.00000,1597.87000,United Healthcare,Commercial,,2864.70,,,,,,,827.58,3087.51,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,inpatient,,,3819.00000,1917.14000,United Healthcare,Commercial,,3437.10,,,,,,,3437.10,3704.43,percent of total billed charges,
MRI CHEST W&WO CNT,6104335,CDM,610,RC,71552,CPT,,,facility,outpatient,,,3819.00000,1917.14000,United Healthcare,Commercial,,3437.10,,,,,,,992.94,3704.43,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,inpatient,,,2546.00000,1278.09000,United Healthcare,Commercial,,2291.40,,,,,,,2291.40,2469.62,percent of total billed charges,
MRI CHEST WO CNT,6104327,CDM,610,RC,71550,CPT,,,facility,outpatient,,,2546.00000,1278.09000,United Healthcare,Commercial,,2291.40,,,,,,,661.96,2469.62,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,inpatient,,,3858.00000,1936.72000,United Healthcare,Commercial,LT,3472.20,,,,,,,3472.20,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT LT,6104376,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,United Healthcare,Commercial,LT,3472.20,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,inpatient,,,3858.00000,1936.72000,United Healthcare,Commercial,RT,3472.20,,,,,,,3472.20,3742.26,percent of total billed charges,
MRI EXT LOWER JT W CNT RT,6104384,CDM,610,RC,73722,CPT,,,facility,outpatient,,,3858.00000,1936.72000,United Healthcare,Commercial,RT,3472.20,,,,,,,1003.08,3742.26,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,inpatient,,,4629.00000,2323.76000,United Healthcare,Commercial,LT,4166.10,,,,,,,4166.10,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT LT,6104434,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,United Healthcare,Commercial,LT,4166.10,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,inpatient,,,4629.00000,2323.76000,United Healthcare,Commercial,RT,4166.10,,,,,,,4166.10,4490.13,percent of total billed charges,
MRI EXT LOWER JT W&WO CNT RT,6104442,CDM,610,RC,73723,CPT,,,facility,outpatient,,,4629.00000,2323.76000,United Healthcare,Commercial,RT,4166.10,,,,,,,1203.54,4490.13,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,inpatient,,,3086.00000,1549.17000,United Healthcare,Commercial,LT,2777.40,,,,,,,2777.40,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT LT,6104400,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,United Healthcare,Commercial,LT,2777.40,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,inpatient,,,3086.00000,1549.17000,United Healthcare,Commercial,RT,2777.40,,,,,,,2777.40,2993.42,percent of total billed charges,
MRI EXT LOWER JT WO CNT RT,6104418,CDM,610,RC,73721,CPT,,,facility,outpatient,,,3086.00000,1549.17000,United Healthcare,Commercial,RT,2777.40,,,,,,,802.36,2993.42,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,inpatient,,,2505.00000,1257.51000,United Healthcare,Commercial,LT,2254.50,,,,,,,2254.50,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT LT,6104467,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,United Healthcare,Commercial,LT,2254.50,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,inpatient,,,2505.00000,1257.51000,United Healthcare,Commercial,RT,2254.50,,,,,,,2254.50,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W CNT RT,6104475,CDM,610,RC,73719,CPT,,,facility,outpatient,,,2505.00000,1257.51000,United Healthcare,Commercial,RT,2254.50,,,,,,,651.30,2429.85,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,inpatient,,,3006.00000,1509.01000,United Healthcare,Commercial,LT,2705.40,,,,,,,2705.40,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT LT,6104525,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,United Healthcare,Commercial,LT,2705.40,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,inpatient,,,3006.00000,1509.01000,United Healthcare,Commercial,RT,2705.40,,,,,,,2705.40,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT W&WO CNT RT,6104533,CDM,610,RC,73720,CPT,,,facility,outpatient,,,3006.00000,1509.01000,United Healthcare,Commercial,RT,2705.40,,,,,,,781.56,2915.82,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,inpatient,,,2004.00000,1006.01000,United Healthcare,Commercial,LT,1803.60,,,,,,,1803.60,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT LT,6104491,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,United Healthcare,Commercial,LT,1803.60,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,inpatient,,,2004.00000,1006.01000,United Healthcare,Commercial,RT,1803.60,,,,,,,1803.60,1943.88,percent of total billed charges,
MRI EXT LOWER NONJT WO CNT RT,6104509,CDM,610,RC,73718,CPT,,,facility,outpatient,,,2004.00000,1006.01000,United Healthcare,Commercial,RT,1803.60,,,,,,,521.04,1943.88,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,inpatient,,,3137.00000,1574.77000,United Healthcare,Commercial,LT,2823.30,,,,,,,2823.30,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT LT,6104616,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,United Healthcare,Commercial,LT,2823.30,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,inpatient,,,3137.00000,1574.77000,United Healthcare,Commercial,RT,2823.30,,,,,,,2823.30,3042.89,percent of total billed charges,
MRI EXT UPPER JT W CNT RT,6104624,CDM,610,RC,73222,CPT,,,facility,outpatient,,,3137.00000,1574.77000,United Healthcare,Commercial,RT,2823.30,,,,,,,815.62,3042.89,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,inpatient,,,3764.00000,1889.53000,United Healthcare,Commercial,LT,3387.60,,,,,,,3387.60,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT LT,6104673,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,United Healthcare,Commercial,LT,3387.60,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,inpatient,,,3764.00000,1889.53000,United Healthcare,Commercial,RT,3387.60,,,,,,,3387.60,3651.08,percent of total billed charges,
MRI EXT UPPER JT W&WO CNT RT,6104681,CDM,610,RC,73223,CPT,,,facility,outpatient,,,3764.00000,1889.53000,United Healthcare,Commercial,RT,3387.60,,,,,,,978.64,3651.08,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,inpatient,,,2509.00000,1259.52000,United Healthcare,Commercial,LT,2258.10,,,,,,,2258.10,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT LT,6104640,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,United Healthcare,Commercial,LT,2258.10,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,inpatient,,,2509.00000,1259.52000,United Healthcare,Commercial,RT,2258.10,,,,,,,2258.10,2433.73,percent of total billed charges,
MRI EXT UPPER JT WO CNT RT,6104657,CDM,610,RC,73221,CPT,,,facility,outpatient,,,2509.00000,1259.52000,United Healthcare,Commercial,RT,2258.10,,,,,,,652.34,2433.73,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,inpatient,,,3023.00000,1517.55000,United Healthcare,Commercial,LT,2720.70,,,,,,,2720.70,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT LT,6104731,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,United Healthcare,Commercial,LT,2720.70,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,inpatient,,,3023.00000,1517.55000,United Healthcare,Commercial,RT,2720.70,,,,,,,2720.70,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W CNT RT,6104749,CDM,610,RC,73219,CPT,,,facility,outpatient,,,3023.00000,1517.55000,United Healthcare,Commercial,RT,2720.70,,,,,,,785.98,2932.31,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,inpatient,,,3627.00000,1820.75000,United Healthcare,Commercial,LT,3264.30,,,,,,,3264.30,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT LT,6104707,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,United Healthcare,Commercial,LT,3264.30,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,inpatient,,,3627.00000,1820.75000,United Healthcare,Commercial,RT,3264.30,,,,,,,3264.30,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT W&WO CNT RT,6104715,CDM,610,RC,73220,CPT,,,facility,outpatient,,,3627.00000,1820.75000,United Healthcare,Commercial,RT,3264.30,,,,,,,943.02,3518.19,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,inpatient,,,2418.00000,1213.84000,United Healthcare,Commercial,LT,2176.20,,,,,,,2176.20,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT LT,6104764,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,United Healthcare,Commercial,LT,2176.20,,,,,,,628.68,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,inpatient,,,2418.00000,1213.84000,United Healthcare,Commercial,RT,2176.20,,,,,,,2176.20,2345.46,percent of total billed charges,
MRI EXT UPPER NONJT WO CNT RT,6105555,CDM,610,RC,73218,CPT,,,facility,outpatient,,,2418.00000,1213.84000,United Healthcare,Commercial,RT,2176.20,,,,,,,628.68,2345.46,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,inpatient,,,870.00000,436.74000,United Healthcare,Commercial,,783.00,,,,,,,783.00,843.90,percent of total billed charges,
MRI GD PLC NDL S&I,6104087,CDM,610,RC,77021,CPT,,,facility,outpatient,,,870.00000,436.74000,United Healthcare,Commercial,,783.00,,,,,,,226.20,843.90,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,inpatient,,,1353.00000,679.21000,United Healthcare,Commercial,,1217.70,,,,,,,1217.70,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR BI,6104574,CDM,610,RC,70336,CPT,,,facility,outpatient,,,1353.00000,679.21000,United Healthcare,Commercial,,1217.70,,,,,,,351.78,1312.41,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,inpatient,,,902.00000,452.80000,United Healthcare,Commercial,LT,811.80,,,,,,,811.80,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR LT,6104582,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,United Healthcare,Commercial,LT,811.80,,,,,,,234.52,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,inpatient,,,902.00000,452.80000,United Healthcare,Commercial,RT,811.80,,,,,,,811.80,874.94,percent of total billed charges,
MRI JOINT TEMPOROMANDIBULAR RT,6104590,CDM,610,RC,70336,CPT,,,facility,outpatient,,,902.00000,452.80000,United Healthcare,Commercial,RT,811.80,,,,,,,234.52,874.94,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,inpatient,,,3489.00000,1751.48000,United Healthcare,Commercial,,3140.10,,,,,,,3140.10,3384.33,percent of total billed charges,
MRI PELVIS W CNT,6104962,CDM,610,RC,72196,CPT,,,facility,outpatient,,,3489.00000,1751.48000,United Healthcare,Commercial,,3140.10,,,,,,,907.14,3384.33,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,inpatient,,,4187.00000,2101.87000,United Healthcare,Commercial,,3768.30,,,,,,,3768.30,4061.39,percent of total billed charges,
MRI PELVIS W&WO CNT,6104988,CDM,610,RC,72197,CPT,,,facility,outpatient,,,4187.00000,2101.87000,United Healthcare,Commercial,,3768.30,,,,,,,1088.62,4061.39,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,inpatient,,,2791.00000,1401.08000,United Healthcare,Commercial,,2511.90,,,,,,,2511.90,2707.27,percent of total billed charges,
MRI PELVIS WO CNT,6104970,CDM,610,RC,72195,CPT,,,facility,outpatient,,,2791.00000,1401.08000,United Healthcare,Commercial,,2511.90,,,,,,,725.66,2707.27,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,inpatient,,,492.00000,246.98000,United Healthcare,Commercial,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP DIFF WRKST,6114037,CDM,610,RC,76377,CPT,,,facility,outpatient,,,492.00000,246.98000,United Healthcare,Commercial,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,inpatient,,,331.00000,166.16000,United Healthcare,Commercial,,297.90,,,,,,,297.90,321.07,percent of total billed charges,
MRI REND 3D W I&R W PP SAME WRKST,6114029,CDM,610,RC,76376,CPT,,,facility,outpatient,,,331.00000,166.16000,United Healthcare,Commercial,,297.90,,,,,,,86.06,321.07,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,inpatient,,,4440.00000,2357.64000,United Healthcare,Commercial,,3996.00,,,,,,,3996.00,4306.80,percent of total billed charges,
MRI BRAIN W CNT,6104848,CDM,611,RC,70552,CPT,,,facility,outpatient,,,4440.00000,2357.64000,United Healthcare,Commercial,,3996.00,,,,,,,1154.40,4306.80,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,inpatient,,,5328.00000,2829.17000,United Healthcare,Commercial,,4795.20,,,,,,,4795.20,5168.16,percent of total billed charges,
MRI BRAIN W&WO CNT,6104863,CDM,611,RC,70553,CPT,,,facility,outpatient,,,5328.00000,2829.17000,United Healthcare,Commercial,,4795.20,,,,,,,1385.28,5168.16,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,inpatient,,,3552.00000,1886.11000,United Healthcare,Commercial,,3196.80,,,,,,,3196.80,3445.44,percent of total billed charges,
MRI BRAIN WO CNT,6104855,CDM,611,RC,70551,CPT,,,facility,outpatient,,,3552.00000,1886.11000,United Healthcare,Commercial,,3196.80,,,,,,,923.52,3445.44,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,inpatient,,,2528.00000,1342.37000,United Healthcare,Commercial,,2275.20,,,,,,,2275.20,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W CNT,6104889,CDM,611,RC,70542,CPT,,,facility,outpatient,,,2528.00000,1342.37000,United Healthcare,Commercial,,2275.20,,,,,,,657.28,2452.16,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,inpatient,,,3033.00000,1610.52000,United Healthcare,Commercial,,2729.70,,,,,,,2729.70,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK W&WO CNT,6104871,CDM,611,RC,70543,CPT,,,facility,outpatient,,,3033.00000,1610.52000,United Healthcare,Commercial,,2729.70,,,,,,,788.58,2942.01,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,inpatient,,,2022.00000,1073.68000,United Healthcare,Commercial,,1819.80,,,,,,,1819.80,1961.34,percent of total billed charges,
MRI ORBIT FACE&/NECK WO CNT,6104897,CDM,611,RC,70540,CPT,,,facility,outpatient,,,2022.00000,1073.68000,United Healthcare,Commercial,,1819.80,,,,,,,525.72,1961.34,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,inpatient,,,3610.00000,1909.69000,United Healthcare,Commercial,,3249.00,,,,,,,3249.00,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W CNT,6104905,CDM,612,RC,72142,CPT,,,facility,outpatient,,,3610.00000,1909.69000,United Healthcare,Commercial,,3249.00,,,,,,,938.60,3501.70,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,inpatient,,,4332.00000,2291.63000,United Healthcare,Commercial,,3898.80,,,,,,,3898.80,4202.04,percent of total billed charges,
MRI SPINE CERVICAL W&WO CNT,6104921,CDM,612,RC,72156,CPT,,,facility,outpatient,,,4332.00000,2291.63000,United Healthcare,Commercial,,3898.80,,,,,,,1126.32,4202.04,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,inpatient,,,2888.00000,1527.75000,United Healthcare,Commercial,,2599.20,,,,,,,2599.20,2801.36,percent of total billed charges,
MRI SPINE CERVICAL WO CNT,6104913,CDM,612,RC,72141,CPT,,,facility,outpatient,,,2888.00000,1527.75000,United Healthcare,Commercial,,2599.20,,,,,,,750.88,2801.36,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,inpatient,,,4532.00000,2397.43000,United Healthcare,Commercial,,4078.80,,,,,,,4078.80,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W CNT,6104939,CDM,612,RC,72149,CPT,,,facility,outpatient,,,4532.00000,2397.43000,United Healthcare,Commercial,,4078.80,,,,,,,1178.32,4396.04,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,inpatient,,,5438.00000,2876.70000,United Healthcare,Commercial,,4894.20,,,,,,,4894.20,5274.86,percent of total billed charges,
MRI SPINE LUMBAR W&WO CNT,6104954,CDM,612,RC,72158,CPT,,,facility,outpatient,,,5438.00000,2876.70000,United Healthcare,Commercial,,4894.20,,,,,,,1413.88,5274.86,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,inpatient,,,3625.00000,1917.62000,United Healthcare,Commercial,,3262.50,,,,,,,3262.50,3516.25,percent of total billed charges,
MRI SPINE LUMBAR WO CNT,6104947,CDM,612,RC,72148,CPT,,,facility,outpatient,,,3625.00000,1917.62000,United Healthcare,Commercial,,3262.50,,,,,,,942.50,3516.25,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,inpatient,,,3639.00000,1925.03000,United Healthcare,Commercial,,3275.10,,,,,,,3275.10,3529.83,percent of total billed charges,
MRI SPINE THORACIC W CNT,6104996,CDM,612,RC,72147,CPT,,,facility,outpatient,,,3639.00000,1925.03000,United Healthcare,Commercial,,3275.10,,,,,,,946.14,3529.83,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,inpatient,,,4367.00000,2310.14000,United Healthcare,Commercial,,3930.30,,,,,,,3930.30,4235.99,percent of total billed charges,
MRI SPINE THORACIC W&WO CNT,6105019,CDM,612,RC,72157,CPT,,,facility,outpatient,,,4367.00000,2310.14000,United Healthcare,Commercial,,3930.30,,,,,,,1135.42,4235.99,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,inpatient,,,2911.00000,1539.92000,United Healthcare,Commercial,,2619.90,,,,,,,2619.90,2823.67,percent of total billed charges,
MRI SPINE THORACIC WO CNT,6105001,CDM,612,RC,72146,CPT,,,facility,outpatient,,,2911.00000,1539.92000,United Healthcare,Commercial,,2619.90,,,,,,,756.86,2823.67,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,inpatient,,,3494.00000,1719.05000,United Healthcare,Commercial,,3144.60,,,,,,,3144.60,3389.18,percent of total billed charges,
MRA HEAD W CNT,6152003,CDM,615,RC,70545,CPT,,,facility,outpatient,,,3494.00000,1719.05000,United Healthcare,Commercial,,3144.60,,,,,,,908.44,3389.18,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,inpatient,,,4193.00000,2062.96000,United Healthcare,Commercial,,3773.70,,,,,,,3773.70,4067.21,percent of total billed charges,
MRA HEAD W&WO CNT,6152029,CDM,615,RC,70546,CPT,,,facility,outpatient,,,4193.00000,2062.96000,United Healthcare,Commercial,,3773.70,,,,,,,1090.18,4067.21,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,inpatient,,,2795.00000,1375.14000,United Healthcare,Commercial,,2515.50,,,,,,,2515.50,2711.15,percent of total billed charges,
MRA HEAD WO CNT,6152011,CDM,615,RC,70544,CPT,,,facility,outpatient,,,2795.00000,1375.14000,United Healthcare,Commercial,,2515.50,,,,,,,726.70,2711.15,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,inpatient,,,2717.00000,1336.76000,United Healthcare,Commercial,,2445.30,,,,,,,2445.30,2635.49,percent of total billed charges,
MRA NECK W CNT,6152276,CDM,615,RC,70548,CPT,,,facility,outpatient,,,2717.00000,1336.76000,United Healthcare,Commercial,,2445.30,,,,,,,706.42,2635.49,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,inpatient,,,3260.00000,1603.92000,United Healthcare,Commercial,,2934.00,,,,,,,2934.00,3162.20,percent of total billed charges,
MRA NECK W&WO CNT,6152292,CDM,615,RC,70549,CPT,,,facility,outpatient,,,3260.00000,1603.92000,United Healthcare,Commercial,,2934.00,,,,,,,847.60,3162.20,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,inpatient,,,2173.00000,1069.12000,United Healthcare,Commercial,,1955.70,,,,,,,1955.70,2107.81,percent of total billed charges,
MRA NECK WO CNT,6152284,CDM,615,RC,70547,CPT,,,facility,outpatient,,,2173.00000,1069.12000,United Healthcare,Commercial,,1955.70,,,,,,,564.98,2107.81,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4051.00000,2301.58000,United Healthcare,Commercial,LT,3645.90,,,,,,,3645.90,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT LT,6152037,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,United Healthcare,Commercial,LT,3645.90,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4051.00000,2301.58000,United Healthcare,Commercial,RT,3645.90,,,,,,,3645.90,3929.47,percent of total billed charges,
MRA EXT LOWER W CNT RT,6152045,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4051.00000,2301.58000,United Healthcare,Commercial,RT,3645.90,,,,,,,1053.26,3929.47,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4861.00000,2761.78000,United Healthcare,Commercial,LT,4374.90,,,,,,,4374.90,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT LT,6152078,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,United Healthcare,Commercial,LT,4374.90,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,inpatient,,,4861.00000,2761.78000,United Healthcare,Commercial,RT,4374.90,,,,,,,4374.90,4715.17,percent of total billed charges,
MRA EXT LOWER W/WO CNT RT,6152086,CDM,616,RC,73725,CPT,,,facility,outpatient,,,4861.00000,2761.78000,United Healthcare,Commercial,RT,4374.90,,,,,,,1263.86,4715.17,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3241.00000,1841.37000,United Healthcare,Commercial,LT,2916.90,,,,,,,2916.90,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT LT,6152052,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,United Healthcare,Commercial,LT,2916.90,,,,,,,842.66,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,inpatient,,,3241.00000,1841.37000,United Healthcare,Commercial,RT,2916.90,,,,,,,2916.90,3143.77,percent of total billed charges,
MRA EXT LOWER WO CNT RT,6152060,CDM,616,RC,73725,CPT,,,facility,outpatient,,,3241.00000,1841.37000,United Healthcare,Commercial,RT,2916.90,,,,,,,842.66,3143.77,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,inpatient,,,4260.00000,2420.32000,United Healthcare,Commercial,,3834.00,,,,,,,3834.00,4132.20,percent of total billed charges,
MRA ABDOMEN W CNT,6152094,CDM,618,RC,74185,CPT,,,facility,outpatient,,,4260.00000,2420.32000,United Healthcare,Commercial,,3834.00,,,,,,,1107.60,4132.20,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,inpatient,,,5112.00000,2904.38000,United Healthcare,Commercial,,4600.80,,,,,,,4600.80,4958.64,percent of total billed charges,
MRA ABDOMEN W/WO CNT,6152110,CDM,618,RC,74185,CPT,,,facility,outpatient,,,5112.00000,2904.38000,United Healthcare,Commercial,,4600.80,,,,,,,1329.12,4958.64,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,inpatient,,,3408.00000,1936.26000,United Healthcare,Commercial,,3067.20,,,,,,,3067.20,3305.76,percent of total billed charges,
MRA ABDOMEN WO CNT,6152102,CDM,618,RC,74185,CPT,,,facility,outpatient,,,3408.00000,1936.26000,United Healthcare,Commercial,,3067.20,,,,,,,886.08,3305.76,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,inpatient,,,3343.00000,1899.33000,United Healthcare,Commercial,,3008.70,,,,,,,3008.70,3242.71,percent of total billed charges,
MRA CHEST W CNT,6152128,CDM,618,RC,71555,CPT,,,facility,outpatient,,,3343.00000,1899.33000,United Healthcare,Commercial,,3008.70,,,,,,,869.18,3242.71,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,inpatient,,,4010.00000,2278.28000,United Healthcare,Commercial,,3609.00,,,,,,,3609.00,3889.70,percent of total billed charges,
MRA CHEST W/WO CNT,6152144,CDM,618,RC,71555,CPT,,,facility,outpatient,,,4010.00000,2278.28000,United Healthcare,Commercial,,3609.00,,,,,,,1042.60,3889.70,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,inpatient,,,2674.00000,1519.23000,United Healthcare,Commercial,,2406.60,,,,,,,2406.60,2593.78,percent of total billed charges,
MRA CHEST WO CNT,6152136,CDM,618,RC,71555,CPT,,,facility,outpatient,,,2674.00000,1519.23000,United Healthcare,Commercial,,2406.60,,,,,,,695.24,2593.78,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3294.00000,1871.49000,United Healthcare,Commercial,LT,2964.60,,,,,,,2964.60,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT LT,6152219,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,United Healthcare,Commercial,LT,2964.60,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3294.00000,1871.49000,United Healthcare,Commercial,RT,2964.60,,,,,,,2964.60,3195.18,percent of total billed charges,
MRA EXT UPPER W CNT RT,6152227,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3294.00000,1871.49000,United Healthcare,Commercial,RT,2964.60,,,,,,,856.44,3195.18,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3953.00000,2245.90000,United Healthcare,Commercial,LT,3557.70,,,,,,,3557.70,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT LT,6152250,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,United Healthcare,Commercial,LT,3557.70,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,inpatient,,,3953.00000,2245.90000,United Healthcare,Commercial,RT,3557.70,,,,,,,3557.70,3834.41,percent of total billed charges,
MRA EXT UPPER W/WO CNT RT,6152268,CDM,618,RC,73225,CPT,,,facility,outpatient,,,3953.00000,2245.90000,United Healthcare,Commercial,RT,3557.70,,,,,,,1027.78,3834.41,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,inpatient,,,2635.00000,1497.08000,United Healthcare,Commercial,LT,2371.50,,,,,,,2371.50,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT LT,6152235,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,United Healthcare,Commercial,LT,2371.50,,,,,,,685.10,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,inpatient,,,2635.00000,1497.08000,United Healthcare,Commercial,RT,2371.50,,,,,,,2371.50,2555.95,percent of total billed charges,
MRA EXT UPPER WO CNT RT,6152243,CDM,618,RC,73225,CPT,,,facility,outpatient,,,2635.00000,1497.08000,United Healthcare,Commercial,RT,2371.50,,,,,,,685.10,2555.95,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,inpatient,,,3664.00000,2081.70000,United Healthcare,Commercial,,3297.60,,,,,,,3297.60,3554.08,percent of total billed charges,
MRA PELVIS W CNT,6152151,CDM,618,RC,72198,CPT,,,facility,outpatient,,,3664.00000,2081.70000,United Healthcare,Commercial,,3297.60,,,,,,,952.64,3554.08,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,inpatient,,,4397.00000,2498.16000,United Healthcare,Commercial,,3957.30,,,,,,,3957.30,4265.09,percent of total billed charges,
MRA PELVIS W/WO CNT,6152177,CDM,618,RC,72198,CPT,,,facility,outpatient,,,4397.00000,2498.16000,United Healthcare,Commercial,,3957.30,,,,,,,1143.22,4265.09,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,inpatient,,,2931.00000,1665.25000,United Healthcare,Commercial,,2637.90,,,,,,,2637.90,2843.07,percent of total billed charges,
MRA PELVIS WO CNT,6152169,CDM,618,RC,72198,CPT,,,facility,outpatient,,,2931.00000,1665.25000,United Healthcare,Commercial,,2637.90,,,,,,,762.06,2843.07,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,inpatient,,,4759.00000,2703.83000,United Healthcare,Commercial,,4283.10,,,,,,,4283.10,4616.23,percent of total billed charges,
MRA SPINE W CNT,6152185,CDM,618,RC,72159,CPT,,,facility,outpatient,,,4759.00000,2703.83000,United Healthcare,Commercial,,4283.10,,,,,,,1237.34,4616.23,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,inpatient,,,5710.00000,3244.14000,United Healthcare,Commercial,,5139.00,,,,,,,5139.00,5538.70,percent of total billed charges,
MRA SPINE W/WO CNT,6152201,CDM,618,RC,72159,CPT,,,facility,outpatient,,,5710.00000,3244.14000,United Healthcare,Commercial,,5139.00,,,,,,,1484.60,5538.70,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,inpatient,,,3807.00000,2162.95000,United Healthcare,Commercial,,3426.30,,,,,,,3426.30,3692.79,percent of total billed charges,
MRA SPINE WO CNT,6152193,CDM,618,RC,72159,CPT,,,facility,outpatient,,,3807.00000,2162.95000,United Healthcare,Commercial,,3426.30,,,,,,,989.82,3692.79,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,inpatient,,,2915.00000,1574.10000,United Healthcare,Commercial,,2623.50,,,,,,,2623.50,2827.55,percent of total billed charges,
NM BONE&/JOINT BODY WHOLE,3411303,CDM,341,RC,78306,CPT,,,facility,outpatient,,,2915.00000,1574.10000,United Healthcare,Commercial,,2623.50,,,,,,,757.90,2827.55,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,inpatient,,,1918.00000,1035.72000,United Healthcare,Commercial,,1726.20,,,,,,,1726.20,1860.46,percent of total billed charges,
NM BONE&/JOINT LTD,3411246,CDM,341,RC,78300,CPT,,,facility,outpatient,,,1918.00000,1035.72000,United Healthcare,Commercial,,1726.20,,,,,,,498.68,1860.46,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,inpatient,,,2292.00000,1237.68000,United Healthcare,Commercial,,2062.80,,,,,,,2062.80,2223.24,percent of total billed charges,
NM BONE&/JOINT MULTIPLE,3411287,CDM,341,RC,78305,CPT,,,facility,outpatient,,,2292.00000,1237.68000,United Healthcare,Commercial,,2062.80,,,,,,,595.92,2223.24,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,inpatient,,,2984.00000,1611.36000,United Healthcare,Commercial,,2685.60,,,,,,,2685.60,2894.48,percent of total billed charges,
NM BONE&/JOINT PHASE 3,3411238,CDM,341,RC,78315,CPT,,,facility,outpatient,,,2984.00000,1611.36000,United Healthcare,Commercial,,2685.60,,,,,,,775.84,2894.48,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,inpatient,,,769.00000,415.26000,United Healthcare,Commercial,,692.10,,,,,,,692.10,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC,3413408,CDM,341,RC,78605,CPT,,,facility,outpatient,,,769.00000,415.26000,United Healthcare,Commercial,,692.10,,,,,,,199.94,745.93,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,inpatient,,,1280.00000,691.20000,United Healthcare,Commercial,,1152.00,,,,,,,1152.00,1241.60,percent of total billed charges,
NM BRAIN 4+ VW STATIC W FLOW,3413416,CDM,341,RC,78606,CPT,,,facility,outpatient,,,1280.00000,691.20000,United Healthcare,Commercial,,1152.00,,,,,,,332.80,1241.60,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,inpatient,,,1878.00000,1014.12000,United Healthcare,Commercial,,1690.20,,,,,,,1690.20,1821.66,percent of total billed charges,
NM DETECTION&LOC LEAK CSF,3411410,CDM,341,RC,78650,CPT,,,facility,outpatient,,,1878.00000,1014.12000,United Healthcare,Commercial,,1690.20,,,,,,,488.28,1821.66,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,inpatient,,,2196.00000,1185.84000,United Healthcare,Commercial,,1976.40,,,,,,,1976.40,2130.12,percent of total billed charges,
NM EMPTYING GASTRIC,3411469,CDM,341,RC,78264,CPT,,,facility,outpatient,,,2196.00000,1185.84000,United Healthcare,Commercial,,1976.40,,,,,,,570.96,2130.12,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,inpatient,,,844.00000,455.76000,United Healthcare,Commercial,,759.60,,,,,,,759.60,818.68,percent of total billed charges,
NM FLOW CSF CISTERNOGRAM,3411394,CDM,341,RC,78630,CPT,,,facility,outpatient,,,844.00000,455.76000,United Healthcare,Commercial,,759.60,,,,,,,219.44,818.68,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,inpatient,,,1305.00000,704.70000,United Healthcare,Commercial,,1174.50,,,,,,,1174.50,1265.85,percent of total billed charges,
NM FLOW CSF EVAL SHUNT,3411428,CDM,341,RC,78645,CPT,,,facility,outpatient,,,1305.00000,704.70000,United Healthcare,Commercial,,1174.50,,,,,,,339.30,1265.85,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,inpatient,,,576.00000,311.04000,United Healthcare,Commercial,,518.40,,,,,,,518.40,558.72,percent of total billed charges,
NM FLOW VASCULAR BRAIN,3411345,CDM,341,RC,78610,CPT,,,facility,outpatient,,,576.00000,311.04000,United Healthcare,Commercial,,518.40,,,,,,,149.76,558.72,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,inpatient,,,809.00000,436.86000,United Healthcare,Commercial,,728.10,,,,,,,728.10,784.73,percent of total billed charges,
NM FLOW VASCULAR NON-CARDIAC,3412962,CDM,341,RC,78445,CPT,,,facility,outpatient,,,809.00000,436.86000,United Healthcare,Commercial,,728.10,,,,,,,210.34,784.73,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,inpatient,,,2462.00000,1329.48000,United Healthcare,Commercial,,2215.80,,,,,,,2215.80,2388.14,percent of total billed charges,
NM HEPATOBILIARY W PHARM W/WO GB,3413804,CDM,341,RC,78227,CPT,,,facility,outpatient,,,2462.00000,1329.48000,United Healthcare,Commercial,,2215.80,,,,,,,640.12,2388.14,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,inpatient,,,918.00000,495.72000,United Healthcare,Commercial,,826.20,,,,,,,826.20,890.46,percent of total billed charges,
NM HEPATOBILIARY W/WO GB,3413796,CDM,341,RC,78226,CPT,,,facility,outpatient,,,918.00000,495.72000,United Healthcare,Commercial,,826.20,,,,,,,238.68,890.46,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,inpatient,,,1102.00000,595.08000,United Healthcare,Commercial,,991.80,,,,,,,991.80,1068.94,percent of total billed charges,
NM INTESTINE,3411691,CDM,341,RC,78290,CPT,,,facility,outpatient,,,1102.00000,595.08000,United Healthcare,Commercial,,991.80,,,,,,,286.52,1068.94,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,inpatient,,,812.00000,438.48000,United Healthcare,Commercial,,730.80,,,,,,,730.80,787.64,percent of total billed charges,
NM KIDNEY,3411931,CDM,341,RC,78700,CPT,,,facility,outpatient,,,812.00000,438.48000,United Healthcare,Commercial,,730.80,,,,,,,211.12,787.64,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,inpatient,,,1407.00000,759.78000,United Healthcare,Commercial,,1266.30,,,,,,,1266.30,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW,3411881,CDM,341,RC,78707,CPT,,,facility,outpatient,,,1407.00000,759.78000,United Healthcare,Commercial,,1266.30,,,,,,,365.82,1364.79,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,inpatient,,,1980.00000,1069.20000,United Healthcare,Commercial,,1782.00,,,,,,,1782.00,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM MULTI,3411899,CDM,341,RC,78709,CPT,,,facility,outpatient,,,1980.00000,1069.20000,United Healthcare,Commercial,,1782.00,,,,,,,514.80,1920.60,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,inpatient,,,964.00000,520.56000,United Healthcare,Commercial,,867.60,,,,,,,867.60,935.08,percent of total billed charges,
NM KIDNEY FUNCTION&FLOW PHARM SGL,3411907,CDM,341,RC,78708,CPT,,,facility,outpatient,,,964.00000,520.56000,United Healthcare,Commercial,,867.60,,,,,,,250.64,935.08,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,inpatient,,,1040.00000,561.60000,United Healthcare,Commercial,,936.00,,,,,,,936.00,1008.80,percent of total billed charges,
NM KIDNEY W FLOW VASCULAR,3411949,CDM,341,RC,78701,CPT,,,facility,outpatient,,,1040.00000,561.60000,United Healthcare,Commercial,,936.00,,,,,,,270.40,1008.80,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,inpatient,,,795.00000,429.30000,United Healthcare,Commercial,,715.50,,,,,,,715.50,771.15,percent of total billed charges,
NM LIVER STATIC,3411576,CDM,341,RC,78201,CPT,,,facility,outpatient,,,795.00000,429.30000,United Healthcare,Commercial,,715.50,,,,,,,206.70,771.15,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,inpatient,,,1124.00000,606.96000,United Healthcare,Commercial,,1011.60,,,,,,,1011.60,1090.28,percent of total billed charges,
NM LIVER W FLOW VASCULAR,3411584,CDM,341,RC,78202,CPT,,,facility,outpatient,,,1124.00000,606.96000,United Healthcare,Commercial,,1011.60,,,,,,,292.24,1090.28,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,inpatient,,,736.00000,397.44000,United Healthcare,Commercial,,662.40,,,,,,,662.40,713.92,percent of total billed charges,
NM LIVER&SPLEEN STATIC,3411592,CDM,341,RC,78215,CPT,,,facility,outpatient,,,736.00000,397.44000,United Healthcare,Commercial,,662.40,,,,,,,191.36,713.92,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,inpatient,,,700.00000,378.00000,United Healthcare,Commercial,,630.00,,,,,,,630.00,679.00,percent of total billed charges,
NM LIVER&SPLEEN W FLOW VASCULAR,3411600,CDM,341,RC,78216,CPT,,,facility,outpatient,,,700.00000,378.00000,United Healthcare,Commercial,,630.00,,,,,,,182.00,679.00,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,inpatient,,,821.00000,443.34000,United Healthcare,Commercial,,738.90,,,,,,,738.90,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 1 AREA 1D IMG,3414356,CDM,341,RC,78800,CPT,,,facility,outpatient,,,821.00000,443.34000,United Healthcare,Commercial,,738.90,,,,,,,213.46,796.37,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,inpatient,,,846.00000,456.84000,United Healthcare,Commercial,,761.40,,,,,,,761.40,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR 2+AREA 1+D IMG,3414364,CDM,341,RC,78801,CPT,,,facility,outpatient,,,846.00000,456.84000,United Healthcare,Commercial,,761.40,,,,,,,219.96,820.62,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,inpatient,,,958.00000,517.32000,United Healthcare,Commercial,,862.20,,,,,,,862.20,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 1D IMG,3412178,CDM,341,RC,78802,CPT,,,facility,outpatient,,,958.00000,517.32000,United Healthcare,Commercial,,862.20,,,,,,,249.08,929.26,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,inpatient,,,1261.00000,680.94000,United Healthcare,Commercial,,1134.90,,,,,,,1134.90,1223.17,percent of total billed charges,
NM LOC RRX TMR PLNR WHL BODY 2D IMG,3412160,CDM,341,RC,78804,CPT,,,facility,outpatient,,,1261.00000,680.94000,United Healthcare,Commercial,,1134.90,,,,,,,327.86,1223.17,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,inpatient,,,971.00000,524.34000,United Healthcare,Commercial,,873.90,,,,,,,873.90,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 1AREA 1ACQ 1D,3414372,CDM,341,RC,78803,CPT,,,facility,outpatient,,,971.00000,524.34000,United Healthcare,Commercial,,873.90,,,,,,,252.46,941.87,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,inpatient,,,1837.00000,991.98000,United Healthcare,Commercial,,1653.30,,,,,,,1653.30,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT 2+AREA 2ACQ,3414398,CDM,341,RC,78831,CPT,,,facility,outpatient,,,1837.00000,991.98000,United Healthcare,Commercial,,1653.30,,,,,,,477.62,1781.89,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,inpatient,,,1099.00000,593.46000,United Healthcare,Commercial,,989.10,,,,,,,989.10,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 1AREA 1ACQ,3414380,CDM,341,RC,78830,CPT,,,facility,outpatient,,,1099.00000,593.46000,United Healthcare,Commercial,,989.10,,,,,,,285.74,1066.03,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,inpatient,,,2178.00000,1176.12000,United Healthcare,Commercial,,1960.20,,,,,,,1960.20,2112.66,percent of total billed charges,
NM LOC RRX TMR SPECT CT 2+AREA 2ACQ,3414406,CDM,341,RC,78832,CPT,,,facility,outpatient,,,2178.00000,1176.12000,United Healthcare,Commercial,,1960.20,,,,,,,566.28,2112.66,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,inpatient,,,1226.00000,662.04000,United Healthcare,Commercial,,1103.40,,,,,,,1103.40,1189.22,percent of total billed charges,
NM LOSS BLOOD GI ACUTE,3411493,CDM,341,RC,78278,CPT,,,facility,outpatient,,,1226.00000,662.04000,United Healthcare,Commercial,,1103.40,,,,,,,318.76,1189.22,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,inpatient,,,1048.00000,565.92000,United Healthcare,Commercial,,943.20,,,,,,,943.20,1016.56,percent of total billed charges,
NM LYMPH SYSTEM,3411683,CDM,341,RC,78195,CPT,,,facility,outpatient,,,1048.00000,565.92000,United Healthcare,Commercial,,943.20,,,,,,,272.48,1016.56,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,inpatient,,,970.00000,523.80000,United Healthcare,Commercial,,873.00,,,,,,,873.00,940.90,percent of total billed charges,
NM MOTILITY ESOPHAGEAL,3411451,CDM,341,RC,78258,CPT,,,facility,outpatient,,,970.00000,523.80000,United Healthcare,Commercial,,873.00,,,,,,,252.20,940.90,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,inpatient,,,1803.00000,973.62000,United Healthcare,Commercial,,1622.70,,,,,,,1622.70,1748.91,percent of total billed charges,
NM MUGA REST W SPECT,3411725,CDM,341,RC,78494,CPT,,,facility,outpatient,,,1803.00000,973.62000,United Healthcare,Commercial,,1622.70,,,,,,,468.78,1748.91,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,inpatient,,,2504.00000,1352.16000,United Healthcare,Commercial,,2253.60,,,,,,,2253.60,2428.88,percent of total billed charges,
NM MUGA REST&STRESS MULTI,3411733,CDM,341,RC,78473,CPT,,,facility,outpatient,,,2504.00000,1352.16000,United Healthcare,Commercial,,2253.60,,,,,,,651.04,2428.88,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,inpatient,,,2457.00000,1326.78000,United Healthcare,Commercial,,2211.30,,,,,,,2211.30,2383.29,percent of total billed charges,
NM MUGA REST/STRESS PLANAR SGL,3411717,CDM,341,RC,78472,CPT,,,facility,outpatient,,,2457.00000,1326.78000,United Healthcare,Commercial,,2211.30,,,,,,,638.82,2383.29,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,inpatient,,,923.00000,498.42000,United Healthcare,Commercial,,830.70,,,,,,,830.70,895.31,percent of total billed charges,
NM PATENCY SHUNT PERITONEAL VENOUS,3411998,CDM,341,RC,78291,CPT,,,facility,outpatient,,,923.00000,498.42000,United Healthcare,Commercial,,830.70,,,,,,,239.98,895.31,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,inpatient,,,5478.00000,2958.12000,United Healthcare,Commercial,,4930.20,,,,,,,4930.20,5313.66,percent of total billed charges,
NM PERF MYOC SPEC WM/EF MULT,3413580,CDM,341,RC,78452,CPT,,,facility,outpatient,,,5478.00000,2958.12000,United Healthcare,Commercial,,4930.20,,,,,,,1424.28,5313.66,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,inpatient,,,4551.00000,2457.54000,United Healthcare,Commercial,,4095.90,,,,,,,4095.90,4414.47,percent of total billed charges,
NM PERF MYOC SPECT WM/EF SGL,3413572,CDM,341,RC,78451,CPT,,,facility,outpatient,,,4551.00000,2457.54000,United Healthcare,Commercial,,4095.90,,,,,,,1183.26,4414.47,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,inpatient,,,1360.00000,734.40000,United Healthcare,Commercial,,1224.00,,,,,,,1224.00,1319.20,percent of total billed charges,
NM PERF PULMONARY,3411626,CDM,341,RC,78580,CPT,,,facility,outpatient,,,1360.00000,734.40000,United Healthcare,Commercial,,1224.00,,,,,,,353.60,1319.20,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,inpatient,,,1209.00000,652.86000,United Healthcare,Commercial,,1088.10,,,,,,,1088.10,1172.73,percent of total billed charges,
NM PLANAR PARATHYROID,3413994,CDM,341,RC,78070,CPT,,,facility,outpatient,,,1209.00000,652.86000,United Healthcare,Commercial,,1088.10,,,,,,,314.34,1172.73,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,inpatient,,,848.00000,457.92000,United Healthcare,Commercial,,763.20,,,,,,,763.20,822.56,percent of total billed charges,
NM POOL BLOOD CARDIAC 1ST PASS SGL,3411360,CDM,341,RC,78481,CPT,,,facility,outpatient,,,848.00000,457.92000,United Healthcare,Commercial,,763.20,,,,,,,220.48,822.56,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,inpatient,,,1071.00000,578.34000,United Healthcare,Commercial,,963.90,,,,,,,963.90,1038.87,percent of total billed charges,
NM REFLEX URETERAL,3411436,CDM,341,RC,78740,CPT,,,facility,outpatient,,,1071.00000,578.34000,United Healthcare,Commercial,,963.90,,,,,,,278.46,1038.87,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,inpatient,,,1792.00000,967.68000,United Healthcare,Commercial,,1612.80,,,,,,,1612.80,1738.24,percent of total billed charges,
NM REFLUX GASTROESOPHAGEAL,3411485,CDM,341,RC,78262,CPT,,,facility,outpatient,,,1792.00000,967.68000,United Healthcare,Commercial,,1612.80,,,,,,,465.92,1738.24,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,inpatient,,,35.00000,18.90000,United Healthcare,Commercial,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ACQ,3412186,CDM,341,RC,78267,CPT,,,facility,outpatient,,,35.00000,18.90000,United Healthcare,Commercial,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,inpatient,,,285.00000,153.90000,United Healthcare,Commercial,,256.50,,,,,,,256.50,276.45,percent of total billed charges,
NM TEST BREATH UREA C14 ANALYSIS,3412194,CDM,341,RC,78268,CPT,,,facility,outpatient,,,285.00000,153.90000,United Healthcare,Commercial,,256.50,,,,,,,74.10,276.45,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,inpatient,,,1012.00000,546.48000,United Healthcare,Commercial,,910.80,,,,,,,910.80,981.64,percent of total billed charges,
NM TESTICULAR W FLOW VASCULAR,3412020,CDM,341,RC,78761,CPT,,,facility,outpatient,,,1012.00000,546.48000,United Healthcare,Commercial,,910.80,,,,,,,263.12,981.64,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,inpatient,,,492.00000,265.68000,United Healthcare,Commercial,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS QN SGL/MULT,3413960,CDM,341,RC,78012,CPT,,,facility,outpatient,,,492.00000,265.68000,United Healthcare,Commercial,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,inpatient,,,739.00000,399.06000,United Healthcare,Commercial,,665.10,,,,,,,665.10,716.83,percent of total billed charges,
NM THYROID UPTAKE MEAS W/WO FLW STM,3413986,CDM,341,RC,78014,CPT,,,facility,outpatient,,,739.00000,399.06000,United Healthcare,Commercial,,665.10,,,,,,,192.14,716.83,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,inpatient,,,515.00000,278.10000,United Healthcare,Commercial,,463.50,,,,,,,463.50,499.55,percent of total billed charges,
NM THYROID W/WO FLOW VASCULAR,3413978,CDM,341,RC,78013,CPT,,,facility,outpatient,,,515.00000,278.10000,United Healthcare,Commercial,,463.50,,,,,,,133.90,499.55,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,inpatient,,,1467.00000,792.18000,United Healthcare,Commercial,,1320.30,,,,,,,1320.30,1422.99,percent of total billed charges,
NM VENT&PERF PULMONARY,3413820,CDM,341,RC,78582,CPT,,,facility,outpatient,,,1467.00000,792.18000,United Healthcare,Commercial,,1320.30,,,,,,,381.42,1422.99,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,inpatient,,,1683.00000,888.62000,United Healthcare,Commercial,,1514.70,,,,,,,1514.70,1632.51,percent of total billed charges,
RRX BICISATE DX/0-25MCI DOSE,3413218,CDM,343,RC,A9557,HCPCS,,,facility,outpatient,,,1683.00000,888.62000,United Healthcare,Commercial,,1551.04,,,,,,,437.58,1632.51,fee schedule,
RRX DTPA AEROSOL DOSE 0-75MCI,3414067,CDM,343,RC,A9567,HCPCS,,,facility,inpatient,,,426.30000,225.09000,United Healthcare,Commercial,,383.67,,,,,,,383.67,413.51,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,inpatient,,,725.00000,382.80000,United Healthcare,Commercial,,652.50,,,,,,,652.50,703.25,percent of total billed charges,
RRX EXAMETAZIME DX/0-25MCI DOSE,3412863,CDM,343,RC,A9521,HCPCS,,,facility,outpatient,,,725.00000,382.80000,United Healthcare,Commercial,,1855.42,,,,,,,188.50,1855.42,fee schedule,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,inpatient,,,1852.00000,977.86000,United Healthcare,Commercial,,1666.80,,,,,,,1666.80,1796.44,percent of total billed charges,
RRX EXAMETAZIME WBC LABELED DX/DOSE,3413473,CDM,343,RC,A9569,HCPCS,,,facility,outpatient,,,1852.00000,977.86000,United Healthcare,Commercial,,1868.26,,,,,,,481.52,1868.26,fee schedule,
RRX I-123 IOD NA DX/100UCI <1MCI,3413457,CDM,343,RC,A9516,HCPCS,,,facility,inpatient,,,110.00000,58.08000,United Healthcare,Commercial,,99.00,,,,,,,99.00,106.70,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,inpatient,,,98.00000,51.74000,United Healthcare,Commercial,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
RRX INDIUM 111 OXYQ DX/0.5MCI,3412624,CDM,343,RC,A9547,HCPCS,,,facility,outpatient,,,98.00000,51.74000,United Healthcare,Commercial,,1662.92,,,,,,,25.48,1662.92,fee schedule,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,inpatient,,,2018.00000,1065.50000,United Healthcare,Commercial,,1816.20,,,,,,,1816.20,1957.46,percent of total billed charges,
RRX INDIUM 111 PENTETATE DX/0.5MCI,3412608,CDM,343,RC,A9548,HCPCS,,,facility,outpatient,,,2018.00000,1065.50000,United Healthcare,Commercial,,1491.24,,,,,,,524.68,1957.46,fee schedule,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,inpatient,,,4325.00000,2283.60000,United Healthcare,Commercial,,3892.50,,,,,,,3892.50,4195.25,percent of total billed charges,
RRX INDIUM-111 PENTET DX/0-6MCI,3413465,CDM,343,RC,A9572,HCPCS,,,facility,outpatient,,,4325.00000,2283.60000,United Healthcare,Commercial,,4001.88,,,,,,,1124.50,4195.25,fee schedule,
RRX MAA DX/0-10MCI DOSE,3413200,CDM,343,RC,A9540,HCPCS,,,facility,inpatient,,,172.00000,90.82000,United Healthcare,Commercial,,154.80,,,,,,,154.80,166.84,percent of total billed charges,
RRX MEBROFENIN DX/0-15MCI DOSE,3413168,CDM,343,RC,A9537,HCPCS,,,facility,inpatient,,,942.00000,497.38000,United Healthcare,Commercial,,847.80,,,,,,,847.80,913.74,percent of total billed charges,
RRX MERTIATIDE DX/0-15MCI DOSE,3413101,CDM,343,RC,A9562,HCPCS,,,facility,inpatient,,,413.00000,218.06000,United Healthcare,Commercial,,371.70,,,,,,,371.70,400.61,percent of total billed charges,
RRX PENTETATE DX/0-25MCI DOSE,3413184,CDM,343,RC,A9539,HCPCS,,,facility,inpatient,,,257.00000,135.70000,United Healthcare,Commercial,,231.30,,,,,,,231.30,249.29,percent of total billed charges,
RRX PERTECHNETATE DX/MCI,3412814,CDM,343,RC,A9512,HCPCS,,,facility,inpatient,,,116.00000,61.25000,United Healthcare,Commercial,,104.40,,,,,,,104.40,112.52,percent of total billed charges,
RRX PYROPHOSPHATE DX/0-25MCI DOSE,3413143,CDM,343,RC,A9538,HCPCS,,,facility,inpatient,,,463.20000,244.57000,United Healthcare,Commercial,,416.88,,,,,,,416.88,449.30,percent of total billed charges,
RRX RBC LABELED DX/0-30MCI DOSE,3413234,CDM,343,RC,A9560,HCPCS,,,facility,inpatient,,,804.00000,424.51000,United Healthcare,Commercial,,723.60,,,,,,,723.60,779.88,percent of total billed charges,
RRX SULFUR COLLOID DX/0-20MCI DOSE,3413226,CDM,343,RC,A9541,HCPCS,,,facility,inpatient,,,172.00000,90.82000,United Healthcare,Commercial,,154.80,,,,,,,154.80,166.84,percent of total billed charges,
RRX TC99 MEDRONATE/0-30MCI DOSE,3412434,CDM,343,RC,A9503,HCPCS,,,facility,inpatient,,,354.30000,187.07000,United Healthcare,Commercial,,318.87,,,,,,,318.87,343.67,percent of total billed charges,
RRX TC-99 SESTAMIBI DX/DOSE,3412707,CDM,343,RC,A9500,HCPCS,,,facility,inpatient,,,277.90000,146.73000,United Healthcare,Commercial,,250.11,,,,,,,250.11,269.56,percent of total billed charges,
RRX TETROFOSMIN DX/DOSE,3412657,CDM,343,RC,A9502,HCPCS,,,facility,inpatient,,,200.00000,105.60000,United Healthcare,Commercial,,180.00,,,,,,,180.00,194.00,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,inpatient,,,197.00000,63.63000,United Healthcare,Commercial,,177.30,,,,,,,177.30,191.09,percent of total billed charges,
INJ EVAL SHUNT PERITONEAL-VENOUS,3412921,CDM,361,RC,49427,CPT,,,facility,outpatient,,,197.00000,63.63000,United Healthcare,Commercial,,177.30,,,,,,,51.22,191.09,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,inpatient,,,468.00000,151.16000,United Healthcare,Commercial,50,421.20,,,,,,,421.20,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID BI,3413762,CDM,361,RC,38792,CPT,,,facility,outpatient,,,468.00000,151.16000,United Healthcare,Commercial,50,421.20,,,,,,,121.68,453.96,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,inpatient,,,312.00000,100.78000,United Healthcare,Commercial,LT,280.80,,,,,,,280.80,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID LT,3413770,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,United Healthcare,Commercial,LT,280.80,,,,,,,81.12,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,inpatient,,,312.00000,100.78000,United Healthcare,Commercial,RT,280.80,,,,,,,280.80,302.64,percent of total billed charges,
INJ RRX NODE SENTINEL ID RT,3413788,CDM,361,RC,38792,CPT,,,facility,outpatient,,,312.00000,100.78000,United Healthcare,Commercial,RT,280.80,,,,,,,81.12,302.64,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,United Healthcare,Commercial,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL INCMP TEST,3413721,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,United Healthcare,Commercial,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,inpatient,,,609.00000,196.71000,United Healthcare,Commercial,,548.10,,,,,,,548.10,590.73,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,4030029,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,United Healthcare,Commercial,,548.10,,,,,,,158.34,590.73,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,inpatient,,,1248.00000,403.10000,United Healthcare,Commercial,50,1123.20,,,,,,,1123.20,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD BI,4002226,CDM,361,RC,20611,CPT,,,facility,outpatient,,,1248.00000,403.10000,United Healthcare,Commercial,50,1123.20,,,,,,,324.48,1210.56,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,inpatient,,,832.00000,268.74000,United Healthcare,Commercial,LT,748.80,,,,,,,748.80,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD LT,4002234,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,United Healthcare,Commercial,LT,748.80,,,,,,,216.32,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,inpatient,,,832.00000,268.74000,United Healthcare,Commercial,RT,748.80,,,,,,,748.80,807.04,percent of total billed charges,
ASP&/INJ JT/BUR MAJ W US GD RT,4002242,CDM,361,RC,20611,CPT,,,facility,outpatient,,,832.00000,268.74000,United Healthcare,Commercial,RT,748.80,,,,,,,216.32,807.04,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,inpatient,,,4235.00000,1367.90000,United Healthcare,Commercial,LT,3811.50,,,,,,,3811.50,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST LT,4039707,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,United Healthcare,Commercial,LT,3811.50,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,inpatient,,,4235.00000,1367.90000,United Healthcare,Commercial,RT,3811.50,,,,,,,3811.50,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN 1ST RT,4039715,CDM,361,RC,19083,CPT,,,facility,outpatient,,,4235.00000,1367.90000,United Healthcare,Commercial,RT,3811.50,,,,,,,1101.10,4107.95,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,inpatient,,,2119.00000,684.44000,United Healthcare,Commercial,,1907.10,,,,,,,1907.10,2055.43,percent of total billed charges,
BX BRST W/WO DEV/IMG US LSN ADD,4039319,CDM,361,RC,19084,CPT,,,facility,outpatient,,,2119.00000,684.44000,United Healthcare,Commercial,,1907.10,,,,,,,550.94,2055.43,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,inpatient,,,1943.00000,627.59000,United Healthcare,Commercial,,1748.70,,,,,,,1748.70,1884.71,percent of total billed charges,
BX MUSCLE NDL PERC,4030409,CDM,361,RC,20206,CPT,,,facility,outpatient,,,1943.00000,627.59000,United Healthcare,Commercial,,1748.70,,,,,,,505.18,1884.71,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,inpatient,,,1426.00000,460.60000,United Healthcare,Commercial,,1283.40,,,,,,,1283.40,1383.22,percent of total billed charges,
BX THYROID NDL CORE PERC,4030474,CDM,361,RC,60100,CPT,,,facility,outpatient,,,1426.00000,460.60000,United Healthcare,Commercial,,1283.40,,,,,,,370.76,1383.22,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,inpatient,,,4202.00000,1357.25000,United Healthcare,Commercial,50,3781.80,,,,,,,3781.80,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL BI,4037222,CDM,361,RC,38505,CPT,,,facility,outpatient,,,4202.00000,1357.25000,United Healthcare,Commercial,50,3781.80,,,,,,,1092.52,4075.94,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,inpatient,,,2801.00000,904.72000,United Healthcare,Commercial,LT,2520.90,,,,,,,2520.90,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL LT,4037230,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,United Healthcare,Commercial,LT,2520.90,,,,,,,728.26,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,inpatient,,,2801.00000,904.72000,United Healthcare,Commercial,RT,2520.90,,,,,,,2520.90,2716.97,percent of total billed charges,
BX/EXCISE NODE NDL SUPERFICIAL RT,4037248,CDM,361,RC,38505,CPT,,,facility,outpatient,,,2801.00000,904.72000,United Healthcare,Commercial,RT,2520.90,,,,,,,728.26,2716.97,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,inpatient,,,832.00000,268.74000,United Healthcare,Commercial,,748.80,,,,,,,748.80,807.04,percent of total billed charges,
PARACENTESIS ABDOMINAL W IMG,4038618,CDM,361,RC,49083,CPT,,,facility,outpatient,,,832.00000,268.74000,United Healthcare,Commercial,,748.80,,,,,,,216.32,807.04,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,inpatient,,,1457.00000,470.61000,United Healthcare,Commercial,,1311.30,,,,,,,1311.30,1413.29,percent of total billed charges,
PERICARDIOCENTESIS INCL IMG GD,4040556,CDM,361,RC,33016,CPT,,,facility,outpatient,,,1457.00000,470.61000,United Healthcare,Commercial,,1311.30,,,,,,,378.82,1413.29,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,inpatient,,,743.00000,239.99000,United Healthcare,Commercial,LT,668.70,,,,,,,668.70,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST LT,4039624,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,United Healthcare,Commercial,LT,668.70,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,inpatient,,,743.00000,239.99000,United Healthcare,Commercial,RT,668.70,,,,,,,668.70,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN 1ST RT,4039632,CDM,361,RC,19285,CPT,,,facility,outpatient,,,743.00000,239.99000,United Healthcare,Commercial,RT,668.70,,,,,,,193.18,720.71,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,inpatient,,,232.00000,74.94000,United Healthcare,Commercial,,208.80,,,,,,,208.80,225.04,percent of total billed charges,
PLC DEV/S BRST US GD LSN ADD,4039350,CDM,361,RC,19286,CPT,,,facility,outpatient,,,232.00000,74.94000,United Healthcare,Commercial,,208.80,,,,,,,60.32,225.04,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,inpatient,,,1364.00000,440.57000,United Healthcare,Commercial,50,1227.60,,,,,,,1227.60,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG BI,4038857,CDM,361,RC,32555,CPT,,,facility,outpatient,,,1364.00000,440.57000,United Healthcare,Commercial,50,1227.60,,,,,,,354.64,1323.08,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,inpatient,,,909.00000,293.61000,United Healthcare,Commercial,LT,818.10,,,,,,,818.10,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG LT,4038832,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,United Healthcare,Commercial,LT,818.10,,,,,,,236.34,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,inpatient,,,909.00000,293.61000,United Healthcare,Commercial,RT,818.10,,,,,,,818.10,881.73,percent of total billed charges,
THORACENTESIS ASP W IMG RT,4038840,CDM,361,RC,32555,CPT,,,facility,outpatient,,,909.00000,293.61000,United Healthcare,Commercial,RT,818.10,,,,,,,236.34,881.73,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,inpatient,,,510.00000,355.98000,United Healthcare,Commercial,,459.00,,,,,,,459.00,494.70,percent of total billed charges,
SONOHYSTEROGRAPHY INF SALINE,4031191,CDM,402,RC,76831,CPT,,,facility,outpatient,,,510.00000,355.98000,United Healthcare,Commercial,,459.00,,,,,,,132.60,494.70,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,inpatient,,,1001.00000,698.70000,United Healthcare,Commercial,,900.90,,,,,,,900.90,970.97,percent of total billed charges,
US ABDOMEN CMP,4030854,CDM,402,RC,76700,CPT,,,facility,outpatient,,,1001.00000,698.70000,United Healthcare,Commercial,,900.90,,,,,,,260.26,970.97,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,inpatient,,,887.00000,619.13000,United Healthcare,Commercial,,798.30,,,,,,,798.30,860.39,percent of total billed charges,
US ABDOMEN LTD,4030862,CDM,402,RC,76705,CPT,,,facility,outpatient,,,887.00000,619.13000,United Healthcare,Commercial,,798.30,,,,,,,230.62,860.39,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,inpatient,,,1022.00000,713.36000,United Healthcare,Commercial,50,919.80,,,,,,,919.80,991.34,percent of total billed charges,
US BREAST CMP BI,4002416,CDM,402,RC,76641,CPT,,,facility,outpatient,,,1022.00000,713.36000,United Healthcare,Commercial,50,919.80,,,,,,,265.72,991.34,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,inpatient,,,681.00000,475.34000,United Healthcare,Commercial,LT,612.90,,,,,,,612.90,660.57,percent of total billed charges,
US BREAST CMP LT,4002069,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,United Healthcare,Commercial,LT,612.90,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,inpatient,,,681.00000,475.34000,United Healthcare,Commercial,RT,612.90,,,,,,,612.90,660.57,percent of total billed charges,
US BREAST CMP RT,4002077,CDM,402,RC,76641,CPT,,,facility,outpatient,,,681.00000,475.34000,United Healthcare,Commercial,RT,612.90,,,,,,,177.06,660.57,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,inpatient,,,945.00000,659.61000,United Healthcare,Commercial,50,850.50,,,,,,,850.50,916.65,percent of total billed charges,
US BREAST LTD BI,4002382,CDM,402,RC,76642,CPT,,,facility,outpatient,,,945.00000,659.61000,United Healthcare,Commercial,50,850.50,,,,,,,245.70,916.65,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,inpatient,,,630.00000,439.74000,United Healthcare,Commercial,LT,567.00,,,,,,,567.00,611.10,percent of total billed charges,
US BREAST LTD LT,4002085,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,United Healthcare,Commercial,LT,567.00,,,,,,,163.80,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,inpatient,,,630.00000,439.74000,United Healthcare,Commercial,RT,567.00,,,,,,,567.00,611.10,percent of total billed charges,
US BREAST LTD RT,4002093,CDM,402,RC,76642,CPT,,,facility,outpatient,,,630.00000,439.74000,United Healthcare,Commercial,RT,567.00,,,,,,,163.80,611.10,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,inpatient,,,577.00000,402.75000,United Healthcare,Commercial,,519.30,,,,,,,519.30,559.69,percent of total billed charges,
US CHEST,4030953,CDM,402,RC,76604,CPT,,,facility,outpatient,,,577.00000,402.75000,United Healthcare,Commercial,,519.30,,,,,,,150.02,559.69,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,inpatient,,,433.00000,302.23000,United Healthcare,Commercial,,389.70,,,,,,,389.70,420.01,percent of total billed charges,
US GD AMNIOCENTESIS S&I,4031100,CDM,402,RC,76946,CPT,,,facility,outpatient,,,433.00000,302.23000,United Healthcare,Commercial,,389.70,,,,,,,112.58,420.01,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,inpatient,,,331.00000,231.04000,United Healthcare,Commercial,,297.90,,,,,,,297.90,321.07,percent of total billed charges,
US GD INTRAOPERATIVE,4031092,CDM,402,RC,76998,CPT,,,facility,outpatient,,,331.00000,231.04000,United Healthcare,Commercial,,297.90,,,,,,,86.06,321.07,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,inpatient,,,662.00000,462.08000,United Healthcare,Commercial,,595.80,,,,,,,595.80,642.14,percent of total billed charges,
US GD PLCMT NEEDLE S&I,4031142,CDM,402,RC,76942,CPT,,,facility,outpatient,,,662.00000,462.08000,United Healthcare,Commercial,,595.80,,,,,,,172.12,642.14,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,inpatient,,,752.00000,524.90000,United Healthcare,Commercial,,676.80,,,,,,,676.80,729.44,percent of total billed charges,
US GD RPR PSEUDOAN ART/FISTULA AV,4031399,CDM,402,RC,76936,CPT,,,facility,outpatient,,,752.00000,524.90000,United Healthcare,Commercial,,676.80,,,,,,,195.52,729.44,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,inpatient,,,182.00000,127.04000,United Healthcare,Commercial,,163.80,,,,,,,163.80,176.54,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4031084,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,United Healthcare,Commercial,,163.80,,,,,,,47.32,176.54,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,inpatient,,,420.00000,293.16000,United Healthcare,Commercial,,378.00,,,,,,,378.00,407.40,percent of total billed charges,
US HEAD NEONATAL,4031225,CDM,402,RC,76506,CPT,,,facility,outpatient,,,420.00000,293.16000,United Healthcare,Commercial,,378.00,,,,,,,109.20,407.40,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,inpatient,,,253.00000,176.59000,United Healthcare,Commercial,,227.70,,,,,,,227.70,245.41,percent of total billed charges,
US HIPS INFANT DYNAMIC,4031175,CDM,402,RC,76885,CPT,,,facility,outpatient,,,253.00000,176.59000,United Healthcare,Commercial,,227.70,,,,,,,65.78,245.41,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,inpatient,,,168.00000,117.26000,United Healthcare,Commercial,,151.20,,,,,,,151.20,162.96,percent of total billed charges,
US HIPS INFANT STATIC,4031183,CDM,402,RC,76886,CPT,,,facility,outpatient,,,168.00000,117.26000,United Healthcare,Commercial,,151.20,,,,,,,43.68,162.96,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,inpatient,,,695.00000,485.11000,United Healthcare,Commercial,,625.50,,,,,,,625.50,674.15,percent of total billed charges,
US JT/EVAL FOCAL EXT NONVASC LTD,4040069,CDM,402,RC,76882,CPT,,,facility,outpatient,,,695.00000,485.11000,United Healthcare,Commercial,,625.50,,,,,,,180.70,674.15,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,inpatient,,,474.00000,330.85000,United Healthcare,Commercial,,426.60,,,,,,,426.60,459.78,percent of total billed charges,
US KIDNEY TRANSPLANTED W DOPPLER,4035002,CDM,402,RC,76776,CPT,,,facility,outpatient,,,474.00000,330.85000,United Healthcare,Commercial,,426.60,,,,,,,123.24,459.78,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,inpatient,,,930.00000,649.14000,United Healthcare,Commercial,,837.00,,,,,,,837.00,902.10,percent of total billed charges,
US PELVIS NON OB CMP,4031332,CDM,402,RC,76856,CPT,,,facility,outpatient,,,930.00000,649.14000,United Healthcare,Commercial,,837.00,,,,,,,241.80,902.10,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,inpatient,,,786.00000,548.63000,United Healthcare,Commercial,,707.40,,,,,,,707.40,762.42,percent of total billed charges,
US PELVIS NON OB LTD,4031340,CDM,402,RC,76857,CPT,,,facility,outpatient,,,786.00000,548.63000,United Healthcare,Commercial,,707.40,,,,,,,204.36,762.42,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,inpatient,,,620.00000,432.76000,United Healthcare,Commercial,,558.00,,,,,,,558.00,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST,4030904,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,United Healthcare,Commercial,,558.00,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,inpatient,,,620.00000,432.76000,United Healthcare,Commercial,59,558.00,,,,,,,558.00,601.40,percent of total billed charges,
US PROFILE BIO FETAL W NST ADDL,4030870,CDM,402,RC,76818,CPT,,,facility,outpatient,,,620.00000,432.76000,United Healthcare,Commercial,59,558.00,,,,,,,161.20,601.40,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,inpatient,,,435.00000,303.63000,United Healthcare,Commercial,,391.50,,,,,,,391.50,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST,4030888,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,United Healthcare,Commercial,,391.50,,,,,,,113.10,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,inpatient,,,435.00000,303.63000,United Healthcare,Commercial,59,391.50,,,,,,,391.50,421.95,percent of total billed charges,
US PROFILE BIO FETAL WO NST ADDL,4030896,CDM,402,RC,76819,CPT,,,facility,outpatient,,,435.00000,303.63000,United Healthcare,Commercial,59,391.50,,,,,,,113.10,421.95,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,inpatient,,,492.00000,343.42000,United Healthcare,Commercial,,442.80,,,,,,,442.80,477.24,percent of total billed charges,
US REND 3D W I&R W PP DIFF WRKST,4038873,CDM,402,RC,76377,CPT,,,facility,outpatient,,,492.00000,343.42000,United Healthcare,Commercial,,442.80,,,,,,,127.92,477.24,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,inpatient,,,331.00000,231.04000,United Healthcare,Commercial,,297.90,,,,,,,297.90,321.07,percent of total billed charges,
US REND 3D W I&R W PP SAME WRKST,4038865,CDM,402,RC,76376,CPT,,,facility,outpatient,,,331.00000,231.04000,United Healthcare,Commercial,,297.90,,,,,,,86.06,321.07,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,inpatient,,,875.00000,610.75000,United Healthcare,Commercial,,787.50,,,,,,,787.50,848.75,percent of total billed charges,
US RETROPERITONEAL CMP,4031415,CDM,402,RC,76770,CPT,,,facility,outpatient,,,875.00000,610.75000,United Healthcare,Commercial,,787.50,,,,,,,227.50,848.75,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,inpatient,,,688.00000,480.22000,United Healthcare,Commercial,,619.20,,,,,,,619.20,667.36,percent of total billed charges,
US RETROPERITONEAL LTD,4031407,CDM,402,RC,76775,CPT,,,facility,outpatient,,,688.00000,480.22000,United Healthcare,Commercial,,619.20,,,,,,,178.88,667.36,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,inpatient,,,465.00000,324.57000,United Healthcare,Commercial,,418.50,,,,,,,418.50,451.05,percent of total billed charges,
US SCREEN AAA,4035010,CDM,402,RC,76706,CPT,,,facility,outpatient,,,465.00000,324.57000,United Healthcare,Commercial,,418.50,,,,,,,120.90,451.05,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,inpatient,,,846.00000,590.51000,United Healthcare,Commercial,,761.40,,,,,,,761.40,820.62,percent of total billed charges,
US SCROTUM&CONTENTS,4031423,CDM,402,RC,76870,CPT,,,facility,outpatient,,,846.00000,590.51000,United Healthcare,Commercial,,761.40,,,,,,,219.96,820.62,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,inpatient,,,482.00000,336.44000,United Healthcare,Commercial,,433.80,,,,,,,433.80,467.54,percent of total billed charges,
US SPINAL CANAL&CONTENTS,4031449,CDM,402,RC,76800,CPT,,,facility,outpatient,,,482.00000,336.44000,United Healthcare,Commercial,,433.80,,,,,,,125.32,467.54,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,inpatient,,,926.00000,646.35000,United Healthcare,Commercial,,833.40,,,,,,,833.40,898.22,percent of total billed charges,
US TISSUE SOFT HEAD&NECK,4031431,CDM,402,RC,76536,CPT,,,facility,outpatient,,,926.00000,646.35000,United Healthcare,Commercial,,833.40,,,,,,,240.76,898.22,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,inpatient,,,292.00000,203.82000,United Healthcare,Commercial,,262.80,,,,,,,262.80,283.24,percent of total billed charges,
US TRANSRECTAL,4031464,CDM,402,RC,76872,CPT,,,facility,outpatient,,,292.00000,203.82000,United Healthcare,Commercial,,262.80,,,,,,,75.92,283.24,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,inpatient,,,827.00000,577.25000,United Healthcare,Commercial,,744.30,,,,,,,744.30,802.19,percent of total billed charges,
US TRANSVAGINAL,4031472,CDM,402,RC,76830,CPT,,,facility,outpatient,,,827.00000,577.25000,United Healthcare,Commercial,,744.30,,,,,,,215.02,802.19,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,inpatient,,,253.00000,176.59000,United Healthcare,Commercial,,227.70,,,,,,,227.70,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST ADDL,4031241,CDM,402,RC,76802,CPT,,,facility,outpatient,,,253.00000,176.59000,United Healthcare,Commercial,,227.70,,,,,,,65.78,245.41,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,inpatient,,,901.00000,628.90000,United Healthcare,Commercial,,810.90,,,,,,,810.90,873.97,percent of total billed charges,
US UTERUS PREG 0-13WK GEST SGL,4031258,CDM,402,RC,76801,CPT,,,facility,outpatient,,,901.00000,628.90000,United Healthcare,Commercial,,810.90,,,,,,,234.26,873.97,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,inpatient,,,460.00000,321.08000,United Healthcare,Commercial,,414.00,,,,,,,414.00,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST ADDL,4031266,CDM,402,RC,76810,CPT,,,facility,outpatient,,,460.00000,321.08000,United Healthcare,Commercial,,414.00,,,,,,,119.60,446.20,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,inpatient,,,1029.00000,718.24000,United Healthcare,Commercial,,926.10,,,,,,,926.10,998.13,percent of total billed charges,
US UTERUS PREG 14+WK GEST SGL,4031274,CDM,402,RC,76805,CPT,,,facility,outpatient,,,1029.00000,718.24000,United Healthcare,Commercial,,926.10,,,,,,,267.54,998.13,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,inpatient,,,959.00000,669.38000,United Healthcare,Commercial,,863.10,,,,,,,863.10,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST ADDL,4030847,CDM,402,RC,76812,CPT,,,facility,outpatient,,,959.00000,669.38000,United Healthcare,Commercial,,863.10,,,,,,,249.34,930.23,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,inpatient,,,558.00000,389.48000,United Healthcare,Commercial,,502.20,,,,,,,502.20,541.26,percent of total billed charges,
US UTERUS PREG DETAIL GEST SGL,4031282,CDM,402,RC,76811,CPT,,,facility,outpatient,,,558.00000,389.48000,United Healthcare,Commercial,,502.20,,,,,,,145.08,541.26,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,inpatient,,,705.00000,492.09000,United Healthcare,Commercial,,634.50,,,,,,,634.50,683.85,percent of total billed charges,
US UTERUS PREG LTD 1+ FETUS,4031316,CDM,402,RC,76815,CPT,,,facility,outpatient,,,705.00000,492.09000,United Healthcare,Commercial,,634.50,,,,,,,183.30,683.85,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,inpatient,,,249.00000,173.80000,United Healthcare,Commercial,,224.10,,,,,,,224.10,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST ADD,4035036,CDM,402,RC,76814,CPT,,,facility,outpatient,,,249.00000,173.80000,United Healthcare,Commercial,,224.10,,,,,,,64.74,241.53,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,inpatient,,,427.00000,298.05000,United Healthcare,Commercial,,384.30,,,,,,,384.30,414.19,percent of total billed charges,
US UTERUS PREG MEAS NUCHAL GEST SGL,4035028,CDM,402,RC,76813,CPT,,,facility,outpatient,,,427.00000,298.05000,United Healthcare,Commercial,,384.30,,,,,,,111.02,414.19,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,inpatient,,,737.00000,514.43000,United Healthcare,Commercial,,663.30,,,,,,,663.30,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS,4031290,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,United Healthcare,Commercial,,663.30,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,inpatient,,,737.00000,514.43000,United Healthcare,Commercial,59,663.30,,,,,,,663.30,714.89,percent of total billed charges,
US UTERUS PREG RE-EVAL FETUS ADDL,4031308,CDM,402,RC,76816,CPT,,,facility,outpatient,,,737.00000,514.43000,United Healthcare,Commercial,59,663.30,,,,,,,191.62,714.89,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,inpatient,,,809.00000,564.68000,United Healthcare,Commercial,,728.10,,,,,,,728.10,784.73,percent of total billed charges,
US UTERUS PREG TRANSVAGINAL,4031324,CDM,402,RC,76817,CPT,,,facility,outpatient,,,809.00000,564.68000,United Healthcare,Commercial,,728.10,,,,,,,210.34,784.73,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,inpatient,,,525.00000,366.45000,United Healthcare,Commercial,,472.50,,,,,,,472.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART CERE FETAL,4033452,CDM,402,RC,76821,CPT,,,facility,outpatient,,,525.00000,366.45000,United Healthcare,Commercial,,472.50,,,,,,,136.50,509.25,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,inpatient,,,319.00000,222.66000,United Healthcare,Commercial,,287.10,,,,,,,287.10,309.43,percent of total billed charges,
VELOCIMETRY DOPPLER ART UMB FETAL,4033445,CDM,402,RC,76820,CPT,,,facility,outpatient,,,319.00000,222.66000,United Healthcare,Commercial,,287.10,,,,,,,82.94,309.43,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,inpatient,,,1437.00000,678.26000,United Healthcare,Commercial,,1293.30,,,,,,,1293.30,1393.89,percent of total billed charges,
ECHO 2D CMP WO CNT,4033759,CDM,483,RC,93307,CPT,,,facility,outpatient,,,1437.00000,678.26000,United Healthcare,Commercial,,1293.30,,,,,,,373.62,1393.89,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,inpatient,,,2143.00000,1011.50000,United Healthcare,Commercial,,1928.70,,,,,,,1928.70,2078.71,percent of total billed charges,
ECHO 2D DOPP&CLR FLW CMP WO CNT,4036356,CDM,483,RC,93306,CPT,,,facility,outpatient,,,2143.00000,1011.50000,United Healthcare,Commercial,,1928.70,,,,,,,557.18,2078.71,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,inpatient,,,755.00000,356.36000,United Healthcare,Commercial,,679.50,,,,,,,679.50,732.35,percent of total billed charges,
ECHO 2D LTD WO CNT,4033767,CDM,483,RC,93308,CPT,,,facility,outpatient,,,755.00000,356.36000,United Healthcare,Commercial,,679.50,,,,,,,196.30,732.35,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,inpatient,,,979.00000,462.09000,United Healthcare,Commercial,,881.10,,,,,,,881.10,949.63,percent of total billed charges,
ECHO 2D REST&STRESS WO CNT W I&R,4033809,CDM,483,RC,93350,CPT,,,facility,outpatient,,,979.00000,462.09000,United Healthcare,Commercial,,881.10,,,,,,,254.54,949.63,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,inpatient,,,436.00000,205.79000,United Healthcare,Commercial,,392.40,,,,,,,392.40,422.92,percent of total billed charges,
ECHO DOPP CMP,4033783,CDM,483,RC,93320,CPT,,,facility,outpatient,,,436.00000,205.79000,United Healthcare,Commercial,,392.40,,,,,,,113.36,422.92,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,inpatient,,,220.00000,103.84000,United Healthcare,Commercial,,198.00,,,,,,,198.00,213.40,percent of total billed charges,
ECHO DOPP LTD,4033791,CDM,483,RC,93321,CPT,,,facility,outpatient,,,220.00000,103.84000,United Healthcare,Commercial,,198.00,,,,,,,57.20,213.40,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,inpatient,,,344.00000,162.37000,United Healthcare,Commercial,,309.60,,,,,,,309.60,333.68,percent of total billed charges,
ECHO DOPP MAP VELOCITY COLOR FLOW,4033775,CDM,483,RC,93325,CPT,,,facility,outpatient,,,344.00000,162.37000,United Healthcare,Commercial,,309.60,,,,,,,89.44,333.68,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,inpatient,,,818.00000,393.46000,United Healthcare,Commercial,,736.20,,,,,,,736.20,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD BI,4037792,CDM,921,RC,93922,CPT,,,facility,outpatient,,,818.00000,393.46000,United Healthcare,Commercial,,736.20,,,,,,,212.68,793.46,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,inpatient,,,545.00000,262.14000,United Healthcare,Commercial,52,490.50,,,,,,,490.50,528.65,percent of total billed charges,
ART PHYS 1-2 LEVEL LTD UNI,4037990,CDM,921,RC,93922,CPT,,,facility,outpatient,,,545.00000,262.14000,United Healthcare,Commercial,52,490.50,,,,,,,141.70,528.65,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,inpatient,,,1347.00000,647.91000,United Healthcare,Commercial,,1212.30,,,,,,,1212.30,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP BI,4037800,CDM,921,RC,93923,CPT,,,facility,outpatient,,,1347.00000,647.91000,United Healthcare,Commercial,,1212.30,,,,,,,350.22,1306.59,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,inpatient,,,898.00000,431.94000,United Healthcare,Commercial,52,808.20,,,,,,,808.20,871.06,percent of total billed charges,
ART PHYS 3+ LEVEL CMP UNI,4038006,CDM,921,RC,93923,CPT,,,facility,outpatient,,,898.00000,431.94000,United Healthcare,Commercial,52,808.20,,,,,,,233.48,871.06,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,inpatient,,,469.00000,225.59000,United Healthcare,Commercial,,422.10,,,,,,,422.10,454.93,percent of total billed charges,
US ART PHYS EXT LWR TREADMILL BI,4032488,CDM,921,RC,93924,CPT,,,facility,outpatient,,,469.00000,225.59000,United Healthcare,Commercial,,422.10,,,,,,,121.94,454.93,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,inpatient,,,1762.00000,847.52000,United Healthcare,Commercial,,1585.80,,,,,,,1585.80,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO CMP,4032520,CDM,921,RC,93975,CPT,,,facility,outpatient,,,1762.00000,847.52000,United Healthcare,Commercial,,1585.80,,,,,,,458.12,1709.14,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,inpatient,,,627.00000,301.59000,United Healthcare,Commercial,,564.30,,,,,,,564.30,608.19,percent of total billed charges,
US DUPLEX ABD/PEL/SCR&/RETRO LTD,4032538,CDM,921,RC,93976,CPT,,,facility,outpatient,,,627.00000,301.59000,United Healthcare,Commercial,,564.30,,,,,,,163.02,608.19,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,inpatient,,,590.00000,283.79000,United Healthcare,Commercial,,531.00,,,,,,,531.00,572.30,percent of total billed charges,
US DUPLEX AO/IVC/ILIAC/GRFT CMP,4032553,CDM,921,RC,93978,CPT,,,facility,outpatient,,,590.00000,283.79000,United Healthcare,Commercial,,531.00,,,,,,,153.40,572.30,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,inpatient,,,1550.00000,745.55000,United Healthcare,Commercial,,1395.00,,,,,,,1395.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR BI,4032447,CDM,921,RC,93925,CPT,,,facility,outpatient,,,1550.00000,745.55000,United Healthcare,Commercial,,1395.00,,,,,,,403.00,1503.50,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,inpatient,,,990.00000,476.19000,United Healthcare,Commercial,LT,891.00,,,,,,,891.00,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD LT,4032421,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,United Healthcare,Commercial,LT,891.00,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,inpatient,,,990.00000,476.19000,United Healthcare,Commercial,RT,891.00,,,,,,,891.00,960.30,percent of total billed charges,
US DUPLEX ART EXT LWR UNI/LTD RT,4032413,CDM,921,RC,93926,CPT,,,facility,outpatient,,,990.00000,476.19000,United Healthcare,Commercial,RT,891.00,,,,,,,257.40,960.30,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,inpatient,,,1402.00000,674.36000,United Healthcare,Commercial,,1261.80,,,,,,,1261.80,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR CMP BI,4032454,CDM,921,RC,93930,CPT,,,facility,outpatient,,,1402.00000,674.36000,United Healthcare,Commercial,,1261.80,,,,,,,364.52,1359.94,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,inpatient,,,980.00000,471.38000,United Healthcare,Commercial,LT,882.00,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD LT,4032405,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,United Healthcare,Commercial,LT,882.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,inpatient,,,980.00000,471.38000,United Healthcare,Commercial,RT,882.00,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX ART EXT UPR UNI/LTD RT,4032439,CDM,921,RC,93931,CPT,,,facility,outpatient,,,980.00000,471.38000,United Healthcare,Commercial,RT,882.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,inpatient,,,1661.00000,798.94000,United Healthcare,Commercial,,1494.90,,,,,,,1494.90,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL CMP BI,4032496,CDM,921,RC,93880,CPT,,,facility,outpatient,,,1661.00000,798.94000,United Healthcare,Commercial,,1494.90,,,,,,,431.86,1611.17,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,inpatient,,,980.00000,471.38000,United Healthcare,Commercial,,882.00,,,,,,,882.00,950.60,percent of total billed charges,
US DUPLEX EXTRACRANIAL UNI/LTD,4032504,CDM,921,RC,93882,CPT,,,facility,outpatient,,,980.00000,471.38000,United Healthcare,Commercial,,882.00,,,,,,,254.80,950.60,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,inpatient,,,1740.00000,836.94000,United Healthcare,Commercial,,1566.00,,,,,,,1566.00,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT CMP BI,4032587,CDM,921,RC,93970,CPT,,,facility,outpatient,,,1740.00000,836.94000,United Healthcare,Commercial,,1566.00,,,,,,,452.40,1687.80,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,inpatient,,,1168.00000,561.81000,United Healthcare,Commercial,,1051.20,,,,,,,1051.20,1132.96,percent of total billed charges,
US DUPLEX VEIN EXT LTD/UNI,4032595,CDM,921,RC,93971,CPT,,,facility,outpatient,,,1168.00000,561.81000,United Healthcare,Commercial,,1051.20,,,,,,,303.68,1132.96,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,inpatient,,,433.00000,232.09000,United Healthcare,Commercial,,389.70,,,,,,,389.70,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY MULTI S&I,4032132,CDM,320,RC,77054,CPT,,,facility,outpatient,,,433.00000,232.09000,United Healthcare,Commercial,,389.70,,,,,,,112.58,420.01,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,inpatient,,,388.00000,207.97000,United Healthcare,Commercial,LT,349.20,,,,,,,349.20,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL LTS&I,4032140,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,United Healthcare,Commercial,LT,349.20,,,,,,,100.88,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,inpatient,,,388.00000,207.97000,United Healthcare,Commercial,RT,349.20,,,,,,,349.20,376.36,percent of total billed charges,
DUCTO/GALACTOGRAM MAMMARY SGL RTS&I,4032157,CDM,320,RC,77053,CPT,,,facility,outpatient,,,388.00000,207.97000,United Healthcare,Commercial,RT,349.20,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,inpatient,,,388.00000,207.97000,United Healthcare,Commercial,,349.20,,,,,,,349.20,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL APPEND,4032124,CDM,320,RC,77081,CPT,,,facility,outpatient,,,388.00000,207.97000,United Healthcare,Commercial,,349.20,,,,,,,100.88,376.36,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,inpatient,,,604.00000,323.74000,United Healthcare,Commercial,,543.60,,,,,,,543.60,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX,4032116,CDM,320,RC,77080,CPT,,,facility,outpatient,,,604.00000,323.74000,United Healthcare,Commercial,,543.60,,,,,,,157.04,585.88,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,inpatient,,,667.00000,357.51000,United Healthcare,Commercial,,600.30,,,,,,,600.30,646.99,percent of total billed charges,
DXA STUDY DENSITY 1+SKEL AX FX VERT,3264363,CDM,320,RC,77085,CPT,,,facility,outpatient,,,667.00000,357.51000,United Healthcare,Commercial,,600.30,,,,,,,173.42,646.99,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,inpatient,,,176.00000,94.34000,United Healthcare,Commercial,,158.40,,,,,,,158.40,170.72,percent of total billed charges,
DXA VERTEBRAL FRACTURE ASSESSMENT,3262227,CDM,320,RC,77086,CPT,,,facility,outpatient,,,176.00000,94.34000,United Healthcare,Commercial,,158.40,,,,,,,45.76,170.72,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,inpatient,,,92.00000,29.72000,United Healthcare,Commercial,LT,82.80,,,,,,,82.80,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL LT,4031597,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,United Healthcare,Commercial,LT,82.80,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,inpatient,,,92.00000,29.72000,United Healthcare,Commercial,RT,82.80,,,,,,,82.80,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST ADDL RT,4031605,CDM,361,RC,19001,CPT,,,facility,outpatient,,,92.00000,29.72000,United Healthcare,Commercial,RT,82.80,,,,,,,23.92,89.24,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,inpatient,,,366.00000,118.22000,United Healthcare,Commercial,LT,329.40,,,,,,,329.40,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT LT,4031621,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,United Healthcare,Commercial,LT,329.40,,,,,,,95.16,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,inpatient,,,366.00000,118.22000,United Healthcare,Commercial,RT,329.40,,,,,,,329.40,355.02,percent of total billed charges,
ASP PUNCT CYST BREAST INIT RT,4031639,CDM,361,RC,19000,CPT,,,facility,outpatient,,,366.00000,118.22000,United Healthcare,Commercial,RT,329.40,,,,,,,95.16,355.02,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,inpatient,,,1117.00000,360.79000,United Healthcare,Commercial,LT,1005.30,,,,,,,1005.30,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST LT,4039681,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,United Healthcare,Commercial,LT,1005.30,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,inpatient,,,1117.00000,360.79000,United Healthcare,Commercial,RT,1005.30,,,,,,,1005.30,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN 1ST RT,4039699,CDM,361,RC,19081,CPT,,,facility,outpatient,,,1117.00000,360.79000,United Healthcare,Commercial,RT,1005.30,,,,,,,290.42,1083.49,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,inpatient,,,559.00000,180.56000,United Healthcare,Commercial,,503.10,,,,,,,503.10,542.23,percent of total billed charges,
BX BRST W/WO DEV/IMG SG LSN ADD,4039459,CDM,361,RC,19082,CPT,,,facility,outpatient,,,559.00000,180.56000,United Healthcare,Commercial,,503.10,,,,,,,145.34,542.23,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,inpatient,,,252.00000,81.40000,United Healthcare,Commercial,50,226.80,,,,,,,226.80,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY BI,4031860,CDM,361,RC,19030,CPT,,,facility,outpatient,,,252.00000,81.40000,United Healthcare,Commercial,50,226.80,,,,,,,65.52,244.44,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,inpatient,,,168.00000,54.26000,United Healthcare,Commercial,LT,151.20,,,,,,,151.20,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY LT,4031878,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,United Healthcare,Commercial,LT,151.20,,,,,,,43.68,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,inpatient,,,168.00000,54.26000,United Healthcare,Commercial,RT,151.20,,,,,,,151.20,162.96,percent of total billed charges,
INJ DUCTO/GALACTOGRAM MAMMARY RT,4031886,CDM,361,RC,19030,CPT,,,facility,outpatient,,,168.00000,54.26000,United Healthcare,Commercial,RT,151.20,,,,,,,43.68,162.96,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,inpatient,,,1148.00000,370.80000,United Healthcare,Commercial,LT,1033.20,,,,,,,1033.20,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST LT,4039582,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,United Healthcare,Commercial,LT,1033.20,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,inpatient,,,1148.00000,370.80000,United Healthcare,Commercial,RT,1033.20,,,,,,,1033.20,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN 1ST RT,4039590,CDM,361,RC,19281,CPT,,,facility,outpatient,,,1148.00000,370.80000,United Healthcare,Commercial,RT,1033.20,,,,,,,298.48,1113.56,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,inpatient,,,379.00000,122.42000,United Healthcare,Commercial,,341.10,,,,,,,341.10,367.63,percent of total billed charges,
PLC DEV/S BRST MAMMO GD LSN ADD,4039491,CDM,361,RC,19282,CPT,,,facility,outpatient,,,379.00000,122.42000,United Healthcare,Commercial,,341.10,,,,,,,98.54,367.63,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,inpatient,,,1015.00000,327.84000,United Healthcare,Commercial,,913.50,,,,,,,913.50,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN 1ST,3205564,CDM,361,RC,10035,CPT,,,facility,outpatient,,,1015.00000,327.84000,United Healthcare,Commercial,,913.50,,,,,,,263.90,984.55,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,inpatient,,,591.00000,190.89000,United Healthcare,Commercial,,531.90,,,,,,,531.90,573.27,percent of total billed charges,
PLC DEV/S LOC TIS SOFT PERC LSN ADD,3205572,CDM,361,RC,10036,CPT,,,facility,outpatient,,,591.00000,190.89000,United Healthcare,Commercial,,531.90,,,,,,,153.66,573.27,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,inpatient,,,271.00000,169.92000,United Healthcare,Commercial,,243.90,,,,,,,243.90,262.87,percent of total billed charges,
MAMMO DX W/WO CAD BI,3206521,CDM,401,RC,77066,CPT,,,facility,outpatient,,,271.00000,169.92000,United Healthcare,Commercial,,243.90,,,,,,,70.46,262.87,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,inpatient,,,211.00000,132.30000,United Healthcare,Commercial,LT,189.90,,,,,,,189.90,204.67,percent of total billed charges,
MAMMO DX W/WO CAD LT,3206505,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,United Healthcare,Commercial,LT,189.90,,,,,,,54.86,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,inpatient,,,211.00000,132.30000,United Healthcare,Commercial,RT,189.90,,,,,,,189.90,204.67,percent of total billed charges,
MAMMO DX W/WO CAD RT,3206513,CDM,401,RC,77065,CPT,,,facility,outpatient,,,211.00000,132.30000,United Healthcare,Commercial,RT,189.90,,,,,,,54.86,204.67,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,inpatient,,,59.00000,36.99000,United Healthcare,Commercial,,53.10,,,,,,,53.10,57.23,percent of total billed charges,
TOMOSYNTHESIS DX DIG BRST UNI/BI,3262235,CDM,401,RC,G0279,HCPCS,,,facility,outpatient,,,59.00000,36.99000,United Healthcare,Commercial,,53.10,,,,,,,15.34,57.23,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,inpatient,,,336.00000,219.74000,United Healthcare,Commercial,,302.40,,,,,,,302.40,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI,3206539,CDM,403,RC,77067,CPT,,,facility,outpatient,,,336.00000,219.74000,United Healthcare,Commercial,,302.40,,,,,,,87.36,325.92,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,inpatient,,,224.00000,146.50000,United Healthcare,Commercial,52,201.60,,,,,,,201.60,217.28,percent of total billed charges,
MAMMO SCRN W/WO CAD 2 VW BI RDC,3206976,CDM,403,RC,77067,CPT,,,facility,outpatient,,,224.00000,146.50000,United Healthcare,Commercial,52,201.60,,,,,,,58.24,217.28,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,inpatient,,,63.00000,41.20000,United Healthcare,Commercial,,56.70,,,,,,,56.70,61.11,percent of total billed charges,
TOMOSYNTHESIS SCRN DIG BRST BI,3263373,CDM,403,RC,77063,CPT,,,facility,outpatient,,,63.00000,41.20000,United Healthcare,Commercial,,56.70,,,,,,,16.38,61.11,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,United Healthcare,Commercial,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,7202526,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,United Healthcare,Commercial,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,United Healthcare,Commercial,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,7202534,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,United Healthcare,Commercial,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,United Healthcare,Commercial,,547.20,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,7202542,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,United Healthcare,Commercial,,547.20,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,United Healthcare,Commercial,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,7202559,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,United Healthcare,Commercial,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,United Healthcare,Commercial,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,7202575,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,United Healthcare,Commercial,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,United Healthcare,Commercial,,192.60,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7202567,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,United Healthcare,Commercial,,192.60,,,,,,,55.64,207.58,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,inpatient,,,609.00000,196.71000,United Healthcare,Commercial,,548.10,,,,,,,548.10,590.73,percent of total billed charges,
AMNIOCENTESIS DIAGNOSTIC,7201056,CDM,361,RC,59000,CPT,,,facility,outpatient,,,609.00000,196.71000,United Healthcare,Commercial,,548.10,,,,,,,158.34,590.73,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,inpatient,,,863.00000,278.75000,United Healthcare,Commercial,,776.70,,,,,,,776.70,837.11,percent of total billed charges,
INJ EPID PATCH BLOOD/CLOT,7201098,CDM,361,RC,62273,CPT,,,facility,outpatient,,,863.00000,278.75000,United Healthcare,Commercial,,776.70,,,,,,,224.38,837.11,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,inpatient,,,900.00000,605.70000,United Healthcare,Commercial,,810.00,,,,,,,810.00,873.00,percent of total billed charges,
EPIDURAL LABOR,7201221,CDM,370,RC,,,,,facility,outpatient,,,900.00000,605.70000,United Healthcare,Commercial,,810.00,,,,,,,234.00,873.00,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,inpatient,,,1940.00000,1102.21000,United Healthcare,Commercial,,1746.00,,,,,,,1746.00,1881.80,percent of total billed charges,
DELIVERY OF PLACENTA,7202328,CDM,720,RC,59414,CPT,,,facility,outpatient,,,1940.00000,1102.21000,United Healthcare,Commercial,,1746.00,,,,,,,504.40,1881.80,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,inpatient,,,422.00000,239.76000,United Healthcare,Commercial,,379.80,,,,,,,379.80,409.34,percent of total billed charges,
INS DILATOR CERVICAL,7201072,CDM,720,RC,59200,CPT,,,facility,outpatient,,,422.00000,239.76000,United Healthcare,Commercial,,379.80,,,,,,,109.72,409.34,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,inpatient,,,1430.00000,812.45000,United Healthcare,Commercial,,1287.00,,,,,,,1287.00,1387.10,percent of total billed charges,
RECOVERY WO DELIVERY VAGINAL,7201601,CDM,720,RC,,,,,facility,outpatient,,,1430.00000,812.45000,United Healthcare,Commercial,,1287.00,,,,,,,371.80,1387.10,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,inpatient,,,745.00000,423.27000,United Healthcare,Commercial,,670.50,,,,,,,670.50,722.65,percent of total billed charges,
VERSION CEPHALIC EXTERNAL,7201080,CDM,720,RC,59412,CPT,,,facility,outpatient,,,745.00000,423.27000,United Healthcare,Commercial,,670.50,,,,,,,193.70,722.65,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,inpatient,,,2655.00000,2487.74000,United Healthcare,Commercial,,2389.50,,,,,,,2389.50,2575.35,percent of total billed charges,
LABOR LEVEL 1 0-12HRS,7201429,CDM,721,RC,,,,,facility,outpatient,,,2655.00000,2487.74000,United Healthcare,Commercial,,2389.50,,,,,,,690.30,2575.35,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,inpatient,,,3990.00000,3738.63000,United Healthcare,Commercial,,3591.00,,,,,,,3591.00,3870.30,percent of total billed charges,
LABOR LEVEL 2 12+HRS,7201437,CDM,721,RC,,,,,facility,outpatient,,,3990.00000,3738.63000,United Healthcare,Commercial,,3591.00,,,,,,,1037.40,3870.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,inpatient,,,290.00000,271.73000,United Healthcare,Commercial,,261.00,,,,,,,261.00,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 1,7202476,CDM,721,RC,99211,CPT,,,facility,outpatient,,,290.00000,271.73000,United Healthcare,Commercial,,261.00,,,,,,,75.40,281.30,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,inpatient,,,735.00000,688.70000,United Healthcare,Commercial,,661.50,,,,,,,661.50,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 2,7202484,CDM,721,RC,99212,CPT,,,facility,outpatient,,,735.00000,688.70000,United Healthcare,Commercial,,661.50,,,,,,,191.10,712.95,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,inpatient,,,1475.00000,1382.08000,United Healthcare,Commercial,,1327.50,,,,,,,1327.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 3,7202492,CDM,721,RC,99213,CPT,,,facility,outpatient,,,1475.00000,1382.08000,United Healthcare,Commercial,,1327.50,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,inpatient,,,2275.00000,2131.68000,United Healthcare,Commercial,,2047.50,,,,,,,2047.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 4,7202500,CDM,721,RC,99214,CPT,,,facility,outpatient,,,2275.00000,2131.68000,United Healthcare,Commercial,,2047.50,,,,,,,591.50,2206.75,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,inpatient,,,3205.00000,3003.08000,United Healthcare,Commercial,,2884.50,,,,,,,2884.50,3108.85,percent of total billed charges,
VISIT OB TRIAGE ESTABLISHED LEVEL 5,7202518,CDM,721,RC,99215,CPT,,,facility,outpatient,,,3205.00000,3003.08000,United Healthcare,Commercial,,2884.50,,,,,,,833.30,3108.85,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,inpatient,,,770.00000,721.49000,United Healthcare,Commercial,,693.00,,,,,,,693.00,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 1,7202427,CDM,721,RC,99202,CPT,,,facility,outpatient,,,770.00000,721.49000,United Healthcare,Commercial,,693.00,,,,,,,200.20,746.90,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,inpatient,,,1475.00000,1382.08000,United Healthcare,Commercial,,1327.50,,,,,,,1327.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 2,7202435,CDM,721,RC,99202,CPT,,,facility,outpatient,,,1475.00000,1382.08000,United Healthcare,Commercial,,1327.50,,,,,,,383.50,1430.75,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,inpatient,,,2210.00000,2070.77000,United Healthcare,Commercial,,1989.00,,,,,,,1989.00,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 3,7202443,CDM,721,RC,99203,CPT,,,facility,outpatient,,,2210.00000,2070.77000,United Healthcare,Commercial,,1989.00,,,,,,,574.60,2143.70,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,inpatient,,,2660.00000,2492.42000,United Healthcare,Commercial,,2394.00,,,,,,,2394.00,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 4,7202450,CDM,721,RC,99204,CPT,,,facility,outpatient,,,2660.00000,2492.42000,United Healthcare,Commercial,,2394.00,,,,,,,691.60,2580.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,inpatient,,,3560.00000,3335.72000,United Healthcare,Commercial,,3204.00,,,,,,,3204.00,3453.20,percent of total billed charges,
VISIT OB TRIAGE NEW LEVEL 5,7202468,CDM,721,RC,99205,CPT,,,facility,outpatient,,,3560.00000,3335.72000,United Healthcare,Commercial,,3204.00,,,,,,,925.60,3453.20,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,inpatient,,,5730.00000,3255.50000,United Healthcare,Commercial,,5157.00,,,,,,,5157.00,5558.10,percent of total billed charges,
DELIVERY VAGINAL MULTI,7201452,CDM,722,RC,,,,,facility,outpatient,,,5730.00000,3255.50000,United Healthcare,Commercial,,5157.00,,,,,,,1489.80,5558.10,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,inpatient,,,3875.00000,2201.58000,United Healthcare,Commercial,,3487.50,,,,,,,3487.50,3758.75,percent of total billed charges,
DELIVERY VAGINAL SINGLE,7201445,CDM,722,RC,,,,,facility,outpatient,,,3875.00000,2201.58000,United Healthcare,Commercial,,3487.50,,,,,,,1007.50,3758.75,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,inpatient,,,519.00000,564.15000,United Healthcare,Commercial,,467.10,,,,,,,467.10,503.43,percent of total billed charges,
TEST NONSTRESS FETAL,7201536,CDM,920,RC,59025,CPT,,,facility,outpatient,,,519.00000,564.15000,United Healthcare,Commercial,,467.10,,,,,,,134.94,503.43,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,inpatient,,,536.00000,582.63000,United Healthcare,Commercial,,482.40,,,,,,,482.40,519.92,percent of total billed charges,
TEST STRESS CONTRACTION FETAL,7201528,CDM,920,RC,59020,CPT,,,facility,outpatient,,,536.00000,582.63000,United Healthcare,Commercial,,482.40,,,,,,,139.36,519.92,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,United Healthcare,Commercial,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,7202583,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,United Healthcare,Commercial,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,United Healthcare,Commercial,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,7202591,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,United Healthcare,Commercial,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,United Healthcare,Commercial,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,7202609,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,United Healthcare,Commercial,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,United Healthcare,Commercial,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,7201544,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,United Healthcare,Commercial,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,inpatient,,,504.00000,261.07000,United Healthcare,Commercial,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
INF IV HYDRATION 31-60MIN,2601359,CDM,260,RC,96360,CPT,,,facility,outpatient,,,504.00000,261.07000,United Healthcare,Commercial,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,inpatient,,,98.00000,50.76000,United Healthcare,Commercial,,88.20,,,,,,,88.20,95.06,percent of total billed charges,
INF IV HYDRATION ADDL HR,2601367,CDM,260,RC,96361,CPT,,,facility,outpatient,,,98.00000,50.76000,United Healthcare,Commercial,,88.20,,,,,,,25.48,95.06,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,inpatient,,,608.00000,314.94000,United Healthcare,Commercial,,547.20,,,,,,,547.20,589.76,percent of total billed charges,
INF IV THRPY 1ST HR,2601375,CDM,260,RC,96365,CPT,,,facility,outpatient,,,608.00000,314.94000,United Healthcare,Commercial,,547.20,,,,,,,158.08,589.76,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,inpatient,,,114.00000,59.05000,United Healthcare,Commercial,,102.60,,,,,,,102.60,110.58,percent of total billed charges,
INF IV THRPY ADDL HR,2601383,CDM,260,RC,96366,CPT,,,facility,outpatient,,,114.00000,59.05000,United Healthcare,Commercial,,102.60,,,,,,,29.64,110.58,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,inpatient,,,187.00000,96.87000,United Healthcare,Commercial,,168.30,,,,,,,168.30,181.39,percent of total billed charges,
INF IV THRPY CONCURRENT,2601409,CDM,260,RC,96368,CPT,,,facility,outpatient,,,187.00000,96.87000,United Healthcare,Commercial,,168.30,,,,,,,48.62,181.39,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,inpatient,,,214.00000,110.85000,United Healthcare,Commercial,,192.60,,,,,,,192.60,207.58,percent of total billed charges,
INF IV THRPY SEQ DRUG NEW 1ST HR,7630148,CDM,260,RC,96367,CPT,,,facility,outpatient,,,214.00000,110.85000,United Healthcare,Commercial,,192.60,,,,,,,55.64,207.58,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,inpatient,,,175.00000,63.18000,United Healthcare,Commercial,,157.50,,,,,,,157.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 1-7,3305570,CDM,331,RC,96405,CPT,,,facility,outpatient,,,175.00000,63.18000,United Healthcare,Commercial,,157.50,,,,,,,45.50,169.75,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,inpatient,,,304.00000,109.74000,United Healthcare,Commercial,,273.60,,,,,,,273.60,294.88,percent of total billed charges,
CHEMO INTRALESIONAL LSN 8+,3305588,CDM,331,RC,96406,CPT,,,facility,outpatient,,,304.00000,109.74000,United Healthcare,Commercial,,273.60,,,,,,,79.04,294.88,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,inpatient,,,284.00000,102.52000,United Healthcare,Commercial,,255.60,,,,,,,255.60,275.48,percent of total billed charges,
CHEMO IVP DRUG ADDL,3305406,CDM,331,RC,96411,CPT,,,facility,outpatient,,,284.00000,102.52000,United Healthcare,Commercial,,255.60,,,,,,,73.84,275.48,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,inpatient,,,458.00000,165.34000,United Healthcare,Commercial,,412.20,,,,,,,412.20,444.26,percent of total billed charges,
CHEMO IVP DRUG INITIAL,3305398,CDM,331,RC,96409,CPT,,,facility,outpatient,,,458.00000,165.34000,United Healthcare,Commercial,,412.20,,,,,,,119.08,444.26,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,inpatient,,,438.00000,158.12000,United Healthcare,Commercial,,394.20,,,,,,,394.20,424.86,percent of total billed charges,
CHEMO SUBQ/IM HORMONAL,3305380,CDM,331,RC,96402,CPT,,,facility,outpatient,,,438.00000,158.12000,United Healthcare,Commercial,,394.20,,,,,,,113.88,424.86,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,inpatient,,,558.00000,201.44000,United Healthcare,Commercial,,502.20,,,,,,,502.20,541.26,percent of total billed charges,
CHEMO SUBQ/IM NONHORMONAL,3305372,CDM,331,RC,96401,CPT,,,facility,outpatient,,,558.00000,201.44000,United Healthcare,Commercial,,502.20,,,,,,,145.08,541.26,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,inpatient,,,482.00000,135.44000,United Healthcare,Commercial,,433.80,,,,,,,433.80,467.54,percent of total billed charges,
CHEMO INF IV 1ST HR,3305414,CDM,335,RC,96413,CPT,,,facility,outpatient,,,482.00000,135.44000,United Healthcare,Commercial,,433.80,,,,,,,125.32,467.54,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,inpatient,,,106.00000,29.79000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
CHEMO INF IV ADDL HR,3305422,CDM,335,RC,96415,CPT,,,facility,outpatient,,,106.00000,29.79000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,inpatient,,,237.00000,66.60000,United Healthcare,Commercial,,213.30,,,,,,,213.30,229.89,percent of total billed charges,
CHEMO INF IV SEQ 1ST HR,3305430,CDM,335,RC,96417,CPT,,,facility,outpatient,,,237.00000,66.60000,United Healthcare,Commercial,,213.30,,,,,,,61.62,229.89,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,United Healthcare,Commercial,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD W FU,3305935,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,United Healthcare,Commercial,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,United Healthcare,Commercial,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT BH SPLD WO FU,3305943,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,United Healthcare,Commercial,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,United Healthcare,Commercial,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOME PMP EXT VNDR SUPPLIED,3305927,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,United Healthcare,Commercial,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,inpatient,,,504.00000,141.62000,United Healthcare,Commercial,,453.60,,,,,,,453.60,488.88,percent of total billed charges,
CHEMO IV HOSP PMP EXT/IMP 8+ HR,3305950,CDM,335,RC,96416,CPT,,,facility,outpatient,,,504.00000,141.62000,United Healthcare,Commercial,,453.60,,,,,,,131.04,488.88,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,inpatient,,,842.00000,266.07000,United Healthcare,Commercial,,757.80,,,,,,,757.80,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 1 UNIT,3902525,CDM,391,RC,36430,CPT,,,facility,outpatient,,,842.00000,266.07000,United Healthcare,Commercial,,757.80,,,,,,,218.92,816.74,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1053.00000,332.75000,United Healthcare,Commercial,,947.70,,,,,,,947.70,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 2 UNITS,3902533,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1053.00000,332.75000,United Healthcare,Commercial,,947.70,,,,,,,273.78,1021.41,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,inpatient,,,1263.00000,399.11000,United Healthcare,Commercial,,1136.70,,,,,,,1136.70,1225.11,percent of total billed charges,
TRANSFUSION BLOOD/COMP 3+ UNITS,3902541,CDM,391,RC,36430,CPT,,,facility,outpatient,,,1263.00000,399.11000,United Healthcare,Commercial,,1136.70,,,,,,,328.38,1225.11,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,inpatient,,,182.00000,127.04000,United Healthcare,Commercial,,163.80,,,,,,,163.80,176.54,percent of total billed charges,
US GD VA EVAL SITE W REC PERM,4036596,CDM,402,RC,76937,CPT,,,facility,outpatient,,,182.00000,127.04000,United Healthcare,Commercial,,163.80,,,,,,,47.32,176.54,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,inpatient,,,210.00000,119.31000,United Healthcare,Commercial,,189.00,,,,,,,189.00,203.70,percent of total billed charges,
EVOK EMISSIONS OTOACOUSTIC 3-6 FREQ,4701504,CDM,471,RC,92587,CPT,,,facility,outpatient,,,210.00000,119.31000,United Healthcare,Commercial,,189.00,,,,,,,54.60,203.70,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,inpatient,,,140.00000,79.54000,United Healthcare,Commercial,,126.00,,,,,,,126.00,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 1,7616725,CDM,510,RC,99211,CPT,,,facility,outpatient,,,140.00000,79.54000,United Healthcare,Commercial,,126.00,,,,,,,36.40,135.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,inpatient,,,190.00000,107.95000,United Healthcare,Commercial,,171.00,,,,,,,171.00,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 2,7616733,CDM,510,RC,99212,CPT,,,facility,outpatient,,,190.00000,107.95000,United Healthcare,Commercial,,171.00,,,,,,,49.40,184.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,inpatient,,,240.00000,136.36000,United Healthcare,Commercial,,216.00,,,,,,,216.00,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 3,7616741,CDM,510,RC,99213,CPT,,,facility,outpatient,,,240.00000,136.36000,United Healthcare,Commercial,,216.00,,,,,,,62.40,232.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,inpatient,,,290.00000,164.76000,United Healthcare,Commercial,,261.00,,,,,,,261.00,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 4,7616758,CDM,510,RC,99214,CPT,,,facility,outpatient,,,290.00000,164.76000,United Healthcare,Commercial,,261.00,,,,,,,75.40,281.30,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,inpatient,,,340.00000,193.17000,United Healthcare,Commercial,,306.00,,,,,,,306.00,329.80,percent of total billed charges,
VISIT ESTABLISHED LEVEL 5,7616766,CDM,510,RC,99215,CPT,,,facility,outpatient,,,340.00000,193.17000,United Healthcare,Commercial,,306.00,,,,,,,88.40,329.80,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,inpatient,,,150.00000,85.22000,United Healthcare,Commercial,,135.00,,,,,,,135.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 1,7616675,CDM,510,RC,99202,CPT,,,facility,outpatient,,,150.00000,85.22000,United Healthcare,Commercial,,135.00,,,,,,,39.00,145.50,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,inpatient,,,200.00000,113.63000,United Healthcare,Commercial,,180.00,,,,,,,180.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 2,7616683,CDM,510,RC,99202,CPT,,,facility,outpatient,,,200.00000,113.63000,United Healthcare,Commercial,,180.00,,,,,,,52.00,194.00,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,inpatient,,,270.00000,153.40000,United Healthcare,Commercial,,243.00,,,,,,,243.00,261.90,percent of total billed charges,
VISIT NEW LEVEL 3,7616691,CDM,510,RC,99203,CPT,,,facility,outpatient,,,270.00000,153.40000,United Healthcare,Commercial,,243.00,,,,,,,70.20,261.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,inpatient,,,370.00000,210.22000,United Healthcare,Commercial,,333.00,,,,,,,333.00,358.90,percent of total billed charges,
VISIT NEW LEVEL 4,7616709,CDM,510,RC,99204,CPT,,,facility,outpatient,,,370.00000,210.22000,United Healthcare,Commercial,,333.00,,,,,,,96.20,358.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,inpatient,,,470.00000,267.03000,United Healthcare,Commercial,,423.00,,,,,,,423.00,455.90,percent of total billed charges,
VISIT NEW LEVEL 5,7616717,CDM,510,RC,99205,CPT,,,facility,outpatient,,,470.00000,267.03000,United Healthcare,Commercial,,423.00,,,,,,,122.20,455.90,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,inpatient,,,248.00000,96.22000,United Healthcare,Commercial,,223.20,,,,,,,223.20,240.56,percent of total billed charges,
COLLECT SPEC BLD PICC NOS,7619984,CDM,761,RC,36592,CPT,,,facility,outpatient,,,248.00000,96.22000,United Healthcare,Commercial,,223.20,,,,,,,64.48,240.56,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,inpatient,,,245.00000,95.06000,United Healthcare,Commercial,,220.50,,,,,,,220.50,237.65,percent of total billed charges,
COLLECT SPEC BLD VAD IMPLNT,7616030,CDM,761,RC,36591,CPT,,,facility,outpatient,,,245.00000,95.06000,United Healthcare,Commercial,,220.50,,,,,,,63.70,237.65,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,inpatient,,,497.00000,192.84000,United Healthcare,Commercial,,447.30,,,,,,,447.30,482.09,percent of total billed charges,
DECLOT CATH/VAD W AGENT THROMB,7616329,CDM,761,RC,36593,CPT,,,facility,outpatient,,,497.00000,192.84000,United Healthcare,Commercial,,447.30,,,,,,,129.22,482.09,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,inpatient,,,357.00000,138.52000,United Healthcare,Commercial,,321.30,,,,,,,321.30,346.29,percent of total billed charges,
INS CATH BLADDER INDWL CMP,7618416,CDM,761,RC,51703,CPT,,,facility,outpatient,,,357.00000,138.52000,United Healthcare,Commercial,,321.30,,,,,,,92.82,346.29,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,inpatient,,,334.00000,129.59000,United Healthcare,Commercial,,300.60,,,,,,,300.60,323.98,percent of total billed charges,
INS CATH BLADDER INDWL SMPL,7616055,CDM,761,RC,51702,CPT,,,facility,outpatient,,,334.00000,129.59000,United Healthcare,Commercial,,300.60,,,,,,,86.84,323.98,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,inpatient,,,194.00000,75.27000,United Healthcare,Commercial,,174.60,,,,,,,174.60,188.18,percent of total billed charges,
INS CATH BLADDER NONINDWL,7616048,CDM,761,RC,51701,CPT,,,facility,outpatient,,,194.00000,75.27000,United Healthcare,Commercial,,174.60,,,,,,,50.44,188.18,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,inpatient,,,1035.00000,401.58000,United Healthcare,Commercial,,931.50,,,,,,,931.50,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 0-4YRS,7636574,CDM,761,RC,36572,CPT,,,facility,outpatient,,,1035.00000,401.58000,United Healthcare,Commercial,,931.50,,,,,,,269.10,1003.95,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,inpatient,,,1137.00000,441.16000,United Healthcare,Commercial,,1023.30,,,,,,,1023.30,1102.89,percent of total billed charges,
INS PICC WO P/P W IMG 5+YRS,7636582,CDM,761,RC,36573,CPT,,,facility,outpatient,,,1137.00000,441.16000,United Healthcare,Commercial,,1023.30,,,,,,,295.62,1102.89,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,inpatient,,,963.00000,373.64000,United Healthcare,Commercial,,866.70,,,,,,,866.70,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 0-4YRS,7636590,CDM,761,RC,36568,CPT,,,facility,outpatient,,,963.00000,373.64000,United Healthcare,Commercial,,866.70,,,,,,,250.38,934.11,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,inpatient,,,990.00000,384.12000,United Healthcare,Commercial,,891.00,,,,,,,891.00,960.30,percent of total billed charges,
INS PICC WO P/P WO IMG 5+YRS,7636608,CDM,761,RC,36569,CPT,,,facility,outpatient,,,990.00000,384.12000,United Healthcare,Commercial,,891.00,,,,,,,257.40,960.30,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,inpatient,,,112.00000,43.46000,United Healthcare,Commercial,,100.80,,,,,,,100.80,108.64,percent of total billed charges,
REM SUTURE&STAPLE NO ANESTH,7639453,CDM,761,RC,15854,CPT,,,facility,outpatient,,,112.00000,43.46000,United Healthcare,Commercial,,100.80,,,,,,,29.12,108.64,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,inpatient,,,84.00000,32.59000,United Healthcare,Commercial,,75.60,,,,,,,75.60,81.48,percent of total billed charges,
REM SUTURE/STAPLE NO ANESTH,7639446,CDM,761,RC,15853,CPT,,,facility,outpatient,,,84.00000,32.59000,United Healthcare,Commercial,,75.60,,,,,,,21.84,81.48,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,inpatient,,,176.00000,68.29000,United Healthcare,Commercial,,158.40,,,,,,,158.40,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 0-50 SC,7632409,CDM,761,RC,97605,CPT,,,facility,outpatient,,,176.00000,68.29000,United Healthcare,Commercial,,158.40,,,,,,,45.76,170.72,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,inpatient,,,283.00000,109.80000,United Healthcare,Commercial,,254.70,,,,,,,254.70,274.51,percent of total billed charges,
WOUND NEG PRESS W DME 51+ SC,7632417,CDM,761,RC,97606,CPT,,,facility,outpatient,,,283.00000,109.80000,United Healthcare,Commercial,,254.70,,,,,,,73.58,274.51,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,inpatient,,,81.00000,44.14000,United Healthcare,Commercial,,72.90,,,,,,,72.90,78.57,percent of total billed charges,
IMMUNIZATION 1ST VACCINE,7616899,CDM,771,RC,90471,CPT,,,facility,outpatient,,,81.00000,44.14000,United Healthcare,Commercial,,72.90,,,,,,,21.06,78.57,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,inpatient,,,41.00000,22.35000,United Healthcare,Commercial,,36.90,,,,,,,36.90,39.77,percent of total billed charges,
IMMUNIZATION ADDL VACCINE,7618515,CDM,771,RC,90472,CPT,,,facility,outpatient,,,41.00000,22.35000,United Healthcare,Commercial,,36.90,,,,,,,10.66,39.77,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,inpatient,,,35.00000,19.89000,United Healthcare,Commercial,,31.50,,,,,,,31.50,33.95,percent of total billed charges,
TELEMED ORIGINATING SITE FAC FEE,7611379,CDM,780,RC,Q3014,HCPCS,,,facility,outpatient,,,35.00000,19.89000,United Healthcare,Commercial,,31.50,,,,,,,9.10,33.95,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,inpatient,,,191.00000,89.39000,United Healthcare,Commercial,,171.90,,,,,,,171.90,185.27,percent of total billed charges,
INJ INTRA-ARTERIAL,9401159,CDM,940,RC,96373,CPT,,,facility,outpatient,,,191.00000,89.39000,United Healthcare,Commercial,,171.90,,,,,,,49.66,185.27,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,inpatient,,,453.00000,212.00000,United Healthcare,Commercial,,407.70,,,,,,,407.70,439.41,percent of total billed charges,
INJ IVP DRUG INITIAL,9400987,CDM,940,RC,96374,CPT,,,facility,outpatient,,,453.00000,212.00000,United Healthcare,Commercial,,407.70,,,,,,,117.78,439.41,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,inpatient,,,144.00000,67.39000,United Healthcare,Commercial,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL NEW,9400995,CDM,940,RC,96375,CPT,,,facility,outpatient,,,144.00000,67.39000,United Healthcare,Commercial,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,inpatient,,,107.00000,50.08000,United Healthcare,Commercial,,96.30,,,,,,,96.30,103.79,percent of total billed charges,
INJ IVP SEQ DRUG ADDL SAME,9401662,CDM,940,RC,96376,CPT,,,facility,outpatient,,,107.00000,50.08000,United Healthcare,Commercial,,96.30,,,,,,,27.82,103.79,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,inpatient,,,144.00000,67.39000,United Healthcare,Commercial,,129.60,,,,,,,129.60,139.68,percent of total billed charges,
INJ SUBQ/IM,9400029,CDM,940,RC,96372,CPT,,,facility,outpatient,,,144.00000,67.39000,United Healthcare,Commercial,,129.60,,,,,,,37.44,139.68,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,inpatient,,,281.00000,131.51000,United Healthcare,Commercial,,252.90,,,,,,,252.90,272.57,percent of total billed charges,
IRRG VAD IMP DELIVERY DRUG,9401019,CDM,940,RC,96523,CPT,,,facility,outpatient,,,281.00000,131.51000,United Healthcare,Commercial,,252.90,,,,,,,73.06,272.57,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,inpatient,,,192.00000,89.86000,United Healthcare,Commercial,,172.80,,,,,,,172.80,186.24,percent of total billed charges,
PHLEBOTOMY THERAPEUTIC,7616881,CDM,940,RC,99195,CPT,,,facility,outpatient,,,192.00000,89.86000,United Healthcare,Commercial,,172.80,,,,,,,49.92,186.24,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,inpatient,,,365.00000,170.82000,United Healthcare,Commercial,,328.50,,,,,,,328.50,354.05,percent of total billed charges,
REFILL&MAINT PUMP PORTABLE,9400771,CDM,940,RC,96521,CPT,,,facility,outpatient,,,365.00000,170.82000,United Healthcare,Commercial,,328.50,,,,,,,94.90,354.05,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,inpatient,,,8391.00000,5856.92000,United Healthcare,Commercial,,7551.90,,,,,,,7551.90,8139.27,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS,7401052,CDM,740,RC,95782,CPT,,,facility,outpatient,,,8391.00000,5856.92000,United Healthcare,Commercial,,7551.90,,,,,,,2181.66,8139.27,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,inpatient,,,6917.00000,4828.07000,United Healthcare,Commercial,52,6225.30,,,,,,,6225.30,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YR W CPAP RDC<6HR,7401078,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,United Healthcare,Commercial,52,6225.30,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,inpatient,,,6000.00000,4188.00000,United Healthcare,Commercial,,5400.00,,,,,,,5400.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS,7401003,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,United Healthcare,Commercial,,5400.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,inpatient,,,6917.00000,4828.07000,United Healthcare,Commercial,,6225.30,,,,,,,6225.30,6709.49,percent of total billed charges,
PSG W 4+ PARAM 6+YRS W CPAP,7401011,CDM,740,RC,95811,CPT,,,facility,outpatient,,,6917.00000,4828.07000,United Healthcare,Commercial,,6225.30,,,,,,,1798.42,6709.49,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,inpatient,,,6000.00000,4188.00000,United Healthcare,Commercial,52,5400.00,,,,,,,5400.00,5820.00,percent of total billed charges,
PSG W 4+PARAM 6+YR RDC<6HRS,7401037,CDM,740,RC,95810,CPT,,,facility,outpatient,,,6000.00000,4188.00000,United Healthcare,Commercial,52,5400.00,,,,,,,1560.00,5820.00,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,inpatient,,,8855.00000,9625.38000,United Healthcare,Commercial,,7969.50,,,,,,,7969.50,8589.35,percent of total billed charges,
PSG W 4+ PARAM 0-5YRS W CPAP,7401060,CDM,920,RC,95783,CPT,,,facility,outpatient,,,8855.00000,9625.38000,United Healthcare,Commercial,,7969.50,,,,,,,2302.30,8589.35,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,inpatient,,,844.00000,917.43000,United Healthcare,Commercial,,759.60,,,,,,,759.60,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME,7401508,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,United Healthcare,Commercial,,759.60,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,inpatient,,,844.00000,917.43000,United Healthcare,Commercial,52,759.60,,,,,,,759.60,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/ANLY&TIME<6HR,7401516,CDM,920,RC,95800,CPT,,,facility,outpatient,,,844.00000,917.43000,United Healthcare,Commercial,52,759.60,,,,,,,219.44,818.68,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,inpatient,,,785.00000,853.30000,United Healthcare,Commercial,,706.50,,,,,,,706.50,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF,7401185,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,United Healthcare,Commercial,,706.50,,,,,,,204.10,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,inpatient,,,785.00000,853.30000,United Healthcare,Commercial,52,706.50,,,,,,,706.50,761.45,percent of total billed charges,
SLP UNATND HOM RT/SAT/FLW&EFF<6HR,7401193,CDM,920,RC,95806,CPT,,,facility,outpatient,,,785.00000,853.30000,United Healthcare,Commercial,52,706.50,,,,,,,204.10,761.45,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4709.00000,5118.68000,United Healthcare,Commercial,,4238.10,,,,,,,4238.10,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT,7400518,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,United Healthcare,Commercial,,4238.10,,,,,,,1224.34,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,inpatient,,,4709.00000,5118.68000,United Healthcare,Commercial,52,4238.10,,,,,,,4238.10,4567.73,percent of total billed charges,
TEST LATENCY SLEEP MULT RDC<4 NAPS,7401110,CDM,920,RC,95805,CPT,,,facility,outpatient,,,4709.00000,5118.68000,United Healthcare,Commercial,52,4238.10,,,,,,,1224.34,4567.73,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,inpatient,,,345.00000,128.34000,United Healthcare,Commercial,,310.50,,,,,,,310.50,334.65,percent of total billed charges,
OXYGN UPTAKE REST CALORMTRY INDIRCT,9402058,CDM,460,RC,94690,CPT,,,facility,outpatient,,,345.00000,128.34000,United Healthcare,Commercial,,310.50,,,,,,,89.70,334.65,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,inpatient,,,120.00000,99.60000,United Healthcare,Commercial,,108.00,,,,,,,108.00,116.40,percent of total billed charges,
DSMT IND 30MIN,9400094,CDM,942,RC,G0108,HCPCS,,,facility,outpatient,,,120.00000,99.60000,United Healthcare,Commercial,,108.00,,,,,,,31.20,116.40,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,inpatient,,,106.00000,87.98000,United Healthcare,Commercial,,95.40,,,,,,,95.40,102.82,percent of total billed charges,
EDUC&TRAIN SELFMGMT IND 30MIN,9402124,CDM,942,RC,98960,CPT,,,facility,outpatient,,,106.00000,87.98000,United Healthcare,Commercial,,95.40,,,,,,,27.56,102.82,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,inpatient,,,32.00000,26.56000,United Healthcare,Commercial,,28.80,,,,,,,28.80,31.04,percent of total billed charges,
MNT GROUP 30MIN,9400185,CDM,942,RC,97804,CPT,,,facility,outpatient,,,32.00000,26.56000,United Healthcare,Commercial,,28.80,,,,,,,8.32,31.04,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,inpatient,,,60.00000,49.80000,United Healthcare,Commercial,,54.00,,,,,,,54.00,58.20,percent of total billed charges,
MNT INITIAL ASSESS INDIVIDUAL 15MIN,9400177,CDM,942,RC,97802,CPT,,,facility,outpatient,,,60.00000,49.80000,United Healthcare,Commercial,,54.00,,,,,,,15.60,58.20,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,inpatient,,,57.00000,47.31000,United Healthcare,Commercial,,51.30,,,,,,,51.30,55.29,percent of total billed charges,
MNT RE-ASSESS INDIVIDUAL 15MIN,9400193,CDM,942,RC,97803,CPT,,,facility,outpatient,,,57.00000,47.31000,United Healthcare,Commercial,,51.30,,,,,,,14.82,55.29,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,inpatient,1.0,ME,7.40000,0.65000,United Healthcare,Commercial,,6.66,,,,,,,6.66,7.18,percent of total billed charges,
AMANTADINE/100MG 100MG CP,6761159,CDM,637,RC,J8499,HCPCS,00904704261,NDC,facility,outpatient,1.0,ME,7.40000,0.65000,United Healthcare,Commercial,,6.66,,,,,,,1.92,7.18,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,inpatient,1.0,EA,6.60000,1.43000,United Healthcare,Commercial,UD,5.94,,,,,,,5.94,6.40,percent of total billed charges,
CEFTAZIDIME/500MG 500MG PWIJ,8481079,CDM,250,RC,J0713,HCPCS,,,facility,outpatient,1.0,EA,6.60000,1.43000,United Healthcare,Commercial,UD,5.94,,,,,,,1.72,6.40,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,inpatient,1.0,EA,2.95000,0.64000,United Healthcare,Commercial,UD,2.65,,,,,,,2.65,2.86,percent of total billed charges,
D5-NACL 0.9%/500ML 1000ML SNIV,8489155,CDM,250,RC,J7042,HCPCS,,,facility,outpatient,1.0,EA,2.95000,0.64000,United Healthcare,Commercial,UD,2.65,,,,,,,0.76700,2.86,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,inpatient,1.0,EA,56.08000,12.11000,United Healthcare,Commercial,UD,50.47,,,,,,,50.47,54.40,percent of total billed charges,
DANTROLENE SOD/20MG 20MG PWIJ,8462483,CDM,250,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,56.08000,12.11000,United Healthcare,Commercial,UD,50.47,,,,,,,14.58,54.40,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,inpatient,1.0,UN,82.10000,28.90000,United Healthcare,Commercial,,73.89,,,,,,,73.89,79.64,percent of total billed charges,
EPO ALFA/1000U 4000U SNIJ,6871586,CDM,636,RC,J0885,HCPCS,59676030401,NDC,facility,outpatient,1.0,UN,82.10000,28.90000,United Healthcare,Commercial,,15.48,,,,,,,15.48,79.64,fee schedule,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.04000,,United Healthcare,Commercial,UD,0.03600,,,,,,,0.03600,0.03880,percent of total billed charges,
FENOFIBRATE/54MG 54MG TB,8421026,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.04000,,United Healthcare,Commercial,UD,0.03600,,,,,,,0.01040,0.03880,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.05000,,United Healthcare,Commercial,UD,0.04500,,,,,,,0.04500,0.04850,percent of total billed charges,
HYDROCOD-ACET/7.5-325MG TB,8401333,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.05000,,United Healthcare,Commercial,UD,0.04500,,,,,,,0.01300,0.04850,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,inpatient,1.0,ME,6.20000,0.55000,United Healthcare,Commercial,,5.58,,,,,,,5.58,6.01,percent of total billed charges,
LEVOFLOXACN/750MG 750MG TB,6828685,CDM,637,RC,J8499,HCPCS,00904635361,NDC,facility,outpatient,1.0,ME,6.20000,0.55000,United Healthcare,Commercial,,5.58,,,,,,,1.61,6.01,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,0.12000,0.01000,United Healthcare,Commercial,UD,0.10800,,,,,,,0.10800,0.11640,percent of total billed charges,
LEVOTHYROXN/112MCG 112MCG TB,8415457,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,0.12000,0.01000,United Healthcare,Commercial,UD,0.10800,,,,,,,0.03120,0.11640,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,inpatient,2.0,ML,5.80000,1.25000,United Healthcare,Commercial,,5.22,,,,,,,5.22,5.63,percent of total billed charges,
LIDO 2%-EPI/1.8ML 1.8ML SNIJ,6780704,CDM,250,RC,J3490,HCPCS,66312017616,NDC,facility,outpatient,2.0,ML,5.80000,1.25000,United Healthcare,Commercial,,5.22,,,,,,,1.51,5.63,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,inpatient,1.0,ME,3.10000,0.27000,United Healthcare,Commercial,,2.79,,,,,,,2.79,3.01,percent of total billed charges,
NICOTINE RESIN COMPLEX/2MG 2MG GU,6785851,CDM,637,RC,J3490,HCPCS,00536136223,NDC,facility,outpatient,1.0,ME,3.10000,0.27000,United Healthcare,Commercial,,2.79,,,,,,,0.80600,3.01,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,inpatient,1.0,EA,44.40000,3.91000,United Healthcare,Commercial,,39.96,,,,,,,39.96,43.07,percent of total billed charges,
PANCRELIPASE/25000U 25000U CP,6856868,CDM,637,RC,J8499,HCPCS,73562011601,NDC,facility,outpatient,1.0,EA,44.40000,3.91000,United Healthcare,Commercial,,39.96,,,,,,,11.54,43.07,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,inpatient,1.0,EA,8.26000,0.73000,United Healthcare,Commercial,UD,7.43,,,,,,,7.43,8.01,percent of total billed charges,
PROGESTERONE/90MG 90MG/1.125G GLVG,8489767,CDM,637,RC,J3490,HCPCS,,,facility,outpatient,1.0,EA,8.26000,0.73000,United Healthcare,Commercial,UD,7.43,,,,,,,2.15,8.01,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,inpatient,1.0,EA,2.19000,0.19000,United Healthcare,Commercial,UD,1.97,,,,,,,1.97,2.12,percent of total billed charges,
RIMANTADINE/100MG 100MG TB,8467862,CDM,637,RC,J8499,HCPCS,,,facility,outpatient,1.0,EA,2.19000,0.19000,United Healthcare,Commercial,UD,1.97,,,,,,,0.56940,2.12,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,inpatient,1.0,EA,28.60000,2.52000,United Healthcare,Commercial,,25.74,,,,,,,25.74,27.74,percent of total billed charges,
TIMOLOL MALEATE 0.25%/5ML 5ML SNOP,6796304,CDM,637,RC,J3490,HCPCS,61314022605,NDC,facility,outpatient,1.0,EA,28.60000,2.52000,United Healthcare,Commercial,,25.74,,,,,,,7.44,27.74,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,inpatient,1.0,EA,2.58000,0.91000,United Healthcare,Commercial,UD,2.32,,,,,,,2.32,2.50,percent of total billed charges,
VANCO MYL/500MG 1.5GM PWIJ,8489650,CDM,636,RC,J3371,HCPCS,,,facility,outpatient,1.0,EA,2.58000,0.91000,United Healthcare,Commercial,UD,2.32,,,,,,,0.67080,2.50,percent of total billed charges,
Bilateral Procedures,,,,,,,,,facility,outpatient,,,,,Banner Health,Banner Choice Plus/Banner Select,50,,,,,,,,,,,150% payment adjustment for the item or service to which the modifier is appended. Multiple surgery guidelines apply.
Discontinued Procedure,,,,,,,,,facility,outpatient,,,,,Banner Health,Banner Choice Plus/Banner Select,73,,,,,,,,,,,50% of the amount for the item or service to which the modifier is appended
CT services furnished with equipment that don't meet NEMA standard,,,,,,,,,facility,outpatient,,,,,Banner Health,Banner Choice Plus/Banner Select,CT,,,,,,,,,,,85% of the amount for the item or service to which the modifier is appended
X-ray taken using film,,,,,,,,,facility,outpatient,,,,,Banner Health,Banner Choice Plus/Banner Select,FX,,,,,,,,,,,80% of the amount for the item or service to which the modifier is appended
Computed radiography x-ray,,,,,,,,,facility,outpatient,,,,,Banner Health,Banner Choice Plus/Banner Select,FY,,,,,,,,,,,90% of the amount for the item or service to which the modifier is appended
Excepted off-campus service,,,,,,,,,facility,outpatient,,,,,Banner Health,Banner Choice Plus/Banner Select,PO,,,,,,,,,,,40% of the amount for the item or service to which the modifier is appended
Non-excepted off-campus service,,,,,,,,,facility,outpatient,,,,,Banner Health,Banner Choice Plus/Banner Select,PN,,,,,,,,,,,40% of the amount for the item or service to which the modifier is appended
X-ray taken using film,,,,,,,,,facility,outpatient,,,,,Humana,Medicare Advantage,FX,,,,,,,,,,,80% of the amount for the item or service to which the modifier is appended
Computed radiography x-ray,,,,,,,,,facility,outpatient,,,,,Humana,Medicare Advantage,FY,,,,,,,,,,,93% of the amount for the item or service to which the modifier is appended
CT services furnished with equipment that don't meet NEMA standard,,,,,,,,,facility,outpatient,,,,,Humana,Medicare Advantage,CT,,,,,,,,,,,85% of the amount for the item or service to which the modifier is appended
Bilateral Procedures,,,,,,,,,facility,outpatient,,,,,Humana,Medicare Advantage,50,,,,,,,,,,,Reimbursement is 150% of the allowable. Multiple surgery guidelines may apply.
Bilateral Services,,,,,,,,,facility,outpatient,,,,,United Healthcare,Commercial,50,,,,,,,,,,,150% payment adjustment for the item or service to which the modifier is appended for codes with Bilateral Procedure Indicator of 1. 200% payment adjustment for the item or service to which the modifier is appended for codes with Bilateral Procedure Indicator of 3.
Discontinued Procedure,,,,,,,,,facility,outpatient,,,,,United Healthcare,Commercial,73,,,,,,,,,,,50% payment adjustment for the item or service to which the modifier is appended
Computed tomography services furnished using equipment that does not meet each of the attributes of the national electrical manufacturers association (NEMA) XR-29-2013 standard,,,,,,,,,facility,outpatient,,,,,United Healthcare,Commercial,CT,,,,,,,,,,,85% payment adjustment for the item or service to which the modifier is appended
X-ray was performed using film,,,,,,,,,facility,outpatient,,,,,United Healthcare,Commercial,FX,,,,,,,,,,,90% payment adjustment for the item or service to which the modifier is appended
X-ray was taken using computed radiography technology/cassette-based imaging,,,,,,,,,facility,outpatient,,,,,United Healthcare,Commercial,FY,,,,,,,,,,,90% payment adjustment for the item or service to which the modifier is appended